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In Reply: My Editorial argued that, given limitations in design in the studies by Bellinger et al¹ and DeRouen et al,² it was unscientific to assume a no-effect conclusion. The limitations were statistical power too low to find a relatively small harmful effect, follow-up too brief, and nondifferential errors in exposure measurement that would lead to a null bias. Neither Dr Ismail nor Dr Fung and colleagues addressed these criticisms.

Ismail states that neurobehavioral deficits in dental professionals have nothing to do with dental fillings and dismisses my mention of the possible effects of amalgam in the aging brain. The findings of neurological deficits in dental professionals were offered in evidence of the neurotoxicity of amalgam, whatever the source. Both trials^1-2 followed up patients for a relatively short period. The potential effects of fetal toxicant exposure on neural function later in life is a subject gathering considerable attention. To accept . . . [Full Text of this Article]

Herbert L. Needleman, MD
hlnlead@pitt.edu
Department of Psychiatry
University of Pittsburgh School of Medicine
Pittsburgh, Pa

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