§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. I Fraser.]
§ 10.45 p.m.
§ Sir Cyril Black (Wimbledon)
On 6th March last in an Adjournment debate on the fluoridation of water supplies my hon. Friend the Joint Parliamentary Secretary to the Ministry of Health said that there was no campaign for fluoridation. He also said this:I cannot accept that we are exercising any bias in favour of fluoridation."—[OFFICIAL REPORT, 6th March, 1963; Vol. 672, c. 612.]In the month following that debate the Ministry of Health published a pamphlet entitled, "Fluoridation". I submit that that pamphlet is most biased, most partial and most misleading, by reason of its many omissions. Indeed, it ignores every fact unfavourable to fluoridation. The pamphlet has been widely circulated by the Ministry to, I believe, all the health authorities throughout the country. I submit that this action in the publication and the circulation of the pamphlet indicates both bias and the existence of a campaign, both of which my hon. Friend denied on the last occasion that this matter was debated in the House.
Obviously I cannot deal with the pamphlet in extenso, but I want to take seven examples of bias or misleading statements or inaccuracies in it. First, the pamphlet says this:The effect of fluoridation in this country has been demonstrated by schemes undertaken in Anglesey, Watford and Kilmarnock.It goes on to list the alleged beneficial results flowing from those schemes. What the pamphlet does not disclose and what I submit it should disclose is the fact that Kilmarnock stopped the scheme after five years—that is to say, at the earliest opportunity at which the scheme could be stopped—and that opinion among the dentists in Kilmarnock was sharply divided about the value of fluoridation.
Further, the paragraph makes no mention of the fact that a scheme was also undertaken at Andover, with the most disastrous results. At Andover the scheme was stopped after two years, much illness was experienced in the 684 town, and one of the victims was none other than the mayor of the town at the time. It was widely believed and claimed that much of that illness was due to the existence of fluoride in the water supply. A meeting was held to protest against the fluoridation of water. In that small town an unprecedented audience of 700 people gathered to express their indignation at what had taken place. The old council which had voted for the insertion of fluoride into the water was overwhelmingly defeated and a new council which was opposed to fluoridation was elected in its place.
Secondly, in the pamphlet the favourable opinion is quoted of the World Health Organisation expert committee on water fluoridation. What we are not told and what I understand is still the case is that the World Health Organisation has never formally adopted that report, although the report was made some five years ago. Nor does the pamphlet state that the committee that brought in the report consisted of six members, all of them dentists or members of dental faculties, and all known to be supporters of fluoridation at the time.
Thirdly, the pamphlet says:Experience in the study areas suggests that the annual cost should be no more than 10d. per head of the population supplied.I am ready to agree that the cost involved is not one of the main criteria by which this matter should be judged, but I must point out that when one talks of 10d. per head of the population it sounds a very small amount, but I understand that if fluoridation were general throughout the country it would involve an annual cost of some £3½ million—a not inconsiderable figure.
I would also point out that in Kilmarnock, which has a population of 48,000, where this scheme was tried out, the amount spent on the five-year experiment was more than £22,000. I believe that it has been estimated by the water engineer there that of the £6,000 spent on chemicals, £5,998 was completely wasted, as it was spent on water used for industrial purposes or for persons whose teeth, by reason of age, could not benefit from fluoridation, and that only £2 of the whole of that expenditure was usefully employed.
685 Again, the pamphlet says:The Government consider that the present powers of water undertakers permit the addition of fluoride to the water they supply.I am not competent to express a view on the legal implications, but I know that a most eminent legal opinion has been given that the introduction of fluoride is not legal. Although I am not at liberty to mention the person by whom that opinion has been given, I have given the information in confidence to my hon. Friend, and I know that he will agree as to the eminent character of the person who has given that advice. I understand that there is a test case pending at Watford, so that clarification of the legal position may soon be forthcoming.
Further, the pamphlet says:Fluoridation is practised extensively in the United States of America, where some 44 million people are now drinking fluoridated water.What is not mentioned, but should have been, are at least the two following facts: that 60 million people in the United States have either rejected fluoridation or, having tried it, have abandoned it, and that, in the United States, referendum after referendum has been held and in almost every case fluoridation has been overwhelmingly rejected. Furthermore, in France, in Sweden and in Western Germany, fluoridation has been rejected by decree as a nation-wide measure, and in Denmark and Italy it has been considered unsuitable. In other parts of the world, similar decisions have been taken.
Yet again, the pamphlet says:But no other method of preventing dental decay has been shown to be as effective or convenient as fluoridation of water.I would ask: what about the experience of Western Germany, where a much larger experiment has been carried out than has been carried out in this country?
The West German experiment has covered over 30,000 children, and three methods have been used simultaneously—first, fluoride added to the water supplies; second, fluoride in sweets; and third, fluoride tablets. After five years of that widespread experiment similar results have been obtained from all three methods, but the West German authorities have decided that the second and third methods are the most desirable.
686 Again the pamphlet says:It is sometimes suggested that fluoridation interferes with the liberty of the subject.and then proceeds to attempt to disprove the obvious. Of course it interferes with the liberty of the subject. What is involved? One hundred per cent. of the public have to inbibe fluoride in the hope of benefiting 7 percent. of the population, and there is, no possibility of contracting out except by the individual sinking a well or distilling water.
I remember some of the controversy that took place regarding compulsory vaccination, and it will be remembered that at no time has vaccination been made 100 per cent. compulsory. An exception has always been made in the case of persons with a conscientious objection, but of course no such exception is possible with the fluoridation of the water supplies.
Fluoridation is greatly troubling increasing numbers of the people, and as the facts regarding it become more and more generally known more and more of the local authorities are rejecting it. It is no exaggeration to say that whenever the subject has been debated with a full knowledge of the facts and the case has been completely stated by those having the necessary knowledge and experience both for and against, in almost every such case a decision against fluoridation has been reached.
I want to conclude with two constructive suggestions to my hon. Friend to which I hope he will give the most careful and serious consideration. First, I suggest that he should withdraw the pamphlet. I think that I have said enough to show that the pamphlet is biased, that it is misleading and that by the omission of material facts it is bound to produce an impression on the mind of the reader which is not in accordance with the full knowledge available to us. I am quite certain that the apprehensions of the public on this matter will not be allayed by further issues of a pamphlet that is so obviously partisan on the subject.
Secondly, I ask my hon. Friend to consider very seriously referring this whole matter to an independent inquiry by a tribunal that has had nothing to do with this matter up to date and has no preconceived ideas about it—perhaps a tribunal presided over by a High Court judge with two expert assessors to assist 687 him. Let the tribunal hear the evidence and hear the experts in favour and the experts against. Let it try to draw the right conclusions from the facts and the statistics, because this is the point at which so many experts go wrong. They fail to draw the right facts and inferences from the statistics available to them.
It is a fact that there is an important psychological aspect of this matter. We all know that a great deal of the benefit of medicine arises from the fact that the person who takes it believes that it will do him good. The converse is also true, that if, as is the case, large numbers of people believe that fluoride in the water is injurious to their health even if, in fact, it be harmless—and it would take a good deal to satisfy me of that—it is still capable of doing them harm if they believe that that will, in fact, be the consequence of their imbibing it.
I ask my hon. Friend to give the most serious attention to what I have endeavoured to say in a very brief compass on a matter which, at the present time, is of great public concern.
§ Mr. Kenneth Robinson (St. Pancras, North)
I rise only to ask the hon. Member for Wimbledon (Sir C. Black) one simple question. Assuming that he believes all that he has just said, what nefarious purpose does he think his right hon. Friend the Minister of Health and the Government had in mind in introducing a policy of recommending fluoridation, after having had access to all the best medical and scientific advice and knowing that this policy was bound to involve some controversy and some expense?
§ Sir C. Black
The answer is very simple. I believe that the Government have made a mistake in the matter and, having made a mistake, I suggest that it would be a good thing to recognise it and change the policy.
§ 11.2 p.m.
§ The Joint Parliamentary Secretary to the Ministry of Health (Mr. Bernard Braine)
It was on 10th December last that my right hon. Friend announced that he was ready to approve, under Section 28 of the National Health Service Act, 1946, arrangements made by local authorities with water undertakers 688 for the addition of fluoride to their water supplies where it was deficient in it naturally. This decision was taken, as the hon. Gentleman the Member for St. Pancras, North (Mr. K. Robinson) has just asserted, after the fullest and most careful consideration had been given to the volume of evidence on the effectiveness, safety and practicability of fluoridation, the advice received from expert advisory bodies and the volume of support for fluoridation from responsible professional and local authority organisations.
This House has twice debated the general question of fluoridation on the initiative of the hon. Members for Greenock (Dr. Dickson Mabon) and Wood Green (Mrs. Butler), and I do not think it incumbent on me tonight to say very much about the merits of the process. I can say, however, that the Government are fully satisfied, in the light of the thorough and careful investigation made, that fluoridation is effective, safe, and practicable and that there is no comparable alternative measure that could so effectively combat the incidence of dental decay.
The purpose of the booklet that my hon. Friend the Member for Wimbledon (Sir C. Black) has criticised is simply to set out briefly the principal fundamental points on which that conclusion is based. It is not meant to be an exhaustive treatment of the subject; for this I would refer my hon. Friend to the detailed studies, published by the Stationery Office, that have been made. Nor did we conceive it to be our duty in the booklet to present arguments for or against fluoridation. It is not a question of presenting evenly-balanced views for public consideration, since the overwhelming body of authoritative medical and dental opinion is that fluoridation is both safe and effective.
The booklet sets out briefly, in simple terms readily understandable by the layman, the salient facts about fluoridation. It deals with the history of fluoridation, what it is and what it does. It gives the main conclusions of the British studies on fluoridation, quotes the views of expert bodies who have studied the question, and gives short answers to some of the questions most commonly asked. The preparation of such a booklet is fully in accordance with my Department's 689 normal practice of providing factual information about health matters for which it is responsible. Health education material is made available on many other subjects, such as immunisation and the dangers of smoking. In the case of fluoridation we felt, since the subject is one of some complexity, that it was desirable that all concerned in making decisions and all others who were interested should have access to the basic facts.
I am very sorry that my hon. Friend considers that the booklet is partisan, and I am surprised that he should think that it is inaccurate. I have indicated why we did not think it appropriate to present argument and counter-argument, and I reject any imputation that the document has been produced in a biased manner.
Certainly, a few members of the medical and dental professions do not support fluoridation. Differences of opinion always arise when new public health measures are suggested. It is not surprising, therefore, that scientific arguments and reports have been published containing opinions adverse to fluoridation. I assure my hon. Friend that these have not been disregarded. They have received the most careful review of their factual basis and the evidence has been weighed against that derived from other sources. None of these reports has carried any conviction, and they do not warrant the suggestion that there is any serious division of medical or dental opinion in this country.
The effect of fluoridation on health has for many years been the subject of extensive investigation throughout the world. Indeed, it is doubtful whether any other public health measure has received so much attention. Every single allegation of harm has been thoroughly and carefully investigated. Despite this, no harmful effects from fluoride at a level of 1 part per million in drinking water have been demonstrated. This is a fact which the public should know, and I am glad that my hon. Friend has given me the opportunity to make it clear once again tonight; we have stated it in the booklet and it needs no qualification.
My hon. Friend made the point that the booklet does not refer to the fact that the studies were brought to an end in Kilmarnock by the decision of the town council. This did not happen, as 690 he said, until after publication of the results of the five-year study, which, incidentally, showed a marked benefit to the children of that town. The council took its decision after an intensive campaign had aroused local opposition. My hon. Friend also mentioned that Andover, one of the towns selected originally as a study area, discontinued fluoridation.
Whatever reasons prompted the two town councils to take their decisions, the fact remains—I am choosing my words very carefully—that no harm to health was demonstrated to have occurred either there or anywhere else. Indeed, had any individual been thought by his doctor to be suffering from ill health resulting from fluoridation in any of the study areas, the matter would have been investigated most closely. As my hon. Friend will know if he has read the report on the studies, arrangements were made for this purpose and local doctors were asked to provide information about any harm arising from fluoridation. No adverse reports were received.
I do not deny that those who are opposed to fluoridation have had their successes. But the booklet is not concerned to conduct an argument; it concentrates on the established facts. And what is more important than the fact that, where the studies were carried out over a period of five years, the average number of carious teeth per child at the age of 3 was reduced from 3.8 to 1.29, at the age of 4 from 5.39 to 2.31, and at the age of 5 from 5.81 to 2.91, reductions of 66 per cent., 57 per cent. and 50 per cent. respectively, without any adverse effect on health whatever? One has to place solid evidence of this kind against the sort of argument which succeeded in two towns in arousing fear and anxiety.
My hon. Friend went on to challenge the assertion made in the pamphlet that expert bodies strongly endorse fluoridation. He made no reference to the fact that the highest medical and dental authorities in this country, my right hon. Friend's Standing Medical and Dental Advisory Committees, people with long experience in medical research, have endorsed the report on the studies carried out here.
My hon. Friend also challenged the conclusion reached by the World Health 691 Organisation's expert committee on water fluoridation in 1958 thatthe effectiveness, safety and practicability of fluoridation as a caries-preventive measure has been establishedby saying that the World Health Organisation never adopted that committee's report. The answer to my hon. Friend is that it is not the policy of the World Health Organisation to endorse the reports of its expert committees. His point, therefore, has no substance. What is of substance is that members of this expert committee were selected for their knowledge and practical experience of research and four of its members had medical as well as dental experience.
As regards the United States of America, the first studies were started in 1945. Since then fluoridation has been introduced into many other districts. According to the latest published reports, about 51 million people now drink water containing fluoride at a level recommended for dental protection. Of these, some 44 million live in 2,300 communities in which the fluoride level in the water supply is adjusted. The other 7 million live in natural fluoride areas. The point is that while some relatively small communities have discontinued fluoridation, the population in areas with controlled fluoridation has been increased by over 1 million each year since 1950.
My hon. Friend mentioned certain European countries. It is not the case that Germany, France or Switzerland have rejected fluoridation. In West and East Germany, fluoridation studies are in progress. In West Germany, a study was started in Kassel in 1953 and is still continuing, and a marked reduction in dental decay has been reported. Fluoridation was started in a town in East Germany about four years ago. In France, fluoridation was considered in 1959 by the Ministry of Public Health and Population and by the Child Health Protection Committee of the Standing Social Hygiene Council and it was thought that before proceeding further, inquiries were necessary into the amount of fluoride in the French diet. The position has not altered since then. In Sweden, a Fluoridation Act was passed in November, 1962. The Act is permissive and is limited for the first five years only to Norrkoping, where fluoridation 692 has been in operation since 1953. Studies are in progress in Holland, Belgium and Czechoslovakia. In Italy, as far as is known, fluoridation has neither been officially proposed or rejected.
My hon. Friend claims that few of the population in this country will benefit from fluoridation. It is correct that initially only young children will directly benefit, but it is shortsighted to look at fluoridation from this point of view. The protection which our children will receive will last long into middle life and if fluoridation is introduced generally now, it follows that in time the whole population will enjoy better dental health.
My hon. Friend referred to cost. It is true that much fluoridated water will be used in ways which cannot help to prevent dental decay, but this does not mean that the process is grossly wasteful. The cost of fluoridation is not expected to be more than 10d. per head per annum, a small sum in relation to the cost, both in money and human suffering, of dental decay at its present level. At the age of school entry, four out of five children in this country have some decayed teeth. If my hon. Friend's estimated figure is correct, it is only a very small fraction of the cost of our present dental services.
Health education in matters of diet is important, and we are paying much attention to this, but no method of proven effectiveness in reducing this level of decay can be ignored Fluoridation should in time halve this rate of decay and no other method available can reach this degree of efficacy. I am advised that fluoridated cooking salt has been on sale in Switzerland for some years, and there is evidence of its limited effectiveness. There is, however, nothing as effective as fluoridated water.
Perhaps I may clear up a misconception about fluoridation which my hon. Friend seems to share. It is not the case that fluoridation adds something to our drinking water which is not already there. Fluoride is present to some degree in almost all drinking water. In some parts of the country, people have been drinking all their lives, and their ancestors for generations before them, water containing up to six times as much fluoride as is recommended for dental health. They have done so without any harm to 693 their health but with obvious benefit to their teeth. Here is the complete answer to those who object to fluoridation. My hon. Friend has asked about the legal position. The Government's view is that subject to any ruling which the courts may give, fluoridation is within the existing powers of water undertakers. If this is disputed, it can be settled only in the courts. My hon. Friend will not expect me to say more on this tonight.
My hon. Friend made the interesting suggestion that to remove doubts and anxieties, an independent body should be set up presided over by a High Court judge. Fluoridation is a means of improving the health of our people. The practical studies which have been carried out have already proved that benefits are conferred upon young children. This is an established fact. And it follows that if fluoridation is adopted, in time the 694 whole nation will enjoy better dental health. A report on those studies was put before my right hon. Friend's Standing Dental and Medical Advisory Committees and the Central Health Services Council. Similar action was taken in Scotland. These expert bodies comprise leading members of the dental and medical professions, people who have long experience of the careful and critical assessment of the results of dental and medical research. None of these bodies made any comments which are other than favourable to fluoridation. With the greatest respect to my hon. Friend, therefore, I do not think that any new body could add to our knowledge and understanding of the subject.
§ Question put and agreed to.
§ Adjourned accordingly at a quarter past Eleven o'clock