Gov't Strategizes with Private Groups to Protect Fluoridation

The following FOIA-obtained emails seems to show how the US Centers for Disease Control (CDC) works closely with the American Dental Association (ADA) and the PEW Foundation to protect fluoridation rather than the American public whose health they are entrusted to protect. The documents also reveal the disdain and lack of respect for people (me) who ask valid questions concerning fluoridation. I added the red parts to further identify the major players.

From: Duchon, Kip (CDC/ONDIEH/NCCDPHP) [CDC National Fluoridation Engineer, Oral Health Division]

Sent: Wednesday, May 05, 2010 11 :53 AM

To: 'McGinley, Jane' [RDH, MBA, Manager, Fluoridation and Preventive Health Activities, American Dental Association]

Cc: Bailey, William (CDC/ONDIEH/NCCDPHP) Dentist, Acting Director, CDC Oral Health Division

Subject: FW: Chinese Fluoride 

I regret to inform you that Carol Kopf seems to have gotten my email and she sent this directly to me, the first such instance, but no doubt, not the last. I am forwarding a copy of my response to you for you of all people probably need to know she is digging deeper into this issue. I think she was very displeased to hear about the Belgium supplier that we only recently identified a couple of months ago.

This was a combined investigative effort of Dave Hellmann and me to identify them and find out about their product They really have not been marketing in the US, but the AWWA committee is working to get the word out for they produce their product using the old Solvay method and looks like a very nice product. I'm not too sure, but wouldn't it be great if it was actually a byproduct of chocolate manufacturing, but it is unlikely. 

Kip Duchon, P.E.

National Water Fluoridation Engineer

---------------------------- 

From: Duchon, Kip (CDC/ONDIEH/NCCDPHP)

Sent: Wednesday, May 05, 2.010 11:06 AM

To: 'Carol S. Kopf

Subject: RE: Chinese Fluoride 

Dear Carol 

Normally requests for information should come in through our public information box so that the correct person can answer the question you might have. That can be found at http://www.cdc.gov/fluoridation/contact.htm

I am probably the correct person for this particular question, so I will be glad to answer your question.

Since the EPA terminated their additives program in 1988, they simply do not have the resources to track the over 50 additives used in water treatment facilities. NSF International is a standards organization and does not track this type of information but they do monitor the activities of the certifying entities and report to the Association of State Drinking Water Administrators and EPA. Both NSF (a different entity from NSF International) and UL, which combined represent over 85% of the water fluoridation additive certification activities, do not publically report on tonnage or marketing.

CDC does not have an additives monitoring program but we compile some limited information on the topic, and I will attempt to give you my best opinion on these answers, but please understand this is my opinion and not the opinion of

CDC since we don't actually have a formal additives program.

My understanding is that the Chinese sodium fluoride that is NSF Standard 60 certified is derived from a full neutralization of fluorosflicic acid using caustic soda, but I have not actually been to the production facilities to confirm that information.

Sodium fluoride products with Standard 60 certification are derived from either full neutralization of fluorosilicic acid, or neutralization of hydrogen fluoride. 

A majority of the sodium fluoride being used in the US is derived from fluorosilicic acid and an AWWA survey of water plant operators using sodium fluoride in saturators that is currently being compiled has preliminary results showing that a majority of operators are satisfied with the fluorosilicic acid derived product, but there seems to be a preference for the hydrogen fluoride derived product. These products are not by-products but are specifically made for uses including water fluoridation. 

At this time, product is available from China, Japan, and Belgium

and a US domestically produced product is certified from a facility in Illinois that is currently not producing product but has periodically been used intermittently in the past few years. 

The AWWA survey is part of our effort to periodically review our standards and if there is change or difference in the products and if an update is needed. That survey is in progress and results are not yet complete.

Sodium fluorosilicate with Standard 60 certification is derived from partial neutralization of fluorosilicic acid. It is not a byproduct but is specifically manufactured for use including water fluoridation. At this time the overwhelming source is domestically US produced, but NSF certified product is also available from China and Belgium

NSF Standard 60 certified Fluorosilicic is overwhelmingly produced in the US as a high-purity vacuum extraction from gypsum slurry derived from phosphate fertilizer production. There are no smokestacks belching this stuff although that is

a great science fiction tale. Less than 5% of the product is from gas partitioning of silica-tetrafluoride from hydrogen fluoride and less than 1% is from hydrogen fluoride etching of silica products. The product is available from US, Mexican,

and Canadian sources.

Kip Duchon, P.E.

National Water Fluoridation Engineer

----------------------------------

From:  Carol S. Kopf

Sent: Wednesday, May 05, 2010 9:32AM

To: Duchon, Kip (CDC/ONDIEH/NCCDPHP)

Subject: Chinese Fluoride

Kip

Both the EPA and NSF International haven’t been able to answer this question for me. Hope you will.

It is about the Chinese fluoride. Is it derived from phosphate fertilizer? If not, what is it derived from.

Also the CDC's website says that most of the fluoridation chemicals are collected from fertilizer companies; but not all. What are the other sources of fluoridation chemicals?

Are they made specifically for fluoridation or are they a by-product of some other manufacturing process?

A Louisiana State Legislator said on the floor of the State Senate yesterday that some fluoridation chemicals are purchased from Belgium? ls that true?

Please name all the countries that import fluoridation chemicals into the US

Thank you for your assistance

 ·

Carol Kopf

From: Bill Maas (Consultant) mailto:BMaas-consultant@pewtrusts.org] [former Director, CDC Oral Health Division and now consultant to the Pew Foundation to promote fluoridation]

Sent: Thursday, May O5, 2011 01:04PM

To: Judy Sherman (ShermanJ@ADA.ORG) ShermanJ@ADA.ORG [Judy Sherman is, a now retired, ADA lobbyist]

Cc: Bailey, William (CDC/ONDIEH/NCCDPHP); Lewis Lampiris (lampirisl@ada.org) [In 2006, Lampris began working with the American Dental Association as director of the Council on Access, Prevention and Interprofessional Relations; he held this appointment until 2012.]

Subject: Implications of CDC demotion, as seen through eyes of CWF opponent

I don't want to overreact to the rantlngs of a long time anti-fluoridationist,  but l.came across something that may get traction in contributing to perceptions about what HHS and CDC really believe about fluoridation now {since to save face, it is unlikely to retract its 1999 proclamations about fluoridation as a great public health achievement}.

Councilman Vallone, of NY City, has proposed discontinuation of CWF in NYC. Dr. Neal Herman, a former city dental director, wrote Vallone a letter, which Vallone's office has shared with many long-standing opponents of fluoridation, including Carol Kopf, who wrote the attached letter. [Apparently the NYC Dental Director shared my letter with Bill Maas. Why? You can read my whole letter here http://fluoridedangers.blogspot.com/p/blog-page.html ] 

As usual, it includes a difficult-to-separate mix of correctly quoted statements from credible scientific reports along with misleading assertions about health risks or lack of health benefits from fluoridation.

But, what caught my eye as new was the following:

"You mention that the Centers for Disease Control recognizes fluoridation as one of the ten greatest and effective public health innovations ever. Then why has tooth decay rates gone up since that statement was made and why was the CDC’s oral health Division demoted to a branch no longer working for children. It seems that statement just doesn't hold water. It's just words strung together that has no scientific basis."

About the only good thing l can say about the reorganization is that the Division of Population Health is to include what used to be the Division of Adolescent and School Health, but I don't know how visible that will be to counter the charge that this is a Division not "working for children".

This certainly is relevant to the recommendations of the IoM committee to HHS that perceptions matter. CDC’s reorganization sends a message about one of the gret public health achievements of the 20^th century that may be difficult to counter.

Bill Maas

----------------------

From: Bailey, William (CDC/ONDIEH/NCCDPHP)

Sent: Thursday, May 05, 2011 1:34 PM

To: 'BMaas~consultant@ pewtrusts.org'; 'shermanj@ ada.org'

Cc: 'lampirisl@ ada.org'

Re: Implications of CDC demotion, as seen through eyes of CWF opponent

So true.

---------------

From: Bill Maas (Consultant) [mailto:BMaas-consultant@pewtrusts.org]

Sent: Thursday, May 05, 2011 01:09 PM

To: 'Sherman, Judy C.'

Cc: Bailey, William (CDC/ONDIEH/NCCDPHP); Lampiris, Lewis N.

Subject: RE: Implications of CDC demotion, as seen through eyes of CWF opponent

Yes, it reveals how carefully fluoridation's opponents watch organizational actions like that of CDC, and how readily they will use that to undermine public health.

----------------------------------

From: Sherman, Judy C. [mailto:shermanj@ada.orgl [ADA Lobbyest]

Sent: Thursday, May O5, 2011 1:07 PM

To: Bill Maas (Consultant)

·Cc: 'wdb9@cdc.gov'; [William Bailey]; Lampiris, Lewis N.

Subject: Re: Implications of CDC demotion, as seen through eyes of CWF opponent

Thank you for this. May I share with people on the Hill?

---------------------------------------

These emails were part of 2600 pages of documents obtained by Dan Stockin, MPH, and revealed at the 5^th Annual Fluoride Action Network conference on September 6-8 in Washington DC.

FOIA Documents here

Stockin PowerPoint

Keep Fluoride Toothpaste Out of Children's Reach, Expert Cautioned in 1980

The following is quoted from Gary M. Whitford, PhD, DMD, August 1981

“Some fluoride-containing products, however, have enough of the ion to be hazardous and should be handled and stored with caution.  For example, a 1.23 percent fluoride gel contains 12,300 ppm or 12.3 milligrams per gram [such as dentists' fluoride treatments]. Thus, one ounce (28.3) grams) contains 348 milligrams, a life-threatening dose for a 11.5 kilogram or a 25 pound child.  Even the popular fluoride toothpastes may be hazardous to small children. These products typically contain 0.1 percent fluoride or 1000 ppm.  Thus, an eight ounce tube containing 226 milligrams of fluoride, could endanger a 16 or 17 pound child…Therefore such products should be kept out of the reach of those who are at risk."

“Dental fluorosis, a disorder of enamel mineralization which can be produced only during the development of the enamel prior to tooth eruption, is generally regarded as a toxic manifestation of chronic intake of excessive fluoride.  Exactly, how much fluoride is too much is uncertain.”

                                                 Gary M. Whitford, PhD, DMD, August 1981

                                “Fluorides: Mechanism of Action Efficacy and Safety,”

                                      Dental Caries Prevention in Public Health Programs

                                        Proceedings of a Conference October 27-28 1980

                                            Sponsored By the National Caries Program

                                                 National Institute of Dental Research

                                           US Department of Health and Human Services

                                         Edited by Alice M. Horowitz and Hilah B. Thomas

Excerpts above and below by Gary M. Whitford, PhD, DMD

Dr. Nichols asks Dr. Whitford the following question:  "If I gave you two items, one a 9 ounce size of Crest toothpaste another a 7 ounce bottle of 0.2 percent sodium fluoride solution, could you discuss the toxicity of each in relation to a 20 kilogram child?"

Dr. Whitford answers "There would be 225 mg of fluoride in the tube. The 7 ounce bottle is about 0.1 percent fluoride so it would contain about 200 mg of fluoride...I think that the potential for toxicity, if ingested all at once, would be about equal.  Assuming that 30 mg of fluoride per kilogram of body weight is fatal, these doses would be dangerous for seven and nine kilogram children, respectively  [15 to 20 pounds]. I'm unaware of any report indicating that death has occurred from the ingestion of toothpaste or a 0.2 percent sodium fluoride solution.  It is, however, conceivable that it could happen. For that reason, when our children were younger, we purchased the 4 to 6 ounce tube of toothpaste and kept them out of their reach."

Fluoride is readily absorbed from the gastrointestinal tract. That which appears in the feces is mainly if not entirely, unabsorbed fluoride and usually accounts for only about 5 to 10 percent of the amount ingested daily. Some factors, however, decrease the absorption of fluoride, particularly divalent and trivalent cations such as calcium, magnesium and aluminum. If high concentrations of these ions are present with the fluoride at the time of ingestion, systemic absorption is reduced.

From the plasma, fluoride diffuses to the extra cellular and intracellular fluids of the soft tissues where it rapidly reaches a steady-state distribution.

As the plasma curve rises, so do the concentrations of fluoride in the muscle, the liver, the heart, and all soft tissues

The excretion pattern of fluoride, however, is not exactly this way in all people.  The age of the individual influences how much fluoride is removed from the body...  The excreted percentage of a fluoride dose generally varies as a direct function of age. The younger the individual, the less excretion.  The older the individual, the more of a given dose is excreted.  This result is attributable principally to the growth rate and age of the skeleton and the surface area of bone mineral available for fluoride uptake. In the growing individual, these factors favor enhanced fluoride uptake so that relatively less is excreted in the urine.

According the some findings that we made a few years ago, fluoride excretion is a function of the pH of the urine. At a low pH, fluoride excretion is also low and as the urine pH rises, the rate of fluoride excretion rises as well.

The diet of most infants is either mother’s milk or a formula based on cow’s milk.  The urine pH of  infants who are solely formula fed is generally lower, sometimes markedly so, then that of solely breastfed infants and the would be expected to excrete less of the fluoride delivered to the kidneys in the blood.  Such differences in excretion rate might or might not be desirable depending on the quantities of fluoride involved.

Thus, difference in diet, among several other important factors, will tend to produce urine pH values that approach one end or the other of the physiologic range. These factors influence the uptake of fluoride by developing teeth and the fluoride levels of the oral fluids. Therefore, they can affect the cariostatic efficacy of fluoride in certain individuals or perhaps the development of fluorosis in others.

Dental fluorosis, a disorder of enamel mineralization which can be produced only during the development of the enamel prior to tooth eruption, is generally regarded as a toxic manifestation of chronic intake of excessive fluoride.  Exactly, how much fluoride is too much is uncertain.”…Probably no single dose, or narrow range of doses can be determined because of several variables. The age and body weight of the child or fetus, the frequency of the doses, the peak plasma levels, the magnitude of the more sustained fasting plasma level, are among the factors to be considered.  Nevertheless, the early data provided by Dean are pertinent. 

According to his findings and classification system, when the community index of fluorosis exceeds 0.6, the incidence and severity of fluorosis begins to constitute a public health problem warranting increasing consideration.  This index value was reached in communities with water fluoride levels of 1.6 to 1.8 ppm.  Thus the margin of safety for avoiding a degree of dental fluorosis which may be of public health concern is rather low at somewhat less than two and is another reason for carefully monitoring fluoride levels in water.