WA-WA WHAT?

There’s this local MD I like and whose research and publications I follow because of his good work on some issues I care about. Today he was curiously highlighting a new study about fluoride and noticing that there was never any serious question about its safety. I responded by asking for comment on evidence for the value of fluoridating the water supply to prevent tooth decay?

The information I’ve been working with, and have written about at length in the past, comes from the Harvard School of Public Health, themselves citing the gold standard, independent international medical experts who review for Cochrane. They say that, though perfectly safe (within longstanding dosage recommendations, of course), the evidence for fluoridation is at best extremely thin, based on bad data and poor research methods, and, even then, looks almost exclusively at young children who still have their baby teeth. A still more recent review, by Cochrane in 2024 of 156 prior studies, shows research failing to account for the introduction of fluoride into toothpaste, mouthwash, and dental procedures simultaneous with its deployment in municipal water supplies. And with that reviewers and public health experts also highlight how states, provinces, and nations who partially or wholly abstained from water fluoridation saw the same declines in tooth decay over the last five decades as those who mostly or entirely fluoridated their water. That's a pretty disruptive piece of data for the popular narrative. Making things more complicated, like most nutritional studies or any looking at what we consume, investigations into fluoride are similarly plagued with countless limiting and confounding factors. Not only is fluoride naturally occurring in the soil and comes down in the rain, so is in literally everything we eat and drink (with 5-10x the daily recommended dose in your typical tea) and thus nearly impossible to isolate, but other social factors such as income, diet and nutrition, physical activity (resulting in jaw-clenching, mouth-breathing, alkaline saliva, facial injuries...), education and school dental programs, access to the medical system and health information campaigns, and more make the matter way more convoluted than most research teams can easily contend with. Those that still make the effort commonly rely upon short-term evidence and the self-reporting of children or their parents, rather than observational studies, which would be extremely challenging. The research is a mess, to say the least.

As anticipated, the MD didn’t initially respond. But I was awarded with being inundated by other commenters assuring me that I was the dumbest person alive or that, of course, all the science in the world strongly supports fluoride supplementation via tap water. Others noted the sources I referenced as showing some studies report that “initiation of fluoridation still leads to a 3% increase in children with no decay [in their baby teeth].” And when asked if they have ever heard, from any source, that the reason we (in a minority of locations) fluoridate everyone’s water is to, perhaps, in one study, reduce cavities in the baby teeth of four-year-olds (which are set to fall out by age six or seven) by a single digit percentage — or you notice that this doesn’t quite make water supply fluoridation look like, as advertised, one of the most significant lifesaving revolutions in public health of all time, on par with vaccination or penicillin — they tell you you’re a politically motivated lunatic who can’t understand anything about anything and block you so you cannot even reply.

When Mr Dr does respond, he tells me that clearly these sources can not be trusted, that “the argument against it is less tenable than the argument for benefit” but without offering any "good" source or just any contrasting evidence of any kind. Critically, he later adds that there is currently “a large discussion on the degradation of Cochrane Reviews” but without providing any details or more information. And when I ask what sources I should be looking to for expertise in this area, if not leading medical or public health schools and institutions and the experts they employ, the conversation was over.

So, don’t trust the science, don’t trust the experts, and most certainly don’t do your own research. Got it. Somehow I suspect that if I had a PhD, or three, and fluoride was my sole focus I could also be on the wrong side of history and facts and good sense if what I was sharing was my own study deviating from this most obvious of all truths.

—Эх, товарищ, — отвечает ему всесоюзный староста, —вместо того, чтобы шляться без дела по улицам, вы бы лучше регулярно читали газеты и из них узнавали о том, что делается в вашем городе…