A6 EZ RE THE WASHINGTON POST.TUESDAY, AUGUST 20 , 2019
BY BEN GUARINOA study of young children in
Canada suggests those whose
mothers drank fluoridated tap
water while pregnant had slight-
ly lower IQ scores than children
whose mothers lived in non-fluo-
ridated cities. But health experts
cautioned that public policy and
drinking-water consumption
should not change on the basis of
this study.
“I still stand by the weight of
the best available evidence, from
70 years of study, that community
water fluoridation is safe and
effective,” said Brittany Seymour,
a dentist and spokeswoman for
the American Dental Associa-
tion. “If we’re able to replicate
findings and continue to see
outcomes, that would compel us
to revisit our recommendation.
We’re just not there yet.”
The American Academy of Pe-
diatrics, likewise, recommends
fluoride in toothpastes and tooth
varnishes for children because
the mineral prevents tooth decay.
In drinking water, “fluoridation
has been incredibly protective,”
said Aparna Bole, a pediatrician
who chairs the Council on Envi-
ronmental Health at the Ameri-
can Academy of Pediatrics.
Fluoridation reduces the prev-
alence of cavities by about one-
fourth, according to the Centers
for Disease Control and Preven-
tion. The CDC considers water
fluoridation one of the 10 top
health achievements of the past
century, on par with vaccines and
antismoking campaigns.
Bole called the new study,
published Monday in JAMA Pedi-
atrics, “an important addition to
our body of knowledge. It sup-
ports the public health commu-
nity’s ongoing reevaluation of
optimal fluoridation levels in
drinking water.”
Study author Christine Till, a
neuropsychologist at Toronto’s
York University, and her col-
leagues acquired data and frozen
urine samples previously collect-
ed by Maternal-Infant Research
on Environmental Chemicals, or
MIREC. That project, run by
Canada’s public health depart-
ment, studied thousands of
mothers who gave birth between2008 and 2012. MIREC research-
ers measured the toddlers’ IQ
after the children turned 3.
Pregnant women reported
their consumption of tap water
and black tea, which is high in
fluoride, in questionnaires. The
authors of the new study also
calculated the amount of fluoride
in municipal water, based on the
levels at wastewater treatment
plants linked to the women’s
postal codes. The researchers es-
timated the women’s daily fluo-
ride intake based on a combina-
tion of those measures.
The researchers compared the
fluoride intake of 400 women,
some who lived in fluoridated
cities and some who did not.
They controlled for factors such
as household income and the
women’s education. A one milli-
gram increase in fluoride intake
was associated with a 3.7-point
drop in children’s IQ, they found.
In another analysis, Till and
her colleagues measured fluoride
biomarkers in urine from 500
pregnant women and found that
a one-milligram-per-liter in-
crease in urine fluoride predicteda drop in IQ of 4.5 points in
young boys. When the research-
ers examined the urine of moth-
ers who had daughters, however,
fluoride had no association with
IQ.
“The decision to publish this
article was not an easy one,” said
Dimitri A. Christakis, the editor
of JAMA Pediatrics and a pedia-
trician at Seattle Children’s Hos-
pital. Christakis appended a note
to the study, a first in his career,
explaining that the journal sub-
jected the paper to “additional
scrutiny.” This included multiple
statistical reviews, he said, but “it
by no means proves definitively
that this is a risk.”
Several researchers unaffiliat-
ed with the report applauded this
work’s publication in the face of
intense review. “This study has
been carefully conducted and
analyzed,” said Pamela Den
Besten, a pediatric dentist who
studies tooth enamel at the Uni-
versity of California at San Fran-
cisco.
But John Ioannidis, a Stanford
University scientist who pub-
lished an influential 2005 papertitled “Why Most Published Re-
search Findings Are False,” said
the study “has major drawbacks
in terms of how the measure-
ments have been made.”
“The results are very border-
line in terms of statistical signifi-
cance,” Ioannidis said. What’s
more, the sex difference in IQ —
the drop observed for boys but
not girls — “makes no sense,” he
said. “If you see a gender differ-
ence claim for this type of associ-
ation, it’s far more likely to be a
spurious finding rather than
something true.”
Bole agreed. “I just don’t know
how to interpret that,” she said.
Some physicians offered ad-
vice based on this study. Philippe
Grandjean, who studies brain
development and environmental
pollutants at the Harvard School
of Public Health, suggested preg-
nant women drink bottled water
and limit black tea to a single cup
per day.
Others did not. “I’m hoping
people don’t conclude on the
basis of this one study, ‘Oh, boy,
we should all be drinking bottled
water.’ No,” Bole said. “Tap waterin most communities is the
healthiest and most environmen-
tally responsible choice.”
And adding more restrictions
to what pregnant women can
consume, Ioannidis said, creates
a “burden of feasibility.”
Seymour said the damage
from dental disease goes beyond
teeth. “Kids in the U.S. who don’t
have access to community water
fluoridation have significantly
higher dental disease, and we
know that impacts their ability to
learn and grow,” she said, includ-
ing harm to sleep, self-esteem
and school performance. Sey-
mour, whose young daughter
drinks city water, would “honest-
ly be more concerned if there was
a decision to stop fluoridating
our water,” she said.
Ioannidis’s concern about
“whether fluoride exposure dur-
ing pregnancy is a bad thing for
the IQ of the child goes up about
threefold,” he said. “If you
thought that it was maybe 1 per-
cent likely to be true, that 1 per-
cent now would become 3 per-
cent. It would still not be true.”
[email protected]Experts urge patience after study on fluoride, child IQ
ers during his week-long vacation
in Bedminster, N.J., focused on
other matters, including the pos-
sibility of an economic downturn,
contentious trade talks with Chi-
na, his nascent 2020 reelection
campaign and concerns about
how the media portrayed the size
of the crowd at his campaign rally
Thursday in Manchester, N.H.
On Monday, Democratic lead-
ers said they viewed Trump’s
shifting posture as a sign that he
was never serious about leading a
push to tighten gun laws.
“We’ve seen this movie before:
President Trump, feeling public
pressure in the immediate after-
math of a horrible shooting, talks
about doing something meaning-
ful to address gun violence, but
inevitably, he backtracks in re-
sponse to pressure from the NRA
and the hard-right,” Senate Mi-
nority Leader Charles E. Schumer
(D-N.Y.) said in a statement.
“These retreats from President
GUNS FROM A1 Trump are not only disappointing
but also heartbreaking, particu-
larly for the families of the victims
of gun violence.”
A White House official rejected
the notion that Trump has shifted
his stance, pointing to remarks he
made to reporters last week in
which he stated support for
“strong, meaningful background
checks” that would help prevent
“people that are insane, people
that are mentally ill” from obtain-
ing firearms.
“The president is not backing
down,” said the official, who spoke
on the condition of anonymity to
discuss the president’s position.
“The White House continues to
work through a policy process
and is engaging with congres-
sional staff on several fronts.”
The slaughter of 22 people in an
El Paso shopping mall and nine in
a Dayton nightlife district in less
than 24 hours in early August
marked the latest instances of
mass violence amid increasingly
frequent mass shootings and ris-
ing concern about domestic ex-
tremism.
But after each round of killings,
the political debate has failed to
produce a significant response by
Congress, as Republicans have
joined the powerful gun lobby in
resisting fresh gun-control legis-
lation.
On Monday, Schumer and
House Speaker Nancy Pelosi (D-
Calif.) called on Senate Majority
Leader Mitch McConnell (R-Ky.)
to let his chamber vote on a bill
approved by the Democratic-led
House that would mandate uni-
versal background checks for gun
purchases, including private
transfers. But McConnell has re-
buffed calls to bring the Senate
back to Washington to deal with
the issue, and his advisers ac-
knowledged that he is unlikely to
act without Trump’s leadership.
McConnell has told advisers
that he would push legislation
only if the president were fully on
board and it had widespread sup-
port among Republicans in theSenate.
One Democratic aide noted
that Trump has signaled that he
would seek reelection by rallying
his conservative base and that it
does not seem plausible that the
president would buck his most
ardent supporters by leading an
effort to strengthen background
checks, which is fiercely opposed
by the NRA. This aide pointed to
the “game of hot potato” between
Trump and McConnell, with each
insisting that the other should
make the first move.
“Trump says it’s on Congress to
lead,” said the aide, who spoke on
the condition of anonymity to
frankly address the political dy-
namics. “That’s an easy way for
nothing to ever get done.”
White House officials said they
are preparing a list of other ideas
on gun and mental health issues
for Trump to review and poten-
tially pass on to Congress with his
support.
But Trump’s campaign com-
missioned a poll on guns after this
month’s shootings, and his politi-
cal advisers warned him that
there is little support for signifi-
cant action among Republican
voters, and even some Democrats,
people familiar with the conversa-
tions said.
“He is going to be very careful,”
said one person close to the presi-
dent, who spoke on the condition
of anonymity to discuss private
conversations. “He isn’t inclined
to do much right now.”
Trump has begun road-testing
his talking points on guns. He
noted to advisers that he got a roar
of approval at the New Hamp-
shire rally when he said: “It is not
the gun that pulls the trigger; it is
the person holding the gun.”
During an exchange with re-
porters Sunday as he prepared to
return to Washington from Bed-
minster, Trump answered a ques-
tion on gun control by talking first
about mental illness. He then sud-
denly shifted topics to assert the
need for stricter voting identifica-
tion measures.
“A lot of people want to see
something happen,” Trump said,
after reporters pressed him on
guns. “But just remember this:
Big mental problem, and we do
have a lot of background checks
right now.”
Since the shootings, NRA offi-cials have repeatedly told the
president and senior White House
officials that universal back-
ground checks won’t do much to
prevent mass shootings, accord-
ing to people familiar with the
private conversations.
NRA officials also have lobbied
Vice President Pence’s office and
acting White House chief of staff
Mick Mulvaney, as well as gover-
nors and lawmakers who face po-
tentially difficult reelection races
in 2020, officials said. White
House aides and NRA officials
have pointed out to Trump that
many of the states he needs to win
next year have a strong contingen-
cy of NRA members who would be
frustrated if Trump made any
drastic moves on gun control.
Gun lobby representatives have
argued that Trump should focus
on prosecuting gun crimes in-
stead, White House officials said.
Some Republicans noted that
Trump has shown no inclination
to lead an effort on any legislation
opposed by the GOP base. Last
year, he floated support for offer-
ing a path to citizenship for some
undocumented immigrants in ex-
change for billions in funding for
a border wall but quickly backed
off in the face of a conservative
backlash.
And Trump has vaguely sug-
gested doing more on background
checks in the wake of past mass
shootings only to drop the matter— most notably after 17 people
were killed in a shooting at Marjo-
ry Stoneman Douglas High
School in Parkland, Fla., in Febru-
ary 2018.
In February 2017, a week after
taking office, Trump rolled back
Obama-era regulations aimed at
making it more difficult for men-
tally ill people to buy firearms.
“I can’t think of a single time he
has really pushed Republicans to
do something they weren’t going
to be doing anyway,” said Brendan
Buck, who served as a top aide to
former House speaker Paul D.
Ryan (R-Wis.), who left Congress
in January.
“I think he personally wants to
do something, but I’m not sure
how equipped he is to maintain
his attention on it for the next two
months — which this would re-
quire — in the face of pushback
from people he cares about,” Buck
said.
Aides in both parties noted that
the president already seems dis-
tracted by numerous other issues,
including his desire for the United
States to purchase Greenland —
though officials there have ruled
it out.
Late Monday, Trump tweeted
an illustration of Greenland, with
a new gold Trump tower rising
over a bay. “I promise not to do
this to Greenland!” he wrote.
[email protected]
[email protected]Prospects for gun-control legislation dim as Trump appears to lose interest
JABIN BOTSFORD/THE WASHINGTON POST
President Trump’s remarks on mass shootings in recent days have
hewed more closely to the views of the National Rifle Association.(202) 816-8844 (703) 565-2375 (301) 841-
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