Document ZJk4o8rY2rjj8pRjaw0GyM9d0

D E P A R T M E N T OF HEALTH, EDUCATION, AND WELFARE PL'BLIC HEALTH SERVICE BETHESDA i4,MD. NATIONAL INSTITU TES OF HEALTH Tel:656-4000 April 6, 1964 In reply refer to: AP 00371-01 Dr. Robert Kehoe Kettering Laboratory for Applied.Physiology University of Cincinnati Cincinnati, Ohio Dear Dr. Kehoe: The enclosed research grant application has been assigned to the Human Ecology Study Section for scientific review. The evaluation of this proposal will be based primarily upon the following considerations: 1. The apparent scientific merit of the project, particularly in relation to other current research; 2. The adequacy of the methods and materials proposed; 3. The qualifications,of the applicants; 4. .The adequacy of the facilities and the research ,- environment. /) We should like to have your comments on the above points and on any other aspects of the proposal that you consider pertinent. We would appreciate having your comments typed on the enclosed form and returned to us in order to be duplicated and distributed prior to our Study Section meeting. Since the application, like your reply, is confidential, it should be returned with your comments in the enclosed prepaid and addressed envelope. * Please accept my thanks, and those of the Study Section, for your assistance with this review. Sincerely yours, Enclosures Evelyn H. Halpin, Ph.D. Executive Secretary Human Ecology Study Section Division of Research Grants '-N2$3 *A reply by April 20 would be appreciated, so that we may forward your comments for the information of Study Section members. : Nr ." >!. .w a! NV oca! In-i?;:.:? j .{ \r:h r;i; a.tu V r: h .,,l.. .-,,-a jn .l Kl JTr (. - .! ; AP 00371-01 OGTSIQB OPIXIOM fro Or. Robert A. b t o a University of Cincinnati NRelation Between Air Pollution and lead Poisoning" 1 . aCHOfflTIC MBRlTi The primary design of the experimental prograa presented herein Is based upon a fallacy, which the work of the authors should have recognised through their own observations as recorded In their attached report. It has been established clearly In several urban centers In the U.S.A. that lead poisoning aaong children results, In the overwhelming proportion of cases from,the Ingestion of lead compounds, principally those represented In paint obtained^by exploring children, from disintegrating surfaces within neglected homes. (There ere exceptions, of course.) That cases of poisoning may occur through tbs Inhalation of lead compounds in the atmosphere of the household, has been found in a number of cities, including Chicago (as referred to in this application) from tbs use of battery boxes, as fuel. Present evidence Indicates that tbs lead content of the ambient atmosphere of apparently characteristic American cities le Incapable of causing lead poisoning in children or adults. If Chicago le an exception to this, even In U n i t e d (Industrial) areas, it would be a surprising fact which would be worthy of detailed Investigation (this night be the case, despite the avail able data), were It not for the apparent feet, suggested by the data sub mitted by the authors of this proposal, that the concentration of lead In Investigated Areas of Chicago Is of the order of that of citiss that have been investigated systematically. Moreoever, the further evidence submitted, as to the levels of the concentration of load In the urine end, more Importantly, the blood of children in the suspected areas of Chicago, Indicates clearly, in so far as the results can be regarded, as valid, that thase children have not absorbed abnormal quantities of lead from any source. (Incidentally the equivalent of the documentary evidence submitted with this application has been denied publication because the discussion within It la flatly contradicted by the data submitted.) This bears on part 03 of this "Outside Opinion" but Is pertinent here. The etiology of lead poisoning aaong children, generally, In American cities Is known. Certain features of its epidemiology should, Indeed, by investigated, specifically (a) the basic factor (or factors) that are responsible for its seasonal character, and (b) the significance of tine (the duration of exposure, whether prolonged or brief) and dosage, taken together, on the frequency of occurrence of encephalopathy (which Is the lethal fora of the disease as sesn with unusual frequency in children). These natters require Investigation of the hone environment of children, and Intensive study of potential, Incipient and severe eases. The ambient air Is, very largely If not wholly, irrelevant to the basic problsa of lead poisoning in young children up to the age of 3.ft to S years of age. The N22313.01 Page S OUTSXXS OPIKIOV AJP 00371-01 principal investigator should know this, and sine* he does not, he has not familiarised himself or digested the information on this subject which is now available. Qd s has rwasoa to ba iatarwstwd in tha land contest of the ataosphara of Chicago (tha stataaa&ts (or iaplicationa> coacarning tha blaat-furnaoea of tha stall Manufacturing company rafarrad to in tha report attached to this application vara examined by others and found to ba ill-founded, but it say vail ba that there are soar probleas of this type in tha industrial areas of Chicago). However, this has little or nothing to do with tha 1Mediately iaportaat problea of public health Involved in tha unduly high incidence of childhood pluablea. Gne this account, if no other (and there is another), this proposal is aads up of two irrelevant parts, and it should not ba prosecuted on tha reaote hypothesis that tha two night be found to ba cameally related. They should at laaat ba dissociated, and prosecuted separately. As indicated previously, the prlasry envlronasatal factor in lead poisoning in children should be the site of investigation. . aococact or Mrraops amp matmlialsi the prior discussion touches upon tha adequacy of the methods, anterials and scientific personnel, it aay ba that tha specific Methods'of song)ling and investigating tha atmospheric environment and the children in the envlronaent, for the purposes described, are intrinsically satisfactory, so far as they go. The procedures with respect to the determination of the lead content of the air aay ba satisfactory, likewise tha aethods of analysis of tha blood and urine of the children for lead (which is the most Meet i n g of tha procedures recommended for employment) aay be adequate. Tha data thus far obtained in both of these matters are comparable to those obtained elsewhere, and this fact suggests that they are reasonably satis factory. One has sons difficulty in viewing these data without bias, however, in view of tha failure of the investigators to realise their meaning. Zn the face of specific analytical data that demonstrate tha lack of anything unusual in either the environment or the children (as a group); the principal investigator, am the basis of utterly non-specific evidence (coprophyrinuria), decides that an appreciable proportion of the children absorbed abnormal quantities of lead. Thus ths matbods in themselves seem to be somewhat irrelevant. This is not a technician's quest, but one requiring scientific critique. 3. QPALITICATIOM OT f APPLICANTS: This is s regrettable situation. The principal investigator is a sensitive and sincere man with instincts of a responsible physician (or sc he seems, am personal acquaintance, to be). He seems utterly Incapable of scientific objectivity, in the presence of the sad facts shout lead poison ing among children, so that ha ignores the evldsnoe of his own data, and embarks on an experimental program in tha spirit of a crusader, which has no likelihood of establishing any facts that are relevant to the experimental hypothesis. Although it is likely that useful information can ba and will ba so obtained, this, in the view of this consultant, is an unduly costly means of obtaining facts which will have to be sifted out of ambiguous Pag 3 OCTSIEE OPINION AP 00371-01 direct tills investigation Into highly productive channels. In Its present lore and with Its present guidance, it can hardly fall to confuse the issues under Investigation. RAK:vr Date: April 13, 1964 Robert A. Kehoe, M.D. /