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Minutes of meeting of the Forum on Fluoridation of 9 November 2000
Great Southern Hotel, Dublin Airport

Present

  • Professor Pat Fottrell (Chairman)

  • Dr Wayne Anderson

  • Dr Dominique Crowley

  • Dr Paddy Flanagan

  • Mr Oliver Fogarty

  • Ms Dorothy Gallagher

  • Dr Gerard Gavin

  • Ms Dora Hennessy

  • Dr Howard Johnson

  • Professor Cecily Kelleher

  • Mr Kevin Moyles

  • Dr Joe Mullen

  • Professor Moira O’Brien

  • Dr Máire O’Connor

  • Professor Miriam Wiley

  • Ms Nessa O’Doherty (Forum Secretariat)

  • Dr Miriam Owens (Report Writer)

  • Dr Margaret Shannon

Apologies

  • Professor John Clarkson

  • Dr Carmel Parnell

Introduction

As this was Professor Kelleher’s first meeting, she introduced herself and gave brief background information.

Professor Fottrell informed the Forum that Dr Miriam Owens is to draft the Forum’s report under his guidance and that of the members. Dr Owens then introduced herself and gave brief background information.

Documentation circulated

The following documentation was circulated to the members of the Forum:

(i) "A Systematic Review of Public Water Fluoridation" , September 2000 (i.e. The York Review)+

(ii) "Water Fluoridation and Public Health", October 1999 (Faculty of Public Health Medicine, Royal College of Physicians of Ireland)+

(iii) "Community Water Fluoridation in America: The Unprincipled Opposition" (Michael W Easley)*

+circulated by Secretariat
*circulated by Dr Owens.

Meeting

The Minutes for meeting of 13/10/00 were read and agreed. Professor Fottrell expressed his gratitude to Dr Shannon for taking the minutes on that occasion.

Professor Fottrell thanked Professor O’Mullane for hosting the meeting of 13/10/00 in UCC.

The following dates were agreed for coming meetings of the Forum:

  • 14 December 2000**

  • 11 January 2001

  • 8 February 2001

  • 8 March 2001

  • 5 April 2001

The meetings on these dates will be held in Dublin to facilitate the majority of the Forum members; consideration will be given to holding subsequent meetings outside Dublin.

Reminder that all members are welcome to give a presentation at any meeting but are requested to submit a synopsis of their presentation to the Secretariat for circulation beforehand.

Following on from the presentations given by the guest speakers at the meeting of 13/10/00, Dr Connett forwarded further documentation, as requested, and this has been circulated to the members; however, nothing further has been received as yet from Professor Limeback although he has received several reminders (by post and telephone). Members of the Forum expressed disappointment at this as Professor Limeback had made several unsubstantiated statements.

Professor Fottrell reminded the Forum members that the Minister is very keen that the public (individuals and organisations) be engaged in the consultation process in order that their views be ascertained.

The Secretariat has been in contact with VOICE - the organisation is to have a Board meeting on 14 November 2000 and the Chairman, Fr McDonagh, will be in contact after that date to clarify if they will be making a presentation to the Forum.

In relation to acquiring advice on dietary aspects, Professor Kelleher may be able to suggest a suitable advisor and also suggested that there is plenty of information available from surveys which may be useful.

The wording of the draft advertisement for the national newspapers was agreed and it is hoped to have it advertised on Sunday 19 November 2000 and Monday 20 November. A questionnaire to be sent to respondents is to be drafted by Dr Flanagan - to be forwarded to Secretariat. Importance of advertising on local radio as well as national radio emphasised - advertisements to be short, catchy and informative.

Web site is now registered as fluoridationforum.ie but a decision needs to be made regarding the following:

(a) what information is to be put on it?

(b) who will update it?

(c) what happens to it after the Forum issues its report?

Issues discussed and actions agreed:

(1) Dr Gavin gave details of a survey carried out by Drury Research in conjunction with the Dental Health Foundation (Ireland) on the subject of fluoridation. It was agreed that relevant representatives would be asked to attend the Forum’s meeting at 10am on 14 December 2000 to present their findings - Dr Gavin to arrange this. Presentation to be followed by Q&A/ discussion.

(2) With reference to the individual who applied to observe Forum meetings, the Secretariat has been in contact with him to ask if he would be interested in giving a presentation to the Forum on his research in the area of fluoridation.

(3) General Council of County Councils has monthly meetings - next meeting to be held on 15 November 2000 - Secretariat to liaise with the General Council to arrange date for meeting - Professor O’Mullane and Dr Mullen willing to give presentation to them concerning the Forum’s terms of reference, work to date, etc. - to be done early in 2001. Important that one representative of public health medicine be involved in this, too.

(4) Should there be a Principal Environmental Health Officer on the Forum? Dr O’Connor to get name(s) of suitable individual(s). To be discussed further at the next meeting of the Forum.

(5) If members identify any other areas from which it would be useful to have representation (i.e., bio-statistician, dietitian), it is important that this would be done asap so that any additional members would be in place soon.

(6) Names of other speakers who could be invited to give presentations: Dr Liz Treasure (or other author of the York Review) and Dr Cyrus Cooper suggested. However, before any decision is made to invite any further speakers (see enclosed list re future activities), it is important that the Forum devise an action plan and timetable so that the work will have structure. Stressed that claims made by speakers must be substantiated by them by reference to peer-reviewed journals.

(7) SAAF video to be viewed at a future meeting.

(8) Dr Mullen gave details of his meeting with Dr Caswell Evans, Director of Public Health in California. He agreed to contact him for a submission which will then be circulated by the Secretariat.

(9) The Forum agreed to address Dr Paul Connett’s "50 Questions".

Presentation made by Dr Flanagan

Recommended that the use of the term "ppm" be replaced by micrograms - more precise. Suggested that the Forum recommend that the distillation method be replaced by the specific ion meter as the latter is more accurate; however, there is no need to specify which method should be used - merely recommend that best practice be established.

Discussion followed the presentation. Recommendations regarding engineering practices will be important in the Forum’s report. Recommendation needed i.e. to specify who is accountable/responsible for each fluoridation-related task/area. It is, apparently, rare for an exceedence to occur in the Dublin area - it might be useful to examine small plants (i.e. outside Dublin) in comparison with the larger ones in Dublin.

(10) Agreed that the Forum should make recommendation regarding distillation method, as detailed above - Dr Flanagan and Mr Moyles to devise wording for the recommendation.

(11) Professor Clarkson to be asked for description of work carried out on the epidemiology contract which was awarded by the Department of Health and Children.

(12) Dr Owens and Forum Secretariat to liaise with the following members to draft headings to be covered in the report, with particular regard to the engineering recommendations required:

Dr Anderson
Dr Flanagan
Dr Gavin
Dr Johnson
Mr Moyles
Dr Mullen.

Headings then to be distributed to the members for observations/information.

No decisions will be made on any of the aforementioned recommendations until the Forum has completed its overall consideration on water fluoridation.

(13) Mr Moyles stated that the Regional Analysts’ Laboratory would be willing to take on regular analysis of water to detect levels of various elements including, specifically, hydrofluosilicic acid; Mr Moyles to draw up wording for the specifications for this.

Informal presentation made by Mr Fogarty

Information regarding training networks organised under the auspices of the Department of the Environment and Local Government - important to bring public health outlook to this training - co-operation in this regard has commenced between the Department of Health and Children and the trainers.

It was pointed out by a member of the Forum during the subsequent discussion that while it is important to remember that the Forum may recommend fluoridation of public water supplies be discontinued, it is also important that, if the Forum recommends it continue, a number of recommendations concerning safeguards, procedures and protocols be made. This was agreed.

Informal presentation made by Ms Gallagher

Ms Gallagher reported that the Council of the Consumers’ Association of Ireland met recently and expressed concern about what they perceived is the extent of the anti-fluoridation view on the Forum. Members of the Forum, including the Chairman, assured Ms Gallagher that they all have an open mind on the fluoridation issue. The Chairman also assured Ms Gallagher that everything possible will be done to ensure a balance is struck and, in his opinion, every effort has been made to date to accommodate every opinion possible. The Minister for Health and Children did not appoint the members for their views on the subject but on their experience in related areas and he, himself, has stated that he is open-minded on the issue. It was also pointed out that the Minister did attempt to get representation from the anti-fluoridation perspective but those invited declined the invitation. Ms Gallagher stated that she had not intended to imply bias on anyone’s part but would still like to see a recognised anti-fluoridationist as a member. It was agreed that the inclusion of such an individual is important and additional efforts should be made to encourage individuals with such views to participate in discussions. Dr Elizabeth Cullen, Irish Doctors’ Environmental Association, was mentioned in this regard.

Observations from other members:

  • crucial also to engage members of the public to get their views
  • need for the members to constantly monitor their work to ensure it is evenhanded
  • all members agreed that if there is scientific evidence to prove that water fluoridation does not work and/or is harmful they will be happy to recommend that it should cease and vice versa.

(14) Agreed that the Forum’s report should clearly state that the members examined both sides of the fluoridation argument in a clear and unbiased manner.

The Council of the CAI also said that in their opinion the public would like an open Forum - more than just submissions - perhaps have a meeting/ conference which is open to the public where interested individuals could contribute.

(15) Agreed that it is important to invite speakers to meet the Forum but also important to send representatives of the Forum to meet other individuals/ recognised groups. Suggested that representatives meet with the Council of the CAI - Ms Gallagher to check with Mr Dermott Jewell, Chief Executive of CAI, if this is desirable/possible.

(16) Letter from the Irish Doctors’ Environmental Association read to the Forum - in view of the discussion just held it was agreed that the Chairman would write to the Minister asking that Dr Elizabeth Cullen (or another representative of the IDEA) be appointed to the Forum; if the Minister agrees to this it is hoped to invite the relevant nominee to the Forum’s meeting on 14 December 2000.

(17) Agreed that any representatives of the Forum who meet with outside groups/individuals should give the Forum’s terms of reference and details of the work of the Forum and not any personal views on the subject which they might hold. Important that Forum members use such meetings as a listening exercise to get people’s views on the issue of fluoridation and then convey these back to the Forum.

(18) Questionnaire which will be issued should be constructed carefully so as not to direct responses.

Informal presentation by Dr O’Connor

Dr O’Connor was involved in the drafting of "Water Fluoridation and Public Health", October 1999 (Faculty of Public Health Medicine, Royal College of Physicians of Ireland) and gave details on this. The members of the Faculty did not necessarily have any views on this issue before drafting the report which was completed in October 1999.

(19) "Water Fluoridation and Public Health" is to be read by the members before the meeting of 14 December 2000 and to be discussed further.

Informal presentation by Dr Mullen

Appreciated the fact that Dr Connett met the Forum in spite of opposition from the anti-fluoridation lobby but was not impressed by the content of his presentation as it was emotive rather than scientific. Had initially recommended Dr Connett as a speaker on the basis of his environmental interest/ expertise but was disappointed that he did not address this area comprehensively in his presentation. However, the Forum should address the "50 Questions" put by Dr Connett as several important issues are raised.

If the levels of fluorosis which Professor Limeback described occurred in Ireland it would be a cause for concern but Dr Mullen and his colleagues have not found this.

Important that informed anti-fluoridation speakers be invited to address the Forum.

Observations from other members:

  • Dr Connett’s comment concerning osteoporosis in his critique of the Phipps article (circulated prior to this meeting) is incorrect and misleading
  • Dr Connett appears to be more impressive in his written submissions rather than his oral presentation - members agreed that how the information was conveyed is unimportant but the content should be examined carefully - some of the points raised by Dr Connett are very important
  • while Dr Connett has provided further documentation supporting his claims, Professor Limeback has not yet done so - Secretariat to follow this up. It may be useful to put specific questions to Professor Limeback - Professor O’Mullane to liaise with Secretariat in this regard.

(20) Suggestion that it would be useful to have a Toxicologist as a member of/ advisor to the Forum - Dr Gavin to ask Professor Jan Ekstrand for submission in this regard.

(21) Copy of oral health statistics to be circulated for discussion purposes - information with regard to toothbrushing particularly useful - Professor Kelleher to assist Secretariat in this regard.

(22) Professor Kelleher invited to forward documentation for circulation to the Forum members concerning the points she would like raised during discussions.

(23) Professor O’Mullane mentioned that he was misquoted in an article concerning fluoridation in a recent edition of the Irish Medical Journal. Members of the Forum discussed how this issue might be handled.

(24) Forum to address the alleged linkages between osteoporosis and fluoridation.

(25) Professor O’Brien to give presentation on osteoporosis at a future meeting of the Forum.

(26) Secretariat to contact each member of the Forum concerning information to be put on the web site.

(27) Sub-group to draft response to Dr Connett’s "50 Questions":

  • Dr Crowley

  • Ms Gallagher

  • Dr Gavin

  • Professor Kelleher

  • Dr Johnson/Dr O’Connor

  • Professor O’Mullane (Chairman of Sub-group)

  • Dr Mullen

  • Professor O’Brien.

Dr Owens and Professor O’Mullane to co-ordinate this - contact between members to be via email to ensure it is done as quickly as possible.

(28) Forum may require Spokesperson - suggestion that Dr Owens may fulfil this role - to be discussed further.

(29) Interim report due for Minister in December - Professor Fottrell to meet with Secretariat and Dr Owens regarding drafting.

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