Lies, damned lies and fluoridation

Background

Adding fluoride chemicals to water supplies for dental purposes commenced in the USA in the 1940s, based on incomplete trials and minimal safety testing. Regardless, most Australian capital cities followed America introducing fluoridation in the 1960s and 1970s. Brisbane though, and numerous regional cities around the country, never embraced the fluoride enthusiasm. Doubts and concerns have long been voiced both in the scientific community and from the public. Dentistry associations and state governments run regular public relations campaigns to try to bolster public support. The ethics of these PR campaigns need to be examined.

Fluoridation as medication

Fluoridation is administered as a “medication” since it was marketed as a substance to combat a disease, tooth decay. Indeed it is a “mass medication” as it is not given to individuals according to need, but given to all regardless. Furthermore it is a “compulsory mass medication” because no amount of home filtration or purchasing bottled water can screen a person from the fluoride - a normal life includes eating and drinking in restaurants, workplaces and other homes.

Prescribing medication for individuals, and certainly for an entire population, must be subject to strong ethical principles. These principles have been enshrined in internationally accepted codes of ethics since the Nuremberg Trials at the end of World War II. Here is a short exerpt from the British Medical Journal that describes the Code:

• The judgment by the war crimes tribunal laid down 10 standards to which physicians must conform when carrying out experiments on human subjects in a new code that is now accepted worldwide.
• This judgment established a new standard of ethical medical behavior for the post World War II human rights era. Among other requirements, this document enunciates the requirement of voluntary informed consent of the human subject. The principle of voluntary informed consent protects the right of the individual to control his own body.
• This code also recognises that the risk must be weighed against the expected benefit, and that unnecessary pain and suffering must be avoided.
• This code recognises that doctors should avoid actions that injure human patients.
• The principles established by this code for medical practice now have been extended into general codes of medical ethics.

Foremost is the concept of “informed consent”. This means that medication can only be given to someone with their clear, unambiguous consent, and only after they have received full, truthful information about that medication and demonstrated that they have understood.

Mass fluoridation clearly violates the consent rule. In fluoridated Australian cities nobody is asked for their consent, rarely when fluoridation commences and certainly not on an ongoing basis. I have not met a single person in fluoridated Melbourne who has been asked if they consent to the treatment since fluoridation began in 1977.

The water authorities charged with fluoridating their consumers do not know whether they consent or not. A referendum can not solve the problem because consent is an individual matter, not for 51 per cent to tell the rest what they must swallow.

Informed consent means truthful information

Telling the truth to patients and the public is a cornerstone of medical ethics. That is the meaning of “informed” in the concept of informed consent.

To assess the truthfulness of information given to the public, and even professionals, it is instructive to look at fluoridation promotional literature produced by the Australian Dental Association and state Health Departments. These booklets and leaflets have monotonously paraded the same set of assertions for the last 30 or 40 years. I contend that the majority of these assertions are non-truthful by omission and commission, with the exception of a single accurate item, the instruction that people should brush their teeth. The following analysis outlines three striking areas of non-truthfulness: claims about benefits; claims about safety; and claims of worldwide acceptance.

Truth decay regarding benefits.

The Victorian Branch of the Australian Dental Association, in 2002 produced a package for politicians and decision makers called Fluoridation - Nature Thought of it First. The package claims that hundreds of studies (even thousands, on one page) show huge reductions in tooth decay resulting from fluoridated water. There is a simplistic, coloured graph of tooth decay rates being higher in non-fluoridated Victorian towns. But these data are not referenced to any peer reviewed, scientific publications. Right in the back of the package, perhaps only meant to be read by the very diligent, is a 1996 scientific study by Professor A.J. Spencer comparing fluoridated and non-fluoridated communities in South Australia and Western Australia. The reductions in tooth decay due to fluoridation found by this study are quite tiny and clinically insignificant. Why is that not announced in this or other fluoride promotional literature?

The package also fails to mention other studies, including the very large population study by the US National Institute of Dental Research, reported upon twice in 1990 that found very little difference in decay rates between fluoridated and non-fluoridated children. How is it that Australian fluoride promoters can claim to have their own non-scientific surveys showing huge benefits, when published, scientific studies show almost none?