Don’t drink the water

Portland’s fluoridation battle shows how tricky it is to integrate science into debates that have as much to do with values as policy.

 

Late one night last April, a teenager had to piss. By itself, this was not terribly newsworthy, but it became so when a security camera caught him unzipping his fly and leaning against the wrought iron fence that surrounds Reservoir #5 on Mount Tabor, in Portland, Oregon.

In response, the city water bureau decided to flush all 38 million gallons from the reservoir. “Our customers don’t anticipate drinking water that’s been contaminated by some yahoo,” a spokesman told the Associated Press. It was a question more of optics than science. A few ounces of urine in so much water posed little threat to anyone’s health.

To Alejandro Queral, though, it was also a question of politics. One of the most liberal cities in the country was showing that selectively drawing on science to support a conclusion that contradicts what the scientific community accepts is not the exclusive province of extreme conservatives. “Portlanders can get pretty crazy about their water,” he says. And he would know.

In September 2012, the Portland City Council voted 5-0 to add fluoride to the city’s drinking water starting the following March. Many thought the move was long overdue: Portland is the largest U.S. city that doesn’t fluoridate its water, and while voters had rejected fluoridation three times since 1956, the council was confident this time would be different. But they were wrong. A local group calling itself Clean Water Portland filed paperwork almost immediately to put the decision to a referendum in a special election that May.

At the time, Queral was a program officer for the Northwest Health Foundation, a nonprofit that works on health issues in Oregon and southwest Washington. A native of Mexico, he has advanced degrees in law and ecology. “I studied water snakes,” he tells me in a Portland coffee shop, grinning through his black beard. He sits on both the Public Health Advisory Board and the Oregon Environmental Council, and when the referendum went forward, he was asked to co-chair the group Healthy Kids, Healthy Portland, which supported fluoridation.

A protester struggles with a security officer during a City Council vote on whether to add fluoride to city water in Portland, Ore. The City Council approved a plan to add fluoride to Portland's water in Sept. 2012, but fluoridation was later voted down in a referendum the following May. Don Ryan/AP Photo

Set against him was Clean Water Portland’s Kim Kaminski. She is pleasant and soft-spoken but with a steely edge. Like Queral, she has a law degree. She grew up in Illinois with fluoridated water and had no problem with it, other than that she still seemed to get a lot of cavities. But by 2012, her feelings had evolved. She and her allies launched an attack dazzling in its variety. They pointed out that the proposed additive, hydrosilicofluoride, was a byproduct of pesticide production, and that a factsheet from the National Sanitation Foundation showed detectable levels of arsenic (43 percent of samples) and lead (2 percent) in hydrosilicofluoride-treated water. A 500-plus-page brick of a report from the National Academy of Sciences raised questions about whether high levels of fluoride led to a dental condition called fluorosis, caused brittle bones or even certain types of cancer, and perhaps lowered intelligence in children.

It was, in a way, a battle for the Rose City’s uniquely liberal-libertarian soul. Portlanders take pride in the cleanliness of their Bull Run watershed, and here, Kaminski thought, were the city fathers making backroom deals to fill it with chemicals. She and her allies framed fluoridation as a matter of personal choice, or its lack; to embrace it was akin to allowing the government to forcibly medicate you. “We live in a creative city. We could do better than just pouring chemicals into our water,” she says, in what would become the battle hymn of the fluoride foes.

Assertion for assertion, Healthy Kids, Healthy Portland challenged Clean Water Portland, listing all the big medical organizations that endorsed fluoridation, including every surgeon general and U.S. president since Kennedy. The group noted Oregon’s spotty dental health statistics: It is 48th in the nation in residents having access to fluoridated water. Nearly two-thirds of Portland’s third-graders show signs of tooth decay, and many of them come from the city’s less-affluent minority communities.

It wasn’t enough. Queral was unprepared for the campaign’s heat. “It was never explicitly personal, but there was a lot of underlying nastiness. Typical Portland,” he says, as two coffee-shop patrons shoot him dirty looks. He watched in dismay as the numbers in support of fluoridation declined from over half, to half, to under half, and on down. When the election arrived, fluoridation was pummeled, 61-39 percent.

Water fluoridation began in the 1940s. Back in the early 1900s, Colorado Springs dentist Floyd McKay noticed that many of his patients’ teeth were mottled, a condition called “Colorado Brown Teeth.” But their teeth were also unusually strong. McKay linked their lack of cavities to naturally high levels of fluoride in local drinking water.

In 1945, the U.S. Public Health Service began its own ambitious experiment. In four metropolitan areas, one community’s water was supplemented with fluoride, and another’s was not. The study was supposed to last 10 years, but produced dramatic results after just five: The incidence of cavities had declined more than 50 percent in those communities with fluoridated water.

Supplementation programs sprang up across the country. As of 2010, close to 75 percent of U.S. citizens drank fluoridated water (and, as Queral has pointed out, “no one’s head has exploded or anything”). Very little is needed to have a significant effect; the current standard is 0.7 milligrams per liter. The number of cavities has dropped, and in 1999, the Centers for Disease Control and Prevention listed water fluoridation as one of the 20th century’s top 10 advances in public health, along with vaccination, seat belts and the recognition of tobacco’s harmful effects.

As fluoride use spread, resistance against it hardened. Objections ranged from its efficacy to its role as a form of socialized medicine and government intrusion. (The John Birch Society called it a communist plot.) Nearly three-quarters of Americans may drink fluoridated water, and it might seem strange to have to adjudicate something that has been around nearly unchanged for more than 60 years, but ever since 1950, when fluoridation comes on the ballot, it loses nearly 60 percent of the time.

The idea of political conservatives dismissing Science (in its capitalized, deified form) when it suits ideology, particularly when it comes to climate change and evolution, is a familiar media trope. The left, however, has hardly covered itself in glory with some liberals’ attitudes toward vaccinations, homeopathy and other issues. In Portland, in fact, fluoridation opponents employed many of the methods more commonly associated with the right.

“Their goal was to destabilize the science,” says Philip Wu, a pediatrician who participated in several forums as a pro-fluoride expert. It hardly mattered, he says, that almost every objection could be contextualized. (The authors of the National Academy of Sciences report explicitly said their work had nothing to do with water fluoridation; the arsenic and lead detected in water samples occurred at levels far below what the Environmental Protection Agency considered unsafe.)

But Kaminski and her supporters, though they prided themselves on their skepticism, didn’t see themselves as anti-science. Rather, they considered themselves diligent if amateur students of science, who saw their lack of expertise as an advantage. “My one credential,” Kaminski says, “was that I know how to read.” When she first encountered fluoridation as an issue in 2005, she dove into the literature and saw a lot of things that scared her not only as a citizen, but also as a mother. “The new science raises questions,” she says. “That’s why it’s best to be cautious. You err on the side of uncertainty.”

For Wu, that attitude shows how a little knowledge can be a dangerous thing. A single study suggests that something might be rotten in the state of fluoride. Fair enough. But one study is only one study. It can and should spur further investigation but, as a study, its reach should be limited. “It can’t lead to grand conclusions,” he says. “That’s the way science works.”

However, he notes ruefully, that is not how politics work. “Once the other side had introduced doubt, that opened the door to talk about other sets of values,” he says. “Not values that say science is bad, but values that perhaps supersede science.” Fluoridation ran into a city that loved the idea of a pristine watershed remaining pristine, that resented being condescended to by a bunch of medical and dental organizations, and was confident in its ability to think for itself. More broadly, the assurances of science can seem abstract if a person wants to protect himself or his family, no matter how miniscule the risk actually is. The difficulties your own child may face are a tragedy; the benefits to thousands of other kids, a statistic. “When the council just rammed it through, a lot of people were like, ‘Let’s take a step back and think about it,’ ” Kaminski says. “Even people who might have supported it under other circumstances.”

In hindsight, Queral feels, fluoride advocates should have spent more time doing groundwork. “I would have spent a lot longer educating people, like two years,” he says. “You explain the nature of the problem, explain who is most at risk, and then talk about what fluoridation does to solve that problem.” He shrugs, pained. “Who knows? Maybe we’ll do better next time.”

Soon after the election, Queral left the Northwest Health Foundation. He now directs the local chapter of the United Way, working on childhood poverty issues. The job has other attractions as well: “It’s nice to be behind the scenes.”

Kaminski, meanwhile, is still in the thick of things. On the day I meet her in northeast Portland, she is carrying three petitions: one for a women’s equal rights amendment, one for a measure on the labeling of GMOs, and the last for the formation of a people’s water trust. She is excited to support the water trust, which will ensure that no one gets blindsided by the city council and its social engineering experiments ever again. (It will eventually fail to get enough signatures, showing that Portlanders’ love for enlightened contrarianism has its limits.)

Today, though, her focus is on the GMO labeling measure. For her it’s a no-brainer, but she says she knows she’s facing an opponent skilled in the art of deception and obfuscation. Similar measures have been defeated in both California and Washington — places she would have thought they had a good shot. That just shows the power of the GMO interests, she says, and is a reminder that everyone needs to stay on their toes. “Those guys go in and create a seed of doubt that they can exploit,” she says. “And they’re very good at it.”