Last year, the Tacoma/Pierce County Board of Health voted to add fluoride to water systems throughout the county. Last year, not coincidentally, the Board of Health got itself sued. It had raised the ire of water providers and anti-fluoridation activists, which in turn raised the ire of Frederico Cruz-Uribe, director of the Tacoma/Pierce County Health Department, who never really liked fluoridation opponents anyway. "The tactic of the anti-fluoride folks is to wear you out, bombard you with misinformationand create confusion," he said in the county's newspaper, The News Tribune, on April 4, 2002. Fluoridation opponents would disagree with that characterization; they say their health and environmental concerns are scientifically supported. And when it comes to tactics, they'd put litigation high on the list, at least in Pierce County, Wa. Cruz-Uribe can be forgiven for the omission: in April, nobody had sued. That would come later.
Cruz-Uribe says he and the board expected opposition to the vote. But if he knew that lawsuits would ultimately greet the decision to fluoridate, he gave no hint of it when quoted in a June 2002 article in the ADA News, a publication of the pro-fluoridation American Dental Association.

The article, headlined, "Fluoride Mandate: Low-income Washington County to benefit," ran two months after the board's initial decision to fluoridate in April. (The work of anti-fluoridation activists soon forced the board to retract its vote and reconsider the issue in October, a story the ADA News missed.) In the article, a confident-sounding Cruz-Uribe acknowledged a handful of objectors to the April vote, but [f]or the public it was not a big deal," he said. "With water district people we had more intense discussion so that they could learn that managing fluoridation is a relatively simple process and a cost-effective way to battle a serious health problem in our county."
Yet, according to some polls, fluoridation may in fact be a big deal for members of the public living in the county's non-fluoridated communities. And "water district people" apparently haven't learned their lesson. Instead, 6 of the 14 water providers affected by the fluoride mandate sued the board, along with a citizens group and the City of Bonney Lake. The claimants will have their hearing on Feb. 14. There's a lot at stake: Pierce County Superior Court Judge Lisa Worswick's decision could determine whether 238,000 more people are drinking fluoridated water in 2004.

The anti-fluoridation movement was once the province of supposed conspiracy nuts and other ideological fringes of Americana typically deemed more freakish than credible. Government plots! Communist schemes! Mind control! God help us! The ominous warnings sometimes amused but didn't resonate with most Americans. However, a different strain of fluoridation doubts, dealing with the substance's supposed toxicity to human health and the environment, has, to a modest degree, entered the public dialogue via alternative publications such as Salon, Portland's Willamette Week and the Arizona Daily Sun. And in 2001, the Sierra Club recommended a national review of fluoridation, observing, "There are nowvalid concerns regarding the potential adverse impact of fluoridation on the environment, wildlife, and human health." Environmental concerns include reduced salmon populations. Human health worries range from cancer to poor bone health to neurotoxicity. And ingesting fluoride doesn't even prevent cavities, fluoridation opponents maintain.

While doubts about fluoridation haven't exactly gone mainstream, the concerns of health and environmental activists and organizations are attracting attention-in addition to credibility. Many communities, including Spokane, Bellingham, Wenatchee, Olympia and Kennewick, have voted against fluoridation.

Citizens of Pierce County may or may not have done the same, but they never had the chance. The county's health board, whose members are appointed officials, did the voting for them on the grounds that public health is not "a popularity contest," in the words of board chairman Kevin Phelps. The Tacoma/Pierce County Board of Health thus became perhaps the first government entity of its kind to mandate fluoridation without a public vote.

But, as noted, the board's self-acknowledged effort to set a precedent is being challenged by activists concerned about the health and environmental impact of fluoridation. Others object to what they see as a thwarting of public process, constitutional rights and democracy. And those six water providers are wary of fluoridation's costs and concerned about their autonomy. As a result, activists and water providers have pushed the fluoride fight into court-and into the mainstream, at least within the confines of a small county in western Washington.

The fluoridation fight began last March, when the board announced it would hold a vote on the issue when it convened the next month. "Our initial strategy was to get as many people as we could at the meeting," says Marianne Lincoln, president of Citizens Opposing Fluoridation in Pierce County (and a resident of Spanaway, one of the cities affected by the board's resolution). An estimated 100 people attended, and about 50 testified for three hours. "We were each given three minutes," Lincoln recalls. "The meeting went over 5 o'clock. Then two minutes were given." The board was unmoved. That night, it reached a unanimous decision approving fluoridation.

"I went to get the advice of an attorney immediately," says Lincoln, whose chemistry degree, fluoride allergy, political connections (she's run for the state legislature), and vocal opposition to fluoridation soon placed her at the forefront of the fluoridation challenge. Lincoln's attorney worked with counsel employed by Washington Citizens for Safe Drinking Water, a group coordinated by longtime anti-fluoridation activist Emily Kalweit. The attorneys insisted that the health board follow provisions of the State Environmental Protection Act (SEPA), legislation designed to ensure the environmental soundness of government decisions. As a result, when the board convened in June 2002, it said it would implement a study regarding the impact of fluoridation on the environment, including salmon populations, and human health.

"By going through the SEPA process," Lincoln says, " we would get all the evidence against water fluoridation on the record"-evidence that could be drawn on in the event of a lawsuit against the health board. They'd also forced the board to withdraw its fluoridation vote. Nonetheless, the prospect of an environmental review reportedly pleased the health department: Cruz-Uribe spoke of using the SEPA process to ensure a "slam-dunk" precedent. It is that threat of a precedent that worries fluoridation opponents. "Cities like Spokane and Olympia that have voted down fluoridation could have it forced on them anyway," Lincoln says.

Anti-fluoridation activists submitted more than 175 pieces of documentation ("Most of them were peer-reviewed, journal, scientific studies," Lincoln says) on fluoride's alleged effects on humans and the environment. But by August, the board had officially concluded that fluoridation presented no threat.

Meanwhile, pressure to fluoridate was mounting on water providers as well as cities, such as Bonney Lake, that operate their own water supplies. In May 2002, the health department had offered $840,000 to providers who agreed to participate in fluoridation. Later it upped the ante to $1.04 million. (Some of the matching funds came by way of a grant from the Washington Dental Service Foundation, supported by the Washington Dental Service, an insurance company.) To receive funds, providers had to commit to fluoridation by signing a letter of agreement. The agreement included language that prohibited them from participating in legal challenges against the mandate. "We don't think that that is a proper action by a government agency, to threaten to withhold funds if we were to utilize our constitutional right to challenge [its] authority," says Parkland Light & Water Co. general manager Jim Sherrill. In June, he told the board: "Your blackmailing us to withhold funds is laughable. I can tell you now that people are going to file suit."

The board also voted to impose a $250-a-day fine on water districts that hadn't signed the agreement by Jan. 1, 2003.
But water providers had plenty of incentive to not fluoridate-and that's why, in Pierce County, the fluoride fight has united two groups who ordinarily might qualify for strange bedfellows: activists worried about the health and environment and water providers, whose fluoridation concerns partially stem from cost. Water provider employees have publicly stated that the board's estimate for implementing fluoridation, $1.5 million, is far too low. "I think it would be generally fair to say we believe that the actual implementation cost would be two to three times what the health board has estimated," Sherrill says. Parkland, he added, estimates that its equipment-installation cost would be approximately $200,000­250,000. The board of health stands by its original estimate, says Cruz-Uribe. That number excludes maintenance costs, which Parkland estimates could reach $80,000 a year for its utility alone.

Of course, if water providers are faced with increasing costs, so are their customers. With the addition of fluoride to their water supply, Pierce County residents will have higher utility bills. "We're in a downturn in the economy in the state of Washington," says Bob Young, Bonney Lake's mayor. "And then to have this kind of cost mandated to us-I take offense at that." The board maintains adding fluoride to the water supply is the cheapest way to achieve dental health. Young disagrees. "I would like to see other ways to accomplish this-topical applications, working with the schools-that are less costly to the community." In Bonney Lake, water customers will pay an average of $16 a month after a 20 percent increase.

When the city polled its residents; 72 percent of respondents said that "they didn't want any part of this," says Young. How pervasive that sentiment is in Pierce County is hard to say. In March 2002, a health board survey showed that 78 percent of Pierce County residents supported fluoridation (half of the county's citizens are already drinking fluoridated water). But that number hasn't been echoed in subsequent polls conducted after March, such as Bonney Lake's, that individually surveyed communities affected by the fluoridation mandate. In the city of Steilacoom, 65 percent of survey respondents said they were opposed to fluoridation. Edgewood's water company found that 87 percent of its customers didn't want fluoride added to their water, judging from the customers that returned their surveys. Sixty-eight percent of Summit Water Supply Co.'s survey respondents reached the same decision, as did 75 percent of Lakewood's.

Regardless, at its October 2002 meeting, the board again voted unanimously to approve the fluoridation mandate, despite the dissenting testimony of citizens, nurses, general managers from water providers, city council members, a mayor, a deputy mayor and a state senator. A News Tribune article published before the vote reported that the board would "reconsider" the fluoridation mandate; yet an Oct. 4 News Tribune editorial, published after the meeting, described a "yawning board" prepared to "spit out a unanimous pro-fluoride vote." Amid the niceties of democratic process, was the board bored? Cruz-Uribe says no. "What happened was that people got up and said the same thing they'd said three times before," he explains, adding, "It wasn't something that stimulated a great deal of discussion."
Recalls Lincoln: "They sure looked bored."

So anti-fluoridation activists and water providers changed their governmental venues of dissent-as they'd prepared to do for months. After the board's October vote, four lawsuits were announced in quick succession. Five water providers (Summit Water Supply Co., Parkland, Fruitland Mutual Water Co., Spanaway Water Co., and Mountain-View Edgewood Water Co.) were the first to sue. Days later, the Lakewood Water District and Citizens Opposing Fluoridation in Pierce County had also filed separate lawsuits against the board. Bonney Lake, which acts as its own water provider, was next.

At a Dec. 13 Superior Court hearing, the lawsuits were combined to form a single legal action. Neither the claimants nor the board protested the decision. Both sides, eager to expedite the process, had finally found something to agree on.

Despite the SEPA review, fluoridation's alleged health risks don't lie at the crux of all parties' legal complaints against the board. While Citizens Opposing Fluoridation in Pierce County's complaint does address health and environmental ramifications of adding fluoride to the water supply, it also says that the board overstepped its authority in issuing the mandate. Water providers are silent on the health and environmental concerns shared by many activists. They allege that the board couldn't legally mandate fluoridation; had no right to demand that nonprofit, private providers fund the project; and was unconstitutional in zeroing in on those serving 5,000 or more customers. And Bonney Lake officials have said that the fluoridation mandate undermines residents' constitutional due process rights to "refuse medical treatment and to preserve their bodily integrity."

"Here's the problem across the country: if you oppose [fluoridation]as a chemical or medicinal factor to the people, there's enough on both sides to bring it to a stalemate, and it goes no where in a court," says Bonney Lake Mayor Bob Young. "So for us to oppose it on a chemical or medical basis is not going to get us anywhere."

Despite some differences, anti-fluoridation activists are glad that water utilities and Bonney Lake have found some common ground. "The really cool thing in this particular situation is that we have the water companies coming up against [the resolution]," says Lincoln, adding that the health department can't easily use discrediting labels like "extremist" when water providers are among fluoridation's opponents. "We actually sought their help," she says.

While the anti-fluoridation claimants await their Valentine's Day hearing, activists have sought a new audience for their concerns: elected representatives. "Over the next few weeks political parties will be holding caucuses, selecting their party leaders and platform agendas," Lincoln told activists via email in January. "If you have the opportunity, participate" and propose a resolution requiring that fluoridation is subject to a vote by elected representatives or the public. Anti-fluoridation activists may also lobby representatives on the issue. "We need to outlaw the fluoridation mandate in our state ... and others, before this idea spreads," wrote Lincoln, adding that activists addressing representatives should focus on the public's right to a vote and the right of communities to refuse fluoridation. Focusing on the toxic impact of fluoridation could incite "smear tactics" and attract the attention and pocketbooks of well-funded pro-fluoridation organizations, she noted.

Of course, pushing for the right of the public to vote on fluoridation will ensure that, outside the courts and legislature, activists will have to continue to bring health and environmental concerns to the fore. And they probably won't have the help of water providers to do it. "Parkland Light and Water is not inherently opposed to fluoride," Sherrill notes. "What we are objecting to is that an appointed health board is mandating the use of fluoride and our customers are not given a vote on the matter." (Parkland hasn't polled its customers.) Lakewood has said that if it wins its fluoridation lawsuit, then it will pass the fluoridation question to the voters in its district.

To sway public opinion, Citizens Opposing Fluoridation in Pierce County is seeking out speaking opportunities at Rotary Clubs and community associations. "I've been chatting with people on how to pare [their presentations] down-it's hard to do this in 15 minutes," Lincoln says. The group has also hung anti-fluoridation banners by high-traffic roads and is looking into advertising, including billboards. "People can throw away a newsletter," she notes. Citizens Opposing Fluoridation in Pierce County hasn't hired an ad agency-there's not much money, and what funds the group has are mostly used to pay lawyer fees. Litigation is costly, but, for now, activists believe it's the key to stopping fluoridation in Pierce County.

But what if the claimants lose? Bonney Lake doesn't have an answer yet. Utilities will likely reach the decision individually. Citizens Opposed to Fluoridation in Pierce County already says it won't quit the fluoridation fight. "We will appeal until we win," Lincoln says. Uribe-Cruz promises the board will do the same.

Look for an update on the fluoride fight in the March issue of Greener.