Breda O’Brien: State hits vulnerable and elderly with more tax

Last October, Minister for Agriculture Michael Creed launched a €3.4 million joint research initiative. Nicknamed "Microbe Mom", it is a collaboration between the Irish firm, Alimentary Health Group, Teagasc, UCD and the National Institute of Biotechnology Research and Training.

It is designed to optimise the use of probiotic supplements for pregnant women in order to give birth to healthier babies. Creed said that optimising food and supplements for women in pregnancy was crucial to long-term health and wellbeing.

I guess that must be the reason why Revenue has decided to slap VAT from March 1st at the highest rate of 23 per cent on probiotics. And on all health supplements, everything from fish oil to vitamins.

Gut microbiota, particularly beneficial bacteria, our essential tiny tenants which do everything from synthesising vitamins B and K to converting fibre into short-chain fatty acids, are a major area of research right now. There are really interesting animal studies which suggest that artificial sweeteners disrupt these beneficial bacteria.

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What is the rate of VAT on artificial sweeteners? Exactly the same as sugar, as it happens: zero per cent.

Revenue has form in this area. In 2014, it decided that the term “tea” only applied to the dried leaves of the camellia sinensis plant and that peppermint, chamomile and other herbal teas should be taxed at 23 per cent.

Michael Noonan intervened and the rate remained at zero per cent. But health food stores had better be selling lots and lots of herbal tea because unless this is reversed, there are tough times ahead. The kind of store that will be most affected is the small, Irish-run concern managed by knowledgeable people who are passionate about health.

An Irish Health Trade Association survey showed that many of its members may have to make staff redundant or even close stores if the VAT increase goes ahead.

Central vision

I have a personal interest in one kind of supplement that is going to increase in price. (Certain supplements, like folic acid and vitamin D3, already have product authorisation from the Health Products Regulatory Association and will continue to be exempt from VAT.)

My father suffered from age-related macular degeneration (AMD), a condition that can result in the loss of all central vision in the eye. Central vision is essential for seeing fine details, reading, writing, interpreting colours and making out facial features.

My father took part in one of the early trials conducted by Prof John Nolan of the Waterford Institute of Technology to evaluate the effectiveness of treatment with the carotenoids lutein, zeaxanthin and meso-zeaxanthin.

Supplements have to be used intelligently and in line with the latest research

I was already convinced by preliminary studies from abroad that supplementation with carotenoids was at least worth a shot and was worried that my father would be one of the subjects given a placebo.

I asked him to consider supplementing and not taking part in the trial and was humbled when my father, in his 80s, said gently that if everyone thought that way, science would never advance.

By taking the supplement, he might help himself. By taking part in the trial, he had the potential to help many people as well as himself.

My father has died but since he took part in the trial, I have kept an eye Prof Nolan’s research. In a two-year trial involving 100 people with early-stage AMD, 40 per cent of trial participants had what is deemed to be a clinically meaningful improvement in their vision after 24 months.

Eye specialists

Carotenoids are not a panacea, but they do help in some people to prevent and slow down the progress of AMD, which is the leading cause of older people being declared legally blind. They are regularly recommended by eye specialists but now they will be subject to 23 per cent VAT.

This is a tax on older people because they are most at risk. A 2016 study published in the Journal of Ophthalmology estimated that the financial and total economic costs of blindness in the Republic of Ireland in 2010 were €276.6 million and €809 million, respectively, and will increase by 2020 to €367 million and €1.1 billion.

The costs of providing social welfare and the pension for blind people were not included.

AMD is not the sole cause of blindness, obviously, and the 2016 study included people aged 18-64 but it is sufficient to indicate the scale of the cost.

Our Department of Health is not much good at doing sums, as evidenced by the national children's hospital debacle, but surely even it can see that a relatively cheap supplement that helps prevent the leading cause of blindness in older people should not be taxed at 23 per cent? Medical treatment costs tens of thousands and may not work.

Dozens of other supplements have positive effects, such as fish oils for depression, particularly when used with other anti-depressant therapies.

Why, when health budgets are spiralling out of control, would you tax people for trying to improve or maintain their health?

Supplements have to be used intelligently and in line with the latest research. But making it more difficult for less well-off and older people to access them shows that all the rhetoric about prevention rather than cure is just hypocritical posturing.