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The C. Everett Koop Papers

Letter from Charles W. Gish, Indiana State Board of Health, Division of Dental Health to C. Everett Koop pdf (282,594 Bytes) transcript of pdf
Letter from Charles W. Gish, Indiana State Board of Health, Division of Dental Health to C. Everett Koop
Number of Image Pages:
3 (282,594 Bytes)
1982-12-08 (December 8, 1982)
Gish, Charles W.
Indiana State Board of Health. Division of Dental Health
Koop, C. Everett
Reproduced with permission of Charles W. Gish.
Medical Subject Headings (MeSH):
United States Public Health Service
Exhibit Category:
Reproduction and Family Health
Box Number: 20
Folder Number: 6
Unique Identifier:
Document Type:
Letters (correspondence)
Physical Condition:
Series: Sequential Files
SubSeries: December 1982
December 8, 1982
Dear Doctor Koop:
The court trial on the Clinton, Indiana, Fluoridation suit brought by the Anti-Fluoridationist has been heard by the judge. This letter is to review what I believe is an excellent example of cooperation of local, state and national health personnel on a health matter important to the health and well-being of people within a community. Realizing the judge must make the decision, I believe the defense witnesses did an excellent job of documenting the benefits, safety and desirability of community fluoridation.
The City of Clinton, Indiana, was being sued, not the State of Indiana, Indiana University, the Indiana Dental Association, the Federal Government, or anyone else. However, this suit would affect the health and well-being of the people in that community and was also against a program recommended and supported by state and national health groups and agencies. There was no regulation involved, only the commitment of responsibility and obligation to the health of a group of people. The local community responded and supplied local testimony to the best of its ability from the local dentist (who was President of the Component Dental Society), the Mayor, support from a local physician, the local health department, and individual residents within the community. It was also important that the city attorney went right to work in regard to how he could best defend the city in the suit. The community, however, did not have experts in several areas of health to call upon for testimony and thus, called upon the Indiana State Board of Health for assistance. The State Board of Health, readily recognizing this as an area of responsibility to the health of people in the state, supplied testimony. The Dental Division documented benefits to citizens through the fluoridation of community water supply and coordinated pre-trial activities. The Division of Water Supply provided testimony from its Director, an Engineer, who discussed water treatment, equipment and its installation. The State Board of Health also provided as a witness, the Director of Public Health Statistics for the State, who related to that Divisions mortality records for the state, fluoride and nonfluoride areas showing no adverse affects attributed to fluoridation.
The State Board of Health concluded not to use an allergist or urologist, however, they did want and did not have expertise in the area of biochemistry, toxicoloy, or cancer epidemiology. They, therefore, turned to Indiana University, who willingly supplied a biochemist, Doctor Stookey, who had done extensive research in the area of fluoride and also the State Toxicologist from the Medical Center, Doctor Forney, who had done work on the use of fluoride. The Indiana Dental Association provided the President of that Association to testify on behalf of the Fluoridation Program for the State and his experience as a practitioner. After these resources were documented and specific persons volunteered to serve the community needs there was still a lack in two particular areas. One was a cancer epidemiologist and the other was for specific research materials and studies which have been conducted on a national basis, as well as worldwide and studies which were conducted in other states that were not readily available in the State of Indiana.
The state ask for assistance from the U.S. Public Health Service who willingly and readily came to the aid of the state and local community's request. The assistance from the Centers for Disease Control in Atlanta, Georgia, was invaluable in providing a cancer epidemiologist (Dr. Clark Heath) as a witness, who was knowledgeable in national and worldwide cancer epidemiology. Also invaluable was the assistance from the Dental Disease Preventive Activity from CDC in providing a great amount of very important references, specific research and studies, documentation in support of the benefits and safety of community fluoridation, and background assistance from national and worldwide data. (Dr. William Bock and Jim Collins specifically assisted.) Valuable assistance also came from the National Institute of Dental Research through John Small and Dr. George Martin.
For all of the above expert assistance to be effective in helping states and local communities, it is necessary to also have administrative support. We, therefore, thank the Surgeon General, Doctor Koop; the Chief Dental Officer, Doctor Mecklenburg and the Director of the Centers for Disease Control, Doctor Foege for their very important administrative support and commitment to the health of people.
The total of these was combined with the volunteer efforts and assistance of the American Dental Association, who also provided expertise in providing information on documented studies and research not only from the United States, but worldwide which supported the benefits from fluoridation as well as its safety. The combined knowledge from individuals who were expert in their particular fields I believe resulted in an excellent cooperative effort in testimony to support the benefits, safety and advisability of community fluoridation. It is also extremely important to note that none of these were provided under pressure or for reasons of regulations. They were provided because of their knowledge and concerns for the people in a local smaller community. People who incidently are often overlooked and who did not have expertise in the special ark's of health needed. It is extremely gratifying to say that no one, local, state or national, withheld their expertise or tried to pass the buck if they believed they had the expertise to answer specific questions or claims. They also readily outlined any particular area where they believed further assistance was needed.
As Director of the Division of Dental Health, I am proud to be a citizen of a country which can quickly combine its professional health efforts at every level (community, state, and national) because of their concern for the mutual health and well-being of a local community group. This assistance was also supplied upon the request of the lower group after they had researched and exhausted their own capabilities of supplying expert witnesses.
Again, I wish to take this opportunity to thank everyone participating in this project which I believe resulted in an excellent example of cooperation on a health subject from the local, state, and national levels and did an excellent job of documenting the benefits, safety, and desirability of community fluoridation.
Charles W. Gish, D.D.S.
Division of Dental Health
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