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World Health

Inaugural Meeting of International Council forControl of Iodine Deficiency Disorders

LARGE populations of the world live in regions where thesoil has been leached of iodine and all food grown there isdeficient in iodine. Particularly prone are mountainous areasin the Himalayas, the Andes, the European Alps, China, andIndonesia, where iodine deficiency disorders (IDD) in theform of goitre and cretinism are very common. They are partof a spectrum of effects of iodine deficiency on growth anddevelopment, including various grades of mental defect,which can be prevented or usually much improved bycorrection of iodine deficiency. Although goitre is the mostfamiliar result of iodine deficiency, its most important effectis on the brain, particularly during fetal life.The International Council for Control of Iodine

Deficiency Disorders was createdl after a meeting in Delhi atthe time of the WHO/UNICEF inter-country workshop onthe control of iodine deficiency disorders in March, 1985.The Council’s chief purpose is to bridge the great gapbetween knowledge and its application in this area.2,3 It seeksto support WHO, other international agencies, and nationalgovernments whose peoples are burdened by IDD.A multidisciplinary network of 200 Council members throughout

the world will advise on communication, planning, and economicsand on technical aspects (iodinated salt and oil and the pathology,physiology, and biochemistry of thyroid disorders). The promotionof monitoring and evaluation procedures is another objective. Sixregional IDD coordinators will take charge of surveillance in thosecountries with a high incidence of IDD. Each coordinator canconstruct a regional multidisciplinary team available forconsultation in the region. Consultations with national

governments and with WHO and UNICEF have already been held.The Council’s policy is laid down by a board, on which WHO,

UNICEF, and the World Bank are represented, and implementedby an executive committee. Financial support has been provided byUNICEF (New York) and the Australian Government through theAustralian Development Assistance Bureau. A secretariat has beenestablished in Adelaide, where Dr B. S. Hetzel is the executivedirector (CSIRO Division of Human Nutrition, Kintore Avenue,Adelaide 5000, Australia). The Council publishes a quarterlynewsletter, edited by Dr J. T. Dunn (Box 511, University ofVirginia Medical Center, Charlottesville, VA 22908, USA).The inaugural meeting of the ICCIDD was held in March

in Kathmandu, Nepal, when experts of different back-grounds consulted about the prevention and control of IDD.The meeting examined the global state of the control of IDDand discussed strategies and goals for the Council’s activitiesover the next three years. A second meeting has been arrangedfor next year in Yaounde, Cameroon.In a message to the inaugural meeting Dr Halfdan Mahler,

Director-General of WHO, said:The sad reality for people who live in iodine-deficient

environments, and who consume exclusively locally grown foods, isthat they suffer from reduced mental ability and are at a

considerably greater risk of producing cretins as offspring, with allthe profound human implications these conditions have for theindividual and the family, and the economic burden for the

community at large. The most tragic aspect of the ravages of thisnutritional deficiency is that proven techniques have been availablefor years to combat it. They are simple, cheap, and fully compatible

1 See. Lancet 1985; ii: 8462 Editorial From endemic goitre to iodine deficiency disorders. Lancet 1983; ii:

1121-223. Hetzel BS Iodine deficiency disorders and their eradication. Lancet 1983, ii: 1126-29

with the primary health care approach. But IDD prevention andcontrol is only in part a medical problem; the other major dimensionis the national and international political will needed to overcomethe geographic, economic, and administrative obstacles.If IDD is under control in the majority of industrialised countries,

as well as in some developing ones, much remains to be

accomplished in Africa, and in many parts of Asia, the Pacific, andSouth America. Immediate action is called for on a number offronts:

improved prevalence assessments, definitions of control methods,and prevention strategies; education of the public, motivation ofhealth authorities, and training of health personnel; drafting andadoption of appropriate health legislation; and establishment ofeffective monitoring and evaluation measures. The InternationalCouncil for Control of Iodine Deficiency Disorders can play animportant role and WHO looks forward to tapping its considerabletechnical expertise and experience, both in helping it to supportcountries which seek to develop sound prevention and controlprogrammes and in conducting research. WHO also considers thatthe Council could play a leading role in helping it develop trainingcurricula for health personnel who are responsible for nationalprevention and control programmes.

Conference

Surgical Research in EuropeTo mark its 20th anniversary the European Society for

Surgical Research met, on May 6-8, in Nancy, so honouringboth its birthplace and its founding father, Prof R.Benichoux. With guest lectures from Jean Dausset, NormanE. Shumway, and R. Y. Calne, transplantation, especially ofthe heart and liver, was well represented. The kidney muchless so. At a time when some have suggested that cyclosporinmight overcome histoincompatibility Professor Daussetremains convinced of the importance of matching and oftransfusions and immunosuppression, all of which

individually have been responsible, in his view, for 15-20%increases in graft survival rate. "Not to take account of HLAcompatibility in 1986, when all the statistics are concordantin this respect, is", he warned "to take on a heavyresponsibility vis-a-vis patients."After a flurry of activity in the late 1960s heart transplants fell into

disrepute, but Dr Shumway’s unit at Stanford carried on, and at theNancy meeting he was able to review experience with 399

operations in 366 patients. The main indications have been

coronary artery disease and cardiomyopathy, but the relative

importance of cardiomyopathy is increasing. Survival to 1 year wasnow around 80% and 9 out of every 10 patients will leave hospitalalive, typically after only 3 weeks, and with good prospects notmerely of survival but also of rehabilitation. The prospects forsurvival to 1 year in patients under 18 may be even better, at about90%. Eighty centres in the United States have now done thisoperation-and that, Shumway thought, was too many, and a policyof regional centres is likely. The heart is the only striated musclethat can survive being parted from its nerves. In dogs the

importance of the pulmonary innervation precluded heart-and-lungtransplantation but the existence of a respiratory centre in primateshas permitted clinical progress with the combined operation, andShumway’s team has now done 30 such operations on 29 patients; i14 are alive and well at a follow-up of 4-57 months, there havingbeen 10 hospital and 5 late deaths. He emphasised that heart-and-lung transplantation had, in obstructive bronchiolitis, the

equivalent of the recurrent coronary artery disease seen in aboutone-third of cardiac allografts. This bronchiolitis shows up early onmeasurement of forced expiratory volume.Dr J. B. Otte and colleagues from Brussels returned to liver

1. Burke CM, Theodore J, Baldwin JC, et al Twenty-eight cases of human heart-lungtransplantation Lancet 1986, i: 517-19