There is no known safe level of lead exposure for children. The Flint water crisis exposed poorly managed infrastructure that desperately demanded repair. But were the children of Flint “poisoned” by toxic lead levels, or is there a deeper story here?

Dr. Hernán F. Gómez, MD, Associate Professor, Dept. of Emergency Medicine, University of Michigan Medicine, Hurley Medical Center joins us on this special episode of Against Medical Advice to talk about this study in the Journal of Pediatrics (of which he was lead author). He works in Flint on the front lines in the emergency department. As with most things involving science and health, the situation with lead levels in Flint, Michigan is vastly more nuanced than the public discourse has lead us to believe. Are we inadvertently stigmatizing a generation of kids in a city that has suffered enough?

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– ♪ One, two, three, four. ♪ ♪ So give me patients, yeah. ♪

– Alright zpack, it’s your boy ZDoggMD, aka, Dr. Zubin Damania. Today we have a really, really, really special guest and a

really important topic. We have Dr. Hernan Gomez, he is Associate Professor at University of Michigan. He is trained in

emergency medicine, pediatrics, and toxicology. A triple threat as we call it. And he has recently been the lead author on

a really fascinating study looking at the Flint lead levels. And if you recall from the news, this has been all over the

news that Flint’s water was contaminated with high levels of lead and are we destroying a generation of young people with

lead poisoning. Today we’re going to get into the science of that we’re gonna get into how we communicate risk and

statistics to the public and was this issue communicated well to the public or have we done potentially a disservice. Dr.

Hernan Gomez, thank you so much for joining us.

– It’s a pleasure Dr. Z. Nice to meet, very nice to meet you.

– Man you look like a professor. White coat, charts, it’s amazing.

– It’s amazing what props can do over here.

– We’re all about props on this show.

– Yes, it’s a fake beard.

– Yeah, a fake beard? Maybe I should get one, I love it. So you know when I started looking into the Flint lead public

health issues, I actually learned quite a bit. Starting with the effects of lead on developing brains, and things like

that.

– With the lead levels that we are discussing here in terms of the Flint area, well we’re really focusing more on IQ,

intelligence level, and capacity for school and so forth.

– So, you know the thing about the Flint story is that it’s so loaded politically and emotionally, because you have issues

around social justice, you have a predominantly lower income largely African American population in a rust belt town that

has seen so much sort of struggle and disadvantage. And then when it hits the news that well, hmm, here’s a situation where

the water supply was changed. Now we have high levels of lead. We’re potentially damaging, irreversibly, with lead the IQs

and the development of these already disadvantaged children. You could see why it could create such outrage and emotionally

charged response in the press that continues to this day. Now the question is, in your interpretation, what was the story?

How did it unfold in Flint so we can get our viewers up to speed for people who don’t know.

– Let me make a quick comment so, you mentioned Roger & Me. I saw Roger & me when I was, if I may say it, an internal

medicine resident. I actually, I’m boarded in internal medicine as well.

– Wow!

– But, internal resident I saw Roger & me. It’s a fantastic documentary, but I said to myself, this is the saddest city in

the country. And I think that Flint had that image even prior to the water crisis. And I do think that that backdrop was

part of why there was this explosion of events.

– [ZDoggMD] Yeah.

– So Flint already had this backdrop. I think Roger & me was perhaps part of that. But, a depressed city, a post industrial

city, there was a switch to the Flint River water. It was as is very famously aware, a change in color of the water, smell

of the water, folks protesting, Seemingly not exactly an immediate response coming from governmental resources or from

governmental services. Then Marc Edwards or Lee Anne Walters, a mother in Flint, famously contacted him through internet.

He sent over 300 graduate students to check bottled water samples. I’m guessing at some point he communicated with

pediatricians in Flint and they communicated with the state. The state’s initial reaction was to rebuff them. And I think

the logic at the time, as I understand it, was that “Well, we need to go the media, it’s “much to important not to.” And

after going to the media within about, I think less than two weeks, the government said, “You’re right, we’re backing off.”

And they proceeded to mitigate the water crisis after that.

– Got it, and my understanding of this and correct me if I’m wrong, is that the original source of water for Flint was Lake

Heron through the Detroit Water Authority.

– Correct.

– And then they switched to the Flint River and something in the composition of Flint River was more potentially corrosive

to lead containing fixtures and pipes, this is the theory, and it wasn’t treated appropriately so as a result lead levels

rose in the water that was delivered to the residents. Is that a correct summary?

– That is correct. The word corrosive, one thinks of acid and base, right. Especially medical toxicology. You’re drinking a

caustic substance. It wasn’t corrosive in that manner. I may say so for a second. So Boulder, Colorado, is perhaps the only

city the actually waters the plant by glacial water, glacial water. It’s corrosive. Why is it corrosive? Because it’s soft

water and basically what it does is it leaches out minerals in pipes. So it’s corrosive in the sense that the Flint Water

Authority or those that were in control of making the switch over, should have placed in simple orthophosphates. It’s

simply the chemical used, very inexpensive. And it’s not a acid or base issue, it’s simply a matter of it being likely to

simply take these years of sediment in piping and cause it to disengage and go flow straight into drinking water.

– Got it. And so there was a doctor, Dr. Hanna-Attisha, who sort of famously started to note that she was seeing elevated

blood lead levels in children. And the American Academy of Pediatrics has recommended blood lead screening in children who

are at risk, lower income and older housing, et cetera, how did that play out.

– Well, first of all, lead levels are mandated by the CDC for all Medicaid patients. About 80% of children in Flint are

Medicaid patients, so the CDC recommends, the guidelines are that they all have cappilary screens, and if their positive

venous samples of lead between the ages of one and five. And to have repeated if it is elevated. So there was a big

database to look into and essentially after the water was reported to have been, have elevated lead, databases were looked

into, I believe that her state looked into 2013, prior to switch over compared to eight and a half months, 2015, and found

an increased percentage above CDC reference range of five micrograms per deciliter.

– Got it, so now this is interesting, ’cause this is where we have to start talking a little bit in the weeds about

statistics and what they’re really reporting.

– [Hernan] Yes, it’s rather interesting. You should actually.

– Yeah, so it seems to me, what they were looking at is a percentage of children who exceeded the CDC threshold for what

they consider unsafe levels of lead. Even though there really isn’t a known safe level of lead. And so the percentage of

kids who now exceeded this doubled, so in other words going from two percent who exceeded the five deciliter range to four

percent. Is that correct?

– That’s correct.

– And the understanding then is that the way that that was sort of communicated through the press is that lead levels

doubled in these children. Is that what actually happened?

– What it communicated in the press is that children were poisoned. That it doubled and children were poisoned. I think

those two messages came out and so what was looked at was the percentage of children that exceeded the CDC reference range

of five micrograms per deciliter. The reference level was never meant to be a clear threshold of when children are

poisoned. The CDC and as written by the CDC, within their own publications are that it was meant simply to be a reference

point for which to identify groups, population groups, not even a single child, population groups and sectors within the

country that are high risk and deserve more resources, mitigation to investigate why these children are high. It was never

meant to be a definitive statement of poisoning. And I think that this is a miscalculation or misstatement that should be

corrected. And that’s one thing I hope to do with the publication of pediatrics.

– And this is a great transition because when I learned about this, my understanding of this changed so profoundly, because

I also was looking at the press and thinking, okay, there’s no safe level of lead, now the percentage of kids that are

above five, which is the CDC’s threshold, which by the way, has been lowered over the years, it used to be 10 and then it

went down to five and again as the CDC sort of evolves, and that threshold, as you mentioned, is a population health sort

of guideline. Not an individual– In other words after you get above five, it doesn’t suddenly mean your IQ plummets or

Untitled.pdf

Saved to Dropbox • Apr 20, 2018 at 7<17 AM

of guideline. Not an individual– In other words after you get above five, it doesn’t suddenly mean your IQ plummets or

some threshold is reached.

– If I may, so as long as were playing the, you’re going back to the, to walk through the history of the CDC reference

range. So the heigth of the Flint population is 200 thousand in 1960. And the reference range in 1960 was 100 micrograms

per deciliter.

– Wow!

– In 1960. And that was when Flint was truly at its peak and truly the envy of the nation, and truly a mortar of the middle

class. And by the way, the birthplace of General Motors. When I began at PGH as a pediatric resident in 1983, a reference

range of the CDC was 25, and part of why I knew that perhaps there was some interpretations that were slightly taken out of

context were that I remember, I had distinct memories of going to mothers and giving them the fine wonderful good news that

the child’s set level was only 20 and therefore their child is going to be just fine.

– [ZDoggMD] Wow.

– And 20 would be considered quite unacceptable now.

– [ZDoggMD] Right.

– Yes.

– And one other interesting point about this to put it in context and again we’re kinda talking about how do you

communicate risk and statistics and danger to the public in a scientific way. If your looking at lead, you wanna kinda step

back and go, “Well before the mid ’70s,” and I was born in 1973, most people in the US, most kids in the US, about 83% had

lead levels around 10 micrograms at least. Right, is that correct?

– So your mother’s lead level was likely in the 15 range when she was pregnant with you. There’s a ratio of the fetus to

the mother of .9. So if you multiply .9 times 15, and I don’t have the calculator in front of me. I’ll say it’s roughly 12

to 13. Likely you Dr. Z, as a developing fetus were being bathed and blood circulated within your developing brain was

around 13, therefore exceeding the reference range of five. Therefore, you are permanently brain damaged. I just want to

inform you of that.

– The kids in Flint had lower blood levels than I had growing up, and I remember leaded gasoline, I remember leaded paint.

And some of the biggest public health advantages were getting rid of those things and the regulations around that. But now

we’ve create– there’s a massive crisis over blood levels that are more around five. And that’s just in a small part of the

population. And that was from the original, sort of, data that came out around the Flint crisis.

– This is correct. So this paper is not about belittling those in Flint. I want to be very, very careful. And we need to

return again. There is no known safe lead level. This is all about placing things in context. And it is about what is

appropriate use of statistics. And it is about what is appropriate communication to the media, to the community, in a way

that’s responsible. So, if I may, going back to the original study of the American Journal on Public Health, So, the number

of children, if you look at the n, if you pull the paper, there are approximately 800 children studied in 2013,

approximately 800 something in 2015. So, just so you know, the number, the total number of children that crossed that

threshold was only 18. That’s it. So 18 more children crossed the threshold of five micrograms per deciliter. And that

caused that quote doubling effect as you mentioned two to four percent.

– [ZDoggMD] Right

– Now was that a public health catastrophe, well it certainly deserves look into, it deserves medication, all the correct

things occurred once this came out and I’m very pleased to report that. And I think it is important that the authorities

did the correct things, as they ultimately did.

– Yeah, and let me back up for a second because I want to reiterate some of the things you said. Everything we’re talking

about here is in no way to say that what happened was appropriate. Or that the people there weren’t the victims of an

injustice. What we’re saying is that the way that you sort of describe a health crisis really has to be put in context and

the context here is that, and we’re gonna see from the data of your study, lead levels have been declining consistently

over the years, including in Flint. There are areas of Michigan with higher lead levels and that I, myself, was probably

bathed in levels of lead that were quite a bit higher than the levels that were of concern in Flint. So we need to

contextualize it, but we also need to learn that, yes, the water situation wasn’t done properly. Yes, it put people at

risk. And yes, there were other issues like Legionnaires that were linked potentially to the river water. So that all being

said now, I want to transition into the work that you did to look back actually at a database. Retrospectively in this

study that was just released in the Journal of Pediatrics and I don’t think it’s in print yet, but it’s still on-line. Is

that correct?

– It is on-line for free. You may go to JPS.com and download it for free.

– And we will put the link in the description for this video where you can read the raw article. And an interesting

editorial that’s attached to it.

– Which is also, maybe, downloadable free of charge.

– Exactly, and that’s by a doc at Oklahoma University where I just was actually talking about contextualizing how we

communicate risk through the public and what this study might actually mean. Now you went back and said, “Okay, from 2006

“until 2016 we actually have access to blood lead level measurements, with Epic it’s starting in 2012 and now remembering

you practice at the epicenter of this in Hurley,

– Yes

– So explain to me what you did.

– Not saying it was an epic journey. But Epic was the beginning of it. So Epic was introduced at Hurley in 2012.

– [ZDoggMD] My condolences.

– I’m sorry.

– [ZDoggMD] My condolences.

– I appreciate that. So one advantage Epic does have is one can inquiry, study rapidly blood levels and so forth. But it

ends there. Then we had to go to legacy databases. And Hurley is not a wealthy hospital. I mean Hurley we really had to go

to legacy databases dating back to 1980s. But we were able to find databases through the laboratory back to January of

2005’s. And from there, go to a second database, and I have to give credit to the informatics people, but we were able to

somehow match up addresses, blood levels, date of blood draw, date of birth, combine all of them, one second, could you

close the door Kamicha. Combine all of them, geo-code, make certain that these individuals lived within the boundary of

Flint, and they were, in fact, receiving the Flint water switch, change.

– [ZDoggMD] Yeah.

– We were basically, open the attic of medical records of Flint, and when we opened up some dusty, ole musty chests, knock

off some cobwebs, and through a little bit of pluck and luck we managed to get back to 2006.

– Got it, so all the way back to 2006 and you looked at blood lead levels. And you looked both at the percentage of people

who exceeded this threshold of five, which is one measurement, and then you looked at the geometric mean of actual blood

lead levels.

– [Hernan] Correct.

– Yeah and looking at that, you found some really fascinating data. And I’ll let you describe it more, but I’ll just kind

of summarize and you tell me how wrong I am as a hospitalist who knows very little about anything. So starting in 2006 the

levels both of percentage of people who exceed the threshold of five micrograms per deciliter of lead that CDC has set and

the geometric mean of actual blood lead level concentrations have declined substantially year over year. From 2006, which I

consider a modern era, that is I, 2006, I mean Usher had done Clear, I mean had done Yeah, just a couple years earlier

withI consider that a new song, even though it’s like 15 years old. And since then they’ve declined year over year with a

couple of glitches. 2010 to 2011 there was a small bump, but it was there. And then 2014 to 15, the year right after the

Flint water shift, there was another bump. But despite that the overall line has been down. And those two bumps were

actually within statistical probability of just being a random event. In other words they weren’t statistically

significant. Okay, there we go.

– [Hernan] It’s a bit glary, I don’t know.

– No this is perfect, I can point to this.

– [Hernan] So one can see that there is one year in 2006 07, but this did not reach statistical significance. The P was

like .1.

– [ZDoggMD] Got it. Then we see between 2010 to 2011 the geometric mean increased by .12 micrograms per deciliter. And then

this is during the water switch, the water switch here is 2014 2015 it increased 0.11 micrograms per deciliter.

– [ZDoggMD] Yeah. This is a linear trend line, R square. And what this means is the calculation is .94. This is very

important because what this means is that all of these curves below and above the line, that there is a 94% chance that all

these changes were random.

– [ZDoggMD] Yeah.

– We’re not going to make a debate here about what caused this increase during the water crisis years. But the changes were

no more than, it would be impossible to distinguish what occurred during the change of water crisis years to what would be

a random event. Now the 2010 2011 was years prior to the Flint water change.

– Okay, so let me summarize this. This is really kind of remarkable data. What we’re ultimately saying is that looking at

actual blood lead levels, there’s a 94% chance that this little bit of bump, year over year around the Flint water crisis

was due to chance and if you look at the absolute values, they are still lower in 2015 when the lead levels bumped, than

they were in 2012.

– [Hernan] They’re much lower.

– [ZDoggMD] Much lower.

– [Hernan] Much lower, yeah, they’re over 50% lower.

– Now, this says nothing about where is the lead bump potentially coming from, if it’s real. It’s not saying if the people

of Flint were not affected by this in any sort of way, by the lead. What it’s saying is if you look at the pure data, if

you look at the pure statistics and you analyze it in a rational way, using statistical methods that are very proven, this

is what you see. Is overall, public health efforts to decrease lead in the Flint area have over time been effective.

– Very effective.

– What’s the take home?

– So actually that’s a great question. So we all know that Flint has been a down and out community for quite some time. We

all know that, in my view, Flint may very well be the saddest city in the country and this is prior to this water issue.

The point of myself and the co-authors in the study is that Flint does not need more stigmatization to the community, nor

do the children need more, because that’s inaccurate. The issue of using the word poison is an incorrect word. There

continues to be, many people across the country, health care workers, professionals, lay folks, who believe that there’s

entire cold generation lost. And the generation loss was a term that was used excessively. If I may show this little one

here, Can you see this here?

– [ZDoggMD] Poisoning the children of Flint.

– From a certain Amanda, this was after Syria was bombed because of the use of Serin Gas, and a nice Amanda from Wooster

wrote shouldn’t Syria be bombing us because we poisoned the children in Flint. And this came out just recently. So this is

out of Wooster, Massachuset and this is these are the images. We had a graduate student from Finland who is staying with us

in our home and the parents became very concerned because this reached international news during the time of the water

switch. This is a Finnish newspaper headline and her parents called our house asking if their daughter was okay, if she was

being poisoned over here in Michigan. Yeah, so things are horribly out of context and things need to be corrected. We have

no evidence that as a general rule Flint where children were poisoned, with one caveat, we as co-authors did not do a

physical exam on every single child in Flint. So we can’t claim to make an overreaching statement like that.

– So, okay let me unpack some of this because you know this is a charged issue, it’s controversial. Looking at it purely

from a scientific stand point. We’ve talked about this now. Now the question is, are we stigmatizing the children of Flint

forever? Are we diverting attention from a real important plight as well, which is education, social determinants of

health, safety, violence those kind of issues that affect their health and the health of many Americans more than what

we’re seeing here. And are we mis-communicating science to the public even though was potentially an issue here, the way

that it was communicated created a kind of a — When 500 thousand American children have blood levels above the CDC

threshold still. In other words this is not an isolated Flint thing.

– It is all about placing things in context. Everything you mentioned, education, nutrition, violence, all of these things,

and I would place violence and feeling secure, I mean, being able to feel like you can walk down the street safely, things

of this sort are extremely important. Certainly efforts to decrease lead should continue, but I think that the Michigan

Department of Human and Health Services have shown themselves to be fully capable of doing that and their good work should

continue. Certainly every single lead pipe in Flint should be replaced because if you broken the china in china shop, well

I guess you gotta pay for the china. So these lead pipes should be replaced. But placing things in context there are many

things — many other issues of extreme importance for the welfare of children in Flint. What we do not want is for children

to have the stigma of being brain damaged and permanently so. And yes I do believe that this will be an on-going thinking

for years.

– Let me ask you this. Did you capture enough lead screening to actually be representative of the population of Medicaid

patients who are at risk.

– So, in a limitation section of the paper, you will note that we are claiming that we captured perhaps 50%. And the way we

calculated this was taking CDC data from another publication, we mixed mathematical calculations and that’s what we came up

with. And Hurley hospital captured perhaps 50%, But we think that’s a very fair representation. If you look at political

polling, for example, you will note that perhaps 2,000 people are used to poll a million in a population and again plus

minus perhaps one percent for an election.

– [ZDoggMD] Yeah. It may not be perfect, but I would argue that 50% is a dog-gone good representation of what we saw in

Flint.

– Got it and the actual test for blood lead levels, how far back is it representing lead exposure. So, in other words, once

you’re exposed, how long can you test that corresponding level?

– There’s an actual calculation of how one can determine how slowly it decreases over time. But, it really would take about

10 months from a certain given level for it to actually go down to zero.

– [ZDoggMD] Got it.

– A contaminant period of time. So if I’ve heard of individuals which will to unnamed saying, “Oh it was water, it went to

the “body, disappeared off of the bone very quickly, therefore “we underestimated lead levels in the blood.”

– [ZDoggMD] Correct.

– This is actually rather inaccurate. Actually, the time it stays in blood is actually for a very significant period of

time, so these numbers are quite accurate.

– And that’s great because that was a criticism that was leveled against the paper’s methodology. But–

– [Hernan] Inaccurate.

– Got it. And the other potential short coming is that infants who are fed formula using water from Flint, you couldn’t

really capture infant blood levels because that wasn’t a typical screening population.

– So we captured, our n was a total of 15,817. Not one of those children we’re completely formula dependent and therefore,

one can not make a statement one way or the other. I will tell you that the description of a water formula dependent or

mixing a powder formula to a new born child is a powerful mental image.

– [ZDoggMD] Yeah.

– It’s very powerful. However, this also has to be taken in context. We’ll go back to Dr. Z when her mother’s blood level

is 15 and yours is likely 13 and we’ll talk about your memories of unleaded gasoline. I too have memories of unleaded

gasoline and the very sweet smell that it had. It’s rather provocative smell. So the reality of it is, is that A,

developing children in utero have far higher blood lead levels than you can possibly conceive of, even postulate it during

the Flint River switch. Number two as soon as they’re all born, yes, they’re formula dependent during the time unleaded

gasoline, but they we’re also oxygen dependent. So they left the hosp and they immediately began breathing the unleaded

gasoline from daddy and mommy’s station wagon.

– [ZDoggMD] The leaded gasoline, yeah, um-hmm.

– That’s correct. So these children had far higher blood lead levels. And I will tell you that in 1976, in a figure in a

graph I have behind me, in 1976, again one of these numbers, but in 1976 and this figure will seem a bit astounding, but

100% of United States children had blood lead levels above the reference range of five micrograms per deciliter.

– [ZDoggMD] Yep.

– So it’s an interesting, provocative image, but let’s keep things in context and that’s what this study is all about.

– You know what, Dr. Gomez? I’m going to use this as a personal excuse now for not reaching my potential of an IQ of 250.

Had my mother not huffed leaded gasoline out of her station wagon, ’cause I know she likes things to smell sweet. To this

day she loves potpourri and leaded gasoline was very similar. But again this is a key point, is that it’s all about context

and statistics can lie, but they can also give us truth that strips away the emotion and the politics, and the charge

around it so that we can actually make rational decisions. And I think our elephants, our unconscientious, are very primed

to respond to things like public health crisis, the poisoning of children, et cetera. But if we look at it more with our

little writer on top who’s hopefully being the rational actor, we can learn something that will actually improve public

health and actually focus our resources around lead around the country, but also other issues like we talked about social

determinants of health, schooling, safety, et cetera. And I think your work has certainly opened my eyes, first of all to

having to learn a lot of statistics that hurts my head, because of my own personal lead poisoning in the 70s. Andand also

kind of brings a perspective that allows us to de-stigmatize this generation of kids in Flint which is already a

stigmatized town.

– Flint has enough, I don’t know if you’re familiar with the Netflix series, Flint Town.

– [ZDoggMD] No, I haven’t seen it.

– Netflix series that came out actually fairly recently. You can maybe look at it, it makes, it’s rather compelling yet

horrific. So Flint does not need more stigmatization. The Flint children have enough things that we can work on to help

them advance and to help them get a good education. I believe that education is the great equalizer. I believe that we

should continue working on Flint, but I believe that Michigan Department of Human Health Services has been doing simply a

fantastic job. And yes, ultimately what you’re saying is correct, let’s keep things in context.

– And I want to thank you for the work that you’ve done. I want to thank you for being on our show. Dr. Hernan Gomez,

emergency medicine doctor, pediatrician, internal medicine board certified, toxicologist, also happens to work on the front

lines at the hospital, treating kids in Flint, Michigan which is I think partially why as a student of history and an

epidemiologist, a toxicologist, you did this study and it has really opened my eyes and hopefully the eyes of many of our

viewers. We’ll be asking questions from the zpack. We’ll be feeding them in and then hopefully we can do a follow up and

learn more.

– That’ll be fantastic. If I may say one word to your zpack. Do not do what I did. I want you guys on residency, perhaps do

a fellowship and continue on with your life.

– I pathway to anybody, I just want to make that very clear.

– The perpetual student pathway wasn’t really something you would recommend to the zpack.

– No, my God, I could do that because I wasn’t married. As soon as I got married, the wife said, “No, you’re not gonna do

more training.” So my career as a resident stopped. As a permanent resident, stopped.

– Hey you know what, I’m a hospitalist. I continue as a permanent resident.

– I think honestly, we all continue as medical students as long as there are physicians. Is that fair?

– That is fair. Everybody involved. Dr. Gomez, what a thrill. Thank you, shout out to U of M, my brother-in-law, James

Riddle over there in ID, I’ll have him say hi.

– Yeah, I want to do one quick shout out, if you don’t mind.

– [ZDoggMD] Yeah.

– To Dr. Riddle of U of M and a shout out to Dr. John Bogden from Rutgers University, a nationally known lead toxicologist

and senior author. Another senior author, Dr. James Oleske, who is the first person to identify the vertical transmission

of HIV to the fetus. These are both nationally renown people. These are fantastic individuals and a big shout out to the

medical school of Rutgers New Jersey where Dr. Bogden and Oleske are located.

– Hey whaddup Rutgers, the ZDogg’s from Moorestown, so I’m neighbors, know what I’m saying.

– [Hernan] Yes.

– I love it.

– Dr. Newark, a shout out to Newark.

– Dr. Newark, hey speaking of which they had very high lead levels in the early ’70s and I was born in Moorestown, so

probably my levels were more like 112. I had lead lines, I’m still a little bit off. But you know what, I’m willing to be

stigmatized. Dr. Gomez, a real honor, a real pleasure, thanks again.

– A pleasure, the pleasure is mine. Thank you very much.

– So zpack, I want to put this all in perspective, okay. What Dr. Gomez kind of has shown us, that the blood levels in

Flint have been declining over time in a remarkable way. Was the river water situation in Flint a problem with lead? Likely

yes. Is there a safe level of lead in children? No. Should we be talking about this? Should the lead situation be cleared

up in Flint? Should the government come clean and actually make changes? Should private industry help? Yes, absolutely.

None of that, however, represents necessarily a poisoning crisis which will further stigmatize the children of Flint. We

need to put it in context and actually use this to learn and to help public health, not just in Flint, but around the

country. We need to understand that nutrition, iron supplementation in some cases, education, parenting, et cetera, can

mitigate a lot of the effects. If you look at me, I grew up in a lead environment that was apparently toxic by today’s

standards, but I turned out marginally okay. There are a lot of factors that go into our children’s health, education,

wellness et cetera, and we need to focus on those social determinants of health as well as the toxicology and the other

issues and put it all in context. zpack, hit like. Hit share, spread the word. If you have questions, concerns, thoughts,

recommendations for another guest we should get on the show, let us know. And we out. ♪ One, two, three, four. ♪ ♪ So give

me patients, yeah. ♪