§ 9.14 p.m.
§ The Parliamentary Under-Secretary of State, Home Office (Lord Glenarthur)
My Lords, I beg to move that this Bill be now read a second time.
Even if the speeches it led to in another place were not noted for their brevity, the Bill before us is a short one; it is simply an enabling measure, designed to put beyond doubt the legal powers under which water may be fluoridated in England and Wales, and to restore the option of fluoridation in Scotland. The need for it stems from the opinion of Lord Jauncey in the Strathclyde fluoridation court case. It may be helpful to your Lordships if I therefore summarise briefly the relevant facts of that case.
In October 1978 a citizen of Glasgow, Mrs. Catherine McColl, applied for an interdict to restrain Strathclyde Regional Council from implementing its decision to fluoridate the water supplies in order to reduce dental decay. The hearings, held in the court of Session, Edinburgh, commenced on 23rd September 1980 and continued until 26th July 1982. The court sat on 201 days, making it the longest and costliest case in Scottish legal history. The petitioner sought to establish that fluoridation would have a large number of adverse side effects, that it would be ineffective in reducing dental decay and that, in any event, Strathclyde Regional Council had no legal power to fluoridate. A large number of witnesses testified on the medical and dental issues, including the leading proponents of the anti-fluoridation case.
Lord Jauncey delivered his opinion on 29th June 1983. His judgment amounted to some 400 pages, of which over 350 were devoted to the medical and dental questions. Lord Jauncey rejected specifically and in detail all the petitioner's assertions that fluoridation was medically unsafe. His general conclusion was that,there is no evidence to suggest that fluoride at the proposed concentration would have an adverse effect upon health".Lord Jauncey also upheld the effectiveness of water fluoridation, and found specifically that,fluoridation of water supplies in Strathclyde would be likely to reduce considerably the incidence of caries"—that is, dental decay. On the legal questions, Lord Jauncey ruled against the petitioner's assertion that fluoridation constituted a nuisance and a breach of Section 8 of the Water Scotland Act, and of the Medicines Act 1968. Lord Jauncey did, however, find 964 against Strathclyde Regional Council on the sole ground that their statutory duty to provide "wholesome water" was insufficient to provide the legal powers for fluoridation.
Following the judgment, fluoridation ceased immediately in Scotland. As Lord Jauncey's judgment is not binding outside Scotland, fluoridation has continued in England and Wales. Nevertheless, since English water legislation is cast in essentially the same terms as the Scottish legislation, it is clear that Lord Jauncey's judgment calls into question the existing legal powers under which 5 million people receive fluoridated water in England and Wales. Hence this Bill seeks to restore the legal position in Scotland to what it is understood to have been prior to Lord Jauncey's judgment, and to clarify the law in England and Wales.
Before returning to the legal powers contained in the Bill, I should like to speak in more detail of the important health and efficacy issues which were raised in Lord Jauncey's judgment. Lord Jauncey's view that there was no evidence that fluoridation adversely effects health is in keeping with the overwhelming weight of scientific opinion. The safety of fluoridation has been repeatedly confirmed in reviews undertaken by national and international bodies such as the World Health Organisation, the Canadian Public Health Association, the United States National Academy of Sciences, the Australian Health and Medical Research Council and, in this country, the Royal College of Physicians. Fluoridation was introduced in this country only after a United Kingdom team of experts had extensively studied the position in the United States, and considered both the dental health and safety aspects. They found no scientific evidence that fluoridation constituted any danger to health, but prudently recommended that research in this area should be encouraged.
When fluoridation was introduced in this country on an experimental basis, a research committee was established to keep the evidence on safety under review. They did this by contact with general practitioners practising in the study areas, analysis of the relevant statistical data and by means of investigations carried out on sample sections of the public. Their conclusion, which is set out in detail in their published reports five and 11 years after the introduction of fluoridation, was that,there is no evidence of harmful effects from the fluoridation of water supplies at the recommended concentrations".I should also like to stress that the health departments keep under regular review scientific studies which may be relevant to the safety of water fluoridation. The report of the Knox Committee established in 1980 to:reappraise the published and otherwise available data and conclusions on cancer incidence and mortality amongst populations whose drinking water is either artificially fluridated or contains high levels of fluoride from natural sourceswas published in January this year. Copies are available in the Printed Paper Office.
After detailed consideration of the many studies covering large populations, the committee have concluded that:We have found nothing in any of the major classes of epidemiological evidence which could lead us to conclude that either fluoride occurring naturally in water, or fluoride added to 965 water supplies, is capable of inducing cancer, or of increasing the mortality from cancer".The committee go on to explain that:the only contrary conclusions are in our view attributable to errors in data, errors in analytical techniques, and errors in scientific logic".Furthermore, the committee state that the evidence permitted them to comment positively on the safety of fluoridated water with regard to allegations of a link with cancer.
I should like also to put on record the work undertaken by the department in response to suggestions made last year that fluoridation could give rise to mutagenic hazard—that is to say, that it might have the ability to alter human cells in ways which might cause cancer or hereditary defects. Lord Jauncey rejected this theory on the basis of the evidence presented to him. However, last year a reputable Japanese scientist (Tsutsui) published several papers demonstrating mutagenesis under laboratory conditions from very high concentrations of fluoride. The authors of the work did not claim that their work proved that fluoride would give rise to mutagenic hazard at the much lower concentration of one milligram per litre which is standard to all British fluoridations schemes.
Nevertheless, the department set in hand a programme of studies intended to replicate the Japanese work and assess its relevance to fluoridation, The results of the work commissioned have been considered by the department's independent expert Committee on Mutagenicity of Chemicals in Food, Consumer Products and in the Environment. They have concluded that there is no evidence from the available data that would lead them to expect, as a result of fluoridation at one part per million, a mutagenic hazard to man through the induction of heritable abnomalites in the germ cells.
I shall not detain the House with a detailed rebuttal of all the charges levelled against fluoridation, alleging that it causes ailments from AIDS to cot deaths, and backache to Down's syndrome, I should however like again to assure the House that the Department of Health and Social Security and its expert advisers examine all substantive evidence relating to the safety of fluoridation and that we shall continue to do this if the Bill is enacted. The present position is, however, that the overwhelming weight of scientific evidence shows fluoridation to be safe, and that it is endorsed by the most reputable international and national health organisations.
Let me turn now from the negative to the positive aspects of water fluoridation and describe its benefits. There has been a general and welcome reduction in dental decay in recent years; but still it remains a serious health problem. For example, the 1983 Children's Dental Health Survey has shown that among 15 year-olds there was an average of 5.6 teeth that were decayed, filled or extracted due to past decay, among children in England. The figures were even higher in other parts of the United Kingdom, with the comparative statistics being 6.7 for Wales, 8.4 for Scotland and 9.2 for Northern Ireland.
Studies conducted in this country, as well as overseas have repeatedly shown that fluoridation 966 makes a significant additional reduction in dental decay over and above the general decline which has been experienced. A study published in 1981 comparing a population of 800 children from the fluoridated city of Birmingham with a similar group from the low-fluoride area in Wolverhampton showed that decayed, missing and filled rates in Wolverhampton are approximately two and a half times those in Birmingham.
There is also significant evidence that fluoridation is of particular benefit to the more socially deprived parts of the population. Thus, another study reported in 1980 contrasting the dental decay experience of 5 year-old children living in fluoridated and low fluoride areas of North-East England found that the difference in mean decayed, extracted and filled teeth between children living in the two areas was 26 per cent. of social classes I and II, 60 per cent. for social class III and 71 per cent. for social classes IV and V. In all cases this was to the advantage of the children living in the fluoridated areas.
I recognise that there are many who accept the efficacy of fluoride as a means of reducing dental decay but believe dental decay would be better reduced by means of other forms of fluoride supplementation rather than water fluoridation, and by increased dental health education. Fluoridated toothpaste is certainly considered to have contributed greatly to the general decline in tooth decay. Fluoride tablets are also very effective if used properly, but studies have shown that many parents find it difficult to maintain the necessary regime of daily administration throughout the whole period of tooth formation.
Dental health education on diet, which we encourage through the Health Education Council, is of course also very important, but there are limits to what can be achieved by this method alone. The evidence is, however, that in otherwise comparable fluoridated and non-fluoridated communities, the fluoridated community will have levels of dental decay between as much as one-third and one-half lower than in the non-fluoridated areas. Against this background the Government believe it is right that the option of fluoridation—and I stress the word "option"—should continue to be available to health authorities under the law.
Turning to the detail of the Bill, I should like to repeat that this is an intentionally modest measure, designed solely to provide specific legal powers for the arrangements for fluoridation which have operated in this country for nearly 30 years. The Bill preserves the present arrangement whereby health authorities may request water fluoridation from a statutory water undertaker, which in turn has discretion as to whether to accede to this request. If both the health and water authorities agree to fluoridate, a contractual arrangement is negotiated by both parties. It is the Government's firm intention that fluoridation should continue, as at present, to be a financial charge on the health authority, subject to the detailed contractual arrangements. Similarly, to assist the water industry, the Government will continue, as at present, to indemnify statutory water undertakers against allegations of injury to health caused by fluoridation. The Government are happy to continue with this guarantee, not least as there has been no successful 967 claim on these grounds in the 30-year history of fluoridation in this country. We shall also consult with the water industry regarding the indemnity in respect of legal actions, although the present legislation should remove the likelihood of such actions in the future.
Returning to the detailed provisions of the Bill, Clause 1(4) provides for the addition of the compounds of fluorine currently used in water fluoridation schemes and, as a contingency measure, Clause 2 allows these to be varied by the Secretary of State subject to the negative statutory instrument procedure. I should like at this point to make the comment that fluoride is in no sense a substance which is normally foreign to the human diet. In fact, it is present to some degree in all our domestic water supplies and also in several foodstuffs—with fish being particularly rich in fluoride. Tea is also very rich in fluoride and, indeed, a heavy tea drinker will ingest more fluoride from tea than from fluoridation of his water supply.
Clause 1(5) provides for fluoridation to take place at the recognised tolerance levels of around one milligram per litre. This simply confirms existing practice, and I might add that fluoridation at this concentration does not, as is often suggested, give rise to any aesthetically significant degree of mottling. Studies conducted in this country have found little, if any, difference in levels of dental mottling between fluoridated and non-fluoridated areas.
Finally Clause 1(6) provides a statutory framework for the existing arrangements whereby statutory water undertakers may, in an emergency, provide fluoridated water to an area, which has not requested it, to maintain the water supply. We shall be moving an amendment at Committee stage to extend this arrangement, in accordance with existing arrangements, to cover routine maintenance.
While on the subject of the Government amendments which will be put before your Lordships at the Committee stage, I should like to make clear that it is our intention, as undertaken by my right honourable friend the Minister for Health in another place, to bring forward an amendment which will require health authorities to undertake general public consultation on proposals for new fluoridation schemes in advance of a decision being taken by the health authority. The amendment will give local bodies, such as local councils, and individuals the opportunity to make representations to the health authority. It is also our intention, again as undertaken in another place, to clarify the drafting of Clause 1 (1) which as a result of an amendment has now become rather complex. We shall also seek to provide specific legal vires for existing fluoridation schemes which will remove the need for health authorities to re-apply under Clause 1 (1).
Finally, I recognise that there are those who may feel that, irrespective of the efficacy and safety of fluoridation, it is wrong in principle to introduce what they regard as mass medication. I of course respect this view, but I have to say that personally I do not in any sense share it. The benefits of fluoridation were first discovered by observing communities which had a natural fluoride level in their water around the optimal concentration for dental health. Artificial fluoridation 968 seeks to do no more than replicate this natural phenomenon. Indeed, half a million people in this country receive water with a natural fluoride content at this level and I have not heard it suggested that they are subject to mass medication, any more than I have heard it suggested that they are mass medicated by the addition of other chemicals to water.
In my view, fluoridation in no way interferes with an individual's rights; he will neither be harmed by it, nor even be aware of it. Personal experience counts for something, and I have seen the enormous benefits which fluoride has provided for the health of my children's teeth. How I wish their advantage could have been mine. Without in any way wishing to do my noble friends Lord Colwyn and Lady Gardner of Parkes out of their professional careers, I am sure that as dentists they will agree that fluoridation is wholly beneficial and will benefit future generations of children by giving them markedly improved dental health, which is an advantage that they will retain throughout their lives. It therefore seems clear where the balance of advantage lies.
The Bill before us does not introduce compulsion. It is designed simply to give the responsible authorities specific legal powers to choose, if they wish, to provide the advantage I have described. I hope that your Lordships will agree that we should preserve this option on the basis which has existed for 30 years. I confidently commend the Bill to your Lordships as a thoroughly valuable measure to benefit the health of our children and grandchildren. My Lords, I beg to move.
§ Moved, That the Bill be now read a second time.—(Lord Glenarthur.)
§ 9.32 p.m.
§ Lord Ennals
My Lords, a week ago today I said that I thought that it was scandalous that a debate on a very important issue such as limited list prescribing should begin shortly before eight o'clock and be voted on after midnight. May I repeat my complaint tonight?
§ Lord Ennals
This debate began at 9.15. I really think that that is grossly unfair to your Lordships' House and undermines our proper ability to give careful scrutiny to Bills which are passed to us from another place.
I shall be speaking entirely personally in this debate. There is in no sense a party line. Neither would I wish in any way—and I do not suppose that any of my noble friends will, either—to seek to divide the House. But I want to say that this is a very important Bill. It affects the whole of our population. It is also a very contentious Bill, as we all know from the correspondence that we have received, whichever view we may take.
The first question I want to ask—and I shall be very brief in several of my questions—is whether there is convincing evidence that fluoride in whatever form in the right quantity has a beneficial effect on dental health. I think that the evidence is overwhelming, as the noble Lord, Lord Glenarthur, said. I shall not go through the list of organisations that take precisely that view. If one compares an area where there has been 969 fluoride in the water with one where there has not, whether one takes Birmingham and Wolverhampton, as was done by the noble Lord, or Northfield, as part of Birmingham, and Dudley, and considers the health of children's teeth, it is perfectly clear where there is an advantage. The number of supporting organisations is really most impressive. I am not going to take up your Lordships' time by going through those reports, because all they do is to confirm what the Minister has said. I think that it is overwhelming.
The second question is this. What about the suggestion that fluoride causes cancer? This also was dealt with by the noble Lord and I shall therefore be extremely brief. The Royal College of Physicians have examined this proposal very carefully and concluded that there was no scientific or statistical basis for the allegation. The noble Lord referred to the Knox report, which many of us will have read, and the comment made upon it by the chief medical officer. He said that it was absolutely clear that there was no evidence whatsoever. So, my Lords, I am perfectly satisfied that fluoride, taken in the appropriate quantities by one means or another, is both safe and beneficial. We know what is the attitude of the health authorities. I quote from the National Association of Health Authorities in a communication which I have just received. They said:This Association which has 93 per cent. of all health authorities in England and Wales in membership very much supports the fluoridation of water supplies since it is the single, most effective preventive measure against tooth decay.Although the great majority of health authorities are in favour of fluoridation, only 10 per cent. of the country's water supply is fluoridated at the moment because of the reluctance of a number of water authorities to agree to fluoridation schemes. This reluctance stems from uncertainty about the legal position which culminated in the Strathclyde court case.".This was dealt with by the noble Lord and I shall not go into what was said then.
My third question, my Lords, is whether mass fluoridation is the best means of achieving the objective which I have said that I personally accept. It is very strongly argued by some that the only way to ensure that children—and they are the main beneficiaries—ingest the appropriate amount of fluoride is to fluoridate all tap water. I must say that I challenge this. It leaves no opportunity for personal choice. Although I am not here to make a 4½-hour speech and I do not go along with many of the arguments that have been used in the other place, I do not think that we can simply brush aside the question of personal choice which I know is held, up and down the country maybe wisely or maybe unwisely. But when there are strong feelings, we must recognise those strong feelings. I know that the Government are in the business, in one sense, of limiting the rights of locally-elected authorities—and I am not going to get into that—in terms of their own issues. I think that it is unsatisfactory that there is no opportunity for personal consultation or for expressions of views that can be taken and considered by elected authorities.
I think that the strength of this argument is emphasised by the views of the water authorities themselves. The Water Authorities' Association who, no doubt, have written to other Members of your 970 Lordships' House, have made it quite clear. They have said:the Bill as at present drafted gives water undertakers a discretionary power … It was argued strongly on behalf of the water undertakers when the Bill was discussed in the House of Commons that this is a quite unsatisfactory arrangement. We have no locus, in our view, in respect of the ethical and medical decisions whether or not to fluoridate in a particular area; this should be for the health authorities to take and the discretion available to water undertakers should relate solely to issues of technical and operational feasibility".We are in a difficult situation because as our organisation now is, we have health authorities which are nominated and we have water authorities which are nominated. I do not believe that that is a satisfactory situation. I believe—and I give notice that an amendment will be tabled by me and by some of my colleagues on these Benches—that there should be a step in which the local authority, the elected local authority has to take its view. I believe that the general public are entitled to express their views through their local councillors and that those local councillors should then be obliged to take a decision before the matter is referred to what is, after all, and is seen to be, by the water authorities themselves, a technical body. Here we have a picture of health authorities knowing what they want, water authorities not wishing to take a decision and the public of two minds. The public, I believe, should have a right to be involved in the decision. This is not just my view. It is the view of the Association of Metropolitan Authorities. I have a letter from the association dated 22nd March in which it says:The Association is concerned that the Bill imposes upon the Health Authority the responsibility for requesting the Water Authority to fluoridate water, i.e. two non-elected bodies. The Association hopes you"—that means me and other of your Lordships—will support local authorities as bodies directly accountable to the local electorate having an input into the process regarding fluoridation particularly in view of their responsibilities under the Water Act 1973".The first point I want to make is that the locally elected authorities should be involved. There is, however, another way of achieving our objective. It is certainly not contained in the Bill. My personal view is that we can achieve the aim of providing fluoride for children aged five to 15 without in any way denying personal choice, through the supply of milk made available to children in schools. This has a double advantage. Many of our children are suffering from forms of malnutrition and under-nutrition. This proposal would return to our schools the milk that was formerly available. It would give to parents the right to decide whether the children should have milk with fluoride or milk without fluoride.
I am influenced in this view by the outstanding philanthropic work of Dr. Edgar Borrow, founder of the Borrow Dental Milk Foundation, a pioneer in the field. I have studied this carefully. Research carried out in a five-year study in Scotland and a three-year study in Hungary show extremely impressive results—the same decrease in dental caries among children as if there had been fluoride in water. The evidence of the nutritional value of milk, particularly skimmed or semi-skimmed, and the benefit of added fluoride has created a new situation.
971 The new situation is that the EEC Commission, in its regulation reported in the official journal of the European Communities of 30th January 1985, has now decided after long debate that the milk subsidy made available to our local authorities, and used by some but not by enough, should in future be available for milk that includes fluoride as well as for milk that does not include fluoride. This gives absolutely and totally the right of choice to parents which I believe your Lordships' House would wish to give.
This is a water fluoride Bill; it is not simply a fluoride Bill. I hope that the Minister in his reply to the debate will comment on both major points that I have made. One is the involvement of the local authorities and the other, this quite different alternative. If we were to go about it the right way, we could ensure that children would be fitter by having milk and that their teeth would be better by having fluoride, if that was the wish of their parents.
I was surprised to see in the financial memorandum to the Bill that no costs are involved. On the financial effects of the Bill, the memorandum states:The Bill involves no additional public expenditure".The Minister has since answered this by saying that the financial responsibility would fall upon the health authority. At a time when health authorities are hard pressed enough, there is no point in saying that this is not additional public expenditure. Public expenditure carried out by the health authority is public expenditure. The same memorandum, on the front of the Bill, also states:The Bill has no effect on public sector manpower".That is absolute nonsense. It is simply not possible to go through the technical operation of putting fluoride into water without manpower being involved.
I have done some study on this. Let us look at the cost of fluoridating all water or providing fluoride in milk for children; that is, on average, one litre of fluoridated milk per week per child, with a population 972 of 9.3 million children, and working on an average of 200 school days per year. We should look at the comparison. If we do it through milk, we need to have less than 2 tonnes—1.86 tonnes of calcium fluoride. If we do it through the method of fluoridating all water, whether it is drinking water, bath water, industrial water, sewage, or what have you, we should be using not just 1.86 tonnes but 11,176 tonnes per year for the total population. The estimate of the cost of doing it through milk is less than £1 million—£930,000—with capital costs which would be no more than £2 million. If we look at the operational costs if the health and water authorities were together to decide that they were going to fluoridate all water, they are estimated to be about £20.5 million per annum and the capital costs would be about £150 million, presumably to be borne, as the noble Lord the Minister said, by the health authorities.
How can we expect health authorities, with all the problems they are facing, to take on this additional burden at this time? Frankly, I think that, in spite of all the time that was taken in the debates in the other place—going through the night, with long speeches—the other place has not done its homework. That is what this House is for—to look carefully at what comes from the other place and make it think again. This is why I give notice that at Committee stage not only shall we seek to involve the local authorities—the elected local authorities—but we shall also put forward an amendment which will deal with the milk option, which I believe is quite the most attractive option.
I have rather rushed my speech. I should have liked to develop several of the points, but I know that many of your Lordships wish to speak and therefore I shall bring my remarks to a close. I want to say in my final sentence that it is quite wrong that this House should not have a proper opportunity of turning into real sense what comes from another place, in the interests of our people and their health, and bearing in mind theists.
§ 9.48 p.m.
My Lords, last week when the noble Lord, Lord Ennals, protested about the fact that your Lordships were being asked to debate a matter of great importance at a very late hour I was wholly in support of the noble Lord. However, I am bound to say to him that on this particular issue I do not think that he is on such firm ground. This time we are not debating something that is exactly new. The case for fluoridation has been proved beyond all possible doubt for something like 30 years. Indeed, it has already been introduced. We are only having this debate, as the noble Lord, Lord Glenarthur, explained in his admirable and very clear speech, because an element of doubt has been brought into the law as a result of a somewhat ambiguous judgment in the Scottish courts. Previously there was no question about the legality of adding fluoride to water, but a new situation has arisen purely because of what has happened in the Scottish courts.
In addition, I would say to the noble Lord, Lord Ennals, that I accept that this is a controversial matter, but experience of some 30 years' involvement in it has convinced me that it is not the kind of matter in which the controversy is likely to be resolved by debate. There is not a great deal of point in preaching to the converted. Thirty years of campaigning for fluoridation has told me that it is not very helpful either to preach to the unconvinced because they will not listen.
My Lords, perhaps I should make my position absolutely clear. I have the honour to be the present president of the British Fluoridation Society. Now that I have said that, noble Lords will know exactly where I stand on this issue. Perhaps I had better make it quite clear where the British fluoridation Society stems from. In the late 'sixties, when the late Mr. Richard Crossman was the Secretary of State for Health and Social Services, he decided that fluoridation was first safe, and secondly very advantageous, and that we ought to go ahead with it. He was also aware that it was somehow rather unpopular and somewhat controversial. He was not actually going to do it. But he wanted the water authorities to do it and he wanted to change public opinion so that it actually happened. Mr. Richard Crossman gave a substantial grant to the Health Education Council to enable it to do what it could to change public opinion about the safety and desirability of fluoridation. The Health Education Council at that time set up the British Fluoridation Society, which was required to do this work. Its first president was my noble friend Lord Avebury who carried on doing that job for many years. I recently had the honour of succeeding him.
I should like to say—and I hope it will be accepted—that by nature, by temperament and by inclination I have always been extremely suspicious of additives of any kind. I am on record in many fields as having protested about food additives, particularly when they 974 are not used for the benefit of the consumer but for the benefit of the manufacturer, the person selling the food or someone else. I have written widely on the subject of pollutants, and I have campaigned widely on the subject of pollutants of one kind or another. I was vice-president for many years of the Conservation Society and have done a great deal of work in that regard. When I had the honour to be the chairman of the Countryside Commission, I sometimes had occasion to fight against the introduction of unnatural elements into our diet or into our environment. However, I say that in the hope that your Lordships will accept that I would only have taken up the stand that I have taken on this issue had I been convinced and totally convinced that it was the right thing to do. I approached all this years ago with great suspicion. I looked at all the allegations, I heard about all the dangers and searched in vain for these cases of people who were alleged to have been harmed by fluoride. I spent years searching for them all over the world and found none. My assumption is that they do not exist. I also believe that they never did exist. I think that most of them were invented. My Lords, why? I do not know. Nor do I know why the anti-fluoride campaign, which has been so vigorous in the United States, has been financed—as reported in the journal of the American Dental Association—for many years by the Ku-Klux-Klan and the John Birch Society. But it rather convinces me that I am in the right camp. I hope perhaps it may persuade one or two others that they have possibly been getting into bed with the wrong bedfellows.
As a doctor, and as a person who has looked into this issue with very great care, I can say that I am wholly convinced that no public health measure has ever been subjected to such exhaustive and close scrutiny and ever been found to be so totally free of dangerous side effects or risks of any kind. Nor do I believe that any public health measure has been demonstrated so clearly to be wholly effective in achieving its aims; namely, a massive reduction in the incidence of dental caries, which is quite an important condition both medically and dentally. Those who doubt its efficacy need only consider what has happened in Birmingham. I shall not go into that case because I am quite sure that the noble Baroness, Lady Fisher of Rednal, who has had personal contact with what has happened in Birmingham, will refer to that. I believe noble Lords who have studied what has happened in Birmingham will be wholly satisfied that there can be no doubt whatsoever of the effectiveness of fluoridation. I repeat that I am satisfied that it is wholly safe and effective and I do not believe that anybody has ever been harmed by fluoride in the concentrations recommended. That is my considered view, and understandably I therefore believe that we should go ahead.
It is not necessary for me to go over all the arguments, as president of the British Fluoridation Society. Noble Lords who have shown a close interest in medical, dental and health matters will have received the literature that the society has sent out including a detailed copy and analysis of the Knox report, to which both the noble Lord, Lord Glenarthur, and the noble Lord, Lord Ennals, made reference, and all the other evidence which has been 975 produced. The massive number of learned and scientific bodies all over the world to which the noble Lord, Lord Ennals, referred, have come to precisely the same conclusion. Therefore, it is unnecessary for me to go over all those matters. There will be detailed points which no doubt we shall investigate, discuss and possibly consider at greater length during later stages in the Bill.
I should like briefly to turn to one or two of the points which the noble Lord, Lord Ennals, made, and to one on particular. He said that he doubted whether the adding of fluoride—one part per million—to water was the best means. I think those were the words he used. In my view it is the only means. The noble Lord suggested that we should add it to milk. I am not against milk. I am all in favour of milk. It is true that I had in practice a medical partner who believed that every bottle of milk should carry a Government health warning. That is not my view. I drink lots of milk, and I was very distressed when school milk disappeared.
However, I wish to make this point. Leaving this action until school age is too late. All the evidence clearly shows that in order to prevent dental caries to the extent to which we hope to prevent it, the necessity is that the ingestion of fluoride should take place at a very early age and certainly before school age.
I am not against other means, but I think that this is the best means. I also think that if we rely on tablets, or even on children swallowing fluoridated toothpaste and all sorts of other methods, the fact remains that the most vulnerable children are in the social groups which the report of Sir Douglas Black showed were so disadvantaged from the health point of view. If we rely on other steps being taken by parents, I believe that the children in those groups will suffer. The only way to ensure that the benefits of fluoridation are enjoyed by the population as a whole is to put it into the drinking water. I believe it is the safest way and also the most effective way.
I have said that I believe it is wholly safe and it is effective. I am bound to say that I think many of the opponents of fluoridation—and I accept that there are many—have accepted that. Having accepted that, they then turn to what they call the moral argument and talk about mass medication. This is not medication. It is not treatment. Nobody has for a moment suggested that fluoride causes dental caries. It prevents it. It is not medication; it is prevention, which is a very different matter indeed.
There is nothing very new about optimising the concentration of a normal constituent of a dietary substance and, if it is deficient, restoring it to its proper level. That is all that is proposed. Natural water contains fluoride. The intention is merely to make sure that those who are deprived of natural fluoride in their water supplies do not continue to be so deprived. There are many precedents. There are the bread and flour regulations which require certain substances to be present in flour. I do not think that the ordinary individual has the right to stipulate the precise chemical composition of the public water supply any more than he has the right to stipulate the voltage of the public electricity supply or the caloric value of the gas supply. There are plenty of precedents. I do not 976 accept the so-called moral argument that it is mass medication. It is not medication; it is prevention.
I now come to one other point. The noble Lord, Lord Glenarthur, in his excellent speech, made quite clear that this is a limited measure, that it is essentially an enabling measure. The noble Lord stressed that it is giving the option. In a sense, I think that this is perhaps a little unfortunate. I go back to the early days when the water authorities had a somewhat small democratic element—at least appointed by local authorities. I was frequently consulted by them in those days when they had the opportunity themselves to consider this question. They said that they were getting hoards of papers and scientific documents from all over the world. They said that as local councillors, or whatever, they were not equipped to decide matters of this kind. They said that this was something which the Government themselves should decide and that they should come out quite clearly and say that it was a good thing and therefore we should put it in the water, rather than leave it entirely to the water authorities.
I accept that there are advantages in leaving a matter of this kind to local or regional decision. However, that would rather depend on the bodies upon which we are relying having some kind of regionally or locally elected element, and while we have water authorities which are wholly appointed and while we have area health authorities which are wholly appointed, one could not say that we are actually being given much local choice in the matter. The choice is not of a democratic nature because the bodies themselves are not democratic. I merely make the point. It has nothing to do with this particular Bill, but I should like to hope that some day we will move to a period when the water authorities do have a genuinely elected, accountable element—that is, accountable regionally or locally.
I should also like to move to a period when the area health authorities have some kind of regionally or locally accountable element; but we have not got that at the moment and therefore, in a sense, I am a little disappointed that this is merely enabling legislation, because I am afraid that what will happen is that the arguments will go on and on and on. We shall hear the same arguments over and over again from different people who will each produce the same examples, and when we pursue them we find that they do not exist. Why they have been invented, I do not know.
I sometimes think, if I may say this, that there is some curious psychological element in this paranoia about fluoridation. I think it is not unrelated to the unfortunate coincidence of the similarity between the suffix "ide" at the end of thalidomide, and the suffix "ide" at the end of "fluoride". Somehow, subconsciously, in the public mind the two have been connected and the public have thought "this is nasty, artificial and dangerous." My view, as a doctor, is that it is not dangerous; my view, as a doctor, is that it is extremely beneficial. My view, as a doctor and as a politician, is that we go ahead and do it.
§ Lord Energlyn
My Lords, before the noble Lord sits down, may I ask him, as chairman of the society, who 977 actually determined the level of concentration of one part per million? Why was it not two parts, three parts, four parts or ten parts? Who determined this level of concentration?
My Lords, I was not privy to the discussions which were going on at that time. It dates right back to the 1940s, as the noble Lord will know; but it was decided by the various authorities, by the dentists and the other scientists together with people in various Government departments at the time. They decided that was the optimum level. All one wants is an adequate level and there is no point in having a level which is higher than "adequate." I think that is why it was decided, but I was not party to the decision-taking at that time.
§ Lord Moyne
My Lords, before the noble Lord sits down for a second time, is he not perhaps overstating the case when he says that there is no case known of anyone who has been made ill?—because the Lady Mayor of Andover, round about 1954, I understand, was ill, as were other people. They recovered when they went on to water taken from a dug well. I cannot substantiate this in any detail, but it is widely believed in Andover and people there obtained an injunction which I thinks stands to this day. Would the noble Lord care to comment on that?
My Lords, I will indeed comment on it. The noble Lord has said that "it is widely believed." It may well be widely believed and the noble Lord has asked me to comment on this particular case. Certainly I will. Many such cases have been put to me over very many years. On every occasion I have followed them up with the greatest possible care and I have never been able to confirm any of them. I could not say with certainty that what the noble Lord has said is not true—it may be true. Maybe he has stumbled on a case that I have never found. All I say is that when cases of that kind have been put to me in the past over the last 30 years, I have done everything I can to investigate them and all those investigations have proved fruitless. But, the noble Lord having mentioned this case, I will most certainly look into it: I promise him that.
§ Baroness Gardner of Parkes
My Lords, again, before the noble Lord sits down, is it not possible that that water could have had some other harmful product in it, equally well?
§ 10.4 p.m.
§ Lord Charteris of Amisfield
My Lords, if I may get an oar in edgeways, this Bill had a jolly rough passage in another place. Indeed, so long drawn out were the debates that they were described as a filibuster. I think that is unfair and unfortunate. It is unfair because if your Lordships read the reports you will find that, generally speaking, they are not the stuff that filibusters are made on, and it is unfortunate because it may make the uninformed believe that those who oppose fluoridation of the water supply are a crazy bunch of cranks and fanatics. This is by no means the case. Of 978 course, I would be the first to admit that a great number of honourable and dedicated cranks are indeed anti-fluoriders, if that is the proper term. But it is also true that there are a great number of sober, sensible people who are against fluoridation and who are not cranks.
As your Lordships know, the case against fluoridation rests on two considerations. The first is simply that it is unethical to treat us without our consent by putting medicine into the water supply. The second is that it is at least possible that fluoride artificially added to the water supply may not be as innocuous as the Department of Health and Social Security, and admittedly a very large body of medical and dental opinion, would have us believe. I should like first to say something about the second consideration.
Can we be absolutely sure that the DHSS has got it right? Here I find myself in a difficulty which I suspect is shared by many noble Lords. Though very free with advice to my family and friends on how to treat their ailments, I have no medical training, and though I thoroughly enjoyed fooling about with test tubes and Bunsen burners in the laboratories of Eton in my youth—incidentally, they are very different now from what they were in those days—I am quite untrained in science. I lack therefore the intellectual equipment to judge the scientific and medical evidence about fluoride and its potential effects.
But I know two things, the first of which is that official medical opinion is not infallible. What is held to be safe today can turn out to be dangerous tomorrow. We have only to remember the confidence with which Thalidomide and Debendox were, in all good faith, declared safe to recognise the force of this argument. The second is that there seems to be a growing body of sober, unhysterical medical opinion, based on the work of scientists engaged in pure research and physicians dealing with patients, which holds that we would be better off without fluoride being put artificially into tap water.
We are told that fluoride poisons certain enzymes. Four Nobel Prize winners—Professor Hugo Theorell, Eyler, Otto Warburg and Dr James B. Sumner of Cornell University—have all independently shown that a number of important enzymes are seriously disturbed by fluoride of concentrations of between 0.2 and one part per million; that is to say, a lower concentration than will be permitted if this Bill becomes law. I do not know how much this matters, but I do not like the sound of it.
Nor do I like the sound of what Dr Robert S. Harris, Director of the National Biochemistry Laboratories, Massachusetts Institute of Technology, had to say on the subject. This is what he said:There is plenty of evidence to indicate that fluoride in the amount of 1 part per million or slightly more interferes with enzyme systems and these enzymes are involved with the growth of bones and the functioning of nerve tissue and so forth. It is clear that fluoridation is a calculated risk".There is another factor which ought to be weighed when the risk is calculated. Fluoride is a cumulative poison, and presumably this means that its ill-effects could be a long time showing. Artificial fluoridation has been practised for only 30 years and in many places for much less time. Only 5 million people in this 979 country drink artificially fluoridated water and in the areas where the natural level is high, which serve about half-a-million, there are also high levels of calcium and manganese which mitigate the toxic effects of fluoride. I do most earnestly hope that if this Bill comes to be made law the risks involved in making it legal to fluoridate the water artificially will prove to have been wisely calculated.
Many other countries have decided that the risk is not worth taking. Fluoridation of the water supply was stopped by West Germany after 18 years. It was abandoned in Holland after 23 years. It was abandoned in Sweden after 10 years' trial because the World Health Organisation was unable to substantiate the claim to the satisfaction of the Swedes that fluoridation was safe. It was abandoned in Chile after 25 years' trial. Japan has no fluoridation; nor has any country in Western Europe except Southern Ireland and ourselves. Are we absolutely sure that we know better and there is no risk involved in the artificial fluoridation of the water supply?
So far as I am concerned, the evidence of doctors who deal with patients is perhaps easier for ignoramuses like me to understand than is the work of scientists with their microscopes and test-tubes. Those in favour of fluoridation say that there are no observable ill effects from drinking fluoridated water. Perhaps it would be not unreasonable to rephrase that and to say, "There are no ill effects which are easily observed, particularly if you are not looking for them".
I understand that doctors in the United States, here and elsewhere are discovering that, if you look, you find. They are seeing patients who exhibit, in varying degrees, some or all of the wide-ranging signs of low grade fluoride poisoning when consuming fluoridated water, and sometimes even as a result of using fluoride toothpaste. These include, I understand, pains and stiffness in the joints and bones, muscle weakness, stomach cramps, nausea, diarrhoea and all sorts of disagreeable complaints which could easily be confused with other illnesses such as arthritis and gastro enteritis. But the interesting point is that blind and double blind tests show that, when the patient stops drinking fluoridated water, the symptoms disappear, and that they reappear when he starts drinking it again.
Nobody, I believe, denies that fluoride is a poison. Nobody denies that it is dangerous to take it in excess. I remain unimpressed by the argument that everything is toxic if taken in excess, including even good, sound claret. The point about fluoride is that, although no one is prepared to say what the "safe" dose is, it is clear that you have to be extremely careful not to overdo the amount you take on board. It is illegal to add it to food and the fluoride tablets you can buy over the counter at any chemist are covered with red warnings not to overdo the prescribed dose.
My understanding is that anyone can buy these tablets even in areas where the amount of fluoride in the water would make it unwise to take them. What seems certain is that it is important not to overdo the dose. I wonder how accurately the amount added artificially to water can be controlled. Perhaps the 980 noble Earl, when he comes to speak at the end of the debate, will enlighten us on that point,
And of course mistakes can happen even in the best run organisations. I am not implying by this remark that any British water authority is likely to repeat the tragic mistake made in Annapolis in 1979, when the fluoridating machinery went wrong and much too much fluoride was added to the drinking water, with the result that two people died and many others were taken ill. But perhaps even a less serious error might have disagreeable effects. It is a great pity that the noble Baroness, Lady Cox, cannot be with us tonight to deploy the medical arguments against fluoridation, which she can do a great deal better than I. I am assured, however, that she will make her contribution when the Bill reaches Committee stage.
I simply want to make the point that I do not believe it can be said with certainty that there is no risk in artificially fluoridating the water, and that if there is any risk, it must be balanced against the gain. Here we must be careful not to be too bemused by those glossy pamphlets which claim that fluoridation halves tooth decay. It is true that tooth decay has diminished dramatically, as we have heard, in areas where the water is artificially fluoridated, but it has also done so in other areas where there is no artificial fluoridation. Perhaps greater awareness of how to avoid tooth decay, and the withdrawal of sweetened orange juice in 1971 from the national health clinics has had as much to do with the improvement as fluoride added to the water.
It seems to me that with those delightful fluoride tablets so readily available on the market and the fluoride toothpaste which is equally available the health of our children's teeth could be achieved without putting the stuff in our water whether we want it there or not. If there is even a suspicion of risk, it seems to me quite improper to take it and make it possible, even likely, that everyone in the country will be subjected to it.
I was glad that the noble Lord the Minister forecast there would be an amendment in Committee so as to bring in something that looks like a democratic process in deciding whether the water is laced with this fluoride stuff, but I must say that it must be a positive decision on the part of the people, and it must not just be a case of the authorities listening politely to complaints and doing it just the same. It must not be a matter of their knowing what is best for us and doing it whether we like it or not.
Moreover, what is proposed in the Bill for deciding which areas should be subjected to artificial fluoridation really borders on the ridiculous. As the Bill is drafted, water undertakers have discretionary powers to add fluoride to water supplies at the request of the appropriate health authorities. This is an arrangement which the Water Authorities Association considers wholly unsatisfactory and, indeed, I have a letter from the secretary of the association on that subject. If the artificial fluoridation of water is made lawful, it surely cannot be left to the discretion of water authorities whether or not to put in the stuff. To draft the Bill in this way indicates to me that the Government are treating the matter in a very offhand 981 way, as something which we should just allow to go through on the nod—not even worth a mention in the Queen's Speech.
I believe this to be an error of judgment. It is not a small matter; it is a matter which many people feel very strongly about. It is really quite unacceptable that not a hint of the democratic process is built into the arrangements for deciding whether or not any area's water should be artificially fluoridated. We shall look for proper amendments during the Committee stage. It seems to me that anything other than allowing the people to decide whether or not they want their water to be laced with fluoride would be ethically indefensible; and that is exactly what the Bill is as it is now written. As I say, it is ethically indefensible, and in being so it breaks new ground, and very dangerous new ground at that.
It really does break new ground. The argument that all sorts of chemicals are put into the water anyway, so why not add a touch of fluoride as well simply will not wash. All other chemicals are put in to make the water safe to drink; they are put in to treat the water. Fluoride is put in as a medicine to treat us, and has nothing to do with making the water safe to drink. This is a real difference, made plain in Lord Jauncey's judgment in 1983, when he ruled that fluoride was a medicine and putting it into the water had nothing to do with making water potable and wholesome.
It is also a difference in a practical way. If the water out of the tap is fluoridated, the very great majority simply cannot avoid ingesting it. If a person objects to vitamin B in margarine, he has alternatives in dripping or butter. If he objects to the calcium added to white bread, he can eat wholemeal bread. But he cannot avoid drinking water out of the tap.
Any noble Lord who spends as much time as I do in the kitchen will know you have to cook with the stuff. One cannot boil fluoride away as one can chlorine. On the contrary, the more one boils fluoridated water, the stronger becomes the concentration. So the next time any noble Lord finds himself making stock in a fluoridated area, he should watch out.
This is a Bill straight out of "Yes, Minister", and it is easy to see how it came to be drafted; drafted in good faith and on the altar of good government. Sir Humphrey Appleby would have said, "Minister, it is just a matter of making legal what we always thought was legal and have anyway been doing for years". And if the Minister had questioned the moral issues, then Sir Humphrey would have said, "Minister, government isn't about morality".
§ Lord Charteris of Amisfield
My Lords, Sir Humphrey would have said, "Government is about stability, about keeping things going, about preventing anarchy, about stopping society from falling to bits and still being here tomorrow". And perhaps Sir Humphrey would have added, "Minister, I advise that the Second Reading should be late at night because that will help to bamboozle their Lordships".
Although it is late at night and although the noble Lord, Lord Ennals, has spoken elequently, as far as I am concerned I am not going to pile Pelion on Ossa 982 and divide the House on this issue, because I do not believe that would be proper in the circumstances.
Anybody who has spent as much time as I have on the edge of Whitehall, and who has the same genuine admiration and affection for the mandarins as I have, can understand exactly how this Bill came to be drafted; drafted in good faith and on the altar of good government. But it is a rotten, bad Bill because the real issues it raises have not been considered as they should have been. Lord Jauncey's judgment and what has flowed from it provides us with a rare opportunity to consider the ethical values which are at stake. So let us be bold and ignore Sir Humphrey Appleby and pay some attention to morality.
§ 10.22 p.m.
§ Lord Nugent of Guildford
My Lords, after that very powerful speech, which set out to destroy the health arguments, I think that I should say immediately that I have read the Knox Report and quite a bit of the extracts from the Jauncey judgment and I would hesitate to dismiss that massive Knox Report as easily as the noble Lord, Lord Charteris, has done. The Knox Committee sat for three or four years and studied the scientific and epidemiological evidence—not only from this country but from all over the world. They reached their conclusions on that basis. My word!—I must as a layman pay some attention to what they have said. They were very clear that the health risks which the noble Lord sees are simply not there.
However, I do not propose to go into a long argument of that kind at this time of night. I would just make the point that there are some 260 million people in the world who are consuming fluoridated water—including our 5 million here—and so there is an immense amount of evidence about what happens to consumers. I believe that the noble Lord hardly did justice to what has been put before us in that report.
Turning to the Bill itself, the noble Lords says that this is a thoroughly bad Bill and not in any way justified. It is exactly the opposite; it is an entirely practical Bill. The Jauncey judgment has precipitated the situation which many of us knew was hanging over us. I knew it for many years and I am sure that the noble Lord, Lord Ennals, knew it, too; that one day the vires of fluoridation would be challenged.
I can remember, when I was chairman of the National Water Council, consulting with Ministers in the Labour Government of the day and telling them that I reckoned we were sitting on a time bomb and that sooner or later someone would take the case to court, when the vires which were in doubt might be found to be ultra vires. On the other hand, we, as the water authorities throughout the country, were being pressed to add fluorine to untreated waters where the local health authority would have liked to see the addition made for the benefit of the children concerned. I consulted with the Ministers of the day and they were sympathetic but they observed that this was a very difficult matter to handle and although the health arguments were convincing to most people—not the noble Lord, Lord Charteris—the liberty of the subject argument was very difficult to deal with. That was something which all of us well 983 understood. I simply had to bow my head and say to the Ministers, "Well, I understand and so we will carry on and do the best we can with areas which are having fluoridated water and others will just have to wait."
What has not happened with this Bill is that it simply sets out to confirm the status quo which everyone has believed to exist for the past 20 or 30 years and which underlies the 5 million people—or 4.5 million people without the naturally fluoridated areas—who are receiving treated water today. To do that seems to me no more than common sense. As to whether there will be any other areas which want to have it, that is something which, to a large extent, is to be a local option. As my noble friend Lord Glenarthur said, he intends to move an amendment, which I very much welcome, which will ensure that the elected local authorities are brought into consultation by the health authority when proposing to introduce these measures. I should also like to see the request to the water authorities to be mandatory rather than optional because I think that that is no more than logical. The water authorities have various technical problems to cope with but the ethical problem and the health problem is certainly one which the health authority, in consultation with the local authority, should decide. Therefore, I hope that my noble friend will be sympathetic to such an amendment, which will evidently come from several quarters by the time we reach the Committee stage.
I turn briefly to the other arguments. The noble Lord, Lord Charteris, said that flouride was the only additive which was added for the good of consumers. That is simply not so. A number of additives are made to water, not just to make it safe, like chlorine, but additives such as calcium, aluminium and even copper sulphate. Copper sulphate is not added for purposes of palatability, but aluminium certainly is. Quite a lot of treatment that people are not generally aware of is given to water in order to make it as palatable as possible. Therefore, it seems somewhat selective to pitch into this substance because of this terrific campaign which has been mounted, particularly in America I am sure the noble Lord took note of this point in the Knox report. The Knox Committee examined the leading American protagonist, Dr. Burk, and the gentleman with the unpronounceable Japanese name, in order to ensure that it had the full weight of the American evidence. So there is no doubt that these aspects were carefully examined.
Finally, in the very few minutes I wish to take—I still want to go to a very important meeting in my village, where we are threatened with losing our rector and having a priest in charge instead, which is almost as serious as fluoridation of our water—I feel that on health grounds and for the benefit of the teeth of our children, and certainly for the most disadvantaged sector of the community, which would receive the most benefit, if you put fluoride in the water, as the noble Lord, Lord Winstanley, said, you will make sure that children get it from the start and there is no doubt whatever that it will be of the greatest possible benefit to their teeth. Therefore, I hope that, both on health grounds and on the general grounds, the House will give the Bill a Second Reading and that we shall have a harmonious Committee stage when we reach it.
§ 10.30 p.m.
§ Lord Harris of High Cross
My Lords, I should like to associate myself mildly with the protests about the lateness of the hour. Having flown back from Europe yesterday to take part in this debate, and having cheerfully missed a first-class dinner this evening, I am afraid that I cannot miss my last train home and shall have to leave before the final throes of the debate. I promise in return not to detain your Lordships for the full four hours that I had in mind.
I want to tell your Lordships perfectly candidly that until a month or so ago I was blissfully innocent of the strange passions that stir the breasts of the rival parties on this issue of fluoridation. I was like the proverbial vegetarian in a butchers' convention: I knew something was going on but I did not really know quite what. This happy state was shattered when I received an unsolicited pack of glossy pamphlets from the Fluoridation Society. Out of the blue it came, and I foolishly made the mistake of opening it. I should not have done, because inside I came across an article written by the noble Lord, Lord Avebury. It was entitled, "Fluoridation and Individual Freedom". I told the noble Lord that I proposed to raise this matter. When I saw that title and that author, my suspicions were alerted since I must say candidly that I have not always found the noble Lord, even as much as other members of the nominally liberal party, a very sure guide on issues of personal freedom.
His article confirmed my worst fears. He offered two proofs that fluoridation could not be opposed on grounds of freedom—just two proofs, my Lords. His first was what I thought was a prime example of tortured prose and tortured logic. It amounted to saying that if the water authorities are empowered by law to add fluoride, then no question of individual liberty can possibly arise. The noble Lord went on:The decision is one for the majority of the members of the water authority, and is binding upon both the objectors and the non-objectors, like any other decision lawfully made".It does not require a great deal of argument to prove that such a legalistic view of freedom is quite untenable. Of course governments have to impose coercive measures on minorities to achieve overriding purposes of public policy, like national defence and the taxation necessary to pay for it. But a law imposing some change in personal conduct or consumption, like the compulsory brushing of teeth, would be an unwarranted invasion of individual freedom.
That in simple terms is the distinction that economists make between a public good and a private good. Governments have to concern themselves with public goods that individuals cannot manage for themselves but not with private goods. Even if a minority or the majority of the population were passionately daily craving for fluoride, they could help themselves by going to the chemist and getting a little bottle of fluoride pills, without requiring a single one of their fellow countrymen to take a mouthful of fluoride involuntarily. I may say that if people buy this bottle at the chemist, they had better read carefully, as the noble Lord said earlier, what the health warning is on the label.
The second proof of the noble Lord, Lord Avebury, was even more splendid. I must quote it in full; 985 otherwise, I shall be accused of invention. He said:The individual liberty arguments against fluoridation are invalid, as can be judged from the fact that the issue has never been taken up"—my Lords, wait for it—by the National Council for Civil Liberties".That is a demonstration of what I mean. When I read this light-hearted pleading from the president, as he then was, of the Fluoridation Society, I thought it worth just a little bit of investigation into what was being said by the anti-fluoridation lobby. I must say that I almost wish I had not; because I was at once overwhelmed by this recital of the conditions and allergies that would be caused or aggravated by fluoride.
Quoting these authorities with unpronounceable names which the noble Lord has just mentioned, there was a catalogue of possible afflictions which included damage to (to me) such mysteries as enzyme systems, hormones, thyroid functions, DNA molecules, cancer and toxicity. There were more modest symptoms that appealed to me such as nausea, lassitude and excessive thirst. A little bit of observation in the Peers' guest room made me wonder whether the water supplies in the Palace of Westminster had been fluoridated as an experiment. I must say that, on the whole, I began to feel like Jerome K. Jerome in Three Men in a Boat—that I had everything in the pharmocology except housemaid's knee; except that the opponents of fluoride suggest that the stuff is also rather bad for arthritis.
I am prepared to allow that the contra-indications of fluoride have been or may have been—and I must be careful about that: it is "may have been"—exaggerated by some of its rather more sensitive opponents. At least, I certainly hope so. But I find impossible to dismiss them to the point of saying that there is nothing in such fears, as the noble Lord, Lord Winstanley, said at the beginning. We have learned in recent years that even the most beneficial drugs prescribed by Lord Winstanley's profession can have the most vicious and malignant side effects which often rule them out for individuals with particular conditions and allergies. They are often discovered a little later when they have been, as they say, "ingested" by patients.
There is the truth that opinions change over time. That, the noble Lord, Lord Winstanley, might understand, is what is called progress. People do go on learning and learning new things. Indeed, a spectacular example is that scientific opinion (which we would all revere at the time) thought that there was little danger from exploding an atomic device at Wick. They changed their minds a little later. Then we may recall rather more significant examples from recent history. We have forgotten the final stages of vaccination against smallpox, which the Government stopped compelling in 1984 but went on recommending until 1971, when it was found that deaths and injuries from vaccination were more than from the disease itself. What about immunisation against whooping cough, which Governments, in the best of faith, have admitted can cause brain damage, and indeed have compensated several hundred victims to the extent of £10,000 each for 80 per cent. disabilities under the 1979 Vaccine Damage Payments Act.
986 The noble Lord, Lord Glenarthur, promised that the effects of fluoridation would continue to be monitored after we had been ingesting the stuff for some years. I think that that would be little comfort to many people who may fear that that will be late in the day. I would go on to quote the most impressive authority that my noble leader Lord Charteris quoted. How could one resist the authority of a man who is director of the Nutritional Biochemistry Laboratories at the Massachusetts Institute of Technology when you discover his name is Dr. Robert Harris? How can he possibly be denied when he says that the stuff may have these effects on enzymes but it is clear that fluoridation is a calculated risk.
My doubts were not removed when I read more carefully the pack of literature from the Fluoridation Society. There are admissions there that fluoridation is indeed mass medication. That comes from Professor Lenihan. There are admissions that it could increase dental mottling, however slightly. That comes from Lord Jauncey, the judge in the Strathclyde case. Among the supportive statements that they quote I find that the Board of the Faculty of Dental Surgery of the Royal College of Surgeons support fluoridation at 1 part per million but express concern that (I quote):excessive intake of fluoride could possibly result from its additional and uncontrolled use in other vehicles".I take "other vehicles" to refer to other sources of fluoride which are known to exist in both the natural and the polluted environment.
At this stage, I looked again more closely at the bottle of fluoride pills which I bought for £1.39. I find that it consists of several months' supply if any of your Lordships wish to absorb them. The label states, "Do not exceed the stated dose. Half a tablet daily for children up to two years of age. One tablet daily at two years and over until teeth develop at about 12." The label goes on, "These doses are usually recommended in places where the water contains not more than 0.3 parts per million of fluoride," In capital letters, it states, "Consult doctor, dentist or pharmacist." And, finally, there appears the injunction, "Keep out of reach of children."
Leaving aside the difference between natural and artificial fluoride, about which I think we shall hear more, two arguments bring me down against the Bill. The first is that all authorities mercifully agree that dental decay among children has fallen dramatically in recent years, equally in areas with and areas without fluoridation, although the Fluoridation Society engagingly admits that it does not know the reason why this has happened.
The Fluoridation Society sends me a further missive today—ready for the debate, presumably—with the stamp, "Fluoridation halves tooth decay." This is not wholly spectacular when one looks closely at the figures. The difference about which it quibbles is the difference, in the case of children up to the age of five, between the possibility of 1.2 teeth on average being decayed in fluoridated areas or 2.5 teeth decayed in other areas. We are arguing about 1.3 teeth in children up to the age of five.
The second argument on the side of caution is that some reputable scientific authorities persist in pointing to a wide variety of serious dangers from fluoridation. However lightly these testimonies are dismissed by the 987 lobbies which we detect behind the Bill, they are taken sufficiently seriously in European countries which have either prohibited fluoridation or reversed earlier decisions in its favour.
The choice is between the large possibility, even the probability, of a small gain from fluoridation and the small, even remote, possibility of a very large mischief from the side effects for at least some people. I propose that we do not gnash whatever teeth we may have left debating how large the risks may be, but that we seek the first opportunity to vote out the Bill in the Lobbies.
§ 10.42 p.m.
§ Baroness Fisher of Rednal
My Lords, before going into the details of why I support the Bill, I should like to draw the attention of the noble Lord, Lord Harris, who listed examples of campaigns, to the fact that there have been some successful campaigns. The polio campaign, the noble Lord I believe would agree, is a successful campaign. The rubella campaign is another that is successful. All of us can point to campaigns that have not been successful to satisfy our arguments. We should also consider the very successful campaigns that have been run by the Government and by local authorities.
The noble Lord, Lord Harris, mentioned rival groups. These groups are not divided on party political lines. Fluoridation has never been a party political issue. The late Mr. Crossman has been mentioned. One also recalls that when Mr. Enoch Powell was at the Ministry of Health, he urged all local authorities to proceed with water fluoridation. So it has never been a party political issue in this House.
The noble Lord, Lord Charteris, worried me with his description of all the people who were consuming fluoride in the water. I come from Birmingham. When I heard that description I thought that when I walk round the city centre I do not see any of those people the noble Lord, Lord Charteris, was talking about—jittery people and people mumbling. I see more people behaving like that when they have drunk a lot of claret.
Birmingham was one of the first major cities in Great Britain to get a fluoridation scheme. That was in 1965. I well remember the avalanche of propaganda. Some of it was quite wild, like some of the remarks we have heard tonight, attributing every disease to fluoride. I can remember the highly emotional debates; they were just like the debate we are having tonight. People were trying to be funny and humorous, thinking that in that way they would get people on their side. My experience sitting here tonight has been exactly the same as my experience when I sat on the city council in Birmingham in 1964, except that there were 158 people listening to the debate instead of the small number present in your Lordships' House.
It was an important matter and members of the city council—elected members; in a moment I shall come back to this—had to decide to sort the wheat from the chaff, if I can use that expression. It was an important decision we had to take. This was the result of prolonged meetings held by various committees of Birmingham City Council. Let us remember that when local authorities were making these decisions 988 they were guided by their medical officers of health. They made their decisions with all the guidance they received from a very important person in medical terms. The decisions were made democratically by elected representatives. It was after listening to the debates and getting all this information that I gave my support to adding fluoride to the water in Birmingham. We added it to the super water we get from Wales.
I should like to mention the figures for dental decay. I am sorry that the noble Lord, Lord Northfield, is not present tonight. The area the noble Lord used to represent—Northfield—is one of the largest districts in the Birmingham local authority area. There are statistics which were compiled in the Northfield area, a new development which took place during the time the noble Lord was the Member of Parliament for that area. I should like to compare these statistics with those for Dudley, a local authority in the West Midlands which does not add fluoride. The figures are compiled year after year and they are showing quite clearly that the Northfield children are far ahead of the Dudley children in not having to have dental treatment.
Adding anything to water has always been a contentious issue. I refer again to Birmingham when it was first being decided that we should have water from Wales. This was at the beginning of the century. Because there was a lot of concern about having water from Wales instead of water from wells, an inquiry was set up. I should like to quote from a book by Thomas Barcley; it was published at the beginning of this century. He was reporting on this inquiry, which was concerned with having water from Wales instead of the well water. Under the heading "Objection" he said:The drinking of soft moorland water, such as it is proposed to bring from Wales, through its deficiency in lime salts, produces rickets in children; and the well water, which contains lime, is much superior to it".The person conducting the inquiry said that this was a physician's question, and so Sir James Sawyer was asked to answer. He replied:The question is a very wide one; but it may be stated generally that drinking water is better without lime salts, as their presence in it does not prevent rickets or any other disease. These salts may produce special morbid effects"—and the book goes into great detail on some of the diseases already mentioned, such as,goitre and its attendant evils, calculi, and probably also some other diseased conditions in the human subject".Somebody complained about that wonderful water that we were to get from Wales, which is perhaps the envy of many local authorities in this country, because there was not enough lime in those days.
I return to what other noble Lords have said about democracy. The medical officers of health used to advise local authorities. If that practice had continued, fluoride in water would now have been almost universal in Great Britain. However, in 1974 there was a change in administration which meant that medical officers of health were no longer required by local authorities. There was a reorganisation of the health service and the power of the medical officer was transferred to the area health authorities. We had to start all over again in trying to convince area health 989 authorities. We thought we were doing well, but there was another reorganisation of the health service and in 1982 the area health authorities were transformed into district health authorities. So another group of people had to be convinced of the arguments and none of them involved a democratic organisation. This is the important thing. When people talk about democracy let us ensure that they have it at all levels and not only at levels which suit their convenience.
I support the point made by the noble Lord, Lord Nugent, and by my noble friend on the Front Bench, that under Section 11 of the Water Act 1973 it is still the duty of the local authority to ascertain the sufficiency and the wholesomeness of water supplies in its area. In view of this statutory responsibility and the direct accountability to the local electorate I believe that there is a need for an input from local authorities. As my noble friend on the Front Bench said, this possibly might merit support for an amendment at the Committee stage. We must remember, too, that privatisation might take place and there would then need to be a more democratic look at the provision of water.
Nobody has this evening mentioned the surveys which were recently conducted in the North-West Regional Health Authority area. They covered Wigan, Manchester and Lancaster and proved quite conclusive. Replies to the question "Do you think that fluoride should be added to water if it can reduce tooth decay?" showed, in various surveys, that 80 per cent., 79 per cent. and 76 per cent. of those people interviewed were in favour of adding fluoride to the water. The surveys covered both sexes and all the various social classes. I think that shows that, contrary to what is said in some quarters, the majority of people still believe that if it can reduce tooth decay, fluoride should be added to water.
I go along with the noble Lord from the Liberal Benches that the experimental period has, in my view, now passed and water fluoridation is universally accepted as a powerful method of preventing dental decay. We need to understand the benefits that this has for children. Fluoride has been proved to be completely safe. It has been proved that it saves teeth. If it saves tooth decay, it prevents suffering of children. Quite obviously—and this must appeal to all noble Lords—it is cost effective. If you do not have to keep on having dental treatment, quite obviously you are saving money when so much money is going into the National Health Service. If we want to reduce dental decay for the nation's children, we should in my view support this Bill this evening.
§ 10.56 p.m.
§ Viscount Monckton of Brenchley
My Lords, I, too, object to being asked to get up so late at night, and there are more unfortunate people to speak after me. It is bad management, and it is easier to say so from these Benches rather than from any others, I suppose.
I must declare that I have always been against additions to water. I came with that in mind. That view has been confirmed much more tonight by two speeches. One is that of the noble Baroness who has just spoken, who posed a loaded question, that if fluoride helps your teeth, would you not like it in your water? For heaven's sake, if somebody said "No" to 990 that, he ought really to be put up against a wall! From the noble Lord, the president of the society, the one question to which I wanted to know the answer tonight is: What is the danger figure? Is it two milligrammes, or three or four? What is the minimum necessary? He did not know. That worries me. Perhaps when the noble Earl comes to answer, he can give us an indication on that point.
I am against it not only as a human being but also as a farmer who studied a bit of animal nutrition at university before going into the Army. I am worried about the effect of fluoride on my cows. If it comes, I am lucky to be in a position, having paid for the right, to extract water from my own sources. I, like most of your Lordships, am rich enough to be able to buy bottled water from whatever source I think is best. I get mine from Belgium at the moment, from the very place called Spa where it all started.
I still go back to the fact that this is forced medication, forced treatment. The next thing will be something put in the water to prevent AIDS. Who knows what can be put in later on? Some argue that it is all right because it is totally natural, it appears everywhere. So does deadly nightshade. It appears at the bottom of your garden. When Socrates took hemlock he knew it was natural and he knew what was going to happen to him when he drank it. Who would drink a glass of fluorine?—nobody here. We have not yet learnt what are the long-term effects. That is what worries me. I absolutely accept all the expertise from doctors and dentists who say that this helps prevent tooth decay in children. I must accept that from all the evidence I have read. What I cannot accept is that we know fully what other effects to the human system might come later on, in 10 or 20 years.
Certainly when it is mixed with calcium I am much more worried about its effects on an animal. It could even have the very reverse effects on a cow's teeth. We can only see that from the studies which are done in the areas which are using it. I hope that that will be done. But I cannot think that other countries who have banned it, changed it or altered it have done so for the wrong reasons. Surely we are not necessarily the only ones who know best.
I take a point also made about the cost. I cannot remember at this time of night where I have heard that. I should have thought that there must be much over-manning if there will be no cost and no extra labour: something is over-manned at the moment in that case.
I am an old man and not many of my teeth are my own. I do not need fluoride in my water, and I hope therefore that I can somehow avoid it without having to pay and to buy myself out of it. I want the choice. If there is some way of giving it to children for only the period they need it, which with the calcium will make that extra enamel, the extra bit going over the teeth to make them proper, good, healthy teeth, then we should do it somehow. But I do not think it should be done by putting fluoride in the water for everybody.
For those of us who are farmers, one of the chief uses of the poison fluorine is the poisoning of rats. It is one of the best poisons there are. If you put it in a little glass phial and watch it go down with the food, you will pick up the dead rats very shortly, a few days afterwards. I 991 would have thought, therefore, as an amateur, that this is a war between experts who have not yet come to a common agreement; and when amateurs—the ordinary people—hear that, then we should start to worry and say, "Wait, wait a bit, before you know". When in doubt, let us insist that we wait for a bit longer.
Secondly and lastly, why not further research into the deeper boring for pure water? I take the point made by the noble Baroness about the excellent water that came from Wales, and which could come from other places if it were looked for. It is not. There is an enormous range of waters at various depths in this country and most other countries, including the desert. Your Lordships will see that I remain against the Bill.
§ 11.1 p.m.
Lord Campbell of Croy
My Lords, all natural supplies of drinking water in this country contain fluoride to a greater or lesser extent. In some areas the water contains one part of fluoride per million, that is the optimum from the point of view of preventing decay of the teeth. People who live in those areas are fortunate communities, because they have for centuries experienced less decay in their teeth than people in other areas.
This Bill allows, as it is an enabling measure, additions to be made in other areas of the country in order to adjust to the optimum amount of fluoride. It clarifies the state of the law, restoring it to what had been thought to be the position until the Strathclyde test case. I fully support this Bill, leaving the decisions to be taken locally for different areas.
One reason why I am concerned with this subject is that I was for four years a Minister for Health, and I think I am the only speaker in this debate, other than from the Government or Opposition Front Benches, who has been a Health Minister. As noble Lords will know, I was not under the influence of the DHSS, which has been regarded by previous speakers as a prime mover towards fluoridation. But during that time in the early 1970s, I was able to investigate for myself in full, with all the information and statistics available on a worldwide basis, whether fluoride was as beneficial as some had indicated and whether there were dangers in applying it to water.
Five years ago I initiated the last debate here in your Lordships' House on the subject, on the 15th November 1979. The question which I raised then was on the position of those communities who had enjoyed natural water supplies containing the optimum quantity of fluoride but whose historic benefit was being reduced by amalgamations of supplies, causing dilution of the fluoride, so that those who were enjoying one part per million in their drinking water from natural sources were finding it being reduced to something less. After all, the opponents of interfering with water supplies cannot have it both ways. If they object to fluoride being added, they should object also to it being taken away, in this case the optimum amount being diluted to something less, to the disadvantage of the local resident population. That was a matter that was raised in that debate, which I am glad to say started shortly after five o'clock, in 1979.
992 Here are some facts. It is no longer seriously contested that the optimum amount of fluoride in water leads to great benefits in reducing decay in teeth. It is especially effective if taken from very early childhood, but it is also effective and continues in a valuable and significant way in adult life, too. Let us consider also the fact that for children a great deal of pain from toothache and suffering from visits to dentists, mental as well as physical, can be eliminated.
My debate in 1979 was during the International Year of the Child. If I had then launched a charitable organisation, perhaps called Spare the Children Pain Campaign, money would undoubtedly have come rolling in for it. The paradox is that children can be spared a great deal of pain by this simple measure, at no expense at all. The modest costs of fluoridation are far outweighed by the money saved by the health services, because of the reduction in dental services needed.
The time of the dental profession would be saved. Instead of carrying out many of the fillings and extractions which they do today following decay in teeth, they could concentrate on other useful and positive work and would be more available for appointments. The NHS would be saved millions of pounds if fluoridation were adopted widely. The money saved would be available for other parts of the health services; for example, more hospital facilities and more kidney machines.
The opponents of fluoridation—that is, where fluoridation is necessary because the optimum amount does not already exist naturally—have put forward objections under two headings. The first is safety, though a number of them do not necessarily raise that particular matter; and the second is dislike of what is called mass medication. If I may deal with the first, safety, there is no evidence of ill effects where fluoride exists naturally; for example, in parts of Essex, the Hartlepools and South Shields. It has existed in some of those areas as more than one part per million.
Over the past 30 years there has been intense research into the possibility of dangers, and I am satisfied that everything that has been raised has been dealt with. Our own Royal Commission unanimously recommended, when it reported in the summer of 1979, that fluoridation should be adopted in this country. The judge in the Strathclyde case said he was quite satisfied on the matter of safety. Incidentally, Mrs. McColl who was involved in that case was photographed immediately afterwards drinking a cup of tea, and tea contains a far greater concentration of fluoride than any fluoridation would have produced. The noble Viscount, Lord Monckton, asked us who would drink a glass of fluoride. I tell him that every time he drinks a cup of tea he drinks a large quantity of fluoride, compared with what would be in water—
Lord Campbell of Croy
I am talking about fluoride, which is what we are dealing with in this Bill. I did not interrupt the noble Lord, Lord Charteris, on this, though I was tempted to do so, because he was talking about his work in the kitchen and gave us an example of boiling water and making stock. But, again, if he 993 had been boiling water to make a pot of tea he would have been producing considerably more fluoride to drink—
§ Lord Energlyn
My Lords, may I interrupt the noble Lord? Can he tell us more precisely what he means by "more fluoride"? Is it in excess of one part per million?
Lord Campbell of Croy
Yes, my Lords, in a pot or a cup of tea—more than is suggested in this Bill as being the optimum.
Lord Campbell of Croy
That probably depends on the strength of the tea. But certainly I can provide the noble Lord with information about this. As I said, it was commented upon in the newspapers, after Mrs. McColl was seen drinking her tea, that certainly she was not worried about safety.
An article in the Economist in January sums this up. It said that there will always be a few people who will not be convinced about safety. I am sure of that and I agree with it. The article went on to say:Some people would disbelieve God if he told them fluoride was safe".Areas where fluoridation has been carried out and where fluoride has been introduced such as New Zealand and Birmingham have shown nothing to cast doubts on safety.
Then I come to the question of mass medication. Various substances are added to drinking water by water authorities. This has happened for years. Chlorine has already been mentioned but there are other substances as well. It is said by the opponents, "Well, that is to purify the water, not to medicate the drinkers". But no drinking water is pure. It has substances dissolved in it. What the health authorities and the water authorities are required to do is to produce wholesome water for that reason.
The difference between adding chlorine or adding fluoride seems to me to be a matter of sophistry. If a substance such as chlorine is added to obviate tummy troubles, is that very different from adding fluoride in order to prevent and reduce tooth decay? Another objection is to mass nannying. It is suggested that it should be left to parents and perhaps schools to provide a ŕegime of tablets or other means of absorbing fluoride. It should be taken from a very early age. Is it really suggested that children of two or three years of age or even younger should have to be treated by mothers in this way for several years? The noble Lord, Lord Ennals, suggested milk in school, but that is too late. Much of the benefit is absorbed earlier, before school age.
But the suggestion that already harassed mothers today, some doing part-time jobs, should have yet another task with their small children is one that I think does not really make sense. Whether they are living in inner cities, in suburbs or rural areas, whether they are badly off or well to do, it would be an almost impossible task. I am not suggesting that this is a new paradise for children where they will never have to brush their teeth. It is that a remarkable improvement can be made with no extra work and little expense.
994 The noble Lord, Lord Harris, in an entertaining speech, produced a bottle of tablets and pointed out the difficulties of carrying out the directions and the problems which this raised; but I think that he completely supported my view that if it has to be left to individuals and mothers to administer to very small children, it really is creating difficulties and complications. As for the programme, "Yes, Minister", to which the noble Lord, Lord Charteris, referred, my version would be a different one. A Minister as he does, or should do, will be consulting his team at meetings on general subjects and saying, "How can we really make an improvement in health in the area for which we are responsible? How can we really make forward steps?" He would be told, "One thing you could do, a very straightforward, simple and effective method would be fluoridation, but I don't recommend it, Minister. A huge amount of parliamentary time will be wasted on this subject, not by cranks but by people who have been got at by a fanatical international opposition who have created an industry for themselves, an anti-fluoride industry". Well, I congratulate the Ministers in the present Government for rejecting Sir Humphrey's advice and going ahead.
With fluoridation we have an opportunity to make life less painful and more healthy for future generations. While they are small children, those generations will get the most benefit. Should we deny them those benefits? A noble Lord asked earlier: Do all of us have to drink the stuff? I say, yes, and it is a small price to pay for the generations still to be born. At our ages we should be prepared to accept that; it would be selfish not to. I know that all the speakers who have so far spoken against this Bill are kind to children, and would not want to inflict unnecessary pain upon them.
Where local authorities, health or local government authorities decide to adjust the fluoride content as allowed by this Bill, in one decision they will probably do more to improve health in their areas than by any other single action they have ever taken.
§ 11.16 p.m.
§ Lord Monson
My Lords, the Government are trying to convince us that this Bill merely restores the position to what it was always imagined to be; in other words, it makes an illegality legal. This reminds me of that old and not terribly funny joke about the Irishman who was asked some complicated directions and replied, "If I were you, I would not be starting from here in the first place", or words to that effect.
Ever since World War II Conservatives have talked about setting the people free; they have told us that Conservative freedom works; they have promised to citizens greater power to make decisions concerning their own future and the future of their families, and so on. Unfortunately, most of the time their actions have contradicted their slogans. The most recent example is the disgraceful volte face on seat belt compulsion. Alan Watkins of the Observer wrote last year that the only freedom granted to us by the Conservatives since May 1979 was the freedom to take or send money abroad, and even this freedom is only provisional, and was never accorded for libertarian reasons anyway. Since then, of course, we have had some minor relaxations governing the sale of spectacles; but that is about all 995 When we saw the distinguished name of the noble Lord, Lord Nugent of Guildford, on the list—and I am sorry he is not in his place—there was no need for any of us to wonder what side he would be on, because if you believe that people must jolly well be protected from themselves whether they like it or not in one sphere of human activity, then logically you must take the same view of other areas of human activity. But for many of us the slogan "people must be protected from themselves", in so far as it applies to adults of sound mind, is one of the most insulting phrases in the English language. Almost as insulting is the unspoken corollary that children must be protected from their parents, which seems to be the leitmotiv of this Bill, with its implication that we parents are a lazy and irresponsible lot who stuff our children full of sweets and ice cream and never, never make them brush their teeth.
As my noble friend Lord Harris of High Cross pointed out, curiously enough parents do have the right to say "No" to the nanny state over the much more serious matter, if the claims of officialdom are correct, of vaccination against chickenpox. But if this Bill goes through unamended I daresay even that freedom will be on the hit list. One wonders, too, if this measure may not open the door in the future in the event of a serious epidemic of rape, indecent assault and other sexual crimes in, say, Liverpool, to the addition of bromide to the water supply in the area, to be consumed not only by lusty and vigorous males in that area, but by the women and babes in arms. The difficulty for the proponents of fluoridation is that very countries most closely associated with compulsory dogoodery and the nanny state—that is to say, the social democracies of Scandinavia—have, unlike the British, really done their homework on fluoride and have come to the conclusion that it is far too dangerous to add to the water supply.
It happens that nearly every single one of our EEC partners has come to the same conclusion.
I do not go for the "chemical waste disposal conspiracy" theory. I am quite prepared to believe that the proponents of fluoridation are entirely sincere in their paternalism, which is doubtless directed at those socio-economic groups who are fairly infrequent purchasers of toothpaste, even less frequent purchasers of toothbrushes, and who stuff their children with boiled sweets to prevent them crying or moaning. It was the noble Lord, Lord Glenarthur, who hinted that this was in fact the case.
The trouble is that it is this socio-economic group which in adult life tends to drink 9 or 10 cups of tea a day which, as we have already heard, contains a great deal of fluoride already; tea which is often made with water poured from kettles which have been simmering on the hob all day so as to concentrate the fluoride therein. It is this group which tends to eat more tinned, as opposed to frozen, convenience foods—for example, tinned sardines which, again, contain an extremely high proportion of fluoride.
So what this particular socio-economic group gains, or may gain if the claims made for the beneficial effects of fluoride are correct, on the swings in the form of a two-year delay in dental decay it will subsequently lose 996 on the roundabouts in the form of a cumulative build-up of fluoride in various organs of the body—particularly the kidneys and thyroid—possible dental fluorosis, possible skeletal fluorosis, and an increased risk of contracting various allergies.
There is also—and we cannot dismiss this—just a possibility that there may be an increased risk of contracting cancer: there is some correlation between fluoridation of the water supply and increased risk of cancer. In the Royal College of Physicians' report published in 1976 it was shown that deaths from cancer were 9.72 per cent. higher in artificially-fluoridated areas than in other areas. Research in the United States seems to bear out that increase. In the United States, 10 fluoridated areas were compared with 10 areas where no fluoride was added and the death rate in the former was 10 per cent. higher.
That is purely circumstantial evidence and it could be merely a coincidence; there could be other factors which would explain the increase. But nobody knows for certain either way. It is a possibility.
As I understand it, old people of every socioeconomic group will be more at risk in so far as ingestion of fluoride in any quantity makes bones more brittle. Anything one hardens—be it steel, bones in the body or teeth in the head—inevitably becomes more brittle at the same time; there is no escaping this. So elderly people who slip and fall on icy pavements in winter, as they tend to do, will be just that little bit more vunerable.
I said earlier, that opposition to compulsory fluoridation was originally strongest in Scandinavia and among our EEC partners. Indeed it was the thorough researches of Dutch GPs, biologists, neurologists, pharmacologists and dermatologists in 1972 which led to the banning of fluoridation of the water supply in the Netherlands in 1976. Evidence of the danger of fluoridation—that is, up-to-date evidence, because I do not mean stale evidence—also comes from North America, most recently from the University of California, and from the South American continent where, as my noble friend Lord Charteris mentioned, research by the co-discoverer of streptomycin, Dr. Albert Schatz, resulted in the banning of fluoridation in Chile.
My noble friend also reminded your Lordships of the four Nobel prizewinners who have independently come to the conclusion that fluoride presents a danger. Increasingly there is opposition, too, from medical quarters in Britain. Articles in medical and scientific journals demonstrate a growing scepticism. The British Cancer Centre—opened by Prince Charles, incidentally—has banned fluoride in any form. A former professor of pharmacology at Trinity College in Dublin who is now practising in Scotland has established another link between fluoride and allergies.
A number of prominent academics, scientists and medical men connected with Reading University have come out in total opposition to fluoridation. They include the Professor of Food Science at Reading University, the Professor of Organic Chemistry at Reading University, a consultant bacteriologist, a consultant surgeon at the Royal Berkshire hospital, a physician, a dental surgeon and a visiting professor at 997 Reading University. They help me, incidentally, to counter the point made by the noble Lord, Lord Glenarthur, that there is no harm in fluoride in recommended concentrations. They point out that some people, drink up to 25 times more water than others, particularly those suffering from chronic ailments such as diabetes and kidney disease.
What is more, an increasing number of dentists are now opposing fluoridation, not only on non-dental grounds, such as I have already mentioned, but on dental grounds, too. Fluoride certainly hardens teeth but it also makes them more brittle, and therefore liable to break or splinter. As someone who over the years has had more than my fair share of both caries and broken teeth, may I assure your Lordships that having a broken tooth repaired is a damned sight more painful and indeed more costly than having a cavity filled.
So we come back to the basic moral issue. It is bad enough to compulsorily medicate those who might benefit from such medication without their consent, but far worse to medicate those who cannot possibly benefit from the medication, and indeed may in many instances—not all, but many—be harmed by it.
Most of us have assumed that only 17 per cent. of the population could benefit from fluoridation: in other words, those of 12 years of age or less. However, a prominent dental surgeon practising in the West End writes to say that fluoride is absolutely no use after the age of six, by which time a child's teeth are fully formed in the gum. He says that,after this time the ingestion of fluoride can have no beneficial effects whatsoever.From this letter one can deduce that only 9 per cent. of the population can conceivably benefit from fluoridation at the time of ingestion, with the remaining 91 per cent. being at risk from side effects to a greater or lesser degree. Therefore, fluoridation of the water supply, as opposed for example to the fluoridation of school milk, is not only immoral in that it almost certainly endangers a minority of individuals who will suffer from one or other of the adverse conditions I have mentioned, but also grossly wasteful.
As my noble friend said, it is a bad Bill, but I hope that we shall be able to make it somewhat less bad in Committee.
§ 11.28 p.m.
§ Baroness Gardner of Parkes
My Lords, I should begin by declaring a non-interest in the Bill. As a dentist this is going to do me out of business and, therefore, I of all people should be opposing it. Indeed, I suspect that those dentists to whom the noble Lord, Lord Monson, referred as an increasing number who are opposing the Bill might be connected with the fall-off in demand for dentistry generally, and particularly with the new charges now coming in. I am, therefore, sorry to hear that my colleagues are losing their great care for the public because of their worry about their own pockets if there is not enough dental business. So I definitely declare a non-interest in that the Bill is opposed to my financial interests. Nevertheless, I think it is the right thing to do and for that reason I strongly support the Government on this Bill.
998 We have heard very interesting speeches, including that of the noble Lord, Lord Ennals. I was interested in what he said about the Borrow dental milk because that is well known, but it is true that because it comes at school age it not so beneficial and it is very much harder to distribute to people. Therefore, I do not think that that is the answer. But, of course, through his means he would keep more dentists employed filling teeth.
The noble Lord, Lord Winstanley, regretted that this was only an enabling Bill, and I agree with him on that. I am sorry that it is only an enabling Bill. I should much prefer it to be mandatory on all water suppliers everywhere. When one sees the opposition that we are getting now on what is simply a formality, think of the opposition that we should have then!
Questions have been asked by many speakers about the quantity—one part per million—and what level is satisfactory and what is not. The very first sign of any change at all in the human frame begins at something like twice that level and is indicated by a degree of white mottling on the front teeth. At about, I think, four times that there is brown mottling on the teeth. That is how the beneficial effect of fluoride was first discovered. There were areas in the United States where the people all had brown mottled teeth. They had no other illnesses or ill effects of any sort, but they had unattractive brown mottled teeth, and they were completely free of dental decay. It is an important point for the public to realise. Long before there is even the remotest suggestion that the level is such as to cause any harmful effect whatever, there are aesthetic effects on the appearance of the teeth.
The noble Lord, Lord Charteris, is not here, so it is rather bad luck. When he talks about putting fluoride in the water, I would ask him, what about all the chlorine that occurs naturally in water, and what about those areas with naturally high fluoride levels and high levels of other elements? The level of elements occurring in the water supply varies tremendously.
It is very important of course that fluoridation should be under the control of water authorities which are able accurately to monitor the level. There is no doubt that in some areas of naturally fluoridated supply, as well as provided supply, the level could be too high and some should be taken out. That point has been referred to by other speakers.
A number of noble Lords have suggested that people should take fluoride tablets. The noble Lord, Lord Harris, produced a bottle. I have had a lot of experience of fluoride tablets over many years. I have been in practice in this country as a dentist for about 30 years. Originally the tablets were the only thing that we could offer people. I took them ante-natally for the sake of my unborn children. My eldest child had white mottled teeth because it is difficult to control the precise dosage by those tablets. A lot depends on what age the child's enamel is formed. That child got her teeth early, so the dosage was higher than if she had got her teeth a bit later.
I have given the tablets to many, many patients over the years. This is where the arguments brought forward on the socio-economic groups are so important. The less intelligent patient believes that if 999 half a tablet is good, a whole tablet is better, and two even better still. They all run the risk either of totally forgetting to give the tablets to the children or giving them far too many. That would never be a danger with a correctly regulated amount in the water supply. I cannot accept that tablets are a satisfactory solution.
I think that the question of civil liberties has been brought up so many times because all other arguments seem to have run thin. All the health scares have really been disproved and I do not think we can attach any importance to them. In areas such as Birmingham, for example, there is no higher incidence of cancer than in any surrounding area, yet there is such a difference in the amount of dental decay that the dental schools in the area have to bus children in to find enough holes in teeth to have the teaching material for their students. That is very significant.
The noble Lord, Lord Nugent, said that by putting fluoride into the water supply the most disadvantaged get the benefit. That is a very important point. The noble Lord, Lord Harris, said that caries had decreased equally in fluoride and non-fluoride areas. That is not so at all, and the facts make that clear. The noble Baroness, Lady Fisher, mentioned that the polio and rubella prevention campaigns have been very successful, as has the diphtheria campaign. If immunising against diphtheria were stopped tomorrow, it would be as great a killer as it ever was. She said that in Birmingham it was the elected members who made the fluoride decision in 1965. None of us could say that there was any lack of free choice there. It was the elected representatives who made that decision and have continued that situation.
When children come to the dentist on their first visit with dental caries—and I have seen plenty of them with their teeth pretty well flat to the gum—they are bad patients for life; and they really get off to such a bad start when they come in in pain, their teeth having kept them awake all night in agony. They are nervous when they arrive and they are never better afterwards.
The noble Viscount, Lord Monckton, asked about the danger level. I have dealt with that point. But he also mentioned that he uses bottled water. Of course, that is a free choice available to him. If he does not want to consume from the ordinary water supply, he is quite free to use bottled water. But what about the other effects? He said, "What about cost?" Compare the cost of fluoridating the water with the cost of supplying all the fillings that have been needed in the past for children. He wanted the children to have fluoride in some other way and, of course, used his greatest siren voice when he said, "Let's wait a little longer". We have been doing that for far too long already.
The noble Lord, Lord Campbell, told us about the optimum of 1 part per million. That is correct. It is the optimum. It is by no means a maximum. It is by no means a safe level, or the amount you can have without intoxicity. It is the optimum. It is aesthetically the best; it gives you the best-looking appearance as well as being totally harmless. He said—and I think that he is right—that we at our age should be prepared to accept fluoride in water for the sake of children.
I would not agree with him if we were putting ourselves at risk. That would be a different situation. 1000 But when we ourselves have nothing to lose, and the safety of this procedure is clearly established, then it is only right that we should think of the children.
The noble Lord, Lord Monson, mentioned seat belts. I must say that the great success of the seat-belt legislation has confirmed the very solid medical opinion supporting the introduction of seat belts. In fact, he gave us alarmist talk about bromide. I thought that his talk was the most alarmist of all. And not only bromide, but cancer. After all, if we got as far as the 11th speaker without having mentioned the cancer scare, then we have done pretty well on this. But the facts again in Birmingham show that this is all an unnecessary worry.
§ Lord Monson
My Lords, would the noble Baroness say how she is so sure that we are right and the other EEC countries and Scandinavia are wrong?
§ Baroness Gardner of Parkes
My Lords, I will reply to that by saying that I believe those decisions to reverse fluoridation there were not based on dental or health grounds, but simply on that same element of freedom of choice. I would mention also that there was an earlier experiment in Scotland where fluoride was introduced in a certain local authority area by the free choice of the elected members. Dental decay fell by 60 per cent. There was a change in control of that council and they removed it from the water. Caries went up by 60 per cent. Few people would accept that they could have their lives played around with to that extent: to be given something beneficial and good and then see it taken away. But that proves conclusively that it did have this beneficial effect dentally. It also makes the point that, for various political reasons such as the civil liberties arguments advanced tonight, people do make decisions to take the fluoride out.
I did not understand at all, and perhaps I misunderstood the noble Lord's point, when he said that those who were slimming were more at risk. Perhaps I misheard his words. I am pleased to see him shaking his head to indicate that that is not right. Then he said that fluoride had no effect whatever after the age of six. That is not correct. It is true that most of the enamel on the permanent teeth, excluding the wisdom teeth, is formed by about the age of six. But your wisdom teeth are formed after that period and the fluoride does go on having an effect in the production of the dentine which is the inner layer of the teeth and it continues to be beneficial.
Another thing that the ladies might like to hear is that it has a beneficial effect in preventing "dowagers' hump"—when you become a bit stooped and develop a bulge at the back of your neck. I think that if that were publicised more widely, a lot of women would be demanding it as a beauty treatment. However, I really must deplore the scare tactics that are being used. I must point out that every standing dental advisory committee and every standing medical advisory committee since the war has supported the introduction of fluoride in the water; and I must support this Bill, which is only an enabling Bill, to allow those authorities who are already using fluoride in their water to continue to do so without any legal worry or concern. Any future fluoridation will, as has 1001 been said, be carefully debated and considered by other authorities before its introduction. I have no hesitation in supporting this Bill.
§ 11.40 p.m.
My Lords, I am not going to argue the scientific case against the safety and efficacy of fluoridating water supplies. There is evidence both for and against doing so. It seems to me that the case is non-proven. There is no consensus. In spite of that, the Government are pushing this Bill through Parliament. But not long ago, on the occasion of the Second Reading of Lord Thurso's District Salmon Fishery Boards (Scotland) Bill, the noble Lord, Lord Gray of Contin, who has, alas, vanished like a wraith from the Chamber again, said à propos the problems of legislating:I believe that we must seek a consensus".—
But that is not all. The Government have no mandate for flogging this Bill through Parliament with a Whip. Had there been no payroll Whip on in another place at Third Reading, the outcome might have been rather different. As the noble Lord, Lord Charteris, said in a most brilliant and entertaining speech, it was not part of the Government's election manifesto. Nor was it mentioned in the Queen's Speech either at the beginning of this Session or at the beginning of last Session. Yet it is a Bill to make it legal for water authorities, described in it as statutory water undertakers—which gives me visions of watery graves—at the request of health authorities, to add fluoride to water supplies, not to make the water safe to drink or even to make it taste less nasty, but to have a specific physical effect on a minority of the population. It is to allow two non-elected bodies, who are not answerable to the electorate, compulsorily to medicate that electorate who, as the Bill stands, will have neither the means nor the opportunity of refusing that medication. It is both totally undemocratic and the thin edge of a very dangerous wedge.
I hope that there will not be a Division. But, in the event that there is a Division tonight, I shall abstain because I simply cannot support the Bill.
§ 11.42 p.m.
§ Lord Bauer
My Lords, many people outside this House, and occasionally even some noble Lords, regard fluoridation as tedious and trivial. Their eyes become glazed at the mention of the subject. In reality, the debate highlights profound issues of politics, even morality. It recalls a memorable phrase by Sir Lewis Namier, the great historian of Parliament:In a drop of dew can be seen the colours of the sun".I know little about medicine or dentistry. But I know enough about academic and scientific debate to recognise whether dissenters from an official, widely articulated viewpoint are mere obscurantists or cranks, or whether there are grounds for legitimate disagreement. The case for fluoridation may not be conclusive even on medical or dental grounds. The opponents may be right that it can be damaging. We 1002 must also remember, as the noble Lord, Lord Charteris of Amisfield, has reminded us, that fluoridation ultimately treats people, not water. However, the central issue is not medical at all, but political and moral.
Dental decay is not infectious or contagious. It cannot be passed on to others. The sole cost to other people is treatment under the NHS of those whose teeth have decayed, a matter to which I shall return. Dental decay can be checked by simple oral hygiene, by regular cleaning of teeth, and by self-control and family control in the consumption of sugar and sugary substances. It can be checked also by using readily available inexpensive fluoride tablets.
Advocates of fluoridation regard it as a manifestation of the caring society. They assume, or expect, that people cannot, will not, or perhaps should not, look after their own well-being and that of their children. Fluoridation by local authorities is an unequivocal instance of the redistribution of responsibility. It subtracts from the responsiblity of individuals and families to look after their own health and welfare, and it adds to the coercive power of the state. There is not even the pretence or semblance of help for the needy or the unfortunate. Nor does fluoridation protect public health, as dental decay is neither infectious nor contagious.
But is not fluoridation justified because many people with preventable dental decay are being treated under the NHS and thus impose costs on their fellow citizens? This has been mentioned by several noble Lords. Does not fluoridation reduce this burden? The net saving under this heading is uncertain because the total effects of fluoridation are still disputed and also because its administration involves costs in money and time additional to those of its immediate application. This was noted by the noble Lord, Lord Ennals, and the noble Viscount, Lord Monckton of Brenchley. But preoccupation with debatable costs diverts attention from the central issue.
People's use of the NHS is much affected by how they live, what they eat and drink, what sports they pursue, and many other aspects of their conduct. The number of children they have affects the costs that they impose on tax-financed education, health and recreational services. The sinister truth is that the claim for fluoridation—that it saves money for the NHS—could be extended to justify close state control of virtually all aspects of people's lives, including eating, drinking and procreation.
Reallocation of responsibility between private citizens and agents of the state is a major component of the welfare state, notably of the NHS. But this is often not immediately clear because redistribution of responsibility is commonly intertwined with redistribution of income and care for the needy. Fluoridation is an unambiguous and unadulterated case of redistribution of responsibility unleavened by redistribution of income or help to the unfortunate. It thus throws into the sharpest relief the true nature of the claims of those who wish persistently to extend the scope of what they call the caring society. What they envisage is a society very different from that of compassionate persons, who are ready to assist those in need, but who respect the right of their fellow men to arrange their own lives whenever possible.
1003 "Big Brother loves you", or at any rate he embraces you; and you have to submit, like it or not. Or perhaps we should talk of the nanny state rather than the big brother state, as one noble Lord has suggested. I am not sure which is more appropriate, but the nanny state is more topical, since the establishment of a Minister for Children is now proposed, and apparently not in jest.
The nanny state treats all private citizens as children who cannot be held responsible for their conduct and who are deemed incapable of looking after their own welfare and that of their families. They must accept the ministrations of their nannies. They must be protected from themselves. They are diminished, dwarfed, shrunken to the status of useful pets—so long as their conduct pleases their self-appointed masters.
§ 11.50 p.m.
§ Lord Rea
My Lords, I can hardly say how much I disagree both with the philosophy and with the facts of the noble Lord, Lord Bauer. There is one matter that I should like to raise and that is that he seems to feel that public health should only deal with infectious disease. More and more public health has to deal with other forms of human suffering, whether these be environmental, nutritional or due to an ageing, degenerating population. Less and less do we have to deal with the problems of infectious diseases.
The positive benefits of fluoride in drinking water in the optimum proportion are now accepted almost universally by all reputable scientific authorities. I do not think there is an argument here, just as Lord Jauncey was clear about this in his judgment. The noble Lord, Lord Campbell of Croy, has pointed out that there are many parts of the world where this optimum proportion, that is one part per million of fluoride, is equalled or exceeded in the natural water supply. There are several such areas in Britain, notably Hartlepool, as the noble Lord mentioned, where 100,000 people live, which has a level of 1.4 parts per million. No harmful effects have been noted among people there and their teeth are much freer from decay than in most other parts of the country.
I regard fluoridation to one part per million as a correction of a relative deficiency, rather than as an addition of an unnatural substance or drug. A close parallel exists with the addition of iodine in areas where there is a deficiency and where goitre is common, such as Derbyshire and several areas in Switzerland and other parts of the world. For maximum benefit fluoride needs to be given very early in childhood, as a number of noble Lords have mentioned, while the teeth are being formed.
In this aspect there is a parallel with a much more serious scourge—that of coronary heart disease. With teeth, once dental caries have developed, there is only marginal gain from administering fluoride. Similarly with arterial disease, once the atherosclerosis and coronary heart disease can be detected, changes in lifestyle, such as diet or exercise, have a marginal effect on the progress of the arterial disease. I will make one exception to that and that is smoking: stopping smoking really does help to stop the progression of the disease. All the evidence is that, to be beneficial, all the 1004 proper dietary habits in regard to heart disease—that is fewer saturated fats, more polyunsaturated fats, more fibre, less salt, less sugar or other refined carbohydrates—must start early in childhood in order to be effective. It is interesting that the last three aspects of diet that I have mentioned are also beneficial in preventing dental caries.
This is one of the arguments, as the noble Lords, Lord Winstanley and Lord Campbell of Croy, have pointed out, why putting fluoride in milk will not be adequate. For instance, some babies—one needs to give it in very early childhood—are breastfed, some drink much more milk than others, and some hate milk and will not touch it. But everyone has to drink water in approximately the same quantities, at least a much less variable quantity. Of course, water can be in various forms but any liquid, anything that we drink, is basically composed of water. The variation in water intake is much less than the variation in milk intake. If you rely on fluoride in milk you will range from a position of giving too much fluoride to a position of not giving enough.
The noble Lord, Lord Charteris, mentioned that high levels of calcium and magnesium are present in parallel with high fluoride in the districts concerned and that they are protective. But Birmingham has soft water and no ill effects from fluoride have been noted, as my noble friend Lady Fisher has clearly pointed out. I could go on, my Lords. A number of other points could be taken up. But it is becoming late. I should like to say that I have no hesitation at all in supporting this very modest Bill.
§ 11.56 p.m.
§ Lord Energlyn
My Lords, I think it is only right to declare that I established the first laboratory in the world to study biogeochemistry. This is the subject about which we are talking tonight: the function of mineral matter in the body cells of animals and plants. The noble Lord, Lord Rea, will agree with that. If we look at this process, what is the magical effect of this element fluorine upon the formation or destruction of bone tissue in the bodies of animals and plants?
I pressed the noble Lord, Lord Winstanley, to explain why this level of toxicity—because that is what it is—is assessed to be one part in one million. I asked him why it was not two parts, three parts, four parts or 10 parts. From where did this figure come? It came from people such as myself who have for four years been using hydrofluoric acid in substantial quantities, and we know from bitter experience—and I emphasise bitter experience—that if flourine is present in the atmosphere of our fume chambers, we are facing disaster. The most noticeable effect is that the fume chamber collapses. The next effect is that we find our skin becoming subject to scurvy; our hair becomes brittle. There have been some very tragic cases of young scientists who have died of leukaemia. This is a dangerous halogen. It is the most dangerous of all the halogens. It will dissolve everything. This is why we use it for the analysis of rocks.
This fluorine is put in the water. The compounds that are chosen have been chosen deliberately to be compounds which will not dissociate in the water but which will distribute themselves uniformly through 1005 the water. That is the claim—that it can therefore be controlled in one part per million.
People talk—rather nonsensically, if I may say so—about large quantities of fluorine in water, far in excess of one part in a million. The noble Lord, Lord Campbell of Croy, mentioned tea. He is talking about fluorine connected with caffeine. He is not talking about free fluorine. When one looks at the analysis of the water that people refer to as rich in fluorine, one is looking at calcium fluoride. It should follow that if calcium fluoride was a very beneficial substance to have in your water, the finest teeth in Britain should be in Derbyshire and the Pennines, where the greatest deposits of calcium fluoride exist.
Part of the Bill says that it will cost us nothing to add fluorine to the water; that is what the Bill tells us. When you talk about the cost of fluorspar, which is the source of hydrofluoric acid from which these chemicals are to be made, you are talking about a substance which is worth between £20 and £50 a tonne; and we produce only about 130,000 tonnes of it in this country. We import just as much from America, because it is all used up in the smelting of iron and steel and ceramics.
Calcium fluoride is not a substance that will enter the bloodstream and it has got to enter the bloodstream before it can have any effect upon our teeth. The closest we have got to an understanding of this process, as we would expect, was from the noble Baroness, a dentist. She explained how this whole idea began, by the development of brown teeth. What are brown teeth? Brown teeth are not calcium phosphate; they are calcium fluorophosphate, and the more fluorine you have in the molecules, the browner the molecule becomes.
Secondly, you then have to have this fluorine entering the bloodstream. Are you going to accept the naïve fact that the blood will then convey all this fluorine to your teeth and nowhere else? That would be far too naïve an observation. Of course it will go elsewhere. And where will it go? It will go in search of calcium, where it can be again crystallised into calcium fluorophospate. And where does that happen? That happens in the elastic layer of our arteries; and despite what the noble Lord, Lord Rea, said, this is where you get the real side-effect—that the more fluorine we drink the greater is the potentiality of the fluoridation of our arteries.
If your Lordships do not believe me, let us take the statistics behind which the "fluoridisers" take great comfort. The West Midlands, they say, is now practically under control so far as caries is concerned. But let us look at the mortality statistics, which one can never deny. This is what the Ministry says:On the SMR basis, deaths in the West Midlands (RHA area) caused by diseases of pulmonary circulation and other heart diseases exceed the national average by 10 per cent.".That was in 1980. In 1982 it had increased by 3 per cent. for females and by 2 per cent. for males. In 1983 it was a 5 per cent. increase for males and a 6 per cent. increase for females. So here we have statistics which are as vivid as the ones for caries, which indicate that if you have excess fluorine in your bloodstream, your chances of developing heart disease are increased. So what is the choice? The choice, my Lords, seems to me 1006 to be that you go along with the "fluoridisers", with flashing teeth and a weak heart, or you go along with people such as myself and the noble Viscount, Lord Monckton, who drink bottled water; and we will go through life with sound hearts and false teeth.
§ 12.4 a.m.
The Earl of Yarborough
My Lords, I am very conscious of the lateness of the hour, but I want to take part in this debate, even for a short time, as I have for some 20 years now been an opponent of fluoride in water supplies and this seems too good an opportunity to miss. Fortunately, most of the arguments I wanted to put have already been placed before your Lordships and I have no wish to repeat them all; nor, indeed, would your Lordships wish me to do so.
I base my objections to this Bill on the moral or ethical grounds that it is mass medication. I am afraid that I cannot accept the argument that fluoride is only one chemical among many that are put into the water supply. It is the only one that is put in with the intent—I think that the lawyers call it mens rea — of bringing about a physiological change in the recipient; that is, the consumer. I call it mass medication. It is also compulsory, because when you live in a fluoridated area you have no means of avoiding drinking the water from the taps. It is very unselective. The target may be young children from 5 to 15 or so, but it hits everybody up to old age pensioners with no teeth and everybody in between.
Secondly, I wish to invite your Lordships to accept that there is considerable doubt about the safety of this process. I am very grateful to the noble Lord, Lord Energlyn, because I was going to suggest that it was evident that experts differ. We have had assurances this evening that it has been tested time and time again and nobody has ever discovered any ill effects. But the speech of the noble Lord, Lord Energlyn, raises doubts anew in my heart. When experts disagree, then it is reasonable to say that there is a doubt. I think that the question mark is a fairly large one. But, be that as it may, doubt there must surely be.
That is emphasised by what we have been told by several noble Lords already, that other countries have had doubts, particularly Holland and, even more so, Sweden, where they threw it out on pharmacological and medical grounds and not just on moral grounds and on the issue of mass medication. As I said, I do not think there is any doubt about the mass medication. It came up in Lord Jauncey's judgment. He called it mass medication and he said:To use the water supply for mass medication is without precedent or legal authority and is illegal",and this Bill has been brought in, as I understand it, as a result of that judgment.
There is just one area which I do not think has been touched upon and that is the effect of fluoride on the environment as a whole. Your Lordships have heard that it is produced by fertiliser factory emissions, aluminium processing and so on, and there is a lot of it around. Reference was made to its effect on cows, for which I can vouch. It is very damaging when it comes through the air and onto the ground and the cows eat the herbage. It is a very toxic, long-term poison, the effects of which are not apparent at once.
1007 I have never understood why anyone should suppose that if you put fluoride into the water the recipients receive it into their bodies and it goes straight to their teeth. The noble Lord, Lord Energlyn, has now explained what happens and it is as I always suspected. It must have an effect on the whole person. The other point about the environment is that it seems to me that there is almost a sea change nowadays in people's concern about everything to do with their environment. They are concerned about air pollution, about pollution in rivers and about pollution from pesticides, spray drifts and so on. That concern extends to what they eat and, presumably, to what they drink and ingest. I think that this accounts for a great deal of the very strong feeling against fluoridation.
I know that this Bill was presented as more or less a fairly innocuous enabling Bill—nothing much to make a fuss about; just a little tidying up to be done to put things back to where they were supposed to be or were thought to have been. The proceedings in another place must surely have indicated that the feeling against it is very strong indeed and is not something that is likely to go away. I prophesy that it will continue and even grow stronger as time goes by, whatever the ultimate fate of this Bill may be. Personally, I think that the Government were unwise to bring the Bill forward at this time. I detect a tide flowing, and I think that that tide is on the make; and I am very much afraid that the Government are swimming against it.
§ 12.11 a.m.
§ Lord Colwyn
My Lords, as you can imagine, I would have much to say on this subject, but owing to the lateness of the hour I have rejected many of my notes and I have put aside the arguments about cancer; the cumulative poisoning effects of fluoride; the inhibitive effects on the enzymes; about kidney disease; the risk to the elderly, the under-nourished and the unborn; and the problems of hydrogen bonding. However, before I go on, I must declare an interest as a dental surgeon and also as a vice-president of the Fluoridation Society.
In fact of course it is not in my interests to speak in favour of this legislation this evening as my noble friend Lady Gardner of Parkes has mentioned, for it will ultimately put my profession out of work. We are discussing a preventive measure which has been more carefully researched, more widely examined, and more comprehensively tested than any other aspect of public health. We know that it works and we know it is harmless.
At a time when the dental profession is suffering from an unfavourable public image, with horror stories in the press and on TV about mythical high earners and over-prescribing within the NHS—and now the continued persecution by the Government by the introduction of new charges—we have a measure to benefit our patients which is virtually 100 per cent. accepted within the profession and yet will considerably affect their ability to practise dentistry by cutting down on the amount of work that will be needed to repair decayed teeth.
1008 Dentistry has changed. When I first qualified in the mid-1960s most of my time was spent repairing the ravages of dental decay in patients between four and 24 years old. This frequently necessitated the removal of teeth from children often as young as three years old—not a pleasant experience for the child or for the operator. Now it is possible, I suppose, that I am cushioned from the harsh realities of dental life in my Wimpole Street practice; but there is no doubt that this sort of dentistry no longer exists in most parts of the country. This is partly due to the fluoridation of some areas, but also to the improvement of preventive techniques in and out of the surgery.
Of course we can apply topical fluorides and suggest the use of fluoridised toothpastes, but these measures will not be available to the 50 per cent. of the population who do not regularly see a dentist or the 30 per cent. to 40 per cent. of the population who do not even own a tooth brush. I have no wish to repeat all the arguments and statistics, some of which have been discussed this evening and on other occasions in your Lordships' House, because our argument has been clearly documented.
With the addition of one part per million of fluoride to water, we have the safest, most widely available method of bringing prevention to patients who do not seek first-hand advice from the dental surgery as well as the regular attenders. I do not intend to repeat any of the arguments now as I feel it would be an insult to the intelligence of all noble Lords who are able to examine and discuss this issue in a logical and unemotional manner, I should, however, like to answer one or two points that have come up during the evening.
The noble Lords, Lord Charteris and Lord Harris of High Cross, and the noble Lady, Lady Saltoun, mentioned the problem of mass medication. Fluoridation is not mass protection, but an adjustment of the normal constituents of natural water to its optimum content from the standpoint of public health. It is not medication, and hence it is not compulsory. "Medication" means to cure. Fluoridation does not cure dental decay, just as chlorine does not cure cholera. Both chlorine and fluoride prevent disease; both are forms of community prevention.
The noble Viscount, Lord Monckton of Brenchley, and the noble Lord, Lord Energlyn, asked why 1 ppm has been selected as the optimum dose. The answer is that it is the level at which the optimum benefits occur. Normal use involves the ingestion of about 1 to 1.25 milligrams of fluoride. Death occurs after the ingestion of 2,500 milligrams, severe symptoms after about 125 milligrams and some chronic symptons after about 20 milligrams.
Lord Energlyn also talked about the distribution of fluoride. It does go to bone, and it does go to areas in the arteries where there is calcium, but the figures that he mentioned are isolated and showed no comparison with figures in other areas. I do feel it is of little relevance, and should not be considered when we are only talking about 1ppm.
At this late stage to bring a little light-heartedness into our debate, I should like to quote a few words 1009 from an article in the Sunday Times of as long ago as May 1971, when Norman Mischler quoted the discovery of a new substance and said:The discovery is announced of a new firefighting agent, to add to the existing range; it is known as W-A-T-E-R, a Wonderful and Totally Extinguishing Resource. It makes rather than replaces existing agents such as dry powder and BCF—bromine/ chlorine/fluorine, which have been in use from time immemorial. It is particularly suitable for dealing with fires in buildings, timber yards and warehouses. Though required in large quantities, it is fairly cheap to produce and it is intended that quantities of about a million gallons should be stored in urban areas and other installations of high risk ready for immediate use. BCF and dry powder are usually stored under pressure. But water will be stored in open ponds or reservoirs and conveyed to the scene of the fire by hoses and portable pumps.The new proposals are already encountering strong opposition, from safety and environmental groups. It has been pointed out that if anyone immersed their heads in a bucket of water it would prove fatal in as little as three minutes. Each of the proposed reservoirs will contain enough water to fill 500,000 2-gallon buckets, each could be used a hundred times so there is enough water in one reservoir to kill the entire population of the United Kingdom.Risks of this size, it is said, should not be allowed, whatever the gain. If the water were to get out of control, the results of Flixborough or Seveso would pale into insignificance by comparison. What use is a firefighting agent that can kill men as well as fire? A spokesman for the fire brigades said he did not see the need for a new agent. Dry powder and BCF could cope with most fires. The new agent would bring with it risks, particularly with firemen, greater than any possible gain. Did we know what would happen to this new medium when it was exposed to intense heat? It had been reported that water was a constituent of beer. Did this mean that firemen would be intoxicated by the fumes? The Friends of the World said they claimed a sample of water and found that it caused clothes to shrink. If it did this to cotton, what would it do to men?I should like to say a few words about the ethics of fluoridation and try to explain why I do not consider fluoridation of water supplies to be an interference with individual freedom. The question of how far the rights of individuals in the society should be controlled in the general public interest is one that cannot be assessed by any scientific inquiry. Fundamental rights are not absolute rights. Individual liberty should never be allowed to supersede the necessary limitations which must be imposed in the general interest of a viable society.
The conflict between the individual's right to live life as he pleases and the necessary demands of an orderly, civilised and healthy society is the essential basis of individual liberty as we know it. Fluoridation of the water supplies does not cause any harmful effect to health or to comfort, other than the injury to a personal sense of liberty.
This may be a serious matter to those who, having been persuaded, wrongly, that water fluoridated with one part per million will injure their health, will be distressed by the difficulty of avoiding it. The fact that some consider that fluoridation is mainly intended to benefit children introduces a difficulty for those who object on the ground of personal freedom.
There are some who claim that the principle involves the right of parents to determine what was, or was not, good for their children. The fact is that, in the interests of children as a class, society has long recognised—and accepts without reservation as right and proper—a considerable limitation on the rights of parents to do what they like in regard of their children's health, education and welfare.
In fact, the very evidence of the prevalence of dental decay in some groups of children makes it clear that 1010 reliance on parental responsibility is not an answer to the problem. However, some opponents of fluoridation do not see it in such terms. To them, fluoridation of the communal water supplies is an invasion of liberty; a moral objection and an infringement of personal rights.
I cannot understand what motivates individuals to object in this way. It would be a perfectly reasonable objection if, by adding fluoride to drinking water, the water became unpalatable or constituted a risk to health. But fluoridated water, unlike chlorinated water, does not affect the taste; neither does it constitute a health hazard. If water fluoridation is safe and effective, the freedom to drink fluoridated water is totally inconsequential. One might expect a person with no teeth at all, for example, to display magnanimity by admitting that even if fluoridated water did not benefit him, it would benefit his children, grandchildren and future generations.
Denial of this benefit is a denial of their human rights. Looked at in this way, the ethical argument of the anti-fluoride lobby is utterly self-defeating. This pseudo-high moral rectitude just when it suits them hardly benefits the anti-fluoride lobby. They have no ethical consideration when they persistently put out false rumours—for example, about cancer and cot deaths—and they have no ethical scruples about denying the right of others to benefit.
Fluoride is a natural constituent of water supplies and other foods. The adjustment of its content to an optimum level cannot be compared with the addition to water of a substance not normally found in water. We have heard this evening about all the other substances that are added to our foods to make them wholesome. Although I have sympathy with the objectors on moral grounds, I am unable to follow their arguments in a logical, unemotional manner.
I regret the Government's delay in introducing this legislation, which has cost the taxpayer thousands of pounds in recent years—but better late than never. I warmly welcome this Bill and look forward to the end of the controversy that has been associated with this measure, at the expense of our health, for 25 or more wasted years.
§ 12.23 a.m.
The Earl of Caithness
My Lords, we have had today the first opportunity for several years to debate the subject of water fluoridation. The debate has been lively and well informed, and I hope it will be agreed that all aspects of the subject have been well aired.
As might have been anticipated, the debate focused on the major issues of the benefit to dental health, the very important question of safety, and the no less important consideration of the ethics of water fluoridation. I should like, if I may, to reply to the debate under these main headings as well as tackling some of the very significant points which have been raised.
After the excellent speeches of the noble Lords, Lord Ennals and Lord Winstanley, the noble Baroness, Lady Fisher of Rednal, my noble friends Lady Gardner of Parkes, Lord Nugent of Guildford and Lord Campbell of Croy, I hope that your 1011 Lordships will be prepared to accept that all the evidence collected in this country shows clearly that fluoridation of the water supplies is an effective means of reducing dental decay and in the right proportions is beneficial. I do not believe that it could have been put more clearly than in the speech of my noble friend Lord Colwyn.
With regard to alternative methods, the Government, of course, accept the importance of dental health education, but we regard this as complementary to the provision of fluoride supplementation. Other forms of fluoride supplementation exist, and, in particular, the widespread use of fluoride toothpaste in recent years is considered to have contributed markedly to the general reduction in dental decay. We have also heard about milk from the noble Lord, Lord Ennals, who, I understand, is a consultant of the Borrow Dental Milk Foundation, and from the noble Lord, Lord Rea, who made a very useful contribution on this point. Although I freely admit that fluoridated milk does help, nevertheless it is only water fluoridation that has all the advantages of reaching the whole of a given community, of not requiring conscious effort on the part of the recipient nor administration by skilled, and expensive, dental staff, and of being highly cost-effective. For these reasons we believe the option of water fluoridation should continue to be available to health authorities.
With regard to safety, and, in particular, the allegation that fluoridation induces cancer—a point raised by the noble Lord, Lord Ennals, although he agreed that it did not—I should like, if I may, to refer to the remarks of the chief medical officer in the preface to the report of the Knox Committee which was published at the beginning of the year. He said:The present Report of the Working Party on the Fluoridation of Water and Cancer draws together the many relevant epidemiological studies, including several analyses commissioned by the Working Party itself. The Report concludes that there is nothing in this extensive range of studies, covering altogether very large populations, to suggest that fluoride or fluoridation, 'is capable of inducing cancer or of increasing the mortality from cancer.' Indeed, the Report goes further and states that in view of the very large human populations which have been observed it can be concluded that 'in this respect the fluoridation of drinking water is safe'. The opposite opinion is still voiced in some quarters but the Report demonstrates that elementary misinterpretations of the facts are responsible for that conclusion".I believe that with this level of assurance we may with confidence recommend the Water (Fluoridation) Bill to the House in so far as the safety of water fluoridation is concerned.
I am somewhat disappointed by my noble friend Lord Yarborough who, if I may say so, made a very good, almost second maiden speech on fluoridation. He made his first on 15th November 1979 and at that time asked for a judicial review. We had one under Lord Jauncey—201 days. The very best of the anti-fluoridation lobby were presented to Lord Jauncey. In particular, there was a Dr. Burk from America who was supposed to be an expert on cancer. This is what Lord Jauncey had to say about him:Indeed Dr. Burk's evidence on the subject of cancer notwithstanding his professed experience in the field tended to be unprecise and did not impress me".1012 He went on to say:Dr. Burk on the other hand did not appear willing on all occasions to answer directly or even indirectly questions which were put to him and on occasion when he did so his answers were rambling and evasive.There was a Dr. Yiamouyiannis. This doctor, says Lord Jauncey,who played so important a part in this case, is undoubtedly a propagandist as well as a scientist … He went so far as to accuse persons serving in the Public Health Service and members of the American Dental Association of knowingly making fraudulent statements concerning the safety and effectiveness of fluoride … Dr. Yiamouyiannis displayed great ingenuity".I have known the noble Lord, Lord Charteris of Amisfield, for many years and he has always based his opinions on sound evidence. I suggest to him that today his evidence is not sound.
When we are talking of safety we must also bear in mind that any scientist worth his salt, if he thinks there is something wrong with fluoride, will, of course, say so. We must also bear in mind that any health Minister who thinks that there is positive proof that fluoride at one part per million does cause any damage should stop it; and the powers to do so exist under the 1977 health act. I think that it is important that with all the studies conducted here and abroad so many countries have come to the conclusion that fluoridation should continue.
I turn to a specific point raised by the noble Lord, Lord Charteris, and that is the safety of the fluoridation procedures. The equipment that is installed is designed to halt the supply of fluoride if the concentration in the water supply begins to exceed the tolerance level, and that is from 0.8 to 1.2. Even if there were a malfunction in the monitoring equipment, the amount of fluoride compound which could enter the supply at any one time is severely limited. The Department of the Environment monitors new plants to ensure that they are operating satisfactorily.
The noble Lord, together with the noble Lord, Lord Harris, who, alas, is not here, I see—and the noble Lord, Lord Monson, has gone too, which is a pity—raised some of the points brought up by a Dr. Waldbott in his studies. He says that fluoridation causes disorders, including nausea, diarrhoea, constipation, headache, backache, skin rashes, brittle nails, convulsions, personality change, mental deterioration and exhaustion. But every investigation of individual cases of supposed intolerance to fluoridated water has failed to confirm fluoride as a cause, and there is no evidence of allergy or intolerance to fluoride as used in the fluoridation of community water supplies.
I turn to the question of enzymes, which was also raised by the noble Lord, Lord Charteris. It is well known that fluoride in high non-physiological concentrations can inhibit or enhance the action of many enzymes. For this reason it is often used as a tool in the investigation of enzyme functions. There is, however, no concrete evidence in humans of enzyme inhibition resulting from the consumption of fluoridated water at one part per million and still less suggestion of any scientific or harmful effect which could be attributed to such enzyme inhibition. Again the noble Lord, Lord Jauncey, commenting on Dr. Yiamouyiannis, said when he was referring to 1013 enzymes: "Thus again like Willy at the wet review in 1881, Dr. Yiamouyiannis marches as the only man in step".
I turn to the noble Lord, Lord Energlyn, who blinded us all with science. He spoke at length about the harmful effects of fluorine, including the collapsing of fume chambers. No one can doubt that fluorine is a very noxious and corrosive gas. But we are concerned tonight with the fluoride ion in solution. The fluoride ion is a fluorine atom which has gained an electron. Its chemistry is completely different from that of the gaseous fluorine. When hexafluorosilicic acid and sodium hydrofluorosilicate are added to water, they dissociate to produce free fluoride ions. These chemicals in the concentrations used for fluoridation of water have no other significant effects, including any on heart disease.
I turn now to ethics. In this context, I think it is also very important to understand that in artificially adding fluoride to the water supply we are in no way introducing a substance which is otherwise alien to us. As has been said, fluoride is in fact widely present in the human diet and is present in particularly high levels in tea. Indeed, as my noble friend Lord Glenarthur and other noble Lords have said, a heavy tea drinker in a fluoridated area will ingest more fluoride from his tea than from the water supply. In addition, it has to be remembered that around 95 per cent. of toothpaste now contains fluoride, although the use of fluoridated toothpaste in a fluoridated, as opposed to a non-fluoridated, area in fact confers additional dental health benefit.
It is also the case, as has been said in the debate, that fluoride occurs natually in all water. Thus, I believe that it is not mass-medication. It is a rectification of the water supply, as so well pointed out by my noble friend Lord Colwyn and by the noble Lord, Lord Winstanley. I would like to make the point that we must be wary of assuming that if water is not fluoridated it is free from chemical additives. As Lord Jauncey pointed out in his opinion, there are some 18 different chemicals which are added to different supplies in Strathclyde and whose purpose is to achieve purity. This, I believe, helps to put the addition of fluoride into perspective.
I recognise that there will always be those who genuinely feel that water fluoridation constitutes mass medication and, as such, should not be permitted. To this view, I think I can only make the point that Nature herself has arranged mass medication—if that is the word to describe it—to the extent that there are 100 million people worldwide who receive water with a natural fluoride content around the optimum level of dental health. That excludes all the other 100 million who receive it artificially fluoridated. I will repeat: 100 million already receive it at about 1 ppm in a natural way.
In the Government's view, it is for the responsible bodies who take decisions locally to weigh any alleged interference with the liberty of the individual against the undoubted benefits which future generations will gain with respect to their dental health as a result of water fluoridation. As with any decision which has to be taken on a community basis, there will inevitably be those who are disappointed whichever way the decision goes.
1014 I turn now to the actual implemention of fluoride into the system. The Government are aware that the procedure whereby decisions on fluoridation are made dissatisfies some Members of this House, and this point has been raised during this debate on a number of occasions. Although it has been suggested that the decision-making on fluoridation is undemocratic, I feel that I must make the point that Parliament has vested responsibility for preventive health measures and the supply of domestic water in, respectively, the health and water authorities. As these are the two functions inherent in fluoridation, it must be right that these bodies should take the final decisions.
Nevertheless, the Government attach great importance to local public opinion having a voice in the decision-making process of fluoridation. Health authorities are already obliged to consult on fluoridation. Their community health councils already have statutory responsibility to represent the views of local people. In addition, we have already undertaken to bring forward an amendment at Committee which will place a duty on health authorities to undertake more general public consultation. This will give local bodies, including locally elected councils and also individual citizens, the opportunity if they wish to make representations to the health authority before any decision is taken.
The noble Lord, Lord Ennals, said that the local authorities must take part in the decision. I think that is what he said. Of course, he said that he might bring forward an amendment. I might just remind him that I hope he drafts it properly because they already have that power in Scotland as the water authorities are the councils that are already elected. Talking of that, there was a point raised by my noble friend Lady Gardner of Parkes when considering the areas in England and Wales which are presently artificially fluoridated. All but one of the areas that are artificially fluoridated were fluoridated before the 1970s reorganisation, and therefore all the proposals for this went through the democratically-elected councils of the day.
May I turn now to specific points? The noble Lord, Lord Ennals, raised the question of costs and manpower. It is entirely correct to say that the Bill will result in no additional public expenditure as the money will be found by health authorities from their cash-limited expenditure. It is equally right to say that the Bill has no effect on public sector manpower as it does not compel the introduction of any new schemes and therefore requires no consequential additional manpower. Even if schemes are expanded manpower numbers will be very low, and in Gateshead four to five man-years annually carries out the fluoridation for three-quarters of a million people.
A number of noble Lords, raised the question of the optimum level of fluoride. We say it is one part per million. This concentration was established by extensive epidemiological investigations of populations consuming fluoride naturally present in the drinking water. At one milligram per litre there was considerable benefit with no harm from dental mottling. Much of the evidence was accumulated in the United States, but further investigations in the United Kingdom and by the World Health Organisation confirmed the American findings. This was explained in detail in the report, Conduct of the 1015 Fluoridation Studies in the United Kingdom and the Results Achieved After Five Years. Subsequent studies have continued to confirm the safety and efficacy of the fluoridation of water to one milligram per litre.
The noble Viscount, Lord Monckton of Brenchley, asked when fluoride would be poisonous. I can tell him that serious acute fluoride poisoning would require, for an average adult, a single ingestion of over 1 gram of fluoride. To obtain this from optimum fluoridated water supply, the noble Lord would need to consume very rapidly over 1,000 litres of water. I suggest that he would come to more serious consequences—
The Earl of Caithness
My Lords, can I please not give way? I have some more material to get through and although the time is early, it is running on. The noble Lord, Lord Charteris, referred to Japan as an area that is not fluoridated. I cannot agree with him. Our information is that 56 million people in Japan receive naturally fluoridated water. He referred to Chile, which had stopped fluoridating. It is often alleged that fluoridation in Chile ceased as a result of Prof. Schatz's work. This is not the case. The latest information we have is that 4.5 million people in Chile receive artificially fluoridated water.
The noble Lord asked why we should believe the medical profession's view that fluoridation is safe when it was so wrong about thalidomide. It is entirely wrong to have any analogy between fluoride and thalidomide. Thalidomide was a new drug but fluoride has been ingested by mankind for all ages.
My noble friend Lord Monckton of Brenchley, the noble Lord, Lord Monson, and my noble friend Lord Yarborough, in his maiden speech in 1979, raised the point of delays in dental decay. It is not merely delay that is due to fluoride. Studies carried out over the past 10 years in areas with a satisfactory level of fluoride in the water supply have shown that fluoridation confers a measure of protection against dental decay which persists thoughout adult life. I would specifically ask my noble friend Lord Monckton to reconsider his views towards our children and indeed towards myself because I can still benefit from fluoride. My noble friend says that it is too late for him to benefit. I do not believe that. But it would be wrong, I believe, for my noble friend to dictate to the rest of us on that.
My noble friend also raised the question of fluoride affecting livestock, fluoridation of water supplies at one part per million does not affect livestock. Fluorosis has, however, been a problem in cattleherds where pastures have been polluted with fluoride from neighbouring factories. Such emissions are now strictly controlled and levels of fluoride in pasture are monitored where significant emissions used to take place.
The noble Lord, Lord Monson, raised one of the many hypothetical points—that fluoride affected thyroids, fluoride is not concentrated by the thyroid. It does not influence its uptake of iodine. After reviewing all the relevant studies, the Royal College of Physicians concluded that there is no evidence that fluoride is responsible for any disorder of the thyroid. 1016 The noble Lord also raised the question that fluoride makes teeth brittle and that it is therefore opposed by an increasing number of dentists. I would only tell him that the British Dental Association has always supported fluoridation and there is no evidence that an increasing number of dentists are opposed to it. fluoridation does not make tooth enamel brittle. It makes the enamel harder, stronger and more resistant to acid dissolution.
The noble Lady, Lady Saltoun, said that we should have consensus. That is exactly what we are allowing for. By putting this Bill before Parliament we are saying to the water authorities and the health authorities, "It is up to you. You get the consensus in your area. The Government are not doing it."
In conclusion, I should like again to stress that the House is being asked to agree neither to a radical new innovation in public health nor to the compulsory nationwide introduction of fluoridation. Fluoridation schemes have been operating in this country for 30 years and five million people are now benefiting from the resulting improvements in dental health. Fluoridation has a proven record of safety in operation in this country and despite specific monitoring has never been demonstrated to be in any way injurious to general health. The Bill will allow decisions on water fluoridation to continue to be taken locally by health and water authorities after consulting public opinion. We are providing no more than the statutory framework for the operation of a public health measure which has been applied in this country on the basis set out in the Bill, safely and efficaciously, for three decades. I hope the House will give it a Second Reading.
§ Lord Ennals
My Lords, before the noble Earl sits down, and in the welcome presence of the Government Chief Whip, will he comment on the complaints made by several noble Lords about the disturbing organisation of Government business which leads to an extremely important and very controversial debate taking place in your Lordships' House at this time of night?
§ Lord Denham
My Lords, this time of night is indeed quite late. The noble Lord, Lord Ennals, will realise that in this House we have no guillotine, we have no selection of amendments. Any noble Lord is entitled to raise a subject when he wishes to do so. This is a freedom for which we must pay. We must pay for it by being prepared to sit perhaps a little later than we should do otherwise. This programme was agreed through the usual channels, and it is not usual to question on the Floor of the House the agreement of the usual channels. If the noble Lord wishes to raise it with his business managers, and they approach me in the morning, I shall certainly take it up with them and discuss it in the future. But this is something that does happen. For an active and professional House of Parliament, a quarter to one in the morning on a rare occasion is not unduly late.
§ On Question, Bill read a second time, and committed to a Committee of the Whole House.