Lead Wars: The Politics of Science and the Fate of America ’s Children
By Gerald Markowitz and David Rosner
University of California Press, $34.95
Reviewed by BILL KOVARIK
Metallic lead is, historically, humanity’s oldest known poison, and yet Americans are still trying to deal with its pernicious effects on public health, especially on the most susceptible low income and racial minorities.
Even though it has been removed from paint and gasoline in the United States and Europe in recent decades, more lead is being mined and crafted into products today than ever before.
Although much of the basic history about public health risk and industry deceit by the leaded paint and gasoline industries was already well known, “Lead Wars” is a solidly crafted historical narrative that fills in an important and little known area of the public health research side of the story.
Markowitz and Rosner begin the story in 2001, as a Maryland state court finds that Johns Hopkins University researchers have acted unethically in using inner city Baltimore residents to do lead abatement research. The residents were not informed and in some cases were harmed by the research.
The court said that, while not as severe, the case presented problems similar to those in the Tuskegee Syphilis Study and other unethical human subjects research.
How is it, Markowitz and Rosner ask, that research by the nation’s leading public health institution was being compared to the bottom rung of public health ethics? The authors look to history for explanations that match the scale of the problem.
They explain that in the mid-to-late 19th century, environmental reform animated Progressive-era public health movements in Europe and the United States.
Physicians, journalists and social activists joined forces with public health agencies and campaigned for housing reforms, mass vaccinations, clean water, sewage systems, and pure food laws.
Those campaigns achieved great victories by the 1930s, although, as it turned out, not in the area of leaded paint and gasoline, where the authors stated that “rapacious industries have knowingly profited from human suffering.”
As the Progressive movement faded into the Depression, a new and more “professional” approach to public health emerged, and the emphasis shifted to a concern for curing the individual rather than reforming the environment. Clinical studies of individual medical cases became the central focus of the profession.
For instance, therapies for reducing high blood lead levels in workers and children (over 60 μg/dl) received far more attention than the possibility that environmental lead from paint and gasoline could have a general impact. That applied not only to lead, but to all kinds of environmental toxics.
By the 1970s, animal tests showed that lower levels of lead induced hyperactivity, and as research accumulated, it became clear that many toxics, including lead, did not follow a linear dose-response relationship. Instead, researchers found that low levels of exposure to toxics like lead, especially at susceptible developmental stages, could result in chronic illnesses or a range of individual harms for which there were no cures.
Also in the 1970s, revelations emerged about a number of highly unethical medical experiments, particularly the 600 impoverished Tuskegee, Alabama sharecroppers whose syphilis was studied for 40 years and who were never told about their disease or given any well-known cures. Outrage about these experiments led to the Belmont Report, a 1978 statement about ethical principles for protecting human subjects. Among the principles: do no harm, ensure informed consent, and ensure that experiments do not go beyond normal risks.
In 1992, Johns Hopkins researchers at the Kennedy Krieger Institute wanted to know how well three types of lead abatement treatments for houses would help in avoiding high blood lead levels.
The experimental design involved finding a practical lead abatement technique that would help prevent the abandonment of inner city housing. The three treatments — costing $1,650, $3,500 and $7,000 — were used in homes rented to 108 inner city residents. The residents were not told which type of home they were in, nor that there were ‘hot spots’in some of the homes, nor that the lower- cost lead abatement techniques would not protect their children.
The study design was approved by an institutional review board which was told of potential benefits from using children as experimental subjects but, apparently, did not foresee potential harm in partly abated homes.
While some children with high blood levels did have lead levels drop, no children had blood lead levels come below the then-existing level of concern of 10 μg/dl (the threshold has since been lowered to 5 μg/dl).
While parents were clearly not informed about the experiment, and some children were exposed to harm, one of the questions that came up in Baltimore, and in other studies involving low-income populations, involves how a ‘normal’risk is defined.
The future of public health, according to Markowitz and Rosner, involves the choice between remaining true to the traditional mission of preventing disease or accommodating the politics of economic feasibility.
“Lead Wars” is a deeply conceived and well-written book by two of America’s best public health historians.
It’s also an important background briefing on the politics and ethics of scientific research for journalists who will be covering environmental health issues like these.
Bill Kovarik, a former SEJ board member, is a communication professor at Radford University in Virginia.
* From the quarterly newsletter SEJournal, Summer 2013. Each new issue of SEJournal is available to members and subscribers only; find subscription information here or learn how to join SEJ. Past issues are archived for the public here.