Why Clean Drinking Water is Overrated

A Sensible Medicine Guest Post

Sometimes, all that is left is satire…

Adam Cifu

In recent months, the security of clean drinking water in the United States has faced unprecedented scrutiny. Health Secretary Robert F. Kennedy, Jr. has publicly condemned fluoridated drinking water. He has stated that the practice, referred to by the Centers for Disease Control and Prevention as “one of the ten greatest public health achievements of the 20^th century,” is adding “industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid disease” to our water supply. A leaked memo from the United States Departure of Agriculture’s Research Service division revealed that the term “safe drinking water” is now banned from official communications. Finally, President Donald Trump’s 2026 fiscal year budget proposal includes a staggering $2.46 billion reduction in funding for federal clean water initiatives. With these policy shifts signaling a departure from long-held practices, perhaps it is time to reconsider whether the public health emphasis on potable drinking water has been overstated.

Clean drinking water has helped reduce infant mortality, largely eradicated typhoid, and eliminated cholera outbreaks in the United States. However, there are serious unintended consequences associated with maintaining a clean water supply. Generations of clinicians have missed out on the opportunity to identify the textbook “rice water diarrhea” of cholera or the classic “rose spot” rash of typhoid fever. With the decline of waterborne diseases, entire chapters of Harrison’s Principles of Internal Medicine on E. coli, norovirus, and giardia are now unappreciated by trainees who assume that they will never encounter these conditions. The absence of routine exposure to chronic diarrheal illnesses deprives young children of formative experiences. What builds character more than the challenge of navigating a battle with rotavirus-induced dehydration? According to UNICEF, diarrhea is a top reason for death among children under the age of five in developing countries, with 535,000 deaths per year. With clean drinking water, children take for granted balanced serum electrolytes and the simple privilege of surviving toddlerhood.

Fluoride, long lauded for its role in reducing tooth decay, has improved dental health for decades. Community water fluoridation has decreased the rates of dental caries in children by 40-70% and tooth loss in adults by 40-60%. But in doing so, it has robbed dentists – job creators – of opportunities to fill cavities, conduct root canals, and maintain a steady flow of income. Every $1 invested in fluoridation saves about $38 in dental treatment costs, $38 stolen from dentists. While cost savings for patients and overall improved dental hygiene seem desirable, one must question: Would allowing tooth decay encourage new avenues for innovation in the field? Might it inspire fresh business models in cosmetic dentistry, creating opportunities for economic growth and competition?

Lead and arsenic are often disparaged for their adverse neurological effects and oncogenicity. Lead, a mineral historically used in everything from paint to plumbing, once played a critical role in child development. Limiting children’s exposure to lead deprives them of the opportunity to grapple with the adversity of managing developmental delays and learning disabilities. Water contamination with arsenic, often vilified as a public health crisis, can be reframed as a research opportunity. Epidemiological studies have suggested that 1 in 10 people with long-term exposure to drinking water contaminated with high levels of arsenic, often in developing countries, die from cancer. Rather than clinging to the idea of eliminating exposure to arsenic, perhaps we should consider this an unparalleled opportunity for researchers to develop new therapies for arsenic-related malignancies. What better way to undermine the cancer screening skepticism rampant on Sensible Medicine than to increase rates of cancer?

Clean drinking water has long been considered a central aspect of public health. It has prevented infectious disease outbreaks, improved dental health, and protected populations from exposure to toxic minerals. However, as recent policy changes shift us away from conventional wisdom, it may be time to reconsider if we have overstated its importance. Perhaps, rather than focusing on maintaining evidence-based standards of water sanitation, we should adopt a more flexible approach. We should embrace new opportunities for medical innovation, training opportunities for young doctors through support for once common infections, economic expansion, and resilience-building for future generations.

Holland Kaplan, M.D. is an Assistant Professor of Medicine and Clinical Ethics at Baylor College of Medicine in Houston, Texas.

Any opinions expressed in this article are those of the author and do not represent the views of Baylor College of Medicine.

Photo Credit: Nathan Dumlao