The Great Fluoride Debate

Ever since fluoridation became widespread in the 1950s, cavities in kids have fallen drastically. The effort is considered one of the ten greatest public health achievements of the 20th century. But it’s also one of the most controversial. Today, the story of what that's so, from our sister podcast, NHPR's Outside/In. CLICK HERE: Visit our website to see all of our episodes, donate to the podcast, sign up for our newsletter, get free educational materials, and more! To see Civics 101 in book form, check out A User's Guide to Democracy: How America Works by Hannah McCarthy and Nick Capodice, featuring illustrations by Tom Toro. Check out our other weekly NHPR podcast, Outside/In - we think you'll love it! Learn more about your ad choices. Visit megaphone.fm/adchoices

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• 0:00Speaker 00

  Para los grandes, para los chicos, para los bajos y los altos, los pacifistas, los valientes, para los optimistas y los pesimistas, los que valoran lo de adentro, para los que están lejos, los que no vende lejos y los que no vende cerca, para los introvertidos y los extrovertidos, para los que piensan y los que hacen, para los que nos mostraron el camino. Coca-Cola, para todos. Compra una Coca-Cola en una tienda cerca de usted.

• 0:31Speaker 01

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• 1:00Speaker 02

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• 1:33Hannah McCarthy?

  This is Civics 101. I'm Hannah McCarthy. Today, we're bringing you an episode from our colleagues at Outside In. The topic? Fluoride. The municipal fluoridation of water is a prime example of the kind of policy we love to dig into on this podcast. And it's very much at top of mind for a lot of people right now as President Trump's nominee to run the Department of Health, Robert F. Kennedy Jr., has called for the reversal of longstanding government recommendations to add fluoride to municipal water supplies, one of the many controversial stances he's promised to bring to that job. The history of local water fluoridation is complicated, which is what today's story is about,

• 2:18Hannah McCarthy?

  as well as some surprising and conflicting ideas about whether the mineral is beneficial to our health or not. Outside In host Nate Hegy digs into all of that and more. Let's take a listen.

• 2:36Speaker 04

  Let's go back to the year 1901. The man? A young dentist named Frederick McKay. He had just arrived in a small frontier town called Colorado Springs. And as soon as he got there, he noticed something strange.

• 2:58Speaker 04

  The townspeople who became his dental patients had dark brown spots all over their teeth. We are talking the color of chocolate.

• 3:06Speaker 05

  But interestingly, when he looked at them, he noticed that they didn't have cavities.

• 3:10Speaker 04

  Brown teeth, few cavities. That, by the way, is Rene Nahera. He's an epidemiologist and director of public health at the College of Physicians of Philadelphia. He says Frederick McKay noticed this was a regional thing.

• 3:24Speaker 05

  In other towns, kids had teeth that were normal for the time with plenty of cavities, but they were nice and white teeth.

• 3:31Speaker 04

  The condition was nicknamed Colorado brown stain. Locals blamed the phenomenon on a number of things: eating too much pork, drinking funky milk. Or maybe there was something in the water.

• 3:49Speaker 04

  That last theory had legs. There was this other town in Idaho that also had Colorado brown stain. But when they switched to a different water source, it went away. Then there was this mining town in Arkansas. They also had cases of Colorado brown stain. Yet, a town five miles away didn't. So, an employee for the mine collected water samples from the town and then sent them to the company lab.

• 4:13Speaker 05

  And the guy at the lab is like, "You contaminated the sample that has way too much fluoride in it. And send me another one." And so they sent another one and they come to the conclusion that the water in some towns had a lot of fluoride in it and the water in others did not, and that that correlated with the staining of the teeth.

• 4:35Speaker 04

  Fluoride. You may be under the impression that fluoride is a chemical we add to water. And that's true. But it's also found in nature. The people in these towns weren't putting fluoride in the water. It was already there.

• 4:50Speaker 05

  You're gonna find it in groundwater, specifically in places that have a lot of volcanic or used to have a lot of volcanic activity.

• 4:57Speaker 04

  But this discovery led to the birth of one of the largest public health initiatives in American history. An effort to save our children's teeth by tinkering with community water supplies all across the country. It's a move that's been as successful as it is controversial.

• 5:13Speaker 06

  Fluoride is safe and effective.

• 5:15Speaker 01

  Fluoride is a neurotoxin.

• 5:17Speaker 07

  It's good in small doses.

• 5:19Speaker 00

  I think fluoride is a poison.

• 5:26Speaker 04

  Today on the show, what's the deal with fluoride? Sure, it has saved millions of mouths and billions of dollars in dental bills. But, as they say in Marathon Man...

• 5:37Speaker 01

  Is it safe? Is it safe? Is it safe?

• 5:40Speaker 04

  Stay tuned.

• 5:52Speaker 04

  North Country Dental. There it is. I figure any good story involving teeth should begin with a dentist. Come on in, Dr. Hartzell's old back waiting. Okay, great, awesome. In this case, Dr. Mark Hartzler. He has a practice in the small town of Gorham, New Hampshire. Hey! Nice to meet you, Mark. I'm Nate. Yeah, sorry about the cold hands. A big part of Mark's day is spent finding and fixing cavities. We've all had cavities, or most of us at least have had cavities. Have you had a cavity, actually? Oh, yeah.

• 6:24Speaker 07

  You can come from a dental family and still get them. It's it it happens.

• 6:28Speaker 04

  These are essentially holes in the enamel of your teeth. For thousands of years, people were convinced that they were caused by worms, burrowing into our teeth the way they might burrow into an apple. The truth is not as gross.

• 6:42Speaker 07

  Think of a tooth like an M and M. You've got the thinner outer layer that's a little harder than the bulk of the M and M inside, which is chocolate, right? So in a tooth, the outer layer is called enamel. The inner layer is called dentin. And there's more dentin than there is enamel. But the enamel, the outer layer, is typically more hardened and calcified. So that provides a little bit more protection in the oral cavity. As we eat various foods, things with sugars, sucrose, glucose, anything like that, the bacteria that are normally in our mouths will break those sugars down themselves and secrete acid. Acid then starts to eat away at the outer enamel of teeth. Eventually, that process continues for a while and you end up with the cavity or a hole that's now formed there.

• 7:27Speaker 04

  Cavities aren't just a pain. If left untreated, they can become an open door for bacterial infections.

• 7:34Speaker 07

  So bacteria can spread down into the jawbone itself and into the blood supply from there. And so a common concern for people with, say, artificial heart valves is that oral bacteria can get into the bloodstream and have and cause issues with their artificial heart valves.

• 7:50Speaker 04

  There have been multiple studies that show the more teeth that you lose because of decay, the shorter your lifespan is. This is why keeping your mouth healthy and cavity free is so important. And we have lots of ways to do that. We get cleanings every six months or maybe fillings when we need them. But all of these are relatively new treatments. Dentistry as we know it has only been around for about 100, 150 years.

• 8:23Speaker 04

  For a lot of human history, the solution to a toothache was just get rid of the tooth. You'd go down to your local barber or blacksmith and they would yank it out. Seriously. And after the Industrial Revolution, when sugary and processed foods got really popular, this happened a lot. Fun fact: the failure to meet a minimum standard of having just six opposing teeth was the leading cause of rejection of people who signed up for military service in both world wars. So for many decades, our mouths were not great. This is why, in the early 1900s, dentists were so intrigued with the discovery that

• 9:07Speaker 04

  ingesting fluoride was, sure, turning teeth brown, but also making those teeth resistant to cavities. But how? For the answer, we're gonna need a little chemistry lesson. The enamel in our teeth, so the hard outer stuff, is made of a mineral called hydroxyapatite.

• 9:29Speaker 07

  Hydroxyapatite is made up of calcium, phosphate, and a hydroxyl group. Hydroxyl group is oxygen, hydrogen. That group is replaced by a fluoride ion.

• 9:37Speaker 04

  Kind of the way that you can swap out a shingled roof for a metal roof? The fluoride replaces parts of your enamel and makes it more durable.

• 9:45Speaker 07

  Fluoride being part of that, um, part of that compound reduces the solubility a little bit, makes it less susceptible to breakdown. It will still eventually break down. You make it acidic enough for long enough, but it, it is, it is harder to get to that point than, um, than if it didn't have the fluoride there.

• 10:07Speaker 04

  But those benefits come with an unpleasant side effect. Ingest too much fluoride, especially when you're a kid, and that added armor will start to turn your teeth a mottled patchwork of white and brown. That's what the dentist called Colorado brown stain back in the 1900s. Today, doctors call it dental fluorosis.

• 10:27Speaker 07

  The area is typically still really hard, not more prone to decay, but aesthetically looks different.

• 10:35Speaker 04

  After the discovery of fluorosis back in the 1900s, the federal government tasked a special group, the dental hygiene unit, to tinker with the levels of fluoride in water. It took them till the late 1930s, but they eventually found the perfect ratio, one that would keep your teeth strong, but wouldn't turn them brown. Here's Rene Nahara, the epidemiologist.

• 10:56Speaker 05

  They said that their sweet spot back then was one part per million or one milligram per liter of water.

• 11:01Speaker 04

  For some places, like Colorado Springs, that's a lot less than the amount that was naturally in their drinking water. But for most people, it was more. So, a few years later, a town in America voted to try boosting their levels of fluoride artificially by adding a small amount to the public drinking water.

• 11:21Speaker 07

  Grand Rapids' fight against tooth decay started in January 1945 when fluoride was added to the water supply.

• 11:30Speaker 05

  A few years later, about 10, 11 years later, they saw that, yeah, the level of cavities had dropped, specifically in children, and the oral health had improved. And there were no apparent side effects from the fluoridation of the water at the time.

• 11:45Speaker 07

  Now, our children can have better health through fluoridated water.

• 11:56Speaker 04

  Other towns, from New York to Texas to Idaho, tried fluoridating their water and had similar results. Cavities in children who were born in the years after fluoridation dropped by more than half. It also leveled the playing field. Kids whose parents couldn't afford to go to a dentist now had stronger teeth without their families paying a dime. In 1962, the US Public Health Service began recommending that towns add fluoride to their water. Now, it wasn't mandated, but many towns chose to do so. And today, about 210 million people across the country are drinking and using fluoridated water.

• 12:35Speaker 07

  They can drink away.

• 12:37Speaker 04

  Tomorrow's tooth decay. It was considered a revolutionary scientific breakthrough. And the CDC has named this as one of the top 10 biggest public health achievements of the 20th century, right up there with mass vaccinations. And, just like vaccinations, fluoridation was also controversial, right from the beginning.

• 13:06Speaker 04

  In the McCarthy era, there were Americans who thought that fluoride in the water was communism in a glass. In the 1950s, you could find flyers warning of the quote "unholy three." The polio vaccine, classroom instructional videos, and fluoridation. All ways for secret communists in the government to control our health and tell us what to do. They warned that fluoride was nothing but a rat poison.

• 13:31Speaker 05

  That it was trying to control your mind, that it was trying to make you sick so that the Russians could come over and invade and, you know, our young people would not be ready to fight.

• 13:40Speaker 04

  This idea was satirized in the movie Doctor Strangelove in 1964. Do you realize that fluoridation is the most monstrously conceived and dangerous communist plot we have ever had to face?

• 14:02Speaker 04

  It was all part of a bigger worry that some folks had about the role of government in their life. Big public health measures like mass vaccination and fluoridation, they didn't start happening in this country until the mid 20th century. It was new and kinda scary. Renee says this is par for the course.

• 14:21Speaker 05

  In public health, there has not been an intervention that has gone without some sort of controversy from people who don't know the science, they don't understand the science, or they're just plainly afraid of these interventions. And this was no different. You know, you're adding something to the water. We all need water, you know, we all need water to survive, and we like it to be nice and clean as possible. We don't like to have anything in it. And when you're adding something to it, then yeah, people are gonna be skeptical of that and they're gonna be worried about that.

• 14:49Speaker 04

  Even now, worries about fluoride have survived, outliving the Soviet Union. RFK Jr., President Trump's pick to run the Department of Health and Human Services, called fluoride "a poison." Complicating all of this, when it comes to the perceived dangers of fluoride, there is actually a grain of truth. Or should I say tooth?

• 15:16Hannah McCarthy?

  More of this story from outside in when Civics 101 returns after a quick break.

• 15:28Speaker 06

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• 16:13Speaker 06

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• 16:48Speaker 06

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• 16:59Speaker 04

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• 17:40Speaker 04

  Just go to incogni.com/civics or use the code civics at checkout. There's a link in the episode description. Remember, they can't harm you if they can't find you.

• 17:53Speaker 00

  Para los grandes, para los chicos, para los bajos y los altos, los pacifistas, los valientes, para los optimistas y los pesimistas, los que valoran lo de adentro, para los que están lejos, los que no vende lejos, y los que no vende cerca, para los introvertidos y los extrovertidos, para los que piensan y los que hacen, para los que nos mostraron el camino. Coca-Cola, para todos. Compra una Coca-Cola en una tienda cerca de usted.

• 18:25Speaker 01

  Born in Texas, made in America. That's Valero, keeping America moving, rain or shine, day or night, 365 days a year. Giving back to our communities and helping businesses thrive. We're proud to fuel the people who keep this country moving. So whether you're exploring new roads or heading down ones you know, we're here, fueling drives coast to coast. Proudly American, proudly getting you where you need to be. Right now, Valero.

• 18:54Speaker 04

  Hey, this is Outside In. I'm Nate Hegy, here with another medical mystery. I'm going to call this one "The Curious Case of the Copenhagen Cryolite Workers."

• 19:12Speaker 04

  Cryolite is a rare mineral used to make aluminum back in the early and mid 20th century. It was mined in Greenland and then some of it was shipped to Copenhagen for processing at a mill there.

• 19:23Speaker 06

  And so they crushed it. And the dust that that created was inhaled by the workers.

• 19:32Speaker 04

  This is Philippe Conjon. He's a professor of environmental medicine at the University of Southern Denmark. And he says these workers were coming down with very strange ailments.

• 19:44Speaker 06

  You know, if they dropped something on the floor, they couldn't pick it up. And if they wanted to look to the side, they had to move the whole body to the side. It was like the spine was, it was stuck.

• 20:02Speaker 04

  Later, one of the workers died and there was an autopsy. His joints had calcified.

• 20:09Speaker 06

  The spine actually came out in one piece, simply because the calcification had ensured that the vertebrae could not move independently.

• 20:40Speaker 04

  Cryolite is also known as sodium aluminum fluoride. And when scientists tested the urine of these workers, they found really high levels of fluoride.

• 20:50Speaker 06

  The workers were exposed to something like 20 mg per workday.

• 20:57Speaker 04

  That's 28 times higher than what the US recommends when fluoridating water supplies. We are talking so high that it causes a condition called skeletal fluorosis. It's where your bones fuse together, causing arthritis, joint pain, and in severe cases, spinal fusion.

• 21:16Speaker 06

  Which is very painful and it affects the movements of the joints. And so it's certainly something that we want to prevent.

• 21:27Speaker 04

  The workers were breathing in the fluoride. But this can also happen when you ingest way too much in other ways.

• 21:38Speaker 04

  There was a woman in Michigan, 47 years old. She loved tea, and she loved it strong. Every day for almost two decades, she drank a pitcher of tea made from over 100 tea bags. Problem is, teas are often grown in fluoride-rich soil in places like China and East Africa.

• 21:57Speaker 06

  And the tea plant will suck up the fluoride. And when you then pick the leaves and dry them, ferment them, then the fluoride gets concentrated. When you pour boiling water on them, you dissolve the fluoride.

• 22:13Speaker 04

  Again, this woman was drinking an ungodly amount of tea. And sure enough, she developed skeletal fluorosis.

• 22:26Speaker 04

  This condition is very rare in the United States because the government has set limits on how much fluoride can be in our water supplies. The absolute maximum amount of fluoride you're legally allowed to have in a community drinking supply is four parts per million. That's the standard set by the Environmental Protection Agency, and it's for water that's already naturally fluoridated, like the water they were drinking back in 1901 in Colorado Springs. Here's Renee Nachhera, the epidemiologist again.

• 22:53Speaker 05

  The EPA does a wonderful job of assessing toxicity of all sorts of things in our environment and telling us the safe limits.

• 23:00Speaker 04

  And at that level, you might have modeling of the teeth, but no severe spinal fluorosis. Now, if you're artificially adding fluoride to the water, the US Public Health Service has a much lower recommended limit: 0.7 parts per million. This number takes into account that people might be getting more fluoride from other sources, from swallowing fluoride toothpaste—don't do that, by the way—to drinking black tea with that water, or that people are drinking more than 2 liters of water a day, which is considered an average amount, because the more fluoridated water you drink, the more fluoride you ingest. But with all of that in mind, nowadays, 0.7 is considered a good threshold to keep your teeth white and more protected from cavities.

• 23:45Speaker 05

  The dose makes the poison. So if I take a little bit of aspirin for a headache, I'm gonna be okay. But if I take a lot of aspirin, I'll bleed to death. If I take Tylenol as recommended, I'm gonna be fine. If I take way too much, I'm gonna hurt my liver. Same thing with fluoride. If you have a little bit of fluoride with your water at the level that we have now evidenced for, you know, 70-plus years, then you're gonna be fine. But if, you know, if you have a lot of fluoride, and we're talking extreme levels, you know, eight parts per million, 10 parts per million, 12 parts per million, then you're gonna have an issue.

• 24:18Speaker 04

  There is a long list of acronym institutions that say our fluoridated water is safe. The EPA, the CDC, the ADA, American Dental Association, the AAP, American Academy of Pediatrics, they all agree. But there is a small, yet growing body of research that suggests it might not be safe. This is where things get complicated.

• 24:47Speaker 04

  Since the early 2000s, there have been 30 peer-reviewed studies looking into how drinking fluoridated water, both by pregnant women and children, affects the IQs of kids. These were limited studies, a little more than 13,000 people in all, spread across Mexico, China, Canada, Denmark, Taiwan, India, and Iran. Philippe Grange, the Danish epidemiologist, was a co-author on one of these studies.

• 25:12Speaker 06

  And almost all of them showed a negative association, that is, the more fluoride, the less the IQ.

• 25:21Speaker 04

  The US National Toxicology Program reviewed these studies this summer. They concluded with moderate confidence that exposure to fluoridated water at higher than 1.5 parts per million consistently correlated with lower IQ in kids. That is just twice the limit of fluoride that the US Public Health Service recommends towns put in the water. But when I poked around on the CDC's website, I found that there are many communities in the US, like Waterville Valley, New Hampshire, or Alpine, Texas, that have naturally fluoridated water that's actually higher than 1.5 parts per million.

• 26:07Speaker 04

  Philippe's research has gone a step further than that National Toxicology report. He's an expert on what happens when fetuses are exposed to stuff like lead, mercury, and fluoride. A peer-reviewed study that he wrote suggests that even if pregnant women are receiving the recommended amount of artificial fluoride in their drinking water, their children are still losing a couple of IQ points.

• 26:30Speaker 06

  Two generations of Americans over the last 60 or 70 years have gotten fluoride into their fetal brains, and we have probably lost millions of IQ points.

• 26:46Speaker 04

  But while a one or two-point IQ drop might sound scary, to put it in perspective, studies have shown that smoking a couple of packs a day can lead to a nearly seven-point drop in IQ. Same with being exposed to the chemicals in dryer sheets, hairspray, and pesticides. And Philippe recognizes his study may have limitations.

• 27:06Speaker 06

  It's hard to be 100% certain, particularly because we study people who are all different. And there could be some factors that we haven't controlled sufficiently.

• 27:22Speaker 04

  Still, from what he's seen, Philippe tells pregnant women to avoid drinking fluoridated water.

• 27:28Speaker 06

  You can take a shower in the fluoridated water, but I wouldn't prepare soup or gravy from your kitchen supply of water, or drink it in your coffee or tea. And if you are a tea drinker, make sure you get something, you know, let's say, organic tea from Nepal that is lower in fluoride, or green tea, which is also lower than black tea.

• 27:59Speaker 04

  This is a hotly debated conclusion, and one that has gotten Philippe a ton of flack.

• 28:04Speaker 06

  I've certainly received messages by email from people who are very much in favor of adding fluoride to the drinking water. And so, so they think I'm lying or something. And, and it's very clear that there are differences of opinion. But I'm, I'm trying to rely on what I observe.

• 28:41Speaker 04

  I need to be very clear here. Philippe's conclusions put him in the minority. The National Toxicology Program says there needs to be way more research to reach the same conclusion. The CDC, the World Health Organization, and a host of other medical bodies say that our current fluoridation limits are safe. And Rene Nahra, the epidemiologist, he pours some cold fluoridated water over this idea that American kids are slightly stupider because of what we drink.

• 29:11Speaker 05

  I've seen those studies. I've looked at the, at the data and they're, they're wanting.

• 29:18Speaker 04

  He thinks these studies are making some big leaps correlating fluoride and intelligence, especially considering that IQ tests can be flawed.

• 29:26Speaker 05

  We know that the IQ test is highly unreliable, even in adults. It depends on how the, the questions are framed. It depends on the population that is being given this test. And in children, it is even more unreliable. You know, children develop at different rates just naturally. They have different developmental milestones that they meet at different times. And that's why we give ranges to things like walking, or learning to read, or learning to hop on one leg. We don't say that by a certain age, they have to be, have met those milestones. And so what the IQ test had given in some of these kids was doing was trying to do just that, to say, at this age, you must have this IQ to be considered normal, and then tying it into fluoride.

• 30:13Speaker 04

  The American Academy of Pediatrics and the American Dental Association have also come out forcefully against these studies, arguing that they are flawed. But that is the nature of new science. It's constantly getting reviewed, confirmed, challenged. It is far from settled, which is why traditionally, we've relied on big government agencies like the World Health Organization, the US Public Health Service, or the EPA to sift through all of this data, take it in stride, and then make their recommendations. But the public's trust in those institutions has eroded, especially in the wake of the COVID-19 pandemic.

• 30:54Speaker 04

  We live in a world where unsettled science, or even bad science, can quickly become doctrine. This past fall, a federal judge ruled that the EPA needs to take a second look at its maximum legal limits for fluoride in American water. Remember, those limits are four parts per million. Philippe Grangeon was an expert witness in that trial, arguing that same point. The judge also said that the US Public Health Service's much lower limit for artificially fluoridated water poses, quote, "an unreasonable risk of reduced IQ in children." And since then, cities in Florida, Washington, Texas, and other states have stopped fluoridating

• 31:38Speaker 04

  their water. This is the direction that Robert F. Kennedy Jr. wants the entire country to go. On the night of the election, he sat down with Tucker Carlson for an interview, and he doubled down on fluoride.

• 31:51Speaker 00

  You know, it's one of the easiest things you can do to start restoring American health is just get the fluoride out of the water. You're gonna have a higher IQ, children. You're gonna have less bone cancer.

• 32:03Speaker 04

  This is crazy. I am not going to touch on all the things that RFK Junior has claimed. A lot of it's been debunked or is based on dubious or unsettled science.

• 32:14Speaker 04

  But the fact is, if RFK Junior is confirmed, the Department of Health and Human Services will probably reverse their recommendations on fluoridating water. Now, he can't tell towns to not put fluoride in their water, but he can reverse official recommendations that say it's a good idea. This is part of his bigger agenda, focusing on personal choice, one that's pushing back against big public health initiatives. You can still get vaccines, but we're not going to mandate them. And if you want fluoride, you can still get it by taking supplements, or brushing your teeth with fluoride toothpaste, or getting that peppermint-flavored topical fluoride treatment at the dentist every six months. It's your choice.

• 33:03Speaker 04

  This kind of clawback has happened before, by the way. Rene Nahara, the epidemiologist, says Windsor, Ontario, in Canada, voted away fluoridation.

• 33:12Speaker 05

  And after 10 years or so, they saw a dramatic rise in the number of cavities in kids. It came roaring back, and they decided to go back into fluoridating the water.

• 33:23Speaker 04

  He says that's the rub with personal choice driving public policy. Not everyone has access to a choice.

• 33:31Speaker 05

  Fluoridation in the water would not be an issue if we all had universal access to dental care and to brushing our teeth, and we all did it on time, and we all went to the dentist every six months and brushed our teeth at least twice. You know, those public health recommendations, if we brushed our teeth at least twice with fluoridated toothpaste, it would not be an issue. Unfortunately, it's not. We have an equitable system of public health and medicine, and this is the best thing that we can do to kind of counter that. So you balance the risk of oral health, bad oral health and outcomes, with the very unlikely, very unlikely risk of a lowered IQ or developmental delays based on fluoride, especially with the levels of fluoride that we use in our water. And my money is on oral health.

• 34:23Hannah McCarthy?

  If you have thoughts about today's episode or your own experiences with fluoride to share, contact our colleagues at Outside In. You can send a voice memo to the team at [email protected] or leave a message on their voicemail. That number is 1-844-GO-OTTER. That's 1-844-G-O-O-T-T-E-R. This episode was hosted by Nate Hedgy and edited by Rebecca Lavoy and Taylor Quimby. The Outside In team also includes Justine Paradise, Felix Poon, Marina Hanke, and Kate Dario. Music in this episode from Blue Dot Sessions. Outside In and Civics 101 are productions of New Hampshire Public Radio.

• 35:17Speaker 05

  This is Phil Bradison, former Democratic governor of the state of Tennessee. If you love digging into how history shapes US policy, check out the new season of You Might Be Right. And this is Bill Haslam, former Republican governor. This season, we're asking the questions that have defined every pivotal moment in American political history. Is democracy really under threat? Or is that just a story as old as the republic itself? We're tackling the biggest questions shaping the 2026 midterms, so join us.

• 35:43Speaker 00

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