Fluoride Action Network

British Lord Criticizes Dental Authorities for Misinforming Public about York Review

House of Lords | 2000

Note: The following transcript can be accessed at http://www.parliament.uk/

House of Lords Debate on the Queen’s Speech:

Earl Baldwin’s statement, 13-12-2000.

Earl Baldwin of Bewdley: 6.35 p.m. 13 Dec 2000 : Column 427…… I turn lastly to the vexed matter of water fluoridation. In the 1999 White Paper, Saving Lives: Our Healthier Nation, the Government announced that they were setting in motion an

“up-to-date expert scientific review of fluoride and health”.

Possible legislation was foreshadowed. Partly because of the many questions I had tabled on this topic, and the debate in my name in December 1998, I found myself on the advisory board to the review team at the NHS Centre for Reviews and Dissemination at York, in close contact with the scientific process from the summer of 1999 to the publication of the final report on 6th October this year.

The expectation of the dental and medical authorities, and it is fair to say of the Government also, was that the safety and effectiveness of fluoridation would be confirmed. That expectation was disappointed. In addressing the five principal questions that were asked, the report is studded with phrases such as “limited quantity”, “moderate quality”, “a small number of studies”, “needs further clarification”, “surprising to find that little high quality research has been undertaken”, “insufficient quality to allow confident statements”, “not…enough good quality evidence…to reach conclusions”. Important gaps in the evidence base were identified.

I pay tribute to the Government for having agreed to institute a high-quality scientific review–the first and only systematic, that is unbiased, assessment of the evidence in half a century of water fluoridation. I pay tribute to them for now taking steps, through the Medical Research Council, to put some much-needed research in hand, not before time. I cannot, however, pay tribute to the dental lobby in the aftermath of the York report.

I am aware that many of your Lordships have had briefings from the British Dental Association, the British Fluoridation Society and/or the National Association for Equity in Dental Health. I am aware, as we all are, that briefings by professional bodies, including professors of dentistry, carry weight with the public, are likely to be believed and therefore bear a particular responsibility for accuracy. These briefings and press releases are little short of extraordinary.

I have collated four pages of statements culled from these documents, with alongside them for comparison quotations from the text of the report itself. I can give the flavour of them in two or three short examples. I have placed copies in the Library for those who would like to read more.

The British Dental Association says,

“The report confirms that there is clear evidence that fluoridation reduces [decay]”;

the report says,

“To have clear confidence in the ability to answer [this] question…the quality of the evidence would need to be higher”.

Column 428

The British Dental Association says,

“There is no evidence that…fluoridation is linked to cancer, bone disease or any other adverse effect”; and, “The report confirms that fluoridation reduces dental health inequalities”;

the report says,

“The research evidence is of insufficient quality to allow confident statements about other potential harms [than dental fluorosis] or whether there is an impact on social inequalities”.

The British Fluoridation Society says,

“If there were any adverse effects…it is inconceivable that the York review would have missed them”;

the York review says,

“Some possible adverse effects…may take years to develop and so…the relationship may go undetected”, and, “High quality research [into adverse effects]…is needed”.

One might have thought, if one did not know that fluoridation had been an article of dental faith for fifty years, that this was simply carelessness. Such a thought is dispelled when one finds a wrong figure quoted for seriously mottled teeth, which could only be cited by the author having read, and misinterpreted, some of the very small print.

This is an important public health issue. It is not the Government who are likely to be misled by such inaccurate statements–at least I hope not–so much as local councils, the public and, dare I say it, Members of Parliament, who have even been urged to put down Questions on this false basis. It is essential to put the record straight. Anyone in doubt about the facts should, as always, go to primary sources. The York report is a long one, but the summary and conclusions are only four pages each and are not hard to understand. I would urge any noble Lord who is thinking of tabling Questions not to rely on briefings, whether from dentists or opponents, but to go to the report itself.

Because I am known to oppose the fluoridation of water, I have taken the greatest care to keep in step with the leading scientists at York and to write and say nothing in interpretation of their report which goes beyond the evidence. I have the permission of Professor Sheldon, the founding director of the NHS Centre for Reviews and Dissemination at York, who chaired the advisory board which oversaw the whole review process, to quote him as follows.

“It is particularly worrying…that statements which mislead the public about the review’s findings have been made in press releases and briefings by the British Dental Association, the National Alliance for Equity in Dental Health and the British Fluoridation Society. I should like to correct some of these errors”.

He continues:

“1. Whilst there is evidence that water fluoridation is effective at reducing caries, the quality of the studies was generally moderate and the size of the estimated benefit, only of the order of 15%, is far from ‘massive’.

“2. The review found water fluoridation to be significantly associated with high levels of dental fluorosis, which was not characterised as just a ‘cosmetic issue’.

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“3. The review did not show water fluoridation to be safe. The quality of the research was too poor to establish with confidence whether or not there are potentially important adverse effects in addition to the high levels of fluorosis. The report recommended that more research was needed.

“4. There was little evidence to show that water fluoridation has reduced social inequalities in dental health”.

I shall skip most of what follows and just give Professor Sheldon’s final point. He states:

“The review team was surprised that in spite of the large number of studies carried out over several decades there is a dearth of reliable evidence with which to inform policy. Until high quality studies are undertaken…there will continue to be legitimate scientific controversy over the likely effects and costs of water fluoridation”.

My only questions to the Minister, in the light of the state of the evidence as set out by one of the two principal scientists involved in the review and of these extraordinary briefing papers, are whether the Government still think it appropriate, first, to go on making financial contributions to the British Fluoridation Society, and, secondly, to encourage certain health authorities, as they have said that they would, to consider water fluoridation schemes. The noble Lord would also do me a good turn if he could secure for me a reply from his colleague the Secretary of State to the personal letter I wrote to him on this matter on 5th August, repeated on 7th October, and reminded again on 14th November. With fluoridation, things tend to take a long time.

Lord Colwyn:8.47 p.m. Column 459-460 (i.e. much later)

Perhaps I may touch briefly on fluoridation. I am well aware that the noble Earl, Lord Baldwin, will have given an opposite view to mine. The recent York Review has confirmed that fluoridation is safe and effective in reducing levels of tooth decay and is essential in the fight to reduce inequalities in dental health. The Government have announced that they will be,

“encouraging health authorities with particular dental health problems to consider fluoridating their water as part of their overall health strategy”.

In recent years more than 50 health authorities with particular dental health problems have persistently attempted to implement water fluoridation. They have conducted extensive publicity and consultation exercises and have demonstrated substantial public and local authority support. Despite that, each health authority has had its request for fluoridation refused by its water supplier. Can the Minister confirm the Government’s White Paper commitment to introduce a legal obligation on water companies to fluoridate where there is strong local support for doing so and give the dental profession an absolute assurance that this policy will be implemented?