Differences between compulsory fluoridation and compulsory wearing of crash helmets for motorcyclists.

1. I am forced to wear a helmet for my own protection. I am forced to swallow fluoride to benefit someone else - and to take it for life.

2. Helmets are to save from death or serious injury. Fluoridation is not. Nor is caries contagious.

3. Motorcyclists cannot so easily be protected in other ways. There are a number of ways of preventing caries (diet, hygiene, toothpaste, drops).

4. Fluoridation is a medical intervention [Lord Jauncey], and medical ethics generally forbid treatment without permission - for good reason if the medical history is not known. In particular, fluoridation may bring harmful side-effects; crash helmets don't.

For these reasons I do not object to wearing a helmet but do object to being given fluoride.

11.2.00; 5.11.02; 2.2.03.

NOTE. There is an interesting comparison with the fortification of flour with folic acid to prevent neural tube defects. Folic acid, unlike fluoride, is classified as an essential nutrient; it is not in the same toxicity league as fluoride; and flour is probably easier to avoid than tap water. Yet COMA in its Folic Acid and the Prevention of Disease (Department of Health Report on Health and Social Subjects no.50, 2000) takes careful account of the likelihood of harmful effects of possible fortification at certain levels, and even extends this to vitamin B12, of which "there is no formal evidence of toxicity", with the warning that "any exposure of the whole population to levels many times their usual intake or requirements should be considered with particular caution" (F.3.7).

A BMJ editorial (Wharton B, Booth I. Fortification of flour with folic acid. BMJ 2001; 323: 1198-99) pointed up the lack of good science underpinning fortification, the weakness of relying on simple 'before and after' data, the caution expressed in a recent Cochrane review, and the unfavourable comparison with the standard of evidence required for a drug (which "is not given in imprecise doses to all members of the population without choice or indication"), listing 6 steps which any fortification programme should satisfy. The contrast to the official line on fluoridation, where almost identical cautions apply, could hardly be more striking. What is sauce for the vitamin goose is surely sauce for the fluoride gander. Fluoride, however, escapes the usual precautionary hoops and safety criteria.

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