Lazy health pol­icy hard to swal­low

The Dominion Post - - Opinion - STAN LITRAS

Clean, whole­some drink­ing wa­ter is a fun­da­men­tal hu­man right. So is the right to de­cline med­i­cal in­ter­ven­tion.

For decades, city coun­cils have strug­gled with the dilemma of in­creas­ing flu­o­ride lev­els in their town wa­ter sup­plies. On one hand, the in­dus­trial chem­i­cals used for wa­ter flu­o­ri­da­tion are en­vi­ron­men­tal con­tam­i­nants. In­ter­na­tional con­ven­tions for­bid dump­ing them into the sea or soil, so how can dump­ing them into drink­ing wa­ter be ac­cept­able?

On the other hand, dis­trict health boards pres­sure them to as­sist in fight­ing tooth de­cay by adding these chem­i­cals.

It seems the coun­cils will soon rest easy. The Health Act Amend­ment Bill, be­ing cham­pi­oned by Jonathan Cole­man and Peter Dunne, aims to shut out pub­lic dis­cus­sion from de­ci­sion-mak­ing and paves the way for gov­ern­menten­forced manda­tory flu­o­ri­da­tion.

The ex­clu­sion of pub­lic over­sight, de­bate and choice on such a broad­reach­ing pro­ce­dure as us­ing the wa­ter sup­ply to de­liver a med­i­cal treat­ment con­tra­dicts val­ues that New Zealan­ders have hith­erto be­come ac­cus­tomed, and sets a wor­ry­ing prece­dent.

To sweeten the bit­ter taste to vot­ers, the ben­e­fits are ex­ag­ger­ated, and risks are down­played.

Health Min­is­ter Cole­man and as­so­ciate Dunne pub­licly pro­claim that tooth de­cay is up to 40 per cent lower in flu­o­ri­dated ar­eas. This is un­true, as demon­strated by data gath­ered by their own depart­ment.

Some 24,592 five-year-old chil­dren ex­am­ined in flu­o­ri­dated parts of New Zealand in 2015 had a to­tal of 43,250 teeth af­fected by tooth de­cay, while 22,356 un­flu­o­ri­dated chil­dren had 41,600. The dif­fer­ence in the amount of tooth de­cay is there­fore not 40 per cent as the min­is­ters claim, but is less than 1 per cent.

Fur­ther, it is widely ac­cepted that flu­o­ride works top­i­cally, not by swallowing it, and there is no ro­bust ev­i­dence that flu­o­ri­da­tion ben­e­fits adults, as claimed. The gold stan­dard Cochrane Re­view 2015 pointed out that although stud­ies from last cen­tury sug­gested a ben­e­fit from wa­ter flu­o­ri­da­tion, these were mostly flawed and un­re­li­able and were con­ducted at a time when there were no other sources of flu­o­ride such as we have now, no flu­o­ride tooth­paste, no re­frig­er­a­tion, no an­tibi­otics in food, no high-sugar car­bon­ated drinks. They are there­fore not trans­fer­able to to­day’s so­ci­ety. The worst cases of early child­hood tooth de­cay to­day oc­cur equally in flu­o­ri­dated ar­eas and are re­lated to so­cio-eco­nomic and so­ciode­mo­graphic fac­tors, such as parental ed­u­ca­tion, child poverty, poor diet, bad oral hy­giene, and ac­cess to care, and not to flu­o­ride lev­els in the wa­ter.

Tar­get­ing pre­ven­tive mea­sures to at-risk groups makes a lot more sense than in­creas­ing the flu­o­ride lev­els of all and sundry, the vast ma­jor­ity of whom will gain no ben­e­fit, and would be a bet­ter use of pub­lic money, as demon­strated in over­seas pro­grams.

The land­mark 2006 re­view of flu­o­ride health ef­fects by the US Na­tional Re­search Coun­cil stressed the need to mon­i­tor flu­o­ride ex­po­sure lev­els in peo­ple to guard against health risks.

Our DHBs, how­ever, do not know what flu­o­ride ex­po­sure lev­els peo­ple have, and they have done no re­search on the con­tri­bu­tion of flu­o­ride to dis­eases to which it has been linked, such as brit­tle bones, thy­roid dis­ease, and men­tal health, and there is no re­quire­ment for this in the Bill.

This is ir­re­spon­si­ble. With al­most half of our chil­dren show­ing signs of den­tal flu­o­ro­sis, the over­ex­po­sure to flu­o­ride is un­de­ni­able and con­cern­ing.

Our gov­ern­ment has done a lot to pro­tect wa­ter flu­o­ri­da­tion. They have rewrit­ten laws and le­gal def­i­ni­tions, funded friendly re­views, de­fended le­gal chal­lenges, run pro­pa­ganda cam­paigns, and made a mock­ery of the demo­cratic process, but are they show­ing due dili­gence to pro­tect New Zealan­ders’ health?

Stan Litras is a Welling­ton­based den­tist and his opin­ion does not rep­re­sent that of the NZ Den­tal As­so­ci­a­tion, which sup­ports wa­ter flu­o­ri­da­tion as be­ing safe and ef­fec­tive.

Flu­o­ride tablets are an­other way in which peo­ple can ab­sorb flu­o­ride.

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