HC Deb 10 November 1978 vol 957 cc1468-82

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Graham.]

4.19 p.m.

Mr. Ivan Lawrence (Burton)

I am grateful for this opportunity of raising a matter that is fast becoming a national scandal—the question of continuing fluoridation of this nation's water supplies. It is reaching scandalous proportions because there is now what there has not been over the 20 years or so that fluoridation has been a subject for argument—powerful evidence that it may be contributing to at least 10,000 excess cancer deaths a year in the United States. Translated into terms of Britain, where 9 per cent. of the population is drinking artificially fluoridated water, those figures mean that over 1,000 and possibly as many as 2,000 people may be dying each year in this country for this reason.

Although it is now three years since the strength of the evidence became obvious, it has not yet been convincingly refuted, although spurious efforts have been made unsuccessfully to discredit it. We are talking not about mere academic argument, nor are we playing mere childish games. We are talking about many people who may be dying agonising and unnecessary deaths.

That I shall be accused of scare-mongering in giving publicity to the evidence does not worry me. I have no doubt that such an accusation was made against those who doubted the safety of asbestos or thalidomide. That the many distinguished doctors and scientists all round the world who have expressed doubts about the safety of fluoride will be branded as cranks and charlatans will not, I expect, worry them, for they are in the tradition of Galileo, William Harvey, Semelweiss and countless others who in their time doubted the conventional scientific wisdom, were reviled and finally were shown to be right.

However, I should like to say this about myself. I do not think that I have a reputation for being immoderate or more of a publicity seeker than any other hon. Member. I am certainly a most reluctant convert to the anti-fluoridation campaign, for I started by being a cynic, by being sceptical about those who endlessly and often irritatingly challenged the opinions and views of some of the most highly respected and eminent medical men in the land. But I have been stirred up to join the fight not only by the hardening of the evidence throwing doubt upon fluoride's safety but by the very peculiar, often misleading and sometimes even paranoid behaviour of the pro-fluoride lobby. If these are the lengths that the pro-fluoride lobby is prepared to go to to deny that there is even a glimmer of doubt about the safety of fluoridation, I am driven to ask myself what on earth it is hiding.

I am a lawyer, not a scientist, so I do not pretend that I know whether fluoridation is safe. With a lawyer's training, I can only ask myself "What is the evidence and how dependable are the witnesses who give it?"

Let me tell the Minister of State, Department of Health and Social Security some of the things that have made me lose confidence in those who so strongly propound the pro-fluoride case. When he replies, rejecting as I expect he will both my conclusion and my argument, he will doubtless rely heavily on the judgment of the Royal College of Physicians in its booklet published nearly three years ago and written, I expect, just over three years ago, "Fluoride, Teeth and Health". I expect that he will also tell me that the views of the Royal College have been endorsed by such independent opinion as the British Dental and Medical Associations, the Royal Society of Health, the World Health Organisation, the National Cancer Institute in America, the Royal Statistical Society, Dr. Taves of Rochester university, New York, and finally, and conclusively, by the eminent medical authorities, Professor Sir Richard Doll, Regius Professor of Medicine at Oxford, and his colleague, Dr. Leo Kinlen, in their paper published in The Lancet on 18th June 1977, nearly—I stress this—one and a half years ago.

What I do not expect the right hon. Gentleman to tell me is that the so-called independence of all those studies is very much open to question. As to matters of safety, the British Dental and Medical Associations were relying principally on the conclusions of the Royal College of Physicians. The two principal authors of the passages on safety in the booklet were Professor Doll and Dr. Kinlen, the distinguished gentlemen who later confirmed the accuracy of their own report in the article in The Lancet. As for the independence of their work, it appears that they base their conclusions upon data and essentials of analysis provided for them by the National Cancer Institute of America, which contains some fundamental statistical errors and quotes the same Doll and Kinlen as supportive authority for the National Cancer Institute's own conclusions.

The absurdity of the affirmation of independent surveys does not, alas, end there. The inaccurate data were then passed on to form the basis of Dr. Taves' support for the Royal College of Physicians and then to the Royal Statistical Society, which likewise gave their support. In other words, if one takes away the data and analysis done by the National Cancer Institute of America, the whole misleading pack of cards built to look like an independent survey collapses. I do not honestly believe that that strengthens one's confidence in the reliability of the pro-fluoride case. I ask whether the Minister thinks that it does.

Another pro-fluoride approach for which I do not much care was demonstrated by the West Midlands regional health authority when representatives of it came to see West Midlands hon. Members in June. It was suggested that we would be falling behind the rest of the world if we did not rush to fluoridate our water. The truth is otherwise. Apart from Australia and some Iron Curtain countries, the general picture is of countries having more and more doubts about the merits of fluoridation.

There is no fluoridation of the public water supplies in Austria, Belgium, France, Greece, Italy or Norway. There is little of it in Switzerland, Portugal or Finland. It has been expressly banned by law in Denmark and Spain and discontinued and banned after 18 years of continuous use in West Germany, after 23 years of use in Holland and after 10 years in Sweden. In America, which had been fluoridated to up to 40 per cent. of the population, nearly 3,000 cities have recently dropped the practice and a number of States have rejected moves to introduce fluoridation.

It appears that fluoridation is becoming passé. It is misleading to pretend otherwise.

Mr. David Mitchell (Basingstoke)

Is my hon. Friend aware that the Wessex regional health authority followed its statutory duty and consulted the local authorities in the Wessex area? Is my hon. Friend aware that 11 out of 13 of those authorities were totally against fluoridation but that the health authority then went on to give its consent and approval for fluoridation? Is not that a further example of the extraordinary way in which officialdom seems to know better than the people for whom it is officiating?

Mr. Lawrence

Not only does that support the trend of my remarks and draw attention to the immense amount that is being done in this area by my hon. Friend the Member for Basingstoke (Mr. Mitchell) but it shows that the age of common sense has not yet entirely passed, for at any rate some of the local authorities that are scattered around the British Isles.

Another feature of the Government's presentation of the pro-fluoride campaign which is misleading is the way in which they speak of fluoridation safety in their circular to the community health councils and others who are part of the decision making process.

I can just about understand why the Royal College of Physicians in its summary of the cancer criticism allowed itself to say baldly: Studies in the USA and Britain have found no relationship between cancer mortality or cancer incidence and fluoride levels in water supplies. The Royal College might not have had time to read the new evidence of the fluoride-cancer link, although it was published six months before that quotation and it is referred to indirectly in footnote No. 18 on page 61.

But I cannot understand the Department telling the Central Derbyshire community health council earlier this week, as is reported in the Derby Evening Telegraph, that the Department could assure members that none of the research, either in this country or abroad, had revealed any harmful effects.

If that is being said, it is utterly disgraceful. The truth is that there is now a substantial amount of evidence of its harmful effects. I am not talking of the vast evidence that fluoride in substantial enough quantities is a dangerous poison which not only discolours teeth and makes them brittle but destroys plants, dissolves human bone, harms the kidneys, causes mongolism and induces a wide variety of allergies—all of which is attested to by medical men in positions of distinction.

I am talking about the evidence of Dr. Ali Mahomed, the professor of biology at the university of Missouri, that fluoride at one part per million—the level of recommended use in the public water supply—produces not only tumours in plants and insects but also cancer and genetic damage to mice. That evidence has recently been repeated on oath in a civil trial brought in Pennsylvania by citizens against a fluoridating water authority and, I understand, was not impeached in any way.

I am also talking of the evidence of Dr. Waldbott, a leading expert in allergies, at the same court hearing, evidence that was certainly uncontradicted, to the effect that fluoridated water accumulating in humans over many years can cause cancer because fluoride is capable of damaging every cell in the body. I am also talking about the evidence produced by Austrian scientists which explains the process by which fluoride can induce cancer, by interfering with the repair DNA, a substance central to the cancer molecule. All this can hardly truthfully be represented as no evidence.

I want to talk specifically about what is at the heart of the fluoridation-cancer link—the evidence of Drs. Burk and Yiamouyiannis, first produced in 1975 and still surviving attempts to discredit it. In what was a very large and extremely thorough epidemiological study, these scientists have demonstrated a striking association between cancer death rates and artificial fluoridation in public water supplied to 18 million Americans in 20 of the largest American cities over a period of 30 years. They chose 20 cities which, in the 10 or so years up until 10 of them were fluoridated, were approximately equal in size, were geographically balanced, were environmentally similar and had roughly identical cancer death rates. Between 1952 and 1956, 10 of the cities were fluoridated, and almost immediately the crude cancer death rate in them rose to about 220 or more per 100,000, while in the unfluoridated cities the crude cancer death rate rose only to about 195 to 200 per 100,000.

Mr. Toby Jesse (Twickenham)

As the claims of the American doctors, Burk and Yiamouyiannis, to whom my hon. Friend has referred, depend on not taking into account the differing age structures in the populations which they examined, is not my hon. Friend taking a terribly heavy moral responsibility upon himself if he seeks to scare the public and the water authorities away from taking a simple health measure, which has been proved to result in a massive cut in pain and dental decay among children, of which he has made absolutely no mention at all so far?

Mr. Lawrence

I have not had an opportunity to mention the point that my hon. Friend has raised. Perhaps he will do me the kindness to presume that I shall be dealing with the point that he makes. I shall answer him briefly by saying that he is as misled as many other people, apparently, in this country into believing that the work that has been done on fluoridation has stayed still in the three years since the Royal College of Physicians produced its report. The work has gone on, and there is apparently no basis in the criticism, frequently made, to which my hon. Friend is referring, and with which I shall deal in a moment.

Since there was, in short, an acceleration of cancer deaths of about 10 per cent. concurrent with fluoridation in the work which has been done by Drs. Burk and Yiamouyiannis, there is clearly every cause for the gravest alarm. Every care of a scientific nature was taken to make sure that the figures could not be doubted on the usual grounds for statistical criticism. To provide a suitable control for the various other causes of cancer death, there is the experience of comparable population groups before and after fluoridation.

To show that there was no bias on behalf of the observers, the control method of a double blind design, where neither the scientist nor those taking part know that an experiment is taking place, exists here because the data were gathered by thousands of people before Drs. Burk and Yiamouyiannis came on the scene. An objective measuring stick for the observation is necessary so as not to build in prejudice by adopting a measure which allows the scientist to be subjective—and cancer death is as certain as anything can be.

These figures, being free from any of the likely scientific distortions, produce the inference that, in the absence of any other explanation, the most likely cause of the excess cancer deaths in those 10 fluoridated cities is fluoridation of the public water supply. These figures represent between 10,000 and 35,000 such excess deaths each year in the United States. If that may be true, there can be no question of artificial fluoridation continuing as anyone's policy. I think that we would all agree about that.

It follows that, if fluoridation is to continue, that evidence must be destroyed. The attempts to do so have often been pitiful and laughable, reflecting little credit on some of the critics. Alas, I do not have time in these 15 minutes to go through them all.

In 1975, the National Cancer Institute said that much of the excess was due to lung cancer. That was speedily disproved and the claim was abandoned.

In August 1975, it was said that, in some of the cities, the cancer death rate went down after fluoridation. Drs. Burk and Yiamouyiannis were able to show that the National Cancer Institute had got its figures wrong. In seven of the cities, the cancer death rate went up, not down, after fluoridation. The eighth city, Seattle, was not even fluoridated during the period studied. In fact, the statistics on cancer death, which are the basis of the graph alleging a cancer-fluoridation link, have now been accepted by the critics as being correct.

The basis of the remaining attack is that the entire difference can be explained by demographic shifts: that, since older people have more cancer than younger people, men have more cancer than women and blacks have more cancer than whites, it seems to have just so happened that all these factors came together in the 10 fluoridated cities to explain the difference. The coincidence would, of course, be incredible, but not impossible.

So Drs. Burk and Yiamouyiannis went back to examine whether those possibilities applied. They showed that, since the only reason why blacks appeared to have more cancer than whites was that more blacks lived in big cities, that criticism was valueless because all 20 cities under observation were big cities. They showed that, if the greater death rate of males was taken into account, the difference between the fluoridated and unfluoridated cities would have been greater, not smaller.

The doctors showed with hard data that, although after 1952 the fluoridated cities grew older faster than the unfluoridated cities, there still remained an acceleration of 5 per cent. in the fluoridated cities overall and that that difference was particularly obvious in people over 45 and again over 65.

Not to be outdone by this proof that their criticism had nothing like the strength necessary to disprove a fluoride-cancer link, the critics examined the evidence by the so-called indirect method of statistical analysis. Drs. Burk and Yiamouyiannis favoured the direct method, arguing that one could apply the indirect method only when there was no opportunity to employ the more accurate direct method. I shall not burden the House with the details of that analysis. I say only that the National Cancer Institute, in its analysis, made a number of cardinal errors.

First, there was a mathematical error in adding up the number of cancer deaths in fluoridated cities. Secondly, in using standardised mortality ratios, all data between 1950 and 1970 were conveniently ignored. Thirdly, a reference population was selected which was dissimilar to the observed population.

At the Pennsylvania trial, Dr. Yiamouyiannis demonstrated that when all mathematical error had been corrected and all available data used and a more reliable reference population chosen, even applying the unreliable indirect method, there was still the clearest evidence that the cancer death rate grew faster by 4 per cent. in the fluoridated cities.

It was on this erroneous data, incidentally, sent to Professor Doll and Dr. Kinlen in England, then to Dr. Taves of Rochester university, New York, and finally to Drs. Oldham and Newall of the Royal Statistical Society, that the claim is still being made that the evidence of Burk and Yiamouyiannis has been disproved. It has not. It is the attempt to disprove it that has failed. In short, the evidence of the fluoridation-cancer link established by Burk and Yiamouyiannis remains unimpeached to the present day.

The state of the evidence is that fluoride in water at low concentrations induces cancer and genetic damage in experimental animals, that fluoride can cause cancer in the human body, and that by a very widespread sophisticated epidemiological study unparalleled anywhere in modern science, covering the cancer-fluoridation experience of 18 million Americans over 30 years—

The Minister of State, Department of Health and Social Security (Mr. Roland Moyle)

Will the hon. Gentleman give way?

Mr. Lawrence

May I finish the sentence?

Mr. Moyle

I ask the hon. Gentleman to give way because I am interested to find out whether, apart from arguing his own case, he has so little confidence in it that he is unwilling that the counter-case should be put, since time is pressing on.

Mr. Lawrence

I am coming to the end. My conclusion is that, in the circumstances and in face of the evidence which has undoubtedly been presented, it cannot conceivably be said by any stretch of the imagination that there is no evidence. If all that stands between that and the possibility that people are dying is an academic argument over statistical analysis and there is nowhere any positive evidence of safety of a thorough scientific kind, surely the position is far too unsatisfactory for us to continue with what might be a thoroughly dangerous process.

It is incumbent upon the Government to stop all further fluoridation until a thorough, extensive, fully scientific, inquiry has been completed. Until evidence has been produced which places the issue beyond all doubt, this Government may be sending hundreds of British people every year early to their deaths, and I, for one, would not like to have to live with that knowledge.

I conclude with the words written by Oliver Cromwell: I beseech you, in the bowels of Christ, think it possible you may be mistaken.

4.42 p.m.

The Minister of State, Department of Health and Social Security (Mr. Roland Moyle)

I am grateful for an opportunity publicly to refute the groundless allegations of a fluoridation-cancer link. I have very little time and I shall therefore concentrate on essentials.

The hon. Member for Burton (Mr. Lawrence) said that he is a lawyer and therefore does not know about the balance in these matters or about the link between fluoridation and cancer. I accept what he says with reference to his own knowledge. I am in a similar position. I have to take advice. No one will prevent the hon. Gentleman from arguing his case, though I greatly doubt whether in the long run he has any possibility of establishing it. However, since he is a lawyer and not an expert in his own right in these matters, I must say that his statement that 1,000 to 2,000 people in this country are dying from cancer every year because of fluoridation is the grossest irresponsibility that I have ever heard since I have been in the House.

The nature of the evidence is such that, even if the hon. Gentleman were to establish his case—I do not believe that he is within measurable distance of doing so—he cannot make such an assessment, and a statement of that kind can only be designed to dramatise a case, which otherwise, I believe, would have no drama to it at all, and to draw attention to his views in a way which needlessly spreads anxiety among a large proportion of the population.

Mr. Lawrence

May I ask—

Mr. Moyle

No. The hon. Gentleman has already taken the greater part of the time available for this brief debate. I propose now briefly to set out the course of research into fluoridation and cancer which has been carried out in this country, if I can possibly get it on the record in the time remaining. This matter has rightly received much attention.

Over twenty-five years ago the then Government, on the recommendation of the Medical Research Council, sent a small expert mission to North America to study fluoridation schemes there. The mission reported that, although the evidence of harmlessness was so strong as to be almost conclusive, research should be encouraged into the effects on health and disease of the continued use of waters containing low levels of fluoride. Studies of fluoridation were accordingly begun in certain areas of the United Kingdom, in some of which fluoridation is still in progress today—with out evidence of harm to health—after over 20 years.

The then Government appointed a research committee, after consultation with the Medical Research Council, to review the evidence on the safety of fluoridation and to commission further studies where necessary. Reports were published in 1962 and 1969 respectively on the successful outcome of the first five and 11 years of the studies. The later report included the following statement by the committee: The Research Committee concludes that the fluoridation of drinking water at the level of one part per million is a highly effective way of reducing dental decay and is completely safe. Several years later the Royal College of Physicians, as I have said, paid much attention to the safety aspect, and concluded that there was no evidence that the consumption of water containing approximately one part per million of fluoride in a temperate climate was associated with any harmful effect.

The earliest investigations of the safety of fluoridation necessarily related to areas with similar proportions of fluoride naturally in their water supplies, compared with suitable low-fluoride areas as controls. Two such investigations, in the United States and in this country, were considered by the research committee on the United Kingdom studies and summarised in the 1962 report.

The investigation in the United States covered 32 pairs of towns in each of which one town had 0.7 part per million or more of fluoride naturally in its water supply and the other had less than 0.25 part per million. No statistically significant differences were found between these towns in mortality from all causes, and from heart disease, cancer, intracranial lesions, nephritis and cirrhosis.

Mr. David Mitchell

rose—

Mr. Moyle

No, I shall not give way.

The British study was on similar lines but covered a wider range of diseases. The results showed that the overall mortality was the same in the fluoride and control areas. Although some differences were found with certain causes of death, these were conflicting and there was no reason to believe that they were due fluoride. These figures were subsequently re-analysed by workers from the Medical Research Council and the London School of Hygiene and Tropical Medicine, who took into account water hardness and socio-economic factors and reported in The Lancet of 2nd November 1974 that they had found no statistically adverse effect of fluoride in water supplies.

At about that time the self-styled National Health Federation began to take an interest in these matters. I have no need to bolster a strong case by speculating on the motives of this body, but I need only say that it has in the past opposed other established public health measures, including pasteurisation of milk and vaccination against smallpox and poliomyelitis, and has sponsored unproved cancer remedies such as laetrile. An account of the federation's origins and activities appears in the Congressional Record for 16th December 1974. pages E7175 to E7177.

In 1974 the federation employed Dr. John Yiamouyiannis, a biochemist, with the specific aim of ending fluoridation in the United States. Since 1975 he and Dr. Dean Burk, a retired biochemist formerly employed by the National Cancer Institute, have been circulating information on an alleged relationship between fluoridation and cancer mortality. This allegation is based on data showing that in two groups, each of 10 large American cities, one fluoridated and the other not, crude cancer death rates rose in the fluoridated group more than in the unfluoridated group. The United States National Cancer Institute has shown, however, that these differences are nullified when necessary corrections are made to the crude mortality rates to take account of factors in the complex matter of cancer causation, such as age, sex, and ethnic group. I totally agree with the intervention of the hon. Member for Twickenham (Mr. Jessel) in the speech of the hon. Member for Burton.

The scientists of the National Cancer Institute made their own independent Investigations of trends in cancer death rates in the United States during 1950–69 and failed to find evidence linking natural or artificial fluoridation of water supplies to cancer. They also found no evidence of cancer risk attributable to fluoridation from a comparison of the numbers of cancer cases diagnosed in 1947–48 and 1969–71 in two major metropolitan areas, one fluoridated and the other unfluoridated.

The study indicated that the well-known risk factors in cancer causation, which I have mentioned, appeared to explain reported variations among fluoridated and unfluoridated areas. These results were published in the institute's journal for October 1976.

In this country the Royal College of Physicians was aware of these American allegations when, after a thorough review of the literature, it concluded in its 1976 report that there was no evidence—

The Question having been proposed after Four o'clock and the debate having continued for half an hour, Mr. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at eleven minutes to Five o'clock.