--:-- Ryan Knudsen: Welcome to The Journal, our show about money, business, and power. I'm Ryan Knudsen. It's Friday, April 4th.
--:-- Ryan Knudsen: So, Chris, how are your teeth? You know, I grew up having a number of cavities. Actually, our colleague Chris Marr has been reporting on one of the biggest debates in teeth: whether or not fluoride should be added to drinking water for decades. Municipalities around the U.S. have been doing this to improve oral health. But recently, fluoride has become more controversial.
--:-- Ryan Knudsen: I have done a lot of reporting on water, but really, to be honest, fluoride never really hit my radar as an issue until last year. Over the past year, communities across the country have started to reconsider fluoride. There's a shift in tone where I think there's just more credence to the position that, you know, fluoride may have been a good thing in the past, but it just may not be necessary now. It's really gaining some momentum.
--:-- Ryan Knudsen: And last week, Utah became the very first state to ban local governments from adding fluoride to water. Utah taking a side in the renewed debate over fluoride in drinking water. Utah's now the first state to ban fluoride in drinking water. Pushing past opposition from some dentists and health organizations who warn that the move could lead to medical problems for some people.
--:-- Ryan Knudsen: It's a pretty historic development. And going forward in Utah, cities are not going to be able to add fluoride to their municipal drinking water. And Chris says more bans could be coming.
--:-- Ryan Knudsen: The debate over fluoride is a tricky one. Because both sides say they're just looking out for the public's health. And both sides also say that they have the science to back it up. A lot of emotions get raised when it comes down to people's health, their children's health. And it can be very emotionally charged.
--:-- Ryan Knudsen: Sounds like a lot of people are clenching their teeth over this.
--:-- Chris Marr: Yeah, that's a good metaphor.
--:-- Ryan Knudsen: Welcome to The Journal, our show about money, business, and power. I'm Ryan Knudsen.
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--:-- Ryan Knudsen: Fluoride is a mineral that occurs naturally in some water sources and can be found in certain foods. It's found in black tea, it's found in different kinds of fish, shrimp, raisins, apparently.
--:-- Ryan Knudsen: The history of fluoride science in the U.S. dates all the way back to 1901, when a dentist in Colorado Springs started to study what he called Colorado brown stain. Initially, what was noticed was that people had brown staining on their teeth, which is now called dental fluorosis.
--:-- Ryan Knudsen: So this is like a cosmetic thing that can happen to your teeth if you have too much fluoride. The dentist realized that people who had this brown stain from too much fluoride were also less likely to have cavities.
--:-- Ryan Knudsen: Over the next few decades, other studies backed up those findings. And in 1945, Grand Rapids, Michigan, became the first city in the country to add fluoride to its water supply. Not with so much fluoride that it would cause those brown stains, but with just enough to reduce cavities.
--:-- Ryan Knudsen: Why did people feel like it was needed back then? Well, dental health was a lot different back then. Just the number of people who had a complete set of teeth in their mouth, you know, was small.
--:-- Ryan Knudsen: It was far more common just to get your teeth pulled. It was far more common for infections and abscesses and serious health consequences to follow on from that.
--:-- Ryan Knudsen: In about 1950, the American Dental Association made its first statement supporting fluoridation. And they just kind of started rolling it out to different communities.
--:-- Ryan Knudsen: In several western towns, children rarely got tooth decay. Why? Their drinking water contained fluoride. Crest with fluoride.
--:-- Ryan Knudsen: By the 1950s, companies started putting fluoride in toothpaste and mouthwash. Crest introduced its first fluoride toothpaste in 1956. Now, after years of fluoride research, Procter & Gamble proudly announces triumph over tooth decay for everyone everywhere as it brings you Crest toothpaste with Florestan.
--:-- Ryan Knudsen: It's exclusive fluoride. And, you know, by the 60s and 70s, that was expanding. So people were getting fluoride in their toothpaste. They were getting fluoride treatments, mouthwash, all kinds of other ways to get fluoride.
--:-- Ryan Knudsen: And early research seemed to say that fluoride, when it was put in water and available broadly, was something like a miracle defense against cavities, especially when it came to lower-income children who often didn't have regular access to dental care.
--:-- Ryan Knudsen: Fluoride helps to remineralize your teeth. So, you know, prevents cavities by basically making the enamel stronger. So, yeah, and I think, you know, there were many studies that said that cavities were reduced by 50% or more.
--:-- Ryan Knudsen: You know, so it was having a huge effect. The CDC said that water fluoridation is one of the greatest, most significant public health achievements of the 20th century.
--:-- Ryan Knudsen: But along with people who thought it was miraculous, there have always been skeptics. There have been scientists who have opposed fluoridation from the start in 1945, when it was first put into water intentionally.
--:-- Ryan Knudsen: And some of those people have continued to oppose it for years. Why were they skeptical? Fluoride is the only thing that's added to water. That is to treat people, you know, health. It's not to make the water safe for people.
--:-- Ryan Knudsen: It's to actually do something in people's bodies. But for a long time, those concerns were considered fringe. For instance, in the 1964 movie Dr. Strangelove, this was the sign that one of the main characters had gone off the deep end.
--:-- Ryan Knudsen: Do you realize that fluoridation is the most monstrously conceived and dangerous communist plot we have ever had to face?
--:-- Ryan Knudsen: But in recent years, new data has given fluoride skepticism new legitimacy. A number of studies have been published over the last decade about the impact of fluoride on the brain and thyroid.
--:-- Ryan Knudsen: Some studies have shown that higher levels of exposure were associated with lower IQ, or ADHD. Other studies show that it could be harmful to a baby's neurological development.
--:-- Ryan Knudsen: And then, last year, a big report looking into fluoride was published by the National Toxicology Program. The National Toxicology Program is part of the Department of Health and Human Services.
--:-- Ryan Knudsen: It's a group of federal scientists who look at, you know, whether substances or chemicals are toxic. So they investigate chemicals for the federal government.
--:-- Ryan Knudsen: The report, which came out in August, validated some of those concerns about fluoride. It found that at high levels, levels double what is allowed in U.S. drinking water, fluoride could negatively impact kids.
--:-- Ryan Knudsen: A U.S. government report from the National Toxicology Program concluding that fluoride at 1.5 milligrams per liter, twice the recommended amount in drinking water, is linked to lower IQ levels in children.
--:-- Ryan Knudsen: So children that had been exposed to fluoride at higher levels had IQ deficits. So fairly earth-shattering for this conclusion to come out.
--:-- Ryan Knudsen: The report found with moderate confidence that elevated levels of fluoride could be associated with a decrease in IQ.
--:-- Ryan Knudsen: One month after the report came out, a judge issued a major ruling against fluoride. This came after a group of parents had petitioned the Environmental Protection Agency about fluoride.
--:-- Ryan Knudsen: The EPA does not mandate fluoride in water but what it does do is set the optimal level. So the judge said that the EPA had to take some kind of regulatory action.
--:-- Ryan Knudsen: You know, he didn't say specifically what the EPA had to do, but he was saying that this is an unreasonable risk. You've got to take some sort of action.
--:-- Ryan Knudsen: I mean, the action could be warning people that there's a risk. It could be lowering the recommended level. So this was a pretty groundbreaking ruling.
--:-- Ryan Knudsen: It caught a lot of people's attention. There's one more thing that's helped bring the fluoride debate into the mainstream. The rise of Robert F. Kennedy Jr.
--:-- Ryan Knudsen: I think fluoride is a poison and it causes severe IQ loss. And last week... Just before President Trump nominated him to run the Department of Health and Human Services, RFK made a big promise about fluoride.
--:-- Ryan Knudsen: Back in November, he tweeted that the Trump administration would advise all public water systems to get fluoride out of the water. So on day one, you know, Trump was going to get fluoride out of the water.
--:-- Ryan Knudsen: That hasn't happened yet, but it could be getting closer. That's after the break.
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--:-- Ryan Knudsen: The decision about whether or not to put fluoride in the water is generally up to local cities and towns. And now, with everything that's happened, the fluoride debate is catching fire.
--:-- Ryan Knudsen: There's hundreds of places that have meetings scheduled that are planning to take a look at this issue. So hundreds around the country, probably in, I would guess, nearly every state or every state.
--:-- Ryan Knudsen: Chris attended one of those meetings in February in a town in Florida called Bartow. It's a city of 21,000 people. It's about an hour east of Tampa.
--:-- Ryan Knudsen: They had been wrestling with the question of whether to keep fluoride in their water. Bartow held their fluoride town hall in the city's civic center.
--:-- Ryan Knudsen: They had 50 chairs set out for residents, all filled, with more people standing in the back. The two sides of the building were all glass, so one side looked out onto some Little League fields that were pretty new.
--:-- Ryan Knudsen: Lights were just coming on as the meeting was starting. And there's a podium right over there. Bartow's mayor was running the meeting.
--:-- Ryan Knudsen: Dr. Johnny, are you ready? The first person to speak was a pro-fluoride lobbyist named Dr. Johnny Johnson.
--:-- Ryan Knudsen: He travels around the country attending debates like this one. He is a retired dentist in his 60s. He's also the president of the American Fluoridation Society.
--:-- Ryan Knudsen: So he's one of the most outspoken proponents of fluoride in the country. He often wears a t-shirt that says fluoridation? F yeah.
--:-- Ryan Knudsen: So that's kind of an expression of his passion for this subject. He must have been excited to be in Florida talking about fluoride.
--:-- Ryan Knudsen: At the town hall in Florida, Johnson ditched the fluoride t-shirt in favor of a button-down. And he was serious about his support for fluoride.
--:-- Ryan Knudsen: People die of dental infections that get into their bloodstream. He showed some slides that showed some mouths that had been really horribly decayed.
--:-- Ryan Knudsen: And I think those were striking for people to see. That's horrible. We don't like to see that at all.
--:-- Ryan Knudsen: He and other dentists argue that especially low people may really be the ones who will lose out from fluoride being taken out of water because they don't have the best access to dental care necessarily maybe not even to fluoride toothpaste.
--:-- Ryan Knudsen: From that perspective, this is potentially you know, very risky for a large segment of the population.
--:-- Ryan Knudsen: Does Johnson or the rest of the dental industry have any financial incentives here? I mean, like, is there sort of like big fluoride that's trying to protect their business in some way?
--:-- Ryan Knudsen: Really what they're saying is that, you know, it's not a financial issue. It's the patients that they treat. It's the suffering that they see. They don't want people to get cavities.
--:-- Ryan Knudsen: But is anybody making money off the fact that there's fluoride in the water? And is that influencing this debate in any way?
--:-- Ryan Knudsen: No. I mean, you take a town like Bartow or some of these other small communities, they're not spending a ton of money on fluoride or this chemical that creates the fluoride.
--:-- Ryan Knudsen: They're spending maybe $20,000 a year. So it's not a tremendous amount of money.
--:-- Ryan Knudsen: At the town hall, after Johnson finished speaking, the anti-fluoride camp took the mic. One person there to represent it was Florida's Surgeon General, Dr. Joseph Latipo.
--:-- Ryan Knudsen: Dental health, very important. Fortunately, there are alternatives, right? There's toothpaste, there's mouthwash. This isn't expensive stuff.
--:-- Ryan Knudsen: I mean, this is stuff that people of all income levels can afford. Lattipo said the benefits of fluoride were outweighed by the risks.
--:-- Ryan Knudsen: This is a very simple issue. The cost in terms of human health is far too high to be fooling around with this. I mean, it actually is reckless for anyone who's knowledgeable to have the information and to continue doing it.
--:-- Ryan Knudsen: For now, localities are largely being left to make sense of the research themselves, something Bartow's mayor said she felt like they shouldn't have to do.
--:-- Ryan Knudsen: This is not our lane. We should be looking at, you know, plan developments and traffic and budget. Health and treating the people of our city should not be our lane, but we're forced into it because this happened way back when and became the norm.
--:-- Ryan Knudsen: In March, the Bartow City Council came to a decision. Bartow City leaders have decided to continue adding fluoride to the city's water supply.
--:-- Ryan Knudsen: The vote was split during an emotionally charged meeting last night. While Bartow decided to keep fluoride, other places are coming to different conclusions.
--:-- Ryan Knudsen: Like in Utah last week, where the governor signed a bill banning the addition of fluoride in drinking water.
--:-- Ryan Knudsen: One thing Chris says he's watching for now is what RFK Jr. does. The thing I'm looking for is definitely to see if there's going to be some federal guidance from EPA or from RFK Jr. himself or the Department of Health and Human Services telling public water systems to either take fluoride out just as an advisory.
--:-- Ryan Knudsen: I think that would have a really significant effect with these fights happening all across the country. Is there a sense right now that fluoride is generally winning or losing?
--:-- Ryan Knudsen: I think right now the anti-fluoride movement has the upper hand. There seem to be more places you know, first of all, more places are putting it to a vote and then when they do they're voting the fluoride out.
--:-- Ryan Knudsen: Even Johnny Johnson will say I'm he's scrambling. He's working constantly to try to address these, put out these fires around the country and to try to fight this fight.
--:-- Ryan Knudsen: And, you know, I think he's losing more of these battles than he ever did. That's all for today. Friday, April 4th.
--:-- Ryan Knudsen: The Journal is a co-production of Spotify and The Wall Street Journal. The show's made by Our engineers are Griffin Tanner, Nathan Singapok, and Peter Leonard.
--:-- Ryan Knudsen: Our theme music is by So Wiley. Additional music this week by Peter Leonard, Bobby Lord, Emma Munger, Nathan Singapok, So Wiley, Epidemic Sound, and Blue Dot Sessions.
--:-- Ryan Knudsen: Fact-checking this week by Mary Mathis, Kate Gallagher, and Najwa Jamal. Thanks for listening. See you Monday.
