[00:00:00] Welcome to the Health Policy Podcast. I'm Brian Hyde, and today I'm joined by Susan Gold Haber. She's a writer for the American Council on Science and Health. Susan, thank you so much for joining us today. Thank you for having me. So, Susan, I'm, I'm looking here and seeing. The word fluoride. And I'm reflecting that I have heard a lot about fluoride over the years, but I understand that the EPA recently announced that it's actually carrying out a new toxicity assessment to determine safe levels of fluoride in drinking water. And before we dive into that topic, which I know is going to, this is gonna peak a lot of people's interest, tell me a little bit about your background and, uh, and where, where your interest in this comes in. My interest in this comes in from back, um, in the 1980s. My first job outta college, I worked at the EPA and one of our, my first assignments was to work on revising the fluoride standard. Okay. How many years ago was that? And um, they were basically [00:01:00] looking at the same things. Where re EPA is looking at now to find out what were the levels where it caused, um, you know, hazards through drinking water. So I spent 10 years working on that then, um, and other chemicals, but that was one. And then fluoride. And then over the years since then, I moved on and I worked for different consulting firms and everyone which had primarily, um, EPA contracts, but other government agencies. And every once in a while. Fluoride would cop up again and basically I would be on a contract and then fast forward to like 2000, um, 18, 19, I was. Put on a, a national toxicology program working on a report on fluoride again, which is one of the real controversial things I'll talk about. So throughout like 40 something years, it's just been there. So for, I've had it. And so I know a lot about that issue. So [00:02:00] Susan, let's, let's start with the really obvious question. Why is fluoride so controversial? I mean, it has been as long as I can remember. Right. Well, you know, fluoride has a really interesting history. Going back to, basically, I'll just do a brief summary of this 'cause most people don't know this. It started back in 1909 when there was a, um. A doctor named Frederick McKay and he went to Colorado Springs, Colorado. 'cause he heard about this group of people there that had these really ugly brown model teeth. And, and the doctors were saying, what? What's going on? So he went out there and he looked, and what he found was, yes they did. But the amazing thing was that the children's teeth didn't decay. They were very resistant. Unlike the rest of the. Population. So he looked at what it was and he discovered that these people had high levels of natural fluoride in their water. Now, most people don't know this, but fluoride does occur [00:03:00] naturally and there are parts of the us, um, particularly in Texas, but other parts where the problem is too much fluoride. And so. And these people get what's called model teeth, which is a, the teeth look brown and ugly, but it's not really, it doesn't affect the teeth stay in, it's not really a traditional health effects, but still who wants, you know, ugly looking teeth. So, you know, they started looking at that over the years. And then we get to World War ii. Okay. And that's when, and the reason. Uh, my goodness. Excuse me here. Um, and the reason why this was an issue in World War II was, believe it or not, we all think of oral hygiene was like really bad back then. In fact, it became a national security issue because I think it was more than. Um, well, first of all, only 7% of Americans brush their teeth regularly. And what happened in the Army, like 30% of recruits were deemed unfit [00:04:00] because they didn't brush their teeth. Okay? So this was not just a few people having bad teeth. And so what happened was after World War ii, um, when they came home, the military made this a national security issue and basically gave all the soldiers when they came home, toothbrushes. Toothpaste, they took it to their families and it basically, you know, kind of changed the way we, you know, taught your children in the old days, which, um, I remember my dad telling me, you only went to the dentist when you had severe pain in your mouth. There was no such thing as preventive death, um, healthcare, which is just so totally different. Okay, so then we get back after World War II and it's starting and they're starting to look at this problem. And so basically what happened was in 1945 and they went back and looked at what had been come about from 1909 from this, like, if we add fluoride to the water, could this be an easy way to get dental health? Um, you know, [00:05:00] up a much better than it is. And so in 1945 Grand Rapids, Michigan became the first. Um, city in the world, they added fluoride to their drinking water. It was an experiment. Um, something we could never do today, but they put it in the drinking water. Um, and basically they looked at it and they followed like, how many was it? 30,000 children for 15 years, and they found out there was like a 60% drop in cavity rate. So that kind of became the turning point. And then after that, um, okay. A lot of cities became adding it, now became adding it. But in all that time, it was still controversial In 1945, some of you may remember the crazy things in the fifties. People were saying that it was a communist plot. I mean, most people are too young to remember that. But there's always been fears and questions about it. 'cause there is, I mean, I look now something scary about putting something in your water. [00:06:00] Okay. So, and this kind of, you know, it's been in the background for these last 20, how many years? 40 years. There's always been a group that's been against it. There's, um, different fluoride, but it kind of came to the forefront recently, I'd say with the Maha moment. Movement, which fluoride became one of their, and so that's kind of why it's come back up, become one of their issues that, you know, it should not, that we should not have added chemicals to anything, including our drinking water. So that's kind of my. So here's my short or not so short answer. Here's the, the first thing that comes to mind as I hear you describe this is, um, obviously we want to have, you know, strong teeth and, you know mm-hmm. As few visits as possible to the dentist. Hey, that makes things really great, you know, in my opinion. But I've also heard some things, some very conflicting things about fluoride. Oh, it calcify the pineal gland in your mind, or, uh, you know. Mm-hmm. I've heard a lot of [00:07:00] things and I, I don't know. What's true versus what isn't. Some of it's very sensational. Some of it I think is, is well intended. Mm-hmm. Talk to me about, uh, at what levels does fluoride actually cause a problem? Right. Okay. So that's the most important thing. Fluoride, like all chemicals has different effects at different levels. How fluoride differs is that fluoride actually has some good effects on her teeth at lower levels. Normally when you think about it, you're like, uh, you don't want any of these chemicals in your drinking water, but fluoride. So basically, um, the. The levels, the EPA a's drinking water standard, which is set at four milligrams per liter, which is the level where it's protective against. Okay, this is. One of the really bad effects. Crippling. It's called crippling. Make sure I got that right. Oh, skeletal fluorosis, which is a bone. If you get enough, it affects your bones and basically it's bone deformities and it's not seen in the us but [00:08:00] so when we set this, when I helped set this standard, that was what? You know, we were protecting against, that's a lot. Okay. So you see that way up there, but that's why the standard for EPA is set at that level. Then when you go down, you get into what? Um, we were talking about the model teeth. Okay. And that's usually around. Two. So that was way above four or five. Now we're gonna get to two milligrams per liter. Okay. And so that's when you start to see the, the brown teeth. Okay? And so. You really don't want that. Um, even though it may not kill you, it's still not a good thing to have. And so then you get down lower and you get to the positive effects. Okay, so this is where EPA does not most people think EPA requires fluoridation or any of that. That's not true. It's a state. The EPA has no authority to do that. It's a state or [00:09:00] locality decision, and they usually take the center of CDC C'S advice. Okay. On what to do about it. So C, D, C, when we're talking about levels, so now we're at like, you don't really want it above two, but what are the levels where it protects your teeth against cavities? So then we get to the CDC and they've come out with their recommendation of one point. I mean of 0.7 to 1.2. Okay. So that's about half the level where you would see, okay, so that's kind of been the standard for the last 40 years, except now I'll get into the more recent what the Maha, what you see from that movement and from others. It's not just a fringe movement anymore. Um. So what's happened is they've, over the years, there's been a lot of research done on different effects, and primarily if it has a, a neuro, they call 'em neuro behavioral, but neurological effects. [00:10:00] Okay. That if it can affect at low concentrations, we've already known it. High concentrations, almost anything can affect your brain. But, you know, so what happened was that kind of caused this a few year to start a few years ago is the, um. S National Toxicology Program, which is a distinguished program within, um, the NIH. Within the CDC, they came out with a report and it basically said that fluoride concentrations above 1.5 are associated with neurological effects. And what, how they measured it was lower IQ in children. Okay. There was studies, so that was what kind of caused a really big, because they never had a government agency saying that fluoride did anything other than. Crippling Fluorosis teeth and, and here they had a federal agency saying that. Um, and so that came [00:11:00] out in, well, the final came out in 2024 of that. But before that, there had been several lawsuits against CPA and all of that, but that caused, once this came out. People are looking like, okay, you know, uh, IQ effects at, um, one point grade, 1.5. Well, that's really close to what the CDC says is the recommended level. So that's kind of the basis of why the EPA is going back now and re-looking at it and, and. The basis of why, when I wrote my article, I said my, my feeling, my very strong feeling is that EPA is gonna end up lowering their standard because it's gonna be very hard for, you know, lowering it from four, because it's gonna be very hard for them to defend that if another government agency is saying, you see things at one point. Um. [00:12:00] Five, and I can go into all the IQ studies and what these are, and they're kind of, you know, and why I have problems with them. But that's kind of the basis of where it's going. Now, Susan, one of the questions that I have is, um, where does the American Dental Association come down on this? I mean, they're the ones who've been recommending it for a long time. Um, do, do they have a dog in this fight? Great question. Yeah, they do. And so far, with all you've heard, and they're, they're one of the ones that I think are gonna be really big in this fight because so far you've haven't heard too much from them other than if you go on their website, um. They just say that for 80 years, you know, you're looking big. 80 years. Um, I guess it's, yeah, they, they'd use 80 years coming from, I don't know what year, 40, um, that fluoridation has been like incredibly important for dental health in the US and that this is very key and they're not gonna, they're not going to just roll over. Okay. And they [00:13:00] have the American Dental Association, um. Has very strong relation on a little bit of a political side. They have very strong relationships, a lot of them with the local state and, um, legislative, they have a lot of power in there. And they do have the point that this, it has been a probably one of the most effective public health, um, measures, you know, over the last century. And to just throw this out, um. And, you know, so they've, they've come out, you can read their statements. I mean, uh, so far there ha you know, you can read about it, but this hasn't yet reached after the EPA comes out, they can't say too much until the EPA comes out with their recommendation. Like, if the EPA says, you know, we're gonna keep it. So, you know, their websites are all talking about it, but it's gonna be a very interesting. Um, kind. Oh, well, probably a fight. I'm sure there'll be lawsuits, but you know, that was why [00:14:00] my last article, I said it's basically kind of Maha versus the a DA. Um, and it's gonna, um, be, um. Very, a a lot of stuff is gonna be coming with it. And um, so thank you for that question. So, um, let's talk about, uh, Maha Make America healthy again. Um, are they on the right path here? Are, are these fair questions? Is I guess what I, what I'm asking Yeah. In, in a very indirect way is mm-hmm. Is, is there hysteria that is driving? Mm-hmm. This, uh, this call for change or mm-hmm. Is this based on sound science? Well, some of it is based on sound science. Um, I'm not gonna throw this out and say it's all just, you know, hysteria and the, I'd say the biggest. Science that I, you know, recognize is true in their arguments is basically that fluoride exposure is much wider today than it was in the 1940s. We have fluoride in [00:15:00] toothpaste, mouthwash, it's also in a lot of our processed foods. Um, and so you do get it and they're saying this was, you know. In, in the old days, it was just from drinking water. So one of their main persuasive arguments is we don't, this is from an old, you know, the old days, we don't need it anymore because, um, people get enough fluoride from other sources Now. Um, as I say, exposure is no longer single source, which is a very good argument. My one problem with that is, yes, that's true. However, where you see the children's, the problem with children's cavities come, um, it's basically when their adult teeth are coming out. I mean, we're talking it, they need the fluoride when they're just several, two or three years old in order it protects against it. Okay? And so, yes, it's true for older kids, but like. I remember trying to get fluoride toothpaste down my kids at that age, and I just know [00:16:00] not much made it. Okay. And so that whole, so I'm not sure that that young of a population will have enough to prevent, you know, the cavities. It, it's, and one of the things that, there have been several studies of, um, places. Where they've shown that, that we're fluoridated. There was one in Canada, there was one in Israel. There's one in Alaska where places whose. Um, stopped floor dating after a number of years, and they did see an increase in cavities in children. And that's one of the ADA's biggest arguments against it is that, um, I mean they, they do have data on that. Um, you know, there's a lot of questions about, there's always questions, you know, it, it's obviously it's more in low income. People who don't, um, you know, may not have access to all the fluoride, but still there has been. So, um. That is a, uh, you know, one of that that's not now the other, um, [00:17:00] that's not just hysteria. It's a very good argument. And, um, the other, um, issue is dealing with these other effects like the IQ and they, um. And what they call these neurological effects that you, that you see these studies and see. Um, the problem is every chemical cause effects at higher doses. I'm not a big person on these IQ studies. And just to let you know, what they do is basically you take one population with fluoridated water, okay? And they look at the average IQ in that one. They take one without. Okay. You can't like dose the kids with fluoride. You just look at the populations and they try to make them comparable. So one's not real rich and one's not real poor. They compare 'em and they have a number of studies that's shown average IQ levels higher in the non fluoridated. Now we do have some studies showing no difference or showing the other way, but. The way our [00:18:00] science works is as soon as you have, having worked on these, these, um, things for um, 40 plus years, when you have positive studies, they always outweigh negative studies because people are like, yeah, you right to be concerned. I'm not big on the IQs. Stuff because IQ is not, it's not a neurological marker. Okay? IQ is a standardized test. There's a five point margin of error. It depends what day you take it. I mean, to me it doesn't, but when you got, you got, that's what you saw at the lowest doses, okay? And so that's what's being used. So to me that's not very persuasive. However. My guess is it's gonna be persuasive to EPA. It's very difficult to throw out a whole, particularly when the National Toxicology Program says that you need to be concerned about this in your article. Fluoride Wars, the upcoming Battle Royale. This is on the, uh, American Council on Science and Health website, right? Acs h.org. Uh, you, you say that you [00:19:00] wouldn't bet against, uh, the American Dental Association. Where's this battle going to be fought out? If this does in, in fact become a battle royale, where are we going to see it play out? Well, it'll come out in the courts and also in the public opinion. Um, you know, the courts EPA has already been, you know, this whole thing has been sued by different fluoride action network over the years. That's what has made them basically re they've already done that, um, been sued by different groups, but the. American Dental, you know, and that's why they're re-looking at it. But if they propose lowering the, um, lowering the drinking water standard, which I think they probably will, then I. I will say that will be fought out in the courts. And I think the a DA will be a big, um, part of the ones, um, defending, not lowering it. Okay. But then there's also the battle over public opinion. And like I say, the [00:20:00] fluoridation is a local issue. Most people don't know it. EPA, it really, I mean it matters, but it, it's basically local legislators. Um. State, it's either at the state or local level. Okay. When they hear from their dentist, their local dentist, who a lot of them have long-term relationships, and the dentists show them, look what happened when, you know, look at the increase in cavities. Do you want this for your, you know, your children? Uh, that's gonna be a very big, I assume, PR and also campaign. And so it's one that I, I pre, I hadn't thought about that because. When I started writing this article, I was only gonna write about the Maha movement because that's like all that's been in the, the news and everything. And you know, and I'm thinking, is there anybody on the other side? Like, it seemed like a slam dunk to me. Okay. They were gonna lower the standard, and then my thought is C, DC would say, well, we don't recommend. Fluoride in the water and fluoridation would kind of go. But then I thought about [00:21:00] it and I started looking and I started talking to my dentist and I started hearing, you know, I don't think it's gonna be that easy. Um, and so they do have some very good, and that's why I, I. I think it's gonna be very interesting in those two places. Again, we are talking with Susan Gold Haber. She is a writer for Amer the American Council on Science and Health. And Susan, I thank you for visiting with us today on the Health Policy Podcast. Thank you. I.