Published online April 3, 2006
PEDIATRICS
Vol. 117
No. 4
April 2006, pp.
1460
(doi:10.1542/peds.2006-0012)
The Folic Acid Debate Continues: In Reply
Robert L. Brent, MD, PhD
Departments of Pediatrics, Radiology, and Pathology
Thomas Jefferson University
A.I. duPont Hospital for Children
Wilmington, DE 19899
Godfrey P. Oakley, Jr, MD, MSPM
Department of Epidemiology
Rollins School of Public Health of Emory University
Atlanta, GA 30322
In Reply.—We appreciate the historical perspective that Maberly provides the readers of Pediatrics concerning the obstacles that have confronted scientists when new ideas or discoveries have been proposed to the scientific and lay communities.1,2 Maberly reflects on the lengthy battle that lasted more than a century before iodination of salt was established as an acceptable public health practice; even after acceptance occurred, there were a few doomsday predictors of catastrophe or poisonings.
We remember from our medical history the trauma and ridicule to which Ignatz Philipp Semmelweis, an Austrian obstetrician, was subjected when he suggested that child bed fever (puerperal fever) was a contagious disease that could be markedly reduced by having the physicians wash their hands before delivering their pregnant patients. He met bitter opposition from the medical community that at times amounted to persecution, and he eventually became insane. The attempt to introduce chlorination and fluoridation of water supplies met with opposition from the lay and scientific community because of concern about the hypothetical risk of cancer and other hypothetical adverse effects. Although both chlorination and fluoridation have markedly improved the health of numerous populations, there are still some lay groups and scientists who have suggested that hypothetical health risks outweigh their benefits.
No child should develop folic acid–preventable spina bifida anywhere in the world. It is tragic when prolonged scientific and policy debate about hypothetical risks prevents public health agencies from implementing public health programs that will be of significant benefit to men, women, and children. We have advocated, in 3 commentaries since 2000,3–5 that the Food and Drug Administration (FDA) should maximize the prevention of folic acid–preventable neural tube defects by increasing the concentration of folic acid in "enriched" cereal grains. We believe that scientists and policy makers should sit down soon and objectively discuss our recommendation without being unduly influenced by those who raise hypothetical risks. When this discussion is held, we think that the FDA will increase the concentration of folic acid that is required in enriched cereal grain products. George Santayana wrote: "Those who cannot remember the past are condemned to repeat it."6 We hope that we do not repeat the iodine history with folic acid and thereby continue for many years to have children born with serious birth defects that could have been prevented by appropriate public health actions.
REFERENCES
- Matovinovic J, Ramalingaswami R. Therapy and prophylaxis of endemic goiter. In: Endemic Goiter. WHO Monograph Series 44. Geneva, Switzerland: World Health Organization: 1960:394
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- Hetzel BS. Historical development of the concept of the brain-thyroid relationships. In: Stanbury JB, ed. The Damaged Brain of Iodine Deficiency. New York, NY: Cognizant Communication Corporation; 1994:1
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- Brent RL, Oakley GP Jr, Mattison DR. The unnecessary epidemic of folic acid–preventable spina bifida and anencephaly. Pediatrics. 2000;106
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- Brent RL, Oakley GP Jr. The Food and Drug Administration must require the addition of more folic acid in "enriched" flour and other grains. Pediatrics. 2005;116
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- Brent RL, Oakley GP Jr. Triumph and/or tragedy: the present Food and Drug Administration program of enriching grains with folic acid. Pediatrics. 2006;117
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- Santayana G. Reason in Common Sense: The Life of Reason. New York, NY: Charles Scribner's Sons; 1905:284
PEDIATRICS (ISSN 1098-4275). ©2006 by the American Academy of Pediatrics
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