Sixteen thousand staff were involved in running the project, which encountered massive bureaucratic obstacles as well as cultural differences, politicking for study designs and funding, the crisis of Tiananmen Square, and testy debates over research ethics. Nevertheless, the researchers persevered in a collaboration that lasted more than three decades and led to landmark findings on the role of folic acid in preventing spina bifida. Fortifying cereal grain products with folic acid became routine in the United States and a growing number of nations around the world: that intervention was named one of the ten great public health achievements of the last decade.
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