Monday, January 25, 2016

Get the lead out

For instance, in Troy, which is about a 45 minute drive from Flint, the 90th percentile reading for lead in 2013 was 1.1 part per billion (ppb). For Detroit, it was 2.3 ppb, a bit higher, but still well below the EPA level for concern of 5 ppb.

In comparison, for Flint the 90th percentile was 27 ppb:
At 27 parts per billion, it’s five times as high as the level of concern, and nearly twice as high as the EPA’s already-generous guidelines. According to the researchers who ran these tests, the health effects of lead levels this high “can include high blood pressure and other cardiovascular problems, kidney damage and memory and neurological problems.” 
Recall, though, that 10 percent of the homes in the sample had lead levels even higher than this. Here’s the highest lead reading in that sample, from a home in the city’s 8th Ward: 
          158 ppm
That’s more than 10 times the EPA limit. It’s 30 times higher than the 5 ppb reading that can indicate unsafe lead amounts.
          But that 158 ppb reading is far from the worst one that turned up in Flint, unfortunately. In
          the spring of 2015, city officials tested water in the home of LeeAnne Walters, a stay-at-
          home mother of four and a Navy wife. They got a reading of 397 ppb, an alarmingly high
But it was even worse than that. Virginia Tech’s team went to Walters’ house to verify those numbers later in the year. They were concerned that the city tested water in a way that was almost guaranteed to minimize lead readings: They flushed the water for several minutes before taking a sample, which often washes away a percentage of lead contaminants. They also made residents collect water at a very low flow rate, which they knew also tended to be associated with lower readings. 
So the Virginia Tech researchers took 30 different readings at various flow levels. What they found shocked them: The lowest reading they obtained was around 200 ppb, already ridiculously high. But more than half of the readings came in at more than 1,000 ppb. Some came in above 5,000 — the level at which EPA considers the water to be “toxic waste.” 
The highest reading registered at 13,000 ppb. 
The professor who conducted the sampling, Dr. Marc Edwards, was in “disbelief.” 
“We had never seen such sustained high levels of lead in 25 years of work,” he said. 
According to Edwards, the team retested the water with extra quality controls and assurance checks, and obtained the exact same results.
When I decided to write this, I realized that our readers might question why this would be an appropriate topic for science-based medicine. After all, the effects of lead poisoning are very well known. Lead can result in developmental delay, decreased IQ, decreased hearing, and ADHD. The children of Flint who were affected with this will likely have behavioral problems, and lead exposure has even been linked to violent crime.

Besides outrage, what motivated me to write was a desire to point out how SBM interfaces with public health in ways not involving vaccines. Science-based water treatment is science-based medicine through its effects on public health, and, arguably even more so than vaccination policy, is a product of politics, which can lead to disasters like this. Everybody knows that clean, uncontaminated water is important for the health of the people using it. What’s not so well known is how difficult it is to produce. For instance, before this crisis, I did know that our state had an aging infrastructure. I was not, however, aware of how widespread lead pipes still are in city water supplies. Even though my bachelor’s degree was in chemistry before I went to medical school, I was still also blissfully unaware of the chemistry of water treatment, because that’s a rather specialized field of applied chemistry. I had no idea that there would be a big difference in the ability of water to leach lead from lead pipes depending on its salt concentration and pH, much less what needs to be done to prevent it from doing so.Here’s the even bigger kicker. Even using the Flint River water, the City of Flint could have prevented the corrosion of its copper and lead pipes relatively inexpensively:
Marc Edwards, a professor at Virginia Tech who has been testing Flint water, says treatment could have corrected much of the problem early on — for as little as $100 a day — but officials in the city of 100,000 people didn’t take action.
It’s not clear whether incompetence or saving money was the imperative here. Whatever the reason, the city failed to treat the Flint River water, leaving it corrosive and able to leach lead and copper from the aging pipes used to transport it. As a consequence, an as-yet unknown number of children have been poisoned with lead, which is most damaging to the developing brain. This is all straightforward science. We know what levels of lead are safe and what levels are not. We know what the effects of lead poisoning are in children. We know how to prevent them. Chemists specializing in water purification know that corrosive water placed in old copper and lead pipes will leach lead and copper out of them. They even know how to treat the water to prevent this leaching! Yet that wasn’t done.

Now we will now be forced to use science-based medicine to treat potentially thousands of children for lead poisoning and science to try to fix the problems caused by this colossal failure of science-based public policy. Worse, it’s still going on, as The Guardian just reported on Friday that water authorities across the US are systematically distorting water tests to downplay the amount of lead in samples.

As I think about that, seeing the Governor throwing mid-level bureaucrats under the bus and other politicians saying that the Flint water crisis is a hoax does not give me confidence in how this crisis will ultimately turn out or that the aging infrastructure that allows such a catastrophe to occur will be fixed any time soon.


  1. Flint, Michigan-based Hurley Medical Center was targeted with a cyber attack this past week, soon after the hacktivist group Anonymous released a video promising "justice" for the city's ongoing water crisis.

    The attack was confirmed by the hospital Jan. 21.

    "Hurley Medical Center has IT systems in place, which aid in detecting a virus or cyber attack," spokeswoman Ilene Cantor said, according to MLive. "As such, all policies and protocols were followed in relation to the most-recent cyber attack on our system. Patient care was not compromised and we are closely monitoring all systems to ensure IT security is consistently maintained."

    Anonymous' posted a video online launching what it dubbed the #OpFlint campaign.

    While the attack closely followed the release of the video, there's no confirmation that Anonymous is responsible for the Hurley Medical Center breach.

    If so, however, it wouldn't be the first time the group has been connected to a hospital hack. In April 2014, Boston Children's Hospital was targeted with multiple DDoS and phishing attacks, reportedly orchestrated by Anonymous members angry about the controversial child custody case of Justina Pelletier, who was then being held at Boston Children's against the wishes of her parents.

    Those attacks, "designed to bring down the site by overwhelming its capacity," according to a hospital spokesperson, lasted for days.

  2. Michigan Gov. Rick Snyder says 89 percent of water samples collected from key locations in Flint measured below the “action level” of 15 parts per billion for lead in an initial round of testing, but concerns remain.

    Samples from the “sentinel” sites will help determine when it is safe to drink unfiltered water again. Snyder says the results are a “start” but “it’s not time to draw conclusions.”

    Snyder told reporters Monday that 11 percent of 175 samples exceeded the action levels, including five homes above 100 parts per billion of lead.

    The data is being collected over the next seven weeks.

    Utilities are required to show water from customers’ taps does not exceed the action level in at least 90 percent of homes sampled.

  3. With half a million young children nationwide known to have blood-lead levels as high as those recorded during the ongoing crisis in Flint, MI, neurologists are being urged to consider and, when appropriate, test for the toxic metal in the process of reaching a differential diagnosis...

    For all the attention that Flint has drawn, however, the incidence of elevated blood-lead levels found there is no higher than that seen in some other states and communities across the United States, according to data compiled by the Centers for Disease Control and Prevention (CDC) and the Michigan Department of Health and Human Services.

    The proportion of children between the ages of 1 and 5 found to have a blood-lead level equal to or higher than the current reference value of 5 micrograms per deciliter (μg/dL) was just below the national average of 2.5 percent in the first quarter of 2015, before peaking at 6 percent in the third quarter of that year, the Michigan Department of Health and Human Services reported. By the last quarter of the year, the proportion had already dropped back down to below 3 percent.By comparison, 27.8 percent of all children between the ages of 1 and 5 in the state of Iowa had a blood-lead level between 5 and 10 μg/dL in 2012, the most recent year for which data are available, according to the CDC. In New Hampshire that same year, 11.6 percent of young children had elevated blood-lead levels, while in Mississippi the figure was 8.4 percent.

    In all, the CDC estimated in a 2013 paper that 2.6 percent of all US children aged 1 to 5, totaling 535,000, had blood-lead levels at or above the upper reference value of 5 μg/dL...

    Far from downplaying the significance of the blood-lead levels seen in Flint, experts who specialize in lead exposure say it highlights the need for renewed attention to the toxin's continuing dangers to children across the United States, particularly among poor minorities living in older homes where the remnants of lead paint can still be found...

    In an interview with Neurology Today, Dr. Bellinger called on physicians to get past the notion that lead toxicity was a problem of the 20th century.“There is a widespread feeling among many physicians that the lead problem was solved,” he said. “Certainly we've made great progress in bringing down blood-lead levels. But it's reached the point where doctors no longer check for it or even consider it. They have to remember the value of taking a good history to learn about a child's living circumstances.”Dr. Bellinger emphasized that for any child referred to a neurologist for learning, emotional, or behavioral issues, a careful history should be taken and a blood-lead test considered, particularly if the child is an African-American living in a poor neighborhood...

    Today, the cognitive, emotional, and behavioral effects of childhood lead exposure, including reduced IQ and significantly increased risk of hyperactivity, continue to be studied. Studies by Dr. Schwartz, for instance, have shown that higher lead levels measured in the bones of adults aged 50 to 70 are associated with a progressive decline in eye-hand coordination and impaired cognitive function.Studies by Kim Dietrich, PhD, a professor and director of epidemiology and biostatistics in the department of environmental health at the University of Cincinnati, have shown that elevated lead levels during infancy and childhood are associated with slightly decreased brain volume, and that prenatal and childhood blood lead exposures are associated with juvenile delinquency and criminal arrests in early adulthood.

  4. Federal officials said on Thursday it is safe for anyone to drink properly filtered water in Flint, Michigan, where a public health crisis erupted after residents were exposed to dangerously high levels of lead.

    The U.S. Environmental Protection Agency (EPA) said in a statement that the most recent testing at nearly 50 locations in the city showed lead levels far below the levels considered dangerous.

    But the city's mayor said some homes in Flint cannot be fitted with filters, so bottled water is still needed.

    Flint, with a population of about 100,000, was under control of a state-appointed emergency manager in 2014 when it switched its water source from Detroit's municipal system to the Flint River to save money. The city switched back in October.

  5. Once-Discounted Flint Physician Heads Lead Poisoning Response

    Pediatrician Mona Hanna-Attisha, MD, MPH, is a champion for Flint, Michigan, and its 100,000 residents beleaguered by lead-contaminated drinking water. Dr Hanna-Attisha leads a multidisciplinary task force that seeks to blunt the harm done to children there. This group, called the Pediatric Public Health Initiative, is looking beyond the immediate problem of safe drinking water and focusing on the "tomorrow problem," as Dr Hanna-Attisha puts it, of lead's neurotoxic effects on young children and their budding brains. As a mother of two young daughters and the wife of a pediatrician, Dr Hanna-Attisha can empathize with Flint parents whose young children have been exposed to unhealthy levels of lead. "In my clinic today, you could see the fear and trauma in their eyes," she said. "They don't know what tomorrow will bring." Dr Hanna-Attisha brings many qualifications to her job, and not just her medical resume. As a high schooler, she worked to shut down a trash-burning incinerator in her town that was triggering asthma. "I guess I have always known the power of people," she said. Dr Hanna-Attisha was named one of Time magazine's most influential people of 2016.

  6. About this same time, Dr Hanna-Attisha started investigating the lead issue. She compared medical records of children treated at Hurley Medical Center before September 2013 with those treated in 2015 through September 15. The percentage of children with elevated blood-lead levels (5 μg/dL or higher) had nearly doubled, increasing from 2.1% before September 2013 to 4% in 2015. In some neighborhoods, the percentage of children testing positive for elevated lead levels topped 6%. She came out with her findings in late September 2015 (revised figures released in December 2015 revealed the lead problem to be even worse).

    At first, Michigan officials challenged the pediatrician's original analysis, saying her numbers did not match theirs. One state regulator was quoted as calling her warnings about lead poisoning "unfortunate."

    "As a scientist, you trust your data," Dr Hanna-Attisha said. "When [a] state team of epidemiologists tells you you're wrong, it's hard not to second-guess yourself. It's emotionally jarring."

    She stood her ground, however, and in early October, the Michigan Department of Health and Human Services announced it had taken a second look at its data on blood lead levels among Flint children. Its conclusion? The agency detected the same spike Dr Hanna-Attisha had.

    With that admission, state and local officials began treating Flint's drinking water as a public health crisis. The city switched back to Detroit's water system that month, which lowered lead levels in tap water, but did not bring them back to normal, said Dr Hanna-Attisha. In January, Governor Rick Snyder declared a state of emergency in Flint and ordered the National Guard to distribute bottled water and lead filters. Obama followed suit with his own declaration of emergency last week, mobilizing federal assistance under the direction of the US Department of Health and Human Services.