In determining what the maximum contaminant level (MCL) of fluoride in water should be, the EPA sought the recommendations of the Surgeon General. In 1983, the Surgeon General assembled a medical committee to advise the EPA on the “non-dental health effects of fluoride.” On April 18 and 19, 1983, the Surgeon General’s panel convened in Bethesda, Maryland to discuss and determine the safe level of fluoride in water.

The Panel’s Conclusions:

According to a transcript of the hearing, the Surgeon General panel concluded that moderate and severe fluorosis are both adverse health effects that should be prevented through enforceable safe drinking water standards. As summarized by Dr. Michael Kleekoper,

“We regard dental fluorosis in the Stage III [moderate] level as an adverse health effect and that is what the regulation has been aimed to prevent. That is really what we have done.”

According to committee member, Dr. Robert Marcus:

“I think it is fairly close to unanimous that we all agreed that dental fluorosis problem is, in fact, has medical ramifications. Almost everybody agreed on that. Not knowing where bone disease begins at any age, what you are saying is that there is something going on in the teeth, then the likelihood is that there is something going on in the bone. You don’t know that it is there, you don’t know that it is not there.”

According to committee member, Dr. Stanley Wallach:

“You would have to have rocks in your head, in my opinion, to allow your child much more than two parts per million.”

In addition to concern about possible bone effects in children with moderate and severe fluorosis, the committee was concerned about the psychological impact of having disfigured teeth. As noted by Dr. Marcus,

“I think that the sense of the committee is that the cosmetic effect represents an adverse health effect, that this is psychologically damaging. People walk around covering their mouths.”

Consistent with the consensus reached at this meeting, a draft report was written following the meeting which stated:

“there was a consensus that mottling or pitting of teeth could represent as yet unknown skeletal effects in children and that severe dental fluorosis per se constitutes an adverse health effect that should be prevented.”

Further, the draft report noted the committee’s concern with the potential for bone damage and possible “cardiotoxic effects” in children with advanced dental fluorosis. In order to protect against these effects, the committee recommended an enforceable MCL of 1.4 to 2.4 mg/L.

Now Enter the Politics:

Before the draft report made it to the EPA, however, it’s conclusions were altered. In the altered version, the report concluded that dental fluorosis was only a “cosmetic” which did not need to be protected with an enforceable standard. Thus, rather than recommend that the MCL be no higher than 2.4 mg/L, the final report recommended that the MCL be increased to 4 mg/L.

In a subsequent investigation by journalist Daniel Grossman, committee members stated that they were never informed of the changes made to their conclusions:

“When contacted recently, members of the panel assembled by the Public Health Service expressed surprise at their report’s conclusions; they never received copies of the final–altered–version. EPA scientist Edward Ohanian, who observed the panel’s deliberations, recalled being “baffled” when the agency received its report. But, he added, “it’s what they give us in writing that counts.”

As documented by Grossman, the panel’s conclusions were altered because the Surgeon General did not want EPA to classify moderate/severe dental fluorosis as an adverse health effect, as this classification could interfere with the viability of water fluoridation programs.

In testimony before a U.S. Senate committee in 2000, Dr. William Hirzy of EPA’s Headquarters Union stated:

“We believe that EPA staff and managers should be called to testify, along with members of the 1983 Surgeon Generals panel and officials of the Department of Human Services, to explain how the original recommendations of the Surgeon Generals panel were altered to allow EPA to set otherwise unjustifiable drinking water standards for fluoride.”

The Documents:

• Transcript of Committee’s Meeting
• Committee’s Draft Report
• Committee’s Final (Altered) Report

media Coverage:

• Fluoride’s Revenge: Has this cure, too, become the disease? – The Progressive, Dec. 1990
• Fluoride Report Softened – Medical Tribune, April 27, 1989
• ’83 Transcripts Show Fluoride Disagreements – Medical Tribune, April 20, 1989

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