Shame on you Folsom Telegraph for publishing this article without doing your due diligence. Ms. Stride is a well known anti-fluoridationist and is extremely biased against this effective public health intervention. She wants the readers to believe there was some sort of "conspiracy" to trick the legislature into voting for AB 733, the state fluoridation law. Her article is so full of twisted science and anti fluoride bias I hardly know where to begin to critique it. I was involved in the passage of AB 733 and there was no trickery or conspiracy in passing this law. The anti fluoride forces had every opportunity to speak out against fluoridation and they brought their own experts to do that. Public testimony was accepted and many people against fluoridation did testify. Unfortunately for the anti fluoride forces, the legislature chose to believe Dr. C Everett Koop and the rest of the scientific experts. Ms. Stride also is a bit misinformed about AB 773. She claims the bill is a "mandate" to fluoridate for all water systems with 10,000 service connections or more. What she doesnt say is that AB 733 is an unfunded mandate. There was not one dollar of taxpayer money spent on fluoridation, and there still hasnt been! The $15 million our coalition has spent to fluoridate Los Angeles, Sacramento, Escondido, Santa Maria, Santa Monica and the huge Metropolitan Water District of Southern California (18 million customers) was provided by the California Endowment, a private foundation. California will become almost 60 % fluoridated when the Met provides us exact data on how many of its customers are receiving optimally fluoridated water. I believe that its time the City of Folsom join Los Angeles, San Francisco, Oakland, Berkeley, the East Bay, the 51 largest cities in America and the 18 million customers of the Met in Southern California in providing the oral health benefits of fluoridated drinking water. According to the CDC, the nation's fluoridation percentage is now 69%, up from 62% just a few years ago. California is only 28.7 % fluoridated. Why should our children experience so much tooth decay and higher dental bills than most of the rest of the nation. The largest unfluoridated city in the US is San Diego, and efforts are underway to change that statistic in the near future. I urge the City of Folsom to join the 21st century and fluoridate its water. Funding may be available through the First Five Commission for Sacramento County. Its time to follow the lead of the rest of the country and the scientific community as well as the CDC, ADA, AMA, World Health Organization and every Surgeon General for the last 50 years in urging this community to protect the oral health of its citizens.

David F. Nelson, DDS, MS

Retired Fluoridation Consultant to the State of California

El Dorado Hills, California

Dr. Nelson has his pants twisted in a knot by directing his anger in the wrong direction. The California Dental Association published the article bragging about how they used trickery and stealth to pass the fluoridation law.

No matter how Nelson launders it, California fluoridation money DOES comes from taxpayers' pockets. Nelson said, " There was not one dollar of taxpayer money spent on fluoridation, and there still hasn't been."

However, the First 5 Commission of California "manages" taxpayer revenues obtained from a 50-cent per pack tax on cigarettes and tobacco instituted by a squeaky 50.5% voter approval of California proposition 10 in 1998. Voters didn't know they, in effect, voted in favor of fluoridation since this is the money that is being used to fund fluoridation schemes throughout California.

The San Diego City Council was recently forced to fluoridate its water supply against its will. San Diego has voted twice to reject fluoridation. San Diego residents don't want fluoride added to their drinking water. The First 5 Commission, arriving with an offer that couldn't be refused (money), forced the San Diego City Council to start fluoridating the water supply,. All of a sudden, this "unfunded" mandate Nelson speaks of became a funded mandate taking local control out of the hands of the city residents and their representatives and into the hands of outsiders who ultimately have control because they have money.

Not only is San Diego forced to fluoridate against the wishes of the community and city council but they are liable for any harm fluoridation causes individuals. I watched the proceedings via internet streaming. Neither the The First 5 Commission nor the California Dental Association would indemnify San Diego.

If Nelson, the California Dental Association and the First 5 Commission is so proud of fluoridation and so sure it won't harm anyone, why won't they sign an affidavit guaranteeing that no one will be harmed?

Kudos to Sally Stride for this penetrating article that's backed up with an impressive bibliography.

I find it repulsive the 'trickery' some fluoridation proponents have engaged in, as Stride finds the CDA journal admits.

Retired fluoridation consultant Dr. Nelson appears to be absolutely wrong about his no-taxpayer claim, as Stride indicates.

The tobacco tax-paying consumer is helping to provide many millions of dollars for forced-fluoridation.

And almost entirely without their knowledge, I'd venture to say.

The CA government agency called the First 5 Commission is clearly the (state approved) conduit for huge tobaccoTAX revenues in CA.

Though that tobacco tax was approved by CA voters by the thinnest of margins (1998), the Prop. 10 initiative language gave no clue that this tobacco tax would enable forced-fluoridation programs.

One can reasonably surmise that voters never would have passed Prop 10 if such a clue had been provided.

(Where are the consumer taxpayer watchdogs on this!?)

Let's get real. First 5 is not the real funding source for some fluoridation programs. CA tobacco taxes are!

The commission is merely the state formed "manager" and conduit for those tax-payer funds. Big difference?

And we're talking big bucks-- to the tune of $2.48 Billion in surplus at this time. (source: http://cssrc.us/web/1/firstfive.aspx )

Very simply, my daughter is allergic to fluoride, whether it's in water, at the dentist or in toothpaste. As a result of water fluoridation, her stomach and skin are suffering more now than ever before. Basically, she is being poisoned by the water. The ADA and CDC only states how wonderful fluoride is for our teeth. Not a thing is ever mentioned about what happens when it's ingested. Those with Kidney problems cannot have any kind of fluoridated water whatsoever.

What happens now Mr. Nelson? Can you help my child? Or everyone else in the world who can't ingest fluoride? Or will you tell me I am one of "those anti-fluoridation people?"

With all of the problems with the water these days, why are we adding unnecessary chemicals to it?

Comments by Fluoride Op

First 5 is using taxpayer money to promote fluoridation- (dare I think, MONEY LAUNDERING?) They also work hand in hand with the Calif. Dental Assoc. (CDA) to promote fluoridation (COLLUSION? –between a state agency and a trade organization?), and grant water districts millions on condition that they use it to fluoridate- (BRIBERY?). And let’s not forget the water districts themselves whose Directors order employees to empty the contents of cartons marked with skull and crossbones into our drinking water, fully aware that those contents are known contaminants not certified as safe, and thus causing the water department to also be in blatant violation of federal law.

I’m tired of showing the world calm, crooked smiles that say “We know they are breaking the law, but what can we do? –they are way too powerful”. We repeatedly remind the world that we are a nation of laws, but right now in California we don’t seem to actually believe it. The CDA and First 5 are purely and simply breaking the laws of the land. Let the CDA spread its money far and wide, it can’t change the facts. There is no defense.

Besides, I don’t recall any reports that the Constitution says a state can be governed by a trade organization. California HAS a Legislature and Governor; it also has an enforcer, the Attorney General, who should now ride into our communities on his white horse, brandishing his lawyerly knowledge, personally slap handcuffs on the law breakers and point to the prison door while allowing the paparazzi to happily snap, snap all the way to the klink.

No matter how many official Departments, Commissions, Projects, Safety Codes, Associations, Health Services and Family Centers are used as cover, the fact is both First 5 and the CDA, are breaking the law and the Attorney General, WHOM WE ELECTED, should now ride bravely forth and do his job.

The San Diego City Council was recently forced to fluoridate its water supply against its will.

Thank you Ms. Stride for your statement above. Too bad you are not in CA and involved in the San Diego issue. Were you to actually be here, you would realize the absurdity of your statement. Please share with me the way the "San Diego City Council was recently forced to fluoridate its water supply against its will". Did some nefarious agency or some politician ride into town and declare that San Diego must fluoridate!!! Absolutely not. Were you to reside in CA you would realize that the current mayor and city council of San Diego are highly in favor of fluoridation and wish their citizens to join the rest of large US cities in fluoridating their drinking water. No one, repeat NO ONE, forced the city council to do anything. This is another example of the twisted logic the anti-fluoride folks use to their advantage. If you are aware of someone actually forcing San Diego's City Council to do something against their will, please let me know about it.

Another example of twisted logic is the conspiracy theory that somehow CDA is "breaking the law of the land". Please tell me how they are doing that? I am not aware of any statute that prohibits a well respected health agency from participating in what the CDC calls "One of the most important public health interventions of the 20th Century". I believe that by doing so CDA is fulfilling a noble promise to its membership and to the citizens of the State of California. If you wish to make the point that First Five tobacco tax money is being used in some conspiratorial will to force some innocent city councils to fluoridate that is your right. What I am referring to is General Fund money, the money all of us send to Sacramento when we pay our taxes. Prop 10 (First Five) dollars are monies derived from the sale of tobacco products in each county. That money is pledged to be used for the improvement of the health of California's citizens. I say the oral health benefits of fluoridated water are a great investment. Millions of children in CA will have less pain, miss less school and stay out of our emergency rooms thanks to fluoridation. What a legacy to leave behind!!

For the lady whose daughter is "allergic to fluoride", I am truly sorry if she really is. Have you seen an allergist and had skin testing to confirm this diagnosis? It is a fact that true allergies to fluoride are extremely rare and almost unheard of in the scientific community. I am not saying she is not allergic, but if she is truly allergic to the fluoride ion I would be surprised. With all the noxious substances in our environment thse days its highly unlikely that this is a true case of fluoride allergy.

I have forwarded this message string to the American Dental Association, the American Medical Association, the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). I am in hopes they weigh into this most interesting discussion. Remember, this is American and a healthy debate such as this is our right as citizens. Sometimes we just have to agree to disagree.

David F. Nelson, DDS, MS.

Dr Nelson, you said:

"There was not one dollar of taxpayer money spent on fluoridation, and there still hasn't been."

Do you not see yet that your statement is absolutely INCORRECT?

FACT: First 5 has directed California TOBACCO TAX REVENUES to Sacramento, San Diego, and Santa Monica with the condition they utilize that "grant" money only for fluoridation purposes.

So, isn't THAT "taxpayer money spent on flujoridation???"

Yes or no? Please reply.

Thank you.

Dear facts...If you want to stretch the truth that far and suppose that tobacco tax dollars are the same as direct tax dollars from the General Fund, go for it. I suppose you might consider tobacco tax dollars as direct tax dollars. I dont. When I made that statement I was referring to direct dollars from the General Fund, which in 1995 was the only source of tax dollars. There was no First Five back then when we passed AB 733. There still hasnt been one dollar of general fund monies spent to fluoridate. The law prohibits that. And FYI, Sacramento and Santa Monica have not received one dollar from First Five. I was intimately involved with both cities and they received only California Endowment money. First FIve has only given money to LA County ($20 million) and San Diego ($5.2 million). Sacramento County First Five has set aside over $14 million for fluoridation in Sac County. The city received NO FF money. The law, as written, directs the Dept of Public Health to seek funding for fluoridation and that funding can only come from private foundations, govt grants, or private citizens. We have used the $15 million from the CA Endowment to leverage millions more for prevention from First Five.

Are any of you aware that this state spends almost a billion dollars ($730 Million in 2004) of YOUR tax money to fix the teeth of its underserved children and adults. Would you like to see some of that saved? Maybe First Five realizes that in order to save direct TAXPAYER DOLLARS we must PREVENT dental disease, not treat it after it occurs. Dr. C. Everett Koop, former Surgeon General of the US has said that "fluoridation is the greatest single thing a community can do to protect the oral health of its citizens". I agree with Dr. Koop. Lets not worry about whether the money comes from the General Fund or tobacco tax revenues, lets just agree that, despite the claims of the antifluoride crowd, water fluoridation reduces dental decay by 20-40% in children and adults and is effective in reducing dental decay. CHeck the peer reviewed science on this subject, not the bogus science quoted by the anti-fluoride movement. Just think how many of our precious tax dollars we could save if we fluoridate our water. Remember, its your money and its mine and I want mine spent to PREVENT disease.

David F. Nelson, DDS, MS.

from FolsomFluorideOp

Dentist Nelson says Sacramento has not received one penny from First 5, when he knows perfectly well that they received 6 million dollars from First 5 to fluoridate. If he doesn't know, there is something wrong with his source of information, which calls into question ALL of his statements.

Dr. Nelson:

Taxpayer money is taxpayer money. Indisputable fact.

Yet suddenly, you appear to be trying to morph that into a 'maybe.'

Any stretching of the fact about what is or isn't "taxpayer funds," I believe is demonstrably and singularly your doing-- not mine.

For example, you indicate now that the usage of only "direct" taxpayer funds for fluoridation has been prohibited since the CA Fluoridation Bill of 1995.

You indicate that "indirect" taxpayer money from tobacco tax revenues for fluoridation is different. That it's somehow not prohibited -- in your mind, at least-- for mandated CA community fluoridation programs involving First 5.

If you can, please cite specifically the law -- if there is one-- that validates the significant distinction you've made about "direct -illegal" vs. "indirect-legal" taxpayer funds for mandated fluoridation.

Could you or one of your trusted experts please do that for us?

Next, this aside. You state, "And FYI, Sacramento and Santa Monica have not received one dollar from First Five."

May I suggest we not split more hairs. First 5's check is virtually in the mail or, from all appearances, seems about to be.

As you likely know:

l.) Santa Monica City Council voted on 7/24/08 to accept $1 Million (for starters?) from First 5 LA for "fluoridation equipment improvements."

2.) San Diego CC voted on 6/10/08 to accept $3.9 Million (for 2 years) from First 5 of S.D. County for new F equipment.

3.) For Sacramento County , as you report, $14 Million has been set aside from First 5 for F programs.

That's wonderful. What's the common denominator? Those are all fueled-- or to be fueled-- by TAXPAYER MONEY.

Can we resolve clearly that TAXPAYER- point, directly or indirectly-- so we can all move on?

Dentist Nelson says Sacramento has not received one penny from First 5, when he knows perfectly well that they received 6 million dollars from First 5 to fluoridate. If he doesn't know, there is something wrong with his source of information, which calls into question ALL of his statements.

Dear Fluorideop, no, I dont know "perfectly well" that the City of Sacramento received 6 mil from First Five to fluoridate. I testifed at those city council meetings and Mayor Joe Serna was a huge advocate of fluoridation. In fact, the City of Sac received approximately $1.4 million from the California Endowment to fluoridate its two treatment plants. The COUNTY of Sac has had $14 mil set aside to assist fluoridation of the counties 17 different water purveyors. Maybe you ought to get your facts in order before questioning my "sources of information". Question all my statements if you wish, but the facts dont lie!

David F. Nelson DDS, MS

Dr. Nelson, don't expect the ADA, AMA, WHO CDC or any other group that "supports" fluoridation to come to your aid. The truth is, that's what they have you for. You, Michael Easley, Howard Pollick, Jaynath Kumar and others do the dirty fluoridation work convincing people fluoridation is good with your title and affiliations but without actually studying the science. And that's just how those organizations like it.

Do you believe they would ever send out a fluoridation spokesperson who didn't behave like a PR person. I have no doubt you believe what you are saying; but I also believe you are too lazy or too stubborn to read the opposing literature and to admit you are wrong. Maybe you just want a part bench named after you like Terran Gall.

. People who actually do the fluoride science will not come to the forefront as you people have done to defend fluoridation. They know it's not safe for everyone. They won't say it because they know research funds will dry up, they will be disinvited to "expert panels" maybe even lose their jobs.

The CDC's Dr. William Bailey told the Fairbanks City Council that the CDC does not do original research. We know the AMA just endorsed fluoridation because the ADA asked them to. The ADA has a vested interest in fluoridation and doesn't do original research. The ADA's Pfaffenbarger institute does do research and they have already found that Amorphous Calcium Phosphate works better than fluoride. But they can't sell that idea because the big toothpaste manufacturers have already convinced everyone they need fluoride - and they are never going to back off that big profit industry until they incorporate ACP with the Fluoride and eventually phase out the fluoride.

I was very surprised that Michael Easley was in favor of creating the new Dental Therapist position against the politics of the AMerican Dental Associaiton. I hope he and you realize that the ADA pushes fluoridation because they don't want their member dentists to be mandated to do what legislators need to do - create a law that requires dentists treat more Medicaid and insurance lacking low-income people or else allow other viable groups to do the job.

Dr. Nelson might be a bit stumped about TAXPAYER MONEY vs TOBACCO TAX MONEY.

So, is there another F- promoting expert who can help out-- please? Here goes again:

Q: Dr. Nelson indicates, to my understanding, that "TOBACCO TAX REVENUE MONEY" is legally distinct from "TAXPAYER MONEY"--

and, therefore, while the usage of TAXPAYER MONEY for mandated fluoridation is prohibited by California Bill AB 733, he feels that TOBACCO TAX MONEY is not (implicitly or explicitly) prohibited by that bill (or any other CA law).

DO YOU AGREE?

if YES, please show us THE PROOF.... that is: the brief and quintessential wording in AB 733 (or any other CA state law) that provides reasonable proof for your opinion.

If NO,... ? (huh, is that possible?).

Dear Factsdoc...I presume you can read. Please go online and check out the wording of AB 733. In that law you will read that monies for fluoridation must come from "private foundations or government grants". The law is very specific about that. Remember that was in 1995. The law goes on to say that rate increases will not be permitted to fund local fluoridation. Remember THERE WAS NO TOBACCO TAX REVENUE when that statute was crafted. The law also specifically directs the CA Dept of Health Services to seek funding for the implementation of the bill. As things have moved forward, the CA Tobacco Tax Law ( PRop 10) was created and a hugh windfall of money for improving the health of all Californians was found. The monies derived from Prop 10, renamed First Five, are derived from the tax on tobacco products, NOT FROM TAXPAYERS. Do taxpayers buy tobacco, you bet they do. Does that make them de facto "tax dollars". Not to me. To you, no doubt. I do not intend to argue that point any further with you.

To NYSCOF, how dare you insult me by saying I am "too lazy or too stubborn to read the opposing literature". I can assure you I have read everything referred to as "peer reviewed science" on the anti-fluoride websites. I am familiar with the writings of the chemist who proclaimed that fluoride was not effective. Unfortunatley for him (and he has since passes away) there are over 3,500 PEER REVIEWED scientific articles that prove his premise to be wrong. Like many of the anti fluoridation folks, he had no medical knowledge and was ill equipped to argue the merits of a public health intervention that has been lauded by the CDC as "one of the most important public health accomplishments of the 20th century". Most, if not all, of the literature quoted on those websites would never pass scientific muster, and you know it. So go ahead and sling the mud. By the way, Teran Gall was a close friend of mine and to ridicule his memory like you have done is indicative of the kind of person you are. May God help you. That comment about a park ( not PART) bench was really low class. You should be ashamed of yourself.

PS, I dont expect the ADA, CDC or CDA or WHO to " come to my aid". I am perfectly comfortable standing on the merits of over 60 years of peer reviewed science on this issue.

David F. Nelson

Dear Dr. Nelson...I admire your remaining steadfast. Now to your comment:

<

People who pay taxes are called tax payers. There, now see how easy that was.

Some taxpayers--those paying a 50-cents special tax per pack of cigarettes- unwittingly are helping to pay the tab for CA forced- fluoridation programs. (Fact again.) Prop 10 which barely passed made no disclosure whatsoever that such collected tax funds would be dished out as "grants" to help pay for the state's F-programs. (Repeated again.)

Tax money IS being used to support CA fluoridation programs. Period.

If you feel ethically at ease about all that money & water activity-- pls note I didn't say "chicanery"--then so be it.

(Note: Please excuse my redundancy. It's a trick I've learned from reading government and ADA- sponsored press releases.)

- factsdoc

Correction to my previous comment:

After " Now to your comment,:" the following was accidentally omitted:

<

(posting glitch- try again.)

Correction to my previous comment:

After " Now to your comment,:" the following was accidentally omitted:

"The monies derived from Prop 10 [...] are derived from the tax on tobacco products, NOT FROM TAXPAYERS. Do taxpayers buy tobacco, you bet they do. Does that make them de facto "tax dollars". Not to me. To you, no doubt."

Dr. Nelson - I'm very happy to learn that you believe yourself to be a principled man. But I've been in your presence when you have ridiculed people opposed to fluoridation and

laughed at others making fun of people opposed to fluoridation in public meetings. In fact, you once mis-represented yourself as a specific federal employee which is a federal offense.

There will be a Fluoride Forum in Toronto on August 11 and, while the Ontario Dental Association sent out a news release urging legislators and communities to stand up for fluoridation, they won't do so themselves.

Perhaps you can make yourself available to defend fluoridation because, apparently, no one else will. More info here: http://fluoridealert.org/august.11.html

Nice try Carol...so, we are talking about the infamous Chicago Fluoriation Summit where your anti-fluoride folks put on such a pathetic demostration. It really was humorous. After all your national searching and pleading for money/attendance only about 20 of you showed up in person, not even the chief anti-fluoride dentist David Kennedy. You have NEVER heard me ridicule anyone in public. And NO, I DID NOT misrepresent my self as Kip Duchon. Why would I do that? What would be gained by doing that? Maybe in your mind, but not in fact. You have twisted the facts here very nicely as you continue to twist the facts on fluoridationl. Federal offense, paaaleeesseee. Nice try calling UCSF and the state trying to get me fired. They just laughed at you, as most people do.

I,nor any of my colleagues would think about :"defending fluoride" in Toronto. It doesnt need to be defended. The fact that 69% of the US is fluoridated is defense enough in my mind. Its high time our citizens join the rest of America in enjoying the oral health benefits and decay prevention as afforded by fluoridated water. Why would any of us appear in Toronto and carry on this ridiculous diatribe? That would give you and your colleagues credibility, which you certainly dont deserve. I am tired of this. It was amusing for a few days but I really must get on to more productiive efforts, such as fluoridating San Diego, Los Angeles County, Sacramento County and the City of San Jose. The fluoride coalition will continue to seek new funding to expand water fluoridatiion in California. As I said before, nice try.

Have a nice day.

David F. Nelson, DDS, MS.

Retired fluoridation consultant to the State of California

Dentists Celebrate Fluoridation Where Children Suffer With Cavities

NEW YORK, July 27 2005 -- While Chicago children suffer with dental pain,

limousines delivered dignitaries to a large white tent, ringed with

yellow-shirted security guards, where dentists and others, on

government payrolls, kicked off a four-day 60th birthday party for

water fluoridation replete with ice sculptures, free duffle bags, food

and specially made fluoridated bottled water, on July 13, 2005, in

Chicago's Millennium Park, hosted by the American Dental Association

(ADA) and the U.S. Centers for Disease Control (CDC).

Attendees came, from many states and 7 foreign countries, for

continuing education credits, to learn political fluoridation strategy

and/or for a free trip to Chicago. But first they had to pass through

protesters handing out a timely Washington Post article entitled,

"Professor at Harvard Is Being Investigated -- Fluoride-Cancer Link May

Have Been Hidden," published on July 13, 2005.(1)

Despite sixty years of fluoridation delivered to 2/3 of Americans via

their water supply and 100% via the food supply, the U.S. Surgeon

General declared tooth decay a national epidemic in 2000.

Time and money spent celebrating

fluoridation for four days, including out-of-towners hotel and other

expenses, could have actually filled many cavities in Chicago's poor.

Chicago, fluoridated since 1956, in Illinois where fluoridation is

state-mandated, has a serious dental health problem. Lieutenant

Governor Pat Quinn said, "Dental disease in Illinois students has

reached epidemic proportions," because few dentists take Medicaid or

KidsCare payments. (2) Only one fourth of Chicago dentists accept

patients covered by government-funded insurance because payment is too

low.

According to the Illinois Public Health Department, 38% of 6 to 8-year-

olds and 30% of 15-year-olds live with untreated tooth decay. Despite

fluoridation, 33% of 3-year-olds have cavities.(3)

On July 14, while the ADA celebrated fluoridation as a cavity remedy

for the poor, the ADA also lobbied in Washington against Dental Health

Aide Therapists (DHATs) -- a viable solution for the dentist-neglected

poor.(4)

DHAT's drill, fill and pull rotted teeth in people and places where

dentists won't go. DHAT'S, with advanced dental hygienist degrees, work

successfully in many countries. Studies show their work is as efficient

but less costly then dentists'.

We believe the ADA's main priority is to protect dentist-members

lucrative monopoly And fluoridation campaigns provide

organized dentistry with political viability to get more perks for

dentists from our legislators. Fluoridation does not help the poor.

Eighty percent of dentists refuse Medicaid patients.(5)

and over 100 million Americans lack dental insurance.

There is no evidence that any American is, or ever was, fluoride deficient.

Organized dentistry would rather deliver fluoride than dental-care.

References:

(1) http://www.post-gazette.com/pg/05206/543465.stm

(2) http://www.oralhealthamerica.org/news/042004.html

(3)

http://www.idph.state.il.us/HealthWellness/oralhlth/BurdenDocument.pdf

(4) http://www.ada.org/prof/advocacy/test_dhat.asp

(5) http://silk.nih.gov/public/hck1o...@www.surgeon.fullrpt.pdf