Plumbism in Flint

A brief commentary (DC Berlinger NEJM 2016; 1101-3) provides a succinct summary of the medical story from Flint.

Historical:

  • Lead exposure has been known to be a hazard since the 1st century: Dioscorides “observed in his De Materia Medica that ‘lead makes the mind give way.'”
  • In 1723, an industrial hygiene act in the colonies prohibited the use of lead in the apparatus to distill rum due to being “unwholesom.”
  • “Water doesn’t receive as much attention as paint…but,…our word ‘plumbing’ derives from the Latin for lead, and lead poisoning is often called ‘plumbism.'”
  • The past 40 years, the U.S. has had dramatic reductions in blood lead levels.  This is “one of the cardinal public health success stories.”
  • Lead in water poses unique problems because “it rarely originates in the source water.  Rather, the problem usually lies near the point of consumption.”

“There is no safe level of lead, particularly for children”

Flint:

  • In 2014, “the city began taking its water from the Flint river rather than Lake Huron.”  This was expected to save ~$100 per day; now, the cost of repairing infrastructure is estimated to be as high as $1.5 billion.  Yet the Flint river water was “19 times as corrosive,” leading to more lead in the water.
  • The incidence of blood lead concentrations above the reference value of 5 mcg/dL rose from 2.4% to 4.9% from 2013 to 2015.  “The increase was greatest, from 4.0% to 10.6%, among children in neighborhoods with the highest lead concentrations.”
  • Disadvantaged children already are at increased risk due to houses more likely to be in poor repair.  In addition, they are at increased risk from higher levels of lead in solid/dust and lead paint.
  • “In coming years, parents will undoubtedly wonder, with anxiety and even guilt, whether their children’s every developmental stumble stems from this episode.”

My take (borrowed from author): “We have the knowledge required to redress this social crime…what we lack is the political will to do what should be done.”

Related blog post:

Gibbs Gardens

Gibbs Gardens

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