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Time to walk boldly
the Journal of the Am e ric a n Dental Ass o cia tio n
Tim e to walk boldly
Donald, R. M cN eil* Ph.D., Mesa, Ariz.
In the past ten years, Dr. M cNeil asserts, the fight over fluoridation has shifted from the scientific to the political arena. The evidence regarding the benefits and safety of fluoridation has won scientific acceptance everywhere but in the mind of the public. The benefits of fluoridation can be seen in the healthier teeth of those who have been reared in communities providing fluoridated water. These benefits, however, continue to be ignored by the opposition, whose forces have become unified, for the most part, beyond the reach of scientific argument and evidence. The problem now faced by many communities in their efforts to achieve fluoridation is essentially political. More biochemical experiments or more endorsements by scientific bodies will not help. Individual dentists, physicians and public health officials must end their apathy and must accept their professional responsibility to join the fight for fluoridation. The health professions are being hurt by the defeats of fluoridation at the polls. Dentists and physicians, maintains Dr. M cNeil, must place their professional prestige on the line in the campaign for fluoridation. Lay leaders need the professional men, as dispensers of scientific information and as enthusiastic spokesmen for the cause. It is time to campaign vigorously against those who would deny the benefits of fluoridation to the nation’s children. Such a campaign, suggests Dr. M cNeil, should include: a fluoridation conference at the White House level; training institutes for public responsibility within the pro fessions; more U. S. Public Health Service funds to finance the campaign; more publicity on the healthful effects of fluoridation; community-wide education to let the truth catch up with the untruths; firm pressure on elected officials; well-planned community organization down to the precinct level, and a vigorous national campaign to benefit the many local campaigns. Such a program will take time, money, energy and perseverance, but it will insure victory.
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T he m eeting here today to discuss the problems of fluoridation is reminiscent of a similar gathering ten years ago in the offices of the U . S. Public H ealth Service. Those of you fam iliar w ith the long fight for fluoridation will recall the incident. I t was a t a m eeting of the state dental h ealth officers in Ju n e 1951. John K n u t son of the U . S. Public H ealth Service had asked Wisconsin’s state dental health officer, the late Francis Bull, to present some “D o’s” and “D on’ts” which other dental directors should observe in fluori dation campaigns. D r. Bull regarded the m eeting as p ri vate an d proceeded to give, on the basis of his extensive experience w ith the city councils and town boards, some “off-thecuff” tips to - his colleagues. H e spoke frankly and w ith great vigor, for D r. Bull was a vigorous m an. His “Do’s” involved organization of comm unity meetings, m ethods of obtaining good publicity, building an educational program to u n derm ine in advance the rash of wild charges certain to be raised against fluori dation. W hen he got around to his list of “D on’ts” he shot from both hips. Prom o tion of fluoridation, he said, should not openly come from state officials, b u t from the locality. D on’t use th e negative ap proach. D on’t let the people vote on it. D on’t let the waterworks people confuse the issue. T h e list of don’ts was long. D r. Bull was unaw are of the stenogra pher in the audience taking a verbatim account of th e m eeting, and later the opposition obtained a copy and from it built th eir case against the “prom oters of fluoridation.” By quoting some of D r. Bull’s candid and vivid phrases such as “D on’t let the people vote on it,” or “knock down the opposition,” o r “w hen they say yes, you say no,” they emphasized the “deceitful nature of the bureaucrats” who are trying to thrust fluoridation on the Am erican people. By excerpting certain sentences, they m ade the entire conference sound
like a devious plot to circum vent the will of the people. Dr. Bull, and m any another proponent of fluoridation, were em bar rassed by the interpretation of the m eet ing, for there was no single charge m ore widely disseminated throughout the U n ited States during those years. T oday I should like to use this famous 1951 m eeting as my control u n it to dem onstrate the similarities and the differ ences between the fluoridation struggle then and the fluoridation struggle now.
FLU O R ID A TIO N STRU G G LE TODAY I t is easy to draw historical parallels be tw een the 1951 m eeting an d the one today. As they were in 1951, we are in 1961, gathered to discuss the problems of acceptance by the Am erican people of one of the most significant an d far-reach ing public health measures in our history. W e are here to analyze, criticize, and to offer constructive ideas for the future. Like those pioneers of a decade ago, we agree th at the evidence is in, th a t we should somehow spread the word to m ore people th an we have in the past. As for the opposition, the general n a tu re of the groups and the types of argu m ents are the same now as then. T h ere are physicians and dentists still opposed; there are health foods advocates, chiro practors, and pam phleteers who hope to profit from their cam paigns; there are anti-Sem itic propagandists, there are those who see a Communist plot in every fluoridated drop of water, and there are those such as Christian Scientists, who sincerely argue against fluoridation on religious and constitutional grounds. T he argum ents against fluoridation haven’t im proved m uch over the ten years either. O pponents still charge th at fluorides produce a vast array of ill effects on the hum an body, th a t profluoridationists distort statistics, th a t fluoridation vio lates individual liberties, and th a t the U . S. Public H ealth Service is prom oting socialism.
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O ne other similarity comes to m ind as we compare the two meetings. As with Dr. Bull, every word uttered here today will be microscopically exam ined under the out-of-focus lenses of the fluoridation opponents. T h eir jaundiced eyes will see hidden meanings, discover inhum an plots against the A m erican people, and find crass admissions of our guilt. W hen they disclose their findings to the A merican people, I predict they will lift passages out of context, overemphasize the points th a t fit their prejudices— distort our logic, our facts, an d our statistics— and om it w hatever fails to support their foregone conclusions. In short, the tw elfth N ational D ental H ealth Conference will be m ade to conform to the antifluoridationists’ preconceived ideas as to the natu re of our efforts. Expect no mercy from them. T o understand the differences between th a t small gathering ten years ago and the one today, it m ay be helpful if we fasten the two meetings to their proper historical pegs. L et m e review briefly.
H IS T O R IC A L R EV IEW Frederick S. M cK ay’s 29 year search for the cause of m ottled enam el resulted in the discovery in 1931 of the guilty agent, fluorine. F ro m there, th e U . S. Public H ealth Service took over an d by 1944, after a series of toxicity studies, to m ake certain there would be no harm ful side effects, the G rand R apids fluoridation experim ent began. In Wisconsin, the hom e of Progressivism 40 years earlier, a zealous group of dentists, led by John Frisch and D r. Bull, decided in 1944 th a t wholesale fluorida tion was im m ediately necessary. Despite W isconsin’s record of 50 fluori dated communities by 1950, the U . S. Public H ealth Service and the American D ental Association reflected the scien tific conservatism of most researchers, dentists and public h ealth officials in the country. O n scientific grounds, between 1945
and 1950 they rejected the Wisconsinites’ argum ents for im m ediate universal fluori dation. T his is an extrem ely im portant point, for it helps us u n d erstand the background of th a t famous 1951 meeting, so widely m isquoted by fluoridation opponents. Dr. Bull had been in the forefront of the struggle since 1944 and represented the “fluoridate now” groups. T h e U . S. P ub lic H ealth Service endorsem ent was less than a year old an d the American D ental Association’s official approval a little m ore than six m onths. T he national or ganizations were feeling their way. M any states and localities were completely un inform ed about the issue, to say nothing of th e rank-and-file dentist, physician, public h ealth w orker, and the ordinary citizen. M any reputable scientists re garded the plunge into the cold waters of universal fluoridation as possibly an overstim ulating prebreakfast swim in the m uddied waters of a lake of w hich they didn’t even know th e depth. “L e t’s w ait a n d see,” they said, w ith justifiable scientific caution. This was the essence of the fam ous Delaney Com m it tee recom m endation more th an a year later.
IG N O R E W ILD C H A R G ES For three years a fte r American D ental Association approval in 1950, there was a strong feeling am ong its officials th a t the Association should not, in the words of th e secretary of th e Council on D ental H ealth, “ dignify th e efforts of the oppo sition” by answ ering every wild charge. I t would, he said, “be best to ignore them completely.” In 1952 he announced th a t after a “great deal o f discussion on strat egy,” the A.D.A. w ould devote itself to distributing au th en tic inform ation and supporting health officials. F u rth er pres sure by th e A m erican D ental Association m ight stimulate a m ore vigorous cam paign on a national basis. A year later, his successor advised dental societies to
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give “professional and technical leader ship” a n d let civic organizations do the prom otional work. In the U . S. Public H ealth Service, the drive b eh in d the agency’s endorsem ent was nom inal. In a few states, local public health officials were enthusiastic leaders; in others, they took the attitude th a t flu oridation should w ait until the people were ready for it. T h e A m erican M edical Association, considering fluoridation a dental m atter, went on record in 1951 for fluorides and left the issue pretty m uch alone. T h ro u g h out the country, there was a feeling on the p a rt of the powerful scientific bodies th a t th e opposition would soon fade away, th a t th e ridiculous charges would eventually prove self-defeating, th a t the public w ould soon awaken, and th a t the fluoridation issue would be settled, quietly and sanely, in th e best traditions of our A m erican democracy. I t was also quite different in the oppo sition ran k s then; for example, when some W isconsin physicians and dentists reflected a cautious attitude, one of the most effective opposition groups of the future — th e chiropractors — condem ned the m edical and dental professions for w ithholding the benefits of fluoridation from th e populace! T h e strategy of the opponents was often confused and contradictory, too. I t may seem strange now, b u t opponents of fluoridation in some towns used to con dem n referendum s— obviously because they fe lt they could defeat fluoridation through th eir elected representatives. You still h e a r faint bleatings of this po sition w h en a town has accepted fluori dation by ballot. In short, then, the lines h ad not yet been d raw n firm. Theories h ad not jelled. T h e issue had not yet been sharply draw n, eith e r w ithin the ranks of the pro fessions, the opposition groups, or the general public. Still— w ith the U. S. Public H ealth Service a n d A.D.A. endorsements in 1950
and American M edical Association a p proval in 1951— the fluoridation move m en t spread. In 1951, 225 communities initiated fluoridation; the next year, 347. B ut w ith the Delaney C om m ittee re port espousing “Go slow on fluoridation,” a n d its subsequent publicity in national magazines, together with the rap id am al gam ation of opposition groups, fluorida tion tapered off. Antifluoridationists be gan winning m ore battles th an they lost and though the num ber of cities an d the num ber of people drinking fluoridated w ater increased— approxim ately 42 m il lion now— the increase was a t a decreas ing pace. I t is paradoxical in m any respects that the more evidence supporting controlled fluoridation which proponents gathered, the less likely they were to win their b a t tles in the local communities. T he opposi tion consolidated, resistance stiffened, an d finally the antis took the offensive; m any communities which had begun flu oridating early were told by the voters to cease and desist. H indsight is a m arvelous power, as I, a historian, know full well. But the es sence of historical appraisal is to under stand the feelings and attitudes of people involved in significant historical events at the time. T he foregoing résumé of events in the postwar period should in no way be interpreted as a critical O lym pian judgm ent of the actions and policies of th e people who have preceded us. If his tory can offer guidelines for the future, it is not in the sense of transplanting the past to the present and saying, “ I told you so.” R ather, history should bring an understanding of past events in such a way as to deepen our understanding of the forces fram ing today’s problems, and to offer suggestions for sensible, respon sible conclusions. So let us talk further of the differences between the two meetings of ’51 an d ’61.In the first place, today we have a t our disposal the results of the original 15 year experiments. M ore th an that, we have
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hundreds of additional fluoridation stud ies on everything ranging from systemic effects to corroded w ater pipes. Scientific caution may have been justifiable ten years ago, for the issue was somewhat cloudy. But to th e best scientific minds, and to the adm irably cautious councils of almost every scientific body in the land, the evidence on fluoridation is in. If there were a shadow of a doubt, now or in the future, as to the safety of fluo rides, these councils would be the first to call a halt. O ne inescapable fact emerges from th e welter of charges raised by opponents. T h ere is not a single shred of scientific evidence indicating th a t fluo rides at the proper levels do anything else than w hat the proponents say they do. Fluoridation is approved. I t is approved everywhere but in the public mind. Secondly, the situation today differs from ten years ago in th a t we have now had experience. W e have seen w ith our own eyes the children who have grown to adulthood drinking w ater w ith fluorides added. W e can physically see and feel the decayless teeth which were a m ere promise ten years ago. Thirdly, m ore th a n experience, we have now had experiences. W e have been stunned and shocked at th e irresponsible charges raised by some of the antifluoridationists. W e do not w ant to believe that wild-eyed fanatics can, w ith straight faces, link fluorides to chemical lobotomies, a bureaucratic socialist plot, a Com munist plot, a Jewish plot. I t is difficult to perceive our antagonists as m en and women of good will when they flamboy antly resort to the skull and crossbones, pictures of deform ed children in wheel chairs, and 30 year old pictures of m ot tled teeth w hich were the result of 12 or 14 ppm fluorides instead of th e 1 ppm being advocated. W e scoff a t a physician who will diag nose fluoride poisoning by m ail, and are flabbergasted th a t such a m an has th o u sands of followers in th e country, th a t he is one of three or four national so-called
“experts” on fluoridation w ho roam the country. W e look w ith dismay at our fel low citizens who can bring themselves to swallow, u nder the guise of scientific verbiage, a mass of silly, stupid state ments. A nd we are bewildered and frus trated w ith experiences of threats of boy cott, vicious personal slander campaigns, and outrageous, sometimes scurrilous lies which opponents resort to in the closing days of a referendum . O u r experiences have created a different atmosphere.
O P P O S IT IO N IS U N IF IE D T h e fourth change th a t has taken place since 1951 is the consolidation of the op position forces. I do not believe th a t there is a single m aster voice behind all opposi tion groups. W hen you break them down, you find th a t opponents rally to the cause for a variety of reasons. But they are no less unified because of varying motives. A t the m om ent, the alleged “scientific ex perts” seem to dom inate the field, though not entirely. Dr. George W aldbott and D r. Frederick Exner, a t great personal and financial sacrifice, I am sure, criss cross the country in answer to the strident pleas of local opposition groups. T heir statem ents become the fodder for thou sands of M im eograph m achines grinding out the half-truths and distortions about fluoridation around the country. In any profession, there are dissidents, and opponents have capitalized on the situation. T h e National Fluoridation News, edited by Dr. W aldbott’s wife, has a list of scientists who have, according to her, “openly questioned the wisdom of adding fluorides to the w ater supply.” Eighteen are from foreign countries, 18 are from the U nited States. O f the Am er icans, significantly, 2 are dentists, 1 is a biochemist, 1 a pharm acologist, 1 a n u tri tionist, an d 13 are physicians. M rs. W ald bott did not p u t her husband’s nam e on the list. B ut even w ithout it, the percent age of dissenters in the scientific profes sions sounds rather small.
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She also submits a carefully selected bibliography of fluoridation writings. A t first glance, the 118 entries look im pres sive, an d one m ight conclude th a t the science professions are split asunder over this issue. But a second look a t the bibli ography reveals the tru e character of the distortions. Sixteen entries are dated in the 1930’s, before anyone even suggested puttin g fluorides in the water. M oreover, those early papers, plus a good share of the later ones on the list, are dealing with fluorides at extremely high levels and have nothing to do w ith the present dilem m a. A nd the hum orous shockers on this list are the names of H . Trendley D ean and G erald Cox, both profluoridationists to the core, who wrote articles about fluorosis caused from high fluorine waters back in the ’30’s. H ere is an exam ple of using history w ith a vengeance.
T A C TIC S O F O P P O S IT IO N We could talk about lies and distortions all day, b u t I ’d like to settle for two ex amples of the tactics of the opposition. Last year, opponents were charging th a t President Eisenhower refused to drink fluoridated w ater. T h e W hite H ouse phy sician finally laid this canard to rest with the statem ent th a t because the President traveled widely, it was felt he should im bibe a uniform type of water. Therefore, bottled w ater was carried from state to state, from country to country in his trav els. B ut the President himself told a press conference th a t he drank tap w ater a t th e W hite House. W as this statem ent sufficient? No. T he antis spread the charge in a hundred newspaper columns an d pam phlets. A nother exam ple of the chicanery of the opponents: O ne of the most repeated charges these days concerns the American Association of Physicians and Surgeons w ith a n estim ated 15,000 members. O p ponents claim th e association has rejected fluoridation. T rack this m isrepresentation to its source and you find th a t the associa
tion, founded to com bat socialized m edi cine, infringem ents on constitutional rights and mass medication, resolved on O ctober 8, 1955 th at all compulsory mass m edication be condemned. O n April 12, 1958, it reaffirmed this principle. In M ay, 1958 in the association’s official newslet ter, Dr. M ai R um ph, president, specifi cally denied the two resolutions concern ing fluoridation. “Both resolutions dealt w ith principles and had no relationship w hatsoever to the scientific aspects.” O ne association m em ber said the association was completely opposed to artificial fluo ridation; D r. R u m p h ’s answer: “T his is not a statem ent of fact.” M oreover, the association has denied its rostrum to Dr. W aldbott. Despite these facts, the action of the association becomes an attack on w ater fluoridation, b u t only after the op ponents have strained the statem ent through their prejudiced minds. T he scientific argum ents are proving popular, b u t there is a cross-fertilization of charges between the antis th a t dem on strates how effectively they have co alesced. A single opponent in a com m u nity can, with one postcard, be deluged w ith m aterial from a variety of sources, all of them consistently harping on the same themes, the harmfulness of fluo rides, the unconstitutionality of fluorides, th e plot of the U . S. Public H ealth Serv ice to use fluoridation as the first step tow ard socializing medicine. A nd now we are faced w ith the dili gent, organized activity of th at organiza tion so often in the headlines today, the Jo h n Birch Society. In the M arch, 1960 Jo h n Birch Society Bulletin, R obert W elch, the founder, wrote how Society m em bers beat fluoridation in Council Bluffs, Iow a, by a barrage of letters and phone calls to the editor of the newspaper a n d to city officials. In M ay, 1960 W elch com plim ented John Birch Society m em bers who took a leading part in the suc cessful fight against fluoridation in A la m eda, C ontra Costa, and M arin County, California. Said Welch, “It was certainly
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most encouraging to ourselves.” I have argued the case of fluoridation with a Joh n Birch Society m em ber in Phoenix and in addition to being anti fluoridation, this particular m em ber is also out to abolish the income tax, the U nited N ations, urban renewal, the city m anager, and C om m unist influence w her ever it rears its ugly head. You can see th at we have o u r work cut out for us. All these charges m ay be similar to the ones which w ere just beginning to be raised ten years ago, b u t the effectiveness and the unity of the approach of the antis is far greater now than in 1951. T h e fifth an d last change since 1951 m ust lead us to an assessment of the advo cates of fluoridation.
T H E PR O B LE M IS PO LITIC A L We cannot escape the fact th at fluorida tion has been wrested from the hands of the scientist an d deposited squarely in the m iddle of th e political arena. Fluori dation is now a political problem. W e are striving to reach the m inds of m en so th a t they will take political action. A thousand, or ten thousand m ore experi m ents will n o t help. A dozen, ten dozen, or fifty dozen m ore pronouncem ents by scientific leaders will not provide the so lution. T en bales, sixty bales, or 60,000 m ore bales of literature on the subject will not be sufficient to win the contest. As a historian-observer, standing just outside the pale of the scientific profes sions, I am aghast a t the effectiveness of this vocal m inority. I t seems incongruous to m e th a t a small, irresponsible, b u t wellorganized group, comprised of a wide as sortm ent of types, w ith conflicting m oti vations and several gradations of veracity, can bring th ree of the most influential and scientific bodies in the land to a stumbling halt. If I seem harsh in my estimation, it is only because I have exam ined a t close range the futility an d ineptness of many proponents. I have seen, and understood,
the reluctance of citizens to become em broiled in a vicious hate cam paign often unparalleled in the history of the com m unity. I have sympathized with the plight of the local leader who is suddenly confronted with a vast array of lies, dis tortions, exaggerations, statements hoisted out of context, trickery, deceit, and du plicity. I understand the nature of the public lie and the difficulty of ever catch ing up w ith it in the public mind.
M U S T E N D A TTITU D E O F D R IFT But there m ust come a tim e in the course of hum an events w hen we, as responsible citizens, an d you, as scientists and pro fessional m en and leaders, m ust stand up and be counted. We m ust (and I say this w ithout any ugly connotations) fight fire with fire. W e do not have to resort to opposition tactics of w arped logic and perversion of fact. W e can use truth, with dignity, an d we can be positive in our approach. I do n o t for a m om ent condemn past actions of the professional organizations. Each generation of adm inistrators m ust m ake its decisions in light of w hat it con siders to be the needs, demands, and public tem per of the people at th a t time. B ut th e situation has so markedly changed in the past ten years th at it is now tim e, I feel, to end this fight for flu oridation once and for all. I do not need to rem ind you th a t the wild antifluorida tion charges against the dental, medical, and public health professions, have im pact in areas far beyond the limited one of adding fluorides to w ater supplies. Physicians certainly know th a t chiro practors are thriving on this opposition to fluoridation and underm ining public con fidence in the m edical profession in other areas. By posing as guardians of the pub lic h ealth in this m atter of fluoridation, opponents use it to arrogate to themselves the m antle of righteous protector in other fields, including m edical treatm ent, the
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ory, diet control and political behavior. Before presenting any criticisms of the professional m an I should like to stress this fact: T h ere are dentists, physicians, public h ealth officials and laymen who have given lavishly of their tim e, money, wisdom, an d energy to bring the benefits of fluoridation to their communities. O ne can tick off m any cities where the p ro fessional m an has fought w ith every re source at his com m and, and even if de feated, he knows, an d his com munity ' knows, th a t he has adm irably m et his responsibilities as a citizen and as a p ro fessional leader. N o appraisal of the situ ation would be tru th fu l w ithout acknowl edging this. However, m y argum ent w ith the pro fessional organizations, their constituents, an d the com m unity leaders, stems from w hat I conceive to be an over-all attitude of drift. I don’t have to be a m em ber of the dental profession to be incensed a t the bem used tone of newspaper articles which good-hum oredly rep o rt th a t th e Am erican D ental Association, the Am erican M edi cal Association, U . S. Public H ealth Serv ice, an d practically every other scientific, professional, educational, and govern m ental agency in the nation has approved fluoridation, yet they continue to be w hipped a t each election by a small, vo cal, belligerent m inority— the 45 losses out of 50 referendum s last November 8 being a splendid example. But how m any dentists an d physicians and public health officials get upset about these facts? I am equally outraged w hen I read or hear of a com m unity turning down flu oridation because of the apathy and futile counterm oves of the local professional m en who should be in there nailing down th e lies, organizing the community, pro viding dynamic leadership. I m aintain th a t as professional leaders and as spokes-' m en of science, the dentist, th e physician and the public health official cannot es cape their public responsibility to fight w ith every resource at their com m and the
i
vicious half-truths, outright lies, and de vious tactics of the misguided, often dis honest, opponents. For those sincerely following their charlatan leaders, the p ro fessional m an has a m ajor educational cam paign before him. T here simply comes a tim e w hen the dentist, physician, public health worker, and com m unity leader has to face scorn, ridicule, and th reats to p u t across w hat he believes in. H e has a vast am ount of community prestige and on some issues he m ust be prepared to risk it.
TOO M A N Y P R O F E S S IO N A L M E N ARE A PA T H E T IC Actually, though, not m any professional m en run away from battle. R ather, they ignore it. I find a vitiating apathy in the ranks of professional men. I have found dentists and physicians who do not even know how to spell the w ord fluoridation. A nd upon questioning, they reveal an appalling ignorance of the single, most effective, most universal public health m easure the dental profession has ever had at its disposal. And I contend this apathy creates re sentm ent in the public mind. I t is not long before the public will take a second look a t the professional m an’s pronounce m ents in other fields. A n indifferent den tist or physician who is content to let others bear the burden of progress will soon find himself ignored as a m an of little consequence in th e community. T he sad p art of the story, though, is how m uch the lay leaders need the pro fessional men. N ot just as educators, as dispensers of inform ation, not as holierth an-thou advisers. But as workers in the ranks, as leaders, as enthusiastic, wellinform ed spokesmen for the cause. A nd often, too often, the layman does not receive m uch m ore th a n nom inal coop eration from his professional allies. T h e end result is defeat and untold harm to th e professions. Since political activity is the strategy
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of the opposition, then I argue th a t the professions h ad better acknowledge it and devise means to m eet their opponents on their own ground. You m ay believe th a t the public is not com petent to judge a scientific m easure such as fluoridation, b u t the fact rem ains th a t the issue is no longer strictly a scientific one. T h e issue is political. I t is a m atter of public policy. In the final analysis, every scientific measure in one shape or another, rests on public approval, w hether it be voting tax monies for research, private donations for scientific experiments, or public poli cies pertaining to the w elfare of the peo ple. T h e professions should acknowledge this and prepare themselves for the p o litical struggle.
against those who would deny the bene fits of fluoridation to our children. A thoroughly aroused dental profession, I believe, could provide the leadership to win. Tw o other professional groups are equally im portant. T h e physician is the dentist’s ally and should perform accord ingly. Any separation of health m atters into spheres of influence between the m edical and dental professions is to be deplored w hen the issue has become po litical. T h e public health official is the third m em ber of the trium virate so necessary for success. T he push should extend from top to bottom , from the Surgeon G en eral’s office down to the local public health official. A nd here, it seems to me th a t President K ennedy and Secretary T H E STR U G G LE A H EAD Ribicoff m ust aid the cause w ith unequiv W here do we begin to reinvigorate the ocal endorsem ent. Already we are fluoridation m ovem ent? I say, start w ith hearing the fam iliar charge: President the dentist, for it is h i s ' responsibility. K ennedy won’t drink fluoridated water. M ake som ething m ore of him than an Strong statements by the Secretary and adviser and inform al kit peddler. I know - the President are badly needed. th a t the dental profession sees as one of its basic problem s the need for an in S H O U L D STU D Y C A U SE S creased sense of social consciousness on O F PU B L IC R E S IST A N C E the p art of the rank-and-file-dentist. I see no better way to change attitudes— the In addition, the Public H ealth Service public’s attitu d e th a t the dentist is a tech should do m ore th an prepare press re nician; the dentist’s reluctant attitude to leases an d keep statistics. I t should finance w ard increased participation in and ac an increasing num ber of pertinent politi ceptance of his civic responsibilities— cal an d sociological studies to determ ine th an to get the dentist deeply immersed the causes of public resistance; it should in the fluoridation struggle until he and provide a vast am ount of assistance his co-workers emerge victorious. T h e in through seminars or short courses, local dividual, the com m unity and the profes health officials, professional people and sion will be better because of the effort. com m unity leaders in a m anner to guar V ictory requires th e best an d most antee a higher percentage of victories. These three professional groups— den sturdy efforts of not just the A merican ^ D ental Association, for it is only as strong tal, medical, and public health— can ini as its constituents m ake it, b u t the state tiate a renewed interest in extending the societies, the regional and local societies, fluoridation horizons. O nce begun, the and lastly, the individual dentist. T hey m ovem ent should spread and pick up should all get excited about the continu strength. T e n years ago, referendum s were the ing losses of fluoridation fights around the exception, now they are the rule. Local nation. I t is tim e, I think, to declare w ar efforts will decide the over-all cam paign,
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but there m ust be concerted action on spect to offer thé cause. But if the m eas ure is forced to a vote, then the profes every front. T h ere can be a fluoridation conference sional m en have to follow through. They at the W hite House level; training insti cannot afford to ru n away from a vote. tutes for public responsibility w ithin the T here should be organization— tough, professions; m ore funds allotted by the knowledgeable, w ell-planned organiza U. S. Public H ealth Service to finance the tion, right dow n to the precinct level. battles. T here can be m ore adequate M others of children who will benefit im representation on public rostrums and m ediately should resort to political de in the local and national studies of radio vices— coffee hours, doorbell campaigns, and television networks. T h ere can be an and get-out-the-vote crusades. insistence th a t the daily and weekly press T h e argum ents of the opponents accept the responsibility of checking out should be anticipated and the proponents, the facts on fluoridation before publish now unified as to purpose and vigor, ing erroneous inform ation in their news should answer the wild charges point by columns. Proponents can m ake news, and point and then leap to the attack with take it to the newspapers, ra th e r than affirmative statem ents of the benefits of wait for the newspapers to come to them fluorides. In short, the w ar should be for “the other side.” T h ere can be a carried out on a thousand fronts simul steady ham m ering of the positive facts taneously. about fluoridation in all of th e mass media. In short, there can be an all-out N A T IO N A L CA M PA IG N NEEDED effort to publicize and prom ote fluorida tion, a t every level, by the awakened I can anticipate some of the answers to professions. ^ the comments presented here. T h e professional m en will need their - Such a vigilant, hard-hitting cam paign comm unity leaders. B ut they should help would only heighten passions and confuse organize the leadership of civic clubs, fra th e public, some will say. A decade ago, ternal organizations, churches, P.T .A .’s; I m ight have agreed w ith this position, they should obtain th e active help of b u t n o t now. I am sym pathetic to those businessmen, industrial leaders and labor people in cities like Cincinnati who have groups. As a nonpartisan issue, fluorida lost th eir second round w ith the voters, tion should be supported by both political b u t I would argue th a t a national cam parties. paign in connection w ith their local one, T h en there should be a community- m ight have changed the outcome. T he wide educational cam paign of sufficient m any local campaigns m ust be tied di duration to let the truths catch u p with rectly to a strenuous national campaign. the untru th s propagated by the oppo T he tim e for concerted action is at nents. A nd this m eans sending out in hand, and the only way out of this w ilder form ed dentists an d physicians to tell the ness of confusion, doubt, and obfuscation, story to groups. T oo often opponents have is action . . . action a t every level. W e will massacred a well-m eaning b u t skimpily not, I m aintain, slip fluoridation quietly inform ed dentist or physician. T h e dentist in the back door. T h a t day is past. W e and the physician should also, I believe, m ust go around to the front door. I t is not be afraid to carry the fluoridation tim e to walk boldly. message to their patients. Finally, firm T here will be criticisms, too, th a t such pressure m ust be brought to b ear on the a program as here outlined w ould cost elected officials who will initiate fluorida u ntold am ounts of money, time and en tion, and here th e professional m an has a ergy. I agree. I t will take time, money, trem endous am ount of prestige and re and energy. Also planning, wise counsel,
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zeal, perseverance an d unfailing courage as well. In those com m unities where the den tist, and th e physician and the public health official have w orked together, pro vided the leadership, stim ulated the lay leaders to large-scale activity, planned a good educational p rogram and followed through when there w as a referendum with good, plain, old-fashioned politick ing in the best sense of th e word, fluorida tion has won. V ictories are almost d i rectly proportionate to the extent the dentist and the physician and the public health officials have throw n themselves into the battle.
I suggest, as a historian, th at we not look to the past for either solace or re criminations. Instead, let us try to under stand th a t past, the forces working against us today, and then set out on a unified, hard-striking cam paign a t every level to bring the benefits of fluoridation to your children, my children, and all the children to come after us. I t is, indeed, tim e to walk boldly.
44 South Miller Street
Presented b e f o r e t h e Twelfth N a tio n a l Dental H ealth C onference, A m e ric a n Dental A sso cia tio n , C h ic a g o , A p r il 26, 1961. *A u th o r, "T h e Fight for F lu o rid a tio n " and "T h e Polem ics of F lu o rid a tio n ."
Th e parallelo-facere: a parallel drilling machine for use in the oral cavity
W illiam Sollé * D.D.S., Oceanside, Calif.
A machinelike unit has been developed for preparing parallel grooves and pin holes in the oral cavity for the retention of fixed bridgework. Although the ma chine requires esthetic refinement, the results it produces are gratifying. The instrument has been in use for three years, primarily in preparations for upper anterior bridges.
Since the p reparation of parallel grooves and pinholes has always been a difficult procedure for m any, this article is pre sented to those who m ig h t be interested in a unit which w ould assist them in this
phase of dentistry. Because interest has been displayed by members of the dental profession who have viewed it or heard about it, a description is herein offered to others in the profession. Prim arily, this is a unit w ith which to construct parallel grooves/ easier, faster, and m ore accurately, and is not a unit w ith which to elim inate all “free-hand work.” Also, it should be borne in m ind constantly th a t the sole purpose of this u n it is to create parallelism. Any discus sion which involves or touches on the technics of dentistry, such as “extension for prevention,” size and depth of pin holes, and so on, will not be included in this article; these technics rem ain a t the discretion of the individual operator.
Tim e to walk boldly
Donald, R. M cN eil* Ph.D., Mesa, Ariz.
In the past ten years, Dr. M cNeil asserts, the fight over fluoridation has shifted from the scientific to the political arena. The evidence regarding the benefits and safety of fluoridation has won scientific acceptance everywhere but in the mind of the public. The benefits of fluoridation can be seen in the healthier teeth of those who have been reared in communities providing fluoridated water. These benefits, however, continue to be ignored by the opposition, whose forces have become unified, for the most part, beyond the reach of scientific argument and evidence. The problem now faced by many communities in their efforts to achieve fluoridation is essentially political. More biochemical experiments or more endorsements by scientific bodies will not help. Individual dentists, physicians and public health officials must end their apathy and must accept their professional responsibility to join the fight for fluoridation. The health professions are being hurt by the defeats of fluoridation at the polls. Dentists and physicians, maintains Dr. M cNeil, must place their professional prestige on the line in the campaign for fluoridation. Lay leaders need the professional men, as dispensers of scientific information and as enthusiastic spokesmen for the cause. It is time to campaign vigorously against those who would deny the benefits of fluoridation to the nation’s children. Such a campaign, suggests Dr. M cNeil, should include: a fluoridation conference at the White House level; training institutes for public responsibility within the pro fessions; more U. S. Public Health Service funds to finance the campaign; more publicity on the healthful effects of fluoridation; community-wide education to let the truth catch up with the untruths; firm pressure on elected officials; well-planned community organization down to the precinct level, and a vigorous national campaign to benefit the many local campaigns. Such a program will take time, money, energy and perseverance, but it will insure victory.
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T he m eeting here today to discuss the problems of fluoridation is reminiscent of a similar gathering ten years ago in the offices of the U . S. Public H ealth Service. Those of you fam iliar w ith the long fight for fluoridation will recall the incident. I t was a t a m eeting of the state dental h ealth officers in Ju n e 1951. John K n u t son of the U . S. Public H ealth Service had asked Wisconsin’s state dental health officer, the late Francis Bull, to present some “D o’s” and “D on’ts” which other dental directors should observe in fluori dation campaigns. D r. Bull regarded the m eeting as p ri vate an d proceeded to give, on the basis of his extensive experience w ith the city councils and town boards, some “off-thecuff” tips to - his colleagues. H e spoke frankly and w ith great vigor, for D r. Bull was a vigorous m an. His “Do’s” involved organization of comm unity meetings, m ethods of obtaining good publicity, building an educational program to u n derm ine in advance the rash of wild charges certain to be raised against fluori dation. W hen he got around to his list of “D on’ts” he shot from both hips. Prom o tion of fluoridation, he said, should not openly come from state officials, b u t from the locality. D on’t use th e negative ap proach. D on’t let the people vote on it. D on’t let the waterworks people confuse the issue. T h e list of don’ts was long. D r. Bull was unaw are of the stenogra pher in the audience taking a verbatim account of th e m eeting, and later the opposition obtained a copy and from it built th eir case against the “prom oters of fluoridation.” By quoting some of D r. Bull’s candid and vivid phrases such as “D on’t let the people vote on it,” or “knock down the opposition,” o r “w hen they say yes, you say no,” they emphasized the “deceitful nature of the bureaucrats” who are trying to thrust fluoridation on the Am erican people. By excerpting certain sentences, they m ade the entire conference sound
like a devious plot to circum vent the will of the people. Dr. Bull, and m any another proponent of fluoridation, were em bar rassed by the interpretation of the m eet ing, for there was no single charge m ore widely disseminated throughout the U n ited States during those years. T oday I should like to use this famous 1951 m eeting as my control u n it to dem onstrate the similarities and the differ ences between the fluoridation struggle then and the fluoridation struggle now.
FLU O R ID A TIO N STRU G G LE TODAY I t is easy to draw historical parallels be tw een the 1951 m eeting an d the one today. As they were in 1951, we are in 1961, gathered to discuss the problems of acceptance by the Am erican people of one of the most significant an d far-reach ing public health measures in our history. W e are here to analyze, criticize, and to offer constructive ideas for the future. Like those pioneers of a decade ago, we agree th at the evidence is in, th a t we should somehow spread the word to m ore people th an we have in the past. As for the opposition, the general n a tu re of the groups and the types of argu m ents are the same now as then. T h ere are physicians and dentists still opposed; there are health foods advocates, chiro practors, and pam phleteers who hope to profit from their cam paigns; there are anti-Sem itic propagandists, there are those who see a Communist plot in every fluoridated drop of water, and there are those such as Christian Scientists, who sincerely argue against fluoridation on religious and constitutional grounds. T he argum ents against fluoridation haven’t im proved m uch over the ten years either. O pponents still charge th at fluorides produce a vast array of ill effects on the hum an body, th a t profluoridationists distort statistics, th a t fluoridation vio lates individual liberties, and th a t the U . S. Public H ealth Service is prom oting socialism.
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O ne other similarity comes to m ind as we compare the two meetings. As with Dr. Bull, every word uttered here today will be microscopically exam ined under the out-of-focus lenses of the fluoridation opponents. T h eir jaundiced eyes will see hidden meanings, discover inhum an plots against the A m erican people, and find crass admissions of our guilt. W hen they disclose their findings to the A merican people, I predict they will lift passages out of context, overemphasize the points th a t fit their prejudices— distort our logic, our facts, an d our statistics— and om it w hatever fails to support their foregone conclusions. In short, the tw elfth N ational D ental H ealth Conference will be m ade to conform to the antifluoridationists’ preconceived ideas as to the natu re of our efforts. Expect no mercy from them. T o understand the differences between th a t small gathering ten years ago and the one today, it m ay be helpful if we fasten the two meetings to their proper historical pegs. L et m e review briefly.
H IS T O R IC A L R EV IEW Frederick S. M cK ay’s 29 year search for the cause of m ottled enam el resulted in the discovery in 1931 of the guilty agent, fluorine. F ro m there, th e U . S. Public H ealth Service took over an d by 1944, after a series of toxicity studies, to m ake certain there would be no harm ful side effects, the G rand R apids fluoridation experim ent began. In Wisconsin, the hom e of Progressivism 40 years earlier, a zealous group of dentists, led by John Frisch and D r. Bull, decided in 1944 th a t wholesale fluorida tion was im m ediately necessary. Despite W isconsin’s record of 50 fluori dated communities by 1950, the U . S. Public H ealth Service and the American D ental Association reflected the scien tific conservatism of most researchers, dentists and public h ealth officials in the country. O n scientific grounds, between 1945
and 1950 they rejected the Wisconsinites’ argum ents for im m ediate universal fluori dation. T his is an extrem ely im portant point, for it helps us u n d erstand the background of th a t famous 1951 meeting, so widely m isquoted by fluoridation opponents. Dr. Bull had been in the forefront of the struggle since 1944 and represented the “fluoridate now” groups. T h e U . S. P ub lic H ealth Service endorsem ent was less than a year old an d the American D ental Association’s official approval a little m ore than six m onths. T he national or ganizations were feeling their way. M any states and localities were completely un inform ed about the issue, to say nothing of th e rank-and-file dentist, physician, public h ealth w orker, and the ordinary citizen. M any reputable scientists re garded the plunge into the cold waters of universal fluoridation as possibly an overstim ulating prebreakfast swim in the m uddied waters of a lake of w hich they didn’t even know th e depth. “L e t’s w ait a n d see,” they said, w ith justifiable scientific caution. This was the essence of the fam ous Delaney Com m it tee recom m endation more th an a year later.
IG N O R E W ILD C H A R G ES For three years a fte r American D ental Association approval in 1950, there was a strong feeling am ong its officials th a t the Association should not, in the words of th e secretary of th e Council on D ental H ealth, “ dignify th e efforts of the oppo sition” by answ ering every wild charge. I t would, he said, “be best to ignore them completely.” In 1952 he announced th a t after a “great deal o f discussion on strat egy,” the A.D.A. w ould devote itself to distributing au th en tic inform ation and supporting health officials. F u rth er pres sure by th e A m erican D ental Association m ight stimulate a m ore vigorous cam paign on a national basis. A year later, his successor advised dental societies to
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give “professional and technical leader ship” a n d let civic organizations do the prom otional work. In the U . S. Public H ealth Service, the drive b eh in d the agency’s endorsem ent was nom inal. In a few states, local public health officials were enthusiastic leaders; in others, they took the attitude th a t flu oridation should w ait until the people were ready for it. T h e A m erican M edical Association, considering fluoridation a dental m atter, went on record in 1951 for fluorides and left the issue pretty m uch alone. T h ro u g h out the country, there was a feeling on the p a rt of the powerful scientific bodies th a t th e opposition would soon fade away, th a t th e ridiculous charges would eventually prove self-defeating, th a t the public w ould soon awaken, and th a t the fluoridation issue would be settled, quietly and sanely, in th e best traditions of our A m erican democracy. I t was also quite different in the oppo sition ran k s then; for example, when some W isconsin physicians and dentists reflected a cautious attitude, one of the most effective opposition groups of the future — th e chiropractors — condem ned the m edical and dental professions for w ithholding the benefits of fluoridation from th e populace! T h e strategy of the opponents was often confused and contradictory, too. I t may seem strange now, b u t opponents of fluoridation in some towns used to con dem n referendum s— obviously because they fe lt they could defeat fluoridation through th eir elected representatives. You still h e a r faint bleatings of this po sition w h en a town has accepted fluori dation by ballot. In short, then, the lines h ad not yet been d raw n firm. Theories h ad not jelled. T h e issue had not yet been sharply draw n, eith e r w ithin the ranks of the pro fessions, the opposition groups, or the general public. Still— w ith the U. S. Public H ealth Service a n d A.D.A. endorsements in 1950
and American M edical Association a p proval in 1951— the fluoridation move m en t spread. In 1951, 225 communities initiated fluoridation; the next year, 347. B ut w ith the Delaney C om m ittee re port espousing “Go slow on fluoridation,” a n d its subsequent publicity in national magazines, together with the rap id am al gam ation of opposition groups, fluorida tion tapered off. Antifluoridationists be gan winning m ore battles th an they lost and though the num ber of cities an d the num ber of people drinking fluoridated w ater increased— approxim ately 42 m il lion now— the increase was a t a decreas ing pace. I t is paradoxical in m any respects that the more evidence supporting controlled fluoridation which proponents gathered, the less likely they were to win their b a t tles in the local communities. T he opposi tion consolidated, resistance stiffened, an d finally the antis took the offensive; m any communities which had begun flu oridating early were told by the voters to cease and desist. H indsight is a m arvelous power, as I, a historian, know full well. But the es sence of historical appraisal is to under stand the feelings and attitudes of people involved in significant historical events at the time. T he foregoing résumé of events in the postwar period should in no way be interpreted as a critical O lym pian judgm ent of the actions and policies of th e people who have preceded us. If his tory can offer guidelines for the future, it is not in the sense of transplanting the past to the present and saying, “ I told you so.” R ather, history should bring an understanding of past events in such a way as to deepen our understanding of the forces fram ing today’s problems, and to offer suggestions for sensible, respon sible conclusions. So let us talk further of the differences between the two meetings of ’51 an d ’61.In the first place, today we have a t our disposal the results of the original 15 year experiments. M ore th an that, we have
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hundreds of additional fluoridation stud ies on everything ranging from systemic effects to corroded w ater pipes. Scientific caution may have been justifiable ten years ago, for the issue was somewhat cloudy. But to th e best scientific minds, and to the adm irably cautious councils of almost every scientific body in the land, the evidence on fluoridation is in. If there were a shadow of a doubt, now or in the future, as to the safety of fluo rides, these councils would be the first to call a halt. O ne inescapable fact emerges from th e welter of charges raised by opponents. T h ere is not a single shred of scientific evidence indicating th a t fluo rides at the proper levels do anything else than w hat the proponents say they do. Fluoridation is approved. I t is approved everywhere but in the public mind. Secondly, the situation today differs from ten years ago in th a t we have now had experience. W e have seen w ith our own eyes the children who have grown to adulthood drinking w ater w ith fluorides added. W e can physically see and feel the decayless teeth which were a m ere promise ten years ago. Thirdly, m ore th a n experience, we have now had experiences. W e have been stunned and shocked at th e irresponsible charges raised by some of the antifluoridationists. W e do not w ant to believe that wild-eyed fanatics can, w ith straight faces, link fluorides to chemical lobotomies, a bureaucratic socialist plot, a Com munist plot, a Jewish plot. I t is difficult to perceive our antagonists as m en and women of good will when they flamboy antly resort to the skull and crossbones, pictures of deform ed children in wheel chairs, and 30 year old pictures of m ot tled teeth w hich were the result of 12 or 14 ppm fluorides instead of th e 1 ppm being advocated. W e scoff a t a physician who will diag nose fluoride poisoning by m ail, and are flabbergasted th a t such a m an has th o u sands of followers in th e country, th a t he is one of three or four national so-called
“experts” on fluoridation w ho roam the country. W e look w ith dismay at our fel low citizens who can bring themselves to swallow, u nder the guise of scientific verbiage, a mass of silly, stupid state ments. A nd we are bewildered and frus trated w ith experiences of threats of boy cott, vicious personal slander campaigns, and outrageous, sometimes scurrilous lies which opponents resort to in the closing days of a referendum . O u r experiences have created a different atmosphere.
O P P O S IT IO N IS U N IF IE D T h e fourth change th a t has taken place since 1951 is the consolidation of the op position forces. I do not believe th a t there is a single m aster voice behind all opposi tion groups. W hen you break them down, you find th a t opponents rally to the cause for a variety of reasons. But they are no less unified because of varying motives. A t the m om ent, the alleged “scientific ex perts” seem to dom inate the field, though not entirely. Dr. George W aldbott and D r. Frederick Exner, a t great personal and financial sacrifice, I am sure, criss cross the country in answer to the strident pleas of local opposition groups. T heir statem ents become the fodder for thou sands of M im eograph m achines grinding out the half-truths and distortions about fluoridation around the country. In any profession, there are dissidents, and opponents have capitalized on the situation. T h e National Fluoridation News, edited by Dr. W aldbott’s wife, has a list of scientists who have, according to her, “openly questioned the wisdom of adding fluorides to the w ater supply.” Eighteen are from foreign countries, 18 are from the U nited States. O f the Am er icans, significantly, 2 are dentists, 1 is a biochemist, 1 a pharm acologist, 1 a n u tri tionist, an d 13 are physicians. M rs. W ald bott did not p u t her husband’s nam e on the list. B ut even w ithout it, the percent age of dissenters in the scientific profes sions sounds rather small.
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She also submits a carefully selected bibliography of fluoridation writings. A t first glance, the 118 entries look im pres sive, an d one m ight conclude th a t the science professions are split asunder over this issue. But a second look a t the bibli ography reveals the tru e character of the distortions. Sixteen entries are dated in the 1930’s, before anyone even suggested puttin g fluorides in the water. M oreover, those early papers, plus a good share of the later ones on the list, are dealing with fluorides at extremely high levels and have nothing to do w ith the present dilem m a. A nd the hum orous shockers on this list are the names of H . Trendley D ean and G erald Cox, both profluoridationists to the core, who wrote articles about fluorosis caused from high fluorine waters back in the ’30’s. H ere is an exam ple of using history w ith a vengeance.
T A C TIC S O F O P P O S IT IO N We could talk about lies and distortions all day, b u t I ’d like to settle for two ex amples of the tactics of the opposition. Last year, opponents were charging th a t President Eisenhower refused to drink fluoridated w ater. T h e W hite H ouse phy sician finally laid this canard to rest with the statem ent th a t because the President traveled widely, it was felt he should im bibe a uniform type of water. Therefore, bottled w ater was carried from state to state, from country to country in his trav els. B ut the President himself told a press conference th a t he drank tap w ater a t th e W hite House. W as this statem ent sufficient? No. T he antis spread the charge in a hundred newspaper columns an d pam phlets. A nother exam ple of the chicanery of the opponents: O ne of the most repeated charges these days concerns the American Association of Physicians and Surgeons w ith a n estim ated 15,000 members. O p ponents claim th e association has rejected fluoridation. T rack this m isrepresentation to its source and you find th a t the associa
tion, founded to com bat socialized m edi cine, infringem ents on constitutional rights and mass medication, resolved on O ctober 8, 1955 th at all compulsory mass m edication be condemned. O n April 12, 1958, it reaffirmed this principle. In M ay, 1958 in the association’s official newslet ter, Dr. M ai R um ph, president, specifi cally denied the two resolutions concern ing fluoridation. “Both resolutions dealt w ith principles and had no relationship w hatsoever to the scientific aspects.” O ne association m em ber said the association was completely opposed to artificial fluo ridation; D r. R u m p h ’s answer: “T his is not a statem ent of fact.” M oreover, the association has denied its rostrum to Dr. W aldbott. Despite these facts, the action of the association becomes an attack on w ater fluoridation, b u t only after the op ponents have strained the statem ent through their prejudiced minds. T he scientific argum ents are proving popular, b u t there is a cross-fertilization of charges between the antis th a t dem on strates how effectively they have co alesced. A single opponent in a com m u nity can, with one postcard, be deluged w ith m aterial from a variety of sources, all of them consistently harping on the same themes, the harmfulness of fluo rides, the unconstitutionality of fluorides, th e plot of the U . S. Public H ealth Serv ice to use fluoridation as the first step tow ard socializing medicine. A nd now we are faced w ith the dili gent, organized activity of th at organiza tion so often in the headlines today, the Jo h n Birch Society. In the M arch, 1960 Jo h n Birch Society Bulletin, R obert W elch, the founder, wrote how Society m em bers beat fluoridation in Council Bluffs, Iow a, by a barrage of letters and phone calls to the editor of the newspaper a n d to city officials. In M ay, 1960 W elch com plim ented John Birch Society m em bers who took a leading part in the suc cessful fight against fluoridation in A la m eda, C ontra Costa, and M arin County, California. Said Welch, “It was certainly
M c N E IL . . . V O LU M E 63, SEPTEMBER 1961 • 21/339
most encouraging to ourselves.” I have argued the case of fluoridation with a Joh n Birch Society m em ber in Phoenix and in addition to being anti fluoridation, this particular m em ber is also out to abolish the income tax, the U nited N ations, urban renewal, the city m anager, and C om m unist influence w her ever it rears its ugly head. You can see th at we have o u r work cut out for us. All these charges m ay be similar to the ones which w ere just beginning to be raised ten years ago, b u t the effectiveness and the unity of the approach of the antis is far greater now than in 1951. T h e fifth an d last change since 1951 m ust lead us to an assessment of the advo cates of fluoridation.
T H E PR O B LE M IS PO LITIC A L We cannot escape the fact th at fluorida tion has been wrested from the hands of the scientist an d deposited squarely in the m iddle of th e political arena. Fluori dation is now a political problem. W e are striving to reach the m inds of m en so th a t they will take political action. A thousand, or ten thousand m ore experi m ents will n o t help. A dozen, ten dozen, or fifty dozen m ore pronouncem ents by scientific leaders will not provide the so lution. T en bales, sixty bales, or 60,000 m ore bales of literature on the subject will not be sufficient to win the contest. As a historian-observer, standing just outside the pale of the scientific profes sions, I am aghast a t the effectiveness of this vocal m inority. I t seems incongruous to m e th a t a small, irresponsible, b u t wellorganized group, comprised of a wide as sortm ent of types, w ith conflicting m oti vations and several gradations of veracity, can bring th ree of the most influential and scientific bodies in the land to a stumbling halt. If I seem harsh in my estimation, it is only because I have exam ined a t close range the futility an d ineptness of many proponents. I have seen, and understood,
the reluctance of citizens to become em broiled in a vicious hate cam paign often unparalleled in the history of the com m unity. I have sympathized with the plight of the local leader who is suddenly confronted with a vast array of lies, dis tortions, exaggerations, statements hoisted out of context, trickery, deceit, and du plicity. I understand the nature of the public lie and the difficulty of ever catch ing up w ith it in the public mind.
M U S T E N D A TTITU D E O F D R IFT But there m ust come a tim e in the course of hum an events w hen we, as responsible citizens, an d you, as scientists and pro fessional m en and leaders, m ust stand up and be counted. We m ust (and I say this w ithout any ugly connotations) fight fire with fire. W e do not have to resort to opposition tactics of w arped logic and perversion of fact. W e can use truth, with dignity, an d we can be positive in our approach. I do n o t for a m om ent condemn past actions of the professional organizations. Each generation of adm inistrators m ust m ake its decisions in light of w hat it con siders to be the needs, demands, and public tem per of the people at th a t time. B ut th e situation has so markedly changed in the past ten years th at it is now tim e, I feel, to end this fight for flu oridation once and for all. I do not need to rem ind you th a t the wild antifluorida tion charges against the dental, medical, and public health professions, have im pact in areas far beyond the limited one of adding fluorides to w ater supplies. Physicians certainly know th a t chiro practors are thriving on this opposition to fluoridation and underm ining public con fidence in the m edical profession in other areas. By posing as guardians of the pub lic h ealth in this m atter of fluoridation, opponents use it to arrogate to themselves the m antle of righteous protector in other fields, including m edical treatm ent, the
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ory, diet control and political behavior. Before presenting any criticisms of the professional m an I should like to stress this fact: T h ere are dentists, physicians, public h ealth officials and laymen who have given lavishly of their tim e, money, wisdom, an d energy to bring the benefits of fluoridation to their communities. O ne can tick off m any cities where the p ro fessional m an has fought w ith every re source at his com m and, and even if de feated, he knows, an d his com munity ' knows, th a t he has adm irably m et his responsibilities as a citizen and as a p ro fessional leader. N o appraisal of the situ ation would be tru th fu l w ithout acknowl edging this. However, m y argum ent w ith the pro fessional organizations, their constituents, an d the com m unity leaders, stems from w hat I conceive to be an over-all attitude of drift. I don’t have to be a m em ber of the dental profession to be incensed a t the bem used tone of newspaper articles which good-hum oredly rep o rt th a t th e Am erican D ental Association, the Am erican M edi cal Association, U . S. Public H ealth Serv ice, an d practically every other scientific, professional, educational, and govern m ental agency in the nation has approved fluoridation, yet they continue to be w hipped a t each election by a small, vo cal, belligerent m inority— the 45 losses out of 50 referendum s last November 8 being a splendid example. But how m any dentists an d physicians and public health officials get upset about these facts? I am equally outraged w hen I read or hear of a com m unity turning down flu oridation because of the apathy and futile counterm oves of the local professional m en who should be in there nailing down th e lies, organizing the community, pro viding dynamic leadership. I m aintain th a t as professional leaders and as spokes-' m en of science, the dentist, th e physician and the public health official cannot es cape their public responsibility to fight w ith every resource at their com m and the
i
vicious half-truths, outright lies, and de vious tactics of the misguided, often dis honest, opponents. For those sincerely following their charlatan leaders, the p ro fessional m an has a m ajor educational cam paign before him. T here simply comes a tim e w hen the dentist, physician, public health worker, and com m unity leader has to face scorn, ridicule, and th reats to p u t across w hat he believes in. H e has a vast am ount of community prestige and on some issues he m ust be prepared to risk it.
TOO M A N Y P R O F E S S IO N A L M E N ARE A PA T H E T IC Actually, though, not m any professional m en run away from battle. R ather, they ignore it. I find a vitiating apathy in the ranks of professional men. I have found dentists and physicians who do not even know how to spell the w ord fluoridation. A nd upon questioning, they reveal an appalling ignorance of the single, most effective, most universal public health m easure the dental profession has ever had at its disposal. And I contend this apathy creates re sentm ent in the public mind. I t is not long before the public will take a second look a t the professional m an’s pronounce m ents in other fields. A n indifferent den tist or physician who is content to let others bear the burden of progress will soon find himself ignored as a m an of little consequence in th e community. T he sad p art of the story, though, is how m uch the lay leaders need the pro fessional men. N ot just as educators, as dispensers of inform ation, not as holierth an-thou advisers. But as workers in the ranks, as leaders, as enthusiastic, wellinform ed spokesmen for the cause. A nd often, too often, the layman does not receive m uch m ore th a n nom inal coop eration from his professional allies. T h e end result is defeat and untold harm to th e professions. Since political activity is the strategy
M c N E IL . . . V O LU M E 63, SEPTEMBER 1961 • 23/341
of the opposition, then I argue th a t the professions h ad better acknowledge it and devise means to m eet their opponents on their own ground. You m ay believe th a t the public is not com petent to judge a scientific m easure such as fluoridation, b u t the fact rem ains th a t the issue is no longer strictly a scientific one. T h e issue is political. I t is a m atter of public policy. In the final analysis, every scientific measure in one shape or another, rests on public approval, w hether it be voting tax monies for research, private donations for scientific experiments, or public poli cies pertaining to the w elfare of the peo ple. T h e professions should acknowledge this and prepare themselves for the p o litical struggle.
against those who would deny the bene fits of fluoridation to our children. A thoroughly aroused dental profession, I believe, could provide the leadership to win. Tw o other professional groups are equally im portant. T h e physician is the dentist’s ally and should perform accord ingly. Any separation of health m atters into spheres of influence between the m edical and dental professions is to be deplored w hen the issue has become po litical. T h e public health official is the third m em ber of the trium virate so necessary for success. T he push should extend from top to bottom , from the Surgeon G en eral’s office down to the local public health official. A nd here, it seems to me th a t President K ennedy and Secretary T H E STR U G G LE A H EAD Ribicoff m ust aid the cause w ith unequiv W here do we begin to reinvigorate the ocal endorsem ent. Already we are fluoridation m ovem ent? I say, start w ith hearing the fam iliar charge: President the dentist, for it is h i s ' responsibility. K ennedy won’t drink fluoridated water. M ake som ething m ore of him than an Strong statements by the Secretary and adviser and inform al kit peddler. I know - the President are badly needed. th a t the dental profession sees as one of its basic problem s the need for an in S H O U L D STU D Y C A U SE S creased sense of social consciousness on O F PU B L IC R E S IST A N C E the p art of the rank-and-file-dentist. I see no better way to change attitudes— the In addition, the Public H ealth Service public’s attitu d e th a t the dentist is a tech should do m ore th an prepare press re nician; the dentist’s reluctant attitude to leases an d keep statistics. I t should finance w ard increased participation in and ac an increasing num ber of pertinent politi ceptance of his civic responsibilities— cal an d sociological studies to determ ine th an to get the dentist deeply immersed the causes of public resistance; it should in the fluoridation struggle until he and provide a vast am ount of assistance his co-workers emerge victorious. T h e in through seminars or short courses, local dividual, the com m unity and the profes health officials, professional people and sion will be better because of the effort. com m unity leaders in a m anner to guar V ictory requires th e best an d most antee a higher percentage of victories. These three professional groups— den sturdy efforts of not just the A merican ^ D ental Association, for it is only as strong tal, medical, and public health— can ini as its constituents m ake it, b u t the state tiate a renewed interest in extending the societies, the regional and local societies, fluoridation horizons. O nce begun, the and lastly, the individual dentist. T hey m ovem ent should spread and pick up should all get excited about the continu strength. T e n years ago, referendum s were the ing losses of fluoridation fights around the exception, now they are the rule. Local nation. I t is tim e, I think, to declare w ar efforts will decide the over-all cam paign,
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but there m ust be concerted action on spect to offer thé cause. But if the m eas ure is forced to a vote, then the profes every front. T h ere can be a fluoridation conference sional m en have to follow through. They at the W hite House level; training insti cannot afford to ru n away from a vote. tutes for public responsibility w ithin the T here should be organization— tough, professions; m ore funds allotted by the knowledgeable, w ell-planned organiza U. S. Public H ealth Service to finance the tion, right dow n to the precinct level. battles. T here can be m ore adequate M others of children who will benefit im representation on public rostrums and m ediately should resort to political de in the local and national studies of radio vices— coffee hours, doorbell campaigns, and television networks. T h ere can be an and get-out-the-vote crusades. insistence th a t the daily and weekly press T h e argum ents of the opponents accept the responsibility of checking out should be anticipated and the proponents, the facts on fluoridation before publish now unified as to purpose and vigor, ing erroneous inform ation in their news should answer the wild charges point by columns. Proponents can m ake news, and point and then leap to the attack with take it to the newspapers, ra th e r than affirmative statem ents of the benefits of wait for the newspapers to come to them fluorides. In short, the w ar should be for “the other side.” T h ere can be a carried out on a thousand fronts simul steady ham m ering of the positive facts taneously. about fluoridation in all of th e mass media. In short, there can be an all-out N A T IO N A L CA M PA IG N NEEDED effort to publicize and prom ote fluorida tion, a t every level, by the awakened I can anticipate some of the answers to professions. ^ the comments presented here. T h e professional m en will need their - Such a vigilant, hard-hitting cam paign comm unity leaders. B ut they should help would only heighten passions and confuse organize the leadership of civic clubs, fra th e public, some will say. A decade ago, ternal organizations, churches, P.T .A .’s; I m ight have agreed w ith this position, they should obtain th e active help of b u t n o t now. I am sym pathetic to those businessmen, industrial leaders and labor people in cities like Cincinnati who have groups. As a nonpartisan issue, fluorida lost th eir second round w ith the voters, tion should be supported by both political b u t I would argue th a t a national cam parties. paign in connection w ith their local one, T h en there should be a community- m ight have changed the outcome. T he wide educational cam paign of sufficient m any local campaigns m ust be tied di duration to let the truths catch u p with rectly to a strenuous national campaign. the untru th s propagated by the oppo T he tim e for concerted action is at nents. A nd this m eans sending out in hand, and the only way out of this w ilder form ed dentists an d physicians to tell the ness of confusion, doubt, and obfuscation, story to groups. T oo often opponents have is action . . . action a t every level. W e will massacred a well-m eaning b u t skimpily not, I m aintain, slip fluoridation quietly inform ed dentist or physician. T h e dentist in the back door. T h a t day is past. W e and the physician should also, I believe, m ust go around to the front door. I t is not be afraid to carry the fluoridation tim e to walk boldly. message to their patients. Finally, firm T here will be criticisms, too, th a t such pressure m ust be brought to b ear on the a program as here outlined w ould cost elected officials who will initiate fluorida u ntold am ounts of money, time and en tion, and here th e professional m an has a ergy. I agree. I t will take time, money, trem endous am ount of prestige and re and energy. Also planning, wise counsel,
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zeal, perseverance an d unfailing courage as well. In those com m unities where the den tist, and th e physician and the public health official have w orked together, pro vided the leadership, stim ulated the lay leaders to large-scale activity, planned a good educational p rogram and followed through when there w as a referendum with good, plain, old-fashioned politick ing in the best sense of th e word, fluorida tion has won. V ictories are almost d i rectly proportionate to the extent the dentist and the physician and the public health officials have throw n themselves into the battle.
I suggest, as a historian, th at we not look to the past for either solace or re criminations. Instead, let us try to under stand th a t past, the forces working against us today, and then set out on a unified, hard-striking cam paign a t every level to bring the benefits of fluoridation to your children, my children, and all the children to come after us. I t is, indeed, tim e to walk boldly.
44 South Miller Street
Presented b e f o r e t h e Twelfth N a tio n a l Dental H ealth C onference, A m e ric a n Dental A sso cia tio n , C h ic a g o , A p r il 26, 1961. *A u th o r, "T h e Fight for F lu o rid a tio n " and "T h e Polem ics of F lu o rid a tio n ."
Th e parallelo-facere: a parallel drilling machine for use in the oral cavity
W illiam Sollé * D.D.S., Oceanside, Calif.
A machinelike unit has been developed for preparing parallel grooves and pin holes in the oral cavity for the retention of fixed bridgework. Although the ma chine requires esthetic refinement, the results it produces are gratifying. The instrument has been in use for three years, primarily in preparations for upper anterior bridges.
Since the p reparation of parallel grooves and pinholes has always been a difficult procedure for m any, this article is pre sented to those who m ig h t be interested in a unit which w ould assist them in this
phase of dentistry. Because interest has been displayed by members of the dental profession who have viewed it or heard about it, a description is herein offered to others in the profession. Prim arily, this is a unit w ith which to construct parallel grooves/ easier, faster, and m ore accurately, and is not a unit w ith which to elim inate all “free-hand work.” Also, it should be borne in m ind constantly th a t the sole purpose of this u n it is to create parallelism. Any discus sion which involves or touches on the technics of dentistry, such as “extension for prevention,” size and depth of pin holes, and so on, will not be included in this article; these technics rem ain a t the discretion of the individual operator.