COUNCIL OF THE CITY OF PHILADELPHIA COMMITTEE ON PUBLIC HEALTH AND HUMAN SERVICES - - - Room 400, City Hall Philadelphia, Pennsylvania Thursday, April 16, 2009 1:20 p.m. - - - PRESENT: COUNCILWOMAN MARIAN B. TASCO, CHAIR COUNCILMAN W. WILSON GOODE, JR. COUNCILMAN JAMES F. KENNEY COUNCILWOMAN MARIA QUINONES-SANCHEZ COUNCILWOMAN DONNA REED MILLER COUNCILWOMAN BLONDELL REYNOLDS BROWN BILL 090124 - An ordinance approving the dental amalgam brochure adopted by the Board of Health pursuant to Section 9-3102 of The Philadelphia Code. - - - V A R A L L O Incorporated Litigation Support Services Eleven Penn Center 1835 Market Street, Suite 600 Philadelphia, Pennsylvania 19103 215.561.2220 215.567.2670 2
Good afternoon. The Council Committee on Public Health and Human Services is now in session. We would like the Clerk to read the bill before us today.
Bill No. 090124, an ordinance approving the dental amalgam brochure adopted by the Board of Health pursuant to Section 9-3102 of The Philadelphia Code.
Thank you very much. We welcome you all here today. We're here to continue the discussion regarding this legislation sponsored by Councilwoman Blondell Reynolds Brown. Let me establish that there is a quorum in the presence of Councilman Kenney, Councilwoman Brown, Councilwoman Quinones-Sanchez, Councilwoman Miller and Councilman Goode. We now recognize Councilwoman Brown for some introductory remarks. 3 4/16/09 - PUBLIC HEALTH - BILL 090124
I thank you, Madam Chairwoman Tasco and all the members of the Committee. We should know that this has been a long road. Only five years ago, we introduced a comprehensive bill to ensure that consumers are made aware of their choices when it comes to what is placed by a dentist in their mouths. Here's what I know: I know that mercury amalgam fillings are something that causes worry in some jurisdictions, and I know also that -- I have learned also that there are alternatives. I also know that there's even a potential problem where mercury amalgam fillings, patients need to know about them and their options. One more thing that I know is that I am a legislator. I am not a physician or a medical expert. So when Council required a brochure to be made, we thought it appropriate and important to have the Health Department, under the 4 4/16/09 - PUBLIC HEALTH - BILL 090124 strong and able leadership of Dr. Don Schwarz, as the best department to handle this challenge. The Board of Health and the Health Department have done a tremendous job of thoroughly, completely examining the issue and coming up with a document that while neither side is completely pleased, both sides have moved closer, and, therefore, we believe we have a more fair document. I want to commend the Consumers for Dental Choice for their strong advocacy on this issue. Patients would not be aware with any certainty of their options if the Consumers for Dental Choice had not stepped forward. Thank you also must go to the Philadelphia Dental Society and the New Era Dental Society for your professionalism and your important work with the Health Department in shaping their brochure. It is indeed the result of a collaborative effort. 5 4/16/09 - PUBLIC HEALTH - BILL 090124 The long road does not end here today, but it is a good stopping point to reflect on where we are, and at the conclusion of this process, it is our hope that Philadelphians will be better informed of their medical options. We want to thank all of those partners for walking with us on this journey. Thank you, Madam Chair.
Thank you, Councilwoman. We now would like to call the first witness, and that would be our Dr. Donald Schwarz, Deputy Mayor for Health and Opportunity, Health Commissioner. (Witness approached witness table.)
Good afternoon, Chairwoman Tasco and other members of the Committee on Public Health and Human 6 4/16/09 - PUBLIC HEALTH - BILL 090124 Services. I am Donald Schwarz, Deputy Mayor for Health and Opportunity and the Health Commissioner for Philadelphia. In my capacity as Health Commissioner, I also serve as the Chair of the Board of Health, according to the Charter. Thank you for the opportunity to present testimony today on Bill 10 090124, which serves as the means by which Council can approve the dental amalgam consumer brochure developed and adopted by the Board of Health. As per the City Charter, the Board of Health serves as the regulatory body of the Department of Public Health, providing expert judgment on matters related to public health issues and regulation. Appointed by the Mayor, the current Board is comprised of the full complement of medical and dental public health professionals defined in Section 23 3-901 of the City Charter. As required in Chapter 9-3100 of The Philadelphia Code, the Board of 7 4/16/09 - PUBLIC HEALTH - BILL 090124 Health met with the Philadelphia Dental Society, New Era Dental Society and Consumers for Dental Choice to create an informational brochure for dental patients in Philadelphia that explains the potential advantages and disadvantages to oral health, overall human health and the environment of using amalgam in dental procedures. Department staff and members of the Board of Health spent hundreds of hours in preparation for the drafting of the final brochure, including time spent in discussion with the Philadelphia Dental Society, the New Era Dental Society and Consumers for Dental Choice, as per City Council direction in Chapter 9-3100. The process leading up to the first public hearing led to agreement among the three named organizations and the City that a brief, clear fact sheet would best meet the intent of Council's direction. A draft fact sheet was then crafted and submitted for public discussion. 8 4/16/09 - PUBLIC HEALTH - BILL 090124 The Board first heard formal testimony from each of the groups in the setting of an official public meeting on December 11, 2008. Of a total of 70 documents submitted at that time, 7 crucial, representative, and 8 scientifically rigorous documents and 9 summaries of the remaining 56 documents 10 were reviewed by the Board of Health 11 during December and January. Based on 12 the testimony presented and the articles 13 submitted, a revised draft document was 14 developed in January 2009 and presented at the subsequent public meeting of the Board on February 10, 2009. Again, the comments of the stakeholders were considered in the process of amending and finalizing the information sheet. The Board adopted the finalized information sheet by regulation at the next public meeting on March 19, 2009. The draft before you today is the draft adopted by the Board of Health as a regulation. It was approved by the 9 4/16/09 - PUBLIC HEALTH - BILL 090124 Law Department March 23, 2009 and will be forwarded to the Records Department for the standard 30-day public inspection period. At the conclusion of this period, it will become an official regulation of the Department of Public Health. Department of Public Health technical staff and the Board of Health will continue to review applicable scientific information on the use of amalgam as it becomes available and will consider revising the brochure as warranted by changes in scientific information. I want to repeat that so that the Council is -- the Committee is clear. The Board determined that it was important enough for us not simply to craft a brochure, but to come back again and review updated or new literature on this topic on an annual basis, and we will do so.
With passage of this ordinance 25 by Council, the wording of the 10 4/16/09 - PUBLIC HEALTH - BILL 090124 information sheet will be retained as it is for distribution to dentists in Philadelphia who use dental amalgam for distribution ultimately to patients. The information sheet will also be posted on the Department of Public Health website. Speaking on behalf of the Board of Health members, I believe that this information sheet is a sound, evidence-based and understandable patient brochure that can be used by dentists in Philadelphia to effectively educate their patients on the health-related advantages and disadvantages of dental amalgam. Through the hard work and collaboration of all parties involved in the process of developing the brochure, I am confident that as a final product, this will provide important information to dental patients in a clear, concise manner and, most notably, inspire patients and dentists to have a dialogue about the issues surrounding dental amalgam. I fully support the adoption of this 11 4/16/09 - PUBLIC HEALTH - BILL 090124 brochure by this Committee and by the Council Committee of the Whole. I want to note, though not in written testimony, that the Board has also considered the issue of translation of this document so that it's available in more languages than simply English. Thank you for allowing me to present testimony on this important issue. I will now answer any questions.
I thank you very much for your testimony, Dr. Schwarz, and I'm sure all of us, but in particular Councilwoman Maria Quinones-Sanchez, is delighted to hear that you've already determined that the brochure will be put in different languages. Any questions or comments for this witness? (No response.)
Well, we thank you for what's called stick-to-itiveness in working with those 12 4/16/09 - PUBLIC HEALTH - BILL 090124 partners around the table to bring us to this juncture.
Thank you very much. Our first panel, please join us Freya Koss, Director of Pennsylvania Coalition for Mercury-Free Dentistry; Paul Gilbert, International Academy of Oral Medicine and Toxicology; Zach Hoover, Office of Senator Daylin Leach. Please move forward to the witness table. (Witness approached witness table.)
Just for the record, the next panel will be Dr. David Tecosky, Philadelphia Dental Society, and Dr. Elsie Casimir with the New Era Dental Society. You'll follow the Pennsylvania Coalition for Mercury-Free Dentistry. Good afternoon.
Please 13 4/16/09 - PUBLIC HEALTH - BILL 090124 state your name for the record.
Yes. And you're welcome to proceed with your testimony.
Thank you. Well, I am finally delighted to be here, and I can't thank you enough. It's been a long road, hasn't it?
Five years. So my name is Freya Koss. I'm the Director of the Pennsylvania Coalition for Mercury-Free Dentistry, which I established in 2004 for the very purpose of bringing public attention to the serious health effects of dental mercury amalgam fillings. I was suddenly struck with double vision in 1998 and was diagnosed with multiple sclerosis, lupus and myasthenia gravis, all devastating autoimmune diseases. The neurologists 14 4/16/09 - PUBLIC HEALTH - BILL 090124 offered me nothing but prescriptive drugs and I was told that my future was dim. Fortunately for me, I quickly discovered that the silver-colored fillings drilled out and replaced seven days before were 50 percent mercury, one of the deadliest elements found on earth. I discovered that I wasn't alone in this journey and was fortunate to find Blanch Grube, a specially trained mercury-free dentist in Scranton, to remove my fillings safely. Slowly I regained my health, with diet change and nutritional supplements. Realizing I was one of many in the general public and the medical profession who knew nothing about the toxicity of amalgam fillings, nor the related illnesses, I knew that I had to do something to enlighten the public about this crime to humanity. I met others who had also become chronically ill and recovered again after amalgam removal. We worked together to hold public events 15 4/16/09 - PUBLIC HEALTH - BILL 090124 enlightening whoever would listen. By 2004, I knew that something had to be done on a widespread scale to reach the masses. It was at that time that I approached Councilwoman Blondell Reynolds Brown about introducing legislation for informed consent. She was more than open to learning about this travesty, particularly for the unsuspecting pregnant women and children. Councilwoman Brown understood what had to be done on the legislative level. Guiding us all the way, she, together with David Forde, Chief of Staff now, and Joe Meade, Legislative Assistant, we forged ahead, and the rest is history. Philadelphia is the first city in the nation to mandate that dentists give their patients a brochure calling silver fillings mercury, with warnings such as "mercury is released as a vapor. Mercury is released as a vapor when amalgam fillings are placed or removed and through chewing. Mercury can be 16 4/16/09 - PUBLIC HEALTH - BILL 090124 absorbed by the body and built up over time. High levels of mercury can cause toxic effects on the brain, the nervous system and the kidneys. " And thanks to Charlie Brown, national counsel for Consumers for Dental Choice, the brochure includes the Food and Drug Administration's admission that dental amalgams contain mercury, which may have neurotoxic effects on the nervous system of developing children and fetuses. The brochure is an important step in creating public awareness about the potential toxic effects of amalgam fillings. Consumers for Dental Choice, the Pennsylvania Coalition for Mercury-Free Dentistry, those injured consumers who are here today, Karen Palmer, Karen Burns, Linda Stein, Dr. Paul Gilbert, Leslie Baird and all of 17 4/16/09 - PUBLIC HEALTH - BILL 090124 those who couldn't be here today, thank City Council for your willingness to examine this issue and to Councilwoman Reynolds Brown for her courage and her fortitude in obtaining passage of the mercury in dentistry law. It hasn't been an easy path, particularly with the Dental Association's relentless lobbying to keep the mercury secret from the public, first attempting to block the bill and then to minimize the dangers of mercury fillings in the patient brochure. Can you imagine? Mercury isn't even called a toxic metal in the brochure. It's simply referred to as a metal. Consumers are entitled to know the warnings and the contraindications of placing mercury in teeth, those listed on the amalgam manufacturers' material safety data sheets sent to dentists, but not privy to patients.
The following are the warnings that the dentists receive and the patients never see, but they are 18 4/16/09 - PUBLIC HEALTH - BILL 090124 entitled to: "This product contains mercury, which is known by the State of California to cause birth defects or other reproductive harm. Removal of clinically acceptable amalgam restoration should be avoided to minimize mercury exposure, especially in pregnant women. " Usually chronic. "The number of amalgam fillings for one patient should be kept to a minimum. " Well, if I had known that, they never would have put a mercury filling in my tooth and I never would have been ill, and neither would any of the people sitting behind me. In addition, there are contraindications that patients don't know about that are on that fact sheet. " We would like to see improvements in the fact sheet addressing the possible removal of several statements which we believe to be untrue, unsubstantiated and/or not helpful to a patient trying to make an informed decision. And that's what the ordinance 11 is about, and it does not fulfill that portion of the ordinance. Realizing the complexity and the breadth of this dental health issue, Commissioner Schwarz generously offered to revisit the fact sheet for revision as new information was presented, and we are grateful for that. We as a group thank Councilwoman Reynolds Brown for coming to the plate to champion this bill, which unlocks the dental profession's longstanding mercury secret. We salute you, and despite our concerns relative to certain language and the exclusion of 20 4/16/09 - PUBLIC HEALTH - BILL 090124 manufacturers' warnings, we request that City Council vote to require immediate distribution of the brochure in its present state so as not to delay consumers from learning that their silver fillings are really mercury and that they have a choice of a non-toxic filling. We ask that steps be taken to prepare a new brochure that at least will provide the same information and warnings that manufacturers distribute to dentists with their amalgam products. Although patients are entitled to receive this information, they rarely do. " I would like to introduce now -- may I do that or will you call the next person?
I have my script here, so I'll be calling up all the others to testify.
Okay. So I won't call anybody up, but I would like to say one more thing. There has been a bill 12 introduced by Senator Daylin Leach on the state level. He introduced it in the House, and now he's a Senator and we have a bill in the House and the Senate now. It's a similar bill for informed consent brochures on the state level, and Leach said, "You don't go to the dentist's office thinking your treatment will involve a potentially harmful toxin. Pennsylvanians should also be aware of the health and environmental threat and of the existing effective alternatives to mercury fillings. My bill will do just that," and we thank him, too. 22 4/16/09 - PUBLIC HEALTH - BILL 090124
We thank you for your testimony. For the record, was it you or a representative from the Coalition for Mercury-Free Dentistry that were able to be a part of those discussions and deliberations over the past many months?
I was at the meetings, along with Charlie Brown and two dentists.
Okay. All right, then. I just wanted that to be reflected in the record.
Any other questions or comments from members of this Committee? (No response.)
Well, we thank you for your advocacy and for your contagious passion around an issue that has caught the attention of all of us and ultimately will make a difference. For me, my impetus was the potential impact 23 4/16/09 - PUBLIC HEALTH - BILL 090124 on newborns and children.
More information is always, always better. What the consumer ultimately does is what they do, but the more information is always better.
You know, my concern -- and I'll just say this. My concern is the way the fact sheet is written now, there are a lot of conflicting comments. One sentence says it's dangerous and the very next sentence says there's no proof that it's a problem. So you have somebody in a dental office with no understanding of what this is all about, and at the end of the brochure, it says ask your dentist. Well, you have a group of minorities and low-income people who also are not aware 24 4/16/09 - PUBLIC HEALTH - BILL 090124 that Medicaid and HMOs will pay for a white filling. That was included in this brochure until the last draft, and nobody at the last meeting with the Department of Health ever brought that up. It was in there and all of a sudden, it surreptitiously disappeared. So you have people who are on Medicaid who will ask their dentist, What is this all about, and he'll say, They're safe, don't worry about it, and they'll throw mercury in a pregnant woman's teeth or in a child's tooth. There is no reason why that Medicaid element was removed, and I would like to ask Dr. Schwarz actually how that happened. It was never part of the discussion during that meeting.
Well, the reality for us today is that there have been many, many months of collaborative thinking around the table, and we work in a process where seldom does anyone at that table end up with 100 percent on 25 4/16/09 - PUBLIC HEALTH - BILL 090124 their issue. It's a process that moves us to find as much common ground as we can, recognizing and accepting that we will never be 100 percent of where we want to be. And the goal of this document was to move the needle so that we're at a different place than where we started five years ago.
I think we're at definitely a better place. It's probably the best brochure in the country. However, it is confusing and it wasn't -- the idea was not to balance it. It was to give patients the truth based on science. And the fact that I'm bringing up the Medicaid issue is, there were many discussions at that last meeting and it went back and forth, take this out, put this in, but that was never brought up. So I was shocked and appalled, and I can't imagine why poor people shouldn't know that they can have white fillings at no extra charge. Why don't they know that? Their dentist is not going to tell 4/16/09 - PUBLIC HEALTH - BILL 090124 them. And that's the first thing that should be changed.
Well, after we take care and wrap this up in a neat way and acknowledge all the work that's been done, that may become a next opportunity, but it's imperative that we wrap up the enormous amount of work that's been done --
And the next issue that has never been addressed is implementation. How do we know that the dentist is giving it to the patient? How do we get it to the dentist? I mean, that's never been discussed in any of the meetings that I've been in.
Well, that's well taken. Our role is legislators. We're not the experts and we're not the implementers. But I'm confident, given the professionalism and 27 4/16/09 - PUBLIC HEALTH - BILL 090124 the leadership of that office, that what we move to and what moves to the Mayor's desk will indeed be honored and executed.
Thank you very much. You're welcome. Our next panel, Dr. David Tecosky, Philadelphia Dental Society, and Dr. Elsie Casimir, New Era Dental Association. (Witnesses approached witness table.)
Please state your name for the record and you're welcome to proceed with your testimony.
I'm Dr. Arnell Lloyd. I'm here representing Dr. Elsie Casimir for New Era Dental Society. Also I'm here on behalf of the Greater 28 4/16/09 - PUBLIC HEALTH - BILL 090124 Philadelphia Health Action Non-Profit Community Health Center, which I'm currently the Dental Director for, and so this topic is near and dear to my heart. I'd like to say that probably in the beginning dentists were a little rowed about this issue, mainly because we've seen how successful fillings have been, amalgam fillings have been, long term compared to the tooth-colored or resin fillings. And so with that said, I'd like to thank City Council and especially Councilwoman Blondell Reynolds Brown for bringing this to the forefront, because I think what you did was educate not only the constituents, the public, but probably a lot of dentists also. We weren't exactly always aware of all of the scientific information that goes into the research which the Department of Public Health put into putting this brochure together. There was a lot of research, and I commend them, commend 29 4/16/09 - PUBLIC HEALTH - BILL 090124 you, because it's based on fact and not just doing, you know, information that cannot be proven. So we're going to stick with that. Also, New Era supports the current brochure in its form. I mean, 100 percent. I mean, I'm sure we would have liked to have had some other issues included. However, it's a starting point and will educate, and contrary to the -- well, I don't want to start anything, but contrary to the previous speaker's statement about dentists not informing the Medicaid population about their choices, a lot of them do know. That's what my population is basically that I deal with, and they do come in and they do request resin fillings, and at that time I do educate them on the differences, not just the differences of amalgam, but resin versus amalgam, why you should or should not have an amalgam and why a resin filling may be better for you or why it may not be better for you. 30 4/16/09 - PUBLIC HEALTH - BILL 090124 And, as you said, an educated consumer is the best type of person, the more information you have. As Oprah says, when you know better, you do better. And that's what we're trying to do. I agree with not putting it into pregnant women's mouths. So that issue is at the top of the list. Young children, because their teeth are going to exfoliate or fall out at some time, it doesn't have to last a long, long time like an adult's. So we can use more resin in children. However, I still say that amalgams last longer and are more compatible with the tooth structure if it's a deep cavity, and a lot of the patients that I deal with have deep cavities. But with that said, again, I'd like to take the opportunity to thank all of City Council, again, Councilwoman Blondell Reynolds Brown. I think that now that the fight is over and, you know, that everything is in place, I think it's 31 4/16/09 - PUBLIC HEALTH - BILL 090124 wonderful what you have done, and we will take this opportunity to inform our patients and talk about the differences between amalgam and resin.
Well, thank you for your testimony. We do have questions, but we want to hear from our other witness and then we'll open it up to questions. Please, sir.
Chairwoman Tasco and members of the Public Health Committee, thank you for allowing me to speak before you today. My name is Dr. David Tecosky. I'm a practicing general dentist in Philadelphia, and I am President of the Philadelphia County Dental Society representing Philadelphia's dentists. I also speak today on behalf of the Pennsylvania Dental Association. I am here today to testify in support of Bill No. 090124, which would approve the dental amalgam brochure 32 4/16/09 - PUBLIC HEALTH - BILL 090124 recently adopted by the Philadelphia Board of Health, and we thank you, Councilwoman Reynolds Brown, for your efforts on this issue, and I think that Dr. Lloyd expressed it very well. As this Committee has wrestled with this issue repeatedly over several years, there is no need to remind you of its long history. Fortunately, the City Council chose to rely on the public health and scientific experts on the Board of Health to develop a scientifically sound brochure, and we are hopeful that we have reached the end of this difficult journey. This brochure was required by legislation passed by City Council on December 13, 2007. Since that time, our dental associations have worked with the Board of Health and the Health Department staff to ensure that this brochure will be a helpful tool as we continue to inform our patients about their dental restorative choices, while maintaining a 33 4/16/09 - PUBLIC HEALTH - BILL 090124 strictly scientific and accurate viewpoint. With the strong leadership of Deputy Mayor Schwarz, the Philadelphia Board of Health approved a brochure in February which we believe accomplishes both goals. Dental amalgam is a safe, affordable and durable material that has been used to restore the teeth of more than 100 million Americans. Dental amalgam has been studied and reviewed extensively and established a record of safety and effectiveness. The Board of Health has reviewed that record and the scientific studies underlying it. The resulting brochure is not what we recommended to the Board of Health, but it is an acceptable compromise that is supported by science and addresses an issue that is clearly of concern to City Council and the Board. On behalf of the dentists of Philadelphia, we ask that this Committee approve the brochure as written by the 34 4/16/09 - PUBLIC HEALTH - BILL 090124 Board of Health. Thank you for your time and consideration.
We thank you very much for your testimony, and we do have questions from Councilman Jim Kenney.
I didn't obviously follow this issue as closely as Councilwoman Brown or the people involved in the discussion, but is it the filling itself or is it the insertion and removal of the filling is what causes the problem? I mean, is the filling in the mouth in a solid state, is that an issue or is it just when it's heated to be put in or heated to be taken out?
I think that the concern is not the material in its use in wearing it. The question is, is there an 35 4/16/09 - PUBLIC HEALTH - BILL 090124 effect of the mercury. It's not heated when it's used. It's mixed. And once it's mixed, it's already in a form that is not free mercury.
But when you're taking it out, you're drilling it out, so you're creating a heat from the --
But I'm saying, is the assertion of its danger when it's going in and when it's coming out or when it's in there?
I don't believe that we believe that there is danger, significant danger, from that.
Okay. But I'm saying once it's -- I go to the dentist enough, and I actually enjoy going to the dentist, frankly. I know a 36 4/16/09 - PUBLIC HEALTH - BILL 090124 lot of people don't like it, but I don't mind it at all. But when it's set in the cavity, there is no -- even the people who are advocating to get rid of it altogether are not contending that there's a leaching issue or any type of --
You have to ask them that, but I believe there's an extremely low level of release in chewing and grinding of teeth, extremely low.
I mean, one of the things -- I mean, the last testimony, certainly people have their opinion and they're dedicated to their issue, but I'm listening to the two of you and I can't imagine you putting anything in anyone's mouth that you knowingly would think was going to harm them. And I'm sorry, Doctor. You're --
In your cohort of patients, I can see you're a dedicated person who is working with a 37 4/16/09 - PUBLIC HEALTH - BILL 090124 population that really needs your help, and I can't imagine that any of you guys would knowingly do something to hurt your patients. I think it's pretty obvious. But, I mean -- because some of the testimony in the past was the Dental Society's secrets and not -- I mean, I just want to make sure that we don't leave here today thinking that you guys are somehow trying to cover up something or hide something.
No, not at all. I still have amalgams in my mouth that I've had for better than 40 years, and I would not remove them unless I needed a new filling, and maybe I would put in a resin filling only for cosmetic purposes. It wouldn't be because I was fearful of the mercury in the amalgam. And then amalgam is what it says, like when you say that amalgam is mercury, it's not -- amalgam by its very definition is a conglomeration of different substances, and it's a little 38 4/16/09 - PUBLIC HEALTH - BILL 090124 of this, a little of that, a little of this. So it's not entirely mercury anyway, and that's a little misleading to --
Well, I've read and been told I can get mercury from eating too much tuna, too.
But you guys are happy with at least the compromise as it is today?
Any other questions from members of the Committee? (No response.)
Well, we thank you very much for your testimony. We appreciate the fact that you are professionally okay with the understanding that it's based on medical 39 4/16/09 - PUBLIC HEALTH - BILL 090124 research and we will use the term "an acceptable compromise." Thank you very much.
Our last panel, Karen Palmer, dental assistant; Susan Kreider, registered nurse, and Karen Burns, dental assistant. Please come to the witness table.
You're welcome to come to the witness table. (Witnesses approached witness table.)
Please state your name for the record and proceed with your testimony. Good afternoon, ladies.
Good afternoon. 40 4/16/09 - PUBLIC HEALTH - BILL 090124 My name is Karen Palmer and I want to thank you for this opportunity to express my views, but, most important, my gratitude to Councilwoman Reynolds Brown for her courage in this ensuing battle for the right to know and to all of the City Council members for their unanimous vote in December of 2007. To hold the distinction of the first city ordinance 11 for an informed consent in a consumer fact sheet is certainly commendable, and I will forever applaud all your efforts. I am compelled to present myself to you in regard to informed consent concerning silver mercury amalgam used in restorative dentistry due to the enormity and gravity of this public health issue that has become largely political for so long to the detriment of people, young and old, everywhere. I would venture to guess that most are at least not initially thinking about the first ones to be exposed and negatively affected by chronic mercury 41 4/16/09 - PUBLIC HEALTH - BILL 090124 vapor exposure, even before the dentist or the patient, and that would be the dental assistants, approximately 266,000 in this country that are serving millions of patients and lack the serious full-body protections needed during the placement and removal of this toxic substance. That number is one less, since I being diagnosed as carrying 1,275 percent toxic mercury body burden above baseline normal and having received a definitive diagnosis of mercury poisoning, I could no longer work. I continue to suffer every day from the neurological damage to my body, the result of handling mercury daily for decades at my job as a dental assistant, now disabled because of the severe paresthesia, chronic fatigue syndrome, peripheral toxic neuropathy, loss of tendon reflexes, along with other symptoms of demyelination that is hallmark of progressive neurodegenerative autoimmune diseases like MS, and memory 42 4/16/09 - PUBLIC HEALTH - BILL 090124 loss. What I am now aware of and experienced firsthand is that all dental hygienists release vapor from mercury when they scale and scrape teeth with a hand or electronic instrument and when they polish teeth with a rubber cup or bristle brush. As dentists drill fillings, even more significant levels of vapor pour off the fillings. The dust and the particles created from the drilling process contaminate the patients, the doctor, the staff, surrounding countertops, walls and floors, and in fact, mercury vapor goes right through the mask and gloves I was told were protecting me. Dental students need to take note and beware. Optimal evacuation and ventilation devices and equipment are so key for everyone who enters into a dental office, school or hospital clinic. What happened to we are "first to do no harm"? Dentists that continue to place 43 4/16/09 - PUBLIC HEALTH - BILL 090124 this known neurotoxin are affecting the health of the entire body as the mercury leaches out of the fillings and is absorbed throughout, sadly, from head to toe. It is most sobering to note that mercury lodges in the brain, where it stays year after year, suppressing the immune system and killing neurons by destroying their myeline sheath. I am proof of that. Have you ever wondered where all the mercury-laden dental wastewater goes and its subsequent use after it reaches the sewage treatment plants? As then called sludge, sold as fertilizer for food that we eat, and the vicious cycle continues. This problem can easily be solved with the installation of amalgam separators that capture the mercury, which is later properly recycled before leaving the dental office. Patients must be told when they are given a choice of filling material 44 4/16/09 - PUBLIC HEALTH - BILL 090124 options that each silver amalgam filling being placed just inches from their brain contains at least 50 percent mercury and that mercury vapor is released when they chew, brush or grind their teeth and also when they eat hot or cold drinks or food.
Mandatory informed patient consent is crucial because of the permanent damage to the brain and kidneys that can occur. Much to my discredit, I now know more about mercury toxicity than in all the years I handled it. Needless to say, I am outraged to learn all this, much too late in coming, when I realize I was slowly poisoned over time from a profession that I gave the best years of my life. " 45 4/16/09 - PUBLIC HEALTH - BILL 090124 It is profoundly clear to me who truly has our best interests at heart. Now I understand fully why individual cities and states are no 6 longer waiting for federal agencies like the FDA or the EPA to best protect their citizens and their pristine environments in Arizona, California, Connecticut, Maine, New Hampshire, New York, Oregon, Rhode Island, Vermont, Kansas, Massachusetts, and the list goes on and on. I hope and pray Philadelphia and Pennsylvania will be added to the list, and soon. This Council has a very unique opportunity to have an enormous positive impact on the current and future health and well-being of the people and environment of this great city. I remain faithful that they will seize the moment to do just that. And if I may just, in closing, address this gentleman, Councilman Jim Kenney, who had a question about the 46 4/16/09 - PUBLIC HEALTH - BILL 090124 mercury in the fillings in the placement. The state House bill by Daylin Leach, if I can just read what his website says, "A full one-half of a typical dental amalgam filling is made up of liquid mercury, but I would surmise that most people are not aware of the risks that can be involved with that. Leach explains that mercury is a toxin that attacks the central nervous system and endocrine systems. Overexposure to mercury can cause damage to the brain, nerves and hormonal functions, often producing a condition nearly identical to autism. " That does not mean that others are not at risk for neurological damage. That would be me. Mercury fillings are currently considered by the federal government to be an environmental hazard before and after their use, and other studies show 47 4/16/09 - PUBLIC HEALTH - BILL 090124 some release of mercury during installation of the fillings and continued emission of mercury vapor throughout the life of the filling.
I do have copies of my testimony for you all. May I present that?
You can remain seated. We'll certainly pick that up from you. Thank you.
I want to say that I have a gift for you, Councilwoman, and for all of you, and it comes in the form of these three color handouts at the back of my testimony.
There are three things. The first thing to protect the patient is known as a clean-up device. It is a small ring that fits around the 48 4/16/09 - PUBLIC HEALTH - BILL 090124 tooth that virtually sucks the vapor and the particulate matter while the tooth is being drilled. The second photo is of a six-inch corrugated hose type that fits on your chest, so that when dentists are drilling and that voluminous vapor is emitted, the hose collects all of it, and the staff and the doctor and the patient are not recontaminated. And the third picture is a picture of a mercury amalgam separator. Three things can solve this whole problem for everybody in this world.
Thank you for your testimony and for your exhibits. Please, you want to state your name for the record and proceed with your testimony.
My name is Karen Burns and I'm a dental -- I'm a disabled dental assistant. I was a dental assistant for 24 years until I couldn't 49 4/16/09 - PUBLIC HEALTH - BILL 090124 do it anymore. First, I want to thank you for your tireless effort in getting this done, and Freya Koss, too, and everybody who sincerely is working on this, not just acting as if they're working on it. There are studies -- everyone is talking about the science and the studies. There are studies in other countries that, of course, we can't use here. And in Norway alone where they did an extensive study on dental assistants getting sick, amalgam has been banned. I believe that since people are all getting sick in different ways -- like Karen spoke about her illness. I have fibromyalgia, chronic fatigue. I can't think straight anymore. I can't type. That's why I didn't type you out what I was going to say today. I gave you my test of the mercury that's in my body. I've been working for years, I guess eight years, trying to get the mercury out of my body, and I've spent 50 4/16/09 - PUBLIC HEALTH - BILL 090124 thousands of dollars out of pocket, because this is socially unacceptable, because there's no science saying that what mercury poisoning is, where I'm getting it from. When I tried to get workers' compensation, they asked me if I ate tuna fish. They would not accept the fact that that mercury -- you see that line -- that that is what's causing my illness. So now for eight years and thousands of dollars, I sit and get IV treatments three times a week and pay for it out of pocket, and it's only come down -- it's still in the elevated area. I think, like Karen said, we need to first protect the patients and then, of course, protect the dental assistants and, of course, the dentists. I don't know how they can think that this is safe and how they can sleep at night, because I'll tell you, I feel terrible that I mixed those amalgams that these dentists put into these patients' mouths, especially young children and pregnant 51 4/16/09 - PUBLIC HEALTH - BILL 090124 women. And that's all I have to say.
Good afternoon. My name is Linda Shein. Thank you for hearing my testimony this afternoon.
I was rarely sick as a child and young adult. Then at age 31, the dentist told me my fillings all needed to be replaced and did I want to use silver or gold. I asked, What's the difference? And the dentist said, Nothing, but the silver costs about one-quarter of the price. As I had just finished graduate school and had serious loans to pay off, 52 4/16/09 - PUBLIC HEALTH - BILL 090124 I say, Well, that's easy, I'll take the silver. Shortly thereafter, I had menstrual bleeding for 40 days, and every day at various times I would feel a fog come over me and be unable to think clearly at work. I did not make the connection to my dental work. Who would? I trusted my dentist, and he didn't tell me that there was really a difference between silver and gold. Over time I developed severe headaches and allergies to all kinds of foods and medicines and got sick with every viral infection that went around. It took weeks to recover from infections that should have passed in days. The allergies got worse over time, progressing to fragrances, including cleaning chemicals and perfumes, making it impossible for me to work in a normal business setting. I spent all I had trying all kinds of therapies, none of which helped and many of which made me 53 4/16/09 - PUBLIC HEALTH - BILL 090124 sicker due to my allergies and weakening immunity. One day I met a realtor and explained the type of fragrance-free housing I needed, and she asked me if I had mercury poisoning, as she had suffered with this same syndrome. She said it was often caused by silver fillings, which are really 50 percent mercury. Mercury, I said? No way. She referred me to a medical doctor who had suffered the same illness, who helped her to recover. I went to see this doctor. The first thing he said was, Open your mouth. Did you know that you have a mouth of full of mercury? I was horrified, really horrified. He took a careful history, which made it very clear that all of my problems started when those very fillings were placed. After removing my fillings last 54 4/16/09 - PUBLIC HEALTH - BILL 090124 year, six weeks later I began to tolerate more vitamins and supplements, things I had not been able to take for years. By being able to take these supportive therapies, my system slowly got stronger, and over the next few months, I was able to tolerate almost any vitamin or supplement I took, and many of my food allergies went away. This was my first amalgam-free winter in many years, and, finally, I was not sick with every bug that came along. I think this might address the question of whether or not there is mercury coming from these fillings once they're placed. It's not just when it goes in and when it comes out, which is clearly when the biggest dangers are, but when you heat them up, as the dental assistants pointed out, when they clean your teeth, when they drill on them one way or the other, when you chew, when you drink coffee. I was having the biggest problem sort of late morning at work after I'd have a cup 55 4/16/09 - PUBLIC HEALTH - BILL 090124 of coffee, right after lunch after I had my next cup of coffee, and that's when my head would go weird, probably because the amalgams were being heated up. So now I am 48 years old. When I was 31, had the dentist told me the truth about the difference between silver and gold fillings was that silver contained 50 percent mercury, not an amalgam of a little bit of this and a little bit of that. There's a little bit of this and that of everything but the mercury, which is 50 percent. Had I been told that there was 50 percent mercury in the filling that he would place, I never would have opted for silver and would not have had my life become one of endless sickness and struggle. It is the right of every American to know what is being placed in his or her body and to make the choice of what he or she wants.
It is really unclear just who we are protecting by not disclosing this critical life-altering 56 4/16/09 - PUBLIC HEALTH - BILL 090124 information. I do not understand the agenda. I do not understand who is being protected by not fully disclosing the actual science around this material. Thank you very much for providing a disclosure flyer for dental patients regarding the mercury content of amalgams so others will have the chance to make the informed decision that I did not have. It is critical to get this brochure approved and distributed without delay, I do agree. However, having reviewed the brochure as it currently stands, I believe it leaves too many ambiguous portions that would enable a trusting patient to turn to the very dentist who placed all the amalgams in his or her mouth and ask, What do you think? There can be no room for doubt in this disclosure flyer, as the well-intentioned dentist -- and they really are well-intentioned. They really truly are not trying to hurt anybody. 57 4/16/09 - PUBLIC HEALTH - BILL 090124 They don't know that they are, and to actually realize as Karen did, that they're placing this poisonous substance into children and adults all over the practice, would be a horrifying thing to realize. Nobody is trying to kill people here. However, the reality is still the reality of what this stuff is. So there can be no room for doubt in this disclosure flyer, as the well-intentioned dentists, many of whom are unknowingly mercury poisoned themselves, truly believe there is nothing wrong with these fillings based on years of trusting the American Dental Association, the same way that I trusted my dentist. For a dentist placing amalgams all these years, it is understandable that this type of information threatens the very core of his or her belief system, implying that he or she may have already poisoned the very patient asking the question about the next fillings he will place. 58 4/16/09 - PUBLIC HEALTH - BILL 090124 There is no room for ambiguity in this disclosure or we risk it will not accomplish its important task. Again, please make whatever changes are being proposed to remove the ambiguity while getting it published without delay. Thank you.
Thank you very much. Any questions from members of the Committee? (No response.)
We wish to thank all of you for your very compelling testimony. Thank you very much. Anyone else to testify on Bill 18 No. 090124? Please, sir, you're welcome to come forward. Are you Mr. Paul Gilbert?
Good afternoon, sir. 59 4/16/09 - PUBLIC HEALTH - BILL 090124
State your name for the record and proceed with your testimony.
My name is Dr. Paul Gilbert and I have a license to practice dentistry in New Jersey, Pennsylvania and New York state. I'm actually retired now, but I did have a license -- or I do have licenses in those states. I graduated in 1962 from the University of Pennsylvania right here in Philadelphia. I practiced about 44 years before I retired in 2006. I used mercury fillings for 11 of those years only, and the remaining years I practiced without it. So I've seen a lot of change occur in dentistry. So you'll understand where I'm coming from, I am a lifetime member of the American Dental Association. I joined it in 1962 when I graduated, and I joined because it represented dentistry and because pretty much everyone just 60 4/16/09 - PUBLIC HEALTH - BILL 090124 simply joined. It was just the thing to do at that time. I followed the American Dental Association's position on amalgam and other things that they tend to emphasize, like fluoride, for years by reading virtually every American Dental Association newsletter that's come out, particularly in the last or years, 11 and reading through all of the journals 12 that they have. They come out with a 13 monthly Journal of the American Dental 14 Association. And from the newsletter 15 particularly, it became evidently clear 16 to me that the American Dental 17 Association is a trade organization, with 18 the sole purpose of supporting the 19 financial well-being of itself and of 20 dentists. I mean, this is what it should be, but the American Dental Association -- and remember, I'm a member -- also supports -- they say they support the health of the public, and this is true only if a particular issue 61 4/16/09 - PUBLIC HEALTH - BILL 090124 makes dentists and the dental profession look good, hence the American Dental Association's relentless support of amalgam and its equally relentless attacks on tobacco, lead and sugar. I'm also a Master of the Academy of General Dentistry. That's an organization that supports general dentistry and fosters continuing education. So I'm well educated. In 1985, I joined the International Academy of Oral Medicine and Toxicology, and I understand that I'm representing them. The International Academy of Oral Medicine and Toxicology -- and I'm a Board member now -- is a network -- and this is on their website -- of medical and research professionals who seek to raise the standards of scientific biocompatibility in dental practice with information from the latest interdisciplinary research. That means that what they teach us comes from scientific research from all over the 62 4/16/09 - PUBLIC HEALTH - BILL 090124 world and from not necessarily just dental professionals. It's also peer-reviewed research. It's only peer-reviewed research that they will present at meetings. And I say this in spite of a derogatory and contradictory statement by Dr. Gamba in a letter that he wrote to the Board of Health. So I want you to understand that I am quite familiar, by having read articles -- or I should add that the International Academy of Oral Medicine and Toxicology, the IAOMT, also has a newsletter, and in that newsletter, every single issue -- they print abstracts of scientific research, international research, almost always on mercury. They're usually abstracts, because the articles are too long to present in a small newsletter. So I have read countless pieces of research that all come to the conclusion that amalgam is toxic or at least because the mercury that's in it. I have never seen a piece 63 4/16/09 - PUBLIC HEALTH - BILL 090124 of research that ever came to a conclusion that it was safe, unless the research came from the American Dental Association. Otherwise, always toxic. Councilman James, you had a question about amalgam, about whether it emits mercury or not, and I wanted to perhaps clarify it even a little further from what you've already heard. If you look in the dictionary -- and I did.
I just took my Webster's College Dictionary, not a very sophisticated one, down from the shelf. If you read the word "amalgam," you will see that amalgam is technically a mixture of any metal with mercury. Now, the word "amalgam" is used for other reasons as well, but that's its technical meaning. It has to be something mixed with mercury. It could be gold, it could be silver, it could be tin, it could be any one of the components that are in dental amalgam. But it's a mixture. And if you read about the definition of the word 64 4/16/09 - PUBLIC HEALTH - BILL 090124 "mixture," you will see it says that a mixture is any substance or several things that are combined, but the key thing is that they always retain their individual properties. So if you had to take salt and you would take sugar and mix them together, you might not be able to tell which is the salt and which are the sugar grains, but nevertheless, each one of those grains is either salt or sugar, whether you put them in water or not, whether you evaporate it and dry them out. It's still always sugar and water, and that's true with amalgam. It is always made up of the metals that combined it. Now, it's a unique mixture because there is some interaction between the components, but the fact is that the silver will -- you can still identify the silver that's in it, the tin that's in it, the zinc that's in it, and you can certainly identify the mercury that's in it. If you shine a mercury vapor lamp on 65 4/16/09 - PUBLIC HEALTH - BILL 090124 it, you can demonstrate the vapor coming off the filling without any -- without doing anything to the filling. You can just hold the tooth with the filling in your hand and you'll see it. If you take a drum analyzer, which is a scientific device intended to measure mercury vapor in the air -- it was intended originally to be used in a factory, but it simply measures mercury in the air. Whether you stick the nozzle of the machine in the air in a factory or you put it in someone's mouth, you can always measure mercury vapor coming off. The point is that these fillings emit mercury vapor all the time. Now, my dental colleagues there tell you that the amount coming off is very small. " In science when you talk about toxins, you must talk about specific amounts, because "very small" and "minuscule" don't really mean 66 4/16/09 - PUBLIC HEALTH - BILL 090124 anything. If I told you that there's a small amount or a minuscule amount of dioxin in the food you're eating, I think you would understand that's still of concern. Or lead, if you -- well, let me give you a good example, an analogy that makes it easier even to understand. If you were stopped by a policeman for speeding and you asked, How fast was I going, and he said, Well, you were going a little over the speed limit. But how fast was I going? You were going a little over the speed limit. You see, unless you have a measurable amount, you can't know how much you were speeding. So the same thing is true with mercury coming off fillings. A scientific organization -- or at least they say they're a scientific organization -- like the dental profession that never tells you the specific amounts, but always puts it in terms that make it sound as though it 67 4/16/09 - PUBLIC HEALTH - BILL 090124 doesn't mean anything, it's insignificant, to me is unprofessional and doesn't tell you the actual truth about the matter. Part of my testimony was to read through part of a letter that I received from James Love. You have a copy of it. He is associated with the International Academy of Oral Medicine and Toxicology, and there's a particular issue that he talks about that I think would be helpful that you understand. His letter is rather long, so I only highlighted significant areas, and I'll reduce it to about a third of its length.
" He said, "Several years ago, I agreed to serve as lead counsel for David Barnes, a dentist who was profoundly injured by his occupational exposure to mercury 68 4/16/09 - PUBLIC HEALTH - BILL 090124 fillings. A lawsuit was filed against Kerr Corporation, America's largest manufacturer of dental fillings," including amalgam, of course. "Dr. Barnes used Kerr's mercury filling products in his practice," and he demonstrated that he was exposed to it in several ways to the Court. "Kerr took the position that Barnes had been adequately warned of mercury's dangers through its material safety data sheets that are distributed with the products. "
Mr. Gilbert, forgive me for intruding on your testimony. We do have another hearing. So I need you to help us honor this clock and move to the back end, last paragraph of your testimony, because we are now under the gun of the clock. 69 4/16/09 - PUBLIC HEALTH - BILL 090124
Okay. Essentially what came out of this court issue is that the warnings that are supplied with amalgam -- and Freya Koss read you them -- apply to the mixed amalgam as well as the mercury, and in the State of Pennsylvania, as well as many other states, there is a law that says -- it's the law of what's called the Learned Intermediary -- that a manufacturer no longer is responsible for passing the warnings on to patients. This has to do with dentists in the healthcare --
Let me ask you this question, because our last hearing that we had a year ago dealt with all the issues around research and the like. What I need to know today is this: Do you approve or disapprove of the brochure that has come before this Committee? That's what we need to know.
I approve of the brochure, but I think -- not I think. I 70 4/16/09 - PUBLIC HEALTH - BILL 090124 am convinced that the information that's in an MSDS about amalgam needs to be incorporated into the brochure, and without that information, the patient is not getting enough information to make a truly informed decision. Thank you.
Okay, then. We thank you very, very much for your testimony. Anyone else to testify specifically on your view with regards to the brochure that is before this body this afternoon? (No response.)
And the amendment has been circulated. 71 4/16/09 - PUBLIC HEALTH - BILL 090124
I have to close the hearing. We'll now close the hearing and go into the public meeting. The Chair recognizes Councilwoman Brown for amendment to Bill 8 090124.
Yes. I do offer an amendment to Bill No. 090124, and essentially it says that once we act on this measure today, that the brochure will indeed be approved and not require the brochure to circle back to this Committee.
Any opposition? (No response.) 72 4/16/09 - PUBLIC HEALTH - BILL 090124
There being none, the amendment is approved. The Chair recognizes Councilwoman Brown for a motion to move Bill 090124 out of Committee.
Thank you, Madam Chair. I do move that Bill No. 9 090124 be moved out of Committee, as amended, with a favorable recommendation and further move that the rules of Council be suspended so as to permit first reading at our next scheduled session of City Council. (Duly seconded.)
It has been moved and seconded that Bill 090124 be reported out of Committee with a favorable recommendation and a recommendation that the rules of Council be suspended so as to have its first reading at Council's next session. All in favor will say aye. (Aye.)
Is there 73 4/16/09 - PUBLIC HEALTH - BILL 090124 any opposition? (No response.)
There being none, the motion is carried. The bill is reported out of Committee. And unless there's any other business, this Committee is called to adjourn. Thank you. (Committee on Public Health and Human Services concluded at 2:30 p.m.) - - - 74 CERTIFICATE I HEREBY CERTIFY that the proceedings, evidence and objections are contained fully and accurately in the stenographic notes taken by me upon the foregoing matter on April 16, 2009, and that this is a true and correct transcript of same. ______________________________ MICHELE L. MURPHY RPR-Notary Public (The foregoing certification of this transcript does not apply to any reproduction of the same by any means, unless under the direct control and/or supervision of the certifying reporter.)