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BUTTERFLIES.PDF

butterflies.pdf


HOUSES OF BUTTERFLIES

Herb Needleman took on the disease of where we live and work.
Rebecca Skloot



From our Winter 2001 issue. See all our past issues here.

Needleman | Credit Frank Walsh

After Frank Durr died in a straightjacket in 1924, workers at the DuPont Deep
Water plant thought they knew what killed him. They figured it was the same
thing that killed William McSweeny—whose sister called the police for help after
he went home sick from his work at a similar Standard Oil facility, then woke up
the next morning violently insane. He died in a straightjacket, too. Fifteen
others did as well, and the dead men shared one more feature: They all had
worked in a House of Butterflies—a building for tetraethyl lead synthesis—so
named because its workers were known for brushing hallucinated insects from
their bodies.

In the early 1920s, in an attempt to outdo Ford’s Model T, General Motors
mounted efforts to find an agent that would quiet the Cadillac, whose knocking
engine kept it lagging in popularity. What they came up with—an old compound
Germans had developed called tetraethyl lead—silenced knocking engines and
inspired a burgeoning new product: Ethyl Gas. But shortly after mass production
of leaded gasoline had begun, workers in Deep Water, New Jersey, and at two
other plants started developing a mysterious and often fatal illness. New York
and New Jersey responded quickly, banning leaded fuel and ceasing its production
at the plants, but their action was only temporary. After a six-hour Surgeon
General’s meeting, the ban was lifted, production resumed, and lead soon found
its way into everyday use, fueling more than half a century of heated debate.

Twenty-five years after the deaths of Durr, McSweeny, and others, the 2
p.m.-break whistle echoed along the Delaware River behind Deep Water, and
Herbert Needleman filed out with the other workers. Needleman, a second year
medical student at the University of Pennsylvania paying his way through school,
had soaked through his clothes in the plant’s heat, which usually topped 100
degrees by early morning. He peeled off his elbow-length rubber gloves and
headed outside for a cigarette. Every day when the break whistle blew, Needleman
and other men would swarm across a field, far from the plant and its explosives,
into wooden smoking shacks with glowing cigar lighters embedded in the walls.
There, Needleman would smoke and check out his coworkers. In the corner, a few
older men sat staring blankly into space, moving slowly and clumsily. If they
spoke, their voices were distant and empty. One day, when Needleman asked other
workers the story behind these men, they all shook their heads. “Oh yeah,” one
told him, “those guys worked in the House of Butterflies.”

Needleman joined the University of Pittsburgh School of Medicine in 1981,
leaving Harvard University to join Pitt’s Departments of Psychiatry and
Pediatrics. Calling professor Needleman a leader in the field of lead research
would be an understatement. (The champion of preventive medicine has long since
kicked the smoking habit, by the way.) He has spent much of his career
attempting to convince others that exposure to lead, even at low doses, has
tragic effects on individuals and society. Though few deny that high doses of
lead are toxic, its lowdose effects have been passionately debated. If you ask
Needleman where arguments against the danger of low-dose lead exposure come
from, he’ll tell you it’s the lead industry—an entity he has fought through
several turbulent decades. The battle starts with Needleman’s first academic
paper, and spans through scientific misconduct charges brought against him (by
researchers who served as paid expert witnesses for the lead industry), to his
work today.

As for the scientific misconduct charges, the committee that investigated him
regarding the allegations directed Needleman to correct and clarify published
reports of certain methodological aspects of his work and to make available to
any interested scholars his complete data set on his tested subjects. More
importantly, the committee asserted that the conclusions from his data were
robust. Needleman had not engaged in scientific misconduct. Further, his early
findings on subclinical lead exposure have since been con- firmed by similar
studies in Australia and elsewhere. And his efforts to de-lead America in the
name of public health, even in the face of scalding controversy, have won him
prestigious honors such as the Dana and Heinz Awards.

As for halting the effects of low-level lead exposure, Needleman has had a few
victories, but at 73, it’s a fight that still consumes him.

Rubbing his eyes gently, Needleman lets out a deep sigh when he talks about lead
and its effects. “Lead does so many things to human biology, we don’t even know
which ones are most important,” he says. It affects neurotransmitters
responsible for nerve conduction, causes leaky capillaries, kills brain cells,
affects RNA transferase and transcription of the genome, and that’s just an
abbreviated list. “There are thousands of articles out there,” he says, “and so
many effects that could be critical, we don’t really know what’s what,” and then
he pauses. “We just know that the more you look for brain effects, the more you
find them, even at very low doses.”

Needleman recalls how in 1960, according to the Centers for Disease Control and
Prevention, a child needed at least 60 micrograms of lead per 100 milliliters of
blood to be officially identified as poisoned. Back then, 20 percent of inner
city children had blood lead levels of 40 to 50 micrograms per 100 milliliters,
and they were considered normal. This made no sense to Needleman. Listen, he
said, if we know for a fact that high-dose lead poisoning causes obvious
problems—like coma, retardation, and death—why should we assume that lower
levels cause no injury to a child’s brain? He has asked this question repeatedly
for about five decades. Almost every time he does, he designs a study to examine
it from a new angle. (Today, the toxic lead level is defined as 10 micrograms
per 100 milliliters, and still 21 percent of inner-city children have lead
levels above that, according to Needleman.)

In the ’70s, Needleman’s community mental health office was what used to be a
living room in an old brownstone in an impoverished section of Philadelphia.
Each morning Needleman stared through his office window into a primary
schoolyard across the street. It was full of poor kids, mostly minorities, who
lived in turn-of-the-century houses with peeling lead paint. As they giggled and
ran by his window, Needleman started to think to himself, How many of those kids
aren’t going to make it because they are lead poisoned? And what other damage
might they suffer from lead’s toxins? To find out, first he needed a better
measuring stick. Lead is a bone-seeker—like calcium, it migrates into bone,
where it accumulates. So if a child were exposed to lead during, say, the first
three years of life, a blood-level test at four might not show any lead. At the
time, the only accurate test of long-term lead exposure was a bone biopsy, which
would not have been acceptable for hundreds of seemingly healthy children. But
when a child loses a tooth, Needleman realized, it’s like a spontaneous,
pain-free biopsy. He got a $500 grant from the federal government, took a chunk
of it to the local bank, and converted it into silver Kennedy half-dollars. Then
he had little badges made up that said “I gave.” With his half-dollars and
badges, Needleman worked with the schools to collect teeth from several
locations—some from Philadelphia’s “lead belt” on North Broad Street, a hot spot
for poisoning, others from areas that rarely reported lead poisoning. Those
teeth, Needleman established, were good markers for lead levels.

That got him an invitation to Harvard, where he would show the world lead’s
subtle destructive powers. In 1979, in a study on Massachussetts children, he
determined their life-long accumlation of lead and examined whether that
correlated with their IQs. He found that children with higher accumulations of
lead also had, on average, five or six fewer IQ points than those from the same
neighborhood, ethnic background, and economic status with lower accumulations.

“That study,” says Philip Landrigan, professor and chair of community and
preventive medicine at Mt. Sinai School of Medicine, in New York, “really
changed the whole way the world thinks about lead poisoning.”

“He really made the world consider the possibility that subclinical exposure to
environmental pollutants could have a serious societal impact,” notes David
Bellinger of Harvard Medical School, who has collaborated on studies with
Needleman.

“These low-level exposures may not result in a child who is clinically ill, but
he showed that there is a more subtle impact: It reduces the child’s quality of
life, and when the effect of lead is projected across the whole population, it
has a cumulative impact that’s really substantial. It’s shifting the whole
distribution of cognitive level a bit toward the lower end.” Needleman calls
this the subtle dumbing down of America; he doesn’t take it lightly.

***

When people hear the story of Needleman working at Deep Water and seeing
lead-poisoned workers from the House of Butterflies, they are likely to say, Oh,
that explains why he’s anti-lead. But actually, it doesn’t. For Needleman, the
significance of that day at Deep Water did not hit him until years later, after
an experience with a young Hispanic girl changed his understanding of lead
poisoning and its causes.

It was the early 1960s, Needleman was a self-proclaimed “cocky” resident at
Children’s Hospital of Philadelphia, and a young girl, we’ll call her Vanessa,
was admitted to his ward with severe lead poisoning. She had eaten the
lead-based paint peeling from her inner-city home, and her story was all too
common. Her brain had swollen to a point where she was dangerously near death.
She didn’t cry, didn’t smile, just lay there, comatose. Needleman treated her
with EDTA, a chelating agent and the only drug available to counter lead
poisoning. Soon, she woke up crying, and Needleman breathed a small sigh of
relief. Within a few days, she smiled the sweetest smile Needleman can remember.
He felt proud, even smug. When he knew the girl was going to make it, he turned
to her mother and calmly told her she had to move from her home.

“If Vanessa eats more paint,” he said, “there’s no question she’ll be brain
damaged.”

Her mother shot Needleman an angry look and snapped, “Where can I go? Any house
I can afford will be no different from the house I live in now.”

Needleman’s smugness vanished. “I realized,” he says, “that it wasn’t enough to
make a diagnosis and prescribe medication. I’d treated her for lead poisoning,
but that was not the disease—the disease was much bigger and caused by forces
embedded in the child’s life. Her disease was where she lived and why she was
allowed to live there.”

Historically, childhood lead poisoning has been a problem for minorities and
low-income families. “There’s much more lead in poor, black, and Hispanic
neighborhoods because of the kinds of houses they live in,” Needleman points
out. “There are middle-class white kids who are affected, but the rate is five
to six times higher in the poor neighborhoods.” Today, old paint is the most
important factor, but for several decades, lead in gasoline compounded the
problem. After the deaths at Deep Water and other plants, there was a brief
moratorium on leaded gasoline. Soon after though, lead became a major component
of everyday life in America, most notably as an additive to gasoline and paint.
In 1973 alone, as Needleman puts it, “200,000 tons of lead were blowing out of
the exhausts of American cars each year.” He thought this was a crime. The more
studies he conducted, the more deleterious effects from lead he found. Through
governmental committees, editorials, and other means, Needleman and other
researchers fought against leaded gasoline for 40 years.

“Dr. Needleman was a key figure in persuading the Environmental Protection
Agency to take lead out of gasoline,” says Landrigan. “That single action of
taking lead out of gasoline has brought a 90 percent reduction in blood lead
levels in children of this country.”

Needleman wants to do the same for leaded paint. He says, “See, if you de-lead a
house, that house is safe forever. It’s not just the kid who’s living there
you’re protecting—it’s any kid who moves in. And in the poor neighborhoods,
during the lifetime of that house, there may be 10 different families in there,
so you’re protecting all those children.” Then he pauses. “In a way,”he
whispers, "it's a bargain.

“People say we can’t afford to do it. We can’t afford not to do it. The actual
cost-benefit analysis done by the Public Health Service shows that, in terms of
avoided health costs and special education fees, there will be a $28 billion
savings for de-leading all the houses. So there are a lot of good reasons to do
it: moral, ethical, and practical reasons.”

When moral and ethical motivations are involved, it seems Needleman will go to
any lengths to right a situation, and it’s not unlikely for him to upset a few
people along the way. As an antiwar activist during the Vietnam War, for
example, he traveled overseas to rescue wounded Vietnamese children and bring
them to the United States for medical care. He and Benjamin Spock, the famous
pediatrician who was a mentor for Needleman, spent their share of time together,
including one night in jail for an antiwar protest. During all of this,
Needleman kept up his fight against lead.

While at Harvard, Needleman studied newborns, taking blood from umbilical cords
to determine prenatal lead exposure. He found that even at very low doses,
infants born with higher lead levels had slower neurobehavioral development than
those from the same backgrounds with less exposure in the womb.

Later, at Pitt, Needleman and his colleagues reexamined kids from the famous
Harvard IQ study that he had conducted 11 years earlier. Those kids, at 17- or
18-years-old, were more likely to be dyslexic, drop or flunk out of high school,
and get arrested if their lead levels surpassed 10 micrograms.

Most of the lead studies to date, including Needleman’s, have focused on IQ, but
he doesn’t think that’s the most important factor. “I think lead affects
attention, behavior, and impulsivity,” he says, quickly pointing out that this
isn’t a new idea. Another mentor, Randolph Byers at Children’s Hospital in
Boston, first saw this connection in a few patients referred to him for
aggressive behavior during the ’40s. But Needleman is the first to explore this
connection through in-depth studies.

In 1996, Needleman conducted his first delinquency study; it involved several
hundred children. He measured their bone lead levels and collected reports of
aggression and delinquency from the subjects, their parents, and their teachers.
With this study, Needleman showed an association between lead and delinquency.
For him, the next logical step was to see if lead affected arrest rates. He
identified about 200 adolescents who’d been sentenced to time behind bars and a
control group of teens from local high schools with no arrest records. He
measured the lead stored in their bone, using a relatively new noninvasive
technique called X-ray fluorescence spectroscopy, and found that, controlling
for race and socioeconomic class, mean lead levels in delinquents were
significantly higher.

“Well,” he says with a tisk, “that’s a lot of delinquency. And the thing about
lead toxicity is, it’s completely preventable.” He shakes his head. “Of all the
causes of delinquent behavior, this is probably the easiest one to get at. If
you just take lead out of the houses, then people won’t get poisoned, and a
significant amount of delinquency might well disappear. Just think of what that
would do for our society.”

“Lead, as Herb has said so many times, is a simple problem,” says Bellinger. “We
know where it is, how it gets into the body, and the damage it can do. In some
ways, it’s a bellwether of our abilities as a society to address these
problems.”



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