Supporting the status quo

There are two controversial items on the agenda of standing committee this week but if staff reports are anything to go by, community activists are likely to be disappointed by the outcomes of both.

The first is the report and recommendation from administrative staff on water fluoridation in response to the Civic Works Committee’s request in January following a long and passionate public participation meeting on the issue. For a brief review of the issues raised there, check out my blog Fluoridation: Power in the bureaucracy?

The committee had requested staff’s response, in consultation with the Health Unit, to the matters raised by the public with specific attention to the legal issues around “informed consent”, the authority to cease fluoridation, and standard of care required by new provincial legislation. The committee also wanted some information on toxicity, suggestions about alternatives to fluoridation, and the process to be undertaken should council wish to discontinue the addition of fluoride to the water.

Anyone who attended the public meeting would not be surprised by the staff report that has come back, 50 pages of essentially repeating and endorsing the statements of the coalition of professional bodies that presented their opinions last January. What is interesting is the way in which the recommendation to continue fluoridation is presented. Rather than simply providing a recommendation, staff has prepared a lengthy preamble in the form of nine “whereases” detailing London’s past practices and identifying the various authorities on which the recommendation is based: the plebiscite of 1966, the World Health Organization, the U.S. Center for Disease Control, Health Canada, and on and on. Even the final recommendation is cloaked in authority and power:

THEREFORE BE IT RESOLVED THAT the Corporation of the City of London affirms its confidence in the integrity and recommendations of the World Health Organization, Health Canada, Ontario’s Chief Medical Officer of Health, and the Medical Officer of Health for the Middlesex-London Health Unit, and thus supports the ongoing fluoridation of the City of London’s drinking water.

It’s not about the drinking water; it’s a vote of confidence in the established authorities.

The report does go on to address the issues raised by the public, all 75 of them.

The one that I found of greatest interest was the issue of “informed consent”. If fluoride is a form of preventative medication, shouldn’t citizens have a right to say no? But how can you say no when it is in the public drinking water?

For this issue, staff referenced the Public Health Ethics Committee (CESP) of the National Public Health Institute of Québec which has recently considered this matter specifically in relation to fluoride. It concluded that “the benefits of fluoridation outweigh its potential negative effects on health and the environment and that such benefits justify impinging on the freedom of choice of people who do not wish to have their water fluoridated.”

Furthermore, according to the staff report, fluoride is not considered to be a drug under the Food and Drug Act, but a nutrient which, under Ontario’s Fluoridation Act, 1990 can be added to the water pursuant to a by-law of a local municipality. There are even a few court cases that establish the right.

And while there may be more effective ways of applying fluoride—in a dental clinic, a private dental practice, or in toothpaste—none is so cheap (38 cents per person per year) and reaches so many people as through the drinking water. And it saves a lot of money in dental bills.

As for the liability of council should the water treatment be shown to have negative side effects in the long term, come next year under the Safe Drinking Water Act, “no person will be considered to have failed in their duties if they relied in good faith on a report of a person whose professional qualifications lend credibility to the report.”

But why, members of the public asked, have dental caries decreased in the many countries of Europe which do not practice fluoridation?

The staff report cited a number of factors, among them diffusion through water-based products from fluoridating countries and better dental care social programs in many European countries as well as the addition of fluoride to other consumer products such as milk. Additionally, the report pointed to increased rates of dental caries in jurisdictions following the discontinuation of fluoridation.

In response to concerns and research finding that hint at links between fluoridation and various adverse health and behavioural effects, the report suggests that these can be discounted since the levels of fluoride cited are exceptionally high and therefore not applicable to the London situation, the research findings are equivocal and not consistent, and the methods of investigation are not sufficiently rigorous. In short, no need to pay attention to the dissenting claims.

The one negative effect that is given some credence is dental fluorosis, the permanent white spots on the teeth that result from excessive exposure to fluoride while the teeth are being formed in early childhood. This condition, it is argued, is not very common and, being cosmetic, does not cause significant harm.

As for the “how” of eliminating fluoride from the water, should council decide to go that route, it would not be difficult in the case of water from Lake Huron. All it would take is a vote by council since the fluoride is added for the city population at the Arva pumping station. No need to involve other municipalities. But for the water from Lake Erie, the fluoride is added at Port Stanley and would require the cooperation of the other counties that would be affected.

It’s doubtful, however, that the “how” will be much of an issue when the report is so heavily weighted to the status quo.

One issue that was not addressed was the matter of the “precautionary principle”, the idea that where matters of health are concerned, a product should be proven to be safe before it is widely distributed, just to be on the safe side.

From the viewpoint of the authors of the report, 45 years of fluoride ingestion have resulted in reduced cavities and no demonstrable negative health effects. But when large populations are all exposed to the same “nutrient”, it may be difficult to link specific health problems that appear to be on the rise—cancers, arthritis and other joint problems, osteoporosis, cardiovascular disease, mental health problems—to what may be one of many contributing factors.

What we do know is that direct topical application of fluoride is superior to fluoridated water flowing over the teeth.  That can be done by using fluoridated toothpastes as is already the case, supplemented by topical applications through dental clinics in the schools. We could even add fluoride to a selected product such as milk or chewing gum, although the last would require something greater than a local effort. But there are possibilities, other than the status quo.

Those are not options seriously contemplated in the report. They are deemed to be too expensive and/or too difficult to implement. It’s easier and cheaper to keep putting fluoride in the drinking water.

The committee’s response will be interesting. It would not be the first time it has set aside a staff recommendation, but my guess is that, despite significant lobbying from some members of the public, the status quo will prevail.