Dear All,

Finally the Fluoridation Forum report is out (September 10, 2002) and can be found at http://www.doh.ie/publications/fluoridation.html.

As expected they flunked my test. I had presented to the Forum (in person) my “50 Reasons to Oppose Fluoridation” and argued that the way they could demonstrate to me and the Irish people that they were going to undertake a genuine and objective overview of the fluoridation issue, was to provide a written and referenced response to them.

In the beginning it looked promising as they set up a sub-committee to undertake this task and for a while they made noises that sounded as if they were actually doing it. Then after ten months they claimed that they didn’t have time to complete the task!

The following quote is the only response (I think!) that I have got for my efforts. It comes in the sub-section entitled “Presentations and Submissions” in the opening “Contents” section. It reads as follows:

“One presenter requested a response to his submission and the response of the Forum to this request will be presented on the Forum website. The final Forum Report has taken account of the issues raised in this submission.”

Well wasn’t that worth a two year wait!

The final Report certainly HAS NOT taken into account my submission. In my 30 minute oral presentation to the Forum among other issues I spent a considerable time going through the latest hip fracture study by Li et al which was unpublished at the time but has been since. Li et al (2001) had compared hip fracture rates in the elderly among six Chinese villages in which the well water ranged from 0.25 ppm to 8 ppm fluoride. Comparing the hip fracture rates with the rate for the village at 1 ppm, the study showed a doubling of hip fracture rates above 1.45 ppm (which was not statistically significant) and a tripling of hip fracture rates above 4.5 ppm (which was statistically significant). This dose-response result strengthened this finding and underlines what a very small safety margin there is for this serious outcome 1.5 -4.5).

The Forum has made no response to this important finding.

I also spent some time explaining Dr. Jennifer Luke’s work, in which she showed that fluoride accumulated in the human pineal gland to very high concentrations, because like the bone and the teeth it is a calcifying tissue. She also showed in animal studies that fluoride lowered melatonin levels (the hormone produced by the pineal gland) and shortened the time to puberty. The human accumulation study has since been published (Luke, 2001).

The Forum has made no response to this extremely important finding.

Much of their report is a rehashing of other reviews, i.e. very little independent analysis. I will be preparing a more thorough critique of this report, when I have had time to wade through all the padding. Suffice it here to add two things I spotted from a preliminary scan of their report.

1) They claim that 39 countries worldwide fluoridate their water. Mr Martin should be asked in the Irish parliament to name those 39 countries. Now this should be a very simple task – 39 names! I doubt very much that Mr. Martin will be able to make it to 20 without giving countries where only one town is fluoridated. As I say this is a very simple task, but if it can be shown that the people who have put this report together can’t count, it goes a long way to explain how poor the rest of their work has been.

2) They tell us that a tolerable daily intake (TDI) for fluoride for adults (actually anyone above 8 years of age) is 10 milligrams of fluoride per kilogram bodyweight per day (10 mg/kg/day). This figure is ridiculously high. For a person weighing 60 kilograms this would amount to 600 mg per day. That is enough to cause them very serious damage. Clearly what has happened here is that they have got their units scrambled. They meant 10 mg per day, not 10 mg/kg/day. Even that is actually far too high. It most certainly would damage bones with lifetime exposure. What is disturbing about this mistake, is that it was made at least twice. Somebody who knows anything about fluoride’s toxicity would have spotted it immediately. Didn’t a toxicologist proof-read this report before it was printed?

Below we have printed a statement from Mr Michael Martin, the Minister of Health and Children; press reports from the Irish Times and The Irish Examiner, and a short section of the report entitled “The Ethical and Legal Dimension” . When you read the latter, it might might make you laugh or pull your hair out. Brace yourself!.

Paul Connett.

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Minister Martin Launches the Report of the Forum on Fluoridation
10 September 2002

The Minister for Health and Children, Mr. Micheál Martin, TD, today (10th of September, 2002) launched the final Report of the Forum on Fluoridation. The Minister established the Forum in May 2000 to independently review the fluoridation of public piped water supplies and the programme of research being undertaken on behalf of health boards in the area and to make recommendations to the Minister.

The Minister welcomed the Forum´s Report and said “It set out to examine scientific evidence for and against water fluoridation: to look at the best available recognized scientific evidence. That scientific evidence – not anecdotal evidence – led to the primary conclusion of the forum: that there are no adverse health effects of water fluoridation at the maximum permitted legal level.

Fluoridation is a public health measure. A public health measure good for the oral health of all age groups and sections of society. It´s effective in reducing dental decay. We´ve got 40 years of documented support for that.

The safety and effectiveness of water fluoridation has also been endorsed by a number of international and reputable bodies such as the World Health Organisation, the Centre for Disease Control and Prevention, the United States Public Health Service and the United States Surgeon General.”

The Forum was comprised largely of persons with expert knowledge from a diverse range of backgrounds such as public health, dental health, food safety, environmental protection, ethics, water quality, health promotion and representatives from the consumer and environmental areas.

The Minister also said “The Forum took a participatory and evidence based approach striving to ensure balance between participants from both sides of the debate on water Fluoridation. And it went out of its way to engage those opposed to water fluoridation.

On an issue that creates strong feelings, it´s vital to have responsible and measured debate wholly based on fact and evidence. Thanks to this Report, future debate on this issue can be based on data published in scientific literature and subjected to minute scrutiny for accuracy and validation, and we can avoid the invalid currency of assumptions and hearsay.

This forum has demanded scientific proof for every opinion expressed to it, and as a result has produced a credible and valuable report.”

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The Ethical and Legal Dimension

While the members of the Forum considered that a detailed treatment of ethical and legal considerations arising from the fluoridation of public drinking water supplies lay outside its remit, they were nonetheless concerned from the outset that such matters should be addressed in the Forum Report, even if only briefly. This position was reinforced considerably by the many submissions received in the public consultation exercise, in which such questions were raised. Accordingly, a Sub-Group was established to consider the ethical and legal dimension.

This is a field which is both wide and complex and thus does not lend itself to summarisation. The Forum heard two major presentations on these topics from a member expert in this area, and these were invaluable to those considering this topic. The Forum came to the view that rather than attempt to précis the presentations, and thereby run the risk of distortion occurring, they should be included in full as one of the Appendices to the Report.

The reader of this Executive Summary will therefore appreciate that it is even more impractical to treat these complex issues briefly here. However, as the Sub-Group consulted an expert in ethical matters and posed three key questions, it may be useful to quote both questions and answers received, with the proviso that to see the complete picture as it appeared to the Forum it is essential that reference be made to both Chapter 13 and Appendices 16 and 17 of the Report.

Question 1 Does the addition of fluoride to drinking water pose any particular ethical problem?

Answer

Even though fluoride is in piped water, there is still an element of choice. People can choose not to drink tap water.

Admittedly the choice is not an easy one, and if the State were concerned about real choice, then consideration would have to be given to supplying an alternative source of water.

Question 2 What about the breaching of bodily integrity and interference with autonomy?

Answer

The addition of fluoride to the water supply is a paternalistic intervention by the State to safeguard the dental health of its citizens. Health in general is seen as an area where paternalistic State intervention is justifiable, and in terms of oral health, the poor dietary habits of the Irish people could be seen as a justification for taking a paternalistic approach. The State makes other interventions which could be seen to breach bodily (and mental integrity) in a much more serious manner, e.g. education. Therefore, the degree of infringement of bodily integrity by fluoridation is relatively minor.

However, if more weight were to be given to autonomy, then a programme of oral health education could be introduced in conjunction with fluoridation, until the education alone could take over.

Question 3 What about the area of uncertainty in science, where it can never be stated categorically that something is completely safe?

Answer

Then it comes down to risk versus benefit. Does the benefit outweigh the risk sufficiently to allow that risk to be tolerated? If the precautionary principle were always followed, then nothing would ever be done. From an ethical viewpoint, risk can be justified if the benefit significantly outweighs the risk.

The above is very much a capsule summary of extremely broad questions. However, the reader should note that the expert who replied to the key questions supplemented his replies with a valuable commentary, which is treated in Chapter 13 of the Report.

Finally, it may be remarked that while this is an area where considerations are often contradictory, and do not lend themselves to definitive statements, on balance, the net position is that the practice of fluoridation – when carried on in accordance with current practice in oral and general health – does not breach ethical or legislative principles.

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The Irish Times
September 11, 2002
Minister defends fluoridation of public water as ‘safe’ health policy

The Minister for Health, Mr Martin, has defended th fluoridation of public water supplies in the State as a ‘safe and effective’ public health policy following the publication of a report which endorses it.

The Forum on Fluoridation, which Mr Martin set up two years ago, concluded in a report published yesterday that fluoridation was ‘harmless to health’ and had been ‘very effective in improving the oral health’ of children and adults in Ireland.

But the report was immediately condemned by the Green Party TD, Mr John Gormley, as a ‘whitewash’. He said the Greens would be introducing private members’ legislation in the Dail to ban the addition of fluoride – a toxic chemical – to water supplies.

Mr Robert Pocock, of the VOICE environmental group, also attacked the forum’s principal finding. It was based on ‘no new scientific research’, even though a review two years ago by the British National Health Service had found ‘a dearth of reliable evidence’.

During the course of 14 sessions, the forum heard presentations from seven Irish and seven overseas experts, mainly those who favoured fluoridation – though it says it was ‘difficult to find or engage people to put the anti-fluoridation point of view’.

Responses to a questionnaire were firmly against fluoridation. Almost 50 per cent of respondents claimed not to use fluoride toothpaste, though it accounts for 95 per cent of the market. ‘This gives an indication of the level of bias,’ it said.

Worldwide, 39 countries add fluoride to their public water supplies and over 300 million people consume fluoridated water. Fluoridation is being introduced on a mandatory basis in South Africa, though it is being ceased in Finland and eastern Germany.

The report noted that dental decay levels were comparable in the Republic and Northern Ireland before the mandatory introduction of fluoridation in 1964. Since then, there had been a large drop in the Republic compared to the ‘unfluoridated’ North.

However, it also found that dental fluorosis is increasing in the South and, while recommending that water fluoridation should continue as a public health measure, the level of fluoride should be reduced from one part per million to 0.7 parts per million.

It recommended amending the Fluoridation of Water Supplies Regulations to reflect modern monitoring and analytical technologies and international quality specifications as well as setting up a permanent expert body to advise the Minister.

While endorsing the continued use of fluoride toothpaste as an additive, the forum said children under two years of age should use water only and those aged between two and seven should use only a ‘pea-sized’ amount of fluoride toothpaste.

It said all products containing fluoride should be so labelled as well as giving clear instructions for use, particularly for children. This should be accompanied by a public education and information campaign as well as further research to collect data on fluoride.

Reacting to the report, the Dental Health Foundation also called for the development of ‘an effective and sustained public information campaign, aimed at the parents of young children, about the proper use of fluoride toothpastes for under-sevens’.

Ms Deirdre Sadlier, the foundation’s executive director, said the public did not appear aware of the difficulties posed by inappropriate tooth brushing, ‘in particular the dangers to children of ingesting excessive levels of fluoride’.

Ms Sadlier said the development of dental care services for children under five needed to be addressed as a ‘key priority’.

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The Irish Examiner.
Upgrades needed ‘to control fluoride’
The Irish Examiner 11 Sep 2002
By Caroline O’Doherty

FLUORIDATION of some public water supplies may have to stop until plants and technology are upgraded to properly control the amounts of fluoride added. The Government’s Fluoridation Forum, which presented its final report yesterday, has also called for a one-third reduction in the amount of fluoride added in all existing fluoridated supplies.

It says of the 74% of the population involuntarily compulsorily connected to fluoridated water supplies: “If the State were concerned about real choice, then consideration would have to be given to supplying an alternative source of water.”

The Forum concluded, however, that fluoridation has been “very effective” in reducing tooth decay in Ireland and it says the policy of adding fluoride should continue. While it notes an increase in dental fluorosis (staining of teeth due to excess fluoride), it says this is primarily due to excessive use of fluoride toothpaste by children.

It has called for a range of measures to prevent inappropriate use of toothpaste and other fluoride products among youngsters including educating parents that children under two should not use fluoride toothpaste and that those aged two to seven year olds should use only a pea-sized amount.

The Forum, which received over 1,000 submissions from members of the public, spent the last two years reviewing the State’s fluoridation policy. Its key recommendations are:

* Amount of added fluoride in water should be reduced from one part per million to between 0.6 and 0.8 of a part per million.

* Products containing fluoride to be better labelled and carry clearer instructions for use.

* Child-proof containers to be used for mouth rinses and certain other products containing fluoride.

* Research into fluoride to continue and be expanded and properly funded.

* Regional public meetings to be held to address public questions and concerns about fluoridation.

* Better measuring and ongoing monitoring of fluoride levels in water with external audits of fluoridation plants.

The Forum says technical problems in some smaller water treatment plants are giving rise to difficulties in maintaining the optimum level of fluoride. “To avoid the risk of over-exposure, it may be necessary to suspend fluoridation of some small public water supplies,” it concludes.

The report was welcomed by Minister for Health, Miche·l Martin, who said it provided detailed, scientific support for the continued use of fluoride in water supplies. He acknowledged it was an issue that “created strong feelings” but said fluoridation was essential in a country which was among the world’s top three consumers of sweets.

The environmental group VOICE (Voice of Irish Concern for the Environment) criticised the Forum’s findings, however, and accused it of displaying a “State knows best” attitude. It said people had the right to make up their own minds whether or not they wished to consume fluoride.

Disability rights campaigner Kathy Sinnott said children with autism and related bowel problems, and other people with certain medical conditions, were particularly vulnerable to chemicals in water and should not have to consume fluoridated supplies.

She called for the existing State grant for installation of a water supply in houses without an existing or acceptable supply should be extended to all households who wished to provide themselves with an alternative supply