Why we need folic acid in our flour

If we are serious about our children deserving better, it also makes sense to give our baked goods a little extra goodness.

You could be forgiven for thinking that the recent report by the chief medical officer for England, Sally Davies, covered only one topic – improving child health. The press picked up on the argument that, given the upsurge in cases of rickets, the government should consider providing free vitamin supplements to all children, but there was much more in the report. Davies’s next point, that we should fortify our flour with folic acid, has been ignored for far too long.

This recommendation arguably has much greater potential impact. Boosting folic acid in foods eaten by pregnant women significantly decreases the occurrence of foetal “neural tube defects”, reducing cases of conditions such as spina bifida and anencephaly, in which large parts of a baby’s brain simply don’t form.

The neural tube, which eventually carries the spinal cord and the brain, starts as a groove that deepens and then closes off. A folic acid deficiency can prevent the closing process, leaving nerves exposed. Folic acid provides a “methyl group” – one carbon atom and three hydrogen atoms – that binds to foetal DNA and ensures the genetic instructions are carried out properly, fully closing the neural tube.

We’ve known about the importance of folic acid since a landmark paper was published in the Lancet in 1991. In an experiment involving 2,000 women known to be at higher risk of having babies with neural tube defects, supplements of folic acid prevented between 70 and 80 per cent of the defects. The benefits were so starkly obvious that the experiment was stopped early: it was deemed unethical to continue to withhold supplements from those in the control group.

The test results led more than 60 countries to mandate the fortification of flour with folic acid. The neural tube forms in the first four weeks of pregnancy, before many women know they are pregnant. For full protection, the foetus needs the folic acid right from conception, yet only 37 per cent of women in the UK are taking folic acid supplements when they fall pregnant.

In the US, the fortification of cereal products with folic acid prevents roughly 1,300 neural tube defects a year and forestalls 360 infant deaths. Every year in the UK, 1,000 children are born with a neural tube defect, one and a half times the number of such births in the entire United States. That’s because the UK government advises only that women who might get pregnant should take folic acid supplements – it has consistently ignored scientific advice to put folic acid in the nation’s flour.

Until early this year, the government was able to hide behind claims that folic acid fortification might increase rates of bowel cancer. Those claims were disproved in a Lancet paper in January. The only remaining fig leaf for the government’s current position is a vague concern that one shouldn’t impose medicines on the country.

There is also an economic case for fortifying flour with folic acid. Each spina bifida patient costs the NHS about half a million pounds over their lifetime. In the US, the financial benefits have been shown to outweigh the cost of fortifying flour by 40 to 1. A 2011 costbenefit analysis of fortifying flour with folic acid suggested it would save the UK several million to hundreds of millions of pounds per year.

By all means, let’s get children out into the sun, and taking Vitamin D supplements if necessary: rickets has no place in 21st-century society. But if we are serious about our children deserving better, it also makes sense to give our baked goods a little extra goodness.

One simple change could make a lot of difference to all of us, personally and financially. Image: Getty

Michael Brooks holds a PhD in quantum physics. He writes a weekly science column for the New Statesman, and his most recent book is At the Edge of Uncertainty: 11 Discoveries Taking Science by Surprise.

This article first appeared in the 06 November 2013 issue of the New Statesman, Are cities getting too big?

Photo: Getty
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We're asking the wrong questions about the Google “anti-diversity memo”

Which sex is better at what skills is less important than which skills we value in the first place. 

Yes, I feel sorry for the Google employee who has been fired for writing an "anti diversity manifesto" and circulating it within the company. (Guess what? It leaked.) Losing your job is painful, and doing it in public is even more so. But the conversation around this is heading in such an unproductive direction (do women suck at maths?) that I can't resist wading in.

I agree with the writer that these issues are hard to talk about, but that pushback comes from both directions. Look at the crap Mary Beard is wading through for trying to inject some facts into a discussion about the racial composition of Roman Britain. Nicholas Nassim Taleb keeps honking about "diversity genes" and refusing to listen to evidence that contradicts him. But in his mind, he's Mr Science - sorry, Professor Science - and she's Madam Arts-Subject.

This matters, because when it comes to diversity, there are fact-based positions on both sides. Yet there is a certain strand of Rational Internet Thinker (let's be honest, mostly men) who solemnly tells everyone that we Must Stick To The Facts while advancing deeply ideological stances, which only happen to look "natural" because they are so embedded in our culture. 

But back to the subject at hand. Here's the recap: the memo was headlined  "Google’s Ideological Echo Chamber" and its writer's firing will be taken as confirmation that his thesis was true. Ironically, this will be done by the same section of the right which usually has no problem with firing at will and normally thinks that HR should be a brutally Darwinian process. (Looked at from that perspective, of course Google would fire someone who brought such criticism on the company.) But now there are Principles involved. Probably Free Speech is under attack. Political Correctness may even have Gone Mad. Social Justice Warriors are on the march. Before it's all placards as far as the eye can see, instead I would like to look at what was actually said, and whether it's an argument with any merit. 

In essence, the memo argued that the gender imbalance of staff in tech companies like Google is primarily the result of biological, not cultural differences. ("They’re universal across human cultures," it argued. "They often have clear biological causes and links to prenatal testosterone".) There are differences in ability between the sexes, the writer said, and that's why most top programmers are men. Men like numbers, and the numbers like them right back.

The memo added:

Differences in distributions of traits between men and women may in part explain why we don’t have 50% representation of women in tech and leadership. Discrimination to reach equal representation is unfair, divisive, and bad for business.

The section about typically female traits is also interesting, because of a couple of points the writer picks out.

"Women, on average, have more...

- Openness directed towards feelings and aesthetics rather than ideas. Women generally also have a stronger interest in people rather than things, relative to men (also interpreted as empathizing vs. systemizing).

- These two differences in part explain why women relatively prefer jobs in social or artistic areas. More men may like coding because it requires systemizing and even within SWEs, comparatively more women work on front end, which deals with both people and aesthetics.

- Extraversion expressed as gregariousness rather than assertiveness. Also, higher agreeableness. This leads to women generally having a harder time negotiating salary, asking for raises, speaking up, and leading. Note that these are just average differences and there’s overlap between men and women, but this is seen solely as a women’s issue. This leads to exclusory programs like Stretch and swaths of men without support.

- Neuroticism (higher anxiety, lower stress tolerance).This may contribute to the higher levels of anxiety women report on Googlegeist and to the lower number of women in high stress jobs.  

Well, SOMEONE has been reading their Simon Baron Cohen. The first point is a distillation of Baron Cohen's argument about "male brains" being better at understanding systems, and "female brains" being better at feelings - which he extends to say that autistic traits might be an "extreme male brain". Unsurprisingly, there are other scientists in the field, such as Cordelia Fine and Rebecca Jordan-Young, who find a lot of the neuroscience of sex difference quite flaky.

I'm not a neuroscientist, but from a lay perspective, my take is that yes, there are some biological differences between the average male and female brain, but that these pale beside a) the way our brain architecture is shaped by stimuli (like years of being told you're rubbish at maths) and b) the overall effect of culture (eg companies which value presenteeism, or make it hard for women to return after having children, or cover up for senior men who are repeated sexual harassers etc etc). 

The "higher agreeableness" point was dealt with by Sheryl Sandberg in Lean In. Women aren't stupidly not asking for raises or being assertive in the office because they are delicate little flowers. One of the reasons they are more agreeable at work is because they face heavier penalties if they are not. As Sandberg formulates it: "Success and likeability are positively correlated for men and negatively for women. When a man is successful, he is liked by both men and women. When a woman is successful, people of both genders like her less.” Women are nicer because there are more negative consequences for them if they are not nice.

The last point about neuroticism is bleakly funny, because while women might report more anxiety, men commit suicide in far greater numbers. Which gender is really more susceptible to stress and anxiety? Women talking more about their mental health on "Googlegeist" is being held against them here, when possibly one of the reasons that more men kill themselves is because of the stigma of talking about their feelings.

Overall, the memo makes some compelling points, but it also chucks in a lot of stuff that "everyone knows" about sex differences, which isn't scientifically supported, and also some evolutionary psychology about "protecting females" which strays into the kind of rhetoric found on MRA sites. Its understanding of male and female work patterns can also be naive, for example:

"Yes, in a national aggregate, women have lower salaries than men for a variety of reasons. For the same work though, women get paid just as much as men. Considering women spend more money than men and that salary represents how much the employees sacrifices (e.g. more hours, stress, and danger), we really need to rethink our stereotypes around power."  

I mean, doesn't this just raise a huge number of questions?

How often do men and women do the same work, and for what reasons might they not? (Clue: women do far more unpaid care work and housework.) Are women spending that money on themselves, or are they running household budgets, which is an unpaid project-management task they are doing alongside any paid work? What an individual finds stressful is also entirely subjective.

The author chucks in a reference to "Marxist intellectuals" but doesn't seem to have read any of the vast and fascinating literature on unpaid care and its interaction with paid work. I'd recommend starting with The Second Shift or Wife Work. Angela Saini's Inferior is a good recent choice, too, on women's overlooked contributions to science.

When I talk about feminism with self-styled rationalist men, this dynamic comes up again and again. They will present my arguments as mere anecdote and emotion, which - sad shake of the head - is contradicted by the available evidence. When you point to peer-reviewed studies, or great ethnographies, supporting your point, which they haven't bothered to read, they steam on regardless. It makes the contest deeply unequal. Internet skeptic types talk about the need to engage with writers they don't agree with, and the importance of free and open debate, but often actually don't want to read the contrary view. 

 

***

If you want to read more about the discussion of the science of sex differences which has arisen as a result of this memo, then this piece by Slate Star Codex is interesting - it argues that interest in STEM subjects, not ability, might be the key difference between the sexes. It also completely misses the point. 

Here's a thought experiment. Say you were recruiting for a spoon-juggler. Your advert would probably mention "needs to juggle spoons". But, almost certainly, there would be other skills involved. Turning up to performances on time. Keeping your spoon inventory in check. Not turning up drunk. Not stealing forks from the fork-juggler. 

This is what the argument that women can't succeed in tech because they are innately bad at the skills needed to succeed in tech sounds like to me. We know that many of the early programmers were women, back when the job was considered to be largely secretarial. (Go watch Hidden Figures for more on this, and also because it's just a lovely film and I am so happy for Mahershala Ali and Taraji P. Henson.) We know that the fastest way to depress wages in a job is to feminise its workforce. It's not unreasonable to wonder if we've constructed the whole idea of "success in tech" in such a way that it makes men's success look natural and pre-ordained. Yes, you need to be able to code to be a coder. But there are other skills you need too. 

Yonatan Zunger, who recently left Google, makes this argument better than I could. And he seems to own a pair of testicles, so you know he's more rational and objective than me:

"Essentially, engineering is all about cooperation, collaboration, and empathy for both your colleagues and your customers. If someone told you that engineering was a field where you could get away with not dealing with people or feelings, then I’m very sorry to tell you that you have been lied to. Solitary work is something that only happens at the most junior levels, and even then it’s only possible because someone senior to you — most likely your manager — has been putting in long hours to build up the social structures in your group that let you focus on code.

All of these traits which the manifesto described as “female” are the core traits which make someone successful at engineering. Anyone can learn how to write code; hell, by the time someone reaches L7 or so, it’s expected that they have an essentially complete mastery of technique. The truly hard parts about this job are knowing which code to write, building the clear plan of what has to be done in order to achieve which goal, and building the consensus required to make that happen.

All of which is why the conclusions of this manifesto are precisely backwards. It’s true that women are socialised to be better at paying attention to people’s emotional needs and so on — this is something that makes them better engineers, not worse ones."

As I said on Twitter, this is a pattern we see again and again - a high status job is coded as "male", requiring "male" traits, to justify men's dominance of it. The same thing happens in politics: we are assured that politicians need to be "strong" and "decisive", when many of the most successful male politicians today have incredible people skills. Jeremy Corbyn makes time for everyone he meets, hugging them and posing for endless selfies. Sadiq Khan has that Queen Mum ability to remember your name and a key fact about you. What's the real difference between the Clintons? Bill demonstrated huge empathy and made people he was talking to feel special; Hillary didn't. But still, maybe men dominate politics because they are just more aggressive and ambitious. Yeah, OK. 

Tech suffers from a similar silent rewriting of core competencies to flatter its mostly male leaders.

We have all these conversations about how hard it is for Mark Zuckerberg to make the leap to being a frontman CEO because he's a maths guy, not a people guy. We treat this like he's doing an amazing project of personal growth. We don't go, "wow, they really lowered the bar for CEOs to let someone without some of the key skills have a go at it". Or, "his poor colleagues, having to make up for the stuff he's not naturally gifted at". 

There was a similar reaction when Sergey Brin and Larry Page brought in Eric Schmidt when it was time for Google to "grow up". We didn't say, "How embarrassing, they have to find someone to counteract their deficiencies." We said: "Smart move. Not every human can possess all skills, it's wise to have a range of experience and aptitudes at the top of your company."

So this, for me, is the most interesting takeaway from the Google memo. "Do women suck at maths" is a complicated question, and I'm not sure how far answering it will move the conversation forwards. "Have we structured society so that those competitions between the sexes that men can win are deemed to be the most important competitions?" is a better one.

Helen Lewis is deputy editor of the New Statesman. She has presented BBC Radio 4’s Week in Westminster and is a regular panellist on BBC1’s Sunday Politics.