This is one of these US-specific polarised debates I find really bizarre, around some kind of issue that the rest of the world has by large solved but without any acknowledgement of this fact. Maybe the US should look into how other countries have solved it? It is completely bizarre witnessing both sides getting so polarised around a basically non-issue.
What I love about this comment is that one person thought "of course every other country just does the right thing when the US doesn't" and posted it, and then a bunch of other people thought "of course every other country just does the right thing when the US doesn't" and upvoted it, and not a single one of them thought to check what the "right thing" is.
> Water fluoridation is considered very common in the United States, Canada, Ireland, Chile and Australia where over 50% of the population drinks fluoridated water.
> Most European countries including Italy, France, Finland, Germany, Sweden, Netherlands, Austria, Poland, Hungary and Switzerland do not fluoridate water.
> 1. The beneficial effect of fluoride occurs only when fluoride is applied externally, in contact with the tooth enamel
I think you are kinda misusing science/not science arguments.
This is indeed the scientific reason why there is flouride in the water. It is also scientific reason why some countries removed it.
In some countries people take care of their teeth on average and in other countries not so much. So there is science for why fluoridation happens. You can read many articles about the fluoride benefits for teeth and what is the impact of teeth for overall health.
>The problem is that fluoridation of the drinking water is not supported by any science.
Yet it is supported by science.
Indeed even the discovery of this property of fluoride came about from the observation of people who naturally consumed fluoride had fewer dental caries and tooth decay.
Further studies cemented the benefits of the passive inclusion of fluoride in drinking water versus control groups.
So no, the science you speak of is almost certainly politics dressed up as science.
Just a note for future people reading this comment. This is completely and totally wrong, and arguably should be deleted from Hackernews for being so deluded.
There have been countless studies that show that communities with flouride in the water have consistently lower rates of tooth decay than communities without fluoride in the water. In fact, community water fluoridation has been recognized as one of the great public health achievements of the 20th century.
Systematic reviews and meta-analyses have shown repeatedly that water fluoridation reduces tooth decay in both children and adults by approximately 25-30%.
Why is that missing context? I don't think anybody who is against fluoridated tap water rejects the benefits of fluoride, they just think the harms of adding it to tap water outweigh the benefits.
The lethal dose of fluoride is in the 5-10g range for an adult [1] with immediate gastrointestinal effects at 15-20x lower. While those levels are quite obviously far above the recommended level of 0.7mg/l, it's very reasonable to call anything that's lethal at 5g, to a human adult, as dangerous.
The latest report from the National Toxicology Program has found a causal reduction of ~1.63 IQ per additional mg/L concentration of fluoride in their urine [2], which would seem sufficient to also call it a neurotoxin, though the NTP under extensive pressure chose to avoid any particular label after having previously declared it a "presumed neurotoxin."
Notably the study from NTP also mentioned something most people here seem to be missing: "There is a concern, however, that some pregnant women and children may be getting more fluoride than they need because they now get fluoride from many sources including treated public water, water-added foods and beverages, teas, toothpaste, floss, and mouthwash, and the combined total intake of fluoride may exceed safe amounts."
Fluoride being seen as desirable at safe levels, may have drove excessive multi-domain inputs of it, which can combine to drive it to unsafe levels.
> it's very reasonable to call anything that's lethal at 5g, to a human adult, as dangerous.
No it is not. It is sensational and intentionally inflammatory. It is especially damming coming from someone in his position.
Vitamin A, vitamin D, vitamin B, iron, and caffeine are all deadly at that level. The first 4 are mandatory for life, shall we call them dangerous too? Or perhaps we have some nuance and acknowledge the co spirit oriel background (and other beliefs) of the people pushing the anti-fluoride message.
Obviously. In looking up the LD50/lethal dose for vitamin A, I ended up here. [1] You might notice the big red symbol "Health Hazard" at the top. And the LD50 for vitamin A ranges from 1500-3700mg/kg, contrasted against fluoride's 26-94! But really one of the biggest issues here is that unless you're actively trying to kill yourself with vitamins, an overdose generally has no major effects beyond some gastrointestinal issues. I've experienced it myself by supplementing with vitamins while body building and consuming an already extremely high nutrient diet.
But with fluoride we're talking about extremely low doses, well below the lethal level, being able to potentially permanently damage the mind's of children. Such an extreme risk justifies an abundance of caution, especially when the reason we're doing it is for some relatively modest dental gains, which are likely increasingly obsolete with fluoride being in tooth paste and many other sources besides water. In fact, as per the study I linked to up above, this is precisely the problem!
"Since 1945, the use of fluoride has been a successful public health initiative for reducing dental cavities and improving general oral health of adults and children. There is a concern, however, that some pregnant women and children may be getting more fluoride than they need because they now get fluoride from many sources including treated public water, water-added foods and beverages, teas, toothpaste, floss, and mouthwash, and the combined total intake of fluoride may exceed safe amounts."
> which are likely increasingly obsolete with fluoride being in tooth paste and many other sources besides water.
See the rest of this thread. If you think the group (at RFK doing so in an official government capacity) using such inflammatory language is going to stop at removing fluoride from just water I don't know what to tell you.
I disagree there. When you actually listen to what RFK says instead of the media's spin on the most extreme cuts taken out of context, it's nowhere near as sensational. In particular RFK has consistently and repeatedly stressed an opt-in view on all things health/pharmaceutical related. If you want it, you can have it. But when you do things like fluoridate public water supplies, you turn it into an opt-out system where unless you go out of your way - you're going to get it.
Tooth paste, and other commercial products, are opt-in systems. And indeed there are already numerous unfluoridated options available.
Generally speaking I see fluoridation as a ridiciulous idea, on the grounds that the vast majority of tap water ends up being used for things other than brushing your teeth. It is wasteful and damaging to the environment, that excess flouride that has no business being there ends up in the drain, or the water you use for your plants.
Flouride should be put in the toothpaste. Then people can make a choice on whether they want it, but most importantly, its in the only product that is actually used for brushing teeth
It's basically a waste product and water naturally has fluoride in it at the same levels, or more, that fluoridated water has, and the environment has been just fine in those places.
While I acknowledge it is not a "solved" issue, I find it bizarre nonetheless, simply because it is so disproportionately low-stakes compared to the amount of controversy around it. Increased risk of cavities versus tentative evidence of losing 1-2 IQ points at 1.5 mg/L? Sounds like a Monty Python sketch to me that people would get so worked up over this.
The risk of cavities is reduced by using toothpaste or mouth washes with fluoride, not by drinking fluoridated water.
Almost all fluoride from the drinking water does not have any effect on tooth enamel, because it has contact with it only for a few seconds, except for an infinitesimal fraction that may exit again the body in saliva.
On the other hand, the harmful effects of fluoride in drinking water are certain and it cannot be predicted exactly how much water will be ingested by someone, i.e. which will be the harmful dose of ingested fluoride.
The only argument of those who support water fluoridation is that most people must be morons who cannot be taught to wash their teeth. I do not believe that this theory can be right.
> The risk of cavities is reduced by using toothpaste or mouth washes with fluoride, not by drinking fluoridated water.
it always surprises me how willing people are to just make something up and be confident in doing so. We've know for almost 75 years that water fluoridation reduces tooth decay[1] and yet here you are straight up denying that.
Do you just not care if you are correct? or do you know you aren't but are driven by the beliefs you already hold?
> Almost all fluoride from the drinking water does not have any effect on tooth enamel, because it has contact with it only for a few seconds
The contact via toothpaste or mouth wash isn’t all that much longer, so why would they be effective if fluoridated water isn’t? People intentionally wash out toothpaste and mouthwash after this short contact.
Im sorry, but I think it’s ridiculous that thinking something that knows off an IQ point or two isn’t a big deal.
For one, we’re literally making everyone slightly less intelligent. While it’s a very small factor, I sure as hell wouldn’t want that for my daughters.
For two, IQ is easy to measure. Through that, we know it’s affecting the brain during development. How else is it affecting it? We don’t know.
Weighed against potentially higher risk of cavities pretty much only during childhood and the math seems incredibly clear to me. I feel like the only reason we haven’t banned adding it to water supplies is because people have a knee jerk reaction to anything that sounds even vaguely anti-vax nowadays.
The fact that until 10 years ago the US allowed significantly higher levels should be a really big deal to people.
I’m on reverse osmosis well water so it doesn’t matter to me personally, for what it’s worth.
IQ points is just an indicator that could be measured consistently. Who knows what else is going on.. and statistically (especially depending on the distribution) 2 IQ points is quite a lot. After all 50% of the population fall into the 20 point range in the middle..
Of course it comes down to whether the relationship actually exists. But picking a slightly higher risk of cavities when the other option is potential mental impairment (however mild) seems like a no-brainer..
you're really genuinely shocked that people would get worked up over chemicals being added to their drinking water without their consent? chemicals which have not been conclusively proven to be non-toxic? chemicals which are already in toothpaste giving people the choice to use them anyway?
flouride naturally occurs in water all over the world, and if you don't want any chemicals in your water you should be drinking distilled water. Almost nobody does, because "chemicals in the water reeeeeee!!!" is just a mindless idiotic shreak, not anything insightful or debatable
having to resort to childish attempts like this essentially invalidates anything "insightful" you might want to say. if you can't see that manually adding safety-unproven chemicals to water without people's consent is a weird and unethical thing to do, then that's fine, but don't embarrass yourself and everyone else like this
> if you can't see that manually adding safety-unproven
Nobody is doing that, so maybe don't embarrass yourself like that?
> without people's consent
Also not happening. Consent was established when it was voted on, and if people want to change their local policies they are always free to do so. People that object against majority are also free to drink alternative water from the free market instead of relying on socialist handouts
If you want to have an actual, good faith debate about the pros/cons of a specific additive that's wonderful. But you didn't, you reduced the entire thing to "chemicals bad because chemicals". But, more significantly, so too has the US's administration which Utah is following suit on. The US is full on "feels not reals" government mode.
my friend at this point you are just wildly throwing whatever pops into your mind into the air and hoping it sticks somewhere
when was it voted on and by who? tell me.
you're also aware that people pay for water, it's not free? quite an odd thing for an adult to not know
"good faith debate". from someone who started making mocking autism noises in the middle of a normal conversation? that's what I suggested was embarrassing, you simply didn't read my comment because you yourself have no interest in having a good faith discussion and you're just blindly throwing terms like that as a way of dismissing an opinion you disagree with.
"chemicals bad because chemicals" I never said anything of the sort, this is a strawman you invented to strengthen your struggling argument. there have quite literally been studies linking increased fluoride to toxicity. it's not "chemicals bad because chemicals" it's "there have been studies suggesting this chemical may be toxic so why are we putting it in drinking water without a public consultation in the last 70 years?"
>The US is full on "feels not reals" government mode.
okay and here we have your real motivation. 90% likely you quite obviously don't give a fuck about fluoridated water or human rights, you are pissed about the current executive branch and you're looking to take it out somewhere. this "debate" is over.
To straw man, you could argue that 1-2 IQ extra might have a large affect on the salary as everything is relative.
If you are on the lower IQ scale, a ten point reduction would double your likelihood of doing crime.
I put in a spelling error in the above paragraph of 215 characters, you still understand it but what was your perception of me from this very small error?
What rights of minorities have been targeted? If the only example is trans rights, it's dumb to think it's a simple issue of trampled rights. There are two competing sets of rights, you grant one set you take away from the other. There isn't a good solution.
If you think all the people advocating for small government must be fools or hypocrites, you don't understand the issues an any depth.
Why do trans people not count as a minority being targetted?
I'm curious, what rights are "granted" by making it illegal for doctors to prescribe puberty blocks when they as a medical professional and a child's parents as their guardian agree they're the best medical course of action for a child?
Saying "it's about granting and taking away" like rights are some zero-sum game feels like it's ignoring the complexity of these issues more than what I'm saying.
> What rights of minorities have been targeted? If the only example is trans rights, it's dumb to think it's a simple issue of trampled rights
So it's not an issue of trampled rights if it's just trans rights, yet you can't come up with a reason that trans rights need to be restricted to ensure freedom of others. And it's being disingenuous to call you out for saying trans rights don't matter when you say this...
Example: trans rights in sports. You let them play, you take away the rights to a fair playing field for women born women. You don't let them play, you take away their right to play sport. There isn't a good solution.
You knew the example. You know why society restricts people below 18 from all kinds of things. You are the very definition of disingenuous.
Trans people playing on the sporting team they want to is not "rights", and your focus on it to deflect from the very real issue I brought up is telling...
I don't mind being called "the very definition of disingenuous" by you.
It’s not at all the same, that’s a terrible example. Child vaccinations help reduce the Rt, regardless of whether the benefit to the individual is significant. Statements to the contrary have just confused the public. (biochemist)
Once you start trying to cross-reference a public health campaign with something related to peoples' diets, it becomes difficult to make super broad and conclusive statements.
Here's some interesting data (2003 I believe, so pretty old) [1]: It reports that most of Europe, Canada, Australia, and South America experiences cavities at rates higher than the United States. However: Many of these countries have public health care; the US does not. Is the US under-reporting? (I didn't dig much deeper into the underlying data; may not be a relevant concern).
Three things I think are likely to be true: (1) Fluoridated toothpaste is widely available and cheap. (2) Cavity rates are significant even in countries with high rates of fluoridation. (3) Fluoridating the water supply carries with it a non-zero monetary cost. I tend to believe that these three realities, at the very least, justify the conversation as being one we should have. It could be the case that water fluoridation made a ton of sense in a world where people didn't have as much access to fluoridated toothpaste, but nowadays the typical person has hit the limit on what it can do for them, and ingesting more is, at best, doing nothing.
Here's another way I like to think about it: Put the science aside for a second (I know, hard, not ideal, but bear with me). You've got two people who are low income. Person A believes, for their own health and in the expression of their own personal liberties, they want access to fluoride; but the Government is not fluoridating their water. They can spend $5 a month to buy fluoridated toothpaste; possibly not even more expensive than the toothpaste they were already buying. Person B is living in the opposite world: They believe that they do not want to ingest fluoride, but the government is fluoridating their water. They would have to spend many dozens to hundreds of dollars a month buying water bottled somewhere more natural. From a personal liberty and economics perspective: Its pretty clear-cut.
Using your "person a" "person b" story, what about "persons c-z" that also want fluoride because they trust doctors?
If one out of a hundred people don't want fluoride, can't they can spend slightly more on bottled water? Why require the other 99 to be up-to-date on research to get the best personal medical outcome?
Direct monetary cost is entirely insignificant, though. Potential risk of mental impairment (of course there is no conclusive evidence of that) seems like a much bigger issue.
IIRC _some_ of the European countries that “do not fluoridate their water” have naturally occurring fluoride levels in their water, obviating the need for them to do it.
Supplementation mainly concerns iodine for non-marine salts. Sea salt naturally contains iodine and fluorine. Salt from salt mines contains much less. For this reason, iodine deficiency was relatively common in the Alps until the beginning of the twentieth century.
To my knowledge, there is no debate or controversy on the subject. Endemic goiters are exceedingly rare and are linked to behavioral and eating disorders.
That is not true. You are probably thinking of iodine. Actually fluoride is prohibited in children's toothpaste in Germany because of its suspected neurotoxicity.
EDIT: I checked. It is possible to buy salt with added fluoride in Germany but it comes with the health note "Zusätzliche fluoridhaltige Präparate sollten nur auf ärztliche Empfehlung eingenommen werden.", which means you should only use it on recommendation by your MD.
Thanks for pointing that out. I wrote "prohibited" from what I remembered when my child was little and the discrepancy to the info you provided made me research the topic, so here is a summary of what the law (1223/2009 Cosmetic Products Regulation Annex III) has to say:
Tooth paste with more than one per mille of fluoride has either to be marked as unsuitable for children or has to have a note that children have to be supervised using it and a doctor or dentist has to be consulted in case the child swallows more than a pea-sized amount.
So, not quite prohibited, but far from recommended.
Germany and France don't fluoridate water, but they add fluorine compounds to table salt.
Meanwhile growing up in Poland in the 90s as kids we had these fluoridation sessions in school, for which everyone had to bring their toothbrush and brush their teeth with some kind of sour tasting fluid that contained fluorine.
The world map is hilarious. Germany sure does not look like this anymore (and this is not the GDR split but goes further back). Maybe they should update this. Draws into the question, the whole data.
Both non-fluoridating countries and country borders are white, so it's not that Germany is drawn wrong, but that that countries near Germany (Czechia, Netherlands, Luxembourg) look like they're part of the same white blob.
The point is basically no one else has politicised this to the extent the US did. Pointing to how different countries solve it differently is missing the point completely.
"Well, whether it's better to fluoridate the water or not, ~half the world got the answer wrong. But the important thing is they didn't argue about it."
They do have a point. If you look at history, Americans do seem to have a bizarre habit of turning everything into a great controversy.
The British abolished slavery with a vote of parliament. The Russian emperor signed a decree, and freed the serfs. Compromised were made, compensation provided and people were made free. But for some reason, Americans felt the matter is important enough to start a civil war around it.
People complain about America being divided and both sides there being unable to compromise, but if anything, that's been the defining feature of the nation since it's creation. "Y'all should take a chill pill, this ain't that important" is a perfectly valid position to have.
> Americans felt the matter is important enough to start a civil war around it.
The answer was the same then as it is now: big business. Slave labor cash crops were central to the economy of the South. Great Britain was not dependent on it in the same way.
> The British abolished slavery with a vote of parliament
The situation was fundamentally different. Colonies that allowed slavery had no representation in parliament and the slave owners received massive “compensation” that the British people had to spend decades paying off..
Also AFAIK most slaveholders were living in Britain and just viewed their plantations as just another investment. There was very little ideological/“way of life”/racial supremacy stuff involved. So if some Liberals wanted to buyout their not necessarily very liquid “property” with cash they didn’t really have much reason to oppose it.
And then there were 5x more slaves in the US in 1864 while the population was only ~30% higher than that of Britain in 1830 (only if we don’t count the colonies).
Not sure how excited would the inhabitants of New England and other free states would have been if they were forced to buy out all the slaves in the country (if that was even an option).
Slavery for the British was a side note at that point while it was a fundamental component of the US economy.
Serfdom was fundamental to the Russian economy, but was abolished nonetheless. Alexander II forced the serfs to pay for their own freedom.
The idea that no compromise was possible sounds somewhat absurd since America did end the civil war with a compromise. "You can free the slaves, but then we oppress them for 100 or so years." Not that it was a good compromise or anything, but it does show that the civil war was fundamentally pointless.
Russia was a centralized absolutist empire. The Tsar could more or less do whatever he wanted as long as the army and some other elements of the bureaucracy supported him.
So it’s hardly applicable to the US (or Britain)
> end the civil war with a compromise
I’m not sure it’s was a compromise per se.
Most people in the north didn’t really actively support country wide abolition before the war (neither did Lincoln) nor were they necessarily particularly concerned about the treatment of the African-American population.
Opposing slavery is a very low bar. Most people in the free states were still deeply racist and segregation was effectively (while not necessarily legally) still a thing there. It only became a major issue in the mid 1900s.
England has 3 or 4 civil wars in it's history entirely focused on the matter of whether people should do as they're told and shut up. The usual result in those conflicts was a resounding victory for the "No" side.
What's rare is for a nation to have a civil war between sides that agree on almost everything, from the structure of the government to the economic system.
I'm not in the US but doesn't that downplay it a bit? Hasn't this been a contentious topic for some time? It's not like no one's been talking about it and Utah suddenly decided out of the blue.
> I'm not in the US but doesn't that downplay it a bit?
No, not really. There are a couple municipalities (Portland, OR, e.g.) that have famously not fluoridated their water forever, but for the most part this is not something most places argue about. UT is an exception.
The irony is that people on the Left will claim that red Utah is ignorantly making public health policy, while deep deep blue Portland is considered “progressive.” The public health “experts” are ripping into Utah but haven’t seemed to care about Portland. Perhaps because the public health people are mostly Democrat and care more about politics than actual health? I would love to be wrong — but why is Portland (and much of Europe) getting a free pass from the controversy, but a (relatively low population) red U.S. state isn’t?
Portland, Oregon is a city so the effects of their policies are a little more limited in scope. IMO if it really is a contentious health issue (well-founded or not, I guess people really do disagree about this issue) it is better to make the decision at the lowest level practical.
I think most cities manage their own utilities. So, Portland has to make some decision on this issue. Utah doesn’t, it was an active choice to intervene.
I'm not sure what you're getting at. What I meant was that it was my impression that the argument over fluoride has been going on for longer and is bigger than this one case. How and why the judge ruled and what the ruling was is tangential to that.
The issue, to my eyes at least, is much less of water, and much more of fluoride itself. That is what seems mostly a settled and non controversial topic elsewhere such that it is not perennially raised anew with tone of fans quoting Dr. Strangelove except meaning it.
I thought the comment was about resolving the issue one way or the other without it becoming yet another polarization topic . It probably matters less in either resolution than the cost due schisms and distrust the "debate" causes.
Regardless of whether the water is fluoridated or not, the main guideline is "brush your teeth with fluoridated toothpaste". No policy maker elsewhere is pushing narratives against fluoride at large like in the US. These narratives there are even dangerous. One can easily look at dental associations reviews, or official state guidelines and see that more or less they say very similar things. It is very easy to find these policy-informing reviews online.
And regardless of whether the water is fluoridated or not, there is no big debate elsewhere about it, nobody cares that much about it, because all the evidence is that in smaller amounts prob it is does not matter much either way, in the presence of people brushing their teeth. A lot of countries stopped it due to logistic purposes. In netherlands they tried fluoride in the water, a court said they should actually pass a law in order to be able to do it, and they did not even bother with that and dropped it. The fact that some countries may not use fluoride in the water is not due to some deeply-held conviction about how destructive fluoride is for the iq of the kids. In terms of risks of fluoride, fluorosis is what is mostly discussed anyway, and to a degree, unless it is too serious, this may just be an aesthetic issue.
From the perspective of one that watches this craziness from outside, the whole debate is non-sense, and whether some european countries use water fluoridation or not is not very important, it does not cause any heated debate in the EU. The debate in the US is not because the US considers some things that others do not consider. There is no actual truthseeking mentality from the current administration or anybody on this to actually find for sure if fluoride decreases iq, or if fluoride in the water is absolutely essential for dental health even if people are brushing their teeth.
What does the UK do? This will tell you what people should do because I’ve seen English teeth.
> In England, approximately 10% of the population, or around 6 million people, receive fluoridated water, either naturally or through water fluoridation schemes, mainly in the West Midlands and the North East.
Uh oh. I know it is better now but in 1978 a third of people in the UK didn’t have their natural teeth.
This was not much different everywhere else. Public dental care campaigns helped a lot, the same with affordable dental care products. Looking at my parents generation there are lots of false teeth going around. (Not uk)
I was reading a while ago about populations that moved to England, and within 2 generations their teeth are messed up (the first gen of kids born is usually raised on the food of their original culture).
You saw it too in Canada when the Inuit went on food stamps and went from eating mostly meat to mostly plants: their teeth went all over the place and full of holes within a single generation.
We also saw that with the advent of agriculture in general, along with a massive decline in average height.
You’re right that dietary changes can impact health, but there are other factors at play. Stress from moving to a new country or experiencing forced dislocation can have serious effects on physical health, weakening the immune system and disrupting overall well-being. Along with this, shifting away from nature-based vocations to more sedentary lifestyles contributes to health decline. The increased consumption of sugar and alcohol also exacerbates dental and general health issues. So, it’s not just diet but a combination of stress, lifestyle changes, and modern substances that contribute to health problems in these populations.
My grandfather, who was still alive in 1978, had all his teeth removed and was given a set of dentures when conscripted into WWII. From what I can gather this was pretty common - the service dentist would check you over on arrival and if you had at least one cavity they'd whip the lot out so that they wouldn't need to do anything else to them for the rest of your service.
The US rarely looks into how other countries solve problems. (i.e. Universal Healthcare, High Speed Trains and so), this is the sad part of "American Exceptionalism"
Those are two odd examples. The Affordable Care Act is similar to the Netherlands health insurance system: https://www.commonwealthfund.org/blog/2011/lessons-abroad-du... (“These similarities are not entirely coincidental. American public officials, health industry leaders, and scholars made frequent visits to the Netherlands in the run-up to the debate over U.S. health care reform, borrowing ideas and, on occasion, citing the Dutch system as a model for what the U.S. might achieve.”).
As to rail, both the first-gen and second-gen Acela is based on the French TGV.
The U.S. has a pitiful amount of high speed rail. It serves no point to mention that this pitiful amount of high speed rail is based off of TGV.
The comparison to the Dutch healthcare system is not apt. While the Heritage foundation may used ideas from the Dutch system our system is quite a bit more Byzantine and inefficient. We spend twice as much per capita on healthcare and have worse outcomes and fewer people covered. Our citizens have far more per capita medical debt than the Dutch.
We didn’t really implement the Dutch system and we didn’t really learn from the French how to build and maintain high speed rail. Saying we learned healthcare from the Dutch because we have doctors like they do makes as much sense as your argument.
The original claim was "The US rarely looks into how other countries solve problems". That claim appears to be false.
Why does the US execution not match that of the countries it looks into? I think it's because talented people in the US disproportionately go into the private sector, leading to an incompetent public sector. American distrust of their government is arguably justified.
I thought the ACA was based on the Swiss system of mandatory insurance? The heritage foundation copied the Swiss, Romney took that proposal to Mass, and Obama thought going with a Conservative initiated plan would make it more bipartisan (it didn’t, but mainly because republicans hated Obama).
IMO the most distinct parts of the Swiss health insurance system is that (1) copay is obligatory but limited (i.e. healthcare isn’t free but it’s not expensive either), and (2) it’s individual, companies cannot pay for it, so there’s no US-like extreme benefit of having a good job.
In the Netherlands we have those two as well, but it is also regulated:
- the cheapest plan must not cost more than 115 eur (dont know exactly), and it has mandatory coverage (‘basisverzekering’)
- there is a maximum copay of 850eur per year (‘eigen risico’)
- some services are not allowed to have copay
- low income people can have extra subsidies to pay for insurance
- insurance is mandatory
- insurance is a personal thing, not a work-thing. Your work absollutely knows nothing about your health insurance
Due to the regulations it is not a big run to the bottom
Yes, having lived in Switzerland I experienced that, and it was the personal buy rather than having group plans was the feature missing from the ACA the most.
aca di. implement a market, it's just that most people buy through their job, because if that's legal you obviously want to be part of a larger bargaining pool for buying.
Group plans suck away cream of crop risk pools. People with good stable high paying jobs tend to be a lot healthier than people working part time crap jobs or working in the trades for themselves.
It isn’t really bargaining power of the pool, but the risk assessment of the pool you are in. Being in a hodge lodge personal pool means you are sharing risk with people who will have more expenses. That’s why Switzerland throws everyone into the same pool, so no crème low risk can be siphoned away.
A less cynical framing is that the US is a much different culture from European countries, and is massively larger in scale. Depending on the problem, some of their solutions simply can't or don't apply.
The scale argument is thrown around a lot as a justification for why the US couldn't possibly implement universal healthcare. The elephant in the room that I'm always surprises at how rarely it's mentioned in these discussions is Brazil, which is a huge country of comparable size (both territory and population wise), and it manages to make UHC work even though it's also a much poorer country.
It's not perfect by any means, but it's definitely much better than nothing. So the US should absolutely be able to at the very least match that, but really most likely it should be able to do much better. That it doesn't is very much a choice.
The elephant in the room is that in every other sphere, scale is the solution, not the problem. The US should find it easier to implement UHC just because of its scale. More tax dollars, more average outcomes, more resources for outliers, more incremental money for research into rarer conditions. That 10x smaller countries like Canada do it effectively is an indictment of America's inability to do it.
America doesn’t do it for political and cultural reasons. It has absolutely nothing to do with scale, economics, or America’s “inability” to do it. Americans (unfortunately imo) have consistently chosen not to do it by not electing politicians who have pledged to do it.
> I think the US would prefer a UHC if we were starting from a blank slate. The difficulty is mapping a path from what we have now to that.
Do you remember when Republicans went on and on about how "Democrats rammed through the ACA without a single Republican vote"? As if that represented a problem on the Democratic Party side, and not the Republican one? Despite the similarities to models proposed by Republicans in the past, and the relative conservative step it represented from "Byzantine kludge of often poor-to-no-coverage" to "something with a higher floor"? That's how hard it would be to find a Republican to "prefer a UHC if we were starting from a blank slate."
It's important not to underestimate the distrust of government services and regulation of any sort of the Republican base. The conservative media - talk-radio, then cable, then social/podcasts - has been intentionally undermining the credibility of government services at every opportunity for 40 years. And the politicians hamstring and sabotage whenever they get a chance to try to make sure that services offered in the US are sub-par compared to elsewhere.
It's a well-oiled machine running a cycle that keeps people focused on anything else but the services they actually use all the time so that cognitive dissonance can't creep in. (Granted, sometimes, when necessary to acknowledge those things, they'll fall back to making it clear that YOU earned/paid for the things you use, but those other gross poor people are just freeloaders.)
It's like with abortion - for decades "overturning Roe V Wade" was what Republicans said they wanted to do. And people kept trying to convince themselves "oh they don't really mean that, they wouldn't do that actually anymore." Take their word on it about wanting to tear down government services.
> It's important not to underestimate the distrust of government services and regulation of any sort of the Republican base. The conservative media - talk-radio, then cable, then social/podcasts - has been intentionally undermining the credibility of government services at every opportunity for 40 years. And the politicians hamstring and sabotage whenever they get a chance to try to make sure that services offered in the US are sub-par compared to elsewhere.
This is partly what I was getting at when I said the culture of the US is different and the scale is much larger than European countries. It's not just geographically larger, but it's politically and ideologically broader too. If you have a wonderful idea like UHC, you need to make it work with liberals, conservatives, and everyone in between. Like it or not, a universal healthcare or Medicare for all plan is either going to be DoA in Congress, or a considerably watered-down and Americanized version if it has any hope at all of getting enough senators to pass it without first seeing massive electoral college reform in this country first.
That is the scale of the US. You can't assume that an idea that's well-liked and popular in another country is going to be popular and well-liked here.
Considering that Europe is composed of many countries with massively different histories, cultures, economies and languages I find that a very unconvincing argument. The US are much more culturualy homogeneous than Europe. I mean just go across the country and look at the patriotic displays of flags which also transcends political differences. In contrast in Europe you first would be seeing different flags, but also displaying flags has very different acceptance rates in different countries.
Right, but we're not talking about "Europe", we're talking about each individual country. I don't think it's reasonable to say that France, for example, is more culturally diverse than the US.
And the various countries in Europe do have different healthcare systems, sometimes significantly different.
> The difficulty is mapping a path from what we have now to that.
It's difficult, but not as difficult as it's often presented to be, as long as you're okay with giving the finger to a relatively small number of wealthy health industry executives.
That depends on who "you" is. Quite a few people in Congress are ok with doing that, but not anywhere near enough to get anything passed. Look at the GOP side of the aisle and you'll essentially find no one willing to do that. Not to mention they are just simply ideologically opposed to the concept of government-provided universal health care.
And that, is the difficulty. Sure, I agree that it wouldn't be too logistically difficult to implement universal healthcare in the US. But that doesn't matter when more than half the country has been propaganda'd into not even wanting it in the first place.
Hell, I expect that there are a ton of Medicaid and Medicare recipients in the US who would tell you that they think government-provided, single-payer healthcare is a bad idea, when that's essentially what they have, to some degree.
I got a Master's Degree in Education and spent 2 years in Educational Psychology Ph.D. program and absolutely 0 time was spent looking at how other countries do education.
It's baffling how despite numerous other countries outperforming the US in educational outcomes we do not even look at other approaches!
Yes, in the Netherlands we have a culture of moaning about everthing. Youd beter not dare suggest sonething is good enough! This complaining is the only thing we are proud of. lol
(If we had patriotic songs worth remembering im sure i would have)
The problem is this, hoe do you fix something you are proud of? It seems a contradiction?
Agreed, I lives in the Netherlands for a couple years and can agree there isn't much patriotism so much as pragmatism! (I actually mean that as a good thing, I was a very fond of NL and the friends I made there).
Speaking as an American, though, I can both be proud of something and recognize its faults. I'm proud of the core principles that America was based upon, for example, but very much recognize how far we've deviated from them and how much we need to fix.
> I'm proud of the core principles that America was based upon
I think there's never much to gain in being proud of things you have nothing to do with or control over. If you like some principles you would be proud when you uphold them personally. It is when we start feeling proud in the abstract that we start having issues.
Can't help but agree. I would go even further and say that pride itself is problematic. Sure, it can perhaps have some good effects, but pride usually blinds people to faults, even if the do acknowledge there are faults.
"Pride goeth before a fall" is a time-worn saying for good reason.
I'm not a big fan of patriotism in general, but something I noticed about the US patriotism is the tendency to call the US "the best country in the world". This crosses all political differences, e.g. I recall being surprised how Michael Moore was saying it in an interview or movie (when justifying criticising policy, he said he does it because he knows that America is the best country in the world). Even the most patriotic friends I have in other countries would typically not say this.
Yeah, as an American I've always found this cringe-worthy, even kinda icky.
Claiming to be the best (at anything) is just tacky and arrogant. Especially with something as impossible to quantify as "best country". There's no such thing as the best country in the world. Every one has strengths and weaknesses, and you can't really balance and rank them.
What does leftist mean in this context? Sure you could say the "nationalist" movements against monarchies and for more democratic processes were progressive at the time, i.e. they wanted to change the status quo. Calling them leftist in the modern sense (again with a huge caveat about what leftist even mean), doesn't make much sense IMO. Also it's important not to forget that the internationalist movements (which I'd argue fit modern definitions of "left" much more closely) developed quite quickly (in historical timeframes) after, e.g. it was only 50 odd years between the Warburg festival in Germany (generally considered the birth of German nationalism) and the Paris commune.
I guess "the best" is doing a lot of work there, for example the most sung anthem for Denmark "Der er et yndigt land" - there is a lovely land does not explicitly say that Denmark is the best ever, there may indeed be other lovely lands, and in comparison with say America the Beautiful it is downright humble, but on the other hand it is my experience that anthems talk up their country, and if they are talking up their struggle for independence or freedom, like say Il Canto degli Italiani, it will be talking up the martial valor of the people so freed and probably talking about how they aren't going to be put down again, another aspect that America the Beautiful goes into.
The difference between America the Beautiful and other anthems is how much it does, for how long, and making sure it gets everything it can possibly cram in there. It's like a bunch of people standing on a stand at a sporting match shouting "America, America, America" unremittingly, whereas most people might be satisfied to shout "Go {my country}" and be done with it.
Which part here exactly cannot work in the US? I am talking about brushing one's teeth with toothpaste containing fluoride, which sounds as plain simple as possible to me. Is it regular brushing teeth that fails in the US for cultural reasons? Fluoride in the toothpaste? Supervising kids while brushing their teeth to make sure they do not swallow? It is an honest question.
In a word: poverty. People do not have free dental care, and poor people aren't guaranteed to have a toothbrush, toothpaste or sometimes even a sink to brush their teeth in. Fluoridated water is one of the few dental protections available to everyone regardless of their income. It's cheap, minimal and cost-effective cavity protection at scale for the entire country.
> poor people aren't guaranteed to have a toothbrush, toothpaste
There is no person in the world who cannot have a toothbrush and toothpaste if they want to. And if you find one such person, they won't have access to any centrally treated water.
Assuming the "less cynical explanation" you're referring to was my original response talking about the cultural and scale differences between America and most countries, that was not in reference to fluoride or dental care. I was specifically referring to the OP's assertion that "American exceptionalism" is the reason that America doesn't just copy things like universal healthcare and gun control policies from other countries.
I'm not sure what you're getting at here, I think we may have lost the plot. Are you simply implying that you find the cynical answer more appealing and believable than the non-cynical answer? In my opinion, the internet and today's modern zeitgeist has instilled a sense in everyone that if it's cynical, or dark, or depressing, it must be the correct answer. That's usually the laziest and easiest answer too.
The other weird thing in US discourse about other countries is that when it does enter the conversation, the "rest of the world", or at least other developed countries, are often treated as some kind of monolithic entity culturally and politically. For example, a lot of people on both left and right in US believe that the rest of the world is single payer, and generally that "single payer" is synonymous to "public healthcare". Similarly with gun control, there's no recognition of the fact that there are countries in Europe where you can own an AR-15 just fine, and countries (different ones!) where silencers are over the counter items not requiring any special registration.
edit: But I will say it works both ways. Most countries do not know what it takes to keep hundreds of millions of people of various backgrounds together under a common way of life with a certain risk vs entitlement balance. Americans as a whole are more risk tolerant AND accepting of failure and reinventing yourself. In most cultures it's a great shame to quit your job with benefits, start a business and not succeed. In the states it's not shameful. You tried? Awesome.
Yes, that's my point. We are literally different people with different cultures, values and problems. Case in point: the firearm control you mentioned. I won't get in a gun control debate here, I have my own complicated views on the matter, but it's an undisputed fact that Americans have a right to own guns (maybe with limitations, maybe not) and many Americans deeply cherish that right. There is no gun control solution we can take from Europe that you could apply to the US, it's simply not compatible with our culture, not to mention our own Bill of Rights. It's not a bad thing to recognize that.
A lot of people are uncomfortable having an opinion without being able to rationalize it.
I have to assume many, maybe most, people that give reasons like you mention just flat out don't want the policy and reach for a reason to justify it.
I can say I don't want gun control laws. Not because it doesn't work elsewhere or couldn't work here. I just fundamentally disagree with it and don't want to live in a place where the only ones with guns are state officials.
The US isn't several countries put together, region by region. It's one big ass country. I really don't see how taking it region by region somehow eliminates scale issues when you still have to apply it to the entire country.
It's a federal country of many states though. The original design of the US is fairly similar to the design of the EU today, US states used to be offered much more independence.
Sure, I don't disagree that in a vague sense the EU and US are kinda similar in terms of countries and states.
> US states used to be offered much more independence.
But even in your own example with the EU, the EU still mandates many health policies for its member countries: food safety; air and water quality; tobacco, sugar and alcohol regulations; and so on. That's not at all dissimilar to what the federal government does in the US, except our states don't implement those policies/directives themselves because the feds enforce it all.
The comment I was replying to pointed out that the US isn't several countries put together. As you describe, the EU is several countries put together and yet the US actually pushes more power to the states.
> yet the US actually pushes more power to the states.
Doesn’t their comment claim the opposite?
Unlike the US Federal government EU has very limited direct means of imposing any if its laws or regulations on member states of they chose not to comply with them.
There shouldn't be a scale issue with regards to fluoride in the water. It is either scientifically shown to be beneficial or it isn't, scale and geography likely have nothing to do with it.
Does it not depend on the chemical composition of local water? The US is vast, geologically diverse, and water quality varies hugely across it. Denmark can likely make a decision that's good for the entire country.
Actually, what most countries seem to do (according to other comments I’ve seen here), is just delegate to local bodies, so country size is a complete non-issue.
You're not wrong in that our culture is different, but that cultural difference is chiefly a self fulfilling prophecy of "the government can't do it," promoted by billionaire owned media, so that those same billionaires can run for-profit industries like healthcare and transportation.
The cultural difference is that our rich people are too rich, our media is too centralized, and none of those in power want to enrich and empower the country, when they could enrich and empower themselves.
This is the excuse all American use about literally every single issue anytime anybody points out that other do things better. Most often without actually having thought about it beyond 'muhuhu US BIGGG! USA! USA! USA!'.
If you want to make that argument, actually make it, because if you try, 99% of the time its not actually true, its simply ignorance.
The point is that flouride has the same effect on your teeth no matter how many hectares of lifeless desert happen to be controlled by your government.
Interesting, though I think you may have missed a good deal of my own point. Regardless, I wasn't actually commenting on the fluoride situation, I was commenting on the belief that American exceptionalism is the reason we don't look at Europe and other countries for a slew of solutions that won't work here. It had nothing to do with fluoride, so I think your comment and hostility are a bit off the mark.
My point is that those that continually point out 'but some things don't apply to the US because X and Y' are mostly themselves just falling into the same trap and almost never actually explain why X and Y change anything, making their 'defense' just more of the same.
I feel like this always comes up in these sorts of arguments, that the US is so unique that solutions that work elsewhere can't work here. And yet this point is always hand-waved in, without and specifics discussed, and is just presented as a given.
I really don't buy it, at least not as a general statement.
If you focus only on the scale part of my argument, sure. But I think the culture part of my argument is more than enough of an answer for insurance and healthcare:
Maybe it's just me, but I find the argument that "Americans won't do X cool thing that Europeans/the rest of the world do because they [are dumb/are corrupt/love money/hate each other/believe in American exceptionalism]" to be a very cynical and lazy argument. Note that the person I was replying to was talking about policies and goals like UHC and High Speed Rail, not specifically about fluoridated water – that was the context in which I was replying.
The simply reality is, culture matters. And if your culture has a strong believe in exceptionalism pointing out how others are better at something often creates backlash and an increase in opposition rather then a decrease.
And this is known by people who do professional advocacy work, on topic I am familiarly with, such as city design and transportation. They take great care to make sure all the examples are from the US, even if those examples aren't nearly as good as others. Because they know, when speaking to American audiences, you lose the audience if you suggest in X town, they should do Y that is done in Europe. In the US selling something as domestic innovation is usually the best, "if people in Indiana can do it, you can do it even better".
To just ignore any explanation that points out that culture matters, and believing that only 'hard' factors matter, is incredibly foolish. Cultural believes, such as exceptionalism absolutely do a play a huge role in determining what happens in the real world. To point that out, is not cynical or lazy.
And this does not just apply to the US, it many countries have different forms of that.
When I was a kid the schools taught us the metric system, telling us it was the world standard, and would become the standard is the US by the time I was an adult. That was over 40 years ago. And that pretty much sums it all up.
The US legally switched to metric when England did. It is taught in all schools and used for international trade. But, just like in England there is a mix of imperial and metric units used domestically. If you dont travel internationally, like many Americans, there is little need to use metric. Another generation and there won't be many people left in the US that didn't at least learn metric.
It's not like England in that respect at all. Yes, there is a mix of usage in the UK but it is very limited. People use metric for everything except miles in cars, pints in pubs, and height and weight of people.
From what I have read about metrication, England required all industries to change. The US government doesn't have authority to do that and US industry wasn't going to change all their tooling at great cost if they didn't need to.
How has the debate been solved by the rest of the world? My understanding is that many countries in Europe don't fluoridate the water supply.
I'm skeptical of results showing IQ loss but I also think fluoridation should be phased out as fluoride toothpaste and mouthwash are now widely available. Banning it seems like the wrong move to me...states should simply decide to continue adding it or not.
> How has the debate been solved by the rest of the world?
By having official country-level guidelines by the health ministries or similar for people to brush their teeth with toothpaste containing fluoride, and specific guidelines around it for kids, as trivial as it may sound. Along with experts' reviews providing more details on these decisions, and explaining tradeoffs properly.
Fluoride containing toothpaste is the main recommendation, even in places that fluoridate the water (which are the minority). There is not much to add to this apart from refining these guidelines. Eg in the EU where some countries fluoridate water, most don't, there is no huge debate about it overall. Most eu countries that fluoridated the water stopped doing it some point mostly because it was no longer needed in preventing cavities, and prob largely due to logistics/costs than possible risks.
Your second paragraph reflects my personal views on it, too. The "banning" is weird, esp since, according to the article, it comes from people that seem to advocate against use of fluoride in general in toothpastes etc. The discussion should be around best policies to prevent cavities etc, but it does not seem to be around that. I see nothing wrong with local communities deciding if they want to put fluoride or not in their water, based on their own opinions but also general situation. Maybe in some much poorer areas fluoridation of water could be beneficial until some other measures take place, for example.
Right. The state made the decision to stop it from being added, which is what OP proposed.
Did OP mean that municipalities should simply decide to keep adding or not? If so, how do we decide (from our various armchairs in most cases far away from Utah) what the appropriate level of government for making this call is?
The state’s Department of Health can issue a guidance explaining the states’ experts’ analysis of the available data and tradeoffs of the decision, and let the municipalities sort it out.
I think the bigger complication though is going to be - depending on the state - how water districts are apportioned. I think even many counties (let alone municipalities) will share water infrastructure so it’s not really clear who has the jurisdiction to make that decision other than the state.
It also makes it easier for the consumer: don’t want fluoride, move to Utah. Rather than having to figure out what random water district is doing what.
Banning its addition is a step beyond — but in Queensland, Australia for example, the state government no longer mandates its inclusion, and thus the local councils are able to set their own policy.
> While more than 90 per cent of Australians have access to fluoridated water, that figure is significantly lagging in the sunshine state, where local councils have ultimate authority over whether it is adopted.
> A decade after the Newman government handed responsibility for fluoridated drinking water to local governments, 51 out of 77 have opted out. That means about 28 per cent of Queenslanders do not have fluoridated drinking water
The same discussion happened in Netherlands in the 70s, and water in NL is no longer fluoridated since the 70s for that reason. So it's not that "US-specific". I don't know about other countries from the top of my head.
Funny thing you mention that. Since it is now monitored and maintained by natural source. There is fluoride, just not added anymore. (It is at lower levels than when added obviously)
>(It is at lower levels than when added obviously)
This is not obvious. Some water has high levels of fluoride, which can cause harm (fluoride added for public health reasons is not the highest level of fluoride you will find [in the UK]).
Fluoridation could be done by mixing of naturally high fluoride water sources into other water.
There’s evidence that despite widespread availability of fluoride toothpaste and mouthwash, fluoridated drinking water improves dental outcomes at the population level.
There’s also evidence that at high levels (not the normal levels it is added at, but at higher levels which can happen on accident) fluoride may reduce IQ.
I’m ok with either trade off but the “solved” phrasing makes it sound like there is an obviously superior choice.
No no, in the US we figure out the worst way to do something, and then do that, and invent reasons why the US is unique such that the reasonable solutions that other countries employ just couldn't possibly work here.
(To be fair, though, many [most?] Western countries do not fluoridate their water. The US is actually not doing the common thing here.)
It's honestly not clear if water fluoridation in the US is necessary or all that useful here anymore, as we started doing it when fluoride toothpaste wasn't really a thing. Now pretty much all(?) toothpaste in the US has fluoride in it. If someone can't afford toothpaste, then they probably can't afford regular dental care either, and fluoridated water isn't going to make much of an impact anyway.
By not adding fluoride into the tap water and let people choose whether to buy toothpaste with fluoride themselves. a.k.a. the European way.
Adding fluoride into tap water always sounds borderline insane to me. The only benefit is to protect your teeth, which, to me, strongly suggests that the correct approach is to put it into toothpaste or other oral hygiene products instead of water.
I remember the first time I went to a German dentist and he told me how amazing my teeth looked and that he could tell I must be American. Fluoride may have some downsides but it definitely has upsides.
Food often has much higher levels of fluoride than water, but the fluoride isn’t as bioavailable to teeth when it is in food, hence putting it in water. Fluorine in food may become more bioavailable further down the digestive tract where it does much less good.
Here in England, there's some areas that put fluoride into the water and other areas already have sufficient fluoride levels. People complaining about the side effects of fluoridation often forget that water can naturally contain high levels of fluoride - it's really not an issue.
> This is one of these US-specific polarised debates I find really bizarre, around some kind of issue that the rest of the world has by large solved but without any acknowledgement of this fact.
> Maybe the US should look into how other countries have solved it?
I mean Utah is trying, sorry it took a while. I know Germany and Sweden don't fluoridate its water, I assume you mean Western Europe by the "world" (sorry if I am interpreting too much here, but that's usually what's popular to compare US to and bash US on how bad it is), so US is getting "with the program", finally I suppose. States having individual laws here is a benefit, one state doesn't have to wait for the Federal Government to act.
> This is one of these US-specific polarised debates I find really bizarre,
I don't think it's that polarizing? Unless 1) you're listening to US media more and 2) you're not getting many non-polarizing issues in the news, because those are well are just boring and don't sell ads.
If you look at the US as a simulation that branched of the mother tree of Europe in the 15th century, you won't find it odd that it is rediscovering what Europe has already figured out. Just in it's own way and time. (No chemicals/colors in foods and adequate drinking water) Wait till they figure out mass transit, that will be a shocker.
Has Europe figured out mass transit? In Barcelona, a trip that takes me 1.5 hours of total time using “transit” takes me 28 minutes on my motor scooter. I think there is still some figuring out that needs to happen before I’ll add 2 hours to my daily commute.
And when you get a tyrant at the top? Every capability you give the government needs to be viewed through the lens of "what happens when we get a really really bad leader?". If you haven't been paying attention, the majority of countries have had at least one really really bad leader over the past few hundred years. Many have one right now.
If you're always looking at things through that lens, the government can never do anything at all, and you'll be left with "complete freedom" to just die from easily preventable issues.
There's absolutely no need to resort to a slippery slope here. We have plenty of examples around the world for things that work without anyone invoking a boogeyman.
They can, you just have to look at each issue and it's costs and benefits and risks over time. You desperately want to world to be simple. It isn't. There is a slippery slope, you can stand on it but you want to have some concept of what happens when you slip.
There are examples of the boogeyman existing in real life - just 80 years ago we had one of the worst. Right now we have some boogeymen although not Hitler level. Get a little historical perspective.
There are a few studies out which say fluoride is bad. But as is often the case with these health idiots, the studies actually refer to places where fluoride is naturally way too high in the water. The entire debate is dumb.
This was my perspective for awhile — recommend you look into more recent studies if you haven’t in the past 2y or so. I don’t think it’s the worst thing in our water but do think it’s objectively a bad idea.
completely bizarre witnessing both sides getting so polarised around a basically non-issue
This isn't a sensible way to think about it. Every contentious conversation I've ever had has gone this way:
Me: why do people want to ban fluoride
Them: [anti government paranoia]
Me: um...but how about tooth decay
Them: pineal gland calcification
Me: idk sounds pretty far-fetched
Them: THAT'S WHAT THEY WANT YOU TO THINK
It's irrational to complain about 'both sides' when only one side is insisting on making it into an issue. I generally just try to disegnage from people as soon as they start freaking out about fluoride/ chemtrails/ vaccinations etc, but people like this frequently treat skepticism as a personal attack. Increasingly they occupy positions of political power (see eg RFK) having acquired them by public displays of conviction rather than any objective criteria.
What they're referring to is the fact that very few countries in the rest of the world even consider the possibility of adding fluoride to the water supply. It's basically just the US, Australia, and to a much lesser extent Canada.
It's not a debate everywhere else because adding fluoride to the water is objectively an unusual thing to do that they just... don't. Presumably they get fluoride other ways.
They are experts in this field, and, unlike “random person on the internet who spent 2 minutes on google”, have informed opinions on this topic.
If you want a serious discussion on why fluoride is good or bad, that’s where you need to go.
Random person on the internet is very easy to disagree with, because we’re all idiots right? It’s a very easy lazy way of self confirmation.
…but if you are serious about critically considering the issue and facing your own biases, talk to an actual topic expert.
My dentist told me he had carefully reviewed the literature and determined to his satisfaction that public fluoridated water was in the best interests of public health, currently. He offered to share some reading that he was convinced by.
You can’t really ask for more that that.
Discussing this here is a bit like protesting by posting on social media; yes, I suppose it’s better than doing nothing and not engaging with the topic at all… but only barely, and not in any meaningful way.
That study is taken grossly out of context. It doesn’t claim what people claim it does and even the study states that the quality of the data on which the weaker claim was made is suspect.
The bigger issue is that we have vast amounts of scientific data and empirical evidence around fluoride toxicity. People are injured and die due to fluorine exposure, we understand how it interacts with biology. Any mechanism of action that can support the hypothesis that fluorine causes brain damage necessarily invalidates all of this evidence and is difficult to explain as a matter of basic chemistry.
And then we have to explain why fluoride in water has this effect but the much higher levels of fluoride in food does not.
Fluoridating municipal water may not offer much benefit but there is no credible science that it is actually harmful. Large regions of the world have water that naturally has far higher fluorine content than municipal water and there is no evidence of IQ reduction in these regions either.
If you're not prepared to listen to an expert, and that's what your dentist is on this topic, then nothing I, or anyone else can say, makes any difference to you.
At some point, you have to accept that your random wikipedia page and 5 minutes on google is not a convincing argument.
This is right up there in the conspiracy theory territory.
Rational discussion means listening to experts and admitting that you are not an expert.
What do you want me to say?
You aren't a qualified expert on this topic. If you want an expert opinion, talk to an expert, not some dubious fucking provenance wikipedia page.
Your dentist is not an expert in this — that’s like saying the guy implementing your frontend is an expert in design. Yes, they’re working in the space, but their job isn’t understanding the whole system.
If you’re this deep on the appeal to authority train, the NIH released a report in the last year linking fluoride exposure to moderate drops in IQ with moderate confidence.
It’s probably not the worst thing in the world, but is definitely not inert.
I am competent on this particular subject matter, I have worked in fluorine chemistry and am familiar with the biology and medical literature of fluorine toxicity. The report made much weaker claims than people seem to think.
There is a very serious mechanism of action problem. Fluorine poisoning is a thing that happens. The observed effects and empirical evidence, as well as the mechanisms of action that cause them, are incompatible with any mechanism of action that supports the hypothesis that it causes brain damage. Basically, it would invalidate the entire history of actual fluoride exposure.
The other serious problem is that people are exposed to far more fluorine through what they eat than through water. What is special about trace levels in municipal water? And many parts of the world have far higher natural fluoride levels in their water than any municipal water supply with no evidence of adverse consequences. This has been studied many times in many countries! In fact, the only consistent correlation with naturally high fluoride levels is better cardiovascular health (for which there is a known mechanism of action).
This notion that trace levels of fluoride in some municipal water is adversely impacting IQ based on thin evidence from the developing world is just the public health version of “faster than light neutrinos”. Someone thinks they measured it but it contradicts everything we know about the subject. The rational approach isn’t to discard everything we know without a hell of a lot more evidence.
I don’t think adding fluoride to municipal water does much these days but it also isn’t harming anyone.
It also seems to mirror the rhyme with the vaccine "debate."
That debate is framed around being vaccinated vs the scare of "vaccine caused autism" (or myocarditis), but that frame is missing the risk of things like measles.
Likewise tooth decay is not only expensive, but it can have dreadful health consequences if left unaddressed. Missing teeth is also socially costly. Being poor or "ugly" or poor looking is a serious adverse health consequence. Imagine parents barely making ends meet or working multiple jobs. It's easy to imagine disadvantaged kids missing out on dental care.
I also explicitly remember reading multiple reports of poor tooth health correlating with dementia development. I've also read that serious infections of any sort can harm IQ.
Sure, but we need to look at this from the other side, too. Does fluoridating water provide benefits? I think it's safe to say it did way back when we started doing it. But we didn't have fluoride toothpaste back then. Putting fluoride in the water is presumably more costly than not doing it. If it's actually providing benefits, and the risk of harm is below some very low threshold, then sure, let's keep doing it. But is it actually providing benefits?
I would be really surprised if dentists had much expertise on the impact of fluorine on physiology or the mechanisms of action for its toxicity. They know what it does to your teeth, and maybe that it is known to have positive effects for cardiovascular health, but that is about the extent of it. The systematic effects on the rest of your body are outside their domain.
Chemists who work in fluorine chemistry on the other hand have to become experts on the biological effects of fluorine exposure. Small and seemingly innocuous exposures can do a lot of damage and kill you, though not in a way that lends any support to the idea that municipal fluoridation will harm you. If you do understand how it kills you (basically by being exceptionally narrowly focused on making free calcium ions and to a lesser extent magnesium ions biologically unavailable), it is hard to describe a chemically plausible scenario that somehow avoids this basic fact of chemistry. Fluoride behaves the same way outside the body.
Municipal water exposure is far below the noise floor for fluoride. Food has far higher levels of fluoride than municipal water and the body has ample excess calcium and magnesium to absorb the loss of bioavailability of a microscopic amount of those minerals. Humans consume calcium measured in grams per day, multiple orders of magnitude more than can be lost via municipal fluoridation. Natural dietary variation will have a far larger effect.
Who do you think conducted those peer-reviewed systematic reviews? I'm sorry if I don't take the word of some random guy's dentist over multiple meta analyses in major medical journals.
And I don't need an expert to tell me people should have the right to make their own medical decisions.
And finally, I live in a country where public health experts have decided against water fluoridation. This is represents the vast majority of countries. What now? Should I pick some other experts to listen to?
Who do you think conducted those peer-reviewed systematic reviews? I'm sorry if I don't take the word of some random guy's dentist over multiple meta analyses in major medical journals.
I don’t understand what you mean here. Are you just wholly rejecting the concept of expert knowledge, trials, meta analyses, basically the foundations of science, just because in order to participate in it you have to have tainted yourself by rigorously studying it?
You are not an expert in this field, and cherry-picking random articles in random journals does not make you an expert.
> Should I pick some other experts to listen to?
I think it's reasonably clear that you haven't spoken to an expert in this field.
> I'm sorry if I don't take the word of some random guy's dentist over multiple meta analyses in major medical journals.
Are you certain you're competent to review and understand the literature on the topic? It takes a lot of time and effort; that's what dentists do as a job. That's why they have to go to school. That's why random people on the internet do not do dentistry.
If you don't trust my dentist, then talk to your dentist.
This is literally my point: I'm not telling you how it is; I'm telling you, talk to someone who knows what they're talking about; and, don't believe that you are an expert because you put some trivial amount of effort into investigating it yourself.
I'm also not convinced that a dentist is credibly an expert here. Sure, I would absolutely expect my dentist to understand what benefits fluoridated water might provide to my teeth. I would not, for example, expect my dentist to be an expert in whether or not fluoridated water could cause damage to other parts of my body.
My previous dentist pushed these $80 (not covered by insurance) fluoride treatments on every cleaning visit. There's no research that shows much of anything about their effectiveness (good or bad). Yet they push them anyway, because it (their words) might help and probably won't harm. That doesn't give me a good feeling about their competence to have an expert opinion on this sort of thing.
I would, however, trust the opinion of someone who is doing medical/dental research, and holds a doctorate in a relevant field.
> Talk to your dentist. They are experts in this field
No they are not. The are experts are filling cavities and treatment. They have no additional knowledge of fluoride in water vs any other interested person.
For that you need to talk to someone in research, which is not someone seeing patients.
The vast majority of dentists are not public health experts, and will have little to offer other than “exposing your teeth to fluoride regularly is good”.
