For folic acid, the B vitamin now added to cereals and wheats in North America, the breakthrough came around 1991. Until that year, scientists suspected, but could not prove, that women who took folic acid during pregnancy dramatically reduced neural tube defects in newborns. When the neural tube doesn’t close properly, the result in fetal development can be such defects as spina bifida, an opening in the spine that causes lower paralysis, or anencephaly, a complete lack of higher parts of the brain,
Britain had long suffered a relatively high rate of such defects as well. As a result, its Medical Research Council started a randomized clinical trial in 1983 to see if women who had borne such a child could take folic acid to lessen their chances of having another.[1] By 1991, researchers saw a 71 percent reduction of neural tube defects, and the Research Council began to encourage all pregnant women to take folic acid.
In 1998, Canada began adding folic acid to enriched pasta, white flour, and cereals; by 2002, it had halved its rate of neural tube defects.[2].Eventually the United States did the same, but how and why folic acid came to be required in American cereals is a long story that I’ll tell later.
Today, folic acid stands as a great success story of North American medicine. It’s also a story of how humans can ethically enhance themselves by creating better babies from conception.
The cases that this book describes show that humans, if they are careful and rational, can enhance themselves, and do so ethically. That is, we can utilize genetics, biotechnology, and medicine in safe, ethical ways. For humans, enhancement is not the enemy of the ethical.
I define “human enhancement” broadly as any attempt to improve humans, whether in a particular life or for future humans, whether in utero or late in life through drugs, whether incrementally by adding vitamins to cereal or suddenly by giving everyone smart phones.
It may surprise fundamentalists that medicine has been quietly enhancing people for decades and has neither become Nazi-like, nor has it, for the most part, seriously harmed anyone. It’s time that we ignore Alarmists and think about human enhancement in public, practical, serious ways.
What are those ways? Well, one of those ways concerns how we “do” ethics. We shouldn’t lump all cases of enhancement together any more than we should lump all kinds of technology together. As Aristotle said, we need to treat different kinds of cases separately. If we don’t, bad things happen.
We also need to transcend the two common frame stories of bioethics: bioconservative alarmism and uncritical enthusiasm. Neither does justice to the complexities of medicine nor to the real problems of enhancing humans.
But we need to get going. By 2012, we’ve had a half-century of bioethics (dating its start from the 1962 God Committee). It’s time that bioethics became part of the solution, not the problem, in making better humans.
Susan White Junod, “Folic Acid Fortification: Fact and Folly,” Update, the bimonthly publication of the Food and Drug Law Institute. http://www.fda.gov/oc/history/makinghistory/folicacid.html
De Wals, “Reduction in Neural Tube Defects after Folic Acid Fortification in Canada,” New England Journal of Medicine 357, July 12, 2007, 135-142.