LEAD Action News
LEAD Action News Volume 12 Number 3, May 2012, ISSN 1324-6011
Incorporating Lead Aware Times ( ISSN 1440-4966) and Lead Advisory Service News (ISSN 1440-0561)
The Journal of The LEAD (Lead Education and Abatement Design) Group Inc.

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Leadnet debate re: historic shift in US CDC childhood lead poisoning prevention policy

Collated by Elizabeth O’Brien, Manager, Global Lead Advice and Support Service (GLASS)

Following on the announcement by the US Centers for Disease Control and Prevention (CDC) [ later published at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6120a6.htm?s_cid=mm6120a6_e ] noted above in the article “Historic Shift in Lead Poisoning Prevention Policy” - a debate ensued on Leadnet, the egroup / listserv for lead poisoning prevention advocates and professionals, based in the USA and run by the National Center for Healthy Housing (NCHH).

Leadnet members have been my greatest ally –LEAD Action News readers can join this free service by subscribing at http://www.nchh.org/Resources/Listserves.aspx

Thank you to the following Leadnetters for permission to web-publish their emails.

From: Tom Laubenthal

Sent: Friday, May 18, 2012 5:46 AM

To: [email protected]

Subject: [Leadnet] New CDC policy & the term blood lead “Level of Concern” (LOC)

CDC's Response to Federal Advisory Committee on Childhood Lead Poisoning Prevention

In January 2012, the Advisory Committee on Childhood Lead Poisoning Prevention (ACCLPP)* recommended that CDC change its "blood lead level of concern," which has been 10 micrograms of lead per deciliter.

The recommendation was based on a growing number of scientific studies showing that even low blood lead levels can cause lifelong health effects. Today, CDC is officially announcing our agreement with that recommendation and the change in CDC policy.

ACCLLP recommends that CDC eliminate the term "level of concern" and lower the blood lead level for remedial action. Instead, the committee recommends linking elevated blood lead levels to data from the National Health and Nutritional Examination Survey (NHANES) to identify children living or staying for long periods in environments that expose them to lead hazards. This new level, called a "reference value," is based on the population of children aged 1-5 years in the U.S. whose blood lead levels are in the highest 2.5% of children tested. Today, that level is 5 micrograms per deciliter (μg/dL) of lead in blood.

In future publications, "level of concern" will be replaced with the reference value and the date of the NHANES that was used to calculate it. The new value means that more children likely will be identified as having lead exposure and that parents, doctors, public health officials, and communities can take action earlier to prevent health effects. For more than 20 years, NCEH’s [National Center for Environmental Health’s] work to eliminate lead poisoning in children has been one of CDC's most visibly successful initiatives. It has contributed to lowering significantly the number of U.S. children ages 1-5 years old with elevated blood lead levels (EBLLs), to increasing the number of children tested for EBLLs, and to promoting state and local lead screening plans and abatement laws.

For more information, please visit: http://www.cdc.gov/nceh/lead/ACCLPP/activities.htm  *

The Advisory Committee on Childhood Lead Poisoning Prevention (ACCLPP) advises and guides the Secretary and Assistant Secretary of the U.S. Department of Health and Human Services and the Director of the Centers for Disease Control and Prevention regarding new scientific knowledge and technical developments and their practical implications for childhood lead poisoning prevention efforts.

Tom Laubenthal

The Environmental Institute

www.tei-atl.com

From: Strane, Doug [Director of Community Health, Michigan]

Sent: Monday, May 14, 2012 2:29 PM

To: [email protected]

Subject: [Leadnet] Cognitive recovery from lead poisoning

Hello all -

I've been looking for information on how parents can assist in their child's cognitive recovery from lead poisoning. We sometimes refer parents to early childhood learning programs, but I would like to give parents more information on activities they can do with their child to lessen the effects of lead poisoning and better prepare them for school. It can't take the place of special attention in school, but it's a way for parents to play an important role in the child's recovery.

Does anyone know of any resources for parents looking to assist with lessening the cognitive effects of lead poisoning? Any first-hand experience that you've had with this would be helpful as well. Thanks much!

Doug Strane

Michigan Department of Community Health

Healthy Homes Section

From: Walsh, Reghan O - DHS

Sent: Wednesday, May 16, 2012 1:18 AM

To: [email protected]

Subject: RE: [Leadnet] Cognitive recovery from lead poisoning

CDC has a webpage on developmental issues:

http://www.cdc.gov/ncbddd/actearly/index.html

Includes a 1-page flyer with parents’ developmental questions and another with suggestions on talking with parents--may be helpful:

http://cirrus.mail-list.com/leadnet/83893034.html

http://cirrus.mail-list.com/leadnet/66484995.html

This is a resource in Wisconsin: http://www.actearly.wisc.edu/actearly.php

You may have something in your area as well.

Reghan O. Walsh

Member of the CDC workgroup called Education Assessment and Intervention

Health Education Specialist

Wisconsin Childhood Lead Poisoning Prevention Program

Madison, WI  53701-2659

Check out our website (http://dhs.wisconsin.gov/lead ) OR call 1 800 LEAD

FYI to learn how to protect children from lead poisoning.

From: Mike Martin

Sent: Wednesday, May 16, 2012 1:07 AM

To: <[email protected]>

Subject: Re: [Leadnet] CDC

Don't forget that in 1999 when the GAO (federal Government Accountability Office) did an investigation that performed actual testing of children on Medicaid, they found that only 10 percent of the children they found to be lead poisoned at 10 micrograms had actually been screened by Medicaid. So when you see a statistic that says 500 kids were found to be lead poisoned at 10 micrograms, the reality is that 5,000 kids were actually lead poisoned and they only detected 10 percent. Even if you assume that things have improved since 1999, and I'm told they haven't, where maybe 20 percent are screened today, that 500 number becomes 2,500 kids actually lead poisoned.

[For non-US readers: “Medicaid was established in 1963 under Title XIX of the Social Security Act to help low-income families and children have access to health care. As written in the legislation, four categories of impoverished people can qualify for Medicaid--blind, disabled, aged, and families with dependent children. In 1967, Medicaid children under age 21 were granted Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) health services. EPSDT offers early screening for health problems. In 1986, Medicaid coverage for impoverished pregnant women and children under age one was added as a state option.” www.ehow.com/about_4612428_what-is-medicaid.html ]

On top of that, how many undocumented immigrants do you have in your community? They are not eligible for screening through Medicaid and are more likely to be lead poisoned for various reasons.

I looked at a couple of states that did publish incident rates at 5 percent a few years ago and I found that there were about 5 times as many kids at 5 micrograms than at 10 micrograms. So I have consistently told people over the past few years that you can generally expect that the number of children actually lead poisoned is about 25 times the number reported, plus the undocumented immigrants.

This becomes important when you talk about interventions and support for school children, and for pre-school children. Even if you do not perform intervention to stop the lead poisoning, which society has decided costs too much, you still have to deal with the children who come to school with the cognitive problems triggered by lead poisoning. So when we have Maria Miranda's work showing test score declines below 10 micrograms, and the Canfield work showing a half standard deviation I.Q. loss by 10 micrograms, you know you have kids with cognitive problems well below the official level of concern.

I have suggested that we certify all children with lead poisoning levels of 5 micrograms and higher and give them a certificate that excuses them from school testing for life. If society has decided these kids are expendable and too expensive to prevent from being poisoned, then society should certify that they don't have to meet the normal requirements of cognitive development. In fact, research says they typically cannot meet the normal requirements of cognitive development, which is what "poisoned" means. If there are no consequences from being "poisoned" then why call it "lead poisoning" and if there are consequences, which research has heavily documented, then why ignore that the kids are not likely to meet normal cognitive development standards?

As I see it, the question is simple. Are we as a society going to prevent childhood lead poisoning, or are we as a society going to take responsibility for the consequences of not preventing childhood lead poisoning? So make the law simple: count any child with a lead level of 5 micrograms or greater as "lead poisoned" and certify that this child is likely not to meet cognitive development standards. The law already says that children with lead levels above 10 micrograms should be identified through I.D.E.A. outreach and receive special education services, which society pretty much ignores, so why not make the law apply to 5 microgram levels where we know from solid research that cognitive damage occurs, and ignore it at that level?

I think it is a little surreal to state that we have solid research showing that children suffer cognitive damage that results in an inability to learn at normal developmental levels with BLLs below 10 micrograms, but we are going to ignore this because we have political and financial reasons to make the problem go away by defining our "level of concern" at 10 micrograms. Teachers in Rhode Island's Central Falls school were fired because of low test scores, but a contemporaneous study showed that Central Falls was one of 4 Rhode Island cities where lead poisoning incidence approached 50 percent in children. This is the reality of Marie Miranda's research: lead poisoned children are NOT going to score at the same level on academic tests as children who are not lead poisoned. That is what "poisoned" means.

The real social cost of lead poisoning has repeatedly been shown to be about 25 times what we officially admit to. We don't screen the kids we officially say we do, we know there are more kids suffering cognitive damage than we officially say we have, and we ignore the laws that officially say we provide these kids with educational assistance. So do we admit to reality and do nothing about it, or do we ignore reality and claim success at solving the problem? I say we should do the former, admit to reality and officially give each lead poisoned child a certificate that admits we have chosen to do nothing about it and we know they will not have normal cognitive development.

Mike Martin

Phoenix, Az

From: Karl Hess

Sent: Wednesday, May 16, 2012 3:38 AM

To: [email protected]

Subject: [Leadnet] Cognitive recovery from lead poisoning - message from a pediatrician

There are assumptions in the way we have been dealing with lead when levels over 10 were common.

The data is now clear that levels over 2 reduce both intelligence and executive control - at enormous cost to the country.

It would cost a lot less to clean up the lead, but that would require thinking ahead and humans are not very good at that.

Recognizing this situation seems to me to require some changes in the way we think about things. (I'm thinking as a pediatrician.)

1. I think we have a moral obligation to tell parents if their child has been ingesting lead and will get significant damage if it continues. Wouldn't you want to know if your child were being exposed?

If we admit that all levels >2 cause damage we can tell them, and help them look for sources.

Some may be obvious once we start looking.

2. Calcium deficiency greatly promotes lead absorption, and most American children don't get recommended amounts of Calcium, which is cheap.

Getting plenty of Iron and Vit C probably helps as well.

My guess is that parents would be a lot more thorough with their child's nutrition if they know that stakes involved.

Dean is right that government agencies do not have the resources to take responsibility for this, so the only way to proceed at present is to shift to secondary prevention through the medical sector - and it is crucial to identify these kids as early as possible.

Millions of investigations will need to be done, as Dean says, but we have to face the facts that in the current political environment, they aren't going to be, so we have to adapt.

That's why we have such large brains. What do you think?

Karl Hess

------------------------------------------------------------------------

From: Dr Perry Gottesfeld

Sent: Wednesday, May 16, 2012 4:40 AM

To: [email protected]

Subject: Re: [Leadnet] CDC

Dear All

This is a very useful debate that has come out on leadnet, but as one of the members of the ACCLPP Committee who played a role in the new recommendations to CDC, I did want to address some of the misconceptions.

1) First, I recommend that people in this field have a look at the entire document which is available on the CDC web site at:

http://www.cdc.gov/nceh/lead/ACCLPP/Final_Document_030712.pdf

2) The document calls for the elimination of the terminology “level of concern” as we are all clearly concerned about levels below 10 µg/dL.

To be clear, 5 is not the new 10!

3) The thrust of the recommendation is that we all move towards a primary prevention model. To quote “Primary prevention is a strategy that emphasizes the prevention of lead exposure, rather than a response to exposure after it has taken place.”

In this effort we don’t suggest waiting for health departments to respond, but instead we are calling for action on the part of pediatricians, parents, housing agencies, social service agencies, and others to play a role in prevention.

4) Some are turning this into a debate regarding costs of abatement or investigations but that is not part of the report.

Already many states and local governments are responding to children with blood lead levels less than 10 µg/dL.

We know that actions to prevent lead exposures are much more cost effective than responding to a child with an elevated blood lead level (e.g. improved nutrition, lead safe housing).

Regards

Perry Gottesfeld

Occupational Knowledge International

PS- Even Congress got the message wrong in the letter sent yesterday to CDC by suggesting that 5 is the new 10!

------------------------------------------------------------------------

From: "Karl Hess"

Sent: Wednesday, May 16, 2012 6:54 AM

To: <[email protected]>

Subject: Re: [Leadnet] CDC

Dr Gottesfeld,

Thank you for entering the discussion.

You are probably aware that congress and the CDC have pretty much eliminated funds for primary prevention and cities and states have had their budgets decimated. That was where the money for primary prevention came from.  No one else has the resources to deal with this, so far as I know.  Everyone prefers primary prevention (partisan statement deleted).

Given that reality, pediatricians can be much more pro-active by implementing the activities which I've mentioned today, and not waiting for  more damage to occur. Since I'm retired I have time to read the literature and no political bosses to try to control me.  When I talk to pediatricians, they have thought that the CDC recommended 10 as a threshold, telling parents that children with levels reported less than that there is no danger.  I know what the documents say, but pediatricians in practice have lots of problems to worry about and aren't going to read 200-page discussions.

Please explain the rationale for using the statistical measure instead of the levels which multiple studies have documented damage to the child's brain - both IQ and executive function.  It looks as though ACCLPP is being dragged kicking and screaming to stop its denial of the true danger of lead.

Regards,

Karl Hess, MD, FAAP

From: Karl Hess

Sent: Wednesday, May 16, 2012 11:42 AM

To: [email protected]

Subject: Re: [Leadnet] CDC

Perry,

So far as I can tell the only safe level is 0, which it was for most of human history.

Widely used equipment can measure lead down to 1.2 µg/dl with a std dev of 0.7, according to the Wisconsin Lead Proficiency studies. So it is impractical at this point to set a level below 2.

If we were as smart as we like to think we are, we would get a lead [in blood level] at the first prenatal visit, and if it is over 2, look for sources, and push the Ca in the diet to keep the lead in the bones as much as possible.

Then we would get a lead level at birth to see where things stand.

If the child is a preemie and needs transfusions, we would make sure the blood used has very low lead levels.

(Isn't that radical!)

Repeat lead levels at regular intervals till age 6.

If the level is going up, look for sources and push the calcium.

Most kids get too little anyway.

As a side benefit, the millions of parents who become aware of their kid's poisoning might make it necessary for the politicians to provide the funds to clean up the mess.

Then we would have primary prevention.

Does that make sense to you?

Karl

From: Lead Safe America Foundation

Sent: Wednesday, May 16, 2012 12:26 PM

To: [email protected]

Subject: Re: [Leadnet] Lead Safe America Foundation film "MISLEAD" due out Winter/Spring 2013

Hi Karl,

that's the idea behind our film - creating awareness in millions of parents ALL AT ONCE - as a first step that will then influence politics and funding! :-)

Can I quote your post (below) on our film's facebook page?

For those who have not yet seen the 16 minutes that is the rough-cut from our New Orleans presentation (with an emphasis on footage done in New Orleans) please watch. The link is below.

I wasn't going to share this with you all quite yet because I wanted to do some more editing - but it seems so timely to the conversation on leadnet over the past couple of days that I would really like you to see it.

This is not meant to represent the WHOLE MOVIE (there are many elements that will be included in the full film that are not addressed here)

- and is just a sneak peek - of the direction we are going in the film.

The first 12.5 minutes are mostly new material - footage from interviews with parents and experts (Rick Nevin, Dave Jacobs, Harrison Newton, Pierre Erville, Neil Leifer, Howard Mielke, Philip Shabecoff, Ronnie Levin, Joel Schwartz, Lee Wasserman, Sanjay Gupta, Philip Landrigan, Leonardo Trasande, Ted Lidsky, John Rosen, David Rosner, Mark Pokras, Jerry Markowitz, Rebecca Morley, Nabil Baddour, Beth Butler, New Orleans Sheriff Marlin Gusman, Senator J.P. Morrell and others) and the last 3.5 minutes are the trailer that you may have already seen (it's tacked on to the end.)

The voices of the parents in the film are the most compelling reason to watch AND the main concept behind the film: get millions of parents to realize this could be their child (encourage pre-natal and preconception testing too!)

Some people have had trouble viewing in Safari - if that happens to you, please try Firefox or another browser. http://misleadmovie.com/Mislead_Movie/PrivateNOLA.html

I'm having a second phone meeting with HBO tomorrow... fingers crossed everyone!

Our Facebook Page

- ("like" it if you want to get regular updates on the film ) http://www.facebook.com/MisleadMovie - We started the facebook page on April 16th and already have 350 "likes".

The intention is to use this film as a tool (for all of you!) to help spread the word - so please encourage people to "like" the film's facebook page as a first step in getting the word out - so when the full film is finally available for the public to view (Winter/Spring 2013), we already have an audience established.

Thank you everyone for all you are doing to protect children.

Tamara Rubin

Executive Director

Lead Safe America Foundation

http://www.leadsafeamerica.org

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