Bioethics Blogs

Folic Acid Supplementation in Canada: What is the Right Dose?

Robyn MacQuarrie comments on the appearance of industry influence on the Joint SOGC-Motherisk clinical practice guideline on folic acid supplementation.
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In an era of evidence-based medicine, healthcare providers generally rely on clinical practice guidelines to help them provide their patients with the highest standards of care. These guidelines are often produced by committees and sometimes one or more committee members will have a conflict of interest as when, for example, a clinical practice guideline concerns a product in which the committee member has a financial interest.  In modern times, it is expected that clinicians will be made aware of such conflicts and also be informed as to how these conflicts were mitigated.

The Canadian Medical Association has published guidelines for physicians in interactions with industry, which state that “physicians with ties to industry have an obligation to disclose those ties in any situation where they could reasonably be perceived as having the potential to influence their judgement.” Unfortunately, all too often, such conflicts are under-reported. A current Canadian example of this problem is the Joint SOGC-Motherisk clinical practice guideline on folic acid supplementation.

Irises, Vincent Van Gogh, J. Paul Getty Museum

Irises, Vincent Van Gogh, J. Paul Getty Museum

Folic acid supplementation is standard prenatal care – a simple way to reduce the incidence of neural tube defects and to improve prenatal outcomes.  In 1989, Canada began fortifying a large variety of cereal and grain products with folic acid. This alone led to nearly a 50 percent decrease in neural tube defects.

In addition, some women who are planning to become pregnant take a daily multivitamin that has 0.4 to 1mg of folic acid.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.