Fluoridation – Mass Medication or a Societal Benefit?

By Michael Edmonds 08/06/2013

The recent decision by the Hamilton City Council to stop fluoridating the Hamilton water supply has received substantial commentary from my fellow science bloggers regarding the science (or lack there of) behind this decision (see hereherehere, here and here). Most of these posts have addressed some of the dodgy scientific arguments put forward by anti-fluoridation advocates, so I won’t dwell on those – what I want to do here is look at the claim that fluoridation is “mass medication”.

This argument reminds me of the debate over the addition of folic acid to bread. The reason for doing this is that folic acid significantly reduces the occurrence of neural tube defects (NTD) in new born babies. NTD’s can result in death or severe disability for the child. In the debate over compulsory addition of folic acid I originally opposed addition of folic acid, as I thought this means of delivery would lead to doses which varied too much to be useful (some women eat very little bread), and that it was a form of mass medication, particularly as it was only really of use to pregnant women to protect the health of their unborn child – surely it would be far more effective for pregnant women to take supplements ensuring the optimum dose of folic acid to best protect their unborn child?

Thanks to vigorous discussion with colleagues here at sciblogs and other advocates for folic acid, I have since changed my mind (which is something a good scientist/rational thinker should do when confronted with new evidence). The three key points which made me change my mind are:

1) Evidence from countries such as Canada where compulsory fortification of foods with folic acid has lead to a significant decrease in NTD’s

2) Not every pregnancy is planned or recognised in time for the woman to take folic acid for the optimum period of time

3) There were no studies showing that folic acid could be harmful to those taking it in the doses it was being introduced into bread. As is happening in the current fluoride debate some opponents pointed out that with high doses there was some early evidence that it might create some health issues. However, we need to remember that in talking about toxicity or adverse health effects you always need to consider the dosage. Even water, which is vital for live can be toxic if we consume too much of it at one time (rapid consumption of around 2 – 3 litres can cause “water intoxication” which can be fatal). As far as I can see there is little evidence that folic acid (or fluoride) in the doses that are being proposed/used could do harm.

With regards to fluoridation another point worth remembering is that some water supplies have natural levels of fluoride. Indeed it was the observation that populations consuming water with naturally occurring fluoride had lower numbers of dental cavities, that first hinted that adding fluoride to water supplies without it might be a good idea. Can we really consider the addition of something that occurs naturally elsewhere as medication?

0 Responses to “Fluoridation – Mass Medication or a Societal Benefit?”

  • There is also the state’s mass medication of the population by adding iodide to salt.

    >Can we really consider the addition of something that occurs naturally elsewhere as medication?

    Or poisoning? A similar argument could apply for using 1080 on possums. It occurs naturally in Australians soils, especially on the east coast.

    • Possum, I think 1080 occurs in some plants (effective way to discourage animals from eating you) but I’m surprised to hear it occurs in soils?

  • An issue with folic acid is that women should start taking it before conception. Now in my day very few people planned children – – they seemed to just happen. I used to joke that I didn’t know what was causing it until our 4th child (who was the only planned one anyway). Of course that didn’t stop us loving them.

    I wish that there had been regular sources of folic acid in my days – we have two cases of neural defect problems in my wider family. But this illustrates the problem of personal responsibility for such supplements.

    Again, it is the more economically and socially disadvantaged group who probably have more unplanned children and less opportunity to start taking folic acid before conception.

  • Possum, are you sure about 1080 in soils, I thought it decomposed quickly in soils, and only occurred naturally in plants in Western Australia?.

    I’d define drinking water supplemental fluoridation as mass medication, and it’s no different to ubiquitous common food additives – such as preservatives.

    In most cases ( including water disinfection – Chlorine, ozone, UV etc. ), are regularly reviewed for efficacy, exposure and risk/benefit versus the hazard they address. Mass medication has been effective in reducing many of the diseases and health issues of 100 years ago.

    Drinking water fluorination has changed over time as technology and knowledge advances, but it’s still considered beneficial to citizens, eg US CDC reviews and NZ’s Ministry of Health reviews of oral health in school children. Fluoridation benefits many NZ children, as the NZ Ministry of Health spreadsheets show.

    It’s disappointing that anti-fluoridation advocates visited Grey Power meetings in Hamilton and accosted people to sign their forms. We should not allow misguided advocates to demonize mass medication as it’s a legitimate and effective strategy.

    The Ministry of Health needs to effectively communicate by interaction with the general adult public to ensure citizens understand issues and make sensible choices. At the moment Ministry staff are invisible or wringing their hands and saying fluoridation is a local choice. How many times have knowledgeable officials visited Grey Power meeting to discuss concerns or advocate for community health initiatives, such as fluoridation?

    If that’s the case let’s disband the Ministry, as there is no point compiling data and hiding it in obscure spreadsheets, perhaps just to comply with some international reporting obligation.

  • Possum, people choose to buy iodised salt. Many people buy rock salt or non-iodised salt. So it’s not mass medication via a utility.

    If people want to avoid F in water they have to install expensive filters or buy non-fluoridated water at great expense. Neither of these are factored into cost/benefit analyses.