Fresh versus clean

16:00, Feb 08 2013

Alistair Bone sees the opening shots as the fluoride debate re-ignites in the Waikato.

Strat Peters is not enjoying this at all. In his final word at the end of the Thames Community Board hearing, he'll say as much and also let it be known he is ticked off over having to make this decision. Almost all the team are annoyed, too.  They are seven in total: an accountant, a car-yard owner, an ex-teacher, a lawyer, a JP and an ex-policeman.  

Depending on which way you lean, they have to decide if Thames township has to remain:

a) involuntarily mass-medicated with a dangerous drug; or,

b) part of one of the greatest public-health initiatives ever.

Around the traps, New Plymouth District Council and Ruapehu-Taumaranui have recently voted to remove it. South Taranaki District Council and Stratford District have decided to start adding it. Christchurch, Whangarei, Napier and most of Western Europe get along without it.  In May, Hamilton City Council will hold a tribunal to decide.

Fluoridation is back, again, as an issue and battle lines are being drawn, deep and wide.

Thames town is the only bit of the wider Thames-Coromandel District Council (TCDC) area that is fluoridated. So when the issue came up again, it was decided that its Community Board - the subset of council dealing with the Thames central - would ask for submissions and report back to the full council on what it thought.

The response was immense.  The TCDC's annual plan covers the whole peninsula and it is usually the big deal event of the year. It got 350 submissions from the public. The community board took 511 submissions on fluoride, even though the consultation period ran over Christmas. Of those, 243 of the submissions wanted to keep fluoride in the water and 268 didn't. But two of the ''against'' votes were actually ''anti'' petitions with 79 signatures between them.

It's not like it's a gentle disagreement, either. Like abortion and the Treaty, fluoridation inevitably prompts a viciously polarising fight. At issue is whether fluoride should be added to the drinking water supply. 

The pros have the system on their side: District Health Boards, the Ministry of Health and the Dental Association. The guts of their argument is that fluoride makes a clear and measurable difference to dental health, especially for the poor and Maori and Polynesians. They say there are some minor side effects, vastly outweighed by the good it does.

The antis say it is a poison foisted upon everyone and is unethical. They believe it has little benefit and a range of serious side-effects, including but not limited to brittle bones, cancers and low IQ levels. Both sides deploy big and important-sounding studies. Both contain heavily credentialed people. Who hate each other.

If you make a submission, you can turn up and speak about it to the board if you want. Bill Barclay made his submission on the pro side. He was a health administrator in Australia and says he saw the damage wreaked on unfluoridated Aboriginal communities. He writes a blog as well as for the Peninsula Press, so he is now sitting at the media desk with that hat on. Most of the local health professionals who are speaking come by to say hello.

The establishment's biggest hitter is the Waikato District Health Board's (WDHB) Medical Officer of Health Dr Felicity Dumble. Her written submission says the WDHB ''strongly supports'' (in bold and underlined) fluoridation. WDHB charts show oral health improves with fluoridation, but especially among Maori and Pacific Island kids. The 2009 Oral Health Survey, the latest one, showed that only 43 percent of Maori between 2 and 27  brushed their teeth twice a day. And only 15.3 percent of 2 to 4 year olds.
''Community water fluoridation is effective irrespective of an individual's behaviour, ethnic or socio-economic status,'' says the blurb. The WDHB thinks it evens up ''oral health inequalities'', especially when it comes to the poor.

The WDHB also takes on the question of ethics. Believing that mass fluoridation, like seat belts, crash helmets, mandatory sewerage, fenced swimming pools and food hygiene laws, are all minor restrictions on personal freedoms for the greater good. The WDHB says the Human Rights Commission looked at the issue years ago and agreed with it.
A string of anti-fluoridists follow.

Pat McNair is over from Hamilton. She challenges the WDHB to produce a New Zealand study that shows fluoride is safe. She asks why the WDHB won't engage in discussion. It is a point taken up by Community Board chair Peters, who is rather staggered that it hasn't happened. McNair says anti-advocates are ''constantly trying to get a meeting going''.

Matthew Hall sells water filtration devices. He says his product is ''amazing'', but even it can't get all the fluoride out. There are more extreme measures involving reverse osmosis or distillation that might get rid of the fluoride, but it removes everything else, too, including minerals, and leaves only ''dead water'' behind. He makes the point that if the fluoride is removed, as he wants, he will be cutting his own throat financially. He lives in unfluoridated Whitianga.

Anti-campaigner Natasha Lynch is aggrieved over the protesters' image: ''You can be vegan or a nudist, but if you want to take fluoride out of the water, then you are very crazy.'' Things haven't been helped on the anti side by the adoption of the issue by lunatic conspiracy theorists. Anti-fluoridists can be found on the same stage as people who believe the Royal family are lizards and aircraft vapour trails are a genocidal plot by the rich. Most of the antis in Thames don't look like the sort of people who believe these things.

Libby Boyd is next up to speak to her submission.

''This promises to be entertaining,'' says someone.

Boyd is a bouncy type with an intense energy and a useful turn of phrase. But she has a rather holistic way of speaking, a fine effort to encapsulate the universe that unfortunately takes a little thrust away from her main axis of attack. She quotes Joseph Goebbels on how Governments lie effectively. The fluoride issue is huge, she believes. ''It's not a can of worms,'' she says. ''It's a 44 gallon drum with a snake in it.''

It is a mystery why political science  students don't pack out these hearings the way law students fill up the stands at court cases. The lowest level of Government is the most open and direct, with all the types of human and their issues sitting right there and free coffee at intermission. The Thames board is peeved to be here, but is still up for it. Three of its members sit on the full council. It asks good questions and chairman Peters walks the line between control and inclusion like a master.

Dr Jane Beck (MBBS, BSC, MRCGP, MFOM), Thames resident, late of England, is among the more authoritative of the antis.  She thinks it might be cleverer to put limits on the sugar that is in everything rather than add fluoride to the water. She points out that fluoride came to Thames water in 1971, before it was commonly included in toothpaste.

Other than that, there are a lot of personal anecdotes of the type ''I grew up with fluoridated/unfluoridated water and have had/never had trouble with my teeth.''

One of the antis comes over to the press desk. She wants to know what kind of phone one of the journalists has because she got a terrible pain in her head when he turned it on.

Mischele ntsT nte Rhodes is the vice president of Citizens and Ratepayers and a member of the fluoridation action network. She and Pat McNair are stars of the anti movement, credited with influencing Ruapehu-Taumarunui District Council to stop fluoridating. She brings the news that boiling water only increases fluoride's toxicity. Chairman Peters again asks why there has been no talking between the WDHB and the anti-groups. Rhodes says the WDHB is ''in the business of health'' and not interested in hearing anything different.

It doesn't really seem to be about the money. Most of the fluoride put into water in New Zealand comes from an Australian multinational called Orica. It's most heavily concerned with supplying stuff to miners and made an A$650 million net profit in 2012. Only 3 per cent of that came from New Zealand. Thames District Council's fluoride costs it just $2300 a year.

Dentists, as a body, want fluoridation, something that goes against their economic interests. When New Plymouth voted to take the fluoride out of its water, the city gave the $18,000 it spent on fluoride to promote oral health.

A block of pro-fluoride people come next at the hearing. They blow the antis out of the water. A doctor, a dentist, a surgeon, all locals. They look immensely competent and vastly experienced and speak clearly and calmly and to the point. In a break, one of the medicos nods vigorously at the suggestion it looks like a surreal class war - the middle against the one per cent. Who are representing the (completely absent) underclass.

Dentist David Fornusek has been in town since the pre-fluoride days. He has practices across the Waikato in fluoridated and non-fluoridated areas. He sees people from both,  with fillings and without. But he is absolutely adamant that people in fluoridated areas have more resilient teeth and fewer problems. He says he's been looking for the kind of health effects the antis claim are caused by fluoridation, but hasn't seen them. In the non-fluoridated areas, he believes oral hygiene is left up to the vagaries of cultural and socioeconomic and family habits.

One of the board members asks him if he is getting any kickbacks from the fluoride pushers. It's a common accusation from the antis and not without some basis. United States and Australian companies have been caught and fined for offering illegal inducements to health workers.

Fornusek says he's never seen a fluoride pusher. If his practices get samples, staff give them to patients, he says.

He goes on the front foot: all the dentists in his practices want to see fluoridation extended to the rest of the TCDC area.

Dr Kerry Hennessy from the Thames Medical centre appears to be angry. He says he has never seen the side effects claimed by the antis, even though he has been actively looking for them. He breaks off to accuse some of the antis of laughing at him. They wisely deny it. He says the issue is way too big for the council to be involved in and should be left to central Government. If the cost of the chemical is a problem, he will write a cheque for the $2300 himself, right now.

The lack of central government leadership is clearly annoying the board. But board members should probably get used to it. The National Party is way too sly to get anywhere near the issue and is happy to leave decisions on fluoride up to local people. Labour says it wants to hold an inquiry and take control over fluoridation away from local councils, but it's almost certainly lying. Fluoridation is a critical issue for many and no coalition Labour Government is going to be telling people who have just voted fluoride out of their area that it is bringing it back. Or that they can't have it even if they want it.

The hearing ends in the early evening. The board will come back for deliberations on the evidence and a decision tomorrow.

Down in Hamilton, there was going to be a referendum on fluoride in October alongside the local body elections. But a council meeting in June decided not to hold the referendum, the gist of the argument apparently that it would cost a lot and not many people would bother to vote.  There will be a tribunal instead running for (an optimistic) two days on May 29 and 30. Antis and pros will form groups and present to council for an hour each and then face questions. Individuals will then be allowed to have their say.

The council will make a decision that holds good for the next three years. The morning after the hearing, the Thames Board members got  down to their vote. The four antis in attendance all shuffle their seats closer at once. ''Intimidation,'' growls Bill Barclay. Strat Peters starts to chase them off, but they complain about being hard of hearing and are allowed to keep their perches.

There are already whispers some of the medicos will club together and hire a lawyer and force a judicial review if the board votes to remove fluoride.

Each member of the board sums up his or her thoughts.

Diane Connors believes in the individual right of people to live the way they choose. She is not sure there is no risk and points out there is no way of knowing your own personal dose of fluoride.

Wyn Hoadley (QSO) used to be the North Shore mayor  before Auckland became a supercity. She is also not convinced fluoride is risk free.

Justine Baverstock thinks it's safe, but sees the concerns of those who disagree. She believes they have options and thinks the bigger issue is that it's cheaper to buy fizzy drinks than milk.

Mark Bridgman thinks it's safe and effective. There is clapping, probably ironic, from the antis. It is clear how it is going to go now. Someone again says central government should get involved. This suddenly incenses Libby Boyd, who shouts her objection to the notion and walks out before she can be shooshed.

Lester Yates says he has given weight to the testimony of the doctors and dentists on the pro side. He votes yes for the greater good of the majority of people.

Peter French says he looked up the addresses of the people who have made submissions and the majority who live in Thames want to keep their fluoride. He also researched a 2006 study cited by one of the antis suggesting a link between illness and fluoride and found it had been superseded by a 2012 study. After, Dr Beck says it was she who submitted the 2006 study and there is something wrong with the 2012 study. It seemed to sum up the whole process.

Strat Peters says fluoridation benefits those who don't brush their teeth. ''I was left with doubt that there was much value for more privileged kids who eat more sensible food and brush regularly.''

He has healthy doubts about medical experts - citing lead in petrol and 245T as things that were supposed to be OK that weren't.

He is ''staggered'' to be in the position of having to decide on fluoridation and can't see why the Ministry of Health and the nay-sayers haven't got together and worked out their differences.

In the end, the Thames board votes for continuance. With a couple of riders. Within the next couple of months, research will be done on how people can opt out of having fluoride added to their water. Some sort of filter system seems in order, the cost to be borne by the council to some unspecified degree. They will also write to the Ministry of Health, asking for stronger direction.