Goitre, cretinism and iodine in South Asia: historical perspectives on a continuing scourge.

Sir Robert McCarrison's work on goitre, cretinism and the thyroid, begun in the western Himalayas in 1902, generated scores of scientific publications during the following thirtyfive years.1 Though that work is often considered the start of serious studies of goitre and cretinism in South Asia, in fact the use of iodine in goitre treatment in this region was noted by Commissioner David Scott at Rangpur in north-east India as early as 1825,2 and was investigated in 1832 by Mountford Bramley at Kathmandu.3 Between Bramley's paper and McCarrison's commencement, over thirty journal papers appeared on South Asian goitre and its treatment. Many district reports and other studies referred to it. Indigenous treatments with iodine-bearing substances and animal thyroid extracts were also recorded. Yet 170 years after Scott's note, at least 10 million people in India, Nepal, Pakistan and Bangladesh still suffer mild to severe iodine-deficiency conditions, and over 150 million are considered at risk.4 In Bangladesh, iodine deficiency diseases have increased over recent decades, as a result of environmental degradation.5 Goitre and cretinism also continue to be significant problems in mountainous areas of China.6 The undoubted progress that has occurred in understanding goitre and cretinism and in knowledge of their treatment has yet to be universally applied. To do so is technically feasible in South Asia, though questions remain on epidemiology and there are serious doubts whether the socio-political will exists to tackle the problem.7 A "technical fix"