Letters to the Editor

Published the week of April 19, 2000

The lead problem in St. Louis is a perfect example of a major public-health conundrum that primarily affects the poor, disempowered and politically ignorant segments of our city's population ("The Lead Menace," RFT, April 12). This problem would be well on its way to being solved if it affected children residing in the more affluent parts of western St. Louis County.

As a pediatrics resident at St. Louis Children's Hospital, I have the opportunity to spend a half-day a week at one of the Grace Hill neighborhood health centers, a facility that serves a population greatly burdened with the "lead menace" and a population whose inability to gain safe and comfortable housing is quite frustrating. I have personally witnessed the difficulty in mobilizing community resources for violations as blatant as rat infestation, not to mention lead. Luckily, the presence of strong extended family networks sometimes allows children in danger to live temporarily in a "lead safe" environment, but, as your article states, it does not always mean the child is no longer lead-exposed.

Children have the right to live not only in homes and neighborhoods that ensure their physical safety and emotional well-being but also in environments that at the very least don't threaten their neurobehavioral potential in the long term. Children are remarkably resilient in recovering from acute illnesses, but the long-term effects of lead poisoning are insidious in onset and irreparable. I agree that the responsibility for solving the lead problem falls on us all, but physicians are in a unique position to advocate for the children we serve, and I sometimes think we fall quite short of that role. Indeed, we are involved with children who are admitted to the hospital for lead-chelation therapy, but these children are the tip of the iceberg. I have a feeling that a larger chunk of that iceberg are the hundreds of children we see every year in our clinics with so-called behavior problems. But, sadly, public health is not emphasized in the major health institutions in this city, even though physicians could have a great impact on the lead problem if we decided to speak up and devote time and energy to advocacy.
Nadim Kanafani

Thank you for printing an article that is useful in helping to reduce childhood lead poisoning. It would be interesting to read a piece on the situation that middle-class and affluent families have with lead exposure. Members of the Kennedy family and even Millie the White House dog (pet of then-First Lady Barbara Bush) have gotten lead poisoning. Lead exposure knows no class boundaries.

The line "The problem continues to disproportionately affect poor children and minorities in central cities with older housing" is correct. For just about every environmental and health problem that exists, the poor are disproportionately affected because they generally have poorer nutrition, access to health care, access to adequate housing, etc. The situation for children in middle-class and affluent families with respect to lead is more complex than most media coverage suggests.

Lead exposure is the No. 1 environmental health threat to young children. Guidelines for St. Louis state that all children aged 6 and under should be screened for lead. Unfortunately, many middle-class and affluent young children are not tested even once. The "1998 Lead Surveillance Annual Report" (St. Louis Health Department) tracks by ZIP-code area the percentages of children screened for lead. ZIP codes 63109 and 63139, residential areas of the city, only had 5 and 7 percent, respectively, of the children tested. Since 95 and 93 percent of the children in these ZIP codes are not being screened, one cannot say that they are not being affected.

Most of the housing in these ZIP-code areas was built before 1950 and certainly contains lead paint on porches, doors and interior wood trim and in window wells.

Until parents and all pediatricians start recognizing that all young St. Louis-area children going to schools built before 1950 and/or living in pre-1950s housing are at risk, only mandatory universal lead screening of young children will identify these cases. How many middle-class children are being treated for "hyperactivity" and learning disabilities who wouldn't need to be if they lived in lead-safe housing and had been screened for lead? Screening, of course, is only an interim solution.

The real solution is to make all housing at least lead-safe and effectively lead-free.

With respect to the lawsuit against the lead-paint manufacturers, a settlement may be reached sooner than people think. A trust created by Eagle-Picher Industries Inc. has solicited scientists to determine ways to "fingerprint" paint chips to tie them to the paint's manufacturer. When scientists figure this out, the lead-paint manufacturers will probably come to the negotiating table rather quickly.

Carol A. Prombo, Ph.D.,
Lecturer in Science, University College
Washington University

When I read that Jill Posey-Smith would no longer be chopping up restaurants for the RFT, I almost did a cartwheel in my cannelloni. (Whoops! I'm starting to lapse into Jill's florid style of overwritten prose. Most unbecoming. Somebody stop me.)

Finally, no more of Ms. Posey-Smith's slicing and dicing of some of our most beloved St. Louis dining institutions, and at the top of that list I put Colorado. What she did to that wonderful restaurant was a travesty.

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