The Fluoride Wars: How a Modest Public Health Measure Became America's Longest Running Political Melodrama by Hardcover

It is clear from the plethora of one-star reviews from denizens of Tin Foil Hat Land that the authors of this book did an effective job of assessing the actual health risks and benefits from fluoridation. The book carefully traces the history of this never ending debate over the alleged conspiracy to "sap and impurify all of our precious bodily fluids" through the addition of small amounts of fluoride to our drinking water. Contrary to the sometimes hysterical criticisms emanating from the one star crowd, the authors actually take the various anti-fluoridarion arguments seriously, subjecting them to careful scrutiny by reviewing the voluminous scientific literature devoted to the question of health risks from fluoridation. In the end, they actually conclude that there is danger, however small, that some people are ingesting larger amounts of fluoride than what is considered safe. Consequently, they recommend that the quantities of fluoride added to drinking water be reduced somewhat.

The book is clearly written and for the most part, entertainingly presented. It does an impressive job of reviewing the history of the politics of fluoridation, as well as the health science associated with the issue. It is by no means a screed against the anti-fluoridation movement. In fact, the authors bend over backwards to give the "anti" arguments their due. But in the end, an assessment of the fluoride controversy has to center on science, not on conspiracy theories or paranoid claims based on just enough knowledge to get it all wrong. Highly recommended.

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book's author secretly paid to promote pesticide, June 19, 2013
By Follow the Money (Massachusetts USA)

Not only is this book biased in a relatively subtle way which may not be obvious to some readers, but at least one of the co-authors and the organization he works with has recently been revealed to have been secretly paid to write an article favorable to a pesticide company.

Jay Lehr wrote a supposedly independent article defending the pesticide atrazine. The pesticide's manufacturer, Syngenta, was gleeful that the article appeared independent yet the organization Lehr worked with was secretly being paid by Syngenta. You can find the full details in an article by investigative journalist Clare Howard at 100r dot org. 100r stands for 100 reporters and is a website by investigative journalists. Here is what they say out about Jay Lehr's relationship to Syngenta and his work for them:

"In an email to Syngenta's head of communications, Thompson [head of PR firm working for Syngenta] praises an essay that ran in the Belleville News Democrat, an Illinois newspaper based about 20 miles from Edwardsville, the community that initiated the lawsuit.

The 2006 essay was signed by Jay Lehr of the Heartland Institute. The essay claimed the Holiday Shores lawsuit could, if successful, shrink the nation's food supply.

'These are great clips for us because they get out some of our messages from someone (Lehr) who comes off sounding like an unbiased expert. Another strength is that the messages do not sound like they came from Syngenta,' Thompson wrote.

The Heartland Institute fought a subpoena all the way to the Illinois Supreme Court in 2012 that would have forced it to disclose any financial relationship with Syngenta and the source of its articles supporting atrazine. The Heartland Institute argued disclosure would violate its First Amendment rights. The case settled before a ruling was issued, so the relationship remains undisclosed.

In response to an emailed question, the Heartland Institute did not deny receiving funding from Syngenta."

Did someone pay Lehr to write The Fluoride Wars? He didn't disclose his financial relationship with Syngenta when he wrote an op-ed favorable to Syngenta. Could he be hiding another conflict-of-interest in The Fluoride Wars?

The 100 Reporters investigative article also found that Syngenta paid ACSH, a group that has never found a chemical it didn't like, $100,000 to assist in defending atrazine. ACSH also, perhaps coincidentally, is one of the most virulent defenders of fluoridation. ACSH attacks and denigrates anyone who questions fluoridation. The emails reveal that the $100,000 paid to ACSH by Syngenta is only for defending atrazine, and is "... distinct from general operating support Syngenta has been so generously providing over the years".

So, industry pays ACSH to appear independent and do their dirty work. What companies might benefit from ACSH's defense of fluoridation? Just like the Heartland Institute, you can be sure ACSH will never willingly reveal this information.

Why should anyone trust this book by an author-for-hire who apparently has a history of being paid secretly to promote industry viewpoints?

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The only objective view of the fluoride controversy I've found, April 19, 2013
By Merilee D. Karr

This book, by a couple of investigative reporters, covers all the claims of both sides. It awards points and demerits to both sides. And it's well written and accessible. Too bad it's hard to find, because it's published by Wiley, an academic and textbook publisher. It should be more widely available. It should be in the pocket and on the kitchen table of everyone who cares about the water they drink.

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Fluoridation: the battles continue, January 28, 2011
By Brian Martin

The proposition seems straightforward: should fluoride be put in public water supplies in order to prevent tooth decay? Fluoridation was tested in the 1940s, endorsed by the U.S. Public Health Service in 1950, and implemented in the United States and many other countries in the following decades. But from the beginning, there was vociferous opposition.

The fluoridation debate was in full swing in the 1950s and continues today in much the same form, with the same sorts of claims and counter-claims. Scientifically, the debate has always been one-sided, with an overwhelming majority of dentists and doctors supporting fluoridation but with a significant minority of critics.

The remarkable persistence of the debate has attracted the attention of social analysts. Attempting to take a middle ground is a perilous enterprise, because the partisans on either side are likely to either adopt a contributor as an ally or attack him or her as an enemy.

Scientists R. Allan Freeze and Jay H. Lehr have boldly entered the fluoridation arena with The Fluoride Wars. Their ambitious aim is to provide a balanced social history of the U.S. controversy. They tackle the major issues in the debate, including arguments over benefits of fluoridation and alleged adverse health impacts such as allergies, cancer, and skeletal fluorosis. They give special attention to dental fluorosis, the staining of teeth due to excess fluoride, typically said by proponents to be of only cosmetic significance but seen by opponents as a sign of fluoride toxicity.

A major contribution of the book is its covering of key developments in recent decades, including the antifluoride position of scientists from the U.S. Environmental Protection Agency, the debate among proponents about whether there is too much fluoride in people's diets, the switch by a few proponents to become opponents, the discrediting of some antifluoride claims, and the support for fluoridation by U.S. courts.

Freeze and Lehr also address the social dynamics of the debate, looking at referenda and statewide implementation measures and commenting on explanations of forces driving the proponents and the opponents. All in all, this is the most comprehensive treatment of the debate available in the literature. It draws on key sources, scientific, sociological, and historical.

Several episodes are given detailed treatment, for example, the first trials in which fluoride was added to town water supplies in the 1940s. The historical detail is not a sustained narrative but more like an occasional highlight, with some irrelevant digressions, such as a lengthy account of the Jonestown massacre, included because it had a deep effect on a key legislative promoter of fluoridation in California.

Freeze and Lehr are sufficiently even-handed that their treatment will please neither side in the debate. The book, though, is not a purely dispassionate account because, as well as discussing the scientific and political issues, the authors want to pass judgment and, in doing so, they often shift from nonpartisan social description to summary judgment that can seem to sweep aside disagreement. In particular, they sum up the debate as if it were a matter only of science and of benefits versus costs. The book is more an assessment of arguments than a social history.

The Fluoride Wars is almost entirely about fluoridation in the United States. The authors mention the situation in other countries but do not pursue the implications of fluoridation outcomes elsewhere. They conclude that popular opposition to fluoridation in the United States is due to risk aversion in referenda, but this does not explain the near absence of fluoridation in Europe, where governments make the decisions.

Freeze and Lehr sometimes make sweeping references to proponents or opponents, attributing the views of a few to an entire movement. Their language is frequently flamboyant and occasionally dismissive, for example in referring to scientist opponents as "zealously committed" (p. 362)--and less commonly labeling proponent scientists in a similar way.

The Fluoride Wars concludes with an appeal for the two warring sides to sit down and talk. Although this suggestion almost certainly will be ignored, Freeze and Lehr have set an admirable example of measured analysis and stimulating writing.

Brian Martin
University of Wollongong, Australia
[...]
(This review appeared in the Bulletin of the History of Medicine, Vol. 84, 2010, pp. 314-315)

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Propaganda disguised as scholarship, August 05, 2009
By Russell Jackson, Holyoke Bookstore & Morgue (Belchertown, MA USA)

The Fluoride Wars is a slick attempt to paint opposition to fluoridation in a negative light while at the same time leaving not so subtle hints that no self-respecting person would become involved in this cause. Each page is crafted to undermine the case for non-fluoridated water by selective citation and half-truths. The writers disperse the evidence that supports an end to fluoridation over scattered pages so that only the most intrepid reader would be able to put it back together. It is a piece of propaganda masquerading as a scholarly work. The pseudo-journalistic style, with flippant references to pop culture, tries to hide the steep slant to the story in which the opponents to fluoridation are "a few local cranks", "kooky antifluoridationists", "unfashionable Don Quixotes", people who have "a creed", or are "tilting at windmills". The book is liberally sprinkled with words like "kooks" and "cranks", "circus" "secret handshakes", "subculture", "fluorophobia" and "quack". The intent is clear: if you have any standing in society, you do not want to be associated with these people.
By page five it is clear the book is not a well-rounded scholarly work, but the latest spin from the pro-fluoridation side:

"Look, Ma. No cavities", say the smiling children in the old Crest ads, as they run toward their mother's outstretched arms. Who could argue against no cavities and a mother's love? Certainly not the American Dental Association, or the Surgeon General, or anybody else that matters, all of whom say that fluoride is good for you. That ought to be enough for most of us.
And so it is for most of us, but not all of us." [Note the confusion over topical vs. systemic application, also the argument from authority logical fallacy.]

The book contains no preface or introduction, so the authors do not tell us what motivated them to write it. Jay H. Lehr is a businessman and motivational speaker, who is said to have written hundreds of journal and magazine articles. A Web of Science database search under his name lists 104 articles, but they are almost all editorials and commentaries from the journals Ground Water and Ground Water Monitoring and Remediation, the most recent being fifteen years ago. Eighty-two of them have never been cited by anyone and so, from an academic perspective, are considered quite literally useless. He is listed as Senior Scientist at The Heartland Institute, the Chicago-based "libertarian"/conservative think tank that opposes the idea that human civilization is creating climate change and opposes regulation of cigarette smoking. He is also Chief Scientist for EarthWater Global, a company that "locates, develops and manages" "megawatersheds". It was recently in the news for entering into an MOU with the government of Kenya, whose water sector is riddled with corruption, according to Transparency International. R. Allan Freeze is a former college professor who now runs his own engineering company. He has published many widely cited papers, again on the topic of ground water. According to the same database neither author has ever previously published anything on water fluoridation, which would explain the lack of preface or introduction. So it appears Freeze is the scientist and Lehr is the popularizer who was brought in - why? The role of the two authors is mysterious in that the text is written sometimes in the plural "we", sometimes in the singular "I", and the acknowledgments are only signed by Freeze. A scholarly book would leave no mystery over the role of the authors. The author(s) acknowledge no research help in preparing the book, yet neither has ever published anything on the topic previously. Since neither author has any background in this area, and since neither has written this type of journalistic investigation before, one has to wonder if the book was ghost written. In any event we have two businessmen-scientists who make a living developing water resources. They appear to be not the "give people the liberty to decide for themselves"-type of libertarians, but rather the "give industry or property owners the liberty to do as they want without government regulations that protect people from toxic exposures"-type of libertarians.
The book is definitely packaged as a scholarly work intended for the academic library, not a trade book for the masses. It has the higher price, the lack of dust jacket (that libraries discard). There are the little, full bibliographic footnotes on the first page of each chapter as in certain scholarly books. It is clearly written to dissuade students or other professionals from the idea that there might actually be something to this opposition to fluoridation. Besides, why risk your career getting involved?
But this is a very slovenly piece of scholarship. For example, the authors like to use tables, and in Table 2.5 - Fluoridation Status of Developed Countries of the World, the authors list the Czech Republic and Russia as two countries that have some population using fluoridated water, but then add the footnote "Before the fall of the iron curtain in 1989. Current situation unknown." Really? Why is that? Are these two countries on some outer planet with which we have no communication? Why didn't the authors investigate? Or at least pay someone to find out?
There are nearly 20 tables in the book. But they use them in a funny way. Instead of being a clear way to make a list of facts, the tables often contain highly subjective statements as in Table 6.1 "An Assessment of Anti-Fluoridation Conspiracy Claims" which lists the question, "Is there any reason to question Hodge's motivations in supporting fluoridation" and the answer "not really". This is opinion not scholarship.
The book is titled The Fluoride Wars to go along with the Culture Wars and the Science Wars, to give the reader the impression that opposition to water fluoridation is not based on principle or evidence, but on mere ideology.
The authors call the struggle a melodrama, which the dictionary defines as a sensational, extravagantly emotional action or utterance. In this case the authors are clearly mistaken. "America's (sic) longest running political melodrama" is the United States Congress. The use of the term melodrama, which can surely be applied to most contentious issues (freedom fries, anyone?), is an indication that the authors want to play up the sensational aspects of the history. The title also suggests that the whole affair is much ado about nothing, so you needn't have any concerns about fluoride. Ditto the chapter subheadings
The chapter subheadings also have this ironic, pop culture language that tries to make the book appear hip and postmodern. The term informed consent does not appear in the book, and it is clear that the authors are oblivious to the fact that this concept motivates much of the opposition to fluoridation. The Heartland Institute should be stripped of any association with libertarianism.
One brief mention of the ethical opposition in Table 2.6 asks "How does fluoridation compare with other intrusive but apparently widely accepted governmental programs, such as tax collection or the setting of speed limits." Dudes, are you kidding me? Tax collection accepted? No way. Everyone tries to get out of paying taxes.
The Fluoride Wars is an example of propaganda in the guise of a scholarly work. Readers who do not know the subject are likely to be misled, and perhaps angry when they realize how far they have been misled.
This book was published in 2009, three years after the National Research Council's report on EPA's fluoridation level, a report the ADA refused to recognize, as do these authors.
To see how densely packed is the deceit by omission, consider the author's treatment of the Chester Douglass scandal. They don't call it that, but we can because it is very rare for a professor to be charged with misconduct. Instead the section is headed "The Osteosarcoma Controversy". In contrast, the authors use the heading the "The Marcus Affair" to focus on the isolated individual
Here is the text with my numbered annotations:

"In an attempt to lay these worries to rest (1), the National Institute of Environmental Health Services (a branch of the National Institutes of Health) decided to fund a 15-year epidemiological study on the possible role of fluoride intake on the incidence of osteosarcoma. The grant was awarded to the Harvard School of Dental Medicine, with Chester W. Douglass as principal investigator (2). Much to the chagrin of the project's leaders (3), the first results, contained in the 2001 doctoral thesis of a graduate student, Elise Bassin, indicated a "robust" relationship between fluoride exposure and osteosarcoma in young males (5 to 10 years old) (4). Douglass, for his part, considered this work preliminary (5). He did not encourage early publication of the results in a technical publication, nor did he report them to NIEHS in a 2004 overview report to the agency (6). It is his contention that Bassin's results have not been replicated in subsequent stages of the overall study (7)
"In June 2005, the Environmental Working Group (EWG), an advocacy group whose primary goal is "to protect the most vulnerable segments of the human population from toxic contaminants," found out about Bassin's thesis and demanded that NIEHS carry out an investigation to determine whether Douglass' actions constituted a cover-up of facts that could pose a risk to society (and to the fluoridation movement) (8). Learning of the EWG charges, Paul Connett of the Fluoride Action Network called for Douglass's immediate removal (9). William Hirzy (a strong anti-fluoride leader whom we meet in Chapter 9) called for a nationwide moratorium on fluoridation until the issue is resolved. (10)
At the behest of NIEHS, Harvard University set up an inquiry panel to review Douglass' actions. One year later, in August 2006, the panel reported the results of their deliberations. They exonerated Douglass, finding that he did not "intentionally omit, misrepresent, or suppress the findings" of his graduate student. Anti-fluoridation web sites have honed in not on the exoneration, but on the word "intentionally". In the same year, Bassin's results were finally published in the journal Cancer Causes and Control (11). Douglass was not a co-author on the paper. In fact, he submitted a letter to the editor that was published in the same journal urging caution and warning against "overinterpretation or generalization" of these early results of the planned long-term study at Harvard.

Annotations:
1. Despite lecturing us on how wrong it is for scientists to conduct a study with the intent of proving something, the authors accept the practice here. Prior to the research it is a preconceived result that fluoridation doesn't cause caner.
2. The authors omit a major criticism of this arrangement - why is a dental researcher being asked to study bone cancer? Secondly, why is someone who is paid by Colgate, a fluoridated toothpaste-maker involved in this research? It is a prima facie case of conflict of interest, but the authors don't tell the readers.
3. Why should the researchers express chagrin? They have done nothing wrong. It should be the opposite - they should be happy they made a discovery that might help save peoples' lives. The unstated propagandistic reason for the "chagrin" is that they may have made a discovery that could jeopardize their carriers. That is what the authors want the readers to understand unconsciously.
4. The authors omit the key point of the Bassin study, that make it superior to other epidemiological studies of this sort, that they actually quantified the exposure in years to the fluoride. So it seems like just another study. They also omit that there was a five-fold increased risk in the fluoridated population.
5. The authors, who like to lecture us on the working of science, omit the fact that it is always expected that PhD students publish their work - generally they try to stretch it into three or more papers if possible. Douglass' action here is the direct opposite of standard academic practice, but the authors don't tell you that.
6. The authors omit the damning fact that Douglass actually reported that Bassin's study found no link to cancer. Black is white to Douglass, but this is omitted.
7. It is his contention, but the authors omit the fact that Douglass has never published these results. It is his word with nothing to back it up, but the reader doesn't know that.
8. The author's omit the charge that he actually lied about the findings.
9. Connett was actually the one who uncovered the whole scandal.
10. The authors omit that it was not just Hirzy but EPA union leaders from around the country. To suggest, as they do, that it was just Hirzy is quite deceitful.
11. The authors omit the fact that Harvard did not follow the government's rules in conducting the inquiry in that the party that brought the charges against Douglass, the EWG, was not allowed to present its case to the panel. This would have forced the panel to address specific questions, and make a cover-up more difficult.
So we have corrections and whole truths that run as long as the original text. This could be done with every page of the book. In this sense, the book is valuable as a study in propaganda.
This book is a piece of propaganda disguised as scholarship written to muddy the water at a time the NRC has released a devastating blow to the pro-fluoride camp.
Ironically these authors clearly see the struggle over fluoridation as essentially a battle between industry and the grassroots over exposure to a toxic industrial pollutant, yet most environmentalists, who profess concern over such matters, remain oblivious to this common cause.
-reprinted (with permission) from a review by Michael F. Dolan, The Non-Fluoridated Consumer, August 2009

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Don't waste your money on this book., April 16, 2009
By C. Kopf

The authors of The Fluoride Wars seem stuck in the 1950's when children played in the spray of DDT trucks, smoking was encouraged by physicians and adding unnecessary fluoride chemicals into public water supplies, as an unproven children's tooth decay medicine, seemed like a good idea. The book is neither objective nor middle ground and borders on plagiarism in parts. It definitely reflects the authors pro-fluoridation beliefs.

It appears the authors did little original research and borrowed many quotes from other published sources. The authors seem to have little interest in, or a poor understanding of, actual fluoride science.

They use inflammatory quotes and stories from articles available on the Internet and then write how worried they are that the Internet is used as a tool for propaganda.

Actually, the internet is almost the only place you can read, unfiltered, what those of us opposed to fluoridation have to say. We believe you are smart enough to sort out the truth.

As pointed out by Dr. Paul Connett in his review of this book, the authors are aware of the National Research Council's (2006) 500+ page report on the health effects and toxicology of fluoride but the authors of The Fluoride Wars don't report on what's in it. Any book on fluoride or fluoridation that doesn't include the findings and recommendations of this major review of current fluoride science shouldn't be taken seriously.

The authors describe the fluoridation battle in Connersville, Indiana, where a fluoride supporter and magician foolishly eats a whole tube of fluoridated toothpaste to prove it is non-toxic. However, it is toxic. Such a stupid stunt by a small child could be fatal. Instead of explaining the health risks associated with this performance, the author denigrates fluoridation opposers for suggesting this magician used sleight of hand to switch to a tube of non-fluoridated paste. The story and quotes are lifted from a newspaper article available on the Internet.

These shenanigans enabled fluoridation to begin in Connersville in 2000 despite a 1999 research article published in Community Dentistry and Oral Epidemiology (1999 Aug;27(4):288-97) which showed that Connersville children already consumed too much fluoride from food and dental products putting them at greater risk of dental fluorosis (discolored teeth). Instead of reducing intake as this research paper advised, local dentists misinformed legislators and residents that children needed more via water fluoridation. The authors of The Fluoride Wars fail to tell readers this vital information even though Wiley publishes both this journal and this book. They should all be very embarrassed.

It's also revealing that the authors acknowledge Warren Wood as providing supportive reviews of the final manuscript. We wonder if this is the same Warren Wood who is on the Louisiana Fluoridation Advisory Board which is charged with promoting water fluoridation. I don't see any evidence that the authors consulted any scientist or activist opposed to fluoridation

Those interested the history and politics behind the unscientific and risky practice of fluoridation can read The Fluoride Deception by award-winning journalist Christopher Bryson. It's original, clearly referenced and a good read.

Those interested in fluoride science and how, even low doses added to public water supplies, can be harmful to some people - especially babies, high water drinkers, thyroid and kidney patients - read the NRC report (Fluoride in Drinking Water: A Scientific Review of EPA's Standards)

Carol S. Kopf, B.S., M.A.

16 of 29 people found the above review helpful.

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