Uneasy Money

I just read this review/essay (“Lead Poisoning: The Ignored Scandal”) by Helen Epstein of the book Lead Wars: The Political Science and the Fate of America’s Children by Gerald Markowitz and David Rosner, in the March 21, 2013 issue of the New York Review of Books.. The story it tells is so outrageous – and on so many different levels — that it makes you want to cry, and to cry out in horror and disgust. And lest you think that it is an old story, think again.

In 1990, Leslie Hanes, another young black single woman, moved into an apartment that was supposed to have been fully stripped of lead paint years earlier. In 1992, she gave birth to a daughter, Denisa, and in the spring of the following year, she too joined the toddler lead study.³ The day before Hanes signed the consent form, the contractor found that her apartment was not in fact lead-free. The remaining lead paint was removed, but by the following September Denisa’s blood lead level had more than tripled and was now six times higher than that currently considered safe by the Centers for Disease Control.

Denisa’s mother was not informed of the blood test result for another three months, by which time it was nearly Christmas. The research assistant who told her about it wished her happy holidays and advised her to wash her front steps more carefully and to keep eighteen-month-old Denisa from putting her hands in her mouth. When Denisa eventually entered school, she had trouble keeping up and had to repeat second grade. This came as a surprise to her mother, a former high school honors student. As Hanes told The Washington Post‘s Manuel Roig-Franzia in 2001, sometimes Denisa came home crying because she thought she was stupid. “No, baby, you’re not stupid,” Leslie told her. “We just have to work harder.”

The effects of putting children at high risk of lead poisoning are tragic and appalling.

Long before the Baltimore toddler study was even conceived, millions of children had their growth and intelligence stunted by lead-contaminated consumer products—and some five million preschool children are still at risk today. One expert even estimated that America’s failure to address the lead paint problem early on may well have cost the American population, on average, five IQ points—enough to double the number of retarded children and halve the number of gifted children in the country. Not only would our nation have been more intelligent had its leaders banned lead paint early on, it might have been safer too, since lead is known to cause impulsivity and aggression. Blood lead levels in adolescent criminals tend to be several times higher than those of noncriminal adolescents, and there is a strong geographical correlation between crime rates and lead exposure in US cities.

In 2000, the two mothers sued the Johns Hopkins–affiliated Kennedy Krieger Institute, which employed the scientists. The mothers’ cases were thrown out by a lower court, but after an appeals court remanded the case to be heard, the mothers reached an undisclosed settlement with the institute. The ninety-six-page appeals court judgment compared the Baltimore lead study to the notorious Tuskegee experiment, in which hundreds of black men with syphilis were denied treatment with penicillin for decades so that US Public Health Service researchers could study the course of the disease.

The toxic effects of lead poisoning were known long ago

The problem began in the early twentieth century when a spate of lead-poisoning cases in children occurred across the United States. The symptoms—vomiting, convulsions, bleeding gums, palsied limbs, and muscle pain so severe “as not to permit of the weight of bed-clothing,” as one doctor described it—were recognizable at once because they resembled the symptoms of factory workers poisoned in the course of enameling bathtubs or preparing paint and gasoline additives. One Dupont factory was even nicknamed “the House of the Butterflies” because so many workers had hallucinations of insects flying around. Many victims had to be taken away in straitjackets; some died.

By the 1920s, it was known that one common cause of childhood lead poisoning was the consumption of lead paint chips. Lead paint was popular in American homes because its brightness appealed to the national passion for hygiene and modernism, but the chips taste sweet, and it could be difficult to keep small children away from them. Because of its well-known dangers, many other countries banned interior lead paint during the 1920s and 1930s, including Belgium, France, Austria, Tunisia, Greece, Czechoslovakia, Poland, Sweden, Spain, and Yugoslavia.

In 1922, the League of Nations proposed a worldwide lead paint ban, but at the time, the US was the largest lead producer in the world, and consumed 170,000 tons of white lead paint each year. The Lead Industries Association had grown into a powerful political force, and the pro-business, America-first Harding administration vetoed the ban. Products containing lead continued to be marketed to American families well into the 1970s, and by midcentury lead was everywhere: in plumbing and lighting fixtures, painted toys and cribs, the foil on candy wrappers, and even cake decorations. Because most cars ran on leaded gasoline, its concentration in the air was also increasing, especially in cities.

Lead paint was the most insidious danger of all because it can cause brain damage even if it isn’t peeling. Lead dust drifts off walls, year after year, even if you paint over it. It’s also almost impossible to get rid of. Removal of lead paint with electric sanders and torches creates clouds of dust that may rain down on the floor for months afterward, and many children have been poisoned during the process of lead paint removal itself. Even cleaning lead-painted walls with a rag can create enough dust to poison a child. Gut renovating the entire house solves the problem, but this too may contaminate the air around the house for months.

The sheer magnitude and duration of those effects is mind-boggling, and the suffering has not ended.

There is no way of knowing how many children were harmed over the past century by America’s decision not to ban lead from consumer products early on, but the number is somewhere in the millions. The most accurate national survey of lead poisoning was probably the 1976–1980 National Health and Nutrition Examination Survey, which found that 4 percent of all children under six—roughly 780,000—had blood lead concentrations exceeding thirty micrograms per deciliter, which was then thought to be the limit of safety.

Black children, the survey found, were six times more likely to have elevated lead than whites. The number of children with lead levels over five micrograms per deciliter—or for that matter over one or two—was obviously much higher, but there’s no way of knowing how high it was. The 1985 leaded gasoline ban and the gradual renovation of slum housing have since reduced the number of poisoned children, so that today, the CDC estimates that some 500,000 children who are between one and five years old have lead levels over five micrograms per deciliter.

As the scale and horror of the lead paint problem came to light, the lead companies played down the bad news. When popular magazines like Ladies’ Home Journal began publicizing the dangers of lead poisoning in the 1930s and 1940s, lead and paint manufacturers placed cartoons in National Geographic and The Saturday Evening Post celebrating the joy that lead paint brought into children’s lives. Advertisements for Dutch Boy paint—which contained enough lead in one coat of a two-by-two-inch square to kill a child—depicted their tow-headed mascot painting toys with Father Christmas smiling over his shoulder.

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The companies also hired a public relations firm to influence stories in The Wall Street Journal and other conservative news outlets, which characterized Needleman as part of a leftist plot to increase government spending on housing and other social programs. So, just as the tobacco industry deliberately obfuscated the dangers of cigarettes until skyrocketing smoking-related Medicaid costs finally led state governments to sue the companies, and just as oil company–backed scientists now downplay the dangers of greenhouse gases, the lead industry also lied to Americans for decades, and the government did nothing to stop it.

During the 1980s, government officials finally agreed that the lead paint crisis was real, but they were conflicted about how to deal with it. In 1990, the Department of Health and Human Services developed a plan to remove lead from the nation’s homes over fifteen years at a cost of $33 billion—a large sum, but half the estimated cost of doing nothing, which would incur a greater need for special education programs, Medicaid and welfare payments for brain-damaged and disabled lead-poisoning victims, and other expenses. But the plan was opposed by the lead industry, realtors, landlords, insurance companies, and even some private pediatricians who objected to the extra bother of screening children. The plan was soon shelved, and instead, the EPA, looking for a cheaper way around the problem, commissioned the Baltimore toddler study.

Since then, the US government has spent less than $2 billion on lead abatement. This money has supported a number of exemplary state and nonprofit programs that work in inner cities, but it’s a tiny fraction of what’s needed, and about twenty times less than US spending on the global AIDS crisis since 2004 alone. It’s worth asking why both Republican and Democratic administrations appear to have cared so little about this threat to America’s children.

And the horror continues

Lead-poisoning prevention once had its partisans too, but they were marginal and rapidly stifled. During the 1960s, the Black Panthers and the Puerto Rican activist group the Young Lords set up community health clinics and carried out screening programs for tuberculosis and sickle cell anemia as well as lead poisoning. The historian Alondra Nelson’s excellent Body and Soul: The Black Panther Party and the Fight Against Medical Discrimination (2011) describes how these groups maintained that new civil rights laws and Great Society programs alone would never meet the needs of the poor unless the poor themselves had a voice in shaping them. The Panthers espoused violence and called for a separate black country. They certainly weren’t right about everything, but when it came to lead poisoning, they probably were.

By the early 1980s, the movements to achieve social justice led by Martin Luther King Jr., Malcolm X, and the Black Panthers had largely subsided, and with them, grassroots advocacy for the health of poor black children. Some scientists continued to raise the alarm about lead poisoning, including Herbert Needleman, Jane Lin-Fu of the US Children’s Bureau, Philip Landrigan of Mount Sinai Hospital in New York, and Ellen Silbergeld, the editor of the journal Environmental Research, but they lacked a strong social movement to take up their findings and fight for children at risk. Although there were some desultory campaigns against lead poisoning, neither the powerful women’s health movement nor environmental groups took up the issue in a sustained manner. The Obama administration has invested no more in this problem than George W. Bush’s did. Lead poisoning isn’t even on the CDC’s priority list of “winnable public health battles.”