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Q+A: Greg Boyed Interviews Kate Wilkinson

Q+A: Greg Boyed Interviews Kate Wilkinson
Minister says consumer choice more important than science when it came to deciding on folic acid in bread.
“The decision that was made was really made on consumer choice rather than the science.”
“I’m not a scientist” - scientists argued black and white on impact of mandatory folic, so listened to submitters.
Decision not influenced by concerns that mandatory folic acid could raise cancer risks.
Wilkinson said she didn’t know where Paediatrics Society got their numbers from regarding how many children will get neural tube defects because of decision to remain voluntary; “overwhelming response was that consumers wanted choice”.
Voluntary fortification one of “a suite of measures” on increasing folic acid consumption by pregnant women, but couldn’t give budget.
Expects bread makers to fortifying 50% of all bread.
Voluntary fortification “has been making a difference”.
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                        You might remember the fuss three years back. Kate Wilkinson came on Q+A to explain why she was making it mandatory to put folic acid in our bread even though she didn’t want to. A week later, Prime Minister John Key came on to say National was rethinking.  Well, on Thursday National finally announced folic acid in bread would remain voluntary. Folic acid champions were furious, with the Organisation for Rare Disorders saying, ‘Up to 20 babies every year will die or be disabled thanks to the government’s decision.’  A big call. So we spoke to Food Safety Minister Kate Wilkinson in her Rangiora electorate office on Friday and began by asking if her decision was influenced by fears that mandatory fortification could raise the risk of cancer in some New Zealanders.
KATE WILKINSON – Food Safety Minister
                        No, it didn’t, really. We went out for an eight-week consultation, and the clear result of that was that consumers wanted choice, and that’s why we’ve made it voluntary.
GREG             Ok, because on this programme three years ago, you said the science around this and the risk of cancer were not robust - was the word you used. So you’re now confident that there is no risk of cancer as a result of folic acid in bread.
KATE              The decision that was made was really based on consumer choice rather than the science, because, as you know with science, you can have scientists arguing black and scientists arguing white. At the end of the day, the consultation went out. The submissions were clearly in favour of voluntary, so people can make up their own mind whether they want folic acid in their bread or not.
GREG             Surely, though, the science is a very, very important part of this decision.
KATE              Uh, well, consumer choice was really the one that made the most difference in terms of the decision. When you’ve got two thirds of the submitters actually wanting that choice, rather than debating the science, then that’s what we listened to.
GREG             On the science side of it, though, David Smith, Professor Emeritus of Pharmacology from Oxford University, told us the last time we spoke to him about six weeks ago putting folic acid in bread could increase the risk by several hundred cases a year of cancer. What do you say to that? Do you agree with that thinking? Disagree with it?
KATE              Well, my decision was made based on the result of the submissions. I’m not a scientist. The submissions clearly showed consumer choice was the most preferred option.
GREG             But surely you have to consider that safety must be an issue. On one side, potentially several hundred cases a year of cancer as a result of this being in bread. Surely there has to be a consideration.
KATE              Well, I think some of that science was looked at, definitely. But my decision was made on consumer choice because that was overwhelmingly the feeling of the submitters.
GREG             Minister, I’m just a bit lost here. I would have thought science and the safety of people and risk of cancer would be the first thing before anything came down to consumer choice.
KATE              Well, as you said before, though, Greg, some scientists are saying there’s no risk whatsoever. Some scientists may say there’s a risk. My decision was, actually, ‘I’m not qualified to make that decision.’ But I am charged with looking at the submissions, putting out the consultation - which I did - and the overwhelming majority wanted consumer choice. So then it’s up to consumers then to decide whether they want to have bread that has been fortified with folic acid, or whether they don’t.
GREG             Actually, on that point, you have asked consumers. Last year, the New Zealand Food Safety Authority - these are your own experts - and I’ve got this in front of me. Women are asked to rank their knowledge of folic acid from one to 10. One knowing nothing, 10 knowing a lot. More than half put either zero, one or two. Only half knew folic acid was actually needed during pregnancy. They don’t know, they’re not informed, yet you’ve made the decision.
KATE              Uh, well, this is only one of a suite of measures that we’re taking in relation to folic acid. Because, you know, I have to say that whenever there’s an NTD baby, you know, that’s tragic, and it’s tragic for the family, and we want to do what we can to avoid that. And, of course, folic acid has been seen as one of those contributing factors that can avoid NTD babies and defects. But what we’ve done is we’ve made it voluntary so that people can read the label and they can make their own decision whether or not they want bread that’s been fortified with folic acid or not.
GREG             No one would disagree with that. One case of NTD, of course, is tragic.
KATE              Absolutely.
GREG             Andrew Marshall from the Paediatric Society has said this could decrease the risk by up to 24 cases a year. What do you say to that?
KATE              I’m not quite sure where he gets his figures from. But as part of the suite that we’re looking at, we’re working closely with Health. We’re working on educational material, we’re working with the industry and the bakers so that they will be fortifying up to 50% of their bread lines with folic acid. We’ve got subsidised prescription folic acid tablets. So there’s a suite of processes that we can use to help to educate women and those that are wanting to get pregnant as to the benefits of folic acid.
GREG             He’s from the Paediatric Society, and his figures are from worldwide research. Presumably you must see that that’s fairly robust. 24 cases possibly decreased or most certainly decreased if folic acid is put in bread. How do you not do it?
KATE              We’re still allowing folic acid to be put in bread.
GREG             Voluntarily.
KATE              As I said, the bakers will be putting it in. 50% is their aim, to put it in 50% of the bread lines. It’s already in about 17% now, and we’ve noticed even in the last couple of years since we’ve had the Folic Acid Working Group. MPI are working with health professionals and the industry, and that’s actually resulted in an increased folate level in women. So, actually, the voluntary fortification that’s been going on already has been making a difference.
GREG             The Paediatric Society who are pushing for this say if it is put in as mandatory, it will decrease by up to 24 cases a year instances of NTD in babies. How do you ignore those numbers?
KATE              We’re not ignoring those numbers, but what we’re saying is that voluntary fortification is one step that we can take to help address the issue.
GREG             Then why didn’t you make it mandatory, then? That’s the question everyone’s going to be asking you. If you believe the science, the science is there. It’s black and white. 24 cases less a year that could be prevented of children born with spina bifida or NTDs, and you’re not doing it.
KATE              Well, actually, we went out to consultation, and consultation is about listening to the submitters and listening to what the population want, and the overwhelming response was that consumers wanted choice.
GREG             What about the mums, the families of possibly 24 children a year who are born with NTDs who, of course, wanted a choice with a healthy baby? What do you say to them?
KATE              Well, they can have a choice to have bread that’s fortified with folic acid, and if we can educate women especially as to the benefits of folic  acid, and they’ve got a choice of 50% of the breads that they buy will be fortified with folic acid, then they can make an educated decision, and we think that will make a difference.
GREG             But your findings have already been that most women don’t know the benefits of having folic acid in their bread, in their diet. Are you going to go some way to making sure they do know if you’re not going to make this mandatory?
KATE              Yeah, that’s part of the tool, which, as I mentioned earlier, was education.
GREG             How? What are you going to do?
KATE              Uh, well, you can have posters up in doctors’ surgeries for a start. You can have television advertising.
GREG             What’s that going to cost, Minister? What sort of budget are you putting aside for that? Roughly, what sort of cost?
KATE              And the media. You can actually help and educate women. Programmes like this is also helping to educate women as to the benefits of folic acid. We’re not saying you can’t have it. We’re just making it voluntary.
GREG             Research has shown, Minister, about 3 cents or 4 cents a loaf as a mandatory thing, folic acid in there. That’s not much of a cost to the bread industry. It’s not going to be much of a cost to the consumer that they’ll notice. You’re talking 3 or 4 cents. Surely that’s a more effective and cheaper way of doing this.
KATE              As I’ve said, though, the decision that I made was based on the result of the submission that was about consumer choice. It wasn’t about cost.
GREG             And the choice of the 24 or so children who are born annually with NTDs, they don’t have a choice; it’s been made for them.
KATE              Their parents, their mothers, will have a choice and will be educated. And we are hopeful and confident that that education will actually impress upon women the advantages of having extra folic acid in case of pregnancies.
GREG             Food Safety Minister Kate Wilkinson there. Let’s just revise those numbers slightly. The Ministry of Primary Industries initially said 20 to 24 NTDs possibly a year. They’re now saying 14 to 20. Let’s keep that in mind.


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