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CONSUMER CHOICE AND IMPLEMENTING FULL

DISCLOSURE IN DENTISTRY

HEARING

BEFORE THE

SUBCOMMITTEE ON HUMAN RIGHTS AND

WELLNESS

OF THE

COMMITTEE ON

GOVERNMENT REFORM

HOUSE OF REPRESENTATIVES

ONE HUNDRED EIGHTH CONGRESS

FIRST SESSION

MAY 8, 2003

Serial No. 108–22

Printed for the use of the Committee on Government Reform

(

Available via the World Wide Web: http://www.gpo.gov/congress/house

http://www.house.gov/reform

(II)

COMMITTEE ON GOVERNMENT REFORM

TOM DAVIS, Virginia, Chairman

DAN BURTON, Indiana

CHRISTOPHER SHAYS, Connecticut

ILEANA ROS-LEHTINEN, Florida

JOHN M. MCHUGH, New York

JOHN L. MICA, Florida

MARK E. SOUDER, Indiana

STEVEN C. LATOURETTE, Ohio

DOUG OSE, California

RON LEWIS, Kentucky

JO ANN DAVIS, Virginia

TODD RUSSELL PLATTS, Pennsylvania

CHRIS CANNON, Utah

ADAM H. PUTNAM, Florida

EDWARD L. SCHROCK, Virginia

JOHN J. DUNCAN, JR., Tennessee

JOHN SULLIVAN, Oklahoma

NATHAN DEAL, Georgia

CANDICE S. MILLER, Michigan

TIM MURPHY, Pennsylvania

MICHAEL R. TURNER, Ohio

JOHN R. CARTER, Texas

WILLIAM J. JANKLOW, South Dakota

MARSHA BLACKBURN, Tennessee

HENRY A. WAXMAN, California

TOM LANTOS, California

MAJOR R. OWENS, New York

EDOLPHUS TOWNS, New York

PAUL E. KANJORSKI, Pennsylvania

CAROLYN B. MALONEY, New York

ELIJAH E. CUMMINGS, Maryland

DENNIS J. KUCINICH, Ohio

DANNY K. DAVIS, Illinois

JOHN F. TIERNEY, Massachusetts

WM. LACY CLAY, Missouri

DIANE E. WATSON, California

STEPHEN F. LYNCH, Massachusetts

CHRIS VAN HOLLEN, Maryland

LINDA T. SANCHEZ, California

C.A. ‘‘DUTCH’’ RUPPERSBERGER, Maryland

ELEANOR HOLMES NORTON, District of

Columbia

JIM COOPER, Tennessee

CHRIS BELL, Texas

———

BERNARD SANDERS, Vermont

(Independent)

PETER SIRH, Staff Director

MELISSA WOJCIAK, Deputy Staff Director

RANDY KAPLAN, Senior Counsel/Parliamentarian

TERESA AUSTIN, Chief Clerk

PHILIP M. SCHILIRO, Minority Staff Director

SUBCOMMITTEE ON HUMAN RIGHTS AND WELLNESS

DAN BURTON, Indiana, Chairman

CHRIS CANNON, Utah

CHRISTOPHER SHAYS, Connecticut

ILEANA ROS-LEHTINEN, Florida

DIANE E. WATSON, California

BERNARD SANDERS, Vermont

(Independent)

ELIJAH E. CUMMINGS, Maryland

EX OFFICIO

TOM DAVIS, Virginia HENRY A. WAXMAN, California

MARK WALKER, Chief of Staff

JOHN ROWE, Professional Staff Member

MINDI WALKER, Legislative Aide/Clerk

TONY HAYWOOD, Minority Counsel

(III)

C O N T E N T S

Page

Hearing held on May 8, 2003 ................................................................................. 1

Statement of:

Lorscheider, Fritz, professor emeritus, medical physiology and biophysics,

University of Calgary; Boyd E. Haley, professor and chair, department

of chemistry, University of Kentucky; Maths Berlin, professor emeritus,

environmental medicine, University of Lund, Sweden, and past chair,

international project of chemical safety, World Health Organization;

and Fred Eichmiller, director, American Dental Association Health

Foundation, Paffenbarger Research Center, National Bureau of Standards and Technology ..................................................................................... 5

Michaud, Hon. Mike, a Representative in Congress from the State of

Maine; Chester Yokoyama, D.D.S., member, Dental Board of California;

Sandra Duffy, esquire, founding member, Consumers for Dental Choice

Northwest; and Emmitt Carlton, immediate past president, Alexandria,

VA Chapter, National Association for the Advancement of Colored People ................................................................................................................... 114

Letters, statements, etc., submitted for the record by:

Berlin, Maths, professor emeritus, environmental medicine, University

of Lund, Sweden, and past chair, international project of chemical

safety, World Health Organization, information concerning an updated

risk analysis .................................................................................................. 77

Carlton, Emmitt, immediate past president, Alexandria, VA Chapter,

National Association for the Advancement of Colored People, prepared

statement of ................................................................................................... 160

Duffy, Sandra, esquire, founding member, Consumers for Dental Choice

Northwest, prepared statement of ............................................................... 132

Eichmiller, Fred, director, American Dental Association Health Foundation, Paffenbarger Research Center, National Bureau of Standards and

Technology:

Consumer choice brochures ...................................................................... 46

Prepared statement of ............................................................................... 51

Haley, Boyd E., professor and chair, department of chemistry, University

of Kentucky, prepared statement of ............................................................ 14

Michaud, Hon. Mike, a Representative in Congress from the State of

Maine, prepared statement of ...................................................................... 117

Yokoyama, Chester, D.D.S., member, Dental Board of California, prepared statement of ........................................................................................ 125

(1)

CONSUMER CHOICE AND IMPLEMENTING

FULL DISCLOSURE IN DENTISTRY

THURSDAY, MAY 8, 2003

HOUSE OF REPRESENTATIVES, SUBCOMMITTEE ON HUMAN RIGHTS AND WELLNESS, COMMITTEE ON GOVERNMENT REFORM, Washington, DC.

The subcommittee met, pursuant to notice, at 2:16 p.m., in room

2154, Rayburn House Office Building, Hon. Dan Burton (chairman

of the subcommittee) presiding.

Present: Representatives Burton, Cannon, Watson, and

Cummings.

Staff present: Mark Walker, chief of staff; Mindi Walker, legislative aide and clerk; Nick Mutton, press secretary; John Rowe, professional staff member; Tony Haywood, minority counsel; and Teresa Coufal, minority assistant clerk.

Mr. BURTON. The Subcommittee on Wellness and Human Rights

will come to order. A quorum being present, we will start the meeting.

I ask unanimous consent that all Members’ and witnesses’ written and opening statements be included in the record. Without objection, so ordered.

I ask unanimous consent that all articles, exhibits, and extraneous or tabular material referred to be included in the record.

Without objection, so ordered.

In the event of other Members attending the hearing, I ask

unanimous consent—we may have other members who would like

to serve as ex officio members of the subcommittee today, and if

they come and would like to participate, we will allow them to do

so. Without objection, so ordered.

Let me start off by saying that we began an investigation of mercury in medical and dental devices in 1999. Our early activities focused primarily on Thimerosal in childhood vaccines, and we quickly recognized a no-win situation for many children and their families.

The government mandates that all children be sent to school.

The government mandates that all children get a series of vaccinations before they go to school, but sometimes things go awry when

conscientious families follow these government mandates.

For far too many years, mercury has been used as a preservative

in almost all childhood vaccinations. As the mandatory number of

shots that children had to get before they could attend school increased, more and more mercury got pumped into their little bodies

in shot after shot.

2

For an alarming number of children, the consequences were tragic. Many kids, including my grandson Christian, got many times

the supposedly safe dosage of mercury that adults can tolerate

from their shots. As a result, Christian became profoundly autistic

almost overnight. Unfortunately, the tragedy that struck my own

family has been repeated over and over again throughout the

United States.

Sadly, autism has become an epidemic of outrageous proportions;

1 child in 10,000 in the United States used to be autistic, and now

it is as many as 1 out of 250 and in some areas of the country it

is 1 out of 150. So it is an absolute epidemic.

This epidemic is continuing to worsen at an alarming rate, growing by as much as between 10 and 17 percent each year. What did

our Federal health agencies do while the autism epidemic spun out

of control? They delayed, denied, and alibied.

Specious arguments were thrown up about safe levels of mercury

that people should be able to tolerate. Silly mathematics were used

to claim that somehow the mercury in a shot is mysteriously absorbed by the body over an extended period of time, such as 180

days, so that the theoretically daily safe dosage would not be violated.

For years, groups that should have been safeguarding our children kept chanting the refrain that there is insufficient evidence to

establish a causal relationship and there is insufficient evidence to

disprove a causal relationship. ‘‘We need to study it. Send us more

money.’’ And they studied it on and on and on, and the kids continued to become sicker and sicker and have neurological problems.

There was argument after argument about ethyl mercury versus

methyl mercury versus elemental mercury, but all of that was

bogus. There are different routes by which mercury gets into the

human body. There are different rates of absorption, but all of it

accumulates to some extent, and all of it hurts us, and, worst of

all, it really hurts the kids.

Just last week, when talking to a group of congressional aides in

the Dirksen Senate Office Building, noted pediatrician Dr. Kathleen Shay said, ‘‘All forms of mercury are toxic. It is a poison in

all of its forms. There is no good mercury.’’ Most profoundly of all,

Dr. Shay emphasized that mercury damage lasts a lifetime, and

she stated, ‘‘You can’t take a pill to fix it.’’

Just last Saturday, in Chicago, Dr. Mark Geier, M.D., Ph.D., and

Dr. David Geier announced the results of a search of about 1,500

articles, not 10 or 15, but 1,500 articles on the adverse effects of

Thimerosal in various medical products. Their conclusion was that

a causal relationship exists between mercury from Thimerosal in

childhood vaccinations and neuro-developmental disorders. Our

Federal health agencies haven’t been able to find a causal relationship, but the Geiers found 1,500 articles that discussed the exact

kind of relationship that exists.

Dr. Boyd Haley, who is here to testify today, also was in Chicago

last Saturday, and he delivered a well-researched science-based

paper laced with common sense in discussing the sources of heavy

metal poisoning that lead to autism and Alzheimer’s disease, and

he stated, ‘‘The ones that stood out were mercury from dental

3

amalgams and vaccinations where Thimerosal was used as a preservative.’’

Dr. Haley mentioned dental amalgams, and that brings us to today’s subcommittee hearing. Last fall, we expanded our investigation to include the mercury-containing dental filling material called

amalgam. Although those fillings typically were called ‘‘silver’’ because of their color, in actuality, they contain 50 percent or more

mercury by weight.

In an attempt to lay a solid foundation of fact, we held a hearing

on November 14, 2002 entitled, ‘‘Mercury in Dental Amalgams: An

Examination of the Science.’’ A panel of distinguished scientists

and researchers, including Dr. Haley, made a good-faith effort to do

exactly that, discuss the science, and we learned a great deal from

them.

A representative of the American Dental Association and representatives of two Federal health agencies also appeared before

the committee, but they seemed more inclined to share anecdotal

evidence rather than solid science. Amazingly, none of those three

individuals was aware of a single study, they didn’t know of a single study that contradicted their oft-repeated refrain that mercurycontaining amalgams are safe and effective. They had heard of no

study that pointed to health problems, not even one.

But today you will hear a different story and testimony from Dr.

Maths Berlin from Sweden. Dr. Berlin is a former Chair of the

World Health Organization’s International Project on Chemical

Safety. So he is not some schlock that we brought in here. He

knows what he is talking about.

He and his colleagues in Sweden identified 936 scientific papers

that dealt with the health implications of amalgam. They found

that over 700 of those studies were credible. Now our health agencies can’t find one. He found over 700.

But, as a result, as recently as last week, on April 28th to be

exact, the ADA hand-delivered a letter to every Member of Congress that said, ‘‘Amalgam has been the subject of numerous rigorous scientific studies and none has revealed any credible evidence

that dental amalgams are unsafe.’’

Later on in the questioning, I want to show you some of the

things that they have put out that show how to dispose of amalgams because they are not safe. I don’t understand that, but we

will get to that later.

Swedish scientists know about hundreds of such studies, but the

American Dental Association, that represents over 147,000 American dentists doesn’t know about a single one. Apparently, scientists at the FDA and NIH don’t know about one either.

Does something sound familiar here? Our health agencies can’t

make the connection between Thimerosal and autism, but the

Geiers found 1,500 articles on the adverse effects of Thimerosal.

I will finish my statement and then we will recess. Five votes?

Well, I will finish my statement, and then you folks can have a cup

of coffee before we get back because it is going to take us about 30

or 40 minutes before we get back here.

Our Federal health agencies can’t make the connection between

mercury and dental amalgams and any adverse health events, but

Swedish scientists found over 700 credible articles. I hope everyone

4

charged with safeguarding the health of the American people is listening.

As chairman of this subcommittee, you need to know that we are

not going to go away. This subcommittee is not going to leave, and

these issues are not going to go away, at least not until they are

thoroughly discussed and dealt with by the appropriate government institutions.

We are going to have another science-based discussion today

with world-class researchers. We will delve into whether the ADA

believes in full disclosure and truth in labeling or whether those

who accuse them of imposing a gag rule that inhibits open discussions with patients about mercury are correct.

We will hear about another no-win situation facing many American children from economically disadvantaged families. With very

few exceptions, government health programs will only pay for mercury-containing amalgam fillings. If indigent families want to get

their teeth fixed, they will get mercury put into their mouths.

In closing, I would like to quote from Dr. Charles V. Chapin, who

lived from 1856 to 1948 and was Harvard-educated and renowned

for his work in Providence, RI. Many consider him to be the godfather of the public health movement.

When discussing the need to abandon old ways and old ideas of

doing things and to embrace the new, he easily could have been

talking about the objectives of this hearing when he said, ‘‘Science

can never be a closed book. It is like a tree, ever reaching new

heights. Occasionally, the lower branches no longer giving nourishment to the tree slough off. We should not be ashamed to change

our methods. Rather, we should be ashamed never to do so.’’

So I would just like to say, while we take this little break, to my

friends at the health agencies, there are 1,500 articles that we

know of that talk about the threat to human beings from amalgams and mercury in dental fillings. The scientists from Sweden

found 700 articles that are credible, and I cannot figure out why

our health agencies can’t find one, and we will put that question

to them when we return.

So we will stand in recess for probably about 25 or 30 minutes.

I apologize for the delay, but the work of government has to go on

the floor, and I will be back in a little bit. We stand in recess.

[Recess.]

Mr. BURTON. First of all, I want to apologize for being gone so

long.

Hey, there’s my dentist back there. How are you?

First of all, I am sorry we took so long. Unfortunately, we had

no control over that.

We will go ahead and bring the first panel up. When Representative Watson comes back or Representative Cannon, we will let

them make some brief opening remarks, if they choose to do so.

But, in the interim, so we can go ahead and expedite this thing,

why don’t we bring Dr. Lorscheider, Dr. Haley, Dr. Berlin, and Dr.

Eichmiller before the committee. I will swear you in, and then

when they return, we will get on with that.

[Witnesses sworn.]

Mr. BURTON. Have a seat.

5

I think while we are waiting, if you would like, we will go ahead

and start the testimony with Dr. Lorscheider because I know it has

been a long day and I don’t want to keep you here an unnecessary

length of time.

Dr. Lorscheider.

STATEMENTS OF FRITZ LORSCHEIDER, PROFESSOR EMERITUS, MEDICAL PHYSIOLOGY AND BIOPHYSICS, UNIVERSITY

OF CALGARY; BOYD E. HALEY, PROFESSOR AND CHAIR, DEPARTMENT OF CHEMISTRY, UNIVERSITY OF KENTUCKY;

MATHS BERLIN, PROFESSOR EMERITUS, ENVIRONMENTAL

MEDICINE, UNIVERSITY OF LUND, SWEDEN, AND PAST

CHAIR, INTERNATIONAL PROJECT OF CHEMICAL SAFETY,

WORLD HEALTH ORGANIZATION; AND FRED EICHMILLER,

DIRECTOR, AMERICAN DENTAL ASSOCIATION HEALTH

FOUNDATION, PAFFENBARGER RESEARCH CENTER, NATIONAL BUREAU OF STANDARDS AND TECHNOLOGY

Mr. LORSCHEIDER. Thank you, Mr. Chairman.

Beginning 1985, a number of published papers from my laboratory, and subsequent papers from laboratories of other medical scientists have focused on the metabolism, toxicology, and

pathophysiology of mercury with specific reference as a component

of dental amalgam tooth fillings.

These papers have employed human clinical studies, also experimental animal models, and in some cases cell culture systems. Numerous peer-reviewed publications have unequivocally concluded

and established that amalgam mercury is continuously released as

vapor into the mouth. It is then inhaled, absorbed into both adult

and fetal body tissues, oxidized to ionic mercury, and, finally,

covalently bound to cell proteins.

So we do understand the body uptake, the tissue distribution,

and excretion of amalgam mercury in some detail, and, indeed,

these various routes and pathways for amalgam mercury are significant. Research evidence does not support the notion of amalgam

safety because both organ system and cell function, as I am going

to show you, are altered due to this mercury exposure.

An extensive review of the relevant literature is contained in the

attached invited review which I have submitted to the subcommittee. This is a commissioned, invited review by the editors of the

FASEB Journal. That is the Federation of American Societies for

Experimental Biology here in Bethesda, MD.

Beginning in 1995, several laboratories, including my own, began

to focus on brain concentration of mercury, including amalgam

mercury, and the effects on both neuronal function in experimental

models and also neural behavioral effects in humans in both biochemical evidence and whole mammalian brain and, more recently,

as I am going to show you, visual evidence with neuron cell cultures clearly demonstrate the molecular mechanisms whereby very

ultra, low levels of mercury exposure will initiate neuronal degeneration.

If we could have the film now, please?

[Video shown.]

Mr. LORSCHEIDER. Just a couple of concluding comments regarding this film. I think it should be pretty evident that medicine

6

clearly does now understand how mercury exerts its toxic effect on

neural cell membranes.

The video film that has been displayed here, the amounts of mercury that were used in these experiments are approximately 1 million times less than the average daily dose of mercury absorbed

due to dental amalgam mercury exposure, and also more than a

million times less than four vaccine shots containing Thimerosal.

So we are talking in order of magnitude here of 10 to the minus

6 less mercury concentration than what the average daily dose of

an amalgam is.

My final comment about this film is that this film is an integral

component of the data of a paper that we published in a British

journal, Neural Report, in the year 2001. Consequently, this is another refereed paper. This paper was adjudicated by Oxford and

Cambridge neuroscientists. The data was also presented for the

first time at the University of Oxford, and the contents of that film

received the same peer adjudication as did this paper, and I have

provided a copy of this paper for the committee.

Thank you very much.

Mr. BURTON. Well, we appreciate that very much, Doctor, and we

have shown that film a number of times. If only people would pay

attention, but, unfortunately, we haven’t broken through that thick

cranium that exists over at our health agencies.

Ms. Watson would like to make a couple of opening comments,

and then we will go to you, Dr. Haley.

Ms. WATSON. Thank you, Mr. Chairman. I would like to commend you for your leadership and hard work on this important

issue.

Last Congress you joined with me and co-authored H.R. 4163,

the Mercury in Dental Filling Disclosure and Prohibition Act. It is

a true testimony to your dedication and concern for the public’s

well-being.

In the 108th Congress, we have not only reintroduced our bill,

recently numbered H.R. 1680, but now serve as the chairman and

ranking member, respectively, on a subcommittee that addresses

human rights and health issues.

Mr. Chairman, you have set the tone for this subcommittee, garnering not only bipartisan support, but tripartisan support in the

first human rights and wellness hearing regarding drug reimportation. I look forward to serving on this subcommittee under your

leadership.

I would like to thank our panelists for taking the time to share

important information with us today. I appreciate that each one of

you has traveled to Washington from many different areas of the

United States, but I must give a special thank you to Dr. Berlin

for his journey all the way here from Sweden.

As the former Chair of the California Senate Health and Human

Services Committee for 17 years, I received constant testimony as

to the status of the health of Californians, especially the lower socioeconomic sector of our population there. One issue that stood

above others was the use of mercury in dental fillings.

Dentists have stood behind a long history of utilizing mercury.

However, a long history of use is no excuse. Mercury in any form

is as much of a health risk as lead paint and asbestos.

7

Mercury is being taken out of other health care products, including disinfectants, thermometers, childhood vaccines, and even

horse medicine. Mercury is a highly neurotoxic substance that has

genetic effects on biological organisms, as you just saw.

Mercury must be removed from the last known use in the human

body. Now it is hoped that this hearing will focus primarily upon

new information relating to possible health implications of mercury

in the human body, and upon disclosing adequate information to

patients, to enable them to make informed choices about the type

of dental restorative material that is used in their mouths.

The science presented by Dr. Lorscheider—I hope I pronounced

that right—and Dr. Haley and Dr. Berlin is important information

that should be highlighted in the public domain. Dr. Berlin will

present, I guess already has, a conclusion from his research that

states, with reference to the fact that mercury is a multipotent

toxic with effects on several levels of the biochemical dynamics of

the cell; amalgam must be considered to be an unsuitable material

for dental restoration. This is especially true since fully adequate

and less-toxic alternatives are, indeed, available.

The American public has the right to know. Consumers are often

given disinformation instead of information. To hide the fact that

mercury is the major component of amalgam, the ADA promotes

the fillings as silver. I find that most consumers do not know amalgams contain mercury. We are keeping the information away from

them.

States are trying to address this problem with statutes, but dental boards and other regulators are not implementing these laws.

Proposition 65 in California adopted in 1986 took 17 years to apply

to dental offices. Finally, in December 2002, dentists received a

mandate from the court instructing them to post signs that warn

that mercury fillings may cause birth defects and other reproductive harm.

In 1992, I wrote a law, section 1648.10 of the California State

Business and Professions Code, that mandated a fact sheet be produced by the California State Dental Board stating the risks and

efficacies of dental materials. Over the next 9 years, the board did

not comply. I am pleased to report that, when Governor Davis got

in office, he installed a new California Dental Board, and one of

those board members is here today.

The new board held hearings on the safety of mercury fillings in

2002, but has, again, bogged down as the California Dental Association argues against effective disclosure of risk. You know, I

would think that dentists would want to opt on the side of reducing

risk, not preaching about assessibility. If we know a toxic is being

used, how could a medical professional not want to tell his or her

patients?

So I applaud the efforts of Representative Mike Michaud in

Maine to produce a fact sheet, and I appreciate the testimony of

Dr. Chet Yokoyama, a mercury-free dentist and a member of the

California Dental Board, because the public has a right to be informed and to make an informed choice.

Regrettably, the American Dental Association has the provision

in its Code of Ethics to stop dentists from initiating communications with patients about the risk of mercury dental filling. If there

8

is anyone here from the ADA, I wish you would meet me outside

and explain to me why that provision is in your Code of Ethics.

This gag rule has, unfortunately, been enforced by many dentistdominated State dental boards. I am happy to report that the attorneys general of Iowa, Oregon, and Minnesota have directed that

the ADA gag order may not be enforced in their States.

The dental board in my home State of California repealed its gag

rule in 1999. Now it is time for the American Dental Association

to stop preventing dentists from disclosing to patients the risk

about amalgam, and it is time for every State dental board to stop

enforcing this gag rule. Oregon attorney Sandra Duffy I hope will

provide the insight into the ramifications of the gag rule.

Increased attention to mercury risk is apparent around the Nation, and I am pleased to inform you that the National Convention

of the NAACP endorsed H.R. 4163. Also, the National Black Caucus of State Legislators has called for legislation to protect children

and pregnant women from mercury dental fillings.

At the low and moderate end of the economic spectrum, no choice

exists. Upper-income consumers are increasingly choosing non-toxic

alternatives, and low-income families are generally forced to choose

mercury fillings or no fillings at all. Alternatives to mercury-based

dental fillings exist. Porcelain and resin fillings, for example, but

many publicly and privately financed health plans do not allow

consumers to choose alternatives to mercury amalgam fillings.

Medicaid should pay for the alternative and not pay for a substance that contains the toxic mercury. At the moment, two States

are trying to change the Medicaid system through legislation, California Assemblyman Jerome Horton and Arizona Representative

Carol Johnson, and they are both from different parties. Both bills

have strong community support.

Emmitt Carlton, the immediate past president of the NAACP, Alexandria, VA chapter, is here to provide a perspective on choice.

So, Mr. Chairman, I look forward to the testimony of the ADA

and everyone on the panel today, and I am pleased to have the opportunity to be able to hear scientific and regulatory testimony on

this issue. So, again, I thank you for your leadership and your hard

work, and I yield back my time, Mr. Chairman.

Mr. BURTON. Well, we will keep working until we get the facts

out and the American people do know all the nuances of this issue.

Next, we will hear from Dr. Boyd Haley. He has become a friend

of mine over the years. Dr. Haley, he is a professor and Chair of

the Department of Chemistry at the University of Kentucky, and

he will advance our science-based information on this important

topic. He will show a PowerPoint presentation with us, is that

right?

Mr. HALEY. I would welcome the appointment of a blue ribbon

biomedical science committee to look at the information and the

science that has been presented to this committee. I am very confident of what I say, and I think if anybody looks at the science,

that they will dispel right away the attitude that there is no

science backing up the toxicity of amalgam fillings. It is incredible

that statement would be made.

What I am going to do today is address the synergistic effects of

other heavy metals on mercury toxicity. I think this is something

9

that appears to have been ignored primarily not in the literature,

but in addressing the level of toxicity of mercury and the fact that

you can’t say what level of mercury is toxic, if you don’t know the

level of lead in a person.

Now could I have the first slide? This slide here is an old slide,

1978. What it says in there is that the administration of essentially

no response level, an LD1 of mercury solution, along with onetwentieth of an LD level of lead salt killed all the animals in this

study. It was a rat study.

What this is telling you, that it should have been one plus only

zero, equaling one. Instead, when you mix lead and mercury exposure, you get a dramatic enhancement of the toxicity of the mercury. This is what we are going to talk about. This is not a new

phenomena. This has been known for many, many years.

They made a conclusion that the combination of synergism was

most toxic when the member was present and near its LD1 dose.

You get a tremendous—and I will give you examples of this in

some of the later slides.

Can I have the next slide? The next slide is just something to say

that it is not just one paper that said this. I have several papers.

Again, they were 1973 and 1972. Why this has been ignored when

we are discussing the medical effects of mercury from dental amalgams, because if you remember the newspaper articles just recently, they are showing that very, very low levels of lead previously considered non-toxic are injuring the IQ or the learning

ability of children. I would submit to you that most likely what

they are not looking at is the level of mercury with the level of lead

that is in these children.

Could I have the next slide? This is a study that is coming out

in the International Journal of Toxicology, and it concerns the mercury level in the birth hair of autistic versus control children. On

the top slide, the top line—it is not going to show up this far

away—on the top line you see going up, that is a plot of the increase in mercury in the birth hair versus the number of amalgam

fillings in the birth mother. In control children, it increases, and

when you get above 10, it goes up quite high.

If you look at the autistic children—they are on the bottom line—

there is absolutely no change in the mercury in their birth hair.

They do not excrete the mercury. The easiest explanation for this

is that they retain it in their bodies, and that is based on the data

by a lot of other people that, if you challenge them with a mercury

challenge test, that they contain hundreds of times more heavy

metals in their body than do control children. So they do not handle the exposure to mercury that is from Thimerosal nearly as well

or from amalgam fillings that their mother has as do control children.

So this identifies a subset of the population that exists that cannot excrete chronic, low-level doses of mercury. It builds up in their

body, and if they are a child, it probably enhances their chances

of becoming autistic.

Could I have the next slide? If we look at the level, on the far

left, those are children who have mild autism; in the center it is

moderate, and then to the right it is severe. The green represents

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the males, and you realize that they are the preponderance of the

patients, the subjects. The black are the females.

What you see is that, as the severity of disease increases, the

level of mercury in the birth hair decreases. I have done some research, not my research but literature research, and you find the

same phenomena in Alzheimer’s disease, in that Alzheimer’s nail

tissue, fingernail tissue, has less mercury in it than does that of

age-matched controls. As the severity of the disease increases over

a period of time, the level of mercury drops. So they represent also

another group of people that appear to have lost the ability to excrete mercury, because if you can’t excrete it, it doesn’t get into the

blood. If it doesn’t get into the blood, it doesn’t get into the hair,

the nails, the feces, or the urine.

So we have to look at this. This is a good lead, I think, on the

causation of a lot of these diseases.

Could I have the next slide? This is an example of the synergism

with regard to Thimerosal with neurons in culture. If we see at the

top, we can keep neurons alive with very little death rate for about

24 hours. You will see the one slide there in the center where it

says, ‘‘50 nanomole’’ or 50 times 10 to the minus ninth lower levels

of Thimerosal.

A vaccine contains 125,000 nanomole levels of Thimerosal. When

we add to that, if you look where we have the red, I will just talk

about a couple of them. If we add aluminum alone, it is only slightly toxic, and the Thimerosal at this time has killed less than 5 percent of the neurons. But if we mix those two together, we end up

at the same time point killing 60 percent of the neurons. So the

aluminum in the vaccine along with the Thimerosal has a synergistic effect on Thimerosal toxicity causing it to be much more

toxic.

The second part that I want to talk about is the effect of testosterone. There was a study done in England where they found that

in the amniotic fluid of mothers that gave birth to autistic children,

they had one aberrancy, and that aberrancy was they had exceptionally high levels of testosterone, meaning the children, when

they were born, were probably carrying high levels of testosterone

or higher than the normal children.

When we added testosterone along with the Thimerosal in this

culture, all the neurons were dead within 3 hours. Nothing else did

this. This is a tremendous enhancement of the toxicity of Thimerosal by testosterone, and this probably explains why boys are 5

times or 4 times more likely to get this disease and why they are

probably 10 times more likely to have severe cases of autism. It depends upon the level of the male hormone in their body, and that

is a genetic factor that none of us have control over.

I think this is a perfect example of the synergism and why we

cannot say what is a safe level of mercury. Aluminum, testosterone,

and I would also point out antibiotics have the same effect, certain

antibiotics.

Could I have the next slide? I am trying to get through something that is rather complex. Dr. Lorscheider presented his film,

and this is a technology that most of you won’t know about called

photo affinity labeling that I invented when I was a post-doc at

Yale. But you can see the sign that says, ‘‘beta-tubulin.’’ That big,

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black spot there tells you that tubulin is very viable. It is alive and

working well in this brain tissue.

When you add Thimerosal, especially Thimerosal that has been

exposed to UV light to enhance the breakdown to ethyl mercury,

you see you totally wipe out its ability to interact with the probes

it has to interact with to polymerize. This fits into exactly what we

see with mercury. We get the same effect, and this is more complex

than that, but I think it points out that mercury from dental amalgams and mercury from Thimerosal both affect the same protein

that you saw cause the complete dissembly of the axons in Dr.

Lorscheider’s film.

Could I have the next slide? This is the effect we see with mercury in Alzheimer’s or control brain. On the left two panels you see

two AD subjects, and you see that the tubulin—it is kind of hard

to see from this distance, but there is no photo labeling of tubulin.

When you get to where that red arrow is on the right hand side,

you see the two controls at the zero level. The tubulin is there; it

is very viable. When you add a little bit of mercury to it, to the

control brain, you make it have the same photo labeling profile as

the Alzheimer’s-diseased brain.

I think that, at the very least, anyone looking at this data would

assume that having 50 years of a lot of mercury circulating in your

blood from your amalgams would make you cross that thin red line

into Alzheimer’s disease quicker because mercury affects the same

protein that is dramatically affected in Alzheimer’s disease.

There is more than one protein like that, and it is very simple

biochemistry to explain to someone that understands protein chemistry. That is the reason I would like to have a blue panel or biomedical group look at it instead of Congressmen.

Could I have the next slide, please? There is something unique

about mercury that scientists, even a lot of scientists were shocked

by this, and even I was also. You cannot prevent mercury toxicity

by chelating it with normal compounds that exist in the body or

that are made to protect people from heavy metal toxicity.

This is an audioradiograph where we have tried to chelate the

toxicity of a lot of the metals away with the compound called ethylene diamine tetra-acidic acid [EDTA]. EDTA prevented the toxicity

of all the heavy metals, and I would point so will citrate, so will

glutamate, so will silver or other chelators. However, all of those

chelators enhance the toxicity of mercury. They do not prevent it.

So mercury is unique that, when it gets into your brain with a

lot of chelators that would be there naturally to protect you from

heavy metal toxicity, it does not work with mercury. It is singularly

exceptional in that aspect, and we published this back in 1988.

Could I have the next slide? There is this question: Is mercury

released from dental amalgams? I think this is something that is

absolutely absurd that we would be discussing this today because

it is very simple to measure mercury coming off of a rock, and that

is what we talked about the last time.

In this particular study, it was done at the University of Singapore, and that is the reason I think this is unique. They showed

that this one form of amalgam—and it is high in mercury; it has

got 66 percent mercury instead of 50 percent—that it released it

at 43 micrograms per centimeter squared per day. But what bothVerDate 11-MAY-2000 11:05 Jul 23, 2003 Jkt 000000 PO 00000 Frm 00015 Fmt 6633 Sfmt 6633 D:\DOCS\87704.TXT HGOVREF1 PsN: HGOVREF1
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ered me, that this had to be done at the University of Singapore,

that it wasn’t done at a U.S. university or at the NIH.

We have repeated the study using the same technique that these

people used on dispersal alloy, which is the normal one. While it

is not this high, it is definitely much higher than what the ADA

spokesmen say comes off of an amalgam. If you brush 30 seconds

twice a day with a toothbrush, the level went up over ten-fold. So

brushing amalgams causes a dramatic increase in the amount of

mercury that is released.

Further, the study by NIH on 1,127 American military personnel,

they showed that people with increasing number of amalgams had

the increasing amount of mercury body burden. So we are not getting mercury in our bodies primarily from eating fish or breathing

the air. It is coming primarily from amalgam fillings, in much of

the population at least.

Could I have the next slide? Are amalgams toxic? If you take an

amalgam made outside the mouth and drop it in a mil of water and

you soak it for various periods of time, you take a sample of that,

and if you add the same tests that we have been doing now or were

reported earlier, you get the same effect. Within 1 or 2 hours, that

solution of water will be toxic, and you can’t tell the difference between adding it and adding a solution of mercury to a control

brain. It inhibits the same protein that is primarily inhibited in

Alzheimer’s disease. So I can’t believe that anybody would say

amalgams are not toxic. This is backed up by other data.

Could I have the next slide? This is a report that described amalgam dispersal alloy. It was severely cytotoxic initially when Zinc

released was greatest, but was less toxic when the Zinc came out.

I would point out that Zinc is a trace element in amalgam fillings.

Zinc is something that cells need to live, and why they would tie

this onto Zinc, you know, is kind of unusual to me, why they didn’t

talk about the mercury levels in these studies. We will address that

in the next slide.

At the bottom you can see that another thing supporting the

amalgam removal is it decreases the mercury body burden of mercury, the amount of mercury that is circulating in the blood.

In this study, we are looking again at the effect of mercury on

the tubulin, the same protein that Dr. Lorscheider showed was disrupted. Using our technology, you can see the top line is Zinc. You

have to go to high concentrations of Zinc to see any kind of effect.

The second line is mercury alone. But if you take the two levels

of Zinc and mercury, where we see less than 5 percent and less

than 6 percent, if you put them together, you see over 70 percent

inhibition of the tubulin. That is the synergistic toxicity, and that

is the reason why in that earlier study they said it was most toxic

when Zinc release was greater. The Zinc potentiates the toxicity

synergistically of mercury that is coming out of the same amalgam,

because Zinc alone is not toxic to cells. Cells absolutely need Zinc,

unless you go to high, really high concentrations. You will notice

these concentrations aren’t very high.

Could I have the next slide? This is something that I think that

I can’t imagine why Congress ignores this, but this was reported

in the Journal of American College of Cardiology, and it showed

that children that die with idiopathic dilated cardiomyopathy have

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23,000 times more mercury in their heart tissue than do people

who die of other forms of cardiac arrest.

Most of these people, some of them have died in southern Indiana. One of them was a young man that was in a high school basketball tourney that was coming to UK to play basketball.

How do you account for that much mercury? I would submit that

people in the inner city and people in southern Indiana don’t eat

a lot of shark. So you have to at least ask the question, where did

the mercury come from and why is it building up in these children,

and why specifically these children?

It points out that, while many of us can have amalgam fillings

and live for a long time and not have any problems, there is a subset of the population, and maybe several subsets, that cannot handle exposure to this. That is reason enough to get rid of them.

Could I have the next slide? These are just the conclusions, and

you can read them as well as I can. But what I would point out

is the take-home lesson: One, there is a subset of the population

that appears unable to excrete mercury. This can be due to several

things. It can be a genetic susceptibility. It can be the fact that

they are exposed to other heavy metals that prevent this. It could

be a fact that they may be exposed to antibiotics or pesticides or

something else that prevents them from excreting the mercury

properly.

We don’t have to know exactly what it is. We can investigate and

find out, but it says you can’t say what is safe with regard to mercury, and the thing to do is just to try and decrease all exposures

to this material.

I think that is probably the end of it. Having an appreciation for

the synergism is something I would like to emphasize today.

[The prepared statement of Mr. Haley follows:]

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Mr. BURTON. Thank you, Dr. Haley. We will get back to you with

questions in a little bit.

Dr. Berlin, thank you very much for coming that long way to be

with us, and you are recognized.

Dr. BERLIN. Thanks for calling the hearing. I am not going to

present any primary research data. I will stick to conclusions here,

the environmental medicine view on this problem.

As has been said, mercury vapor is a potent toxin which is released from amalgam fillings and that was accumulated in the

brain of the bearer and also the brain of the fetus. It is important

to stress here that I talk about mercury vapor; actual mercury like

Thimerosal and methyl mercury behave differently in the body.

Also, bivalent mercury, like mercury salt, also behaves differently.

So that is just mercury vapor we are now discussing.

In fact, amalgam is the dominating source of mercury in the

brain of the population. There are populations with high fish-eating

habits which may come up to a number of mercury concentration

in the brain which is close to this, which amalgam is close.

There is a correlation between number of amalgam fillings and

mercury concentration in the central nervous system of the bearer

and also a correlation between mercury concentration in the brain

of the newborn and the mother’s number of amalgam fillings.

The mercury concentration range in the brain of the fetus with

an amalgam-bearing mother is similar to the concentrations that

result in a gross effect in tissue cultures of animal brains, like Dr.

Lorscheider mentioned.

Although a percent of available information is insufficient to

allow risk assessment in terms of prevalence figures, the risk of inhibiting effect of mercury from amalgam on brain development is

obvious. There is a number of animal experiments and tissue studies showing the effect on the nervous system of mercury vapor.

Until proven otherwise, it is necessary to assume that mercury

vapor released from amalgam can cause retardation of brain development. Consequently, amalgam should not be used for dental restoration in women of child-bearing age or in children.

Considering the potent nature of the mercury molecule with

many possible targets in the body, it is likely that mercury can

cause serious side effects in a fraction or a subset of the population

with deviating higher sensitivity to mercury for genetic reasons.

Such people with deviating sensitivity have recently been identified. Physicians and dentists have in the past tended to disregard

or even deny this possibility, resulting in suffering of patients. It

is important that more awareness of this fact develop within the

medical profession and that more attention is given to this possibility in unclear cases of illness.

It will require clinical research, systematic clinical research, on

this problem to elucidate the mechanisms involved and possible diagnostic methods.

Finally, I will say that it is my opinion, and that has been mentioned already, that amalgam is not a suitable material for dental

restorations. It was defendable 20 years back in time; it was true

that most people with amalgam in the mouth don’t have any problems, don’t show any health effects, but in a small fraction of the

population, an estimated or an informed guess results in more than

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1 percent of the population is likely to see side effects like that, and

because we have not really established amalgam populations,

which I think excludes prevalence of effects over 10 percent, 10 to

20 percent.

But, today, as mentioned, there are other alternatives, less toxic

ones, and our learning is much more developed in terms of the effects of mercury vapor on the nervous system. Therefore, today the

only reasonable thing to do is to use less toxic alternatives for dental restoration material.

Mr. BURTON. Thank you, Dr. Berlin. I will get back to you.

Now I didn’t mention this when I introduced you, but you are the

past chairman or Chair of the International Project of Chemical

Safety of the World Health Organization, is that correct?

Dr. BERLIN. No.

Mr. BURTON. No, it is not correct?

Dr. BERLIN. No. Well, I was the chairman of that expert committee which finalized the criteria document for inorganic mercury in

1990, 1991, the two criteria documents, one for inorganic mercury

and one for methyl mercury.

Mr. BURTON. Was that with the World Health Organization?

Dr. BERLIN. Yes, the World Health Organization, through ITCS.

Mr. BURTON. OK.

Dr. BERLIN. I have an activity, they use reviews and assessment

of the chemical substances through the guidance of member nations.

Mr. BURTON. OK.

Dr. BERLIN. To produce this, they called together scientists in the

field from all over the world. The scientists are in the capacity of

knowledge and reputation. Then this group of scientists are left for

a week or two to finalize documents, prepare and document them.

Then this group of scientists, they elect among them a chairman,

and I was selected chairman for these two groups.

Mr. BURTON. And this was in what, 1990?

Dr. BERLIN. And the document I am sure you have here in the

United States.

Mr. BURTON. OK.

Dr. BERLIN. These documents are circulated to all member countries for review and comments before they finally are finalized.

Mr. BURTON. OK, Doctor.

We now come to Dr. Eichmiller, Dr. Frederick C. Eichmiller. He

is the DDS director of the American Dental Association Health

Foundation at the Paffenbarger Research Center, National Bureau

of Standards and Technology in Gaithersburg, MD. Is that a government-subsidized center?

Dr. EICHMILLER. Our center falls under the auspices of the American Dental Association Foundation. We are just located within a

Department of Commerce facility.

Mr. BURTON. Who funds that?

Dr. EICHMILLER. It is funded by money from grants from the National Institute of Health and from a grant from the American Dental Association, and also some money from the Department of Commerce.

Mr. BURTON. So it is primarily funded by the Government of the

United States?

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Dr. EICHMILLER. Yes, correct.

Mr. BURTON. OK, proceed.

Dr. EICHMILLER. Thank you, Mr. Chairman. Members of the subcommittee, my name is Fred Eichmiller. I am a dentist. I am director of the Paffenbarger Research Center, which is one of the world’s

premier dental materials facilities. It is an affiliate of the American

Dental Association Foundation located in Gaithersburg, MD. Scientists at the Paffenbarger Center conduct basic and applied studies to benefit the oral health of the American public.

I am grateful to have the opportunity to discuss not only dental

amalgam, a topic often surrounded by misinformation, but also the

overall subject of dental restorative materials.

I begin by stating that the American Dental Association concurs

with the views of the World Health Organization, the Food and

Drug Administration, the National Institutes of Health, and many

other health organizations, that dental amalgam is a safe and effective treatment for dental decay. The ADA provided the full committee here extensive documentation of that during its hearing on

November 14, 2002.

It is not the intent of the ADA to promote amalgam over any

other safe and effective material dentists use to restore decay. The

association actively conducts and supports research to develop a variety of materials to improve health, oral health. In fact, it was

Paffenbarger Center researchers who invented composite resin fillings, also known as ‘‘white fillings,’’ in the late 1950’s. Today composites are the most commonly used dental filling material in the

United States.

Our goal is to ensure that dentists and their patients have the

best treatment options available for the unique needs of each patient. Because the ADA and our member dentists want patients to

make informed choices, we provide both dentists and patients with

educational materials concerning the advantages and disadvantages of materials used to treat decayed teeth. I would like to provide the subcommittee with copies of these consumer choice brochures, which I have here, and charts for the record.

[The information referred to follows:]

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Dr. EICHMILLER. It is noteworthy that for more than a decade in

our patient information on amalgam, the ADA has indicated the

presence of mercury. To facilitate patient choice, we encourage private and publicly funded dental plans to cover a full range of restorative treatment options, not simply the least-costly option,

which is usually dental amalgam. Unfortunately, many States continue to dramatically underfund their Medicaid and SCHIP dental

programs.

In an effort to draw attention to this problem, this past February

the ADA undertook a massive campaign to ‘‘Give Kids a Smile Program,’’ to emphasize the need to improve access to dental care for

children. This program treated an estimated 1 million children at

approximately 5,000 locations in all 50 States, and we are working

with some of your colleagues in the House and Senate to develop

legislation that will focus on increasing access to oral health care

for needy children.

Health care policy must be based on sound science because our

patients deserve nothing less. Then I would like to set the record

straight about a few of the misconceptions that some hold concerning dental amalgam.

The first is that amalgam is considered toxic: ‘‘Before it is placed

in a patient and after it is removed from a patient, it is toxic in

a patient’s mouth.’’ Dental amalgam is not the same as mercury.

The mercury in the dental amalgam is chemically bound with other

metals, including silver, copper, and tin. These components are

bound into a hardened stable and safe substance.

The only relevant question is whether this substance creates a

measurable negative effect on health, and dental amalgam does

not. Like many substances used in health care, dental amalgam requires proper handling during the manufacture, shipping, storage,

use, and disposal, in accordance with Federal, State, and local regulations.

Second is ‘‘the ADA attempts to conceal that mercury is a principal component of amalgam by calling the fillings ‘silver.’’’ Dentists

and scientists generally refer to this material as ‘‘dental amalgam.’’

Many traditionally referred to these restorations as ‘‘silver fillings’’

because of the color of the material, differentiating them from gold

fillings or the more-recently developed white fillings or composite

resins. It is that simple. We always indicated the presence of mercury in our patient information on amalgam.

Third, ‘‘the ADA has a gag rule that prevents dentists from talking about the dangers of amalgam.’’ The ADA neither has the

power nor the desire to gag anyone. Rather, we support and defend

the right of dentists to discuss freely, appropriately, and accurately

all aspects of dental care with their patients. This information

should be consistent with accepted science and the standard of care

governing clinical practice.

That said, a dentist who recommends removal of a serviceable

filling from a non-allergic patient claiming that doing so will remove toxic substances and cure some non-dental disease is acting

unethically by misleading that patient about therapeutic value of

the proposed treatment.

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These are but a few of the misguided claims made by some concerning amalgam, and I would direct the members to our written

testimony for a more complete discussion.

The ADA’s mission is to protect the rights of dentists and their

patients to choose the most appropriate material that is safe and

effective, based on the individual needs of that patient. We remain

committed to research on improving restorative materials, making

composites stronger, more resistant, longer lasting, usable for a

larger variety of cavity types.

Recently, our laboratories have developed composite resin to

stimulate the natural healing abilities of teeth, rather than just repairing the damage done by decay. To reap the benefits promised

by these and other improvements, however, we must work to incorporate them into the options that dentists and their patients have

to treat oral disease, not eliminate safe and effective choices already providing relief to millions.

Thank you, Mr. Chairman. I would be happy to answer questions.

[The prepared statement of Dr. Eichmiller follows:]

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Mr. BURTON. Dr. Berlin has worked with the World Health Organization, and you were chairman of that committee during the

early nineties on metals and the toxic components of them, right?

Dr. BERLIN. Inorganic mercury was one document, and the other

committee was methyl mercury.

Mr. BURTON. What did the World Health Organization say about

those metals being used in human beings?

Dr. BERLIN. Well, 1990, we said in the document that the information available, when it comes to low doses of exposure, low levels of exposure, wasn’t enough to make an assessment, but we said

also that we didn’t exclude the possibility of adverse effects. We

clearly stated—we didn’t say it was safe. We said that we didn’t

have enough information to make any assessment.

Mr. BURTON. But you were the chairman of that, were you not?

Dr. BERLIN. Yes.

Mr. BURTON. And didn’t you just say a few minutes ago that you

didn’t think amalgams containing mercury were suitable for

human beings?

Dr. BERLIN. I didn’t get your question.

Mr. BURTON. Didn’t you just say in your testimony that mercury

in amalgams was not suitable for human beings?

Dr. BERLIN. That’s right, today, because—yes.

Mr. BURTON. That is fine.

Now, Dr. Eichmiller, how can you say that the World Health Organization says this is safe?

Dr. EICHMILLER. The World Health Organization, in their most

recent statement on dental amalgam, has held that they do not see

any adverse effect from the use of amalgam.

Mr. BURTON. Well, this guy sitting right next to you, a very eminent scientist from Sweden, who headed the panel back in the

early nineties, now says that he doesn’t think that it is safe for humans to use those. How do you respond to that?

Dr. EICHMILLER. That is not the current statement of the World

Health Organization.

Mr. BURTON. So you think he is full of prune juice, right?

Dr. EICHMILLER. Excuse me. This was put forward today, and I

have just seen testimony this morning, but that is not the current

World Health Organization statement, no.

Mr. BURTON. Are you familiar with this thing called the ADA

News?

Dr. EICHMILLER. Yes, I am.

Mr. BURTON. This is your publication. You have an article here

that says, ‘‘ADA’s best management practices offered,’’ and it says

here what you should do with amalgams. It says, ‘‘Do recycle used,

disposable amalgam capsules. Do use chair-side straps to retain

amalgam and recycle the content. Do appropriately disinfect extracted teeth that contain amalgams.’’ And it says, ‘‘Don’t dispose

of extracted teeth that contain amalgam restorations in biohazard

containers, infectious waste containers, red bags, or regular garbage. Don’t flush amalgam waste down the drain or toilet.’’

Why wouldn’t you want to do that?

Dr. EICHMILLER. Those recommendations are primarily based

upon proper handling of waste amalgam both from an environmental standpoint and from the standpoint of infection control.

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Mr. BURTON. OK, but I mean you think there is a hazard or else

you wouldn’t have these recommendations made in your publication, right?

Dr. EICHMILLER. Those are done for the proper handling and recycling of amalgam material.

Mr. BURTON. Right, I know, but there is a reason for that. There

is something that you are concerned about being put into the environment, and that is the mercury in amalgams, is that not correct?

Dr. EICHMILLER. It is correct that we would rather see the mercury, yes, absolutely, we would rather see the mercury recycled and

not put into the environment.

Mr. BURTON. Because you don’t want it in waste water treatment

centers, where they clean that waste water treatment in the process and put it back out into water that goes back out and is consumed by human beings? You wouldn’t want that mercury out

there floating around getting back into human beings when they

ingest that, right?

Dr. EICHMILLER. Waste water treatment centers are subjected to

regulations which restrict——

Mr. BURTON. I know, I know.

Dr. EICHMILLER [continuing]. The amount of mercury they can

emit, and we are cooperating with them in trying to reduce their

mercury burden through these best management practices.

Mr. BURTON. That is why you don’t want to flush this down the

toilet or down the drain?

Dr. EICHMILLER. That is correct.

Mr. BURTON. Now when I had my teeth filled with mercury, with

amalgams, I remember he mixed it up, you know, in one of those

things that mixed it up real quickly, and then he put it in some

kind of an instrument that he scrunched into my tooth. You know,

he shoves it up in there.

I recall very clearly little fragments falling down into my mouth

that he tried to suck out with some kind of a vacuum cleaner, but

all of it didn’t get sucked out. A lot of it went into my body. What

do you think happened to that stuff? It was mercury. You know

part of it was mercury and it wasn’t hard because he was putting

it in. Do you think there was a danger there at all?

Dr. EICHMILLER. Elemental mercury swallowed has a fairly short

half-life and a fairly low absorption, and we have not seen any research to show that scrap amalgam during placement would cause

any adverse effect on health.

Mr. BURTON. Dr. Lorscheider, how do you respond to that?

Mr. LORSCHEIDER. Well, first of all, Dr. Eichmiller, in his initial

statement, the very first point that he raised, that mercury is

bound in amalgam and that this mercury is stable, is patently incorrect.

The American Society of Metallurgy’s Handbook makes a comparison of dental amalgam with another metal that we are all familiar with, stainless steel. The principal metal in amalgam is mercury, 42 to 54 percent, depending upon the manufacturer. The principal metal in stainless steel is iron. Now the American Society of

Metallurgy, notwithstanding the American Dental Association,

classifies this mixture of mercury with other metals, classifies this

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amalgam as a solid emulsion, whereas they classify stainless steel

and the iron within it as a true alloy.

The reason for this is that there is covalently bonding of the metals in stainless steel, but there is no covalent bonding whatsoever

in the metals that are in dental amalgam.

Mr. BURTON. Put that in laymen’s terms, so everybody understands it.

Mr. LORSCHEIDER. OK. What this means is that the mercury that

is put into an amalgam is not chemically bound, as the dentists

would like you to believe, but, in fact, is simply a solid emulsion.

It is a free substance.

The evidence for this, which the American Society of Metallurgy

gives, is that with respect to stainless steel, iron no longer rusts

once it is put into stainless steel, as a component of stainless steel.

In other words, the original physiochemical properties of iron have

changed irreversibly because of this covalent chemical bonding.

Mr. BURTON. Right.

Mr. LORSCHEIDER. But in the case of amalgams, mercury still vaporizes and comes off of amalgams. Now that is the first point that

I wanted to make about what Dr. Eichmiller said.

The second point is with respect to his comments on the stability

of mercury in amalgams. Congressman Watson made reference to

the California State Dental Board’s hearings last fall. This was a

hearing which both I and Dr. Haley were invited to speak at, and

the topic was pregnant women and children are at increased risk

for exposure to mercury from dental amalgam.

Just to cite one paper, the scientific evidence clearly shows that

human fetal liver and kidney and also infant kidney and brain

mercury burdens are directly correlated with their mother’s amalgam load. In other words, a mother that has a lot of amalgam fillings, her newborn invariably, or in the case of some these were

aborted fetuses, her fetal or newborn will contain significantly

more mercury than if she did not have amalgam fillings.

So here you have human clinical evidence done in pathology labs

in medical schools showing that this mercury in amalgam is not

stable, and you also have evidence from the American Society of

Metallurgy classifying dental amalgam as a solid emulsion. There

is no chemical bonding—repeat: no chemical bonding—of mercury

to any of the other metals.

Mr. BURTON. Dr. Haley, I think you testified about this before,

but you said that you dropped amalgams in a glass of water. Can

you, once again, reiterate what happened when that happened?

Mr. HALEY. With these experiments that were done, you would

soak amalgams in water. You take aliquots out and you test them

for toxicity using common enzymology.

Mr. BURTON. And what do you find?

Mr. HALEY. Well, they are toxic. I mean, his comments that they

are not toxic, they fly in the face of stuff that has been published

in the Journal of Dental Research.

I just gave a reference up there where they said solutions in

which amalgams have been soaked were severely cytotoxic. There

was a paper that came out just this year again saying, you know

clamoring, saying they were the first people to show neurotoxicity

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from dental amalgams by soaking amalgams in solution and exposing them to neurons and killing the neurons.

I would like to point out one other thing.

Mr. BURTON. OK.

Mr. HALEY. When he says NIH, FDA, and WHO agrees with the

American Dental Association, nothing could be further from the

truth. That is like saying a committee of Republicans say something that I don’t agree with, and so, therefore, I am wrong.

These committees, if you go back to the committees he is making

reference to, there were committees in the National Institutes of

Dental and Cranial Facial Research and in the FDA and in WHO

that were primarily made up of dentists. I took the time to go back

and look at the credentials of these people to see what mercury toxicologist they had on those committees, what neurologists they had

on those committees, what publications members of that committee

had done, because I couldn’t recognize very many of the names,

none of them, to be honest with you.

What I would say, there is a big difference from having a committee in WHO that is primarily constructed by the dental organization to have a meeting and release a report than have all of the

World Health Organization agree. I would suggest that your committee go and look at the, ‘‘expertise’’ of the people that were on

these committees that he says support them.

So I just think that sometimes it is a ploy to have a committee

that you have set up that will agree with what you want to have

them agree with and then say all of the NIH agrees with you. I

doubt that the American Medical Association would agree that it

is a good idea to have something in your mouth that increases your

mercury body burden by 80 percent, especially in light of the National Academy of Sciences study and the EPA study that says 8

to 10 percent of American women have such high mercury circulating in their blood that their children are at risk of neurological

damage when they are born.

I mean, so common sense would say you get rid of that source,

if you look at the science, I mean published science and refereed

journals, and I really find it objectionable that he would sit here

and say that mercury doesn’t come out of amalgams. I mean I am

a chemist. That is easy to do.

I do know that most dental schools don’t have one instrument to

measure mercury coming off amalgam, and we have five in our department. It comes off. It is simple to measure, and it comes off at

a rate that anybody would say is unacceptable for human health.

I think that people like Dr. Eichmiller is giving dentistry a bad

name. I have a lot of good friends who are dentists who are saying

they are wanting somebody to stand up and say, ‘‘What the hell is

the truth?’’ Yet, you go to the UK dental school and they will tell

you, well, the mercury coming off of dental amalgam isn’t very

much. And they use the weasel terms: ‘‘We estimate’’ or ‘‘It is just

a little bit’’ or ‘‘It is an insignificant amount.’’ Scientists don’t talk

that way. They talk in micrograms per kilogram body weight or

some other measurable unit.

If they want to show—and he has been in charge of a major research unit—he should have published the amount of mercury coming off per centimeter squared of all of the amalgam fillings that

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the FDA and ADA have approved. I would like to know they have

done that, why they haven’t done it if they haven’t, and where in

the hell did they publish, if they did, because this is something that

he should have done a long time ago.

Mr. BURTON. That’s OK. Would you like to respond, Dr.

Eichmiller?

Dr. EICHMILLER. There has been a fairly longstanding debate

about what the proper measurement method should be for mercury

coming off of amalgam. I don’t think that the scientific community

denies that there is mercury vapor that comes off of amalgam. The

debate has been, how much?

Where I think many of the studies that you are referring to have

been done; in fact, have been done quite extensively over the years.

I think if you go back to the work Mackert and Bradts, they have

pretty clearly shown that there is mercury released and it is at a

known but very low level.

Mr. BURTON. Let me ask you, so the ADA does admit that there

is a mercury vapor that comes off of the amalgams? Is that correct?

Dr. EICHMILLER. Would you repeat this?

Mr. BURTON. The ADA, for which you are a spokesman, admits

that there is a mercury vapor that does come off of the amalgams?

Dr. EICHMILLER. Yes, we have never denied that.

Mr. BURTON. Is there anybody that you know of or any scientific

expert that would say that any amount of mercury vapor going into

a person on a constant basis wouldn’t be a risk?

Dr. EICHMILLER. I couldn’t speak to that.

Mr. BURTON. You can’t speak to that?

Dr. EICHMILLER. I wouldn’t know, no.

Mr. BURTON. Well, the reason I asked—I mean, can you cite any

scientist that would say or any doctor that would say that mercury

vapor being put into a person’s mouth on a constant basis would

not be a risk? Just any scientist that you know that would say,

‘‘Mercury vapor in anyone’s mouth on a constant basis would not

be a neurological risk?’’

Dr. EICHMILLER. The debate here is dose. We know that mercury

vapor is released, but what we don’t know is, or what we don’t see

is, that it is released in a sufficient quantity to be a risk.

Mr. BURTON. What is a sufficient quantity?

Dr. EICHMILLER. Right now, most of the data is from industrial

data, looking at vapor levels, and the level has been set at around

50 micrograms per cubic meter for air. However, I think Dr. Berlin

indicated that the World Health Organization I think is looking at

lowering that some, but it is still—we plainly fall well within.

Mr. BURTON. If I have five fillings in my mouth that are amalgams, how much vapor comes off of that?

Dr. EICHMILLER. That I don’t know.

Mr. BURTON. Well, that is the point: You don’t know. People are

chewing and brushing their teeth and being exposed to this vapor

on a regular basis, and the people that you represent don’t know.

Dr. EICHMILLER. Excuse me, but I don’t know off the top of my

head.

Mr. BURTON. I certainly don’t want to beat up on you because I

know that you probably feel like that when you leave this place,

but the fact of the matter is we have got millions and millions of

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people that have these things in their mouth. I was one of them

until my dentist out there very kindly got it out of there.

But the fact is there is a risk factor, and you don’t know how

many micrograms, or whatever, is being emitted from these amalgams and you don’t know how much per body weight is going to

adversely affect people. It seems to me that the ADA, if they are

concerned about humanity and the people that they serve, would

want to double-check that and have scientific research done to

make sure that they are protecting the American public.

Now if they don’t, I think there is a risk factor here because

these hearings over the next year, 2 years, 3 years, however long

I am chairman, however long will they go on, we are going to buildup a body of evidence I think that is going to show that there is

a risk factor. I think the ADA, or any agency or any organization

that continues to deny that there is a risk factor, in view of the

facts that are being built up over this period of time, are going to

leave themselves open to all kinds of potential lawsuits.

It seems to me that the prudent thing to do would be get on with

research with the ADA to make sure that you guys aren’t stepping

on a land mine. Do you see what I am saying? I really, for the sake

of your dentists around the country, I think that if there is any

doubt whatsoever about the veracity of what has been said by these

gentlemen or yourself, then there ought to be a scientific study

done by the organization itself to protect itself against the potential

of litigation down the road.

Yes, sir, Dr. Haley?

Mr. HALEY. I am chairman of the chemistry department that has

a building that is 40 years old, and we have threats to shut down

the water supply to our building because the water going out and

the effluent is too toxic for them, too high to take, and it is much

less than what would be in the saliva of anybody with a single

amalgam filling.

I would point out that chemistry has known for at least 20 to 30

years how to accurately measure mercury coming off of any substance. To say that we don’t know how much mercury will come off

of a amalgam filling is silly. I mean it is preposterous. Anybody,

any chemistry department, if you call them—and I would suggest

you not believe me, but call chemistry departments and say, ‘‘Can

you accurately measure to less than a microgram level per day how

much mercury comes off of a solid, fixed substance?’’ They would

tell you they can.

This data should have been published, should have been done by

the American Dental Association or the FDA or the NIH a long

time ago. This is not rocket science. This is as simple as chemistry

gets to measure mercury coming off of a hard substance such as

an amalgam.

Why this isn’t done, well, it doesn’t baffle me. I think I truly understand that it is not for good reasons. It is something that should

be done, that has been done, and why the ADA can make the claim

that we don’t know what is just a little bit—and his reference to

Dr. Mackert, Dr. Mackert estimated the amount of mercury coming

out of an amalgam filling by using a vapor sniffer or something

measuring it in the mouth, which is one of the most inaccurate

ways of doing it.

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But making amalgams outside the mouth, leaving them untouched, and measuring the mercury that comes off in the air or

in water or any solution you want is very easy to do. It has been

done several times. I think this is something that the American

public should be made aware of. It is not rocket science.

Mr. BURTON. Dr. Lorscheider, do you have any comment on that?

Mr. LORSCHEIDER. Well, I am surprised at Dr. Eichmiller’s comment that, even though he does concede that mercury does come

off of amalgams, first, he claimed that dentistry has always admitted that. I can tell you that before 1985 they did not admit that,

but after 1985, as ours and other papers began to come out in the

literature, they had to concede that mercury does come off of fillings.

Now if he claims that dentistry believes this mercury to be a

very small amount, in the Commission review article that I submitted to you, there is a reference, No. 17, by the World Health Organization. This was a committee chaired by Dr. Lars Friberg. They

published a document in 1991 on inorganic mercury.

On page 36 of this document is a very nice table showing the

sources of all mercury exposure that humans would incur. In that

table, it includes air, water, diet, foodstuffs, and also dental amalgams. And the No. 1 source of mercury exposure to humans as far

back as 1991 is clearly dental amalgams, not mercury in the diet,

not mercury in the air or water.

So, again, I totally disagree with Dr. Eichmiller’s statements.

The research evidence does not support what Dr. Eichmiller claims.

In medicine we can only deal with published adjudicated evidence.

Mr. BURTON. Did you give us a copy of that document for the

record, sir?

Mr. HALEY. I will indicate which reference citation that is in this

review article.

Mr. BURTON. Well, we would like to have—in fact, I will have my

staff make a copy of that, so we can have a copy for our record,

if you would like.

Mr. HALEY. Well, I don’t have the original WHO document with

me, but Dr. Berlin may, in fact, have that document.

Mr. BURTON. OK. Well, Dr. Berlin, do you have that article?

Dr. BERLIN. We are talking about that chart, and, in fact, yes,

first of all, I really have the original document here. But on top of

that, in the report I handed over it is referred to, and we stated

that 3 to 70 micrograms per day is taken up from amalgam in a

toxin with an average number of amalgam fillings.

And later on, it was discovered that some people, those people

who have the habit to chew chewing gums through the day, and

especially those people who use this nicotine chewing gum to stop

smoking, these people, some of them, tended to excrete a very high

amount of mercury when they did this, up to levels——

Mr. BURTON. Again, would you pull the mic closer? We want to

make sure we hear what you say.

Dr. BERLIN. Sorry. They came up to levels which are around that

level of 50 micrograms per liter urine where we see effect in mercury workers. But the range in extreme cases, amalgam can cause

so much mercury excretion that it is up to what we consider the

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limit for industrial populations exposed to mercury. These are all

references you can find——

Mr. BURTON. In your report?

Dr. BERLIN. Yes.

Mr. BURTON. Well, we will put that in the record. We will put

that report in the record.

[The information referred to follows:]

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Mr. BURTON. After we have our hearings over the period of the

next 6 months to a year, Representative Watson and myself, there

will be a report issued that will go into all these details and

itemize each one of these reports and what they were.

Ms. Watson? Excuse me 1 second. I will be back in about 5 minutes.

Ms. WATSON. Thank you so much, Mr. Chairman.

Let me apologize to panel one for my absence for a few minutes.

We have a highly secret briefing on the floor of Congress.

This is a question to Dr. Eichmiller and maybe you have responded to it: The ADA is telling its members that amalgam fillings are hazardous material, is that true?

Dr. EICHMILLER. The ADA is educating us members in the proper

handling of the material as a hazardous waste, yes, that is true.

Ms. WATSON. Yet, the ADA resists telling the patients this salient fact. Would you agree with me today that dentists should tell

a patient before putting in a mercury filling, and they should tell

them that the filling is a hazardous material when removed?

Would you agree to that?

Dr. EICHMILLER. I would agree that a practitioner should talk

about all the risks and benefits of any filling material that is being

placed, but to discuss it as a hazardous material from a waste disposal aspect, I am not sure that would be useful information for

that patient.

Ms. WATSON. Why would you not tell them that?

Dr. EICHMILLER. It really doesn’t relate to the therapeutic or the

health effect of that material.

Ms. WATSON. As I understand from the research that has been

done to this point, even a baby’s tooth, if it has been filled, can give

off the vapors. An adult, should they not know that if they had that

tooth pulled or additional work done on that tooth, that there could

be very hazardous vapors escaping? I want you to tell me, very directly, why you wouldn’t want to tell patients the same things you

tell the dentists. If there is even a trace element that could be toxic

internally, why should you keep the patient in the dark but tell the

dentist?

Dr. EICHMILLER. Well, we certainly don’t want to keep the patient in the dark on anything. I think that is why we encourage

dentists to talk about the risks and benefits, and if that dentist

feels that the mercury release from that alloy is a risk, then he

should discuss that with the patient. We certainly would not discourage that.

Ms. WATSON. Do you promote it?

Dr. EICHMILLER. We do promote discussion of all the risks and

benefits of all the filling materials. The patients and dentists openly discuss this.

Ms. WATSON. Well, why for so long did you have a gag order on

dentists telling the patient about the ‘‘silver’’ filling?

Dr. EICHMILLER. The Code of Ethics was there to protect patients. What it does is really restricts a dentist from being able to

offer any type of treatment, whether it is any type of filling, as a

cure for a disease when there is not good scientific evidence that

is true or when it falls outside their expertise.

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Ms. WATSON. Dr. Eichmiller, would you agree that mercury is a

neurotoxic?

Dr. EICHMILLER. Yes, in some forms mercury is a neurotoxin.

Ms. WATSON. Yes or no, would you agree?

Dr. EICHMILLER. In some forms it is a neurotoxin, yes.

Ms. WATSON. Would you agree that in the filling of a child or an

adult that they have within that filling what is highly toxic, and

would you agree that calling it ‘‘silver’’ is very deceptive?

Dr. EICHMILLER. I don’t think that we have been deceptive

intentionally——

Ms. WATSON. You have been calling a mercury filling, 50 percent

mercury, you have been calling that silver, have you not? Yes or

no?

Dr. EICHMILLER. We have called them silver fillings, but we have

also called them amalgam fillings.

Ms. WATSON. OK.

Dr. EICHMILLER. All of our patients——

Ms. WATSON. Have you explained what an amalgam filling contains?

Dr. EICHMILLER. All of our patient education information has explained the composition of an amalgam filling——

Ms. WATSON. When?

Dr. EICHMILLER [continuing]. And mercury is listed in there as

a composition——

Ms. WATSON. When?

Dr. EICHMILLER. Over the last 10 years.

Ms. WATSON. Is it all the time? You know, I am astounded that

people in a medical profession put up an argument. And do you

know what I have been told? And I have got a letter right here.

Do you want to pull that letter from the National Dental Association?

Their bottom line is that, if patients knew that they had a choice,

if patients knew that amalgam contained as much as 50 percent

mercury, that it would reduce the assessibility to dental health

care. So what they are saying to me, the bottom line is assessibility

rather than reducing the risk to health, and particularly for pregnant women and particularly for little children.

I still can’t reconcile it in my mind why you, medically prepared,

dentally prepared, providers wouldn’t see any form of mercury in

the body as a risk. Right now they are telling us on the West Coast

that we shouldn’t eat a lot of fish because of the mercury content,

but, still, you are going to put these amalgams in people’s mouths

and not want to tell them that you are deceiving them. You know,

people without a lot of education think silver is silver, and it really

isn’t.

For the life of me, I cannot understand that. Now I have worked

very, very hard in California, and I will continue to work hard in

Washington, DC, because I don’t think poor people need to be deluded, need to be deceived. I am going to do everything that I can—

I want you to take this back to the ADA and anyone here from the

NDA—I am going to do everything I can to be open and honest,

give people a choice, and rid their bodies of those substances that

we know can be harmful.

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If we are going to take it out of a thermometer, why would you

even want to risk even a trace element of putting it in someone’s

mouth? Can you explain that to me?

Dr. EICHMILLER. In decisions on materials, we really have to use

the entire body of the best available evidence. I think that is what

the major health organizations have done, is to review the entire

body of evidence related to the use of amalgam. That is how they

came to their conclusions, was after weighing the entire body.

Now this is not a process that ends. It is a process that is ongoing. I know the FDA and HHS are currently pulling a panel together to review again the most recent evidence.

We at the ADA, with our Council on Scientific Affairs, do much

the same thing. We will continue to assess the new evidence, and

as new evidence is published and new theories come forward, we

will certainly take those into account and we will review those.

Ms. WATSON. OK, that is your explanation, but I see a number

of mercury-free dentists in the room right now, and that number

is growing dramatically. I just want to ask you, how long do you

think the ADA can continue to advocate for mercury when its

membership base is rapidly abandoning mercury?

I just saw that in your ADA News that you talked about the

tooth fairy and you talked about handling toxic amalgam waste,

and then you talked about contact amalgam, and then you say, if

we put a baby’s tooth underneath the pillow, is that contact hazardous? Well, it is that kind of ridiculous play that really bothers

me in the health delivery community, and your responses are really

bothering me because I don’t think there is anyone in the medical

profession or dental profession that will disagree that mercury is

toxic. Would you disagree?

Dr. EICHMILLER. As I said, I think in some forms we all know

that mercury is toxic and in some doses, but it is the form and the

dose of mercury that make it a poison.

Ms. WATSON. OK. And I just am completely amazed because I

know what is going on here. You are looking at the bottom line.

My dentist told me that, and then he stuck something in my mouth

and I couldn’t respond. It is because the amalgam is cheaper. So

why disturb a good thing? I was appalled, as I am appalled at your

responses.

Thank you, Mr. Chairman.

Mr. BURTON. Well, I think we will excuse this panel. But, as we

excuse you, let me just say that, as we complete our report, one of

the things that we have been able to do on my full committee, and

hopefully as a subcommittee chairman, is we have been able to contact news organizations that are interested in the subject matter

that we discuss. I just want the panel to know, especially Dr.

Eichmiller, that when we get enough data that we think proves the

case that we believe to be the case, we are going to go to every single one of those news organizations and try to make sure that they

get all the facts, so that they can consider doing a case on ‘‘20/20,’’

‘‘60 Minutes,’’ or something else.

That is something that we always do, and I think that the ADA

ought to know that this isn’t going to go away. I mean, you can tell

she is committed, and I am, too, and we will continue to push forVerDate 11-MAY-2000 11:05 Jul 23, 2003 Jkt 000000 PO 00000 Frm 00117 Fmt 6633 Sfmt 6633 D:\DOCS\87704.TXT HGOVREF1 PsN: HGOVREF1
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ward until we get mercury out of everybody’s mouth, and it will

happen; you can bank on it.

With that, thank you very much for this time.

[Applause.]

Mr. BURTON. On our next panel, we have one of our colleagues,

I understand, with us, a distinguished Member of Congress, Mike

Michaud, who represents the second district of Maine, so far north

that it never quits snowing. [Laughter.]

We also have Dr. Chester Yokoyama, who is a dentist and a

member of the Dental Board of California. We have Sandra Duffy,

esquire, founding member of Consumers for Dental Choice Northwest from Lake Oswego, OR, and Mr. Emmitt Carlton, immediate

past president of the Virginia Chapter of the National Association

for the Advancement of Colored People [NAACP], of Alexandria,

VA.

Would you all come forward, please, and take your place at the

table? Would you all come forward and rise?

First of all, I want to apologize for the length of the hearing and

the vote that we took on the floor. I didn’t expect that to happen,

so I apologize for you having to wait so long.

[Witnesses sworn.]

Mr. BURTON. Be seated.

Representative, Congressman, thanks for being so patient. Doggone it, usually, we don’t make our colleagues wait that long. So

you have my humble apology. You can proceed.

STATEMENTS OF HON. MIKE MICHAUD, A REPRESENTATIVE

IN CONGRESS FROM THE STATE OF MAINE; CHESTER

YOKOYAMA, D.D.S., MEMBER, DENTAL BOARD OF CALIFORNIA; SANDRA DUFFY, ESQUIRE, FOUNDING MEMBER, CONSUMERS FOR DENTAL CHOICE NORTHWEST; AND EMMITT

CARLTON, IMMEDIATE PAST PRESIDENT, ALEXANDRIA, VA

CHAPTER, NATIONAL ASSOCIATION FOR THE ADVANCEMENT OF COLORED PEOPLE

Mr. MICHAUD. Thank you, Mr. Chairman. You don’t need to

apologize. Actually, I enjoyed listening to the last panel, having

dealt with this issue in the State of Maine over the last 4 years.

Actually, we did get some snow last week in the northern part

of my district, not much, but we did get some.

I do want to thank you for inviting me here today to talk to your

subcommittee. Mr. Chairman, it is a great honor and a privilege.

I know you have led the way in addressing the health risks of mercury in health care and trying to get our Federal agencies to recognize the breadth of this problem, and I know the ranking member,

Chairwoman Watson, as a State Senator, you wrote the first law

in the country addressing health risks in mercury fillings, a pioneer statute for subsequent bills and laws around the country.

Despite the strenuous efforts both of you have made, as I understand, major roadblocks have been erected. Thus, Federal agencies

have not yet provided the warnings that science demonstrates they

should. California regulators, despite repeated efforts, have still not

implemented the law that you passed when you were in the legislature.

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Perhaps, then, our experience in Maine to get some consumer

disclosure can be of some help. I might add that it has been a longgoing effort. The original law was just to ask for information, and

the Dental Association came full force and opposed just advising

consumers of mercury amalgams.

After several years, under the leadership of Senator John R.

Martin, the last time around, the legislature finally passed my bill

to require that information be distributed about mercury dental

fillings. After another year of intense follow-through and passage

of a second bill, we are able, actually, to implement it.

Thus, Maine was first in the Nation to have a brochure to tell

people that they had better think twice before agreeing to have

mercury fillings implanted in their children’s teeth. The need for

action in Maine was apparent. Mercury fillings were promoted as

silver, even though they have almost twice as much mercury as silver. I wanted to stop this marketplace deception and, if you will,

call a spade a spade. Thus, my bill calls for fillings to be labeled,

‘‘mercury amalgams,’’ and we insisted that both posters and cover

of the brochure say exactly that.

In coordination with the Atlantic Province, New England has a

zero-mercury tolerance campaign. A major source of mercury is

from the dental office. The report entitled, ‘‘Dentist the Menace,’’

says dental offices are the No. 1 source of mercury in the waste

water. I have seen no evidence from the other side to dispute that.

In my region we had a compelling need to reduce the use of mercury in dental offices for environmental reasons alone. Your experience in California, Congresswoman Watson, was that the Dental

Board blocked enforcement of the law, and I am glad to see Dr.

Chet Yokoyama from Los Angeles, the Dental Board member from

California who is trying, I know, his hardest to get the information

so that consumers will know what is going on.

In Maine, to ensure that the legislation was implemented, we

gave the authority to write the poster and the brochure to the Bureau of Health, not to the Dental Board, and to impose a strict

timeframe when that was to be done. Also, the director of health

was also required to report back to the legislature in the following

session with proposed rules which we could then adopt or amend.

The first draft of the Bureau of Health fell short from what the

law actually required, but after a hearing, and again with intense

involvements of consumer activists, the Maine Toxic Action Coalition and individual Maine dentists and physicians, we persuaded

the bureau to write a stronger disclosure statement. Passage of this

statement was harder than we expected because the Maine Dental

Association vehemently opposed it, and we had to work very hard

to make sure to get this passed. Actually, I do have a copy of it,

and you can get it on the Internet as well.

I think dentistry is divided over whether to continue using mercury fillings. The number of mercury-free dentists is growing. Dentists I have talked to realize that there eventually will be an end

to mercury in dentistry in the near, hopefully, future. It could be

for different reasons, health reasons. It could be for consumer protection reasons. It could be for environmental reasons or it could

be for all three.

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Although I have had my differences with the Dental Association

on this issue, I am still supportive of other areas as far as reimbursement rates for dentists. I think, when you look at Maine’s law

and what had happened, and listening to the testimony earlier,

even the very fact, let alone banning mercury fillings, just the very

fact that we were just trying to give the consumers advice on what

potentially was being put in their mouths, they fought tooth and

nail against that effort.

Hence, that is why when I submitted the bill in the second session, we changed the title to an environmental title; hence, went

to the environmental committee. We had a very intense several

work sessions on the bill. I will be glad to provide the committee

with the documents that were presented at that time, if the committee so chooses.

So I want to thank you once again for inviting me here to say

a few words about Maine’s law and want to commend both the

chairman and the ranking member for your strong position in this

area. I really appreciate it. Thank you.

[The prepared statement of Hon. Mike Michaud follows:]

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Mr. BURTON. Well, we appreciate your efforts. It is tough in the

State legislature or in the Congress to get things done, and you are

to be commended for taking that ball/bat all the way through. We

appreciate that. I hope that you will join with Congresswoman

Watson and myself to win this battle here as well, and we do appreciate it very much. Thank you for waiting so long as well.

Mr. MICHAUD. Yes, thank you.

Mr. BURTON. Dr. Yokoyama.

Dr. YOKOYAMA. Yes, thank you very much. I will just say, to the

Honorable Mike Michaud, that California is looking at the brochure

that they produced in Maine as a possible template for moving forward with a consumer-friendly fact sheet.

With that, I will thank you very much for allowing me to speak

today and inviting me. I will say that, although I am a member of

the Dental Board of California, I am not speaking on behalf of the

board, nor am I authorized to speak on behalf of the board. My

comments reflect my personal opinions. I am a mercury-free dentist

practicing in the State of California.

I have been asked to comment on the subject of informed choices

as it relates to dental fillings, and specifically mercury fillings. To

do so, I would like to focus on the struggle, California’s struggle to

implement the California State Watson bill. This bill, as has been

said here, that was passed in 1992, sponsored by the then-State

Senator Diane Watson, recognized the misconception that silver

fillings are not primarily silver, but mercury.

First of all, most people of that time, and many people even

today, do not know that mercury is the main and majority ingredient in their filling material. Second, it was widely believed by dentists that there is no way that the mercury can be released because

it was mixed together to form a solid metal. Both of these concepts

are still around today, and neither add but are contrary to informed choices.

My first point: There is still today major misconceptions on the

part of consumers and dentists alike concerning mercury in fillings.

In 1992, the Watson bill became law. It called for the California

Dental Board to make a fact sheet on the risks and efficacies of

dental materials. The emphasis was on educating the dentists so

they could educate their patients.

Again, the main reason was to shed light on the misunderstood

issue of mercury in fillings. This would make for better consumer

choices. Sadly, little progress was made in 7 years, and I jump to

1999, when the Consumers for Dental Choice and the Center for

Public Interest Law petitioned the California Dental Board to write

the fact sheet as called for in the Watson law.

The board contracted a behavioral scientist that contracted a

dental materials professor to write the dental materials fact sheet.

This dental materials expert appears to have worked alone. No

toxicologists were asked to give input. The biography shows a distinct lack of available scientific articles on toxicology, on the toxicity of mercury, and the associated health risks.

Remember that the Watson bill’s intent and the needs of the people of the State of California were to clarify the mercury misconceptions. So point two: The primary intent of the fact sheet explained or the explanation of health risks from mercury in dental

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amalgam was not well-inspected and not well-documented, in my

opinion.

In 2000, a new law by State Senator Liz Figueroa created a new

board and required that dentists give a fact sheet to their patients.

Again, this was an attempt to inform consumers about health risks

of dental materials, and specifically of mercury.

A public informational hearing was convened to explore the question: What peer-reviewed scientific evidence exists that suggests

health risks for pregnant women, children, and diabetics from mercury from dental amalgam? Now the reason why that question was

posed like this was that the existing fact sheet in the State of California proclaimed that there was, ‘‘No research evidence that suggests pregnant women, diabetics, and children are at increased

health risk from dental amalgam fillings in their mouth.’’

In my opinion, this statement is incorrect, and the implied conclusion that pregnant women and children are without risk is also

false. It was proven at the informational hearing that was convened that there was research evidence that suggests increased

health risk and health risks in general.

What is also clear is that there exists a strong, scientific controversy. These applied and assumed conclusions from reading the

existing fact sheet in the State of California, in my opinion, are

misinformation and should be corrected.

So point three: There has been a long struggle to implement the

Watson bill in the State of California. In my opinion, this has not

allowed full disclosure or informed choice. In my opinion, there

should be an advisory issued, since the safety or harm of mercury

fillings is not yet scientifically conclusive.

So the Dental Board of California should advise parents and

pregnant women that, as a precaution, children and pregnant

women should not be given amalgam fillings. This reflects the precautionary principle which requires action once the possibility of

harm exists.

So my fourth point: In my opinion, if—and I quote the Dental

Materials Fact Sheet—‘‘There exists a diversity of various scientific

opinions regarding the safety of mercury dental amalgams,’’ and

that, ‘‘these opinions are not scientifically conclusive,’’ then, in my

opinion, advisories should be made and cautions given.

So on the day that I was preparing this testimony I found in the

Los Angeles Times an article entitled, ‘‘Warnings on Canned Tuna

Urged.’’ The subtitle was, ‘‘Advocates question why public health

advisories on mercury fail to give specific advice about the most

frequently eaten seafood in the country.’’

In all industries, including medicine, there is an acute awareness

of dangers of mercury. Mercury is no longer used in medicine. Yet,

we continue to insist that mercury amalgams stored in the mouth

presents no health risk. Pregnant women are advised that mercury

fillings are safe. Yet, dental personnel are warned not to touch the

mixed amalgam with ungloved hands. Skin contact exposes the

dental assistant to mercury, which is a substance known to the

State of California to cause birth defects and reproductive harm.

I respectfully submit this testimony and thank you very much for

the opportunity.

[The prepared statement of Dr. Yokoyama follows:]

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Mr. BURTON. Thank you, Dr. Yokoyama. I think you make a very

salient point. You can’t touch it with your hands, but they will sure

put it into your gums.

Ms. Duffy.

Ms. DUFFY. Chairman Burton and Ranking Member Watson, I

am Sandy Duffy, and my day job is as a lawyer from Multnomah

County, OR. That is the county where Portland is located.

I became involved in the mercury-free dental cause when my 48-

year-old husband’s prostate cancer treatment failed and he was

sent home to prepare for the inevitable. With a 7-year-old son, it

was not an answer that I was willing to accept.

In searching for help for my husband, I learned that mercury

suppresses the immune system and that the primary source of

mercury in our bodies comes from dental amalgams. I was astounded. I knew mercury to be a serious toxin and could not believe that the Federal Government hadn’t done something about a

toxic product found in 80 percent of American mouths. How could

this be?

I now know that my lack of knowledge was not unique, that 60

percent of Americans are unaware of the fact that there is even a

controversy over the safety of mercury amalgams. How has dentistry hidden this information? My written materials contain a

comprehensive list, and I am going to mention just three of them.

They have accomplished this by: one, using the term ‘‘silver fillings’’ and hiding the fact that amalgams are 50 percent elemental

mercury; two, by adoption of ethical rules by the dental trade associations and the dental regulatory boards which deem it unethical

and fraudulent for dentists to tell patients that removal of mercury

amalgam dental fillings removes a toxin from the body, and, three,

by using dental regulatory boards to prosecute mercury-free dentists for advertising mercury-free dentistry and for violating these

ethical rules by telling patients about the mercury toxicity.

These uses of ethical rules are essentially gag orders, and they

have been particularly powerful and effective tools in intimidating

mercury-free dentists from informing their patients about the existence of mercury in dental fillings and the risks of such fillings. The

ADA led the way. They have an ethical rule, Rule 5(a), which

states, ‘‘Removal of amalgam for the alleged purpose of removing

toxic substances from the body, when performed solely at the recommendation or suggestion of the dentist, is improper and unethical.’’

While the ADA claims that it does not tell dentists not to talk

about amalgams, this rule clearly tells the dentists not to speak

about a specific topic, the topic of removal of amalgams from the

human mouth. Mercury-free dentists are concerned that any speech

critical of amalgam can be construed by a vigilant dental board as

advocating removal of amalgam.

The Oregon Board of Dentistry adopted an even more onerous

policy, which provided that it is a fraud for dentists to advocate to

a patient the removal of amalgams. In Oregon, this law is the basis

for revocation of a dentist’s license.

Last year I was able to enlist the help of the ACLU to challenge

this policy with the Board of Dentistry, and the ACLU convinced

the attorney general of Oregon to recommend to the board that

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they rescind its policy because it was unconstitutional abridgment

of free speech. On March 8, 2002, the board did rescind that policy.

Last week I asked my mercury-free dentist what the rescission

of this policy personally meant to him. He asserted that it took

away a very effective gag order. He now feels free to advise his patients about the hazards of mercury in dental fillings, and he tells

them about safe alternatives. He did not feel he could speak this

freely before the rescission of the policy.

In May of last year, I flew to Des Moines, IA to testify before a

legislative committee reviewing administrative rules, which was

considering a similar Board of Dental Examiners rule. The legislative committee requested an opinion on the Constitutionality of the

rules from the attorney general and, after intervention by the Iowa

ACLU, the attorney general finally did issue an opinion, and it concluded, ‘‘Dentists do have a free speech right to voice a personal

opinion. We advise the board to reassess the continued viability of

the rule.’’ The Iowa Board of Dental Examiners has scheduled a

meeting for June 18, 2003 to rescind that Iowa rule.

The Arizona legislature took the unprecedented step of sending

a letter of reprimand to its dental board for its extensive and expensive prosecution of a mercury-free dentist simply for being mercury-free.

I would like to make just a comment off my notes here about Dr.

Eichmiller’s comments about this gag order. He said that the rationale for the rule was to prevent dentists from promising health

cures by removing amalgam. That is not what that ethical rule

says.

We agree that dentists can’t promise cures, just like an orthopedic surgeon can’t promise to cure back pain if he gives them surgery. That is a distinction.

The experiences in Oregon, IA, and Arizona show that the mercury-using majority of dentists have exerted regulatory power to

control the free-speech rights of mercury-free dentists, and they

have interfered with the relationships between the patients and

their dentists in order to protect the majority’s unfettered use of

mercury as a restorative material. The intended effect of this gag

rule is anticompetitive. Mercury-using dentists are limiting the

practice of mercury-free dentists who now account for 21 to 28 percent of practicing dentists. And here is a question that needs to be

asked: On the issue of mercury amalgams, are Federal agencies

protecting the health of citizens or the economic interests of mercury-using dentists?

Due to the time limits today, I will limit my remarks to just the

National Institute of Dental and Cranial Facial Research. In the

1940’s, the ADA successfully lobbied to get a separate division of

the National Institute of Health for research related to dentistry.

The NIDCR has been safely in the hands of mercury-using dentists

ever since. They decide who gets taxpayer research dollars, what

topics are researched, and what results are published.

While the ADA repeatedly claims that there are no credible studies linking mercury amalgam to specific diseases, the NIDCR research data base reveals that it has funded 543 studies related to

amalgams since 1972. I have reviewed 222 studies in the data

base. That represents the last 10 years’ worth. These 222 studies,

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paid for with taxpayer dollars, only 1 of those could I find that has

ever been published, 1 out of 222.

Is the NIDCR sitting on a mountain of evidence that mercury

amalgams are safe and effective? I think not. It would have been

published in a timely manner and they would have been highly

publicized by the ADA.

I urge this committee to request copies of all 543 of these research studies, not the abstracts, the studies that were actually

done by the scientists and provide mercury-free advocates copies of

these.

Finally, I would like to show you a prime example of the misleading information produced by the ADA for use by practicing dentists. Off to my right is the display of a brochure that mercuryusing dentists buy from the ADA 100 or 500 at a time. On the front

you can see that it says, ‘‘Is It Safe: Silver Fillings,’’ and it continually throughout the brochure refers to silver fillings.

It posits questions that a patient might ask, and then it gives the

answers which are the ADA answers. In the materials that I have

provided to the committee I have a rebuttal to each one of those

answers, and I also have their questions as well, and I have cites

to each of the references that I used to do that.

In conclusion, the scope of this committee includes human rights.

I submit that the continued use of mercury amalgam with the complicity of Federal agencies is a violation of the Nuremburg Code

which prohibited human experimentation without informed consent. The code has been determined by the National Institute of

Health to be applicable to its actions, and that includes the

NIDCR. It is disturbingly appropriate to apply the code to the

amalgam issue.

I urge you to continue to investigate this important health issue.

Thank you.

[The prepared statement of Ms. Duffy follows:]

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Mr. BURTON. Thank you very much. Ms. Duffy, those studies

that you referred you, that you could only see one, you only got

one?

Ms. DUFFY. There was only one that had actually been published

in Pub. Med.

Mr. BURTON. Are those pretty voluminous, those studies?

Ms. DUFFY. Actually, I can get you a list of all of those studies,

and I actually have provided those to your assistants at this time.

Mr. BURTON. I understand, but what I was wondering is, you

said you thought we should get all those several hundred studies,

and I just wondered how voluminous they are, because I don’t

know that I have enough staff to go through all those. [Laughter.]

Ms. DUFFY. But, you know what, if you got those, we would find

some staff out here to go through them.

Mr. BURTON. All right, you tell us what studies we should be

asking and we will try to get the committee and the full committee

to subpoena those, ask for them first, subpoena them if we don’t

get them, and if we have to, we will figure out another way to get

them, but we will figure out a way to get them.

Ms. DUFFY. I will be very happy to do that, and that will happen

next week.

Mr. BURTON. OK.

Ms. WATSON. May I just add, too——

Mr. BURTON. Yes.

Ms. WATSON [continuing]. In listening to Dr. Eichmiller, he said

there is some vagueness about this scientific research. What I

would like to do, once we receive those, is go through and publish

that material, so that there will be empirical evidence to support

the claim. Apparently, you are telling us only one has been made

public. I would like to see what was in those others and why they

weren’t made public. So, if the Chair agrees, I think once we go

through and look very closely at the data there, then we should

make it public.

Mr. BURTON. Well, we definitely will do that——

Ms. WATSON. Yes.

Mr. BURTON [continuing]. Representative Watson, and we will

have a report that will go into all this before this is over.

Ms. WATSON. And let’s do a big press conference.

Mr. BURTON. We will probably do that, too.

Ms. WATSON. Yes.

Ms. DUFFY. OK, this will be very important for the FDA, which

is planning to have another dental panel before they classify mercury amalgams and have a rule on that. So this body of evidence

would obviously be relevant.

Mr. BURTON. Well, we will try to make sure that the FDA and

HHS and CDC and all of them hear from us, I promise you.

Ms. DUFFY. Thank you.

Mr. BURTON. They know we are here. [Laughter.]

Ms. DUFFY. Thank you.

Mr. BURTON. I promise you they know we are here.

Mr. Carlton.

Mr. CARLTON. Mr. Chairman, thank you. I am Emmitt Carlton.

I am immediate past president of the Virginia NAACP. The

NAACP has endorsed the Watson/Burton bill and similar State

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bills. I am honored to appear in front of the lead sponsors of this

bill, Chairman Burton and Ranking Member Watson. The NAACP

salutes you for your national leadership. I am especially happy to

be here, Mr. Chairman, since I am from Indianapolis.

We learned a lot about the so-called ‘‘silver’’ dental fillings. They

are about 50 percent mercury. We have learned that mercury is

toxic, that it is a neurotoxin. Because mercury is neurotoxic, the

development of the brains of children are particularly at risk as are

pregnant women and children; that mercury in health care is being

banned or phased out of almost all health care uses; that mercury

fillings are toxic material going into the mouth and a hazardous

waste coming out; that toxic mercury vapors emanate from the fillings; that the FDA has never approved mercury dental fillings as

being safe, even though you would think so from looking at the

ADA’s brochure they passed out.

We have learned that the Government of Canada recommends

that children and pregnant women not receive mercury fillings.

One would think that we, as Americans, given Canada’s decision,

would have a choice not to get mercury fillings, but, in general,

Medicaid requires dentists to put mercury back in children’s bad

teeth, and so does the Bureau of Indian Affairs. Poor children still

get mercury fillings or they get no fillings at all.

Is high cost the reason why our children do not have a choice in

dental fillings? Probably not. In ongoing price surveys of 300 cities

you can find on a great Web site called bracesinfo.com, a pattern

is clear. For permanent teeth, one-surface fillings, mercury fillings

cost a little more than resin fillings, and generally children only

need one surface filling. For baby teeth, the cost of mercury fillings

is a little less than resin, but we must ask, why do we even allow

mercury to go into baby’s teeth?

One possible reason for continuing to use mercury fillings may

be dental convenience because the dentist can do the procedure for

mercury fillings a little faster, 2 minutes faster, we learned in some

State testimony.

Another possible reason is inertia. Mercury fillings have been the

most common filling for a long time. Or there may be another reason, callous indifference to the poor children of America.

As we have learned from Ranking Member Watson, there is a lot

of action going on at the State level in the Medicaid policy: mercury

fillings or no fillings. State Representative Karen Johnson, Republican of Arizona, Assemblyman Jerome Horton, Democrat of California, have both introduced bills to stop their States from dictating that mercury goes into children’s mouths.

Obviously, we are on the same panel with former Maine Senate

president Mike Michaud. He talked about his work. Obviously, he

is now in Congress. It is also a pleasure to be here on this panel

with Dr. Yokoyama and Ms. Duffy.

I am pleased to inform the subcommittee that these consumer

choice changes are favored by many in organized dentistry. The

National Dental Association, the largest association of AfricanAmerican dentists, has testified in favor of changing Medi-Cal to

allow choices for the consumer. The California Dental Association,

the largest State affiliate of the ADA, testified for the Horton bill

in California. The International Association of Oral Medicine and

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Toxicology, the American Academy of Biological Dentistry, both National Associations of Mercury-Free Dentists have been working as

well on the issue.

We commend the dental groups and individual dentists who

want low-income consumers to have choices the rest of us have. So

we want to work with those who will increase the number of dentists that serve the poor. We want to work to change the Medicaid

system, the third-party payment system, at the bottom of the economic realm, to spur changes in the third-party payment system in

general, including private insurance and public employee insurance. The NAACP resolution endorses changing the third-party

payment system on fillings so consumers have a choice and so all

dentists may participate.

Finally, we want to create a system that is more fair to dentists.

The time for transition out of mercury fillings is now. We don’t

want to punish or straitjacket our dentists. We want a payment

mechanism so that dentists can fully participate in the transition

to mercury alternatives.

In summary, don’t leave poor children behind. We don’t want a

two-tiered system that leaves mercury fillings on Indian reservations, in the inner cities, in the barrios and Appalachia. All of

America’s children deserve what Canada’s children and Sweden’s

children, and increasingly America’s middle-class children, get: a

mercury-free childhood. It is time to offer alternatives to mercury

fillings for all Americans as the first step toward ending their use

once and for all.

Thank you, Mr. Chairman.

[The prepared statement of Mr. Carlton follows:]

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Mr. BURTON. Thank you, Mr. Carlton. One of the things you said,

Mr. Carlton, that stuck with me was that you said the mercury fillings are less expensive?

Mr. CARLTON. We have seen on this Web site in some cases they

are less; in some cases they are more. We were surprised by that.

We thought that in baby teeth, basically, less; with adult teeth, basically, there is a price difference.

So the only thing we were trying to illustrate is it is not simply

a price thing, and maybe it takes longer to fill them, and there are

multiple reasons why there is some opposition.

Mr. BURTON. But, Dr. Yokoyama, you are a dentist.

Dr. YOKOYAMA. Yes.

Mr. BURTON. If the cost is very similar to, say, composite fillings

or something else, why would you use mercury?

Dr. YOKOYAMA. That is a good question.

Mr. BURTON. I mean, why is the ADA fighting so hard, if it is

not an economic issue?

Dr. YOKOYAMA. It is twofold really. I think it is an economic

issue. It is also a convenience——

Mr. BURTON. Well, how is it an economic issue? Can you tell us?

Dr. YOKOYAMA. Well, I am unfamiliar with the information that

was just given about the cost. I am not familiar with the exact cost

compared throughout the United States, but I can say that economically it is common knowledge in dentistry that a composite

filling will cost more than a mercury filling because it is more difficult to do.

The degree of difficulty really comes from perhaps familiarization

with the materials. It appears that, as you familiarize yourself

more with the composite materials, it becomes less of a factor. So

I will say that familiarization and ease of placement might make

an amalgam less expensive at this time, but as we transition, the

amount of added difficulty might become much less.

Mr. BURTON. What I can’t understand—and I am not going to

ask a lot of questions of this panel because I think you have acquitted yourself very well in your statements, but what I can’t understand, if it is not a major economic factor, then why in the world

is the ADA fighting this so much? I mean, they know that mercury

is toxic. They know there is a risk. They know that they are probably looking down the barrel of a gun at some point. Why in the

world—the logic alludes me. Can you explain that to me?

Dr. YOKOYAMA. That is a rhetorical question. I do not know myself.

Mr. BURTON. Did that guy leave that represents them? He did?

The heat was on. [Laughter.]

One second. You haven’t been sworn in. Who are you, sir?

Mr. LORSCHEIDER. Dr. Lorscheider.

Mr. BURTON. Oh, I am sorry. You were not at the table.

Mr. LORSCHEIDER. I was going to answer the question which you

posed, Congressman.

Mr. BURTON. OK, go ahead real quickly, sure.

Mr. LORSCHEIDER. Though I am not a dentist, I have had this explained to me by——

Mr. BURTON. You look like you are choking a chicken or something. [Laughter.]

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Mr. LORSCHEIDER. Though I am not a dentist, I have had this explained to me by a couple of dentists at two different dental

schools, and the issue really comes down to this. The examples I

will use are just very simple, round figures, and any dentist here

can correct me on this.

But if you go to a dentist and ask for a silver filling, everything

is predicated on chair time, and it is going to take the dentist perhaps 4 minutes to put that amalgam filling in, remove the old one,

put a new one in, or drill out some of the tooth, prepare it, and

put the filling in. For that, the charge might be $100.

Now if you, instead, say to the dentist that you would like a composite filling of some sort, glass ionimer or some other material,

your first visit to the dentist can take as long as 30 minutes because you are going to be in the chair while the tooth is excavated,

and then a silicon rubber impression mold is made of that excavation in order to prepare a casting. Then you will go back a second time for about 10 minutes while the dentist removes the temporary filling that he put in, while he then cements in the casting

and burnishes it, and so forth, to get the occlusal bite quite clear.

Now, by rights, since the dentist has now invested 40 minutes

of chair time into the preparation of that tooth, if he charged you

$100 for 4 minutes of time for an amalgam, theoretically, he should

charge you $1,000 for 40 minutes of chair time. But what is going

to happen, if he charges $1,000 for 40 minutes of chair time, you

are soon not going to go back to that dentist. So the dentist ends

up charging about $300 to $350 for that casting, that composite

casting, that he has put in the tooth.

So if you rate it all on the basis of per-unit-chair-time, the dentist has lost money by putting that composite in versus the amalgam. I have had two dentists, one at Oregon and at Illinois, explain

this to me because they knew I wouldn’t understand the business

of dentistry. But this is really the bottom-line issue. It is an economic issue for dentists.

Mr. BURTON. Let me ask one more question and then I am going

to yield to Ms. Watson. And that is, Dr. Yokoyama——

Dr. YOKOYAMA. Yes?

Mr. BURTON [continuing]. You are a non-mercury dentist?

Dr. YOKOYAMA. Yes.

Mr. BURTON. Can you tell us from your experience the difference

in time and cost as relates to what the gentleman just said?

Dr. YOKOYAMA. Time and cost, I can only estimate, as I really

haven’t done mercury fillings in 10 years. So I don’t know what I

would charge, even if I did them right now.

But the fee that I charge is substantially more for a composite

filling when I do a direct composite filling. That is, a casting, as

Dr. Lorscheider is mentioning, which is different—I mean that is

a totally different procedure than to try to refill a tooth. You can

fill it with mercury amalgam or you can fill it with composite.

I suppose, as my skills get better, the time becomes more like the

time that I would spend trying to fill a tooth with amalgam versus

composite, but I know that it is a technique-sensitive material and

it takes longer to do.

Mr. BURTON. OK, thank you very much.

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Dr. YOKOYAMA. Economically, I am not sure how that plays out,

but it is more difficult.

Mr. BURTON. I just was wondering what the primary reason was,

if the cost of the materials was pretty much the same, why there

would be such opposition to that.

Representative.

Mr. MICHAUD. Yes, Mr. Chairman, all I can say is I know, when

I put the first bill in—and, mind you, the original bill I submitted

was just to inform about the health effects—at that time a lobbyist

told me privately, when I was really amazed that they were opposed, let alone it wasn’t to ban it or anything, just to get the information out there. The concern was that if they admit that there

might be some toxics put into the mouth, the concern was liability

and later on down the road suits brought against the dentist for

putting mercury fillings into the mouth. That might be one of the

reasons why they are so adamant about any legislation dealing

with mercury amalgams.

Mr. BURTON. Well, I think as time goes by, with new scientific

evidence and new information coming out, through your efforts or

Ms. Watson’s, or somebody else, I think that risk becomes greater

and greater. It seems like they would get on with it if they could

see the inevitable.

Ms. Watson.

Ms. WATSON. I want to first say to the Honorable Mike Michaud,

thank you so much for coming and sharing your experience with

us. Would you tell my good friend, John Martin, that I said hello?

We have worked together on other issues, and I hope to work

through you and him and people like yourself around this country

on furthering the kind of legislation that in the long run will benefit the health of Americans. So thank you very much.

Dr. Yokoyama, I want to thank you for taking your own time to

come here. I know what a difficult task you have. May I ask you,

what brought you to the position of being a mercury-free dentist?

Dr. YOKOYAMA. Well, when I was working as a hospital dentist,

I would use amalgam almost primarily for the patients that were

developmentally disabled, and we would bring them into the OR

and do all of their dentistry all at one time. I could see that this

was doing a lot of amalgam all at once. My feelings slowly over the

years became more—I became more aware of the problem and saw

that, as I was doing this large amount of amalgam, that I felt that

it was not doing the patient the justice that they deserved and I

stopped doing it.

I have evolved over time to make my practice completely mercury-free. There are several other reasons for changing in myself,

and I could go into that, but I think you are asking me what

brought me to do this, and that is the reason.

Ms. WATSON. I am very interested in the fact that you were

working on developmentally disabled young people.

Dr. YOKOYAMA. Yes.

Ms. WATSON. And I have my own theories, too. As a school psychologist in my other life, I would walk into schools in the lowersocioeconomic areas and the teacher would say, ‘‘Every child in

here is mentally retarded. I want these children tested.’’ She would

hand me 36 of their folders.

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And I said, ‘‘Well, why do you think so?’’ ‘‘Well, it is the way they

speak. They speak in two-word sentences.’’ I said, ‘‘You would, too,

if it is: ‘Get up,’ ‘Shut up,’ ‘Sit down,’ ‘Eat up.’ ’’ [Laughter.]

And I thought about it, why should these children have problems

with their academic studies? What are the circumstances in their

environment that could attribute to that? I mean, I am talking

about years ago in the late sixties and early seventies, where we

found, one, it was the lead in paint on the cribs, and the kids would

get up and teething, chew, and get the lead in their bodies.

Then we found out in buildings—you know, in Los Angeles we

throw uprisings now and then—and we found that new construction had within it asbestos. I was horrified. I had a crew out there

cleaning up during the 1992 uprising, and someone ran to me and

said, ‘‘There is asbestos in the air.’’

So when you put all of these together and then when we know

there is mercury involved in what goes in our mouth, then I can

understand why our children are not functioning up to par.

So that was my intent: to inform people as to what might impact

on the health of themselves and their children.

Putting together this fact sheet seems to be a task that only a

nuclear physicist could do. [Laughter.]

Can you tell us—and I was very impressed by you on point one,

explained point two very concise, very clear, and those kids that I

had to test would understand. If you could, what would you have

in your brochure that would be informative to patients?

Dr. YOKOYAMA. Well, I did mention that I really feel that a caution or an advisory is warranted for pregnant woman and children,

young children.

Ms. WATSON. Similar to what we do with cigarettes?

Dr. YOKOYAMA. Similar, yes.

Ms. WATSON. What a concept.

Dr. YOKOYAMA. That is the primary thing that I am right now

working toward in California. Second, I will say that I applaud Mr.

Michaud’s efforts in Maine because I really think the consumerfriendly look and readability of that document far outstrips the

California document that was basically made for dentists’ consumption.

So, as we develop a consumer-friendly, readable fact sheet, I

would like two things. I would like to update what we know now

as to the science, the things that have come up recently since 2001,

and I would also like to make it much more a brochure that someone could pick up and say, ‘‘Gee, I didn’t know that. I’m glad I saw

that in here.’’

Ms. WATSON. Dr. Yokoyama, is there a fair factor here with dentists with the gag order and in the Code of Ethics? Was that a fair

factor? Was that intimidation? And then I am going to go to Mrs.

Duffy.

Dr. YOKOYAMA. OK. You have pressed a point and——

Ms. WATSON. I intended to. [Laughter.]

Dr. YOKOYAMA. Yes. It is hard for me to talk about intimidation,

but I do feel that I am not supported—or how should I say this?

Ms. WATSON. Just say it.

Dr. YOKOYAMA. I love the support and the feeling here in this

chamber today because that is giving me so much more a good feelVerDate 11-MAY-2000 11:05 Jul 23, 2003 Jkt 000000 PO 00000 Frm 00172 Fmt 6633 Sfmt 6633 D:\DOCS\87704.TXT HGOVREF1 PsN: HGOVREF1
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ing toward going out and doing the work that I am doing. So I will

just say that.

Ms. WATSON. Thank you.

Mr. BURTON. Would you yield?

Ms. WATSON. Sure.

Mr. BURTON. I would like to pin this down a little bit.

[Applause.]

Mr. BURTON. Are you saying that the Dental Association or organization in California is not that supportive? [Laughter.]

Dr. YOKOYAMA. Well, I think that is their position, yes.

Mr. BURTON. Yes. OK, thanks.

Ms. WATSON. If I might just say that we will back you up with

anything that you need.

Dr. YOKOYAMA. Well, I appreciate that. Thank you very much.

Ms. WATSON. I still am very close to people in California, and if

they try to come after you, just let us know. [Laughter.]

Dr. YOKOYAMA. Thank you.

[Applause.]

Ms. WATSON. Mrs. Duffy, I must commend you—see, it takes one

person, just one person, a citizen like yourself, who realized something was wrong, and you have made a difference. You have raised

an issue that has been bothering me for a long time, and that is

a provider’s first amendment rights. How could you ever tell a certified board member who is a doctor, a dentist, a chiropractor, a

whatever, that they could not explain to their patients the truth

about something, a procedure or an ingredient in whatever they

put in a product, or what is in the medication they provide to you?

Now the Chair of this committee is very concerned about inoculations, vaccinations, and so on. I have warned a lot of people in my

district not to get the flu vaccine, not to get the chicken pox vaccine, because you are getting a little bit of the germ, the virus. If

your health is not good, put it together. You know, connect the

dots.

Not everyone can tolerate. If you are allergic, like I am, to many,

many things, then there are certain things that I cannot put into

my body. Through the process of trial and error, I found that out,

and I finally got medical attention. You know, use a histamine.

That wasn’t it. I was allergic to certain foods.

So, anyway, first amendment rights, and you went that route,

and I would like you to explain a little more because I think you

have hit on something. I am going to raise these questions with the

ADA.

Is anyone here from the ADA who wants to admit that they are

here from the ADA? [Laughter.]

I wish the doctor had stayed in the room. But I think there is

a problem, and if you have gone through your medical training and

you know the scope of practice, why they would not allow you to

tell your patients just simple information. I think it is a violation

of first amendment rights. You have pursued this, and I would like

you to elaborate just a little more.

Ms. DUFFY. OK. One of the things that the ADA has done here

is to put the dentists in a horrible position because, if the dentists

don’t give the information to the patients that they need to give—

‘‘Here are the risks for this procedure; here are the alternatives to

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this procedure’’—and something goes awry, that dentist is going to

be sued for failure to warn. I mean that is a real typical kind of

a case that you are going to have.

And, yet, the ADA is telling dentists: There are certain things we

don’t want you telling your patients. So they have interfered in

really a sacrosanct fiduciary relationship between a patient and

their doctor.

On the other hand, the ADA—and it has been sued around the

country, and it files Motions to Dismiss, and it says: We should not

be in this lawsuit because we didn’t place mercury amalgams in

these patients’ mouths. You shouldn’t be looking at us. Basically,

they are saying everything except: Go after the dentist; don’t go

after us.

So they really are not friends to the dentists either. I think that

the sooner the dentists realize that, that they will actually embrace

your bill here federally; they will embrace my bill in Oregon, and

they will embrace bills in every State and use it as cover to get out

from under using amalgam. They will just say, ‘‘It’s not legal anymore. We’re not using it anymore.’’ And they are really foolish not

to do that.

Ms. WATSON. Thank you so much.

And, Mr. Carlton——

Mr. BURTON. Excuse me. Would the gentlelady yield?

Ms. WATSON. Yes.

Mr. BURTON. First of all, I have to leave, and Ms. Watson, although she is in the other party, she is going to chair the rest of

this meeting, and that is rare. [Laughter.]

Ms. WATSON. We work together.

Mr. BURTON. That is rare, but I have great confidence in her.

[Applause.]

Ms. WATSON. Thank you. Thank you.

Mr. BURTON. If you guys keep that applauding up, I may not

leave. [Laughter.]

But let me just say that I really appreciate your patience here

today, and I appreciate your testimony. We are going to continue

this fight, as I said, with Ms. Watson for many months, maybe

years to come, and we will get the job done eventually. So thank

you very much, and she will take care of you for the rest of this.

Ms. WATSON [assuming Chair]. Thank you so much, Mr. Chairman.

Mr. Carlton—Congressman Michaud, do you have to leave now?

If you do, please feel free to get up and leave. We appreciate your

spending the time with us.

Mr. MICHAUD. Well, thank you very much. I do have another

meeting I have to run off to. I really appreciate it, and thank you

very much once again for inviting me here.

Ms. WATSON. We appreciate the time you spent with us.

Mr. MICHAUD. Thank you.

Ms. WATSON. Yes.

[Applause.]

Ms. WATSON. Mr. Carlton, your testimony was so cogent because

you are getting to something that people want to avoid, and that

is, when we talk about the poor and we talk about our ethnic communities, they are the ones that really suffer. What we are finding,

171

we just started a National Diabetic Association, and the reason

why we did this, because their ADA, American Diabetic Association, had the background, the expertise, the products, and so on,

in my area, but the people who seemed to be most afflicted by diabetes/hypertension are the last to know what the ADA offers.

I think you put your finger right on it. That is why I am directing this to you. What can we do to highlight the fact that our communities are being underserved, and we know that. We have seen

studies that show in the African-American community and also in

the Hispanic community people are underserved, and the outreach

just doesn’t go deep and far enough into the community.

Can you give us some suggestions or advice——

Mr. CARLTON. Yes.

Ms. WATSON [continuing]. As to what we can do?

Mr. CARLTON. Thank you, ranking chairman, Congresswoman

Watson.

The NAACP salutes this committee, the subcommittee, and salutes you in particular, for your putting a spotlight on a very serious issue. A lot of people don’t know anything about this. They get

their dental fillings. They think it is the only thing they have; they

don’t have any consumer choice.

So when Members of Congress sponsor legislation, especially legislation that runs into opposition, we are very grateful because it

allows us to rally around you and to support you and say, ‘‘Look,

this is the sort of thing we ought to be doing in health care.’’

The NAACP has been doing this for a long time. In fact, I think

back in the 1930’s Dr. Montague Cob set up the first subcommittee

of the NAACP. Access to health care has always been an issue. I

mean, we have done four major health care conferences in the last

10 years, hooked up with major organizations, started health committees at the branch level, because if we want to get the information out in the community, you have to do it at the branch level.

That is what I did when I was a branch president. We had a health

committee to get the information out there.

There are always things that affect people disproportionately in

poor communities and ethnic communities. We just have to keep

working and getting the word out because that is really the first

barrier. If people know, we have informed consumers of choice, that

is the first stage. If you get funding after, that is even better.

I know President Fume put out a call to every NAACP branch

in the country a couple of days ago, a minority AIDS/HIV initiative,

to fully fund that in this Congress. So, again, thank you for your

efforts.

Ms. WATSON. Thank you so much for being here.

Both panels, are there last-minute statements or words you

would like to leave with us? If so, just state your name into the

microphone, come up to this mic. Dr. Haley.

Mr. HALEY. Yes, my name is Boyd Haley, chairman of chemistry,

University of Kentucky.

What I would like to make a comment was with the safety of

dental amalgams and looking at people that were exposed environmentally. The change is that, as we age, the compound that removes mercury from the body called glutathione drops dramatically

after the age of 50 and it keeps going down. So a person that is

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responding well and taking care of the mercury toxicity from dental

amalgams when they are 30, 40, and 50 years old runs into a different situation as they age or as they become ill, and the levels

of glutathione scientifically have been proven to drop after that,

and those people lose their protection against removing mercury. It

drops dramatically. And when they reach the age of 60–65, they

are much more susceptible to mercury toxicity than they are when

they are 40.

So while they can say that amalgams are safe and we put them

in people and they have no problems, I think that they really fall

flat on their faces when they go and they look at the percent of glutathione drop in an aged person versus a young person and saying

that these people still are safe from amalgam exposure.

Ms. WATSON. Thank you so very much.

I am also thinking about looking at nickel in jewelry that we

wear next to our skin. I am very highly allergic to nickel and it is

in most cheap jewelry.

Somebody is pointing to their mouth. Did you want say something?

Ms. DUFFY. And braces for children contain nickel.

Ms. WATSON. Yes. So we are going to look into that, too.

I just refuse to accept the notion that African-American children

are retarded or Hispanic-American children, or whatever. That has

not been my experience as a teacher as well.

So I have taken a personal look and been on a personal mission

to gather evidence to show why children have such a difficult time

when they live in very poor areas and overcrowded areas and live

together. So I carried a bill when I was in the senate that said, ‘‘Violence is a health condition’’ because I find that when children live

in a violent environment, it affects their ability to deal with the

concrete.

So, I mean, there are just so many things, so many factors, that

we hope 1 day to remove, and there are environmental conditions

that we hope to address as well. So this is my mission. This is the

one I will be on as long as I am in public office.

I want to thank all of you who have come in and shared with

us your expertise. It is very important that you do not give up the

fight, and it is a fight. It is a challenge.

You have to understand, we live in a capitalistic society, and all

that we do is framed within that box. So we have to get around

that. We have to appreciate what factors in the environment, what

factors that go into our bodies are part of that environment, and

we can’t just focus on the bottom line.

I really want to say in California that we have dealt, through

propositions, with these kinds of issues. So we looked at the herbicides and pesticides and other toxic substances that we use in our

environment. We listed them, and mercury was at the top.

So we have been struggling. It is not easy because you are developing policy. Dr. Yokoyama, I just want to tell you, don’t give up;

don’t get deterred, but I don’t think he is. I don’t think he is.

[Laughter.]

Dr. YOKOYAMA. I’m inspired, let me say.

Ms. WATSON. Because, as I said, it took us 14 years on the smoking issue, smoking policy, anti-smoking policy, and I used to

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carry—we had propositions passed—and I used to carry the budget

line for the media, and the tobacco industry came in with an open

checkbook. Anybody that was on foot, even in a wheelchair, with

blood running through their veins was given a blank check to lobby

me. [Laughter.]

Very interesting. When I write my book—but we prevailed. As

you know, California was the first State to say: No smoking in our

airspace. It spread across the country. Now it has spread around

the globe.

So, as I said to you, Ms. Duffy, you know, it just takes one person

and a team of people and continuing on their mission to bring it

to fruition.

So, with that, I want to say that we are going to work on this

bill. I have a good partner in Congressman Burton. He is very committed. His staff is committed, and we are not going to give up,

even if we have to subpoena the ADA in.

With that, thank you very much. Have a good evening and good

night.

[Applause.]

Ms. WATSON. And I will now adjourn this meeting. Thank you

again.

[Whereupon, at 6:11 p.m., the subcommittee was adjourned, to

reconvene at the call of the Chair.]

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