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Health: Folate

Volume 789: debated on Thursday 1 March 2018


Asked by

To ask Her Majesty’s Government what assessment they have made of the article in Public Health Reviews, Public health failure in the prevention of neural tube defects: time to abandon the tolerable upper intake level of folate, published on 31 January; and whether they will meet with the authors.

My Lords, the study was referred to the Committee on Toxicity, an independent expert committee which advises Her Majesty’s Government. It agreed that, as maximum intakes of folic acid were last considered in 2003, it was time to review the evidence that underpins them. Reconsideration of the maximum recommended intake will be undertaken by the COT, which has the discretion to consult the authors if appropriate.

I thank the Minister for that Answer—which is a move, I fully accept, because the science always has to be tested. Do she and her officials agree that this paper in effect removes the last scientific barrier to a more humane policy than allowing two terminations a day and more than two live births a week with lifelong disability due to neural tube defects?

Recent Written Answers given by the Minister indicated that there had been no discussion with the Scottish Government, the food industry or the wider scientific community—and, what is more, no discussion with countries with high and low rates of pregnancy affected by neural tube defects. This paper, which is only 11 pages long, publishes on page 4 the up-to-date list of 81 countries that do folic fortification. Which countries have been contacted since the new advice from the Scientific Advisory Committee on Nutrition and the new information became available to check out the pros and cons? Have the Government started talking to anybody?

My final point, which is slightly unrelated—

I do not know whether the Government have talked to other countries about this issue, but the Secretary of State is very keen to make progress and any delay is not intended. I am sure that the noble Lord will understand that getting this under way takes time, gathering together personnel, et cetera, and relevant cross-government approval, which needs to be attained, but I can assure him that it will happen—not fortification, but looking into it, and the times will be communicated once clearance has been received from various government departments.

The Minister referred to taking time. The original study into this was published in 1991, when I had four small children and was involved in issues of maternal health. In the intervening time, I have had four small grandchildren. Eighty-one countries have acted on this British, publicly funded research, which has saved untold suffering throughout the world. Is it not a disgrace that we have not got to the point of preventing that suffering in our own country? If the Secretary of State is interested in this issue, will he agree to the meeting suggested in the Question?

Well, I cannot. I am sure that he would be willing to meet, but I cannot answer for him. The noble Baroness is completely right. One reason that there has not been movement on this until now may be because of problems with the upper level, which this report says is not a problem. If the upper level is no longer needed, that will provide reassurance on the safety of mandatory fortification and we will be able to proceed.

My Lords, much of the first world, and indeed parts of the rest of the world, are heeding the advice of British scientists, and I am delighted that we are here now getting a bit nearer to putting folic acid in flour. The Minister said that several departments would need to be involved in this. Will she tell us which departments?

My Lords, time was mentioned, but the Scientific Advisory Committee on Nutrition backed this in 2006 and again in 2017—not to mention the earlier study referred to by the noble Baroness. The evidence is backed by the Scottish and Welsh Governments. I accept that the Minister cannot control the Secretary of State’s diary, but could we have an assurance that they will talk to their Welsh and Scottish counterparts about why they feel strongly about it? Will she make a positive recommendation to the Secretary of State—and, if his diary is too busy, will she agree to meet these representatives and listen to what they have to say?

I know that the Secretary of State is always willing to meet people, and I am sure he will. We know that this is a complex issue, involving many interested stakeholders from the scientific community, industry and the general public. All aspects and impacts will need to be fully understood. But there is no doubt that the Secretary of State is aware of the fact that Wales and Scotland are also interested in this. That is partly why we are trying to proceed with this as quickly as we possibly can.

My Lords, there are two main reasons why the Government may feel resistant to this. One, which I think we have discarded now, is the dosage level, which we now know is not toxic. The second is that we do not want to be described as a nanny state. If the noble Baroness buys a tuna and sweetcorn sandwich in the Bishops’ Bar, she will find that in the wheat we already add calcium, iron, niacin, thiamin, preservative E282 and treatment agent E300. Nanny state? This folic acid is certainly vital. Does she agree?

I do not think that the nanny state comes into it—certainly not as far as we are concerned. It is interesting that Department of Health officials have told me that its mailbag from the general public has been saying that they do not want mass fortification in their food—but that will all be part of any proceedings going forward in discussions, and it is not what is holding us up at the moment.

My Lords, the last time we debated this, I described the molecular basis for the prevention of the tragedy that the noble Lord described of two terminations a day and two babies born with neural tube defects. The only scientific basis for prevention of this is supplementation of folic acid. Do the Government know of any other scientific evidence without using supplementation that could prevent these tragedies?

No—I think that the noble Lord knew when he asked the question what the answer was. I can only keep reiterating that the Secretary of State is very keen to proceed and that there is no intended delay on this. As I said earlier, it is just a case of getting cross-government approval from the various departments before we go ahead.