Libertarian Resistance to Mandatory Health Interventions

"Some of the comments that are being made are reasonable. Others are just very, very aggressive, and there's an aggressiveness I've never experienced prior to being in this field ... Calling me a fraud, questioning my integrity."
"It seems like this [population-level] approach [in building public-health campaigns is meeting resistance in the public] is in demise ... and I really think that's problematic."
"I do feel like some of the media coverage made it out to be stronger than it was [her observational study and its logical conclusions]."
"These are very, very big challenges for public health as a field. The onus is on us to sort this out and understand it, and figure out what it means."
"But I don't think that means we fight it, because I don't know it's something that can be fought  -- [people's] deeply held [and likely unchangeable values]."
Professor Lindsay McLaren, public health researcher, University of Calgary

A study that compared grade two students in both Edmonton and Calgary found the effects of fluoride cessation in Calgary has had an impact on children’s dental health. Lindsay McLaren, PhD, from the Cumming School of Medicine and O’Brien Institute for Public Health, is the study's lead author. Photo by Riley Brandt, University of Calgary

"The research is vital to helping people in Calgary understand the effects of ending fluoridation."
Juliet Guichon, bioethicist, University of Calgary

"Take nothing that a forced fluoridation fanatic says at face value. Because they are bald-faced liars."
Dan Germouse, forcedfluoridationfreedomfighters.com website, Australia

Professor McLaren undertook a study, the result of which both confirmed the apparent benefits of fluoridation in municipal potable water supply, and at the same time discounting some of the alleged risks associated with fluoridation. Her conclusion resulting from the study suggests that the removal of fluoride from Calgary's water system had the effect of increasing cavities in children's teeth, and that the additive does not, as some allege, cause learning disabilities, nor is it linked to thyroid disease.

The anti-fluoride community was swift to respond, trashing Professor McLaren's study methodology, asserting that her public support for fluoridation has the effect of undermining her credibility as a result of her lack of objectivity. This, in the wake of a new attempt to reinstitute the addition of fluoride to Calgary tap water, after it was withdrawn in 2011. The group Calgarians for Kids Health has urged voters to select their October municipal election candidates carefully, to ensure they are pro-fluoride.

A researcher from the University of Calgary is investigating children's teeth roughly two years after the city pulled fluoride out of the drinking water. (iStock)

The bioethicist who spearheaded the campaign to bring back fluoride in the water supply, celebrates Professor McLaren's conclusion as a needed scientific validation of what area dentists have been saying, that tooth decay is on a steady rise, and dramatically so. As for anti-fluoride campaigner Dan Germouse, media statements by McLaren relating to the cavity study and the paper suggests to him she had given too much significance to what he considers to be a casual conclusion; that no actual proof of a causal link between increased cavities and the elimination of fluoride has been provided.

Even the U.S.-based Fluoride Action Network campaigning against fluoridation cites its own research director commenting that Professor McLaren had omitted data on cavity rates that, had they been included, would have negated her findings. What, in fact, had motivated Professor McLaren was her realization of a general step backward from mass public-health prevention measures, such as adding folic acid to flour for the purpose of reducing birth defects, or fortifying salt with iodine in prevention of goitres and to boost brain health, or campaigns and laws making car passengers wear seat  belts.

Her fear is that the trend could have the result of pulling broad societal support out from under society's efforts to increase public awareness and health safety meant to benefit civic populations. Fluoridation presented as the "perfect example" of the trend, leading her to view fluoridation in Calagary as an opportunity to observe the effects and consequences in a scientific forum. She looked at tooth decay trends in Calgary and Edmonton in 2004-05 and 2013-14 in relation to Calgary's move to halt fluoridation in 2011.

Her conclusion that worsening cavities were weighted in the period of fluoridation removal from the water supply, matched the scientific literature. What she has taken exception to is the media having interpreted her results as absolute proof of the advantages of fluoridation, a claim that could only result from a randomized clinical trial with scientists planning a controlled experiment, unlike hers which was an observational study, absent proof of a causal link, lending itself to a plausible hypothesis.

Her linked study had her extract rich data from a federal health survey where she could investigate how much of the mineral was in the urine of participants when their water supply delivered fluoride, resulting in a more precise indicator of exposure. And while one paper discovered evidence lacking of a feared link between fluoride exposure and thyroid disease, the other found no "robust" association in fluoride use with learning disabilities.

The Alberta Public Health Association, coincidentally has strongly endorsed the benefits of fluoride in the water supply; coincidentally Professor McLaren is currently president of the group. Leading her to admit biases are simply unavoidable as a researcher, and one with specific associations, while the goal of scientific enquiry is transparency and explicitness to plainly show how conclusions are reached, allowing review by scientific peers.

Fluoride ions (F–) replace hydroxyl groups (OH–) in hydroxyapatite to form fluorapatite in the tooth enamel. A portion of the apatite crystal lattice is depicted showing the replacement of hydroxide for fluoride.