How the Manhattan Project Sold Us Fluoride Newburgh, Harshaw, and Jim Conant's Ruse For half a century assurances from the Public Health Service that water fluoridation is safe have rested on the results of the 1945 New-burgh-Kingston Fluorine-Caries Trial, in which the health of children from the fluoridated town of Newburgh, New York, were compared for ten years with children from neighboring nonfluoridated Kingston. But recently declassified documents link the wartime Public Health Service's interest in fluoride to the Manhattan Project. And a trail of papers showing how bomb-program scientists from the University of Rochester secretly monitored the Newburgh experiment, studying biological samples from local citizens — and crudely manipulating at least one other wartime study of fluoride's dental and toxic effects — suggests that Newburgh was simply another cold war human experiment, serving the interests of the nuclear industrial state. THE VIEW FROM the Old Firehouse on Broadway in the city of Newburgh, New York, is one of the more majestic in the Empire State. The boulevard climbs purpose-straight through the center of town from the valley below, and whipped by a January wind, a lone pedestrian can see east across the mighty Hudson River to a spine of rolling hills in the Connecticut distance. In the spring of 1945 the wind carried the laughter of hundreds of excited school children as they chattered their way to a free public-health clinic inside the Old Firehouse. Doctors wanted to examine the children. HOW THE MANHATTAN PROJECT SOLD US FLUORIDE 79 Newburgh had become only the second place in the United States to artificially add fluoride to public water supplies. Last week came news that fluorine is to be tried out with whole towns as guinea pigs, Time announced approvingly in April '944 The magazine suggested that, where fluoride was found naturally in the groundwater, "dentists' chief occupation is holding citizens' mouths open to display their perfect teeth. ' It wasn't just teeth the doctors were interested in. The New-burgh-Kingston Fluorine-Caries Trial, as it was formally known, was considered the most extensive of the several fluoride experiments then being planned around the United States. Over a period of ten years a team from the New York State Department of Health would conduct a battery of psychological exams and X-rays on the Newburgh children, plus measuring their blood, urine, height, and weight. The information would be compared with data from children in the neighboring fluoride-free town of Kingston, New York. The news that Newburgh would host the experiment created a buzz among local citizens. The gritty, blue-collar industrial town was home to a large population of immigrant Italian Americans as well as African Americans who had come from the South. Most considered themselves fortunate to be early recipients of a new public-health measure. "I can remember a lot of excitement as a young child," remembered a lifelong Newburgh resident and former Mayor, Audrey Carey, who regularly attended the Broadway clinic in 1945 as a child. Careys parents were poor, she explained. Her father became only the second African American on the Newburgh police force, and the family was grateful for the daughters free health checkups. In the front room there was a dental chair and someone would check your teeth and you would see the nurse," Carey recalled. "You would have your height, your weight [measured, and] they would do some urine. I can remember that occurring every month of the year for a very long time. The tests were designed to answer a simple safety question — whether the chemical produced nondental health problems (a medi cal agenda that, of course, was not publicized to local citizens). Are there any cumulative effects — beneficial or otherwise, on tissues and organs other than the teeth — of long-continued ingestion of 8o CHAPTER SIX such small concentrations ... [of fluoride]? the doctors explained to their colleagues in various academic publications and conferences on the topic' Some of the most powerful voices in the nation were asking similar questions about fluoride's toxicity — with wartime urgency. Earlier in the fall of 1943 President Roosevelt s science adviser, James Conant, had organized a major Conference on Fluoride Metabolism, secretly convened on behalf of the Manhattan Project. The conference was held on January 6, 1944, in New York City, and conference transcripts and letters from Conant are among the first documents that connect the atomic -bomb program to water fluoridation and to the Public Health Service (PHS).' Weapon makers wanted to use the health service as a wartime camouflage, a fig leaf for the atomic bomb. In a letter dated September 25, 1943, Conant explained to the chief of the Division of Industrial Hygiene, J. J. Townsend, that a "consultant" Dr. Stafford Warren would secretly provide the conference financing. This consultant, of course, was none other than Colonel Stafford Warren, the Manhattan Projects Medical Director. It is sincerely hoped that the Public Health Service will be willing to sponsor the conference and to send out the invitations to the contributors under its own letterhead, Conant wrote to Townsend. All the arrangements such as the selection of the speakers will be taken care of by Dr. Warren. The purpose of this letter," Conant added, "is to assure you of the importance of this symposium and of the real need for the information in connection with the war effort. However, this picture of the purpose of the meeting is for your information only, and it is desirable that the impression be given that the interest is in industrial hazards only." Dr. Townsend replied that if the Public Health service could review the agenda and "the qualifications of the individuals who might be invited to attend ... the Surgeon General would be very glad to call such a conference. 4 On January 6, 1944, a Whos Who of the wartime fluoride industry passed through the doors of New York's Hotel Pennsylvania. Mingling were the top medical men from the army and from the companies and universities building the atomic bomb, including DuPont, Union Carbide, Columbia, and Johns Hopkins. Also HOW THE MANHATTAN PROJECT SOLD US FLUORIDE 81 attending were Alcoa s top fluoride expert, Francis Frary; Helmuth Schrenk from the Bureau of Mines; the biochemist Wallace Armstrong from the University of Minnesota; and Edward J. Largent from the Kettering Laboratory. Dr. Paul A. Neal of the National Institutes of Health outlined the critical importance of fluoride to the war economy — and emphasized how little doctors knew about health effects on workers. Aluminum, magnesium, refrigerants, aerosol propellants, insecticides, phosphates for animal feeds, hydrofluoric acid ("especially its use as a catalyst in oil refining ), and the employment of fluoride fluxes among an estimated 150,000 welders were just some of the burgeon ing uses for fluoride in the war effort, Neal reported. There was a " definite need," he added, "for careful, thorough investigation on workmen who have been exposed for many years to fluorides. However, it has been postponed until after the war since such an investigation could hardly be made at this time without undue interruption of the output of these industries." 5 The conference organizers had made what seemed to be a surprising addition to the guest list: Dr. David B. Ast, chief dental officer of the New York State Health Department. Dr. Ast was then preparing to add sodium fluoride to the drinking water of Newburgh, New York, in a stated bid to improve dental health in children. Although the conference had been secretly arranged by the Manhattan Project — whose industrial contractors were concerned that workers in bomb factories would be poisoned by fluoride — the dental researcher quickly justified his attendance at the conference. Military officials and industrial contractors heard a conference report that animal tests were of doubtful value" in studying fluoride toxicity in humans, and that there was confusion over amounts that "may cause deleterious effects in adults." Dr. Ast then boldly volunteered a solution.' He suggested that researchers could examine whether fluoride in drinking water was harmful to people, and thereby help to determine whether the chemical posed a risk to workers in factories. The "accumulated effects of small doses of fluoride in drinking water [could] be studied in the U.S.... [and that] evidence of the effects of consumption of fluoride over that period of time might [ become apparent], Ast told the conference.' Until such human fluoride studies could be done, however, a 82 CHAPTER SIX temporary workplace standard had to be fixed. Following the morning conference session, the Manhattan Project had arranged a luncheon for ten persons who will meet to set standards." It is not clear if the ten men who met for lunch that day — including the Public Health Services H. Trendley Dean, the researcher who had reported that fluoride found naturally in water in some areas of the country was associated with fewer cavities — knew that their meal was paid for by the Manhattan Project. But Harold Hodge knew: he paid the tab with bomb-program funds. "It would be convenient if cash can be provided and delivered here by Dr. Harold Hodge," the Manhattan Projects Captain Ferry had ordered.' A sacrifice was needed from war workers, the lunch team decided. Although earlier that morning DuPonts Dr. A. N. Benning had described how i part per million of hydrogen fluoride in air etched glass in two hours, the diners determined that 6 parts per million of fluoride breathed in factory air would be the wartime fluoride standard for an 8-hour workday, six days a week. The existing 3-ppm threshold in several states was an arbitrary figure not based on any specific evidence, stated Dr. Carl Voegtlin of the University of Rochester, who chaired the lunch session. We do not want to set up standards that are so extreme on the lower side that it makes it hard to operate the plants, Voegtlin added, We can say that in the absence of definite evidence, we feel... [emphasis in original]. Francis Frary of the Aluminum Company of America doubted whether standards were even necessary. "The best guide is the individual response," suggested Frary, explaining that "I doubt in the case of man whether there is enough hydrofluoric acid in the air that is comfortable to breathe that would cause any damage." Hodge finessed the problem, suggesting that We can also say that men working in plants where we know the atmosphere is varied at all times, should by certain screening methods, be protected. A lone dissent drifted across the lunch table. "I should think that someone is going to be hurt by the long exposure to the irritant," interposed Dr. Wallace Armstrong from the University of Minnesota.' Following the New York conference, as the giant gaseous diffusion plant secretly rose amid the virgin woodland at Oak Ridge, Tennessee, planning for the public-water-fluoridation experiment HOW THE MANHATTAN PROJECT SOLD US FLUORIDE 83 in Newburgh also proceeded apace. A Technical Advisory Committee was selected to guide the New York Health Department. The chairman of that expert committee, it was announced, would be a pharmacologist from the University of Rochester, Dr. Harold Hodge. "Possible toxic effects of fluoride were in the forefront of consideration, the Advisory Committee stated.'" On May 2, 1945, the Hudson River city became the second community in the world to be artificially fluoridated. Over the next ten years its residents were studied by the New York State Health Department. Secretly, in tandem with the states public investigation, Hodge's classified "Program F" at the University of Rochester conducted its own studies, measuring how much fluoride Newburgh citizens retained in their blood and tissues — key information sought by the atomic bomb program." Health Department personnel cooperated, shipping blood and placenta samples to the Rochester scientists. The samples were collected by Dr. David B. Overton, the Department's chief of pediatric studies at Newburgh.' Hodge was not the only scientist associated with the Newburgh experiment who had ties to the bomb program. Dr. Henry L. Barnett, who joined the Technical Advisory Committee after the war, was described as a pediatrician. But Barnett had also been a Manhattan Project medical captain, sent to Japan following the nuclear bomb ings as a leading member of the Atomic Bomb Casualty Commis-sion. 13 And Dr. Joe Howland, who drew control samples of blood from residents of Rochester, New York, where no fluoride had been added to water supplies — for comparison with fluoride levels in the blood of Newburgh citizens — was an especially practiced human experimenter.' On April 10, 1945, for example, as chief of Manhattan Project medical investigations searching for information on the health effects of bomb program materials, Captain Howland had driven a plutonium-laden needle into the arm of Ebb Cade, an unsuspecting victim of a Tennessee car accident, who had the simple misfortune of landing in the Oak Ridge hospital.' Although Dr. David Ast of the New York State Health Department clearly realized that water fluoridation could give industry useful information about fluoride s health effects on humans — as evinced by his testimony at the Manhattan Projects 1943 Conference on Fluoride Metabolism (above) — today he maintains that he 84 CHAPTER SIX did not know about the Manhattan Projects involvement at New-burgh. If I had known, I would have been certainly investigating why, and what the connection was, Dr. Ast told me.' The final report of the Newburgh Demonstration Project, published in 1956 in the Journal of the American Dental Association, concluded that "small concentrations" of fluoride were safe for U.S. citizens. The biological proof — based on work performed ... at the University of Rochester Atomic Energy Project — was delivered by Dr. Hodge." Publicly the safety verdict boosted federal efforts to promote water fluoridation. Privately the data was also helpful to the nuclear weapons industry, explained Hymer L. Friedell, the Manhattan Project's first medical director. Workers alleging harmful exposure to fluoride would now find it more difficult to sue the government or its industrial contractors, Friedell stated.' "Any claim about fluorides — here was the evidence that it was of no consequence," said Friedell. 19 "Anything that was evidence of a no-effect' level was important information," agreed the former Rochester scientist and historian, J. Newell Stannard. 20 Although he claimed no knowledge of the Medical Section's role in the Newburgh experiment, Hymer Friedell was not surprised that bomb-program scientists had been involved. "There may have been some things done that were not ever in the record," he admitted. But there were records. In the once-secret archives of the Manhattan Projects Medical Section, there exists an entire file on New-burgh. Inside the file — coded "G-lo by the U.S. Army — is a startling revelation: The top fluoride scientist for the U.S. Public Health Service, Dr. H. Trendley Dean, the man who later became famous as "the father of fluoridation," had secretly opposed the Newburgh fluoridation experiment, fearing fluoride's toxicity. 21 Dean's opposition was a potential disaster. News that the leading fluoride scientist from the PHS was against adding fluoride to Newburgh's water — on the grounds of toxicity — would certainly have frightened the Newburgh citizens, perhaps aborted the nations water-fluoridation program entirely, and eventually have alerted nuclear workers to the danger of handling fluorides. But Deans dissent was never made public. Instead, Harold Hodge passed the troubling news on to Colonel Stafford Warren at Oak Ridge: Dear Staff: Hodge wrote on September 15, 1944. Here is a copy of the current file relating to the Kingston-Newburgh study. If desired, I would be glad to come down to your place and talk this problem over. Sincerely, Harold. (Scrawled on the letter in what may be Warrens handwriting is a note: Return to Medical Section files.")" Enclosed with Hodge s letter are key documents detailing the planning and protocol for the Newburgh experiment. The Manhattan Project was, indeed, deeply interested in public water fluoridation. The papers include letters from Hodge to Newburgh planners requesting additional "bone" studies — key information sought by the bomb program — and an agenda for a meeting of the Newburgh Technical Advisory Committee, with the word Warren scrawled across the top. 23 The G-io file also records Dean's opposition to water fluoridation. His showdown with the Newburgh planners occurred at 2:00 PM on April 24, 1944, at the Department of Healths offices at 80 Centre Street in New York City, according to the Advisory Committee meeting minutes sent to Colonel Warren.- Dr. Harold Hodge chaired the meeting. Almost immediately, a question of cumulative poisoning was raised. This is the crux of the whole problem of toxicity as it relates to this study," meeting minutes record. Dr. Dean took the floor. The PHS expert explained that in parts of the country with high levels of groundwater fluoride (8 ppm) he had seen evidence of "toxic effects" in local residents, including " bone changes" and "cataracts." He wanted more time "to study lower concentrations to see at what level the effects disappear," he told the committee. Dean worried that fluoride posed a special risk to the elderly; he told the committee that he feared Newburgh's citizens might experience "cumulative effects past middle age." The govern ment expert explained that if, for example, a persons kidneys did not work well, that person would be at greater risk for poisoning as more fluoride accumulated in their body. According to the Technical Advisory Committee meeting minutes, an unanswered question about the pending experiment was what to look for in the way of 86 CHAPTER SIX evidences of early intoxication. Dr. Dean recommended that both the child and the past middle age groups be considered. With the renal impairment common to older age groups, fluorine intake and output even in small concentrations may not be balanced." But Hodge and his Newburgh team were anxious to proceed. Much publicity had already been given to the proposed experiment, recalled Dr. Edward S. Rogers of the New York State Department of Health. Similarly, another Advisory Committee member, Dr. Philip Jay from the University of Michigan, felt this was the propitious time for such a study from a psychological standpoint. Another Committee member alluded to pressure from Washington policy makers. While her own feeling was conservative, noted Dr. Katherine Bain of the U.S. Department of Labor's Children's Bureau, "the project had the approval of the Children s Bureau. (The Children s Bureau was financing the Newburgh experiment.) Chairman Hodge called a final Advisory Committee vote at 4: 15 PM, on whether to proceed with the experiment. Dean was the lone voice in opposition. Dr. Dean did not agree that the proposed program could be considered a perfectly safe procedure from a public health point of view," the meeting minutes record. Nevertheless, the committee voted in favor of the experiment to fluoridate Newburgh's water. Shortly afterwards, as wartime pressures mounted in that summer of 1944 Dean performed an unreported but spectacular flip-flop, transforming himself from foe to friend of water fluoridation. Just three months after giving Newburgh the thumbs-down, Dean announced that he now favored adding fluoride to public drinking water in the city of Grand Rapids, Michigan. He would be one of the lead investigators, comparing children's teeth for ten years with another neighboring nonfluoridated city, Muskegon. Six months later, on January 25, 1945, America's great fluoride experiment began. One hundred and seven barrels of sodium fluoride were delivered to Grand Rapids, where, at 4:00 PM city technicians gingerly began tipping it into the citys drinking water supply. Dean's wartime gyration was well rewarded. In 1948 he was appointed the first director of the National Institute of Dental Research, and in 1953 he took a senior position with the American Dental Association. Until now Deans dissent on Newburgh has how the Manhattan project sold us fluoride 87 never been made public. The government has long dismissed claims that any of its scientists ever endorsed water fluoridation despite reservations regarding its safety.' When the scientist and historian Newell Stannard was told of the once-classified correspondence between Hodge and his Manhattan Project bosses on Newburgh — as well as the military s involvement in the public water fluoridation experiment — he was surprised but saw the logic. I dont think [the military] was really interested in water fluoridation. I think they were looking for information on toxicity on fluorine, and fluorides," he said. But former Newburgh Mayor Audrey Carey is appalled at the news that medical officials from the atomic weapons establishment secretly monitored and studied her fellow citizens during the cold war. "It is reprehensible; it is shocking; it reminds me of the experiments that were done regarding syphilis down in Alabama [in which African Americans were not told that they had the venereal disease, so government doctors could study them]," she said in an interview.' Now Carey wants answers from the government about the secret history of fluoride and about the Newburgh fluoridation experiment. I absolutely want to pursue it, she said. It is appalling to do any kind of experimentation and study without people's knowledge and permission." Did Harold Hodge and the Rochester bomb scientists suppress or censor adverse health findings from the Newburgh study? There is some indication that they did; however, as we shall see, prying information from the University of Rochester's cold war archive is no easy task, confounding the best efforts of a Presidential Commission in 1994. (For a further discussion of censorship and of Newburgh health effects today, see chapters 7 and 17.) Evidence that military censors did remove information about fluoride's harmful effects can be seen in another study performed by Rochester bomb-program scientists, published in the August 1 948 issue of the Journal of the American Dental Association. A comparison with the original, unpublished secret version found by the medical writer Joel Griffiths in the files of the Manhattan Projects Medical Section illustrates the ways cold war authorities censored damaging information on fluoride, to the point of tragicomedy. 88 CHAPTER SIX In these files Manhattan Project Captain Peter Dale at the University of Rochester reported in the second half of 1943 on the preliminary results of two dental investigations, a study of oral conditions among laboratory fluoride workers at Columbia University, and a study of dental conditions among workers exposed to dilute and anhydrous hydrofluoric acid in production. The results from Columbia, where scientists at the War Research Laboratories were using fluoride to enrich uranium, were disappointing, even worrying. Fluoride did not prevent cavities, Captain Dale suggested. Of the ninety-five laboratory workers examined, "the total number of tooth surfaces filled and attacked by caries was not significantly altered by exposure to hydrofluoric acid vapor," Dale reported. 29 The fluoride might have been producing a harmful effect. Dr. Homer Priest, a leading fluorine scientist, reported that his "teeth seemed to be deteriorating rapidly." Dr. Priest also told the Medical Section that his gums bled more freely and that there has been a progressive increase in the degree of slowness of healing and of pain in the period he has been doing this work. 30 The Columbia data were never published in the scientific literature. But the results of the second dental study, on the laborers at the Harshaw Chemical Company in Cleveland, became an important piece of evidence for the idea that fluoride reduced cavities. 31 The study is particularly illustrative. As we saw earlier, work conditions at Harshaw Chemical Company were appalling. Two workers had been killed by fluoride acid in 1945. So much fluoride and uranium was escaping from the plant that the FBI had been called in. And the Atomic Energy Commission proposed secretly tracking former workers, to discover the incidence of lung cancer. 32 None of that was made public, however. All that the medical community learned about Harshaw and fluoride was from a study published in the 1948 issue of the Journal of the American Dental Association — a study "based on work performed ... for the Manhattan Project at the Uni versity of Rochester at the suggestion of Harold C. Hodge" — that reported that the men had better teeth. When compared with the original secret study, the published version reveals crude censorship and data distortion, according to the toxicologist Phyllis Mullenix, who read both versions. 33 89 • The secret version states that most of the men had few or no teeth; they were "in large proportion edentulous [toothless] or nearly edentulous. This information, however, was left out of the published version. The published study merely notes that the fluoride workers had fewer cavities than did unexposed workers. • The published version omits the suggestion that fluoride was actually harming the mens teeth. While the secret version states, " There was some indication [teeth] may have been etched and pol ished by [the acid], and that exposure of the teeth to the acid may have contributed to the attrition observed, the public version, instead, concocts an observation seen nowhere in the original. It states that strangely enough, dental erosion or decalcification of enamel and dentin commonly seen in workers exposed to inor ganic acids [fluoride] was not seen. The published version omits information about the harmful effect that fluoride may have had on teeth, ignoring physical evidence that indicated otherwise. A lie, commented Mullenix. The published version had simply reversed the original medical observation that fluoride may have corroded and consumed the men's teeth, she said. • The published version implies that the men were at fault for refusing to wear protective masks, instead preferring to chew tobacco or gum for protection." The secret study makes no mention of masks (and a later Ohio State study criticized Harshaw for not giving its workers protective masks). • The published study states that men "with clean mouths" had good teeth. Men "with neglected mouths" had "a peculiar brownish deposit which seemed to cover the enamel of the anterior teeth in large quantities." The secret version, however, makes no distinction in the mens oral hygiene, noting that all men, as a group, neglected their mouths." The published report therefore makes the bad, or discolored, teeth appear to be the workers fault. The dirty brown teeth were now a function of the mens hygiene, Mullenix remarked. In other words, [the censored study is] blaming the victim for not having a clean mouth. 90 CHAPTER SIX The published Harshaw study helped to shift the national medical debate over exposure to industrial fluoride. Several studies during the 1940S had already shown that acid in an industrial environment hurt workers teeth, and Dr. Priests experience at Columbia University suggested that the same was happening with wartime fluoride workers. Now, said Phyllis Mullenix, instead of blaming fluoride for eroding teeth, with the help of "a clever editing job" the published study became a piece of dental propaganda that buries the American fluoride worker. It totally changes the viewpoint, Mullenix told me. This makes me ashamed to be a scientist." Of other cold war-era fluoride safety studies, she asks, Were they all done like this? Recently, in Cleveland, a roomful of surviving Harshaw fluoride workers erupted in grim laughter when told about Harold Hodges censored dental study. I showed Allen Hurt the once-secret results of the long-ago measurements of fluoride in his urine, analyzed by AEC doctors at the University of Rochester; the fluoride was recorded at the extraordinarily high levels of 17.8 mg/liter." Today he is plagued with arthritis, he says, while many of his Harshaw friends died young of cancer. Nevertheless, smiling a largely toothless grin, Hurt commented on the published dental study: They had to come up with something." 7 A Subterranean Channel of Secret-Keeping
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