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?