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Consumers for Dental Choice: A Critical Look

Stephen Barrett, M.D.

Consumers for Dental Choice, headquartered in Washington, D.C., has a curious name. It does not appear to be a consumer group (most supporters are offbeat dentists), and its aim is to restrict choice by banning the widely used amalgam fillings. In addition, its acronym -- "CDC" -- is the same as that of the U.S. Centers for Disease Control and Prevention, which is a highly respected public health agency. The group's Web site states:

Consumers for Dental Choice (CDC) was established in 1996 by consumer advocates, mercury poisoning victims, scientists and mercury-free dentists as a 501(c)(3) non profit organization. The purpose of the organization is to promote access to mercury-free dentistry; to legislate informed consent before placement of mercury amalgams; and, to ultimately abolish the use of mercury in dental restorations.

Initially, CDC's work was all defensive, fighting to support mercury-free dentists who were being harassed by state licensing boards with threats of losing their professional licenses. CDC's work has now grown to include legal challenges to state regulations which prohibit mercury-free dentists from advising dental consumers about the risks of mercury amalgams, as well as support of national and state legislation to require informed consent before placement of mercury amalgams, to limit the use of mercury amalgams in vulnerable populations, and to ban the use of mercury amalgams for all by 2007.

In addition, targeted litigation has been filed in a number of states to challenge the deceptive practices of the American Dental Association (ADA) which continues to perpetuate the fraud that mercury amalgams are "silver fillings" when the primary component is mercury (50%), and to make claims of safety for mercury amalgams when there are no peer-reviewed scientific studies which support that claim [1].

Amalgam is the most thoroughly studied and tested filling material now used. Compared to other restorative materials, it is durable, easy to use, and inexpensive. The American Dental Association (ADA), Consumers Union, the FDA, the U.S. Public Health Service, the World Health Organization, and many other prominent organizations have concluded that amalgam is safe and effective for restoring teeth [2-6]. It is safe to assume that if a better material is developed, the dental profession will adopt and use it. But Consumers for Dental Choice disagrees. As stated in a report on Guidestar, its objectives are:

  • To legislate informed consent in more states, by requiring dentists to give dental consumers a statutory form with an accurate description of the risks of mercury amalgams.
  • To abolish the use of mercury amalgams by 2007, by working for the passage of bills which mandate warnings to consumers about the use of mercury in dental fillings, and to work for the passage of bills which ban the use of mercury in dentistry.
  • To enforce environmental laws against mercury amalgam -- by working with, or challenging in court, the EPA and State agencies to stop environmental contamination from mercury amalgams, and by seeking legislation requiring water disposal filtration systems in dental offices [7].

Consumers for Dental Choice is also described as (a) "a consumer policy research institution managed by the National Institute for Science, Law, and Public Policy, affiliated with the law firm of Swankin & Turner" in Washington, D.C. [8] and (b) "organized" by Citizens for Health and Dental Amalgam Mercury Survivors, a group based in Albuquerque, New Mexico said to be "made up of victims of mercury poisoning from dental fillings" who seek to "alert consumers to the risks of amalgams and to ensure that ethical, mercury-free dentists are permitted to practice." [8]

Consumers for Dental Choice's national counsel, Charles G. Brown, is a former West Virginia attorney general who is a partner in Swankin and Turner. He is also counsel and a lobbyist for the Coalition to Abolish Mercury Dental Fillings, the lobbying arm of the movement and is a director of Dental Choice Fund, a 501(c)(3) nonprofit corporation whose sole purpose is to raise money for Consumers for Dental Choice [9]. Consumers for Dental Choice's "national legal counsel" Shawn Khorrami, of Van Nuys, California, has relentlessly criticized the ADA and filed several lawsuits against it.

Funding

Consumers for Dental Choice and the Dental Choice Fund are both tax-exempt 501(3)(c) nonprofit organization. Their recent Form 990 reports provide the following numbers:

Consumers for Dental Choice

2001 

 2002

Total revenue $288,586 $316,001
Program services ("education of consumers about the dangers of using mercury in dental fillings'") $297,099 $312,747
Professional fees paid (included in program services). The 2001 figure includes $52,840 paid to Charles Brown.
$185,348
$157,994
Consulting fees (included in program service) 1,000 5,298
Legal fees 39,286 54,802

Dental Choice Fund

2001

2002

Total revenue

$130,000

$152,200
Program services
   (2001: "raised money to support Consumers for Dental Choice")
   (2002: "public education about the dangers of using mercury in dental fillings")

$138,000

$124,967
Consulting fees (included in program service) paid to Brown

$51,779
 

The group's Web site identified about 120 supporters. The minimal annual fee for this is $1,000 for company sponsorships and $1,200 for professional sponsorships. In April 2004, the site listed the Wallace Research Foundation (Scottsdale, Arizona),The Garfield Foundation (Marion, Massachusetts) , a few companies, a few individuals, and 103 dentists who are also listed in the site's directory of "mercury free dentists." The Wallace Foundation has also funded research done by amalgam opponents.

Anti-Amalgam Lawsuits

During the past two years, anti-amalgamists have filed more than 30 lawsuits challenging the use of amalgam and naming the ADA and others as defendants. In March 2004, American Trial Lawyers Association held a continuing legal education seminar hosted by Brown and titled "Mercury Silver Dental Fillings as the Next Mass Tort." The seminar's purpose was to encourage more lawyers to file such suits. All of the speakers blamed the ADA for amalgam's continued use, and one (Attorney Sandra Duffy) even expressed hope that lawsuits could "basically drive the ADA out of business." However, by March 1, 2004, the ADA had been dismissed as a defendant in 33 cases [10], and I believe the rest will eventually be dismissed.

The most important of these cases was filed by Khorrami and Brown in 2001 against the ADA, the California Dental Association, and unnamed dentists by Kids against Pollution, DAMS, another anti-amalgam groups, and one individual patient [11]. The suit alleged that the ADA has made deceptive representations about amalgam, derives income from advocating amalgam use, and and maintains a "gag" rule under which it "aggressively lashes out against those who oppose its views." In May 2003, the California Court of Appeals concluded that the plaintiffs had presented no evidence of a "gag" rule and that the dental associations have a right to express their views about safety of amalgam fillings and when it is unethical to remove them [12]. The antiamalgamists have appealed to the California Supreme Court but are unlikely to prevail.

Meanwhile, the ADA is suing Khorrami for libel in a suit which characterizes his activities as "a self-promoting campaign of lies and distortions." The suit seeks compensatory damages for harm suffered by the ADA and punitive damages to deter further wrongful conduct against the ADA. The complaint [13], filed in May 2002, states:

  • Khorrami falsely and maliciously accuses the ADA of defrauding and endangering the lives of the American public by promoting allegedly unsafe dental practices -- specifically the use of dental amalgam fillings -- and exerting "undue and unfair pressure" on dentists as a result of a purported "vested economic interest" of the ADA in amalgam.
  • Khorrami has falsely stated that, "When scientifically analyzed, amalgam fillings represent nothing more than a con on the U.S. population, orchestrated by the American Dental Association and its web of constituent associations and component societies."
  • Khorrami was well aware that numerous scientific and leading consumer organizations, independent of the ADA, have concluded that dental amalgam is safe.
  • The ADA has no vested economic interest in amalgam.

In January 2004, the district court judge denied Khorrami's motion to dismiss the suit and concluded that the ADA will prevail if it proves that its allegations are true [14]. I believe that it will.

References

  1. About us. Consumers for Dental Choice Web site, accessed April 24, 2004.
  2. ADA Council on Scientific Affairs. Dental amalgam: Update on safety concerns. JADA 1998;129:494-501.
  3. The mercury in your mouth. Consumer Reports 1991;56:316-319.
  4. Benson JS and others. Dental Amalgam: A Scientific Review and Recommended Public Health Strategy for Research, Education and Regulation. Washington, DC: US Public Health Service, 1993.
  5. Consumer Update: Dental amalgams. FDA Center for Devices and Radiological Health, Feb 11, 2002.
  6. World Health Organization. Consensus Statement on Dental Amalgam. Mjor IA, Pakhomov GN. Dental Amalgam and Alternative Direct Restorative Materials. Geneva: World Health Organization, 1999.
  7. Consumers for Dental Choice: Goals and results. Guidestar Web site, accessed April 24, 2004.
  8. Consumers for Dental Choice. Swankin & Turner Web site, accessed April 27, 2004.
  9. Dental Choice Support Fund: Mission and programs. Guidestar Web site, accessed April 24, 2004.
  10. Berry J. Two more amalgam cases dismissed. ADA News, March 15, 2004, pp 1, 11.
  11. Complaint. Kids against Pollution; Dental Amalgam Mercury Syndrome, Inc.; American Academy of Biological Dentistry; Debra Seltenreich et al. v American Dental Association; California Dental Association; and Does 1 through 2000, inclusive. San Francisco Superior Court #322109, filed June 12, 2001.
  12. Decision. Kids against Pollution et al. v. California Dental Association. Court of Appeal of the State of California, First Appellate District, Division Three, case #A098396, filed May 21, 2003.
  13. Complaint for defamation. American Dental Association v. Shawn Khorrami. U.S. District Court, Central District of California Civil Case No. 02-3853, filed May 14, 2002.
  14. Order denying defendant's motion to dismiss. American Dental Association v. Shawn Khorrami. U.S. District Court, Central District of California Civil Case No. 02-3853, filed January 26, 2004.

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This article was posted on April 30, 2004.