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The Fluoride Wars: How a Modest Public Health Measure Became America's Longest Running Political Melodrama [Hardcover]

R. Allan Freeze , Jay H. Lehr

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Book Description

April 20 2009 0470448334 978-0470448335 1

A lively account of fluoridation and its discontents

Since its first implementation in Grand Rapids, Michigan, in 1945, public drinking water fluoridation and its attendant conflicts, controversies, and conspiracy theories serve as an object lesson in American science, public health, and policymaking. In addition to the arguments on the issue still raging today, the tale of fluoridation and its discontents also resonates with such present concerns as genetically modified foods, global warming response, nuclear power, and environmental regulation.

Offering the best current thinking on the issue, The Fluoride Wars presents a witty and detailed social history of the fluoridation debate in America, illuminating the intersection of science and politics in our recent past. This reader-friendly assessment explores the pro- and anti-fluoridation movements, key players, and important events. Full of amusing and vivid anecdotes and examples, this accessible recounting includes:

  • A careful and non-condescending look at the hard science, popular science, pseudo-science, and junk science involved

  • A look at fluoride issues including dosage, cost, financial and funding interests, fluorosis, and problems of risk-cost-benefit analysis

  • The back-and-forth drama between pro- and anti-fluoridation factions, with all its claims, counterclaims, insults, acrimony, and lawsuits

  • Case studies of various cities and their experiences with municipal water fluoridation initiatives

  • Fluorophobia and popular conspiracy theories involving fluoride

  • The colorful characters in the debate including activists, scientists, magicians, and politicians

A richly and considerately told tale of American science and public life, The Fluoride Wars offers an engrossing history to both interested general readers and specialists in public health, dentistry, policymaking, and related fields.


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Review

"The authors have put an enormous effort into acquiring the data in this book and... it is a very interesting and stimulating read." (Chromatographia, June 2010)

“The authors should be commended for providing all of the facts of the controversy in one place. Their call for both sides to get together to study the health issues with reason and respect is also a worthwhile goal because, as they point out; perhaps then ‘this long-standing and somewhat silly dispute could finally he laid to rest.’” (Chemical and Engineering News, September 2009)

About the Author

R. Allan Freeze is one of North America's leading researchers in the field of environmental water quality, and has acted as the consulting engineer on drinking water quality at a number of sites across North America. He was a member of the University of British Columbia's engineering faculty in Vancouver for twenty years and is the author of over 150 technical articles and the coauthor of several books.

Jay H. Lehr is Senior Scientist with The Heartland Institute and Chief Scientist for EarthWater Global, an international water supply company. A graduate of Princeton University, he developed the first PhD program in hydrology at the University of Arizona and was on the faculty at The Ohio State University. Lehr has authored or coauthored over twenty books, hundreds of journal and magazine articles, and is an internationally renowned expert who speaks worldwide on environmental topics.


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Amazon.com: 2.0 out of 5 stars  11 reviews
5 of 6 people found the following review helpful
5.0 out of 5 stars The only objective view of the fluoride controversy I've found April 19 2013
By Merilee D. Karr - Published on Amazon.com
Format:Hardcover|Verified Purchase
This book, by a couple of investigative reporters, covers all the claims of both sides. It awards points and demerits to both sides. And it's well written and accessible. Too bad it's hard to find, because it's published by Wiley, an academic and textbook publisher. It should be more widely available. It should be in the pocket and on the kitchen table of everyone who cares about the water they drink.
11 of 15 people found the following review helpful
4.0 out of 5 stars Fluoridation: the battles continue Jan. 28 2011
By Brian Martin - Published on Amazon.com
Format:Hardcover
The proposition seems straightforward: should fluoride be put in public water supplies in order to prevent tooth decay? Fluoridation was tested in the 1940s, endorsed by the U.S. Public Health Service in 1950, and implemented in the United States and many other countries in the following decades. But from the beginning, there was vociferous opposition.

The fluoridation debate was in full swing in the 1950s and continues today in much the same form, with the same sorts of claims and counter-claims. Scientifically, the debate has always been one-sided, with an overwhelming majority of dentists and doctors supporting fluoridation but with a significant minority of critics.

The remarkable persistence of the debate has attracted the attention of social analysts. Attempting to take a middle ground is a perilous enterprise, because the partisans on either side are likely to either adopt a contributor as an ally or attack him or her as an enemy.

Scientists R. Allan Freeze and Jay H. Lehr have boldly entered the fluoridation arena with The Fluoride Wars. Their ambitious aim is to provide a balanced social history of the U.S. controversy. They tackle the major issues in the debate, including arguments over benefits of fluoridation and alleged adverse health impacts such as allergies, cancer, and skeletal fluorosis. They give special attention to dental fluorosis, the staining of teeth due to excess fluoride, typically said by proponents to be of only cosmetic significance but seen by opponents as a sign of fluoride toxicity.

A major contribution of the book is its covering of key developments in recent decades, including the antifluoride position of scientists from the U.S. Environmental Protection Agency, the debate among proponents about whether there is too much fluoride in people's diets, the switch by a few proponents to become opponents, the discrediting of some antifluoride claims, and the support for fluoridation by U.S. courts.

Freeze and Lehr also address the social dynamics of the debate, looking at referenda and statewide implementation measures and commenting on explanations of forces driving the proponents and the opponents. All in all, this is the most comprehensive treatment of the debate available in the literature. It draws on key sources, scientific, sociological, and historical.

Several episodes are given detailed treatment, for example, the first trials in which fluoride was added to town water supplies in the 1940s. The historical detail is not a sustained narrative but more like an occasional highlight, with some irrelevant digressions, such as a lengthy account of the Jonestown massacre, included because it had a deep effect on a key legislative promoter of fluoridation in California.

Freeze and Lehr are sufficiently even-handed that their treatment will please neither side in the debate. The book, though, is not a purely dispassionate account because, as well as discussing the scientific and political issues, the authors want to pass judgment and, in doing so, they often shift from nonpartisan social description to summary judgment that can seem to sweep aside disagreement. In particular, they sum up the debate as if it were a matter only of science and of benefits versus costs. The book is more an assessment of arguments than a social history.

The Fluoride Wars is almost entirely about fluoridation in the United States. The authors mention the situation in other countries but do not pursue the implications of fluoridation outcomes elsewhere. They conclude that popular opposition to fluoridation in the United States is due to risk aversion in referenda, but this does not explain the near absence of fluoridation in Europe, where governments make the decisions.

Freeze and Lehr sometimes make sweeping references to proponents or opponents, attributing the views of a few to an entire movement. Their language is frequently flamboyant and occasionally dismissive, for example in referring to scientist opponents as "zealously committed" (p. 362)--and less commonly labeling proponent scientists in a similar way.

The Fluoride Wars concludes with an appeal for the two warring sides to sit down and talk. Although this suggestion almost certainly will be ignored, Freeze and Lehr have set an admirable example of measured analysis and stimulating writing.

Brian Martin
University of Wollongong, Australia
[...]
(This review appeared in the Bulletin of the History of Medicine, Vol. 84, 2010, pp. 314-315)
19 of 28 people found the following review helpful
5.0 out of 5 stars Makes It A Fair Fight June 11 2009
By Karen Bond - Published on Amazon.com
Format:Hardcover
Definitely an interesting read - a unique mix of social history and popular science. I learned more about fluoride than I thought there was to know! It's filled with lots of anecdotal stories and interesting historical tidbits, vignettes of the principal players on both sides for the fluoride discussion.

I didn't think that the book chose one side or another - and then I read the first reviews. Interestingly, some of the people who gave the book unfavorable reviews are all strong opposers of fluoride who's organizations and arguments are covered in the book.

It's an interesting conflict - covering the controversy of fluoridation (which I didn't realize was a controversy until I read this) - including the almost universal support from the medical-dental establishment, as well as the effective and street-smart strategies of a well-organized opposition.

Fluoride is a double-edged sword. The authors conclude that public water fluoridation, together with the advent of fluoridated toothpaste, are undoubtedly responsible for the precipitous drop in the incidence of childhood dental cavities. But they also join the call for reduced fluoride dosages in public supplies to protect against the threat of negative bone health impacts.

"The Flouride Wars" discusses the heated conflict between the pro-fluoride and anti-fluoride camps. Nothing makes this case more clearly than the first reviews posted on Amazon.com by some of the leaders of the antiflouridation movement in America.

It's definitely a "war" that makes for an interesting read. I don't want a book to make decisions for me, I want it to present both sides honestly. Open-minded readers will find balanced coverage of this long-standing controversy so they can make their own decisions.
39 of 66 people found the following review helpful
1.0 out of 5 stars Fluoride Wars- polemics not science April 14 2009
By Paul Connett - Published on Amazon.com
Format:Hardcover
Fluoride Wars- polemics not science

Despite lofty claims of objectivity, and being published by a major Science publisher (Wiley), the book "Fluoride Wars" by Freeze and Lehr is not a scholarly work but rather a slanted polemical analysis which gives final victory - with a few caveats about some of their bullying tactics - to the status quo.

More journalism and pseudo history than science. Why on earth spend four pages discussing Jonestown? Freeze and Lehr provide their thesis in the subtitle: "How a modest public health measure became America's longest running political melodrama." However, you can only describe water fluoridation as a modest measure if you conveniently ignore - as these authors do - the fact that the level of fluoride added to water (i.e. 1 milligram per liter or 1 part per million or 1 ppm) which may seem small to some, is actually 250 times the level found in mothers milk (0.004 ppm). This means that a bottle fed baby in a fluoridated community gets 250 times more fluoride than nature intended.

To support their thesis of a "political melodrama" they focus their attention more on the extreme wings of the debate (Michael Easley, Stephen Barrett, Darlene Sherrell) than on the calmer scientific middle. They spend more time discussing and debunking conspiracy theories then on a careful balanced analysis of the scientific details.

The authors show little first hand knowledge of the primary literature and derive most of their conclusions from governmental reviews and review articles, sprinkled with self-serving commentary from the American Dental Association. Even this analysis is dated. Incredibly, while on page 250 they make it clear that they are aware of the massive 507-page groundbreaking review by the National Research Council (NRC) "Fluoride in Drinking Water: A Review of EPA Standards" published in 2006, apart from acknowledging that the authors called for a lowering of the EPA's drinking water standard, Freeze and Lehr do not provide any commentary on the scientific findings of this important work. This despite the fact that this landmark NRC review cited 1100 references to the primary literature, and addressed two of the key questions Freeze and Leher raise: "What is the status of current medical research into the impact of fluoride on human health? What conclusions can be drawn on the basis of toxiciological and epidemiological evidence currently available with respect to each potential impact or disease?"( p.31).

If objectivity was their aim it is surprising that Freeze and Lehr completely ignore the NRC analysis, while spending considerable time on earlier reviews. An "inconvenient review" perhaps if one's ultimate aim is to support the medical establishment's continued promotion of this unacceptable medical practice. Unacceptable, because once fluoride is put in the water, you can neither control the dose nor who gets it (young or old, sick or healthy) as well as depriving the individual's right to informed consent to what medication he or she takes. Throw in the fact that no one is monitoring side effects and we have a really horrible medical practice.

Had Freeze and Lehr studied the NRC (2006) review they would have realized that their own review of health effects was dated and limited. For example take fluoride's potential to impact the brain. Instead of the few studies that they cite, they would have discovered that there have been many more studies published since the ones they addressed. In fact, if they had availed themselves of the health data base on the web site of the Fluoride Action Network they would have discovered that there are now over 50 animal studies which indicate that fluoride damages the brain and no less than 23 studies (from four different continents) which show that high fluoride exposure is associated with lowered IQ in children. Maybe nature had reasons for keeping fluoride so low in mothers milk.

While the book reveals some fascinating bits of history about some of the protagonists in this debate and acknowledges some of the shabby treatment they have received at the hands of pro-fluoridation sources, the book is not very helpful in drawing serious conclusions about the science of the debate over either effectiveness or the safety of this measure.

As a protagonist myself, I do not feel that my 13 years of painstaking review of this issue, first as a professor of chemistry, and then as executive director of the Fluoride Action Network, was served very well. While I was amused that they mentioned my classical music program on my local public radio station, I would have much preferred it if they had attempted a blow by blow critique of my "50 Reasons to Oppose Fluoridation." If readers were to avail themselves of this documented argumentation they would get a better feel of just how much of the fluoridation debate was side-stepped by these authors.

Paul Connett, PhD,
Professor Emeritus of Environmental Chemistry,
St. Lawrence University, Canton, NY
And
Executive Director,
Fluoride Action Network,
[...]
16 of 31 people found the following review helpful
1.0 out of 5 stars Don't waste your money on this book. April 16 2009
By C. Kopf - Published on Amazon.com
Format:Hardcover
The authors of The Fluoride Wars seem stuck in the 1950's when children played in the spray of DDT trucks, smoking was encouraged by physicians and adding unnecessary fluoride chemicals into public water supplies, as an unproven children's tooth decay medicine, seemed like a good idea. The book is neither objective nor middle ground and borders on plagiarism in parts. It definitely reflects the authors pro-fluoridation beliefs.

It appears the authors did little original research and borrowed many quotes from other published sources. The authors seem to have little interest in, or a poor understanding of, actual fluoride science.

They use inflammatory quotes and stories from articles available on the Internet and then write how worried they are that the Internet is used as a tool for propaganda.

Actually, the internet is almost the only place you can read, unfiltered, what those of us opposed to fluoridation have to say. We believe you are smart enough to sort out the truth.

As pointed out by Dr. Paul Connett in his review of this book, the authors are aware of the National Research Council's (2006) 500+ page report on the health effects and toxicology of fluoride but the authors of The Fluoride Wars don't report on what's in it. Any book on fluoride or fluoridation that doesn't include the findings and recommendations of this major review of current fluoride science shouldn't be taken seriously.

The authors describe the fluoridation battle in Connersville, Indiana, where a fluoride supporter and magician foolishly eats a whole tube of fluoridated toothpaste to prove it is non-toxic. However, it is toxic. Such a stupid stunt by a small child could be fatal. Instead of explaining the health risks associated with this performance, the author denigrates fluoridation opposers for suggesting this magician used sleight of hand to switch to a tube of non-fluoridated paste. The story and quotes are lifted from a newspaper article available on the Internet.

These shenanigans enabled fluoridation to begin in Connersville in 2000 despite a 1999 research article published in Community Dentistry and Oral Epidemiology (1999 Aug;27(4):288-97) which showed that Connersville children already consumed too much fluoride from food and dental products putting them at greater risk of dental fluorosis (discolored teeth). Instead of reducing intake as this research paper advised, local dentists misinformed legislators and residents that children needed more via water fluoridation. The authors of The Fluoride Wars fail to tell readers this vital information even though Wiley publishes both this journal and this book. They should all be very embarrassed.

It's also revealing that the authors acknowledge Warren Wood as providing supportive reviews of the final manuscript. We wonder if this is the same Warren Wood who is on the Louisiana Fluoridation Advisory Board which is charged with promoting water fluoridation. I don't see any evidence that the authors consulted any scientist or activist opposed to fluoridation

Those interested the history and politics behind the unscientific and risky practice of fluoridation can read The Fluoride Deception by award-winning journalist Christopher Bryson. It's original, clearly referenced and a good read.

Those interested in fluoride science and how, even low doses added to public water supplies, can be harmful to some people - especially babies, high water drinkers, thyroid and kidney patients - read the NRC report (Fluoride in Drinking Water: A Scientific Review of EPA's Standards)

Carol S. Kopf, B.S., M.A.

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