Lesley Riddoch: No delays, we must meet MS head on

It’s Scotland’s multiple sclerosis.

Not a catchy slogan. Yet with 10,500 sufferers north of the Border, MS is as peculiarly common to Scotland as those valuable oil and gas deposits. It has received far less attention even though higher rates of smoking, lower rates of oily fish consumption, lack of sunshine and consequent vitamin D deficiency mean Scotland has the highest mainland MS rates in the world.

What can we do about that, short of hauling cloudy Scotland south towards the natural protection that appears to come with year-round sun?

According to George Ebers, Professor of Clinical Neurology at Oxford University – quite a lot.

The professor made an angry contribution to last week’s news, saying he warned Scotland’s chief medical officer Harry Burns years ago about Scotland’s rising tide of vitamin D deficiency and told him about new research that showed it can switch off genetic changes that trigger diseases like MS.

Prof Ebers doesn’t mince his words.

He thinks Scotland’s medical and political establishment has failed to grasp the nettle and push for vitamin D supplements in flour to turn the tide on MS, heart disease, diabetes and certain forms of cancer.

Is he right? It would take several pages and a medical background to rehearse all the arguments.

Studies show young Scots who migrate to sunnier climes before the age of 15 acquire their new homeland’s susceptibility to MS. After that age, Scots take their higher susceptibility to MS with them.

Another study shows fewer people with MS are born in November (at the end of the protection-conferring summer) compared with May (at the end of the vitamin-D deficiency inducing winter).

A survey of pregnant women in Glasgow found their vitamin D levels were insufficient (by any official measure) even though they were healthy women.

An international comparison in the Neurological Science Journal (2001) concluded MS rates “for mainland Scotland are the highest so far detected anywhere in the world for large populations” – higher even than populations living far further north in the Nordic countries, Russia and China.

So what are we waiting for then? Why isn’t Alex Salmond’s government ringing the alarm bells to ensure every Scot does what almost every health profession already does – eat mackerel, pop a daily vitamin D tablet or take cod liver oil capsules during the winter months?

Since celebrity chefs have failed to make oily fish popular – why not go the extra mile and make Scotland the first country to put vitamin D in the most appropriate food?

The official response is that a large randomised trial is needed first to establish whether mass vitamin D supplementation is safe and effective in preventing MS – and that means spending millions to give relatively high doses to hundreds of thousands of youngsters for several years before we could be sure the strategy works.

Well, why don’t we get on with it then?

Some experts like Prof Ebers believe there’s already enough proof that vitamin D works. On the other hand, there was certainty about the restorative power of other vitamin supplements which failed to deliver.

Wouldn’t a change of diet be a better and cheaper long-term fix than popping another pill – especially when naturally occurring vitamin D appears to protect more powerfully than any supplement?

Vitamin D supporters snort at this. They argue the hormone’s unique way of working in the body makes comparison with vitamins A and C pointless and well behind the curve of recent breakthrough scientific findings.

Without expertise and free access to academic papers, the lay person will find it hard to judge. But health professionals should have neither problem.

Is the unpalatable truth that a randomised trial in Scotland might not prompt action anyway?

Just such a “full experiment” was conducted in the UK to test the efficacy of folic acid in reducing birth defects. The Lancet reported in 1991 that “folic acid had a 72 per cent protective effect” and on the strength of that the US Food and Drug Administration ordered all flour to be fortified with folic acid. The British – who conducted and paid for the randomised trial – did not.

As a result, according to a Medical Research Council update in 2007, the US, Canada, Chile and Costa Rica – all of whom fortified flour – have seen a drop in NTD (neural tube defect) rates among live newborn babies of between 23 and 78 per cent. The UK rate is now one and a half times greater than the Americans.

So perhaps the folic acid story tells us something important about Britain. We won’t accept additives in our food even if it could save lives. We don’t trust our governments or scientists enough to let them “tamper” with our food. Why not? Are irresponsible UK newspaper headlines about “mad boffins” and “Frankenstein foodstuffs” to blame?

Or could it be that the British public has hardly had a say? Could it be that the health establishment – once rebuffed by politicians – is simply too scared to act and too easily cowed by the negative reactions of an untrusting public?

The 2003 campaign for fluoride in Scottish water is cited by health professionals as proof positive that the public will reject any new additive proposal.

Fluoridisation is supported by the BMA, Centre for Disease Prevention and Control, Medical Research Council, British Dental Association, World Health Organisation and the UK Parliamentary Group on Primary Care.

Of course, they could all be wrong. But they firmly believe they are right and 90 per cent of our politicians believe them. They are all certain we could save money and tackle Scotland’s appalling dental health record by putting fluoride in water.

But they are too scared of public opinion to push the case again. Why? A Scottish Government consultation found 97 per cent of responses from the general public against and 93 per cent from professionals for fluoridisation.

You could say that’s democracy.Or you could say that’s shocking – a mismatch of opinion that’s been shelved not resolved, and sits as a subconscious block to new additive proposals in the minds of politicians and health professionals.

If a trial really is needed, let’s hear how Scotland can share costs, extend scope and regain the power to act by conducting vitamin D supplement trials with our Nordic neighbours in 2012.

Fear of public opinion cannot be a reason to delay.