Mr David Hinchliffe, MP
Chair, Health Select Committee,
The House of Commons,
Westminster,
London, SW1A 1AA.

FOR URGENT ATTENTION, PLEASE.

Dear David,

PCTs and water fluoridation: simple ignorance or fraudulent misrepresentation?

I write to you in your capacity as my MP and as Chair of the Health Select Committee to draw your attention once again to some very disturbing developments in the matter of artificial water fluoridation. I would be most grateful if you would bring the contents of this letter to the attention of Rt. Hon. Hazel Blears, MP and the Secretary of State for Health.

The York Report noted the poor quality of all the studies they scrutinised, including those relating to serious adverse effects. We believe that exclusion of all animal, biomedical and biochemical studies from this Review were very serious omissions and we said so at the time. Despite the narrow criteria of this review, the authors said that dental fluorosis affects about 48% of people living in fluoridated areas and that 12.5% of these cases were "of concern." Despite its limitations, the final Report provided no basis for formulating a policy on water fluoridation.

The Medical Research Council report, however, dismisses any of York's worries, considering that any further research into the effects of fluoride on cancer, Alzheimer's, Down's Syndrome, etc to be of "low priority."

The MRC chose, instead, to recommend research "to determine the public perception of aesthetically unacceptable dental fluorosis." This clearly led the Public Health Minister to the surprising conclusion that public perception of dental fluorosis, rather than the prevalence of this disease, must be "the crucial issue"! (Note: The World Health Organisation classifies dental fluorosis as "a disease.").

In order to highlight some of the published studies already available George Glasser and I co-authored a paper (enclosed and in press) entitled Public Perception of Dental Fluorosis: 'The crucial issue?' It is supported by 57 references.

Why is more taxpayers' money being spent on yet more studies on this topic? Does the MRC believe that they may hit on one which shows that the public are happy about dental fluorosis - or have no opinion on it whatever?

We also have serious concerns about highly misleading statements made by public health personnel around the UK. In particular, we wish to inform you of two recent meetings of the Hyndburn and Ribble Valley Primary Care Trust at which I represented North West Councils Against Fluoridation. I enclose relevant papers from the second of those meetings, to which I shall refer.

At the first meeting, in Accrington, on 12 December, the Professional Executive Committee of the PCT met to discuss Dental Health: Fluoridation of the Water Supply. The purpose was to enable the Committee to make a recommendation to the PCT Board.

Dr Michael Duffy, secretary of the Local Dental Committee, was co-opted onto the PEC for this meeting, to ensure that the views of general dental practitioners were reflected. No such invitation was extended to any member of the local group of opponents - nor to any member of the public, who might have something to say about the mass treatment of population via the drinking water supplies, particularly since fluoridation was rejected by the elected Councils of both Hyndburn and Ribble Valley following a full public consultation some years ago. Many local people feel that for health bodies to promote this issue again is tantamount to harassment.

Dr J.G. Whittle, Consultant in Dental Public Health, made an oral presentation of a paper, "Dental Health in Hyndburn and Ribble Valley" (enclosed) which he co-authored with Dr W.S. Morton, the PCT's Director of Public Health and Health Standards, who was also present.

I spoke to our paper on the public perception of dental fluorosis, to which was appended a statement from Professor Sheldon, Chair of the Advisory Panel of the York Review.

The time allotted for each of these presentations was five minutes. Five minutes! This was strictly enforced and I was unable to complete the reading of our paper. I therefore urged the members to complete the reading for themselves.

Dr Whittle and I left the meeting to allow the Committee to continue its deliberations on what recommendations they would make to the Trust members who were to meet a week later. Although four members of this Committee opposed the measure, preferring to wait for guidance from the Department of Health, it was decided, on a 9 to 4 vote, to recommend fluoridation to the Primary Care Trust Board.

We seriously question the validity of this decision.

On the 19 December, I returned to Accrington for the meeting of the Primary Care Trust Board. The Chairman welcomed everyone and expressed his surprise at the presence of so many members of the public.

Dr Whittle addressed the members of the PCT and told them that the York Review had found that fluoridation

· reduces tooth decay,
· reduces health inequalities and
· is safe.
He urged the members to support water fluoridation.

A couple of days prior to this meeting, we had received a copy of a letter to the Minister for Public Health by the Director of the NHS Centre for Reviews and Dissemination and three other scientists involved in the York Review, in which they expressed concern about some continuing misinterpretations of the evidence on water fluoridation which could have implications for public health policy (copy enclosed.).

I distributed copies of this letter to the PCT members prior to the meeting and read it aloud, since they had had no time to consider its implications for policy making.

As you see, the letter specifically refuted the three main points which had just been made by Dr Whittle.

Following the presentations, Dr Whittle and I answered a few questions, but were not permitted to take any further part in the discussions. However, since this was a public meeting, we remained in the room.

On page 3, No. 11, the Whittle-Morton paper incorporates a section entitled "Arguments Against Fluoridation". Under the second bullet, the authors cite a paper from Newcastle [* go to abstract below] which Dr Whittle included in his oral presentation. The Whittle Morton paper states that "The effect of providing advice to parents on how to reduce the risk [of dental fluorosis] has been demonstrated in fluoridated Newcastle, where the level was found to be 3%." Dr Whittle told the PCT Board - and allowed them to believe - that "only 3%" of people in fluoridated areas have dental fluorosis and that only a small proportion of them had fluorosis of concern.

This erroneous information was deliberately repeated later by Dr Morton, the Director of Public Health and Health Standards, who co-authored the report presented by Dr Whittle.

Dr Morton tried to dismiss my own presentation by repeating Dr Whittle's astonishing assertion that "the NPWA does not understand dental fluorosis." He also recited the now-familiar misinterpreta-tions of the York Report.

Historically, scientists who disagree with the claims of the fluoridationists have been routinely denigrated as "kooks and crackpots" (evidence is available, including personal testimonies from leading scientists.). In order to further influence his colleagues, Dr. Morton then felt moved to dismiss the letter from the Director of the NHS CRD (who was one of the authors of the York report) and his three co-signatories, by attempting to diminish the credibility and the expertise of the York scientists. Improvising on his feet, he told the meeting that the letter had been written by "a sub group on the York Review".

The use of such tactics by a Director of Public Health and Health Standards is totally unacceptable. It demonstrates a determination to "win at any cost." And he succeeded. In a "first vote" of the Board members, the Chairman of the Board had opted to "wait for guidance from the DoH." In the second (final) vote, following Dr Morton's statements, the Chairman opted for fluoridation.

The Newcastle study, referred to by Drs Whittle and Morton actually found that
· 54% of people in fluoridated areas have dental fluorosis.
· 3% of these people have fluorosis of concern.
· 20% of people in non-fluoridated areas have dental fluorosis.
· 0.5% of people in non-fluoridated areas have fluorosis of concern.

These findings, if accurate, show that in fluoridated areas dental fluorosis of concern is six times higher than in non-fluoridated areas. Moreover, once again the results raise disturbing questions about the total fluoride exposure in both population areas, which cannot be entirely due to the use of fluoridated toothpaste.

One can only conclude that either Drs Morton and Whittle did not read that paper and received their information from some other source, or they fraudulently misrepresented it in order to influence the Professional Executive Committee and the PCT Board.

In any case, they should have corrected their errors when they presented to the full PCT board. They did not - even though I had drawn particular attention to this at the previous meeting of the Professional Executive Committee a week earlier.

To further advance their case, Drs Whittle and Morton resorted to quoting statistics from the dental health "league tables" which were specifically excluded from the York Review because they are unscientific. There are many other examples of inaccuracies and misrepresentations in the Whittle-Morton statements. To itemise them all would be tedious.

We are extremely concerned that the Whittle-Morton statements may well be incorporated into the regular "catechism" of others who sell fluoridation. Many such "tried and true" phrases have been built into scripts for use in the promotion of fluoridation.

On 20 January, 2003, the issue of water fluoridation is on the Agenda of Blackburn with Darwen PCT. Dr Whittle is listed as Consultant in Dental Public Health.

You will be aware that the National Pure Water Association was very critical of the narrow criteria under which the York Review was conducted. These criteria specifically excluded all animal, biochemical and biomedical studies from consideration by the Review Panel. This effectively ruled out many studies on cancer, thyroid damage, neurological and many other effects which are well documented in the literature.

Notwithstanding these omissions, the York Report provided no sound basis on which Government could make a policy on water fluoridation and the Medical Research Council was subsequently asked "to determine what further research is required to strengthen the evidence base."

In an extensive critique of the Medical Research Council's report, (a copy of which, I believe, was sent to you), Lord Baldwin wrote:

·"The MRC acknowledges York's arguments for great caution in interpreting studies on this issue because of their poor quality before overruling them with "authoritative reports" of its own (4.3), reports of which York was aware but which it did not consider good evidence. This produces the unqualified statement in the lay summary, repeated in similar terms in the conclusions under 4.3.3 & 6.1 and unfortunately echoed in the Department's press release, that "The majority of the research conducted to date indicates that water fluoridation reduces dental caries inequalities between high and low social groups".

· 2.6 In 5.1.3. the MRC highlights a recent study by Hillier on bone health as evidence of absence of risk over a lifetime's exposure to fluoride, pointing to a "possible limitation" that the fluoride was natural and not artificial. It would have been helpful in assessing the evidence to know that York had assigned this study to level 'C' ("lowest quality, high risk of bias" with a validity score of 4/9. Another curious example of evidence is the MRC's treatment of the cancer issue under 5.2.1.i). The 1977 analysis by Yiammouyiannis & Burk, which suggested an association with fluoridation, is criticised; the 1991 study by Hoover, which suggested no association, is cited with approval. Both were classed level 'C' by York, but with validity scores of 4.1. for Yiammouyiannis and 3.3 for Hoover.

· 2.11 York considered that "The outcomes related to infant mortality, congenital defects and IQ indicate a need for further high quality research" (12.4). Whiting et al's more recent systematic review of the evidence for Down's Syndrome cited by the MRC (5.4.) repeats the call for more high quality research. The MRC does not share these concerns, assigning low priority to two of these and not discussing infant mortality at all. Again, whose interpretation should be accepted?

Indeed!

Further examples of questionable events featuring water fluoridation.

East Lancashire Health Authority

On 20 December 2000, a meeting was held by the (then) E. Lancs. HA to discuss a report of the results of the York Review. Inter alia, Dr Whittle told the Board that York found that 12.5% of the population has some degree of dental fluorosis. He stated that water fluoridation is safe and effective. Dr Morton was also present at this meeting.

Cllr E Vaughan, of North West Councils Against Fluoridation, subsequently wrote to the Chairman, correcting several erroneous statements made by Dr Whittle. No reply was received.

Dr Peter Tiplady, Director of Public Health, North Cumbria.

In January, 2002, at a meeting in Whitehaven between United Utilities, the Health Authority and delegates from North West Councils Against Fluoridation and the NPWA, the "Newcastle paper" was cited by Dr Peter Tiplady, Director of Public Health. He asserted that Professor Andrew Rugg-Gunn (one of the authors of the Newcastle paper) found that dental fluorosis is "only 3% in fluoridated areas"- much lower than that determined by the York review. Dr Tiplady was adamant that the York Report had found fluoridation to be effective, to reduce social inequalities and to be completely safe!

Recent readers' correspondence in a North West newspaper discussed the BMA "New Guide to Medicines and Drugs" (Third Edition 1994), which states: 'Prolonged intake of water containing more than 2ppm may lead to mottled or brown discoloration of the enamel of developing teeth.' It mentions other negative effects.

[Incidentally, this BMA publication states that 0.15mg fluoride is a safe daily intake for children under 3 months and up to 0.5 mg/F for babies 3months to 2 years. A new-born baby can drink 20 fl oz of milk daily. If the infant is on formula feed made up with fluoridated water, a new-born will receive over 0.5 mg fluoride in every litre of its daily feed. This is over three times the limit set by the BMA. Correspondingly, a three-month-old child weighing around 14 lb can drink around 1.75 pints - and receive approximately 0.875mg of fluoride daily via its feeds alone. This is almost six times over the limit recommended by the BMA. Public health officials in fluoridated areas do not warn mothers of ANY potential dangers.].

Dr Tiplady wrote to the News & Star (19 December): "I have established that the statement on negative effects [in the BMA publication] is in fact an ERROR in the current edition of this publication which, I understand, will be corrected in the next edition." [This supposed "error" has been in the public domain for nine years!]

Note: Shortly after the publication of the York report, Dr Tiplady was appointed to the Chair of a central BMA committee on public health and community health medicine for England.

The All Party Group for Public Health and Primary Care.

On 23 December 2002, we received a message on our answerphone from the "Press and Parliamentary Department" of the British Dental Association (a trade association.). The caller informed us that the All Party Group on Public Health and Primary Care is holding "a short enquiry into water fluoridation" and that "we" (unclear whether she meant the BDA or APPG) will be holding "short evidence sessions" on 29 January. The BDA wanted to know whether we could attend.

We have not responded to the BDA and have received no subsequent communication on the matter from the All Party Group concerned. The Green Party was also contacted with a similar message.

In our view, the BDA's actions indicate a disturbing example of lobbyists being directly involved in, if not driving the political agenda on water fluoridation.

The Royal Institute of Public Health.

In April 2003, the Royal Institute for Public Health is holding a "symposium" on water fluoridation. According to their website, this will be "Of interest to the food industry, the water industry, directors of public health, environmental health officers and directors, toxicologists, dentists and physicians, lawyers, consumer and environmental groups."

When I telephoned for information, I was told that they don't know who the speakers will be. My informant said that the food industry is particularly interested because they fear litigation. When I asked which consumer groups would be represented on the speaker list, she expressed surprise that any should be! Needless to say, the National Pure Water Association has not been contacted by the RIPH.

Curiously, the preamble on the RIPH site mentions the Irish Fluoridation Forum but makes no reference to the York Review or the MRC Report.

Note: The President of the RIPH is Sir Donald Acheson, who strongly endorsed water fluoridation in his 1998 Report. This report has repeatedly been cited as an "expert endorsement."

The British Fluoridation Society Ltd.

This company, has long been funded by the Department of Health, the Scottish, Irish and Welsh Offices and health authorities to promote water fluoridation. It supplies much of the material on water fluoridation used by government advisers, Ministers, MPs, Lords, dental and public health officers, health authorities and others.

In 2002, the BFS commissioned WRc-NSF - at a cost of £30,000 - for a study on the Chemistry and Bioavailability Aspects of Fluoride in Drinking Water. (Report No.: CO 5037, July 2002, Authors: P J Jackson, P W Harvey and W F Young, Contract Manager: M Hosford, Contract No.: 09607-7).

The WRc-NSF authors created a hypothetical scenario, based on theoretical modelling. Among their 14 references, they cited the York review. In the Appendix, they cited two studies on aluminium absorption. They made no mention of the three Varner, et al neurotoxicity studies which caused the United States EPA to request the National Toxicology Program to commission studies on aluminium and fluoride in drinking water.

The WRc-NSF paper was severely criticised by an independent chemical engineer, a forensic ecologist and the NPWA - see http://www.npwa.freeserve.co.uk/jackson.html. However, it is featured on the website of the British Fluoridation Society as "an authoritative independent review." See http://www.liv.ac.uk/bfs/wrcreport.pdf.

The Health Select Committee should hold an enquiry into the activities of the British Fluoridation Society Limited and invite us to give evidence.

NOTE: on 19 November 2002, the Department of Health Policy Research Programme advertised for tenders for a study on the bioavailability of fluoride in drinking water. The funding offered is £30,000. (More taxpayers' money.). They cited, as references, the discredited WRc-NSF report and the MRC Report, (but not the York Review!). THIS PROPOSED STUDY HAS NOTHING TO DO WITH HEALTH. IT IS A BLATANT ATTEMPT BY THE DEPT. OF HEALTH POLICY RESEARCH PROGRAMME TO JUSTIFY THE ADDITION OF SCHEDULED PART II POISONS INTO THE PUBLIC DRINKING WATER SUPPLY.

In November, 2002, the BFS, in company with the British Dental Association and the British Medical Association held a conference on water fluoridation. More than 70 representatives of Primary Care Trusts attended. Mr Jackson, of the WRc-NSF was one of the speakers. The Chairman for the morning session of the conference was Dr. Peter Tiplady.

We realise that ministers rely heavily on their advisers. Those advisers involved in water fluoridation appear to be hell-bent on sustaining entrenched political beliefs no matter what the cost in funding or reputations. The spin and outright misinformation being disseminated by the Dept. of Health and health officials around the country remains unchecked.

This must cease forthwith.

International research unfavourable to water fluoridation cannot be suppressed for ever. Peer reviewed studies are available to anyone with access to the internet. Educated members of the public (particularly the lawyers) are well able to determine who are the "kooks and crackpots".

When Sir Ivan Lawrence, QC was an MP and serving on the Health Select Committee in the 1980s, he "couldn't have cared less" about water fluoridation. However, when examining "experts", he was astonished when they were unable to answer even simple questions. He said, "I realised that there was a rat rotting somewhere." He diligently set about educating himself on the issue. I commend to you his speeches to the House of Commons (recorded in Hansard, Feb. 1985) during the fluoridation debates, prior to the passing of the Water (Fluoridation) Bill. Incidentally, the voting figures on that Bill are worth revisiting -

MPs in favour of fluoridation 165
MPs against fluoridation 82
Abstained (not "absent"!) 399 (excluding the four Tellers.).

In our opinion, the Department of Health is now in grave danger of falling into disrepute over water fluoridation. We urge the Health Select Committee to examine the entire issue - and the conduct of PCTs who "discuss" water fluoridation - as a matter of urgency. We would welcome an invitation to give evidence to your Committee.

Yours sincerely,

Jane Jones,
Campaign Director.

Copies to:

Professor Jos Kleijnen, Director, NHS CRD, University of York.
Sir Iain Chalmers, Director, UK Cochrane Centre.
Professor Trevor Sheldon, Head of Department, Dept. of Health Sciences, University of York.
Professor George Davey-Smith, Dept. of Social Medicine, University of Bristol.
The Lord Hunt of Kings Heath, House of Lords.
Sir Liam Donaldson, Chief Medical Officer.
Sir Anthony Cleaver, Chairman, Medical Research Council.
Rt Hon. Jack Straw, MP.
Mr Jimmy Wray, MP, Chairman, All Party Group on Water Fluoridation.
Mr Bill Etherington, MP, Secretary, All Party Group on Water Fluoridation.
The Earl Baldwin of Bewdley, House of Lords.
Dr Peter Mansfield, Good Healthkeeping.
Mr Doug Cross, EurProBiol, CBiol, MIBiol, BSc.
Mrs Kath Reade, Chairman, Cumbria & Lancashire Health Authority.
Mr Nigel Evans, MP.
Mr Greg Pope, MP.
Mr Liam Fox, MP.
Mr Graham Brady, MP.
Mr Tim Collins, MP.
Sir Ivan Lawrence, QC.
Cllr Noel Spendlove, Chairman, North West Councils Against Fluoridation.
Mr G. Martin Hill, MBE, BSc, Chairman, Hyndburn and Ribble Valley Primary Care Trust.
Mrs Pauline A. Walsh, Chairman, Blackburn with Darwen Primary Care Trust.
Mrs Linda Forrest, Chair, Fight Against Fluoridation, Blackburn, Hyndburn and Ribble Valley.
Dr Paul McCormick, D.Phil, President, National Pure Water Association.

* ABSTRACT of the Newcastle paper, taken from Pubmed. Note the term "fluoride deficient", which is used to describe waters without artificial fluoridation.

Br Dent J 2000 Aug 26;189(4):216-20
Dental fluorosis in permanent incisor teeth in relation to water fluoridation, social deprivation and toothpaste use in infancy. Tabari ED, Ellwood R, Rugg-Gunn AJ, Evans DJ, Davies RM.
Newcastle City Health NHS Trust, Walkergate Centre, Newcastle upon Tyne. Tabari@BTinternet.com

OBJECTIVES: To determine the prevalence and severity of fluorosis in permanent incisor teeth in young children in a fluoridated and a fluoride-deficient community and to establish what relationship, if any, there was between the occurrence of dental fluorosis and the reported use of fluoride toothpaste in childhood.
DESIGN: A prevalence study of children aged 8-9 years who had been continuous residents in fluoridated Newcastle or fluoride-deficient Northumberland.
METHOD: The permanent maxillary central incisor teeth were examined clinically and photographically by one examiner using the Thylstrup-Fejerskov index; the photographs were read blind to child identity and clinical score. A closed-response questionnaire enquired into the child's early experiences of toothbrushing and use of fluoride toothpastes. Social deprivation was measured by a Jarman score. The study took place in 1998.
OUTCOME MEASURE: Prevalence of dental fluorosis measured by the Thylstrup-Fejerskov index.
RESULTS: Complete data were available for 78% (n = 409) and 79% (n = 403) of eligible sampled children in the two areas, respectively. Clinical and photographic results agreed closely and had high reproducibility. The prevalence of fluorosis was 54% in the fluoridated area and 23% in the fluoride-deficient area when all grades (> 0) of fluorosis were included; percentage prevalence of mild to moderate fluorosis (> or = 3) was 3% and 0.5% in the two areas, respectively. [See also the relevant item in Public Perception of Dental Fluorosis: "The crucial issue"? enclosed.]. Multivariate analysis indicated that area of residence (odds ratio = 4.5), Jarman score (odds ratio = 0.99 per Jarman unit) and type of toothpaste (odds ratio = 1.6) were statistically significantly related to presence or absence of fluorosis: the risk factors were--fluoridated area, affluence, and use of adult toothpaste.
CONCLUSIONS AND RECOMMENDATIONS: The prevalence of aesthetically important dental fluorosis was low, although higher in the fluoridated area. Use of a child's toothpaste (with lower fluoride concentration) could decrease risk in a fluoridated area. Adherence to the guidelines published by the British Society of Paediatric Dentistry is recommended.