John Crown (Independent) | Oireachtas source

I was trying to find out what was the first paper from Ireland on the issue of FA and neural tube defects because a lot of research was done on this here by Professor Weir and Dr. Scott. Ireland has contributed significantly to this area. I am delighted to see such high quality publications from Professor Turner and others in this area.

I thank Professor Turner. This is very important. Much time is wasted within the walls of these buildings but there is a real chance that something could come out of today’s meeting that could make a difference. Professor Turner refers to people having surgery for neural-tube defects and while I am rusty on paediatrics my clear recollection is that the surgery for patients with neural tube defects does not correct the underlying neurological deficit. If somebody is born with severe spina bifida to the extent of having neurological compromise or paralysis the surgery does not fix that, it closes the defect in the skin and back. There is no treatment for a neural tube defect. What you see is what you get.

What is the cost of FA supplementation? Whenever we attempt anything in public health which can be construed as mass medication there will be a fringe of objectors who will raise concerns about potential side effects and health consequences of the intervention because we are medicating many people who do not need the intervention to bring a great benefit to a small number of people. Is there any credible evidence that there are any side effects from mass medication with folic supplements, either medicinally or through food supplementation? Do we know what was the chain of events whereby the food industry decided to reduce the folic content? Was it just a cost issue? Did it find it cheaper not to do it or were there other considerations? This may not be something Professor Turner has first-hand experience of but I would welcome his speculation on it.

Some of the issues Professor Turner has mentioned about the epidemiology of the decline in the uptake of FA among women presenting for antenatal care had a little ring of being a surrogate for socio-educational status and I presume that is a major factor. In so many issues in public health, be it obesity or cigarette smoking, we find that the burden of preventable illness is falling on the people who can least afford it. I would be grateful for Professor Turner’s insights into that.

What would be Professor Turner’s best guess if we had a folate tsar? I dread to say it because I am sure the Health Service Executive, HSE, will think of appointing one. If we had full compliance with best practice, knowing what we can achieve with maximum folate supplementation, what does Professor Turner think would be the impact of that nirvana-like implementation of health policy on the reduction in the number of cases of neural tube defects?

I thank Professor Turner and encourage him to keep up the good work clinically and in the research arena.