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July 27 - September 9, 2019
Today pockets of old-money affluence remain in Flint, but you can also buy a house here for less than $30,000. And I’m talking about a decent house, similar to the Royal Oak home where I grew up. The national poverty rate is about 16 percent, but in Flint, almost 60 percent of children live in poverty, some in extreme poverty.
What drew me to Flint—and has kept me here—was something else I saw. Something that made me think of my dad and mom, of the family stories I’d heard. It was the tenacity and endurance of its people, the passion of its strikers and workers, and its legacy of steel-plated grit and resilience.
Governor Snyder’s enthusiasm for the emergency manager law seemed totally genuine and unforced—not something he was pushed to do by the Tea Party or anybody else. One of the first bills he signed was Public Act 4, a beefed-up version of a prior EM law that allowed him to take over a municipality that was beset with financial problems. Even though Michigan voters shot down Public Act 4 in a referendum, the ideologues in the legislature ignored the voters and passed the law again, one month later.
The EM had to balance the books, no matter the cost. The EM law has so many miserable aspects, it’s hard to know where to start. City employees and their pensions and benefits were a primary target.
The extreme austerity—which was also behind the water switch—decimated Flint’s police force. Between 2008 and 2016, it shrank from 265 sworn personnel to 98.
Numbers may appear to be black-and-white and simple, but they have a way of hiding secrets if a study and analysis aren’t properly done. A lot of thinking goes into a study, and often there are many revisions, times when you have to start all over from scratch.
I heard back just a few minutes later. That’s the miracle of electronic medical records. So much time goes into crunching—or into fine-tuning and designing a study. But once you ask the right questions, spitting out the results happens in an instant.
We decided to look only at kids five and younger; to look at only one level per child—the highest level; and to include all kids no matter what was in their chart as a potential source. As for time period, we agreed that we’d look at an equal length of time before and after the water switch—January 1, 2013, to April 24, 2014, versus April 25, 2014, to September 9, 2015.
Putting a study together was like working on a jigsaw puzzle—it was kind of addictive, hard to stop, and offered a dopamine hit of pleasure when you reached the end.
Jenny, being an obsessive researcher, had become paranoid about antibiotics, vaccines, the germy environment of daycare, and all the other worries that can plague a parent, especially a parent let loose on the Internet.
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.
All research done on humans is protected by ethical guidelines that were established in 1979 in reaction to terrible historic incidents in which people were experimented on in cruel and exploitative ways, especially poor, disadvantaged, or mentally ill people.
So while the process of getting an IRB approval could be bureaucratic and time-consuming, the principle behind it—that people are more important than any institution or system or research project—was so good, solid, and right, I couldn’t complain.
I was beginning to see that over the last century, lead seemed to bring out the very best and the very worst in people. And I knew already which side of history Wurfel and his MDEQ bosses would be on.
IN FLINT, EVERYBODY KNOWS THE NAME Kettering. His inspiring quotes can be found on plaques and signs around the city: “Believe and act as if it were impossible to fail,” or, my personal favorite, “My interest is in the future, because I am going to spend the rest of my life there.”
LEAD IS PROBABLY THE most widely studied neurotoxin, a metal that humans—including my ancient Assyrian ancestors—have been using for thousands of years. Even the word “plumbing” is derived from the Latin word for lead, plumbum.
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.
Everybody knew lead was toxic, but what it did to the human body was insidious and invisible, while its benefit to industry was tangible and quantifiable in dollars. The story of lead in the United States, where industry has the upper hand, is a little different than in Europe.
Given the rejection of lead in 1922 by most of the world, it’s kind of amazing that just a year later it was added to gasoline in America. It was heralded as a giant technological breakthrough, a “gift from God.” It’s funny how we talk about “unleaded” gasoline now, as if lead were a natural component of gas and removing it required a complicated chemical process, maybe even at great expense.
The entire concept of “unleaded” is a misnomer, in fact. Lead was mined from the earth and added to gasoline. The reason? To stop engine knocking, an annoying noise in early car engines that occurred when the mix of fuel and air burned unevenly.
The health hazard of TEL, over and above normal lead, was no secret. 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.
In October 1924, noxious fumes poisoned and killed workers in a section of a Standard Oil refinery in New Jersey where the new gasoline with TEL was being made. Several exposed workers were straitjacketed after exhibiting paranoid behavior, experiencing delusions, and becoming violent.
For the remainder of 1924 and most of 1925, the public health debate about tetraethyl lead in gasoline was one of the sharpest of the early century—much more heated than what eventually transpired over lead in paint, or than what has yet to transpire over lead in plumbing.
Hamilton is now one of my heroes, a stubborn badass who devoted her life to improving the lives of workers, the poor, and children. When things became stressful for me in Flint—and there were some tough days to come—I thought of how hard she tried to right a wrong, to make the world safer for kids, and to prevent a totally preventable public health scourge.
In Chicago, she also became a member and resident of Hull House, the first settlement established by Jane Addams and Ellen Gates Starr, where newly arrived and impoverished European immigrants were given full or “wrap-around” services—from healthcare to education and advocacy—and a safe place to live. Hamilton opened a well-baby clinic and eventually expanded care to include children up to eight years old.
When she was offered a position at Harvard Medical School in 1919, she was the foremost American authority on lead poisoning, and one of only a handful of specialists in industrial disease. 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.
During Hamilton’s years fighting lead in gasoline, she was adept at feeding tragic stories of lead poisoning to the popular media, knowing this would light fires that no academic study could.
When GM and Standard Oil pushed back, they claimed that Hamilton and other anti-lead activists were “hysterical”—that code word for “stupid woman, overreacting”—while the industry’s work to improve gasoline was based purely on rational science.
“Safe until proven dangerous” became known as Kehoe’s Paradigm, or the Kehoe Rule. The approach was later taken by climate change deniers.
The public health approach, however, is far wiser than the Kehoe Rule. The Precautionary Principle holds that a product or chemical should be considered unsafe unless the manufacturer can prove otherwise.
Leaded gasoline, or “ethyl,” became phenomenally successful, appearing in virtually all major-brand gasoline sold in the United States and around the world throughout the ensuing three decades. The costs of the surgeon general’s decision have been incalculable. By 1960, almost 90 percent of all gasoline contained TEL.
By 1965, according to the work of geochemist Clair Patterson at Caltech—who inadvertently stumbled onto the man-made contamination of lead in the environment while on a quest to determine the age of the earth—the average American had one hundred times more lead in her body than her ancient ancestors did.
In 1955 the director in charge of “health and safety” for the Lead Industries Association described childhood lead poisoning as primarily a “slum problem” and a “major ‘headache’…the only real remedy lies in educating a relatively uneducable category of parents.”
Twenty years later, still blaming the victims, the industry’s “health” director was making even less-veiled racist remarks. “The basic solution is to get rid of our slums, but even Uncle Sam can’t seem to swing that one. Next in importance is to educate the parents, but most of the cases are in Negro and Puerto Rican families, and how does one tackle that job?”
Now I knew, as I browsed online, why there are so many books and journal articles about the public health history of lead—from Lead Wars, by Gerald Markowitz and David Rosner, to Toxic Truth, by Lydia Denworth. It is because the story has so many twists and turns, and so many great characters.
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?
Lead was finally restricted—but not totally outlawed—in plumbing in 1986. The same year, leaded gasoline was taken off the market in the United States, and it was banned in Europe by 2000.
The United Nations conducted a ten-year campaign to eliminate it from developing countries, but according to the UN environment program, in 2016 three Arab countries—Algeria, Yemen, and Iraq—still added TEL to gasoline. Ugh. And for some inexplicable reason, it is still allowed in airplane fuel.
Where consumption of leaded gasoline declines, so does violent crime. The connection between lead and crime is still speculative, but the correlations are there.
And what have we learned about how much lead the body can safely handle? Medical science has now concluded there is no safe level of lead in the human body.
When people tell you that government is inept and ineffective, all you have to do is remind them of the good work that the right policies can achieve.
Unfortunately, I must point out, the perceived “victory” over lead can create new problems. I run into older pediatricians all the time who believe the battle over lead has been won because they no longer see kids comatose from lead exposure in ICU beds. To them, the problem is fixed. Lead is a problem of yesterday. But given that we now know that even low levels of lead exposure can change our brains and bodies, our concern should be heightened and our resources increased, not reduced. In fact, given what I was learning about lead in water, the lead battle had a new front.
Soil is another place where lead can linger. Over the decades when lead was used in gasoline, car exhaust settled in surface soils in city schoolyards, playgrounds, and backyards, leaving them with accumulated and concentrated lead. This is why today’s urban gardens on vacant land in Detroit, Flint, and elsewhere have to import their soil and often grow produce on raised beds.
To catch up on what I had missed in my environmental health education, I started reading Werner Troesken’s gripping book, The Great Lead Water Pipe Disaster, which covers more than a century of lead-in-water disasters and the lack of political will to do anything about it. As far back as the eighteenth century, when lead pipes were installed to carry water, we’ve had kids with mysterious illnesses, moms with miscarriages, and adults with neurological complaints.
In the 1890s there was a crisis in my birthplace, Sheffield, England, when the “softness” of the water caused lead contamination. Thereafter the pregnant women of Sheffield began miscarrying, which later led to the invention of a lead-based abortion pill.
The action level the Safe Drinking Water Act settled on—15 ppb—does not make any sense. It was created with water utility companies in mind—and what was economically feasible for them—rather than the best protection of children.
The eyes don’t see what the mind doesn’t know.
Years passed, and I still remembered his stoicism and hesitant smile. I thought about everything he’d been through, largely preventable, all the toxic stresses: violence, fear, bullet wounds, hospital visits, surgeries, and PTSD, and then the effects of lead poisoning. For many people, life isn’t long enough to recover from a childhood like that.
