THE SURGEON GENERAL'S ROLE IN THE POLLUTION STORY OF FLUORIDATION

with Melissa Gallico

SYNOPSIS.

Episode 10 of the #Fpollution podcast reveals how and why the Office of the U.S. Surgeon General abused its power to inflate the safety standard for fluoride in drinking water at the expense of public health.

Ep10 with Melissa Gallico

The Surgeon General's Role in the Pollution Story Behind Fluoridation

The U.S. Surgeon General is the prime endorser of artificial water fluoridation in the United States. In this revealing episode, former military intelligence officer Melissa Gallico explains how and why the Office of the U.S. Surgeon General altered the recommendations of its own panel of medical experts to inflate the safety standard for fluoride at the expense of public health.

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Melissa Gallico is a former FBI analyst and military intelligence officer. She is also author of The Hidden Cause of Acne, illustrator of F Is for Fluoride, and host of the #Fpollution podcast, dedicated to exposing the pollution story behind fluoridation. She has a degree in science and technology in international affairs (STIA) from Georgetown University and a master's in international security studies from the University of St. Andrews in Scotland where she spent a year as a Fulbright scholar to the United Kingdom.

 

READ THE TRANSCRIPT.

This podcast is produced by Gallico Studios, a multimedia effort supported by a community of activists who share the goal of exposing the pollution story behind fluoridation. To join the studio or learn more, visit our website at www.Fpollution.com.

Melissa Gallico: Welcome to #Fpollution podcast. I'm your host, Melissa Gallico, author of The Hidden Cause of Acne: How Toxic Water is Affecting Your Health and What You Can Do About It and F Is for Fluoride: A Feasible Fairytale for Freethinkers 15 and Up.

We are nearing the end of season one of the #Fpollution podcast. In this season, we focused on how fluoridation happened, and that means telling the pollution story behind it. In upcoming seasons, we will be taking a deep dive into how fluoride effects specific aspects of health and the environment, and we will also hear from a variety of hometown heroes who have worked or are in the process of working to end fluoridation in their communities. If you have a special request for a certain speaker or topic, reach out to me. You can find me on Twitter, Instagram, YouTube, Facebook, or you can contact me at Fpollution.com.

But before we move on, there is one more government agency I want to focus on because of its pivotal role in the effort to cover-up (that’s just the most accurate way to describe this) the adverse health effects of fluoridation.

During my conversation with Dr. Robert Carton for episode 4 on the EPA,  I asked him if there were officials from any other government agencies that pressured EPA scientists to increase the safety standard for fluoride. He didn’t hesitate in pointing the finger at a very powerful federal agency, the Office of the Surgeon General.

The Surgeon General of the United States is often referred to as the Nation’s Doctor. It’s a political position appointed by the president and confirmed by the senate. The Surgeon General is a commissioned officer—they were a uniform similar to the one I wore as an intelligence officer in the Navy—and they lead a group of over 6,000 other uniformed officers within the Department of Health and Human Services. Their sole mission is to protect and promote the health and safety of the nation. In this episode, we’ll cover how and why such an elite group of public health officers leveraged their influence to conceal the adverse health effects of fluoride and continue to ensure the American people that fluoridation is safe despite volumes and decades of scientific evidence to the contrary.

First, some background. In episode 7 with Daniel Stockin, he explained how a small group of officials in the CDC’s Oral Health Division is the epicenter of the U.S. government’s fluoridation policy. In fact, at least as of 2011 when CDC responded to this particular Freedom of Information Act request, the CDC’s Oral Health Division, a small group of 30 or so people, was the only division that had any input on the CDC’s policy on fluoridation. Not toxicology, neurology, endocrinology, pediatrics, or any other specialty division that you would expect to be providing guidance on the nation’s fluoridation policy.

While the CDC is the epicenter of fluoridation, the Office of the Surgeon General is the prime endorser. From the beginning, the Surgeon General’s endorsement of fluoridation has been the critical factor that allowed fluoridation to spread throughout the country, and ultimately, to a significant portion of the English-speaking world. As we discussed in episode 3, the Surgeon General’s office first endorsed fluoridation in 1950 in a small blurb buried on page 93 of the Journal of the American Dental Association. I will link to it in the show notes.

Up until that point, the U.S. Public Health Service was reticent to endorse fluoridation. The idea that H. Trendley Dean, the so-called  “Father of Fluoridation,” pushed for city-wide trials because fluoride was so amazing at preventing cavities is a myth that is exposed by his own words. His letters to Frederick McKay and the official transcripts from government meetings show that Dean thought the dental benefits of fluoride were overblown and he was against experimenting with fluoridation on the American people because 1) there were no safety studies and 2) there was evidence of harm. But Dean’s objections were overruled, the experiments went forward, and less than 5 years later—without any additional safety studies—assistant Surgeon General Bruce Forsyth, a dentist, officially endorsed fluoridation for the entire country on behalf of the U.S. federal government.

This endorsement from the Surgeon General’s office set of a chain-reaction of copycat endorsements. Within months, other influential groups like the American Dental Association, the American Public Health Association, the National Research Council, the American Waterworks Association, and the American Medical Association also endorsed fluoridation, or at least made vague statements about it that fluoride promoters then used to claim that all those groups endorsed fluoridation as a safe way to prevent cavities.

In 1952, during the first round of congressional hearings focused on fluoridation, Congressman Arthur Miller, a medical doctor and the former state health director of Nebraska, asks Forsyth about these endorsements. Regarding the working, he says, “would [it] be safe to put another qualification in there, that these organizations have made no experiments, no examination, as to what the effect might be, by their own testimony?…They have said they have carried on no experiments in that field. So why should they endorse it when there have been no experiments in that field? That is what bothers me.”

One of the groups that Miller was most concerned about was the lack of safety studies regarding how fluoridation affects pregnant women. If you listened to last week’s episode about the recent study published in JAMA Pediatrics on the neurotoxicity of fluoride in children, you know this was a valid concern for Congressman Miller to address.

During that same hearing, special assistant to the Attorney General, Vincent Kleinfeld, asks Bruce Forsyth, the assistant Surgeon General who made the first endorsement of fluoridation, what prompted the U.S. Public Health Service to change its mind and “unequivocally” endorse fluoridation in June of 1950 when the Surgeon General himself had testified in January of the previous year that there was insufficient evidence to support an endorsement. Forsyth claims they received new information from the Grand Rapids experiment run by H. Trendley Dean and he passes the question to Dean for an answer.

Dean explains the new evidence they accumulate each year about how fluoride reduces cavities, but Kleinfeld wants to know what new evidence they have that fluoride is safe. He tries to clarify his question several times. Finally, he says, “I want to get this straight. I think I am trying to put my question understandably… When these experiments were set up, let's say Grand Rapids or Evanston or Newburgh, N.Y., was it explained specifically at the time these projects were set up that apart from watching the reduction of the incidence of dental caries, regular periodic medical examinations on children and other groups of the population would be made?”

Dean knows that the Grand Rapids experiment is only concerned with fluoride’s effect on children’s teeth but he tries to claim that those medical studies were being done in the Newburgh experiment. Kleinfeld, however, has done his research and he catches Dean on that one. He says, “Now the report that I have examined from Newburgh indicates they make only pediatric examinations on children. Is that incorrect?” Dean reveals he is unfamiliar with the results of any medical examinations from Newburgh and says he would have to look it up. “Then, as I understand you,” Kleinfeld continues, “your decision to endorse unqualifiedly this program was not based on any new specific experimental work connected with medical aspects of the program?” Dean admits they have no new research on fluoride’s safety, but then he changes the story again and says they already did those studies in 1943, nearly a decade ago, in towns with naturally occurring fluoride in the water.

With the benefit of hindsight, it is easy to see what Dean is doing here. He’s a company man. He’s a team player. He’s towing the party line. We know from the transcript from the Newburgh meeting in 1944 that Dean was personally concerned about the longterm safety of fluoridation and he tells the other participants that “we have looked at nothing but teeth.” “We don’t know what we will find even in the low concentrations,” he says. If those studies from 1943 proved unequivocally that fluoridation is safe, why was Dean against starting fluoridation trials on the American public in 1944?

So that is the background on the Surgeon General’s original endorsement of fluoridation. It was made prematurely—several years before the first experiments in Grand Rapids, MI and Newburgh, NY were scheduled to be completed—and without any significant toxicological studies to evaluate the negative health effects of artificial water fluoridation. The Surgeon General of the United States has been unequivocally endorsing artificial water fluoridation ever since.

But the Surgeon General has participated in the pollution story behind fluoridation beyond simply offering their influential endorsement. As Dr. Carton explained, they also used their political influence to prevent the Environmental Protection Agency from implementing regulations that would protect the American people from fluoride’s adverse health effects.

Here’s the story.

The Environmental Protection Agency was created in 1970 and the Safe Drinking Water Act was instituted shortly thereafter, in 1974. Prior to that time, there were no enforceable national standards for organic contaminants in public drinking water systems. The U.S. Public Health Service had set a guideline in the 1940s that the level of fluoride in public water supplies was not to exceed 1.5 parts per million—just sightly higher than what they deemed optimal for preventing cavities—but that limit was not enforceable at the local level. In 1962, the federal limit was changed to two times the optimal concentration, which means the legal maximum limit for fluoride would be between 1.4 and 2.4 depending on climate. At the time, CDC was recommending a range for the optimal level of fluoride in water because they presumed that people in warmer climates drink more fluids. But again, this guideline was not enforceable.

That changed in 1977 when, under their newfound authority from the Safe Drinking Water Act, EPA issued a regulation that would make the federal guideline of two times the optimal concentration binding.

Water providers were given several years to comply with this new regulation. But as the deadline approached, instead of seeing more communities removing high levels of fluoride from their drinking water, EPA began to experience increasing pressure to change the rule. As anyone who has ever tried to filter fluoride from their water knows all too well, filtering fluoride from water is expensive. And some community officials that have high amounts of fluoride in their water naturally did not want to invest in the equipment necessary to reduce fluoride to a level that would prevent children from developing dental fluorosis, a permanent discoloring and mottling of the tooth enamel.

According to EPA statistics at the time, over 1300 communities serving approximately 2 million people (mostly in rural towns) were consuming water over the 2 ppm threshold for fluoride. The agency calculated that 10 percent of children in these communities would develop dental fluorosis if authorities did not comply with the new regulation. Officials from South Carolina, a state with significant amounts of fluoride in some of their public water supplies, were particularly opposed to the ruling. In 1981, they petitioned EPA to do away with the regulation for fluoride in drinking water altogether.

Senior EPA officials responded by asking the Surgeon General to put together a panel of experts to provide guidance on the issue of fluoridated drinking water and dental fluorosis. Now, this was a strange request for EPA to be making. They had never asked the Surgeon General for help evaluating a chemical before and to my knowledge, they haven’t since then either. EPA is well equipped with its own toxicologists and risk assessment analysts and water experts and furthermore, they had a mandate from the Safe Drinking Water Act to work with the National Academy of Sciences to gather information on contaminants in drinking water and their impact on health. There was no reason to involve the prime endorser for fluoridation, the Surgeon General, an office that had been unequivocally promoting artificial water fluoridation for over 30 years.

But that is what they did and in 1982, the panel of dental experts issued their final report which stated that while it would be prudent to limit fluoride in drinking water to twice the optimal concentration, dental fluorosis is purely a cosmetic condition and therefore fluoride has no adverse effects on dental health. Without dental fluorosis as an adverse health effect, EPA would not be able to set an enforceable regulation. The Surgeon General himself, C. Everett Koop, was well aware of the ramifications of this wording. In his letter to EPA that accompanied the report, he “encourages” communities to provide children under nine years of age with water of optimum fluoride concentration so as to avoid dental fluorosis, making it clear this act of generosity would not be enforceable.

Koop makes this even more clear in a memo sent to his supervisor, the assistant secretary for health, Edward Brandt, where he states, “If we send this letter, it means that [EPA] will not be able to publish [binding] drinking water regulations [for fluoride]… I think we should go ahead with this letter, in spite of the fact that EPA will not like our response.” (See "Fluoride's Revenge: Has this cure, too, become a disease?" by Daniel Grossman, The Progressive, December 1990, 29-32.)

If you are not familiar with Everett Koop it is helpful to know a little bit about him to understand the power dynamics at the time between the Office of the Surgeon General and the EPA. While EPA was a relatively new agency and going through some major leadership challenges, Koop was perhaps the most influential Surgeon General the United States has ever had. Before he was appointed by President Ronald Reagan in 1982, Koop was the chief surgeon at Philadelphia Children’s Hospital for 35 years where he became famous for his operations separating conjoined twins. In 2013, the Associated Press claimed he was the only Surgeon General to ever become a household name.

But the year after Koop sent his letter to EPA prohibiting them from setting an enforceable standard for fluoride in drinking, EPA was appointed a highly respected administrator of its own, William Ruckelshaus. He had served as the first administrator of EPA in the 1970s and was responsible for issuing the agency’s ban on DDT. He was later named as director of the FBI and eventually the Deputy Attorney General where he solidified a place in history when he and his boss, Elliot Richardson, resigned their positions instead of obeying President Nixon’s order to fire the special prosecutor in the Watergate scandal, an event known as the “Saturday Night Massacre.” When Ruckelshaus came back to the EPA in 1983, he was intent on setting a safety standard for fluoride that would prevent children from developing dental fluorosis. EPA requested the Surgeon General to convene a second panel of experts on the health effects of fluoridation but this time they did not want the panel to be filled with dentists. They wanted medical doctors to provide their assessment of the non-dental effects of fluoride.

And here is where things really get interesting. The panel of experts met over a 2-day period in April 1983. It was composed almost entirely of toxicologists, epidemiologists, pediatricians, nutritionists, biologists, and other non-dental medical professionals—people with presumably no financial or reputational stake in protecting the practice of artificial water fluoridation.

I’ll link to the transcript of the panel’s deliberations in the show notes. This is the conversation that pretty much set the legal limit for fluoride in drinking water that exists to this day. It’s really interesting to read through it for a number of reasons. The first thing that jumps out is how little data is available to them on which they are basing their decision. The United States had been adding fluoride to public water supplies for nearly forty years at this point and yet, the panel is desperate for hard data on fluoride’s safety. At one point, one of the endocrinologists asks about the studies done by dentists in local communities and he’s astounded at their lack of curiosity on how fluoride affects parts of the body other than teeth. He says, “Did anybody ask any other questions of the kids? Thousands of kids have been studied, have they not, in epidemiologic studies.”

Dr. James Carlos, a dentist and the associate director for the National Caries Program at NIH responds, “Well, there have only been a few recently. These are listed in one of the documents. So, it would be a few thousand children in Illinois and Texas mostly, and Carolina.”

“Were there any medical questionnaires?” asks the epidemiologist. Dr. Carlos replies, “Not that I know of.”

“So it was just ‘show me your teeth’? Is that what it was?” Again, Dr. Carlos responds, “As far as I know.”

Another striking aspect of their deliberation is how ad hoc the process was for how the panel came to the decision of what constitutes an unsafe amount of fluoride in public water supplies. In episode 4, Dr. Carton talked about the standard operating procedure at the EPA used by risk assessment analysts who are required to identify vulnerable sub-populations and then calculate an acceptable daily dose with an adequate margin of safety to protect those most at risk of experiencing negative health effects from a particular contaminant. That is not what happened here. For most of the session, when any of the medical experts try to bring up vulnerable sub-populations like diabetics or kidney stone patients, they are told they will talk about special cases at the end of the day which they do briefly, but it’s long after they voted on the safety standard for fluoride. They did not vote on a standard that protects vulnerable sub-populations. They voted on a standard that, in their opinion, is protective of healthy children and adults.

Nevertheless, the panel voted to set the standard for children under nine years of age at two times the optimal concentration, which is what EPA was proposing originally. For everyone else, they recommended a safety standard of four times the optimal level. The experts were split over recommending the lower limit for teenagers. Almost half of the panel, particularly the pediatricians, voted to set the more restrictive standard for adolescents under 18 years of age, as well as children. They were mostly concerned about the effect of high levels of fluoride consumption during the rapid periods of bone development in puberty. But in this deliberation, democracy ruled and the pediatricians were outvoted.

The panel is well aware their recommendation will not be easy for the Surgeon General to swallow. One of them quotes the wording from the Surgeon General’s previous letter to EPA, noting “Dr. Koop says he ‘encourages’ communities [to limit fluoride in water]. That doesn’t sound like primary regulation.” Jay Shapiro, the acting director of the National Institute of Health’s clinical center and the one running the panel says, “We are making a medical judgment. The medical judgment is that twice the optimal of .7 to 1.2 for children up to the age of 9 and four times the optimum for individuals above the age of 9 as primary regulation… and don’t go to South Carolina.”

At the end of the day, the panel muses on how their recommendations will be received by Dr. Koop, the Surgeon General, and Shapiro says, “As a pediatrician, I don’t think you could argue with tightening up the rules to protect children. I can’t imagine a political question that would compromise our recommendation.”

Oh dear.

So, a few weeks later, Shapiro sends a draft of the panel’s report to the committee members. He writes, “You all probably are aware of the interest our meeting generated, in part because the American Dental Association cited it in a recent newsletter sent to a very large audience.” In episode 9, I spoke with Dr. David Kennedy about the ADA’s financial stake in fluoride and their extensive lobbying efforts in support of artificial water fluoridation.

Shapiro also says that the draft report follows from the transcript of their discussion. He did not plan on making any significant changes in their recommendations. The draft report recommended a strict limit of twice the optimal level for children under 9 and four times the optimal level for everyone else.

Theoretically, here is how that should have worked in practice. In warmer climates where people drink more water, the maximum contaminant level for fluoride would in effect have been 1.4 ppm for any water supply that served children under 9. This is a common legal limit for fluoride even in colder countries, like Canada and Sweden, and it was right in line with the guidance given by the U.S. Public Health Service as far back as the 1940s. Under the new guidelines, in cooler parts of the United States, where people presumably didn’t drink as much water, the fluoride level could be as high as 2.4 ppm.

As far as the separate regulation for people over age 9, the panel discussion makes it very clear how they see that working.  As one of the panelists describes it, “[F]our and above for another age group, really says the standard is really two because there is a large number of people who are at that age group; however, if you run into situations where you have segments of people that don’t include the high risk group, you may be able to deal with that a little differently. You can be more liberal in the way you apply the thing. That kind of device is helpful.”

It seems clear that by adding this higher regulation to a segment of the population, the panel was trying to give some leeway for situations like, for example, a water supply system to a retirement community or a nursing home or a small town where it was easier to provide filtered water to children instead of installing a system that would filter fluoride for everyone.

The draft report also notes the lack of safety studies on how fluoride effects parts of the body other than teeth. It reads, “The committee favors continuation of fluoride in the primary regulations because of lack of information regarding fluoride[’s] effect on the skeleton in children (to age 9) over 3 ppm, and potential cardiotoxic effects at that level… There was some sentiment (especially among the pediatricians) in the committee that the age limit for children… should be as high as 18 years because of continued rapid bone development between ages 9 and 18; however, the lower value ultimately was agreed to.”

The draft report was sent to the panel members in May, a few weeks after the meeting, but it took four more months before the final report was released by the Surgeon General.

And this is why in their testimony to the U.S. Senate in June 2000, the EPA union called for a congressional inquiry into the Surgeon General’s role in the federal government’s failure to protect the public from harm from fluoride. The final report from the Surgeon General does not include the panel’s recommendation to set an enforceable limit of 1.4 to 2.4 ppm to protect children in the United States from the adverse health effects of fluoride. Instead, it recommends the higher guidelines of four times the optimum level as the enforceable limit for fluoride in drinking water. With regard to children, the report merely states that it is “inadvisable” for them to drink water fluoridated at more than twice the optimal level in order to avoid the uncosmetic effects of dental fluorosis.

Besides the fact that “uncosmetic” is not a word, no where in the final report does it mention the committee’s concerns about the skeletal and cardiotoxic effects of fluoride over 3 ppm, their recommendation that dental fluorosis be considered an adverse health effect, or their split vote for the higher cutoff age to protect adolescents from harm from fluoride. The experts were very clear that fluoride levels over 2 ppm for children should not be legal. One of the VA docs from New York put it this way. He said, “You would have to have rocks in your head, in my opinion, to allow your child much more than two parts per million.” Yet someone at the Office of the Surgeon General took it upon themselves to change the panel’s recommendations to, in effect, double the legal limit for fluoride in drinking water.

One of the EPA scientists who sat in on the panel later told journalist Daniel Grossman that he was baffled when the agency received the final report but as anyone in government knows, it’s what they receive in official writing that counts. Many of the other panelists didn’t even know their recommendation had been altered until Grossman asked them about it years later.

The EPA Administrator, William Ruckelshaus, did not give up on his intention to set an enforceable limit to protect children from dental fluorosis. The following year, he took a different route and asked the National Institute of Mental Health to provide an assessment on the psychological effects of dental fluorosis. In episode 7, Daniel Stockin told us about a project he did where he went into the streets of Atlanta with pictures of dental fluorosis and talked to people with the condition to tell them what caused it. I recommend listening to that episode if you haven’t heard it yet. He is so interesting to talk to. The reactions he received from showing people these pictures show just how deeply this condition can affect people well into adulthood.

The National Institute of Mental Health concluded that individuals with moderate to severe dental fluorosis are at increased risk for psychological and behavioral problems. EPA staff finally had the medical justification they needed to set an enforceable safety standard for fluoride that would protect children from developing dental fluorosis. In an interview a few years later, the analyst at EPA responsible for writing the standard, Paul Price, remembers thinking, “Here is our silver bullet.” And the debate shifted to whether the limit should be set to either 2 ppm or even lower, at 1 ppm.

But then, two months later, in January 1985, Ruckelshaus retired and his replacement, Lee Thomas, didn’t share his same level of concern over protecting children from harm from fluoride. As it just so happens, Thomas was born and raised in South Carolina—prior to his federal service, he worked for the governor of South Carolina as the director of the Division of Public Safety Programs. As you recall, South Carolina is the very state that petitioned EPA to eliminate the safety standard for fluoride altogether and had just filed a lawsuit against EPA over the regulation for fluoride.

Sure enough, it wasn’t long before Thomas agreed with the Surgeon General’s recommendation and EPA officially increased the safety standard for fluoride to 4 ppm. Writing for the Progressive, journalist Daniel Grossman interviewed many of the EPA scientists involved and confirmed they had settled on a safety standard of 1 ppm. A draft of the regulation sent to Thomas reads, “It is legally and scientifically indefensible to set the [standard] at anything other than optimum (e.g. 1 ppm).” Grossman adds that a handwritten note was scribbled on top of the memo stating that a higher-level office controlled by political appointees prefers a binding standard of 4 ppm and “they have the final say!” The note ends with an exclamation point.

There is another government agency that played a role in this story. I’m not planning to do a separate episode on it so I’ll just tell you about it here. It’s the Office of Budget and Management. OMB’s mission is to produce the president’s budget—it’s the largest office within the Executive Office of the President. They also measure the quality of government programs to see how they comply with the president’s policies. They’re not scientists or medical professionals, but in April 1985, a few months before EPA officially increased the safety standard for fluoride, OMB’s Administrator for the Office of Information and Regulatory Affairs, Douglas Ginsburg, sent an official 10-page letter to EPA Administrator Lee Thomas under letterhead of the Executive Office of the President—I will link to it in the show notes—arguing that since the Surgeon General’s panel found no adverse health effects from fluoride in U.S. drinking water, it would be more cost effective to grant South Carolina’s request by rescinding the enforceable regulation for fluoride, and instead, set a nonenforceable limit to avoid the purely cosmetic effect of dental fluorosis.

I want to remind you that the year this took place was 1985. This was the same year the Office of  Budget and Management was caught red-handed by the EPA Union colluding with the asbestos industry to circumvent EPA’s regulation of asbestos at the expense of public safety. It was one of the first issue the union took up and I want to read to you a short section of a letter the union sent to EPA Administrator Lee Thomas about it because it’s just such an inspiring little piece of American history. It’s a 2-page letter signed by 128 employees including the managers at the Office of Toxic Substances, I will link to it in the notes. They conclude the letter to Thomas by saying, “If all future decisions on risk control are to be made by OMB in private consultations with special interests who are not identified in the public record, what is the meaning of our work? What is the public getting for the money spent at EPA? Are we to be simply a preliminary screening group, whose task is to present options to OMB and its unknown clients, and then to await their decisions and execute them? We did not come to work for EPA to do that, and neither, we think, did you.”

The union was very successful in exposing the corruption at OMB on the asbestos issue. Congress held a 6-month inquiry and ended up coming down hard both on OMB who it found had committed an “unlawful abuse of power” and the EPA Deputy Administrator A. James Barnes, who Congress found capitulated to external pressure to abdicate EPA’s responsibility to regulate asbestos. Congress ordered a Memorandum of Understanding between OMB and EPA that specified there would be no future secret meetings between OMB and parties with an interest in proposed EPA Rules and that EPA would be invited to all meetings between OMB and interested parties.

This MOU was not yet in place when Douglas Ginsberg sent his letter from OMB to Lee Thomas urging him to abdicate EPA’s authority to establish an enforceable limit for fluoride in drinking water. I don’t know what special interest group if any might have prompted Ginsberg to write such a letter, but I do know this. Two years later he was nominated to the Supreme Court and the senior Republican on the judiciary committee overseeing the confirmation process was Strom Thurman, the longtime senator from South Carolina who was fiercely opposed to EPA’s regulations on fluoride in drinking water.

Ginsberg was eventually forced to withdraw his nomination over unrelated scandals. Strom Thurmon then advocated for a local nominee from South Carolina but the confirmation eventually went to Justice Anthony Kennedy. I have seen no evidence that the South Carolina connection is anything other than a coincidence. But given OMB’s track record at the time of improper influence at EPA over the asbestos issue, it does make me wonder what compelled OMB to write such a detailed letter over the safety standard for fluoride when only one state out of fifty seems to have been overly concerned about the cost of meeting the proposed regulation.

So, that just about wraps up our story of how the Office of the Surgeon General and the Office of Management and Budget abused their power to influence the EPA’s decision to set the maximum legal limit for fluoride at 4 ppm. As Dr. Carton explained, they didn’t actually calculate anything. It was based on politics, not science. If you haven’t yet listened to that episode, it picks up the story at EPA from here when the union got involved and eventually moved to join a lawsuit with the Natural Resources Defense Council against EPA—their own agency—over the inflated safety standard for fluoride.

The Surgeon General’s story doesn’t end here, either. Since the 1980s, the Office of the Surgeon General has dutifully continued their role as the prime endorser for fluoridation. The CDC website displays a prominent link to statements of endorsement from a variety of U.S. surgeon generals dating back to 1995. They are effusive in their praise of fluoridation and each one is accompanied by a picture of the surgeon general in his or her uniform which is designed to look like that of a high ranking Navy Admiral.

As usual, I will link to this page in the show notes, along with all the documentary evidence available for this episode. And the reason I am able to do that is really thanks to one woman, Marth Bevis. A longtime fluoride activist from Houston, Texas, she actually worked on Lyndon Johnson’s staff when he was a senator and later when he was vice president under John F. Kennedy. She was also the founder of the Safe Water Foundation of Texas and played a key role on a national level as an organizer, researcher, and funding source for the anti fluoridation movement. In my conversation with Dr. Carton, he mentioned that he happened to sit next to Ms. Bevis at a public hearing on fluoride in D.C. and it was through his conversation with her that he started to realize there was a network of respectable scientists like Drs. John Lee and John Yiamouyiannis who were opposed to fluoridation.

Martha Bevis is the reason we have all of this inside knowledge about what went on at the Office of the Surgeon General in the 1980s with regard to the EPA’s safety standard for fluoride. She worked with her congressman to obtain copies of the transcript and the draft report from the expert panel that shows their recommendation was altered. These documents eventually found their way to reporter extraordinaire Joel Griffiths who exposed the scandal in two articles published in the Medical Tribune in April 1989. (See

Martha Bevis’ papers are now housed at the University of Massachusetts at Amherst whose library is home to the largest collection of papers from anti-fluoridation activists in the country. One of those papers—and we’ll end the story here—is a record of a phone conversation she had with Edward Ohanian, one of the EPA scientists who sat in on the Surgeon General’s panel on the non-dental effects of fluoride in drinking water.

According to her notes, Dr. Ohanian explained to Ms. Bevis that EPA tried to set a lower limit for fluoride but the Surgeon General interfered. “Your problem is with the Surgeon General, not the EPA,” she records him as saying. “But EPA is responsible for drinking water,” she counters. “Not the Surgeon General.” She then paraphrases his response which was something to the effect of, “How can we fight the health empire—the Surgeon General, HHS, the AMA, the ADA, the Association of Territorial Dental Directors, the Association of Territorial Health Directors.” And again, she insists that EPA is responsible for setting the standard, not those other organizations.

“I wish I had thought to tell him he could do what Bob Carton is doing,” she writes. “I then thanked him for his time, and asked that he give me a call if anything comes up. He said he would as long as I kept it confidential.”

Ms. Bevis did keep her conversation with Dr. Ohanian confidential until 1992 when another EPA scientist who refused to keep quiet, William Marcus, lost his job while trying to defend the American public from adverse health effects of fluoridation, in this instance, over evidence that fluoride increases the risk for a rare form of cancer. You can hear more about that in episode 5 with Dr. William Hirzy. Ms. Bevis sent the record of her call with Dr. Ohanian to Marcus’s lawyers in the hopes it would help with his lawsuit—which was ultimately successful—to be reinstated at EPA under the Whistleblower Protection Act.

Dr. Ohanian still works at the Environmental Protection Agency, as does Paul Price, the analyst charged with writing EPA’s regulations for fluoride in drinking water in the mid-1980s. Jay Shapiro, the endocrinologist who oversaw the panel, is a staff member at John Hopkins’ Suburban Hospital. If these men were to provide candid testimony under oath about the Surgeon General’s role in increasing the safety standard for fluoride, it would be clear the regulation is not based on science and was not made in the interest of public health. The EPA union called for such an inquiry in their testimony in front of the U.S. senate 19 years ago. There is no reason our congressional representatives can’t hold those hearings today.
 

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