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Draft NHMRC Public Statement 2017: Water fluoridation and human health in Australia submission

ID: 
7
Personal Details
First Name: 
Stuart
Last Name: 
Khan
Question 1
Q1. A. The draft Public Statement is presented in a format and manner that is useful, and is easy to read and understand: 
Agree
Comments on a particular section of the Public Statement: 
Question 2
Q2. A. The boxed ‘NHMRC statement’ (page one) in the draft Public Statement is justified and supported by the evidence in the Information Paper: Effects of Water Fluoridation on Dental and Other Human Health Outcomes : 
Neutral
Q2. B. If disagree or neutral, please provide recent scientific evidence not previously submitted to NHMRC. Refer to what is ‘Out of scope for this public consultation’ below: 

I support the text presented. In particular, I strongly support the inclusion of the word “ethical”. I suggest shifting the adjective “strongly” from the start of the first sentence to the start of the second sentence. The reason is that the second sentence more precisely describes the important advice that is being provided and supported by NHMRC (while the first sentence is more general).

Question 3
Q3. A. For policy makers, the draft Public Statement provides sufficient information to support decision making in your jurisdiction or local area: 
Neutral
Overarching/General comments on the Public Statement: 

See comments following about the need to include some justification for the boxed claim that CWF is "ethical". The NHMRC should not leave the need to provide this justification to end-users (who are often local government organisations).

Comments on a particular section of the Public Statement: 
Question 4
Q4. How could the Public Statement be effectively disseminated?: 
Who would find the draft Public Statement useful?
This public statement would be useful for all community members. It should be especially targeted to local government organisations, including elected local government Councillors.
Question 5
Q5. Is there any other information that may be useful to include in the draft Public Statement? If so, please provide details: 

Importance of Community Water Fluoridation:
Despite my general support for the information and positions presented in this fact sheet, I do not think the following sentence is accurate: “Having healthy teeth requires access to fluoridated drinking water, a healthy diet, good oral hygiene, appropriate use of fluoridated toothpaste and regular dental check-ups”. As it is written, this sentence implies that ALL of these measures need to be in place in order for a person to have healthy teeth. Such an implication can be easily disproved by the existence of people with “healthy teeth” living in non-fluoridated areas. In my opinion, this inaccurate sentence leaves the overall statement open to criticism. Perhaps a better form of the sentence would be: “While drinking water fluoridation has clearly proven benefits, additional measures are also required to maintain healthy teeth. These include a combination of healthy diet, good oral hygiene, appropriate use of fluoridated toothpaste and regular check-ups”.

Ethical issues:
The boxed statement refers to community water fluoridation as “safe”, “effective” and “ethical”. The accompanying fact sheet then goes on to provide some justification and discussion for “safe” and “effective”. However, the issue of “ethical” is notably absent from any further discussion. The NHMRC may feel that being ethical is implied by the fact that it is “safe” and “effective”. However, the issue of ethics around “mass medication” is often a key concern for community members. As such, I feel that some justification for why NHMRC considers CWF to be ethical would be appropriate.

FIGURE 1:
The caption says “at 0.6 mg/L or above”. Is there any reason not to simply say “at 0.6-1.2 mg/L"? If it is because of naturally occurring higher concentrations, perhaps this issue should be discussed at some point?

Supporting Documents, Other useful resources. References:
Some of the URLs are in these lists are live (ie, one can click on them with a mouse). Others are just plain text (not live URLs). I suggest that this be corrected so that all of the URLs are “live”.

Page reviewed: 9 November, 2017