11 to 2 and 73 to 23. Those were the votes that stopped water fluoridation in Basel, Switzerland.
The first vote was from Basel’s Health & Social Commision (GSK), after conducting a re-examination of fluoridation’s merits.
The second vote was from Basel’s City Parliament, on April 9, after receiving GSK’s recommendation.
With the two votes, 41 years of water fluoridation will soon come to an end (although salt fluoridation will – unfortunately – begin), and Basel will lose its distinction as the only city in Switzerland to fluoridate its water supply.
After “‘weighing carefully the pros and cons… the GSK took its decision to recommend [the] abolition of water fluoridation by a 11:2 margin”, stated GSK board member Dr. Tobias Studer.
In March, the GSK presented their advice to end water fluoridation in a ten page report delivered to Parliament. Based on a rough translation of this report, coupled with later communications between FAN and GSK board members, two of the key reasons supporting GSK’s recommendation were:
1) Lack of evidence that water fluoridation is more effective than salt fluoridation in reducing tooth decay.
As noted in GSK’s report:
“No study or investigation can belay clearly that water fluoridation obtains better results as a measure to reduce tooth decay than other means of base (systemic) fluoridation” (i.e. salt fluoridation).
It is clear throughout the report that the GSK had developed serious doubts about the effectiveness of water fluoridation. Adding to these doubts were recent findings showing that tooth decay had risen in Basel’s children since 1996, coupled with an absence of any evidence showing Basel to have a lower rate of tooth decay than other Swiss cities (most of which have low - although increasing – rates of tooth decay).
In 1999, the GSK had asked public dental clinics to investigate whether Basel had a lower rate of tooth decay than “areas or cities with similar population structures, such as Zurich or St. Gall” which fluoridate their salt. Four years later, these investigations had yet to be conducted.
According to GSK’s President, Jurg Merz, “we said [in 1999] that we would like to get more results and comparisons. Four years later they were not able to bring them forward. So the GSK discussed the case again. We advised the whole parliament to stop (water) fluoridation.”
As noted in the report, the lack of evidence that water fluoridation had benefits over and above those obtained from salt fluoridation (a practice which the GSK considered less intrusive), undermined the justification for the “intervention into personal freedom” that water fluoridation presented.
According to board member Tobias Studer,
“The freedom of the individual to choose the appropriate prophylaxis method itself was also a major point in the debate… While fluoridated water as supplied by the city has virtually no competition, it is possible to buy non fluoridated (and non iodized) salt anywhere.”
2) The inefficiency/wastefulness of water fluoridation.
As noted in the GSK report, “only a minimal part of so-called ‘drinking water’ is used for drinking and cooking.” The GSK estimated that “over 99 percent of the fluoride” added to water is never consumed by humans, leading in turn to “an unnecessary load on the environment.”
According to GSK’s president, Jurg Merz, “More then 99% of the water is not drinking water but is used for washing cars, cleaning stairs, showering, to pour on flowers and so on. Fluoride is poison that loads our rivers.”
As noted by Dr. Studer, “The fluoridation of water therefore had a minimal efficiency as most of the fluor was spoiled. It was supposed that fluoridation of table salt has a much higher efficiency.”
Thus, the GSK recommended to stop water fluoridation, and switch to fluoridating salt.
Water Fluoridation Status in Western Europe
With Basel rejecting water fluoridation, only 3 western European countries now have any water fluoridation programs remaining (Ireland, Spain, and United Kingdom).
In Ireland, the most fluoridated country in Europe, there has been a mounting national campaign to end the practice. In the UK, a recent effort to fluoridate water in Scotland stalled out due to fierce opposition, while a recently-disclosed plan to fluoridate all water in England and Wales has created a burgeoning national controversy.
European countries which have rejected water fluoridation include: Austria, Belgium, Denmark, Finland, France, Germany, Iceland, Italy, Luxembourg, Netherlands, Norway, Portugal, Sweden, and Switzerland.
Fluoridation & Medical Ethics
Based on recent letters from European health & water authorities, it is apparent that a key reason why these latter countries rejected water fluoridation is the belief that it violates medical ethics. Namely, that when a medicinal product is added to the water supply (fluoride is the only chemical added to water for purposes other than water treatment), people lose their right to “informed consent”, the cherished medical ethic (enshrined by the Neuremburg Code) whereby the patient has the ultimate right to decide which medications they take.
Moreover, when a medicinal product is added to the water supply, there is an inability on the part of governments to control the dose each individual receives, due to the wide variation that exists not only in individual water consumption, but also in exposures to fluoride from other sources. The inability to control the dose is particularly important considering:
- Exposure to fluoridated water doesn’t just last a week or a month, but an entire lifetime.
- Individual susceptibilities to fluoride vary greatly (e.g. those with impaired kidney function or nutritional deficiencies are more vulnerable to fluoride’s toxic effects).
- The margin of safety between the range of fluoride exposures typically found in fluoridated communities and the range of exposures associated with fluoride-related health problems (such as arthritis & bone fracture) are poorly defined and, if existent, remarkably narrow.
European Views on Fluoridation
Concerns about the medical ethics of water fluoridation were voiced quite strongly by the recent Nobel Prize Recipient for Medicine, Dr. Arvid Carlsson of Sweden. Carlsson, who helped lead the successful campaign to stop water fluoridation in Sweden, argued that public water supplies were not an appropriate vehicle with which to deliver “pharmacologically active” drugs to the entire population. According to Carlsson:
“I am quite convinced that water fluoridation, in a not-too-distant future, will be consigned to medical history… The addition of drugs to the drinking water means exactly the opposite of an individualized therapy. Not only in that the dose cannot be adapted to individual requirements. It is, in addition, based on a completely irrelevant factor, namely consumption of drinking water, which varies greatly between individuals and is, moreover, very poorly surveyed.”
Carlsson’s views are quite similar to those recently expressed by various European health authorities. For example:
According to the chief water authority in Belgium:
“[it] is the fundamental position of the drinking water sector that it is not its task to deliver medicinal treatment to people. This is the sole responsibility of health services.”
According to the chief water authority in Luxembourg:
“In our views, the drinking water isn’t the suitable way for medicinal treatment and that people needing an addition of fluoride can decide by their own to use the most appropriate way.”
According to a representative from the German government:
“The argumentation of the Federal Ministry of Health against a general permission of fluoridation of drinking water is the problematic nature of compuls[ory] medication.”
According to the head of Environmental Protection in France:
“Fluoride chemicals are not included in the list [of 'chemicals for drinking water treatment']. This is due to ethical as well as medical considerations.”
Tooth Decay Trends in Europe vs. US
In the United States, water fluoridation is touted by government authorities as being “one of the top 10 public health achievements of the 20th century.” The Centers for Disease Control states that water fluoridation has been the key factor in the decline of cavities among US children during the past 50 years.
Based on statements such as these from the US Government, one could be forgiven for assuming that western Europe has somehow suffered higher rates of tooth decay by not fluoridating its water.
However, according to extensive data compiled by the World Health Organization, unfluoridated countries in western Europe (including countries with little to no salt fluoridation) have experienced - without exception - the same general decline in tooth decay over the past 3o to 50 years, as that experienced in the US.
As a result, children today in unfluoridated countries such as Denmark, Germany, The Netherlands, and Sweden have as low – or even lower – levels of tooth decay as US children.
The evidence from Europe, therefore, suggests that water fluoridation is an entirely replaceable and unnecessary means of reducing tooth decay – a fact consistent with the Basel Health & Social Commission’s conclusions, but at profound odds with the massive promotion campaign by the US Government to fluoridate more water in the US.
Note: The quotes from GSK members Tobias Studer and Jurg Merz were obtained from email correspondence with Michael Connett in May 2003.