Randy Dotinga

On Tuesday, voters in Salt Lake City; San Antonio; Spokane, Wash.; and several towns from Arizona to Vermont will decide whether to add fluoride to their drinking supplies to improve dental health. Meanwhile, southern Nevada voters will consider whether Las Vegas should flush the compound out of its water system.

Armed with the support of a small group of scientists, the water police hope to build on a base of recent anti-fluoride victories. Once derided as right-wing kooks, they have gained the support of some reputable environmentalists and leftists, including Ralph Nader. But to win at the polls they will have to fight off voter apathy and a reputation as being members of the lunatic fringe. They’ll also have to beat back well-funded health groups that have adopted an above-the-fray strategy of refusing to debate their opponents in person.

Fear of fluoride is nothing new, although the opposition movement has gone through various incarnations during the 55 years that scientists and dentists have been trying to dump the compound into public water supplies. Ironically, science first discovered fluoride’s benefits in the early part of this century by stumbling upon what happened when people got too much of it. Researchers noticed that children raised in Colorado Springs, Colo., suffered from severe staining and mottling of their teeth, but were also blessed with a low rate of tooth decay. A check of the water supply revealed that it was naturally fluoridated, according to a history compiled by the National Institutes of Health.

Over time, scientists examined fluoride to figure out how much or how little would prevent tooth decay without destroying the teeth. In 1945, Grand Rapids, Mich., became the first major city to fluoridate its water. The cavity rate dipped significantly, inspiring other cities and towns to follow, but it didn’t take long for groups like the ultra-right John Birch Society to see fluoridation as an invasion of personal rights.

“The rhetoric of the 1950s is partly crazed and totally paranoid, but revealed a level of distrust and fear that was profound,” said Char Miller, a history professor at San Antonio’s Trinity University who specializes in the environment. “They saw an attempt of the government to literally invade the body of the citizenry, and in the process dominate their minds and control their behaviors in a way that was emblematic of what we understood the Soviets to do to their own citizens.”

Critics didn’t have much luck, however, as dentists and health departments clamored for fluoride. City after city began adding fluoride at the rate of about one part per million to their water supplies. Philadelphia, San Francisco and Chicago did so in the 1950s, followed by New York, Detroit and Dallas in the 1960s. Now, according to fluoride supporters, of the country’s 50 largest cities only San Diego; San Antonio; San Jose, Calif.; Honolulu; and Portland, Ore.; don’t have fluoridated water — although San Diego’s city council recently voted to add the substance to the water supply and Honolulu is considering it.

The most recent federal statistics, from 1992, estimated that 56 percent of the nation’s population was served by fluoridated water. The number is certainly higher now since some large cities have joined the trend since then. Fluoridation is not as popular overseas, however. Most countries in Europe, for example, do not fluoridate their water because government officials and scientists do not view it as necessary for the public health.

But fluoride foes have had their own successes, especially in California, where local officials are resisting a recently enacted state law requiring cities with populations over 100,000 to fluoridate their water. In the San Diego area, critics have convinced several communities, including the city of Escondido, Calif., (pop. 120,000) to refuse to do so. Santa Barbara, Calif., has also declined.

The critics say fluoride is a threat to both public health and personal freedom. Indeed, fluoride can be toxic if taken in large doses. Warning labels on toothpastes and fluoride rinses tell users to not swallow, and children under six are advised not to use toothpaste at all.

Critics charge that fluoridation causes numerous health problems, including cancer, lowered intelligence, weakened bones and damage to reproductive systems. They say it also causes mottling of teeth. Some of the health concerns have been boosted by recent research that suggests increased rates of mottled teeth in fluoridated areas and a link between fluoridation and hip fractures caused by bone decay.

But supporters of fluoride cite many other studies that support its use. A large British study released this year analyzed thousands of studies of fluoride and determined it does not post a medical risk, and the U.S. medical community as a whole remains firmly in favor of fluoride.

There is no question that tiny amounts of fluoride are beneficial, said Dr. John Stamm, dean of the school of dentistry at the University of North Carolina at Chapel Hill and a spokesman for the American Dental Association. Fluoride works by reducing decay that occurs when minerals in tooth enamel are eroded by acids, he said, and it also helps teeth rebuild minerals after erosion.

But Connett, the New York professor, said fluoride supporters are ignoring the facts. “A lot of research has been done in the last 10 years and you’d think they’d be answering these findings and reviewing them very carefully,” he said. “They’re just completely ignoring them, continuing to maintain there is no debate. It’s full speed ahead as far as they’re concerned.”

In Utah, fluoride foe Rae Howard says the personal freedom issue is just as important as the health concerns. “I don’t feel it’s appropriate to use the public water supply as a delivery system for a medication,” said Howard, a health food store chain owner and president of an organization called Health Forum. “There will be people who will receive a medication without their consent. We wouldn’t allow that under other circumstances. There are two places where you can force someone to take medication without their consent — at a mental health institution and in prison.”

Two large counties and several towns in Utah will face fluoridation votes next week. Howard has tried to get her message out through community forums, but fluoride supporters have refused to engage her in public. In both Salt Lake City and Spokane, Wash., medical experts declined to debate Connett. In Utah, he debated 24 empty chairs representing health experts who were invited to speak. He faced eight chairs in Spokane.

According to polls, voters appear to be closely divided on the wisdom of fluoridation in Las Vegas and Spokane. Both sides claim to have momentum in this election, but some acknowledge that things could go awry for their side. “My sense is if Vegas stops it (fluoride), that’s a really remarkable indication of a shift in people’s feelings about this,” said Miller, the San Antonio history professor who is a strong supporter of fluoride.

Prominent anti-fluoride voices could sway some people too, especially since they’re coming from both sides of the political spectrum. While newspapers generally support fluoride, the Salt Lake Tribune recently editorialized against it, quoting a study in a prominent dental journal that said fluoride in drinking water is not as important as some health experts think.

And during a visit to San Antonio, long a center of fluoride battles, Nader urged voters to reject fluoridation. According to published reports, he said fluoridation isn’t appropriate if “its only objective” is to reduce tooth decay. In 1971, in fact, he wrote that there are more effective ways to fight cavities among children than exposing everyone to fluoridation. Nader isn’t the only leftist to worry about the water supply. In 1999, voters in Santa Cruz, Calif. — a town known for its liberalism — narrowly rejected fluoride.

Miller is surprised by liberals and conservatives’ meeting of the minds. “The left in the 1950s wouldn’t be caught dead in the same bailiwick as the John Birch Society,” he said. “I’m fascinated by the process in which the left in this case has really cozied up to the right and has embraced many of its arguments and endorsed its tactics. The language is very paranoid and distrustful.”

But even if the war over drinking water unites ideological enemies, Miller said it’s important to note that fluoride foes don’t win most of their battles. “Over time, they’ve actually lost,” he said. “Let’s not lose sight of that fact.”

Not so fast, say fluoride foes. Disgusted by what they see as media bias, they hope to harness the power of the Internet to spread the word about the dangers of tinkering with drinking water. Then, they hope, the time will be up for fluoride supporters. “This,” Connett declared, “is their last gasp.”

“I don’t necessarily want even my friends knowing where I am,” says Ben Shapiro, a 22-year-old senior who is designing the project’s privacy rules. “Maybe students aren’t out of the closet and don’t want people to know they’re going to the Gay & Lesbian Resource Center. Maybe you’re cheating on your girlfriend and you don’t want her to know you’re in somebody else’s dorm room. It’s creepy Big Brother.”

Shapiro is no stranger to speaking his mind. In his freshman year, he and the ACLU successfully sued UCSD after he got in trouble for posting a handwritten sign that said “Fuck Netanyahu and Pinochet” on his dorm room window. But Shapiro actually likes the location-tracking software despite his misgivings. “If the system has enough protections for people’s privacy and enough people use it, it could be really great,” he says.

The official goal of the PDA project is to test whether location trackers will encourage students to find each other more easily on a sprawling and rapidly growing campus. “What used to feel like a small town is starting to feel like a big city,” said William Griswold, a computer science professor who is overseeing the project.

The PDAs detect each other through the university’s Wi-Fi (Wireless Fidelity) network, the same radio wave-based system that allows lap-toppers to go online from coffeehouses and airports.

The location-tracking software itself, developed by a 15-year-old student at the university, draws upon triangulation technology used by global positioning system (GPS) devices. The PDAs figure out their locations by comparing the strength levels of signals traveling from the devices to various Wi-Fi antennas.

The software only allows a person to track the location of another user if both agree. If Shapiro doesn’t want his best friend to track him, he can leave him off his PDA’s equivalent of an America Online “buddy list.” According to Griswold, the location data is protected by the standard SSL Internet encryption technology.

But critics are skeptical. “They have created a security risk for every single student who uses the software,” says Nick Van Borst, a 25-year-old senior majoring in world literature who criticized the tracker system in a university magazine. “People are hacking things on campus all the time, and there’s always these crazy viruses going around. Somebody’s going to want to (hack) it just for the hell of it to see if they can.”

Hackers don’t even need to be on the campus to invade the PDA location tracker system. Students can log in to a Web site from anywhere and check where their friends are. The system offers both a zoomable map of the campus — with moving dots representing their friends — and a text list of where people are. If students program their PDAs properly, their buddies can also track their locations around the world whenever they log into a Wi-Fi network.

System administrators can gain access to the locations of students or employees equipped with the PDAs, although designers hope to eventually make that impossible. Law enforcement officers could also conceivably try to track someone without their knowledge, but “it’s not our intention to be a party to activities like that,” Griswold says.

The PDA project will get bigger. UCSD has a few dozen more donated PDAs to give away to students, and it hopes to equip 330 freshmen with them this fall when it opens a sixth mini-college on campus.

Hewlett-Packard, which has provided the PDAs for free, wants to know what college students do with the devices, Griswold says. “What 18- or 20-year-olds will do with these PDAs today is what 35-year-olds will be doing with them tomorrow.”

That’s what worries privacy advocates who are already monitoring the growing use of location-tracking GPS microchips in cellphones.

Trouble looms around the corner “even if there’s a rock-solid privacy policy, even if certain safeguards are built in,” says Beth Givens, director of the San Diego-based Privacy Rights Clearinghouse. “Whenever someone develops a new service that uses personally identifiable information, there will be in the future other uses found for that information. You can count on it.”

UCSD officials contend that students know what they’re getting into. The PDA project is an experiment so users must sign waivers before using the devices, Griswold said. “The approach we’ve taken is to put control into the hands of the user and explain to them what it means. The students at this university are very bright, and we expect them to all be able to understand the things we say to them.”

Some students don’t even bother looking at the waiver. They turn down the new technology for a very old-fashioned reason. “They’re afraid that if they break them, we’ll charge them for it,” Griswold said.

For now, at least, both their pocketbooks and their privacy will remain intact.

Small planes remain a weak link in the nation’s aviation security system, as last Saturday’s airborne attack on a Florida skyscraper revealed. The alleged suicide pilot, 15-year-old Charles J. Bishop, didn’t even have to break into a plane. A flight instructor reportedly left him alone to do a preflight check on a Cessna 172 at St. Petersburg-Clearwater International Airport.

Bishop was too young to have a student pilot’s license, the rough equivalent of a driver’s training permit, which would have allowed him to fly solo during training. While anyone can take flying lessons, the licenses are issued only to those 16 and older.

Bishop flew off anyway and crashed into the 28th floor of a Bank of America building in downtown Tampa, killing himself but injuring no one else. Bob Collins, president of Aviation Crime Prevention Institute, contends that Bishop hadn’t even technically stolen the Cessna. “He broke the rules, took the plane without authority, but when you’re handed the keys to something, you don’t steal it,” Collins said.

Not that Bishop would have faced much of a challenge if he did want to fly off with someone else’s plane. While they are frequently worth tens or hundreds of thousands of dollars, private planes are often protected by flimsy security systems that make The Club look positively high-tech. Some pilots don’t bother with any security precautions. Others rely on simple chains wrapped around their propellers or locks on yokes and tires. Some flight schools with large fleets of planes save money by using the same ignition key for several of them.

Ironically, before Sept. 11 many pilots actually wanted to make their planes easy to burglarize, said Bill Dalby, airport manager at Brown Field, a small San Diego airport.

“There was an attitude that ‘I’m not going to restrict them from breaking in. It will cost me more to slow them down than just allow them to get in and steal what they want,’” Dalby said.

That attitude is changing, however. In the wake of Sept. 11, Brown Field and a sister airport now require all pilots to secure their planes with some sort of security device.

Pilots have had good reason to be nonchalant about security. Thefts of small planes are extremely unusual — just 15 were stolen in 2001, all but six in California, according to the Aviation Crime Prevention Institute. Eleven were taken in 2000 and 20 in 1999.

Authorities suspect that most were stolen for use in drug smuggling or for their parts. Burglaries are also rare.

Many small airports have no security at night. Control towers, if they exist, often close for business at 6 or 9 p.m. Security fences are uncommon, although some airports, like Brown Field, are erecting them now.

The lack of security seems to fit the freewheeling world of private aviation, which nearly collapsed when the federal government banned many private flights for weeks after Sept. 11.

“Very few other countries allow flying to the extent that we do in the United States,” said Dalby of Brown Field. “It’s one of those freedoms that people enjoy and cherish to the nth degree.”

It doesn’t take a terrorist attack to turn a small airport into a fortress, however. Fullerton Municipal Airport, south of Los Angeles in Orange County, became one of the most secure small airports in the country after four planes were stolen in 1999.

Now, the airport has security fencing, extensive lighting, limited-access gates, and several 24-hour security cameras. Airport employees even monitor an airplane gas station.

Even though security remains lax at many small airports, there is no precedent for Bishop’s suicide mission. While planes often crash into hills, mountains and each other, they hardly ever hit tall buildings, even though some downtown areas — like San Diego’s — are near airport approach paths.

Before Sept. 11, the nation’s most famous skyscraper collision came in 1945, when a B-25 bomber got lost in fog and slammed into the 79th floor of the Empire State Building. The accident was horrific: An engine flew through the entire floor and came out the windows on the opposite side of the building, which shook but remained intact.

Three crewmen and 11 office workers died. The death toll would have been higher if the accident had taken place on a weekday instead of a Saturday morning. The almost-forgotten Empire State disaster suggests that the Tampa skyscraper suicide offers only a taste of the damage a single terrorist pilot could cause.

Protections against renegade private pilots remain scant. The federal government still doesn’t require private pilots to carry photo identification, said Propst, the airport manager. “We need to have pilot’s certificates that are as good as driver’s licenses,” he said.

Propst supports background checks for private pilots. But critics say that’s going too far, and they question whether planes are dangerous enough to require more protection than cars. Small airports, after all, are essentially parking lots for planes. And how many car parking lots have extensive security?

“There’s only two people I know of that are dead because of general aviation crashes that are on purpose,” said Collins of the aviation security firm, referring to the Tampa crash and the 1994 suicide crash of a private plane on the White House’s South Lawn.

“Why pick on airplanes?” Collins asked. “How many cars and trucks and buses have been used to kill people in the past in one form or another?”

Last year his quest led him to Scotland to see Dr. Robert Smith, a surgeon who has performed two amputations on healthy limbs. Smith agreed to operate on him after three psychologists reviewed Furth’s case, and the two wrote a book about the disorder.

But Furth’s luck ran out. The public hospital where Smith performed the earlier operations backed out amid bad publicity. Then on Aug. 25, a private Scottish facility rejected Smith’s request that he be allowed to perform operations there.

Now appalled Scottish politicians are clamoring for laws banning the amputations and creating a media flurry in the U.K. Dennis Canavan, a member of Scotland’s parliament, told a newspaper last week that the surgery is “obscene” and demanded an investigation by health officials. “The whole thing is repugnant and legislation needs to be brought in now to outlaw this,” said Canavan, who represents the Falkirk region, home to a hospital that allowed two amputations of healthy limbs.

Stung by his critics, Smith, who reportedly has six other patients lined up for healthy-limb removal, warned of dire consequences for his patients. “They may take the law into their own hands, they may lie on a railway line and get run over by a train. They may use shotguns and shoot their limbs off,” he told reporters recently. “They are really quite a desperate bunch.”

Meanwhile, officials at the private hospital are suggesting that the surgeries be done at a university facility instead. “We’re not unsympathetic to what’s happening, but unfortunately we don’t think this is the right hospital for the procedure,” said hospital manager Beth Martin.

Furth in turn contended that the British press misrepresented the hospital’s decision as a rejection of an operation on him. Smith did not make a specific request about a patient, said Furth, so they could not have been rejecting his procedure.

Could there really be a public debate on the viability and ethics of cutting off healthy limbs?

“It’s meshugeneh — absolutely nuts,” said medical ethicist Arthur Caplan, turning to Yiddish. “It’s absolute, utter lunacy to go along with a request to maim somebody.”

Caplan, the director of the University of Pennsylvania’s Center for Bioethics, explained that such an amputation would violate the Hippocratic Oath in the extreme. “The cure is not to yield to the illness and conform to the obsession. And this is not just about ‘do no harm.’ It’s also about whether (sufferers) are competent to make a decision when they’re running around saying, ‘Chop my leg off.’”

While the fate of Furth’s leg hangs in the balance, his public plight has shined a light into the dark world of amputation obsession. No one knows how many people live their lives in hope of cutting off a healthy limb, but Furth says he knows of about 200. Among the annals of abnormal psychology, mentions of the disorder — known as apotemnophilia — lurk in footnotes and a handful of academic papers.

“I’m not an expert in this. Nobody is,” said Dr. Katharine Phillips, a Brown University psychology professor and leading authority on body dysmorphic disorder, a much more common condition in which people cannot accept their bodies. Sometimes those afflicted with the disorder take drastic measures — including unnecessary plastic surgery and self-mutilation — to try to fix body parts they think are deformed.

Some amputation hopefuls say their condition is a type of body dysmorphic disorder, but Phillips isn’t so sure. “My patients are not trying to get rid of a body part. They’re just trying to make it look better,” she said.

The guru of apotemnophilia, if there is one, is John Money, an expert in sexuality and professor emeritus at Johns Hopkins University. In 1977, he coined the word and defined the disorder as a kind of extreme sexual fetish. Apotemnophilia victims, he wrote, want to cut off their limbs so they can have better sex.

Sufferers like Furth downplay the sexual angle, and he prefers to use another term, “body identity transfer.” But for more than a century, medical experts have written about people who are sexually obsessed with amputation, said Richard L. Bruno, a specialist in brain-body disorders — known as a psychophysiologist — who runs a program for polio survivors in New Jersey.

Entire Web sites are devoted to nude people missing their arms or legs. Most aficionados are men who love to gawk at female amputees, Bruno said. But there is also a gay community and groups for those turned on by leg braces, deformed feet and bunions.

Bruno, who studies the amputation-obsessed community’s coming-out in the age of the Internet, said three groups have developed. The “devotees” love amputees, and some are so obsessed that they’ll stalk disabled women in shopping malls. The “wannabes” hope to become amputees and the “pretenders” use wheelchairs and crutches to feign disability.

Wannabes are similar to people who suffer from gender-identity disorder and want to change their sex, Bruno said. “Apotemnophilia is the result of individuals believing that the only way they can be loved is by being an amputee.”

Some sufferers do appear to be sexually frustrated. A documentary that aired this month on the Discovery Health Channel profiled a Los Angeles woman named Corinne who wants both her legs amputated above the knee.

Corinne admitted she’s never had a normal sexual relationship. “For me, sexuality is being comfortable with my body,” she said. “Inside, I feel my legs don’t belong to me and they shouldn’t be there. There is just an overwhelming sense of despair sometimes. I don’t want to die, but there are times I don’t want to keep living in a body that doesn’t feel like mine.”

Furth, 55, has not publicly discussed his own sex life. “Everybody’s projecting their stuff into it, and they don’t understand. It’s not about sex, it’s not about getting off with someone,” he said. “It’s about becoming able-bodied.”

With his salt-and-pepper hair and mild, soft-spoken manner, Furth seems an unlikely poster boy for a bizarre mental disorder. He looks like a man who would work well with kids. And indeed he does. He is a Jungian analyst who specializes in counseling terminally ill children. Furth has written a book about the importance of art therapy, and he advocates the use of play therapy to test the mental health of children. In June, he was scheduled to make a presentation about Jungian analysis at the Swiss Embassy in Washington.

Furth has been infuriated by what he considers to be incompetent media coverage of his disorder and only agreed to a brief, antagonistic interview with Salon. But he did talk extensively about his life in testimony before a San Diego jury last year.

Furth has wanted to cut off his “alien” leg since the age of 4 or 5. Like his fellow sufferers, his feelings began after he saw an amputee in public. He has long searched for “fringe doctors” to remove his leg, figuring a specialist in unusual surgeries might be willing to take on an amputation. So he was thrilled to read a story about an underground surgeon in San Diego who specialized in secretive sex-change operations.

Unknown to Furth, this surgeon had a nickname in the San Diego area: “Butcher Brown.” He had a gory history of botching transsexual operations, and he spent time in prison for operating without a license. But John Ronald Brown, 77, was willing to perform an amputation, as long as the operation took place in Mexico.

“He saw it as all the same. You cut off a boob, you cut off a penis, you cut off a leg,” said Stacy Running, a hard-nosed San Diego deputy district attorney who prosecuted Brown months later.

Furth’s operation never took place. In the first attempt, a Mexican doctor backed out. The second time, as the price rose to $10,000 from $3,000, Furth panicked after seeing an assistant carrying a large knife. “I realized that was not where I wanted to be,” he said.

But the doctor’s work wasn’t done. Furth had traveled to San Diego with a friend, 80-year-old Philip Bondy of New York, who shared the same condition. They had met each other through the amputation-obsession grapevine 26 years earlier.

On May 9, 1998, Bondy went to a Tijuana, Mexico, clinic where Brown cut off his leg. Bondy was delighted, Furth said, and he returned to California, where he checked into a Holiday Inn motel. Furth talked to him by phone and became worried by his friend’s raspy voice and his refusal to eat.

Furth flew to San Diego and checked into the motel. The next morning, he found Bondy in his bed dead of gangrene, the victim of the surgeon’s carelessness and lack of medical attention.

Prosecutors, appalled by Brown’s recklessness, soon accused him of second-degree murder — an unusually extreme charge in a medical case. Furth, who had at first told police that Bondy died of car accident injuries, received immunity in exchange for his testimony. When he walked into the courtroom, spectators craned to see if he still had his legs. He did.

Brown’s attorney said the doctor was a savior to people shunned by society. As for his client’s medical skills, the attorney said the victims knew “that they weren’t checking into the Mayo Clinic.” The jury wasn’t swayed. Brown was convicted and sentenced to 15 years to life in prison.

Furth has vowed to continue his hunt for a surgeon. But Bruno, the New Jersey psychophysiologist, said amputation “will not solve the problem of being loved.” He thinks sufferers should turn to psychotherapy and antidepressants that have been useful in treating obsessive compulsive disorder, which seems to be related to amputation obsession.

Furth said therapy will only work in some cases. “Psychotherapy for some individuals is fine, like AA is great for some drunks.”

It’s unclear if doctors can legally perform physically unnecessary amputations in the United States. Stacy Running, the San Diego prosecutor, said she knows of no law that would prevent a licensed doctor from performing an amputation on a healthy limb.

Running has kept in close contact with Furth, and the two have a friendly relationship. But she still doesn’t understand his illness. While preparing Furth for his testimony last year she grappled with the fate he was wishing upon himself.

“He was in my office with his legs crossed like men do, balancing books and his notes in his lap,” she recalled. “I looked at him and said you’re not going to be able to do that after the surgery.”

Furth’s response was short and sweet. “You’re incorrigible,” he said. Then he continued trying to find a doctor to save his mind by sacrificing his leg.