| Odoslal: | Martin Rusnak |
| Dátum: | February 28, 2000 o 15:23:46 |
| Subject: | DUMBING DOWN THE CHILDREN |
The NEW YORK TIMES reported in 1999 that, "Federal investigators
say most states are flouting a 1989 law requiring that young
children on Medicaid be tested for lead poisoning. As a result,
they say, hundreds of thousands of children exposed to
dangerously high levels of lead are neither tested nor
treated."[1]
The TIMES explained that, "The General Accounting Office [GAO],
an investigative arm of Congress, found that 'few Medicaid
children are screened for blood-lead levels,' even though the
problem of lead poisoning is concentrated among low-income
children on Medicaid." Medicaid is a federal medical insurance
program for poor people. In the U.S. today, more than 40% of all
poor people are children.[2]
Today nearly a million children (983,000) in the U.S. younger
than 5 are believed to suffer from low-level lead poisoning,
according to the federal Centers for Disease Control.[3]
Low-level lead poisoning can cause permanent learning
disabilities, hyperactivity, poor motor coordination, and other
developmental deficits. Indeed, reduced IQ, hearing loss and
diminished stature are associated with lead levels considerably
lower than the 10 micrograms of lead per tenth-of-a-liter of
blood now deemed "acceptable" by the U.S. government.[4]
Supplementing and corroborating the GAO study, the state auditor
of California, Kurt R. Sjoberg, reached a similar conclusion
about Medicaid compliance in a separate 1999 report. "'Thousands
of lead-poisoned children have been allowed to suffer
needlessly,' because California has not complied with the federal
requirement to test them for lead poisoning, Mr. Sjoberg said,"
according to the TIMES.[1]
Federal rules require that children in the Medicaid program be
tested for lead poisoning at age 12 months and again at age two
years. The GAO report found that states varied considerably in
their compliance with this federal law. Washington State tested
fewer than 1% of eligible children; New Jersey tested 40%.
Alabama performed best, testing the highest proportion but still
fewer than half (46%) of all eligible children.
The TIMES also reported that many states simply don't keep the
necessary records to know whether they are complying with federal
law or not. "Many states, including Connecticut [the wealthiest
state in the Union] said they did not have statewide data on
testing rates or the prevalence of lead poisoning," the TIMES
reported. The question occurs, why would a state not maintain
records to assess the size of this problem and the steps being
taken to solve it?
>From a state's perspective, the problem isn't one of cost. A lead
poisoning test is relatively cheap at $10 or less and besides the
federal Medicaid program pays 100% of the costs of testing. If a
child is found to have elevated lead levels, Medicaid will pay
100% of the costs of treatment. (Medicaid will NOT pay to test
water, paint or house dust to find the source of the
contamination, however.)
To summarize: An 11-year-old federal law requires all children up
to age 2 in the Medicaid program to be tested for lead poisoning.
Medicaid pays all the costs. The purpose of the law is to catch
signs of lead poisoning early in hopes of limiting the damage to
the child's central nervous system. Lead poisoning, even at low
levels, can leave a permanent legacy of slow learning, hearing
impairment, cardiovascular disease, behavioral problems and
delinquent behavior.2 But the states are thumbing their noses at
the federal law, thus allowing these debilitating medical
conditions to develop in tens of thousands of American children
each year.
Why? Why are governments refusing to comply with a public health
law intended to protect children?
Here are a few preliminary reasons:
** Dr. Maxine D. Hayes, the acting health officer for Washington
state, gave a states-rights explanation: "We don't think it's
right for the Federal Government to dictate what states should
do," she told the NEW YORK TIMES. Dr. Hayes seems to be asserting
a state's right to ignore the poisoning of its children and to
disregard federal law if it chooses to do so, a dubious legal
proposition at best (leaving aside the ethical issues it raises).
The question still remains, why would a state government choose
to do such a thing?
** Washington state does participate in the federal Medicaid
program. The state's Medicaid director gave the TIMES a different
explanation: "We don't believe we have much of a problem with
lead exposure here." However, this is speculation and the purpose
of the lead-testing program is to lay such speculation to rest by
producing hard evidence. Bitter experience shows that testing is
likely to identify some lead-poisoned children who live in homes
built prior to 1978, particularly homes that have been poorly
maintained. Eighty percent of housing built before 1978 contains
some lead-based paint, which in poorly-maintained buildings is by
now probably turning into a fine powdery dust, which toddlers may
get on their hands and then into their mouths. But of course
without testing, a state official is free to speculate that his
or her state is, miraculously, an exception to this general rule.
The question remains, why would a state medical officer choose to
speculate rather than acquire hard data?
** Many states have turned over their Medicaid responsibilities
to health maintenance organizations (HMOs) but have neglected to
specify the full range of services they expect HMOs to provide,
so lead testing has often slipped through the cracks. The
question remains: since Uncle Sam is picking up the tab, why
don't states require lead testing when they negotiate contracts
with HMOs?
The long and the short of it seems to be that most state
governments have designed policies that assure that the
lead-poisoning of children continues, and the federal government
seems paralyzed in the face of this rebellion.
The question remains, Why?
* * *
There are two major sources of lead in the environment, both of
them human in origin. The first is leaded gasoline, which was
outlawed in the U.S. in 1976 but which left a residue of about
5.9 million metric tonnes (13 billion pounds) of lead in the
environment in the form of a fine, toxic dust.[2] Much of that
powdery lead is still moving around in soil and house dust.
Furthermore leaded gasoline is still being used in many countries
outside the U.S., so contamination of the atmosphere continues,
producing a steady toxic fallout.[5] Without human help, nature
does produce some lead dust, but humans now produce 19 times as
much as nature produces each year -- a startling reminder of how
numerous market-based decisions can add up to an intractable
problem of enormous proportions.[5]
The second major source of lead dust is lead in paint. Lead, the
soft, gray metal makes an excellent white pigment, and paint made
with white lead pigment provides a high-quality, durable
protective coating. Eventually, however, even lead-based paint
deteriorates. It begins to flake, peel and disintegrate into a
fine, powdery dust, which is toxic. Lead in paint was restricted
on a voluntary basis by the paint industry in 1955, but voluntary
compliance proved ineffective so, in 1970, Congress outlawed
leaded paint for interior uses. However there is evidence that
leaded paint was used illegally inside buildings until at least
1978. Between 4 and 5 million metric tonnes (approximately 10
billion pounds) of lead were used in paint in the U.S. between
1889 and 1979 and much of it remains where it was originally put,
slowly deteriorating into a toxic dust. An estimated 42 million
families live in homes containing an average of 140 pounds of
lead in paint. If it has not been covered, this paint is a
constant danger to toddlers who often pick up the dust on their
hands, then transfer it into their mouths.[3]
The danger of lead in paint was first identified 96 years ago
when J. Lockhart Gibson, an Australian physician, published the
first report in a medical journal describing children poisoned by
lead-based paint. Gibson specifically described the dangers to
children from lead-based paint on the walls and verandas of
houses.[1] The following year Gibson urged that, "[T]he use of
lead-based paint within the reach of children should be
prohibited by law."[6] Australia finally took Gibson's advice in
1922, 50 years before the U.S. took similar action.
Unfortunately, lead is extremely toxic, especially to children
whose developing nervous systems are particularly susceptible to
lead poisoning. As little as 10 micrograms ingested daily can
poison a child;[2] a microgram is a millionth of a gram and there
are 28 grams in an ounce. With 10 micrograms being a toxic daily
quantity, the 10 million metric tonnes of lead introduced into
the environment by humans during the 20th century creates an
almost unbelievably large "sink" of toxic powder available in
soil and in house dust, waiting to cause brain damage in
toddlers.
Lead poisoning of children in the U.S. was first described in
medical literature in 1914.[7] In 1917, a physician at Johns
Hopkins University in Baltimore suggested that, if physicians
looked harder for lead poisoning in children, they would find
more of it. A pediatric textbook in 1923 described 8 cases of
childhood lead poisoning: "The poisoning was caused in each
instance by the child's nibbling and swallowing the paint from
his crib or furniture."[7] In 1924 an article in the JOURNAL OF
THE AMERICAN MEDICAL ASSOCIATION said, "There are many mild cases
of lead poisoning in children, manifested by spasms or colic."[7]
The article pinpointed the source of the problem as window sills,
porch railings, and crib railings coated with lead paint. In
1926, an article in the AMERICAN JOURNAL OF DISEASES OF CHILDREN
said, "Lead poisoning is of relatively frequent occurrence in
children."[7]
Jane Lin-Fu, a well-known lead researcher, summarizes the early
history of childhood lead poisoning in the U.S. this way: "By the
1920s... severe forms of childhood lead poisoning were
recognized, and it became obvious that the illness was quite
common in the U.S."[7] The federal Centers for Disease Control
concurred in 1979, saying, "Lead poisoning in children from paint
was recognized early in this century."[7] But recognizing a
problem and acting upon it are two different things.
[More next week.]
==============
[1] Robert Pear, "States Called Lax on Tests for Lead in Poor
Children," NEW YORK TIMES August 22, 1999, pg. A1.
[2] Laura E. Montgomery and others, "The Effects of Poverty,
Race, and Family Structure on US Children's Health: Data from the
NHIS, 1978 through 1980 and 1989 through 1991," AMERICAN JOURNAL
OF PUBLIC HEALTH Vol. 86, No. 10 (October 1996), pgs. 1401-1405.
[3] Howard W. Mielke and Patrick L. Reagan, "Soil Is an Important
Pathway of Human Lead Exposure," ENVIRONMENTAL HEALTH
PERSPECTIVES Vol. 106, Supplement 1 (February 1998), pgs.
217-229.
[4] Institute of Medicine (U.S.) and National Institute of Public
Health (Mexico), LEAD IN THE AMERICAS (Washington, D.C. and
Cuernavaca, Morelos, Mexico: Institute of Medicine and National
Institute of Public Health, 1996), pg. 62.
[5] Jerome O. Nriagu and Jozef M. Pacyna, "Quantitative
assessment of worldwide contamination of air, water and soils by
trace metals," NATURE Vol. 333 (May 12, 1988), pgs. 134-139.
[6] Gerald Markowitz and David Rosner, "'Cater to the Children:'
The Role of the Lead Industry in a Public Health Tragedy,
1900-1955," AMERICAN JOURNAL OF PUBLIC HEALTH Vol. 90, No. 1
(January 2000), pgs. 36-46.
[7] Richard Rabin, "Warnings Unheeded: A History of Child Lead
Poisoning," AMERICAN JOURNAL OF PUBLIC HEALTH Vol. 79, No. 12
(December 1989), pgs. 1668-1674.}}
Descriptor terms:
################################################################
NOTICE
In accordance with Title 17 U.S.C. Section 107 this material is
distributed without profit to those who have expressed a prior
interest in receiving it for research and educational purposes.
Environmental Research Foundation provides this electronic
version of RACHEL'S ENVIRONMENT & HEALTH WEEKLY free of charge
even though it costs the organization considerable time and money
to produce it. We would like to continue to provide this service
free. You could help by making a tax-deductible contribution
(anything you can afford, whether $5.00 or $500.00). Please send
your tax-deductible contribution to: Environmental Research
Foundation, P.O. Box 5036, Annapolis, MD 21403-7036. Please do
not send credit card information via E-mail. For further
information about making tax-deductible contributions to E.R.F.
by credit card please phone us toll free at 1-888-2RACHEL, or at
(410) 263-1584, or fax us at (410) 263-8944.
--Peter Montague, Editor
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DUMBING DOWN THE CHILDREN--PART 2
We began this series last week with a 1999 report from the NEW
YORK TIMES which said state governments in the U.S. are refusing
to comply with a 1989 federal law requiring that children be tested
for lead poisoning. Even at low levels, lead poisoning can reduce
a child's IQ, impair hearing and stunt growth. Federal law
requires all children enrolled in the Medicaid medical insurance
program to be tested for lead poisoning at age 12 months and
again at age 2 years. The federal government pays the costs of
testing and subsequent treatment for any children found poisoned.
However, according to a 1999 study by the General Accounting
Office (GAO), an investigative arm of Congress, state governments
are simply refusing to comply with the law. As a result, the
GAO said, hundreds of thousands of children exposed to
dangerously high levels of lead are neither tested nor treated,
the TIMES reported. (See REHW #687.)
We are seeking an answer to the question, "Why would governments
set policies that continue to poison children?"
* * *
Childhood lead poisoning is not new. Medical reports of children
poisoned by lead began to appear in the U.S. in 1914. By the
1930s, a torrent of information about the problem was appearing
in medical journals.[1,2,3] Prior to World War I, one obvious
source of the problem had been clearly identified: lead-based
paint applied to the walls, toys, and furniture in children's
homes. Lead, the soft, gray toxic metal makes an excellent white
pigment (to which other colors can be added) and leaded paints
provide durable protective coatings. Nevertheless, as time
passes, leaded paint dries out and begins to peel, flake and
disintegrate into a toxic powder. As a result, toddlers can get
toxic flakes or dust on their hands, then into their
mouths.[4,5,6] Brain damage often follows.
Long before World War I this information was so widely understood
that France, Belgium and Austria restricted the use of leaded
paint in 1909. Tunisia, Greece and Australia took similar action
in 1922, the same year the Third International Labor Conference
of the League of Nations recommended a complete ban on leaded
paint for indoor use. In 1924, Czechoslovakia restricted the use
of lead paint; Great Britain, Sweden and Belgium followed suit in
1926; Spain and Yugoslavia in 1931; Cuba in 1934. The U.S. on the
other hand took no action until 1970.[3]
How did the paint and lead industries react to the information
that their products were poisoning children? Recently, as a
result of a lawsuit, many internal documents from the paint and
lead industries became public for the first time. Two historians,
Gerald Markowitz and David Rosner, have summarized some of these
documents in a remarkable history published last month in the
AMERICAN JOURNAL OF PUBLIC HEALTH.[3]
To begin with, lead paint manufacturers acknowledged -- at least
privately -- that lead was toxic. In 1921, Edward J. Cornish,
president of the National Lead Company, manufacturer of the
leading brand of lead-based paint, wrote to David Edsall, dean of
the Harvard Medical School, saying that, as a result of "50 or 60
years" of experience, paint manufacturers agreed that "lead is a
poison when it enters the stomach of man -- whether it comes
directly from the ores and mines and smelting works"1 or from the
finished forms of lead (carbonate of lead, lead oxides, and
sulfate and sulfide of lead).
As early as 1897 one paint manufacturer in New York City was
advertising that "Aspinall's Enamel is NOT made with lead and is
non poisonous."[7]
Within the paint industry, there were voices of prudence. In 1914
the director of the scientific section of the Paint
Manufacturer's Association predicted that "lead poisoning will be
done away with almost entirely"[1] because "sanitary leadless"
paints had been developed.[3] In truth, titanium and zinc
substitutes for lead paint pigments had become readily available
during the latter part of the 19th century, so there was never
any compelling need for toxic lead-based pigments. However, lead
was plentiful and profitable and its victims were not organized.
As the bad news about lead-based paint accumulated, the paint and
lead industries took the offensive by using images of children in
their advertising and sales promotions. Starting in 1907, the
National Lead Company began to promote its "Dutch Boy White Lead
Paint" using the image of a child on the label. Before 1920,
National Lead was explicitly aiming its marketing and advertising
at children. An ad in 1918 showed a little girl purchasing "Dutch
Boy White Lead Paint." The ad recommended that paint merchants
should "Cater to the children." It asked, "Have you stopped to
think that the children of today are the grown-ups of
tomorrow..." A 1920 ad -- headlined "Don't Forget the Children"
-- suggested that paint sales personnel should give gifts to
children who visited their paint store accompanied by a parent.
"Parents appreciate little attentions of this sort paid to their
children," the ad said. In 1924, National Lead began promoting
the use of lead-based paint in public schools.
The Lead Industry Association (LIA) was formed in 1928 to promote
the use of lead. At that time, lead-based paint was the single
biggest user of lead, though lead in gasoline was rising as well.
Acknowledging the poisoned-children problem, the LIA claimed it
was urging toy and furniture manufacturers to avoid lead-based
paints, but toy manufacturers who tested their products found
them contaminated with lead-based paints. Someone was lying. For
its part, National Lead -- the lead-paint industry leader -- was
aggressively marketing lead-based paint to children. For example,
the firm published a booklet for children in 1930, showing the
Dutch Boy skipping along hand-in-hand with 2 children, then
mixing white lead with colors and painting walls and furniture.
The booklet contained this jingle:
Another promotion showed a crawling infant making hand-prints on
a painted wall. The caption said, "There is no cause for worry
when fingerprint smudges or dirt spots appear on a wall painted
with Dutch Boy white-lead." Historians Markowitz and Rosner
observe, "The explicit message was that it was easy to clean the
wall; the implicit message was that it was safe for toddlers to
touch woodwork and walls covered with lead paint."
In addition to using images of children to sell lead paint,
National Lead emphasized that lead was healthy. Beginning in
1923, National Lead was advertising in NATIONAL GEOGRAPHIC that
"lead helps to guard your health." Throughout the 1920s, National
Lead advertised in MODERN HOSPITAL magazine, calling white lead
paint "the doctor's assistant." The ads assured readers that
walls covered with lead-based paint "do not chip, peel, or scale"
-- an obvious falsehood.
The Lead Industry Association (LIA) promoted lead paint in a 1930
booklet: "White lead paint is widely used for home interiors."
Accompanying illustrations showed several home interiors
freshly-painted with lead.
There were warnings against such practices from within the lead
industry. In 1933, Robert Kehoe, chief medical scientist at the
Ethyl Corporation (which was at that time busy providing millions
of tons of toxic lead to the nation's children via gasoline)
urged in the JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION that
"strenuous efforts must be devoted to eliminating lead from
[children's] environment." Kehoe was specifically referring to
lead-based paint.
Nevertheless, in 1938 the LIA began a multi-year nationwide
"White Lead Promotion Campaign." The purpose of the campaign was
to "dispel fear or apprehension" about using lead-based paint in
your home. Three years later, in 1941, the secretary of the LIA,
Felix Wormser, noted that the campaign was helping: "[I]n the
long run [the campaign] will share in dispelling anxiety about
[lead's] use. In any event the problem remains serious for our
industry. Hardly a day passes but what this office has to devote
some attention to lead poisoning," Wormser said.
In December 1943 TIME magazine reported on a medical study of
children poisoned by lead-based paint used on toys, cribs and
window sills. The result was permanently reduced IQ, with
learning disabilities, among the children.
Felix Wormser of the LIA took the offensive; in a response to the
TIME article, Wormser claimed that the connection between lead
poisoning in infancy and later mental retardation had never been
proven. For the next 15 years this was the LIA's position --
permanent injury to children from sub-lethal lead poisoning had
not been proven.
Wormser's position was scientifically indefensible in 1941.
Wormser's position was insupportable. Robert Kehoe informed the
head of the LIA that in his own work he had observed "serious
mental retardation in children that have recovered from lead
poisoning." Kehoe argued that Wormser's position was not
consistent with the available facts: "Unfortunately for Wormser's
thesis, comparable results [i.e., mental retardation] have been
obtained in almost every other area of the United States where
there have been facilities that enable accurate investigation of
this type to be made," Kehoe wrote.
By the 1950s, the lead and paint industries both acknowledged
that their products were poisoning children, and their defense
took a new turn. In its 1959 annual report the LIA noted that
"lead poisoning, or the threat of it, means thousands of items of
unfavorable publicity each year."[8]
"This is particularly true," the LIA report continued, "since
most cases of lead poisoning today are in children, and anything
sad that happens to a child is meat for newspaper editors and is
gobbled up by the public. It makes no difference that it is
essentially a problem of slums, a public welfare problem. Just
the same the publicity hits us where it hurts,"[8] the LIA report
said, clearly implying that it SHOULD make a difference that only
slum children were being poisoned.
This became the lead industry's main line of argument: lead only
harmed slum children. In 1955 the LIA's director of health and
safety went on record saying, "Childhood lead poisoning is common
enough to constitute perhaps my major 'headache,' this being in
part due to the very poor prognosis in many such cases, and also
to the fact that the only real remedy lies in educating a
relatively ineducable category of parents. It is mainly a slum
problem with us." To summarize the Lead Industry Association's
argument: The poisoning of children cannot be remedied because of
parents who live in slums and cannot be educated. In short, lead
poisoning is the parents' fault.
More next week.
Descriptor terms: lead; paint; children's health; national lead;
lead industry association; lia;
################################################################
NOTICE
In accordance with Title 17 U.S.C. Section 107 this material is
distributed without profit to those who have expressed a prior
interest in receiving it for research and educational purposes.
Environmental Research Foundation provides this electronic
version of RACHEL'S ENVIRONMENT & HEALTH WEEKLY free of charge
even though it costs the organization considerable time and money
to produce it. We would like to continue to provide this service
free. You could help by making a tax-deductible contribution
(anything you can afford, whether $5.00 or $500.00). Please send
your tax-deductible contribution to: Environmental Research
Foundation, P.O. Box 5036, Annapolis, MD 21403-7036. Please do
not send credit card information via E-mail. For further
information about making tax-deductible contributions to E.R.F.
by credit card please phone us toll free at 1-888-2RACHEL, or at
(410) 263-1584, or fax us at (410) 263-8944.
--Peter Montague, Editor
################################################################