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Seanad Éireann debate -
Wednesday, 13 Feb 2002

Vol. 169 No. 4

Adjournment Matter. Water Fluoridation.

I welcome the Minister of State at the Department of Health and Children, Deputy Moffatt, to the House.

I am grateful to the Minister of State, Deputy Moffatt, for being here this evening. He will recall that last June I raised this matter on the Adjournment and that I was deliberate and sustained in the points I made on that occasion. I will not reiterate every one of them as I take it the Minister is aware of them. I refer specifically to the debate we had in the House on that occasion.

The Minister was relatively generous in his response last June. However, he said that the report of the Food Safety Authority of Ireland's scientific sub-committee on any risks associated with the reconstitution of infant formula with fluoridated tap water would be published in September. He also indicated a certain acceptance of the need to prioritise this area. I am speaking to the Minister not only in his capacity as a politician, as I am, but also as a medical doctor with a particular interest in this area.

We know the statistics. The British Medical Association has very clear views on the safe limit for fluoride concentration in infant formula. This limit is 0.15 ppm. The average load of fluoride in public sector tap water in this country is many times this, at least 0.5 ppm. A neonate drinks a pint of reconstituted infant formula per day in the first three months of its life. Medically, scientifically or nutritionally, fluoride is not necessary in any amount – even a trace amount – in our diet. Some 40 or 50 years ago there was some justification, given the level of scientific knowledge and the major problem with dental caries and oral hygiene generally, for embarking on a policy of mass medication of the public water supply.

My feelings are extremely strong about the risk to neonates and young children from having to ingest such quantities of fluoride, a totally non-essential nutrient, in their infant formula. It is a specific risk because we have a special duty of care to children. Apart from that risk, I ask the Minister whether it is still ethically sustainable to mass medicate the people with a totally unnecessary nutrient that has long since proven to do more harm than good.

The original defence was the need to reduce the rate of dental caries. Since fluoridated tooth paste – it is almost impossible to buy non-fluoridated toothpaste – and the compulsory fluoridation of the public water supply, there is no doubt that there is over-ingestion of fluoride by the 75% of the Irish public dependent on the public water supply.

Is it ethical to continue compulsory medication with a totally unnecessary element such as fluoride? I ask the Minister to look at the issue. How much longer do we have to wait? Since we spoke in June, almost eight months ago, two or three generations of neonates have been reared. The first three to six months of life are the critical period in terms of infant formula as that is before infants move on to solids or alternative sources of nutrition.

What is our response to the crisis? What is the Minister's response as a Minister in the Department of Health and Children and a medical doctor who understands the implications of what I am talking about? What is his response to the fact that one in three of our children shows evidence of overdose and fluoride toxicity by fluorosis in their teeth? We can read the evidence of overdosing by fluoride and of the damage done to those children through fluorosis. How do we know the damage done to the unborn child, to the neonate or to those with no alternative but public water?

There is a well accepted principle, the precautionary principle, in scientific and environmental circles. That principle means that there must be political regulation of scientific uncertainty. The scientific jury is out on the issue of fluoridation but there is a growing body of evidence from around the world that it is an unsafe practice. At the very least, while the scientists differ and the jury is out, the Minister should invoke the precautionary principle and cease an unnecessary practice. Fluoridation is unnecessary medically and nutritionally and is a dangerous practice because of the unscientific source of fluoride we are using, the lack of testing by local authorities, despite what the FSAI says, and the arbitrary manner in which our public supply is fluoridated.

The Minister should please put on the FSAI hat and invoke the precautionary principle. He should not wait for the formal fluoridation report. Why has that been delayed yet again? Will we see a report this side of the general election? I apologise for being somewhat cynical but I must put the point bluntly. I asked for an update on the delay in publishing the report of the FSAI and the Department of Health and Children. There is also an Eastern Regional Health Authority report which is not due until mid-2002. How much longer must we prevaricate and how much longer must we wait for a responsible Minister to invoke the precautionary principle in this area of mass medication?

Will the Minister of State, Deputy Moffatt, note that if there have been problems for this and the previous Government in relation to the anti-D hepatitis C tragedy those problems will be only an introduction to the class action that is likely to result, unless there is an immediate precautionary action by a responsible Minister, in the area of fluoridation and mass medication of our public water supply? Some 98% of Europe and almost all the developed world have abandoned fluoridation so why have the Irish authorities a monopoly of wisdom on the issue notwithstanding the global experience?

I thank Senator Doyle for raising this issue. I addressed the Seanad on 19 June 2001 and set out the initiatives being undertaken to consider the safety of infant formula reconstituted with fluoridated water. I welcome this opportunity to update this House on developments since then.

In June I pointed out that the issue of infant formula reconstituted with fluoridated water had been raised at the forum on fluoridation. In response, the Food Safety Authority, which is represented on the forum, requested its scientific sub-committee on additives, contaminants and residues to conduct a risk assessment in relation to this issue. The group was due to report by September 2001. I am informed by the authority that the primary reason for the delay in publication of the report on risk assessment of potential hazards of using fluoridated water for reconstituting infant formula is that the issues involved are complex and are still under discussion by the scientific sub-committee.

Minister, please.

It is not in order to interrupt the Minister.

There is a large amount of scientific literature under review by the scientific committee, which is a voluntary committee made up of members with full-time commitments outside the Food Safety Authority. However, the authority is keen to produce a balanced report taking into account all available scientific facts and evidence. I am informed that the key issues under discussion relate to how to define harmful effects, what levels of fluoride cause harmful effects and what is the scientific and real evidence that these levels actually cause harm. The Food Safety Authority expects that a final report will be referred from its scientific committee to the board following the meeting of the committee on 6 March.

International consensus on the issue of infant formula and risk of over-exposure to fluoride causing dental fluorosis is not established. While dental fluorosis is recognised as an increasing problem in the United States of America, a recent report of August 2001 from the Centre for Disease Control and Prevention on fluoride use does not advise reconstituting infant formula with water low in fluoride. A 1997 report from the UK comes to a similar conclusion.

I am advised that dental fluorosis has not been observed to be a problem in baby teeth in this country. Nonetheless, because of increasing interest in the amount and pattern of fluoride ingested by infants up to the age of six months, my Department has commissioned research on the prevalence of enamel fluorosis and of infant feeding practices.

When account is taken of the age at which the formation of enamel of the crowns of primary and permanent teeth commences, the level of fluorosis in primary molars is regarded as a good indicator of the amount of fluoride ingested during the period up to six months of age. The main aim of the research which has been commissioned is to measure the prevalence of dental fluorosis in primary teeth in five year old residents of fluoridated and non-fluoridated communities and to relate these findings to the pattern of infant feeding. Until this research is completed we will not have a definitive picture as to whether and to what extent infant feeding practices, including the use of infant formula, contribute to dental fluorosis in baby teeth. Studies have shown that children under five years of age living in fluoridated communities have much better dental health than children living in non-fluoridated areas.

The second part of Senator Doyle's motion refers to the publication of the report of the forum on fluoridation. Lest there be confusion, I stress that the publication of the forum's report is not dependent on the report of the Food Safety Authority. The forum was originally to report in September 2001. As a result of foot and mouth disease precautions, the March 2001 meeting was cancelled and on foot of this a one month extension was approved to October 2001.

I am informed by the chairman of the forum on fluoridation that a number of complex issues arose during finalisation of the report which caused a considerable additional and unexpected workload and further delay. I understand that the report's editor suffered a serious illness over the Christmas period from which he is only now recovering. A final draft of the report will be considered at a meeting of the forum scheduled for tomorrow and I presume it will be published in the near future.

I would have liked the Minister to reply with his personal views on the ethics of continued mass medication of the public water supply. I would love to know what his views are on that.

The Seanad adjourned at 8.30 p.m. until 10.30 a.m. on Thursday, 14 February 2002.

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