The Fluoride Ruling Was Vacated—But the Science Wasn’t
The recent Ninth Circuit ruling on fluoride changed the legal trajectory of the case, but it did not resolve the scientific debate. If anything, it exposed how badly the country now needs something it still lacks: an independent, trusted evaluation of the totality of evidence on fluoride’s risks and benefits.
Population strategies are among the most powerful tools public health has. Clean water, vaccination, sanitation, and reductions in lead exposure have saved millions of lives and improved health on a scale that clinical medicine alone could never achieve. But precisely because these strategies operate across entire populations, their safety and effectiveness must be evaluated with exceptional rigor. If a population strategy is not safe—or no longer as effective as once believed—that power itself becomes part of the problem.
The recent Ninth Circuit decision only heightens that urgency. The appeals court did not conclude that fluoride is safe, nor did it reject the growing body of studies linking higher fluoride exposure with lower IQ in children. Instead, the court ruled that Judge Edward Chen went too far procedurally when he delayed the case to await newer scientific evidence—including the National Toxicology Program review—and then incorporated that evidence into a second phase of the trial. In short, the appellate court concluded that the case should have been decided using the original trial record rather than newer evidence that emerged afterward.
That is why this moment demands something more than prolonged regulatory delay or courtroom battles over procedure. We urgently need an independent evaluation by the National Academies of Sciences, Engineering, and Medicine—one that brings together toxicologists, epidemiologists, neurologists, dentists, exposure scientists, and risk assessors without financial or political stake in the outcome.
The goal should not be to “win” the fluoride debate. It should be to honestly evaluate the totality of evidence: neurodevelopmental risks, effectiveness for preventing tooth decay in the modern era, potential effects on bone and thyroid function, susceptible populations, biomarkers of exposure, and the implications of cumulative fluoride intake from multiple sources. Public trust depends not on certainty, but on transparency, independence, and a willingness to follow the evidence wherever it leads.
Bruce - when I was on the EDSTAC in the mid '90s, I thought we were all on the same page: to create a testing system that would identify chemicals that interfere with hormone systems and protect the public. 3/4 of the way through that 2 year process, I realized that half the people in the room were from industry and THEY were all on the same page. Ana Soto and I were the only "independent" people - the others were various industry, govt, some NGOs. Recently, I was on an EFSA panel evaluating fluoride (and bromide). One orientation was that the report shouldn't emphasize the neurodevelopment/behavior element because of public concern. When did scientists quit being scientists? The work I did a long time ago that was truly "curiosity driven" was so much more fun (pure, interesting). Can a neural system characterized by a single transmitter be involved in separate functions and are they separable in space (in the brain)? Does thyroid hormone from the mother actually affect brain development in the fetus before the fetus can make its own thyroid hormone? These are curiosity driven, but they aren't unimportant. When I worked on the UNEP/WHO State of the Science of EDCs in 2012, we fought over almost every sentence that did not contain hedge words because "we have to be sensitive to our donors". I'm not sure even the NAS would be devoid of this perversion of science. I try to remember your story of "100 years", but I'm not sure humanity has that much time. (It's been raining alot lately, so maybe that accounts for this negative attitude).
The delay this recent decision has inserted is a setback for children’s health, since it will only mean more children will be harmed. It demonstrates the current system to prevent harm from environmental causes is too weak and way too slow. But there are two issues raised by this post that need more context:
1.) The Appeals Court remanded the case to the trial court to reach a decision based on the testimony available from the first trial. While that first trial now seems many years ago and there is no scientific rationale for restricting a ruling to that evidence, people probably forget how strong the case was at that time for ruling that fluoridation poses an unreasonable risk of neurodevelopmental harm under the TSCA law. At the conclusion of that trial Judge Chen severely criticized the defendant EPA for demanding a scientifically unachievable level of proof instead of the proper standard which is built into TSCA. Both sides, as well as the judge, seemed to all agree that there were several strong human studies together with many lower quality studies and many animal studies that all consistently showed harm, including at exposure levels too close to those from fluoridation to be considered safe under TSCA. So, Judge Chen, on remand, could make the same ruling that fluoridation poses an unreasonable risk under TSCA based entirely on the evidence from the first trial. That could save the need for another years-long review on the heels of the NTP’s rigorous review that was dragged out for 7 years because of interference from those trying to protect fluoridation.
So, I don't believe an additional review by anyone, including NASEM, is needed to reach a conclusion that fluoridation poses an unreasonable risk under TSCA. Such a ruling would trigger a legal requirement that fluoridation be regulated so as to eliminate that risk, which realistically would require banning fluoridation. While that process would likely still drag out far too long, a final judicial ruling would go a long way to getting local areas to stop fluoridating.
2.) Furthermore, NASEM is not as unbiased and unconflicted an authority as many may assume. My research on the sugar industry's manipulation of fluoride science found that from the first time the National Academies weighed in on fluoridation they have been consistently giving biased reviews. The first committee in 1952 was composed largely of dentists who originated the idea. Prominent in that first report was chemist Gerald Cox who had been secretly funded by the sugar industry starting in 1930. The industry wanted him to try to find a cure for tooth decay so that the sugar industry could absolve itself of blame. In 1939 Cox was the first person to ever publicly suggest adding fluoride to public water supplies and was an ardent promoter for the rest of his life. The National Academies (now NASEM) has issued almost a dozen reports on fluoridation since that first one in 1952, with almost all being stacked with dentist promoters of the practice. The only NAS report out of these that has not praised fluoridation and exonerated it of harm was the 2006 NRC review, which uniquely had some committee members who were not pre-inclined to support fluoridation. NASEM is a private entity despite its name making it sound like a government agency, and it chooses committee members opaquely and almost all committee deliberations are secret.
The history of NASEM bias on fluoride extends to the present day, including the two NASEM peer-reviews of the NTP systematic review. Those dismissed the consistent evidence from hundreds of animal studies and nit-picked the evidence from human studies. Their chair was eventually hired by the EPA to be its star epidemiologist witness in the second trial. He received over $100,000 for his services, but Judge Chen largely rejected his arguments in his ruling.
My investigations of NASEM also revealed massive financial conflicts of interest that have been largely unknown, until recently. For example, in 2023 a front-page story in the New York Times revealed that Purdue Pharma, of opioid epidemic “fame”, had helped get some of their people to influence a NASEM committee that recommended doctors more aggressively treat pain, including with the opioids sold by Purdue. The owners of Purdue (the Sackler family) had donated $19 million to NASEM.
As if that isn’t a big enough “bribe”, sugar-industry-associated companies have donated much more. The WK Kellogg Foundation (majority owners of Kelloggs cereal company) is listed in the highest category of donors, giving more than $25 million. Other sugar industry and dental industry donors to NASEM include Coca-Cola, PepsiCo, Dr. Pepper Snapple, Mars International (candy), Tate & Lyle (sugar company), Hershey (candy), Proctor & Gamble (fluoride toothpaste), Colgate (fluoride toothpaste), and the California Dental Association
Another example of corruption at NASEM – this one connected to both fluoride and the tobacco industry – was only uncovered because of the tobacco industry settlement that forced millions of pages of internal documents to be made public. Buried in those documents are the contracts and memos between RJ Reynolds Tobacco Company and Dr. Bernard Wagner, who was the chair of one of the NAS committees that exonerated fluoride in 1993. Wagner was secretly receiving a $500,000 a year from RJ Reynolds, which by that time had bought Nabisco so was also a processed-foods, cookies, and candy behemoth. Wagner's memos back to RJ Reynolds brag about being appointed chair of the fluoridation review committee and promise he will try to get one of the cigarette company’s scientists appointed to an NAS committee on carcinogenesis.
You can read about this backstory of the National Academies with fluoride, and much more, in my article on the long history of the sugar industry’s manipulation of fluoride science, available here:
https://doi.org/10.1186/s12940-025-01154-x
So, I’m not sure calling for one more NASEM review of fluoridation risk and benefits is going to be the fastest or best way to decide what to do about fluoridation. There is certainly a need for a faster way to address environmental health harms, including from fluoride. NASEM could possibly play a role, but only if its currently compromised and opaque processes were overhauled. Bruce does call for a committee of experts “... without financial or political stake in the outcome.” Whether that is achievable under NASEM is not clear. And even if it were achievable, I fear it could just produce additional delays in protecting children's developing brains from fluoride.