Dave Erickson: Folic acid is a vitamin which can
protect a developing baby from getting a serious
problem that can cause difficulties walking.
Spina bifida.
Anencephaly.
These are major birth defects that are either fatal
or have serious, long-term consequences for the child.
And, in contrast to polio, where you only get motor-
you only lose motor function- with spina bifida,
you lose both motor function and sensory function.
We estimate that about 300,000 babies are affected
by neural tube defects around the world.
Joe Mulinare: Dave and Godfrey Oakley had invited me
to come to CDC to work
on the Vietnam veterans agent orange risk study
for birth defects.
And we analyzed that data and published it and it was one
of the first population based studies that was done to show
that folic acid
in a multivitamin could reduce the risk of neural tube defects.
Dave Erickson: And it was enough to prompt us to figure
out whether this was really an idea worth promoting
on a public health scale or whether it was something
that was just a fluke.
Godfrey Oakley: June the 24th at 5 PM,
1991 was probably the most marvelous professional moment
of my life, when I got a call from, now Sir Nicolas Wald,
telling me that the randomized control trial that he had done
to find out if Folic Acid
or a different vitamin would prevent Spina Bifida,
it had turned out to be such a positive study.
Godfrey Oakley: It prevented 72%
of spina bifida and anencephaly-
And, it was in the gold standard study
that we call a randomized control trial.
And it meant that we could bet the farm
that Folic Acid prevented spina bifida.
So, you're doing something that prevents diseases
and prevents conditions
Margie Watkins: with the result
of not only saving children's lives,
but improving their quality of life.
So the first thing we did was make a recommendation for women
who had previously had an affected child
with either anencephaly or spina bifida,
these two very severe birth defects.
Godfrey Oakley: And that was one
of the easiest policy things I ever did at the CDC.
Dave Erickson: This was a special recommendation
because it called for what we really now call a high dose
of folic acid, a pharmacological dose of folic acid.
If you can prevent something like this,
especially on the scale of preventing thousands
of these birth defects, then this is a real accomplishment.
Godfrey Oakley: How much prevention you get depends
on how bad off you are.
The China study was really public health at its best.
At the time we did the China Study, people didn't know
for certain whether folic acid, by itself,
would prevent neural tube defects.
We sent RJ off to China
Godfrey Oakley: to do a large community intervention.
He wound up showing some really fascinating things.
We were asking folks in the field- the health providers
that were in the villages- to take pictures of these babies
in a way that we could then use the picture to make a diagnosis.
Godfrey Oakley: Among the things that he showed was
that how much prevention you get depends upon how high the
incidence is when you put the Folic Acid into the population.
And in parts of China it went down almost ninety percent.
And, the China Study was the first and only study that showed
that folic acid, by itself, without other vitamins,
prevents neural tube defects.
Godfrey Oakley: And from that moment on I knew
that all we needed to do to keep tens of thousands
of kids each year out of wheel chairs, was to get everyone
with a reproductive age 400 micrograms
of Folic Acid every day.
We have lots of success stories
about preventing spina bifida
with Folic Acid fortification programs.
And the key is you have to make it
so that every manufacturer has to do it.
So, in the US, you know, it was prohibited before February
of '96 and then it was required twenty-one months later.
And so beginning in
January one 1998 all enriched grains in the US had
to have Folic Acid in it.
Margie Watkins: So, once the folic acid was added
to cereal grain products, added to the flour that goes
into the bread that we eat and other cereal grain products
then you want to count how many cases
of neural tube defects there were.
Dave Erickson: It has resulted
in a substantive reduction in the occurrence
of neural tube defects among babies
who have been born in the United States.
Godfrey Oakley: There're roughly three hundred thousand
cases of anencephaly and spina bifida around the world
and we're preventing some place around about fifteen percent
of that, so some place on the order of twenty thousand,
thirty thousand a year.
Godfrey Oakley: And, it's wonderful.
I mean, thousands of kids don't have spina bifida
and anencephaly.
Joe Mulinare: To have something so simple as
folic acid in fortified foods that can prevent fifty
to seventy percent of these children
from having this condition, and actually being born healthy
to me is a success story beyond belief.
Smallpox is gone.
Polio's on the way to being gone.
I'd like for spina bifida F to be the next one.
And, that to me is an exceptional thing
to have happened and I have had the opportunity
to be a part of that.
Tough not to be...
...tough not to be an evangelist for this, you know.