§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. MacArthur.]
§ 12.55 a.m.
§ Mrs. Joyce Butler (Wood Green)
I am glad to have this opportunity to express some doubts about the campaign for the fluoridation of water supplies to which the Minister of Health has now given his blessing. In this very short debate I shall not attempt to counter the arguments put forward in favour of the campaign, but I want to draw attention to one or two rather disturbing features of it.
The support of fluoridation by a number of medical bodies has, I think, been taken by the public to be the expression of a substantial body of informed opinion in support of fluoridation, whereas in fact what those bodies have usually done has been merely to re-echo the views of other bodies. There has in fact been very little research and investigation of the facts on which these comments have been made. The Report on the Conduct of the Fluoridation Studies in the United Kingdom which has given the go-ahead to the advocates of fluoridation, for example, did not present exact data in many important respects. The use of a process of averaging in compiling most of the figures makes it difficult to evaluate them and ignores important differences in individuals.
It is a fact that this study followed a mission to the United States which advocated that the studies in this country should include full medical and dental examinations at all ages, but in fact no such examinations have been made. It seems quite unscientific and misleading to claim that after an experiment for a period of five years, in which attention was concentrated upon the milk or deciduous teeth of children of 3 to 7 years of age, we know the ultimate effects on permanent teeth or the cumulative effects on the body generally of fluorides applied over several decades. The British Pharmaceutical Codex, 1934, under the heading "Sodium Fluoride", states:Chronic poisoning may occur from the continued ingestion of small quantities of 605 fluorides and is characterised by slowly progressive wasting, anaemia and brittleness of the bones.Advocates of fluoridation say that this will not be the result of taking small quantities, but it is extremely difficult on the research so far done in this country to support that contention.
It is a fact that a dosage of one part per million is advocated as being safe, whereas only half a decimal point more fluoride added is regarded by most authorities as dangerous. There is a fine line drawn between what is safe and what is unsafe in this respect. Very little study has been made of the difference in action between calcium fluoride, which occurs in natural supplies, and sodium fluoride, which it is proposed to add to supplies. There has been no research on the effect of added fluoride on the complete life cycle of animals and human beings. We do not have the evidence to show what the effect will be of adding fluoride to supplies taken by people suffering from diabetes, nephritis or febrile diseases, or even on people who drink more than the normal amount. The amount regarded as necessary is between four and six glasses of water which has been fluoridated by one part per million, but many people, particularly in hot weather, and especially children, drink more than that.
One could go on on the question of research. The research which has been made has been extremely scanty, but on this basis we are going forward encouraging water authorities to add fluoride to the water supply because it is said that the bad state of the teeth of children is such that it could be remedied only in this way. I draw attention to the fact that it is widely thought that any possible benefits to teeth are confined to those of children up to 12 years. A book on dental care states:In England, Weaver observed in 12 year old children consuming naturally fluoridated water less caries than in control groups. However, 15 year old children showed an equal caries incidence in both groups.It seems that the campaign for fluoridation is diverting attention away from the causes and possible cure of dental decay, and other methods of reducing dental caries have not been sufficiently examined, and this is realised by dental authorities.
The fact is that dental decay is not isolated from the other aspects of the body's health, and it seems that this is 606 being completely overlooked. Decayed teeth usually indicate a faulty diet which, of course, is not good for the health of the whole body as well as not being good for teeth. Similarly, the first specific symptom of injury resulting from fluoridation to a child—that is the whole child—is a mottling of the teeth. There is no doubt that tooth mottling from fluoride is a warning of future disease, although it may take as long as 25 to 30 years before the first toxic symptoms appear. This is an important factor which seems to have been completely overlooked in this campaign.
The people who have expressed doubts about the wisdom of fluoridation are not cranks, half-wits or liars—although they have been described as such by medical representatives who have been discussing the fluoridation campaign. It is doubtful whether a campaign which has to proceed with such abuse and which has refused to allow opponents of the idea of fluoridation to speak at conferences on this subject is proceeding in the best possible way and in the public interest, for many people have been very much disturbed about what is being suggested, and I should have thought that they have a perfect right to express their views. It is essential in a democracy that people with contrary views should be allowed to express them.
Unfortunately, once fluoride is added to the water supply no one can contract out of imbibing it. This is in contrast to all other forms of medication because there is no control on the amount which the individual may take. There is also no means of reducing the amount consumed, particularly when such an amount as must be consumed may be harmful to the individual. Thus, those who do not want to take it, or who should not do so, will be compelled to through the normal water supply. It is also a wasteful method.
In Hull, for example, it has been estimated that to make the appropriate quantity of fluoride available to the appropriate age group—that is, very small children—20 lbs. of fluoride each year would be needed. Even if this were not a waste product of the aluminium industry, the cost of making this quantity available to the children annually, along with their welfare foods, would be trifling. But to add it to the water supply of Hull 607 would require 33 tons a year, of which all but the requisite 20 lbs. would go into the Humber without being of benefit to anyone—and the price charged would be likely to be £500 per ton; a wasteful and ineffective way of going about it.
Those who wish to give fluoride to their young children can do so in tablet form, but the Minister has refused—he did so when replying to a Question which I put to him—to make these tablets available through welfare clinics.
This brings me to another point of extreme importance—advice which the Minister has given to water works and undertakings on this subject. The Parliamentary Secretary will know that the Waterworks Association, which represents water undertakings, has expressed grave doubts about the admissibility of adding fluoride to water supplies because, in its view, the prime duty of water authorities regarding the supply of water for domestic purposes has been and remains a duty placed on them by Parliament to give the householder a wholesome and abundant supply. The water undertakings fear that the deliberate use of the public water supply as a convenient method of administering fluoride to the population is at present outside the functions and powers of the water authorities.
This is a view which I think is held by anyone who is concerned with water supply. But, further than this, the Minister has written to the Waterworks Association, or discussed with it, this point about its powers in this respect and has said that he is aware that doubts have been expressed as to whether the present powers of water undertakings permit this addition. He writes: "The point could only be determined by the Courts, but the Minister takes the view that the present powers are adequate and has decided to advise local authorities who so wish to proceed with arrangements for this useful measure for protecting children's teeth. In the event of court proceedings he will indemnify both the local authority concerned and the water undertakers".
This is very serious, because this promise of indemnity goes far beyond anything the Minister has powers to perform. It is probably a breach of the law in that it is a fundamental part of the constitution, derived ultimately from the Petition of Right, that the Government have no power whatever to grant dispensations from compliance with the existing law. 608 The only thing the Minister could do in such an eventuality would be to introduce a Bill to indemnify, and the indemnification would eventuate only if Parliament adopted and enacted such an act of indemnity.
I am gravely concerned that the Minister has put himself in this position in support of fluoridation. I hope that he will take an early opportunity of considering this point and give rather different advice to the water undertakings. I can assure the Parliamentary Secretary, although I do not expect him to say that the Minister will change his mind, that what I am saying expresses very serious public concern about the whole subject. I would ask whether he would make an opportunity available for a much wider discussion of this matter and that if in particular areas there is a demand by public authorities for the adding of fluoride to water supplies there should be an opportunity for public opinion to express itself through a poll or in some other way before that step is taken.
§ 1.8 a.m.
§ The Joint Parliamentary Secretary to the Ministry of Health (Mr. Bernard Braine)
I am grateful to the hon. Lady the Member for Wood Green (Mrs. Butler) for providing me with an opportunity to remove certain misconceptions. I find myself in some difficulty in replying to her references to a campaign for fluoridation. There is no such campaign, although there is, of course, a ground swell of opinion in the country in favour of fluoridation. It is true that the Government, having carefully considered all the evidence available concerning fluoridation, have become convinced of its value. In view of the suffering which is caused by dental decay, I think that any Government would be failing in their duty if they did not bring to the attention of those authorities most closely concerned their view that fluoridation is a beneficial health measure.
What my right hon. Friend has done is to announce, in the House on 10th December last, that he is ready to approve under Section 28 of the National Health Service Act arrangements made by local health authorities with water undertakings for the addition of fluoride to the water supply where is deficient in it naturally. My right hon. Friend came to this decision 609 only after giving very full and careful consideration to the volume of evidence on the effectiveness, safety and practicability of fluoridation, to the advice which he had received from expert advisory bodies, and to the volume of support for fluoridation from responsible professional and local authority organisations. On 14th December my Department issued a circular to all local authorities informing them of my right hon. Friend's announcement and enclosing an extract from the relevant part of the OFFICIAL REPORT.
The next step clearly lies with the local authorities, and we naturally hope that they will not be slow to secure for residents in their areas the benefits of fluoridation. Indeed, the unreserved support for it expressed by the County Councils Association and by the Association of Municipal Corporations encourages us to think that they will not be so. Hon. Members will be aware that as recently as 26th November we were able to have a similar debate on the general subject of fluoridation, on the initiative of the hon. Member for Greenock (Dr. Dickson Mabon). In my reply on that occasion I gave a very full description of the background to fluoridation, and I would not wish to weary the House again by reiterating all the detail that I laid before it at that time. Nevertheless it may help hon. Members, and the hon. Lady in particular, to see the matter in perspective if I briefly review the evidence in favour of fluoridation.
For more than 30 years it has been known that the presence of fluoride in drinking water is a factor in dental health. Studies not only in this country but in other countries have shown that children nurtured in areas where the water naturally contains fluoride at a level of one part per million have less than half the dental decay of children in areas where there is only a trace of fluoride. Their teeth are well formed and of good appearance and there is strong evidence that the benefit of fluoride lasts well into middle age.
I must emphasise that the presence of fluoride in water is a perfectly natural occurrence. For generations people all over the world and in certain places in this country have been living in areas where the drinking water has far more than this level of fluoride, and they have 610 enjoyed better health. In my own county there are areas where people all their lives have been drinking water which contains up to six parts per million—six times as much as is recommended—without any harm to health.
What is fluoridation? It simply means the addition of fluoride to water supplies to increase the amount already present—and I stress "already present" because almost all waters contain some fluoride naturally—to one part per million, which is the level shown in the fluoride areas to be the most beneficial for dental protection.
The hon. Lady has made some play with the difference between natural fluoride and fluoride which may be added to water supplies. It is calcium fluoride which occurs naturally in water, but when artificial fluoridation is introduced it is sodium fluoride that is used. It is correct that the source of much of the fluoride occurring naturally in water is probably fluorspar—calcium fluoride—but it is not practicable to use calcium fluoride because of its low solubility. Sodium fluoride, which is commonly used, is also derived from fluorspar, and its effects on the human body are precisely the same. This is because at the very low concentrations which are used in fluoridation these salts lose their identity and break up into their component parts, called ions. The fluoride ion is exactly the same, whatever its origin, whether it has come from calcium fluoride or from sodium fluoride. It is this which is the active agent in preventing dental decay. All drinking waters contain sodium, calcium and other ions in addition to fluoride ions.
If the hon. Lady lives, as I think she does, in the area served by the Metropolitan Water Board ate may be interested to know that she and her family are probably already drinking water which has between 0.2 and 0.3 parts per million of natural fluoride. Indeed, there are some consumers in the area served by the Board who are drinking water with a content above one part per million of fluoride. As I say, in the neighbouring County of Essex there are places where people are drinking water with up to six parts of fluoride, and where it is known that there is far less dental decay among the children.
611 Thus, all that fluoridation does is to increase the concentration of something which is already in the water. Studies have shown that the addition to drinking water of fluoride up to the level of one part per million, where the natural level is below this, has the same beneficial effect on teeth as the same amount of the fluoride present in the water naturally. It cuts dental decay by half, and extensive investigations conducted on a scientific basis have failed to demonstrate any harmful effects.
There seems to be a great deal of muddled thinking on the subject of pure water. The only really pure water is distilled water, and I can assure the hon. Lady, if she has not tried it, that it is very unpleasant. I do not recommend her to make the family tea with it. A good deal of our drinking water is sterilised by the use of chlorine. Some water authorities use up to 30 chemicals in order to ensure wholesome drinking water. Is it argued that it is wrong to add fluoride to water where a trace of it already exists, but it is right to add chlorine and other chemicals to water which does not contain them? The answer to that, surely, is no. Anybody who has travelled outside this country knows that there are very few countries where there is such a universally clean and wholesome water supply as here.
In my reply to the debate on 26th November, I spoke in some detail about the studies made in the United States from 1945 onwards, of the British mission to North America to study fluoridation in operation, and of the detailed studies which have been carried out in selected areas in this country since 1955. I referred also to the expert advice which my right hon. Friend had had from his Standing Medical and Dental Advisory Committees and from the Central Health Services Council, and to the similar advice received by my right hon. Friend the Secretary of State for Scotland. I made plain that none of these bodies consulted had made any comments which were other than favourable to fluoridation.
It really seems extraordinary to me that, in the light of this, the hon. Lady should assert that there is insufficient scientific evidence in support of fluoridation. The General Dental Council, the 612 British Dental Association, the Royal Society of Health, the British Medical Association, have all expressed their unreserved support of fluoridation as a health measure. Could there be a wider range of more important and influential bodies than this in matters of health? It is obvious that such bodies would have weighed the scientific evidence most carefully. As for the bodies which advise my right hon. Friend directly, they comprise some of the most eminent figures in the medical and dental professions in this country, and, may I say, the world.
I cannot accept that we are exercising any bias in favour of fluoridation. Indeed, perhaps the strongest support has come from the hon. Lady's side of the House. She will remember—no doubt, she was present—when the hon. Member for St. Pancras, North (Mr. K. Robinson), speaking about fluoridation, described it as amedico-social advance in which all the evidence is on one side, to a quite unprecedented degree".—[OFFICIAL REPORT, 26th November, 1962; Vol. 668, c. 178.]In that view I concur.
Before reaching his decision, my right hon. Friend had regard to the views expressed by all the authoritative bodies representative of medical and dental opinion. None expressed views other than favourable to fluoridation. It is true, of course, that a few members of the medical and dental professions do not support the idea. Some difference of opinion always arises when new public health measures are suggested, and it is natural that contrary opinions should be strongly held. The scientific documents and reports containing opinions adverse to fluoridation which have been published have received the most careful review of their factual basis, and their evidence has been weighed against that derived from other sources. I say in all seriousness to the hon. Lady that none of these reports has carried any conviction. Indeed, in some cases the writers have subsequently admitted that their conclusions were based upon inaccurate information.
While objective scientific studies of fluoridation are welcome, whatever their conclusions, I must, of course, distinguish those from the quantity of anti-fluoridation propaganda which has been produced. This is a campaign which is 613 both biased and misleading and contains the most reckless statements. As an example of this worthless literature, I have a leaflet headed "Danger! Poison in our water". It suggests that fluoridation may lead to paralysis and early death and is especially dangerous to the unborn child. That is utter nonsense and is completely without foundation.
I quite understand that any proposals to introduce fluoridation give rise to questioning. It can be said, as the hon. Lady said tonight, that this is an infringement upon the rights of the individual, it gives the individual no choice but to drink fluoridated water, and there may be doubts whether fluoridation is really necessary.
To argue that it is morally wrong to interfere with the water supply and that fluoridation is mass medication is to ignore the fact that water occurring in nature is never pure and needs to undergo extensive chemical treatment at waterworks before it can emerge from the domestic tap as wholesome drinking water. It is also to ignore the fact that nearly all water supplies contain some fluoride and that already in this country—the hon. Lady must be careful where she goes—half a million people drink water with a natural content of one part per million, which is sufficient for dental protection. Fluoridation is simply a deliberate adoption on a wider scale of a natural process.
The answer to the question whether it is necessary is that we are, of course, pressing on with health education. The problem of dental decay is, however, so formidable that we cannot afford to ignore a simple, safe, natural, proven way of laying the foundations for healthy teeth.
At the age of 5, when children start school, four out of five of them have decayed teeth. It is, of course, accepted that the modern diet, including a heavy consumption of fermentable carbohydrates, is largely responsible, but it is extremely difficult to change dietary habits. It is true that fluoride is available in tablet form and in theory—I stress "in theory", because in practice little evidence is available—the effects of tablet fluoride should be similar to those of fluoridation of water. But this would entail a daily administration in regular doses 614 throughout childhood, involving a degree of perseverance which, I suggest, we could expect few parents to maintain.
The argument must be seen against what was actually achieved after five years of fluoridation in the study areas of this country. It achieved a reduction by 1961 of 66 per cent. in the dental decay in children aged 3, a 57 per cent. reduction in children aged 4 and a 50 per cent. reduction in children aged 5. The hon. Lady says that this is too short a time, but we are not dealing with this matter in a vacuum. This is entirely in line with American experience, and the studies which have been under way in that country for between 10 and 15 years show that these striking results are maintained.
My right hon. Friend the Minister would not favour fluoridation if it involved a risk of health. To quote from the report of the World Health Organisation Expert Committee on Water Fluoridation:The most convincing evidence of the safety of water fluoridation comes from the numerous population groups who have drunk naturally fluoridated water containing 1 part per million or more during their lifetimes. In these groups water drinking has been of course uncontrolled and there have been well and ill babies as well as healthy young adults and frail elderly people. Medical practitioners and specialists in these areas have never detected and defined a systematic aberration in health of any kind related to the fluoride consumed.It is this which indicates why fluoridation is gradually extending throughout the world.
Fluoridation is practised extensively in the United States of America. Forty-eight million people there now drink fluoridated water. Canadian schemes cover 1½ million people and shortly this number will double. From a careful review, therefore, of all the available evidence, we are entitled to conclude that objections to fluoridation are objections to a valuable public health measure which has been shown to be not only beneficial, but safe.
§ The Question having been proposed after Ten o'clock on Wednesday evening and the debate having continued for half an hour, Mr. SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned at twenty-five minutes past One o'clock.