~~~~~ sss~~~~~~~~~~~~~~~~sML
Exposure
The Centers for Disease Control (CDC) have published a major revision (1) of their 1985 statement Preventing Lead Poisoning in Young Children (2). The new CDC statement (2) relies heavily on the advice of the CDC Advisory Committee on Childhood Lead Poisoning Prevention. As the chairperson of this committee, I am writing on behalf of 11 committee members* to respond to inaccurate or outdated assertions in Joseph Palca's News & Comment article of 23 August 1991 (p. 842) and a letter by Claire B. Erhart and Sandra Scarr (14 Feb., p. 783). Our advisory committee examined new evidence on lead at low exposures as a public health problem, particularly studies conducted since issuance of the 1985 CDC statement. This evidence encompasses areas of epidemiology, experimental animal models of lead's toxic actions, and mechanistic rationales for its potent effects. The CDC committee concurs with Department of Health and Human Services Secretary Louis Sullivan's recent finding that lead is the number one environmental health threat to American children, and it concluded that the evidence linking low levels of lead exposure [10 micrograms (pug) or more per deciliter (dl) of whole blood] and a constellation of neurotoxic and other adverse effects in young children is compelling. Convincing data are contained in the recent international prospective studies of children reported in Boston (3), Cincinnati (4), and Port Pirie, Australia (5). Such studies have changed how our committee and public health agencies approach childhood lead poisoning. To characterize the pioneering study of Herbert L. Needleman and his co-workers (6), based on measurement of dentine lead in children with blood lead levels (BPb's) between 30 and 50 Ipg/dl (6), as the "backbone" of current public health policy relating to the definition, treatment, and prevention of this pervasive disease in American children ignores progress in this field during the past decade plus. The studies in Boston (3), Cincinnati (4), and Port Pirie (5) found neurobehavioral and cognitive deficits in infants exposed to lead at BPb's as low as 7 gxg/dl. The Cincinnati study (4) found effects of prenatal exposure on Mental Developmental Index scores that amounted to an 8-point deficit for each 10 ILg/dl increase in BPb. The study in Port Pirie (5) assessed children up to 4 years of age and related the integrated BPb's to the McCarthy Scales of Children's Abilities. The BPb's were observed to be inversely related at age 4, with children having cognitive scores 7.2 points less, once BPb reached 30 pIg/dl, compared with children with a BPb less than or equal 294
to 10 pig/dl (5). These and a dozen crosssectional studies are remarkably consistent in identifying the link between low levels of lead exposure during early development and neurobehavioral performance reflected in deficits in indices of early childhood development. In its day, the study by Needleman et al. (6) produced important information of considerable public health relevance. However, to say that Needleman et al.'s 1979 article (6) is the centerpiece of public health policy today is erroneous. A consensus, based on the consistency and strength of the science (1, 3- 5, 7, 8), has been readily achieved by federal agencies (1, 7, 8) concerning the adverse effects of low levels of lead [much lower levels that those examined in Needleman et al.'s initial study (6)1 on IQ and neurobehavioral development. John F. Rosen Albert Einstein College of Medicine and Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467 REFERENCES Preventing Lead Poisoning in Young Children: A Statement by the Centers for Disease Control (Centers for Disease Control, Atlanta, GA, 1991). 2. Preventing Lead Poisoning in Young Children: A Statement by the Centers for Disease Control, (DHHS #99-2230, Centers for Disease Control, 1.
Atlanta, GA, 1985). Bellinger et al., N. Engl. J. Med. 316, 1037
3. D.
(1987).
4. K. N. Dietrich et al., in Lead Exposure and Child Development: An International Asessment, M. Smith, L. D. Grant, A. Sors, Eds. (MTP Press, Lancaster, United Kingdom, 1989), pp. 320-331. 5. A. J. McMichael et al., N. Engl. J. Med. 319, 468
(1988).
6. H. L. Needleman et al., ibid. 300, 689 (1979). 7. The Nature and Extent of Childhood Lead Poisoning in the United States: A Report to Congress (Agency For Toxic Substances and Disease Registry, Public Health Service, Atlanta, GA, 1988). 8. Air Quality Criteria for Lead: Supplement to the 1986 Addendum (EPA/600-8-89-049f, Environmental Criteria and Assessment Office, Office of Research and Development, Environmental Protection Agency, Research Triangle Park, NC, Au-
gust 1990).
Comment article that are not supported by either data or logic. They neglect to mention that it was they who placed allegations against me with the National Institutes of Health Office of Scientific Integrity. In 1983, Scarr was appointed to an EPA review committee chaired by Lester Grant, Director of the Environmental Protection Agency (EPA) Criteria Office. The committee was asked to suggest possible ways of reanalyzing data on the relationship between low doses of lead and IQ. After examining my printouts and Erhart's, the committee recommended that I reclassify subjects by mean dentine lead levels, enter age into the model, and reanalyze the data. The reanalysis showed that after age was added in the regression of raw IQ scores, there was a significant association between lead and IQ (P < 0.025). This finding was presented to EPA's Clean Air Science Advisory Council (CASAC) on 27 April 1984 and published in a letter in Science (1). It is well known that IQ scores are adjusted for age. Lead in tooth is correlated with age (r = 0.2). If one adjusts for age in models that use age-adjusted outcomes, one is necessarily subtracting out variance due to lead. Such a classic case of overcontrol is a subject generally dealt with in early statistics courses.
Ernhart and Scarr were
Downloaded from on March 28, 2016
Effects of Low Levels of Lead
I---------------
present when
CASAC, having reviewed my testimony and that of EPA statistician Hugh Pitcher,
recommended that my studies be included in the Criteria Document and that the Committee report not be published. Grant, noting that the lead industry, through Hill and Knowlton, was disseminating the discarded draft report as official EPA policy, wrote to me as follows (2).
It is unfortunate that the parties concerned apparently choose to allude to the 1983 Neurobehavioral Committee Report out of context and to ignore later developments . .. [These] include the following widely known facts: (1) Reanalyses have been carried out by you and your colleagues in response to criticisms and recommendations .. [These] confirm your earlier published findings on significant associations between pediatric lead exposures and decreased IQ. Similar results were found by reanalyses of the original data set carried out by EPA's Office of Policy, Planning and Evaluation. (2) All those reanalyses were made available for public review by the [CASAC], which judged that they adequately resolved issues raised by the Neurobehavioral Committee Report. .
*Ronald L. Fletcher, Greene Memorial Hospital, Xenia, OH; Lynn R. Goldman, Department of Health Services, Emeryville, CA; Dwala S. Griffin, Board of Health, Louisville, KY; Richard J. Jackson, Chairman, American Academy of Pediatrics Committee on Environmental Hazards, California Department of Health Services, Berkeley, CA; Rudolph E. Jackson, Morehouse School of Medicine, Atlanta, GA; James C. Keck, Lead Tec Services, Baltimore, MD; Sergio Piomelli, Columbia University (Babies Hospital), New York, NY; Stephanie L. Pollack, Conservation Law Foundation of New England, Boston, MA; Noel V. Stanton, State Laboratory of Hygiene, Madison, WI; Beverly Coleman-Miller, Commission of Public Health, Washington, DC; Knut Ringen, Laborers' National Health and Safety Fund, Washington, DC.
In their letter of 14 February, Scarr and Ernhart repeat arguments attributed to them in Palca's 23 August 1991 News & SCIENCE
*
VOL. 256
*
17 APRIL 1992
In 1974, Emhart published a study that showed a relationship between lead and IQ in 80 preschoolers (3), concluding, "analysis of group data indicate quite clearly that performance on an intelligence test is impaired. ... [T]he criteria set for lead poisoning need re-examination...." In 1981,
subjects (4) and, despite finding a significant relationship between contemporary blood lead and IQ, concluded, "If there are, in fact behav-
she followed up 63 of those
ioral and intellectual sequelae at low levels these effects are minimal." of lead Within a year Ernhart was a grantee of the lead industry. EPA's comments (5) are .
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[A]n association between lead and lower Verbal Index scores was nevertheless observed across several of the analyses (at p values ranging from an association between 0.04 to 0.10) and preschool lead levels and General Cognitive Index scores approached significance at P < .09.
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At a recent international meeting, T. Greene and Emhart reported that children with elevated dentine lead levels had lower verbal IQ scores, after covariate adjustment (5). They appear to have replicated the study we published 13 years ago. Their bibliography contained no reference to the work of my group. Scarr and Emhart make no substantive claims against the three published metaanalyses of the field (6), all of which show a strong lead-IQ association, but they appear to dismiss two because I was the senior author. Meta-analysis is relatively free of experimenter bias if the methods are applied properly and the arithmetic is correct.
Science provides a way to transmute this debate from polemic to inquiry: Scarr and Erhart can check my arithmetic, and then meta-analyze the same data set, including the papers published after my analyses. Others can then evaluate their conclusions-after checking their arithmetic.
Herbert L. Needleman Western
Psychiatric Institute and Clinic, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213-2593 REFERENCES
1. H. L. Needleman, Science 227, 701 (1985). 2. L. D. Grant, personal communication, 15 May 1986. 3. J. Perino and C. B. Ernhart, J. Learn. Disabil. 7,26
(1974).
4. C. B.
Ernhart, B. Landa, N. B. Schell, Pediatrics
67, 911 (1981).
5. C. B. Ernhart and T. Greene, paper presented at the Heavy Metals in the Environment meeting, Edinburgh, United Kingdom, 16 to 20 September 1991. 6. H. L. Needleman and D. Bellinger, in Lead Exposure and Child Development: An International Assessment, M. Smith, L. Grant, A. Sors, Eds. (MTP Press, Lancaster, United Kingdom, 1988); H. L. Needleman and C. A. Gatsonic, J. Am. Med. Assoc. 263, 673 (1990); J. Schwartz, H. Pitcher, R. Levin, B. Ostro, A. L. Nicholas, Cost and Benefits of Reducing Lead in Gasoline: Final
Regulatory Impact Analysis (Office of Policy Analysis, Environmental Protection Agency, Washington, DC, 1985).
your old
Bibliographic
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Niles & Associates, Inc. 2000 Hearst Ave. #200 Berkeley, CA 94709 Phone: (510) 649-8176 Fax: (510) 649-8179 A=
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Exposure
The Centers for Disease Control (CDC) have published a major revision (1) of their 1985 statement Preventing Lead Poisoning in Young Children (2). The new CDC statement (2) relies heavily on the advice of the CDC Advisory Committee on Childhood Lead Poisoning Prevention. As the chairperson of this committee, I am writing on behalf of 11 committee members* to respond to inaccurate or outdated assertions in Joseph Palca's News & Comment article of 23 August 1991 (p. 842) and a letter by Claire B. Erhart and Sandra Scarr (14 Feb., p. 783). Our advisory committee examined new evidence on lead at low exposures as a public health problem, particularly studies conducted since issuance of the 1985 CDC statement. This evidence encompasses areas of epidemiology, experimental animal models of lead's toxic actions, and mechanistic rationales for its potent effects. The CDC committee concurs with Department of Health and Human Services Secretary Louis Sullivan's recent finding that lead is the number one environmental health threat to American children, and it concluded that the evidence linking low levels of lead exposure [10 micrograms (pug) or more per deciliter (dl) of whole blood] and a constellation of neurotoxic and other adverse effects in young children is compelling. Convincing data are contained in the recent international prospective studies of children reported in Boston (3), Cincinnati (4), and Port Pirie, Australia (5). Such studies have changed how our committee and public health agencies approach childhood lead poisoning. To characterize the pioneering study of Herbert L. Needleman and his co-workers (6), based on measurement of dentine lead in children with blood lead levels (BPb's) between 30 and 50 Ipg/dl (6), as the "backbone" of current public health policy relating to the definition, treatment, and prevention of this pervasive disease in American children ignores progress in this field during the past decade plus. The studies in Boston (3), Cincinnati (4), and Port Pirie (5) found neurobehavioral and cognitive deficits in infants exposed to lead at BPb's as low as 7 gxg/dl. The Cincinnati study (4) found effects of prenatal exposure on Mental Developmental Index scores that amounted to an 8-point deficit for each 10 ILg/dl increase in BPb. The study in Port Pirie (5) assessed children up to 4 years of age and related the integrated BPb's to the McCarthy Scales of Children's Abilities. The BPb's were observed to be inversely related at age 4, with children having cognitive scores 7.2 points less, once BPb reached 30 pIg/dl, compared with children with a BPb less than or equal 294
to 10 pig/dl (5). These and a dozen crosssectional studies are remarkably consistent in identifying the link between low levels of lead exposure during early development and neurobehavioral performance reflected in deficits in indices of early childhood development. In its day, the study by Needleman et al. (6) produced important information of considerable public health relevance. However, to say that Needleman et al.'s 1979 article (6) is the centerpiece of public health policy today is erroneous. A consensus, based on the consistency and strength of the science (1, 3- 5, 7, 8), has been readily achieved by federal agencies (1, 7, 8) concerning the adverse effects of low levels of lead [much lower levels that those examined in Needleman et al.'s initial study (6)1 on IQ and neurobehavioral development. John F. Rosen Albert Einstein College of Medicine and Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467 REFERENCES Preventing Lead Poisoning in Young Children: A Statement by the Centers for Disease Control (Centers for Disease Control, Atlanta, GA, 1991). 2. Preventing Lead Poisoning in Young Children: A Statement by the Centers for Disease Control, (DHHS #99-2230, Centers for Disease Control, 1.
Atlanta, GA, 1985). Bellinger et al., N. Engl. J. Med. 316, 1037
3. D.
(1987).
4. K. N. Dietrich et al., in Lead Exposure and Child Development: An International Asessment, M. Smith, L. D. Grant, A. Sors, Eds. (MTP Press, Lancaster, United Kingdom, 1989), pp. 320-331. 5. A. J. McMichael et al., N. Engl. J. Med. 319, 468
(1988).
6. H. L. Needleman et al., ibid. 300, 689 (1979). 7. The Nature and Extent of Childhood Lead Poisoning in the United States: A Report to Congress (Agency For Toxic Substances and Disease Registry, Public Health Service, Atlanta, GA, 1988). 8. Air Quality Criteria for Lead: Supplement to the 1986 Addendum (EPA/600-8-89-049f, Environmental Criteria and Assessment Office, Office of Research and Development, Environmental Protection Agency, Research Triangle Park, NC, Au-
gust 1990).
Comment article that are not supported by either data or logic. They neglect to mention that it was they who placed allegations against me with the National Institutes of Health Office of Scientific Integrity. In 1983, Scarr was appointed to an EPA review committee chaired by Lester Grant, Director of the Environmental Protection Agency (EPA) Criteria Office. The committee was asked to suggest possible ways of reanalyzing data on the relationship between low doses of lead and IQ. After examining my printouts and Erhart's, the committee recommended that I reclassify subjects by mean dentine lead levels, enter age into the model, and reanalyze the data. The reanalysis showed that after age was added in the regression of raw IQ scores, there was a significant association between lead and IQ (P < 0.025). This finding was presented to EPA's Clean Air Science Advisory Council (CASAC) on 27 April 1984 and published in a letter in Science (1). It is well known that IQ scores are adjusted for age. Lead in tooth is correlated with age (r = 0.2). If one adjusts for age in models that use age-adjusted outcomes, one is necessarily subtracting out variance due to lead. Such a classic case of overcontrol is a subject generally dealt with in early statistics courses.
Ernhart and Scarr were
Downloaded from on March 28, 2016
Effects of Low Levels of Lead
I---------------
present when
CASAC, having reviewed my testimony and that of EPA statistician Hugh Pitcher,
recommended that my studies be included in the Criteria Document and that the Committee report not be published. Grant, noting that the lead industry, through Hill and Knowlton, was disseminating the discarded draft report as official EPA policy, wrote to me as follows (2).
It is unfortunate that the parties concerned apparently choose to allude to the 1983 Neurobehavioral Committee Report out of context and to ignore later developments . .. [These] include the following widely known facts: (1) Reanalyses have been carried out by you and your colleagues in response to criticisms and recommendations .. [These] confirm your earlier published findings on significant associations between pediatric lead exposures and decreased IQ. Similar results were found by reanalyses of the original data set carried out by EPA's Office of Policy, Planning and Evaluation. (2) All those reanalyses were made available for public review by the [CASAC], which judged that they adequately resolved issues raised by the Neurobehavioral Committee Report. .
*Ronald L. Fletcher, Greene Memorial Hospital, Xenia, OH; Lynn R. Goldman, Department of Health Services, Emeryville, CA; Dwala S. Griffin, Board of Health, Louisville, KY; Richard J. Jackson, Chairman, American Academy of Pediatrics Committee on Environmental Hazards, California Department of Health Services, Berkeley, CA; Rudolph E. Jackson, Morehouse School of Medicine, Atlanta, GA; James C. Keck, Lead Tec Services, Baltimore, MD; Sergio Piomelli, Columbia University (Babies Hospital), New York, NY; Stephanie L. Pollack, Conservation Law Foundation of New England, Boston, MA; Noel V. Stanton, State Laboratory of Hygiene, Madison, WI; Beverly Coleman-Miller, Commission of Public Health, Washington, DC; Knut Ringen, Laborers' National Health and Safety Fund, Washington, DC.
In their letter of 14 February, Scarr and Ernhart repeat arguments attributed to them in Palca's 23 August 1991 News & SCIENCE
*
VOL. 256
*
17 APRIL 1992
In 1974, Emhart published a study that showed a relationship between lead and IQ in 80 preschoolers (3), concluding, "analysis of group data indicate quite clearly that performance on an intelligence test is impaired. ... [T]he criteria set for lead poisoning need re-examination...." In 1981,
subjects (4) and, despite finding a significant relationship between contemporary blood lead and IQ, concluded, "If there are, in fact behav-
she followed up 63 of those
ioral and intellectual sequelae at low levels these effects are minimal." of lead Within a year Ernhart was a grantee of the lead industry. EPA's comments (5) are .
NEW!
EndNote Plus for the IBM PC is shipping!
..
noteworthy.
[A]n association between lead and lower Verbal Index scores was nevertheless observed across several of the analyses (at p values ranging from an association between 0.04 to 0.10) and preschool lead levels and General Cognitive Index scores approached significance at P < .09.
Upgrade
...
At a recent international meeting, T. Greene and Emhart reported that children with elevated dentine lead levels had lower verbal IQ scores, after covariate adjustment (5). They appear to have replicated the study we published 13 years ago. Their bibliography contained no reference to the work of my group. Scarr and Emhart make no substantive claims against the three published metaanalyses of the field (6), all of which show a strong lead-IQ association, but they appear to dismiss two because I was the senior author. Meta-analysis is relatively free of experimenter bias if the methods are applied properly and the arithmetic is correct.
Science provides a way to transmute this debate from polemic to inquiry: Scarr and Erhart can check my arithmetic, and then meta-analyze the same data set, including the papers published after my analyses. Others can then evaluate their conclusions-after checking their arithmetic.
Herbert L. Needleman Western
Psychiatric Institute and Clinic, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213-2593 REFERENCES
1. H. L. Needleman, Science 227, 701 (1985). 2. L. D. Grant, personal communication, 15 May 1986. 3. J. Perino and C. B. Ernhart, J. Learn. Disabil. 7,26
(1974).
4. C. B.
Ernhart, B. Landa, N. B. Schell, Pediatrics
67, 911 (1981).
5. C. B. Ernhart and T. Greene, paper presented at the Heavy Metals in the Environment meeting, Edinburgh, United Kingdom, 16 to 20 September 1991. 6. H. L. Needleman and D. Bellinger, in Lead Exposure and Child Development: An International Assessment, M. Smith, L. Grant, A. Sors, Eds. (MTP Press, Lancaster, United Kingdom, 1988); H. L. Needleman and C. A. Gatsonic, J. Am. Med. Assoc. 263, 673 (1990); J. Schwartz, H. Pitcher, R. Levin, B. Ostro, A. L. Nicholas, Cost and Benefits of Reducing Lead in Gasoline: Final
Regulatory Impact Analysis (Office of Policy Analysis, Environmental Protection Agency, Washington, DC, 1985).
your old
Bibliographic
Software now!
Good News for Dos and Windows users! EndNote Plus on the PC is shipping! If you're Word for Windows, Wordusing Microsoft Perfect, or WordPerfect for Windows, EndNote Plus can save you hours of work! You want to cite a paper? Simply switch to EndNote Plus, select the reference and paste it into any of these word processors! When your paper, select a you're ready to submit and EndNote Plus will forbibliographic style mat both the bibliography and the in-text citations according to the selected style.
* Can I easily move between fields even if I'm not finished entering one? * Can I add fields for my own use? Are there fields for abstracts and notes? to al these quesIf you answered "ayesEndNote Plus. tions, you're using
Unbiased Opinion:
Obviously, we're a little biased, so here's what the press has said about our products: "the dear winner in the bibliographic data-MacGuide base management race." "[it does] practically everything except type in the data" -Personal Computer World Why is EndNote Phs Better? "The results we got from EndNote Plus were 'lts all in the details" -MacWeek outstanding." Most bibliographic software packages in- "EndNote Plus is a terrific bargain." -Information Today clude basic features like the ability to search for references and output them in different formats. But as one of our users told us Importno Other Programs "It's all in the details". The differrecently: ences emerge when you ask yourself ques- We realize that you may have thousands of records in your old program, so we made it tions like these: easier for you to switch. We have instruc* Can my records include expressions like a tions on transferring data from several biblior 14C and diacritical marks like e or i? ographic programs into EndNote Plus. Call * Does my software reformat just the bibli- us to see if these instructions cover the softography or also the in-text citations? ware you currently use. * Does it work directly with Windows word processors? with WordPerfect? * Does it support different reference types? Upgrade Now for $169 (e.g. journal articles, books, theses, etc.) If you upgrade before 5/30/92, you'll pay just * Does it output the bibliography in my $169 instead of $249. Send a photocopy of word processor or just as an ASCII file? the first page of the manual of any biblio* Will it take me less than 5 minutes to graphic software (PC or Mac). Attach it to teach a student how to enter data? your check or fax it with your university pur* Can it output authors with full names or chase order to (510) 649-8179. If you're not initials? with or without periods? with or 100% happy with EndNote Plus, simply without spaces? with or without commas? return it within 30 days and we will refund * Does it have a TSR? If does it allow me so,
to add, edit and search references? * Can it output the first author's name as J. Smith and the second author as Johns, G.? * Will it find records quickly and easily? * Can I share data with Mac users without loosing Greek characters and diacriticals? * Can I easily create my own style? * Is it completely free of copy-protection? *Was it updated in the last 12 months?
your money. I
J
Niles & Associates, Inc. 2000 Hearst Ave. #200 Berkeley, CA 94709 Phone: (510) 649-8176 Fax: (510) 649-8179 A=
~* ^-=~
Purchase orders accepted only from universities in the U.S. All trademarks acknowledged.
Circle No. 6 on Readers' Service Card
