In January of 1997, Brisbane
Australia considered the possibility of fluoridating the water
supply. Knowing the political firestorm which errupts when fluoridation
is considered, the city wanted an unbiased analysis of whether
it was actually needed. A number of experts from the Dental Association,
Medical Association, University of Queensland, Society for Environmental
Medicine and other professionals were asked to join. A balanced
task force was created with persons with a variety of existing
viewpoints.
In October of 1997, the Task
Force issued their report after having reviewed the following
considerations:
History and Legal Issues
Ethical Considerations
Dental Costs and Benefits
Human Health Effects
Environmental Impact
Consideration of Economic Cost/Benefit
Analysis
Public Consultation
Assessment of Benefits and Risks
The Task
Force Report is written for the lay person and is easy
to understand. What follows are selected quotes.
11.10 Conclusions
A significant proportion (23%) of Taskforce members shifted position
from strong support for fluoridation, or in one case uncertainty,
to opposition.
It is clear from responses
that the case presented by the medical/dental experts on the
Taskforce, as well as the literature supporting fluoridation,
failed to convince these members about a number
of areas of concern:
[Editor: These are the claims
which the Task Force found unconvincing]
that the dental caries problem in Brisbane was sufficiently serious
to
require fluoridation (in the light of declining decay rates);
that health risks were negligible,
particularly in relation to increased risk of
hip fracture; the possible effects of accumulation of fluoride
over a lifetime
of exposure; and excessive total intake by babies and young children;
that the margin of safety between
a toxic and safe dose was significantly
wide;
some commented that health professionals
who supported fluoridation
were not prepared to carry out research in Australia to prove
that
fluoridation was still effective or, more importantly, completely
safe.
Many Taskforce members were
unconvinced by assurances that serious risks to health were negligible
or non-existent. In particular, there was concern about ambiguous
scientific evidence of an association between water fluoridation
and
higher levels of hip fracture.
The Taskforce noted that the
1991 NHMRC Working Group, which had supported fluoridation, had
expressed considerable concern about the fact that it could not
point to a single Australian study which had monitored adequately
the
impact of possible adverse consequences of fluoridation (NHMRC
1991, Section 8). The majority of the Taskforce was concerned
that these inadequacies have still not been addressed.
There was also concern about
the lack of scientific research on the lifetime effects of an
accumulation of fluoride in the body, in spite of the 1991 NHMRC
Working Group statement that it was imperative that public
health recommendations in the future be based on accurate knowledge
of the total fluoride intake of Australians (NHMRC 1991,
Section 8.3). This aspect was highlighted by most Taskforce members
as an area which required further scientific investigation.
4.3 Toxicity of Fluorides:
The physical and chemical properties of the various compounds
of fluorine vary considerably, and the toxic properties range
from extremely toxic to completely non-toxic. Fluoride salts
are widely used as insecticides and poisons for rodents. In concentrated
form they act as very powerful inhibitors of the enzymes which
produce the energy requirements of living cells.
At doses in excess of 2 grams
this effect could also be fatal in humans. The fluoride salts
commonly used in fluoridating public water supplies are sodium
fluoride; sodium fluorosilicate; and fluorosilicic acid. These
are primarily by-products of the
phosphate fertiliser industry.
Basic Argument: The basic argument
in favour of fluoridation is that the state ought to act to achieve
fundamental benefits for its citizens. The paper explores two
main areas of ethical concern about fluoridation:
The Safety Objection: can a decision to fluoridate be ethical
if fluoridation may have harmful effects?
The Compulsion Objection: is
the state justified in compelling people to consume fluoridated
water?
6.12.4 Benefits Mainly Topical:
The Taskforce agreed that most of the caries prevention effect
of fluoridated water was topical, i.e. it results from the effects
of fluoride at the surface of the teeth rather than systemically
(via the bloodstream), as used to be thought. Consequently, there
was limited value from actually swallowing the water.
6.12.5 Excessive Ingestion
Causes Dental Fluorosis
Excessive ingestion of fluorides by children under the age of
six can lead to dental fluorosis. The extent of the damage to
teeth depends on the level of fluoride intake, and the length
of time these levels are maintained.
6.12.6 Fluorosis Not Simply
a Cosmetic Problem
WHO [World Health Organization] stated that dental mottling is
a definitive sign of fluoride toxicity . The Taskforce agreed
that any level of dental fluorosis in children was undesirable.
8.2 Environmental Impact
of Fluoride
Fluoride was taken up by animals and stored mainly in the skeletal
or exoskeletal parts of the body. Fluoride is a chemical element
and the introduction of any fluoride will produce a toxic response
in the environment. Some species of animals and plants would
adapt to the introduction of additional fluoride. However, fluoride
would affect some species and at different stages of their life
cycle e.g. an adult form of a species may be more sensitive that
the juvenile (e.g. rainbow trout).
The introduction of fluoride
to the environment would present a relative (increased) risk
to livestock, some terrestrial and agricultural plants, sensitive
freshwater plants and animals, and freshwater creeks (especially
under low flow conditions) found in the Brisbane area.
Task
Force Report |