Fluoridation: The Great Dilemma.
Waldbott GL, Burgstahler AW, and McKinney HL. (1978)
Coronado Press, Inc., Lawrence, Kansas. p. 295-305.
INDUSTRY AND FLUORIDATION
INDUSTRY WELCOMED fluoridation with open arms. Chemical Week, a publication for the chemical industry, vividly portrayed this fact in 1951 with an enthusiastic news account:
All over the country, slide rules are getting warm as waterworks engineers figure the cost of adding fluoride to their municipal supplies. They are riding a trend urged upon them by the US Public Health Service, the American Dental Association, the State Dental Health Directors, various state and local health bodies, and vocal women’s clubs from coast to coast. … it adds up to a nice piece of business on all sides and many firms are cheering the USPHS and similar groups as they plump for increasing adoption of fluoridation. (1)
The beneficiaries named in this article were chemical companies and equipment firms: General Chemical, Harshaw Chemical Co., Blockson Chemical Co., American Agricultural Chemical Co., Aluminum Co. of America (ALCOA), Davison Chemical Corp., and Baugh Chemical Co. Chemical Week obviously failed to discuss how many other industries in addition to chemical corporations would eventually gain financially from the unexpected bonanza. Even so, the desire of corporations to sell their products was not the only significant motive for industry to “plump” for the new health measure.
In the early 1930s, ALCOA and other manufacturers of aluminum had a problem so serious that it threatened their very existence. During the smelting and reduction process, when bauxite (aluminum oxide) is dissolved and electrolyzed in molten cryolite, hydrogen fluoride and other volatile fluorides are released into the air, and sodium fluoride remains in the bath. (2) The latter cannot simply be dumped on the ground because it seriously pollutes grass and other forage. Indeed, in 1950 ALCOA’s plant in Vancouver, Washington, was fined for dumping fluorides into the Columbia River, and the airborne fluorides heavily contaminated the grass and forage, “which resulted in injury and death to cattle.” (3) If it could be established further that human health also suffered from fluoride pollution, the consequences to the company in terms of damage suits would have been immeasurable.
Damage to Animal Life. Many other industries, especially the manufacturers of steel and phosphate fertilizer, shared this problem with ALCOA. On August 25, 1961, W. S. Meader and his wife May, near Pocatello, Idaho, obtained a judgement in the US Court of Appeals, Ninth Circuit, against Food Machinery and Chemical Corp. for the sum of $57,295.80 and against J. R. Simplot Co. for $4,246.41. The factories of these corporations emitted solid and gaseous fluoride compounds which seriously damaged the Meader trout farm and fish hatchery. According to the court record, “eggs were worthless” and did not hatch properly; the fish also exhibited malformations. “During the week after rains, the Meaders were hauling away about a ton of dead fish per day.” (4) Fluoride levels in water samples from the Meader hatchery ranged between 0.5 and 4.7 ppm – no different than the fluoride concentrations in food and drinks consumed today by humans in many places. Inevitably, the business of the farm began to deteriorate as “customers were lost.”
Damage to fish is not the only source of litigation resulting from environmental fluoride. Ever since the beginning of the industrial revolution, wholesale pollution of air and of the countryside with fluoride fumes and fallout has taken place, and fluoride poisoning has become an important industrial hazard. Early reports of damage came from Great Britain and also from Freiburg, Germany, where by 1893, 880,000 marks (about $200,000) had been paid for current injuries and 644,000 marks for permanent relief. Around the industrial city of Freiburg in Saxony a disease of cattle, endemic for 20 years, was identified in 1907 as fluoride poisoning from the smelters. (5) At about the same time, cattle near copper mines of Anaconda, Montana, were reported to have developed “copper teeth,” which were remarkably similar to what was later recognized in humans as “Colorado brown stain” or “mottled teeth” (Fig. 17-1). (6)
In the early 1950s American industry was plagued with a virtual epidemic of litigation. In 1950, Mr. and Mrs. Julius Lampert had won their suit against the Reynolds Metals Company’s Troutdale aluminum plant for fluoride burns to their gladiolus crops. (7) In Blount County, Tennessee, prior to January 1, 1953, ALCOA had hardly made up the loss of income incurred by 141 farmers and cattle raisers, (8) when another suit charged that fluoride fumes “damaged farmlands, injured registered cattle,” making them unmarketable, and caused premature deterioration of teeth, stiffness of joints, knots on ribs, loss of appetite, and general retardation of growth. (9)
Other suits involved the ALCOA plant at Vancouver, Washington, which had to pay cattleman William Fraser $60,000 in 1962 and in the same year, $20,000 to Earl Reeder because of fluoride injury to their cattle on Sauvies Island. (10) In 1961 Fairview Farms. Inc., received $300,000 from the Harvey Aluminum Company’s reduction plant in The Dalles, Oregon, because of damage to dairy herds, loss of forage and of milk supply, as well as depreciation of the lands. Orchardist W. J. Meyer and his wife Mary Ann also received $485,000 for “willful damage” to cherry, apricot, and peach crops. (11)
The threat to farming by fluoride pollution can be visualized if we realize that Polk County, which was Florida’s leading cattle producer in 1954 with 120,000 head, had some 30,000 fewer cattle by 1965. Fluoride emissions from phosphate plants on pastures were building up toxic levels as high as 1800 ppm in the grass and other forage. The official maximum allowable concentration for cattle is 40 PPM, (12) but even this level permits significant damage. (13)
Human Health. When human health was at stake, the spectre of these damage suits became even more ominous for the corporations. In the 1955 suit Paul M. Martin and his wife Verla vs. Reynolds Metals, it was proved for the first time in the United States that fumes from an aluminum reduction plant had caused illness to humans. (14) The significance of this litigation is underscored by the fact that seven other aluminum, metal, and chemical companies joined Reynolds Metals as “friends of the court” to obtain a reversal of the judgement against their fellow corporation. Fred Yerke, a Reynolds attorney, “contended that, if allowed to stand, the verdict would become a ruling case, making every aluminum and chemical plant liable to damage claims merely by operating.” (15) The verdict did stand: in June 1958, the U.S. Court of Appeals upheld the decision against Reynolds by a five to one vote. (16) Finally, in 1968, the company settled the case by buying the Martin ranch – a solution to the problem that has been followed by other corporations.
Another suit involving human health threatened the Rocky Mountain phosphate plant in Garrison, Montana, when residents complained constantly of “strep” throats, burning eyes, and asthmatic symptoms which they associated with fumes emanating from the plant. Classes of the Garrison school were interrupted 35 times during the first year of the plant’s operation (1963-1964) because of fluoride fumes. That fluoride was the chief culprit became evident when ranchers observed: their cows suffered from mottled teeth (Fig. 17-1) and legs so stiff and painful that they had to graze on their knees (Fig. 17-2). Samples of vegetation near the stack fallout showed fluoride concentrations several thousand times the usual levels. (17) In spite of the installation of pollution control equipment, the plant had to be shut down repeatedly. Finally, the factory discontinued operation altogether for reasons unrelated to the pollution problem.
In another part of the country, a jury decided on March 13, 1972, in favor of P. G. and P. N. Barci, father and son, in the suit of Barci vs. Intalco Aluminum Company of Ferndale, Washington, because of damage to cattle, trees, and to human health. A lung specialist from Spokane testified that P. G. Barci suffered from pulmonary fibrosis, a permanent lung disease which had completely disabled him. (18) About two years later, the same aluminum company lost a $130,500 fluoride emission suit to Ray and Helen Freeman, who resided a mile away from the plant on Lake Terrell. (19)
These are but a few of the numerous law suits highlighting the magnitude of environmental damage by fluoride. Ironically, the expenditures I have discussed are small compared to the cost of installing effective air-cleaning equipment. For instance, by 1957 the United States Steel Corporation’s Columbia-Geneva Division’s plant in Provo, Utah, had spent $9 million to install electrostatic precipitators and other anti-pollution devices. The same company had previously been faced with nearly 900 damage claims totaling approximately $4.5 million. (20) Unfortunately, even high-priced air-cleaning equipment does not solve the problem, since fluoride scrubbed from chimneys does not disappear; it has to be washed onto the land or into rivers and lakes and eventually creates further difficulties.
Dismayed by the prospect of continuous litigation and fearful of recognition of widespread damage to human health, corporations initiated extensive research programs to convince communities and the courts that small amounts of fluorine are not harmful to man. They collaborated with scientists at leading universities and at industrial research laboratories.
One of these temples of learning is the Mellon Institute in Pittsburgh, Pa., founded by Andrew W. and Richard B. Mellon, the former owners of the Aluminum Company of America. LIFE magazine of May 9, 1938, described the Mellon Institute as an “Intellectual holding company and a laboratory for applied science open to the US businessman” where every possible resource and piece of equipment is available to industry. Such varied subjects as shaving, cigarette technology, or insecticides could be studied to improve products or to find new uses for them. LIFE added: “When a manufacturer is in trouble, for example, he finds the market for his goods is shrinking, he goes to the Institute. For $6,000 or more he gets a fellowship entitling him to employ a scientist for a year and use laboratory facilities. When the research is satisfactorily completed, all discoveries are turned over to the manufacturer exclusively.” (21) Thus, findings incriminating to the corporations need not be published or presented to the medical and veterinary professions.
Whereas the Mellon Institute was the most logical place to seek aid in their precarious plight, corporations also sought help from other institutions of higher learning, especially the Universities of Tennessee, Cincinnati, and Wisconsin, all of which received large research grants to create a favorable climate of opinion for fluoride. Between 1940 and 1960, a flood of scientific reports issued from these institutions, which acknowledged the receipt of financial support from nine corporations, several of whom had been dumping fluoride into the environment. (22)
One of the scientists engaged in research at the Mellon Institute, Gerald J. Cox, a biochemist, was to play a major role in promoting fluoridation. (23) Some of his research had suggested to him that fluoride “may be specifically required for tooth formation.” (24) He therefore recommended that it be added to water supplies as a means of reducing tooth decay. (25) On September 29, 1939, Cox told the Western Pennsylvania Section of the American Water Works Association meeting at Johnstown that “the present trend toward complete removal of fluorine from water and food may need some reversal.” Cox’s term “reversal” referred to the fact that water works engineers had been recommending 0. 1 PPM as the maximum level of fluoride in drinking water because they felt that at least a tenfold margin of safety should be maintained (Table 17-1 ). (26)
Recommended Maximum Levels of Ions in Water
Used for Drinking and Cooking, 1939 (26)
Ion Max. Level (ppm)
At that time even the official USPHS regulations stated: “The presence of . . . fluoride in excess of 1 p.p.m…shall constitute ground for rejection of the water supply.” (27) Because fluoride had been universally recognized as a toxic agent until then, Cox realized that water works officials might be held liable for poisoning people drinking fluoridated water. He therefore cautioned his audience: “Fluorides are among the most toxic of substances. Mottled enamel results from as little as 0.0001 percent of fluorine in drinking water [1 PPM] . The results on adults of drinking water containing sufficient fluoride to prevent dental caries in children must be determined.” (25) Cox undeniably sensed The Great Dilemma right at the start.
Cox’s theory that fluoridated water could protect teeth against decay was based on his own experiments and on evidence provided in 1938 by W. D. Armstrong, professor of biochemistry at the University of Minnesota, and a consultant for the Dental Division of the PHS. In collaboration with P. J. Brekhus, Armstrong had reported more fluoride in enamel of healthy than in decayed teeth. (28) Twenty-five years later, however, his own reinvestigation convinced him that he had misinterpreted his early data, and he realized that the differences in the fluoride content between the sound and the carious teeth in his study were due to differences in the age of the teeth and did not reflect their susceptibility to decay. (29) Thus the basis of Cox’s main argument for recommending the addition of fluorides to drinking water was later shown to have been wrong!
In 1943, F. A. Arnold, Jr., of the National Institute of Dental Research in Bethesda, Maryland, took up Cox’s suggestion. He advocated fluoridation in the Journal of the American Dental Association on the basis of Cox’s experiments, Dean’s PHS surveys, and the Armstrong-Brekhus fluoride analyses of tooth enamel. Arnold stated: “The cumulative toxic effects on the body from ingestion of fluoride in this concentration is admitted to be a possibility. However, all things considered, such a possibility seems rather remote.” (30) Even in 1946 he still maintained in his AAAS report that “such a procedure cannot be recommended for other than research purposes at the present time” and suggested a study which “may take 12-15 years before the final answer is clearly delineated.” (31)
In the early 1940s Cox had an excellent opportunity to introduce his idea to scientists when he became a member of the Food and Nutrition Board of the National Research Council (23) and prepared for this illustrious body several pro-fluoridation summaries of the literature on dental caries. Through this organization, with its close link between industry and government, he was able to influence many scientists…
Cox lost no time in implementing his project. On September 20, 1939, five years before Newburgh and Grand Rapids experiments were initiated, and at the very time when he first suggested the fluoridation idea to the water engineers in Johnstown, he recommended fluoridation for that city; (25) however, his proposal was rejected. Subsequently he promoted the measure more successfully before chemical and dental organizations, parent-teacher associations, and city councils.
Nevertheless, Cox’s research at the Mellon Institute and his political activities fell short of relieving the aluminum industry of its distressing plight. ALCOA also tackled its fluoride pollution problem on another front, namely through the Kettering Laboratory in Cincinnati. This institute was founded in 1930 by gifts of the Ethyl Corporation, General Motors’ Frigidaire subsidiary, and the duPont Company to investigate chemical hazards in American industrial operations. Like the Mellon Institute, it has made many valuable scientific contributions. Its 1955 budget of $643,000 was funded by industry (about 90%) and most of the rest by government agencies. (33) Dr. Robert A. Kehoe, its first chief, one of the nation’s leading industrial toxicologists, personified the close link between PHS and industry since he was Medical Director of the Ethyl Corporation and a consultant of the Division of Occupational Medicine of the PHS, the Tennessee Valley Authority, and tile Atomic Energy Commission. He and his staff have also been consulted almost routinely by editors of medical journals as to the suitability of articles submitted for publication and have thus given industry a foothold in influencing the medical literature on fluoride. Kehoe and his colleagues at Kettering also played a key role in developing government standards to prevent lead poisoning in industry. These standards have subsequently been criticized severely because they were far too lax. (34)
Since 1931 a considerable portion of the Kettering Laboratory’s facilities has been devoted to the study of fluoride, particularly the refrigerant gas Freon 12. Like the Mellon Institute’s findings, those of the Kettering Laboratory are made available to the professions and to the public only upon approval of the industrial donor of the grant. Article 8 of one of the contract agreements between the Aluminum Company of America and the Laboratory specified that the University of Cincinnati shall “disseminate for the public good any information obtained. However, before the issuance of public reports or scientific publications, the manuscripts thereof will be submitted to the Donor for criticism and suggestions. Confidential information obtained from the Donor shall not be published without permission of said Donor.” (35) The corporations were allowed to interpret the term “confidential information.” One can only guess how much valuable research has been lost to the medical profession because of these agreements.
During the mid-20th century, the research that issued from the Kettering Laboratory dominated the medical literature on the toxicology of fluoride. Among its most useful products in the area of fluoride research were the abstracts and an annotated bibliography prepared by Irene R. Campbell covering the literature on fluoride through 1971. (36, 37)
Although written mostly by proponents, many scientific articles in Campbell’s annotated bibliography reveal serious health hazards of fluoride even in small amounts and at low concentrations. It is impossible to understand, therefore, how Kehoe could state publicly in March 1957 that “the question of the public safety of fluoridation is nonexistent from the viewpoint of medical science.” (38)
Kettering Institute scientist E. J. Largent, who subsequently became consultant for Reynolds Metals Company, has written a book entitled Fluorosis: The Health Aspects of Fluorine Compounds, which was expressly designed, as indicated on its jacket, to “aid industry in law suits arising from fluoride damage.” This book has been used as a reference source by many physicians and health organizations and strongly supports the use of fluoride in drinking water and discounts or minimizes its toxicological effects: “in recent years additional surveys of information have been reported that establish again and again the complete safety of fluoridating drinking water.” (39)
(from page 311-314)
Interestingly, the corporations that originally sponsored fluoridation rarely promoted their product publicly. In 1950-1951 ALCOA had explicitly advertised sodium fluoride “of a uniform high degree of purity” for addition to water supplies in the Journal of the American Water Works Association (61). On May 22, 1957, however, ALCOA’s Chemical Sales Manager, H.P. Bonebrake, stated in a letter to C.A. Barden of Oberlin, Ohio, that his firm was not promoting fluoride for water fluoridation or selling it “directly to any municipality.” Nevertheless, Hearings on Fluoridation before the Committee on Interstate and Foreign Commerce, House of Representatives, suggest that ALOCA was the driving force behind fluoridation:
In 1944 Oscar Ewing was put on the payroll of the Aluminum Company of America, as attorney, at an annual salary of $750,000. This fact was established at a Senate hearing and became a part of the Congressional Record. Since the Aluminum Co. had no big litigation pending at the time, the question might logically be asked, why such a large fee? A few months thereafter Mr. Ewing was made Federal Security Administrator with the announcement that he was taking a big salary cut in order to serve his country. (62)
It was Ewing, as chief of the PHS, who officially gave the green light to fluoridation only five years after the initiation of the 10 to 15-year experiments in Grand Rapids, Michigan, and Newburgh, New York. At that time the permanent teeth of children born under fluoridation had not yet erupted, and therefore no reliable scientific conclusions concerning its benefits could possibly have been reached.
Prior to Ewing’s tenure of office in the federal government, Andrew Mellon, the founder of ALCOA, had been the U.S. Treasurer. The PHS was then in the Department of the Treasury. One can only speculate concerning Mr. Mellon’s role as protector of his company. Nor can it be ascertained whether or not such scientists as Knutson, Dean, Russell, and their colleagues in the Dental Division of the PHS, were in any way influenced in their desire to please their boss, Oscar Ewing. This thought is bound to occur to anyone who is familiar with governmental agencies; it is also driven home clearly by the Watergate affair. When decisions are made at the top level -be they right or wrong -it is not easy for government employees to report “corruption, waste, or regulatory abuse.” The consequences: “Too often they are characterized as troublemakers, then are fired, frozen out of promotions or subjected to personal harassment for the rest of their careers.””
Industry’s vital role in promoting fluoridation cannot be doubted nor can the leadership of ALCOA be denied in this affair. In carefully orchestrated harmony, industry, science, and the PHS collaborated in a plan that instituted a health procedure touching virtually everyone in America. Enormous research activity produced a mountain of evidence-much positive-that fluoridation was the long-sought answer to our dental health care problems. But what of the serious problems discovered? Why were they obscured, discounted, or simply ignored? If we examine the fluoride literature closely to determine how much of it was supported or generated by industry and/or the PHS, we shall find the answers to our questions. We shall also understand some of the reasons why scientists, physicians, and dentists are generally ignorant of the true consequences of fluoridation.
1. Water Boom for Fluorides. Chemical Week, July 7, 1951, p. 14.
2. Davenport, S.J., and Morris, G.G.: US Bureau of Mines. Circular 7687, US Dept. of Interior, June 1954, p. 8.
3. Oregon Rancher Asks $200,000 of Aluminum Co. Seattle Times, Dec. 16, 1952.
4. Food Machinery and Chemical Corporation vs. W.S. Meader and May Meader, United States Court of Appeals, Ninth District, Aug. 25, 1961.
5. Ost, H.: Der Kampf gegen schadliche Industriegase. Z. Angew. Chem., 20:1689-1693, 1907.
6. The So-Called Copper Teeth of Cattle. Br. Dent. J., 28:141-142, 1907.
7. Damages Awarded for Crop Burns. Lewiston (Idaho) Morning Tribune, Feb. 6,1962.
8. Jury Decides Alcoa Liability Ended in 1955. Knoxville (Tenn.) Journal, May 7, 1958.
9. Alcoa Sued for Nearly $3 Million. Knoxville (Tenn.) Journal, July 30. 1955.
10. Sauvies Island. Portland (Oregon) Reporter, June 26, 1962.
11. Harvey Loses Fluoride Case. Hood River (Oregon) News, Oct. 29, 1970.
12. Lewis, H.R.: With Every Breath You Take. Crown Publishers, Inc.. New York, 1965, pp. 110-111.
13. Gordon, C.C., and Tourangeau, P.C.: The Impact of Fluoride on the Farmlands of Buckeystown, Maryland, Caused by the Eastalco Aluminum Smelter (cover title). Environmental Studies Laboratory, University of Montana, Missoula, Mont., February, 1977.
14. Three Win in Fume Suit. The Oregonian (Portland), Sept. 17, 1955.
15. Seven Enter Fluoride Case. The Oregonian (Portland), Oct. 15, 1957.
16. Aluminum Firm Loses Appeal in Poison Case. Cleveland (Ohio) Press. June 6, 1958.
17. Smog Battle Ends in Montana Town. New York Times, Sept. 17, 1967.
18. Park, R.: The Intalco Trial. Northwest Passage, Bellingham, Wash., March 20 – April 2, 1972, p. 9.
19. Intalco’s Fluoride Emissions Exceed State Standards, Manager Tells Jury. Bellingham (Wash.) Herald, Jan. 17, 1974. Jury Awards Damages from Intalco. Ibid., Jan. 27, 1974.
20. Utah Steel Mill Curbs Pollution. New York Times, Nov. 10, 1957.
21. Science Means Business in This Grecian Temple. LIFE, May 9, 1938, p. 48.
22. Aluminum Co. of America; American Petroleum Institute; E.I. du Pont de Nemours Co.; The Harshaw Chemical Co.; Kaiser Aluminum and Chemical Corp.; Pennsylvania Salt Manufacturing Co.; Reynolds Metals Co.; Tennessee Valley Authority; and Universal Oil Products Co.
23. Institute Hill PTA to Discuss Fluoridation. Butler (Pa.) Eagle, Jan. 28, 1959.
24. Cox, G.J.: Experimental Dental Caries. I. Nutrition in Relation to the Development of Dental Caries. Dental Rays, 13:8-10, 1937.
25. Cox, G.J.: New Knowledge of Fluorine in Relation to Dental Caries. J. Am. Water Works Assoc., 31:1926-1930, 1939.
26. Babbit, H.E., and Doland, J.J.: Quality of Water Supplies in Water Supply Engineering. 3rd Edition, McGraw Hill, New York, 1939, p. 454.
27. USPHS: Public Health Service Drinking Water Standards. Public Health Rep. 58:69-111, 1943 (at p. 80).
28. Armstrong, W.D., and Brekhus, P.J.: Possible Relationship between the Fluorine Content of Enamel and Resistance to Dental Caries. J. Dent. Res., 17:393-399, 1938.
29. Armstrong, W.D., and Singer, L.: Fluoride Contents of Enamel of Sound and Carious Human Teeth: A Reinvestigation. J. Dent. Res., 42:133-136,1963.
30. Arnold, F.A., Jr.: Role of Fluorides in Preventive Dentistry. J. Am. Dent. Assoc., 30:499-508, 1943.
31. Arnold, F.A., Jr.: The Possibility of Reducing Dental Caries by Increasing Fluoride Ingestion, in F.R. Moulton, Ed.: Dental Caries and Fluorine, 1946, pp. 99-107, and p. 105.
32. Doctor Appointed. Pittsburgh (Pa.) Post Gazette, April 4, 1962.
33. Testimony of Dr. R. Kehoe in Paul Martin Family vs. Reynolds Metals Corp., p. 960.
34. Bryce-Smith, D., and Waldron, H.A.: Lead in Food – Are Today’s Regulations Sufficient? Chem. Brit., 10:202-206, 1974.
35. Contract Agreement Between Aluminum Co. of America and U. of Cincinnati, signed by N.P. Auburn, Vice-President and Dean of Administration (April 30. 1947). Testimony McCarthy vs. The Cincinnati Enquirer, 1956.
36. Campbell, I.R., and Widner, E.M.: Annotated Bibliography: The Occurrence and Biological Effects of Fluorine Compounds. The Kettering Laboratory, Cincinnati, Ohio, 1958.
37. Fluoride Abstracts. Supplement to Annotated Bibliography The Occurrence and Biological Effects of Fluorine Compounds. The Kettering Laboratory, Cincinnati, Ohio, 1955-1971.
38. “Our Children’s Teeth,” Report to the Mayor and the Board of Estimate of the City of New York by the Committee to Protect Our Children’s Teeth, Inc., March 6, 1957. p. 27
39. Largent, E.J.: Fluorosis: The Health Aspects of Fluorine Compounds. 1961, p. 73.
61. High Purity ALCOA Sodium Fluoride for the Fluoridation of Water. J. Am. Water Works. Assoc., 42:5, 1950; Fluoridate Your Water with Confidence. Use High Purity ALCOA Sodium Fluoride. Ibid., 43: 45, 1951.
62. Hearings before the Committee on Interstate and Foreign Commerce, House of Representatives, Eighty-Third Congress, Second Session on H.R. 2341, May 25, 26, and 27, 1954, p. 51.
63. When Workers Blow Whistle on Federal Waste, Fraud. U.S. News and World Report, Dec. 19, 1977, p. 55.