Addressing the arguments

Cheng et al¹ are well placed to sound cautionary notes about fluoridation as two of the authors were involved in the only scientifically defensible assessment of the evidence so far.² I also served on the advisory panel to the York review, after two years of parliamentary questioning of the rationale for fluoridation.

It is depressing then to see restatements of old positions, instead of engagement with their arguments. After 60 years we are still not clear about fluoridation's benefits, even less clear about harms, and least clear about reductions in dental health inequalities. York and the Medical Research Council³ are not the only bodies to outline areas of needed research. Yet while government accepts this, fluoridation continues, new schemes are encouraged, and in the seven years since York one small and inconclusive study has been funded.⁴ This looks more like lip service than commitment to good science. Can promoters of fluoridation not see the possible risks to 5 million people taking a lifetime's uncontrolled dose of fluoride? And how do they interpret Cheng's graph showing that several European countries do well without it?

Medical ethics are crucial. Cheng at al pointed to the need for patient consent before treatment. In their response the chief officers conflate scientific and ethical arguments as though benefit could over-ride patients' lack of consent; they cite Cheng at al for an argument they did not use and claim parliamentary support for an ethical standpoint that was not voted on.⁵ Meanwhile the Medicines and Healthcare Products Regulatory Agency may be challenged in court for its failure to adhere to the European directive on medicinal products; the fact that a substance is governed by another law, such as the water act, is no defence.

To avoid a continuing dialogue of the deaf, defenders of fluoridation should address Cheng et al's points. And, in the interests of good science, the government—which deserves praise for setting up the York review—should provide for the review's updating and incorporation into the Cochrane Library.