Friday, August 16, 2013

Fluoride and Consenting Adults

As newly elected Councillor for Ballina Shire, my phone doesn't usually run that hot. Normally I can drop my little man at day care and get to work without too many interruptions. Not any more.

It is only a couple of days since I poked my head up and expressed an opinion on fluoridating the Ballina water supply. I knew this was a hot button issue from the number of questions on fluoridation I recieved during the election, but I have been surprised at the ferocity of the attacks on my judgement and my scientific understanding.

If I was advocating that fluoride be added, I'm sure I would have copped a bucket load of criticism from the anti-fluoride brigade. To say these people feel passionately about fluoride is about as understated as you can get. I mean, I've spoken against fluoridation and I've still had calls from fluoridation opponents at 6am. Big hint to all concerned here: don't ring at that time if you want me (or anyone else) to listen to your point of view.

But no, the attacks on my scientific knowledge, intelligence and judgement have come from health professionals and politicians. I'm eithern ignorant of the facts, playing populist politics or have been captured by a vocal minority. I believe none of these is true.

I first studied biomedical science and ethics as part of a Bachelor of Science completed in 1990, with majors in natural resource economics and science and environment policy. From 1995 to 2000, I was Executive Director of the Mental Health Association of Qld and a member of the West Moreton Health District Ethics Committee.

A large part of my work was contributing to a complete re-write of Queensland legislation that dealt with consent to medical treatment, namely The Power of Attorney Act 1998, the Guardianship Act 1999 and the Mental Health Act 2000. In addition to a range of other improvements, for the first time, a person that experienced episodic mental illness gained a legal means to refuse Electro-Convulsive Therapy (ECT), through an Advanced Health Directive developed in conjunction with their Doctor.

Now I agree it's a big jump from ECT to fluoridating the water supply, but the issues of consent and the right to withhold consent to treatment are central to both.

It's probably more than a coincidence that both also gained popularity around the same time, the 1950's & 60's, when our State Institutions swelled with unmarried mothers and homosexuals in need of 'psychiatric' treatment. I dare say that the standards of consent to treatment were substantially less than we would find acceptable today.

So the first question to answer is whether adding fluoride to the water supply constitutes medical treatment.

The Therapeutic Goods Act says this depends on whether the addition of Fluoride is for therapeutic purposes or simply one of the chemicals (eg. Chlorine) used to ensure clean water. Given that the sole reason advanced for the addition of Fluoride is the prevention of caries, this is clearly treatment. That it is a preventative action makes no difference, if you add something to the water supply to achieve a therapeutic outcome it constitutes medical treatment.

I agree with all the scientific evidence presented by NSW Health and the Australian Dental Association, fluoridation of the water supply has substantial oral health benefits. I'd also agree that there is a very low risk of side effects from such low levels of Fluoride, but I cannot accept that there is no risk.

There is a body of peer reviewed and corroborating evidence published by The Harvard School of Public Health in July 2012 that high levels of Fluoride in the water can result in impaired intellectual development in young children. There is no data that corroborates such a finding in regard to low fluoride levels, but the study was unable to establish a minimum threshold. It gives lie to the suggestion that there is no risk.

While the people who believe that fluoride is a toxic poison or that they have a personal susceptibility may be a little fervent in their beliefs and over zealous in their methods, they, for all other purposes, are sane. They cannot be ignored. They have a right to object to treatment without consent.

In my view, without that consent, local authorities cannot proceed with fluoridation. Even if two thirds of the local population want fluoridation, you cannot interfere with the water supply to achieve a therapeutic goal without the consent of the other one third.

I would also note that there has been some medical professionals linking opposition to fluoridation to an anti-vaccination stance. They are wrong. As the father of a young child, I strongly encourage following the approved vaccination program and wish there was a far higher vaccination rate in this area.

As in the case of fluoridation, I urge everyone to accept the science. I believe however that there is a substantial difference between supporting an active vaccination program and seeking to inoculate an entire population through the water supply.

It must also be understood by the community that in the case of vaccines, there is no effective alternative treatment.

If your baby gets sick from Whooping Cough, s/he may die. By not immunizing your child, you increase the risk not only for your child, but also for my child. I'm not impressed.

In the case of fluoridation, there are a range of other, less intrusive options, to achieve these same health outcomes.

If fluoridation of the water supply is a medical treatment then any consumer of that supply has the right to withhold consent to that treatment.

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