fluoridation of water supplies

5
animal breeding, one must first fully comprehend the Communist maxim, "Truth is absolute, but not final"; after this, one can realize that the Lysenkoist view, in the U.S.S.R., can be made to cover the situation in agriculture. If hy- brid corn is being used, it is safe to say that a way has been found to explain the results in Lysenkoist terms, and the same hedging maxim allows for change if, for some reason, the gene has to be ''recognized" to correct a desperate situation in agricultural production. What has escaped most writers on the subject of Lysenkoism is the depth of the Soviet commitment to environ- mentalism. LINCOLN PETTIT Department of Natural Science, Michigan State University, East Lansing Fluoridation of Water Supplies Leo Levine, in a recent letter [Science 133, 1674 (1961)], deduced from the recent political reverses on fluorida- tion of water supplies that the relation- ship between the scientific community and the public at large is growing more attenuated and unsatisfactory. It is difficult to see how such a con- clusion can be drawn from the particu- lar issue which he describes. There are many prominent scientists who dis- agree entirely with fluoridation, though not because there is no evidence that in controlled circumstances and for certain young children there is a bene- fit to be gained thereby. The reason is that from a purely scientific point of view the evidence is entirely inconclu- sive regarding the deleterious effects that may occur over long periods of time in parts of the body other than the teeth of young children. This doubt has been thoroughly aired during the var- ious political campaigns on fluorida- tion, and it is a most legitimate doubt to which a good answer has never been given. It is difficult to see how the public can be blamed for being concerned about this question, and it is the fault of the scientific community itself that it has not come to grips with so basic an issue. The greatest danger that faces the scientific community in its dealings with the public is to assume a holier- than-thou attitude in which it is pre- sumed that what is stated by the scien- tific community to be good for the public is thereby holy writ. I think, in general, our citizens are much more intelligent than they are given credit for being, and it is particularly true that the recent unfortunate episodes regarding food ad- ditives, such as the famous cranberry scare of several years ago, have left the public with the feeling that there is a great deal of experimentation going on by industry and by the scientific com- munity at their expense. The groups who have opposed fluori- dation include, of course, a number of fanatics, but their success or failure is largely tied to the correctness of the stand that they take, and I think it is important for all scientifically trained people to recognize that one should be very cautious and conservative in rec- ommending the use of drugs and medicines for the public. We have too many incidents of side effects coming up when drugs have been used, which are well known to all people, and I do not think that the issue is a political one at all, as Levine indicates. RALPH LANDAU 2 Park Avenue, New York Fluorides may reduce tooth decay, but little information has been offered on their possible long-term effects on flowers, skin, laundry, or highballs. Nor have alternative methods of fluoride application been discussed in the many local campaigns for mass medication. Cobalt 6 0 Irradiation IJOU now liave a choice of r £fjfi V t rjjrJjim IM'JJXs Select the model and dose-rate to suit your research program and your budget. GAMMACELL GAMMACELL GAMMACEU 220 200 100 Dose rates up to (r/hr) 2xl0 6 I 3xl0 5 I 3xl0 5 Irradiation Chamber size (inches) All 3 models are completely self-shielded, are in- herently safe and convenient to operate, and permit the irradiation of solids, liquids or gases under a wide variety of environments. For complete information please write to: ATOMIC ENBRGY OF CANADA LtMtTEO COMMERCIAL PRODUCTS DIVISION, P.O. BOX 93, OTTAWA, CANADA 60-S 874 SCIENCE, VOL. 134

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Page 1: Fluoridation of Water Supplies

animal breeding, one must first fully comprehend the Communist maxim, "Truth is absolute, but not final"; after this, one can realize that the Lysenkoist view, in the U.S.S.R., can be made to cover the situation in agriculture. If hy­brid corn is being used, it is safe to say that a way has been found to explain the results in Lysenkoist terms, and the same hedging maxim allows for change if, for some reason, the gene has to be ''recognized" to correct a desperate situation in agricultural production.

What has escaped most writers on the subject of Lysenkoism is the depth of the Soviet commitment to environ-mentalism.

LINCOLN PETTIT

Department of Natural Science, Michigan State University, East Lansing

Fluoridation of Water Supplies

Leo Levine, in a recent letter [Science 133, 1674 (1961)], deduced from the recent political reverses on fluorida­tion of water supplies that the relation­ship between the scientific community and the public at large is growing more attenuated and unsatisfactory.

It is difficult to see how such a con­

clusion can be drawn from the particu­lar issue which he describes. There are many prominent scientists who dis­agree entirely with fluoridation, though not because there is no evidence that in controlled circumstances and for certain young children there is a bene­fit to be gained thereby. The reason is that from a purely scientific point of view the evidence is entirely inconclu­sive regarding the deleterious effects that may occur over long periods of time in parts of the body other than the teeth of young children. This doubt has been thoroughly aired during the var­ious political campaigns on fluorida­tion, and it is a most legitimate doubt to which a good answer has never been given.

It is difficult to see how the public can be blamed for being concerned about this question, and it is the fault of the scientific community itself that it has not come to grips with so basic an issue. The greatest danger that faces the scientific community in its dealings with the public is to assume a holier-than-thou attitude in which it is pre­sumed that what is stated by the scien­tific community to be good for the public is thereby holy writ. I think, in general, our citizens are much more intelligent than they are given credit for being,

and it is particularly true that the recent unfortunate episodes regarding food ad­ditives, such as the famous cranberry scare of several years ago, have left the public with the feeling that there is a great deal of experimentation going on by industry and by the scientific com­munity at their expense.

The groups who have opposed fluori­dation include, of course, a number of fanatics, but their success or failure is largely tied to the correctness of the stand that they take, and I think it is important for all scientifically trained people to recognize that one should be very cautious and conservative in rec­ommending the use of drugs and medicines for the public. We have too many incidents of side effects coming up when drugs have been used, which are well known to all people, and I do not think that the issue is a political one at all, as Levine indicates.

RALPH LANDAU

2 Park Avenue, New York

Fluorides may reduce tooth decay, but little information has been offered on their possible long-term effects on flowers, skin, laundry, or highballs. Nor have alternative methods of fluoride application been discussed in the many local campaigns for mass medication.

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60-S

874 SCIENCE, VOL. 134

Page 2: Fluoridation of Water Supplies

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Hence, thinking citizens apply the sci- entific method and reject the syllogism that, since children who have drunk fluoridated water develop fewer cavi- ties, everyone (and everything) must drink such water-and also bathe, irri- gate, and flush with it. Involved here is not, as Leo Levine claims, a lack of communication between "science" and "public," but a lamentable lack of sci- entific procedure on the part of would- be scientists.

Perhaps fluoride actually does more good to young teeth than harm to old bones. But must such medication be ap- plied only through drinking water? Even so, must it be all water? Are individual home dispensers, similar to water soft- eners, impractical? Would fluoridation of water only in school buildings be in- adequate? Why not add fluorides to milk, like vitamin D, or to table salt, like iodine?

Until these alternatives are demon- strated to be impractical, and adultera- tion of the public water supplies is dem- onstrated to be the only feasible method of reducing dental caries, yet to cause no degradation of the many other uses of the water, mass fluoridation deserves scientific skepticism and continual dem- ocratic defeat.

ARNOLD COURT 3 Haynes Road, Saxonville, Massachusetts

A recent letter on fluoridation of water supplies expressed concern re- garding the unpopularity of this meas- ure by voters in towns of high socio- economic and educational levels. In re- cent years, fluoridation proposals, when placed on the local ballot, have suffered overwhelming rejection and have di- vided hundreds of communities into militant factions.

Why has fluoridation been one of the most unpopular health measures of the century? Political and public opinion surveys have revealed that many indi- viduals do not know the meaning of fluoridation, and in many instances ig- norance and fear have been used to defeat such a scientific measure ("Conceptions and misconceptions re- garding fluoridation" was the subject of my M.S. thesis at Bowling Green State University, 1961). These studies have shown that many (over 50 percent) proponents did not know the meaning of fluoridation or confused it with water purification (chlorination), even in high socioeconomic groups.

Unless an educational campaign is skillfully conducted well in advance of

876 SCIENCE, VOL. 134

Page 3: Fluoridation of Water Supplies

the vote, these uninformed proponents may be changed into the semi-informed, fearful opponents. Although fluorida- tion has been endorsed by many medi- cal and dental associations, the final outcome has very often been deter- mined by referendum where "a little knowledge can be a very dangerous thing." Should the safety and efficacy of such a public health measure be de- cided by qualified professionals, or should its fate be determined via the popular vote?

JULIE DARE BOYD Rossford, Ohio

I was very much interested in the letter by Leo Levine, primarily because I have been an opponent of fluoridation and perhaps can offer some insight as to why fluoridation is continually de- feated. Incidentally, we have just man- aged to defeat fluoridation at Allen- town, Pa., by a ratio of 5.5 to 1, which is to my knowledge the most resounding defeat fluoridation has yet suffered.

I agree wholeheartedly with Levine that the fluoridation issue does afford an insight into the question of com- munication between the scientific wm- munity and the public. Or perhaps it would be better to say that fluoridation offers a chance to evaluate the com- munication between some portions of the scientific community and the public, for the reason that we are able to defeat fluoridation so easily is that not all the evidence is on the fluoridation side. It is true, of course, that the Public Health Service and the American Dental Association are on the side of fluoridation, but that does not mean that there are not very reputable and capable scientists who are opposed to fluorida- tion and who have produced evidence indicating that fluoridation is a poten- tially harmful practice. The voter in a fluoridation election, therefore, is put in the position of choosing between two branches of scientific thought. He is not making a choice betweeri science and non-science, as Levine implies.

There is also another factor that en- ters the picture, and that is the scien- tist's ego. The scientist likes to feel that he is the master of the public's destiny in certain areas, and the average person can sense that egotistic drive if given half a chance. In the case of fluorida- tion, the question of scientific ego can- not be disregarded. Would it not be a wonderful thing for science if the addi- tion of a single chemical could over- night cure tooth decay? The potential benefit of such an event to the standing

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Page 4: Fluoridation of Water Supplies

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of science and to the standing of certain scientists is so great that there is ample drive to continue the fluoridation cam- paign in the face of increasingly severe defeats at the hands of the voters and In the face of an increasing body of evidence indicating that fluoridation may not be safe. I think the voters sense this egotistic drive of the men in white coats to tamper with their water.

There is another factor. Could it not be that science is becoming equated in the public mind with artificiality and chemicalization of our environment, and that the people want the pendulum to swing back to our more natural ex- istence of previous years? The great

bulk of scientific advances add some chemical pollutant to either our soil, our food, our water, or our air. Almost every time there is a new breakthrough we find a new toxic residue to cope with. I spend 8 hours a day trying to convince people of the truth of those ideas, and I find that as the years go by it becomes easier and easier to do that.

ROBEKT RODALE Prevention, Enzinaus, Pennsylvania

As Levine points out, the controversy over water fluoridation has been an ex- cellent example of failure of communi- cation. The failure, however, is two-way.

Not only have thc scientists been unable to conimunicate to a part of the public, as the nature of many of the arguments used against fluoridation indicates, but the scientists thenlselves seem con~plete- ly unaware of the existence of quite weighty arguments against fluoridation of community water supplies. Although I myself favor such fluoridation, I do not regard it as a simple open-and-shut case, and I would like to make an effort to remedy a failure of communication by presenting what I think is a strong argument on the other side.

In a sizable minority of American families, perhaps 25 percent, drinking water is obtained from a bottle kept chilled in the icebox. If the community water supply is not fluoridated, it would be a simple matter to add a little fluorine conlpound to this bottle. In any com- munity in which there is a sizable nun- ber of people who wish to drink fluori- dated water, it should be easy to ar- range with druggists to keep dilute solu- tions in stock for this purpose. Thus, in a colnmunity in which the water supply is not fluoridated, it is quite possible for families to obtain the advantages of fluoridation for themselves. If the water is fluoridated at the waterworks, how- ever, it is quite difficult to "unfluoridate" it.

If there are in a community some people who wish to have their water fluoridated, and some who do not, then both can have their desire if the com- munity water supply is left unfluori- dated, although the ones who want fluoridation will be put to some incon- venience. If the water is fluoridated, on the other, some people will be deprived of their freedom to choose in this field. We may disagree with the people who object to fluoridation of their water, but is there any reason why we should de- prive them of their freedom of choice in the matter?

It seems to me that this is a respect- able argument, although not necessarily conclusive. On the other side, fluorida- tion at a central plant is certainly cheaper and more convenient. Personal- ly, I would prefer to spend a little bit more to preserve freedom of choice, but obviously there can be two opinions here. The argument which leads me to favor fluoridation concerns the fact that "home fluoridation" would, of neces- sity, be carried out by the parents while the principal beneficiaries would be the children. The question is thus analogical to the old legal problem of whether a Christian Scientist should be compelled to provide conventional meciical care

SCIENCE, VOL. 134

Page 5: Fluoridation of Water Supplies

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for his children. I would say "yes," but I do not regard the problem as an easy one. Perhaps the "trend of voting on this issue in towns of the highest socio- economic and educational levels" rep- resents not a victory of "antiscience" but a simple difference of opinion on a difficult problem of public policy.

GORDON TULLOCK University of South Carolina, Columbia

Experimental Design

The arguments of Cronbach and Gleser (I) and Loewe (2) would have been fairly clear if they had made care- ful distinctions between individual char- acteristics, population characteristics, and estimates of population charac- teristics.

Lowe is apparently treating the "graded-response" curve as if it were the sample mean value of E as a func- tion of D, since he refers to "test curves for individuals." Most statisti- cians would consider the "graded re- sponse" curve to be the expected value of E as a function of D.

At any rate, Loewe's first conclu- sion, that the quantal-responie curve (at a single E level) cannot replace the graded-response curve, is quite ob- vious. If his second conclusion amounts to suggesting an analysis in which the graded-response data is converted to quantal-response data for each of sev- eral values of EO (that is, dichotomies), then I agree. These values should be spaced uniformly, unless there is some information about the type of distribu- tion (which is true less often than the normal distribution is used). As for the dosage levels, there should be only one dose for each individual, and dosage levels should be repeated on a second individual only rarely, if at all. Testing many items at exactly the same level is vestigial experimental design: probit analysis is passC, and some form of stochastic approximation (3) should be used for sequential design of response experiments.

Cronbach and Gleser have over- looked the main practical reason for quanta1 experimentation: a two-valued scale is cheapest. It requires hardly any effort to detect a dead animal, or a metal plate with a hole in it. It would take a great deal more effort to measure some functional impairment in a poi- soned animal, or to measure some char- acteristic of a projectile's remains after it had penetrated a plate of armor.

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880 SCIENCE, VOL. 1