I had been given the names of two Queensland Health employees to contact by Robbie Katter since they had been involved in the “efforts” to reduce lead exposure in Mt Isa since 2006. When I contacted them, one of them responded, one didn’t. When I pointed out that nothing was being done to treat children with raised blood levels in Queensland, aside from “emergency” treatment of seriously raised blood lead levels (at or above 45ug/dl), the justification I was handed for doing nothing was a couple of clinical studies which indicated that chelation treatment failed to reduce symptoms of neurological damage, while not reducing blood lead levels below 15ug/dl in the chelation-treated children.

My reaction was to point out that the available current literature indicated significant neurological effects in the range 5-10 ug/dl so unless blood lead levels are depleted to below 5ug/dl, you are simply not hitting the target.

In any event, the justification for Queensland Health doing nothing was basically why bother because we wouldn’t achieve anything useful.

I wonder how parents with lead affected children would feel about that?

Take the time to listen to this a 2012 ABC News podcast (https://www.abc.net.au/listen/programs/backgroundbriefing/4408246) which talks about the renovation of flooded older houses, and painters and people and children who were exposed to lead paint. It doesn’t do any credit to Queensland Health.

I’ll probably add more to this blog post, but I’m still digesting a beautiful piece of spin-doctoring from the Queensland Premier’s office.

Neither WHS nor most health professionals seem to understand that most of the lead you absorb stays in your bones, whether you’re a child or an adult and it accumulates over time.

The only quantitative measurement of body lead burden has been blood lead levels, so the whole understanding about lead toxicity is centred around blood lead, and that has led to some gloriously incorrect conclusions.

As a result we have clinicians that make their clinical decisions based on blood lead levels (BLL) that can be completely misleading. High BLL can be due to recent acute exposure to lead, or they can be due to the accumulation of lead over a long period, where the high BLL indicates a high body burden of lead. The treatment needed in those scenarios is rather different, but how can they know?

Since both Safe Work Australia AND the WHS bible, “Hunter’s Diseases of Occupations” both say the same thing, that most lead stays in the body and ends up in the bones, it’s hard to understand why after nearly 50 years that simple fact is still ignored in the WHS regulations for managing lead risk worker exposure. Lead does NOT rapidly leave the body. Lead risk workers are absolutely not safe working under the existing regulations. They are being harmed because of a lack of understanding about what happens to lead in the body.

What possible justification can there be for doing nothing to improve a harmful situation? Where is the “safety” that’s quoted in the names of our regulatory organizations?

Once informed of the true state of affairs, continuing as before can only be interpreted as deliberately ignoring their duty of care.

But I’d like to re-emphasize where things have gone wrong in the understanding around the effects of lead.

The most important concept to understand is that once lead is absorbed it enters the circulation and is distributed throughout the body. I will present a simplified summary of how lead is distributed in the body, but if you don’t mind a difficult read, this paper is the real deal (Toxicokinetics of Bone Lead by MB Rabinowitz, Environmental Health Perspectives, Vo. 91, pp 33-37, 1991). Please note that it was published over 30 years ago.

There are two scenarios that have to be considered with regard to body lead distribution: what happens in the case of acute exposure and what happens in the case of chronic exposure to lead.

In the event of acute exposure and absorption of lead, lead first appears in the blood and some of it binds to red blood cells. Most of the lead in blood will be in the red blood cells, but the larger portion remaining will have been distributed to the soft tissues, which represent a much larger pool, and then eventually to bone.

When BLL (blood lead level) is measured after acute exposure, you are measuring lead in red blood cells (RBC), which is only a fraction of the lead in the rest of the body, primarily in soft tissues. As an example, brain (astrocytes) bind lead quite avidly.

As the RBC are broken down, RBC-bound lead appears in the urine and faeces, and BLL drops, but the bulk of the lead remains in the body. Over time, bone lead will account for up to 90% of the body’s lead burden. Lead in bone has a half-life ranging from 2-9 years or longer depending on the age of the individual and bone type.

Bone lead represents a reservoir of lead that will maintains a low but chronic level of lead in the body, in the soft tissues and brain and in the circulation. In the absence of lead exposure, BLL will be maintained at a more or less constant level due to the slow release of lead from bone.

If you don’t remove the lead, it stays in the body for a very long time.

You can accelerate the loss of lead from the body by taking calcium and other food supplements, but it is still a very slow process. Chelation, using chemical agents that bind lead, is the only treatment that removes lead from the body in a reasonable time frame.

Chelation is most effective in removing lead from the body, from a quantity of lead removed per time viewpoint, while most of the lead is still in the soft tissue and circulation pools. In the case of chronic exposure to lead, the bulk of the body’s lead burden will be in bone, where it can only be removed much more slowly.

When you use a chelator, it removes lead from the soft tissue pool and circulation, which produces a drop in BLL. If there is significant bone lead, when chelation is stopped the soft tissue and blood lead levels will be replenished by lead released from the bones and the BLL will rise.

If we only use BLL as an indicator, chelation “appears” to produce an immediate effect, because it has removed lead from the soft tissue pool and circulation, but since bone lead can represent  up to 90% of body lead in adults, you have only removed at most a fraction of the total lead still in the body.

BLL isn’t really a very good indicator of the body’s lead burden.

A child being treated for high BLL, in the absence of symptoms of encephalopathy, will likely be given an oral chelator, DMSA (dimercaptosuccinic acid) to reduce BLL and hopefully avoid the more serious consequences of severe lead poisoning.

DMSA or Succimer, is the preferred pediatric chelator, despite the fact that it is metabolized in the body producing side effects, and is quite objectionable to children because of it’s smell. However it is well absorbed and is specific for metals that interact with sulphur such as lead, cadmium and mercury, and generally doesn’t appear to remove significant amounts of other divalent metals such as copper, zinc and magnesium.

EDTA (ethylene diamine tetraacetic acid) has a much longer history of safe use, but it also has a degree of notoriety that is totally undeserved.

In the 1950s, there was a lot of indiscriminate use of EDTA, with doses that were too high or that represented too large a cumulative dose, and that could lead to renal damage and even death. Careful investigation of the renal damage and animal experiments (1962) showed that the renal changes reverted to normal when EDTA administration stopped. Provided a lower dose was used, with a pause between treatments, no renal damage was ever observed.

One other cause of notoriety in the Paediatric world was the death of a 5-year old autistic child with raised heavy metal levels, who died of heart failure due to hypocalcemia while receiving chelation therapy. The doctor had requested calcium disodium EDTA (Versenate) which cannot result in hypocalcemia, the pharmacy provided Na EDTA (Edetate), which unfortunately did.

As a result, it has become “common knowledge”, from many sources, “that the chelation therapy with EDTA is risky, can cause kidney damage and even death. In fact, chelation therapy with EDTA resulted in the death of a child.”

I’d like to present the case for EDTA.

EDTA is administered as a salt because pure EDTA is insoluble. That is also the reason why oral EDTA, as Ca Na EDTA or NA EDTA, is absorbed relatively poorly (about 5%). If you want to avoid the effects of stomach acids, Ca or Na EDTA should be taken with food, or administered in enteric capsules.

Three main salts of EDTA are used:

• Disodium EDTA is used to treat hypercalcemia and digitalis toxicity-associated ventricular arrhythmias. It removes calcium from the circuation, and is also used to effectively treat atherosclerosis. Uncontrolled administration of Na EDTA can result in hypocalcemia.
• Calcium Disodium EDTA is used to remove lead and other heavy metals from the body, and it conserves calcium in the body. You cannot induce hypocalcemia using Ca Na EDTA.
• Magnesium disodium EDTA can be used for intramuscular injection of EDTA in the case of acute lead toxicity, if IV CA Na EDTA is impractical. It is used because intramuscular injection of calcium disodium EDTA is extremely painful.

As mentioned earlier, the absorption of EDTA salts, while poor compared to DMSA, can be improved by the use of enteric capsules. EDTA has a far longer safety record, despite it’s “notoriety”, than DMSA. It is tasteless so doesn’t have any rejection problems with children, it isn’t metabolized in the body, so has few side effects with the exception of the removal of some other divalent metals, in particular zinc and magnesium/ Little copper is lost in humans as opposed to rats. zinc, magnesium and copper. If the oral dose is low enough the normal dietary content of essential metals is usually enough to maintain a healthy balance.

That brings me to the last point, which is the protocol for removing lead from the body. As I’ve stated, in the scenario of long-term or chronic exposure to lead most of the body’s lead is in the bones. If you want to remove lead from bones, in particular hard bone, it is a slow process.

You will see rapid release of lead from bone is in the presence of gestation, breast-feeding, osteoporosis, blood cancers, inflammatory disease and thyroid disease.

I’d like to propose that the best way to remove lead from the body is at the same rate as lead is released from bone, namely slowly. The idea is to continually deplete the soft tissue and blood pool, which will eventually cause depletion of the bone lead pool.

I would also argue that oral Ca Na EDTA, in enteric capsules, is far less likely to result in undesirable side effects when administered for longer periods, provided potential essential metal depletion is managed.

In adults (lead risk worker), 600mg of Ca Na EDTA in enteric capsules appears to prevent further net uptake of lead, and slowly deplete bone lead. If you weren’t dealing with constant exposure to lead, an even lower dose would probably be effective for an adult.

While the ideal scenario would be to measure bone lead with XFR, a steadily dropping BLL is a good indicator of positive progress. The target endpoint should be a BLL of under 5ug/dl or perhaps even lower in children.

Children would require a yet lower dose of chelator to avoid essential metal depletion. Here we are probably looking at 50-100 mg of Ca Na EDTA per day, interleaved with a vitamin supplement which includes trace metals. I believe that would result in a reduction in neurological effects of lead and in a significant reduction in the risk of long-term damage due to lead exposure.

That’s pretty simple, so why isn’t it happening?

Why are children that have BLL below 45ug/dl not treated to remove lead when we know that it will cause harm? Why are lead risk workers left to suffer a myriad of lead-related diseases, without any concern about the continued accumulation of lead in their bodies?

I can’t provide an answer to those questions without causing offence to someone, but we could definitely have better outcomes.

I thought I’d say a bit more about the workplace health and safety (WHS) processes for lead risk workers and what the health department doesn’t do for children exposed to lead. What prompted this was a picture I found on social media about mine canaries.

As you know, canaries used to be taken down into coal mines because they would be affected by poison gases before the miners. If the canary fell off his perch, then it was time to get out of the mine. That seems a bit hard on the canaries and despite the horrible working conditions for miners in a coal mine, they made this:

The cylinder has an oxygen tank and if the canary fell off his perch, the glass door would be closed and the oxygen turned on to revive the canary and keep it alive while the miners left the mine with the canary.

The miners cared enough for the life of a small bird that was protecting their lives, to value its life and keep it alive.

I’d like to talk about two situations where people exposed to lead are used in a way similar to mine canaries, except perhaps that their lives aren’t valued as much.

The first situation is the one faced by lead risk workers, people exposed to lead in their occupations, their jobs. I have a earlier blog that talks about lead risk workers, though I have to be realistic and point out that some of them aren’t monitored for blood lead levels, people like soldiers for example. But let’s go on.

If only the WHS authorities and employers were half as caring about lead risk workers as the miners about their canaries. Or perhaps update their decades-old regulations that indicate they really don’t care.

Lead risk workers are their own mine canaries from the viewpoint that if by accident, bad hygiene or increased lead pollution their blood lead levels (BLL) increase above the actionable limit, the excess BLL is an indication of some sort of lead exposure failure. That is supposed to trigger some sort of investigation and remedial action, but more often than not it doesn’t. Things go on as usual.

If your BLL goes above 30ug/dl, you are removed from the lead risk, and your BLL is monitored, and once your BLL drops below 20ug/dl you can return to the lead risk work because the lead is gone.

If the fall in BLL truly indicated a drop in body lead levels, that would be a perfectly reasonable thing to do, except we’ve known for the last 40 odd years that it doesn’t. BLL falls because red blood cells containing lead are cleared from the body, most of the rest of the lead goes to your soft tissues and then your bones.

Unlike the canary, removing you from lead risk work doesn’t remove the lead you’ve absorbed, you don’t end up safe until the next time. Lead accumulates in your body and once the lead levels get high enough, they will result in all sorts of harm.

The sad truth is when you go back to work, you will continue to accumulate more lead.

So is anything done to protect you from the ill effects of lead, like the oxygen fed to the canary?

NO!

If your BLL goes above 70ug/dl, you will get a relatively short course of a medical treatment, chelation therapy, to drop your BLL back down to “safe” levels. If you’ve accumulated a lot of lead, once the chelation therapy has stopped, a few weeks later your BLL will go back up, because of lead released from your bones This is called rebound and for the most part, clinicians don’t understand why it happens because they know so little about the toxicokinetics of bone lead. There’s an interesting article in Environmental Health Perspectives, Vol 91, pp 33-37, 1991 by MB Rabinovitz that makes sense of the active distribution of lead between the bones and soft tissues in the body. Notice the date, 1991, 33 years ago!

Unless a low dose, long term chelation protocol is used, lead cannot be effectively removed from the bones, or the body.

If your BLL goes over 30ug/dl, there are a multitude of risks that start to climb astronomically, like the risk of soft esophageal cancer, cardiovascular death, behavioural changes, violence and so on.

Nothing is being done in Queensland, or indeed in Australia, to reduce these risks.

NOTHING!

In an ideal world we would have environmental monitoring of the workplace to detect excess lead hazards, BLL monitoring combined with measurement of bone levels, and chelation to remove accumulated lead, and to stop it accumulating.

That’s something that could be done right now, but the WHS authorities or employers aren’t interested in changing what they are doing, because they would then be legally aware of the workers’ risks, and that could have unfortunate consequences, including having to spend money to make the workplace safer.

The second situation I’m going to describe is in a lot of ways worse.

Children get exposed to lead, by eating or licking lead paint, by environmental exposure, old batteries and other sources of lead, like lead from eating a wild duck, shot by a hunter.

With the exception of children in Australia’s lead cities, Broken Hill, Port Pirie and Mt Isa, children rarely have their BLL measured unless they are showing overt signs of lead exposure. I’d like to point out that the symptoms used to diagnose overt lead exposure are the ones used 60 years ago, before evidence was available that much lower levels of BLL indicated harm.

If a child’s BLL is above 45ug/dl. they will be treated with chelation therapy, either with IV chelation (Ca Na EDTA) if encephalopathy is evident, or with oral DMSA (dimercaptosuccinic acid). Either type of treatment is generally short-term and discontinued once the BLL drops to what is considered safer levels. Of course that’s ignoring the American CDC, who has dropped the recommended maximum level to 3.5ug/dl but also states there are no safe levels of lead in children.

If the child has been chronically exposed to lead, several weeks after the chelation therapy their BLL will increase, a rebound, due to the release of lead from bone. The rebound has been described as indicating the failure of the effectiveness of chelation. Chelation is generally not continued because of the mistaken belief it is risky.

In any event, children with a BLL below 45 ug/dl generally receive no treatment. Their parents are counselled, sometimes with a site inspection, to reduce exposure to lead, ideally that includes nutritional counselling which can make a big difference for children.

But most of the lead in their bodies remains. We now know that relatively low levels of lead, below 10ug/dl, can have major deleterious neurological effects. But nothing is done to remove the harmful lead.

We also know that any amount of lead in the body is potentially harmful, but our medical authorities do nothing. We know that BLL levels of 10ug/dl can lead to a drop in IQ, in severe educational challenges, and also lead to behavioural changes that can manifest themselves as violence in older children, but our medical and educational authorities do nothing.

These children are the mine canaries for lead exposure, an indicator of excess lead in the environment. But they get no “oxygen” when they start to succumb to the effects of lead. They are simply discarded as faulty.

The government agencies that we are supposed to be able to trust, ignore their duty of care and look the other way, whether because of ignorance, laziness or corruption. In this scenario my definition of corruption has to be pretty broad, because a government as a whole can be so influenced by mining interests, historically the lead industry cartel, that the “unofficial” line for public servants is to look the other way. And sometimes, it can be because the government fears the results of the public finally finding out about their long-term failures to control environmental hazards. Think about asbestos if you don’t think that’s possible.

The really sad joke about all this activity to hide the effects of lead exposure is that we now have the means to protect workers and children from the ill effects of lead absorption and accumulation. But in order to move forward, we have to admit our past failings. Bureaucrats hate admitting they were wrong, it’s simply not in their genes to admit fault UNLESS they’re caught out.

So here we are. We know there’s a problem, we know about the solutions, and as far as Queensland is concerned, we do nothing. Makes you proud to be a Queenslander doesn’t it?

I’ll be up front about the fact that I am convinced that excess exposure to lead has long term adverse health outcomes. Nothing I’ve read suggests that lead is safe so be warned. On the other hand, I also think that with the proper measures, living with lead could be safe, but those measure aren’t yet being applied in Mt Isa or most other places in Australia.

If you live in a lead-rich environment like Mt Isa, there is always the potential that children can be exposed to and absorb lead. Good hygiene and good health and diet will reduce the amount of lead that is absorbed. Making sure children don’t play in the dirt and keeping the house dust free will help as well, but the risks of lead absorption are only reduced, not absent.

If you’re careful and observant enough, the risks of lead affecting your children can be minimised, although never completely. Lead safety takes a lot of vigilance, and a lot of care. It takes something else as well, an appreciation of the fact that situations can arise where all your care and vigilance won’t be enough.

The biggest dangers are complacency and denial.

Half of the people interviewed in a James Cook University study in Mt Isa indicated that lead wasn’t a health risk, and they were often people who were born and raised in Mt Isa. No level of lead in your body is safe, and the only real question is how much risk people are prepared to ignore.

I think it’s better to say that you need to know your enemies, understand them, before you can decide if they’re harmless or not. That avoids nasty surprises.

I absolutely understand that the presence of lead is associated with the prosperity of the city, with jobs and careers, with property values and with the economic wellbeing of the community. It would be silly to suggest that lead isn’t an incredibly important part of the lifeblood of the community. But that doesn’t mean it should be in the bloodstream of people in the community as well. My only goal is to reduce the very real risks of adverse health outcomes in Mt Isa.

I also can’t ignore human nature because acknowledging the dangers of lead when you’ve ignored them in the past involves some uncomfortable self-analysis that most people will try to avoid. The denial concerning lead can extend to harassing people who are publicly outspoken about the dangers of lead and this can get really uncomfortable for people who have a genuine concern, because at some level they are seen by some as a potential danger to the community as a whole.

And then there are people who generally don’t have a voice regardless.

These are people, who because of their socio-economic circumstances, don’t have the same opportunities to avoid lead exposure to their children. People who live in older pre-1980 houses or lead-painted social housing, whose diet means that their children are even more likely to be iron and calcium deficient. People who don’t have grass-covered back yards and where dirt is the only play area for their children. The fact that their children are at much greater risk of lead poisoning because iron deficiency and lead poisoning go hand in hand, and calcium deficiency increases the amount of lead absorbed is generally overlooked.

Let’s face it, every study of blood lead levels carried out in Mt isa has shown that indigenous children have higher blood lead levels and are more at risk of lead poisoning.

So, the big question that has to be answered is whether leaving things as they are, or trying to improve them, is the best long-term strategy. But change can be difficult, though the end result can be so much better.

Active community involvement in minimising the risk of lead exposure makes an enormous difference, but that’s pretty hard in a community in denial. There are programs, Vegesafe and Dustsafe, sponsored by Macquarie University, that will analyze soil and dust samples sent in by people who want to find out if their yards are safe. The data is then made available in a global environmental database, (Map My Environment: Global (shinyapps.io).

Let’s compare Broken Hill and Mt Isa:

Guess which community is in less interested in lead contamination and which one is taking an active role in detecting and minimizing lead exposure. If you don’t do the tests, you don’t know the truth, and it may not be what you think.

Do the people of Mt Isa honestly believe they have a safer environment than a lead mining city like Broken Hill that doesn’t have a smelter? Where ore is shipped to Port Pirie instead of being ground up a processed into lead concentrate for the smelter or export from Townsville?

Unless the Mt Isa community actually starts taking an active role in lead risk management, and not just leaving things to the city council and the Lead Alliance, they will never own the problem or control it, and as you’ll find out, that’s important.

I’d like to talk about a hidden danger in Mt Isa that is doubly hidden because talking about lead dangers is pretty unpopular.

There are places in Mt Isa where the risks from lead are extreme, and they have nothing to do with lead from the mine or smelter, but everything to do with the risks of lead paint. I’ll restate that so you really get it. The worst lead polluted yards in Mt Isa have nothing to do with the mine or the smelter or the lead ore deposits under Mt Isa.

This serious lead poisoning danger is from lead paint made from white lead (lead carbonate). Lead paint can contain between 20%-50% lead , in a form that is extremely bioavailable. It tastes sweet and is irresistible to young children and animals. There are many recorded instances of children in Queensland being poisoned or even dying from licking lead paint. Sanding a house painted with lead paint can contaminate the whole neigbourhood and there are reports of clusters of lead-poisoned children near where old houses were being renovated.

Lead paint for domestic use was officially banned in Queensland in 1922, but because the ban didn’t include lead paint for industrial use, lead paint continued to be used for houses, particularly by the larger builders, until the late 1970s. There are probably hundreds of lead-painted houses in Mt isa. Australia has 3.5 million houses built before 1970.

Lead paint is not something you can afford to ignore, but that’s pretty much what happens in Australia at a government level..

In the US, lead paint on older building is treated the way we treat asbestos removal, with mandated protection and removal procedures to make sure the lead paint doesn’t contaminate the neighborhood around a house being renovated.

The EPA issued a new regulation called ‘Renovation, Repair and Painting’ (RRP) regarding the renovation of residential housing and child-occupied buildings built before 1978 on April 22, 2008. The rule (Federal Register: July 15, 2009 (Volume 74, Number 134)) became effective April 22, 2010. 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.

In Australia you can find warnings about lead paint removal from the Health Department and EPA, and there’s even an Australian Standard (4361.2 Guide to lead paint management, part2: residential and commercial buildings) but no apparent enforcement or regulatory legislation.

Here’s something you won’t see in Australia:

An old house can be coated with a kilogram or more of lead in the paint. Sanding an old house would leave more lead on the ground than you’d find almost anywhere else, so if we aren’t regulating its removal, I think it’s reasonable to say we are most certainly not managing the danger.

Lead paint removal HAS to be regulated, but until it is, you’re on your own, hoping the painters working on the old house up the street are doing it safely. Going by the number of painters with actionable blood lead levels, that is somewhat unlikely.

That brings us to what else you can do to reduce exposure to lead, at least if you’re willing to concede it might be dangerous.

Imagine a scenario where provided you detect and deal with any lead hotspots, you “could” safely ignore the harmful effects of lead because it wouldn’t be harming you, or your children. YOU, not the government agencies that look the other way when it comes to lead, or the mining company that is more interested in profit than people’s safety.

There is an industrial heavy metal complexing agent, called TMT that is used to remove heavy metals from flue gases and industrial wastes. It’s very probably used at the smelter.

TMT binds lead so tightly that it effectively passivates the lead so it is no longer biologically available. It makes lead safe for humans because they can’t absorb the lead from a TMT/lead complex.

When NQ cattle that were part of the live export trade, were tested for lead content some of them had unacceptable levels of lead. That created a problem for NQ cattle stations on lead-rich land because it threatened to kill their export market. The solution was to feed TMT to the cattle until all the lead was removed, and they were then deemed fit for consumption.

A more important use for TMT has been found in China where the mixing of industrial waste with sewerage meant that sewerage that was once used as an organic fertilizer was now unfit to be used because of heavy metal contamination. When TMT was mixed into the contaminated sewage the TMT completely passivated the heavy metals so that plants fertilised by the treated sewage were free of heavy metals, including lead.

TMT could provide an effective way to “decontaminate” lead-rich back yards in a way that would be far more elegant than covering a back yard with concrete and artificial turf.

IF the effort were made to identify dangerous concentrations of lead instead of ignoring the situation, they could be treated and rendered safe. I think that could be a pretty big deal for Mt isa because it could mean that Mt Isa could be safe for children. That’s of course dependent on the community dealing with the problems instead of ignoring them, but it’s possible.

The last part of the puzzle is what do we do about the lead that has already been absorbed by adults and children? That has to be considered because if body lead levels are high enough people WILL be harmed and this is especially true for young children. A lowered IQ, learning difficulties and behavioral problems may not be all that noticeable, but would youth violence caused by lead exposure get your attention?

If we could remove the accumulated lead and get rid of the potential for harm, wouldn’t that be worth doing?

Chelating agents, chemicals that bind and remove heavy metals, have been in use since the 1940s. Despite nearly 80 years of experience in removing lead, it’s still not commonly done, in the face of more than adequate evidence that lead can be safely removed from the body.

The story of why we’re not removing harmful lead is a sad one. Most clinicians don’t understand what chelation is about and confuse the various types of chelators and treatments. And then there are the urban myths about chelation being risky, causing kidney disease and even death. That was certainly true in the 1950s when too high a doses of chelating agent were applied for too long, but safe protocols were established 30 years ago.

As a result, our health authorities only use chelating agents when an individual has very high blood lead levels, or has clinical signs of lead poisoning. The point at which the use of chelating agent is considered is when blood lead levels are above 45ug/dl in children and 70ug/dl in adults. Chelation isn’t recommended or used for levels of blood lead below these values, despite the huge amount of data that shows values well under 45/70 ug/dl are most certainly harmful.

The NHMRC have a 2016 document titled “Managing Individual Exposure to Lead in Australia — A Guide for Health Practitioners” that states the following about blood lead levels between 20-44ug/dl:

• Patients may present with acute symptoms of lead exposure, such as gastrointestinal disturbances (e.g. nausea, vomiting, constipation and abdominal pain) and neurobehavioural effects (e.g. forgetfulness, irritability, headache and fatigue) in adults and behavioural changes
  and reduced haemoglobin in children.

Note the comment about behavioural changes. Those changes include reduced cognitive ability, reduced decison-making ability and increased violence.

What the NHMRC guidelines failed to report is the increased risk of cancer, increased blood pressure and greatly increased risk of dying of cardiovascular disease as a result of blood lead levels between 20-44ug/dl.

The present situation is like only treating someone with cancer if they have stage 4 disease and ignoring it otherwise. How many more people would die of cancer if we took that approach?

Low dose oral chelating agents, are almost completely safe because the only possible risk is the depletion of essential trace metals, something you can avoid with the occasional mineral and multivitamin tablet.

We could safely remove lead from the body, prevent and reverse at least some of the neurological damage and safely avoid the ill-effects of lead exposure. But not while we’re ignoring the fact that lead is dangerous.

How many people do you think die because we do essentially nothing about lead exposure or removal? If the US CDC are correct in their estimates, and if we translate US figures to the same population ratio in Australia, somewhere between 35,000-40,000 Australians a year may die of diseases where lead was a contributing factor.

That’s twice the population of Mt Isa dying as a result of lead exposure every year. The NSW government estimates that 4000 Australians die every year of asbestos related disease, so we now take asbestos exposure seriously. But 10 times that number of people dying of lead-related causes doesn’t worry anyone?

Is it really safe to ignore the presence of lead?

Is doing nothing about dangerous levels of lead in the body the best possible solution?

If lead was safely removed from children and adults and if we add in the passivation of lead in contaminated back yards and playgrounds with TMT, Mt Isa could be safer for adults and children than any other city, despite the presence of lead, regardless of the source.

Safe removal of lead paint on older houses would have to be part of the solution, but older public housing represents an awful lot of government-owned houses so don’t expect much from the government there. I remember when the state government commissioned a survey of Legionella in buildings in the Brisbane CBD, prior to enacting legislation. Turns out most of the CBD building with Legionella were government-owned, so no legislation.

Mt Isa can’t afford to depend on government agencies to take any meaningful action on the behalf of the safety of the people of Mt Isa when it comes to lead and Glencore doesn’t care. You’re on your own.

The people of Mt Isa need to face the truth, face reality, and get busy protecting themselves. As a challenge: if people in New Souths Wales, in Broken Hill, can start to take control, surely Queenslanders can do the same.

That’s a somewhat controversial title for this post. Where lead exposure “safety” is concerned, my opinion is they’re not doing their job. But that statement requires clarification.

We have a regulatory body for workplace health and safety that develops regulatory models for the states and territories of Australia (except Victoria). This is what Safe Work Australia (SWA) say about their role:

Safe Work Australia is a national policy body representing the interests of the Commonwealth, states and territories, as well as workers and employers. We work to achieve healthier, safer and more productive workplaces through improvements to work health and safety ( WHS ) and workers’ compensation arrangements.

When SWA formulates regulations about workplace health and safety issues, it is a complex process of introducing amended rules, discussion and then deciding whether the changes are justified, much like parliament, where the people with primary voting and indeed veto rights are the employers , and representatives of employers and government agencies. While workers are allegedly represented I have found no evidence of direct worker consultation or representation.

When you look at the decision-making process around lead biohazard management, as an example dear to my heart, there is no evidence that worker safety had any sort of precedence.

Lead exposure management regulations have remained unchanged for over four decades, with the exception of the lowering of the trigger blood lead values for work removal and resumption. This is despite an overwhelming amount of clinical and epidemiological evidence that indicates the basic premise of these actions is incorrect. It is despite the fact that SWA’s own publicly accessible documentation very clearly indicates the basic premise of the regulation is simply wrong.

And yet they continue this abomination in their regulatory model because it best suits the employers. If you know you’re doing harm, what does that say about an organization that refuses to consider change?

I’d like to present an email I sent to the SWA Chemical Policies director after getting a reply that basically did what bureaucrats do, repeat what the organization does instead of answering any specific questions.

Here it is:

I have to apologise for bothering you again, but I have had a prior issue around lead exposure management in lead risk workers that I tried to raise with SWA.

I was pretty naïve at the time, not having any experience with the workplace health and safety mantras, and not understanding how safety had to be cost-acceptable when proposing updated safety regulations.

You would be aware of the fact that lead exposure monitoring and management achieves nothing but excess lead exposure detection , and only IF the employer sees rising blood lead level (BLL) as a failure of exposure limiting processes and does something about it.

I have second-hand information about lead risk workers removing their dust masks because of 50 degree heat, with their faces running with black sweat and of change rooms that were too crowded with lead dust on the floor.

If rising BLL is used as an indicator of degrading environmental safety, or unacceptable worker habits or actions, and as a trigger for investigation and rectification, then I acknowledge its value in exposure monitoring and management.

But nothing is done about the continued bioaccumulation of lead.

SWA documentation makes it pretty clear that whoever composed the document on lead knew about lead bioaccumulation and the very long half-life of lead in bone, as well as the fact that most lead ends up in bone.

But aside from a reference to how  x-ray fluorescence (XFR) spectrometry could possibly be used to measure bone lead and saying XRF wasn’t ready yet (2019), SWA has no alternative to measuring BLL, doing what they’ve been doing for decades, with the occasional adjustment of the trigger levels (now 30ug/dl and 20ug/dl). I would like to provide an update (enclosed) where work by Linda Nie’s group at Purdue University now has portable XRF measurement of bone lead at a point where it can and should be used.

If we don’t measure bone lead and by extension body lead levels, we remain unable to even attempt to manage lead worker’s ever increasing body lead burdens, which WILL cause disease in the future, if not already.

A long-term Monash study of lead workers, mentioned in a SWA document, notes a 7-times higher rate of oesophageal cancer in workers with a BLL of 30ug/dl. When a worker leaves lead risk work, they have a 2-3 fold higher risk of dying of cardiovascular disease at a BLL of 15ug/dl. We also have  gout, high blood pressure, atherosclerosis and a host of other conditions.

SWA knows about this and effectively ignores it as far as the current regulation model is concerned. Lead risk workers’ have a real risk of developing serious disease or death because the true dangers of their lead risk work, aren’t properly addressed.

I accept that any effective way of reducing the bioaccumulation of lead (an inevitable result of exposure)  is worth doing, but it ignores the result of the bioaccumulation.

I’ve neglected the truly devastating effects to children of mothers who have worked as lead risk workers. Lead, like calcium is removed from the body during gestation and during breast feeding.

Doing nothing about managing a worker’s body lead burden can have devastating consequences.

Even if XRF finds it’s way into the model regulations, we are still left with the problem of what to do about the already accumulated lead. Chelation or removal of lead provides a remarkably elegant solution, provided we stick to oral chelators.

I need to point out the US OHSA explicitly forbids using “prophylactic” chelation to remove lead since it interferes with BLL measurements and confuses the results of monitoring. I would like to argue that removing lead that is already present is not prophylactic, but I don’t have the proper bureaucratic mindset.

Nevertheless, the inescapable truth is that if we know the body lead burden of a worker using XRF, and we are hopefully minimising exposure using BLL, we still need to manage body lead levels either by preventing lead being absorbed at all, or by removing it.

Cattle in far north Queensland live on land that is rich in natural lead. As a result they end up having so much lead in their bodies that they are now unfit for human consumption. A few weeks in a feedlot eating an industrial chelating agent leaves them lead-free and fir for consumption.

The station owners needed to produce a cost-effective solution to make their cattle saleable, and they found one. Is it really too hard to look at this for lead-risk workers?

I’ve managed to get a few lead risk workers to volunteer for a trial of 600 mg Ca Na EDTA in an enteric capsule (cost 13 cents per capsule, with occasional trace metal supplementation) daily. The sample size is too small to be meaningful, but what we are seeing is a steady fall in BLL, in spite of continued exposure to lead. The first time something like this was reported was in 1962, so I’m simply repeating something already done 60 years ago, albeit at a much lower dosage (they used 4g Ca Na EDTA daily).

My logic was that it takes time to remove bone lead, so slow and steady minimised any risk, and was probably going to be more effective. I guess we’ll see.

Removing lead with oral chelators is not a new idea. But it’s high time it was considered as a tool to make sure that lead risk workers didn’t carry an awful legacy from their work, all while they were under the protective umbrella of SWA or their state WHS organizations.

I am aware that part of the decision process for formulating updated (and perhaps safer) model regulation is cost-driven, namely the cost of implementation and employers can argue against changes that are deemed to be too costly. In a proper cost-benefit analysis, a costing has to be included for the costs of NOT changing the regulations.

I’m sure you wouldn’t be surprised to learn that I didn’t receive an answer. That’s par for the course when a bureaucrat doesn’t want to answer an awkward question. Ignore it and it will go away.

I’ve talked about the constraints on people in organisations about communication, how hard it is to be a whistleblower and the likely outcomes of speaking up. We know what happens to whistleblowers in Australia and what it says about the claimed openness of our governments agencies.

Nevertheless, it was disappointing, because if SWA as an organization cares more about employer opinions than worker safety, they aren’t doing their stated job. I understand that safety regulations that are too expensive can affect the viability of an industry and unemployed workers aren’t that well off either. When invoking updated safety regulations that would actually reduce employer costs and improve worker safety are blocked because of hubris, indifference and inertia, is SWA doing its job?

I thought I’d be a bit more forthright because expecting mining companies and government agencies to actually care about people exposed to lead is looking more and more like something that doesn’t happen.

Glencore is Australia’s biggest employer of lead risk workers, and since this whole thing started with them, keeping them in the spotlight seems quite reasonable to me. But don’t ever forget that there are a lot more industries involved that expose workers to lead risks.

I approached Glencore about 5 months ago to point out their (government-mandated) workplace health and safety procedures for managing lead biohazard safety of lead risk workers was harming their workers.

The safety procedures were formulated over 40 years ago when a lead exposure management policy was put in place in the US, which removed workers from lead exposure if their blood lead levels went over 60ug/dl. Once the worker’s blood lead level reduced below 40ug/dl, which was interpreted as indicating that absorbed lead had left the body, they were allowed to go back to work. 

The only thing that has changed in that policy is that the blood lead levels have been halved to 30ug/dl and 20ug/dl respectively. That represents over 40 years of sloth, disinterest and disregard for the safety of lead workers on the part of occupational safety regulators. I had initially added ignorance to that list, but that’s not true because they know it’s wrong.

What’s wrong with this decades old policy is that a falling blood lead level on removal from lead exposure does NOT mean any significant amount of lead has been lost, it just indicates that the lead has gone to other organs, and bone. If you’re reasonably healthy (no cancer) and an adult male, almost all the lead you absorb ends up in your bones (about 95%), where it stays and screws up your health for the next 30-40 years or so, if you live that long. The story for females is infinitely worse, but in a different way.

You could reasonably think that having found out that the existing workplace health and safety policy for lead risk workers was causing long-term harm to their workers, that Glencore would have welcomed suggestions on how to fix the problem. That’s certainly what I thought, but Swiss-owned multi-nationals have other priorities it seems, and avoiding long-term harm to their workers isn’t one of them. Denial and obfuscation, in whatever form, is how they handle things.

I pointed out that the potential for future legal action by lead workers who discovered their health had been screwed up by lead exposure. I suggested that Glencore HAD to know about the total body lead burden of workers to manage that risk. I’m talking about thousands of workers, potentially anyone who has done lead risk in Mt Isa for the last 40 years or so. 

As long as it’s cheaper to handle worker law suits with out of court settlements and NDAs, denying there is a problem is probably reasonable from their viewpoint. In the absence of a working lead burden management policy, that almost makes sense in a truly disgusting way, since admitting there is a problem potentially opens a Pandora’s box of class actions by former workers. Then again, they had the defense that they were following regulatory mandates.

I think that it’s monumentally stupid and short-sighted view but who knows what goes on at head office. A corporate mentality that would rather spend resources on legal fees than even think of fixing a long-standing environmental health issue is completely at odds with their “public image” of a good community citizen.

I’ve pointed out that a woman of child-bearing age who has worked in lead risk work is carrying an awful legacy from the lead she has absorbed, because that lead will be passed to her unborn child through the placenta, and via her breast milk if she breast-feeds her child. That’s a case Glencore couldn’t win, about harm to a lead-affected mother and her lead-affected child.

I still have an issue with imagining how any company can miss seeing the potential for legal disaster in that scenario. Are their legal advisers so arrogant they can’t see that? Or does Glencore have some kind of “get out of jail” free card to avoid class actions? Then again, most of the lead risk workers are men, so maybe it’s no big deal.

But Glencore could defuse the legal liability of managing lead accumulation in lead risk workers by measuring accumulated bone lead and removing the lead. Surely, doing that would be much less expensive than endless litigation.

It would be a damn sight better for the workers too.

But since this is about trying to encourage Glencore to show a bit of sense, let’s look at what else is at stake. Lead affected adults suffer reduced cognitive ability, poorer decision making, and are more likely to be violent. They are more likely to die of poor decisions and more likely to die of cardiovascular disease, more likely to get cancer, renal disease and the list goes on. What does it say about a company’s basic culture if it ignores the consequences of it’s action, or in this the consequences of it’s inaction?

It is important to point out that inaction isn’t a crime within the scope of mandated lead worker safety procedures. I would not want to criticize Glencore for a failure to follow the rules, but following the rules blindly, without even an attempt to come up with something better, despite the fact that they now KNOW they are causing harm? That’s hardly praiseworthy.

And in that sense, the problem isn’t primarily with Glencore. It lies with the regulatory authorities (like Safe Work Australia) that have been too spineless to change something they know is wrong. This is not the way occupational health protection should work, and this appears to reflect failures at every level of government.

We have the technology and the knowledge to manage lead exposure risks as well as lead exposure. The problem is so neatly defined, the causes known, and the solution so neatly packaged that if we can’t eliminate this travesty of occupational safety, it’s because the government agencies are working actively to avoid doing anything.

We have the knowledge required to do something provided we have the political will. If common sense in our Health services translates to pressure on Safe Work Australia to update their ignorant and damaging policies, lead risk employers like Glencore will have to follow suit. This is only going to happen if it’s driven by community involvement and concern.

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?