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Joint class on law and lead looks for solutions

Say the words "lawyer" and "doctor" and most people probably think "malpractice." But law and medicine intersect for other reasons, too, often in the public's interest.

"We look to the publichealth community in my profession to tell us what's wrong," Boston attorney Neil Leifer told DMS and Vermont Law School (VLS) students at a joint class during spring term. (Leifer, of the law firm Thornton and Naumes, is best known for leading Massachusetts's successful fight against the tobacco industry.)

Cases: Litigation "doesn't start with the lawyers. We don't dream up the cases—despite what the doctors are taught in medical school," he joked.

For several years, Leifer and Dr. James Sargent, a Dartmouth pediatrician, have co-taught a class on lead poisoning for VLS environmental law students. More recently, Sargent began lecturing on the topic in a course on environmental and occupational health for Dartmouth M.P.H. students. By combining the lectures into one joint session, Sargent reasoned, VLS and DMS students would have a chance to interact and gain more from the experience. The course directors at both schools agreed, and the session was combined for the first time this past spring.

"I hope this becomes an annual event to go back and forth and look for ways to build on the really rich aspects of this topic for public health and environmental law," noted Dr. Carolyn Murray, chief of occupational medicine at DHMC and codirector of the DMS course. Leifer lectured the class on the history of lead paint in the United States from the late 1800s through the 1970s, when it was finally banned. He is currently representing Rhode Island in a lawsuit against the paint industry, which continued producing paint with lead long after its toxic effects on children were known. The difficulty of such litigation,

Leifer explained to the students, is proving causation—that children's disabilities are a direct result of the industry's actions, or lack thereof. To do this, Leifer must rely on medical experts like Sargent.

"The goal of a medical expert is not to impress jurors with credentials," Leifer explained, "but to educate them."

Sargent then talked about the toxicity of lead; the effects of lead poisoning—such as anemia, abdominal pain, brain damage, and, in extreme cases, encephalopathy; and the first national lead-screening programs.

In the 1970s, when the Centers for Disease Control and the Public Health Service "started screening kids, they found out that lead was pervasive in the cities, especially in the ghettos—the inner cities of the eastern seaboard," Sargent told the class. Today, the average human lead concentration is about 2 micrograms per deciliter of blood, according to Sargent, but in the 1970s, inner-city kids were averaging 25 to 30 micrograms per deciliter. "Why was lead so pervasive?" Sargent asked. Substandard housing with lead paint was partly to blame, but the bigger culprit was the lead being added to gasoline to increase octane counts. It took 23 years, from 1973 to 1996, for the U.S. Environmental Protection Agency to completely phase out leaded gasoline for on-road vehicles.

"Now lead poisoning is not a pervasive exposure; it's a point exposure," said Sargent. "It's the exposure of a kid that happens to live in a house where the lead paint's deteriorating."

Exposure: When Sargent has a patient who tests positive for lead poisoning, he counsels the parents on how to reduce or eliminate the child's exposure to lead paint. Sometimes, the best solution is for the family to move, but many families cannot afford to do so. Even though in most states, lead poisoning is a violation of sanitary codes, enforcement programs often lack sufficient funding, so property owners are rarely pressured to abate the hazard, noted Leifer.

"Frankly," explained Sargent, "the reason I became interested in lead poisoning is because it wasn't a problem that I could solve in the office. I was frustrated by it. These kids would get lead poisoning, I'd send them back out to the house, they'd get poisoned again. I knew that there had to be a bigger solution to this. I wanted to make a difference in a bigger way than I could in the office."

Linked: "The big picture," he added, "is that lead poisoning is a public-health problem . . . and it is inextricably linked with corporate behavior, the legal system, and the political system. . . . Neil's taught me that."

Jennifer Durgin

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