THE DENTIST, Letters Page, 18th April 2002.

Dear Editor

Re: Debate on fluoride, 21 March issue.

It's a pity more science is not used instead of opinion in such articles. Let's keep this simple and stick to the facts. Can the pro-fluoride lobby answer the following?

What dose of fluoride in mg gives the effect claimed? One part per million in water is irrelevant. How much water is drunk per individual? How much fluoride is absorbed by food in processing and so on? Any drug has a dose mg/kilo effectiveness. So what is the dose for fluoride? Simple science but never researched.

How much fluoride are people getting anyway as an average in their diet, etc? Basic question but, again, no answer.

Give one double blind study that shows fluoride claimed effect that will stand scientific scrutiny. Strange to say, there is not one study that stands up to scrutiny. All are flawed in some way and some are downright fraudulent.

Also, why did the US Food and Drug Administration (FDA) scientists independently publish a report over their concern with the cancer causing potential of fluoride?

Does fluoride delay development of children and cause a reduction in IQ as some scientific reports suggest? Fluoride delays eruption of permanent dentition. A tooth erupted certainly alters the decay statistics!

Is the increase in sarcomas seen in young males, and the increase in bony fractures among the elderly, that occurs in fluoridated areas a coincidence?

Is the increase of criminal behaviour seen in lactose deficient individuals seen in fluoridated areas also coincidental? Milk being the antidote to fluoride, of course.

Crops irrigated with fluoride water show enzyme deficiencies. Should we be concerned with this?

‘A wealth of practice experience’ is only opinion. Let us have the simple basic science instead of spin and we can make our own minds up.

Personally, until these questions are satisfactorily answered, I would not advocate the use of fluoride.

G Munro-Hall BDS, Stagsden, Bedfordshire.

Dear Editor

I totally agree with the comments of Tony Lees.

I am against mass medication; I think that individuals should have a choice on whether or not their water should be fluoridated. I, for one, would not drink it.

I think that the onus should be on the pro-fluoridation lobby to prove that it is safe. I am afraid that they have not convinced me!

Rob Pears BDS, DPDS

Dear Editor

Please can you share with your readers this letter to the Minister for Health from Lord Baldwin? He has very kindly agreed to allow us to share his recent letter to Lord Philip Hunt of King's Heath. It is self-explanatory.

Jane Jones, National Pure Water Association.

Dear Philip

Re: fluoridation

I am sorry I was not in the Chamber when Lord Beaumont of Whitley asked his ‘starred question’ about fluoridated milk on Wednesday 13 February. Since I have been out of action you have been spared hearing from me on this subject for a while! But I must enter the fray again now, having read the Hansard contributions to Lord Beaumont's Question, to correct some of the impressions that were given.

As you know, I was a member of the Advisory Board to the systematic scientific review of water fluoridation conducted by the NHS Centre for Reviews and Dissemination at York, whose report was published 18 months ago. I enclose once again what the distinguished Chairman of that board wrote in January 2001 (http://www.npwa.freeserve.co.uk/sheldon_letter.html) in refutation of misleading statements of the review findings put out by various bodies. It is discouraging to see some of these unscientific claims repeated in the House. None of what follows is my view; it is what the scientists found and can be read in their report.

1. You twice used the word ‘robust’ about the York review This may have been true of the methodology, and of the skills of the reviewers, but it is a term which is usually used of findings and York's findings were not robust. The review team was surprised by the weakness of the evidence. You made the findings sound clear cut; they were anything but.

2. You were right to speak of 'no clear association' with mortality (col. 1088). You were wrong to speak of ‘no evidence of the allegations ...made about fluoridation’ (col. 1090). There was evidence of harm but, because it went both ways, and the studies weren't well conducted, the jury is still out on the safety issue. That is why the report called for research to settle the question and why Professor Sheldon wrote, ‘The review did not show water fluoridation to be safe.’ The Medical Research Council's job is now to refine this recommendation. The ‘current scientific evidence regarding the health effects of water fluoridation’ (col. 1089), such as it is, has already been provided to you in exhaustive detail by the York report.

3. Having at last brought fluoridation within the purview of proper scientific enquiry, the Government should not now revert to unscientific (because poorly controlled) comparisons between e.g. Birmingham and Manchester, as you did in col. 1088, purporting to show ‘the effect of fluoridation in the water supply’. It did not show this and, indeed, the 1993-94 survey you cited was not even of a quality to be included by York among the other very low-quality studies (average validity score 1.6/8) which looked at comparisons between areas.

4. Similarly, for Lady Gardner to revert to worldwide opinion (on the extreme beneficence of fluoridation, col. 1089) is a retreat from science. It was largely to get away from opinion that the Government set up the York review. How can you, as a Minister, find this wholly persuasive (col. 1089)? Does the Government stand by the York findings and good science or not?

5. Though I support Lord Beaumont in the question he asked, he is not accurate in saying that fluoridation does not reduce decay. In terms of good-quality evidence, we just don't know. York thought that it probably did, to the tune of perhaps 15%, but that to be sure `the quality of the evidence would need to be higher' (Report 4.9).

6. The BDA's support for ‘targeted fluoridation’ (Lord Tomlinson, col. 1088) may sound admirable but, once again, the York review found little evidence for it. The supposed reduction in social inequalities in dental health was the most speculative finding of all, in a meticulous scientific survey which found no reliable evidence of anything.

7. The Question was about milk, but if the evidence for water is thin after more than 50 years that for the benefits and dangers of fluoride in milk must be exiguous. Can you tell me what, if any, research has been done on this? [See school milk fluoridation campaign story on page 3.]

This is all pretty depressing. If as a tax-paying member of the public I contribute to a year-long, world-class scientific investigation into a public health measure, I at least expect the Government that commissioned it to pay close attention to what it found, and not keep substituting their own interpretations of what the reviewers have so carefully assessed. As I have emphasised before, York looked at the whole body of work on fluoride from the beginnings until now, and pronounced it wanting. In this sense it is the history of everything, including your 1993-94 Birmingham survey, and you and your advisers cannot just pull out the bits you fancy, especially if they are contradicted by the review findings. As for 'opinion', this is of no value at all.

Earl Baldwin of Bewdley

Cc:

The Lord Tomlinson

The Baroness Gardner of Parkes

The Lord Clement Jones

The Countess of Mar

The Baroness Uddin

Professor T Sheldon

Professor J Kleijnen

Sir lain Chalmers