The Paradox of Lead Poisoning Prevention

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Science  11 Sep 1998:
Vol. 281, Issue 5383, pp. 1617-1618
DOI: 10.1126/science.281.5383.1617

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Subclinical lead toxicity, defined as a blood lead level of 10 micrograms per deciliter or higher, is estimated to affect 1 in every 20 children in the United States. The results of numerous studies argue that efforts to prevent neurocognitive impairment associated with lead exposure should emphasize primary prevention--the elimination of residential lead hazards before a child is unduly exposed. These data contrast, paradoxically, with current practices and policies that rely almost exclusively on secondary prevention efforts--attempts to reduce a child's exposure to residential lead hazards only after a child has been unduly exposed. There is also a paucity of data demonstrating the safety or benefits of lead hazard controls for children with blood lead levels below 25 mg/dl. Despite a strong federal commitment to children's health, it is unlikely that the U.S. Environmental Protection Agency's final residential lead standards will adequately protect urban children from undue lead exposure. The author argues it is time to establish a scientifically based strategy to eliminate subclinical lead toxicity resulting from residential lead hazards.