"Lead paint is bad to eat": the lead industry and child lead poisoning.

Historians of public health are familiar with Benjamin Franklin's letter to a friend in which he recounts his knowledge of the many professions in which lead is a health hazard. He concludes by saying: "This, my dear Friend, is all I can at present recollect on the Subject. You will see by it, that the Opinion of this mischievous Effort from Lead is at least above Sixty Years old; and you will observe with Concern how long a useful Truth may be known and exist, before it is generally receiv'd and practis'd on." [1] Unfortunately, old Ben made no effort to enlighten his friend (or future generations) as to why such delay being so common is a good example of how powerful economic interests can prevent the implementation of a "useful Truth."

For several decades after they became aware of the danger to young children of lead paint, the lead and lead paint industries continued to produce and sell it. Through a variety of tactics, including suppression of research findings, lobbying against government regulation and misleading advertising, these corporations and their trade associations created a public health problem of major proportions.

Although dramatic, life-threatening cases of lead poisoning had long since become a rarity, in 1991 the illness was still of such concern that the Secretary of Health and Human Services declared it the nation's most serious environmental pediatric disease. Even today, nearly one million children under the age of six have blood lead levels that can cause lowered intelligence, hyperactivity, learning difficulties and behavioral problems. Studies suggest that these effects persist beyond early childhood and into adulthood.

What did they know?

As early as 1904 an Australian physician, J. Lockhart Gibson, published an article on the source of childhood lead poisoning among his patients. He concluded that the lead-based paint on walls and porch railings was the main culprit. [2] Ten years later the first case study of a child poisoned by lead paint appeared in the US. The authors, Thomas and Blackfan, after searching the literature, concluded that such cases were rare. [3] However, three years later Dr. Blackfan reversed his judgment and asserted that reports of child plumbism were uncommon only because pediatricians were not looking for it. [4] As more doctors and public health authorities became aware of the problem over the next several decades, the medical and scientific literature would become full of studies describing the sources, symptoms and effects of childhood lead poisoning. Toys, furniture, windowsills, doorframes and other woodwork all were sources of lead for the young child. One author put it succinctly: "A child lives in a lead world." [5]

By the 1930s a number of hospitals and a city health department in North America were systematically counting and reporting lead poisoning cases. Boston's Children's Hospital reported 89 cases between 1924 and 1933. [6] In Toronto's Hospital for Sick Children 23 children were admitted, 5 of whom died, in a two-year period in the early 1930s. [7] Between 1931 and 1940, the Baltimore Health Department recorded 135 cases of child lead poisoning, including 49 deaths. [8]

There is ample evidence that early in the century the lead industry knew the dangers of lead paint for young children. A few years before it began manufacturing lead pigment and selling lead paint, the Sherwin-Williams Company instructed its sales staff to point out the toxic nature of lead paint to their customers. Even the industry's own medical and legal experts expressed their view that lead paint was highly toxic.

Dr. Robert Kehoe was medical director of the Ethyl Corporation, the producer of the gasoline lead additive, and arguably the nation's preeminent authority on the health effects of lead. For the most part, he tended to minimize the occupational and environmental health effects of lead. Yet on several occasions, both in scientific forums and in private correspondence with the Lead Industries Association (LIA, the lead industry's trade group), he made no secret of his view that lead paint was most hazardous to young children. At the annual conference of the American Medical Association in 1933 Kehoe emphasized the danger of lead in a child's environment:

    It is of particular interest and importance that in children with
  lead poisoning there is a striking tendency for symptoms of the
  central nervous system to develop, indicating the fundamental
  difference in the disease in children and adults. Encephalitis in
  children, as in adults, has a bad prognosis. From available figures
  one concludes that the prognosis in children and the outlook for
  complete recovery are even somewhat worse than in adults....
  [S]trenuous efforts must be devoted to eliminating lead from their
  environment. [9]

Ten years later, a landmark study was published by Drs. Elizabeth Lord and Randolph Byers, showing the effects of lead on the intellectual and behavioral development of young children. [10] When Time magazine reported on the article, the LIA attempted to cast doubt on the study's conclusions and methodology. Felix Wormser, the LIA's Secretary, tried to enlist Dr. Kehoe in his campaign, but Kehoe wrote to Wormser: "I am disposed to agree with the conclusions arrived at by the authors and to believe that their evidence, if not entirely adequate, is worthy of very serious consideration." [11] He went on to state that he had seen first hand cases similar to those described by Byers and Lord.

[ILLUSTRATION OMITTED]

Of some irony is the role, albeit inadvertent, played by one Anthony J. Lanza in exposing the culpability of the lead paint industry. Dr. Lanza would later go on to play a notorious role in protecting the manufacturers of asbestos by hiding the dangers of that product from workers and the general public. But in 1934, as Assistant Medical Director of the Metropolitan Life Insurance Company, he read a paper to an American Medical Association symposium on lead poisoning in which he noted the occurrence of child lead poisoning in the US and Australia. [12]

The National Paint, Varnish and Lacquer Association, the paint industry's trade organization, offered confidential legal advice to its members in 1939 that the seller of a hazardous product had a duty to warn its customers of the dangers involved. Among the toxic ingredients listed in that letter was, of course, lead and its compounds. [13]

Aside from the evidence offered by independent and industry-connected researchers that lead paint, as Dr. Byers once put it, was not good to eat, the paint industry early on revealed such an awareness in its own advertising. Glidden, in the 1920s, extolled its zinc-based paints, in part, because they were lead-free and therefore safe. Meanwhile, the company assured the consumer of the unsurpassed quality of its leaded paints.

Defending the industry

By the 1920s leaders in the industry saw the need to vigorously defend themselves from public attack. From such concern was born in 1928 the Lead Industries Association. As the LIA Secretary told the members: "[I]f all other reasons for the establishment of a cooperative organization in the lead industries were to disappear, the health problem alone would be sufficient warrant for its establishment." [14] To deal with this pesky "health problem" the LIA resorted to a variety of tactics. One was the use of outright intimidation. In 1930 the Metropolitan Life Insurance Co. published in its statistical bulletin the results of its survey of pediatricians. The physicians were asked for their opinion of the frequency and causes of lead poisoning in children. The report concluded that,

    Chronic lead poisoning occurs much more frequently among infants and
  young children than has been generally supposed. It would be a more
  prominent item in both morbidity and mortality records but for the
  fact that the condition is often unrecognized by physicians.... The
  most informing reply to the Company's letter was that of a Boston
  physician who stated that 50 cases of lead poisoning in children had
  been seen in a single Boston hospital during the last six years ...
  and that the lead had been ingested, for the most part, as the result
  of chewing paint from cribs, woodwork or toys ... A majority of the
  pediatricians agreed that chronic lead poisoning in infancy and
  childhood is by no means a rare condition ... [15]

Needless to say, the lead industry was none too pleased and let its displeasure be known. In writing to the US Children's Bureau, Louis Dublin, Met Life's statistician, requested,

    that because of the "strong remonstrance by the Lead Industries
  Association" about the publicity resulting from the earlier article,
  the Bureau refrain from mentioning "[t]he Metropolitan, either
  directly or by inference, in connection with whatever releases you may
  make." The Metropolitan official explained that "you will readily
  understand that we wish to avoid any controversy with the lead
  people." [16]

At least one other researcher experienced the heavy hand of the lead industry. Following the appearance of the Time article on Drs. Byers and Lord's study, Wormser paid Byers a personal visit in Boston and threatened to sue him. (Although no public retraction was made, the threat was never carried out.)

Shortly thereafter, the LIA turned its attention to a branch of the US government. The Children's Bureau had received numerous inquiries over the years from concerned parents who wanted to know how to identify the paints that contained lead, in order to avoid them. To address this concern the Bureau began to issue a series of pamphlets. However, the LIA mobilized its membership to flood the Bureau with letters that raised technical questions that the agency was unable to answer. Acknowledging defeat, the Bureau called off its campaign.

In a few jurisdictions this public concern translated into an attempt to regulate the industry. In 1933 the Massachusetts Division of Occupational Hygiene considered prohibiting the application of lead paint inside buildings. When Wormser became aware of this proposal, he paid a visit to the division director, Manfred Bowditch. The minutes from the LIA's 1934 annual meeting reveal the outcome:

    During the year an effort was made by the Massachusetts Department
  of Labor to establish regulations which would have seriously affected
  the use of white lead in painting buildings. This subject was
  discussed by the Secretary with the State official having the matter
  in hand and a satisfactory adjustment was procured. It was
  particularly important to obtain a hearing and settlement in
  Massachusetts otherwise we might have been plagued with an extension
  of similar restrictive painting legislation in other States, affecting
  the use of white lead. [17]

Such cordial relations were to again prove mutually "satisfactory" several years later when Bowditch, after working for the asbestos industry, became the LIA's director of health and safety.

The regulatory threat raised its ugly head again in the form of labeling requirements in California in 1945 and in Maryland and New York City in the early 1950s. In the case of California and Maryland the LIA was successful in its efforts to have the laws repealed almost immediately after enactment. The proposed New York rule was watered down to exclude the word "poison" in the warning label.

The industry's advertising also played a role--although a more subtle one--in deflecting attention from lead's toxic qualities. Many of the ads, particularly those of the National Lead Company, featured infants and young children, thereby implying that lead paint was a safe product. [18] Painting the nursery with bright and durable lead paint was a frequent theme. So was the image of children painting. To get the attention of young children and hopefully make them eventual customers, National Lead printed a series of children's paint booklets. And, of course, the little Dutch Boy was everywhere.

The public health response

What was the response of the public health community to this public health disaster? Unfortunately, the answer is all too simple: not much. Until the 1950s only one major city in the US (Baltimore) had a program to deal with the problem in a systematic manner. And although several medical journals, such as the Journal of the American Medical Association and the American Journal of Diseases of Children, published no small number of case studies, publications with a public health orientation such as the American Journal of Public Health printed no articles on the subject. The American Public Health Association, the nation's voluntary public health organization, which annually passed resolutions of public health interest, was silent on this issue until 1969. As noted above, the federal government, through its Children's Bureau, made a half-hearted attempt in the 1940s to alert the American public to the dangers of lead paint, but then retreated in the face of industry opposition.

Certainly, the causes of this inaction did not derive from an ignorance of the devastating health effects of lead poisoning. Severe stomach cramps and joint and muscle pain, extreme weakness in the ankles (ankle-drop) and the wrists (wrist-drop), blindness, convulsions, coma and death were all well-documented effects in lead-poisoned children.

One explanation of a general nature can be found in the direction that public health as a whole was taking in the 1920s and 1930s. During this era the focus of attention was on the individual rather than the environment. Charles Chapin, the health commissioner of Providence, Rhode Island, expressed the predominant view that infected individuals, rather than their environment, were responsible for the spread of disease:

    With minor exception, municipal cleanliness does little to prevent
  infection or decrease the death rate. Municipal cleanliness is no
  panacea. It will make no demonstrable difference in a city's mortality
  whether its streets are clean or not, whether the garbage is removed
  promptly or allowed to accumulate, or whether it has a plumbing
  law. [19]

With such a viewpoint it is easy to see why child lead poisoning was not seen as a public health problem, but rather one to be addressed by the individual child's parents and physician.

Perhaps of more immediate importance to the issue of lead poisoning is the fact that in matters of environmental and occupational health, research was firmly under corporate control from the 1920s until the 1960s. Government for the most part did not see itself as the leading force in evaluating, much less regulating, the toxins and other hazards created by industry. The view was that such research was best left to the corporations that created the potential hazards to workers and the public. And industry did conduct or sponsor a good deal of (self-interested) research.

How industry could determine the outcome of a controversy by controlling the terms of debate was strikingly and tragically illustrated by the case of a close relation to white lead: the gasoline additive tetraethyl lead (TEL). General Motors had been searching for a means of boosting the power of their engines without producing the "Knock" (premature combustion of the fuel/air mixture) that greatly shortened engine life.

The ability of ethanol (derived from corn) to perform such a function had recently been demonstrated, but its production would not bring large royalty payments since a patent could not be obtained for such a well-known product. To produce and bring TEL to market, GM (which was under substantial control of DuPont) and Standard Oil of New Jersey (now known as Exxon) jointly formed the Ethyl Corporation. When the deaths of several TEL (also known as ethyl) production workers and the subsequent banning of the lead additive in New York City threatened to put a permanent halt to all production of ethyl, its producers looked for a way to calm the public's fears.

Although they were well aware of TEL's likely long-term effects on the public's health, GM, DuPont and Standard Oil took control of the research agenda to yield the desired result. Such research was nominally performed at the behest of the federal government, but the dominant role played by industry figures on advisory committees and the design of the research assured a "satisfactory" result. In 1924 when the public reaction to worker deaths was becoming extremely worrisome, Ethyl contracted with the US Bureau of Mines to conduct animal studies of TEL. Included in the contract terms was the corporation's authority to approve the content and control the timing of the release of the study results.

Needless to say, the study gave ethyl a clean bill of health. When news of more deaths and illnesses from "looney gas" (as TEL came to be known because of the hallucinations it caused) produced near panic, a public meeting was called by the US Public Health Service that presumably allowed all points of view to get a fair hearing. With few exceptions, however, attendees were pro-industry figures. Standard Oil's (and Ethyl's) Frank Howard declared that we could not forgo the progress that this "gift of God" would bring out of a misplaced concern for some potential and ill-defined health effect.

Finally, to put the controversy to rest, the Surgeon General appointed an advisory committee, to conduct a definitive study and make recommendations regarding the production and sale of tetraethyl lead. However, the study, which looked at the effect of TEL on workers who had occupational exposure to the substance, took only a few months, a period of time that would not allow the observation of long-term effects. Since no ill effects were detected, TEL was soon approved for unrestricted use.

As the principal defender of the lead pigment industry's interests, the LIA funded a significant amount of lead research; so did the industry-connected foundations and institutes: the Kettering Laboratory, the Mellon Foundation, the Industrial Health Foundation. Dr. Kehoe, who directed the Kettering Laboratory, dominated the lead research field from the 1920s to the 1960s. The lead poisoning committee of the American Public Health Association was composed almost exclusively of industry personnel (including Kehoe and the DuPont Corporation's medical director). Most of the research conducted by the US Public Health Service on lead was initiated at the behest of lead-using companies, such as battery and pipe manufacturers. Not surprisingly, major health problems were not usually found, and if they were, a legislative solution was not suggested.

Lead paint "phased out"

At different times and circumstances the lead paint industry has stated that it eliminated lead from consumer paints by 1940, during the 1940s and 1950s, and by 1955. In 1970, in testimony to Congress on legislation to ban residential lead paint, the General Counsel to the National Paint, Varnish and Lacquer Association declared that the paint industry had halted the sale of lead paint for interior use over 30 years previously. At that point, because child lead poisoning was much in the news, and lead paint had a small and declining market, the industry was publicly supporting such legislation.

To further distance itself in the public's eye from a major and possibly costly public health problem, it was useful to distance itself chronologically from responsibility. Besides, at that point there were no data to expose the lie. On other occasions industry representatives point to the voluntary standard published in 1955 by the American Standards Association, which limited interior paints to 1% lead by weight. Recently, in response to actual and threatened lawsuits against the lead pigment industry, brought by both lead-poisoned children and states and cities, the lead industry has claimed that it phased out lead paint in the 1940s and 1950s when it learned of the dangers of lead paint to children. [20]

However, since lead paint's hazards were well-established by the 1920s, demonstrating that they ceased lead paint production in 1945 instead of 1955 would not appreciably reduce the industry's culpability. But the point is moot, since several federal government housing surveys conducted since the mid-1970s have conclusively shown that lead paint was applied to houses even past 1970. And when in 1971 the New York City Department of Health--to enforce its 1960 law that banned lead paint--analyzed 76 brands and types of paint offered for sale in paint and hardware stores, it found eight of them to have illegal amounts of lead. [21]

For over 50 years the lead paint industry conducted its business with full knowledge of the harm that it was causing. Our legacy is a widespread, serious childhood disease and the lead contamination of millions of homes.

Richard Rabin initiated the first lawsuit against the lead paint industry. www.sueleadindustry.homestead.com

References

1. Letter from Benjamin Franklin to Benjamin Vaughan, July 31, 1786.

2. Gibson JL: A plea for painted railings and painted walls of rooms as the source of lead poisoning amongst Queensland children. Australasian Medical Gazette 1904; 23:149-153.

3. Thomas HM, Blackfan KD: Recurrent meningitis, due to lead, in a child of five years. Am J Dis Child 1914; 8:377.

4. Blackfan KD: Lead poisoning in children with especial reference to lead as a cause of convulsions. Am J Med Sci 1917; 153:877-887.

5. Ruddock J: Lead poisoning in children. JAMA 1924; 82:1682-1684.

6. McKhann C, Vogt E: Lead poisoning in children. JAMA 1933; 101:1131-1135.

7. Ross J, Brown A: Poisonings common in children. Can J Public Health 1935; 26:237-243.

8. McDonald J, Kaplan E: Blood lead determinations a health department laboratory service. Am J Public Health 1942; 32:481-486.

9. Kehoe, R commentary in: McKhann C, Vogt E: op cit.

10. Byers R, Lord E: Late effects of lead poisoning on mental development. Am J Dis Child 1943; 66:471-494.

11. Kehoe to Wormser, February 7, 1944, LIA Papers.

12. Lanza AJ: Epidemiology of lead poisoning. JAMA 1935; 104:85-87.

13. National Paint, Varnish and Lacquer Association letter "To Class 'A' Members," July 18, 1939.

14. LIA Board of Directors Meeting, January 17, 1940, Report of the Secretary.

15. Metropolitan Life Insurance Co: Chronic lead poisoning in infancy and early childhood. Stat Bull 1930; 11(10):4-5.

16. Louis Dublin to Ella Oppenheimer, September 14, 1939, quoted in Markowitz G, Rosner D: "Cater to the Children:" the role of the lead industry in a public health tragedy, 1900-1955. Am J Public Health 2000; 90:36-46.

17. LIA Annual Meeting, June 5, 1934, Federal Trade Commission, In the Matter of National Lead Co, et al, Docket No. 5253, p. 5535.

18. Markowitz G, Rosner D, op cit.

19. Chapin CV: Selected Papers. New York: Commonwealth Fund, 1934; 213 (quoted in Ozonoff D: Failed warnings: asbestos-related disease and industrial medicine. In: Bayer R: The Health and Safety of Workers, Case Studies in the Politics of Professional Responsibility. New York and Oxford: Oxford University Press, 1988; 139-218).

20. National Paint and Coatings Association website: www.paint.org; Pendell J: The lawyers' next target: the paint industry. Wall Street Journal, October 18, 1999.

21. New York Times: August 4, 1971. p. 18.