This story captures most of the good news from this study about the benefits of folic acid and iron supplementation in children in rural Nepal, but it skirts some of the thornier issues, namely the costs associated, the specific benefits and harms involved and the question of availability. We applaud the story for tackling an issue that is not U.S.-focused. We just wish a little more information had been included.
Iron deficiency is a critically important public health problem worldwide, particularly in the developing world, and some studies have shown a link between iron deficiency and cognitive impairment. If vitamin and iron supplementation prove to be a low-cost and effective way to improve the lives of children in poor countries, we all will benefit.
There is no discussion of costs. This is a problem because even if the individual doses of iron and folic acid are relatively cheap, their application on a large population, including staff time, monitoring and the attendant paperwork, would no doubt become costly quickly. We’re talking about a study of 676 kids, but there are billions of children worldwide who could benefit from this type of intervention. Some nod to costs should have been made here.
The benefits are not quantified, which is a shame. If there were tangible differences between the groups of kids, they should be spelled out. Literally billions of dollars in global health funding could be at stake for programs like this. Policymakers need strong guidance not optimistic quotes. We need to understand the absolute benefits of this program and others like it.
Any vitamin supplement taken in very high doses can be harmful and some acknowledgment of this should have been made here. Even citing the author or another expert about a lack of observed or known harm would have been sufficient.
The story gives very little attention to the study design, and it fails to bring a critical eye to the evidence. All the story does is allow one of the researchers to make a rather broad claim about the findings. “”What we showed is prenatal iron and folic acid supplementation had a significant impact on the offspring’s intellectual level and motor ability and ability during school age, which was a very exciting finding,” she said. “It had an impact across a range of function, including intellectual function, executive function and fine motor function,” factors that could affect a child’s later academic success.”
The story says, “Iron deficiency is the most common and widespread nutritional disorder in the world, affecting 2 billion people, according to the World Health Organization. Early iron deficiency can interfere with nerve development, biochemistry and metabolism, hampering both intellectual and fine motor development.” It does not engage in disease-mongering. In fact, we would have liked to have seen a little more information about the problems associated with a lack of iron.
The story does point out how the study was funded, but it does not make use of any experts other than one of the study’s authors. This is too bad because certainly another researcher in the field could have provided some context for how widely applicable a program like this would be. There are always significant barriers to scaleup for public health interventions in poor countries, and something as simple in theory as vitamin supplementation may not be simple on the ground. Another researcher or clinician with global health experience could have provided perspective.
The story does not compare the approach used in the study with any other approach.
One assumes that iron and folic acid supplements are widely available, but this may not be the case in some countries. There wouldn’t be a need for this sort of intervention if these nutrients were part of the regular diet in Nepal and other countries. At least some nod to how hard it might be to get access to these supplements was warranted. It also would have been helpful to include information about whether any existing public health programs routinely supplement with iron and folic acid in developing countries.
What’s novel here is the real-world application of a supplementation program in a low-resource setting and then enough follow through to generate results connecting the intervention to actual improvements in health and behavior.
The story does not rely on a news release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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