Inertia on folic acid fortification: public health malpractice.

Globally, 500,000 children are born each year with spina bifida and anencephaly, two of the most common and severe birth defects (Berry et al., ’99). One causes permanent paralysis and the other fetal or infant death (Botto et al., ’99). For more than a decade, we have had randomized controlled trial proof that increased consumption of supplemental, synthetic folic acid will prevent approximately 375,000 of these birth defects each year (MRC Vitamin Study Research Group, ’91; Czeizel and Dudas, ’92). This prevention is urgent! To paraphrase Roosevelt, we can “in little time” implement fortification programs that will “do so much.” The advent of the polio vaccine brought a war-like urgency. In the US, within a few months of the conclusion of the trial establishing that the vaccine prevented polio, a massive amount of vaccine was produced, movie theaters across the country were rented to educate the medical community, and, within a year of the completion of the study, American children received 4.0 million doses of vaccine. Folic acid-preventable birth defects are as preventable as polio! Preventing these birth defects is equally urgent. The technology to fortify is simple and can be inexpensively and almost immediately implemented for large population groups.