Florida Surgeon General Joseph Ladapo issued guidance Friday against adding fluoride to drinking water in the Sunshine State because of its negative neurodevelopmental effects on children exposed during pregnancy.

“It is public health malpractice, with the information we have now, to continue adding fluoride to water systems in Florida,” said Ladapo at a press conference Friday morning.

Fluoride has been added to public drinking water in the United States since the mid-1940s for oral health and cavity prevention, according to the National Institute of Dental and Craniofacial Research, part of the National Institutes of Health.

However, several recent studies on fluoride exposure conducted in Mexico and Canada, cited in the Florida Health Department guidance, found that prenatal fluoride exposure was associated with lower IQ in both girls and boys. High prenatal fluoride exposure was also found to be associated with an increased incidence of ADHD.

In August, the Department of Health and Human Services National Toxicology Program report evaluated fluoride exposure from all sources, including drinking water, highlighting the concern that fluoride intake for pregnant women and children may exceed safe standards.

Current standards recommend 0.7 milligrams of fluoride per liter, and there is currently insufficient data to determine if fluoride levels lower than this recommendation pose any health risks. However, the HHS report concluded that there is “moderate confidence in the scientific evidence” that shows an association between higher levels of fluoride and lower IQ in children.

In September, a U.S. District Court ruled, based upon the HHS report, that community water with fluoride levels at 0.7 milligrams per liter presents an “unreasonable risk of injury to health” and that the Environmental Protection Agency must review current standards.

The matter of fluoride in drinking water has drawn significant attention in recent weeks, particularly because of the scrutiny over President-elect Donald Trump’s nominee for HHS secretary, Robert F. Kennedy Jr. 

Recommending the removal of fluoride from drinking water has been a key component of Kennedy’s “Make America Healthy Again” agenda, along with removing other chemicals from the American diet and changing recommendations for childhood vaccinations.

Ashley Malin, an epidemiology professor at the University of Florida, addressed reporters at the press conference, with Ladapo saying fluoridation policy should not be politicized.

“Although this issue has been politicized recently, I really don’t view this as a political issue,” said Malin. “I view this as a human rights issue and a public health issue, and one that is separate from other public health issues that are currently being highlighted in the media and political sphere.”

Malin, who has been researching the effects of fluoride exposure for over 10 years, said multiple comprehensive studies in recent years have shown that “chronic, relatively low prenatal fluoride exposure are associated with poorer neurodevelopmental outcomes, including reduced IQ, more symptoms of ADHD, and declines in executive function.”

Ladapo, like Kennedy, has drawn significant criticism for his skepticism of vaccines. He was supported by Gov. Ron DeSantis (R-Fl) and others as a possible HHS secretary for Trump prior to the announcement about Kennedy. As of Friday afternoon, Trump had not yet named his pick for the national surgeon general position.

Ladapo told reporters Friday that he has, in the past, supported water fluoridation as “something we learned in medical school” but has changed his position in light of this new evidence.

“In my family, we’ve pulled back in terms of sources of fluoride because we’re concerned about the effects in adults also,” said Ladapo. “There’s less research there, but my sense is that research will also show adverse effects. That remains to be seen.”

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The official recommendations and the HHS toxicology report state that there are trace amounts of fluoride in public water, water-added foods and beverages, teas, toothpaste, dental floss, and mouthwash. 

Approximately 70% of communities in Florida and 75% on average nationwide have a water fluoridation program.