What Do Doctors Need To Do About Lead?  

fact sheet created 11 October 2006

Lead Poisoning is too often associated with children only

The history of Lead Poisoning has indicated that much focus is placed on case management for people with a HIGH blood lead levels, in which HIGH is classified as a blood lead level over 10 micrograms per decilitre (10 µg/dL), based World Health Organisation’s goal to be less than 10 µg/dL [1].

Focus has also been placed on looking at lead poisoning in children. Doctors still need to ask questions, rather than just look for symptoms. The LEAD Group recommends testing on the basis of a parent’s response to the ‘Is your child safe from lead? pdf’ questionnaire, found on The LEAD Group website.

Many studies have found children with lead poisoning have destructive effects in intellectual, physical and psychological development. Now, however, focus also needs to be placed on monitoring adults.

The new found health effects of low lead levels in adults

Recent studies indicate that even lower blood lead levels, as low as 2 µg/dL, can have catastrophic effects on a person’s health, including early death from heart disease, heart attack or stroke.

One study, conducted by Andy Menke, MPH, of Tulane University School of Public Health in the U.S. found that 408 of the 14,000 participants that were tested and studied over a 12 year period died from a heart attack or stroke. They found that compared with adults with very low levels of lead in their blood, those with blood lead levels of 3.6 to 10 µg/dL of blood were two and half times more likely to die of a heart attack, 89% more likely to die of stroke and 55% more likely to die of cardiovascular disease [2].

Doctors need new Lead Poisoning Practice and Principles

With this research coming to light, looking only for blood lead levels which are over 10 µg/dL is no longer valid. Not only do all blood lead levels that are detected need follow-up, but also more emphasis needs to be placed on prevention of lead exposure.

A worrying belief of doctors is in fact that lead poisoning is no longer a problem, therefore they do not test for lead and do not attribute health conditions to lead poisoning. The overlooking of lead as a major problem in Australian health is highlighted by the absence of national studies of lead in adults and the rescinding of Australia’s Federal Health Policy on lead. Therefore there are no average figures of blood lead levels in adults or policy.

The resulting problem for doctors who are not required to test blood lead levels in patients continuously over a lifespan, is that they cannot easily conclude whether health problems and death have been caused by lead poisoning.

What should Doctors do?

The role of Doctors is important in monitoring and preventing the normally overlooked health problems which can be caused by lead poisoning. The Lead Group is keen for doctors to understand that the majority of their adult patients are at risk of having a blood lead level over 2 µg/dL, due to every adult being alive during the era of leaded petrol. In order to reduce its harm, lead needs to be monitored by doctors in the following ways:

•  Test the blood lead level of every patient and implement this testing as a standard practice in the patients’ medical check ups.

• Testing from the age of crawling to the age of 6 every year, as well as regular testing throughout the patient’s life.

•  Once a blood lead level above 2 µg/dL is found, direct the patient to information that can aid them in identifying sources and reducing exposure

  References:

[1] This is based on the US Centers for Disease Control 1991 statement that having a blood lead level below 10 µg/dL is defined as “not lead poisoned.” Centers for Disease Control (CDC) “Preventing Lead Poisoning In Young Children” 1991 www.cdc.gov/nceh/lead/Publications/books/plpyc/contents.htm

[2] Source: WebMD medical News – ‘Lead in Blood: ‘Safe’ Levels Too High?’, by Miranda Hitti, www.medicinenet.com/script/main/art.asp?articlekey=64228 

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