Folic acid is taken by women to make a very rare disease even rarer. Although it is important to try and combat this just as we should combat every disease, I still suspect that the enormous waste of resources involved in mass medication could probably be used to achieve greater results if targeted on another health problem.

I just cannot see how such a wasteful policy could be the right thing to do – quite apart from the moral issues with mass medication.

To quote Henry Hazlitt: “The art of economics consists … in tracing the consequences of that policy not merely for one group but for all groups”. It is easy to look at this and say it might prevent some birth defects, which may well be true, but that does not necessarily mean it is a good policy. How much cash are we talking about? And how many other health problems could be solved with that cash? That’s what no-one ever seems to consider.
Mr Dennis´s last blog ..Mrs Dennis is a right social moderate

Actually, the Canadian and American experience is that it has been highly effective – much more so than a strong advertising drive to get all pregnant women to take their folate. Frankly, my first thoughts about this matter were like yours, but the facts are the facts…

Stick with pills, subsidise them if you really want to get socialist about it,

Too late – folate is already subsidised. The socialists beat you to it!

During the first trimester many women have upset appetites and find it difficult to eat some foods – so in this situation not only may the pregnant woman’s intake of folate during the first trimester be actually LOWER than during the rest of her life (if her appetite is reduced), it may be virtually nil if she is living on complan and fruit (or whatever other wacky diet the pregnant mind thinks up).

We would be wasting tonnes of folate to try and treat a few women, who may not be being medicated by it at all. You may as well try and shoot a flea with a shotgun.

Stick with pills, subsidise them if you really want to get socialist about it, but don’t force us all to eat something we don’t need.

Here’s a more effective socialist scheme: Take the cost of ‘5c a loaf’, multiply that by how many loaves we buy, and you’d probably have more than enough cash to give every woman 20 years supply of folate pills upon leaving high school. Problem solved far more simply and cheaply.
Mr Dennis´s last blog ..I am a right moderate social libertarian, apparantly

For all sorts of reasons I say NO to mass medication.

I don’t know where they get the figure of 1-5 birth defects a year from. The Canadian and US literature puts it at a minimum 25% reduction and as high as 60% in areas of high defect rate. New Zealand has a rate of 25 neural tube defects a year, but that does not include the neural tube defects picked up on amniocentesis and terminated, which would at least double that figure. That means between 15 and 30 NTD prevented annually.

To get that level of prevention, women would have to be taking folate throughout the first trimester of pregnancy. Given that a woman won’t know she is pregnant until about six weeks, and often not until several months, the only way to ensure adequate folate supplementation in that first trimester is to supplement all women of child-bearing age. Hence fortification of flour.

The cost of this to you is about 5c a loaf. And folate supplementation has a number of additional positive benefits, including reduction in the rate of dementia and, possibly, reduction in heart disease. Apart from a few small children, exceeding the maximum recommended dosage (which is a guess anyway – there is no evidence folate is toxic beyond that dose) is extremely difficult. An adult would have to eat an entire loaf a day. I submit to you that someone who eats an entire loaf of bread a day probably has bigger issues in his/her life than a bit of extra folate.