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Mitigating the Harm Done to Children's Health in Flint

Wednesday, 03 February 2016 00:00 By Brian Moench, Truthout | Op-Ed
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Taeyana Brown, 2-months-old, has her temperature taken during an exam with Dr. Mona Hanna-Attisha in Flint, Mich., Jan. 20, 2016. Brown was added to a new database of children under 6 who may have been exposed to lead in the water, a group Hanna-Attisha said she believes could number some 8,000. Of all the concerns raised by the contamination of Flint’s water supply, none is more chilling than the possibility that the tattered city’s children may have suffered irreversible damage to their developing brains and nervous systems from exposure to lead. (Brittany Greeson / The New York Times)Taeyana Brown, two months old, has her temperature taken during an exam with Dr. Mona Hanna-Attisha in Flint, Michigan, January 20, 2016. Brown was added to a new database of children under 6 who may have been exposed to lead in the water, a group Hanna-Attisha said she believes could number some 8,000.  (Photo: Brittany Greeson / The New York Times)

Providing safe drinking water is the most fundamental of government services, because it addresses the most fundamental of human needs. Nothing a government does is more important. That's why the water scandal in Flint, Michigan, is rippling throughout the country and is as corrosive to our trust in government as it is to the water pipes in Flint.

In sum, through incompetence, ignorance, arrogance, callousness, lying and cover-up, an assortment of local, state and federal officials have managed to ruin the municipal water supply of this city of 100,000 people, who are mostly poor. The human and economic costs are staggering and growing by the day. Every new revelation makes the scandal appear even more putrid than the last, even more putrid than the water.

Thousands of Flint children have suffered lead exposure, with likely irreversible brain damage of varying degrees.

In January 2015, Gov. Rick Snyder's administration began trucking in clean, outside water to the building in Flint where Michigan state employees worked. But for the next 10 months, he keep telling Flint residents their visibly disgusting tap water was safe. Snyder finally promised to "fix the problem," but so far there has been no fixing, just more scandal. Part of the state's response was to hand out water filters. But recent random testing revealed the levels of lead still in the water greatly exceed the ability of those filters to remove lead. So for as long as that was a presumed solution, the residents were, once again, being unknowingly exposed.

The economic costs go far beyond what it takes to secure enough bottled water. Businesses throughout Flint are suffering, and real estate values are likely nonexistent. Who could sell a home in Flint now? Some people are expecting Flint to become a ghost town.

There is seemingly no end to the injustice and the outrage in Flint: Residents are not only being charged for water they can't use, but also they have been paying some of the highest water rates in the country. And for some residents the rates have increased since the scandal broke.

Presidential candidates are finally talking about the scandal, although Jeb Bush had the jarring audacity to praise the politician most implicated, Governor Snyder. I'm guessing that Jeb will not be winning delegates or electoral votes from Michigan any time soon. National mainstream and cable news have picked up the story, and celebrities like Jimmy Fallon, Pearl Jam, Cher and members of the NFL's Detroit Lions have made contributions of money and bottled water.

The heart of the scandal is that thousands of Flint children have needlessly suffered lead exposure, with likely irreversible brain damage (that's what lead does, even in small doses) of varying degrees, depending on the amount of exposure and the age of the child.

In the toxic substances hall of shame, lead has achieved a level of infamy almost unequaled by anything except perhaps radioactivity. All of us have some lead in our bodies, the result of living in an industrial world, and a sinister lead industry that for decades successfully fought off attempts to curtail its deadly products. But there is no "normal" or "natural" blood level of lead. Lead serves no biologic function and all of it is harmful, especially to brain function.

The Centers for Disease Control and Prevention (CDC) and medical organizations like the American Academy of Pediatrics have officially stated that no amount of lead exposure can be considered safe, and estimate that at least 450,000 children in the United States are exposed to enough lead that interventions like removal from a lead-contaminated home should be required. In the last several years, leading manufacturers of toys, clothing, housewares, mini-blinds, medicines, candies and costume jewelry were sent reeling when millions of their products were withdrawn in dozens of recalls because of trace amounts of lead and other toxic heavy metals. 

Lead Poisoning Is Not the Only Toxic Threat - in Flint and Beyond

While lead's infamy is well deserved, it is hardly the only bad actor, and Flint is hardly the only scene in this poisonous play. In 2014, leading scientists in pediatrics and public health warned of a "silent pandemic" of brain disorders, citing strong evidence that "children worldwide are being exposed to unrecognized toxic chemicals that are silently eroding intelligence, disrupting behaviors, truncating future achievements and damaging societies." These toxins - heavy metals, fluoride, chemicals like PCBs, toluene, solvents, flame retardants, BPA, phthalates, pesticides and polycyclic aromatic hydrocarbons (PAHs) - are found in the air you breathe, the industrial processed food you eat, the water you drink and the grass your kids play on. 

Lead is not even the most neurotoxic heavy metal. Mercury destroys nerve cell endings, forms stronger, irreversible bonds with tissue proteins, and is between 10 and 1,000 times more toxic to brain cells, especially to the developing brain of a fetus. Overlooked entirely in the discussion of lead-caused brain damage is the fact that no one is exposed to just one toxic substance, including just one neurotoxic substance. There is strong evidence in animals that lead, mercury and testosterone act synergistically, or produce toxic results that have a greatly multiplied effect, rather than just additively, which gives some explanation to the distinct outcome that males suffer brain damage at much higher rates than females when exposed in utero or in infancy.

Mercury is a ubiquitous byproduct of coal combustion from power plants and other industrial sources that now contaminates the global environment. Marine mammals harbor about 12 times more mercury in their bodies compared to the pre-industrial age. Humans throughout the world now harbor more mercury in their bodies than ever before: According to the UN, our mercury levels are at least three to five times higher than they were just a few decades ago. The Environmental Protection Agency and CDC have estimated that one in six women of childbearing age have enough mercury in their bodies to harm the brain of a baby they might carry.

Other highly neurotoxic compounds like PAHs are found in other pollution sources, like cigarette smoke, oil refinery emissions and wood smoke (which has particularly high levels of PAHs). Just as there is no safe amount of lead or mercury exposure, and there is no safe number of cigarettes a person can smoke, there is no safe level of air pollution a person can breathe, especially pregnant mothers because babies in utero are exquisitely sensitive to biological insults from chemicals and pollution, whether from water or air.

The fetal brain begins its development by three weeks after conception. Any interference during this early period can result in severe abnormalities of the brain and spinal cord. By the third trimester, brain and nerve cells are migrating to final positions and establishing critical interconnections. Eventually there is a minimum of 100 trillion nerve-to-nerve connections, 1,000 times more than the stars in our galaxy. For the fetal brain to develop properly, everything has to happen in exactly the right order and at exactly the right time, making that period of brain development particularly vulnerable to contamination by neurotoxic chemicals that cross the placenta. There are no second chances in fetal brain development.

Numerous studies have shown that the tiny particles in air pollution can have significant clinical affects on brain function and disorders throughout the age spectrum, ranging from autism to Alzheimer's. Other studies in both animals and humans document changes in brain size, structure, microbiology, DNA and chemical composition.

One of these studies starkly illustrates the effect. Researchers measured PAH concentrations in inhaled air and in the blood and urine of 40 mothers in their third trimester of pregnancy, as well as in their children's urine after birth. They followed the children until they were 7 to 9 years old, performing M.R.I. exams on their brains at that age. They found a powerful dose-response relationship between prenatal PAH exposure and a loss of white matter (the part of the brain composed of nerve fibers and insulating myelin sheaths) on the left side of the child's brain involving almost the entire surface. The degree of damage to the white matter showed a linear correlation with decreased intelligence scores, and a higher rate of behavioral problems like attention deficit hyperactivity disorder (ADHD), similar to what would be expected from lead exposure. Additional effects of PAH exposure after birth and during childhood were found in the prefrontal cortex of the brain. This study confirms the loss of neurons, and a reactive abnormal increase in non-neuron brain cells (think scar tissue), all of which is the classic response to brain injury.

The linear relationship demonstrated that there was not a safe threshold of PAH exposure below which no harm could be found. The study's lead author, Dr. Bradley S. Peterson, director of the Institute for the Developing Mind at Children's Hospital Los Angeles, told The New York Times, "Pregnant women and young children are very vulnerable to environmental insults to the developing brain, and these exposures are likely having devastating effects."

Can Anything Be Done to Reverse the Damage?

Whatever damage has been done to a child's brain by lead and other neurotoxins is largely irreversible, and inversely proportional to the age of the child at the time of exposure. But because lead makes its way from the blood into more permanent storage in bones and teeth, there is the potential for lead to be mobilized from those reservoirs under conditions like prolonged immobilization, hyperthyroidism, chemotherapy, tumor infiltration of the bones and menopause, unleashing subsequent neurologic damage. Most concerning is that pregnancy and breast feeding are well known to mobilize bone lead deposits providing a pathway for lead to harm more than one generation from a single exposure. Blood lead levels that cause a pregnant mother no symptoms can elicit significant harm to a fetus or nursing infant.

A legitimate question should be raised about whether there are therapies that may prevent Flint's exposed children from further damage - a question not apparently raised by the mainstream media, and certainly not addressed by Governor Snyder's (we can't be bothered to) "fix it team." 

Chelation is accepted therapy that has been successfully utilized in cases of life-threatening, symptomatic lead poisoning. The most commonly used chemical, calcium disodium ethylenediaminetetraacetic acid (CaNa2EDTA), has a strong negative charge, which attracts the strong positive charge of a lead atom, and the complex can then be excreted in urine or stool. Chelation chemicals can vary widely as to their efficacy and possible toxic side effects, but the therapy is very complex physiologically and a great deal can go wrong if a patient is not monitored closely. CaNa2EDTA may transiently even increase brain and kidney lead levels. Only a multidisciplinary medical team trained in this therapy should be involved, and it is very expensive. 

A chelating compound called Succimer has a very high therapeutic index (i.e. the potential benefit divided by the potential toxicity is very favorable), so it is possible that it would be helpful to Flint's children, most of whom are likely to have more subtle neurologic symptoms. Because of the potential for a rebound effect, chelation cannot be employed if a child may be re-exposed to lead. And of course, with what has been going on in Flint, one has to assume that is distinctly possible.

Lead wreaks havoc by interfering with critical biomolecules, inducing "oxidative stress," i.e. an imbalance between free radical production and antioxidant capacity. It would seem logical then that enhancing a child's antioxidant capacity might mitigate some of the neurologic harm from lead, and indeed, research supports the concept in this circumstance. Although antioxidant supplements are probably a waste of money for most healthy people, and excessive consumption may even be harmful, for the children of Flint this may offer some real benefit. Antioxidants that might help include vitamins B6, C and E, zinc, selenium, ethoxyquin, taurine, alpha-lipoic acid, S-adenosyl-L-methionine, and N-acetylcysteine (NAC).

Beyond supplements, a diet rich in fresh fruits and vegetables will help provide natural antioxidants, but it would be important that they be organic, or in other words, not contain pesticide residue. Fresh fish without mercury, or the PCBs and other chemicals in farmed fish, (which narrows it down to wild Alaskan salmon) would provide omega-3 fatty acids, which help preserve brain volume and cognitive function. Given the paucity of grocery stores in Flint, this part of "fixing it" would seem like another one of Snyder's cruel "pipe dreams" unless he plans to send his personal chef to Flint to feed 100,000 people. Come to think of it, after he resigns, that's exactly what he should do, and he should pay for it himself.

The lead poisoning in Flint is a raw political scandal, a public health crisis for at least thousands of children and a profound moral failing of our society. But with far less media coverage and public outrage, billions of people worldwide, including in Flint and throughout the United States, are silently being harmed by a flood of other neurotoxins, as well. Nowhere near enough is being done to protect any of them. And so far virtually nothing is being done for the victims in Flint.

Copyright, Truthout. May not be reprinted without permission.

Brian Moench

Brian Moench, president of the Utah Physicians for a Healthy Environment, is a member of the radiation and health committee, Physicians for Social Responsibility (PSR) and a member of the Union of Concerned Scientists (UCS). The opinions expressed are his own and not an official position of UCS or PSR.


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Mitigating the Harm Done to Children's Health in Flint

Wednesday, 03 February 2016 00:00 By Brian Moench, Truthout | Op-Ed
  • font size decrease font size decrease font size increase font size increase font size
  • Print

Taeyana Brown, 2-months-old, has her temperature taken during an exam with Dr. Mona Hanna-Attisha in Flint, Mich., Jan. 20, 2016. Brown was added to a new database of children under 6 who may have been exposed to lead in the water, a group Hanna-Attisha said she believes could number some 8,000. Of all the concerns raised by the contamination of Flint’s water supply, none is more chilling than the possibility that the tattered city’s children may have suffered irreversible damage to their developing brains and nervous systems from exposure to lead. (Brittany Greeson / The New York Times)Taeyana Brown, two months old, has her temperature taken during an exam with Dr. Mona Hanna-Attisha in Flint, Michigan, January 20, 2016. Brown was added to a new database of children under 6 who may have been exposed to lead in the water, a group Hanna-Attisha said she believes could number some 8,000.  (Photo: Brittany Greeson / The New York Times)

Providing safe drinking water is the most fundamental of government services, because it addresses the most fundamental of human needs. Nothing a government does is more important. That's why the water scandal in Flint, Michigan, is rippling throughout the country and is as corrosive to our trust in government as it is to the water pipes in Flint.

In sum, through incompetence, ignorance, arrogance, callousness, lying and cover-up, an assortment of local, state and federal officials have managed to ruin the municipal water supply of this city of 100,000 people, who are mostly poor. The human and economic costs are staggering and growing by the day. Every new revelation makes the scandal appear even more putrid than the last, even more putrid than the water.

Thousands of Flint children have suffered lead exposure, with likely irreversible brain damage of varying degrees.

In January 2015, Gov. Rick Snyder's administration began trucking in clean, outside water to the building in Flint where Michigan state employees worked. But for the next 10 months, he keep telling Flint residents their visibly disgusting tap water was safe. Snyder finally promised to "fix the problem," but so far there has been no fixing, just more scandal. Part of the state's response was to hand out water filters. But recent random testing revealed the levels of lead still in the water greatly exceed the ability of those filters to remove lead. So for as long as that was a presumed solution, the residents were, once again, being unknowingly exposed.

The economic costs go far beyond what it takes to secure enough bottled water. Businesses throughout Flint are suffering, and real estate values are likely nonexistent. Who could sell a home in Flint now? Some people are expecting Flint to become a ghost town.

There is seemingly no end to the injustice and the outrage in Flint: Residents are not only being charged for water they can't use, but also they have been paying some of the highest water rates in the country. And for some residents the rates have increased since the scandal broke.

Presidential candidates are finally talking about the scandal, although Jeb Bush had the jarring audacity to praise the politician most implicated, Governor Snyder. I'm guessing that Jeb will not be winning delegates or electoral votes from Michigan any time soon. National mainstream and cable news have picked up the story, and celebrities like Jimmy Fallon, Pearl Jam, Cher and members of the NFL's Detroit Lions have made contributions of money and bottled water.

The heart of the scandal is that thousands of Flint children have needlessly suffered lead exposure, with likely irreversible brain damage (that's what lead does, even in small doses) of varying degrees, depending on the amount of exposure and the age of the child.

In the toxic substances hall of shame, lead has achieved a level of infamy almost unequaled by anything except perhaps radioactivity. All of us have some lead in our bodies, the result of living in an industrial world, and a sinister lead industry that for decades successfully fought off attempts to curtail its deadly products. But there is no "normal" or "natural" blood level of lead. Lead serves no biologic function and all of it is harmful, especially to brain function.

The Centers for Disease Control and Prevention (CDC) and medical organizations like the American Academy of Pediatrics have officially stated that no amount of lead exposure can be considered safe, and estimate that at least 450,000 children in the United States are exposed to enough lead that interventions like removal from a lead-contaminated home should be required. In the last several years, leading manufacturers of toys, clothing, housewares, mini-blinds, medicines, candies and costume jewelry were sent reeling when millions of their products were withdrawn in dozens of recalls because of trace amounts of lead and other toxic heavy metals. 

Lead Poisoning Is Not the Only Toxic Threat - in Flint and Beyond

While lead's infamy is well deserved, it is hardly the only bad actor, and Flint is hardly the only scene in this poisonous play. In 2014, leading scientists in pediatrics and public health warned of a "silent pandemic" of brain disorders, citing strong evidence that "children worldwide are being exposed to unrecognized toxic chemicals that are silently eroding intelligence, disrupting behaviors, truncating future achievements and damaging societies." These toxins - heavy metals, fluoride, chemicals like PCBs, toluene, solvents, flame retardants, BPA, phthalates, pesticides and polycyclic aromatic hydrocarbons (PAHs) - are found in the air you breathe, the industrial processed food you eat, the water you drink and the grass your kids play on. 

Lead is not even the most neurotoxic heavy metal. Mercury destroys nerve cell endings, forms stronger, irreversible bonds with tissue proteins, and is between 10 and 1,000 times more toxic to brain cells, especially to the developing brain of a fetus. Overlooked entirely in the discussion of lead-caused brain damage is the fact that no one is exposed to just one toxic substance, including just one neurotoxic substance. There is strong evidence in animals that lead, mercury and testosterone act synergistically, or produce toxic results that have a greatly multiplied effect, rather than just additively, which gives some explanation to the distinct outcome that males suffer brain damage at much higher rates than females when exposed in utero or in infancy.

Mercury is a ubiquitous byproduct of coal combustion from power plants and other industrial sources that now contaminates the global environment. Marine mammals harbor about 12 times more mercury in their bodies compared to the pre-industrial age. Humans throughout the world now harbor more mercury in their bodies than ever before: According to the UN, our mercury levels are at least three to five times higher than they were just a few decades ago. The Environmental Protection Agency and CDC have estimated that one in six women of childbearing age have enough mercury in their bodies to harm the brain of a baby they might carry.

Other highly neurotoxic compounds like PAHs are found in other pollution sources, like cigarette smoke, oil refinery emissions and wood smoke (which has particularly high levels of PAHs). Just as there is no safe amount of lead or mercury exposure, and there is no safe number of cigarettes a person can smoke, there is no safe level of air pollution a person can breathe, especially pregnant mothers because babies in utero are exquisitely sensitive to biological insults from chemicals and pollution, whether from water or air.

The fetal brain begins its development by three weeks after conception. Any interference during this early period can result in severe abnormalities of the brain and spinal cord. By the third trimester, brain and nerve cells are migrating to final positions and establishing critical interconnections. Eventually there is a minimum of 100 trillion nerve-to-nerve connections, 1,000 times more than the stars in our galaxy. For the fetal brain to develop properly, everything has to happen in exactly the right order and at exactly the right time, making that period of brain development particularly vulnerable to contamination by neurotoxic chemicals that cross the placenta. There are no second chances in fetal brain development.

Numerous studies have shown that the tiny particles in air pollution can have significant clinical affects on brain function and disorders throughout the age spectrum, ranging from autism to Alzheimer's. Other studies in both animals and humans document changes in brain size, structure, microbiology, DNA and chemical composition.

One of these studies starkly illustrates the effect. Researchers measured PAH concentrations in inhaled air and in the blood and urine of 40 mothers in their third trimester of pregnancy, as well as in their children's urine after birth. They followed the children until they were 7 to 9 years old, performing M.R.I. exams on their brains at that age. They found a powerful dose-response relationship between prenatal PAH exposure and a loss of white matter (the part of the brain composed of nerve fibers and insulating myelin sheaths) on the left side of the child's brain involving almost the entire surface. The degree of damage to the white matter showed a linear correlation with decreased intelligence scores, and a higher rate of behavioral problems like attention deficit hyperactivity disorder (ADHD), similar to what would be expected from lead exposure. Additional effects of PAH exposure after birth and during childhood were found in the prefrontal cortex of the brain. This study confirms the loss of neurons, and a reactive abnormal increase in non-neuron brain cells (think scar tissue), all of which is the classic response to brain injury.

The linear relationship demonstrated that there was not a safe threshold of PAH exposure below which no harm could be found. The study's lead author, Dr. Bradley S. Peterson, director of the Institute for the Developing Mind at Children's Hospital Los Angeles, told The New York Times, "Pregnant women and young children are very vulnerable to environmental insults to the developing brain, and these exposures are likely having devastating effects."

Can Anything Be Done to Reverse the Damage?

Whatever damage has been done to a child's brain by lead and other neurotoxins is largely irreversible, and inversely proportional to the age of the child at the time of exposure. But because lead makes its way from the blood into more permanent storage in bones and teeth, there is the potential for lead to be mobilized from those reservoirs under conditions like prolonged immobilization, hyperthyroidism, chemotherapy, tumor infiltration of the bones and menopause, unleashing subsequent neurologic damage. Most concerning is that pregnancy and breast feeding are well known to mobilize bone lead deposits providing a pathway for lead to harm more than one generation from a single exposure. Blood lead levels that cause a pregnant mother no symptoms can elicit significant harm to a fetus or nursing infant.

A legitimate question should be raised about whether there are therapies that may prevent Flint's exposed children from further damage - a question not apparently raised by the mainstream media, and certainly not addressed by Governor Snyder's (we can't be bothered to) "fix it team." 

Chelation is accepted therapy that has been successfully utilized in cases of life-threatening, symptomatic lead poisoning. The most commonly used chemical, calcium disodium ethylenediaminetetraacetic acid (CaNa2EDTA), has a strong negative charge, which attracts the strong positive charge of a lead atom, and the complex can then be excreted in urine or stool. Chelation chemicals can vary widely as to their efficacy and possible toxic side effects, but the therapy is very complex physiologically and a great deal can go wrong if a patient is not monitored closely. CaNa2EDTA may transiently even increase brain and kidney lead levels. Only a multidisciplinary medical team trained in this therapy should be involved, and it is very expensive. 

A chelating compound called Succimer has a very high therapeutic index (i.e. the potential benefit divided by the potential toxicity is very favorable), so it is possible that it would be helpful to Flint's children, most of whom are likely to have more subtle neurologic symptoms. Because of the potential for a rebound effect, chelation cannot be employed if a child may be re-exposed to lead. And of course, with what has been going on in Flint, one has to assume that is distinctly possible.

Lead wreaks havoc by interfering with critical biomolecules, inducing "oxidative stress," i.e. an imbalance between free radical production and antioxidant capacity. It would seem logical then that enhancing a child's antioxidant capacity might mitigate some of the neurologic harm from lead, and indeed, research supports the concept in this circumstance. Although antioxidant supplements are probably a waste of money for most healthy people, and excessive consumption may even be harmful, for the children of Flint this may offer some real benefit. Antioxidants that might help include vitamins B6, C and E, zinc, selenium, ethoxyquin, taurine, alpha-lipoic acid, S-adenosyl-L-methionine, and N-acetylcysteine (NAC).

Beyond supplements, a diet rich in fresh fruits and vegetables will help provide natural antioxidants, but it would be important that they be organic, or in other words, not contain pesticide residue. Fresh fish without mercury, or the PCBs and other chemicals in farmed fish, (which narrows it down to wild Alaskan salmon) would provide omega-3 fatty acids, which help preserve brain volume and cognitive function. Given the paucity of grocery stores in Flint, this part of "fixing it" would seem like another one of Snyder's cruel "pipe dreams" unless he plans to send his personal chef to Flint to feed 100,000 people. Come to think of it, after he resigns, that's exactly what he should do, and he should pay for it himself.

The lead poisoning in Flint is a raw political scandal, a public health crisis for at least thousands of children and a profound moral failing of our society. But with far less media coverage and public outrage, billions of people worldwide, including in Flint and throughout the United States, are silently being harmed by a flood of other neurotoxins, as well. Nowhere near enough is being done to protect any of them. And so far virtually nothing is being done for the victims in Flint.

Copyright, Truthout. May not be reprinted without permission.

Brian Moench

Brian Moench, president of the Utah Physicians for a Healthy Environment, is a member of the radiation and health committee, Physicians for Social Responsibility (PSR) and a member of the Union of Concerned Scientists (UCS). The opinions expressed are his own and not an official position of UCS or PSR.


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