It's 1957. Dr. Herbert Needleman is on his way to see a three-year-old patient at the Children's Hospital of Philadelphia.
Needleman is a young doctor, about six feet tall, with brown eyes and dark hair. This is the first case of lead poisoning he's ever seen.
When he shows up, the girl is not in good shape. Her eyelids are drooping. Her pulse is slow. She's not making a sound.
"This girl was lethargic and almost comatose," says Lydia Denworth, who wrote a book about Needleman and lead poisoning called Toxic Truth. (Needleman has Alzheimer's disease and was unable to interview for this story.)
Needleman prescribes the girl a medicine that gets rid of the lead in her blood. Over the next couple days, she starts to feel better, and Needleman thinks he has fixed her problem.
He talks to the girl's mother, saying, basically: your daughter is okay, but she was probably poisoned by lead paint or dust at home, and you can't go back there.
"And the mother just looked at him and said, 'Well where am I supposed to go'?" Denworth says. "She didn't have any money. She was a single mother. And suddenly Needleman says it's like the scales fell from his eyes."
As a doctor, Needleman couldn't go home with this family and remove the lead from their apartment. This girl was probably going to end up back in the emergency room again.
For Needleman, this patient marked the beginning of a lifelong crusade. He would later go on to make a huge discovery that changed the way we think about the dangers of lead. And surprisingly enough, in 2016, a lot of doctors are in the same position he was that day: there's not much they can actually do for patients who come in with lead in their blood.
A long history
In the 1950s, when Needleman was a new doctor, lead was everywhere: in paint, pipes, gasoline, and toys. People had been using lead since the time of the Romans.
Doctors knew lead was poisonous at high levels, but they thought that was primarily a problem for industrial workers who were around the metal all the time. That perception began to change as both adults and children came into their doctors' offices with the same symptoms as metal workers and painters.
Still, a lot of doctors weren't testing kids for lead, because many of the symptoms of acute lead poisoning — like vomiting, fatigue, and seizures — looked like other diseases, Denworth says.
As an experiment, Dr. Needleman's hospital started testing all kids for lead. The doctors began to see that lead poisoning was more widespread than anyone had imagined, she says.
After this, Needleman became obsessed with lead. Sometimes he thought about it on his commute to the hospital from his home in West Philadelphia.
"He describes riding along in the trolley and looking at all the faces of the kids who were in the apartment buildings and houses and playing on the street and beginning to wonder just how many of those children were lead poisoned," Denworth says.
Crusading for justice
It's important to note that Needleman is, as everyone describes him, a crusader against injustices — large and small. His son Josh Needleman (who's also a doctor) tells this story about a canoe trip the family took when he was a kid:
He and his father are in a canoe, paddling along a small river, and they spot a group of teenagers sitting on the shore and smoking.
"It was generally the kind of group that I think now, as an adult, I would try to avoid," Josh says. "And they were throwing rocks at a duck that was floating in the river."
So his father, Dr. Needleman, gets really angry that the kids are trying to hurt this duck.
"And he began to shout at them and said, 'Leave that duck alone!'" Josh says.
The teenagers are so shocked that they stopped.
"He could just not hold himself back when he saw something that was unjust," Josh says.
The same thing went for lead, he says.
After Needleman saw all those children come into the hospital with lead poisoning, he started digging through research. He came across a study from the 1940s showing that children who had been poisoned by lead later had behavioral problems and low IQ scores.
These children all had severe lead poisoning. But Needleman wondered about the smaller amounts of lead most kids were exposed to every day. Could that be damaging their brains?
He designed a study to find out, using children's baby teeth to measure their lead exposure. That meant turning to Josh for help. "I was a kid losing my teeth when this was going on," Josh says. "So he actually piloted a lot of that on my teeth."
So much for the tooth fairy. But that sort of myth would never have been perpetuated in the Needleman home, anyway. "I can't imagine my father deliberately deceiving his children even in fun," he says. "It's not the kind of person he was."
Needleman got a job at Harvard University, where he collected thousands of baby teeth from children who lived in suburbs of Boston and had never gotten severe lead poisoning. He and several other researchers gave the children tests to measure their IQ and learning ability, and had their teachers fill out questionnaires about them.
The study, published in 1979, found that children "who had high lead in their teeth, but who had never been identified as having any problems with lead, had lower IQ scores, poorer language function, and poorer attention," Needleman explained years later, in a Bill Moyers documentary that aired on PBS.
The findings were controversial. Critics, including companies that made lead products, said IQ deficits, learning disabilities, and behavioral problems can be caused by a lot of things — like family life and education.
"A kid in the inner city has all kinds of problems, right?" Denworth says. "They said the lead is one teeny piece of this, and the effect is minimal, even if there was any effect at all. And Needleman thought any effect at all was criminal."
When Needleman published the results, he thought the world was going to catch on.
A month later, he told his colleague at Harvard, Dr. David Bellinger, that things weren't moving fast enough.
"He said that he felt a little down because he thought when that paper was published that the world would change," Bellinger says, chuckling. "It did change the world. It's just that those changes don't happen overnight."
Change did eventually come. The Environmental Protection Agency had already started phasing lead out of gasoline in the 1970s. It sped that up. In the mid-1980s, there was also a federal ban on lead pipes. (The government had already banned lead paint in 1978, knowing it could poison kids at high levels.)
And then the federal government put out a plan to eliminate lead poisoning for good. It said that more children should be tested for lead and that we needed to get lead out of kids' homes, so they're never poisoned in the first place.
In 1991, Needleman testified in front of the House of Representatives, in support of a bill that would fund those efforts.
His hair was grey, and he wore wire-rimmed glasses and a beige suit.
"There is a broad consensus on the part of everyone but the lead industry and its spokesmen that lead is extremely toxic at extremely low doses," Needleman said.
He said removing lead from gasoline was a public health triumph, but there was more work to do. And he praised the way the United States had eliminated another disease: smallpox. "We can have the same course if we have the same kind of dedication in dealing with lead poisoning," Needleman said.
There was resistance to this idea of lead abatement from various groups, including landlords and realtors, who said it was too expensive. The bill and others like it didn't pass Congress.
In 1992, Congress passed the Residential Lead-Based Paint Hazard Reduction Act, which required landlords to disclose lead paint hazards to tenants. But the law was hard to enforce.
In the meantime, Needleman was worried about something else, too. A couple scientists who had represented the lead industry in lawsuits accused him of scientific misconduct, saying he cherry-picked his data to prove a point.
In the PBS documentary, Needleman compared that accusation to a professional death sentence. "If you're found guilty of scientific misconduct, you're out of business," he said. "Your reputation is ruined. You're through."
The University of Pittsburgh, where he worked at the time, investigated for almost a year and found no scientific misconduct. The university did say Needleman mischaracterized some of the procedures in the study, but not in a way that changed the findings.
"There were a couple of errors in the work," says Denworth. "It wasn't perfect. But the basic fundamental principle of it was still true. Even if you took pieces away — you still showed the same effect from lead."
Soon after the investigation, Needleman and his wife, Roberta, went on vacation to an island in Florida. "I believe he slept about 20 hours a day, for several days in a row," Josh Needleman says.
As time went on, more and more studies showed that even at low levels, lead could cause children cognitive problems. But government agencies stopped talking about eliminating lead poisoning entirely. Some people said public health dollars were better spent on other problems, like obesity and diabetes. There are people who make that argument today, too.
Needleman, though, never gave up.
In 2007, during a presentation on lead poisoning at a toxicology conference in Las Vegas, he clicked through slide after slide, explaining why lead poisoning was still a threat so many years after his first study.
He said people dismissed lead poisoning because they thought it only affected poor, black residents. That was wrong, and racist, he said.
He added that everybody thought lead poisoning was yesterday's problem. "People say, 'didn't we take lead out of gasoline? Don't we have a law banning its use in lead paint? What are you worried about? It's over.'"
To him, it wasn't.
Dr. David Bellinger says Needleman changed the world. "Certainly for the better," he says. "Many, many children are healthier now as a result of the commitment that he made."
Lead levels in young children have dropped by more than 90 percent since the late 1970s, when Needleman published his early research, according to data from the National Center for Health Statistics. But a lot of children are still exposed to lead, through dust, old paint, and pipes. And the Centers for Disease Control and Prevention says no amount of lead in the blood has been proven safe.
Needleman always felt like we hadn't done enough, Denworth says. "It became old news," she says. "We thought we solved the problem. We never really were willing to finish it."
And that's why, despite all that has changed, kids still end up at the doctor with lead in their blood. And like Needleman back in the 1950s, there's only so much that doctor can do.
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