Food Fortification with Folic Acid for Prevention of Spina Bifida and Anencephaly: The Need for a Paradigm Shift in Evidence Evaluation for Policymaking

This article advocates a shift from excessive reliance on hierarchal models of causal evaluation based on RCTs towards context-specific evidence evaluation

Quick takes:

  • Robust and consistent evidence from individual and pooled studies support folic acid fortification as an effective public health intervention for reducing the incidence of Spina Bifida and Anencephaly
  • Skepticism to implement fortification by some policymakers in countries with no folic acid fortification programs arises from a concern that evidence of causation and efficacy is not supported by RCTs
  • Several studies highlighted limitations of RCTs in providing information to guide public health interventions, highlighting that the pyramid of evidence may vary, giving more weight to specific study designs, depending on the kind of decision to be made
  • A paradigm shift towards context-specific evidence evaluation, and away from excessive reliance on experimental study designs, is advocated in modern epidemiology to support public health policy decisions
  • Current evidence should be sufficient to generate the political will to implement fortification programs 

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