Review of the Revised NTP Monograph on Fluoride Exposure and Neurodevelopmental and Cognitive Health Effects

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In 2019, the National Toxicology Program (NTP) released the draft monograph Systematic Review of Fluoride Exposure and Neurodevelopmental and Cognitive Health Effects. Given the controversies surrounding the risks and benefits associated with fluoride exposure and to ensure the integrity of its evaluation, NTP asked the National Academies of Sciences, Engineering, and Medicine to review the draft monograph. The 2020 report Review of the Draft NTP Monograph Systematic Review of Fluoride Exposure and Neurodevelopmental and Cognitive Health identified deficiencies in the analysis of various aspects of some of the studies and in the analysis, summary, and presentation of the data in the draft monograph, provided many suggestions for improvement, and concluded that NTP had not adequately supported its conclusions.

At the request of NTP, Review of the Revised NTP Monograph on the Systematic Review of Fluoride Exposure and Neurodevelopmental and Cognitive Health Effects determines whether substantive concerns raised in the 2020 report have been sufficiently addressed by revisions of the monograph and whether the evidence presented by NTP in the revised monograph supports its conclusions.

Publication information

28 pages · 8.5 x 11 ·
ISBN Ebook: 0-309-16269-6
DOI: https://doi.org/10.17226/26030

Suggested citation

National Academies of Sciences, Engineering, and Medicine. 2021. Review of the Revised NTP Monograph on the Systematic Review of Fluoride Exposure and Neurodevelopmental and Cognitive Health Effects: A Letter Report. Washington, DC: The National Academies Press.

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David A. Savitz

David A. Savitz (Chair) is professor of epidemiology and associate dean for research of the Brown University School of Public Health, with joint appointments in obstetrics and gynecology and pediatrics at the Alpert Medical School. He was vice president of research at the university from 2013 to 2017. His epidemiologic research has addressed a wide array of important public-health issues, including environmental hazards in the workplace and community, reproductive health outcomes, and environmental influences on cancer. He has worked extensively on health effects of nonionizing radiation, pesticides, drinking-water treatment byproducts, and perfluorinated compounds. Before joining Brown University, Dr. Savitz held appointments as the Charles W. Bluhdorn Professor of Community and Preventive Medicine at Mount Sinai School of Medicine and professor at the University of North Carolina School of Public Health. He was president of the Society for Epidemiologic Research and the Society for Pediatric and Perinatal Epidemiologic Research and was a North American regional councilor for the International Epidemiological Association. Dr. Savitz was elected to the National Academy of Medicine in 2007. He received an MS in preventive medicine from Ohio State University and a PhD in epidemiology from the University of Pittsburgh Graduate School of Public Health.

Germaine M. Buck Louis

Germaine M. Buck Louis is dean of the College of Health and Human Services of George Mason University. Her research has addressed a mixture of environmental exposures, including endocrine disruptors, stress, diet, and physical activity in relation to a spectrum of reproductive outcomes in men and women. She was an early pioneer in the application of the exposome research paradigm for understanding environmental influences on human fecundity and fertility impairments. Before joining the university, Dr. Louis was the director of the Division of Intramural Population Health Research in the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health, where she led population-health scientists in designing research aimed at enhancing the health and well-being of fetuses, pregnant women, children, and young adults. She has served the National Academies, Pan American Health Organization, US Environmental Protection Agency, and World Health Organization in various roles. She is a former president of the Society of Pediatric and Perinatal Epidemiologic Research and of the Society for Epidemiologic Research and has served on the boards of the American College of Epidemiology and the International Society for Environmental Epidemiology. Dr. Louis received a PhD in epidemiology from the State University of New York at Buffalo.

Kevin Crofton

Kevin M. Crofton is principal and consultant at R3Fellows, LLC. Previously, he worked for more than 35 years as a developmental neurotoxicologist in the US Environmental Protection Agency (EPA) Office of Research and Development. Dr. Crofton has also served as an adjunct associate professor at Duke University, the University of North Carolina, and North Carolina State University. His research interests include developmental neurotoxicity with an emphasis on understanding the consequences of endocrine disruption on neurodevelopment. He recently received the EPA Distinguished Career Service Award. Dr. Crofton received an MS in toxicology from Miami University and a PhD in toxicology from the University of North Carolina at Chapel Hill.

Akhgar Ghassabian

Akhgar Ghassabian is an investigator and assistant professor in the Departments of Pediatrics, Population Health, and Environmental Medicine of the New York University (NYU) School of Medicine. Her research focuses on identifying environmental exposures that contribute to the etiology of developmental disabilities in childhood. Before joining NYU, Dr. Ghassabian was the intramural research training award fellow at the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health. During her doctoral and postdoctoral training, Dr. Ghassabian was involved in birth-cohort studies in Europe and in the United States. She was a collaborator on European epidemiologic consortia examining the effect of nutrition and air pollution on children’s neurodevelopment. Dr. Ghassabian was the recipient of the Rubicon Award from the Netherlands Organization for Scientific Research in 2014 and the Robin/Guze Young Investigator Award from the American Psychopathological Association in 2019. She obtained an MD from Tehran University of Medical Sciences and a PhD in epidemiology from Erasmus University Rotterdam, the Netherlands.

Judith B. Klotz

Judith B. Klotz is an affiliate faculty member in the Department of Environmental and Occupational Health of the Dornsife School of Public Health, Drexel University, and an adjunct associate professor in the Department of Epidemiology of the Rutgers School of Public Health. She is a member of the Health Effects Committee of the New Jersey Drinking Water Quality Institute and of the Public Health standing committee of the Science Advisory Board, both advisory groups of the New Jersey Department of Environmental Protection. She served as environmental scientist and program manager in environmental health and in cancer surveillance in the New Jersey Department of Health from 1984 to 2003 and focused especially on toxic substances in drinking water and environmental epidemiology of cancer and reproductive outcomes. Dr. Klotz has served on several National Academies committees, including the Committee on Fluoride in Drinking Water and the Committee on the Review of the Styrene Assessment in the National Toxicology Program 12th Report on Carcinogens. She received an MS in genetics from the University of Michigan and a DrPH in environmental health sciences from Columbia University.

Juleen Lam

Juleen Lam is an assistant professor in the Department of Health Sciences of the California State University, East Bay. She is also an affiliate researcher in the Department of Obstetrics, Gynecology and Reproductive Sciences of the University of California, San Francisco, School of Medicine. Her research interests are in environmental epidemiology, evaluation of population exposures to environmental contaminants, assessment and communication of environmental risks, and reproductive and developmental health. She specializes in analysis of environmental-health data and development and application of risk-assessment methods. Dr. Lam has been involved in the development of systematic review methods for environmental-health data and has had a pivotal role in implementing, publishing, and disseminating these approaches in academic and government settings. She is a member of the US Environmental Protection Agency Board of Scientific Counselors Chemical Safety for Sustainability Subcommittee. She is currently serving on the National Academies Committee to Review DOD’s Approach to Deriving an Occupational Exposure Limit for TCE. She received an MS in environmental engineering management from George Washington University and an MHS in biostatistics and PhD in environmental-health policy from the Johns Hopkins University Bloomberg School of Public Health.

Pamela J. Lein

Pamela J. Lein is a professor of neurotoxicology in the Department of Molecular Biosciences of the University of California, Davis, School of Veterinary Medicine. Her research interests are in how environmental stressors interact with genetic susceptibilities to influence the risk and severity of neurodevelopmental disorders and neurodegeneration. Because altered patterns of connectivity are associated with neurologic deficits, her research focuses on investigating how environmental contaminants, chemical convulsants, and inflammation perturb neuronal connectivity as determined by using biochemical, morphogenic, and electrophysiologic end points. Her group is also developing biomarkers of organophosphate neurotoxicity and testing novel therapeutic approaches for protecting against the neurodegenerative effects associated with neurotoxic proconvulsants. Dr. Lein was a member of the National Academies Committee to Review Report on Long-Term Health Effects on Army Test Subjects. She received an MS in environmental health from East Tennessee State University and a PhD in pharmacology and toxicology from the State University of New York at Buffalo.

Michael L. Pennell

Michael L. Pennell is associate professor in the Division of Biostatistics in the College of Public Health of Ohio State University. His research interests are in nonparametric Bayes, first hitting time models for survival analysis; design and analysis of group randomized trials; joint modeling outcomes of different scales; statistical methods in toxicologic risk assessment; and statistical applications in biomedical research, including cancer control, pathology, and veterinary medicine. Dr. Pennell has served as an ad hoc member of the US Environmental Protection Agency (EPA) Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA) Scientific Advisory Panel, the EPA Science Advisory Board on trichloroethylene and Libby amphibole asbestos, and the Chemical Safety Advisory Subcommittee for 1-bromopropane. He currently serves on the National Academies Committee to Evaluate the IRIS Protocol for Inorganic Arsenic. He received an MS and a PhD in biostatistics from the University of North Carolina at Chapel Hill.

Craig Steinmaus

Craig Steinmaus is an associate adjunct professor of epidemiology at the University of California, Berkeley (UCB). He is also a public-health medical officer III in the California Environmental Protection Agency (CalEPA) and is the UCB director of the Arsenic Health Effects Research Group. He is a board-certified physician with over 12 years of patient-care experience. His epidemiologic research has involved studies of drinking-water contaminants with a focus on early-life exposure and other factors conferring susceptibility. He also teaches graduate courses on epidemiology, causal inference, and systematic review at UCB and at the University of California, San Francisco. Dr. Steinmaus has served on several study sections of the National Institutes of Health and Centers for Disease Control and Prevention and is a full member of the Cancer, Heart, and Sleep Epidemiology, A study section. His work in the CalEPA water toxicology section has involved systematic reviews and risk assessments of drinking-water agents, including nitrate, arsenic, copper, perchlorate, fluoride, chromium, and trihalomethanes. He received an MD from the University of California, Davis School of Medicine and an MPH in environmental-health sciences from UCB.

Charles V. Vorhees

Charles V. Vorhees is a professor in the University of Cincinnati College of Medicine. He is co-director of the Animal Behavior Core and program director of the Teratology Training Program. He is on the graduate faculty of the Graduate Programs in Neuroscience and Molecular and Developmental Biology. His research focuses on brain development and behavior. He was a founding member of the Neurobehavioral Teratology Society in 1977 and was elected president in 1984–1985 and 2012–2013. Dr. Vorhees has served on multiple scientific advisory committees for the US Food and Drug Administration, US Environmental Protection Agency, and National Institutes of Health. He was on the National Academies Subcommittee on Reproductive and Developmental Toxicants. Dr. Vorhees obtained an MA and a PhD in neurobiology from Vanderbilt University.

Kimberly Yolton

Kimberly Yolton is a professor in Cincinnati Children’s Hospital Medical Center (CCHMC) and the University of Cincinnati College of Medicine and director of research in the Department of General and Community Pediatrics. She is a developmental psychologist and epidemiologist with over 25 years of experience studying the effects of prenatal and early-life exposures on neurobehavior from infancy through childhood and directs the longitudinal Health Outcomes and Measures of the Environment (HOME) Study. She was formerly the director of a follow-up clinic serving high-risk infants and young children and has extensive experience with infants and children who were prenatally exposed to substances of abuse, who were born prematurely or at low birth weight, or who come from disadvantaged home environments. She was involved in the initial development of the NICU Network Neurobehavioral Scale (NNNS), a specialized neurobehavioral assessment tool used with healthy and high-risk newborns, and conducts frequent training on the proper administration, scoring, and interpretation of the instrument for research and clinical purposes. She has been affiliated with the National Institutes of Health–funded Neonatal Research Network for over 25 years at two sites as an examiner, Gold Standard reviewer for intelligence testing, follow-up principal investigator, and steering-committee member. She often collaborates with investigators regarding neurobehavioral assessment and staff training strategies to acquire the most appropriate outcome measures with the highest standards of reliability and validity. She earned a PhD in child development and developmental psychology from Ohio State University and completed a 3-year National Research Service Award in Pediatric Environmental Health at CCHMC.

Ellen K. Mantus

Ellen Mantus, Ph.D. is a Scholar and Director of the Chemical Sciences Roundtable on the Board of Chemical Sciences and Technology at the National Academies of Sciences, Engineering, and Medicine. She has almost 20 years of experience as a study director at the National Academies. She has worked on a variety of topics, including chemical alternative assessments, a research agenda for separation science, health implications of various chemical exposures, strategies for applying modern scientific approaches in toxicology and risk assessment, guidance to federal agencies on risk-based decision-making, and barriers to deployment of electric vehicles and associated charging infrastructure. Before joining the National Academies, Dr. Mantus was a project manager with ICF Consulting where she served as a primary reviewer for numerous toxicological studies and provided risk assessment and regulatory support on a wide array of projects. Dr. Mantus received a PhD in chemistry from Cornell University in Ithaca, NY.

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Review of the Revised NTP Monograph on Fluoride Exposure and Neurodevelopmental and Cognitive Health Effects

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Review of the Revised NTP Monograph on Fluoride Exposure and Neurodevelopmental and Cognitive Health Effects

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Review of the Revised NTP Monograph on the Systematic Review of Fluoride Exposure and Neurodevelopmental and Cognitive Health Effects: A Letter Report

Description

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Board on Environmental Studies and Toxicology

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Provide feedback

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More like this

Modernizing Mathematics Education for Grades 9-14

Health Care Financing to Improve Availability of Affordable Contraception: Identifying Promising Practices

Review of Methods in the Report on Carcinogens Handbook

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Life Sciences and Biotechnology Program Area

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