Flint, Michigan recently declared a “State of Emergency” in the wake of lead contaminated drinking water. As a result, we are once again faced with the age-old discussion regarding the health implications of lead accumulation. We know that protecting all people from lead exposure is extremely important to lifelong good health. Children, however, are particularly vulnerable to the harmful effects of lead because they absorb lead much more readily than adults. The current controversy over treatment revolves around three questions:
Who should be considered at higher risk for harm and offered treatment?
What treatments should be offered to individuals with elevated lead levels?
At what blood lead level burden is it appropriate to start therapy?
Unfortunately, this tragedy goes far beyond Flint, Michigan. People worldwide continue to be exposed to potentially harmful levels of many toxic metals that can profoundly affect their health. They face potentially enduring, serious and complicated health issues. Perhaps the major question, especially in children, is the level of lead in the blood to cause concern.
The CDC states, “Experts now use a reference level of 5 micrograms per deciliter to identify children with blood lead levels that are much higher than most children’s levels. This new level is based on the U.S. population of children ages 1-5 years who are in the highest 2.5% of children when tested for lead in their blood. In the past, blood lead level tests below 10 micrograms per deciliter of lead in blood may, or may not, have been reported to parents. The new lower value means that more children will likely be identified as having lead exposure allowing parents, doctors, public health officials, and communities to take action earlier to reduce the child’s future exposure to lead.”
The CDC also states, “What has not changed is the recommendation for when medical treatment is advised for children with high blood lead exposure levels. The new recommendation does not change the guidance that the therapy used to eliminate lead from the body be considered only when a child has been tested with a blood lead test result greater than or equal to 45 mcg/dL.” [http://www.cdc.gov/nceh/lead/ACCLPP/blood_lead_levels.htm]
However, medical science has determined that even very low blood lead levels in children can affect IQ, ability to pay attention and future academic achievement. It is now clear that IQ loss in lead-exposed children can occur at levels below 5.0 mcg/dL. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2212280/, from Neurotoxicology, 2006 Sep; 27(5): 693–701.
The American College for Advancement in Medicine (ACAM), an educational organization and a leading authority in the field of heavy metal toxicity and treatment believes, as the CDC does, that “no safe blood lead level in children has been identified.” The effects of lead exposure on child cognitive development and behavior may be permanent if no intervention occurs. Experts from ACAM believe that certain interventions may be useful in lessening the symptoms and long-term neurocognitive damage that lead causes in children.
ACAM experts also contend that the myriad, harmful effects that lead can cause in other organ systems in people of any age should also be lessened. The original guidelines for intervention in lead poisoning were based on early FDA drug approval studies from the minimal research conducted in pediatric patients with blood lead levels above 45 mcg/dL. ACAM believes that appropriate medical intervention may be beneficial to those suffering from lead levels even at the current CDC cutoff of 5 mcg/dl, the level that places the child in the upper 2.5% of tested individuals.
Due to the lack of current, cohesive, long-term studies in children with elevated blood levels below 45 mcg/dL, the decision when to initiate chelation therapy is a personal choice between a patient and their physician. To better elucidate what is the best treatment strategy for lead poisoning, ACAM is calling for the immediate initiation of a collaborative long-term research project. The project, conducted through appropriate channels, could provide immediate medical attention and intervention to all children and adults in Flint who have high blood lead levels (>5 mcg/dl). This research project should also investigate assessing those common genetic and metabolic defects that could render individuals even more susceptible to the harmful effects of lead.
We can take a more proactive approach to prevent permanent damage and disability not only in the population of Flint, MI but to everyone exposed to the potential devastation caused by lead.