Edward Baldwin and Ian Wylie: The Case for a White Wash
Fluoride in the water - saving children from the dentist, or an abuse of our civil rights? Edward Baldwin and Ian Wylie disagree.
Dear Ian,
Water fluoridation is one of the most widespread treatments in this country, already reaching over five million people. Yet unlike all other medical treatments, it is given to whole populations, many of whom won't benefit from it, without informed consent, without normal medical licensing, by an uncontrolled dose, for a lifetime, via water supplies which feed into the environment.
Doesn't this take some explaining, whatever your understandable zeal to protect children's teeth? There are ethical and environmental concerns here, quite apart from issues of safety and effectiveness, where, as you know from the recent York review of the evidence, plenty of research is still needed.
Germany, Japan, Sweden, Switzerland, Finland, the Netherlands, the old USSR and Czechoslovakia all gave it up, for health, ethical, ecological or other reasons. Most countries outside the English-speaking world never started. Why are you so keen on mass medication, when the trend is rightly away from the nanny state and towards responsibility for our own health?
Yours, Edward
Dear Edward,
If anyone were proposing mass medication, without licence, you could count me among your strongest supporters. But this is simply not the case. Fluoride is a naturally occurring mineral. It is no more a medicine than calcium or magnesium, which also occur naturally and are routine supplements to our diets because they too give a health benefit.
A proportion of the UK population is fortunate to live in areas where fluoride occurs naturally. Several million others are from communities which decided decades ago to add fluoride, and their oral health is significantly better. All that is now proposed is to give local communities the right to take the decision on their water supplies.
The opportunity exists now to improve the health of the most vulnerable members of our society. In particular, very young children in poor and disadvantaged communities suffer disproportionately from tooth decay, at significant cost to their health and welfare. The solution to their problems is available, cheap, effective and has no harmful side effects. As members of a civic society, on what moral basis would we deny this?
Yours, Ian
Dear Ian,
Aluminium, arsenic, lithium and lead are also naturally occurring minerals. This doesn't mean we put them in everyone's water, at several times their normal concentration. Lord Jauncey in the 1983 Strathclyde case found fluoride in water to be a medicinal product within the Medicines Act 1968; he has not been overruled.
Indeed, its status as a medicine is confirmed by the wording of the latest European Directive, and by the fact that it makes specific medical claims, which dietary supplements such as calcium are not allowed to do. It is also a poison under the Poisons Act 1972.
No one is denying fluoride to disadvantaged communities! There are gels, varnishes, rinses and of course toothpaste, all of which (unlike fluoridated water) have good science behind them. What are you going to say to your vulnerable communities if serious side-effects emerge?
You claim "no harmful side-effects". Senior scientists who were responsible for the York review have gone on record three times to stress that the evidence on safety is too thin to claim anything. Even the Department of Health conceded in a Parliamentary Answer that mottled teeth were a sign of "systemic toxicity". Public health people in this country have never seriously tried to look for possible harm, because the love affair with fluoride has been so strong.
A patient in our society has a right to refuse treatment: look this up in the Patient's Charter, and in the European Biomedicine Convention, where it stands in black and white. There is nothing there about being outvoted by your local community: in medical ethics, choice is an individual matter. On what moral basis do you compel A to take a substance she doesn't want, for B's benefit? Why should fluoridation alone break the normal rules?
Yours, Edward
Dear Edward,
This is a strange argument. You now suggest that fluoride should be considered as a medicine and treated as a poison! Despite this, you go on to advocate giving this medical poison to disadvantaged communities, but only in gels and toothpaste, because otherwise there will be serious side-effects.
The introduction of fluoride into toothpastes, some decades ago, together with general improvements in health, has had a significant effect on the rates of tooth decay. As a result, many children have grown up without experiencing the misery of decay. The tragedy is that too many still do suffer: children who, for whatever reason, simply do not get the care they need.
For decades, dentists and public health workers have looked at different ways to improve oral health, because the most effective tool - water fluoridation - was only available in a limited number of areas.
In 1998, the report into health inequalities by the former Chief Medical Officer, Sir Donald Acheson, strongly endorsed fluoridation and the Government has since commissioned studies into fluoridation by York University and the Medical Research Council. Both studies found evidence for the health benefits of fluoridation and no evidence of harm. York rightly pointed out that much of the research would not pass modern technical standards but as no new schemes have happened for the past quarter century, that was hardly surprising. Yet over this time, dozens of communities have requested fluoride. What is proposed is that these local decisions are respected and acted on.
In his essay On Liberty, John Stuart Mill wrote that "a person may cause evil to others not only by his action but by his inaction". Inaction is what we have now.
Yours, Ian
Dear Ian,
I am astonished that you were unaware (if you were) of fluoride's status as a poison, and of the difference in law between medicines and food supplements.
I advocate nothing here - you put words in my mouth. Those who want fluoride are at liberty to take it for themselves, on their judgment of the risks and benefits. They are not at liberty to impose it on others. I note that you didn't answer my question why fluoridation alone should break the accepted rules of medical ethics.
As you know, I served on the panel of the York systematic review, described by scientists who should know as "the only scientifically defensible assessment of the evidence worldwide". It could not find one good, unbiased study anywhere, least of all on dental health inequalities. This means that literally nothing can be claimed with confidence. Claims that there is "no evidence" of harm are disgraceful: look at the York report for the studies on cancer, bone defects, infant mortality and so on. The evidence is there, and it is mixed but the safety studies are bad, and few, and the work is still to do. No drug would be licensed on this kind of evidence.
I believe the public health community has invested so heavily in fluoridation for so long that it cannot go back without loss of face. York has been a profound shock to a deeply held belief and the spin placed on its findings by those in authority has been outrageous.
Regards, Edward
Dear Edward,
Isn't the problem here that you really do advocate nothing? You have no solution, other than that we tell very young and disadvantaged children to go and find their own health care, judging risks and benefits. This is no solution at all.
I am sorry that you have so little trust in health professionals who hold different views to you. But the more important issue is whether we trust local people to decide matters of public interest and public health.
Yours, Ian
Dear Ian,
I think you are right that there is an issue of trust. Health professionals in their time have endorsed brands of tobacco, and have called osteopathy quackery; they are not infallible.
Do-goodery can get out of hand. You'll have read recently about the many lives lost because people don't take their heart drugs. I've heard no proposals to put aspirin or statins [drugs for lowering cholesterol] in the water - and that's a really serious illness. Campaign by all means, for better dental services, for reduction of sugars in our food (the real cause of dental decay), for good oral hygiene. I'll support you on that. But not on fluoridation.
A medical friend of mine put it well: "What physician in his right mind would prescribe for a person he has never met, whose medical history he does not know, a substance which is intended to create bodily change, with the advice: 'Take as much or as little as you like, but you will take it for the rest of your life because it may benefit other people's teeth'?"
Regards, Edward
Dear Edward,
The body of world-wide scientific opinion is that low-dose fluoride has a beneficial effect on oral health. In America, almost two-thirds of the population has drunk water with fluoride, without a problem, for decades. Yet no amount of evidence would be sufficient to persuade you. And if one individual opposed it, you would deny the benefit to everyone. So you seek to do what you accuse others of: that is, to impose your beliefs.
Yours, Ian
Earl Baldwin of Bewdley is vice chair of the All-Party Parliamentary Group Against Fluoridation. Ian Wylie is chief executive of the British Dental Association.
Water fluoridation is one of the most widespread treatments in this country, already reaching over five million people. Yet unlike all other medical treatments, it is given to whole populations, many of whom won't benefit from it, without informed consent, without normal medical licensing, by an uncontrolled dose, for a lifetime, via water supplies which feed into the environment.
Doesn't this take some explaining, whatever your understandable zeal to protect children's teeth? There are ethical and environmental concerns here, quite apart from issues of safety and effectiveness, where, as you know from the recent York review of the evidence, plenty of research is still needed.
Germany, Japan, Sweden, Switzerland, Finland, the Netherlands, the old USSR and Czechoslovakia all gave it up, for health, ethical, ecological or other reasons. Most countries outside the English-speaking world never started. Why are you so keen on mass medication, when the trend is rightly away from the nanny state and towards responsibility for our own health?
Yours, Edward
Dear Edward,
If anyone were proposing mass medication, without licence, you could count me among your strongest supporters. But this is simply not the case. Fluoride is a naturally occurring mineral. It is no more a medicine than calcium or magnesium, which also occur naturally and are routine supplements to our diets because they too give a health benefit.
A proportion of the UK population is fortunate to live in areas where fluoride occurs naturally. Several million others are from communities which decided decades ago to add fluoride, and their oral health is significantly better. All that is now proposed is to give local communities the right to take the decision on their water supplies.
The opportunity exists now to improve the health of the most vulnerable members of our society. In particular, very young children in poor and disadvantaged communities suffer disproportionately from tooth decay, at significant cost to their health and welfare. The solution to their problems is available, cheap, effective and has no harmful side effects. As members of a civic society, on what moral basis would we deny this?
Yours, Ian
Dear Ian,
Aluminium, arsenic, lithium and lead are also naturally occurring minerals. This doesn't mean we put them in everyone's water, at several times their normal concentration. Lord Jauncey in the 1983 Strathclyde case found fluoride in water to be a medicinal product within the Medicines Act 1968; he has not been overruled.
Indeed, its status as a medicine is confirmed by the wording of the latest European Directive, and by the fact that it makes specific medical claims, which dietary supplements such as calcium are not allowed to do. It is also a poison under the Poisons Act 1972.
No one is denying fluoride to disadvantaged communities! There are gels, varnishes, rinses and of course toothpaste, all of which (unlike fluoridated water) have good science behind them. What are you going to say to your vulnerable communities if serious side-effects emerge?
You claim "no harmful side-effects". Senior scientists who were responsible for the York review have gone on record three times to stress that the evidence on safety is too thin to claim anything. Even the Department of Health conceded in a Parliamentary Answer that mottled teeth were a sign of "systemic toxicity". Public health people in this country have never seriously tried to look for possible harm, because the love affair with fluoride has been so strong.
A patient in our society has a right to refuse treatment: look this up in the Patient's Charter, and in the European Biomedicine Convention, where it stands in black and white. There is nothing there about being outvoted by your local community: in medical ethics, choice is an individual matter. On what moral basis do you compel A to take a substance she doesn't want, for B's benefit? Why should fluoridation alone break the normal rules?
Yours, Edward
Dear Edward,
This is a strange argument. You now suggest that fluoride should be considered as a medicine and treated as a poison! Despite this, you go on to advocate giving this medical poison to disadvantaged communities, but only in gels and toothpaste, because otherwise there will be serious side-effects.
The introduction of fluoride into toothpastes, some decades ago, together with general improvements in health, has had a significant effect on the rates of tooth decay. As a result, many children have grown up without experiencing the misery of decay. The tragedy is that too many still do suffer: children who, for whatever reason, simply do not get the care they need.
For decades, dentists and public health workers have looked at different ways to improve oral health, because the most effective tool - water fluoridation - was only available in a limited number of areas.
In 1998, the report into health inequalities by the former Chief Medical Officer, Sir Donald Acheson, strongly endorsed fluoridation and the Government has since commissioned studies into fluoridation by York University and the Medical Research Council. Both studies found evidence for the health benefits of fluoridation and no evidence of harm. York rightly pointed out that much of the research would not pass modern technical standards but as no new schemes have happened for the past quarter century, that was hardly surprising. Yet over this time, dozens of communities have requested fluoride. What is proposed is that these local decisions are respected and acted on.
In his essay On Liberty, John Stuart Mill wrote that "a person may cause evil to others not only by his action but by his inaction". Inaction is what we have now.
Yours, Ian
Dear Ian,
I am astonished that you were unaware (if you were) of fluoride's status as a poison, and of the difference in law between medicines and food supplements.
I advocate nothing here - you put words in my mouth. Those who want fluoride are at liberty to take it for themselves, on their judgment of the risks and benefits. They are not at liberty to impose it on others. I note that you didn't answer my question why fluoridation alone should break the accepted rules of medical ethics.
As you know, I served on the panel of the York systematic review, described by scientists who should know as "the only scientifically defensible assessment of the evidence worldwide". It could not find one good, unbiased study anywhere, least of all on dental health inequalities. This means that literally nothing can be claimed with confidence. Claims that there is "no evidence" of harm are disgraceful: look at the York report for the studies on cancer, bone defects, infant mortality and so on. The evidence is there, and it is mixed but the safety studies are bad, and few, and the work is still to do. No drug would be licensed on this kind of evidence.
I believe the public health community has invested so heavily in fluoridation for so long that it cannot go back without loss of face. York has been a profound shock to a deeply held belief and the spin placed on its findings by those in authority has been outrageous.
Regards, Edward
Dear Edward,
Isn't the problem here that you really do advocate nothing? You have no solution, other than that we tell very young and disadvantaged children to go and find their own health care, judging risks and benefits. This is no solution at all.
I am sorry that you have so little trust in health professionals who hold different views to you. But the more important issue is whether we trust local people to decide matters of public interest and public health.
Yours, Ian
Dear Ian,
I think you are right that there is an issue of trust. Health professionals in their time have endorsed brands of tobacco, and have called osteopathy quackery; they are not infallible.
Do-goodery can get out of hand. You'll have read recently about the many lives lost because people don't take their heart drugs. I've heard no proposals to put aspirin or statins [drugs for lowering cholesterol] in the water - and that's a really serious illness. Campaign by all means, for better dental services, for reduction of sugars in our food (the real cause of dental decay), for good oral hygiene. I'll support you on that. But not on fluoridation.
A medical friend of mine put it well: "What physician in his right mind would prescribe for a person he has never met, whose medical history he does not know, a substance which is intended to create bodily change, with the advice: 'Take as much or as little as you like, but you will take it for the rest of your life because it may benefit other people's teeth'?"
Regards, Edward
Dear Edward,
The body of world-wide scientific opinion is that low-dose fluoride has a beneficial effect on oral health. In America, almost two-thirds of the population has drunk water with fluoride, without a problem, for decades. Yet no amount of evidence would be sufficient to persuade you. And if one individual opposed it, you would deny the benefit to everyone. So you seek to do what you accuse others of: that is, to impose your beliefs.
Yours, Ian
Earl Baldwin of Bewdley is vice chair of the All-Party Parliamentary Group Against Fluoridation. Ian Wylie is chief executive of the British Dental Association.
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