In the latest in a series of emotionally charged battles throughout California over water fluoridation, voters in Redding will decide Tuesday whether to prohibit the addition of the chemical compound to their water system.
On one side of the argument is the medical and dental establishment in this city of 85,000, including its two major hospitals, its large community health center and a number of prominent dentists and pediatricians. Fluoridation is an essential tool in preventing tooth decay for all ages and socioeconomic levels, they argue.
On the other side is a small but vocal group of activists whose rallying cry is, "Don't mess with our drinking water."
"I don't like anybody telling me what to eat and drink," said Betty Doty, a family counselor and a Redding resident for 50 years. She said most people who promote the measure want "the right of choice" over whether to drink fluoridated water.
Measure A, put on the ballot through a citizens initiative, would prohibit the addition of "any substance or chemical for the purpose of treating the physical or mental functions of any person" unless the chemical is approved by the U.S. Food and Drug Administration. The FDA has no jurisdiction over water quality issues.
The measure does not specifically mention fluoride.
But the initiative drive was prompted by a City Council decision last year to approve fluoridation, pending an examination of the costs. A 1995 state law requires fluoridation in communities with at least 10,000 water connections if money is available from sources other than taxpayers or water system bondholders.
The California Department of Health Services is not campaigning against the anti-fluoridation measure, said Dr. Kathleen Acree, the agency's chief of chronic disease control.
But, she added, "the state Legislature has expressed its intent that fluoridation is a good thing and ought to be done in California, particularly since we are one of the lowest-ranking states" in terms of how many people drink fluoridated water.
However, Michel Czehatowski, a Redding acupuncturist and herb store owner who is leading the anti-fluoride campaign, complained that "all of a sudden there was a vote, with virtually no public discussion" about whether fluoridation was wise.
Dean Germano, chief executive officer of the Shasta Community Health Center and leader of the pro-fluoride group, said those pushing for Measure A use fear as their best tool.
"They know they can't win on the science, but what they do is bring up a laundry list of scare tactics: Alzheimer's, cancer, brittle-bone disease," Germano said. "What you want to do in an election is just put a little doubt out there." He said polls show pro-fluoride sentiment holding a slight edge.
Fluoride started being added to community water systems in the United States in 1945. Nationwide, about two-thirds of the population lives in areas where the water is fluoridated. Forty-two of the 50 largest cities, including Los Angeles, Washington D.C., New York and San Francisco, are fluoridated.
California is far behind the rest of the country in fluoridation rates; only about one-third of the state's population has fluoridated water.
Redding, 160 miles north of Sacramento, has never had it.
Proponents of fluoride point to its widespread use as proof that it is safe.
"After 50 years, 150 [million] or 160 million people routinely using fluoridated water -- where are the bodies?" Germano said.
The anti-fluoride efforts in Redding and other California cities have been led by, or greatly assisted by, a San Diego-based group called Citizens for Safe Drinking Water.
Jeff Green, the group's director, said the Redding initiative is not about fluoride, though that is the focus of fliers being circulated there. The fluoride compound the city would use, fluorosilicic acid, is a "hazardous waste" with contaminants such as arsenic that would have to be removed, Green said.
He said fluoride has been linked to hip fractures and lead poisoning in children, among other things. "There seems to be plenty of evidence out there, but [the media] are not reporting it."
Germano called such conclusions "junk science fed by the Internet."
Dr. David F. Nelson, a fluoridation consultant with the state Health Services Department, said the amount of arsenic sometimes present in fluorosilicic acid is minuscule -- "way, way, way below the standard allowed" -- and presents no danger.
The fluoride feud has made its way to other California cities. Last year, Modesto voters said no to fluoridation. Santa Cruz voted against it in 1999. The City Council in Santa Barbara rejected it the same year. This year, a measure is on the ballot in Watsonville, just south of Santa Cruz.
What may be lost in the imbroglio is the reason for fluoridation: the state of Redding residents' teeth.
Water fluoridation reduces cavities as much as 60% in children and nearly 35% in adults, according to the American Dental Assn. And it is cheap; the additive would cost Redding residents an estimated $1.08 a month per hookup.
"I think it's tantamount to reducing the amount of decay present," said Dr. Gus Petras, a pediatric dentist who has been practicing for 26 years in Redding.