31Yet the more I looked, the more I realized that fluoridation encapsulates
several recurring medical dilemmas. How much trust should we give to expert
judgment? How much potential harm can we expose one group to in the
course of helping another? And how much evidence should be required before
we allow governments to force people to do something for their own good?
Modern dentistry isa formidable example of human progress. Our
grandparents’ jaws used to hurt all the time. Tooth decay plagued everyone—
rich and poor, famous and obscure. George Washington, an affluent planter,
had lost all but one of his teeth by age 57, when he was first sworn in as presi-
dent. His quest to fill his mouth led him to wear sets of dentures made from
his own pulled teeth, from animal teeth (donkey and horse up top, cow on the
bottom), and from other people’s teeth, possibly including those of his slaves.
Washington was not alone. People on both sides of the Atlantic participated
in a lively black market in cadavers’ teeth. Fortunately for denture customers,
Europe had a ready supply. Scavengers followed wartime armies, according
to the medical historian Lindsey Fitzharris. After the shooting stopped at the
battle of Waterloo, many of the dead were toothless within hours.
The widespread introduction of sugar worsened society’s dental difficul-
ties. In the first decades of the 20th century, American dentists regularly
made full sets of dentures for teenagers so that they would look presentable
at graduation. American soldiers were required to have a minimum number
of opposing teeth: six on the top, six on the bottom. Thousands of would-be
doughboys and GIs were barred from service in the First and Second World
Wars for failing to meet this standard.
So dire was the state of U.S. dentition that in 1901, Frederick McKay’s
discovery that many of his patients’ teeth were mottled with ugly brown
stains generated little notice. McKay was a dentist in Colorado Springs.
Intrigued, he and two colleagues examined 2,945 schoolchildren for what
they called “Colorado stain.” To their shock, 87.5 percent had stained teeth.
McKay contacted a famous Chicago dentist (famous in dental circles, any-
way) and got him to describe the syndrome to the Colorado state dental asso-
ciation. Hardly anyone paid attention. Trying again, McKay and the Chicago
dentist evaluated students at Colorado College, in Colorado Springs. They
found that students raised in Colorado Springs had discolored teeth, whereas
students from other areas had normal teeth. Hardly anyone paid attention.
The two researchers then published an article, “An Investigation of Mottled
Teeth: An Endemic Developmental Imperfection of the Enamel of the Teeth
Heretofore Unknown in the Literature of Dentistry.” Unknown in the Literature
of Dentistry! Still, hardly anyone paid attention.
In the 1930s, McKay and others identified the staining agent: naturally
occurring fluoride compounds in water supplies. (This kind of staining,
along with the other negative effects of fluorine absorption by bones and
ligaments, is now called fluorosis.) The researchers also discovered something
else: Although the staining looked terrible, people with fluoride stains had
fewer decayed and missing teeth. A small group of dentists began agitating
to add low levels of fluoride to drinking water—low enough to avoid stain-
ing and also low enough to be safe.
Those dentists would soon get corporate reinforcement. Fluorine, a chemical
element, is lethal in small doses and extremely reactive. Fluorides—compounds
of fluorine— can be nearly as toxic but are much more stable. They are a com-
mon waste product of the fertilizer, pesticide, refrigeration, glass, steel, and
aluminum industries. In the ’30s, many of these industries were facing protests
and lawsuits for poisoning workers, polluting the soil, and contaminating water
supplies. Understandably, executives were thrilled to discover that the chemicals
they had to get rid of because they could seep into city water systems might be
gotten rid of by being jettisoned into city water systems.
Less understandably, some later anti-fluoridation activ-
ists described the corporate embrace of fluoridation as
evidence of a Communist plot.
It was more like a capitalist plot. From 1921
to 1932, the secretary of the Treasury was Andrew
W. Mellon, a founder of the Aluminum Company
of America, better known as Alcoa. The U.S. Public
Health Service was then under the jurisdiction of the
Treasury Department. In January 1931, Alcoa chem-
ists discovered high levels of fluoride in the water in
and around Bauxite, Arkansas, an Alcoa company
town. By May, at Mellon’s urging, a Public Health
Service dentist had been assigned to examine the link
between fluoride and reduced cavities. Eight years
later, a biochemist at the Mellon Institute, in Pitts-
burgh, became the first researcher to call for the wide-
spread fluoridation of water.
Additional impetus came during the Second World
War. The Manhattan Project— the crash effort to
develop the atomic bomb—processed uranium by
combining it with huge amounts of fluorine to form
uranium hexafluoride. Large quantities of other fluo-
ride compounds, including the DuPont refrigerant
Freon, were needed. Accidents exposed employees to
these little-understood substances, killing some and
sickening others. Fearing litigation, the Manhattan
Project created a “medical section” to study fluorides.
Together with industry, it pushed for clinical trials of
fluoride’s effects. Under the guise of protecting teeth,
the Manhattan Project set about obtaining data on
long-term fluoride exposure.
Starting in 1945, tests were conducted in Grand
Rapids, Michigan, and Newburgh, New York. Both
cities added fluoride to their water. In both cases,
the control was a nearby city that did not add fluo-
ride. The experiments were supposed to continue for
at least a decade, with dentists in each city examin-
ing their patients to evaluate long-term effects. As
it happened, one of the control cities fluoridated its
water within seven years because its citizens had heard
rumors about the benefits.
Fluoridation took off. So did the anti-fluoride
movement, a loose coalition of Christian Scientists,
Boston society ladies, chiropractors, biochemists,
homeopaths, anti-Semites, and E. H. Bronner, the
spiritualist soap-maker. A woman named Golda Fran-
zen, from San Francisco, testified before Congress
in the early 1950s that fluoridation was a Commu-
nist plot to turn Americans into a race of “moronic,
atheist ic slaves.” Franzen was later convicted of vio-
lating state health laws for peddling a “cancer cure”
machine consisting of a speakerless tape recorder that
vibrated as it played “Smoke Gets in Your Eyes.”
The opposition mostly failed. At an annual cost
of about $325 million, more than 70 percent of