Dear All,

The CDC will be producing its fluoride recommendations in the Mortality and Morbidity Review (MMWR) on August 16 or 17. Be ready.

Two things to look for in the CDC report:

1) Discussion on the need to reduce total exposure to fluoride, which is currently too high amongst US children, as reflected by the rampant level of dental fluorosis (one in three children in fluoridated communities have two or more fluorosed teeth according to Heller et al, 1997).

2) Discussion on the fact that fluoride’s benefits, whatever they are, are topical not systemic.

In light of these two concessions, it will be interesting to see how the CDC attempts to justify water fluoridation.

Simply put – if fluoride’s effects are topical, not systemic, water fluoridation becomes totally unnecessary. And if we have a problem with overexposure to fluoride (as we do), the quickest way to cut down on that exposure is to stop fluoridating the water. In this way, not only will the water have less fluoride, but also the processed foods, beer, soda and juice, prepared with it.

To review the past spin the CDC has put on this issue ( MMWR, October, 1999), visit http://www.fluoridealert.org/cdc.htm

I still find it incredible that this “prestigious” agency could have produced such a poor defense of fluoridation. I remain flabbergasted that they should dismiss health concerns in just three short sentences based upon a chapter in a book written in 1986 and a review written in 1993! They were thus 6 years behind the literature in 1999. US taxpayers deserve better than this.

Also below, is a memo. from June Allen, which is based upon information gleaned from the American Water Works Association, which had several meetings with the CDC on the way they (the CDC) planned to handle this embarassing situation. This memo gives an indication as to why this latest statement from the CDC has taken so long to concoct.

To be forewarned is to be armed!

Paul Connett.

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From June Allen, June 2000
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THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) convened a meeting on December 16, 1999 to discuss their draft document:

“Recommendations for the Use of Fluoride to Prevent and Control Dental Caries in the United States.” (Intendeded publication date: May 2000)

THE AMERICAN WATER WORKS ASSOCIATION (AWWA) attended the 12-16-99 CDC meeting, reporting in its Regulatory Update of January 3, 2000 that this CDC fluoride publication would be

“a different look at the data…”

and would build upon the 1993 National Academy of Sciences report: “Health Effects of Ingested Fluoride.”

At the meeting CDC’s document revisions were not shared with stakeholders.

There followed a “unanimous vote…that CDC not publish the report.”

“The group did not want CDC to hide [?] the information, but be careful, clear and concise…” per AWWA’s update.

AWWA noted that there was an “air of tension” at the meeting, a “carryover from the previous meeting” on the draft report. Dosage and “over-fluoridation of young children” was a concern.

No report was published in May of 2000 nor in May 2001. CDC said on 6-12-01 that its “clearance process” could further delay publication till between August and December of 2001 in CDC’s Morbidity and Mortality Weekly Report (MMWR).

What is the significance of this long CDC silence on fluoride?

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AWWA Report to which June Allen refers:
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AWWA Government Affairs

Regulatory Update – January 3, 2000

FLUORIDE UPDATE

The Centers for Disease Control and Prevention (CDC) held a meeting on December 16th to discuss their draft document, Recommendations for the Use of Fluoride to Prevent and Control Dental Caries in the United States. The intent of the meeting was to discuss collaborative activities to improve the understanding of the basic scientific principles behind the recommendations, and to discuss communication activities, so as to improve their adoption by health care professionals and the public.

The meeting was attended by a small group (15) mostly from dentistry, except for CDC and AWWA. Organizations represented included the Consumer Health Products Association, pharmaceuticals, public health associations, Association of Pediatric Dentists, state dental directors, American Dental Association, American Academy of Pediatrics, dental schools, and the dental hygienists’ association. There was an air of tension from the outset that apparently is a carryover from the previous meeting where an invited group (same group as today) was asked to review and comment on the draft report.

This report was compiled by an expert panel using existing data. In other words, this is a different look at the data that has been circulating for years. CDC’s report builds on the 1993 report by the National Academy of Sciences, Health Risk of Ingested Fluroide. CDC has made revisions to the report based on the previous meeting and is planning to publish the report sometime in May 2000. Basically CDC was asking this group to identify ways in which they were planning on presenting this information to the media. CDC’s stated audience for the report are 1) physicians, clinicians, and healthworkers involved with the dispensing of fluoride prescriptions, and 2) parents of young children (children Since the previous meeting, CDC has made revisions to the report, but has not shared them with the stakeholder group. Therefore, the group was unwilling to sign off on an implementation plan of a report they had not reviewed. There was a lot of discussion about what approach CDC should take in releasing this information. The bottom line was that the group did not want CDC to hide the information, but be careful, clear and concise in its presentation of the information. The meeting concluded with the group taking a unaimous vote (with AWWA and 3 other organizations abstaining) on a recommendation that CDC not publish the report. The group recommended that CDC instead convene a broader stakeholder workshop in which all players would help develop a national strategic plan for recommendations for the Use of Fluoride to Prevent and Control Dental Caries in the United States. This idea was based on a previous CDC workshop that developed strategies for oral cancer prevention.CDC was noncommital on their next steps. There are two scenarios for the potential distribution of this report. The first scenario is that CDC convenes a meeting in late February 2000 to take comments and develop media strategies. Then, CDC would brief the medical/dental community at their spring meetings and would publish the report in their Morbidity and Mortality Weekly Report (MMWR) in late spring. In the other implementation scenario, CDC would convene a workshop in March-April 2000 to develop a national strategic plan for recommendations for the Use of Fluoride to Prevent and Control Dental Caries in the United States, and then would publish the strategic plan in MMWR.The bottom line for water utilities is that this report, if published as last reviewed, will bring as much controversy as it is trying to bring clarification to a very complicated issue. In our discussions with CDC, it seems that the general feeling is that fluoridated drinking water is a good thing, as long as it is within the prescribed ranges and a caution about over-fluoridation of young children is understood. At a local level, water utilities will still have to wrestle with the fluoride issue.</paragraph

Since the previous meeting, CDC has made revisions to the report, but has not shared them with the stakeholder group. Therefore, the group was unwilling to sign off on an implementation plan of a report they had not reviewed. There was a lot of discussion about what approach CDC should take in releasing this information. The bottom line was that the group did not want CDC to hide the information, but be careful, clear and concise in its presentation of the information. The meeting concluded with the group taking a unaimous vote (with AWWA and 3 other organizations abstaining) on a recommendation that CDC not publish the report. The group recommended that CDC instead convene a broader stakeholder workshop in which all players would help develop a national strategic plan for recommendations for the Use of Fluoride to Prevent and Control Dental Caries in the United States. This idea was based on a previous CDC workshop that developed strategies for oral cancer prevention.

CDC was noncommital on their next steps. There are two scenarios for the potential distribution of this report. The first scenario is that CDC convenes a meeting in late February 2000 to take comments and develop media strategies. Then, CDC would brief the medical/dental community at their spring meetings and would publish the report in their Morbidity and Mortality Weekly Report (MMWR) in late spring. In the other implementation scenario, CDC would convene a workshop in March-April 2000 to develop a national strategic plan for recommendations for the Use of Fluoride to Prevent and Control Dental Caries in the United States, and then would publish the strategic plan in MMWR.

The bottom line for water utilities is that this report, if published as last reviewed, will bring as much controversy as it is trying to bring clarification to a very complicated issue. In our discussions with CDC, it seems that the general feeling is that fluoridated drinking water is a good thing, as long as it is within the prescribed ranges and a caution about over-fluoridation of young children is understood. At a local level, water utilities will still have to wrestle with the fluoride issue.