§ 5.22 p.m.
§ Lord CAMPBELL of CROY rose to ask Her Majesty's Government whether they will consider action to restore the optimum percentage of fluoride, for protecting teeth, in water supplies in those areas where it has for centuries existed naturally, but where that optimum percentage has been diluted as an unintended result of amalgamating water systems, in order that families shall not be deprived of the benefit previously experienced in their districts. The noble Lord said: 1432 My Lords, I beg leave to ask the Question standing in my name on the Order Paper. I raise this subject because the time is approaching when all the information should be available, enabling decisions to be taken upon adding to, or subtracting from, the fluoride which exists naturally in all water supplies in Britain. After at least 20 years of trials, schemes in parts of this country and elsewhere and searching investigations, progress in one direction or the other should be made. My interest in this subject arises because, as a Minister of Health for nearly four years, from 1970 to 1974, I was naturally committed heart and soul to trying to improve and assist the health needs of the 5 million people within my responsibility. That was, of course, when I was Secretary of State for Scotland and one of several of my functions was Minister of Health for Scotland.
§ Because fluoride exists in natural sources of drinking water supplies in Britain, in greater or less proportions, I am asking the Government to consider the position of families where fluoride has for centuries existed at approximately one part per million or more, until the modernisation of water systems and amalgamations diluted the proportion of fluoride. It is accepted by the large majority of medical and dental authorities in the world that if drinking water contains about one part per million (1 ppm) of fluoride by weight, the incidence of caries—the disease of decay in teeth—is greatly reduced, particularly in children.
§ The families who have lived in parts of Essex, South Shields and the Hartlepools, for example, have had the benefit of that protection. In some of those areas the introduction of wide distribution systems has incidentally diluted the fluoride to less than the ideal level. I am therefore raising the subject for a minority, but a very substantial minority, of people in this country: such people, I suggest, have just as much right to object to interference with their natural water supplies—perhaps even more right—as those people who have objected to small additions to the existing fluoride to bring it up to the ideal level in other areas.
§ How should the decisions on this matter be taken in this country? Because the amount of fluoride varies naturally from area to area, my view is that decisions should be taken separately in different 1433 areas. That is the position that exists today in Britain; but I believe it is the task of Government to provide all the relevant information and to ensure that the interested public have the latest facts. The Government, rightly, wish to be completely satisfied about safety, and in particular about possible links with cancer. My honourable friend Dr. Gerard Vaughan, the Minister of State for Healh in England and Wales, announced last month that a further inquiry into safety was being undertaken. I assume this is an internal inquiry within the DHSS and I would ask my noble friend Lord Cullen of Ashbourne, who is to reply, if he can tell us on behalf of the Government when it is likely to be completed. I would remind him that the Royal College of Physicians carried out a special inquiry over a period of three years, and that its committee reported as recently as 1977. Is the new inquiry to go over the same ground, or is it to go on from that report?
§ All the necessary information should become available soon to enable definite conclusions to be reached on whether fluoride in water, naturally or artificially, has any dangerous side effects, or whether its particular benefits to health make it, in the optimum quantity, a friendly aid to man's passage through life. If one is concerned to reduce pain for humankind, and in particular suffering among children, one cannot simply ignore the overwhelming recommendations in favour of arranging for 1 ppm in water supplies. I say "arranging" because, as I pointed out, in some areas naturally there is more than 1 ppm and therefore "arranging" is the correct word.
§ The British Medical Association, the British Dental Association and the Royal College of Physicians are quite clear in their recommendations that arrangements should be made for 1 ppm of fluoride in water supplies. Also the Royal Commission on the National Health Service, which reported only last July, recommended unanimously that fluoride should be added in order to bring the amount up to approximately 1 ppm. That Commission were not asked to make such a recommendation within their terms of reference, but they none the less did so because they felt it important to draw attention to this. They felt that an immense improvement could be made in 1434 health as a result, and they were impressed by the large scale of the accompanying relief to the hard pressed health services. No one could surely suggest that all 16 members of that Royal Commission were in some way duped or deluded.
§ On the international scene, the World Health Organisation has recommended the same thing. There are now about 100 million people in the United States and Canada who enjoy the benefits of fluoridated water. Nor, my Lords, should anyone ignore the warnings of those who are worried about safety. Of course they should not be ignored. The facts must be set out, and the conclusions of those best equipped to interpret them made clear. For example, any suspicions of a connection with an increase in cancer must be scrupulously and fully investigated. The medical profession were definite and explicit in finding links between smoking and an increase in lung cancer, but the inquiry of the Royal College of Physicians has stated otherwise where fluoride is concerned.
§ There are two reasonable doubts about arranging for the optimum 1 ppm in water supplies. First is the possibility of dangerous side effects, particularly cancer. On this the Royal College, as I have stated, have categorically said that there is no evidence of any harmful effect to the water or the environment by adding fluoride to the 1 ppm level. The second doubt which is sometimes raised is whether, in principle, authorities should "doctor" the main water supplies for whole communities. All water from natural sources on land contains dissolved substances, including fluoride. For many years, several additions of further substances have been made by water authorities—for example, chlorine—with the object of rendering the supplies wholesome and palatable.
§ If adjustment of the fluoride content will result in the elimination of toothache and much suffering by children on a massive scale, without increasing risks of cancer or other dangers, why are we waiting? If I were to start a charity for this purpose, in this International Year of the Child, to reduce pain and increase health, money would surely pour in. I would call it something like Save the Children Pain Campaign. But money is not needed. That is the paradox.1435
§ Indeed, the process of fluoridation, if adopted all over the United Kingdom, would save about £80 million for the health services, for a cost of about £4 million. The money saved could be spent on kidney machines, extra hospital beds or be sent to the starving in Calcutta, if you like. It could be available for other purposes. Must many children, in the years to come, have to suffer pain and dentistry which could be avoided, in order to defend a principle? That question is there and it will not go away. I believe that decisions on it should be taken democratically in different parts of the country. Provided that the ideal quantity of fluoride is proved to be completely safe in water supplies, I would encourage people to vote in favour of it.
§ As for the principle of tampering with water supplies at all, some additions are made and some processing is carried out, anyway, to avoid upset stomachs or other ill effects of a supply which would not otherwise be wholesome. As I have indicated, the organisation of supplies over wider areas has unintentionally diluted the quantities of fluoride, where it was above what is regarded as the ideal level. That, of course, would be satisfactory in certain places. For example, in the Mersea area of Essex the amount naturally there is about 4 or 5 ppm, and if that were reduced to 1 ppm by dilution that would be satisfactory. But elsewhere, where it has been about 1 ppm, the dilution has of course had the effect of taking away the benefit.
§ May I point out, in passing, that most fish contain 4 to 5 ppm of fluoride, and that the sea itself is at the state almost all over the world of about 1 ppm of fluoride. Anyone drinking a cup of tea at the normal strength is imbibing it at the rate of 1 to 2 ppm. In fact, if they chewed tea leaves they would find themselves taking it at the rate of about 100 ppm.
§ I understand the attitude of those who say: "This should be left to the individual". In fact, they would have to say "to the individual family", because it is not really a choice for a child under about 6 or 7, which is the most important time of his life so far as this subject is concerned. Of course, a contribution can be made by fluorided toothpaste, but it is nothing like the protection from decay which is achieved by water supplies.1436
§ There is a régime of taking tablets, but to be effective that has to be daily from birth, or shortly afterwards, until the age of 12 or 14, taking small portions of a tablet each day until a certain age and then, eventually, a whole tablet a day. That is feasible in the case of extremely conscientious mothers. In practice, research has found that few, even though they started in earnest on this, have been able to carry it out fully for at least 12 years, with a dose a day to a child from about six months or even younger. Then, of course, there is the danger that the child will find the bottle and swallow about 100 or 200 at a time. That has already happened in various cases, and that is a danger which is not there when it is supplied in water.
§ It has also been pointed out that much decay in teeth could be eliminated if the population as a whole deliberately shunned sweets, sugar and similar food. I believe that that situation is virtually impossible to bring about. Again, it reveals a state of being completely out of touch with the conditions of family life, particularly in the more populated urban areas, to suggest that such a rigorous disciplinary diet could be generally adopted and adhered to. It would certainly be regarded by the children as an unnecessary hardship.
§ Anyone who, like me, has been involved in social work and conditions in areas such as the Glasgow conurbation, where there are over 2 million people, knows that many mothers are already over-taxed in coping with ordinary life and looking after the basic bringing up of their children. Some are also doing jobs during the day. The idea that many of them could apply a tablet régime for 12 to 14 years continuously is simply not practical. It has also been suggested that this task might be given to school teachers during the periods when children are at school. I really think that that is not a starter either. School teachers already have enough tasks given to them to do, which are not wholly connected with teaching, and I would quite understand their feeling that they should not be asked to do this as well.
§ I would remind your Lordships that there were similar fears and warnings at the time when vaccination and inoculation were first being considered, 70 and more years ago. Of course, safety then had to be thoroughly investigated, and it still 1437 has to be; but the boon of the virtual elimination of diphtheria and smallpox, and now the massive reduction of polio, has ended that controversy. We should remember that there were vigorous campaigns against vaccination and inoculation at the time, besides the ordinary anxiety about safety, which was right and was to be expected.
§ What worries me is that there are some who are putting out anti-fluoride material which is specially selected and slanted. I completely understand and respect, as I think I have indicated, the view that, as a principle, such a substance should not be added or subtracted. That is a view, though I do not share it myself. Should millions of unborn children suffer pain and unnecessary loss of teeth during their lives, as a penance for that principle? Should it be a penance? Should it be the price of supporting a principle?
§ What seems to me to be inexcusable is to distort facts concerning safety and cancer. I was naturally interested in the comparison made by Dr. Dean Burk, a retired American biochemist, and a colleague of his into the incidence of cancer in cities in the United States and also in this country, particularly Birmingham, where water had been fluoridated, in contrast with cities where it had not. The results in both cases appeared to show a connection between fluoride and increased cancer. But those results have been demonstrated to be invalid by the British Royal Statistical Society in the work commissioned by them and carried out by Professor Newall and Dr. Oldham.
They were invalidated for the reason that Dr. Burk had not taken into account the changes in age groups and other demographic changes in cities which affect cancer rates in a given size of population. For example, seaside towns in Britain where many elderly people settle in retirement have a higher than normal cancer rate. Cancer is more prevalent in the over 60s than in the under 40s. That kind of fact was ignored. Dr. Burk has been invited to travel widely in the world giving warnings, but his cause is damaged when facts are withheld. For example, a body calling itself the National Anti-Fluoride Campaign has circulated something which I think has come to many noble Lords. In paragraph 17 it says:
It should be noted that Dr. Burk was one of several witnesses who gave evidence last year in an American court case, the sole purpose of which was to determine whether or not there was a fluoridation-cancer link. The court found in favour of the evidence given by Dr. Burk and his anti-fluoridation associates. His credibility was well-established in these matters".
Paragraph 17 failed to add that that court's finding was later set aside as a result of a ruling by the United States Supreme Court. Surely that important point should have been included. Its exclusion causes one to have doubts about the objectivity of those putting out this material.
§ Some objectors have alleged that there is a difference between substances introduced and those existing naturally in water—a difference, for example, between calcium fluoride and sodium fluoride. But in the very small quantities in water which we are discussing, complete ionisation takes place. So we are speaking of the fiouride ion in water, and the differences alleged between these substances have no validity whatever.
§ On the procedure for taking local decisions, I would draw attention to the fact that there are three types of bodies involved. First, there are the water authorities responsible for the mechanics and physical supply. I am very glad to see that my noble friend Lord Nugent of Guildford is to speak in the debate because of his knowledge of the water industry. Secondly, there are the health authorities. Their members are appointed. Then there are the local government councils who are elected.
§ I should add that the organisation and the system are different, as one would expect, in Scotland. In 1972, I, as Secretary of State, carried out the reform of the Scottish Health Service a year before reform was carried out in England and Wales. Incidentally, I adopted a single tier of health authorities. In Scotland, there is only one tier of health boards. When there is criticism now about the two-tier structure and people say that one of them should be taken away, I hope they will remember that that applies only South of the Border because this seems to have been one of those occasions in Scotland when we got it right the first time.
§ It means that there is a difference as to how the decision is taken in Scotland. The effective decision on fluoride lies with 1439 the local government councils—the elected representatives. I understand that the situation is different in England and Wales. At present the situation is very well reflected in Scotland where the regional council of Strathclyde has a decision impending, and all the health boards in its area have recommended in favour of I ppm of fluoride.
Before I conclude, I must draw attention to a press release—which I understand has also been circulated to a large number of noble Lords—because it seems to be about me. First, it takes just a few words from my Question. My Question amounted to only five lines, but instead of just reproducing my question the press release takes about 1½ lines out of it and then, in four lines, tries to give its meaning—and, of course, gets it wrong. It then goes on:
If what Lord Campbell says were true as a general statement, then his Lordship would have provided a most interesting and original argument in favour of fluoridation. But what he says is untrue".
Of course, anybody looking at my Question sees that it was not a general statement because the words are:
… the optimum percentage of fluoride … in water supplies in those areas where it has for centuries existed naturally …".
I was making no general statement. Having got my wording wrong, they then go on to imply that I am being used by private interests,
to promote the implementation of fluoridation by spreading yet another false statement in its favour".
That Press release comes from a body with headquarters at Thames Ditton.
§ I think that anybody who knows me will recognise that this is a nonsensical allegation. I have no private interests in fluoridation, and no private interest has prompted me to raise the matter. I understand that the private interests which they have in mind are industrial companies who might be able to sell some fluoride waste products. But that, as anybody who knows anything about this will recognise, is a derisory and minimal aspect and could hardly be of any great interest to industry.
§ I need hardly say that I am raising this subject in the same spirit in which I helped to start the parliamentary campaign for 1440 the severely disabled 14 years ago in the House of Commons. That was in 1965 and 1966 when I was fortunate in winning some ballots. I had to declare an interest then, because, as I think noble Lords know, I myself am 80 per cent. disabled as a result of the passage of a bullet through my middle. I am glad to say that that campaign was successful. I started it over three years before Mr. Alf Morris told me that he was going to take up the subject when he came first in yet another ballot in November 1969. I was able to assist the late Megan du Boissons to start an organisation called DIG—the Disabled Income Group—and its counterpart in Scotland. I rehearse this because it may recall memories to certain members of this House who were in another place in those days and who know the reasons why I raise subjects of this kind.
§ The selection of particular words from my Question on the Order Paper, the presentation of it then as a general statement—which was wrong—and the suggestion that I am misleading this House with a falsehood for the benefit of private industry I can only describe as a childish and outrageous distortion. It completely discredits anything else in that Press release which has been circulated and also the body which produced it.
§ I am very pleased that several noble Lords with special qualifications to speak have found the time to be here today and take part in the debate, including the noble Baroness, Lady Robson of Kidding-ton, who is a distinguished and successful chairman of a health board, the noble Lord, Lord Lovell-Davis—because I know of his special interest in children's welfare—and my noble friend Lord Colwyn who is a practising dentist. I look forward also to hearing the maiden speech of my noble friend Lord Yarborough. I shall watch, I am sure with some admiration, the way in which he manages to observe the usual convention of avoiding touching on controversial matters.
§ I appeal for more courage in public life. Once all the facts are clear the Government should make them widely available. Communities in different areas should be enabled to take their own decisions because of the quantities of fluoride already existing in the natural supplies there. It must be pointed out that children 1441 and grandchildren as yet unborn are those who will be most affected by decisions taken now. They will not thank us, nor will they bless us, for being timid and dilatory. The facts should be brought before the interested members of the public before decisions are taken by their representatives. Men and women in public life should not run away from this subject nor should they delay decisions on it indefinitely. The safety question is—I repeat—a vital one; but, if that is finally answered, a councillor in local government could well look back 20 years hence and realise that in one decision he had brought about more good for his area in measurable health standards and in saving resources than all his other council decisions during that period added together. That is the scale of the benefits that are involved.
§ 5.52 p.m.
§ Lord AVEBURY
My Lords, I should like warmly to congratulate the noble Lord, Lord Campbell of Croy, on his introduction to this important debate which, if I may say so, was animated by common sense and by a sense of compassion for the hundreds of thousands of people who have to suffer unnecessarily as a result of our failure to implement fluoridation in this country. I should like to begin by declaring an interest because I am president of the Fluoridation Society, a post which I have held for some years, and the subject which the noble Lord has raised is one which has interested me ever since I first came into another place in 1962 and when I studied carefully the evidence which arose from the studies in Watford, Anglesey and Kilmarnock, and equally I studied the evidence (such as it was) which was presented to us by the opponents of fluoridation.
I agree with the noble Lord, Lord Campbell of Croy, that at a time when the National Health Service is by no means flush with resources the prevention of disease should be given far greater emphasis than it is. My noble friend Lord Winstanley emphasised this point yesterday in introducing the debate on the National Health Service generally, when he said that people give three loud cheers every time that preventive medicine is mentioned although they are not always prepared to do something about it. The fluoridation of public water supplies is, 1442 of all preventive public health measures, the most thoroughly tested in history. My noble friend Lord Winstanley said yesterday:No public health measure has ever been so exhaustively studied and found so free of undesirable side effects or consequences, and demonstrated to be so capable of making a substantial contribution to the public health".—[Official Report; 14/11/79, col. 1261.]My noble friend is, of course, a general practitioner and, in saying that, he was echoing the views of the overwhelming majority of general practitioners in this country.
The noble Lord, Lord Campbell of Croy, has reminded us that millions of people in different countries of the world have been the subject of extensive studies over many years in respect of fluoridation, and these have all reached the same conclusions, that adjustment of the public water supply to a content of one part of fluoride per million of water by weight reduces tooth decay very substantially while, as the World Health Organisation report emphasises, this is:the only sign of physiological or pathological change in lifelong users of optimally fluoridated water supplies".Apart from the number of persons drinking fluoridated water in the United States of America, mentioned by the noble Lord, Lord Campbell of Croy, there were in 1969 13 million people in the USSR drinking fluoridated water; in 1971 there were 4.9 million in Australia; in 1969 there were 3.6 million in Hong Kong. One might carry on with this list but I would not wish to weary your Lordships with a recital of the numbers of countries and the many millions of people who have been drinking artificially fluoridated water for many years without a single sign of ill-health resulting from that measure.
The scientific evidence for the safety of fluoridation is massive and overwhelming. The noble Lord, Lord Campbell of Croy, has mentioned that in the United Kingdom the Royal Commission on the National Health Service and the Royal College of Physicians most recently endorsed this measure. One could add the British Dental Association and numerous other bodies which have published authoritative endorsements of this as a public health measure. It is hard to imagine what additional information is likely to be provided by the study to which the noble 1443 Lord, Lord Campbell of Croy, referred. One fears that this is simply another device to put off making the decisions which the noble Lord, Lord Campbell of Croy, has called upon us now to take.
Therefore why is it taking so long for this country to realise the enormous benefits which undoubtedly would accrue for the dental health of the people, at a negligible cost? The noble Lord touched on what I think is one of the main reasons; that is, the effect on public health of anti-fluoridation propaganda. The allegations made by opponents have included an increased incidence of mongolism, arthritis, allergies and cancer. As soon as one false statement is knocked on the head then, like a hydra, another one appears and has to be refuted. The anti-fluoridationists are continually abandoning one position and turning to another, but there is no doubt that over the years of all the allegations which I have mentioned the one which associates the fluoridation of water supplies with cancer is one of the most powerful weapons in the armoury of the anti-fluoridationists; and of course the suggestion carries added weight when it is made by persons who appear to have some scientific qualification.
The noble Lord, Lord Campbell of Croy, mentioned the work of Dr. Dean Burk which has been used as the keystone of the literature and propaganda of the anti-fluoridation campaign. Dr. Burk, with an associate, Dr. John Yiamouyiannis of the National Health Federation of Monrovia, U.S.A., published evidence which claimed to show that where public water supplies had been fluoridated in the United States of America there had been a substantial increase in cancer death rates. It was said that because of the power of the vested interests behind fluoridation these two doctors had not yet been able to get official recognition of their evidence. I am quoting from the propaganda put out by the National Anti-Fluoridation Campaign. I think it is important to emphasise that neither Dr. Burk nor Dr. Yiamouyiannis are medical doctors—they are both biochemists; that the so-called National Health Federation is a front organisation in the United States of America for quacks and mountebanks who try to foist useless treatments on gullible sick people, such as the use of a 1444 substance called Laetrile which is derived from apricot stones and is alleged—quite falsely—to be a cancer cure.
As it has been alleged that fluoridation led to increased morbidity from cancer, it was clearly essential that epidemiological studies should be undertaken, as indeed they have been, to refute these allegations. In Britain there was a comprehensive study published by Dr. L. Kinlen in 1975, comparing the incidence of cancer of the breasts, bladder, colon, rectum, kidney and thyroid in a population of approximately 1.3 million people living in fluoridated areas with an equivalent matched population of similar size drinking unfluoridated water, and no differences were detected. The same result has been found wherever this comparison is made, in the United States, in Holland and in New Zealand, for example.
Dr. Dean Burk, however, published a critique of this study of Dr. Kinlen's purporting to show, by reanalysing the data in a different way, large increases of cancer in the fluoridated areas and pointing out the remarkably large difference in the absolute rate of cancer between two of the tables in Dr. Kinlen's paper which he said were unexplained. In fact, this was due to an elementary misreading of the tables, because they related to data which was accumulated over different periods of time and were thus not comparable, as Dr. Kinlen himself had clearly explained in a footnote. I think this illustrates the kind of propaganda we have to deal with when those who are analysing statistical data are not themselves even capable of reading the footnotes to tables.
§ The Earl of LONGFORD
My Lords, if I may interrupt the noble Lord, as an absolute ignoramus listening with enormous interest to the noble Lord and the previous speaker, I am quite ready to believe everything the noble Lord says is true, but if so, how have the others got away with it so far? On the showing of the noble Lord they are all a lot of nitwits or cranks or something. Just listening to the noble Lord one really cannot understand why this cause has not prevailed long ago.
§ Lord AVEBURY
My Lords, it is very remarkable. What I am trying to demonstrate to your Lordships is that the fear of cancer, and indeed of the other diseases 1445 mentioned by the anti-fluoridationists, is so strong that people do not look very carefully at the evidence and do not go into analysis of claims made by persons such as Dr. Dean Burk and Dr. Yiamouyiannis. They merely see that in the anti-fluoridation literature these people are represented as having scientific qualifications. If one reads the pamphlets one sees an enormous list of papers published by this gentleman which at first sight look very authoritative and make one think that anything he says should be taken extremely seriously. It is a fact of psychology that people do take these claims made by the anti-fluoridationists seriously. This is why it is important to examine them, as the noble Lord, Lord Campbell of Croy, said, but that we should refute them in a scientific manner rather than simply telling people not to read them.
Perhaps I can refer the noble Earl to a very interesting article in the American consumer reports for July 1978. The author of this article says that,' the real goal of anti-fluoridation groups', explains an American Dental Association official, 'is to create the illusion of a scientific controversy and to this end the facts are incidental '.What we are trying to do and what we ought to be trying to do is to bring it hack on to a scientific plane. That is why one should look carefully, for example, at the information which is provided by Professor Sir Richard Doll, the Regius Professor of Medicine at Oxford University, who confirms the original study of Dr. Kinlen, that his findings were correct. He writes in fact that Dr. Burk's methods of analysing them were quite improper. There has indeed been an increase in cancer in Birmingham, which accounted for the vast majority of the 1.3 million people in the study, but as Sir Richard says, his colleague, Mrs. Cook-Mozzafari, looking at cancer mortality over a longer period and bringing the figures right up-to-date, confirms that increases have been recorded in all provincial towns with more than 400,000 inhabitants, a factor which Dr. Burk totally ignores in his analysis.
But, my Lords, when all these technical arguments have been demolished the anti-fluoridationists fall back into their hunker of alleging that this adjustment of the fluoride content of water is a violation of civil liberties. I take this very seriously, 1446 as someone who was formerly chairman of the parliamentary Civil Liberties Group over a period of seven years, and who is still extremely interested and concerned to ensure that the British people maintain and uphold the civil liberties that we have always enjoyed. When this matter has been dealt with by the courts of law the argument has failed, because it is based on the false assumption that fluoridation is a method of treating disease and is therefore a form of mass medication for a condition which individual patients ought to be allowed to deal with in accordance with the method of their own choice, on professional advice, which, of course, they are free to seek or not.
But the medical and dental authorities have made it absolutsly clear that fluoridation is not effective as a method of countering tooth decay when it has already occurred. It is a means of preventing that decay, and it is only one of as many as 38 chemicals which may be added to the water supply for improving its quality or safety. But we do not say that the addition of any of these other substances to the water supply is an invasion of our liberties. Nor have we demanded anything like the standard of proof of their safety which has been required in the case of fluoridation. Yes, by all means, I say to the noble Lord, Lord Campbell, let us give people the opportunity of objecting. But the fact is that by preventing or delaying a measure of proven effectiveness, against which not a shred of valid evidence of harm has ever been produced, the anti-fluoridationists are denying to the public at large the relief from suffering and improvement in wellbeing that a reduction of over a half in tooth decay would bring.
§ 6.7 p.m.
The Earl of YARBOROUGH
My Lords, I have delayed rather longer than usual, addressing your Lordships for the first time in, I think, something like 10 years, but I would crave the indulgence which customarily your Lordships accord to someone in my situation today. I know what I ought to do; I should be brief and non-controversial. As my noble friend Lord Campbell of Croy said, it is a little difficult to be non-controversial on this highly controversial subject. But I am comforted by the thought that at least it has no party political undertones. I 1447 would expect divergent views on this subject from all parts of your Lordships' House. I am just about to introduce the divergence on this side—at any rate the first divergence on this side of the House.
Perhaps I might be allowed to state, first of all, my general stance in regard to the whole matter, which is that I have been an opponent of fluoridation since the idea was first mooted, for the basic reason—and this has been touched upon already—that it interferes with what I at any rate conceive to be the liberty of the individual. So far as I am concerned, it has nothing to do with making the water pure and treating the water as such. I regard it as medication. I think the intent of fluoridation is to create a pathological change in those, or at lease some of those, who drink it, and that to my mind is medication, and one can call it mass medication certainly. So I find it unacceptable that a public service like the water supply should be used to convey any substance. It happens in this case to be sodium fluoride, but I would object just as strongly if it was anything else. Given the intent, and I think the intent is important, to put what I regard as a medicinal product in it, intended to affect the body of the recipient, I would regret anything being put in it for that purpose, however good the result might be. It is perhaps a somewhat purist view, but it is, I think, a view which my noble friend Lord Campbell of Croy said he respected, although the noble Lord, Lord Avebury, does not really think very much of it.
I object particularly strongly because I lean rather heavily towards the homeopathic approach to medicine. As your Lordships know, under that approach everything is done to provide what a particular individual may need on an individual basis. That type of treatment is the exact reverse of what is proposed. However, I recognise that not everyone will take that view and so I shall put that behind me, having stated that it is the fundamental reason for my holding the view that I do hold.
In the Question and indeed as regards what has already been said, optimum levels have been considered. The first thing I should like to know is optimum for whom?—given that we are all different; that we all drink different amounts of 1448 liquid in which there may or may not be fluoride; and that we all eat different foods in which, as has been pointed out already, there is very often fluoride. Presumably if we were considering a middle-aged person with dentures the optimum would be nil. The optimum might very well be nil for the great majority of the population.
Let us consider for a moment those to whom fluoridation is directed—that is, children between, let us say, seven and 14. I read some figures which seemed to indicate that there was a factor of eight as regards the difference between the bottom and the top of what they might consume, at any rate in liquid form. What is one to do? Just put the pin in the middle and say, "That's it"? I suggest that that is a rather unscientific and haphazard way of reaching an answer.
What of the other members of the population who do not need fluoride? The vital question is: how safe is it? I do not want, especially on this occasion, to engage in a battle over statistics or who said or did what. But it is my sincere understanding that there are medical grounds for at least suspecting it—leaving it as vague as that—especially as regards mongolism, genetic change and certainly the incidence of cancer. I have read a number of different opinions. I would only say tonight that I am very concerned that there is a safety problem. There needs to be more research especially on what may be the long-term effects of fluoride. If we put it in all the water supplies it will be a life sentence—we must have it.
I should like to consider the situation which has obtained for a number of years. The whole area of fluoridation has resembled nothing so much as a battlefield. Skirmishes have taken place throughout the country with local authorities and health authorities. Sometimes the result has gone one way and sometimes the other way. Sometimes decisions have been reversed and sometimes they have been upheld. I should like to suggest that the pressure be taken off and that we have a cease-fire or perhaps a moratorium.
I was delighted to learn that there is to be another inquiry. I did not know that until I came to your Lordships' House this evening. However, I suggest that it should 1449 be a judicial inquiry and not an internal inquiry. There is so much disagreement and suspicion of each side's motives—although I am prepared to accept that most of it is unfounded, it does exist—that what is needed is some judicial body to hear the evidence and to weigh it, because that seems to me to be a judicial function. All the experts could give evidence. Their evidence would doubtless conflict as it normally does when there are two or three experts together. It would be the function of this commission, body or whatever one might call it, to come out with its findings.
Already this evening examples have been quoted of what occurred in America. What I read was rather different from the picture painted this evening. It was my understanding—if the case quoted was the case in Allegheny in Pennsylvania—that it was found proven that fluoride was a danger to health. I know that there was some legal wrangle about jurisdiction but I thought, on the facts presented by a number of experts, that that was the finding and that the facts had not been challenged but merely the jurisdiction of the court to grant a temporary injunction. However, I could well be wrong. In any event that exemplifies the difficulties of the matter.
One must also have regard to what has happened in other countries, especially Europe. We are the only country, apart from Eire, that now has fluoridation. Other countries have tried it. For example Sweden tried it and did away with it in 1971. Holland had it, but got rid of it in 1973. I am sure that all those countries have gone into the question of safety and in some cases they have concluded that it is a potential health hazard. Therefore, I do not think that all the evidence points in one direction.
One reason why I suggest that we should have some judicially based body, is that it is difficult to escape the feeling—and I do not want to be critical especially on this occasion—that those in the Health Service and the Department of Health have over the years adopted an entrenched position. Those of us who have tried individually and in groups to influence these issues and let the other side of the case be heard, have found them perhaps a little unresponsive. As came out earlier they have also been somewhat dismissive. 1450 Whether your Lordships think that I am a nut case this evening, I do not know, but I shall no doubt be told in due course. There have been some fairly rude aspersions cast at anybody who—I assure your Lordships in my case very sincerely—opposes the whole idea of fluoridation.
In conclusion I should like to say that I am entirely sympathetic with the motives of those who want fluoride. I understand perfectly what they are trying to do. I would question—because I think that there is some doubt—how effective it is. It certainly has an effect on children's teeth. My understanding is that all it does in fact is to delay the incidence of caries and that it does not prevent it. However, that is something with which I am sure other noble Lords will deal.
In this age in which we live our environment is heavily dependent on chemicals in one way or another, and deeply involved with chemicals. We have them in our food in the form of colouring; we have additives; and preservatives; we have chemicals in our drinks; they are in the soil and in the air. I know that there are specified bodies whose duty it is to monitor those matters and I am sure that they do their job admirably. However, there seems to me to be a great danger in adding to the number unless it is absolutely necessary.
I would include fluoride in this category of potentially dangerous substances. We may set a safe limit for the vast majority of people but there are always those on the fringe who, for some reason, are particularly sensitive to some chemical or another. If we add to the numbers of such chemicals that are potentially dangerous, it increases the likelihood of those people who are particularly sensitive encountering one that will be severely damaging to them. Turning to the Question, and holding the views I do, in this particular instance I believe that the water authority has done a service by reducing a naturally high level of fluoride to one that is lower and I would therefore suggest safer.
§ 6.21 p.m.
§ Lord LOVELL-DAVIS
My Lords, I am very pleased to be the first to congratulate the noble Earl, Lord Yarborough, on his maiden speech; especially on his temerity 1451 on making it on a subject as controversial as this. His was an interesting and reasonably-stated contribution to the debate and it is, of course, right that he should state his views and reservations as clearly as he has. I feel sure that, if his future interventions are as non-controversial, we can look forward to hearing them keenly. I shall now proceed to disagree with him totally!
I am not sure whether the noble Lord, Lord Campbell of Croy, as a member of the Government party, is testing the water but I am glad that lie has raised once more this too long debated matter. Perhaps our debate this evening will encourage some action. If it does, millions of people—in particular children—will lead happier and healthier lives. Everyone in this House must have suffered toothache and, as a result of dental caries, had fillings and extractions, and experienced the pain that dental treatment often causes. Probably everyone, too, can remember how much worse it all was in childhood. I can, vividly.
For children the experience can be traumatic and can create a lifelong fear which makes many adults—and I know several—simply let their teeth go, avoid the dentist's chair and finally opt for false teeth. Treatment is much better today and involves far less discomfort, but only the overconfident or masochistic face a visit to the dentist without some sense of fear. I do not want to dwell on this aspect of the subject, although I want us to achieve a position where the need for dental treatment is dramatically reduced, where that treatment is simpler and where suffering and fear are replaced by real interest in preventing dental disease. Much the worst aspect of it, of course, is the unnecessary loss of teeth—often complete loss in childhood.
I intend neither to discuss the cases for and against fluoridation nor to comment on the documents that we have received from an address in Station Road, Thames Ditton, except to say that in telling us where our duty lies, the language is exaggerated and the tone strident, if not almost hysterical. They remind me of nothing so much as a re-run of that once fiecrely debated question "Can man live at 100 miles an hour?"
1452 I have weighed the evidence myself; it is the best that I can do. As a member of your Lordships' House, it is my responsibility to do so and then, if I feel strongly about the subject—as I do in this case—to put my view before the House. My view is that we should put into effect a programme of water fluoridation. I have been persuaded to this point of view by a number of considerations, and not least by the findings and recommendations of two important reports. One, entitled Fit for the Future, is the report of the Committee on Child Health Services under the chairmanship of Professor Donald Court, which was published in December, 1976. Pointing out, in a section on dental health, that fluoridation isone measure that would prevent a great deal of dental caries without individual effort",it says:The presence of fluoride, to a level of one part per million in all water supplies, would substantially reduce dental caries in children and restrain it in adults, and the procedure is safe, effective and cheap".On safety, it quotes the 1976 Report of the Royal College of Physicians which concludes, as the noble Lord, Lord Campbell of Croy, and the noble Lord, Lord Avebury, have pointed out, that there is no evidence that the consumption of water containing one part per million of fluoride in a temperate climate is associated with any harmful effects. On the other hand, the effectiveness of fluoridation is indicated by, among others, the case of New Zealand, where there has been a dramatic decrease in the need for dental care since fluoridation, and the average number of fillings inserted annually has fallen from five to three per child.
Why, the Court Report asks, do only8 per cent. of the people of Britain enjoy the benefits of fluoridation",while 92 per cent. are deprived? It concludes that:The real obstacles are public apathy, minority prejudice and governmental reluctance to impose a political solution. The cost in unnecessary disease, personal pain and discomfort, misuse of professional resources and national expenditure has been immense".The committee's recommendation is unequivocal:We recommend that immediate steps should be taken to introduce fluoridation on a national scale, if necessary with new legislation".1453 The second report, which has already been referred to by the noble Lord, Lord Campbell of Croy, is that of the Royal Commission on the National Health Service, under its chairman, Sir Alec Merrison, which was published in July of this year. The section on fluoridation is quite lengthy and I shall not delay your Lordships by quoting extensively from it. I should like simply to quote one short section, which reads:We are not simply convinced of the wisdom of introducing fluoridation, if necessarily compulsorily; we are certain that it is entirely wrong to deprive the most vulnerable section of the population of such an important public health measure for the sake of the views of a small minority of adults for whom its benefits come too late".The Commission's recommendation is as direct as that of the Court Committee. It is:the Government should introduce legislation to compel water authorities to fluoridate water supplies at the request of health authorities".Finally, I am greatly impressed by the views of dentists themselves, such as the noble Lord, Lord Colwyn, who, it seems to me, display professional responsibility of the highest degree in pressing the case for fluoridation. I not only support the request of the noble Lord, Lord Campbell of Croy; I would go further and ask the Government if they will accept the recommendations I and others have referred to—and recommendations such as the resolution of the 28th World Health Assembly in 1975—and take action to introduce fluoridation on a national scale. By doing so they will not only save children and adults unnecessary suffering, but will also save the nation's professional resources and its money.
§ 6.29 p.m.
§ Baroness ROBSON of KIDDINGTON
My Lords, I, too, should like to join in congratulating the noble Earl, Lord Yar-borough, on his maiden speech. I am afraid I must admit that I shall also disagree with him; but that, after all, is the essence of the debate, and I shall welcome exchanging views with him many times in the future. I am sure that there are many subjects on which we could agree, but on this one I must take the opposite view. I was going to finish my remarks with a certain statement, but I think I shall start them with it. It seems tragic that on a question as im- 1454 portant as this, the voice of the anti-lobby is heard so much more loudly than the voice of the pro-lobby. This is true with many problems that face us. The people who are in favour tend to keep quiet. I am therefore delighted that so far in this debate we have had one, two, three, and this is the fourth speech in favour, and only one against so far. I think it is our duty, if we believe in fluoridation of water, for us to go out and say so as loudly as the anti-lobby.
I was tremendously sad not to be able to be present yesterday at the debate on the Health Service. Many speakers in that debate referred to the problems of the finances of the Health Service itself, and to the fact that if ever we are to be able to meet the costs of the needs of this nation from a health point of view, we must concentrate on preventive measures which can, and will in the long run, reduce the cost to the nation and to the service. Here, I agree, is one measure which could demonstrably help to save money, and it could do that at the same time as it would prevent suffering for a lot of young people.
There has been a great deal of reference to the question of safety. Various reports have been quoted. I want only to add one thing to that. It is interesting to see that in Australia, to which my noble friend Lord Avebury referred, there are 4.9 million people drinking fluoridated water. In Australia they have recently carried out a research project into the suggested connection between cancer and fluoride, the outcome of which has been that the Director-General of Health has lately issued a report supporting fluoridation in that country. That is one additional support for the safety angle.
I really want to talk about the problems of implementation as they affect a regional health authority. The noble Lord, Lord Campbell of Croy, said that he felt that the decision should be taken locally and that individuals locally should have a right to participate in the decision-making. In actual fact that is what happens at the moment, because it is the responsibility of the health authorities to consult as widely as they can with interested bodies before they take a decision to recommend fluoride.
May I talk about my own region. Every single area in my region has taken 1455 the decision, and so has the region, that we should like fluoride added to the water supply within our region. For a number of years we have attempted to get this done. The problem is that there is no enforcement order between the health authority's recommendation and the water authority's need to comply with those recommendations. I believe that on the whole the water authorities are resistant to this recommendation because of their responsibilities under the Water Act to produce clean, wholesome water. If they are worried about it, I think they should refer to a case that was brought in 1964 to the Judicial Committee of the Privy Council. The noble Earl, Lord Yarborough, will perhaps be glad to hear that it was a judicial committee that considered the subject. It was a case brought from the New Zealand courts by the Attorney General of New Zealand against the Lower Hutt City Corporation. The judicial committee decided that the addition of fluoride added no impurity and that the water remained pure water, and that the corporation, as a water authority, was empowered to make the addition. I know that this case does not apply to this country, but at least it is something to which we can refer.
Since the setting up of the new regional health authorities, the only water authority in this country to comply with the health authority's recommendation to add fluoride to the water is the Yorkshire Water Authority. The Calderdale Metropolitan Borough Council began an action to prevent the Yorkshire Water Authority from implementing the area health authority's decision, and the water authority accepted the Secretary of State's immediate offer of indemnity, and so the case was to go forward. This all happened in the middle of 1978, practically a year and a half ago. So far the case has not been heard, and no date has even been set for hearing. If we want to test the case, surely the hearing should be brought forward.
I recognise that the previous Administration did almost all they could to help the health authorities implement their desire to have fluoride added to the water under the present system. They went to great lengths to give indemnity assurances to the water authorities, but that was not enough. There were, therefore, strong 1456 requests from health authorities that legislation must be introduced, because when questions were asked in the other place about enforcement the Minister of State at the Department of the Environment in the last Administration, Mr. Denis Howell, said:I have no powers to give such a direction [to a water authority]. As I have made clear on a number of occasions, I have encouraged water authorities to comply with requests made by area health authorities to add fluoride to water supplies, where it is technically possible to do so".—[Official Report, Commons, 8/3/78, col. 637.]But he had no power.
At the end of the life of the last Administration the Parliamentary Secretary to the Department of Health and Social Security, Mr. Eric Deakins, on 29th June, when addressing the National Association of Health Authorities, admitted that we had come to the point where introducing legislation was probably the only answer, but he said that it was impracticable for that Administration to do so at that late stage. Well, I agree with that.
I speak in this debate because I should like the present Government to give strong consideration to introducing legislation to enforce decisions taken by health authorities, because I believe that the consultation that health authorities carry out before they come to the decision that fluoride should be added is very wide, and is adequate for pressure groups in the population of that area to make their wishes known. I would ask the present Government to consider this very seriously.
As a regional chairman I am always interested in funds for the Health Service. About four or five years ago a special fund was created in the department to help health authorities with the setting up of fluoridation schemes, and £500,000 a year was set aside centrally for that purpose. It will cost health authorities quite a bit of money, and as the years go by the cost will be higher. I sincerely hope that that fund is sacrosanct, and if we get the power to introduce fluoride that the money will be forthcoming from the department.
§ 6.40 p.m.
§ Lord NUGENT of GUILDFORD
My Lords, I thank my noble friend Lord Campbell of Croy for introducing this interesting subject for us to discuss 1457 and I congratulate my noble friend Lord Yarborough on his very interesting maiden speech. In this particular field, which is controversial, up to date he has found himself a single voice on the side of those who oppose fluoridation, but he has comfort to come because I see the noble Lord, Lord Douglas of Barloch, in his place and I know he is a doughty warrior among those who wish to keep fluoridation out of our water. He will therefore have substantial support there. And of course it is a fact, as noble Lords well know, that outside the House there are many people who feel passionately on this matter and therefore it is right and proper that we should debate it here and listen with great attention to those who sincerely feel opposed to it.
I am making a brief intervention from the point of view of the water industry primarily, for which I was responsible until this time last year. The position is that water supply is now in the hands of what is, in effect, a national water industry composed of 10 regional water authorities and 28 water companies, and substantially the position in regard to the fluoridation of water is that it is unchanged by the new structure which came into existence in 1974. It is substantially unchanged in regard to fluoridation; that is to say, the new water authorities have carried on with fluoridised supplies where they existed in the past and substantially have not made any change. The noble Baroness, Lady Robson of Kiddington, is right in saying that the Yorkshire Water Authority were preparing to introduce fluoridation in supplies in their area, but so far as I know they have not yet done so, but Calderdale have taken out a writ against them and, so far as I know, that is still lying there, so that physically the position has not significantly changed.
Three years ago we, through myself as chairman of the National Water Council, had considerable discussion with Ministers on this matter. It was perfectly true that Ministers in the last Government wished to see an extension of this treatment and the position is, as the noble Baroness said, that the regional health authority would make the request to the regional water authority and then it would be for the regional water authority to carry it out if they thought it was the proper thing to do. The difficulty for regional water 1458 authorities was that in their judgment the law was not sufficiently clear to authorise them to proceed to give the fluoridation treatment to water supplies within their regions as the law now stands.
Therefore, we explained to the Secretary of State for the Environment that we were unable to make this treatment unless the Government were prepared to legislate, first, to clarify the statutory authority of regional health authorities to make this request; secondly, it would oblige regional water authorities to carry it out; and, thirdly, there would be complete indemnification for regional water authorities against anybody who took an action against them in damages.
We felt that that was the only proper course we could take in this very controversial field where action could be taken from either side, either by those who felt that regional water authorities should be so treating the water or by those who were bitterly opposed to it. In the event, as the noble Baroness recorded, the last Government were not able to legislate in this field, and so the position remains substantially unchanged.
In regard to the technical point in my noble friend's Question—that the effect of the regionalisation of supplies might dilute previous fluoridised supplies—that has not significantly happened, although of course regional networks of water supply have been developed and were substantially completed following the emergency of the drought in 1976. The position remains thus. I wish to deal with the point which Lord Yarborough dealt with so cogently, which is of course one of the major objections to the fluoridation of water—namely, that it would amount to an unwarranted medication of water by introducing a chemical into the water and so adulterating it. The present practice is, as the noble Lord, Lord Avebury, rightly said, that many chemical substances are added to water, the four main ones being chlorine, copper sulphate, aluminium and calcium; but there are many others as well and these are added first to make the water safe and secondly to make it palatable.
We must not overlook the fact that a very large part of our water supply has mixed with the natural supply what is called re-used water. If we take, for instance, the supply of excellent water we 1459 drink in London every day, this comes as two-thirds from the River Thames. The water in the River Thames has been used by millions of people living on the banks of the Thames, from the large towns of Swindon, Oxford, Reading and many smaller towns all the way down its banks. However, by processes of very carefully controlled treatment, these sewage effluents are made perfectly safe so that by the time the water comes to London it can be finally treated by the Thames Water Authority. This water is supplied through the pipes to us safe and clean and in every way palatable. What has gone into that water from factories and homes by the thousand is every sort and kind of chemical and impurity. However, these can be cleaned up and the water can be made perfectly satisfactory and palatable to use. We must therefore have a sense of proportion about this. It just does not make sense to say that one small chemical addition of fluoride will so adulterate the water as to make it completely objectionable.
This has brought me away from the position of complete neutrality which I took, I thought advisedly, when I was chairman of the National Water Council. I then thought I should be completely neutral and I have never before expressed in public a view about the merits of fluoridation. But now that I am, so to speak, a free man and can do so, I declare that I am entirely convinced by the evidence both in this country and throughout the world that the case for fluoridating the water is absolutely unanswerable. I may say that I am fortified in this view because my wife has for nearly 30 years been a governor of the Eastman Dental Hospital and therefore I am freely and well-advised at home by my ever-loving wife of the truth of this matter.
If one looks at any of the documents which have been so lucidly quoted today by many noble Lords, one sees that the scientific evidence is really compelling, and I shall refer to only a few points. One that struck me most forcefully was from a report of the Royal College of Physicians in 1976; that 37 per cent of the population of this country over the age of 16 have no teeth at all left in their heads—they have nothing but dentures—and in Scotland, where my noble friend comes from, the figure is 44 per cent. This 1460 really is terrible and, as the noble Baroness will know well, unfortunately in over half our households a toothbrush never appears. But if before they were born their mums were drinking water with fluoride in it, these children would have natural protection against this miserable disease which costs the National Health Service £140 million a year as well as inflicting a great deal of pain and suffering. The greater part of this would be saved.
Experience throughout the world—the World Health Authority has been quoted—shows that in no less than 30 countries this treatment is given to water, covering a population of the order of 150 million. The WHO made a firm recommendation to consider fluoridation of water "as a proven health measure". They said that in 1969 and they reiterated it in 1975. That is really convincing evidence. It has been tried worldwide by over 100 million people and found to be satisfactory.
We have of course all this scientific evidence to show that the health dangers about which the opponents are so con-cerned—particularly cancer—are simply non-existent. I quote only one sentence from the report of the Royal College of Physicians:There is no evidence that fluoride increases the incidence or mortality of cancer in any organ".and they deal with various other possible afflictions, too.
So I conclude my few remarks by saying that I hope it may be possible that this Government, who are full of such splendid purpose, and who have many other things to put right, can include in their programme this splendid piece of legislation. In a few areas there is natural fluoridation of the water, and there the population are enormously lucky. I should like to see that splendid natural benefit spread to the whole country, and I hope that my noble friend will find time for this legislation.
§ 6.51 p.m.
§ Lord DOUGLAS of BARLOCH
My Lords, I am very happy to have the opportunity of congratulating the noble Earl, Lord Yarborough, on his maiden speech in which he dealt with a controversial subject in a way which I think every Member considered to be unexceptionable, and I hope that we shall soon hear 1461 him again. If I do not make myself heard, will someone prod me—I am suffering from the aftermath of influenza.
Fluoridation is one of the greatest delusions that has ever afflicted the medical and dental professions. It started with some statistical surveys made in the United States and published in 1942, comparing the incidence of dental decay in children of 12 and 14 years in areas which had varying amounts of fluoride in the water supply. The author of this report said that his figures showed that there was a reduction of 50 or 60 per cent. in dental decay. That is totally untrue. The statistics showed quite clearly that there were enormous variations between places which had the same amount of fluoride in the water supply—differences of up to 50 per cent.
This is typical of the way in which people have approached this subject ever since, because they have made the tacit assumption that the only factor that affects the level of dental decay is the amount of fluoride in the water supply. That indeed is exactly where the Royal College of Physicians' Report starts off in its very first sentence by saying:It has been shown in many parts of the world that the amount of dental caries in the population varies inversely with the amount of fluoride in drinking water".That statement is not true. There are very many other factors which affect the incidence of dental decay.
There is at any rate one case in which some allowance was made for the fact that other causes might be at work. That was in an experiment carried out under the auspices of the Ministry of Health in which the precaution was taken of having a survey in the year preceding fluoridation in order to ascertain whether the area to be fluoridated was comparable to a control. After 11 years a report was published on the results of the experiment, and it showed that at age 8 there were on average in the permanent teeth of children two decayed teeth in the control area and 1.2 in the study area; a difference of 0.8 of a tooth. At age 14 the difference was exactly the same. Dental decay had increased by equal amounts in both the control and the study areas. A saving of decay in less than one tooth for one year is not a substantial contribution to solving dental decay, and still less is it a 1462 contribution to solving the problem of teeth, because after the age of maturity the loss of teeth is mostly occasioned by paradontal disease, not by dental caries, and that will not be altered at all by fluoridation. The result will be that there will be almost exactly the same situation as at present.
After all, what has happened in the United States, where 90 million people are having fluoride in their water supply? The cost of dental treatment is going up every year. The amount spent on research—millions of dollars—is also going up every year. This panacea has not altered anything substantially.
Let me point out, first, that fluorides are not nutrients. They are in this connection drugs. Of course drugs are not necessarily medicinal. They may also be preventive, and this is well recognised. I shall quote one well-known authority, Vruton and Simmonds' General Bio-chemistry. They say:Bromide and fluoride … are generally considered non-nutritive and toxic for higher animals".In a book written by the late Lord Horder and Sir Charles Dodds, it is pointed out that,fluorine is an extremely powerful enzyme poison".This is what we are asked to add to the water supply and therefore we certainly ought to be extremely careful.
It has in fact been known for a very long time that fluorides have detrimental effects. In 1937, Colonel H. E. Short, FRS, conducted a series of investigations in India showing that fluoride (in, I agree, somewhat higher amounts) had caused serious skeletal disability, pain and so on; and in the same year there was published in London and Denmark a classical study by Dr. Roholm, who collected all the information relating to his book, and who described his own personal experiences and experiments with regard to fluorides.
The conclusion to which he came was that they were very toxic, and that they should on no account be added to any foodstuff. He pointed out, in particular, that their effect upon the enamel of teeth was, on the whole, detrimental; and this was found in the United States at an early stage, because it was found that teeth with dental fluorosis were brittle and difficult 1463 to repair. Observe that at this so-called optimal level there are going to be quite a number of children who will have some fluorous teeth. The figure of one part per million was not chosen as an optimal or desirable level. It was chosen as the maximum which should certainly not be exceeded, as many water suppliers were exceeding it, although even at that level 10 per cent. of children would develop dental fluorosis. This, as the Medical Research Council has said, is the first detectable symptom of chronic fluoride poisoning, and so it is a serious warning.
In 1924, the Ministry of Health Departmental Committee on Preservatives in Food made a report in which they said that fluoride and formaldehyde were the most toxic substances which had been proposed as food additives; and during the last 50 years, in this country, it has been illegal to add fluoride to foods, with one minor exception. Unfortunately, under our legislation water is not classified as a food, but, nevertheless, the inference is very clear. There are other indications of injury from fluorides. I will not say that everybody will develop symptoms, but we are at a point where some people will.
A very extensive survey was carried out in the United States by a very competent doctor, Dr. Rapaport, of the incidence of births of children suffering from a mental disorder popularly known as mongolism, or Down's syndrome. He found that the number of cases was correlated with the amount of fluoride in the water supply. This was an investigation in four American States and a second one in one of these over a different period of years. I took the trouble to calculate what the odds were that these results were credible. I found that the odds were 62½ million to one that this was not due to chance. This research has been brushed aside on most trivial grounds. One member of the American Public Health Service said he had made a survey of some of the area covered by Rapaport, and had found that any difference was probably due to chance. But that investigation has never been published. No data are available, and yet it is quoted all over the world as evidence. It is not evidence of anything at all; and this is the way in which many of these matters have been handled.
1464 My Lords, there is a very large amount of evidence. There is, indeed, a memorandum of the Medical Research Council on goitre which indicates that fluoride may cause goitre. This has been verified in various parts of the world—in this country, in South Africa, in India and elsewhere—and a very eminent Austrian doctor called Gorlitzer von Mundy——
§ Lord AVEBURY
My Lords, may I interrupt the noble Lord? Has the noble Lord finished with the subject of mongolism?
§ Lord AVEBURY
My Lords, may I intervene briefly? I merely want to make sure that when people read the noble Lord's remarks in Hansard they also appreciate that the work which he has mentioned, of Rapaport, alleging a connection between fluoridation and mongolism, has been refuted; for example, by Berry, WTC, in a study of the incidence of mongolism in relation to the fluoride content of water, in the American Journal of Mental Deficiency, 62: 634 (1958). So anybody reading the noble Lord's remarks will also have the reference to the article in which they are refuted.
§ Lord DOUGLAS of BARLOCH
My Lords, I am perfectly familiar with that paper, and the conclusion to which Berry came was that the incidence of mongolism in this country was not well indicated by a count of cases being cared for in institutions. That was intended to be a criticism of Rapaport, who included those and others. Since then, Berry's statement has been quoted as a refutation. It is nothing of the kind.
My Lords, I was going to quote Dr. Gorlitzer von Mundy, who conducted thousands of animal experiments and afterwards treated very many cases of goitre by the administration of small doses of fluoride. What he said was that fluorides should not be administered indiscriminately, especially to young children whose need of iodine was very great. These observations have never been refuted.
1465 Let me say just a word about this question of cancer. It is becoming acutely controversial. Dr. Dean Burk and his colleague produced a very impressive paper which showed a connection between fluoride and cancer as a result of a survey of 10 of the largest fluoridated cities in the United States and 10 of the largest unfluoridated ones. The United States National Cancer Institute and Professor Newall in this country have said that insufficient adjustment has been made for the effect of age, race and sex. They produced a calculation which purported to show that fluoridation had not increased the incidence of cancer.
I do not want to go into the technique of this statistical argument. What I will say is that the method which they adopted, and which they said was the only valid method of correcting crude statistics, was used by another American investigator, Dr. J. D. Erickson whose paper was published last year in the New England Journal of Medicine. This survey covered an even larger population of 46 cities of over 250,000 people, about half fluoridated and half not. Crude death rates were higher in the fluoridated group. Dr. Erickson processed the figures in the way which these critics have said is the only proper and valid method and he still had an excess of cancer deaths in the fluoridated cities. He then processed the figures for length of schooling and percentage of open space, and came up with a different result. If anybody believes that the latter operation was a valid method I am surprised. Certainly nobody ever demonstrated a connection between the incidence of cancer and the number of years people had been at school.
Now let me go back for a moment to this question of a so-called optimal level of fluoride in the water supplies. As I said, it was never adopted for that purpose. The World Health Organisation in its resolution in 1969 recommended Member States to introduce, where suitable, fluoridation in public water supplies where the intake of fluoride from all sources was below an optimal level. There are many sources besides water supplies; more probably may come from food or from drinking tea.
Anyhow, the simple point is that every individual is different, his consumption of water and many other things is different. 1466 There is no such thing as an optimal level for a population. There might or might not be one for an individual, but for a population not at all. Therefore the resolution passed by the World Health Organisation is absolutely meaningless. Nobody could ever carry it out because one cannot ascertain how much every member of the population is consuming. Nor can one determine how much more one will get if one puts fluoride into the water supply. This, like many other authorities which are quoted, is a meaningless statement which can carry no conviction for anybody who thinks about what it implies.
The report of the Royal Commission on the National Health Service certainly made the recommendation which has been quoted, but I do not know what evidence they received. I do not know whether they heard anybody who had any criticism to make of fluoridation; and it certainly was not in their terms of reference. That is a rather strange circumstance. Reference has been made to a case heard in the United States asking for an injunction to prevent fluoridation in which the judge, after hearing evidence for and against of the most eminent kind, came to the conclusion that fluorides were dangerous to health and liable to induce cancer. That judgment still stands. The decision to issue an injunction was appealed against and it was decided by the higher court of Pennsylvania—not the Supreme Court of the United States—that the injunction ought not to be issued. But the substance of the finding has been unassailed.
Reference has also been made to the decision of the Judicial Committee of the Privy Council in this country on an appeal from New Zealand. All that the Privy Council did was to confirm the judgment of the court below, which was based, as it said, on the assumption that fluorides are naturally found in water supplies and that the water supplies of New Zealand were deficient. That finding was made entirely upon the evidence advanced by the promoters of fluoridation, because the plaintiffs did not call any evidence. They assumed, it would seem, that the case was so to speak, self-evident. So that judgment clearly has no bearing upon the controversy which we are considering.
Always appeals are made to emotion—about children having dental treatment 1467 and suffering from pains in their teeth—and appeals are made to authority in the shape of bodies such as the Royal College of Physicians' Committee. I pointed out that it started off on the wrong foot and anybody who reads the report can see that the conclusions are quite unbelievable because, although they quote evidence of injury from fluoride they quote other people who said they had not found it. If they had said that on balance they thought there was no damage to the human body from fluoride, one could possible have believed it. But to say in chapter after chapter that there is no evidence, when the evidence is palpable—I have given some examples tonight—is certainly not a scientific way of going about things. I am reminded of what Galileo said; that in matters of science the opinion of one informed person may be worth that of thousands of others.
There are a great many eminent scientists all over the world, including Nobel prize-winners, who have objected to fluoridation, and on health grounds. After all, there still remains the ethical question: What right has any Government to impose a method of treatment upon people against their will? It has been a cardinal principle of the National Health Service since its beginning that no compulsion would be exercised on doctors as to their method of treatment. If they are not to be compelled, their patients certainly are not to be compelled. It is quite improper that they should be.
It is all very well to say that fluorides are found naturally in some water supplies. Very rarely are they in amounts such as are proposed. Lots of other things are found naturally in the water supplies—radioactive materials, for example—but it does not prove it is a good thing that they should be there: far from it. So I say once more that it is totally wrong that anybody should impose a treatment of this kind.
Reference was made by one speaker to vaccination against smallpox. Smallpox was never so rife in this country as at a time when vaccination was most stringently enforced on the population. The elimination of smallpox from the world has come about, not by vaccination but by the simple plan, known for a century or so, that what you need to do is to isolate the 1468 contacts and prevent the disease from spreading. That is an illustration of a medical myth which is still believed everywhere. I hope it will not be so for long.
§ Lord SEGAL
My Lords, before my noble friend sits down, purely as a matter of information, could he inform the House whether he has a conscientious objection to drinking chlorinated water?
§ Lord DOUGLAS of BARLOCH
My Lords, I have to drink chlorinated water; but let me point out that chlorine is added to water supplies in order to kill germs in them. It is not there for the purpose of being a treatment or as medicine for the consumers.
§ 7.26 p.m.
§ Lord COLWYN
My Lords, I, too, welcome the introduction of this debate today by my noble friend Lord Campbell of Croy. I agree it is high time something was done about this subject. We have heard some interesting speeches and I should like to include my contratulations on the maiden speech of the noble Earl, Lord Yarborough, although I did not really agree with anything he said.
I appreciate that fluoridation is a very emotive subject and I have no doubt that our deliberations this evening will have reprecussions for many weeks to come. When society is involved in vigorous, acrimonious and frequently apparently irrational debate on a topic which admits of no compromise, the time comes to stand back a little from the detailed battle and review the general position. Such a topic is the great issue before your Lordships' House today.
Over a number of years I have practised dentistry myself. I ought to have declared an interest, although just before the debate started the noble Lord, Lord Wells-Pestell, reminded me that perhaps it was not an interest to declare since if everything goes through I shall have no work to do at all! I shall not go into all the minute details about how many teeth are saved, 1469 and what happens to this or that, because I, too, could go on for two to three hours and bore your Lordships.
The scientific arguments for fluoridation are no longer in question. There is no room for scientific doubt that the addition of one part per million of fluoride to the public water supply is astonishingly effective in reducing the incidence of tooth decay. The apparent irrationality of some of the arguments offered by those of us who are against fluoridation and their consequent difficulty in defending them, must not lead those of us in favour of fluoridation to be too contemptuous, especially on occasions such as this, for it is often the case that in human affairs such a response is indicative of a deep socially important sense of duty which is not always rationally expressed by those who hold it. Indeed, such people may not even realise the nature of the deep-seated reason for their opposition to an innovation which looks to so many other citizens as overwhelmingly desirable.
The experience of the City of Birmingham, for instance, where the introduction of fluoride has now resulted in there being not enough children with decay for dental students in the hospitals to practise on, is just the most recent dramatic example of the effectiveness of fluoride. It may be that this particular episode in the nearly century-long history of knowledge of the effectiveness of fluoride in caries reduction will prove the ultimate clinching argument which will turn the balance of public opinion in the direction of fluoridation of the public water supply.
Current dental practice is very much aimed at prevention. We hear of topical applications, of fluoride rinses, of fissure sealants, and my noble friend Lord Campbell mentioned fluoride tablets. In fact, I disagree with him. They have to be taken for only six years, because teeth actually start forming six years before they appear in the mouth, so that if they are taken at conception and finish at around the age of six, that is sufficient protection. It is also a fact that correct oral hygiene—that is, cleaning of the teeth—done properly, will completely also eradicate dental caries.
But the present scope of dental treatment is just not reaching the vast majority of the population of this country. Only 40 1470 per cent. of us regularly visit our dentist, and 60 per cent. hardly go at all ! Only 30 per cent. of the population of this country have a functional toothbrush. That is a sobering thought. If everybody decided in the next week or so that they would go and see their dentist, the dental services just would not be able to cope with the patient demand.
Why do so many dentists—and I number myself among them—tend now towards private practice? It is because, under the health system, we were dealing with between 40 and 60 patients a day with dental decay. That is hard work, and as you get older is just impossible to deal with. We cannot cope with this epidemic problem. Perhaps the introduction of fluoride in the water supplies would enable far better use to be made of our National Health Service.
Before us we have a proved and effective treatment reaching the entire population. I have seen the children who suffer. It is all very well saying that they should clean their teeth and that we should take their sweets away from them. But it is not until you have had to hold down a screaming four-year old child, anaesthetise it and pull out baby teeth that you realise the difficulties and the immorality of not initiating a proved comprehensive treatment plan that will prevent untold cases of future suffering. Never has so much research been put into a single preventive programme. There are 158 million people in 38 countries who now drink fluoridated water. The scares and the correlation of fluoride in one part per million to detrimental health have been shown to be totally untrue. I have papers here—hundreds of them—showing not a single correlation between any of these diseases. The connections between cancer deaths are as vague as showing that cancer deaths in London are related to the frequency of No. 11 buses.
To be slightly light-hearted for a minute, in March, 1977, the Sunday Times warned us of the dangers of a new fire-fighting agent called "water"—a wonderful and total extinguishing resource. Its effectiveness in dealing with fires had been thoroughly tested and proved. But what of its dangers? Despite its efficiency, we must not store it in open spaces for people might fall in. If anyone accidentally immersed his head in a three-gallon 1471 bucket, it would prove fatal in three minutes. A reservoir might hold enough water to fill 500,000 of these buckets. If a bucket was used 100 times, there is enough water in one reservoir effectively to kill the entire population of the United Kingdom. Risks of this size should not be allowed, whatever the gain. If the water were to get out of control, the results of Flixborough or Seveso would pale into insignificance by comparison. What use was a fire-fighting agent that could kill men as well as fire?
I do not see fluoridation as compulsory medication. It is merely a process of supplementation or adjustment of a normal constituent of most natural waters to its optimum content, from the standpoint of public health. In any organised community, some sacrifice of personal liberty for the general good is inevitable. Insistence on absolute personal liberty is compatible only with anarchy. It seems to me to be possible that some, at least, of the strength of feeling of those against fluoridation has been due to the attempts of those, such as myself, to comment on the possible dangers of fluoride in too authoritative or too derisory a manner. Authority is all very well and is, of course, necessary in what we call a free society—by which term we mean a society in which the individual is not really free to do anything he feels inclined to do, but has to observe the restraints necessary to allow the rest of us to be free. But it is all too possible in these days, when we are already over-administered, to take authority too far, even to the extent of inciting a backlash. It seems to me that this point may well have been reached some years ago in the continuing fluoride debate.
The ordinary citizen has become more than a little tired living in a society which is usually described as free, but which he knows all too well is not, because he has to spend a great deal of his life filling in official forms, which become more and more intrusive as the years go by, and being careful to observe all manner of regulations the purpose of which is not always clear to him. The state of mind induced by this kind of experience, which we all share, is bound to induce in some the urgent need to express themselves as opposed to yet another intrusion upon their freedom.
1472 Where such a climate of opinion exists, it is really no wonder that some opposition will be of the diehard variety, and completely deaf to what those of us who are convinced of the benefit of fluoridation feel sure are reasonable arguments, such as the presence already in our water of various additives to make it wholesome as the law requires health and water authorities to supply. Their ears will also be closed to statements that we consider true, such as that fluoride in the strictly limited amounts necessary is perfectly safe.
One of the most noticeable facets of the important and continuing debate is that, in the main, the politicians keep out of it. They know how votes can get lost. Some Members of the other place have shown that they know it, by publishing their names in this circular which we have from Thames Ditton. On the other hand, the dental and medical professions, out of true compassion for the children and adults whose teeth could be spared the purges of decay, appear sometimes to move beyond their specialised and expert permit, and to enter further into the political arena than is their place or is likely to advance their cause.
In conclusion, I think I speak for most of my colleagues when I say how distressed we are that progress towards fluoridation has been so slow. I urge the Government to introduce legislation to compel water authorities to fluoridate our water supplies at the earliest opportunity.
§ Lord MONSON
My Lords, before the noble Lord sits down, may I put one short question to him? Could he confirm that fluoridation of the water supply can have no beneficial effect whatsoever upon anybody who has already achieved the age of 13 years or more?
§ Lord COLWYN
My Lords, the noble Lord is quite correct. The fluoride in the water certainly has a beneficial effect on the formation of teeth. But it is quite possible—and research is still going on—that the existence of fluoride may well have some kind of inhibitive reaction on the bacteria which actually cause decay. So that I would not necessarily agree with the noble Lord's statement.
§ 7.39 p.m.
§ Lord WELLS-PESTELL
My Lords, in view of the length of time that this Unstarred Question has taken, I am sure it will be of interest and pleasure to your Lordships to know that as I have to catch a particular train I shall not be speaking in this debate. There are, however, just one or two comments that I want to make. First, I should like to congratulate the noble Earl, Lord Yarborough, on his maiden speech, and of course I hope that he will not wait the same number of years before he delivers his second speech. Speaking for myself, it was rather a joy to hear my noble friend Lord Lovell-Davis again, and the noble Lord, Lord Colwyn, and I hope that we shall hear them more often than we have heard them recently.
I remember that on 12th March 1975 the noble Lord, Lord Aberdare, raised a question on this matter in your Lordships' House. He drew attention to a survey which had been carried out in Anglesey. Fluoride had been introduced into the water and the survey showed conclusively that the dental health of children there was much better than the dental health of children in Bangor and Caernarvon. I mention that for one reason and one reason only.
When I was talking to my noble friend Lord Cledwyn of Penton today, he happened to remark that at that particular time the decision to introduce fluoride into the water was taken by the county council. There seems to have been a change, either in recent months or in recent years, for it is now done by the area health authority. I was not aware of this, and I am wondering whether this ought not to be done by the elected representatives.
I am also wondering whether the noble Lord could find time to write to me at a later stage and let me know whether this is done exculsively by the area health authorities in this country. Certainly it is not done by the health authority in Scotland because I understood the noble Lord, Lord Campbell of Croy, to say that it is done by the local councils. It seems to me that it is a decision which should be taken by them.
The only other matter I want to raise is this. The noble Earl, Lord Yarborough, made some reference to the Department of 1474 Health and Social Security. I think he said that the health authority appears to have taken an entrenched position. I take "the health authority" to mean the Department of Health and Social Security. I spent some five years in the department and got to know it very well. I came away with the deepest and greatest respect for the ability and competence not only of the department generally but of the medical division in particular. If there are experts anywhere, they are to be found there. They would not have advised any Secretary of State or, for that matter, anybody else to take a particular course of action unless they were perfectly satisfied that what they were suggesting was based upon sound medical and, if I may say so, scientific evidence, because they also had on their staff a very distinguished scientist. I do not want to say anything more about that because it is terribly important that we should hear what the noble Lord the Minister is going to say by way of answer to this debate.
§ 7.43 p.m.
§ Lord CULLEN of ASH BOURNE
My Lords, I am sorry that we are going to be denied hearing a little more from the noble Lord, Lord Wells-Pestell. However, it is getting late. I shall be as quick as I can, but I am afraid it will take me a little time. I am sure that the whole House is grateful to my noble friend Lord Campbell of Croy for introducing this debate and to those who have spoken from their knowledge of this subject, with its implications for dental health and hence the general health of the whole community. I am sure that attention will be paid outside this House to the remarks of noble Lords who have spoken in this debate, especially those with expert knowledge of the subject.
The score is 7: 2 at the moment. I imagine that the noble Lord, Lord Wells-Pestell, is on the side of those who are in favour of fluoridation. Those seven in favour would like me to be able to say that the Government will wish to legislate during their term of office. The other two would like me to say that an inquiry will be held. I am afraid that I shall not satisfy any noble Lords. However, I can tell my noble friend that the announcement of an inquiry by the Minister of State is not accurate. Ministers are continuing to encourage fluoridation and their professional advisers will continue 1475 to examine carefully any material about fluoridation which gives adequate information on data and methods. I noticed in the newspaper today a report which said that a plan for legislation on fluoridation had now been scrapped. In point of fact, there was no plan. So these Press reports have to be very carefully looked at.
I was asked by the noble Baroness, Lady Robson of Kiddington, whether the fund was still in existence, the fund of £½ million a year. The fund is still in existence and intact. I am afraid that I am bound to be rather repetitive, but I have quite a lot to say. Much of it will answer points which have been raised by noble Lords. As to my noble friend's Question, I understand that nearly all water supplies contain some fluoride, but that in Scotland—where he has served with distinction as Secretary of State—some 95 per cent. of public water supplies are derived from surface water with a low fluoride content. I am advised, therefore, that it is most unlikely that there are any areas of Scotland where the optimum proportion of fluoride is present.
Lord CAMPBELL of CROY
My Lords, if my noble friend will give way, I tried to make it clear that the areas were South of the Border. There are no areas in Scotland. I mentioned some of the areas: Essex, South Shields and Hartlepool. I want to make it clear that I was not raising it in a Scottish context because it does not apply in Scotland.
§ Lord CULLEN of ASHBOURNE
My Lords, I am afraid that I shall be mentioning some of those, too. In England, which my noble friend has in mind, there are only a few water resources which contain naturally one part per million or more of fluoride. These are groundwater sources—as my noble friend says, occurring mainly in Buckinghamshire, Bedfordshire, Lincolnshire, Essex, Dorset, Derbyshire and Cleveland. With the exception of one major area, these sources are relatively minor and those which contain more than one part per million are either diluted with low fluoride water or are only used as emergency supplies. My right honourable friend the Secretary of State for the Environment is not aware of any sources of supply which naturally contain the optimum level of fluoride but which 1476 are intentionally or unintentionally diluted to below the optimum before being put into supply or into distribution. It would, however, take a disproportionate effort to establish this for certain.
The major area with a natural fluoride level of rather more than one part per million of fluoride is Hartlepool in Cleveland, to which I shall refer later. The water is supplied by the Hartlepool Water Company to a population of about 100,000 and the fluoride level is 1.3 to 1.4 parts per million. Although there are relatively few water supplies naturally containing the optimum level of fluoride, the better dental health of communities in areas served by such sources directed the thoughts of medical and dental research workers some 40 years ago to the possibility of devising a means of reducing the prevalence of dental decay—one of the commonest diseases—not merely in individuals but in the whole community.
These workers found that the greatest dental benefit occurred when a community's drinking water naturally contained about one part of fluoride per million parts of water. In temperate climates this was therefore regarded as the optimum proportion mentioned by my noble friend. Since, as I have said, nearly all water supplies contain some fluoride, the research workers considered that similar beneficial dental effects would be obtained by adjusting to the optimum level the fluoride content of supplies deficient in it naturally. Such adjustment was termed "fluoridation". Studies which began in the United States and Canada in 1945 showed that fluoridated water in the study areas, by comparison with low-fluoride control areas, also produced the protective effect against dental decay which had been observed in the areas with a satisfactory natural level of fluoride. For the greatest protective effect, fluoridated water had to be consumed from birth during the years of tooth formation; that is, to 14 years of age.
These results stimulated interest in this country and, on the advice of the Medical Research Council, the then British Government sent to the United States and Canada a mission consisting of dental, medical and scientific experts to study fluoridation in operation and to advise whether fluoride should be added to those 1477 water supplies in the United Kingdom which were deficient in it naturally. The mission reported in 1953 that fluoridation was a valuable public health measure through its effect in reducing dental decay, but that in this country fluoride should be added to the water supplies of some selected communities before its general adoption was considered.
Studies accordingly began in three areas of the United Kingdom in 1955–56, and reports published in 1962 and 1969 on the first five and 11 years showed substantial dental benefits in children who had consumed fluoridated water from birth, compared with children of the same ages in low-fluoride control areas. My noble friend will know that a study area in Scotland, Kilmarnock, decided to cease fluoridating its water supply in 1962. I am sorry to say that by 1968 experience of dental decay in five-year-old children, having previously improved, had in consequence increased to substantially the level of the unfluoridated control town. An expert Research Committee, set up to supervise the studies, concluded in the report on the first 11 years:The fluoridation of water supplies at the level of a part per million of fluoride is a highly effective way of reducing dental decay".Later studies of children brought up in fluoridated areas have confirmed the substantial benefit to their dental health compared with children in unfluoridated areas.
The reports of the official studies and of others in the United Kingdom could examine the effects on dental health only of children, bearing in mind that fluoridation in the areas concerned had not been in progress long enough for older people to have consumed fluoridated water during their early years. Fortunately, however, the areas with about the right level of fluoride naturally in their water supply provided an opportunity to study the effect of the optimum level of fluoride in water consumed during childhood on dental health later in life.
Studies in Hartlepool, for example, have shown substantially better dental health in adults who have lived all their lives there compared with people of the same ages in low-fluoride York. In one such study it was found that in dentate persons aged 45 and above the 1478 number of carious sites in teeth was 44 per cent lower in Hartlepool than it was in York. Such results disprove the suggestion that fluoridation merely delays the onset of dental decay. On the contrary, a satisfactory intake of fluoride in childhood confers protection against dental decay which persists during adult life. Experience has shown that other methods of providing an adequate intake of fluoride—for example, fluoride tablets or drops—are less effective than fluoridation, principally because it is difficult to ensure the necessary regular administration in all children over a period of years. However, other methods have a place in areas where the water is not yet fluoridated or where it is not feasible to do so.
My Lords, some of you will know that some years ago the Royal College of Physicians decided, as an independent body concerned with public health, to review the evidence on the fluoridation of water supplies. A committee of the college carried out a comprehensive review and reported in 1976 that fluoride in water, added or naturally present, over the years of tooth formation substantially reduced dental caries throughout life. There was, moreover, no sound evidence at all of harm to health. One chapter of the report dealt with an alleged link with cancer and concluded that there was no evidence that fluoride increased the incidence or mortality of cancer in any organ.
This and similar conclusions have attracted criticism notably from two United States biochemists, Drs. Burk and Yiamouyiannis, who have claimed that cancer mortality increased more in 10 American cities than it did in 10 unfluoridated cities in the same period. This claim was carefully examined by recognised cancer epidemiologists and medical statisticians in this country and North America, who have independently concluded that there is no difference in the changes in cancer mortality in the two groups of cities when appropriate corrections are made for different changes which have taken place in their age/sex/race compositions. Drs. Burk and Yiamouyiannis have since announced the results of further analyses, although without the necessary supporting evidence at certain critical points or in some cases at any point. Moreover, this material has not 1479 appeared in the usual scientific Press, where it would have been open to assessment by other scientists.
Dr. Burk has also re-examined data published in a 1974 paper from Oxford University about differences in cancer incidence in various organs between certain fluoridated areas and certain similar control areas, and between sets of areas with varying levels of fluoride naturally in their water supplies. I understand that differences reported in the Oxford paper could have arisen by chance and, as the author himself concluded, do not indicate an association between cancer incidence and fluoride in drinking water, whether present naturally or added artificially. It is notoriously easy to mislead by the inappropriate use of statistics. I have been advised that the persistent attempts to persuade the public by the use of figures which take no account of the demographic composition of populations under study is without justification and bound to mislead. I know that this judgment would have the widest and most vigorous support from expert epidemiologists and medical statisticians.
Because of the allegations of Drs. Burk and Yiamouyiannis many other studies of this question have been undertaken by appropriately qualified persons and published in scientific journals of good repute. The results of none of these studies support the allegations. Furthermore, reviews by experts in this and other countries have concluded that animal and other laboratory tests do not support the view that fluoride is a carcinogen; no properly authenticated tests have supported the assertion that fluoride salts, as used in fluoridation, are a mutagenic hazard to man.
My Lords, reference is often made to a case brought by local residents before the Court of Common Pleas, Allegheny County, Pennsylvania, to require a water authority to stop fluoridation in part of Pittsburgh and some outlying districts. The judge, sitting alone, said he was "compellingly convinced" of the plaintiffs' evidence, based largely on claims by Drs. Burk and Yiamouyiannis of a link between fluoridation and cancer. He therefore issued a preliminary decree until the court held a final hearing or until the matter was dealt with by the Pennsylvania 1480 Department of Environmental Resources. The court's jurisdiction is still the subject of an appeal, but meanwhile the Department of Environmental Resources, having considered the evidence given to the court, has directed that the water authority should continue to fluoridate. Fluoridation also continues in the rest of Pittsburgh, where it began in 1952. The case has therefore had little local effect, and the implications claimed for it are not convincing.
A commission appointed by the Governor of Minnesota also considered the claims of a link with cancer, including the evidence given in the Allegheny court. The commission issued a report last February concluding that claims of carcinogenic and other adverse health effects—were not supported by the preponderence of available scientific data".More recently still, a working party of the Australian National Health and Medical Research Council has reviewed the evidence available up to mid-1979 on possible adverse effects of fluoridation. The working party summarised its conclusions as follows:The evidence suggesting various adverse effects, and in particular the recently much published allegations that fluoridation leads to an increase in cancer mortality, does not stand up to scientific scrutiny".It is perfectly apparent that there is an overwhelming weight of evidence and of properly qualified scientific judgment that fluoridation is not a cause of cancer and is safe.
My Lords, on behalf of my right honourable friends the Health Ministers I must emphasise that the Government's professional advisers will continue to examine in the normal way the whole question of fluoridation. However, I hope my remarks have shown that there is no good reason to disturb the conclusion of the Royal College of Physicians and others that there is no evidence that the measure is associated with any harmful effect.
Noble Lords may have heard that the Quebec Government has declared a moratorium on fluoridation. I understand that this consists of the suspension by the present Quebec Government of the previous Government's measure to require all municipalities in the Province to fluoridate their drinking water, as distinct 1481 from the general position of encouragement of fluoridation by the Federal Government, while leaving the decision to individual municipalities. I gather that some Quebec municipalities, representing about 14 per cent. of the urban population, are continuing to fluoridate, and that about 46 per cent., which is about 8 million people, of the total urban population of Canada now receives fluoridated water.
We and the Republic of Ireland are at present the only EEC countries with fluoridation, and the reasons why the process is not more popular in Continental Europe are not entirely clear. I understand that comparable studies to our own were undertaken in the Netherlands with comparable results, but that fluoridation had to be discontinued because of a Supreme Court ruling that a separate unfluoridated water supply should be provided for those who wished to have it, This, of course, was technically impracticable. The measure continues on a substantial scale in the United States, Australia and New Zealand.
Finally, my Lords, I should like to assure my noble friend Lord Campbell of Croy and others that the Government, like their predecessors of both main parties for many years, continue to support the fluoridation of water supplies as a valuable preventive health measure. Our support stems from the results of our own properly controlled studies which have been endorsed by reports from independent workers and from medical and dental organisations, both here and abroad. We will, of course, continue to consider carefully any propely supported contrary claims which may be made. My honourable friend the Minister of Health will, I am sure, read with great interest the speeches made by your Lordships today. The Government will, however, be considering the recommendations of the Royal Commission on this, together with many other issues.