The fight over fluoridation
Driving the Day
FLUORIDE'S LAST STAND? Health Secretary Robert F. Kennedy Jr. looks poised to win the battle over fluoride, to the dismay of dentists and oral health advocates, POLITICO's Danny Nguyen reports.
Florida and Utah banned the cavity-fighting mineral from their drinking water this year, and several other Republican-led states are considering similar measures. Oklahoma has dropped its recommendation that localities fluoridate.
Why it matters: The nearly three-quarters of Americans who drank fluoridated water before Kennedy became HHS secretary is set to plummet.
For Kennedy, who's long believed drinking fluoride is unhealthy, that's a win.
'Fluoride's predominant benefit to teeth comes from topical contact with the outside of the teeth, not from ingestion,' an HHS spokesperson told POLITICO. 'There is no need, therefore, to ingest fluoride.'
The impact of the retreat from fluoridation on oral health will reveal whether dentists are correct when they predict a cavity crisis will follow, or whether Kennedy's view that Americans can get the fluoride they need through toothpaste and mouthwash will bear out.
Drilling down: The CDC has included fluoridation in its list of the 10 greatest public health achievements of the 20th century, citing data that it reduces tooth decay by as much as 70 percent in children and tooth loss by as much as 60 percent in adults.
Kennedy nonetheless believes the case to remove fluoride is urgent because of reports that it could curtail children's brain development. It's a position bolstered by a report from the National Institutes of Environmental Health Sciences — although none of the studies were conducted in the U.S., and the levels of fluoride they examined were higher than what Americans typically consume — and a federal judge's order in September that the Environmental Protection Agency regulate fluoride in drinking water, citing risks that higher levels could impact intellectual development.
Dentists see it differently.
'This is revving up an antiscience narrative,' said Dr. Brett Kessler, the president of the American Dental Association, the country's leading dentists' group. 'There are ways to get fluoride in toothpaste, some of the foods we eat, some of the drinks we drink, topical fluoride mouthwashes. … But without fluoridated water, you're already behind the eight ball because you've got vulnerable teeth.'
WELCOME TO THURSDAY PULSE. Former President Joe Biden's doctor declined to answer questions today about Biden's health during the presidency in a GOP House probe, citing patient confidentiality and the Fifth Amendment. Send your tips, scoops and feedback to khooper@politico.com and sgardner@politico.com, and follow along @kelhoops and @sophie_gardnerj.
AROUND THE AGENCIES
THE SCOTUS ORDER FALLOUT — HHS employees are bracing for the Trump administration to move forward with mass firings after a Tuesday order from the Supreme Court cleared the way, POLITICO's Erin Schumaker reports.
The set-to-be-terminated employees' final hope rests on the ruling's suggestion that lower courts could still consider direct challenges to agencies' reorganization plans. But that will require plaintiffs to bring more detailed cases quickly and convince judges to stop the layoffs before they become a fait accompli. As cases become more granular, plaintiffs will likely face an uphill battle.
The White House said it plans to restart the terminations immediately.
Federal workers, who have long seen civil service laws and collective bargaining agreements as shields protecting their jobs, told POLITICO their world has been shaken.
'All of my friends are resigned to the worst,' said a National Institutes of Health staffer who was granted anonymity due to fear of retribution.
On Wednesday, federal workers remained in wait-and-see mode, uncertain and awaiting word from agency lawyers on how to interpret the ruling's implications for them. Staffers at HHS described feeling anxious and exhausted by the back-and-forth over their jobs.
'Fuck it,' another NIH staffer said. 'I'm ready to retire if I can.'
Key context: A number of more limited challenges to the layoffs remain viable, said attorney Max Stier, founding president and CEO of the Partnership for Public Service, a nonprofit group that aims to improve the way the government functions.
'[The order] shouldn't, in and of itself, resolve those other cases,' he said.
The administration, for example, faces other legal challenges over its restructuring of HHS, which saw a quarter of its workforce bought out or let go, although hundreds of those workers have since been reinstated.
'HHS previously announced our plans to transform this Department to Make America Healthy Again and we intend to do just that,' HHS spokesperson Andrew Nixon wrote in a text Wednesday.
At the Courts
DOJ TARGETS TRANS CARE — President Donald Trump's Justice Department intensified its campaign against gender-affirming medical care Wednesday, issuing subpoenas to at least 20 doctors and clinics that treat transgender minors, POLITICO's Simon Levien reports.
The DOJ's announcement coincided with a Federal Trade Commission hearing where opponents of gender transition-related medical care accused providers of not being truthful about the consequences of the treatments, such as counseling, hormone replacement therapy and surgery.
Chad Mizelle, DOJ chief of staff, said the providers 'perpetrated one of the greatest medical frauds.'
The DOJ didn't name the clinics but said it's also investigating false statements.
'Medical professionals and organizations that mutilated children in the service of a warped ideology will be held accountable by this Department of Justice,' said Attorney General Pam Bondi in a press release.
Why it matters: Trump has long assailed gender-affirming care for children, making his opposition to it a keystone of his 2024 campaign. HHS issued a report in May arguing there was little evidence to show the care is effective and 'a growing body of evidence pointing to significant risks.'
But most major U.S. medical organizations say the treatments are safe, can boost patients' quality of life and save children's lives.
The subpoenas are the administration's latest attempt to crack down on the small number of health care clinics that provide gender-affirming care to minors. Most states already restrict or ban the practice for children.
What's next: FTC Commissioner Melissa Holyoak said her agency would scrutinize how providers describe gender-affirming care when consulting patients.
In Congress
FIRST IN PULSE: BIPARTISAN PBM BILL — Rep. Buddy Carter, a GOP pharmacist running for a Georgia Senate seat, will introduce legislation today with 11 bipartisan colleagues that would overhaul the practices of the drug-price middlemen known as pharmacy benefit managers — an industry that's become a perennial congressional target, Lauren reports.
The bill incorporates proposals — including two dropped from the recently passed Republican megabill — addressing a range of issues that PBM critics say contribute to high health care costs and low reimbursement rates for independent pharmacies.
The package would resurrect a ban on spread-pricing in Medicaid and a survey requirement for retail pharmacies to report their drug-acquisition costs — provisions dropped from the reconciliation bill after the Senate parliamentarian ruled the Medicaid language would be subject to the 60-vote Byrd rule point of order. It also would aim to limit pharmacy steering of Medicare Part D beneficiaries and delink PBM compensation from drug costs.
'It's time to bust up the PBM monopoly, which has been stealing hope and health from patients for decades,' Carter said in a statement. 'As a pharmacist, I've seen how PBMs abuse patients firsthand, and believe that the cure to this infectious disease is transparency, competition, and accountability, which is exactly what our bipartisan package provides.'
Original co-sponsors include Reps. Rick Allen (R-Ga.), Jodey Arrington (R-Texas), Debbie Dingell (D-Mich.), Vicente Gonzalez (D-Texas), Diana Harshbarger (R-Tenn.), Raha Krishnamoorthi (D-Ill.), Nicole Malliotakis (R-N.Y.), Greg Murphy (R-N.C.), John Rose (R-Tenn.), Deborah Ross (D-N.C.) and Derek Tran (D-Calif.).
GLOBAL HEALTH CUT CONCERNS — Some Republican senators expressed concerns about slashing funding for global health at their weekly lunch Wednesday, arguing that the White House's request to claw back $9.4 billion in congressionally approved funding should be tweaked.
Those concerns included the impact of slashing global AIDS funding and other international health funds, POLITICO's Jordain Carney reports. Republicans also sought clarity in the meeting about proposed reductions to food aid to other countries.
The pushback is the latest sign Republicans will have to make changes to the administration's rescissions package if they hope to pass it.
'Just by listening to the conversations — one, members still need to understand it better,' Sen. John Hoeven (R-N.D.) said in a brief interview after the closed-door Republican lunch. He added, 'I think we will get it passed, but in all likelihood it will be modified.'
Sen. Josh Hawley (R-Mo.) said, 'I just heard a lot of concerns raised in this meeting just now. People have a lot of stuff they want changed.'
What's next: Congress has until the end of the day on July 18 to get the legislation to President Donald Trump's desk or the rescissions request expires, forcing the administration to spend the money as Congress originally intended. And assuming the Senate does make changes, it would bounce the legislation back to the House for a final vote. Senate leaders are gambling that their counterparts across the Capitol will just swallow those revisions.
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The New York Times' Joseph Goldstein reports that 1.5 million New Yorkers could lose health insurance under the One Big, Beautiful Bill Act.
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'All this voluntary stuff only goes so far. It really does minimal impact,' Popkin said. 'Unless he goes to the FDA and has the FDA change a regulation … there's nothing.' Kennedy has also singled out the use of high-fructose corn syrup as a major contributor to diabetes and obesity. He has previously called it 'poison,' an epithet he repeated in late April when talking about sugar. When Steak 'n Shake said earlier this month it was going to sell Coca-Cola with real cane sugar, Kennedy praised the move. 'MAHA is winning,' Kennedy posted on X. But experts said there's no substantial difference in the benefits of using cane sugar as a substitute for high-fructose corn syrup. 'At the end of the day, a Coke is still a can of Coke. It's not a fruit or a vegetable, right? 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