§ 4.10 p.m.
§ Debate resumed.
§ LORD COHEN OF BIRKENHEAD
My Lords, I should like at the outset to make two points. The first is that nobody, certainly including those who are protagonists in the matter of fluoridation, would in any way impugn either the sincerity or the integrity of the noble Lord who has introduced this Motion. What we do impugn is his judgment, and I propose in a few moments to apply myself to that issue.
The second point which I should like to make is that, in a measure, I have an interest in this subject because I was Chairman of the Standing Medical Advisory Committee of the Ministry and of the Central Health Services Council during much of the relevant discussion on the question of fluoridation. It should be remembered that it was no sudden flash-in-the-pan decision on the part of the Ministry to recommend fluoridation to local authorities. It was, indeed, seven years after fluoridation had been commenced in the United States and Canada that the Medical Research Council recommended that a British Government commission should visit the United States and Canada and report on whether fluoridation did, in fact, delay the onset of dental decay, and whether there were any evident general health hazards associated with the fluoridation of water supplies. They returned in 1953, giving answers which were quite specific to both those questions: that fluoridation did delay the onset of dental caries and, secondly, that there was no evidence that there were any 106 hazards to general health. But they recommended that there should be special studies in this country, which were indeed carried out, and they were reported on in 1961.
This, in fact, is where I come in, because in 1961 the Standing Medical Advisory Committee recommended to the Minister, on the basis of all the available reports, that fluoridation should be adopted. The Minister then, with appropriate caution, said, "Be that as it may, we must be certain that there are no general hazards to health". So a Joint Committee of the Standing Medical Advisory Committees of England and Wales and of Scotland was appointed, with myself as Chairman, to examine this matter, and we examined it with great care. We studied intensively not only the report of those who had carried out the investigations in this country, but also the reports of the commissions which had been held in Ontario, New Zealand and elsewhere. We came to this conclusion:there was no evidence to support the view that fluoridation carried any hazard to general health in a concentration of one part per million.I agree that that evidence is based essentially on negative findings, but your Lordships will be aware that no experiment or investigation can ever be devised to prove a null hypothesis. What you have to do is to give the facts a chance to disprove it; and the Committee found:the weight and consistency of well-founded facts carried the firm implication that fluoridation should be generally adopted in view of its considerable benefit to dental health.This advice, which was given to the Minister, was endorsed by the Standing Medical Advisory Committee and the Central Health Services Council.
I am grateful to the noble Lord, Lord Douglas of Barloch, for having provided me with a reference, but it reads a little differently, as I understand it, from what he quoted. The pamphlet says:The number of scientific papers bearing on the safety of fluoride—not on fluoridation, but on the safety of fluoridation—is prodigious; by 1958 the World Health Organisation's expert committee on water fluoridation estimated that the number approached 3,000 over a period of 20 years".But the 3,000 referred to the papers on the safety of fluoridation, and not on 107 fluoridation itself. The Ministry's pamphlet goes on to say that:any reports on the safety or efficacy of fluoride will always receive the closest attention. There is no truth whatever in the allegation that the Government ignored reports unfavourable to fluoridation in deciding to encourage its introduction. All such reports have been carefully evaluated.What the noble Lord, Lord Douglas of Barloch, did not tell your Lordships was the view of the expert committee on fluoridation of the World Health Organisation. They said:The effectiveness, safety and practicability of fluoridation as a means of preventing dental caries is now established. All the findings fit together in a constant whole that constitutes a guarantee of safety…a body of evidence without precedence in public health procedures.
My Lords, will the noble Lord give a reference for these various pamphlets? I believe that is not in one of these published pamphlets.
§ LORD COHEN OF BIRKENHEAD
No, my Lords. This is, in fact, in the World Health Organisation's pamphlet itself.
I shall have to refer to certain specific points which the noble Lord, Lord Douglas of Barloch, has made. I do not propose to deploy all the pros and cons of fluoridation this afternoon. They have, indeed, been reiterated on several occasions in Parliament, and to consider them in detail would take many days. Indeed, in the High Court of Dublin in 1963 there was a hearing on this very subject which took 65 days. In that case a lady challenged the right or the constitutional validity of what was called the Health (Fluoridation of Water Supplies) Act 1960, and many expert witnesses were called on both sides. No one, I think, would deny the great distinction of Mr. Justice Kenny who tried the case. He cannot be accused of the partiality which is sometimes attributed to doctors in respect of fluoridation. Perhaps I may therefore read one or two excerpts from his judgment after hearing evidence for 60 days. In paragraph 35 he says:Having heard the evidence and read the literature which it was agreed I should read, I am satisfied that the fluoridation of public water supplies at a concentration of one part per million will not in our temperate climate be dangerous to anybody—old, young, healthy 108 or sick. I am also satisfied that there is no reasonable possibility that it may involve an element of danger or risk to life or health to any of the citizens of this country.Then he goes on to say in paragraph 36:It would, I think, be sufficient for the purposes of this case to say that the plaintiff has not proved that the fluoridation of public water supply is dangerous, but I do not think that I should so confine myself. The evidence given on behalf of the plaintiff at the earlier stages in this case received wide publicity"—that is, the evidence against fluoridation—while the far more compelling evidence for the defendant received little public notice. It is possible that the evidence for the plaintiff, some of which was of a sensational character, may have created public uneasiness. Let me say, then, that I am satisfied beyond the slightest doubt that the fluoridation of the public water supplies in this country at a concentration of one part per million will not cause any damage or injury to the health of anybody—young, old, healthy or sick—who is living in this country, and that there is no risk or prospect whatever that it will. The evidence on which I base this view consists of a number of items each of which is conclusive; when taken together they are compelling.Then, my Lords, Mr. Justice Kenny proceeded to review the evidence in great detail (this is published, and is available to any Member of your Lordships' House), and he also expressed his view of some of the witnesses. He spoke in the highest terms of those who had given evidence for the defence—in fact, he rebuked counsel for having imputed ulterior motives to one of the expert witnesses for the defence—but he had some observations on those who had given evidence for the plaintiff, and I will quote what he said because many of the names which are quoted by the learned judge are those given in the pamphlet issued by the National Pure Water Association as critics of fluoridation. This is what the learned judge said:I reject the evidence of Professor Gordonoff, of Dr. Rozeik, of Dr. Waldbott and of Dr. Dillon. There was a marked note of fanaticism and passionate conviction about their evidence. I got the impression that they were determined at all costs to make a case against fluoridation.The learned judge went on to say, referring to matters which the noble Lord, Lord Douglas of Barloch, has quoted in relation to fluoride and goitre:The evidence of Professor Benagiano and Dr. Fiorentini"—109 both of whom are critics of fluoridation noted by the National Pure Water Association—that there is a relationship between the presence of fluoride ion in the drinking water and the high incidence of goitre, together with an unusual basal metabolic rate…is not, in my opinion, reliable.Of two others, he said that their evidence was such that, while they were impressive witnesses, he was unable to accept their evidence in relation to goitre. They were Professor Steyn and Dr. Sinclair, who conceded during cross-examination that many of the ill-effects which he mentioned would not arise when the concentration of fluoride ion in the water was one part per million.
My Lords, you may think that that is only an individual judgment, but there have been several such judgments. I have quoted this one at length because it was suggested in another place in July, 1963 (column 686 of Hansard of July 17), that there should be a judicial inquiry. But this was a judicial inquiry in a court of law, where evidence was given on oath. And the inquiry was conducted by a judge who was skilled, not only in the assessment of evidence but also in determining the credibility of witnesses.
§ VISCOUNT STUART OF FINDHORN
My Lords, may I ask whether the judge was skilled in this question of the chemical action?
§ LORD COHEN OF BIRKENHEAD
The judge heard expert witnesses on both sides. I suppose it may be said that those who are most skilled in this field are the most suspect, because those who are most skilled in this field have supported fluoridation. However, in this country it was suggested that there should be a judicial inquiry, and it is not uncommon for matters of expert decision to be taken by judges in a court of law, with appropriate witnesses.
§ LORD COHEN OF BIRKENHEAD
I am coming to that, and the noble Viscount will, I am sure, approve of what I am about to say.
Let me refer now to what was said by another judge in New Zealand—and it is quoted in a judgment of the Judicial 110 Committee of the Privy Council delivered on July 22, 1964, to which I propose to refer later; but I should like to quote this judgment as another illustration of the judicial approach. The Judicial Committee said that the action came before Justice McGregor, and he examined the evidence with meticulous care. At one stage of his judgment, he said this:I have heard considerable evidence in the matter, and I must say at the outset that I have never hitherto experienced evidence more impressive and cogent than that of the defendant, establishing that it is, to use a neutral expression, most desirable that fluoride should be added to the water.Later in his judgment, he said:In the present case, I was satisfied, on the evidence, (1) that there is a high incidence of dental caries in New Zealand generally; (2) that there is almost a complete absence, or at least a high deficiency, in the fluoride content of the natural well water supply at Lower Hutt;"—which was the place in question—(3) that the absorption of fluoride has a substantial effect in reducing the incidence of dental caries, especially in young children; (4) that there are no deleterious or toxic effects on the human body from the absorption of fluoride, more emphatically in the minute proportion of one part to a million; (5) that any surplus fluoride taken in the body is without harmful effects and is excreted; and (6)"—a point which I shall deal with later—that tablets or other vehicles for the taking of fluoride are unsatisfactory in that the required regularity with children would not be achieved, and that natural water is the only satisfactory vehicle.My Lords, what are the established facts? The first is that dental decay is a major and a serious national problem. In 1964, 6¼ million permanent teeth of schoolchildren were filled and 1 million were extracted. Now, fluoridation diminishes, reduces, the level of decay by about 50 per cent. It is wrong to suggest that it will not do so in adults who have started taking fluoridation at birth, or during the mother's pregnancy. There is increasing evidence about this; and, if the noble Lord is in any doubt, I can provide him with some. Here, for example, I have a study from one of the places where fluoridation was introduced early in which, at the ages now of 12 to 18, there are 50 per cent. fewer decayed, missing or filled teeth, and 62 per cent. fewer teeth needing attention.
§ LORD DOUGLAS OF BARLOCH
My Lords, would the noble Lord say what this comparison was made with? Fewer than what?
§ LORD COHEN OF BIRKENHEAD
Fewer than occurred in an area which was comparable except in relation to the natural fluoride of its water supply. The comparison was between Aurora and Rockford. Both these places are in Illinois, and the noble Lord may have visited them, as I have. Again, there is the comparatively recent Grand Rapids report which shows that this trend continues. The point is that before 1945, except in those areas of natural fluoridation, there was no attempt to increase the fluoride content of water supply, and so one could not expect that in those areas there would be less decay. It is less use starting after a child has been without it for a year or two years; the beneficial effects may not be seen. What I have said about the seriousness of the position is this. It is not only the discomfort which is given to children: it is the fact that there is the problem of providing sufficient dentists to deal with, this matter—and by the use of fluoridation there would be a saving of not less than 500 whole-time practising dentists.
The second point I would make—and it is of prime importance, because the noble Lord kept referring to medication—is that fluoride is not a drug. It is present naturally in many water supplies; and in some, in far higher quantities than the proposed one part in a million. It is adjusted to a level of one part per million. It does not affect the taste, colour or odour of the water. What it does is to prevent dental decay. And it prevents: it does not cure. Medicinal treatment, medications, tend to cure disease. Fluoridation does not cure. Once decay is established, fluoridated water will not cure it. I agree with the noble Lord that fluoridation is not the only measure that can be adopted. It so happens that it is very important; but there are other measures.
Brushing the teeth after meals (and preferably five minutes after meals), in order not to allow the development of lactic acid from carbohydrate residues, is most important. The eating of some coarse foods, such as apples, carrots, celery, at the end of a meal to remove the debris which is forming around the teeth is also an 112 excellent measure. To deny children sweets between meals is of great importance. But a six-monthly visit to the dentist is also important in order that there might be seen the incipient evidences of dental decay, which can be controlled. But how many parents can enforce such a régime on children? How many parents themselves carry out such a régime? Moreover, there are far too few dentists to supervise this kind of régime on the lines suggested.
The next point that is established is that fluoridation is safe. Unfortunately, there has been serious reaction to emotional and misleading propaganda. In Charlotte, North Carolina, for example, where the local authority announced that it would fluoridate the water supplies on April 1, 1949 (why April 1 was chosen I do not know), there flooded into the town hall during the ensuing week complaints that people were suffering from indigestion, from skin irritation; that cutlery was stained; that photographic plates were blurred; that goldfish were dying; that flowers were fading, and so on. The fact is that the corporation did not fluoridate the supplies on April 1, 1949. They postponed fluoridation, and then introduced it several weeks later without any public announcement—and there were no complaints.
Again, those of us who practise medicine know perfectly well of the fallacies of the post hoc, propter hoc argument. The fact that a person has indigestion after fluoridation does not mean that it is due to fluoridation. There are, alas! thousands upon thousands of people who suffer from indigestion, or who have a skin complain in areas whether the water is not fluoridated. And this is further evidence of post hoc, propter hoc.
I should like to return to two matters raised by the noble Lord: Mongolism and goitre. I shall not deal in detail with goitre, because I have already referred to it. In regard to Mongolism, I myself saw the Rapaport papers and I wrote to Dr. Rapaport (this, I may say, was on June 23, 1964), and asked him whether he would explain certain features of his results which I found somewhat misleading. I received no direct reply from Dr. Rapaport but I had an indirect reply from a friend of mine (who, incidentally, is a critic of fluoridation) who had met him. The letter was marked "Private", 113 but the gist of the matter is that Dr. Rapaport refuses now to discuss his findings with anyone, because he says that he has been subjected to undue criticism.
What the noble Lord did not mention was that Dr. Berry, who is one of the medical officers of Health, published a paper showing that in the areas which Dr. Rapaport was discussing the incidence of Mongolism was far lower than in any area where there had been a proper investigation of Mongolism; and the incidence of Mongolism in this country was, in many areas, at least twice as high as that found by Dr. Rapaport in fluoridated areas. The noble Lord mentioned the county of Essex. The fact is that the difference in the incidence of Mongolism where the supply is from 0.2 to 4 parts per million and in areas with less than 0.25 part per million is such that it is not in fact statistically significant. Dr. Berry's paper is available to anyone, and might be read with considerable profit and interest. If it be true that with 0.3 part per million, goitre appeared in Japan, why is it not appearing all over this country where much of the water has more than 0.3 part per million? Why not in every European country where much of the water has more than 0.3 part per million? The answer, with respect, is that of course if an observation of that kind contradicts all other findings, one must view it with great care and scepticism.
Let me make this further point. There is no practical substitute for fluoridation. I know that the giving of fluoride tablets has been advised; but this means irregularity in their administration. We know how parents behave with measures of this kind. After all, a significant percentage of mothers did not take up many of the food supplements given them during the war: moreover, to have bottles of fluoride in your cupboard means that you run the risk of inducing some toxic effects. Local application of tin fluoride needs dental application and is not as effective; and it costs 300 times as much. Fluoride cannot be conveyed in milk or food. Dentifrices are not very satisfactory, but research goes on: pyridoxine, phytates, molybdenum, zirconium and other substances are being tried; but the conclusion is that there is no practical substitute for fluoridation. It is the only available safe, feasible and 114 economic method of benefiting the public. One must accept that in discussing its ethical aspect.
The noble Lord, Lord Douglas of Bar-loch, mentioned that if fluoride is introduced there will be no practical alternative to consuming fluoridated water for those living in the area. I agree with the noble Lord; I do not think there is an effective substitute. The use of bottles of non-fluoridated water; obtaining supplies of water from neighbouring sources; the use of de-fluoridators—none of these alternatives has yet been established. Dr. Fremlin, Reader in Physics at Birmingham University, has devised something of the kind; but it is not yet practicable. But to use the words "mass medication", or "medical treatment" seems to me wholly inapplicable to this situation. It will not be clarified by copious references to dictionary meanings of drug, nutrient, medicine, prevention and cure. There is, indeed, too great a current tendency to seek to persuade people by describing a situation, which is difficult to comprehend because of its complexity, by some meretricious phrase or label which carries implications that cannot be justified by the facts.
The issue here is not a question of semantics and is not affected by labels. To call fluoridation "mass medication" obscures the issue. The issue is that of deciding whether adjusting the level of the natural content of a natural constituent of water, in the interests of children, who, as a result have better teeth now and when they grow up, is justified, even if a proportion of citizens will derive no immediiate benefit. And remember that it is the children who will be benefited at this stage, and these children cannot themselves take the initiative. They cannot protect their own health and their own teeth. They are dependent on the knowledge, thought and care of their parents; and often it is those children who are most in need who have the least degree of parental care.
It has been said that fluoridation renders water impure. This is the stand of the National Pure Water Association, of which the noble Lord, Lord Douglas of Barloch, is President. But may I refer once again to the judgment of the Lords of the Judicial Committee of the Privy Council, delivered on July 22, 1964, when there were present at the hearing 115 Lord Radcliffe, Lord Morris of Borth-y-Gest, Lord Pearce, Lord Upjohn and Lord Donovan—no mean assessors of evidence. This is what they said in relation to the question of pure water supply:Their Lordships are of opinion that an Act empowering local authorities to supply pure water should receive a fair, large and liberal construction as provided by Section 5, paragraph (j) of the Acts Interpretation Act 1924. They are of opinion that as a matter of common sense there is but little difference for the relative purpose between the adjectives 'pure' and 'wholesome'. The water of Lower Hutt is no doubt pure in its natural state but it is very deficient in one of the natural constituents normally to be found in water in most parts of the world. The addition of fluoride adds no impurity and the water remains not only water but pure water and it becomes a greatly improved and still natural water containing no foreign element. Their Lordships think it right to add that had the natural water of Lower Hutt been found to be impure it would of course have been the duty of the respondent corporation to add such substances are were necessary to remove or neutralise those impurities. But that water having been made pure they can see no reason why fluoride should not be added to water so purified in order to improve the dental health of the inhabitants.My Lords, I do not propose to discuss the general issue of the relationship between individual rights as against the State's rights. This problem has been discussed by theologians, by philosophers and by politicians from the days of ancient Greece. But I would point out that no recognised civil rights or liberties are absolute and unqualified. We all believe in freedom of speech, but that freedom is limited by laws which impose penalties for sedition, blasphemy and obscenity and for criminal libel. The noble Lord said that he doubted the legality of fluoridation. He has had an opportunity of testing it. An action was to have been heard. I believe at Watford, but was withdrawn. But in fact the legality of fluoridation has been tested. I have read two judgments, but there are others. In the United States every single court of last resort which has had occasion to review the question has ruled, after a full hearing of its merits, that fluoridation is legal and a proper exercise of governmental power, and does not constitute an enfringement of individual constitutional rights. And this ruling has been affirmed on many occasions by the Supreme Court of the United States.
116 My Lords, it has been said that this is "the thin end of the wedge". It is the kind of argument which is so often advanced when all other objections have failed, against innovations to improve the public health. It came with the reinforcement of bread. But are we not entitled to assume that if any other measure is proposed it will receive the same careful degree of scrutiny and control as has been given in this case by the Ministry of Health? They suggested the introduction of fluoridation after eleven years of the most careful study, through free discussion of its value. The noble Lord must not confuse freedom of action for freedom of belief. After all, if fluoridation is introduced into any area (I am glad to say that more than 90 local authorities have adopted fluoridation as against 50 who have rejected it) and if it is introduced with the consent of the elected representatives of the people, there will still be no restriction on the noble Lord and his colleagues from ventilating their views against fluoridation and trying to persuade the appropriate authority to alter its decision.
§ VISCOUNT STUART OF FINDHORN
My Lords, would the noble Lord not agree that it depends on the local water supply? In the north of Scotland, where you get more peat, you want more medication, and if you go to Dorset, say, where you get a lot of chalk, you probably will not want any at all.
§ LORD COHEN OF BIRKENHEAD
I am sure, my Lords—I am sorry; I put a sweet in my mouth in order to moisten it—
§ LORD COHEN OF BIRKENHEAD
I should be quite prepared to drink half a tumbler of fluoridated water.
Certainly this has to be decided by the local conditions, and that is why I say it is decided by the elected representatives of the people. But I hope that if the National Pure Water Association and its supporters continue to object to fluoridation, as I have no doubt that they will, they will pay greater regard to the ethics of public controversy and refrain from reckless, inaccurate and misleading statements. They have declared on several occasions that fluoride is a poison. My Lords, "Fluoride is a poison", "Fluoride 117 is not a poison", are, in fact, statements which are neither true nor false, because it depends upon the dose whether fluoride is or is not poisonous, just as it depends on the dose whether aspirin is curative or poisonous. In bitter almonds, my Lords, though you may not have suspected this, and in the almond icing which you all so much enjoy, there is prussic acid, but not in amounts likely to cause toxic effects. Those of you who have been nearly drowned know the toxic effect of common salt in seawater. It is true that sodium fluoride and sodium fluoro silicate, which are added to water for the purpose of fluoridation, are included in the British Poisons List Order of 1962, Part II, Schedule 2. So is hydrochloric acid, and I trust that all of us who are healthy have not less that .02 to .04 per cent. of hydrochloric acid in our stomach juices.
§ LORD COHEN OF BIRKENHEAD
I suppose that that has only been in the last few years. To say that fluoride is a poison is a meaningless phrase, which is designed to produce an emotive response. To put through the letterboxes in and around London a card saying that it is proposed to put a poisonous substance in the water supply, so worded and designed that the Metropolitan Water Board had to make an announcement saying that it was not from them, seems to me to go beyond the normal ethics of public controversy.
The noble Lord, Lord Douglas of Barloch, said that Manchester had refused fluoridation. In fact, it did. The Chairman of the City's health committee, Alderman W. O'Nions, in defending this recommendation, said that President Kennedy—this was in August, 1963—did not drink water with fluoride in it although fluoride was contained in the Washington water supply; the President and Members of the Senate had a supply from private sources. That was absolutely untrue. When that appeared I 118 wrote to my friend the Surgeon-General of the United States and asked him whether any change had been made in the President's drinking habits, and he said, "No." He wrote that the President had made a statement only two or three months before saying:I urge parents, dentists and health organisations to renew their efforts to improve the dental health of the nation's children by stressing the value of dental education and advocating such preventive measures as the fluoridation of public water supplies. Such contributions will mean stronger, healthier children and eventually a healthier America.And Dr. Janet Travell, the personal physician of the President, said that the President and his family drank the water provided by the District of Columbia. That your Lordships may think is a curious type of controversy.
A month or so ago in The Times there appeared a letter stating that the Pasteur Institute was against the fluoridation of water supplies. I wrote immediately to the writer of the letter saying that this was untrue and would she please acknowledge that it was untrue. She sent me a personal letter saying that she had made a mistake, but there was never a public withdrawal. Again, it was said that in this Ministry pamphlet, which has been referred to so much, the Minister had said that we should not boil water because it might so concentrate fluoride that it would have poisonous effects, and we should not drink water in which vegetables had been boiled if the water supply had been fluoridated. That is a complete fabrication, which was denied by the public relations officer of the Ministry.
Then there is the worst form of criticism, which implies ulterior motives—that the fluoridation programme has been established in order that the waste product of a particular industry might find some use. It has been alleged (I have a letter here, though I will not read it, from a Mr. Bridges) that the price of fluoride has increased tenfold since fluoridation was introduced. That, too is untrue. The price has increased by 5 per cent., due to increased labour charges.
But of these statements, perhaps the most outrageous is one which is on one side of a leaflet on which is a reprint of a letter from the noble Lord, Lord Douglas of Barloch, to the Daily Telegraph. I do not hold the noble Lord 119 responsible for that, but on the other side of the leaflet it says:Red scheme for mass control".
§ LORD DOUGLAS OF BARLOCH
My Lords, will the noble Lord allow me to interrupt? I did not authorise its publication, and when it came to my notice I wrote to the people who had put it out and objected to it most vigorously.
§ LORD COHEN OF BIRKENHEAD
My Lords, I did say that I did not think that the noble Lord had allowed his letter to be published on the back of this document. However, it says thatFluoridation is a very definite method of ultimately reducing the individual's power to resist domination by slowly poisoning and narcotising an area of brain tissue which will make him submissive to those who wish to govern him".I can only say that this is not a Party political issue, and that no Party can expect to derive any particular form of benefit from this form of medication. Indeed, it was during the former Administration's period of office that fluoridation was advised, and it was as keenly supported by the present Minister when he was in Opposition, as he does now as Minister. This is no nefarious or subtle plot. It is a measure designed to improve the health of the people which, as Disraeli observed, is the chief foundation of our power and happiness as a State, and it is supported by bodies whose integrity and authority are overwhelming.
It is perhaps a revealing comment on some of the criticism of fluoridation that a Mrs. Sykes, in the Rotherham Advertiser of November 2, 1953, wrote:Fluoridation is not a public health measure but a stunt for extending the power of public officials.In nearl, half a century of the study and practice of medicine, I have witnessed the same opposition, usually from the same quarters, to innovations designed to improve the health of the people. The pasteurisation of milk was opposed. The incidence of surgical tuberculosis is now 7½ per cent. of the incidence 25 years ago. Diphtheria immunisation was opposed less than a quarter of a century ago. It was introduced in 1942. In the decade before 1942 there was an average annual incidence of 55,000 cases of diphtheria, involving 2,783 deaths. Until a death early this year, for two years there have 120 been no deaths from diphtheria in this country and but a handful of cases. In 1957, when I chaired the committee which advised reintroduction of polio vaccination, against great public opposition from certain quarters, there were 5,000 cases of polio, with 200 deaths and many hundreds of gravely crippled patients. In 1965, there were two deaths. I cannot give the exact figure of cases at the moment because it has not yet been finally ascertained, but there were certainly not more than twenty or thirty.
In all these cases, the objections were overcome and hundreds of lives have been saved and made happier, fuller and more productive, because of these beneficial measures. I am confident that intelligent people will not allow the most authoritative and informed professional advice to be nullified by unfounded assertions and emotional pleas.
§ 5.0 p.m.
My Lords, my noble friend Lord Cohen of Birkenhead has almost completely disposed of my noble friend Lord Douglas of Barloch. He has not quite done so—he was too kind. My noble friend Lord Douglas of Barloch, whom we all admire and like very much, did not hesitate to impute motives to the officers and advisers of the Ministry of Health and to many medical scientists throughout the world.
Let us see what my noble friend did say. I made notes of some of the things he said. He said that fluoridation was a form of or parallel to an international war cry. He said that it was supported by dubious statistics, suggesting, presumably, that they are "cooked". They are not "cooked". Indeed, if there is any evidence of "cooking", I think it is the other way. "Concealment of relevant facts" was another phrase that he used. There has been no concealment of relevant facts, save by the advocates of anti-fluoridation. "Completely unscientific; inaccurate and misleading statements", were other phrases he used. But the most awful statement he made was that fluoridation "might cause congenital deformity". That is a most irresponsible thing to say.
121 Then he said it "might cause mongolism". My noble friend Lord Cohen of Birkenhead has dealt with the case advanced that fluoridation causes mongolism; and it is, of course, nonsense. Equally, to suggest that fluoridation causes congenital deformity is rubbish. We were told that "up to 10 per cent. will suffer from chronic fluoride poisoning". This is all nonsense.
The tragic thing about it is that my noble friend does not confine his nonsense to us here in your Lordships' House, who have the benefit of my noble friend Lord Cohen of Birkenhead to put us right. This sort of thing is sent out to all local councillors whenever the subject is raised. They receive a pamphlet from the so-called National Pure Water Association, which again, as my noble friend Lord Cohen of Birkenhead has shown, is a fabric of misrepresentations arid, I would say, falsehoods. It is hard on the councillors. I feel that this is a most unfair and very had form of propaganda. And it is hard on the children who get the dental caries.
What does my noble friend suppose that we who advocate fluoridation think about it? I do not particularly advocate fluoridation: I take the evidence such as it is; and, on that evidence, it is common sense that this is the right thing to do. This is not a sort of great plot to enforce fluoridation on people. It is highly desirable, if dental caries can be prevented, that it should be prevented. But we have to counter all this propaganda. Every time the matter comes up before the unfortunate councillors, who are by no means necessarily so skilled in assessing highly technical evidence, and certainly have not the benefit of the speech of my noble friend Lord Cohen of Birkenhead, it makes it very hard indeed for them. There is a very good letter in the Lancet this week from a medical councillor describing what happens. I will not read it, but it is a clear statement of the way in which the National Pure Water Association gets at the councillors and confuses them, with the result that the children's teeth suffer. I do not propose to say anything more. I think my noble friend Lord Cohen of Birkenhead has completed the job, and the less we hear in the future on the subject of anti-fluoridation, the better.
§ 5.4 p.m.
§ LORD AMULREE
My Lords, when I first saw this Motion on the Order Paper in the name of the noble Lord, Lord Douglas of Barloch, I thought that we might be able to have an interesting and constructive debate, going round the subject and approaching it from various points of view. I am bound to say that I was rather shocked at the way in which he put forward his case. I do not say that I associate myself entirely with what the noble Lords, Lord Cohen of Birkenhead and Lord Taylor, have said, but I cannot agree with the way in which the noble Lord, Lord Douglas of Barloch, put his case.
I have risen to my feet to make two short points, and in respect of one I must declare some interest, because in 1955–56 the Ministry of Health in England decided to carry out a controlled experiment in six areas. They were going to take three areas where the water did not contain a great deal of fluorine, and the results were to be contrasted with areas where the fluorine content of the water was to be put up. One of the areas chosen was supplied by water from a company of which I have the honour to be one of the directors, and naturally I was interested. Hard water which comes from chalk, from an uncontaminated source, has to be treated by Act of Parliament to make it soft, and before it goes into distribution we give it a certain amount of chlorine as a final disinfectant. But the content of fluorine is very low, about 0.1 parts per million, which is almost as good as saying none at all. The results on children up to six or seven were to be contrasted with those in a corresponding town where the fluorine content had been pumped up to about 0.9 parts per million.
The other four areas involved happen to be in Wales, and there, when the result came out, it showed what one expected from the large amount of statistical evidence, which I agree had come mainly from America: that in the areas where fluorine content was high the amount of dental caries was considerably lower than it was in the areas where the fluorine content was low. The rather curious thing about it was that it was not entirely parallel with the results that came from the area in which I am interested and the one which was 123 chosen against it. There the effects were far more equivocal. One did not get a really clear picture about whether children do not get less dental caries or about the proportion who are free from dental caries. What we did find was that the number of children who had ten or more teeth affected by dental caries fell considerably in the part of the world where the fluorine content was increased. So that, although it was not completely conclusive, the tendency was the same, though not so well marked. This was a good-class residential area (I think my noble friend Lord Cohen of Birkenhead referred to this) where parents take good care of their children—probably considerably better care than in some of the more country parts. It seems that other factors come in as well as the fluorine content of the water
The second point I wish to raise comes from some kind of sympathy with the people whom the noble Lord, Lord Douglas of Barloch, represents. Supposing there happens to be a certain proportion of the population who object—whether conscientiously, or not, I do not know—to their water being treated in some way to improve their health. That again is a very curious thing. These people who object to things being put in the water to improve their health do not object to drugs and chemicals being added to make the water potable. They are happy that water should be treated to make it wholesome, but they are not prepared to accept water being treated if it is done as a preventive measure
Another way occurred to me in which fluoride could be given, I would not say universally, but in order that mothers could use it for their children. I would refer to what has occurred with regard to some Alpine waters which you meet with in the middle of Europe. Recently there was a large amount of vaud-goitre due to the fact that there was not sufficient iodine in the waters coming from the mountains. There was a big educational compaign in that part of the world to make people take salt which was treated with iodine—iodised salt. That campaign was fairly successful, and I should like to quote to your Lordships one or two figures. In one of the Cantons of Switzerland, the incidence of goitre among the adult population was 77 per cent. in 1924, and it fell to 21 per cent. 124 in 1937 after the campaign for iodised salt. In two other Cantons, where young recruits going into the Army were examined, the incidence of goitre fell in one Canton from 7 per cent. to 0.1 per cent., and in the other from 4 per cent. to 0.5 per cent. In the town of Lausanne, where schoolchildren were tested, the amount of goitre fell from 57 per cent. in 1924, to 1 per cent. in 1937.
I do not pretend to be a chemist, and I do not pretend to know much about the pharmaceutical industry, but I am told by those who do that it would be possible to prepare a form of fluorised salt as one prepares iodised salt. I wonder whether it might be a way round the difficulty, if the numbers of people who object to fluoride in their drinking water is very large, if some kind of educational campaign were carried out among mothers; because, after all, the important time to get the fluorine is between the ages of 2 and 7, or 2 and 10. If that could be done, I wonder whether we should get a certain result coming from it? I agree that we should not get as big a result, because there would be some people who would not take advantage of this. But I wonder whether it would not be worth while thinking about that—not because I sympathise with the people who object to it, although I can see that they have a point of view, but if one wants to carry out a big reform one wants to carry it with willing support rather than against hostility
I think those are the only two points I want to make. I should like to repeat what has already been said; that is, that there is no evidence at all that giving fluoride up to 1 part per million can cause any danger to health at all. Such danger has never been shown and I think it is not true when people say that a poison is being put in their water. I admit that if an enormous amount of fluoride were added to water it would be a poison, in the same way as an enormous amount of chlorine in the water would be poisonous. If you put an enormous amount of lime in the water to soften it, that would be a poison. Any thing can be made a poison. but we are talking about bringing it in in a perfectly safe therapeutic dose, and I can see no reason to say that any harm can occur 125 by water being treated with the amount of fluorine which is proposed.
§ 5.15 p.m.
§ BARONESS SUMMERSKILL
My Lords, although I fully understand how strongly my noble friend feels and, indeed, realise how strongly he expressed himself just now on the statements made by my noble friend Lord Douglas of Barloch—statements so sweeping in character, so dogmatic, and, indeed, statements which outside this House could be slanderous—nevertheless. I confess that I listened to my noble friend Lord Douglas of Barloch more in sorrow than in anger. We have listened to him time after time condemning colouring substances and preservatives which are used in food, which have not been adequately tested, and many of us have supported him. We have listened to him on the case of Rachel Carson's book on pesticides, and we have recognised that many of these fertilisers and pesticides are lethal. Again, very often we have supported him. But I find it difficult to understand why, having studied these matters so carefully, he has not realised that there are exceptions to all these rules. Surely he does not, for instance, suggest that D.D.T., which is used to eradicate malaria, is lethal—or does he?
Then again, having read my noble friend's Motion, it looks to me as though he condemns all preventive medicine, because in his Motion he is dealing not only with fluoride but with all mass medication. The whole field of immunisation can be regarded as preventive medicine. According to the Motion before the House to-day, the noble Lord does not simply condemn fluorides; he condemns preventive medicine as practised in the field of immunisation.
§ BARONESS SUMMERSKILL
I am glad that he withdraws mass medication, because if he reads his Motion he will see that any doctor would interpret it in that way.
I would ask him whether he thinks that nature is infallible; that man-made drugs and substances can make no contribution to improving upon nature. When I mentioned D.D.T. I recalled that in the Press this week it was said that in Jamaica and Trinidad malaria has been eradicated 126 with D.D.T. and the anti-malarial drugs. I think that man is evolving and proving himself capable of outwitting nature. The case before us to-day leads us to believe that this is so, and if we believe it then we must inevitably accept the expert opinion.
I am the fourth doctor who has spoken in this debate, and none of us pretends to be an expert on fluoridation. But why do we support it? We support it because we are capable of assessing the value of the expert opinion which has been expressed, precisely in the same way as the judges who have been mentioned. The noble Viscount, Lord Stuart of Findhorn, asked my noble friend Lord Cohen of Birkenhead whether the judge he quoted was an expert in the matter. No, but judges are put where they are because they have a training and possess a wisdom and a common sense which makes it possible for them to assess evidence which comes before them. The reason why the four doctors in this debate are unanimous on this issue is that we are able to assess the evidence. We know the kind of people who are at the Ministry of Health: and, after all, they have been talking about this matter and discussing it for the last eleven years. We know they are men of integrity, and we know they have no interests in making money in fluoride.
The latest pamphlet which has been sent to us only this afternoon—one to my noble friend and one to me—has on the front a picture of a man with a dollar sign on his hat, and it suggests that he is making money out of fluoride. I presume the corollary of that is that we here are supporting fluoridation because perhaps my noble friend and I are making 5 per cent. on the side. This kind of suggestion is absolutely fantastic. It underestimates our intelligence, besides insulting it; and I would ask my noble friend, in his own interests, to stop this really scurrilous form of propaganda. It does not help; it only condenms him and his friends.
My noble friend Lord Cohen of Birkenhead has mentioned pasteurisation. I was going to make that point, and if there are noble Lords here who are still unsure whether the experts should, on the whole, be supported or rejected, I would remind them that for fifty years in this country experts, doctors and all kinds of people warned the country that milk could be 127 dangerous; that it could cause gastrointestinal complaints; that thick, creamy milk, looking delicious, straight from the cow, particularly from the West Country, could be alive with tubercle bacilli and could cause bovine tuberculosis, with the result that little children got meningitis, the glands in the neck were affected, there were joint infections, and such children spent their lives in some orthopædic hospital.
The debates went on, here and in another place, for years, and I am sure that many noble Lords present who were in another place will remember that the noble Viscount, Lord Dunrossil, who was formerly the Speaker of another place and before that Minister of Agriculture, sought to introduce a Bill which embodied in it a proposal to pasteurise all the milk of the country. That was in 1938. Within a few days of the production of that Bill the Minister of Agriculture had to resign, and the President of the National Farmers' Union took his place. The kind of prejudice that we have heard to-day, the antagonism to reform in this field, was so great that it was very difficult to clean the milk supply of the country.
I had the great satisfaction of introducing the Clean Milk Bill in 1947. What has been the result? From 1947 to 1966 the great orthopædic hospitals which housed these pitiful children lying in plaster have had beds to spare, and we are wondering what to do with them. The change has been so dramatic that it is difficult even for doctors to believe that such a thing could happen. For years we heard speeches of the kind that we have heard this afternoon, condemning those who wanted to clean the milk as cranks; as ignorant. We were told, precisely as we have been told this afternoon, that if we tampered with the milk of the country the ailments from which the people of the country would suffer would be numberless. They sat in another place and listened, as no doubt they did in your Lordships' House, with the result that decades passed before the House could get that legislation through. But now it has been proved beyond doubt that the Ministry of Health in those days was absolutely right. All those reports we had coming from the Ministry of Health, all the deputations, all the investigations, 128 have been proved to be valid, and I ask you this afternoon, my Lords, again to recognise that history is repeating itself: The experts are saying to you that, after careful investigations of all kinds, they believe that this is the right policy.
I would remind you, too, that the United States of America have been doing this for eleven years. Are they behind us, so far as the organisation of their food and drugs bodies is concerned? Not at all. Let me remind your Lordships that when the thalidomide scandal came to Europe, America was saved. No deformed baby was born in America as a result of the use of this drug, because their food and drugs organisation was so strong that it refused to allow thalidomide to be distributed. Would these same people have allowed fluoride to be added to their water without an outcry? As those of your Lordships who have visited America will know, they are all very health-conscious, and they have had fluoride added to their water for eleven years. All we are asking now is that we should do precisely the same in this country.
I would say one thing to my noble friend, Lord Douglas of Barloch. He was warning the House about what would happen if fluoride was added, as though it were something fresh to be added to water. But I would ask: does he realise that he has consumed fluoride to-day? It is in our normal diet. On the many occasions that we have chatted together at teatime, he has been drinking fluoride, because tea contains, in proportion to its weight, more fluoride than any other commodity. I know that he has refused to have milk in his tea, because he has said to me that it was probably pasteurised; but apparently he has not realised that he has taken fluoride in his tea. I say this to prove that one cannot make these dogmatic statements, dismissing the people who have devoted the whole of their lives to the subject, and say, "Well, after reading a few pamphlets I am an expert."
Therefore, my Lords, I ask you to-day to be guided by the men and women in this country, in Europe and in the United States of America who have knoweldge of this subject, and particularly by that powerful speech given by my noble friend Lord Cohen of Birkenhead, and to support the fluoridation of water supplies.
§ LORD COHEN OF BIRKENHEAD
My Lords, may I make one point? I think the noble Baroness said that in the United States of America fluoride has been added to the water for eleven years. It is in fact twenty-one years since it was first instituted.
§ BARONESS SUMMERSKILL
I am sorry if I was in error. But it is better to make an under-statement than an overstatement.
§ LORD COHEN OF BIRKENHEAD
My Lords, I quite agree, and I hope that the noble Baroness will remember that in future.
§ 5.28 p.m.
My Lords, I feel rather a David among many Goliaths in intervening in this debate. We have heard to-day some eminent doctors. I, for one, am not likely to wish to disagree lightly with the noble Lord, Lord Cohen of Birkenhead, to whom I do not say dramatically that I owe my life, but I certainly owe my health to him. Therefore I do rot want to disagree with anybody. I want to try to lower a little the passions that have been raised in this debate. I must first of all perhaps declare an interest—it is fashionable to do that in your Lordships' House nowadays. My interest is that for some thirty years I have been connected with the water industry in one way or another and for many years I have been a director of one of the biggest statutory water companies. Also for many years I have served on the water supplies committee of a county council, and I have always been tremendously interested in this subject. However, I am not speaking on a waterworks brief today, and anything I say is purely a personal view and a personal request for information.
I think it is fair to say, if I give my personal view of what I think the opinion of the water industry is, that we are benevolently neutral to this fluoridation of the public supplies of water. We think we can do the job if we are asked to do it. If the public want it and the public health authorities say we should and it is required by the Government, we think we have the technical skills. I would say at once that there is no particular reason why we should want to do it; there is no money in it for the water 130 companies, and there would be difficulties in doing it. It would be easy for the big companies with a big central source, but it would be more difficult for small companies with a large number of individual sources. Birmingham which has, I understand, already agreed to fluoridation, has perhaps rather an easier job than some to deal with it. The cost, I understand, will not be very great.
A point that some people feel ought to be considered is that the amount of water which is actually drunk, and not used for industrial purposes or simply going down the drain, is a very small proportion of the gallonage. I do not know what the proportion is in my own company. We supply something like 55 million gallons a day. I do not know what proportion is drunk or what proportion of that drinking portion is drunk by children or pregnant women; it must be very small indeed. And yet we have to fluoride all the water. But let that pass.
I want to speak for a moment on another point. In passing, I must say that I feel that there is a little more in the principle of objection to mass medication. I know it has been argued that this is not mass medication; that fluoride is an additive. But, be that as it may, there is a constant temptation by the experts and the scientists and our rulers to know best and to be—shall we say?—at best paternalistic and at worst resolved to try to compel us to be good. I am not at all sure that is always desirable, and it is not always—in fact, it is very seldom—possible. We must beware of this desire to do good in this way unless we are very very sure of ourselves.
We could, for instance, most sincerely go a long way on this particular subject. Most of us, I think, know that alcoholism is a very great evil and causes dreadful damage and loss and expense to the community. No doubt it would be possible to put into the public water supply some harmless chemical that would not produce mongol babies but would make people sick when they had a glass of beer. I do not believe you would be justified in doing it. The same thing, of course, could be done with cigarette smoking: something could be added to the food which would make people not wish to smoke cigarettes. I do not believe you should do it. Where would you stop? 131 You could add some form of tranquilliser to make people more patient on the motor ways and not overtake and not be bad tempered. It would save a lot of money and save much time in the law courts. But it is not quite what we ought to do.
This, perhaps, is the justification for the noble Lord, Lord Douglas of Bar-loch, using in his Motion the words that we must "draw attention to the question of mass medication". This is not in any way, surely, in the words written here, opposing diphtheria immunisation or the pasteurisation of milk, which the noble Baroness, Lady Summerskill, was talking about. I should hate to be associated with any such propaganda. I myself, long before I had a seat in your Lordships' House, was a member of a public health committee of a county council, and proud to work with the medical officer of health there, Dr. Savage, who was, I think, one of the first in this country—it was in the early 'thirties—to introduce diphtheria immunisation. And how hard we had to work to get it introduced! But there is a difference here from that kind of thing. It is extremely difficult for the layman to argue against the expert, and the only question I want to raise this afternoon is: are we quite sure that here, in this fluoridation of public water supplies, there is an acceptable risk, or, indeed, that there is no risk at all? Because I doubt whether we ought to embark on this unavoidable medication, or compulsory additive to the water supplies, even if the great majority of expert opinion is at this moment satisfied that it is making an improvement to our teeth, as long as there is any reasonable shadow of doubt. It is because of the very nature of the case that it is unavoidable.
There has long been conscientious objection to vaccination—or there was; I do not know whether it still exists—and many of us, as magistrates, had tussles with our consciences when we had to sign certificates for lazy or superstitious people, saying that they conscientiously objected to vaccination. But we had to do it. If you go to a lot of trouble you can find and buy whole-meal bread, if you feel you ought to eat it. If you go to a lot of trouble you can buy unpasteurised milk, if you think you prefer to take these risks.
I do not know whether you can buy it but you can certainly drink it, because I do in my own household—not because I object to pasteurised milk, but I happen to be a cheesemaker, and all our own milk is used in our dairy and it is not pasteurised.
§ BARONESS SUMMERSKILL
The milk I was talking about was the milk which came from cows which were unattested in the old days.
One of my own daughters and one of my domestic servants suffered from bovine surgical tuberculosis of a most disagreeable character from drinking milk from tubercular cows, which I bought in good faith as tuberculin-tested cows. That was many years ago. But the point I was making was that the difference here, in the mass additive to a public water supply, was that, for better or for worse, there was no practical alternative for most people if they conscientiously objected to the addition. Except for a very few people living in the country who might have their own well, it would not be possible. Therefore, all I say on that point is that we must be quite clear that there are no risks, and we must not chance our arm at all.
This is where it becomes difficult for a layman to speak, having heard the noble Lord, Lord Cohen of Birkenhead, in his most powerful speech. I hope he will not think, and the noble and learned Lord who sits on the Woolsack will not think, I make a joke in bad taste if I say that I remember a book that was written about the ghost at Borley Rectory. I happen to know quite a lot about it because my family, or my ancestors, were involved in it. An edition of that book had a preface, I believe by a learned Judge, or at least a learned King's Counsel, who said that the evidence of whoever had written the book was so good that he had hanged a man on—it or words to that effect. 133 We know how unfortunate that remark was, because before the man who wrote that book died, he admitted that he had fabricated it all. So even the most skilled people in weighing evidence can make mistakes; we are human.
I do not want to labour that point. The experts have made mistakes in the past. I should have thought that, taking away all the prejudice, taking away all the pure propaganda—because there is a great deal of pure propaganda in much of the literature from the Pure Water Association (or whatever it is called; and I am not a member of that Association)—there still remains an element of sincere and knowledgeable doubt. The noble Lord opposite shakes his head, but I, as an absolute layman, as a member of the public with no scientific knowledge at all, am entitled to say that the impression I get is that there is a slight element of doubt.
The noble Lord says "Sincere, but not knowledgeable". We have had a certain amount of logic chopping and interruption this afternoon. I did not want to engage in this, but I think I shall have to.
The noble Lord, Lord Newton, interrupted the noble Lord, Lord Douglas of Barloch, when there was a discussion on Mongolism, a subject on which I do not know anything. The evidence the public have is contained in two documents. I asked the noble Lord what evidence he was quoting on another subject, and he said it was not a published document that was available to the public. But these two documents are available to members of the public. One of them is a public health leaflet, No. 105, and there is a Ministry of Health leaflet on fluoridation. It is so short that I must quote it. I thought that my noble friend Lord Newton was a little unfair, to the noble Lord, Lord Douglas of Barloch, on this point.
On page 43 of the Ministry of Health document there is a short paragraph on Mongolism which says this:Rapaport (1956 and 1959) reported that in towns and cities in four American States there was a positive relationship between the proportion of Mongol births and the fluoride content of the water supply. Berry (1958), who investigated the incidence of 134 Mongol births in South Shields, West Hartlepool, the high fluoride part of Slough and suitably matched low-fluoride areas, obtained no confirmation of Rapaport's findings.One man says it was, and the other man says it was not. The Ministry of Health pamphlet says that a careful investigation has shown that there is no basis whatever for any suggestion that there is a connection between fluoride in the water and the number of births of Mongol children. These are the only two pamphlets that I, or ordinary members of the public, have on this subject. Noble Lords can draw their own conclusions as to whether we think that is a fully argued case. I would have suggested, from what I have heard and seen and read about this matter, that if one were a Scottish lawyer one might be glad temporarily to be able to say "Not proven". I am not sure. I wonder. I hope that the Minister will be able to help a good deal when he comes to reply.
At the great age that I have now attained, and with such a vast number of grandchildren, one is always accused of being hopelessly reactionary and conservative. Also, one's mind does not work so fast as it did; one cannot pick up all these new ideas, and it is getting more and more difficult to keep pace with the experts. Of course we must take risks. But are we, perhaps, on occasion nowadays, being just a little too precipitate? Do we sometimes go too fast, and is it wrong to say that? The technologists get urged on by the economists—an unholy combination of people, neither of whom one can ever understand. They are saying that it pays, and also that it is scientific. There we are.
Then we had thalidomide. There were some rather red faces about agene in bread. The scientist tells us: "You really must take it from me that it is all right. I am a scientist; I know." Then of course somebody found that a dog went mad when it ate biscuits which contained agene. It was thought that a man might go mad, and had we not better withdraw it? So it was withdrawn. It is extremely difficult for us, as laymen, not to remember these cases which happen from time to time. How can we as laymen know whether it was wise of all these factories to connect themselves so 135 precipitately to this new-fangled gas produced by this new-fangled process in the West Midlands region before they knew whether or not the machinery would work? Now, apparently, everybody who is responsible for making these machines says, "Oh, but you must have realised that these were new and untried, and of course we must have our teething troubles. Goodness, what do you expect?". What do we expect?
Of course we want, for instance, to have long link rails on the Western Region of the railways, on which I travel, and on which I hope to travel this evening, if I do not speak for too long. We were told when we were children that if very long links of rail were put down they would expand in hot weather and contract in cold, and so we had to have short links, because otherwise the trains would run off the rails. It is said, "This is nonsense. You are not up to date in your science". And now they have put long links down by Didcot and the trains run off at the rate of about 19 a month—or so it seems to those of us who travel on this railway. Then the diesel locomotives came in, and it was said, "You do not want to go about with coal-fired locomotives any more, do you? You might as well go back to the horse and carriage and have done with it, if that is your view." All right; but do not let these experts force these things upon us before they are ready to be used. Half the time now the diesel engines are broken down, and the steam arrangement which is supposed to heat the carriages in cold weather does not do so.
Travellers in aeroplanes are proverbially anxious to get as quickly as they can from point A to point B. They also strongly object to being taken in nosedives towards the airports. They like to be taken down gently. But are we quite wise to work out a flight plan which takes you only two thousand feet above the summit of Mont Blanc in a snowstorm in mid-winter, as a result of which over 100 people die? Their relatives probably think that is not quite wise. So there is always this: that you can go too fast. You have to stand up against the experts, and if you are going to carry on sensibly you have simply got to make them prove these things without any shadow of doubt to a lay mind, before 136 you accept some new-fangled arrangements.
I come to the two points that I want to raise. I hope I shall not be considered critical of the engineers or technicians in the industry to which I am proud to belong, the water industry, if I ask one or two questions which I hope that the Minister may be able to answer when he comes to reply. One part per million of the substance, that is to say the free fluoride ion, is the optimum dose we should have in water. I think that it is added to the water as rather more like two or three parts per million of sodium silico fluoride. This stuff obviously dissolves, but to my mind one part per million is long odds, when two, three, four, five or six parts per million is considered too much. I suppose we are now absolutely certain that this stuff is going to permeate or diffuse (or whatever is the correct scientific term) equally throughout the million gallons of water. Is it going to come to the top, or go to the bottom, or stick to the pipes at the side? Will it have any chemical reaction, with some other chemical or some other impurity which may be in the water? I certainly do not know the answer to these questions. We certainly have not been told about these things because the process is still in its comparatively early days. Do we really know about this, or have we, as is so often said in these pamphlets, no evidence to the contrary?
§ LORD COHEN OF BIRKENHEAD
My Lords, may I interrupt for one moment? This is quite untrue. The Government Assistant Chemist, Dr. Longwell, published a paper in 1957 which showed, from the taking of samples at regular intervals from fluoridated water supplies, no significant difference in consecutive samples taken over a long interval of time. So that there is no doubt that fluoridation cannot give rise to such excess that it would give rise to toxic symptoms.
I thank the noble Lord very much, but that does not quite answer the point I am making. If I may develop the point, from my slight contacts with scientists I thought that what they were pretty clear about was their lack of knowledge concerning what I believe is called Brownian motion, as to how substances disperse or diffuse. Do 137 we know exactly how this chemical is going to diffuse through the supply? I know of cases in which there are doubts. It would be interesting if the Minister when he comes to reply would let us know whether, for instance, in Birmingham or in any of the other big cities with fluoridated supplies they have had, or are having, any difficulty in getting this chemical to dissolve satisfactorily in bulk. I am not trying to spread alarm and despondency, but I think that perhaps alarm and despondency have been raised by excessive propaganda.
Mine are intended to be sober questions which can be simply answered, if the answers are known. Perhaps the Minister can assure us that there is thoroughly satisfactory testing apparatus available which will test and record the amounts of fluoride actually present in the supply. This may be perfectly possible to do in an analyst's laboratory, but I think that the public want to be assured that the ordinary hobnail-booted assistant at a waterworks has a machine which can do this accurately in the field, as we say. Most of us have had experience of some chlorination plants which go wrong. If one puts too much chlorine in the water one knows it at once, and the complaints come flooding in. Nobody can make tea because it smells horribly. I am told that fluoride is tasteless and is not easily detected. It may be easy to do these things in practice, but I want to be assured that in fact it is.
I have heard it said that some of the apparatus is in its early days. I received a letter written in 1964 in regard to an area where there was a fluoridation of supply, which said that there had been considerable difficulty in getting the substance to dissolve satisfactorily. Apparently, the chemical in suspension was passing onward from the solution tank, the design of which had already had to receive one alteration. Therefore, we want assurance on these points. I have doubts about the mechanics of it. It has been said that one part per million is not dangerous, which I accept. It has been said that that amount is good for us, which I also accept. But we want to be absolutely sure that we are not, because of some human error, going to get 40 parts per million, which might be bad for us. We need to be assured of this, 138 by quite positive proof, before we impose this process on people who conscientiously object to it.
There is another area in which I am interested personally, and upon which I shall touch briefly. My wife is at this moment in correspondence with the Minister of Health about this matter. He is being most helpful, courteous and thorough in his inquiries and in the correspondence which is ensuing, and therefore I hesitate to bring up the matter at all. But I happen to have had a grandchild who was born in Kenya where there is an excessive amount of fluoride in many of the boreholes. My grandchild's deciduous teeth were practically non-existent, and all had to be removed. The next batch of teeth are now erupting, there is considerable difficulty and it is turning into a long medical case.
The dentists in Nairobi had no doubt that this was clue to there being too much fluoride in the water. They said, "We get this a good deal in borehole water. It affects Europeans rather more, as they are not used to it. We are always running across it. Bad luck!" It is a little worrying when the Minister's reply, so far, is in these terms:I am advised that it is doubtful whether the dentist in Nairobi was fully justified in his conclusion that the dental condition was due to fluoride.He may be right, but we are going on with this inquiry. The point is that he is not quite sure; there is an area of doubt. He then ends up with an argument (it may have been written for him, it may have been written by himself—I do not know) which does not help the layman who is fighting an uphill battle against the experts:I can assure you that if I and my predecessors did not believe that our experts were the best in the world, we would not be doing it at all.I know that the Minister is an honest man. But there it is. First of all, he says that perhaps it was not due to the fluoride. We say that perhaps it was, and that we are trying to find out from the Nairobi dentists. The next thing he says is that there would not be all that much fluoride, and nobody is going to add the amount that was contained in the Nairobi borehole. But we, the public, must know what elements of risk 139 there are if there are any risks. I am prepared to be reassured: it is a matter of a balance of judgment. The principle which I think we must adopt on this question of risk-taking is this: if you are going to take a risk which affects you yourself, you are entitled to take a very high degree of risk, but if you are going to impose a risk on others, it must be so small as to be almost imperceptible. This principle has not always been adopted by those in authority.
I am not quite happy about what I think is called creta præparata in bread. I am not quite happy about all the food additives which are allowed, although they are generally all right. But as a completely non-scientific layman I would say to those advocates of the fluoridation of public water supplies at this moment, and with the greatest respect, obviously, for the sincerity and knowledge of the great authorities such as the noble Lord, Lord Cohen of Birkenhead, who has spoken so eloquently this afternoon, that there seem to me to be rather too many sincere and knowledgeable people who at this moment are against this step. I am afraid that it will be necessary to wait a bit. Incidentally, that is what my own county council has said; and it is also what the City of Bristol, which is supplied by my waterworks company, has said. I believe that this attitude of "Let us first hear a little bit more about it" is perhaps the attitude of the general public at this moment: and, as so often, perhaps the general public are right.
§ 6.2 p.m.
My Lords, I do not wish to detain your Lordships for very long at this late hour, and I am exceedingly grateful for being allowed to butt in like this. I live in Kilmarnock and many of us there were proud indeed when the local authority was among the first in the country to accept fluoridation. The results exceeded all that we could have hoped, as will be seen from the figures in the report. A few years ago, in fact from the time since the fluoridation was introduced, a constant campaign was carried on against it, with the sort of arguments which we have heard from the Floor of this House to-day. Unfortunately, to the regret of many mothers of young children, and (I think I am right in 140 saying) of the whole of the medical profession, that decision was overturned, to the great disadvantage of the children who are growing up in the area to-day.
Perhaps I may be allowed to digress for a short time, on behalf of my fellow dairy farmers, to refer to the strictures by the noble Baroness, Lady Summerskill, on their backwardness. I am sorry to have to say this in her absence, and I hope that she will excuse me. At the time of which the noble Lady was speaking the techniques of pasteurising were exceedingly elementary, and much milk sold as pasteurised from very unhygienic quarters and produced by very unhygienic means was finding a ready market, when in fact the pasteurisation was completely ineffective. All that had been done was to destroy the lactic bacteria which would normally have given notice, by smell and taste, of the ineffective methods which had been used to make it, so-called, safe. I am very proud of the fact that Rowallan was, I think, the first property to be wholly attested. I think that the liquid creamery which we ran was the first creamery in the country to pay on bacterial count. That was well before the last war. We did not receive at the time, either from the Government or from the medical profession, the support to which we thought we were entitled. Far too much emphasis was placed on pasteurisation, and far too little on hygienic methods and tuberculin-testing to eliminate disease. So I do not think we can altogether be blamed for being against pasteurisation and against the efforts being made by Her Majesty's Government on behalf of others, when we were at least as keen as they were and felt very strongly that we were setting about the matter from the right end.
I thank your Lordships for allowing me to intervene. I must apologise if I have to leave, but this is Australia Day and I have been invited to go along to the reception of the High Commissioner.
§ 6.6 p.m.
LORD STRATHEDEN AND CAMPBELL
My Lords, I had not intended to intervene in this debate. In fact, when I came up to London I expected a very different kind of debate to take place. But as this debate has gone on I have realised more and more the implications of it in regard to my position at the 141 moment. I speak now as the convenor of a county council in Scotland which is in the process of putting in a county water supply, and which is being pressed to install fluoridation. I should just like to impress on the noble Lord who is to reply that the points raised by my noble friend Lord Waldegrave are exactly the questions which are being put to me and to the chairman of the water committee on the county council. They are very difficult questions for a layman to give a proper reply to, and it would be of enormous help if we could have a really authoritative statement which would clear the minds of all those perfectly genuine people (they are not conscientious objectors or anything like that) who are sincerely worried about what the long-term effects may be. I hope that some of those problems may be cleared up in the Minister's reply to the debate.
§ 6.8 p.m.
§ LORD NEWTON
My Lords, I had not intended to intervene in this debate, either, but your Lordships may recall that in his speech my noble friend Lord Waldegrave referred to me and said that he thought I had been rather unfair in interrupting the noble Lord, Lord Douglas of Barloch, when I did. I shall come to that in a moment. As to Rapaport and mongolism, I thought that that aspect of this matter was so effectively dealt with by my noble friend Lord Cohen of Birkenhead that it would be presumptuous of me to add anything to it.
The first thing I want to say is that we are very much indebted to the noble Lord, Lord Douglas of Barloch, for enabling my noble friend Lord Cohen of Birkenhead to treat us to the terrific rebuttal which he did of the very cause which the noble Lord, Lord Douglas of Barloch, was concerned to advance. I think that this House, and, indeed, the country as a whole, are greatly in the debt of my noble friend Lord Cohen of Birkenhead, and I should have thought that the best way of satisfying the doubts to which my noble friend Lord Stratheden and Campbell has just referred would be for people feeling doubts to read the speech of my noble friend Lord Cohen of Birkenhead when it is published.
The reason why I interrupted the noble Lord, Lord Douglas of Barloch, twice, 142 and I hope with reasonable courtesy, was simply that it seemed to me—and I think it also appeared to other speakers in this debate—that he was impugning the intellectual integrity of those who now work, and who have in the past worked, for the Ministry of Health. I hope that, as a result of this debate, he will hesitate before he says the same sort of things again. Some of your Lordships may recall that for some years I spoke on behalf of the Minister of Health in your Lordships' House—and, indeed, for part of the time I was Parliamentary Secretary in that Department. It was my duty, and indeed my pleasure, from time to time to advocate to people both here and outside the policy of fluoridation. I say it was a pleasure because I believed then—and I still believe—that it is the right policy. I am not concerned to defend my own intellectual integrity, but I think that perhaps I, as well as others, ought to protect the distinguished, though often anonymous, professional advisers in the Department, on whom the Minister relies now, as Ministers have always relied in the past.
My Lords, the third and last thing I should like to say is this. I hope that, also as a result of this debate, the noble Lord, Lord Douglas of Barloch, will use his great influence with the National Pure Water Association to secure that in future they carry on the advocacy of their case with rather different methods. One very good way of doing that, I suggest, would be for them, when in future they send out pamphlets or put them through people's letterboxes, to distribute at the same time copies of the speech made by the noble Lord, Lord Cohen of Birkenhead.
§ 6.12 p.m.
§ THE MINISTER WITHOUT PORTFOLIO (LORD CHAMPION)
My Lords, I am an almost fanatical student of court procedures on television—Perry Mason and the rest—and at this stage I feel very much inclined to call attention to some witnesses that we have had before us to-day—the noble Lord, Lord Cohen of Birkenhead, my noble friends Lord Taylor and Lady Summerskill, and the noble Lord, Lord Amulree—and just say, "I rest my case", and sit down. Unfortunately, I cannot quite do that. I have to answer here for the Ministry of Health, and, of course, I have to 143 reply to some of the points that have been made in the course of the debate and to some of the questions that have been asked.
I must say that I very much welcome the opportunity which my noble friend Lord Douglas of Barloch has given us of having a debate on this subject of fluoridation. The last occasion upon which it was the subject of a Parliamentary debate was on March 2, 1964, in another place. The present occasion we regard as very timely, because in the past six months fluoridation has been debated in almost every forum throughout the country except on the Floor of this House. We have to remember that the decision whether or not to arrange for the fluoridation of the water supplies in its area is in each instance the responsibility of the local health authority, and upon them a great responsibility undoubtedly falls. As the noble Lord, Lord Stratheden and Campbell, said, it is only right that those authorities should have the best guidance that it is possible for them to have when arriving at a decision which is, and must be, full of dangers if some people's feelings on this issue have any substance at all. If the doubts expressed by my noble friend Lord Douglas of Barloch have any justification at all, then of course tremendous responsibility will fall on those local authorities who say, "Go ahead" on the "say-so" of the Ministry of Health and the other experts.
Many local authorities are undoubtedly perplexed by the technicalities of the subject, or confused by the statements of what I am bound to call in this regard a small but vocal element of the community—represented this afternoon, I think, by my noble friend Lord Douglas of Barloch. It is doubly important I would say, in the sense that local authorities will be looking to this House for a lead in this matter, that we should weigh the merits of fluoridation carefully and objectively in the balance, so that those who look to us for a lead may be wisely guided.
The signal for the opening of the present discussion on fluoridation was the issue by my right honourable friend the Minister of Health on August 3 last of a circular urging all local health authorities to make arrangements for the fluori- 144 dation of public water supplies. This followed the discontinuance, with costs against the relator, of an action against the Corporation of Watford claiming a declaration that the corporation, as a water supply authority, were not empowered to add fluorides to the public water supply. I ought perhaps to emphasise here that, in taking the view that a water supply authority had power under English law to add fluoride to the water it supplies, and in commending fluoridation to local authorities, the present Administration had no fundamentally new decisions to take, and that the present Minister's policy, as the noble Lord, Lord Newton, pointed out, follows closely that of his predecessors in office.
From the ensuing discussions in local committees and councils, and in the national and local Press, two important factors have emerged: first, that among local health authorities the weight of opinion is predominantly in favour of fluoridation; secondly, that in many instances the discussions have been conducted in a cloud of doubt and misunderstanding about the basic facts of fluoridation. I should like in a few moments to say something about these two items, but before doing so it would be appropriate for me, I think, to remind your Lordships of the case for fluoridation of water supplies.
§ LORD BOOTHBY
My Lords, before the noble Lord does so, may I just put this point to him: that there will never be any satisfactory solution of the problem of the water supply in this country until it is nationalised—and I thought that was what this Government was all about.
§ LORD CHAMPION
I am grateful for the noble Lord's intervention. It seems to me to be slightly off-point—perhaps a little more than slightly off-point—but I welcome his support of the idea of the nationalisation of water supplies. Although we did not actually include it in our last programme, we might include it in the next one and satisfy the noble Lord, Lord Boothby; but it is off-point here.
I had just said, first that among local authorities the weight of opinion is predominantly in favour of fluoridation; and, secondly, that in many instances the discussions have been conducted in a 145 cloud of doubt and misunderstanding about the basic facts. In many respects—and this is the point at which I had arrived when the noble Lord intervened —our children are healthier, both physically and mentally, than ever before. But in at least one respect our achievements are still woefully inadequate. As were his predecessors, the present Minister of Health is deeply shocked, as we all are, or ought to be, by what he is told of the state of our children's teeth. Dental decay is a serious health problem in this country. On first entering school, a very large proportion of children have some decayed teeth. Among children in England and Wales between the ages of 5 and 17, over 9½ million fillings are inserted in permanent teeth and over 1½ million permanent teeth are extracted each year. These figures reveal a state of affairs which can only be described as disgraceful. They reflect no credit on anyone; particularly when we remember that there is a simple, safe and effective way of laying the foundations for healthy teeth—and I mean, of course, the fluoridation of water supplies.
Children born and brought up in areas where the water contains fluoride at a level of about one part per million have been found to have about half the dental decay of children in areas where there is only a trace of fluoride. Carefully controlled statistical studies have shown that by means of fluoridation the prevalence of caries can be reduced by as much as 50 per cent. to 60 per cent. in some age groups, and that some of the benefits are maintained at least to the age of 60. This is proved not by recent decisions taken in America and elsewhere, but by comparison with groups that have lived all their lives in areas where fluoride at this rate of about one part per million is present in the water as a result of natural processes and not as a result of the action of mankind.
In North America major fluoridation studies show for children between 12 and 14 years old a reduction in caries ranging from 48 per cent. to 70 per cent. In Brantford, Ontario, after 17½ years of fluoridation, children of 16 to 17 years of age had on average fewer than five defective teeth; whereas in Sarnia, the non-fluoridated (control) city, the comparable figure was more than ten defective teeth. The percentage of children 146 caries-free was nearly 12 per cent. in Brantford, but less than half of 1 per cent. in Sarnia. In Hastings, New Zealand, after ten years of fluoridation, children aged ten showed a reduction in dental caries of 55 per cent. In the first five years of the British fluoridation studies the percentage reduction in caries teeth ranged from 64 at the age of three years to 47 at the age of five. These figures speak for themselves. The point should be made that fluoridation is essentially a long-term measure and it takes a number of years for the benefits to reveal themselves.
We hear much to-day about the importance of prevention. Indeed, the Health Service is often criticised for the attention it pays to curative as distinct from preventive medicine. In fluoridation we have a heaven-sent opportunity to lessen the incidence of a form of disease which has become a national scandal. Fluoridation is one of the most useful preventive health measures which medical and dental science have so far made available to us in our fight against dental decay. It is simple, safe and effective—and I stress the word "safe". No other health measure has been subjected to such prolonged and detailed investigation before being officially commended for general use. Do not let us be deflected by propaganda and emotional prejudice from our duty to ensure that no child is denied the benefits which those in more fortunate parts of the country have always enjoyed and which can now be made available to all.
My noble friend gave a list of local health authorities which have rejected fluoridation. I think I ought to put the record straight. According to the latest information available to me, 100 local health authorities in England and Wales have decided in favour of fluoridation. This is not far short of double the number which have voted against, which is 55. I must congratulate the 100 on their wisdom and good sense, while regretting that others have not yet seen fit to adopt the same course.
§ LORD CHAMPION
My Lords, this is the job of the local health authorities. We do not propose to impose this upon them. We think they should take their 147 decisions in the light of the information which we are putting before them and which has been put before them; and we hope they will see the good sense of looking after their children. The noble Lord, Lord Boothby, rather surprises me. He is a great libertarian. He believes in liberty for the people, but now suggests that we impose this on them without regard to local feelings. We do not think that this should be done—at any rate, at this stage.
I am bound to say that if those 55 local authorities who have rejected fluoridation had been able to examine and assess all the facts with calm detachment, they would have arrived at the same decision as did the 100. I must say I only wish it had been possible for the whole of the representatives of those 55 authorities to have been in this House to-night to hear the speeches of the noble Lord. Lord Cohen of Birkenhead, and of my noble friends Lord Taylor and Lady Summerskill. Had they been able to do so there would have been no doubt about their decision. Unfortunately, local councillors are often denied the opportunity of calm and detached consideration of matters of this sort because they are subjected to an unceasing barrage of propaganda against fluoridation. For example, a councillor complained last week to the Ministry of Health that he had received literature or personal letters by nearly every post for the three weeks prior to the debate in his council. All of this gave a totally erroneous impression of a lot of public opposition to fluoridation. Fortunately, he was able to recognise the arguments against fluoridation as (as he put it) a "product of scientific ignorance, prejudice and sheer unreasoning emotionalism." I believe his words are true in this respect.
Apart from the very substantial support given to fluoridation by individual health authorities, the main associations presenting local authorities have declared their support. Leading professional opinion is almost entirely in favour. The Minister's expert medical and dental advisory committees strongly endorsed the report of the studies in this country and recommended the general adoption of fluoridation which they were satisfied carried no hazard. These committees comprise leading members of the medical 148 and dental professions in this country, including people with long experience of careful and critical assessment of the results of medical research. Their endorsements accord with the conclusion of the World Health Organisation's Expert Committees on Water Fluoridation thatthe effectiveness, safety and practicability of fluoridation as a caries-preventive measure has been established.Moreover, in expressing the view that fluoridation is both beneficial and harmless, the Minister of Health has the unreserved support of such bodies as the General Dental Council, the British Dental Association, the British Medical Association, the Society of Medical Officers of Health and the Royal Society of Health. This is a not inconsiderable body of people. They are not the sort of people who would express themselves on something of this sort without the most careful consideration.
Everyone may make a mistake, as the noble Earl, Lord Waldegrave, pointed out, but I do not believe it possible, after all these years of experiment and research and of careful delving into the statistics and looking at this question from a scientific angle, as has been done, that the possibility of a mistake here still exists. I believe that it has been settled beyond any reasonable doubt which might cause a local authority to say, "We do not think we should do it at this time." The advantages are obviously such that they ought to accept the recommendation of bodies of this sort—and surely, as laymen, that is what we have to do—that this has been proven beyond all doubt.
My Lords, will the Minister allow me to interrupt him on this point? I do not question that one part in a million is desirable, but in all the evidence I have not seen it stated as absolutely certain that one part per million is what I shall get.
§ LORD CHAMPION
My Lords, I shall come to that point in a few moments. The noble Earl put a specific question to me about a guarantee that one got one part per million and not, as the result of some accident or something of that sort, something more.
Fluoridation has been adopted on a world-wide scale. I am advised that 149 over 58 million people in 2,900 communities in the United States of America are consuming water to which fluoride has been added. Of these, 1,000 communities have been receiving fluoridised water for over ten years, and there are a further 1,900 communities, comprising a population of 7,500,000, whose water supplies contain fluoride naturally. My present information is that in Europe fluoridation is being practised: for example, in Belgium, Czechoslovakia, the Federal Republic of Germany, the German Democratic Republic, Switzerland, and the Soviet Union.
My noble friend, Lord Douglas of Barloch, has recently circulated, with his letter of January 10, copies of the National Pure Water Association's booklet, Fluoride, Facts and Fancy. The Ministry of Health has produced in reply a detailed commentary dealing with the main points of criticism in his booklet. The booklet which the noble Lord sent out to us contains many errors and dogmatic statements unsupported by facts, but the principal danger lies in the selection of material, regardless of accuracy, to support the Association's case and the misquotation of facts in such a way as to give misleading impressions. In the limited time available to me to-day I do not propose to seek to refute all his points, but I will gladly arrange to supply a copy of the Ministry's commentary to any noble Lord who wants one.
For present purposes, I should like to deal with some of the more common doubts and misunderstandings about fluoridation. In the first place, let us consider the allegation that fluoridation means mass medication. To describe fluoridation as mass medication is to confuse the issue. The noble Lord, Lord Cohen of Birkenhead, made a point of this. It is surely nonsense, particularly when it is followed, as is sometimes the case, by the statement that fluoride is a drug. I understand that it is nothing of the sort. It is a natural substance. It is certainly not a drug in the sense in which I believe my noble friend Lord Douglas of Barloch used the term. In normal parlance, medication is intended to mean the administration of some medicinal substance to cure disease. But fluoride is not a drug or a medicine. It is present naturally in most water, and is a common element in our every- 150 day diet. It is more in the nature of a nutrient than a medicament and provides an important constituent for growing teeth. It is not being administered to cure disease. Its object is to prevent disease and to make the body more resistant to disease by building better teeth. Fluoridation consists simply of adjusting, where necessary, the fluoride content where the water supply is naturally deficient in it.
We are told that fluoridation is harmful, but this is not so. The effect of fluoridation on health has been exhaustively investigated all over the world, and for many years, and, I would stress, at the recommended level, as has been pointed out this afternoon. It could be very dangerous if the level were too high, as is the case with many other substances where too much is bad for one. While we were talking about this, my noble friend Lord Hughes whispered to me that he thought even water could be very dangerous if added too extensively to whisky. I do not know enough about that to pronounce any judgment. But, as I say, the effect of fluoridation at the recommended level has been exhaustively investigated all over the world, and for many years. Allegations of harm are carefully and scientifically examined, but not one single instance of harm as a result of fluoridation at the level recommended by the Ministry has been proved.
Not only is fluoridation completely safe at the recommended concentration of one part per million, but safety precautions and devices and automatic control over the addition of fluoride are such as to ensure that the concentration of fluoride in the water supplies is kept at a constant level. This was the point raised by the noble Earl, Lord Waldegrave. I am advised, in answer to the question to what limits of accuracy is modern plant at the water works capable in applying fluoride components to water—the essence of the first part of the noble Earl's question—that the application of a steady dose of fluoride to public water supplies is no more difficult than the addition of other chemicals used in normal waterworks practice. It has been the experience in America that concentrations of fluoride can be maintained in drinking water within 10 per cent. of the intended dosage. This has been confirmed in the fluoridation studies in the United King- 151 dom where, for over five years, the average concentration has been kept at 0.9 parts per million, the standard deviation being 0.1 part per million.
The next question asked by the noble Earl was this: Although fluoride may be added to water at a uniform rate at the source, is there any possibility or likelihood of the fluoride tending to form pockets in water pipes which would give rise to occasional concentrations? The answer to that is, "No." At the concentration of one part per million the fluoride is completely soluble and will not be precipitated out of solution, even in hard water. The concentration of fluoride at the plant tap will be carried throughout the distribution system, but if there were a change in the concentration at the plant there would be a time lag before the change reached outlying parts of the distribution system. That, of course, will be obvious to the noble Earl. In fluoridation studies in this country, the concentration of fluoride ion over five years has been the same at the plant taps and at various points in the distribution system. This confirms that pockets of fluoride were not formed in the water pipes.
My Lords, may I thank the noble Lord very much for his courtesy in replying so fully? I am sure that his remarks will comfort a number of people. They comfort me, and I hope that the evidence on which these statements have been made will be given wide publicity to help us all.
§ LORD CHAMPION
I thank the noble Lord. This is an important matter. I admit that I was enormously impressed by his speech. I am bound to say (although perhaps I should not say it) that it impressed me much more than the speech of my noble friend. It seemed to me to have a balance which I did not find in the speech of my noble friend.
It must be obvious to all thinking people that no Minister of Health would advocate a measure of this nature unless he were convinced beyond all possible doubt of its safety. It is the Minister's responsibility. He has made a recommendation, as did his predecessors—a recommendation in which a number of people have had to accept some responsibility but the major responsibility falls 152 on the Minister of Health and on those Ministers associated with him, as was the noble Lord, Lord Newton, with the previous Minister of Health.
My Lords, there is a point which worries me a good deal, and perhaps the noble Lord could answer me on this—I refer to the possibility of accidents. The sort of thing I can visualise in Scotland, where we have very severe frosts, is that a container of fluoride may split in the frost and the fluoride may go straight into the water supply. It is the possibility of a disaster of that sort that worries me a little.
§ LORD CHAMPION
My Lords, I am not going to attempt to answer the noble Viscount on that point. I think that it would be most unwise for me to do so, because I have not been able to take the advice of the experts. What I will do is to consult them and write to the noble Viscount. I imagine that there is no danger here, but I dare not commit myself without seeking the advice of those whose job it is to advise the Minister on such technical points as this.
Some people object to fluoridation because it compromises personal liberties, but I think that we must look at this in its proper perspective. It is not the erosion of personal freedom that is at stake here, but the erosion of millions of teeth and the resulting suffering and misery of thousands of children, which fluoridation, we assert with confidence, would go far to prevent. The support of this Government and of its predecessor for fluoridation cloaks no sinister designs on personal liberty. The only consideration which has influenced them is the well-being of this and future generations.
It is said that there are no alternatives which would make fluoridation unnecessary. I agree with the noble Lords, Lord Amulree and Lord Cohen of Birkenhead, that correct diet, dental hygiene and sustained dental health education are important, and go a long way to prevent dental caries. I do not see fluoridation as a substitute for dental hygiene, but rather as something in addition to it.
§ LORD COHEN OF BIRKENHEAD
My Lords, may I interrupt to say that the noble Lord will doubtless have observed that I have a Motion down on the Order 153 Paper on the Report on Health Education of a Committee which I chaired, which I hope will be debated in your Lordships' House at a later date.
§ LORD CHAMPION
My Lords, we shall look forward to that debate, to which I shall listen with the same interest as I did to his speech to-day. But these measures are not enough. Nor are fluoride tablets an effective alternative. There is no practical way of ensuring that hundreds of thousands of children will take them day after day, or that their parents will insist upon their so doing. The difficulties are well known to everybody who is, or has been, a parent of young children.
The noble Lord, Lord Amulree, asked if there was some other way in which we could ensure that fluoride gets to children; and he suggested adding fluoride to salt. This is something which has been considered but there are considerable objections to this method. It is a disadvantage that salt is not consumed very much by infants during the first two years, which are all-important for the sound founding of teeth. There is much greater variation in the consumption of salt than in the consumption of water. I sincerely trust that no local health authority will delude themselves into thinking that they can fulfil their responsibilities in this matter by rejecting fluoridation and doling out fluoride tablets instead. When, added to the fact that the Minister of Health and leading professional opinion advocate fluoridation, there is substantial world-wide agreement on the subject, backed by a wealth of scientific data in support of the overwhelming benefits and safety of fluoridation, it is beyond comprehension that some local authorities persist in denying their children the benefits of stronger, healthier teeth.
What is it, then, that can account for the stand taken by the local health authorities who have voted against fluoridation? I am convinced that the doubts which these local authorities have felt about the merits of fluoridation are due in very large part to the propaganda of a small section of the community, who seek to create the maximum of controversy and persist in deliberate misrepresentation of the facts. These are strong words. I believe that they are justified in the nature of the case.
§ LORD BOOTHBY
My Lords, if the noble Lord thinks that they are justified, why does he not order the local authorities to do it and have done with it? That is why he is there.
§ LORD CHAMPION
My Lords, I have already replied to the noble Lord on this point and I do not think I need do so again. Perhaps I can repeat it to him over a drink in another place—we will certainly not have too much fluoride added to the water there.
If we are to combat effectively the wholly excessive amount of dental disease in this country, we cannot afford to stand idly by while local health authorities are misled by the sensational and often quite outrageous allegations of this tiny minority. I use the term "outrageous" advisedly. The Minister and the Government are repeatedly accused, for example, of promoting fluoridation for the sole purpose of helping the aluminium industry to dispose of its waste products, including sodium fluoride. It is appalling that responsible people should suggest that any Minister of Health would be influenced by such motives. I gratefully acknowledge the fact that my noble friend Lord Douglas of Barloch did not make this allegation to-day, and neither did I find it in the Association's booklet, Fluoride—Facts and Fancy. But this allegation was made on a recent occasion by the mayor of a local authority, who must have been carried away by the fanaticism of this propaganda. In point of fact, I am informed that the aluminium industry in this country has no such disposal problem and that the extremely pure forms of sodium fluoride and sodium silico-fluoride used in the fluoridation of water are prepared from mineral sources by the chemical industry in the normal course of business.
My noble friend Lord Douglas of Barloch quoted the assertions of a Dr. Rapaport that there is a connection between mongolism and water that has had fluoride added to it. If I were a member of a local authority and had that statement made to me before I was going to take a decision on whether or not I would add fluoride to the water, such an allegation would scare me to death, and I would vote against the addition of fluoride unless I had had an opportunity to check on the facts. Some of the facts in this 155 matter have been given to us to-day by the noble Lord, Lord Cohen of Birkenhead. He referred, quite rightly, to the careful investigation of this issue by Dr. Berry, a senior medical officer of the Ministry of Health. The facts are available, and I will supply them to anyone who seeks the correct information about this matter. But the Ministry say at this stage that the pamphlet of this doctor is superficially plausible, but its argument fails when the original papers and documents are consulted and the scientific basis of Dr. Rapaport's work is analysed. His views are based primarily on the results of two investigations which he published in 1956 and 1958 respectively, and in each case it was immediately apparent that certain defects in the statistical data were such as to invalidate his findings.
My Lords, I must intervene, because this is really the whole point. We members of the public cannot know that. All we can know is what is published in the Ministry's leaflet, and in that leaflet you make no comment on whether Dr. Rapaport or Mr. Berry is or is not a respectable scientist. You do not say that one is in the Ministry and that with the other nobody agrees. You merely put the two facts side by side: Rapaport says mongolism; Berry says none. We have heard over and over again that scientists disagree. Then we pick up the leaflet which says: "No evidence of mongolism". If it is based on that, it does not follow.
§ LORD COHEN OF BIRKENHEAD
My Lords, I think it should be pointed out that on June 22, 1964, the Chief Medical Officer wrote a letter to all medical officers of health in this country pointing out the fallacies and short-comings of Rapaport's papers (which were published in France, and not in America, although he lives in America), and this enabled these doctors to convey this information to their authorities.
It may well be that this is because of libel laws or some such thing. But we, the public, are not being helped. We cannot see these letters that are sent to doctors. We do our homework and read the Ministry's pamphlet, and this is what we see. The noble Lord will have to tell us more. If 156 he does not like Dr. Rapaport's findings, then he will have to tell us that they are no good.
§ LORD CHAMPION
If we put everything in our pamphlet it would be a tremendous document. What we had to do was to be selective. That is all we could do, and I think it was right to do that. Not everybody has the time to read all the documents one would like to read on this. I myself have not read them all, although I have read a mass of them during the last few days. The amount of material on this subject is quite enormous.
The final point that I would make in this connection is that Dr. Rapaport's statements were very carefully examined, and the final sentence of the Chief Medical Officer's letter on this was that, in particular, there is no basis whatever for any suggestion that fluoridation might cause even one mother to give birth to one Mongol child.
§ VISCOUNT BLEDISLOE
My Lords, may I ask whether it is suggested that Dr. Rapaport was misled, or was dishonest? He was a scientist making an experiment, was he not? Is it suggested that he was misled, or is it suggested that he was being dishonest in putting forward a theory which his experiments did not prove?
My Lords, perhaps I may say one word. It is very easy to do bad statistical work, and this happened to be a piece of had statistical work.
§ LORD CHAMPION
This is what I was going to say. It is the point that I read out before. There were certain defects in the statistical data, and these defects were such as to invalidate the conclusions at which he arrived. That is all I can say about that.
There is very much more that I could say about this question, and much of it has been very well said by the noble Lord, Lord Cohen of Birkenhead. I may appear to have laboured the point about the methods of the anti-flouridationists.
157 But this I have done quite deliberately. It is most important, we in the Ministry of Health think, that improvements in the nation's health should not be thwarted by a minority who are in no way representative of the community as a whole. All that we at the Ministry of Health have tried to do is to publicise as widely as possible the true facts about fluoridation.
My right honourable friend is considering—and some of the suggestions that have been made in the debate to-day will be considered, too—what further steps he can take with the end in view of ensuring that nobody should be misunderstood about this, including, of course, people who are going to take the important decisions. Our policy has been directed primarily towards providing information in an easily readable form by members of the public and the health authorities who have to take the decisions. We have been reminded by the noble Earl, Lord Waldegrave, of the document written in non-technical language, the green booklet from which he read. This was circulated to local health authorities. We shall have to consider whether that is enough or whether we ought to do much more. That we shall do as a result of to-day's debate.
There is not much more that I need say. There have been a number of interruptions which have caused me to speak rather longer than I originally intended to do. There are some points, however, that I should make. Where the local health authority is not the water undertaker the policy decision is still that of the local health authority. The Minister's discussions with the British water industry have led him to believe that individual water undertakings will respond readily to any request made to them by local health authorities for fluoridation. The noble Earl, Lord Waldegrave, although he said he was speaking for himself, also spoke with a knowledge of these undertakings, and virtually, I should have thought, supported the pledge that had been given to the Minister by the industry as a whole. I am sure that the decision by the local health authority should be the result of persuasion and voluntary local action. But if these means fail, not on the merits of fluoridation as a policy but because of ignorance and prejudice, the Minister of Health and the Government will have 158 to consider what further steps are open to them.
In making arrangements to demonstrate the value and the technique of fluoridation, it has been felt that the safeguard for the individual's true rights lies in ensuring that any decision made by an authority is taken in compliance with proper constitutional procedure and in the light of well informed opinion. Your Lordships will be aware from what I have already said that the pressure and volume of literature to which local councillors are subjected by the opponents of fluoridation are considerable, and the democratic decisions of local health authorities cannot be said to have been made without full knowledge of the arguments against.
The Government's main concern, however, is that these decisions have not always been taken in the light of well informed opinion. This is one reason why the Minister of Health has decided that he should take the initiative and accept full responsibility for ensuring that the true facts are disseminated as widely as possible. The Minister has stated publicly on a number of occasions that he is completely convinced of the desirability of fluoridation on health grounds and he is convinced of its safety; and that he would be failing in his duty if he did not urge all local health authorities to make early arrangements for fluoridation in their areas. I think that we should all pay special heed to these views.
I would conclude by referring to the British Dental Journal of October, 1965, which carried a symposium by acknowledged authorities on the main aspects of the fluoridation question. The concluding words of the introductory note to the symposium, which appeared to me to be eminently sensible and reasonable, were these:The debate"—and here they are referring to the whole debate which has raged about this matter—has not always been to the point, and accusations of self-interest in this matter have been made, but not by any worthy advocate on either side We must accept that opponents of fluoridation hold their philosophical point of view conscientiously, but we must remember that we are now presented with a public health measure that can greatly improve the dental health of the nation, has been 159 exhaustively investigated by the Ministry of Health, and is now unreservedly advocated by the Government. Fluoridation is not for the diseased tooth—it is not medication, mass or otherwise—it is for the purpose of providing an essential constituent for the growing tooth in the growing child. Its use reduces disease and promotes health—at a cost of about 10d. per person a year.I believe that that is the gist of the matter, and I recommend it to the House and to everyone who will have to take a decision on this matter in the near future.
§ 7.4 p.m.
§ LORD BOOTHBY
My Lords, I want to make only two points, and they will take one minute each. The first is the point I raised with the noble Lord, and I do not expect an answer today. My friend Mr. Levy, who was on the extreme Right wing of the Tory Party, advocated the nationalisation of the water supplies of this country, in and out of season, for years and years. I believe he was right, and it seems to me incredible that the present Government have not nationalised them, instead of dithering on about steel which is much less important—because that is really what they were elected to do. They would get enormous support from the country, and we need not have had this debate at all. The second point I want to make is with regard to my noble friend Lord Waldegrave, when he said that people did not read Hansard. It is the only thing worth reading to-day. I read Hansard every morning from both Houses, and I recommend him to do the same and to cut the newspapers out.
§ 7.6 p.m.
§ LORD DOUGLAS OF BARLOCH
My Lords, first of all may I thank all noble Lords who have taken part in this debate for their various contributions? I should have apologised for the very short notice which was given of it and which, unfortunately, prevented a number of noble Lords who wished to be here from being so. In particular, Lord Glentanar, Lord Saltoun and Viscountess Davidson wrote to me saying how much they regretted they could not be here, and so did some other noble Lords.
I want to try to deal with this debate as briefly as I can. It has ranged over a very wide field of matters which I never 160 raised in the beginning at all, and all kinds of side issues have been introduced into it. But there are a few salient facts to which I must refer. The noble Lord, Lord Cohen of Birkenhead, made great play about certain legal decisions. After all, the legal decision given by Mr. Justice Kenny in Dublin is his decision; it is his opinion. As a lawyer, I may have a great deal of respect for him, but as a scientist I am not necessarily bound by anything he says.
Then the noble Lord referred to the decision of the Judicial Committee of the Privy Council in the New Zealand Appeal. I think it is just as well that the facts with regard to this should be put on record. That case was conducted by the plaintiffs, rightly or wrongly, upon the basis that they called no evidence whatsoever with regard to the merits or demerits of fluoridation. They took the view—in the end they were unsuccessful in it—that as a point of law they were entitled to a decision that fluoridation was illegal, irrespective of what anybody might say about the effects of fluorides. The other side gave a great deal of evidence to say that fluorides were highly beneficial; that the waters of New Zealand were naturally deficient in them, and so on. Upon the basis of those facts the Judicial Committee confirmed the decision of the lower courts, but only upon the basis of those facts, which were entirely one sided.
§ LORD COHEN OF BIRKENHEAD
I did not say what the decision was in this case. I simply referred to what the Judicial Committee of the Privy Council had observed in relation to the interpretation of the words "pure water", and on the fact that, in their view, the addition of fluoride adds no impurity. It was on the question of mass medication that I raised it—on the ethics of the problem, and not on the decision taken. I am well aware of the central decision which was in issue, and I did not mention it.
§ LORD DOUGLAS OF BARLOCH
But, with all respect to the noble Lord, what he has said exactly confirms what I 161 was saying. This is their comment about the question whether, under the law of New Zealand, this constituted pure or wholesome water or not, and they based their decisions upon the evidence as it was presented to the court, which was in fact entirely upon one side alone. Therefore I say that that decision has no bearing upon any case in which the facts for and against might be presented.
The noble Lord has also said that every court of last resort has given a decision in favour of fluoridation, and he included the Supreme Court of the United States of America. The Supreme Court of the United States of America has never given a decision upon this question at all. The Supreme Court of Canada has given a decision, in which it held that fluoridation was illegal. Therefore, it is not correct to say that there is this weight of judicial opinion upon the matter.
My Lords, it has been said over and over again in the course of this debate, and in the Ministry pamphlet, that fluorides are natural constituents of water. It is perfectly true that one can find in some water supplies an appreciable amount of fluoride and if one pushes the analysis far enough one can find traces of almost anything in every water supply, because in the course of millions of years nature has mixed up the constituents of this earth so thoroughly that there is hardly a water supply anywhere which does not contain something or other if we look for it hard enough. But to deduce from that that it is a natural and proper thing to have one part per million in the water supply is a totally different thing; and this argument is introduced for the purpose of trying to make out that the addition of fluorides to public water supplies is not a form of medication.
Curiously enough, the British Medical Association was asked a question about this, and said that it regarded fluoridation as being a "preventive medical treatment". Now what is the treatment? It is treating people with fluorides; and if you put fluoride into the water supply, then of course you are engaged in compulsory mass medication of a very curious kind, because it is agreed that it cannot possibly benefit the vast majority of people. The noble Lord, Lord Cohen of Birkenhead, has said that it is no use 162 starting after the age of one or two years, so that all the rest of the population have it forced upon them without any excuse whatsoever.
I am not going to follow my noble friend Lady Summerskill into the digressions which she introduced into this debate, and which have nothing whatsoever to do with the question, but I would point out that the question raised by the noble Earl, Lord Waldegrave, was a very serious and pertinent one. He quoted from the Report No. 105, and compared it with the Ministry's green booklet; and, of course, the two things are not the same. Report 105 stated quite clearly that Dr. Rapaport had found a certain result and that Dr. Berry had not. That is a perfectly fair statement to which I have no objection whatsoever. But to put it in the way in which the green booklet puts it, that there is no evidence whatsoever that fluorides can cause mongolism, is a totally different thing.
I want to pursue this matter just a little further, because my noble friend Lord Champion has referred to it and has stated once more that there are some reasons why Dr. Rapaport's conclusions could not he accepted. But he has not stated what those reasons are. I have given the two reasons which the Chief Medical Officer of Health gave in his circular to the local medical officers, and I have pointed out that neither of them disproves Dr. Rapaport's work at all.
This brings us to a fundamental point. So far as the scientific aspects of this matter are concerned, opinions are of no value whatsoever. What we are concerned with is facts; and the facts are not going to be got rid of by somebody's saying that he disagrees with them or does not like them. What Dr. Rapaport found were facts. What I have quoted from the original investigators of fluoridation in relation to teeth, that fluorides cause a disturbance in the development of the teeth which can be described either as an abnormal development or a subnormal development, is a fact which still remains. Nobody has disproved it, and nobody can disprove it, because it is a fact.
When you are administering fluorides to people you are, in fact, producing a physiological change of an abnormal 163 character, and therefore you are administering medication. That may be justifiable on an individual basis. It is open to the noble Lords, Lord Cohen of Birkenhead, Lord Taylor and their medical colleagues, as doctors, if they choose to do so, to prescribe fluorides for people. That is their responsibility, and their patients have the right to refuse or to accept the advice which is given to them. However, the noble Lords are not entitled to impose fluorides on other people who are not their patients, by means of putting it into the public water supply. That is the issue, and that is why I say that fluorides in this connection are drugs and nothing else.
My noble friend Lord Champion has said that there is no other practical way. This is the argument that "the end justifies the means", and that you can take any step you please if you see a desirable objective in front of you. I am not prepared to accept that, and I hope that the majority of people in this country are not prepared to accept it, either. It is impossible for anybody to prove that fluoridation is perfectly safe. This question has been raised time after time in the United States of America, and anxious people have written, for example, to the American Medical Association. I have in my hand a copy of a letter which that Association wrote in reply to such a question only last year. This is what it says:The American Medical Association is not prepared to state that 'no harm will be done to any person by water fluoridation'.This is after twenty years.
§ LORD DOUGLAS OF BARLOCH
I will, with pleasure, because it reinforces what I am saying.The American Medical Association has not carried out any research work, either long-term or short-term, regarding the possibility of any side-effects.Therefore, the endorsement of fluoridation by the American Medical Association, which had rushed into it when it joined the bandwagon in the early stages, is of no importance whatsoever. It just does not mean any practical thing in terms of science or medicine.
164 Very much the same thing, of course, happened in this country. The case of fluoridation is made out by saying that this, that and the other association have supported it. But that means nothing at all, except that they have accepted what somebody has said to them. It does not mean that they have any practical knowledge about it. Quite recently the British Medical Association decided to send out a circular to local authorities urging them to adopt fluoridation. And what was the reason for that? This is what the chairman of the representative body of the British Medical Association said: "Lay people were going against the advice of their medical experts and those experts were colleagues who should be supported". That is the argument: because the medical officer of health has recommended it (though not all of them have done so, incidentally) to his local authority, therefore the B.M.A. has to send out a circular. But I was glad to see that one voice, at any rate, was raised at this meeting of its council. Dr. Beynon said, "there was mounting anxiety about a project which, whatever the profession might say, was mass medication. In his view it would be inopportune for the Council to associate itself with a campaign which he had little doubt was failing throughout the country". I believe it is.
I am not going to detain your Lordships by recounting a great many other facts which I have at my disposal, but there is one thing which I ought to say. It has been suggested that there is a great deal of support for fluoridation in Europe. That is very far from being the case. In France the medical authorities do not approve of it. In Denmark it has been expressly declared illegal to put fluorides into food, drink, including water, or anything else. Broadly speaking throughout Europe—and Europe has a great many eminent doctors and has contributed much to medical research—the movement towards fluoridation is extremely slight. There are a few cases where it has been practised more or less on an experimental basis, but in the vast majority it is not adopted and it is not approved. Do not let us think that there is a monopoly of wisdom in this country. Do not let us think that the gentlemen in Whitehall always know best. There is a field within which human 165 beings are entitled to their freedom, and one of those fields is the right to accept or refuse a medical treatment which is offered to them. My Lords, I beg leave to withdraw my Motion.
§ Motion for Papers, by leave, withdrawn.