"Scientific Knowledge in Controversy: The Social Dynamics of the Fluoridation Debate" - Brian Martin, State University of New York Press, Albany, 1991.

Chapter 5: Professional Attack

What I have called in the previous chapter the "struggle over credibility" has mainly been carried out using rhetoric, namely written and spoken language. In spite of the viciousness of some of the verbal attacks, language has its limits. By itself, rhetoric does not have the capacity to prevent a scientist from doing research nor does it bar a dentist from dental practice.

Rhetoric is a way of exercising power, but there are other ways. In the fluoridation controversy, methods of struggle have not been limited to rhetoric. In this chapter, I present a number of cases in which attempts have been made to stop antifluoridationists from expressing their views, doing research, and practicing dentistry. (1)

The implication of these examples is that the fluoridation debate has used more than rhetorical tools. Various other forms of power have been deployed. It is necessary to realize the extent of this activity in order to understand the dynamics of the fluoridation issue. In particular, assessing the technical disputes over fluoridation requires a simultaneous assessment of the wider exercise of power.

Most of the cases of the sort presented here have been documented by antifluoridationists. Some may be incorrect or overstated. But the number of cases is very large, and they fall into comprehensible patterns. In my study of this phenomenon in other areas, there are always many more cases occurring than end up being documented. (2) So I am convinced that these cases point to an important dynamic in the fluoridation controversy. What the cases actually mean is something to which I will return to later in this chapter.

SOME CASES

Dr. John Neilands, professor of biochemistry at the University of California at Berkeley, signed a ballot argument against fluoridation. A local proponent of fluoridation wrote to the chancellor of the university requesting that Neilands be reprimanded, and called for him to be expelled from his professional society. (3)

Ivan H. Northfield, a dentist living in Duluth, Minn., made a speech against fluoridation during a campaign in 1965. As a result, his local dental society suspended his membership for one year, without allowing him to speak in his own defense. (4)

In 1964, a sociology student at a U.S. university carried out a survey of a medical society and found that only half of the respondents favored fluoridation while a third opposed it. George Waldbott reports that "The assistant dean, prompted by the fluoridation chairman, wrote a letter berating the student for allegedly abusing the good name of her school." Although threat of a legal action by the student forced a retraction of the letter's allegations, the attack discouraged the student from publishing her data. (5)

While Edward Groth III was a graduate student in biology at Stanford University in the late 1960s, he became interested in the fluoridation issue and, after studying the arguments, wrote a letter to the president of the university suggesting that a ballot argument for the proponents had falsely claimed that there was no evidence of harm. Groth sent copies of his letter to two proponents whom he had interviewed. One of them approached the head of the biology department and vehemently attacked Groth at length, suggesting that he should be expelled from graduate school. But the department head defended Groth. (6)

Dr. Chong W. Chang had done work showing that fluoride interfered with the biochemistry of living tissues. Chang said in a 1972 letter to Waldbott. "I have been associated with six years of basic research on fluoride since my study at the University of California and the USDA [U.S. Department of Agriculture] here. However, in recent years, USDA keep demanding me to do the research area which is not related to fluoride. After careful consideration, I have strongly determined to find some other position where I could continue my research on fluoride." (7)

Virginia Crawford, a registered nurse living in Detroit, found that she was severely affected by fluoridated water, and became a vocal opponent. In 1964, she stated that many people had threatened that her nursing license would be taken away because of her activities. (8)

According to George Waldbott, in the 1950s "one internist, still practicing in Detroit, received a warning from a member of his hospital staff. Should he continue to publicly oppose fluoridation he would jeopardize his consultant practice, even his hospital staff appointment. He was profoundly distressed. Reluctantly he withdrew. He had no other choice."

A doctor in Windsor, Ontario who recommended in 1962 to a patient to stop drinking fluoridated water in order to overcome a stomach ailment asked the patient to refrain from revealing his diagnosis to anyone so that his position in the eyes of his colleagues, especially Windsor's medical officer for health, would not be jeopardized. (10) ...

Waldbott said that, whereas many presidents or secretaries of dental or medical societies would privately express concern about fluoridation, to do so openly would mean the end of their careers in these societies. (13)

Carol Farkas, a Canadian researcher who has studied the levels of fluoride in foods and warned that some people may be ingesting too much fluoride, (14) gave a talk on this subject to the Canadian Dental Association's annual meeting in the 1970s. After the talk, several dentists came forward, asked for her phone number and said they would call. Five of them did so, "saying they agreed with what I had said but couldn't say so in public because they would get black-balled from the CDA." (15)

In 1963, Dr. R.J. Berry of Oxford published results of research showing a reduction in the rate of growth of cancer cells in the presence of 0.1 parts per million of fluoride. (16) This sounded good in terms of cancer, but actually pointed to the dangers of fluoride for normal cells. At any rate, Berry decided to abandon further work on fluoride after being criticized and subjected to "veiled threats." (17)

Hans Moolenburgh, a doctor and leader of the campaign against fluoridation in the Netherlands, reports that he was instructed by a medical official not to write articles against fluoridation. (18) A friend of Moolenburgh's, named Mien Bulthius, did research for her dissertation on the role of fluoride in inhibiting the activity of the enzyme cholinesterase. A special committee of the Netherlands' Health Board discussed the dissertation in May 1973. According to the minutes of the meeting, "Mr de Wael remarks [that] he has had a telephone call from Mr Drion (Chief Inspector of Health), who requested that he exert his influence in order to prevent remarks relating to the possible effect of fluoride on humanity from being published in the Bulthius dissertation, as the subject was already receiving to much publicity that it could cause unrest among the population." (19)

John Polya, associated professor of chemistry at the University of Tasmania, claimed in 1973 that his staff and equipment had been taken away because of his public opposition to fluoridation. (20)

Geoffrey Smith in 1979 worked as a dentist at Proserpine Hospital in Queensland and supervised a dental therapist at a local primary school. He drew attention to the high level of dental fluorosis in children there, and began collecting data on this and on dietary sources of fluoride. He claims that he was officially warned by the Queensland Health Department to cease research and, after media coverage elsewhere in the country, was fired. (21)

Mark Diesendorf worked until 1985 as a principal research scientist at the Commonwealth Scientific and Industrial Research Organization (CSIRO). Officials of the Australian Dental Association wrote letters to the chairman of CSIRO and to the federal Minister for Science and Technology, who was responsible for CSIRO, complaining, for example, that Diesendorf had "mis-used his CSIRO connections to lend weight to his views on subjects outside his expertise," and requesting the taking of "all necessary steps to ensure [that] this deceptive practice does not continue." CSIRO defended Diesendorf in correspondence on the grounds that he had made clear that he spoke about fluoridation in his "private capacity." (22)

In 1986, Mark Donohue, a doctor, wrote a letter to the editor of a regional Australian newspaper, attacking fluoridation. He received a letter from the state medical board informing him that the board had received a complaint about his letter to the editor, that the board had concern that his comments were not in agreement with standard medical views, and that a newspaper was not the most appropriate place to present his views on fluoridation. (23) This is an example of what Waldbott would call a "veiled threat."

John Colquhoun describes the difficulty of assessing the role of pressure against antifluoridationists in the following manner.

In New Zealand the late R E T Hewat resigned from his position with the Medical Research Council in the same year that he revealed to his colleagues his doubts about the [fluoridation] paradigm. The author knows that he was fulfilling a long-held wish to go farming, but to what extent he was influenced by pressures to make his decision at that particular time, with the Hastings experiment just started, is not known. The minutes of the Dental Association show that some within the profession believed he resigned under pressure. The late Owen Hooton was a respected Auckland dentist, in private practice, who felt bound by conscience to write to the newspaper dissociating himself from support for fluoridation and agreeing with Sir Arthur Amies' assessment. He was visited by Evan Williams, an officer of the Dental Association, and told that he (Hooton) should desist from such public differences with his colleagues. Hooton promised to reconsider, but after doing so wrote explaining why, in the light of the evidence available to him, he could not change his stance. He added, "The majority of people are against fluoridation. I make that statement on the evidence of the ten referendums held in New Zealand. The methods being used by both the Health Department and the NZDA to force the issue are just repugnant to me." Hooton resigned from the Association in 1968, and died soon after, saddened by the ostracism he had suffered from most of his colleagues." (24)

Colquhoun himself experienced direct pressure. After being quoted, in a newspaper article, as warning parents about the danger of their preschool children swallowing fluoride toothpaste, he received a letter from his employer, the Director-General of the New Zealand Health Department. The letter stated that "a staff member who is required to carry out instructions which are abhorrent to him should seek a transfer to another position where this conflict will not exist, or he should resign." (25)

A colleague of Colquhoun's made a similar warning in a newspaper, but anonymously, "was visited by a superior officer who had learned her identity and warned that she had committed 'a dismissable offence'" since she, like Colquhoun, had contradicted the official policy that recommended fluoride toothpaste for all children with teeth, namely two-years six-months and older. (26) In New Zealand in the 1950s, the profluoridationists even arranged for the police to secretly investigate the political affiliations of opponents. (27)

The combination of direct attacks on some public opponents of fluoridation, their fears about loss of grants, and the general labeling of opponents as ignorant and misguided combine to discourage many scientists from doing research or speaking out on the issues. The relative lack of open opposition, in turn, encourages a perception of the "fringe" position of critics.

The direct attacks that occur, plus fears of jeopardizing careers, help to ensure that research projects which may lead to criticism of fluoridation are less often undertaken, and create an atmosphere in which those studies that are carried out are affected by a profluoridation bias. (28) Hence, relatively few articles critical of fluoridation are ever submitted to scholarly journals. Of those that are, there is evidence that it is more than usually difficult to obtain publication.

Mark Diesendorf submitted an article critical of fluoridation to the Australian journal New Doctor. It was rejected because "it might encourage the antifluoridationists." The editor did not supply the referee's comments, and would not even write in a letter that the article was rejected. He offered this information only over the telephone. (29)

Sohan L. Manocha, Harold Warner, and Zbignew L. Olkowski submitted a paper about enzyme changes in monkeys who drank fluoridated water to the Journal of Environmental Health. One reviewer wrote that the paper "appears to be written with the intent to discredit the use of fluoridated water for the maintenance of dental health" and wondered, since the safety of fluoridated water had been demonstrated "exhaustively and repeatedly," whether there was any point in "reviving an issue that has already been resolved." Another reviewer gave, as a reason for recommending against publication, this statement: "this is a sensitive subject and any publication in this area is subject to interpretation by anti-fluoridation groups. Therefore, any detrimental fluoride effect has to be conclusively proven." The paper was rejected. The authors were warned by their head of department not to seek publication in any other U.S. journal, since the head had been cautioned by the National Institute of Dental Research that the results would hurt the fluoridation cause. (30)

British scientist R.S. Scorer wrote, "I know of one paper rejected by a prestigious British journal on the grounds that it would cause public alarm if published - it raised the issue of a possible relationship between fluoride and cancer mortality." (31)

Waldbott, in a court hearing, was asked, "How did it happen that the Journal of the American Medical Association, the Annals of Internal Medicine, the Journal of Gerontology, and the Annals of Allergy turned down your articles on fluoride poisoning?" Since the question enumerated "every single journal that had ever rejected an article of mine," Waldbott inferred that Public Health Service officials, as editorial consultants, must have advised the editors of these journals to turn down the articles, and that the editors had provided the information that they had done so." (32)

Albert Schatz, often noted as the codiscoverer of streptomycin, sent three separate letters to the editor of the Journal of the American Dental Association in the 1960s. Apparently because Schatz was a known critic of fluoridation, all three certified letters were refused and returned to Schatz unopened. (33)

On 15 to 17 October 1962, a conference on the toxicology of fluorine was held in Bern, Switzerland. The conference was originally planned for the Netherlands but, due to "opposition from dental interests" there, it was transferred to Bern. "The conference proceedings were to be published as a book. One publisher of medical and dental literature set the text in type, investing some 10,000 Swiss francs, before pulling out. The publisher was allegedly threatened by a boycott from the dental profession, and was offered compensation for dropping the book. (34)

Phillip Sutton reports that after the first edition of his monograph Fluoridation: Errors and Omissions in Experimental Trials was published by Melbourne University Press in 1959, copies were dispatched to the press's United States agent, Cambridge University Press. The executive director of the Nutrition Foundation, a body funded by the American food industry, wrote to Cambridge University Press, saying "The professional standing of the Cambridge University Press among scientists and educators would seem to preclude publication of such a book by Cambridge University Press." (35)

Sutton also says that the type of his monograph was, without authorization, melted down soon after publication and had to be reset for the second edition only a year later. At that time, Melbourne University Press normally kept for at least six months. (36)

The Index to Dental Literature, published by the American Dental Association, did not include either the first or the second edition of Sutton's book. It included negative reviews of the book, but not positive ones. (37)

Not surprisingly, journal editors usually deny any improper behavior on their parts. In 1957, dental editors responded to charges of bias by issuing a resolution which stated that "no dental journal is restrained or has been restrained from being free to publish both sides of all controversial matters." (38) Of course, it is quite possible for editors to believe that they are unbiased, while bias, as inferred by others, is at the same time, present.

The above cases are examples of attacks on antifluoridationist. (39) I have heard of only one exception to this pattern. The Australian journal Simply Living has published several articles critical of fluoridation. After one of them appeared, Gordon Medcalf, a dentist, submitted a brief reply. The editor rejected it, saying that the views on fluoridation expressed in Medcalf's article were contrary to the facts as Simply Living understood them. (40)

The attacks against antifluoridationists predictably are documented almost entirely by antifluoridationists themselves. (41) It is not normally considered proper to reject a scientific paper or deny a research grant simply because of a person's views on fluoridation. Therefore, such cases are not normally publicized by profluoridationists, but are, sometimes, referred to by opponents in order to condemn the methods of the proponents.

Most of the cases have been documented by leading opponents of fluoridation who are scientists rather than, for example, members of citizens' groups. There are several reasons for this.

First, leading opponents who are scientists attract a disproportionate share of the attacks because it is especially important to proponents to reduce the effectiveness which derives from their greater credibility. If an accountant, bricklayer, or homemaker makes claims about fluoridation, it is easy for dentists, doctors, and scientists to dismiss the claims as coming from uninformed sources. In the public debate, and in many scientific forums, the credibility of a statement relates more to the formal status of the person who makes it rather than to the content of the statement itself. For the purposes of the fluoridation debate, the claims of relevant professionals - especially those who have written and done research in the field - take on an exceptional significance.

Then, too, because most professionals have favored fluoridation, the few public opponents play a special role. If their credibility can be damaged or their activities which hurt fluoridation can be reduced, this can help change the situation from debate - however unbalanced it may be - to unanimous professional support. Therefore, the leading opponents are much more likely to be targeted for attack.

Also, leading opponents are likely to document attacks because they are prominent nodes for communication. People hear them give talks, read their articles, and, as a result, send them further information. These key figures thereby obtain masses of information, some of which they may publish as accounts of attacks on opponents.

Finally, leading opponents are more able to publish accounts of attacks - especially attacks on themselves - because they have little to lose and something to gain by doing this. They are already prominent in their opposition. Others may not want to spend their lives as antifluoridation partisans, but may simply want to continue work as dentists or medical researchers. For such people, to publicize attacks on themselves would be to bring further attention to their activities and perhaps induce further problems. A safer path is often to simply say nothing and avoid arousing the antipathy of fluoridation opponents.

Attacks on opponents probably have the greatest impact on those who are less prominent in the debate. They provide moral lessons in what may happen to those who take up the "wrong stand."

The normal idea of professional practice holds that measures such as dismissal are taken only against those who are incompetent, unethical, or simply "not good enough." A decision to reject an article submitted to a professional journal is supposed to take place on the basis of peer review, itself based on scientific or scholarly criteria. Membership in professional societies is normally withdrawn only from those who have severely breached professional ethics. How, then, are the sorts of attacks on antifluoridationists described here to be interpreted?

Some profluoridationists perhaps see continued open opposition to fluoridation as evidence of poor judgment, scientific incompetence, unethical behavior, or worse. The imposition of measures against certain opponents is quite justifiable in this context.

Furthermore, no doubt, some of the cases can be explained (or "explained away") as exaggerated accounts or paranoid interpretations by people who have "an ax to grind." But this does not explain the full pattern of attacks.

Most antifluoridationists see the use of professional power against opponents as a violation of professional principles, and as evidence of the unscrupulous behavior of promoters of fluoridation. Opponents of fluoridation frequently raise these cases of "suppression" as showing the political rather than the scientific basis for the promotion of fluoridation. By highlighting discrepancies between the stated norms of scientific behavior and the actual behavior of certain scientists, the opponents use the category of "unjustifiable behavior" as a resource in their struggle.

A middle-of-the-road approach might categorize these examples as unfortunate excesses, not representing proper behavior and possibly being counterproductive for the proponents. But, since the opponents are believed to be wrong and have so little professional credibility, it is not worth making a big fuss about particular cases.

This apparently moderate and balanced view ignores one thing: the organized efforts within the dental profession to denigrate the reputations of antifluoridationists. (42) The dossiers published and distributed by the American Dental Association create a climate of contempt, in which attacks on antifluoridationists become more acceptable. The opponents are, the dossiers suggest, "only cranks anyway."

In summary, the profluoridationists, through their influence in dental and medical associations, their positions and influence with health authorities - especially the U.S. Public Health Service - and their influence over the editorial policies of journals and publishers, have created a climate in which some zealous promoters use a variety of aggressive techniques to stop the expression of antifluoridation views by professionals. (43)

This point again illustrates the impossibility of assessing the fluoridation issue without a full consideration of the dimension of power. An assessment of the scientific evidence is incomplete without knowledge of what research may have been inhibited from being done in the first place, prevented from being published, or relegated to marginal status by attacks on the credibility of the researchers.

See also:

• Suppression of Scientific Dissent on Fluoride's Risks and Benefits - Compilation of articles
• Voices of Opposition have been Suppressed since early days of Fluoridation - Chemical & Engineering News August 1, 1988
• Suppression of Dissent in Science - Dr. Brian Martin, Research in Social Problems and Public Policy, 1999
• Analyzing the fluoridation controversy: resources and structures (.pdf file)- Dr. Brian Martin, Social Studies of Science, May 1988