Dear all:

It never ceases to amaze me in the realm of indicators how hotly disputed their use is 
and the most respected scientists sometimes cling to "beliefs" about indicators that are 
inconsistently applied.  

So, here are the controversies in several other nutrients.

Iodine in international nutrition:
urinary iodine excretion is the indicator of "intake"
TSH is the indicator of hormonal function
thyroid size is the indicator of clinical disease measured by palpation or ultrasound
DQ or IQ is the indicator of developmental delays
IQ is the indicatorcretinism is the indicator of severe irreversible mental and physical 
impairment.

The controversy = using a simple finger stick test for thyroid function.  This would be a 
highly portable easily collected indicator to determine whether or not public health 
programs for iodinated salt were decreasing iodine deficiency.

Urinary iodine excretion requires a laboratory and works best with an autoanalyser.  This 
is an incredibly tedious test and despite being able to work in a genetic engineering lab, I 
was not good at urinary iodine excretion because I found the timing to be challengin.

Thyroid size is a late stage indicator and when tested against ultrasound, all the 
"specialists" in research on iodine deficiency had something like a 30% error rate when 
palpating the thyroid.

Discussion over TSH was incredibly heated with vociferous arguments against its use and 
so at least when I was still in the field, there were merely goiter surveys and a few 
scattered labs in developing countries and one lab in Belgium that could do the urinary 
iodine tests.

More to come ---- on vitamin A and iron next for more indicator controversies.... 

And why I think we need to think about all the ways in which we "Judge" the situation

when I get back to the computer tonight.

Best, Susan

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