MEDICINE TODAY
On Fluoridation
By JOHN ROWAN WILSON
lN controversies concerning the public health it often seems that no resolution is possible, since the two parties to the argument are using entirely different languages and terms of refer- ence. This lack of common basis for discussion was characteristic of the early religious objec- tions to anaesthesia and the bitter attacks on vaccination when it was first introduced. A similar situation, intensified by the great modern developments in techniques of persuasion. exists nowadays in relation to fluoridation of water supplies.
Fluoridation, as we all know, is a measure designed to introduce one part per million of fluorine ions (in the form of sodium fluoride) into drinking water, in order to reduce the incidence of decay in the teeth of children. It has been known for about twenty-five years that dental decay is much reduced in areas where the water contains, from natural sources, this level of fluorine. Experience in North America has shown that the artificial addition of sodium fluoride produces the same effect. The study of communities with a naturally high level of fluorine, and of those where it has been arti- ficially added, have shown no difference in health from other communities—except that they have less dental caries. The Ministry of Health, the • professional bodies of the medical and dental professions, and the World Health Organisation, have all declared themselves satisfied that fluoridation is both effective and safe.
What then, is the argument about? Putting aside purely crackpot notions such as the idea that the whole thing is either a Communist or capitalist plot, fluoridation can be logically attacked on several possible grounds. It may be argued that it is ineffective or that it is dan- gerous. Alternatively, it may be argued that even if it is effective and safe it is still contrary to personal freedom, since an individual has a right to a personal choice as to whether he drinks fluorinated water or not.
As regards efficacy, even its opponents find it difficult to deny the value of fluoridation in the prevention of caries. Arguments against this tend to 'be similar to the ones advanced against the connection of smoking and cancer, in that they demand a degree of proof which it is obviously impossible ever to obtain in human medicine. The doubts about safety again tend to demand criteria of safety which would end up by bringing common salt up for assessment by the Committee on Safety of Drugs. If we are to use the standards of scientific proof which are generally accepted throughout the world. the anti-fluoridationists must fail on these two counts.
We are left with quite the most interesting ob- jection—the ethical one. Has the Government a right to decide what people should have in their drinking water? Well, it's generally agreed that it has a right to decide what they shouldn't have; it uses chlorine to kill bacteria without asking the permission of the individual drinker. And we cannot say there is a principle against the introduction of chemicals as such, since chlorine is a chemical. Fluorine is not a drug and fluori- dation cannot be regarded as compulsory mass- medication, as has sometimes been alleged. It is more comparable to supplying the community with a component of diet in which it is deficient.
The argument is made that the individual has a right to decide for himself whether he receives this component, just as he can decide whether he eats meat or takes vitamins or chooses to accept or reject a blood transfusion. This has a strong natural appeal to those of us who believe that in the long run the preservation of per- sonal freedom is more important than any incidental harm individuals may do to them- selves. But, unfortunately, it makes no sense in the present case, since those who are really ,affected by fluoridation are children, who are in no position to understand the issue or to make a choice for themselves. It is disingenuous of the anti-fluoridationists to say they are fighting for freedom. They are fighting for the right to im- pose on the community their own minority views on the correct composition of drinking water. And when they win a local battle. their victory is not over the doctors or the dentists or the Government. It is over the next generation.
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