If a majority of submissions said dragons were the biggest risk to our nation's defence, would National change its foreign policy? Such are the questions that arise when a minister shrugs off science in favour of "listening"

When it comes to making it mandatory to put folic acid in our bread, I've kept an open mind these past three years. Mandatory is a pretty big step, one that you should only take if you're utterly convinced of the science urging you in that direction.

Ah yes, science.

In 2009 when the new National-led government stalled on Labour's commitment to fortify all bread with folic acid, there was a fair bit of doubt floating about. Britain and Ireland had delayed their intended fortification because of three pieces of research that raised the possibility of a link with folic acid and cancer.

When you had ACT and the Greens both urging you to jam on the brakes, perhaps it was time to adhere to the old journalists' maxim "if in doubt, leave it out".

So the government set up a working group and spent a long, long three years working through the issue. In that time, so the likes of the Paediatric Society say, further research has down-played the cancer link. Any number of doctors are prepared to say that, without question, folic acid is safe, nothing more than a vitamin with no adverse side effects.

Now some still disagree. They seem to be in the minority, but if after three years of debate that was the consensus, fair enough. Or a minister might say that even the concerns of the expert minority are enough to make her pause. If after three years of working group work remaining voluntary was their considered advice, a minister could point to that as grounds for a difficult decision.

But surely one thing a minister wouldn't do, after all this time spent by the working group, the controversey and the screeds of global scientific research, is say 'meh' to science and that her priority was to listen to submissions in an eight week consultation period.

With the risk of several hundred more cancer cases per year being argued by one side and the potential to save 20 kids a year from spina bifida being argued by more doctors on the other, surely the one thing you don't do is say science doesn't matter.

And yet that's just what Food Safety Minister Kate Wilkinson has said. Or should we call her Food Choice Minister, because safety implies a focus on scientific evidence as to risk, and that's clearly something that doesn't trouble her.

Wilkinson blithely said on Q+A that:

"The decision that was made was really based on consumer choice rather than the science..."

She repeated the assertion (eg "consumer choice was really the one that made the most difference in terms of the decision"), mentioning that the science was conflicted and as she was no scientist, she wasn't well placed to judge. The cancer risk, however, didn't influence her decision. It really was all about choice and people making up their own mind. She stressed that as minister her job was to listen to consultation. Given that 88 of the 134 submissions favoured remaining voluntary – largely on the grounds of consumer choice – that was what she'd do.

Which is a quite remarkable statement. I'm sure many of you can think of examples when a majority of submissions has been ignored (mention them in comments). For one, if this government is so committed to listening, it'll surely announce an end to its partial asset sales programme today!

Is National now going to make policy simply on the weight of public submissions? Will no judgment be applied? Is all you have to do is convince National now is simply stack submissions? Is that good governance?

There are questions about the decision itself – such as whether "choice" is a sufficient reason when over 50% of people surveyed by her own ministry last year put 0,1, or 2 out of ten when asked if they knew much about folic acid. And there's the point that starting to take folic acid as soon as you learn your pregnant won't save the extra 20-odd kids a year from neural tube defects, such as spina bifida, that could have been saved by mandatory fortification.

But that's not what this post is about; it's about the decision-making process.

As we saw in the debate on the alcohol purchasing age, there can be there intense debate over what evidence means, but it's expected these days that good policy is evidence-based policy. I can't remember ever hearing a minister simply say that evidence wasn't part of her decision making and that she relied entirely on submissions.

So who were the submitters and what did they say? Here's the Ministry for Primary Industries' summary, which noted that 88 of the 134 submissions were against mandatory fortification and 39 were pro:

Submitters who favoured mandatory fortification considered that the benefits of fortification outweighed the costs and said the risks to the general population were minimal or non- existent. Submissions favouring mandatory fortification were mainly from professional medical associations, doctors and families affected by a neural tube defect (NTD) pregnancy.

Those submitters who did not support mandatory fortification were concerned about the risks associated with adding folic acid to bread, questioned the proportionality of the response (fortifying all bread when only a very small subset of the population would benefit) and objected to the lack of choice mandatory fortification would impose on consumers. Submissions favouring voluntary fortification were mainly from individual consumers, industry associations and individual bakery firms.

So the baking industry won the day over the medical folk, not by the strength of their arguments or superiority of their science, but by the weight of numbers.

Bizarre.

We're an anti-intellectual enough country at the best of times, but to be so cavalier about science is a terrible signal to send.

Of course Wilkinson may totally understand the science and may be stressing the importance of choice for political gain and to avoid taking sides in the scientific debate. But in a way that's even worse. It's like dumbing yourself down so you fit in with the cool kids.

I suspect politically she's with the majority here; New Zealanders hate being told what to do and public opinion tends stress that people don't want to be "dosed" without their consent or face "mass medication".

And if Wilkinson shared that view and was worried about the risk to the many over the benefit to the few, then she could and should have made that case.

But to simply shrug off the science and choose choice is to abdicate any responsibility as a minister. We might as well just have accountants in that role to tally up submission numbers.

 

Comments (19)

by Danyl Mclauchlan on September 03, 2012
Danyl Mclauchlan

I see miracles all around me
Stop and look around, it's all astounding
Water, fire, air and dirt
Fucking magnets, how do they work?
And I don't wanna talk to a scientist
Y'all motherfuckers lying, and getting me pissed

- Miracles, Insane Clown Posse.

by Dave Guerin on September 03, 2012
Dave Guerin

Umm, Tim , for a piece arguing that we should depend upon science, all you've done is link to transcripts of two duelling experts on Q+A and the Minister. If you'd linked to the working group's work, that might have been more in tune with your argument, but I recognise your posts are cross-promotion for Q+A.

You've also set up a false dichotomy of science being perfect and public opinion being bad. I'll trust you that the science shows that adding folic acid to bread will help save 20 kids from neural tube defects. Once you have that information though, you need to balance that up against the costs, which do include (unscientific as it may be) people being pissed off at having something added to their food..I'm not too fussed either way about it, but others are and they're allowed to have an opinion.

by Richard Aston on September 03, 2012
Richard Aston

I am sorry Tim but I don't have the same level of faith in "science" as it seems you do.

I also find it in-congruent that the "scientific" view is against many supplements being sold over the counter but ok to add a supplement like Folic acid into everyone's bread.

I could say the arrogance is breathtaking but I'll try not to get emotive about it.

The bigger question for me is the crowd engineering idea , regulating an additive that all will consume to reduce the harm to a small number of people. The only precedent I am aware of is Iodine in our salt and fluoride in some water supplies.

Personally I am glad the debate on Folic acid was protracted and difficult , it at least constrained the impulse to manipulate the dietary intake of whole populations.

If Folic acid supplements truly do reduce the risk of Neural tube defects why can we not run education programmes for potential parents advising them to include folic acid in their diets - provided free if needed?

 

 

 

by Will de Cleene on September 03, 2012
Will de Cleene

I'm just glad they didn't put thalidomide in bread back in the day.

by nommopilot on September 03, 2012
nommopilot

@Richard

I don't think Tim's argument is that science is infallible, but that given the investigation done by the working group it seems the minister has been pretty quick to ignore the science because she doesn't feel qualified to judge the debate.

If this is the case it seems like relying on public submissions from interested parties (because only interested parties would really bother) is risky.  As he points out if policy gets decided this way then anyone with any interest in a particular decision will know the best tactic is to drum up enough scientific controversy to confuse the minister and then stack the submission process as much as possible.

Good-bye evidence-based decision making . . . .

by Rich on September 03, 2012
Rich

<i>The only precedent I am aware of is Iodine in our salt and fluoride in some water supplies</i>

Vitamins in breakfast cereal - I'm not sure if NZ mandates these, but they were put in because of the tendency for people who replaced more traditional foods with cereal to suffer deficiency. 

On a related topic, I saw a great piece of Hippie Quack Bollox at the Save The Children shop - a facial scrub that claimed to "remove toxins through electromagnetic attraction". The best bit of that is that it's actually true - any detergent would remove toxins (from S. Aureus or something) that might be present on the skin, and the process involves electromagnetic attraction. But that probably isn't what they mean.

 

by Tim Watkin on September 03, 2012
Tim Watkin

Dave, you're missing the point. I know you're no fool, but you're on an entirely different page from what I wrote. As I said, I'm not arguing with the decision itself but at the remarkable way the minister said she reached it. 

If you want more, here's the Paediatrics Society's submission on its website (you don't have to 'trust' me, I did credit them and the link to the Andrew Marshall interview is the Chair of the Society spelling out very cleary why they think as they do). Or I'm sure you're capable of googling 'folic acid working group'!

But I don't think I need to walk people through the science to make my point, which is simply that it disturbs me when a minister making a decision about food safety says science isn't her primary concern.

Same with your second par – I never said public opinion is right or wrong. For one, the submissions don't represent all public opinion. And two, it's irrelevant to my argument. Again, at the risk of belabouring it, my point is that 134 submissions shouldn't be what decides a minister of the Crown, should it? Don't we want our leaders to listen to evidence, whichever side they come down on?

by Tim Watkin on September 03, 2012
Tim Watkin

Richard, Mic has helped me out. If you're looking for infallability, you'll need the divine! I'm just asking for judgment based on evidence, is all. It's a pretty basic post-enlightment argument, I would have thought. I'm kind of amazed you'd even question that!

As you say, it's good the debate was difficult. Indeed, my exact point was that after all that debate and given all the science available the minister said that wasn't what her decision was based on. So essentially you're saying the same thing as me... It feels like no-one read the post! I also said anything mandatory should be seriously and carefully considered.

And there are additives in most foods, are there not? Why is this one any different? Do you know every additive you consume? And how do you define additive? This one's a pretty humble vitamin... Oh, and another mandatory precedent – pasteurised milk.

@ Will. Where did that come from? Again, you're a smart man, why on earth make a comparison between two utterly different things?

by Will de Cleene on September 03, 2012
Will de Cleene

Yeah, I should have included a paragraph or two before that pronouncement.

I have become less averse to mandatory folate in bread than when I wrote this post on the subject, but the point remains that I'm in the half of the population who doesn't need the extra folate. Just as marketing wonks have got women drinking green or yellow top milk, there's nothing stopping breadmakers making "women's bread." Burgen have taken this path with a dazzling array of must-have bread for women. So why the need to spike everyone else's bread?

Thaildomide is an extreme example of bad side effects from bad medicine sold to us by the powers that be (doctors with rubber stamps from the MoH). With the amount of bread some blokes I know eat, can mandatory folaters guarantee that there are no contraindications or toxicity from folate?

The other worry is that food is getting hollowed out by additives as it is. Already I'm wondering how much of the store-bought milk is fresh cow juice and how much is glorified milk powder. Is it too much to ask for 100 percent pure unadulterated bread flour to bake with?

by Rab McDowell on September 04, 2012
Rab McDowell

We need a whole range of nutrients in our diets if we are to be healthy. Many of them are not present in our foods in optimum amounts. Iodine, selenium and fluorine are just three of them. These three are deadly in excess but essential in traces. In most of NZ they are present in suboptimal amounts.

Iodine is added to salt but many who believe natural salt is, well, more natural get less than optimal amounts. In many parts of NZ selenium is available in the food in sufficient amounts primarily because the bread available locally is made from Australian wheat which is grown in soils higher in selenium than NZ soils.  

Fluorine can be added to the drinking water.

Tim, keep the argument the same but change the subject of your post to fluorine and see what reaction you get in the debate between science and consumer choice.

by Richard Aston on September 04, 2012
Richard Aston

Good reframe Rab - yes it would be interesting to change the debate to Fluorine in drinking water. Its the same essential issue for me around the morality of social/medical engineering ie adding stuff to people's diets whether they want it or not because certian experts have decided what is good for us.

And Will good point about consumer choice , ie woman's bread, though I imagine it would have to be supplied at the cheap end as well as Burgan. Those on lower incomes are less likely to be spending money on dietry additives.

 

by Tim Watkin on September 04, 2012
Tim Watkin

When it comes to the actual folate debate, you get closer to the problem in your last comment, Richard. Marketing, especially a line of women's bread that is likely to be high end, doesn't cut it for the poor and young, who are the folk the mandatory fortification would be trying to save.

Of course the more you put it in different ranges of food -- there's nothing special about bread, I'm told, except that it's so widely eaten -- the more kids are saved. But to get the maximum impact (of around 20 kids) the uncomfortable fact is that mandatory's the only way. Of course you pay the price in choice. Which is more important?

(Although that wasn't the point of the post!).

Rab, to pick up your line of thought, perhaps there are already 'additives' in all bread -- or other foods -- that aren't there to begin with. So why do we obsess on this one? One example that leaps to mind - sugar and salt is added to all... I don't know... pre-made pizzas? Because that's bad for everyone. Something else? I know there's a difference between mandatory and universal, but I'm wondering out loud if they're that great and if there are other examples of additives in everything...

 

by Rab McDowell on September 04, 2012
Rab McDowell

Folic acid is not the first nutrient supplement that has been suggested for bread.

Let us put aside fluorine for a moment and consider selenium. New Zealand soils are generally low in selenium. North Islanders generally eat bread made from Australian wheat which is grown in soils with higher selenium content and this goes a fair way to redressing their suboptimal selenium intake. South Islanders, on the other hand, eat bread made from locally grown wheat so don’t get this boost and their intake, on average, is about 20 micrograms a day less than what is considered optimal.  

Let me put this into perspective. A microgram is one millionth of a gram. The population of the South Island is one million. Twenty micrograms each is 20 grams of selenium per day for the whole South Island. That is one tablespoon of sodium selenate. That’s all the South Island is short of each day.

An infinitesimal amount like that could be added, in very dilute quantities to the salt, sugar, flour, butter, water, or almost any part of the diet and so very cheaply. But this was regarded as mass medication so, about 7 years ago, it was suggested that south island wheat growers should apply selenium enriched fertiliser to their wheat fields. It would have no effect on the wheat yield. But it would have meant farmers charging around thousands of hectares of wheat fields burning diesel and wearing out machinery just so a tablespoon of selenium would have been made available to the whole island in a way that was considered “natural”.

The cost would have been many many times more expensive than adding it closer to the consumer. Fortunately, from the farmers’ point of view, the idea was shelved. Presumably, south islanders, apart from the few that take supplements, are still deficient in selenium and suffer the health problems that go with that.

by Will de Cleene on September 05, 2012
Will de Cleene

"Beer contains significant amounts of magnesium, selenium, potassium, phosphorus, biotin, and is chock full of B vitamins." - I love the internet.

by Dave Guerin on September 05, 2012
Dave Guerin

Tim, thanks for the reply. We disagree, but on rereading your piece I take your point about your concern about the decisionmaking process. I underemphasised that before.

You also wrote that "it disturbs me when a minister making a decision about food safety says science isn't her primary concern." But of course this isn't about food safety at all - it's about whether something should be added to food to improve population health. And public health is a pretty poltiical area, as it straddles social and science issues.

by Rab McDowell on September 06, 2012
Rab McDowell

Will - Beer, at least real beer, is made of hops barley malt and water. If the hops and barley are grown in soils that are deficient in some ot hese nutrients then it ain't necessarily so that "Beer contains significant amounts of magnesium, selenium, potassium, phosphorus, biotin, and is chock full of B vitamins."

by Ross on September 07, 2012
Ross

I tend to agree with Richard  Ashton.

A few years back we saw "science" triumph over common sense when the MeNZB vaccine was rolled out by the Healthy Ministry, the biggest health campaign in history. Some $250 million later, experts revealed that maybe one life had been saved. At the time of roll-out we were (wrongly) told that many lives would be saved and it was imperative that we have a vaccine for meningococcal disease. Photos of children without their limbs were shown to frightened parents, showing just how essential vaccination was. The public were treated shabbily, by both officials and scientists. (Ironically, more scare-mongering has recently occurred with the death of a child from meningococcal disease, notwithstanding that the child had been vaccinated against the B strain.)

by Ross on September 07, 2012
Ross

"I'm just asking for judgment based on evidence, is all."

Well, yes, but in this case, we're talking very small numbers of affected kids, similar to the situation with meningococcal disease. And we're also talking about estimates of what will happen to X if we do Y. As I've shown, the same argument was made with respect to MeNZB and it turned out to be a huge waste of taxpayer's money to go with the "science".

 

by danniel on February 09, 2013
danniel

So what's wrong with putting folic acid in bread after all? It's for our best health as far as scientists can say, that's enough to know for me. I rather drink calcium milk and eat folic acid bread instead of staying in a hospital and doing a long treatment for a long term condition that I didn't even know I had. My husband is getting prepared for a teleradiology next week, he's been feeling ill lately, we all hope it's nothing serious.

 

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