Comment by tritium | Hacker News Reader

Comment by tritium | Hacker News Reader

The social mechanisms and agents operating business channels to broadly affect change in behavioral norms through obtuse, distributed influence and produce widely held beliefs with financial results for large companies and economic outcomes across an entire industry, doesn't interest me as much as other aspects surrounding the story of twentieth century medical and cosmetic products.

Namely, what toothpaste is, how it works, and the prevailing clues offered as bellwethers for its effectiveness as a preventative treatment.

This is the story of how to make something happen, whether it's useful and valuable to the individual or not. I'd rather see that story prefaced or intermingled with the details of a product's true utility, before hearing about the complicated and concerted effort to bring such a product to market (warts and all). I don't feel that such details are beyond the scope of a story of commercial success. Far from it. The mechanics of genuine utility are of paramount relevance, at least eye-to-eye with the behind-the-scenes schmoozings of success.

Missing from the story are the odd details that reveal flouride's role in dental health, and its hazards and side effects as a medication. Also missing, is the detail regarding the industrial scale source of flouride's precursors, glossed over, even with the mention of at least one aluminum company, and hints implying a nod to the war effort, prior to the start of the second world war.

It's also short on specific dates, skipping across broad periods, mentioning mostly decades as eras of activity or progress.

Flouride and dentistry are weird topics with a lot of trivia, but this article only explains the activities of businessmen operating from advantageous positions, which for the most part, given the hindsight of the article lend an almost obvious and deterministic view of the outcome of their success. It reads like the musings of an amateur hunter relishing the idea of a canned hunt.

Without including the low-level hard science of why toothpaste is effective, this story casts toothpaste in a role as seemingly empty as perhaps the Juicero juicer [0], or any number of other hollow products sold via infommercial or trumpeted alongside buzz words like Internet of Things.

[0] https://en.wikipedia.org/wiki/Juicero

>the low level hard science

The science is pretty basic. CaCO3 powder made into a paste form provides a source of calcium and alkalinity - protecting the teeth from acid created by bacteria. The rest is marketing. The effective way to deliver flouride is a higher concentration that only touches your teeth, which is how it is used at the dentist after a cleaning.

If toothpaste's success was based on utility there would be brands offering probiotic paste that colonizes your mouth and uses glucose with out making biofilms or having acid as an end product of metabolism. Then you wouldn't even really need to constantly brush your teeth or buy more toothpaste. The maximum utility product would cost a lot to develop and ruin the business model.

That science isn’t basic, considering the period in which the product was introduced. The manner of action is pretty subtle, and an impatient person seeking immediate results would not be inclined to believe in mechanisms that lack readily observable results.

This is why toothpaste’s marketing relies heavily on peer pressure and establishing trust in habitual use. Habitual use also carries the obviously juicy benefit of boosting volume and revenue.

> change in behavioral norms

You should have seen the "shall I tell him he has body odour?" ads that the soap manufacturers ran a few decades ago.

Big score, there's deodorant as a life necessity installed in the common mind.

Not a complaint, I just think that soap makers are the unacknowledged legislators of the world.

Reading that made me wish you'd written an article on the efficacy of toothpaste. So what do you think about its utility, and what are your thoughts on fluoride?

The clues about flouride’s long-term action, and role as medication are usually avoided, because the medical curiosities that demonstrated flouride’s interaction with bone and tooth chemistry, and pointed the way to it’s discovery are possibly unsettling, and hinder the sales pitch of flouride in general.

And of course there’s the politicized paranoia of contaminating the public water supply, and who should get to decide such things, and why they might choose to do it.

But, those stories usually focus on intrigue, and don’t explain much about the chemistry of the element flourine, ionic compounds, or much of anything else, and dissolve into hand-wavey boogie men.

You basically get two incomplete pictures of the same story. What both sides leave out is that flouride has medical utility, but while toxicity is a potential risk, it’s not some mysterious subversive threat, and the benefits weigh favorably against the side effects.

Also, no one ever tells you that a little bit won’t hurt. Opponents offer hysterics of zero tolerance for poisonous toxic waste and brain damage. See also, Dr. Strangelove, and the idea of precious bodily fluids.

Meanwhile, advocates never tell you that you might be okay with flouride toothpaste just once a week, and no flouride at all the rest of the week, brushing with just pure, ordinary water (Mandrake). Instead, advocates advise twice a day, ...no more, but certainly no less.

And proponents of public flouridated water usually sidestep the premise of prescriptive public health as offering a leg up to people who might not have disposable income for toothpaste. Charity chafes all sides. Some might be too proud to accept the premise of assistance. Others bristling at the undertones of that idea amounting to other people’s needs conflicting with the autonomy of those with the capacity for choice between such options.

Nicely balanced! However what's this about disposable income for toothpaste? A tube can last a long time; most people use far more than the pea-sized amount recommended by dentists. And what's the balance between using toothpaste (even bicarbonate + salt works well, if pushed) and the cost of visiting a dentist? Of course you can skip the latter and unless you're very lucky, enjoy a shorter lifespan. Recently we've become much more aware of the definitive link between rotten oral health and vascular (heart) disease.

>even bicarbonate + salt works well, if pushed

If you don't need fluoride, even water works well:

https://www.ncbi.nlm.nih.gov/pubmed/27513809

"The cumulative evidence for this systematic review demonstrates that there is moderate certainty that toothbrushing with a dentifrice does not provide an added effect for the mechanical removal of dental plaque."

If you had to choose between food and toothpaste, you’d choose food. At that level, visiting a dentist isn’t even an option, and no income is disposable. Do people not face such choices?

Also consider that only a small amount of treated water is consumed by people, but all of the fluoride added to our water supply ends up in our waterways.

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