It is pleasing to see this article being accorded ‘classic’ status. I am also glad to be able to offer comment on it since, by coincidence, I was ‘on the sidelines’ during the development of several stages of what became a multidisciplinary research-and-intervention odyssey, spanning the 1960s to the 1980s. Around 1970, Basil Hetzel, Foundation Professor of Social and Preventive Medicine at Monash University, Melbourne, Australia—and supervisor of my (unrelated) PhD—saw clearly the need and opportunity to pursue a programme of research for which this classic article is the prime foundation. The programme sought, via epidemiological research and then animal experimental studies, a fuller understanding of the developmental and health consequences of lifelong iodine deficiency. Whereas goitre (sometimes associated with cretinism) had been known to medicine in Europe and China for many centuries, its usual causation by micronutrient deficiency was not understood and neither was its linkage with a wider range of disabilities. Hence the importance of research to achieve, first, the elaboration of the full spectrum of iodine deficiency disorders (IDDs), and, second, the mobilization of international agency support for large-scale population interventions and evaluations. Basil Hetzel was Professor of Medicine during my undergraduate clinical years (1964–66) at the University of Adelaide. I knew nothing, then, of his nascent interest in the problem of iodine deficiency and goitre in the Papua New Guinea (PNG) highlands. In describing the source of his interest, he has noted in his autobiographical book, Chance and Commitment: Memoirs of a Medical Scientist (2005), the role of serendipity in one’s research life—in this case, his being asked to review a journal paper, in 1963, on an exploratory study of goitre prevention in PNG. During my first 2 years in the Department of Social and Preventive Medicine at Monash University, there were occasional frissons of excitement relating to the ongoing randomized controlled trial of cretinism prevention in newborns in a sample of villages in the PNG highlands. The intervention, in 1966, entailed intramuscular injection of reproductive-aged, alternate, women with iodized oil or saline. Follow-up of pregnancy outcome occurred over the next 3 years, via copious boot-leather epidemiology in the mountainous PNG highlands. This classically experimental study was a relatively novel epidemiological research design in the late 1960s—and especially so for non-communicable disease outcomes. (Further, of course, it was carried out at a time when the process of research ethical review was a much lesser source of delay and frustration than is now the case.) Interestingly, at that time, the concepts and terminology of epidemiological research, especially for non-communicable diseases, were in a rather intuitive and unsystematized state. The leading epidemiology textbook of the day, by McMahon and Pugh, did not mention the actual word ‘confounding’. (When I arrived in 1972 at the highly regarded Department of Epidemiology, University of North Carolina, the senior academics there referred to case– control studies as ‘association studies’). Hetzel was fortunate to have able and energetic field-working colleagues, well-attuned to tramping around the PNG highlands—Drs Ian Buttfield and, especially, Peter Pharoah. The support from the PNG Department of Public Health was also invaluable. Meanwhile, back in Australia, the other side of the ‘iodine coin’ was causing public health concern. Tasmania, with its long-standing problem of iodine deficiency and adult goitre, had introduced iodine-supplemented bread in 1966. At that same time, coincidentally, iodine-based sterilizers (iodophors) were introduced into the dairy industry to ensure a safe milk supply. This became a second, unintended, source of iodine supplementation in the diet. A subsequent rise in thyrotoxicosis occurred due to over-exposure to supplementary iodine and, hence, overactive thyroid glands. Hetzel was called in as an advisor. Here was further confirmation of a central role for dietary iodine imbalance as a source of various human health disorders. Published by Oxford University Press on behalf of the International Epidemiological Association
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Sep 1, 2017
Veronika J Wirtz + 1
Open Access
