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Minutes of meeting of the Forum on Fluoridation on 8 February 2001 
The Boardroom, Dublin Dental Hospital 

Present

  • Professor Pat Fottrell (Chairman)

  • Professor John Clarkson

  • Dr Dominique Crowley

  • Dr Elizabeth Cullen

  • Mr Oliver Fogarty

  • Ms Dorothy Gallagher

  • Dr Gerard Gavin

  • Dr Howard Johnson

  • Mr Kevin Moyles

  • Dr Joe Mullen

  • Professor Moira O’Brien

  • Professor Denis O’Mullane

  • Dr Carmel Parnell

  • Ms Nessa O’Doherty (Forum Secretariat)

  • Dr Miriam Owens (Rapporteur)

  • Dr Margaret Shannon

Apologies

  • Dr Wayne Anderson

  • Professor William Binchy

  • Dr Paddy Flanagan

  • Ms Dora Hennessy

  • Professor Cecily Kelleher

  • Dr Máire O’Connor

  • Professor Miriam Wiley

Meeting

Apologies were given for the members of the Forum who could not attend this meeting.

Update details

(a) The Chairman and members of the Forum expressed their disquiet at the allegations made by Dr Don MacAuley in his recent letter (in which he declined the invitation to make a presentation) that in his opinion the Forum is not independent. It was agreed that a formal response to his unfounded allegations and claims will be sent to Dr MacAuley. Members commented that it was highly unusual for a professional individual, such as Dr MacAuley, to decline an invitation to make a presentation to his peers on allegations and claims while he is willing to make his views known to the media. (See also ix, page 4) 

(b) Since the Forum's meeting in January 2001, Dr Cullen has been in contact with VOICE in relation to the invitation to make a presentation of their concerns to the Forum. A response is still awaited.

(c) Headings need to be drafted now for the Final Report.

(d) The Chairman expressed regrets that Ms Gallagher had been unable to give her presentation during the January 2001 meeting but explained that she is free to do so at a future meeting if she so wishes.

(e) There is a need to summarise the work to date of the Forum in order to identify gaps or need for further balance - the Rapporteur will draw up a document in this regard for the meeting on 8 March 2001.

(f) The radio advertisements inviting submissions from the public are now running (since 5 February 2001). It is hoped that there will be a good response.

(g) Professor O'Mullane stated that the sub-group working on Dr Connett's "50 Reasons" should have their report back by the meeting on 8 March 2001; the collection of all relevant articles has involved a lot of work.


Minutes of Meeting of 11 January 2001

The minutes were agreed as an accurate reflection of the meeting of 11 January 2001.


Matters arising

(i) Dr Cullen stated that she has written to the Minister for Health and Children asking about the existing levels of fluoride prior to the commencement of fluoridation; the IDEA is worried that levels of fluoride in ground water appear to have risen - is this an indication that there is a build-up of fluoride over time? It was agreed that this issue will be discussed by one of the sub-groups.

(ii) Professor Fottrell emphasised that all members are encouraged to raise any issues which are of concern to them at any stage - it may be appropriate to have a sub-group (either existing or a new one to be created for that purpose) to examine the issue(s) and report back to the Forum.

(iii) It was agreed to circulate Dr Cullen's e-mail regarding the EPA Report to all members - it will be discussed at the meeting on 8 March 2001 and a decision will be made as to whether to refer it to a sub-group for research/consideration.

(iv) Ms Gallagher asked if there are any studies on fluorosis in non-fluoridated areas; Professor O'Mullane explained that there are - levels of fluorosis have been monitored constantly since 1984 but (a) it is extremely difficult to measure and (b) not all fluorosis can be attributed to fluoridation. This area could form part of an important recommendation/observation of the Forum's Final Report. It was agreed to have a presentation on this and Professor Clarkson agreed to focus part of his forthcoming presentation on this area.

(v) Approximately 150 questionnaires have been requested to date, including 20 requests already received as a result of the radio advertisements; 30 completed submissions have been received so far.

(vi) A sub-group was established to examine all submissions received:

Dr Flanagan - Chair/Convenor 
Professor Clarkson 
Dr Cullen 
Ms Gallagher 
Dr Gavin 
Professor O'Brien. 
*see note in relation to Ethics below


This group will be required to liaise among themselves and report back to the Forum as soon as possible after the closing date for receipt of completed submissions.

(vii) NB Dates of future meetings:

8 March 2001 (all day) - previously agreed 5 April 2001 - previously agreed

New dates to be added to members' diaries: 
10 May 2001 
14 June 2001 
12 July 2001 
9 August 2001.

Professor Clarkson has very kindly arranged for all of these meetings to be held in the Boardroom of the Dublin Dental Hospital and the Chairman thanked him for this.

(viii) Dr Gavin has contacted two specialists and a consultant for advice on renal/nephrology related issues - the specialists are willing to advise on issues in the paediatric area and the consultant will advise on the impact of fluoride in adults with impaired kidney function. The questions raised by Dr Cullen will be put to these advisors and they will be asked for a formal response. A decision as to whether it would be useful/necessary to ask them to address the Forum will be made at a future meeting.

(ix) The Forum agreed that it was extremely disappointing that Dr Don MacAuley declined the invitation to give a presentation to the Forum. The sub-group, to be chaired by Dr Flanagan, which will to examine all submissions will write to Dr MacAuley in this regard to encourage him to meet the Forum to express his concerns. It may be unethical of Dr MacAuley to withhold his views from the Forum if he has evidence of any alleged harm caused by fluoridation because this has public health implications. It is crucial that the Forum address all areas of concern. It is also essential that all relevant evidence and references be provided by individuals or groups who make allegations about water fluoridation.

(x) It was agreed to forward part of Dr MacAuley's correspondence (i.e. the Sheldon letter) to Professor Treasure so that it can be addressed at the meeting in March 2001.

(xi) Dr Andrew Rynne has also made serious allegations regarding fluoridation - it was agreed that he should be invited to speak to the Forum and to submit evidence for his allegations.

(xii) It was agreed to invite Dr Caswell Evans, USA, to speak to the Forum on his experiences in the area of fluoridation.

(xiii) A sub-group was established to address bio-statistical issues with particular reference to the "York Review":

Dr Johnson - Chair/Convenor 
Dr Anderson 
Professor Clarkson 
Professor Kelleher 
Professor O'Mullane 
& Dr Owens.

This group will meet as soon as possible.

Professor O'Mullane and Dr Johnson are to discuss their nominees and advise the Secretariat; it is crucial that the bio-statistician(s) be present for the presentation by Professor Treasure on the "York Review". (A copy of the "York Review" will be provided to the bio-statistician(s) by the Secretariat in advance of the meeting in March 2001.)

(xiv) The material for the Forum's web site will be sent to the designers as soon as possible.

(xv) A sub-group was established to meet with County Councils which have written to the Forum*:

Dr Mullen - Chair/Convenor 
Dr Crowley 
Mr Fogarty 
Dr Gavin 
Mr Moyles 
Dr Parnell.

* It is important that County Manager/County Engineer be present at such meeting(s).

This group should liaise with the Secretariat.

(xvi) As mentioned at the start of the meeting, there has been no response as yet from VOICE to indicate whether they will make a presentation to the Forum. Professor Fottrell mentioned that following contact from Dr Cullen, Mr Robert Pocock rang the Secretariat on 7/02/01. Mr Pocock stated that (1) VOICE have several reservations regarding the Forum and (2) it is too early for them to make a decision as to whether they are prepared to meet with the Forum. Mr Pocock continued by saying that they will be in contact with the Forum at some stage but could not give a definite date for this. The Forum agreed that it is crucial that VOICE's concerns be expressed and encouragement to the organisation to engage in the consultative process will continue.


Guest Speakers

The Chairman gave details of the guest speakers who have been invited to give presentations to the Forum:

8 March 2001 
Ms Darina Allen 
Professor Elizabeth Treasure

(The Bio-Statistician(s) will be present for the latter presentation.)

5 April 2001 
Professor John Clarkson 
Professor Hannu Hausen

10 May 2001 
Professor Denis O'Mullane 
Ms Margaret O'Neill - Dietitian

The members were reminded that if they have any specific questions which they would like directed at any of the above speakers, they should contact the Secretariat in order that the speaker(s) can prepare/research.

Ms O'Neill, Dietitian, will deal with sources of fluoride intake and the cumulative totals. (This will also be discussed by Professor O'Mullane during his presentation.) Forum members who wish Ms O'Neill to discuss specific issues should contact the Secretariat. The following issues were raised: (1) are there any foods which increase/decrease intake or absorption of fluoride? (2) details regarding consumption levels of milk and any link with fluoride levels; is it possible that dairy products have a protective effect in this regard?

Professor Cyrus Cooper was invited to make a presentation but is, unfortunately, unavailable until the summer - a decision will be made at a later meeting as to whether he should be invited to meet the Forum at that stage; the Secretariat has written to Professor Cooper to ask him for a written submission.

It was agreed that Professor Gary Whitford should be invited to give a presentation to the Forum - June 2001 meeting suggested.

Dr Philip Michael of the IDEA will let the Forum know via Dr Cullen as to whether he will make a presentation.

Toxicological issues and fluoride were discussed. Dr Cullen expressed particular concerns about this issue and suggested a toxicologist recommended by the IDEA who could give a presentation. Dr Gavin has been in contact with a Toxicologist in Beaumont Hospital who is prepared to advise the Forum. The Forum will await recommendations from Drs Cullen and Dr Gavin in relation to this matter.

Professor Clarkson mentioned a review which is being carried out by the Centre for Disease Control in Atlanta which will be released in the next few months - it would be useful for the Forum to examine this if possible and to invite a representative of the CDC to speak to the Forum.


Ethics

Dr Cullen raised the issue of ethics in relation to water fluoridation. It was agreed that this is a very important area for the Forum to discuss in depth i.e. right to choose, ethics of fluoridation when there may be other choices available, etc. The sub-group which was established to examine submissions (see vi, page 3) was also asked to discuss the issue of ethics. Dr Parnell raised some points in this area and the Chairman asked her to prepare a brief paper on issues which she considers should be addressed by the sub-group. Dr Parnell agreed to be a member of that sub-group.

Members were also reminded that Professor Binchy has undertaken to have a paper regarding ethical issues raised in relation to water fluoridation in Ireland in the 1960's. This will be discussed at a future meeting.


Comparisons with Northern Ireland

It was agreed that the Chief Dental Officer of Northern Ireland, Ms Doreen Wilson, will be invited to speak to the Forum on the overall dental health strategy in Northern Ireland with particular emphasis on their decay rates, their strategies for oral health promotion and her views (as Chief Dental Officer) regarding the potential, if any, of water fluoridation to improve levels of dental health there.


Oral Health Promotion

It was pointed out by a member that those most at risk of dental caries are the poor and underprivileged. If there is a viable, safe and effective alternative to water fluoridation the Forum has a duty to consider it. Dr Mullen has a report which discusses the success rates of oral health programmes in relation to the relative wealth of the country involved and will submit this to the Secretariat.

A sub-group was established to look at alternatives to water fluoridation:

Professor O'Mullane - Chair/Convenor 
Professor Binchy 
Dr Crowley 
Dr Cullen 
Ms Gallagher 
Professor Kelleher 
Dr Parnell 
& Dr Shannon.

Ms O'Neill, Dietitian, will be asked for comments/advice as to alternatives and to liaise with this sub-group.


Visit to Water Plant

It was suggested that it would be useful to visit a water plant where fluoridation is carried out in order to see the fluoridation process first-hand. This was agreed and the sub-group which will meet County Councils (see xv, page 5) will do so. The Rapporteur will accompany this group.


Presentation by Mr Ray Parle, Principal Environmental Health Officer, South Eastern Health Board

The text of Mr Parle's presentation was circulated to the members prior to the meeting. He recommends that regular checks on fluoridation plants be made mandatory and that there should be better ventilation in plants.

In response to a query from Dr Cullen, Mr Parle said he was unaware if levels of fluoride in water plant workers were measured.

Mr Parle agreed to liaise with the Forum on issues which may arise and, in particular, with the sub-group which will be visiting a water plant.

In response to a request from the Chairman, Mr Moyles agreed to prepare a paper for the Forum on levels, purity and testing of fluoride/hydrofluosilicic acid. Mr Fogarty agreed to liaise with Mr Moyles on the issue of quality control and related areas.

It was agreed that detailed information on the source of hydrofluosilicic acid is required by the Forum. Details on the remit of the Local Fluoride Monitoring Committees will be requested.

Dr Cullen suggested that the Forum visit a fertiliser factory but it was noted that difficulties may be encountered in gaining observer access to a factory.


Meetings of Sub-Groups

Sub-groups which wish to meet between meetings of the Forum are encouraged to do so; they may contact the Secretariat with regard to booking rooms for this purpose.

Date and location of next meeting

Please note that due to the number and length of presentations planned, the next meeting will commence at the earlier time of 9am on Thursday 8 March 2001 in the Boardroom of Dublin Dental Hospital.

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