How Switzerland cured endemic goiter

Switzerland's problem with goiter–swelling of the thyroid, associated with various other symptoms–was as outsize as everyone's necks. The debate over what caused it and how to deal with the consequences was itself an institutionalized feature of the country's medical establishment, so when country doctors began figuring it out–it was caused by iodine deficiency–it was only the beginning of solving the problem of getting the stuff into people's bodies. Jonah Goodman's long article about the crisis and the social controversy caused by its solution serves as a reminder of history's repetitive tendencies.

Treatments in Swiss pharmacies might contain a daily dose of one gram of iodine, but Hunziker argued that a ten-thousandth of this was all that was required, and that the Jod-Basedow effect (now known as iodine-induced hyperthyroidism, or IIH) was a sign of overdose. Indeed, he claimed to have tested tiny doses for years, with no ill effects: during treatment, goitre shrank; when treatment ceased, it returned. Goitre was not an alien growth or an infection, merely an enlarged thyroid. Hunziker addressed cretinism (now known as congenital iodine deficiency syndrome) with logic: in the rare instances when babies are born without a thyroid, they suffer only after birth, meaning that in utero they must use their mother's thyroid hormones. Goitre-related birth defects – from deafness to cretinism – must therefore be due to the mother's lack of iodine, probably in the first trimester. To end the ancestral curse, all the Swiss people needed was a tiny, daily dose of iodine delivered in an everyday commodity: table salt. …

but in Switzerland criticism was fierce. Shortly after its publication, a leading doctor at the University of Zurich, Adolf Oswald, wrote a scathing rebuttal in the country's most authoritative medical journal demanding that the proposal 'must be vigorously opposed'. To his detractors, Hunziker was historically illiterate and his theory a recipe for mass poisoning.

The most fascinating part: after it was made completely clear what was going on, the people responsible for saving the country from goiter were marginalized by a rich far-right crank who, despite having formally voted to approve iodized salt in his own capacity as a medical doctor on the national Goitre Commission, launched a lifelong campaign of claiming it was dangerous. Iodized salt had, it turned out, harmed the market for his own treatment for goiter.

Bircher became the editor of the Swiss Medical Weekly in 1926. During the 1930s and 1940s, he occupied an ever increasing number of senior positions in the Swiss industrial, political, medical and military establishment. His opposition to iodised salt was fixed and unchanging, long after its effects were essentially beyond dispute. Until his death in 1956, annual sales of iodised salt in Aargau, the fourth-largest canton, Bircher's home and the centre of his power, amounted to less than 10 per cent of all salt sold there. In 1931, by which time goitre had virtually disappeared among Swiss young people, 95 per cent of the schoolchildren in Aarau still had swollen thyroids.

Modern-day antivaxxers, of course, love iodine.