I want to make some comments on this proposed ordinance as it relates to both process and substance. How did we get here and what are the arguments for and against fluoride use in our public water systems.
First on process, there is no way to describe the process we have engaged in to reach today a second reading on this ordinance as other than flawed, mistaken, and a disservice to our residents.
To begin with, we agreed on a list of 56 priorities for Council to address back in May and fluoride was not among them. It was not even mentioned at that time by any of us here on the dais. On October 6, during the informal “Communications” portion of our meeting, the issue of fluoride was raised for the first time even though it was not on our agenda that day nor had it ever been noticed on any prior agenda for discussion. By a narrow 4-3 consensus, there was an effort to immediately vote on a ban, without noticing, which was prevented only by our city attorney stating that this was not possible since we already had an ordinance in effect providing for fluoride use. The City Attorney was then instructed by the same majority to bring back an ordinance that would remove the existing ordinance and ban fluoride in our city water supply.
A first reading then occurred on November 6, and today we have a second reading. All in less than two months. If only we would move with such speed in addressing issues like resiliency and flood mitigation, water quality, or better approaches to land use planning.
Why did this happen? It occurred because we allowed an out-of-town special interest group to cut in line and move to the head of the line in front of our other 56 priorities to advocate for their issue. And we didn’t give ourselves or our residents the benefit of what we have always considered to be the “regular order” of how we do business by scheduling a workshop and asking our staff to engage in research necessary to bring us information on all sides of this issue. Instead, we moved immediately to consideration of this ordinance at a time when residents were still returning to town for season. There was no effort to make residents aware that we were considering this matter. Why the rush to judgment on this matter?
When word finally began to get out, eight HOA presidents, representing 80 or more percent of the city’s population, asked us to pause consideration of this ordinance until a more full discussion could take place. Their plea was simply ignored.
As one community leader said to me, “one couldn’t have designed a more non-transparent, biased process if one tried”. And as another said to me when I urged her to come and make public comment given her strong feelings on this matter, “Why should I take the time to do that? The game has been rigged and the decision has been already made?” In my many conversations in our community, that is a common view on this matter.
It has been suggested from this dais that this second reading provides the opportunity for the public comment and input that has been requested. After the first reading, which few in our community outside our special interest advocates knew was occurring, I asked the city clerk to look back 10 years at all the ordinances that city council passed and whether any votes changed from first to second reading. Her research revealed that 199 ordinances were passed between 2014 and the present, and there was not one time when the vote changed on second reading. I suppose there is always a first time and I hope it happens today, but history would not suggest that second readings are the time when open, thoughtful discussion can and does occur and questions can be asked. That is why we have workshops.
Now, let me move to substance. We have received 100 or so emails from individuals urging us to ban fluoride. Each email is essentially a replica of the others, part of a robo-email campaign by the special interest ban fluoride advocacy group. And the ban fluoride campaign essentially makes three arguments as to why this action should take place:
- First, they point to a recent National Toxicology Program report that identifies a link between fluoride and lower IQ in children. To be precise, the NTP report actually tentatively concludes with “moderate confidence” that fluoride levels of 1.5 mg/L or higher may be associated with lower IQ. Let’s remind ourselves that the level of fluoride provided in public water systems (including Naples), and recommended by the U.S. Government, is .7 mg/L. Thus the report’s suggested possible correlation between fluoride and IQ is based on applications of fluoride more than twice the recommended and actual level in public water systems across the country. In short, it is not based on real proactice. And as a side note, the NTP reviewed 72 studies to compile this report, of which the NTP itself said only 19 had a low risk of bias, none of which had been conducted in the United States.
- Second, the ban fluoride advocates cite a recent Federal Court ruling from the Northern District of California that found that fluoridation of drinking water at levels typical in the United States poses an unreasonable risk of reduced IQ in children. But if you read a sentence or two further in the opinion, the Judge states that this finding “does not conclude with certainty that fluoridated water is injurious to public health, rather there is unreasonable risk…. that is sufficient to require the federal government/EPA to engage in a regulatory response”. To translate, the judge is asking the federal government, in this case the applicable agency, the EPA, to take this matter under advisement, study it further, report its findings, and modify its guidance if appropriate. This is a sound and sensible process that occurs all the time within our judicial and administrative systems. It does not constitute an order to ban fluoride.
- Third and finally, the special interest advocates for banning fluoride cite the principal of “informed consent” as a basis for prohibiting fluoride use in our public water. They cite Florida Statute 381.026 as the basis for this contention. Based on my research, they are misapplying that statute, which purpose is to ensure full transparency and access to information in private health care decisions, to the matter of fluoride use. It is unlikely that anyone would get far in any court of law using that argument.
Veiled threats by the ban fluoride advocates that we are in legal jeopardy if we continue to use fluoride in our water system are baseless. Ask our city attorney. There is no law at any level that requires us to ban fluoride just as there is no law requiring us to use it.
So the three basic arguments the “ban fluoride” advocacy group is making are weak reeds indeed to lean on. A report that makes tentative findings based on a level of fluoride more than twice the level actually found in our public water systems; a federal district ruling that has no enforcement power but simply asks EPA to study this issue further, and a legal theory that actually has no application to the matter at hand. And this is the primary “evidence” on which we are expected to take action to ban fluoride!
I do agree with the “ban fluoride” advocates in one respect. This matter, like all important public health issues, should continue to be investigated by credible government, educational, and research organizations through peer reviewed studies. We will learn more and be able to make informed decisions as to whether to modify current guidance or whether it reinforces current judgments. This is how public health decisions on a wide range of matters actually are made in the U.S. and should continue to be made, not through knee-jerk decisions and non-transparent processes.
In closing, let me state some real facts about fluoride use in Naples, the larger geographic area we serve, and America as whole. This information includes reasons why there are strong substantive reasons why fluoride should continue to be provided in our water system because of the health benefits it provides:
- Naples approved use of fluoride in our water system in 1950, almost 75 years ago. It was debated and upheld in a public referendum in 1955.
- Over time, the city began to provide public water to areas outside the city. We estimate that the population we serve during peak season to be 82,783 people, divided approximately evenly between city and county residents and visitors.
- Fluoride is a mineral that is naturally present in all water. It is not a medication. Over time, research found that at appropriate levels it had significant beneficial effects in reducing cavities and improving oral health. It strengthens and re-mineralizes enamel and prevents an acid-breakdown that leads to cavities. Research has shown it decreases tooth decay in children and adults by 25%
- These benefits have been confirmed by hundreds of peer-reviewed studies carried out by credible U.S. as well as international based researchers and organizations.
- Today an estimated 209 million people, or 72 % of the people served by public water systems, have fluoride in their water systems. This has been a major public health benefit to our country as it is a cost-efficient way to provide this cavity-fighting aid to a wide population but especially to people and communities that need it most because they lack health insurance, access to dentists, or do not always practice good oral care at home.
- The people who know the most and best about this subject strongly defend this practice: the American Dental Association, the American Academy of Pediatrics, the American Medical Association, and the list goes on and on. They have no economic self-interest. More cavities would mean more business for dentists.
- Fluoride toothpaste is a complement not a substitute to fluoridated water. Fluoride toothpaste actually provides a higher concentration of fluoride at certain times of the day or evening if used. We can debate forever how well people of all stripes practice good oral health care at home (remember the admonition, “brush your teeth three times a day” even though national surveys show a majority of Americans brush once a day or less). Fluoridated water provides these benefits to all for the common good.
- Finally, our meager agenda packet provides a business impact statement for this ordinance, as required now under state law for all local ordinances that we pass. If only we would do a Human Impact assessment of this ordinance and try to calculate the harm that it would bring, especially to those lacking health and especially dental insurance and families balancing stressful work and income realities in their lives. As usual, those who can afford it least will be hurt the most if this ordinance passes.
In summary, I believe the passage of this ordinance will be a step backward not forward for public health in Naples and the portion of Collier County we serve. My request is that we continue this second reading until we have a properly noticed workshop on this matter when people on all sides of this issue can attend and speak. As part of this, staff can be directed to research and provide information that they believe would be relevant for us to have in order to make an informed decision on this matter.
Thank you.