Some objections to fluoridation (...continued)

Environmental

Fluoride is toxic at low doses, as textbooks describe. Pollution by fluorides and subsequent litigation were the spur for US industry-sponsored research in the 1930s which led to their introduction into drinking water as an anti-caries measure (the US Environmental Protection Agency has described fluoridation as "an ideal environmental solution to a long-standing problem"). Most mains water by-passes mouths and stomachs on its way to the wider environment. The EU now discourages the use of unnecessary chemicals because of their possible environmental consequences. At least one country (Denmark) has rejected fluoridation because too little is known about its effects on the environment.

Ethical

The right to refuse treatment is accepted as fundamental in a free society, and has been enshrined in human rights legislation, the Patient's Charter and elsewhere. There is thus a moral imperative on a Government (whether or not it sees itself as legally bound) which can possibly be lifted only in cases of national emergency, and/or highly infectious and/or life-threatening epidemics.

Lacking any of these features, fluoridation is unprecedented in its imposition by majority vote on a population-wide basis, on many (e.g. the edentulous) for whom no risk/benefit ratio applies since they cannot possibly benefit, none of whose medical histories is known, and for a lifetime's exposure.

As a matter of policy Governments are generally wary of overstressing health and lifestyle advice for fear of appearing to 'nanny'. In this context fluoridation, as a forcible measure, is again unprecedented. Not even (targeted) vaccination is compulsory.

Legal

Apart from human rights, there is a serious question why fluoridation has been allowed to escape the usual demands of medicines law. The arguments of the Medicines and Healthcare products Regulatory Agency are far from convincing in this, as the provisions of European Directives and case law appear to rule out any other interpretation. The Government may be open to challenge.

Alternatively, sodium silicofluoride being a registered poison under the Poisons Act 1972, it is questionable whether poisons legislation is being properly observed.

Scientific

The first question to ask is: How strong does the evidence have to be to support a health measure which is imposed on populations, many of whom cannot benefit from it - as distinct from a drug prescribed one-to-one with knowledge of the patient's history, or a medicine bought over the counter? It has only to be asked to be answered: the highest standards of proof available to medical science are needed, for very obvious reasons of public safety and (cost-)effectiveness.

There has been one reliable, high-quality scientific exercise in half a century of fluoridation, the systematic review conducted in 2000 by the NHS Centre for Reviews & Dissemination at the University of York. This shows the evidence across all the areas examined to fall a long way below the standards needed even for a licensed drug, let alone for a mass public health measure. Once again, fluoridation occupies an unprecedented position. Because there has been general difficulty in accepting the findings which have overturned previous beliefs on the subject (cp. the recent findings on HRT and ß carotene), two open letters are appended in which the senior author of the York report and his independent scientist colleagues correct the major misrepresentations that still abound.

Later the York NHS CRD placed a similar correction on its website at www.york.ac.uk/inst/crd/fluoridnew.htm.

Cost-effectiveness

There are unanswered questions about efficiency of delivery in the light of estimates that less than 1% of mains water reaches the teeth of the target population of growing children. The expense to industries that have to remove fluoride from water is as yet uncosted.

Technical

Corrosion problems with the fluorides used in fluoridation schemes can be severe. Care must also be taken over the concentration in view of fluoride's narrow therapeutic window.

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