Longview should reject fear tactics and continue fluoridating its drinking water

Halvorson proposal to eliminate naturally occurring mineral supported by Bellevue dentist, but local MDs defend the practice and call his claims 'gish galloping'

An italicized paragraph in this story has been changed to clarify the possible range of actions the council may take.

If you watched anti-fluoridation advocate Bill Osmunson address the Longview City Council Thursday night, you could have come away with several impressions:

• That people in Longview and hundreds of millions of other Americans who drink fluoridated water live with elevated risks of cancer, heart disease, broken bones, thyroid problems and other ailments or that they have diminished intellects.

• That all the nation’s major doctor, dental and health organizations are engaged in a giant coverup about the dangers of fluoride or are too uninformed to understand its risks. Osmunson even suggested that the 21st Century medical community is as ignorant about the dangers of fluoride as the doctors of centuries ago were unaware of the risks of “bloodletting” as a cure for multiple diseases.

• That local dentists and pediatricians, who are reportedly unanimous in support of continued fluoridation of city drinking water as a way to combat tooth decay, are gravely mistaken and need “more education.”

In other words, you’d be scared. That’s exactly what the anti-fluoridation movement wants in order to get its way.

Don’t buy it. This is part of a broader conservative effort in rural Southwest Washington to undermine established science and established medicine. It would weaken public health, especially for the low income.

The Longview City Council is wrestling with member Erik Halvorson‘s proposal to stop adding tiny amounts of fluoride to city drinking water, a widely practiced and studied measure to combat tooth decay. Nearly three-quarters of Americans drink fluoridated water, and they’ve been doing it for three quarters of a century without ill effects.

Osmunson, Halvorson’s science point man, has been peddling fear and distortions about this for more than 20 years. He has failed to win any significant support from the medical or regulatory communities.

Halvorson says stopping fluoridation would save the city money, even if it would be a comparatively paltry amount (far less than the city wasted when Halvorson and the conservative city council majority fired City Manager Kris Swanson without cause last March). Halvorson believes the practice is unsafe. It also rankles him and other conservatives that fluoride is added to water without individual citizens’ consent.

This is a solution in search of a problem. This was not a campaign issue. No one in town was publicly challenging fluoridation before Halvorson brought it up.

Fluoridation is a classic case of government doing the public good. And this is a bad time to challenge it. The city just hired a new city manager, and the council is finally rebalancing itself after the Swanson upheaval. The city has far bigger challenges to address than fluoridation and does not need a divisive issue before it at this time.

Virtually every prominent U.S. dental and medical group endorses fluoridation. The local medical community is said to unanimously support it, and 45 local doctors and dentists have written the city in opposition to Halvorson’s proposal.

The issue was the subject of a timed panel debate the City Council staged Thursday night in which Osmunson — a Bellevue dentist — squared off against five panelists, including two local doctors and two dentists, one each from Longview and Portland.

The debate was a prelude to a public hearing the council will hold on Feb. 27. That night, the council could reject Halvorson’s proposal, send the matter to voters to decide, or notify the state that it intends to discontinue fluoridation.

The discussion ultimately was frustrating, ending with many loose ends and unaddressed or unexplained assertions. Osmunson made some unchallenged but extreme conclusions. (One of them: Women shouldn’t consume fluoridated water for 20 years if they intend to get pregnant.)

Advocates argued for the merits of fluoridation but ran out of time before they could address what they consider Osmunson’s distortions and misrepresentations. Later, they accused him of “gish galloping,” the rhetorical practice of rapidly making an excessive number of arguments, with no regard for accuracy or strength, making it impossible for the opponent to address them in the time available.

More on the debate later.

This is an important public health issue, especially because this community has a shortage of dentists and an astonishingly high percentage (72%) of children who don’t see dentists regularly and who are risk of tooth decay, according to the local medical community.

Poor dental health can lead to life-threatening infections, early loss of teeth and (because of aesthetic consequences), low self esteem and diminished career opportunity.

Fluoride is a naturally occurring mineral found in almost all raw water worldwide. It has been added to U.S. municipal drinking water since the middle of last century. Grand Rapids, Michigan, in 1945, became the first city to do so. Longview started the practice in 1968.

Fluoride’s ability to rebuild tooth enamel and kill cavity-causing bacteria has been known since 1905, when a researcher discovered that residents of Colorado Springs had few cavities but stained and mottled teeth as a result of high, naturally occurring fluoride levels there.

Longview’s water has natural concentrations of 0.25 milligrams of fluoride per milliliter (expressed as 0.25 mg/l). The city adds small amounts to bring it up to the federally recommended public health standard of 0.7 mg/l). That concentration is the equivalent of one minute in 1,000 days or 1 inch in 23 miles.

Fluoridation has been hailed as one of the miracles of 20th-Century public health. But occasional challenges arise, most recently based primarily on foreign studies that high doses of fluoride can reduce developing children’s IQ.

Southwest Washington is in the midst of such an organized conservative rebellion, with challenges to fluoridated water arising recently Battle Ground and Camas. Earlier this January, Aberdeen — a coastal city of about 20,000 residents — discontinued 27 years of fluoridation after a year’s worth of study. (State law leaves fluoridation decisions up to each municipality and public water system.)

The city of Longview recently received a letter from Battle Ground resident Derek Kemppainen threatening to sue the city if the council here does not vote to discontinue fluoridation on February 27, when it has scheduled a public hearing on the issue. Kemppainen asserts a whole range of legal and civil claims predicated on assertions that fluoridation is unsafe and is illegally added to water as a drug without consumers’ consent. He threatens to seek $211 million in damages if the council declines his demand.

Why is a Clark County resident trying to tell Longview citizens what their city should do? What happened to democratic and republican processes? What a brazen intimidation tactic.

This is coming at the same time that cities such as Buffalo and the Canadian city of Calgary are resuming fluoridation after experiencing increases in tooth decay after they had abandoned the practice.

The debate about all this became hotter in September when U.S. District Judge Edward Chen in San Francisco sided with several advocacy groups, finding that fluoridating drinking water supplies presented “unreasonable risks” for children’s developing brains. The EPA needs to develop new regulations, he said.

But Judge Chen stressed he was not concluding with certainty that fluoridated water endangered public health. The American Dental Association and 12 other groups last month urged the EPA to appeal Chen’s decision.

The court ruling reflects a “fundamental misunderstanding and misapplication of the prevailing scientific literature on the safety of fluoride and community water fluoridation,” according to a January 10 letter to the EPA from the ADA and a coalition of medical groups.

However, Robert F. Kennedy Jr., President Trump’s nominee to lead the U.S. Department of Health and Human Services, has said Trump will seek to end fluoridation of public water supplies.

Chen’s ruling followed an August report by the federal government’s National Toxicology Program that reviewed studies conducted in Canada, China, India, Iran, Pakistan and Mexico (apparently no U.S. studies have evaluated fluoride for possible effects on childhood intelligence). The NTP concluded that drinking water containing more than 1.5 mg/l was associated with slight decreases in childhood IQs.

However, the U.S. recommended level of fluoride in drinking water (the 0.75 mg/l standard) is less than half the level those studies found harmful. Fluoride advocates point out that many of the studies considered in the NTP’s review involved water with very high levels of fluoride and were flawed by bias. Even so, they found only discoloration of teeth and a one-point IQ drop associated with high levels of fluoride, in the 2.0 to 4.0 mg/l range.

For Thursday’s Longview debate, Halvorson chose Osmunson as his sole panelist.

Councilwoman Ruth Kendall chose five panelists, including four longtime medical providers: Longview pediatrician Erin Harnish; retired Longview pediatrician and geneticist Blaine Tolby; retired dentist and current Cowlitz Family Health Center Director David Meyers; and retired dentist Kurt Ferre (Fur-RAY),formerly with Permanente Dental Associates in Portland. Each side had 45 minutes to make its case and 10 minutes each for rebuttals.

Ferre says he has faced off against Osmunson on this issue for 20 years.

Before the experts even began, the council took 20 minutes of public comment, with 16 of 21 speakers advocating for continue use of fluoride. Dentist Jeff Langdon, a Longview resident who practices in Rainier (which does not fluoridate its water), told the council said he sees a large number of cavities and broken teeth.

Osmunson led off the panel discussion with a rapid-fire Power Point presentation that asserted that fluoride is toxic, that it is a drug, and that the U.S. Clean Water Act bars introduction of a substance into drinking water other than disinfectants, such as chlorine. (Fluoride is, however, a disinfectant in that it kills bacteria that cause tooth decay.)

He quoted the Florida Surgeon General’s guidance that community water fluoridation causes behavioral and neurological problems and a private group of EPA scientists (not the agency itself) that requiring fluoridation of drinking water “borders on criminal behavior on the part of government.”

He cited studies, some of them more than two decades old, he said show that fluoridation increases infant mortality, heart disease and osteosarcoma — a rare but lethal form of bone cancer young males. Baby formula made with fluoridated tap water contains 144 times the level of fluoride as mothers’ breast milk, he said.

He also made the surprising claim that fluoridation does not work.

His presentation was so fast-moving that it was difficult to follow and impossible to know the context of the data or whether studies cited had been vetted or peer reviewed. At the very least, it raised more questions than it answered and left so many loose ends. It certainly did not come close to providing an adequate justification for the city to change course.

Ferre afterwards wrote to fellow fluoride supporters and the City Council that Osmunson had engaged in “gish galloping.”

“Dr. Osmonson made so many intentional misrepresentations of the facts that I would be remiss on not correcting at least some of these false allegations,” he wrote to the City Council on Friday.

For example, he noted that Osmunson has asked the Washington Board of Health and the Washington Pharmacy Board more than 15 times to classify fluoride as a drug and was denied every time. Ferre said he “about fell off my chair” when Osmunson said fluoridation doesn’t reduce cavities. Ferre cited abstracts from 10 studies showing that it does.

Ferre pointed to a 2011 peer-reviewed study for the International and American Association for dental research finding no significant link between bone fluoride levels and osteosarcoma in young men.

Pediatrician Erin Harnish, who has practiced in Longview for 28 years, led most of the pro-fluoridation group presentation, asserting that multiple studies have proven the practice safe and effective.

“No credible health care organization” opposes fluoridation, Harnish said.

She spoke about how fluoride works to strengthen teeth and about human’s need for fluoride to grow healthy bones.

Removal of fluoride would mean “the health care system would be overwhelmed by dental problems” due to the shortage of dentists and vulnerability of low-income families to afford dental care, Harnish said.

The cost of fluoridating Longview water is only 38 cents per person a year, and the cost of one filling averages $286, Harnish said. Removing fluoride would cost the public far more in long-term dental care than it will save in chemical and water treatment costs, she said.

(Osmunson had reported that fluoride use costs people an average of $556 a year, mostly for projected declines in earning power from an assumed 3-point loss in IQ.)

It’s easy for non scientists to get cross-eyed trying to sort out all the competing claims. But we’ll have to if the City Council decides to put the matter up to a public vote.

If it comes to that, please don’t do a Google search just to confirm your biases. Science looks to refute theories, not support opinions. So if you look up objections to fluoride on the Fluoride Action Network web site, make sure you also look up the American Dental Association’s page on myths about fluoridation.

There are several salient points to make here.

One: There’s no doubt that fluoride is toxic. Otherwise Alcoa would not be forced to clean up fluoride contaminating the old Reynolds Metals Co. plant site west of Longview. But just because something is toxic does not eliminate its potential medical value. Chlorine is highly toxic but is used to disinfect water. Radioactivity can be lethal but is used to treat tumors in measured doses. Warfarin, formerly used as rat poison, is widely used as a blood thinner to clear blood clots and arteries. So far, the evidence is that fluoride used at the prescribed level is safe, despite Judge Chen’s ruling. He is a judge, not a research doctor.

Two: Measuring IQ and tracing how it can be affected by minerals and other compounds is a difficult task because so many factors affect intelligence. Furthermore, extrapolating out what a point or two loss in IQ may mean for a person’s earning power is a dicey exercise. Smarter people generally earn more, but the connection between IQ and earning power is unsettled.

Three: Whom do you believe here? My trust goes to the local doctors and dentists who care for this community. They have decades of local experience and demonstrated commitment. Dr. Harnish, for example, is the founding president of the Children’s Discovery Museum. She is on the board for the Washington State Medical Association and legislative committee for the Washington chapter of the American Academy of Pediatrics and is a delegate representing Washington nationally at the American Medical Association. Her heart is for this town’s welfare.

I know many of these doctors, and I know they would never knowlingly injure their patients. Could they all be wrong? Not likely. Osmunson’s comparison of them to the bloodletters of centuries ago is demeaning and ignores the fact that they are highly trained and experienced. “It’s not easy to speak against my colleagues” in the medical community, Osmunson acknowledged.

Still, Halvorson is asking the City Council at this point to ignore the advice of the professionals who best know this community’s health needs.

Four: Osmunson is a “true believer” in his cause, pursuing it with a kind of messianic fervor. I don’t question his motives, but some of what he says discredits him, like the advice about pregnancy and drinking fluoridated water.

Five: I reject the notion that community water fluoridation is ethically and politically objectionable because individuals don’t get to choose. This is one of the primary motivators of the anti-fluoridation advocates. Osmunson makes this assertion. And at the tail end of the Thursday debate, Longview Councilman Keith Young said it’s not the government’s job to care for teeth.

“That’s your job,” he told the medical panelists.

Well, the preamble to the U.S. Constitution states that “promoting the general welfare” is a goal of government. Taxpayers have a compelling interest in maintaining the public’s oral health because they pay significant dental costs for the low income and retirees. And what about the rights of people who want fluoridated water? Surely, it is humane, inexpensive and legal to use this safe, proven methodology to benefit the public good.

Longview should not abandon fluoridation. We don’t, as Harnish said, want to repeat the experience of Calgary and Buffalo.

“They learned the hard way.”