Science for Sale: How the US Government Uses Powerful Corporations and Leading Universities to Support Government Policies, Silence Top Scientists, Jeopardize Our Health, and Protect Corporate Profits
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When Speaker Newt Gingrich greeted Dr. David Lewis in his office overlooking the National Mall, he looked at Dr. Lewis and said: You know you’re going to be fired for this, don’t you?” I know,” Dr. Lewis replied, I just hope to stay out of prison.” Gingrich had just read Dr. Lewis’s commentary in Nature, titled EPA Science: Casualty of Election Politics.” Three years later, and thirty years after Dr. Lewis began working at EPA, he was back in Washington to receive a Science Achievement Award from Administrator Carol Browner for his second article in Nature. By then, EPA had transferred Dr. Lewis to the University of Georgia to await termination—the Agency’s only scientist to ever be lead author on papers published in Nature and Lancet.
The government hires scientists to support its policies; industry hires them to support its business; and universities hire them to bring in grants that are handed out to support government policies and industry practices. Organizations dealing with scientific integrity are designed only to weed out those who commit fraud behind the backs of the institutions where they work. The greatest threat of all is the purposeful corruption of the scientific enterprise by the institutions themselves. The science they create is often only an illusion, designed to deceive; and the scientists they destroy to protect that illusion are often our best. This book is about both, beginning with Dr. Lewis’s experience, and ending with the story of Dr. Andrew Wakefield. This new edition, now for the first time in paperback, features a new introduction by the author.
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Reviews for Science for Sale
1 rating1 review
- Rating: 2 out of 5 stars2/5This book makes some very important points and does expose some serious problems in the EPA and other research venues, but it is poorly enough written that I soon lost interest. Some good editing could have reduced the length of this book in half (maybe more) without losing anything. In fact, editing it down would make it have more impact. As it is I felt like I was reading the same things 3-4 times over. This is partly due to the author's justified anger over how he was treated as a whistle blower. I was also turned off a bit by his advocacy for Andrew Wakefield, the scientist behind the MMR vaccine/autism scandal. Although I can partly agree with Lewis' assessment of the Wakefield controversy, i.e. that Wakefield was unjustly charged with fraud, Lewis also seems to hint that there may have been something to do with the link to autism. Considering that no other research has turned up any link to autism, and that we now know that autism begins prenatally, there is no scientific sense in even still suspecting any sort of link.
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Science for Sale - David L. Lewis
Copyright © 2014 by David L. Lewis
All Rights Reserved. No part of this book may be reproduced in any manner without the express written consent of the publisher, except in the case of brief excerpts in critical reviews or articles. All inquiries should be addressed to Skyhorse Publishing, 307 West 36th Street, 11th Floor, New York, NY 10018.
Skyhorse Publishing books may be purchased in bulk at special discounts for sales promotion, corporate gifts, fund-raising, or educational purposes. Special editions can also be created to specifications. For details, contact the Special Sales Department, Skyhorse Publishing, 307 West 36th Street, 11th Floor, New York, NY 10018 or [email protected].
Skyhorse® and Skyhorse Publishing® are registered trademarks of Skyhorse Publishing, Inc.®, a Delaware corporation.
www.skyhorsepublishing.com
10 9 8 7 6 5 4 3 2 1
Library of Congress Cataloging-in-Publication Data is available on file.
ISBN: 978-1-5107-4310-6
Ebook ISBN: 978-1-5107-4317-5
Printed in the United States of America
Author’s Proceeds go to the Nonprofit
National Whistleblower’s Center (www.whistleblowers.org)
This book is dedicated to my wife, Kathy, the love of my life,
and to our children, Josh and Jedd, our greatest joy.
CONTENTS
Foreword
Acknowledgments
Prologue
President Dwight D. Eisenhower’s Farewell Address
1. Ask Your Dentist
2. Ask Your Endoscopy Clinic
3. Ask Your Garden Center
4. Sludge Magic
5. Black Magic
6. Holy Science
7. Brian Deer—Hero or Hoax?
8. The GMC Formula
9. Government Domination of Science
10. Institutional Research Misconduct
11. The Nuremberg Code
12. Changing Direction
Epilogue
President John F. Kennedy’s Legacy
About the Author
Afterword
Appendix I Ten Myths about Biosolids
Appendix II Biosolids Cadmium Data Pre- and Post-
Appendix III Some Things Never Change
Appendix IV Sludge Magic versus Native American Beliefs
Appendix V Senate Testimony Prepared by David Lewis
Appendix VI Senate Testimony Prepared by Andy McElmurray
Appendix VII The Nuremberg Code
Chapter Notes
Index
FOREWORD
"Mayor: The matter in question is not a purely scientific one; it is a complex affair; it has both a technical and an economic side…. As a subordinate official, you have no right to express any conviction at odds with that of your superiors.
Dr. Stockman: What I am doing, I am doing in the name of truth and for the sake of my conscience"¹-²
—Ibsen, An Enemy of the People, 1882
Scientific progress and the advancement of civilization are inextricably linked. At the threshold of the third millennium the virtuous cycle of public support and investment in science, which has yielded multifold returns via improved quality and quantity of life, has been eroded at a most inopportune moment—sound science is the best hope for saving humankind from itself.³ Yet the public is rightly becoming skeptical of the motives of modern science, which has frequently betrayed the public trust and faces rising external criticism to reform.⁴-⁶
Ibsen’s classic An Enemy of the People,
illustrates the dangers of consensus science under the influence of institutions. Heroic Dr. Stockman, who sacrifices his career and personal standing to protect the innocent from harm, discovers that the scientific truth offends self-serving bureaucrats and powerful economic interests, and is soon denounced as a lunatic and An enemy of the people
for defending the truth. Unfortunately, scientists have been very poor students of their own history, and suffer from misplaced moral overconfidence in their enterprise, institutions and judgment, which have always been subject to fraud, misconduct and the delusion of crowds as chronicled brilliantly by Ibsen.⁷ More recently, the inexorable rise of big and collaborative science, necessary to solving increasingly complex problems, has created a belongingness
imperative for scientists on a scale and intensity never imagined by Whyte in The Organization Man.
⁸ Success in modern science has become too dependent on networking and teamwork, appeasing group pressures in the name of cohesion and expedience—scientific dissent and skepticism that play critical roles in good science are rarely encouraged or even tolerated.
The experiences and career of Dr. David Lewis, like the fictional Dr. Stockman, exemplify the type of heroic action that will be necessary if modern science is to become self-correcting.
His work provides important insights to those who care about the scientific enterprise, and is a call to action for brave souls capable of sacrificing to preserve the integrity and promise of science for future generations. David highlights a pernicious threat to science which he first defined and personally named, institutional scientific misconduct,
in which science has little to do with the seeking of truth and serving the public good, but rather, is conscripted to perpetuate the power/policies of institutions via conjuring of pseudo-scientific illusions. He defines institutional scientific misconduct as follows:⁹-¹⁰
Institutional Scientific Misconduct or, in the case of research, Institutional Research Misconduct, is the fraudulent manipulation of science by government agencies, corporations and academic institutions to support government policies and industry practices. It often involves the suppression of credible scientific research by using false allegations of scientific or ethical misconduct against honest scientists who document the adverse effects of government policies and industry practices on public health and the environment.
Institutional scientific misconduct has gone largely unappreciated and unreported because its practitioners are often the very agencies we have empowered to police scientific integrity in one way or another. And, at least superficially, they appear to lack a direct profit motive that would explain or cause scrutiny of their unethical actions. Many still mistakenly believe that such motives are a necessary inducement to incentivize scientific misconduct. In my opinion, the abuses and dangers of institutional scientific misconduct far exceed those arising from misconduct in industrial science, as society has developed certain checks and balances to control industrial science abuses while still preserving its undeniable benefits to society.
I personally witnessed institutional scientific misconduct during an event known in the press as The Washington D.C. Lead in Drinking Water Crisis,
during which government agencies first inadvertently triggered release of hazardous levels of lead from plumbing to drinking water in tens of thousands of homes in the nation’s capital, and later criminally hid the health threat from the public for more than three years.¹¹-¹⁸ Unaware of the health hazard in their drinking water, parents were unable to protect their unborn fetuses, children or even themselves from the best known neurotoxin (lead). Hired to develop an understanding of the problem by the United States Environmental Protection Agency, and then acting to hold the public’s interest paramount over my own self-interest or that of the agencies, my funding and access to data from experiments I designed were terminated.¹³
After the dimensions of the hazard were exposed in an award winning Washington Post investigative report in early 2004, the agencies and their minions published a series of reports relying on false or non-existent data, which created an illusion that the unprecedented exposures and the agencies’ criminal actions had not poisoned a single man, woman or child.¹⁹-²³ The fact that their results contradicted over two thousand years of human knowledge and experiences regarding health harm from elevated lead in drinking water, was neither deterrent or hurdle, in their exercise of power via abuse of science.²³ The agencies then stood by and even encouraged the spread of their pseudo-scientific lies, harming children in other parts of the United States and the world. None of those responsible were held accountable, although a few were later inexplicably given Gold Medals
and other honors for public service by the agencies.²³
It took more than six years of personal effort and a U.S. Congressional investigation to finally discover that the agencies’ data,
which they purportedly relied on for their landmark conclusions and publications, had strangely disappeared if it ever existed in the first place.²⁰-²³ Other dimensions of their falsification were also exposed.²⁰ Yet, to this day, agency reports and publications for which data cannot be found, and with conclusions proven to be false by numerous investigations and some of the agencies’ more recent research, have still not been retracted.²⁰-²³ The Centers for Disease Control even issued a new falsified report, which in an Orwellian fashion, brazenly claimed that their prior work had actually concluded that D.C. citizens had been poisoned by the years of high lead in water, but that the CDC had communicated their results poorly and had been misunderstood by readers!²⁴-²⁶ Demands to retract the falsification of a falsification, which e-mails demonstrate was crafted at the highest levels of the CDC, were completely ignored.²⁷
I mention my own experiences because they are relatively well-documented, the information has been thoroughly vetted in the press and in Congress, and before living through it myself I would never have believed it possible.²⁶, ²⁸-²⁹ Having grown up worshipping at the altar of science, I never even thought to question the motives of government agencies, the policemen that we pay to protect us, and who would seem to have no financial motive to behave unethically. Indeed, when I first heard of David Lewis and his battles with the EPA in the 1990s, I was too busy establishing my own career to pay any attention, much less delve into the details and sort out the truth. That is the reality of scientific whistleblowing. Whistleblowers and heroic scientists, are always destined for singular journeys, because even our most supportive colleagues have little choice but to be bystanders and there is no higher authority in science that can serve as an impartial judge and jury. As David found, sadly, a courtroom run by non-scientists is often the only recourse. It takes great courage, persistence and a supportive family to see matters through to a conclusion, as David did in his years as a successful
EPA whistleblower.
As is his nature, above and beyond his documented successes in demonstrating shortcomings in CDC infection-control policies and exposing wrong-doing at EPA, David does not shy away from new, challenging and controversial subjects. The book details his personal journey to try and better understand details of the Brian Deer and Wakefield drama, a subject on which, after decades of painful struggle, establishment science has reached a consensus verdict that Wakefield was guilty of scientific misconduct. David’s work and belief suggests that this consensus is an over-reach supported by dubious data and interpretations. As a scientist with a newly discovered appreciation of history, I can only say that there are many prior precedents that should give one pause whenever institutions harshly judge their critics, or those who are reporting results inconsistent with the political winds of the day. Our institutions, which fancy themselves as impartial, beyond reproach and worthy of passing judgment on others, never seem to find that their own egregious actions ever rise to the level of scientific misconduct.
Consider the Cyril Burt affair. Lauded for his work on genetics and intelligence before dying in 1971, Burt’s work came under intense scrutiny shortly thereafter.⁷ Unable to defend himself because he was dead, and a key critic had successfully recommended that all of his notes/data be burned, a series of articles concluded that Burt’s career and life’s work had been a complete fraud.⁷ But later work noted that Burt’s key results had withstood the highest test of science, replication by others with modern methods, while obtaining virtually identical results. The bizarre rush to impeachment included an apparently false claim that Burt had even gone so far as to invent the names of his collaborators and co-authors!⁷,³⁰-³² It seems safe to say that the Burt affair will never be satisfactorily resolved, even though his key results and conclusions ultimately withstood the test of time.
Unsatisfactory resolution of scientific controversy in cases of scientific misconduct and whistleblowing, is currently the rule and not the exception. I recently defined whistleblowing, as it is practiced in government agencies, as a human perversion of natural selection, whereby weak, deceitful, cowards survive, and strong, honest heroic truth-tellers are destroyed.
³³ David Lewis is one of a few whistleblowers who was not destroyed, who continued to practice science productively, and who remains fiercely independent and productive. He willingly shares his vast experiences and wisdom with others, as was the case when he spoke to my graduate engineering ethics classes, and by offering assistance to other whistleblowers so that their journey is not quite as lonely as it might otherwise be.
Despite experiences that would break a normal human, Lewis remains optimistic about the future of science, and is rightly proud of his career before, during and after his personal ordeals with institutional misconduct within EPA. These characteristics might go far in explaining his personal success as a scientist and citizen. As you read his story which is part self-reflection and part memoir, Lewis feeds and encourages critical debate on many subjects, but first and foremost he embodies Ibsen’s observation that The strongest man in the world is he who stands most alone.
³³ I cannot help but reflect that if brave whistleblowers such as David Lewis were to ever go extinct, given the magnitude of the science and engineering challenges that confront us; our civilization is not likely to be far behind.³⁴
Marc Edwards
Charles Lunsford Professor of Civil Engineering
Virginia Tech
ACKNOWLEDGMENTS
This book is the culmination of innumerable acts of kindness, moral support, and technical guidance extended to me by family, friends, supervisors, coworkers, and colleagues at the U.S. Environmental Protection Agency, Centers for Disease Control & Prevention, Food & Drug Administration, Harvard University’s Science Technology and Society Program, Boston University’s Department of Environmental Health, and to the University of Georgia (UGA) Department of Marine Sciences, School of Ecology, and College of Engineering—especially Professor David Gattie. Since publishing my 1996 Nature commentary, EPA Science: Casualty of Election Politics,
the National Whistleblowers Center (www.whistleblowers.org) was my refuge. So were a number of government administrators, political appointees and elected officials, and others, including Rosemarie Russo, former director of the EPA research laboratory in Athens, Georgia; Robert Hodson, former UGA director of marine programs; Bernard Goldstein, former EPA assistant administrator for the Office of Research & Development under President Reagan; Jerry Melillo, former associate director for the environment in the White House Office of Science & Technology under President Clinton; and the late congressman Charlie Norwood.
Stephen and Michael Kohn and others at the law firm of Kohn, Kohn, and Colapinto in Washington, DC, and Ed Hallman and Richard Wingate of Hallman & Wingate in Marietta, Georgia, carried me through my legal battles with EPA and the treated sewage sludge (aka biosolids) industry from 1996 through 2013. I’m also grateful to my attorneys, James Carter in Madison, Georgia, and Finis Williams in Concord, New Hampshire, and Ed Hallman for their help regarding efforts by Brian Deer, the British Medical Journal (BMJ), and their supporters in the biosolids industry to undermine my current research on environmental triggers associated with autism and other neurological and immunological disorders and diseases. Christopher Shaw at the University of British Columbia is my primary collaborator. Technical guidance and/or financial support provided by Caroline Snyder (www.sludgefacts.org), Barry Segal, Claire and Al Dwoskin, and Abby Rockefeller (www.sludgenews.org), have been also critical to my success.
For enabling me to write this book, I am particularly indebted to Sheldon Krimsky, Tony Lyons, and Kristin Kulsavage. I’m also very grateful to Marc Edwards and Caroline Snyder for writing the foreword and afterword.
Finally, my investigations into the original documentation behind allegations of research fraud against Andrew Wakefield would have never succeeded without the full cooperation of Andrew Wakefield and his wife, Carmel.
PROLOGUE
This book reveals in graphic detail how government control over the scientific enterprise, which President Dwight D. Eisenhower predicted would eventually pose a grave threat to America’s future, has finally come to pass. It also builds upon the prolific work of authors Daniel Greenberg, Sheldon Krimsky, David Michaels, and others.
The American silver plug penny minted in the 1790s proclaims liberty as the parent of science and industry. The founding fathers were convinced that freedom from corruption was vital both to a healthy economy and to scientific progress.¹ Few people today would disagree, and recent, highly publicized events surrounding the collapse of the housing market, corporate fraud, and the dire need for campaign finance reform have made the public well aware of the alarming influence that corrupt special interests have gained over the political process in the last several decades. While their insidious effects on the economy are well documented, most people have only had a glimpse of their impact on science.
During my thirty-plus years as a research microbiologist in the Environmental Protection Agency’s Office of Research and Development (ORD) and at the University of Georgia (UGA), I experienced the far-reaching influence of corrupt special interests firsthand. As this book will describe, my dealings with civil servants, corporate managers, elected officials, and other scientists expose the ease—and disturbing regularity—with which a small group of individuals, motivated by profit or personal advancement, can completely hijack important areas of research science at even our most trusted institutions. The result is that today, many government-funded scientific endeavors have become little more than an arm of industry marketing efforts and government policymakers.
Many factors lead to the ease with which the scientific process is corrupted by outside influences. Some are largely unavoidable. The complexity of the science itself often makes it so that only a tiny fraction of outside observers have the background knowledge to notice when the pieces don’t add up to a whole. On top of that, research is expensive, time-consuming, and inherently risky, making it hard for the small number of people who are able to understand any given area of research to unveil the corruption.
But the culture of our scientific institutions, and the priorities of many of their leaders, shares a lot of the blame. A 2008 survey of ORD’s scientists by the Cambridge-based Union of Concerned Scientists reflects what many of my colleagues have become accustomed to: researchers are systematically subjected to top-down pressure to avoid conducting research or drawing conclusions that undermine government policies.² In a great many cases, those who do are fired, have their careers dead-ended, and are sometimes even prosecuted and imprisoned. These problems are mirrored in industry, which hires scientists to support its business. And they have spread to universities, which are heavily invested in obtaining grants that ultimately support government policies and industry practices.
If the trend continues, integrity in science may one day become about as rare as a silver plug penny. Unfortunately, organizations dealing with scientific misconduct are designed only to weed out those who commit fraud behind the backs of the institutions where they work. But the greatest threat of all is the purposeful corruption of the scientific enterprise by leaders within the institutions themselves. The science they create is often only an illusion, designed to deceive, and the scientists they destroy to protect that illusion are often our best.
Throughout my career as a research scientist, I’ve worked in areas where policymakers and industrial managers have a keen interest in controlling what gets published in the scientific literature. I have watched government officials, university administrators, and corporate executives manipulate science without restraint time after time to advance and protect their own interests, funding scientists to carry out research projects with predetermined outcomes, fudging data, and using false allegations of research misconduct to eliminate scientists who question their science.
Since 1996, I’ve spent much of my time fighting governmental, industrial, and academic entities jointly engaged in efforts to stop my research and discredit my coauthors and me by any means necessary. This book describes the most important issues that my coauthors and I have investigated, along with important research topics that leaders at government agencies and in the corporate world have prevented me from ever undertaking. Along the way, I’ve discovered much about the methods that are sometimes used within government agencies, corporations, and academic institutions to manipulate science.
My coauthors and I, for example, were the first researchers to document adverse health effects associated with treated sewage sludges (biosolids) applied according to EPA’s current regulation, the 503 sludge rule. This rule allows municipalities to collect industrial pollutants at wastewater treatment plants and spread them on farms, forests, school playgrounds, and other public and private lands without monitoring any pollutants other than nine metals and two nutrients, nitrogen and phosphorus.
EPA’s attempts to stop our research and discredit the researchers with false allegations of research misconduct prompted two congressional hearings by the House Science Committee, a review by the National Academy of Sciences, and the passage by Congress of the No Fear Act of 2002. At first, Democrats in the House of Representatives refused to support efforts to clean up the scientific fraud and the silencing of concerned scientists behind EPA’s biosolids program, choosing instead to cast Republicans as anti-environmental for attacking EPA regulations.³ Then, as a Senate Briefing was scheduled, Republicans torpedoed that effort.⁴
Similarly, I spent almost two years obtaining and analyzing the U.K. General Medical Council’s (GMC’s) confidential documents behind allegations of research misconduct that Brian Deer and the British Medical Journal (BMJ) published against Dr. Andrew Wakefield. In the process, I discovered a document showing that the analysis of patient records that Deer published in 2010 perfectly matches an analysis requested by the GMC’s lawyers in the GMC proceedings four years earlier. The analysis, which Deer published in the BMJ, was the result of a deliberate plan by individuals working for the GMC to conflate a blinded expert analysis of biopsy slides with routine pathology reports to make it appear that Wakefield had misinterpreted the records to link the MMR vaccine to autism. What the GMC’s lawyers could probably never get away with in the courtroom—which was to condemn Andrew Wakefield for research fraud—Deer accomplished by publishing the GMC’s convoluted analysis in the BMJ.
My hope is that this book will give our judicial system, the news media, and the general public a better idea of what goes on behind the scenes, where enormous resources are being invested to create the illusion of science needed to protect government policies and industry practices. Somehow, we must find a way to prevent this illusion from supplanting the real science that is desperately needed to protect public health and the environment. It is up to us to ensure that future generations do not pay the price for the institutional research misconduct that has become such a large part of science during our generation.
PRESIDENT DWIGHT D. EISENHOWER’S FAREWELL ADDRESS
President Dwight D. Eisenhower on Scientific Research:¹
A steadily increasing share is conducted for, by, or at the direction of the Federal government.... The free university, historically the fountainhead of free ideas and scientific discovery, has experienced a revolution in the conduct of research. Partly because of the huge costs involved, a government contract becomes virtually a substitute for intellectual curiosity.... The prospect of domination of the nation’s scholars by Federal employment, project allocations, and the power of money is ever present and is gravely to be regarded. Yet, in holding scientific research and discovery in respect, as we should, we must also be alert to the equal and opposite danger that public policy could itself become the captive of a scientific-technological elite.
STORY OF THE IRON HORSE
David Lewis. Photo courtesy of Walker Montgomery, circa 2010.
The famous Iron Horse is a symbol of the University of Georgia. It stands exiled to a cornfield visible from Georgia State Highway 15 south of Watkinsville, Georgia, near the author’s home. Forged by artist Abbott Pattison and erected on UGA’s main campus in May 1954, it’s an example of iron sculpture introduced at the end of World War II.
Modern art was new to the campus, and students at the agricultural university abhorred it. As night fell, firefighters turned their hoses on a large crowd that piled hay and old tires around the Iron Horse and set it on fire. In a PBS documentary aired in 1980, Pattison said that he considered it a lynching. The author was similarly banished from the UGA campus in 2008.
1
ASK YOUR DENTIST
DO YOU HEAT-STERILIZE YOUR HANDPIECES AFTER EVERY PATIENT?
Everyone should have regular dental care. It not only saves your teeth; it may well save your life. As a microbiologist, I know how important it is to get regular dental checkups and maintain good dental hygiene. But, after conducting research on dental handpieces used to drill and polish teeth, I would never let a dentist or hygienist work on my teeth unless their handpieces have been heat-sterilized after every patient. Many don’t, and you should always ask to make sure.
Key Players
Research conducted by the author and his coauthors at UGA, Washington University’s Medical School, and Loma Linda University’s School of Dentistry prompted the CDC, the FDA and other public health organizations worldwide to recommend heat-sterilization for every item that enters the oral cavity before it can be reused on another patient.¹ There were many key individuals and organizations in government, industry, and academia that fought on one side or the other. Here are some of the key players.
David Kessler, FDA Commissioner
Thomas Arrowsmith-Lowe, who handled dental issues for the FDA, walked into Kessler’s office in 1992 with a copy of our Lancet study and the journal’s editorial in hand. The editors summarized: On p. 1252, Lewis and colleagues report that HIV-infected material can be sucked back into waterlines and expelled via a dental handpiece.
² At a meeting at the headquarters of the American Dental Association in Chicago, Tom announced that the FDA was sending a letter to every dentist in the United States, and every possession of the United States, instructing them to heat-sterilize their handpieces after every patient.³
Harold Jaffee, CDC Director
In an interview with ABC Primetime Live producer Sylvia Chase in 1992, Jaffee watched a videotape of me operating a dental drill and prophy angle
used for cleaning teeth after they had been exposed to blood and prepared for the next patient according to CDC guidelines. Traces of red blood could be seen streaming out as the devices were run over a container of clear water. Is it not the same thing—this kind of blood transfer—as sharing a needle?
Chase asked.
Dr. Jaffee opened his mouth, but no words came out. After a long pause, he said, Clearly, we don’t want one patient to be exposed to another’s blood.
Diane Sawyer introduced the segment by announcing that the CDC had decided to change its guidelines. Dr. Donald Marianos, the head of the CDC’s dental section, called me the next morning to say what an impact the visual demonstration had on the staff at the CDC. Evelyn Lincoln, President Kennedy’s personal secretary, also called me. She said that he would have personally taken action had this surfaced on his watch.
Kimberly Bergalis, University of Florida Student
Despite suffering in the final stages of AIDS, and unable to speak louder than a whisper, Kimberly testified before Congress. She waged a national campaign to force the government to get to the bottom of how she and at least five other patients in a Florida dental practice contracted HIV from their dentist—and stop it from ever happening again. Barbara Webb, a retired schoolteacher who was one of the other five, donated a blood sample for us to use in a study we published in Nature Medicine.
Dental handpiece drawing by David Lewis.
The Story
My older brother Mike joined the Navy in 1962, and was trained as a dental technician. After serving his four years, he worked for a dental supply company in Atlanta, Georgia. While visiting dental practices throughout the Southeast, he noticed traces of blood in the crevices of high-speed dental handpieces prepared for the next patient. Dental handpieces are divided into two categories: high-speed, for drilling, and low-speed, for polishing.
Dental drills run on air pressure controlled with foot-pedals. When the pressure is cut off, suck-back causes blood, saliva, and other patient materials to be drawn back into the handpiece. Although dental handpieces are re-lubricated between patients, they are not cleaned internally.
Slow-speed handpieces used to clean and polish teeth have the same problem. As hygienists scrape plaque from tooth surfaces along the gum line, bleeding occurs. Then, when low-speed handpieces equipped with prophy angles—rotating rubber cups—are run along the gum line, they suck back abrasive pastes contaminated with blood and saliva as the air-flow is disrupted. When reused, they expel the traces of blood and other patient materials directly into areas where tissues are bleeding in subsequent patients.⁴ Our studies published in Lancet and Nature Medicine demonstrated that, even when the devices are disinfected, they can still expel infectious levels of bacteria and viruses, including HIV.⁵ Only heat-sterilization can penetrate water-insoluble lubricants containing traces of patient materials trapped inside.
I mentioned to Mike that I often developed throat infections after routine dental procedures, and tested positive for strep throat. When I asked my dentist whether he autoclaved his dental tools, he replied, Everything but handpieces.
I told Mike that I wanted to take a closer look at what’s inside handpieces, and he gave me an old one to play with. My dentist had assured me that nothing from patients gets inside handpieces because air blows through them during the procedures. So, the first thing I did was to get the contact information for a dental equipment repair company from my brother and give the owner a call. That was in the late 1980s, before the Bergalis case surfaced. I doubt that the owner would have been inclined to talk about the problem after the HIV outbreak caused widespread panic.
When I called the repair shop, I told them I was Mike’s brother and wanted to do a little research on handpiece contamination. I asked, What do you see inside them when they’re repaired?
He replied, Tooth material, amalgam, bits of tissue, blood.
Well, if it’s going in,
I said, then it must be coming back out when the handpiece is reused, right?
That’s right,
he replied. To check it out myself, I scooped some of the debris from inside the old handpiece my brother gave me, and took a look at it using an electron microscope with X-ray diffraction to detect heavy metals. Lots of red blood cells, tissue, and mercury-silver amalgam particles were clearly visible.
It was unsettling to me, as a microbiologist, to realize what had been injected into my bloodstream with dental drills over the years. All I could think about was the countless strains of antibiotic-resistant staphylococci and streptococci from thousands upon thousands of patients lodging on my heart valves, and remaining there—a few cells here, a few cells there. Little ticking time bombs buried in some microscopic scar tissue or cholesterol deposit, waiting for my immune system to go downhill from diabetes or some other chronic disease, just sticking it out until I grow old. There’s nothing in the world that can be done about it now.
I asked Mike if he knew any dentists who heat-sterilized their handpieces after every patient. He recommended Robert Boe, a dentist in the Atlanta area who was known for welcoming AIDS patients. Soon, I was taking my wife and two children to Dr. Boe to get our dental work done, and driving to his office after getting off work at EPA to experiment with dental handpieces. Dr. Boe was one of only 1 percent of dentists in the United States who was heat-sterilizing handpieces after each patient at the time.
HIV Outbreak in Florida
In July 1990, the Centers for Disease Control and Prevention (CDC) in Atlanta reported a possible case of HIV transmission in a Florida dental practice.⁶ It would eventually trace the source of the infection in a University of Florida student, Kimberly Bergalis, and five other patients with no identified risk factors to their dentist, Dr. David Acer.⁷ In 1991, Dr. Acer’s hometown newspaper published a front-page story about our research, which ran in more than seven hundred papers nationwide.⁸ One of our studies included a blood sample from one of Acer’s patients.⁹
The CDC considered