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reviewed 9/94 Scientific Knowledge in Controversy: The Social Dynamics of the Flouridation Debate. Brian Martin. SUNY Press (1991). ISBN 0-7914-0539-7. 266 pp. $19.95 paper ($59.50 cloth).

This is an excellent exploration of the challenges posed by a social debate that involves science and of the confusions about the role of science that permeate such debates. The case is the flouridation of public water supplies. For many, flouridation is such an obvious benefit for preventing tooth decay that the notion of a controversy may seem somewhat implausible. Most Western European nations, however, do not flouridate their water. Critics note studies that indicate problems of both excessive individual dosage (and possible flourosis) and risks of cancer. The convergence of benefits and risks introduces important questions about the nature of public decision-making and the ethics of individual autonomy in accepting risk.

Martin presents the controversy with increasing levels of complexity. First, we learn about the research findings and how they are assembled into arguments "pro" and "con." Next, we see how the views become polarized. With no easy resolution at this level, we find a shift in emphasis from the credibility of claims to the credibility of the spokespersons who make those claims. As debate deepens, professional power is deployed to build or undermine alternative voices--affecting publication, research grants and even personal careers, all in the name of defending good scientific conclusions. Finally, Martin probes the interests of the aluminum producers (that generate flouride as a waste), the dental profession, and the sugar and toothpaste industries--who shape the direction of science by funding research on flouride. All these levels of science and appeals to science pose the background for considering the systems by which such disputes can be settled. The teacher will find a wealth of information for conveying an understanding of how science threads its way into society with no easy demarcation, each level relying on the next.

Two unwarranted assumptions, however, guide the commentary in this book--and reflect, perhaps, broader public (mis)conceptions. First, science is treated as an unproblematic authority and arbitrer whose conclusions are: (a) always certain and unambiguous; and (b) universal in domain, capable of eclipsing even ethical issues. First, Martin does not consider that scientific findings at any given moment may be uncertain--that findings about cancer, say, may be indicative, while still needing further controls and statistical rigor. Nor does he grant that science may reach multiple conclusions that could conflict in policy decisions. In this case, fairly reliable findings indicate both benefits and risks. The values of dental health and risk of cancer are not commensurable, however. Science cannot assess conclusively whether flouridation is "acceptable" without some formula for weighting or combining these different values. Yet both sides of the controversy appeal to research findings as though this can and should resolve the dispute. (Martin hints that this failure demonstrates the poverty of science, rather than a flaw in reasoning.) Further, proponents use the scientific results on reduced tooth decay to dismiss ethical arguments about whether risk can be imposed on a public or must be accepted individually. Such arguments intersect but do not mix. Flouridation may be undeniably effective, but one must also address ethical questions. Science is a component of, not a substitute for, responsible public decisions. Again, the fallacy is that science is the only or final authority. At his worst, Martin makes no distinction between scientific and public decisions. Thus, he treats a community's decision about whether to flouridate water, based in part on scientific findings, as "scientific knowledge" about whether it is safe (see title).

The second faulty assumption lies in casting the scientific debate in stark either-or terms. The controversy, Martin shows vividly, is hyper-polarized. No one is willing to "concede" knowledge that does not wholly support their position. This, in itself, deserves analysis in terms of possible cognitive dispositions for unilateral coherency and/or the politics of consolidating power. But the science is not black and white, though both sides of the debate portray it as such (each with opposite conclusions). As indicated above, in this case multiple conclusions converge on an issue of public concern. Typically in scientific debates, each "side" has a hold on some reliable findings, and the task is to reconcile or differentiate the interpretations--not to choose between them. The either-or, winner-take-all image of science needs to be replaced in this and other cases with the recognition that science can be complex--and does not always provide information that resolves social problems.

The sub-text of this book is "debunk and disempower science" (or worse, possibly, "exploit it wherever it can promote your own ends"). What the book demonstrates, however, is the need for better public understanding of the role and limits of science and how ethical issues can be bound up in scientific findings. Martin offers a rich portrayal of one case for developing this understanding, while never quite reaching it himself. The reader will find an intelligent summary, however, in a critique of Martin's study by Edward Groth III, which is included as the final chapter. "Which side is science on?" Groth asks. "Neither side," he answers. This is a genuine controversy, with a clash of both ethical values and scientific experts.

--Douglas Allchin

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