§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Allen.]
§ 10.1 pm
§ Mr. Desmond Swayne (New Forest, West)
The existing state of the law governing the addition of fluoride to the water supply is most unsatisfactory. The water industry resents the discretion—and, therefore, the responsibility—that is placed upon it. Those who oppose the addition of fluoride to water resent very much the power and influence that is placed in the hands of health authorities and water companies. For my part, I share the natural suspicion of any free man with respect to the presumption of health professionals to decide what is good for me and whether or not I should consume it. Are we horses to be led to water and forced to drink?
I am happy to take advice, from any informed source, about what may be good for me with respect to medicine or diet, but I reject utterly the notion that the decision about whether to consume should rest in any other mind than my own. However, it is not that philosophical question upon which I wish to dwell this evening.
My initiation of the debate results from the persistent lobbying of my constituent, Dr. Anthony Dunstan Fox, who practises in Barton-on-Sea. He has drawn my attention to the fact that fluoride compounds are a poison, so much so that I am persuaded that we should be taking considerable steps to remove fluoride compounds from our environment, not providing yet another source of them.
The state of the debate in this country is rather quaint. The Government pride themselves on their modernisations, so it is odd that we still appear to be addressing in this debate the preoccupations, fads and fashions of the 1960s and the 1970s. In the United States, for example, localities and cities are discontinuing their former policy of adding fluoride to the water. In Europe, that trend is equally apparent. Indeed, Germany—which is so much the model for the Government's modernisations—has abandoned the policy of adding fluoride to the water.
That trend is a consequence of a growing consensus—a growing body of evidence—that fluoride compounds are a poison. In the United States, the Food and Drugs Administration has required since June 1997 the makers of any toothpaste product containing fluoride compounds to publish a health warning on the packaging. Consumers who ingest the product are advised to seek the advice of a poison control centre. The National Treasury Employees Union, which represents the Government's most prominent scientists, toxicologists and lawyers, has voted unanimously to oppose any fluoridation of the water.
There is a growing volume of evidence of the poisonous consequences of fluoride compounds. In this brief debate, I cannot possibly do any justice to that evidence, nor am I qualified to do so, but I draw the attention of the House to the work of Dr. Phyllis Mollenix, the toxicologist at the Boston children's hospital in Massachusetts. Her work attempts to define a causal relationship between the presence of fluoride products and changes in brain activity that may give rise to hyperactivity and learning difficulties. Hon. Members may be aware of the work of Professor Shusheela, 700 who has tried to find a causal relationship between the presence of fluoride compounds in very small quantities and irritable bowel syndrome, anaemia, bone weaknesses, dental and skeletal fluorosis, genetic damage, still-birth and miscarriage.
However, the medical establishment in this country is still wedded to the notion that fluoride compounds are good for us and should be put into the water supply. It is either unwilling or incapable of addressing the growing volume of evidence. That may be due to intellectual laziness, but if it is, it is strange that it is wedded to a campaigning zeal. Its unwillingness to consider the evidence goes back a long way. As far back as 1970, the British Dental Journal contained an article which stated:Perhaps the greatest deterrent to meaningful political engagement of dentists in the promotion of water fluoridation is the mistaken but widespread assumption that to do so they must have full and complete knowledge of the detailed and voluminous scientific literature on the relationship of water fluoridation to dental and general health. They do not … as soon as dentists recognise their responsibility in the politics of fluoridation, their performance will be outstanding…the emphasis is on propagandising rather than education.I doubt that any of the Government's spin doctors could have put the point better. Indeed, it is an opinion of which Dr. Goebbels would have been proud.
All I can say about my party's position on fluoridation is that it was inherited from the previous Administration. My party believes that there are benefits from fluoridation—a view I regard as curious—but the decision to add fluoride compounds to the water should be taken locally. I believe that it should be taken at a very local level—by the consumer. Whether any meaningful locality could be defined for the purposes of a water supply is problematical.
I am grateful to my hon. Friend the Member for Rutland and Melton (Mr. Duncan) for opening up the debate on this subject. He has asked the medical establishment—the British Medical Association in particular—to produce new evidence to prove that fluoride compounds are good for our dental and general health, and that they are not bad for us. I welcome his initiative but, when surfing the internet, I noted that the website of the pro-fluoridation lobby names him as one of its supporters. As I understand it, that is not his position, and I urge him to correct that.
The medical establishment clings to the tenuous belief that fluoride compounds are good for our dental and general health, despite the fact that the evidence is pretty thin. If fluoride compounds attack the bacteria that would otherwise decay our teeth, it is probably because they attack all living organisms, including us. I cannot imagine why any mammal would ingest fluoride compounds. They are pollutants and are increasingly evident in our environment largely as a result of industrial and agro-chemical processes, such as fertilisers. We should make strenuous efforts to remove those compounds from our environment rather than add another source. If we add fluoride to our water, it will be in our milk; it will be in our cereals; it will be in our vegetables; it will be in our soup; it will be in our tea; it will be in our beer.
§ Dr. Doug Naysmith (Bristol, North-West)
Does the hon. Gentleman therefore conclude that chlorine should 701 not be added to water, because it is nasty? Chlorine is clearly a poison, which kills living things, including bacteria.
§ Mr. Swayne
I thank the hon. Gentleman for his intervention, but I sought an Adjournment debate so that I could speak about the addition of fluoride compounds to the water supply. I am uniquely unqualified to follow the direction in which the hon. Gentleman wishes to lead me. I shall merely say that I have the benefit of swimming a quarter of a mile in the Serpentine every morning, and that, fortunately, for most of the year chlorine is not added to the water—and very healthy it is.
It would be legitimate for the advocates of fluoride compounds to ask, "Where are the casualties? Where are the sick children, and the sick elderly people, who must be consequences of the fact that fluoride compounds are added to 10 per cent. of our water supply?" I would answer that question with another question: "What resources has the Minister's Department—have we—put into identifying the victims? What new studies have we initiated to update ourselves about evidence of the damage that is being done by fluoride compounds?"
In that context, let me draw attention to the findings of Dr. Schatz. Dr. Schatz is no ordinary physician: he discovered streptomycin. In 1993, Dr. Schatz said that artificial fluoridationmay well dwarf the thalidomide tragedy, which was dramatic because it produced crippled children who are living testimonials to what that drug has done. Many victims of artificial fluoridation, on the other hand, die quietly during the first year of their lives, or at a later age under conditions where their deaths are attributed to some other cause.I urge any water authority and any water company seeking to acquiesce to a health authority's suggestion that fluoride should be added to water to bear those words in mind. I urge the Minister to consider them before introducing any measure that would ensure that my constituents and their children had to drink water to which fluoride compounds had been added.
§ The Minister of State, Department of Health (Mr. John Denham)
I congratulate the hon. Member for New Forest, West (Mr. Swayne) on securing a debate on the important issue of improving oral health, especially that of children. As we have heard, the subject provokes forceful reactions both for and against the fluoridation of water supplies, and I think it important for me to discuss it in the broader context of public health.
The country has seen dramatic improvements in health over the past 50 years, and that includes oral health. Along with the key role played by the dental profession, the addition of fluoride to both toothpaste and water has made a significant contribution to reducing the amount of dental decay, especially in children. That is in line with the first of two key aims that we set out in our consultative Green Paper "Our Healthier Nation":to improve the health of the population as a whole".However, we cannot be complacent. More than half the country's 15-year-olds still experience decay in their permanent teeth. Significant inequalities remain in the oral health of the population.
For example, in 1995, five-year-olds in the west midlands had, on average, less than half the number of decayed, missing or filled primary teeth of those in the 702 north-west, and 19 per cent. more five-year-olds in the west midlands had no tooth decay at all compared with their counterparts in the north-west. A similar picture emerges when we look at 12-year-olds and their permanent teeth.
Above all, all other things being equal, the worst off in society have the poorest oral health. The Government are determined to change that and to narrow the health gap—the second key aim in "Our Healthier Nation". That was also the main theme of the recently published report of the independent inquiry into inequalities in health, which was led by Sir Donald Acheson, former chief medical officer at the Department of Health. The commissioning of that report by the Government should be viewed as a measure of our determination to tackle inequalities in health.
The great challenge for local health authorities is how to improve oral health generally and how to tackle those inequalities in health status. Reducing inequalities in dental health will not be easy. In some places, there is a history of sporadic dental attendance. Many people visit a dentist only when they are in pain. They may not maintain regular brushing regimes with fluoride toothpaste. Some children do not even possess a toothbrush.
That is why proposals are made to fluoridate the water supply in areas with high dental decay. The evidence shows that fluoridation of the water supply to the optimum level of one part per million can reduce the amount of tooth decay in children from similar backgrounds by one third to a half.
In this country, about 500,000 people receive water that is naturally fluoridated at, or about, the optimum level of one part of fluoride per million. A further 1 million people receive water that is naturally fluoridated at a lower level, but that still confers some dental benefit. Those areas are generally found in a band running down the eastern side of the country from Hartlepool in the north to parts of Essex. Some 5 million people receive water where the fluoride content has been artificially increased to a level of one part per million. Major schemes operate in Birmingham and throughout the west midlands, and in Tyneside.
The Government are aware of the persuasive evidence that fluoridation is an important and effective method of protecting the population from tooth decay. In "Our Healthier Nation" we quoted the example of Sandwell. The water supply there was fluoridated in 1986. Over the following 10 years, the amount of tooth decay in children more than halved. During the same period, Oldham, an area with a comparable population mix and no fluoridation, saw little change in children's oral health.
That example has been replicated in many other places over the past 50 years. Sadly, it is also true that, where fluoridation schemes have been withdrawn—in Anglesey and in Kilmarnock, for example—levels of tooth decay in children have risen, after having fallen during periods of fluoridation.
§ Mr. Alan Duncan (Rutland and Melton)
Does the Minister believe that mass fluoridation ever has any adverse side effects? Is he prepared to commission new modern evidence that will assess both sides of the argument?
§ Mr. Denham
If hon. Gentleman will bear with me, I was just going to turn to the scientific evidence and the issues that we need to consider.
703 I acknowledge that some people have concerns about the safety of fluoride. It is important to examine carefully any claims that risks may attach to fluoridation, as well as the benefits.
On the overall question of safety, it is unfortunately true that virtually all medical and public health intervention carries risks as well as benefits. On fluoridation, it is for scientists—specialists in toxicology and dentistry—to advise on the balance of those risks to the benefits, and for Government to decide what is acceptable.
The current position is that, over the years, many health problems alleged to be linked to fluoridation have been investigated and no link has been found. The most recent research in this country of which we are aware concerns a potential link with hip fractures. So far, that has also proved to be unfounded. There is yet to emerge any convincing evidence of harm to general health as a result of drinking artificially fluoridated water at one part per million. Indeed, it is estimated that, throughout the world, some 210 million people drink artificially fluoridated water.
The view that fluoridation of water at that level is safe is that of the majority of medical and scientific opinion throughout the world, based on practical experience and research over the past 50 years. There is currently evidence of just one minor, cosmetic side effect of fluoridation—dental fluorosis, or slight tooth mottling. Where water is fluoridated at the optimal level of one part per million and parents follow the instructions on fluoridated toothpaste to ensure that children do not swallow excessive amounts, that is seldom noticeable. The teeth are still endowed with extra resistance. If someone is concerned about the cosmetic effect, dentists have several remedies. Often a satisfactory outcome can be achieved by the dentist who polishes the teeth. Within that context, the evidence on fluoridation is highly persuasive.
Half a million people in Britain receive water that contains fluoride naturally present at a level close to or above the optimal one part per million, and 5 million people receive water supplemented to that level. The corresponding figures for the United States are 10 million people receiving naturally fluoridated water and 135 million people receiving supplemented water. Before and during the past half-century of fluoridation, there have been extensive studies of the health of those populations. Apart from improved oral health, the health experience of those receiving the optimal concentration of fluoride is no different from that of the population at large.
As to whether artificially added fluoride would have a different effect on health from the naturally occurring chemical compound, I have been advised that the chemistry of the fluoride ion is identical at relevant concentrations. The effects on levels of fluoride in blood, bone and urine, and the effects on teeth and bone, are identical. Therefore, we can learn from studies of populations who have been exposed to high concentrations of fluoride present naturally in drinking water for generations.
Too much fluoride can, of course, be harmful—just as too much oxygen, too much water or too much of some vitamins can be harmful. The experience on the Indian 704 sub-continent, where much drinking water comes direct from wells dug locally, reinforces the need for the rigorous controls that we have on water purity in the United Kingdom.
It is impossible to say precisely at what concentration fluoride poses a risk to health, but fluoride at the optimal concentration of one part per million has always been present in some water supplies. All the evidence from the United Kingdom, and other countries practising fluoridation, indicates that the total intake from such water, together with that from food and beverages such as tea, is harmless.
I should like now to deal with the process by which decisions on fluoridation are taken, and answer the question on research asked by the hon. Member for Rutland and Melton (Mr. Duncan).
§ Mr. Duncan
I am grateful to the Minister for giving way again; he has a bit of time left. How extensive would the adverse side effects have to be before he would deem mass medication to be unacceptable?
§ Mr. Denham
My understanding of the evidence—I have some scientific training, but not in this specific discipline—is that there is no evidence of harm giving rise to any question of deeming it to be unacceptable. I shall therefore decline the hon. Gentleman's invitation to take part in a hypothetical exercise. One should consider the scientific evidence that has been presented. Although millions of people drink water that has been fluoridated—either artificially or naturally—at one part per million, there is no evidence of damage to the health of those parts of the population.
§ Mr. Brian H. Donohoe (Cunninghame, South)
At what age do people realise the benefits of adding fluoride to the water supply?
§ Mr. Denham
The examples that I gave earlier in the debate show that fluoridation leads to significant improvement in the amount of tooth decay suffered by children. The Sandwell study suggests that, in the 10-year period after fluoridation began, the level of tooth decay in children more than halved. That is a significant change.
The final decision on implementing fluoridation schemes rests with the water undertaker. The Water (Fluoridation) Act 1985 was consolidated in the Water Industry Act 1991. Section 87(1) of the 1991 Act states:Where a District Health Authority have applied in writing to a water undertaker for the water supplied within an area specified in the application to be fluoridated, that undertaker may, while the application remains in force, increase the fluoride content of the water supplied by the undertaker within that area.December's judgment in the judicial review, in which the Tyneside health authorities sought unsuccessfully to challenge Northumbrian Water's refusal to accede to their request to fluoridate their water, confirms that the Act has not worked. Since 1985, 55 health authorities in England—nearly half, taking into account the mergers that have taken place in the past 12 years—have requested water companies to introduce water fluoridation, but none of those requests has been accepted. There have been no new fluoridation agreements since 1985, because none of the water companies has exercised their discretion to agree to a health authority's request. We said in the Green 705 Paper "Our Healthier Nation" that the legislation needed to be reviewed. The key issue is whether "may" should become "shall".
We have been encouraged by the readiness with which water companies have said that they are prepared to look again at the legal and practical problems of fluoridation. What they most want is clarity over the distribution of responsibilities. They have emphasised that their primary duty is to provide a sufficient and wholesome supply of water. They consider that the question whether a water supply should also contribute to wider public health objectives should be for the health service to decide. Should a fluoridation scheme be approved, the health service should meet the operational costs and indemnify the water operator against any unforeseen cost consequences. There is little in those arguments with which we disagree. We shall seek the views of the water industry on any proposals for legislative change.
§ Mr. Duncan
How does the Minister define an unforeseen cost consequence? Will he undertake that "may" will not become "shall" during this Parliament, given that the proposal was not in his party's manifesto?
§ Mr. Denham
I was about to explain how we intend to proceed. The Green Paper "Our Healthier Nation", which we published last year, initiated a consultation on oral health and fluoridation. The responses were overwhelmingly positive. The great majority took the view that no other oral health promotion measure would be as effective in reducing inequalities in dental health as the fluoridation of water in areas with high levels of tooth decay.
However, there were also comments from people opposed to fluoridation, mirroring some of the concerns expressed by the hon. Member for New Forest, West. Some commentators questioned the effectiveness of 706 fluoridation and, together with a larger group, argued—[Interruption.] The hon. Member for Rutland and Melton persists in interrupting. I was merely pointing out that the water companies have said that the health service should meet the operational costs and indemnify the water operator against any unforeseen cost consequences.
§ Mr. Denham
The hon. Gentleman has interrupted consistently. I must press on towards the end of my remarks.
Some commentators questioned the effectiveness of fluoridation. They joined a larger group of those who suggested that its safety was in doubt. A few were also opposed on the grounds that mass medication was unethical. I have acknowledged the breadth of views and representations from the water industry and others. We are considering all those views carefully in drawing up a policy statement to be included in the forthcoming public health White Paper planned for the spring.
I am not able to answer all the points that have been raised this evening, many of which will need to be addressed in response to that consultation process. The White Paper will take full account of the sensitivity of this issue, the potential benefits to dental health and the importance of building a consensus on clearly established evidence for the safety and effectiveness of fluoride.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-nine minutes past Ten o'clock.