In response to:
Lead Poisoning: The Ignored Scandal from the March 21, 2013 issue
To the Editors:
We are pleased that Helen Epstein took our book, Lead Wars, and the issues that it raises, so seriously [NYR, March 21]. The tragedy of the Kennedy Krieger case is that it is emblematic of a much broader societal failure to protect America’s children. We are particularly gratified that she emphasized two of the major themes of the book: first, that in light of the conservative onslaught of the past three decades and the growing identification of low-level environmental threats as a source of chronic disease and damage, public health has constricted its historic mission of prevention. Second, as we describe, the public health profession’s power emanates from the political and social movements that it is embraced by, and which it embraces, not necessarily from its scientific authority.
We do want to point out, however, that there were some misstatements in the review. First, the author states that the children in the KKI study “all…were healthy and normal and had low blood lead when they joined the study.” It is true that all the children in the study were recruited as “healthy and normal” but the first blood lead levels that the researchers collected were after these children moved into the study homes and most of these initial blood lead levels were elevated (although this was not true of “Max,” the first case Epstein cites). It is likely that most of the children coming from Baltimore’s polluted housing stock had elevated blood lead levels.
Second, it should be clear that Mark Farfel was reluctant to talk to us in view of ongoing lawsuits about the KKI case. He did not “refuse” as we did not press him.
Third, Epstein is right that “lead paint [is] the most insidious danger of all because it can cause brain damage even if it isn’t peeling,” and as we make clear, lead paint continues to be a terrible threat to children as long as it is on the walls of housing. But it is misleading to imply that it can leach past intact coverings. The danger lies when walls are damaged through wear and tear, renovation, leaks, sanding, or even nails that release underlying lead dust.
Fourth, although Epstein is correct that one estimate for the total cost of removing lead from the nation’s homes was $33 billion, other estimates by HUD and other agencies were substantially higher by at least a factor of ten.
We hope that the book (and the review) will contribute to a much broader public discussion of the dangers of lead and other environmental toxins and lead to a commitment by our society to protect all children no matter what the cost.
Mailman School of Public Health
New York City
John Jay College and
CUNY Graduate Center New York City
Helen Epstein replies:
I thank Gerald Markowitz and David Rosner for their letter, and for their admirable book. I am especially grateful to them for clarifying that lead dust can’t drift off intact painted surfaces that are not degrading or penetrated with nails, sanders, etc.
However, I’d also like to point out that “Denisa’s” blood lead level upon enrollment in the study was nine micrograms per deciliter1 which, like Max’s (six micrograms per deciliter) was normal according to the CDC standard in the 1990s—(ten micrograms per deciliter or below). The CDC only reduced its “level of concern” to five micrograms per deciliter last year. At the beginning of the study, the geometric mean blood lead concentrations of all the children was between nine and fourteen micrograms per deciliter (depending on the study arm).2 Although some children did have relatively high levels of lead, according to the standard of the time most would have been considered borderline.
Also, HUD’s 1990 $330 billion price tag was for refurbishing all 64 million US homes estimated at the time to contain any lead paint. But only 14 million of these had extensive areas of damage, of which about half, or seven million, had excessive levels of lead dust. We can assume that not all were occupied by families with small children.3 If the $33 billion plan proposed by the Department of Health and Human Services (then known as Health, Education and Welfare) had been funded, it would have been possible to implement Farfel and Chisolm’s “level III abatement”—including window replacement—in nearly 5 million US homes.
If this plan had been properly targeted to those buildings with the most serious hazards that were also occupied by families with small children, we’d have a much more manageable lead poisoning problem today, or perhaps none at all.
1 Manual Roig-Franzia, “‘My Kids Were Used as Guinea Pigs’; Lead Paint Study Adds to Debate on Research,” The Washington Post, August 25, 2001. ↩
2 See the EPA report “Lead-Based Paint Abatement and Repair and Maintenance Study in Baltimore: Pre-Intervention Findings,” August 1996, available at www.epa.gov/lead/pubs/r95-012.pdf. ↩
3 See “Report on the HUD National Survey of Lead-Based Paint in Housing (Base Report),” June 1995, available at www.epa.gov/lead/pubs/r95-003.pdf. ↩
Manual Roig-Franzia, “‘My Kids Were Used as Guinea Pigs’; Lead Paint Study Adds to Debate on Research,” The Washington Post, August 25, 2001. ↩
See the EPA report “Lead-Based Paint Abatement and Repair and Maintenance Study in Baltimore: Pre-Intervention Findings,” August 1996, available at www.epa.gov/lead/pubs/r95-012.pdf. ↩
See “Report on the HUD National Survey of Lead-Based Paint in Housing (Base Report),” June 1995, available at www.epa.gov/lead/pubs/r95-003.pdf. ↩