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In the early 1980s, the Environmental Protection Agency sought to determine the maximum level of fluoride in drinking water this is safe for human consumption. As part of this review, the EPA solicited the recommendations of a Surgeon General panel of scientists and doctors. The panel’s conclusions were clear: both moderate and severe dental fluorosis are adverse health effects and EPA should enact an enforceable drinking water standard no higher than 2.4 ppm to prevent these effects from occurring. As one panel member noted, “you would need rocks in your head” to “allow your child much more than 2 parts per million.” Unbeknownst to the panel members, however, their conclusions were later altered by pro-fluoridation officials in the Surgeon General’s Office. A revised, gutted version of the Panel’s report was then sent to the EPA recommending that the Agency classify dental fluorosis as only a “cosmetic” effect and increase the allowable level of fluoride to 4 ppm.

As with the Surgeon General’s panel members, most experts that the EPA consulted — including a panel of the National Institute of Mental Health, the National Drinking Water Advisory Council, and its own professional staff and scientists — concluded that moderate and severe fluorosis are adverse health effects and that the  allowable level of fluoride in water should be no higher than 1.4 to 2.4 ppm. Officials in EPA Management, however, succumbed to intense political pressure and raised the fluoride standard to 4 ppm, prompting a lawsuit by the Natural Resources Defense Council (NRDC) that the Agency’s own scientists attempted to join. As noted by NRDC’s attorney, “I’ve never seen scientific evidence discounted and refused to be looked at the way they’re doing with fluoride. . . . They’re changing the standard for reasons that have nothing to do with science.”

Background:

The US Environmental Protection Agency (EPA) regulates the amount of fluoride that can be legally present in drinking water supplies. In 1975, following passage of the Safe Drinking Water Act (SDWA), the EPA set the Maximum Contaminant Level (MCL) for fluoride at 1.4-2.4 ppm, which is just twice the level of fluoride added to water in artificial fluoridation programs (0.7 to 1.2 ppm).  The EPA issued this MCL in order to prevent children from developing advanced forms of dental fluorosis (a brown and and black discoloration of teeth with pitting and cracking of the enamel).

EPA’s establishment of a nationally enforceable fluoride standard caused a strong backlash from two interest groups. Pro-fluoride dental institutions argued that regulating fluoride as a contaminant would interfere with the promotion of fluoridation as a cavities prevention program, and states such as South Carolina with high levels of fluoride in their water were concerned about the costs of removing the fluoride.

In response to these groups’ objections, the EPA began a reassessment of its MCL in the early 1980s. As part of this reassessment, EPA consulted with multiple scientific panels, including the Surgeon General, the National Institute of Mental Health, and the National Drinking Water Advisory Council. The majority of these medical panels shared the view that EPA’s MCL should not be increased as severe dental fluorosis was deemed an adverse health effect that should be prevented. Although this view was shared by most of EPA’s professionals working on the reassessment, EPA Administrators decided in 1985 to increase the allowable level of fluoride to 4 ppm, a level that the Agency admitted would produce disfiguring dental fluorosis in 40% of children. On the day the EPA announced its decision, a scientist who worked on the standard circulated a mock press release among staff employees which stated:

“Up to now EPA, under the Safe Drinking Water Act, has regulated fluoride in order to prevent children from having teeth which looked like they had been chewing brown shoe polish and rocks. The old standard . . . generally kept fluoride levels below 2.4mg/L. EPA in response to new studies, which only confirmed the old studies, and some flat out political preasure, has decided to raise the standard to 4 mg/L. This increase will allow 40% of all children to have teeth gross enough to gag a maggot. EPA selected this level based upon a cost effectiveness study which showed that it is cheaper for people to keep their mouths shut then to remove the fluoride.”

The NRDC’s Lawsuit

EPA’s decision to increase the MCL to 4 ppm drew intense criticism from the Natural Resources Defense Council (NRDC), which – in 1986 – took the EPA to Court to challenge the new standard. As noted by an NRDC lawyer, the EPA was “changing the [fluoride] standard for reasons that have nothing to do with science.” The NRDC contended that EPA unjustifiably altered its definition of dental fluorosis and that it inadequately examined medical research indicating other toxic effects from fluoride at levels below 4 ppm.

EPA’s Union of Scientists Blasts EPA’s Decision

The NRDC was not alone in its criticism of the Agency’s decision. In an unusual and unprecedented move, EPA’s union of scientists and professionals voted to join the NRDC it its suit against the EPA. According to the President of EPA’s Headquarters Union, Dr. Robert Carton:

“Our responsibility to defend EPA professionals’ reputations and to protect public health in this situation requires us to put loyalty to the public interest and to moral principle above loyalty to persons or to [a] government department.”

While the court did not allow the EPA union to join as a party, and while NRDC did not prevail in the suit, the NRDC’s and Union’s concerns about the MCL have subsequently been vindicated. In 2006, the National Research Council (NRC) published a report which concluded that the MCL is unsafe and needs to be lowered. To date, however, the EPA has yet to revise the MCL.

The EPA FLuoride FIles:

• The Documents: FAN’s extensive documentary history of the politics and controversy surrounding EPA’s decision to increase the MCL to 4 ppm.
• The Fluorosis Timeline (1974-2011): A timeline documenting the pressures the pro-fluoride community placed on the EPA to redefine severe dental fluorosis as a cosmetic effect, not a health effect.
• The Altered Conclusions of the Surgeon General’s Panel: At the request of the EPA, the Surgeon General assembled a panel to provide recommendations on the “non-dental health effects” of fluoride. The panel concluded that moderate and severe dental fluorosis were both adverse health effects that placed children at risk of psychological damage and possibly bone damage and cardiotoxicity. The EPA never received the panel’s conclusions, however, because the panel’s recommendations were changed (without the members’ knowledge) by pro-fluoridation officials in the Surgeon General’s office.
• The NRDC Lawsuit: A summary of NRDC’s legal and scientific critiques of EPA’s altered MCL, with links to NRDC’s legal briefs, the EPA Union’s amicus brief, and the court’s ultimate decision.
• News Coverage: News coverage from the New York Times, Boston Globe, Progressive Magazine, and more.

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