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July 27 - September 9, 2019
The other thing is that unlike lead paint, the risk from lead in water is highest in children under age 15 months, and is especially high for infants drinking formula.
The study had to be perfect, otherwise it would be tossed out and dismissed or else cause unnecessary alarm in a city that was facing too many challenges already.
(In a future lifetime, I’d like to invent an all-in-one soccer cleat, shin guard, and sock combo that also functions as a water bottle.)
MOST OF MY PROFESSIONAL LIFE is pretty predictable—to me, at least. Clinics, meetings, presentations, red tape, trainings, and lots of talking with faculty and residents and patients. It’s the life of a doctor, the life of a healthcare professional, the life of an educator. But now it was becoming something else—the life of a renegade and detective. And standing there on Field 3, with our backs to the kids, huddled like two spies, my life was suddenly beginning to feel like an episode of Scandal.
We stayed activists in college, and in our careers, but accomplishments in the adult world turned out to be harder to achieve and far less exciting than our wide-eyed, swashbuckling teenage activism. The problems we found now were mired in complexity, and victories were faded by trade-offs.
Elin is usually pretty reserved, not a screamer or crier, but her reaction now—her hand squeezing my arm tightly—was as demonstrative as I’d seen her since those old days.
Considering the deafening silence coming from the state and county health departments, and the attacks on Edwards—and all the previous attacks on residents who tried to raise concerns about the water—it was painfully obvious that this was going to be a political issue. But how political, and how heated?
The health departments were blatantly covering up, stalling, or inefficient and slow to respond, or they truly didn’t care. It could be laziness or, worse, an indifference to poor black and brown people. They didn’t hear the sirens I was hearing, while I couldn’t get them out of my head.
But that week, as I listened to the reflux discussion, I felt the knot in my stomach tighten. I couldn’t remember the last time I’d had a real meal—or eaten more than a few bites. I was losing weight. My pants were baggy and my white lab coat was starting to swim on me, as if I’d borrowed it from somebody else.
I wanted to explain what was happening, but I knew I had to take special care with Bebe. She falls easily into dark holes of anxiety and dread. Anything I said would spur a race of new worries in her mind.
Experience had taught her that leaders can be evil and do evil—not just Iraqi leaders but people in power anywhere, anyone who sees people as disposable instruments in their own plans.
Lunch would be at Steady Eddy’s, my favorite go-to place inside the Flint Farmers’ Market, just downstairs from the clinic. Located next to the stalls of fresh produce, local honey, and a great deli, Steady Eddy’s is one of those classic crunchy hippie cafés with sprouts in the sandwiches, vegetarian chili, tofu, and fantastic, fresh multigrain bread.
We said our greetings, moved the chairs around, and nervously reached for our water glasses. But then we stopped. Nobody wanted to sip the water.
In 2004 there had been reports that Lansing had elevated lead levels in its water. At the time, the conventional wisdom propagated by the CDC was that lead in water was a minor concern—very minor compared to lead paint exposure.
But ultimately Virg Bernero and Edwards won the battle and put in a plan to get Lansing’s lead pipes replaced. It took a decade, but Lansing is now the only city in the country besides Madison to have replaced all its lead service lines. And that was only sixty miles from Flint.
In 2010 Virg Bernero ran against Snyder for governor and obviously lost. But what if he hadn’t? I couldn’t help but think that the Flint water switch never would have happened.
“This kind of thing takes a long time,” he said more than once while shaking his head. “I’d be surprised if anything we do makes a difference.” He expressed such a strong distrust of government—the state, the federal players like the EPA and the CDC—that it shocked me. He seemed bitter and wounded—and angry.
Edwards said the lack of MDEQ oversight violated both the Safe Drinking Water Act and the Lead and Copper Rule.
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.
“My experience is,” he replied, “the EPA and the states work hand in hand to bury problems. EPA rarely challenges the states.” I had feared that but hated hearing it.
He knew of a similarly corrosive water supply in Maryland, where even a staff of thirty water engineers couldn’t manage to control it properly. Compare that with Flint, where only one half-time person had worked on the city water prior to the switch.
Edwards felt that until Flint was restored to treated Detroit water, its old source, its tap water would remain dangerous.
I had to marvel at how different Edwards and I were, basically opposites. He is a tall, older white guy who looks like his ancestors came over on the Mayflower. I’m short and brown, an immigrant from a country that the United States has basically been at war with for three decades. He resided in a place that was in the heart of the Confederacy. I lived so far north, it was practically Canada. He talked skeptically of government, while I believe in government’s capacity to help people—and even to remedy historic wrongs and injustices.
Solving a public health crisis should have been the business of the people we’d empowered and entrusted and funded with our tax dollars to keep our air and food and water supplies safe—and not left to an out-of-state engineering professor or a pediatric residency director. But for Edwards, it wasn’t a choice.
The proper ratio of powder to water is one scoop for every two ounces of water. But some new moms found it confusing and diluted the formula with too much water, sometimes on purpose, hoping to make it last a little longer. Watery formula can result in poor growth, low sodium, and sometimes even seizures. Now, on top of those concerns, in Flint at least, adding more water also increased an infant’s exposure to lead.
As the lunch was coming to an end, and totally out of the blue, in sort of a non sequitur, Marc blurted out the words “I trust you” to me.
So that was it: we were back in the Bizarro World of the Kehoe Rule, where we had to prove there was danger and harm before anything could be done. The onus was on us.
In recent years, since we had been working hard to upgrade the program, we were up to thirteen hundred or so applications per year. That number is whittled down to a list of two hundred applicants whom we invite for interviews to fill our seven slots.
We were attracting a more competitive and diverse group of residents, ones who increasingly looked like our patients. They came from all over—caring, idealistic, and passionate new docs who wanted to change the world. And they wanted to live and work in Flint, which shows how dedicated they were.
THE NEXT DAY OUR IRB application was approved. We had submitted it on Tuesday, and it was approved on Wednesday, an unheard-of turnaround time. Hurley may not have dozens of NIH-funded researchers and an entire building dedicated solely to research, but we don’t have the sputtering and stalling bureaucracy that often comes with all that either. We are small and lean and responsive. Everyone knows everyone. And the credibility that Jenny and I had built over the years carried weight.
Before EMRs, this kind of study would have taken months, possibly years. It would have been painstaking work, reviewing paper chart by paper chart by hand. An analysis still took time now, but getting the data itself took only minutes.
Never mind that I was a lifelong progressive and believer in government—and was quickly losing faith. A sea of red tape lay between me and an official health advisory, which would hopefully free up resources and qualify the city for bottled water, filters, and other aid.
The only solution was getting someone to declare a state of emergency or issue a “health advisory,” which we hoped would kick into gear a number of governmental responses, including bottled water deliveries, water filters, and maybe premixed baby formula. But nothing could happen without this official action. We talked about the quickest way to get it done.
I am passionately pro-vaccination, and convincing parents to have trust in the science on vaccines is one of the most important tasks facing pediatricians today. Combatting this dangerous trend of science denial, I always explain to my patients the concrete evidence about vaccine safety and efficacy—literally how many millions of lives have been saved—and I share that I have no hesitation immunizing my own daughters.
Since doctors would be talking about the importance of vaccination at the press conference, I brought my white coat, even though I am usually reluctant to wear it—or scrubs, for that matter—outside the clinic or hospital. Flaunting the white coat is something only medical students and new doctors do. But I was supposed to give media interviews that day on camera, where the white coat screams credibility.
How many Flint kids who were required to get a Medicaid-mandated screening, I wondered, actually got one? The number of at-risk kids who never got screened would dramatically impact our sample as well as the findings.
“Primary prevention” means preventing harm from occurring before a child moves into a house, before a mom gets pregnant. A truly visionary program would be methodically identifying and eliminating the lead from our environment completely before a child is exposed.
As briefly as possible, I explained the history of the water issue. And I knew one story would drive it home: I told them how GM had stopped using the water a year before because it was corroding engine parts, but we were still expecting the kids of Flint to drink it.
We couldn’t decide what to do about children who had multiple blood-lead levels. For the study, we needed only one level per child. But if a child was diagnosed with an elevated level, the protocol was to take their blood levels repeatedly. Should we use their highest lead level or their first lead level? The literature seemed to contain both kinds of examples. We were constantly going back to published research, reading article after article, to see how other studies were done.
Water-lead levels are affected by heat and the seasons of the year. Lead in water peaks when the outside temperature is higher. That’s why you’re never supposed to use hot water from your tap.
But what would have been a painstaking, time-consuming, and months-long endeavor just five or ten years ago was a pretty quick undertaking. Due to advances in statistics software and algorithms for sorting and analyzing data, she was able to run the new study and send me the new numbers while I was sitting at a lecture at the MIAAP conference.
I thought we had it right this time—we controlled for seasons, and we used the highest lead level if a child had more than one.
We had the proof we’d been looking for: kids were being harmed every day, with every sip of water they drank, with every bottle of formula.
Marc saw the main responsibility of water treatment experts—whether they worked at a utility, a city treatment plant, a state health department, a university, or the EPA—as providing safe drinking water, one of the central foundations of any society, from the humblest prehistoric settlement to modern nations. For him, what was happening in Flint wasn’t just a Flint problem. It tarred his entire profession.
As Dr. Reynolds and I walked back to the conference, both of us were fuming. He turned to ask me a question. “Have you heard about the concept of environmental injustice?” I nodded. “Of course. I studied with Professor Bunyan Bryant.”
Bryant had even fought lead pollution in Flint decades ago, when a plant that burned lead-painted wood chips was built in a predominantly African-American neighborhood.
In lectures, Bryant had specifically called out the persistence of lead in paint and paint dust in black and brown and poor communities as a form of “environmental racism.”
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.
Honestly, I didn’t even know there was a public works department or what it did.
One minor error and all our efforts would be for nothing, and Flint kids would go on being poisoned. I was already out on a limb—and already being ignored. We had to produce a study that couldn’t be.
