By Jan Worth-Nelson
Emphasizing, “there is no safe amount of lead to be ingested by children, pregnant women, or any person daily for 15 months without any risk to health and/or development,” the Genesee County Medical Society has chosen not to concur with a recent decision by the Hurley Medical Center doctors to use the word “lead-exposed” instead of “lead-poisoned” for those who’ve experienced the Flint water crisis.
A statement from Hurley physicians led by toxicologist Dr. Hernan Gomez, issued in early May, declared that changing the word “poisoned” to “exposed” would help prevent stigmatizing a generation of children who lived through the crisis. The Hurley doctors also asserted “not a single child in the City of Flint has been lead poisoned from the water switch. Rather, they were lead-exposed.”
But offering a series of arguments based on emerging science, disparate methods of blood lead level measurement, issues of community trust and questions of environmental justice, the GCMS physicians write, “The statement issued from the most recent HMC Medical Staff meeting does not represent the opinion of the Genesee County Medical Society,” according to a June 4 press release.
According to Executive Director Peter Levine, the GCMS has about 500 members, including Hurley doctors.
Word change may do harm
While the GCMS physicians assert their own communications have “never used the term ‘lead poisoned’,” they add that when health care professionals feel the need to eliminate the word “poisoned” when referring to the crisis, they “may in fact be doing harm.”
“Despite the well-meaning intention of removing the possible stigma due to exposure and ingestion of tainted water, their statement may in fact increase stress levels, anger and distrust…” the GCMS statement reads.
“They may be perceived as denying or dismissing traumatic lived experience. We fear this may seriously damage the doctor-patient relationship and the community’s trust in the medical community in general.”
In a presentation to the Hurley Medical Center board of managers last week, a group of water activists made much the same point, with one of them, Yvonne Lewis, stating, “When we start hearing those whom we’ve entrusted our lives to, to seemingly minimize the impact of this very important issue, it becomes devastating and then another hit at trust. And if we can’t trust those who care for us, who can we trust?”
No safe level of lead
The GCMS statement began with arguments based on the science of lead: “Because the literature repeatedly states that there is no safe level of lead we do not feel comfortable declaring a population safe unless all of its members are free of preventable exposure to a known neurotoxin. It is even more egregious that this neurotoxin is present in their tap water,” the GCMS physicians write.
“It is very important to recognize there are no strict guidelines that would allow us to state that using the term ‘exposed’ is different than using the term ‘poisoned’ in regard to physiologic disruption caused by the toxic metal lead,” the GCMS statement reads.
“While there are still some who must see organ failure, seizures or altered consciousness to use the word poisoned, many medical and scientific experts along with the CDC [Centers for Disease Control] have recognized the more subtle effects of lead poisoning and have repeatedly lowered the level of concern from 40 to 5 ug/ml starting in the 1970s.
“This has happened in part because the methods to measure blood levels have improved as well as the tools to evaluate brain function.” Additionally, they write, screening doesn’t measure lead storage in other organs.
Further, echoing some of the findings of the Michigan Civil Rights Commission 2017 report suggesting Flint’s woes were selectively neglected because of the city being a majority-minority community, the GCMS physicians wrote, “As an environmental justice issue, there is no acceptable reason why any one group of Michigan residents should tolerate a higher level of lead exposure and ingestion than others just because they live in a certain city of service issue.
“Perhaps more importantly, we have come to recognize that just because something is common, it does not make it acceptable.”
They add, “Our patients should not be exposed to any toxins when that exposure is preventable. As a clarifying analogy, we note that if a manufacturer knowingly produced a product containing lead for human consumption, they would be stopped from doing so. So too, for our government.
Levine said the GCMS statement was written by a committee of physicians and “approved through our process.” He said, “There is enough pain and anguish in this community now. So we’ve tried to be very careful in our statements–we’re trying very hard to be neutral scientific arbiters.”
EVM Editor Jan Worth-Nelson can be reached at firstname.lastname@example.org.