It seems like a brilliantly simply idea. Indian women with iodine deficiencies could be spared severe medical conditions, says an advertising agency, if they use a special version of an everyday beauty accessory: the Jeevan Bindi or the Life-Saving Dot. The firm says it has handed out packets of iodine-coated bindis to women in rural areas, which will provide users with their daily dose of the essential element through the skin on their foreheads.

"It's the difference between life and death," Grey For Good, the philanthropic arm of Singapore-based direct marketing and advertising firm Grey Group, claimed in a video that has received wide media coverage.

Iodine deficiency is a major health problem in India. The soil of the subcontinent has little iodine, so food grown on it shows few traces of the element. As a result, all Indians are prone to iodine deficiency disorders. The most popular method of tackling the problem has been to encourage the consumption of iodised salt, which reaches about 91% of Indian households. Even so, some 350 million people remain at risk of iodine deficiency disorders that can lead to goiter, hypothyroidism and even brain damage. Even mild iodine deficiency in pregnant women can result in children being born with cretinism and mental retardation.

Dr Prachi Pawar, president of the Neelvasant Medical Foundation and Research Centre that partnered with Grey to distribute the bindis in Nashik, explains that the stickers, which are coated with 150-200 microgrammes of iodine, are supposed to work like a nicotine patch. “The absorption [of iodine] is sub-dermal through the skin,” said Pawar who is an ophthalmologist. “What is required in a day is only 150-200 micrograms. When there is a deficiency, only then the absorption takes place.”

But does it work?

Spokespersons at Grey For Good said the advertising agency came up with the idea after looking at research online and consulting a few doctors. It's an idea that sells. But does it work?

The Jeevan Bindi is supposed to function on the same principle as the iodine patch test, in which a solution of iodine is applied to an arm or abdomen. If the iodine disappears, the person who is undergoing the test may have an iodine deficiency, which is indicated by the fact that the solution was quickly absorbed by the skin. However, medical literature is also replete with references to how most of any iodine solution applied to the skin evaporates and less than 12% is actually absorbed by the body. If 150 micrograms had to be available in the thyroid gland and other tissues where iodine is processed, a far bigger dose may be required on the skin.

“The body will take up only what it requires but it has to go internally first,” said Dr Chandrakant Pandav, professor and head of the Centre for Community Medicine at the All India Institute of Medical Sciences. "If I have 500 micrograms and my body needs only 150 micrograms, the rest will be excreted in urine."

Pandav said applying iodine to the skin might work, provided that it is in a high concentration. There are instances in historical records of people applying Lugol’s solution, a concentrated iodine solution, to the neck area where the thyroid gland is located. But Pandav questions the use of the iodine bindi when it has been well established that ingesting iodine orally with salt or bread or even toffees is effective.

No follow-up

A solution to a medical problem like iodine deficiency typically needs many tests and the success of the Jeevan Bindi would depend on passing those tests. “A urinary iodine estimation is the gold standard to know what is happening to the iodine metabolism,” said Pandav. “The second study we do is radio-iodine uptake, and the third is the thyroid hormones.” There has been no follow-up in the Jeevan Bindi campaign to see if the bindi-wearing women’s iodine-related health problems have been addressed.

“In tribal areas where we distributed bindis, they are still using crystal salt, which has not gone through the process of iodisation,” said Pawar. Grey is looking at bringing in more partners and setting up marketing and distribution networks. This network will have to have unprecedented reach to get to supply Jeevan Bindis on a regular basis to women who can't get any iodised salt.

The agency's promotional video says that the “Life-Saving Dot” has been distributed through medical camps across rural India. “In a nation of over 500 million women, bindis were no longer just a symbol of beauty.”

Harish Bijoor, management consultant and brand domain specialist, said that many companies and advertising agencies are intent on creating a “soft aura” about themselves. “Due diligence needs to be done very, very keenly by marketers and their advertising agencies before embarking on campaigns which touch people so intrusively, especially when it comes to health,” he said.