Letters

Folic acid and the prevention of neural tube defects

EDITOR,--Nicholas J Wald and Carol Bower advocate the compulsory addition of folic acid to flour to prevent 1000 of the 1500 pregnancies in which the fetus has spina bifida that occur annually.¹ Few cases of children with spina bifida being born would be prevented. Most cases are already discovered in utero and terminations occur in most cases, so the main financial saving would be that of fewer terminations being performed. Ultrasound screening of pregnancies would undoubtedly continue, so there would be no savings there. Any savings made must be set against the cost of fortification.

When health policies entailing compulsion are proposed the transitory nature of medical "truths" must be borne in mind. Which general practitioner has not smiled wryly on going through an old patient's notes? Such records are a catalogue of misguided and unsafe medical . . . [Full text of this article]

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Relevant Articles

Folic acid supplementation before pregnancy remains inadequate

W J Huttly, N J Wald, and J C Walters
BMJ 1999 319: 1499. [Extract] [Full Text]

Folic acid and the prevention of neural tube defects

Nicholas J Wald and Carol Bower
BMJ 1995 310: 1019-1020. [Extract] [Full Text]

This article has been cited by other articles:

• Persad, V. L., Van den Hof, M. C., Dube, J. M., Zimmer, P. (2002). Incidence of open neural tube defects in Nova Scotia after folic acid fortification. CMAJ 167: 241-245 [Abstract] [Full text]  
• Huttly, W J, Wald, N J, Walters, J C (1999). Folic acid supplementation before pregnancy remains inadequate. BMJ 319: 1499-1499 [Full text]