You Can't Handle the Tooth

It's an April evening at Dishman Community Center in Northeast Portland, and people are pissed.

The occasion is a public debate between Healthy Kids, Healthy Portland, the local campaign that's backing the Portland ballot measure to fluoridate our water, and its fluoride-hating counterpart, Clean Water Portland.

Local public-policy debates aren't usually hot tickets, but this one is so packed that organizers had to call the fire marshal for permission to admit a beyond-capacity crowd. Every seat is taken, and people are sitting on the gym floor.

Sentiment in the room is running heavily against fluoride. While debate organizers warn against audience outbursts ("you won't be asked to leave, you will be removed"), on several occasions dentist and fluoride backer Mike Plunkett is hissed like a silent-movie villain.

At the end of Clean Water Portland's closing statement, an overwhelming majority of those assembled erupt in applause (no such luck for Healthy Kids, Healthy Portland's final speech), and a ragged chant of "No fluoride!" bubbles up from the back of the hall. 

Fluoride supporters may have the federal Centers for Disease Control and Prevention and the vast majority of the medical profession on their side, but—tonight at least—the advantage in naked passion lies with the opposition. 

As the crowd files out, it's hard not to be struck by the variety of the opponents—gutter punks, yoga moms, septuagenarian military veterans. The mix reflects Clean Water Portland's diverse support base: The political action committee's roster includes the Pacific Green Party, the Oregon Progressive Party, the Organic Consumers Association, the Oregon Association of Acupuncture and Oriental Medicine, and libertarian groups like Cascade Policy Institute. 

It's as if an Occupy protest, a talk on artisanal cheesemaking, and a Tea Party rally were all accidentally booked at the same hotel ballroom. It's hard to imagine such a diverse group all voting the same way on anything. But fluoridation has always seemed to grab people in a way unlike any other issue.

Since last September, when the issue lurched back into Portland's consciousness following a naive attempt to enact the practice through a City Council vote, opponents have assailed fluoridation (and its supporters) with chest-poking intensity. 

Facebook battles are raging, lawn signs are being ripped down, and fluoride backers' phone numbers are being posted on the Internet. 

What's even more remarkable than the primal revulsion that opponents feel toward fluoridation, though, is the unlikely coalition of political forces that have allied to battle it here in Portland. 

Fluoride has had its impassioned enemies for decades. In cities across America, whenever fluoride has reared its cavity-free head, vocal detractors have emerged to oppose it.

For decades, that opposition came from the ideological right: anti-communism, individual freedom, the Tea Party. As recently as 2011, a fluoride battle in Florida was led by what the Tampa Bay Times called "anti-fluoride zealots and Tea Party conservatives."

That won't work here. So what has emerged instead is an unlikely movement where traditionally leftist constituencies—peace punks, alternative-health practitioners and organic-produce enthusiasts—take the lead, backed by the political support of local conservative groups and money from national hard-right donors. Politics, like tequila, makes strange bedfellows.

In case you've spent the past year or so vacationing on Neptune, here's some background: 

On Sept. 12, the Portland City Council voted unanimously to build a $5 million plant near Dodge Park that would add fluoride to what is currently the nation's largest unfluoridated city water supply.

If the plan proceeds, fluoridation would begin in 2015, at a cost to ratepayers of about 25 cents a month per household. 

Just 22 days after the vote, the Wile E. Coyote of fluoridation was beaned by its first anvil in the form of 20,000 signatures (opponents would eventually gather more than 33,000) that took the matter out of the City Council's hands and put it on the May 2014 ballot.

The waters were further fouled when the council chose to move that vote to a May 21, 2013, special election. Fluoride opponents groused that the fast-track vote was an effort to sabotage democracy, while backers cheered that the new election date would eliminate a year of needless uncertainty.

Whoever wins, the vote on Measure 26-151 will probably be close. The last publicly available scientific poll was conducted by The Oregonian last August, before the initial council vote. At that time, fluoridation squeaked out a 50.47 percent to 49.53 percent victory. An unscientific readers poll on the Portland Business Journal's website showed a tie. A source close to one of the campaigns says recent polls show that voters are slightly in favor of fluoride—but the numbers are very close.

Mark Wiener, a Portland political consultant working with pro-fluoride Healthy Kids, Healthy Portland, won't disclose the results of that group's internal polling, but one gets the impression that every vote counts. "There are people who look at [fluoridation] as simple common sense," Wiener says, "and those people need to remember to mail in their ballots."

Dream on. For decades, the opposition to fluoride was the province of blood-and-guts, hard-right forces, as exemplified by the John Birch Society, the group that led the U.S. anti-fluoride charge through the 1950s and '60s.

The John Birch Society was founded in 1958 by, among others, Fred C. Koch, patriarch of the petrochemical empire now helmed by his sons David and Charles. (These days, the two sons are generally lumped together by their many progressive foes as "the Koch brothers.")

It may be an oversimplification to call the John Birch Society a cross between the Tea Party and the Ku Klux Klan, but as oversimplifications go, it's a pretty useful one. John Birchers called liberals "secret communist traitors," believed that the civil rights movement was a communist plot, and called Republican President (and WWII hero) Dwight Eisenhower a "dedicated, conscious agent of the communist conspiracy."

Fluoridation, too, was denounced by the John Birchers as a communist plot to weaken America, possibly through mind control.

By 1964, fluoridation paranoia was so closely associated with the red-baiting right that director Stanley Kubrick used it as a running gag in his film Dr. Strangelove.

It's hard to get much further from Dr. Strangelove's war room than Southeast Hawthorne Boulevard, where vaguely hippie-looking cool kids wave anti-fluoride signs as passing Priuses honk approvingly, and to understand how far since the John Birch Society days the anti-fluoride movement has come. 

Anti-fluoride activist Zia McCabe is keyboardist for Portland rock band the Dandy Warhols. "I'm sure I land somewhere in the liberal, environmentalist category," she says. "I was fairly active for animal rights in my early teens, and I was on the news during the 'No on 9' campaign [a successful push to defeat a 1992 anti-gay Oregon ballot measure] wearing braces. But I didn't make any real-time investments in a political movement until now.” 

McCabe has organized a series of seven anti-fluoride benefit concerts to raise money and awareness, and is encouraging other liberally inclined local musicians to take up the cause. Perennial Burning Man favorite MarchFourth Marching Band—whose song "Skin Is Thin" includes an apology to the human race "for being a white man"—led an anti-fluoridation march through Last Thursday festivities April 25. 

At a recent event at Southeast Portland's Goodfoot bar, music scenesters and young environmentalists made their case against fluoridation.

"It's an environmental issue," says Seth Woolley, who was the Pacific Green Party's candidate for Oregon secretary of state in 2012. "We're part of the wider environment.” 

Anti-fluoride volunteer Kristi Parson, a twentysomething pharmacist, thinks the John Birch Society connection is irrelevant. "It's a whole different generation now," she says.

It's not clear when the left began to adopt the far right's opposition to fluoride, but sometime during the past couple of decades, the fear that fluoride was a Jewish plot to "weaken the Aryan race mentally and spiritually," according to a midcentury newspaper publisher in San Diego, gave way to a liberal concern about putting a chemical in the water supply.

As Jim Moore, a political science professor at Pacific University in Forest Grove, puts it, the concern about fluoride comes from the same set of liberal beliefs "that looks suspiciously at immunization. Parents look at immunization and see that the science is unclear and believe that social engineering like this has in the past created big problems."

According to the authors of The Fluoride Wars, a  2009 book, early social studies linked anti-fluoridation attitudes with poverty and ignorance. No more. There are many new constituencies that vote against fluoridation. "Chief among them is the environmental constituency, whose members have exhibited a growing reluctance to have chemical agents of any type added to the environment," write authors R. Allan Freeze and Jay H. Lehr. "There has also been a growth in the number of people who question...increased government interventions in our lives. It is not just alienated cranks who sometime doubt the wisdom of government-recommended programs."

Fluoridation may have found new, young foes on the left, but its old enemies haven't gone away either. Lifelong Portlander Stu Tyson has voted against fluoridation "three or four times" over the years. (Portlanders voted down fluoride in 1956 and 1962. In 1978, voters approved fluoridation but overturned it two years later.)

As to the considerably more left-leaning fluoride opponents just down Hawthorne, Tyson shrugs. "I guess it's something we can all agree on," he says.

While most of the votes against fluoride in this race will seemingly come from the left, most of the money will come from the right. As reported by WW, Clean Water Portland got its largest contribution, $43,000, from James Garvey, founder of the limited-government, free-market Kansas Taxpayers Network. He's also a financial supporter, through his family trust, of the Koch brothers' Americans for Prosperity group. (The largest campaign contribution to the pro-fluoride campaign is $215,000 from the Northwest Health Foundation.)

Another $9,000 to the anti-fluoridation campaign came from Abundant Living, an organization founded by Utah businessman Ken Howard to promote his political views. The group's website divides its time between bashing fluoridation and recoiling from conservatives' triple-headed nightmare of Obamacare, taxation and social welfare spending.

It's a lot to ask of a cash-strapped grassroots organization to turn down money from any source. "We're just happy to have the support," says Clean Water Portland spokeswoman and physical therapist Kellie Barnes, adding that she doesn't share these supporters' political views, or even know what those views are. She says the majority of contributors are local, small-amount donors.

Fluoride proponents characterize this kumbaya moment a little differently. "[It's] where the crazy right meets the crazy left," says Wiener, the political consultant, “and they link arms and march into battle.” 

Fact From Fiction

Many opponents of fluoridation acknowledge there's a consensus in the scientific establishment that fluoride is safe. What they dispute is whether that consensus is correct. I looked at some of the claims about fluoride promoted in Clean Water Portland's literature or by its spokespeople. Here's what I found.

Claim: A National Academy of Sciences study saw a possible link between fluoride in drinking water and severe skeletal fluorosis, osteosarcoma and thyroid dysfunctions.

Fluoride occurs naturally in much of the world's groundwater. Some water, like Portland's, contains no fluoride at all. Other sources contain 10, 20 or even 30 times more fluoride than the 0.7 parts per million proposed for our city. 

At these high levels, fluoride can cause problems. Public health officials need to know how much naturally occurring fluoride can be in water before it's not safe to drink, and they've done studies to find out.

Scary-sounding studies like the aforementioned one are talking about the phenomenon of naturally occurring high concentrations of fluoride, not the low concentrations seen in artificially fluoridated water.

The most common side effect of fluoridated water is mild dental fluorosis, a mottling of tooth enamel. 

According to the Centers for Disease Control and Prevention, children under age 8 are at risk of moderate or severe fluorosis only if their water has more than 2 ppm of fluoride, nearly three times Portland's proposed level.

Claim: A Harvard University study of Chinese children found high fluoride was associated with lower IQ scores.

Like the study above, this paper dealt with populations exposed to water naturally fluoridated to ultra-high levels. In this case, the levels ranged from 2.5 to 26 times the level proposed for Portland.

But let's be fair: This high-fluoride group did have lower IQ scores than the low-fluoride group. How much lower? One whole IQ point.

Still, any loss of IQ is too much, especially for my brother-in-law. But this result was only found in children receiving massive doses of fluoride, not the Department of Health and Human Services-approved levels proposed for Portland.

Speaking of which, just out of curiosity, those smarter kids—you know, the control group that didn't lose an IQ point, like the high-fluoride group did—how much fluoride was in their water? 

The answer is an average of 0.78 ppm, just a bit more than the 0.70 ppm proposed for the Rose City. 

I'll say it again: The control group—the one that didn't have the problems highlighted in the study—was receiving a higher level of fluoride than that proposed for Portland.

The Harvard study's authors further found that the reduced IQ effect caused by high fluoride reversed itself by adulthood: "The intellectual ability, and even life expectancy, of people in the high-fluoride endemic region appeared to be higher than the non-endemic region, indicating that the effect of fluoride poisoning on intellectual ability is negligible."

Claim: There has never been a placebo-controlled, double-blind study—the gold standard of scientific research—on community water fluoridation.

The previous two claims could be chalked up to honest mistakes, but this one seems willfully misleading. 

There have been multiple studies on the safety and efficacy of fluoride, but it is technically correct to say that there's never been a placebo-controlled, double-blind study on community water fluoridation. Here's why:

Such a study would involve taking two separate cities, giving one of them fluoride and withholding it from the other, without telling anyone involved which city was getting it and which one wasn't.

Putting aside the political difficulty of such a plan—if you think fluoride opponents are cranky now, imagine how they'd feel about not only risking fluoridation but being kept in the dark about it—it's not a practical experiment.

Claim: The Portland Water Bureau plans to use fluorosilicic acid, a byproduct of the phosphate fertilizer industry, for fluoridation. This product is contaminated with lead and arsenic, which will in turn contaminate our water.

Fluoridation backers prefer the term "co-product," but this claim about the source of the fluoridation agent is substantially correct—the chemical process employed at phosphate facilities produces several products, one of which is used for fertilizer and another of which is used for fluoridation.

However, according to Water Bureau spokesman Tim Hall, contaminant levels in all water additives nationwide are monitored by the National Sanitation Foundation. Hall, quoting the NSF, wrote: "NSF test results continue to show that fluoride 'does not add measurable amounts of arsenic, lead, other heavy metals or radionuclide contamination to drinking water.’” 

Emotions Running High

In another incident, the email address and work phone number of Healthy Kids, Healthy Portland volunteer Jennifer Snook were posted on a fluoridation opponent's Facebook page with the comment, "I would never suggest that each and every one of my friends send her some educational information about fluoride or call just to chat, nor would I ever suggest that anyone complain to her supervisor." The supervisor's name and work email address were included in the comment.

Contacted for comment about these tactics, Clean Water Portland executive director Kim Kaminsky suggests there's plenty of blame to go around.

"We have people calling us every day about their 'No Fluoride' signs being stolen," she says. With regard to the posting of personal information, she says, "We obviously can't control idiots on the Internet regardless of what side of the fluoridation debate they're on."

Clean Water Portland campaign manager Kristen Robison says pro-fluoride commenters haven't been all angels either. "[One] apparently said that he hoped some of the 'no fluoride' commenters were hit by drunk drivers."

It's nice to see everyone getting along. 

WWeek 2015