The Cost of the Amalgam Issue

As we move through the second half of the year 2001, we find the dental profession in California at the center of two controversies regarding the health and safety of the public. The safety of mercury in dental amalgam is pivotal to both.

At this point, we have no idea of what the final compromises, decisions, or agreements will be. To us, it is not just a matter of whether dentistry wins or loses, or whether other groups claiming to represent the best health interests of the public prevail. Our analysis suggests that the only real winners will be the legal interests who are driving the public controversy over mercury and other materials used in dentistry that have been alleged to be hazardous to health.

We are concerned about the debates that have consumed more than their share of organized dentistry’s attention in the first half of 2001. If the private enforcer activity implementing Proposition 65 warnings in the dental office through fines has not been a large enough thorn in dentistry’s side, then the class-action lawsuit filed in June accusing the American Dental Association and the California Dental Association of unlawfully deceiving patients about the presence of mercury in dental amalgam certainly will be. The headline in the Los Angeles Times went even further when it said, "Suit Seeks to End Use of Mercury in Dentistry."

In the former case, an organization called As You Sow has been at the center, while several groups and individuals including Consumers for Dental Choice and Kids Against Pollution are behind the recent activity to eliminate the use of dental amalgam and to seek "restitution" for payments that the ADA allegedly received to endorse amalgam products. The suit, labeled by both ADA and CDA as "without merit," also included a notice of intent to sue the ADA under Proposition 65. It would seem that all of these well-funded groups have determined that the time is right to remove amalgam from the dental landscape.

Dentistry has successfully defended the science that supports the conclusion that there is no link between amalgam fillings and systemic diseases or chronic illness. The U.S. Public Health Service has concluded that "there is no persuasive reason to believe that avoiding amalgams or having existing amalgams replaced will have a beneficial effect on health." Armed with science and scientific opinion on its side, dentistry has been able to fend off the controversies that individuals and small groups brought into media prominence. We well remember the ill-defined "60 Minute" effort that challenged dentistry to defend the safety of amalgam in the early 1990s. Despite a very negative national media event, the defense of amalgam was successful. But that was THEN, and we are sensing a more formidable threat NOW. Legal maneuvers and the court system are now being used to attack the scientific information and opinion that has been supporting dentistry’s position.

For good reason, we believe that the outcome of the current debates will be costly and not in the best interests of the public or its health. The reason is simple. In the matter of Proposition 65, as of this writing, many costly hours of CDA staff and volunteer time have already gone into the efforts to achieve an acceptable compromise on the appropriate wording of warning signs to be posted in the dental office.

While the length and breadth of the legal battle in the amalgam litigation is not easy to determine at this early stage, one prediction is easy to make. Organized dentistry, in the words of ADA President Robert Anderton, "will mount a vigorous defense." That defense will undoubtedly have a significant price attached.

If dentistry were to lose in the litigation, it could forever compromise the ability of the association to effectively inform and educate the public on scientific opinion based upon valid scientific evidence. But even if dentistry prevails this time, it cannot be considered a victory because of the high anticipated cost.

A reality underlying the debates is that research has been unable over many years to develop a new material that has the advantages of amalgam, but not the controversy of the safety questions that have long plagued this reliable material. It seems unfortunate that the significant funds that will be expended on both sides of these two closely related matters could not be channeled directly toward scientific investigation that might result in development of a safe, long-term restorative material.

These contemporary controversies illustrate our rather unfortunate conclusion that those who seek changes in the interest of public safety, as well-meaning as their efforts might be, often only contribute to higher-cost public health solutions. It is a shame that dollars that could benefit research progress end up being spent on emotional causes that do not directly contribute to the health or the safety of the public.