COUNCIL OF THE CITY OF PHILADELPHIA COMMITTEE ON LICENSES AND INSPECTIONS - - - Room 400, City Hall Philadelphia, Pennsylvania Wednesday, May 30, 2007 1:15 p.m. - - - PRESENT: COUNCILMAN DANIEL SAVAGE, CHAIR COUNCILMAN JACK KELLY COUNCILWOMAN BLONDELL REYNOLDS BROWN COUNCILMAN FRANK RIZZO BILL 040904 - An ordinance amending Title 9 of The Philadelphia Code, entitled "Regulation of Businesses, Trades and Professions," by adding a new Chapter requiring dentists to post and distribute certain information concerning the use of mercury in dental procedures, and requiring dentists to install systems that permit the recycling of mercury waste; all under certain terms and conditions. - - - 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 Committee on Licenses and Inspections is now in session. Will the Clerk please read the bill to be heard today.
An ordinance 8 amending Title of the Philadelphia 9 Code, entitled "Regulation of Businesses, Trades and Professions," by adding a new Chapter requiring dentists to post and distribute certain information concerning the use of mercury in dental procedures, and requiring dentists to install systems that permit the recycling of mercury waste; all under certain terms and conditions.
I would like to recognize that a quorum is present. To my left we have Councilman Rizzo, Councilman Kelly and Councilwoman Blondell Reynolds Brown. We will now hear testimony on Bill No. 040904. Is there anyone here from the Administration to testify? 3 5/30/07 - L&I - BILL 040904 The Chair recognizes Councilwoman Blondell Reynolds Brown for remarks.
I thank the Chairman of the License and Inspection Committee. On behalf of the staff and all of the stakeholders who have worked over the past many months on this issue, we want to first say thank you, and we need to acknowledge that some things are not as they seem. Silver fillings must be silver, right? The answer is wrong. They are mainly mercury, a toxic material. But a Zogby poll says that over three-quarters of Americans simply do not know that. The United States Food and Drug Administration makes sure that only safe products are on the market, right? Not in 2007. The FDA admits it doesn't know if those mercury silver fillings are safe or unsafe, yet keeps them on the market without warnings. 4 5/30/07 - L&I - BILL 040904 Exposure to mercury can permanently injure the developing brain of a child or fetus. FDA bans mercury in any medicine or lotion for horses and dogs. So for the FDA, children are coming in last. Not acceptable. The dentists should decide on what kind of filling material to use, right? Yes and no. Healthcare decisions should be made by the patient with proper informed advice. The EPA says for the sake of a baby, a pregnant woman should try to avoid all mercury exposures, and silver fillings is one of them. She should tell the dentist she is pregnant and ask about the alternative, such as the white-colored fillings also known as resin. With these contradictions, it's time for us as public policymakers to look deeper. I've introduced a bill to require disclosure of this mercury to all patients and, further, to put environmental requirements in place to 5 5/30/07 - L&I - BILL 040904 stop this mercury from going from dental offices into our City's wastewater. So this is also for us an environmental issue. Today's hearing here in these Chambers will allow the members of the License and Inspection Committee to examine and look for solutions. With FDA taking a pass, we may indeed have to solve this problem for ourselves. I thank you for the testimony, Mr. Chairman, and we can now move to those offering remarks.
Thank you. We will now hear testimony from the Administration. Could you please state your name for the record.
Good afternoon. I'm Dr. James Dean. I'm the Medical Director for the Department of Public Health. Chairman Savage and members of the Council and the Committee on Licensing and Inspections, thank you for the opportunity to offer the perspective 6 5/30/07 - L&I - BILL 040904 of the Department of Public Health on Council Bill 040904, which would require that public information on the use of mercury in dental procedures be made available to patients of all dental practices in the City and require the installation of amalgam separators in the wastewater lines of dental practices in the City. The issues surrounding the proposed legislation include the concerns of whether the mercury content of amalgam fillings causes toxic amounts of mercury to enter the body and whether additional pre-treatment of wastewater discharges from dental offices is needed to remove solid materials that might contain mercury from the wastewater prior to discharge into the City's sewer system. Dental amalgam restorations, commonly known as, quote, "silver fillings," are used to fill or restore tooth surfaces that have cavities. Amalgam is a metal alloy comprised 7 5/30/07 - L&I - BILL 040904 primarily of silver, copper, tin, zinc and mercury, and it's been used as a reliable dental restorative material for more than 150 years. The use and safety of dental amalgams has been comprehensively reviewed for many years and has generally been established as a safe and effective means of restoring tooth surfaces. Professional organizations and government agencies nationally and internationally, including the United States Public Health Service, the Food and Drug Administration, the American Dental Association, the American Medical Association, the World Health Organization, the Centers for Disease Control and Prevention, and the National Institutes of Health, have continued to investigate the safety of amalgams used as dental restorations. These organizations have reviewed and investigated scientific literature looking for links between dental amalgams and health problems and, to date, no 8 5/30/07 - L&I - BILL 040904 valid scientific evidence has been reported by any of these agencies that shows the use of amalgam causes harm to children or adults, except in the rare cases of allergy. The recommendation of these agencies is, therefore, that amalgam is safe and effective for restoring teeth and should continue to be used in the general population. While there's insufficient evidence to assume that components of other restorative materials would have fewer potential adverse health effects than dental amalgam, including allergic reaction, there remains some controversy on the use of amalgam. We acknowledge that there are anti-amalgam proponent groups that include dentists, other healthcare professionals and scientists. Some advise not only against the use of amalgam fillings but also recommend that persons with existing amalgam fillings have them removed and replaced with other materials. 9 5/30/07 - L&I - BILL 040904 Bill 040904 has been in Committee since October of 2004, affording the Department an opportunity to evaluate the feasibility and efficacy of such a regulation and its impact on public health. As the Medical Director, I've reviewed the recommendations of the appropriate organizations and government agencies, but also the Department's dental program managers and supervisors, as well as the Board of Health, whose function it is under the Home Charter Rule to promulgate regulations that are to be enforced by the Department of Public Health, have looked at the issue. At this time, we are examining the recommendations of the United States Food and Drug Administration. In brief, the Department has identified the following facts in the area of dental health and amalgam fillings: Number one, the use of mercury in dental procedures remains a highly controversial issue across the country. 10 5/30/07 - L&I - BILL 040904 We acknowledge that.
Number two, while the hazards associated with mercury in the environment in humans are relatively well known and documented by the scientific community, little or no scientific evidence currently exists on the extent, if any, to which the mercury in amalgam fillings affect humans. Number three, many dental insurers do not reimburse the full cost of non-amalgam dental fillings for the use where amalgam fillings are generally deemed appropriate. Non-amalgam, or composite restorations, tend to be more expensive than amalgam fillings and the difference between what is billed and what is received from a patient's insurance will ultimately be the patient's responsibility. The potential reluctance of patients to receive needed fillings because of the amalgam material used, coupled with their inability or unwillingness to pay for more extensive 11 5/30/07 - L&I - BILL 040904 fillings, could have a negative impact on the overall delivery of needed dental care. Number four, for several reasons, large urban areas, including Philadelphia, have large numbers of underserved individuals, both medically and dentally. Persons who postpone needed dental care are more likely to develop more serious dental and other medical problems as a consequence. And, finally, there is a potential for a negative economic impact on dentists serving in the underserved areas of the City, which could result in a further decline in the availability of dental services in these needed areas. Considering the possible negative impact the provisions of Bill 21 040904 could have on public dental health, we are continuing to seek the scientific evidence we need to further clarify the issue and allow us to make the most informed decision on how best to 12 5/30/07 - L&I - BILL 040904 proceed. In May of 2006, in order to address public concern related to the use of dental amalgam, the FDA Associate Commissioner for Science charged the then Acting Director of the FDA's National Center for Toxicological Research with preparing a report on the state of the science on this issue. The purpose of the assessment was to review literature published since 1997 to search for substantive changes that have taken place in the health risk associated with the use of dental amalgam. This report was referred to as the White Paper. And upon completion in September of 2006, the White Paper was presented to a joint committee -- actually, three committees, the FDA's Medical Devices Advisory Committee, the Committee for the Center of Devices and Radiologic Health and, finally, the Peripheral and Central Nervous System's Drugs Advisory Committee. The joint committee members 13 5/30/07 - L&I - BILL 040904 voted to reject the draft White Paper until more research was completed that would accurately assess whether or not mercury in dental amalgam posed a significant health threat. Upon receiving the recommendation from this joint panel, the FDA then opened a public docket in order to collect additional research requested by this committee. The FDA is currently reviewing the new research that was received before their November 9, 2006 deadline in order to determine what, if any, changes would be made to the stance originally set forth in the White Paper. The Department of Public Health believes the scientifically based recommendations of the FDA on the safety of using dental amalgam fillings will provide us with a sounder basis on which to form future recommendations on this issue, and we will continue to monitor the progress of the FDA on this issue. Regarding the issues of this 14 5/30/07 - L&I - BILL 040904 bill that relate to the requirement for the installation of amalgam separators in dental offices for the removal of solid amalgam material from wastewater discharges for recycling, the Department neither regulates the chemical content or the quantities of materials discharged into the City's wastewater system, nor the handling of hazardous chemical waste materials.
We appreciate the concerns of the City Council regarding the public health issues brought forth in this ordinance. At this time, the Department considers the use of mercury in dental amalgam of possible significance and looks forward to the finalization of the ongoing national review of scientific evidence and the issuance of recommendation on the issue. Thank you for the opportunity to present this testimony and I will now answer questions.
Thank you 15 5/30/07 - L&I - BILL 040904 for your testimony. Are there any questions from members of the Committee? The Chair recognizes Councilman Rizzo.
Doctor, thanks for your testimony. Doctor, I read recently that there's been high levels of mercury in farm-raised fish. Could you comment on how that's occurring and what this could be contributing? From what I understand, that it's pretty much limited to fish that are raised in fish farms. And I read in the article that it has to do with what we're talking about today, that mercury is entering into the water system through offices, homes, et cetera, runoff or whatever, but could this be possibly contributing to the high levels of mercury that have been identified in farm-raised fish? I just noted recently this weekend that a restaurant was advertising the fact that their fish that 16 5/30/07 - L&I - BILL 040904 they sold on their menu was -- what's the word I'm looking for? Wild fish, the ones that come from the ocean and not raised in a pond some place. Could you comment on that, please?
What I could comment on, you are correct, there was this concern with farm fish. Most of the mercury that gets into the groundwater is from industrial discharge. In terms of this bill, the average dental office would probably release less than 35 milligrams of mercury into wastewater per day, but large industrial processing plants are where the large amounts of mercury end up into the water.
Well, Doctor, what's such a bad idea? I went and got my flu shot and they wiped me with the alcohol and they put the wiper in a little thing for contaminated materials. Why would we not want to lessen and try to go to zero what we 17 5/30/07 - L&I - BILL 040904 flush down the toilet or drop in the sink?
Our concern and the concern of the Department is that we know dental health in our inner city is a problem, and based on the professional organizations that I mentioned, as well as the governmental organizations, at this point, the evidence doesn't support changing the recommendation. Now, as I said, the FDA is currently reviewing over 3,000 responses that they received to their public docket to the White Paper. If we cause fewer dental practices to be available in the underserved areas of the City, then we run the risk of actually causing a problem because of the medical problems that can exist from untreated cavities and infections, including bone infections, infections of the heart valves, et cetera. So we want to be very careful that we don't discourage individuals from getting needed dental 18 5/30/07 - L&I - BILL 040904 care and causing another problem until we have the appropriate scientific evidence.
Are you suggesting that using an alternative material other than mercury would do what you just described? Are you suggesting that it's so costly that a person wouldn't go to the dentist to get a cavity repaired because there's an upcharge, if any? I just can't imagine there would be that much of a difference in the cost of the material. Is that what you're suggesting, the cost of the replacement for the amalgam filling?
That has been one of the concerns, yes. On the average, from the information that I have, amalgam fillings can cost anywhere from to 30 20 percent more than the traditional -- I'm 21 sorry; the composite fillings can cost 22 more than 25 to 30 percent more. What we 23 don't know is if third-party 24 reimbursement will pay for that and how 25 much of that cost will get passed on to 19 5/30/07 - L&I - BILL 040904 individuals, and at least within the Health Department, the individuals that we see have no -- they don't have dental insurance. They don't have medical coverage. So we're concerned that those who actually see private dentists may have undue burden.
I think what we need for you also to do -- and I'll end it -- is, I don't want to assume anything here. It's too serious an issue that we're discussing. I would hope the Health Department would have the answers to those questions. Is it more expensive or isn't it?
Is it a given that the insurance companies, knowing that there's a health risk, would dismiss paying the upcharge for the alternate material? I think we've got a lot of areas here that I don't feel confident, no disrespect to you, Doctor. 20 5/30/07 - L&I - BILL 040904 But what I need is a matter of fact that the insurance companies would reject or try to pass on to their patients. So I think we need to know the answers to that, and I'm sure that you could help with that, pass it on to an associate or someone to talk to the various providers of dental insurance. There's not that many left, so I don't think it's a tough question to get the answer to. Thank you, Mr. Chairman.
Doctor, I just want to know, who would enforce the adherence to this bill, what department?
In other words, how are we going to know if dentists are advising their patients about the risk of mercury fillings?
The educational component would be the responsibility of 21 5/30/07 - L&I - BILL 040904 the Health Department. The discharge into the wastewater would be the responsibility of a variety of state organizations, the Environmental Protection organization, the Water Department.
Well, is there anyone presently inspecting dentist offices; do you know?
With your permission, I would like to call our Assistant Health Commissioner to help answer that, who is in charge of our environmental health services program.
Mr. Melhem, I just asked the question of who is going to be enforcing this policy as far as requiring dentists to advise their patients about the risk of mercury 22 5/30/07 - L&I - BILL 040904 fillings.
Well, as Dr. Dean had stated, the educational component would come from the Health Department.
And also the other part of this is, of course, the waste matter.
Correct. The Pennsylvania Department of Environmental Protection, the Waste Management Unit, handles any discharges and any generation of hazardous waste in the State of Pennsylvania.
But do you know offhand if there's anyone presently inspecting dentist offices?
I am not aware that the state Department of Environmental Protection actively has inspected --
As far as the Health Department, L&I or any state agency, as far as you know.
The state agencies 23 5/30/07 - L&I - BILL 040904 I am not aware of. This would also be a Water Department and perhaps a plumbing issue to ensure that proper plumbing fixtures are in place to capture any discharges into the waste stream from a dentist's office. The cuspidors, I know, dentist chairs, they have filtration systems and strainers to catch any discharges, which should be maintained. I'm assuming it would be the Department of Licenses and Inspections, the Plumbing Unit, that would ensure that they have the proper plumbing fixtures in place.
Thank you. The Chair recognizes Councilwoman Reynolds Brown.
Thank you very much, Mr. Chairman. Good afternoon, gentlemen, and 24 5/30/07 - L&I - BILL 040904 thank you for your important testimony and perspective. Reduced to its lowest common denominator, we're hearing that the Administration and the Health Department are not in favor of this bill because of the potential negative economic impact; is that what we're hearing?
One of the concerns is the potential negative impact. The major concern is that we may in fact discourage people from getting the necessary dental care done that needs to be done and then we will see more complications of untreated dental disease.
And could there not be the flipside to that, which could be the better and more informed consumers are about the options and alternatives available to them for treatment of their dental needs, the better choices they make because a better choice is available? 25 5/30/07 - L&I - BILL 040904
And certainly should the scientific evidence suggest that, then, yes, then the informed consumer can make a better decision.
And so am I hearing also that because we do not have an affirmative, as defined by FDA, then this move or this action doesn't warrant the type of action presented in this bill?
Not only the FDA, but the professional organizations, the American Medical Association, the American Dental Association, at this time upon review of what currently is available did not have the -- does not have the evidence, does not feel comfortable with saying that regulations need to be put in place.
Isn't it possible that those who stand to not benefit from a measure like this would not move eagerly in the direction of putting in place something that at the 5/30/07 - L&I - BILL 040904 end of the day is going to be in the best interest of a consumer? That's a rhetorical question. Finally, there are two sides to this. There's the health issue and then there is also the environmental aspect to this. And you've testified that -- forgive me for not remembering the department you represent.
I'm with the Health Department. I'm the Assistant Health Commissioner.
A particular division of the Health Department, correct?
The Pennsylvania Department of Environmental Protection. It's the state Environmental Protection Agency.
And currently there are no practices or need for your division of the Health Department to be visiting or examining dental offices, correct, currently? 27 5/30/07 - L&I - BILL 040904
Currently, that's correct. Although the state Department of Environmental Protection indicated that they would enforce the disposal of the amalgam that is collected through the plumbing system.
Okay, then. Then thank you very much for your testimony. Thank you, Mr. Chairman.
Doctor, I may have missed it when we were comparing the mercury filling versus the alternative material. Is there any difference -- and I know you're not a dentist, at least I don't think so. Is there any difference between -- the word that I guess I'm trying to use, is the 28 5/30/07 - L&I - BILL 040904 alternative, even though it's more expensive, does it serve as well as the amalgam material?
You're correct, I'm not a dentist. However, we do have our dental specialists here and with your permission, I would like to call them to the stand.
I would like to know that, and since we have a dental specialist here, we'll add a second question. So could they come to the table and identify themselves for the record, please.
The question that 29 5/30/07 - L&I - BILL 040904 you asked, the scientific evidence seems to indicate that the composite resins and the glass isomers are not as effective and long lasting as amalgams. That has been scientifically evaluated. It also coupled with what Dr. Dean was saying at the joint committee, it does not last. And we also don't know the effectiveness in terms of the medical end of those composites and glass isomers.
If you have something that has a life expectancy of X number of years versus an amalgam filling, some people are 50, 60 years, I would assume, or more with some of that material. So that's important for me to know, that one of the issues could be the effectiveness and the longevity of that particular material. The other question, there wasn't a firm answer whether or not the 30 5/30/07 - L&I - BILL 040904 insurers would pick up the cost for that material. If a patient said, Look, I'd prefer not to have the mercury filling in my mouth, I would prefer to have the alternative even if it meant a short life of the material, is it in fact more expensive and will the insurance companies not pick up the entire tab for that extra cost associated with a person's decision to use an alternative material?
They have not yet made -- they still make a distinction in terms of amalgams versus composites or resin composites, and the patients have had to pick up that difference. The insurance companies are still not paying the same cost for amalgams as they do for composites.
Well, that's also an interesting point, where some lobbying probably would need to be done at that end. Is there -- and I don't want to take too long. Is there a reason 31 5/30/07 - L&I - BILL 040904 other than the cost? Is it the life expectancy of the treatment? What is the reason? Is it strictly dollars?
It's financial. It's mainly financial also. I think they are aware that the longevity of the composite resin restorations and the glass ionomer restorations, which are basically the substitute restorative filling materials, do not last as long as the amalgam restoration. They have a higher wear than the amalgam restorations, also known to have marginal leakage, which lends itself to secondary caries or recurrent caries between the tooth restoration interface.
Well, thank you. I was thinking to myself, after 11 and a half years in this Council, I think it's the first time we ever had three doctors at one time at the witness table. So I won't forget today. Thank you. Thank you, Mr. Chairman. 32 5/30/07 - L&I - BILL 040904 Thank you all.
Thank you for your testimony. Zack Hoover, please come forward. Good afternoon.
Good afternoon. My name is Zachary Hoover and I'm here today on behalf of State Representative Daylin Leach, who represents the 149th District, comprising parts of southern Montgomery County bordering on Philadelphia. I'm also here as a resident of Philadelphia's 2nd Ward. It is an honor to speak before this body on an issue of vital importance to the health of our neighbors and to the ecological viability of our City. I know you will be hearing from experts who can speak with far greater authority on both of these issues than I can. For my part, I would like to tell you how we are working on the state level to tackle the health threat posed by mercury in dental 33 5/30/07 - L&I - BILL 040904 amalgam fillings. Several states, including Arizona, California, Connecticut, Maine and New Hampshire, have enacted statutes mandating that patients be notified of the potential health threat posed by fillings containing mercury. My boss, Representative Leach, will soon be introducing legislation aimed at having Pennsylvania join the ranks of these states. Specifically, Representative Leach's bill authorizes the state Departments of Health and Environmental Protection to jointly create a patient education brochure concerning all of the following: The presence of mercury in amalgam fillings; health and environmental concerns arising from the use of amalgam fillings; cavities, tooth decay and what a patient can do to avoid needing fillings in the first place; the procedure used in filling a cavity; and, most importantly, choices a patient has for filling materials. 34 5/30/07 - L&I - BILL 040904 I'm sure this fact will be repeated over the course of this hearing that those whose health has been negatively impacted from having fillings containing mercury implanted in their teeth would have considered other options had they known other options existed. Unfortunately, making patients aware of the potential danger posed by using amalgams containing mercury is not the practiced standard of care in Pennsylvania. Fundamentally, this is not an issue about the environment or an issue about the general public health. This is about empowering our neighbors to take a more active and informed role in decisions relating to their personal healthcare. Little can be more important to an individual. I know I join Representative Leach in applauding the City of Philadelphia for being ahead of the pack on this issue. The measure before this body takes on some of the environmental 35 5/30/07 - L&I - BILL 040904 factors that you will hear about from subsequent witnesses, in addition to the patient notification aspect I have discussed. He urges you that you pass this bill favorably out of committee. Thank you, and if it pleases the Chair, I'll be happy to take questions.
Thank you for your testimony. Are there any questions from members of the Committee? The Chair recognizes Councilwoman Reynolds Brown.
I thank you very, very much, and please extend my thanks to State Representative Leach, and I would ask that you keep our office informed of your proceedings with the introduction of this bill going forward.
Thank you. Charlie Brown, please come forward. Good afternoon. Please state your name for the record.
Yes. Mr. Chairman, I'm Charlie Brown. I'm National Council of Consumers for Dental Choice, came up here from Washington. Our organization works closely with Freya Koss, who is here, who is the head of the Pennsylvania Coalition for Mercury-Free Dentistry, and we're certainly honored that Councilwoman Reynolds Brown has put this issue on the table for the good folks of Philadelphia. As she mentioned, the Zogby poll says that three-fourths of Americans still cannot identify the major component of amalgam. The term "silver" is not an accident. It's not an expression. It's how the American Dental Association markets amalgam fillings. Here's their brochure, and they call it silver fillings. The ADA doesn't want people to 37 5/30/07 - L&I - BILL 040904 know that the material is 50 percent mercury. That's why government intervention is needed, when the private sector is not working. If mercury fillings are unsafe, people have a right to know, of course. If we don't know whether they're safe -- and that's where FDA is now. You may hear from dentists saying FDA says they're safe. Not anymore. The panel has said, the scientific panel advising the staff, has said we disagree with you. FDA is in equipoise. Amazingly, as the Councilwoman noted, the federal agency that's supposed to protect us said in a federal court brief two months ago five times they don't know if it's safe or not. If people don't know if it's safe, doggone it, people ought to know. If we're certain it's safe, even if that's so, what's the harm? For a pregnant woman who is trying to avoid all exposure to mercury -- mercury is poison, you know. If a pregnant woman is trying to 38 5/30/07 - L&I - BILL 040904 avoid that, shouldn't she be told this is a mercury filling? I mean, she'd probably have her personhood right out of that chair immediately and leave the office. So if we want to increase dental care, think about the Councilwoman's angle. If we destroy public confidence in dental care, which we're going to do if this mercury continues, because the public is getting more and more aware, then people won't go to their dentists. The way to get people to their dentists is for you to say, We're going to put the cards on the table for you, the patient, and if you feel this is toxic, mercury is toxic, then you have a right to go to a dentist who will give you that material. Now, every dentist can do a non-mercury filling. This is not rocket science. Every dentist can do it. The mercury filling is archaic. It's 19th century. It's toxic material. It's an 39 5/30/07 - L&I - BILL 040904 environmental hazard coming out of the mouth. And they carve out good teeth matter. It's primitive. They carve out good teeth matter and then -- whereas, resin filling doesn't. They just adhere to the teeth. So they carve out good teeth matter. You have a weaker tooth and you have the mercury fillings. Now, Councilman Rizzo, you raised a great question about how long these last. Some people say the resin now lasts as long, but assuming it doesn't, what's the harm on baby teeth? For a child's tooth, just six to 12 years, the resin and mercury are the same, but we don't have that mercury vapor implanted three inches from a child's brain if we don't give them a mercury filling. So for goodness sakes. You led so many things in Philadelphia. It's such credible -- your big, ornate City Hall. This whole building is just historic and you've been a leader. I was out there sitting under 40 5/30/07 - L&I - BILL 040904 the Tom Paine statue, when he came here and energized America with his written word coming over from France. I mean, you're a city that's led and led and led. Now we have -- and I've got the book The Tipping Point here. We have dentistry, 52 percent, according to a magazine survey, of dentists no longer use mercury fillings at all, 52 percent, according to a survey we have, which we can e-mail you. I don't know if it's exactly accurate, but it's clearly been growing.
That means every dentist doesn't have to use it. Many of them are. They're old-fashioned, they're operating assembly lines. They don't have to do it. Medicaid has changed now. Medicaid in Pennsylvania used to say put in mercury. They don't anymore. They give the patient a choice. We can give them that choice by this right to know. There's no harm in right to know. Now, one thing the doctor in 41 5/30/07 - L&I - BILL 040904 the Health Department didn't mention is the cumulative effect of one dentist office after another. The largest source of mercury in the wastewater is dental offices. Don't you have enough toxic products in this City? Don't you think there's a link between toxic people and violence, toxic people and sick people? Don't you think we can improve the quality of life, reduce violence, improve public health by trying to remove as many toxins as possible? There's no reason that dentists can't spend 700 bucks and block that mercury from going in the water. And if you don't require it, then some dentists, the responsible ones, like Dr. Don Robbins, Dr. Andrea Brockman, Dr. Vinny DiLorenzo, they're all here, they're all mercury free, they will buy it, but many dentists won't. Let's just have them all buy it for a few hundred dollars. Then you reduce the largest source of mercury in the wastewater. 42 5/30/07 - L&I - BILL 040904 You have a witness here from Toronto. He'll tell you when Toronto required it, the amount of mercury in their waste system went down by over 50 percent immediately, because dentists are the largest source of mercury in the wastewater. It's unnecessary. It's not the 19th century anymore. If they tell you it's good because we've done it for a hundred years, offer them a cigarette, because we've done that for a hundred years, too. So I just think, folks, that -- Councilpersons, excuse me, I just think you really have a chance to help. It's the low-income people in particular still getting the mercury. Thank you, Mr. Chairman and members of Council.
Thank you for your testimony. The Chair recognizes Councilman Rizzo.
Thank you 43 5/30/07 - L&I - BILL 040904 for your testimony. I'm just here following along. Wastewater treatment plants, from what I understand, are very sophisticated. They can separate oil. They can separate a lot of various materials that are put into the public sewage system. Do you know of any municipality that has the ability when it gets to the treatment plant to be able to filter out the mercury levels that may be in any wastewater?
I think Mr. Darcy from Toronto can answer that better, Councilman Rizzo, but let me point out the taxpayer angle to this. Why should the taxpayers of Philadelphia pay to have the wastewater removal done when the dentist can pay 700 bucks and put it in his office? The point is, let's shift the burden upstream. (Applause.)
I agree. That's a good first stop. 44 5/30/07 - L&I - BILL 040904
But what about the people that don't comply? Wouldn't it be great if we could catch it at the water treatment facility?
Yes, and I think you ought to get a technical person. I wish I could answer that, Councilmembers, and I apologize for not being able to, Mr. Rizzo.
Thank you for your testimony. Can you speak to hurdles that the other states may have endured before they moved to a place where -- before moving to a place where now consumers are informed and educated about their choices; namely, Arizona, California, Connecticut, Maine and New Hampshire?
Well, Councilwoman Reynolds Brown, it is a battle, because the dental boards don't want people to 45 5/30/07 - L&I - BILL 040904 know. We have to battle dental boards. Within the Departments of Public Health, you always have dentists who are saying, Under our philosophy, it's good, we've done it for a hundred years. It is a barrier. If you pass this bill, frankly, lady and gentlemen, you're going to have to bird-dog that Department of Public Health. That's been our experience in New Hampshire, in Maine, in Connecticut, in California, in Arizona. So don't think passing the law is going to create this fact sheet without good follow-up. So it's been a burden.
I will tell you from two years ago when we first started looking at this issue and doing the research, the dollar cost to put in the separators was a lot more than what it is today.
You bet. It keeps going down. And by the way, you're at the edge now where it should happen 46 5/30/07 - L&I - BILL 040904 geographically. Almost all New England states mandate separators. Then New York mandated it by law. New Jersey mandated it statewide without even a law, just an Executive Order from the Governor. And so basically we've come from New England. We're now at Philadelphia. So I think it's logical. On the right to know, you're cutting edge. On the separators, it's logical, because New Jersey already requires it. They're not dumping things into the Delaware River, and maybe you shouldn't either.
And again in your testimony, just to underscore this fact that I was not aware of, you stated that the largest source of the environmental -- mercury is the largest source of waste in water.
The largest source of mercury in the wastewater is dental offices by far. And mercury we know is toxic. They break a thermometer or spill 47 5/30/07 - L&I - BILL 040904 it in the chemistry lab, they shut down the high school. Have you had that in Philadelphia ever? It's happened all over the country. That's how serious this is. So dentists can be responsible, and it's time we just had them step up to the plate like every other polluter. I mean, I respect these men and women, but they're polluters when they dump mercury out of their office and let it go down the drain.
Our Medical Director didn't concur -- I'm not putting words in his mouth. I asked that specific question, and the industrial is obviously the bigger volumes, are the biggest contributor to mercury in the water. At least I believe that's what you said, Doctor, not coming from dental 48 5/30/07 - L&I - BILL 040904 offices. So our Medical Director is not on the same page with you, obviously.
Well, two reports have come out by major environmental groups, one in 2002, one in 2006, that say clearly in the wastewater. Now, the groundwater is a different mercury source and the air is yet another one. So all that -- just the wastewater cumulative. He just said one dentist only does 0.35, whatever it was, but he's not talking about the hundreds of them. By the way, a major source -- do you know why a crematory isn't supposed to go near a school now? You may know that issue. One reason: The mercury from the fillings, right. So let's stop putting it in. I mean, more and more of us are choosing cremation as our final exit from the planet and that means more mercury is going into the air. In the United Kingdom, the largest source of mercury in the air is now crematories, 49 5/30/07 - L&I - BILL 040904 and crematories in the United States are more and more common. So we just -- I mean, ask the dentist why they won't phase this out. We went to the ADA. I met with them in December, sat down in their offices. I said, We don't want a dollar. You don't have to admit it's unhealthy. For environmental reasons, announce a phaseout. Their lawyers wanted to do it. They just couldn't pull the trigger. They don't have an inalienable right to use mercury forever. No other health profession does. It's time for them to phase them out. So if the ADA or the PDA or the City DA is here, why don't you ask them, Do you have a phaseout plan to stop using this toxic product? Because we sure would like to know that.
Thank you. Finally, to the moral issue you raise, do you have facts or numbers or background information to substantiate the observation that in low-income areas the 50 5/30/07 - L&I - BILL 040904 mercury fillings are used more predominantly than the alternative?
Yes. We have that from the survey that came out on the -- 52 percent are mercury free, but in the cities, it is much less than 52. It's under 40 percent. So we still have -- it's true, but doggone it, the child -- it's more important they not get the toxic, and you know why, Councilwoman? Because of the synergies of toxins. The lead damage per child combined with the mercury damage, the synergies are not one plus one. They're multitudes. Where the child is already toxic from other products, that's the biggest reason. There's a wonderful organization in our movement, the Connecticut Coalition for Environmental Justice, run by a black doctor named Mark Mitchell in Hartford, and he stresses this, how the biggest problem for toxins in the cities -- and you folks are the 51 5/30/07 - L&I - BILL 040904 cutting edge, Councilman Kelly, all three of you and all on Council, by being able to say, We're going to look at this toxin one at a time, here's a big one, we can reduce its load. You reduce it by the separators and you reduce it by choice, because, as I say, the pregnant woman, if she's told there's mercury fillings, she's either going to leave the office or say, I don't want them, something else.
The interesting thing with me is, for years and years, my doctor is saying too much beef, too much beef, start eating more fish, start eating more fish. Well, I start eating more fish and then I read an article that says make sure -- now I feel like a little strange. I walk into a 52 5/30/07 - L&I - BILL 040904 restaurant. The young server, I'm asking him, Is this fish caught in the ocean or did it come from a farm? Wait. I have to check with the chef. And the chef comes out, What can I do for you, sir? You know, it's just -- you don't know what you're doing.
Councilman Rizzo, you had the right point, which was the fish aren't creating that mercury themselves. This is coming from dental offices and other sources, all the other sources, so here's --
What are we doing to correct the fish mercury problem? I mean, is this one piece of the puzzle? Lessening that, you start to --
Yes. That's how we do it. The fish aren't putting mercury in their own bodies, I assure you. It's coming from manmade sources, and we can have a major --
We thank you enormously for making the trip and thank you for your testimony, Mr. Charlie Brown, with the National Consumer for Dental Health. (Applause.)
If we could have Mike Ewall, Sean Jacobs and Mike Darcy to please come to the witness table. So that we are seeking to a have balanced perspective here, a representative from the ADA, please come forward, sir. Gentlemen, if you would, come to the witness table so that we can offer up the balanced perspective now as we proceed with subsequent testimony from these gentlemen. Please come forward.
Just take the seats behind the stand, please. The guys at the table, if you could excuse 54 5/30/07 - L&I - BILL 040904 yourself just for time for the testimony from the ADA. Could you please state your name for the record, please.
Good afternoon, Chairman Savage, Councilwoman Reynolds Brown, Councilman Kelly, Councilman Rizzo, my name is Dr. Thomas Gamba. I am a general dentist practicing in Philadelphia. I am the President-Elect of the Pennsylvania Dental Association, a past President of the Philadelphia County Dental Society, and with me is Dr. Peter Carroll, a trustee of the Pennsylvania Dental Association, a member of the Board of Governors of the Philadelphia County Dental Society and also a practicing dentist in Philadelphia. We are here today to testify representing more than 5,000 members who are licensed to practice dentistry in Pennsylvania and the more than 500 members who practice dentistry in Philadelphia. We're here today to oppose this 55 5/30/07 - L&I - BILL 040904 bill for three basic reasons. First, we feel it will jeopardize access to dental care for the children of Philadelphia and other needy Philadelphia patients. Secondly, we feel there is no credible science to support the claim that dental amalgam is hazardous to dental patients or to the environment. And, third, mandating amalgam separators and warning posters will pose an unwarranted burden on Philadelphia dentists as small business owners. Regarding the access to care, which we feel is the most important issue, placing unwarranted restrictions on dental amalgam will eliminate a viable and safe treatment option for thousands of medical assistants and CHIP patients who might otherwise not receive care. All Philadelphians should have access to quality dental care, especially those who don't benefit from routine dental preventive services. Children who are eligible for 56 5/30/07 - L&I - BILL 040904 MA and the CHIP program are three to five times more likely to experience tooth decay. Only to 30 percent of MA 5 pediatric patients see a dentist 6 annually, and their oral health problems 7 have severely worsened by the time they 8 do visit a dentist. 9 More than 50,000 children are 10 treated each year by the dental services 11 in the Philadelphia hospital system. The 12 rate of tooth decay in children in the 13 Philadelphia school system is 66 percent, 14 far above other populations. Fifty 15 million school hours are lost due to 16 toothache, the single largest cause of 17 lost school time in the United States 18 every year. 19 Many uninsured and underinsured 20 patients receive their dental healthcare at community clinics or through charitable efforts, such as the American Dental Association's Give Kids a Smile program. In this program, volunteer dentists try to diagnose and treat dental 57 5/30/07 - L&I - BILL 040904 disease to as many patients as possible in a limited time period. The number of patients treated could be reduced by as much as 75 percent if dental amalgam were phased out or limited as a restorative option and composite resin or glass ionomer cements had to be used. This is because placing dental composite restorations is much more technique sensitive. It requires more time from the dentist, and it leaves less time to treat additional patients in these situations. Dental amalgam, unlike any other restorative materials, can be placed even in moist areas such as below the gum line, in the very back teeth and in very deep cavities. This is critical when working with young children or with special needs patients, who often have difficulty remaining still in the dental chair. Dentists could be faced with the need either to sedate these patients in order to achieve the level of cooperation 58 5/30/07 - L&I - BILL 040904 that is necessary to place composite fillings or be forced to extract teeth that could otherwise be retained. Compounding that problem is that most insurance companies will not cover the cost of administering dental anesthesia in a hospital setting if patients need to be referred there for dental treatment.
Placing roadblocks to a patient's ability to choose an amalgam restoration will surely increase the cost of dental care and negatively impact access to quality, affordable dental care in the City of Philadelphia, both in private offices and in public dental facilities, as I think we've heard from your Health Department. Now, regarding the environmental issues, both the Environmental Protection Agency and the Pennsylvania Department of Environmental Protection do not consider dental amalgam to be a hazardous substance. Now, the major source of mercury in lakes, rivers 59 5/30/07 - L&I - BILL 040904 and streams, Councilman Rizzo, comes from industrial smokestack emissions. 1 percent. Emissions from dental offices do not appear on this chart. Less than one percent of the mercury released into the environment comes from dental amalgam, according to this study. And even this amount is in the form of dental amalgam. It is not in the form of methyl mercury. Methyl mercury is the form of mercury that is of particular concern. There is no methyl mercury in dental amalgam. The American Dental Association contracted with an environmental consulting firm, Environ, to assess the impact of dental offices' release of mercury into wastewater. The Environ 60 5/30/07 - L&I - BILL 040904 report states that amalgam separators do not result in a meaningful reduction in the concentration of mercury in the environment. Dentistry relies on the scientific studies and analyses provided by scientists independent of the profession. Dental amalgam has been studied and reviewed extensively. It has established a record of safety and effectiveness. " 61 5/30/07 - L&I - BILL 040904 Because the independent scientific community has not found dental amalgam to be of any risk to patients, we believe it should remain an option for dentists and for patients. Other organizations that find the use of dental amalgam completely safe and effective include the Centers for Disease Control, the World Health Organization, the World Dental Association, the National Multiple Sclerosis Society, the National Autism Association and the Alzheimer's Association. Nonetheless, recognizing that dentistry must do its part to protect the environment, the Pennsylvania Dental Association partnered in 2002 with the Pennsylvania Department of Environmental Protection to reduce amalgam waste. We have worked together with the DEP to produce our best management practices and our waste management guidelines, a copy of which I have for you, including two updates. In 62 5/30/07 - L&I - BILL 040904 2004, PDA became part of the DEP's Mercury Reduction initiative, and in 2006, we signed a Memorandum of Understanding with the DEP to help collect old elemental mercury from dental offices through the Elemental Mercury Collection program. That is a program where the inspectors who check out our x-ray equipment every two years, if there is any old elemental mercury -- and that's the dangerous kind -- remaining on the shelf, they have been collecting it, and we have been very successful with that program. Please remember that the American Dental Association and its affiliated state and local societies have always placed the health of the public first. And, by the way, I resent some of Mr. Brown's comments about being irresponsible as far as the dental associations go. Just one example would be dentistry's decades-old position as a 63 5/30/07 - L&I - BILL 040904 champion of water fluoridation. Fluoridation, along with ADA's many public education campaigns, has reduced the incidence of tooth decay for millions and millions of children. Our profession has placed this preventive health benefit far above any loss of income resulting from the decrease in the number of fillings we have placed over the years.
We believe that educating the dental profession about best management practices for the removal of dental amalgam waste is the most practical and reasonable solution to protecting the environment, while at the same time ensuring that patients have access to affordable dental care. Now I'd like you to hear just a minute from Dr. Carroll.
Pete Carroll, general dentist. Regarding the dentist as a small business owner, a mandate to install amalgam separators will be an 64 5/30/07 - L&I - BILL 040904 unwarranted burden which is totally unsupported by any credible scientific study. Installing amalgam separators is often complicated by factors such as building configuration, available installation space, access to centralized plumbing lines and lease agreements. Retrofitting dental offices with amalgam separators and testing, tracking and the recording-keeping necessitated by their installation will be an unnecessary expense to small business owners, who will ultimately eliminate the option of dental amalgam for patients, thereby impacting patients' ability to access affordable care in Philadelphia. We also believe that requiring dentists to display posters and disseminate brochures to patients about the potential risk of dental amalgam is unnecessary because there are no 23 associated risks with this restorative option. Displaying posters and brochures about mercury amalgam will only alarm 65 5/30/07 - L&I - BILL 040904 patients about a substance that is an alloy, entirely different properties than pure mercury, and this will cause stress over a treatment option that is harmless to their health and well-being. However, in the interest of educating the public, the American Dental Association is currently devising a brochure that will explain all the options available to patients who need restorative dental treatment. We believe that distribution of the ADA's brochure to the public will provide better guidance to patients who wish to make informed choices about their oral health. In conclusion, we ask that you not jeopardize the long-term health of our Philadelphia community by imposing these unwarranted, scientifically unsupported restrictions on dental care delivery. Thank you for allowing us the opportunity to speak to you. The important issues pertaining to patient 66 5/30/07 - L&I - BILL 040904 safety, access to dental care and environmental protection are important to all of us.
Thank you for your testimony. Are there any questions from members of the Committee? The Chair recognizes Blondell Reynolds Brown.
Good afternoon, gentlemen. Could you please talk to us more about the elemental collection program.
Yes. As the best example, my dad was a dentist and we practiced together for a number of years, and I've been in practice for 30 years. So in 1976 when I graduated, my dad had a machine -- you're too young to remember this, Councilwoman, but the dentist would buy elemental mercury, the same kind that's in thermometers, and he would put that in one little vile on the top of this machine and he would put the silver 67 5/30/07 - L&I - BILL 040904 alloy powder in the other side, and then you would hit it once back and forth and it would drop into a capsule and the machine would amalgamate it. Now when you go, you have the little capsules where the mercury is sealed in and there's no exposure to the environment until it's mixed with the metal alloy and triturated and then it becomes more stable. So when we switched over to that new capsule system probably -- well, certainly more than years ago, here we 15 have actually a mason jug full of 16 elemental mercury, and that remained on 17 my shelf, because I didn't know what to 18 do with it. I sealed it up and taped it 19 until we had this elemental collection 20 program. So now the DEP inspector comes 21 every two years to inspect the x-ray 22 equipment in every dental office, and 23 when they come in, they take away any 24 elemental mercury that remains on the 25 shelves of, I want to say, just a few 68 5/30/07 - L&I - BILL 040904 dental offices in the state, not too many. But we have collected several hundred pounds of elemental mercury that will be properly taken care of by the Department of Environmental Protection.
And would you say it's universal? I mean, is it a universal practice or it's an option, practice, procedure for dentists who care to participate?
It's optional, yes, but I would say it's a small percentage of offices in the state that still have elemental mercury.
Yeah, because it's 69 5/30/07 - L&I - BILL 040904 been phased out for quite a number of years.
And the environmental issue is addressed because they take it and then they handle it in the way that would be acceptable to the environmental community, right?
Yes. I'm assuming they recycle it in some way, because I know mercury has industrial uses and commercial uses. I couldn't comment on how they dispose of it or use it, but they -- I would trust them to do the right thing.
Okay. And then talk to us more about this brochure that you mentioned in your testimony, sir.
The brochure, which I believe I have like a hard copy, not of the actual brochure but of the information that will be in it, and it just lists all the advantage and the risk. I can leave it for you. But it 70 5/30/07 - L&I - BILL 040904 lists gold, porcelain, composite resins, amalgams so that you would have something to show your patient and discuss the choices.
If you could see that that gets to the Chair. Would you say based on what you know about the brochure that in many ways it addressed the right to know issue that is at issue here, as well as simply providing the patient with all the various options available and that addresses the interest of wanting to educate the consumer?
Well, I'll read to you from the general description from the amalgam in here. The very first sentence says, it says it's mixture of mercury and silver alloy powder. It states right off the bat that it's a mixture of mercury and silver alloy. So if that's what you're getting at, I'll leave it with the Chair.
Okay. 71 5/30/07 - L&I - BILL 040904 We'd certainly be interested in reviewing that further. We thank you for your testimony, gentlemen. Any other questions or comments? (No response.)
We will now move into our public meeting and resume testimony after the public meeting, given the large number of people who are scheduled to testify.
Excuse me, Mr. Chairman. Who shall I leave the materials with?
We will now move into our public meeting. The Chair recognizes 72 5/30/07 - L&I - BILL 040904 Councilwoman Reynolds Brown for an amendment on Bill No. 040904.
Thank you, Mr. Chairman. I move that Bill No. 6 040904 be amended. (Duly seconded.)
The ayes have it. The Chair recognizes Councilwoman Reynolds Brown for a motion on Bill No. 040904.
Mr. Chairman, I move that Bill No. 040904 as amended be reported out of Committee with a favorable recommendation. (Duly seconded.)
All in favor say aye. 73 5/30/07 - L&I - BILL 040904 (Aye.)
The ayes have it. Bill No. 040904 will be voted out of Committee with a favorable recommendation. We will now resume the Committee on License and Inspections. We're going to move back into our public meeting. The Chair recognizes Councilwoman Reynolds Brown for a motion on Bill No. 040904.
Thank you, Mr. Chairman. I move that Bill No. 19 040904 as amended be reported out of Committee 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. (Duly seconded.) 74 5/30/07 - L&I - BILL 040904
The ayes have it. Bill No. 040904 will be voted out of Committee with a favorable recommendation. This concludes our public meeting, and the Committee on License and Inspections will now resume and go back into session. Would Mike Ewall, Sean Jacobs and Mike Darcy please come forward. Good afternoon. Please state your name for the record.
My name is Mike Ewall. I'm the Director and Founder of Action PA.
My name is Sean Jacobs. I'm Project Coordinator for the Clean Air Council. 75 5/30/07 - L&I - BILL 040904
My name is Mike Darcy. I'm President and CEO of M.A.R.S Bio-Med Processes. We manufacture amalgam separators.
Hi. Thank you for having me. My name is Mike Ewall. I direct an organization called Action PA. We're a statewide environmental organization based here in Philadelphia. First I'd like to just start by addressing some of the earlier speakers and point out that it's sad, but not surprising, to see the dental associations continuing to support mercury, yet they were founded by the split in the dental community that was in favor of mercury. And so knowing that organizational position has not changed on that or water fluoridation in spite of much evidence on the harms of those over the years is not a surprise. But to see the Health Department speaking in favor 76 5/30/07 - L&I - BILL 040904 of continued use of mercury in the dental industry is much more upsetting to me. They seem like they spend more time defending pollutants from the public instead of protecting the public from pollutants, and this is not the first issue I've seen them do this on. However, in some other areas of the country, the precautionary principle is starting to become a public policy that has been given more attention. I know in San Francisco they have passed a law of that sort. And the precautionary principle basically says that no risk is acceptable if it's avoidable. And just like with cigarettes, they didn't wait until all of the scientific conclusive evidence came around to prove how they cause cancer. They saw the writing on the wall. There was enough anecdotal evidence and enough scientific evidence to say, Hey, there's something going wrong here, and decades before they knew exactly how it caused cancer, they put 77 5/30/07 - L&I - BILL 040904 warning labels on cigarettes. And I think this is the same sort of thing that falls under that precautionary mode of thinking, that we don't need to wait until the FDA finally decides officially that this is a mistake and this is dangerous to act. We have enough information now that we can be acting. Now, to fully protect public health, toxic materials must be contained, concentrated and isolated, not released and dispersed, and when things are dumped down the drain, that's essentially what's happening, is that they're being dispersed, yet toxins, certain ones, have a nasty habit of concentrating themselves back into places that we least want them, like our food supply. When things are dumped down the drain -- and this is not just in Philadelphia, but in general -- the way sewer systems work, you have liquids, solids, you have all sorts of things are 78 5/30/07 - L&I - BILL 040904 dumped down the drain and they go to sewage treatment plants, and these plants basically -- they don't have ultra fancy technology that enables them to remove every single pollutant. There's all kinds of pollutants that get dumped down there. A lot of them just get mixed all together and they end up either in the solid stream or the liquid stream. Essentially to simplify it, what a sewage treatment plant does, it separates the liquids into effluent, which is dumped back into rivers and streams, and it separates the solids into what's called sewage sludge. They like to call it biosolids because it sounds better, because the public relations industry they hired said, Call it that, people won't know what it means. But sewage sludge is basically the solids that are left over from everything that goes down the drain, and it's not just human waste, but industrial waste also going down the drain and things from dental offices. 79 5/30/07 - L&I - BILL 040904 And that sewage sludge ends up in many different places. You can find this on the Philadelphia City government's own website exactly where it goes. It tells you what percentages are going to what types of things. The largest category is that some of it is going to landfills, but the second largest category is that it's going to farm fields. They call it agricultural utilization on the website.
But basically that means they call it fertilizer and bring it to places like York and Lancaster Counties where we have most of our agricultural industry in the state concentrated, and it's dumped on farm fields as if it's fertilizer. This is the places that are growing our food. Now, a good bit of it, another 20 percent, goes to what they call compost marketing. That basically means they heat it up. And mercury at room 23 temperature already is a liquid and can vaporize at that temperature. When they heat it up in this process, it helps it 80 5/30/07 - L&I - BILL 040904 vaporize and makes sure that you get more of the mercury into the air in the process, and then what's left over, the sewage sludge that is then the sludge compost, is marketed as Earthmate here in Philadelphia. I think they changed the name. They call it EQ now. But basically they make this available to people to use in their gardens and their other kinds of gardening-like uses, and it's toxic still because of not just mercury but many other things that get dumped down the drain. And so that's another place that's a concern for us as far as where the stuff ends up. Some of it also ends up in public works projects. Ten percent of the City's sewage sludge goes to public works. Another 15 percent gets dumped in the coal mines in central Pennsylvania. And there are documented cases of teenage boys who have died in the mid 1990s from Philadelphia sewage sludge specifically being dumped in coal mines and on farm 81 5/30/07 - L&I - BILL 040904 fields in central parts of Pennsylvania. So it's not the mercury that did that so quickly; it was other things in it that kill people a lot quicker. But the mercury that's in there will contribute to other health problems that people have that won't be as obvious and quick. So earlier the -- was it the ADA that was just up here?
They were testifying that this is not a source of methyl mercury, and I found that very interesting, because there's some truth to that, except for the fact that when it goes down the drain, there are only two known sources of methyl mercury. One of them is sewage sludge and the other one is landfill gas, and this is proven according to an Oak Ridge National Laboratory study that was done only a couple years ago, and I'll be glad to provide that study. I just didn't know the issue was going to come up here. 82 5/30/07 - L&I - BILL 040904 But they follow where mercury ends up in the waste stream, and it's mostly falling into landfills and things like that. But they did comment that sewage sludge is the only other source of methylated mercury. And the reason why there's a distinction, the reason why it's important to know whether it's methyl mercury or not is because methyl mercury is the kind that has fat soluble that can climb up the food chain and do the things that Councilman Rizzo was worried about in terms of it getting into fish or into other animals. And so for those of us who are not vegetarian, who are actually still eating fish or other animal products, this is a very big concern, because it concentrates and accumulates in these things, because it loves fat and certain chemicals, like dioxins, do the same thing. They hate water and they love fat and they climb up the food chain very effectively. In Pennsylvania, we have over 83 5/30/07 - L&I - BILL 040904 2,000 fish consumption advisories a year. We're actually one of the worst states in terms of mercury in the fish. We're one of the very few states where they actually warn all people, not just pregnant women or children, but all people to avoid all types of fish. Usually they say just certain types, but in Pennsylvania it's all types of fish, and from all water bodies. Every lake and every river and stream in Pennsylvania is under advisory for mercury in the fish. And so it's not just the farm-raised ones which are known to have the highest levels of dioxin in them. I didn't realize about the mercury in farm-raised fish, but it's well known that the mercury in the wild fish is high enough that in Pennsylvania we're not supposed to be eating much of them at all and we're advised to have very small amounts of them. So the precautionary principle would tell us that the way to deal with 84 5/30/07 - L&I - BILL 040904 this is really to deal with it up front, and that's what the other speakers will be speaking to specifically, is to get it out at the source so that we can then have better control over it. And I can speak to the issue where it goes when it's properly recycled just so that's known and can perhaps inform where this legislation ends up going. In Pennsylvania, we happen to be home to the largest mercury recycler in North America. They're called Bethlehem Apparatus. They operate right outside Bethlehem in a town called Hellertown. They use a distillation process and they take mercury wastes, they purify it and get other things out of them through this distillation process. And then they put it back out on the market, which is a shrinking market globally, but they put it out so that industries can continue to use mercury. But they realized that since the industry is moving away from using 85 5/30/07 - L&I - BILL 040904 mercury and there's more and more that's being collected in thermometer exchanges and other things that are trying to get mercury out of our landfills and our wastewater, they're realizing that they need to go in a different direction that may end up requiring them to store mercury or, ideally, convert it to a state where it's not liquid at room 11 temperature, where it's not going to be as dangerous.
And they're actually applying -- they already have patents for converting mercury back into cinnabar, which is a sulfur bound with mercury type of compound that is the natural state where we get mercury and we get it out of the ground before we get the sulfur out and make it what it is. And so that's the technology that we feel pretty happy to know exists and is being pursued by a Pennsylvania company. We would not like to see -- I mean, we would love to see the mercury collected not in the sewage systems, but 86 5/30/07 - L&I - BILL 040904 we would like to see things go a little further and make sure that when it does get collected, we follow it, because it's still going to go somewhere, and say that if Philadelphia can help create an incentive and say that rather than put this stuff back out on the market where it can continue to do damage, that we create an incentive and say, if possible, get this stuff converted back into cinnabar when companies make that option available. It's not available yet, but it is the direction we're moving in. Thank you.
Thank you for your testimony. Any questions from members of the Committee? (No response.)
Hi. My name is Sean Jacobs. I'm a Project Coordinator 87 5/30/07 - L&I - BILL 040904 for mercury at Clean Air Council. Clean Air Council is a non-profit environmental and public health advocacy group that works to protect everyone's right to breathe clean air. Founded in 1967 and operating in Pennsylvania, Delaware and New Jersey, the Council has 7,000 dues-paying members, with roughly 4,000 of those residing in the City of Philadelphia. The Council supports the general purpose of Bill 040904 to ensure informed consumer consent with respect to the use of mercury amalgam in dental procedures and proper disposal of toxic mercury waste in connection with these procedures. The Council also supports the specific mechanisms proposed in the bill; namely, more aggressive consumer education about options to mercury and the required use of amalgam separator systems to reduce the discharge of mercury from dentist offices into the waste stream. 88 5/30/07 - L&I - BILL 040904 The facts regarding human health and mercury are well known and have been documented by other testimonies today. Those who discharge mercury into the environment are being asked forcefully and with greater justification than ever to dramatically reduce their emissions. The amount of mercury in circulation from use in dental procedures is significant. S. citizens today. S. S. today is for dental fillings. You might be wondering at this 89 5/30/07 - L&I - BILL 040904 point what happens to all this mercury in our mouths. Well, if it is not captured and recycled, there is a good chance that some of it is ending up back in our school lunches and on our dinner plates, causing the well-documented problems for children, mothers, families and the rest of us. At the dentist office in Philadelphia, unlike a growing number of other places, this mercury is not captured and recycled according to the best technology. Without a device to effectively prohibit its discharge, a significant amount of mercury is released into the wastewater stream when new fillings are put in and old ones removed. According to the US EPA, dentists estimate that percent of amalgam 20 escapes into the wastewater system. From there, mercury can enter the environment in a number of ways: directly into surface waters via effluent from publicly owned treatment works; mercury emitted from sewage sludge incinerators; 90 5/30/07 - L&I - BILL 040904 volatilization of mercury from land-applied biosolids; and, lastly, the leaching of mercury from landfills. In Philadelphia, mercury is finding all these pathways to work its way back into the environment. While there is some dispute about how much of the mercury that's removed from the mouths of dental patients ends up back in the environment, the ADA says very little, a claim that echoes the assertions of fuel manufacturers who wrongly, as it turned out, argued in the 1970s that removing lead from gasoline would have very little impact on lead levels in the environment and individuals. It is beyond doubt that technologies remove mercury amalgam. Specifically, amalgam separators have been highly effective. In fact, in King County, Washington, an aggressive inspection program around wastewater discharge has been implemented, with the 91 5/30/07 - L&I - BILL 040904 result that mercury in biosolids has dropped by 50 percent since 2000. An intense effort in Boston has yielded even greater improvements in mercury reduction flowing in Boston's Harbor. Amalgam separators that capture mercury from wastewater leaving the dental office are currently on the market. The units are installed in the plumbing system of the office and can collect up to 98 percent or more of mercury in wastewater. New Jersey, New York and most New England states and several municipalities now mandate separators. In New York, where all dental offices will be --
Sir, can I ask you to repeat the last paragraph that talks about amalgam separators, the paragraph you just read.
Amalgam separator units that capture mercury from wastewater leaving the dental office are currently on the market. The units are 92 5/30/07 - L&I - BILL 040904 installed in the plumbing system of the office and can collect up to 98 percent or more of mercury in wastewater, and I listed a few states that have already laws.
In other words, the separators are affordable, and the regulations also require and detail the proper recycling of amalgam. In Philadelphia, with a large number of dentists and two very large dental schools at the University of Pennsylvania and Temple, the benefit to wastewater discharge of the installation of amalgam separators would be significant. Given that a few pounds of mercury can render 93 5/30/07 - L&I - BILL 040904 millions of fish inedible and cause untold damage to human health, Philadelphia, and then the Commonwealth, should be next in taking aggressive steps to limit mercury discharge through amalgam separators. Toxic mercury released from dental offices is identifiable and its release is controllable. Clean Air Council strongly urges Philadelphia City Council to prevent the discharge of hundreds of pounds of mercury into the environment, where it is ultimately absorbed into the food that Philadelphians and their families eat. We urge City Council to pass Bill No. 18 040904. Thank you for your time.
Thank you for your testimony. Are there any questions from members of the Committee? (No response.)
Thank you 94 5/30/07 - L&I - BILL 040904 for your testimony. Mike Darcy.
Thank you very much for having me. I actually started here bringing out a PowerPoint presentation and I've decided to throw it out. I've heard very much different testimonies and a lot of thoughts by people who are saying that the mercury amalgam is not a danger to the environment, it's safe, mercury is embedded in an amalgam, which means it doesn't leak and that there is no significant evidence to say that it's not so. I beg to differ, because I'm going to bring out a couple of things, and that's what I was doing over here, is pulling out literature. As a matter of fact, while the ADA is referring to the safety of the product, they may want to advise Dr. " What he was doing was identifying the vapor that was being released from amalgams. So I guess he doesn't work very well. Great Lakes articles has come up and we've talked about the minimal amount of mercury separated, a Great Lakes article September 8th, '05, and the report was to find that the Michigan power plants emitted 2,464 pounds of mercury annually, which was of great concern. If we take the national averages, we find out that dentists in Pennsylvania emit approximately 4,000 pounds. They also stated that there was a great -- let's see. Oh, yes, the World Health Organization. I have a paper in front of me, a policy paper, from the World Health Organization and Item No. 2, 96 5/30/07 - L&I - BILL 040904 and I will quote, "Dental amalgam is the most commonly used dental filling material. It is a mixture of mercury and a metal alloy. The normal composition is 45 to 55 percent mercury, approximately 30 percent silver and other metals such as copper, tin and zinc. " The report that actually was just mentioned was from Massachusetts. I have a copy of that. They have approximately 3,000 of their 4,000 dentists that are using amalgam separators, about 3,000 or 4,200. Their wastewater sludge has reduced their mercury by 50 percent. In Toronto, which was mentioned earlier, they have a separator program in 97 5/30/07 - L&I - BILL 040904 where we require a 99 percent. Actually, it's ten parts per billion separation. The general calculations from the city Water Department indicate that a reduction of over 70 percent has happened in Lake Ontario, in the Toronto area. gov, who clearly states, Item No. 2, Health Hazards Information, Effects on Humans: Mercury vapor can cause effects in the central and peripheral nervous systems, lungs, kidneys, skin and eyes in humans. It is also immunogenic and affects the immune system. Acute exposure of the high concentrations of mercury vapor cause severe respiratory damage, while chronic exposure to lower levels is preliminarily associated with central nervous system damage. What we have -- and I may want to explain this. I started out in -- obviously didn't start my life in the 98 5/30/07 - L&I - BILL 040904 separator industry. I started out just like everybody else, and unfortunately, I had what my dentists used to refer to as soft teeth. So I ended up with a mouth full of it. We went through an awful lot of difficulties. Most of the things that these people talk about in health I've had. In 1999, I had my last amalgam removed. We still have some challenges. In 2005, I bought the company, because it's actually very important to not only Philadelphia and not only Pennsylvania -- I know this is a focus here, but this is actually a global problem. We're allowing a known toxin. It hurts people. It kills people. It destroys families. I couldn't help when the, I believe it was, Dr. -- excuse me for this. My apologies. Dr. Gamba was talking about concern about kids not getting into the program and not getting fillings done. However, they're willing to put a known toxin in. So instead of 99 5/30/07 - L&I - BILL 040904 like giving them a cavity, we'll make them sick some other way. This is not acceptable to me. We've heard that there's no 6 credible science. I have about 20 inches of paper in my office.
I can give you credible science that can fill this room. The concept that the burden on the dentist, the financial burden on a dentist, when we take a look at the average cost of an efficient separator that will take 99 percent, ISO approved 99 percent separator, take that much mercury out of the wastewater, the cost from an average practice should be about 31 cents a patient. And I would challenge anybody in this room to walk out and ask any mother out there for 31 cents if she'd like to have the mercury taken care of. I'll probably pay heavily for anybody that says they don't want to, because everybody out there is going to say no. For 31 cents, let's get it out of here. 100 5/30/07 - L&I - BILL 040904 Pennsylvania is very -- has a strong tourist fishing program. I mean, everybody knows it's quality here. We've just heard that the waterways are polluted. One of the biggest myths about mercury, amalgam mercury and methyl mercury, is that somehow it magically goes out of the dental office, flows through this water system and it's dumped into the water. It is not. I have spent the past two years studying mercury. I've probably listed about -- I don't know. Let's be conservative and say 16 to 3,000 websites and reports on the 17 subject. One of the biggest 18 misconceptions is exactly that, it's in 19 the water. Folks, it's not in the water. 20 Mercury leaves a dental office, goes 21 through the pipe to the vacuum pump, is 22 discharged into the sewer system. From 23 the sewer system, it goes to extremely 24 efficient wastewater plants. And I've 25 seen wastewater plants. I have a report 101 5/30/07 - L&I - BILL 040904 here from East Bay Municipal in Oakland, California. I've looked at your system in Philadelphia. It's very efficient. The problem they have is, what's coming in settles out in the sludge. They can detect it, and they do, and they detect it very well, because they need to detect it to make sure that it's not over EPA levels when it leaves the plant. And it isn't. Matter of fact, I think yours is about percent -- or, no, 80 percent 13 below EPA requirements. It's excellent. 14 It's in the sludge. When it 15 gets in the sludge, mercury becomes what 16 I'd like to refer to as the perfect 17 terrorist. If you look for it in solids, 18 it will go liquid. If you look for it as liquid, it will become vaporous. It responds to its environment. It's invisible. You can't smell it. You can't taste it. When it gets into the sludge, if you, as we heard before, make biosolids or use the biosolids for 102 5/30/07 - L&I - BILL 040904 fertilizer, you heat it. You heat it, it goes vaporous. It goes vaporous. It gets high enough up, it cools down, it goes liquid. It comes down with the rain. It comes down in your lakes. You fish it in. And because it's heavier than water, it sinks to the bottom. The smaller fish eat it. The plankton eat it. They move up the food chain. It's bioaccumulative. By the time you're eating that small-mouth bass, it's poisonous. This is where the problem is. This is where the misunderstanding is. When we talk about mercury, I'm almost to the point in this industry of saying it's not when you take a look at how many different types of mercury and it can't be any mercury amalgamated -- well, it's after -- it's removed. It can become methyl mercury, trust me. We talk about what happens, it can't leak, it's perfectly safe because it's bonded. We have proof to say, well, it unbonds quite 103 5/30/07 - L&I - BILL 040904 nicely. The American Medical Association -- that's one of the other things that I do when I do my research, I stay away from the ADA, I stay away from the FDA, because a lot of the information that is gathered there is co-dependent, let's say. However, the American Medical Association has Mercury and Fish Consumption: Fetal exposure to large amounts of methyl mercury from maternal consumption of fish results in a pattern of severe neurodevelopmental defects and fatalities.
Chronic low-dose prenatal methyl mercury exposure from maternal consumption of fish has been associated with more subtle decrements in several measures of neurological development, which may resemble a number of learning disabilities present in the overall population of children. A study of 237 children in New Zealand born in the early 1980s and who were tested at ages four and six found 104 5/30/07 - L&I - BILL 040904 the scores on the Denver Developmental Screening Test were significantly lower in those whose mothers had mercury hair concentrations exceeding six parts per million. 8 nanograms per liter. Values were fourfold higher in those who had eaten fish in the last 30 days. By the way, we're not talking about something you can hold in your hand and say that's a pound of mercury. We're talking about if I put it on a table, it would take you all day to find it. That size. We have Sources of Mercury and Mercury Exposure, a featured AMA report, which I was just looking for -- I'd have to find that -- quote, "The primary source of elemental mercury in the general population is via inhalation of vapors from dental amalgams, which are 50 105 5/30/07 - L&I - BILL 040904 percent mercury. In the absence of fish consumption, body burdens of mercury correlated with a number of amalgam surfaces present. Mercury exists in an elemental form and in various inorganic and organic complexes, which differ in toxicity. " And on that subject, I found something very interesting, as I normally do when I've got any spare time at all, searching a few things. In 1999, Mr. Berglin from, I believe it was, the Minnesota DEC was doing a study on amalgam -- sorry; on rubber dams to prevent materials coming back into the patient. One of the side-effects on that or the side results of that was that they measured the amount of mercury present in the plasma and in the urine, not only seven days later but they were lucky enough to go back a year after that. What they did is, after the amalgams were 106 5/30/07 - L&I - BILL 040904 removed -- and they were, of course, comparing to a control group -- the mercury levels in the group that had the amalgams removed had dropped over 50 percent in the plasma and 70 percent in the urine. I'm here to tell you they're leaking and they're poisonous. Mercury also quite nicely is what we refer to as lipophilic. It likes fatty tissue and muscles. So it doesn't sit back in the blood for long. Actually, that's why most people who have blood tests don't recognize they have mercury, because it moves on, is deposited. In Philadelphia, you have a population just, by the way, from 2005 estimates, of about 1,463,281; children under five, 109,746. The numbers of women between 18 and 64 is 476,956. By the national estimate, you have 38,156 women that shouldn't be having children.
Let me 107 5/30/07 - L&I - BILL 040904 ask, please, do you have any experience with any of the other states that have successfully moved on this type of legislation?
Yes. We're waiting, of course. New York has just come into play. They enacted law May 12, 2006, gave a two-year grandfathering, which means everybody in New York needs to have a law by May the 12th or need to have an amalgam separator, 2008.
They gave them two years. We had a discussion with the DEC, Pete Pettit and Christine Barnes, who we deal quite closely with. In hindsight, that was a mistake. Most of the dental practices tend to leave it to the last minute anyway, so why are we bothering with two years?
Most of the dental 108 5/30/07 - L&I - BILL 040904 practices will leave it 'til the end, won't buy the separator until the end of the mandated period. So why are we giving them two years? We should just give them a year and get on with it. It's going to happen, it's going to happen. New Jersey has just started. We've just started and had some conversations with Art Meisel, the Executive Director of the New Jersey Dental Association, who is very interested in separators and wants to make sure that they comply. People in the Northeast, a lot of people -- the Northeast is pretty well taken care of. They've started the laws. Massachusetts just simply has the best management practice, but they had a very significant program to convince practitioners to get amalgam separators. Even at that, only 3,000 of the 4,200 complied. If 3,000 can drop it by 50 percent, we're looking at 75 percent, 109 5/30/07 - L&I - BILL 040904 which is exactly the kind of numbers we see in Toronto.
It works. The science of amalgam separators has changed. It's most efficient when it has a separation settlement chamber and an ion chelation, which actually there's a biomedia and, oddly enough, a sulfur impregnated carbon that attracts mercury in a liquid form. That's where we get the 99 percent.
If there's anyone here that's going to testify and they would like to leave, they can leave their testimony and we will include it in the record. That's an option that I want to put out there. Thank you for your testimony. 110 5/30/07 - L&I - BILL 040904 Would Frederick Burton, Donald Robbins, Mr. Ellis and Dr. John Tierney please come forward. Good afternoon. If it's possible, since a lot of the testimony today is basically parallel, if it's possible, if you could summarize your testimony if it be lengthy, I'd appreciate that. Thank you.
I'd be very happy to. Thank you for the opportunity to speak on this subject. My name is Frederick Douglas Burton, M.D. I practice in both Allentown and Wynnewood, and I'll be very, very brief. First of all, I appreciate you having this discussion. I think it's crazy that we're even sitting here talking about whether or not it's good to have a poison in your mouth sucking on it 24/7. I had mine taken out about 20 years ago for the very reason that it makes no sense. 111 5/30/07 - L&I - BILL 040904 I'm sure all of you have had an experience where you've gone and broken a thermometer when you were a kid and told, Don't play with that stuff because it's poison. So we all know basically it's not good to do. I just want to relay a couple of basic stories to you. One, last year two students in Washington, DC public school were fiddling with a machine that contained mercury in one of the science classes and they intentionally broke it. The school was closed down and the students were suspended from the school for doing that, because it required a thousand dollars and lots of man hours to clean the school up from the toxic mercury from the machine. The Mayo Clinic a few years ago had a big controversy as to whether or not their sphygmomanometers should be used with mercury. I'm sure all of you remember the tall rolling blood pressure cuffs that used to be used very common in 112 5/30/07 - L&I - BILL 040904 the old days and not too common today, but bottom line is, they had the long columns of mercury that measured the pressure. Well, there was a controversy there about whether or not they should still be used, because when one was broken, it cost the Mayo Clinic upwards of $30,000 to clean the room of the mercury that was released. The other story I'd like to relay to you is, I have a good friend who is a dentist in the Michigan area, and I met him back in the early 1990s at a meeting in Pittsburgh and he relayed to me a very interesting story. He said, you know, I decided as a means of saving myself and my patients to stop using amalgam in Michigan. Word got out and I was called onto the carpet by the dental association and dental board of Michigan, and the only thing that saved me is when they asked me why I stopped using dental amalgams, the mercury, I told them I stopped because the safety of my 113 5/30/07 - L&I - BILL 040904 employees was very important and OSHA regulations require that I protect my employees. You don't have to protect the patients, but you have to protect your employees. So this is a real basic discussion. I heard a lot of the scientific readings that the other side made, but you have to relay to your own personal gut common-sense understanding that mercury, in no sense of the word, is considered to be safe to suck on, and that's basically what we're doing when we put it in our mouths. Thank you.
Thank you for your testimony. Any questions from the Committee? (No response.)
Thank you for your testimony. Could you please identify yourself. 114 5/30/07 - L&I - BILL 040904
Yes. Dr. Donald Robbins. I'm a practicing biologic dentist in Exton, Pennsylvania. You have my testimony. I had sent it before for copies. But there's certain things that you should know. I've been in practice for years as a biologic dentist, and 9 it's not difficult to be a biologic 10 dentist to not use mercury. I stopped in 11 the early '80s because I realized by 12 going through scientific toxicology 13 studies and reading up on it that this 14 stuff was pretty bad stuff, and I didn't 15 want it to expose my patients, I didn't 16 want it to expose my staff and I didn't 17 want to get it myself. So I took it out 18 of my office in the early '80s and I've 19 been practicing that way ever since. 20 I want to tell you, I'm here to 21 tell you that the ADA and the PDA are 22 selling you a bill of goods. They are 23 not telling you the whole story. They're 24 giving you half truths about some of the 25 studies they have cited. 115 5/30/07 - L&I - BILL 040904 In 1999, World Health Organization and the Health and Human Services put out a study on mercury. 3 percent micrograms per day of mercury exposure. Of that, they found that dental -- the average dental fillings between three and -- the 10 average dental fillings were six, but the 11 level of mercury in those people was 12 12 to 17 micrograms per day. 3 total. People are worried about fish? If they have more than a few fillings in their mouth, fish becomes a very secondary thing. And I don't mean to put that down, because this is a real serious health issue. My patients are sick when they come in. They get better after I treat them, after physicians treat them and get the mercury out of their body burden. They are tremendously improved. But this was the World Health Organization in '99, Department of Health 116 5/30/07 - L&I - BILL 040904 and Human Services, came out stating that the number of fillings was two to ten times what the contamination was from fish. I'm going to tell you what the Pennsylvania Dental Association told you about putting -- Oh, well, we can't put bonded fillings in a wet environment. Well, I'm here to tell you that there's no dental school in the country that's going to teach a dentist to put a filling in a wet environment. I don't care if it's a child or an adult or an elderly person. You have to have a dry field to put your mercury filling in. You have to have a dry field to put your bonded filling in. That's just a smoke screen for the whole issue. To the idea of people not getting care because it may cost $5 more or $10 more is also not true. I have patients coming in who are indigent, on public assistance. They're reaching into their pockets to pay to be safe. They 117 5/30/07 - L&I - BILL 040904 don't want this stuff in their mouth. I sent you -- and if you don't mind, I will read this. I get e-mails on my website. I get telephone calls all the time. This is from a woman October 2006 in Mountain, Pennsylvania. "Help. I'm weeks pregnant and I am 43 years 9 old. This is our first child, coming 10 unexpectedly, and I recently read an 11 article about mercury fillings causing 12 autism in unborn children and even later on. I have about six and I have upwards of ten mercury fillings in my mouth. Is my baby truly at risk, and is there anything I can do to protect it? I appreciate any help you can give me. " I get stuff like this all the time over the Internet. People who go to their dentist and literally the dentist laughs when they say that, Well, I don't really want that mercury because it's dangerous. Dentists are actually laughing at patients, saying that. 118 5/30/07 - L&I - BILL 040904 They're not taking their feelings into account or their concerns.
And this goes directly to the ordinance that you are voting on, because I'm going to tell you, you need an amendment to have the patient or guardian sign that they have received the literature that is supposed to be distributed to them, because I'm going to tell you, you put that placard in a waiting room and you put some brochures in that waiting room, it's going to gather dust. If the dentist, as you heard from the PDA themselves, believes in mercury, they're going to do mercury. This woman wants a choice, but right now the dentists are not giving the patients the choices. The dentist is making the choice for them. You need to tell them what needs to be done. This is basically a no-brainer. You don't even have to believe me about the mercury being dangerous or anybody else. This is a choice of just telling them what's in it, and this is very 119 5/30/07 - L&I - BILL 040904 important for their health. And if you have any questions, I'd be glad to answer them.
Thank you for your testimony. The Chair recognizes Councilwoman Blondell Reynolds Brown.
Thank you, Mr. Chairman. Let me be absolutely certain I've heard a recommendation you've put forth, and, that is, in addition to the consumer information brochure, have what we do in a lot of medical offices already, signs saying that they have been duly informed of the options, if you will? Is that a summary of what you're offering here as a recommendation?
Well, at least that they acknowledge that they've been told that mercury filling was recommended and alternative fillings were recommended.