kabbasi@bmj.com Follow Kamran on Twitter @KamranAbbasi In 1999 we published a letter by Nicholas Wald and others that estimated that 45% of pregnant women had taken folic acid supplements “immediately before becoming pregnant” (doi:10.1136/bmj.319.7223.1499).1 A Medical Research Council study from 1991 had shown a “lower risk of pregnancy affected by neural tube defects” with periconceptional supplements. [...]the evidence for the benefits of breast cancer screening is disputed, and money would be better spent on promoting informed choice on the balance of benefits and harms (doi:10.1136/bmj-2021-065726).3 Is overpromoting an intervention, for instance, a form of negligence? What if you wrongly advise millions of people, on national television, about the efficacy of vaccines (https://www.sciencemediacentre.org/expert-reaction-to-a-doctor-challenging-the-health-secretary-sajid-javid-on-compulsory-vaccination-at-kings-college-hospital)?4 Or fail to stay up to date with the latest research on vaccines and myocarditis (doi:10.1136/bmj-2021-068665)?5 Perhaps you need an update on management of chronic anal fissures (doi:10.1136/bmj-2021-066834) and extreme preterm birth (doi:10.1136/bmj-2021-055924)?67 How about the company executives refusing scrutiny of their trial data while profiting by the billion (doi:10.1136/bmj.o102)?8 Or the editors, journalists, and politicians unwilling to cover the growing concern about China’s human rights abuses (doi:10.1136/bmj.o44)?9 What of Facebook’s responsibility in trying to censor legitimate concerns about the conduct of clinical trials (doi:10.1136/bmj.o95)?10 This is before we start asking about the people turning a blind eye to the crises in social care and the NHS (doi:10.1136/bmj.o107;doi:10.1136/bmj.o103;doi:10.1136/bmj.o125;doi:10.1136/bmj.o118;doi:10.1136/bmj.o99) and the impact of covid on other illnesses and death (doi:10.1136/bmj.o100).111213141516 In each and every one of these instances somebody is making decisions that could be suboptimal or placing people at risk;somebody may be found “responsible” in a court of law.
Folic acid supplementation and the complexities of blame