Reflections upon the death of a hero, Dr. Herbert Needleman.
The passing of a great doctor and a fine American who shined a light on the injustice of lead poisoning.
At the close of each of my teaching courses at UCLA to young pediatricians and public health students, I focus on the listeners' own future, and on the critical importance in their lives, not just of knowledge, but of character and courage.
“We work to take care of, and to protect, people, especially children, not merely the status quo or corporate interests." I then often show a photo of Dr. Herb Needleman sitting on crumbling porch steps at the home of a poor family, probably a place in Pittsburgh where a child has been poisoned by lead in the paint.
Dr. Needleman was a pediatrician and a psychiatrist. He had a strong sense not just of the injustice of lead poisoning, but that this poisoning affected far more people than the dozens of children with seizures and coma who died of it each year in American cities. And that the harm from lead was to everyone, and that these effects were lifelong. His ideas disturbed the lead industry and some landlords, and even some doctors found this irritatingly farfetched.
Herb was asserting that lead, an indestructible element used to make water pipes and paint, batteries and gasoline, was doing enormous harm. Everyone knew about lead poisoned children, but also believed that once the child looked better, they were better. The lore in the 1960s and 70s was that if you had a “normal" blood lead level, say between 20 and 50 mcg/dl, you were fine—why, most doctors and elected officials had those lead levels!
Dr. Needleman's assertion was that the long term effects of lead, especially on the brain, remained.
For this he was persecuted.
Dr. Needleman's assertion was that the long term effects of lead, especially on the brain, remained. For this he was persecuted.
In children most lead exposure occurs during the first years of life when nearly all of human brain growth occurs; that is when new cells and synapses are developing. After that time, new growth of the brain cells diminishes and the overall wiring architecture is established.
Dr. Needleman's idea was dismissed, sometimes ridiculed, in particular by those who were responsible for the vast quantities of lead saturating the environment, largely in paint and in gasoline. When lawsuits were brought about the damage to individual children, attorneys and mercenary toxicologists working for landlords and polluters asserted that if the children had low functioning, failing in school and behaving poorly, it was because they had “single mothers who were poor, uneducated, and often black".
And there was another strong argument: the lead in the blood of these children when they were school age was not much higher than the other children. “Expert witnesses" argued that once the obvious poisoning symptoms are past—the child is out of coma and her anemia is resolving—that she like the rest of us was just fine.
So, were children now in their school years suffering from their early life lead exposures? Their blood levels were roughly the same as others. Dr. Needleman's brilliant solution for estimating early life exposure was (as he humorously stated) to pay more for baby teeth than did the tooth fairy. These shed teeth are chemically stable products of an infant's early diet and exposures.
Lead levels in soft tissues like the brain and the marrow will eventually drop when there are reduced lead exposures, although the damage to brain function remains. Would children whose baby teeth had higher lead levels have poorer school performance, maybe even lower IQ's? So while a lab analyzed the children's numbered teeth (not knowing the child's history), teachers evaluated their school performance.
In 1979 when Dr. Needleman reported his study findings in the New England Journal of Medicine, substantial lead levels have been present in American children for 60 years. For us pediatricians, Needleman's findings were earthshaking.
Children who had high levels were performing poorly in school, even after cancelling out the effects of poverty and parental education levels. In essence, the report showed that all of us were functioning with about 5 fewer IQ points than we should have.
Needleman was a hero? No, he became a pariah. He was attacked by the lead industry, hounded by columnists, snooped after by hired investigators, had his files endlessly combed over by high priced consultants, and was indifferently supported by many of his colleagues at his university. Herb and his steadfast wife Roberta went through years of attack.
The resolution of all of this….Herbert Needleman's work was authenticated by a high level review committee. His findings were subsequently corroborated by studies around the world. Damage to children's brains was worldwide. Sadly, the damage he found in young school children, perdures in the individual. Young adults with too much lead are more likely to learn poorly, be impulsive, drop out of school, have higher rates of unwanted pregnancy, get into trouble, and to be incarcerated.
So the lesson in the last class – keep your idealism, protect your character, and embrace the one virtue without which all other virtues are meaningless: courage.
I have been inspired by Herb Needleman. He was brilliant, but more importantly courageous and generous.I have been inspired by Herb Needleman. He was brilliant, but more importantly courageous and generous.
I would like to offer one last memory of Herb. When he was honored with the prestigious John Heinz award for his scientific contributions, he directed his financial prize to inaugurate the “Alliance to End Childhood Lead Poisoning". This organization was instrumental in the funding and creation of programs at CDC and HUD to end lead poisoning, not just in America, but across the world. For example, China has eliminated lead from gasoline. There were technical and engineering causes for this, but in the banner of “END LEAD POISONING" the middle letter of END is N—for Needleman.
A great doctor and a fine American.