Water fluoridation controversy
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The water fluoridation controversy refers to the ongoing debate over the safety of the addition of fluoride to public water supplies.The current stance of several major medical and dental research associations is that water fluoridation is a safe and effective way to prevent tooth decay and improve oral health.CDC website, page accessed March 3, 2006.National Institute of Dental and Craniofacial Research website, "The Story of Fluoride", page accessed March 3, 2006.International Association for Dental Research policy statements, including water fluoridation, page accessed March 3, 2006.Opponents of fluoridation argue that studies show a connection between fluoride and various health problems. Additionally, fluoridation opponents argue that fluoridating water is compulsory mass medication that takes away an individual's right to choose whether to consent to medical treatment. They also point to a lack of quality research into its efficacy and safety.Centre for Reviews and Dissemination, University of York, York, UK. http://www.york.ac.uk/inst/crd/fluorid.htm Fluoridation of Drinking Water: a Systematic Review of its Efficacy and Safety. Accessed 2007-06-23
Use throughout the world
Water fluoridation is utilized in the United States, United Kingdom, Canada, and Australia, among other countries. The following developed nations previously fluoridated their water, but stopped the practice, with the years when water fluoridation started and stopped in parentheses:
Effectiveness
Frequently, opponents point to a study by the National Institute of Dental Research showing little difference in tooth decay rates among children in fluoridated and non-fluoridated communities. In the study's results, the difference between the children exposed to water fluoridation, and those who were not exposed, was very small, between 0.12 and 0.30 DMFS (Decayed Missing and Filled Surfaces).The "Fuzzy Math" of Fluoride Promotion, No Fluoride website, Paul Connett, accessed 18 February, 2006.Opponents also argue that in the instances that fluoride prevents tooth decay, the effects are merely topical.Health Effects: Fluoride & Tooth Decay (Caries), Fluoride Alert website, accessed 18 February, 2006. Therefore, fluoridating water is unnecessary and ineffective. Instead, they argue, direct applications of fluoride to teeth as done in dental offices and with fluoridated toothpastes should be the recommended methods.Opponents point out that dental decay continues to exist in water fluoridated communities. They reason that if fluoride is effective, then there would be no more tooth decay. While, in theory, the poorest members of society would be aided the most by fluoridated water, baby bottle tooth decay (BBTD) and tooth decay in general is still prevalent in those social groups. Opponents conclude that, in light of the continuing dental health problem, water fluoridation is unable to successfully increase health standards and thus should not be used.Facts about Fluoridation, Fluoride Alert website, accessed 22 February, 2006.Finally, opponents argue that the general decline of tooth decay is the result of factors beside water fluoridation, including toothpaste with fluoride, improved diets, and overall improved general and dental health.Why I am now officially opposed to adding fluoride to drinking water, Second Look website, Hardy Limeback, accessed 22 February, 2006.The Centers for Disease Control and Prevention published in its Morbidity and Mortality Weekly Report (MMWR) that starting or continuing water fluoridation decreased the incidence of tooth decay by 29%, and that stopping water fluoridation increased the incidence of tooth decay in some communities.Promoting Oral Health: Interventions for Preventing Dental Caries, Oral and Pharyngeal Cancers, and Sports-Related Craniofacial Injuries: A Report on Recommendations of the Task Force on Community Preventive Services (in pdf format), from the Morbidity and Mortality Weekly Report (MMWR) produced by the CDC, page accessed 4 March, 2006. Other organizations also see a clear link between desired fluoride levels in water and a decrease in tooth decay.In addition, since oral health is affected by many factors, fluoride alone would be unable, nor would it be expected, to eradicate the disease. The social groups that would be more likely to benefit from water fluoridation are those living in poorer conditions, and an important factor to decrease dental health disparities may be water fluoridation programs.World Health Organization website, "World Water Day 2001: Oral health", page 3, page accessed March 3, 2006. Nonetheless, it is understood that these communities suffer from various problems which would impede oral health, such as lack of access to dental care and poorer oral hygiene education. Water fluoridation is only a single factor to improve dental health.Safety
Some opponents of fluoridation believe fluoride is a poison that can lead to death or, more commonly, dental fluorosis in instances of overdose. They argue that having a lethal chemical in the water is reckless and leads to many health problems in the general public.These persons point to research which they say supports the notion that fluoride causes chromosomal damage and interferes with DNA repair.[http://www.fluoridealert.org/health/cancer/mutagen.html Health Effects: Fluoride's Mutagenicity (Genotoxicity)], Fluoride Alert website, accessed 18 February, 2006. They point to animal studies that they say demonstrate that rats fed for one year with 1 ppm fluoride in their water had detrimental changes to their kidneys and brains,Health Effects: Fluoride & the Kidneys, Fluoride Alert website, accessed 18 February, 2006. an increased uptake of aluminum in the brain, and the formation of beta amyloid deposits, a characteristic of Alzheimers disease.Health Effects: Fluoride & the Brain Fluoride Alert website, accessed 18 February, 2006. In animal studies, fluoride has been shown to inhibit melatonin production and promote precocious puberty. [http://fluoridealert.org/health/pineal/luke-1997.html] Fluoride may have an analogous inhibitory effect on human melatonin production, as fluoride accumulates readily in the human pineal gland, the brain organ responsible for melatonin synthesis. [http://www.icnr.com/jluke/fluoridedeposition.html] Further, it is argued by some opponents that fluoride can weaken the immune system, leaving people vulnerable to the development of cancer and AIDS.Diseases: Question 25, Fluoride Debate website, accessed 19 February, 2006.Theses groups further emphasize that an overdose of fluoride is associated with liver damage, kidney function, and fluorosis in children.PubMed NCBI Dose-effect relationship between drinking water fluoride levels and damage to liver and kidney functions in children. At high doses, fluoride has many side effects. Animal studies demonstrate that fluoride can damage the male reproductive system in various species.The reproductive effects of fluoride intake, Fluoridation.com website, accessed 18 February, 2006. Consequently, fluoride is considered dangerous by these groups.Advocates of water fluoridation agree that fluoride in high concentrations produces harmful effects to the body. Nonetheless, they argue that almost any substance is harmful because toxicity is based on the amount of exposure.Is fluoride poisonous?, from the Austrialian Dental Association website, page accessed 18 March, 2006. In defending water fluoridation, the American Dental Association points out that vitamin A, vitamin D, iron, iodine, aspirin, and water are potentially harmful if given in certain amounts.Fluoridation Facts (in pdf format), from the ADA website, page accessed 18 March, 2006. As is true for all vitamins and minerals, recommended dosages for fluoride represent levels which maximize health benefits and minimize adverse effects.Towards Better Oral Health in Children, from the Scottish Executive website, page accessed 18 March, 2006.The greatest concern with fluoride overexposure is dental fluorosis. Fluorosis is undesirable because, in severe cases, it discolors teeth, causes surface changes to the enamel, and makes oral hygiene more difficult.Enamel Fluorosis, from the American Academy of Pediatric Dentistry website, page accessed 18 March, 2006. Government agencies, such as the Center for Disease Control and Prevention, keep records on the prevalence of fluorosis in the general public.Surveillance for Dental Caries, Dental Sealants, Tooth Retention, Edentulism, and Enamel Fluorosis --- United States, 1988--1994 and 1999--2002, from the CDC website, page accessed 18 March, 2006. Also a concern, skeletal fluorosis is a disease in which fluoride deposits into bone, causing joint stiffness, joint pain, and sometimes changes in bone shape.Water-related diseases: Fluorosis, from the World Health Organization website, page accessed 18 March, 2006. For skeletal fluorosis to occur, chronic, high level exposure to fluoride is required. A mild form of skeletal fluorosis, osteosclerosis, is seen when levels of fluoride reach 5 parts per million (ppm) and the time of exposure lasts for 10 years.Fluoridation Facts (in pdf format), from the ADA website, page accessed 18 March, 2006.In order to best prevent fluorosis, health organizations have created guidelines restricting the amount of fluoride exposure. The United States Environmental Protection Agency limits the maximum amount of fluoride in drinking water to 4.0 milligrams per liter of water and recommends water supplies to contain between 0.7 and 1.2 milligrams of fluoride per liter.ToxFAQs for Fluorine, Hydrogen Fluoride, and Fluorides, from the Agency for Toxic Substances and Disease Registry (ATSDR) website, page accessed 18 March, 2006. The World Health Organization cautions that fluoride levels above 1.5 milligrams per liter leaves the risk for fluorosis.Fluoride, from the Agency for World Health Organization website, page accessed 18 March, 2006. When fluoride levels in water are low (usually below 0.6 ppm), fluoride supplements are sometimes prescribed to encourage healthy dental development. There are accepted recommended guidelines on the amount of fluoride to prescribe, which depend on the fluoride levels in the drinking water and on the age of the child.Fluoride Therapy (in pdf format), from the American Association of Pediatric Dentistry website, page accessed 18 March, 2006.Moreover, health organizations have affirmed the currently accepted belief that recommended levels of fluoride does not contribute to the many diseases water fluoridation detractors accuse fluoride of causing. The Centers for Disease Control and Prevention and the National Cancer Institute have both issued statements that water fluoridation is not believed to cause osteosarcomas.CDC Statement on Water Fluoridation and Osteosarcoma, from the CDC website, page accessed 18 March, 2006.National Cancer Institute website, "Fluoridated Water: Questions and Answers", page accessed March 3, 2006. Cancer in general is not believed to be caused from water fluoridation.Knox, E.G. "Fluoridation of water and cancer: a review of the epidemiological evidence", hosted on the British Official Publications Collaborative Reader Information Service website, page accessed 18 March, 2006. Full text can be found here"Inorganic Fluorides Used In Drinking-water and Dental Preparations", by the International Agency on Research for Cancer website, page accessed 18 March, 2006. There is no clear link between Alzheimer's disease and water fluoridation.Fluoridation Facts (in pdf format), from the ADA website, page accessed 18 March, 2006. A study in 1998 suggested a possible relationship between fluoride exposure and Alzheimer's disease.Varner, J.A., K.F. Jensen, W. Horvath, R.L. Isaacson. "Chronic administration of aluminum-fluoride or sodium-fluoride to rats in drinking water: alterations in neuronal and cerebrovascular integrity", abstract from PubMed website, page accessed 18 March, 2006. Research groups point out that the study contained methodological limitations, which prevent a definitive conclusion on the subject. As a result, research and health agencies currently believe fluoride is not a risk factor for Alzheimer's disease, and instead age and family history are the most important risk factors.Causes", by the [http://www.nia.nih.gov/alzheimers Alzheimer's Disease Education and Referral (ADEAR) Center] website, a division of the National Institute of Aging, page accessed 18 March, 2006. Moreover, there is some research that suggests Alzheimer's disease can be prevented with water fluoridation because of the competition between aluminum and fluoride absorption.Kraus, A.S. and W.F. Forbes. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1617567&dopt=Citation "Aluminum, fluoride and the prevention of Alzheimer's disease."], abstract from PubMed website, page accessed 18 March, 2006. Nonetheless, this research is also limited by design and no definitive conclusion of this effect can be made.Other health concerns, such as kidney disease, Down syndrome, lead poisoning, heart disease, decreased fertility rates, and inhibition of biologic enzymes, are not believed to be attributed to water fluoridation.Fluoridation Facts (in pdf format), from the ADA website, page accessed 18 March, 2006.Reliance on experts
Many fluoridation opponents rely on experts opposing water fluoridation to validate their argument of the dangers of fluoride, particularly those scientists (including at least one Nobel Prize winner, Arvid Carlsson) who have stated their opposition to water fluoridation.Why EPA headquarters Union of Scientists Opposes Fluoridation, hosted on the National Treasury Employees Union. Page accessed January 21, 2007.Nobel laureate opposes fluoride,hosted on the Second Look website. Page accessed January 21, 2007.In response, scientific and health organizations criticize opponents of water fluoridation for trying to engage in "polling practices" with research. When a group opposing water fluoridation claims an award-winning researcher or dental expert agrees with them, the argument is supposed to be more convincing to the general public. Researchers emphasize that voting or polling is not how scientific progress is made."Impact of Fluoridation of the Municipal Drinking Water Supply: Review of the Literature", hosted on the University of West Florida website, page accessed 4 March, 2006. Thorough review of methodology and design of multiple studies over time lead researchers to conclusions. Even in the critical analysis of these studies, content is the focus, rather than the researcher who led the study.Another criticism given of water fluoridation opponents regards their reference to research seeming to support their view. Generally, those studies are criticized by the majority of scientific researchers on basic principles, such as the methodology used. More problematic is the accusation that some anti-fluoridation research is published in journals, such as "Fluoride", that are deceptively made to appear peer-reviewed."Impact of Fluoridation of the Municipal Drinking Water Supply: Review of the Literature", hosted on the University of West Florida website, page accessed 4 March, 2006.Ethics
One aspect of opposition to water fluoridation regards the social or political implications of adding fluoride to public water supplies. Setting aside the claim that water fluoridation may improve dental health, such an act would violate an individual's right to pursue free choice of, or form of, medical treatment and it is argued that water fluoridation is "compulsory mass medication" because it does not allow proper consent.The Fluoride Debate: Question 34, Fluoride Debate website, accessed 23 February, 2006.It is also argued that, because of the negative health effects of fluoride exposure, mandatory fluoridation of public water supplies is a "breach of ethics" and a "human rights violation."Fluoride Primer: Fluoridation is a serious breach of ethics, International Institute of Concern for Public Health website, accessed 22 February, 2006. Litigation, both pro and con, has been a frequent outcome of forced water fluoridation.Many advocates of fluoridation do not consider it a violation of people's right to consent to medical treatment. They usually argue that fluoridation is not a form of mass medication because fluoride is naturally present in all water systems.Fluoridation Facts (in pdf format), from the ADA website, page accessed 18 March, 2006. Opponents argue that the form of fluoride found in naturally fluoridated water supplies is not the same as the form used to artificially fluoridate water. Likewise, opponents argue that the pharmacy grade fluoride used in many studies to support fluoride as a tooth decay preventative is not the grade used to fluoridate water. Frequently, those who promote water fluoridation make the comparison to the fortification of other types of foods, such as adding vitamins to breakfast cereals and baby foods.British Medical Association website, statement on water fluoridation, page accessed March 3, 2006. In addition, proponents propose that preventing broad, easy access to fluoride is unethical. Since the populations which benefit most from water fluoridation are children and those in poorer communities, fluoridation is considered an avenue to relieve some of the health disparities between socio-economic groups."The Ethics of Water Fluoridation" publication (in pdf format), from the British Fluoridation Society website, page accessed March 19, 2006. Fluoridation is defended further by its relative low cost. The Canadian Task Force On Preventive Health Care describes water fluoridation as "the single most effective, equitable and efficient means of preventing coronal and root dental caries."Lewis DW and Ismail AI. Prevention of dental caries. In: Canadian Task Force on the Periodic Health Examination. Canadian Guide to Clinical Preventive Health Care. Ottawa: Health Canada, 1994; 408-17. Page accessed August 13, 2006. In the United States, the cost can be as low as 31 cents per person, per year.Ringelberg, M. L., S. J. Allen, L. J. Brown. "Cost of fluoridation: 44 Florida communities.", abstract from PubMed website, page accessed 19 March, 2006. As a result, many health organizations defend fluoridation and do not consider it a violation of ethical principles.The precautionary principle
In an analysis published in the March 2006 issue of the Journal of Evidence Based Dental Practice, the authors examine the water fluoridation controversy in the context of the precautionary principle. The authors note that while the precautionary principle is "often criticized as antiscientific," it is based on the notion that:"if there is uncertainty, yet credible scientific evidence or concern of threats to health, precautionary measures should be taken. In other words, preventive action should be taken on early warnings even though the nature and magnitude of the risk are not fully understood."Tickner J, Coffin M. (2006). What does the precautionary principle mean for evidence-based dentistry? Journal of Evidence Based Dental Practice, Issue 6, pages 6-15.The authors note that “The need for precaution arises because the costs of inaction in the face of uncertainty can be high, and paid at the expense of sound public health.” In determining whether the precautionary principle should be applied to fluoridation, the authors note that:Government and industry conspiracy
Some opponents point to a government conspiracy that has modified scientific research to further its own political goal. The particular conspiracy involves the secret development of the atomic bomb during World War II. The argument usually involves characterizing research as flawed or edited for the public in order to avoid public concern over military research. As some have put it, "The science of fluoridating public drinking water systems has been, from day one, shoddy at best . . . . the basis of that science was rooted in protecting the U.S. Atomic bomb program from litigation."Fluoride, Teeth, And the Atomic Bomb, Flordiation.com website, Joel Griffiths and Chris Bryson, accessed 18 February, 2006. Other conspiracy theories involve large industrial companies wanting to rid themselves of fluorine "waste products".Water Fights: Believe it or not, the fluoridation war still rages — with a twist you may like - efforts to have cities no longer fluoridate water, FindArticles.com website, Jay Nordlinger, accessed 22 February, 2006. Some argue that fluoride is a waste product that is unusable and expensive to dispose of properly. Because of this expense, industrial companies desiring to protect their profits release "millions of tons of waste fluoride into the environment."Fluoride: Commie Plot or Capitalist Ploy, Fluoride Alert website, Joel Griffiths, accessed 18 February, 2006. As a result, these opponents of water fluoridation say, "it is now clear that the one utterly relentless force behind fluoridation is American 'big industry' ".Fluoride: A Protected Pollutant, Flordiation.com website, Dr. F. B. Exner, accessed 18 February, 2006. In spite of this, a large majority of government agencies and medical organizations support water fluoridation in locations needing fluoride supplementation and agree that it is a safe practice. (See Medical approval for a list of health organizations.) The Centers for Disease Control and Prevention (CDC) has listed water fluoridation as one of the ten greatest achievements in public health of the 20th century.CDC, website, "Achievements in Public Health, 1900-1999: Fluoridation of Drinking Water to Prevent Dental Caries," page accessed 4 March, 2006. Overview of list can be found here. In 2000, a report by the Surgeon General of the United States titled "Oral Health in America" stated, "Community water fluoridation remains one of the great achievements of public health in the twentieth century."Reports of the Surgeon General, hosted by the National Library of Medicine, page accessed 4 March, 2006. The document, "Oral Health in America: A Report of the Surgeon General" can be found here (in pdf format). Various international groups, including the World Health Organization (WHO) and the International Association for Dental Research (IADR) support water fluoridation as a safe and effective method to fight tooth decay.World Health Organization website, "World Water Day 2001: Oral health", page 3, page accessed March 3, 2006.Medical and scientific organizations
More than 100 national and international health service agencies and professional organizations see benefits in community water fluoridation as a means of preventing dental decay.National and International Organizations that Support Fluoride, from the Massachusetts Coalition for Oral Health website, page accessed March 19, 2006. They include:EPA employee and citizen opposition
In 2005, eleven EPA employee unions representing over 7000 environmental and public health professionals of the Civil Service called for a moratorium on drinking water fluoridation programs across the USA and asked EPA management to recognize fluoride as posing a serious risk of causing cancer in people. The unions acted following revelations of an apparent cover-up of evidence from Harvard School of Dental Medicine linking fluoridation with an elevated risk of osteosarcoma in boys, a rare but fatal bone cancer.The Washington Post: "Professor at Harvard Is Being Investigated" http://www.washingtonpost.com/wp-dyn/content/article/2005/07/12/AR2005071201277.html [http://nteu280.org/Issues/Fluoride/fluoridesummary.htm]In addition, over 1000 health industry professionals, including doctors, dentists, scientists and researchers from a variety of disciplines are calling for an end to water fluoridation in an online petition to Congress. [http://www.fluoridealert.org/statement.august.2007.html]Their petition highlights eight recent events that they say mandates a moratorium on water fluoridation, including a 500-page review of fluoride’s toxicology that was published in 2006 by a distinguished panel appointed by the National Research Council of the National Academies. [http://www.nap.edu/catalog.php?record_id=11571] While the NRC report did not specifically examine artificially fluoridated water, it concluded that the U.S. Environmental Protection Agency's safe drinking water standard of 4 parts per million (ppm) for fluoride is unsafe and should be lowered. Despite over 60 years of fluoridation without a single double-blind study of fluoride's effectiveness and many basic research questions that have never been addressed, the panel reviewed a large body of literature in which fluoride has a statistically significant association with a wide range of adverse effects.http://www.nap.edu/catalog.php?record_id=11571Several prominent dental researchers and government advisors who were leaders of the pro-fluoridation movement have announced reversals of their former positions after they concluded that water fluoridation is not an effective means of reducing dental caries and that it poses serious risks to human health. The late Dr. John Colquhoun was Principal Dental Officer of Auckland, New Zealand. In an article titled, "Why I changed my mind about water fluoridation", he published his reasons for changing sides. [http://www.fluoride-journal.com/98-31-2/312103.htm] http://www.fluoride-journal.com/98-31-2/312103.htm Why I changed my mind about water fluoridation. Colquhoun, J. Perspectives in Biology and Medicine 41 1-16 (1997) Dr. Hardy Limeback, BSc, PhD, DDS was one of the 12 scientists who served on the National Academy of Sciences panel that issued the aforementioned report, Fluoride in Drinking Water: A Scientific Review of the EPAs Standards. Dr. Limeback is an associate professor of dentistry and head of the preventive dentistry program at the University of Toronto.http://www.fluoridealert.org/limeback.htmLetter. Limeback, H. April 2000. Faculty of Dentistry, University of Toronto He detailed his concerns in an April 2000 letter titled, "Why I am now officially opposed to adding fluoride to drinking water"''. [http://www.fluoridealert.org/limeback.htm]In a presentation to the California Assembly Committee of Environmental Safety and Toxic Materials, Dr. Richard Foulkes, B.A., M.D., former special consultant to the Minister of Health of British Columbia, revealed:"The fluoridation studies that were presented to me were selected and showed only positive results. Studies that were in existence at that time that did not fit the concept that they were "selling," were either omitted or declared to be "bad science." The endorsements had been won by coercion and the self-interest of professional elites. Some of the basic "facts" presented to me were, I found out later, of dubious validity. We are brought up to respect these persons in whom we have placed our trust to safeguard the public interest. It is difficult for each of us to accept that these may be misplaced." [http://www.sonic.net/kryptox/politics/lead20s.htm]Despite various concerns by private citizens, government agencies such as the CDC and WHO continue to support water fluoridation as being a safe and effective means of reducing dental decay.Science reviews
In the United Kingdom the Department of Health funded a systematic review in 1999, which looked at all of the evidence so far published, into the efficacy and safety of adding fluoride to drinking water. This work was carried out at the University of York. They concluded:The report was checked by the Medical Research Council (UK) after publication.Court cases
United States
Fluoridation has spawned many court cases. Anti-fluoride activists have sued municipalities, claiming that their rights to consent to medical treatment, privacy, and due process are infringed by mandatory water fluoridation.Cross, D. W., R. J. Carton. "Fluoridation: a violation of medical ethics and human rights.", abstract from PubMed website, page accessed 19 March, 2006. Individuals have sued municipalities for a number of illnesses that they blamed on fluoridation of the city's water supply. A substantial majority of courts have held in favor of cities in such cases, finding no or only a tenuous connection between health problems and widespread water fluoridation.Beck v. City Council of Beverly Hills, 30 Cal. App. 3d 112, 115 (Cal. App. 2d Dist. 1973) ("Courts through the United States have uniformly held that fluoridation of water is a reasonable and proper exercise of the police power in the interest of public health. The matter is no longer an open question." (citations omitted)). To date, no federal appellate court or state court of last resort (i.e., state supreme court) has found water fluoridation to be unlawful.Pratt, Edwin, Raymond D. Rawson & Mark Rubin, Fluoridation at Fifty: What Have We Learned, 30 J.L. Med. & Ethics 117, 119 (Fall 2002)Early cases
A flurry of cases were heard in numerous state courts in the 1950s during the early years of water fluoridation. State courts consistently held in favor of allowing fluoridation to continue, analogizing fluoridation to mandatory vaccination and the use of other chemicals to clean the public water supply, both of which had a long-standing history of acceptance by courts.In 1952, a Federal Regulation was adopted that stated in part, "The Federal Security Agency will regard water supplies containing fluorine, within the limitations recommended by the Public Health Service, as not actionable under the Federal Food, Drug, and Cosmetic Act."17 Fed. Reg. 6743 (July 23, 1952). The Supreme Court of Oklahoma analogized water fluoridation to mandatory vaccination in a 1954 case.273 P.2d 859, 862-63 (Okl. 1954) (available at FindLaw for Legal Professionals) The court noted, "we think the weight of well-reasoned modern precedent sustains the right of municipalities to adopt such reasonable and undiscriminating measures to improve their water supplies as are necessary to protect and improve the public health, even though no epidemic is imminent and no contagious disease or virus is directly involved . . . . To us it seems ridiculous and of no consequence in considering the public health phase of the case that the substance to be added to the water may be classed as a mineral rather than a drug, antiseptic or germ killer; just as it is of little, if any, consequence whether fluoridation accomplishes its beneficial result to the public health by killing germs in the water, or by hardening the teeth or building up immunity in them to the bacteria that causes caries or tooth decay. If the latter, there can be no distinction on principle between it and compulsory vaccination or inoculation, which, for many years, has been well-established as a valid exercise of police power."273 P.2d 859, 862-63 (Okl. 1954) (available at FindLaw for Legal Professionals)In the 1955 case Froncek v. City of Milwaukee, the Wisconsin Supreme Court affirmed the ruling of a circuit court which held that "the fluoridation is not the practice of medicine, dentistry, or pharmacy, by the City" and that "the legislation is a public health measure, bearing a real, substantial, and reasonable relation to the health of the city."69 N.W.2d 242, 252 (Wis. 1955)The Supreme Court of Ohio, in 1955's Kraus v. City of Cleveland, said, "Plaintiff's argument that fluoridation constitutes mass medication, the unlawful practice of medicine and adulteration may be answered as a whole. Clearly, the addition of fluorides to the water supply does not violate such principles any more than the chlorination of water, which has been held valid many times."127 N.E.2d 609, 613 (Ohio 1955)Fluoridation consensus
As cases continued to be brought in state courts, a general consensus developed that fluoridation, at least from a legal standpoint, was acceptable. In 1973's Beck v. City Council of Beverly Hills, the California Court of Appeal, Second District, said, "Courts through the United States have uniformly held that fluoridation of water is a reasonable and proper exercise of the police power in the interest of public health. The matter is no longer an open question."Beck v. City Council of Beverly Hills, 30 Cal. App. 3d 112, 115 (Cal. App. 2d Dist. 1973) (citations omitted).Contemporary challenges
Though courts have consistently rejected arguments against fluoridation, advocates continue to challenge the spread of fluoridation. For instance, in 2002, the city of Watsonville, California chose to disregard a California law mandating fluoridation of water systems with 10,000 or more hookups, and the dispute between the city and the state ended up in court. The trial court and the intermediate appellate court ruled in favor of the state and its fluoridation mandate, however, and the Supreme Court of California declined to hear the case in February of 2006.Jones, Donna [http://www.santacruzsentinel.com/archive/2006/February/10/local/stories/07local.htm "Supreme Court turns down Watsonville's appeal to keep fluoride out of its water."] Santa Cruz Sentinel. February 10, 2006. Since 2000, courts in Washington,Parkland Light & Water Co. v. Tacoma-Pierce County Bd. of Health, 90 P.3d 37 (Wash. 2004) Maryland,Pure Water Committee of W. MD., Inc. v. Mayor and City Council of Pure Water Comm. of W. MD., Inc. v. Mayor and City Council of Cumberland, MD. Not Reported in F.Supp.2d, 2003 WL 22095654 (D.Md. 2003) and TexasEspronceda v. City of San Antonio, Not Reported in S.W.3d, 2003 WL 21203878 (Tex. App.-San Antonio 2003) have reached similar conclusions.Republic of Ireland
In Ryan v. Attorney General (1965), the Supreme Court held that water fluoridation did not infringe the plaintiff's right to bodily integrity.Ryan v. A.G. IESC 1; IR 294 (3 July, 1965) — text of the Irish Supreme Courts judgement'' However, the court found that such a right to bodily integrity did exist, despite the fact that it was not explicitly mentioned in the Constitution of Ireland, thus establishing the doctrine of unenumerated rights in Irish constitutional law.Pop culture references
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