FLUORIDATION

HC Deb 06 March 1980 vol 980 cc772-800

9.6 pm

Mr. Ivan Lawrence (Burton)

I make no apologies for taking this opportunity to raise once again the question of fluoridation. It is an issue that has been described only this week by Dr. John Yamouyannis as the greatest medical fraud of the century". He made that comment when he spoke earlier this week to the all-party anti-fluoridation committee, of which I have the honour of being chairman.

Dr. John Yamouyannis is one of the foremost experts in this field. He is an American biochemist whose experience and bona fides are acknowledged by all but a few who have no knowledge of the man and little knowledge of his subject. Their passion for mass medicating the public's water supply with a possibly dangerous substance understandably leads them into total errors of judgment. Apart from his presence in Britain to explain the Burk-Yamouyannis study that indicates the link between fluoridation and cancer, which may take upwards of 10,000 lives a year in the United States, there are two other reasons for raising this subject.

First, there is the recent news that another half a million people in the West Midlands will receive fluoridated water by 1981. That brings the total number of those who drink fluoridated water in Britain to nearly 10 per cent. That area in the West Midlands includes Coventry, part of Solihull, Warwickshire and a small area of Hereford and Worcester.

Mr. Michael Spicer (Worcestershire, South)

My hon. Friend mentioned Hereford. Has he heard about the manner in which the area health authority has gone about putting its case across? Has he heard that the health commissioner has produced a document that indicts the local authority for the bureaucratic and insensitive way in which it has attempted to convey its case? Indeed, he used the word "pompous" in his report, which was published a few days ago. It has tried to bully through its case. I wonder whether my hon. Friend has heard of that report.

Mr. Lawrence

I have heard about the report, and it does not surprise me in the light of what I hope to say, which reflects on the regional authority, if not directly on the area health authority. At any rate, the extension of fluoridated drinking water is very much a Government responsibility.

The second reason why I raise this subject for debate is that there is circulating in the West Midlands area a quite disgraceful publication entitled "Fluoridation News", issue No. 4, January 1980, from the West Midlands regional health authority, and therefore published with taxpayers' money. That is another Government responsibility.

I do not propose to speak tonight about the infringement of individual liberty involved in forcing everyone to drink doctored water, not to save life, as with chlorine, but merely to improve some people's teeth, an improvement that could be brought about by more brushing and less sugar consumption. It is a drive that is regardless of whether the majority need or want that medication.

I also do not have time to deal with other interesting questions of how substantial or illusory the alleged benefits of fluoridation are or the legality of fluoridation or the completely undemocratic process by which it often occurs. My hon. Friend the Member for Worcestershire, South (Mr. Spicer) gives a further example of how some areas in his constituency have recently started to be fluoridated by the Severn-Trent water authority. I shall concentrate on some of the preposterous assertions in "Fluoridation News" by individuals and an organisation which the citizen has a right to expect will not mislead him and whose scientific conclusions such a citizen ought to be able to trust.

May I repeat a point that I always try to make when speaking on this subject. I am not attacking the honesty of anyone. For all sorts of reasons—and it is true that some of them are hardly credible—honest and well-meaning men, doctors and dentists mostly, become convinced that fluoridation of the public water supply would be a good thing and then proceed to make statements in support of that thesis which are demonstrably false or which cannot be shown to be scientifically true. The publication is full of such statements.

Before I give a few specific instances, may I give one general example. The headline of that edition says: No truth in cancer allegations. I expect that that edition is circulated to health centres and other places where the public gather. If it were a headline in the Morning Star or another daily newspaper, the public would know that it was merely an expression of journalistic opinion, without the necessary authority behind it. They would be quite likely to take it with a pinch of salt, and no harm would be done. However, when they see that it is an official publication, the author of the article being no less than the Birmingham area dental officer, and they see inside that the work of the same regional health authority is endorsed in its fluoridation extension by none other than the Secretary of State, all caution will surely go out of the window. The absolute accuracy of the statement No truth in cancer allegations is likely to be accepted. People are likely to take the headline as being scientifically substantiated fact which no reasonable body could in any way challenge.

They would be wrong. They would have been misled by that headline. The truth is that the headline is just opinion, and an exceedingly bold overstatement of the true position, even for someone in favour of fluoridation. The reader would be very surprised, not to say alarmed, to discover that what purports to be scientific fact is no such thing and has been rejected as such by reasonable bodies.

Let me give two examples. The first is the judgment in a court of law in the United States. For five months in 1978 Justice Flaherty heard the best scientific evidence that the pro-fluoridation lobby could muster to argue that there was no truth in the cancer fluoridation allegation. For probably the first time, those scientists gave evidence on oath, and they were tested in cross-examination. At the end, Justice Flaherty—who has since been elevated to the Pennsylvania Supreme Court—ruled that he was convinced that there was truth in the cancer allegations. He said: Point by point, every criticism defendants made of the Burk-Yamouyannis study was met and explained by the plaintiffs. Often, the point was turned around against the defendants. In short, this court was compellingly convinced of the evidence in favour of the plaintiffs. The plaintiffs were the citizens who were bringing an action against the water authorities on the basis that it was not safe to fluoridate the water.

He went on to give an example of one of the principal witnesses for the profluoridationists, who acknowledged certain unresolved doubts concerning the safety of fluoridation. When he was asked whether it was his testimony that he recommended fluoridation in water supplies, his answer was: I don't want to state on that. Later, on 31 July 1979, Justice Flaherty wrote to the mayor of Auckland, New Zealand, who had written to him about the matter, because all the water in New Zealand is fluoridated. The judge wrote: The trial brought into my court experts on the subject of fluoridation, and I meticulously considered the objective evidence. In my view, the evidence is quite convincing that the addition of sodium fluoride to the public water supply at one part per million is extremely deleterious to the human body, and a review of the evidence will disclose that there was no convincing evidence to the contrary. Since my decision, I have received hundreds of letters, quite a few of which have been sent by physicians and dentists, all concurring with my decision. He continued: Prior to my hearing of this case, I gave the matter of fluoridation little, if any, thought, but I received quite an education, and noted that the proponents of fluoridation do nothing more than try to impugn the objectivity of those who oppose fluoridation. I seriously believe that few responsible people have objectively reviewed the evidence. If you are interested, I suggest that you review the 2,800 pages of testimony and all of the exhibits presented in this case. That is the first of my examples. I need hardly say that there is no reference to that judgment in Fluoridation News".

I give a second example. In Quebec in November 1976 the new Government decided to make a thorough review of fluoridation before implementing a Bill requesting all municipalities to add fluoride to the water at 1.2 parts per million in order to prevent dental caries. That governmental inquiry consisted, as one would expect, of 10 highly qualified persons, such as the scientific adviser to the advisory council on the environment, the director of a hospital research centre, the chief of the environment protection services and the senior adviser to the Minister of the Environment for Quebec. The conclusion was in favour of an indefinite moratorium on fluoridation from August 1977, which is still in force.

It is difficult to select just one passage from the committee's report, and I recommend that hon. Members should read it all: it is not very long. The report suggested, under the heading of "Pathology of Fluorides": Fluorides are highly toxic for humans and a narrow margin separates an 'acceptable level' from a toxic level. According to Dean, at a 0.9 ppm level in drinking water approximately 12 per cent. of the children examined during the course of his investigations showed signs of dental fluorosis. At a 1.2 ppm level, 20 to 30 per cent. of the children showed signs of intoxication. It is not surprising, therefore, to find a recent study published in the American Medical Association journal which showed that nearly 70 per cent. of the children living within a fluoridated area and receiving vitamins containing fluoride had dental fluorosis. Dental fluorosis seems to be the first indication of chronic toxicity of fluorides. The seriousness of the diseases caused by fluorides appears to progress with the level of ingestion. … In people who drink greater than normal amounts of fluoridated water such as people with renal insufficiency, those suffering from polydipsia and people on dialysis machines, a number of cases of osteomalacia and/or osteosclerosis have been reported. The report continues: Two reports taken from the abundant literature on fluoride toxicity merit particular attention. The first one is a group of studies carried out by Rapaport which showed a dose/response effect between drinking water fluoride level and the number of mongoloids in the population. All are aware of the genetic factors which have an influence on this disease. It goes on: other studies have now shown quite convincingly that fluorides, by some still unknown mechanism, seem t o produce chromosome breaks and/or aberrations. These reports of unsuspected cellular damage are highly disturbing and merit all the attention of the scientific community. The second disturbing study is that of Yamouyannis and Burk which showed a higher cancer death rate in fluoridated cities than in comparable non-fluoridated ones. When first published, this study was ridiculed by public health officials. More recently, however, it has been reaccredited before a court of law as a scientific study done according to the state of the art. It is rather amusing to find that courts of law are doing the work that public health officials should have been concerned with. The Yamouyannis study is not altogether surprising, however, and many scienists have suspected their conclusions for some time. What is implicit in this study is that fluoridated organic compounds and the fluoride ion may be as potent carcinogens as chlorinated organic compounds". The report then says: The possibility of formation of fluoridated organic compounds either during the water treatment process in public waterworks or during later use by industry takes on a new dimension and should be of utmost concern to all who are interested in Public Health. This report, needless to say, is not referred to in "Fluoridation News". I wonder whether anyone imagines that anyone other than a handful of fluorofanatics would feel justified in taking the risks implicit in these two reports.

I shall refer to one or two particularly serious misstatements in an article in "Fluoridation News", which has the presumption to end with these words: It is a tragedy that the misinterpretation of data can generate doubts in the minds of those who do not have the medical and statistical knowledge to enable them to make their own informed judgments". The first misleading statement is this: The first set of results were published by Burk and Yamouyannis in 1977. That is quite wrong, but it is only a small point. They compared the cancer mortality of the 10 largest fluoridated cities in the USA with that of the 10 largest non-fluoridated cities. The results they published indicated, they claimed, an increase in the cancer death rate following water fluoridation. These figures have been re-examined by experts in this country and in America and they have shown a number of fallacies in the original publication". The article goes on to refer to some of those fallacies: The figures took no account of age, sex and ethnic structure of the population. It is well known that cancer is strongly related to age and to a lesser extent sex and race. When the mortality data is standardised to account for these factors, no association is found". The first of those statements—that The figures took no account of age, sex and ethnic structure of the population —is simply untrue. All except the earliest papers of Burk and Yamouyannis have taken those factors into account. Anyone who denies that merely proves that he has not bothered to read the latest studies. That is a complaint that can commonly be made against those who often speak loudest in favour of fluoridation. That is what Justice Flaherty said in the court case about that subject: Dr. David J. Newell who has a Ph.D. in medical statistics, and is head of the Department of Medical Statistics at the University of Newcastle, England, testified that the Burk-Yamouyannis Study did not take age, race and sex variables into account. For example, Dr. Newell stated the cities' populations were changed drastically between the years 1950 to 1970, due to the large influx of black people. Statistically, black people have a higher incidence of cancer than white people. Responding specifically to this criticism, Dr. Yamouyannis testified that the growth of cancer rates for non-whites coincides with their influx from rural to urban centres, and that there is no racial difference in susceptibility. Thus, he argued, the different racial mixtures of the subject cities are of no consequence. Furthermore, Dr. Yamouyannis stated that many cities stopped keeping records based on race in the late 1950s and the early 1960s, and that for the 1970 census the available figures were no longer reliable at all, since people were classified by asking them how they wished to be identified, rather than on a firmly defined basis. In response to the criticism that the Burk-Yamouyannis study age groups were too large and therefore distorted the results, Dr. Yamouyannis explained that he had broken the groups down into smaller ones to see which population groups were increasing in number, but he had found that the smaller groups had essentially the same increases in numbers as the larger ones, so the larger group could be properly used. As for the criticism of the sex variable not being taken into account, Dr. Yamouyannis responded that the proportion of males to females actually went down in the fluoridated cities as opposed to the non-fluoridated cities. Therefore, since males have a higher rate of cancer than females, if he had adjusted for sex in the manner suggested by his critics, there would have been an even larger cancer mortality than the Burk-Yamouyannis Study revealed". The judge seemed to think, and common sense seems to support, that the statement regarding age, sex and race in "Fluoridation News" is simply untrue. The statement when the mortality data is standardised to account for these factors, no association is found is simply untrue. The standardisation referred to was based, first, on data now admitted to have been inaccurate and, secondly, by drawing a line on a graph that only joins the starting point to the end point and ignores the other nine-tenths of the points. That is atrociously unscientific. On the contrary, once errors and omissions have been corrected, Burk and Yamouyannis said, an association between fluoride and cancer was shown in all the studies considered.

I could go on to indicate other misleading and false statements in the same article. Burk ignored sites where there was a decrease in cancer incidence or failed to read Kinlen's tables and footnotes correctly. I have no wish to bore the House more than is necessary. I merely make the point that in that article in "Fluoridation News" what is alleged to be scientific fact is at the lowest wrong and at the highest disputed by reputable scientists. Therefore, the article is misleading and ought not to be in circulation. Certainly it ought not to be in circulation through taxpayers' money.

But that article is not the only misleading matter in "Fluoridation News". Incidentally, I have provided my hon. Friend the Under-Secretary with a copy so that he knows to what I am referring. Another article by a former opponent of fluoridation tells why he changed his mind and saw the light. It is entitled Million reasons for a change of heart and states: I became convinced that the merits of the anti-fluoride case are in inverse ratio to the noises they make—says a former opponent". He explains that among other reasons the figures for Birmingham, since fluoridation in 1964, support the benefits of fluoridation. He says: The number of children in Birmingham making emergency visits to dentists with acute toothache dropped from 10,000 in 1964, the year of fluoridation, to 2,000 in 1975. The number of children given general anaesthetics for tooth removal dropped from 18,400 to 3,800 in the same period. In Wolverhampton it increased by 30 per cent. In Birmingham one in 3,500 children was supplied with false teeth: in Wolverhampton the figure was one in 280–12 times higher. In order to reach those conclusions, there would have to be a scientific consideration of the data. In order to say what effect fluoridation has had, one must be able to show what the treatment of teeth was like in the period up to fluoridation. There are two serious things wrong with the conclusion that that writer draws from the undisputed figures. The figures that he gives are not challenged, because they were the figures that were given to me by my hon. Friend in a parliamentary answer.

First, those figures are misleadingly selective. A fuller consideration of the figures shows that in 1965, before fluoridation, 113,536 children were examined, 44,815 fillings were made to permanent teeth and 4,367 fillings were made to temporary teeth. In 1976, after fluoridation's magic had more than halved dental decay—which is the boast that is put around in the West Midlands area—106,680 children were examined, 42,927 fillings were made to permanent teeth and 15,616 fillings were made to temporary teeth. In other words, per child examined, fillings to permanent teeth increased by 2 per cent. and to temporary teeth by 281 per cent. Therefore, a selective choice of figures is hardly a good scientific basis for feeding those members of the public who are expected to read "Fluoridation News" and to accept the statements therein as being scientific truth.

Secondly, the figures show an immediate sharp drop on fluoridation, which would be truly miraculous if the cause were fluoridation, as it takes several years before it stops teeth decaying. More likely, what happened in Birmingham was that with the public dispute and argument over fluoridation the attention that was drawn to it in the newspapers and the discussion about it with dentists, there was a campaign that alerted people to the dangers of dental caries. More teeth were brushed. More care was taken of children's teeth. Perhaps parents read more and learnt that a better diet helped to improve teeth. Perhaps the fashion of general anaesthetics for teeth removal, or for taking out a tooth when it could be filled, changed. Those are far more realistic explanations, in the light of the figures that I gave, than that immediately after the introduction of fluoridation there was a sudden drop in dental decay. Those figures are either unscientific and, therefore, false or, at their highest, disputed by statisticians.

Is it not time that the Government started to take more seriously new evidence about cancer and the benefits of fluoridation? We all respect careful scientific analysis, but is there any laboratory evidence in the world showing that fluoridation improves teeth or proving that fluoridation is completely safe? The opponents of fluoridation have laboratory evidence that it is not safe. I dealt with that matter in my last speech on the subject on 23 January, when the House debated the Merrison report on the National Health Service. That report recommended fluoridation, although it was not within the committee's terms of reference. It heard no evidence on the subject, even if the subject had been within its terms of reference.

This is the usual syndrome. The medical authorities all say "If Professor Sir Richard Doll and Leo Kinlen at Oxford university say that it is safe, that is OK for us." That is still just the opinion of two men. One part at least of their inquiries was based on inaccurate data. That was admitted. The fact that the data were inaccurate is not important. What is important is the fact that those two highly thought of and reputable gentlemen are as capable as anyone else of slapdash work. That is not a basis for building a whole theory of safety in the face of other evidence when the re- sults are 10,000 deaths a year in America and perhaps 2,000 a year in this country.

Certainly, if there is any doubt in the matter the risks are enormous. For the safety of the people, the benefit of the doubt must be given to those who can show evidence that fluoridation is unsafe. The Government must put aside the calcified blinkers of the Department and consider the evidence afresh.

I conclude by reading a letter that was written to Justice Flaherty by the chancellor of Fairleigh Dickinson university. It encapsulates what is wrong with the debate on fluoridation. Perhaps it is an indication of the way in which I hope the debate will progress. The chancellor, Peter Sammartino, in a letter to Judge Flaherty dated 19 December 1978, wrote: Having founded a school of dentistry I accepted fluoridation like everyone else and had faith in my faculty, in the ADA"— the American Dental Association— in the public Health Service, which made sizeable grants to our school. Then one day I read somewhere that water for kidney machines had to be defluoridated. Since I am prone to kidney stones, the statement aroused my interest. I found that the fluorides combine with the calcium in the body and could cause serious illness or even, death. I began to ask my dentists, all of whom are specialists in the field and for whom I have a great regard. In a pleasant way they said, Look Peter, this is not your field. Fluoridation is good and it decreases cavities by 60 per cent.' But I began to read and the more I read the more I became conviced that fluoridation was evil. I began to prod the ADA. Again, the cavalier response: Why everyone knows fluoridation is good. Do you think the Public Health Service would be for it if it wasn't good?' So I began to poke around in Washington. I ran into a wall of gobbledegook. They pointed majestically to the Kingston-Newburgh experiment. Well, I read the report of that experiment six times. That was the most unscientific and souped-up experiment ever foisted as a breakthrough. The strange part of it all is that the Department of Agriculture tells farmers not to use fluoridated water, and of course, the FDA —the Food and Drug Administration— forbade the manufacture of pre-natal fluoride tablets. But even if the case for the 60 per cent. decrease had been established (which it hasn't) the fact remains that in the United States and in a number of other countries it is becoming abundantly clear that the medical side-effects are most serious. And then, even if fluoridation were effective and even if there were no side-effects, the forced medication is totally repugnant to basic principles. Now, it is becoming evident that fluoridated communities have eventually a higher rate of tooth defects than non-fluoridated communities. I am 74 and it doesn't make too much difference to me, but when I think how every day, in fluoridated communities, we are adding a little poison to bodies, knowing full well that some of it (probably about 40 per cent.) is cumulative I cringe at our stupidity. Well, apart from Eire, Great Britain is the only country in the Common Market that now fluoridates its water. Apart from Portugal, a scheme in Basle in Switzerland and, I think, a scheme in Finland, no other countries in Europe fluoridate their water. The reason may be political, but my hunch is that even if there is no merit in any of the criticisms that I have read out tonight there is a lot of scientific support for the decisions that have been taken by those countries either not to touch fluoridation or to discontinue it if they have had it.

I therefore implore my hon. Friend and his Department to take their blinkers off and to look again in an objective way at the sum total of the evidence. I am sure that in the end they will agree that on an issue of such importance, upon which medical and scientific men of great calibre conflict, it would be totally unjustified to continue to fluoridate any water in this country.

9.43 pm

Mr. Anthony Nelson (Chichester)

I welcome the opportunity to contribute to the debate. My hon. Friend the Member for Burton (Mr. Lawrence) has done the House a service in raising this issue. The catalogue of scientific data which he has assembled and presented is persuasive and interesting, and it certainly behoves the Minister and the Department to reply objectively and to reassure people on this matter.

However, I hope that my hon. Friend will allow me to take a rather different line from that which he has taken in his speech. I do so without any pretence of having great knowledge of this matter or any scientific array of figures in front of me, but as a former secretary of the all-party dental health group in the House of Commons I have taken a general interest in this matter. My understanding has always been that the majority of principal health authorities in this country and internationally support rather than oppose fluoridation.

My hon. Friend dealt almost entirely with the scientific and medical evidence that has been assembled rather than with the point of principle of compulsory medication by adding fluoride to water supplies. It is important to differentiate between the voluntary and the compulsory use of fluoride. Presumably, if one takes as true my hon. Friend's conclusions, there is a case for reviewing the voluntary use of fluoride in its various forms in this country and elsewhere.

My view, on balance, is that fluoride is a considerable help in reducing the incidence of caries. An extraordinary fact which I found difficult to believe when I first heard it, but it is true, is that one in three people over the age of 16 have no teeth. In most cases tooth decay sets in in the first 16 years of a person's life. That is when fluoride can be of most assistance. Once people are adults, there is perhaps less need for fluoride.

It is important to understand that, however far we go down the road of voluntary dental health education programmes, however much we encourage the voluntary use of fluoride, we shall never be able to reach out to the many families and individuals who are entitled to basic standards of dental health without leaving open the option of using fluoride through the public water supplies. I hope that my hon. Friend the Minister will be able to reassure us on the medical evidence and will not close the door to the use of fluoride in water.

I hope that even those who question on a point of principle or on scientific evidence the addition of fluoride to public water supplies will recognise that there is a place for the voluntary use of fluoride. One of the most valuable methods of administering fluoride as a means of encouraging dental health is through fluoride mouthwashes for children at school. This has been done in this country and abroad to some extent but not generally. Here, parents have an option, if they object to the use of fluoride, not to let their children use the mouthwash. If they feel that it is a valuable means of ensuring dental health, they have that option open to them, an option which perhaps they would not take if they had to buy fluoride pills.

I have a young daughter, and as soon as she is able to take them I intend to give her a daily dose of fluoride pills to ensure that she benefits from the protection that fluoride can provide. Can the Minister say anything about the extent to which his Department has considered making fluoride pills available through the National Health Service? I understand that they cannot be obtained on an NHS prescription. Although they are by no means expensive, the cost is sufficient to put many people off.

Perhaps more expensively but maybe most effectively, dentists can treat the teeth of young children with fluoride in various ways, thus providing the most adequate protection and the most effective treatment to ensure dental health in adult life. One method used is the topical application of fluoride. That is a simple procedure with young children whereby a mould is placed over the teeth on which the fluoride sets a fine coating. That is sufficient to protect children's teeth against caries for a long time. There is also a more effective method of fissure sealant whereby fluoride is introduced into the cracks in teeth, thus ensuring a more secure moulding protection for teeth. Although this procedure is more expensive and slightly more complicated to apply, it is one of the most effective means of treatment. Will the Minister say something about the extent to which such treatment is available from dentists under the NHS?

Returning to the question of the compulsory fluoridation of water supplies, it is appropriate for those of us who support fluoridation to question why we make out a case for the introduction of such a chemical into our water supply. My political leanings and personal inclination are against such compulsory measures. Nevertheless, the high incidence of caries in adulthood and the tremendous costs that we all have to meet for dental treatment either under the NHS or through private practice are sufficient to justify the case for leaving the door open on this question.

My understanding is that the financial cost of the application of fluoride through water supplies is infinitesimal compared with all the other options that I have described. The evidence that I have seen—and I recognise the force of the evidence presented by my hon. Friend the Member for Burton—does not lead me to the alarmist conclusion to which his evidence led him.

In to some extent putting the opposite view and, in so doing, representing a number of other hon. Members who are not able to participate in the debate, I hope that my hon. Friend the Minister will understand that there are views on both sides. It would be against my wishes and, I believe, those of a number of other Members if he were to respond by indicating that the door on the discussion of public fluoridation of water supplies will be closed.

Mr. Lawrence

I wonder whether I might put a point to my hon. Friend the Member for Chichester (Mr. Nelson), bearing in mind his concern for personal freedom and the problems of compulsion. Suppose that one set of scientists said that fluoride was safe and another set of scientists, equally credible, said that it was unsafe. Would not my hon. Friend concede that there was a doubt about the question of safety? If the effect of there being fluoride in the water was to kill one person—never mind hundreds or thousands—would his concept of freedom not drive him to the conclusion that the risk should not be run, and that if there was a doubt there should not be fluoridation? If his answer is "Yes", why does he take the attitude that he has manifested in the course of an otherwise interesting speech?

Mr. Nelson

The answer to the first part of my hon. Friend's intervention is "Yes". If a number of scientific experts came to the conclusion that fluoride was entirely safe, and an equal number decided that it was entirely unsafe, I would be a good deal more concerned than I am. My understanding—even after my hon. Friend's speech—is that that is not the case. My understanding is that the overwhelming majority of medical opinion is that fluoridation is safe.

Even if one decides that fluoridation is probably safe, if it is responsible for one death out of millions one must ask whether it is justified. I do not like to compromise on issues of principle. I know that my hon. Friend the Member for Burton does not like to compromise either. I am strongly against the compulsion involved in the seat belts issue, for example. However, on this issue one must make a judgment. It is not entirely black or white, good or bad or entirely true or false. That is why a political decision and judgment are involved.

From what I have read, the majority of evidence indicates overwhelmingly that fluoridation is beneficial to dental health. It is likely to reduce substantially the incidence of caries. I do not rule out the possibility of some people reacting badly to fluoridation. However, some people react badly to penicillin. Nevertheless, it would be wrong to rule out the application of that medication, because it is beneficial to the majority.

9.56 pm

Mr. Nicholas Winterton (Macclesfield)

I am pleased to contribute to this important debate. I congratulate my hon. Friend the Member for Burton (Mr. Lawrence) on being able to debate this subject so unexpectedly. My hon. Friend the Member for Chichester (Mr. Nelson) said that the issue was not clearcut and that it was not black or white. The issue will be mottled or brown if the Government side with the pro-fluoridators and legislate compulsorily to fluoridate water supplies.

I pay tribute to my hon. Friend the Member for Burton. I do not think that I shall tread on any bureaucratic toes if I say that he probably knows more about the subject than the Under-Secretary of State who is to reply to the debate. My hon. Friend probably knows more about it than many of the civil servants in the Department who have probably provided the Under-Secretary of State with a brief.

I had the privilege of sitting with my hon. Friend the Member for Burton on the Social Services and Employment Sub-Committee of the Expenditure Committee in the last Parliament. We carried out a lengthy inquiry into preventive medicine. Teeth and fluoridation took up much of our time. We heard conflicting evidence. My hon. Friend has presented a good argument for the Government's being careful about the stance that they take.

The Under-Secretary of State might use the pro-fluoridation argument. Evidence from highly respectable and reputable medical experts indicates that fluoride can be dangerous to humans in the long term. My hon. Friend said that a certain percentage of fluoride taken into the body is permanently retained by the body. There is a strong case against the compulsory fluoridation of the public water supply.

I shall not argue tonight the libertarian cause that it is wrong to medicate the water supplies, because that would mean compulsory medication for everyone in this country. I believe that it is wrong, and I am delighted that my hon. Friend the Member for Chichester supports this argument to an extent in that he does not believe that the House should legislate on the compulsory wearing of seat belts. I played a part in that debate, 10 days or so ago. My hon. Friend the Member for Burton played an even greater and more important part in that debate.

It being Ten o'clock, the motion for the Adjournment of the House lapsed, without Question put.

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

Mr. Winterton

I was saying that my hon. Friend the Member for Burton played an important part in the debate on seat belts, and I am sure that he will do the same tomorrow.

I am fundamentally opposed to compulsory medication. I am sure that my hon. Friend the Member for Chichester will say that we already have certain chemical components in public water supplies. I agree with him. Of course we do. That makes it safe to drink. It does not seek to medicate everyone, a small percentage of whom may benefit.

The statistics relating to Birmingham quoted by my hon. Friend the Member for Burton are pertinent. Statistics can prove anything. We can prove anything if we choose the right statistics. I am sure that I could present to the House or any other academic body an extremely good argument to support anything that I was putting forward by using statistics, as my hon. Friend the Member for Burton clearly illustrated.

Fluoride is an industrial waste. There is perhaps a hidden, faceless lobby that seeks to find a use for that industrial waste. Perhaps there is a profitable business in finding a use for it. I am happy to allow my hon. Friend the Member for Chichester to develop his argument and I await the reply of my hon. Friend the Under-Secretary about the voluntary use of fluoride.

Mr. Lawrence

It is not just that fluoride is an industrial waste; one-tenth of an ounce of fluoride kills immediately.

Mr. Winterton

I fully take the point made by my hon. Friend. Fluoride is a poison. I wonder how many people realise that. I fully support the argument that my hon. Friend the Member for Burton put forward earlier; I believe that there is a direct connection between the imbibing of fluoride and the incidence of cancer. It is interesting that cancer is an increasing problem in modern society. I wonder whether there is a more direct or alarmist connection between the adding of fluoride to the public water supplies and the growing incidence of cancer than that which my hon. Friend the Member for Burton put forward? I do not want to labour the point, but I do not agree with my hon. Friend the Member for Chichester that my hon. Friend the Member for Burton presented a dramatic or alarmist case. I believe that he gave the facts and figures that had been produced by reputable and respected people.

I hope that my hon. Friend the Under-Secretary will give a constructive and considered reply and not just quote from a brief provided by those faceless men who advise him and trot out the same old statistics from the DHSS.

I say to you, Mr. Deputy Speaker, that I believe that there is some form of conspiracy to try to foist upon the people of this country the compulsory medication of public water supplies. Successive Governments have toyed with this idea but because of the pressure of those of us who oppose them they have held back. I only hope that my hon. Friend will not be the one Minister to announce that the Government will support the compulsory fluoridation of all public water supplies in this country.

The evidence that my hon. Friend produced so extremely competently was compiled after lengthy work by many reputable people in the medical profession. What about the countries that have fluoridated their water supplies and have now terminated that practice? What about the states in the United States of America and the countries within the European Community and elsewhere in Western Europe that previously fluoridated their public water supplies and have now terminated the practice? What about the mottling of teeth where fluoride has been applied? What about the mottling of teeth of those who have imbibed fairly large quantities of fluoride? All these questions must be answered.

I hope, too, that my hon. Friend will reply sensibly on the probable connection between fluoride and cancer and the damage that might be caused later in life because fluoride has been retained in the body and has perhaps contributed to the contracting or development of cancer. My hon. Friend the Member for Chichester referred to the voluntary use of fluoride. If people wish to buy milk to which fluoride has been added, fair dos; I am in favour of that. That is a voluntary choice. The same applies to the taking of fluoride tablets or pills. Fluoride toothpaste is widely available.

Mr. Lawrence

Under the National Health Service.

Mr. Winterton

I do not know whether that is so, but I have used it. I have used it because it was a voluntary decision for me to make. I have three children. My oldest boy is now nearly l9½ years. He has only two minor fillings. That is because I have always advocated and encouraged the cleaning of teeth. In his early years I cleaned his teeth for him. He has always been taught to clean his teeth.

There are better ways of going about improving the dental health of the children and people of Britain than doing it compulsorily by fluoridating the public water supply. This is a matter of great importance. There is a great divide that extends beyond the two sides of the Chamber and exists between those who sit on the same Benches. We must have more dental health education. I say to my hon. Friend that he should not seek to introduce legislation compulsorily to add fluoride to the public water supply. If he does, my hon. Friend the Member for Burton and I will oppose him hook, line and sinker. We believe that it is fundamentally wrong and that the case has not been proved.

10.8 pm

The Under-Secretary of State for Health and Social Security (Sir George Young)

This has been an interesting and long debate. I shall try to deal with as many of the issues that have been raised as I can. If I do not have time to deal with all the issues, I undertake to write to my hon. Friends to give them replies to the questions they have asked.

I say to my hon. Friend the Member for Macclesfield (Mr. Winterton) that this is a subject that has interested me for many years, and long before I became a Minister. I remember attending one or two meetings of a Back Bench committee on health while in Opposition that was concerned with this very subject. I do not approach it entirely reliant on the advice of civil servants. I spent some time in Opposition briefing myself on the subject.

I am grateful to my hon. Friend the Member for Burton (Mr. Lawrence) for giving me the opportunity of restating the Government's position on fluoridation, as explained in a debate in another place on 15 November 1979 and by my right hon. Friend the Secretary of State for Social Services in the debate on 23 January on the report of the Royal Commission on the National Health Service.

My hon. Friend the Member for Chichester (Mr. Nelson) made a welcome contribution. He outlined the advantages of fluoridation. He was right to say that the area health authorities are in favour of fluoridation. In England, 84 of the 90 area health authorities have independently decided to fluoridate water supplies. There is a similar majority in Wales and Scotland. My hon. Friend asked me about alternative methods of fluoridation, as did my hon. Friend the Member for Macclesfield.

For the greatest protective effect against dental decay, fluoride must be provided from birth during the years of tooth formation up to about 14 years. Other methods are possible such as fluoride tablets, which benefit the individual rather than the community, but experience has shown that the necessary regularity of administration for the first 14 years of life is seldom achieved. Fluoride in school milk would not be ingested during the first five years of life, which is an important period of tooth formation, nor during school holidays. Moreover, some children do not like milk.

Salt has sometimes been suggested as a vehicle for fluoride. However, it is unsatisfactory for young children. Fluoride mouth rinses give much less benefit than fluoridation in relation to the resources required. Fluoride toothpaste, which now accounts for over 90 per cent. of toothpaste sales, has a useful complementary effect to that of fluoride in drinking water. Topical application—which I have had applied to my son—is available. However, I believe that it is not free on the NHS. One has to pay for it.

My hon. Friend the Minister for Health and I are about to undertake an active review of dental health policy. We shall look at these alternatives and discuss them with those concerned. My hon. Friend the Member for Macclesfield asked whether we had any plans for legislation. The Government have no plans to legislate on this subject. My hon. Friend referred to the work of the Expenditure Committee and to its conclusion. In contrast, a number of other bodies have also examined this subject. They have decided to support fluoridation. That includes the Royal College of Physicians, the British Medical Association, the British Dental Association, the Royal Society of Health, the World Health Organisation and, more recently, the Royal Commission on the National Health Service.

My hon. Friend the Member for Burton drew heavily on "Fluoridation News", issued by the West Midlands regional health authority. I hope he will accept that my Department has no direct responsibility for the West Midlands regional health authority. I shall draw its attention to his remarks.

I think I should first explain that fluoride occurs naturally in most water supplies, sometimes at a satisfactory level for the prevention of dental decay. Fluoridation consists merely of the adjustment to the optimum level for dental protection—one part per million in temperate climes—of the fluoride content of those water supplies that are deficient in it naturally. When water containing the optimum level of fluoride is consumed during the years of tooth formation, the protection conferred in childhood continues during adult life.

I recognise that my hon. Friend the Member for Burton was a member of the inquiry into preventive medicine carried out some years ago by the Social Services and Employment Sub-Committee of the Expenditure Committee of this House. The bodies which gave evidence to the Sub-Committee endorsed the efficacy and safety of fluoridation. They included the Royal College of Physicians, the British Dental Association, the British Medical Association and my Department. The Government continue to support their views today.

Fluoridation was proposed some 40 years ago because of observations by research workers of the better dental health of communities served by water supplies naturally containing about one part per million of fluoride. Contrary to suggestions made by opponents, the idea was proposed purely as a means of reducing the prevalence of dental decay, not only in individuals but in the entire community.

Studies from about 1945 onwards in the United States and Canada showed that consumption of fluoridated water in certain study areas, by comparison with low-fluoride control areas, led to a reduction in dental decay similar to that which had been observed in areas with an adequate level of fluoride naturally. For the best effect, fluoridated water had to be consumed from birth up to 14 years of age—that is, during the years of tooth formation.

On the recommendation of a mission sent by the then Government to North America, similar controlled studies were undertaken in the United Kingdom from 1955–56 onwards. Reports on the first five and 11 years of those studies, published in 1962 and 1969, showed substantial improvements in the dental health of children who had consumed fluoridated water from birth in the study areas. An expert research committee, set up to supervise the studies, concluded that it had shown fluoridation to be both safe and effective.

These and other studies in fluoridated areas of the United Kingdom could examine only the effects on the dental health of children, since fluoridation in those areas had not been in progress long enough for older people to have consumed fluoridated water from birth. How- ever, studies of lifetime residents of areas with similar proportions of fluoride naturally in their water supplies have shown that a satisfactory intake of fluoride in childhood confers a protection against dental decay that persists during adult life.

Some years ago, the Royal College of Physicians, as an independent body concerned with public health, set up a committee to carry out a comprehensive survey of the evidence on the safety and efficacy of fluoridation. The Royal College published a report in 1976, concluding that fluoride in water, added or naturally present, over the years of tooth formation substantially reduced dental caries throughout life. There was, moreover, no sound evidence at all of harm to health.

Mr. Lawrence

Will my hon. Friend give way?

Sir G. Young

I wonder whether I may make progress, and I shall give way in a few moments. I must try to respond to the arguments put forward.

One chapter of the Royal College's report dealt with the alleged link between fluoridation and cancer and concluded that there was no evidence that fluoride increased the incidence or mortality of cancer in any organ. That, however, has been the main point of criticism by those who allege that fluoridation is not safe.

Mr. Lawrence

On that very point, is my hon. Friend aware that the Royal College of Physicians did not take into account the Burk-Yamouyannis studies?

Sir G. Young

The next line of my speech runs as follows. Two United States biochemists, Drs. Burk and Yamouyannis, have claimed that cancer mortality increased more in 10 fluoridated American cities than it did in 10 unfluoridated cities over the same period. That claim has been examined in much detail by cancer epidemiologists and medical statisticians here and in North America, who have independently concluded that there is no difference in the changes in cancer mortality in the two groups of cities when appropriate corrections are made for demographic factors that play an important part in the complex matter of cancer causation.

Much is made of some small corrections needed in the results obtained by these experts, but these occurred through slight transcription errors, which happened when the published national statistics were collated for their use. As I have said, their statistical analyses were conducted independently, and the corrections that they made—and published—did not affect their conclusions.

It is entirely defensible to use as basic data statistics collected in that way and, despite suggestions to the contrary, this is quite different from accepting another scientist's experimental results.

Drs. Burk and Yamouyannis have since announced the results of further analyses, although without necessary supporting evidence at certain critical points.

If, as my hon. Friend said, Dr. Yamouyannis yesterday described fluoridation as the greatest fraud this century, at best he was mischievous and at worst he has caused quite needless concern.

Dr. Burk has also re-examined data published in a 1974 paper from Oxford university about differences in cancer incidence in various organs between certain fluoridated areas and certain similar control areas and between sets of areas with varying levels of fluoride naturally in their water supplies. I understand that differences in the Oxford paper could have arisen by chance or because of difficulties in the selection of adequate control areas and do not indicate an association between cancer incidence and fluoride in drinking water, whether present naturally or artificially.

Moreover, Dr. Burk has attempted to show from these and other figures that cancer mortality has risen more in Birmingham since fluoridation than in Manchester and other unfluoridated British cities. However, I am advised that he has selected figures from the Oxford study that tend to support his case and that he has not taken account of appropriate demographic factors. I understand that, while the increase in cancer mortality may be greater in Birmingham since fluoridation than it was in Manchester, it was less than in unfluoridated parts of the West Midlands. Moreover, the increase in cancer mortality was greater in certain other unfluoridated cities.

Perhaps it is relevant here to recall what the Royal College of Physicians' report said on the subject of Birmingham, since my hon. Friend mentioned it. That report considered allegations that the cancer death rate had risen unduly in Birmingham since fluoridation started there in 1964. It pointed out, by reference to the Registrar-General's Statistical Reviews of England and Wales, that mortality from cancer, and from leukaemia in particular, had not increased in Birmingham relative to low-fluoride parts of the same area. Slight increases had occurred in both, but these were greater in the low fluoride areas. The chapter concluded: There is no evidence that fluoride increases the incidence or mortality of cancer in any organ. The college considered that the enormous body of information bearing on the subject of fluoride and health amply justified the conclusion that there was no evidence that the consumption of water containing about one part per million of water in a temperate climate was associated with any harmful effect.

No other studies carried out by appropriately qualified persons and published in scientific journals of good repute support the allegation of a link between fluoridation and cancer. Moreover, the suggestion that fluoride is a carcinogen is not supported by reviews by experts in this and other countries and reviews that have taken full account of animal and other laboratory studies, as well as epidemiological studies of cancer in several countries. No properly authenticated tests have supported the conclusion that fluoride salts as used in fluoridation are a mutagenic hazard to man.

Perhaps I can now deal with the question of an inquiry by my Department into these matters. Press reports last year were wrong in suggesting that Ministers had instituted a formal inquiry. However, as my noble Friend Lord Cullen of Ashbourne said in another place on 15 November 1979, this does not mean that we shall not continue to examine carefully any properly supported claims that may be made as to the safety or efficacy of fluoridation, even though we are at present satisfied on both counts. Indeed, following approaches to my Department by Drs. Burk and Yamouyannis, my professional advisers have been in correspondence with them and they have recently received answers to a number of questions about both their published and unpublished work. They will be studied with care and, as is always the case with a matter of this kind, advice will be obtained from the academic experts who regularly advise my Department, to the extent that it may prove necesssary.

It was suggested during the debate that fluoride was a poison. Fluoride is a natural substance and it occurs widely in the diet and most water supplies. In some water supplies, it occurs naturally at around the level of one part per million used in fluoridation. Fluoride, like many other items in the diet such as salt, iron and vitamin D, would be toxic if taken in great excess. However, at a level of one part of fluoride per million parts of water it cannot be considered poisonous.

Those opposed to fluoridation have pressed for a formal inquiry, and even for a suspension of our efforts to encourage fluoridation. The Government are clear that that would be unjustified. No a priori case that there is a cancer hazard has been established. In the past, Drs. Burk and Yamouyannis have been prepared to advance arguments based, for instance, on the use of figures which take no account of demographic differences between populations or on the selection of results which tend to favour their case, which receive no credence in usual scientific circles. Their more recent, and somewhat more sophisticated, published work contains notable omissions. Much of their case depends on claims to an American court, unbacked by publications. The material that has now been provided may repair some of these omissions. It will be examined objectively and in detail. The result of the study will come before Ministers in accordance with normal procedures. But, it would be quite wrong to anticipate that their claims will in the end prove to be justified.

I should like also to refer to the case brought by local residents before the Court of Common Pleas, Allegheny County, Pennsylvania, to require a water authority to stop fluoridation in parts of Pittsburgh and some outlying districts. The judge, sitting alone, said he was "compellingly convinced" of the plaintiffs' evidence, based largely on claims by Drs. Burk and Yamouyannis of a link between fluoridation and cancer. He therefore issued a preliminary decree until the court held a final hearing or until the matter was dealt with by the Pennsylvania Department of Environmental Resources.

Although the court's jurisdiction is still the subject of an appeal, the Department of Environmental Resources has considered the evidence given in the court but has, nevertheless, directed that the water authority should continue to fluoridate. Fluoridation also continues in the rest of Pittsburgh, where it began in 1952.

Perhaps I could say a word about the position in Canada, since it was raised by my hon. Friend the Member for Burton. Fluoridation began in Canada in 1945. Of the total population of 18 million with piped water, 46 per cent.—8.3 million—at present received fluoridated water. The decision to fluoridate rests with individual communities. On the basis of a preliminary report, the new Quebec Government decided to suspend implementation of their predecessors' Bill which would have required communities to fluoridate. The report was based on the alleged fluoride-cancer link, although the Canadian Government hold to the view in their 1977 report, based on a detailed study, that no such link exists. The so-called "moratorium" does not, however, prevent other Quebec communities from fluoridating, although those are relatively small, because much of the population of the province is concentrated in Montreal. At present, fluoridation covers 14.4 per cent. of the Quebec population supplied with piped water.

The Canadian Public Health Association, with the assistance of Health and Welfare, Canada, undertook a study of fluoride in drinking water, and its final report, published in 1979, recommended that the optimum concentration of fluoride in Canadian drinking water should be established at 1.2 parts per million.

Perhaps I can also deal with the position in other countries abroad. Although the United Kingdom and the Republic of Ireland are at present the only EEC countries with fluoridation, the reasons why various Continental countries have not adopted it are not always completely clear. I understand that fluoridation had to stop in the Netherlands—where it had been adopted to a considerable extent—because of a Supreme Court ruling that a separate unfluoridated supply should be provided for those who wished it. This, of course, was impracticable on technical grounds. The measure continues on a substantial scale in the United States, Australia and New Zealand.

Finally, as my right hon. Friend indicated last January, it remains the Government's view—like that of their predecessors for many years—that extensive trials throughout the world have shown that fluoridation safely and effectively reduces the prevalence of dental caries—one of the commonest diseases and one which has lifetime consequences for general and dental health.

Of course, my advisers will be examining figures of cancer incidence in fluoridated and non-fluoridated areas of the country from the usual sources, alongside the material provided by Drs. Burk and Yamouyannis. All this information is rigorously analysed by experts in my Department who are fully conscious of their responsibility for public health and are supported by the best independent advice that is available. They are satisfied that the current policies are right, and Ministers in the Department fully endorse their views.

Question put and agreed to.

Adjourned accordingly at twenty-six minutes past Ten o'clock.