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I turn now to the issue of the lower oil price. I should point out to the noble Lord that it was totally fortuitous that I chose to change careers at this particular time. However, one of the interesting features of the nine dollar oil price, or thereabouts, is that the industry regarded itself as sophisticated, despite the fact that it seemed to drill vertical wells for 80 years. That was always surprising when the thought that you might drill them horizontally was perhaps more appropriate for developing a reservoir. However, I leave that thought with the noble Lord. We are talking about a truly technological application of a new process to change the terms of an industry. So it could even happen in the oil industry.
The point that I wish to make is that that industry, sophisticated as it is, will have totally to rebench-mark its performance capacity to flourish in a nine dollar oil environment. The demands that will be made on that industry are quite extraordinary, but I am sure that it will face up to them. Indeed, we may find many parts of the industry thinking that alternative investment in energy saving projects is probably quite a good way of increasing their return on capital in this current phase. Therefore, there may well be hope for that sector of industry which I know the noble Lord has long cherished and supported.
Lord Desai: My Lords, although I welcome the extra money for research in universities, can my noble friend the Minister assure us that blue skies research, which is high risk/high return research, will be protected and that it will not be discouraged in favour of more applied research? Further, does my noble friend agree that the best use of competition is getting prices down for the consumer? Indeed, I do not see any mention made of the consumer in the document, but I hope that my noble friend agrees with me that consumers must benefit from competition.
Lord Simon of Highbury: My Lords, I can assure my noble friend that the terms and conditions for blue skies research in so far as the government are involved with its encouragement--indeed, I believe that that should be so, as do the Government--will not be changed by anything in the Statement. I also agree that the main beneficiary of competitiveness should be the consumer. After all, the drive is to give the consumer
Lord Simon of Highbury: My Lords, perhaps the easiest response would be that well known expression, "I can't explain it but I know it when I see it". The best definition of a "cluster", in terminology that we currently understand, derives from Silicon Valley, which is the strip of road running south from San Francisco through Menlo Park and past the Stanford complex down to San Diego. It is known to be the greatest centre of the exploitation of digital technology in the world. We are now developing southwards from Cambridge with much the same intent: to create a digital centre of excellence in a "cluster", which is a joint availability of academic excellence, small businesses and large businesses to create an area where the trade-off of ideas, knowledge and technology in partnership creates more value for all within the system.
Earl Baldwin of Bewdley: My Lords, I am grateful for the chance to raise the issue of water fluoridation, which I do not think has been considered in any depth in your Lordships' House since the Water Bill in 1989. The context is the Green Paper Our Healthier Nation, and the pressure that is being exerted on the Government to extend fluoridation schemes. This is a subject I have been studying for many years, and the predecessor of the noble Baroness, Lady Hayman, the noble Baroness, Lady Jay, in conversation earlier this year, urged me to put down a Motion which could help to clarify thinking on the subject.
There are two strands to my Motion. For the wording of the first part I am indebted to Dr. Iain Chalmers, the head of the UK Cochrane Centre which has a brief for high-quality scientific evidence in health-care, who believes that:
The second strand recognises the fact that this is not just a scientific matter, but that reaching whole populations through the public water supply involves questions of ethics, social policy, cost and cost-effectiveness, appropriateness of the decision-making process, environmental consequences, and so on. Only through a public inquiry, in an area where feelings have always run extraordinarily high, can such matters be properly addressed.
There are logically three questions to which would-be fluoridators must be able to give an unequivocal Yes. First, is water fluoridation effective in reducing dental decay among children, the purpose for which it is put forward? If it is, then, secondly, is it safe? Finally, is it appropriate? For example, as a society we compel motorcyclists to wear helmets, but we do not force people to be vaccinated against quite serious diseases. I say the answers must be unequivocal, because it is axiomatic that for a major public health measure, where millions of people cannot avoid the treatment even if they want to, the science must be beyond reproach.
It is impossible in a short debate to cover all aspects of the argument. Let me start by telling a tale of my attempts to get at the evidence, conscious that the field resounds with claims and counterclaims by scientists on both sides. (And let me say for a start that to anyone like myself who keeps a regular eye on the medical press the notion that the controversy is a scientifically "bogus" one is quite unsustainable.) The only reliable approach in such a case is to go to primary sources.
For more than a year I have been tabling Written Questions to this Government and their predecessor. My first request for the scientific evidence for efficacy and safety was turned down. I then asked for the principal studies, and in particular those that had been randomised. I was given a list which consisted of other people's reviews, which, as any scientist will tell you, are of no value if one is trying to eliminate bias. Next, in an attempt to make things even easier, I asked for the major controlled studies. I was referred again to the list. At the same time I was corresponding with the National Alliance for Equity in Dental Health, and after three letters met with the same lack of success apart from a motley collection of secondary sources and reference to a large number of studies in the literature. My Lords, this should be bread-and-butter stuff in the world of science; any reputable body expects to have to display its best evidence if challenged. Even the Committee on Toxicity did so over Vitamin B6 in the summer. Finally, I had a meeting with the noble Baroness, Lady Jay, and her advisers, where, after initial demurring, I was promised a selection of studies but with a warning that some of them were quite old and not of the standard of today's methodology. Indeed. That was in May, and I have had nothing yet.
This has been an eye-opener, and something I have found to be replicated, not only in others' experiences, but in most of the other scientific aspects of fluoridation which I have pursued through Questions. Why is good methodology so important? Among other reasons, because dental caries has long been declining worldwide, and it requires a well-designed trial to determine whether a reduction in decay is due to fluoridation or some other factor; also because the temptation is to cherry-pick your regional examples so as to get the result you want. (Did your Lordships know that quite recently 15 out of the best 25 areas for children's teeth were unfluoridated, and that for 12 year-olds an unfluoridated area headed the list?) No amount of poorly designed studies can constitute good evidence.
What I have been able to see leads me to believe that few, if any, studies meet the criteria of good science, despite all the assertions to the contrary; and that what the arch-fluoridationist Dr. John Colquhoun found, which caused him to change his mind, is probably true--namely, that when proper epidemiological methods are followed and comparisons are made over whole populations and not isolated areas, in New Zealand, in the UK, in the USA, the supposed benefits of fluoridation melt away. Dr. Paul Connett, professor of chemistry and international authority on environmental toxins, is on record as being
I must confess, however, that this has surprised me, since it had always been the safety issue that really concerned me. The problem with fluoride is that it is no harmless nutrient, as it is sometimes portrayed, but is a substance that ranks alongside arsenic and lead in tables of toxicity. It inhibits bodily processes. No essential function has been proven in humans, as a recent Department of Health report confirms. The origins of fluoridation are interesting, because it was as a result of major environmental problems in the disposal of fluoride as a toxic waste product of American industry in the 1930s that the impetus came to put it into the water supply, and the research behind this was largely funded by the industry concerned. The US Environmental Protection Agency has described it in a letter which I have seen as
Incidentally, the claims that it is not medication at all, and that 1 ppm simply replicates the best that is found in nature, were dismissed as wrong by the noble and learned Lord, Lord Jauncey, in the Strathclyde case often cited favourably by fluoridationists. If it is not intended to treat, will proponents please stop talking about teeth. As for the claim that 1 ppm is an "optimal" level, I quote from the Journal of the American Dental Association that this
None of this should make it too surprising that reports of possible harm have been appearing in the world literature with increasing frequency. Dental fluorosis we all know, that unsightly mottling that can so distress children and which now runs at between 10 per cent. and 30 per cent. in artificially fluoridated areas. Allergy to fluoride is a worry. Skeletal fluorosis is a serious concern, with reports now appearing to link hip fractures to fluoride in the water. Up-to-date research which I have seen, shortly to be published, casts doubt on current recommended safety levels and predicts that over a lifetime of artificial fluoridation we may see an epidemic of bone and joint problems in this country. At present doctors are not trained to look for this because of the ingrained belief in fluoride's safety, and there are no routine NHS tests to indicate possible fluorosis; so the well-worn phrase "there is no evidence" will once again be literally true, but only for want of looking. I will quote two other developments among many.
India has a major problem, with very high levels of natural fluoride producing crippling fluorosis. This has given them a strong incentive for research, which their leading expert talked about on a visit here in October. Professor Susheela, a former president of the International Society for Fluoride Research, stressed that India took no lessons from the West in either quantity or quality of peer-reviewed studies, and expressed her shock at the weakness of our research base and the lack of official interest in remedying this and in facilities for testing. Their principal finding was that there was no change in caries prevalence between 0.5 ppm and way above the maximum limit at 5 ppm; also that fluoride toothpaste gets quickly into the bloodstream, and that a variety of health problems result. The findings have been so clear that the Indian medical and dental professions are now united in wanting to get rid of fluoride at any concentration at all. They are thus poised to join Germany, Japan, the old USSR, the Netherlands, Finland, Sweden, Chile, and other countries and regions, in abandoning the fluoridation of water. Most other countries have rejected the practice from the start.
The second example comes from America. Last year the Washington DC branch of scientists and other professionals working for the Environmental Protection Agency publicly repudiated the fluoridation of water, and stated:
Lest there be misunderstanding, let me emphasise that this body embraces the in-house scientists working for the EPA in the Washington area--some hundreds of chemists, toxicologists, and those whose job it is to assess the risks of fluoride; except that, curiously, they were prevented from doing this formally when their political bosses almost uniquely contracted out their most recent fluoride assessment to scientists of a different persuasion. I have contacted Washington and verified these details. This is no bogus controversy, my Lords. Time and evidence have moved on since Jauncey, Knox and the Royal College of Physicians' report.
How is it, then, that the great majority of dentists and doctors in the very few countries that now fluoridate are convinced of its benefits and have persuaded others to follow them? In the first place, only a tiny minority of professionals actually read the primary papers: assertions of absolute safety, extensive research and of the "unscientific" nature of anything which disagrees with this, are mostly based on what the professional bodies put out in their publications, and I have to say that these are highly selective. Your Lordships will find nothing of what I have said in these pamphlets produced by the fluoridation lobby (which, incidentally, receives a goodly annual sum from the Government). Knowing some of the background, I find them quite breathtaking in their bias. Independent commentators have pointed to the refusal to publish contrary views, an "unwillingness", in the words of an American dental journal, "to release any information that could cast fluorides in a negative light", in such a way that organised dentistry has now lost its scientific objectivity.
This suppression and distortion of evidence are well documented. Selective presentation is what distinguishes propaganda from science. "The emphasis", the British Dental Journal has advised dentists, is on "propagandising rather than education". (It is there, my Lords, in black and white!) I had an interesting experience recently when, at an All-Party meeting on the subject the MP in the chair, who described herself as a scientist, felt it was entirely right to have three panel speakers in favour of fluoridation and only one against. This mindset is not at all unusual.
What comes across most clearly, and again I quote independent sources, is that fluoridation was a campaign from the beginning, before the first trials were ever completed. It has now, sadly, become a dogma, which is hard to retreat from, and the zeal that accompanies it can be frightening. Few scientists dare oppose it publicly. But the problem that its proponents recognise is that once public doubts take root the campaign is lost; hence, I believe, the absolute nature of the claims that are made and the attempts to bludgeon all opposition.
Political correctness; a bandwagon effect; the emotional satisfaction of a "cause", especially when you are persuaded you are making a difference to society: all these have been quite enough to subvert a profession which is at the same time under pressure from sections of industry to keep up the campaign. (For if flouride is the answer to poor teeth, that lets the sugar and food industries off the hook.) Professions can be wrong, my Lords. Remember what doctors used to think of
I shall have to leave to other speakers the ethical issues of mass medication, what those who are allergic to fluoride are supposed to do, why we put fluoride and not Prozac in the water supply, what environmental effect the other 99 per cent. of water may have that does not go into children's teeth, why a Government that do not want to be seen as a "nanny" so easily buy the red herring of dental inequality when, even if fluoride were proven to be safe and effective, there are other solutions to the problem.
I am convinced that a full and unbiased review of the evidence is long overdue. I know that the WHO is about to look at the subject again, but I doubt from what I have heard that its process will be as comprehensive as Dr. Chalmers of the Cochrane Centre is asking for. I believe that nothing less than a full public enquiry will meet the case. If this does not happen, I fear that when the hexafluorosilicic acid eventually hits the fan, as sooner or later it will, the Government and their advisers will find they have nowhere to hide. My Lords, I beg to move for Papers.
Lord Rea: My Lords, what an enormous windmill the noble Earl has constructed and how lustily he tilts at it! This issue has been on the agenda for 30 or 40 years. In fact, most of the scientific work was done quite a long time ago. There has been some new work. But, so far as I am aware, recent papers have nothing more to offer to those who are opposed to fluoridation than the original ones.
I am grateful to the noble Earl for raising this subject because it allows me--I hope it will allow me--to reassure him about the safety of fluoridation at one part per million or thereabouts. However, it seems that I shall not make much headway as the noble Earl has amassed a wonderful array of arguments to back up his case and I cannot possibly deal with each one of them in the debate. I am also very much handicapped because I had written a rather careful speech exactly timed to 11 minutes and containing much detail and references. But 10 minutes before my time for speaking arose I discovered that I had left it at home. Therefore, I am having to speak in a rather extemporary way.
Another reason why I am grateful to the noble Earl for bringing the subject forward is that it enables me to ask my noble friend on the Front Bench about current government policy towards fluoridation as a whole, but particularly with regard to the effectiveness of the Water (Fluoridation) Act 1985 which was subsumed in the 1991 Act.
The noble Earl suggests that the science which backs up the use of fluoridation is somehow less defensible than the science which does not. It is very difficult on the Floor of your Lordships' House to argue the benefits of one type of science versus another. It is something that is done all over the country in academic meetings
The credentials of those who favour fluoridation are extremely good. They include 39 national organisations which are concerned with dental health; for example, the British Dental Association, the British Medical Association, the Health Education Authority and, the noble Earl may be interested to know, the Patients' Association, quite apart from the fact that many eminent epidemiologists helped the noble and learned Lord, Lord Jauncey, in 1983 to come to the conclusion that the use of fluoride at one part per million in water supplies was perfectly safe and also beneficial.
There are now five million people in this country who have a fluoridated water supply or who live in naturally fluoridated districts. Obviously there are some exceptions but the general trend is that those who live in fluoridated districts, whether naturally or artificially fluoridated, have better dental health. The noble Earl mentioned deprivation. As regards districts which are not fluoridated there is a clear trend for those in the most deprived areas to have the worst teeth with the greatest number of cavities, fillings and missing teeth. However, even in deprived areas, with fluoridation people's teeth do well and are healthier in some cases than the teeth of people in well off areas.
Hartlepool has a natural level of 1.2 parts per million of fluoride in the water, slightly above what is advocated. It is a relatively deprived area. However, it is absolutely top of the league in dental health. In this regard there is also no evidence whatever of cancer, hip fracture or any other kind of problem there which is ascribed to fluoridation. One of the most important functions of fluoridation is to reduce the unfair discrepancy as between the teeth of well off and poor children.
It is perfectly true that fluoride acts mainly on the surface of the teeth and that the frequent and regular use of fluoride toothpaste is effective. However, such toothpaste is far less regularly used in deprived areas, and in those areas the diet is also poorer than in better off areas. The noble Earl says that we can do something about that. I hope that we do but it will take a long time to upgrade the standard of living of the people living in the worst circumstances in this country. The noble Earl knows well that that is a matter on which I have been trying to persuade governments of both complexions to act ever since I was dragged, unwillingly, as it were, into the political sphere about 15 years ago.
Sir Donald Acheson, in his recent report on inequalities in health, states that the difference in the dental health of the top social classes; that is, classes 1, 2 and 3 (non-manual) and the bottom social classes, 4 and 5, was 17 per cent.--if my memory serves me correctly--in 1983 but the difference had increased to 79 per cent. in 1993. It seems to me that despite the availability of fluoride toothpastes, we are going backwards with regard to eliminating inequalities in dental health. Sir Donald is the ex-Chief Medical
As regards the safety issue, the two main dangers mentioned in this regard are cancer, mostly osteosarcoma, and hip fractures in elderly women. In a seminar held about two years ago, many papers were submitted on fluoridation which reviewed--I believe quite dispassionately--all the research that had been done. One paper studied the effects of fluoridation with regard to cancer. It was written by Dr. Paula Cook-Mozaffari, who is a disciple of Sir Richard Doll. She stated:
In conclusion I ask my noble friend what the Government are doing to speed up the wider introduction of fluoridation and what they intend to do, if anything, about strengthening of the relevant legislation and making it mandatory instead of permissive--changing "may" to "shall"--to allow health authorities to ask water companies to fluoridate when the former feel that is necessary in their district. Yesterday, a judgment was given in judicial review. It was stated that Northumberland Water Authority was within its rights as the law stands not to fluoridate, although the health authority said it should. That suggests to me that the law needs to be changed.
Baroness Gardner of Parkes: My Lords, when I saw that this subject of fluoridation was to be debated today, and I noted that the noble Earl was calling for a review, my first reaction was one of exasperation. How could anyone want more research when the amount already done, and fully scientifically assessed, is so extensive and so conclusively in favour of the benefits of fluoridating the water supplies?
Then I stopped and thought again, and for this reason I welcome the debate being brought to your Lordships' House today by the noble Earl, Lord Baldwin. Today we have the opportunity to put the clear facts to the House and finally to put the false arguments against fluoridation to rest. I hope that the Government will take the necessary action to ensure that the public will be able to enjoy the huge dental health benefits that come from a fluoridated water supply.
Fluoride occurs naturally in water supplies throughout the world and therefore has been ingested for centuries. A high concentration in natural water produces mottling of the teeth, fluorosis. This is unattractive but not unhealthy and does not occur where there are correct concentrations of fluoride in the water.
There are already 3 million UK residents using fluoridated water and a further 3 million would benefit if fluoride was in the water supplies in the north-west of England. On the basis of firm evidence, over 60 district health authorities have decided that fluoridation of their water supply would be beneficial for their communities.
There are instances where fluoride has been used in the water supply and for some reason later discontinued. These cases have shown a direct correlation between fluoride and dental health. The Welsh Water company began fluoridation of the water supply to Anglesey in 1956. This continued until 1991. By 1994 dental health had become as bad again as on the mainland. The Kilmarnock study gave much the same result. With fluoridated water, dental decay was reduced by more than 50 per cent. against the "control" community in five years. It was reversed again on cessation.
As an Australian dentist, with no personal interest to declare, I must ask your Lordships to look at the Australian experience and health patterns. Fluoridated water has been in constant use in Tasmania since 1953, in Canberra since 1954, and fluoride is in the water supplies of all major cities in Australia. There is no strange incidence of any "Australian" disease that differs from the rest of the world.
I have a nephew who is a dentist in Sydney. He treats most of the pupils from a large school, which has both day pupils and boarders. I heard from him that he never sees tooth decay now in the city boys but can tell instantly when a boy from the bush comes in, from an area where the family use rain water or a local supply. The country lad's teeth are still as bad as they used to be in Sydney in the days when I was a dental student, before the fluoridation of the water supply.
The Australian nationwide experience spans not just one generation, but two or even three generations. There have been no known adverse effects on general health and markedly good effects on dental health. Australia is advanced in medical research. If all the cancer scares we have heard raised had some basis in fact, the Australia researchers would have been aware of them and the world would have that information. No, we must not be taken in by alarmist talk. Cancer is a disease spread throughout the world and specific links between, for example, smoking and lung cancer have been confirmed. There are no known links between cancer and fluoridation and scare tactics have been used for too long.
We have heard that strange bone deposits are seen. Only last week I put this point to an eminent consultant orthopaedic surgeon and asked him if he had seen such cases, as he is constantly studying X-rays of knees, hips and other bones. His reply was that in many thousands of patients he had treated, he had never seen any sign of unusual bone development, or spicules of the type described linked to fluoride. The most clearly established fact is that fluoride at correct strength in the water supply results in a marked drop in dental caries and has no adverse effects.
It is easy for those who are fortunate in life to say that fluoridation is not necessary. They do not stop to think of the most deprived sections of society who suffer the pain caused by severe tooth decay. In Northern Ireland, the north-west of England and some parts of Scotland, tooth decay is rampant. Hundreds of children each week need to have teeth extracted and suffer great pain from massive tooth decay. The educated, the affluent, have little if any understanding of the pain and suffering caused by toothache due to teeth so badly decayed that the nerve is involved. It is useless to say that those people should go to a dentist for a check up. Until the agonising pain of toothache manifests itself, they are not even aware that dentists exist. They desperately seek relief for the child's pain and the distress caused to the family by disturbed sleep.
The British Medical Association reports that more and more patients are asking their general medical practitioners for help with dental pain and emergency dental treatment. They state that only about 55 per cent of the population are registered with a dentist and many dentists do not accept NHS patients.
Once the toothache pain level has reached this degree of intensity, extraction is usually the only answer to relieve the child's pain. In February this year, in the national health debate, I mentioned that nearly 100 children a week in Blackburn needed to have teeth extracted under general anaesthesia. The situation of such children has dramatically worsened recently, as dentists are no longer to be allowed to administer general anaesthetics and so the child must wait until a medical anaesthetist is available, probably in the local hospital. The shortage of anaesthetists in the UK means prolonged pain for those children to endure. Pain killers will be the only interim answer.
Here today, in your Lordships' House, we have the luxury of debating this subject. Few in this House would be unable to afford to drink bottled water if they were genuinely worried about even the remotest possibility of fluoride being damaging. The situation is quite different for the most deprived section of the community. They need help which can reach even those least informed or aware of health needs.
The only way to ensure an improvement in dental health, and its consequential improvement in general health, for these children is by the introduction of fluoridation to the general water supply throughout the UK. As Water UK says, it cannot be piecemeal. In particular, those members of society living in areas of deep deprivation, who have virtually no contact with the NHS, would be reached and would benefit from the fluoridation of water supplies. Again, I emphasise that the level of concentration is always to be carefully controlled to one part per million.
In September 1983, the noble and learned Lord, Lord Jauncey, delivered his verdict in what has become known as the Strathclyde case. In his 392-page judgment the noble and learned Lord completely vindicated the safety and efficacy of fluoridation. He went thoroughly into all the points raised. Surely there could be few more thorough considerations of the huge amount of evidence on fluoride. All the applicant's complaints of toxicity, medicinal purpose and harm were rejected.
It was ruled that it was ultra vires--that is, that the council did not have the necessary powers to add the fluoride--so the 1985 Water (Fluoridation) Act, in which I played a part, was passed to remove this grey area and make fluoridation legal. It is an enabling Act.
Over the years I have followed the many interesting questions that the noble Earl, Lord Baldwin, has asked. I have always considered that his wide-ranging interest in complementary medicine and other non-routine treatments was not harming others, and for that reason I have supported rather than opposed many of the rather obscure questions the noble Earl has put on health matters. Today, I am completely opposed to what I consider a most damaging demand for delay and further delay, adding further deprivation to the already deprived.
I consider that fluoridation in water is a well-established practice and has been in use for many years. It is time to decide that fluoridation should be implemented. There are so many aspects of health that can benefit from more research and the money available for research can be much better spent on subjects other than fluoride. I hope the Government will not accept the Motion misguidedly put forward today.