NZ Fluoridation review – HS Micklen responds to critique

I have posted several articles in a series critiquing contributions to the Fluoride Free NZ report Scientific and Critical Analysis of the 2014 New Zealand Fluoridation Report which is aimed at discrediting the recent review Health Effects of Water Fluoridation: a Review of the Scientific Evidence produced by the Royal Society of NZ together with the Office of the Prime Minister’s Chief Science Advisor. The articles in this series are collected into a pdf document which can be downloads from Download report analysing anti-fluoride attacks on NZ Fluoridation Review.

In an attempt to encourage a discussion on the fluoridation review and the FFNZ report I offered all the authors and “peer-reviewers” of the FFNZ report the right of reply to my critiques. So far Dr H. S. Micklen (whose article I critiqued in Fluoride Free NZ report disingenuous – conclusion), is the only one to take up this offer.

Here is his reply. 

I thank Dr Perrott for reproducing my notes on the NZ Fluoridation Review and appreciate his comments. My appreciation would be warmer had he spent less time using his imagination and paid more attention to what I actually wrote.  He has me bustling around, agenda in hand, clutching at straws here, raising bogeys there, scaremongering, relying on this, calling for that, and getting confused about different grades of fluorosis (as if..,). All nonsense.  If I “distort the science” as Perrott’s headline proclaims, he does a great job of distorting the distortion.

Most of my short piece merely commented on a few places where, in my opinion, the NZ report failed – through error, omission or incompetence – to reach proper standards of objectivity and impartiality and exhibited ill-founded complacency. Since the NZ report was highly biased in favour of fluoridation, any criticisms of it are likely to have an anti-F flavour. Too bad; I was dealing with the report’s view of the science, not pushing my own. I avoided speculating on the outcome of issues that I consider unresolved, dental fluorosis (where Perrott makes nonsense of what I wrote) being the only exception.

Most of these issues have been argued over ad nauseam and I shall not try to unscramble Perrott’s lucubrations. The question of chronic kidney disease and its possible cardiovascular consequences is perhaps an exception. I gave credit to the Review for discussing the paper by Martin-Pardillos. Agreeing with the Review’s opinion that the results needed to be confirmed, I remarked “The interesting question is, what should happen meanwhile?” That is not a rhetorical question. What does, or should, happen when an alarm bell sounds over a long-established procedure? Does further research on the topic receive any funding priority, for example?  Perrott uses a piece of grammatical legerdemain to pretend that I called for CKD sufferers to be warned to avoid tap water, which I did not. In fact, I am inclined to agree with him that that might be extreme in the present state of knowledge. Perhaps it would be embarrassing, too, for a government to insist on putting fluoride in the water and then advise a substantial number of people not to drink it – or so one might think. But Perrott concludes “Any patients who are particularly worried can then take steps like using filtered water for their own peace of mind. This seems more appropriate than denying the rest of the population access to a simple, effective and safe (for them at least) social health policy like CWF.”  So that’s all right then, thanks to the patients, whom Perrott doubtless consulted, being willing to promote the alleged greater good. He has pricked a hole in the old mantra, though: “effective and safe – for some”.

Perrott asked for my feedback on his idea about the possible effect of dental fluorosis on IQ.  Since then his paper has appeared online as a short article in Neurotoxicology and Teratology. Perhaps the best thing I can do at this stage is pretend that it had arrived on my desk for peer review. I would have commented as follows.

“This communication refers to a recent paper by Choi et al (2014) that reports certain cognitive defects in young children affected by moderate-severe dental fluorosis. Choi et al suggest that this is due to an adverse effect of fluoride on the developing brain. The present author proposes an alternative explanation, namely that fluorosis itself, and the stress of living with it, can affect learning and general quality of life and result in poor performance in certain types of cognitive test. This appears to be a novel idea and, as such, is suitable in principle for publication as a short communication. There is, however, a fundamental question that the author should be invited to address and clarify with a view to possible resubmission.

“The paper is somewhat discursive and lacking in focus and in the course of it the author seems to lose track of what age group he is talking about. Surprisingly, he does not mention the age of Choi’s (2014) subjects, which averaged 7 years  (range 6-8). When he finally presents evidence that moderate-severe fluorosis is aesthetically displeasing and likely to impair quality of life, all of it relates to older children, mainly teenagers, who have reached an age to be self-conscious about their appearance and have been living with fluorosis for several years. In contrast, 16% of Choi’s (2014) subjects had no erupted permanent teeth at all and in the remainder eruption of the first permanent teeth would have been very recent. Since fluorosis was common in the community, having the condition would not appear abnormal. The crucial question is whether the author is proposing that the quality of life of these young children is so compromised by fluorosis as to impair their performance in cognitive tests. Apparently the answer is a tentative affirmative: It is just possible that the negative quality of life associated with oral defects like severe dental fluorosis contribute to cognitive deficits reported by Choi et al. (2012, 2014)’

“The author needs to discuss this issue in a transparent fashion so that readers can judge for themselves whether the proposal is plausible. Conversely, if he is not making such a proposal, that too should be made clear.

“The author might wish to refresh his memory of the paper by Hilsheimer and Kurko (1979), which really is of virtually no relevance to his argument.”

I hope this helps.

H S M 12 February 2015

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9 responses to “NZ Fluoridation review – HS Micklen responds to critique

  1. Micklen’s response here mirrors antifluoridationist arguments in general……no substance, and cowardly little word games

    Micklen claims that Ken’s statements are “nonsense”, “lucubrations”, and “grammatical legerdemain”, but instead of explaining why, he uses the standard anti dodge of “I could explain but won’t waste time doing so here” which he expresses as “Most of these issues have been argued over ad nauseum and I will not try to unscramble Perrott’s lucubrations”. If he could explain the criticisms, he would. Period.

    Micklen’s protestation that “Perrott uses a piece of grammatical legerdemain to pretend that I called for CKD sufferers to be warned to avoid tap water, which I did not.” is nothing short of ridiculous. What Micklen did in his article was to claim that CKD patients should be “warned” about tap water, while cowardly leaving himself an escape hatch of rhetoric. He stated in his article:

    “The interesting question is, what should happen meanwhile? I suspect that most opponents of fluoridation would call for CKD sufferers to be warned to avoid tap water. Possibly the NZ health authorities have done so. If not, will they follow the “no adverse effects” message on page 9, or will they adopt a more precautionary approach to protect this group of patients from possible harm? And will further study of the matter be given any degree of priority?”

    Antifluoridationists use this cowardly tactic frequently when making claims they know to be erroneous, libelous, and/or completely false. They will state such things as “many consider…..”, “some people say…..”, “it has been said…….”, etc. etc, instead of having the courage and conviction to stand behind their own claims and beliefs. That Micklen attempts this transparent tactic is bush league, and demonstrative of his own lack of credibility.

    Steven D. Slott, DDS


  2. Hi Steven
    A friend sent me this and I thought of you and Ken!


  3. The logic of the comparison and therefore the analogy is glaringly flawed yet
    I bet it bamboozles the faithful.
    I’m assuming, Trevor, that you can’t see where its flawed.


  4. Richard – C’mon do the world a favour and enlighten us on where the analogy has holes in it. As a faithful proponent of fluoridation you should be capable of unbamboozling us surely!


  5. Trevor, I’ll assume your reply is an admission that you can’t identify any of the logical fallacies in the clip.

    Claim: The reality of the universe is that cruelty and suffering exist and is suffered by more than just our species. That is, the universe is imperfect from that viewpoint. This provides reason to disbelieve the existence of a a creator that claims to be omniscient, perfect and benevolent.

    Counter claim: Because dental decay exists, that is reason to believe that dentists don’t exist, because dentists are not responsible (or are responsible, either way the argument is nonsense) for existence of decay.

    Go figure,

    It is interesting that you thought this is an argument worth sharing.


  6. from the original post by Ken under the Kidney disease section:

    “I reject Micklen’s suggestion that:

    “Perhaps it would be embarrassing, too, for a government to insist on putting fluoride in the water and then advise a substantial number of people not to drink it – or so one might think.”

    That is silly – it is like a conspiracy theory. Why would genuine health authorities refuse to give warnings to a small group of people who might be put at risk from a social health policy that is beneficial to the vast majority? Surely they are used to such situations.”

    That all depends on how you define the risk of mild dental fluorosis. Is that a risk worth reducing? If you do belive it’s worth preventing, then I will answer your question as to why “genuine health authorities refuse to give warnings.”

    Fluoridation is supposedly a trade off, more fluorosis for less tooth decay. You might think that public health would want to prevent mild fluorosis caused by fluoridated water when fluoridated water provides no benefit to the individual. Infants fed formula prepared with fluoridated tap water are at greater risk for fluorosis of permantent teeth for no benefit, but parents don’t know that becaue to tell them casts doubt on fluoridation. So public health dentistry opposes all efforts to prevent fluorosis by informing doctors and parents about this risk. When you consider that this high dosage causes skeletal fluroosis you might think that these infants have been carefully studied to check for other adverse effects. But that has not happened.

    Certain avenues of scientific research into fluoride effects are avoided in fluoridating nations. Here’s another example of that from FAN:

    “In 1979, scientists at the Mayo Clinic documented the occurrence of crippling skeletal fluorosis in patients with advanced kidney disease drinking water with just 1.7 ppm fluoride. (Johnson 1979). Based on these findings, the authors reasoned that a similar risk would likely exist at the fluoride level (1 ppm) added to water to prevent tooth decay. Despite the Mayo Clinic’s findings, and despite numerous calls for studies to determine the rate of skeletal fluorosis among people with kidney disease, there has yet to be a single such study in the United States or any other fluoridating country, to determine the prevalence of skeletal fluorosis, or more subtle indications of fluoride toxicity, among patients with kidney disease.”

    To discover that advanced kidney patients are being harmed by fluoridation would be bad for the public image of fluoridation. So maybe it would be better to not even try to find out if they are harmed. Thus, no more research into that. This way no warnings have to be given to these kidney patients and they will not join together to oppose fluoridation.

    A well known, powerful high level public health official and fluoride scientist in the U.S. belives that we should not try to prevent mild fluorosis. He also believes that severe dental fluorosis is not an adverse health effect. With attitudes like that it’s not suprising that the proposal to reduce the recommended fluoridation level by one federal agency was shot down by others in the government.

    A lot of the differences we have are due to widely different opinions on how serious fluroosis is and wether it should be reduced. In nations with fluoridation fluorosis is seen as only a minor cosmetic issue. In nations with skeletal fluroosis their researchers find a lot more harm from fluoride and are opposed to fluoridation.

    Who are the scienfific experts on skeletal fluorosis in the U.S. and New Zealand? Are there any? If they can’t be identified then I wonder how good our fluoride reserchers are compared to nations that seriously study skeletal fluroosis.


  7. Douglas, you are confused again. You have jumped from a comment I made about CKD to dental fluorosis. A different subject altogether.

    You relate your original question to “mild dental fluorosis” and then ask vague question if that is a risks worth reducing? And then attribute a question to me as to why “genuine health authorities refuse to give warnings!” Where the hell do I make that claim?

    Again you make the unwarranted claim that “fluoridated water provides no benefit to the individual!” A claim conflicting with the scientific evidence and one you present as axiomatic!

    Infants entirely formula fed are at increased risk to having the milder forms of dental fluorosis (and of course children who are not fed like this are still at risk, although maybe slightly smaller, of this dental fluorosis). On the one hand these milder forms are generally not considered aesthetically negative (in fact they are often considered positively). On the other hand the benefits of fluoride are well established for infants.

    But you are completely wrong to claim health authorities refuse to inform parents of these risks. They in fact do – clearly indicating that it is not something to be concerned about and hence recommending continuing to make up formula in the same way. But at the same time they provide a “peace of mind” advice to parents who are concerned that they should at least occasionally use unfluoridated water in making up the formula.

    Nothing is being hidden from parents, the advice is well based scientifically and any remaining concerns parents may have is taken into account in the “peace of mind” advice.

    You also misrepresent the situation with skeletal fluorosis which is extremely rare in countries like NZ and is not caused by CWF. You are simply scaremongering and using a conspiracy theory as part of that scaremongering.

    You may not be aware of it because you rely on fluoride alert rather than the scientific journals but research on fluoride, it’s benefits and possible health effects is ongoing. No one is trying to prevent it or hide the results.

    But there are people who maliciously attempt to distort and misrepresent the research findings. I suggest you have too much faith in those people.



  8. Douglas

    Yes, mild dental fluorosis may be an effect to be avoided……..but only if there are no consequences to so doing. Given the resistance to dental decay associated with this effect, though, it is highly questionable as to whether it should be avoided at all. This benign, barely detectable effect does not, in any manner rise to the level of warranting an interruption in water fluoridation. On one hand you have an effect which is barely even detectable, is indicative of increased resistance to dental decay, and causes no adversity on cosmetics, form, function, or health of teeth. On the other, you have a public health initiative which has been clearly demonstrated effective in preventing disease which causes lifetimes of extreme pain, debilitation, black discoloration of teeth, development of serious medical conditions, and life-threatening infection.

    I have practiced dentistry in a fluoridated community surrounded by fluoridated communities, for 33 years, fluoridation having begun in these areas over 40 years ago. During that entire time, I have as yet to see one, single case of dental fluorosis in any manner attributable to optimally fluoridated water, that would even be detectable outside of close examination in my dental chair. I fed my infant children powdered infant formula reconstituted with fluoridated water, and recommened they now do so with their own infant children…..which they do. I have no reason to second guess that decision in either case, and would make the same one again, without hesitation.

    There is no valid evidence that mild dental fluorosis is indicative of any problems within the body. Mild dental fluorosis is not an issue. Period.

    Steven D. Slott, DDS


  9. Pingback: Fluoride and Water Fluoridation - Hillside

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