Nothing is sacred in Washington D.C., not even children's health.

In a 2004 report, "Scientific Integrity in Policymaking," the Union of Concerned Scientists detailed concerns that the federal Centers for Disease Control and Prevention (CDC) panel that advises the government on childhood lead poisoning had been politically compromised.

"In the summer of 2002," the report explained, "the CDC Advisory Committee on Childhood Lead Poisoning Prevention was preparing to consider whether to revise the federal standard for lead poisoning. Š According to numerous sources familiar with the committee's work, the advisory group at this time was likely to rule in favor of a more stringent federal standard for lead poisoning, reflecting the latest research linking ever-smaller amounts of lead exposure to developmental problems in children.

"Just a few weeks before the committee's scheduled meeting, at which the question of toughening the standard further would be discussed, the George W. Bush administration intervened. Tommy Thompson, [then] secretary of Health and Human Services (HHS), took the unusual step of rejecting nominees selected by the staff scientists of a federal agency under his own jurisdiction. Š In place of the respected researchers the CDC staff had recommended, Thompson's office appointed five individuals who were all distinguished by the likelihood that they would oppose tightening the federal lead poisoning standard."

Such behind-the-scenes maneuvering is common in Washington, and often escapes the notice of the mainstream media. But in this case, with this issue, Northeast Ohioans should pay attention. When it comes to lead poisoning, few parts of the county have as much at stake.

In 2002, 20 percent of children tested in Cleveland had what the federal government calls elevated blood levels of concern (EBL), earning Cleveland a dubious number one ranking in the nation. A 2003 report from the U.S. Department of Housing and Urban Development (HUD) indicated that Glenville is a "high-risk" area where "lead poisoning rates exceed 50 percent in some Census tracts."

But the situation could be even worse than these reports suggest. Homes built before 1978 are likely to have surfaces painted with lead paint; in Cleveland, 96 percent of the city's housing units were built before 1980, and nearly half before 1940. Roughly 300,000 units in Cuyahoga County remain unabated.

The Cleveland Department of Public Health says that children under the age of 6 are particularly susceptible to such poisoning, which can cause irreparable damage to the kidneys, nervous system and brain, and can result in learning disabilities, decreased intelligence, behavior problems and impaired growth and development.

The specification of what constitutes an elevated blood level has been a source of controversy. In 1992, the CDC defined an EBL as 10 or more micrograms of lead per deciliter of blood. But many contend that the level for intervention should be reduced to five micrograms, or even less.

Bruce Lanphear was one of the nominees recommended by the CDC but overruled by Thompson's office. Lanphear, director of the Environmental Health Center at Cincinnati Children's Hospital Medical Center, as well as a professor of environmental health at the University of Cincinnati, told a Cleveland City Club meeting that there is no safe level of lead exposure. In a recent interview, Lanphear discussed political interference with the CDC advisory panel.

"Those aren't suspicions," says Lanphear. "Probably the most public [evidence] was a interview on This American Life with Bill Banner [one of the replacement candidates chosen under Thompson's watch], who described that process, how he was contacted by somebody from the lead industry and asked if he'd be willing to be nominated for the committee. I've talked to people at CDC who are in a little bit more difficult position, but who also said essentially the same thing. So it's not really a suspicion anymore."

James - His developmental disorder was linked to lead.

Lanphear says his research into the matter made him a target for Thompson's office.

"We were nominated in 2000, a year and half went by, then in the spring of 2002 all of this unfolded and then within a few months people representing the lead industry, directly or indirectly, were put in our place," says Lanphear. "There's two reasons for me — I've been pretty outspoken about the lead industry and their role in this epidemic. And then probably even more importantly, was we already had some research showing that there were adverse consequences below 10 micrograms per deciliter."

Lanphear's view is backed up by an October 2002 report from U.S. Rep. Edward Markey (D-Massachusetts) titled, "Turning Lead Into Gold: How the Bush Administration is Poisoning the Lead Advisory Committee at the CDC."

As to whether lead levels under 10 micrograms have been proven unsafe, Lanphear says there is a consensus among scientists in the know. "I would say it's generally recognized and confirmed time and again in various studies," says Lanphear. "So with the exception of the rented white coats and people who have conflict [of interest] or industry affiliation, I would say that that's generally accepted. Now whether pediatricians per se know about it is a different story, but people in this field generally recognize that the evidence is pretty consistent and definitive."

The motivation for keeping the level of concern where it is (or to raise it, as reportedly was attempted in 2002) is not hard to identify: Lowering the level would raise the number of kids diagnosed with lead poisoning, and the size of any potential plaintiff group in future class action legislation against makers of the lead-contaminated paints.

State Senate Bill 117, which was rushed through the Ohio legislature late last year, is supposed to make it more difficult to sue manufacturers (Plain Dealer columnist Thomas Suddes called it "a sloppy GOP kiss bestowed on clients of Ohio's big-business law firms"). Columbus, Cincinnati and other Ohio cities have all filed class action lawsuits against Sherwin-Williams over the matter. Cleveland has not, despite the fact that Cleveland has more than 50 percent of all the lead poisoned children in Ohio.

Advocates for lowering the EBL understand that Cleveland Mayor Frank Jackson probably finds himself in a difficult situation, due to the fact that Sherwin-Williams is based in Cleveland, as is the law firm that has represented the company for decades, Jones Day.

But future litigation is only one consideration. Dr. Ash Sehgal, co-medical director of the Cleveland Department of Public Health and a Case Western Reserve University medical school professor, as well as a MetroHealth doctor, concurs with Cincinnati's Lanphear that new evidence suggests the EBL should be lowered and that the difference between an EBL of five as compared to 10 would have a significant effect on the number of children who receive needed assistance.

"There are new medical studies that suggest that there's adverse effects for kids at levels below 10, things like intellectual impairment, attention deficit disorder, decreased muscle growth, decreased bone growth," says Sehgal. "So we as a public health community in Cleveland and Cuyahoga County have been considering whether it would make sense, based on this new medical evidence, to lower the action level from 10 down to five. [I]f you do that, then the percentage of kids in Cleveland who have elevated blood levels would go from 11 percent to 42 percent."

The CDC's Web site lists three reasons not to change the current EBL at this time:

"No effective clinical interventions are known to lower the blood lead levels for children with levels less than 10 [micrograms of lead per deciliter of blood] or to reduce the risk for adverse developmental effects. Children cannot be accurately classified as having blood lead levels above or below a value less than 10 Š because of the inaccuracy inherent in laboratory testing. Finally, there is no evidence of a threshold below which adverse effects are not experienced. Thus, any decision to establish a new level of concern would be arbitrary and provide uncertain benefits."

Dr. Sehgal disputes all of these assertions.

Mother and son - Julie Smith is a member of ACORN.

"We've talked to laboratory experts, both people who run the laboratories in the Cleveland area and the national experts, and they don't believe that's the case," says Sehgal of the CDC's contention that there is a lack of lab technology to accurately classify levels below 10. "They believe it is possible to accurately obtain lead level results, even at the lower levels. Maybe when you get down to levels of zero or one or two, that might be a problem getting the test results to be accurate. But when you're talking about five, six, seven, eight, nine, that's not a problem. So our impression is that it is possible with current technology to measure these things accurately at lower levels."

Regarding there being no known effective clinical interventions for poisoning at levels below 10, Sehgal says, "Well, that's true, but that's also true for kids who have levels of 15. So it's true we don't do clinical interventions with kids that have those levels, but there are environmental interventions that are very important."

As to the assertion that establishing a threshold below 10 would be arbitrary, Sehgal says, "We feel that there's all these kids in Cleveland who are suffering the adverse effects of lead, and, sure, it would be arbitrary to lower it to five instead of three or six or whatever, but you have to start somewhere and we think going down halfway is a good place to begin. Maybe in the future there'll be more studies that'll say it should be even lower, but based on the scientific evidence, we think that five is a reasonable place to shoot for."

Sehgal said that the Greater Cleveland Lead Advisory Council (GCLAC), a local coalition of community organizations and public health agencies, was looking at going around the CDC to establish lower intervention levels on a local level.

"They're considering endorsing this lower action threshold, and if they do that, then I think we as a community could go ahead and start acting on that, independent of the federal levels," Sehgal said before the January 8 GCLAC meeting. "What we want to do if they endorse it is, all the things that are currently done for kids where the levels are between 10 and 15, we would say, "Let's do those things where the levels are between five and 15. I believe that if the lead advisory council endorses it, then that would be sufficient. So there's two parts of it — endorsing the idea and then there's actually making it happen. Making it happen would involve educating the public, educating physicians and nurses, trying to generate more resources so that we could actually do some of these things."

But minutes of the GCLAC from a January meeting disclosed some serious reservations and a tabling of the issue for further consideration. This leaves Cleveland trailing behind Cincinnati, whose city council unanimously passed a resolution in September that lowered the level for environmental intervention by the city health department down to five.

"I think [lowering the level of concern from 10 to five] is a very important move for all health departments to take," says Marketa Gillam, a housing lawyer in Cincinnati's Legal Aid Society who deals with the lead issue. "The savings associated with preventing [poisoning] are significant and beyond debate. There's scientific evidence to suggest that the greatest loss is from zero to 10."

Recent comments by Becky Johnson Rescola, a senior staff member of the Ohio Department of Health (ODH), at meetings of the GCLAC, complicate the matter. ODH urges local partners to emphasize that there is no safe level of lead in the blood, but also echoes the CDC's reasons for maintaining the current EBL and noting that Ohio gets considerable CDC funding.

Steve Inchak, a congressional staffer who handles child welfare and health issues for U.S. Rep. Dennis Kucinich, has been involved with the lead issue for two years and has recently been placed on the GCLAC steering committee. Inchak says he and Kucinich are keeping a close eye on the issue.

"There's currently not enough HUD funding to reach those children in houses at 20 and above," says Inchak. "So if we were to increase the level of access down to five, you still won't be able to cover everybody. With the number of interventions at play and regulatory impact, we are still looking at the best way to do this."

Marian Harris, member of the board of Columbus-based Help End Lead Poisoning (HELP), supports lowering the EBL but also notes, "We don't have enough funding to deal with the lead poisoning of 10 micrograms and over; we don't have the funding to do the abatements that we need done. Prevention does seem like a no-brainer, but it seems like the last thing they can find money for."

Harris suggests a penny tax or fee associated with purchases of new paint to help raise funds for lead abatement.

BRUCE LANPHEAR - Kept off CDC committee for political reasons.

Whether Cleveland health officials can act on lowering the EBL without endorsement from city council is nebulous. Cleveland Councilwoman Pat Britt, chair of the health committee, is giving it serious consideration though.

"I believe [Lutheran Metropolitan Ministry, see sidebar] and all of the other advocates in our community have mounted a powerful argument for lowering the intervention level," says Britt. "The safety of our city's children is paramount. The CDC's support, or lack thereof, will not dictate whether or not we have the discussion."

Other potential allies include new Ohio Gov. Ted Strickland (and his appointed ODH director, Dr. Alvin Jackson, a prominent Cleveland physician knowledgeable on lead issues), and the Democratic majority in the U.S. Congress (a new senator from Rhode Island has two children with lead poisoning). These changes suggest that the playing field will be leveled between science and politics.

And such changes are the best hope for parents like Julie Smith, a Cleveland member of ACORN (the Association of Community Organizations for Reform Now), which works on the lead poisoning issue. Smith's 6-year old son, James, was diagnosed with PDD-NOS (pervasive developmental disorder, not otherwise specified) when he was 3, due to lead paint poisoning. Symptoms include delayed speech, lack of focus and behavioral problems.

Smith says it took about six months from the time she first started noticing James' problems until she got a referral to Cleveland MetroHealth, where the battery of testing included a lead screening. James came up with a reading of 18 micrograms per deciliter, the only abnormal result in any of the tests. Smith was told it was probable that the lead count was the cause of James' problems. The house Smith was living in at the time tested clean, but she found out that the daughter of the downstairs neighbor who shared the house she had moved from in Tremont had also been tested and had shown a high lead count.

"What my son needs and what he gets are actually two different things," says Smith of James' needs due to the lead poisoning. "He needs 40-hour-per-week therapy sessions. What he gets is a mom who home-schools him and does her own therapy with him."

James is smart, but Smith worries that he won't be able to attend college. He needs speech therapy and struggles with oppositional defiant disorder, getting overly angry about things. "For me, it's kind of grounded me to the house, because there are only so many people I can trust to watch him, that aren't going to be frustrated by him. I'm just getting to the point in the past year or so where I can take him places and not worry too much about him acting out in public."

"The arguments that are being brought up against [lowering the EBL] hold no water," says Smith. "It starts from the bottom up — if our kids go to school and they can't learn, they won't become productive members of society Š and a lot of these children, the problem that they have is that they were exposed to lead. So why not make it a mandatory lower level? If you don't know for sure that damage is caused [at certain levels], then why not err on the side of caution?

"No one wants the paint companies to go bankrupt, no one wants to put them out of business, we just want them to help clean up the neighborhoods and our houses."

A version of this article will appear in the newsletter of Lutheran Metropolitan Ministry. LMM's mission is service and advocacy with those who are oppressed, forgotten and hurting, including collaborating in a community-wide partnership to eliminate childhood lead poisoning by 2010. Further information is available at lutheranmetro.org or from LMM's co-director of advocacy at delliott@lutheranmetro.org. Another useful resource is Environmental Health Watch at ehw.org. Please contact your elected representatives and your local health department official supporting these lowered EBL levels.