HomeMy WebLinkAboutBoard of Health June 14 20051
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DISCLAIMER: This document contains the Whatcom County Council or Committee
minutes, as approved. However, unless an attested signature page is attached, they
are not the final approved minutes.
WHATCOM COUNTY COUNCIL
Board of Health
June 14, 2005
Council Chair Laurie Caskey- Schreiber called the meeting to order at 10:30
a.m. in the Council Chambers, 311 Grand Avenue, Bellingham, Washington.
Present:
Barbara Brenner
Dan McShane
Sam Crawford
Seth Fleetwood
Sharon Roy
1. PUBLIC SESSION
Absent:
L. Ward Nelson
Dale Bjornson, 2829 Birchwood Avenue, Bellingham, stated he is a retired
science teacher. He is concerned about the City of Bellingham's plans to fluoridate
their water. There is a dental decay crisis in Bellingham and many cities in the
United States, including cities with fluoridated water. There are many examples
that show fluoridation doesn't do what advocates think. It will give a very harmful
substance to the citizens. One can suffer from dental fluorosis with too much
fluoride. If in the water, it's impossible to control the dosage of the fluoridation
medicine. There is fluoride in the food. Fluoride has been banned in most
countries in the world. It is harmful in the diet and doesn't do what advocates
claim. The substance used to fluoridate water is a waste product from the fertilizer
industry.
Shirley Jacobson, 620 Creekbend Lane, Bellingham, submitted information
(on file). Read from her information from the International Academy of Oral
Medicine and Toxicology 2003 position policy. The panel consisted of both
proponents and opponents of fluoridation. Data indicate that some people are
unusually susceptible to fluoride toxicity, including the elderly and people with
kidney problems. This report contradicts the reports of the Centers for Disease
Control (CDC) and others.
Sharon Crozier, Bellingham, stated this issue is brought forward by people
who think asbestos is good for them. European cities are removing fluoride from
their water. The best way to treat children is topical application of fluoride on the
teeth. It accumulates in bones. There is no science behind it, or the science is old.
New science shows that fluoridated water isn't good. The fertilizer industry is
paying for this campaign.
Board of Health, 6/14/2005, Page 1
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DISCLAIMER: This document contains the Whatcom County Council or Committee
minutes, as approved. However, unless an attested signature page is attached, they
are not the final approved minutes.
Dr. Grant Deger, resident, stated there is 60 years of proof of the safety and
efficacy of fluoridated water. There has always been a 40 to 60 percent reduction
in cavities. Forty -three of the 50 largest cities use fluoride in the water to protect
their population. Fluoride is the 17th most common element. It's everywhere.
Their water, which is glacier runoff, doesn't have enough to protect teeth. The
ocean has 1.2 parts per million (ppm). The biomass of the ocean is doing fine. A
level of one ppm will protect teeth. All age groups, including the elderly, would
benefit. People die of abscesses in their jaw. No appellate court in U.S. has ever
spoken against the safety of fluoride in the water. It is used worldwide. The
Scandinavian countries have chosen to use other methods to provide fluoride, but
they still use it. Fluoridation is endorsed by every health organization, including the
World Health Organization, surgeon general, federal and state public health
agencies, and doctors and dentists. The dental industry wants to help because it
lowers the cost of dental care for people who can't afford it. It helps people into old
age carry their teeth for a lifetime.
Crawford stated a certain amount of fluoride is beneficial. The debate is how
much and whether it should be in the public water. He asked if it's possible to get
too much by dose or accumulation over a lifetime. Deger stated fluoride is cleared
readily by the body, but it becomes part of the minimal structure of the teeth.
That's how it protects. Toxicity is difficult. The amount in toothpaste has 2,500
times the amount that would be in the water. In the water, there is a low level all
the time, so it creates an environment where a person doesn't get an acid injury.
Huge doses given during a study showed toxicity, but toxicity in huge doses can
happen with anything. They are talking about a miniscule amount over the long
haul.
Crawford asked if a person drinks fluoridated water, uses fluoridated
toothpaste, and uses fluoridated rinses throughout an entire life could be damaged.
Deger stated he or she cannot. They must be careful with infants if the water is
fluoridated. Don't also give them fluoride drops and fluoridated toothpaste. It
won't accumulate in too much over a lifetime.
Larry Williams, Bellingham, stated the body does get rid of fluoride to a
certain extent, but a residual amount remains. Fluoride has a minimum range of
safety to be effective. Around one microgram per kilogram of body weight is okay.
Up to five micrograms can be a problem for a particular age group. People get
fluoride from many sources now. One doesn't know how much they get from all the
sources now. Fluoride can bring lead out of leaded pipes in the city. In older
homes, people will be subjected to lead leaching caused by fluoride in the water.
That lead will attack the nervous system. They haven't monitored what they need
to protect the teeth of young children. Children need fluorine, not the industrial
waste product.
Dr. Curtis Smith, 800 Highland Drive, Bellingham, stated fluoride is not a
heavy metal. The safety of fluoridation has been studied for 60 years. In some
communities, the dosage is considerably higher than one ppm, by 10 to 15 times.
Board of Health, 6/14/2005, Page 2
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DISCLAIMER: This document contains the Whatcom County Council or Committee
minutes, as approved. However, unless an attested signature page is attached, they
are not the final approved minutes.
There have been many studies on many possible effects. Safety is not an issue at
this point. The national organizations that are responsible for keeping the
population safe endorse fluoridation without exception.
Marie Bjornson, Bellingham, handed out information (on file) and stated that
Dr. Grant Deger has taken on an issue. The Federal Drug Administration (FDA) has
not approved fluoride. There are no studies to prove the safety of fluoride and
fluoridated water. The fluoride acid is a different form of fluoride than what is in
toothpaste. Dr. Deger is not an expert at the issue of fluoride. He has refused to
read the literature she's given him on fluoride. He's going by 50 -year old studies.
When researching fluoride, one can be inundated with information. They have an
issue with over - fluoridation in the United States. They are asking for a choice.
They don't want to be over - medicated.
2. PUBLIC HEALTH ADVISORY BOARD CHAIR REPORT
Laverne Oreiro, Public Health Advisory Board Chair, stated the Public Health
Advisory Board discussed and acted on issues, including a statewide review of
public health standards, healthy youth survey results, health risk behaviors of
various ages, and pandemic influenza planning. The Public Health Advisory Board
took action on an immunization advisory group, strategies, and progress; formation
of an onsite septic (OSS) subcommittee, and; oral health in Whatcom County. The
Public Health Advisory Board requests input on additional topics it should consider
during the remainder of 2005.
She handed out information (on file). The Public Health Advisory Board
recommends the safety and efficacy of water fluoridation. She read the
recommendation and conclusions.
Crawford stated the oral health issue has a lot of attention. The Board of
Health will get this presentation. The Public Health Advisory Board recommends
that the Board of Health clarify its role. He asked if this consideration is hand -in-
hand with the City's proposal for water fluoridation.
Regina Delahunt, Health Department Director, stated the Health Department
has been involved with the Oral Health Coalition in looking at the status of oral
health in the community and the range of measures to improve oral health. One
issue that has come up is the initiative for water fluoridation. They aren't
coincidental. They are tied together. The Public Health Advisory Board reviewed
information on the Smile Survey in the community, and other information on the
safety and effectiveness of community water fluoridation. The Public Health
Advisory Board wanted to present to the Board of Health something for the Board
of Health to discuss on this issue. It's not the Board of Health's role to allow or
prohibit fluoridation in the community water. It is a public heath issue, and
fluoridation is a topic in the community. The Public Health Advisory Board stated
that it might want to play a role in community dialog, looking into safety and
Board of Health, 6/14/2005, Page 3
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DISCLAIMER: This document contains the Whatcom County Council or Committee
minutes, as approved. However, unless an attested signature page is attached, they
are not the final approved minutes.
efficacy. The Board of Health should have some role in this public health issue.
That's what the Public Health Advisory Board is bringing forward.
Crawford asked if the strongest role the Board of Health would play is
passing a resolution with a recommendation. Another option is for the Board of
Health to do nothing. Delahunt stated they are options.
Caskey- Schreiber stated the Public Health Advisory Board is also asking its
role in getting involved. The Board of Health and Public Health Advisory Board will
have a joint meeting in the fall when it can discuss the issue.
3. ONSITE SEWAGE SYSTEMS PUBLIC HEALTH ADVISORY BOARD
SUBCOMMITTEE UPDATE
Regina Delahunt, Health Department Director, stated the new State
regulations are almost finalized. The Board of Health asked the Public Health
Advisory Board to have a subcommittee to look at the issues in the community.
The committee is together and has held one meeting.
Jim Goode, Onsite and Drinking Water Supervisor, stated the committee is
comprised of a broad section of the community, including the onsite sewage system
(OSS) industry, building industry, Lake Whatcom interests, and shellfish districts.
They have invited someone from the real estate industry, but no one has attended.
They are interested, but haven't been able to attend the first meeting last week.
Ten members are on the subcommittee.
The work plan in the packet was slightly revised. They changed sections two
and three. Operations and maintenance (O &M) is part of the regulation and
update, but it will take a huge amount of time.
The two tasks are updating the code and formulating an O &M plan. The
State Board of Health hasn't adopted the State regulations yet. The State is taking
comments until June 22. Those issues are O &M and lot sizes for new subdivisions.
Roy stated this is a huge issue for shellfish beds throughout the county. She
asked who on the committee represents the shellfish industry. Goode stated Geoff
Menzies is on the committee.
Roy stated she's very excited about this committee. It's an extremely
important issue for the marine and lake waters in the county.
Brenner referenced the recommendation in section 2(b) to delete the Appeals
Board and use the Hearing Examiner instead. She asked how the Hearing Examiner
will deal with issues of health and safety. He deals only with issues of law. She
would rather have someone do this who has a health background.
Board of Health, 6/14/2005, Page 4
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DISCLAIMER: This document contains the Whatcom County Council or Committee
minutes, as approved. However, unless an attested signature page is attached, they
are not the final approved minutes.
Caskey- Schreiber stated this is a rough draft of items the subcommittee will
review.
Brenner asked who was on the Appeals Board. Delahunt stated the
membership varies. Some members did know a lot about septic systems, and
others who don't. The County Council makes the appointments to the Appeals
Board. The only qualification is to live in a particular area.
Brenner asked about item 2(c). She asked the reason for the concern about
a gravity mound system. Goode stated there is no particular concern. They are
giving the committee an opportunity to review all the issues in the Whatcom County
code that are not duplicated in the minimum State code. They will consider
whether they should go by minimum State code or add to it. Minimum State code
doesn't allow gravity mound systems. Whatcom County allows it because of a
waiver obtained several years ago. It's lawful because of a waiver, not because of
a minimum regulation.
Delahunt stated it is a special allowance for Whatcom County. Those
systems are something to look at. They want to look at anything that is different
from the new State code.
Brenner asked if other counties have the same waiver. Goode stated he is
not aware of any. However, they seem to be having good success with them here.
Delahunt stated she hopes to have more information for the Board of Health
by November.
Brenner referenced 3(c)(9) about identifying O &M needs and strategies for
special watershed areas of concern. She hopes the entire county is considered,
because all areas are special watersheds.
4. ORAL HEALTH UPDATE
Regina Delahunt, Health Department Director, stated the department's role
related to oral health and fluoridation is to provide the community information
about oral health. The Health Department is the expert on the status of oral health
in the community. It's other role in the fluoridation issue is to provide the best
available scientific information they can find in the literature, and then let the Board
of Health know what the State and federal experts say on the topic. The County
staff aren't experts on fluoridation, but have spend a lot of time on the literature.
They can say who the experts are and what the experts are saying.
(Clerk's Note: End of tape one, side A.)
Delahunt continued to state that fluoridation is a community decision to be
decided by the community.
Board of Health, 6/14/2005, Page 5
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DISCLAIMER: This document contains the Whatcom County Council or Committee
minutes, as approved. However, unless an attested signature page is attached, they
are not the final approved minutes.
Diane Lowry, Centers for Disease Control (CDC) Fellow, stated she doesn't
have a background in oral health. She learned from the community and her
research. She handed out and read from a power point presentation (on file) on
factors involved with dental disease and the results of the Bellingham School
District third grade Smiles Study showing the prevalence of tooth decay, severity of
tooth decay prevalence by income group, tooth loss among Whatcom County
adults, access to dental care, increased use of the emergency department, and
current oral health programs. Each factor influences the rate of decay in
individuals. Tooth decay rates in Whatcom County are higher than the state
average, and significantly higher than King County rates.
She read the presentation on examples of food and water supplements as
public health intervention. Other public health interventions have used
supplements in water and food. She continued to read about the safety, including
examples of other interventions, data sources, optimal fluoride levels, evidence of
association with health problems, enamel fluorosis, toxicity, bone health, and water
safety.
She continued to read the presentation about the effectiveness of community
water fluoridation, including how fluoride works, review of evidence for fluoridation,
reduction in decay with water fluoridation, the Newbrun study, and the increase in
decay when fluoridation is stopped.
She completed reading the presentation about the cost of community water
fluoridation, including cost savings and estimates for Bellingham. Policy statements
from the reviews she looked at all recommend community water fluoridation by the
CDC, National Research Council (NRC), Public Health Service (PHS), and American
Academy of Pediatrics.
Brenner asked about factors involved with dental disease. She asked what
sealants on the back teeth do. Lowry stated sealants are a protective coating so
bacteria can't get to pits and fissures on the teeth. Sealants are only effective on
the molars, which have the pits and fissures. Front teeth don't have them.
Brenner asked about the severity of tooth decay. She asked if the same
people do all the same studies. Lowry stated there is a calibrated statewide study
through the State Department of Health every five years. All the screeners are
trained on how to look for decay so the information is consistent.
Brenner referenced the presentation slide on current oral health programs.
She asked about how long the Lummi reservation has been fluoridated. Lowry
stated the Lummi reservation has been fluoridated off and on over the past few
years. There was a period of time where they stopped fluoridation. Only the last
couple of years it's been fluoridated consistently.
Dr. Curtis Smith, 800 Highland Drive, Bellingham, stated the last speaker
stated the Lummi reservation became fluoridated the last time beginning in 2002.
Board of Health, 6/14/2005, Page 6
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DISCLAIMER: This document contains the Whatcom County Council or Committee
minutes, as approved. However, unless an attested signature page is attached, they
are not the final approved minutes.
Brenner referenced the presentation slide on food supplements for public
intervention. She asked who was involved. Lowry stated the Oral Health Summit.
That slide was not related to other public health interventions. It was her lead -in
for community water fluoridation. The summit happened in 2004 and included
about 80 community members. The Health Department facilitated the summit and
invited the dental, medical, and social service communities.
Brenner referenced the presentation slide on the optimal fluoride level. She
asked how the optimal level range works. Lowry stated the optimal level balances
out prevention effects with trying to keep enamel fluorosis low. They estimate 10
to 12 percent of very mild enamel fluoride at this level, but it's a significant level to
decrease tooth decay.
Brenner asked about fluoride from other sources they get daily. She asked
how they calculate how it will increase fluorosis. Lowry stated there are estimates
that take that into consideration. There is a formula. The maximum contaminant
level is set so there aren't effects, even with those other sources.
Brenner asked how they calculate for differences in peoples' sizes and
consumption. Lowry stated the Environmental Protection Agency (EPA) looks at a
variety of human factors and takes it into consideration.
Delahunt stated the EPA takes all of those factors into account. They also
add a safety margin. A level of eight parts per million (ppm) was the level the EPA
considered there could be some health effects, so they set the acceptable level at
four ppm, which includes a level of safety. In general, the EPA bases any
maximum contaminant level (MCL) on at -risk population, such as children.
Brenner referenced the level of fluoride parts per million. She asked the
acceptable amount. Lowry stated that at a level of one ppm, there is no evidence
of association between fluoride and the types of tooth decay listed.
Brenner asked about enamel fluorosis. She asked about side effects of over-
consumption in early childhood and the health effects to teeth. She asked how
different teeth are than bones in development. Delahunt stated that at high
concentration, it can cause brittleness in bones. The presentation included effects
of skeletal fluorosis.
Lowry stated it has to do with topical application of the fluoride. The fluoride
touches the teeth, not bone.
Fleetwood asked about the low prevalence of mild fluorosis. He asked why a
fluorosis level of 10 to 12 percent is acceptable. Lowry stated the Public Health
Service determined that level, which is very mild and mild fluorosis is barely
discernable, and may not be visible.
Board of Health, 6/14/2005, Page 7
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DISCLAIMER: This document contains the Whatcom County Council or Committee
minutes, as approved. However, unless an attested signature page is attached, they
are not the final approved minutes.
Delahunt stated it is a balance and judgment call. Weigh how much to
accept against the benefits of prevention.
McShane stated that generally, teeth in most animals have much higher
levels of fluoride than in bone. One is more likely to find teeth fossils than bone
fossils.
Brenner referenced the presentation slide on the bone health. She asked
about the studies on bone fractures, and whether the studies included the elderly.
Lowry stated the epidemiological studies looked at fluoridated and non - fluoridated
communities. The studies looked at outcomes of bone fracture, age, race, gender,
and other individual characteristics. Age was definitely taken into consideration.
The study included people at risk of osteoporosis and fractures.
Smith stated the bone health studies are look -back studies on elderly,
specific to hip fractures. The two studies that were done were in the 1990's and
concluded there was no correlation. The studies look at people with hip fractures,
and what their exposures were to fluoride over their lifetime. Fluoride accumulates
in the enamel of teeth. There is no effect on part of teeth that is more like bone.
Brenner referenced the presentation slide on bone health. She asked about
the quote on bone cancer. Lowry stated the study was published in 1993.
Brenner asked the difference between the National Cancer Institute (NCI)
and American Cancer Society. Delahunt stated NCI is a governmental agency.
Brenner stated the American Cancer Society removed its endorsement of
fluoridation.
Fleetwood stated the Council received a memo from the Public Health
Advisory Board recommending that the Board of Health engage in community
dialog. He asked what that meant. Delahunt stated the Public Health Advisory
Board believed that it is not the Board of Health's role to mandate or prohibit
fluoridation of any water supply, but it is a public health issue. Because there is so
much discussion in the community, the Public Health Advisory Board felt the Board
of Health should have some discussion of the issue.
McShane asked for a more recent study than 1993 on current MCL
evaluation. Lowry stated an update will be in 2006.
Brenner asked the key informant who was quoted on packet page 15. Lowry
stated key informants included dental, social services, and other professionals.
Janet Davis, Community Health Manager, stated she can supply the Board of
Health with the key informant survey, which will indicate who made that particular
quote.
Board of Health, 6/14/2005, Page 8
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DISCLAIMER: This document contains the Whatcom County Council or Committee
minutes, as approved. However, unless an attested signature page is attached, they
are not the final approved minutes.
(Clerk's Note: End of tape one, side 8.)
Crawford stated he would like to have the Health Department draft a
resolution for the Board of Health to support fluoridation of water systems beyond a
certain size and when its cost - effective. The public is dealing with the issue, and
there is an initiative process to get it on the ballot. After listening to the speakers
with concerns, presentation, and Public Health Advisory Board recommendation, he
concludes that fluoridation is an appropriate public health measure that this Board
could recommend to the community. Timing the resolution with a public debate
that will occur leading up to a ballot initiative would be appropriate.
Brenner stated she opposes a resolution. One person who testified was a
science teacher in the community. There are people with many opinions on this
issue. It's clear that in Whatcom County there is a problem with certain groups of
people getting services from private dentists. Instead of fluoridation, work with the
private dentists to take more Medicaid patients. A study done at the Harvard
School of Dental Health found a link from fluoride and bone cancer in boys. She
relies on her anecdotal information. The Environmental Protection Agency also said
that DDT was safe. She would like to read the studies. There are many issues
involved, including the issue of choice. If something is in the home's drinking
water, people have little choice. She is very opposed to a resolution supporting
public fluoridation.
Roy stated she doesn't know where she will be on this issue. Many times
things are said to be safe, and it turns out they are not. This has happened many
times. She needs to be convinced. People get excited about helping and adding to
mother nature, but humans usually get it wrong. However, she would like to have
this debate when the resolution comes forward. She has two questions. She would
like to know if there was ever a study correlating obesity and overweight children to
dental decay. Also, she would like to know why all the European countries have
moved away from fluoridation. She would like information on those two questions.
Lowry stated they can provide that information. A lot of European countries have
chosen to fluoridate their salt, instead.
Delahunt stated oral health and dental disease consist of many factors. It is
one factor, with many other factors involved. This is one way that many
communities have approached the issue.
Caskey- Schreiber asked the timing of the Board of Health resolution.
Delahunt stated community debate would happen after the signatures are gathered
for the initiative. The debate will happen before the November election. The next
Board of Health meeting is in October.
Fleetwood stated he agrees with Councilmember Roy. He won't support or
not support a resolution today. He presumes that appropriate fluoridation is
acceptable. However, he's received a lot of information from opponents. Delahunt
stated there is much information out there. The Health Department staff looked at
Board of Health, 6/14/2005, Page 9
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DISCLAIMER: This document contains the Whatcom County Council or Committee
minutes, as approved. However, unless an attested signature page is attached, they
are not the final approved minutes.
research done by expert panels that looked at all those studies and separated the
credible and non - credible information. They must be critical about which
information they look at. They tried to look at the government studies and opinions
as best as they can.
Brenner stated the issue is oral health, not endorsing a ballot measure. The
issue is not about a resolution, but about ideas on how kids can get the fluoride
they need. According to the graphs, there is a connection with the ability to get to
dental care. If there were some way to bring the choice of providing fluoride drops
into the classroom and schools, and give parents that option through the school, it
would make a difference. She doesn't have a strong opinion about small doses of
fluoride being safe. She has a strong opinion on the sources and choices. She
doesn't believe that toxicity only happens at much higher levels. Talk about ways
to work with the dental community. Send forward ideas to the Health Department.
She wants to know what the dental community is willing to do. Delahunt stated
many things need to be done in the community for dental health. Community
fluoridation is just one factor. There is work coming out of the Oral Health Coalition
about other factors, as well. The discussion today is on community fluoridation,
because that is the discussion going on in the community.
Roy stated those other components should be included in the findings of a
resolution. They need to look at the other issues, as a community, and this is one
aspect of it.
Caskey- Schreiber asked the councilmembers to provide their ideas to the
Health Department.
1. PUBLIC SESSION
Dr. Terry Poth, 3783 Brownsville Drive, Bellingham, stated the study by the
International Academy of Oral Medicine and Toxicology wasn't considered. All the
studies mentioned were reviewed by the academy. That study said there is animal
and human evidence linking dental fluorosis to neurological impairment. That
evidence wasn't shown in the CDC review papers. They must go directly to the
studies. Someone with knowledge must look at the study to make sure it is well
done to know that study is reputable. This academy is an outside agency looking at
the CDC work.
The study from the National Cancer Institute on incidents of cancer was
turned over to the U.S. Public Health Service for peer review. In the process of
doing that peer review, every cancer was downgraded.
When he sees that government agencies alter the findings of the original
studies, he has doubt. He agreed that other medicines were deemed safe, but were
determined to be unsafe years later. Review the paper from the International
Agency for Oral Medicine and Toxicology.
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DISCLAIMER: This document contains the Whatcom County Council or Committee
minutes, as approved. However, unless an attested signature page is attached, they
are not the final approved minutes.
Mary Lou Anderson stated she is a nurse and nutritional consultant in the
community. She is concerned about safe health practices. Education is very
important. It is important to teach kids what good dental health is. Putting fluoride
in the water won't teach kids about good dental health. Small kids don't drink a lot
of water. They drink juice, pop, and other foods with fluoride, such as tea. It's a
cumulative problem. They can't regulate fluoride levels if it is in the drinking water.
Many studies have been done on other types of fluoride. The water fluoride
additives is a toxic byproduct of the fertilizer and hasn't been proven to be safe.
The Environmental Protection Agency considers it an unproven drug. Look into the
issues of long -term side effects.
She asked why people from out of town are so interested in having their
water fluoridated. Find safe studies. She is all for educating kids about being
healthy. Mass medication is not the way to go. Allow a choice.
ADJOURN
The meeting adjourned at 12:15 p.m.
Jill Nixon, Minutes Transcription
The Council approved these minutes on July 12 , 2005.
ATTEST:
WHATCOM COUNTY COUNCIL
WHATCOM COUNTY, WASHINGTON
Dana Brown - Davis, Council Clerk Laurie Caskey- Schreiber, Council Chair
Board of Health, 6/14/2005, Page 11