There was plenty to like about this story. There are quotes from three experts who emphasize different perspectives on the results, and the take-home message about supplements — women should be taking them to prevent birth defects, regardless of any link to autism — is spot on. But the story gets tripped up when it uses active verbs (“may reduce” and “may prevent”) to describe the importance of the findings, and its use of relative risk figures was inadequate to convey the benefits. Presenting only the statistic “39% less likely” is particularly problematic. Even the abstract of the paper on which the story was based provided the absolute differences: rates of autistic disorder of 0.10% for the group taking folate, and 0.21% among nonusers. This is a very small absolute risk difference – and from an observational study at that.
As a result, readers will get a somewhat-too-rosy picture of what this study found and what it means.
It would be great if a simple intervention like taking a folic acid supplement — something women of childbearing age should be doing anyway — could help prevent autism. And these results do support the idea that folic acid might be protective. But there are also good reasons to question whether it’s the folic acid, or something else, that could be responsible for the findings. And it’s not clear that the benefits reported apply to women in the United States, who are already getting some extra folic acid from food fortification.
The cost of folic acid supplements is not in question.
The story says women who took folic acid “were 39% less likely to have children with autism.” This is inadequate, because it doesn’t reflect just how rare a diagnosis of autism was in this study. (Only 114 children out of about 85,000 received that diagnosis.) The findings in absolute terms would have been more informative, as they show that autism was diagnosed in 0.10% of children whose mothers took folic acid compared with 0.21% of children whose mothers didn’t.
There are hypothetical, but plausible concerns about harmful effects of getting too much folic acid, especially an increase in cancer risk. This is why many countries have not embraced mandatory folic acid fortification of the food supply. The story should have mentioned this.
This was a tough call. On the plus side, the story quotes a researcher who says “the data really do not establish anything close to a causal connection.” That’s terrific and absolutely true, since this was an observational study. But why then have a headline and lead sentence that say folic acid “may help reduce” and “may help prevent” autism, since these phrases clearly imply a causal relationship between folic acid and autism prevention? It’s also incorrect to suggest that supplements are a “tangible [thing] a woman can do to reduce her risk of giving birth to a child with the disorder.” That hasn’t been established.
We really like the way the story closed out with a great quote: “Caring for individuals with autism and their families would be a whole lot easier if we had simple answers about cause and risk. The reality is, autism is a complex disorder and our best answers about causes and treatment are going to be complex as well.”
But there are a couple of other important points that really should have been made, but weren’t:
Ultimately, we’ll rule this unsatisfactory, but with credit due as noted.
There was no overt disease mongering, but as discussed above, we wish that the story had been clearer about just rare how a diagnosis of autism was in this study.
The story includes a nice mix of voices, including experts from an autism advocacy group, the March of Dimes, and in independent autism research program. This was a strong point of the story.
There aren’t any proven strategies to reduce autism risk, although research suggests a link to maternal smoking, the father’s age at conception (older than 40 = higher risk), and exposure to air pollution and pesticides. The story could have mentioned these, but we won’t ding it for not doing so. The best we can rule it is Not Applicable.
The availability of folic acid supplements is not in question.
The story explains that folic acid is already recommended for the prevention of neural tube defects. But it could have noted that at least one other study has documented an association between folic acid use and reduced autism risk. The JAMA paper on which the story is based cites several prior research efforts showing association with folate in early pregnancy and severe language delay or autism.
There is enough original reporting that we can be sure this wasn’t based on a press release.
Systematic, Criteria-Driven
Federal health agencies block journalists’ access to COVID-19 experts & information. By Gary Schwitzer (USA) (@garyschwitzer) ➡️
https://www.healthnewsreview.org/2020/03/federal-health-agencies-block-reporters-access-to-covid-19-experts-information/
Fed agencies have censors/public information officers controlling reporters' news gathering. It's worse that journalists won't tell the public about it. @nytimes @spj_tweets https://twitter.com/garyschwitzer/status/1243143047908659201
A national emergency is no excuse to lose a pillar of democracy. Do you really want the federal government deciding what you need to know? https://twitter.com/garyschwitzer/status/1243143047908659201
Comments (1)
Please note, comments are no longer published through this website. All previously made comments are still archived and available for viewing through select posts.
MTHFREase
March 13, 2013 at 11:41 amand yet this study says that Folic Acid harms embryonic development.
Our Comments Policy
But before leaving a comment, please review these notes about our policy.
You are responsible for any comments you leave on this site.
This site is primarily a forum for discussion about the quality (or lack thereof) in journalism or other media messages (advertising, marketing, public relations, medical journals, etc.) It is not intended to be a forum for definitive discussions about medicine or science.
We will delete comments that include personal attacks, unfounded allegations, unverified claims, product pitches, profanity or any from anyone who does not list a full name and a functioning email address. We will also end any thread of repetitive comments. We don”t give medical advice so we won”t respond to questions asking for it.
We don”t have sufficient staffing to contact each commenter who left such a message. If you have a question about why your comment was edited or removed, you can email us at feedback@healthnewsreview.org.
There has been a recent burst of attention to troubles with many comments left on science and science news/communication websites. Read “Online science comments: trolls, trash and treasure.”
The authors of the Retraction Watch comments policy urge commenters:
We”re also concerned about anonymous comments. We ask that all commenters leave their full name and provide an actual email address in case we feel we need to contact them. We may delete any comment left by someone who does not leave their name and a legitimate email address.
And, as noted, product pitches of any sort – pushing treatments, tests, products, procedures, physicians, medical centers, books, websites – are likely to be deleted. We don”t accept advertising on this site and are not going to give it away free.
The ability to leave comments expires after a certain period of time. So you may find that you’re unable to leave a comment on an article that is more than a few months old.
You might also like