This story deals with a new scientific paper hypothesizing about folate in the grain supply and possible increases in colorectal cancer rates. The article is generally well written and includes many of the salient features of the arguments, as well as advice to consumers.
While highlighting an increase in the incidence of colorectal cancer that appears to have occured just after fortification of the food supply, the story failed to report that despite the increase that occured around the time of fortification, the data demonstrate that there has been a general decrease in colorectal cancer from 1985 until today. And while there was an increased incidence just after fortification of the food supply, it also appears that the incidence has again begun to decline when incidence is adjusted for age.
The story is an interesting perspective about unintented consequences of interventions and could have highlighted the potential trade-off between 1,500 fewer children being born with birth defects such as spina bifida and 15,000 more cases of colorectal cancers in any given year. It is an example of the kind of trade-offs that are part and parcel of public health decisions.
Although costs weren’t mentioned, most people know the costs of the foods and daily multivitamins mentioned in the story as sources of folate.
The story described the benefit of folate fortification of the food supply as cutting the 3,000 cases of spina bifida in half (i.e. eliminating 1500 cases of spina bifida per year).
The story discussed the increase in colorectal cancer incidence that has been observed.
It does not seem that the story appropriately presented the information about folate and colorectal cancer. The title of the study described it as a ‘hypothesis’. In science, a hypothesis is something to be tested. The report itself discusses the ‘temporal association’ between folic acid fortification and the increase in the incidence of colorectal cancer that has been observed. The quote from the first author of the paper – "What we’ve discovered is that folate seems to have a paradoxical effect" – is an overstatement about the information they have gathered to date.
To do the reader justice, this story should have provided some insight about research hierachy and that while this is an interesting hypothesis, it requires scientific scrutiny to determine its certainty.
The story mentioned the hypothesis that increased folic acid consumption may be responsible for the increased incidence of colorectal cancer; it described this as an increase of 4-6 colorectal cancers per 100,000 people or an additional 15,000 new cases per year.
The story also mentioned several positive associations that have been observed with increased folate levels.
In addition to the first author of the study, quotes from several clinicians who were not involved with the present hypothesis paper but who had expertise about folate, were included in this story.
Other than a recommendation to keep folate intake to somewhere less than 1,000 micrograms per day, there were no treatment recommendations in this story, nor alternative treatment options presented. A treatment option for colorectal cancer prevention is removal of the precursor lesion, polyps via surveillance colonoscopy.
The story mentioned the folate fortification of the North American food supply; it also noted that folic acid is found in multivitamins. The story is mainly about recent analysis about possible consequences of folate supplementation of the food supply.
The story mentioned that it was based on a new publication (in the July issue of the journal Cancer Epidemiology Biomarkers and Prevention). The story specifically comments on the timeline of the addition of folate to the grain supply in two different countries.
Does not appear to rely on a press release
Systematic, Criteria-Driven
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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