In the absence of any official interest in actively managing lead levels in the body, reducing exposure to lead is pretty much all we can do, unless we manage the problem ourselves, particularly for children. I’m going to make references to Mt Isa because that’s where this blog started. The comments apply everywhere in Australia where there is contamination from leaded petrol or lead paint.

If you’ve been reading my blogs, you’ll realize that we need to appreciate that lead is so dangerous because it is a subtle poison that first affects the brain and nervous system, and then slowly damages other organs as body lead levels increase. Enough lead will kill you, but even low amounts of lead will cause some damage. There is no level of lead that is safe.

I’m going to repeat a lot of what I’ve already said in other posts because you really need to appreciate just what we’re facing.

My wife wrote a poem called “Terminal Man”. that I think is pretty amazing. I’d like to quote one paragraph, which is a terribly apt description of the mining industry:

Out in the countryside giant machines rip ore from the bowels of the earth, leaving it torn and bleeding.
Factories belch clouds of ash and smoke into the atmosphere from taller and still taller chimneys, ensuring the acid a global distribution.
Even in the most remote corners of the earth, trace amounts of toxic wastes are found.

I have to stop here and try and make the point that I understand the necessity of allowing mining from an economic viewpoint, It is pointless and somewhat self-defeating to try and shut down mining. BUT we have had nearly a century of lies and deceit about the dangers of lead, and one of the sources of those lies and deceit was the mining industry. In their defence, their efforts were minor compared to the paint manufacturers and companies selling leaded petrol, but they have some responsibility.

There is a Veritasium channel YouTube video about leaded petrol, entitled ” “The man who killed the most people in history” (https://www.youtube.com/watch?v=IV3dnLzthDA). It’s a really interesting story, and it makes the last part of the above poem excerpt terribly apt when it comes to lead and it’s dispersion around the world.

I’d like to continue with some historical and oddly current quotes that finish setting the scene:

From Benjamin Franklin (1786):

You will see … that the Opinion of this mischievous Effect from Lead is at least above Sixty Years old; and you will observe with concern how long a useful Truth may be known and exist, before it is generally receiv’d and practis’d on.

From Gordon Thayer (1913):

And shall we not signally fail of our guarantee of a reasonable surety for the health and happiness of all those within our borders, if this cry of suffering, now audible after many years of dumb endurance, remains unheeded and unanswered.

From environmentalist René Dubos (1969) who warned that the problem of childhood lead poisoning:

“is so well-defined, so neatly packaged, with both causes and cures known, that if we don’t eliminate this social crime, our society deserves all the disasters that have been forecast for it.”

These quotes and warnings span over 3 centuries, and remind us that change is a difficult process, particularly when there are forces working against change if they see that it benefits others at the expense of their profit. Workplace health and safety regulations have been essentially static for over 50 years except for a halving of the removal value from 60ug/dl. We’ve learned so much more about the harmful effects of lead on adults and particularly children that we no longer have the excuse of ignorance.

The US had the advantage of a society that for a time attempted to rectify socio-economic wrongs in America, epitomized by the disproportionate effects of lead on disadvantaged people. This spurred a huge effort to learn about and reduce the effects of lead, particularly on children.

While aboriginal and islander people are in a similar situation in Australia, we haven’t seen a similar rise of interest in understanding and minimizing the effects of lead on our indigenous people, or indeed the non-indigenous population.

I’ve come to the uncomfortable conclusion that we can’t depend on government agencies influenced by mining companies to do anything about reducing the risk of lead exposure in Australia.

It isn’t that there aren’t people in government that care, but government policies make sure that any changes pertaining to lead are very slow in happening, if at all. My opinion, on the basis of epidemiological information available, is that lead paint is a much greater risk to the population as a whole than asbestos. And yet we have only warnings, not legislated safe procedures for dealing with lead paint, unlike the US.

If you’ve been reading my previous (see below this one) blog posts, you’ve heard all the information about how lead harms you before. But please bear with me because you HAVE to realise that this information is about you and your family, and what lead can do to you.

What happens when you’re exposed to lead?

Once lead is absorbed from the intestine, it enters the blood plasma space. Red blood cells (RBC) have both a high affinity for and a capacity to hold lead. In a blood sample, about 97% of the lead is found in or on the RBC. Lead is transported in blood and delivered throughout the body.

Studies that used radioactive lead given to volunteers have shown that lead has a half-life in blood of a few weeks. In contrast, lead that accumulates in your brain has a half-life of 1-2 years and in bone, the tissue that accounts for up to 95% of the lead in an adult (about 75% in a child), lead will remain for decades.

Lead is distributed to all organs. Toxicity is mediated through several mechanisms. Calcium-binding proteins (eg, calmodulin, troponin) preferentially bind lead . Once lead has bound to those molecules, processes that are normally calcium mediated may be activated or inhibited, thus disrupting normal intracellular calcium-relayed messages. One of the mechanisms is calcium-dependent neurotransmitter release, resulting in altered intercellular communication. Enzymes may bind lead, resulting in adverse function. Lead binds to sulfhydryl and amide groups in enzymes, altering their configuration and diminishing their activities.

Lead interferes with heme pathway enzymes which are found in all cells. At least 3 of the 7 enzymes involved in the production of heme are downregulated by lead, resulting in a dose-dependent diminished production of heme and in the accumulation of precursor molecules. The appearance of precursors like protoporphyrin were used before BLL to indicate lead exposure.

I nearly forgot to add that lead also causes extensive free radical damage to organs, cells, cell membranes and DNA, contributing to conditions like atherosclerosis and Alzheimer’s.

As lead substitutes for calcium in the skeleton, it results is weaker bones and slower fracture healing, but most importantly, lead in bone acts as a reservoir of lead that maintains circulating (blood) lead levels. 

As the amount of lead in our bodies increases, so does the functional interference and damage to organs, and the brain is the organ most affected by even low levels of lead. 

I hope that’s plain enough, even small amounts of lead do some harm and as the amount of lead you’ve absorbed increases, so does the harm.

It’s a great pity that the only tool we’ve got for “measuring” lead exposure at the moment is blood lead levels (BLL) There are other options possible to measure body lead, but they aren’t generally used in Austrlia, at least not for humans. So BLL is pretty much the only tool in our toolbox. A bit like the story about the carpenter who only had a hammer, so everything looked like a nail. A lot of decisions about safety and treatment are made that rely totally on BLL.

I’d like to provide a bit of extra emphasis about what lead does in your body, so let’s use my favourite chart again:

This is what you will see as BLL rises: (this leaves out the 7-fold increase in esophageal cancer at 30ug/dl and the doubling in cardiovascular deaths at 10ug/dl)

There is a huge problem with our reliance on BLL because it is solely a measure of how much lead is circulating in the blood not how much lead is elsewhere in the body. BLL only measures lead in one of the body’s pools of lead, the blood.

If you go back to my description of what happens when you absorb lead, some of the lead binds to red blood cells (RBC), the rest goes to other organs, the brain and the bones. BLL indicates the sum of the lead that is bound to red blood cells, and the lead contribution from lead already stored in your body.

After exposure, as the red blood cells containing lead get broken down over a period of several weeks, your BLL will fall because the red blood cells that bound lead are being broken down.

The single biggest misconception about BLL is that a fall in BLL after exposure means you’ve lost the lead you absorbed. A little bit of lead is lost but most of it stays and as I’ve said, it stays there for decades, often the rest of your life. As you absorb lead from food, or from renovating a house, shooting a gun or rifle, repairing electronics and so on, you will slowly accumulate ever more lead.

I do have to qualify that statement because there are times when lead can be rapidly released from the bones: pregnancy, breast-feeding, osteoporosis and some blood cancers. though I doubt that provides some comfort to mothers that they can get rid of the harmful lead in their bodies.

The rise of BLL after exposure to lead and the fall in BLL in the absence of lead exposure is used to “manage” lead exposure in lead risk workers. 

This is where I started with Glencore and what I viewed as insane lead biohazard management.

Lead risk workers get their BLL measured regularly. If you’re a lead risk worker and you’ve either been careless, or there is more lead pollution in your workplace that you couldn’t avoid, you’ll absorb extra lead. As a result, that lead will get into your bloodstream and your BLL will increase. If your BLL goes above 30ug/dl you get removed from lead risk work.

While you’re away from exposure to more lead, your body is breaking down red blood cells that have bound lead which appears in your bile, but most of the lead absorbed is moved to your bones. That decreases the amount of lead in your blood, so the BLL will decrease. When your BLL goes back down to below 20ug/dl, it’s deemed okay for you to go back to work, presumably in the belief that the lead you’ve absorbed has left your body.

That was certainly the belief over 50 years ago, despite the fact that even then it was recognized that most of the lead absorbed went into bone. If you take tissue samples, including bone during autopsy, most of the lead is found in the bones.

The Glencore principal health and hygiene made the following comment in a letter to me:

We have a range of stakeholders, including health experts that we engage with around the management of occupational exposure, with the implementation and monitoring of any measures based on strong clinical evidence and supported by peak medical bodies and State and Federal Government.

And the health experts missed the strong clinical evidence that lead bioaccumulates in bones? If we assume that the experts do know better, the only other explanation I can think of for not updating the ”management” of lead exposure, namely monitoring and removal, is that everyone involved in the occupational health area thinks it’s more important to manage excess lead exposure, than to manage lead risk worker health.

I admit that if the lead HAD left your body, removal would make sense, but that’s not what happens. It achieves nothing, except giving the worker and employer a false sense of security. Employers, if they know the truth, which is certainly true for Glencore, since I’ve told them, are looking the other way while their workers continue to accumulate a deadly legacy.

It’s not about worker safety or worker health, it’s all about exposure control.

I absolutely get the idea of managing lead exposure, because that manages an important part of the total risk of accumulating lead. But surely there has to be a better way than using lead risk workers as ultimately disposable lead exposure detectors, like mine canaries in a coal mine?

The challenge with biohazards is they’re invisible, not like a crushed foot or a death in the mine. Aside from the dust from the mine, or the fumes from the smokestack, they’re invisible. We can manage obvious hazards, but biohazards are a bit like magic, so sometimes managing them uses sleight of hand. Workers “think” they’re being kept safe, but that’s not really the case at all.

We have to do better, we could do better IF a few people woke up to the harm being done to workers. SWA know from a Monash study that as BLL increases, so does the incidence of cancer, so does kidney disease, so do cardiovascular deaths and so does neurological disease and behavior changes. They admit they know this on their web site. But the regulations haven’t changed.

I hope I’ve explained what BLL means and what lead does, so let’s get stuck into non-occupational lead exposure reduction, because that is what this whole thing is about. After all, occupations that are exposed to lead are well protected and managed. Damn, that sounds like sarcasm.

Reducing exposure to lead is the only option we “appear” to have at the moment for limiting some of the effects of lead on our health. I’d like to add that bone lead levels can be easily measured without any needles poked into you, but not in Australia. We can measure bone lead levels in wildlife, but it’s too hard to do that for humans, or maybe it’s because it would expose the awful truth of generations of poisoned lead workers.

I’m pretty sure I wrote a blog on the sources of lead exposure but I’m going to concentrate on the big ones, lead from buildings painted with lead paint and lead in the environment (natural, mining/smelters or leaded petrol pollution). .There’s also lead from old lead acid batteries, lead paint on motor vehicles and boats and lead from using firearms, and a host of minor sources of lead, but let’s put the effort where it counts.

Just about every single house in Australia that was built before 1975 will likely have been painted with lead paint. If you’re in Brisbane, for example, that means thousands of housing commission houses on the outskirts of the city (50 years ago), not to mention older stately homes. 

Lead paint has been a huge danger for children and animals because it tastes sweet and is nearly irresistible to children and animals. Children have died from licking lead paint. Queensland clinicians have recognized lead paint as a grave danger to children since the early 1900s but they now seem to have forgotten the early lessons.

And the lead paint is still there, today, right now. Every time a house or building painted with lead paint is sanded or renovated, paint dust, containing up to 50% lead, kilograms of it, is spread around the house, in the yard, in neighboring yards. That’s pretty major lead pollution. Would it surprise you to learn that painters are high on the list of lead affected individuals? It’s a pity we don’t know how many children are affected,

In the United States, lead paint is recognized as gravely dangerous for children, and the EPA legislation “Renovation, Repair and Painting” (RRP) has been enacted to minimise the risk from renovating old buildings:

Under the rule, contractors performing renovation, repair and painting projects that disturb lead-based coatings (including lead paint, shellac or varnish) in child-occupied facilities built before 1978 must be certified and must follow specific work practices to prevent lead contamination. EPA’s RRP rule impacts many construction trades, including general contractors and special trade contractors, painters, plumbers, carpenters, glaziers, wood floor refinishers and electricians.

Activities performed by all of these trades can disturb lead-based paint and have the potential to create hazardous lead dust. For most individuals, eight hours of training is required. However, individuals who have successfully completed renovation courses developed by HUD or EPA, or an abatement worker or supervisor course accredited by EPA or an authorized State or Tribal program, can become certified renovators by taking a four-hour EPA-accredited renovator refresher training.

That looks a lot like the regulations about asbestos in Australia, because asbestos was finally recognized as dangerous, probably because it’s no longer mined in Australia. While the various Australian EPA and health organizations do have warnings about the dangers of renovating lead-painted buildings, there is no protective legislation, only an Australian Standard.

A quote in a 2018 RFI document from a senior Queensland Health employee in Townsville makes an interesting point about lead paint:

“As things stand, I do not believe that government owned houses, with highly contaminated soils and exposed Lead paint, are safe places for children in Mount Isa.
Rehabilitation of known contaminated environments is where we need to act,“

So what are government agencies doing about lead exposure from renovating old buildings? Pretty much nothing.

That kind of makes protecting you and yours from lead paint a bit more difficult doesn’t it?

I guess it’d be okay if getting a blood test for lead exposure was common and you could remove any lead that was absorbed, but avoiding exposure to lead paint is something where there’s very little good advice that I can give you. Sorry.

The only real solution is what the US EPA did, and I can’t see that happening here. It is my sad belief the mining companies have a firm grip on the decision of parts of our governments agencies.

Lead dust exposure is the other big one, though I’d like to exclude lead dust from leaded petrol because that’s a big city problem. I’d like to concentrate on the lead dust affecting the people living in one of the lead cities, or that live near the Port of Townsville when the wind is blowing their way when ships are being loaded with lead concentrate.

It is ridiculous to think, in Mt Isa, after 90+ years, that the lead contaminated yards, the lead-containing dust in the houses, in the attics, is all due to natural causes. Who do they think they’re kidding? The real tragedy is some people in Mt Isa are certain that lead isn’t a danger.

Lead dust, from crushed lead-containing ore or lead concentrate, or from smelting lead ore gets into everything. It settles on the ground, on roofs, it washes into rainwater tanks. Plants or animals grown on lead-contaminated ground absorb the lead. If you’re scrupulously careful and make sure children don’t play in the dirt and don’t touch anything covered in lead dust without washing your hands afterwards, you’ll get by. One badly contaminated yard in Mt Isa was “fixed” by removing the grass and trees, covering the yard with concrete and adding artificial turf.

While that’s a wonderfully creative way to stop kids playing in contaminated dirt, I can’t help wondering if that’s the best possible solution.

In the absence of due diligence and monitoring by an agency other than the polluter, community monitoring is probably the only thing that will work. That should be the role of the EPA, but often isn’t because there is always a political component. A when a previous EPA director gives evidence on the behalf of a miner, you have to wonder about influence.

There is a “solution” to this problem, and that’s to use a compound possibly used at the smelter to remove heavy metals from the flue gases. Glencore very likely have some. It makes lead biologically inert and works brilliantly to decontaminate heavy-metal contaminated sewage and soil.

If you rely on rainwater, then you’d better filter your water before you use it and get an air purifier for you house because it will mop up a lot of the dust in the air. A vacuum cleaner with a HEPA filter would be useful too.

I have a blog post on how to protect yourself and your loved ones from lead exposure, but lead paint is a challenge.

Let’s talk about what the health services do in the event of excess lead exposure.

The medical term for doing things to reduce exposure to lead is intervention. If a child has raised BLL, medical authorities will instigate an intervention to reduce lead exposure. I’ll describe the process below.

It’s hard to get the intervention order below quite right, because in the past, the job of detecting the source of lead exposure came after signs of exposure. However, depending on the tools used, detection can happen first. So the approaches to reducing exposure are:

(1) Detection, know your enemy. You need to know where the lead is so you know where to focus your efforts. In the past that meant sending samples off to be tested or using insensitive lead test kits, but the possibility now exists to quickly measure lead contamination with a portable x-ray fluorescence spectrometer (XRF). One very interesting sentinel for high environmental lead levels is your dog or your chickens if you have some (just don’t eat the eggs). High BLL in dogs or chickens means high levels of exposure around your house. Ask your vet.

(2) Reduction of lead contamination. Anything you can do to reduce lead exposure is a step in the right direction. That can be really difficult if you’re living in a pre-1970s house that is covered with lead paint. While there are EPA guidelines which stress being careful about contamination when renovating an older house, anyone can sand a house without taking any care to minimise the spread of lead paint chips ad dust. I’ve written a blog (just scroll down) on some of the things you can do.

Then we get to something that is eminently possible, something that has been in use for over 60 years, and something that isn’t used unless clinical signs of lead poisoning are present, removing the lead.

(3) Where lead exposure can’t be prevented completely, removal of excess lead. That introduces the concept of chelation which is regarded as quack medicine by most of the medical industry, for no currently justifiable reasons. Why is chelation a normal treatment option in places like Italy, and not used except in extreme need in Australia (and the US and UK)? It’s a long story I’ve covered in other blog posts.

I’d like to provide more information on intervention (doing something to reduce lead exposure) to reduce lead exposure and what triggers intervention.

In the United States it is quite common to test for blood lead levels in children and in adults, even those not in lead risk occupations. Unfortunately, that isn’t the case in Australia, with the exception of occupational lead risk workers and children in Port Pirie, Broken Hill and Mt Isa. There is very little testing otherwise so while the detection of children with raised blood lead levels is not at all uncommon in the US, and again with the exception of the lead towns of Port Pirie, Broken Hill, and Mt Isa, testing for lead is relatively uncommon in Australia. The situation with non-occupational testing of adults is no better.

If a child’s blood lead level (BLL) is above the notifiable level, now 5ug/dl, a number of interventions are undertaken. If the BLL is above 45ug/dl, lead removal by chelation therapy is a recommended option.

There are differences in the extent of intervention.

In the US intervention consists of

Education for caregivers (which includes nutritional advice and information about reducing exposure in the home); a voluntary home environment investigation; and a referral to lead remediation services.
A more intensive intervention can be triggered by tests over 15ug/dL or 20ug/dL. In addition to educating caregivers and providing a referral to remediation services, the intensive intervention typically includes: a mandatory home environment investigation; nutritional assessment; medical evaluation; developmental assessment; and a referral to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

There are also subsidies available for lead-painted wooden window replacement in older houses, lead paint remediation services and replacement of lead plumbing.

Intervention in Queensland is similar: investigation, restriction and counselling. The intervention isn’t as thorough or complex and the other stuff like subsidies for rectification work to reduce lead exposure, and nutrition advice on reducing the effects of lead don’t exist.

There is no treatment for sub-clinical lead poisoning.

This is a basic flaw in intervention and lead exposure reduction insofar as it mostly doesn’t do anything if the child has been exposed to lead for long enough to accumulate significant bone lead stores.

My opinion is that raised BLL is something that should be treated in the same way as snake venom or infections, or diabetes because if no treatment is applied to remove the lead, something will go wrong.

I’d like to provide a some encouragement as to the importance of reducing lead exposure. I mentioned that due car and hygiene (and nutrition) will limit the amount of lead absorbed. If body lead levels can be kept low enough, particularly between the ages of 0-4 years, some serious neurological effects can be avoided. That means avoiding or minimising behavioural problems and educational problems, and that’s absolutely worth doing.

Why would we not want to give our children as good a chance at a normal life as possible. How can we possibly think of our children as disposable because it’s too hard to manage the problem of lead exposure?

That is probably a good place to emphasize another important difference between the US and Australia. In the US intervention and rectification is a multi-agency activity, because the effects of lead on children includes cognitive decline and behavioral problems, which have a direct impact on education and the youth justice system and well as health issues. Dealing with the problems of health exposure aren’t just the responsibility of the health authorities or considered a “pollution” issue for the EPA.

In the absence of a whole of government initiative, we won’t see any real progress in minimizing lead exposure.

How can Queensland Health effectively protect children if other government departments don’t get involved in fixing their part of the problem? This is a issue not just for Health, but also Education, Youth Justice, Public and Community Housing and the EPA. That’s a challenge because unless the Premier’s department gets involved, what is the likelihood of multiple ministries working together?

Another challenge is community attitudes.

As an example, the biggest advances in reducing lead exposure, and children’s lead levels happened in Broken Hill when the local community got actively involved in exposure reduction for children. 

Would it surprise you to find that approach is much more useful in reducing childhood lead exposure than denial?

Ignoring the problem, insisting there’s anything wrong, or even harassing people that speak up about protecting their children being as important as protecting their jobs, does not fix the problem. A community working together, recognizing the challenge and dealing with it can deal with the dangers of lead. That’s without risking jobs or property values, or stirring up prejudices. Mt Isa does not have to accept that children getting poisoned is part of the cost of living and working in Mt Isa.

You’ need to know that a portable x-ray fluorescence spectrometer (XRF) could be used by the community to detect lead contamination in your houses and yards.

Empowering the community with the means to detect and resolve lead pollution is by far the most powerful way to protect your children. Broken Hill hasn’t shut down so why would getting Glencore to clean up their act a bit more, and community action for the real good of your children harm Mt Isa?