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THIS IS THE STORY of the most important and emblematic environmental and public health disaster of this young century. More bluntly, it is the story of a government poisoning its own citizens, and then lying about it. It is a story about what happens when the very people responsible for keeping us safe care more about money and power than they care about us, or our children.
we pediatricians are at the pivotal intersection of clinical care and prevention. Every aspect of my job—from immunizations to emphasizing the importance of bike helmets—is not just about ensuring kids are healthy today. It’s about tomorrow, next year, and twenty years from now. We see life at its beginning, when it can be shaped for good. As Frederick Douglass said, “It’s easier to build strong children than to repair broken men.”
He challenged residents to know every possible disorder or genetic syndrome under the sun and its underlying pathophysiology. When discussing a case and trying to figure out a diagnosis, he watched us run through our limited supply of options, and he always criticized us for not reading enough and therefore not knowing enough, for not seeing the whole picture. “How can your eyes see something,” he’d say, “that your mind doesn’t know?”
Navy SEALs and other special ops medics train in Flint because the city is the country’s best analogue to a remote, war-torn corner of the world.
A kid born in Flint will live fifteen years less than a kid born in a neighboring suburb.
When we know about the child’s environment, we can treat these kids in the best, most holistic way, which will leave them with much more than just a prescription for amoxicillin.
Years ago we talked about these environmental factors as “social determinants of health.” Today we call them “adverse childhood experiences” (ACEs) or “toxic stresses.”
The other new concept is our realization that a child’s neuro-endocrine-genetic physiology can be altered. Prolonged, extreme, and repetitive stress or trauma—due to exposure to an ACE, including poverty, racism, violence—chronically activates stress hormones and reduces neural connections in the brain, just at the time in a child’s development when she should be growing new ones. In a landmark study analyzing the health data of more than 17,000 HMO members, researchers found that the more ACEs a child has, the greater the chances of long-term physical and behavioral health issues.
It’s important for my pediatric residents to read the most up-to-date literature and science from the leaders in the field about ACEs, toxic stress, neurodevelopment, and resilience. They watch tutorials on brain development and the impact of toxic stress from Harvard’s Center on the Developing Child and watch Nadine Burke Harris’s TEDMED talk, a fan favorite in the curriculum.
A significant amount of lead exposure can cause swelling of the brain, headaches, lethargy, anemia, dizziness, muscular paralysis, sleeplessness, loss of appetite, and abdominal pain. It can affect vision and hearing, and in extreme cases, it can cause kidney failure, coma, and death. Even at lower, single-digit levels, the damage is irreversible. For an infant like Nakala or a two-year-old like Reeva, enough exposure can mean developmental delays, cognitive impairment—literally, a drop in IQ—as well as memory issues, attention and
The following month a city employee was sent to test the water in her house. Prior to taking a sample, the employee ran the tap for a few minutes—explaining that he was following MDEQ guidelines to “pre-flush.” This struck Walters as strange—if there was something in the water to worry about, wouldn’t whatever it was get flushed out too? People don’t usually flush tap water before they drink it.
Even with flushing, the sample came back showing an astronomically high amount of lead in Walters’s water. Particles and metals in water are measured in parts per billion, or ppb, and the lead in Walters’s water tested at nearly 400 ppb. Based on the latest scientific studies, the maximum amount of lead that should be allowable in water is 0 ppb.
When Walters notified the city of her children’s high blood-lead levels, she was told that her household plumbing must be to blame, since the tests of city water showed lead levels in compliance with regulations. The city arranged for a garden hose to run from a neighbor’s house to Walters’s house to provide “lead-free” water.
That had forced her to install all-new plumbing made of polyvinyl chloride (PVC), a strong but lightweight plastic. She had told this to the city employee when he came to test. If all her pipes were made of plastic, how could they be leaching lead?
Not using corrosion control was a breach of federal law. There were no corrosion control chemicals on the city list.
Out of curiosity, Edwards decided to do a test for lead, suspecting that a chemical change in the water could be causing deterioration of the D.C. pipes. As he would later recount at congressional oversight hearings, the level of lead on his first test exceeded his meter’s range. He had to dilute the water and test again. When he did, even the diluted water tested at a minimum of 1,250 ppb of lead, a level that Edwards later said “would literally have to be classified as a hazardous waste.”
the public health community continued to believe the CDC mantra: that lead in the water could not harm kids. The CDC carried a lot of credibility. Everybody knew what eating lead paint chips did to kids, but without ironclad studies to disprove the CDC’s assurances about lead in water, the misperception continued. And the CDC, now invested in a cover-up, did nothing to reverse its claims until it had to. In 2010 a congressional investigation found that the federal agency had made “scientifically indefensible” claims that the lead levels in D.C. were not harmful—and had knowingly used flawed
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The average annual Flint residential water bill in 2015 was $864—about $300 more than in any other city in Michigan. In fact, it was the highest in the nation.
According to a recent review, as many as one million lives could be saved worldwide each year if more people washed their hands.
One sample, collected after forty-five seconds of flushing, exceeded 1,000 ppb—sixty-five times the federal action level of 15 ppb. The numbers were frightening.
He couldn’t hide his feelings, another thing I love about kids: it was clear he was anxious.
First, in October 2014, just six months after the switch, General Motors stopped using the water at its engine plant. The company got a waiver to go back to the Lake Huron water as its source. “You don’t want the higher chloride water (to result in) corrosion,” the GM spokesperson said. “We noticed it some time ago.” If the water was corroding metal engine parts, what was it doing to the ancient lead pipes under the city?
Justice Thurgood Marshall wrote in his dissent to Milliken v. Bradley that the “Court’s refusal to remedy separate and unequal education” leaves “little hope that our people will learn to live together and understand each other.”
Comparing children under five years of age with elevated lead levels (greater than or equal to 5 μg/dl) for about the same duration of time pre–water switch (January 1, 2013, to April 24, 2014) to post–water switch (April 25, 2014, to September 9, 2015), the percentage increased from 1.5 percent to 8.5 percent. The p value was 0.007. In statistics, the “p value” shows statistical significance. And the lower the p value, the stronger the significance. Anything less than 0.05 is significant. There it was. Lead. It was real. The impact was there in the numbers. It was exactly what Elin had
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The Romans used it to coat their famous aqueducts two thousand years ago. It was also employed in almost every aspect of wine-making, something else the Romans were famous for. A food additive, it was sprinkled on everything, like salt. All this lead in the Romans’ food, wine, and water has provoked theories that lead poisoning contributed to the fall of their empire.
Art historians suspect lead pigments may have contributed to the illness and demise of many great painters, including Correggio, Raphael, and Goya. There’s even a story that Vincent van Gogh was fond of the flavor of one pigment in particular and liked to suck on his paintbrushes. That wouldn’t surprise a pediatrician. White lead is noted for its sweetness, which is why lead paint tastes good to kids.
Fat-soluble and easily absorbed by the skin, TEL was even tested by the U.S. War Department as a nerve gas. Just five teaspoons applied to healthy skin could be fatal. Five teaspoons on the skin…this didn’t stop GM or even slow the company down, it seemed. It collaborated with DuPont and Standard Oil/Exxon on a new “high octane” style of gas, dubbed “ethyl,” that allowed cars to drive better and engines to work more efficiently, never to knock or ping.
But when Harvard University offered to hire her as its first woman professor, it made three stipulations: She was forbidden to enter the Faculty Club. She could not have tickets to football games. She was not allowed to march in the commencement procession.
It was a turning point, not just in the history of lead but in so many other aspects of public welfare and safety. “Safe until proven dangerous” became known as Kehoe’s Paradigm, or the Kehoe Rule. The approach was later taken by climate change deniers.
Based on 2015 data, the Institute for Health Metrics and Evaluation (IHME) estimates that lead exposure accounts for 494,550 deaths and the loss of 9.3 million disability-adjusted life years due to its long-term effects on health. The IHME also estimates that lead exposure accounts for 12.4 percent of the global burden of developmental intellectual disability, 2.5 percent of the global burden of heart disease, and 2.4 percent of the global burden of stroke.
That is the legacy of Charles Franklin Kettering, the American inventor, engineer, businessman, and philanthropist, a holder of 186 patents and a man of platitudes and corporate pop-optimism. His work added more lead to the environment and to children’s blood than any other application of the metal. It is one of the largest environmental crimes ever. Tell me again why we’re naming universities after him?
we know lead’s potential to twist behavior, attack every system in the body, erode cognition, and possibly even warp one’s DNA. Lead exposure has been linked to almost every kind of developmental and behavioral problem, including school dropout rates and criminality. A recent study looked at six U.S. cities that could provide good crime data and blood-lead-level data going back to the 1950s. Going neighborhood by neighborhood in New Orleans, it found that a rise in blood-lead levels matched a rise in incidence of violent crime. Econometrics studies looking at worldwide crime trends also show
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If children who have an empty stomach or are deficient in certain nutrients are exposed to lead, their bodies will absorb more of it.
The eyes don’t see what the mind doesn’t know.
He explained that after the D.C. crisis in the early 2000s, new regulations had been put into place, ensuring that anytime a water source is switched, significant sampling needs to be done before and after. This didn’t happen in Flint. Instead, the agency was gaming the system and sampling in a way to get the results it wanted.
Bryant backed up his many examples of environmental injustice with hard-core research, showing how industrial waste, incinerators, trash dumps, and chemical plants were often located in neighborhoods where residents
had fewer resources to fight them.
Lead shifts down the entire bell curve of intelligence, as Dr. Reynolds and I knew, not only adding more people with severely reduced intellectual capacity but also reducing the number of exceptionally gifted people. We knew that lead is more prevalent in poor and minority communities, and thus lead exposure exacerbates our horrible trends in inequality and the too-wide racial education gap. We knew that if you were going to put something in a population to keep people down for generations to come, it would be lead.
MONDAY, SEPTEMBER 21. A SIMPLE PLAN: to meet the mayor at 1 P.M., show him my study results, reveal the proof of elevated blood-lead levels, and have him issue a health advisory that would finally alert the residents of Flint to stop drinking the water.
“The vast evidence supports an increased likelihood of a decrease in IQ. Even a blood level of 1 to 4 μg/dl—which is not yet considered above the reference level—drops the mean IQ by 3.7 points. This reduces the number of high achievers, or those with an IQ over 130, and increases the number with low IQ, at 70—shifting that bell-shaped curve to the left. This impacts not only life achievement expectations but special education services and employment prospects. This has drastic implications at the population level. “Elevated lead levels in childhood also increase the likelihood of ADHD
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I described the methodology and approach, how we had used data processed at Hurley Medical Center, received IRB approval for our research, and zeroed in on blood-lead levels of all children five years of age and younger in seven Flint zip codes. Two periods of study were compared: pre-switch blood-lead levels from January 1 to September 15, 2013, and post-switch levels during the same months of 2015. The sample used was 1,746 Flint children pre- and post-switch. Post-switch, the percentage of children with blood-lead elevation was almost double. I emphasized that this increase was contrary to
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The next slide compared Flint to the rest of Genesee County, where the water was the same as ever. This comparison made it clear that there was no statistically significant increase in elevated blood-lead levels in the rest of Genesee County—only in Flint.
Next, I really wanted to bring home that my blood-lead results, although striking, underestimated the potential exposure. Medicaid mandated lead screenings at a child’s one- and two-year checkups, but that was way too late if you were worried about lead in water. “Infants are not screened for lead exposure,” I said, and “lead has a short window of detection in blood—a half-life of twenty-eight days.” Also, many children who are supposed to be screened never are.
“The moment when a child’s medical doctor learns of an exposure to this powerful toxin, it is too late. We grossly failed at primary prevention.”
The next slide described next steps: Encourage breastfeeding No tap water for high-risk groups such as infants on formula and pregnant mothers Declare a health advisory Distribution of lead-clearing NSF-approved water filters Public education regarding precautions Reconnect to Lake Huron water source ASAP I ended my presentation with the photograph of the little girl I called Makayla. I figured if I didn’t get them with data, facts, and numbers, I could get them with emotion. Makayla looked at the camera with such trust and innocence. “She seems great now,” I said. “She’s smiling and looks
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It also mattered that Dr. Reynolds is African American and lives in Flint, the eighth-largest “majority minority” city in the United States—57 percent black, 37 percent white, and 6 percent other, mostly Latino. The installment of the EM, even a black one, rather than an elected official to represent Flint, had been the last straw. Black Flint residents knew how the city had lured their great-grandparents and grandparents with promises of industry jobs and prosperity, and that they had often had to accept lowly jobs, crappy housing, and segregated neighborhoods while their white counterparts
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The mayor was finally ready to talk water. “We’ve just this morning had a meeting about this with the EPA and DEQ,” he said. “And they’ve told us there’s no corrosion issue. It has to do with old pipes in residents’ homes and couldn’t be helped.” Something inside me wilted. He was copping out already. Okay, maybe there is lead in the water, he was saying, but it isn’t the city’s, the state’s, or the feds’ responsibility—or mine. It’s the people’s fault. I couldn’t help but think how this echoed the lead industry’s blaming of victims. Then he mentioned the prohibitive cost of switching back to
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I spoke up again. “This is a crisis. This is an emergency.” I talked about needing bottled water for the infants in the city, or premixed formula. And the water had to be switched back immediately. “That’s impossible!” Henderson had been sitting at the table for almost an hour and hadn’t said a word, but now she finally spoke up, with unshakable certainty. She made it clear that there was absolutely no money for Flint to switch back to Detroit water. “The pipeline to Detroit has already been sold.” She shot me a disapproving why-are-you-wasting-my-time-with-this-crap look.
“They say there are no corrosion issues,” she said. “The water tested fine at the source—” “The source isn’t the problem!” I interrupted, then began to describe why testing at the source was irrelevant. I had taken a crash course in water treatment only in the last couple of weeks, I explained, but I had consulted a former EPA water treatment scientist (Elin) and had met with Marc Edwards. The second I said Marc’s name, I felt a blast of arctic air from Henderson and Croft.
I gave the mayor an ultimatum—delivered as kindly and benignly as possible. It was pretty simple. If he wouldn’t stand with me and make the announcement that there was lead in the blood of the kids of Flint, then we would do it without him. Kirk, Melany, Senator Ananich, Andy, and I had agreed on this step going into the meeting. Andy had been adamant about issuing a deadline for the mayor, and he wanted it to be Wednesday, September 23, at noon.
