By Trent Cash
In 1939, the United States government – along with many other developed nations – began including fluoride in the public water supply in an attempt to promote oral health amongst its citizens (Centers for Disease Control [CDC], 2016). Despite the purported benefits of fluoridation, critics (henceforth referred to as anti-fluoriders) have claimed since the 1950s that the practice is obsolete, dangerous, a violation of individual freedoms, and, in the most extreme cases, a government (or communist) mind-control plot (Ewens, 2016). While beliefs about the negative or null effects of fluoridation have faded since the fall of the Soviet Union, they are now primarily held by individuals who are prone to believing in conspiracy theories – often referred to as “truthers” – but the belief has found a foothold in academic and medical circles, with professionals primarily debating the ethical implications of forced fluoride intake (Ewens, 2016). Additionally, the sentiment is frequently espoused in so-called “Mommy Blogs,” where the primary argument is that fluoride should not be given to children because of its supposed toxicity (Dr. Jill, 2018). Sources discussing the potential implications of fluoride range from large organizations such as the Fluoride Action Network to fringe blog sites, such as “Science Based Life.” Despite these arguments, research has consistently shown that fluoridation has an overwhelmingly positive effect on health, and is even considered one of the top ten greatest public health achievements of the 20th century (CDC, 2016). As such, the fears surrounding fluoridation should be considered an extreme belief, as validation of the belief would not only shake our foundations of scientific understanding, but also bring into question the credibility of democratic governments around the world. Furthermore, if the extreme belief is unfounded, its propagation could set oral health services back nearly a century and diminish the oral health of millions. As such, eradication of the myth is in the public’s best interest.
When you discount the mind control discussion and the “Hitler used fluoride” point (read more here), the fluoride argument really comes down to two major points: is fluoride safe, and is fluoride necessary? In addressing the first point, anti-fluoriders claim that fluoride is a toxin that has a host of negative effects on your health. While nearly every negative outcome under the sun has been suggested, the most-frequently cited ailment is bone cancer (American Cancer Society [ACS], 2015). The bone cancer argument is frequently supported by an unpublished dissertation from a Harvard graduate student finding that young boys (note: N=11) exposed to fluoride between the ages of 5-10 have an increased risk of osteosarcoma from ages 10-19 due to accumulation of fluoride in growth plates (Woffinden, 2005). Similar results were found in male mice, but no human replication of these studies has been published in a reputable journal (ACS, 2015). In contrast to these reports, the American Cancer Society (ACS; 2015) obviously cannot “prove the negative,” but they claim that the weight of the evidence (i.e. thousands of studies from dozens of countries) does not support the carcinogenicity of fluoride, and that the unpublished Harvard dissertation was impacted by flawed research methods. Additionally, the ACS (2015) notes that concerns regarding osteosarcoma are often inflated due to the extreme rarity of the condition, which receives 400 diagnoses per year in the United States.
As to the matter of the necessity of fluoride, anti-fluoriders often argue that fluoride is unnecessary because it is “unnatural” and “not an essential nutrient” (Fluoride Action Network, 2012). Proponents of fluoridation do not claim that fluoride is “necessary,” but they do defend its myriad of benefits. The CDC (2016) claims that drinking fluoride reduces cavities in children by 25% and saves resources within the public health system. In corroborating this claim, the American Dental Association (ADA; 2019) claims that every $1 spent on fluoridation reduces public dental health spending by $38. Furthermore, the ADA (2019) notes that fluoride is in fact naturally present in groundwater and the ocean (i.e. natural), and that the government is simply increasing it to a recommended level.
There are definitely a variety of cognitive distortions at work in the fluoridation debate. First and foremost, I think that anti-fluoriders are influenced by the causal fallacy, meaning that they don’t understand that correlation does not equal causation. I think this is best evidenced by the fact that many of the blogs, such as one cool blog called “Fluoride – Drinking Ourselves to Death,” take evidence from studies showing relationships between fluoride and negative health outcomes and use the relationships as evidence that fluoride causes the negative health outcomes (Bollinger, 2015). Beyond this, I believe the arguments of anti-fluoriders are influenced by a misunderstanding of statistics – namely the need to replicate and ignorance of base rates. In fact, the ACS (2015) directly states that the anti-fluoride studies are rarely replicated, and that concerns regarding osteosarcoma result from the extreme rarity of the disease (i.e. a low base rate) skewing correlational data. Finally, I think the anti-fluoriders are influenced – as we all are – by the confirmation bias, meaning that they are more likely to search for evidence that confirms their beliefs and interpret ambiguous evidence in a way that supports their beliefs. The “Drinking Ourselves to Death” blog is a perfect example of this, as the author ONLY mentions evidence that supports his claim (Bollinger, 2015).
In terms of social context, I think there are a few major factors at work. First and foremost, the whole anti-fluoride movement is underwritten by a notion of freedom from government intervention, a political ideology (Ewens, 2016). Basically, many of the anti-fluoriders think – at minimum – that individuals should be able to choose whether they want fluoride or not, a relatively reasonable request. However, like many ideologies, the anti-fluoriders come together and their beliefs become more extreme, likely as a result of common social psychological phenomena, such as groupthink and group polarization. This deepening of beliefs can lead to some of the more outrageous beliefs (e.g. government mind control) that line up with what I would call radical libertarianism. Aside from the tendency of social networks to create more-extreme beliefs, they also provide benefits to the members in the forms of entertainment value and sense of belonging. To me, this is a particularly important element of continued adherence to the anti-fluoride movement because adherents seem to be primarily middle-income, white, not college educated, and young to middle age – all of which are groups that tend to have a decent amount of free time, some disposable income, and a grave need for social connection. So, even if these people aren’t really that interested in the anti-fluoride movement, being a part of the group makes them feel good, so they will begin to adjust their beliefs to make the group like them more. In my opinion, this is what makes any conspiracy theory particularly enticing to the human psyche.
All things considered, I think the most important thing to realize about the anti-fluoride movement is that, like anything, it comes in many forms. While it’s fun to laugh at the people who think it’s a form of government mind control, there’s an equally large (or larger) number of people who just want to feel that they get to make the choice themselves. This need for decisional control lines up with self-determination research showing that having control over one’s life is a critical aspect of maintaining a healthy self-esteem and overall psychological well-being (Ryan & Deci, 2000). Like believers of any extraordinary belief, anti-fluoriders are simply trying to make sense of the crazy world around them and find their niche in society. While the overwhelming majority of science may not support their beliefs, psychology is perfectly clear on why they would embrace their beliefs: it makes them feel good. While we may not know the exact mechanism for each individual’s extraordinary belief, all of the believers are doing what they feel will make them best off – even if this means distorting facts through a variety of biases (e.g. confirmation bias, omission bias) or crafting fallacy-laden arguments. When it comes down to it, I firmly believe that the anti-fluoriders are incorrect at best and potentially-harmful at worst – but ultimately, I don’t think most of them are any crazier than the rest of us. I mean, haven’t you ever done something that others would call stupid just to fit in, have friends, feel good, or be happy?
American Cancer Society. (2015, July 28). Water Fluoridation and Cancer Risk. Retrieved February 6, 2019, from https://www.cancer.org/cancer/cancer-causes/water-fluoridation-and-cancer-risk.html
American Dental Association. (2019). 5 Reasons Why Fluoride in Water is Good for Communities. Retrieved February 6, 2019, from https://www.ada.org/en/public-programs/advocating-for-the-public/fluoride-and-fluoridation/5-reasons-why-fluoride-in-water-is-good-for-communities
Bollinger, T. (2015, April 22). Fluoride – Drinking Ourselves to Death? Retrieved February 6, 2019, from https://thetruthaboutcancer.com/fluoride-drinking-ourselves-to-death/
Centers for Disease Control. (2016, October 4). Community Water Fluoridation. Retrieved February 6, 2019, from https://www.cdc.gov/fluoridation/index.html
Dr. Jill. (2018). Why You Should REFUSE Fluoride Treatments for Your Child [Web log post]. Retrieved February 6, 2019, from https://realfoodforager.com/why-you-should-refuse-fluoride-treatments-for-your-child/
Ewens, H. (2016, August 12). A Deep Dive Into the Conspiracy Theory That Governments Are Controlling Us with Fluoride. Vice Magazine. Retrieved February 6, 2019, from https://www.vice.com/sv/article/kwz5m3/why-are-governments-putting-fluoride-in-our-water-sheeple
Fluoride Action Network. (2012, August). FLUORIDE IS NOT AN ESSENTIAL NUTRIENT. Retrieved February 6, 2019, from http://fluoridealert.org/studies/essential-nutrient/
Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55(1), 68-78. doi:10.1037/0003-066x.55.1.68
Woffinden, B. (2005, June 12). Fluoride water ’causes cancer’. Retrieved February 6, 2019, from https://www.theguardian.com/society/2005/jun/12/medicineandhealth.genderissues