DANIEL G. STOCKIN

Americans' distrust of societal institutions continues to grow, and now comes evidence of yet another burgeoning scandal: Fluoride-Gate. A torrent of recent bad news about the safety of fluorides has brought key names to the surface from the murky alphabet soup of players in the fluoride game at EPA, CDC, FDA, NIDCR, USDA, ADA, and AMA. The inevitable questions have begun about who knew what, when, and why was certain information kept quiet.

The first ominous drumbeats started in 2006, when a National Research Council committee recommended that the Environmental Protection Agency lower the allowable amount of fluoride in drinking water - to an unspecified level. As if that wasn't unnerving enough, the committee specifically stated that kidney patients, diabetics, seniors, infants, and outdoor workers were susceptible populations especially vulnerable to harm from fluoride ingestion.

Centers for Disease Control officials strove mightily to dismiss NRC's report as irrelevant, but in August of 2007 CDC's ethics committees received a formal ethics complaint about CDC's activities in promoting fluoridation. The complaint circled the globe via the Internet. A Kentucky attorney began assembling a list of "potentially responsible parties." After having been contacted by angry kidney patients, in September he formally notified the National Kidney Foundation that the organization may be held liable for failure to warn its constituents that kidney patients are particularly susceptible to harm from fluorides. The issue was immediately put on the agenda of the next meeting of the foundation's national board and the foundation's former position statement about fluoridated water has been retracted and the issue is now undergoing review.

The ethics complaint became a hot potato. How would CDC explain why its own data showed blacks to be disproportionately harmed by moderate and severe "dental fluorosis" teeth damage, yet CDC had not felt it necessary to openly show photos of the conditions to the black community? What would be the response of CDC's Chief of Public Health Practice, Dr. Stephanie Bailey, an African American woman who witnessed the presentation of the complaint? The complaint embarrassingly documented that Bailey had acknowledged earlier that a CDC-funded and nationally distributed public health ethics policy was not being implemented internally by CDC.

Apparently Bailey's concern about public health ethics did not extend to fluoridation. A 2007 Tennessee water agency report describes how the Harpeth Valley Utility District had accidentally introduced so much fluoride into its water that the concentration reached 18 times the amount generally in the water. The report describes how HVUD contacted Bailey, who told the district she believed "there was no health threat to HVUD's customers." This statement would be welcome news to a nervous HVUD, but is highly suspect, since Bailey could not possibly know how much of the tainted water individuals had consumed, the body weight of those who drank it (babies, children, etc), or individuals' prior health status (such as end-stage kidney disease). How could such a remarkably convenient statement come from a physician whose job description calls for her to be the "conscience of public health practice" at CDC?

Instead of having its ethics committee comprised of external ethicists look into the matter, CDC decided that the ethics charges against Director Dr. Julie Louise Gerberding and Oral Health Director William Maas would be handled internally by Dr. James Stephens, who works for Chief Science Officer Dr. Popovic, who reports to Dr. Gerberding. Without addressing many of the specifics in the complaint, Dr. Stephens predictably concluded that he had "found no evidence" that CDC managers had acted inappropriately. But the proverbial holes in the fluoridation dike can no longer be contained. This month's edition of the journal Scientific American has an article entitled "Second Thoughts about Fluoride." The cat is out of the bag that the Department of Agriculture has voiced concern about fluoride exposures.

Bailey's job description calls for her to address emerging and cross-cutting issues. Dr. Popovic's job is to ensure timely translation of science into practice by CDC. Citizens, attorneys and political leaders now have these officials' names and job descriptions. They should be the first, but not the only parties brought into court and into congressional hearings. Now that the "Fluoride-Gate" has swung wide open, it's time for names to be named.

• Daniel G. Stockin is a career public health professional who works for The Lillie Center Inc., in Georgia. For inquiries or to share information in confidence, he may be contacted at This email address is being protected from spam bots, you need Javascript enabled to view it or at TLCI, P.O. Box 839, Ellijay, GA, 30540.

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