This story includes appropriate caution about jumping to conclusions that folic acid can indeed prevent some cases of autism, as well as the size of any potential effect. It does a better job than the Reuters Health story of explaining why a study of women in Norway may not be relevant to women in the US. But the Reuters Health story probably does a better job of telling readers how small the underlying autism risk is in Norway. This LA Times blog post, though, graded slightly better than a CNN blog post on the same study.
Stories that may encourage millions of people to change behavior in order to possibly, but not certainly, affect a small risk, should proceed with caution. But since folic acid supplementation is already strongly recommended to reduce the risk a baby may be born with spina bifida or other neural tube defects, reporting on this research is important, even if any potential benefit appears to be relatively small and tentative.
Not applicable. No discussion of costs, but since folic acid supplement pills cost only a few cents each, the omission is not important.
This story reports both the raw data differences in autism risk between the folic acid and non-folic acid groups (a 2-to-1 difference) and the much smaller 39 percent difference the researchers reported after adjusting for education and other maternal characteristics. However, by stating the overall absolute risk of a child with autism as 0.13% instead of about 1 in a thousand, readers of this story may not get as good an understanding of the absolute risks as readers of the Reuters Health story we also reviewed.
This is a tough call.
The US Preventive Services Task Force and other expert bodies state that there is no evidence of potential harm from recommended levels of folic acid supplementation. But there are hypothetical, yet 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 could have mentioned this.
The point is that there are always potential harms. This is not a risk-free substance. Stories may not always find the time/space to delve into hypothetical/plausible potential harms, but we wish they would.
This story is cautious in its language, emphasizing “link…association…more likely” and avoiding cause-and-effect inferences. It includes details about possible factors besides folic acid supplements that could explain differences (such as education, smoking, whether the pregnancy was planned) and that researchers adjusted their results to try to account for those factors. This story also has a clear discussion of the underlying differences between autism risk in Norway and the US and how caution should be exercised in applying study results from one country to the other.
The story mentions the puzzlement about why rates of autism appear to be rising in the US, thus giving readers a sense of how much remains unknown about potential causes or responses.
Unlike the Reuters Health story (which quoted two independent sources), this one does not include comments from an independent source, just a quote from a journal editorial (and that quote doesn’t directly address the quality of the evidence). The competing CNN.com story (also a blog post), reviewed a day earlier, had three independent sources.
There are no broadly-recommended ways to reduce autism risk.
It is clear that folic acid supplements are widely available and have long been recommended for women considering pregnancy.
The story reports the long-standing recommendation that women considering pregnancy take folic acid supplements and that many common foods are already fortified with the vitamin.
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 reseach efforts showing association with folate in early pregnancy and severe language delay or autism.
The story does not appear to rely on a news release.
Systematic, Criteria-Driven
Why fact-checking is not enough to prevent the spread of misleading health care news...@HealthNewsRevu https://t.co/fzC2JbDYGV
Simply fact-checking an article "fails to capture questions of nuance and context that arise – or should arise – whenever evaluating medical evidence." https://t.co/HrYkGj12q1
We wrote only about efforts that label themselves as “fact-checking” projects. You’ll see that if you read the piece.
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