Toxicology Litigation Support: Lead
Lead is ubiquitous in our environment. It used to be contained in gasoline but has now been replaced. It has been used in pipes, ceramic glazes, paints, and solder, among other sources. Exposure can be oral through ingestion of food or water or by inhalation from lead-containing dust or dirt. Once in the body it goes to soft tissues including the brain and kidneys but eventually is deposited in bone. It is then released from bone slowly over a period of time causing elevated lead concentrations in the blood and accumulation in the brain, resulting in behavioral and intellectual deficits in both children and adults. Children are the most susceptible. Lead is passed from mother to fetus and neonate via transplacental transfer and mother's milk. From fetus to neonate to young child, lead is accumulated faster in children than in adults, resulting in serious neurobehavioral problems, delayed developmental effects, and mental retardation. Lead also disrupts hemoglobin formation causing anemia. Currently, no safe level of lead in a child's blood has been identified, but a level of 10 ug/dl is considered a good guideline for maximum lead levels in children. In assessing the potential causal relationship in lead cases, we must be certain of the source. Cases involving lead paint must be carefully evaluated.
A case involving an alleged exposure to lead paint when there was no obvious lead paint available, resulted in the discovery that the child was given orange juice daily from a lead laden pitcher from Morocco. Each case requires careful evaluation, but no one disputes the neurotoxicity and nephrotoxicity of lead. Dr. Parent has participated in many lead cases for both plaintiff and defense. Selected references from our sizable lead database are provided below.
Acra, A., Dajani, R., Raffoul, Z. and Karahagopian, Y., Lead-glazed pottery: a potential health hazard in the Middle East. Lancet, 1(8217), 433-434 (1981).
Al-Khayat, A., Menon, N. S. and Alidina, M. R., Acute lead encephalopathy in early infancy-clinical presentation and outcome. Annals of Tropical Paediatrics, 17(1), 39-44 (1997).
Alexander, L. M., Heaven, A., Delves, H. T., Moreton, J. and Trenouth, M. J., Relative exposure of children to lead from dust and drinking water. Archives of Envionmental Health, 48(6), 392-400 (1993).
Anonymous, Blood lead levels in young children-United States and selected states, 1996-1999. Morbidity and Mortality Weekly Report, 49(50), 1133-1137 (2000).
Agency for Toxic Substances and Disease Registry (ATSDR), Toxicological profile for lead. Agency for Toxic Substances and Disease Registry (ATSDR), Public Health Service, US Department of Health and Human Services, 582 pages, August (2007).
Azcona-Cruz, M. I., Rothenberg, S. J., Schnaas, L., Zamora-Munoz, J. S. and Romero-Placeres, M., Lead-glazed ceramic ware and blood lead levels of children in the city of Oaxaca, Mexico. Archives of Environmental Health, 55(3), 217-222 (2000).
Baghurst, P. A., McMichael, A. J., Wigg, N. R., Vimpani, G. V., Robertson, E. F., Roberts, R. J. and Tong, S. L., Environmental exposure to lead and children's intelligence at the age of seven years. The Port Pirie Cohort Study. New England Journal of Medicine, 327(18), 1279-1284 (1992).
Banks, E. C., Ferretti, L. E. and Shucard, D. W., Effects of low level lead exposure on cognitive function in children: a review of behavioral, neuropsychological and biological evidence. Neurotoxicology, 18(1), 237-281 (1997).
Barltrop, D., Chronic neurological sequelae of lead poisoning. Developmental Medicine and Child Neurology, 15(3), 365-366 (1973).
Beattie, A. D., Moore, M. R., Goldberg, A., Finlayson, M. J. W., Graham, J. F., Mackie, E. M., Main, J. C., McLaren, D. A., Murdoch, R. M. and Stewart, G. T., Role of chronic low-level lead exposure in the aetiology of mental retardation. Lancet, 1, 589-592 (1975).
Bellinger, D., Sloman, J., Leviton, A., Rabinowitz, M., Needleman, H. L. and Waternaux, C., Low-level lead exposure and children's cognitive function in the preschool years. Pediatrics, 87(2), 219-227 (1991).
Bernard, A. and Lauwerys, R., Renal effects of environmental lead in children. Archives of Environmental Health, 51(6), 467 (1996).
Bolla-Wilson, K., Bleecker, M. L. and Agnew, J., Lead toxicity and cognitive functioning: A dose response relationship. Journal of Clinical and Experimental Neuropsychology, 10, 88 (1988).
Dietrich, K. N., Krafft, K. M., Shukla, R., Bornschein, R. L. and Succop, P. A., The neurobehavioral effects of early lead exposure. Monographs of the American Association of Mental Deficits, Number 8, 71-95 (1987).
Donohoe, M. T., Intellectual impairment and blood lead levels. New England Journal of Medicine, 349(5), 500-502; author reply 500-502 (2003).
Ernhart, C. B., Effects of lead on IQ in children. Environmental Health Perspectives, 114(2), A85-A86; author reply A86-A87 (2006).
Goldstein, G. W., Neurologic concepts of lead poisoning in children. Pediatric Annals, 21(6), 384-388 (1992).
Harvey, P. G., Hamlin, M. W., Kumar, R. and Delves, H. T., Blood lead, behaviour and intelligence test performance in preschool children. Science of the Total Environment, 40, 45-60 (1984).
Hernandez Avila, M., Romieu, I., Rios, C., Rivero, A. and Palazuelos, E., Lead-glazed ceramics as major determinants of blood lead levels in Mexican women. Environmental Health Perspectives, 94, 117-120 (1991).
Hughes, J. T., Horan, J. J. and Powles, C. P., Lead poisoning caused by glazed pottery: case report. New Zealand Medicine, 84(573), 266-268 (1976).
Jacobs, D. E., Clickner, R. P., Zhou, J. Y., Viet, S. M., Marker, D. A., Rogers, J. W., Zeldin, D. C., Broene, P. and Friedman, W., The prevalence of lead-based paint hazards in U.S. housing. Environmental Health Perspectives, 110(10), A599-606 (2002).
Koller, K., Brown, T., Spurgeon, A. and Levy, L., Recent developments in low-level lead exposure and intellectual impairment in children. Environmental Health Perspectives, 112(9), 987-994 (2004).
Lemus, R., Abdelghani, A. A., Akers, T. G. and Horner, W. E., Health risks from exposure to metals in household dusts. Reviews in Environmental Health, 11(4), 179-189 (1996).
Lockitch, G., Berry, B., Roland, E., Wadsworth, L., Kaikov, Y. and Mirhady, F., Seizures in a 10-week-old infant, lead poisoning from an unexpected source. Canadian Medical Association Journal, 145(11), 1465-1468 (1991).
Marcus, W. L., Lead health effects in drinking water. Toxicology and Industrial Health, 2(4), 363-407 (1986).
Nation, J. R. and Gleaves, D. H., Low-level lead exposure and intelligence in children. Archives of Clinical Neuropsychology, 16(4), 375-388 (2001).
Needleman, H. L., The neurotoxic, teratogenic, and behavioral teratogenic effects of lead at low dose: a paradigm for transplacental toxicants. Progress in Clinical and Biological Research, 281, 279-287 (1988).
Needleman, H. L. and Gatsonis, C. A., Low-level lead exposure and the IQ of children. A meta-analysis of modern studies. Journal of the American Medical Association, 263(5), 673-678 (1990).
Routh, D. K., Mushak, P. and Boone, L., A new syndrome of elevated blood lead and microcephaly. Journal of Pediatric Psychology, 4, 67-76 (1979).
Rummo, J. H., Routh, D. K., Rummo, N. J. and Brown, J. F., Behavioral and neurological effects of symptomatic and asymptomatic lead exposure in children. Archives of Environmental Health, 34(2), 120-124 (1979).
Silbergeld, E. K., Lead in bone: implications for toxicology during pregnancy and lactation. Environmental Health Perspectives, 91, 63-70 (1990).
Tuthill, R. W., Hair lead levels related to childrens classroom attention deficit behavior. Archives of Environmental Health, 51(3), 214-220 (1997).
Vega-Franco, L., Alvear, G. and Meza-Camacho, C., [Glazed pottery as a risk factor in lead exposure. Salud Publica de Mexico, 36(2), 148-153 (1994).
Vermont Housing and Conservation Board, Facts about lead in porcelain and ceramic glazes. Vermont Housing and Conservation Board, Lead Hazard Reduction Program, 4 pages, (2004).
Wasserman, G. A., Factor-Litvak, P., Liu, X., Todd, A. C., Kline, J. K., Slavkovich, V., Popovac, D. and Graziano, J. H., The relationship between blood lead, bone lead and child intelligence. Child Neuropsychology, 9(1), 22-34 (2003).
Winneke, G., Lilienthal, H. and Kramer, U., The neurobehavioural toxicology and teratology of lead. Archives of Toxicology, 18(Suppl), 57-70 (1996).
Richard Parent, PhD, DABT, FATS, RAC, ERT, has been providing consultations and testimony for both plaintiff and defense and has testified in local, state and federal courts around the country. He has lectured and continues to lecture on causation related to toxic exposures. He is board certified in Toxicology by the American Board of Toxicology and the Academy of Toxicological Science and is also Regulatory Affairs Certified and a recognized expert in Toxicology in the European community.
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