Pien Huang
Appearances
Short Wave
Stopping A Deadly Disease On Apache Lands
To be totally honest, I am unfamiliar with Rocky Mountain Spotted Fever. What does that disease involve, Ping?
Short Wave
Stopping A Deadly Disease On Apache Lands
Wow, that sounds really bad. And did they call it Black Measles because it cause like dark splotches or something?
Short Wave
Stopping A Deadly Disease On Apache Lands
You're listening to Shortwave from NPR. Hey, short wavers. Emily Kwong here with health correspondent Ping Huang and NPR producer Megan Lim. Hi, you both. Hey, hey.
Short Wave
Stopping A Deadly Disease On Apache Lands
Okay, so that's kind of the history of the disease, how it got to have such a big range. Megan, what does it do? to those who get bitten?
Short Wave
Stopping A Deadly Disease On Apache Lands
Yeah. Okay. This sounds like a very serious disease. And it's one of the reasons you two went to report this story in Arizona. Before we get into how the tribe turned the disease around, why has the infection rate been so high?
Short Wave
Stopping A Deadly Disease On Apache Lands
I am from Connecticut, where there's lots of ticks. So I know a vector is just like... Fancy science word for a creature that carries a disease. It can be a mosquito. It can be a flea. In this case, it's a tick.
Short Wave
Stopping A Deadly Disease On Apache Lands
And it's upon these dogs that this new tick vector is being carried, spreading Rocky Mountain spotted fever to children. And it all just sounds like a bad combination of things.
Short Wave
Stopping A Deadly Disease On Apache Lands
OK, so given this perfect storm. Who then has been turning this disease around and how?
Short Wave
Stopping A Deadly Disease On Apache Lands
This is why we love public health, though. They're all about prevention. They're all about partnerships. Okay, so how is the tribe and the CDC doing this?
Short Wave
Stopping A Deadly Disease On Apache Lands
This reminds me of, what was it during the pandemic we all did? Contact tracing? Contact tracing, yeah. Exactly, yeah.
Short Wave
Stopping A Deadly Disease On Apache Lands
And it's so, this One Health approach is so multi-pronged. It is making a difference, but it does sound really labor intensive. How does the tribe keep all this going?
Short Wave
Stopping A Deadly Disease On Apache Lands
I've heard... In other public health interventions, individuals like that are called like super communicators or nerd nodes of trust. They're just like people who are really good at spreading awareness because people already trust them.
Short Wave
Stopping A Deadly Disease On Apache Lands
Well, we will take and celebrate any win we have right now. Five years, no deaths from Rocky Mountain spotted fever in this community. Ping, Megan, thank you so much for bringing us this story. You're welcome. Thanks for having us. If you liked this episode, make sure you never miss a new one by following us on whichever podcasting platform you're listening to.
Short Wave
Stopping A Deadly Disease On Apache Lands
And hey, if you have a science question, send us an email at shortwave at NPR.org. This episode was produced by Burleigh McCoy. It was edited by our showrunner, Rebecca Ramirez, and fact-checked by Tyler Jones. The audio engineer was Kweisi Lee. Beth Donovan is our senior director, and Colin Campbell is our senior vice president of podcasting strategy. I'm Emily Kwong. I'm Ping Kwong.
Short Wave
Stopping A Deadly Disease On Apache Lands
And I'm Megan Lim. Thank you for listening to Shortwave from NPR.
Short Wave
Stopping A Deadly Disease On Apache Lands
That's amazing. All right, well, I want to hear about how they did it. Today on the show, the long battle against Rocky Mountain spotted fever on Arizona tribal lands. Ping and Megan are going to take us around the San Carlos Apache Reservation. and show you how the tribe is winning against the ticks. I'm Emily Kwong, and you're listening to Shortwave, the science podcast from NPR.
Short Wave
Fluoride: Fact vs. Fiction
At the time, I spoke with Ashley Mullen, who's an outside researcher...
Short Wave
Fluoride: Fact vs. Fiction
And there were experts, especially within the dental community, that raised concerns about the report immediately. I mean, they were worried that people would misconstrue it to mean that any fluoridation in drinking water is a problem. when the amount of fluoride being discussed was twice what's added to the public drinking water.
Short Wave
Fluoride: Fact vs. Fiction
Yeah, yeah. So it gave us some more details about how they'd done their research for this analysis. They had looked at dozens of studies, mostly from China and India. And they use this to conclude that some babies and kids exposed to high levels of fluoride may experience some amount of neurodevelopmental harm.
Short Wave
Fluoride: Fact vs. Fiction
Now, these results are controversial, but the analysis has spurred opponents of fluoridation to call for a new assessment of its benefits and its risks.
Short Wave
Fluoride: Fact vs. Fiction
Okay, so the story starts at the turn of the 20th century, early 1900s, when dentists in the U.S. started noticing that people who live in certain areas have lower rates of tooth decay. And they don't know why until a few decades later, the 1930s, when they realized that in these areas, there's actually a higher than normal amount of fluoride in the water.
Short Wave
Fluoride: Fact vs. Fiction
Yeah, naturally. And it's also in the 1930s that a team of scientists at the University of Pittsburgh proposed in a paper to add a controlled amount of fluoride to the drinking water to prevent tooth decay.
Short Wave
Fluoride: Fact vs. Fiction
And then in the 1940s, cities started experimenting with adding fluoride to the water. So it starts with Grand Rapids, Michigan in 1945. By the end of the decade, dental examiners are reporting markedly lower cavities. And so hearing this, you know, other towns in Michigan, Texas, and Wisconsin start their own programs.
Short Wave
Fluoride: Fact vs. Fiction
And that doubles the number of Americans who get fluoridated water to over a million. Wow. So if you fast forward to 1962, federal drinking water standards are updated to give fluoride guidelines. And then over the subsequent decades, more and more Americans get access to fluoridated water to protect against tooth decay. That figure is up to around 70% in the U.S. today.
Short Wave
Fluoride: Fact vs. Fiction
Yeah, it's been the case for decades now. I mean, basically every toothpaste I've used throughout my entire life has had it in it. Plus it's in mouth rinses. It's in dental floss.
Short Wave
Fluoride: Fact vs. Fiction
Yep, we're talking fluoride, which is a topic that NPR has covered in drinking water around the U.S. for literally decades. Hmm. Fluoride is a very common mineral that occurs naturally in almost all soil, in water, even in many rocks.
Short Wave
Fluoride: Fact vs. Fiction
The science is clear, Emily. Fluoridating water lowers the numbers of cavities in people, which it does by restoring minerals to teeth that are lost when bacteria grow inside the mouth, especially after, like, say, drinking sugary drinks. And this is especially useful for lower-income families who might not have access to fluoride products like toothpastes and mouth rinses.
Short Wave
Fluoride: Fact vs. Fiction
There's a study by the Colorado School of Public Health which found that adding fluoride to the water saved around $6.8 billion in dental expenses in one year alone.
Short Wave
Fluoride: Fact vs. Fiction
Yeah. So ever since it started, there's been this debate over fluoridating water. Our colleagues Jeff Brumfield and Selena Simmons-Duffin have reported about conspiracy theories surrounding fluoride in drinking water. There was this time in the 1960s when the John Birch Society, this far-right group, alleged that it was part of a communist plot.
Short Wave
Fluoride: Fact vs. Fiction
And there are lots of other theories around it as well, different versions that reflected the concerns of their times. But meanwhile, the scientific understanding is also evolving, which brings us to this latest research in JAMA Pediatrics. It was done by government scientists at the National Toxicology Program. That's the part of the NIH that you mentioned earlier. Uh-huh, with that August report.
Short Wave
Fluoride: Fact vs. Fiction
That's the one. And like we were saying, they just published a study in JAMA Pediatrics that looks at a few dozen studies that other people have conducted. And it finds this link between high levels of fluoride and a small decrease in children's IQ. Now, it's not totally definitive. This is something that they're saying with moderate confidence.
Short Wave
Fluoride: Fact vs. Fiction
So moderate confidence is basically like a grade that they put on the quality of evidence that's available to them. It's not low quality. It's not high quality. It's enough to say something with moderate confidence. Does that make sense?
Short Wave
Fluoride: Fact vs. Fiction
Yeah. Science. So many words. Yeah. And while this conclusion is not new, this research has already been quite influential in the debate over fluoride in drinking water. It was accompanied by two op-eds in the paper that was published on Monday. One questioned its methods, disagreed with its conclusions, and the other fully supported it. I spoke with Dr. Bruce Lanphier.
Short Wave
Fluoride: Fact vs. Fiction
And most people in the U.S. get fluoridated drinking water. It's added to the water to prevent tooth decay and cavities. The current U.S. Public Health Service recommendation is 0.7 parts per million optimally, which is three drops in a 55-gallon barrel.
Short Wave
Fluoride: Fact vs. Fiction
He's at Simon Fraser University, and he co-authored that supportive piece.
Short Wave
Fluoride: Fact vs. Fiction
So he's arguing that there's enough evidence to prompt this reassessment of the risks and the benefits of fluoride in the water system. Hmm. Now, on the other hand, you've got a dentist like Stephen Levy. He's a public health dentist at the University of Iowa. He wrote the other op-ed that argues for staying the course. And he says that using this data for that debate is a stretch.
Short Wave
Fluoride: Fact vs. Fiction
So he says that they didn't fully consider some other recent research that cast doubt on the links between fluoride exposure and IQ. And he also makes the point that, you know, because water fluoridation is so common, we take its benefits for granted. You know, there are problems definitely associated with getting cavities too. It can be painful. You can get infections.
Short Wave
Fluoride: Fact vs. Fiction
You can have to go to the dentist and get expensive fillings, or you can miss school for it. Like there are all these problems that are also associated with getting cavities.
Short Wave
Fluoride: Fact vs. Fiction
Yeah, so there are a couple that are being raised right now. One of them is about whether, you know, because people get fluoride not just from their drinking water, but also from the food that they eat, the toothpaste and mouthwash they use.
Short Wave
Fluoride: Fact vs. Fiction
whether that total cumulative fluoride might be pushing some vulnerable people, again, that's pregnant people and young children, whether that's pushing their fluoride levels to levels that might be harmful. And another question is really on the benefit side of it.
Short Wave
Fluoride: Fact vs. Fiction
There is recent analysis that showed that fluoride in the drinking water definitely prevents cavities, but it's not to the same extent that it was back in the 40s, 50s, 60s, before fluoridated toothpaste became a regular thing. So Some are saying that it's time to reweigh the risks and the benefits given how society has changed.
Short Wave
Fluoride: Fact vs. Fiction
I think they're interesting. I think that, like, it's useful to have a real scientific debate about these questions. You know, as a science reporter, you're like, OK, great. These are the questions. Let's get more evidence.
Short Wave
Fluoride: Fact vs. Fiction
But my concern is that even in the lack of evidence, you know, there's this huge public debate that's swirling and political and sort of happening regardless of whether the evidence becomes clear or not.
Short Wave
Fluoride: Fact vs. Fiction
Yeah, so there's a couple things that are coming up. The Environmental Protection Agency has this deadline coming up in the next two weeks. over whether they want to appeal this recent court decision that told them to tighten their fluoride regulations that could have bearing on the debate. And then there's Robert F. Kennedy Jr.
Short Wave
Fluoride: Fact vs. Fiction
Right, Emily. And it used to be a range, but in 2015, it was revised down to the standard minimum, 0.7 parts per million, because there were concerns that at levels higher than that, it could be causing dental fluorosis, which is, you know, streaking or mottling on kids' teeth.
Short Wave
Fluoride: Fact vs. Fiction
He's President-elect Donald Trump's nominee for health secretary, and he told NPR that one of his priorities is to get the country to stop fluoridating the water. So... We'll have to see what happens there. And finally, there's also what's happening on the local level. So there are some communities that are going through transitions with their drinking water.
Short Wave
Fluoride: Fact vs. Fiction
For example, NPR has reported that Calgary in Canada removed fluoride from its water supply. And then after data came back showing that dental cavities rose significantly, they're now reintroducing it. On the other hand, you've got Florida Surgeon General Joseph Latipo, who made headlines recently for advising local governments in Florida to stop adding fluoride to their water supplies.
Short Wave
Fluoride: Fact vs. Fiction
So yeah, there's a lot happening with fluoride right now. It's going to be interesting to track those decisions and what the public health outcomes are. So we will see what happens.
Short Wave
Fluoride: Fact vs. Fiction
You're welcome. Thanks for having me on. And I'm sure we're going to talk much more about fluoride in the future.
Short Wave
Fluoride: Fact vs. Fiction
And it still is, Emily, but a debate is evolving over whether the risks and the benefits of fluoride have changed. So back in August 2024, part of the National Institutes of Health called the National Toxicology Program released a big report. It was over 300 pages long, and it linked high levels of fluoride exposure with a slight decline in children's IQ.
Short Wave
The Biggest Health Stories of 2024
Yeah, I mean, it has gotten better since the pandemic. So there was this nationally representative survey that the Pew Research Center did at the end of October. And it found that 76% of respondents were at least fairly confident in scientists. You know, they thought that they were intelligent, focused on solving real world problems.
Short Wave
The Biggest Health Stories of 2024
So like I said, that's up, but it's still lower than it was before the pandemic. And people in the US are split about whether scientists should be actively focusing on policy or if they should be staying out of the fray. And now people in public health Wow. Wow.
Short Wave
The Biggest Health Stories of 2024
Yeah, absolutely. So this has been a big year for drinking water. There were two big new rules from the EPA in April. They passed a rule to limit the amount of Six PFAS chemicals, that stands for per-polyfluoroalkyl substances. We've talked about them here before.
Short Wave
The Biggest Health Stories of 2024
And these are man-made chemicals that have been used for many, many decades in waterproofing, stain-proofing products that people can buy in the store or use in flame retardants. They're called forever chemicals because they have this really strong carbon-fluorine bond that can stay bonded and intact for centuries. So they don't really fall apart in nature. They are in most human bodies.
Short Wave
The Biggest Health Stories of 2024
They've been linked to liver damage, high cholesterol, certain cancers, suppressed immune response in children. So the new PFAS regulation requires water systems that find even low levels of PFAS in the water to filter them out. Oh, wow.
Short Wave
The Biggest Health Stories of 2024
So the other one is lead, which we have known about for a really long time. We know that lead is a neurotoxin. It's especially dangerous for kids and their developing brains, and it can leach out of lead pipes and into people's drinking water. So- A little background here.
Short Wave
The Biggest Health Stories of 2024
Lead pipes in drinking water have been banned since the mid-1980s, but there are still more than 9 million lead pipes that were installed before that that are still in use and in the ground. So the EPA also passed a new rule this year that requires all of those 9 million lead pipes to be dug up, replaced with non-lead pipes within the next 10 years.
Short Wave
The Biggest Health Stories of 2024
So all of that is really great, but there is work that remains. You know, there are other chemicals of concern in the water. some questions about what might happen to the work on PFAS on lead when the new Trump administration takes effect. Some of these things are being challenged in court right now, so we will see if what has been passed this year is kept and whether that momentum keeps going.
Short Wave
The Biggest Health Stories of 2024
Yeah, exactly. Now, that is a whole separate can of worms, fluoride and drinking water. So A lot of communities have added it to drinking water since the 1940s to cut down on cavities. And RFK Jr. has said that if he is confirmed, he's going to push to get it out of the drinking water.
Short Wave
The Biggest Health Stories of 2024
And we're already seeing some states like Florida, their state surgeon general already has encouraged places to stop adding fluoride to the water. So there could be a lot of changes there. We'll see.
Short Wave
The Biggest Health Stories of 2024
Yeah, I mean, there are so many buckets to look into, from forever chemicals to lead to fluoride.
Short Wave
Is The Trump Administration Breaking Science?
So a lot of similarities with what you just heard about NIH. So like the NIH, the CDC was hit by a communications freeze. People who had grants with CDC or had calls with them for ongoing outbreaks, couldn't speak with anyone there for a few weeks.
Short Wave
Is The Trump Administration Breaking Science?
Also, as a result of Trump's executive orders, there was this weekend at the end of January where web pages and data sets started disappearing from the CDC website. You know, this was when references to trans people and pregnant people were taken down, along with some tools that policymakers used to track HIV and STIs and adolescent health. Now, some of that has gone back up.
Short Wave
Is The Trump Administration Breaking Science?
And in February, a federal judge actually ordered them to put the websites back up.
Short Wave
Is The Trump Administration Breaking Science?
And then also in terms of the workforce, like at the other health agencies, there was a firing at CDC around 750 people were let go around Valentine's Day. although some have actually been asked to come back. And all of this has just been really distracting from the agency's mission, which is to keep the nation safe.
Short Wave
Is The Trump Administration Breaking Science?
What are we dealing with when it comes to disease? So right now, there are more than half a dozen active outbreak responses at CDC right now. So those cover things like bird flu, mpox. There's East Africa viral hemorrhagic fever, also tropical insect-borne diseases, dengue and orapouche. And There's also one for measles in Texas and now New Mexico and an ongoing polio response.
Short Wave
Is The Trump Administration Breaking Science?
And those are just the formal responses. It doesn't include the CDC's regular other work on things like worker health or preventing accidents or chronic diseases or dealing with the health effects of environmental toxins, for instance.
Short Wave
Is The Trump Administration Breaking Science?
There were two programs in particular that got a lot of attention for being wiped out. That was the Laboratory Leadership Service, which is this partner fellowship to the Epidemic Intelligence Service, which is well known. It's the EIS program. And then also the Public Health Associate Program, which puts recent graduates in state and local health departments together.
Short Wave
Is The Trump Administration Breaking Science?
Those left some gaps in the public health system that our colleague Will Stone and I have been reporting on. Now, the members of these two fellowships in particular have been asked to return. They got these emails last week saying, Your termination has been rescinded. You can come back and, quote, we apologize for any disruption that this may have caused.
Short Wave
Is The Trump Administration Breaking Science?
And these fellowships make up a sizable number of the 180 or so people that have been asked to return. But still, you know, these rescindments offered no protections against future reductions in force, which are expected to be coming to the agency.
Short Wave
Is The Trump Administration Breaking Science?
Yeah, Emily, all of this chaos and confusion at the agency is having some lingering effects. There are scientists and researchers that have this mistrust of the data on the CDC website now. They're concerned that it's corrupted or that – The data that was re-uploaded? Yeah, yeah, yeah.
Short Wave
Is The Trump Administration Breaking Science?
So they're worried that it won't be collected in the same way going forward or that there might be interruptions to it. They're not sure that they can rely on it. Right. The agency is also, even though the communications freeze has officially lifted, it's not back to super normal communications. And staff morale is really awful.
Short Wave
Is The Trump Administration Breaking Science?
I mean, some teams have lost really critical people and nobody there feels like their job is safe. So this week, there's a confirmation hearing for Dr. Dave Weldon, who is Trump's pick for the CDC. It's the first time that a CDC director needs to be confirmed by the Senate, and it could soon have a new leader.
Short Wave
Is The Trump Administration Breaking Science?
I mean, I can jump in here, Emily. So based on how it's gone so far, people we've spoken with are worried that these cost-cutting measures are making things less efficient in the short term, and they're undermining these agencies and their ability to fulfill their missions to protect and improve people's health in the long run. Okay.