Creswell Eastman

Creswell John Eastman (30 March 1940 – 17 May 2025) was an Australian endocrinologist who was the Clinical Professor of Medicine at Sydney University Medical School, Principal of the Sydney Thyroid Clinic and Consultant Emeritus to the Westmead Hospital. Eastman directed or conducted research and public health projects into elimination of iodine deficiency disorders (IDD) in Malaysia, Indonesia, Laos, Cambodia, Thailand, several Pacific Islands, Hong Kong, China and Tibet and Australia. For his work in remote areas of China, he was dubbed the "man who saved a million brains".

In 2013 Eastman expressed concern that IDD may be affecting Australian children's ability to perform at school and reiterated that view in 2016. While the initial focus was mostly on indigenous children, he latterly expanded it to include all children.

Early life and education Eastman was born on 30 March 1940 in Narrandera, New South Wales. He was the fourth child of Albert Edward and Margaret Mary Eastman. He gained his primary education at Woodburn and Lismore in Northern NSW and secondary schooling at Marist Brothers Boarding School in Bowral/ Mittagong, NSW. He studied medicine at the University of Sydney, graduating as a Bachelor of Medicine, Bachelor of Surgery (MBBS) in 1965 and was awarded his Doctorate of Medicine (MD) by research thesis in 1980. In 1967, he became a Research Fellow in Endocrinology at the Garvan Institute of Medical Research and between 1969 and 1970 was a Research Fellow of The Asthma Foundation of New South Wales also at The Garvan Institute of Medical Research.

Eastman was awarded the Overseas Travelling Fellowship of the Royal Australasian College of Physicians (RACP) and the Searle Travel Grant in Endocrinology in 1971 and worked as a Research Fellow and Honorary Physician, Institute of Clinical Research and Institute of Nuclear Medicine, The Middlesex Hospital Medical School, London, UK from 1971 to 1972.

In association with Dr Ian Hales from Sydney and Dr Shigenobu Nagataki from Japan, Eastman was the initiator of the movement to establish an Asia Oceania Thyroid Association and held numerous positions within this organisation. He was the Treasurer, an Executive Councillor and President (1980–1982) of the Endocrine Society of Australia and was a life member. He was Member and Chairman of the National Health & Medical Research Council (NH&MRC) Regional Grants Committees and held numerous positions with the Royal Australasian College of Physicians (RACP).

Controlling and preventing IDD When teaching students, Eastman explained that the average person only needs a teaspoon of iodine over his or her whole life. Even mild Iodine deficiency can cause goitres and decreased IQ. Severe iodine deficiency can likely lead to cretinism if it occurs in a child's early development.

Malaysia Eastman's research into IDD within specific populations started in the late 1970s when he and Dr Glen Maberly visited remote parts of Sarawak, Malaysia where a large percentage of the villagers had goitres. The research was focused on determining the cause, and iodine deficiency was identified. To confirm their diagnosis the research team organised to have tiny doses of iodine introduced into the water being delivered to the village long houses. After 12 months the goitres in children had disappeared, proving iodine deficiency was the problem. Subsequently, the Malaysian government regulated that only iodized salt could be imported into Sarawak and the problem was thought to have been eliminated. A study from 1998 continues to advocate for the introduction of iodine into water.

China Eastman examining Tibetan schoolchildren for goitre in Tibet Autonomous Region May 2000In the early 1980s, it was estimated that 25% (250 to 300 million people) of the Chinese population was suffering from goitre and millions more had some level of intellectual disability. Once the problem and solution had been identified, the Chinese Government moved to have all salt iodized. Since then the goitre rate is down to 5% and no new congenital iodine deficiency syndrome have been recognised in recent years.

During his first visit to the Tibet Autonomous Region, Eastman discovered that 13% of the population was afflicted with cretinism which he believed was a result of severe Iodine Deficiency.

Thailand

Thailand has identified iodine deficiency and has implemented programs to have iodized salt (universal salt iodization) within the country. However, with shifting priorities, the effectiveness of programs can change and in 2004 the director-general of the Department of Health of the Ministry of Health, Thailand, requested the Network for the Sustained Elimination of Iodine Deficiency to undertake an external review of the Thai IDD programme, which was led by Eastman. This program developed numerous recommendations in program policy and management: salt production and iodization; monitoring, surveillance and quality assurance; advocacy and communication. In 2006 the National IDD Control Board (NIDDCB) met, presided over by Princess Maha Chakri Sirindhorn to develop an IDD 5 Year Master Plan based on the 2004 report. In 2009, a review of the master plan was undertaken. While progress had been made, universal salt iodization remained a problem, and 17 additional recommendations were made. A further review was completed in 2013. For his work in assisting in the elimination of IDD in Thailand Eastman was awarded the 2014 Health Promotion Princess Award.

Polynesia and Micronesia

Eastman instigated or participated in a number of studies within Polynesia and Micronesia. Although it is generally thought that people close to the sea are less likely to suffer from IDD, studies have identified iodine deficiency in these islands. In a study published in 2008 the children on the island of Tanna in Vanuatu were shown to suffer from moderate iodine deficiency. Only 40% of the children on Tanna ate fish on a weekly basis and only 30% ate fresh fish, which is insufficient to ensure an adequate daily iodine intake. A survey in Samoa in 2015 showed probable iodine deficiency in women and Samoa does not have mandatory iodization of salt.

Australia

Eastman and others undertook the National Iodine Nutrition Survey from 2003 to 2005 in Australia, confirming that iodine deficiency has re-emerged in Australia. However, for logistical reasons the Northern Territory was not included. As a result of this study, legislation made it mandatory to use iodized salt in all bread made in Australia, (excluding "organic bread") from September 2009. While Eastman agreed that the addition of iodized salt to bread had helped the situation, he remained very concerned about the iodine intake of Australian pregnant and lactating women and also for the inhabitants of remote communities in the Northern Territory and northwest Western Australia. In his day to day practice at the Sydney Thyroid Clinic he gave priority to pregnant women. Eastman's work in China indicates that adequate iodine intake has resulted in an overall increase in the national IQ.

Personal life Eastman was married to Annette, whom he met while a medical student, and had four children Katherine (Kate), born 1966; Damien, born 1968; Phillipa, born 1970 and Nicholas, born 1974.

Death Eastman died at his home in Sydney on 17 May 2025, at the age of 85.

Awards and recognition Little Shop Research Fellow, St. Vincent's Hospital, Sydney for his contributions to Medicine, particularly in the field of Endocrinology 1998 Honorary Professor of Medicine Tianjin University Medical College, Tianjin, People's Republic of China 2003 Made Life Member of the Endocrine Association of Australia. 2003 NSW Finalist: “Senior Australian of the Year” 2008 University of Sydney Alumni Award for Professional Excellence 2011 Peter Heiman Plenary Lecture International Association of Endocrine Surgeons Yokohama Japan 2018 Officer of the Order of Australia for "distinguished service to medicine, particularly to the discipline of pathology, through leadership roles, to medical education, and as a contributor to international public health projects." 2019 Distinguished Service Award of the AOTA (Asia and Oceania Thyroid Association) for " his distinguished contributions to clinical and laboratory thyroidology, his work to establish and support AOTA, his regional and international work in the epidemiology and eradication of iodine deficiency disease (IDD), and his mentoring of colleagues to develop and contribute to clinical thyroidology in our region."