Mr. WARBURTON. What do you mean by bringing about fluoridation? Dr. KNUTSON. This film is designed for the use of, let's say, local health councils or State health people, who are interested in bringing about fluoridation in a community which has a fluoride-deficient water supply. And this presents facts relating to that fluoridation; what benefits they can expect; how readily and how easily they can control the adjustment of the water supply; what will be the cost of this procedure; and so on. Mr. WARBURTON. In other words, it gives the selling arguments for fluoridation? Dr. KNUTSON. That is correct. Mr. WARBURTON. How does that get into the hands, for example, of town A in the State of Washington? Dr. KNUTSON. He will get it from his State health department, not from the Public Health Service. Mr. WARBURTON. How does the State health department get it? Dr. KNUTSON. They get prints of the film from our regional offices. We have a limited number of them, and, as you might imagine, these prints are not in use full-time, so that with the limited number and through that distribution system, they are made available whenever they are requested. Mr. WARBURTON. And they are requested. They have to be requested by the particular State board of health which wants to use them within the State? Dr. KNUTSON. That is correct. Mr. WARBURTON. No further questions. Thank you, Doctor. Mr. HALE. Thank you very much, gentlemen. The committee appreciates your contribution, which has been important. Maj. Robert W. Hobson. How long will your statement take, Major Hobson? STATEMENT OF MAJ. ROBERT W. HOBSON, DENTAL CORPS, RESEARCH AND DEVELOPMENT DIVISION, OFFICE OF THE SURGEON GENERAL Major HOBSON. Two to three minutes, sir. Mr. HALE. You are very welcome. Major HOBSON. Mr. Chairman and members of the committee: I am Robert W. Hobson, major, Dental Corps, a member of the Research and Development Division of the office of The Surgeon General, Department of the Army. I represent the Department of Defense in expressing the opposition to the enactment of H. R. 2341. The principle of fluoridation of certain portable water supplies as a means of preventing dental caries in children has been accepted by the American Medical Association, by the house of delegates of the American Dental Association, by the Food and Nutrition Board of the National Research Council, by the governing council of the American Public Health Association, by the United States Public Health Service, and by other Federal and State agencies interested in public health. Irrespective of the views taken by the above agencies, it has been asserted that fluoridation is still in the experimental stage. The fact is that fluoridation of public water supplies cannot be considered "experimental" in the usual sense of the word or that the procedure has not been adequately studied. Various factors relating to fluoridation have been under study for at least 25 years. Controlled studies of the addition of fluorides to water supplies began in 1945, and have shown almost the same pattern of protection against dental caries for children born and reared in these communities as is observed in areas where fluorides occur incidentally to the water supplies. Continued observations will establish the degree of effectiveness in older age groups who used fluoridated water during childhood. It has further been asserted that artificial fluoridation may not produce the same results as do natural fluorides. Actually there is no such thing as "artificial fluoridation." Fluorides are always added to water, generally being picked up by water running through underground passages and crevices where the ground contains various fluoride compounds. In this process man has no control over the concentration. Studies show that the same results occur whether the fluoride is added in controlled amounts or whether added happenstance by nature, except that desired results are assured when the fluoride is added in controlled amounts. As controlled studies on the subject of fluoridated water are continued, there is increasing evidence that older populations may also benefit from this practice. If this point is proved, then it will be desirable for the armed services to fluoridate water on posts where the water is deficient in this chemical. In order to reaffirm the position of the agencies mentioned in the first paragraph of this statement and to determine the present position of the National Research Council, the Council was asked to restate its position on the principles of fluoridation of potable water supplies in September 1953. The following statement was received from the National Research Council: The Committee on Dentistry of the National Research Council believes that there is sufficient scientific evidence of the merits of fluoridation of public water supplies to justify its use on military posts whenever feasible, and especially where there is a child population in residence. In view of the above positions taken by authoritative bodies, it is the opinion of the Department of Defense that under controlled conditions the fluoridation of water supplies is a public health asset and that legislation which would prohibit this practice would be detrimental to the public interest. Therefore, the Department of Defense opposes enactment of H. R. 2341. Mr. HALE. Thank you, Major Hobson. Are there any questions? Mr. Pelly? Mr. PELLY. Major, are any defense appropriations used for research in the field of fluoridation? Major HOBSON. None in the field of fluoridation in this sense: There are some and I don't know the extent-topical applications of fluoridation. Mr. PELLY. What do you mean by that? Major HOBSON. Topical application of fluoride is the application of fluoride to teeth by a dentist or a trained technician. Mr. PELLY. As far as we know now, according to the testimony that has been given, fluoride does not benefit teeth beyond the age of 9 years; is that right? Major HOBSON. It is my opinion, from what I have read, that there is increasing evidence that it might, and in that case we are interested. Mr. PELLY. Up to now, how far? Major HOBSON. We are not fluoridating water on any military post, camp, or station that I know of. We are, on some posts, camps, or stations, receiving fluoridated water that is purchased from local communities. Mr. PELLY. In other words, you would be affected by this legislation? Major HOBSON. Yes, sir. Mr. PELLY. Thank you. Mr. PRIEST. Just one further question, Mr. Chairman. So far as you know, Major, is it contemplated that perhaps in the immediate or more remote future there might be fluoridation of water on military posts, if a supply is not available locally? Major HOBSON. I would say I believe all services have had such requests, sir. Mr. PRIEST. I believe the recommendation of the National Defense Council was that it should be done particularly where children were present on the post. Major HOBSON. Yes, sir. That is correct. Mr. PRIEST. That is all, Mr. Chairman. Mr. HALE. Dr. John D. Porterfield, Association of State and Territorial Health Officers. STATEMENT OF JOHN D. PORTERFIELD, M. D., VICE PRESIDENT, THE ASSOCIATION OF STATE AND TERRITORIAL HEALTH OFFICERS Dr. PORTERFIELD. This opportunity to appear before you is much appreciated. I am a physician specializing in public health and have worked in that specialty for the past 15 years. Since 1947, I have been director of health for the State of Ohio. Presently, I am vice president of the Association of State and Territorial Health Officers. In that capacity I speak to you today as the designated representative of the 53 health authorities of the States and Territories of the United States. It is these officers who carry a major responsibility within the respective States for the maintenance of standards governing municipal water supplies. They are also responsible in great part for dental health programs with particular emphasis on preventive measures in this field. The Association of State and Territorial Health Officers has taken the following actions, by vote of the full membership, approving and recommending the controlled addition of optimum amounts of fluorides to public water supplies for the partial prevention of dental caries: Association of State and Territorial Health Officers, Annual Meeting, 1950: Whereas careful scientific observations since 1929 indicate that tooth decay is not as prevalent in individuals using water supplies containing sodium fluoride; and Whereas the artificial fluoridation of public water supplies was experimentally instituted and has been under continuous study since 1945; and Whereas these studies have shown that there is no menace to the teeth of the persons using 1 part per million of sodium fluoride; and Whereas State and Territorial dental health directors have endorsed in principle the fluoridation of public water supplies as a partial protection against dental caries: Therefore be it Resolved, That the Association of State and Territorial Health Officers recommends, where the medical and dental professions concur and where communities can meet the standards of the State health authorities that all State health officials approve the artificial fluoridation of public water supplies for the partial control of dental caries. And in its annual meeting of 1951, the following recommendation was made: That the State and Territorial health departments be urged to conduct more intensive promotional and educational programs designed to bring the benefits of water fluoridation to all communities as soon as possible. In its annual meeting in 1952, the following recommendation was made: That the State and Territorial Health Officers Association, in view of the overwhelming evidence in favor of water fluoridation, reemphasize that the full benefits of this public health measure should be brought to all communities as rapidly as possible, and that association members aid communities in developing fluoridation programs by providing effective information, dental and engineering assistance. And in its annual meeting in 1953: It is recommended that the Department of Health, Education, and Welfare develop jointly with the State and Territorial health officers and their dental directors a plan to further expand, emphasize, and distribute information concerning the values of fluoridating water systems deficient in fluoride. In addition to these formal actions taken by the association, virtually all individual State health authorities have established procedures for the approval of community fluoridation plans. Rather than review the scientific evidence which formed the basis for these actions, I would like to describe the responsibility of a State health officer regarding the use of newly developed procedures for the prevention or control of disease. A State health officer is charged by law with the protection of the public health and the prevention and control of disease. When any procedure is purported to provide health benefits he must carefully evaluate its effectiveness, safety, and practical worth. This serious responsibility is one which leads to the development on the part of a State health officer of an extremely conservative attitude and a very critical point of view with respect to new advances in health practices. It is within this framework of responsibility that the association examined the scientific evidence and, recognizing its responsibility, not only to safeguard the public health, but to promote procedures designed to improve the health status of our citizens, has seen fit to endorse and recommend controlled water fluoridation for the prevention of tooth decay. The association took due cognizance of the claims that the procedures would be a hazard to health and found them without basis in scientific fact. Therefore, the Association of State and Territorial Health Offices is firmly of the opinion that the passage of H. R. 2341 would not be in the public interest and, furthermore, its enactment would in fact be a contradiction of the overwhelming scientific evidence supporting water fluoridation as a safe and effective preventive of dental caries. Mr. HALE. Are there any questions of Dr. Porterfield? Mr. Beamer? Mr. BEAMER. Dr. Porterfield, I have received letters from the Indiana Dental Society, which substantiates the statement you have made, and I take it all the States have organizations that belong to your association? Dr. PORTERFIELD. No, sir, the Association of State and Territorial Health Officers is made up exclusively of the State health officer of each State and Territory. In each of those States and Territories, there is a dental association. And much as Dr. Knutson described his use of advisory councils of experts, so, too, State health officers, in coming to these decisions of policy, confer with the dental health councils when it is a dental matter and with other people who have experience or ability in the field in question. Mr. BEAMER. The reason I make this statement is because I have received no letters from the Indiana State health officer, although I have received numerous letters from the dental societies and from individual dentists. I am wondering whether or not the State health officer confers with the various dental societies. Dr. PORTERFIELD. It is my understanding that he does, sir. I am personally familiar, to some degree, with both the State health officer and with his methods of operation in that State, and that is his practice. And I know personally that he has endorsed, as the chief health officer of Indiana, the fluoridation program. Mr. HESELTON. Doctor, I notice that beginning in 1951, and following it up in 1952 and 1953, at the annual meeting, the association voted to urge the State and Territorial health departments to conduct a more intensive promotional and educational program. In effect, that is the same sort of a vote as taken in 1952 and 1953. Will you describe briefly the type of program that you were urging? Is there any literature that was provided for distribution? If so, of what type was it, and how widely disseminated? Dr. PORTERFIELD. The association, as such, sir, does not have funds to carry out operations of any nature as an association. It confines itself pretty much to its annual meeting and conferences of that type. However, each of the individual State health officers has, in keeping with his resources and interest, developed things. A number of the States have developed educational or informational material on this question of fluoridation. They have also availed themselves of the resources both of the Public health service and of the American Dental Association. Several of them, I know, individually have collected a kit of their own by personal solicitation from the various authors who have published in this field, both pro and con, in order to determine for themselves what. their policy should be, and then to promote that policy, that recommendation, in the form of health education within their State. |