Parliament of Victoria
Mr KAVANAGH (Western Victoria) – I would like to explain in some detail why I believe that it is wrong, regardless of the opinions of affected people, to fluoridate new areas of Victoria and therefore why all members should vote for the Health Fluoridation (Amendment) Bill. I will argue that the efficacy of fluoridating water supplies to prevent tooth decay is actually dubious, that it is very possibly harmful and that the democratic principles to which we all aspire demand that this mass medication should not proceed against the wishes of affected people.
There is very strong opposition to fluoridation throughout western Victoria, and not just by a small vocal minority. I have attended some very large meetings throughout western Victoria, including one with 800 people about six weeks or so ago in Warrnambool – the largest public meeting ever held in Warrnambool.
Yesterday I tabled in this house a petition signed by 2543 people from Western Victoria urging all members to support this bill. On Friday I was sent a letter, which was described by Mr Vogels, which was signed by 21 medical practitioners, including specialists, in Warrnambool. They were all opposed to fluoridation. Their opposition to fluoridation is expressed on the basis of scientific evidence suggesting that fluoridation may be harmful. I am not a scientific expert, but I will attempt to outline some of the scientific concerns over the possible effects of fluoridation.
It is often assumed that proponents of fluoride represent modern scientific thinking, that fluoride is the norm in advanced countries and that its use is growing around the world. None of that is true. Fluoridation is common in North America, Australia and New Zealand; however, less than 6 per cent of the world’s population drinks deliberately fluoridated water. Several advanced countries have stopped adding fluoride to their water supplies, including Germany, Finland, Japan, the Netherlands, Switzerland and Sweden – not Alabama, Mr Pakula. I have a reference from the British Medical Journal of last month. Parts of Canada have also recently decided to stop fluoridation their water supplies.
Fluoride, or more accurately fluorosilicic acid, also known as hydrosilicofluoric acid, which is actually the fluoride compound added to Victoria’s water supplies, is toxic even in very small doses. Indeed fluoride is a prescribed poison under the national drugs and poisons schedule, and I have the Australian government internet site reference for that schedule. The fact that something is very toxic does not necessarily mean that it can never be consumed by people under any circumstances. Sometimes even poisons can be beneficial in their effects – for example, radiation treatment. Inherent toxicity surely does demand, however, that any benefits must be demonstrated before it is used on human beings, particularly when it is proposed to be used on people who are not sick and is intended to be distributed to tens of thousands of people, whether they want it or not, and will continue to be given to them for the rest of their lives. It seems to me very clear that the onus of proving that a poison is beneficial and not otherwise harmful is on the proponents of the practice – those who want to add fluoride to our drinking water – and the not on those who would oppose it. In that context Ms Pulford quoted something which she assumed supported her argument – that there is insufficient evidence to draw conclusions about other possible negative consequences of fluoridation. She said it is impossible to prove that fluoridation is harmful and that therefore is an argument for adding it to the water supply. I think the onus should be the other way around. The onus should be on those who are wanting to add this poison to the water supply to show that it is not harmful.
Not very long ago my main interest in requiring referenda as a prerequisite to fluoridation was based on democratic principle. I thought that fluoridation was probably quite beneficial to teeth and otherwise harmless but that people should have a say in whether their water supplies would be fluoridated. I have been surprised to learn that the benefits of fluoridating water supplies are actually very to extremely limited, that mildly adverse effects are common and that severely harmful consequences are, on the basis of the scientific evidence, entirely possible. I found that the opponents of fluoridation are not a lunatic fringe; they include some of the world’s finest scientific minds. The average standard of dental health of children varies greatly within fluoridated areas such as Melbourne. The average standard is much higher in, say, Brighton than in, say, Sunshine. This difference in standards between different parts of fluoridated areas would not negate the case for fluoridation if it could be shown that fluoride significantly increases average standards and that it is clearly not harmful to other aspects of health. There are reasons to seriously doubt both of these propositions.
What do the proponents of fluoridation argue? David Davis quoted rather old figures for fluoridation – 48 per cent and 36 per cent. In fact the Victorian government no longer claims even that fairly modest improvement in dental health. According to the most recent documents it claims a 36 per cent reduction in caries for children who are six years old and a 22 per cent reduction in caries for children who are —
Mr D. Davis – It was a 2006 document I quoted from.
Mr KAVANAGH – This refers to the figures Mr Davis gave and says they are basically obsolete. They are from Dental Health Services Victoria’s school dental service for 2002. The better figures, it says, are 36 and 22 per cent respectively. For 12-year-olds, a more important sample group because it includes children who have been six years old and includes a study of permanent teeth, not baby teeth, it claims that fluoridation reduces caries by 22 per cent. These claims are much lower than the claims made in the recent past, including those of 60 per cent put around not very long ago by the Victorian government. It is a big decrease from 60 to 22 per cent. Even these modified claims, however, are at the higher end of estimates.
According to an article in the British Medical Journal of October 2007, 3200 studies of the effects of fluoridation claim on average that the proportion of children in fluoridated areas with no caries is 15 per cent higher than the proportion of children in non-fluoridated areas. Even this modest claim is doubted by the authors, because in the studies reviewed ‘potential confounders were poorly adjusted for’, and I have an academic reference for that. In this context the confounders they refer to are other factors besides fluoridation that contribute to the average dental standards in fluoridated and non-fluoridated areas. This claim is undoubtedly true. It is often claimed that the prevalence of caries in Victoria is higher in unfluoridated areas – that is, there is more decay in unfluoridated areas. That is undoubtedly true. It is also true that confounding factors may well explain this.
These confounding factors include higher average incomes in areas that have long been fluoridated, principally Melbourne, which has a higher average standard of living than areas that have not yet been fluoridated. Along with income disparity of course come differences in nutrition and different abilities to pay for dental services. Furthermore, it is also obvious that dental services are less widely available and accessible in many parts of Victoria outside Melbourne – that is, those areas that are largely, though not entirely, unfluoridated. If, for example, fluoridated areas tend to be wealthier areas of a country, state or province, then this claim of 15 per cent is very dubious indeed. It is reasonable to believe that the 15 per cent so-called improvement is even more dubious if dental services are more plentiful and if nutrition tends to be better in fluoridated areas. In the case of Victoria all of these factors are true.
It is relatively easy to compare average standards of health in any two populations. It is much more difficult to account for these confounding factors. The British Medical Journal refers to reviews of the effectiveness of fluoridation by the Medical Research Council and the Scottish intercollegiate guidelines, which were based on the York study, to which David Davis also referred, and says of those findings that along with many other supporters of fluoridation they used the York review’s findings selectively to give an overoptimistic assessment of the evidence in favour of fluoridation. Studies concluded that the efficacy of fluoride in preventing dental decay in preschool children could not be determined because of factors such as the use of fluoride toothpaste, socioeconomic status and sugar consumption.
The BMJ (British Medical Journal) authors added: We know of no subsequent evidence that reduces the uncertainty.
In Warrnambool it takes at best two weeks to see a dentist if you are in pain. If you are not in pain and you go to a private dental practice, it takes about six to nine months. The situation in Ballarat is not much better and David Davis referred to many areas in Victoria where the wait for public dental services is not of the order of weeks or months but years.
Regardless of fluoridation, would it be any wonder if the standards of dental health were found to be lower in Warrnambool and Ballarat than they are in Melbourne? It would not be, would it? If you have to wait nine months to see dentist, even if you are paying, and five years if you are not in a position to pay, it would not be surprising if dental standards were not very high!
Dental health has improved dramatically in fluoridated areas in recent decades. Dental health has also improved dramatically in unfluoridated areas. Some studies have shown that in every fluoridated capital city of Australia the incidence of caries among children has declined to a fraction of what it was decades ago. In Brisbane the incidence of caries in children declined by around 65 per cent between 1977 and 1987, an improvement of the same order as the improvement in every other large Australian city. Brisbane’s water has never been fluoridated, yet in one 10-year period dental cavities decreased by 65 per cent.
Even this field study on a mass scale is superseded by studies in the United States. Comparisons in American states, some of which are fluoridated and some of which are not, showed no discernible difference in the rates of improvement in dental health. The same is true of the European Union. The dental health of children in European Union countries has increased very sharply over the last 30 years. These improvements have occurred in countries that are or have been largely fluoridated, such as Germany, and those which are not fluoridated, such as Sweden. I have academic references for that proposition.
Fluoride can be beneficial to teeth, but its effect, it now seems quite clear, is topical – that is, its benefits are achieved like an antiseptic, by contact with affected body parts, in this case teeth. Fluoride in toothpaste is extremely effective at avoiding or preventing dental caries. Little benefit is achieved from drinking it, however, because the prevalence of fluorides in saliva is only about one-sixtieth to one-hundredth of the ratio that is in the water that is consumed. As Mr Vogels said, you would not drink iodine or something like that, but that is what is happening with fluoride. The benefits are topical, achieved by contact, but the method of dispensing it is by drinking it.
The proponents of fluoride claim there is no proven case of fluoride doing harm. This depends on what is meant by proof. It is true that even in pro-fluoride publications, the government admits to dental fluorosis, a very common condition of discoloration of the teeth, staining of the teeth, and in severe cases pitting and mottling of teeth.
General practitioners and patients have told me in western Victoria of people who do react very badly to fluoride, even at very low levels. They break out in rashes and asthma can follow. Indeed some people moved to Geelong from Melbourne decades ago to avoid fluoridation in Melbourne‚s water. They tell me that if they ever come to Melbourne they bring their own water with them, so that if they want a cup of tea they can have one without breaking out in an adverse reaction.
In some parts of the world, particularly China and India, high levels of fluoride occur naturally in water, not by addition but because rocks have fluoride in them. Those levels are admittedly much higher than the levels the Victorian government intends to fluoridate our water. In those places skeletal fluorosis, which is a deforming condition something like arthritis throughout the body, is common, and not just dental fluorosis which occurs at lower levels.
The PRESIDENT – Order! I advise Mr Kavanagh that he has a right of reply and is able to sum up the points raised in the second-reading debate. I refer to a passage from the House of Representatives Practice on speaking in reply, and I want Mr Kavanagh to think about it:
The mover of a substantive motion of the second or third reading of a bill may speak on a second occasion in reply, but must confine any remarks to matters raised during the debate.
I have to say to Mr Kavanagh that I think he has gone beyond that on numerous occasions in extrapolating points that he has made, to the extent that in my opinion it is another crack at his initial contribution to the debate. I want Mr Kavanagh to think about that. His summary has been going for 17 minutes, which I have to say by any stretch is a long time.
Mr KAVANAGH – Many comments were made that fluoride was not harmful. Therefore, I thought it was relevant to respond to those comments. Some of the contributions were much longer than I have been going so far.
The PRESIDENT – Order! Mr Kavanagh’s contribution is a summary.
Mr KAVANAGH – I refer to a study by the American National Research Council where some of the greatest minds in the United States reviewed the evidence last year.
The PRESIDENT – Order! As an example, I am not able to remember that study being raised during the debate by any member who made a contribution to the debate. That is my point exactly.
Mr KAVANAGH – What about if someone had mentioned that there was no evidence of fluoride harming people’s mental capacity?
The PRESIDENT – Order! I remind Mr Kavanagh that during his contribution he had the opportunity to make reference to those very remarks that he wishes to make now. If they were not raised by anyone during their contribution then he really is on thin ice in trying to get them in now. I am reminded that he cannot introduce new material in his summary.
Mr KAVANAGH – Thank you, President. To summarise, there is considerable evidence of a decrease in IQ in fluoridated areas, and among other things a sharp increase in osteosarcoma among young males in areas that have been fluoridated.
To refer only to the points that have been made specifically, I will say that while Mr Davis suggested there is no proven link of bone cancer resulting from fluoridation, in fact evidence of that has been printed recently in 2006 or 2007. It was pointed out that standards of dental care are very poor in Victoria and should be improved. The point of those who do not support fluoridation is that there are better and safer ways to achieve that.
To just finish on one point, there have been a lot of comments made that the bill does not provide for compulsory voting. In fact there has been no reason given for speakers reaching that conclusion. It is not a conclusion that I would reach on the basis of the bill. In summary, there is good evidence that fluoride is harmful to people’s health, and that it is of minimal help in avoiding or preventing tooth decay. The bill seeks to invoke our democratic principle of people deciding for themselves whether substances which are of dubious benefit should be added to their water supply.
The PRESIDENT – Order! On a further point, the last three points Mr Kavanagh raised were well within the bounds of his ability to summarise the debate which has just taken place, because he referred to contributions that people had made. The concern was that he was introducing new material. As I say, that is for future reference.
House divided on motion:
Kavanagh, Mr (Teller)
Koch, Mr (Teller)
Davis, Mr D
Davis, Mr P.
Broad, Ms (Teller)
Pulford, Ms (Teller)
Lenders, Mr T
Motion agreed to.
Read second time.
Clauses 1 to 3 agreed to.
Ms HARTLAND (Western Metropolitan) – I move:
1. Clause 4, page 3, line 8, after “on” insert the question”. This is basically around the issue of who writes the question, because the bill does not actually have that. By doing this we believe it clarifies what the question should be.
Mr KAVANAGH (Western Victoria) – I support the amendment.
Ms BROAD (Northern Victoria) – I rise to oppose the amendment for the same reason as I opposed the bill – that is, that this bill and this amendment have no credibility. In my view the arguments put forward by the Liberal Party amount to nothing less than voodoo science and the government, scientists and policy-makers are expected to invest scarce public funds – that is, taxpayers money – in disapproving speculation about issues that there is no evidence for.
No amount of focusing on process in this bill, something the Liberal Party likes to spend a great deal of time debating in the Legislative Council these days, can disguise the fact that the Liberal Party is now supporting voodoo science in order to win votes in this place. No amount of amendments by the Greens can disguise the fact that they are complicit for entirely expedient reasons. The Liberal Party and the minor parties are going to have to do a lot better than this if they expect Victorians to support the Legislative Council as a genuine house of review in line with the Labor Party’s reforms to this house.