Fluoride in the water.
Is it one of the 10 greatest achievements in health care in the 20th Century, as a U.S. Surgeon General once put it, in the same league as the polio vaccine or the seat belt?
Or is it a government-sanctioned intrusion into the private life of citizens, whether one wants it or not?
A version of that debate went on for hours this week before Pinellas county commissioners, who eventually made the rare decision to take the chemical out of the water supply - eight years after an earlier board voted to put it in.
The debate mostly pitted the health care profession, mostly dentists and pediatricians, who vouched for fluoride's benefits, particularly for the dental health of young children, with a group of conservative activists. Those residents questioned the veracity of the numerous scientific reports and studies supporting water fluoridation and were deeply suspicious of the very notion of the county putting something into their water.
One of their supporters was Commissioner Norm Roche.
"I've never believed it was our job to medicate the water, if you will," Roche said after the workshop. "We have to provide clean, safe drinking water. Beyond that, if medication or other additives are there I believe the public deserves a vote on that."
Though fluoridation is backed by the Center for Disease Control, the American Dental Association and the last five U.S. Surgeons General, Roche said he wants more studies done.
And if such studies emerge, he wants people to be able to vote on fluoridation because, "They're the ones drinking the water."
Roche wasn't a county commissioner when the board voted almost unanimously to fluoridate the water in 2003. He was recently elected after changing his party affiliation to Republican.
Susan Latvala was a county commissioner when the board voted for fluoridation in 2003, as were current board members Ken Welch, Karen Williams Seel, and John Morroni. Like Latvala, Welch and Seel voted to keep fluoridation, but Morroni changed his position during Tuesday's workshop on the issue, joining the three relative newcomers, including Roche.
Latvala said the vote reflects the surging political power of those who want an extremely limited form of government.
"The tea party is alive and well in Pinellas County and they attend every single workshop and meeting we have," said Latvala, a Republican. "They take notes, ask questions and take positions and speak on any issue along these lines."
"There's a segment of the board that's listening to them without considering the constitutional and charter responsibilities of the Board of County Commissioners," she said. "Public health is under our purview."
Hillsborough County is not having this level of grassroots involvement.
According to Luke Mulford, the water quality engineer for Hillsborough County Public Utility, both Hillsborough and Tampa fluoridate their water, and there's no talk of that coming to an end. Pasco County doesn't fluoridate its water.
Mulford said commissioners do occasionally receive emails on the county's fluoridation program, either from young families considering moving into the area, or from activists who provide links to "un-peer-review" reports, such as one that says high doses of fluoride may hurt one's health.
Before the vote, commissioners heard from Robert Powell, who's in charge of water operations for Pinellas County Utilities. Powell acknowledged there have been reports that fluoridation can cause staining on some children's teeth. But not a single national scientific organization opposes fluoridation, he said.
Roughly 98 percent of the population in Pinellas now has fluoridated water, and 87 percent do in Hillsborough, Powell said. Roughly 9 percent of the population in Pasco does.
Pinellas County Utilities provides water for all the county's citizens, except those in St. Petersburg, Dunedin, Gulfport, and Belleair. Tarpon Springs is working on supplying itself with its own water. And Clearwater gets 60 percent of its water from the county.
At the hearing, dentist after dentist attested to fluoridation's healthy effects. It reduces tooth decay, which in turn reduces time spent away from the classroom and work and means fewer visits to the emergency room, they said. A dentist for the county's health department called fluoride a "safety net."
The dentists' effort was so coordinated that they each chose a specific advantage of fluoride during their allotted three minutes of time before the board so their observations didn't overlap.
Most of the commissioners weren't convinced.
Morroni asked if fluoride might be a neurotoxin. Roche wondered aloud whether there should be a campaign, in lieu of fluoridated water, encouraging more tooth-brushing and less soda drinking.
And Commissioner Nancy Bostock, who also voted for removing the fluoride, said she heard of an advisory warning parents not to use fluoridated water with infant formula. Commissioner Neil Brickfield noted that, with all the talk about fluoride benefitting children, it appeared "the rest of us" would have to put up with it.
The physicians often wondered where the commissioners were getting their information from.
Tony Caso, of Pinellas Patriots, also spoke.
"Who in their right mind wants any toxic substance put into their body," the Palm Harbor man said. "This is all part of an agenda that's being pushed forth by the so-called globalists in our government and the world government to keep the people stupid so they don't realize what's going on."
"They're tired of being medicated and controlled," he said. "This is the US of A, not the Soviet Socialist Republic."
He was applauded.