Exclusive: CDC considers lowering threshold level for lead exposure

cdc

 

The U.S. Centers for Disease Control and Prevention is considering lowering its threshold for elevated childhood blood lead levels by 30 percent, a shift that could help health practitioners identify more children afflicted by the heavy metal.

Since 2012, the CDC, which sets public health standards for exposure to lead, has used a blood lead threshold of 5 micrograms per deciliter for children under age 6. While no level of lead exposure is safe for children, those who test at or above that level warrant a public health response, the agency says.

Based on new data from a national health survey, the CDC may lower its reference level to 3.5 micrograms per deciliter in the coming months, according to six people briefed by the agency. The measure will come up for discussion at a CDC meeting January 17 in Atlanta.

But the step, which has been under consideration for months, could prove controversial. One concern: Lowering the threshold could drain sparse resources from the public health response to children who need the most help – those with far higher lead levels.

The CDC did not respond to a request for comment.

Exposure to lead – typically in peeling old paint, tainted water or contaminated soil – can cause cognitive impairment and other irreversible health impacts.

The CDC adjusts its threshold periodically as nationwide average levels drop. The threshold value is meant to identify children whose blood lead levels put them among the 2.5 percent of those with the heaviest exposure.

“Lead has no biological function in the body, and so the less there is of it in the body the better,” Bernard M Y Cheung, a University of Hong Kong professor who studies lead data, told Reuters. “The revision in the blood lead reference level is to push local governments to tighten the regulations on lead in the environment.”

The federal agency is talking with state health officials, laboratory operators, medical device makers and public housing authorities about how and when to implement a new threshold.

Since lead was banned in paint and phased out of gasoline nearly 40 years ago, average childhood blood lead levels have fallen more than 90 percent. The average is now around 1 microgram per deciliter.

Yet progress has been uneven, and lead poisoning remains an urgent problem in many U.S. communities.

A Reuters investigation published this month found nearly 3,000 areas with recently recorded lead poisoning rates of at least 10 percent, or double those in Flint, Michigan, during that city’s water crisis. More than 1,100 of these communities had a rate of elevated blood tests at least four times higher than in Flint.

In the worst-affected urban areas, up to 50 percent of children tested in recent years had elevated lead levels.

The CDC has estimated that as many as 500,000 U.S. children have lead levels at or above the current threshold. The agency encourages “case management” for these children, which is often carried out by state or local health departments and can involve educating families about lead safety, ordering more blood tests, home inspections or remediation.

Any change in the threshold level carries financial implications. The CDC budget for assisting states with lead safety programs this year was just $17 million, and many state or local health departments are understaffed to treat children who test high.

Another concern: Many lead testing devices or labs currently have trouble identifying blood lead levels in the 3 micrograms per deciliter range. Test results can have margins of error.

“You could get false positives and false negatives,” said Rad Cunningham, an epidemiologist with the Washington State Department of Health. “It’s just not very sensitive in that range.”

The CDC doesn’t hold regulatory power, leaving states to make their own decisions on how to proceed. Many have yet to adapt their lead poisoning prevention programs to the last reference change, implemented four years ago, when the level dropped from 10 to 5 micrograms per deciliter. Other states, including Virginia and Maine, made changes this year.

The U.S. Department of Housing and Urban Development is close to adopting a rule requiring an environmental inspection – and lead cleanup if hazards are found – in any public housing units where a young child tests at or above the CDC threshold.

If the CDC urges public health action under a new threshold, HUD said it will follow through. “The only thing that will affect our policy is the CDC recommendation for environmental intervention,” said Dr. Warren Friedman, with HUD’s Office of Lead Hazard Control and Healthy Homes.

To set the reference value, the CDC relies upon data from the National Health and Nutrition Survey. The latest data suggests that a small child with a blood lead level of 3.5 micrograms per deciliter has higher exposure than 97.5 percent of others in the age group, 1 to 5 years.

But in lead-poisoning hotspots, a far greater portion of children have higher lead levels. Wisconsin data, for instance, shows that around 10 percent of children tested in Milwaukee’s most poisoned census tracts had levels double the current CDC standard.

Some worry a lower threshold could produce the opposite effect sought, by diverting money and attention away from children with the worst exposure.

“A lower reference level may actually do harm by masking reality – that significant levels of lead exposure are still a problem throughout the country,” said Amy Winslow, chief executive of Magellan Diagnostics, whose blood lead testing machines are used in thousands of U.S. clinics

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Benjamin Franklin Letter On Lead Poisoning

The Famous Benjamin Franklin Letter On Lead Poisoning

Phila July 31, 1786 (To Benjamin Vaughan)

Dear Friend,
I recollect that when I had the great Pleasure of seeing you at Southampton, now a 12 month since, we had some Conversation on the bad Effects of Lead taken inwardly; and that at your Request I promise to send you in writing a particular Account of several Facts I then mentioned to you, of which you thought some good Use might be made. I now sit down to fulfil that Promise.
The first Thing I remember of this kind, was a general discourse in Boston when I was a Boy, of a Complaint from North Carolina against New England Rum, that it poisoned their People, giving them the Dry Belly ach, with a Loss of the Use of their Limbs. The Distilleries being examing on the Occasion, it was found that several of them used leaden Still-heads and Worms, and the Physicians were of the Opinion that the Mischief was occasioned by that Use of Lead. The Legislature of the Massachusetts thereupon passed an Act prohibiting under severe Penalties the Use of such Still-heads & Worms thereafter. Inclosed I send you a Copy of the Act, taken from my printed Law book.
In 1724, being in London, I went to work in the Printing-House of Mr. Palmer, Bartholomew Close as a Compositor. I there found a Practice I had never seen before, of drying a Case of Types, (which are wet in Distribution) by placing it sloping before the Fire. I found this had the additional Advantage, when the Types were not only dryed but heated, of being comfortable to the Hands working over them in cold weather. I therefore sometimes heated my Case when the Types did not want drying. But an old Workman observing it, advised me not to do so, telling me I might lose the Use of my Hands by it, as two of our Companions had nearly done, one of whom that used to earn his Guinea a Week could not then make more than ten Shillings and the other, who had the Dangles, but Seven & sixpense. This, with a kind of obscure Pain that I had sometimes felt as it were in the Bones of my Hand when working over the Types made very hot, induced me to omit the Practice. But talking afterwards with Mr. James, a Letter-founder in the same Close, and asking him if his People, who worked over the little Furnaces of melted Metal, were not subject to that Disorder; he made light of any Danger from the Effluvia, but ascribed it to Particles of the Metal swallowed with their Food by slovenly Workmen, who went to their Meals after handling the Metal, without well-washing their Fingers, so that some of the metalline Particles were taken off by their Bread and eaten with it. This appeared to have some Reason in it. But the Pain I had experienced made me still afraid of those Effluvia.
Being in Derbishire at some of the Furnaces for Smelting of Lead Ore, I was told that the Smoke of those Furnaces was pernicious to the neighboring Grass and other Vegetables. But I do not recollect to have heard any thing of the Effect of such Vegetables eaten by Animals. It may be well to make the Enquiry.
In America I have often observed that on the Roofs of our shingled Houses where Moss is apt to grow in northern Exposures, if there be any thing on the Roof painted with white lead, such as Balusters, or Frames

of dormant Windows, &c. there is constantly a streak on the Shingles from such Paint down to the Eaves, on which no Moss will grow, but the Wood remains constantly clean & free from it.–We seldom drink Rain Water that falls on our Houses; and if we did, perhaps the small Quantity of Lead descending from such Paint, might not be sufficient to produce any sensible ill Effect on our Bodies. But I have of a Case in Europe, I forgot the Place, where a whole Family was afflicted with what we call the Dry-Bellyach, or Colica Pictonum, by drinking Rain Water. It was at a Country Seat, which being situated too high to have the Advantage of a Well, was supply’d with Water from a Tank which receiv’d the Water from the leaded Roofs. This had been drank several Years without Mischief; but some young Trees planted near the House, growing up above the Roof, and shedding their Leaves upon it, it was suppos’d that an Acid in those Leaves had corroded the Lead they cover’d, and furnish’d the Water of that Year with its baneful Particles & Qualities.
When I was in Paris with Sir John Pringle in 1767, he visited La Charite, a Hospital particularly famous for the Cure of that Malady, and brought from thence a Pamphlet, containing a List of the Names of Persons, specifying their Professions or Trades, who had been cured there. I had the Curiosity to examine that List, and found that all the Patients were of Trades that some way or other use or work in Lead; such as Plumbers, Glasiers, Painters, &c. excepting only two kinds, Stonecutters and Soldiers. These I could not reconcile to my Notion that Lead was the Cause of that Disorder. But on my mentioning this Difficulty to a Physician of that Hospital, he inform’d me that the Stonecutters are continually using melted Lead to fix the Ends of Iron Balustrades in Stone; and that the Soldiers had been emply’d by Painters as Labourers in Grinding of Colours.
This, my dear friend, is all I can at present recollect on the Subject. You will see by it, that the Opinion of this mischievous Effect from Lead, is at least above Sixty Years old; and you will observe with Concern how long a useful Truth may be known, and exist, before it is generally receiv’d and practis’d on.
— I am, ever,
Yours most affectionately
B. Franklin
(Benjamin Vaughan was a youthful admirer and close friend of Franklin, who was 80 years old when he wrote to Vaughan. The letter press copy of Franklin’s communication is in the Library of Congress, the holograph not having survived. The letter is reproduced here with the original capitalization and spelling.)

Exercise for Your Best Brain Health by Pamela Costello MD PC

Exercise For Your Best brain Health

by Pamela Costello MD PC 

Holistic Neurosurgeon, Neuroscientist

“If the body be feeble, the mind will not be strong.”  Thomas Jefferson

Pam

    Exercise is a critical component of creating your best brain health. Modern day neurotoxins, including heavy metals and industrial pollutants, as well as a genetically modified and adulterated food supply, radiation, and an increasingly contaminated water supply, are all factors which have brought our brains to a low point of neurologic health. When undertaking the process of identifying and treating your neurotoxic burden, physical movement through exercise  is a key component. Your brain is under constant modification, both constructive and degenerative. This ‘plasticity’ provides us the opportunity to not only repair damage from lifelong neurotoxic burdens, but actually to improve our brain and neurologic function to a higher level, once the neurologic terrain has been detoxified and maximally supported.Exercise of all forms stimulates the brain to work at improved capacity by promoting neurons to repair and strengthen their interconnections and provide protection from oxidative stress. Scientific studies have illustrated that during exercise nerve cells release brain growth proteins known as neurotrophic factors, such as brain-derived neurotrophic factor (BDNF).BDNF triggers numerous other chemicals that promote neural health, and has a direct benefit on cognitive function. Among elementary school students, 40 minutes of daily exercise  increased IQ by an average of nearly 4 points. Among 6th graders, the fittest students scored 30 percent higher than average students. At any age, exercise serves as a powerful tool to  maximize our brain health and function. In more advanced age groups, exercise has been effective with Alzheimer’s disease, as even mild to moderate exercise can reverse normal brain shrinkage by 2 percent, effectively reversing age-related Hippocampal degeneration.  Whatever your current neurological health or physical functional level is, the healing of your brain and nervous system is best facilitated by an appropriate level of exercise. Exercise helps maintain healthy blood pressure and weight, improves circulation and lymphatic toxin drainage, strengthens the heart, increases the production of endorphins, improving energy and mood, and lowers stress and anxiety, all of which contribute to enhanced brain health and a heightened sense of wellness. Whichever exercise program you choose, commit to establishing exercise as a routine, as it is a medicine with a multitude of benefits, including achieving your best brain health.From Sean Plake, Certified Personal Trainer (www.seanplakephw.com): What is keeping you from starting an exercise program for improved health? Some people are intimidated by weights and the thought of sweat, or are unsure of their ability to participate in an exercise program. You should never feel intimidated by exercise, which is simply performing body movements at different rates. Television creates the illusion that exercise is only for ‘fit’ people, which could not be further from the truth. Exercise and movement are for EVERYONE! Exercise can be done at your local workout facility, outside at a park, in your home, and even in your office. When starting an exercise program with a qualified, Certified Personal Trainer, and after medical clearance from your physician, you should begin a program appropriate for your level of ability, and then slowly increase the intensity and volume as tolerated. You just need to start moving to see improvement of your overall mood, alertness, energy and general health! For a comprehensive brain health/neurotoxin burden evaluation and individualized treatment protocol, please contact Dr. Costello’s office at 505-503-8325 for an appointment.