JULY 01, 1956 by GORDON B. LEITCH M.D.
Dr. Leitch is a practicing physician and surgeon and a former member of the editorial star of Northwest Medicine.
Pap on tap! Or is it poison?
Anyone who wants to argue for or against fluoride treatment to reduce tooth decay should have little trouble finding medical and dental authorities to support whatever stand he takes. Some experts are confident that sodium fluoride is a normal constituent of the human body; others maintain that it is a deadly poison and that any presence of it in the human body is purely incidental to the widespread distribution and combining power of the element fluorine in nature. Some cite statistical evidence that sodium fluoride prevents or reduces tooth decay; others find the same statistics scientifically unreliable and inconclusive. Some testify that one part per million of sodium fluoride in drinking water is perfectly safe; others question that any quantity can be taken without danger because of the tendency to accumulate in the body. Some contend that the American Medical Association endorses the use of sodium fluoride in community water supplies; others say it has done nothing of the kind. Some assert that fluoridation involves the same principle as does chlorination of the water supply; others reply that chlorination is designed to control communicable diseases through enhancing the purity of the water, whereas fluoridation does absolutely nothing to increase water purity but is mass medication against noncontagious tooth decay.
The fact that experts are as far from agreement on the matter as are laymen may be amusing as well as confusing. But it raises a most significant point: How well and reliably informed are the experts? Which of them are making pronouncements based on opinions and which base their judgment on sound scientific evidence?
This frightful fuss about fluoride seems comparable in many respects to the arguments about iodine as a preventive of goiter—another issue over which authorities disagree. But fortunately, in the interest of peace among men, someone hit upon the happy suggestion of iodized salt, rather than iodized drinking water.
No public problems grew out of a manufacturer’s decision to put a laxative in chewing gum; nor did the addition of vitamin D to milk cause civil war. There was no great furor over mentholated cigarettes; nor does the baking of some bread from enriched flour cause strife between neighbors. Even the offering of fluoridated toothpaste fails to precipitate a crisis, any more than if fluoride were offered in milk, bread, salt, chewing gum, or cigarettes. Fluoridated toothpaste, however, does carry a warning against children under six using it lest they swallow it. Mixing fluoride with water is about the only way to make a public problem of it; and then only in the instance of a community water supply, where the problems of ownership and management tend to complicate the fluoridation issue.
If water is privately owned and controlled, as from a spring or well on a man’s own property, the owner may do with it pretty much as he pleases; provided, of course, that he does not use it in a manner detrimental to the proper interests of others. This water possibly may have certain qualities which accord it a distinct market value. In that case, who will object if the owner offers some or all of it for sale, assuming he makes no false claims as to its properties? The water may contain fluoride. If the owner is willing, why not let him sell to willing buyers at a price acceptable to both parties? Surely no public problem grows out of such a procedure.
The public problems linked with the fluoridation issue arise only in those instances where ownership and control of the water is uncertain. Who owns the community water supply? That is the question, and in spite of the many community water supplies, it is not entirely an academic one.
Theoretically, if a private individual or corporation supplies the water for a community—in contrast to a municipal water works—the question of ownership would be quite clear. The water would be delivered, according to contract, by one private owner to another.
In practice, however, when a community is dependent for its water on a single supplier, that supplier is subjected to such public health requirements and other governmental standards and controls, including rate regulation, that any claim of private ownership largely loses its meaning. Indeed, under such conditions many private suppliers have willingly disposed of their enterprises to municipalities or other political units rather than endure the harassment incidental to operating under government regulation.
Ask yourself the next time you draw a drink: “Do I control this water supply? If it is not wholly mine, then who determines its amplitude and its purity? Has it been fluoridated? Will it be?” Honest answers to these questions should help toward an understanding of the difference between a politically or governmentally controlled commodity or service and one that depends upon voluntary market relationships. The latter can prevail only under private ownership and control and open competition between willing buyers and willing sellers. The free market process thrives upon competition and frowns upon a single supplier with a franchise empowering him to exclude competition by force of law.
The fact is that in most populous urban communities, water is now and long has been considered a public utility, with production and distribution of the commodity and service subject to strict regulation in the public interest. This amounts to monopoly control of the water supply according to the politically expressed will of the majority. Thus in nearly every instance of a community water supply under one management, the voters of the community directly or indirectly will determine what processing or treatment, if any, is to be applied to the water which flows through the mains.
A person who advocates a single water supply in a given community is thereby suggesting departure from the free market process of competitive private enterprise. And from such a position it would appear that he may not logically claim a right as an individual to determine the conditions under which his “share” of the water is to be delivered. If he accepts the process of majority rule as the determinant of the nature of his water supply, he may not at the same time stand upon his rights as an individual to receive non-fluoridated water; not if the vote favors fluoridation.
Under majority rule, of course, the individual has a right to vote as he chooses, but if the majority goes against him, he has no recourse. This is a sad but inevitable consequence of political action, a consequence which can and should be clearly anticipated before one authorizes political control over a water supply or over anything else upon which he is dependent.
In politically determining matters pertinent to a community water supply there is, however, another side to this coin of majority rule (a side not generally realized) which makes it completely consistent for an individual who has accepted a monopoly water supply for his community nevertheless to oppose fluoridation. Inherent in rule by political majority is the moral law, not abrogated by any political decision, that a political majority may not destroy a minority, that the rights of a minority must be protected by the majority.
In the United States of America a person may use reasoned argument and persuasion to his heart’s content; but it is a violation of the moral law at least for one individual to try to compel or force another individual to do, or not to do, something against the latter’s will. Nor is the moral law changed in the slightest if such an individual is joined by other individuals to form a committee, community, society, or a majority, bent on compelling another individual to do something against the latter’s will. These collective entities have no rights or privileges different from those of the individuals comprising them. The moral law is not a matter of numbers.
Basically, the extensive and deep-rooted opposition rests upon the fact that fluoridation of community water supplies violates minority rights under the moral law. In the arrangement whereby most community water Supplies are managed on a monopoly or public utility basis, the chief concerns implied in the arrangement, for both supplier and consumers, are the abundance and particularly the purity of the water. As long as the emphasis remains on purity, everyone seems happy. Trouble arises only in conjunction with the idea of using the community water supply as a vehicle for medication—the idea of adding a substance to the water not to enhance its purity but solely to affect the body and physiologic processes of those consuming the water.
The toxicity of sodium fluoride is not open to question insofar as the chemical itself is concerned. If anyone doubts that it is a deadly poison, he can quickly end the doubt—and risk doing the same with his life—by swallowing enough of the white powder to cover a nickel, a lethal dose. How toxic it may be when minutely diluted simply has not as yet been scientifically determined. Claims of absolute safety are still in the realm of unsubstantiated opinion, and, to say the least, hazardous in the face of the known cumulative nature of the substance.
In face of the substance’s known toxicity, and while the hazards and uncertainties involved in its ingestion from a community water supply remain unresolved, what can those opposed to fluoridation do to protect their rights should they be a minority without political recourse? They must rely largely upon appeal to reason. They might reasonably advocate that those wishing to use fluoride for themselves or their children utilize sodium fluoride tablets, which are available in precise dosage, or drops from a stock solution precisely compounded at the corner drugstore. Or why not fluoridized salt, toothpaste, brand of milk, or some other commodity readily available in the free market, in contrast to fluoridation of a monopolized product such as the community water supply?
Or if the majority, disregarding these readily available and cheaper alternatives, still insists upon fluoridating water, why not look into the possibility of injecting fluoride at the point where the water enters each home, thus allowing each family its choice in the matter?
Whether to attach the fluoridation equipment ahead of or behind the water softener might be a problem in some homes. This raises another question: If the majority should insist on fluoridated community water regardless, would it then be illegal for a person to install water-treating equipment which would remove the fluoride from his own portion of the water supply? Would such a nonconformist be deemed a toothless menace to the community and haled into court for violating the law or endangering the public health?
The role and interest of public health authorities in fluoridation should not be lightly dismissed. The Surgeon General of the United States Public Health Service has publicly predicted that nationwide research “will produce sooner than we think findings capable of turning public health work upside down.” In discussing mass application methods for preventing noninfectious disease—many alert observers consider fluoridation the trial run or pilot plant test for such mass medication methods—Dr. Leonard Scheele told a 1953 Washington conference of state and territorial health and hospital authorities that community-wide attack on “far more serious dis-eases than dental decay” probably will be forthcoming after laboratory tests have paved the way.
Those opposing water fluoridation and other believers in the libertarian way of life might reasonably ask if there is any logical end to such public health measures. Why not public regulation of the amount of candy and sweets and other tooth-decaying foods to be allowed each person? Why not a law to assure regular brushing and other tooth care? Or is community-wide fluoridation supposed to relieve the individual of all necessity for exercising any other precautionary measures against tooth decay?
As long as any semblance of voluntarism remains with respect to the care or abuse anyone may lavish upon one’s own person, it would seem reasonable to propose that use of fluoridated water to combat tooth decay also be left to the will and judgment of each individual.
That means keeping fluorides out of the community water supply. 
Paternalism means ultimate tyranny because all paternalism presupposes and promotes the feebleness of the individual paternalized.
George Wendell Maxey (1878- ), Chief Justice of Pennsylvania, 1943.
The Equilibrium Between Liberty and Government.