Getting the lead out

November 1, 2007

The author discusses a pediatrician who has pioneered lead prevention and abatement in the pediatric community.

John Rosen, MD, was a research fellow at Rockefeller University during the mid-'60s, doing research on the body's use of calcium. He of course knew lead poisoning was bad, but it wasn't until he learned about calcium that it struck him how pernicious lead truly is.

"The role calcium plays in every single cell, every single organ, is disrupted by lead," Rosen, a toxicologist and pediatrician, said. "Lead kicks calcium out of its role in the development of the central nervous system of young children." There was far too little being done at the time to combat the dangers of lead. Rosen changed his elemental focus: "Getting into the lead field," he noted, "was an easy switch."

When Dr. Rosen joined the staff of Children's Hospital at Montefiore (CHAM), in Bronx, N.Y., lead poisoning was common. Rosen set up a method to measure lead in blood, turning himself into an expert in lead poisoning. Thanks to advances in chelation therapy, and scheduling diets high in iron and calcium and low in fat (fat acts as a lead magnet), Rosen can drop lead levels in the blood of a child with lead poisoning. "The medical management is pretty straightforward," he says.

Although the concept was a "no-brainer," it wasn't until 1991 that Rosen could find the funds to establish the innovative Safe House for Lead Poisoning Prevention. CHAM generously provided three apartments at no cost, where families can stay while their residence is scrubbed free of lead paint. The New York City Department of Health helps refurbish the house, also at no cost to the family.

In 1994, with the help of the Robert Wood Johnson Foundation, the Safe House received the funds to grow into a seven-apartment facility, located near CHAM. Hundreds of families-to date over 250 families, with over 800 children-have been sheltered while their houses were made safe.

Peeling paint on the walls is not the only culprit in lead poisoning cases. Besides the recent news about lead painted toys from China, Rosen warns that heavily-leaded jewelry sold in malls and vending machines are potential hazards as well.

Pediatricians who want to follow in Rosen's footsteps can check out the Centers for Disease Control and Prevention's rules, many of which Rosen helped craft during his 1985 and 1991 tenures on the Preventing Lead Poisoning in Children committees. The American Academy of Pediatrics recommends similar guidelines.

Anticipatory guidance comes first. Inform families of the dangers of lead paint. Then, ask questions. "The basic tenet is, on every pediatric visit starting at six months, to carry out a risk assessment. Focus on the family, the state of the home environment." Test suspected children's blood for lead.

The real problem with lead comes years after successful chelation therapy, when the long-term effect of the developmental delays begins to be noticed in school. Brain damage, intellectual impairment, language deficits, hyperactivity, and trouble focusing could all pop up at age six or seven. It's an unfixable problem, which is why Rosen has devoted his life to stopping it before it starts.