SB 277 protects kids + gets us useful public health data

While I was busy reading everything written about the King v Burwell decision and celebrating a massive human rights win, California governor Jerry Brown eliminated “personal belief” vaccine exemptions. California now joins Mississippi and West Virginia as the only states that require vaccines for all children unless contraindicated due to medical necessity.

The most important result of the passage of SB 277 is that it says, boldly and definitively, that vaccines are not only safe and necessary for protecting an individual child, but that the safety of the population will not be threatened by pseudoscience and conspiracy theories.

Even if the law doesn’t significantly change vaccination rates, its passage elevates the status of vaccines. It says to California parents you can believe whatever outrageous ideas you want, but your anti-science views cannot endanger other people, especially other children.

SB 277 implementation also gives officials an opportunity to research the ways that vaccine legislation impacts public health. Wired puts it nicely:

Whether or not the law has a significant effect on the health of California’s kids, this is a prime opportunity to carefully study the effects of legislation like this on both vaccination and disease rates. Health officials would love to know for sure that SB277 will have a meaningful impact on public health. But they can’t. It’s notoriously hard to draw connections between statewide vaccine laws and disease numbers.

This is awesome! Ending the personal exemption means that all kids enrolled in public school must receive all vaccinations. And we’ll be able to get good data on potential connections between legislation, vaccination rates, and disease outbreaks. End of story. Right?

Not necessarily.

There seems to be a loophole that will allow doctors who have inexplicably been converted over the anti-vaccine cause and who believe that a vaccine may harm a child to give medical exemptions. 

Presumably, this exists because some kids are just flat out allergic to some vaccines (on a personal note, I’m allergic to the pertussis vaccine so I depend on herd immunity, myself).  I haven’t found much analysis of this caveat aside from general statements about not giving a vaccine to kids who are allergic to it. I wouldn’t be surprised if we see families seeking exemptions through a doctor who believes vaccines are harmful for all children and who are then being kept from enrolling their children in public schools.

I’m eager to see how this unfolds, both among pro- and anti-vaxxers and as a new way of understanding how policy decisions impact public health. California, thank you for giving this a shot for the rest of us, and thank you for taking a stand against the nonsense bubbling up across the country.

Study shows no link between HPV vaccine and increased sexual activity

Big news on the sexual health front: a new longitudinal study was published yesterday in JAMA showing that young women who have received the HPV vaccine are no more likely to contract other STIs than unvaccinated women. While it is never a good idea to make generalizations about anything based on one study, this particular one seems well-designed and will hopefully lead to further study on this question. 'The Public Vaccinator' by Lance Calkin. Credit: Wellcome Library, London.

HPV causes cervical, vaginal, and anal cancer and has been connected to various head and neck carcinomas. The vaccine protects against four strains of the virus most often responsible for those cancers. To be clear: the HPV vaccine is a vaccine against cancer. Despite the potential benefits, many parents (and non-parents) fear that by giving their child the HPV vaccine, their child will feel free to engage in risky sexual behavior.

Because of this fear, HPV vaccine uptake has been abysmal in the United States. Only about half of young women and one-third of young men have received the first dose of the HPV, and even fewer have completed the three-dose series.

Looking at a sample group of women over 208,000 women aged 12-18, researchers found that young women recieved the HPV vaccine were no more likely to seek treatment for chlamydia, gonorrhea, herpes, HIV/AIDS, or syphilis than were unvaccinated women. That’s right, there was no evidence that getting the HPV vaccine increased the likelihood of being diagnosed with an STI.

Using pharmacy claims, researchers also determined that vaccinated women were more likely to use oral contraceptives. 17.9% of vaccinated women across age ranges received a prescription for hormonal birth control while 9.2% of unvaccinated women did. This could be due to a few factors: young women who intended to engage in any sexual activity were more likely to request the vaccine as well as contraceptives; the HPV vaccine was suggested by doctor during appointments for acquiring contraceptives; or parent perception of daughters’ likehood of being sexually active influenced their decision to vaccinate or seek contraceptives for their child.

There are, of course, some limitations to this study. The researchers were only able to access records, so by design they missed undiagnosed STIs, may have included STI screenings rather than diagnoses, and omits the use of non-prescription contraceptives like condoms. Researchers were also unable to use records from anonymous clinics. Researchers also could not acquire information about SES and motivations for receiving the vaccine. This study also does not look at young men in the same age range, which would give a more complete picture of how HPV vaccine impacts adolescent sexual activity.

The psychology of vaccine risk perception is fascinating. Beyond the concerns of “naturalness,” parents who are less inclined to vaccinate may feel more responsible for potential injury to their child if the injury is connected to a vaccine rather than to a disease that could have been prevented by that vaccine. A parent whose child has a seizure after the HPV vaccine may feel more responsible for that event than if the child contracts HPV. I wonder how the parents would feel if, after a decade, their child is diagnosed with an HPV-related cancer.

To an extent, I get it. I’m not a parent, but I do possess empathy and can imagine how frightening parenting must be. The world seems full of danger, and parents want to do everything in their power to keep their children safe. Sometimes not acting--not vaccinating--seems safer than risking the side effects of the vaccination or of the disease itself.

Fearing risky adolescent sexual activity also makes some sense to me. Most parents don’t want to see their child become a parent during their sophomore year of high school. Most parents don’t want their child to live with HIV or herpes.

But nearly everyone becomes sexually active at some point in their lives, and about 70% of people have their first sexual experience before age 19.  Half of sexually active men and women will have HPV. That means that means that when parents decide not to vaccinate their children, they allow their children to have a one-in-two chance of contracting HPV. And while most cases of HPV clear up on their own with no adverse effects, there are more than 33,000 cases of HPV-related cancer diagnosed each year in the United States.

No study can stand alone. We should not take the results of this study and make bold proclamations about young women’s behavior and sexual activity. I do believe, however, that this robust study provides some much-needed evidence that reducing young women’s risk of infection does not turn them into crazed sex machines making risky choices. I look forward to subsequent studies that can provide more evidence for parents to use to make informed choices.

Note: I know that women over age 18 don’t need parental permission in order to get the vaccine and may be more inclined to seek it out. But this study looked only at women under age 18, so I stuck to that age group as well.

Friday Five: National Immunization Awareness Month

national immun awareness monthThis week’s Friday Five focuses on five important or interesting facts about vaccines in honor of National Immunization Awareness Month. Most of the sections are adapted just slightly from other sources. You can find the original source material by clicking the link next to each subheading.  

How do vaccines work? (History of Vaccines)

Vaccines work to prime your immune system against future “attacks” by a particular disease. When a pathogen enters your body, your immune system generates antibodies to try to fight it off…Vaccines work because of this function of the immune system. They’re made from a killed, weakened, or partial version of a pathogen. When you get a vaccine, whatever version of the pathogen it contains isn’t strong or plentiful enough to make you sick, but it’s enough for your immune system to generate antibodies against it. As a result, you gain future immunity against the disease without having gotten sick: if you’re exposed to the pathogen again, your immune system will recognize it and be able to fight it off.

 

What is herd immunity? (Vaccines Today)

Herd immunity is a form of immunity that occurs when the vaccination of a significant portion of a population (or herd) provides a measure of protection for individuals who have not developed immunity. It arises when a high percentage of the population is protected through vaccination against a virus or bacteria, making it difficult for a disease to spread because there are so few susceptible people left to infect…These include children who are too young to be vaccinated, people with immune system problems, and those who are too ill to receive vaccines (such as some cancer patients)…The proportion of the population which must be immunized in order to achieve herd immunity varies for each disease but the underlying idea is simple: once enough people are protected, they help to protect vulnerable members of their communities by reducing the spread of the disease. However, when immunization rates fall, herd immunity can break down leading to an increase in the number of new cases.

 

Do children get too many shots? (from CHOP Vaccine Education Center)

Newborns commonly manage many challenges to their immune systems at the same time. Because some children could receive as many as 25 shots by the time they are 2 years old and as many as five shots in a single visit to the doctor, many parents wonder whether it is safe to give children so many vaccines…From the moment of birth, thousands of different bacteria start to live on the surface of the skin and intestines. By quickly making immune responses to these bacteria, babies keep them from invading the bloodstream and causing serious diseases. In fact, babies are capable of responding to millions of different viruses and bacteria because they have billions of immunologic cells circulating in the bodies. Therefore, vaccines given in the first two years of life are a raindrop in the ocean of what an infant’s immune system successfully encounters and manages every day.

 

What do vaccine preventable illnesses look like? (Immunization Action Coalition)

Most people in the US have never seen a case of polio or diphtheria. This photo gallery may help remind us why immunizing against these diseases is so important.

 

How can we lessen the pain of getting shots? (CHOP Vaccine Education Center)

(This is important for scaredy-cats like me.)

For most children, getting vaccines simply means the pain of getting a shot. Although pain is to some extent unavoidable, there are a few things worth trying in older children.

Blowing away the pain

One technique is called "blowing away the pain." Just before the shot, take out a feather, tell the child to take a deep breath, closing his eyes if he wants, and then to blow out...blow, and blow on the feather until you or the nurse tells them to stop. The distraction of blowing on the feather has been shown in one study to lessen the amount of pain perceived by the child.

Cold versus pain

Another idea is to swab a small amount of alcohol on the forearm of the opposite arm that will receive the vaccine. The child then blows on the alcohol before and during the shot. Our bodies don't feel cold and pain in the same place at the same time. Rather, when confronted with the choice of cold or pain, the body picks cold. So the feeling of pain from the shot will be reduced.

EMLA cream

For older children with severe phobias to needles, you might consider the use of an EMLA patch applied to the skin. The limitation of this technique is that the patch (which helps to numb the area) must be applied at least one hour before the injection. Also, EMLA cream works to decrease pain caused by injections under the skin (called subcutaneous injections), but doesn't lessen the pain of vaccines given in the muscles.

Friday Five: withdrawal, Amanda Bynes, gluten-free labels, vaccine rates, urgentrx

Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week. Pulling out is surprisingly popular

A study that will be published in the September issue of Obstetrics & Gynecology shows that 31% of women aged 15-24 used withdrawal as the primary form of contraceptive at least once. The study also found that 21% of those women became pregnant, compared to 13% of women who used other methods. I was pretty outraged to learn that so many young women rely on their partners to pull out, so I consulted the Kinsey Institute site Kinsey Confidential to compare different forms of contraceptives:

Method Typical Effectiveness Theoretical Effectiveness
Withdrawal 81% 94%
Male condoms 85% 98%
Oral contraceptives 92% 99.9%
Intrauterine Device (IUD) 99% 99%
Implant 99.01% 99.01%

Whelp, turns out the much-touted condoms don’t fare much better in preventing pregnancy than withdrawal, but IUDs and implants are far better. Advocating for more extensive use of IUDs and implants would help more women learn about their effectiveness and safety, and could play a major role in reducing the number of unplanned pregnancies. (FYI: condoms protect against some STIs, so keep using them, okay?)

Now we know what’s ailing Amanda Bynes

After publicly unraveling, actress Amanda Bynes has been placed on psychiatric hold and reportedly diagnosed with schizophrenia. Schizophrenia is a debilitating yet treatable disease that can lead to delusions, hallucinations (including hearing voices and smelling odors that don’t exist), and cognitive issues, among other symptoms. I sincerely hope that her family and doctors help her find the right treatment so she can find relief from her suffering. This story is playing out all over the gossip mills, and we can learn from this: erratic behavior requires intervention. In an open letter, her former co-star Nick Cannon also taught us an important lesson about how provide compassion:

So I say to my sister Amanda Bynes you’re not alone. I’m here for you. I understand. I care and I appreciate you, because that’s what family does and that’s what family is for. I also extend this to anyone else in my life, past or present that may find themselves in hard times. I’m here! Call me! Because I truly believe, the hand you’re helping up today may be the one you’re reaching for tomorrow.

Side note: take a look at this fantastic Atlantic article with Dr. Christine Montross titled “How well do we really understand mental illness?” for more insight into the hows and whys of treating severe mental illness.

Gluten-free labels, now with accuracy!

People with celiac disease, those with gluten sensitivity/intolerance, and dieters can all rejoice because this week, the FDA standardized the label “gluten-free.” The limit is 20 ppm, the lowest amount of gluten detectable in a food product. Foods such as fresh fruit and eggs can carry the label “gluten free” because they naturally contain no gluten. Regulations like this help consumers make informed choices. Considering more than two million Americans cannot digest gluten, having consistent, effective labels is the right thing to do for their health.

State-by-state vaccine rates tell us about exemptions

Each year, the CDC analyzes vaccine rates among the 50 states, Washington DC, five cities, and eight other US jurisdictions that receive federal funding for immunizations. This year, Mississippi topped the list, with 99.9% of kindergarteners receiving full doses of MMR, DTaP, and varicella (chicken pox). Overall, median exemption rate for the country was 1.8%; Oregon had the highest, with 6.5% of kindergarteners not meeting the vaccine standards. Interestingly, Mississippi does not allow religious or philosophical exemptions for immunizations. Removing religious and philosophical exemptions altogether wouldn’t be appropriate, but perhaps the success Mississippi has with getting children vaccinated will spark a conversation about strengthening the requirements for getting an exemption.

UrgentRx: alleviating upset stomachs, potentially saving lives

Forbes just published its list of what it deems the 25 most innovative consumer and retail brands of the year. An over-the-counter medication company, UrgentRx, made the cut. The company produces powders of common treatments for headaches, allergies, and digestive issues, along with plain aspirin intended for use during a heart attack. UrgentRx powders can be taken without water, meaning that you can give yourself a hit of heartburn medicines whenever you need it. The implication for potentially life-saving doses of aspirin are immense: a study in the American Journal of Cardiology, as reported by Harvard Medical School, showed that chewed aspirin worked faster against heart attacks than swallowing it whole or taking a liquid version. For a person with heart disease, carrying around a powdered dose eliminates the need to chew and provides the benefits of aspirin as quickly as possible.

Why we can't let Jenny McCarthy join The View

Jenny McCarthy’s dangerous vaccines-cause-autism message has been well catalogued and critiqued by writers across the Internet (you can start here, here, and here). But I hadn’t ventured far into her world until hearing the news that she was “in serious talks” to join the popular daytime talk show The View. Vaguely knowing that she advocates for some batty autism cures, I stuck my toe into the world that literally made her its president, Generation Rescue. My conclusion? If ABC makes the mistake of hiring her, and she brings her anti-doctor, anti-science rhetoric to The View, all of us concerned with spreading evidence-based information better be ready every day to combat her misinformation. McCarthy's book chronicling how she "cured" her son of autism.

A note about sources: finding balanced sources on vaccine safety is a tough task, and I found myself questioning both the Generation Rescue folks and the people criticizing them. Many of the sources I found are very biased and a link to them does not mean I endorse their message. As you find yourself going down the rabbit hole, remember to read everything skeptically. However, the best resource I found for anyone interested in the actual science regarding this issue is the Children’s Hospital of Philadelphia’s Vaccine Education Center.

I learned about the “Biomedical” approach to “curing” autism through a video McCarthy made a few years ago. Generation Rescue no longer has on its site, but YouTube squirreled it away for our viewing pleasure—Part 1 Part 2.  She goes into detail about how and why “Biomedical” is the only thing that makes sense for healing children with autism. I suggest you carve out fifteen minutes to watch it so you know what’s coming if she makes it onto The View.  Warning: the video may cause bouts of rage.

The two most important parts of the video are direct quotations from McCarthy that summarize the danger she poses to public health:

  1. After listing brand name supplements and referring viewers to Kirkman Laboratories to purchase them, McCarthy encourages parents to give supplements to children in order to “detox” them from yeast and toxins, and says, “If you’re unsure about dosage, ask your pediatrician.” Then she rolls her eyes. “Or, most of the time, they don’t know anything. So I would say, um, ask someone at Kirkman Laboratories.”

So here we have McCarthy herself telling us not to trust pediatricians. Rather, we should call up a company that sells allergen free supplements and ask them how much to give to children. She encourages us to trust salespeople over trained professionals, simply because she believes in what they’re selling. In her view, doctors are useless and possibly malicious.

2. Attesting to the power of positive thoughts, she invokes the book “The Secret” and says, “Whatever you think becomes your reality.”

This is some serious magical thinking. McCarthy believes that her wishes will come true. She imagined her own son being healed of autism, and lo and behold, he was! When all a person has to do is believe something is true, she has no need for scientific facts. Give that person a microphone, and she may be able to convince others that whatever they believe is the truth, too.

By lending her face and considerable charisma to the cause, McCarthy has already done serious damage to immunization levels across the country by raising the profile of misguided vaccine fears. Many states are below the necessary vaccination level to maintain herd immunity for pertussis, measles, and diphtheria. Herd immunity means that there is a certain percentage of the population that needs to be vaccinated against a disease in order to keep the unvaccinated safe. Vaccination keeps infectious diseases from spreading by containing the possibility of an outbreak. For example, in order to protect those who cannot be vaccinated—infants, pregnant women, etc. from measles, 92-94% of the population needs to be vaccinated against it. When immunization levels drop below 92%, the population is at risk for an outbreak and the same people who could not get the vaccine are now at risk for the disease.

The View is a daily show. If she’s hired, I’m sure McCarthy will talk about anything from insomnia to hair color to shoe insoles, if her Twitter feed is any indication. But it will only be a matter of time until the issue for which she is best known becomes part of the conversation. When it does, we must be ready to talk openly about the results of research and the reliability of doctors to give sound, proven advice. Though talking about it over and over may seem redundant or boring, the truth is that vaccine levels are declining and we must speak on behalf of public health.

In the meantime, tell ABC what you think about McCarthy joining The View. Phil Plait at Slate has an excellent example of the polite note he wrote and inspired me to write to them and make my note public. Here is what I wrote to them. Feel free to use some version of my letter if you’d like:

I strongly urge you not to hire Jenny McCarthy as a new co-host. She is the president of the group Operation Rescue, which advocates for practices that harm the public's health, especially avoiding vaccines. If she is hired by The View, she will have a daily opportunity to influence the health decisions of viewers. Please do not add to the ease with which bad and potentially dangerous health information is spread.

For more information, please see http://bit.ly/12pTOyW  

Sincerely,

Teagan Keating

Please take the time to write to ABC before they hire her. Because if she does make it onto the show, we’ll have to do a lot more than that.

Friday Five: Chicago, ACA, firefighters, prescription drugs, vaccine recall

Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week.  

Fourth of July shootings in Chicago

This Fourth of July weekend is proving to be deadly for Chicago. Yesterday, eight people were killed and more than 30 were hurt in shootings across the city. The youngest victim is just five years old, and was shot while attending a party in a park with his family. These shootings are a disgrace, as is the lack of national coverage of the violence permeating Chicago. Victims’ stories should be plastered across every news station and website, and the nation should be reviving the post-Sandy Hook gun conversation in light of this inexcusable violence.

 

Another ACA delay

The Obama administration added to the confusion surrounding the Affordable Care Act by pushing the employer mandate deadline back one year to January 1, 2015. Another instance of caving to private sector demands means increased misunderstanding for the public. The law was incredibly complicated as written, and the administrative tweaks, House repeals, and flat-out lies disseminated by the media ensure that nobody has any idea what’s going on. The ACA is the single most important change to health care the US has seen since 1965, and its frustrating to watch it falter. Hopefully, the exchanges will still open as scheduled on October 1.

 

Firefighters killed in Arizona fires

Nineteen elite firefighters were killed on Sunday battling a blaze that is still only 45% contained. Their deaths have reminded us that the people suffering from these fires are not only those who lose their homes, but the people who are willing run into the flames to try to protect those homes. We’re learning about the hotshot teams specially trained to fight wildfires, an aspect of firefighting that was unknown to many people. I’ve been trying to imagine what it’s like to do what these teams do: go out to the fire, live near it for days, battling it while awake and smelling it while you sleep. I am in awe and very grateful.

 

More ‘scripts, more problems

This was a big week for news about prescription drugs. A brief rundown:

  • 70% of Americans take at least one prescription a day, mostly antibiotics, antidepressants, or painkillers
  • The number of fatal overdoses in women quadrupled between 1999 and 2010, and approximately 42 women die daily from overdoses
  • The FDA busted 1600 illegal online pharmacies

 

Hepatitis B Vaccine recall

Merck issued a recall this week for one lot of the Hepatitis B vaccine Recombivax. The issue is not with the vaccine itself, but with the glass vials that may easily crack. Merck is concerned about the sterility of the vaccine, and the FDA assures consumers there’s no need to be revaccinated if a doctor administered one of the recalled lot. The anti-vaccine websites I visited seem to have not picked this up yet, so maybe this vaccine news won’t be misconstrued. We can only hope.

In honor of yesterday's Fourth of July holiday, here's a little Katy Perry to get you dancing:

http://www.youtube.com/watch?v=QGJuMBdaqIw

Friday Five: violence, HPV, obesity, smog, Obamacare

Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week. Global rates of violence against women are alarmingly high

This week, the WHO released a study showing that more than 30% of women around the world have been victims of physical or sexual violence, particularly from their spouse or partner. The report also outlines the health issues associated with violence against women: death, depression, alcohol use, STIs, unwanted pregnancies and abortions, low birth weight babies. The WHO recommends that health care providers take violence more seriously. These findings remind us that violence is not a far away issue that impacts other people—all of the WHO regions have violence rates hovering between 23-38% (map). Whether we realize it or not, we all know women who have experienced violence against them, and we are all responsible for ensuring women have the education and mobility they need to keep themselves safe.

 

HPV rates are lower in teen girls thanks to vaccine

And now for some good news: the prevalence (number of cases currently in the population) of vaccine preventable HPV in teen girls has dropped 56% since the introduction of the vaccine. The ultimate goal is to have 80% of American children vaccinated in order to create herd immunity, meaning that enough people are vaccinated so the virus has nowhere to go. However, only about half of teen girls have gotten the necessary three doses of Gardasil or Cervarix. It’s time to stop stalling. Vaccinate kids and help prevent them from developing cervical, anal, or—as Michael Douglas reminded us—throat cancer.

 

AMA declares obesity a disease

The American Medical Association (AMA) voted this week to define obesity as a disease, identifying it as a complex issue that requires therapeutic medical treatment. They hope to reduce stigma and understand obesity to be a disease because it impairs some body functions. Critics denounced the decision, saying that because obesity is defined using BMI, it is not a precise diagnosis and that obesity has no specific symptoms of its own, only that it a contributing factor to other diseases. Although obesity is often characterized as a willpower and laziness issue, the resolution, as quoted in the New York Times, says:

The suggestion that obesity is not a disease but rather a consequence of a chosen lifestyle exemplified by overeating and/or inactivity is equivalent to suggesting that lung cancer is not a disease because it was brought about by individual choice to smoke cigarettes.

Hopefully, the AMA’s decision will lead to increased insurance reimbursement for obesity treatments, including nutritionists and gym memberships, as well as medical interventions and therapy.

 

Singapore is covered with smog

Fires in Indonesia are causing dangerous smog in the country and Singapore. Though no one has fessed up to starting the fires, they are likely due to illegal land clearing practices in Sumatra, which is west of Singapore. Today, Singapore’s Pollution Standards Index (PSI) hit 401, far higher than the “dangerous” level defined by a PSI of 300, and is considered “life-threatening” to the ill and elderly. Smog is a mixture of accumulated greenhouse gases and smoke, and is made worse by the combination of pollutants, sunlight, and heat that creates ozone. Smog causes serious respiratory, eye, and skin problems, and this smog is so thick visibility is seriously impaired.

 

Dems love the term “Obamacare,” Republicans don’t

The Kaiser Family Foundation June tracking poll shows that when referred to as “Obamacare,” 73% of Democrats responded favorably to the Affordable Care Act (ACA), as compared to 58% when the ACA was called “health reform law.” Republicans, however, saw an increase in unfavorable responses when the ACA was called “Obamacare,” from 76% to 86%. Apparently, the pejorative likely coined by none other than Mitt Romney has been successfully appropriated and turned into a rallying point for Democrats in support of the ACA. Obama is a linguistic master, and this shows he can turn even the most negative epithet into a compliment. Take that, Sarah Palin!

It's the first day of summer! This lion knows how to celebrate:

http://www.youtube.com/watch?v=mV1CVTPVAJg

Why Won't Portland Fluoridate?

Portland, Oregon votes tomorrow on whether or not to fluoridate its water supply. I’m fascinated by the ways people adopt non-mainstream beliefs, so I jumped right into the anti-fluoridation activism vortex and found a culture motivated by fear and a desire for purity. I started with the Fluoride Action Network (FAN). My first thought: these people have money. The site is nicely designed and full of videos so the information is accessible to all. FAN focuses on the idea of “mass medication,” arguing that adding fluoride to the public water supply constitutes forcing drugs on unwilling people. According to FAN, people with kidney disease are at particular risk for fluoride toxicity.   They say, “it is unethical to compromise the health of some members in a population to obtain a purported benefit for another—particularly in the absence of these vulnerable members’ knowing consent.” FAN interprets fluoridation as an attack on personal liberty, a medical harm, and an informed consent issue. They allude to a government conspiracy to medicate and dull the intelligence of the public through fluoride.

Then I found Clean Water Portland, a group dedicated to keeping fluoride out of the city’s water supply. The first reason Clean Water Portland gives for voting no tomorrow is that “Industrial byproducts don’t belong in our water.” The chemical in question is fluorosilicic acid (FSA), a waste product from fertilizer manufacturing. Associating water and fertilizer is a great way to increase skepticism. Just the phrase “industrial byproducts” seems sinister and contaminated.

Clean Water Portland also invokes parents’ anxiety about harming their children by citing the conclusions of a Harvard meta-analysis of Chinese studies on the relationship between fluoride and IQ. The studies found an approximately 7 point drop in IQ when children lived in communities with fluoridated water. The researchers in the Harvard study note that this is a preliminary analysis and that there may be other issues contributing to the IQ drop.

Clean Water Portland frames the link between fluoridated water and IQ by asserting that “in a large population such as Portland, a shift of 5 IQ points would cut the number of geniuses in half and double the number of mentally handicapped.” Whoa! A vote for fluoridation is a vote for robbing your child of genius status. How could you? This shows Clean Water Portland’s inclination toward using parents’ natural desire to protect their children as a means to maintain the “purity” of Portland’s water.

Finally, I arrived at the Facebook page of Fluoride Free Portland. It has 415 likes, and appears to be a somewhat active community of Portlanders sharing links and encouraging people to promote the anti-fluoridation message. “Clean” and “natural” are their most important buzzwords. The posts show the true fear and disgust some Portlanders have for fluoride. The page is littered with photos of FSA tanks labeled “corrosive” and “caution.” Political cartoons, quotations placed over images of pristine lakes, and photos of kids holding anti-fluoride signs adorn the page. Supporters call for their perspective to be included on the Portland Water Board website but get their information about the dangers of fluoride from unreliable sources.

Like other fringe health activist groups—I’m looking at you, anti-vaxxers—the anti-fluoride coalition exists in a world where there is a pure, clean version of life that is endangered by deceptive medicine and industry. While I believe we must have a healthy amount of skepticism, particularly regarding the motivations of corporations, the anti-fluoride groups seem to have abandoned reason. They subvert their own cause by their radical opposition. I think there are plenty of people who would be willing to have a conversation about informed consent and the potential health effects fluoride can have on vulnerable populations. The alarmism and guilt used by these groups makes the rest of us tune out their potentially valuable contributions to the conversation.

Whether Portland starts fluoridating its water is up to the voters. But we should keep an eye on the anti-fluoride movement. Anti-vaccine groups were not taken seriously at first, and now we have outbreaks of pertussis and measles. With the easy communication afforded by the Internet, anti-fluoride could become the next big health movement, and our teeth will suffer.