Muddy waters: the use and abuse of findings from the 'York Review' on fluoridation Paul Wilson

1. Muddy waters: the use and abuse of findings from the 'York Review' on fluoridation Paul Wilson

2. What policy makers ‘really really’ want • breadth • gap identification • cumulative knowledge • ‘big questions’ • quick answers • reliability

3. Saving Lives: Our Healthier Nation 1999 • There is strong evidence (Acheson Inquiry,1998) that water fluoridation improves dental health and significantly reduces inequality in dental health. • Present legislation not working. No new schemes since 1985. • CRD to carry out scientific review of fluoride and health. • If it confirms that there are benefits to dental health from fluoridation and that there are no significant risks, we intend to introduce a legal obligation on water companies to fluoridate where there is strong local support for doing so.

4. Major issues concerning policy on water fluoridation • The likely positive effects (reduction in average levels of dental caries). • The likely positive effects above that offered from other interventions (e.g. fluoridated toothpastes). • Negative health effects. • Ethical, environmental and legal issues.

6. Fluoride 'can help poorer children' By Marie Woolf, Political Correspondent A REVIEW into the fluoridation of drinking water commissioned by the Health Department has concluded that it could particularly benefit children from deprived social backgrounds who tend to have more cavities than middle class children. Wide-scale fluoridation would iron out social inequalities in the quality of teeth caused by diet and other factors, said the report. The draft results, based on worldwide studies of fluoride, have concluded that the evidence suggests adding fluoride to the water supply can lead to fewer cavities in children's teeth. Daily Telegraph 15 May 2000

7. NPWA: WATER FLUORIDATION: TONY - START LISTENING NOW! • The Final Report…will be available on 6 October, 2000. Key words to watch for - "marginally beneficial". • White Paper specifically stated that this Review would examine the effects of FLUORIDE ON HEALTH. HOWEVER, the NHSCRD focussed only on "Water fluoridation" - and was HIGHLY SELECTIVE in the papers it accepted for review. • The Review SPECIFICALLY EXCLUDED all animal studies, all biochemical studies, all mathematical models, therefore ignoring decades of international scientific research which found serious adverse effects from fluoride exposure - including exposure to naturally fluoridated AND artificially fluoridated water.

8. Main Findings of the ‘York Review’ • Little good quality research undertaken in this field. • Evidence that fluoridation reduces caries (tooth decay) prevalence. A smaller reduction than previously reported, but estimates ranged from a substantial benefit to a disbenefit. • Evidence of a an increase in the prevalence of fluorosis. • No association found between fluoridation and other adverse effects such as cancer, bone fracture and Down’s syndrome. • Limited evidence about reducing inequalities in dental health - poor quality, contradictory and unreliable.

9. The final word on fluoride? “a classic example of an exercise in controlled propagandist disinformation”

10. DoH: ‘Government Welcomes New Report On Water Fluoridation’ • This report clearly shows that fluoridating water helps to reduce tooth decay. In areas where overall health is lower than average, dental health is much higher if the water is fluoridated. • The findings show that water fluoridation improves dental health and the Government will be encouraging health authorities with particular dental health problems to consider fluoridating their water as part of their overall oral health strategy. • no association has been shown between water fluoridation and cancer, bone fracture or Down's Syndrome.

11. NPWA: GOVERNMENT MINISTER MISINTERPRETS THE "YORK REVIEW" • ALMOST HALF of populations living in fluoridated areas have dental fluorosis. Nevertheless, the British Public Health Minister believes that the recent NHS review provides the basis for recommending water fluoridation. • The vast majority of included studies graded Level C – “poor quality with a high risk of bias.” • Review found a reduction in tooth decay of only 14.6% (not the 50% - 60% formerly claimed by pro-fluoride lobby). • 48% of those living in fluoridated areas have some degree of dental fluorosis. 12.5% have moderate / severe dental fluorosis.

12. British Fluoridation Society: ‘York review: Questions and Answers’ • The report is unequivocal: water fluoridation is EFFECTIVE and SAFE. • Fluoridation reduces tooth decay by on average 2¼ teeth per child, and increases the proportion of children completely free from tooth decay by an average of 15%. • No association between fluoridation and adverse health effects. Dental fluorosis recognised as cosmetic issue. • Review confirms that water fluoridation reduces inequalities in dental health.

13. Did the ‘York review’ influence policy ? • 2003: House of Commons voted in favour of an amendment to the Water Bill. • Under the amendment, water fluoridation will take place if a water company is asked to do so by a Strategic Health Authority, but only after public consultation at local level has shown sufficient support for it.

14. Was the ‘York review’ useful ? • Policy making informed by the best "available" evidence. • Provided certainty about the extent of uncertainties. • Challenged interested parties to review / defend theirbeliefs. • Informed the future research agenda. • Will inform future consultations at the local level on the introduction of water fluoridation schemes.