Friday, 8 November 2013
Health (Fluoridation of Water Supplies) (Repeal) Bill 2013: Second Stage [Private Members]
I move: "That the Bill be now read a Second Time."
I will set the Bill in context. Next January it will have been 50 years since a woman named Gladys Ryan took a case regarding fluoridation to the High Court on the basis that citizens had no choice other than to drink medicated water. As the coming year will see another woman take a case to the High Court for the same reason, it would be a fitting tribute to Gladys if the Government supported the Bill before the House and ceased the mass fluoridation of the public water supply. After 50 years it is surely time to stop the fluoridation of public drinking water.
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 for 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. Ethical approval was given by no less than the Guild of Saint Luke, Saint Cosmas and Saint Damian which had been established by the Catholic Archbishop of Dublin, John Charles McQuaid. This led to the Health (Fluoridation of Water Supplies) Act 1960 which mandated compulsory fluoridation by local authorities. In 1965 the legacy of 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 1960s 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. We also have improved dental services. In my constituency of Laoighis-Offaly, particularly County Laois, children do not see a dentist until they are 12 years old, which is scandalous. The matter must be addressed by the Department. It is a number of years since I was at school, but I recall seeing a dentist in primary school when we were eight years old. We could redirect the money used on fluoridation in the provision of proper dental health care for children.
A 2001 report in the United States detailing recommendations on using fluoride to prevent and control dental caries 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 toothpaste. Swallowing fluoride is unnecessary and potentially dangerous; therefore, there is no justification for forcing people to consume fluoride through the water supply. Fluoride toothpaste is the most widely used and rigorously evaluated fluoride treatment and a report entitled, Oral Health in the United States: The Post-Fluoride Generation, states 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.
I will move to the side effects of fluoride. Fluoridation of the water supply leads to fluoride accumulating in the body. Healthy adult kidneys - many people's kidneys are not healthy - only excrete 50% to 60% of the fluoride ingested each day, with the remainder accumulating in the body, largely in calcifying tissue such as bones and the pineal gland. Infants and children excrete less from their kidneys and retain up to 80% of ingested fluoride in bones. The fluoride concentration in bones steadily increases over a lifetime. The World Health Organization stated in 2006 that "excessive exposure to fluoride in drinking water can give rise to a number of adverse effects". These range from mild dental fluorosis to crippling skeletal fluorosis as the exposure increases. Dr. Robert Bolan claims that "recent studies show that brain adult exposure to fluoride induces central nervous system disturbance." He has also linked exposure to fluoride with the risk of developing Alzheimer's disease and osteoarthritis. Meanwhile, the Russian Academy of Sciences, the British Medical Research Council, the NHS York review, the USA Academy of Sciences and the European Commission have all detailed concerns.
Right across Europe countries have ceased the practise of the fluoridation of water such that 98% of Europe's population no longer drink fluoridated water. This is the only country with a state-wide 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 remain stable or continued to decline after water fluoridation stopped. A pan-European report entitled, Community Water Fluoridation and Caries Prevention: A Critical Review", indicates:
The caries reduction directly attributable to water fluoridation has declined in the last decades as the use of topical fluoride has become more widespread, whereas enamel fluorosis has been reported as an emerging problem in fluoridated areas. Several studies conducted in fluoridated and non-fluoridated communities suggested that this method of delivering fluoride may be unnecessary for caries prevention, particularly in the industrialized countries where the caries level has become low.
Report after report has confirmed that where fluoridation has been discontinued in communities in Canada, the former East Germany, Cuba and Finland, dental decay has not increased but has generally continued to decrease. In 2001 the World Health Organization statedfluoridation was an effective way to prevent tooth decay in poor communities. It stated:
In some developed countries, the health and economic benefits of fluoridation may be small, but particularly important in deprived areas, where water fluoridation may be a key factor in reducing inequalities in dental health.The Minister of State might use that line to make a different point, but what the WHO is really talking about is communities where fluoridated toothpaste is not available or not used to a great extent. That is similar to the situation in Ireland 50 to 60 years ago when fluoridated water was being considered and fluoridated toothpaste was not widely available or used. Ireland has moved on, yet the Government has not. It is sticking to its policy of fluoridation from a bygone era. Sweden had an official commission which published its final report in 1981 and recommended other ways to reduce tooth decay by improving dietary and oral hygiene habits instead of fluoridating tap water. Arvid Carlsson, winner of the 2000 Nobel prize for medicine, took part in the debate in Sweden, where he helped to convince parliament that fluoridation should be illegal for ethical reasons. He believed that it violated modern pharmacological principles, which indicate that medications should be tailored to individuals. The key point is that the effectiveness of water fluoridation declines where a country improves its dental care, increases the use of fluoride toothpaste and when the population improves its dietary intake.
The Commission for Health and Consumers in the European Union stated, "People do not need fluoride for normal growth and development". The European Court of Justice has defined fluoridation as a medication and refused to sanction its implementation. Mass fluoridation violates Article 35 of the European Charter of Fundamental Rights, under which article the right to health care includes the right to refuse health care, for whatever reason. It establishes the individual's right to receive particular drugs or treatments or to prevent him or her from having such treatment administered against his or her wishes. The use of fluoridation chemicals to medicate the public indiscriminately violates the code of medical ethics set out in the Council of Europe's Convention on Human Rights and Biomedicine. The convention establishes a valid code of medical ethics and is widely accepted throughout Europe. The failure of the Government to subscribe to it does not render its provisions invalid, as all such national codes should comply with the principles set out in it. States may not medicate any individual, except under exceptional conditions of recognised public health emergencies. All medical interventions must be carried out under proper medical supervision and in accordance with the patient's needs and fully informed wishes.
There has been a lack of debate in the State on the matter. It appears that the State is incapable of having a healthy debate on this matter, if Members will pardon the pun. In 2000 the forum on fluoridation was established by the then Fianna Fáil Minister for Health, Deputy Micheál Martin. The Food Safety Authority of Ireland, FSAI, drafted a risk assessment on the presence of fluoride in tap water used in infant formulae. The document, according to the chairperson of the FSAI's scientific committee, Mr. Wayne Anderson, was submitted on 18 October 2001. He wrote on 26 October 2001:
Since the document was tabled and members of both committees have had a chance to see the final document, two issues have been raised. One concerns the toxicology and the appropriateness of the NOAEL [a test] and other concerns the risk characterisation and the issue of repeated exposure over time.Because of time restraints the risk assessment had to be withdrawn. Therefore, there was no mention of a risk assessment in the final report of the forum on fluoridation to the Minister. The final report noted that all of the benefits of fluoride were topical and that all of the risks were from swallowing it. It stated: "Although the predominant beneficial effect of fluoride occurs locally in the mouth, the adverse effect, dental fluorosis, occurs by the systemic route". In other words, a problem arises when fluoride is ingested.
While still in opposition the then Green Party Deputy John Gormley compiled a report on fluoridation in 2007. He now claims that the report was buried by the Joint Committee on Health and Children which had commissioned it. Had its recommendations been acted upon, we might not be having this debate today. The Government's own expert panel has no toxicologist on it. The chairperson of the panel has been a long-time vocal advocate of mass fluoridation. Therefore, it is by no means independent and its expertise does not include a toxicologist, which gives rise to questions. Despite the lack of a credible Government review and quashed reports and in the face of overwhelming evidence to the contrary, the Government continues to impose fluoride on 4.6 million people at a cost of €4.8 million to purchase the product, an unknown amount to administer it and in operational costs to local authorities in monitoring it and ensuring it is correctly added to the water supply.
This is not a party political issue. Sinn Féin has tabled the Bill, but Members of all parties to whom I have spoken privately have expressed concern. I also spoke to councillors from a Government party last night who were opposed to fluoridation. We are all being slowly poisoned by the use of fluoride in the water supply. It is an issue that affects the vast majority of households in the State and I urge the Minister to revisit the matter. Fifty years of fluoridation is sufficient. I wish to focus on what the scientific committee stated at the time of the 2001 report. It agreed that the precautionary principle should apply and, in the case of infant formulae, recommended that it not be reconstituted with fluoridated tap water. The evidence is stacking up and the case against mass fluoridation is overwhelming. The pro-fluoridation lobby has not been able to justify its continuation. I appeal to the Government to at least commence a debate on the issue, examine it and allow the Bill to go through to the next Stage. I hope we can re-examine the matter and take a more sensible approach.
I welcome the opportunity to address Members to set out in the strongest terms the reasons this Bill which would provide no benefit for the public and be likely to result in deterioration in the oral health and, therefore, general health of the population should be opposed. Deputy Brian Stanley’s Bill proposes that the Health (Fluoridation of Water Supplies) Act 1960 be repealed in full and that it be an offence for a body corporate or certain officers of a body corporate to add fluoride to water. Given the importance of water fluoridation as a public health measure, I cannot support the Bill.
Deputy Brian Stanley claims that water fluoridation is unsafe, that there are huge health questions surrounding it and that the weight of scientific evidence is against it. Nothing could be further from the truth. The balance of scientific evidence worldwide confirms that water fluoridation, at the optimal level, does not cause ill effects and protects the oral health of the population. Water fluoridation is the adjustment of the natural concentration of fluoride in drinking water to the optimal recommended level for the prevention of dental decay. Fluoride is a natural mineral found in soil, fresh water, sea water, plants and many foods.
Fluoridation began in Ireland in 1964 on foot of the Health (Fluoridation of Water Supplies) Act 1960. The Act provides that the health authorities arrange for the fluoridation of public piped water supplies and that local authorities act as agents for the health authorities in providing, installing and maintaining equipment for fluoridation, in adding the fluoride to water and testing the fluoride content of water to which fluoride has been added. These functions are provided for in the Fluoridation of Water Supplies Regulations 2007 which revoke previous fluoridation regulations. The constitutionality of the Act was challenged in the High Court in 1963, as adverted to by Deputy Brian Stanley, and in the Supreme Court, on appeal, in 1964. In July 1964 the decision of the Supreme Court confirmed the constitutionality of the fluoridation Act.
Approximately 68% of the population receive fluoridated public water supplies. The legislation on water fluoridation requires a daily test to be carried out at water treatment plants by the local authority water services staff. Monthly fluoride testing is carried out by the HSE. The Environmental Protection Agency also carries out testing which requires monitoring of fluoride levels in water supplies. If the fluoride levels are found to be outside the range specified in the legislation, those responsible are notified, prompt adjustments are made to the dosing equipment and a new test is carried out. The Environmental Protection Agency’s 2011 report, The Provision and Quality of Drinking Water in Ireland, indicates that 98.8% of samples from public water supplies and 98.9% of samples from public group water schemes were in compliance with the legislative requirements.
A code of practice is in place to ensure the proper implementation, by all personnel involved, of the procedures for the fluoridation of the public water supplies to the prescribed standards, in order to minimise the risk of injury or damage to plant, personnel and the environment.
It has been claimed, although not by Deputy Stanley, that fluoride used in Ireland is "a by-product of the fertiliser industry". This is not true. While a fluoride ion is a fluoride ion no matter where it comes from, the fluoride currently used for water fluoridation is sourced as a primary product. It is mined directly as a raw material in the form of the mineral fluorospar, which consists of calcium fluoride. It then goes through a purification process to conform to tightly controlled specifications to produce hydrofluorosilicic acid. Some fluoridated public water supplies have background levels of naturally occurring fluoride. These levels are augmented using the acid to the prescribed optimal level.
At present, the level of fluoride in drinking water is in the range of 0.6 to 0.8 parts per million. A higher level of 0.8 parts to 1 part per million was applied until 2007. Parts per million is equivalent to milligrams per litre. The level was reduced to take into account both international and Irish research on fluorosis occurrence and the increased availability of fluoride to the population from other sources. It is worth noting that 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 approximately half that permitted by EU legislation.
The Irish Expert Body on Fluorides and Health, established in 2004, advises on fluoride safety and related issues. The expert body and its sub-committees have broad representation from areas such as dentistry, toxicology, biochemistry, environmental health and public health medicine. Safety is determined from the available scientific evidence. In evaluating ongoing research, the expert body accepts the standard and fundamental scientific principle that any single piece of scientific evidence by itself remains hypothetical unless it can be repeated or confirmed by other scientists. Therefore, it considers scientific evidence that has been 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 that the advice provided by the expert body is impartial and evidence-based.
Studies conducted internationally have consistently indicated that water fluoridation is safe and effective in preventing dental decay in both children and adults. It is the most efficient way to prevent one of the most common childhood diseases, tooth decay. Comprehensive reviews have been conducted in many countries. Reviews from the United Kingdom include the York review of 2000 and the review by the Medical Research Council in 2002. There have also been more recent reviews in Australia in 2007, Canada in 2010 and, most recently, the European Union in 2011. None of these reports has established any basis for considering that fluoridated water at an optimal level poses any systemic health risks.
The question is sometimes raised about the need to drink fluoridated water if fluoridated toothpaste is used. Fluoride in water works directly on the tooth surface. It also works indirectly via the saliva, so it has a double effect. There is also a pre-eruptive protective effect from fluoride working indirectly. Toothpaste works directly on the tooth surface only.
The national survey of children’s oral health in 1984 found that lifetime residents of fluoridated communities had substantially lower levels of dental decay than lifetime residents of non-fluoridated areas. Eighteen years later, in the North South Study of Children’s Oral Health 2002, again it was found that levels of dental decay were substantially lower in lifetime residents of communities living in fluoridated-water areas. These studies clearly show the benefits of water fluoridation in Ireland since its introduction.
Contrary to what has been claimed, the North South Survey of Children’s Oral Health in 2002 demonstrated substantial benefits of fluoridation in the Republic of Ireland compared to Northern Ireland, whose water is not fluoridated. There are ongoing oral health promotion and healthy eating campaigns in both jurisdictions. Fluoridated toothpastes are also widely available in both areas. Nevertheless, there continues to be a clear benefit from water fluoridation.
The North-South survey found that of those living in areas with fluoridated water, more than one in three children, or 37%, have dental decay by the age of five. In areas where there is no fluoride in the water, over half, or 55%, of all five-year-olds have experienced dental decay. The study entitled Oral Health of Irish Adults 2000-2002 showed decay scores were lower among fluoridated groups for all age groups and particularly in the 35-44 age group.
The forum on fluoridation, which reported in 2002 and which had senior representation from a broad range of relevant sciences, found there was no evidence at that time of any negative health effects, stating that "The best available and most reliable scientific evidence indicates that, at the maximum permitted level of fluoride in drinking water at 1 part per million, human health is not adversely affected". As I have stated, the level of fluoride in drinking water in Ireland was reduced to between 0.6 and 0.8 parts per million in 2007.
There are five categories of dental fluorosis, ranging from very mild to severe. The two lowest levels are mild and very mild and are only detectable by a dentist as faint white flecks on the surface of teeth. There are no known side effects of optimal water fluoridation other than mild dental fluorosis, a cosmetic or aesthetic condition that refers to the way teeth look. It is not considered to be an adverse health effect. At the levels at which fluoride is present in Ireland's water supplies, any occurrence of dental fluorosis is very mild or mild. Not all enamel defects are caused by drinking fluoridated water. In the majority of cases, dental fluorosis generally does not require any treatment. This is in contrast to the treatment of tooth decay, which may on occasion involve the use of general anaesthesia and hospitalisation. Furthermore, non-treatment of dental fluorosis has no health consequences, whereas non-treatment of tooth decay can lead to pain, trauma, disfigurement, loss of teeth and function, problems with nutrition and growth, work or school absenteeism and a significant financial and social cost.
Sometimes the risk of dental fluorosis is wrongly equated with health risk. The American Dental Association issued a letter in 2007 stating its concern that some opponents of water fluoridation may have been mischaracterising its report Interim Guidance on Fluoride Intake for Infants and Young Children to mean that fluoridated water should not be used to mix infant formula. The association’s advice is that using fluoridated water is safe. The Food Safety Authority of Ireland and the expert body also advise that there is no significant evidence of any adverse effects to the health of infants from consuming infant formula made up with fluoridated tap water. Fluoride concentrations in Irish tap water pose no known medical problems either for infants or for the population in general.
Contrary to what was suggested by Deputy Stanley, the Department of Health has rigorously monitored dental fluorosis and responded to evidence of a change in fluorosis levels. The 2002 study on children’s oral health showed an increase in the levels of enamel fluorosis over what had been detected in the 1984 study. Since the levels of fluoride in water had not changed over this period, the most likely explanation for this change was the increased use, and also the inappropriate use, of fluoridated toothpaste. "Inappropriate use" refers to swallowing toothpaste rather than spitting it out after brushing. On the recommendation of the forum on fluoridation, the Department of Health introduced two strategies to minimise fluorosis. The first of these was in relation to the appropriate use of fluoride toothpaste, and the second was to lower the level of fluoride in water, as I have mentioned.
The Deputy claims there are huge health questions surrounding fluoridation. A number of claims have been made in certain media concerning negative effects of fluoridation, alleging links to almost every conceivable illness. I am conscious that such claims, however erroneous, have potential to cause concern or even alarm. Consumers too, sometimes express concerns about potential negative effects on health of drinking fluoridated water or on the composition and source of fluoride or on the fact that other countries do not fluoridate their water supplies.
The National Cancer Registry has stated there is no good evidence to link fluoride levels in water, whether natural or added, to cancer risk. I welcome their reassurance in this regard.
It is important to continue to assess health statistics on a regular basis to address any concerns that general health may be affected by fluoridation. Accordingly, the effects of fluoride on health and related matters are kept under constant review, despite what has been alleged. This is required pursuant to sections 6 and 7 of the 1960 Act. As part of this ongoing work, an assessment of reviews on the effectiveness of fluoride and of general health databases is planned. Both reviews will be carried out systematically, with a particular focus on the Irish context. This work will be commencing shortly and will provide us with repeatable and rigorous search methods. The work on the general health databases will be supported by a general public health specialist. The chief dental officer, who was appointed earlier this year and with whom I work very closely in this area, will also have a key role in this regard.
Objective, independent reviews, conducted systematically, will serve a useful purpose in allaying any outstanding concerns of the public in this respect, particularly on general health issues. I am also committed to supporting ongoing original research to investigate and keep under review how fluoridation relates to oral and general health.
The Department of Health is collaborating in a research project, led by University College Cork, called Fluoride and Caring for Children's Teeth, which will specifically examine the oral health status of children and inform national policy. 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 fluoride in drinking water in 2007. It is focusing on five-year-old and 12-year-old children. The HSE has released dental staff and is providing funding to support the study.
Consideration is also being given to 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 Ageing, TILDA.
Ireland is not alone in benefiting from water fluoridation. Many other countries have water fluoridation schemes too, including the United States, Canada, the United Kingdom, Spain, Australia and New Zealand. Data from 2012 for the United States shows over 185 million, 60% of the population, have fluoridated water. Over 80% of the Australian population, approximately 18 million, people have fluoridated water. Almost 5.8 million people in the UK have fluoride added to their water while another 330,000 have naturally fluoridated water.
These are verifiable facts that Members can check if they want to deny them.
Use of fluoride is an essential part of oral health policy in Europe. In countries or areas which do not fluoridate water, this can mean fluoridation of salt, milk or provision of community fluoridation through other means, such as fluoride varnishes or fluoride mouth rinses.
Since its introduction in Ireland in the 1960s water fluoridation has made a significant contribution to the prevention of tooth decay among all the population. Water fluoridation is also cost-effective. The total cost per annum is €4 million - roughly €1 for each inhabitant - and the entire population in fluoridated areas receives the benefit, adults and children alike. The expert body's advice that water fluoridation, at the optimal level, does not cause any ill effects and protects the oral health of the population is supported by major international scientifically validated reviews, contrary to the erroneous suggestion of Deputy Stanley that the overwhelming evidence is in the other direction.
Support for this Bill would be a backwards step. Rejection of this Bill will ensure this public health programme continues, led by science, and we continue to benefit from what the United States Centers of Disease Control and Prevention rightly recognise as one of the ten great public health achievements of the 20th century.
The suggestion the Department of Health has never commissioned or taken interest in any study in this area since the 1960s is entirely wrong.
The reports have been on the health benefits of the policy. While there is much expertise in this Chamber, I am not quite sure there is any scientific expertise. As legislators we need to have regard for the science, not to accept it blindly and to see what the preponderance of the evidence is. One will always find one study that will differ from others. There will always be people complaining or criticising.
One needs to look at this issue in the round and not rely on one or two isolated studies.
I believe we should maintain the fluoridation policy which is an important public health imperative. The suggestion we should repeal the 1960 Act with this one-liner Bill is grossly irresponsible.
In September 2002, the then Minister for Health and Children, Deputy Martin, launched the final report of the Forum on Fluoridation. He had established the forum in May 2000 to independently review the fluoridation of public-piped water supplies, the programme of research being undertaken on behalf of health boards in the area and to make recommendations to the Minister. The forum set out to examine scientific evidence for and against water fluoridation, to look at the best available recognised scientific evidence. That scientific evidence - not anecdotal evidence - led to the primary conclusion of the forum, namely, there are no adverse health effects of water fluoridation at the maximum permitted legal level.
The safety and effectiveness of water fluoridation has also been endorsed by several international and reputable bodies such as the World Health Organisation, the US Centers for Disease Control and Prevention, the US Public Health Service and the United States Surgeon General.
The forum comprised persons with expert knowledge from a diverse range of backgrounds such as public health, dental health, food safety, environmental protection, ethics, water quality, health promotion and representatives from the consumer and environmental areas. It took a participatory and evidence-based approach striving to ensure balance between participants from both sides of the debate on water fluoridation. It went out of its way to engage those opposed to water fluoridation.
On an issue that creates strong feelings, it is vital to have responsible and measured debate wholly based on fact and evidence. Thanks to this report, future debate on this issue can be based on data published in scientific literature and subjected to minute scrutiny for accuracy and validation. Accordingly, we can avoid the invalid currency of assumptions and hearsay. This forum demanded scientific proof for every opinion expressed to it. As a result, it produced a credible and valuable report.
The then Minister, Deputy Martin, subsequently established the expert body on fluorides and health in April 2004. It has broad representation from the areas of dentistry, public health medicine, toxicology, engineering, management, environment and the public, as identified within the report on fluoridation. It has a strong consumer input in terms of members of the public and representatives of consumer interests, in addition to the necessary scientific, managerial and public health inputs. The expert body monitors new and emerging issues on fluoride and its effects on health and related matters. It is satisfied, having studied current peer-reviewed scientific evidence worldwide, that water fluoridation causes no ill effects to the health of adults or children. It advises that the balance of scientific evidence worldwide confirms that water fluoridation, at the optimal level, does not cause any ill effects and is the safest and most cost-effective method of protecting the oral health of the population.
Water fluoridation is supported by reputable international authorities including, among others, the World Health Organisation. There are several authoritative international reviews of the evidence available, the most recent of which was carried out by the European Commission’s, Scientific Committee on Health and Environmental Risks. It concluded in 2011 that the available evidence did not support a clear link between fluoride and osteosarcoma and cancer in general. Since then, a major study from Harvard University, An Assessment of Bone Fluoride and Osteosarcoma, concluded there is no evidence of a link between fluoride and osteosarcoma.
The results of the study, Drinking Water Fluoridation and Osteosarcoma Incidence on the Island of Ireland, do not support the hypothesis that osteosarcoma incidence on the island of Ireland is related to public water fluoridation. The European Commission’s Scientific Committee on Health and Environmental Risks published its opinion on critical review of any new evidence on the hazard profile, health effects, and human exposure to fluoride and the fluoridating agents of drinking water in 2011. Its main conclusion is there are no known health implications from fluoridating water at levels used in the EU.
Under SI 42, Fluoridation of Water Supplies Regulations 2007, water services authorities are required to arrange for the daily testing of the fluoride content of water to which fluoride has been added. The water services authorities have regard to the code of practice on the fluoridation of drinking water to ensure effective and efficient implementation of the technical aspects of the fluoridation of drinking water. The Health Service Executive, HSE, undertakes monthly sampling of tap water and can access the daily records of the water services authorities if an issue arises regarding fluoridation levels.
The Environmental Protection Agency, EPA, also collects and analyses the monitoring results carried out by water services authorities on drinking water supplies. Its most recent report in 2010 on the provision and quality of drinking water in Ireland includes information on water supplies where fluoride parametric values are exceeded. Of the 3,398 samples from public water supplies which were analysed, 74 were above the Irish statutory requirements of 0.8 mg per litre. All but one of these elevated levels was below the EU standard of 1.5 mg per litre.
Water fluoridation is one of the most widely studied public health policy initiatives in the world. Studies indicate the health benefits of water fluoridation outweigh its costs. To date there has been a significant reduction in the proportion of decayed, missing and filled teeth of people living in areas supplied by fluoridated drinking water when compared to those in non-fluoridated areas. The cost of fluoridation was €3.86 million in 2011. While the Department of Health has not conducted a cost-benefit analysis on this policy, the expert body on fluorides and health, which monitors new and emerging issues on fluoride and its effects on health, advises that water fluoridation is the safest and most cost effective method of protecting the oral health of the population.
I reiterate that the balance of scientific evidence worldwide confirms that water fluoridation, at the optimal level, does not cause ill effects and continues to be safe and effective in terms of the oral health of all age groups. As the Minister of State said, other countries that have water fluoridation schemes include the United States, Canada, the United Kingdom, Spain, Australia and New Zealand. Water fluoridation is less common in Europe, but fluoridated salt is often available as an alternative, although some populations are supplied with naturally fluoridated public water. Despite the aforementioned, I welcome the Government's commitment to continuously review fluoridation policy and continue to acknowledge and scientifically analyse the reports and issues that arise regularly regarding those who believe this is not a healthy water treatment method.
I acknowledge the Minister of State's comments on the Department of Health's co-operation with UCC and their ongoing project on children's oral health. I acknowledge his commitment to continuously update and review all scientific reports and recommendations or submissions to the bodies that have responsibility for this issue. I am sure he will honour that commitment and make available to the House the results of any such monitoring to allay the fears of many people who are led by much of what has been produced by parties that do not have the scientific analysis required, expected and provided for by the State in the ongoing review of that policy.
I join the Minister of State in recommending that we do not support the Bill, despite its best intentions. It is a very short Bill which is outlandish in the manner in which it seeks to repeal the legislation of the 1960s and the recommendations made thereafter. It could not be supported by this House. I acknowledge the fears and worries people may have about this issue based on some analysis of the subject, but my party and I are more inclined to respect the authorities, expertise and scientific bodies represented on the State's boards which seek to allay the public's fears.
I congratulate Deputy Brian Stanley on bringing forward this very important Bill which I will support. Having listened to the Deputy and read about the so-called expert group on fluoridation, I am reminded of a comic from the 1980s and 1990s called Viz. Every now and then it would carry an advertisement showing a child with a stick of lard in his mouth with the caption "Lard is good for you" and in small print underneath, "The Lard Council". It sounds a little like this expert group which is not quite independent. Before I heard the Minister of State's speech, I was under an illusion that he might support this Bill. That illusion was based on the fact that Fine Gael, before it entered government, had told us it was against fluoridation.
A policy document stated: "Fine Gael believes there are sufficient grounds to point to serious health risks from cumulative amounts of fluoride in our piped water supply system". It stated there were deep environmental concerns about the current programme of fluoridation of the country's water supplies aimed at reducing tooth decay. I wonder what has changed. At the time less than 2% of Europe's population had fluoridated water and a number of countries had rejected, discontinued or banned the practice. Fine Gael also informed us that the Dutch had introduced a constitutional amendment in order that it could never be reintroduced. Mass hysteria, obviously, on the part of the Minister of State's Government partner, if what he says is correct. Fine Gael stated there had been claims of allergic responses to fluoridated water, including skin irritations, mouth ulcers, headaches, stomach upset and irritable bowel syndrome.
Last year when students from Mercy secondary school, Mounthawk, Tralee, County Kerry gave a presentation in the audio-visual room and educated many of us on this topic, Fine Gael and Government representatives fell over themselves to tell them they would do something about it. It looks as though nothing will be done. Worse, if students from that school wanted to come and give a presentation today, because of the "open and transparent" government we have, they would not be allowed to do so in the audio-visual room because the Government's main policy is that there shall be no dissent. If it is such a good idea to fluoridate water, why does the vast majority of Europe reject it? If it is such a good idea, why are we not top of the dental health league table? We are not. Belgium, Germany and Greece are ahead of us and do not fluoridate water.
It is not just Fine Gael that told us it would do something about this issue. The Labour Party's Whip who will whip people into voting against the Bill is in favour of banning fluoridation. He has said there is overwhelming evidence that it causes damage to the human body and that the idea of compulsorily applying it to every citizen who uses the public water supply is archaic in the extreme. This evidence against fluoridation, collected by serious scientists, is being presented to the Minister of State, yet he seems to be relying solely on the expert group. What is new? He needs to look beyond that group, "The Lard Council", at the large volume of counter evidence available, including from dental experts, on the necessity for this continued forced treatment. The Minister of State should listen to his Whip.
Tá athas orm go bhfuil an t-ábhar seo á phlé againn agus gabhaim buíochas leis an Teachta Stanley. This has been a controversial topic. In the couple of years I have been here I have received some lengthy correspondence on it which has led me to ask a number of parliamentary questions. In one I asked the Minister to ask the Irish Medicines Board to carry out a test to determine if fluoride was safe. The reply was that it was not necessary to do this because it was neither a medicine nor a drug. I asked another question about the Irish expert body on fluorides and health and if its work could be considered fair, transparent and impartial. The reply was that it was impartial and evidence-based, but we know evidence can be very selective. Another question was on the expert body and the reply was that it had a strong consumer input from members of the public. That is difficult to accept because we know the extent of public criticism; therefore, I wondered about this.
A number of local authorities have passed all-party motions calling for an end to fluoridation. Are we putting resources into fluoridation which are not needed? Millions of euro are spent every year on fluoride, but we must also consider the local authority resources which could be put into the building of very badly needed houses to reduce housing waiting lists, for example.
What exactly is in fluoride? It is not a single substance but a gas combined with other elements which have consequences for our health. Like Deputy Luke 'Ming' Flanagan, I was intrigued to see what was in the 2001 Fine Gael manifesto about the effects of fluoride. With the Green Party, Fine Gael listed the adverse health effects. People have examined the product specification and there seems to be a cocktail of various toxic elements, including mercury, nickel and lead, but there is a major difference between the current product and the one used originally in 1962.
I have asked further questions about these products. One answer was that the fluoridation of drinking water should be seen as a measure consistent with general public health management. There may have been reasons in the past for introducing fluoridation. Perhaps dental care was poorer then, but times have changed owing to exercise, improved diet and oral hygiene. There is fluoride in toothpaste; children are encouraged to brush their teeth; there is easier access to dentists; and there is not the same fear of dentists. There is evidence on one side of the debate, but there is also evidence on the other. If all of the evidence suggests fluoridation is positive, why have countries such as the Netherlands, Sweden, Finland, Germany, Japan and, most recently, Israel banned fluoridation? Countries that have banned fluoridation have not seen an increase in dental decay.
Are we continuing with fluoridation because it is a habit that is too difficult to break? If this Bill does not pass Second Stage, I ask that all of the evidence, not just selective evidence, be examined by an impartial independent group.
I am not a scientist nor a dentist and do not know all the facts on fluoridation. The onus is on the Government to refute the serious questions that have been raised in this debate and by campaigners on this. I pay tribute to the campaigners against fluoridation for their persistence. It is their action and determination that have forced this debate to happen.
It is clear that this issue does not just concern a few campaigners, but that they have compiled a serious body of evidence, and the onus is on the Government to refute that. The arguments have been rehearsed clearly. First, why has the rest of Europe and why have many other countries in the world removed fluoride from their water? For the most part, they have removed it on ethical grounds, on the basis that people should not be forced to ingest fluoride in their water without their prior agreement. These are strong grounds. At the least, there must be a national debate in which people decide whether they want fluoride in their water, but that debate has not happened here and the people have not made the decision. In Sweden, Arvid Carlsson, a winner of the Nobel Prize in medicine, convinced the Swedish Parliament to stop fluoridation in Swedish water on those ethical grounds, pointing out that it should not be done without the permission of the people.
Serious health issues have also been raised in regard to fluoridation. It is believed fluoride can cause fluorosis, is bad for the teeth, is bad for bone development, affects the thyroid and is associated with diabetes, neurological and gastrointestinal illnesses. These results are from official studies conducted in the United States. I do not know if this evidence is conclusive, but it raises serious questions. The default position should be to follow the precautionary rule, meaning we should not do anything that may have adverse effects unless the evidence is compiled, we have had the debate and have heard all sides of the argument. We have not done any of that. At the least, we should remove fluoride from our water until we have had that discussion. If the Government feels so strongly that we should have fluoride in our water, let it make the case. We should have a full and open debate at committees and elsewhere and should allow the public to participate in that debate. I find it telling and quite conclusive that other countries have removed fluoride from their water without causing adverse effects on dental health. Ireland does not have better dental health than countries that do not fluoridate their water. Therefore, there is no sustainable argument for continuing to fluoridate our water.
I found the Minister of State's tone unhelpful. It is a progressive move for us to discuss this topic today and I compliment Deputy Stanley on tabling the Bill. Despite the Minister of State's protestations, from the beginning of Ireland's attempts to fluoridate our water, this has been a controversial issue.
Fifty years ago this year, Gladys Ryan took a High Court, and ultimately a Supreme Court, challenge against the State. Just as I salute the campaigners against fluoridation today, I want to salute Gladys Ryan, a woman who died in her 90s this year. As a housewife, this woman took on the State in the battle against fluoride, something that was not done at the time. The Minister of State will be aware that this was an important legal case which lasted for 65 days and went on appeal to the Supreme Court. This woman was an environmentalist before her time. She challenged fluoridation on a number of points, but mainly on the point that it was unconstitutional to interfere with the public water supply because people had no option but to drink from it. She argued that those who wanted fluoride had an alternative and could get it in toothpaste. That argument still stands. Gladys Ryan was represented by Seán McBride and had a huge legal team who operated pro bono. The team argued that fluoridation was an infringement of human rights because it removed choice. Many international experts who presented evidence in the case argued that fluoridation caused more damage than the help it was designed to provide. That has been the nub of the issue since. We need to re-examine this issue because time has moved on and we have more experience now.
Many of the points made by the Minister of State seemed to be caught in a bit of a time warp. He claimed boldly that supporting Deputy Stanley's Bill would lead to a deterioration in dental health. That is not true. We do not need to cite scientific studies to refute that claim. There are many such studies, but the Minister of State seemed to rely on one or two from 20 or 30 years ago. We do not need the studies because we have the direct experience of the 98% of the European countries that do not fluoridate their water supplies but whose dental health standards are far in excess of ours. We have the direct experience of the fact that only nine other countries fluoridate more than 50% of their water supply. We are not the league table leader in terms of dental care and standards. We are well down the list. Therefore, it is quite clear that fluoride is not helping, and that is a fact.
I am not so sure of the evidence with regard to many of the other claims regarding the damage caused by fluoride. However, many able scientists have presented evidence that there are significant negative health impacts. The Minister of State relied significantly in his argument on the Irish expert group report. I understand that report was 350 pages long, but that only approximately a page and a half dealt with the health issues. With the greatest respect to dentists, I do not believe they are experts in the biological effects of consuming toxins. Paediatricians, oncologists, toxicologists and neurologists should be and should have been involved in any serious health examination. The point being made is that there has not been a serious analysis of the health effects of fluoride in our water.
I would like the Minister of State to comment on the fact that following the expert group report here, the Food Safety Authority of Ireland was concerned and recommended that fluoridated water should not be added to infant formula. That recommendation was made because of the concern that infants might be poisoned. If that danger existed then, why do we say now there is no case to answer? We should take a practical attitude towards this issue. The way the Finnish authorities dealt with the issue is to be recommended. They removed fluoride without debate or discussion. We cannot do that here because we need to change the law. The Finnish authorities found that when they examined the health of the nation after the removal of fluoride, there were considerable improvements in health in a number of areas.
Why do we not conduct an experiment of our own? If we were to accept that the information is not conclusive, though it is overwhelmingly in favour of the fact that fluoride does harm rather than good, why would the Government not just remove fluoride for a year and carry out a survey at the end of the year? The worst that could happen would be that the Government would save €4 million that could be used on other beneficial projects. If our experience in Ireland was the same as that of the other European countries, the Government would save a potload of money on its health budget also. We should consider doing something of this nature.
This discussion is long overdue. Many of the points made by the Minister of State were the same as those made years ago, but science and experience have moved on. He mentioned other countries where fluoride is present in water supplies.
Most of the countries which the Minister of State said continue to fluoridate water are actually contemplating removing it. Ireland should follow suit.
It is reprehensible that the State would medicate the population on a systematic basis when there really is no need to do so. I am extremely disappointed by the Government's attitude on this issue. Its approach is regrettable and completely behind the times. I wonder whether those in government are of the view that if they remove fluoride from water supplies, they will be acknowledging the fact that it should never have been put into them in the first instance. That may be the case but I am of the view that the Government should be mature about this matter and avail of the opportunity that exists.
I wonder what it is about Fridays and the abuse to which those of us on this side are subjected during these sittings. When the House sits on Tuesdays, Wednesdays and Thursdays, it is all about the Government taking abuse. Fridays, however, present it with an opportunity to turn the tables on us. The abuse that occurs on each Friday that the House sits is that nothing ever happens. I have had the privilege to introduce two items of legislation during Friday sittings and, as a result, I am aware of the effort involved in drafting a Bill. In addition, one must wait months before one's legislation finally comes before the Dáil. When one is eventually given the opportunity to introduce a Bill, the Government never seems to attribute any merit to it. Legislation introduced on Fridays almost never goes any further. There is a futility about being in the House today.
I researched what some people said about this matter in the past and I take this opportunity to pick on one particular individual and what he said in response to the document produced by the former Deputy, Mr. John Gormley. Mr. Gormley's document was very comprehensive and included expert opinion. The individual to whom I refer is the Tánaiste and Minister for Foreign Affairs and Trade, Deputy Gilmore, and I am interested in placing his comments on public confidence in the fluoridation of water on the record of the House. Obviously, those comments predated-----
-----his promotion to the position of Tánaiste and Minister for Foreign Affairs and Trade. In response to Mr. Gormley's document, the current Tánaiste stated:
There isn't a great deal of confidence, I'm afraid, in committees of departmental experts. We've had departmental experts telling us that blood was safe, that various areas of food were safe, that some aspects of the environment were safe, and unfortunately their conclusions turned out to be quite unfounded or unsound in many cases. So there is a public scepticism about committees of Government experts telling us what's good for us.He also stated, "The fact that some county councils have been expressing concern about it and have been voting against fluoridation, I think is reflecting a growing public concern, and a growing public doubt about fluoridation."
There is public concern in respect of this matter.
We all hear that concern expressed by our constituents. It is not always expressed by very organised or vocal groups. One hears it from people in the course of routine conversations. I am of the view that one of the things that is going to change matters quite dramatically is that fact that people are going to be asked to pay to have something in their water which many of them are of the view they should be able to choose not to have in it. I hope that a very generous free allowance will be allocated to people in order that they will not be obliged to pay for water. However, the point I make is worth considering.
It is interesting that the current Government and that which preceded it have excluded many people from having dental repairs carried out under the PRSI scheme. It was the previous Administration which removed the entitlement in this regard. In most cases, people were previously entitled to annual dental check-ups. Following a check-up now, having dental repairs carried out, teeth removed or whatever very much depends on whether one has the money to pay for the procedure. When we discuss dental health, therefore, we must examine matters in their totality and consider Government policy from the point of view of achieving the optimum outcome in the context of maintaining people's dental health.
Fluoridation of water supplies first came about in the 1950s. If one looks at photographs or television footage from the 1950s and 1960s, one will nearly always see people who have gaps in their teeth. It is funny when one looks back. Quite rightly, there was an amount of concern about this at the time. A number of issues arose during that period in the context of people's general health and the quantity and quality of healthy food that were available. There is no doubt that the advent of the Second World War would have limited the range and types of food to which people would have had access. I understand the concerns which informed what was done in the 1950s and 1960s. However, fluoridation was never universally supported and, as we know, there have been various legal challenges to it in the interim. People are now much more careful about what they put in their bodies and they want to have control in that regard. They know they can buy toothpastes which contain fluoride and that they do not need to ingest it in order to limit the number of dental cavities with which they might end up.
Let us consider the experience in other countries. As previous speakers noted, parts of Finland have reported no worsening of dental caries after fluoridation was stopped in 1992. In British Columbia, dental caries rates actually decreased when fluoridation ended. The latter may have been because people may have been obliged to make a conscious effort to use fluoride toothpaste. Germany, France, the Netherlands, Norway, Sweden, Austria and Belgium do not currently artificially fluoridate water supplies. Sweden engaged in a particularly vigorous debate on this issue in the 1960s and 1970s and eventually decided against fluoridation. The notion that fluoridation leads to universal benefits does not appear to hold weight in other countries. None of the countries to which I refer reported any serious dental health issues among members of the general public in the absence of fluoridation and all have levels of dental care and practice which are comparable to those which obtain in Ireland.
During my time in politics, both at local and national level, experts have often said to me that a particular way of doing things was the right way. On a good few occasions I did not really believe them and in many instances I was correct. It is right that we should be sceptical and that we should question the opinions of experts. The general public is not always wrong and its concerns should not just be dismissed. The Minister of State referred to expert after expert during his contribution. Many people want to be given the choice as to whether they should accept the advice of experts who want their water to be free of fluoride. These individuals would be happy to change their habits in order to ensure that they take fluoride orally and are not obliged to ingest it. Most people are of the view that being obliged to ingest fluoride via drinking water is an imposition.
The Government should allow the Bill to proceed to Committee Stage to give Deputies an opportunity to debate the legislation further, to question experts in the field and, at a minimum, satisfy themselves as to the robustness of expert opinion. I wonder if it is worthwhile holding Friday sittings when so few of the Bills introduced in these sittings have proceeded to Committee or Remaining Stages.
I thank Deputy Brian Stanley for introducing the Bill. It is important to place matters such as the fluoridation of public water supplies on the agenda in order that Deputies can discuss them in detail. We must deal in a fair and objective manner with the many health concerns arising from water fluoridation. It is amazing that the main Government party's general election manifesto in 2002 included a commitment to cease the practice. Many senior figures in the Labour Party, including Ministers, have also expressed serious concerns about water fluoridation. The Government parties appear to have done another U-turn.
I have an open mind on water fluoridation in contrast to many of those, particularly from the Government side, who have contributed thus far and appear to have closed minds. The fact that many experts, scientists and politicians disagree with opponents of water fluoridation is not a reason to dismiss out of hand concerns that have been raised about the practice. The Government immediately dismisses challenges and concerns raised about particular issues, including fluoridation. One can blind oneself with science and statistics.
The vast majority of citizens and consumers of public water have major doubts and concerns about the health and safety of the public water supply. For this reason, I commend Deputy Brian Stanley on introducing the Bill and stimulating public debate on this important health issue. My attitude to fluoridation reflects the motto, "If in doubt, leave it out." Why do the authorities in Germany, the Netherlands, Norway, Sweden and Switzerland not fluoridate their public water supplies? This is a legitimate question given that all of these countries have progressive policies on public health and safety. I ask the Minister of State to look deep into his heart and ask the same question.
I want to see scientific facts. The science establishment must be challenged on this issue and the role of Independent Deputies, including my colleagues in the Technical Group, is to issue such challenges. For this reason, I welcome the challenge the Bill presents. Many of those involved in health and science believe fluoridation is dangerous. They argue, for example, that the dose each individual receives is impossible to control because people drink different amounts of water. Between 40% and 50% of fluoride ingested each day by adults accumulates in the body and many children are over-exposed to fluoride. I want scientific facts presented on whether fluoride has the potential to cause major damage to the brain. While the theory has not yet been proven, some also argue that fluoride causes bone cancer. Research must be done on this and other fundamental questions.
Water fluoridation gives rise to major health concerns and is our duty, as legislators, to raise them. The Minister of State knows in his heart that many Deputies on the Government side share these concerns. This sets a red light flashing in my mind. I ask him to ensure research is done to ascertain the facts about water fluoridation. There is a lack of good quality scientific literature on the issue and the arguments in favour of fluoridation seem to have been accepted without any serious critical analysis.
The Minister of State should ask his family and friends how safe they believe their drinking water is and whether they use much bottled water. Does he filter tap water before drinking it, as I and most young parents do?
He should wake up, smell the coffee and get his facts right because there is much at stake.
Fluoride also has the potential to damage the environment. Scientific research must also be done on this issue. Many people do not realise that the agent, hydrofluoric acid, is listed as a poison in the Poisons Regulations of 1982.
Since 1993, the Czech Republic has not treated drinking water in public water supplies with fluoride. The four reasons cited for the country's change in policy were that fluoridation is uneconomical, is not ecological and is unethical and dangerous to health. The Czechs have clearly called this issue as they see it. Toxic fluorides have never been added to the public water supplies in Denmark, while fluoridation of drinking water is generally forbidden in Germany. These countries are known for taking their public health policies seriously.
The Minister has a brass neck coming here and telling us there is no doubt that fluoridated water is safe. He cannot make such a statement given the many serious questions and concerns about water fluoridation. It is important that all of us read Deputy Stanley's Bill and keep an open mind on this issue.
I thank all ten Members present for participating in this constructive debate, which looked into the corners and examined the history of water fluoridation, including the checks and balances that have been put in place. I congratulate Deputy Brian Stanley on introducing the legislation. The Minister of State's speech was comprehensive, as one would expect, while Deputy Barry Cowen's contribution reflected the work and endeavours in which his associates engaged over the years. We have all benefited greatly from the contributions of Opposition Deputies, primarily from the Technical Group. I am in the category of "Others". Some thought provoking questions were raised, observations articulated and cautionary advice imparted.
It struck me that we must avoid the temptation to allow political undertones creep into the debate. It is understandable that Deputies will point out that the Labour Party Chief Whip and Fine Gael Party expressed certain views on water fluoridation at a certain point.
There are three elements that we, as human beings, enjoy in the spirit of our lives. We breathe air - the Latin word for breathing is spiritus. The second element is water. The third element escapes me. What is it?
These are the three common elements. We are concerned when the air becomes polluted by lead emitted by buses and cars.
If one goes back one will find that even the delivery of public water came through a plumbing system in which all of the pipes were made of lead. People were doing their best in those times, and then insights from science showed them that the reason people in Pompeii were getting a little giddy and light-headed or could not remember what they were doing before the volcano erupted was that there was so much lead in the pipework.
As Deputy Catherine Murphy stated, photographs of people from the 1950s show the gaps in the teeth, the rotten teeth, etc., but the other detail that one notices is the bright eyes. Maybe people were happier in their relationships even though they had economic distress in their lives. We can observe that, too, but that is for another debate.
The questions raised at the end by Deputy Finian McGrath were good ones. Why have some countries stopped doing this? We could put vitamin D into something that we take each day, which is water. We all need vitamin D. We do not get enough in this country because of the lack of sunshine.
Exactly - except for this year, 2013, the summer of sunshine. That is the reason there are other deficiencies in our physical well-being. We do not put vitamin D in the water, but it is there on the shelves. If people want to take their cod liver oil, it is there. In fact, interestingly, in the Soviet system's command-and-control economy, every primary school child had to line up to take cod liver oil.
This raises the ethical question of forcing the ingestion of substances. It is a useful debate. This Friday has been enlightening.
There are old habits that are easy to follow. I understand the Minister of State gets all the information and he has done his homework, and he is presenting it honestly and openly. However, Deputy Stanley is also making use of the preliminary work done by previous Dáil Members to advance the process. We are not trying to jostle in the queue for the press release or the television camera. That is not the business. We are here to serve as best we can and bring our knowledge, our skills and our insights to organise how citizens receive the things that public enterprises, the Civil Service and the semi-state bodies deliver to them.
One of the good outcomes of this debate could be that we take a fresh look at things and get an update on the position. Let us not just do the surface dentistry, to use the metaphor, but also a little root-canal work - a little odontology.
-----it may be time to double-question this.
Water filters were mentioned earlier. We have our water filter at home. Everybody needs a water filter because if one looks at the porous porcelain through which the water flows from the ingress tap to the smaller tap, one will see that it gets filthy. I am the guy who deals with this at home - I do the drains and the plumbing at home - so I know this. I have to scrub the filter clean with a wire implement every four weeks or so, and I can see the sediment, which is not visible in the water but accumulates like a fur on the porcelain filter. I suggest that those who can afford it after paying their property tax buy one of these filters, because it will help to eliminate the impurities.
What Deputy Maureen O'Sullivan stated is important too. Fluoride is a cocktail of elements - a bit of mercury, a bit of lead. We know all about lead.
Let us agree that we have all made helpful contributions to this. Words disappear; they evaporate and are no longer heard. They do not even resonate, because something else comes into our heads. Let us not put it on bits of paper that get filed in lever-arch files. Let us get the best forensic medical people to look at this and be honest about it. Maybe we do not need it any more. Let us break what Deputy Maureen O'Sullivan referred to as the habit we have followed from 1963 to 2013, which is 50 years, or half a century.
It is a habit. It was done with the best intentions, like use of lead in Roman times, and even in our more modern times. I used worry that the pipe from the mains into our house could still be one made of lead. When I get forgetful, I worry about all these matters.
Let us take it forward. Let us compromise. Let us not shoot this down. Let us compromise and set up an update study with a view to probably taking fluoride out of the water supply. That is my suggestion.
I commend everyone who contributed to the debate, including Deputy Stanley, who introduced this Bill. I assure him and the House of the Government's collective determination to continue to keep this important public health measure under review and to act in accordance with expert advice.
To pick up on Deputy Mathews's last point and the frustration that Deputy Catherine Murphy expressed about the debate here today and on Fridays generally, if what Members are advocating is that we should have a continuing debate and discussion on this issue and that all of the expert evidence, from whatever source and in whatever direction, should be available to this House and, through it, to the public, I have no difficulty with that. I am not in dismissive mode. It has been suggested that I am dismissing something-----
-----but I am rejecting the Bill. I am rejecting the simple, bald proposition that the House vote to repeal the 1960 Act. Without any doubt, I am rejecting that. I do not want there to be any doubt about that.
If what Deputy Stanley and others are saying - in the spirit of what Deputy Mathews stated, although I did not agree with what he said at the very end - is that the public are entitled to information, to have a debate and to know about the research, rather than having me stand up and say that I have looked at it, I have had the advice of the expert group and I am satisfied that the expert group is not the Lard Council, as has been suggested, but is a genuinely committed public body determined to ensure that the best research is made available, assessed and reviewed - in other words, if it is being suggested that the material should be available to the public, rather than just being asserted by me, and that people should have a forum and an opportunity to discuss, examine and review that material - I entirely agree. Maybe that is what Fridays should be about, in a sense.
My problem - I say this because I do not want there to be any doubt about it - is that the Bill to repeal the 1960 Act is not acceptable and is not accepted by the Government. If Members of the House, in the context of the concerns that are communicated to TDs, Senators and otherwise, want to ensure that this discussion happens and that I, as Minister, come in with the information that I have - perhaps even with an opportunity to question witnesses, etc. - it seems there is a forum in the Oireachtas for that to be done. In my respectful submission, it is not the way to proceed - neither this Bill, nor Deputy Clare Daly's suggestion that we take a chance on a temporary change of policy. I do not accept that taking a chance like that on people's health is the right way to go and I am not prepared to experiment in the manner in which she suggested, I am quite sure, in good faith. Taking a chance for a few months or years is simply not going to be done.
It comes back to the question of our role as legislators. Everybody in here has stated that we are not scientists. There is an issue of public trust. Whoever quoted the Tánaiste and Minister for Foreign Affairs, Deputy Gilmore, reflected a general concern that exists across society. Over the past few years, trust in many public institutions, including this one, has been considerably undermined.
That has arisen to some extent because of the crisis but also for other reasons. How should we respond? We clearly cannot reject public concerns or ignore our constituents when they tell they are worried about the potential for bone and breast cancer, or any of the other conditions which people have suggested are connected with fluoridation, for which I say there is no evidence. I am not suggesting that Deputies should refrain from raising those issues but sometimes what we say in this Chamber can contribute to public concerns. If, for example, our constituents hear us raise the concern that fluoridation may be connected to this or that illness, they may believe there is a genuine basis for such assertions even though we are only expressing concern. It is almost a circular argument. We raise the concerns that have been expressed with us and when others hear us they become concerned as a result.
Deputy Stagg is entitled to his view. That is politicising the matter. Deputy Mathews is correct that Deputy Luke 'Ming' Flanagan should resist the temptation to reduce this debate to who said what when. I am not prepared to accept the Bill, although I believe Deputy Stanley introduced it in good faith. However, I am prepared to facilitate continuing public discussion of and access to the evidence, which on my reading as a non-scientist is overwhelmingly in favour of maintaining this policy. The preponderance of scientific evidence supports the continuation of this policy. That would be the result of any fair minded and balanced review of the material available to us.
The Minister of State was very dismissive of our concerns in his opening contribution but he seems to have softened his stance over the course of the debate. As we appear to be having some effect, perhaps it was worth Deputy Catherine Murphy's time to participate after all. I would like to see an outright ban on fluoridation. He said we cannot take a risk but we are already taking risks. Is he saying the other 98% of Europe is taking a risk? What risks are the countries which never introduced fluoridation taking? People are not dropping dead because they are not getting their daily dose of fluoride.
The logic of his argument falls flat. We are told in this State that we should take it because it is good for us. Think about how that type of advice worked for previous generations. There is considerable spin on this issue but he was unable to quote a shred of research on the affects on health. He spoke about the affects on teeth while ignoring diet and the use of toothpaste. Despite having a bank of officials at his disposal he was not able to present evidence on the affects on people's health.
There is no way a report can be produced on safe limits because some people drink half a glass of water per day and others drink half a gallon. I know people who never drink water. I am concerned about them because water that has not been poisoned is good for them. When we were children we drank large quantities of water, particularly during the summer. The forum report from 2001 was quoted by the Fianna Fáil Member but a vital piece of information was missing from that report because the FSAI would have been required to sit one more time to produce it. That would have taken another day or week.
The Ireland of today is a long way from the Ireland of 50 years ago. We have moved away from Archbishop McQuaid giving his blessing to policies. The basis for the introduction of fluoridation was completely flawed. In 1956 the fluoride consultative council was established by the then Minister for Health, Thomas F. O'Higgins of Fine Gael. The council's chairperson was the professor of social and preventive medicines and registrar at University College Dublin, Thomas A. Murphy. The aim of the council was to advise whether, with a view to reducing the incidence of dental caries, it was desirable to provide for an increased intake of fluorine and, if it considered it so desirable, to advise as to the best method of securing such an increased intake along with any precautions and safeguards necessary. A new Government in 1957 saw Seán McEntee appointed as Minister for Health. Meanwhile, Professor Murphy had been sent on a fluoridation fact finding mission to the United States, where scientists sponsored by the US public health service unsurprisingly gave him an overwhelmingly positive report on the safety and dental benefits of fluoridation given that the service was promoting it. Soon after Professor Murphy gave his report to the Minister, Mr. McEntee, the latter introduced a water fluoridation Bill to the Dáil. According to the former Fine Gael Minister for Finance, Richie Ryan, there was an incredible pro-fluoridation bias in the debate. He recounted in a recent interview with Hot Press that throughout the debate on fluoridation in the Dáil and the legal proceedings in the courts, whenever there was tittle tattle from any part of the pro-fluoridation lobby across the world, the Department of Health issued a press release but it never revealed that certain nations voted down fluoridation. In other words, it carried out a propaganda campaign. I recall when Richie Ryan was Minister for Finance.
That is correct. He was equally emphatic in respect of the current Government, saying that the Department of Health is now even more determined not to be found in the wrong. He claimed this is the reason it has never revealed the long-term health effects of fluoride. He thinks it has a closed mind and takes the attitude of defending itself at all costs because it does not want a situation in which it might be proved wrong. It is okay to be proved wrong, however. I have often been proved wrong. There is evidence on both sides of the debate but the precautionary principle should apply. If the Government thinks it is good for us it should use the €4.6 million in funding to supply it in tablet form. We could have the choice of adding it to our tea. I had it this morning because the Government forced me to include it in my tea. It is an awful situation. This is forced medication.
The Government's prime witness in the 1964 case was a Dr. Harold Hodge from the United States. Dr. Hodge's reputation has been seriously damaged by the publication of a book, The Plutonium Files: America's Secret Medical Experiments in the Cold War, for which its author, Eileen Welsom, won a prize. The book documents human experiments in which the subjects did not even know they were being tested to find the safety limits of uranium and plutonium. In 1945, Dr. Hodge attended a meeting in which these experiments were planned and a memo from the US Atomic Energy Commission thanked him for his planning and suggestions in the experiments. The US Government eventually settled with the victims with an average payment of €400,000. In 1953, Dr. Hodge arranged for Dr. William Sweet of Massachusetts General Hospital to inject 11 terminally ill patients with uranium for their brain tumours. These patients may not have known that tests were being administered on them. The judge in the 1964 case singled out Dr. Hodge for special thanks for giving evidence over six days with unfailing courtesy and in an non-technical language.
Prior to the introduction of fluoridation up to 600 dentists were practising in this State.
If fluoridation brought about the promised 65% reduction in dental decay, many of the dentists could have gone on the dole or sought other careers. Today, we have some 2,000 dentists in the State and that statistic sums up the argument against fluoride. The passing of time has made a policy of mass fluoridation, if it was ever justified, completely redundant. We have plenty of dentists and we can have more if we need them. We also have toothpaste and we can improve our diet. We can cut down on sugary drinks that children are taking.
I see the effect of it. My grandchild is getting fluoridated water but it is not stopping the problem. She started drinking Coca-Cola behind people's backs and that is having an effect on her back teeth.
The future of dental health lies in dental health policy, diet, making sure we look after these issues and making dental services available. I ask the Minister of State to take note of the issue I raised in respect of children in County Laois, who do not see the school dentist until 12 years of age. It is a scandal. I have previously raised the matter and it seems to get nowhere. People in County Laois are frustrated and it may also be happening in other counties. The Minister of State should examine this across the State because that type of prevention, not mass medication, solves these problems. Getting children seen earlier means these fillings can be done earlier and it can act as preventative treatment. While we laud ourselves in all the advances made, such as the web summit last week, we have gone back more than 50 years. Some 45 years ago, I saw the dentist for the first time but children now do not have that benefit in the county in which I live and perhaps others. The Minister of State at the Department of Health is in a position to find out if that is the case. The money spent on mass fluoridation for the population would be better spent on improving dental services and education on dental health and hygiene.
The Minister of State referred to evidence and risk. Some 98% of Europe cannot be wrong and there is no risk. They are not falling over and dying and their teeth are not falling out. I have been in other countries in Europe and the people look perfectly healthy. If anything, they have better dental health than we do. I appeal to the Minister of State to show leadership. Members from Government parties have mentioned this issue to me. We should try to have an open debate. I welcome the comments of the Minister of State, provided that the debate is not dominated by the pro-fluoridation lobby, the people who want to take pro-fluoridation reports and present them as the expertise.