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      For Andrea and Kathy

      And

      In memory of John Rosen, MD, whose life was dedicated to protecting children and their families from the scourge of lead poisoning.

      Contents

		Foreword by Carmen Hooker Odom and Samuel L. Milbank
		Preface
		Acknowledgments
1.		INTRODUCTION: A LEGACY OF NEGLECT
2.		FROM PERSONAL TRAGEDY TO PUBLIC HEALTH CRISIS
3.		PEELING THE ONION: NEW LAYERS OF THE LEAD PROBLEM
4.		THE CONTENTIOUS MEANING OF LOW-LEVEL EXPOSURES
5.		THE RISE OF PUBLIC HEALTH PRAGMATISM
6.		CONTROLLED POISON
7.		RESEARCH ON TRIAL
8.		LEAD POISONING AND THE COURTS
9.		A PLAGUE ON ALL OUR HOUSES
		Notes
		Index

      Foreword

      The Milbank Memorial Fund is an endowed operating foundation that works to improve health by helping decision makers in the public and private sectors acquire and use the best available evidence to inform policy for health care and population health. The Fund has engaged in nonpartisan analysis, study, research, and communication since its inception in 1905.

      Lead Wars: The Politics of Science and the Fate of America’s Children, by Gerald Markowitz and David Rosner, is the twenty-fourth book in the series California/Milbank Books on Health and the Public. The publishing partnership between the Fund and the University of California Press encourages the synthesis and communication of findings from research and experience that could contribute to more effective health policy.

      Markowitz and Rosner’s first book published in the California/Milbank series, Deceit and Denial: The Deadly Politics of Industrial Pollution, provided the early history of the lead industry’s efforts to sell its product while knowing the devastating health effects it had on those exposed to it, particularly factory workers employed in lead-based industries and children living in homes decorated with lead paint. In Lead Wars, the authors reveal how this preventable, century-long public health scourge continues to plague children because partial removal of lead from homes—a process that proponents claim yields safe levels of lead—has been the chosen policy over complete abatement. While children rarely die of lead poisoning today, their exposure to “safe” levels of lead, instead of being protective, has caused them irreparable damage in the form of neurological, physiological, and behavioral problems.

      Lead Wars underscores the present-day challenge of public health, with the field’s shift of focus from prevention to harm reduction in the face of declining resources, lack of political mandate, and questionable professional will. As a result of the authors’ thorough research and analysis, this book will provide compelling reading for historians, sociologists, public health officials, ethicists, environmentalists, and anyone else interested in the effects that public policies have on people’s health and the environment.

      Carmen Hooker Odom

      President, Milbank Memorial Fund

      Samuel L. Milbank

      Chairman, Milbank Memorial Fund

      Preface

      In 1996 the City of New York Law Department asked us if we would evaluate a huge cache of documents they had received on lead poisoning and the lead industry. Several families whose children had been injured by lead paint used in some of the city’s public housing had sued the City; the City, in turn, had filed a suit against the lead industry, claiming that the industry bore some responsibility for injuries to these children. Through the discovery process the City had now amassed a roomful of documents that were drawn largely from the Lead Industries Association, the trade association for manufacturers of lead paint and other lead-bearing products. What, the City wanted to know, was in these voluminous papers it had accumulated? Could we help them figure out what these records showed about the history of lead, lead pigment, lead poisoning, and what the industry knew of lead’s dangers? Thus began a journey into the world of childhood lead poisoning that led ultimately to the writing of this book.

      What we found in that roomful of material and the further investigations it spurred became the basis for part of our earlier book, Deceit and Denial: The Deadly Politics of Industrial Pollution. That account of industry’s role in the development of a public-health tragedy would not have been possible without litigation, which brought to light literally hundreds of thousands of pages of company documents. In fact, without the cases, historians would never have seen internal memos and minutes of meetings in which company representatives from the National Lead or Sherwin-Williams companies, among others, discussed among themselves the dangers that lead paint posed to children as early as the 1920s. Nor would we have been able to learn of marketing campaigns aimed at counteracting public concerns over the dangers of lead—ads claiming lead paint was safe, sanitary, and useful on children’s walls, furniture, and the like.

      The documents gave us a new perspective on the history of lead poisoning, especially childhood lead poisoning, and its effects. The immediate fruit of our efforts was a lengthy affidavit that became part of the New York City case and then was quickly incorporated in other legal actions that, by the end of 2002, were under way in Chicago, New York, Buffalo, San Francisco, St. Louis, Milwaukee, and other cities around the country. Some of these cases were quickly dismissed by judges, but others were allowed to go forward. We were contacted and agreed to serve as expert witnesses in a number of these suits and, subsequently, other ones.

      As we were preparing Deceit and Denial, the Attorney General’s Office of Rhode Island asked if we would serve as historical consultants and, possibly, expert witnesses, in what would prove to be a groundbreaking lawsuit against the lead pigment industry.¹ After years of document review and preparation, we were each deposed for many days and then appeared on the stand as experts for six days each. The jury verdict in favor of the State was exhilarating for us: history, we saw, had played an important role in addressing one of public health’s oldest and most frustrating epidemics—childhood lead poisoning. Two years later, however, Rhode Island’s Supreme Court overturned the jury verdict, reasoning that the case had been brought to court under the wrong law.² Controlling the lead poisoning disaster, like resolving so many other environmental problems that currently plague the nation, would require more than history and good science.

      In 2006 we were asked to testify about the history of lead poisoning in Maryland’s House of Delegates in conjunction with a hearing on proposed legislation. Lead poisoning had a special resonance in Maryland at the time because of the continuing epidemic that affected Baltimore’s children in particular and because of a highly controversial court case that had attracted national attention and was still fresh in the minds of community advocates, researchers, and legislators. This case, which revolved around research conducted at Johns Hopkins University involving more than a hundred African American children, is a leitmotif that runs through this book. As we looked into the case (in which we had played no role) and the circumstances behind it, we realized that it offered a window into the broader arguments about lead poisoning, society, and the emerging scientific evidence on the harmful health effects of relatively low-level exposure to various pollutants, lead among them.

      If the history of lead poisoning has taught us anything, it is that the worlds we as a society construct, or at least allow to be built in our name, to a large extent determine how we live and how we die. The social, economic, political, and physical environments humans create bring about specific diseases that are emblematic of these conditions. If poverty, for example, and great disparities of wealth result in those on the bottom of the social scale living in crowded conditions without access to pure water, adequate sanitation, or pure air, we can expect infectious and communicable diseases to predominate as they did in nineteenth-century American cities. If we systematically pollute our water and air, we can expect chronic diseases emblematic of the late twentieth century to predominate.

      Lead poisoning is a classic example of what happens when we take a material that was once buried deep underground and

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