Are Austin's water fluoridation policies dangerous? It depends who you ask.
The reduced form of the highly reactive chemical element fluorine – better known as fluoride – is commonly added to municipal tap water, in order to strengthen our teeth. When we eat sugars and refined carbs, bacteria lurking in our mouths use them to form acids. Eventually the acids can grow strong enough to eat through tooth enamel in a process known as demineralization, which eventually creates cavities. Fluoride promotes remineralization – while that can't plug cavities, it can stop or slow their growth, help build a new coat of enamel, and kill the acid-creating bacteria. That's the theory behind Austin's use of fluoride since the Seventies, re-endorsed this month by an official city report as providing "a public benefit." The federal Centers for Disease Control has recognized water fluoridation as one of "Ten Great Public Health Achievements" of the 20th century, along with other noble causes like vaccinations, infectious disease control, and recognizing the dangers of tobacco.
Or so they'd have you believe.
Think of fluoride opposition, and your mind tumbles into a rabbit hole of Cold War, Red-baiting hysteria with reactionary conservative groups chiming in; for instance, the John Birch Society, which explicitly described fluoridation as part of a nefarious Communist plot or form of mass indoctrination – a paranoia famously aped in Stanley Kubrick's 1964 black comedy Dr. Strangelove, as General Jack D. Ripper launched a nuclear assault on Russia, supposed seat of the fluoride threat:
"Do you realize that in addition to fluoridating water, why, there are studies underway to fluoridate salt, flour, fruit juices, soup, sugar, milk – ice cream. Ice cream, mandrake, children's ice cream. ... How does that coincide with your post-war Commie conspiracy, huh? It's incredibly obvious, isn't it? A foreign substance is introduced into our precious bodily fluids without the knowledge of the individual. Certainly without any choice. That's the way your hardcore Commie works."
Sterling Hayden as Ripper was spectacularly ludicrous, and Strangelove may have marked a cultural tipping point from conservative orthodoxy to liberal disdain for anti-scientific Red Scares. Yet nearly half a century later, fluoride's effect on the essence of our natural bodily fluids is once again under debate, and not as a part of Red Scare hysteria or a socialist plot. Locally, much like Coca-Cola working the night shift on an unsuspecting molar, a steady drip of citizen pressure has eroded the city's resistance to the discussion.
And the question is raised anew: Does water fluoridation pose a threat to public health?
Citizen communications, the public forum held at high noon during each City Council meeting, allows (every week until recent rule changes) speakers to sign up and address the council for three minutes on any topic of their choice. It's a popular occasion for impassioned, if sometimes factually challenged, speakers to flog their miscellaneous hobbyhorses. Rae Nadler-Olenick, a slight, soft-spoken retired Austinite, at first glance fit the shaky cit-com profile, especially once you learned her favorite topic. But she kept coming back, often with her husband, Walter, or similarly like-minded speakers and a battery of scientific opinions to try and drive home her argument to council: Austin's water fluoridation policies – not to mention most of America's – are bad for our health.
We talked in a quiet corner of City Hall a few minutes after her latest cit-com appearance – a charming, well-researched speech that held up "Austin's own folk icon" John Henry Faulk as wary of fluoridation. "A few years ago," she says, "my husband was diagnosed with osteopenia," a bone-thinning condition that's often a precursor to osteoporosis. "Now when I heard this, my first reaction was just amazement, because as far as I knew, osteoporosis – bone thinning – had always been described as a disease of middle-aged women. It's not a man's disease at all, and here he was with it."
The Olenicks chalked it up to increasing age until a couple of years later when they were hanging out with friends, and it turned out two other men they knew were taking Fosamax, the same drug her husband, Walter, had been prescribed for his condition. "That grabbed my attention. That looked like a cluster to me. I was alarmed," Nadler-Olenick says, shocked to learn that "two other people in the same group, all outdoor-type guys in good health," faced similar ailments.
"What else could they have in common?" she asks. One shared trait was that, like Walter, they all work in construction – and drink lots of liquids. "I know my husband has always got a bottle of, usually, juice in his case; he's constantly hydrating, because he works outdoors, doing carpentry. And these other men have similar profiles, they're outdoorsmen."
"I don't remember exactly what pushed me on to look at fluoride," she continues. "We live in such a polluted environment anyway, and it's hard to single one thing out. But I started hearing a little bit here, a little bit there, and then this book, The Fluoride Deception, came to my attention. I read it, and it was like a veil falling away."
The Fluoride Deception, written by Christopher Bryson and published in 2004, is the Rosetta stone of modern fluoride resistance. Essentially, Bryson argues that fluoride, produced first in large quantities as an industrial waste byproduct of smelting and then as part of the Manhattan Project's uranium enrichment efforts, was made in such volumes, and at such considerable health risks, that the best course of action for the implicated business and governmental elites was to dispose of the stuff by adding it to drinking water, thereby inoculating themselves from lawsuits by whitewashing it as a teeth-strengthening agent with the help of a concerted push from industry, government, and the nascent public relations field.
Reduced so infinitesimally, it sounds unbelievable, deserving a spot on some nervous bookshelf between a copy of Behold a Pale Horse and the collected works of Alex Jones – yet another vociferous fluoridation opponent. But in light of the 20th century history of physician-prescribed cigarettes, lobotomies, asbestos, shock treatment, lead paint, Thalidomide, Vioxx, Fen-phen, and BPAs, does it really sound that far-fetched?
Signs of the Stain
"I'm likely going up against everybody else, because in organized dentistry this is a panacea," says fluoride-free local dentist Griffin Cole. "It's seen as a cure-all, and I don't see it that way." Cole, who's been practicing for almost 18 years, is a dentist with a "biocompatible focus," not just eschewing fluoride but using advanced filtering for mercury removal and performing "oxygen-ozone therapy" in his procedures. "I would say that topically, if you put fluoride on the tooth, you are going to get somewhat of an anticariogenic effect, an anti-cavity effect," he says. "But that's not the issue. It's putting it in the water and drinking it systemically which does nothing for your teeth. That's the huge argument."
Indeed, it's relatively settled on both sides of the argument that fluoride's beneficial effects are topical, and swallowing fluoridated water has no direct strengthening effect on teeth. The concept behind mass fluoridation is that drinking optimally fluoridated water raises the persistent level of fluoride in saliva and plaque fluid and thereby has a cumulative effect that remineralizes enamel and kills decay-causing bacteria. In Western Europe, where fluoridation is much less common than in the U.S., similar effects are achieved with topical fluoride gels (or toothpaste) – and public dental care is also more universal.
But if a little fluoride may be good for you, too much can definitely be bad. Fluoride overdoses do occur, although not necessarily associated with municipal fluoridation – it's more often a consequence of industrial production or else a rural anomaly. The iconic fluoride image is teeth bearing a distinctive, dappled brown stain, a sign of those exposed to high levels in childhood. Known as the "Colorado Brown Stain" (for the place it was first documented) or "Texas Teeth" (due to the state's pockets of dense, naturally occurring fluoride), the scientific nomenclature is dental fluorosis, which can register as barely visible white streaks, brown stains, or, in severe cases, a "pitting," or cracking, of the teeth. Higher levels of fluoride poisoning can lead to skeletal fluorosis, a crippling, weakening bone disease.
Fluorosis is one of several worries in the anti-fluoride movement. The Fluoride Action Network (www.fluoridealert.org), perhaps the largest online opposition clearinghouse, stokes worries about an increased risk of bone cancer, kidney malfunction, impacted thyroid gland and pineal gland function, brain damage, lowered IQ, and more. You can spend hours scouring the FAN website, each of its health claims seemingly supported with scientific findings – just as you can spend days combing through the statements from the CDC, the Texas Department of State Health Services, the American Medical Association, and the American Dental Association, to cite a few, endorsing water fluoridation and saying such afflictions can't be caused by the current amounts in our drinking water. In the debate over water fluoridation, each side claims science as an ally, and each yields no quarter.
But some science does evolve. In a burst of ammunition for fluoridation opponents, in 2006 the ADA revised its position on fluoride for infants and young children, citing concerns over dental fluorosis. Its "Interim Guidance on Reconstituted Infant Formula," while endorsing breast-feeding, says that if preparing a dry-mix formula, "parents and caregivers should consider using water that has no or low levels of fluoride."
Consider the Smorgasbord
It's a clear, bracing day at the Ullrich Water Treatment Plant in West Austin, which, perched on a grassy hillside, provides a broad, rolling view of the city. Overlooking one of the huge open-air water tanks at Ullrich, Jane Burazer, assistant director of treatment at Austin Water Utility, describes the five-step process in the tanks: disinfection, in which chemicals including chlorine are added to kill pathogens; coagulation, which readies undesirable particles to combine; flocculation, which stirs the waters so they do combine; sedimentation, when the particles finally settle out; and filtration, a "final polishing step" that gets the stuff that didn't settle.
The water then leaves the tank through underground tubes, where fluoride in the form of hydrofluorosilicic acid is added. Whenever the plant receives a shipment, trucks pull up to a special feed station and start funneling the stuff – through high-density plastic tubes because hydrofluorosilicic acid will eat through metal – into two 6,800-gallon polyethylene storage tanks which stand in a separate, open-air building. Looking at the imposing pair, they seem ripped from a set design for The Toxic Avenger. And after everything I've heard about hydrofluorosilicic acid, I'm slightly paranoid.
"You can tell that there's something in the air, I feel," I say. "Or am I overreacting?"
"I think you're overreacting," says Burazer.
"You really don't smell the chemical aroma?" I say. Maybe it's just endemic to the plant, period, because when we walked in, it smelled like a chlorinated swimming pool.
"I really don't. I'm not just saying that."
Much of my hydrofluorosilicic acid knowledge comes from Neil Carman, clean air program director of the local Lone Star Chapter of the Sierra Club and a fluoride opponent. Most hydrofluorosilicic acid, he says, is created as a byproduct of phosphate fertilizer production. "They're mining this in Florida, because it's an old sea bed down there. There's a lot of phosphorous there. The problem is they've got some contaminants or impurities they don't want" – one being fluorine, which, Carman says, fertilizer manufacturers remove because it kills plants. "This is a very toxic substance." So at the end of the fertilizer refinement process, the leftover fluorine is collected in the form of hydrofluorosilicic acid. "What [the city's] getting is a toxic industrial waste byproduct that comes from the wet scrubbers of phosphate fertilizer plants," Carman says. Moreover, other undesirable elements are refined from the phosphorous ore, he adds. "There's heavy metals, there's lead, cadmium. It's a smorgasbord of a toxic soup that's in this stuff that they're buying."
Carman draws a distinction between the hydrofluorosilicic acid – the most popular form of water fluoridation – and naturally occurring sources of fluoridation. "You don't have hydrofluorosilicic acid [in nature]," he says. "You have things like calcium fluoride, magnesium fluoride, potassium fluoride. ... But they're not adding those naturally occurring mineral fluorides. What they're adding is industrial toxic waste." Other steps in the refinement process, including air pollution, water pollution, the strip-mining of the phosphate ore, and phosphogypsum – leftovers from refinement containing radioactive elements like uranium – all worry Carman. "People don't know this at all." (There's also the cost: Fluoride costs have risen each year since 2006, and the utility estimates it will spend about $310,000 over the next year and $1,500 each at the two plants on upkeep.)
The Water Utility has a purchasing contract with Florida-based Lucier Chemical Industries for its acid needs, but Lucier is just the vendor; the actual manufacturer is the Mosaic Company, the self-described "world's leading producer and marketer of concentrated phosphate." AWU notes that for every million gallons of water treated, it adds 2.7 gallons of hydrofluorosilicic acid. By the utility's own estimate, since it started fluoridating in 1973 through July 2009, it's added 25,150 tons.
Heavy metals such as lead are indeed present in hydrofluorosilicic acid, along with another corrosive acid, hydrofluoric acid; both are present in very small amounts, less than 0.02% and 1% respectively, according to a Lucier product data sheet. Burazer says that the fluoride, as well as all other chemicals the Water Utility uses, meets National Sanitation Foundation Standard 60 certification requirements, a universally recognized standard which controls for purity and the presence of contaminants like lead, arsenic, radionuclides, and all other manner of things you wouldn't want to drink. (The NSF is a nonprofit, nongovernmental agency with no regulatory authority, but it does certify products as being safe at the maximum dose, and pure to an acceptable level.) "We get the information from NSF," Burazer says. "They're not going to certify a company that doesn't meet their regulations and rules." The utility also performs its own water purity tests.
Burazer doesn't take a stand on fluoridation one way or another. It's not her job; the utility is simply "feeding it because of the will of the people." But she recognizes fluoride is fundamentally different from all the other chemicals used in the treatment process. "Most of our treatment is designed around disease prevention," so "fluoride is an unusual thing. You're not feeding it for a water quality issue. It's a health issue, and we're not health experts, so we don't take a position on it. ... The issues are still out there, and we're not in a position to say this is the absolute correct thing; we're doing it because of the referendum."
Health and Environment
Austin has been fluoridating the water supply since 1973. A nonbinding fluoridation election was put to Austin voters in 1971 – it passed overwhelmingly (73%); put to a binding referendum vote the following year, it passed again, albeit by a smaller margin (57%). But as that election was initiated by council action and not citizen petition, it would require a simple majority vote by a subsequent council – just four members – to change or end the city's fluoridation policies.
That's among the findings in a recent Water Fluoridation Report prepared by the city and issued to council Nov. 13, and it's pretty much the only good news fluoridation opponents will find there. The report, assembled by Assistant City Manager Rudy Garza, called upon several city departments to address fluoridation procedures, health effects, environmental impacts, and legal issues. Garza's summary states, "The report findings show that the present level of fluoride in Austin's drinking water has no harmful impact to human health or adverse effect on aquatic life and provides a public benefit in preventing dental decay."
Philip Huang, medical director for the Austin/Travis County Health and Human Resources Department, says, "The weight of the peer-reviewed scientific evidence does not support" claims of "any adverse health effect or systemic disorder, including an increased risk for cancer, Down syndrome, heart disease, osteoporosis and bone fracture, immune disorders, low intelligence, renal disorders, Alzheimer's disease, or allergic reactions." The Watershed Protection Department delivers a less ringing endorsement of fluoride's environmental effects. "At the present levels of fluoride addition, there does not appear to be a strong potential for adverse aquatic life impacts," the department finds, later noting, "from a purely environmental protection standpoint, there is no reason to fluoridate drinking water. The decision to fluoridate drinking water should be based on the comparison of human health benefits from reduced dental cavities versus any potential human health risks."
Garza says the report was put together at the behest of City Manager Marc Ott, partially in response to "concerns raised by some citizens consistently for the past year. The manager ... directed us to form this multidepartment team to look at all the aspects of this and submit a final report." Separating fluoride worries into "two big issues: impact to health and impact to the environment," Garza says the report "finds no concern" for either. As for the effects fluoridation opponents warn of, Garza says, "I feel pretty confident that the medical director and our environmental folks both agree that it could become problematic," if fluoride was ingested in higher levels. "But again, it's such a small amount."
"It was a rubber stamp, basically," responds Nadler-Olenick. A post on her Fluoride Follies blog says, "The assistant city manager's disingenuous report" is a "feel-good opus rubber-stamping the status quo [and] smacks of bad faith. It settles nothing." She asks what happened to a motion from the city's Environmental Board, issued this summer, which called for City Council to appoint an "independent task force/committee" to study fluoridation, including, but not limited to, the groups that participated in the city manager's study. "It is not the panel that the Environmental Board had in mind, I'm sure of that. And I'm not exactly sure why it emanated from the city manager's office. That is surprising to me, because the Environmental Board's recommendation was to the council." However, the Environmental Board serves in a purely advisory capacity and can't force the council to act on its recommendations. Moreover, it sounds like there was a communication lapse between the groups. Phil Moncada, board secretary, was surprised to hear about the report, which he had yet to see. "Why would we have moved forward asking council to do something, if it was already being done?"
The Long Fight
America's demagogic id, always bubbling along beneath the glossy pop-cultural surface, has been newly unbridled in recent months, running across the country in the form of birthers, deathers, tea partiers, and other assorted members of the right-wing's cult of professional victimhood. As historian and Nixonland author Rick Perlstein noted in a column for The Washington Post, "the crazy tree blooms in every moment of liberal ascendancy," and the hysteria surrounding health care reform appears closely akin to the John Birch Society's fluoride frenzy in the midst of JFK's Camelot and LBJ's Great Society. In that respect, fears of fluoridation – an omnipresent, inescapable component of daily city life – seem tailor-made for our latest age of anxiety.
Nadler-Olenick acknowledges the strange history of fluoridation and anti-fluoridation and the awkward position in which it places her and other local fluoride opponents – that due to the crackpot theories espoused by the Birchers and persistent in their political descendants, science-based opposition to mass fluoridation may be similarly consigned to the loony bin of history. "The science has moved on," she says, echoing a line from Neil Carman. "My way of saying it would be, evidence of harm is accumulating. ... It really doesn't matter what the John Birch Society was doing back then."
In Texas, fluoride opponents have achieved some limited victories. A fluorid battle has raged in the San Antonio suburb of Alamo Heights, where the City Council, after authorizing fluoridation in 2004 but never actually implementing it, voted to repeal authorization last year, with cost cited as an issue. The Elgin City Council voted to end fluoridation in 2007, seemingly more out of health concerns. But with a new, bullish report from city staff, it doesn't seem like reconsidering fluoridation is high on the Austin council agenda. (See "Change on Tap? Council on Fluoride.")
Nadler-Olenick says she'll keep her website and blog (www.fluoridefreeaustin.com) going and continue speaking to council. She also hopes to spread the message on public access TV and build inroads with Austin's minority communities to keep spreading her message. "This could be a very long battle; I hope not, but it could be. This didn't happen overnight, and it won't be undone overnight. A lot of people will fight a while, and then they'll get tired, because it's so exhausting. I'm not planning to get tired – no matter what – but it could be a real long fight."
Parts Per Million: Pick a Number
Fluoride is an optional additive, so there's no minimum level that must be met, but there's an array of maximum suggested levels, and guidelines for effective dosage vary tremendously. Here are some benchmark fluoridation levels, in parts per million:
4.0 Maximum level allowed by the EPA, to prevent serious health effects such as skeletal fluorosis
2.0 Secondary guideline standard, above which dental fluorosis and mottling may occur
1.0 World Health Organization recommended level
0.7-1.2 "Optimal fluoride levels," according to the Centers for Disease Control (adjusted for climate)
0.75 Average fluoride level in Austin water