The report brought forward by one of our members, Deputy Gormley, who has been working on this report since 2004 has been circulated.
Report on Water Fluoridation: Discussion.
Even longer.
Yes. We are trying to be helpful to Deputy Gormley to ensure the report is published as quickly as possible because it has been in the process for many years. To be fair to the author, we will try to devote as much time as we can now to discussing the report. I invite Deputy Gormley to give the committee an overview of what is contained in the report, following which the committee will discuss its recommendations. We have an hour set aside for the discussion.
The report is long and I am aware Deputies and Senators are busy but I hope they have had an opportunity to examine elements of it. At the outset I ask members to forgive the few typographical errors in the report. They will be corrected. In terms of the recommendations, there is one conclusion which is actually a recommendation. Those are minor aspects I want to mention.
What we tried to do in this report is examine objectively the question of water fluoridation, which is a controversial subject. Irish water supplies have been fluoridated for approximately 40 years. I have circulated to members some supplementary documentation, part of which I hope to include in the report. I welcome suggestions or proposed deletions from members because this is not a political report. If members are sensitive to certain aspects of it, I am happy to delete those items as long as the essential elements remain in the report.
I ask the Deputies and Senators to read the Health (Fluoridation of Water Supplies) Act 1960 because it is essential that we understand what happened at that time. In the report I detail some archive material. I examined the debates in the National Archives to try to understand the thinking at the time. It is clear from those that there was a serious dental caries problem at that time. I will not detail all the issues in the report but suffice to say there were not enough dentists to treat people at the time. We had a serious problem in that regard and therefore the problem could not be dealt with on a treatment basis. A prophylactic measure, as it was known, was examined. That was seen to be successful in the United States and it was adopted here.
During the debate it was clear that health studies were to be conducted. That is mentioned under section 6 of the Act, which I have circulated in the supplementary document, to which I refer the members. It is important that I include the legislation in the report because it gives a better understanding of the issue.
On what page is the reference to section 6?
The legislation is in the last document. Section 6 states: "It shall be the duty of the Minister to arrange from time to time for such surveys as appear to him to be desirable to be made as respects the health, or any particular aspects of the health, of persons, or of particular classes of persons, in the functional area of a health authority in relation to whom the regulations under section 2 of this Act are in force." That is important because it is clear that no health studies, and this is what this committee determined, were ever carried out under section 6.
The Minister now has a difficulty regarding the introduction of the recommendations of the Forum on Fluoridation. That forum reported some years ago but not a single one of its 33 recommendations has been implemented. The central recommendation was the reduction of the fluoride level to seven parts per million. My understanding of the legislation is that that cannot be done because health studies were not carried out. If members read section 2 they will see that. I may be misinterpreting that section but that is my reading of it. In any case, in my view it represents a dereliction of duty on the part of successive Ministers that health studies were not done when they ought to have been done.
I have examined various reports and the most important report on fluoridation, and the one that is recognised internationally, is the York review. It states in simple terms that when all the literature and the studies done have been reviewed, in terms of the effectiveness of water fluoridation dealing with dental caries, there is approximately a 14.6% difference between fluoridated and non-fluoridated water. That is not as high a percentage as that put forward by the people who presented to the committee, who said there was a 40% difference. I deal with that in the report and show that some of those studies were not reliable. We are talking about a 14.6% difference. On the other hand, the York review states that in terms of fluorosis, and this is an issue we as a health committee ought to be concerned about, the difference is 48%.
There has been a sevenfold increase in dental fluorosis. Many children now suffer from dental fluorosis, which is a manifestation of fluoride overload. We must be concerned about that. It is important that we examine the common ground. We are aware that 50% of the fluoride ingested remains in the body and in the hard tissue. I could go into the health effects of fluoride.
When I was preparing this report, I found many contradictory studies on the health effects of fluoride such that it was difficult to draw a conclusion on it and state definitely that it has a health effect. However, we know that fluoride is a toxic substance and once it is in the body, it remains in it. We also know that to combat dental caries, fluoride does not need to be ingested. All the people involved have admitted that. Those who are pro-fluoridation and those who are anti-fluoridation have said clearly it was thought that when fluoride was introduced, it acted systemically and had to be ingested, but they now know that it acts topically. In other words, one only has to have it in one's mouth. That is why all sides agree that fluoride toothpaste has made a big contribution to dental health.
With regard to decayed, missing and filled teeth, DMFT, differences will arise in children but there are no statistical differences in adults in terms of fluoridated and non-fluoridated water. The various reasons for that are detailed in the report. There is an issue in delayed tooth eruption, which I have outlined. We believe fluoride has the effect of delaying the eruption of teeth. I have given the detail of this in the supplementary documentation.
The key issue on which we focused, and on which the committee focused, is water fluoridation and infant formula. It seems clear that fluoridated water should not be used in reconstituting infant formula for bottle-fed babies. Having checked the Internet and many reports dealing with this issue, it seems that even people who are pro-fluoridation have admitted this in various reports. I give that information in the documentation and it should be included. I quoted a report from the Dublin Dental Hospital and Dental School which clearly states that. As well as this, Professor John Clarkson produced a report in 2000 in which he states that.
From the committee's point of view, it is interesting to note that the scientific committee of the Food Safety Authority of Ireland, which reported to the Forum on Fluoridation, initially stated clearly that it should not be used and then, peculiarly, changed its mind. We know that from freedom of information documentation. I believed, as did the Chairman's predecessor, that something was not quite right about that explanation. I draw the committee's attention to the fluoridation report where, on one page, it is stated that the authority recommended continuing to reconstitute infant formula with boiled tap water but on the next page it is stated that an increase in the rate of breast feeding in this country would contribute significantly to a reduction of the occurrence of dental fluorosis. That is a clear contradiction because if breast feeding contributes to a decline in dental fluorosis, then clearly people should not be giving boiled tap water to their children. That is crystal clear to me. I put it to the representatives of the authority when they appeared before this committee, the reason for the authority's volte-face was that it knew that if there was a recommendation in the report that parents should not use fluoridated water, it would spell the end of water fluoridation. Those are the key elements of the report.
The Chairman asked me to go through the recommendations and I will quickly outline them. I have given members the background to the report. Should I go through the conclusions as well or only the recommendations?
Yes, the Deputy should go through the conclusions.
The first conclusion relates to the claim that the rates of dental decay and the lack of dentists justified the introduction of a prophylactic measure such as water fluoridation. Those who advocated water fluoridation were motivated by concern about the serious decline in dental health standards. All of that is clear from what I have read on this subject. We believe that basic health and hygiene habits in society have changed dramatically in the intervening period. We note that dental health has improved to the same degree in countries where there is no water fluoridation. That is an important point. We are not top of the league when it comes to dental health; we are in sixth place.
In what countries is there no water fluoridation?
In most countries in Europe there is no water fluoridation, namely, in Germany, Austria and all those countries that are ranked higher than we are on the league table. Having regard to the York review, the claim that there is a huge difference between fluoridated and non-fluoridated water and that water fluoridation has overwhelming benefits is not justified.
Another conclusion deals with the claimed sevenfold increase in fluorosis since 1984, which we consider unacceptable and requiring immediate action. We are disappointed that no general health studies, as provided in section 6 of the 1960 Health (Fluoridation of Water Supplies) Act, have ever been carried out, especially considering the high rates of fluorosis. By disregarding this provision of the Act, the Department of Health and Children has left itself liable for the harmful effects of fluoridation of drinking water. That statement may be controversial and, if a member wants it to be deleted, I will agree to that. Dr. Connett's 50 reasons to oppose fluoridation were not answered.
The ninth conclusion is controversial. While it is a valid point, I could delete it and was considering doing so. The Forum on Fluoridation failed to deal with question of toxicology. That is clear from the scientific critique of it. We note the FSAI's recommendation advising against the use of fluoridated water and that its recommendation was subsequently changed following representations from a minority of members.
I will explain what happened in that respect. Fifteen members were on that committee, nine turned up for a meeting at which it was unanimously agreed that fluoridated water should not be used for the bottle feeding of babies. When Dr. Wayne Anderson appeared before this committee, he said that some of the people who had not been at that meeting rang and said that they were not happy about that. A newspaper report at the time stated that one of the six people who had not turned up for the meeting rang indicating unhappiness about that. That is what happened at the time.
That type of comment by a person ringing after a meeting to voice disagreement should have been disregarded.
Did that information come from the minutes?
When Dr. Don McCauley from Irish Dentists Opposing Flouridation appeared before the committee, he gave a hard copy of his submission. I do not have his submission on computer and I need to get a copy of that from the Chairman. He sourced that under the freedom of information legislation. That is how he found out about that and when that deputation came before the committee, we questioned them on that.
Therefore, it is obviously in the form of a minute.
We have the minutes of that.
In what year did this happen?
It was changed in 2001.
Therefore, it was after that.
I have all that information for the committee. It is contained in the written submission from Dr. Don McCauley and it is important to have it. The manner in which this was done was irregular and suspect, and represented a "process mess". Those words were used by the Chairman's predecessor, Deputy Batt O'Keeffe, when he questioned those people. The replies from Dr. Wayne Anderson were unsatisfactory. We noted a similar change of advice on using fluoridated water given by Dr. John Clarkson. We note that the vast majority of those on the forum for fluoridation had records of being strongly in favour of water fluoridation. It is clear and accepted by both the pro and anti-fluoridation sides that the action of fluoride is topical and not systemic. Of the 33 recommendations of the fluoride forum, not one has been implemented to date.
The next point is important. The question will arise as to what would happen if water fluoridation ceased. All the evidence suggests there would be no statistically significant increase in dental caries but there would be a reduction in fluorosis. There is no evidence to suggest that Irish people are fluoride deficient. The evidence at hand suggests we have too much fluoride in our systems. On the basis of the available archive material the committee believes the original fluorine consultative council did not approach its task with an open mind. When I tried to get the minutes of the original fluorine consultative council I discovered the minutes of only one of the meetings exist and they only run to one page. The rest of the material has disappeared. When I asked about this I was told the other minutes had been destroyed in a flood. That is not a good way to deal with an historical record.
That was the great flood. Everything washed away.
It is accepted by all sides that the sources of fluoride in our diet have increased dramatically since the introduction of water fluoridation. We believe fluoride toothpastes have contributed to a decline in dental caries in this country and other states. Point No. 21 is more of a recommendation and should come later on. The increase in membership of Irish Dentists Opposing Fluoridation from single figures when the forum reported, to more than 120 dental practitioners today reflects the growing professional opposition to the policy. There is sufficient scientific evidence on health effects, albeit contradictory, to justify the application of the precautionary principle.
We will need to suspend for a few minutes as a Dáil division has been called.
I am due to speak in the Seanad and will need to leave. I welcome the report and congratulate Deputy Gormley on all his hard work. It is very well laid out. I would like more time to read it. It only arrived on my desk the day before yesterday and I was at a funeral in Kerry yesterday. I have some questions on it. Am I correct that we will not sign off on it today?
We had hoped to do so.
Yes.
I agree with Senator Feeney. The report contains a considerable amount of detail. Would it be possible to allocate some time to it during one of our meetings in January?
We will go through it and see how far we get.
I request to be contacted if we are to sign off on it.
Sitting suspended at 11.05 a.m. and resumed at 12 noon.
I will be brief. I congratulate Deputy Gormley on his report, a labour of love which has taken considerable time to produce. A presentation which has in excess of 370 references indicates that a large amount of work has been done. As with Senator Feeney, I received a hard copy of the report two days ago but owing to the volume of work facing Members at this time of year, I have not had an opportunity to read it in full. I have, however, read a substantial part of the report and have some difficulty with parts of it. I recall a meeting with a number of dentists held one year or 18 months ago.
It took place three years ago.
A significant number of the dentists were in favour of water fluoridation.
Most of those who appeared before the joint committee on the day in question favoured fluoridation.
I would like some of their arguments included in the report. Chapters 3 to 8, inclusive, put the case against water fluoridation. To achieve balance the report should put some of the case in favour of fluoridation. As this is a contentious issue and a body of opinion favours fluoridation, the report would be more balanced if it included such opinion. While I am keen to have the report finished, to give it justice I would like to have time to read it in its entirety. I suggest the joint committee postpone discussion of the report until January to give members an opportunity to read it in full.
I compliment Deputy Gormley on the considerable amount of work he has done on water fluoridation. I have been contacted regularly on this matter. Ultimately, it boils down to the simple question of whether one favours mass medication. For example, should aspirin or other medication people might need be added to water? When one considers the large increase in the number of dentists, improvements in dental services and the presence of fluoride in toothpaste, I question the reason it is considered necessary to add fluoride to the water supply. I did not hold this view a few years ago.
The joint committee must make a decision on this matter. Those who wish to avoid drinking fluoridated water cannot do so because it is added to all public water systems. Other countries have not adopted this practice. I understand water fluoridation has been linked to irritable bowel syndrome. Is that correct?
Yes, that is one of the links. I will return to members' questions.
To be fair to Deputy Gormley, the joint committee should make a decision on his report and it should not be afraid to take a bold one. While consumers are able to decide which toothpaste to use and, as such, how much fluoride they consume while brushing their teeth, they do not have a choice regarding fluoride in water. Fluoride has some benefits but we know it also has downsides. In other countries where it is not added to the water supply, dental health has not been adversely affected. This is sufficient evidence for me.
I have discussed this issue with many dentists, including a number of friends, and they remain divided on whether fluoride should be added to the water supply. I am not satisfied that the quantity of fluoride being added to the water supply has been properly monitored by local authorities. A specific problem has arisen in this respect in south Carlow. Water fluoridation belongs to a different era and it is time we updated our approach.
Deputy Devins made a valid point. The chapters to which he refers are padding and it would probably be better to include in the appendices the presentations made by pro-fluoridation witnesses and one opponent of fluoridation at a meeting of the joint committee. I mentioned this issue earlier because the presentations were made in hard copy format which means I cannot access them on the Internet. As they contained some valuable information, I am willing to accede to Deputy Devins's request to include them in the report. As I made clear this morning, I would be more than happy to accept proposals to amend or delete parts of the report. To be honest, I have a pain in my face with this report and do not want to see it again.
For clarification purposes, which part of the report are we considering removing?
We are discussing procedure. Deputy Devins indicated that the report would be more balanced if a certain approach were adopted. I am willing to accede to his proposal.
I want a speedy resolution to this issue, preferably before Christmas. If this is not possible, I suggest we form a small sub-committee of interested members to ensure the report is ready for January. While my preference is to make amendments to the report at this meeting, I am prepared to listen to argument to postpone a decision.
Although a phenomenal amount of work has been done on the report, it would be better to remove certain parts of it, for example, the information from a Japanese report on uterine cancer. While Deputy Gormley has probably read the original report, I have not been able to do so. Deputy Gormley's report does not even indicate whether the cancer occurs in the body or cervix. Given that the results are equivocal, it does not help to include reference to the Japanese study in the report.
The report also refers to absorption of fluoride through the skin.
It is known as dermal absorption.
Are references available in this regard? It is a major step to refer to it as a danger given that all of us have been showering and bathing for decades. One would have to show an increase in hypothyroidism in Ireland over the period of 30 or 40 years since water fluoridation was introduced. It would be difficult to do this. The Deputy would also need to provide good references on cancer and osteosarcomas as the references in the report were not good enough. Serotonin is an emotive issue to include in the report.
We are giving those references and mentioning it but we are not categorically stating it should be the case.
I know that, but I do not think it strengthens the report. I do not know what Deputies Devins and Fitzpatrick would think going through it, but if I am constantly coming across information where the references are equivocal, I get very doubtful about it after a while.
I agree with Senator Henry.
It is the first thing that would spring to mind for anyone with a medical background.
It is more from a purely scientific point of view. If one quotes from a source that is not a standardised, double-blind trial, one is quoting an opinion rather than a fact. One must be careful when one translates that into a publication.
It was stated the infant mortality rate in Chile is high and there is widespread malnutrition. A man has sworn an affidavit to this effect. Reference was made to artificial fluoridation in this regard. However, most babies in Chile are breast-fed. One really cannot link that with the fluoridation of water. We must look at the facts. The mechanism for mutagenicity is not known. Deputy Gormley has made a very good case but the inclusion of such information weakens it. What is the evidence for the eruption patterns?
There is substantial evidence in this regard. Even those people who are pro-fluoridation referred to that.
Is there anything about the mechanism?
People who are pro-fluoride stated the mechanism of how fluoride acts on the tooth is still not fully understood. Senator Henry raised a number of valid points. In an effort to make a constructive suggestion, I propose a sub-group of the committee would be set up to discuss the matter. I am more than happy to go through the issue with Senator Henry and Deputy Devins. I accept Senator Henry's concerns are genuine.
I am willing to do that.
I will be very honest. I would be happy if the Deputy would include the hard copy from the pro-fluoridisation lobby to give a degree of balance. Senator Henry has obviously read the report in more depth than I.
I value people's input. I would like to go through the report with Senator Henry. I am more than happy to do that and to make the necessary changes.
In fairness, Senator Henry has read it in great depth. I have not yet had a chance to do that.
Deputy Gormley can see people want to accommodate him on this report. That is a given. We are due back here on 18 January 2007. We can come back on 11 January for those who wish to be part of this sub-group. I will ask the clerk to write to all members outlining that a meeting will take place on 11 January 2007 for those who are interested in this issue. Is that okay?
That is fine.
I suggest meeting with interested parties before the meeting. Otherwise the meeting will be spent explaining matters.
Deputy Gormley should contact me. Perhaps we can meet on the beach in Sandymount.
I suggest people contact Deputy Gormley if they have specific points so the meeting can run more smoothly.
That is a good suggestion. If members wish to meet with Deputy Gormley, I suggest Wednesday, 7 January at 3 p.m. Is that agreed? Agreed.
The meeting proper will be on Thursday.
In the meantime I will get the hard copies of the presentations.
Ultimately, Deputy Gormley has been mandated to consider the issue of water fluoridation and he has produced a report. The committee must make a decision whether to leave things as they are or to remove fluoride from the water supply. Is that the ultimate decision we have to make? I accept the points made by Senator Henry and Deputy Devins on the medical confirmation for one side of the argument or the other. However, it is very difficult to prove one case or the other. I am sure the same would be true if we were currently investigating the harmful effects of smoking. No doubt some groups would tell us smoking is good for us, as has been done. That is the reality. It is not possible to get a conclusive—
I do not believe people would suggest anything to that effect.
My point is that on the question of mobile telephones, nobody will say they are good for us but, equally, nobody will say they are bad for us because there is no conclusive proof. In spite of this, we know they cannot be good for us. When I hear how the sound system in the room is affected when mobile telephones ring, I question what it does to our brains when they ring.
I wondered about that, Senator Browne, but it does not appear to affect everybody in the same way.
The main issue relates to choice. The fluoridation measure was introduced in 1957 or 1958. That was a completely different time. I am not even sure whether toothpaste had fluoride back then.
No. It was introduced in the 1970s.
There has been a revolution since then. People can now opt for toothpaste with fluoride. The scenario is different. We are talking about mass medication and choice should be provided.
That is the what the meetings on 10 and 11 January will decide.
If I decide on a given day I do not wish to use fluoridated water, I cannot do anything about it because that is what is provided to us.
I did not address the philosophical or ethical issue of mass medication because it is such a complex one. We could be here all day arguing about the pros and cons of that matter. The report does not address this issue in any detail. I accept people have views on this issue but we are members of a health committee not an ethics committee.
Anyone who wishes to meet Deputy Gormley in a committee room may do so at 3 p.m. on Wednesday, 10 January.
The joint committee adjourned at 12.10 p.m. until 2 p.m. on Thursday, 18 January 2007.