HL Deb 26 January 1966 vol 272 cc84-98

2.58 p.m.

LORD DOUGLAS OF BARLOCHrose to draw attention to the question of mass medication, as exemplified by the fluoridation of public water supplies; and to move for Papers. The noble Lord said: My Lords, I beg to move the Motion standing in my name on the Order Paper. The matter which I am asking your Lordships to consider this afternoon is one which has been, and will continue to be, a source of much acute controversy among members of the community generally, because this is a matter which affects every one of them, and also among members of local authorities, because they are the instruments by means of which successive Ministers of Health have endeavoured to impose this nostrum upon us.

It is a matter of grave concern to all of us because it is an entirely unprecedented attempt at compulsory mass medication. It is all the more extraordinary in that a drug is forced upon every consumer of water, without regard to whether or not he could possibly benefit from it, and without regard to his age or state of health, in haphazard doses which depend entirely upon the amount of tap water which he happens to consume, and without the possibility of anyone withdrawing himself from this treatment. It contravenes the fundamental principles laid down by the International War Crimes Commission and applied at the Nuremberg trials relating to the principles upon which alone medical experiments may be conducted. These principles are, briefly, that the patient must know what is being done to him, must give his consent, and must be free to withdraw at any time. These principles are still true to-day and, indeed, under our law, no surgeon and no doctor is empowered to impose a treatment upon a patient without his consent.

Fluoridation is, therefore, a matter also of grave concern to members of local authorities and particularly to the local health authorities—that is to say, in England and Wales, the counties and county boroughs, and in Scotland, the counties and the large burghs. They are being urged to carry out this policy by a continuous stream of circulars and other publications, many of them paid for by the rates and taxes which the public are contributing. It is certainly strange that taxes paid by citizens who object bitterly to this proposal should be used for the purpose of influencing local authorities to impose it upon them.

The reason why the local health authorities come into this matter is that it is alleged by the Minister of Health that they have powers under Section 28 of the National Health Service Act, 1946. This section provides that a local health authority may, with the approval of the Minister, make arrangements for the prevention of illness and, with the like approval, recover from persons availing themselves of the services such charges, if any, as the authority consider reasonable. If Parliament had been told in 1946 that this was intended for the purpose of imposing compulsory medical treatment upon people, whether they need it or not, I cannot think that either House would have agreed to it. For myself, I do not believe that this section bears the meaning alleged, and I firmly consider that fluoridation is an abuse of the powers of local health authorities and of the Minister. Some day perhaps someone with sufficient means will be public-spirited enough to test this matter in the courts.

In many instances, of course, the local health authority is not a supplier of water, and in that case it can only try to persuade the local water authority to add fluorides to the water supply. This is a proposal which is regarded with some suspicion, and the British Waterworks Association has advised its members that they should not agree to add fluorides to the supply unless they obtain from the local health authority a complete indemnity against any claims or proceedings which may be brought against them. Even so, a number of water authorities have decided that they will not on any terms be parties to fluoridation. This includes Woking and District Water Company, the Thames Valley Water Board, the Mid-Wessex Water Board, the Cotswold Water Board, and a number of others.

If it be the case that local health authorities have no legal power to engage in fluoridation, then the question would also arise whether an undertaking by them to indemnify a water supplier could be enforced or whether it would be invalid as being ultra vires. But whether fluoridation is legal or illegal, it is in my view something which no local authority should for one moment consider. It involves the members of the council putting themselves in the position of doctors and arrogating to themselves the right to impose a medical treatment upon the whole of their citizens, which those citizens' own doctors could not impose upon them. This is a preposterous notion.

In fact, despite the strenuous propaganda of the Ministry and other bodies, many local authorities have refused to be parties to this tyranny. They include county boroughs, such as Liverpool, Manchester, Brighton, Cardiff, Carlisle, Plymouth, Halifax, York, and many others, and in many of these cases by a majority of two to one, or more. Many counties also—Cornwall, Devon, Kent, Norfolk, East Suffolk, and others—have rejected it. In Scotland, too, Aberdeen, Dundee, Dunfermline, Kinross, Sutherland and other local health authorities have voted against the proposal. I do not believe that any local authority would have approved this policy if the issues had been clearly presented to them, instead of being obscured by emotional appeals, irrelevant arguments, dubious statistics and the suppression of material facts.

Let me, therefore, try to make clear what are the basic issues and what are the relevant facts. The question is not whether fluorides administered to children can, in some cases, to some extent and for some time, afford a resistance to dental decay. The first question is whether it is right to compel the whole population to take fluorides. No one would object to the State or to the local health authority offering to supply fluorides, in tablets or in solution, to be taken in the way in which medicines are normally taken, but with liberty for the patient or for the patient's parents or guardian to refuse, if they do not consider this kind of therapy to be desirable. But to force people to take fluorides by the device of putting them into the public water supply is a totally different proposition, involving not only compulsion, but arbitrary dosage and the continuance of the treatment for a lifetime.


My Lords, may I ask my noble friend a question? Where water naturally contains fluoride, is he suggesting that it ought to be removed?


My Lords, that would be a very good thing. I will come back to this point in a moment. So far as I know, there has been only one instance in the history of this country where a medical treatment has been compulsorily imposed upon the whole population—namely, vaccination against smallpox. That evoked so much and so determined opposition that a large avenue of escape was provided, of which very many persons took advantage, and ultimately the compulsory provisions were repealed by the National Health Service Act 1946. In that case there was at any rate the excuse that smallpox is a highly dangerous and infectious disease. Dental decay is not in that category. The case of vaccination is also instructive, because the vast majority of doctors over five or six generations obstinately held to the view that infant vaccination was essential, and it is only in the last few years that it has been officially admitted that vaccination should not be performed in the first year of life, and high medical opinion is that routine vaccination at any age is a mistake.

It is generally admitted by the advocates of fluoridation that fluorides in solution act on the teeth only during the period of tooth formation; that is to say, up to the age of about eight or perhaps ten years. It is also obvious that if fluorides are put in the public water supply, the dosage depends entirely on the quantity of water consumed, and this may vary between wide limits, especially in the case of very young children deriving the liquid they require mainly from milk and fruit juice, as compared with others drinking dried milk reconstituted with tap water. The whole idea of fluoridation is completely unscientific and entirely contrary to accepted medical practice. It is on that account, no doubt, that it is promoted by an enormous apparatus of inaccurate and misleading statements which are well calculated to mislead anybody who has not heard the other side of the case.

First of all, it is presented as if the choice were between fluoridation and no fluoride, and opponents of fluoridation are accused of depriving innocent children of the benefits of fluoride. That is not the issue. The alternatives are to have fluoride forced upon you, or to have the right to take it or not according to your own free will. Then it is said that fluorides are present as a natural constituent in almost all drinking waters. This is nicely calculated to make the casual reader believe that it is common to find natural water supplies containing the amount postulated to be desirable. This paves the way for the contention that: Fluoridation therefore consists merely of the adjustment of the optimum level for dental protection of the fluoride content of those water supplies which are deficient in it naturally. This sentence, which, like the previous one, I have quoted from the Ministry of Health booklet entitled Fluoridation, is quite a masterpiece of misrepresentation. It emphasises the insinuation that it is quite exceptional for water supplies to have less than the postulated amount, and that fluoridation is merely correcting an occasional aberration of nature. It further suggests that fluorides are essential in order that teeth should be healthy, and that there is some optimum level in the water supply which provides this amount. There is no evidence that fluoridated water is necessary in order that people should have healthy teeth. There are, and have been, millions of people with strong teeth free from dental decay who have never had any water containing any appreciable amount of fluoride, and this would be impossible if fluoridated water were an essential in human nutrition. I could quote many authorities on this matter, but I will quote from the standard text book on biochemistry by Professor Fruton and Assistant Professor Simmonds, of Yale University, who say: Bromide and fluoride, both of which are found in animal and plant material, are generally considered non-nutritive and toxic for higher animals. Nor is it possible for there to be an "optimum level" of fluoride in the water supply. There may be an optimum dose of fluoride, which, like the dosage of other medicines, would depend upon factors such as age, sex and bodily health. But it is self-evident that no level of fluoride in the water supply can yield the optimum dose for each individual, because the dosage in that case depends upon the quantity of water consumed. Moreover, the optimum dose for the five-sixths of the population, at least, whose teeth have matured is zero. Hence, in order to make this absurd proposal acceptable to the general public, the advocates of fluoridation are driven to asserting that "fluoridated water can have no harmful effect", and that it provides "a wide margin of safety". These, again, are statements from the Ministry of Health booklet. But if they are not true, fluoridation means sacrificing the health or shortening the life of some persons in order to protect the teeth of others. I do not think that this is a principle which many would be prepared to accept.

This claim that fluoridated water is absolutely harmless rests upon the assertion that in some areas where there are fluorides in the water supply, either naturally or artificially, no ill-effects have been observed. If this were indeed the case, it would not carry conviction. People smoked tobacco for centuries before it was established that there was a connection between smoking and lung cancer. Mercuric powders were administered to infants for many decades before it was recognised that they were highly dangerous. The history of the practice of medicine is full of such examples, and I will not multiply them.

But, my Lords, it is not true that no ill-effects have ever been observed in areas having fluoride in the water supply. In Japan, it was observed in a district near the coast, where there was no question of any deficiency of iodine, but where the water supply contained 0.3 part per million of fluorine, there were more cases of goitre than where the water supply contained only 0.1 part per million of fluorine. In both cases, the level of fluorine was only a fraction of that alleged to be safe, but increasing that fraction from one-tenth to three-tenths increased the number of cases of goitre. To give another example, in a district in Spain where the water supply contained 1.18 parts per million of fluorine it was found that from age 40 onwards the inhabitants suffered from an affection resembling rheumatism, and that this was frequently accompanied by some deformity of the spinal column.

Observation in India, where there are a number of areas with water supplies containing one part per million and upwards of fluorine, has shown that the bones are specially liable to be affected, especially the spinal column, in some cases resulting in severe paralysis and crippling of the lower part of the body. Numerous other illustrations can be found of well-attested medical observation of the ill-effects of fluorides in small doses. Indeed, hardly a month passes without some new scientific paper appearing which emphasises the folly of subjecting whole populations to the effects of a cumulative poison.

Even in official circles, happily, all do not speak with one voice. In 1957, the Food Standards Committee of the Ministries of Food and Health, in its report on fluorine in foods, said: There is considerable evidence that the drinking of water containing about one part per million is accompanied by a reduction in the incidence of dental caries. On the other hand, the drinking of water containing two parts or more of fluorine often gives rise to small white flecks on tooth enamel, and the softening of teeth. Now the usual practice of food and drug authorities, when they permit the addition of a cumulative poison to a foodstuff, is to limit the permitted amount to one-hundredth of the cumulative toxic dose. Adding fluorides to water supplies at the rate of half an admitted toxic dose is a dangerous violation of this wise principle, Fluoridated water is already in the toxic range; there is no margin of safety.

It can hardly be believed, of course, that any intelligent person can imagine that the toxic effects of fluorine are confined to the teeth when it is well known that fluorine is found in many other body tissues. Many years ago, Professor D. G. Steyne, who was then Professor of Pharmacology in the University of Pretoria, and who has probably conducted more research on fluoride toxicity than anyone else, noted that fluorides affected the functioning of the thyroid gland. He drew the conclusion that the ingestion of fluorides might affect the development of the fœtus and cause congenital deformities.

More recently, Dr. Ionel Rapaport, of the University of Wisconsin, conducted a series of investigations on the incidence of mongolism in high and low fluoride areas in four of the United States. Mongolism is a congenital condition in which the child, if born alive, is an idiot or imbecile and suffers from certain physical defects also. He found that in each case the proportion of mongol births was higher in the high fluoride areas, and that the differences were statistically significant. I worked out the probability of the combined results of his inquiries, and I found that the odds were 62½ million to one that the connection was not due to chance. This is as near to certainty as one is ever likely to arrive in human affairs.

When attention was drawn to this matter in this country, the Chief Medical Officer of the Ministry of Health sent out a circular in which he invited the medical officers of health to disregard Dr. Rapaport's findings. He gave two reasons. One was an allegation that Dr. Rapaport had not found all the cases of mongolism. This is a quite amazing argument. Dr. Rapaport did not personally find any cases of mongolism. The data which he used were the officially recorded cases. It is not to be believed that the officers responsible for these records, in four different States, and in scores of towns, all made systematic errors in their records which produced a totally false result. In any case, it is quite surprising that such an argument should be advanced in these days, when statistical techniques of sampling are used in public opinion polls and for many other purposes.

The other ground put forward by the Chief Medical Officer was that Dr. W. T. C. Berry, of his Ministry, had not found a higher incidence of mongolism in high fluoride areas in this country. There is no proof, of course, that Dr. Berry found all the cases of mongolism, and on the Chief Medical Officer's first ground his results should also be disregarded. What is more important is that Dr. Rapaport's research covered a much larger number of cases. Still more important is the fact that in the only case in which Dr. Berry chose the high and the low fluoride areas at random, namely, the county of Essex, his figures show that the incidence of mongolism was one-third higher in the high fluordide areas than in the now fluoride areas. His results, however, were presented in such a confusing fashion that probably few of those reading his paper would have noticed this.

I have drawn attention to this as an example of the way in which the propaganda for fluoridation has been conducted. Every scientific fact which indicates that fluoridation is a risky procedure is either ignored or else is brushed aside for plausible, but inconsequent, reasons. I was brought up in the doctrine that it was the duty of public officials to present the facts for and against any proposal fairly and impartially. I must say that that principle has not been observed in the case of fluoridation. The tactics adopted in promoting it seem to have been largely invented in, and imported from, the United States. It is not irrelevant to glance at the history of this matter.


My Lords, may I interrupt the noble Lord for a moment? He seems to be making rather severe charges against those who in this country were responsible for promoting the idea of fluoridation. I was in the Ministry of Health at the time, and we were very interested in it. I hope the noble Lord will feel that he is able fully to justify these charges, or not make them.


I thank the noble Lord. To return to what I was saying—I will come back to this presently—the fact had been observed in various countries, including the United States, that the teeth of many people in certain districts were affected by a disease which was popularly called" mottled enamel". This ranged from a slight blemish to severe staining and pitting of the teeth. This was eventually found in the early 1930s to be caused by fluorine in the water supply. The efforts of the United States Public Health Service were then directed towards removing fluorides from public water supplies. This is in fact somewhat difficult to achieve without bringing into operation a new supply free from fluoride. Consequently, it was proposed that the amount of fluorine in the water supply should be reduced to not more than one part per million. This was based upon the assumption that at that level not more than 10 per cent. of the population would be affected by mottled enamel and that in most of those cases the attack would not be very severe. Thus the figure of one part per million was regarded as the maximum permissible amount, and this was based solely upon consideration of the teeth and without any regard to the effects of fluorides on other parts of the body.

It was also noticed at that time that some teeth—and I repeat, some, but not all—affected by mottled enamel showed, for a time at any rate, a greater resistance to dental decay. The idea was then put forward in 1939 by Mr. G. J. Cox, a research worker in the Mellon Institute, that fluorides should be added to the public water supplies, or else to milk and other beverages, in order to prevent dental decay. Later the United States Public Health Service took up this idea, but at first with a certain amount of caution. In 1945 experiments were started in several American cities to try out the effects of artificial fluoridation of the water supply. These experiments were designed to run for at least ten years. After five years, and before there was any chance of observing the effect on the permanent teeth of the children born after the experiment began, it was suddenly announced that it had been a tremendous success. Caution was thrown to the winds and within a few months the State health and dental directors, the American Dental Association and other bodies endorsed the fluoridation of public water supplies. Everybody climbed on to the bandwagon. Large sums of public money were spent on propaganda.

All this, my Lords, has stemmed out of the dental section of the Public Health Service of the United States of America and was dominated by dental considerations. The effects of fluorides on other parts of the body were completely ignored. In the early stages of research on mottled enamel, before the idea of fluoridation was conceived, the persons who investigated it described this condition as a dystrophy; that is to say, an abnormal development of the teeth; or else it was described as a hypoplasia; that is to say, an under-development or defective development of the teeth. It was also described as chronic dental fluorosis; that is to say, a disease of the teeth caused by fluorine. These statements, which were made, among others, by H. Trendley Dean, who later became the first director of the United States National Institute of Dental Research, have never been repudiated or withdrawn. They are in fact reprinted in a collection of papers entitled Fluoride Drinking Waters, pub- lished by the United States Department of Health as recently as 1962.

This volume also includes a paper first published in 1943 by Mr. F. J. McClure, who subsequently became the chief of the Laboratory of Biochemistry of that Institute. I will quote his opening sentences: With few exceptions the biochemistry of fluorine emphasises its toxic features. The production of endemic dental fluorosis (mottled enamel) in human beings by fluorine in drinking water is an outstanding example of the toxic effect of an excessive intake of the element. That statement was true then and it is true now. What is now described as an optimum level of fluorine in the water supply, but which was originally called a maximum permissible level, was arrived at upon the assumption that not more than 10 per cent. of the population would be afflicted by fluorosis; but hence it follows that up to that number will suffer from chronic fluorine poisoning.

In this same paper Mr. McClure says: It cannot be said that fluorine is an essential element in the diet in the accepted sense of the term. It has not been shown that the complete withdrawal of fluorine from otherwise adequate diets produces fatal or disabling symptoms. Dental caries cannot be classified as a fluorine deficiency disease until it has been demonstrated that inadequate amounts of fluorine in the diet invariably produce the disease. That, of course, has never been demonstrated. These statements have never been withdrawn or repudiated. They are true now as they were true then. So what, my Lords, becomes of the oft-repeated assertions of the Ministry of Health that fluoride is of "the nature of a food or nutrient" and that fluoridation is merely remedying a natural deficiency of it?

The fact is that the propaganda in favour of fluoridation is not an impartial presentation of scientific fact, but an example of high-powered salesmanship in which every statement is carefully slanted to achieve the desired result and every uncomfortable fact—


My Lords, may I interrupt the noble Lord once again? I am sorry to do this.


Do not interrupt him. The noble Lord is destroying his case in this way.


The noble Lord has a very good case.


As I was saying, my Lords, every uncomfortable fact is ignored or misrepresented. A typical example of this was the statement in the Ministry's booklet that The number of scientific papers bearing on the safety of fluoride is prodigious; by 1958 the World Health Organisation's Expert Committee on Water Fluoridation estimated that the number approached 3.000 over a period of 20 years. This is well calculated—


My Lords, may I just interrupt the noble Lord for one moment? It seems to me that once again he is impugning the motives and the integrity of the responsible people in the Ministry of Health, and I really must ask him not to do that.


My Lords, the Minister is responsible for this and I am entitled to criticise what has been done. I do not blame anybody in particular, but this is the effect. The noble Lord interrupts my argument, so perhaps I may now return to it, and say this.


My Lords, would the noble Lord please give the reference for the statement, so that I might look it up?


I I cannot tell the noble Lord the page offhand. He will find it.


I cannot find it, and I should like the reference because I want to refer to it later.


I will give the noble Lord the reference in a moment. This statement is calculated to make the reader believe that there were 3,000 scientific papers attesting the safety of fluoridation. I hope it is accepted that that is a fair interpretation. What in fact the World Health Organisation committee said was this: The rich literature on the subject"— that is of fluoridation, not of safety— comprises nearly 3,000 research publications in the last twenty years. Important findings have been confirmed in the laboratories of many countries. It is not implied that this research field is unique in freedom from controversy. In other words, the World Health Organisation's expert committee pointed out that the papers did not all point in one direction: some pointed in one and some in the other direction. Therefore I say that the statement to which I have referred is calculated to convey a totally false impression. It may be inadvertent. It may be due to public relations officers or other people summarising data which are put before them and with which, possibly, they are not technically familiar. I do not know what the explanation of it is but this is the kind of thing that has happened.

To sum up, fluoridation, in addition to being an abuse of power and an encroachment on the basic liberty of human beings, is hopelessly unscientific and contrary to all the established norms of medical practice. It is unscientific to administer drugs to people who cannot possibly benefit by them, and to continue doing so, day after day, for a lifetime. It is a basic tenet of medical practice that drugs should be administered in measured doses, regard being had to the age, sex and condition of health of the patient, and that they should be continued only so long as needed.

Fluorides are considered of value only during the period of tooth formation. Indeed, one of the most active advocates of fluoridation in this country, Miss Jean Forrest, lately of the Ministry of Health, stated in a paper on dental conditions in Slough, a town in which fluorides are found naturally in the water supply to the extent of about the postulated amount, that at age 12 to 14 children who entered that town after the age of one year had just as much dental decay as children in her control groups. If this observation is true, there is little point in administering fluoride after one year of age. But this is exactly the stage of life when many children drink little or no water. They are suckled by their mothers, or are drinking cows' milk, and only those drinking dried milk reconstituted with water will receive any fluorine from the water supply.

This may be one of the reasons why, in several experiments in the direct administration of fluorides in measured doses, much better results have been reported than are gained from fluoridation. For example, a recent experiment reported by the Dean of the Dental Faculty of Otago University showed that a group of 24 children, of ages 3 to 5, who were treated in this way had only one decayed tooth between them. The British experiments in fluoridation showed that children in the fluoridated areas had at these ages one, two or three decayed teeth each. Hence, if voluntary methods persuaded only half the child population to have fluoride tablets, the number of teeth saved, for a time at least, would be far greater than from universal fluoridation.

I must, however, repeat that I do not consider the administration of fluorides to be a solution of the problem of dental decay. Dr. Robert Weaver, who was for many years Chief Dental Adviser to the Ministry of Education, made a careful investigation of the effects of drinking fluoride water. He came to the conclusion that it did not prevent dental decay and, at most, only postponed the incidence of it for some three years. From a report published in 1963 on nine years of fluoridation in Hastings, New Zealand, we have confirmation of the fact that the benefit wears off in the course of a few years. From this report it appears that 91.5 per cent. of children aged 7 in this district who had had fluoride water from birth were suffering from dental decay, and that 44 per cent. of their first dentition was decayed. Dr. Weaver also observed that there was in fact no very striking difference in the incidence of caries in the two towns of North Shields and South Shields. He then made this significant comment: If the protection given by fluoride in South Shields had not been shown to be of quite brief duration, members of the dental profession would have been faced with an embarrassing question. That question would have been: If the incidence of dental caries in South Shields is so very much less than in North Shields, and if dental disease is inimical to health, why is it that there seems to be no evidence that the South Shields population is healthier than the population of North Shields? Although the advocates of fluoridation have made many desperate efforts to prove that fluoridated water is quite innocuous, the most that they have ever dared to assert is that the state of health in fluoridated areas is no worse than in other areas, and they are hard put to it even to maintain that. Hence, the dilemma posed by Dr. Weaver still remains. Or, alternatively, are any benefits to health from better teeth cancelled out by other toxic effects of fluorine? Dental decay is not caused by lack of fluoride. It is caused mainly by errors in diet. This is clearly pointed out in the Joint Circular of the Ministries of Education and Health issued to local education authorities in 1962, and also in the excellent eight-page leaflet entitled Dental Health issued by the Ministry of Health at about the same time.

The ill-effects of dietary errors are not confined to the teeth. Excessive consumption of sugar is ruinous to the teeth, and is considered also to be a principle cause of arterial and heart disease. This is another reason why it is a grave error to try by mass medication to remove dental decay without removing the causes. The only rational and constructive course is that indicated by the official publications which I have just mentioned. It is a policy which does not violate the right of the citizen to the integrity of his own body; nor does it breach the accepted code of conduct of the medical practitioner towards his patient. My Lords, I beg to move for Papers.