The Oireachtas (Joint Irish Houses of Parliament) Draft report on Water Fluoridation in Ireland

4 HISTORICAL BACKGROUND

Water Fluoridation in Ireland

Much of the information contained in this account is taken from Paul Beirne's Ireland's mandatory fluoridation policy: an historical analysis of the policy process. Other sources include Dail debates and the National Archives.

The Department for Health was headed by five different Ministers between 1948 and 1960. During that period, however, the senior civil servants in the Department remained unchanged. The Secretary of the Department, Padraig O'Cinnéide and the Assistant Secretary, Paddy Murray played pivotal roles in the water fluoridation policy-making process.

The public dental services had never been a major priority for the Department, but this changed in July 1951 when the Minister for Health, Dr Jim Ryan (Fianna Fail), appointed a dental consultative council to advise him on "the improvement and extension of the dental services at present provided by Local Authorities"¹. The Council noted that there were 624 names on the dental register in Ireland. Of these, only 560 dentists were in active practice, which gave a dentist to population ratio of 1:5,300. The Council noted that this dentist-to-population ratio did not compare favourably with other countries — Norway 1:1,600, Sweden 1: 2,300, Denmark 1: 2,300, Scotland 1: 4,100, England & Wales 1: 4,600.

The Council did express the view that the dentist/population ratio in other countries might not be necessarily fully comparable with this country, as there were "too many unknown factors involved, such as, the relative incidence of dental caries and the extent to which persons would seek treatment"². Nevertheless, they recommended that 325 dentists would be required in the Local Authority Dental Services to cater for four priority groups:

Pupils of National Schools;
Children attending Welfare Clinics and women in respect of motherhood;
Adolescent 14-19 yrs. Group³; and
Adults eligible for treatment under the Public Assistance Act 1939⁴.

The first investigation into dental caries in Ireland was undertaken in 1952 by the Medical Research Council of Ireland at the request of the Minister for Health, Dr Ryan, in order "to ascertain whether there are significant differences in dental conditions amongst school children living in different areas of the country and whether such differences, if they existed, could be related to the dietary intake of the children"⁵. It was later correlated with the Irish National Nutrition Survey, which was first undertaken in 1956⁶.

The dental survey related to three age groups:

- 8 -

Children aged five and six years;
Children aged seven and eight years; and
Children aged twelve and thirteen years.

Overall, 2,000 children were examined.

In the first age group, decayed or missing teeth represented 35.7% of the total number of teeth. In the second group, 41% was decayed and 6% missing. In the cases of children aged twelve and thirteen, 45% of the first teeth were decayed or missing, and 25% of the permanent teeth were decayed.

The above statistics would seem to correspond to the account given by Dr O'Mullane to the Committee;

"I worked in the School Dental Service in West Cork for a number of years in the mid 1960's. Children constantly had gum boils and toothaches and I spent all of my time travelling from town to town-extracting teeth. That was all I could do. There was a general anaesthetic session almost every day of the week in City Hall in Cork to extract the teeth of frightened children of frightened mothers; in other words we are talking about children with bad teeth in the 1960"⁷.

The results from the dental caries survey indicated that the recommendation for an extra 325 dentists was very wide of the mark. Nor was the recommendation practicable. in 1953, only 70 dentists were employed in the Local Authority Services. This had increased to a mere 74 by 1960. According to figures from the National Archives, the combined total of dental graduates from universities in the Republic came to 53. Of these, the majority emigrated as soon as they qualified⁸. Clearly, the Department was faced with an impossible situation and could not deal with the problem of dental caries on a treatment basis alone.

One of the recommendations of the Dental Consultative Council's Report was the appointment of a full-time dental surgeon to the staff of the Department of Health "in order that the Minister may be adequately advised on dental matters and in particular on those relating to Local Authority Dental Services"⁹. Seamus MacNeill was subsequently appointed to this key position. In outlining his new proposals for the Department, McNeil noted that:

"the prevalence of dental diseases, the problems involved and the cost of adequately controlling them appear on the face of it almost insurmountable in view of our limited resources...... At the present time we are trying to move from a position where the only resort is the mass extraction of diseased teeth due directly to a general state of neglect. The resort to such radical measures is not only incompatible with the function of public health but cannot be indefinitely tolerated by an enlightened administration"¹⁰.

Two key elements of a new strategy were to be "prevention" and "prophylaxis"¹¹.
These were entirely in keeping with the later proposals for fluoridation. Until 1955, fluoridation had not been properly investigated by the Department¹².

- 9 -

In March 1955, the Assistant Secretary of the Department, Paddy Murray, began an examination of fluoridation following the publication of a statement on fluoridation in the British Medical Journal of 26^th February, 1955¹³. The statement concentrated on the main findings of the "United Kingdom mission to report on the fluoridation of water supplies in North America"¹⁴.

"Epidemiological studies in America have demonstrated beyond doubt that among children and adults who have been born and brought up in areas where the drinking water contains fluoride at a level of 1ppm or more, there is much less dental caries than in areas were the water is free from fluoride. Compared with areas where the drinking water contains little or no fluoride there is 60% less dental caries among children aged 12 to 14 years and about six times as many children have permanent teeth which are free from caries.... We consider that an artificially fluoridated water similar in its action to one containing naturally derived fluoride.... We have found no scientific evidence that there is any danger to health from continual consumption of water containing fluoride at a low concentration Many suggestions have been made that certain ill effects may nevertheless occur. We can only comment that the proving of a negative is extremely difficult"¹⁵.

The first Departmental Memorandum on fluoridation was submitted in April 1955. In May 1956, a decision was taken by the Minister for Health to establish the Fluorine Consultative Council¹⁶. In January 1957, Minister T.F. O'Higgins appointed the Fluorine Consultative Council to advise on the following matters:

"whether with a view to reducing the incidence of dental caries it is desirable to provide for an increased intake of fluorine, and, if the Council considers it so desirable, to advise as to the best method of securing such an increased intake and as to any safeguards and precautions necessary"¹⁷.

The Fluorine Consultative Council had eighteen members. Its Chairman was Tom Murphy, Professor of Social and Preventative Medicine at UCD. There were five dentists on the Council, including Seamus MacNeill of the Department, three doctors, two engineers, two senior administrators, a vet, a geologist, a pharmaceutical chemist, the Chairman of a County Council who was also a Senator and a research chemist. Mr. Jim Ivers from the Department of Health was Secretary of the Council.

Minutes of the meetings of the Council indicate that it had less than an open mind on the question of fluoridation. In fact, the Council could be characterised as being avidly pro-fluoridation. Arguments put forward by organisations and individuals opposing fluoridation were immediately dismissed. At a meeting of the Council on March 12^th, 1957, Professor T Murphy, UCD, "the Chairman, suggested that a letter such as that received from Mr. Gerry Nolan of 10 Albert Place East, Dublin, should be read in full to the Consultative Council as an example of the unreasoned arguments put forward by most individuals" ¹⁸.

"Referring to the letter from Firinne, he said that their objections were based mainly on `spiras (sic)' articles. He questioned the authenticity and the reliability of the writings. It was argued that no point was raised in any of the letters, which the

- 10 -

Committee could not answer. The Chair suggested that all points could be answered under the following headings:

Harmful effects of fluoride as a poison. Arguments under this heading could be answered on the grounds that no proof is offered in their support.
Different consumption of water by individuals make the calculation of a safe dose if possible. Individual consumption does not vary widely in this country and anyway a wide safety gap is allowed when deciding the dose.
Fluoridation of water supplies causes teeth to harden and makes their treatment impossible. There is no evidence to support this argument.
Fluoridation only postpones dental decay. This is good in itself.
Arguments that fluoridation can have a harmful effect on the brain, etc. can be dismissed as unfounded.
The point regarding the benefits going to the aluminium industry does not affect the question to be decided by the Committee.
The administration of fluoride in tablet form is considered impracticable.
Hazards to operators, these can be overcome."

It is claimed that the Fluorine Consultative Council met on fifteen occasions, yet only the minutes of the above cited meeting survive. According to the Department of Health and Children, the other minutes and documentation relating to the Fluorine Consultative Council meetings were destroyed by floods¹⁹.

The Fluorine Consultative Council came to the following conclusions:

Having considered all the information available to it on the relation between fluoride and dental decay the Council is satisfied that increased intake of fluorine will reduce the incidence of dental caries and that it is desirable to provide for such an increased intake. The Council is further satisfied that the increased intake of fluorine can best be provided by fluoridation of public water supplies to the level of 1 part per million F.
In so recommending the Council is aware that quite 50% of the community would thereby benefit at present even if all public water supplies in the country were fluoridated but the percentage will increase according as public water supplies are extended.
Before any public water supply is fluoridated the Council considers that steps should be taken to assess the incidence of dental caries in children resident in the area served by that water supply. The Council also considers that subsequent to fluoridation adequate steps should be taken to permit a proper evaluation of the results.
Insofar as the engineering aspects of the fluoridation of public water supplies are concerned, the Council sees no particular difficulty in the procedure as the

- 11 -

methods employed in the addition of fluoride to a water supply are similar to those in common use for the addition of other chemicals to water. The methods used in the protection of public water workers handling fluoride salts are similar to those used in the handling of other chemicals which may have harmful effects and do not need special description here.

The Council is in doubt as to whether local authorities have the necessary statutory authority to add fluoride to public water supplies. It recommends the introduction of any legislation, which may be necessary to enable Local Authorities to discharge this function.

On the 8^th October, 1958, the report from the Fluorine Consultative Council was published, together with a statement that the Government had accepted, in principle, the recommendations of the Council.

The Government now wished to proceed as quickly as possible with a fluoridation policy, as it was a far more attractive economic option than dealing with dental caries on a treatment basis. A "Memorandum for the Government's Information" outlined the facts:

"Some indication of the dental manpower and financial problems which would arise if it were decided to attempt to cope with dental caries by treatment methods alone may be gained from the fact that in order to match Norway 's dentist to population ratio, this country would need a further 1,250 dentists, in addition to the present 625, at an extra cost to the community of about £2.5 millions per annum. Present public authority expenditure on dental services here is under £0.5 million pounds per annum. The shortage of dentists in Great Britain and the attraction of highly paid employment for newly qualified dentists there have already caused much difficulty in filling of Local Authority Dental Posts. Even if there were no emigration of graduates it would take many decades to increase dental man power to the extent indicated²⁰."

come from Exchequer and local funds. The initial capital costs were estimated at £100,000, which would involve no charge to the Exchequer. As a preventive health measure, fluoridation promised value for money.

The central concern of the Department was how to put the recommendation of the Council into legislative form. Although Local Authorities had the power and duty to provide "pure and wholesome" water to members of the public, the addition of a substance like fluoride would require new legal powers.

Discussions in the Department centred on whether the new legislation would be "enabling" or "mandatory". Initially, an Assistant Principal Officer in the Department, in a memorandum submitted on the 2^nd December, 1958 to Mr. Paddy Murray, Assistant Secretary, recommended enabling legislation. He was of the view that mandatory legislation would be unconstitutional. However, Mr. Murray took a different view and recommended mandatory legislation to the Secretary of the Department, Mr. O'Cinneide, who in turn recommended mandatory legislation to the Minister, Mr. McEntee. On the 8th December, 1958, the Minister approved the recommendation for mandatory legislation by his senior civil servants²¹.

- 12 -

Two key factors influenced the decision to opt for mandatory legislation. One was the problem of overlapping boundaries, for example, if Kildare decided to fluoridate while Dublin decided against, Dubliners would still have to drink fluoridated water if the supplies came from Kildare. These practical difficulties were alluded to by Dr Gavin when he came before the Committee²².

The second reason for opting for mandatory legislation was international evidence that allowing local communities to decide on this issue would result in long, drawn- out debates, making its introduction far more difficult. Mr. McEntee himself believed that Councillors simply did not have the competence to deal with "complicated questions of public health policy" (Dáil debates 9.11.60).
Dáil Debate of the Fluoridation Bill & High Court Case On the 5^th April, 1960 the Second Stage Debate on the Fluoridation of Water Supplies Bill 1959 began. In introducing the Bill, Minister McEntee stated: "This measure is intended to curb and reduce the incidence of disease which not only caused suffering, but also, because the damage it does may lead to grave disorders and prolonged ill health. The disease in question is dental caries"²³. The Minister claimed that, "the incidence of dental caries in the country is probably amongst the highest in the World"²⁴. The Minister went on to claim that "dental decay ... is not only a virulent source of suffering and mental strain but often the root cause of economic hardship and financial loss"²⁵.

The Minister also concentrated on the effects of this disease, dental caries, on children.

"For the past 40 years research into the problem of finding a prophylactic against dental caries has been intensively pursued in many countries. All results indicate that, if piped water supplies are available to the community, it is possible and easily practicable to build up in young children a high degree of immunity from it"²⁶.

The use of the word "immunity" suggests that the Minister believed that fluoride through ingestion somehow prevented this disease.

He rightly pointed out that fluoride occurred naturally as a trace element, not only in drinking waters but also in the "majority of foods, in vegetables, meats, cereals, fruit, fish and notably in tea"²⁷. It is a normal constituent of bones and teeth. In relation to the prevention of dental caries he was quite explicit in saying that "it would appear that an adequate intake of fluoride has a strongly inhibiting effect on its development"²⁸. Again, this suggests that the Minister was of the belief that the ingestion of fluoride was necessary in preventing dental caries.

Much of the evidence cited by Minister McEntee came from the New Zealand Commission on the Fluoridation of Public Water Supplies. He quotes their report: "fluoride is a natural component of all teeth and by hardening their mineral structure it makes them more resistance by acids"²⁹.

- 13 -

Interestingly, their report also states that the regular ingestion of a substantial excess of fluoride (more than 1.9 parts per million) in the drinking water may cause dental fluorosis. This is the only mention of dental fluorosis by the Minister. Part 3 of this report also dismissed as absurd and entirely misleading the arguments contained in anti fluoridation literature. In particular, Part 5 of the Commission's Report rejects the view that fluoride is harmful to health. The Minister also stated that the American Medical Association, the American Dental Association, the National Council, the College of American pathologists and the commission on chronic illness all sponsored and recommended fluoridation. To bolster his arguments the Minister quoted from the Pure Water Association, which opposed fluoridation. In their submission to the Minister they stated unequivocally "it would be idle to deny that good grounds exist for believing that the presence of fluorine in the diet, in some ways as yet unexplained, renders the teeth of young children resistant to decay". On the question of whether water fluoridation represented mass medication, he declared it was not a medication but rather a nutrient. He also dismissed arguments that this represented a grievous infringement of the rights of the individual. Public water supplies, he argued, did not belong to the individual but belonged to the community. Throughout the debate he studiously avoided the word "state", which under the circumstances would have been more appropriate, and continued to use the word "community". The Minister sought to placate those with health concerns by stating that section 6 of the Bill would enable the Minister for Health to carry out health studies on a particular area. In the Senate on the 14^th December, 1960 the Minister also dismissed the argument that the problem of dental caries be tackled by expanding the facilities for treating the disease. According to the Minister there were only 620 dentists in the country and proportionately only one third of countries like Sweden and the USA. Even then countries with the highest ratio of dentists to population could only treat properly one third of the people. We would therefore it seemed have to increase the number of dentists here nine fold to be able to tackle the problem adequately on a treatment basis.

Most opposition Deputies accepted the merits of water fluoridation. They could hardly do otherwise, as it was the main opposition party, Fine Gael, who had in fact set up the Fluorine Consultative Council. Instead, they objected to the mandatory nature of the Bill, saying that it flew in the face of the Fluorine Consultative Council's recommendation that enabling legislation be used. Many of the speakers drew attention to Recommendation 41 of the report, which explicitly provided for such enabling measures.

The leader of the opposition, James Dillon, put it in these terms:

"if there is a principle involved at all here it is the principal of excessive bureaucratic control. We have Local Authorities, we maintain them and I think it is true to say that in general principle we should avoid transferring the powers of these Local Authorities to the Custom House. As I would have understood it, that was the general philosophy of all Deputies here in so far as this should be quoted as a precedent for further actions, I think it is a bad precedent"³⁰.

- 14 -

He was fully supported by other Fine Gael Deputies. T.F. O'Higgins said, "we must accord to Local Authorities the liberty which our democracy has given to them, that is freedom of action".

"this Bill has the same sense of compulsion, the same smell of dictatorship about it as any that might be produced by a person who fails to recognise the integrity of the individual, who believes in the communist doctrine or the fascist doctrine that a person must be sub-ordinate to the interests of the State and not that the State is there to serve the interests of the individual if one believes in democracy, in Christian principles, in fair play, one must reject as improper this proposed mass medication without the consent of the people.......what has become of this country's professed ideal of the voluntary society?"³¹.

The Seanad Debate took a similar direction. When challenged to name another country in the world that has introduced fluoridation nationally, the Minister was forced to concede that none existed:

"in relation to the question as to whether the parliament of any other country than ours has accepted responsibility for empowering a Minister to secure that the public piped water supply will be fluoridated, I am not aware of any, but then if other countries do not carry their responsibilities, that is no justification for our failing to accept them and if it happened that for one reason or another the Swedish Parliament failed to live up to these responsibilities, I hope the Irish Parliament will live up to them ......as you know somewhere, sometime by some person, a beginning must be made" ³².

At the end of the Dáil Debate, Richie Ryan, frustrated by the lack of engagement with the subject in the Dáil remarked, "..I feel this House has not yet properly debated this radical proposal. Of its one hundred and forty-seven members, I believe only ten members have yet spoken their minds in public on this very important matter"³³.

A number of Local Authorities refused to obey the provisions of the Fluoridation of Water Supplies Act 1960. Leitrim and Tipperary Urban District Councils adopted resolutions protesting against water fluoridation. In April 1962, Cork Corporation passed a motion "informing the Minister for Health that it wished to take no part in the proposed scheme of fluoridation of the public water supplies of Cork"³⁴. Following extensive lobbying by the Irish Dental Association, the Councillors reversed their decision. Also in 1962, Dublin Corporation withheld approval for the expenditure of £1,100 to purchase fluoridation equipment. Minister McEntee responded by issuing an ultimatum to the Corporation to fluoridate the water supplies by the 1^st April, 1963. He threatened to abolish the Council and set up an inquiry, the cost of which would be borne by those members who objected to the measure³⁵. At the beginning of the meeting, a letter from the Minister was read out by Mr Robert Briscoe, urging the Corporation to "fulfil its obligations" and "obey the law". A decision on the issue had been deferred from the previous meeting pending the

- 15 -

outcome of a High Court action protesting the constitutionality of the Health Act by Mrs Gladys Ryan. The solicitor acting for Mrs. Ryan was Richie Ryan, T.D. who spoke vigorously against Mr. Briscoe's motion.

Under such enormous pressure from Central Government, Dublin City Council eventually voted 25 votes to 15 to authorise the necessary expenditure, following an acrimonious debate.

The High Court Case

There is little doubt that much of official certainty about the policy of water fluoridation can be explained by the High Court Case presided over by Judge John Kenny, and the Supreme Court challenge which followed it.

While the High Court case has been subjected to interminable legal study and has been quoted in Fluoridation Forum report, the Committee has not occupied itself with the details of the case for a number of important reasons.

Firstly, the Committee is dealing with a health policy today that should and can be scrutinized by the Oireachtas just as for any other health policy that is being implemented today.

Secondly, Judge Kenny's support for the conclusions of the Fluorine Consultative Council was based on the Council's assertion that "no other vehicle or techniques for the prophylactic application of fluorides can at present replace the fluoridation of drinking water as a public health measure" (Kenny J. 1963). The addition of fluoride to toothpastes from the 1970s onwards allied to other equally effective dental interventions have shown how unwise it was to be guided so completely by this assertion.

Thirdly and of crucial significance in this matter, the decision of the High Court relied on judicial interpretation of the scientific evidence by the learned judge. On the key issue of "whether fluoridation of water is or may be dangerous to the citizens of the State" ( ibid ), Judge Kenny's self-acknowledged reliance on one apparently expert witness has since been shown to have been extremely unwise. In The Fluoride Deception by Christopher Bryson, 2003, the evidence of Prof Hodge of the US PHS is revealed to have been less than reliable not to say entirely disingenuous, because of his undeclared role to protect US government strategic interests in fluorides.

Following the legal verdict that "there is no reasonable possibility that it (fluoridation) may involve an element of danger or risk to life or health to any of the citizens of this country" ( Kenny J 1963) it was all the more imperative for the Department of Health should apply the key provision of the legislation to investigate the other health effects that opponents had pointed to. But for the next forty years this crucial intervention was simply overlooked. The Kenny judgement which has been quoted so often since can now be seen to have been fundamentally flawed. Nevertheless it had profound social and political significance because it has effectively silenced any proper media debate on fluoridation since that time.

- 16 -

The Fluoridation Forum

The then Minister for Health, Micheal Martin, set up the Fluoridation Forum in 1999. The Forum was to investigate all aspects of the Water Fluoridation Policy, dating back forty years, and the report was to be completed within a year.

The fundamental problem for the Forum however soon emerged — how to meet the minister's wide terms of reference when virtually all previous research used to justify fluoridation had been done by dentists. As had already been noted by the UK York Review, even this research whether of UK, Irish or international origin, could not be relied upon to inform policy because of its poor quality. And as for non-dental or general research into fluoridation, the Minister himself confirmed it was needed when he referred at the launch of the report to "the absence of scientific risk assessment of the risks" of fluoridation. Below are some of the reasons why the public had cause to be worried and why the Forum did not produce, contrary to the Minister's assertion at its launch, "a credible and valuable report".

From the outset, the Forum's membership was subjected to serious criticism. Opponents questioned the overwhelming representation of government employees and dentists with very limited independent medical or toxicological expertise. Moreover the only medical group involved, Irish Doctors Environment Association, subsequently criticized the Forum for publishing its report without answering their own and other health-related questions, in particular the 50 Reasons to Oppose Fluoridation that were submitted in person by Dr Paul Connett to leading Forum members. The issue of bias was raised at the Committee by Dr Don MacAuley of Irish Dentists opposed to fluoridation:

"One of my reasons for refusing to attend the Forum in January 2001 was that it was pro fluoride and, therefore, it was not a serious, independent or fair assessment of fluoridation in Ireland. The Minister referred to the open nature of the Forum but how open was it? If we look at the Forum we can see it as another of the international fluoridation promoters. Professor O'Mullane is on a leaflet of the British Fluoridation Society where he is promoting fluoridation to the elderly. Other connections include the British Nutrition Foundation. Professor O'Mullane presented at a 1999 conference. Their advice on improving oral health placed fluoridation at No. 2 and sugar reduction moved to No. 5. Irish Dentists Opposing Fluoridation believe that tooth decay is not due to lack of fluoride but a sugary diet is a major factor. This member appears to favor fluoridation before diet education. Professor John Clarkson is past president of the International Association of Dental Research which fully endorses and strongly recommends the practice of water fluoridation. Therefore, he would also not appear to be open on this subject. National fluoridation supporters include Dr. Gerard Gavin. These people have made their position on fluoride clear to the media, in publications and at conferences. Dr. Gerard Gavin has stated that 'we consider fluoridation safe at the levels it is being used in Ireland'.".

Dr. Maire O'Connor and Dr. Howard Johnson co-authored a report which strongly supported the continuation of fluoridation. Dr. Joe Mullen was reported in the Irish

- 17 -

Medical News as saying "fluoridation benefits dental health and adverse medical effects are unproven". (Health Committee, 10 July 2003)

The failure to answer the fundamental questions about fluoridation has undermined both the Forum and the Minister's promise that it would allay the fears of all those who were worried about fluoridation. Even those aspects which the report did address such as the public perception of fluoridation, were not clearly reported in order to downplay the finding that over 90% of public submissions were opposed to fluoridation.

The report's failings were further compounded by the Minister when he claimed that it was based only on scientific and not anecdotal evidence. Within two months this claim was rejected by international scientists (Scientific Critique of the Fluoridation Forum Report, October 2002) who exposed the lack of scientific scrutiny in the report. The Minister was specifically criticised for not addressing the scientific evidence available in the published literature and in particular that evidence that had been directly raised by Dr. Connett and Dr. Limeback in their submissions to the Forum in Cork in October 2000. Worse still the Forum was accused of not even being familiar with the international science on the subject. (UK NHS York Review, September 2000)

Other criticism of the Forum was made to the Committee in relation to matters arising in the Food Safety Authority of Ireland in 2001 when it investigated fluoridated water used in making up infant formula. The Committee was disquieted to learn that the minutes of a meeting of its Scientific Committee, which recommended that parents not use fluoridated tap-water to make up infant formula, were subsequently changed to state almost the exact opposite. The explanations given by Dr. Wayne Anderson in this regard were unconvincing:

"At the meeting, nine of the 15 members of the committee were present and six were absent. The nine members in attendance read through the report, listened to the discussions and accepted the report on behalf of the scientific committee, at which point I was correctly under the impression that the report was passed by it."

The meeting of the Fluoridation Forum was held a day or two after the scientific committee meeting and so I presented the report as the conclusions of the scientific committee. In the preceding few days, some of the members who were not present at the scientific committee meeting contacted the Food Safety Authority of Ireland and the chairman of the scientific committee and basically said they felt that, having now read the report, it contained some errors and that it did not necessarily take account of all the available scientific evidence. At that point the chairman said that, effectively, the report was no longer supported by the majority of the scientific committee and I had to withdraw the report at the next meeting of the Fluoridation Forum. (July 20, 2003)

The former chairman of the committee, Batt O'Keefe TD, reacted to this explanation thus:

- 18 -

Chairman: It sounds like a real process mess. How many scientists of the overall group were present when this was first adopted?

Dr. Anderson: Nine out of 15; there were six absent.

Chairman: Was it the six people who were not present who subsequently made the objections to the scientific analysis and basis of it, or did members who adopted the report make objections subsequently?

Dr. Anderson: It was some of the absent members. (10 July 2003)

The Committee believes that the Forum Report's subsequent Risk Assessment on fluoride intake of Irish infants consuming infant formula re-constituted with fluoridated water was an attempt to put scientific respectability on this volte-face by the FSAI. The manner in which this key recommendation was changed was both irregular and suspect.

There were other contradictions between what the Forum recommended and what individual members stated on a particular issue, in this case once again relating to fluoridated water in infant feed. One of its most prominent members, Dr. John Clarkson, Professor of Dental Health & Dean of Dublin Dental School & Hospital, further undermined the credibility of the Forum on the issue of tap water and infant formula when he published a paper (with his colleague Dr. Jacinta McLoughlin) "Role of Fluoride in oral health promotion" in the International Dental Journal (2000) in the same year as the Forum was at work.
(www.fdiworldental.org/assets/pdf/commission/97_6_1.pdf).

It contained the following advice:

"Fluorosis and infant formulas -
The risk of fluorosis resulting from the use of infant formulas has been reduced considerably as a result of the action of manufacturers in reducing the amount of fluoride in these products. However, infant formulas should still be prepared using non-fluoridated water".

Recommendation 5 of the Report of the Forum of which Prof Clarkson was a leading member, advised something completely contrary -

"Infant formula should continue to be reconstituted with boiled tap water in accordance with manufacturers' instructions. Alternatively ready-to-feed formula can be used".

The Forum website elaborates as follows but nowhere does it advise, as does Professor Clarkson, using non-fluoridated water.

Question 3: Should I use fluoridated water to make up my baby's feeds?
Answer: Yes. The Forum recommends that parents continue to prepare baby feeds with boiled tap water and to follow the manufacturers' instructions."
It should be noted that no manufacturer issues instructions to use fluoridated water.

- 19 -

Question 4: Is it okay to use bottled water to make up feeds?
Answer: The Forum recommends that you do not use bottled water to make up your baby's feeds. Bottled water on sale in Ireland may contain salt which is not recommended for babies."
(was at www.doh.ie/publications/fluoridation/faqpar.html; full report at
www.dohc.ie/publications/fluoridation_forum.html)

While the Forum and its report have been regularly referred to in subsequent ministerial statements, none of its thirty three conclusions have been implemented. This raises fundamental questions about fluoridation policy within the Department. And as admitted by Forum member and Principal Dental Surgeon on 10^th July, 2003, it is not acceptable that Health Boards have been left in limbo. Health Boards (HSE) still have no new legal guidance on what concentration fluoride should be dosed at. Even at the most basic level of public approval, the Forum report clearly demonstrated that fluoridation is extremely unpopular with the individual members of the public- for a whole variety of reasons- who the Forum simply dismissed as poorly informed.

Aftermath of the Fluoridation Forum

While the Forum fell far short of expectation and achievement there is evidence to suggest that as a proper investigation of policy, it was compromised from the outset. The minister appointed his most senior adviser on dental policy, the Chief Dental Officer, to the Forum. How could an objective assessment of policy be achieved if the prime and long-time exponent of that policy was a leading player on the investigation? Fluoridation has been so central to Irish dental policy for many years that it would have been inconceivable for any forum to conduct a fair investigation with the prime advocate for the policy being an integral member of the review.

Several members of the Committee expressed their reservations at the time the Forum was announced, however it was not until the Forum released the report a full year later that its limitations were fully revealed. Its key recommendation --- to reduce the fluoride concentration from 1 ppm to 0.7 ppm in response to the increase in dental fluorosis — was a totally inadequate response to the over-exposure to fluoride in children. Equally inexplicable was the eighteen month delay before the body that was set up to implement the far-reaching recommendations of this "credible and valuable" report, first met in April 2004.

There was another explanation for the policy drift following the Forum report. Some eight months after its publication, in May 2003, the same Chief Dental Officer and departmental spokesman on fluoridation policy, resigned to take up a position in the private sector. At the same time that the allegedly far-reaching recommendations of the Forum were to be implemented, the top government adviser on dental policy resigned. The Committee finds this further compelling evidence to question the wisdom of the Minister to have appointed the Chief Dental Officer to membership of the Forum.

- 20 -

Whatever the reasons for its failure, the Forum did consult experts from the UK, Canada and the United States. It started work just after the publication of the York Review. This Review revealed alarming results of fluorosis in a population exposed to drinking water fluoridated at the concentration legally enforced in Ireland. Almost half (48%) of people in a fluoridated area such as Ireland showed some form of dental fluorosis and the Review found a clear dose response relationship between the concentration of fluoride in water and fluorosis. Dr. Don MacAuley of IDOF is of the view that this key finding was not addressed properly by the Forum. Dr. Paul Connett has also made it clear that the Forum did not answer the scientific evidence presented to it. His fifty questions about fluoridation were not addressed in the Forum Report.

- 21 -

This page was blank in the report.

- 22 -

Next >>

<< Previous

back to top of document