Good morning, y'all. Did they say y'all in Florida? I don't say it very naturally coming from Maryland. Hi, I'm Mary Ann Cloran. I'm going to be acting as more of a moderator in this session. I'm an associate professor at the University of Maryland School of Medicine, and I'm here with a good friend and expert in education in occupational medicine. I'll introduce Dr. Ghassan in just a second, but let me go through some announcements. First of all, we're going to try to time this so that we have 10 minutes at the end for Q&A, and I'll be walking around with the microphone at that time, because this is being recorded. We'd like to capture the question as well as the answer. Please make sure you silence your cell phone. Make sure you have the app. The app makes it very easy to evaluate and claim credit. I think you can find AECOM people when you need them. All right, so today is about lead, both the history, and there's some very interesting stuff. I've been doing occupational medicine for a long time, and I learned a lot about the history of lead that I was not aware of before from Dr. Ghassan, and also we think of it as an historic problem. It's a current problem, even in developed countries. Neither of us have any potential conflicts. Thank you. To introduce Dr. Ghassan, Jambier Ghassan has an MD, an MPH, and a PhD. He's dedicated his life to occupational safety and health, not just OCMED, capacity building in low- and middle-income countries. He is a consultant and an educator. He was born in Rwanda. That's where he went to medical school, and then he got his MPH and PhD at the University of Chicago. He has served as a professor, educating a variety of people about occupational health and occupational medicine at Florida International University, Kuwait University, and he's also developed and provided online education through the Medical College of Wisconsin. Currently, he has a new venture called Global Applied Prevention Center. He's the founder and the chair. He serves as a board member for Medi-Chem for their education and training, and also is a leader in Ash Africa, which you can probably figure out what that is from the name, and his contact information is at the end. So I'm going to turn it over to Dr. Ghassan. I'm going to mostly be timekeeping and helping with the Q&A at the end. Dr. Ghassan. Thank you, Marianne. This is a topic I've been working on for a while. In fact, when I was in University of Illinois Chicago, our professor of air pollution got an idea. What happened to the lead that we had coming out of exhaust for about 70 years, and then the lead peels off from some of the buildings in downtown Chicago? So we used to walk around with, basically, we took samples at that time, and we took them to the lab and measured. We found out the closer you were to the highway, I-90, the ones from Chicago, I-290 going west, and then we found out the closer you were to the highway, the more lead we had. And by degrade, as Michael said in a previous presentation, lead is sitting there. So we have lead around the globe, as you see some of the maps we have, and it's not going anywhere. So then when I got the job at Florida International University back in 1995, I went to the health department. I said, what's the situation of lead here in Miami? And the woman who came in, she was an African-American nurse who was the head of the program, said, oh, with my heavy accent, I said, where are you from? I'm from Rwanda, but we don't have a problem with lead in Miami, so no, no, no. I just got it from Chicago. Chicago has had problems for the last 25 years. So then I keep pushing, and then the second week, we count the cases of lead from cases from doctors from hospitals, and they had 500 cases every year. They didn't know anything about it. We kept them drawers. And then I went on to conduct a pilot study and found out 25% of kids who live in our city in Miami have high lead levels. But it's not just the lead from the environment, but also we get to eat about the diet, because we had a similar, a small sample from Coral Gables. The peeling is not, I mean, the paint is not peeling off in Coral Gables. I mean, it's where the communities, they didn't have high lead levels compared to the ones downtown Miami. So that's how, you know, you can see even lead here, and lead is a chemical of major public concern, and it's a worldwide issue, you know. So... If you're going to stand there, it's probably you should just use the arrows, instead of the remote. It's up to you. Okay. Actually, yeah. So it's a heavy matter. It's a part of the cost of the earth, you know. There's nothing we can do about this, you know. So we've been extracting from the environment for a while, and now it's a major issue in low-income, low- and middle-income countries. And we'll be told, actually, when we study this, in fact, we take more in by inheriting them, inheriting lead, because our lungs take more air than anything else, you know. So it's widely spread exposure, you know, opportunities, work, home, and neighborhoods. A little bit about chemistry of lead. It's a metal. Like, usually, the metal used to include gold, silver, copper, and tin, and it's a good metal because it makes things stick together. That's how it was added to lead, to paint, you know. And then it was helping the engine, as you will see, when you have an old car and happen to add lead, and then the engine does well. So many other elements, since it's been added to the list, but we have metalloid, we have properties of half of a metal, non-metal, that's arsenic. And you can see these heavy metals, it's number five here. Lighter metals, that's aluminum, and then we have non-metallic toxic elements, arsenic. When you look at the simplified period table of elements, you can see the left side, that's where we have most of the metals, you know. And when you go down here, you can see this is what's happening, and as we studied radiation, that took some courses on radiation, it shows how the disintegration of basically radioactive material really, it's an ongoing process. You know, in the lead, at one point, it would be the final product, but at the same time, the cycle goes on, and as you know, some would take minutes, some would take centuries, some would take millennia, and this goes on in the environment. Some history, I, ten years ago, I got an opportunity to go to Democratic Republic of Congo. I happened to be born in Rwanda, next door, and because I spoke a little Swahili, they wanted people to talk to the local people, artisanal miners, the small-scale miners. And we looked around, and we did an exhaustive study of the environment, the air, the water, the soil. We had a Canadian geologist who would take measurements of all those media, so we were able to show how they would exceed WHO and other countries' standards. And you can see in the back of that picture, the water doesn't look that blue, you know, but in this case, it's blue, because it's been dumping things in there, and then regulations, they do have regulations, but they're now enforced, you know. Of course, that's because of corruption, as we found out. So the Romans used to use lead, and it makes things sweeter. Actually, when I was doing the study in Miami, I went in the home, peeled the paint, and they tasted it. It's sweet. You tasted it? Yeah, I did. I mean, you put it in your tongue, it's really sweet. That's why kids really always just... And one of our vice presidents was actually a gentleman of Irish descent who was growing up in Boston. He said, I used to eat this, but my mom made sure that I drink milk, a gallon of milk a day. In fact, when I was growing up, I don't drink milk anymore, but now I see what saved me, because we see there, the calcium competitive lead, if you have a good diet, it really doesn't affect you. So it's sweet. That's why the Romans used to add it to their wine, and in the end, he said, basically some speculation, in fact, the Roman Empire was destroyed by lead, because the aristocrats would drink wine with a load of lead, because they kept the lead in containers underground, and they all went crazy. So now, lead is found, it's used in pipes, and dishes, and cosmetics, coins, in paint. So era days of gasoline, we see this, pure gasoline, it's not burning in an internal combustion engine, so they have to find a way of making it. In the 1920s, there's more powerful engines for both cars and aircraft. Thomas Midget, we see his picture in the next slide. So at that time, they mixed the gasoline and ethanol, and they called the farmers fuel, and actually it's funny, one of the founders of the manufacture of cars, Henry Ford, was opposed to use lead. He said, no, no, let's not use lead, because it's really bad. And then they use, they try to trick people, they try tetraethyl lead, so it's like ethanol, you think it's some organic thing, so that's how they were able to convince people to go ahead and use lead in a car. So Midget and his boss went to work for GM, and then they forgot the ethanol, because they said, any idiot will come up with ethanol, we won't be able to make any money. So let's use something, and get the money from it. So we have the danger of leads now unknown, and we have lead, you know, barrel factories, and this actually happens in many, many countries, but even at this time, these workers were psychotic, and they went into comas, and died of scoliosis. So the Mass Midget discovered, no, no, it's hard to do, you know, to do gasoline, and then, you know, some end up in a sanatorium, due to lead exposure at that time. So lead based was controversial, and the environmentalists like Alice Hamilton, basically the mother of occupational medicine in the US, was doing work in Chicago, and she was really opposed to this, but DuPont, GM, and Standard Oil, they said, the owners, the TEL partners, didn't include lead in the name. They used ethyl. So if you see ethyl, oh, you must be safe. As you can see, the legacy of Tetra, you know, it's taken water, and basically, it's stretched darker, too many died, and so a lot of exposure at the time. And then, we have Thomas Midgley, he was an inventive chemist, because he convinced all car manufacturers, and aircraft manufacturers, oh, if you add lead, the engine will really perform well. So everybody followed, and today, we think he did a tremendous job to us, and, you know, but that's not new, because what happened was, DDT is the same thing, but at the same time, it was able to help us. You know, the way he found out about, actually, this issue, I was attending a conference by Mario Morino, he got a Nobel Prize, and he discovered the CFCs, the free one. He was in Mexico City, at the university, and he was doing all kinds of experiments. He had a free one here, and he had CFCs on the side, and then he's doing all these experiments, and he was really tired at the end of the day, he said, you know, let me go home. He went home, and he came back in the morning, the ozone layer was eaten up by just the CFCs next to it, because he couldn't really put them aside, because he was so tired. And then, he called his colleague, who was still at home, hey, we just made a discovery. Who did you discover? Oh, you come here, and I'll show you. So, the CFCs I left, because I was tired, it ate up, basically, the ozone, so that's probably what's causing the ozone hole. They immediately applied for, and they got a Nobel Prize for chemistry, you know. He was teaching at MIT at one point, he left Mexico and then to MIT, and fortunately, a few days, I mean, a few years ago, he died. So, you can see that, you know, this man, he gave us lead, then he gave us CFCs, the ozone, you know, so, when the fix lead to more problems, so, Thomas Midgley, like I said, he was really embarrassed, but devices sometimes leak, refrigerant gases, and some others, and they cause problems, and now, in the third countries, we see this in Miami, we have kids from Cuba, from Haiti, they use radiators, they remove the liquid, and then they use them planting flowers, or whatever, but then they see this in the environment, and the kids, when they're coming to Miami, they have high lead levels, you know, so, you know, it's really one of these issues we learn as we go, as my professor used to say, trial and error, you know. So, Thomas Midgley's legacy, so, we have lead all over the places, and what Midgley couldn't have known at the time was this gas, we eventually see a huge hole in the ozone layer, which protect us from the sun's carcinogenic radiation, so, you can see that he's showing off some of what he discovered to these women, and, you know, so, currently, what we have here, so we have lead, and so, for almost 100 years, we've been using, you know, this additive in the gas, because some countries are still using this, you know, and, in fact, what I said that, you know, you will see, I'll show you in the end, the study we conducted in Miami 20 years ago, because I spent eight years in Kuwait, I left last January, we just finished a study of, replicated a study from Miami in Kuwait, and we found out 81 children out of 150 have high lead levels, now, the doctors are really just calling from all over the place, saying, what's going on, I mean, well, lead is in the environment, oh, really, how, I mean, you know, and then I'm trying to explain to them what's happening, so, you and me have been trying to really get rid of this problem. Many countries, not many, but, you know, a handful, number of countries are still using lead gasoline, because they have old cars, even in Kuwait, it was 1995, to phase out the use of lead, you remember, in the U.S., it was mid-1970s, so, some are still behind, so, lead is with us, you know, and, so, today, you know, in countries, mostly, you phase out the countries, but some still have them, and then, even in the U.S., the soil, along those highways, I-9 in Chicago, downtown Miami, they have that lead that came out of exhaust, and then, if you happen to have old homes, the paint is peeling off, it gets in the environment, and it's combining factors, so, kids are playing with this, and then, they inhale this, and they get lead poisoning, and if that is not that great, they get affected, you know, that's how, so, it goes, and during summer, because of the wind, the whole thing really gets, you know, back, suspended up in the air, look what's happening around the globe, the U.S., we don't measure, actually, lead now, during the, you see the air pollution monitoring station around the country, in Miami, I used to take my students to the monitoring stations, and they keep me scared, and they said, oh, you're not measuring lead, well, when you don't measure, it's so low now, because U.S., at some point, when they did get those measures, it was reduced almost by 99%, so, what we're talking about, it's 1%, but still big, because, you know, because people live in those, you know, city, living in those old homes, have that problem, but look at the rest of the world, it really, I mean, even, look at India, look at the Central Africa, you know, it's really a serious problem, and that comes from the mining, too, you remember that mining I went to in Congo? Oh, yeah, we had lead in the samples we got from the water, the air, and the soil, so, lead is everywhere, and if some of you probably know this, you know, some of the paint, this is the gathering, showing how the lead looks, and this is another one, you know, this is, in New York, when they get the paint, they said, oh, will your paint last 100 years? I was weird, because it was what they call dark, boy, white lead, so everybody wanted to buy the lead, the lead-based paint so it can last 100 years in your house, you know, it was the publicity at that time, you know, and so, you know, lead toxicity, it's quite a tricky matter, actually, we have some other matters of toxin, but the issue of lead, it affects all your organs, you know, and it circulates in the blood, and it goes in the bones, as Michael said, and then you will be there for about 30 years, if you're a young lady, at 20, you walk in the smelter, and then you move out, and you decide to get pregnant, at age 35, you still have lead to give to that baby, and Howard, who, from Harvard, at the time he was at Harvard, he did a study in Mexico City. He found out that 95% of children born of those women who work in lead smelters had mental retardation at birth, because they had some taste that were using. They all have problems early on when they were born. And then it affects the frontal lobe, you know, and affects your judgment. And so when you lose your frontal lobe, what happens, you don't, you be stealing as a young child, I mean, an adolescent, and then you see the police, oh, I'm caught, because you don't, or a young lady go ahead and have sex, unprotected sex, and it's, oh, I'm pregnant, because the judgment's gone somehow. There is a study actually showing how the increase of use of lead increased the crime rates and all the issues that's been published by Rick Nevin, and that's really true in all developed countries. He had US, Canada, Australia, and then European countries. Crime went up, and then it went down, you know. You probably somebody remember that when Giuliani said, well, I clean up the crimes in New York City, he said, no, it's the lead they've been loaned by the government. It's actually reduced. You know, so it's quite a, you know, it's, it is absorbed, it depends on your age, nutrition status, and the rate of exposure. And so you can see adults absorb about 20% of ingests in organic lead after meal, and up to 60 to 80, on an empty stomach. If your stomach doesn't have anything, lead goes straight in there, because what happens, it will compete with all the essential minerals, calcium, iron, some of the essential minerals, and then what happens, lead will go out, and then those minerals will go in. But when you don't have them, lead will go in your system, and you end up suffering from it, you know. And that's actually, we hypothesize, in fact, one of the reasons we see a lot of black children and Asian descent children, why they have high lead levels, not only they live in old homes or whatever, but also they have lactose intolerance. If you born of parents who don't, who didn't drink milk for a long time, because there's a genetic changes, you know, you have lactose intolerance, and it will prevent them from drinking milk. You remember the vice president of research at Florida International University, who used to eat lead-based bread, but he was the vice president of research, I mean, the manuals, you know, because he was served by the milk his mom used to give him. If you don't give milk, that's why they start adding calcium and some of the iron to the juice, because that help for people who don't drink milk. So, we take more air, I mean, more lead from air absorption, you know, when we inherit. So, you see, lead and calcium, they look alike. If you have a lot of calcium, lead will just be eliminated. But if you don't have lead in it, then lead will just take its place. So, it's in the brain chemistry and the bone formation, too. So, cells will mistake lead for calcium, and therefore giving direct access to vital organs. And lead will disturb the movement and storage of calcium inside the cells, and lead hijacks the calcium roles in the brain, communication between neurons. Actually, it seems when Einstein died, the surgeon said, well, he told the family, you can bury the body, but can I have the brain? The family said, oh, go ahead. He removed the brain, and now it's sitting somewhere in the universe of Kansas somewhere. And they did, when you look into that brain of Einstein, there's no holes in it. And then you have a kid who had been lead poisoned, you see holes when you compare those two. That shows, in fact, that lead really destroys the neurons. And you got really a very serious problem when that happens. You end up learning disability in school. You show up in school, oh, he's stupid. He's from those areas. But you've been poisoned, actually. It's not your fault, but somehow we think it's your fault. So, lead will circulate in the blood. So, when you measure lead, we're really measuring the lead circulating in your system. But the lead in your bones, I mean, we do x-rays. We can see that you have lead, but we really can't measure the lead in your bones. And that's really another problem. So, this is the lead in the brain. It competes with calcium, as I said a moment ago, moving the neurons. And then it gets inside the neuron, and it leads neurotransmitters, setting a weaker sign to the following neuron. Primarily, they don't communicate anymore. Lead can also cause neurotransmission and release, you know, activate the neurons and, you know, the neurons receiving appropriate signals. So, basically, it's just messing up your brain. And then neurotransmitters signaling is especially important, as you know, in learning and memory. And lead exposure impairs the process for children. See, you and I, when we get exposed to lead, our brain, the brain is really so strong, he says, just go ahead. You can't get in here. But for a child, you know, when you touch the head of the baby, you know, the scalp, they're searching, because that meant the brain is still growing. We the only animals that can still grow, growing a brain the first two years of our life. And that's when you're grabbing stuff and putting it in your mouth. You know, because other animals, by the time they're born, the brain is already formed. It's matured. So, by humans, we have that feature, and that can be a problem, you know. So, defective road, you'll be delayed in the reverse development, you know, permanent learning disabilities, IQ, seizure, coma, even become shorter, because lead goes in your bones, and then there is no way, because to be taller, actually, it's pretty much the bones of your legs, you know, and then because the lead is impeding the growth of those bones, you'll be short. And with learning disabilities, you can see that it's a lot of problems you end up with. So, about 73% of total lead burden in children is mineralized, you know, mineralizing in tissues, basically. I mean, Dr. Niedermann basically used, you know, those teeth we lose, some kids will keep them, and they bring them to him, and then you measure them. The ones with high lead levels, you know, decayed teeth, basically, they had high dropout. They just really, basically, they couldn't measure. The ones who have less, they're just graduating, just went on to become doctors, you know, lawyers. So, the bones and teeth are the same. So, lead will predominately accumulate in the trabecular part of the bone during childhood, and the reverse bone blood modification can happen as you grow older, because there is, might be bone fracture, kidney disease, pregnancy. We really don't know exactly how and how often and when the lead will come out from the bone to the blood. So, you know, it's still a puzzle. And then, the measurement mechanism to this increases the generation of reactive oxygen species, basically. This interferes with generation of antioxidants, and it's increased, and it leads to, you know, cell membrane damage and eventually cell death. And so, lead, the biomarker. Someone asked a question about ZPP. We're no longer using ZPP, I'm sorry, because now you go straight to the money. You just measure using, you know, basically, the machine we have today, you can see lead. You don't have to go through ZPP to try to find it, you know, because many things can cause an increase of ZPP. So, we have soft tissue lead, half-life is 1 to 1.5 months, and bone lead, half-life is about 25 to 30 years. You remember the story of a young lady, I told you, she's 20 and she decided to get pregnant at 35. She still had another 15 years to have that lead. So, all the children will be born from her. They've been inheriting some of the lead from her, you know. So, the blood lead levels, it's really the most widely used measure. In Kuwait, I tried to convince them that we need to get the venous blood, and they said, let's do capillary. So, there's a lot of contamination in my capillary, and it went back and forth, but in the end, they said, well, the mom, we won't accept it. You know what I did? Because I used to work with community workers in Rwanda, even in Miami. I had my students, they were in the community, and before we know it, the moms will call us, oh, we heard about this stuff. We need to make sure we really, you know, how can I get my child tested? So, we went to all the vaccination clinics, and the folks in the Ministry of Health said, oh, my God, how did you do that? Well, I used, by Kuwait students, your children to go ahead in the community, and basically, they had, we had TV, the graduate students and some of the representatives from the Ministry of Health went on TV. They talked about lead, and basically, the moms kept calling us, and we sent them, and they ended up having a very good sample. It's about 200 now that we got, and so, remember, you know, and the blood lead, it's not really effective, all the, you know, the burden of lead, because some in your bones, you know. So, it's definitely short-term, I'm going to support lead because of the short life. About medicine now, you know, you know, environmental medicine, basically, this is something I started with, and later on, I ended up with occupational medicine. In fact, my last assignment was in Qatar, where I had to design a workshop on environmental and occupational medicine program for their doctors. I keep reminding them about this. So, we have consumer opportunities, and, you know, we have product exposures, imported canned foods, you know, we have imported jewelry, some products used in home remedies. During Lead Awareness Week in Miami, we once tested, it was a plate from former Yugoslavia, and it has 75% lead in that beautiful plate the woman kept. I said, oh, God, you should display it in the front of your house, but don't try to use it, because if you use it, you take all this lead, especially if you store it in the fridge, that lead will leach into the food, and then we end up with, actually, another case in Miami with tamarind candy. When we went to this house, you know, this couple had two kids with high lead levels. We did search everywhere. We looked at the water, the air, everything. We couldn't find a source, and somebody said, can you open the fridge? I said, go ahead, and then he opened the fridge. What is this? Oh, just a candy. Grandma, you know, grandma was sitting there. Oh, yeah, that's a candy. When they cried, I gave them a piece of that candy. So, can I take a piece of it? Oh, of course you can take a piece. Took a piece and went to the lab, and the guy said, oh, my God, there's a lot of lead in this candy, because the container was storing the lead, I think, which is sticking into that beautiful candy that the kids were eating. So, there is so many exposures. Now, ethnic product. In the Middle East, they have what they call kohl. They put it to make young girls beautiful on their eyes here. It was having, you basically test to find if you have lead levels. Some of the products that we have, Mexican, and Asian, and Middle Eastern, and that's alcohol, the kohl that we have. So, there are so many sources there. Now, the opportunity, the homes that's cracked and peeling all the paint. Remember I told you about Coral Gables? The homes are beautiful. They paint over the old lead base paint. Doesn't expose anybody, but in downtown Miami, everything is falling off, because the landlord said, well, these people don't even pay rent, so what should I worry? So, home renovation, you disturb the old lead paint, can spread invisible dust. In fact, when I was in Coyote, I'd be driving around with my wife, and my wife sees somebody, they're demolishing an old house. I'm sure you think about lead. Oh, yes. Because they had, those old homes had old, I mean, lead base paint. And the way they do it, it's not like we do it here, where I cover up the whole thing. It's open. Everything goes up in the air. People are just walking around, no pee-pee, no nothing. And, you know, that's where the lead is coming from, the one that's been affecting the children. Lead from old lead base paints can, I mean, household dust and nearby soil, and they sit there because it's heavy metals. And so, soil may still have higher levels from the pre-1976 gasoline. Actually, in Miami, when I finished my study, we were able to lobby the state of Florida, and in 2006, there was an ordinance, I mean, actually, a law requiring pediatricians to screen every child under six years of age. We were able to embed it into obesity prevention or whatever. Governor Jay Bush, somebody said, oh, you signed a form about lead prevention. No, no, no. I signed obesity prevention. But they had, they opened up the whole book and said, well, look, this is lead poisoning. But it became a law. At that time, the city of Miami got really, really clever. They said, let's find out what's happening with recursion parks. They took samples. They met, oh, have high lead levels. They said, we're closing all the parks in Miami. They removed the top layer, and then they brought new dirt in there, and they allowed people to go back and children to play because they found out that they, and at the time, there was the fountains around all the buildings in Miami have high lead levels. They removed them, too. So you can do something, and then you can really do some improvement. And then if you have lead in the mining area, the smelters, that adds to the issues. And then you see how kids, you know, we injecting, you know, wood and alcohol may be significant for central population. Injection of primer where children are exposed to the lead, inhalation, as I said, it's a primer exposure. You can see that kid is trying to pray to grab something, and, you know, if it's really paint, and it might be trying to test it. And then we have a job with lead exposures, lead smelting, mining, car battery manufacturing, construction and modeling, auto repair, plumbing, police officer who went to those shooting ranges. In Hollywood, which is sitting next to me, I live in the Pines, the guy who used to go and see the shooting range, and the guy, he's shaking, he says, he says, what happened to me, doctor? Well, you've been exposed to lead. Let's take some samples from that. Because he's having people coming to shoot, and the lead goes up in the air, and the whole environment is just loaded with lead. And the policemen go there, they have the same exposures. So we see we have those in the environment we live in. So there are many other sources, too. And then you have car repairs, you know, artistic painting and soldering, bullets, and, you know, I'd say, somebody made a joke, it wasn't really a nice joke. When a kid from, you know, Chicago or Miami gets shot, what kills them? It's the lead in that bullet that is in their body or something, you know, because it's almost like 100% lead, so, you know. So then you have a kind of, you know, contaminated lead containing pipes, you know, brass faucets, or, you know, boiling oil. I mean, the water. We advise people, if you suspect you have old pipes, make sure when you open your sink in the morning, you let the water run first, because the first drops will be full of lead, especially trying to get the hot water. So, you know, running cold water before use, that may reduce the exposure. And then, you know, Flint, Michigan gave us a story about lead in our system, and Washington have those issues. In homes, there are so many places in your home, they might have lead, and those pipes, and, you know, but they are okay if you don't touch them. But, you know, if somehow they start leaching out in the water, like the ones on a pipe, you end up having to turn the water. So in the current event now, we have car exhausts, something in the past, in most countries, but some countries are seeing lead. In Flint, Michigan, you have old homes, and then you have some of, you know, the basic artistic areas, or you're trying to draw using, you're an artist, but you're using some lead product. So, this is actually a study done by graduate students of Kuwait University. I happen to have a gentleman who is his professor, head professor, actually. I ended up becoming the principal investigator because I was leaving in January, but he's the one, actually, who really educated me about lead in Kuwait. So, in one of these studies, more than half of the population in Kuwait have, you know, basically BLLs, and, you know, blood lead levels above CDC level, reference level, are five. You remember that now it's down to 3.5, and 13% have more than 10 micrograms per deciliter. So it's really a public concern. And then you can see the governorates, and when you look at the governorates, you know, some have intense industrial activities, like asthma, this is the capital. So, more than this study were needed. So, there is a need of public intervention, the public awareness. That's what the study did for us. I mean, you know, now everybody is talking about this. You know, this is where it's coming from, what do we do about this? This is a map of Kuwait, it's a small country. It's across the size of the state of Maryland. It's really tiny, you know, it's just, you know, it's got, below, actually, you know, you have Iraq and then Saudi on the other side and then the rest is, you know, Gulf. They have a lot of industrial activities. They have basically recycling of radioactive material, the barrel recycling factories, Kuwait pipes and oil in the industry. You know, they will even oil refinery. Remember, there is an environment. If you open up any place, the lead will come out because it's not really much, but somehow, you know, maybe if you're still adding lead in the gasoline, you understand that even becomes a worse problem. So this is some industrial areas. That's where we have more children who have high lead levels from these areas. The study is still ongoing. We, what we did now, we're about to do an environmental assessment because there's no point just to say where they have high lead, where the lead is coming from. We're buying this XRF machine, which has now, the new ones are very good. In Miami, we used to carry them on our back. It was really tremendous work, but now we have this portable XRF machine. You can point to food, to water the wall, to the, you know, to the carpet, and tell you how much we have in there. That's what we have, and we worked with, it's a key, so which is Kuwait Institute of Research, Scientific Research, and they have this machine. The machine, it was costly. It was like a 19,000 KD, which you translate in American dollars, it's about like $70,000. But now, the new, the new XRF machine, they are really, they are the lower price now. You can have them about, you know, 35,000, not $70,000, so it's easy. So, as a summary, we have, you know, lead additive to gasoline distributed in environment and large quantity in the U.S. until 1986. That's the end of phase out, and the lingers and measurements report in the mining areas and around the cementing facilities. And people forget, in terms of low tonnage, the amount of lead and gasoline over seven years of use equals all the lead in paint in 94 years of lead production, which is 1978. So, lead contamination of soil, the legacy of decades of use of lead gasoline, additive in gasoline and paint. However, some countries are using lead gasoline as base paint. And so, the common conception is that lead base paint alone accounts for the amount of lead in environment, but according to the studies, both sources are important. You know, given the study we did in Miami and the one we're just finishing up in COVID. So, prevention is in order. Only the prevention solution, along with healthy diet to calcium and other essential minerals, is competitive lead in the gut, letting the lead getting out of the stool. You know, that's really the key. If your child have lead, before you even find the source, make sure you change their diet. Make sure they have a lot of calcium, iron, and that lead prevent, you know, that lead to go in the brain of a child. So, you know, that's really what I need to use my resources that I use in two studies we conducted in Miami. We did an enhanced study. You know, we're looking at the low lead blood concentration in thyroid function in American adults. This was published back in 2013. And then we did another one, urinary heavy metals and associated medical condition in the U.S. adult population. Michael present about this, you know, because this is really an ongoing issue. Lead is still with us. We got to make sure we know how to deal with it. You know, it's not a hopeless case, because people say, oh, what do we do if I'm well? If you really take care of the, you know, the child, then make sure when they're crawling around, when you bring your car keys, your remote, just making sure you are. If they use them, you have to wash them. The toys, you remember the toys you receive from China? You know, in Kuwait, they have many of those. So, the XRF machine will be pointing to those toys, and then telling, look, you've got to wash these toys on a regular basis, because that's how they have lead. And then looking at the recreational parks, too, because it's pretty much a vast environment. There's a lot of lead really being suspended up in the air and it comes back, you know. So, that's really all I had to tell you, you know. So, thank you for your attention. Thank you. Thank you very much. I wanted to point out that a few of the articles that Dr. Kasana was speaking about are in the resources for this talk in the app. Yeah. And also, the slide set itself. So, we actually, you did that in record time. I'm actually really impressed with how fast. No, no, thank you. It's a little light-hearted variation. Yeah. Do we have the timer on? Yeah, this time I was. So, we have some time for discussion. Hi there. Any comments on the results of the analysis of Beethoven's hair and the blame of lead intoxication, because he allegedly drank sweetened wine? Oh. You know what, the Romans of the. Beethoven. Beethoven? Beethoven's hair? Actually, because we tried to do a similar study in Cayman Island. The gentleman who was in charge of the environment said, oh, did you know Beethoven? He sent me a clip of Beethoven saying because he became deaf because basically he was lead poisoned. In fact, with the CEO of one of the companies in Chicago, he said, we don't know what's causing learning disabilities. Is deafness or the brain or whatever, you know. So, yeah, Beethoven. Thank you. Thank you. Thank you for your presentation. Does OSHA have any plans to update its lead surveillance policies? I have a lot of companies that are just adamant. We go with the OSHA, you know, cutoff levels. And OSHA says you get a ZBP, so we want a ZBP. Michael, can you answer that question? Because his presentation the other morning was about that, about OSHA standards. I spoke about this at 8 a.m. But OSHA has it on their regulatory agenda, but it's not at the top, so it's going to take a while. But California, effective January 1st, has made a major change, lowering the PBL to 10, lowering medical movement protection to 20, and many other changes that are the most protective in the world. And that may be an influence on the rest of the country, given that California, you know, is one-eighth the population in the eighth largest economy in the world. Hopefully that will have an effect. There's also a very good ACOM guideline, guidance statement related to that topic. So it's a good reference. Up there. Hi. Thank you very much. With elevated lead levels in children in Kuwait, have they talked about chelating them? Or is there some kind of treatment that they're considering? Actually, there's a doctor who, he had a chelation treatment he's promoting around, and he said, you don't chelate until the levels are really high. We talk about, you know, 10 micrograms, 12, 15. It's not worth it to have that child go through chelation, because as all of you know, it's quite a tedious process to have that kid just, you know, perfusions around, and trying to, I mean, and then it's not really 100%. You don't remove all the lead even with one session of chelation. You have to do many sessions. In fact, I had a gentleman who was a pediatrician at Nova Southern University in South Florida. He called me and said, I got a guy who was fishing, and his child was sitting next to him, and then he grabbed one of the fishing rods, and he swallowed it. And then when the dad was, she looked around, and the kid was just struggling, and he rushed him to the ER, and he met that pediatrician, and he said, and then they did an X-ray. They found that the rod was in the gut, and at the time when they measured the lead, it was 45 micrograms per deciliter, and they put him on chelation treatment. After three months, it was down to 15, and actually after six months, most of the lead were gone, but you have to have high lead levels. You don't just, you know, low lead levels, it's not worth it, you know, so that's it. Yeah, okay. Yeah. You've been there. I see cases periodically where a worker that was exposed to lead 15, 20, 25 years ago, you know, legitimate with no documentation of levels, alleging that today there is a chronic renal failure is secondary to that exposure 20 years ago from lead leaching out of bone tissue, that sort of thing. Is there any validity to those arguments that many years later? Again, I'm going to back to Michael, because he talked about that, too, because, you know, you were talking about the mortality, neuroendocrine diseases, you know, Michael, if you don't mind. You know, you know, there has been a link between long-term chronic lead levels, generally above 80, and developing chronic renal failure. Now, whether or not lower levels of lead contribute is more of a controversial question. You know, lead's associated with increased risk of high blood pressure, and uncontrolled hypertension is one of the risk factors for chronic renal insufficiency. So it's, there's a potential that there's contribution, but whether or not you could draw a straight line in an individual case as well as opposed to a population increased risk would be hard. It's not impossible, but, you know, that would be the situation if someone had really high lead exposures in the past to maybe look at like non-invasive measurement of lead in bulk and possibly draw an investigation on that. Yeah. I was wondering, how much do dietary changes in like increased calcium, how much is it clinically relevant? How much can it actually lower the children's blood levels? How much, when you use diet, or? Yeah, how much can diet make a difference? Well, this is because, this is ongoing, because if the child is exposed, you make sure they have, you know, a diet with really good calcium content. And it would take a number of months and maybe years, but you stop the entry of lead in the stomach already. But the lead that's already grown in a bone, there's not much you can do. You still have that one, but at least you can, you know, lower the absorption of lead by just the calcium. So I don't have a timeline when you really quite sure when, you know, you'll be lead-free because of your diet. And then it had to be iron and the other essential minerals, not just calcium. So just make sure you do that and then prevent them from, you know, the mouthful hand activities. When they do that, make sure you work their, you know, their toys. And, you know, you take a lot of, you know, measures. Just make, when you map, use the weight, you know, techniques. You don't want to steal dust in the house when you use a broom and, you know, so there's a list of precautions we came up with, we showed to the parents to lower. It's not just one thing. You know, it has to be a comprehensive package you get to use to do that. Yeah, so, yeah. diet is for people who are particularly in women in developing countries where they might have had increased levels of lead is to maintain an increased high calcium intake during pregnancy and lactation. Because pregnancy, and particularly lactation, produce a big demand for calcium and increased mobilization if you don't have adequate calcium in the diet. And some studies done in Mexico, as you know, by Dr. Hu, found that it's particularly important to maintain a high calcium diet if you've had a past history of high lead exposure and you become pregnant or are nursing. Indeed, that's why the government added the calcium in some of the juice we drink, in the milk we drink. So it's not a problem in the global north. But the global south have that problem. Any other thoughts, questions, discussion? Ignore that blinking light. We set it for 10 minutes early. So we still have a little more time. A little time. I enjoyed your talk. And I loved, especially, your historical references to mid-lead. Mid-HD OED. It's fascinating. And it's fascinating about how they didn't use ethanol and gas to simulate. That's very interesting. One of the things I think that we ought to be concerned with right now as a society, there's a big push by the Biden administration to get lead out of plumbing and lead pipes, which is good. But right now, a lot of the lead that's being removed is being exported to China and Mexico for secondary smelting because they don't have the controls. So one of the things that we're looking at, and I think ENCOM may advocate for this if we can get it done and some other people are, to require that US federal funds are used to support removing lead pipes is that those pipes need to be not exported for lead recovery. Most of the lead, lead is highly recycled. 90% of lead is recycled. But we don't want it done in Mexico where there's not nearly the protections. For example, in Mexico, there's no medical removal protection no matter what your lead level is. They don't have that. So what we want to do is have, say that, OK, if you get federal funds, you have to have it recycled. And by the way, the facilities that recycle lead batteries and are set up to recycle lead, that lead stock from pipes is very, very good. It's very easy for them to use. It's relatively pure lead. So I think from a political action level, say, great, let's get all this lead out, but let's recycle it in the United States, not export it. If I can have a comment, if anybody would like to replicate the study we did, I have all the tools. I got actually the question from Bruce Renfield, that's my co-author this morning, because we met and we talked about the many years they're going to give me the booklet of questionnaires that are validated. And so you use the questionnaire, you take the blood samples, and then you take the samples in the environment. And that's a perfect scenario. It shows you where to go from there. So thank you. Thank you for the talk. It was interesting. One thought that came to my head is, as we are not using lead to create materials, we're not using lead in making what we're making, like in lead pipes and all, do we have other metals that we're replacing lead with? Because we have data right now on lead and its danger on health, do we have other trials or data on what these replacements metals would have on the effect of humans as we replace lead with whatever we're replacing it with? That's a very good question, actually, because my professor used to say, well, being humans, we use trial and error. You remember when Thomas Midgley introduced CFCs, that was actually when the first refrigeration, they used ammonia. In the back of the fridge, we had ammonia. And people found out, oh, if the whole thing breaks, everybody in the house will die. So that's when Thomas Midgley advised them to use freon, fluorocarbons. And then he found out that it was causing basically the ozone layer depletion. So we need or not, unless we use what they call systems approach, what are you doing? Maybe the replacement. We told them now, when you place CFCs in the refrigeration, it's safe, until we told, well, actually, they're not that safe. So it's the trial and error. I'm sorry. Sorry. It's a trial and error process that we go through as human beings. Because if you were a god, we'd know what just to use next. Yeah, that's a very good question. And we just live with this for a while. We're just about time, but we're going to take one more question. Hi, just a follow up to not exporting lead to Mexico. Don't disagree with that, but what do you do with it? It's got to go somewhere. And I imagine in a landfill, someone would just use it for recycling. The recommendation was to recycle it in the United States, where we have better controls and use it for where it's needed, not in pipes. Yes, like Michael said, you can recycle it, but you've got to have the tools to be able to recycle it. Because you're right. When you take it from, let's say, the recreational parks in Miami, you take it somewhere else, it might be a problem where you take it. So you get to always look at those issues. And recycling is one of the best ways you can deal with this. Thank you very much.

lead exposure

occupational settings

environmental contexts

leaded gasoline

lead-based paints

industrial activities

health risks

neurologic impacts

developmental issues

diet and lead absorption