WATER FLUORIDATION

Adjourned debate on motion of Ms Bressington:

That this council urges the Minister for Health, the Hon. John Hill, MP and the Principal Water Quality Adviser for the Department for Health, Dr David Cunliffe, to attend the public meeting being held in Mount Gambier on 9 October 2010 on the issue of water fluoridation.

(Continued from 29 September 2010.)

The Hon. R.P. WORTLEY (18:01): I move to amend the motion as follows:

Leave out all words after 'That this council' and insert—'notes the public meeting held at Mount Gambier on 9 October 2010 on the issue of water fluoridation and endorses the continuing process of fluoridation across country South Australia.'

The government is fully supportive of water fluoridation. Fluoridation has been practised in Australia since 1953 and in South Australia since 1971. Currently, over 80 per cent of Australians receive fluoridated drinking water. It is estimated that around 300 million people in about 10 countries consume fluoridated water. A further 200 million people in a number of other countries consume fluoridated salt as an alternative.

There is clear evidence that water fluoridation, in combination with other measures such as improved dental hygiene and use of fluoridated toothpaste, has contributed to substantial improvements in dental health. A number of scientific reviews have been undertaken and, other than mild dental fluorosis—which results in small, white opaque areas in tooth enamel, of which the only result is a slight visible impairment—risks to public health in Australia have not been found.

The claims presented by the honourable member about water fluoridation are similar to those presented by the anti-fluoridation lobby. The claims are based on a mixture of selective and often outdated information that ignores the majority of available evidence. There is a tendency for the anti-fluoridation lobby to equate the health effects caused by exposure to high concentrations of fluorides in countries such as China and India as being the same as those with exposure to low concentrations used in drinking water fluoridation in Australia.

These opponents of fluoridation often allege that they alone have examined the scientific evidence and that governments, ministers and agencies that support fluoridation have not reviewed all published information. This cannot be further from the truth. Published evidence on water fluoridation is kept under ongoing review by the South Australian Department of Health, along with peak health agencies such as the National Health and Medical Research Council.

The NHMRC has undertaken four comprehensive reviews, with the most recent being published in 2007. This review catalogued and assessed 5,418 scientific articles published since 1996 dealing with beneficial and potentially harmful effects of water fluoridation, including dental and skeletal fluorosis, cancer and Down syndrome. All publications listed in the review are publicly available and accessible to all.

Contrary to claims by the honourable member, the review did consider all scientific publications available. The review was impartial, evidence-based and undertaken in a fully transparent way, with scrutiny from a range of independent scientists. In particular, doubts raised by the honourable member about the scientific rigour and integrity of the work undertaken by the Australian Research Centre for Population Oral Health at the University of Adelaide are without substance and are rejected.

The only potential harmful effect identified by the NHMRC review as being associated with water fluoridation was dental fluorosis. However, as identified by Food Safety Australia New Zealand in its review of bottled water fluoridation in 2009, dental fluorosis in Australia is almost exclusively either mild to very mild. This fluorosis strengthens tooth enamel and is not visible to the naked eye. Visible forms of fluorosis are rare in Australia and, although the prevalence of water fluoridation is increasing in Australia, dental fluorosis is decreasing. This is due to the education on appropriate use of other sources of fluoride, including toothpaste and supplements.

Based on a 2007 review, NHMRC recommended that drinking water be fluoridated as it remains the most effective and socially equitable means of achieving community-wide exposure to the caries prevention effects of fluoride. Drinking water fluoridation is also endorsed by the Australian Health Ministers' Conference through the National Oral Health Strategy 2004-13 and supported by the state Oral Health Plan 2010-17, which was subject to public consultation.

Other reviews published by the FSANZ in 2009, the European Commission in 2010 and the National Institute of Public Health in Quebec, Canada, in 2010 also found that evidence of negative impacts of water fluoridation is generally limited to fluorosis. Evidence of potential impacts, such as cancer, developmental neurotoxicity and reproductive toxicity could not be substantiated. The Quebec report identifies over 150 international agencies that have indicated support for fluoridation.

I now refer to claims made by the honourable member about severe skeletal fluorosis. Effects occur in countries such as China, India and Kenya, where the natural concentration of fluoride in water can be 30 to 50 milligrams per litre. One simply cannot compare these concentrations to the levels in Australian drinking water, which are set at 0.8 to one milligram per litre. To be clear, this is 30 to 50 times lower than the levels seen in parts of China, India and Kenya.

This pattern of health impacts is not limited to fluoride. Many chemicals, such as selenium and copper, are essential for good health at low concentrations but are harmful at high concentrations. It is incorrect and misleading for the honourable member to suggest that these high concentration effects are associated with lower concentrations. Claims by the honourable member regarding the United States National Research Council Review should also be treated with caution.

This report states that it did not include an examination of the benefits and risks occurring at concentrations used in drinking water fluoridation. Instead, its term of reference was to review the United States Environmental Protection Agency's maximum guideline value of four milligrams per litre and a secondary limit of two milligrams per litre for fluoride in drinking water. The report recommended that a maximum concentration should be reduced from four milligrams per litre, primarily because of concerns about fluorosis. It made no comment on the one milligram per litre used in drinking water.

Claims have been made that fluoride is not recommended for reconstituting infant milk products or for renal dialysis. The first statement is said to be based on the potential risk of dental fluorosis, but Australian research reported by NHMRC concluded that there is no evidence for this, and fluoridated water can be used to reconstitute infant formula. The second statement that is misleading is that no mains water, irrespective of fluoride content, is recommended for renal dialysis without treatment. Treated fluoridated water is used in Australia for renal dialysis.

Claims have been made that products used to fluoridate drinking water supplies are not pure. This is nonsense. All chemicals used by SA Water, including those for fluoridation, are subject to strict quality control. Certificates of analysis are required and constantly monitored. They show that the concentrations of other constituents or impurities are well below that defined by the Australian drinking water guidelines for fluoridation chemicals.

Claims have been made that adding fluoride to drinking water is unreliable and that concentrations will vary. Again, this is wrong. In terms of reliability, SA Water and its contractors operate a number of fluoridation plants. The performance of these plants is continuously monitored and results are routinely reported to the health department. Results from the past 15 years demonstrate consistent performance in providing the required dose of 0.8 to one milligram per litre.

I have addressed the misleading information that has been provided by the honourable member regarding the alleged toxicity of fluoridated drinking water. I now refer to the very positive benefits for dental health. A number of countries fluoridate their water supplies, including the United States, Canada, New Zealand, Singapore, Ireland and the United Kingdom.

Drinking water fluoridation is less common in Europe because, instead, it is added to cooking salt in Germany, Switzerland, France, Austria, Belgium and Spain. Salt is also fortified with fluoride in a number of countries in the Caribbean and Central and South America. Fluoride is also added to milk in a number of countries. Many wide-ranging independent studies, including those already mentioned, have found that water fluoridation does protect teeth against tooth decay without causing any of the side effects that are frequently claimed.

These studies have been published in the British Medical Journal and the American Medical Association Journal. The World Health Organisation supports the measure, and the US Centers for Disease Control and Prevention have rated water fluoridation as one of the great 10 public health achievements of the 20^th century. The concrete evidence of the benefits and safety of a fluoridated water supply is also readily available closer at hand. The 40-year history of fluoridation in Adelaide stands as a testimony to its safety. The benefits of fluoridation can also be clearly demonstrated in South Australia.

Mount Gambier is the last substantial community supplied by SA Water that does not receive adequate concentrations of fluoride in its drinking water supply. Evidence from the South Australian Dental Service shows that, in the absence of fluoridation, children in Mount Gambier had 78 per cent more decay than children from Adelaide, and 40 per cent more decay than children in the Riverland. This results in an oral health burden for these children that will affect all their lives.

Most recently, there have been increasing rates of dental decay in Mount Gambier despite decreases across the state as a whole. Over the past five years the South Australian Dental Service has successfully adopted several strategies to try to reverse the trend of increased tooth decay experienced throughout the 1990s. This was related to an increase in sugary foods and drinks and increased drinking of rainwater and bottled water that had low fluoride levels. As a result of these strategies, in the past 18 months we have seen an 8 per cent reduction of decay across 12-year-old children in South Australia.

This improvement has been even better in country areas. The only exception has been in the South-East of the state where the amount of dental decay among 12 year olds actually increased by 5 per cent in the past two years. These figures are, of course, dominated by Mount Gambier which, until Thursday 14 October 2010, has been the only major centre whose water supply does not have adequate levels of fluoride. The government is committed to providing the same health benefits to the people of Mount Gambier as those experienced by the people of Adelaide and other major centres.

In February 2009, after much discussion and consultation on the state Oral Health Plan in 2005, the decision was made to fluoridate the Mount Gambier water supply to improve dental health. This was a proper and well-informed, evidence-based decision and we stand by it. The government is in favour of water fluoridation and has not allowed the scaremongering of a few lone voices to delay the implementation of these measures.

[Sitting suspended from 18:03 to 19:49]

The Hon. J.M.A. LENSINK (19:49): I am not going to speak about the merits of fluoridation or otherwise. The Liberal Party supports fluoridation and made this clear prior to the election and our position has been consistent, so I do not propose to address that particular aspect of this motion and, indeed, I note another item on the Notice Paper to be moved by the Hon. Ann Bressington on a similar issue. If we do end up proceeding with debating that, then I may speak about the merits or otherwise of fluoridation at that point.

In relation to this motion, it is about a meeting and whether the minister and some of his advisers should have attended. I think it is just another case of this government's arrogance in ignoring matters which are clearly of concern to communities. We have seen that on a raft of issues. We have seen a number of community groups which have had their rights ignored by a government that announces and defends rather than engaging in genuine consultation. I think this is another example of that. I note that the meeting has occurred, and so, unfortunately, I do not see that there is a huge amount of merit in debating this issue this evening.

I will not be supporting the amendment of the Hon. Russell Wortley because it has been dropped on us at the last minute, and therefore I have not been able to obtain advice from our shadow minister for health Dr Duncan McFetridge, the member for Morphett. I am quite ambivalent about whether we will support the motion as it stands, without the amendment, given that it is a meeting that has expired.

The Hon. R.I. Lucas: We haven't had a chance to consult about Russell's amendment yet because the party room hasn't met.

The Hon. J.M.A. LENSINK: Well, that's correct; we haven't had an opportunity—

Members interjecting:

The Hon. J.M.A. LENSINK: Well, it wouldn't be the first time that's happened, would it? With those comments, I indicate the Liberal Party's position and look forward to debates on other issues.

The Hon. A. BRESSINGTON (19:53): As the Hon. Michelle Lensink has pointed out, this debate is not about fluoridation, whether it should or should not occur. It is about—

An honourable member interjecting:

The Hon. A. BRESSINGTON: It was not—it is about whether or not the people of Mount Gambier should have had the opportunity to put questions relating to their concerns about water fluoridation to the health professionals (the health department officials) who were promoting it, basically forcing it on an entire township, and whether the minister had any responsibility at all to explain that position.

The entire content of my speech was made up of quoted scientific research. The only opinion in my entire speech was at the end, where I stated that the people of Mount Gambier, certainly in a democratic society, should have the right to go face to face with the minister and the health officials and ask the questions that needed to be answered.

The point made in my speech was that the research they have been reading and the concerns they have have been absolutely and completely ignored. When we say that there has been extensive public consultation, everyone in this chamber knows what that means, except the Labor Party. We know what the word 'consult' means, and that is to consider other people's opinions, points of view and concerns—but that is not what has happened with this. To highlight how pathetic that process was, on the day of the public meeting, every resident in Mount Gambier received a letter in their junk mail that said that water fluoridation would continue, after widespread public consultation. That is the level of consultation that was held.

There was a meeting held to discuss the national dental health plan and fluoridation was not even mentioned on the proposal put to the people of Mount Gambier to encourage them to attend that meeting. Fluoride was not even mentioned. So, of course, there was a poor turnout to that, because it actually was not raising the issue that they were concerned about. This motion was not on the benefits or harms of fluoride.

I quoted the research that has been made available that these people have availed themselves of—and so have I—and they have serious concerns about it, with every expectation that they would. When you get public officials who refuse to rebut that research, one can only assume that silence is consent, that they cannot rebut the points that are made in this research and, therefore, they do not front up to their equals.

Dr Andrew Harms, past president of the Australian Dental Association, has done his research on this and is now trying to make up for promoting fluoride in South Australia, based on the research he has done in South Australia. Dr Cunliffe from the health department promised—promised—in January of this year on ABC radio that there would be a public meeting for the people of Mount Gambier to ask their questions before fluoride went online. That was his promise to the people of Mount Gambier. It never happened.

So do not tell me, Mr Wortley, that there has been wide consultation on this issue, because when a public health official makes a promise to an entire town that a public meeting will be held to allay their concerns and answer their questions, and then the entire town is fobbed off, letters are written that are not answered, requests are made to meet Dr Cunliffe if there is not going to be a meeting and that is denied to these people, is that public consultation? No, it is a flyer in their junk mail two weeks before fluoride is due to be turned on. That is not public consultation.

I will respond to some of the comments that the Hon. Russell Wortley made in his address about the NHMRC and its extensive support for fluoride. In a 1991 report, the NHMRC made this recommendation at page 142:

It is desirable to explore in a rigorous fashion whether the vague constellation of symptoms which are claimed to result from ingestion of fluoridated water can be shown to be reproducibly developed in these 'susceptible' individuals. These claims are being made with sufficient frequency to justify well-designed studies which can properly control for subject and observer bias.

That is the 1991 NHMRC report on fluoride. No studies on the effect of fluoride on tissues, other than teeth, in Australia has been—

The Hon. I.K. Hunter: What did the 2006 report say?

The Hon. A. BRESSINGTON: Excuse me?

The Hon. I.K. Hunter: Tell us what the 2006 report from the NHMRC says.

The Hon. A. BRESSINGTON: This recommendation was never carried through. Why would we ignore a recommendation made in 1991 in relation to whether or not we expand fluoridation? We heard the Hon. Mr Ridgway in his question today say that, after extensive lobbying, the NHMRC have lowered their standards of safety for water with faecal content. So, obviously, they have turned into guns for hire, science for hire. Why would you ignore a recommendation in 1991 to extend fluoridation and not do this? They are calling for the basic scientific studies to be done, because there is sufficient frequency of reports of ill health due to fluoride.

In the rhetoric and the diatribe that the public health department pours out about fluoride, this recommendation is never mentioned, nor is the World Health Organisation recommendation, before fluoride is introduced or rolled out any further. This point is also ignored:

To determine when it is appropriate to fluoridate is a matter that requires the prior determination of prevailing fluoride intake from all sources including drinking water, food and the general environment.

That recommendation of the World Health Organisation is also ignored in the rhetoric and diatribe that is poured out by the health department about fluoridation. We have never done surveys of the intake of fluoride from other sources in water.

The Hon. Russell Wortley made the point that our limit is 0.8 to 0.1 part per million. If we eat a can of tuna a day and we drink a glass of water a day and we eat vegetables and fruit that are sprayed with phosphate fertilisers, we have no idea of the amount of fluoride that we are actually taking into our body.

There is something else: Dr Hardy Limeback, who is head of preventative medicine in Toronto, was pro-fluoride up until 1991 or 1992, when he was called on to do a research project on fluoride. He had been trained in dentistry and it had been drummed into him about fluoride. He accepted what he had been taught and then, in December 1999, Dr Hardy Limeback made a public apology to the people of Canada and to his students over 15 years. He said:

Speaking as the head of preventive dentistry, I told [my faculty and students] that I had unintentionally misled my colleagues and my students. For the past 15 years I had refused to study the toxicology information that is readily available to anyone. Poisoning our children was the furthest thing from my mind. The truth...was a bitter pill to swallow, but swallow it I did.

He is among 3,200 healthcare professionals—neurologists, toxicologists, biochemists, paediatricians, nurses and dentists—who have withdrawn their support for water fluoridation because they have studied the toxicology of fluoride at one part per million, not—as the Hon. Russell Wortley or whoever wrote that speech for him did—pick one paragraph out of the NRC report.

The NRC report was the trigger for 3,200 professionals to sign a petition to stop water fluoridation immediately. As we see, there is a selective choice of information that is put on the public record here which, I believe, almost goes to misleading this parliament when the whole content and the whole intention of that NRC report and its findings are not published on the record.

In summing up, I would just like to say that I went on a tour of New South Wales last week. I met two children; one is a 4½-year-old little girl who has six months to live. She has cancer that is directly linked to fluoride ingestion. How do we know this? We know this because there are now about 40 healthcare professionals around this country who have the equipment to check for fluoride toxicity. They are compiling their own studies and they are going to have them peer-reviewed and scientifically published. So far, one healthcare professional has 80 people who are fluoride toxic and suffering from this, and governments all around this country absolutely refuse to read the research.

In the lift, the Hon. Russell Wortley called me a conspiracy theorist. If I am a conspiracy theorist, I am in great company: 14 Nobel laureates oppose water fluoridation and 3,200 healthcare professionals oppose water fluoridation, so I do not mind being a conspiracy theorist in the company of those people. I hope that when we come one day to debate climate change in this place we remember how we demonised Nobel laureates, because Al Gore can be dismissed—one Nobel laureate, a Nobel Prize winner for climate change and we will all bow down and kiss his feet—but we have 14 of them we will ignore because it is convenient.

We should go back and say we made a mistake and review the research that has come to light since 1995—not 40 years ago. It was stated on ABC radio that these are fairy tales from 40 years ago. The fact is, 40 years ago, the science on this was known. The fact is public health officials refuse to publicly debate fluoride toxicity because they cannot disprove it and they have not studied the toxicology of it. They have not done the studies that were asked of them by the World Health Organisation and by the NHMRC back in 1991—those two requirements.

It was a conditional endorsement of water fluoridation by those two organisations that the public health department spouts all of the time. It was conditional on these studies and surveys being done for other sources of fluoride intake, and we have never done them. We have got no idea how much fluoride we take in in our daily diet. It is just too much trouble for governments to start doing these studies. It is too much trouble to train medical professionals to recognise the early signs of fluoride toxicity, and why? You might be embarrassed. Why? Both major parties might actually have to say 'Sorry, we got this wrong.'

There was a study in the United States that was challenged in court. It showed that, in the United States, at one part per million, 50,000 American people die each year from fluoride poisoning. That study was challenged and the two scientists who did that study were taken to court. They had to produce the evidence in court, and guess what? They won. The court and the judgement ruled in favour of the veracity and accuracy of their studies. The person who took them to court actually had to admit that he had falsified information. This is the sort of research that needs to be looked into.

If we do the toxicology studies and the testing of certain groups and we find that this has all been a fairytale, that this has all just been a conspiracy theory, what have we lost? Absolutely nothing: fluoride people until the cows come home—I do not care. But this is a public health concern, and people may think in this place that this debate went away when this was forced on people in South Australia 40 years ago. Let me tell you it is far from over. There are hundreds and hundreds of people out there who know not to drink this water. When I put out an offer on FIVEaa for a DVD on the history and toxicology of fluoride, we got 300 requests for that DVD in one morning.

So, do not tell me that I am a conspiracy theorist. Do not tell me that the science of this is not worth reviewing and do not tell me that we do not have a duty of care to the people of this state who we are forcing to drink water that is toxic. Apart from the sodium fluoride, on top of all that, this month we have uranium in our bloody water. That is all okay, because you know what? It is only at 0.2 parts per million, or whatever, but then you take 30 different chemicals that are known to be carcinogenic and mutagenic, and you pile them on top of each other, and you force people to drink that water.

One day the Hon. Mr Wortley and the Hon. John Hill just may have to apologise for the words that have been spoken in here because, as I said, when the results of the studies of those 40 health care MDs and dentists come in, we may all be left just a little red faced. With that, Ms Acting President, I would like this notice of motion, order of the day to be discharged because, as the Hon. Michelle Lensink made the point, the meeting is far gone and the point for the vote just would not be valid. I therefore move:

That this order of the day be discharged.

Motion carried; order of the day discharged.