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Culture War Roundup for the week of November 4, 2024

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In the particular case of fluoridating water, the ruling elite had a good story. Scientists knew that naturally occurring levels of fluoride varied from place to place. Did it matter? They did the epidemiology thing and decided that less than one part per million made tooth decay noticeably worse. More than four parts per million caused dental fluorosis, but nothing else showed up strongly with natural levels of fluoridation. So topping up fluoride to bring low fluoride water up to one part per million seemed super safe; lots of people were already living with 1ppm. And had been for their entire lives. It was a rare case where we have data (albeit epidemiological) on all cause mortality, due to pre-existing "natural experiments".

... without facing widespread riots or resistance is just insane ...

Your confusion is the result of a garbled account of events. That is bad in itself, but I want to make the case that it is important to say that "topping up" and "adding" are different and that the claim that we "add" fluoride to the water supply is a lie.

First I will offer paradigms of "topping up" and "adding" and then make my case that things can go horribly wrong if we tolerate people confusing them.

Topping up Measure the level. If it comes in at 0.5 ppm, add enough to increase the level by 0.5 ppm. Measure again. If it is in the range 0.9 to 1.1 ppm declare victory. If outside that range, find out why, and adjust appropriately.

Adding Don't bother measuring, or if some-else has measured, just ignore it. Add enough to increase the level by 1 ppm. Continue to fail at measuring and be smug that the level is at least 1 ppm because our addition guarantees that out-come.

Now picture a town debating water fluoridation. Why? Well, Mr Bad Guy hopes to get kick backs from the contracts for fluoridation equipment and chemicals. He persuades his fellow citizens to top up fluoride levels at public expense. They vote for it. Mr Bad Guy sets it in motion. The measured natural level turns out to be 1.3 ppm. There is nothing to be done. No contracts, no kick backs. Mr Bad Guy looks around and notices that nobody is watching. He arranges contracts for equipment and chemicals to add enough fluoride to increase the levels by 1 ppm. He pockets his bribe money. Fluoride levels increase to 2.3 ppm. Mr Bad Guy feels safe. No-one will notice 2.3 ppm and if he falls under suspicion for corruption, he can always say that he misunderstood.

Later Dr Nerd measures the fluoride and checks the records of the old measurements. Dr Nerd is unhappy about the waste of public money, or about the dangers of fluoride, take your pick. He tries to "blow the whistle". But what language does he speak? If he uses the vernacular he complains that we are adding fluoride to the water supply and we shouldn't be doing that, we should instead be adding fluoride to the water supply [sic]. Nobody understands his point. So he switches to Nerd-speak and complains that we are adding fluoride to the water supply when we should be topping up; very different. Topping up is free! But the towns-folk don't speak Nerd-speak, so Dr Nerd still fails to make himself understood.

Talking about topping up fluoride levels using the word adding is bad. It covers up corruption and is why we cannot have nice things.