HL Deb 16 December 1998 vol 595 cc1394-430

5.50 p.m.

Earl Baldwin of Bewdley

My Lords, I am grateful for the chance to raise the issue of water fluoridation, which I do not think has been considered in any depth in your Lordships' House since the Water Bill in 1989. The context is the Green Paper Our Healthier Nation, and the pressure that is being exerted on the Government to extend fluoridation schemes. This is a subject I have been studying for many years, and the predecessor of the noble Baroness, Lady Hayman, the noble Baroness, Lady Jay, in conversation earlier this year, urged me to put down a Motion which could help to clarify thinking on the subject.

There are two strands to my Motion. For the wording of the first part I am indebted to Dr. lain Chalmers, the head of the UK Cochrane Centre which has a brief for high-quality scientific evidence in health-care, who believes that: a group should now be commissioned which is seen to he independent of any particular viewpoint in order to draft a protocol, to be endorsed by both supporters and opponents of fluoridation, for a scientifically defensible systematic review of the available evidence (published and unpublished), and that the results of such a review should be made public". The second strand recognises the fact that this is not just a scientific matter, but that reaching whole populations through the public water supply involves questions of ethics, social policy, cost and cost-effectiveness, appropriateness of the decision-making process, environmental consequences, and so on. Only through a public inquiry, in an area where feelings have always run extraordinarily high, can such matters be properly addressed.

There are logically three questions to which would-be fluoridators must be able to give an unequivocal Yes. First, is water fluoridation effective in reducing dental decay among children, the purpose for which it is put forward? If it is, then, secondly, is it safe? Finally, is it appropriate? For example, as a society we compel motorcyclists to wear helmets, but we do not force people to be vaccinated against quite serious diseases. I say the answers must be unequivocal, because it is axiomatic that for a major public health measure, where millions of people cannot avoid the treatment even if they want to, the science must be beyond reproach.

It is impossible in a short debate to cover all aspects of the argument. Let me start by telling a tale of my attempts to get at the evidence, conscious that the field resounds with claims and counterclaims by scientists on both sides. (And let me say for a start that to anyone like myself who keeps a regular eye on the medical press the notion that the controversy is a scientifically "bogus" one is quite unsustainable.) The only reliable approach in such a case is to go to primary sources.

For more than a year I have been tabling Written Questions to this Government and their predecessor. My first request for the scientific evidence for efficacy and safety was turned down. I then asked for the principal studies, and in particular those that had been randomised. I was given a list which consisted of other people's reviews, which, as any scientist will tell you, are of no value if one is trying to eliminate bias. Next, in an attempt to make things even easier, I asked for the major controlled studies. I was referred again to the list. At the same time I was corresponding with the National Alliance for Equity in Dental Health, and after three letters met with the same lack of success apart from a motley collection of secondary sources and reference to a large number of studies in the literature. My Lords, this should be bread-and-butter stuff in the world of science; any reputable body expects to have to display its best evidence if challenged. Even the Committee on Toxicity did so over Vitamin B6 in the summer. Finally, I had a meeting with the noble Baroness, Lady Jay, and her advisers, where, after initial demurring, I was promised a selection of studies but with a warning that some of them were quite old and not of the standard of today's methodology. Indeed. That was in May, and I have had nothing yet.

This has been an eye-opener, and something I have found to be replicated, not only in others' experiences, but in most of the other scientific aspects of fluoridation which I have pursued through Questions. Why is good methodology so important? Among other reasons, because dental caries has long been declining worldwide, and it requires a well-designed trial to determine whether a reduction in decay is due to fluoridation or some other factor; also because the temptation is to cherry-pick your regional examples so as to get the result you want. (Did your Lordships know that quite recently 15 out of the best 25 areas for children's teeth were unfluoridated, and that for 12 year-olds an unfluoridated area headed the list?) No amount of poorly designed studies can constitute good evidence.

What I have been able to see leads me to believe that few, if any, studies meet the criteria of good science, despite all the assertions to the contrary; and that what the arch-fluoridationist Dr. John Colquhoun found, which caused him to change his mind, is probably true—namely, that when proper epidemiological methods are followed and comparisons are made over whole populations and not isolated areas, in New Zealand, in the UK, in the USA, the supposed benefits of fluoridation melt away. Dr. Paul Connett, professor of chemistry and international authority on environmental toxins, is on record as being appalled by the poor science underpinning fluoridation". That the experts on the subject have been unable to refute my suspicion that the evidence is not there, when it would have been so easy to provide it, I find highly indicative, and I draw my own conclusions.

I must confess, however, that this has surprised me, since it had always been the safety issue that really concerned me. The problem with fluoride is that it is no harmless nutrient, as it is sometimes portrayed, but is a substance that ranks alongside arsenic and lead in tables of toxicity. It inhibits bodily processes. No essential function has been proven in humans, as a recent Department of Health report confirms. The origins of fluoridation are interesting, because it was as a result of major environmental problems in the disposal of fluoride as a toxic waste product of American industry in the 1930s that the impetus came to put it into the water supply, and the research behind this was largely funded by the industry concerned. The US Environmental Protection Agency has described it in a letter which I have seen as an ideal environmental solution to a long-standing problem". For substances of high toxicity, where parts per billion are common currency, 1 part per million can be quite a big dose. But of course it is not a dose at all: it is merely a concentration, and old and young, sick and healthy, malnourished and well-fed, will drink and absorb greatly varying amounts of fluoride. As one doctor has put it: No physician in his right mind would prescribe for a person he has never met, whose medical history he does not know, a substance which is intended to create bodily change, with the advice: 'Take as much or as little as you like, but you will take it for the rest of your life because it may benefit other people's teeth.'". Incidentally, the claims that it is not medication at all, and that 1 ppm simply replicates the best that is found in nature, were dismissed as wrong by the noble and learned Lord, Lord Jauncey, in the Strathclyde case often cited favourably by fluoridationists. If it is not intended to treat, will proponents please stop talking about teeth. As for the claim that 1 ppm is an "optimal" level, I quote from the Journal of the American Dental Association that this has never been determined scientifically and has been used only in general terms". It was a ball-park figure arrived at in the 1950s, since when, with toothpaste, drops, and a large increase in fluoride in our food and environment, it is overdue for revision downwards and has in fact been revised by some authorities. And yet our own experts, the same ones who cannot find the good scientific studies, are still standing pat on 1 ppm.

None of this should make it too surprising that reports of possible harm have been appearing in the world literature with increasing frequency. Dental fluorosis we all know, that unsightly mottling that can so distress children and which now runs at between 10 per cent. and 30 per cent. in artificially fluoridated areas. Allergy to fluoride is a worry. Skeletal fluorosis is a serious concern, with reports now appearing to link hip fractures to fluoride in the water. Up-to-date research which I have seen, shortly to be published, casts doubt on current recommended safety levels and predicts that over a lifetime of artificial fluoridation we may see an epidemic of bone and joint problems in this country. At present doctors are not trained to look for this because of the ingrained belief in fluoride's safety, and there are no routine NHS tests to indicate possible fluorosis; so the well-worn phrase "there is no evidence" will once again be literally true, but only for want of looking. I will quote two other developments among many.

India has a major problem, with very high levels of natural fluoride producing crippling fluorosis. This has given them a strong incentive for research, which their leading expert talked about on a visit here in October. Professor Susheela, a former president of the International Society for Fluoride Research, stressed that India took no lessons from the West in either quantity or quality of peer-reviewed studies, and expressed her shock at the weakness of our research base and the lack of official interest in remedying this and in facilities for testing. Their principal finding was that there was no change in caries prevalence between 0.5 ppm and way above the maximum limit at 5 ppm; also that fluoride toothpaste gets quickly into the bloodstream, and that a variety of health problems result. The findings have been so clear that the Indian medical and dental professions are now united in wanting to get rid of fluoride at any concentration at all. They are thus poised to join Germany, Japan, the old USSR, the Netherlands, Finland, Sweden, Chile, and other countries and regions, in abandoning the fluoridation of water. Most other countries have rejected the practice from the start.

The second example comes from America. Last year the Washington DC branch of scientists and other professionals working for the Environmental Protection Agency publicly repudiated the fluoridation of water, and stated: Our members' review of the body of evidence over the last eleven years, including animal and human epidemiology studies, indicates a causal link between fluoride/fluoridation and cancer, genetic damage, neurological impairment and bone pathology. Lest there be misunderstanding, let me emphasise that this body embraces the in-house scientists working for the EPA in the Washington area—some hundreds of chemists, toxicologists, and those whose job it is to assess the risks of fluoride; except that, curiously, they were prevented from doing this formally when their political bosses almost uniquely contracted out their most recent fluoride assessment to scientists of a different persuasion. I have contacted Washington and verified these details. This is no bogus controversy, my Lords. Time and evidence have moved on since Jauncey, Knox and the Royal College of Physicians' report.

I quote another US professor of chemistry: In the development of drugs.. we generally insist on a [margin of safety] of the order of 100; a therapeutic index of 2 or 3 is totally unacceptable, yet that is what has been proposed for public water supplies. Researchers at Odense in Denmark have likewise drawn attention to the exceptionally narrow margin in water fluoridation. Fluoride tablets and drops have to be sold as medicines; why has fluoridated water never been assessed by the Committee on Toxicity? Given all that I have said, it is small wonder that disquiet remains and that assurances do not reassure.

How is it, then, that the great majority of dentists and doctors in the very few countries that now fluoridate are convinced of its benefits and have persuaded others to follow them? In the first place, only a tiny minority of professionals actually read the primary papers: assertions of absolute safety, extensive research and of the "unscientific" nature of anything which disagrees with this, are mostly based on what the professional bodies put out in their publications, and I have to say that these are highly selective. Your Lordships will find nothing of what I have said in these pamphlets produced by the fluoridation lobby (which, incidentally, receives a goodly annual sum from the Government). Knowing some of the background, I find them quite breathtaking in their bias. Independent commentators have pointed to the refusal to publish contrary views, an "unwillingness", in the words of an American dental journal, "to release any information that could cast fluorides in a negative light", in such a way that organised dentistry has now lost its scientific objectivity.

This suppression and distortion of evidence are well documented. Selective presentation is what distinguishes propaganda from science. "The emphasis", the British Dental Journal has advised dentists, is on "propagandising rather than education". (It is there, my Lords, in black and white!) I had an interesting experience recently when, at an All-Party meeting on the subject the MP in the chair, who described herself as a scientist, felt it was entirely right to have three panel speakers in favour of fluoridation and only one against. This mindset is not at all unusual.

What comes across most clearly, and again I quote independent sources, is that fluoridation was a campaign from the beginning, before the first trials were ever completed. It has now, sadly, become a dogma, which is hard to retreat from, and the zeal that accompanies it can be frightening. Few scientists dare oppose it publicly. But the problem that its proponents recognise is that once public doubts take root the campaign is lost; hence, I believe, the absolute nature of the claims that are made and the attempts to bludgeon all opposition.

Political correctness; a bandwagon effect; the emotional satisfaction of a "cause", especially when you are persuaded you are making a difference to society: all these have been quite enough to subvert a profession which is at the same time under pressure from sections of industry to keep up the campaign. (For if flouride is the answer to poor teeth, that lets the sugar and food industries off the hook.) Professions can be wrong, my Lords. Remember what doctors used to think of alternative medicine—how osteopathy was "quackery" for 80 years until, hey presto, for no good scientific reason opinions changed. Fifty years ago the American Medical Association was endorsing brands of tobacco.

I shall have to leave to other speakers the ethical issues of mass medication, what those who are allergic to fluoride are supposed to do, why we put fluoride and not Prozac in the water supply, what environmental effect the other 99 per cent. of water may have that does not go into children's teeth, why a Government that do not want to be seen as a "nanny" so easily buy the red herring of dental inequality when, even if fluoride were proven to be safe and effective, there are other solutions to the problem.

I am convinced that a full and unbiased review of the evidence is long overdue. I know that the WHO is about to look at the subject again, but I doubt from what I have heard that its process will be as comprehensive as Dr. Chalmers of the Cochrane Centre is asking for. I believe that nothing less than a full public enquiry will meet the case. If this does not happen, I fear that when the hexafluorosilicic acid eventually hits the fan, as sooner or later it will, the Government and their advisers will find they have nowhere to hide. My Lords, I beg to move for Papers.

6.5 p.m.

Lord Rea

My Lords, what an enormous windmill the noble Earl has constructed and how lustily he tilts at it! This issue has been on the agenda for 30 or 40 years. In fact, most of the scientific work was done quite a long time ago. There has been some new work. But, so far as I am aware, recent papers have nothing more to offer to those who are opposed to fluoridation than the original ones.

I am grateful to the noble Earl for raising this subject because it allows me—I hope it will allow me—to reassure him about the safety of fluoridation at one part per million or thereabouts. However, it seems that I shall not make much headway as the noble Earl has amassed a wonderful array of arguments to back up his case and I cannot possibly deal with each one of them in the debate. I am also very much handicapped because I had written a rather careful speech exactly timed to 11 minutes and containing much detail and references. But 10 minutes before my time for speaking arose I discovered that I had left it at home. Therefore, I am having to speak in a rather extemporary way.

Another reason why I am grateful to the noble Earl for bringing the subject forward is that it enables me to ask my noble friend on the Front Bench about current government policy towards fluoridation as a whole, but particularly with regard to the effectiveness of the Water (Fluoridation) Act 1985 which was subsumed in the 1991 Act.

The noble Earl suggests that the science which backs up the use of fluoridation is somehow less defensible than the science which does not. It is very difficult on the Floor of your Lordships' House to argue the benefits of one type of science versus another. It is something that is done all over the country in academic meetings and conferences many times a year and occupies much time. Noble Lords are not experts. The best we can do is to look at the credentials of those who back one view or another of a scientific argument.

The credentials of those who favour fluoridation are extremely good. They include 39 national organisations which are concerned with dental health; for example, the British Dental Association, the British Medical Association, the Health Education Authority and, the noble Earl may be interested to know, the Patients' Association, quite apart from the fact that many eminent epidemiologists helped the noble and learned Lord, Lord Jauncey, in 1983 to come to the conclusion that the use of fluoride at one part per million in water supplies was perfectly safe and also beneficial.

There are now five million people in this country who have a fluoridated water supply or who live in naturally fluoridated districts. Obviously there are some exceptions but the general trend is that those who live in fluoridated districts, whether naturally or artificially fluoridated, have better dental health. The noble Earl mentioned deprivation. As regards districts which are not fluoridated there is a clear trend for those in the most deprived areas to have the worst teeth with the greatest number of cavities, fillings and missing teeth. However, even in deprived areas, with fluoridation people's teeth do well and are healthier in some cases than the teeth of people in well off areas.

Hartlepool has a natural level of 1.2 parts per million of fluoride in the water, slightly above what is advocated. It is a relatively deprived area. However, it is absolutely top of the league in dental health. In this regard there is also no evidence whatever of cancer, hip fracture or any other kind of problem there which is ascribed to fluoridation. One of the most important functions of fluoridation is to reduce the unfair discrepancy as between the teeth of well off and poor children.

It is perfectly true that fluoride acts mainly on the surface of the teeth and that the frequent and regular use of fluoride toothpaste is effective. However, such toothpaste is far less regularly used in deprived areas, and in those areas the diet is also poorer than in better off areas. The noble Earl says that we can do something about that. I hope that we do but it will take a long time to upgrade the standard of living of the people living in the worst circumstances in this country. The noble Earl knows well that that is a matter on which I have been trying to persuade governments of both complexions to act ever since I was dragged, unwillingly, as it were, into the political sphere about 15 years ago.

Sir Donald Acheson, in his recent report on inequalities in health, states that the difference in the dental health of the top social classes; that is, classes 1, 2 and 3 (non-manual) and the bottom social classes, 4 and 5, was 17 per cent.—if my memory serves me correctly—in 1983 but the difference had increased to 79 per cent. in 1993. It seems to me that despite the availability of fluoride toothpastes, we are going backwards with regard to eliminating inequalities in dental health. Sir Donald is the ex-Chief Medical Officer of Health in the Department of Health. One of the recommendations in his report is that fluoridation of the water supply should be increased.

As regards the safety issue, the two main dangers mentioned in this regard are cancer, mostly osteosarcoma, and hip fractures in elderly women. In a seminar held about two years ago, many papers were submitted on fluoridation which reviewed—I believe quite dispassionately—all the research that had been done. One paper studied the effects of fluoridation with regard to cancer. It was written by Dr. Paula Cook-Mozaffari, who is a disciple of Sir Richard Doll. She stated: Professor Knox in 1985 referred to twenty papers that had examined cancer incidence or mortality in relation to natural levels of fluoride and had found no adverse effect; and to seven geographical and over 30 time-trend studies that had looked for an effect of artificial fluoridation on cancer risk in different parts of the world and had found none. Only the work of Yiamouyiannis and Burk stands out against this weight of negative evidence and their analyses have repeatedly been shown to be flawed in both content and argument". Yiamouyiannis and Burk are two American statisticians.

As regards hip fractures, Professor Cyrus Cooper, of the Medical Research Council Epidemiology Unit in Southampton, states: The burden of evidence suggesting that fluoridation might be a risk factor for hip fracture is weak and not sufficient to retard the progress of the water fluoridation programme". In conclusion I ask my noble friend what the Government are doing to speed up the wider introduction of fluoridation and what they intend to do, if anything, about strengthening of the relevant legislation and making it mandatory instead of permissive—changing "may" to "shall"—to allow health authorities to ask water companies to fluoridate when the former feel that is necessary in their district. Yesterday, a judgment was given in judicial review. It was stated that Northumberland Water Authority was within its rights as the law stands not to fluoridate, although the health authority said it should. That suggests to me that the law needs to be changed.

6.17 p.m.

Baroness Gardner of Parkes

My Lords, when I saw that this subject of fluoridation was to be debated today, and I noted that the noble Earl was calling for a review, my first reaction was one of exasperation. How could anyone want more research when the amount already done, and fully scientifically assessed, is so extensive and so conclusively in favour of the benefits of fluoridating the water supplies?

Then I stopped and thought again, and for this reason I welcome the debate being brought to your Lordships' House today by the noble Earl, Lord Baldwin. Today we have the opportunity to put the clear facts to the House and finally to put the false arguments against fluoridation to rest. I hope that the Government will take the necessary action to ensure that the public will be able to enjoy the huge dental health benefits that come from a fluoridated water supply.

Health statistics are kept for all parts of the United Kingdom. There are no health patterns anywhere that indicate that fluoridated water produces any adverse health effects, when used in the correct proportions, that is one part per million. The noble Earl sent me a paper today which quoted four parts per million as being the safe level. That is not the level recommended as optimal and all water supplies that are artificially fluoridated are at 1 ppm, so you can see there is a very high margin of safety at the optimal dental benefit level.

Fluoride occurs naturally in water supplies throughout the world and therefore has been ingested for centuries. A high concentration in natural water produces mottling of the teeth, fluorosis. This is unattractive but not unhealthy and does not occur where there are correct concentrations of fluoride in the water.

This morning I received a letter from Water UK which states, the decision whether to fluoridate a water supply should lie with the health authority—the current discretion on water operators whether to accede to an application from a Health Authority should be removed". Water authorities want the duty to be imposed upon them. They are clearly tired of the pressures put upon them by those opposed to fluoridation of the water supply. They want to be able to say, "We were obliged to do it", and to pass the responsibility on to the health authorities.

There are already 3 million UK residents using fluoridated water and a further 3 million would benefit if fluoride was in the water supplies in the north-west of England. On the basis of firm evidence, over 60 district health authorities have decided that fluoridation of their water supply would be beneficial for their communities.

There are instances where fluoride has been used in the water supply and for some reason later discontinued. These cases have shown a direct correlation between fluoride and dental health. The Welsh Water company began fluoridation of the water supply to Anglesey in 1956. This continued until 1991. By 1994 dental health had become as bad again as on the mainland. The Kilmarnock study gave much the same result. With fluoridated water, dental decay was reduced by more than 50 per cent. against the "control" community in five years. It was reversed again on cessation.

As an Australian dentist, with no personal interest to declare, I must ask your Lordships to look at the Australian experience and health patterns. Fluoridated water has been in constant use in Tasmania since 1953, in Canberra since 1954, and fluoride is in the water supplies of all major cities in Australia. There is no strange incidence of any "Australian" disease that differs from the rest of the world.

I have a nephew who is a dentist in Sydney. He treats most of the pupils from a large school, which has both day pupils and boarders. I heard from him that he never sees tooth decay now in the city boys but can tell instantly when a boy from the bush comes in, from an area where the family use rain water or a local supply. The country lad's teeth are still as bad as they used to be in Sydney in the days when I was a dental student, before the fluoridation of the water supply.

The Australian nationwide experience spans not just one generation, but two or even three generations. There have been no known adverse effects on general health and markedly good effects on dental health. Australia is advanced in medical research. If all the cancer scares we have heard raised had some basis in fact, the Australia researchers would have been aware of them and the world would have that information. No, we must not be taken in by alarmist talk. Cancer is a disease spread throughout the world and specific links between, for example, smoking and lung cancer have been confirmed. There are no known links between cancer and fluoridation and scare tactics have been used for too long.

We have heard that strange bone deposits are seen. Only last week I put this point to an eminent consultant orthopaedic surgeon and asked him if he had seen such cases, as he is constantly studying X-rays of knees, hips and other bones. His reply was that in many thousands of patients he had treated, he had never seen any sign of unusual bone development, or spicules of the type described linked to fluoride. The most clearly established fact is that fluoride at correct strength in the water supply results in a marked drop in dental caries and has no adverse effects.

It is easy for those who are fortunate in life to say that fluoridation is not necessary. They do not stop to think of the most deprived sections of society who suffer the pain caused by severe tooth decay. In Northern Ireland, the north-west of England and some parts of Scotland, tooth decay is rampant. Hundreds of children each week need to have teeth extracted and suffer great pain from massive tooth decay. The educated, the affluent, have little if any understanding of the pain and suffering caused by toothache due to teeth so badly decayed that the nerve is involved. It is useless to say that those people should go to a dentist for a check up. Until the agonising pain of toothache manifests itself, they are not even aware that dentists exist. They desperately seek relief for the child's pain and the distress caused to the family by disturbed sleep.

The British Medical Association reports that more and more patients are asking their general medical practitioners for help with dental pain and emergency dental treatment. They state that only about 55 per cent of the population are registered with a dentist and many dentists do not accept NHS patients.

Once the toothache pain level has reached this degree of intensity, extraction is usually the only answer to relieve the child's pain. In February this year, in the national health debate, I mentioned that nearly 100 children a week in Blackburn needed to have teeth extracted under general anaesthesia. The situation of such children has dramatically worsened recently, as dentists are no longer to be allowed to administer general anaesthetics and so the child must wait until a medical anaesthetist is available, probably in the local hospital. The shortage of anaesthetists in the UK means prolonged pain for those children to endure. Pain killers will be the only interim answer.

Here today, in your Lordships' House, we have the luxury of debating this subject. Few in this House would be unable to afford to drink bottled water if they were genuinely worried about even the remotest possibility of fluoride being damaging. The situation is quite different for the most deprived section of the community. They need help which can reach even those least informed or aware of health needs.

The only way to ensure an improvement in dental health, and its consequential improvement in general health, for these children is by the introduction of fluoridation to the general water supply throughout the UK. As Water UK says, it cannot be piecemeal. In particular, those members of society living in areas of deep deprivation, who have virtually no contact with the NHS, would be reached and would benefit from the fluoridation of water supplies. Again, I emphasise that the level of concentration is always to be carefully controlled to one part per million.

In September 1983, the noble and learned Lord, Lord Jauncey, delivered his verdict in what has become known as the Strathclyde case. In his 392-page judgment the noble and learned Lord completely vindicated the safety and efficacy of fluoridation. He went thoroughly into all the points raised. Surely there could be few more thorough considerations of the huge amount of evidence on fluoride. All the applicant's complaints of toxicity, medicinal purpose and harm were rejected.

It was ruled that it was ultra vires—that is, that the council did not have the necessary powers to add the fluoride—so the 1985 Water (Fluoridation) Act, in which I played a part, was passed to remove this grey area and make fluoridation legal. It is an enabling Act.

Over the years I have followed the many interesting questions that the noble Earl, Lord Baldwin, has asked. I have always considered that his wide-ranging interest in complementary medicine and other non-routine treatments was not harming others, and for that reason I have supported rather than opposed many of the rather obscure questions the noble Earl has put on health matters. Today, I am completely opposed to what I consider a most damaging demand for delay and further delay, adding further deprivation to the already deprived.

I consider that fluoridation in water is a well-established practice and has been in use for many years. It is time to decide that fluoridation should be implemented. There are so many aspects of health that can benefit from more research and the money available for research can be much better spent on subjects other than fluoride. I hope the Government will not accept the Motion misguidedly put forward today.

I look forward to the day when dental pain will be something that even the least fortunate children in Britain do not suffer.

Baroness Farrington of Ribbleton

My Lords, perhaps I may remind Members on all sides of the House that when the figure 10 appears on the clock, 10 minutes have been completed.

6.28 p.m.

Lord Monson

My Lords, we must all be grateful to my noble friend Lord Baldwin for initiating the debate. This is a subject about which a growing number of people are increasingly concerned as new and worrying evidence comes to light. Few people in this House can have worked so hard on this subject as my noble friend who has sifted through evidence from all parts of the world—not all of which seems to have permeated in this direction—and few can match his acquired expertise.

Perhaps I may turn from the medical to the moral aspects of fluoridation. There are some people who maintain that it is quite wrong to administer a medicine to whole populations via the public water supply, even if it could be proved that not one single individual suffered adverse side-effects. I do not take such a purist view. If there were substantial benefits and absolutely no disadvantages, it would not be easy to argue against the controlled addition of a "medical product", as the noble and learned Lord, Lord Jauncey, described it in his famous judgment.

However, that is entirely academic. No medicines, not even aspirin or sodium bicarbonate, are entirely harmless to everybody. Fluoride is vastly more dangerous than either of those. It is actually more toxic than lead and almost as toxic as arsenic. It used to be used as a rat poison, and the American Food and Drugs Agency requires poison warnings to be placed on the labelling of fluoridated toothpaste in the United States.

Fifty years ago, it was genuinely believed that fluoride in very small doses—in the proportions given by the noble Baroness—was entirely safe, just as it was believed that strychnine in very small doses was safe enough to add to tonics then sold in chemists across the counter without prescription; that DDT was entirely safe; and that asbestos was safe enough to be used in children's playgrounds as a substitute for sandpits, as was revealed on "Newsnight" two or three days ago. Somewhat more recently, it was believed that thalidomide and leaded petrol were safe and that tobacco was relatively safe. It was believed that tranquillisers were safe enough to be prescribed in their hundreds of thousands like Smarties, as they used to be in the 1960s.

Now, strychnine, asbestos and thalidomide are banned. Leaded petrol is soon to be banned, and sales of DDT, tobacco and tranquillisers are heavily curbed. Fluoride is not banned, but even the British Dental Association, in November 1996, admitted that there are risks in fluoride use, even though the association went on to contend that the risks were outweighed by the benefits.

That is where moral considerations kick in. Can it be right to add something to the public water supply which may help some at the expense of others, particularly when there are alternative ways of administering this chemical which would target it much more precisely on the narrow age group—those aged 12 and under—it is supposed to benefit?

Suppose there were to be an epidemic of rape and other sexual assaults carried out by young men in one particular part of the country. Would the Government consider adding bromide to the region's water supply? Of course they would not. The addition of bromide might well reduce the incidence of rape and similar assaults, but it would also be ingested by women, elderly men, boys under the age of puberty and babes in arms, with unforeseen consequences.

If only one person in a million were seriously adversely affected by fluoridation, it might conceivably be justified—but certainly not if the figure were one in 10,000, still less one in a hundred. Yet somewhere between the latter two figures seems more probable than one in a million.

Are Her Majesty's Government aware of recent research in Boston, Massachusetts—not Boston, Lincolnshire—which indicates that fluoride adversely affects the central nervous system? Similar research was carried out during the Second World War, in 1944, which seemed to reveal the same, but because of the war it remained a classified secret. Do the Government agree that fluoridated water leaches lead from old pipes—of which plenty remain in this country? Are they aware that since 1990, 54 American and Canadian cities, together with Brisbane—which the noble Baroness will concede is a major Australian city—have rejected or stopped fluoridation? Are they aware that in the past few years 17 prominent American organisations have withdrawn their endorsement of water fluoridation? They include the American Cancer Society, the American Diabetes Association, the American Heart Association, the National Kidney Foundation and the Society of Toxicology.

Do the Government agree that fluoridated water cannot be used for kidney dialysis anywhere, nor for the manufacture of babyfood in many countries? Do they agree that fluoride is deemed to be a dangerous substance under the 1995 EC dangerous substances directive?

That brings me to my last point. The Government constantly proclaim their determination to be at the heart of Europe. Are they aware then that every single continental EU country, together with Norway, rejects fluoridation? Some have never tried it, some have tried it and found it dangerous and have subsequently banned it, notably the Netherlands. Those countries include such ultra health-conscious countries as France, Sweden and Germany.

Despite that—and this may answer some of the noble Baroness's points—Denmark, Sweden, Finland and the Netherlands have as good a record where the health of children's teeth is concerned as the UK, and a better record than the heavily fluoridated Republic of Ireland. Will the Prime Minister, Mr. Blair, at the next EU summit, be trying to convince the other 13 EU countries that they are all wrong and that the United Kingdom and Ireland alone are right?

6.35 p.m.

Lord Stoddart of Swindon

My Lords, I too congratulate the noble Earl, Lord Baldwin, and I welcome the debate in advance of possible public action. I am sorry that the noble Baroness, Lady Gardner of Parkes, feels incensed that the matter should have been raised again. I would have thought that if she is so confident of her case she would not be worried about a public inquiry but would welcome it as an opportunity to have all the arguments put from both sides. That is what the noble Earl asks and it is an eminently reasonable request. I hope that the Government will accept it and put it into operation.

The noble Earl, Lord Baldwin, made an authoritative and well researched case against fluoridation on scientific and medical grounds, as did the noble Lord, Lord Monson. So there is no need for me to go over it again, except to say that in my view any evidence that the addition of fluoride to water supplies assists in preventing tooth decay in children is not conclusive. I shall go no further than that. The medical risks to the general population cannot be ignored, particularly since, as we have heard, fluoride accumulates in parts of the body over time.

My noble friend Lord Rea and I are so often at cross purposes. It is a shame because he is such a nice fellow. He says—and he made it part of his case—that the credentials of those who support fluoridation are good. He cited 39 of them. But how can he say, and who is he to say, that the credentials of the people on the other side are not equally good? After all, when Darwin brought forward his great theory of evolution, all or most of the great scientists and religious people were against him at the time. Should he have dropped his ideas? How the world would have suffered if he had.

In addition, try telling that to the noble Countess, Lady Mar. She has been fighting on the issue of organophosphates. Time and time again she has been told by the experts that there is no danger. We are now discovering, and the experts are coming around to the fact, that organophosphates are dangerous and may have been responsible for many diseases and injuries to people who worked with them. Let us not be so confident that the experts are always right. That is another reason why we should have a public inquiry.

Even if the evidence of benefit to children up to the age of 11 is overwhelming, the case for forcing the remainder of the population, throughout the rest of their lives, to ingest a known poison, whose long-term effects on the human body are not really known, is weak. Dental decay is not a life-threatening condition. Why on earth, for the benefit of perhaps as few as 1 million children, should the remaining 58 million have to ingest this substance throughout their lives when there are other ways to ensure that children's teeth and dental care are good?

In a free society mass medication cannot be right in any circumstances. Noble Lords should ponder that. Once we start along that road where do we stop? No doubt all kinds of claims can be made for various substances that benefit one minority section of the population or another, whether it be the young, middle-aged, old, or male or female. The proposition that we mass medicate the whole of the population in order to benefit only a small proportion of children up to the age of 11 is preposterous and one that every person who believes in individual freedom should reject out of hand. Furthermore, it is inefficient and potentially dangerous for the rest of the population.

Tooth decay among children and adults has declined dramatically over the past 25 years. That is due not to artificially fluoridated water but to better dental care, education, diet and free dental treatment, particularly for children. It is upon those factors that we should proceed, not mass medication. There should be better education about the care of teeth, regular check-ups at the dentist and diets that promote healthy teeth. That is what the Government should concentrate upon, not the slipshod and potentially dangerous route of compulsory mass medication.

My noble friend said that the worst cases of dental decay occurred in deprived areas. Let us get rid of the deprived areas, not feed the rest of population with fluoride. I believe that that is the sensible approach to take and I hope that my noble friend agrees with me.

I emphasise "compulsory" since in any given area there is no choice as to the water that a person drinks. There is no escape from the ingestion of a substance that one believes is harmful to oneself and others. Furthermore, individuals cannot give up drinking water if they believe that it contains poison. Water is a life-supporting substance, unlike tobacco or alcohol. We must drink or we die. I hope that noble Lords will recognise the force of the argument about compulsory fluoridation. The supporters of compulsory fluoridation say that the concentration is only one part per million and therefore it cannot do any harm. It can, because it accumulates over a period of time. In addition, because virtually all toothpastes now contain fluoride the amount that is ingested particularly by children may be very much more than one part per million.

In conclusion, off and on over the past 30 years or so I have entered the debate on fluoridation. When I was leader of Reading County Borough Council in the 1960s I helped to resist compulsory fluoridation of Reading's water supplies, and I am glad that I did. Later, when I was chairman of the Land and Works Committee of Thames Valley Water Board, I had some influence in resisting the fluoridation of water supplies in Berkshire. I still believe in what I did then. It is wrong compulsorily to medicate people's water supplies. But I am prepared to support the call of the noble Earl, Lord Baldwin, for a public inquiry. That is the least that the Government should do before they embark on any further measures to introduce the compulsory fluoridation of the water supplies of this country.

6.46 p.m.

Lord Craigmyle

My Lords, I thank the noble Earl, Lord Baldwin, for bringing the issue of fluoridation before the House today. The noble Earl has steeped himself in the science of the debate, none of which I care to tackle. I believe that all sides of the argument have been well shaken out this evening. The case that I make for a review of the evidence is made on behalf of the consumer. I declare an interest, for I am a poor, bewildered consumer. My dentist tells me to use fluoride but my doctor is unenthusiastic, while a steady stream of evidence through the media over 20 years or more on balance appears to warn against the use of fluorides. The consumer needs guidance on this subject and that needs to come from a disinterested party.

Just last week in your Lordships' House the noble Countess, Lady Mar, introduced a debate on organophosphates. I do not dwell upon the medical aspects of organophosphates, but the noble Countess expressed disappointment at a report on organophosphate sheep dips. That has a parallel with the present debate. The noble Countess was concerned about the membership of the working party which produced the report, and its terms of reference. She believed that both predisposed them to a particular conclusion. We face similar problems in examining the issue of fluoridation. The consumer knows that a fishmonger will sell him fish. We all know with equal certainty that the BDA and the Fluoridation Society will sell us fluoride. I do not question the good work of those bodies, any more than I question the good intentions of my fishmonger. However, the case for a review of the evidence for and against fluoridation needs to be not only scientifically defensible, but also defensible before the consumer, particularly as the latter may be told to accept fluoride whatever his wishes.

What we appear to lack is a random blind trial with sensible controls. I have asked the British Dental Association for help in this matter and it has provided me with a good deal of information. I have picked out what I believe to be one of its most promising statistics to try to improve its case. It begins by saying that poor dental health is a disease of social deprivation—a true and brave admission. But we are then asked to compare the tooth decay rates of children from Bolton with those from fluoridated south Birmingham. The comparison may well be valid. It may well make a good case for fluoridation. But there are regional and social variations in tooth decay rates. We need to know where Bolton fits into the pattern. We need to know the histories of dental care in the two areas. We need to know the histories of health care for pregnant women. Quite simply, there are too many variables in such comparisons. Even the opinions of individual dentists can vary as regards which teeth need to be filled and which should be pulled. As I say, that point, and indeed other points raised by the BDA and the BFS, may be valuable. But if the proponents of fluoridation want to persuade people of their case, they must share their evidence, not just their opinions however well founded.

Gone are the days when a man in a white coat on a public information film was enough to quell public anxiety. If people feel that fluoride is a poison which should not be in their water, they will need full and open debate to persuade them otherwise before the Government move forward on the matter. That is a case for a review of the evidence.

6.51 p.m.

The Earl of Clanwilliam

My Lords, I enter the debate with a strong sense of déjà vu, and thank the noble Earl, Lord Baldwin, who is at the forefront of our search for healthy living and clean medicine, for his telling speech in support of a review of the evidence. I well remember discussions at home when the subject was first debated. My mother, who was a devoted adherent of Lady Eve Balfour, took up the cudgels against her brother who was MP for Abingdon and a member of the Thames Water Board. The noble Lord, Lord Stoddart of Swindon, may have been on the same board with him. It was then considering the need to impregnate London's water supplies with fluoride. So I have been brought up in an atmosphere of division in the matter.

The futility of fluoridation has been well demonstrated. Upwards of a quarter of all water is lost through leakage, and of the remainder most is used by industry so only a minimal amount gets into the drinking water. Reports of the success of fluoride are largely anecdotal. Therefore, if the need is to protect against tooth decay the way to do so is not through a massive waste of the product. Ironically enough, the fluoride used is itself a waste product of the agricultural fertiliser and nuclear industries, among others, so all we are doing is to recycle a corrosive chemical back into the environment through our river system. That is hardly something that we should be doing today.

Regardless of the fatuity of the scheme, there is the problem of the ethics of mass medication, which noble Lords have discussed in detail. Were such a scheme necessary it would still be debatable whether it should be done by enforcement, leaving the individual in the area concerned no option but to be subjected to the use of contaminated water. It may be said that chlorine is used in that way, but at least we can filter out that chemical. We cannot filter out fluoride.

Calcium fluoride, which most importantly occurs naturally in our diet and daily life, is beneficial in the quantities supplied by nature, whereas the waste byproduct of our farming and nuclear industries which is fed into our water system contains trace minerals such as lead, and its cumulative properties have been shown to have a deleterious effect on several of our bodily organs. It has also been described as a cumulative proto-plasmic poison. That surely should be enough for us. Indeed, it is not even a nutrient; and, in addition, it inhibits important enzymes in the human system.

Is fluoridation necessary in any event? Caries may be distressing but it is not life threatening, as the noble Lord, Lord Stoddart of Swindon, pointed out. Is this not a case of nuts and sledgehammers?

So much for fluoridation in principle. The social reason often given to excuse this waste of resources is that the less well off are the ones who need help with the protection of their children and they are less able to define the need. Besides being supercilious and condescending, the principle is no longer true except perhaps among teenaged single mothers, who can surely be approached in a number of other ways. The noble Lord, Lord Rea, mentioned the use of toothpaste.

The real problem is simply one of diet in general and rationing of a child's sugar intake in particular. Perhaps supermarkets, which claim that they are so beneficial to society, could display sugar-free sweets at the checkout. That might have an instant effect, but whether that would be greatest on the children's teeth or the supermarkets' profits I am not sure.

The efficacy of fluoride for the purpose for which it is intended has been shown to be counterproductive by noble Lords from all sides of the Chamber. I shall not detail the wealth of evidence that has accumulated over the years, and which other noble Lords have clearly demonstrated. Most of our colleagues in Europe have accepted and acted upon a determination to ban the product.

The noble Lord, Lord Monson, pointed out the number of poisons which have been introduced into our society from chemical companies in the past 50 years, many of which we have been persuaded were vital to the success of the world in the future and which have now been put in the dustbin. There may therefore be some benefit from harmonisation if it comes about since the Commission will undoubtedly find an early opportunity to ban the use of fluoridation. In the meantime, we need a scientific review of the matter. I support the noble Earl's Motion.

6.56 p.m.

Lord Dean of Beswick

My Lords, I compliment the noble Lord on initiating the debate. However, my appreciation of the subject ends there because I totally disagree with everything that he said. I have been involved in the issue of fluoridation since it first became a topic in the 1960s when I was a young councillor on the health committee in Manchester. In those days Manchester was the biggest water authority in the United Kingdom outside the metropolitan authority.

We agonised over the issue. In fact, I almost have a feeling of déjà vu because the same tactics were used then as now, only the lead figure is a different person. Every few months we had a different scare as to what fluoridation was supposed to do. We had run out of steam at one stage so Mongolism was dug up; and the argument that fluoridation produced children with Down's syndrome. That was totally blown out of the water when investigated. There was also an argument about bone malformation. We have had a plethora of those types of argument.

The noble Earl graciously sent me a document today containing certain statistics and names. I cannot find anything modern in it; it is history. It goes back to the early 1970s. I believe that it mentions someone from the 1950s. I am sad that some noble Lords who are anti-fluoride seem to denigrate the professional people, medical people of high standing, who happen to be in favour of fluoridation. Those noble Lords seem to rubbish them as though only those names they put forward—I have never heard of some of them—are the people of conscience.

The noble Earl calls for an independent review. I hope that he will not be a member of that review body, having heard the biased and unsubstantiated remarks that he made today. I have a document—other noble Lords may have received it—from the British Dental Association. It is fairly recent—2nd November. I did not ask for it. The document is available in the Library. It states: Figures published today by the National Alliance for Equity in Dental Health show that children in non-fluoridated areas of the UK are up to four times more likely to have teeth extracted due to tooth decay than those in fluoridated areas. However, over 60 health authorities are being prevented from implementing water fluoridation policies because current legislation is flawed. The Alliance is calling on the Government to take action and extend water fluoridation to reach 25 per cent. of the population where tooth decay rates are unacceptably high". Within that organisation is the National Alliance for Equity in Dental Health. It consists of 39 national medical, dental and voluntary organisations, including the British Medical Association, the British Dental Association, the National Health Service Confederation, the Health Education Authority and Mencap. How dare anyone discount almost entirely, as the noble Earl tried to do today, evidence from such outstanding bodies?

I believe that we should move forward. It is certain that in non-fluoridated areas of the UK the decay in children's teeth is five times as high as in fluoridated areas. That statistic is no coincidence; it has been tested and tested again. That is one argument that needs to be put to rest.

My noble friend Lord Rea dealt with the argument concerning cancer, which is the latest scare. There is no definite evidence, but it is said that fluoridation causes a high incidence of cancer. My noble friend referred to a woman doctor who carried out the most recent research on that subject, which showed that it was a load of nonsense. That theme is carried through. They talked about India as if they were talking about the whole continent of nearly three-quarters of a billion people, but they were actually talking about one village which had become polluted not only with an overdose of fluoride gas but with other deadly chemicals which cause other illnesses.

When I was involved in Manchester, I asked our distinguished medical officer of health what he would do regarding his family. He said, "I have grandchildren and I hope that the area where we live will be fluoridated". I asked how much water must a person drink per day before becoming adversely affected by fluoride. He said, "Twice the amount of water which you would use for a bath". That is the volume of water we are talking about according to distinguished medical experts.

I shall not take any longer because all the statistics are evident. The noble Earl has made up his mind. Anyone who is agin him is talking rubbish and anybody who is on his side is brilliant and a genius. There are three of us on these Benches so the die is cast over here. The noble Earl is not going to persuade anyone to his point of view. I believe that it is an act of mischief, it is unnecessary and will affect an increasing number of children and adults. I hope that the Government will not give way on the issue. They have evidence from the most distinguished medical experts in this country and in other parts of the world who have been dealing with the problem for years.

7.4 p.m.

Lord Harris of High Cross

My Lords, I join other noble Lords in thanking the noble Earl, Lord Baldwin, for initiating the debate. It has been interesting, lively and mostly good-natured. With a few exceptions, it has even been moderate in the claims of the opponents of fluoridation as compared with an earlier debate when the opponents seemed to blame fluoridation for almost every ailment, with the exception of housemaid's knee.

I am not concerned to offer evidence or proof one way or another about the possible unintended effects of a fluoridated water supply. But I believe that the debate has already established that there is sufficient evidence of conscientious doubt about whether the private water companies should make themselves responsible for undertaking such a measure of compulsory indiscriminate mass medication. Anyone with doubts might ask the noble Earl for a paper written by a man with a Scots name which inspires confidence, Dr. John Colquhoun, first published by the University of Chicago Press, which tells a most impressive story of a former zealous enthusiast for fluoridation, an active professional advocate of the idea, who has gradually come round to see the opposite of the noble Lord, Lord Dean. He had been involved in a mischievous activity and wished to declare his guilt and to atone for it by joining the ranks of the noble Earl, Lord Baldwin.

There are serious doubts about the issue. The Government may take refuge in saying that they have expert scientific advice. The trouble is that scientists do not necessarily agree on the matter. That has been exposed by several contributors today. I am impressed by the idea that tooth decay, which the noble Baroness told us was a painful and distressing condition, is not a lethal, life-threatening disease. On the whole, you would tend to take the prudent view and refrain from artificial fluoridation.

The problem with fluoridation is that it is one of those causes which busybodying interventionists are attracted to like moths to a candle. The single issue pressure groups, which are the curse of modern politics, pick it up as a holy crusade that all water should be fluoridated by government decree. If zealots persist in urging fluoridation, it may not be sufficient for the Government to shield behind their scientific advisers. After all, scientific advisers are not eunuchs; they are infected by irrational enthusiasm, especially when one particular view becomes established as received wisdom and then the voice of the establishment.

I apologise for raising the matter, but I have spent much of this year studying what I now regard as the pseudo-science of passive smoking in connection with a book I helped to write called Murder a Cigarette. I have absolutely no doubt whatever that the scientific committee on tobacco and health was so carried away by its initial antipathy to smoking that it has exceeded its brief by introducing into what should be a scientific discourse opinionated, biased, fraudulent surveys which are based on no acceptable scientific canons. Close scrutiny of the papers, the original research reports, and then the summary of those reports, demonstrates that there is absolutely nothing in the idea that second-hand tobacco smoke can cause non-smokers to die of cancer. And yet 11 academics, doctors and others on the scientific committee on tobacco and health unanimously signed an official report supporting the received wisdom of the establishment view of the matter.

I say to the Government: beware of official science; beware of politicised science; beware of secret science; beware of pressure group science; and beware of consensus science. If we are to have a review, which I very much favour, let it all be above board.

I hope to bring an original note to the debate by recalling a paper published by my old firm, the Institute of Economic Affairs, back in 1960. It was by a name that some will recognise as APH, A.P. Herbert. It was called Anything But Action?. It was a marvellous, passionate but witty study of a whole range of Royal Commissions and committees of inquiry.

I wish that there were time to do full justice to APH, but I quote one topical extract from page 49 where he says: Somebody—I know not who—has decided to put something called fluorides in our water because it is good for the children's teeth. But I have seen it stated that the stuff is bad for old men's bones. No child specialist would care about that. This tale may be untrue. But, however abstruse the subject and wise the specialist, I should always like to see an ordinary watch-dog or two on guard". That led APH to make some proposals, serious and gay, about the future government approach to committees of inquiry.

He examined the possibility of "committees of nobodies" to get away from, the quiet firm murmur of the Establishment". He thought of having a "committees of everybody", selected almost at random, on the model of a jury, which would hear rival pleadings on fluoridation and everything else and then decide which was most to be trusted.

His devastating comment on committees of experts was: Left to themselves the specialists can get up to odious mischief". They are, he suggests, flawed by a search for unanimity which stifles dissenting minority views which, in the long run, often turn out to be the most dependable.

In his final guidance, the wisdom of APH, he quotes someone saying: If a minister requires a considered judgement on a problem of public importance in which action is urgently needed, why not set up two committees, one of people known to favour one course, and one of people known to favour another? Then he would receive two reports, giving the best possible statements of each point of view, without any toning down by a mediating chairman and a tactful secretary. The minister could then decide—which is his job in life". I close on that note. This would be an ideal subject on which to put to the test the suggestion made by A.P. Herbert almost 40 years ago. We should have two committees. We should allow the noble Earl, Lord Baldwin, to appoint his team and the noble Lord, Lord Rea, to try to assemble a quorum to represent his view. We should then have two committees taking evidence. They would then present the matter in a way which would allow ordinary people, as well as the Government, to reach a better understanding and decision.

7.14 p.m.

Lord Dixon

My Lords, it is not my intention to cover the scientific points or the very strong case against fluoridation which has been put so ably by the noble Earl, Lord Baldwin. I congratulate him on successfully securing this debate this evening, and I pay tribute to him for all the work that he has carried out on this important issue.

I am opposed to fluoridation and the more I read and hear about it—indeed, the more I have heard in this debate—the more I am opposed to it. The noble Lord, Lord Monson, was correct to talk about the civil and moral liberty argument. It is very important. The concept that fluoride can be added to drinking water supplies for entire populations constitutes a threat to people's individual rights. It is mass medication without consent. Once the state starts to say that it will enforce the addition of medicine to the water supply, we are in a very dangerous area. What right has anyone to compel another person to consume fluoride? That encroaches on individuals' rights to the extent that persons will be forced to drink water containing a substance which they do not want to drink.

If I—or anyone else—wish to use fluoride, there are many sources available—toothpaste, mouthwash, floss, fluoride tablets, to name just a few. If fluoride is good for health, why is it that Ireland is the only democracy in the world which forces fluoride on all its citizens by law? I am informed also that in Ireland, one tonne of fluoride is put into the drinking water every day. Of that, 99.5 per cent. is not drunk with the water so all that fluoride, which is toxic waste, is effectively dumped into the environment without any environmental audit or research into its effects.

If fluoride is good for health, as the noble Lord, Lord Monson, said, why has continental Europe virtually none? Holland has banned it. Germany, Denmark and Sweden have stopped using it. Portugal, Greece, Belgium and Austria ended fluoride experiments long ago. France, Italy and Norway never even tried fluoridation and rejected it out of hand. No one is going to tell me that in the many European countries which do not add fluoride to the drinking water, their teeth are worse than those in Ireland which forces fluoride on all its citizens. The noble Lord mentioned parts of India. In parts of India now, attempts are being made to take fluoride out of the water by installing plants and equipment to carry out that task.

Doctor Peter Mansfield, president of the National Pure Water Association, said: No physician in his right senses would prescribe for a person that he has never met, whose medical history he does not know, a substance which is intended to create bodily change, with the advice, 'Take as much as you like, you will take it for the rest of your life because some children suffer from tooth decay'". A couple of weeks ago in the Mail on Sunday I was struck by a short letter by a John Graham of Romford, Essex. He wrote: I suffered from IBS [irritable bowel system] from 1975 to 1996 until I discovered that fluoride is more toxic than lead and only slightly less toxic than arsenic. I switched to non-fluoride toothpaste and the IBS stopped overnight, closely followed by my backache, stiff joints and chronic fatigue". That proves what Dr. Mansfield said. Fluoride is more toxic than lead. In the other place, where I represented my constituency for many years, I fought against and heard representations about the amount of lead piping in the water supply which was affecting people's health. We were partly successful in relation to that.

If fluoride is good for health, why do we see so much bottled water being used? Most local government officers, and even people in this building, use bottled water. I have never seen anyone in the dining rooms or the tea-room putting fluoride tablets into bottled water. If it is that good, why not?

I am a diabetic and was concerned to learn of the effects that fluoride has on people suffering from diabetic mellitus—they are at increased risk from fluoride. It is also important to point out that of the many national organisations in America who have withdrawn their endorsement of fluoride in recent years, the American Academy of Diabetics and the American Diabetics Association are but two.

The truth is that no one has yet proved that a low-level dosage of fluoride is safe. The one-part-per-million level enshrined in the pro-fluoridation propaganda has never been established and was not established in the debate this evening. As my noble friend Lord Stoddart said, the whole case for adding fluoride to drinking water is based on tooth decay and that is caused by poor dental hygiene and poor diet, especially one high in sugar.

I feel that the case has been made by the noble Earl, Lord Baldwin, for having a public inquiry before any further fluoridisation takes place in this country. I was pleased to hear that the Newcastle and North Tyneside health authorities' applications to force Northumbria Water to add fluoride to its water were turned down.

Lord Rea

My Lords, before my noble friend sits down, he said that no case has been made for levels of one part per million. What about Hartlepool, which has natural levels of one part per million? Teeth there are very good, people are healthy and no harm has been done.

Lord Dixon

My Lords, that is one of the arguments that was put forward. There are arguments both ways. I have heard scientists and I have heard lawyers. In that regard I was once told that there are over 100,000 laws on the statute book and lawyers have not yet improved on the Ten Commandments. I feel that that probably applies in the case of some health scientists as well.

7.22 p.m.

Lord Clement-Jones

My Lords, this has been a difficult and hotly debated topic for over 30 years, as many noble Lords made clear. The passionate and powerful contributions to this debate testify to that. But this debate, instituted by the noble Earl, Lord Baldwin, is very timely in view of the White Paper on public health due in the New Year. I cannot pretend to have the extent of scientific and technical expertise which Members of this House displayed during the course of the debate, but one thing is clear; that is, that the Water (Fluoridation) Act 1985—now consolidated in the Water Industry Act 1991—is not working. It was originally meant to settle the issue. I was interested in the note of slight exasperation in the speech of the noble Lord, Lord Dean, in that respect.

Since then some 60 health authorities have made requests to water undertakers to fluoridate the supply. Each of those requests was preceded by a procedure laid down in the original Act which involves close consultation between health authorities and local authorities. Yet each request was refused. The water companies—no doubt we all received the briefing from them—say that they wish to be completely indemnified by the Department of Health for so doing. The worst case has been in the north west where over 20 local authorities made the request for fluoride but were refused. Ironically, the water company adopted what it believed to be the precautionary principle for fluoride but, as we have seen from recent reports, has been slow to accept the threat from cryptosporidium or deal with it. As a result, detailed publicity and consultation exercises carried out by health authorities prior to each request to fluoridate have been a waste of limited NHS resources.

Millions of young children, many of whom live in deprived areas, continue to suffer from painful, distressing, yet preventable dental disease. We heard the statistics tonight—figures released on 2nd November. One in five children living in the poorest districts of the UK can expect to have had a tooth extracted under general anaesthetic by the age of five. The noble Baroness, Lady Gardner of Parkes, described the problems of delay that restrictions on general anaesthetics will create in the future.

Sir Donald Acheson recently pointed out that the differential between the better off social classes I, II and III and others in terms of dental health has grown over recent times. He strongly recommends fluoridation. The evidence of the beneficial effect of fluoride in the right dose is very clear. The most recent evidence shows that the rate of decay of young children's teeth in cities with fluoridated water such as Birmingham and Newcastle is four times lower than that of children in cities with non-fluoridated water such as Glasgow, Liverpool and Manchester. A clear example is Sandwell in the West Midlands. Its water supply was fluoridated in 1986; 10 years later the rate of tooth decay in five year-olds has halved.

For many years now anti-fluoride campaigners have been fighting a rearguard action against fluoridisation. But what is the real evidence? The noble Earl, Lord Baldwin, was kind enough to give me copies of his papers. I read them carefully and am prepared to accept that in high doses fluoride can cause skeletal fluorosis. I do not believe that there is any evidence to date that low doses of one part per million of fluoride is causing harm. I did not see evidence properly attested to in that regard in those papers.

Water fluoridisation has been endorsed as being safe and effective, as we heard from several noble Lords tonight, by every reputable scientific body in this country, and 39 organisations belong to the national alliance. We need to look at those credentials. The noble Lords, Lord Rea, and Lord Dean, were right to point to them.

I am not a great believer in medical orthodoxy but I am a lawyer. I do not believe that this is the same as MMR, organophosphates or the Gulf War syndrome. I want to see evidence of harm. Where are the legal cases? Where are the allegations of harm? Where are the litigants? This is not like organophosphates. We need to see a clearly defined group of victims and I have yet to see that. However, on these Benches we would not object to and indeed would support the Government commissioning further research or a review into aspects of fluoridation to lay to rest some of those fears. We would be interested to see evidence from other European countries and the reasons why they have either withdrawn fluoride from the water or would not wish to see it added.

In terms of the action we wish to see in the short term the Government must base their decision on existing evidence of the benefits and the extensive practical experience of this public health measure. They should act on behalf of the great majority of people who support this public health measure, and in particular on behalf of those children who continue to suffer unacceptable levels of tooth decay. Putting fluoride in toothpaste is simply not enough.

Some opponents of fluoridation raised the issue of human rights today and on other occasions. On that subject I cannot improve on the words of my noble friend Lord Avebury, who is a noted human rights campaigner when he said, in 1994, Fluoride is a natural constituent of water supplies, as it is indeed of many foods. The adjustment of the quantity to an optimum level cannot be compared with the addition to water of a substance not found there ordinarily". I feel that that settles the matter in relation to human rights.

On these Benches our health team wishes to see action on this issue during this Parliament. We believe that the arguments on health inequalities carry the day. In their Green Paper—Our Healthier Nation—the Government supported making fluoridation mandatory once the proper procedures had been followed and a request had been made to water suppliers. I do not know what responses were forthcoming to that Green Paper, but we agree with that approach.

The Government must make a commitment on this issue in the public health White Paper, due in the New Year. If that involves an indemnity to the water companies, so be it. I do not believe that it will ever need to be invoked to any great extent. If we need to improve consultation procedures, let us do it. That should be the proper forum in which to air these doubts and fears. Above all, the Government need to grasp the nettle.

7.30 p.m.

Earl Howe

My Lords, I am sure that we are all grateful to the noble Earl, Lord Baldwin of Bewdley, for initiating this short debate. Although I should declare my hand at the outset by saying that in common with my noble friend Lady Gardner and the noble Lords, Lord Dean of Beswick, Lord Rea and Lord Clement-Jones, I do not share the noble Earl's concerns, nevertheless, I have nothing but respect for his persistence and continuing questioning of the scientific and ethical issues associated with the fluoridation of water supplies.

This evening the noble Earl has raised some issues which clearly merit a serious and considered response from the Minister. However, many of them seem to me to have been dealt with satisfactorily already in Written Answers in Hansard—notably those that appeared on 10th June, 3rd September and 11th November this year. I say to him, in all candour, that nothing that he has said tonight persuades me that there is a substantive case to answer. Nevertheless, on these Benches we are glad to have the opportunity of restating our views on the subject.

I know that my noble friend Lord Colwyn—a vice-president of the British Fluoridation Society—wanted to take part in the debate and to reiterate his own personal and professional support for fluoridation as a public health measure. He is unable to be here, but he has made it clear to me that he is well aware of the problem of tooth decay and the role that fluoridation can play in reducing it.

The previous government, in which I was proud to serve, were convinced of the safety and efficacy of adding fluoride to water at the level of one part of fluoride per million parts of water. Our position in opposition remains unchanged. Independent scientific advisers consistently endorsed fluoridation as safe, as I understand do the present Government's advisers. That confidence about the safety of fluoridation is based on well documented evidence, drawn from over 50 years of practical experience and extensive research. Nevertheless, the numerous and varied charges levelled against the safety of fluoridation have always been properly investigated. On each and every occasion, the charges have been found to be totally without scientific or medical foundation.

We need to be absolutely clear that there is no controversy within the scientific community about water fluoridation. Every reputable scientific body which has ever considered the issue has pronounced that this public health measure is safe. I have a list of the major authoritative reviews which I can pass later on to the noble Earl, if he wishes, although from what he has said I expect that he is already aware of most of them.

Tooth decay is a painful, distressing and disfiguring disease which all too often results in the removal of teeth under general anaesthetic. I am told that babies as young as two commonly undergo gas anaesthetics for the removal of rotten, infected teeth. That experience is not just extremely traumatic at the time, but there is also the inherent risk of undergoing an anaesthetic. In addition, it has been shown to undermine a child's ability to establish regular dental attendance patterns throughout life.

Fluoridation has led directly to a halving in the incidence of tooth decay. That is particularly welcome for the vulnerable in society; for example, very young children living in socially deprived areas. In fact, water fluoridation has been shown to benefit most those who have the greatest social and material deprivation. That is surely one of the key points to be made in answer to those who believe that fluoride toothpaste, for example, could achieve equivalent results on its own. Fluoridated water reaches those who seldom brush their teeth and seldom see a dentist. In addition, the benefits of fluoridation are not confined to young children. The evidence indicates that all age groups, including older adults, can benefit from a fluoridated water supply.

There are those who, although accepting overwhelming evidence of the safety and efficacy of fluoridation, oppose this public health measure on ethical grounds because they believe that it infringes civil liberties. The trouble with that argument, it seems to me, is that it seeks to belittle or trivialise a major public health problem; namely, dental caries.

As many noble Lords have pointed out, no individual is at liberty to drink water entirely free from fluoride, as fluoride is found to be present naturally, at varying levels, in all water supplies. As the noble Lord, Lord Clement-Jones, so succinctly pointed out, fluoridation is simply the process of topping up the level of fluoride in the water to the optimum level for dental health, so, for example, the residents of Birmingham can enjoy the dental benefits that the residents of Hartlepool enjoy naturally. A recent survey by the British Association for the Study of Community Dentistry found that the residents of the West Midlands enjoyed the best dental health in England.

Anyone who is inclined to follow the noble Lord, Lord Stoddart, in seriously doubting the evidence of the efficacy of fluoride would find it instructive to look not only at the examples of various inner cities, but also at Anglesey. That example was quoted in a Written Answer in another place on 1st December this year, which stated: The dental decay rate of children aged five years in Anglesey was reduced by 50 per cent. after fluoridation was introduced there in the mid-fifties. However, since withdrawal of the last of the Anglesey fluoridation schemes in 1991, there has been a 168 per cent. increase in tooth decay".—[Official Report, Commons, 1/12/98; WA 35.] When we know, as certainly as we can know anything, that a public health measure is safe and that it can benefit millions of people, I think it can be argued that it is unethical not to implement that benefit. The charge that the general public do not want fluoridation is not supported by the evidence of properly conducted opinion polls, which have consistency shown overwhelming support for the measure. By all means, let questions be asked about fluoridation, but, in my view, it is quite wrong and highly regrettable that as a result of that process a key plank of public health policy should have unnecessary doubt cast upon it and thereby become undermined.

The previous government, in their determination to take practical steps to improve the health of the nation, introduced, as many noble Lords have mentioned, the Water (Fluoridation) Act 1985 with cross-party support. Although that piece of legislation stands as a testimony to the real commitment to improve public health, it is clear that the Act has not worked in the way in which it was intended. When the Act was introduced, it was expected that technical feasibility would be the only grounds on which water undertakers would refuse to fluoridate. Regrettably, that has not always proved to be the case. The last Minister of State for Health in the previous government, Gerald Malone MP, consistently called for water suppliers to co-operate with health authorities so that the policy could be implemented. Despite those vehement efforts, over 60 health authority requests to fluoridate have been turned down by water companies and no new fluoridation scheme has been introduced since 1985.

The Opposition welcome Sir Donald Acheson's recent recommendation on water fluoridation. The Independent Inquiry into Inequalities in Health points out, with regard to oral health, that although overall dental health in children is improving, inequalities in dental health are widening. The report highlights the proven efficacy of water fluoridation in reducing those inequalities and recommends the fluoridation of the water supply.

In order for the Government to fulfil their promise to reduce inequalities in health, those recommendations must be acted upon. The Minister for Public Health stated that the conclusions of Sir Donald's report will, contribute to the development of a new strategy for health". In the case of water fluoridation, the strategy required is not the commissioning of another review or inquiry at the taxpayers' expense, but amendment of existing legislation so that fluoridation schemes can be implemented at the request of health authorities. Under existing legislation the scope for dialogue has, I fear, been exhausted. The Opposition await, with eager anticipation, the arrival of the forthcoming public health White Paper and hope that it will contain a clear statement of policy which will take us beyond the current stalemate on the issue of water fluoridation.

7.40 p.m.

Lord Hunt of Kings Heath

My Lords, perhaps I may start by congratulating the noble Earl, Lord Baldwin, on securing a debate on what I regard as an important issue. It also allows me to acknowledge his work in the field of complementary medicine, which I have long appreciated.

I should also like to acknowledge the contribution of other speakers to what has been an excellent and wide-ranging debate. As the noble Lord, Lord Clement-Jones, suggested, the subject is one which provokes forceful reaction. Certainly, in my 25 years in the health service before coming to your Lordships' House, fluoridation often played a part in my working life, first as a CHC Secretary in the 1970s; secondly, holding public meetings to discuss the issue as a member of the British Fluoridation Society Council and, thirdly, as director of the National Association of Health Authorities and Trusts where many of our health authority members have been wrestling with those issues for well over 20 years.

In responding to the debate I want to start by discussing it in the broader context of public health. Indeed, I would argue that we should always see the oral health of the population as an integral part of its general health. We need to assess any scientific evidence for health problems caused by water fluoridation as carefully as we examine the evidence for oral health benefits.

This country has seen dramatic improvements in health over the past 50 years, and oral health is no exception. In addition to the key role played by the dental profession, addition of fluoride to both toothpaste and water has made a significant contribution to reducing the level of dental decay, particularly in the teeth of children. That, of course, is in line with the first of the two key aims we put forward in our consultative Green Paper Our Healthier Nation. That was to improve the health of the population as a whole … ". But we cannot be complacent. More than half of the country's 15 year-olds have still experienced decay in their permanent teeth. We also have very good evidence that significant inequalities remain in the oral health of the population. Even at regional level there are significant differences in the levels of tooth decay in children. For example, in 1995 five year-olds in the West Midlands had on average less than half the numbers of decayed, missing or filled primary teeth than those in the north west—a point forcefully made by my noble friend Lord Dean. Nineteen per cent. more five year-olds in the West Midlands had no tooth decay at all compared with their counterparts in the north west.

A similar picture emerges when you look at 12 year-olds and their permanent teeth. One further thing stands out when you consider smaller population groups, at health authority level: other things being equal, the worst off in society have the poorest oral health. Now, the Government are determined to change that and to narrow the health gap—the second key aim in Our Healthier Nation.

The challenge for health authorities is how to improve oral health generally and to tackle these inequalities in health status. I do not think that anyone suggests that will be easy. Some people have a history of sporadic dental attendance. As noble Lords have suggested, many people visit a dentist only when they are in pain, and they may have difficulty in maintaining a regular brushing routine with fluoride toothpaste.

There is, of course, the further option then of fluoridating the water supply in areas with high levels of dental decay. The evidence shows that fluoridation of the water supply to the optimum level of one part in a million can reduce the amount of tooth decay in children from similar backgrounds by one third to a half. About half a million people in this country receive water which is naturally fluoridated at or about the optimum level of one part of fluoride per million of water. A further one million people receive water which is naturally fluoridated at a lower level, but which still confers some dental benefit. These areas are generally found in a band running down the eastern side of the country, from Hartlepool in the north to parts of Essex. Some 5 million people receive water where the fluoride content has been artificially increased to a level of one part per million. Major schemes are in operation in Birmingham, throughout the West Midlands, and also in Tyneside.

The Government recognise that fluoridation is an important and effective method of protecting the population from tooth decay. It also has the advantage of benefitting the whole population. I make no apology for drawing your Lordships' attention to the example of fluoridation quoted in Our Healthier Nation. Other noble Lords have also referred to it. The example was Sandwell, in the West Midlands, where the water supply was fluoridated in 1986. Over the following 10 years the amount of tooth decay in children had more than halved. During the same period an area with a comparable population mix—Blackburn—saw little change in its children's oral health. That example has been replicated in many other places over the past 50 years. The point made by my noble friend Lord Rea and the noble Earl, Lord Howe, about the particular advantage this can give in deprived areas is very significant. It is also, sadly, true that where fluoridation schemes have been withdrawn—Anglesey and Kilmarnock have been quoted—levels of tooth decay in children have risen after having improved during the periods of fluoridation.

The noble Earl, Lord Clanwilliam, said that dental decay and dental problems are not life-threatening. However, the noble Baroness, Lady Gardner, made a significant point, as did the noble Earl, Lord Howe, about the use of anaesthesia in young children and the pain which many children suffer as a result of dental problems.

As I have said, we must carefully examine any risks which may attach to fluoridation, as well as the benefits. The noble Lord, Lord Monson, talked about risks. Over the years, many health problems alleged to be linked to fluoridation have been investigated and no link has been found. There is yet to emerge any convincing evidence of harm to general health as a result of drinking artificially-fluoridated water at one part per million. Indeed, it is estimated that around the world some 210 million people drink artificially-fluoridated water.

The noble Lord, Lord Harris of High Cross, thought that I might pray in favour expert advice. Yes, I do. The view that fluoridation of water at this level is safe is based on medical and scientific opinion throughout the world. As the noble Earl, Lord Howe, said, that is based on practical experience and research over the past 50 years. There is currently evidence of just one minor, cosmetic side-effect of optimal fluoridation-dental fluorosis or slight tooth mottling. Even where that happens, teeth are still endowed with extra resistance and I want to reassure the House that that is not a sign of any greater harm and is not significant at the optimal concentration of fluoride used in the water supply.

The noble Earl, Lord Baldwin, raised a number of issues about the safety of fluoride. He has put down a number of questions on some of these matters. As he stated, he met with my noble friend Lady Jay and officials earlier in the year. Rather than respond specifically to every point raised by the noble Earl and other noble Lords on the scientific impact, I want to discuss them in more general terms. However, on the more specific detail, I am sure that discussions between the noble Earl, other noble Lords and the Department of Health will continue. I would encourage that. Certainly, the Department of Health would be happy to explore what kind of study Professor fain Chalmers at the Cochrane Centre has in mind.

I respect the thoroughness of the scrutiny which the noble Earl made in relation to the scientific evidence on the safety of fluoride. However, I make two points on the question of safety. First, it is true that virtually all medical and public health intervention carries risks as well as benefits. It is for the scientific community to advise on the balance of those risks to the benefits and for the Government to decide what is acceptable. Secondly, it is impossible to prove a negative. However many studies attest to the safety of a procedure, it is still not possible to say categorically that it carries no risk.

However, within that context, the evidence I mentioned earlier is highly persuasive. Half a million people in this country receive water which contains fluoride naturally present at a level close to or above the optimal one part per million, and five million receive water supplemented to that level. The corresponding figures for the USA are 10 million and 135 million respectively. Before and during the past half-century of fluoridation, there have been extensive studies of the health of those populations and, apart from improved oral health, the health experience of those receiving the optimal concentration of fluoride is no different from that of the population at large. I thought that that point was very well made by the noble Baroness, Lady Gardner of Parkes.

I should also like to refer to the point made by the noble Lord, Lord Clement-Jones. Given the readiness with which American citizens resort to litigation on health matters, it seems inconceivable to me that, as fluoridation could be harmful to health, no claim for compensation has gone through their courts.

Of course, too much fluoride can be harmful, just like too much oxygen, too much water, or too much of some vitamins. As has been mentioned, the experience on the Indian sub-continent, where much drinking water comes direct from wells dug locally, reinforces the need for the rigorous controls we have on water purity in the UK. It is impossible to say precisely how much fluoride is too much, but fluoride at the optimal concentration of one part per million has always been present in some water supplies. All of the evidence from here and other countries practising fluoridation indicates that the total intake from such water, together with that from food and beverages, such as tea, is harmless. Naturally, this is a matter which we will continue to keep under review; for instance, in assessing the forthcoming new estimates of dietary intakes in the UK.

The noble Earl, Lord Baldwin, asked about major control studies which are relied on to support the effectiveness and safety of water fluoridation. Over 60 years of research into the effects of fluoride and fluoridation has resulted in tens of thousands of published scientific studies. That is the foundation for the overwhelming view of medical and scientific authorities that fluoridation of water supplies is effective and that no likelihood of harm has been demonstrated. In addition, many detailed and authoritative scientific reviews of the literature have been published. I am sure that the noble Earl is aware of several of the most prominent and most recent of those reviews.

The noble Earl also mentioned the question of skeletal fluorosis. This is a condition in which accumulation of fluoride in the bones leads to thickening within the bone. In its early stages it may be found on X-ray but cause no symptoms and no harm. Excessive accumulation may result ultimately in hardening of ligaments, stiffness and pain in joints, weakening of the bones, muscle wasting and compression of nerves. The fact is that studies of the fluoride content and structure of bone, and radiological surveys, in communities in the UK and the US have not demonstrated clinical skeletal fluorosis, even when fluoride levels occurring naturally in drinking water were several times that used in optimal fluoridation.

The noble Lord, Lord Monson, referred to studies from Boston on the effect of fluoride on the central nervous system. These were studies which used very high levels of fluoride on rats. The author does not claim that fluoridation of water is harmful; indeed, she claims only that there are effects at much higher doses. There is epidemiological evidence available; for example, the 1986 paper from New Zealand in which seven years of study of more than a thousand children found no effect of fluoridation on child health and behaviour. That supports the conclusion that fluoridation is harmless.

The noble Lord, Lord Monson, and the noble Earl, Lord Clanwilliam, raised the issue of water fluoridation in Europe. In fact, many countries in Europe have opted for fluoridation of salt; namely, Switzerland, parts of France and Germany. The concern that we would have in following likewise is that this practice could convey a confusing message when it is the advice of many of our health and nutritional experts that we should eat less salt.

My noble friend Lord Dixon referred to the use of bottled water. He may not be aware, but many popular bottled waters are natural mineral waters and that, unlike drinking water, there is no limit on the concentration of fluoride in natural mineral waters. Indeed, some of them contain concentrations which are much higher than the one part per million used in fluoridation.

I should like to turn now to a point raised by the noble Lord, Lord Monson, the noble Earl, Lord Clanwilliam, and my noble friends Lord Stoddart and Lord Dixon; namely, whether fluoridation can be described as "mass medication". I would say no. Almost all water contains some naturally occurring level of detectable fluoride. Even where that natural level reaches or exceeds the optimum level for dental benefit, it cannot be described as mass medication. Artificial fluoridation merely adjusts that level to the optimum level for dental health benefits and does not therefore add any substance or medication which is alien to the water supply. It is worth making the point that many substances, like chlorine, are added to the water to make it safe to drink without it being termed "mass medication".

I move on now to the point raised by my noble friend Lord Rea about current legislation. He is right. The final decision on implementing fluoridation schemes rests with the water undertaker. The Water (Fluoridation) Act 1985 was consolidated in the Water Industry Act 1991. Section 87 (1) of that Act states: Where a Health Authority have applied in writing to a water undertaker for the water supplied within an area specified in the application to be fluoridated, that undertaker may, while the application remains in force, increase the fluoride content of the water supplied by the undertaker within that area. I give way to my noble friend.

Lord Dean of Beswick

My Lords, I thank my noble friend for giving way. Is he aware that the north west has a closer connection in this respect than the north east? For example, when Manchester ran the water authority it fluoridated the water in the north west for 17 other authorities, but that was cancelled when the industry was privatised with the results that have been quoted tonight.

Lord Hunt of Kings Heath

My Lords, I am most grateful to my noble friend for that information. Certainly, in my own experience, I believe that Birmingham City Council, which fluoridated the water many years ago, showed a great deal of foresight which has reaped enormous public health benefits for those living in the city.

As my noble friend Lord Rea suggested, the operation of the Act has not been successful. Indeed, that was confirmed by yesterday's judgment in the judicial review, to which my noble friend Lord Dixon referred, in which the Tyneside Health Authority sought unsuccessfully to challenge Northumbrian Water's refusal to accede to its request to fluoridate its water. Since 1985, 55 health authorities in England—and that is nearly half of them, accounting for the mergers which have taken place in the past 12 years—have requested water companies to introduce water fluoridation. However, as the noble Earl, Lord Howe, suggested, none of those requests has been successful. So there have been no new fluoridation agreements since 1985. The reason for this is quite simply that none of the water companies has exercised its discretion to agree to a health authority's request.

It was noted in the Green paper, Our Healthier Nation, that this legislation needs to be reviewed. As my noble friend Lord Rea suggests, the key issue is whether the word "may" should become "should". We will be announcing our decision on any changes necessary in a policy statement on fluoridation in the public health White Paper planned for the new year.

The noble Lord, Lord Craigmyle, raised the issue of the public. I have two comments to make in that respect. First, opinion polls have quite clearly demonstrated public support for fluoridation. Secondly, in our response in the White Paper we shall be looking at ways in which the public consultation process can be strengthened. In the meantime, we are encouraged by the readiness with which the water industry has indicated that it is prepared to look again at the legal and practical problems surrounding fluoridation.

In his Motion, the noble Earl asks for a public inquiry. Such inquiries are normally held where a case of major public maladministration is suspected which has resulted in harm to health, often significant loss of life and/or costly damage to property and the environment. These criteria do not apply to fluoridation, but we are not complacent. There has been, and continues to be, no shortage of authoritative scientific reviews of the safety and efficacy of fluoridation, and of the effects of fluoride. The Government will, of course, continue to review the latter and look sympathetically at soundly-based proposals for further UK-based research.

In conclusion, I again thank the noble Earl for the opportunity to hold this very important debate on the issue of fluoridation. I acknowledge the impassioned contributions of other noble Lords. The oral health of our nation is important and is part of a wider concern for the overall health of the nation. Despite reductions in the levels of dental decay, the instance of dental decay is still too high. Fluoridation is an important and effective method of protecting the population from tooth decay. The Government believe that there has not emerged any convincing evidence of harm to general health as a result of drinking artificially fluoridated water at one part per million. The Department of Health will continue to monitor the results of research on the effect of fluoridation, but fluoridation will remain one of our tools in improving oral health and fighting tooth decay.

8 p.m.

Earl Baldwin of Bewdley

My Lords, I think I have a few minutes and I will take only a very few minutes to wind up. First, I thank all those speakers, an encouraging number, who have come to take part this evening. I am very grateful for the debate that we have had. I do not intend to pick up the whole field and repeat everything that has been said. I just want to pull out a few key points. As regards the noble Baroness, Lady Gardner, I am very sorry that I have exasperated her. I can quite understand that, as a dentist, she must feel exasperated when this particular matter is challenged. But I have to say that from what she said and from what the noble Lord on the Front Bench has said, all I have heard is just the assertions with which I started one year ago when trying to get at the evidence. I would urge any of your Lordships who want to find out what the truth is, to try your luck, as I have—and I hope you have better luck than I have had in actually getting the hard primary sources which can alone solve these questions.

With respect to our doctor who spoke earlier, and to someone else who mentioned credentials, it is not ultimately credentials that matter, but the quality of the science. It is on that point that I take my stand in this debate.

Passing to one point that the noble Baroness mentioned when she said that there was no evidence from Australia and that there were no known adverse effects, and researchers would have been aware if there had been, my mind went at once to smoking. How many years was it before people began to think that perhaps they ought to look? Unless you actually look—this is a fundamental thing in medical science—unless there is a culture of thinking there might be a problem, you can have all sorts of things, not necessarily Australian diseases, as was said, but the ordinary bone diseases which we all have, and of which there is a growing epidemic for causes unknown. It needs looking at to see what are the causes. So it is a question of saying, "there is no evidence". If you do not look you will not see evidence.

I understand—and it is obviously particularly dear, I suppose, to a Labour Government—the argument for the deprived and the poor. Do we not all feel that? I draw to your Lordships' attention the Chilean experience where they went specifically for the deprived and the poor. They stopped fluoridating because they found that the deprived were, by definition, less well nourished than the others and were less able to stand the toxic effects of fluoridation in the water supply. It was therefore discontinued. So it is no good starting with that argument, which everybody uses—and I quite understand it—in favour of the deprived unless you are quite, quite certain that you are doing good and that you are not doing harm.

I very much warm to what my noble friend Lord Harris of High Cross said about being beware of the consensus of science. He raised some of the slight worries that I also have about passive smoking and the other issues which can very rapidly become a crusade. I think that that is something that we need to be aware of and to beware of. Having studied these things for some time, I am forming a tentative law, which says that the quality of the science is in inverse proportion to the public profile of the issue. It is because these things come up and there is premature consensus that it becomes politically incorrect in the scientific community to oppose it. And anything which later contradicts it has great difficulty in being heard. The noble Lord had a very good point there and I am glad that he raised it.

I turn again to what I said in my opening remarks about optimum levels. It is not so; there is no good science supporting an optimal level here. The noble and learned Lord, Lord Jauncey of Tullichettle is much quoted in this regard and I would like to read what he said. He said: There is no evidence"— —this is in his many pages of judgment, to which the noble Baroness, I think, referred— that water with a natural fluoride content of 1 p.p.m. is normal by world standards". And I skip a bit: Thus to suggest as do the respondents that they are merely replicating nature by increasing the fluoride content of surface water is inaccurate". The point about Jauncey, who is prayed in aid by the noble Lord, Lord Rea, among others, is that, first, it was a long time ago, back in the early 1980s. Science, as I said in my opening remarks, has moved on since then. Secondly, I would submit—and I say this also to the noble Lord, Lord Clement-Jones—that a court of law is not the ideal forum in which to judge a scientific matter. It depends among other things, on whether all your witnesses can appear, and that did not happen in the Jauncey case. So whereas you can look to him for matters of definition, I think it is wrong to try and take courts of law as authorities in systematic scientific reviews, which is what Dr. Chalmers and I are calling for in this case.

We heard what could be described as, perhaps not unfairly, "party lines" from the Benches on this side. Perhaps, in the interests of time, I should skip them and move on to the remarks of the noble Lord, Lord Hunt. Of course, I was disappointed, on the whole, by what he said, but I did welcome the encouragement that he gave and the fact that the department will look at what Dr. Chalmers is saying. I am grateful to him for that.

He echoed the noble Lord, Lord Clement-Jones, and said that it was inconceivable, that there were no legal claims. I wonder if they are not aware that Colgate has paid out £1,000 for somebody damaged by fluoridated toothpaste. Beyond that isolated point on toothpaste, I think that it is easily answered because how would people who have a disease—it may be a chronic bone disease or some other kind—know that it was to do with fluoride in the water? Their doctors would not tell them so if there is no culture of looking at this and understanding that it could cause problems? I think at present that there is no way that people are going to come forward and claim—unless they are clearly allergic, and there have been cases of this—that the water supply is to blame.

On the question of mass medication, again the noble and learned Lord, Lord Jauncey, is prayed in aid. Let me quote him. He talks about Section 130 of the Act defining "medicinal products". He said: I am satisfied that fluoride in whatever form it is ultimately purchased by the respondents"— and he is talking here about the water supply— falls within the definition. He had no doubt whatever.

There is one final question that I thought I would like to leave with the noble Lord, Lord Hunt, because among all the cherry-picking of the areas, Birmingham is always quoted. There are worries in my mind about Birmingham. One of them is that the number of dentists has gone up by 84 per cent. while the population has decreased by 15 per cent. during fluoridation. The other—and I would be very surprised if this has been looked at quite as carefully as the noble Lord says—is quoted in the Cancer Control Journal, which noted a, marked rise in the cancer death rate after the introduction of fluoridation in Birmingham". Birmingham is also known as an infant mortality blackspot. I should like to see the studies. I accept the noble Lord's point that you cannot prove a negative, but I would like to see some studies after a year to reassure me on that point. On the bone question, I wonder how Birmingham has tackled this. I have seen a letter, and I quote, Birmingham Health Authority has no facility to collect biological samples. And a letter from the House of Commons Library confirming: No Birmingham research on the uptake of fluoride in bone has been done. I believe that there are still questions around that and I would leave that thought with you.

In conclusion, this issue reminds me of nothing more than one of those wild west stage sets, which look very impressive but, when you get closer, you find that it is only a façade and that behind there is in fact little but scrub and empty desert. I would remind your Lordships, as the noble Lord, Lord Hunt, emphasised, that it was not I who framed that initial wording but a doctor who is at the very heart of evidence-based medicine, Dr. lain Chalmers, who shares my concern that the case has not been fully made out.

My Lords, once again I thank everybody for taking part in this debate. I beg leave to withdraw the Motion.

Motion for Papers, by leave, withdrawn.

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