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Monday, January 30, 2012

Fluoridation: Power in the bureaucracy?

It’s doubtful that many hearts or minds were changed as a result of the meeting on fluoride last week. Most of the several hundred people who attended the public participation meeting in Centennial Hall came to cheer or jeer depending on what side of the argument each of the 59 delegations was taking.

The meeting was rumoured to last beyond 11p.m., the usual deadline. Anything later than that requires as special motion of the committee, in this case, the Civic Works Committee. As it was, things didn’t wrap up until after 1 a.m.

I wasn’t looking forward to another long night, but I was glad to see this issue finally come forward for discussion. It has been a long time coming.

I can recall some of the original debate and plebiscite on this matter. The city was full of talk about putting rat poison in the water. Despite the concern at that time, the proposal passed in 1967, our centennial year. London has continued to put fluoride in the water ever since although some weeks were missed a few years ago because of shortages of fluoride. Every year, the city spends about $133,000 on this.

For a public health measure, that’s not a lot of money, only 38 cents per person, as was constantly pointed out by the pro side at the meeting. Especially for something that the U.S. Centers for Disease Control and Prevention declared to be one of the ten great public health achievements of the 20th century.

But very early in my tenure on city council, I, along with other councillors, was approached by those who begged to differ, namely Chris Gupta, a local activist who works with the citizens’ group, Waterloo Watch. Their presentation on the possible negative effects of fluoride prompted me to sit down with the head of our water department to discuss our practices at the city. I learned that Health Canada was undertaking a full review of fluoridation; I should wait for the outcome of that review. That was in 2008.

The review took a long time, although it turned out to be only a literature review re-spouting  what others had said before. Not surprisingly, it concluded that fluoridation was a public good and should be continued.

The argument for fluoridation is simple: since the introduction of fluoride in public drinking water, rates of dental caries have declined. Although fluoride is a toxin, it creates adverse effects only if the concentration reaches a certain level. As long as you stay below that level, there will be benefits in dental health, especially for the poor who may not have access to alternative sources of dental care. The only downside is that a few people may develop white spots on their teeth known as dental fluorosis which is generally mild and cosmetic in nature.

That was the basic argument put forward at the meeting. Most of those who spoke to endorse it came from the public health and dental establishment—dentists, dental hygienists, professional associations of the foregoing, public health agencies. It was an impressive array of credentials. Many of them spoke at the outset of the meeting while councillors, attendees and media were still fresh. Many left when their presentations were concluded, and much of the media left with them. There were deadlines to meet and the meeting wouldn’t be over anytime soon.

The speakers on the other side were not completely lacking in credentials--retired science professors, a nutritionist, a chemistry PhD, the Canadian Association of Physicians for the Environment--and many of those without independent credentials quoted experts or brought in videos of researchers in other cities, provinces and countries refuting the claims of safety and efficacy.

If fluoride is so safe, they asked, why is it that US manufacturers of fluoride toothpaste have warnings on their product advising consumers not to swallow and to get help if they accidentally do so? If fluoride works, why is it that there are no statistically significant differences in the rate of tooth decay between jurisdictions with and without fluoride? What about the research pointing to links of fluoride ingestion to reduced sperm production, bone cancer, osteoporosis? And even if it works, why put it in the water when the benefits are from topical application which can readily be done by brushing or rinsing with a mouthwash? And how can one claim that there is a safe dosage when the amount of water ingested is not controlled? What about the smiles of victims of dental fluorosis?

They were all good questions with few answers or explanations forthcoming. But even if there were, few in attendance were listening, preferring instead to applaud or cheer when a speaker met their fancy, primarily those who advocated ceasing adding fluoride to the drinking water.

Those speakers defending the practice who remained to the end of the meeting were probably surprised by the passion of their non-believing opponents.  They had stressed repeatedly how all the evidence was on their side. To prove their point, they named the individuals and organizations that had said fluoride was both benign and beneficial. “Every good group promotes fluoride,” concluded a local orthodontist.

That was too much for one delegation. “That’s evidence, not of science, but of their power in the bureaucracy,” he pronounced to loud applause.

But of all the arguments and concerns, the one that resonated most was that of “informed consent,” the basic principle in medicine and in science that the individual has right to refuse treatment based on full knowledge of the benefits and risks. It’s impossible to avoid fluoride when it’s in the water that you use for drinking, cooking and bathing.

The message was loud and clear for the members of the Civic Works Committee. “Informed consent, you don’t have that,” said the final speaker. “Please stop putting it in the water.”

It was well after midnight, too late for entering into a prolonged debate. The mayor moved that the delegations be received and referred to staff for a report back with a recommendation at a subsequent meeting. To that Councillor Joni Baechler added an amendment that the report should include information on the toxicology of fluoride as well as a legal opinion on the implications of informed consent and the new regulation pertaining to standard of care that is expected to take effect in January of 2013. As well, staff was asked that the report include information on the jurisdictional issues over water treatment and some possible alternatives to fluoridation.

Playing to his populist base, Councillor Steve Orser tried to raise the spectre of fluoride as a Nazi plot and then advised the room that under the Fluoridation Act council could be forced to submit the question to a plebiscite if so requested by a petition signed by 10 percent of the eligible voters.

Let’s hope that isn’t necessary. The fluoride activists, despite their lack of decorum from time to time, have made significant gains in putting forward their case. Most on the committee seem to have open minds. And while a simple majority of those voting could decide the question, such a vote would be complicated by the fact that London shares its water treatment facilities with other counties.

There is no requirement to hold a plebiscite to make things happen. Council can simply pass a by-law if it wishes. It will, however, need the cooperation of the other affected municipalities.

That could take a little time, but perhaps much less than a plebiscite.

For my report on the public meeting that took place last March, see Is it time to reconsider fluoridation?


Mike Sloan said...

Those opposing fluoride remind me of the same types of people that oppose immunization. There is a element of hysteria in the way the issues are discussed. There is nothing wrong with reviewing public policy, but I can't find evidence that there is harm in fluoridation or immunization. What does exist is only anecdotal.

Oliver Hobson said...

When medicare was first introduced by Saint Tommy Douglas, the medical community, especially in Saskatchewan, objected going so far as to strike in opposition of its introduction.

At the heart of the medical community's objection was money.

Governments were not going to pay the full amount for their services as recommended in fee schedules set out by the Colleges of Doctors and Surgeons.

If taking fluoride out of the water has a negative effect on peoples teeth, it could increase a demand for the services of local dentists which might in turn pressure them to drop prices...or face public calls for inclusion of dentistry in our healthcare system.

Perhaps that's why some dentists spent their time supporting calls for keeping fluoride in the water.

Anonymous said...

To Mike: it should be our choice, we don't have a choice unless we filter our water...($$$). If you want fluoride use toothpaste, it's cheap but don't force fluoride into the water.

The people that are professionals and recommend putting fluoride in our water... do they drink filtered, bottled or straight from the tap?... ask them, it's our duty.

I bet (ask them) since they are educated and most likely have substantial amounts of money that their home water is purified in some way. They will reply that they drink purified water at home because of other "potential" pollutants or they purchase bottled water because of the convenience of not having a portable container handy at the drink fountain.

We get extra fluoride in our food from farms in other cities that wash food with fluoridated water also.

Use the extra money from not using fluoride in our water to make it cleaner... the city should purchase 100x more coconut carbon and keep the council spenders happy!

Anonymous said...

I AM a poor person with a poor family and even we can afford toothpaste which is all the fluoride I truly need. I prefer to have a CHOICE in what I use, not be force fed it because someone else said I have to have it. I notice that when it is for another group's benefit suddenly we care about the poor again. Here is something....raise the welfare rates and perhaps the poor could afford the proper nutrition and wouldn't need fluoride ANYWHERE to get good dental care.

Carol Burns said...

If the issue of informed consent prevails, how will that impact on the city's ability to purify the water, enforce public health measures which might result in trace amounts of chemical residue in food or on clothing, etc.?

Anonymous said...

I agree with with Orser...only a Nazi would plot to medicate our drinking water without our informed conscent and I applaud his audocicty for saying so, out loud, in public.

Rockinon said...

When my granddaughter was born, her one grandmother, a dental hygienist, insisted that the little girl be given only non-fluoridated bottled water. Babies should not be given fluoridated water, she insisted.

I thought this was nuts. But, when I checked the American Dental Association site I read,"If your baby is primarily fed infant formula...check with your dentist, pediatrician or family physician on the most appropriate water to use to mix with the formula."

I also read, "Do not use fluoride toothpaste until the child is two years old..." For children older than two there were warnings about always supervising children while brushing, using no more than "one pea-sized amount of fluoride toothpaste" at each brushing and making sure they spit all out and didn't swallow.

When I was a little boy, 60 years ago, I had my teeth painted with fluoride as part of a research program. I have good teeth. The other children in the that testing program also have good teeth, as far as I know. I have slowly come to believe that there is little reason to worry folk by messing with their water. It is possible to easily, cheaply and efficiently get fluoride in many other ways today. And we can control the dosage delivered with great accuracy and insure the maximum benefit.

Remember the AMA says, "Getting the right amount of fluoride is best — not too much and not too little." With published advice like that, it is no wonder some people worry.

Anonymous said...

Agreed! There is very little rational, scientific ground for the anti-flouride folks to stand on. The proof, as they say, is in the peer-reviewed medical journals.
If people are really concerned about drinking flouride then buy a $30 activated alumina water filter.
- Robin Wing

Barry Wells said...

There are scores and scores of bona-fide scientific reports and studies that suggest water fluoridation is both harmful to human health and unnecessary.

And there is no question whatsoever that it is unethical in the "informed consent" and mass-medication department.

Simply Google Dr. Hardy Limeback ~ one of Canada's leading authorities on preventive dentistry and water fluoridation ~ and you'll find his article on this subject, an article that cites many, many relevant scientific studies which indicate water fluoridation is bad news.

One has a choice in getting the flu shot for example. I had it once in 2004 and had an allergic reaction.

Londoners have no choice in the water fluoridation department, noting the most recent ballot question was 45 years ago in 1967 ~ before the vast majority of Londoners were born or of legal voting age.

Further, if the U.S. Centers for Disease Control and Prevention has declared water fluoridation to be one of the 10 great public health achievements of the 20th century, I'm shocked they haven't also declared me to be the certified Caliph of Baghdad.

Finally, it's interesting to note the Middlesex-London Health Unit is buying the Health Canada party line hook, line and sinker regarding water fluoridation but refused to do so when it vigorously opposed the cosmetic use of pesticides.

It's time to get this toxic crap out of our public drinking water and the environment.

It's also time for industry to pay to dispose of waste fluoride at toxic waste disposal sites as should have been occurring since Day One.

Barry Wells said...

The article and scientific studies regarding water fluoridation can be found here (the scientific studies are cited at the end of the article): http://www.fluoridealert.org/limeback.htm

Barry Wells said...

Water fluoridation is the only case in modern civilization's history (to my knowledge) where industry has managed to avoid the costs of taking its toxic waste to toxic waste disposal dumps and somehow managed to be paid for its toxic waste products and have them dumped into the public drinking water ~ for many decades.

Give it some thought.

Anonymous said...

Actually, Stevie O, flouride is a Commie plot. http://www.youtube.com/watch?v=X4XhhTF7vRM

And the dentists would love less fluoridation - more work for them. But seriously, the ones who would suffer from having more cavities are those who cannot afford dental care. And no, the government will not include dental care on the OHIP list.