Monday, March 15, 2010

The 2009 Study that Found Health Harm from DC's Lead-in-Water Contamination Wins Best Science Paper Award

Last week, the prestigious chemical and environmental research journal Environmental Science & Technology announced its selection of best papers of 2009.

The journal gave its top award to the paper "Elevated Blood Lead in Young Children Due to Lead-Contaminated Drinking Water: Washington, DC, 2001-2004," coauthored by Virginia Tech Professor of Civil and Environmental Engineering and MacArthur Fellow Dr. Marc Edwards, Virginia Tech doctoral candidate Simoni Triantafyllidou, and Children's National Medical Center pediatrician Dr. Dana Best.

The journal considered 1,400 peer-reviewed studies in total. It awarded the Edwards et al. paper for being "of the highest caliber" and for its anticipated "significant and long-lasting impact on the field."

WASAwatch wrote about the Edwards et al. paper in a previous blog and offered a summary of the study's methodology and findings. It is worth restating that the research contradicted years of public assurances by WASA, WASA's paid consultants at the George Washington University School of Public Health, DC government, the Environmental Protection Agency (EPA), and the Centers for Disease Control and Prevention (CDC) that exposure to almost three years of astronomical levels of lead in drinking water resulted in no measurable public health harm and that cases of elevated BLLs during that time were consistently linked to lead paint and dust. The Edwards et al. paper also prompted two still active investigations -- one by Congress and the other by the DC Office of the Inspector General -- into possible negligent or intentional wrong-doing by city and federal agencies.

Here are the Edwards et al. key conclusions:
  1. In 2002 and 2003, the total estimate of elevated blood lead level (BLL) cases (i.e., equaling or exceeding 10 micrograms of lead per deciliter of blood) from high water lead levels for children 2 1/2 years old and younger is 859 (this number is probably much lower than the actual for reasons highlighted in the paper).
  2. The greatest health impact from the city's 2001-2004 contamination was in the second half of 2001, when lead-in-water levels rose suddenly and dramatically and the incidence of elevated BLLs increased 9.6 times, as compared to the first half of 2001 (when the lead problem was just beginning).
  3. The incidence of elevated BLLs did not return to levels observed in 2000 (before the contamination) until about 2005, when WASA once again met EPA lead-in-water standards.
  4. The screening guidelines of the CDC, which recommend testing children for elevated BLLs at around 1 and 2 years of age, are not designed to detect lead exposure in infants and thus provide only limited insight to the effects of lead at the tap on the under-12-months age group.
  5. The public health impact of the 2001-2004 Washington DC contamination was consistent with decades of research in the US and Europe linking lead-contaminated drinking water to elevated BLLs.
The Environmental Science & Technology award is a dramatic measure of the highest level of respect the environmental science community has for the Edwards et al. research.

When the paper was originally published, numerous officials from the relevant government agencies and their allies made pejorative private and public statements questioning the study's methods and validity (none of these officials, by the way, had similarly questioned the "no significant harm" conclusions of two earlier papers, authored by government representatives and WASA-paid consultants with clear conflicts of interest).

It has been over a year since the paper's publication and, despite assurances by WASA, DC government, and EPA Region III that they were going to evaluate carefully the merits of the study, to date no agency has made public any such evaluation. More importantly, no agency has ever acknowledged the harm done to DC children in 2001-2004, nor have they once apologized for the role they played in the fiasco. Given the active $200 million class action lawsuit against WASA, maybe this silence is understandable from a legal and economic perspective. From a public health and social justice perspective, however, it is unethical and unconscionable.

Some readers might wonder why we are opening old wounds. After all, the 2001-2004 lead-in-water crisis purportedly ended 5 years ago. Moreover, WASA now has a new, charismatic, highly skilled, and trustworthy General Manager. What's the point of revisiting this controversy from the past?

It's a valid and important question.

Even though positive changes have been made since the publication of the Edwards et al. study, there are three main reasons why the question of health harm from the 2001-2004 crisis continues to matter:

1. DC residents, and certainly the parents of the approximately 42,000 children who are today between 5 and 10 years old, deserve an honest appraisal of the harm that may have been done to their fetuses, infants, and toddlers in the past, especially if they were using unfiltered tap water for mixing infant formula, drinking, and cooking. To date, no government official has acknowledged the public health implications of the city's historic lead-in-water contamination.

2. Critical nodes of the intricate, multi-agency web that created the lead-in-water crisis, and that for five subsequent years misled DC residents and communities around the country about its health consequences, are still firmly in place. Specifically:
  • Several employees at WASA, EPA Region III, and the CDC with a documented history of misleading the public continue to control information and make decisions about drinking water safety in DC or childhood lead poisoning prevention nationwide. None of these employees have been held accountable.
  • The flawed 2004 CDC report -- currently under Congressional investigation -- that found no cases of elevated BLLs due to DC's contaminated drinking water still sits on the agency's website. Seven months ago, Congressional investigators revealed that the CDC analysis had omitted thousands of blood lead measurements, including hundreds of elevated BLL data points, which led WASAwatch to call for the report's full retraction. To date, the CDC has shown no inclination to publicly correct their flawed study, even though its principal author, the chief of the CDC's lead branch, now admits that the work was "not scientific."
  • The WASA-funded paper that was published in the peer-reviewed journal Environmental Health Perspectives (EHP) in 2007 and claimed "no measurable harm" from the 2001-2004 contamination still sits on EHP's website. Serious questions about undisclosed financial conflicts of interest, possible data fabrication, and the scientific integrity of this study, authored by former George Washington University professor Dr. Tee L. Guidotti and his colleagues, are laid out in detail in a March 2009 letter from Dr. Edwards to EHP and have been discussed on WASAwatch and the newsletter of the American Association for the Advancement of Science (AAAS). You may be also interested in Dr. Guidotti's response letter to the AAAS editor, which studiously avoids a factual response to key points of the allegations, and the reporter's reply. Although EHP has not disclosed this publicly, the Guidotti et al. paper continues to be under investigation.
3. Although DC's 2001-2004 lead-in-water contamination was unique in its severity, lead-in-water problems around the country may be more serious and widespread than presently believed. We know, for example, that:
  • Lead service lines, lead-containing solder, and leaded brass fixtures -- which are all sources of lead in water -- are widespread around the country.
  • Even though water utilities may still underreport lead-in-water problems, every year at least some utilities exceed the federal lead-in-water standard.
  • Water utilities that meet federal lead regulations can still have lead-in-water problems in up to 9% of the homes they monitor.
  • The number of documented states affected by lead-contaminated drinking water in schools is at least 39 (including DC). There is no scientific or practical reason to believe that the problem does not extend to schools in all 50 states.
  • Children living in homes with partially replaced lead service lines are at a significantly higher risk of experiencing elevated BLLs than children living in homes without lead service lines, and such replacements have been performed in numerous locales in the US and Canada during the past 20 years.
  • 30% or more of current elevated BLLs do not have an immediate lead paint source, and studies suggest that lead exposures result from multiple environmental sources.
  • The detection of lead-in-water contamination requires a proper testing protocol that not all utilities use. Moreover, the detection of lead particles (i.e., small pieces of detaching lead solder or lead rust that can contain excessively high concentrations of lead) is difficult, even with the use of a proper testing protocol.
Despite these facts, and the high incidence of elevated BLLs among children in cities like Providence, Milwaukee, Chicago, and Philadelphia that are known to have high concentrations of lead service lines, the US approach to childhood lead poisoning prevention focuses almost exclusively on lead paint and dust hazards, and tends to downplay risks of lead-contaminated drinking water.

The Edwards et al. paper points to the need for a serious national reexamination of lead poisoning prevention laws, protocols, and programs to prevent fetuses, infants, and children from being needlessly harmed by lead at the tap.