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Great Debate on Environmental Lead Poisoning in the U.S .A

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Great Debate on Environmental Lead Poisoning in the U.S .A 제중원의 초기 의학 교육 - 80 醫史學 제8권 제1호 (통권 제14호) : 1- 11, 1999 K orean J M ed H is t 8 : 1- 11, 1999 © 大韓醫史學會 ISSN 1225- 505X Great Debate on Environmental Lead Poisoning in the U.S .A . : A Historical Analy sis KIM Ock - Joo* , CHO Sung - Il* * , and HWANG Sang - Ik * * * Lead poisoning am ong children in poor district of old Am erican cities is a very American phenom enon.199) Lead poisoning has been the m ost prevalent of childhood toxicological diseases in America, but is easily preventable. T he m ain source of lead poisoning in children has been chips or dust of lead paint , which had long been used. A s early as 1894 in Brisbane, Au stralia, T urner and colleagues reported on cases of childhood lead poisoning due to lead- based paint . In the 1920s, m any European countries banned the use of lead- based paint , but in Am erica it continued to be used. Not until the 1970s did the Am erican governm ent began to take action again st the hazards of environmental lead. In the 1970s, the new Environm ental Protection Agency (EPA ) issued it s fir st regulations on lead emissions, and the Congress identified lead- based paint as a health hazard, and ordered that it no longer be used in federally subsidized hou sing. Nevertheless, lead remained on the painted w alls and w oodw ork of dw elling s, and m any children w ould continue to suffer from lead toxicity .200) Why did it take m ore than a half century to regulate environm ental lead pollution in America? A ccording to Graebner , the lead industries ex ercised enorm ous influence ov er the production and dissemination of knowledge about lead poisoning in the period from 1925 to 1965.201) T he prim ary lead- extracting and sm elting industry in America had * Departm ent of History of Science, Harv ard University ** School of Public Health, Harvard Univer sity *** Departm ent of the History of M edicine and M edical Hum anities, Seoul National Univer sity College of M edicine; Corresponding Author (em ail ; hw [email protected] .ac.kr ) 199) In Britain , for ex ample, F actories Act for Prevention of Lead Poisoning w as legislated in 1883 to protect w orker s at factories dealing with lead. In 1923, the u se of lead paint to inner side of house w as banned. 200) T he New York T im es. Aug 26, 1990. 201) Graebner W . Hegem ony through science : inform ation engineering and lead toxicology 1925- 1965. In Rosner D, M arkowitz G (eds ). Dying for W ork : W orker s ' Safety and Health in T w entieth - Century America. Bloomington , IN ; Indiana Univ Press, 1987. KIM OJ, CHO SI, HWANG SI : Debate on Environmental Lead Poisoning - A Historical Analy organized to control research findings on lead health hazards.202) T he Lead Indu stries A ssociation (LIA ), incorporated in 1928 funded lead poisoning research, influenced public opinion , and ex erted influence over the developm ent of public policy . In November 1930, just after a public health controver sy over leaded gasoline, LIA began to publish their journal, L ead, to advert to the public the u sefulness, the pow er , and even the beauty of lead. Such titles a "Lead Pipe ' s Great Record for New Belford ' s W ater Supply ," "Unusual Lead W ork on a Unique Hom e," "Lead F aced Building Blocks Economical and Attractive," and finally "U se of T etraethyl Lead Growing Rapidly ," in which LIA boasted of the increasing amount of lead used annually for leaded gasoline. At the bottom of the back page of the journal, they say , "T he Lead Industries A ssociation invites inquires on any subject relating to lead and will be glad to cooperate in the solution of your problem ." LIA w as not the only organization to prom ote positiv e attitudes to the u se of lead. Individuals such as Robert Kehoe, Charles Kettering , and private organizations like the M ellon Institute, and the Kettering F oundation , which w ere also funded by big indu stries, contributed to determine Am erican s ' attitude to the lead hazard.203) Dr. He rbe rt Needle ma n a nd low leve l lead toxicity In 1979 Dr . Herbert Needlem an, a pediatrician and psychiatrist at Harvard M edical School, published a paper in New England Journal of M edicine, which becam e a landm ark in the history of lead poisoning research. T he paper show ed that schoolchildren who had elevated, but not actually toxic, levels of lead in their teeth did significantly poorer in classroom and had m easurably low er IQs than those with low lead levels.204) Using tooth lead m easurem ent as a biom arker of chronic lead exposure, Needlem an et. al. show ed that lead exposure w as associated with m easurably low er IQs and significantly poorer perform ance in a classroom activity among school children . T his association w as apparent at doses below the lev els known to produce clinical toxicity . T his w ork received con siderable attention from both the m ass m edia and professional journals. T he implication of Needlem an ' s study w as that even low dose of lead in children could result in distinct neurophy siological deficit s. Giv en the high prev alence of environmental lead exposure, this could be a trem endou s impact in the population level. Since blood lead level do not represent as cumulated lead in the body , Needlem an also 202) F or the history of m anipulating activities of the Lead Indu stries A ssociation over the public health science and policies, see Rosner D, M arkowitz G. A 'Gift of God ' ? T he public health controver sy over leaded gasoline during the 1920s. Am J Public Health 1985 ; 75 : 344- 352; Graebner W . ibid; Baldwin D. Heavy M etal. Common Cause M agazine 1992 F all ; 14- 18 203) Graebner W . ibid. note 3. 204) Needlem an HL, Gunnoe C, Leviton A , Reed R, Peresie H , M aher C, Barrett P . Deficit s in psychologic and classroom perform ance of children with elevated dentine lead levels. New England Journal of M edicine 1979 ; 300(13) : 689- 695 醫史學 제8권 제1· 2호 (통권 제14호) 1999년 established the use of the lead level in teeth as a useful indication of the total amount of lead exposure in the body . T w o year s after Needlem an ' s article appeared, Claire Ernhart, a psychologist now at Case W estern Reserve Univer sity , and her colleagues criticized Needlem an ' s conclusion . In 1974 Ernhart had published research in which she reported that lead w as associated with low er IQ in a group of Long Island black preschooler s.205) In 1981, how ever , she withdrew her own previou s conclu sions, and suggested that there w ere seriou s m ethodological flaw s in the Needlem an ' s paper.206) Ernhart wrote that Needlem an ' s studies showing positive relation s betw een low lead level and decrease of developmental statu s had m ethodological w eakness. In particular she criticized Needlem an ' s 1979 paper , "both because it received m ass m edia attention and becau se a serious attempt w as m ade to consider methodological issues."207) She listed (a) inadequate marker s of exposure to lead, (b ) insensitive m easures of perform ance, (c) biased selection of subject s, and (d) inadequate identification and handling of other confounding v ariables that affect developm ent . Stressing the fourth, she said that parental intelligence w as a m ajor correlate of children ' s intelligence, but few scholars reporting positive effects had con sidered the parenting effect . She concluded, "If there are, in fact , behavioral and intellectual sequelae of low levels of lead burden ... these effect s are minim al."208) Shortly after publication of her paper , Ernhart becam e a grantee of the International Lead Zinc Research Organization (ILZRO), receiving $ 375,000 for next seven year s. Alm ost all the paper s she wrote with the grant from ILZRO stressed that the adver se health effects of lead w ere minim al.209) When there w as a m ove to put lead back in 205) Perino J, Ernhart CB. T he relation of subclinical lead level to cognitive and sen sorim otor impairment in black preschooler s. Journal of Learning Disabilities 1974 ; 7 : 616- 620 206) Ernhart CB, Landa B, Schell NB. Subclinical levels of lead and developm ental deficit — a multiv ariate follow - up reassessm ent . Pediatrics 1981 ; 67(6) : 911- 919 207) ibid. p.911. 208) ibid. p.918. 209) Ernhart CB. Lead levels and confounding variables. Am erican Journal of P sychiatry 1982 ; 139 : 1524; Ernhart CB, W olf AW , Sokol RJ, Brittenham GM , Erhard P . F etal lead exposure : antenatal factor s. Environm ental Research 1985 ; 38(1) : 54- 66; Ernhart CB, Landa B, W olf AW . Subclinical lead level and developmental deficit : re- analy ses of data. Journal of Learning Disabilities 1985 ; 18(8) : 475- 479; Ernhart CB, W olf AW , Kennard MJ, Erhard P , Filipovich HF , Sokol RJ. Intrauterine exposure to low levels of lead : the status of the neonate. Archiv es of Environm ental Health 1986 ; 41(5) : 287- 291; Ernhart CB, M orrow - T lucak M , M arler MR, W olf AW . Low level lead exposure in the prenatal and early preschool periods : early preschool dev elopm ent.
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