Short abstract:

Focusing on the controversy around mandatory folic acid fortification in the UK, this paper examines how contestations over scientific evidence subtract from the controversy to reach a resolution. The heuristic of thinking with folate is then explored as a way to add to the terms of the debate.

Long abstract:

In 2021, the UK Government announced its plans to implement mandatory folic acid fortification, a public health intervention that has as its aim to reduce the number of pregnancies affected by Neural Tube Defects (NTDs). We might say then that insofar as there exists a problem of NTDs, mandatory folic acid fortification is now being proposed as its solution. Yet, concerns around the adverse health effects of high doses of folic acid – such as the masking of B-12 deficiencies and the possibility of an increased risk of some cancers – have embroiled the intervention in much controversy. Attempts to forge a way forward have been made by reviewing available scientific evidence both for and against mandatory fortification. While such contestations between different medical knowledge and evidence may indeed prove useful in ‘settling’ the controversy, we argue that what this also does is delimit the extent to which we may develop an appreciation for all that folic acid can do. We therefore ask: what might it mean to take folic acid not simply as a solution (i.e. fortification) to the problem of NTDs, but as a problem in its own right? Relatedly, how might doing so change the way we think about the problem of NTDs and its proposed solutions? If contestations over scientific evidence subtract from the controversy to reach a resolution, this paper will think with folate so as to add to the terms of the debate instead.