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Lead & CDC 10 to 2 – 10/15/05 Toxic Environmental Exposures: Science and Health Impacts – “Out of Harm’s Way: Preventing Toxic Threats to our Children’s.

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Presentation on theme: "Lead & CDC 10 to 2 – 10/15/05 Toxic Environmental Exposures: Science and Health Impacts – “Out of Harm’s Way: Preventing Toxic Threats to our Children’s."— Presentation transcript:

1 Lead & CDC 10 to 2 – 10/15/05 Toxic Environmental Exposures: Science and Health Impacts – “Out of Harm’s Way: Preventing Toxic Threats to our Children’s Health” October 15, 2005 Spokane, WA Steven G. Gilbert, PhD, DABT www.asmalldoseof.org Lead and Child Development or Why the CDC Should Lower The Blood Lead Action Level From 10 to 2 mcg/dL

2 Lead & CDC 10 to 2 – 10/15/05 A Small Dose of Toxicology Agency Blood Lead Levels

3 Lead & CDC 10 to 2 – 10/15/05 A Small Dose of Toxicology “Conclusions: Blood lead concentrations, even those below 10 mgc/dL, are inversely associated with children’s IQ scores at three and five years of age, and associated declines in IQ are greater at these concentrations than at higher concentrations. These findings suggest that more U.S. children may be adversely affected by environmental lead than previously estimated.” Canfield et al. 2003, NEJM, 384 Canfield et al…, 2003

4 Lead & CDC 10 to 2 – 10/15/05 A Small Dose of Toxicology Lead Based Paint 1887 - US medical authorities diagnose childhood lead poisoning 1904 - Child lead poisoning linked to lead-based paints 1909 - France, Belgium and Austria ban white-lead interior paint 1914- Pediatric lead-paint poisoning death from eating crib paint is described 1921 - National Lead Company admits lead is a poison 1922 - League of Nations bans white-lead interior paint; US declines to adopt 1943- Report concludes eating lead paint chips causes physical and neurological disorders, behavior, learning and intelligence problems in children 1971- Lead-Based Paint Poisoning Prevention Act passed

5 Lead & CDC 10 to 2 – 10/15/05 A Small Dose of Toxicology Lead Industry Advertisements http://www.cincinnatichildrens.org/research/project/enviro/hazard/lead/lead-advertising/default.htmhttp://www.cincinnatichildrens.org/research/project/enviro/hazard/lead/lead-advertising/default.htm History of Lead Industry Advertisements (LINK)LINK http://www.cincinnatichildrens.org/research/project/enviro/hazard/lead/lead-advertising/default.htm

6 Lead & CDC 10 to 2 – 10/15/05 A Small Dose of Toxicology A Small Dose of …. Toxicology & The Vulnerability of Children

7 Lead & CDC 10 to 2 – 10/15/05 A Small Dose of Toxicology Lead In Homes

8 Lead & CDC 10 to 2 – 10/15/05 A Small Dose of Toxicology Lead - Absorption Orally Consumed Lead Absorbed In Place of Calcium CHILDREN – 30-50% OF LEAD ADULTS – 5-10% OF LEAD Increased During Pregnancy

9 Lead & CDC 10 to 2 – 10/15/05 A Small Dose of Toxicology Lead in Families

10 Lead & CDC 10 to 2 – 10/15/05 A Small Dose of Toxicology A Small Dose of …. Exposure (multiple sources)

11 Lead & CDC 10 to 2 – 10/15/05 A Small Dose of Toxicology Recycling Lead

12 Lead & CDC 10 to 2 – 10/15/05 A Small Dose of Toxicology Sources Of Lead Lead Paint Dust, Soil Water Industry Hobbies Traditional Ethnic Remedies

13 Lead & CDC 10 to 2 – 10/15/05 A Small Dose of Toxicology Lead in Jewelry http://www.leadinspector.com/

14 Lead & CDC 10 to 2 – 10/15/05 A Small Dose of Toxicology Children & Candy & Lead Data from WA DOH (http://www.doh.wa.gov/EHSPHL/Epidemiology/NICE/Lead/candy.htm)

15 Lead & CDC 10 to 2 – 10/15/05 A Small Dose of Toxicology WA State Guidelines The Washington State Department of Health advises consumers not to eat candy from Mexico or southeast Asia that contains tamarind or chili powder. (http://www.doh.wa.gov/EHSPHL/Epidemiology/NICE/Lead/candy.htm) California also has documented lead in candy. See the Orange County Register series on lead in candy: http://www.ocregister.com/investigations/2004/lead/index.shtml

16 Lead & CDC 10 to 2 – 10/15/05 A Small Dose of Toxicology Lead in WA Candy Data from WA DOH (http://www.doh.wa.gov/EHSPHL/Epidemiology/NICE/Lead/candy.htm)

17 Lead & CDC 10 to 2 – 10/15/05 A Small Dose of Toxicology Pottery with Lead Data from WA DOH (http://www.doh.wa.gov/EHSPHL/Epidemiology/NICE/Lead/pottery.htm)

18 Lead & CDC 10 to 2 – 10/15/05 A Small Dose of Toxicology Lead & Lunchboxes The Center for Environmental Health (CEH) http://www.cehca.org/lunchboxes.htm

19 Lead & CDC 10 to 2 – 10/15/05 A Small Dose of Toxicology Policy Implications Drinking water in Seattle Schools

20 Lead & CDC 10 to 2 – 10/15/05 A Small Dose of Toxicology A Small Dose of …. Health Effects (< 10 mcg/dL)

21 Lead & CDC 10 to 2 – 10/15/05 A Small Dose of Toxicology Needleman, NEJM, 1979

22 Lead & CDC 10 to 2 – 10/15/05 A Small Dose of Toxicology Consequences for Society (Slide from B. Weiss)

23 Lead & CDC 10 to 2 – 10/15/05 A Small Dose of Toxicology Lead-associated Reading Deficits in U.S. Children Blood lead levels (  g/dl) Reading Score Lanphear BP, et al. Public Health Reports 2000;115:521-529. (BL’s slide)

24 Lead & CDC 10 to 2 – 10/15/05 A Small Dose of Toxicology Canfield R, et al. NEJM 2003;348:1517-1526 IQ and Blood Lead Life time overall Increase in 1 mcg/dl = 0.87 IQ drop Covariates - 1 mcg/dl = 0.46 IQ drop 1 to 10 mcg/dl (bigger drop) Increase in 1 mcg/dl = 1.37 IQ drop Non-linear - 1 mcg/dl = 7.4 IQ drop

25 Lead & CDC 10 to 2 – 10/15/05 A Small Dose of Toxicology Canfield R, et al. NEJM 2003;348:1517-1526. (slide from BL) IQ and Blood Lead

26 Lead & CDC 10 to 2 – 10/15/05 A Small Dose of Toxicology Environmental Pollutants and Disease in American Children: Estimates of Morbidity, and Costs for Lead Poisoning, Asthma, Cancer, and Developmental Disabilities, by Landrigan, P. et al. EHP, 110, July 2002, 721-728. Cost of Childhood Lead Assumptions in calculating costs All lead is harmful and from environment Blood lead of children age 5 – 2.7 ug/dl (CDC) 5-year old boys (1,960,200) and girls (1,869,800) 1 ug/dl of lead = 0.25 IQ point reduction Cost – boys $27.8 and girls $15.6 Billion Total Costs $43.4 Billion

27 Lead & CDC 10 to 2 – 10/15/05 A Small Dose of Toxicology Stephen J. Rothenberg and Jesse C. Rothenberg, Testing the Dose-Response Specification in Epidemiology: Public Health and Policy Consequences for Lead Environ Health Perspect 113:1190-1195 (2005) Policy Consequences of Lead “The Centers for Disease Control and Prevention action limit of 10 µg/dL for children fails to protect against most damage and economic cost attributable to lead exposure.”

28 Lead & CDC 10 to 2 – 10/15/05 A Small Dose of Toxicology A Small Dose of …. Ethics Precaution & Environmental Justice

29 Lead & CDC 10 to 2 – 10/15/05 A Small Dose of Toxicology “To ensure that all living things have the best opportunity to reach and maintain their full genetic potential.” Steven G. Gilbert, 1999 Human & Environmental Health

30 Lead & CDC 10 to 2 – 10/15/05 A Small Dose of Toxicology "A thing is right when it tends to preserve the integrity, stability, and beauty of the biotic community. It is wrong when it tends otherwise." - Aldo Leopold, 1949, A Sand County Almanac The First Bioethicist ---------- 1887 - 1948 ---------- Aldo Leopold

31 Lead & CDC 10 to 2 – 10/15/05 A Small Dose of Toxicology A Small Dose of …. Regulation (CDC Guidelines)

32 Lead & CDC 10 to 2 – 10/15/05 Current CDC Policy Blood lead level µg/dL) b Actions Time frame for beginning intervention 10-14Provide caregiver lead education. Provide follow-up testing. Refer the child for social services if necessary. Within 30 days 15-19Above actions, plus: If BLLs persist (i.e., 2 venous BLLs in this range at least 3 months apart) or increase, proceed according to actions for BLLs 20-44. Within 2 weeks 20-44Above actions, plus: Provide coordination of care (case management). Provide clinical evaluation and care. c Provide environmental investigation and control current lead hazards. Within 1 week 45-70Above actions.Within 48 hours 70 or higherAbove actions, plus hospitalize child for chelation therapy immediately. Within 24 hours

33 Lead & CDC 10 to 2 – 10/15/05 Proposed CDC Policy Blood lead level (µg/dL) ActionsTime frame for beginning intervention <2No action 2-5Provide caregiver lead education. Provide follow-up testing. Refer the child for social services to investigate possible sources of lead exposure. Within 30 days 5-10Above actions, plus:If BLLs persist (i.e., 2 venous BLLs in this range at least 3 months apart) or increase, proceed according to actions for BLLs 10-20. Within 2 weeks 10-20Above actions, plus: Provide coordination of care (case management). Provide clinical evaluation and care. Provide environmental investigation and control current lead hazards. Within 1 week 20-70Above actions.Within 24 hours 70 or higherAbove actions, plus hospitalize child for chelation therapy immediately. Within 24 hours

34 Lead & CDC 10 to 2 – 10/15/05 A Small Dose of Toxicology Policy Implications An Ethical and Precautionary Approach to Protecting Our Children Drinking water in Seattle Schools

35 Lead & CDC 10 to 2 – 10/15/05 A Small Dose of Toxicology Agency Blood Lead Levels

36 Lead & CDC 10 to 2 – 10/15/05 A Small Dose of Toxicology Lead 10 to 2 Campaign Steven G. Gilbert www.asmalldoseof.org sgilbert@innd.org

37 Lead & CDC 10 to 2 – 10/15/05 A Small Dose of Toxicology Lead - References EPA – Lead site – the best http://www.epa.gov/opptintr/lead/index.html CDC Childhood Lead Poisoning Prevention Program http://www.cdc.gov/nceh/lead/lead.htm A Small Dose of Toxicology www.asmalldoseof.org

38 Lead & CDC 10 to 2 – 10/15/05 A Small Dose of Toxicology Authorship Information For Additional Information Contact Steven G. Gilbert, PhD, DABT E-mail: smdose@asmalldoseof.org Web: www.asmalldoseof.org This presentation is supplement to “A Small Dose of Toxicology”

39 Lead & CDC 10 to 2 – 10/15/05 A Small Dose of Toxicology See: www.asmalldoseof.org -- smdosesmdose

40 Lead & CDC 10 to 2 – 10/15/05 A Small Dose of Toxicology A Small Dose of ™ Lead

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