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After decades of pushing water fluoridation as one of the greatest public health accomplishments in U.S. history, the U.S. surgeon general’s office stopped issuing public statements of support after a National Toxicology Program report linked fluoride to children’s lower IQs.
Even today, the Centers for Disease Control and Prevention (CDC) calls water fluoridation one of the “ten great public health achievements of the 20th century.”
However, internal email communications shared with The Defender suggest that as early as 2020, officials at the highest levels of the U.S. Public Health Service — the Office of the Surgeon General — were having second thoughts.
“These emails show that despite public statements to the contrary, there is a lot of concern in the federal government about the potential link between fluoridated drinking water and lower IQs,” said Michael Connett.
Connett, an attorney, represents plaintiffs in a lawsuit against the U.S. Environmental Protection Agency (EPA). The suit seeks to end water fluoridation based on science linking low-level fluoride exposure to lower IQ scores in children.
The emails were obtained via a Freedom of Information Act (FOIA) request and shared with The Defender by plaintiffs in the lawsuit.
They reveal that in 2020, on the 75th anniversary of water fluoridation, U.S. Surgeon General Jerome Adams declined to make a statement endorsing water fluoridation, despite strong encouragement and behind-the-scenes organizing by his Chief Dental Officer Timothy Ricks.
Adams’ office also stopped Ricks from co-signing, with eight previous chief dental officers, and releasing a letter supporting community water fluoridation and celebrating the anniversary.
The U.S. surgeon general’s public support for water fluoridation has been considered key to boosting water fluoridation since the practice began.
Until 2020, every surgeon general had made oral or written statements supporting water fluoridation, according to the communications among previous chief dental officers — appointees who advise the surgeon general and the U.S. Department of Health and Human Services on the recruitment and development of oral health professionals.
However, on this important anniversary, Adams’ staff told Ricks the surgeon general was reluctant to make a pro-fluoridation statement because he knew government scientists at the National Toxicology Program (NTP) were about to publish a systematic review of the literature on fluoride and neurotoxicity in children.
The NTP report found that neonatal and childhood fluoride exposure had negative cognitive and neurodevelopmental effects for children.
“One thing these emails demonstrate is what is undiscussed in the public sphere is that the science on fluoridation is very troubling, not just in high doses but at levels applicable to water fluoridation in the U.S.”
“The fact that this concern is being expressed by an office that has historically been very supportive of fluoridation further highlights the serious implications of the NTP’s findings,” Connett said.
Surgeon General Vivek Murthy, who also held the office under the Obama administration, publicly endorsed water fluoridation in 2016. That was after he officially lowered the recommended dosage for water fluoridation the year before from 0.7-1.2 milligrams per liter (mg/L) to 0.7 mg/L after considering “adverse health effects” along with alleged benefits.
The original draft version of Murthy’s revised water fluoridation recommendations included a summary of some research on fluoride’s impact on IQ and other neurological issues with a statement saying further research was needed on the topic and that reducing the recommended levels for water fluoridation maintains benefits yet “reduces the chance of unwanted effects.”
Those statements were not present in Murthy’s final draft.
The Defender could not locate any public statement by Murthy in support of water fluoridation during his current term, which began in March 2021. Murthy’s office did not respond to an inquiry about his latest position on the issue.
The Defender did not receive responses from the offices of Adams or Ricks.
NTP report raised concerns about fluoridation while CDC continues to ‘blindly support’ it, emails show
As the 75th anniversary of water fluoridation approached, Ricks — appointed chief dental officer by Adams — drafted a statement endorsing the water fluoridation for Surgeon General Adams to sign.
However, Rick discovered Adams “didn’t want to sign such a statement because NTP was developing a monograph on fluoride that would undercut our long-standing support,” Ricks wrote in an email to a member of the surgeon general’s office.
In a series of emails over the next several months to the surgeon general’s staff, Ricks rallied the support of previous surgeon generals and chief dental officers for a statement, and attempted to convince the office that the NTP report was flawed or that the findings on fluoride’s neurotoxicity ought not to raise concerns.
The NTP is an interagency program housed at the National Institutes of Health (NIH) that investigates environmental toxins to determine if they threaten human health. Scientists there have been studying the neurological effects of fluoride on human health since 2016.
The NTP’s study was launched 10 years after the National Research Council concluded its own multi-year study, which determined fluoride is an endocrine disruptor that can interfere with brain function and mandated further research into the issue.
After years of research, NTP’s report went through multiple rounds of peer review — more than any other publications put out by the NTP, because of the controversial or “sensitive” nature of their findings on fluoride’s neurotoxicity.
Documents obtained through public records requests also later revealed lobbying by the dental industry and coordination with government officials from other agencies within the NIH, including the National Institute of Dental and Craniofacial Research (NIDCR), to weaken the conclusions, delay the report or stop its publication went on behind the scenes for several years.
Ricks coordinated with the American Dental Association (ADA) on how to continue to advocate for community water fluoridation in response to the report’s anticipated findings.
In April 2022, when the NTP finally announced it was ready to publish its final report, the ADA and other organizations obtained copies of the report and lobbied federal officials to block its publication.
Dental officials at the CDC, the NIH and the NIDCR pressured HHS Assistant Secretary for Health Rachel Levine to prevent the review from being published.
Levine told the NTP to put the report on hold and send it for another round of peer review.
In March 2023, the draft NTP report linking prenatal and childhood fluoride exposure to reduced IQ in children was finally published under court order. In the process, many officials publicly and privately objected to the review process, which they claimed was politicized by agencies and individuals with a vested interest in water fluoridation.
The report is a key document in the ongoing lawsuit filed by Food & Water Watch, the Fluoride Action Network, Moms Against Fluoridation and private individuals against the EPA seeking to end water fluoridation.
Arguments in that lawsuit began in June 2020, but it was put on hold pending the publication of the NTP report. The landmark fluoride trial resumed in January of this year and the judge is currently deliberating on his final decision.
While the lawsuit and the political wrangling over the report were ongoing in 2020, Ricks reached out to his colleagues for help getting the surgeon general to maintain the office’s support for water fluoridation.
In an email labeled, “Not for dissemination; keep confidential,” Ricks shared a “bombshell” with former chief dental officers. He told them the National Institute of Environmental Health Sciences (NIEHS), the NTP and the NIDCR had informed the Office of the Surgeon General that the NIEHS/NTP report would “state that fluoride was definitely neurotoxic to children” and the surgeon general would be withdrawing the letter that Ricks had prepared.
Ricks and others planned for the dental officers, without Ricks’ signature, to issue their own letter and share it at the meeting of the ADA. Ricks would privately facilitate wide circulation of the letter, he said.
The impacts of the surgeon general’s decision raised concerns for Ricks. In another email, he worried the public would begin to think that the U.S. Public Health Service no longer backs water fluoridation.
When Ricks received a draft of the NTP report in August 2020, he again reached out to the surgeon general’s office to seek a signature, downplaying the report’s conclusions.
Ricks quoted the NTP report’s new summary statement, which said that at water fluoridation levels typically found in the U.S. “effects on cognitive neurodevelopment are inconsistent, and therefore unclear.”
He highlighted the sentence and contended that uncertainty over whether fluoride damaged cognitive development made it “safe for the Surgeon General to issue a statement of support.”
According to the excerpt highlighted by Ricks, “However, when considering all the evidence … NTP concludes that fluoride is presumed to be a cognitive neurodevelopmental hazard to humans.”
Others at NIH voiced concerns that there would be public pushback, “since there is now preliminary early evidence about potential risks to fluoride.”
Ricks also wrote that the surgeon general indicated he would sign such a document only if he had full backing from both NIH and CDC. He wondered whether then-acting director Lawrence A. Tabak, Ph.D., also a dentist, and Francis Collins, M.D., Ph.D., would support such a letter.
By the end of August, Ricks had given up on the letter. In an email to Deputy Surgeon General Erica Schwartz, he said what he called the “anti-fluoride movement” was “more organized than ever before.”
He added that the NIH was now “on the fence about fluoride” despite the fact that the CDC was “seemingly blindly supporting fluoridation.”
In his last email to Schwartz, Ricks expressed his concern that a “very well put together” video would be aired at the next meeting of the International Society for Environmental Epidemiology.
He also noted that the president of the largest dental public health organization in the U.S. “has contributed to anti-fluoride research.”
Ricks was referring to research published by E. Angeles Martinez Mier, Ph.D., professor and associate dean for Global Engagement at the Indiana University School of Dentistry and former president of the American Association of Public Health Dentistry.
Martinez Mier co-authored an NIH, NIEHS and EPA-funded study published in Environmental Health Perspectives on a group called the ELEMENT cohort in Mexico that found that higher prenatal fluoride exposure was associated with lower cognitive function in children tested at age 4 and ages 6-12.
That 2017 article is just one of several recent studies that have identified the neurotoxic effects of fluoride exposure on children.
The study Martinez Mier worked on was part of one of four major recent studies on fluoride neurotoxicity done examining birth cohorts, which are considered the “gold standard” of epidemiological studies. In cohort studies, researchers collect epidemiological data during pregnancy and then from children over their lifetimes to study a variety of health outcomes tied to environmental exposures.
A significant body of scientific research has cast doubt on the dental health benefits of ingesting fluoride — and demonstrated negative health consequences of fluoride exposure, ranging from dental and skeletal fluorosis to developmental neurotoxicity.
However, the media, public health officials and even other researchers have until recently systematically discredited anyone, including scientists, who raised concerns about fluoride, going so far as to label them “conspiracy theorists.”
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Author: stuartbramhall
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