Ever since the Public Health Service (PHS) endorsed fluoridation in 1950, detractors have charged that PHS and the medical and dental establishment, such as the American Medical Association (AMA) and the American Dental Association (ADA), have suppressed adverse scientific information about its effects.

Some of those who generally support fluoridation make similar charges. For example, Zev Remba, the Washington Bureau editor ofAGD Impact, the monthly publication of the Academy of General Dentistry, wrote last year that supporters of fluoridation have had an “unwillingness to release any information that would cast fluorides in a negative light,” and that organized dentistry has lost “its objectivity-the ability to consider varying viewpoints together with scientific data to reach a sensible conclusion.”

The dozen or so scientists C&EN was able to contact who have done research suggesting negative effects from fluoridation agree on this aspect. They all say that fluoridation research is unusual in this respect.

If the lifeblood of science is open debate of evidence, scientific journals are the veins and arteries of the body scientific. Yet journal editors often have refused for political reasons to publish information that raises questions about fluoridation. A letter from Bernard P. Tillis, editor of the New York State Dental Journal, written in February 1984 to Geoffrey E. Smith, a dental surgeon from Melbourne, Australia, says: “Your paper . . . was read here with interest,” but it is not appropriate for publication at this time because “the opposition to fluoridation has become virulent again.” The paper poses the question: Are people ingesting increasing amounts of fluoride and can they do so with impunity?

Sohan L. Manocha, now a lawyer, and Harold Warner, professor emeritus of biomedical engineering at Emory University medical school in Atlanta, received a similar letter in 1974 from the editor of AMA’s Archives of Environmental Health. The editor rejected a report Manocha and Warner submitted on enzyme changes in monkeys who were drinking fluoridated water because of reviewers’ comments such as: “’l would recommend that this paper not be accepted for publication at this time” because “this is a sensitive subject and any publication in this area is subject to interpretation by antifluoridation groups.”

These papers were subsequently published in prestigious British journals. Science Progress (Oxford) and Histochemical Journal.Many other authors have reported similar difficulties publishing original data that suggest adverse effects of fluoridated water.

Most authoritative scientific overviews of fluoridation have omitted negative information about it, even when the oversight is pointed out. Phillipe Grandjean, professor of environmental medicine at Odense University in Denmark, wrote to the Environmental Protection Agency in June 1985 about a World Health Organization study on fluorine and fluorides:

“Information which could cast any doubt on the advantage of fluoride supplements was left out by the Task Group. Unless I had been present myself. I would have found it hard to believe.”

In his 1973 Ph.D. thesis on the fluoridation controversy, Edward Groth III, a Stanford biology graduate student at that time, concluded that the vast majority of reviews of the literature were designed to promote fluoridation, not to examine evidence objectively. Groth also noted a number of antifluoridation reviews that were equally biased.

According to Robert J. Carton, an environmental scientist at EPA., the scientific assessment of fluoride’s health risks written by the agency in 1985 “’omits 90% of the literature on mutagenicity, most of which suggests fluoride is a mutagen.”

Several scientists in the U.S. and other countries who have done research or written reports questioning the benefits of fluoridation or suggesting possible health risks were discouraged by their employers from publishing their findings. After their paper had been rejected by the editor of Archives of Environmental Health, Manocha and Warner were told by the director of their department not to try to publish their findings in any other U.S. journal. NIDR had warned the director that the research results would harm the cause of fluoridation. Eventually, Manocha and Warner were granted permission to publish their work in a foreign journal.

In 1982, John A. Colquhoun, former principal dental officer in the Department of Health in Auckland, New Zealand, was told after writing a report that showed no benefit from fluoridation in New Zealand that the department refused him permission to publish it.

In 1980, Brian Dementi, then toxicologist at the Virginia Department of Health, wrote a Comprehensive report on ‘Fluoride and Drinking Water” that suggested possible health risks from fluoridation. This 36-page study has been purged from the department’s library even though it is the only one the department has prepared on the subject. According to current employees, no copy exists anywhere in the department. Spokesmen say the report was thrown away because it was old but also say the department will be preparing another report on the subject soon.

Carton: EPA document omitted 90% of mutagenicity studies

An ADA white paper written in 1979 states: “Dentists’ nonparticipation [in fluoridation promotion] is overt neglect of professional responsibility.” An ADA spokesperson says this is still the association’s official policy. In recent years, several dentists who have testified on the antifluoridation side have been reprimanded by their state dental officers.

ADA and PHS also have actively discouraged research into the health risks of fluoridation by attacking the work or the character of the investigators. As part of their political campaign, they have over the years collected information on perceived antifluoridation scientists, leaders, and organizations. Newspaper articles about them are stored in files, as are letters about them from various proponents of fluoridation. Little or no effort has been made to verify the accuracy of this information. It is used not only in efforts to counteract arguments of the antifluoridationists, but also to discredit the work and objectivity of U.S. scientists whose research suggests possible health risks from fluoridation.

One example is the false information about the late George L. Waldbott, founder and chief of allergy clinics in four Detroit hospitals, that ADA disseminated widely to discredit the validity of his research. Rather than deal scientifically with his work, ADA mounted a campaign of criticism based largely on a letter from a West German health officer, Heinrich Hornung. The letter made a number of untrue statements, including an allegation that Waldbott obtained his information on patients’ reactions to fluoride solely from the use of questionnaires. ADA published Hornung’s letter in its journal in 1956 and distributed a news release based on the letter. ADA later published Waldbott’s response to this letter. But the widely disseminated original news release was not altered or corrected, and continued to be published in many places. As late as 1985, it was still being quoted. Once political attacks effectively portrayed him as “antifluoridation,” Waldbott’s work was largely ignored by physicians and scientists.

In November 1962 and 1965, ADA included in its journal long directories of information about antifluoridation scientists, organizations, leaders, and others known to be opposed to fluoridation. Listed in alphabetical order were reputable scientists, convicted felons, food faddists, scientific organizations, and the Ku Klux Klan. Information was given about each, including quotes from newspaper articles, some of which contained false data. The information was published for use by proponents of fluoridation in local fluoridation referenda.

John S. Small, information specialist at the National Institute of Dental Research, is quite willing to talk about the files he keeps on antifluoridation organizations and their leaders. “Of course, we gather information,” he says. ‘”These people are running all over the country opposing fluoridation. We have to know what they are up to.” Consumer advocate Ralph Nader has a different view of this activity. He calls it an “institutionalized witch-hunt.”

It is easy to understand why research on risks of fluoridation has never been more vigorously pursued. Most of the individuals and agencies involved have been promoting fluoridation publicly for nearly 40 years. Research that suggests possible harm threatens them with a loss of face. For example, PHS has historically been the principal source of funds for fluoride research: but ever since June 1950, PHS has been officially committed to and responsible for promoting fluoridation. Thus, the agency has a fundamental conflict of interest.

Colquhoun, now teaching the history of education at the University of Auckland, offers another explanation for what appears to be the suppression of research. He notes that the editorial policy of scientific journals has “generally been to not publish material which overtly opposes the fluoridation paradigm.” Scientific journals employ a referee system of peer review. But when the overwhelming majority of experts in an area from which the referees are selected are committed to the shared paradigm of fluoridation, Colquhoun notes, the system lends itself to preservation and continuation of the traditional belief that fluoridation is safe and effective. This results in “single-minded promotion, but poor-quality research, and an apparent inability to flexibly reassess in the presence of unexpected new data,” he says.

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