“Fluoridation May Not Prevent Cavities, Scientific Review Shows” is a Newsweek report on the extent to which fluoridating water is a good idea. During my childhood (1970s!), people who were against fluoridated water were considered extremists and scoffed at by the educated elite (i.e., they occupied the same position in society as climate change deniers do today).
Could this be yet another example of people calling themselves scientists who are “often in error, but never in doubt”?
Related:
philg: “Could this be yet another example of people calling themselves scientists who are “often in error, but never in doubt”?”
Or not…
Article: “Studies that attest to the effectiveness of fluoridation were generally done before the widespread usage of fluoride-containing dental products like rinses and toothpastes in the 1970s and later, according to the recent Cochrane study. So while it may have once made sense to add fluoride to water, it no longer appears to be necessary or useful, Thiessen says.
It has also become clear in the last 15 years that fluoride primarily acts topically, according to the CDC. It reacts with the surface of the tooth enamel, making it more resistant to acids excreted by bacteria. Thus, there’s no good reason to swallow fluoride and subject every tissue of your body to it, Thiessen says.
Another 2009 review by the Cochrane group clearly shows that fluoride toothpaste prevents cavities, serving as a useful counterpoint to fluoridation’s uncertain benefits.”
It may have been useful. It appears that fluoride in other products works better.
And, it was “people calling themselves scientists” who figured it out.
The practice of medicine isn’t really -science- anyway.
In general, it made sense in the early part of the 20th century to solve public health problems en masse by adding things to food/water so that you were able to treat 100% of the population – iodide to salt, “enriching” vitamins to milk/bread/rice, cereal, flour, etc. This was very effective – nutritional deficiency diseases such as goiter, beriberi, pellagra, etc. almost disappeared. Water was never an ideal vehicle for fluoride because its action appears to be topical rather than systemic but it was better than nothing at a time when most people had no other source of fluoride (before most toothpastes became fluoridated and maybe some people didn’t use toothpaste at all).
As with the previous posts about the unreliability of evolving scientific consensus (anti-biotic regimens, nut allergies, etc.), I completely agree with the narrow assertions that people within the medical establishment who claim the authority of “science” can be as misguided or arrogant or stupid as anyone. If the overall thrust of these posts is simply “scientific consensus is fallible and therefore warrants a measured skepticism”, then I totally agree. If, however, there is meant to be some implication that the scientific establishment has failed us and therefore we are free to treat [insert favored theory here] as winner by default, I guess I don’t see it. I would offer that if we are going to impugn the track record of the scientific establishment in general or the medical establishment in particular, we should probably assess the totality of their failures against the totality of their successes and compare both the numerator and the denominator with their analogues from other forms of collective epistemology: personal intuition, folk wisdom, religious revelation, Mother Earth mysticism, conspiratorialism, etc.
I know of no example for which older, thinner science has been superseded by anything other than newer, deeper, more rigorous science — which I think offers a useful litmus test: Are the voices leading the assault on a given bit of scientific consensus (fluoridation, vaccination, etc.) insisting that we remedy our imperfect understanding with deeper, more rigorous study, or are they intimating that the breach will be filled by their pet theory? The epistemic failure of, say, anti-vaxxers is not necessarily with their skepticism toward claims made by the medical establishment. Rather, it’s the manner in which they pair this hardened skepticism toward the claims of science with a vaporous credulity toward any emotionally satisfying claims of fact made by their fellow travelers.
Guys: https://en.wikipedia.org/wiki/Toothpaste#Modern_toothpaste says that the first toothpastes with fluoride came out in the 1890s, i.e., about 120 years ago.
Completely true. But consider something that didn’t come out 120 years ago: the longitudinal studies used by the Cochrane Collaboration in their 2015 review of the published literature that you are citing. It’s possible that fluoridated water offered better outcomes than the median outcome prevalent in 1960, but that modern dentistry plus old-fashioned fluoride toothpaste offer better outcomes still. Making adjustments and corrections along the way is part of the process.
No doubt this is true, but it glosses over an important distinction. I would be shocked to find evidence of educated elites from 1970 scoffing at anyone who said something modest and prescient like “I believe that fluoride works topically rather than systemically and that fluoridated drinking water leads to troublesome variances in dosage, so I’m not on board with the fluoridation campaign.” The reason there is a history of elite scoffing is because there is a history of tinfoil hat types rejecting public health policy based on tribal kookery.
http://en.wikipedia.org/wiki/Water_fluoridation_controversy#Communist_conspiracy_theory_.281940s-1960s.29
https://xkcd.com/1520/
What would she say about CS?
Maybe the 1st one came out in the 1890s, but if you keep reading, it was not until P&G paid to have rigorous studies done in the ’50s that it was finally accepted by the ADA in 1960. When Crest came out (in the mid 50s) it was the only mainstream fluoridated toothpaste on the US market and at first had a small market share. So probably at least until some point in the late ’60s when the other major brands began adding fluoride to compete with Crest, the majority of Americans got no fluoride except from their water supply.
Again, the prevalent impulse at that time was to keep adding stuff to widely consumed products in the interest of public health for everyone and not just those who were tuned into the latest recommendations and motivated enough and financially able to follow them by. Probably fluoride was the bridge too far, but the others had been spectacular successes (and the “enrichment” process continues to this day – Vitamin D in milk, thiamin, niacin and iron in rice, etc.) so the thought was to keep going and solve even more problems. For a minimal expense (currently maybe $1/person/year), the thought was, we could wipe out cavities among almost the entire population.
RobF, the John Birch Society and many others criticized use of fluoride for medical reasons before 1970. The state of California refused to fluoridate water until the last 10 years or so. European countries also refused.
So yes, it is absolutely true that many people pointed out that the medical evidence for benefit of fluoridated water was extremely weak.
I have asked many forced-fluoridation fanatics to tell me how much accumulated fluoride in the body they think is safe. So far not a single one of them has been able to answer the question.
http://forcedfluoridationfreedomfighters.com/a-preliminary-investigation-into-fluoride-accumulation-in-bone/
George: That the John Birch Society was against fluoridation was, at least in the 1960s and 1970s, considered additional evidence for the efficacy of fluoridation and the wonders of science and rational analysis. Due to their non-centrist (for the time) political beliefs we assumed that whatever else they believed was “kooky.”
To clarify my understanding of what is being asserted here, are folks claiming the history of this issue follows an arc along the lines of:
1) The medical establishment in cahoots with liberty-hating central planners concocted a program for forced fluoridation back in the 1950s.
2) The John Birch Society correctly identified obvious flaws in the science underpinning the case for forced fluoridation.
3) In the press and at cocktail parties of left-wing elites (same thing, ha!), the John Birch Society and its fellow travelers were mocked for their unfashionable scientific theories on the merits of fluoridated water.
4) The best evidence from recent studies vindicates JBS and aligns better with their scientific claims than with those of the forced-fluoridators.
5) The climate change debates are the next cycle of this same story about an outcast but prescient band of right-wing truth-tellers being being unjustly slandered by the high-priests of the lefty establishment.
RobF: You’ve added a lot of personal motivations and inferences. The point of my original posting was, similar to the related previous postings, that including medical/dental research under the rubric of “science” tends to lead to public skepticism regarding anything that a “scientist” might say.
philg: I think maybe I’ve badly mis-read you here. My sense was that you were a building a case along the lines of “Modern ‘science’ is a big arrogant hoax — look at all these errors!” Are you instead making a case that there is “real science” and “pseudo-science” and that the entire field of medical research falls into the pseudo-science camp? That would be a surprising stance to me since medical research seems like a fully-fledged science in good standing. We can, for instance, follow your example and find peer-reviewed write-ups of peanut allergy clinical studies in the BMJ:
http://www.bmj.com/content/312/7038/1074.short
If medical research is in the credibility-sapping, pseudo-science camp, what kinds of research qualify as “real science”?
RobF, I am not even remotely right-wing, or a climate change denier. I also have a science education, and did my honours project on solar energy. In reality forced-fluoridation is right-wing because it is highly authoritarian. Forced-fluoridation is based on pure pseudoscience, which is very different from legitimate science, but unfortunately many people don’t have the scientific literacy to understand the difference and as a result forced-fluoridation gives science a bad name.
http://forcedfluoridationfreedomfighters.com/fluoridationism-versus-climate-science/
RobF: What qualifies as “real science”? We would need a scientifically objective standard, starting from http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020124 (“Why Most Published Research Findings Are False”)! Take the 10 most prestigious journals in a field. If more than X% of the findings cannot be replicated and/or turn out to be false, the field can no longer be called “science.” If you check out https://philip.greenspun.com/blog/2014/07/08/book-review-bad-pharma/ you’ll see that for virtually any value of X clinical trials of new drugs would not qualify as “science.”
We would probably have to divide this up a bit within fields. So cosmology would have to be separated out from other kinds of physics and evaluated separately.
Then perhaps we could get to the point that public policy could be reliably based on “science.”