I move:
That Seanad Éireann notes the fundamental human right of every Irish citizen to choose whether or not they have their water medicated with fluoride given that they are, from 1 October 2014, paying for it.
Fluoridation of Water: Motion
This is an historic day as most people realise today is the first day in the history of the State that citizens will be charged for their water. I could not think of a better day to put forward my motion for the fundamental right of citizens to choose whether or not they have their water medicated with fluoride given that from today, 1 October, they are paying for it.
It is inarguably a breach of the European human rights and biomedicine directive Article 1 which states, "Parties to this Convention shall ... guarantee everyone ... respect for their integrity and other rights and fundamental freedoms with respect to the application of biology and medicine." Article 5 states, "An intervention in the health field may only be carried out after the person concerned has given free and informed consent to it." As the Irish public has not given consent nor has it been given full information on the adverse risks, this medical intervention is in breach of these directives. I would like to see these human rights directives become law.
In March 2006 the National Research Council, an arm of the US National Academy of Scientists, issued a review of all the available literature on fluoride's health effects. The report was written at the request of the USA's Environmental Protection Agency. The report represented three years work of deliberations by a panel of 12 scientists who were selected for their balanced views. It acknowledged the following adverse effects of fluoride not previously identified: thyroid impairment; type 2 diabetes - an issue that upsets the Minister as Minister for Health; dental fluorosis; arthritis; bone fractures; lowering of IQ; and brain damage, the latter especially in the presence of aluminium. All of these effects with the possible exception of bone fractures and lower IQ can occur at one part per million, that is 1 ml per litre.
Eminent scientists, doctors, toxicologists and chemists have written countless books and reports on the adverse effects and dangers of fluoride. The Government has reviews that suggest this is perfectly safe. The National Research Council's three year reports say it is not safe. We all know for sure with any medical controversy we must err on the side of safety.
I am not a scientist, a doctor or a chemist and never will be, but having taken the NRC's findings into my thinking and considering the countless books that have been written by these erudite academics and scientists, I am not willing to continue to risk the health of my family, who are here today, by exposing them to fluoridated water or stand here as a Senator. I know for sure we cannot continue to take a chance. If even one minutia of what these scientists, doctors, books and countless studies say is correct we must cease fluoridation and remove any risk from the future health of citizens. I am pleased the Minister of State, Deputy Kathleen Lynch, is present but I wish the Minister, Deputy Leo Varadkar, was present also.
I might add that I believe every Irish citizen who chooses has the right not to pay Irish Water for water that is fluoridated. I am delighted to pay for Irish water but please do not put medication in it without my permission. Some 98% of Europe has rejected fluoridation so why are we still doing this? It is against the law in Holland but compulsory by law in Ireland. This makes no sense.
One of us has got it terribly wrong. I repeat my sentiment that just in case Sweden, Holland, Belgium and most recently Israel have got it right, should we not look at the issue?
Why do we not have the same labelling as our American counterparts, namely, "Warning, keep out of reach of children under eight years of age"? I have a tube of American toothpaste with me. As I have stated, it reads:
Warning, keep out of reach of children under eight years of age. If more than that used for brushing is accidentally swallowed, get medical help or contact a poison control centre right away.
Based on this warning alone we should clearly understand that fluoride is a poison. Under US law, the FDA's warning must be on packaging, boxes and tubes in the United States of America. I have with me another tube of toothpaste which is Irish but does not have that warning.
I absolutely love everything to do with America. It brought fluoridation here in 1963 when it appeared to be the right thing to do. That was 51 years ago. In the United States all fluoridated toothpaste carries a poison warning. If one swallows more than a pea sized amount, one should contact a poison control centre. The very same toothpaste sold here has no warnings. I ask the Minister to ask the expert group on fluoridation why our citizens are being kept in the dark about its dangers.
Critically, fluoride is added to tap water at potentially toxic levels. A glass of Irish tap water contains the same amount of fluoride as a pea-sized amount of toothpaste. I am having dinner in the restaurant tonight and I hope to see the Minister of State there. I ask her to remember that a glass of tap water contains the same amount of fluoride as a pea sized amount in toothpaste. Fluoride is a pharmaceutical-grade chemical that goes into the toothpaste. We take an industrial grade from a super-factory in Spain, near the Basque region.
Excuse me if I cannot pronounce it. It is hydroflurosilicic acid that goes into our water. This is not quite as straightforward as fluoride. I have left a graphic with my speech which I am going to give to the ushers now on the toothpaste packaging, for everyone to see. There is nothing like seeing is believing.
On fluoride, many people have said to me, "Mary Ann, I have been brushing my teeth for years. I have been drinking water. I am fine, my children are fine." However, it is a cumulative poison. I want to give the Minister of State an analogy. Think of tobacco. Think of the Minister of State and I having a cigarette tonight. We are not going to get lung cancer. We are going to have to smoke for a long time before it is going to have dreadful, devastating effects on our health. The Minister of State and I could have got a job in the shipyards in Belfast with the asbestos. We would not have died after three months but what about had we stayed there working as others did? After fifty years, deaths occurred. It is the same thing with fluoride.
Fluoride is a medicine. I tried to look at what levels of dosage we should take. One milligramme per hour? One milligramme every four hours or once a day? Drugs should be prescribed by body weight. We all know and understand that. Those who really are affected by the nationally prescribed drug, fluoride, are vulnerable young children, who are lighter in body weight. The Minister of State and I - if I can catch her attention for a moment - often come in here and talk about vulnerable babies. That is what I am here to talk about this evening. These are the people I really want her to think about. Never mind us old codgers and Senators. We have had our lives. These babies are lighter in body weight and drink three to four times more liquid than adults relative to their size. Therefore, they get three or four times more fluoride toxic effects. As they cannot excrete fluoride, 90% of it stays in their bodies. I am not quoting off the top of my head. Everything I am saying has been researched and can be backed-up. With one of the lowest breast-feeding rates in Europe, Irish mothers are feeding fluoridated water mixed with baby formula to our precious babies, their children.
It is arguably a breach of human rights to drug a population against their will via the water system. Given hydroflurosicilic acid is an unlicensed and untested medicinal substance, this motion seeks to give back the human right to the Irish population to choose what drug each citizen does or does not take into their bodies. I urge all Senators to consider this. I am sorry that the Fianna Fáil political party meeting just started at 5 o'clock, because I want everyone to please put pressure on their colleagues and anyone else in a position of power to join the fight for Ireland's health freedom for their citizens.
I thank the Minister of State for coming into the House for this debate which I think will be very interesting and one that I have not heard debated here. It was debated before in this House but it was quite some time ago. I, like Senator Mary Ann O'Brien, do not remember a big debate about this in 1963. It must have been a very emotional time when it was being done. It is taking away the rights of every citizen to feed themselves with fresh water by ensuring there is something in that water. Having studied this issue for the last week or two, I am concerned when I order a glass of water. I am not sure whether I am drinking fluoridated water or not. As Senator Mary Ann O'Brien says, if it is tap water it will contain fluoride. I am not sure if the water in front of me is tap water. Neither can I always be sure if the water we buy in bottles comes from a well or a tap. I have 16 grandchildren and I know that my sons and daughters, who are concerned about the well-being of those children, are going to give much more thought to this in the future when it is brought to their attention.
The Sinn Féin amendment is interesting. Usually when an amendment is put before the House, it disagrees with the provision. Senator Mary Ann O'Brien's motion is that Seanad Éireann notes the fundamental human right of every citizen to choose whether or not to have their water medicated with fluoride given that they are from 1 October paying for it. The Sinn Féin amendment seeks to delete all the words after "Seanad Éireann" and substitute the following: "calls for the removal of fluoride from the public water system". One is capable of being accepted as much as the other.
Senator Mary Ann O'Brien has spoken vividly about the figures around the world. I have done some work on that also. The motion is very important. It is a huge change for citizens that we now have to pay for our water. From a business perspective it is right that the citizen is given the opportunity to choose the type of product that they purchase. We do not have that choice. We purchase water but we do not have the option of non-fluoridated water. I do not want to go through the figures Senator Mary Ann O'Brien has given at length but it must be emphasised that most EU countries do not add fluoride to water. Some major and influential countries are not even allowing local authorities to make their own decision on fluoridation. Senator Mary Ann O'Brien mentioned the situation in Germany, Japan, the Netherlands and Sweden. They are among the countries who have banned fluoridation altogether. We only need to look north of the Border where there is no fluoridation. It is interesting to see Mr. Walter Graham here tonight. He was instrumental in playing a very large part in drawing the attention of various towns in the North to the issue to the extent that they no longer have fluoridation there.
Belgium went so far as to ban tablets and chewing gum that contain fluoride over fears that they might increase the risk of brittle bone disease. There does not appear to be any worldwide movement for countries to start to add fluoride to water supplies, the opposite is the case. Last August, Israel officially stopped adding fluoride to its water supply on the basis that it is medical treatment and people have the right to choose whether they want to be medicated. It is interesting to consider the country with the world's largest population, China, does not add fluoride to its water supply. These are strong examples and it is very clear that what we are doing is completely out of the norm. Is Ireland right on the issue and the rest of Europe wrong? There is no fluoridation in Scotland, Wales and most of England. These other countries are not fluoridating their water on the basis of medical evidence.
There is also an ethical issue when it comes to medicating a water supply. There is a range of well documented side-effects linked to excessive fluoride use in the medical evidence. Senator Mary Ann O'Brien has dealt with some of these. I will not get involved in them but the most common is dental fluorosis which changes the appearance of teeth. In addition, various studies have pointed to lower intelligence levels in children, an increased incidence of bone cancer in teenage boys and increased risk of bone fractures and thyroid dysfunction. Senator Mary Ann O'Brien drew our attention to the tubes of toothpaste and the cartons of toothpaste for sale in America. The example provided says: "Warning: Keep out of reach of children under six years of age. If you accidentally swallow more than used for brushing get medical help or contact a poison control centre immediately". That is very interesting. What is particularly interesting is that it does not apply to toothpastes that do not contain fluoride. They do not have that warning. In America, it is necessary to have that health warning on every tube of toothpaste that contains fluoride. A new study published in one of the best known peer-reviewed medical journals, The Lancet, now labels fluoride as a development neurotoxin which could cause damage to the brain. This is due to a link between high levels of fluoride exposure and reduced IQ in children, mostly in China. The study puts fluoride in the same category as substances such as arsenic, lead and mercury. There are a number of interesting articles on that issue.
I will deal briefly with two other points. Some 98% of the countries of Europe have rejected fluoridation. Why are we doing it? There is an international movement away from fluoridation. It is becoming redundant.
It has been rejected in countries and communities around the world and fluoride is a highly poisonous substance. Most people are unaware of how toxic it is. There is enough fluoride in a tube of toothpaste to kill a 12 year old child. While Members have a great deal to do this regard and have a great deal to learn, this is the start of a debate and I hope the Minister of State will enlighten them in the time ahead, in order that they can make a decision on the subject.
I move amendment No. 2:
To delete all words after "Seanad Éireann notes" and substitute the following:
"that water fluoridation is not medicinal but the adjustment of the natural concentration of fluoride in drinking water to the recommended level for the prevention of dental caries (tooth decay);
that water fluoridation is a safe and effective means of prevention of tooth decay;
that there is no evidence that water fluoridation, at the recommended level, causes any ill effects to human health; but that fluoridation, and its effects on health and related matters, is kept under constant review.".
I welcome the Minister of State. I also welcome this debate and it is important that Members bring up such matters for review on an ongoing basis and if there are new developments in this area, Members certainly should consider them. In the context of discussing the possibility of fluoridation causing problems, it is interesting to note that when the Act was passed in 1960, the average life expectancy in Ireland was then 69.69, whereas it is now 80.5.
On a point of order, that has nothing to do with fluoride.
That is not a point of order. Senator Colm Burke to continue, without interruption.
No, but as risks to health are being raised, I refer to the progress made in Ireland in respect of health and well-being. Progress has been made and the average life expectancy is now 80.5 years in real terms.
The constitutional issues are interesting and I have downloaded a copy of the case of Gladys Ryan v. the Attorney General. It was dealt with by Mr. Justice Kenny and then by the Supreme Court. Interestingly, Richie Ryan, who subsequently became Minister for Finance, acted as a solicitor for Gladys Ryan although he was not related to her. He assembled a quite strong legal team to deal with the matter in the High Court and Supreme Court. He had, as senior counsel, Seán MacBride, T. J. Connolly and Seamus Egan, that is, a strong legal team to fight this question concerning the constitutional provisions. It dealt with the Constitution under Articles 40.3, 41 and 42. The matter of the constitutional issues was clearly argued in both the High Court and the Supreme Court. I read an article containing an interview with Richie Ryan some years ago in which he raised the issue as to whether all the information was made available to the courts at the time. While he raises serious concerns from that point of view, this is the case law we now have.
A number of steps have been taken since 1963 and 1964, when the case was dealt with in the courts. There have been a number of reviews on the issue and a number of recommendations were produced in a report in 2002. Interestingly, the motion's proposer raised the issue of fluoride and the danger to children. It is an important issue because one recommendation in the 2002 report pertained to infant formula and perhaps it is also a question of disseminating more information. The fifth recommendation of the aforementioned report stated that infant formula should continue to be reconstituted with boiled tap water in accordance with manufacturers' instructions or that, alternatively, ready-to-feed formula could be used. The other part of the recommendation was that the use of bottled water to reconstitute infant formula was not recommended unless the labelling indicated its suitability for such use. I believe that report contained a total of 33 recommendations and the question is whether all of them were implemented fully and whether people are aware of them. I believe this certainly is an issue that should be revisited. If Members wish to consider this issue because other matters must be examined of which people must be made more aware, they certainly should do this. They should make people aware, in the public domain, as to what are the concerns.
The Irish Dental Association appears to be strongly in favour of fluoridation. In a statement it issued it noted that it:
strongly endorses water fluoridation as the most practical, cost effective and safe, public health measure to control the occurrence of tooth decay in Ireland. Community water fluoridation is endorsed by the World Health Organization ... as the first choice method of providing fluoride to communities. The US Centers for Disease Control and Prevention ... and the EU Scientific Committee on Health and Environment Risks ... have also endorsed water fluoridation. The US Surgeon General described water fluoridation as one of the top ten greatest public health measures of the twentieth century.
I am quoting from the Irish Dental Association statement and while I do not suggest this is gospel, I note that association clearly is strongly in support of the current policy with regard to water fluoridation.
I will revert to the constitutional issue, as the Gladys Ryan v. the Attorney General case established a strong position with regard to bodily integrity. However, one aspect of Mr. Justice Kenny's decision in the High Court held that there is no contractual right to a piped water supply. It stated:
The plaintiff has no legal right to a supply of piped water and the Act of 1960 does not impose any obligation on her or on the members of her family to drink or use the water coming through the piped water supply ... the plaintiff probably has a right of access to a supply of water, but this does not give her a right to a supply of water which has not been fluoridated through the piped water supply ... I am satisfied that the plaintiff ... can, by the expenditure of a few pounds, remove all or almost all the fluoride ions from the water coming through the piped water supply.
Members must deal with this debate in that context. I believe the constitutional issues have been dealt with. Members certainly must review and keep in mind constantly developments that have occurred in recent years and make the public aware of them, but I strongly support the amendment to the motion and ask my colleagues for their support on the matter.
I thank Senators Mary Ann O'Brien and Feargal Quinn for giving Members an opportunity to speak about this issue. For me, the jury is out on this question and I have read a considerable amount on the subject in recent weeks. I do not like the thought of being forcibly medicated, any more than anyone else would, and I do not like the thought of anything being applied forcibly. While I cannot support the motion in its current form, nor can I support either of the amendments, including the Government amendment. The latter is the set-piece Government amendment and when Fianna Fáil was in government, such amendments were no different. It commends the Government, maintains the current position, will not change and all the rest of it.
This issue last was reviewed in 2002 and it is time to review it again. I desire that a review be undertaken on the effects of fluoridation, given the additional research that is available, of which there is quite a lot from the United States. In this context, Senator Mary Ann O'Brien may have mentioned many countries in Europe, including Austria, Denmark, Finland, France, Germany, Iceland, Italy, Luxembourg, the Netherlands, Northern Ireland, Norway, Scotland, Sweden and Switzerland, to mention a few. I have known people from these countries and did not note they had any particular tooth decay issues. They were fine, healthy people and these countries clearly have taken a decision not to have fluoride applied to the public water system for a reason. There are clear concerns about it, as fluoride is poisonous, as has been outlined in respect of toothpaste and processed foods. Even before one comes to treated drinking water or toothpaste, children could be taking in much more fluoride than is safe in a general sense. A huge number of studies link it to quite a number of different diseases and there is a body of scientific research that supports this view.
From what I have read in recent days, we are not talking about a bunch of crazies who have a vested interest in getting this. Equally, I do not think the State believes it is doing harm by keeping it in there, but it warrants a review. It is something that comes up frequently. Some friends of mine will only have bottled water and will try to ensure their children do not have access to fluoride.
The reasons for Senator Mary Ann O'Brien tabling the motion are absolutely sound. I read her very good article in today's Irish Independent. I also read the comments that people added online. An interesting broad church of people gave their responses to it. We certainly could do worse than have a review at this time given that it is 12 years since the last one when we decided to continue with the policy. It would be timely to review it again and the Minister of State would be doing us all a favour by answering that this evening - there might be no need for a vote.
Some of the information highlighted to me on the effects of fluoridation of water is indeed frightening. It was clearly a 1950s solution and approach to a particular issue which is outdated. We have all taken on board our responsibilities in the context of dental health. I do not believe it is impossible for us to continue to be dentally healthy as a nation if we opted to change the policy. I accept we do not want to scaremonger and say we are all going to die. Senator Mary Ann O'Brien made the point about it being the cumulative impact of this over a long period. There may be links to some of these illnesses and perhaps if we took it out and monitored it over a ten-year period, we might see some results.
Our starting point should not be that fluoridation is the bees' knees and we will continue with it. The approach ought to be that policies need to be reviewed on an ongoing basis. It has been 12 years since the last review, other research is available and there are fears out there. At an absolute minimum, even if we were to continue with the policy, we should reassure people why we are doing that and we should outline the levels of fluoride in water, why it is there and how it is possible to avoid intake of it by avoiding fluoridated drinking water. People are entitled to know that and the nation should inform people about the level of fluoridation in the water in order that if they feel they do not want themselves or their children exposed to it, they must get other forms of water for drinking, brushing teeth and so on.
We should have tabled an amendment but were not quick enough. If we had tabled an amendment, it would have called for a review and that ought to be done. I do not want to delay the House. I thank Senator Mary Ann O'Brien for her very informative article in today's newspaper. It certainly gave me new information that I did not have in addition to other information that was given to me. According to my documentation 97% - Senator Mary Ann O'Brien mentioned 98% - of people in Europe clearly have concerns and they are not crazies so let us have a look at the most up-to-date research on the issue with an open mind and be flexible on what we might do following a review. I know where Senator Mary Ann O'Brien is coming from, but I do not think it is possible that we could all have an individual choice because of water supply - John next door cannot have it if I do not want it. Perhaps we might look at this.
I am not convinced that I want it completely removed from the water system. I have major concerns as an individual with young children. The Minister of State would be best advised to conduct a review at an absolute minimum among the staff at her Department. I am sure there is no additional cost for that - people are being paid in the usual way as members of staff. Perhaps she could report back to us in a month or two with the results of that review and we could consider the issue again.
I thank the previous speaker for the suggestion, but I think from the content of my speech the Senator will realise that the issue of fluoridation is under continual review. I thank Senator Mary Ann O'Brien for tabling the motion and acknowledge that some Senators have a particular interest in it. Unlike others, I have been listening to the debate about fluoridation all my life. My father had a particular interest in it, as did my father-in-law after that, so it is a debate I have been listening to for many years.
I acknowledge and thank the Senators for holding this debate. I commend everyone who contributed. I know others are yet to contribute, but I have to leave early. The Government will not support the motion in its current form, but the Government has proposed an amendment that provides for the continuing review of this important issue of public interest and concern. I commend the Government amendment before the House and hope everyone has read it.
Water fluoridation is the adjustment of the natural concentration of fluoride in drinking water to the recommended level for the prevention of tooth decay. Fluoride is a natural mineral used by the body to strengthen teeth and bones. Fluoride occurs naturally in all water supplies at different levels and is found in soil, fresh water, seawater, plants and many foods. As the Senator pointed out, fluoridation began in Ireland in 1964 on foot of the Health (Fluoridation of Water Supplies) Act 1960. The Act and the Fluoridation of Water Supplies Regulations 2007 provide for the making of arrangements by the HSE for the fluoridation of public water supplies. The local authorities, acting on behalf of Irish Water, act as agents for the HSE in providing, installing and maintaining equipment for fluoridation and in adding the fluoride to water and in testing the fluoride content of water to which fluoride has been added.
In Ireland, naturally occurring levels of fluoride tend to be so low that they do not provide sufficient dental benefits. However, there are exceptions. Among the evidence presented to the Oireachtas prior to the introduction of fluoridation 50 years ago was the discovery that the public water supply serving the village of Patrickswell, County Limerick, had a fluoride content of around 0.7 to 1 parts per million. No other water supply in the city or county of Limerick was found to contain fluoride to that significant effect. The then Medical Research Council of Ireland carried out a special examination of children attending Patrickswell national school. It found that the teeth of the children who had been using the naturally fluoridated water supply in that village since birth or the greater part of their lives had less dental decay than the other children attending schools in the rest of the city and county of Limerick.
Artificial water fluoridation replicates a natural benefit by making good a fluoride deficiency in some water supplies. The benefits to oral health brought about by fluoridation have been experienced all over the world. It is hardly surprising that water fluoridation is recognised by the Centers for Disease Control and Prevention of the United States Public Health Service as one of the ten greatest public health achievements of the 20th century. As Senator Colm Burke outlined, in the case of Ryan v. Attorney General in 1964, the Supreme Court did not accept that the fluoridation of water was, or could be described as, the mass medication or mass administration of drugs through water, as suggested by the Senators.
The Health Products Regulatory Authority is the competent authority for the licensing of human and veterinary medicines and medical devices in Ireland. The HPRA considers that neither drinking water itself nor the fluoride added to drinking water in the form of fluoride salts or silica fluoride, as defined in the Health (Fluoridation of Water Supplies) Act 1960, should be categorised as medicinal products. The HPRA considers that the fluoridation of drinking water should be seen as a measure consistent with general public health management. Fluoridation can be likened to adding vitamin D to milk or folic acid to cereals. More than 370 million people worldwide receive the benefits of water fluoridation. All EU member states have fluoride, in one form or another, at the centre of their public policy approach.
For some European countries, water fluoridation is impracticable due to the large number of separate water sources. Many of them choose salt fluoridation or milk fluoridation as an alternative to give the health benefits of fluoride exposure to their citizens. Several countries have opted to use other approaches to fluoridation such as investing in large public dental services, as in the Netherlands and in Nordic countries. In such cases, fluoride is administered to children in school clinics. There is evidence, however, that other methods of fluoridation such as milk fluoridation or topical applications are not as clinically effective or as cost effective. There is some evidence too that water fluoridation may have particular benefits for persons on lower income.
Major fluoridating countries include the USA, Australia, New Zealand, Canada, Malaysia, Singapore, Hong Kong, Colombia, Chile and several others. Fluoridation coverage in the USA is approximately 200 million people. Almost 6 million people in the UK have fluoride added to their water with another 330,000 having naturally fluoridated water. Approximately 10% of the population in Spain has fluoridated water. Salt fluoridation is practised in many South and Central American countries, as well as in the European Union, notably in France, Germany and other central European countries.
In Ireland, approximately 3 million people have fluoridated water supplies. Fluoride strengthens the teeth. Strong teeth result in fewer fillings, fewer extractions, fewer visits to the dentist and lower dental bills. To date, there has been a highly significant reduction in the proportions of decayed, missing and filled teeth of people living in areas supplied by fluoridated drinking water when compared to those in non-fluoridated areas. Even with a background of widespread availability of fluoridated toothpastes, the difference between fluoridated and non-fluoridated communities remains. A further factor is Ireland's high level of sugars consumed and the poor tooth brushing habits of our children and adolescents compared to their European counterparts. Accordingly, the use of fluoridated toothpastes alone is insufficient to prevent tooth decay.
By comparing similar fluoridated and non-fluoridated populations, we can assess the benefits of fluoridation. The study, Oral Health of Irish Adults 2000 to 2002, showed decay scores were lower among fluoridated groups for all age groups and particularly in the 35 to 44 age group. A 2014 study by Public Health England compared fluoridated and non-fluoridated parts of England. It found that in fluoridated areas there were 45% fewer hospital admissions of children aged one to four for dental caries than in fluoridated areas. The recently published Queensland study, Child Oral Health Survey 2010 to 2012, commissioned by the Queensland Government in Australia, shows substantial differences between the levels of primary tooth decay in long-term fluoridated Townsville at 39% and the previously non-fluoridated rest of north Queensland at 57%.
Consumers sometimes express concerns about potential negative effects of drinking fluoridated water. Such concerns are not allayed by scaremongering and misinformation used by opponents of fluoridation. I accept, however, that the arguments on both sides have not been fully fleshed out.
They never will be.
I accept that.
The only known side effect of optimal water fluoridation is mild dental fluorosis, a condition known about since the 1930s. Dental fluorosis is a cosmetic or aesthetic condition which refers to the way teeth look. It is not considered to be an adverse health effect. At the levels of fluoride present in Ireland's water supplies, any occurrence of dental fluorosis is very mild or mild. In most cases, it is only detectable by a dentist as faint white flecks on the surface of the teeth.
Regularly conducted studies on dental health in Ireland, carried out when the upper limit for fluoridation was one part per million, confirm the low level of dental fluorosis. In the majority of cases, dental fluorosis generally does not require any treatment. The non-treatment of dental fluorosis has no health consequences.
The policy of fluoridation was the subject of a major review in 2000. A forum on fluoridation was established, comprising largely of persons with expert knowledge from the fields of public health, dental health, food safety, environmental protection, law and ethics, water quality and health promotion and a consumer representative. The main conclusion of the forum’s report, published in 2002, was that the fluoridation of public piped water supplies should continue as a public health measure. The forum also recommended that, given the increased access to fluoridated toothpaste and in light of the best available scientific evidence, the optimal level of fluoride in water should be redefined from the then level of 0.8 to one part per million to between 0.6 and 0.8 parts per million with a target value of 0.7 parts per million. Parts per million is equivalent to milligrams per litre. This change was implemented by the Fluoridation of Water Supplies Regulations 2007.
Another important recommendation of the forum was that an expert body should be established to implement the recommendations of the forum, as well as advising the Minister and evaluating ongoing research on all aspects of fluoride. Accordingly, the expert body on fluorides and health was established in 2004. It continues to share its expertise and provide advice on fluoridation and related matters. It considers scientific evidence submitted to examination by other scientists, usually by publication in recognised peer-reviewed scientific journals after such publication has been approved by independent referees. This ensures the advice provided by the expert body is impartial and evidence-based. The expert body is satisfied, having studied current peer-reviewed scientific evidence worldwide, that water fluoridation at the level permitted in Ireland does not cause any ill-effects and continues to be safe and effective in improving the oral health of all age groups. These views are supported by reputable international agencies and valid scientific articles and reviews.
It is worth noting EU law defines a maximum permitted concentration of 1.5 parts per million for public water supplies through its drinking water directives. The Irish levels are set at around half that permitted by EU legislation. Systematic and comprehensive reviews of fluoridation have been conducted in many other countries too including the United Kingdom, such as the York review in 2000 and the Medical Research Council in 2002, Australia in 2007, Canada in 2010, the European Union in 2011 and New Zealand in 2014. None of these reports established any basis for considering that artificially fluoridated water poses any systemic health risks.
Nevertheless, the Department of Health keeps the policy of water fluoridation under constant review. The work done by the expert body and what we learn from international studies have been invaluable. It is important the public is continually reassured about the use of fluoridated water. It is for this reason that we have asked the Health Research Board to undertake a review of evidence on the impact of water fluoridation at its current level on the health of the population and on the environment. This particular initiative will consolidate the research worldwide using a systematic approach. We expect to have a definitive report from the Health Research Board by the end of this year.
The Department is also collaborating in a University College Cork-led research project, Fluoride and Caring for Children's Teeth, FACCT. The study will consider the impact of changes on the oral health of children following policy decisions relating to toothpaste use by infants and young children made in 2002 and the reduction in the level of fluoridation in drinking water in 2007. In addition, a study on general and oral health findings in adults linked to the duration of exposure to fluoridated water as part of the Irish longitudinal study on aging, TILDA, has commenced.
I note the concerns expressed by Senators do not relate specifically to health but to an ethical argument, namely, freedom of choice. The suggestion is that it is the right of every citizen to choose whether their water is fluoridated. This is troublesome and, as far as I understand, not supported by the Supreme Court.
How would it operate in practice? Would there be two separate public water supplies, one that is fluoridated and one that is not? Clearly, such a system would be impractical and expensive beyond our current capacity. There are parallels with the ban on smoking in the workplace. Some people would like to have the freedom to choose whether to smoke in a workplace. However, the exercise of that choice can have a negative impact on the health of others. Therefore, we see the value in restricting an individual's freedom of choice when it impacts upon the health and well-being of others. Is it ethical to stop fluoridation if doing so leads to poor dental health? We have a duty to make that choice, informed by evidence and in the best interests of the public. Tooth decay has a significant impact on health and well-being and results in high costs to the individual and the State. It is largely preventable and, therefore, a high priority for oral health promotion.
The Oireachtas, in its wisdom, introduced fluoridation 50 years ago. The Department of Health continues to review this policy and sees no benefit in its cessation. The costs of cessation are likely to be considerable. Ceasing water fluoridation without putting in place an alternative programme would be very costly. Fluoridation is known to decrease dental decay substantially, for example, in the order of 40% in children, according to Irish health statistics. The lifetime cost per person is approximately €1 per annum. Ceasing water fluoridation would lead not only to the additional financial burden of treating tooth decay but also to social costs, as tooth decay can lead to pain, trauma, disfigurement, loss of teeth and function, problems with nutrition and growth, and work or school absenteeism.
In some European countries that do not fluoridate their water, fluoride varnishes are applied to children's teeth twice per year. In Ireland, screening is usually provided twice for children in primary schools, typically in second class and again in sixth class. The introduction of a similar programme in Ireland would mean that children would be seen 16 times in primary school. This would require a significant investment in personnel and resources. Water fluoridation is the most cost-effective method of preventing dental decay and overcoming the poor risk profile in Ireland.
The Nuffield Council on Bioethics in the United Kngdom published a landmark report on ethical issues in public health in 2007. It recognised the tensions between protecting personal autonomy and promoting the welfare of all. To quote from the report: "From an ethical and practical standpoint, an important dimension of public health policy is, therefore, to balance the liberal emphasis on choice and autonomy with the imperative to support those who do not have the opportunities to choose, because of, for instance, poverty or dependency." Given that fluoridated water does not smell or taste differently from non-fluoridated water, the freedom of choice argument is essentially a debate about whether individuals who have a personal preference not to drink water containing 0.6 to 0.8 parts per million of fluoride should be able to prevent the rest of society enjoying the considerable benefits afforded by fluoridation. It is the view of the Government that they should not.
I thank the Senator for introducing a topic that I have been examining for all of my life. The arguments on both sides will probably never be fully concluded.
One hopes we will not be examining it for too much longer.
I thank the Minister of State for her attendance and comments. I will begin my support for Senator Mary Ann O'Brien's motion by addressing the issue of semantics. According to the Government's amendment to our motion, water fluoridation is not medicinal. I looked up definitions of "medicine". A fairly standard one is "a drug or other preparation for the treatment or prevention of disease". The amendment goes on to argue that water fluoridation is an effective means of preventing disease, namely, tooth decay. As such, the first line of the amendment is intended to lead us down a detour while the Government contradicts itself in the amendment's second line, making the detour a dead end.
I will address the substance of the motion. Fluoride is the only chemical added to public water to treat the consumer of the water rather than the water itself. Therefore, fluoride is viewed by the Government as a form of medicine or a health treatment that prevents disease. Consequently, the fluoridation of public water must be held to the strict scrutiny and standards applied to other health treatments. Citizens must enjoy the same rights as regards water fluoridation as they do in respect of other aspects of health. Reducing human rights arguments to a "liberal emphasis on choice" is unacceptable.
In no other area of health care does the Government impose a blanket treatment on the entire population without the expressed and informed consent of those affected. Citizens must be given choice over their health treatment and be provided with a recourse to opt out if they wish to forgo said treatment. It is unethical to force an unwanted health treatment on an individual. The Government should not continue to impose water fluoridation requirements universally. If the national mandate continues, the Government must provide support to those who do not want to be treated. There are practical ways of doing so.
Every human has the right to "the enjoyment of the highest attainable standard of physical and mental health", as articulated in the UN Convention on Economic, Social and Cultural Rights, which we have signed. To ensure the health and safety of its residents, the Government must re-evaluate its law and policy in light of the recent emerging evidence to which Senators Mary Ann O'Brien and Feargal Quinn referred. The Minister of State referred to the constitutional case, which Senator Colm Burke first mentioned. While that is interesting, if scientific evidence emerges to indicate that fluoride can be a risk to our health, it must at the very least mean that our citizens should have a choice. We do not have a right to choose to reject an imposed health treatment, particularly if there is evidence indicating that it may create a risk to our health. A growing body of scientific literature questions the long-term safety of water fluoridation, but I will not go over it again.
It is important to note that rates of tooth decay have plummeted in Ireland since the 1960s. We do not know how much of that improvement in oral health can be attributed solely to the fluoridation in water. Education and practices in oral health have also improved dramatically in recent decades. The improvement could have been owing to these, even in the case of poorer children who are well able to be educated like the rest of us. In the same timeframe, many European countries witnessed similar declines in the rate of tooth decay without the use of public fluoridation of water. In Finland and Germany, for example, the number of cavities did not increase. Some countries saw declines despite the cessation of water fluoridation. This must be taken into account.
A point that has not been mentioned much in this debate is that opposition is growing to the fluoridation of public water. As Government representatives, we must consider this issue. In 2002, a public survey found that 45% of people in Ireland had concerns about water fluoridation. Many local efforts have worked to stop the fluoridation of water. Since 2012, local councils have passed motions calling for the cessation of water fluoridation. The Government, in its wisdom, needs to listen and the growing public resistance must be incorporated into national policy.
Ireland is the only EU country with a national regulation stipulating public water fluoridation. This year, Israel stopped adding fluoride to its drinking water following a decision of its Supreme Court. That ruling was clearly rooted in the individual's human right to decide whether to consume water treated with fluoride.
Like others, including some UN conventions, it is my opinion that legislation must guarantee the human right to choose in questions of health and ensure an adequate standard of living, including access to adequate drinking water. Therefore, I support the motion and call on the Government to change the law. The Government must first ensure that, as the Hippocratic oath demands, its health policy does no harm.
I will welcome one Minister of State and bid the other farewell in the same breath.
I have some sympathy for the motion, although I am not convinced that fluoride-free water is a fundamental right. The motion overstates the case. Senator Colm Burke referred to the Supreme Court ruling of Mr. Justice John Kenny that it is not a fundamental right. While people generally should be free to choose, it is difficult to see how this right can be balanced with the undoubted benefits to the public of fluoridation of water.
Nothing in the contribution by the proposer of the motion is uncontested. Senator Marc MacSharry has said the jury is out on this, but it is not. The expert body on fluorides and health is unambiguous about the safety of fluoridation of water. Fluoridation is measured as parts per million and 0.6 to 0.8 parts per million is deemed to be the optimal level for protecting overall oral health for all age groups without causing any risk to health. The correct amount of fluoride in water is not harmful according to the expert body. The WHO is also clear on it, and explicitly recommends that those countries which do not have access to optimal levels of fluoride and have not yet established systematic fluoridation programmes consider the development and implementation of fluoridation programmes. The US Center for Disease Control and Prevention rated fluoridation as one of the ten most important public health achievements in the 20th century.
The idea that fluoridation is compulsory by law in this country and banned in others is incorrect. Senator Katherine Zappone spoke about the semantics of the argument, and I would like to have a debate on the importance of our use of language, although we do not have time in this contribution. Fluoridation is supported by law in this country. It is not banned in other countries, just not required in law. This is very different from taking an active legislative measure to ban it, which is not the case. The EU Scientific Committee on Health and Environmental Risks is unable to conclude that fluoridation of water places any risk on human health or the environment. It is very difficult to understand why we would have such little faith in the organisations charged with weighing the scientific evidence in an objective manner and suppose that, somehow, they are conspiring in some way to cause public ill health when their objective is the opposite. The Health Products Regulatory Authority, HSE, Department of Health, the expert body on fluorides and health, the EU bodies, WHO and the US Center for Disease Control and Prevention are all giving assurances that there are no demonstrable risks to health from fluoridation and I am happy to take their advice.
The Minister of State, Deputy Kathleen Lynch, referred to peer-reviewed scientific evidence and this is the most important factor when we consider any argument for or against any measure. The last time we debated fluoridation of water in the House I heard very many inaccuracies, including that the fluoride used in water was a by-product of some industrial process, possibly fertiliser production. It is very important that we, as legislators in this House, no matter what our different views, put the facts into the public domain rather than scaremonger, as the Minister of State said.
While I have some sympathy with the argument, I am very familiar with the Nuffield study, which weighs the balance between the right to choose the use of a product against the public health benefits of a product. While the jury is out on that question, it is not out on the health risks related to fluoridation of water. Even if I were to state I was an advocate of the right to choose in virtually all areas of life, it is very difficult to see how, with one public delivery system, we can provide both fluoridated and non-fluoridated water. Regarding the balance of rights, this cannot be provided. To say it is a fundamental human right is an overstatement of the case and does no justice to those who propose, in genuine good faith, that water should not be fluoridated.
I welcome the Minister of State, Deputy Gerald Nash. I agree with most of what Senator John Gilroy said. One of the functions of the university constituencies is to bring the research of those universities to the House. The Minister of State, Deputy Kathleen Lynch’s statement corresponds with the research. In the Patrickswell example, where fluoride was naturally present, the decayed, missing and filled teeth index was much lower than in the rest of County Limerick. That was not a plot by any chemical industry, as speakers have said; it was naturally present in the water. Fluoride is naturally present in a number of areas, such as Gyles Quay, which is in the Minister of State's constituency. It is also present in a number of places in the United Kingdom, where 330,000 people have water that is fluoridated naturally by the topography of their area. A study found North-South differences, including a dramatic difference between the dental health in Sligo and Derry, in favour of Sligo. There are differences in dental health over time since we started fluoridation many years ago. Last month, a paper was presented at the World Dental Conference in New Delhi confirming the positive aspects of fluoridation.
The evidence is overwhelmingly in favour of the benefits of fluoride. The benefits are particularly obvious in deciduous teeth. Those who want the choice to have non-fluoridated water would impose a particular cost on children, whose deciduous teeth will fall out much more. If they succeed, there will be a significant cost by way of dental fees to restore the resulting decayed, missing and filled teeth index. For €1 per year a person receives all the benefits stated in the literature. I commend the dental profession for being in favour of a public health measure which reduces the demand for the services of dentists. I would like other professions in the country to be as patriotic as dentists. Usually, when professions come here, they want more money for themselves. Dentists are a noble exception, saying this public health measure reduces the demand for their services. This is a commendable difference between dentists and other professions.
The expert body on fluorides and health continues to do research. When this began, 50 years ago, it dealt with the arguments about the damaging effects of fluoride. The quantities of fluoride one would have to consume to experience the damaging effects were massively in excess of anything that is present in water. Fluoride is not a risk to health in the current quantities but has very positive general health impacts. What happens if we return to the previous situation of high levels of decayed, missing and filled teeth? It would have serious impacts on people’s general health to have a head full of decaying teeth, and it is not included in the calculations. Fluoridation of water has been a success in health terms and is supported in the literature in refereed journals, as the Minister of State said, and as the previous Minister of State, Deputy Kathleen White, said here on the previous occasion it was debated. While I appreciate we must examine any instance where medical treatment damages people’s health, iatrogenic disease in general, the balance of the literature is that fluoridation is overwhelmingly positive and, therefore, I support the Government amendment.
This is a successful public health policy by any measure. As we said, one can compare Patrickswell to the rest of County Limerick at the past, one can compare Derry to Sligo in recent time, or one can compare the naturally fluoridated parts of the United Kingdom to the unfluoridated parts. The fact is that eminent dental conferences such as the one in New Delhi last month continuously present the evidence and fluoridation is overwhelmingly endorsed.
There are many other issues in the health service which deserve some of the attention that has been focused on the fluoridation of water. This issue has been well discussed, well debated, and the research continually shows it has been a worthwhile endeavour so let us go on to some of the other much more urgent problems in the health service.
I dtús báire, ba mhaith liom fáilte a chur roimh an Aire Stáit Nash agus comhghairdeas a dhéanamh leis faoin ardú céime atá faighte aige agus gach rath a ghuí air. Beimid á mharcáil go tréan agus táim ag súil leis.
Sinn Féin has brought forward an amendment to the motion which in no way negates the sentiment that is being put forward by the Independent Senators. However, we feel that in a situation like this we must call a spade a spade and it is our policy that fluoridation of public water should be discontinued immediately. I disagree with many of the sentiments put forward by my good friend and colleague Senator Sean D. Barrett; we often agree but not on this. I have no doubt that when the Government of the day first introduced fluoridation in the 1960s it may have believed it was acting for the correct reasons. According to a 2002 report from the Forum on Fluoridation, the fluoridation process was introduced as it was considered to be a much cheaper way of improving the quality of children's teeth than employing more dentists. This led to the Health (Fluoridation of Water Supplies) Act 1960, which mandated compulsory fluoridation by local authorities. In 1965 the legacy of the mass medication of the population began.
Fluoridation was introduced at a time when tooth decay was a significant health issue, representing a cheap way to deal with a widespread problem, especially among poor and marginalised people. The Department of Health has never conducted any research on the health effects on the population of mass fluoridation in the intervening period, despite the fact that this was stipulated in the 1960 legislation. The argument today is that there is no longer a requirement within the scope of public health for continued water fluoridation. The need for fluoridation, if there ever was a need, has been entirely negated by modern use of fluoride toothpaste, which ensures a more than adequate supply of fluoride for the purpose of improving dental health and we also have improved dental services. A 2001 report in the United States detailing recommendations on using fluoride to prevent and control dental decay claimed that earlier studies from the 1950s indicated that water fluoridation had led to a reduction of 50 to 60% in childhood cavities. More recent studies, however, indicate a much lower rate of 18%.
There is no need to swallow fluoride in order to protect teeth and dentures. The purported benefits of fluoride are topical, they are on the surface, but the risks are systemic. Therefore, it makes more sense to deliver fluoride directly to the tooth in the form of a toothpaste. Fluoride toothpaste is the most widely used and rigorously evaluated fluoride treatment. A report entitled Oral Health in the United States: The Post-Fluoride Generation states that the introduction of fluoride in the early 1970s is considered to be the main reason for the decline in tooth decay in industrialised countries and toothpaste appears to be the single common factor in countries where tooth decay rates have declined.
Across Europe, countries have ceased the practice of the fluoridation of water such that 98% of Europe's population no longer drink fluoridated water. This is the only country with a statewide policy of mandatory fluoridation and local authorities cannot make the decision to stop the process. Many local authorities have approved motions to seek to stop the process, but they have been told it is not possible for them to do so. Most countries in Europe have experienced substantial declines in cavities without the use of water fluoridation. For example, in Finland and Germany tooth decay rates remained stable or continued to decline after water fluoridation stopped.
I, therefore, hope the Government amendment to the motion will be defeated and that our amendment will be accepted because although we agree with the statement about the human right of citizens, we feel the only way to end this policy of fluoridation is to call for the removal of fluoride from the public water system. This would allow people to choose whether to use toothpaste with fluoride in it.
There may also be a technical issue with the Government's amendment. I do not think that the first part of the amendment, "that water fluoridation is not medicinal but the adjustment of the natural concentration of fluoride in drinking water to the recommended level for the prevention of dental caries (tooth decay)", is a sentence, and it does not seem to make any sense. Even on that technical issue the Government should withdraw this nonsensical amendment. It is nonsensical both in its wording and in its sentiment.
There is a general sense, as was put forward in a Private Members' Bill brought by my colleague Deputy Brian Stanley in the Dáil recently, that there is no argument for the continued fluoridation of water. I commend the people who have lobbied on this issue, some of whom are in the Visitors Gallery, and we will support them until fluoridation is ended. If people then wanted to have that choice, they have the choice of what type of toothpaste to buy. I agree with Senator Gilroy, something that does not happen very often. As he said, it will be difficult if people are given a choice as to whether or not they want their water fluoridated because the water is fluoridated at a central source, so it will be impossible to give fluoridated water to one person and non-fluoridated water to the person next door. That is why we feel the amendment we are putting forward, calling for the removal of fluoride from the public water system, is the way to go. We hope we do get to put the amendment and that we receive full support from the House.
I begin by strongly commending Senator Mary Ann O'Brien on bringing forward the motion. It is important that the people's Parliament in the Oireachtas discusses an issue of fundamental human health. Whether one agrees with the fluoridation of water, or where there is conflicting scientific evidence as to whether the fluoridation of water is beneficial to human health, it is only right that we should debate it here. I have read many journal articles in this area. As a former food technologist I have a particular interest in the area, and as someone who worked in the food safety sector, I would like to think that I know something about it. One must only look at the conflicting evidence that is coming from all over the world. One would have to, on looking into one's heart, say there is a need for a systematic review of the fluoridation of public water drinking supplies. Simply because of the existence of conflicting evidence, one would have to at least look at doing that.
When the legislation was brought forward in 1960, a young Fine Gael Deputy at the time put forward an amendment which was accepted by the Government requesting that there would be periodic reviews of the fluoridation of our public water supplies. There have been ad hoc reviews and surveys but there has been no conclusive review. One recent review was carried out by the Department of Health in January, but it only scratches at the surface; it does not look at the conflicting international evidence and does not come up with a detailed response to all of that. I ask why this is the case. People will pay for their water from this day forth and therefore an individual who is purchasing a public good will purchase that good, whether they agree with the fact that there is fluoride added to the water. Is that right? I do not think so. They are paying for a product. They may not agree with what is in the product; therefore, why should they have to pay for the product because they have no alternative way of getting that water into their property? There are fundamental and ethical questions in that alone.
It costs €10 million a year to fluoridate our public water supply. The product specification given by the company that supplies the fluoride to the HSE, Chemifloc limited, is alarming when one reads the list of what is contained in the parameter elements of fluoride - things like arsenic, mercury, nickel, lead and selenium. Not since 1960 has the Department of Health in Ireland undertaken any environmental impact analysis of fluoride.
That is not true.
One would have to ask why. If the product is being added to prevent gum disease or mouth disease, surely it is a medicinal product being added to the public water supply. Why, therefore, is it not categorised as a medicinal product?
On a point of information, the forum on fluoridation in 2002 reviewed that matter.
We do not allow points of information.
It did not review it.
The Senator is giving misinformation.
The Senator may disagree with Senator Brian Ó Domhnaill, but he is allowed to make his point.
I have a copy of a reply from the Minister for Health dated 24 October 2013 which confirms that the matter was not reviewed and that the Irish Medicines Board, which has responsibility and is designated by the Department of Health as a competent authority, believes it is not necessary to accredit fluoridation as medicinal. Why? Surely it should be accredited.
I agree with my colleague, Senator Marc MacSharry, that there is a need for an urgent review. I thank Senators for tabling the motion, which I would love to be able to support. Our party has, however, taken a different view and I have to stand with it. There are serious questions. This is the only country in Europe that adds fluoride to the public drinking water supply, although one can argue that there are small municipal councils across different parts of Europe that add fluoride. As the argument was made about other countries, let us look at the other countries. In France, for example, the head of the Paris directorate for the protection of the environment said that fluoride chemicals are not included in the list of chemicals added to drinking water due to ethical as well as medical considerations. In Norway there was a rather intense discussion on the subject some 20 years ago and the conclusion was reached that drinking water should not be fluoridated. That was from the national institute of public health in Norway. In Sweden, drinking water fluoridation is not allowed by the national food administration drinking water division. Israel was mentioned earlier. In 2013, Israeli health Minister, Dr Yael German, stated that water fluoridation poses dangers such as lowered IQ, brittle bones and teeth, and damage to the thyroid gland. It was ruled that water fluoridation is unconstitutional, emphasising that it is dangerous and that the science defending the practice is outdated and no longer widely accepted.
This is a very useful debate. I thank Senators Mary Ann O'Brien, Feargal Quinn and Katherine Zappone for tabling the motion. I do not have all the answers, but I stand as a concerned citizen, a legislator and a mother. I have heard enough to say we should be concerned and careful. We are talking about the public water supply in Ireland that is fluoridated without us having a choice in the matter. This water comes into every one of our homes. It flows out of the tap and we are told to drink at least four litres of it a day. In a way, if I were to take it to an extreme, we are medicated according to thirst. Looking at the wording of Senator Mary Ann O'Brien's motion, there is a fundamental human right of every Irish citizen to choose whether to have their water medicated with fluoride. Putting fluoride into the public water supply is giving us a drug without our consent. That is an imposition. The only basis on which it can be done is if it is totally safe to human health.
Senator Mary Ann O'Brien and others have raised a political argument in the context of us paying for water from today. That is another argument. Let us go back to the substantive issue, which is about human health. There is enough doubt raised in my mind to convince me that we have to research this area very carefully. The first question I would ask is whether countries without water fluoridation have significantly worse teeth than Irish citizens. The evidence I have looked at does not show that this is the case. The main case for the fluoridation of water is that it reduces tooth decay. Someone is wrong.
I was seconded to work in public health for a short time, and worked with a HSE doctor for whom I had huge respect. I have contacted him on this matter. He believes the fluoridation of water is justified on public health grounds, but that it is an ethical issue, and that public health experts have not sufficiently acknowledged this. Here is a man giving a view that there is a lack of balance in this matter. He said it is critical that the Health Research Board reviews all the relevant evidence, and I would say urgently and within a timeframe. As Senator Brian Ó Domhnaill said, there have not been regular periodic reviews. It has not been adequate at all.
The citizens' health is at risk in this regard. Children are in far greater danger because their body weight is much lower. There are shocking statistics that if a child were to eat a whole tube of toothpaste, which I know is unlikely, given his or her body weight and the amount of poison that would be ingested, he or she would die. Half a tube of toothpaste would put him or her in a coma. That is from the forum report to the Government in 2002. We are all told to give children a pea-sized amount of toothpaste, but children under two do not have the reflexes to spit out and there is toothpaste with fluoride for children up to two years of age. In America, that very same tube of toothpaste carries a warning that it is a poison. That is not on our tube of toothpaste here.
A total of 98% of Europe has rejected fluoridation, so why are we still doing it? Are they all wrong while we are right? It is prohibited by law in Holland but compulsory in Ireland. There is a range of evidence that others have reflected in their arguments. It was interesting that the Israeli minister for health, Ms German, said Israel's decision not to go with the fluoridation of water was supported by World Health Organization statistics proving that tooth decay has declined equally in countries with no mandatory fluoridation. If that is the case, why do we have it? I am not saying Israel is the only example we should look at, as 98% of Europe is also not choosing it. There is an international movement away from fluoridation. It is becoming redundant and is being rejected in other countries.
Fluoride is a highly poisonous substance. It carries a poison warning in the United States. There are more than 1,000 scientific studies saying fluoride in water causes health damage, from osteoporosis to arthritis to gastrointestinal cancer to dementia. These are very serious claims which would contradict what Senator Sean D. Barrett is saying. We urgently need a time-bound review of the research in this area. Will the Minister of State request the Health Research Board to conduct a systematic review of the evidence in this area urgently, and to report back to this House by January 2015 at the latest? It should answer the following questions. Do the citizens of countries without water fluoridation have significantly worse tooth decay than Irish citizens? Is there a greater incidence of diseases such as osteoporosis, bone cancer, lower IQ, and other major illnesses such as dementia in countries with fluoridated water versus countries without fluoridation? How effective is using fluoride in toothpaste, which can be spat out, versus a fluoridated water supply in preventing tooth decay?
I thank the Senators who tabled the motion for being thought-provoking. It is in the interests of public health. The very least we can do for each other is come up with some definitive answers that will help us inform future policy in this area.
I am very disappointed that this motion has been tabled by Seanad colleagues. Fluoridation has consistently been the subject of misinformation and distortion of evidence. It is quite disappointing to see the sponsoring Senators join this bandwagon. We should be celebrating the fact that this year marks the 50th year of the fluoridation of public water supplies in Ireland.
This public health measure has been reviewed numerous times and every review shows fluoridation has benefited the dental health of Irish children. Its introduction in Ireland was promoted by Seán MacEntee, then Minister for Health, who passionately believed children deserved no less. Its legitimacy was validated at a long High Court hearing in 1965. In the same year, the Supreme Court rejected the assertion that fluoridation of public water violated the Constitution's guarantee to bodily integrity, a finding which this motion should recognise and on which its proposers should inform themselves.
A number of respected and expert reviews of fluoridation in Ireland have taken place to review concerns expressed. The then Minister for Health and Children, Deputy Micheál Martin, established the Forum on Water Fluoridation in Ireland in 2002 and launched its report in the same year. How can the sponsors of the motion cast aside the main findings of the forum's report? Water fluoridation has been very effective in improving the oral health of children but also that of adults and the elderly. The best available and most reliable scientific evidence indicates that at the maximum permitted level of fluoride in drinking water in Ireland, namely, one part per million, human health is not adversely affected.
The expert body on fluoride and health was established as a result of the forum's recommendation to advise the Minister with responsibility for health on all aspects of fluoride, emerging issues and research findings. This expert body, under the chairmanship of Dr. Seamus O'Hickey, continues to meet and discharge its responsibilities. It has found no study which casts doubt on the safety of water fluoridation in Ireland. The expert body states the only known side-effect of water fluoridation is dental fluorosis, a superficial staining of the tooth surface which has no adverse health effect and can be removed easily.
The expert group states much dental fluorosis comes from sources other than fluoridation of water such as the inappropriate use of fluoride toothpastes which are generally 1,500 times more concentrated than fluoridated water. The expert group recommends that fluoridated toothpaste should not be given to children under two years of age and adults should supervise children aged between two and seven years when brushing with fluoridated toothpaste; therefore, a tiny amount is used and it is not swallowed.
The Senator would want to talk to Senator Brian Ó Domhnaill about that.
Backing this recommendation on restricting or supervising children's use of fluoridated toothpaste would make for a far more pro-health motion in the House than that which we have.
I admire the role of Fianna Fáil, from its initial champion, Seán MacEntee, when he was Minister for Health through to Deputy Micheál Martin who, as Minister for Health and Children, established the Forum on Fluoridation in Ireland and the expert group which continues to do excellent work on behalf of the Government.
Senator Mary Ann O'Brien has four minutes to conclude.
I do not know where to begin and would need 40 minutes. I welcome the Minister of State and I am sorry he was not here for the beginning of the debate. I am extremely sorry the Minister, Deputy Leo Varadkar, is not here. Senator Sean D. Barrett made the point we need to get on with this and get back to discussing serious health problems. The entire population is involved in this discussion. Before Senator Mary White leaves, I wish to state there is more to our bodies than our teeth, but all I heard from her was about teeth.
I listened to the professionals and experts.
I am sorry, a Leas-Chathaoirligh-----
Senator Mary White is entitled to leave the Chamber.
If one has a glass of water it goes at 100 miles by our teeth and into our tummies. Fluoride is not intelligent; it does not have a label stating it must go straight to the teeth. It goes into our tummies. It is soluble. Within five minutes it is in every cell in one's body. I want Senator Sean D. Barrett to listen to this because we are not only talking about teeth but every cell in the body. What about the rest of the skeleton? Everyone has stated dental fluorosis is a definite and we have found something on which we all agree. What about skeletal fluorosis? If teeth get dental fluorosis why cannot the rest of the skeleton get fluorosis? Skeletal fluorosis is a bone disease which in mild form can cause fractures. Golly gosh, that is a cost to the nation for older people with hips, broken bones and brittle bones.
I was very glad to hear Senator Mary White clarify the point on children aged under two years. To return to my speech, what about children aged under two who must drink bottled feeds? I believe it was Senator Colm Burke, but perhaps it was Senator John Gilroy, who stated one must follow the manufacturer's instructions when making up formula feeds. Having had five children, I cannot remember a manufacturer's feeding tube stating it should be mixed with boiled fluoridated water. Babies are not supposed to have fluoridated water. They cannot excrete fluoride efficiently. Adults can filter 50% but babies retain 90%. This is based on studies which have been conducted and are true. Babies weigh between 12 and 25 pounds and per body weight need three to four times more liquid per day than adults to stay alive because they do not have any teeth so they cannot eat. Their food comes from drink and bottles. They take in three or four times more liquid and fluoride than we do, which is a serious problem.
To come back to Senator Sean D. Barrett who may not have been here for my speech, I quoted from the National Research Council report from the United States. It is an arm of the US National Academy of Sciences. It conducted the largest piece of research ever conducted in the history of the human race since fluoridation has become apparent, when 12 scientists chosen for their balanced nature spent three years examining the pros and cons in 1,000 reports. The Senator can read my speech later because I have very little time left.
I did not know that fluoride is found in pharmaceuticals, steroids, anti-inflammatories, antimalarial drugs, anaesthetics, anti-fungal treatments and antibiotics which are given to children.
The pharmaceutical industry is with us on this also.
Will the Minister of State, Deputy Gerald Nash, also ask the Minister of State, Deputy Kathleen Lynch, whether the expert group tested our water recently? Can we have a breakdown of exactly what is in the water? How many humans and how many counties have been tested regarding their levels of fluoride? I bet she will tell me they are never tested. How many foods have been tested? How many beers have been tested? How many Irish soups and ready meals? How much Irish cheese? How many Irish smoothies? They all contain fluoride because they all are made with fluoridated water. Earlier someone said one can make a baby's bottle with boiled water. Boiling does not make fluoride go away.
I must put the question.
I thank the Leas-Chathaoirleach for his patience.
Israel banned fluoride this year. Its decision was supported by the World Health Organization's statistics proving that tooth decay has declined equally in countries with no mandatory fluoridation. It is about diet; it is about calcium, magnesium and zinc. It is the toothbrush that is the greatest invention of the past 70 years, not fluoridation. We need education, not fluoridation.
Shame on them all. I wish the Minister of State, Deputy Kathleen Lynch, had stayed because we need to review this outdated 51 year old policy and not have Senator Mary White in here looking wistfully back to the past and quoting outdated health policies. I ask the Minister of State, Deputy Gerald Nash, to bring this message back. I will not press the matter to a vote because we will not win it this evening. I am glad Sinn Féin is with me on this issue. We are on a journey and we will get this done. In Israel, it had to be taken to the Supreme Court. If we must do the same to get this done, we will.
Well done.
Amendment put and declared carried.
As amendment No. 2 has been agreed to, amendment No. 1 cannot be moved.
I do not agree with any of them. I have stated I am choosing not to put it to a vote.
Is it not up to the Senator to decide whether it should be pushed to a vote?
Senator Mary Ann O'Brien has already indicated.
I do not agree with any of the amendments. To be honest, most of them are a joke.
Amendment No. 1 not moved.
Question, "That the motion, as amended, be agreed to," put and declared carried.
When is it proposed to sit again?
At 10.30 a.m. tomorrow.