Sunday Commentary II: Beyond Fluoridation

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fluoride-water

Last December, I ran a piece called “The Other Davis,” which referred to a subsection of people who live in Davis and whom we may not see every day at our community meetings.  These are not the affluent members of our community, but they are present in our community nonetheless, and may be a growing subsection.

This was driven home to me this week as I dropped my nephew off at his new school at Pioneer which, by all appearances, looks like a typical Davis mix, and then headed over to Montgomery where my daughter is going to preschool through Head Start – and the contrast was amazing.

Barbara King’s letter to the editor today argues that “fluoridation is not social justice.”  While I remain ambivalent on the benefits of fluoridated water, I am convinced that the overall situation which we are attempting to deal with is about social justice.

However, as I unfairly steal from Medwoman’s quote, I believe she is correct in saying that “multiple fluoridation strategies will work.”

I am not a believer in many of the opposition’s arguments against fluoridation – I do not see this as a choice issue, I believe that society as a whole has the obligation to step in to make sure that the least of us are protected.  Most of the studies citing the dangers of high exposure to fluoridation are citing figures far higher than what is being proposed and, even then, the risks are relatively low.

On the other hand, there is a cost to fluoridating the water and I am far from convinced it is the best bang for the buck.  For most people, who have access to dental coverage and toothpaste, there are probably other ways to get the extra protection that fluoridated water might provide.

Furthermore, the children who really need the treatment are likely not consuming enough tap water to get the fluoride they need.

Opponents will point out that Medi-Cal and apparently the Affordable Care Act will provide low-income people with fluoride tablets and other augmentations to dental care and regular application of fluoride through toothpaste, but what concerns me is the subsection of the population who are impoverished children, not getting adequate dental coverage or adequate parental supervision.

One commenter on Friday made a much more telling comment than I think was intended: “Oh, you mean parents acting responsibly. So would you also want us to provide healthy meals to each child’s home and to go into their homes and make sure that the parents are feeding them properly?”

In fact, schools provide low-income children breakfast and lunch.  For some kids, sadly, these are the only meals they will eat.  Last year, four elementary schools in Davis qualified for Title I funding: Birch Lane, Montgomery, Patwin, and North Davis Elementary.

We do not have statistics available as to how many kids have those as their only meals.  But we should not be naïve that we have poor people in Davis.

Moving our nephew from Patwin to Pioneer this year meant that he did not have a breakfast provided by the school anymore.  And while that is not a huge problem for us, I wonder for how many people in this community that is a burden.

My eyes have been increasingly opened to the existence of two communities within our broader Davis community, and that point was driven home earlier this week as I first dropped my nephew off at Pioneer and then my daughter at Head Start at Montgomery.  We do not think of Davis as having differentiation, but the differences in the populations at the two schools were stark – and surprisingly so.

The issue of fluoridation has caused me to look at these differences in a new light, and I realized that we are not doing all we can for our lesser-advantaged kids.

The question becomes – because I believe that fluoridation of the water is probably by itself not going to solve the problems, and because I believe that fluoridation is politically infeasible – how do we ensure that those kids, the ones most vulnerable in our community, get the care that they need?

Following up on the work of one our councilmembers, there is a way forward here and that may be by bringing the treatment to the kids.  There are programs in other communities that deliver dental services through the use of mobile dental vans to outlying areas of counties, targeting children who are low-income and whose parents are uninsured.

One such program operates in San Luis Obispo County and Northern Santa Barbara County through the Community Health Center located in Nipomo, just north of Santa Maria.

Here they operate on an annual budget of $200,000 to $300,000.  But because they target mainly children with Medi-Cal or Denti-Cal, if half of the children have Medi-Cal, they can be fully funded through federal grants from various organizations and charities.

Similar programs could work here in Davis by creating a mobile dental clinic that works alongside a community clinic such as CommuniCare.

One estimate of the cost would be $250,000 to $500,000.  If we could get part of that funded through grants and through CommuniCare, the rest could be covered by funding that would have gone to fluoridating the water.

The question has arisen why now – has this not been a problem for the last 50 years?  I do not know if it has been a problem for the last fifty years. I do know that our underserved population has grown and I also know that this debate over fluoridation has raised my level of awareness about the problem.

Truth be told, I am increasingly concerned, not just about underprivileged children getting dental care, but having access to health care in general, as well as food.

So, while I agree that multiple fluoridation strategies are needed, I also believe that the need goes beyond fluoridation and beyond dental health.

My biggest concern is that I believe this is a rising population group and that we as a community really have no idea how many children this impacts or what the scope of the problem is.

However, I believe the best approach is to avoid polarizing issues, and work together on common solutions that most of us can agree to.

—David M. Greenwald reporting

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About The Author

David Greenwald is the founder, editor, and executive director of the Davis Vanguard. He founded the Vanguard in 2006. David Greenwald moved to Davis in 1996 to attend Graduate School at UC Davis in Political Science. He lives in South Davis with his wife Cecilia Escamilla Greenwald and three children.

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62 thoughts on “Sunday Commentary II: Beyond Fluoridation”

  1. medwoman

    [quote]I believe the best approach is to avoid polarizing issues and work together on common solutions[/quote]

    I agree with you whole heartedly David. However, if even part of the funding is to be voluntary as suggested by Brett Lee, or through funding that “would have been used for fluoridation”, I think this proposed alternative will fail. And I believe that it will fail for a very simple reason. It is not just fluoride that is a polarizing issue.
    It is the provision of public health care and or provision of health care for anyone other than oneself that is polarizing.

    You have to look no further than the comment you quoted :

    [quote]Oh, you mean parents acting responsibly. So would you also want us to provide healthy meals to each child’s home and to go into their homes and make sure that the parents are feeding them properly?”[/quote]

    and the multiple scornful comments made by Frankly who genuinely does not believe there is any need to provide for less advantaged members of our community as recently posted :

    [quote]you and others cannot seem to get out of the way of that soft bigotry of low expectations that provides you an emotional connection to save people from their own bad decisions.[/quote]

    So you see David, we didn’t need the issue of fluoride to polarize us. We are already polarized between those who feel that there is no need to take care of those who are less advantaged, because the children are the responsibility of their parents, and those of us who feel that the children and less advantaged are the responsibility of all of us. It seems to me that the issue is not “saving people from their own bad decisions” but frequently saving children from the bad decisions of their parents. Do we really believe as a society that this is not a worthy goal which will ultimately make us stronger as individuals and ultimately as a society ?

  2. B. Nice

    “It seems to me that the issue is not “saving people from their own bad decisions” but frequently saving children from the bad decisions of their parents. Do we really believe as a society that this is not a worthy goal which will ultimately make us stronger as individuals and ultimately as a society ?”

    I agree, and would say goes beyond just bad decisions from parents, who sometimes lack knowledge regarding proper dental care and appropriate nutritional choices, as well as access to dental care (not talking about cost, but transportation issues, getting off work, etc) and their kids suffer.

    The more I think about this issue, and others related to it, I realize we different model of care to help this population of kids. We are trying to force a square peg into a round hole. Why not add a square hole? Instead of thinking of this as, “you and others cannot seem to get out of the way of that soft bigotry of low expectations that provides you an emotional connection to save people from their own bad decisions.” Why not view it instead as providing more options so it’s easier for people to make good decisions? (This isn’t about fluoride as much as alternative idea’s like Mobil Dentist Van).

  3. David M. Greenwald

    “So you see David, we didn’t need the issue of fluoride to polarize us. “

    This is true. However, in Davis, I think we have stronger support for helping the less fortunate than we do for fluoridating water. But I hear you.

    In terms of Brett’s voluntary proposal, I think that came early in his research and there might be other ways to fund that are through medi-cal and grants. That’s what the research I saw indicated.

  4. B. Nice

    Another “beyond fluoridation” idea. I think DJUSD should consider operating a year-round program (probably at Montgomery). Kids could go to school for the same number of days but breaks would be spread out during the year. This would benefit our migrant population who’s kids are here during the summer, and from what I understand from teachers often leave for long stretches in the winter, and it would help lower income families who cannot afford childcare or expensive camps for their kids over the summer. It would also provide meals for those who qualify for under Title Funding.

  5. Edgar Wai

    Re: Differences in policy types

    A key property of water fluoridation as a policy is that it does not implement an voluntary option. A policy that implements a voluntary option does not require a change in action to avoid, it only requires a change in action for those that choose the effect.

    The more involuntary the policy, the more justification is required. The weight of justification follows this ranking:

    1. The involuntary policy prevents the entity subjected to the change from harming others. (Ex. Mandatory security check at airports.)

    2. The involuntary policy prevents the entity from creating an issue that costs unaccounted spending of public assets.

    3. The involuntary policy maintains a standard of the community which the community has been using to make plans and decisions.

    4. The involuntary policy prevents the entity from harming the entity’s self.

    * * *

    In our context, when the proponents of water fluoridation cites the statement that for every $1 spent on the project, $38 is saved, they are alluring to the justification for a Type 2 policy.

    The justification for that type of policy requires the following numbers:

    A) The current cost of inaction
    B) The cost to make the individuals accountable (instead of the entire public to be accountable)
    C) The cost of the involuntary policy that reduces the existing cost.
    D) The compensation to those subjected to the involuntary policy.

    To justify the policy, these inequalities must hold:

    a. It is more expensive for the community to make the individuals accountable than to just absorb the cost. [b]B > A[/b]
    b. The cost of the alternative plan is lower than the current cost. [b]A > C[/b]
    c. The compensation to those subjected to the policy plus the cost of the plan is less than the current cost of the plan. [b]A > C + D[/b]

    The policy is justified when B > A > C + D.

    If any of the inequality does not hold, then the policy is illogical because it worsen the situation.

    From what I know about issue is the following:

    A)Unknown. The policy makers should know how much the situation is currently costing our system. Otherwise there is no basis to justify a change that visibly would withdraw money from the public asset. Making a decision without knowing the current cost is equivalent to materializing a hypothetical loss.

    B) Unknown. An involuntary policy that makes the individuals accountable would be similar to the policy where a parent would go to jail if their kids skip school. In this case, we would be talking about a fine for the parent who fail to take their kids to regular dental check-up.

    C) According to the discussion, there are these plans:
    i) Water fluoridation, $837K to $2067K [Ref] ([url]https://davisvanguard.org/index.php?option=com_content&view=article&id=7630:analysis-fluoridation-to-go-forward-for-discussion-on-october-1&catid=60:water&Itemid=92[/url])
    ii) Mobile dental clinic, $250K to $500K [Ref: This article] ([url]https://davisvanguard.org/index.php?option=com_content&view=article&id=7635:sunday-commentary-ii-beyond-fluoridation&catid=60:water&Itemid=92[/url])
    iii) Medi-Cal program, $200K to $300K [Ref: This article] ([url]https://davisvanguard.org/index.php?option=com_content&view=article&id=7635:sunday-commentary-ii-beyond-fluoridation&catid=60:water&Itemid=92[/url])

    D) Unknown.

  6. Edgar Wai

    Sorry I misread a paragraph there is no option (iii) in the article. C should be just these:

    [quote]C) According to the discussion, there are these plans:
    i) Water fluoridation, $837K to $2067K [Ref]
    ii) Mobile dental clinic, $250K to $500K [Ref: This article] [/quote]

  7. Edgar Wai

    A community should first and foremost define the responsibilities of the citizens. It is important for a person to know that they are being helped when they are given help, so that the people do not take assistance for granted and weaken the ownership of accountability and responsibility.

    By grade school a kid should know that they are responsible for their health. A kid should have the ability to tell when their parents are not taking care of their health.

    This understanding of responsibility and ethics is more important then preventing dental caries, because once a person understands their responsibility, they become conscious enough to take initiatives to resolve their issues and the issues of others. We need those kids to understand their responsibilities so that they do not see themselves as dependents, but an asset of new knowledge and ethics in their own family.

    The world has many irresponsible people. It is a noble act to uphold one’s own responsibility and to transform the others so that everyone become responsible, because there is a peer/social pressure against responsible people when they go to a place surrounded by people who are irresponsible. It requires integrity to accept and uphold one’s own responsibility. Various kinds of corruptions occur because people cannot uphold that integrity. The community needs to train people who can do this in order to change the world.

    The school teaches the kids this, the kids go home and see first hand the difficulty to uphold it, even in the smaller scale of their own home. But that is not a problem. That is the training ground to forge the new generation. The general plan does not settle in making people self-sufficient. The general plan aims for training a generation that can turn the tides. We are trying to train heroes. When we tell a kid to be responsible of themselves and uphold it to transform their family, we as a community should acknowledge that the kid is taking on a noble deed. Any kids who accepts that challenge are not dependents, but assets of the community.

  8. JustSaying

    Edgar, your scheme doesn’t seem to include a factor for the relative effectiveness of the three alternatives. Good luck on determining this, the way the debate is going. And, what does your system do when the arguments are so conflicting and emotional?

  9. ebowler

    [quote]It is not just fluoride that is a polarizing issue.
    It is the provision of public health care and or provision of health care for anyone other than oneself that is polarizing.
    [/quote]

    It is not only inaccurate, but also simplistic and arrogant, to suggest that water fluoridation opponents are opposed to health care coverage for all. For example, while I support single payer universal health care, I oppose water fluoridation because it is ineffective and does nothing to address the problem of the excessive consumption of sugar, processed foods and refined carbohydrates that is causing the health problems in the first place.

    Lauren Ayers, in a commentary on this site, called for an overhaul of the school breakfast and lunch programs, which I strongly support. Also on this site, I have repeatedly called for restriction of the sale of sugary drinks to children in much the same way that we restrict sales of alcohol and tobacco to minors. I have yet to hear any fluoride proponents express their support for this proposal, which would actually address the dietary issues underlying dental decay, obesity and a host of other problems.

  10. Frankly

    Bravo Edgar! Exactly.

    And related to your fine points…

    Yes we are polarized on this issue. We are polarized by the very simple to understand malady of classism. Davis elites are obsessed with it. They stratify the community as those having a certain amount of money belonging in one class and those having less belonging to another class. Two classes: the haves, and the have-nots.

    As if that isn’t bad enough, Davis elites also attribute lower intelligence and certain bad behavior to people in their definition of lower class. Of course they will deny this with their standard denials and dichotomy of social justice good and bad; but their actions always speak loudly in conflict with their words. Their actions say “Poor people are ignorant and we highly-educated elites have a responsibility to provide the care that they themselves will always be incapable of providing themselves.” And then the next smokescreen (ironically the same used to protect teacher jobs in crappy schools): “It is for the kids.”

    Maybe having been born to one of those elite-defined low-class families causes me to burn hotter in rejection of the negative inferences. Maybe because I spent much of my life working as a have-not to climb to higher levels of prosperity, I know that there is nothing preventing most others from doing the same.

    I realize that the fluoride issue is not necessary ideological. There are right-leaning people in this community that also support water fluoridation. However, these people support it for different reasons. They support it because they tend to value tradition and, frankly, they have a much higher threshold of proof before they let go of tradition. But they are the minority here. And, many have jumped to the anti-fluoridation side because their burden of proof has been satisfied.

    Just reading the Vanguard and the letters to the editor in the Davis Enterprise, 90% of the opinions in support of water fluoridation are the liberal social justice flavor.

    So, let’s say that someone like me can get over Davis elites’ negative class-based inferences and simply “do it for the kids”. Well, there are several problems.

  11. Frankly

    1. As Edgar points out, we [b]would perpetuate bad dental hygiene habits[/b] in our population…
    [quote]It is important for a person to know that they are being helped when they are given help, so that the people do not take assistance for granted and weaken the ownership of accountability and responsibility. [/quote]
    This is a key point that seems lost on the elite social justice do-gooder. It is the common “no good deed goes unpunished”, and the “the road to hell is paved with good intentions” principles at work. You can train any animal to become more destructively dependent… especially the human animal.

    2. [b]There are better alternatives to improve the incidents of tooth decay in the population.[/b] Fluoride is proven most effective as a topical medication. Obamacare provides low income families access to dental care where they can be prescribed topical fluoride.

    3. [b]It does not help.[/b] The data clearly shows that dental carries for all countries, including those that fluoridate the water and those that don’t, have declined in the last 50 years to be almost exactly the same. The body of scientific evidence is conflicted at best, but tends to back the claim that there are no longer any material measurable benefits to water fluoridation.

    4. [b]It is harmful.[/b] Ingesting excessive fluoride is harmful. It causes fluorosis and other health problems. The incidences of fluorosis are higher in areas where there are higher levels of fluoride in the water. The FDA defines fluoride as a toxin/poison and requires it be labeled as such on products. It is in far more products. Artificial sweeteners have been developed and hence children’s toothpaste has been made to taste like candy. Parents cannot stop the younger kids from swallowing some of the toothpaste. Adding fluoride to the water exacerbates the risk that some children will ingest too much fluoride.

    5. [b]It force-mediates the population against their will.[/b] Purchasing bottled water is not an alternative. First, fluoride would be ingested from taking showers or baths and washing hands. It would be on drinking glasses and dishes washed with tap water. Bottled water is not a viable solution. It is expensive. Water is heavy. Many people in the city do not have the money purchase it nor the strength to carry it from the store to their homes. Forcing people who do not want to purchase drinking water would force them to purchase more disposable plastic water bottles, and this is bad for the environment. And it is highly inconvenient to extreme. The amount of water that would need to be purchased by the average family to avoid ingesting fluoride in the tap water makes it an extreme burden.

    Overall this is a crappy idea that we should not be debating and the city council should easily vote no and move on. Davis elites need to look for another social justice, class-based, codependent saver idea to push.

  12. Growth Izzue

    David
    [quote]The question has arisen why now – has this not been a problem for the last 50 years? I do not know if it has been a problem for the last fifty years.[/quote]

    And it sounds like you have no idea if it’s a problem now.

  13. medwoman

    David

    [quote]there might be other ways to fund that are through medi-cal and grants. That’s what the research I saw indicated.[/quote]

    There may well be. I would be interested in whom is being expected to take on the lead in this. When I had spoken to Brett earlier, he had indicated that he would be happy to fund raise, but was interested in Communicare taking on the actual implementation of this. And yet, it would seem to me that the majority of folks who are involved in public health, who are the most knowledgeable in the acquisition of grant money, and who are most involved in the actual provision of care, see fluoridation as the most cost effective option.

    So what we have is a group of people who are willing to make suggestions, which I always see as a positive step in the right direction. But who are not willing to themselves step up and say they would take an active role themselves in making it happen. If I am wrong about this, I would love to stand corrected.

  14. medwoman

    ebowler

    [quote]It is not only inaccurate, but also simplistic and arrogant, to suggest that water fluoridation opponents are opposed to health care coverage for all. [/quote]

    I am very sorry if I offended you personally. You will notice that at no point did I point a finger at you. What I did was to say that there are some members of our community that do feel this way and quoted a couple of comments in support.

    Do you really believe that there are no people who do not both oppose fluoridation and generally oppose health care coverage for all ? This is a classic example of “if the shoe fits, wear it” and if it doesn’t apply to you, lovely.

  15. medwoman

    Edgar and Frankly

    [quote]It is important for a person to know that they are being helped when they are given help, so that the people do not take assistance for granted and weaken the ownership of accountability and responsibility.[/quote]

    Ah, another point of complete agreement. I fully agree that when a child is receiving a school lunch, that they know that it is being supplied by other members of the community and that they also have a responsibility to give back once they are in a position to do so. Actually, this was an integral part of my childhood an adolescent out of school education. I was helped by first by Social Security, by a government first job for economically challenged teens program, and ultimately by having medical school in part paid for by the Indian Health Service.
    So yes, your parents taxes helped me get my education. I heard loud and clear the message that this was assistance and it was my duty to give back when I could. This is the piece that you seem to believe that all liberals miss. But I guarantee you that individual responsibility is very high on my list of priorities. I just take it further than you do. I believe that the individual has the responsibility to act not only for themselves and their immediate family, but for the well being of our entire society.

  16. medwoman

    Edgar

    [quote]By grade school a kid should know that they are responsible for their health. A kid should have the ability to tell when their parents are not taking care of their health. [/quote]

    In an ideal world, yes. But what happens Edgar when the response to the child telling the parent this is a smack across the bottom, or worse yet, the face ?

    Are you really suggesting that a grade school child will be able to, or should have the responsibility to educate or shame his parent into better behavior ? Maybe this is true in some sit coms and movies, but ask yourself if you think this is really the predominant child/parent paradigm in our community.

  17. Nancy Price

    Mobile Health Clinics might also serve the needs of the somewhat or entirely home-bound elderly and the disabled among us so we start taking care of the needs of the many in our community. This discussion over fluoridation may just provoke the broad comprehensive discussion we need about empathy, compassion, and care for our brothers and sisters that goes beyond the narrow discussion discussion to date on fluoride. By thinking about the segment of underserved population I menntion above, maybe the economic providing such care for the young and the elderly and indigent with local, state and federal funding could just work to the benefit of all and keep flouride out of the water supply and win/win for all including the fish.

  18. Nancy Price

    sorry, I was previewing my above comment to make corrections, which it obviously needs and somehow hit before getting to the edits. So, for the sake of literacy:
    Mobile Health Clinics might also serve the needs of the somewhat or entirely home-bound elderly and the disabled among us so we start taking care of the needs of not just the young and their teeth, but of all who need such care and don’t have access. This discussion over fluoridation may just provoke the broad comprehensive discussion we need about empathy, compassion, and care for our brothers and sisters that goes beyond the narrow discussion to date on fluoride for the young. By thinking about the segment of under-served population I mention above, maybe the economics of providing such care for the young and the elderly and indigent with local, state and federal funding could just work to the benefit of all and keep fluoride out of the water supply – a win/win for all including the fish.

  19. medwoman

    Edgar

    [quote]This understanding of responsibility and ethics is more important then preventing dental caries, because once a person understands their responsibility, they become conscious enough to take initiatives to resolve their issues and the issues of others. We need those kids to understand their responsibilities so that they do not see themselves as dependents, but an asset of new knowledge and ethics in their own family.
    [/quote]

    What steps would you suggest a six year old take to :
    1) Impress upon his parents the importance of regular dental care ?
    2) Provide enough money for that care if his parents can’t ?
    3) Force his parent’s employer to give his parent enough time off to take him to the dentist ?
    4) Get pain relief independently when he has a painful cavity ?

    Your posts suggest that all parents have no constraints, that they are just unaware and that a simple conversation with their elementary school child about the child’s needs will somehow fix the situation. I guarantee you having been nine, living rurally with no parent who drove, that a simple conversation would not have led to a different outcome. I didn’t have the conversation about some very important issues because I knew my mother could not help. What was the point in shaming her ? Luckily for me, there was public help available. If we do not provide a safety net, both with food, clothing, shelter, education, and yes, medical / dental care, then we are consigning to children to whatever their own parents can, or cannot provide. I think as an extremely wealthy nation, we can and should do better.

  20. medwoman

    Frankly

    1. We would perpetuate bad dental hygiene habits in our population.

    Your evidence that the dental habits of children in any fluoridated city are worse than those in a non
    fluoridated area would be what ?

    2. There are better ways. And since virtually our entire health care community does not agree, who exactly do
    you see as designing, paying for, and implementing these “better ways”? Are you volunteering ?

    3. Fluoride only works with topical application.

    4. It is harmful.
    Only if you overdose. And as one dentist put it, it is more likely that a child will develop fluorosis from
    applied fluoride as in toothpaste or drops or chewable tablets than by water fluoridation. Your own
    families experience would seem to support this view.

    5. It force medicates – no it doesn’t
    No one is forced to ingest the water. No one is coming to make you drink it. The bathing and present on the
    glasses argument simply doesn’t cut it since this would be far, far less than the amount you saw fit to
    administer to your own children.

  21. medwoman

    ebowler/Frankly

    [quote]Davis elites need to look for another social justice, class-based, codependent saver idea to push.[quote]

    This is the kind of comment that leads me to believe that there is polarization with regard to ideas about social justice and public welfare.

  22. ebowler

    [quote]Do you really believe that there are no people who do not both oppose fluoridation and generally oppose health care coverage for all ? [/quote]

    Of course there are some water fluoridation opponents who oppose universal health care, just as there are some water fluoridation proponents who oppose universal coverage. It is your generalization and characterization of water fluoridation opponents that I find objectionable. In fact, I probably know many more water fluoridation proponents who oppose a single payer system than I know opponents who do. I find generalizations of that kind to be frequently inaccurate and almost always unhelpful.

  23. tleonard

    medwoman, you state that adding fluoride to our water supply is not forced medication. In a prior post, you stated that a patient with renal impairment can make an educated decision to avoid drinking Davis tap water after the water is fluoridated. How do you propose that a [i]child[/i] with renal impairment will avoid drinking Davis tap water, particularly if it is a child in the less advantaged group that you are attempting to target with the water fluoridation program?

  24. Frankly

    [i]Your evidence that the dental habits of children in any fluoridated city are worse than those in a non
    fluoridated area would be what ? [/i]

    It is really very simple medwoman. You want fluoride in the water as a solution. Assuming you win, many people will stop caring about the real root causes of the problem. Some will say, “You got your damn fluoride in the water, now stop whining about dental care for poor people.” Some will think “Ok, I don’t need to stop drinking sugary drinks, and I don’t need to brush my teeth today since fluoride is in the water and it will prevent me from getting cavities.”

    People are infinitely trainable. It is our strength, and it is our curse. Your approach amplifies the curse.

    As a doctor, I’m sure you know the difference for treating symptoms and causes.

    Sure you will say “We should do it all!” In fact there is just no end to what your bleeding heart will demand. Always another lower socioeconomic class tragedy in circumstances that needs your attention… that allows you to work off that appreciation (guilt?) for all the help you got that allowed you to, I guess, magically become a doctor.

    I see you seeking to help yourself more than you are TRULY helping the targets of your altruism. In fact, I see it as destructive altruism.

    Have you ever experienced the moment when a person who is lacking in self-isms has the light bulb go on? I have, and in the moment I know that person is saved from ever having to be a social welfare charity case. Problem fixed… permanently.

    But with your approach, my work to help mentor, educate and develop that person would be undermined. You would be there to “save” the person. You would make it seem normal that one does not need to overcome certain levels of diversity and struggle (based on how bad it might make you feel). You would give people excuses for why they would not need to be persistent in extra effort to break the cycle of crappy family circumstances, crappy parenting, crappy public education, crappy job prospects, crappy pop-culture, etc., etc., etc… because medwoman and her liberal friends will come riding in on a white horse and save the day.

    The root causes of tooth decay are:

    1. Poor dental hygiene
    2. Poor diet
    3. Genetics

    The root cause of tooth decay is not insufficient fluoride in the water.

    It is a stupid idea at this point and time.

    Let’s work on solving root causes, and not corrupting public policy with so many expensive Band-Aids only treating symptoms which perpetuate problems just to make liberals feel better about themselves. The focus should be getting care and education to people that need it. Let’s invest in programs that develop self-sufficient people that can take care of themselves for the long run… that will have children one day and be better parents because the learned the lessons for making good choices and doing the right things. You know this is the right approach medwoman… I know you do.

  25. ebowler

    [quote]This is the kind of comment that leads me to believe that there is polarization with regard to ideas about social justice and public welfare.[/quote]

    Unfortunately, there are divisive comments being made on both sides of the issue.

  26. medwoman

    Frankly

    [quote]I see you seeking to help yourself more than you are TRULY helping the targets of your altruism. In fact, I see it as destructive altruism.
    [/quote]

    Tell that to the child who does not have enough to eat.

  27. medwoman

    Frankly

    [quote]But with your approach, my work to help mentor, educate and develop that person would be undermined[/quote]

    You have no evidence that this is true. Your speculations about what people might say if the water is fluoridated are just that, pure speculation. Maybe someone would be equally likely to say, “wow, with all of this talk about fluoridation, I am now more aware of the issue and plan to take even better care of my teeth.”

    I fail to see how fluoridation of the water prevents us in any way from your mentoring approach. As a matter of fact, I see them as complimentary approaches.

    If we are going to speculate, why just speculate on the negative side. David said this has raised his awareness of the issue. Is he the only one ? I suspect quite a few readers have gained a different perspective on the issue and its importance.

    [quote]Let’s work on solving root causes[/quote]

    I am all for this. However, the root cause of malaria is mosquitos. Would you have us with hold anti malarials from people who need them because it does not address the root cause ?
    My response is, let’s address the root causes that you have outlined ( as I also did in a previous thread) and at the same time, let’s optimize the fluoride in our drinking water. These are not exclusive approaches. I favor both.

  28. ebowler

    [quote]However, the root cause of malaria is mosquitos. Would you have us with hold anti malarials from people who need them because it does not address the root cause ? [/quote]

    medwoman, you have cited an excellent example for the case against fluoride. Anti-malarials are extremely effective treatments for malaria, just as antibiotics are highly effective against various infectious diseases. The same cannot be said, however, about water fluoridation as a treatment for dental decay and the other diseases caused by improper nutrition. At best, fluoride is modestly effectively when applied topically, not when used internally. Even given the effectiveness of the anti-malarials, I am not aware of their involuntary administration to entire populations in malaria-endemic areas.

  29. medwoman

    ebowler

    [quote]Fluoride is modestly effectively when applied topically, not when used internally.[/quote]

    This does not appear to be the opinion of the majority of dentists in the public health care community or those I have spoken with independently.

  30. ebowler

    [quote]This does not appear to be the opinion of the majority of dentists in the public health care community or those I have spoken with independently.[/quote]

    Indeed, the same people who continue to reassure us of the safety of mercury in amalgam fillings.

  31. B. Nice

    “Also on this site, I have repeatedly called for restriction of the sale of sugary drinks to children in much the same way that we restrict sales of alcohol and tobacco to minors”

    I would love to see schools prohibit kids from bringing anything to drink from home besides water. I’m on elementary campuses a lot and I see disheartening amounts of Gatorade, Sunny D, and other high sugar content drinks being consumed by young children.

  32. B. Nice

    “You would give people excuses for why they would not need to be persistent in extra effort to break the cycle of crappy family circumstances, crappy parenting, crappy public education, crappy job prospects, crappy pop-culture, etc., etc., etc… because medwoman and her liberal friends will come riding in on a white horse and save the day.”

    I thought we were talking about young children. Are 2 year olds ready to break the cycle of crappy family circumstances?

  33. ebowler

    [quote]I would love to see schools prohibit kids from bringing anything to drink from home besides water.[/quote]

    B. Nice, I agree but I would go even further and ban sugary drinks for children due to sugar’s extreme toxicity. Until we have effective public policy in place to control the use/abuse of sugar by children, I fear that the health problems will only continue to worsen.

  34. Edgar Wai

    Re: Medwoman

    [quote]What steps would you suggest a six year old take to :
    1) Impress upon his parents the importance of regular dental care ?
    2) Provide enough money for that care if his parents can’t ?
    3) Force his parent’s employer to give his parent enough time off to take him to the dentist ?
    4) Get pain relief independently when he has a painful cavity ? [/quote]

    Scenario:

    1) The kid learns in class that one should take care their own health, that includes good hygiene by brushing twice a day
    2) The kid knows that he doesn’t brush, and there is no tooth brush or toothpaste at home.
    3) The kid goes home and wants to ask his parent to get him toothbrush, but the parent is absent or ignores him.
    4) The kid returns to school and tells the teacher that he does not have toothbrush, but he wants to take care of himself.

    Event 4 is significant because at that point the kid had accepted his responsibility. The intention of the kid is correct.

    5) The teacher commends the kid for taking the responsibility. The teacher either gives the kid toothbrush, or directs the kid to get it from community resources.

    Event 5 is significant in this sequence because that is where material help enters the picture. In this sequence, material help is provided after the kid had taken responsibility.

    6) The kid gets the toothbrush and toothpaste, and makes a note that he owes the teacher or the community a toothbrush and toothpaste.

  35. B. Nice

    [quote]3) The kid goes home and wants to ask his parent to get him toothbrush, but the parent is absent or ignores him.
    4) The kid returns to school and tells the teacher that he does not have toothbrush, but he wants to take care of himself. [/quote]

    I’m sorry but I’m going to get snarky here. What planet do you think this scenario will actually play out? I have to ask, do you have any contact with 6 year old children? If so, and you know one that would behave as stated in your scenario I want the names of their exceptional parents so I can get some advice.

    One of the parts I dread most in my day is getting my kids to BRUSH THEIR TEETH! This would never happen voluntarily and with out some sort of impressing, imposing, or force involved. Coercion is always necessary. From conversation with parents I guarantee you I’m not alone.

  36. B. Nice

    Wait a second Edgar, is Ashton Kutcher with you? Are you punking us, just to get the kind of indignant response I just gave you? Good one! Got to go coerise my kids into brushing their teeth.

  37. tleonard

    From an earlier thread, medwoman wrote (emphasis mine):

    [quote]Also, I completely disagree with the notion that fluoridation is in any way forced medication. It is certainly the responsibility of any governing body that chooses to fluoridate to inform the population that they are doing so.[b]It is the responsibility of health care professionals to advise those who might be at some theoretical risk[/b] ( though I am not sure of what condition ) [b]if they have known renal compromise to avoid drinking tap water. It is then up to the citizen to decide whether or not to drink or cook with the water and at what levels.[/b] I can virtually guarantee you that there will be no government agency charged with going from home to home to ensure that you are drinking the tap water as is implied by “forced medication” or “mass medication”. [/quote]

    I would like to ask again the question that I posed earlier: How do you propose that a child with renal impairment will avoid drinking Davis tap water, particularly if it is a child in the less advantaged group that you are attempting to target with the water fluoridation program?

  38. ebowler

    quote] How do you propose that a child with renal impairment will avoid drinking Davis tap water, particularly if it is a child in the less advantaged group that you are attempting to target with the water fluoridation program? [/quote]

    I don’t expect you’re going to get an answer to that question – the fluoride proponents don’t have one. They also can’t explain how parents of children under 1 year of age are supposed to avoid fluoridated water per the recommendations of the American Dental Association and the Academy of General Dentistry. Perhaps they are planning to install reverse osmosis filters in the homes of families with infants and children with renal impairment?

  39. Frankly

    [i]You have no evidence that this is true. Your speculations about what people might say if the water is fluoridated are just that, pure speculation. Maybe someone would be equally likely to say, “wow, with all of this talk about fluoridation, I am now more aware of the issue and plan to take even better care of my teeth.” [/i]

    LOL. Well then just keep talking about it and don’t do it. Because after you do it, people will stop talking about it.

    Who are these shadow ignorant people in Davis that require so much saving? I think you are living in the wrong community. Might your social justice impulses be more useful in some inner city where there is a real need? Are you trying to manufacture some altruistic purpose in this highly affluent community that purchase toothpaste, take kids to the dentist and demand good dental hygiene?

    Please stoop trying to poison all of us just to get some extra points on your “good liberal” card.

  40. medwoman

    “…
    How do you propose that a child with renal impairment will avoid drinking Davis tap water, particularly if it is a child in the less advantaged group that you are attempting to target with the water fluoridation program?

    I don’t expect you’re going to get an answer to that question – the fluoride proponents don’t have one. They also can’t explain how parents of children under 1 year of age are supposed to avoid fluoridated water per the recommendations of the American Dental Association and the Academy of General Dentistry. Perhaps they are planning to install reverse osmosis filters in the homes of families with infants and children with renal impairment?”

    Actually, I do have a response. First, this kind of renal impairment in children is very rare. Secondly, those with impairment significant enough to be affected would likely be either on dialysis or such a tight dietary regimen that virtually everything that they eat or drink would be prescribed and likely subsidized. Now if anyone is really interested in the actual risk, you really don’t have to look any further than West Sac where disappointingly enough for those of you who enjoy accusing me of trying to poison you, there has not been an epidemic of childhood renal failure.
    How do I know ? Well by speaking to pediatricians in both Davis and Sacramento. But , oh wait, I am sure that none of them or competent and/ or must be in on the conspiracy with me. Who knew !

  41. Edgar Wai

    By six year old a kid would be in 1st grade or 2nd grade. They would need to go to school, they would need to get to school, how to bring or get lunch, how to go to restroom themselves, how to wash their hands, how to do homework and turn in homework, how to take a shower on their own, etc.

    I don’t see how brushing teeth is special on this list. Perhaps there is a general lack of positive reinforcement for someone that does brush their teeth.

    If a kid only gets nagged when they don’t brush their teeth, their instinct is to avoid being known that they didn’t brush their teeth. It makes them want to avoid the standard that they feel is imposed onto them. If a kid gets praised when they have clean teeth, their instinct is to maintain it and show it because it is something good about themselves that they earn.

    * * *

    Classifying helping other as a responsibility defines a social pressure that can result in altruist being exploited in a society.

    Because of this, I think the philosophical foundation is more robust if the boundary of a citizen’s responsibility is set to keeping promises, paying debts, and repaying favors received.

    Helping others just for the sake of helping them should not be a responsibility of a citizen. A citizen who does that can be classified as being noble. But such person would not, and should not look down on those who do not help (by definition, a noble person does not look down on anyone because a noble person can only see their own inability to ignite the nobility of other people).

    When responsibility is defined like this, it avoids irresponsible people from “guilt-trip” altruists into sustaining irresponsible ways of life.

    Helping others should be purely a choice. It should not be bound by any guilt. You help people because you believe it is the right thing to do, not because society expects you to do so.

  42. ebowler

    But of course, dialysis is the solution for children with renal impairment!

    And what about children under 1 year of age?

    [quote]But , oh wait, I am sure that none of them or competent and/ or must be in on the conspiracy with me.[/quote]

    Incompetent, conspiracy, really?

  43. Growth Izzue

    Medwoman
    [quote]Secondly, those with impairment significant enough to be affected would likely be either on dialysis or such a tight dietary regimen that virtually everything that they eat or drink would be prescribed and likely subsidized.[/quote]

    Oh but wait, what if that child with renal impairment had bad parents that didn’t make sure the child didn’t drink the water? After all, we have to look after everyone don’t we, what if one was to slip through? Kind of like those Nugget peanut butter cookies that I love so much, huh Medwoman. Oh the hypocrisy.

  44. B. Nice

    “By six year old a kid would be in 1st grade or 2nd grade. They would need to go to school, they would need to get to school, how to bring or get lunch, how to go to restroom themselves, how to wash their hands, how to do homework and turn in homework, how to take a shower on their own, etc.”

    These are far simpler tasks then the ones you laid out. Expecting a 6 year old to brush his/her teeth is one thing (and no small feat in my house). Expecting them to arrange for their own toothbrush and paste is another.

    “If a kid gets praised when they have clean teeth, their instinct is to maintain it and show it because it is something good about themselves that they earn.”

    If it was only this easy…..

  45. tleonard

    [quote]. Now if anyone is really interested in the actual risk, you really don’t have to look any further than West Sac where disappointingly enough for those of you who enjoy accusing me of trying to poison you, there has not been an epidemic of childhood renal failure. [/quote]

    Your statement seems to be implying that fluoride opponents are saying that water fluoridation will lead to an epidemic of renal impairment, and you are saying that one need only look to West Sac to see that this is not the case. In fact, no one here has made that claim.

    [quote]Secondly, those with impairment significant enough to be affected would likely be either on dialysis or such a tight dietary regimen that virtually everything that they eat or drink would be prescribed and likely subsidized.[/quote]

    What exactly do you believe is renal impairment “significant enough to be affected”? Renal patients who are not in end stage disease will be harmed by water fluoridation. Yes, even those who are not on dialysis.

    Some information on this topic, from the Fluoride Action Network:

    It is well established that individuals with kidney disease are susceptible to suffering bone damage and other ill effects from low levels of fluoride exposure. Kidney patients are at elevated risk because when kidneys are damaged they are unable to efficiently excrete fluoride from the body. As a result, kidney patients accumulate up to four times more fluoride in their bones than healthy individuals, and have similar increases in their blood as well.

    The risk faced by kidney patients has been known since as far back as the 1940s when a team of American doctors suggested that any one with “signs of renal impairment should have radiographic examinations of the skeletal system to rule out the existence of fluoride osteosclerosis.” (Linmans & McMurray 1943). In 1952, at the first congressional hearing on fluoridation, congressional committee members expressed serious concern about the potential for fluoridated water to harm kidney patients. When Dr. Heyroth, a proponent of fluoridation was asked by committee member: ”Would you give fluoridated water to one with kidney trouble,” he responded: “No, the advice would be that he drink fluoride-free spring water.”

    The evidence that low-level fluoride exposure kidney patients has continued to mount. Yet, despite repeated calls for government health agencies to conduct systematic studies to verify the safety of fluoride exposures for people with kidney disease, no such research has ever been done.

  46. tleonard

    Here is a small sample of the cited studies at the FAN website [url]http://www.fluoridealert.org/studies/kidney01/[/url]:

    “[A] fairly substantial body of research indicates that patients with chronic renal insufficiency are at an increased risk of chronic fluoride toxicity. Patients with reduced glomerular filtration rates have a decreased ability to excrete fluoride in the urine. These patients may develop skeletal fluorosis even at 1 ppm fluoride in the drinking water.”
    SOURCE: Schiffl H. (2008). Fluoridation of drinking water and chronic kidney disease: absence of evidence is not evidence of absence. Nephrology Dialysis Transplantation 23:411.

    “Individuals with kidney disease have decreased ability to excrete fluoride in urine and are at risk of developing fluorosis even at normal recommended limit of 0.7 to 1.2 mg/l.”
    SOURCE: Bansal R, Tiwari SC. (2006). Back pain in chronic renal failure. Nephrology Dialysis Transplantation 21:2331-2332.

    “Persons with renal failure can have a four fold increase in skeletal fluoride content, are at more risk of spontaneous bone fractures, and akin to skeletal fluorosis even at 1.0 ppm fluoride in drinking water.”
    SOURCE: Ayoob S, Gupta AK. (2006). Fluoride in Drinking Water: A Review on the Status and Stress Effects. Critical Reviews in Environmental Science and Technology 36:433–487

    “In patients with reduced renal function, the potential for fluoride accumulation in the skeleton is increased. It has been known for many years that people with renal insufficiency have elevated plasma fluoride concentrations compared with normal healthy persons and are at a higher risk of developing skeletal fluorosis.”
    SOURCE: National Research Council. (2006). Fluoride in Drinking Water: A Scientific Review of EPA’s Standards. National Academies Press, Washington D.C. p140 .

    “We hypothesize that elevated serum F levels might contribute to the disturbances in mineral ion homeostasis that are observed in patients with CRI [Chronic Renal Insufficiency]. This is of particular concern since the incidence of dental fluorosis has increased due to increased F– uptake from multiple fluoridated sources. The ubiquitous presence of F in food and beverage products regardless of the degree of water fluoridation suggests that the overall F exposure in individuals with CRI may need to be more closely monitored.”
    SOURCE: Mathias RS, et al. (2000). Increased fluoride content in the femur growth plate and cortical bone of uremic rats. Pediatric Nephrology 14:935–939

  47. Frankly

    Helping people is fine and noble. But it should be a personal choice.

    What really bothers me about this issue is that there are people pushing their idea of help on everyone else even though a large percentage of people absolutely believing it to be harmful.

    These pushers are simply rejecting the legitimate and justified fears of many only to reach a very few. Who does that? Who ignores the legitimate fears of many others only to win a selfish argument?

    This might be worth consideration if there was no better alternatives. And I have not read a single rejection of these alternatives from those that don’t want fluoride. There is someone like medwoman that trumpets cooperation instead of competition; yet here she is using her medical credential to browbeat others into submission. On one hand I am impressed. Apparently she is competitive!

    But this isn’t the kind of competition that adds value to society. It is the type that divides a city and creates a long-lasting bad taste (no pun intended as I think the toxin is flavorless), and won’t easily be forgotten because it will ALWAYS be in our water.

  48. tleonard

    medwoman, another point: You claim that every study that shows that fluoridation has harmful effects is not applicable to our city, or is flawed (remember the Harvard meta-analysis showing fluoride’s effects on IQ that you put so little credence in?), yet you repeatedly bring up conversations that you have with unnamed colleagues (your “curbside consultations”) as evidence of the safety and efficacy of water fluoridation. With all due respect to you and your colleagues, your curbside consultations are not convincing, statistically robust evidence of effectiveness or safety.

  49. nyscof

    First of all, those most harmed and least benefited by fluoridation are the malnourished who most often are the most poor.

    Politics of organized dentistry got us here. The American Dental Association and its constituent armies lobbied against have dental benefits as part of Medicare.

    80% of dentists refuse Medicaid patients and 130 million Americans don’t have dental insurance. Many of those with insurance can’t afford dentistry’s high out of pocket expenses.

    When fluoridation began, it was projected that tooth decay would all but be eliminated and dentists would go out of business. None of that has come to pass

    Organized dentistry lobbies with its pockets full of corporate cash against any viable solution preferring to keep it’s lucrative monopoly and treat the water of and not the teeth of low income Americans – even though increasing numbers may die from the consequences of untreated tooth decay.

    Rotten diets make rotten teeth and no amount of fluoride will stop or fix that.

  50. ebowler

    [quote]Politics of organized dentistry got us here. The American Dental Association and its constituent armies lobbied against have dental benefits as part of Medicare. [/quote]

    it always seems to come back to money

    [url]http://online.wsj.com/article/SB10001424052702304441404577478723769027162.html[/url]

  51. Edgar Wai

    [quote]Helping people is fine and noble. But it should be a personal choice.

    These pushers are simply rejecting the legitimate and justified fears of many only to reach a very few. Who does that? Who ignores the legitimate fears of many others only to win a selfish argument? [/quote]

    There is a related philosophical concept that solves this dynamic. The concept is that “help” is not a help if the helper does not own the risk of that action.

    When a noble person tries to help, his first action would be to inform people how to help themselves, and how they can voluntarily help one another. The effect of the dialog stays in the voluntary realm, no one is forced to change, everyone who wants to change is taking their own risk. This is the natural way a noble person would act because they are caution and is aware that, depending on the risk involved in the deed, they might not be able to insure everyone that follows his lead. Therefore they can only offer the method, take the risk himself, and ask others to take the risk also if they choose to. He cannot force others to share [i]his[/i] risk.

    If information alone does not work, the noble person might resort to forming a foundation with his own resources to cover the costs and risks for executing the form of assistance he believes. This kind of foundation is difference from lobbying group because its objective is to not cause policy change. Its objective is to provide direct help and directly taking the risk of its own action.

    A noble person knows that they are responsible for the risks they are taking to help others. That understanding of accountability keeps them humble, and keeps them from pushing their believes onto others.

    This understand solves the dynamic Frankly described because the the “argument” has no reason to exist. When the helper believes in his cause, the help takes the risk for their own action. There is no need to argue. They are not trying to make others take the risk for their ideals. They simply act and bypass the political realm.

  52. ebowler

    [quote] You claim that every study that shows that fluoridation has harmful effects is not applicable to our city, or is flawed (remember the Harvard meta-analysis showing fluoride’s effects on IQ that you put so little credence in?), yet you repeatedly bring up conversations that you have with unnamed colleagues (your “curbside consultations”) as evidence of the safety and efficacy of water fluoridation. [/quote]

    One of the authors of the recent meta-analysis, Philippe Grandjean MD, has responded to criticisms of the study by fluoridation proponents as being irrelevant to US water fluoridation programs. [url]http://braindrain.dk/2013/02/fluoridated-water-and-brains/[/url]

  53. ebowler

    [quote]This does not appear to be the opinion of the majority of dentists in the public health care community or those I have spoken with independently. [/quote]

    The American Dental Association has continued to reassure the public that mercury amalgam fillings are safe. I am certain that we will ultimately be successful in eliminating the use of mercury fillings in this country in the same way that we will be successful in eliminating water fluoridation.

    [url]http://www.doctoroz.com/episode/are-your-silver-fillings-making-you-sick[/url]

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