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Peter Williams: Folic acid in bread - are you ok with mass medication?

Peter Williams 08/07/2021

OPINION: I'm ok with folic acid being added to my bread - it's for the overall good 

This decision about putting folic acid in our bread-making flour. The government has decided it will finally do it, 12 years after Australia started doing it, because there is very strong evidence that it reduces the number of babies born with neural tube defects, the most common of which is spina bifida. So why has New Zealand been such an outlier on this when reportedly over 80 countries already do it? And are you in agreement with this policy?  It comes soon after the government also decided that the decision on fluoride in water supplies would be made by the central government and not by local councils.

To be honest the numbers and the costs involved are, in the overall context of the New Zealand health system, not huge. The fortification of bread with the folate is expected to prevent upwards of ten neural tube defected pregnancies a year in the next three decades, and therefore save up to 50 million in health, education and productivity costs over that same time. And all this for a relatively small one off investment of 1.6 million for the appropriate equipment for the flour millers, and presumably a small ongoing annual cost for the folate itself. But the actual benefits could be higher because the addition of folate could prevent miscarriages early in pregnancies, statistics for which are not kept.

The pushback against the addition of folic acid seems to have been based more on the arguments of “nanny state” and “mass medication” rather than on any real evidence of a disadvantage to society at large if most bread was made from fortified flour. Yet evidence of the advantages of folate being added seem pretty conclusive. Australia has had it in place for 12 years and the incidence of neural tube defects in babies born has dropped by 14 percent and by a huge 74 percent for indigenous women and 55 percent for teenage mothers. The reason for the discrepancies in those numbers is that most pregnancies in indigenous and teenage women are not planned, therefore there was no opportunity for the women to take the appropriate folate supplements before getting pregnant, and the defects form in the first 14 to 28 days after conception, a time when a lot of women don’t even know they are pregnant.

So are you pleased this decision has finally been made? The results from Australia since 2009 seem conclusive, another study here by the Prime Minister’s Chief Science advisor as recently as 2018 concluded that the benefits of mandatory fortification outweigh any potential adverse health effects, with no evidence of harmful effects in adults, at least in the low doses in the range suggested for fortification. So for those of you worried about the concept of mass medication, doesn’t the evidence from our nearest neighbour over more than a decade stop you worrying? Public health decisions have to be weighed up on a risk and benefit basis. It would seem that this should be one of the least contentious public health decisions of recent times. A small investment to reduce the cost of ongoing benefits required for people who would otherwise need long term assistance in life because they’re born with a disability.

Listen to Peter Williams every weekday from 9am on Magic Talk.