Thank you.

Sincerely,

Graham Bottomley, Trent Harris, Andreas Schuld, Wendy Small, Bob Johannsen
Executive Committee
Parents of Fluoride Poisoned Children (PFPC)
Vancouver, BC, Canada

References

1. Susa M - "Heterotrimeric G proteins as fluoride targets in bone (Review)" Int J Mol Med 3(2):115-126 (1999) http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=9917518&form=6&db=m&Dopt=b

2. COMMUNICATION WITH THE UK REVIEW http://www.bruha.com/fluoride/html/uk_review.html

3. COMPARISON TABLE:SYMPTOMS/ASSOCIATIONS - FLUORIDE POISONING / HYPOTHYROIDISM -THYROID DYSFUNCTION http://www.bruha.com/fluoride/html/symptoms_hypo_f.html

4. Laugwitz KL, Allgeier A, Offermanns S, Spicher K, Van Sande J, Dumont JE, Schultz G - "The human thyrotropin receptor: a heptahelical receptor capable of stimulating members of all four G protein families" Proc Natl Acad Sci U S A 93(1):116-20 (1996) http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=8552586&form=6&db=m&Dopt=b

5. Gerlach RF, de Souza AP, Cury JA, Line SR - "Fluoride effect on the activity of enamel matrix proteinases in vitro" Eur J Oral Sci 108(1):48-53 (2000)

6. Limeback H - "Enamel formation and the effects of fluoride" Community Dent Oral Epidemiol 22(3):144-7 (1994)

7. Wright JT, Chen SC, Hall KI, Yamauchi M, Bawden JW - "Protein characterization of fluorosed human enamel." Dent Res 75(12):1936-41 (1996)

8. ECOPRAVA Liev - Sosnivka FINAL REPORT, USAID SCIENTIFIC ASSESSMENT GRANT available from pfpc@istar.ca

9. FLUORIDE:EFFECTIVE?

10. Hillier S, Cooper C, Kellingray S, Russell G, Hughes H, Coggon D - "Fluoride in drinking water and risk of hip fracture in the UK: a case-control study" Lancet 355(9200):265-9 (2000)

11. China Daily , August 8, 1999 available from pfpc@istar.ca

12. FLUORIDE & THYROID http://www.bruha.com/fluoride/html/f_thyroid.html

After 55 years of artificial water fluoridation it is time for opening the scientific debate on this subject. Dentists' dogma and their doctrine that water fluoridation is a safe and effective public health measure can no longer be defended in science. Professor Rudolf Ziegelbecker, 5 August 2000.

Publication of the government White Paper, Saving Lives: Our Healthier Nation, seemed an ideal time to get the fluoridation issue settled. In 1998, the National Pure Water Association (NPWA) called for an independent public enquiry to examine all the evidence on alleged benefits and harm of total fluoride intake from allsources to end that debate once and for all.

The British government's proposed fundamental change in the fluoridation decision-making process, by giving responsibility to local councils, was also anticipated by the National Pure Water Association. Suspecting that the government had a hidden agenda, whereby fluoridation would be forced on people, in October 1998 the NPWA flew in Professor AK Susheela, a world-renowned authority on fluoridation from the All India Institute of Medical Science, to meet with, and give a presentation to, the Minister for Public Health, Tessa Jowell, and other officials from the Ministry of Health. At the same time NPWA presented the Minister with a 30,000 signature petition.

The British government commissions a review
Professor Susheela's presentation appeared to achieve little. The Minister said she had confidence in both her officials and their advisers, one of whom, Dr Waring of the Department of Health, said that experience in the USA, where artificial fluoridation schemes had been in place for over fifty years, provided the necessary evidence of efficacy and safety. The government refused the NPWA request for a full independent inquiry. Instead, they set up an in-house review. It was to be an independent, exhaustive, systematic review of water fluoridation, "once and for all . . . unchallengeable" said the then Health Minister, Frank Dobson.

While disappointing, this came as no surprise. Whenever new scientific evidence has threatened fluoride's status, governments of fluoridated countries have immediately appointed a commission or review panel, typically composed of veteran fluoride defenders (no-one opposed to fluoridation has ever been allowed a place on a review panel) to assess the evidence. Such reviews invariably dismiss the new evidence and reaffirm the status quo.

The National Health Service, Centre for Reviews and Dissemination (NHSCRD) at the University of York began its work in July 1999. The Review Panel consisted originally of:

From the NHSCRD, University of York:

and from the Dental Public Health Unit, Cardiff:

Later in the process Dr Bradley left the Panel and Ms Jan Cooper, from the University of Wales Dental School, Cardiff and Paul Wilson of NHSCRD, joined it. Apart from members from NHSCRD, the only people on this review panel were dentists. You might think this is not unreasonable: after all, isn't fluoride to do with teeth? Well, no. Surely chemicals entering and being incorporated into the body, as fluorides are, fall within the purview of toxicologists. There is no reason whatsoever for any dentists to be on this review panel.

Lord Baldwin, Drs Sheila Gibson and Peter Mansfield are anti-fluoride. Their inclusion on the advisory panel may have been an attempt to pacify antifluoridationists and give the review a veneer of fairness. The advisory panel, however, could only advise, they would have no say in the final outcome of this review.

A fluoridation review web-site was created which "aims to keep the public updated on the progress of the review at all stages and to provide them with information on how the review is being conducted, so that the review can be monitored and seen to be free from bias towards either side of the fluoridation debate".⁽¹⁾

The review was funded by the National Health Service (which is known to be in favour of fluoride); three of the review panel's eight members were dentists, one of whom, Elizabeth Treasure, sat on a similar review in New Zealand which concluded that fluoride was safe; the other five are NHS officials: they work for the organisation that favours fluoridation and was paying for this review. With such a make-up, this panel did not look either independent or unbiassed. The NHSCRD addressed this point saying "our centre is part of the University of York and is a scientific unit that works independently. We never bow to any pressure towards certain conclusions, because inevitably that will ruin the Centre's prestige, which is high both nationally and internationally. Our output is based on scientifically valid systematic reviews".

Inclusion (or should it be exclusion) criteria
Presumably to ensure that any dangers from fluorides were not missed, the York review's original protocol stated that: "All studies showing any negative effects from water fluoridation in humans will be considered for inclusion in the review".⁽²⁾

As fluorides are so widespread in modern society, it would consider: "where possible the actual consumption of fluoride from water and exposure to other sources of fluorides in the different populations so that the results can be considered in the context of total fluoride exposure and that attributable to water supply."⁽³⁾ (Emphasis added)

The Background to the York Review's draft results stated: "This study aims to provide a systematic review of the best available evidence of benefits and harm in order to assess the effects of water fluoridation. . . ."

"Systematic reviews locate, appraise and synthesise evidence from scientific studies in order to provide informative empirical answers to scientific research questions . . . Rather than reflecting the reviews of the authors all being based on only a (possibly biased) selection of the evidence, they aim to contain a comprehensive summary of the available evidence."

At first sight, then, it seemed that the Review's deliberations would serve a useful purpose.

But it was not to be. There are literally tens of thousands of papers on the safety, efficacy and adverse effects of fluoride, yet the review panel only managed to locate 3,236, of which 734 met their relevant criteria and just 214 were included for review. Most of the studies that cast doubt on fluoride were deemed unworthy of consideration. The protocol for the review made sure of this by excluding all animal studies, all biochemistry, all mathematical models and all studies on the effects of fluoride from any source other than artificial water fluoridation - despite their use of the phrases, "exposure to other sources", "total fluoride exposure" and "comprehensive" quoted above.

Such exclusions make a mockery of the whole process.

For inclusion any study had to fulfill the following criteria:

1. It must be a primary study (i.e. not a review or commentary on existing studies). Despite admitting that much of the work done on fluoridation is of poor quality, York Review allows the early studies but does not allow criticism which shows the mistakes made in these studies. It also does not allow follow-up studies which give a much better idea of the effectiveness or otherwise of fluoridation. For example, the heavily criticised, original study conducted in Kingston and Newburg, is considered suitable for inclusion, but not the better quality, later analyses of 1986⁽⁴⁾ and 1995.⁽⁵⁾ These showed that there was less tooth decay in unfluoridated Kingston than in fluoridated Newburg. Moreover, the children in Kingston also had only half the level of dental fluorosis compared to fluoridated Newburg. By not including these data, the York Review panel could only conclude that the fluoridated children were better off - exactly the opposite of the truth.

2. Use human subjects, no animal studies will be included in the review. Just as in other fields of medicine, a great deal of experimental work was conducted on specially bred animals in laboratory conditions: work that would be impossible on humans for ethical reasons. This criterion ruled out work such as Dr Phyllis Mullenix's landmark neurotoxicity study on rats. http://www.cadvision.com/fluoride/brain.htm

3. Consider fluoridation of public drinking water, studies investigating the effect of fluoride solely from other sources will not be included. There is so much fluoride in our lives today, even in unfluoridated communities, that excluding the effects from any source other than the artificial fluoridation of drinking water is beyond belief.

Louis Ronsivalli, for many years Laboratory Director at the Massachusetts Institute of Technology, and recipient of four US Government Awards said of this exclusion:

The Review's objectives
The York review set out with five objectives or questions to be answered:

1. What effects does fluoridation have on the incidence of dental caries? The answer to this question is fundamental for if there is no benefit, there is no point in fluoridation at all. So why did the Review omit recent large-scale and even whole-population surveys in such heavily fluoridated countries as Australia,⁽⁶⁾ Canada,⁽⁷⁾ New Zealand,⁽⁸⁾ and the USA⁽⁹⁾ which showed little or no reduction in tooth decay in children's permanent teeth? Doubt about any significant anti-caries effect of water fluoridation can also be seen in the fact that tooth decay rates in much of continental Europe are generally lower without fluoridation than in many fluoridated communities. How can this Review claim to be an "expert scientific review" of fluoridation if it does not consider such evidence?

2. If these effects are beneficial, how do they compare with alternatives to fluoridation? How can we tell? Since there is such a huge body of evidence indicating no significant reduction in dental caries in the permanent teeth of children in fluoridated communities compared to nonfluoridated communities, there is little point in trying to "compare" anti-caries effects of water fluoridation with other methods to reduce tooth decay.

3. Does fluoridation result in an equitable reduction in caries across groups and different geographical locations? This question relies on a fundamental assumption that there is a benefit from fluoridation, an assumption which is not supported by a substantial body of evidence. British Dental Association figures show that dental caries is similar in areas with and without fluoridation.

4. Does water fluoridation have negative or adverse health effects? The Review shows a marked bias in this question. Many studies fitted the Review's inclusion criteria but were not considered for one reason or another. For example: in one (Morgan 1998), behavioural problems in children were classified according to dental fluorosis levels, not water fluoridation. For this reason it was excluded - even though fluorosis is caused solely by fluoride.

The studies included and considered did, however, provide overwhelming evidence that when you fluoridate the water you see an increase in dental fluorosis - damage to the tooth enamel. As fluorosis is indicative of enzyme damage within the tooth, it is clear that other enzymes are being damaged in the body. So why couldn't the York Review find any?

5. Do natural and artificial water fluoridation differ in their effects?The York Review considered eighty-eight studies of a variety of adverse effects but could reach no firm conclusion. They say: "A wide range of outcomes was considered with many outcomes only discussed in one or two studies. There is thus insufficient evidence for any of these outcomes to compare the effects of artificially and naturally fluoridated water".

But an important aspect of this question is the difference between the chemical used for artificial fluoridation today and what was used previously. Don't forget that the fluorosilicates used in water fluoridation, have never been tested. As there are no tests, the York review cannot include them.

The criteria are narrowed still further
Andreas Schuld is head of a Canadian organisation, Parents of Fluoride Poisoned Children. Reading through the inclusion criteria and the studies being considered, Schuld noticed that there was not one study on the effects of fluoride on the thyroid gland although the review panel said they had looked for them. He wrote to the Review board listing a hundred studies that he believed should be included.⁽¹⁰⁾ Dr Matthew Bradley replied:

Shortly after this exchange, Dr Matthew Bradley left the Review Panel. As he had said, however, the criteria were narrowed and wordings were changed to exclude Schuld's evidence:

Section 4.2. If fluoridation is shown to have beneficial effects, what is the effect over and above that offered by the use of alternative interventions and strategies?

Under Participants the wording was changed subtly but significantly:

Under Intervention there were similar changes:

The same wording changes were made to section 4.4 Assessment of the negative health effects of fluoridation.

These changes removed all sources of fluoride except for that which is added artificially - and that effectively removed most of the evidence of adverse effects of fluoride.

But it still left one glaring omission which was picked up by George Glasser: studies included so far only considered the effects of fluoride which was drunk, not the effects of fluoride in fluoridated water that entered the body through the skin.

You absorb more fluoride from a bath
The significance of exposures of the skin to contaminants in the environment has been known and accepted for toxicological testing for many years. It is well documented that environmental contaminants such as fluorides are absorbed readily both through the skin and by inhalation.⁽¹¹⁾

Studies by Drs H.S. Brown, D.R.Bishop and C.A. Rowan in the early 1980s, demonstrated that an average of sixty-four percent of the total dose of waterborne contaminants, such as fluoride, are absorbed through the skin.⁽¹²⁾ Studies by Dr. Julian Andelman, Professor of Water Chemistry, University of Pittsburgh Graduate School of Public Health, also found more chemical exposure from using fluoridated water to wash clothes or take a shower than from drinking it,⁽¹³⁾ as absorption through the skin and breathing them in directs any contaminants directly into the blood stream.

The US EPA's own studies confirm these findings. Yet EPA, as the regulatory agency setting contaminant levels for fluorides in the drinking water, has never commissioned a published study on dermal absorption of fluorides in drinking water,⁽¹⁴⁾ despite applying in 1998 for a grant to research children's vulnerability to toxic substances, because: "Children have a greater surface area to body weight ratio than adults which may lead to increased dermal absorption".⁽¹⁵⁾

Fluoride and the thyroid
Between 1932 and 1962 Gorlitzer von Mundy cured hyperthyroidism (over-active thyroid gland) effectively with fluoride baths. Von Mundy warned that such treatment should only be applied to hyperthyroid patients, for to apply such measures to euthyroid (normal) people would surely lead to hypothyroidism (underactive thyroid).⁽¹⁶⁾ It is no surprise, therefore, that hypothyroidism is rising alarmingly in the USA and may now affect as many as ten percent of the population.⁽¹⁷⁾

Young children will often spend from forty-five minutes to two-hours playing in the bath. This suggests a significant potential for dermal exposure to waterborne fluorides. Often shampoo, bubble bath, and soap are used. Glasser and Schuld point out that almost all bathing products contain sodium lauryl sulfate (SLS) as a foaming agent and that pharmaceutical manufacturers use SLS to increase the absorption of medications used on the skin. SLS added to bath water has been estimated to increase absorption of fluoride from bath water by nine percent. SLS is also added to toothpastes which contain up to 2,500 ppm of fluoride. George Glasser believes that it is most significant that no agency in any country that promotes fluoridation of water has ever presented a single study about the most significant route of exposure: The Skin.

Hypothyroidism: iodine deficiency or fluoride excess?
According to WHO, hypothyroidism "affects 740 million people a year. It causes brain disorders, cretinism, miscarriages and goiter. It is the world's single most important and preventable cause of mental retardation". In South-east Asia, excluding China, maternal and fetal 'iodine deficiency' is responsible for 101,800 stillbirths and 93,500 neonatal deaths each year.

In 1996 in the European Journal of Clinical Nutrition paper claimed that the high incidence of transient neonatal hypothyroidism in Hong Kong was the result of iodine deficiency.⁽¹⁸⁾ But how can this be? Sea foods, rich in iodine, are eaten extensively in Hong Kong, just as they are throughout southeast Asia. Examination of the iodine content of foodstuffs by the Consumer Council in association with the Chinese University of Hong Kong, showed that, far from being low, the amount of iodine customarily consumed in a Chinese Hong Kong meal was much higher than WHO recommended daily intakes for either children or adults.

Excessive fluoride intake through water, food and air is known to reduce biologically active iodine in the system and cause iodine deficiency. This is the mechanism by which it worked to cure hyperthyroid patients - and at concentrations lower than the 'optimal' 1 ppm. Hong Kong's water was fluoridated in 1961. So is it really caused by iodine deficiency, or by too much fluoride?

This is another area that was excluded from York Review by their (amended) criteria.

To be fair the Review Panel, in their opening remarks, they emphasized that this review can only be a part of the evidence that the British government must examine before making a decision to fluoridate the rest of Britain's public water supplies. Nevertheless, the review is being treated by some members of the press as if this is the 'last word' on the fluoridation debate. It is not. It is not the last scientific word and it is certainly not the last ethical word.

Results
The review found "a median 15% reduction in tooth decay or a median 2.25 fewer decayed, missing, and filled primary/permanent teeth - amongst children living in fluoridated areas compared to non-fluoridated areas". But how accurate is this figure? If 2.25 is fifteen percent, that means that the average number of DMFT among non-fluoridated children is fifteen teeth. It isn't. In fact, in Britain, average DMFT in fluoridated areas is 1.08 and in unfluoridated areas it is 1.97 - less than one tooth difference.

They found no clear evidence of other potential adverse effects - their inclusion criteria made sure of that. They also say that prevalence of fluorosis was also highly associated with water fluoride concentration - at least they got that right.

Peer Reviews of the York Review
The combined literature of the York Review and its critics would fill a book. Here are quotes from just three world-renowned scientists who were asked to peer-review the York Review's results⁽¹⁹⁾ and other interested parties:

Paul Connett, PhD, Professor of Chemistry, St. Lawrence University, Canton, New York.

"The danger of such a review as conducted by the York team is to make everything appear extremely complicated for the ordinary citizen. Let's simplify the picture. No risk is acceptable if it is avoidable. Why take these risks when based upon the largest study of teeth done in the US the benefit of fluoridation at most represents half a tooth surface saved per child? Why protect the teeth on the outside with a method which has a high chance of damaging them from the inside (dental fluorosis)? Why take these risks when all but three countries in Western Europe do not fluoridate their water and there is no evidence to suggest that their teeth are worse than countries that do? . . . The toxic properties of fluoride are not in dispute.

"The York Review has provided enough information for reasonable citizens, scientists and governments to act now. The time has come to end the practice of putting fluoride into drinking water."

Albert W. Burgstahler, Ph.D. Professor Emeritus of Chemistry, The University of Kansas, Lawrence, Kansas, USA.

"From a scientific standpoint, the exclusion of animal and laboratory data from the review . . . places undue reliance on admittedly deficient epidemiological investigations that can only be as valid as the adequacy and completeness of the date included in them, no matter how sophisticated the statistical analyses might be. In terms of human population studies, the omission of all reference to unrefuted peer-reviewed reports of reversible adverse health effects of fluoridation points up a major defect in the review. By not citing pertinent experimental and clinical case-study data on the toxic properties and biomedical hazards of fluoridation, the review clearly has a serious major shortcoming.

"Moreover, by not allowing examination of other admittedly important aspects of fluoridation, the DOH has been able to tailor the report to its own restricted views of the subject, thereby making the review very inadequate and misleading in its presentation.

"Both fluoride and lead are persistent environmental pollutants and, like lead, fluoride accumulates in the human body with disastrous consequences to health. Only by acknowledging and dealing honestly with this fact and its implications can this or any other review of fluoridation ever be considered an acceptable scientific document."

Dr Bruce Spittle MB ChB DPM FRANZCP, Senior Lecturer, Department of Psychological Medicine, University of Otago Medical School, Dunedin, New Zealand

"I have major reservations about the credibility of the review because of the narrowness of the inclusion criteria and the associated difficulties at looking at the effects of fluoride irrespective of its source using the full range of information available including biochemical and animal studies."

Professor Rudolf Ziegelbecker, PhD. Institute of Environmental Health, Graz, Austria

George Glasser, US investigative journalist specialising in pollution

"Many observers, including this writer, who investigate current scientific review criteria will dismiss the York review on the basis that the panels did not address all modes of exposure, and most importantly, the special children's issues."

E.M. Vaughan, on behalf of the Directors, National Pure Water Association Limited.

"We are particularly critical of the exclusion of all existing animal studies, exposure via dermal absorption and the biochemistry of fluoride exposure from sources other than drinking water. Nor did the Review consider the total exposure of human populations to toxic fluorides, which essentially determines the severity of adverse health effects.

"NPWA Ltd regrets that this Review represents a missed opportunity to explore the breadth of fluoride research. Whatever the Final Report may conclude, the self-evident deficiencies of this Review compromise the security of the NHS CRD's findings."

The Green Party of England and Wales

"The Review has looked at fluoride in drinking water. But fluoride is a cumulative poison, and it's the overall dose which counts. . . . The methods by which the Review has conducted its work, together with the narrowing of the Protocols from the original intention to look at fluoride and health, is wholly unacceptable - there should be an inquiry into the procedures of the Review." . . . "Tooth decay is about poor dental hygiene and high-sugar diet. Mass medication with fluoride doesn't address this problem, and doesn't respect individual choice, but does have a cumulative toxic effect on the human body."

The Green Party supports the National Pure Water Association's stance - calling for the repeal of all existing legislation permitting water fluoridation.

Conclusion
The British government's Review, indeed all research conducted on drinking water fluoridation, is concerned only with direct oral ingestion from water, using either calcium or sodium fluoride. No research has ever been carried out on the chronic effects of exposure to fluorosilicates, whether they be in water, food or air, and none seems likely while 'reviews' restrict their examinations to the effects produced by the addition of sodium fluoride to water alone. Any claims that these substances are safe or efficacious are specious.

This review was about 'Water fluoridation' to 1ppm specifically, as stated in the criteria reiterated by Matthew Bradley to Andreas Schuld. It was not about the biochemistry, and/or the cumulative nature of fluoride; or of existing levels in people, despite a warning by MoH Mission in 1953; or total ingestion from all sources (WHO 1994). Neither did it consider the crucial differences between calcium fluoride and fluorosilicic acid. Even Dr Peter Mansfields's West Midlands urine tests were about determining total ingestion levels - so the criteria of this review specifically ruled them out.

In 1985 Professor Phillipe Grandjean, Professor of Environmental Medicine at the University of Odense, Denmark, wrote to the US Environmental Agency about a WHO study on fluorine and fluoride. He pointed out:

The same can be said of this review. One is now left to wonder why the review was conducted. If this review was worth a year's work by a many highly paid scientists and government officials; if it was worth spending scarce NHS money on; if it were really to be a once and for all, unchallengeable, examination of the benefits and adverse effects of fluoridation, why were the inclusion criteria manipulated to exclude data that might show fluoridation in a bad light.

The title the NHSCRD dreamed up for their press release was "The Final Word on Fluoride". It isn't.

The Government's White Paper on health specifically stated that this Review would examine the effects of fluoride on health. It didn't.

References
1. http://www.york.ac.uk/inst/crd/fluoinc.htm

2. http://www.york.ac.uk/inst/crd/fluofaq.htm

3. http://www.york.ac.uk/inst/crd/fluorid4.htm

4. Kumar JV, Green EL,et al. Trends in dental fluorosis and dental caries prevalences in Newburgh and Kingston, NY. Am J Public Health 1989; 79: 565-9.

5. Kumar JV, Swango PA et al. Changes in dental fluorosis and dental caries in Newburgh and Kingston, New York.. American Journal of Public Health 1988; 88: 1866-1870.

6. Diesendorf M. A re-examination of Australian fluoridation trials. Search 1986;17: 256-61.

7. Gray, A.S. Fluoridation: Time for a new base line? J Can Dent Assoc 1987; 53:763-5.

8. Colquhoun, J. Fluorides and the decline in tooth decay in New Zealand. Fluoride 1993; 26:125-34. Cf. Community Health Studies 1987; 11:85-9; 1988;12:187-91.

9. Hildebolt CF, Elvin-Lewis M., Molnar S, et al. Caries prevalences among geochemical regions of Missouri. Am J Physical Anthropol 1989; 78: 79-92. Yiamouyiannis, JA. Water fluoridation and tooth decay: Results from the 1986-1987 National Survey of U.S. schoolchildren. Fluoride 1990;23:55-67. Steelink, C. Letter. Chem & Eng News 17 July 1992:2-3. Cf. abstract of AAAS presentation: An analysis of the causes of tooth decay in children in Tucson, Arizona. Fluoride 1994; 27: 238.

10. http://www.bruha.com/fluoride/html/conversation_with_uk.html is a record of correspondence between Andreas Schuld and the York Review panel

11. Prevention, Pesticides and Toxic Substances (7101), EPA 712-C-96-350 June 1996 Health Effects Test Guidelines, OPPTS 870.7600, 870.7600, Dermal penetration. EPA, Exposure Factors Handbook, August 1996: "Factors that affect dermal exposure are the express way in which a combined amount of material comes into contact with the skin; the dose-response relationship to calculate risk and the rate at which the contaminant is absorbed; the body weight to be used in the exposure calculations; and the exposure duration." and Dermal Exposure Assessment Principles and Applications, EPA/600/8-91/011B, January 1991.

12. American Chemical Society Meeting, Anaheim, California, 1986.

13. Andelman J. American Journal of Public Health, May 1984

14. Dermal Exposure Assessment Principals and Applications. EPA/600/8-91/011B, January 1991.

15. Opening Date: June 30, 1998 Closing Date: Sept 30, 1998, Children's Vulnerability To Toxic Substances In The Environment Science to Achieve Results Program: 1999 Research Grants

16. Gorlitzer von Mundy. Einfluss von Fluor und Jod auf den Stoffwechsel, insbesondere auf die Schilddrüse. Münch Med Wochenschrift 1963; 105: 234-247.

17. Canaris GJ, Manowitz NR, Mayor G, Ridgway EC. The Colorado Thyroid Disease Prevalence Study. Arch Intern Med 2000;160: 526-534

18. Kung AWC, Chan LWL, Low LCK, Robinson JD. Existence of iodine deficiency in Hong Kong - a coastal city in southern China. Eur J Clin Nutr 1996; 50: 8.

19. http://www.fluoridealert.org/york.htm contains peer reviews of the York Review

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