As Vital to Our National Life As a Spark Plug to a Motor Car THE RAW MILITARY power that won World War II flowed directly, as molten metal, from blast furnaces and aluminum pot lines and from the American mastery of the atomic bomb. Fluoride was at the chemical core of all these operations. While the American public was told that fluoride was safe and good for children s teeth, U.S. strategic planners stockpiled fluoride during the cold war for a feared global war with the Communists.' Fluoride was declared a "strategic and critical" material by the government after World War II. In 1950, as the Korean war erupted, President Truman asked the head of CBS television, William S. Paley, to chair a task force to study the United States' mineral reserves — and its vulnerabilities to having imports cut off in wartime.' Fluoride was the lifeblood of the modern industrial economy, the Paley Commission reported. "[Fluoride] ... is an essential component of enormously vital industries whose dollar value is measured in billions and upon which the whole national industrial structure increasingly depends, wrote one Paley analyst in a document marked RESTRICTED. Without this little known mineral, the document continued, "such industrial giants as aluminum, steel, and chemicals would be most severely affected. Little or no aluminum could be produced; steel production would be reduced substantially; the output and quality of important chemical products such as refrigerants, propellants for insecticides, and plastics would be significantly cut down. ' AS VITAL TO OUR NATIONAL LIFE . Fluoride was as vital to our national life as a spark plug to a motor car, announced C. O. Anderson, the vice president of the nations largest fluorspar producer, Ozark Mahoning. (Fluorspar is the mineral ore from which most industrial fluoride is produced). Your car doesnt run if the spark plug is in the control of any foreign country, Anderson warned the Paley Commission. Fluorides importance would only grow, predicted Miles Haman, Manager of the Crystal Fluorspar Company in Illinois. General expansion of industrial facilities and building up of war machines all over the world [would necessitate] using much aluminum and steel and consequently more fluorspar.' There was bad news, Paley's team heard. Fluoride stockpiles had fallen below danger point levels and domestic supplies were growing short. The U.S. is vulnerable security-wise were a hot war suddenly to develop, stated Paley analyst Donor M. Lion.' While 369,000 tons of fluorspar had been consumed by industry in the United States in 1950, a million tons would be needed by 1975, the team projected. If the United States were compelled to rely on natural fluorspar alone, serious obstacles to growth and security would emerge, the group reported. But a magic bullet promised to ensure a continued strong national defense, planners heard. Short on fluorspar reserves, the United States was blessed with one of the worlds largest supplies of natural phosphate, a raw mineral that lay in huge geological deposits in Florida. The mineral was the feedstock for the production of superphosphate fertilizer. It contained significant quantities of fluoride — 3 or 4 percent — and traces of numerous other chemicals, including uranium.' America was sitting on its own virtually inexhaustible supply of fluoride. Could the phosphate industry supply fluoride for the nation, the government asked? Sure — if the price was right, answered Paul Manning, a vice president of the phosphate -producing International Minerals and Chemical Corporation. If the fluoride that was then being belched as pollution into the orange-perfumed Florida air — some nineteen tons in 1957 alone — could only fetch a better price on the market, then the phosphate industry might just be willing to trap some of their waste as silicofluoride! The difficulty with this, Manning told the Commission, is that sodium silico fluoride is a drug on 150 CHAPTER ELEVEN the market, and the price which can be obtained for it is not attrac tive enough to result in its production. ' The Florida phosphate producers could supply fluoride, explained Manning, but they had little current incentive. Despite a hornets nest of lawsuits from farmers and angry local citizens gassed by fluoride fumes, it appeared cheaper for industry to fight the lawsuits and concomitant efforts to regulate pollution than to trap the toxic emissions.' "At the present time we have no idea as to the point to which prices would have to rise to justify the current recovery techniques," Manning told the Commission. The dilemma was clear. The government wanted the Florida fluoride in case of wartime emergency — but the state's phosphate producers needed a carrot before capturing their toxic waste. "The phosphate industry is primarily interested in super-phosphate, and fluorine recovery is a very minor matter. This is the kind of potential shortage that could develop into a full-blown crisis before a move is made to avert it, warned one Paley analyst." An elegant solution existed, of course. Using the phosphate industry's waste to fluoridate public water supplies meant that the fertilizer producers would now pay far less, if anything, to dispose of their most troublesome toxic waste. They would be guaranteed a source of taxpayer revenue for installing pollution-control devices; and U.S. strategic planners would win a nearly inexhaustible potential supply of domestic fluoride. There was yet another potential cold-war reason for disposing of fluosilicic acid in public water supplies. The Florida phosphate beds were also an important source of uranium, harvested for the Atomic Energy Commission. Because uranium is only a trace mineral in the phosphate deposits, enormous quantities had to be processed to glean worthwhile amounts of uranium, so much waste fluoride was also produced. Permitting that fluoride to be dumped in public water supplies — rather than being disposed of as toxic waste — reduced the cost of such uranium extraction and provided a supply of fluoride. 12 In 1983 the EPA's Rebecca Hamner acknowledged that fluoridating water with phosphate -industry waste was a fix for Florida's environmental pollution. "This Agency regards such use as an ideal environmental solution to a long standing problem, the Deputy Assistant Administrator for Water wrote. "By recovering by-product AS VITAL TO OUR NATIONAL LIFE . 151 fluosilicic acid from fertilizer manufacturing, water and air pollution are minimized, and water utilities have a low-cost source of fluoride available to them, she added. 13 DID COLD-WAR PLANNERS also encourage water fluoridation to guarantee an alternative supply of fluoride for war industries or to reduce the cost of disposing of fluoride waste generated by uranium production? On June I, 1950, as communist troops prepared for an invasion of South Korea, the Public Health Service abruptly reversed its opposition and declared that it now favored adding fluoride to water supplies. 14 The PHS now smiled upon fluoride, announced Oscar Ewing, whose Federal Security Agency was in charge of the PHS. He attributed this change of opinion to results from the water fluoridation experiment in Newburgh, New York, which showed a 65 percent reduction in dental cavities in local children. 15 But the origins of the Newburgh study, as we saw in chapter 6, were manifestly suspicious. And irrespective of the dental data ( which have been seriously questioned 16 ), the Newburgh fluorida-tion experiment was a safety trial — designed to last for ten years to research potential side effects of drinking fluoridated water. When Ewing announced the government's about-face in 1950, the safety study was only half complete. Ewing was well placed to act on ulterior national security concerns or on behalf of industry. His Federal Security Agency was one of the most powerful cold- war government bureaus. He had been Alcoa s legal liaison to Washington during World War II, shaping the massive expansion of the nation's aluminum industry. And the former Wall Street lawyer was a member of an inner circle of Truman confidants known as the Wardman Park group, who ate each Monday night at Ewing's Washington apartment and whose cigar-smoking, steak-dining members included Clark Clifford, who was famously close to the Pentagon and the CIA." "No Injury Would Occur" — Harold Hodge Turns the Tide WATER-FLUORIDATION ADVOCATES greeted the government flip-flop with rapture. Two Wisconsin dentists were especially elated. 152 CHAPTER ELEVEN Dr. John Frisch and Dr. Frank Bull, the state dental officer, had been among the nations earliest profluoridation activists, lobbying federal officials with an enthusiasm that bordered on the perverse. In 1944 Dr. Frisch began giving his seven-year-old daughter Marylin water from a jug hed prepared with 1.5 ppm fluoride. (That same year the Journal of the American Dental Association had editorialized, Our knowledge of the subject certainly does not warrant the introduction of fluorine in community water supplies. ) Frisch placed "Poison" labels on the unfluoridated kitchen faucets, to remind Marylin to drink his potion instead. Three years later the fathers passion was rewarded, according to historian Donald McNeil as related in his 1957 book, The Fight for Fluoridation. Sitting in a Madison restaurant, Dr. Frisch noticed a "flash" on his daughter's teeth. "He could hardly believe his eyes," McNeil wrote. It looked like a case of mottling. He rushed her out -side in the bright sunlight and thought he noticed it again. Next day he excitedly asked Frank Bull over to get his opinion. Bull con curred.... It was mottling. (Remember, fluorosis does nothing to strengthen a tooth, may in fact weaken it, and is a visible indicator of systemic fluoride poisoning during the period that the teeth were being formed. No matter how mild the mottling, it is an external sign of internal distress, according to the scientist H. V. Smith, one of the researchers who in the 1930s discovered that fluoride was mottling teeth.)' Now, as the PHS endorsed water fluoridation for the rest of the United States, a similar thrill ran through the Wisconsin dentists. "Cease firing!" wrote Frisch. "The hard fight is over," added Frank Bull. 19 But the fight was just beginning. Almost immediately citizens began to learn some disturbing information. The world's leading fluoride authority, Kaj Roholm, had opposed giving fluoride to children. The AMA and the ADA had all editorialized against fluoridation as recently as the early 1940s. And leading scientists, such as M. C. and H. V. Smith, also worried about adding fluoride to water supplies. Although mottled teeth are somewhat more resistant to the onset of decay, they are structurally weak; when the decay does set in the result is often disastrous, the husband-and-wife team reported. AS VITAL TO OUR NATIONAL LIFE . The Smiths sounded an obvious warning. "If intake of fluoride ( through drinking water) can harm the delicate enamel to such an extent that it fails to enamelize the unborn teeth in children, is there any reason to believe that the destructive progress of fluoride ends right there? The range between toxic and non-toxic levels of fluoride ingestion is very small, Drs. Smith added. Any procedure for increasing fluorine consumption to the so-called upper limits of toxicity would be hazardous. 21 Fluoride was put to the vote for the first time on September 19, 1950. It was a gloriously unruly and democratic spectacle. The Wis consin town of Steven s Point had been fluoridating its water for five months, but local activists — including a poet, a railroad repair -man, and a local businessman — forced the town council to put the issue to the ballot. After a colorful debate in the pages of the local newspapers, and rallies with activists caroling Good-bye, Fluorine to the tune of Good Night, Irene, fluoridation was defeated in Steven s Point by a vote of 3,705 to 2,166. A wildfire of citizen protest now flashed across the United States. The antifluoride camp found one of their most distinguished voices in a Michigan doctor, George L. Waldbott. The German-born physician was a medical pioneer and allergy specialist who had carried out the first ever pollen survey in Michigan in 1927 and the first national fungus survey in 1937. 22 In 1933 he reported on sudden deaths from local and general anesthetics, and was the first scientist to report on similar fatal allergic reactions to penicillin, drawing the attention of Time magazine. He had written a book on skin allergies called Contact Dermatitis, and in 1953 he published the first medical report on the emphysema caused by smoking cigarettes. 23 Waldbott now turned his attention to fluoride. In the spring of 1953, Waldbott's wife, Edith, pointed him to recent medical criticism of water fluoridation at a February 1952 Congressional hearing on the use of chemicals in food. Waldbott, the vice president of the American College of Allergists, began his own investigations and soon found that fluoride was no different from many other drugs and chemicals: some people were uniquely sensitive and suffered acute, painful, and debilitating allergy to small amounts of additional fluoride in their water. 1 54 CHAPTER ELEVEN Again and again Waldbott came across patients in his own practice who, when they ceased intake of their fluoridated water supply, were relieved of symptoms ranging from stiffness and pain in the spine to muscle weakness from stomach upsets to visual disturbances and headaches. His first report of such a patient appeared in medical literature in 1955, and by 1958 he had come across many more cases.' In these patients, ranging from an eight-year-old girl to a sixty-two-year-old woman, he ran scientific "double blind" tests in which the patients were given water without knowing whether it was fluoridated or not. The symptoms recurred only if they were given fluoridated water, the scientist reported." Waldbott was not the only doctor to spot that some people were especially sensitive to fluoride. A former University of Rochester researcher, Dr. Reuben Feltman, who was working on a PHS grant at the Passaic General Hospital in New Jersey, also reported that fluoride supplements given to pregnant women caused eczema, neurological problems, and stomach and bowel upsets." Medical professionals saw that it was impossible to control how much fluoride somebody ingested. Athletes and other active individuals, or people in hot climates, diabetics, or the kidney-injured drink more and therefore consume more fluoride. There are varying amounts of fluoride in food, while hundreds of thousands of workers are exposed to fluorides in their jobs." There seemed to be little or no margin of safety between the amount of fluoride that was associated with fewer cavities and the amount that would cause injury. Unfortunately the line between mottling and no mottling is an elusive one and the degree of control to be exercised seems to be very fine, concluded Dr. George Rapp, professor of biochemistry and physiology of Loyola University School of Dentistry." (Even at the level of 1 part per million, at which the optimal cavity-fighting effect was reported, dental mottling was seen in a portion of the population, according to the PHS expert H. Trendley Dean.'") Fluoride promoters had a simple solution. Mottled teeth were described as a "cosmetic" issue, not a health problem. Most importantly, promoters vigorously denied that any injury to bones or organs could ever be produced from drinking water fluoridated at 1 part per million. AS VITAL. TO OUR NATIONAL LIFE. 155 To make that safety argument, the government turned to a familiar face, Dr. Harold Hodge from the University of Rochester. In two key papers for the National Research Council (NRC) and the American Association for the Advancement of Science (AAAS), pub lished in 1953 and 1954 respectively, Hodge maintained that Present knowledge fails to indicate any health hazard associated with the extra deposition of fluoride in the skeleton that will undoubtedly accompany water fluoridation. For a generation, these papers would be a primary source for the reassurances given to Congress and to millions of citizens in the United States and around the world of the safety of water fluo-ridation. The small print at the end stated that they were based on work performed under contract with the U. S. Atomic Energy Project, Rochester, New York. Hodges assurances were profoundly helpful to industry and the nations fledgling nuclear program. The large doses he found to be safe for the public and for nuclear workers became for several gen- erations of establishment health officials the medical template for discussing the dangers of fluoride exposure, and laid a medicolegal foundation for the courtroom defense that worker sickness could not possibly be due to fluoride? Hodge also wielded his safety assurances in Congress to cut down the citizen protest against water fluoridation that was springing up across the country. By the mid-1950s, unimpressed by the Public Health Service endorsement — and connected by George and Edith Waldbotts bimonthly newspaper called National Fluoridation News, which contained reviews on the latest medical information, updates of antifluoride referenda around the country, and cartoons by New Yorker contributor Robert Day — an unruly alliance of doctors, dentists, scientists, and community groups were successfully turning back fluoridation at the ballot box. Seattle had experienced a tumultuous debate in 1952, voting almost 2 to 1 in a referendum against fluoride. The following year Cincinnati voters also said no. By the mid-1950s the tide of public opinion appeared to be moving against fluoride, according to the historian Donald McNeil. "[By December 1955] The U.S. Public Health Service reported that of 231 communities voting on fluoridation 127 had rejected it, McNeil wrote. Adverse referenda votes in twenty-eight communities 156 CHAPTER ELEVEN had discontinued established projects. Six months later the proponents had won eight more elections campaigns, the anti-fluorida-tion forces forty-five, he added." In 1954 national legislation banning fluoridation was proposed in Congress by Rep. Roy Wier of Minnesota. The suggested law, HR 2341, was titled A Bill to Protect the Public Health from the Dangers of Fluoridation of Water. It forbade any federal state or local authority from adding fluoride to water supplies. Hearings were held at the end of May in Room 1334 of the New House Office Building, with a great array of medical figures testifying against and in favor of the bill. 31 George Waldbott led the opposition. Symptoms of chronic low-level fluoride poisoning, such as nausea, general malaise, joint pains, decreased blood clotting, anemia were vague and insidious testified Waldbott, and could therefore easily be blamed on something other than fluoride — which made a correct diagnosis difficult, particularly for doctors who knew little about fluoride s toxic potential. Waldbott repeated his arguments that as a result of the danger of allergic reaction, the varying amounts of water drunk by different people, the risk to kidney patients or diabetics, and the extra fluoride consumed in food, there can be no such thing as a safe concentration. Neither the benefit nor the safety of fluorida-tion water supplies are sufficiently proven to warrant experimenta tion with human life, Waldbott told Congress. But once again Harold Hodge stepped into the breach, saving the day for the government. He blunderbussed fluoride opponents with his National Academy of Sciences-approved data. The Rochester scientist was the nation's leading fluoride authority, a member of the Mellon Institutes Industrial Hygiene Association, chairman of the prestigious National Academy of Sciences Committee on Toxicology — and, of course, the former chief toxicologist of the Manhattan Project. It would take a massive dose of fluoride, Hodge testified — between 20 and 8o milligrams consumed daily for to to 20 years — to produce injury. Waldbott was mistaken, water fluoridation was harmless, Hodge insisted. Even if all the fluoride ingested in the drinking water (1 part per million) in a lifetime were stored in the skeleton, Hodge told Congress, no injury would occur.' Hodge s sober assurances provided the coup de grace for the AS VITAL TO OUR NATIONAL LIFE 157 legislation. The proposed law banning fluoridation expired in committee and never made it to the floor of the Congress for a full vote. And Hodges safety data were repeated for a generation, mantralike, in countless speeches, official documents, pamphlets, magazine articles, and textbooks. They were widely used by the American Dental Association and the World Health Organization. As recently as 1997 these same numbers were cited by the federal Institute of Medicine. 3 " And no one noticed when, in an obscure paper published in y79, after all the tumult and shouting had died down, Hodge quietly admitted that his safety figures had been wrong (see chapter 17). 12 Engineering Consent
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