Water Fluoridation: the Arguments

• Fluoridation is important because 5+ million people receive it - more than most medical drugs
• The controversy can't be understood without the history/social history - e.g. whose interests have shaped policy, where power and bias lie in providing information, what pressures may have promoted/inhibited research. Fluoridation was a campaign from the beginning, not a scientific enquiry. It is largely unknown outside the English-speaking world
• Few participants (on either side) are unbiased in this high-octane debate. Almost everyone exaggerates, and selects the evidence that suits their argument
• Fluoridation is a very unusual medical procedure in several respects
• From these peculiarities flow the issues that have to be addressed: environmental, ethical, legal, scientific, technical, cost-effectiveness related
• There are environmental worries because > 99% of fluoridated water misses its target (viz. children's teeth) and goes into the environment. Fluorides are of high toxicity. The Copenhagen Charter discourages countries from discharging toxic chemicals that are not strictly necessary
• Medical ethics, reinforced in the Patients Charter and the European Biomedicine Convention, include the basic principle of individual 'informed consent' to treatment. Fluoridation (alone) breaches this principle, so that other people can decide to medicate you
• Fluoride's legal status is uncertain. It comes within the Poisons Act 1972; it also falls within the European definition of a medicine, yet the MCA declines to treat it as such, bypassing the usual scientific hurdles of drug registration
• The first ever thorough, systematic, transparent, even-handed, and scientifically defensible review of the evidence (conducted in 2000: the 'York review') showed the limited evidence for fluoride's effectiveness to be of 'moderate' quality, i.e. it is probably effective [but not to the standard required of a licensed prescription drug]. Most of the rest of the evidence was too poor for either danger or safety to be demonstrated
• Since the York report the fluoridation lobby has continued to press for more schemes, pronouncing themselves satisfied that fluoride is safe and effective. 3 subsequent UK reports have downplayed or misquoted what the York reviewers found. Almost no one has been prepared to alter previously held beliefs

Back to the Archive index.