Dr Fraser Dunbar and Dr Mark Goodhew support community water fluoridation. Most dentists do.

Their opponents, Mary Byrne and Kane Titchener from Fluoride Free New Zealand, do not.

These old school public debates on scientific topics are rare. But in Timaru, as it is in many other towns and cities, fluoride is not like other scientific debates; it remains as contentious now as it was half a century ago.

We can follow this trail in Timaru to the early 1960s, when the city first tried to fluoridate the water. The plan was spiked following a last minute referendum, after the council had already bought the equipment from a supplier in Australia. It sold the equipment on to another community, which also spiked its fluoridation plans.

Fluoride was added to Timaru’s water in 1973. It was tolerated for a while; then, pushback. Some complained of health problems; others refused to drink the water out of principle, choosing to fill up bottles by the gallon at a public tap near the local park.

Building on these complaints, a powerful lobbying campaign killed off fluoridation in 1985. The issue was dead, and has remained so: Despite vigorous efforts by dentists and public health officials, Timaru is approaching 40 years without fluoride in its water.

It may not reach that milestone.

Under a new law, the Government has signalled it may come over the top of locals and order communities to fluoridate their water supplies. Towns and cities that have resisted fluoridation — or have swung between fluoridating and not based on the whims of local politicians — will soon have no choice.

Rather than neutralise the debate once called “the longest running technical controversy in the public eye”, it appears to have triggered a resistance movement.

Amid declining trust in public health measures and growing opposition to centralised decision-making, fluoride politics have come roaring back.

Back to the debate.

Fluoride Free was in Timaru for a reason.

The group’s campaigners use a tried and true strategy. When a council puts fluoridation on the agenda, the group asks to speak during the public submission section. They usually get five minutes — 10, if they’re lucky — and have perfected a rapid-fire elevator pitch: Fluoride is the new lead; a toxic waste byproduct that reduces IQ and is linked to various health issues, information that has been either ignored or covered up by the medical establishment.

They will often pack the public gallery with local fluoridation opponents, and — ideally — a dissident dentist or two.

The effect is simple and striking: Your community does not want this. Expect a fight.

Byrne and Titchener had executed this strategy before the Timaru District Council on the day of the debate, running through a slideshow, backed by placard waving supporters. That evening, they had the chance to share those views with a wider audience.

It was clear the audience did not need convincing. If there were enthusiastic pro-fluoride supporters in attendance, they did not reveal themselves.

Goodhew opened by asking the 150-strong crowd to raise their hands if they supported fluoridating Timaru’s water supply.

“Around eight people did,” he recalls. “The rest of them were vehemently opposed.”

When Byrne or Titchener stood to answer questions, they received applause. The dentists were met with silence.

It was not a referendum. The extent of anti-fluoride sentiment in Timaru is unknown.

If nothing else, it showed how fluoride inflames passions, enough to gather a large crowd in the dead of winter.

Based on the audience’s reaction, Byrne would nevertheless claim victory.

“We definitely, definitely won the argument,” she said later in an interview on Reality Check Radio.

“The audience was definitely on our side.”

A contentious issue

Ever since Mark Goodhew moved to Timaru in 1986 — the year after fluoridation stopped — fluoride has been a touchy subject.

Like the vast majority of dentists, he accepts data showing fluoride is linked to reduced rates of tooth decay, and believes Timaru “has paid the price” since its removal with needlessly poor levels of oral health.

It’s not always an easy position to take.

Goodhew’s public advocacy has put him at odds with some Timaruvians, including a few of his own patients.

One of them was Imelda Hitchcock, the fiery figurehead of Timaru’s anti-fluoride movement, who led the successful effort to have it removed from the water in the 1980s.

She remained a staunch fluoride opponent until her death in 2017, firing missives in the letters section of the local newspaper, even from her hospital bed.

“It’s a really difficult thing to live in a community and to say to people every day, well, I think you’re wrong and this is why and I’ll be doing my best to make sure that we can change the situation,” Goodhew says.

“It’s a small town and people know each other. I’m sure there are people who think I’m a complete loony for wanting to push this chemical on to people, as they would phrase it, but you carry on based on the best evidence.”

To those who want to expand fluoridation, community opposition has always been a stumbling block.

It often doesn’t matter if most of a community supports fluoridation; the energy it inspires among opponents can overwhelm any support, which tends to be more passive.

The success of opponents is obvious when you look at the scoreboard. The proportion of New Zealanders drinking fluoridated water — about 51% — is the same as it was in the 1970s. Some towns and cities, such as Timaru, have added fluoride then removed it. Many more have kept their heads down and avoided the topic completely.

Most of the South Island does not fluoridate, including Christchurch city, despite its epidemic levels of severe tooth decay among children.

Many local politicians have seen what happens when fluoride becomes a political football. Individual councillors are targeted and pressured to vote one way or the other. They hear a barrage of conflicting arguments: fluoride is safe and effective; it’s a neurotoxin used as rat poison. Supporters and opponents spar in public, exchanging blows in the form of references to studies.

When a small council in Taranaki started fluoridating its water supplies, it was sued by fluoride opponents all the way to the Supreme Court. Councils have been pressured to hold expensive referendums. Put simply, it’s a lot.

Councillors would often default to the status quo, which in many cases meant not fluoridating.

This dynamic frustrated successive governments, which saw fluoridation as a tool to reduce the burden on the healthcare system. Research shows the cost of fluoridation is massively outweighed by the benefits.

In 2016, the National government proposed handing fluoridation decisions to district health boards. It lost the election before it could pass a law, but the issue was picked up again in 2021 by the Labour government. It had abolished the boards, so fluoridation decisions would instead be made by the director-general of health.

It was meant to disarm the favoured weapon of anti-fluoride campaigners — public pressure on local councillors. Public health decisions would be made by public health officials.

The outcome is likely to be the largest expansion of fluoridation in recent memory.

Fourteen councils have already been ordered to fluoridate their supplies, and another 27 have been told they are being considered for an order. They will receive some funding from a central pool to help.

If all go ahead, more than two-thirds of New Zealanders will be supplied with fluoridated water, including long-term holdouts such as Timaru, Nelson, and Tauranga.

For the first time in a while, the wind is behind the fluoridationists. But instead of jubilation, caution prevails.

Fluoride has always been controversial, but Goodhew thinks the temperature has risen.

“It’s developed more of a contentious flavour over the last wee while because of the director-general’s ability to direct councils to fluoridate water supplies,” he says.

“I think there’s also a strong connection to the anti-vax movement that’s come through in the last 3 or 4 years with the Covid vaccinations and so forth. I think they feed off each other.”

The fight back

The anti-fluoride movement has not admitted defeat. It has regrouped, with new supporters.

Fluoride Free has a strategy. Its campaigners, Byrne and Titchener, have been visiting councils subject to Government directives, urging them to fight back — legally, if they have to.

“Councillors are also there to represent the people in the community,” Byrne says.

“They are not there as a branch of central government. Councillors are being made aware that fluoridation is potentially harmful to the residents they are charged with protecting, then it is incumbent on them to do so.”

They have already had one small win.

After Fluoride Free spoke to the Western Bay of Plenty District Council, councillors voted to request an exemption, which was denied. They have explored other ways to fight back.

Elsewhere, Fluoride Free has had councillors ask what they can do in response to the orders.

One avenue is legal. The anti-fluoride group New Health New Zealand — the one that fought the issue previously in the Supreme Court — has filed a judicial review against the Ministry of Health, trying to stop the orders. If a council files an interim injunction, it could delay the process until that case is heard.

“We think it is likely that New Health New Zealand will win this court case as the information against fluoridation is overwhelming,” Byrne says. “The science is continuing to flood out.“

(No council has yet filed an injunction. The Ministry of Health says its orders remain active while the result of the lawsuit is pending.)

Other options include protesting the cost of fluoridation. While some money has been set aside to help councils, they will have to pick up costs, which comes amid wider funding pressures.

The most dramatic option would be to not comply. Doing so would come with a hefty fine – up to $200,000, followed by $10,000 per day of non-compliance. But in the same way the Christchurch City Council defied the Government’s building density laws, it would be a powerful statement.

These arguments might have had less appeal nearly a decade ago.

But the terrain has shifted. Fluoridation opponents are operating in a post-Covid environment that works in their favour.

Professor Philip Schluter is a public health researcher at the University of Canterbury. Much of his work is epidemiological — looking at how disease is distributed across a population.

He has studied rates of severe tooth decay and is convinced fluoridation makes a difference. One study examined the records of hundreds of thousands of New Zealand children, separated between fluoridated and non-fluoridated areas.

“We were able to show that in terms of severe early childhood caries — that’s having really bad teeth, like rotten teeth, and a mouth full of them — that those who lived in fluoridated areas had a 20% reduction, which is massive,” he says.

Another study, looking at about 11,000 children in Canterbury — almost all in non-fluoridated areas — found around one in five children had severe tooth decay.

“That has massive consequences on them as a person, both physically and mentally. It induces pain, and in the worst cases, they’re waiting to get their teeth removed. I just can’t imagine what that’s like.”

Schluter also studies something else: Trust in public health. During the pandemic, that trust has declined both internationally and in New Zealand, he says.

It was already showing up in lower immunisation rates, and risked expanding to other public health measures such as fluoride acceptance.

“Some of us are calling trust as a determiner of health,” he says.

“When we have decreased trust, we’re seeing increases in morbidity and mortality.

“I think what we’re seeing in the fluoridation argument is a generalisation of that — where people are feeling disempowered to make what they see as individualistic choices rather than collective benefit choices.”

It is unsurprising that some opponents to the Covid response have pivoted towards fluoride, using similar arguments about mass medication, the centralisation of government, and opposing the mainstream medicine establishment.

Voices for Freedom – the group founded in opposition to the Covid response, but has shifted into broader grievances — has taken up the anti-fluoride cause, as has Counterspin Media, which hosted Byrne and Titchener on its show.

Titchener has encouraged these connections.

“The people who understand the vaccination issue… if they can understand that stopping fluoridation is a major step towards vaccination awareness, I believe we can make a huge difference,” he said in a 2022 interview with Dr Sam Bailey.

Whether this low-trust environment, combined with the growing influence of central government, will be enough to slow the onwards march of fluoridation is unclear.

Other events have already had an impact.

The Ministry of Health says the 27 councils being considered for a fluoridation order are being given more time before a decision is made, “to allow consideration of the impact of several wider factors”.

“These include the Government’s Water Services Reform programme, capacity pressures across the water services sector, and the impact of the weather events in the North Island,” a spokesperson says. Only one of the four councils required to have started fluoridating by now under the first wave of orders have started.

In the meantime, no other communities are being considered for orders, the spokesperson says. That includes Christchurch, the white whale of fluoridation.

Among those hoping progress won’t be slowed is the New Zealand Dental Association (NZDA), which represents most dentists.

“It’s been shown through repeated scientific studies that [with fluoridation] you get a reduction in the level of dental caries across a population group“, says Dr Robin Whyman, the NZDA’s director of dental policy.

“We also know that the benefit is higher in lower socioeconomic groups — or in groups that are at most risk of dental decay — so it’s also a measure that has greater benefit for those in greatest need.”

He points to a comprehensive 2017 review published in Australia — where 89% of the population has access to fluoridated water — that showed water fluoridation reduced tooth decay by 26% to 44% in children and adolescents, and by 27% in adults.

Those echoed results found in New Zealand by the Prime Minister’s Chief Science Advisor in a 2014 review.

Whyman also knows the benefits first-hand. When he was a practising dentist, he worked in both fluoridated Hutt Valley and unfluoridated Whanganui.

The differences were striking.

“In areas that are not fluoridated, the decay is just bigger. It tends to be harder to treat, and you end up doing more extractions just because of the levels of dental decay amongst very similar population groups,” he says.

“It’s the practitioners who work between fluoridated and non-fluoridated areas who will see that, and I’ve had personal experience of it.”

Back in Timaru, there is cautious optimism.

After decades of supporting fluoridation, Goodhew is hopeful it will finally happen; that the twists and turns of the city’s fluoride politics will be settled once and for all. But he’s not proclaiming victory just yet.

“It’s not a done deal,” he says. “I’ll be happy when it actually happens, let’s put it that way.”

– The Press

*Original full-text article online at: https://www.thepost.co.nz/a/nz-news/350080891/they-feed-each-other-fluoride-politics-come-roaring-back-post-covid-flavour