With the best intentions: Lead research and the challenge to public health

American Journal of Public Health

Volumn 102, Issue 11, 2012, Pages

  Rosner, David ^a   Markowitz, Gerald ^b  

^a Department of Medicine   (United States)

^b CITY UNIVERSITY OF NEW YORK   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CHILD; ETHICS; HISTORY; HUMAN; HUMAN EXPERIMENT; LEAD POISONING; LEGAL ASPECT; MEDICAL SCHOOL; PUBLIC HEALTH; RESEARCH ETHICS; UNITED STATES;

BALTIMORE; CHILD; ETHICS, RESEARCH; HISTORY, 20TH CENTURY; HUMAN EXPERIMENTATION; HUMANS; LEAD POISONING; MARYLAND; PUBLIC HEALTH; SCHOOLS, MEDICAL;

EID: 84867497863     PISSN: 00900036     EISSN: 15410048     Source Type: Journal    
DOI: 10.2105/AJPH.2012.301004     Document Type: Article

References (61)

1. Centers for Disease Control and Prevention, "CDC Response to Advisory Committee on Childhood Lead Poisoning Prevention Recommendations in 'Low Level Lead Exposure Harms Children: A Renewed Call Primary Prevention.'" Available at http://www.cdc.gov/nceh/lead/acclpp/CDC- Response-Lead-Exposure-Recs.pdf (accessed June 6, 2012).
2. For the history of government policy and research in the past few decades, see Gerald Markowitz and David Rosner, Lead Wars: The Politics of Science and the Fate of America's Children (Berkeley: University of California Press/Milbank Fund, forthcoming).
3. See Gerald Markowitz and David Rosner, Deceit and Denial: The Deadly Politics of Industrial Pollution (Berkeley: University of California Press/Milbank Fund, forthcoming)
4. and Christian Warren, Brush With Death: A Social History of Lead Poisoning (Baltimore: Johns Hopkins University Press, 2000) for discussions of this long history.
5. Recently, a class action suit has been initiated that revives the legal struggles over this case. See K. Moisse, "Baltimore's Kennedy Krieger Institute Sued Over Lead Paint Study," ABC News With Dianne Sawyer. Available at http://abcnews.go.com/Health/Wellness/baltimores-kennedy-krieger- institute-suedlead-paint-study/story?id=14536695 (accessed June 6, 2012).
6. Court of Appeals of Maryland, Ericka Grimes v. Kennedy Krieger Institute, Inc., Myron Higgens, et al. v. Kennedy Krieger Institute, Inc., Nos. 128, 129, September term 2000, August 16, 2001, Westlaw, MD. 29, 782 A.2d 807, p. 10.
7. C. Tamber, "The Shore's Straight Shooter, Judge Dale R. Cathell Steps Down," The (Baltimore) Daily Record, July 30, 2007. Available at www.highbeam.com/doc/1P2-8984315.html (accessed July 11, 2012).
8. S. Vogel, Is It Safe?: Bisphenol A and the Struggle to Define the Risks of Chemicals (Berkeley: University of California Press, 2013).
9. A.L. Fairchild, D. Rosner, J. Colgrove, R. Bayer, and L.P. Fried, "The EXODUS of Public Health. What History Can Tell Us About the Future," American Journal of Public Health 100, no. 1 (2010): 54-63.
10. Centers for Disease Control and Prevention, "Blood Lead Levels Keep Dropping; New Guidelines Proposed for Those Most Vulnerable." Available at http://www.cdc.gov/nchs/pressroom/97news/bldlead.htm (accessed September 28, 2011).
11. Environmental Protection Agency, "Air Quality: EPA's Integrated Science Assessments, Chapter 1, Executive Summary." Available at http://oaspub.epa.gov/eims/eimscomm.getfile?p-download-id=505107 (accessed March 12, 2012).
12. R.L. Jones, D.M. Homa, P.A. Meyer, et al. "Lead Testing Among US Children Aged 1 to 5 Years, 1988-2004," Pediatrics 123, no. 3 (2009): e376-e386. Available at http://pediatrics.aappublications.org/content/123/3/ e376.full (accessed June 8, 2012).
13. B.P. Lanphear, "Editorial: The Conquest of Lead Poisoning: A Pyrrhic Victory," Environmental Health Perspectives 115, no. 10 (2007): A484-A485.
14. E. Fee, "Public Health in Practice: An Early Confrontation With the 'Silent Epidemic' of Childhood Lead Paint Poisoning," Journal of the History of Medicine and Allied Sciences 45, no. 4 (1990): 570-606.
15. Ericka Grimes v. Kennedy Krieger Institute, Inc.; Myron Higgins, a minor, etc., et al. v. Kennedy Krieger Institute, Inc., Court of Appeals of Maryland, No. 128 (September 2000); Opinion by J. Cathell, para 219 (August 16, 2001).
16. Medical Record of J.T. Johns Hopkins Hospital, Harriet Lane Home for Invalid Children, Rec. No. A-14795 (May 21, 1940 through July 20, 1943),Medical Records Department.
17. In January 2012 the CDC's Lead Advisory Committee recommended that the level of concern for lead poisoning in children be reduced from 10 to 5 mcg per dL of blood, which would make Joseph's blood lead level nearly 80 times that standard.
18. Baltimore Health Department, Radio Broadcast (October 15, 1935), Health Department Archives. 20.
19. See the first of many studies by J. Lockhardt Gibson, "A Plea for Painted Railings and Painted Walls of Rooms as the Source of Lead Poisoning Amongst Queensland Children," Australasian Medical Gazette 23 (1904): 149-153.
20. Public health also faced internal crises that did not help its cause. The swine flu vaccination program, organized during the administration of Gerald Ford as a national effort to protect the population from a perceived potential epidemic, was broadly considered a fiasco when the disease failed to appear. Many see this moment as a cause of the decline in public health authority, but it must be put into a larger historical perspective. See Richard Neustadt and Harvey Fineberg, The Epidemic That Never Was: Policy-Making and the Swine Flu Scare (New York: Vintage Books, 1983).
21. US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (Atlanta, GA: Strategic Plan for the Elimination of Childhood Lead Poisoning, 1991).
22. H.L. Needleman, "What Is Not Found in the Spreadsheets," Neurotoxicology and Teratology 24 (2002): 460.
23. US Department of Health and Human Services, "Strategic Plan for the Elimination of Childhood Lead Poisoning."
24. Needleman, "What Is Not Found in the Spreadsheets," 461.
25. Ericka Grimes, 2000 29, 782 A.2d 807, p. 10.
26. "Final Report, Quality Assurance Project Plan for the Kennedy Krieger Institute Lead-Based Paint Abatement and Repair and Maintenance Study," to EPA (July 22, 1992).
27. "Third-Year Renewal: RPN No. 91-05-02-01, Lead-Paint Abatement and Repair and Maintenance Study in Baltimore," received by Joint Committee on Clinical Investigation, Johns Hopkins University (April 21, 1995).
28. R.M. Nelson, "Appropriate Risk Exposure in Environmental Health Research: The Kennedy-Krieger Lead Abatement Study," Neurotoxicology and Teratology 24 (2002): 445-449.
29. Susan Boyce for KKI, "Memorandum of Points and Authorities in Support of Motion to Dismiss," in Circuit Court for Baltimore City, February 22, 2000 (Exhibit 2 in Wallace v. KKI), pp. 8, 10-11 [italics in original].
30. "Official Transcripts of Proceedings," Baltimore, MD, "In the Circuit Court of Baltimore City Maryland Before Honorable Allen L. Schwait," in Myron Higgins et al., Plaintiffs v. Lawrence Polakoff, Defendant, Case No. 95066067/CL 193461 in Court of Appeals of Maryland (April 5, 2000).
31. For a detailed discussion of the consent form and the controversies around it, see Markowitz and Rosner, Lead Wars.
32. "Official Transcripts of Proceedings," April 5, 2000.
33. Suzanne Shapiro of Kerpelman and Assoc., Appeal to Court of Special Appeals of Maryland. In Myron Higgins, a Minor, etc., et al. Appellants v. Kennedy Krieger Institute, Inc., et al., Appellees. Appeal From the Circuit Court for Baltimore City Brief of Appellants and Joint Record Extract (January 17, 2001).
34. S. Reverby, Examining Tuskegee: The Infamous Syphilis Study and Its Legacy (Chapel Hill: University of North Carolina Press, 2009);
35. James Jones, Bad Blood: The Tuskegee Syphilis Experiment (New York: Free Press, 1993).
36. "Supplemental Brief of Appellee," Court of Appeals of Maryland, September Term, 2000," No. 129.
37. Myron Higgins, a Minor, etc., et al. Appellants v. Kennedy Krieger Institute, Inc., et al., Appellees. Appeal From the Circuit Court for Baltimore City Brief of Appellants and Joint Record Extract (ca. June 2001).
38. "Oral Arguments Taken in Reference to 'In re: Myron Higgins,'" State of Maryland, Court of Appeals, p. 3 (July 10, 2001).
39. Jonathan Bor, "Kennedy Krieger Doctor Defends Lead Paint Study," Baltimore Sun, August 18, 2001, 1-B.
40. J. Biemer, "Maryland's Highest Court Scolds Researchers in Lead Paint Study," USA Today, August 21, 2001. Available at http://www.usatoday. com/news/nation/2001/08/21/lead-paint.htm (accessed June 22, 2009).
41. T. Lewin, "U.S. Investigating Johns Hopkins Study of Lead Paint Hazard," New York Times, August 24, 2001, A-11.
42. M. Roig-Franzia, "'My Kids Were Used as Guinea Pigs,'" Washington Post, August 25, 2001, A-1;
43. Tom Scocca, "Test Case: Hopkins Arm Sued Over Lead-Paint Study," Baltimore City Paper, August 8, 2001. Available at http://www.citypaper.com/printStory.asp?id=4810 (accessed June 5, 2009);
44. Bor, "Kennedy Krieger Doctor Defends Lead Paint Study."
45. D.C. Bellinger and K. Dietrich, "Ethical Challenges in Conducting Pediatric Environmental Health Research: Introduction," Neurotoxicology and Teratology 24 (2002): 443.
46. G. Young, "Lead Paint Suit Breaks New Ground, Sparks Government Investigation," National Law Journal 28 (September 3, 2001): B-1.
47. "Baltimore's Lawsuit Over Children Being Exposed to Lead in Johns Hopkins University Study," NPR, All Things Considered, August 27, 2001. Available at http://www.highbeam.com/doc/1P1-49225418.html (accessed June 22, 2009).
48. J. Kaiser, "Human Subjects: Court Rebukes Hopkins for Lead Paint Study," Science 293 (August 31, 2001): 1569. The popular press was sometimes damning of the court decision.
49. See "The Judge Went Too Far," Editorial, Washington Post, September 29, 2001, A26.
50. For an informative discussion of the differences between the Tuskegee and other studies, see Amy Fairchild and Ronald Bayer, "The Uses and Abuses of Tuskegee," Science 284 (May 7, 1999): 919-921.
51. P. Mushak, "Studies of Pervasive Toxic Contaminants in Children: Staying the Ethical Course." Neurotoxicology and Teratology 24 (2002): 463.
52. T. Williams, "Racial Bias Seen in Study of Lead Dust and Children," New York Times, September 16, 2011, A11.
53. National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, "Report and Recommendations: Research Involving Children," DHEW Publication No. OS 77-0004, September 1977. Available at http://www.bioethics.gov/reports/past-commissions/Research-involving-children. pdf (accessed June 25, 2009).
54. D. Rosner and G. Markowitz, "Industry Challenges to the Principle of Prevention in Public Health: The Precautionary Principle in Historical Perspective," Public Health Reports 117, no. 6 (2002): 501-512.
55. Needleman, "What Is Not Found in the Spreadsheets," 459-460 [italics in original].
56. Ibid., 460. See also Laura Stark, Beyond Closed Doors: IRBs and the Making of Ethical Research (Chicago: University of Chicago Press, 2011).
57. Needleman, "What Is Not Found in the Spreadsheets," 461.
58. See Sherry L. Dickson, David E. Jacobs, Jonathan W. Wilson, Judith Y. Akoto, Rick Nevin, and C. Scott Clark, "Window Replacement and Residential Lead Paint Hazard Control 12 Years Later," Environmental Research 113 (2012): 14-20.
59. See Jessica Leighton, Susan Klitzman, Slavenka Sedlar, Thomas Matte, and Neal Cohen, "The Effect of Lead-Based Paint Hazard Remediation on Blood Lead Levels of Lead Poisoned Children in New York City," Environmental Research 92 (2003): 182-190.
60. In Nigeria, China, and elsewhere, acute lead poisoning is still a major tragedy. See "Human Rights Watch, Nigeria: Child Lead Poisoning Crisis," February 7, 2012. Available at http://www.hrw.org/news/2012/02/07/ nigeria-child-leadpoisoning-crisis (accessed June 6, 2012).
61. Since the 1970s the issue of the relative responsibilities of the individual, the government, and society for controlling chronic disease has been the source of a critical debate among policymakers, ethicists, and public health practitioners, stimulated in part by the appearance of Marc Lalonde's 1974 report "A New Perspective on the Health of Canadians" (Ottawa, Canada: Department of National Health and Welfare).