Health and Care Bill

Lord Reay Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Lord Reay (Con)]

My Lords, I extend a warm welcome to the noble Lord, Lord Stevens, although like my noble friend Lady McIntosh, I respectfully disagree on the topic of water fluoridation, a measure that I strongly oppose and that I will focus on tonight.

It is disappointing that mandatory fluoridation has been slipped, virtually unnoticed, into the nether regions of such an important Bill, without its own debate and without proper scrutiny. Moreover, it all seems very rushed. I stand before noble Lords today not as a scientist or a connected party of a lobby group but as someone who has grave concerns about the risks posed by widespread water fluoridation. I contend that high-quality evidence that has come to light in North America since 2017 suggests that fluoride can damage the developing brain and reduce IQ. I conclude that water fluoridation has not been adequately researched by those who have initiated the Bill. The practice cannot be considered safe and should not be extended throughout the country.

In Europe the only countries that have agreed to water fluoridation are Ireland and the UK, with 10% population coverage, with Spain, Poland and Serbia having done so to a very minor extent. In studies in 1999 and 2001, the Centers for Disease Control and Prevention acknowledged that fluoride’s benefits are mainly topical, not systemic. There really is no need to swallow fluoride or put it in drinking water, when topical treatments like fluoridated toothpaste are available.

Children, particularly bottle-fed babies, are unfortunately being overexposed to fluoride. Infants consuming formula mixed with such water receive the highest exposure to fluoride by body weight—a dosage 100 to 200 times higher than a breastfed baby. This overexposure leads to dental fluorosis, or discolouration of the enamel, when the permanent teeth erupt. Since we have now learned that fluoride crosses the placental membrane, it is evident that the foetus receives an even higher exposure than a bottle-fed infant at a more vulnerable time.

Proponents claim that over 60 years of research has demonstrated that the measure is safe and effective. However, most of that research has focused on the hard tissues: the teeth and bone. It is only recently that high-quality research has focused on other tissues, with disturbing results. According to recent US Government-funded studies published in leading global journals—Bashash, 2017 and 2018; Green, 2019; and Till, 2020—fluoride has the potential to damage the developing brain of both the foetus and the infant, leading to lowered intelligence and increased symptoms of ADHD. Making these observations even more alarming is that the damage was observed in fluoridated communities in Canada—a country that fluoridates at 0.7 parts per million, versus 1 part per million in the UK. The Till paper showed an IQ decline of 9 points among bottle-fed children in fluoridated versus non-fluoridated communities. These findings are so serious that they make any discussion of dental benefits of this practice moot. You can repair a damaged tooth but not a damaged brain.

The irony of the Bill’s proposals is that they will harm most those whom they seek to help. Those most likely to suffer from poor nutrition, and thus most likely to be vulnerable to fluoride’s toxic side-effects, are the less well-off, who are the very people being targeted by the proposed fluoridation programmes. We should be spending our efforts trying to increase the access to dental care for low-income families and invest in programmes such as Childsmile in Scotland.

In his written evidence to the recent White Paper, Professor Stephen Peckham, government adviser to the current Select Committee on Health in the other place, chaired by Jeremy Hunt, stated that

“if the Secretary of State was looking for ways to improve oral health then water fluoridation should not even be considered given its lack of effectiveness. More attention should be given to schemes such as Childsmile in Scotland which has been proven to reduce inequalities, reduce admissions for tooth extractions and provide broader public health benefits beyond oral health. Such a scheme links very clearly to addressing obesity issues as well”.

Professor Peckham rebuts government claims in the White Paper that water fluoridation is proven to improve oral health and reduce oral health inequalities. He argues that such claims are based on inconclusive evidence and studies predominantly carried out pre 1975, before the wide use of fluoride toothpaste. Peckham further argues:

“We should not be considering any new schemes given the increasing amount of evidence linking fluoridation to harmful health effects.”


Only eight years ago, the Government made a decision to transfer decisions on this issue from the NHS strategic health authorities to local government. The specific reason given was that local communities should have a stronger say. This Bill reverses that position and reverts to the centralisation of control with the DHSC.

Surely, if health measures are to be imposed on the individual and if the community’s final say in the matter is removed, the scientific evidence should show overwhelmingly that the measure is both beneficial and safe. In the case of water fluoridation, I do not believe it is either. At the very least, I urge a delay in proceeding with this measure until the National Toxicology Program in the US—which for the last five years has been undertaking a systematic review of the fluoride neurotoxicology studies—publishes its report, expected in early 2022. The public will not easily forgive us for rushing ahead without availing ourselves of the best scientific research on the matter.

Health and Care Bill

Lord Reay Excerpts

Lords Hansard - Part 1 & Committee stage
Monday 31st January 2022 Lords Chamber

[Lord Reay (Con)]

My Lords, I have added my name in opposition to Clauses 147 and 148 standing part of the Bill—tabled by my noble friend Lady McIntosh of Pickering and supported by the noble Baroness, Lady Jones of Moulsecoomb. These clauses enshrine the Government’s intentions to expand the rollout of water fluoridation throughout the UK. In case the House should decide that they remain, I will also speak to Amendments 259B and 259D in my name, which would make the implementation of the policy conditional on an environmental impact assessment and the analysis of recent US Government-funded, peer-reviewed studies.

My noble friend Lady McIntosh apologises for not being present in the Chamber today, as she has been pinged. However, she wanted me to convey her support of Amendments 259B and 259D.

It is most unfortunate that the important topic of water fluoridation has not been granted a full debate of its own in this House. That it has been slipped in by these back-door clauses does a huge disservice to the issue and detracts from the important debate over the Health and Care Bill itself. These clauses in effect ride roughshod over the current status quo on water fluoridation in terms of legal precedent; they also ignore the existence of effective alternative strategies for fighting tooth decay, as practised not only in Scotland but in most other countries in the world.

While roughly 10% of the population lives in artificially fluoridated communities, it is true that no areas have been added since the late 1980s. Successive Governments have tried to increase the coverage but have failed, including in Southampton a few years ago, because the measure meets stubborn resistance from local communities, who do not wish to be mandated to drink fluoridated water. In Scotland, Lord Jauncey in the case of McColl v Strathclyde Council 1983 concluded that fluoridation amounted to illegitimate medical treatment via the public water supply. Since then, the health service in Scotland has focused on other measures to improve children’s oral health, with a considerable degree of success.

The government policy paper used to support the insertion of these two unfortunate clauses appears to report only what the fluoridation proponents want Ministers to hear: namely, that the practice benefits teeth and poses no threat to the rest of the body. However, four high-quality US Government-funded studies published since 2017, all peer reviewed, looked at the effects on the brain. Each one reached concerning conclusions. The first of these studies, by Bashash et al, appeared in the high-impact journal Environmental Health Perspectives in 2017. This mother-child cohort study showed a four-to-five-point loss of IQ in offspring associated with maternal fluoride intake, typically experienced in a fluoridated community. Some 300 mother-baby pairs were followed for 12 years, with a mother’s fluoride exposure measured directly via urinary fluoride level, and the paired offspring’s IQ was measured at four, and at six to 12, years of age.

Since this study a further three, similarly robust US- Government funded studies—Bashash 2018, Green 2019 and Till 2020—all point in the same direction: damage to the infant brain, IQ loss, and/or increased ADHD symptoms associated with fluoride exposure at the doses experienced in artificially fluoridated communities—which, I might add, were at lower fluoridation levels than those considered for the UK, with 0.7 ppm versus 1 ppm. According to Dr Philippe Grandjean from Harvard University,

“Fluoride is causing a greater overall loss of IQ points today than lead, arsenic or mercury.”


Another recent study in 2015 by Professor Stephen Peckham, an adviser to the Select Committee on Health and Social Care, chaired by Jeremy Hunt, showed that incidences of hyperthyroidism are nearly twice as likely to report high prevalence in the West Midlands, which is a fluoridated area, in comparison to non-fluoridated Greater Manchester. Professor Peckham’s study has been omitted from the policy paper’s references. So, too, has the conclusion of the important 2015 Cochrane review, which found as follows: no strong evidence that fluoridation reduced tooth decay in adults; no strong evidence that tooth decay increased when fluoridation was halted in a community; and, contrary to claims from promoters that fluoridation helps low-income children, it found:

“There is insufficient evidence to determine whether water fluoridation results in a change in disparities in caries levels across”


socioeconomic status. All these scientific findings are extremely important, but I find it very worrying that they appear either to have been ignored or dismissed by the authors of this policy paper. Amendment 259D commits the Government to have these four US studies reviewed by expert toxicologists.

I turn to the matter of why fluoride in the UK is not considered a medicine when the WHO has recently classified it as such. Why do the Government refuse to do the same? They contend that water fluoridation has a medical benefit in terms of reduced tooth decay. Could it be that by defining fluoridation water as medicine, the Government then submit themselves to regulation and scrutiny? The MHRA is responsible for the licensing requirements for medicinal products. If fluoridated water were treated as a medicine, individuals would then have the absolute right to refuse the administration of water fluoridation by choice, and industrial-grade fluoridating chemicals would not be allowed. Of course, if it were defined as a medicine, it could not be administered without consent. When fluoride is delivered via toothpaste, the individual has a choice in the matter. When it is carried through the public water supply, there is no individual choice and the ingested fluoride goes to every tissue in the body, including those of the unborn child. This is particularly unfortunate for lower-income families, who cannot take avoidance measures such as bottled water or filters. Moreover, there is no assessment of individual health, size, dose, physical and mental state. Contrary to the direction of modern medicine, whereby treatments are increasingly tailored to the individual, water fluoridation is a crude, one-size-fits-all strategy.

The legality of the Government’s determination to avoid defining water fluoridation as medicine is questionable. The Supreme Court of Canada in the Municipality of Metropolitan Toronto case in 1957 held that fluoridation was using the water supply for a medicinal purpose, which was separately reaffirmed by Lord Jauncey years later. The Lord Jauncey decision explains why Scotland has no communities with artificial fluoridation. The Scottish health department, to its credit, instead has developed an exciting programme called Childsmile. This is a programme of early education on both dental hygiene and diet. It involves both schools and parents and has proved successful and cost effective. Not only has dental decay been reduced but the overall health of children in terms of fighting sugar consumption and obesity has been improved. This programme is relevant to the cut and thrust of the Bill but it has been ignored in the policy paper. Given the success of Childsmile in Scotland, can the Minister say whether the Government will consider a rollout of this programme throughout the UK?

It is conservatively estimated that only 2% of the water supplied by water companies is consumed by domestic users. This would mean that 98% of the water containing fluoride would re-enter waterways, with the potential for damaging plant and aquatic life and entering the food chain. Under the EU dangerous substances directive, fluorides are classified as deleterious to the aquatic environment. Last month, the Environmental Audit Committee in the other place published a report concluding that a chemical cocktail is polluting English rivers and putting public health and nature at risk. We must refrain from adding fluoride to the toxic mix. I add that, in addition to the toxicity of fluoride itself, contaminants such as lead and arsenic are often present in the industrial-grade fluoridation chemicals used. These frequently derive from the hazardous waste of the phosphate fertiliser industry. Given the repercussions for the environment, our waterways, animals, fish and other wildlife from this policy, it seems surprising that Defra does not appear to have been involved in the decision-making process for water fluoridation. Perhaps the Minister can explain why.

Last year, we heard the Secretary of State for Health and Social Care announce that £10 million will be charged to water bill-payers for the rollout of water fluoridation. However, I suggest that it will cost taxpayers considerably more. Greater Manchester has around 22 treatment plants, which would need to be refitted for £1 million to £2 million each. Using a back-of-the-envelope calculation, to cover parts of the UK not already fluoridated will conservatively cost in excess of £300 million, excluding chemicals or running expenses. The policy paper fails to reveal how much the proposals will actually cost.

Perhaps the Minister can share with us the forecasted costings of rolling out water fluoridation throughout the UK in terms of plants, chemicals and other extraneous expenses. In addition, have Her Majesty’s Treasury, the Public Accounts Committee or any respected independent bodies such as the Office for Budget Responsibility or the IFS scrutinised the real costs and their effect on the public finances and health budget? Will these unknown extra costs be met by cuts to NHS dental departments or other parts of the health budget? This money would be far better spent on early intervention on dental hygiene and diet, as in the Scottish Childsmile programme.