HEALTH CARE/Joan Retsinas

Folic Acid: A Liberal's Holiday Story

Most holiday legends showcase wonderfully jovial heroes (Santa Claus), courageous heroes (the Maccabees), pious heroes (St. Nicholas). None showcase government -- certainly not today's contentious Congress or the unwieldy bureaucracy of the Department of Human Services. Yet in this season of feasting, the tale of folic acid deserves telling. And Congress, along with the federal Department of Human Services, deserves our thanks -- even the thanks of those who yearn to shrink government.

The tale begins 10 years ago with a few grim, but seemingly inexorable, statistics. The infant mortality rate in the United States has plummeted since the start of the century (thanks to public health measures -- again, government as a mini-hero in another public health tale). Nevertheless too many infants die from birth defects -- most often, anomalies in the spine and brain. Each year 4,000 pregnant women carry fetuses with neural tube defects; 2,600 of those infants will be born alive. But many die at birth, or shortly afterward. The survivors suffer from paralysis that ranges from mild to severe.

There is no one bacterial culprit, no one deadly virus scientists can attack.

Scientists, though, discovered that increased levels of folic acid (a B-vitamin) would help prevent those anomalies. Specifically, women who consumed 0.4 mg daily would dramatically reduce their chances, by as much as 50%, of carrying a fetus with a neural tube defect. In 1992 the United States Public Health Service officially urged all women of "child-bearing age" to take folic acid.

From science to practice is not a short leap, however. First, the normal diet rarely provides that level of folic acid -- even for vegetarian women addicted to broccoli. Second, women will reduce their risks if they increase their folic acid before conception and for the first few months of pregnancy: This is when the key fetal organs are being formed. Yet many women don't plan to conceive when they do; and few women think about the welfare of babies conceived only if contraception fails. Third, few people know what folic acid is or does. In the barrage of admonitions to gulp calcium to stave off osteoporosis, Vitamin E to stave off dementia, and vitamin C to stave off colds, the folic acid message gets lost.

Enter the federal government. In January 1998 the Food and Drug Administration required the producers of "fortified" foods to add folic acid to the list of fortifications. Today pasta, flour, cornmeal, rice, and cereals generally have folic acid. So the pumpkin pie served for Thanksgiving dessert, the channukah latkes, the Christmas cookies all may have folic acid. And women who might or might not get pregnant are consuming more folic acid, without any concerted effort on their part.

The early results are promising. The CDC reported that the levels of folic acid in a recent sample of women had more than doubled from blood samples taken six years ago, before the FDA ruling.

As for the future, some people -- like the Spina Bifida Association -- argue for higher levels of folic acid fortification; but the Department of Human Services fears that increased levels in food would harm elderly people. [An excess of folic acid can mask pernicious anemia in the elderly.] On the personal level, the March of Dimes continues its campaign to make physicians recognize the importance of folic acid, and to make "childbearing-age" women take supplements.

Meanwhile, though, the families toasting their good fortune around holiday tables -- and the thousands of infants lustily, and healthily, squealing their way into the world this coming year -- should rejoice that a contentious government, with its unwieldy bureaucracy, entered the fray on their behalf.

Joan Retsinas is a sociologist who writes about health care in Providence, Rhode Island.

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