FOR APPROXIMATELY 60 years, many cities in the country have been adding fluoride to drinking water for the primary purpose of preventing tooth decay. Fluoridating public drinking water, however, remains somewhat controversial, with its critics claiming at best it provides little to no benefit and may do more harm than good.

Squarely in the anti–fluoridation group are Paul Connett, James Beck, and Spedding Micklem, who wrote "The Case Against Fluoride." The book is well written and easily understood by a lay person without scientific knowledge. The book is divided into six parts: “Ethical and General Arguments against Fluoridation,” “The Evidence that Fluoridation Is Ineffective,” “The Great Fluoridation Gamble,” “The Evidence of Harm,” “Margin of Safety and the Precautionary Principle” and “The Promoters and the Technique of Promotion.”

The authors do not claim to present arguments both pro and con for fluoridating public drinking water, but rather attempt to debunk what they see as claims of public health officials regarding the benefits from fluoridating water while pointing out the potential pitfalls from the process. The book is well documented and the authors site numerous studies, some of which purport to find that adding fluoride to drinking water may cause serious public health problems including negative effects on the brain, bones and kidneys, as well as damage to teeth in the form of fluorosis, which can occur when a child gets too much fluoride during tooth development.

The most compelling arguments against fluoridation of drinking water may well be the social and ethical arguments as opposed to the science-based ones. The authors point out that much research regarding fluoridation’s affect on preventing tooth decay indicates that any positive effect is from topical application, rather than systematic application, of fluoride. These findings raise serious questions regarding the cost and efficiency of fluoridating water supplies when most of the water used is not ingested but is instead used for household chores such as bathing, cleaning dishes and watering the lawn. The authors point out that consumers desiring to have fluoride applied to their teeth would be much better served by using one of the many brands of toothpaste that contain fluoride.

Many Americans who use public drinking water are forced to ingest fluoride without having a choice, short of purchasing bottled water which may not be an affordable option for many, a fact that is pointed out by the authors. Polls indicate that Americans are becoming increasingly skeptical of government claims and forced fluoridation of public drinking water may be reason enough for many to oppose the mandated process.

It is more difficult for the lay person to draw definitive conclusions from the portion of the book that deals with potential public health threats from fluoridation of water. Although the authors cite many studies to support their contention that fluoridation of water may have casual links to various diseases, supporters of adding fluoride to drinking water can point to studies and experts that claim the small quantities of fluoride added to water do not pose a threat to public health and the dental benefits of fluoridation are outweighed by any insignificant health risk.

One chapter in the book deals with application of the precautionary principle. The precautionary principle is particularly controversial as its rigid application would make it virtually impossible to make scientific advancement with new consumer products and drugs as almost any new application of chemicals can have some risk. To the credit of the authors, they specify eight criteria that must be met before the precautionary principle should be applied. The application of these criteria, however, requires a high level of discretionary decision making, which can lead to a cumbersome process.

While fluoridation of public drinking water is a widespread practice in America, it is not universally practiced by developed countries. Countries that do not fluoridate their water include China, India, Japan and nearly all of Europe. As more and more units of government are confronted with budgetary constraints, they will likely reconsider if the cost of fluoridating water is justified. Fluoridation of public drinking water in Michigan is mandated by state law and local jurisdictions currently are left with little choice in the matter baring a change in the law.

For anyone concerned about the practice of fluoridation of drinking water, “The Case Against Fluoride” is a must read. Although one may not agree with all of the authors’ contentions, they certainly raise serious issues that should be considered regarding the practice.


Russ Harding is senior environmental policy analyst at the Mackinac Center for Public Policy and director of the Center's Property Rights Network. From 1995 through 2002, Harding served as director of the Michigan Department of Environmental Quality, having previously held senior management posts in environmental and natural resources departments in Arizona, Alaska and Missouri. Before joining the Center, Harding was senior director for environment and energy affairs with Scofes, Kindsvatter & Associates, a consulting firm.