Water Fluoridation – the emotional tail wags the dog in Hamilton

By Helen Petousis Harris 05/06/2013 32


It is a very sad day for evidence based public health in Hamilton today.  Council have voted to remove fluoride from the town’s water supply, 8/13 councillors voted on the matter and 7 voted to remove the fluoride.  It is also striking that councillors who served on the district health board and likely knowledgeable on the issue were directed to abstain due to a conflict of interest.

In viewing the Council Agenda is sickening to see promoted advantages/benefits lined up against promoted disadvantages with no regard as to the weight of evidence. This is no way to make decisions affecting the health of the community, especially the most vulnerable.

There is a jolly good reason that fluoride is added to many water supplies worldwide. It is because these water supplies have levels of the mineral below that which optimises oral health.  The water in NZ is relatively low in fluoride and adjusting the parts per million of fluoride to 0.7-1.0ppm corrects this deficiency. The NZ Dental Association strongly support and promote community water fluoridation  as do the Ministry of Health and the World dental federation . What is Hamilton Council thinking?

A NZ study found  a 30% lower rate of tooth decay in five year olds residing in cities with fluoridated water (i.e. Wellington) compared with those without (i.e. Christchurch) and 40% lower rates in 12 year olds and the independent association between fluoridated water and these findings was confirmed after multivariable analysis. The differences are greater for Maori and Pacific children.

The National Health and Medical Research Council in Australia (NHMRC) carried out a systematic review of high level evidence as to both the efficacy and safety of various forms of fluoridation.  The evidence for water fluoridation was the most extensive.  They concluded the following on safety:

  • Consistent evidence that water fluoridation can cause dental fluorosis (discolouring of teeth) however this uncommon with appropriate use of all fluoride sources
  • Fluoridation at the recommended levels (0.6-1.1mg/L) may reduce rather than increase fracture risk
  • There is no consistent evidence that fluoridation increased risk for cancer
  • No evidence on other possible negative effects

They concluded the following on effectiveness in preventing dental caries

The existing body of evidence strongly suggests that water fluoridation is beneficial at reducing dental caries. After adjustment for potential confounding variables, McDonagh et al (2000a) showed in their systematic review that the introduction of water fluoridation into an area significantly increased the proportion of caries-free children, and decreased mean dmft/DMFT scores compared with areas which were non-fluoridated over the same time period. The findings of McDonagh et al (2000a) also suggest that cessation of fluoridation resulting in a narrowing of the difference in caries prevalence between the fluoridated and non-fluoridated populations. Only one additional relevant original study was identified in the current review and this did not change the conclusion of the existing systematic review.

The McDonagh review is summarised in the BMJ.

In contrast, the “body of scientific evidence’ produced in Hamilton claiming that fluoridation was harmful is actually largely pseudoscience or irrelevant. For example:

The report from someone called Declan Waugh is not a report on the evidence on water fluoridation but some kind of personal rant.  And another study submitted as evidence of harm is a review on the effects of fluoride toxicity in areas that have very high levels of fluoride (largely naturally occurring) with the reverence exposures around 0.6-1mg/L. Utterly irrelevant to this argument.

Hamilton, you have just taken a BIG step backwards in terms of public health and caring for your most vulnerable members of the community. You ignored advice from the experts such as your own District Health Board and Medical Officers of Health 


32 Responses to “Water Fluoridation – the emotional tail wags the dog in Hamilton”

  • Just out of curiosity, I wonder if philosophies used with children of trophies for everything, no-one losing, parents not using the word “no” etc, designed to empower kids & boost self-esteem, could have had an impact on the prevalent attitude of people considering their (often ill-informed) opinions merit equal weight with evidence based experience of specialists?

    Just recently, I read of a Wellington city councilor taking on a geotechnical engineer from GNS as to whether slippage is an issue in Wellington or not. It’s just not about balance or representation of both “sides”.

    … Frustrated.

  • I understand that the same discussion is going on in Hastings? I have heard there is a community group that wants an end to fluoridation because of links to thyroid disease (among other things). They also claim to have “evidence”. Wonder what the merit of that evidence is. Is there such a link?

  • “councillors who served on the district health board and likely knowledgeable on the issue were directed to abstain due to a conflict of interest”

    Leaving aside the science issues for a moment, I’d want to know who made this direction/order, that person’s interests in this, and if they are even allowed to deliberately skew a vote like that. It seems quite undemocratic.

  • It’s cases like this that make me feel very conflicted.

    On one hand, it does my head in when the science is misunderstood/misrepresented by people who have such strong feelings as to be impervious to logic. But then again, if it is what a community wants, then it is their right to decide.

    Maybe it is an example of the failings of science communication to the public? It does seem that for whatever reason the hysterical get heard the loudest.

    • Yes, while I whole heartedly agree that Democracy must prevail I have two big issues with what has occurred here.
      1. It is unlikely that the submissions actually reflect the community in general as submitters would have been a very self selecting group (the loudest)
      2. On what basis/information are the community making their decision? In this case I strongly suspect is is not based on scientific evidence but on misinformation therefore not an informed decision.

      Definitely a failing of communication to the public through appropriate channels by appropriate authorities me thinks!

  • I wonder if someone could seek judicial review of the decision, on grounds of unreasonableness. I struggle to think who would be well-funded enough to take it to court though.

    Andrea, the post-modern idea that everything is just a point of view is older by about 20 years than the self-esteem education thing. And the kids most affected by the latter would be too young to be seriously influential in this debate.

  • Also conflicted.

    While I fully support the benefits of mass fluoridation, I do wonder at the ethics of the imposition of what amounts to medical treatment on an entire population.

    This is of course separate from the issue of democratic decisions being made on the basis of manipulative fairy tales

    • Agree, although I think in this case one can argue that fluoride occurs in greatly varying amounts world wide, with some communities exposed to toxic amounts naturally. An optimal exposure range has pretty good evidence so adding a small amount to increase the concentration to that which is naturally occurring in other places is maybe not the same as medicating. Same argument goes for adding iodine to salt to prevent goitre and cretinism. Do the rights of the few outweigh the good of the all? Tricky arguments that do my head in.

  • Helenph:

    Yes you are right, and I think it also seems to hail to some innate mistrust of “authority figures” trying to convince us something is safe, which is healthy to a certain degree ( I guess so many people think back to the likes of DDT, Chromium, Thalidomide etc).

    But I think the trouble too is that the worldview of a scientist is that reason, evidence and logic are the key tools in any debate. Maybe it should be the case, but when opposition has become so emotionally invested in a point of view (which science rarely does, or deliberately pushes the emotion aside) that is what gets people’s attention.

    So maybe we need more passion from people in the science community on these issues? I think we do have scientists in this country with the charisma to achieve this in the public forum, but they need to bring more than information. They need to bring the kind of spirit that gets people behind them.

  • It has been noted that the council has effectively overturned a binding referendum in 2006 in which the majority voted for continue fluoridation – something worth considering when deciding whether this decision was truly democratic.

  • As a child who lived in Hastings after fluoridation was introduced, I’m greatly saddened that councils even contemplate removing fluoride. I listened to the comments of all the adults who had lost their teeth in their thirties, saying how lucky I was.

    The graphs available at the Ministry of Heath site show that greatest fluoridation benefit occurs during youth, and the benefit is unambiguous.

    The people who believe fluoride toothpaste is a suitable alternative usually ignore the detail that it’s the poorer families that will feel the extra cost, and that any adverse consequences don’t appear for years. Examples that anti-fluoridation campaigners may use as locations are Finland, Germany where society encouraged good school dental programmes, and also encouraged diligent tooth care at home. NZ doesn’t.

    It’s amazing that only 60-70 years is required for people to forget the situation before water fluoridation, when lots of poor people had no/rotting teeth. The sad history that made people want to introduce vaccinations, iodized salt, potable water treatment, etc etc. is disappearing under a pile of strident assertions and claims of personal responsibility that overwhelm historical evidence.

  • I have just watched the story on Cambell Live regarding the Hamilton council’s decision and am left feeling very sorry indeed for their constituents. The Mayor did not come across at all well, and the woman from FANNZ was just awful – she left me believing even more vehemently that water fluoridation must continue, and that we need to speak up against these zealots who seem to have been brainwashed with dodgy ‘science’ and are almost fanatical about their cause (have a look at their Facebook page). I am feeling very fortunate at this moment to live in the Hutt Valley, though I will be keeping a close eye on the goings on at my local council just in case!

  • NZ is generally deficient in Fluoride in it’s waters. Just like cobalt in the soil caused bush sickness in cattle, science had a hand in figuring that out and lo, subtle application of said element cured the problem. Farmers do it all the time with trace elements throughout the world. These picked up by plant and beast, eventually benefit said plant and beast and eventually human physiology. For the life of me I cannot figure out why fluoride cannot be treated the same.

    This is another piece that must be added to the Geek Manifesto and all Geeks should shout from the rooftops about it.

    YAAAAAAAAAHHHHHHHH !!

    PS – how bloody stupid that the council suggested a conflict of interest from those on Health Boards etc. Hypocrites.

  • What do some experts say about fluoridation?

    • Dr Hardy Limeback, Associate Professor and Head, Preventive Dentistry, University of Toronto, and panel member for the National Research Council report on ‘Fluoride in Drinking Water’ (NRC, 2006)
    “. . . we now know that fluoride doesn’t need to be swallowed, that the public has to be informed. They should be told that it doesn’t work by swallowing it.”

    • Dr Robert Isaacson, panel member, NRC 2006.
    “As far as I can see, there’s no doubt that the intake of fluoridated water is going to interrupt basic functions of nerve cells in the brain, and this is certainly not going to be [for] the benefit of anybody.”

    • Dr Arvid Carlsson, Nobel Laureate in Medicine (2000) and official advisor to the Swedish Government.
    ”Fluoridation is against all modern principles of pharmacology. It’s obsolete. I don’t think anybody, not a single dentist would bring up this question in Sweden anymore.”

    • Dr John Colquhoun, former dental health officer for Auckland and former editor of the international journal Fluoride, who on the basis of firm evidence became one of the most articulate critics of fluoridation.
    “It is my best judgement, reached with a high degree of scientific certainty, that fluoridation is invalid in theory and ineffective in practice as a preventive of dental caries. It is dangerous to the health of consumers.”

  • It’s been a source of frustration and embarrassment as someone with a scientific background who values reason and logic, to live in Tauranga which also stopped fluoridation of it’s drinking water. Hamilton stopping it’s fluoridation brings to the fore all my frustration and embarrassment once again. Even worse this time around are the dodgy politics at work – with the majority of Hamiltonians wanting fluoridation to stay.

  • Ross2: it doesn’t take much digging to find that all the examples you have quoted are shallow and misleading – and much bandied around by the antifluoridation brigade.
    To take one example: Dr Robert Isaacson is a psychologist, and has a very shaky grasp of basic principles of chemistry and toxicology from what I have read of his writings on the subject. Here’s an example: “As a consequence, when silicofluorides are added to our drinking water there are really two toxic hazards: one coming from the fluoride and another from the silicon. Silicon can produce its own toxic hazards including the formation of solids (silica and silicates) that can lodge anywhere in the body.”
    This is just silly.

  • I attended the first day of the 3 day meeting held in Hamilton to present a possible way forward, which the counciil declined to take up. This was based on the work of Peter Sandman – (http://www.psandman.com/) who coined the equation: Risk = Hazard + Outrage. The science is really clear – fluoride in drinking water is a LOW HAZARD situation – it’s the outrage factors such as loss of choice, its association with industrial waste, fear and distrust of authority etc which are the big issues here. As Sandman says – if the hazard is low and the outrage is high – address the outrage. Don’t insult people by saying the risk is zero, mild dental fluorosis is a small but relevant (to some people) issue.

    • Hi Pat,
      Absolutely agree, we must deal with the outrage issues. Is anyone able to comment on the communications to the public about this issue? Not being from Hamilton I and maybe others are wondering about how the issue was presented, what information was provided (risks and benefits) and by whom. I think it is so important not to allow misinformation and scaremongering to thrive in a vacuum but not sure where or who has provided the public health perspective during this process and if there was a coordinated informed response?? We certainly know from experience that vaccine outrage factors can be addressed successfully in exactly the way you say – including don’t tell people it is all completely safe.
      helen

  • A sample user comment from :

    “Jason Halbert wrote:

    Sodium Fluoride is poisonous. What else do you want to know?”

    And Mr Halbert is not alone in his (sorry – no nice way to say it) moronic thinking, as much of the rest of the comment feed shows.

    That sodium fluoride has a toxic level is utterly _meaningless_. Magnesium, iodine, zinc, etc, etc, etc all have toxic levels. So does every single other mineral essential to human life, and merely useful ones like sodium fluoride (though it’s debatable whether avoiding cavities and the loss of one’s teeth can be considered non-essential. I know I consider my teeth essential). Are fools like Mr Halbert going to kill themselves by avoiding those minerals as well?

    Are they going to avoid H2O which also has a toxic level to humans??? Seriously, I don’t just mean drowning in it – .

    I joke, but really – how do people with such stupid thinking utterly absent any reason or logic, survive in the modern world?

  • Regarding the question of public opinion in Hamilton.

    The binding referendum in 2006 showed 70% support for fluoridation.

    The Council itself had access to two recent polls. To quote their own summary:

    “The results of the Quarterly Residents Survey showed 50.20% of participants would like Council to continue adding fluoride to the water supply, 31% would like Council to stop and 18% of participants did not know. ”

    And

    “The results of the Citizens panel on-line survey showed 56.1% of participants would like Council to continue adding fluoride to the water supply and 43.9% would like Council to stop. ”

    So the Council disregarded the clear opinion of their citizens – even while acknowledging they, and their staff, did not have the expertise required to judge the science!

    No wonder many Hamiltonians are pissed off.

  • Well, over at iPredict, Julie Hardaker is at 87% likelihood to win the Mayoralty. If you have no competition, who cares what people think?

  • It’s been pointed out to me that a study cited by FANNZ doesn’t actually back their position. It seems to hinge on the amount of fluoride in the water with high amounts lowering IQ a little.

    I’ve found the study (http://goo.gl/WvHEp) and I’ve found references to the recommended amount for it to be beneficial. What I haven’t found is a reliable source that tells me the level that was in the water in Hamilton.

    Can anyone assist there?

  • Gold, I think this study “Fluoride Neurotoxicity: Review of evidence from drinking water studies” ( http://www.rph.org.nz/content/e3859047-6183-4f45-b6de-1c1ee5ba9995.cmr) analyses the study – and similar ones – you refer to. It is from National Fluoridation Information Service Advisory (http://www.rph.org.nz/content/5141a5c5-bdae-4c3d-afca-e0f916e22e2f.html) which provides access to many recent paper on this issue.

    The Hamilton City Council Policy used to be adjustment of water supply to achieve a concentration of 0.7 – 1.0 mg/l.

    I have also been going through somne of the FANNZ reviews of literature. It seems to me that they gloss over many things, even suggest things which aren’t true. It’s probably what you can expect from any activist group with an agenda. It really pays to check out the original papers.

    Life is far more complicated thnan they suggest.

  • One source I saw gave those figures but said the river water can, at times, go as high as 0.6 ppm or more.

    Water treatment itself removes a lot of the natural F, another reason for supplementing it.

  • I object totally to mass fluoridation of the water. Since I have been in Hamilton I have been unable to drink the water because it stinks. Since the fluoridation stopped, so has the stench. There should be freedom for individuals to choose in matters of health or would the Ewan Wilsons of this world have us live in a Nazi state? He will be the first councillor I vote against.