With the best intentions: lead research and the challenge to public health

Our plain-English summary of With the best intentions: lead research and the challenge to public health, by D. Rosner, G. Markowitz (American Journal of Public Health, 2012).

The study

• Authors: D. Rosner, G. Markowitz
• Journal: American Journal of Public Health
• Published: 2012;102(11):e19-33
• Type of article: Historical article
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

In 2001, Maryland's court of appeals was asked to decide whether researchers at Johns Hopkins University had engaged in unethical research on children. During the 1990s, Johns Hopkins's Kennedy Krieger Institute had studied 108 African American children, aged 6 months to 6 years, to find an inexpensive and "practical" means to ameliorate lead poisoning. We have outlined the arguments in the case and the conundrum faced by public health researchers as they confront new threats to our health from environmental and industrial insults. We examined the case in light of contemporary public health ideology, which prioritizes harm reduction over the historical goals of prevention. As new synthetic toxins-such as bisphenyl A, polychlorinated biphenyls, other chlorinated hydrocarbons, tobacco, vinyl, and asbestos-are discovered to be biologically disruptive and disease producing at low levels, lead provides a window into the troubling dilemmas public health will have to confront in the future.

In plain English

This article was a historical and ethical essay about lead, not a study of asbestos. The authors examined a legal case over a 1990s Kennedy Krieger Institute (KKI) project in Baltimore. It recruited 108 families with young children, also described as 108 African American children aged 6 months to 6 years. Three groups lived in homes given partial lead paint repairs costing $1650, $3500 or $7000; two comparison groups lived in homes thought to have been fully abated or built after 1978. Children's blood lead was measured periodically. The authors reported that blood lead levels of children in at least two of the homes rose during the study. They reported that the consent form hardly mentioned any potential danger to the children. A Baltimore circuit court dismissed the case on April 5, 2000. Maryland's court of appeals found the research highly suspect and sent the case back for trial, but the parties settled out of court. A class action suit followed in 2011. The authors concluded that public health has become willing to settle for halfway measures.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Historical and ethical analysis (essay in the journal's "Public Health Then and Now" section) of a legal case about a lead abatement research project; not an original data study
• Who was studied: The subject was the Kennedy Krieger Institute Repair and Maintenance Project in Baltimore, Maryland, in the 1990s. It recruited 108 families with young children, described as 108 African American children aged 6 months to 6 years. Most families were single African American mothers and their children. Two of these children and their families brought the lawsuits.
• Exposure: The exposure was lead in homes, mainly from lead paint and house dust. Three groups of homes received partial lead paint abatement costing $1650, $3500 and $7000. No asbestos exposure was studied.
• Main results:
  • The design also included two control groups: children in homes thought to have undergone full lead abatement, and children in homes built after 1978 and presumed to be lead free.
  • Blood lead levels of children in at least two of the study homes rose during the study.
  • The consent form approved by the Johns Hopkins institutional review board hardly mentioned any potential danger to children living in the partially abated homes.
  • The Circuit Court of Baltimore accepted KKI's argument and dismissed the case on April 5, 2000.
  • The Court of Appeals of Maryland found that Johns Hopkins had engaged in highly suspect research. The court compared the project with Tuskegee and other research abuses.
  • The court of appeals sent the case back for trial, but the parties settled out of court.
  • In September 2011, lawyers in Baltimore filed a class action lawsuit against KKI.
• The authors' conclusion: The authors concluded that public health now accepts harm reduction rather than prevention. In their view, society has become willing to settle for halfway measures that allow certain classes of people to be exposed to possible harm. They also saw the lead story as raising issues for other toxins found harmful at low levels.

Topics

Medical terms in this study, explained in our Lexicon: Appeal.

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