the amalgam debate just won't go away
with one claim or another questioning the safety of dental
amalgam every few years during the past two decades, small
wonder at least two congressmen now want to abolish the
country's most economic and durable restorative material.
If the allegations aren't true, why would anyone continue
the debate for so many years? A closer look at what
motivates four anti-amalgamist leaders attempts to answer
the four individuals selected for this story are by no
means the only leaders in this debate, they are among the
most prominent. And, as the following vignettes show, each
of these leaders plays a unique role in this ongoing
litigator—Shawn Khorrami, a California attorney who is
the lead litigator behind several lawsuits against the
ADA, some state dental associations and a host of dental
scientist—Boyd Haley, a professor and chairman of the
chemistry department at the University of Kentucky.
lobbyist—Charles Brown, a lobbyist and an attorney who
serves as national counsel of Consumers for Dental Choice,
a coalition of anti-amalgam groups.
evangelist—Dr. Hal Huggins, who has reached an untold
number of dentists, physicians and patients since he began
spreading his anti-amalgam message in 1974.
Haley, Ph.D., professor and chairman of the chemistry
department at the University of Kentucky, is happy the ADA
is suing Khorrami for defamation because now the
association has to go to court and discuss the issues.
want to see them put their expert witnesses on the
stand," says Haley, "and then you walk up and
lay 100 papers in front of them that talk about mercury
toxicity and talk about mercury coming out of amalgam
To Haley, the great amalgam debate is simple: Mercury is
toxic. Keep it out of the mouth. End of story.
"Can I prove that chronic exposure causes any one
specific disease? Well, that takes a long time to do that
kind of research. It's hard to prove that," says
Haley, who even some of his critics say has earned a solid
reputation as a researcher. He's received millions in
funding from the National Institutes of Health between
1975 and 2000 for various research projects that led him
to develop photoaffinity labeling with nucleotides.
It was his work with photoaffinity labeling while
researching Alzheimer's disease that drew him to the
amalgam debate in about 1992. Shortly after publishing a
study that found mercury caused aberrancies in rat brains
similar to those found in human brains with Alzheimer's
disease, he came under attack by the dental profession.
"Then I started being called a quack and a
crackpot," he recalls. "And that's what really
got me irritated, because I was being very cautious."
Haley, for instance, doesn't say removing amalgam will
cure any disease. On the other hand, he does suggest that
doing so would reduce a person's exposure to mercury and
that would take "an oxidated stress off of the
body—a very significant one."
He admits that he's suggested to people with one disease
or another that he would have his amalgam removed if he
had the same problem. "When they do, they get
better," he notes.
When his wife, Sandra, had her amalgam removed, he says
her energy level increased.
Anecdotal evidence aside, Haley simply can't understand
the ADA's position on amalgam, which is that it is safe
and no scientific evidence exists that shows any
cause-and-effect relationship between mercury in dental
amalgam and any disease. "If you say wait until you
prove that this toxic material is really reaching a
concentration to harm a significant number of human
beings," says Haley, "it seems to me that that's
kind of a heartless way to look at protecting the
Like Khorrami, Haley discounts the NIH amalgam study on
children designed to address the very questions Haley and
others like him have raised. He says he is suspect of the
National Institute of Dental and Craniofacial Research and
its role in that study.
While Haley could not decide who should do such a study,
he is emphatic that the ADA should admit it has made a
mistake and change it, instead of belittling people who
have done research.
"I have a good reputation," Haley adds.
"I've published too much that everybody has repeated,
and I haven't had to write a retraction ever in my life
that I did anything that wasn't right."
What's more, he continues, he published a paper in 1992
that suggested glutamine synthetase was a possible
diagnostic marker for Alzheimer's disease. Last March,
Haley says, other researchers published a study that found
that to be the case. "The increase of the release of
that enzyme from the brain tissue and the inhibition of it
is due to mercury toxicity.
"So I have a history of being right when I talk about
things. I'm very careful."
In the years since publishing that first paper suggesting
a link between mercury and Alzheimer's disease, Haley says
he's tried to share the information with the appropriate
government agencies and the ADA, hoping that they would
then take care of the alleged amalgam problem. "But
you write letters and they don't even respond to them.
"So now I've become more of an activist because I
have lost total respect for the dental branch of the Food
and Drug Administration and for the ADA," he
continues. "If they were honest people, they'd invite
me to a talk and beat me up."
As for the government reviews of the science questioning
the safety of amalgam, Haley discounts them because he
says they were conducted by a committee consisting largely
of dentists and material scientists.
If anyone believes anything the government says anymore,
then Haley is mistaken. One of the U.S. Public Health
Service reviews evaluated 175 citations related to the
potential adverse effects of mercury in dental amalgam.
"The citations represented an assortment of
literature, including peer-reviewed publications,
non-refereed publications, untranslated foreign documents,
print media articles and letters to the editor,"
according to the FDA. Scientists from the Office of
Science and Technology "performed a triage of the
citations" so that evaluation could focus on studies
that met a set of criteria established by the review
"This process resulted in 57 articles, which were
reviewed by scientific experts from FDA, CDC and NIH
representing disciplines of general toxicology,
neurotoxicology, immunotoxicology, epidemiology, dental
materials and clinical dentistry," the FDA reports.
"These experts commented on the strengths and
weaknesses of each paper, the appropriateness of
methodologies, control groups and statistics, and whether
the conclusions were supported by the data. The
conclusions drawn by these experts were overwhelmingly
unanimous. None of the reviewers suggested that any study
under review would indicate that individuals with dental
amalgam restorations would experience adverse health
All lies, according to Haley. To counter such alleged
misinformation, Haley collected a myriad of anti-amalgamist
studies, papers and other information and posted all of it
to the Web site of ALT Inc., a company he co-founded in
1997 that, among other things, sells nucleotide
photoaffinity probes to researchers.
"I put that mercury stuff on (the Web site) because I
got damned tired of the ADA saying there's no
science," he says. "It's just something I feel
compelled to do because I have a real distaste for people
who lie. And the ADA right now is lying to Congress
telling them that this is just junk science."
That these reviews can discount the research by anti-amalgamists
and that the ADA refers to it as "junk science"
is particularly disturbing to Haley. And he plans to
retaliate, suggesting that he has considerable influence
among the anti-amalgamists to organize a massive
letter-writing campaign to Congress. "Even I'm
surprised at how much clout I have, not that I have a lot
of money or anything, but people think that I'm a very
honest person and I pride myself on that. I'm going to
make sure Congress gets flooded with a very short request
from voters." He wants political leaders to go to
Medline on the Internet and type in "mercury
toxicity" and "amalgam" and see how much of
the resulting list of research links looks like junk
Like Khorrami, Haley seems convinced that the ADA would
discredit any science questioning the safety of amalgam
because of the association's economic interest in amalgam.
Aside from the money manufacturers pay to have their
amalgam products considered for the ADA Seal, Haley claims
that dentists earn more by using amalgam than they could
by switching to a composite resin, despite the fact that
composite resin restorations clearly are more expensive to
patients. Amalgam, he says, has a higher profit margin
because dentists can produce more amalgam restorations in
a day than they can composite resin fillings.
As quick as he is with theories about the economic
interests of the ADA and dentists, Haley is even quicker
to disavow any financial interest of his own in the
ongoing amalgam debate. When asked about the products he
sells through the ALT Inc. Web site, Haley insists that
"you won't find one thing on there that we sell that
makes money off of mercury."
But he does make some money on the message that amalgam is
dangerous. The site sells videotapes of various
presentations from an ALT-sponsored conference. Several of
Haley's presentations on mercury toxicity are available
for purchase on the site.
addition, the ALT site also sells Toxicity Prescreening
Assays (TOPAS) to dentists. As the site notes, TOPAS
allows dentists "to quickly distinguish between
current disease activity and old damage (deep pockets),
something not possible with simple periodontal probings."
In short, the test reportedly can measure the amount of
toxic thiols produced by periodontal disease bacteria.
according to a paper authored by Haley, "the reaction
of oral mercury from amalgams and the reaction of this
mercury with toxic thiols produced by periodontal disease
bacteria very likely enhances the toxicity of the mercury
this statement would seem to indicate that the TOPAS
device could be used by dentists to illustrate to patients
the severity of their mercury toxicity exposure, Haley
dismissed the notion. "This is something that would
escape any but the brightest of them (dentists)," he
he adds, "there is no doubt" that the thiols
produced by periodontal disease bacteria and measured by
TOPAS could be used to indicate to a patient that his or
her mercury vapor exposure will be more severe.
notes, though, that the site really doesn't make any
significant income from the videotapes or TOPAS. The main
income is from the sale of photoaffinity nucleotide
analogs to researchers.