Ethical Issues in Using Children's Blood Lead Levels As a Remedial Action Objective

Overview

Journal Am J Public Health

Specialty Public Health

Date 2011 Aug 13

PMID 21836120

Citations 3

Authors

Sue M Moodie

Emily Lorraine Evans

Affiliations

Soon will be listed here.

Abstract

The Environmental Protection Agency measures the success or failure of Superfund site remediation efforts against remedial action objectives (RAOs). RAOs are frequently based on environmental contaminant concentrations, but with lead exposure, blood lead levels from the population at risk are often used. Although childhood lead screening is an important public health tool, an RAO based on child blood lead levels raises ethical concerns: public health efforts that are more reactive than preventive, a blood lead standard (10 μg/dL) that may not be fully protective, the use of a measure whose validity and reliability may be easily compromised, and exacerbation of environmental injustice and systematic disadvantages. The example of Bunker Hill mine, Kellogg, Idaho, allowed an examination of these ethical concerns.

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References

Rao R, Henriques W, Spengler R, Lee C . Geographic distribution of mean blood lead levels by year in children residing in communities near the Bunker Hill lead smelter site, 1974-1983. J Public Health Manag Pract. 1999; 5(2):13-4. View

Heckman J . The economics, technology, and neuroscience of human capability formation. Proc Natl Acad Sci U S A. 2007; 104(33):13250-5. PMC: 1948899. DOI: 10.1073/pnas.0701362104. View

DeRosa C, Choudhury H, Peirano W . An integrated exposure/pharmacokinetic based approach to the assessment of complex exposures. Lead: a case study. Toxicol Ind Health. 1991; 7(4):231-48. DOI: 10.1177/074823379100700401. View

Hornung R, Lanphear B, Dietrich K . Age of greatest susceptibility to childhood lead exposure: a new statistical approach. Environ Health Perspect. 2009; 117(8):1309-12. PMC: 2721877. DOI: 10.1289/ehp.0800426. View

Ryan M . The politics of risk: a human rights paradigm for children's environmental health research. Environ Health Perspect. 2006; 114(10):1613-6. PMC: 1626442. DOI: 10.1289/ehp.9002. View

Miranda M, Kim D, Galeano M, Paul C, Hull A, Morgan S . The relationship between early childhood blood lead levels and performance on end-of-grade tests. Environ Health Perspect. 2007; 115(8):1242-7. PMC: 1940087. DOI: 10.1289/ehp.9994. View

Braun J, Froehlich T, Daniels J, Dietrich K, Hornung R, Auinger P . Association of environmental toxicants and conduct disorder in U.S. children: NHANES 2001-2004. Environ Health Perspect. 2008; 116(7):956-62. PMC: 2453167. DOI: 10.1289/ehp.11177. View

von Lindern I, Spalinger S, Bero B, Petrosyan V, von Braun M . The influence of soil remediation on lead in house dust. Sci Total Environ. 2003; 303(1-2):59-78. DOI: 10.1016/s0048-9697(02)00356-x. View

Boreland F, Lyle D . Using performance indicators to monitor attendance at the Broken Hill blood lead screening clinic. Environ Res. 2009; 109(3):267-72. DOI: 10.1016/j.envres.2008.11.009. View

10.

Simon D, Maynard E, Thomas K . Living in a sea of lead--changes in blood- and hand-lead of infants living near a smelter. J Expo Sci Environ Epidemiol. 2006; 17(3):248-59. DOI: 10.1038/sj.jes.7500512. View

11.

Landrigan P, Baker Jr E, Feldman R, Cox D, Eden K, Orenstein W . Increased lead absorption with anemia and slowed nerve conduction in children near a lead smelter. J Pediatr. 1976; 89(6):904-10. DOI: 10.1016/s0022-3476(76)80594-x. View

12.

Dietrich K, Ware J, Salganik M, Radcliffe J, Rogan W, Rhoads G . Effect of chelation therapy on the neuropsychological and behavioral development of lead-exposed children after school entry. Pediatrics. 2004; 114(1):19-26. DOI: 10.1542/peds.114.1.19. View

13.

Liu X, Dietrich K, Radcliffe J, Ragan N, Rhoads G, Rogan W . Do children with falling blood lead levels have improved cognition?. Pediatrics. 2002; 110(4):787-91. DOI: 10.1542/peds.110.4.787. View

14.

Needleman H . Low level lead exposure and the development of children. Southeast Asian J Trop Med Public Health. 2005; 35(2):252-4. View

15.

Guilarte T . Prenatal lead exposure and schizophrenia: a plausible neurobiologic connection. Environ Health Perspect. 2004; 112(13):A724. PMC: 1247541. DOI: 10.1289/ehp.112-a724a. View

16.

von Lindern I, Spalinger S, Petroysan V, von Braun M . Assessing remedial effectiveness through the blood lead:soil/dust lead relationship at the Bunker Hill Superfund Site in the Silver Valley of Idaho. Sci Total Environ. 2003; 303(1-2):139-70. DOI: 10.1016/s0048-9697(02)00352-2. View

17.

Dietrich K, Ris M, Succop P, Berger O, Bornschein R . Early exposure to lead and juvenile delinquency. Neurotoxicol Teratol. 2002; 23(6):511-8. DOI: 10.1016/s0892-0362(01)00184-2. View

18.

Rogan W, Dietrich K, Ware J, Dockery D, Salganik M, Radcliffe J . The effect of chelation therapy with succimer on neuropsychological development in children exposed to lead. N Engl J Med. 2001; 344(19):1421-6. DOI: 10.1056/NEJM200105103441902. View

19.

Zuckerman B, Halfon N . School readiness: an idea whose time has arrived. Pediatrics. 2003; 111(6 Pt 1):1433-6. DOI: 10.1542/peds.111.6.1433. View

20.

Opler M, Buka S, Groeger J, McKeague I, Wei C, Factor-Litvak P . Prenatal exposure to lead, delta-aminolevulinic acid, and schizophrenia: further evidence. Environ Health Perspect. 2008; 116(11):1586-90. PMC: 2592283. DOI: 10.1289/ehp.10464. View