Skip to main content
University of California Press

Lead Wars

The Politics of Science and the Fate of America's Children

by Gerald Markowitz (Author), David Rosner (Author)
Price: $29.95 / £25.00
Publication Date: Apr 2013
Edition: 1st Edition
Title Details:
Rights: World
Pages: 326
ISBN: 9780520954953
Series:

Read an Excerpt

1

Introduction

A Legacy of Neglect

In August 2001, the Court of Appeals of Maryland, that state's highest court, handed down a strongly worded, even shocking opinion in what has become one of the most contentious battles in the history of public health, a battle that goes to the heart of beliefs about what constitutes public health and what our responsibility to others should be. The court had been asked to decide whether or not researchers at Johns Hopkins University, among the nation's most prestigious academic institutions, had engaged in unethical research on children. The case pitted two African American children and their families against the Kennedy Krieger Institute (KKI), Johns Hopkins's premier children's clinic and research center, which in the 1990s had conducted a six-year study of children who were exposed by the researchers to differing amounts of lead in their homes.

Organized by two of the nation's top lead researchers and children's advocates, J. Julian Chisolm and Mark Farfel, the KKI project was designed to find a relatively inexpensive, effective method for reducing-though not eliminating-the amount of lead in children's homes and thereby reducing the devastating effect of lead exposure on children's brains and, ultimately, on their life chances. For the study, the Johns Hopkins researchers had recruited 108 families of single mothers with young children to live in houses with differing levels of lead exposure, ranging from none to levels just within Baltimore's existing legal limit, and then measured the extent of lead in the children's blood at periodic intervals. By matching the expense of varying levels of lead paint abatement with changing levels of lead found in the blood, the researchers hoped to find the most cost-effective means of reducing childhood exposure to the toxin. Completely removing lead paint from the homes, Chisolm and Farfel recognized, would be ideal for children's health; but they believed, with some justification, that a legal requirement to do so would be considered far too costly in such politically conservative times and would likely result in landlord abandonment of housing in the city's more poverty-stricken districts.

Despite the intentions of KKI researchers to benefit children, the court of appeals found that KKI had engaged in highly suspect research that had direct parallels with some of the most infamous incidents of abuse of vulnerable populations in the twentieth century. The KKI project, the court argued, differed from but presented "similar problems as those in the Tuskegee Syphilis Study, ... the intentional exposure of soldiers to radiation in the 1940s and 50s, the test involving the exposure of Navajo miners to radiation ... and the secret administration of LSD to soldiers by the CIA and the army in the 1950s and 60s." The research defied many aspects of the Nuremberg Code, the court said, and included aspects that were similar to Nazi experimentation on humans in the concentration camps and the "notorious use of 'plague bombs' by the Japanese military in World War II where entire villages were infected in order for the results to be 'studied.'" More specifically, the court was appalled that many of the children selected for the study were recruited to live in homes where the researchers knew they would be exposed to lead and thus knowingly placed in harm's way. Children, the court argued, "are not in our society the equivalent of rats, hamsters, monkeys and the like." The court was deeply troubled that a major university would conduct research that might permanently damage children, given what was already known about the effects of lead.

How could two public health researchers who had devoted their scientific lives to alleviating one of the oldest and most devastating neurological conditions affecting children be likened to Nazis? Was this just a "rogue court," an out-of-control panel of judges, as many in the public health community would argue? These were the questions that initially drew our attention. We soon became aware, however, of the much more complex and troubling story underlying the case, about not just the KKI research but also the public health profession, the nation's dedication to the health of its citizens in the new millennium, and the conundrum that we as a society face when confronting revelations about a host of new environmental threats in the midst of a conservative political culture. In its ubiquity and harm, lead is an exemplary instance of these threats. Yet there are many others we encounter in everyday life that entail similar issues, from mercury in fish and emitted by power plants to cadmium, certain flame retardants, and bisphenol A, the widely distributed plastics additive that has been identified as a threat to children.

For much of its history, the public health field provided the vision and technical expertise for remedying the conditions-both biological and social-that created environments conducive to harm and within which disease could spread. And throughout much of the profession's history, public health leaders have joined with reformers, radicals, and other social activists to finds ways within the existing political and economic structures to prevent diseases. Although the medical profession has often been given credit for the vast improvements in Americans' health and life span, the nineteenth- and early-twentieth century public health reformers who pushed for housing reforms, mass vaccination campaigns, clean water and sewage systems, and pure food laws in fact played a major role in improving children's health, lowering infant mortality, and limiting the impact of viral and bacterial diseases such as cholera, typhoid, diphtheria, smallpox, tuberculosis, measles, and whooping cough. In the opening years of the twentieth century, for example, Chicago's public health department joined with Jane Addams and social reformers at Hull House to successfully advocate for new housing codes that, by reducing overcrowding and assuring fresh air in every room, led to reduced rates of tuberculosis. And New York's Commissioner of Health Hermann Biggs worked with Lillian Wald and other settlement house leaders to initiate nursing services for the poor, pure milk campaigns, vaccination programs, and well-baby clinics that dramatically reduced childhood mortality. Biggs, Addams, and other Progressives worked from a firm conviction that as citizens we have a collective responsibility to maintain conditions conducive to every person's health and well-being.

These broad public health campaigns to control infectious diseases yielded great victories from the 1890s through the 1930s. But with the first decades of the twentieth century, a different view of the profession began to gain ascendancy, redefining the mission of public health in ways that belied its role as an agent of social reform. In 1916 Hibbert Hill, a leading advocate of this new direction, put it this way: "The old public health was concerned with the environment; the new is concerned with the individual. The old sought the sources of infectious disease in the surroundings of man; the new finds them in man himself. The old public health ... failed because it sought [the sources] ... in every place and in every thing where they were not." In this view, the idea was for the fast-growing science of biological medicine to concentrate on treating disease person by person rather than on eradicating conditions that facilitated disease and its spread, in some cases encouraging reforms in behavior to reduce individual exposure to harm. Hence, like numerous other fields in the early decades of the century, public health became professionalized, imbuing itself with the aura of science and setting itself off as possessing special expertise.

By the middle decades of the twentieth century, public health officials thus typically conceived of their field mainly as a laboratory-based scientific enterprise, and many public health professionals saw their work as a technocratic and scientific effort to control the agents that imperiled the public's health individual by individual. We can see this shift in perspective in treating tuberculosis, for example. An infectious disease that terrified the American public in the eighteenth and nineteenth centuries, tuberculosis had begun to decline as a serious threat by the early twentieth century, mainly because of housing reforms, improvements in nutritional standards, and general environmental sanitation. By midcentury, public health officials tended to downplay such environmental conditions and came to rely instead on the armamentarium of new antibiotic therapies to address the relatively small number of tuberculosis victims. The history of responding to industrial accidents and disease offers another example. In the early

About the Book

In this incisive examination of lead poisoning during the past half century, Gerald Markowitz and David Rosner focus on one of the most contentious and bitter battles in the history of public health. Lead Wars details how the nature of the epidemic has changed and highlights the dilemmas public health agencies face today in terms of prevention strategies and chronic illness linked to low levels of toxic exposure. The authors use the opinion by Maryland’s Court of Appeals—which considered whether researchers at Johns Hopkins University’s prestigious Kennedy Krieger Institute (KKI) engaged in unethical research on 108 African-American children—as a springboard to ask fundamental questions about the practice and future of public health. Lead Wars chronicles the obstacles faced by public health workers in the conservative, pro-business, anti-regulatory climate that took off in the Reagan years and that stymied efforts to eliminate lead from the environments and the bodies of American children.

About the Author

Gerald Markowitz is Distinguished Professor of History at John Jay College and the Graduate Center of the City University of New York. He is, along with David Rosner, coauthor of Deceit and Denial: The Deadly Politics of Industrial Pollution (UC Press), and eight other books.

David Rosner is Ronald Lauterstein Professor of Public Health and Professor of History at Columbia University and Co-director of the Center for the History and Ethics of Public Health at Columbia's Mailman School of Public Health. In 2010 he was elected to the Institute of Medicine of the National Academy of Sciences.

Table of Contents

Foreword
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

Reviews

“In Lead Wars, CUNY’s Gerald Markowitz and Columbia University’s David Rosner convincingly show that the Baltimore toddler study emerged from a century of policymaking in which the US government, faced at times with a choice between protecting children from lead poisoning and protecting the businesses that produced and marketed lead paint, almost invariably chose the latter.”
New York Review of Books
"Chronicles the monstrous irresponsibility of companies in the lead industry over the course of the 20th century."
New York Times
“A fascinating new book.”
PBS Newshour
"Thoroughly researched and clearly written, this book does an excellent job of illustrating the problem society encounters when science and industry face off over likely harm versus economic benefit."
Library Journal
"A deeply conceived and well-written book by two of America's best public health historians. It's also an important background briefing on the politics and ethics of scientific research for journalists who will be covering environmental health issues like these."
SE Journal
"The definitive history of childhood lead poisoning in the United States."
Bulletin of the History of Medicine

"Lead Wars is full of ideas and interpretations that historians and other scholars will grapple with for some time. . . . It is hard to recommend this well-researched, well-written, and well-conceptualized book enough."

H-Net
"The prolific team of Gerald Markowitz and David Rosner has done it again. Lead Wars: The Politics of Science and the Fate of America’s Children is a thoroughly researched, passionate, and gripping history of a major public health problem. . . . Lead Wars challenges us to take better care of our children by fighting those industries that appear to regard them—especially poor black and Latino children—as disposable."
Health Affairs
"Lead Wars is not a happy story, nor does it have a happy ending. It is a sobering, cautionary, and ongoing tale."
Social Forces
Lead Wars clearly shows that the scandalous and tragic history of lead is one that our society is doomed to repeat over and over again unless we develop and fight for better safeguards against chemicals and new technology.”
Mother Nature Network
"Thought provoking and well argued, Lead Wars is an excellent book. . . . [Highly recommended] to anyone with interests in lead poisoning, public health, political economy, and the intersection of science and public policy."
Business History Review
"I want to thank David Rosner and Gerald Markowitz for what that they've done to bring the story of the lead paint wars to the public."—Senator Sheldon Whitehouse

“The story Rosner and Markowitz tell of generations of children gravely damaged by promiscuous dispersal of lead, and the persistent attempts made to evade responsibility for the harms caused, is both true and shocking. This book will not just educate future environmental and health leaders, it should outrage them.”—Richard J. Jackson MD, MPH, Professor and Chair, Environmental Health Sciences, UCLA Fielding School of Public Health

"Lead Wars argues that the tragedy of lead is one that our society is doomed to repeat again and again unless we develop better safeguards to protect us against chemicals and new technology. This book is a "must read" for public health professionals as well as for political scientists, social historians and for all who care about the future of America's children."—Philip J. Landrigan MD, Ethel H. Wise Professor of Community Medicine and Chairman in the Department of Preventive Medicine at the Mount Sinai School of Medicine

"Can being poor justify differing standards for research or a focus merely on harm reduction and the politically feasible? Markowitz and Rosner make the compelling case that in public health the practical and possible may in the end be immoral and dangerous, and a consequence of the war on science. A necessary read for anyone who cares about public health, the role of government, children, medical experimentation and environmental justice."—Susan M. Reverby, McLean Professor in the History of Ideas and Professor of Women's and Gender Studies, Wellesley College

“Lead poisoning remains a tragedy (and scandal) of immense proportions, and the authors utilize new sources—including previously unexamined court records—to tell a story that is as gripping as it is important.”—Robert N. Proctor, Professor of the History of Science at Stanford University and author of Cancer Wars

"This book tells the story of a public health tragedy affecting millions of children, the determined doctors who tried to help, and an industry propaganda campaign which prolonged and worsened the tragedy. For as long as powerful corporations manipulate politicians and public opinion to profit from dangerous products, this will remain an important story for our country."—Sheldon Whitehouse, United States Senator

"Lead Wars makes clear the public health dangers we face if we continue to ignore this corporate strategy that defines “acceptable” levels of risk for the thousands of chemicals in use. It brings home the importance now more than ever of taking a precautionary approach to managing toxic chemicals. This book is a must for any activist who wants to understand the strategies polluters use to continue business as usual."—Lois Marie Gibbs, Executive Director, Center for Health, Environment & Justice

"In this outstanding book, Gerald Markowitz and David Rosner utilize historical scholarship to expose a major tragedy in recent public health: the failure to protect children from the harms of lead in our environment. Despite the fact that the toxic effects of lead have been known for centuries, they show—using previously unavailable documents—how the lead industry has protected their profits at public expense, despite their explicit knowledge of its many dangers. Lead Wars brings this tragic history to light in a narrative that integrates deep investigation and analysis with compelling advocacy and compassion for children who continue to be at risk from one of the world’s best-known toxins."—Allan M. Brandt, Professor of the History of Medicine at Harvard University, and author of The Cigarette Century: The Rise, Fall, and Deadly Persistence of the Product That Defined America

"Markowitz and Rosner have majestically woven the key characters and elements of the history of lead poisoning into a captivating narrative that exposes a tremendous and terrifying truth; unless it serves the needs of private enterprise, public health is incapable of controlling the causes of chronic disease and disability. In place of prevention, we have settled for partial solutions. Everyone who has an interest in public health, health policy or history should read this book."—Bruce Lanphear, MD, MPH, Clinician Scientist, Child & Family Research Institute BC Children’s Hospital and Professor of Health Sciences, Simon Fraser University, Vancouver, BC

Media

Watch Senator Sheldon Whitehouse laud David Rosner and Gerald Markowitz for their work on Lead Wars.