Robert F. Kennedy Jr. said this month that the new Trump administration would recommend removing fluoride from public water supplies. The suggestion that fluoride was unsafe was immediately criticized by many public health experts as anti-science misinformation.
But there’s a real danger to painting everyone with concerns about fluoride as a conspiracy theorist. It’s not that we should remove fluoride from tap water (we shouldn’t), but fluoride is a complex topic, and glossing over that complexity — as public health experts and agencies often do — leaves people understandably skeptical.
Public health agencies typically tell people what to do and what not to do, but they don’t regularly explain why — or why people might hear something different from others. They also often fail to prioritize. In the end, advice for a range of topics is delivered with the same level of confidence and, seemingly, the same level of urgency. The problem is that when people find one piece of guidance is overstated, they may begin to distrust everything.
Consider three topics of much public discussion: measles vaccines, raw milk and water fluoridation. All three represent fault lines between what is said by public health agencies and by Mr. Kennedy and other skeptics. Where their messages differ is in the strength and complexity of the evidence.
Measles vaccines have decades of safety data and save lives every day. Concern about autism has been conclusively debunked in large and reliable data sets. Measles is extremely contagious, and without widespread vaccination, many people — including babies — will be vulnerable to infection and some will die.
The case of raw milk is more complex. Raw milk is more likely to cause disease than pasteurized milk. Pasteurization kills pathogens and makes milk safer, especially milk that is shipped and stored for longer periods. In the early 1900s, raw milk was responsible for significant tuberculosis outbreaks. Even now, more illness is caused by unpasteurized than pasteurized dairy.
However, the number of illnesses are small. Although about an estimated 11 million people in the United States consume raw milk, it causes an average of only 760 illnesses per year, according to a 2017 estimate. In 2023 and early 2024, there was a salmonella outbreak linked to raw milk from one farm, though it resulted in fewer infections than a similar outbreak involving cantaloupe around the same time.
It should be said: There is no good evidence of any health benefits associated with raw milk. But the overall picture here is of a slightly elevated risk, and one that is in the range of other risks people take, especially for healthy individuals. (A particular concern has been raised about bird flu being spread through raw milk; although this seems possible in mice, we haven’t seen cases derived from raw milk in humans yet.)
Finally, water fluoridation. Fluoride has been shown in numerous studies to reduce dental problems in kids. While evidence on the impact of municipal water in the United States is more limited than ideal, recent data from Israel — where water fluoridation was ended in 2014 — shows an increase in dental work for 3- to 5-year-olds.
Some have raised concerns that water fluoridation may pose a risk of neurodevelopmental problems, particularly for pregnant women and young children. This has been widely studied. At high levels, fluoride does appear to affect development. There are areas in China where levels of fluoride in the water are as much as four times as high on average as what the World Health Organization considers safe. In these settings, increases in fluoride are linked to decreases in I.Q. However, studies examining lower fluoride levels similar to those typically found in U.S. cities show no such effects.
As with many things, the dose matters. Overall, water fluoridation has benefits and is safe at the levels we use in the United States.
My suggestion is that when asked about these topics, health experts provide this level of detail. Simply saying that vaccines are good and raw milk is bad misses specifics that people find important. People often do their research, and if they feel the risks of raw milk have been exaggerated, it can erode their trust. Now perhaps that person is more likely to distrust the vaccine messaging, too. With more information, we provide room for people to drink raw milk but also vaccinate their kids. Which is, basically, a reasonable choice.
Providing context also helps people make sense of new information. People have been alarmed by a 2019 study from Canada on water fluoridation that raises concerns about exposure in pregnancy. If we tell people only that “fluoride is safe,” then studies with different findings seem contradictory and, again, trust is lost. But with more detail on what the bulk of the research shows, people can understand that most studies do not support the notion that fluoride is unsafe. (In that particular study in Canada, for example, the results vary for verbal and performance I.Q. as well as gender, raising questions about the validity of the findings as a whole).
Deservedly or not, public health authorities lost a lot of trust, especially during the pandemic, and they have struggled to get it back. This has left an opening for others. The reaction from public-health officials often seems to be to yell the same thing, only more loudly. This isn’t working.
Being more nuanced will not be easy for public health agencies. They need to put more trust in their audience. This means communicating that sometimes the evidence is uncertain or complicated and may change over time. It may mean acknowledging that reasonable people may make different choices on a given issue.
It also requires health authorities to recognize that prioritizing this messaging means making trade-offs. If health experts share a more balanced message about raw milk, more people might drink raw milk. And, yes, that does entail some increased risk. I am arguing that in exchange you may get higher measles vaccination. It’s not a perfect scenario, but it may mean that fewer people get sick and die. Which, after all, should be the ultimate goal.
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