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Saturday, May 04, 2013

 
[#] [1]
i find myself in the surprising position of voting against fluoridation. as a child from a fluoridated small town, i was shocked when i moved to portland to find the water wasn't fluoridated.

i appreciate that portland was willing to vote on this issue, but a lot of hysteria around fluoridation kept me from engaging with it for a long time. the essence of the the anti-fluoride argument seemed to be "CHEMICALS BAD!" while the essence of the pro-flouride case seemed to be "IF YOU VOTE AGAINST THIS YOU HATE POOR CHILDREN."

but ultimately i've come to decide that fluoridating portland's water will not provide enough good to justify medicating the water supply. my top 3 reasons are ones i haven't seen discussed a lot elsewhere and had to come to on my own:

1. i have a strong personal ethic to support autonomy and consent whenever possible. this is especially true when it comes to medical treatment. when municipal water is modified, nobody can opt out. in that situation, the only way to control an individual dose of fluoride is to buy bottled water. plus, not everyone affected by this change can vote on it, creating a system of fluoridation w/o representation. portland is voting on this because the portland city council has the authority to make this change, but fluoridation will affect three counties and several cities who won't have a choice in the matter. i think vaccinations and schools have a higher compulsory value than fluoride, and both of those legally allow for exemptions.

2. fluoride is only effective topically. it was once thought to be systemic, hence the creation of fluoridated water systems. so... why go through the hassle and expense and non-consent if there are other, more effective topical treatments? for instance, the oregon department of human services recommends four things to enhance the dental health in all of oregon, only one of which is community water fluoridation. the others are early-childhood cavities prevention programs, school-based fluoride supplement programs, and school-based dental sealant programs. i would prefer to start with the least invasive methods first to see what impact they have before taking more drastic measures like fluoridation.
[http://public.health.oregon.gov/PreventionWellness/oralhealth/Documents/smile_2007.pdf]

3. but wait! here's the amazing part: according to the same report by the oregon department of human services (the most recent SMILE survey available), dental health in metro pdx is vastly better than the rest of oregon, and even better than the national average! 21% of portland 3rd graders have untreated decay, compared to 29% of the national average and 44% of the rest of oregon. so it looks to me like the area already served by our unfluoridated water doesn't even need to be remediated! in addition, the cdc promotes a maximum of 60% reduction in dental decay when fluoridated water is added to the water supply. which sounds big until you do the math: in the best case scenario, we'd only be moving from a rate of 21% to a rate of 13%, an absolute change of 8%.
[http://public.health.oregon.gov/PreventionWellness/oralhealth/Documents/smile_2007.pdf]
[http://www.cdc.gov/fluoridation/pdf/natures_way.pdf]
ETA may06: from a draft of the 2012 SMILE survey: "...the oral health of 6 to 9 year old children in Oregon has improved" primarily due to school intervention programs rather than fluoridation.
[http://images.bimedia.net/documents/SMILE+Survey+2012+Draft+Results_4-23-13%5B1%5D.pdf]

so for me, i would want to see overwhelming benefit to justify overriding personal autonomy and consent. based on my research, i feel the pro-fluouride side uses the statewide numbers to justify the city vote, and that makes me feel manipulated and resentful. but i am still open to other thoughts because this is such an unexpected position for me.