July 30, 1982: “This letter is in response to your request that the Public Health Service (PHS) review the scientific aspects of the epidemiological studies related to the effects of fluoride ingested through drinking water and provide advice on the validity and significance of the findings relative to dental fluorosis.”
On July 30, 1982, C. Everett Koop wrote the above paragraph in a letter to John W. Hernandez, Jr., Deputy Administrator at the U.S. Environmental Protection Agency. EPA needed to re-assess and finalize interim drinking water standards set in 1975, shortly after the passage of the Safe Drinking Water Act in 1974. Fluoride was one of many compounds for which the agency needed to set an upper limit for safety. EPA had asked the Public Health Service to weigh in, and Surgeon General Koop was reporting back the findings of a committee his Chief Dental Officer had convened to conduct EPA’s requested review.
Fluoride, like chlorine, is in a unique position in drinking water: having benefits at low levels but adverse effects at higher levels. Public health professionals, and Surgeon Generals in particular, have advocated for adding low levels of fluoride to water in order to prevent tooth decay. Indeed, in his letter to Mr. Hernandez, Surgeon General Koop gave a strong endorsement of fluoridation, “I encourage the dental profession in communities which do not enjoy the benefits of an optimally fluoridated drinking water supply to exercise effective leadership in bringing the concentration to within an optimum level.” More such endorsements from Surgeon Generals can be found in “Is fluoride good for your teeth?” an article at the site Fluoride Exposed, at CDC’s fluoride and fluoridation page here, and at ADA’s fluoridation resources here.
Because we so often associate Surgeon Generals with this kind of promotion of adding fluoride to drinking water, and because we seem to forget that Surgeon Generals have also worked to make sure drinking water does not have too much fluoride in it, this quote in Surgeon General Koop’s letter is particularly interesting:
“As one concerned about the total well-being of the individual and one dedicated in helping people avoid impediments to their reaching their maximum potential in society, I cannot condone the use of public water supplies that may cause undesirable cosmetic effects to teeth, just as I cannot condone the use of water supplies below the optimum concentration because of a diminished protection against dental caries. Therefore, I encourage communities having water supplies with fluoride concentrations of over two times optimum to provide children up to age nine with water of optimum fluoride concentration to minimize the risk of their developing esthetically objectionable dental fluorosis.”
The office of the Surgeon General currently works to ensure that Americans do not get too much or too little fluoride in drinking water. The most recent effort was by Surgeon General Vivek Murthy who reviewed, endorsed, and introduced the Public Health Service’s final decision to lower the recommended level for fluoridation in 2015, from a range of 0.7-1.2 mg/L dependent on regional temperature to a single level (0.7 mg/L) for the entire country.
A copy of the original Koop letter is available here.
Acknowledgement: Many thanks to Effie Greathouse for providing the excellent narration for this celebration of Dr. Koop’s letter.
July 30, 1894: New York Times Headline. Jersey City’s Foul Water; Sewage-Filled Passaic the Source of Its Supply. “Plenty of Good Drinking Water to be Had and Many Syndicates Ready to Furnish It — None, However, Has Influence Enough to Get a Contract — Tremendous Debt a Serious Obstacle, but Public Health Demands a Change. The people of this city are thoroughly satisfied that they have the worst drinking water to be found anywhere in the United States. This is no sudden conclusion of theirs. It is the result of a steady growth, born of an experience extending over eight or ten years.
When the Passaic River was first tapped as a source of supply, the water was pure. Dr. Chilton of New York and Prof. Horsford of Yale University, who made the analysis, pronounced it better than the water supplied to Philadelphia, New York, or Albany. But that was forty years ago, and the Passaic of 1854 was very different from the river of today.
Then the towns on its banks were merely hamlets. Paterson was only a village and Passaic and Belleville were mere dots on the map. None of them had any sewers to empty into the river, there were no factories along the banks to pollute the waters, and the fluid brought to Jersey City was limpid, clear and sparkling.
Paterson and Passaic are cities now, with extensive sewerage systems, and all the sewage of these two cities, with a population, probably, of 60,000, empties directly into the river. [Sewer Pipe, Water Pipe Death Spiral] In addition, there are many factories, mills, and dye works along the banks of the river, and all the refuse from these goes into the river along with the sewage, to further pollute the water.”
Commentary: The article goes on to catalogue the evils of the lower Passaic River as a source of supply. It would not be until 1899 that a contract was signed with Patrick H. Flynn to develop a new water supply 23 miles west of the city by building a dam on the Rockaway River forming Boonton Reservoir. It was to this water supply that Dr. John L. Leal added chlorine for the first time to disinfect drinking water for consumers. The story forms the basis for my book, The Chlorine Revolution: Water Disinfection and the Fight to Save Lives, which was published in 2013. The Sewer Pipe, Water Pipe Death Spiral was developed for the book and succinctly describes the water contamination problems of the late 19th century.