Water fluoridation controversy

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The water fluoridation controversy arises from political, ethical, economic, and health considerations regarding the fluoridation of public water supplies. For deprived groups in both maturing and matured countries, international and national agencies and dental associations across the world support the safety and effectiveness of water fluoridation.[1] Proponents of water fluoridation see it as a question of public health policy and equate the issue to vaccination and food fortification, citing significant benefits to dental health and minimal risks.[2][3] In contrast, opponents of water fluoridation view it as an infringement of individual rights, if not an outright violation of medical ethics,[4] on the basis that individuals have no choice in the water that they drink, unless they drink more expensive bottled water.[5] A small minority of scientists have challenged the medical consensus, variously claiming that water fluoridation has no or little cariostatic benefits, may cause serious health problems, is not effective enough to justify the costs, and is pharmacologically obsolete.[6][7][8][9]

Opposition to fluoridation has existed since its initiation in the 1940s.[10] During the 1950s and 1960s, now-debunked conspiracy theorists claimed that fluoridation was a communist plot to undermine American public health.[11] In recent years, water fluoridation has become a prevalent health and political issue in many countries, resulting in some countries and communities discontinuing its use while others have expanded it.[12][13] The controversy is propelled by a significant public opposition supported by a minority of professionals,[14] which include researchers, dental and medical professionals, alternative medical practitioners, health food enthusiasts, a few religious groups (mostly Christian Scientists in the U.S.), and occasionally consumer groups and environmentalists.[15] Organized political opposition has come from libertarians,[16] the John Birch Society,[17] the Ku Klux Klan,[18] and from groups like the Green parties in the UK and New Zealand.[19]

Proponents of fluoridation have been criticized for overstating the benefits, while opponents have been criticized for understating them and for overstating the risks.[20][21] Systematic reviews have cited the lack of high quality research for the benefits and risks of water fluoridation and questions that are still unsettled.[12][21][22][needs update] Researchers who oppose the practice state this as well.[23] According to a 2013 Congressional Research Service report on fluoride in drinking water, these gaps in the fluoridation scientific literature fuel the controversy.[13]

Public water fluoridation was first practiced in 1945, in the U.S. As of 2015, about 25 countries have supplemental water fluoridation to varying degrees, and 11 of them have more than 50% of their population drinking fluoridated water. A further 28 countries have water that is naturally fluoridated, though in many of them there are areas where fluoride is above the optimum level.[24] As of 2012, about 435 million people worldwide received water fluoridated at the recommended level, of whom 57 million (13%) received naturally fluoridated water and 377 million (87%) received artificially fluoridated water.[24] In 2014, three-quarters of the US population on the public water supply received fluoridated water, which represented two-thirds of the total US population.[25]

  1. ^ Cite error: The named reference Pizzo was invoked but never defined (see the help page).
  2. ^
    • McNally M, Downie J (December 2000). "The ethics of water fluoridation". Journal. 66 (11): 592–593. PMID 11253350.
    • Cohen H, Locker D (November 2001). "The science and ethics of water fluoridation". Journal. 67 (10): 578–580. PMID 11737979.
  3. ^ Perrella, Andrea ML, and Simon J. Kiss. "Risk perception, psychological heuristics and the water fluoridation controversy." Canadian journal of public health 106.4 (2015): e197-e203.
  4. ^ Cross DW, Carton RJ (1 March 2003). "Fluoridation: a violation of medical ethics and human rights". International Journal of Occupational and Environmental Health. 9 (1): 24–29. doi:10.1179/107735203800328830. PMID 12749628. S2CID 24127394.
  5. ^ Coggon D, Cooper C (July 1999). "Fluoridation of water supplies. Debate on the ethics must be informed by sound science". BMJ. 319 (7205): 269–270. doi:10.1136/bmj.319.7205.269. PMC 1126914. PMID 10426716.
  6. ^ Cite error: The named reference FRWG was invoked but never defined (see the help page).
  7. ^ Ko L, Thiessen KM (3 December 2014). "A critique of recent economic evaluations of community water fluoridation". International Journal of Occupational and Environmental Health. 21 (2): 91–120. doi:10.1179/2049396714Y.0000000093. PMC 4457131. PMID 25471729.
  8. ^ Hileman B (4 November 2006). "Fluoride Risks Are Still A Challenge". Chemical & Engineering News. 84 (36): 34–37. doi:10.1021/cen-v084n036.p034. Retrieved 14 April 2016.
  9. ^ Krimsky S (16 August 2004). "Book review: Is Fluoride Really All That Safe?". Chemical & Engineering News. 82 (33): 35–36. doi:10.1021/cen-v082n033.p035. Retrieved 19 April 2016.
  10. ^ Cite error: The named reference Martin1989 was invoked but never defined (see the help page).
  11. ^ Johnston RD (2004). The Politics of Healing. Routledge. p. 136. ISBN 978-0-415-93339-1.
  12. ^ a b "Introduction to the SCHER opinion on Fluoridation". European Commission Scientific Committee on Health and Environmental Risks (SCHER). 2011. Retrieved 18 April 2016.
  13. ^ a b Cite error: The named reference Tiemann2013 was invoked but never defined (see the help page).
  14. ^ Martin B (May 1988). "Analyzing the fluoridation controversy: resources and structures". Social Studies of Science. 18 (2): 331–363. doi:10.1177/030631288018002006. PMID 11621556. S2CID 31073263.
  15. ^ Reilly GA (2007). "The task is a political one: the promotion of fluoridation". In Ward JW, Warren C (eds.). Silent Victories: The History and Practice of Public Health in Twentieth-century America. Oxford University Press. pp. 323–342. ISBN 978-0-19-515069-8.
  16. ^ "Consumer protection". Libertarian Party. Retrieved 28 June 2010.
  17. ^ Freeze RA, Lehr JH (2009). The fluoride wars: how a modest public health measure became America's longest-running political melodrama. Hoboken: Wiley. ISBN 978-0-470-44833-5.
  18. ^ McNeil, Donald R. (1985). "America's Longest War: The Fight over Fluoridation, 1950–". The Wilson Quarterly. 9 (3): 140–153. ISSN 0363-3276. JSTOR 40256913.
  19. ^ Nordlinger J (30 June 2003). "Water fights: believe it or not, the fluoridation war still rages – with a twist you may like". Natl Rev.[permanent dead link‍]
  20. ^ Cheng KK, Chalmers I, Sheldon TA (October 2007). "Adding fluoride to water supplies". BMJ. 335 (7622): 699–702. doi:10.1136/bmj.39318.562951.BE. PMC 2001050. PMID 17916854.
  21. ^ a b "What the 'York Review' on the fluoridation of drinking water really found" (PDF). Centre for Reviews and Dissemination. York, United Kingdom: University of York. 28 October 2003. Retrieved 12 April 2016.
  22. ^ Iheozor-Ejiofor Z, Worthington HV, Walsh T, O'Malley L, Clarkson JE, Macey R, et al. (June 2015). "Water fluoridation for the prevention of dental caries". The Cochrane Database of Systematic Reviews. 6 (6): CD010856. doi:10.1002/14651858.CD010856.pub2. PMC 6953324. PMID 26092033.
  23. ^ Peckham S (2012). "Book Reviews: The case against fluoride: how hazardous waste ended up in our drinking water and the bad science and powerful politics that keep it there, by Paul Connett, James Beck, and H Spedding Micklem". Critical Public Health. 22 (1): 113–114. doi:10.1080/09581596.2011.593350. ISSN 0958-1596. S2CID 144744675.
  24. ^ a b The British Fluoridation Society; The UK Public Health Association; The British Dental Association; The Faculty of Public Health (2012). "The extent of water fluoridation" (PDF). One in a Million: The facts about water fluoridation (3rd ed.). Manchester: British Fluoridation Society. pp. 55–80. ISBN 978-0-9547684-0-9.
  25. ^ "Community Water Fluoridation --- 2014 Water Fluoridation Statistics". cdc.gov. Retrieved 19 April 2016.