Where RFK Jr.'s fluoride-free dream is already a reality

Summary

Post Reports: Where RFK Jr.'s Fluoride-Free Dream Is Already a Reality

Episode Release Date: November 21, 2024
Hosts: Martine Powers and Elahe Izadi
Reporter: Fennet Neerupil

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Introduction to the Fluoride Debate

In this episode of Post Reports, health reporter Fennet Neerupil delves into the contentious issue of water fluoridation, exploring its history, benefits, and the growing opposition spearheaded by figures like Robert F. Kennedy Jr. The discussion centers around recent developments in Oregon, where communities are reevaluating the presence of fluoride in their drinking water.

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The Science of Fluoride

Fennet Neerupil [05:08]:
"Fluoride is this naturally occurring mineral that's actually already found naturally in some water sources. It's supposed to reinforce the enamel in your teeth and strengthen them to prevent tooth decay and cavities."

Fluoride has long been lauded by health organizations, including the CDC, as a crucial element in preventing dental cavities. Approximately 62% of Americans receive fluoridated water, a practice that began in Grand Rapids, Michigan, in 1945. The initial success in reducing tooth decay led to widespread adoption across the United States by the 1960s.

Elahe Izadi [05:45]:
"The CDC describes fluoride as one of the top 10 public health achievements of the 20th century."

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Historical Context and Widespread Adoption

Fennet Neerupil [05:53]:
"By 1980, nearly half of Americans were getting fluoride in their drinking water."

The introduction of fluoride into municipal water supplies was driven by extensive research demonstrating its benefits in dental health. Initially embraced across the political spectrum, fluoride became a standard public health measure aimed at improving oral hygiene and reducing the prevalence of cavities, especially among children.

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Rising Controversy and Opposition

Robert F. Kennedy Jr. [03:38]:
"I think the faster that it goes out, the better."

The endorsement of Robert F. Kennedy Jr. by then-President-elect Donald Trump as his Health and Human Services secretary brought fluoride into the national spotlight. Kennedy has been vocal about his opposition to water fluoridation, advocating for communities to remove fluoride from their water supplies.

Elahe Izadi [18:59]:
"There are new questions about how effective and necessary fluoride is to dental health for children in this country, and there are still pending questions, maybe even renewed questions about whether adding fluoride to the water could have some sort of detrimental effect to like, children's brains."

Recent studies, including a review by the Cochrane Library, suggest that the effectiveness of fluoride in preventing tooth decay has diminished with the widespread availability of fluoridated toothpaste and other oral care products. Additionally, the National Toxicology Program reported a moderate association between higher fluoride levels and lower IQ in children, sparking further debate.

Fennet Neerupil [16:16]:
"The National Toxicology Program... concluded with moderate confidence that higher levels of fluoride is associated with lower IQ in children."

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Case Study: Portland, Oregon

Portland stands as the largest U.S. city without fluoridated water, a decision rooted in longstanding skepticism about fluoride's safety and efficacy.

Fennet Neerupil [08:28]:
"People in Oregon have been skeptical of fluoride across the political divide, from liberal Portland and its suburbs to the more conservative rural parts of Oregon."

The 2013 Portland ballot measure to add fluoride to the water supply ignited intense public debate. Proponents, including many dentists like retired Portland dentist Kurt Frey, argued that fluoride was essential for preventing tooth decay. Opponents framed the issue as a matter of personal choice and government overreach.

Kurt Frey [09:14] [11:05]:
"It's much easier to scare the public than to unscare them... Their passion is a mile wide, but only about 2 inches deep for the opposition to fluoride."

Conversely, some dental professionals, such as Stacey Whitman, initially supported fluoridation but later changed their stance after reviewing new data, emphasizing the importance of consent and ethical considerations in public health measures.

Stacey Whitman [12:13]:
"I think we're wrong about water fluoridation. And aside from the health concerns, there's a medical ethical component to it, and people should be giving consent."

Ultimately, Oregon voters in Portland rejected the fluoridation measure, reflecting broader national tensions regarding public health policies.

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Other Communities: Hillsboro and Lebanon, Oregon

Following Portland's example, other Oregon communities have grappled with fluoridation debates.

Hillsboro:

Hillsboro, one of Portland's largest suburbs and part of the "Silicon Forest," recently held a ballot measure to add fluoride to its water supply. Led by pediatrician Beth Mossman, proponents highlighted escalating dental issues, such as patients selling their last vehicle to afford dental care.

Beth Mossman [23:16]:
"I was seeing kids in dental crisis. One of my patients' parents sold their car to afford oral surgeries."

Despite these efforts, Hillsboro voters rejected the fluoridation proposal by a significant margin (58% against, 42% in favor), mirroring Portland's outcome.

Lebanon, Oregon:

In Lebanon, a town of 20,000 in Central Oregon, voters recently decided to remove fluoride from their water supply. The process was straightforward, involving a simple switch-off mechanism at the water treatment plant. This decision was influenced by local advocacy groups and reflected similar sentiments seen across Oregon.

Ron Whitlatch [32:31]:
"You turn fluoride off and you turn fluoride on. It’s just really easy."

The cost of maintaining fluoridation is relatively low (~$25,000 annually), but opponents argue that even modest expenditures should not be forced upon taxpayers unwilling to consent.

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The Role of RFK Jr. and National Politics

Robert F. Kennedy Jr.'s stance against fluoride has energized anti-fluoridation movements nationwide. With his potential appointment as Health and Human Services secretary, communities look to Oregon's experiences as a blueprint for future debates.

Fennet Neerupil [34:48]:
"There is a broader tension here about the role of public health in society and what obligations we have to our fellow citizens."

The intertwining of fluoride debates with national politics suggests that local measures may increasingly reflect partisan divides, moving beyond Oregon's hyperlocal conflicts.

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Implications and Takeaways

The Oregon fluoride saga underscores the complexity of public health initiatives that balance collective benefits with individual autonomy. As fluoride becomes a flashpoint in broader political and ideological battles, communities across the United States are revisiting long-held beliefs about water fluoridation.

Fennet Neerupil [34:48]:
"I would avoid creating characters of people with this issue. I would be careful about just assuming that everyone who opposes fluoride is a tinfoil hat wearer or is a conspiracy theorist."

This nuanced issue highlights the necessity for informed dialogue and evidence-based policies in addressing public health challenges.

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Conclusion

This episode of Post Reports provides an in-depth examination of the fluoride controversy, blending scientific analysis with personal narratives from affected Oregon communities. As the national conversation evolves, the experiences of Portland, Hillsboro, and Lebanon offer valuable insights into the enduring debate over fluoride in drinking water.

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Notable Quotes:

• Robert F. Kennedy Jr. [03:38]: "I think the faster that it goes out, the better."

• Fennet Neerupil [16:16]: "The National Toxicology Program... concluded with moderate confidence that higher levels of fluoride is associated with lower IQ in children."

• Kurt Frey [09:14] [11:05]: "It's much easier to scare the public than to unscare them... Their passion is a mile wide, but only about 2 inches deep for the opposition to fluoride."

• Stacey Whitman [12:13]: "I think we're wrong about water fluoridation. And aside from the health concerns, there's a medical ethical component to it, and people should be giving consent."

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This summary encapsulates the key discussions and insights from the episode, providing a comprehensive overview for listeners and non-listeners alike.

Transcript

[Fennet Neerupil]

Hello. How are you doing? Are you Ron?

[Ron Whitlatch]

I'm Ron. Nice to meet you.

[Fennet Neerupil]

Bennett with the Washington Post. Mayor. I'm Mayor Jackala. Hey, it's nice to meet you.

[Ron Whitlatch]

So what do you guys want to do?

[Fennet Neerupil]

Want to see where the magic happens?

[Ron Whitlatch]

Where the magic happens? Well, we'll give you a tour of the plant.

[Fennet Neerupil]

Go ahead.

[Martine Powers]

What you're hearing is health reporter Fennet Neerupil entering a water treatment facility last week in Lebanon, Oregon. The mayor's there, the city councilor, the city manager. They're going into this building about the size of a big gymnasium with pipes everywhere. The plant operator, Tyson Keane, leads the way.

[Fennet Neerupil]

Oh. How do I even describe what I'm seeing? I'm seeing a lot of white cylinders. What are those cylinders that we're looking at?

[Ron Whitlatch]

Easiest way to describe it is if you've ever made, like, spaghetti. It's basically a colander. It's a mechanical device that has super small pores that basically blocks the things you don't want. You're drinking water on one side and lets water that you do want to drink go through, pass through the fiber onto the other side so you have clean water.

[Martine Powers]

Lebanon is a small town in Central Oregon. About 20,000 people. Fennett had traveled there to this plant because there was something specific he wanted to see and understand.

[Fennet Neerupil]

I saw something in there over by where we were standing with fluoride.

[Ron Whitlatch]

Yeah. We keep it in its own room with its own ventilation system, its own access.

[Martine Powers]

What Fennett wanted to see was fluoride and how it makes its way into drinking water.

[Fennet Neerupil]

So there's like, there's a separate area where fluoride is added. It's like a side room on the building. So here in this room, you see two large tanks of that are labeled as hydrofluoric acid, 24%.

[Martine Powers]

These tanks are holding fluoride in its concentrated liquid form.

[Ron Whitlatch]

You don't want to get it on your skin. You don't want to. It does have an inhalation hazard as well.

[Martine Powers]

From there, small diluted amounts are pumped into the water.

[Ron Whitlatch]

We add a small amount to millions of gallons of water.

[Martine Powers]

This fluoride right here recently got very controversial in Lebanon. And more generally, fluoride is about to get a whole lot more contested nationwide.

[Fennet Neerupil]

So you have this big fight that's playing out over whether individuals are okay with the government putting something in the drinking water under the theory that it's helping everyone.

[Martine Powers]

Fennett sat down with my colleague Elahi Izadi after he came back from this reporting trip to break this all down.

[Elahi Izadi]

So, Fennett, just how heated are the conversations in general right now about fluoride?

[Fennet Neerupil]

You know, fluoride has been a pillar of public health for decades. And the reason that it's put in water is because it's supposed to reinforce the enamel in your teeth and to strengthen your teeth. But that's about to change, or that's now under reconsideration.

[Robert F. Kennedy Jr.]

Having him is such a great honor. I've been friends of his for a long time, and I'm going to let him go wild on health. I'm going to let him go wild on the food.

[Martine Powers]

Incoming President Donald Trump has said he plans to nominate Robert F. Kennedy, Jr. To be his Health and Human Services secretary. Kennedy has said that one of his first priorities is telling communities to take fluoride out of their water supplies. Here he is on NBC News shortly after the election.

[Robert F. Kennedy Jr.]

I think the faster that it goes out, the better.

[Fennet Neerupil]

So in Oregon, passions have been running really high about fluoride for decades. And, and if you have RFK and if you have the federal government encouraging communities to remove fluoride, we can learn a lot from the battles in Oregon and even just earlier this year, what they went through as voters decided whether or not to keep fluoride in the water.

[Martine Powers]

From the newsroom of the Washington Post, this is Post Reports. I'm Martine powers. It's Thursday, November 21st. Today, the Science and politics of fluoride. We go to Oregon where some communities have never had fluoride in the water or have fought to take it out. And we hear about what those battles looked like and what they might reveal about where the country is going. Here's Elahi with Fennet.

[Elahi Izadi]

So, Fennet, I know we're gonna get in this conversation back to Lebanon and also some of these other communities that are talking about fluoride in their water. But I have a water bottle right here, cap unscrewed near all this equipment.

[Fennet Neerupil]

I have my water bottle, too.

[Elahi Izadi]

You have your water bottle, too? We both are in the District of Columbia right now. And I looked this up, and I didn't actually know this. I assumed that the water had fluoride. But until this conversation kind of came up in the national consciousness, I didn't bother to check. But the water here does have fluoride. So what is fluoride exactly?

[Fennet Neerupil]

Yeah. So fluoride is this naturally occurring mineral that's actually already found naturally in some water sources. And so because we've learned that fluoride can have a beneficial effect to teeth in Areas where it's already in the water, You've started to see more water districts start to add fluoride to have that same benefit. The idea is that when we're eating food and acid is forming in our mouth, that starts to degrade our teeth, and we start to lose some natural minerals in our teeth. And fluoride's supposed to add some of that lost mineral back and then make your teeth stronger so that you can avoid tooth decay and so that you can avoid cavities.

[Elahi Izadi]

And when did folks start putting it in the drinking water, at least in the United States? When did it start getting added to the drinking water here?

[Fennet Neerupil]

The United States is actually where the fluoridation of water started.

[Elahi Izadi]

Oh, wow.

[Fennet Neerupil]

So grand rapids, Michigan, in 1945, was the first city in the world to add fluoride to its water supply. This is grand rapids, Michigan, a town becoming widely known to dentists and municipal authorities. Tooth decay. And it was part of this experiment to see if this would make a difference. The children in Grand Rapids have less tooth decay than they did six years ago. What researchers found is that the children in Grand Rapids who were born after fluoride was put into the water had a much lower rate of cavities than the kids who were alive before. They can drink away tomorrow's tooth decay.

[Elahi Izadi]

So did it just spread from there that it just became sort of the status quo, that municipal and county and city drinking water would just have this added to it?

[Fennet Neerupil]

Yes. So this trend really started to take off. And by the early 1960s, the federal government was making this a recommendation to add fluoride to the water supply. And then by 1980, nearly half of Americans were getting fluoride in their drinking water.

[Elahi Izadi]

And right now, how many Americans have fluoride added to their drinking water?

[Fennet Neerupil]

According to the CDC, it's about 62% of all Americans have fluoride in their drinking water. The CDC describes fluoride as one of the top 10 public health achievements of the 20th century. So this is something that health experts and dental associations and dentists have described as a huge game changer to our oral health, because it's the kind of thing that they have had research that suggests that fluoride has drastically reduced the amount of tooth decay and cavities in children.

[Elahi Izadi]

But as you said, not everyone or everywhere has fluoride in their drinking water, including in some places in Oregon, which is where you went. So tell me about. Why don't they have as much fluoride in the drinking water there? How has this conversation about Fluoride played out in Oregon.

[Fennet Neerupil]

Yeah, there's just been this deep seated skepticism of fluoride in Oregon for, I guess, more than a half century now. Portland is the largest city that doesn't have fluoride, and its voters have voted against adding fluoride for different. And it's interesting because we typically think of Oregon as a blue state, but you also have a big swath of rural Oregon. It's a major logging area. There are tiny rural towns. You have big agricultural sections. But people in Oregon have been skeptical of fluoride across the political divide, from liberal Portland and its suburbs to the more conservative rural parts of Oregon.

[Elahi Izadi]

How did this debate around fluoride play out specifically in Portland, and what can we learn from that?

[Fennet Neerupil]

You know, I started my career at the Oregonian in 2013 when they voted on fluoride the last time. It was just so intense.

[Elahi Izadi]

Well, it was intense, even though they like, has it ever been in the drinking water there?

[Fennet Neerupil]

No, it's never been in the drinking water. So when there was a proposal to add fluoride to the drinking water, it really unleashed these big passions because the opponents would often cast it as adding a chemical into our water supply. And so you had people saying that this is threatening our children. You're trying to kill our children.

[Elahi Izadi]

Well, yeah. I mean, I'm wondering about how contentious these debates were. And I wonder if you can tell me about the types of people who were really active in the fluoride debate in Portland.

[Fennet Neerupil]

Well, you have dentists at the front lines. So a lot of dentists are some of the most prominent proponents of fluoride, along with other medical professionals. And then you have these citizen activists who are often the ones leading the charge against fluoride, because these are people who have been paying attention to these issues. They've been seeing things on YouTube or in other media casting doubt on fluoride, and then they start to look at the issue in their own communities.

[Elahi Izadi]

And so can you tell me a little bit more about some of the people you met who are active in this?

[Fennet Neerupil]

Sure. There's Kurt Frey. He's a big proponent of fluoride in the water.

[Kurt Frey]

I've been involved with what I call the politics of fluoridation since 2001, 2002. And my observation is it's much easier to scare the public than to unscare them.

[Fennet Neerupil]

He's this retired Portland dentist who's really been on the front lines of these fluoride fights all over Oregon in different communities for more than two decades.

[Kurt Frey]

I know it's anecdotal, but I know what I see. And in my practice, I had a little hobby. Anytime I got a new patient in the chair, I wouldn't look at their demographics right away. I just do a quick drive by, and they're looking in their mouth, and I could tell probably 80, 85% of the time. You didn't grow up here, did you? And inevitably, yes, they grew up in a fluoridated part of the country just by looking at the amount of dentistry that had been done in their mouth. And I can honestly tell you that the longer I practiced, the greater I understood the importance of prevention and the less I really wanted to pick up my dental drill and start drilling on a tooth. I happened to be kind of a pack rat.

[Fennet Neerupil]

And then he invited us to come over to his Portland home, where he spread out all these newspaper clippings from that 2013 Portland ballot measure. Fighting.

[Kurt Frey]

Okay, here's a letter to the editor says, I don't get it. A man parading back and forth in front of the library recently had a no fluoride chemical sign in one hand and a burning cigarette in the other.

[Fennet Neerupil]

There was both a sign and a shirt that said F. Yeah. Cause F is the.

[Elahi Izadi]

All right. Yeah.

[Fennet Neerupil]

The way that Kurt described it is that fluoride is the kind of issue where the passion is a mile wide, but only about 2 inches deep for the opposition to fluoride.

[Kurt Frey]

They're not as many of them, I call it. Well, maybe I'd say an inch wide of support in Portland, probably 2 inches. But their passion runs to the center of the earth.

[Elahi Izadi]

And so did you meet anyone in Portland who was really against having fluoride in the. In the drinking water? And what did they tell you about that experience for them?

[Fennet Neerupil]

I went to this dentist office called nopo. Kids in North Portland, we're in the dental office for Stacy Whitman, advertised as a holistic dental practice.

[Stacey Whitman]

Do you mind if I look in your mouth? Is that okay with you? Okay. Thanks, bud.

[Fennet Neerupil]

So the dentist there was one of the few dentists who actually speaks out against fluoride. So her name is Stacey Whitman. And back when Portland had its vote on fluoride, she actually campaigned in favor of fluoride.

[Stacey Whitman]

So initially in dental school and after, before I was exposed to this other information, I did have a knee jerk reaction. I would say it's the tin hat brigade. I would say these are pseudoscientists. They're woo woo. They're just crazy.

[Fennet Neerupil]

But that's when she also started to change her mind. And have second thoughts. And so Stacy Whitman said after she did an extensive review of data and studies, she started to change her mind about fluoride. And now she no longer recommends her patients drink fluoridated water or even use fluoridated products.

[Stacey Whitman]

You know, it's really hard, I think, to be taught something for so many years and believe it, and you speak of it as your mantra and then to say, well, wait, maybe I was wrong. It's really hard for someone to say maybe we're wrong. And I'm saying, I think we're wrong. I think we're wrong about water fluoridation. And aside from the health concerns, at the end of the day, there's a medical ethical component to it, and people should be giving consent.

[Fennet Neerupil]

You know, this is an argument that I kept hearing a lot, that fluoridation and opposition to fluoridation is about choice, that people want to be able to choose what's in their water. And I even heard this from a parent in the office. When it comes to the benefits of fluoride, there's actually not a lot of data in Oregon. Nationwide, we have seen evidence that oral health improves when there's fluoride in the drinking water. But there's not great evidence when you look at Oregon itself and compare Portland and other communities without fluoride to the places that do have fluoride. That said, the pro fluoride dentists in Oregon that I talked to say that they see the difference in the dental office, that people who grew up without fluoride tend to have a lot more cavities and just generally worse teeth.

[Elahi Izadi]

Well, Fennett, you know, we're talking a lot about these inflamed passions around fluoride. And we've also talked about how it became such like, a mainstay of public health in many communities across the country. But can we dig into the science here on fluoride? What do we know about how fluoride affects our health?

[Fennet Neerupil]

So the CDC and other medical associations have long been praising of fluoride. So one of the things you can just see on the CDC website right now is that evidence shows that water fluoridation prevents tooth decay by providing frequent and consistent, consistent contact with low levels of fluoride, ultimately reducing tooth decay by about 25% in children and adults. So that's the core argument for fluoride, is that it prevents tooth decay. It prevents cavities by strengthening teeth.

[Elahi Izadi]

And can you just tell me, like, why that's important? Because maybe some people just think, oh, well, I'll just avoid cavities. But why is dental health so important?

[Fennet Neerupil]

Yeah, I think that's really important to know is that dental care isn't just like limited to your teeth. What's happening in your mouth and what's happening in your teeth is affecting the rest of your. So when you have tooth decay and when you have cavities, that can actually contribute to bacteria making its way into the rest of your body and causing other health issues. So this is like also a reason that there's this consternation in the medical community about why do we treat dental insurance as a whole separate thing? Why do we treat like the dentist as something independent of like classic or traditional doctors? Because, like, what's happening in your mouth is relevant for your whole body. It's not just aesthetic, it's not just about, like having pearly nice looking teeth.

[Elahi Izadi]

Yeah. And if things go south, it can have some really dire consequences for the rest of your body.

[Fennet Neerupil]

Right, Absolutely.

[Elahi Izadi]

So, okay, that's sort of the general argument, I guess. What does the science say about what are the risks to fluoride?

[Fennet Neerupil]

Yeah, so there have been developments, particularly over the last year, that started to challenge some of the conventional thinking around fluoride. So the Cochrane Library is this organization that does extensive reviews of literature and they're well regarded in the field of science and medicine. And when they did an extensive review of research and data about fluoridation, what they found is that water fluoridation may slightly reduce cavities and tooth decay in children, but the effect has become smaller since the 1970s when fluoridated toothpaste and other oral products became widely available. So.

[Elahi Izadi]

Oh, so it's like it's perhaps suggesting it's not as necessary because now toothpaste often has fluoride in it. And that's a pretty good way of getting fluoride on your teeth.

[Fennet Neerupil]

That's right. So the argument is that, you know, it's not the 1950s anymore. Now kids are prescribed fluoride tablets when they're coming in for their dental checkups. Doctors can apply fluoride to their teeth. They can be getting daily fluoride through their toothpaste or their mouthwash. So the argument is that fluoride might not be as valuable as it used to be. But I should also say that a co author of the Cochrane Review said that this report shouldn't be used to justify removing fluoride from the water supply. The idea behind this report is like, maybe it's not as good as it used to be, but not that it's harmful. It didn't conclude that there's any harm. But on the subject of harm, the National Toxicology Program, which is part of the federal government, they also did a literature review and they concluded with moderate confidence that higher levels of fluoride is associated with lower IQ in children. And this was a really significant finding. And a federal judge in September used this report to order the Environmental Protection Agency to further regulate fluoride in drinking water. And now this is like a piece of evidence that's at the heart of anti fluoride arguments. But there are really important caveats here because the underlying research came outside of the United States in communities with levels of fluoride that are higher than what's recommended by the CDC and the who. So the issue here is, are these studies where you're looking at other countries with really high levels, levels of fluoride really applicable here? And then there's even questions of the all right, well, how reliable is IQ test, especially when we're talking about young children? And there's a question of like, well, you know, there's an association of lower IQ and higher fluoride, but correlation doesn't equal causation. So is it actually the fluoride that's causing it? There's still open scientific questions here.

[Elahi Izadi]

Well, Fennet, yeah, it sounds like what you're describing is on the one hand, there are new questions about how effective and necessary fluoride is to dental health for children in this country. And there are still pending questions, maybe even renewed questions about whether adding fluoride to the water could have some sort of detrimental effect to like, children's brains. And that these are open questions, that there's not conclusive data necessarily here, but that these are questions that scientists and researchers are actively grappling with.

[Fennet Neerupil]

That's right. So I wouldn't be knee jerk dismissive about opponents of fluoride, which is interesting.

[Elahi Izadi]

I think Fennet, because I think like, honestly when I first started hearing about like remove fluoride from the drinking water, I'm like, wait, is this like, you know, I'm thinking about, you know, Dr. Strangelove and like conspiracy theories and all these things. But this is really fascinating that there are really legitimate open questions right now.

[Fennet Neerupil]

Right. There's a long history of conspiracy theories about a fluoride and how the government is putting it in to control Americans. So in the very early days in the 1950s, the John Birch Society and Senator Joseph McCarthy were out there making the argument that it's part of a communist plot. And it was considered so absurd that it was parodied in the Dr. Strangelove movie back in 1964. And then you've also heard arguments that a fluoride is part of a sugar industry plot to sell more sugary sweets to kids. I think often the anti fluoride movement is lumped in with anti vaxxers, but they really are different because with the anti vaxxer, what you're seeing is that people are constantly repeating these debunked claims like vaccines causing autism, for instance. But in the case of fluoride, you have this research that's been cited by well regarded institutions and there's scientific discussion about it, and then there's questions about methodology and whether this research is applicable in the United States. But broadly speaking, there is a question here of whether fluoridation is worth the trade offs. And so I think this is one of those bigger questions in public health is that should the government subject an entire community to a measure that's supposed to benefit the entire community when some individuals in that community are uncomfortable with that?

[Elahi Izadi]

Well, let's go to some of these communities. I think that's a really natural segue.

[Martine Powers]

After the break, the great fluoride debates of this year in the suburbs of Portland. We'll be right back.

[Elahi Izadi]

So, Fennet, we've been to Portland, but I know that you were also reporting in some other towns and communities in Oregon that are having these active debates today about fluoride. So tell me about Hillsboro, which is one place you went.

[Fennet Neerupil]

One of the things to know about Hillsboro is that it's an educated suburb, one of Portland's largest suburbs. It's actually where intel has one of its largest campuses worldwide. And it's known for being a part of Oregon that's called Silicon Forest, kind of like California's Silicon Valley. There's also a very large immigrant community in Hillsborough, particularly a large Latino population. So we mentioned that Portland is the biggest city without fluoride, but actually in some of the suburbs, most of those communities do have fluoride. And so Hillsborough was this exception in Washington County, Oregon, where it's one of the few cities there that actually doesn't have fluoride in its water supplies.

[Elahi Izadi]

Well, why did you go there?

[Fennet Neerupil]

So we went to Hillsborough because there was a recent vote on fluoride. Proponents figured, all right, maybe this one's not going to be as controversial as Portland because so many neighboring communities already have fluoride. So the Hillsborough ballot measure started as an effort from a local pediatrician and other medical Professionals to try and add fluoride to the water supply because they were seeing the condition of children who were raised in Hillsborough without fluoride in their waters. You heard them go before the city council to make the public health case for adding fluoride. I'm Beth Mossman.

[Martine Powers]

I'm a pediatrician at Hillsborough Pediatric Clinic.

[Fennet Neerupil]

And even at one of the public hearings, we heard a pediatrician, Beth Mossman, make an argument that she was seeing kids in dental crisis. She mentioned that for one of her.

[Martine Powers]

Patients, his parents sold their last vehicle to afford their dental care.

[Fennet Neerupil]

One of her patients parent had to sell their car in order to afford oral surgeries. They live less than one mile from.

[Martine Powers]

The fluoridation boundary where their Hillsboro citizen counterparts are receiving fluoridated valley water districts.

[Elahi Izadi]

So this is a huge lapse in.

[Martine Powers]

Their opportunity to have thickened enamel.

[Fennet Neerupil]

You know, when dentists see kids with poor oral health who are living in communities without fluoride, there are other things that they can do, such as prescribing fluoride tablets, giving applying fluoride to their teeth, telling their parents, like, when you buy them toothpaste, you should look for fluoride in it. But the question isn't so much the kids who are coming to the dentist as it is the kids who aren't coming to the dentist or who can't come to the dentist that much. Because for kids who are on Oregon's a Medicaid plan, for instance, there can be long waits to see a dentist, or there can be a lot of dentists who don't even accept Medicaid because of low reimbursement. So the idea behind putting fluoride in the water is that this is the easiest, most efficient way of making sure that all children in a community are getting access to fluoride, even if you don't have great access to the dentist. So the city council ended up referring the issue to voters similar to Portland. It ended up being a very emotional, turbulent campaign, and voters ultimately voted against adding fluoride.

[Elahi Izadi]

I do wanna learn a little bit more about just how passionate people were in this community because, you know, we learned about Portland and how it played out there. But this is a much more recent issue that took place in the community of Hillsborough. Can you tell me about what it was like there?

[Fennet Neerupil]

One of the differences between 2013 and 2024 is that there's a lot more social media now. So a lot of these discussions that used to happen face to face are now actually happening online. So what we found when we Went to Hillsborough. I think one of the things that really st meeting with these dental hygiene students. I'm Bennett. Very nice to meet you. Nice to meet you.

[Savannah]

I'm Savannah.

[Martine Powers]

Hello, Sarah.

[Fennet Neerupil]

Nice to meet you. So I met Mary tran, Sarah robinette, and Savannah christensen, who are all students at pacific university in Hillsborough, and they actually decided to help out the fluoride campaign and do outreach as part of a school capstone project. And they were telling us stories about how intense the campaign was there. What kind of reactions were you getting as you were campaigning for fluoride? What were you seeing both and in person and on social media?

[Savannah]

Well, oh, this is Savannah again. I think one thing that I just honestly was not prepared for. I was kind of like, okay, you know what? This is fluoride campaign. It's for kids who's gonna say no to any of this? And I was quickly proven wrong because it didn't matter if you voted red or if you voted blue. Everybody had an opinion. And on this community page, we put out a cute, like, little statement, and then we had all these cute designs and like, woohoo, you know, vote yes for fluoride. And then within minutes, we just get flooded with so much anti fluoride. And again, it's coming from both sides.

[Fennet Neerupil]

You had people who were saying things like, my body, my choice. Echoing reproductive rights language. A few of them talked about how when they went to just drop flyers off at doors, people ended up yelling at them and saying that they voted against fluoride and just treating them with real hostility that you don't always see for someone dropping literature for city council candidate.

[Mary Tran]

I completely agree with Savannah. I was not prepared for all of the opposition at all.

[Fennet Neerupil]

So Mary tran grew up in hillsborough, in parts of California where there was no fluoride in the water. And she was also taken aback by the kind of hostility that she faced.

[Mary Tran]

And on the first day that we went canvassing, I encountered the sweetest old lady on her porch. I thought she looked so kind. And I was like, I'm just here to pass out this election, you know, fire. And she saw. And then she got really angry at me. She like, oh, no, I already voted. I voted no. I already talked to the council members. You don't need this in your water. Just brush your teeth. But, you know, clearly I brushed my teeth growing up, and I still have a lot of cavities.

[Fennet Neerupil]

Do you find any arguments did. Did win people over, or did you have experiences where people who are skeptical of fluoride ended up voting yes or feeling More positive about fluoride.

[Savannah]

This is Sarah, I think, personally talking to friends. You know, there's not really a lot of winning them over if they're already against it. This is Savannah again. I also think, too, you know, when you see all these Facebook posts and people commenting, there comes a point where you're like, it doesn't matter what we say, what we comment back. We are not going to change their mind. You're going to believe what you're going to believe, so why waste my time?

[Elahi Izadi]

So in the end, how did this vote turn out?

[Fennet Neerupil]

The fluoride ballot measure in Hillsborough ended up losing 58 to 42.

[Elahi Izadi]

I mean, that's pretty big margin.

[Fennet Neerupil]

And it was kind of surprising because the local government there did an informal survey of residents there, and they found that there was support fluoridation. But then after this campaign went underway and you started seeing people make a case against fluoride, people ultimately ended up opposing it. And so after the ballot measure failed, we actually went to a celebration party from the anti fluoride people, the people who opposed the ballot measure. And they were essentially this small, ragtag group that wasn't, like, formally organized. I saw on Facebook that you have a cake that gluten and fluoride free.

[Lloyd Labison]

Well, I think fluoride free was a joke.

[Fennet Neerupil]

Yeah. Yeah. Sarah Genta was one of the organizers of the anti fluoride clean water Hillsboro campaign. And it was at this big food hall with a lot of food trucks and a bar inside. It was a karaoke night, and she was setting up a table in the food hall. There was cake. There are actually two cakes and signs that said our water, our choice.

[Lloyd Labison]

So I'm a registered nurse. Retired. Yeah, yeah, yeah. It was really important to me that we not distribute medication to people without the five rights of medication administration that we learn in nursing school.

[Fennet Neerupil]

Yeah.

[Lloyd Labison]

You know, right route, right dosage, right patient, right timing, all of those are violated if we put medication in water.

[Fennet Neerupil]

Sarah was going around and offering cake to people who weren't there for the celebration. And people did eventually come by, including people like Lloyd Labison.

[Lloyd Labison]

Do you know why we had the cake today?

[Robert F. Kennedy Jr.]

Yeah, the fluoridation thing passed, didn't it?

[Lloyd Labison]

Yeah, it did not pass.

[Robert F. Kennedy Jr.]

It didn't pass, really?

[Lloyd Labison]

Yeah.

[Robert F. Kennedy Jr.]

Someone told me they passed.

[Lloyd Labison]

60% of the voters said, no, thank you.

[Fennet Neerupil]

So Lloyd Labison was there, decked out in all this American flag apparel, and he was even singing a karaoke, proud to be an American earlier that night. And he actually thought the pro fluoride people had Won. But Sarah told him otherwise.

[Robert F. Kennedy Jr.]

Well, fluoride is not necessarily a bad.

[Lloyd Labison]

Thing, but if you put it in the water, it's harder to then have choice.

[Robert F. Kennedy Jr.]

I see, I see. You don't have a choice to.

[Fennet Neerupil]

Got it. And he was a supporter of fluoride and he was telling us how. Well, I wish that I had that and it would have saved me a lot of dental bills growing up. He didn't have access to fluoride growing up and neither did his kids.

[Robert F. Kennedy Jr.]

With my kids with all the dental bills I used to pay for them when they're young, I like fluoride. I don't think that's an imposition on me. You know, what did you think of.

[Fennet Neerupil]

The argument that there shouldn't be fluoride in the water because people should have the choice whether to consume it or not?

[Robert F. Kennedy Jr.]

You know, the things. Right now it's more of a political thing. I think it's a preference. People don't like to be told, we're gonna shove this down your throat. That feeling.

[Elahi Izadi]

So what about places that already have fluoride in it in the water? And now they're talking about or voting to get rid of it. And I'm thinking like this is what R.F. kennedy Jr. Is talking about, just getting rid of fluoride. And a lot of places already have it. How has that played out in Oregon?

[Fennet Neerupil]

Yeah. So communities across the United States have been taking out fluoride from their water supplies for years. Actually, it's not a brand new trend, but Lebanon, Oregon was one of the most recent to do it. This was a town of 20,000 people in Central Oregon, and just like Hillsborough voted on a fluoride ballot measure to add it. Lebanon voted on a ballot measure to remove it. And this was a result of advocacy from citizens. And ultimately the city council decided to refer the issue directly to voters to have the last say.

[Elahi Izadi]

And the voters voted to take it out. We heard a little bit earlier about this treatment plant where, you know, the fluoride is. So I guess tell me about how easy it will be to remove the fluoride from the drinking water for them.

[Fennet Neerupil]

Oh, it's simple. You know, in Hillsborough it was gonna take years to set fluoridation up. But in Lebanon, they said all it basically is is just pressing a button and then you're done with fluoride.

[Ron Whitlatch]

You turn fluoride off and you turn fluoride on. So that's really. We'll de energize everything, clean the room up and that'll be it.

[Fennet Neerupil]

So Ron Whitlatch the interim city manager was telling me this right outside the fluoride room back at the water treatment plant in Lebanon. And we were also with the plant operator, Tyson Keane.

[Ron Whitlatch]

Where's the switch? Yeah, it's just basically on your SCADA screen. So it just gets turned off.

[Elahi Izadi]

No light switch?

[Ron Whitlatch]

Yeah, there's no light switch for it. Yep.

[Fennet Neerupil]

No big red button.

[Ron Whitlatch]

No big red button.

[Fennet Neerupil]

It's just basically hitting a button on the computer. And then they do have that room that they use as the fluoridation room. So then they would just remove the tanks, they would remove the pumps, and they said that they're probably gonna use that room for storage.

[Ron Whitlatch]

If anything, it makes our job a lot easier.

[Elahi Izadi]

Is this gonna cost them any money or save them any money?

[Fennet Neerupil]

The price tag for fluoridation is about $25,000 a year, so it's not a huge amount of money. But you also hear opponents of fluoride saying, well, like, why should our taxpayer money go towards this at all when some of us are uncomfortable with it and, you know, some saving, even if it's not like a massive expenditure, some savings is better than none.

[Elahi Izadi]

Mm. Mm. Fennet, it's just so fascinating to hear you talk about these communities that have been grappling with this question for many years. This isn't a new thing, but now many more people are thinking about it ever since Robert F. Kennedy, Jr. Has made this promise or has indicated that this is what he wants to do. He wants to remove fluoride, and Trump says he will nominate him as his next health secretary. So I'm wondering, after this time you spent in Oregon, going back to the place where you started your career, what's your takeaway? What can, like the rest of us, learn from the experiences that Oregon went through?

[Fennet Neerupil]

I think first and foremost is I would avoid creating characters of people with this issue. I would be careful about just assuming that everyone who opposes fluoride is a tinfoil hat wearer or is a conspiracy theorist. And to be clear, there is a lot of misinformation circulating about fluoride. That's certainly the case. But there's also just a broader tension here about the role of public health in society and what obligations we have to our fellow citizens. And so I think one of the big takeaways that I had about fluoride and what's gonna be coming is that this is an issue that's been very hyperlocal but also intense. And now we're gonna see it get even more intense because it's gonna have the partisan politics of the Trump administration. And people feel very strongly about rfk. They feel very strongly about Trump. And that's the difference here, is that these fluoride ballot measures that were happening in Oregon, they were divorced from national politics. And then already actually in the last week, we saw Florida city voting to remove fluoride. And one of the commissioners cited RFK and RFK skepticism of fluoride as one of the reasons to do so. So we're gonna see more communities take the same path that communities in Orego again have.

[Elahi Izadi]

Well, Fennett, thank you so much for sharing your reporting with us. This has been so fascinating.

[Fennet Neerupil]

Yeah, thank you for having me and letting me nerd out about this. This is such a fascinating topic and such a fascinating story.

[Elahi Izadi]

Cheers.

[Fennet Neerupil]

Cheers.

[Martine Powers]

Fennet Neerpil is a national health reporter for the Washington Post. He reported this story in Oregon with our producer Alana Gordon. He spoke with my colleague Elahi Izadi. Before we go, we've got a couple other pieces of news we want to share today. First, former Republican Congressman Matt Gaetz has announced that he is withdrawing his name from consideration for attorney general. In a social media post today, he said his confirmation was, quote, unfairly becoming a distraction. There's a lot to unpack here and what it means for the transition to the Trump presidency. So we'll be talking about this a lot more on Friday's episode of the campaign moment. And in a world completely beyond DC Politics. If you're anything like me, this is the weekend that you have been waiting for for months, maybe even four years, the weekend of Wicked. Don't be afraid.

[Lloyd Labison]

I'm not afraid.

[Martine Powers]

It's the wizard who should be afraid of me. The film adaptation of the hit Broadway musical comes out on Friday. And if you want even more reason to get hyped about it, the posters published a great story, an oral history of Elphaba, one of musical theater's most empowering roles. Her colleague talked to seven actresses who have played the part on stage about their nerve wracking auditions, the perils of flying in front of a live audience, and what it's like to date when your skin is constantly a shade of green. To check that out, find the link in our show notes [e-mail] that's it for Post reports. Thanks for listening. If you want to show your support for the show, please subscribe to the Washington Post. Not only is it a great way to help us continue to do this work, but you can now get access to Washington Post podcasts ad free in Apple Podcasts. Subscribe in Apple Podcasts or by following the link in our show notes. Today's show is produced by Ilana Gordon with help from Sabi Robinson. It was mixed by Justin Gerrish and edited by Rena Flores with help from Lucy Perkins. Thanks also to Tracy Jan Fan. I'm Martine Powers. We'll be back tomorrow with more stories from the Washington Post.