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DUMBING DOWN THE CHILDREN--PART 3
We have previously published considerable information about toxic lead and its permanent detrimental effects on young children.[1] At low levels, lead impairs hearing, diminishes growth, and reduces IQ. Children with low levels of lead in their blood may have a hard time paying attention, controlling their impulses, and learning. In some children, lead contributes to delinquency and violence.
In recent weeks we started asking, Why are governments refusing to comply with a 1989 federal law that requires all infants and toddlers in the Medicaid program to be tested for lead poisoning? Medicaid is a federally-funded medical insurance program for poor people. It is well-established that lead poisoning now occurs mainly in poor neighborhoods.[2] In 1998, 13.5 million children (18.9% of all children in the U.S.) lived in poverty.[3] The General Accounting Office (an investigative branch of Congress) reported during 1999 that "hundreds of thousands of children exposed to dangerously high levels of lead are neither tested nor treated," because state governments are refusing to comply with the law, the NEW YORK TIMES said.[4]
The current federal "acceptable" level of lead in children's blood is 10 micrograms (mcg) of lead in each deciliter (tenth of a liter) of blood, expressed as 10 mcg/dL. One way to get this lead toxicity standard into perspective is to compare it to naturally-occurring levels. Even before Europeans arrived in North America, humans had some lead in their blood (and bones, where it is still measurable today) because lead is a naturally-occurring element and some of it is always blowing around on the wind. We could argue about whether it is proper to call this a "natural background level" because humans have been mining lead out of the ground for perhaps 6000 years, so some human-mobilized lead has been blowing on the wind for aeons, adding to the levels that nature produces by itself.[5]
In any case, according to the National Research Council, people in the U.S. have average body burdens of lead approximately 300 to 500 times those found in our prehistoric ancestors.[6]
So how does the "acceptable" limit of 10 mcg/dL compare to pre-historic lead levels? The relationship between lead in people's bones and lead in their blood is well-known. Careful measurements of the bones of pre-Columbian inhabitants of North America reveal that average blood lead levels were 0.016 mcg/dL -- about 625 times lower than the 10 mcg/dL now established as "acceptable" for our children.[7] On the face of it, the current 10 mcg/dL standard seems imprudent because it assumes that a potent nerve poison at levels 625 times as high as natural background is "acceptable" for children.
Indeed, some of the nation's most prestigious medical organizations acknowledge that children are being harmed at the current federally-established "acceptable" level. The American Academy of Pediatrics in 1993 reviewed 18 medical studies showing that lead diminishes a child's mental abilities. "The relationship between lead levels and IQ deficits was found to be remarkably consistent," the Academy said. "A number of studies have found that for every 10 mcg/dL increase in blood lead levels, there was a lowering of mean [average] IQ in children by 4 to 7 points." Four to 7 IQ points may not sound like a major loss, but an average loss of 5 IQ points puts 50% more children into the IQ 80 category, which is borderline for normal intelligence. It also reduces the number of high IQs; for example, one group that should have had 5% children with IQs of 125 (or above) contained none.[8] So 10 mcg/dL of lead -- the federal government's current "acceptable" standard for lead poisoning -- is sufficient to cause a general dumbing down of children exposed at that level. As the federal Centers for Disease Control (CDC) acknowledges, "Blood lead levels at least as low as 10 mcg/dL can adversely affect the behavior and development of children."2 Thus the federal government has set a "acceptable" level of lead in blood that it acknowledges does not protect children. Indeed, damage to children has been documented at blood-lead levels considerably below 10 mcg/dL. The federal Agency for Toxic Substances and Disease Registry (ATSDR, within the CDC) cites studies showing that children's growth, hearing, and IQ can be diminished by blood-lead levels as low as 5 mcg/dL.[9]
In any case, federal law says that all children in the Medicaid program should be tested for lead at age 12 months and again at 2 years. Many states have no idea what percentage of children they have tested because they have failed to keep records. Among states that have kept records, the worst is Washington state, which has tested only 1% of eligible children; the state with the best record, Alabama, has tested only 46% of those eligible.[4] Why?
Is it because the problem is too small to merit attention? Has the problem of lead-poisoned children gone away, as some would have us believe? Here is the most recent published information: During the period 1991-1994, the federal Centers for Disease Control (CDC) tested the blood of a representative sample of the U.S. population, looking for lead poisoning. They found that 4.4% of children ages 1 to 5 have at least 10 mcg/dL; CDC says 4.4% represents just under a million children (890,000) ages 1 to 5.[2] Of course each year roughly 200,000 of these children grow to age 6 and leave the "high-risk" group (carrying their intellectual deficit with them) and another 200,000 children join the "high-risk group" and become brain-damaged. In some cities of the northeastern U.S., 35% of pre-school children have 10 mcg/dL or more of lead in their blood.[10]
Who are these children? Although poverty itself is a good predictor of childhood lead poisoning, there is a clear racial disparity at work as well.[11] One researcher who examined this question reported that "the homes of Black children had higher levels of lead-contaminated dust and their interior surfaces were in poorer condition."[11] Children living in low-income families are 8 times as likely to be lead poisoned as children who are not poor. Black children are 5 times as likely to be lead poisoned as white children.[12]
How can this problem be fixed? The source of the lead must be eliminated without leaving a dangerous residue of toxic dust. The American Academy of Pediatrics said in 1993, "Identification and treatment of the child poisoned with lead continues to be essential, but of greater importance is IDENTIFICATION OF THE SOURCE and PREVENTION OF SUBSEQUENT EXPOSURES for that child and other children in the future."[8] [Emphasis in the original.] In other words, the only real solution is primary prevention.
Testing children for lead poisoning is the current federally-approved method for identifying lead-contaminated homes. It is important to recognize that this approach is not primary prevention. This approach uses children the way miners formerly used canaries -- as a signal that trouble has already occurred. In the mines, a dead canary meant that toxic gases had built up to dangerous levels in the mine; similarly, finding 10 mcg/dL or more of lead in a child's blood is a sign that excessive lead is present in the child's environment and poisoning has already occurred.[10]
Primary prevention -- preventing lead exposures -- is the only permanent solution to this problem, and it will be expensive. It has been estimated that the first-year cost of reducing lead hazards in federally-owned and federally-assisted housing would be $458 million. However, the calculated benefits from such lead abatement would be $1.538 billion -- a net benefit of $1.08 billion,[11] so it is certainly affordable.
Other public policies could help. A careful study of two districts in Massachusetts and neighboring Rhode Island showed that lead poisoning is much less common in Massachusetts.[13] For 20 years, Massachusetts has required lead abatement in all homes built before 1978 that are inhabited by children younger than 6. And Massachusetts law makes property owners legally responsible for damage sustained by lead-exposed children. Rhode Island has no such policies and it has a much higher incidence of lead poisoned children. Most states have no laws like those in Massachusetts.
When lead abatement occurs, it can be done well or it can be done badly. Five to 10 percent of current childhood lead poisoning in the U.S. is thought to have resulted from sloppy lead abatement.[12] Here again, public policies have gone awry. The main source of lead in children is house dust. Both the federal Department of Housing and Urban Development (HUD) and the U.S. Environmental Protection Agency (EPA) have set standards for lead in dust which, if met, essentially guarantee that childhood lead poisoning at the level of 10 mcg/dL will continue. Even if the current government standard for lead in dust were reduced to one-tenth its present level, it would still allow children to be poisoned by lead in dust.
In sum, we have a federally-mandated blood-lead standard (10 mcg/dL) that permanently dumbs down any children who meet it, which is nearly a million children at any moment, and roughly 200,000 new dumbing-downs are occurring each year. Medical authorities agree that the only real solution is primary prevention -- keeping lead-contaminated dust away from children. Credible estimates show that the federal government could make a profit of $1.08 billion by undertaking primary prevention in federally-owned or -assisted housing, but instead the government requires the dead-canary approach, blood-lead testing, which the states then refuse to carry out. We know from the Massachusetts experience that public policies that put the onus on the private sector can make a big difference -- but most states have failed to adopt such policies.
Most of the victims of all this are babies born into poverty. We can only conclude that current government policies must reflect the values of those who hold power. Those who make public policies must feel a need to maintain a permanent pool of people disadvantaged from birth. Governments throughout the U.S. must be doing what powerful elites want them to do -- refusing to confront the lead industry, the paint industry, the housing industry, the real estate industry and the campaign contribution industry, refusing to apply the primary prevention approach to this public health menace, and, instead, continuing to poison hundreds of thousands of poor black and hispanic children each year.
If you are skeptical of (or offended by) the suggestion that this problem is allowed to endure because it mainly affects poor children and minority children, ask yourself this: how long would this problem persist if those being poisoned were mainly white children who spent their summers at the country club?
DUMBING DOWN THE CHILDREN--PART 2
We began this series last week with a 1999 report from the NEW YORK TIMES which said state governments in the U.S. are refusing to comply with a 1989 federal law requiring that children be tested for lead poisoning. Even at low levels, lead poisoning can reduce a child's IQ, impair hearing and stunt growth. Federal law requires all children enrolled in the Medicaid medical insurance program to be tested for lead poisoning at age 12 months and again at age 2 years. The federal government pays the costs of testing and subsequent treatment for any children found poisoned. However, according to a 1999 study by the General Accounting Office (GAO), an investigative arm of Congress, state governments are simply refusing to comply with the law. As a result, the GAO said, hundreds of thousands of children exposed to dangerously high levels of lead are neither tested nor treated, the TIMES reported.
We are seeking an answer to the question, "Why would governments set policies that continue to poison children?"
Childhood lead poisoning is not new. Medical reports of children poisoned by lead began to appear in the U.S. in 1914. By the 1930s, a torrent of information about the problem was appearing in medical journals.[1,2,3] Prior to World War I, one obvious source of the problem had been clearly identified: lead-based paint applied to the walls, toys, and furniture in children's homes. Lead, the soft, gray toxic metal makes an excellent white pigment (to which other colors can be added) and leaded paints provide durable protective coatings. Nevertheless, as time passes, leaded paint dries out and begins to peel, flake and disintegrate into a toxic powder. As a result, toddlers can get toxic flakes or dust on their hands, then into their mouths.[4,5,6] Brain damage often follows.
Long before World War I this information was so widely understood that France, Belgium and Austria restricted the use of leaded paint in 1909. Tunisia, Greece and Australia took similar action in 1922, the same year the Third International Labor Conference of the League of Nations recommended a complete ban on leaded paint for indoor use. In 1924, Czechoslovakia restricted the use of lead paint; Great Britain, Sweden and Belgium followed suit in 1926; Spain and Yugoslavia in 1931; Cuba in 1934. The U.S. on the other hand took no action until 1970.[3]
How did the paint and lead industries react to the information that their products were poisoning children? Recently, as a result of a lawsuit, many internal documents from the paint and lead industries became public for the first time. Two historians, Gerald Markowitz and David Rosner, have summarized some of these documents in a remarkable history published last month in the AMERICAN JOURNAL OF PUBLIC HEALTH.[3]
To begin with, lead paint manufacturers acknowledged -- at least privately -- that lead was toxic. In 1921, Edward J. Cornish, president of the National Lead Company, manufacturer of the leading brand of lead-based paint, wrote to David Edsall, dean of the Harvard Medical School, saying that, as a result of "50 or 60 years" of experience, paint manufacturers agreed that "lead is a poison when it enters the stomach of man -- whether it comes directly from the ores and mines and smelting works"1 or from the finished forms of lead (carbonate of lead, lead oxides, and sulfate and sulfide of lead).
As early as 1897 one paint manufacturer in New York City was advertising that "Aspinall's Enamel is NOT made with lead and is non poisonous."[7]
Within the paint industry, there were voices of prudence. In 1914 the director of the scientific section of the Paint Manufacturer's Association predicted that "lead poisoning will be done away with almost entirely"[1] because "sanitary leadless" paints had been developed.[3] In truth, titanium and zinc substitutes for lead paint pigments had become readily available during the latter part of the 19th century, so there was never any compelling need for toxic lead-based pigments. However, lead was plentiful and profitable and its victims were not organized.
As the bad news about lead-based paint accumulated, the paint and lead industries took the offensive by using images of children in their advertising and sales promotions. Starting in 1907, the National Lead Company began to promote its "Dutch Boy White Lead Paint" using the image of a child on the label. Before 1920, National Lead was explicitly aiming its marketing and advertising at children. An ad in 1918 showed a little girl purchasing "Dutch Boy White Lead Paint." The ad recommended that paint merchants should "Cater to the children." It asked, "Have you stopped to think that the children of today are the grown-ups of tomorrow..." A 1920 ad -- headlined "Don't Forget the Children" -- suggested that paint sales personnel should give gifts to children who visited their paint store accompanied by a parent. "Parents appreciate little attentions of this sort paid to their children," the ad said. In 1924, National Lead began promoting the use of lead-based paint in public schools.
The Lead Industry Association (LIA) was formed in 1928 to promote the use of lead. At that time, lead-based paint was the single biggest user of lead, though lead in gasoline was rising as well. Acknowledging the poisoned-children problem, the LIA claimed it was urging toy and furniture manufacturers to avoid lead-based paints, but toy manufacturers who tested their products found them contaminated with lead-based paints. Someone was lying. For its part, National Lead -- the lead-paint industry leader -- was aggressively marketing lead-based paint to children. For example, the firm published a booklet for children in 1930, showing the Dutch Boy skipping along hand-in-hand with 2 children, then mixing white lead with colors and painting walls and furniture. The booklet contained this jingle:
Another promotion showed a crawling infant making hand-prints on a painted wall. The caption said, "There is no cause for worry when fingerprint smudges or dirt spots appear on a wall painted with Dutch Boy white-lead." Historians Markowitz and Rosner observe, "The explicit message was that it was easy to clean the wall; the implicit message was that it was safe for toddlers to touch woodwork and walls covered with lead paint."
In addition to using images of children to sell lead paint, National Lead emphasized that lead was healthy. Beginning in 1923, National Lead was advertising in NATIONAL GEOGRAPHIC that "lead helps to guard your health." Throughout the 1920s, National Lead advertised in MODERN HOSPITAL magazine, calling white lead paint "the doctor's assistant." The ads assured readers that walls covered with lead-based paint "do not chip, peel, or scale" -- an obvious falsehood.
The Lead Industry Association (LIA) promoted lead paint in a 1930 booklet: "White lead paint is widely used for home interiors." Accompanying illustrations showed several home interiors freshly-painted with lead.
There were warnings against such practices from within the lead industry. In 1933, Robert Kehoe, chief medical scientist at the Ethyl Corporation (which was at that time busy providing millions of tons of toxic lead to the nation's children via gasoline) urged in the JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION that "strenuous efforts must be devoted to eliminating lead from [children's] environment." Kehoe was specifically referring to lead-based paint.
Nevertheless, in 1938 the LIA began a multi-year nationwide "White Lead Promotion Campaign." The purpose of the campaign was to "dispel fear or apprehension" about using lead-based paint in your home. Three years later, in 1941, the secretary of the LIA, Felix Wormser, noted that the campaign was helping: "[I]n the long run [the campaign] will share in dispelling anxiety about [lead's] use. In any event the problem remains serious for our industry. Hardly a day passes but what this office has to devote some attention to lead poisoning," Wormser said.
In December 1943 TIME magazine reported on a medical study of children poisoned by lead-based paint used on toys, cribs and window sills. The result was permanently reduced IQ, with learning disabilities, among the children.
Felix Wormser of the LIA took the offensive; in a response to the TIME article, Wormser claimed that the connection between lead poisoning in infancy and later mental retardation had never been proven. For the next 15 years this was the LIA's position -- permanent injury to children from sub-lethal lead poisoning had not been proven.
Wormser's position was scientifically indefensible in 1941. Wormser's position was insupportable. Robert Kehoe informed the head of the LIA that in his own work he had observed "serious mental retardation in children that have recovered from lead poisoning." Kehoe argued that Wormser's position was not consistent with the available facts: "Unfortunately for Wormser's thesis, comparable results [i.e., mental retardation] have been obtained in almost every other area of the United States where there have been facilities that enable accurate investigation of this type to be made," Kehoe wrote.
By the 1950s, the lead and paint industries both acknowledged that their products were poisoning children, and their defense took a new turn. In its 1959 annual report the LIA noted that "lead poisoning, or the threat of it, means thousands of items of unfavorable publicity each year."[8]
"This is particularly true," the LIA report continued, "since most cases of lead poisoning today are in children, and anything sad that happens to a child is meat for newspaper editors and is gobbled up by the public. It makes no difference that it is essentially a problem of slums, a public welfare problem. Just the same the publicity hits us where it hurts,"[8] the LIA report said, clearly implying that it SHOULD make a difference that only slum children were being poisoned.
This became the lead industry's main line of argument: lead only harmed slum children. In 1955 the LIA's director of health and safety went on record saying, "Childhood lead poisoning is common enough to constitute perhaps my major 'headache,' this being in part due to the very poor prognosis in many such cases, and also to the fact that the only real remedy lies in educating a relatively ineducable category of parents. It is mainly a slum problem with us." To summarize the Lead Industry Association's argument: The poisoning of children cannot be remedied because of parents who live in slums and cannot be educated. In short, lead poisoning is the parents' fault.
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