Herbert L Needleman

Lead toxicity and poverty

The knowledge that lead can be toxic is almost as old as use of the metal itself. The focus of medicine had been on acute disease, treatment to lower blood concentrations of lead by reducing exposure, and chelation to draw out the poison. Meanwhile, the scope of unacknowledged subclinical disease increased in industrialised countries in the 20th century, owing to increased use of lead in products such as paint and gasoline.

Needleman saw the effects of acute lead poisoning when he served as chief resident at Children’s Hospital of Philadelphia in the 1950s. And, as he recounted in an extended 2005 interview in Public Health Reports, he came to realise that the inner city children of poverty he was seeing were trapped in an environment that was killing them.1

Over the years he began to wonder how many of the children who were coming to the low income community clinic were in fact a missed case of lead poisoning. Although concentrations of lead in the blood were not necessarily high, perhaps the damage had occurred earlier in life and then the poison cleared from the blood.

Needleman suspected that past exposure was an important piece of the equation and that signs of that exposure might be found in slow growing tissue. Hair and nails might offer a window to this past exposure, but they also could be contaminated by environmental contact. Bone biopsy would provide a cleaner sample, but that was invasive and difficult to obtain. He settled on sampling “baby teeth,” which typically fall out during elementary school years.

Opposition

Then as now, vested interests that benefited from lead and the status quo employed a panoply of tactics—similar to those used by the tobacco industry and climate change deniers—in an attempt to discredit Needleman’s findings and his integrity. Those efforts included a lengthy investigation by the University of Pittsburgh that found some minor quibbles with his methods that did not undercut the major findings of the research.

The experience “was absolutely horrible,” Needleman said in the 2005 interview. “What I discovered is that not only did the university not come to defend me, but they wouldn’t give me an even playing field.” It led him to become active in the university tenure and academic freedom committee.

Sense of social justice

Needleman had a profound sense of social justice that manifested itself not only in his research but also in his volunteer work and community involvement. In 1966 he founded the Committee of Responsibility to Save War Burned and War Injured Vietnamese Children, known by the acronym COR, to bring injured children to the US for medical care. He was arrested with fellow paediatrician Benjamin Spock at antiwar protests at the Pentagon in 1967.

He received the John Heinz Award for innovative contributions to the environment in 1996 and used the $250 000 prize to fund the Alliance to End Childhood Lead Poisoning. Other honours included were the Prince Mahidol Award (2003) and the Rachael Carson Award for Integrity (2004) from the Center for Science in the Public Interest.

“While Dr Needleman was not perfect, his research ultimately spurred efforts to first control and then eliminate childhood lead poisoning, a public health success story of the late 20th century,” Marc Edwards told The BMJ. The Virginia Tech environmental scientist made his name by identifying lead poisoning in the water systems of Washington, DC, and Flint, Michigan.

“I’ve been inspired by Herb Needleman. He was brilliant, but, more importantly, he was courageous and generous,” wrote Richard J Jackson in Environmental Health News.4 Jackson is a former director of the National Center for Environmental Health at the US Centers for Disease Control and Prevention (CDC) and a professor at the University of California Los Angeles (UCLA).

Herbert L Needleman was born into an immigrant family of pickle makers in Philadelphia, Pennsylvania, on 13 December 1927. He graduated from Muhlenberg College in Allentown, Pennsylvania, in 1948 and qualified in medicine in 1952. He practised medicine as a paediatrician in the US Army and private practice, and taught at Temple University, Harvard Medical School, and the University of Pittsburgh. He leaves his second wife of 54 years, the former Roberta Pizor; two children; seven grandchildren; and three great grandchildren.