Fluoridation Fails in Portland

The Firehole River is full of pure, naturally occurring fluoride 12 mg/L, a truly dangerous level. Photo by Larry Grant

The Firehole River is full of pure, naturally occurring fluoride 12 mg/L, a truly dangerous level. Photo by Larry Grant

Update: A friend points out this perfect example of politics done right. Trying to get people on both sides of this debate to work together on the root problem of children’s health. Check it out here.

I have a familiar set of feelings today, as I go over the reactions to Portland’s voters turning down a measure to add fluoride to their drinking water. On the one hand I’m sorry the measure failed. On the other, I can’t help but feel offended when I hear people sneering about those benighted, anti-scientific wingnuts who appeal to nature and want water that’s and “pure.” Hey, that’s me you’re talking about, and I’m on your side. But the real reason this stings is that this measure lost because fluoridation activists failed to understand and respect people like me. It would be nice to see some humility and soul searching in response to this loss, rather than more of the insolence that brought it about.

First of all, briefly, the evidence: When you look at the systematic reviews of all the evidence that’s been collected on fluoridation at <2 mg/L, it’s pretty clear that there’s scientific consensus: At that level it does no harm, and there is some evidence that it does good. Natural-leaning medicos like the American Osteopathic Association support fluoridation. (Updated: A friend disagrees with me about scientific consensus and points to this article in SciAm – I’d love to know more about this. It should be noted the the scientist upon whom that story rests has continued to study that population and found that the source of the problem was infant formula, and toddlers swallowing toothpaste. He says there is real danger at levels of over 8 mg/L but it’s clear that at low levels it’s helpful).

The problem here is that there’s this rationalist assumption that everyone will sit down, look at the same data and come to the same conclusion. That’s never how politics has worked, and that’s never how human decision-making has worked. To ignore this is to fail politically (over and over again). If you want to get through to people, don’t shove a bunch of data at them; instead, you have to understand, and truly respect, their values.

“Reason is, and ought only to be, the slave of the passions, and can never pretend to any other office than to serve and obey them.”

David Hume

Want to know what natural-leaning people like me are passionate about? I think I can sum it up in two points:

1. Purity: We have a feeling that our reliance on technology has set the world awry in ways we didn’t expect: We see all sorts of examples in the environment but also applied personally

2. Independence: We have a basic distrust for medical and corporate authority. (These are the same people that told us to trade butter for transfat-filled margarine and said thalidomide (see note at bottom) and Vioxx were safe. Don’t expect us to be convinced because the AMA or the CDC has given a seal of approval).

You are not going to change these passions, or convince us that we should shift to being scared of nature (and instead default toward the better living through chemistry option), so don’t try. If you are going to win us over, you have to convince us that this political choice (be it on fluoride, or vaccination, or GMOs, or taxing sugar) actually fits with our core values.

I should mention that I’m drawing here on Jonathan Haidt’s wonderful book, The Righteous Mind: Why Good People Are Divided by Politics and Religion. As Haidt puts it:

If you think moral reasoning is something we do to figure out the truth, you’ll be constantly frustrated by how foolish, biased, and illogical people become when they disagree with you. But if you think about moral reasoning as a skill we humans evolved to further our social agendas—to justify our own actions and to defend  the teams we belong to—then things will make a lot more sense.

Jonathan Haidt

Sound familiar? All the debate, all the back and forth, is mostly noise. It’s people justifying their core beliefs. These days there is plenty of information available to back up any conclusion. On the fluoride debate there were lots of “review articles” floating around like this one, which claims that low levels of fluoridation can hurt salmon. At first glance it looks somewhat legit. But if you take the time to look up the actual journal things start getting pretty shady. And if you go thru the references and read the study that it bases it’s main claim upon, you’ll see how wildly it is exaggerating the case. But, unless you have a pretty high level of aptitude—and a lot of time—for evaluating evidence, you are a lot more likely to turn to someone you trust for guidance.

So, how do you actually change minds? How do you engage in smart politics, rather than hoping (despite all the times that it’s failed) that science will trump the debate?

I have a suggestion for the folks up in Portland if they were to try again. First of all, don’t spend so much money on media. Ads work great across a large area with a diverse set of values, but if you are trying to influence people like me, advertising is a turn off. And in a dense urban area, community networks are way more important than ads. Instead, I’d use some of that money to allow a few people to spend the time to meet with community leaders around small tables, preferably over food. These people would have to be highly empathetic, great communicators, and highly knowledgeable about the science. Throwing data up on the internet doesn’t change minds. But a small group can trace concerns back to the source, and patiently differentiate between good evidence and bad. And this is a crucial difference: Evidence works in the small setting–where we can see one-another’s humanity across the table, and catch false assumptions–but on the internet it fails. By working at the grass-roots level you appeal to that spirit of independence: Rather than ask me to trust an authority on TV, you are empowering me to make a truly independent decision. And if I’m someone who is trusted in my community, I’m going to bring a lot of people over with me.

*Note on thalidomide: A reader pointed out that, though, the medical authorities did say it was safe in many countries, in the US the system actually worked! Frances Oldham Kelsey  refused to approve the drug for market. I’m interested in learning more about that history – she must have been one of the few women at the FDA then….

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