Of RSS Swadeshi Sewer Rats and Iodized Salt
Sid Harth
Gandhi's Spirit Hovers as India Debates Iodized Salt
By CELIA W. DUGGER
EW DELHI, Nov. 1 — India has made tremendous progress in eradicating
the ancient scourge of iodine deficiency — the single most preventable
cause of mental retardation — by making cheap, iodized salt available
to most of its billion people. But a recent government decision has
jeopardized these advances, medical researchers say.
Indeed, India's entire scientific establishment, including the Indian
Medical Association and the Indian National Science Academy, seems
aghast that Prime Minister Atal Behari Vajpayee and his Health Ministry
lifted a two-year-old ban on the sale of noniodized salt in September.
In doing so, the government bowed to a lobbying campaign by Hindu
nationalists, Gandhians and small- scale salt producers.
"It is a great tragedy for India to have found a solution, to have come
such a long way and now, this has happened," said V. Ramalingaswami,
who at age 80 is regarded as one of India's eminent medical
researchers. His field studies more than 30 years ago helped establish
that the simple addition of iodized salt to the diet radically reduced
the incidence of goiter, an unsightly swelling of the thyroid gland on
the neck that is the most visible sign of this insidious deficiency.
But those who opposed the ban apparently convinced the prime minister
that people should be allowed to choose whether to buy iodized salt or
common salt, which is slightly cheaper. They dispute the view of
scientists who maintain that the most effective way to combat iodine
deficiency, which is endemic throughout the subcontinent, is to ensure
that all salt is iodized. It is especially important in a developing
country like India, where about 40 percent of the population is
illiterate.
The ghost of Gandhi the independence leader and the symbolism of salt,
that most humble of condiments, hover over this debate. In 1930, Gandhi
led a march to the sea to protest a tax on salt levied by India's
British rulers.
Those on both sides of iodization claim to be the true inheritors of
Gandhi's legacy. The scientists say Gandhi would be happy that salt has
become a way to ensure that even India's poorest children do not have
their intelligence dulled by a lack of iodine, while some followers of
Gandhi contend that he would object to the compulsory iodization of
salt.
Thakurdas Bang, the 83-year-old leader of Sarvodaya, a Gandhian group,
said he told the prime minister when they met: "Mahatma Gandhi made
this simple commodity a medium of our liberation. It's now being used
as a medium of exploitation."
Since the mid-1980's, salt has increasingly become a medium for
combating iodine deficiency in India and all across the developing
world. Unicef and the World Health Organization have spearheaded global
efforts to iodize salt as the simplest and most effective way to make
up for iodine deficiencies in an estimated one billion people at risk
worldwide.
Though all but three Indian states have banned the sale of noniodized
salt, iodized salt is still not universally available. Salt is iodized
by adding the chemical potassium iodate to it. India's salt
commissioner, R. Prakash, said iodization adds only a small fraction of
a penny to the cost of a pound of salt. Each Indian consumes, on
average, 10 pounds of salt a year.
A 1999 government-financed study found that 70 percent of Indian
households use adequately iodized salt. Unicef and other experts here
estimate that 200 million of India's billion people are at risk of
iodine deficiency disorders — and that 70 million have goiter.
Two years ago, the central government imposed a national ban on the
sale of noniodized salt, extending it to all the states.
But India's health minister, C. P. Thakur, who is a medical doctor and
an impassioned advocate of iodized salt, said opponents of the ban
convinced the government that the ban on the sale of common salt was "a
little coercive."
The prime minister's spokesman, H. K. Dua, declined to comment on the
reasons that Mr. Vajpayee, agreed to lift the ban, saying only, "The
government's decision is also his decision."
Scientists say that lifting the ban means that common salt can again be
sold legally in three states and may leak across their borders to
markets in neighboring states. The reversal of the central government
policy also sends a signal that may encourage lax enforcement of state
bans, they say.
In India, where most salt is sold loose out of gunny sacks, "if you
have both iodized and noniodized salt, people will never know which is
which and we will slip back," said N. Kochupillai, who is the chairman
of the department of endocrinology at the All India Institute of
Medical Sciences.
Among those who personally lobbied the prime minister to lift the ban
were leaders of the Swadeshi Jagran Manch — or National Awakening
Front — part of the same Hindu nationalist family of organizations as
the Bharatiya Janata Party, which leads India's coalition government.
In recent interviews, Murli Dhar Rao, the group's organizing secretary,
and Mahesh Sharma, a member of Parliament who is on the group's central
steering committee, made a series of factual assertions that India's
experts on iodine deficiency disorders called baseless and unscientific.
Both men said that iodized salt loses its effectiveness when used in
cooking dal and other Indian dishes at high heat — an assertion the
scientists said was false.
Mr. Rao also asserted that iodine deficiency is largely confined to the
country's hilly regions. "People in the plains don't need to consume
iodized salt," he said. Scientists and government officials replied
that his view is a myth. Surveys have documented that the problem is
widespread throughout the subcontinent, including the plains regions,
where chronic flooding has leached iodine from the soil.
During an interview at his office here, Mr. Sharma called attention to
an article about iodized salt in a recent issue of Manthan, a magazine
he edits. It charged that the potassium iodate added to make iodized
salt is poisonous, that iodized salt is part of a "well-hatched
conspiracy" by multinational corporations to capture the Indian salt
market, and that excessive use of iodized salt makes people
vulnerable "to TB, diabetes, cancer and peevishness."
Doctors were taken aback when they heard these allegations. Dr.
Kochupillai, whose research helped document the devastating effects of
iodine deficiency on the brains of babies, said, "This reflects an
unscientific outlook on life and its issues by our leadership."
This May, Dr. Kochupillai went back to the remote villages he had
studied in the state of Uttar Pradesh in the 1980's — places where
mentally retarded children were commonplace. Sitting in his office,
surrounded by huge mounds of paper, he first pulled out photographs of
village children taken in the 1980's. Their eyes were dull and their
height stunted. Then he showed off snapshots of the bright-eyed, normal-
looking boys and girls he saw this spring.
"Before iodization, the children were so dull they couldn't even tell
us their names," he said. "Now, the children are so smart that they
even told us their birthdays."
Dr. Kochupillai said he would go back to the same villages at regular
intervals over the next two years to see whether noniodized salt makes
a comeback along with cretinism and mental retardation.
Meanwhile, Mr. Rao, of the Swadeshi Jagran Manch, said his group would
take its fight against bans on the sale of common salt to the
states. "The center has no role now," he said. "This is a regional
problem."
http://www.unfoundation.org/unwire/archives/UNWIRE000918.cfm#4
4 INDIA: Doctors Oppose Lift Of Ban On Non-Iodized Salt
India has lifted a two-year ban on the sale of non-iodized salt,
asserting that food consumption is a matter of individual choice.
Yet doctors and state health officials say the decision threatens to
expose Indians to the risk of iodine deficiency, which can cause birth
defects, goiter and the deterioration of mental and physical functions.
State health ministers last month voiced their opposition to Delhi's
proposal to allow the sale of non-iodized salt, saying the move would
harm public health. They said the Swadeshi Jagran Manch, a nationalist
group campaigning against foreign goods and manufacturers, has
pressured the government to allow the sale of non-iodized salt. That
group says the cost of iodized salt is at least six times higher than
regular salt and claims the 1998 ban was influenced by foreign salt
companies, which have a major share in the $500 million annual business
(BBC Online
<http://news.bbc.co.uk/hi/english/world/south_asia/newsid_926000/926271.
stm>, 15 Sep).
http://news.bbc.co.uk/hi/english/world/south_asia/newsid_926000/926271.s
tm
India revokes salt ban
A salt seller weighs rock salt on the streets of Bombay
By Abhishek Prabhat in Delhi
India has lifted a two-year ban on the sale of non-iodised salt,
ignoring medical opinion and opposition from state governments.
A government order says the ban has been revoked because food
consumption is a matter of individual choice.
But the move is opposed by doctors who say it will expose a large
section of people to the risk of iodine deficiency.
They say the government's decision has been made to please the
protectionist lobby led by a nationalist group, the Swadeshi Jagran
Manch.
Health risk
The general secretary of the Indian Medical Association, Dr Prem
Aggarwal, told the BBC the government had given in to political
pressure to lift the ban.
A salt worker collects salt from the sea to dry in salt pans in north
Bombay
Terming it as unfortunate, Dr Aggarwal said this would put people
across the country at the risk of iodine deficiency disorders -
prominent of which is goitre.
Iodine deficiency can lower the production of thyroxin hormone by the
thyroid gland and lead to abnormal enlargement of the gland in the
neck, slowing down physical and mental functions.
Doctors say if not treated, it could cause brain deficiency.
Pregnant women suffering from iodine deficiency run the risk of giving
birth to physically and mentally underdeveloped babies.
Protecting local producers
State governments had also opposed lifting the ban.
At a meeting last month, state health ministers opposed Delhi's
proposal to allow the sale of ordinary salt.
All the states, with the exception of Bihar and Kerala, described the
move as a retrograde step going against public health.
They said the Swadeshi Jagran Manch - a nationalist group leading the
campaign against foreign goods and manufacturers - had been putting
pressure on the government to allow sale of ordinary salt.
The group says iodised salt is at least six times costlier than the
ordinary salt produced by local manufacturers.
The group also alleges that multinational companies, having a major
share in the more than $500m annual business, were behind the ban
imposed in 1998.
http://www.saltinstitute.org/37.html
Iodized Salt
David Marine (1880-1976) is the "father" of iodized salt in the United
States. As the result of his and co-workers research on endemic goiter
and iodine deficiency, the Michigan State Medical Society, in 1924,
approved and began a goiter prevention program using iodized salt. Salt
producers cooperated and made both iodized and plain salt available at
the same cost. Newspapers urged people to use iodized salt for the
prevention of iodine deficiency. The Michigan program was highly
successful and iodized salt use quickly spread throughout the country
<idd.html>. Ultimately, household use of iodized salt eliminated iodine
deficiency in the North America, though continued public education
<http://www.bostonherald.com/lifestyle/health_fitness/heal04022000.htm>
is needed.
During 1955, researchers reported that 75.8% of U.S. households used
only iodized salt. The Salt Institute estimates that today more than
half of the table salt sold in the United States is iodized. The U.S.
Food and Drug Administration approves both potassium iodide and cuprous
iodide for use in table salt. U.S. salt producers use potassium iodide
</iodide.html> at a level of 0.006% to 0.01% KI. Daily Iodine intake
should not exceed 225 micrograms for adults and children over 4 years
of age.
Potassium iodate is preferred in some countries, particularly in
tropical regions, because it is more stable than potassium iodide under
hot, humid conditions. Loss of iodine from iodized salt produced and
sold in the United States is not a concern because producers use
moisture proof packaging, added stabilizers, and storage conditions in
the grocery distribution system are suitable. Table salt packaged and
stored under proper conditions has an indefinite shelf life.
Fortifying salt is an important worldwide public health initiative
(<http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/su48a14.htm>
<http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/su48a26.htm>). Iodine
deficiency in less developed countries and in the former Soviet Union
<http://www.mn-net.org/iddstat/> is still a serious problem
<http://www.tulane.edu/~icec/aboutidd.htm>; it was identified as the
top health priority at the 1990 World Summit for Children and is the
top service project of Kiwanis International
<http://www.umich.edu/~circlek/idd.html>. One particular problem is
that these countries lack high quality manufacturing
<http://www.idrc.ca/mi/idddocs/iodman6.htm> and packaging
<http://www.idrc.ca/mi/idddocs/iodman11.htm> technologies. With active
cooperation by the Salt Institute (including a major effort by Salt
Institute member Morton Salt <http://www.kiwanis.org/kiwanis-
morton_partnership.html> -- for more information on Morton's role,
visit the company's website
<http://www.mortonsalt.com/como/iddccomm.htm>) and the European Salt
Producers Association, a combination of efforts are underway through
UNICEF <http://www.unicef.org/> (their "status" page
<http://www.idrc.ca/mi/usi.htm> is usually old news), the World Health
Organization <http://www.who.int/>, the ICCIDD
<http://www.people.virginia.edu/~jtd/iccidd/>, the World Bank
<http://www.worldbank.org/>, Kiwanis International
<http://www.kiwanis.org/worldwide_service_project.html> (check out
their substantial "progress" page
<http://www.kiwanis.org/progress.html>), the Program Against
Micronutrient Malnutrition <http://www.sph.emory.edu/PAMM/>, the
Micronutrient Initiative <http://www.micronutrient.org/> and the
Thyroid Federation International <http://www.thyroid-fed.org/> to
eradicate iodine deficiency, primarily using iodated salt
<http://icb.usp.br/~lats/BURGI.HTM>. The ICCIDD considers salt
<http://www.idrc.ca:80/mi/idddocs/iodman4.htm> its most valuable means
of combatting iodine defiency disorders
<http://www.idrc.ca:80/mi/idddocs/iodman21.htm> and maintains an
extensive database on technical questions
<http://www.idrc.ca/mi/idddocs/iddindex.htm> involved in iodizing salt.
UNICEF maintains a website to report the status of its anti-IDD project
<http://www.idrc.ca/mi/usi.htm>. The World Health Organization has an
active anti-IDD program <http://www.who.int/inf-pr-1999/en/pr99-
wha17.html>. TheLatin American Thyroid Society
<http://icb.usp.br/~lats/nogidd.htm> has a web page summarizing
progress in the fight against IDD in Latin America. Unappreciated, IDD
is also a problem in Europe <http://www.idrc.ca/mi/idddocs/idd293.htm>.
Examples of national IDD eradication campaigns are online for Vietnam
<http://www.kiwanis.org/wsp/zirkle3.htm>, Kenya and Nigeria
<http://www.unicef.org/pon96/nuiodize.htm> and for the City of Bombay,
India <http://www.idrc.ca/cfp/facts15_e.html>. India has had
considerable difficulty
<http://www.newscientist.com/ns/970906/nsalt.html> overcoming local
opposition to iodizing salt.
Progress on the global campaign to virtually eliminate the public
health threat of Iodine Deficiency Disorders was a featured part
<http://www.micronutrient.org/highlights/iodine.shtml> of the May 7-11,
2000 International Symposium on Salt, Salt 2000
<http://www.sph.emory.edu/PAMM/salt2000.html>. To maintain momentum in
the collaborative efforts to eliminate IDD, primarily by iodizing salt,
a working group Salt 2000: Iodine Inside
<http://www.sph.emory.edu/PAMM/SALT2000/salt3.htm>, is organizing
follow-up activities.
The technology for iodizing or iodating salt is well know, readily
available, and inexpensive. However, in some countries consumer
purchasing habits, availability, and distribution conditions may
discourage the use of iodized or iodated salt.
Several countries, including France
<http://www.salins.com/uk/dossiers/index.htm>, Mexico and Switzerland,
add fluoride to table salt to prevent dental caries. Calcium- and iron-
fortified salt is sold in Egypt and use of double-fortified
(iodine/iron) salt has been demonstrated in Ghana, Bangladesh and
Guatemala
<http://www.micronutrient.org/highlights/double_fortification_of_salt.sh
tml> and is being investigated in India and Nigeria
<http://www.micronutrient.org/news/index.cfm?action=read&article=95>
(also see IDRC <http://www.idrc.ca/nayudamma/malnusalt_e.html> on this
subject).
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Before you buy.