Lead and Meds

Childhood lead poisoning is a medical problem with a political solution.

History lessons

• Herbert Needleman in Wikipedia and PBS 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.)

 
1989 -- Medicaid requires blood lead screening for children enrolled in the program as part of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program. 

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 Law (ORC 3742) focuses on child testing, certification of lead professionals.

1999 -- HUD Lead Safe Housing Rule. Amended in 2004 and 2016. GAO acknowledges a failure to enforce. 

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1993-Today. Every Mayor since Mike White has proposed to "do something about lead" and then abandoned the project. 

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."

2016 -- Cleveland advocates come together to form Cleveland Lead Safe Network and drafted an ordinance that created a lead safe certificate program. In the next two years, Council never held a hearing.

2019 -- Cleveland Lead Safe Network merged with 9 other grassroots organization to form a political action committee to put the Lead Safe Certificate ordinance on the ballot. Facing the reality, Mayor Frank Jackson and Council President Michael O'Malley created the Lead Safe Cleveland Coalition (a public private partnership) which took the outline of the CLASH initiative and adopted the Cleveland Lead Safe Certificate ordinance on July 24, 2019.

Why are we giving you this history? Lead Poisoning is not just a disease. It is an environmental epidemic rooted in economic, social, cultural and racial discrimination. For a century, business interests have stymied research, regulation, and enforcement. These financial forces have been supported by the unconscious bias of health professionals, academics, and politicians. The history of CLASH is a manifestation of the fact that Lead is a Political issue.

What do MDs need to know about lead exposure

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

Unlike infectious diseases, patients who are exposed to lead need more than medical treatments. 

• Luckily we understand better the need for early detection, removal of lead hazards from the patient's environment, and surveillance of blood lead levels throughout the patients' childhood. New testing techniques can increase the physican's ability to detect small levels of exposure even after lead has migrated from the blood to the bones and organs. 

• April 05, 2024 Lead Has Not Gone Away — What Should Pediatric Clinicians Do? Stories from the front lines.

• 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.`

• 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."
  
  

Nevertheless pediatricians are trained to conduct a rigorous risk assessment before conducting a blood lead test. 

• • • • Ohio's Guidelines for child lead testing is a cumbersome risk management process based on high risk zip codes. 

      • American Academy of Pediatricians' testing guidelines Unrealistic! "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." 

      • Since 2023, Universal child testing has become the standard in most of the states surrounding Ohio. The cumbersome distraction of a "risk assessments" before testing has been eliminated in New York, Indiana, Michigan, and Wisconsin...and is underway in Pennsylvania and Illinois.  Ohio is the center of the Lead Belt as well as the Rust Belt.