September 2, 2002
Brushing beats supplements - Belgium's fluoride ban
(Note: This article was originally available,
September 2nd, at http://www.nutraingredients.com/news/news.asp?id=5259
02/09/02 - A ban on the sale of fluoride supplements passed by Belgium on 1 August provoked strong reactions, in particular from anti-fluoride campaigners who viewed the news as a sign of progress. Belgian health minister at the time Magda Aelvoet said she was now pressing for a Europe-wide ban, hinting that the removal of supplements was just the first step towards removing the chemical from the food chain.
The supplements have not been re-stocked on pharmacy shelves for nearly three weeks now (they will be phased out gradually - current stocks will not be replenished), although they are still available with a doctor's prescription. NutraIngredients.com tried to assess the impact of the move for manufacturers of the supplements, and asked a Belgian health ministry spokesman (who preferred not to be named for this interview) if Belgium's policy would ever have an impact on the rest of Europe.
The spokesman said that the issue had been given exaggerated coverage in some media, and that in fact, supplement manufacturers and the dental profession were behind the move.
"We do not think there is an economic impact on the industry. In Belgium at least, Novartis takes care of around 99 per cent of the market. I don't have the figures to hand, but the size is not that significant and fluoride supplements are usually a marginal application for the companies involved.
"The main product available in Belgium is Zymafluor, in tablets, which is produced by Novartis Consumer Health. We have spoken to them and they had no negative reaction to the move. In fact they had an existing registration for the drug as a medicine, so they are going to bring it back onto the market," he said.
However he did admit that the ban could be seen in a negative light in some cases. "There could be opposition from the industry because of the image of fluoride - if some uses of fluoride are banned, this could undermine the use of fluoride as a whole."
Belgium's ban is a result of a report carried out by the health ministry's advisory body, the High Council for Health, which claimed to have reviewed all scientific studies on fluoride supplementation. It concluded that excessive use of fluoride increases the risk of osteoporosis, and could also lead to damage of the nervous system.
This is of course disputed by other experts and individual studies but the health ministry is now planning to present the review, currently being prepared by its advisory body, to the European Commission this month in a bid to make Europe follow its lead.
There is however one major barrier to European legislation, and also Belgium's current ban - the EU directive on food supplements which was passed this year and must be implemented from July 2003. The directive already includes fluoride, so to maintain the ban, Belgium must persuade other member nations to support its move. Without Europe's support for the policy, supplement manufacturers would in theory be able to bring Belgium to the European Court of Justice for blocking free European trade.
"We think we have very strong arguments for the ban," responded the ministry spokesman. "And it is rather uncertain when the list of supplements (the Directive) will come in. We have asked the council of health to prepare a review of the existing scientific evidence to be presented to the European Commission so we are presenting them with a solid scientific basis for the ban to be brought into Europe."
Given that Ireland and the UK both currently have water fluoridation programmes, and other countries such as Switzerland, Germany and Austria have fluoridised salt widely available, changing European opinion is going to be a formidable task for Belgium.
"At least we will have the opportunity to discuss it. We are not trying to change everything in Europe. This issue has been around since 1995 when Aelvoet first tried to put it on the European agenda, and it has surfaced again. We are hoping to be able to ban it on a European level as soon as possible though," said Belgium's spokesman, although he declined to speculate on the obvious consequences - without this ban on a European level, fluoride supplements could soon be back on sale in the country.
Belgium's scientific review is also likely to witness some opponents. Evidence that suggests fluoride does not in fact harm health is substantial. A UK study published in 2000 found that there was no clear evidence that water fluoridation was linked to any health problems. Belgium however looks at the argument from the other side of the coin:
"We base our opposition to fluoride on the fact that there is no positive impact from the supplements - brushing teeth with fluoride toothpaste is sufficient and there is no reason to do anything else. Fluoride should be applied topically to prevent caries, but should not be swallowed, especially by children who are more vulnerable to it. Although there is natural fluoride in tea and water, for example, we think that there are significant differences between the natural chemical and the synthetic fluoride used in dental products. And we have looked at a general review of the total literature, rather than a single study - we all know studies can sometimes be biased," responded the health ministry spokesman.
Belgian officials are still prepared to agree that the ban is controversial but suggest that as with any change in opinion to accepted scientific thinking, time will lessen the impact.
Belgium's spokesman also claims that the controversy arose largely through the way the news was presented and not because of the issue.
"The news came out mid-summer, while Magda was still on holiday and before we had actually officially released it. It was used as a cover story on one magazine (the Belgium-based Humo), and as the minister was away, speculation couldn't be controlled. The reaction was clearly about the communication of the idea, rather than the decision," said the spokesman.
He explained: "The way it was presented in the press led to much confusion over whether it applied to toothpaste. The position is very clear now, and it is supported by the dentists in Belgium. People should not consume fluoride but instead use it directly on teeth, such as when brushing with fluoride toothpaste. There may be an issue for children under the age of six, who sometimes swallow toothpaste, but we recommend that doses should be as low as possible.
"There has been no decision whatsoever on toothpaste however, despite other interpretations of our position. But I think we've cleared up the controversy and the debate is finished," he added.
Belgium's spokesman may be confident that the debate is over, but it is clear that an altogether bigger one is imminent when the European Commission hears Belgium's case. Magda Aelvoet has since resigned from office over a separate issue and it remains to be seen how far the new health minister plans to take the issue (in the interview with Humo, Aelvoet said that she would ask manufacturers to make toothpaste fluoride-free).
Whatever the outcome, it will take more than one
country to change the opinions of those who believe that fluoride is a beneficial
factor, whether in water or in the form of supplements and dental products,
but Belgium seems intent on trying.