Councilmember Puts Forth Compromise on Fluoridation

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BrettLeeRby Brett Lee

The Water Advisory Committee recently made their recommendation on the issue of water fluoridation for our future drinking water system.  Over the course of three meetings, they had several presentations made to them.  At the first meeting a presentation was made by those in favor of fluoridation.  At the second meeting, a presentation was made by those opposed to water fluoridation.  The third meeting was devoted to general discussion amongst the members of the WAC as they tried to decide what recommendations to make.

As a member of the City Council and a member of the community, I watched these proceedings with great interest.  We will soon be deciding what path we should take regarding this issue in the near future.  And while the WAC is not composed of experts in this specific area of science or health policy, the WAC is composed of very knowledgeable and thoughtful members of our community.  Their recommendations do carry a lot of credibility.

In the end, the WAC decided to recommend that our future drinking water supply be fluoridated.

Here are some of my observations:

The pro-fluoride argument is based upon the improved dental health of our community, especially for those children who lack consistent and proper dental care.  Water fluoridation has been shown to provide positive dental health benefits.  In the past (40-50 years ago) the positive effect was more pronounced, but even today with improved diet, improved access to dental care and widespread use of fluoridated toothpaste the scientific literature continues to show some positive dental health effects.

The anti-fluoride argument is multi-faceted, but the core argument seems to be two fold: first, there may be negative health effects associated with the fluoridation of water (in addition to that of dental fluorosis, where the connection is quite clear).  The second argument is that there are far better and cost effective means of improving dental health, namely direct preventative dental care.

I was impressed by the arguments and information put forward by both sides.  Having said that, it does seem that adding fluoride to the drinking water supply would improve the dental health of many in our community.  What was interesting though was that many countries around the world have been able to achieve the same or better dental health without water fluoridation.  These countries appear to have more robust early childhood dental care programs than we currently do.

I was also quite surprised by the estimated cost of adding fluoride to the water system.  The estimated cost of water fluoridation has an initial capital cost of between $1,000,000 to $2,000,000 and an ongoing operational expenditure of around $150,000 to $200,000 per year.  These are very serious sums of money.  The average ratepayer would be paying an extra $15/yr for the operational costs alone.

So one might ask, instead of using the money to pay for water fluoridation, why not use that money for early childhood dental care programs?  The problem with that approach is that we are not allowed to use people’s utility fees to pay for things other than the running of the utility system.

The proponents of water fluoridation rightly understand that if we add fluoride the dental health of the community will be improved for many; if we do not add fluoride those funds will not automatically be available for other dental health programs.

So here are some additional facts that provide context on this issue.  The opponents of water fluoridation are unlikely to accept a council decision in favor of fluoridation as the final word; they will likely seek to have the issue placed on the ballot for an upcoming election.  The outcome of a citywide election on the issue is unclear.  What is clear is that an election would be expensive and time consuming for both sides.

The water project is due to be completed in 2016, so even if we decide to add fluoride to the water, the earliest people would potentially see a benefit would be 3 years from now.

In this decision I am guided by what I would want for my family.  Would I want fluoride added to the water system or would I want my child to receive yearly preventive dental care and be taught proper dental hygiene?  I know that this is not a strictly either / or decision, but it does help to think about it this way to get a sense of prioritization.

For the same amount of money that would be spent on a non-targeted fluoridation program, we could target those funds towards low income families with children and provide them with proper preventative dental services.  Yes, per household the cost of fluoridation is only around $15/year, but what percentage of households do not have access to dental health care?  If we estimate that percentage to be 10%, then for the same amount of money, we could be providing those families with approximately $150/year to help provide them with dental care.

I must confess to being an optimist when it comes to our community.  As a result, I have the following proposal.  I would like to have a voluntary check off box on the city services bill where our community can voluntarily donate a dollar or two each month to early childhood dental care programs.  It is my hope that sufficient funds could be raised in this manner so that we could provide robust early childhood dental programs for our children.  This would be the most efficient way of dealing with the dental health needs of our community and would result in all of us saving money on the cost of water fluoridation.  In addition, the benefits of this approach would be immediate; there would not be a delay until 2016.

Should the community not be supportive at the level needed, we can always revisit the fluoridation issue in a year or two.  The basic design and construction of the plant is such that the decision to add or remove fluoridation can be done at any time.  The new plant will not be complete until 2016.

So the question is will we as a community be willing to voluntarily help provide for improved dental access and care for the children in our community?

Brett Lee is a member of the Davis City Council

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139 thoughts on “Councilmember Puts Forth Compromise on Fluoridation”

  1. Growth Izzue

    Question:

    Since our well water hasn’t been flouridated are there any statistics on where Davis ranks in tooth decay compared to other communities that do flouridate?

  2. David M. Greenwald

    That would be a tricky statistical analysis because you would have to account for income and educational disparities in the comparison in order to get a valid comparison.

  3. medwoman

    Brett

    [quote][quote]For the same amount of money that would be spent on a non-targeted fluoridation program, we could target those funds towards low income families with children and provide them with proper preventative dental services. Yes, per household the cost of fluoridation is only around $15/year, but what percentage of households do not have access to dental health care? If we estimate that percentage to be 10%, then for the same amount of money, we could be providing those families with approximately $150/year to help provide them with dental care.[/quote][/quote]

    First, I want to thank you for the time, interest and thought that you have put into this issue. I agree that this is not an either/or situation and that as a community we would probably best be served by both fluoridating and provision of improved dental care, not only for young children, but across all ages. Also, $ 150 /year to help with dental care would cover the cost of approximately one filling ,of one cavity, one time. I honestly do not see this as a comparable benefit.

    Your idea of a voluntary means of provision funding for a dental health care program is of a lot of interest to me. I would like to see details of how you would envision such a plan. How would you identify which families to help? What group would you envision implementing and administering the program? ( Communicare has already stated that they do not have nearly enough resources to meet the demonstrated need ).

    Also, another couple of points. Water fluoridation helps not only those children in the lower income group, but also those who are not as meticulous with dental hygiene, who have difficulty with performing activities of daily living, and all age groups including the elderly. Your plan as stated would not help any of these groups.

    Compromise, by its very nature, means that each side is giving up something in order to achieve a mutually desired goal. While I see the very good intention behind your proposal, I do not, in any way see this as a
    compromise. In this proposal, the opponents gain their goal of blocking fluoridation with no guarantee that they will not be equally as obstructionist if this were to be brought forward again for “another look” in one to two years. The proponents are being asked to drop the issue, with no guarantee that it will be addressed again, for a proposal that will not have, even if the community were at its most generous, nearly the same impact.

    I agree however, that looking at what one would want for one’s own children is a valuable exercise in decision making. So I will share what I would want for my family. I would want my children, and everyone else’s to have full health and dental care provided from our taxes. If a preventive health care measure can be provided through the public water system, I would want that for my children thus saving me the expense of supplements and dental care that benefit only my family. If I did not want that for my children, the answer is simple. I would buy them non fluoridated water and appreciate the fact that in this country we have ready access to as many choices as we have and that I can be a part of providing a health benefit for others, even though I may not avail my family of it.

  4. Frankly

    Good article David. However, you did leave out one other important argument against fluoridation of our drinking water. It is a moral one. Just like the arguments in opposition of Proposition 8, a majority benefit is no excuse for causing harm to a minority. Of course I will always argue that with equal rights civil unions there is no material harm (only emotional impacts which I consider de minimums and more the problem of those emoting.) In the case of fluoride in the drinking water, there is indisputable physical harm done to a minority. fluorosis is a genuine and serious health problem that has been proven as being caused by fluoridation of the drinking water. This fact was not known 60 years ago when we started the practice.

    Medical doctors that continue to demand that we add this drug to our drinking water are guilty of breaking their Hippocratic Oath for not causing harm, and are suspect of having a propensity to over-medicate their patients.

    It is immoral to force medicate a population when there is clear evidence that the practice causes real material harm. That real material harm should effectively cancel out the justification based on benefits derived… especially when there are other solutions like you suggest.

    I support your suggested solution.

    Related to this, what in the hell good is Obamacare if we cannot expect it to deliver health improvements to those currently lacking access to healthcare? The political left won this massively complex and costly god-pile of legislation, so why are we not leveraging the win to solve the type of health challenges that are the claimed justification for dumping toxic fluoride drugs into our drinking water?

  5. alanpryor

    Conceptually, this is similar to the proposition made to WAC by the anti-fluoridation forces 2 months ago. But rather than a check-off box (which most people don’t even see when they are paying bills in a hurry); I would instead make it a tax and subject it to an election which would be binding. As the voluntary Co-Chair and Treasurer of both Measure D (the recent Parks Tax) and Measure I (the Surface Water Project), I would be happy to similarly devote myself to getting an issue of this type passed.

    To Medwoman re:

    [quote]CommuniCare has already stated that they do not have nearly enough resources to meet the demonstrated need[/quote]

    This seems incongruous. What Councilmember Lee is saying is that money (resources) would be provided to them to meet that demonstrated need.

    [quote]…the opponents gain their goal of blocking fluoridation with no guarantee that they will not be equally as obstructionist if this were to be brought forward again for[/quote]

    For the record, thus far it has been the relentlessness of the pro-fluoridationalists who have been repeatedly, time-and-time-again, brought this issue back to the Davis community for reconsideration. It is their unending and adamant attempts to impose fluoridation on unwilling communities that I am worried about. I think the more likely scenario would be that even if a huge contribution were made by the Davis community to fund, say, a mobile dental van for the disadvantaged Davis community, that CDA and First 5 would be back in a year or two saying, “here’s the money…now by law you have to fluoridate too”. There should be assurances that if the substantial monies are raised and spent as suggested on community low-income dental needs, that we are not two-timed later by fluoridation zealots.

    [quote]Compromise, by its very nature, means that each side is giving up something in order to achieve a mutually desired goal. While I see the very good intention behind your proposal, I do not, in any way see this as a
    compromise[/quote]

    The compromise is that the anti-fluoridationalists impose a tax on themselves to avoid contamination of their water. The pro-fluoridationalists gain improved dental access for disadvantaged communities which have been demonstrably proven to result in better dental health than fluoridation. If better dental health care is medwoman’s primary objective, this would provide that. It was, in fact, medwoman who only yesterday posted that Europe had as good as or better dental health than the US without fluoridation because they provided better access to dental care than in the US. Well, Councilmember Lee’s proposed solution is a chance for Davis to provide just that improved dental access. And we can do so without dumping an extra 12 tons per year of a toxic waste into our environment and not exposing the Davis community to the proven adverse effects of fluoridation such as fluorosis and hypersensitivities. What is not to like about that? It seems to be the best of both worlds.

    [quote]Water fluoridation helps not only those children in the lower income group, but also those who are not as meticulous with dental hygiene, who have difficulty with performing activities of daily living, and all age groups including the elderly. Your plan as stated would not help any of these groups.[/quote]

    Why not, improved dental health care could also be provided to seniors in this type of program and doing so would undoubtedly better their dental health. In fact, there is NO evidence showing that fluoridation would similarly do so why should we assume that it would. Saying fluoridation helps everybody is a completely unproven and unscientific statement and discredits those promoting fluoridation.

    [i][b]Sorry, but I now have to leave for the entire day and will not be able to join in or respond to later posts.[/b][/i]

  6. tleonard

    Brett….

    Thank you for your wonderful suggestion.

    Water fluoridation is neither safe nor effective as I have pointed out on the many comments that I posted on various other Vanguard fluoridation articles. Preventative dental services are the solution to dental health issues.

  7. hpierce

    [quote]Compromise, by its very nature, means that each side is giving up something in order to achieve a mutually desired goal.[/quote]Yes, for those who espouse fluoridation, the ‘compromise’ is a new baseline including not only fluoridation, but ALSO new contributions (voluntary, but if that is ineffective,taxes) for universal dental and medical coverage for those not already covered…

  8. keithvb

    My kids were raised on un-fluoridated water from our private well. They brushed regularly with one toothpaste or another. They are now adults and their teeth are fine.

    To add fluoride to our water and then remove it from the waste stream seems expensive and unnecessary.

  9. David M. Greenwald

    But Keith, in all fairness, your kids are not the ones that are of concern by those who favor fluoridation. When we got our nephew, he was only six (this was in 2010), his mouth was full of cavities. The question is not whether your kids would have benefited, but whether kids like my nephew would have.

  10. hpierce

    Ok David, and how many of your nephew’s teeth will still have cavities when he is 15? And so we should cover the costs for the neglect your nephew’s parents?

  11. Nancy Price

    In addition to the proposals above, I would like to see the school district launch, if not already in place, a good pre-school and K-12 educational program on best practices in regard to good nutrition and good hygiene for improved dental health. Additionally, there could be better education of new mothers so that infants and toddlers are not left sucking on bottles of milk and sugary drinks at nap and bedtime and sure way to impact dental health.

    I for one would like to see some kind of baseline study of dental health and need for fluoridation in Davis. I know such a study might be difficult, but it should be done to demonstrate the need, rather than using general information and statistics in from many countries, communities and sources, often from past years and not contemporary data to really demonstrate need in this community.

  12. Nancy Price

    Money down the Drain????

    Question: if there is not a demonstrated need for or support for fluoridation of all Davis water, after water treatment at the new surface water plant, can fluoride be added to the pipe delivering water to Woodland, if Woodland wants fluoridation, and not to the pipe delivering water to Davis?

  13. ebowler

    Thank you, Brett, for this thoughtful piece. I agree that preventive dental services would be a vastly superior use of the city’s limited financial assets compared to water fluoridation. As I have previously stated here and elsewhere, I am even more interested in addressing the CAUSE of dental disease (which is the same thing that causes obesity, heart disease, hypertension, diabetes and many cancers), which is the over-consumption of sugar and refined grains by most Americans. Perhaps the City Council would be interested in tackling this problem by proposing restrictions on the sale and purchase of sugary drinks along the lines of New York City? I and other physicians I know would certainly be supportive of such a move.

  14. Don Shor

    The cost of fluoridation is high. I’m also not sure how they would equalize the distribution, since we’d be using a mix of surface water and deep well water and the proportions would vary. It isn’t clear to me that there is actually a funding source for this for installation or ongoing costs. Finally, I’m still not clear how Davis would comply with state law on this issue. And we don’t actually know the extent of the problem of inadequate dental care in Davis.

    It seems to me there are some practical concerns that need to be addressed. Meanwhile, Brett’s proposal can begin to address the issue of dental care for those who need it.

  15. Dianne

    “chemicalizing”everyone and everything is not a solution to the problem (except perhaps chemical co’s bottom line), so I like the proposal to aid those in need without putting toxins in our soil as well as out mouths. We all could rethink “one size fits all” as a general answer to problems. Targeted solutions work for everyone.

  16. David M. Greenwald

    [url]Ok David, and how many of your nephew’s teeth will still have cavities when he is 15? And so we should cover the costs for the neglect your nephew’s parents? [/url]

    Too many of them are on permanent teeth, I assume, that’s what you were asking?

    You are covering the costs for the neglect. My guess is that the state pays a lot more for his Medi-Cal dental coverage than they would for fluoridation.

  17. hpierce

    Permanent teeth? @ six? I welcome a dentist to correct me, but baby teeth don’t avulse until ~ 5, and take about a year to “bud out”. The most trouble-prone teeth (molars) avulse and grow later. The state may pay for the dental care (why don’t you?), but the question is does Davis pay for fluoridation? Those who genetically have ‘soft-spots’ on their molars do not benefit from fluoridation. I consumed nothing but fluoridated water from infancy to my twenties, brushed fairly regularly with fluoride toothpaste, and got molar cavities.

    The state never paid for my dental costs, nor those of my children.

    Hope you are working with your nephew to brush well, with a fluoride toothpaste.

    I only oppose the current proposal as it is completely inefficient on a cost/benefit ratio to the target purpose. I do not buy the “poison” theory, but it occurs to me that there may be some out there who are super-sensitive to fluoride. Peanut butter is a good protein, yet it may kill some.

  18. Growth Izzue

    [quote]Perhaps the City Council would be interested in tackling this problem by proposing restrictions on the sale and purchase of sugary drinks along the lines of New York City? I and other physicians I know would certainly be supportive of such a move. [/quote]

    Here we go, once you open the door for curtailing wood fires, plastic bag bans and other liberal feel good agendas there’s no end to it.

  19. David M. Greenwald

    “Here we go, once you open the door for curtailing wood fires, plastic bag bans and other liberal feel good agendas there’s no end to it.”

    As opposed to seat belts, smoking bans, or helmet laws?

  20. Growth Izzue

    How much could it cost to hand out free flouridated tooth paste and toothbrushes and have the parents do their job to make sure their kids maintain good dental hygiene.

  21. David M. Greenwald

    Making parents do their job sounds like a good idea until you’ve dealt with parents who have a whole long list of problems.

  22. Growth Izzue

    So we become a nanny state where everyone has to ingest flouride because of the few parents who can’t or don’t want to parent because they’re either lazy or have a whole list of problems?

  23. ebowler

    [quote]Here we go, once you open the door for curtailing wood fires, plastic bag bans and other liberal feel good agendas there’s no end to it. [/quote]

    We restrict the sale of alcohol, and sugar (especially HFCS) is at least as addicting as alcohol, probably more so, and it is certainly more damaging to health.

  24. David M. Greenwald

    “Permanent teeth? @ six? I welcome a dentist to correct me, but baby teeth don’t avulse until ~ 5, and take about a year to “bud out”. The most trouble-prone teeth (molars) avulse and grow later.”

    He was a few days before turning seven. I could find out how many are permanent, but I know a few were.

    “The state may pay for the dental care (why don’t you?), but the question is does Davis pay for fluoridation?”

    Because he is not covered under our insurance.

    “The state never paid for my dental costs, nor those of my children.”

    Well you were fortunate enough to work for a place that provided you with full medical coverage. But there are a lot of people who are not so fortunate.

    “Hope you are working with your nephew to brush well, with a fluoride toothpaste.”

    And fluoride tablets.

    I only oppose the current proposal as it is completely inefficient on a cost/benefit ratio to the target purpose. I do not buy the “poison” theory, but it occurs to me that there may be some out there who are super-sensitive to fluoride. Peanut butter is a good protein, yet it may kill some.

  25. David M. Greenwald

    “So we become a nanny state where everyone has to ingest flouride because of the few parents who can’t or don’t want to parent because they’re either lazy or have a whole list of problems?”

    That’s to be decided, although I’ll point out most of the country has done exactly that for the last forty years.

  26. Growth Izzue

    So we’re going to river water because of high amounts of certain minerals in our well water just to now in turn possibly add another mineral into the river water that will have to be removed at great expense. Does anyone else think this is just too funny?

  27. Frankly

    From a larger and long-term view we are always better off teaching and expecting responsible behavior rather than assuming people cannot care for themselves and then force-apply help in the name of social justice. When we take the latter approach we grow more lazy, entitled and ignorant people. But then that provides liberals with more reliable dependent people that are programmed to vote for the party more apt to take care of their inability to care for themselves.

  28. David M. Greenwald

    If you explain it in such basic terms it’s very funny. The reality is that we are going to river water ostensibly because our groundwater had too high a concentration of certain minerals which impacted the discharge. Some are proposing to a completely different mineral into the river water for a completely different purpose. You do understand that one mineral is not the same as another mineral?

  29. Don Shor

    [quote]But then that provides liberals with more reliable dependent people that are programmed to vote for the party more apt to take care of their inability to care for themselves.[/quote]

    You just can’t help yourself, can you? Please stay on topic. You’ve veered off topic three times already.

  30. Growth Izzue

    [quote]Some are proposing to a completely different mineral into the river water for a completely different purpose.[/quote]

    Yes, a mineral that we’ve done without and will now add and [b]HAVE TO REMOVE IT ON ORDER TO DISCHARGE IT BACK IN THE RIVER[/b]. All of this at a great cost on top of our water bills that are already tripling.

  31. Frankly

    Don, I am completely on-topic and you should know it.

    I think this issue will end up on a city ballot and readers need that perspective of the impulses driving this.

    For you to so narrowly define the scope of on-topic means you are guilty of inserting your bias into the discussion by blocking points you disagree with.

    I appreciate your contribution to the blog, but you are in a position of power and I think you should wield that power more carefully and with greater restraint.

  32. K.Smith

    [quote]From a larger and long-term view we are always better off teaching and expecting responsible behavior rather than assuming people cannot care for themselves and then force-apply help in the name of social justice. [/quote]
    So, until these children get old enough to take individual, personal responsibility, we just let their teeth rot (or allow them to suffer the effects of whatever other conditions aren’t being met by their parents?)

    My mother used to run a home daycare, and had several children whose teeth were literally rotting out of their heads. Their parents obviously were not taking care of this, and my mother’s house was probably the only place they were getting their teeth brushed. They were in pain for a big part of the day and could hardly chew.

    Guess they should have learned some good, old-fashioned personal responsibility, eh? Maybe, at 6, they could hike on down to the corner store and buy some fluoride toothpaste, or make an appointment with a dentist and pay for it by cleaning dental instruments or something after hours.

  33. Frankly

    So K. Smith, what are the root causes of parents not taking responsibility for ensuring their children brush regularly with fluoride toothpaste and limit their intake of sugar and acidic-sweet soda-pop?

    Might at least part of that be generations of social welfare families that lack the will or understanding how to take care of themselves?

    Why would you or anyone else expect any less from these families than you would any family with gleaming white healthy teeth resulting from quality hygiene practices?

    The soft bigotry of low expectations seems alive and well and perpetuating the very problems they claim to be addressing.

    David mentions seatbelt laws and helmet laws. I don’t support those either except for people 22 years old and younger. Once an adult, you should be expected to accept the consequences of your situation and ongoing decisions.

    As for good oral hygiene, I advocate that we rip out much of the left-tilted social-brainwashing humanities from the education curriculum and replace it with life-skills classes. How to care for your self. How to be a good parent. How to interview for a job. How to determine your life path. All of these things are infinitely more important that “Race and Diversity in History”.

    But we have the AMA recently classifying obesity as a disease.

    Our primary destructive “disease” is this tendency to believe that we can continue to layer copious rules and protective services only to protect people from their own poor choices without admitting that it increases the number of poor choices that will be made.

    Teach people to do for themselves so they can become self-sufficient and successful. Don’t do for them what they should be doing for themselves because you create dependent victims that will always need you to do for them what they should be doing themselves.

    If the problem is too much tooth decay in certain segments of the population, then target hygiene teaching and dental health services to those segments to help improve their family’s long-term prospects improving their self-care. Don’t just dump drugs in the water.

  34. K.Smith

    Obviously, in the example I brought up, the parents were not from the alleged “generations of social welfare families,” since they were out working while my Mom was being paid to care for their kids. I don’t know what the issue was with these particular families, but their children’s teeth were not being cared for.

    Yes–there are people who lack the will or understanding of how to care for themselves. There are people who cannot afford to go to a dentist. If you’re not fortunate enough to have a healthcare plan offered by your employer that covers dental care, it is difficult for really poor families to come up with the money for a dentist visit–most of which can run upwards of $200 for a regular cleaning and check-up.

    For the record: I’m not for fluoridating the water. I would like to see other solutions, like more education and targeted help (like providing toothbrushes and toothpaste to low-income children).

    I was reacting in a rather hyperbolic manner to the cavalier attitude that was expressed by a couple of posters who seemed to think that it’s just oh so easy for some people to pay for their own dental care, when there are people who just cannot afford it.

    And many of these people are in hard-working, lower-income families who are not on the social welfare programs you are taking issue with.

  35. Frankly

    K.Smith – It appears we are in-synch on these points related to the topic. There is a line that leads to long-term ills from immediate assistance, but I agree that we should be addressing the dental hygiene and dental care of children. How we do that in a most efficient and cost effective way is open for debate.

    I have a large company IT management background, and problem management was one of my specialties. For a large company with thousands of computer systems and computer users, you can understand the long-term catastrophe that would develop by only focusing on solutions addressing the symptoms. Sometimes we needed an immediate short-term fix. But root-cause analysis and permanent resolution was always the follow-up. It was part of constant-improvement loop that allowed the company to achieve progressive change because it wasn’t stuck with all its resources tied up dealing with yesterday’s problems.

    Like for IT problems, if we don’t invest our limited resources on attempting to permanently solve the root causes of our social problems, then we will forever be stuck treating symptoms. And frankly, we cannot afford to do this any longer.

    We have too many people suffering from tooth decay. Looking out 5-years, 10-years, 20-years…. how do we achieve material reductions in those numbers? We have already been dumping fluoride in water systems, yet there is still a high rate of tooth decay in many demographic groups. The benefit is marginal at best. But adding fluoride to the water also dissuades people from advocating for better solutions… because they rest easy at night thinking they have done enough winning the fluoride-dumping war, and their subjects believe that they can even brush and floss less since that miracle drug is automatically ingested when they drink the water from the tap.

  36. Don Shor

    Here’s an interesting study: [url]http://www.ucsf.edu/news/2010/06/4419/if-mother-has-tooth-decay-odds-increase-child-does-too[/url]
    Bottom line: untreated tooth decay in mothers correlates with higher tooth decay in children. “The findings indicate a strong relationship between the oral health of mothers and their children, the authors say. They also suggest that entire families need access to dental health education, prevention and treatment.”
    This all seems obvious, and leads to the logical conclusion that the long-term solution is better education for parents.
    There is a strong correlation between poor dental care and low income. That isn’t surprising: dental care costs money. And poor people are likelier to be on social welfare.
    Here’s where Frankly makes a logical leap that is not supported by evidence:
    [quote]Might at least part of that be generations of social welfare families that lack the will or understanding how to take care of themselves? [/quote]
    It is people that lack the will or understanding. Not ‘social welfare families’. Even if you showed a correlation between status on social welfare programs and tooth decay, you still wouldn’t be proving causation.
    As a matter of policy, training in good dental hygiene is going to be easier with children than with their parents because we already have the place to do it: schools. But even that won’t get at the problems at the level of infants and toddlers. So it’s well and good to talk about trying to educate parents, and schoolchildren. but we need a mechanism for improving the dental health of the youngest in the population.

  37. Don Shor

    [quote]But adding fluoride to the water also dissuades people from advocating for better solutions… because they rest easy at night thinking they have done enough winning the fluoride-dumping war…[/quote]
    The major proponents of fluoridation (CDA, ADA, etc.) also strongly advocate for other measures, including grade-school education, funding for state and local programs, modernizing data about dental health, expanding access to dental sealants for children, etc. I think your statement about them “resting easy at night…” and having “…done enough…” has no basis.

  38. Don Shor

    [quote]When we take the latter approach we grow more lazy, entitled and ignorant people. But then that provides liberals with more reliable dependent people that are programmed to vote for the party more apt to take care of their inability to care for themselves.[/quote]
    The most active, vocal opponents of fluoridation in Davis are all, to my knowledge, liberals — at least the ones I know who post under their own names and table at the Farmer’s Market. So your bias in this instance doesn’t even make sense.

  39. SouthofDavis

    K.Smith wrote:

    > There are people who cannot afford to go to a dentist.
    > If you’re not fortunate enough to have a healthcare
    > plan offered by your employer that covers dental care,
    > it is difficult for really poor families to come up
    > with the money for a dentist visit–most of which can
    > run upwards of $200 for a regular cleaning and check-up.

    I’m self employed and I have not had dental insurance for almost 10 years. I started paying $80 cash for a cleaning and a check up and going every other year. Now my wife makes me go at least once a year and I’m paying $120 a year even though I’m sure I would be fine if I was still going every other year (along with brushing and flossing every day). If you are dirt poor there are programs to pay for dental care, the rest of the “poor” (who have cable with 5 extra pay stations, iPhones with internet access and $200 sneakers) just don’t care about dental care…

    > For the record: I’m not for fluoridating the water.
    > I would like to see other solutions, like more education
    > and targeted help (like providing toothbrushes and
    > toothpaste to low-income children).

    Like K. Smith I’m not a fluoride proponent (I don’t care either way and we bought fluoride drops at CVS when our kids were little before they started using fluoride toothpaste), but I think we (as a society) need to get tougher on bad parents (using existing laws about child abuse already on the books). If a kid comes to school with poor dental health I don’t want to just add fluoride to the schools water or give him a toothbrush I want to make his parents spend a Saturday morning learning how to take care of the kids teeth (and let them know that unless his kid starts brushing that he will spent every Saturday morning taking dental care classes. There needs to be some down side to not taking care of your kids or we will just end up with more people like this guy:
    http://articles.latimes.com/2012/may/18/nation/la-na-nn-tennessee-man-has-30-kids-20120518

  40. Frankly

    [i]The major proponents of fluoridation (CDA, ADA, etc.) also strongly advocate for other measures, including grade-school education, funding for state and local programs, modernizing data about dental health, expanding access to dental sealants for children, etc.[/i]

    Advocating and getting it done are completely different things. Adding fluoride to the water impacts the getting it done part. Advocates are a dime a dozen. I advocate that all people are free, there are no wars and no hunger. Whoopee… aren’t I great person for advocating these things!!!?

    [i]The most active, vocal opponents of fluoridation in Davis are all, to my knowledge, liberals — at least the ones I know who post under their own names and table at the Farmer’s Market. [/I]

    Not me. I find exactly the opposite. Although I admit that the topic better crosses ideological lines that others.

    The people on the left that I talk to about this raise the social justice argument. I have not met one right-leaning person that supports dumping Fluoride in the water… especially having the cost of doing so added to their water bills.

  41. Matt Williams

    Don Shor said . . .

    [i]”What exactly is my bias on the topic of fluoridation?”[/i]

    Don, I’ve never seen any bias on your part vis-a-vis the topic of fluoridation, but I would argue that the topic of today’s article is “public health” just as much as it is “fluoridation.” Similarly I would argue that the topic of today’s article is “medical ethics” just as much as it is “fluoridation.” Finally I would argue that the topic of today’s article is “social justice” just as much as it is “fluoridation.”

  42. Don Shor

    [quote]Advocating and getting it done are completely different things. Adding fluoride to the water impacts the getting it done part. Advocates are a dime a dozen. I advocate that all people are free, there are no wars and no hunger. Whoopee… aren’t I great person for advocating these things!!!?
    [/quote]
    The CDA and the ADA get it done. That is why we are even facing this issue in the first place. They get states to pass laws requiring fluoridation. They fund it. They fund programs educating people. They press for dental health programs. They do all the things advocates do. If it weren’t for them, we wouldn’t even be having this conversation.

    [quote]Not me. I find exactly the opposite. [/quote]
    Alan Pryor, Barbara King — call your offices. Apparently now you are conservatives. These are the folks who are pushing hard against fluoridation, who are running the tables, who are leading the charge.

  43. Matt Williams

    Growth Izzue said . . .

    [i]”So we’re going to river water because of high amounts of certain minerals in our well water just to now in turn possibly [b]add another mineral into the river water that will have to be removed at great expense[/b]. Does anyone else think this is just too funny?”[/i]

    GI, your bolded words confuse me. Where has there been any talk about removing fluoride from Davis water at great expense?

  44. Matt Williams

    Don Shor said . . .

    [i]”Alan Pryor, Barbara King — call your offices. Apparently now you are conservatives. These are the folks who are pushing hard against fluoridation, who are running the tables, who are leading the charge.”[/i]

    Frankly, I concur 100% with Don on this. Lots of Davis citizens have taken the time to talk to me as a WAC member about fluoridation, and I would characterize virtually all the anti-fluoridation folks as liberals. You and Growth Izzue are the only Conservatives I know who have spoken out against fluoridation.

  45. Frankly

    I don’t personally know Alan or Barbara. So, I don’t know if they are liberal or not. But if you say so I will accept it.

    Those are two names.

    I would venture a guess that the social justice argument drives the opinion of support for fluoridation for most Davisites that would identify as being politically liberal. At least that has been my experience, and I think it is mostly reflected in the opinions of the bloggers on the Vanguard (except for the two names mentioned).

    However, I do know a few people that identify as liberal that are also quite holistic and determined in controlling the substances going into their bodies, so I have been a bit surprised that I have not run into more that tell me they are against fluoridation of the water. The conservatives I know are generally libertarian conservatives, and the simple fact that government is charging them to dump drugs in the water that they don’t need and don’t want is enough for them to loudly reject fluoridation.

    My experience is that there is a clear partisan divide with a few crossing over. But I admit that I have not been out and about much lately and may be missing much of the dialog outside the Vanguard.

  46. Growth Izzue

    [quote]Growth Izzue said . . .

    “So we’re going to river water because of high amounts of certain minerals in our well water just to now in turn possibly add another mineral into the river water that will have to be removed at great expense. Does anyone else think this is just too funny?”

    GI, your bolded words confuse me. Where has there been any talk about removing fluoride from Davis water at great expense? [/quote]

    Matt, here’s some excerpts from David’s Sunday June 23 article:

    [quote]The staff report estimates, “The cost to add fluoride to our deep wells is estimated to be between $92,000 and $454,900 per well site. So to equip all six deep wells, the total cost would be between $837,000 and $2,067,400.”

    It continues, “The cost to add fluoride at the Woodland Davis Water Treatment Plant (WTP) is estimated to be $602,000. Davis’ portion of this would be 40%, or approximately $240,800. If Davis decides to fluoridate but Woodland does not, then the cost would be closer to ½ of the total for both, or $301,000.”

    [quote]But there is more – there is also an added Water Treatment Plant to get the fluoride out of the water supply which would be another $1 to $2.4 million.
    [/quote]
    And remember these are not one-time costs, they would be annual costs because putting fluoride in and taking fluoride out
    [/quote]

  47. Growth Izzue

    Do the math people, to add and remove flouride we’re looking at near $5 million per year because you know it’s going to come in on the high side. So $5,000,000. divided by $150. per cavity and our Davis children that are poor or have parents with problems or don’t just give a shoot could get over 33,000 cavities fixed with the flouride money. The Davis dentists are licking their chops.

  48. Downtown

    The city doesn’t have enough money to support its current infrastructure (see: Community Pool, closure of.) The fiscal impact of the new water project remains unclear, and could worsen as water conservation efforts and private systems go online, in the face of new rates. We don’t have data-only anecdotes- as to the local population’s dental needs. Yet there’s consideration of spending money we don’t have, for fluoridation at an unknown cost, to treat something that may (or may not) be a problem? We don’t know if it wouldn’t be cheaper to just create a dental voucher program. It seems like leaping aboard a fluoridation wagon might not be prudent.

  49. Adrienne Kandel

    I like Brett’s proposal. I like Alan Pryor’s better. I like adding the health education. For people who prefer to accept the uncertain effects of systematic fluoride on their teeth (which they hope is meaningfully positive) and the rest of their body (which they hope is negligible), and who can’t be counted on to take fluoride pills nor brush or rinse with fluoride, why not do like some foreign countries’ residents and ingest the fluoride in salt? We could import and provide fluoridated salt to everyone who wants it at a much lower cost to our pocketbooks, the environment, and people who are sensitive to fluoride’s downsides, rather than spreading it throughout the entire water supply. For example I just checked a French big box store (Carrefour)’s online grocery purchases for salt, which generally is fluoridated: $1.62 for a 500 gram package, retail (1.26 euros). Let’s double the price to $3.24 as if the cost to import is as high as the cost to buy, for example. As a really rough approximation, if 5000 families need to ingest fluoride and each uses one 500 gram salt shaker a month we’re spending $194,000, or just over $3 per Davisite.

  50. nyscof

    This is a very good solution! No American is, or ever was, fluoride deficient; but many are dentist deficient. The money can be used to pay dentists who now refuse to treat low-come Californians. It’s ironic that dentists want fluoridation for the sake of poor children; but most dentists refuse to treat Medicaid patients. Some do charity work once a year with a lot of PR and fanfare for them and their corporate sponsors. But all Americans should be able to get dental care. After all, dentists received government and corporate hand-outs for their tuition, dental schools and more. It’s time they give back. They should be required to treat a certain percentage of Medicaid patients every year.

  51. Brett

    HI Medwoman,
    Your post had some direct questions for me, so I will try to answer. I think most of the other posts have sort of answered themselves in one way or another.

    You often mention evidence based decision making. That is a good start – “does it work” but the follow on question is also crucial “at what cost?”

    Effectiveness and cost effectiveness are both important measures.
    The literature that I have read on the fluoridation subject does not indicate that water fluoridation eliminates all cavities. It reduces the number. Your reference to the cost of filling one cavity seemed to imply that water fluoridation would eliminate that cavity, while preventative dental care would not. If anything, appropriate preventative dental hygiene probably has a greater “effect size” than simple water fluoridation. However in both cases, kids will still get cavities.

    I do not make the fixed assumption that poor kids=poor dental hygiene. I do make the assumption that there are kids and families that could benefit from a proactive dental health education program and dental care program.
    At the last WAC meeting, I recollect that someone mentioned that the entire Communicare dental program budget was around $200,000 per year. So my proposal would ideally double that. The added resources would mean that more kids could be served with greater frequency.

    From a public health perspective for a prosperous community such as ours where the vast majority of people have good access to dental care, I think a robust education and care program would be far more effective (and cost effective) than a fluoridation program.

    As far as “compromise”, David added the title to what I wrote. I think I am suggesting an alternative, not a compromise. However, in some sense it could be viewed as a compromise – in exchange for the pro-fluoridation movement taking a pause on the issue, we can see if the community can step up and create a more robust dental care program for the people of Davis. If the pro-fluoridation movement is unwilling to wait and see, I foresee that this issue will go to the voters and all the time and energy (and money) spent on the election is time and energy (and money) that is not spent on improving dental health care.

    Hope this helps

  52. B. Nice

    Should the same arguements that apply to fluoridation apply to the spraying of pesticides?

    “Three Davis parks were scheduled to sprayed between 8 p.m. and midnight Monday to kill adult mosquitoes that may carry the West Nile virus.
    The Sacramento-Yolo Mosquito and Vector Control District targeted Northstar, Chestnut and Mace Ranch parks for treatment. Each park was sprayed via an ultra-low volume backpack. The products applied by the district are designed to quickly reduce adult mosquito populations and to protect public health and welfare.”

  53. Frankly

    [i]If the pro-fluoridation movement is unwilling to wait and see, I foresee that this issue will go to the voters and all the time and energy (and money) spent on the election is time and energy (and money) that is not spent on improving dental health care.[/i]

    I remain pessimistic that those demanding we add fluoride to our water will back down (pause) and prevent another trip to the Davis direct democracy ballot box. But I still hope otherwise.

    For those motivated by a social justice cause (e.g., low-income people have a higher incidence of tooth decay and derive greater benefits from water fluoridation), this alternative of doubling the outreach dental care budget should be an agreeable alternative. Teach a child adequate dental hygiene and you help him for life.

    For those against government spending and low efficiency, the alternative is much more cost-effective and efficient in terms of solving the problem.

    [I]Should the same arguements that apply to fluoridation apply to the spraying of pesticides?[/I]

    I don’t see the correlation or comparison. Mosquitos are airborne and migratory bugs. How can an individual protect himself from being bitten by a West Nile infected mosquito? Contrast this to tooth decay where each individual has easy access to everything he or she needs to prevent it.

    Fluoride in the drinking water addresses an individual information and behavior deficiency (based on the simple fact that eating right and brushing regularly with fluoride toothpaste and flossing will effectively eliminate tooth decay.) Spraying mosquitos to reduce the risk of West Nile has nothing to do with individual behavior.

    Since you brought up this comparison, let me turn it around to be more relevant.

    How about we add DDT or DEET to the drinking water so that it oozes through our pores and repels mosquitos?

  54. Downtown

    While my earlier comment focused on the cost, I was trying to do some research for comparable systems. Instead, I found an NIH publication suggesting that fluoride may not necessarily be benign, and that safe exposure levels for children have not been established: “The results suggest that fluoride may be a developmental neurotoxicant that affects brain development at exposures much below those that can cause toxicity in adults.” Perhaps we should rethink whether this is a good idea.

    [url]http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3491930/[/url]

  55. B. Nice

    Frankly, I have not taken taken a stand on the fluoridation issue, I agree with certain aspects of both sides. (I will say on the pro-floridation side I am sympathetic to children, who through no fault of their own pay the price for poor dental hygiene). Nor have I taken a stand on the practice of spraying insecticides to combat West Nile, (I’m not convinced it makes a difference, but I admit I could be wrong)

    I did think it was interesting that the arguments for fluoridation, are similar to the arguments used for spraying insecticides, and was honestly wondering if the same people were are on the same side of this issue.

    That being said here are my thoughts on your response:

    [quote]I don’t see the correlation or comparison. Mosquitos are airborne and migratory bugs. How can an individual protect himself from being bitten by a West Nile infected mosquito?[/quote]

    From fight the bite website:

    DRAIN any standing water that may produce mosquitoes.
    DAWN and DUSK are times to avoid being outside. This is when mosquitoes are most active.
    DRESS appropriately by wearing long sleeves and pants when outdoors.
    DEFEND yourself against mosquitoes by using an effective insect repellent, such as DEET, Picaridin or Oil of Lemon Eucalyptus. Make sure you follow label directions!
    DOOR and window screens should be in good working condition. This will prevent mosquitoes from entering your home.

    [quote]Contrast this to tooth decay where each individual has easy access to everything he or she needs to prevent it. [/quote]

    This is true for adults, but not always for children.

  56. Davis Progressive

    for those bellyaching about the cost of fluoridating the water, that’s pennies compared to the $20 to #50 million potentially lost in the wastewater debacle. but everyone is focused on this issue.

  57. Frankly

    B.Nice, The difference is that my neighbor can leave standing water that produces mosquitoes that bite me. If I am precluded from going outside, that is a material impact on me (damages my quality of life). If I cannot wear shorts or short-sleeve shirts, that is also an impact and damage to me.

    However, if another person does not care for his teeth, it only impacts him and his quality of life. If he is an adult capable of caring for himself then I say too bad, so sad. Not my problem. Lazy idiots will always walk the earth, and we cannot save them from themselves… they can only save themselves. And they currently have plenty of “help” for doing so, IMO.

    I agree with your point about children not having access, but then I expect solutions addressing that problem… not some short-term shotgun approach that damages others while missing most of the target.

  58. Frankly

    B. Nice – When I was age 6-8 living in Hollywood Florida, I used to run around with other kids in the fog created by the trucks spraying pesticides to reduce the mosquito population. That might explain some things! 😉

    Seriously, there are other ways to address the mosquito problem than using the old shotgun approach.

    So you get my tilt, I support policy and law intervention to solve problems based on the test of material harm. But I prefer long-term corrective solutions of root causes rather than immediate treatment of symptoms.

    Mosquitos can cause material harm, but so can aerial spraying. We are better off with regulation, education and enforcement for eliminating standing water sources, and spot treating areas of mosquito infestation. If incidents of West Nile started to explode, I would then be in favor of some aerial spraying.

    Fluoride in the drinking water can and does cause material harm. I would prefer outreach, teaching and clinic funding to foment long-term improvements in the oral hygiene practices of the general population. I would never be in favor of water fluoridation because it: 1 – causes material harm to some, 2 – only treats symptoms and does nothing to attack and solve the root causes.

  59. B. Nice

    Frankly, you helped clarify my thoughts on this issue. I personally have no problem with our drinking water being fluoridated, I think there are benefits to it, and that potential harms are exaggerated. But since these same arguments are made about pesticides use (and I don’t want them being sprayed over my house), I’m willing to respect the view point of those arguing against fluoridation.

  60. Frankly

    B.Nice – That is a quality final analysis in my opinion. I think the differences we and others share is generally our individual valuation of harm and benefits. I appreciate acknowledgement of other’s valuation of harm and benefits even if there is disagreement.

  61. medwoman

    Brett

    Thanks for taking the time to answer my specific questions.
    A few comments in return. My intent was never to imply that there is a cavity per cavity direct correlation in the savings attributable to fluoridation, or any other specific preventive intervention. My point was that I do not believe that your estimated $150.00 per year would give comparable benefit for all who might benefit, especially if the benefits are limited to families with young children. This brings me to a couple more questions.

    1) Do you have any knowledge that suggests that the provision of an additional $200,000 to Communicare would be enough to provide them with additional staff to provide the anticipated level of need ? If so, this would seem to be a reasonable suggestion if….. and that is a big if….there were a way to guarantee that the funding coule be applied to this purpose.

    2) Could you draft a proposal sufficiently directive to be placed before the city council ? And if so, would you be willing to put it out for public consideration prior to making the proposal.

    3) Would you consider a proposal that sets a definite time for assessment of success and a guarantee that fluoridation of the water supply would indeed by looked at again if sufficient funds were not available for an alternative or if there were other problems precluding implementation or continuation of such a program.

    My concern here is what I have stated previously. I fear that if we do not adopt the fluoridation proposal, those who are saying they would support an alternative will simply fade away once they have achieved their objective of blocking fluoridation. I may not be as optimistic about our community’s willingness to act on this issue.
    However, I think history is on my side on this one. This issue has been brought before past city councils and when defeated, no further action has been taken. I think this history speaks for itself. What we have seen this time are individuals who are passionate about blocking water fluoridation, but no one who is passionate about presenting a fully fleshed out alternative, complete with numbers and some kind of assessment addressing the feasibility of their plan.

    I think that this is one of the rare instances in which I actually agree with Frankly. Opponents of fluoridation have an obligation to our community to admit that dental health is a problem in our communtiy and either lead, follow…..or get out of the way.

  62. medwoman

    A comment for those who are promoting fluoridation of salt. Again it is very important to weigh the risks and benefits of any medically based recommendation. While all of the potential adverse effects of fluoride at the proposed levels with the exception of fluorosis are “potential” or “speculative” meaning that they are not proven, the risks of salt in the diet are well known. I spend much of my time dealing with hypertensive disorders which are extremely common in our society. Much of that counseling is with regard to reduction of salt in our diets. I think it would be extremely unwise to advise patients to supplement their fluoride through use of salt when I spend much of my time counseling people to use no added salt in their diet.

  63. Frankly

    I think the idea is that people could choose to purchase salt with fluoride as an alternative to other salt they might purchase and continue their routine for using salt, not that they would be encouraged to consume more salt that contained fluoride.

    In other words, I don’t think you can make the leap that adding fluoride to salt would result in any increase consumption of salt.

    I remember reading a recent medical science article of recent studies that disputed the original opinion that salt in the diet was responsible for as much hypertension and/or heart-related maladies as previously thought. My mother in-law, who starts vigorously shaking salt on everything before she even tastes it… I think due to weak taste bud from chemo and radiation treatments from her breast cancer, was ecstatic at this report since prior to this her doctor admonished her to cut out salt from her diet.

  64. Frankly

    [i]My concern here is what I have stated previously. I fear that if we do not adopt the fluoridation proposal, those who are saying they would support an alternative will simply fade away once they have achieved their objective of blocking fluoridation.[/i]

    This argument is incongruous unless you believe that those against water fluoridation are just cold-hearted non-caring people.

    I would more worry about the same if we do move forward with water fluoridation… that many people will say “well since we are doing that and spending money on that I am doing enough to help those people improve their tooth decay situation.”

  65. ebowler

    [quote] While all of the potential adverse effects of fluoride at the proposed levels with the exception of fluorosis are “potential” or “speculative” meaning that they are not proven, the risks of salt in the diet are well known.[/quote]

    The science behind the recommendation for salt restriction to below 1500 mg per day is even more murky than the science behind the benefits of water fluoridation. According to the recent Institute of Medicine publication “Sodium Intake in Populations: Assessment of Evidence (2013)” there is “insufficient and inconsistent” evidence that salt restriction to below 2300 mg per day has any effect, either positive or negative, on health outcomes with the exception of CHF in which case salt restriction is associated with greater negative outcomes.

    The fluoridated salt option is an excellent one for people who wish to ingest fluoride. This is the option that most European countries have adopted and it seems to work well. When I lived in Europe, it was a simple choice at the grocery store of fluoridated or non-fluoridated salt.

  66. B. Nice

    One of the biggest barriers I see in providing dental care to kids who need it most is that their parents for a various number of reasons don’t bring their kids in for dental care. The reason fluoride in the water is attractive to me is it brings care, at least in some respects, to these kids. Is there any type of mobile dental care that could bring some basic dental care to kids, at schools/churches/migrant camps?

  67. Don Shor

    [quote]I fear that if we do not adopt the fluoridation proposal, those who are saying they would support an alternative will simply fade away once they have achieved their objective of blocking fluoridation.[/quote]
    Are you sure there is guaranteed funding for the installation and ongoing provision of fluoride? We seem to be pretty far down on some priority list, which has not been clarified.
    Are you advocating that the rates be raised to cover those costs?
    We haven’t had an answer yet as to how the cost of fluoride in the surface water and each of the deep wells will be covered, nor how the fluoride will be distributed evenly given the variability of how our water supply will operated (surface vs. deep wells).

  68. medwoman

    “In other words, I don’t think you can make the leap that adding fluoride to salt would result in any increase consumption of salt. “

    I agree. And nowhere did I say that I felt anyone would increase their consumption. What I feel is that most of us consume too much salt as it is.

  69. Matt Williams

    Frankly said . . .

    [i]”Fluoride in the drinking water can and does cause material harm. I would prefer outreach, teaching and clinic funding to foment long-term improvements in the oral hygiene practices of the general population. I would never be in favor of water fluoridation because it: 1 – causes material harm to some, 2 – only treats symptoms and does nothing to attack and solve the root causes.”[/i]

    Frankly, I know you have done it before, but could you please repeat what [u]material[/u] harm fluoride at the recommended levels causes.

    Based on all the homework I have done at the recommended concentration levels, 1) the incidence of mild fluorosis that happens in relatively small numbers do not rise to the level of [u]material[/u] harm, 2) the incidence of hypersentitivity to fluoride (which is clearly scientifically documented when fluoride is added at high concentration levels) does not rise to the level of [u]material[/u] harm, 3) the perceived moral violation of the principle of informed consent does not rise to the level of [u]material[/u] harm, 4) the perceived moral violation of the principle of forced medication does not rise to the level of [u]material[/u] harm.

    With that said, A) material harm has come and does come when fluoride has been/is used at concentrations above those that are recommended, and B) material harm comes if we spend millions of dollars without any measurable positive impact on the target population.

    Further, I wholeheartedly agree with you and B.Nice that the differences we and others share is generally our individual valuation of harm and benefits. I acknowledge and respect your valuation of harm and benefits. I simply don’t agree with it.

    Finally, I want to thank Brett for putting forward his alternative. It bears serious consideration.

  70. medwoman

    “This argument is incongruous unless you believe that those against water fluoridation are just cold-hearted non-caring people.”

    This is once again nothing more than you telling me what I “must believe”.
    Based on the historical precedent in this community, I will absolutely stand my ground on this point. If you believe I am wrong, please tell me after which previous episode in which fluoride was turned down previously did the opponents of fluoridation rally around and come up with a comprehensive plan to improve the dental care of the undeserved population ? If I missed it, I will stand corrected. Otherwise, I see no reason to believe that this time will be any different.

  71. medwoman

    Don

    I do not know that there is guaranteed funding. I have not looked into this aspect. However, I do believe that fluoridation of the water is more economical than any approach that has any chance of being accepted, implemented and maintained. Our community, and our society, for what ever reason has simply not made the health of disadvantaged members of our community a major priority and I do not foresee that changing in the near future.

  72. Frankly

    Matt, the occurrence of fluorosis is quite high and exacerbated by the fact that there is more fluoride toothpaste and much of tastes like candy and little children swallow it.

    From the CDC:

    [quote]Twenty-three percent of persons aged 6-49 had dental fluorosis in 1999-2004. Approximately 2% had moderate dental fluorosis and less than 1% had severe dental fluorosis. Dental fluorosis was most prevalent among children aged 12-15, and less prevalent among older age groups. The prevalence of dental fluorosis among children aged 6-11 was lower than the prevalence among adolescents aged 12-15. This may be explained by an incomplete set of permanent teeth among children aged 6-11; some posterior permanent teeth, including premolars and second molars, erupt between ages 10 and 12.

    The levels of very mild, mild, and moderate or severe dental fluorosis were higher among adolescents aged 12-15 in 1999-2004 than in 1986-1987.[/quote]

  73. Don Shor

    [quote]Our community, and our society, for what ever reason has simply not made the health of disadvantaged members of our community a major priority and I do not foresee that changing in the near future.[/quote]
    So how do you propose the installation and ongoing costs of fluoridation be funded?

  74. Frankly

    [i]Based on the historical precedent in this community, I will absolutely stand my ground on this point. If you believe I am wrong, please tell me after which previous episode in which fluoride was turned down previously did the opponents of fluoridation rally around and come up with a comprehensive plan to improve the dental care of the undeserved population ? If I missed it, I will stand corrected. Otherwise, I see no reason to believe that this time will be any different.[/i]

    medwoman, we are both talking about Davis, right?

  75. Matt Williams

    Frankly said . . .

    [i]”Matt, the occurrence of fluorosis is quite high and exacerbated by the fact that there is more fluoride toothpaste and much of tastes like candy and little children swallow it.

    From the CDC:

    Twenty-three percent of persons aged 6-49 had dental fluorosis in 1999-2004. Approximately 2% had moderate dental fluorosis and less than 1% had severe dental fluorosis.” [/i]

    Frankly, you and the CDC make my point for me. 97% of the total US population had less than moderate levels of fluorosis. Less than moderate levels of fluorosis is a purely cosmetic condition that does no [u]material[/u] harm. Based on your reading of the CDC information what was the concentration levels of fluoride in those persons who fell into the moderate and/or severe fluorosis category. Further, since the recommended concentration of fluoride has been reduced in recent years, what does the CDC say about the impact of that reduction?

    Regardless of your answers to the questions posed above, fluorosis is a cosmetic condition. The susceptibility of some people to cosmetic conditions is well documented. My wife has a skin type that causes her to get many more freckles than I do when we are equally exposed to the sun. As a result she exercises a certain amount of caution when she is exposed to the sun. I really don’t see fluorosis in a significantly different light (pun intended).

  76. medwoman

    Don

    [quote]So how do you propose the installation and ongoing costs of fluoridation be funded?[/quote]

    I am sure that you are aware, as anyone who has read my posts, that business, finance and questions of funding are not within my area of expertise. I have ceded this point many times. What I do know is that many communities in this country have found a way to do it. West Sacramento, fairly recently found a way to do it.
    I have confidence that if approved, we also we find a way to do it. I am not the person to find that way.

    The question I would ask of you in return is, what communities that you know of have chosen to establish and maintain funding for dental care for their underserved populations ? How have they funded these programs ?

  77. ebowler

    [quote]Less than moderate levels of fluorosis is a purely cosmetic condition that does no material harm.[/quote]

    Unfortunately, even mild dental fluorosis, if it occurs on the front teeth, can significantly affect a child’s self-image and bring about a “reluctance to smile or a lack of confidence.” (Rodd 2011; Marshman 2008). There is a growing body of literature on this topic and also on the racial discrepancy in the incidence of fluorosis, with African American children being disproportionally impacted. As dental fluorosis is a visible sign of fluoride toxicity, the increasing rates of fluorosis due to the increasing exposure to fluoride (especially in processed foods) should be of some concern.

  78. medwoman

    Frankly

    [quote]medwoman, we are both talking about Davis, right?[/quote]

    A bit of a non response in my opinion.
    I ask directly whether you are aware of any comprehensive preventative dental health program that has been championed and implemented by previous ( or current) opponents of fluoridation within our community and this is your response.
    If you feel that I am in error and that such a program has been implemented, please either tell me about it
    or explain to me why you believe that this time will be any different.

    Brett has put forward an alternative and I thank him for his thoughtful approach. What he has not done is to flesh out this plan, discuss how it would be implemented, who would administer it ( as in determining who is eligible and ensuring that those in need are provided with adequate care), how it would be sustained over time.
    I also think it is a good idea, and would be in full support, if and only if, it did not have the intended results, those opposed to fluoridation would agree to not oppose it at the time of the reconsideration in one to two years.

    I am not opposed to an alternative to fluoridation. I just do not believe that the history of dental care in this community ( or country )suggests that such a plan is likely to be implemented this time either.

    Who amongst the opponents to fluoridation is going to step up and champion such an alternative all the way to implementation ? Brett, is it your plan to do so ? If so, I would love to hear more details. I truly admire your thoughtfulness and leadership and would love a better alternative to water fluoridation but at this time am
    unconvinced that it is likely to happen.

    Alan, Adrianne, T.Leonard, GI , Frankly…. anyone willing to own this ? Or is it just convenient to state your support for the idea until you manage to defeat water fluoridation ?

    Don, you have expertise in business and presumably some financing savvy. Would this be something you would be willing to own ?

  79. Growth Izzue

    Why are we even talking about this when Obamacare is supposed to take care of children’s flouride:

    [quote]Preventative screenings and supplements apply to all children under the age of 18. Some tests and procedures have age restrictions or recommendations: Alcohol and drug use

    Autism

    Behavioral assessments and developmental screening (including depression)

    Blood pressure

    Congenital hypothyroidism and Dyslipidemia

    [b]Fluoride chemoprevention and oral health screenings

    [/b] Newborn screenings including gonorrhea preventive medication, sickle cell, PKU and hearing screening

    Height, Weight and Body Mass Index measurements and obesity screenings

    Hemoglobin

    HIV screening and STI prevention counseling for adolescents at higher risk

    Immunization vaccines

    Iron supplements (for infants at risk for anemia)

    Lead poisoning (for children at risk of exposure)

    Medical history for all children throughout development

    Tuberculin testing for infants and children at higher risk of tuberculosis

    Vision screening for all children
    [/quote]

  80. Matt Williams

    ebowler said . . .

    [i]”Unfortunately, even mild dental fluorosis, if it occurs on the front teeth, can significantly affect a child’s self-image and bring about a “reluctance to smile or a lack of confidence.” (Rodd 2011; Marshman 2008). There is a growing body of literature on this topic and also on the racial discrepancy in the incidence of fluorosis, with African American children being disproportionally impacted. As dental fluorosis is a visible sign of fluoride toxicity, the increasing rates of fluorosis due to the increasing exposure to fluoride (especially in processed foods) should be of some concern.”[/i]

    Again I get back to material harm. There are a myriad of factors that can affect a child’s self image, and if you were to rank order those factors where would “mottling of tooth enamel” fall in the list? Way, way down. That is especially true if you look at the image example of mild fluorosis on the Wikipedia page (see [url]http://en.wikipedia.org/wiki/Dental_fluorosis[/url]). The fluorosis affected areas are whiter than the rest of the teeth. So without fluorosis, the teeth would simply look uniformly dingy/yellow. Where would “having dingy/yellow teeth” with no fluorosis fall on your ranked list?

    With the above said, the brown stains and pits in the teeth that are associated with severe fluorosis would rank very high on my personal ranked list.

    Regarding racial disparities in the incidence of fluorosis, that is a subject that is definitely a concern, and I think it ties back to the incidence of fluoride in processed foods that you mentioned above. That is one of the reasons I find Brett Lee’s alternative worthy of further pursuit. If we could adjust the American diet so that it contains less processed food and less sugar we would be doing what Frankly has advocated for . . . addressing the root causes of both fluorosis and obesity.

  81. Davis Progressive

    probably because people like you and your ilk are trying to block and gut the implementation of the affordable care act. you can’t have it both ways.

  82. Growth Izzue

    [quote]probably because people like you and your ilk are trying to block and gut the implementation of the affordable care act. you can’t have it both ways. [/quote]

    LOL, you mean like the recent pushback to 2015 of the employer mandate by Obama?

  83. Matt Williams

    medwoman said . . .

    [i]”Brett has put forward an alternative and I thank him for his thoughtful approach. What he has not done is to flesh out this plan, discuss how it would be implemented, who would administer it ( as in determining who is eligible and ensuring that those in need are provided with adequate care), how it would be sustained over time.
    I also think it is a good idea, and would be in full support, if and only if, it did not have the intended results, those opposed to fluoridation would agree to not oppose it at the time of the reconsideration in one to two years.

    I am not opposed to an alternative to fluoridation. I just do not believe that the history of dental care in this community ( or country )suggests that such a plan is likely to be implemented this time either.

    Who amongst the opponents to fluoridation is going to step up and champion such an alternative all the way to implementation ? Brett, is it your plan to do so ? If so, I would love to hear more details. I truly admire your thoughtfulness and leadership and would love a better alternative to water fluoridation but at this time am
    unconvinced that it is likely to happen.

    Alan, Adrianne, T.Leonard, GI , Frankly…. anyone willing to own this ? Or is it just convenient to state your support for the idea until you manage to defeat water fluoridation ?

    Don, you have expertise in business and presumably some financing savvy. Would this be something you would be willing to own?”[/i]

    medwoman has laid out the key challenge associated with virtually all the alternatives to water fluoridation. The European countries that have significantly reduced caries rates without water fluoridation, also have some form of national health. Such a system essentially eliminates the “devil is in the details” challenge medwoman has pointed out.

    So, as long as Don doesn’t think this is going off-topic, I see this fluoride debate in Davis as a perfect opportunity to renew my vocal support for a single-payer health system that covers 100% of the populace here in the USA.

  84. Davis Progressive

    gi – whatever, my point is i do think you are trying to have your cake and eat it too by trying to kill the legislation at the same time you argue it as a reason not to fluoridate.

  85. Growth Izzue

    Kill the legilation? How can I do that? It’s Obama that’s [b]bypassing his own law[/b] by not implementing all it’s facets on the enactment dates. That being said the individual mandate is for now still in place which would cover fluoride chemoprevention and oral health screenings for children under 18. So why are we even considering paying twice for something that’s already going to be covered because many of us are already paying for Obamacare in one form or another.

  86. ebowler

    [quote]If we could adjust the American diet so that it contains less processed food and less sugar we would be doing what Frankly has advocated for . . . addressing the root causes of both fluorosis and obesity. [/quote]

    Exactly my point. Neither dental disease nor obesity is the problem, they are merely symptoms of the underlying problem which is the Standard American Diet filled with sugar and processed foods. Until we begin to address the root cause, we will just be whistling in the wind and all the fluoride and dental care in the world will be for naught. The Kentucky experience, with nearly 100% water fluoridation and a recently declared
    dental emergency among the state’s children, clearly demonstrates that point.

  87. medwoman

    ebowler

    [quote]Unfortunately, even mild dental fluorosis, if it occurs on the front teeth, can significantly affect a child’s self-image and bring about a “reluctance to smile or a lack of confidence.”[/quote]

    A reasonable concern.
    This statement could equally apply to damage to teeth and loss of teeth from cavities. Also, damaged and lost teeth from cavities or other causes such as trauma can lead to bone loss resulting in the need for very expensive and ongoing reconstructive work. I know since I lost teeth to trauma at age 21 and have had to have extensive oral surgery, grafting and and will soon be under going orthodontics and implant placement. This represents 40 years of intermittent and expensive and painful treatment. Given the trade off of risks and benefits, my preference would be for fluorosis over dental loss every time.

  88. medwoman

    Matt

    [quote]I see this fluoride debate in Davis as a perfect opportunity to renew my vocal support for a single-payer health system that covers 100% of the populace here in the USA.[/quote]

    I enthusiastically support your alternative above all others presented !

  89. medwoman

    GI

    [quote]Kill the legilation? How can I do that? [/quote]

    You can’t single handedly. However, it has been opposition from folks who do not desire a more comprehensive solution in the form of single party payer ( which I presume you do not support, please correct me if I am wrong who have made the present very messy bill known as the ACA the only
    reform supported by enough legislators to move forward. Please recall that single party payer was off the table from the beginning due to lack of political support. From my point of view, this bill is far from ideal
    but represents some positive steps forward. As Matt wisely pointed out, the devil is in the details. This is no less true for Obamacare than it is for alternatives to water fluoridation.

    So since you responded to the issue of “killing the bill”, how about responding to my request for someone who opposes fluoridation to taking ownership of an alternative ? Alan’s, Brett’s…..your own ?

  90. medwoman

    GI

    [quote]Kill the legilation? How can I do that? [/quote]

    You can’t single handedly. However, it has been opposition from folks who do not desire a more comprehensive solution in the form of single party payer ( which I presume you do not support, please correct me if I am wrong who have made the present very messy bill known as the ACA the only
    reform supported by enough legislators to move forward. Please recall that single party payer was off the table from the beginning due to lack of political support. From my point of view, this bill is far from ideal
    but represents some positive steps forward. As Matt wisely pointed out, the devil is in the details. This is no less true for Obamacare than it is for alternatives to water fluoridation.

    So since you responded to the issue of “killing the bill”, how about responding to my request for someone who opposes fluoridation to taking ownership of an alternative ? Alan’s, Brett’s…..your own ?

  91. Growth Izzue

    Medwoman:
    [quote]So since you responded to the issue of “killing the bill”, how about responding to my request for someone who opposes fluoridation to taking ownership of an alternative ? Alan’s, Brett’s…..your own ? [/quote]

    Medwoman, the Obamacare individual mandate supplies the solution as stated: [b]Fluoride chemoprevention and oral health screenings [/b]
    You and other liberals on here have always backed Obamacare and it specifically addresses your concerns. What’s the problem? Do you and other liberals not have faith in legislation you have defended since it’s inception?

  92. Don Shor

    From Bob Dunning’s column today:
    [quote]my friend Alex writes to say there is no need to “formulate a program to make fluoride available to all low-income families desiring it,” as I suggested in a recent column … notes Alex: “Topical fluoride treatments are included in the Affordable Care Act’s Covered Preventive Services of September 23, 2010 as ‘Fluoride Chemoprevention supplements for children without fluoride in their water source.” … there you have it … adds Alex: “Since the group in question is the indigent, they are already covered for fluoride supplements (as a chewable tablet) at no cost through Medi-Cal. The tablets can be prescribed by a dentist, pediatrician, family doctor, nurse practitioner or physician assistant.” … or, presumably, even a newspaper columnist … after noting that “Medi-Cal eligibility was recently expanded to allow even more children to qualify, and those with private or employer-sponsored health insurance also have coverage at no cost (deductibles, payments and co-insurance are waived for all preventive services and treatments),” Alex concludes: “In short, fluoride supplements are currently available at no cost to nearly all those in the target group for municipal water fluoridation.”[/quote]

  93. Frankly

    Single payer (aka government-run) healthcare is a terrible idea. Just like all other government-run anything it ends up too politicized and ultimately declines under its own unsustainable bureaucratic bloat. Think healthcare service comparable to a trip to the DMV. Think healthcare business similar to the USPS.

    [url]http://www.fraserinstitute.org/uploadedFiles/fraser-ca/Content/research-news/research/publications/canadas-medicare-bubble.pdf[/url]

  94. Growth Izzue

    Frankly, since Obamacare supplies flouride for children under 18 why are these liberals not embracing that? Do they know and are now finally admitting that Obamacare isn’t going to work so they’re looking for other solutions even before their coveted legislation has a chance to get started?

  95. Don Shor

    I think most people involved in this discussion are unaware of the facts presented by Bob Dunning’s correspondent ‘Alex’ above. If his/her statement is true, then there is no need to provide fluoride through the water supply. Supplements are available free, can be readily prescribed. So it seems it is mostly just a matter of getting the information out.

  96. Growth Izzue

    Don I already posted the ACA Healthcare mandates for children:

    Obamacare Preventative Coverage for Children

    Preventative screenings and supplements apply to all children under the age of 18. Some tests and procedures have age restrictions or recommendations:

    Alcohol and drug use

    Autism

    Behavioral assessments and developmental screening (including depression)

    Blood pressure

    Congenital hypothyroidism and Dyslipidemia

    Fluoride chemoprevention and oral health screenings

    Newborn screenings including gonorrhea preventive medication, sickle cell, PKU and hearing screening

    Height, Weight and Body Mass Index measurements and obesity screenings

    Hemoglobin

    HIV screening and STI prevention counseling for adolescents at higher risk

    Immunization vaccines

    Iron supplements (for infants at risk for anemia)

    Lead poisoning (for children at risk of exposure)

    Medical history for all children throughout development

    Tuberculin testing for infants and children at higher risk of tuberculosis

    Vision screening for all children

    [url]http://www.wikihow.com/Get-Obamacare[/url]

  97. nyscof

    Allowing dental therapists to work in Davis County as they do in rural Alaska would solve the problem. Dental therapists need just two years training to do simple dental procedures just as effectively as dentists and can afford to accept Medicaid patients. Minnesota just legalized Dental Therapists and many other states are considering it. The Pew Foundation strongly recommends it it’s an effective remedy to the growing problem of untreated tooth decay. They have worked successfully for decades in other developed countries.

    Organized dentistry has a history of lobbying against any group or procedure that infringes on its lucrative monopoly. That’s why they lobby against Dental Therapists, solo-working hygienists, denturists working directly with the public (they are the ones who make false teeth). They even close down tooth whitening kiosks because there’s too much money to give up.

    Fluoridation does not hurt dentists’ bottom line. That’s why they support it. It’s time to break up dentists’ monopoly and allow dental therapists do the work dentists refuse to do.

  98. Davis Progressive

    GI: if you are putting forth aca as the solution, you have to support aca for it to be your solution. is that what your suggesting?

  99. Growth Izzue

    David Progressive:

    I don’t have to support it or like it but unfortunately it’s the law of the land. So like any law you have to work with what you’ve got. And in the Davis flouridation issue Obamacare looks like it will take care of the children (if the wikihow site is correct) which is what everyone is concerned with, right?

  100. Davis Progressive

    if you’re putting forth aca as an alternative to fluoridation, you can’t very well say, hey, i’d end aca if i could, but here’s your alternative. it’s disengenous at best.

    everyone’s concern is that the republicans have attempted to kill aca at every turn, blocked it at the state level, and defund it when they can. until it’s implemented, no one is expecting it to be implemented.

    at the same time, i know i speak for many, aca is not my preferred solution, single-payer is. to me, aca was a compromise and i think most liberals on this site at least probably would prefer single-payer.

  101. Growth Izzue

    It seems idiotic to me to pay for a local children’s flouridation dental program when it’s going to be covered in 2014 by federal law that most of us are paying for anyway.

  102. Frankly

    [i]It seems idiotic to me to pay for a local children’s flouridation dental program when it’s going to be covered in 2014 by federal law that most of us are paying for anyway.[/i]

    I agree. I made that point early on.

    I think this debate is over. The libs won on their Obamacare dream of one more step toward a communist-style healthcare system. It addresses the problem that they claim to care about driving their insistence that we dump fluoride drugs into our drinking water.

    So we can reject fluoride in the water because the alternative is already being put in place.

    The reply to anyone still demanding fluoridation of our water should simply be…

    [b]Do like Notsee Peloski did after voting for Obamacare… go read the bill and discover that topical fluoride will be made available to all that cannot afford it.[/b]

  103. David M. Greenwald

    “The libs won on their Obamacare dream of one more step toward a communist-style healthcare system. “

    I echo the comments of DP, I think most liberals preferred single-payer but hold out hope that ACA will be better than the existing system – which is could hardly be worse.

  104. Frankly

    [i]there is no need to provide fluoride through the water supply. Supplements are available free, can be readily prescribed. So it seems it is mostly just a matter of getting the information out.[/i]

    What Don Shor said.

    [i]It seems idiotic to me to pay for a local children’s fluoridation dental program when it’s going to be covered in 2014 by federal law that most of us are paying for anyway.[/I]

    What GI said.

    Why are we even debating this?

    If Notsee Peloski and other DEMS in the Senate had actually read the Obamacare legislation before voting for it, maybe we would have had a chance to understand what was in it.

  105. Don Shor

    I think Brett’s check-off funding idea could be used to fund outreach and educational programs aimed at preschools, day care providers, and the range of professionals who can prescribe these supplements.

    Note: please don’t use ‘cute’ disparaging names for politicians or political groups here. That kind of thing tends to get out of hand and it’s harder to make subjective moderation decisions than to just ask that we all refrain from it.

  106. Frankly

    [i]please don’t use ‘cute’ disparaging names for politicians[/i]

    Got it. Just understand that there is contextual meaning in the name I used. She did [b]not see[/b] the legislation before she voted on it, and is on record being in favor of a federal communist-style healthcare system.

    But point taken.

  107. David M. Greenwald

    Frankly: I don’t really want to prolong the discussion, but legislators rarely read an entire bill. Their staffers may, but most of the time they rely on the digest. We can discuss whether that’s wise and surmise that it’s fraught with abuse. I won’t dispute either point.

  108. Growth Izzue

    Frankly, this flouridation issue puts these Davis liberals in a quandary. They would love to force us Davisites to pay for some kind of free flouride dental program but now that it has been pointed out that their beloved Obamacare will provide care they are now squirming for some way around it. I guess they don’t trust Obamacare either.

  109. David M. Greenwald

    Again you’re being too loose in your net here. As someone said the other day, all of the people leading the way against fluoridation are liberals. So which liberals are you talking about?

  110. Frankly

    GI, Yeah I am thinking the same. It irks me that this pile of bad legislation was passed to the glee of the left, and they continue on like it has not changed a thing.

    David’s comment that legislators rarely read an entire bill, with respect to Obamacare, irks me too since healthcare and healthcare service is extremely detailed and complex, and any Senator or congress person to have voted on it without having studied it deserves to be blasted with scorn and criticism. Paul Ryan read it cover to cover. What, Democrats can’t read? Or maybe they are too busy at their liberal Democrat fund-raising cocktail parties and don’t have time to read.

    In any case, it is right and prudent to push back on anything and everything they continue to opine for in the name of social justice if a solution is contained in the mega costly Obamacare bill. And, since just about everything is already contained in the Obamacare bill, I would expect very little opining from the left on these issues.

  111. Frankly

    David, list the liberals (or those that claim independence but with demonstrated left-leaning tendencies for the political issues debated) that blog on this site and just check off who supports water fluoridation and who does not.

    Then do the same for the right-leaning posters.

  112. Growth Izzue

    Frankly. it’s amusing just to sit back and now watch them back off Obamacare. Most of these Davis liberals, just like the Democrats in Congress, are running as fast as they can from it.

  113. David M. Greenwald

    I don’t have time to do that Frankly.

    GI, I really believe you don’t really understand the liberal position on health care and how for most what Obama passed was a compromise. But maybe we can discuss that more later as council goes on break and there is less in the way of local news to cover for the next few months.

  114. Growth Izzue

    Frankly, saying that they wanted single payer is how most liberals are going to run from Obamacare now that they can see the writing on the wall even though they defended it.

  115. Don Shor

    This is nonsense.
    68% of liberals support the ACA.
    12% oppose it because it is not liberal enough.
    The premise that liberals are going to run away from or back off from the ACA has no basis.
    [url]http://i2.cdn.turner.com/cnn/2013/images/05/28/healthcarepoll.pdf[/url]

  116. Frankly

    I think what GI is saying, and I absolutely know that he is correct, is that as Obamacare moves forward and every problem that the critics said would happen does happen, the left will slither to a comfortable escape strategy of saying that they wanted single-payer so the Republicans are responsible for the problems since it was their demands for compromise that caused the stinking and crappy pile of costly legislation that we call Obamacare.

    Those on the left demonstrate over and over again that they lack the humility, honesty and moral standards to every admit when they are wrong. They were wrong about Obamacare, and the political-right was correct. It is making a mess out of our healthcare system for very little, if any, net gain.

  117. Don Shor

    I think that is completely incorrect because most people will be happy with the changes the ACA has brought and will continue to bring, and would support minor legislative changes to fix any minor glitches in implementation. We expect it will be of considerable benefit to many, many people. I don’t personally expect everything to go perfectly.
    It is typical for there to be a need for followup legislation, for corrective regulations, and other changes to make implementation go more smoothly. There are also some outcomes that simply cannot be predicted in advance, such as the degree of compliance with the individual mandate, how governors would react to the Medicare expansion, and so forth.

    I think you consider me to be on the left, and certainly David, medwoman, and others. I’m sorry you think we’re arrogant, dishonest, and immoral. That is exactly what you just said. I don’t make those sorts of disparaging comments about you or about the conservatives that I know.

  118. K.Smith

    [quote]Those on the left demonstrate over and over again that they lack the humility, honesty and moral standards to every admit when they are wrong. [/quote]
    This is a problem that seems to exist liberally in both parties. I hope you’re not suggesting that all of those on the right ALWAYS demonstrate the UTMOST humility, honesty and moral standards?

    This black-and-white thinking is pretty astounding.

  119. Frankly

    K. Smith, no I don’t think there is much absolute anything when it comes to group behavior. Just insert “generally” or “generally speaking” in front of everything I write about liberals and conservatives.

    This constant denial of common and general liberal group behavior is pretty astounding especially as it is occurring at the same time it is being denied. What are liberals if not members of a group that exhibit certain common behavior, opinion and ideas? I don’t deny that I am a conservative person and that I exhibit common behavior, opinion and ideas matching my peers in the conservative group. Why does it set off liberals so much to be identified the same way?

    I think people with a left political orientation more often than not are more risk averse and demonstrate a greater fear of failure that drives their opinions and decisions. They are so fearful of failure that they will spend significant effort designing exit strategies for potential accountability. This is not absolute by any stretch, but I see it as a general truth for liberals as a group. This lack of accountability presents a serious problem for granting leadership authority. Obama is a prime example. What has he taken responsibility for? He is the Teflon king executing a well-planned strategy to never having to accept responsibility for mistakes and errors. When members of the press attempt to call him on some administrative calamity he bristles, denies and attacks the messenger for being mean, stupid, biased… etc. These are classic liberal behaviors and tactics.

    I truly see less ideological absolutism from the political right for topics like healthcare. Conservatives will support an approach that provides the best value at the lowest cost. Liberals are more driven by an ideological agenda that in turn is driven from an emotional basis that also demands their version of social justice. However, Obamacare was sold to the public as improving healthcare and lowering government spending and lowering individual healthcare costs. Those that pushed it and supported it are turning out to be wrong… very wrong. Are you going to stand up and take responsibility for being so wrong (assuming you supported it)?

    One last thing… liberals are in control of this city, this state, and they control most of the policy, legislative decision-making at the federal level. Power and leadership comes at a cost of having to accept more criticism. If Obama has proven anything it is that skin color is far less of an issue than is the thinness of a president’s skin. Will he stand up and say “I screwed up” when Obamacare leads to greater unemployment and greater under-employment; higher healthcare costs; increased delays for service; and far fewer that 100% of the currently uninsured being insured? Don’t bet on it.

  120. Frankly

    [i]I don’t make those sorts of disparaging comments about you or about the conservatives that I know.[/i]

    No Don, those on the left just says we are stupid, uneducated, racist, greedy, non-caring, bible-thumping, gun-loving people.

    But they generally do it with artful nuance and elegance so they can rely on an exit strategy of not having to admit they actually “meant” those things.

  121. Matt Williams

    Frankly said . . .

    [i]”Single payer (aka government-run) healthcare is a terrible idea. Just like all other government-run anything it ends up too politicized and ultimately declines under its own unsustainable bureaucratic bloat. Think healthcare service comparable to a trip to the DMV. Think healthcare business similar to the USPS.”[/i]

    You and I differ substantially on this issue. First off, a single payer system would not be “government run,” it would be run by the administrative/operational (TPA) arms of the current insurance industry. The only role that the government would play in it would be to manage the single actuarial pool to calculate the rates that would apply to the various “flavors” of coverage that would be offered. The base coverage would be very, very inexpensive (for some free), and other flavors with increasing levels of coverage would be offered for an incremental fee over and above the base coverage.

  122. Don Shor

    [quote]Those on the left demonstrate over and over again that they lack the humility, honesty and moral standards to every admit when they are wrong. [/quote]
    [quote]… I exhibit common behavior, opinion and ideas matching my peers in the conservative group. Why does it set off liberals so much to be identified the same way? [/quote]
    I can’t imagine.

    What’s interesting is this thread is about fluoridation, and we have strong evidence that the Affordable Care Act, with its emphasis on preventive care, will provide the benefits of fluoridation with little cost to local government. Yet it led to this long rant about the ACA and liberals, and how the act will fail (is already a failure, apparently), and on and on.
    So in this instance, the ACA works.
    By the way, it was designed by those folks — a coalition of liberals and centrists — who you say are ‘risk averse’ and have a ‘fear of failure’. So sometimes, apparently, the ACA is a massive, radical restructuring of the economy and our health care system, yet the people who did it with [i]zero[/i] help from conservatives are ‘risk averse’.
    I do think that ‘single payer’ is being disparaged unnecessarily. I don’t support having the whole health care system single payer. But a large part of it already is. The United States has a mix of private insurance and single payer — VA and Medicare provide for a large number of people. One effect of the ACA is to increase the number of people on one form of single payer — Medicare. But the overwhelming majority of people will remain on private insurance.

  123. Growth Izzue

    Too funny Don, the problem was that when Frankly and I pointed out that it looks like the ACA will pay for children’s flouridation it was your many of your friends on the left who started backing away from this news.

  124. Ernesto

    David, as a fellow parent, I feel for the dental issues you’re having with the children in your care.

    It does not follow however that they would not have the dental issues if their water had been fluoridated. Kids in fluoridated municipalities get cavities at the same rates as those in non-fluoridated areas.

    Yes, some will dispute this assertion by citing specifically chosen studies, but the York meta-survey found, at best, very minimal evidence that water fluoridation actually did any good, about a 0.2 difference in caries (i.e. one fifth of a single cavity per child), and even so the York researchers concluded that quality of fluoridation studies was weak.

    The evidence for the benefits of water fluoridation is weak, if you approach the research from an unbiased starting point. Especially when compared to its costs. This is why most advanced nations in the world have rejected it.

  125. Brett

    Hi Medwoman,
    I am working on a specific proposal to present to my council colleagues. I hope I will be able to place it on the council agenda so we can discuss and vote on it. Hopefully my colleagues will support it.

    Just as an FYI, this is not like we are pioneers in this area. Many communities have mobile dental health clinics that visit schools and churches to help kids and families with improved dental health.

    [url]https://www.google.com/search?q=mobile+dental+clinic&noj=1&tbm=isch&tbo=u&source=univ&sa=X&ei=VwDeUer6OfL3yAG_6oCIBQ&sqi=2&ved=0CFkQsAQ&biw=1010&bih=556[/url]

  126. medwoman

    [quote]the left will slither to a comfortable escape strategy of saying that they wanted single-payer so the Republicans are responsible for the problems[/quote]

    i would like to echo and perhaps elaborate on some of Don’s points. There will be no “slithering to a comfortable escape strategy for me. For over 40 years I have supported a single party payer system and supported Obamacare only as the only way that I could see that anything would likely occur to move to an actual health care system. My emphasis is on the word “system”. As I have posted previously I do not believe that the United States has a “system” of health care at all. What we have is not as the most applicable definition of the word I could find in the Miriam Webster dictionary “an organization forming a network especially for distributing something or serving a common purpose “. What we have is a poorly distributed, arbitrarily priced, arbitrarily favored treatment modalities, employment dependent, fee for service , insurance mitigated mess.

    You think that you and your doctor make the decisions about your care without outside profit driven motivation ? This is only likely to be true if : a) you are extremely wealthy and are going to pay for your care out of pocket and simply dont care about the cost b) you are eligible for care provided by the military or Veteran’s Administration c) you have care through a very large integrated care system such as a major center such as the Mayo or Kaiser or a Kaiser model integrated care plan. If not, what studies you have done, in what order and what treatments and medications you will be offered depends upon what the non medical staffer at an insurance company company chosen by your employer decides you can have.

    So what would be the characteristics of a health care system I would favor be ?
    1) Universal coverage for everyone
    2) Prevention focused
    3) Salaried doctors, nurses, and ancillary health care workers
    4) No fee for service
    5) Not linked to employment
    6) Unfettered choice of physicians and other providers
    7) Universally accessible electronic medical records ( you would probably not believe the amount of unnecessary costly testing that occurs because of unavailable test results)
    8) Diagnostics and treatment based on best evidence available – not simply someone’s opinion based on
    their sometimes wildly outdated training or because ” it has worked for me”
    9) No “gifts” from drug and equipment representatives frequently leading to much more expensive and no more
    effective treatment options.
    10) Mandatory arbitration for all “malpractice” or ” poor outcome cases”
    11) Maximal utilization of the skills of providers at all levels of care. No artificial blocking or restricting of the
    practices of mid level providers. Care provided by the lowest cost practitioner having the demonstrated competency to deal with the condition for which you are seeking care.
    12) Not dependent on any “pre existing condition” or any trumped up error you may have made on an application
    13) Provide as much care in or as close to the patient’s home, school, or job as possible.

    If someone wants to call this a “communist system” fine, have at it. But in the many, many developed countries that have much better health outcomes than we do, much of their systematic approach incorporates many of these principles.

  127. medwoman

    Hi Brett,

    I would also like to see such a dental outreach program. Having on a number of occasions participated in
    “outreach” rural gynecology clinics, I am very much aware of the value of this approach. I am eager to see the
    “nuts and bolts” of your proposal and how you might envision paying for the start up and maintenance costs.

    I remain concerned about the feasibility and sustainability of this type of program when we have not even, on the county level, been able to sustain school nurses with some highly undesirable but fully predictable outcomes on public health which I would be happy to discuss with you off this thread since unrelated to the current topic.

  128. Brett

    Hi Medwoman,
    Just so it is clear, I am not going to propose that the City run a dental clinic or program. The City’s role would be to facilitate donations and the money would be used by Communicare or another nonprofit that does have experience running and providing dental programs.

  129. medwoman

    Brett

    [quote]Just so it is clear, I am not going to propose that the City run a dental clinic or program. The City’s role would be to facilitate donations and the money would be used by Communicare or another nonprofit that does have experience running and providing dental programs
    [/quote]

    This is absolutely clear to me. It is also part of the reason that I have supported fluoridation so strongly. What I have seen in the past and I suspect will see again is that while public attention is temporarily drawn to the subject of preventive dentistry when a controversial issue such as water fluoridation arises, this attention will rapidly fade once the proposal is defeated. Unless there are some guarantees that the funding source will be constant, the program will fade as soon as attention is drawn elsewhere. Water fluoridation, while far from a perfect solution, does provide a level of prevention which does not have to be constantly revisited.
    Also, it benefits a far larger segment of the population than just underserved children but rather individuals who may be at need across their lifespan. When considering alternatives that would be run by a non profit, I think it is a good idea to consider what the appropriate professionals from those non profits feel is the best solution. It would seem to me that the very experienced professionals at Communicare who are the best equipped to understand their own strengths and limitations strongly support water fluoridation.

    I see this as an “and” situation, not a “either/or”. I remain in support of water fluoridation….and….I support, as always funding for programs such as you are suggesting.

  130. ebowler

    In many European countries, dental screenings are conducted in elementary schools similar to the vision screenings currently being done in Davis schools. This is one place where dental therapists would be very helpful, nyscof. I also like the mobile dental clinic idea for treatment of dental disease.

  131. Frankly

    Matt – That is fine, but that is not what single-payer is. Single-payer is essentially government taking over the health care insurance industry. I think what you are proposing is that government take over the actuarial process and also completely regulate the plan designs as mandates. How would profit opportunity and loss risk transfer to insurance providers with this model? You would have to implement a general profit and loss pool distribution model to all private service providers. At that point you might as well just have the government take over the insurance industry because it would be a mess.

    Here is what I would suggest instead:

    – Greater competition of insurance companies across state lines.
    – Tort reform
    – Government regulations for requiring providers to publish the actual costs and the contracted costs for all procedures, products and services so healthcare service consumers can make good choices.
    – Government regulations to collect patient and care outcome statistics for all care providers and publish healthcare service consumers can make good choices.
    – Mandates for insurance providers to cover people with pre-existing conditions with a sliding scale for the number of months without insurance coverage. Exceptions for genuine demonstrated financial hardship (using tax-reported family income).
    – Promotion of HSA PPO high-deductible coverage plans. Tax incentives to promote health savings through better individual healthcare consumer utilization management.
    – Tax incentives for employer wellness programs.
    – Economic development and tax incentives for health clinics in underserved areas.
    – Enhance programs to supplement healthcare professional education for students’ commitments to work in clinics in underserved territories for a period of time.

    We have really screwed this up by allowing our social justice hearts to overwhelm our market-focused brains. The US is a unique country made great by our ability to leverage the natural human pursuit of self interest to maximize the benefits of the resulting innovation and creativity energy. The whole is absolutely greater than the sum of its parts. Instead of taking this market-based approach where government can implement the framework to foment competition that helps keep value high, we have allowed a few “smart” people to implement a takeover.

    I like the sports analogy of the NFL where Obamacare is like the game being played with a bunch of men in suits running around the offices and the field directing the owners, coaches and players’ every move… and then building a list of excuses for why it is not their fault that the game declined and fans grow less and less satisfied.

    We have taken the exact wrong approach to healthcare reform because some of us think we can be Norway.

    By the way, related to Obamacare, it is clear that the politicians running States and Cities will start attempting to push their retirees onto the insurance exchanges as a bailout for their over-commitments to public employee unions in return for political power. You have to wonder if this wasn’t part of a master plan given the alternative.

  132. Matt Williams

    Frankly said . . .

    [i]”Matt – That is fine, but that is not what single-payer is. Single-payer is essentially government taking over the health care insurance industry. I think what you are proposing is that government take over the actuarial process and also completely regulate the plan designs as mandates. How would profit opportunity and loss risk transfer to insurance providers with this model? You would have to implement a general profit and loss pool distribution model to all private service providers. At that point you might as well just have the government take over the insurance industry because it would be a mess.

    Here is what I would suggest instead:

    – Greater competition of insurance companies across state lines. “[/i]

    Frankly, I couldn’t disagree with you more. Competition between insurance companies isn’t going to resolve a single problem that our current health system has.

    Think about all the totally wasted and wasteful money that insurance companies spend on marketing and sales. All those hundreds of millions (dare I say billions) of dollars would be redirected into paying for preventative care. The number of billing and collections personnel that work for hospitals would be halved. Virtually all the financial analysis department personnel in hospitals and supporting physicians groups would be eliminated and the hundreds of millions of dollars spent thereon redirected into care. You would wipe out a whole cadre of [u]totally unnecessary[/u] middle managers. [u] In essence the parasites sucking the life out of care giving would move on to other industries.[/u] When I came into healthcare in the early 80’s, administrative overhead was in the 8-10% range. Now it is in the vicinity of or above 20%. The waste is mind boggling. The multitude of private healthcare plans is the single largest contributor to that increase in administrative costs.

  133. Don Shor

    “Already, the law has provided 54 million Americans free access to preventive services like check-ups and mammograms.
    More than six million seniors have saved more than six billion dollars on their prescriptions.
    Nearly 13 million consumers have received more than one billion dollars in rebates from insurance companies that had overcharged them.
    … more than three million … young adults … have been allowed to stay on their parents’ health insurance until they turn 26.”
    Jon Favreau

    Individuals with pre-existing conditions will be able to get insurance.

    When the exchanges come on line, shopping for private insurance by individuals and small businesses (presently unable to readily buy in group plans) will be greatly simplified.

    An essential benefits package will be mandated, eliminating the capricious coverage exclusions that insurance companies had been using to cut costs and increase profits.

    This is what conservatives are afraid of. The ACA benefits millions of Americans immediately and permanently, in tangible ways. All the reactionaries will have is ‘horror’ stories about a small number of businesses that will drop coverage, and employers who will supposedly refuse to increase employment because of the insurance costs. Most of those stories will be anecdotal, unprovable, and frankly implausible. What they are afraid of is that ACA will ‘work’ for a huge percentage of the population, will barely affect the overwhelming majority of Americans, and will become an established entitlement that they had nothing to do with enacting.

    So they have already started the drumbeat. It’s a failure, they say. There are already businesses cutting jobs because of it, which is not plausible. Employers are already claiming to be hurt by it. Because they need to ramp up the rhetoric now, before most of the benefits kick in.

    And it is clearly the policy of the Republican leadership in Washington to refuse to try to improve the bill, and of Republican governors to refuse to enact any portion over which they have control. They know they’ve only got a few months now to try to persuade Americans that the ACA is bad, bad, bad, and all they have is scare tactics and obstructionism.

    The fact is, there will never be a definition of ‘works’ for the ACA, because it was intended to do several things and the analysis of those outcomes will be very partisan. Most people will consider it a success if it increases access to health care and reduces the hardships created by lack of insurance or under-insurance, conditions which were increasing dramatically over the last few years. If it reduces health care costs somewhat, so much the better. But nobody will ever be able to prove the impact on jobs or the economy, because there are too many other variables involved. So all you have left is ‘my brother-in-law says his company is making everyone part-time because of Obamacare’.

    Well, so what? Some employers will make stupid decisions about employment. Not all business owners are rational. And for a few, it might make more sense to urge their employees toward the exchanges, and make up the cost in their wages or salaries. Some will drop insurance, others will offer it for the first time. A lot of poor people will be able to get insurance with subsidies. There will be a lot of benefits to a lot of people, and the ACA isn’t going away. So serious lawmakers who actually want to do their job will propose fixes and work to make it better. And frivolous lawmakers will vote 37 times to repeal it, knowing full well that their actions are pointless and look plain stupid at this point.

    And it provides an alternative source of fluoridation.

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