Lead and Meds

History lessons

• Herbert Needleman in Wikipedia and NOVA The Man Who Warned the World About Lead May 31, 2017 

"In the 1970s, Needleman conducted a study at Harvard Medical School that yielded strong evidence that lead, even at very low levels, can affect a child's IQ. By measuring levels of lead in children’s deciduous teeth, Needleman provided the first evidence that low level lead exposure at the time these teeth were formed not only reduces IQ levels, but also shortens attention spans and delays acquisition of language proficiency. In studies that followed, he determined that lead poisoning had long-term implications for a child's attentiveness, behavior, and academic success." Wikipedia

• Public Policy initiatives since Needleman and sporadic enforcement throughout

1973 Clean Air Act sets standards for lead in gasoline resulted in elimination in automobile fuel in 1996. Use of lead in aviation gas continues.
1978  Consumer Products Safety Commission mandates the removal of lead from residential paint. Commercial use of lead in paint  continues
1986: The amended Safe Drinking Water Act mandates that water pipes in new drinking water systems be lead-free. (However, “lead-free” is defined as pipes with no more than 8% lead.)
Medicaid Mandatory child lead testing; reducing action levels. 2024 Biden administration sets a 10 year goal of replacing lead pipes in water systems.

1992 --  EPA Mandatory disclosure of known lead hazards in rental housing built before 1978. Loopholes: The requirement to disclose "known lead hazards" discourages landlords from having their properties inspected and there's no simple enforcement mechanism*.

1996-97 -- Ohio codifies Lead Poisoning Laws. 

2015 -- Flint Water Crisis and suddenly the US understood that Lead is not a medical problem...but a political problem. July 1, 2025 Wapo. Flint finally replaced its lead pipes. "Erik Olson, senior strategic director for health at the NRDC, said the crisis in Flint changed the world. He called the removal of lead pipes there 'historic. [....] It really showed people power to push back against a government that was shrugging its shoulders and not caring about the people across the city that had lead-contaminated water,' Olson said."

Why are we giving you all this history? Lead Poisoning is not just a disease. It is a manifestation of economic, social, cultural and racial discrimination. Business interests have stymied research and enforcement. Unconscious bias of professionals, academics, and politicians have minimized the consequences. The history of CLASH is a manifestation of the fact that Lead is a Political issue.

Symptoms of Lead Poisoning 

When I asked Dr. Ellen Wells what points to emphasize she told me:

a) no amount of lead is safe

b) we need to screen for lead

c) signs of lead poisoning are nonspecific and often confused with other illnesses (like flu!)

d) by the time you can observe symptoms, damage has probably already been done.

The symptoms of childhood Lead Poisoning resemble a zillion other maladies. Often there are no symptoms. Rigorous testing is the only way to diagnose the condition.  

Lead in Your Practice--More than Medicine

Medical systems are designed to screen out child lead testing by substituting "risk assessment" (interviews and questionnaires) for actual testing. Universal testing is the answer. Rigorous testing is desirable. The Medicaid model won't capture lead exposure in situations where families move frequently and have spotty access to primary care. CDC recommendations to physicians (see below) fail to take account of today's medical practice. 

There is no safe level of exposure. The current CDC reference level for blood is 3.5 micrograms/deciliter of blood. In many states, including Ohio, the action level where the public health officials investigate is 10 micrograms/deciliter. 

Lead never goes away. Despite efforts to reduce exposure, lead pathways include soil, water, and air pollution...in additional to lead paint dust.

Ohio's Guidelines for child lead testing is a cumbersome screening process based on high risk zip codes. Do you know the parable of the drunk looking for his keys? "A policeman sees a drunk man searching for something under a streetlight and asks what the drunk has lost. He says he lost his keys and they both look under the streetlight together. After a few minutes the policeman asks if he is sure he lost them here, and the drunk replies, no, and that he lost them in the park. The policeman asks why he is searching here, and the drunk replies, 'this is where the light is' " In a medical practice the practitioner looks at the zip code on the form and then guesses if the patient is covered. My childrens' pediatrian told me that even thought we lived in a high risk zip code, he didn't test because there was no lead in Cleveland Heights. 

AAP testing guidelines Unrealistic!

• "Lead poisoning usually is detected by measuring the level in blood. Many screening procedures use capillary blood as point-of-care testing. While finger-prick samples are appropriate for screening tests, all elevated capillary levels should have confirmation with a venous blood draw since capillary tests can yield frequent false positives. An elevated capillary lead level indicates that lead is in the child's environment even if the venous level is low, however, so primary prevention and education should be initiated." 

• "The current Bright Futures/AAP Periodicity Schedule recommends a risk assessment at the following well-child visits: 6 months, 9 months, 12 months, 18 months, 24 months, and at 3, 4, 5 and 6 years of age. The recommendation is to do a risk assessment, and do a blood lead level test only if the risk assessment comes back positive.  According to the AAP and CDC, universal screens or blood lead level tests are not recommended anymore except for high prevalence areas with increased risk factors such as older housing." Bad thinking. All of the states around Ohio have moved to Universal Testing in recognition of the pervasiveness of lead sources, the mobility of low and moderate income families, and the decline in primary care services. 

• April 14, 2024. CDC. Recommended Actions Based on Blood Lead Level. CDC recommendations to MDs recognize the behavioral and environmental elements of medical treatment of elevated blood lead levels.

April 05, 2024 Lead Has Not Gone Away — What Should Pediatric Clinicians Do?

• Remediation efforts have focused exclusively on removing the amount of lead going into the environment, but have not dealt with the persistence of lead already in the environment, Lead never goes away.

• Lead is ubiquitous in the environment. New lead vectors are being discovered weekly. 

• Pediatricians need to adopt a team approach to treatment to address the medical and social/environmental dimensions of lead exposure

March 7, 2024 The Conversation. Lead from old paint and pipes is still a harmful and deadly hazard in millions of US homes.
Child lead testing based on a blood lead test is an unreliable tool for identification of lead exposure. MDs aren't trained, EBLLs are transitory, new technologies hold the promise of better identification."

Send in the Change Agents

Expand Public Awareness and expose the curse of Lead and Amnesia. Public media, grassroots events, civic organizations, community opinion leaders

Foster Grassroots activism (citizens taking charge of their own treatment and environment: Putting demands on housing and health providers to pay attention to their needs, Empower households with DIY testing devices and self-help legal enforcement of standards.

Advocate for systemic social and political changes to reduce lead in the environment. Lead safe certificate, reducing action levels, requiring universal testing, replace lead pipes.

Support research and innovation. New tools for lead sequestration, home lead testing and child testing.

Lead and Power: the Cleveland Story

Lead and Social Justice

Mortgage Redlining

Industrial and highway siting