After more than four years in court, a U.S. District Court judge has reached a historical ruling: fluoride in drinking water poses an “unreasonable risk” to brain development in children and the U.S. Environmental Protection Agency (EPA) must take regulatory action to eliminate that risk.
Judge Edward Chen who ruled on the case was careful to say that his ruling “does not conclude with certainty”1 that fluoridated water is causing harm to public health but said that that potential risk had enough evidence to warrant the EPA taking action.
In his ruling, Judge Chen wrote:
In all, there is substantial and scientifically credible evidence establishing that fluoride poses a risk to human health; it is associated with a reduction in the IQ of children and is hazardous at dosages that are far too close to fluoride levels in the drinking water of the United States.1
Chen’s ruling is a striking discord to a practice that has been hailed by the U.S. Centers for Disease Control and Prevention (CDC) as “one of the 10 greatest public health achievements of the 20th century.2 He described several ways the EPA could regulate fluoridation, up to and including a ban on the substance, but warned: “one thing the EPA cannot do, however, in the face of this court’s findings, is to ignore that risk.”1
NIH Systematic Review Finds Association Between High Levels of Fluoride Exposure and Lowered IQ in Children
The court’s ruling cites a 324-page systematic review done by the National Toxicology Program, which is housed under the U.S. National Institutes of Health (NIH). The systematic review found that 18 of 19 studies it deemed “high quality” concluded with “moderate confidence” that there is an association between higher levels of fluoride exposure and lowered IQ in children.3
According to court documents, this review was finalized in May of 2022 but was postponed by the NIH as the agency subjected the report to additional and unprecedented peer-reviews that delayed the report.4
For reference, prior reports on other chemicals typically have just one peer-review.4
Former NTP Official Says Dental Organizations Lobbied Federal Officials to Block NIH Report
Brian Berridge, former NTP official, agreed that these additional reviews were unprecedented, stating in court that dental organizations obtained internal drafts of the review then began to lobby federal officials.4
“After 17 years in the industry, I’ve seen efforts to modify messages to fit commercial interests,” Berridge wrote in an e-mail to NIH colleagues. Berridge ultimately resigned over the report’s repeated delays and testified in court about the process. “That’s not the way I want do science,” he stated.4
AAP, CDC, Dental Associations Continue to Recommend Fluoridated Water
Despite the additional peer reviews, the American Academy of Pediatrics (AAP) and American Dental Association (ADA) questioned the validity of the NIH’s report and is among other groups that continue to stand by their recommendation of using fluoridated water.3
The AAP, ADA, and other critics of the NTP’s systematic review argue that high fluoride was defined at a minimum of 1.5 milligrams per liter of water—double the concentration the EPA recommends in community water. The CDC also continues to recommend that fluoride be added to community drinking water.3
However, data shows that many cities fluoridate their water above the recommended amount. Even if using the recommended parts per million (ppm) of fluoride, water is an inexact delivery route. It is impossible to tailor the amount of fluoride in drinking water for each demographic group or to know how much fluoride individuals are consuming through additional sources such as food, pharmaceuticals, and dental products.4
Chen ruled that even at the reviewed higher limits, there is not enough of a “margin of safety” at the current levels and pointed to studies of pregnant mothers that found their fluoride exposure could be ever higher.
The AAP and ADA also argue that the demographics included for analysis in the NTP review were “geographically heterogenous” and that factors such as socioeconomic status, familial, culture, genetic, and nutritional cofounders could be the larger contributing factors.
Michael Connett, lead attorney for the groups who brought the lawsuit against the EPA, stated:
Clearly, the length of time the judge took to decide this case shows that the court did not rush to make this decision. It took its time, it allowed extensive testimony and evidence. So it was certainly not a rush job, just the opposite of it.5
Fluoride Action Network Lawsuit: First Time a Citizen’s Petition Has Gone to Trial
EPA spokesperson Jeff Landis said the agency was reviewing the decision but offered no further comment.4 This trial represents the first-time a group has been able to use the law to take a citizen petition to trial. The trial began as a Citizen’s Petition under the Toxic Substances Control Act of 1976 (TSCA), which allows citizens to petition for the EPA to evaluate whether chemicals pose unreasonable risks. After requesting a ban on fluoridation and being denied in 2017, the Fluoride Action Network, along with several other consumer advocacy groups and individuals, filed the lawsuit in federal court.6
The EPA could technically appeal to the Court of Appeals, or they could take several years to develop new guidelines.
Stuart Cooper, executive director of the Fluoride Action Network wrote:
Policymakers at the local and state level do not need to wait to take action. The federal government doesn’t mandate fluoridation, and thus local and state decisionmakers can take action immediately. The public didn’t sign up to have a chemical added to public drinking water that could adversely affect the brain. And while a cavity can easily be filled, damage to the brain is permanent, and the consequences are lifelong.6
Many Countries Have Stopped Adding Fluoride to Drinking Water Systems
Community water fluoridation was implemented in 1945 and, since then, has gone largely unquestioned in the United States. Despite most U.S. cities fluoridating their water, dental decay continues to be the most prevalent chronic health disease in both children and adults. Many countries throughout the world, including Germany, Sweden, Japan, Denmark, Austria, Belgium, have discontinued or rejected adding fluoride to their water systems.
According to attorney Michael Connett:
The court has done what EPA has long refused to do: applied EPA’s risk assessment framework to fluoride. It’s a historic decision… As we await EPA’s rulemaking proceeding, policymakers would be well advised to ask: should we really be adding a neurotoxicant to our drinking water?7
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