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Column: Trump's anti-science backers go after water fluoridation, a historic healthcare success

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Column: Trump's anti-science backers go after water fluoridation, a historic healthcare success

Regular visits to the dentist to fill cavities used to be a shared ordeal for millions of American children and adults. The reason that hasn’t been the case for late baby boomers and subsequent generations is that the fluoridation of drinking water became common starting in the late 1940s and continuing today.

So it’s right to question why Donald Trump’s nominee to head the Department of Health and Human Services, Robert F. Kennedy Jr., has placed the ending of fluoridation atop his list of first-day initiatives in his campaign against American public health.

“On January 20,” Kennedy tweeted a few days before the election, “the Trump White House will advise all U.S. water systems to remove fluoride from public water.”

‘Fluoridation is the most monstrously conceived and dangerous Communist plot we have ever had to face.’

— The unhinged Gen. Jack D. Ripper in the 1964 film ‘Dr. Strangelove’

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The reason, he asserted, is that “fluoride is an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid disease.”

That’s all flatly untrue or grossly misleading. Kennedy’s screed against fluoridation is part and parcel of a policy package that has legitimate scientists warning of a public health catastrophe in the making.

Fluoridation of tap water has generated local controversies ever since it was introduced in the U.S. in 1945. But it remains fully supported by a majority of Americans and by professional organizations including the American Dental Assn. and the American Academy of Pediatrics. That suggests that the proper stance of a Health and Human Services secretary would be to voice support for the practice. Kennedy has done just the opposite.

According to the Centers for Disease Control and Prevention, fluoridation is one of the 10 great public health achievements of the 20th century, up there with vaccination, family planning and recognition of the health dangers of tobacco.

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Fluoridation revolutionized dentistry, especially for children. Fluoridation of tap water was credited with reducing the incidence of tooth decay by as much as 70% when it was first introduced; by the mid-1980s, when other sources of fluoride, such as fortified toothpastes, were available, the effects of tooth decay in children were still 18% lower among those living in fluoridation communities than in those without it.

Who would benefit from the end of community fluoridation and a recrudescence of tooth decay? Dental supply companies, investors in which are rubbing their hands in glee at the prospect of more demand for their products. For example, shares of Henry Schein Inc., a distributor of specialty dental products, have risen more than 9% since RFK Jr. was named as Trump’s choice for HHS secretary.

Kennedy’s tweet about fluoridation exemplifies the anti-vaccine crowd’s method of casting doubt on established public health policies. There are two elements. One is to portray rare adverse health effects — some so rare that their very existence is questionable — as major and acute threats. The second is to downplay the beneficial effects of a policy. That leaves the public believing that the policy has only adverse effects, and that those are immediate and severe.

Tooth decay is a little-recognized public health problem, in part because fluoridation has made it rarer than it used to be. But it hasn’t disappeared. The American Academy of Pediatrics calls it “one of the most common chronic diseases in children,” and one that can have “lifelong consequences.” It disproportionately affects children who are racial minorities, come from low-income families or have special needs.

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It’s not only about the occasional toothache or cavity needing filling. Tooth decay can produce “incapacitating pain,” bacterial infection that may spread throughout the body, and, of course, to the loss of a tooth. In the first part of the last century, the only remedy for decay was to pull the tooth.

As of 2012, two-thirds of Americans had access to fluoridated tap water. Thanks to fluoridation, the CDC says, “tooth loss is no longer considered inevitable, and increasingly adults in the United States are retaining most of their teeth for a lifetime.”

More baby boomers reached 60 with “a relatively intact dentition at that age than any generation in history,” the CDC says. Interestingly, that makes water fluoridation more important than ever, since it means that seniors have more teeth vulnerable to decay than before.

Communities that have ended fluoridation have seen dental illnesses soar. Since fluoride was removed from drinking water in Calgary, Alberta, Canada, in 2011, Alberta Children’s Hospital has seen dental infections requiring treatment with IV antibiotics increase by 700%, a hospital specialist told the City Council in 2019. Half of those infections were in children younger than 5.

Windsor, Ontario, Canada, voted in 2018 to resume fluoridation five years after it had ended the program, after discovering that the number of children with tooth decay or oral conditions requiring urgent care had increased by 51% in the interim.

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Opponents of fluoridation have played on paranoid fears for decades, but into the 1960s, these were popularly dismissed as ravings from fringe organizations. In the 1964 film “Dr. Strangelove,” the unhinged Gen. Jack D. Ripper declares that “fluoridation is the most monstrously conceived and dangerous Communist plot we have ever had to face” — echoing the position of the John Birch Society.

The anti-fluoridation camp has long claimed that the process “increased the risk for cancer, Down syndrome, heart disease, osteoporosis and bone fracture, acquired immunodeficiency syndrome, low intelligence, Alzheimer disease, allergic reactions, and other health conditions,” the CDC noted in 1999. “No credible evidence supports an association between fluoridation and any of these conditions,” the agency stated.

More recently, critics object that fluoridation “is being imposed on them by the states and as an infringement on their freedom of choice,” the National Research Council reported in 2006 — similar to the elevation of individual “freedoms” over communal interests that animates the anti-vaccine movement.

The anti-fluoridation camp scored a legal victory in September, when federal Judge Edward M. Chen of San Francisco, an Obama appointee, ordered the Environmental Protection Agency to review its safety standard for fluoridation in tap water. Chen concluded not that “fluoridated water is injurious to public health” but that “there is unreasonable risk of such injury,” triggering a legal mandate that the EPA take a closer look.

Chen’s findings were heavily based on a government study with a checkered research history. More on that shortly. Despite the limitations of his order, it may well be taken as a validation of suspicions about fluoridation.

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What of RFK Jr.’s roster of adverse health effects? Let’s take them one by one. To begin, although fluoride can be a byproduct of industrial processes, it’s also a mineral naturally present in soil, groundwater, plants and food.

Arthritis? The National Research Council’s 2006 analysis of government fluoride standards identified “no indications” in the existing scientific literature implying “that fluoride had a causal relationship with … rheumatoid arthritis.”

Bone fractures? The 2006 analysis determined that the leading evidence for fluoride’s effect on bone strength pointed to lifetime exposure to fluoride at concentrations at or exceeding 4 milligrams per liter, which is more than five times the concentration in fluoridated tap water. The effect was found chiefly in people prone to concentrating fluoride in their bones, such as those with kidney disease.

Bone cancer? The main source of this claim appears to be a 15-year study led by the Harvard School of Dental Medicine, published in 2006 in the journal Cancer Causes and Controls.

In the same issue of the journal, however, two Harvard experts cast doubt on the study, noting that the original researchers were unable to replicate their findings when they repeated their study with new subjects. The results, they said, “do not suggest an overall association between fluoride and osteosarcoma” (that is, bone cancer).

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Evidence of “thyroid disease,” as Kennedy tweeted, is similarly inconclusive, especially at the approved levels of fluoride in tap water.

That brings us to Chen’s ruling in the San Francisco lawsuit. His findings relied heavily on a monograph by the National Toxicology Program first published in 2019. The paper initially concluded that “fluoride is presumed to be a cognitive neurodevelopmental hazard to humans,” based on findings that children exposed to high concentrations of fluoride showed lower IQs than others.

The survey focused on the effect of water with more than 1.5 milligrams of fluoride per liter, more than twice the approved level in the United States. It acknowledged that it had only “moderate confidence” that such concentrations could result in lower IQs, and stated that it had “insufficient data” to determine that the 0.7 mg/liter concentration in fluoridated tap water affects IQ.

There were lots of problems with the National Toxicology Program’s monograph. Two peer reviews by the National Academies of Sciences, Engineering, and Medicine essentially ripped it apart, rejecting it both times. The program “had not adequately supported its conclusions,” the peer reviewers wrote.

The monograph lacked a “rigorous statistical review.” The reviewers recommended that the program “make it clear that the monograph cannot be used to draw any conclusions regarding low fluoride exposure concentrations … typically associated with drinking-water fluoridation.” Among other changes in the final monograph published this summer, the program removed references to a “neurodevelopmental hazard to humans.”

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Critics also pointed out the inherent problems with treating IQ as an all-purpose measure of intelligence, since it’s well-known that IQ can be affected by “socioeconomic, physical, familial, cultural, genetic, nutritional, and environmental factors,” the American Academy of Pediatrics observes.

Kennedy’s mindset is curious: He has promoted treatment of COVID-19 with ivermectin and hydroxychloroquine, which have been proven to be useless for the purpose, but he campaigns against fluoridation, which has demonstrated a health benefit over nearly eight decades. Is this any way to run a public health agency such as the HHS?

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A tale of two Ralphs — Lauren and the supermarket — shows the reality of a K-shaped economy

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A tale of two Ralphs — Lauren and the supermarket — shows the reality of a K-shaped economy

John and Theresa Anderson meandered through the sprawling Ralph Lauren clothing store on Rodeo Drive, shopping for holiday gifts.

They emerged carrying boxy blue bags. John scored quarter-zip sweaters for himself and his father-in-law, and his wife splurged on a tweed jacket for Christmas Day.

“I’m going for quality over quantity this year,” said John, an apparel company executive and Palos Verdes Estates resident.

They strolled through the world-famous Beverly Hills shopping mecca, where there was little evidence of any big sales.

John Anderson holds his shopping bags from Ralph Lauren and Gucci at Rodeo Drive.

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(Juliana Yamada / Los Angeles Times)

One mile away, shoppers at a Ralphs grocery store in West Hollywood were hunting for bargains. The chain’s website has been advertising discounts on a wide variety of products, including wine and wrapping paper.

Massi Gharibian was there looking for cream cheese and ways to save money.

“I’m buying less this year,” she said. “Everything is expensive.”

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The tale of two Ralphs shows how Americans are experiencing radically different realities this holiday season. It represents the country’s K-shaped economy — the growing divide between those who are affluent and those trying to stretch their budgets.

Some Los Angeles residents are tightening their belts and prioritizing necessities such as groceries. Others are frequenting pricey stores such as Ralph Lauren, where doormen hand out hot chocolate and a cashmere-silk necktie sells for $250.

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People shop at Ralphs in West Hollywood.

People shop at Ralphs in West Hollywood.

(Juliana Yamada / Los Angeles Times)

In the K-shaped economy, high-income households sit on the upward arm of the “K,” benefiting from rising pay as well as the value of their stock and property holdings. At the same time, lower-income families occupy the downward stroke, squeezed by inflation and lackluster income gains.

The model captures the country’s contradictions. Growth looks healthy on paper, yet hiring has slowed and unemployment is edging higher. Investment is booming in artificial intelligence data centers, while factories cut jobs and home sales stall.

The divide is most visible in affordability. Inflation remains a far heavier burden for households lower on the income distribution, a frustration that has spilled into politics. Voters are angry about expensive rents, groceries and imported goods.

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“People in lower incomes are becoming more and more conservative in their spending patterns, and people in the upper incomes are actually driving spending and spending more,” said Kevin Klowden, an executive director at the Milken Institute, an economic think tank.

“Inflationary pressures have been much higher on lower- and middle-income people, and that has been adding up,” he said.

According to a Bank of America report released this month, higher-income employees saw their after-tax wages grow 4% from last year, while lower-income groups saw a jump of just 1.4%. Higher-income households also increased their spending year over year by 2.6%, while lower-income groups increased spending by 0.6%.

The executives at the companies behind the two Ralphs say they are seeing the trend nationwide.

Ralph Lauren reported better-than-expected quarterly sales last month and raised its forecasts, while Kroger, the grocery giant that owns Ralphs and Food 4 Less, said it sometimes struggles to attract cash-strapped customers.

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“We’re seeing a split across income groups,” interim Kroger Chief Executive Ron Sargent said on a company earnings call early this month. “Middle-income customers are feeling increased pressure. They’re making smaller, more frequent trips to manage budgets, and they’re cutting back on discretionary purchases.”

People leave Ralphs with their groceries in West Hollywood.

People leave Ralphs with their groceries in West Hollywood.

(Juliana Yamada / Los Angeles Times)

Kroger lowered the top end of its full-year sales forecast after reporting mixed third-quarter earnings this month.

On a Ralph Lauren earnings call last month, CEO Patrice Louvet said its brand has benefited from targeting wealthy customers and avoiding discounts.

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“Demand remains healthy, and our core consumer is resilient,” Louvet said, “especially as we continue … to shift our recruiting towards more full-price, less price-sensitive, higher-basket-size new customers.”

Investors have noticed the split as well.

The stock charts of the companies behind the two Ralphs also resemble a K. Shares of Ralph Lauren have jumped 37% in the last six months, while Kroger shares have fallen 13%.

To attract increasingly discerning consumers, Kroger has offered a precooked holiday meal for eight of turkey or ham, stuffing, green bean casserole, sweet potatoes, mashed potatoes, cranberry and gravy for about $11 a person.

“Stretch your holiday dollars!” said the company’s weekly newspaper advertisement.

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Signs advertising low prices are posted at Ralphs.

Signs advertising low prices are posted at Ralphs.

(Juliana Yamada / Los Angeles Times)

In the Ralph Lauren on Rodeo Drive, sunglasses and polo shirts were displayed without discounts. Twinkling lights adorned trees in the store’s entryway and employees offered shoppers free cookies for the holidays.

Ralph Lauren and other luxury stores are taking the opposite approach to retailers selling basics to the middle class.

They are boosting profits from sales of full-priced items. Stores that cater to high-end customers don’t offer promotions as frequently, Klowden of the Milken Institute said.

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“When the luxury stores are having sales, that’s usually a larger structural symptom of how they’re doing,” he said. “They don’t need to be having sales right now.”

Jerry Nickelsburg, faculty director of the UCLA Anderson Forecast, said upper-income earners are less affected by inflation that has driven up the price of everyday goods, and are less likely to hunt for bargains.

“The low end of the income distribution is being squeezed by inflation and is consuming less,” he said. “The upper end of the income distribution has increasing wealth and increasing income, and so they are less affected, if affected at all.”

The Andersons on Rodeo Drive also picked up presents at Gucci and Dior.

“We’re spending around the same as last year,” John Anderson said.

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At Ralphs, Beverly Grove resident Mel, who didn’t want to share her last name, said the grocery store needs to go further for its consumers.

“I am 100% trying to spend less this year,” she said.

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Instacart ends AI pricing test that charged shoppers different prices for the same items

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Instacart ends AI pricing test that charged shoppers different prices for the same items

Instacart will stop using artificial intelligence to experiment with product pricing after a report showed that customers on the platform were paying different prices for the same items.

The report, published this month by Consumer Reports and Groundwork Collaborative, found that Instacart sometimes offered as many as five different prices for the same item at the same store and on the same day.

In a blog post Monday, Instacart said it was ending the practice effective immediately.

“We understand that the tests we ran with a small number of retail partners that resulted in different prices for the same item at the same store missed the mark for some customers,” the company said. “At a time when families are working exceptionally hard to stretch every grocery dollar, those tests raised concerns.”

Shoppers purchasing the same items from the same store on the same day will now see identical prices, the blog post said.

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Instacart’s retail partners will still set product prices and may charge different prices across stores.

The report, which followed more than 400 shoppers in four cities, found that the average difference between the highest and lowest prices for the same item was 13%. Some participants in the study saw prices that were 23% higher than those offered to other shoppers.

At a Safeway supermarket in Washington, D.C., a dozen Lucerne eggs sold for $3.99, $4.28, $4.59, $4.69 and $4.79 on Instacart, depending on the shopper, the study showed.

At a Safeway in Seattle, a box of 10 Clif Chocolate Chip Energy bars sold for $19.43, $19.99 and $21.99 on Instacart.

The study found that an individual shopper on Instacart could theoretically spend up to $1,200 more on groceries in one year if they had to deal with the price differences observed in the pricing experiments.

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The price experimentation was part of a program that Instacart advertised to retailers as a way to maximize revenue.

Instacart probably began adjusting prices in 2022, when the platform acquired the artificial intelligence company Eversight, whose software powers the experiments.

Instacart claimed that the Eversight experimentation would be negligible to consumers but could increase store revenue by up to 3%.

“Advances in AI enable experiments to be automatically designed, deployed, and evaluated, making it possible to rapidly test and analyze millions of price permutations across your physical and digital store network,” Instacart marketing materials said online.

The company said the price chranges were not dynamic pricing, the practice used by airlines and ride-hailing services to charge more when demand surges.
The price changes also were not based on shoppers’ personal information such as income, the company said.

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“American grocery shoppers aren’t guinea pigs, and they should be able to expect a fair price when they’re shopping,” Lindsey Owens, executive director of Groundwork Collaborative, said in an interview this month.

Shares of Instacart fell 2% on Monday, closing at $45.02.

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Apple, Google and others tell some foreign employees to avoid traveling out of the country

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Apple, Google and others tell some foreign employees to avoid traveling out of the country

Big Tech companies, including Apple, Google, Microsoft, and ServiceNow, have warned employees on visas to avoid leaving the country amid uncertainty about changing immigration policy and procedures.

Following an attack on National Guard members in Washington, the Trump administration expanded travel bans earlier this month, and beefed up vetting and data collection for visa applicants. The new policy now includes screening the social media history of some visa applicants and their dependents.

Soon after the announcement, U.S. consulates began rescheduling appointments for future dates, some as late as summer 2026, leaving employees who required appointments unable to return.

“Please be aware that some U.S. Embassies and Consulates are experiencing significant visa stamping appointment delays, currently reported as up to 12 months,” noted an email sent by Berry Appleman & Leiden LLC, the immigration firm that represents Google. The advisory also recommended “avoiding international travel at this time.”

Business Insider earlier reported on the travel advisories.

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Microsoft’s memo noted that much of the rescheduling is occurring in India, in cities such as Chennai and Hyderabad, and that new stamping dates are as far out as June 2026.

The company advised employees with valid work authorization who were traveling outside the U.S. for stamping to return before their current visa expires. Those still in the U.S. scheduling upcoming travel for visa stamping should “strongly consider” changing their travel plans.

Apple’s immigration team also recommended that employees without a valid H1-B visa stamp avoid international travel for now.

ServiceNow, a business software company, similarly issued an advisory recommending that those with valid visa stamps return to the U.S.

Microsoft declined to comment on its memo. Apple, Google and ServiceNow did not immediately respond to requests for comment.

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Companies warned that delays due to enhanced screening is for H-1B, H-4, F, J and M visas.

H-1B is a high-skilled immigration visa program that allows employers to sponsor work visas for individuals with specialized skills. The program, capped at 85,000 new visas per year, is a channel for American tech giants to source skilled workers, such as software engineers.

Big Tech companies such as Amazon, Google, and Meta have consistently topped the charts in terms of the number of H-1B approvals, with Indian nationals as the largest beneficiaries of the program, accounting for 71% of approved H-1 B petitions.

H-1B visas are awarded through a lottery system, which its critics say has been exploited by companies to replace American workers with cheap foreign labor.

In September, the Trump administration announced a $100,000 fee for new H-1B employee hires. But after severe pushback, it clarified that it applied only to employers seeking to use the H-1B visa to hire foreign nationals not already in the U.S.

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The H-1B program is an issue that has not only animated the right but also splintered it. Those on the tech-right, such as Elon Musk and David Sacks, are strongly in favor of strengthening skilled immigration, while the core MAGA base is vehemently opposed to it.

Proponents of the program often highlight that skilled worker immigration made the U.S a technological leader, and nearly half of the fortune 500 companies were founded by immigrants or their children, creating jobs for native-born Americans.

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