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Lord Dean of Beswick: My Lords, I thank my noble friend for giving way. Is he aware that the north west has a closer connection in this respect than the north east? For example, when Manchester ran the water authority it fluoridated the water in the north west for 17 other authorities, but that was cancelled when the industry was privatised with the results that have been quoted tonight.

Lord Hunt of Kings Heath: My Lords, I am most grateful to my noble friend for that information. Certainly, in my own experience, I believe that Birmingham City Council, which fluoridated the water many years ago, showed a great deal of foresight which has reaped enormous public health benefits for those living in the city.

As my noble friend Lord Rea suggested, the operation of the Act has not been successful. Indeed, that was confirmed by yesterday's judgment in the judicial review, to which my noble friend Lord Dixon referred, in which the Tyneside Health Authority sought unsuccessfully to challenge Northumbrian Water's refusal to accede to its request to fluoridate its water. Since 1985, 55 health authorities in England--and that is nearly half of them, accounting for the mergers which have taken place in the past 12 years--have requested water companies to introduce water fluoridation. However, as the noble Earl, Lord Howe, suggested, none of those requests has been successful. So there have been no new fluoridation agreements since 1985. The reason for this is quite simply that none of the water companies has exercised its discretion to agree to a health authority's request.

It was noted in the Green paper, Our Healthier Nation, that this legislation needs to be reviewed. As my noble friend Lord Rea suggests, the key issue is whether the word "may" should become "should". We will be announcing our decision on any changes necessary in a policy statement on fluoridation in the public health White Paper planned for the new year.

The noble Lord, Lord Craigmyle, raised the issue of the public. I have two comments to make in that respect. First, opinion polls have quite clearly demonstrated public support for fluoridation. Secondly, in our response in the White Paper we shall be looking at ways in which the public consultation process can be strengthened. In the meantime, we are encouraged by the readiness with which the water industry has indicated that it is prepared to look again at the legal and practical problems surrounding fluoridation.

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In his Motion, the noble Earl asks for a public inquiry. Such inquiries are normally held where a case of major public maladministration is suspected which has resulted in harm to health, often significant loss of life and/or costly damage to property and the environment. These criteria do not apply to fluoridation, but we are not complacent. There has been, and continues to be, no shortage of authoritative scientific reviews of the safety and efficacy of fluoridation, and of the effects of fluoride. The Government will, of course, continue to review the latter and look sympathetically at soundly-based proposals for further UK-based research.

In conclusion, I again thank the noble Earl for the opportunity to hold this very important debate on the issue of fluoridation. I acknowledge the impassioned contributions of other noble Lords. The oral health of our nation is important and is part of a wider concern for the overall health of the nation. Despite reductions in the levels of dental decay, the instance of dental decay is still too high. Fluoridation is an important and effective method of protecting the population from tooth decay. The Government believe that there has not emerged any convincing evidence of harm to general health as a result of drinking artificially fluoridated water at one part per million. The Department of Health will continue to monitor the results of research on the effect of fluoridation, but fluoridation will remain one of our tools in improving oral health and fighting tooth decay.

8 p.m.

Earl Baldwin of Bewdley: My Lords, I think I have a few minutes and I will take only a very few minutes to wind up. First, I thank all those speakers, an encouraging number, who have come to take part this evening. I am very grateful for the debate that we have had. I do not intend to pick up the whole field and repeat everything that has been said. I just want to pull out a few key points. As regards the noble Baroness, Lady Gardner, I am very sorry that I have exasperated her. I can quite understand that, as a dentist, she must feel exasperated when this particular matter is challenged. But I have to say that from what she said and from what the noble Lord on the Front Bench has said, all I have heard is just the assertions with which I started one year ago when trying to get at the evidence. I would urge any of your Lordships who want to find out what the truth is, to try your luck, as I have--and I hope you have better luck than I have had in actually getting the hard primary sources which can alone solve these questions.

With respect to our doctor who spoke earlier, and to someone else who mentioned credentials, it is not ultimately credentials that matter, but the quality of the science. It is on that point that I take my stand in this debate.

Passing to one point that the noble Baroness mentioned when she said that there was no evidence from Australia and that there were no known adverse effects, and researchers would have been aware if there had been, my mind went at once to smoking. How many years was it before people began to think that perhaps they ought to look? Unless you actually look--this is a

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fundamental thing in medical science--unless there is a culture of thinking there might be a problem, you can have all sorts of things, not necessarily Australian diseases, as was said, but the ordinary bone diseases which we all have, and of which there is a growing epidemic for causes unknown. It needs looking at to see what are the causes. So it is a question of saying, "there is no evidence". If you do not look you will not see evidence.

I understand--and it is obviously particularly dear, I suppose, to a Labour Government--the argument for the deprived and the poor. Do we not all feel that? I draw to your Lordships' attention the Chilean experience where they went specifically for the deprived and the poor. They stopped fluoridating because they found that the deprived were, by definition, less well nourished than the others and were less able to stand the toxic effects of fluoridation in the water supply. It was therefore discontinued. So it is no good starting with that argument, which everybody uses--and I quite understand it--in favour of the deprived unless you are quite, quite certain that you are doing good and that you are not doing harm.

I very much warm to what my noble friend Lord Harris of High Cross said about being beware of the consensus of science. He raised some of the slight worries that I also have about passive smoking and the other issues which can very rapidly become a crusade. I think that that is something that we need to be aware of and to beware of. Having studied these things for some time, I am forming a tentative law, which says that the quality of the science is in inverse proportion to the public profile of the issue. It is because these things come up and there is premature consensus that it becomes politically incorrect in the scientific community to oppose it. And anything which later contradicts it has great difficulty in being heard. The noble Lord had a very good point there and I am glad that he raised it.

I turn again to what I said in my opening remarks about optimum levels. It is not so; there is no good science supporting an optimal level here. The noble and learned Lord, Lord Jauncey of Tullichettle is much quoted in this regard and I would like to read what he said. He said:

    "There is no evidence"--
--this is in his many pages of judgment, to which the noble Baroness, I think, referred--

    "that water with a natural fluoride content of 1 p.p.m. is normal by world standards".
And I skip a bit:

    "Thus to suggest as do the respondents that they are merely replicating nature by increasing the fluoride content of surface water is inaccurate".

The point about Jauncey, who is prayed in aid by the noble Lord, Lord Rea, among others, is that, first, it was a long time ago, back in the early 1980s. Science, as I said in my opening remarks, has moved on since then. Secondly, I would submit--and I say this also to the noble Lord, Lord Clement-Jones--that a court of law is not the ideal forum in which to judge a scientific matter. It depends among other things, on whether all your

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witnesses can appear, and that did not happen in the Jauncey case. So whereas you can look to him for matters of definition, I think it is wrong to try and take courts of law as authorities in systematic scientific reviews, which is what Dr. Chalmers and I are calling for in this case.

We heard what could be described as, perhaps not unfairly, "party lines" from the Benches on this side. Perhaps, in the interests of time, I should skip them and move on to the remarks of the noble Lord, Lord Hunt. Of course, I was disappointed, on the whole, by what he said, but I did welcome the encouragement that he gave and the fact that the department will look at what Dr. Chalmers is saying. I am grateful to him for that.

He echoed the noble Lord, Lord Clement-Jones, and said that it was inconceivable, that there were no legal claims. I wonder if they are not aware that Colgate has paid out £1,000 for somebody damaged by fluoridated toothpaste. Beyond that isolated point on toothpaste, I think that it is easily answered because how would people who have a disease--it may be a chronic bone disease or some other kind--know that it was to do with fluoride in the water? Their doctors would not tell them so if there is no culture of looking at this and understanding that it could cause problems? I think at present that there is no way that people are going to come forward and claim--unless they are clearly allergic, and there have been cases of this--that the water supply is to blame.

On the question of mass medication, again the noble and learned Lord, Lord Jauncey, is prayed in aid. Let me quote him. He talks about Section 130 of the Act defining "medicinal products". He said:

    "I am satisfied that fluoride in whatever form it is ultimately purchased by the respondents"--
and he is talking here about the water supply--

    "falls within the definition."
He had no doubt whatever.

There is one final question that I thought I would like to leave with the noble Lord, Lord Hunt, because among all the cherry-picking of the areas, Birmingham is always quoted. There are worries in my mind about Birmingham. One of them is that the number of dentists has gone up by 84 per cent. while the population has decreased by 15 per cent. during fluoridation. The other--and I would be very surprised if this has been looked at quite as carefully as the noble Lord says--is quoted in the Cancer Control Journal, which noted a,

    "marked rise in the cancer death rate after the introduction of fluoridation in Birmingham".

Birmingham is also known as an infant mortality blackspot. I should like to see the studies. I accept the noble Lord's point that you cannot prove a negative, but I would like to see some studies after a year to reassure me on that point. On the bone question, I wonder how Birmingham has tackled this. I have seen a letter, and I quote,

    "Birmingham Health Authority has no facility to collect biological samples."

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And a letter from the House of Commons Library confirming:

    "No Birmingham research on the uptake of fluoride in bone has been done."
I believe that there are still questions around that and I would leave that thought with you.

In conclusion, this issue reminds me of nothing more than one of those wild west stage sets, which look very impressive but, when you get closer, you find that it is only a facade and that behind there is in fact little but scrub and empty desert. I would remind your Lordships, as the noble Lord, Lord Hunt, emphasised, that it was not I who framed that initial wording but a doctor who is at the very heart of evidence-based medicine, Dr. Iain Chalmers, who shares my concern that the case has not been fully made out.

My Lords, once again I thank everybody for taking part in this debate. I beg leave to withdraw the Motion.

Motion for Papers, by leave, withdrawn.

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