Monday, May 17, 2010

Ethics of prophylaxis

Recently the issue of the fluoridation of our drinking water was raised in parliament, to which Minister of Health Khaw gave a written defence.

We have had fluoride in our drinking water since 1954, and it is without doubt the most effective way to protect growing teeth against caries. But it's been more than 50 years, and we are now no more a backward rural third world community with poor dental hygiene. Do we still need that paternalistic hand of protection shovellings fluoride down our throats?

It just made me wonder about what the ethical issues are with respect to governments forcing public health prophylaxis upon citizens. De we have a choice or say in the matter?

No doubt the government has a responsibility to impose public health measures on the population for the public good. I can think of compulsory seat belt laws, or crash helmet laws.... but then these are to protect against serious potentially fatal risks. Compulsory vaccinations at birth.... but these may be defended because they protect the vaccinated and people around them against serious diseases.

Fluoridation does not much more than protect against dental cavities.... an almost trivial concern by comparison. Plus, there are alternative ways to protect the teeth.... good hygiene, fluoride in toothpastes, etc. The public does have a choice in the matter.

How about fortification of milk or beverages with all sorts of vitamins and good-for-you kind of stuff, you say? These are not mandated by law.

So how ethical is it for a government to spike the drinking water with fluoride and force its citizens to consume excessive fluoride? I wonder.


14 comments:

Anonymous said...

you working for a dentist?

gigamole said...

why? Are dental assistants necessarily more curious about ethics?
:)

Anonymous said...

ethics? what ethics?? basic fact of life...no fluoridation, more cavities, more cavities, more money for dentists....

angry doc said...

From what I see in my work, basic dental hygiene is still lacking in our population. And I'm not just talking about the old, but children and young adults, who should know better.

Anonymous said...

well said! all the more these people need help with controlling dental caries!

Anonymous said...

well said! all the more these people need help to control their dental caries! One thing less to worry about!

gigamole said...

:) playing devil's advocate....

now why does one think that gahment should have a responsibility to step in and protect poor helpless people who do not care to look after their teeth?

Should we also legislate mandatory bath time?

Anonymous said...

certainly cheaper than having to treat them when problems arise. After all, doesn't everyone want quick, good, cheap, or free treatment,even when it's their own fault?

gigamole said...

Not sure about the balance of costs..... I imagine there must be a cost to tax payers for maintaining the fluoride content of piped water. And also a cost to managing dental fluorosis, a well known consequence of excessive fluoridation.

Anonymous said...

very negligible compared to providing dental treatment for the masses. Also dental fluorosis in its mild form doesn't require any management (see report). Also major fluorosis doesn't occur unless you're consuming fluoride by the kg

gigamole said...

fair 'nuff.....
guess we are all still quite comfortable with a paternalistic gahment approach towards management of health risks... :)

....there is actually an ethical issue of whether it is appropriate to make compulsory the consumption of an artificially added chemical, even though it is 'for our own good'. Somewhat Orwellian....

Anonymous said...

unfortunately Orwell's philosophies don't work nowadays!

Anonymous said...

Convince me.

Anonymous said...

run for next elections and see!