President Trump’s Secretary of Health and Human Services (HHS), Robert F. Kennedy Jr., has drawn criticism for his desire to remove fluoride from the water supply.
According to PBS, the American Dental Association president said, “When government officials like Secretary Kennedy stand behind the commentary of misinformation and distrust peer-reviewed research, it is injurious to public health.”
Similarly, headlines out of outlets like Politico say that “Dentists are struggling to counter [Kennedy] on fluoride.”
Much of the recent criticism cites a new study estimating a sharp rise in cavities if fluoride were removed. But the enamel-strengthening mineral is not added to water supplies in most of the world, and even countries that had done so stopped when fluoride toothpaste became commonplace.
To understand the relative merits of removing fluoride from the water, we’ll need to review some of the arguments from science, then discuss how markets adjudicate competing claims.
The Fluoride Controversy
There are upsides and downsides to the use of fluoride. Fluoridation tends to improve dental health, especially in children. That’s why fluoride is used in toothpaste and dental cleanings. If it helps in these scenarios, why wouldn’t it help when included in water?
The problem is, fluoride also has downsides. Several studies in recent years have found negative relationships between fluoride intake and infant IQ. These are peer-reviewed articles in highly regarded journals, so the research cannot be summarily dismissed as inconclusive.
IQ isn’t the only worry with fluoride. Parneet Singh Sohi, a pediatric dentist writing for The Wall Street Journal, argues that, although targeted use of fluoride is beneficial, there are clear scientific downsides. For example:
An expanding body of research has associated chronic ingestion with skeletal fluorosis, diminished bone resilience and elevated fracture risk. These findings are no longer theoretical abstractions: Geriatric and adolescent fracture rates are surging, and orthopedic practices in numerous regions have reported exponential growth, suggesting a possible link to cumulative fluoride burden.
He argues that while water fluoridation may have made sense in an era before widespread access to toothpaste, it’s no longer necessary in the US.
In short, experts are split. So how should we adjudicate this issue when experts disagree? Well, that’s where the benefits of markets shine.
Markets Allow for Individual Values
Scientific research indicates both costs and benefits to fluoride, and the value of each is subjective.
Political processes often allow us only an all-or-nothing result. If 51 percent of people vote for (or against) fluoride in the municipal water, then their decision is imposed on the other 49.
Markets, however, allow for more granularity. If individuals believe fluoride will be good for themselves or their children, they have the option of buying fluoride and frequently using it in the form of toothpaste, rinses, and dental cleanings. Those willing to take the risk of lower IQ are free to buy and use it.
But if someone else thinks even a slight possibility of lower mental functioning is worth avoiding — and is willing to take the risk of more cavities — it makes sense to let them run that tradeoff.
Sometimes the provision of goods from the government is argued on the basis of what economists call positive externalities. If an individual purchasing a good benefits his neighbor somewhat, but he doesn’t get to absorb the benefit himself, this may result in him purchasing less than he would otherwise.
You can stretch almost any example to have externalities, but in the case of fluoride, externalities seem small. If someone chooses to buy fluoride, she personally receives the benefit of cleaner teeth, but the positive externalities of her pearly white smile are negligible.
Some might argue that fluoride is beneficial because it helps prevent the negative externality of people delaying dental care and leaving the public to cover the cost. While that’s possible in theory, the numbers tell a different story. Americans make over 155 million emergency room visits each year, but only about two million — just over one percent — are dental-related, and even fewer go unpaid. Dental spending is a relatively small piece of the broader US healthcare puzzle. To the extent that costs of quasi-socialist dental care are imposed on taxpayers, that’s a separate issue from whether fluoride should be imposed on us instead.
The beauty of markets is that individuals can weigh costs and benefits themselves and make judgments according to their values. Since the natural sciences are value-free, there will never be a study to confirm people ought to use fluoride. Given this ambiguity, we should allow people to purchase fluoride if they want it. Let’s stop treating fluoride as the default. Rather, let’s encourage individuals to take responsibility for their own health.