Medical Examiner

What’s the Matter With Portland?

The city has been fighting fluoridation for 50 years. Will facts trump fear this month?

Glass filled with drinking water from kitchen faucet.
As of 2010, almost three-quarters of Americans drink fluoridated water from community water systems

Photo by Juri Samsonov/Think Stock

America is a fluoride nation. Beginning in 1945, when Grand Rapids, Mich., became the first city in the world to add the stuff to its water supply, the practice has spread across the United States. In most areas it is simply understood that ingesting minuscule levels of fluoride is good for dental health. As of 2010, almost three-quarters of Americans drink fluoridated water from community water systems, and the nation’s 30 most populous cities consume it.

With one weird exception: Portland, Ore., whose water system, sourced from the Bull Run River, serves 900,000 people.

A fluoridation proposal was put up for a popular vote in 1956, when many major metropolitan areas were adopting the practice, but it failed by a sizeable margin: 105,191 to 75,354. A similar attempt in 1962 failed, too. The late 1970s saw a flurry of activity, long after the issue had faded from the national political discourse. Oregon voters killed a statewide ballot initiative that would have banned fluoride (1976); Portlanders voted to add fluoride to the water (1978); and then they reversed course and voted to keep it out of the water supply (1980).

The fluoridation debate remained dormant until last summer, when someone leaked to the Oregonian that a coalition was quietly pushing the City Council to simply approve fluoridation without relying on a ballot measure. Less than a month later, the council unanimously did just that by enacting Ordinance 185612, which required the Water Bureau to add fluoride at 0.7 parts per million beginning in March, 2014. Atlantic Cities’ Nate Berg wrote approvingly at the time, “resistance from one of the country’s biggest cities may be coming to an end.”

Resistance was just beginning. The banners of dissent were quickly raised. A public hearing on the ordinance lasted for almost seven hours, and almost all of the speaking time was taken by people against fluoridation. When the council voted the motion through, protesters booed loudly, vowing to bring the matter before the public. (Several of the more boisterous activists were expelled from the chamber.) Within a month more than 43,000 signatures were collected, more than twice the number needed to bring the issue to a popular vote.

“The fact that we collected so many signatures shows the citizens of Portland were really upset that they were going to fluoridate without a public vote,” says Kellie Barnes, spokeswoman for Clean Water Portland. “We are entirely grassroots. The executive staff are all volunteers, none of us are paid. … I’m a physical therapist and a mother who cares about not adding contaminants to our water.”

On paper, the fight over fluoridating Portland’s water supply looks absurdly uneven. The pro-fluoridation group Healthy Kids, Healthy Portland, as of May 13, had received $689,376 in cash and $65,093.64 in the form of donated supplies and labor. The anti-fluoridation Clean Water Portland received $194,333 and $59,137. Healthy Kids enjoys the backing of a diverse coalition that ranges from major health care and dental providers, such as Kaiser Permanente and the Oregon Dental Association (both have donated tens of thousands of dollars), to organized labor and almost all of the region’s major groups representing and organizing with people of color and low-income communities. Oregon’s Wild West campaign spending laws (they basically don’t have any) allow huge contributions: The Northwest Health Foundation alone has donated well over $200,000. The Urban League is the premiere advocacy group for Portland’s African-American community and it has an organizer devoted full-time to the cause.

Arguably most importantly, Healthy Kids and fluoridation have the endorsement of the massed forces of rationality and medical authority. Almost every credible national, state, and local health and science organization—private and public—gives its blessing to optimal levels of water fluoridation: The American Medical Association, the American Dental Association, the Environmental Protection Agency, the World Health Organization, American Academy of Family Physicians, and  the Center for Disease Control and Prevention, which named the measure one of the 10 greatest public health achievements of the 20th century. They all agree that fluoridated water is perfectly safe and extremely effective at preventing tooth decay.

Clean Water Portland’s anti-fluoridation supporters include the Pacific Green Party, Nutritional Therapy Association, Organic Consumers Association, Oregon Association of Acupuncture and Oriental Medicine, and the Cascade Club, a local libertarian think tank. The Portland chapter of the NAACP is the only local organization representing people of color that has come out against fluoride, but according to most political observers it is tiny and has very little influence. (United Latin American Citizens is also listed as a supporter because their national organization has opposed the policy generally, but according to Barnes their Portland chapter has not officially endorsed CWP.) Out-of-state supporters include the Fluoride Action Group and Kansas Taxpayers Network, which is a far-right group that recently merged with Americans for Prosperity. Anti-fluoride funding also comes from a variety of groups bearing the name of Joseph Mercola, a doctor the FDA censured multiple times for making untrue health claims. His website includes articles opposing fluoridation, vaccinations, and mammograms. also features an extensive interview with a man who denies that HIV causes AIDS.

But while Mercola and company are proving some funding for Clean Water Portland, the bulk of the work is being done by local volunteers. Clean Water Portland signs blanket the city, their slogans denouncing the city’s attempt to tamper with a pure, natural resource: “Keep Portland’s Water Clean” and “Vote No Fluoride Chemicals.” Town halls are overwhelmingly attended by hissing anti-fluoride activists, and the controversy is dividing friends and family members. (One woman told me she was avoiding certain friends until after the vote because she knew their positions differed so strongly.)

“I’ve heard it said that the support for fluoridation is a mile wide and the passion runs an inch deep, while the opponents of fluoridation … the support isn’t nearly as wide but the passions runs to the center of the Earth,” says Kurt Ferre, president of the board of directors for the Creston Dental Clinic, which serves low-income children and is the only school-based clinic of its kind in Multnomah County. “The opponents are very good at raising fear, using words like chemical and industry, and there is this basic fear of change. There is a terrible fear that somehow fluoride is going to muck up our Bull Run water system.”

The anti-fluoridation appeal appears to be working. While an August 2012 poll showed the two sides evenly splitting the vote, a poll conducted by KATU last week shows the fluoride opposition ahead by 48 to 39 percent. The pollsters interviewed 800 Portlanders and found especially strong opposition among African-American, Asian, and especially Latino voters, who expressed only 9 percent support.

A look back at Oregonian accounts from the 1950s shows that relying on medical and scientific rationality has not been a successful strategy. Pro-fluoride forces called on an impressive list of supporters to sway voters; one article includes a list of scientific, dental, and medical organizations in support of fluoridation that goes on for four paragraphs.

“It would appear the backers of this new aid to dental health made the classic military error of underestimating the enemy,” reads a May 25, 1956 Oregonian editorial, after 10 of 12 fluoridation measures across the state went down to defeat, as the Portland effort would that autumn. “They relied too heavily on the presumed confidence of voters in the AMA, ADA, U.S. Public Health Service, and state and local health authorities who have given fluoridation their blessing. … [but] after [fluoride opponents] fire their counterbarrage of speeches, leaflets, mailing pieces and newspaper ads, the poor voter is baffled and uncertain. The strategy of fluoridation’s foes is to put its friends on the defensive, to create doubts in the voters’ minds. Once this is accomplished, they know people are likely to vote to maintain the status quo.”

It’s amazing how little has changed. The 1956 campaign saw the Committee to Save Our Children’s Teeth square off against the Pure Water Committee. (The latter stooped to more grotesque rhetoric than do their contemporary equivalents: “Some unscrupulous dispensers of POISONOUS FLUORID … have amalgamated a sinister propaganda for SLOW MASS MURDER … and the fattening of their purses.”) The pro-fluoridation campaign relied on medical authority and pleas for dental health for low-income people. The antis insisted there are better ways to care for teeth: “I still advocate that a correct diet of natural grains, fresh vegetables and fruits, eggs and meat, sans the highly refined sweets and starches, will prevent tooth decay,” reads a Feb. 8, 1956  letter to the Oregonian. Bull Run’s natural purity is also evoked, as in this April 13 letter, 1956: “when we’ve been blessed with such pure water, we should be eternally grateful and keep it that way.”

While there are surely conspiracy theorists and anti-government militants among the ranks of today’s Clean Water Portland, the organization’s spokespeople and supporters generally do not express the conservative rhetoric (such as invoking “socialized medicine”) that defines fluoride opposition elsewhere. Such tactics would never work in this liberal city. Instead, opponents rely on attachment to the environment and natural health care, as well as the current mistrust of pretty much all institutions.

“We have many better alternatives that people aren’t speaking about, including Obamacare’s federal dollars to support the state for low-income oral health,” says Barnes, of Clean Water Portland. “What is alarming to me … is that [fluoride includes] known contaminants … I don’t think it makes any sense to add more contaminants to our kids’ water.”

She is referring to a National Science Foundation study from June 2012 that showed that 43 percent of “fluoride products” contain trace elements of arsenic, 2 percent contain similar proportions of lead, and 2 percent copper. However, what Clean Water Portland does not say is that the report finds that the amounts of heavy metals found in these samples are so minuscule as to be completely innocuous; none come remotely close to the EPA’s Maximum Contaminant Levels. Similar flaws can be found with Clean Water Portland’s analysis of many of the studies that supposedly support their cause. The centerpiece of their argument is a Harvard review of studies which concludes that naturally occurring fluoridation may lower child IQ—at levels more than 10 times higher than any ever recommended in the United States. The research looks pretty shaky anyway, considering that most of the studies didn’t control for parental education and household income, among other factors. CWP claims that a 2006 study from the National Academy of Sciences links fluoride in drinking water “to a broad spectrum of human health ailments from neurological damage and thyroid disorders … and increased risks of bone cancer.” But, again, the study looks at far higher concentrations of fluoride than have ever been recommended in the United States. The chairman of the commission responsible for the study, John Doull, even wrote (regarding a policy battle over fluoridation in Kansas City): “I do not believe there is any valid scientific reason for fearing adverse health conditions from the consumption of water fluoridated at the optimal level.”

The 2012 Smile Oregon survey shows the state’s oral health improving, but that doesn’t disprove the utility of fluoride, especially because the factors that have allowed these improvements are not standardized or funded sustainably. “One example is the first tooth program frequently talked about by the opponents, which trains med[ical] staff to do dental screenings and [fluoride] varnishes among other things,” says Mike Plunkett, Dental Director of CareOregon (which has donated tens of thousands of dollars to Healthy Kids) and public health dentist at Neighborhood Health Center, a community health center that serves primarily Medicaid enrollees and the uninsured. “They call it a very success[ful] federally funded program that should be expanded. … It lost its federal funding last year and has a questionable financial future to say the least.” It is frequently claimed that European nations have abandoned the practice of fluoridation, which simply isn’t true. (Britain, Ireland, and Spain fluoridate their water, while other nations put fluoride in table salt or get it naturally from drinking water, as in Sweden and Italy.) Clean Water Portland insists that emerging science supports its claims, but most of them consist of data cherry-picked from limited research and studies that actually conclude in favor of fluoridation. 

Politically, that hasn’t really mattered. It’s easy to sow fear about chemicals being dumped in a pure, natural resource. The pro-fluoridation Healthy Kids, Healthy Portland simply seems to have been out-organized. They haven’t done a good job of refuting inaccurate claims, instead mostly sticking to arguing in favor of fluoride’s positive effect on dental health. They’ve brought policy papers to a gun fight.

“The anti-coalition has done a really good job of putting their junk science in mainstream media and in front of people in a really aggressive way, and the pro-fluoride side has been a little too nice,” says Felisa Hagins, political director of SEIU’s 10,000-strong Local 49, which represents janitors, security  officers, and health care workers, among others. We haven’t called bullshit bullshit, we haven’t said that the studies they keep showing, frankly, they are picking and choosing their science. Because [Healthy Kids] has been so eager to be inclusive there has been some hesitancy to do that, but that’s what we need to do.”

But they are almost out of time. Final ballots are due on Tuesday, May 21.* All reports from the ground indicate that the issue is extremely divisive. Sign stealing and fights over dinner have become the norm in this usually calm political environment. Almost everyone interviewed cited the same argument for the ferocity of the opposition, even in the face of near-universal scientific consensus about the safety and benefits of fluoridation: Portlanders’ attachment to their status as one of the greenest big cities in America, a sense of identity tied up with a perceived link to an unsullied environment. (“Industrial byproducts don’t belong in our drinking water” is “the No. 1 reason” that Clean Water Portland opposes fluoridation.)

“This obsession with the quality of the water … There isn’t anything new in [Clean Water Portland’s] arguments,” says Rep. Earl Blumenauer (D), who represents much of Portland and was in the state legislature during the late 1970s statewide fight over fluoride. “Since then we’ve had 30 years more experience, and we don’t have people growing extra heads; the supposed dangers haven’t materialized. It truly is not a science-based rational argument.” 

But doubt and fear can trump rationality. Many Portlanders have “an enlightened sense of natural [connection],” says Plunkett. Opponents of fluoridation say it “is going to taint that pure relationship, then they produce enough doubt.” And as we know from things like anti-vaccination efforts and the political debate over climate change, creation of doubt can be enough to win.

Correction, May 17, 2013: This story originally misstated the date on which ballots are due. Voting ends on Tuesday, May 21, not March 21. (Return to the corrected sentence.)