So the FSA's recent decision to recommend rejection of the compulsory fortification of flour with folic acid might seem absurd. But there are strong arguments to support the FSA's decision. First, folic acid can mask a deficiency of vitamin B12 in elderly people which, if not picked up, can lead to neurological damage. At the moment, we simply do not know enough about the effect on the incidence of B12 deficiency if folic acid were added to flour. Aside from the health risks, there is also a consumer principle at stake. Mandatory fortification is effectively a form of mass medication and, as such, there is an issue of consumer choice. Under a mandatory policy, it would be very difficult for those who wish to avoid folic acid to do so. In addition, even if fortification at the suggested level were introduced, not all women would achieve the desirable levels of folic acid intake. Thus, fortification would not eliminate the need to continue to advise all women who could become pregnant to take a supplement. We would like to see continuing public health messages on folic acid supplementation. Perhaps the question is, who is going to pay for this? Could it be that public health education carries ongoing costs while mandatory measures, by passing on costs to industry and consumers, is a cheaper option for government? While we think the FSA's decision is the right one, it does not solve the problem of how to encourage greater folic acid intake among women of childbearing age. Perhaps free supplements to those on limited incomes might be a start? {{NEWS }}