Fluoride Action Network

Statement on Fluoridation from Dr. Ian Robb

Source: Western Mail | Clinical senior lecturer and honorary consultant in public health medicine.
Posted on July 25th, 2005
Location: United Kingdom, England

In 2003 the Government passed the Water Act to allow water authorities to add fluoride to the public drinking water – fluoridation – if there is a request from statutory health agencies after they have consulted on the issue.

In this article I explain why, as a doctor, I advise against fluoridation.

Autonomy is the key ethical principle because it gives the highest priority to respecting people, not violating their wishes and feelings, and treating them as individuals with rights and responsibilities.

Adding fluoride to water means everyone would have to receive the fluoride and that conflicts with respecting each person’s autonomy.

People should be able to decide for themselves whether to add fluoride or not to their water.

To be more specific, the evidence about the safety and effects of fluoridation was systematically reviewed by a highly reputable research group from York and Cardiff in 2000 and published following peer review in the British Medical Journal.

Among other conclusions, the review found that little high quality research had taken place and autonomy would be honoured if people were to be given that information from the review.

Also, based in the review, they should be advised that six people need to receive fluoridated water for one extra person to be free of tooth decay – about 14% of the population.

Furthermore, they should be advised that mottling of the teeth associated with fluoride – known as fluorosis – causes aesthetic concern to about 12% of the population.

A study published in the British Dental Journal in 2004 of 6,000 UK households found similar results when combining the parameters of satisfaction, attractiveness and need for treatment to define aesthetic concern.

The importance of aesthetic concern might be debated but children and their parents should have the right to decide for themselves whether they wish to risk their teeth appearing mottled.

The York-Cardiff review did not find reliable evidence about other harmful effects but it repeated that the quality of the evidence is low.

This is an important point because fluoride can accumulate in glands in the body like the thyroid and the pineal glands.

Also, a recent report from the Harvard School of Dental Medicine suggests a link between fluoridation and bone cancer in male children. This work by Dr Elise Bassin is still being peer reviewed so it has not been published yet and therefore we cannot assess its value.

Nevertheless, people should have their autonomy respected and the potential risks from fluoridation should be made clear.

After autonomy, another key ethical principle is beneficence – the doctors who are consistent with beneficence give a high priority in their advice to the active duty of care through advising and treating others as they would wish to be advised and treated and as if everyone should act in this way.

Thus, as regards fluoridation, they believe in the universal opportunity for everyone to have information about the benefits and harms from fluoridation and to have awareness about the use of alternative forms of fluoride, for example, in toothpastes or toothbrushes.

Specifically, the evidence about preventing dental decay in children and adolescents using fluoride toothpastes was systematically reviewed by another reputable research group in 2003 and published following peer review in the Cochrane Database of Systematic Reviews.

The review found relatively high quality research that provided clear evidence for the benefits from fluoride toothpastes in preventing tooth decay.

Beneficence would be honoured if people were to be given this information especially as it gives more power for choice by each person.

Some health care professionals believe that the main need is to prevent tooth decay and that autonomy and beneficence are less important.

They think in the interests of justice, that is, fairness in relation to the allocation of resources, fluoridation should be given to everyone.

They recognise that some people might be harmed by fluoride but they believe more people will benefit.

If we do not join together to oppose fluoridation then these professionals will win with their absolutism as they seem to have the support of the Government health and environmental policies, the privatised water companies, and some health services.