May 19th, 2010
In general, public health officials in this country do an amazing job with limited resources. While not all their decisions are optimal, or are proven correct by later events, most public health officials can be be trusted to generally act in the public interest.
During the Bush years I was afraid that one effect of the overt politicization of so many government agencies would be to reduce further the public trust in government bureaucrats. In public health, especially, control of all sorts of problems, from infectious disease to pollution, depend upon trust.
One agency that was affected by Bush-imposed bad management was the Centers for Disease Control and Prevention. Now the Washington Post brings an account of high CDC officials covering up the extent of lead poisoning caused by water in Washington DC. The effects of official lying by health officials are extremely corrosive. When a future crisis hits, people will be less willing to trust official statements. Society suffers greatly when this type of trust is eroded.
CDC misled public on health risks of lead in D.C. water, investigation finds
By Carol D. Leonnig
The nation’s premier public health agency knowingly used flawed data to claim that high lead levels in the District’s drinking water did not pose a health risk to the public, a congressional investigation has found. And, investigators determined, the agency has not publicized its later internal research showing the problem did harm children and continues to endanger thousands of city residents.
A House investigative subcommittee concludes the Centers for Disease Control and Prevention made “scientifically indefensible” claims in 2004 that high lead in the water was not causing any noticeable harm to the health of city residents. The CDC hurriedly published its analysis though officials knew the research relied on incomplete and misleading blood test results that played down the health impact, the investigation found.
The House science and technology subcommittee investigation, scheduled to be released Thursday, was spurred last year by other scientific journals and Washington Post reporting showing that the 2004 CDC analysis was missing many test results for children who had lead poisoning. With its final report, the committee reveals the missing data showed clear harm to children from the water problem — and that CDC authors knew the data were flawed and in several instances ignored clear indications that their analysis improperly played down the lead risk. It finds the CDC ultimately misled the public and failed in its primary duty.
“The leaders of the CDC lead program, keenly aware of all of these problems even before the publication of the [2004 report], failed in their public health duty to protect and inform the public,” the committee’s investigative report states. “CDC’s actions in publishing — and continuing to stand by [the report] made the problem go away for the agency and the politicians, but not for the parents and the children throughout the nation who will suffer life-time consequences from this misguided document.”
The CDC analysis was largely used to calm public fears in early 2004 during the discovery that 1 million D.C. and Northern Virginia residents had been relying on a water supply with unsafe lead concentrations for at least a year. The study, published in the CDC’s “Morbidity and Mortality Weekly Report,” has since been repeatedly cited around the nation and in foreign countries as evidence that even astronomically high lead levels in water are not cause for concern.
Lead is a toxic metal long known to cause brain damage and developmental delays in fetuses and children when they or their pregnant mothers ingest significant amounts. The CDC analysis was viewed as counter-intuitive, even by some its co-authors: For several years, established researchers had found that children suffered permanent damage from very low levels of lead in their blood, and that infants drinking formula are especially vulnerable to lead poisoning from tainted water.
CDC officials said they are preparing a statement responding to the House subcommittee’s findings.
The House subcommittee’s investigation also chides CDC for not alerting the public to its more thorough subsequent study that directly contradicted its earlier claims. This 2007 research determined there was a clear link between the city’s water problem and lead poisoning in D.C. children. For example, it showed, city children with high lead in their blood were significantly more likely to live in homes with lead pipes, and after the city fixed its water treatment problem, CDC saw a “dramatic reduction” in lead poisoning in young D.C. children.
The committee also urged release of this research to alert residents to a continuing, lurking threat — in an estimated 9,000 D.C. homes where water utility crews replaced part of the lead service pipe bringing water to the house. The CDC study concluded that the D.C. Water and Sewer Authority’s $93 million effort to reduce lead risks after the 2004 lead crisis had largely backfired: Children living in homes with partial lead pipe replacements were four times more likely to suffer from unsafe levels of lead in their blood than those in homes without lead pipes.
“While still defending its hasty 2004 publication, which was based on faulty and incomplete data, CDC officials are suddenly reluctant to publish the results of the follow-up study because of data quality issues,” the committee investigators said.
The House committee went back to recover thousands of missing blood tests, when the city’s water lead levels were the highest, in 2002 and 2003. It found the number of D.C. children who suffered lead poisoning had spiked — not fallen or remained stagnant as the CDC first said — during the years when lead levels were highest in the city’s water supply.
A group of lead experts and community activist groups joined together to petition CDC to withdraw its 2004 analysis as fatally flawed. Marc Edwards, a civil engineer and lead expert at Virginia Tech who early on raised doubts at the counterintuitive findings, said it’s long past time for the agency to make amends by retracting the paper. He also recommended that Mary Jean Brown, the lead author of the paper and CDC’s director of lead poisoning prevention, step down from her position.
“The CDC paper was a publicity stunt that was used to obfuscate the harm done to D.C.’s children during the lead crisis,” Edwards said. “They should apologize for their historic betrayal . . . and for their dangerous conclusions which endanger child
Rep. Brad Miller (D-N.C.), the House subcommittee chairman, said the “scientific failings” of the 2004 report “are indisputable. The CDC should withdraw that publication.”
The House science subcommittee reserves its strongest criticisms for Brown, whose office is responsible for funding and monitoring the District’s and states’ lead poisoning prevention efforts. In the wake of the lead revelations in the District, she worked with D.C. Health Department officials to marshal facts, review blood test results of city residents and frame CDC’s response to the problem. After a compressed several-week research process, Brown led a team in publishing the conclusion that the lead problem wasn’t having a serious health impact.
Brown summarized the paper’s “main message” this way: “There is no indication that DC residents have blood lead levels above the CDC levels of concern . . . as a result of lead in the water.”
But the committee said it found evidence — including her own words — that Brown knew this claim rested on a shaky foundation. She knew that the Health Department data they used were missing thousands of blood test results in a critical period of the lead crisis. She told investigators she believed all the missing data were for low-blood levels, but she never tried to obtain the original results from D.C. labs to check.
The committee did go back to the labs for the original test results and has now learned something striking: Three times as many children had lead poisoning during this high-lead period than the CDC said, 954 instead of 315. The difference was politically significant — because it showed lead poisoning rising during the city’s water crisis, not falling or staying the same.
In one part of the 2004 report, the CDC paper presented what was dubbed the worst-case scenario by analyzing the blood of children and adults living in homes with astronomically high lead levels in the tap water — 300 parts per billion of lead, or 20 times the amount raising concern — and said not one was suffering from elevated lead in their blood. The report never mentioned, however, that Brown and her co-authors knew most of those tested had been drinking bottled water for weeks and months before their blood was analyzed, because city officials urged them to avoid the risky tap water.
In an e-mail, a public health scientist and co-author asks Brown whether they should mention this to the public, as “this may help to explain why currently none of the persons have blood lead levels above the level of concern.” It was never mentioned.