dave erickson: folic acid isa vitamin which can protect a developing babyfrom getting a serious problem that can causedifficulties walking. spina bifida. anencephaly.
folic acid, these are major birthdefects that are either fatal or have serious, long-termconsequences for the child. and, in contrast to polio,where you only get motor- you only lose motorfunction- with spina bifida,
you lose both motor functionand sensory function. we estimate that about300,000 babies are affected by neural tube defectsaround the world. joe mulinare: dave andgodfrey oakley had invited me to come to cdc to work on the vietnam veteransagent orange risk study for birth defects. and we analyzed that dataand published it and it was one of the first population basedstudies that was done to show
that folic acid in a multivitamin could reducethe risk of neural tube defects. dave erickson: and it wasenough to prompt us to figure out whether this was reallyan idea worth promoting on a public health scaleor whether it was something that was just a fluke. godfrey oakley:june the 24th at 5 pm, 1991 was probably the mostmarvelous professional moment of my life, when i got a callfrom, now sir nicolas wald,
telling me that the randomizedcontrol trial that he had done to find out if folic acid or a different vitaminwould prevent spina bifida, it had turned out to besuch a positive study. godfrey oakley:it prevented 72% of spina bifida and anencephaly- and, it was in thegold standard study that we call a randomizedcontrol trial. and it meant that wecould bet the farm
that folic acid preventedspina bifida. so, you're doing somethingthat prevents diseases and prevents conditions margie watkins:with the result of not only savingchildren's lives, but improving theirquality of life. so the first thing we did wasmake a recommendation for women who had previouslyhad an affected child with either anencephalyor spina bifida,
these two very severebirth defects. godfrey oakley:and that was one of the easiest policy thingsi ever did at the cdc. dave erickson: this wasa special recommendation because it called for what wereally now call a high dose of folic acid, a pharmacologicaldose of folic acid. if you can preventsomething like this, especially on the scaleof preventing thousands of these birth defects, thenthis is a real accomplishment.
godfrey oakley: how muchprevention you get depends on how bad off you are. the china study was reallypublic health at its best. at the time we did thechina study, people didn't know for certain whetherfolic acid, by itself, would prevent neuraltube defects. we sent rj off to china godfrey oakley: to do alarge community intervention. he wound up showing somereally fascinating things.
we were asking folks in thefield- the health providers that were in the villages- totake pictures of these babies in a way that we could then usethe picture to make a diagnosis. godfrey oakley: among thethings that he showed was that how much prevention youget depends upon how high the incidence is when you put thefolic acid into the population. and in parts of china it wentdown almost ninety percent. and, the china study was thefirst and only study that showed that folic acid, by itself,without other vitamins,
prevents neural tube defects. godfrey oakley: andfrom that moment on i knew that all we needed to doto keep tens of thousands of kids each year out of wheelchairs, was to get everyone with a reproductiveage 400 micrograms of folic acid every day. we have lots ofsuccess stories about preventing spina bifida with folic acid fortificationprograms.
and the key is youhave to make it so that every manufacturerhas to do it. so, in the us, you know, itwas prohibited before february of '96 and then it was requiredtwenty-one months later. and so beginning in january one 1998 allenriched grains in the us had to have folic acid in it. margie watkins: so, oncethe folic acid was added to cereal grain products,added to the flour that goes
into the bread that we eat andother cereal grain products then you want tocount how many cases of neural tube defectsthere were. dave erickson:it has resulted in a substantivereduction in the occurrence of neural tube defectsamong babies who have been bornin the united states. godfrey oakley: there'reroughly three hundred thousand cases of anencephaly andspina bifida around the world
and we're preventing some placearound about fifteen percent of that, so some place onthe order of twenty thousand, thirty thousand a year. godfrey oakley:and, it's wonderful. i mean, thousands of kidsdon't have spina bifida and anencephaly. joe mulinare: to havesomething so simple as folic acid in fortifiedfoods that can prevent fifty to seventy percentof these children
from having this condition,and actually being born healthy to me is a successstory beyond belief. smallpox is gone. polio's on the wayto being gone. i'd like for spina bifidaf to be the next one. and, that to me isan exceptional thing
to have happened and ihave had the opportunity to be a part of that. tough not to be...
...tough not to be anevangelist for this, you know.