The ethics of pediatric lead studies
March 1, 2013, 9:41 pm
In the current (March 21, 2013) issue of the New York Review of Books, Helen Epstein reviews the forthcoming book Lead Wars: The Politics of Science and the Fate of America’s Children by Gerald Markowitz and David Rosner. In the review, Epstein discusses the marketing of lead paint in the United States during the early and mid-twentieth century, as well as the important legal case of Grimes v. Kennedy Krieger Institute.
As Epstein notes, by the time of the Great Depression public health experts knew that ingestion of lead paint chips frequently caused pediatric lead poisoning. At that time, many European nations stopped using interior lead paint. Kin the United States, however, the Lead Industries Association fought attempts to ban their products, including leaded gasoline, plumbing fixtures, candy wrappers, and cake decorations. While some products were withdrawn from the marketing the 1950s, lead paint was available until banned by Congress in 1978.
However, lead paint remained in many homes, especially in disadvantaged communities, where it continued to produce dust that filled the air and settled onto floors and carpeting. Windows presented a particular danger — opening and closing them was very effective in spreading lead dust.
In the early 1990s, the Johns Hopkins-affiliated Kennedy Krieger Institute (KKI0— in association with the US Environmental Protection Agency — carried out a study to determine the most efficient (translation: cheapest) way to remove lead from homes. Parents of young children were encouraged to rent housing that was likely to be contaminated with lead. These units were then subjected to 1 of 3 different procedures for lead abatement, only 1 of which included replacement of windows — an intervention that was known to be necessary for best results. The main study outcome was the kids’ blood lead levels.
There has been considerable controversy over the ethics involved in the design of this study (for a good discussion of this controversy, click here). However, there have also been allegations of shoddy informed consent procedures, and less-than-timely disclosure of blood lead level results to parents. In 2000, mothers of 2 of the children involved in the study sued KKI. A lower court threw out the suit, but on appeal it was reinstated and an undisclosed settlement was reached. There is now a class-action suit brought on behalf of other subjects.
I had not been aware of the KKI study, and found Epstein’s review quite interesting. I am looking forward to reading Lead Wars.
Those interested in this topic may also want to look at Kevin Drum’s recent article in Mother Jones suggesting that toxicity from lead in gasoline may do much to explain the change in crime rates over the last 50 years.