Having stalled for three years and tried to minimise public debate, National is facing a tough decision on whether or not to compel bakers to put folic acid in all our bread. Either way, there's a price to pay

So, the thing about making it mandatory to put folic acid in bread is that it's a choice about choice - you can either have "free choice" or you can save up to 24 kids a year from spina bifida. You can't have both. So which do you choose?

That's the end of this journey, though. Let's begin at the beginning, and to do that I need to start by saying 'I'm no scientist'. I'm just a journalist. So I'm relying on other experts for the science and employing whatever skills and judgment 20-something years of journalism have afforded me. So away we go...

What's the issue? Three years ago New Zealand was poised to follow Australia (and Canada, the US and 70 other countries, although none in Europe) and put folic acid in all non-organic New Zealand bread; it was to be mandatory. Then Food Safety Minister Kate Wilkinson went on Q+A and got herself in a tangle.

It was Labour who'd committed New Zealand to the folic course, under our joint food safety regulations with Australia. The likes of Annette King and Steve Chadwick were big fans of the health gains they thought would eventuate -- that is, fewer kids getting spina bifida and other neural tube defects. National, as a centre-right party founded on principles of individual choice, had reservations, but didn't want to upset any apple carts with the Australians and felt obliged to honour the previous government's commitments.

But at that point new research had suggested possible links between increased folic acid intake and cancer. Britain and Ireland had delayed their plans to make folic acid in bread mandatory while it was reviewed. Wilkinson ended up saying that she didn't want to do it, couldn't guarantee it was safe ("the science is light"), but had to do it and would review it soon after introducing it.

It was a mess. So a week later John Key - in the first instance of what has become a bit of a pattern with this government - stepped in to clean up. He announced a deferral until May 2012.

So, with a slight delay, here we are.

A working group has been negotiating this since 2009 and, although you'd hardly know it, is in the midst of public consultation. Indeed, that consultation ends in just a week.

You'd think that a major public health policy change would warrant a major public debate. The "stakeholders" involved seem to think otherwise. Try as we might to get them to discuss this on Q+A, they preferred to stick to their "rules of engagement", which amounted to, well, no public debates. It seems they want to build consensus and the like. To be fair to them, it stems from a reasonable fear that the public may get unnecessarily hysterical about the issue. My read is that the doctors are concerned people will hear "mass medication" and panic, while the businesses are afraid people will stop buying their bread.

But it still sounds a heck of a lot like stitching things up behind closed doors. That's woefully disrespectful of you and me.

Ultimately, the only way to deal with an ill-informed public is to inform them, not shut them out. If those of who eat bread aren't "stakeholders", then I don't know who are.

In the end we were able to get some pros and cons to air. But it's fraught. Certainly the science community here in New Zealand seems largely pro-mandatory fortification. Bakers' groups and Food & Grocery Council are opposed.

The latter are using the research of Emeritus Prof. David Smith, formerly of Oxford University, who claims the link between increased folic acid and cancer is real. He says his thinking is mainstream and properly cautious; the trade-off isn't worth it. In this country, Sir Peter Gluckman, the Paediatrics Society and others say he's talking hokum and is "completely" wrong. Their message: It is safe. Full stop.

What's more, since bread was fortified in the US, cancer rates have fallen and there may be a link to the falling number of deaths by stroke.

I can't go much further on the science without leaving the shores of my usefulness far behind, but there are a couple of underlying points worth exploring.

First, our rate of neural tube defects (NTDs) has been falling at much the same rate as it has in the US, where their bread is fortified. All agree on that. So is our improving nutrition and good rates of folic acid amongst women fixing this without the need for mandatory fortification?

To some extent. NTDs have roughly halved since voluntary fortification began in 2009. But Dr Andrew Marshall of the Paediatric Society reckons another 24 kids could be saved from those defects every year if it was made mandatory.

So it seems to come down to this: Do you believe there's a cancer risk or not? Most of the science suggests there's no risk; that which does suggest a possible risk says it's "borderline".That risk, as I understand it, is that it may stimulate existing cancer cells in a few sub-groups of the population. No-one's saying it will "give" you cancer.

Everyone has to come to their own conclusions as to who they believe on that front.

But what seems to upset most people about this is the lack of choice. How dare my right to choose not to eat consume folic acid be removed? And how dare the government decide what goes in my food?

To which I'd reply, they already do. We have food standards up the wazoo. But to be fair, this is an additive, something extra. And people are rightly skeptical.

Then again, what if it was Vitamin C? Would people feel as fearful of a more familiar vitamin? In other words, is choice the issue or does it really come back to risk?

Many say, why not just put it in some bread and leave the rest (as we do now)? Why not educate pregnant women? Why not target it more? If only it were that easy.

Because here's the nub: That won't work for those 24 kids. Or put another way, those kids who can be saved from NTDs by folic acid later in pregnancy are already being saved.

The reality is that many women get pregnant without planning to -- especially those who are young, can't afford many GP visits for "education" and are most resistant to public health campaigns. Even those planning a pregnancy might take a long time to strike oil. And for folic acid to work for those extra 24 kids each year, their mums have to be taking it before they get pregnant.

By the time a woman has found she's pregnant -- typically some weeks after conception - those defects are already there. It's too late to folate, you might say.

So by my reckoning it comes down to an uncomfortable choice. You either protect that free choice or you protect those children. You can't have both.

Still reckon you could run the country better? It's a rotten choice, really, but one we have to make as a country in a matter of days.

Comments (11)

by Lucy Hawcroft on July 08, 2012
Lucy Hawcroft

" Wilkinson ended up saying that he didn't want to do it,"

I know both Cabinet and the political blogosphere are ridiculously dominated by men, but that doesn't mean Kate's gender has changed. With regards to the actual folate - I'd say we might as well just add it now but I'm also not a scientist so my view is of similarly limited value.

(And it's changed - Tim)

by Andre Terzaghi on July 08, 2012
Andre Terzaghi

A few random thoughts to add here...

Calling what's proposed an additive is misleading since folate is already present in baked goods, just in much lower concentrations than needed to minimise diet-related neural tube defects for diets high in baked goods and low in fruits and vegetables. Calling it a supplement or fortification better describes what's proposed.

I would guess that the target group that will benefit most from folate fortification because of a diet high in baked processed goods and low in fresh fruit and veg don't particularly care what's in the s*** they eat. And if you do care about what's in your food and drink, research what's already being put in and compare it to the proposed folate fortification. Or perhaps not, if you scare easily.

If, as a consumer, you want to avoid folate fortification, it will be easy. Buy organic.

We already have a clear precedent for folate fortification: fluoridation of water supplies. We know that excessive fluoride is very harmful, but at the appropriate dosage it is very beneficial for children's developing teeth and poses negligible risk to the rest of the population. Memo to regulators: set the folate fortification rate at the absolute minimum needed to achieve the expected benefits. A little bit being good probably does not mean more is better, something Americans in particular tend to forget.

I find it interesting that the organisations opposed to folate fortification also opposed mandatory labelling of contents, and howl to the moon whenever any additives such as synthetic flavourings or colourings finally get banned because of proven harmful properties.

I don't see that this particular choice is any more uncomfortable than other public health choices such as fluoridation or vaccination. We employ scientists to gather and analyse the evidence and make recommendations based on the evidence. In this case the scientific recommendation is clear and we should act on it. Bring on the folate fortification.

by Ross on July 09, 2012
Ross

> That won't work for those 24 kids.

Oh please, that is just scaremongering. We heard the same scaremongering when the MenZb vaccine was rolled out. The vaccine was apparently needed to stop kids from dying in their droves. That whole exercise was an exercise in propaganda. NZ's most expensive health campaign "may" - according to the Health Ministry - have saved 1.3 lives. Maybe no lives were saved. An incredible waste of taxpayer's money. But obviously a boon for the vaccine manufacturer.

There no doubt will be winners over this matter too. I doubt the general public will be one of them.

 

by Ross on July 09, 2012
Ross
by on July 09, 2012
Anonymous

Once had this debate with pundit three years ago. There is no conclusive proof that by adding folic acid to bread there will be any reduction in NTD's.

All I asked then was that you research this and the false claims you make. Developmental congenital disorders and NTD's have not been reduced with the adding of folate fortification to bread. There are many variables to birth defects, such as obesity etc.

 'So, why are we adding folate/folic acid to bread anyway? The quick answer is, because we're required to under an agreement with Australia.' I find it disturbing that you would  use disabled children  to promote a  costly international agreement.  

http://sci.waikato.ac.nz/bioblog/2009/07/food-folate.shtml

by on July 09, 2012
Anonymous

No Tim you are very wrong ....It's because of  an agreement with Australia. 

There is no choice unless people are informed  and how can that be if the media make up lies.Retract your false claims now Tim, save some face and stop using children as a human shield in policy war. Its about an agreement with Australia.

 

 

 

by Matt Smith on July 09, 2012
Matt Smith

Hi BDBinc

The University of Waikato's Alison Campbell did say "The quick answer is, because we're required to under an agreement with Australia."

But she also cited a study that said "periconceptional folate supplementation has a strong protective effect against neural tube defects".

 and went on to describe the benefits and risks of the proposal without coming down on one side or the other.

Tim: A well written piece. My first reaction to to your story was "Well... crap. I'm glad I'm not in the hot seat right now."

 

 

by on July 10, 2012
Anonymous

Hi Matt, Its BDBinc I got blocked but let me respond.

Alison did note the whole reason for adding folate. I repeat it is "Because we're required to under an agreement with australia."

There has been no evidence to support your claim that  NZ woman in eating 11 pieces of bread per day would even eliminate or reduce NTD or CD .  http://www.drfuhrman.com/library/folic_acid_dangers_and_prenatal_vitamins.aspx

As I said NTD have many causes that are not addressed (genes, fertility drugs, alcohol,B12,poor diet, obesity,drugs). 

 [Ed: The reason you got blocked is because you insist on accusing people of saying things they didn't (such as saying Matt "claim[ed]  that  NZ woman in eating 11 pieces of bread per day would even eliminate or reduce NTD or CD" ... he did no such thing), and then repeatedly proclaiming "there is no evidence" that folic acid in bread can lower the rate of NTD's (the evidence may not be 100% conclusive, but it does exist).

Here at Pundit, we require you to argue in good faith and without misrepresenting those you are responding to. If you can't do that, we will stop you from participating because you add no value to the debate.]

by on July 10, 2012
Anonymous

Ed That is not true, you blocked me as you did not like my request for you to stop making false and unsubstantiated scientific claims.(You have once again failed to give me the link for this instead telling me " it does exist"). Supporting  data for your claim does not exist.

 Studies have produced mixed results with unclear data. Some scientists still claim folate increases already existing cancer  tumor growth.

My response to Matt  was in the first sentence in my comment regarding Alison's link.I did not disagree with Matt's post ,in fact if you read the comment Matt had said the link from Alison that I had posted was neutral.( Sorry  Matt if you thought  that I was directing my whole post to you- guess this is Tim's way of getting out of the hot seat. )

The real truth of NZ adding folate to our bread is  "Because we're required to under an agreement with australia."

I think its unfair to stop people from posting at Pundit for no reason.I did not misrepresent or break any rules .

 [Ed: Your statement "Retract your false claims now Tim, save some face and stop using children as a human shield in policy war" breaches our "play the ball, not the man" rule. Furthermore, you insist on claiming that "we" are making "false and unsubstantiated scientific claims" simply by reporting what scientists are saying on this matter - and without providing any evidence whatsoever to back up your repeated claims that what the scientists are saying is wrong.

Finally, you have what the cops would call "form" in relation to this issue - see the comment thread here. This is your second go around on this topic, which is quite enough.]

by on July 22, 2012
Anonymous

There is no choice unless people are informe--replica handbags

by danniel on December 04, 2012
danniel

Well, keeping a good health should be first our individual priority. Some people may choose not to take the folic acid for various reasons, they should be allowed to chose. I wish they'd put an element in our food that's good for teeth though. As far as I know the health of the teeth is hereditary so in some cases, brushing them correctly is not quite enough. I read few interesting things about that on this Noblesville sleep apnea dentist resource.

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