Must-read article: America’s Misguided War on Childhood Lead Exposures

March 23, 2018, 12:58 am

Photo: shutterstock/jamie hooper

Very soon, the Centers for Disease Control and Prevention “reference level” for blood lead concentration will be lowered from 5 μg/dL to 3.5 μg/dL. As Charles Schmidt  explains in his superb well-researched article “America’s Misguided War on Childhood Lead Exposures” just published by Undark Magazine, there are several crucially important things to realize about this change:

  1. This impending lowering of the reference lead level is the latest in a long series. The reference level was 40 μg/dL until it was lowered to 10 μg/dL in 1999. The last decree was to 5 μg/dL in 2012.
  2. The reference level is not really a clinical standard or predictor of significant lead toxicity. It is mean to indicate that the child should enter a lead case management program involving, among other things, analysis of the child’s home environment and institution of abatement measures as needed.
  3. At this point the “reference level” is determined by statistics, not clinical evidence. Every 4 years population data is reevaluated, and the level readjusted to the point where 97.5% of children have lead levels below the standard. (Note that a corollary of this procedure is that the more successful we are at lowering lead levels in the population, the lower the reference level will go. At all times, 2.5% of children will be deemed in need of case management. This is truly a toxicological protocol worthy of Sisyphus.)
  4. The lowering of the reference lead level to 3.5 μg/dL will make hundreds of thousands additional children eligible for case management in a system that is already overburdened and under-resourced, without any proof that this change would result in improved health or do anything except alarm families.
  5. Dr. Kim Dietrich — the only person on the CDC’s 16-member expert panel to vote against lowering the reference level — claims in the article that most labs can not accurately measure lead levels as low as 3.5 μg/dL.
  6. Many pediatricians are not well-versed in the nuances of interpreting lead levels, and do not realize that the reference level is a marker of lead exposure, not an indicator of lead toxicity.

This article is essential reading for all pediatricians, emergency practitioners, and toxicologists.

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