    [House Hearing, 108 Congress]
    [From the U.S. Government Publishing Office]

         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

                                     ______

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                         COMMITTEE ON GOVERNMENT REFORM

                         TOM DAVIS, Virginia, Chairman
    DAN BURTON, Indiana                  HENRY A. WAXMAN, California
    CHRISTOPHER SHAYS, Connecticut       TOM LANTOS, California
    ILEANA ROS-LEHTINEN, Florida         MAJOR R. OWENS, New York
    JOHN M. McHUGH, New York             EDOLPHUS TOWNS, New York
    JOHN L. MICA, Florida                PAUL E. KANJORSKI, Pennsylvania
    MARK E. SOUDER, Indiana              CAROLYN B. MALONEY, New York
    STEVEN C. LaTOURETTE, Ohio           ELIJAH E. CUMMINGS, Maryland
    DOUG OSE, California                 DENNIS J. KUCINICH, Ohio
    RON LEWIS, Kentucky                  DANNY K. DAVIS, Illinois
    JO ANN DAVIS, Virginia               JOHN F. TIERNEY, Massachusetts
    TODD RUSSELL PLATTS, Pennsylvania    WM. LACY CLAY, Missouri
    CHRIS CANNON, Utah                   DIANE E. WATSON, California
    ADAM H. PUTNAM, Florida              STEPHEN F. LYNCH, Massachusetts
    EDWARD L. SCHROCK, Virginia          CHRIS VAN HOLLEN, Maryland
    JOHN J. DUNCAN, Jr., Tennessee       LINDA T. SANCHEZ, California
    JOHN SULLIVAN, Oklahoma              C.A. ``DUTCH'' RUPPERSBERGER,
    NATHAN DEAL, Georgia                     Maryland
    CANDICE S. MILLER, Michigan          ELEANOR HOLMES NORTON, District of
    TIM MURPHY, Pennsylvania                 Columbia
    MICHAEL R. TURNER, Ohio              JIM COOPER, Tennessee
    JOHN R. CARTER, Texas                CHRIS BELL, Texas
    WILLIAM J. JANKLOW, South Dakota                 ------
    MARSHA BLACKBURN, Tennessee          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                   DIANE E. WATSON, California
    CHRISTOPHER SHAYS, Connecticut       BERNARD SANDERS, Vermont
    ILEANA ROS-LEHTINEN, Florida             (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

                                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

         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.
        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 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 mercury-containing 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 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.
        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 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.
        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 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
    dentist-dominated 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 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 one-twentieth 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 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, 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 bothered 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 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 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?
        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.
        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.
        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 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 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 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 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.
        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 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.
        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.
        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 forward 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.
        Perhaps, then, our experience in Maine to get some consumer
    disclosure can be of some help. I might add that it has been a
    long-going 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.
        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 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 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, 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 mercury-using 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 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
    African-American 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 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.]
        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.
        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
    lower-socioeconomic 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.
        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
    consumer-friendly 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 feeling 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 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, 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 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 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.]
        [Additional information submitted for the hearing record
    follows:]

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