UPDATED July 12, 2003: Based on
critical feedback concerning this article, FAN has made a few modifications
to our original May 26 version. According to the group Parents
of Fluoride Poisoned Children, the original article failed to
clarify the fact that Basel authorities endorsed a salt fluoridation
program as an alternative to water fluoridation. It is true that the
Basel authorities have called for salt fluoridation, a policy with
which the Fluoride Action Network strongly disagrees. In the following
modified article, this fact is made clear.
Fluoride Action Network
May 26, 2003
Basel Switzerland Votes to Stop
by Michael Connett
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
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)
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 left (Ireland,
Spain, and United Kingdom).
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
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,
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
"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. For surely,
a policy which ranks as one of the top 10 public health achievements
of the entire 20th century would be noticed by its absence. Would
In the case of water fluoridation, the answer to this question
is quite clear, and not what some Americans might expect.
According to extensive
data collected by the World Health Organization and
various national/regional surveys, 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