(05/01/16) A summary of 'Cochrane Collaboration systematic review of water fluoridation 2015' has been posted in Reports.
(16/04/14) A critique of 'One in a Million: The Facts' has been posted in Reports.
(16/04/14) 'Fluoridation: Popularity' has been posted in the Archive.
(18/04/10) New fluoridation scheme for Southampton
(18/04/10) The Reports and Archive sections have been updated with further documents and links
(11/07/09) A critique of Prof. Newton's report to South Central SHA has been posted in Reports.
(28/09/08) A critique of the South Central Strategic Health Authority Consultation Paper on Water Fluoridation in Southampton, has been posted in Reports.
(07/09/08) A response to the Chief Dental Officer's 'Dear Colleague' letter of guidance for new schemes, endorsed by scientists from the York review, has been posted in Reports.
(23/06/08) Isle of Man has announced on 12th June that it will not be fluoridating its water supply
Letter to Stephen Hesford MP
19th January 2003
Thank you for the information about your All-Party Group's enquiry into fluoridation.
I didn't mean to cause offence in setting out my concerns on paper, or to imply that the conduct of the enquiry was anything other than your Group's proper responsibility. On independence, I only hoped that any outside advice you took on participants or assessment of evidence would come from neither of the entrenched wings of the argument (e.g. the BDA or the NPWA), or else (as with the York review) from both equally. In the absence of any reliable information on what it was about, apart from the surprising telephone invitation to contribute from the British Dental Association, I felt I had to take the initiative in finding things out if I was going to be able to decide whether to take part.
Although keen to contribute further to the fluoridation debate, I have come to the reluctant conclusion that I would not in this case help the cause of the advancement of knowledge and policy on the subject by participating. While it is normally right to contribute, there are times when the exercise appears so flawed as to make any input valueless or counter-productive. For the following reasons I think this is one of those occasions.
1. Basically I think you are sending a boy to do a man's job. Fluoridation in all its facets and disagreements (ethical; philosophical; environmental; scientific; technical; financial) is too complex for an All-Party Group to take on, however well resourced and organised.
2. I don't have the impression that this is well organised. As Secretary you were unaware that the BDA was involved in inviting witnesses. There has been no written information about the enquiry. An All-Party Group of which I'm an officer tried your registered secretariat for news, and drew blank. The structure is unclear. The timescale is much too short: by the time I was able to get a full enough picture of what was involved it was only a week before your sessions began, which is not enough for the preparation of good evidence.
3. Most important, there exists a discrepancy between York and the MRC on such fundamental questions as whether the effectiveness of fluoridation is established, whether we need more good evidence about safety, and - a particular plank of the Government's - whether it evens out dental health inequalities. (I sent the enclosed letter of 11th December by the four distinguished independent scientists from York to Howard Stoate earlier in the week.) This cannot be fairly resolved by giving a slot to one of the parties, and expecting the other to find out about the enquiry at short notice and take pot luck on a day which may turn out to be inappropriate and crowded with other speakers. Your suggestion when we spoke that I could line up colleagues from York is surely not appropriate: it is not my job, and I have neither time nor secretarial resources to do so. To a potential participator the process appears altogether too haphazard to ensure the good evidence that the topic calls for.
4. To press the point a bit further, 'best evidence' on the current state of the science comes from York, because of the kind of review it was. A good judge who can confirm this is Sir Iain Chalmers, until recently head of the UK Cochrane Centre (for evidence-based medicine), who served on the York review and was also invited by the MRC working party but could not participate. Significantly, both the Chief Medical Officer and the Minister in the Lords have given me assurances that the MRC report would not be used to detract from York's findings (Hansard 19th November 2002). As the evidence base considered by the two bodies was all but identical, the fact that the MRC came later is not the crucial issue; but of course they could quite well have shared a platform with York. Since there are differences at a high level about what York actually said, and not just about its interpetation, it is asking a lot of Members to get the answers right if they have invited only one side to appear before them.
5. I don't know how many of the key players who harbour serious doubts about the science underpinning fluoridation will be able to make it to your enquiry, but I suspect that because it has been made more difficult for them to present evidence than it has for the dental associations and the MRC who were alerted in good time, few who understand the scientific isssues may appear. They may consider, as I do, that even if they can attend it will lend a legitimacy to the conclusions which is not warranted.
I do not write this out of pique, but out of long study of the past history of the fluoridation controversy where rigour has been absent and selective presentation from both sides the norm.
Since I first began the parliamentary questioning which led to the setting up of the York review, in which I participated, I have taken my stand on good evidence and good science. Where I feel this is compromised beyond repair, I prefer not to be involved. There has been a useful illustration of what can happen when second or third-rate evidence is relied on, in the case of HRT which has been in the news. I enclose as background two recent articles about this from the BMJ, showing how when top-class methodology is applied, previous understandings on effectiveness and safety can be overturned. The writer speaks of "the difficulty of coming to terms with unexpected new evidence and of relinquishing entrenched beliefs", and of the "damage control" that can result. These are what we have seen since York reported two years ago; but I would be surprised if much of this will come across in your enquiry as it is set up. Having said this, there are of course major areas of congruence too between York and the MRC.
I have much to say on the ethical, philosophical and environmental aspects of fluoridation, and evidence (including scientific) from other countries is instructive here. This is not something that, for example, tends to feature in dental or medical association briefings, so it does not reach a wide public. But again, I do not believe this is the place to say it, since you do not provide the time or structure in two short evenings, after the MRC, in which it can be developed and tested, nor do you have the scope to investigate why, to give one example, Denmark decided against fluoridation on environmental grounds. I am sorry this is so long, but I needed to explain the reasons for the unusual position of declining to help the enquiry. Since, however, in raising my concerns I have already put some material on paper to you and Howard, and you told me you were thinking of putting my previous letter in as Written Evidence, I would be happy with this in principle. I think it would be important to submit:
(a) this letter & my letter of 13th to Howard; in addition, of the papers I sent him
(b) the letter from the four York scientists dated 11th December 2002;
(c) the open letter from Professor Sheldon at York dated 3rd January 2001;
(d) my longer critique of the MRC report dated 27th September 2002, which has been fully endorsed by Professors Kleijnen and Sheldon at York. I also have a letter from Prof. Kleijnen in which he deals with some of the MRC's misapprehensions where they departed from York's findings, but it is not in the public domain and you would really need to have heard evidence from him on that.
If you think your Members would be interested in the two BMJ articles as an indication of the dangers of relying on second-best evidence, particularly in a public health measure for which it might be thought the scientific case should be stronger than for individual-level interventions like HRT and carotene, then these could be circulated too. I doubt whether my letter and enclosure of 6th January setting out the background concerns would actually add to the above, unless you wanted to include the latter.
I am copying this to the three Chairs of your Group, and may circulate it more widely if it seems appropriate later.