Understanding the fluoride wars

Earlier this year, in episode #2273 of the Joe Rogan Experience, the world’s most successful podcaster started sounding off about fluoride, calling it a “neurotoxin” and citing “conclusive studies” linking high levels of fluoride in the water to lower IQs. In a clip that has been viewed more than 1.2 million times, Rogan expressed bafflement to his guest Adam Curry, the entrepreneur and media personality: “We know it’s bad for you in large doses, and yet there are fucking people out there with college degrees who read the New York Times who will get angry if you want to remove this neurotoxin from water because, ‘Look at all the strides its done in preventing tooth decay,’ and you just wanna say hey man fuck you, this is stupid.”

Rogan is one of the loudest voices in the growing anti-fluoride movement, which has just notched a major legislative win with Utah becoming the first US state to ban the addition of fluoride to public drinking water. Once widely considered as one of the 20th century’s great public health advances, the fate of fluoride has never seemed so uncertain, with the new Department of Health and Human Services secretary having run for president on a ticket which included a promise to remove it from the country’s drinking water. But is fluoride really a “neurotoxin?” And are we being exposed to high levels of it that are making us “stupid?”

Water fluoridation can be traced back to 1901 when young dentist Frederick McKay observed that residents of Colorado Springs had brown-stained teeth that were unusually resistant to decay. He suspected it might be something to do with the water, but it wasn’t until 1931, with the advent of better water testing, that he was able to confirm that high fluoride levels were the cause. This discovery led to a landmark 1945 experiment in Grand Rapids, Michigan, where fluoridating drinking water significantly reduced tooth decay – by 60 percent in children – without causing discoloration, marking a major scientific breakthrough by making tooth decay a preventable disease for the first time in history. Beginning in the 1960s, the US government started rolling it out across the country, and it now benefits more than 200 million Americans.

So what went wrong?

Water fluoridation has always had its enemies. While it was instantly embraced and widely promoted by the medical community, it was dogged by conspiracy theorists – some even feared it was a communist plot to undermine public health – and linked to various diseases and conditions such as skeletal fluorosis, thyroid disfunction, bone cancer and kidney issues. Other concerns related to questions of individual liberty: should Big Sam really be putting stuff in our water? This seems to be where Rogan is coming from: “How about just brush your fucking teeth? Why do you have to put that shit in the water? So every time I cook spaghetti I have fluoride in my fucking spaghetti, like what are we doing?’”

Earlier this year, the issue was dragged into the spotlight when a review conducted by the Department of Health and Human Services concluded “with moderate confidence, that higher levels of fluoride exposure, such as drinking water containing more than 1.5 milligrams of fluoride per liter, are associated with lower IQ in children.” Citing a 2019 study by JAMA Pediatrics, the review found that IQ levels were slightly lower in three- and four-year-old children whose mothers had higher measures of fluoride in their urine when they were pregnant. While the review was inconclusive about whether fluoride was actually affecting IQ at the 0.7mg/L level currently recommended in most US drinking water, the review accounted for fluoride exposure from all sources – including water-added foods and drinks, teas, toothpaste, floss and mouthwash.

We have never been so over-exposed to synthetic fluoride. This led a federal court to rule that the report’s findings were enough to warrant forcing the Environmental Protection Agency (EPA) to do more to address the potential risk. All of this of course has been grist for the mill for fluoride’s most public opponents, a colorful bunch corralling libertarians, the John Birch Society, the Ku Klux Klan, the Green party and of course RFK Jr., who recently described fluoride as “an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders and thyroid disease.” Most public health experts have dismissed these claims and allege that Kennedy has cited data from other countries with higher fluoride levels. But the anti-fluoride movement has gained huge legitimacy thanks to the report and in light of the Utah ban, other states, including Florida and Ohio, are now weighing similar legislation.

While RFK cannot order communities across the country to stop fluoridation, he can direct the CDC to stop recommending it and advise the EPA to change the allowed amount. As of April this year, as Secretary of the Department of Health and Human Services, he directed the CDC to reconvene an independent panel of 15 health experts to examine the role that fluoride plays in water sources and whether it can be detrimental to public health. The fate of fluoride hangs on this report.

For those in the pro-fluoride camp, and this includes most medical professionals and public-health experts, you are still among a large majority – a recent poll from Axios/Ipsos suggests that 48 percent Americans wanted to keep fluoride in public water supplies while only 29 percent supported its removal. But the results from this report could be devastating. When Utah became the first state to sign the fluoride ban into law on March 28 (which will go into effect on May 7), RFK Jr. made no secret of his delight: “It makes no sense to have it in our water supply. And I’m very, very proud of this state for being the first to ban it. And I hope many more will come.”

Like so much in this administration, the tables have turned on what once was considered sacrosanct and institutional: a fringe issue, once punted around the sidelines by only the most extreme conspiracy theorists, health nuts and libertarians, has now entered the headstream of American politics. And it is unlikely to go away.