Brush with Death: A Social History of Lead Poisoning By Christian Warren (Baltimore: Johns Hopkins University Press, 2001) (384 pages; $25 paper)
Deceit and Denial: The Deadly Politics of Industrial Pollution By Gerald Markowitz and David Rosner (Berkeley: University of California Press, 2002) (408 pages; $45 cloth; $19.95 paper)
Both Brush with Death and Deceit ami Denial ate solid reads on a topic that should not be taken lightly-lead poisoning in America. Although the "epidemic" appeared to reach its peak between the 1950s and 1970s, the consequences of lead production and use are still in existence. Warren's approach is matter of fact; Markowitz and Rosner's work has been described as a "detective story" that goes beyond lead poisoning to include vinyl chloride poisoning. Warren provides his evidence and data sources in a narrative fashion, while Markowitz and Rosner link their evidence to theories that are mysterious and complex.
In Brush with Death, Warren explains his basic purpose as that of filling a void in the contemporary historical analysis on the topic. The author quickly reviews the nature of lead poisoning in America, from Benjamin Franklin to the contemporary era. Warren further applies a framework that explores the issue of lead poisoning from occupational, pediatrie, and environmental points of view. After the introduction, Brush with Death proceeds in a chronological order, from the poisoning of children and industrial workers during the 1920s and 1930s to the more recent frustrations associated with lagging resources being allocated for "low-level" lead poisoning. The majority of Warrens study traces the use, and resulting poisoning, occurring from lead-based paint and leaded gasoline, although he acknowledges other sources of the "epidemic." Multiple graphs and figures help to explain the rise and fall of lead poisoning cases, resulting regulation, and morbidity/mortality rates. The text is filled with ample notes for each chapter, although the bibliographic sources selected for each topic are somewhat limited.
The last three decades have seen substantial legislation to control and rectify the effects of lead poisoning on America's children and lead industry workers, as well as members of the general public who are exposed to environmental sources of lead. Although Warren acknowledges a financial burden on government agencies that have been involved in identification, abatement, and regulation of lead poisoning, he indicates that landlords of hazardous buildings have traditionally incurred the largest financial costs.
In the final analysis of his data sources, Warren indicates that one link between lead poisoning has held fast. It is still an unrecognized source of other diseases, in spite of the fact that the symptomatology has changed over time. The course of lead poisoning in America has followed the path of other biotic diseases-progressing from a search for a single cause through the "epidemiologic transition" to implicating lead poisoning in a multitude of medical problems such as certain renal and cardiac problems. In the final chapter of Brush with Death, Warren leads us to the conclusion that we still place our faith in science, but he also cautions that science is no longer a source of mathematical precision. More questions arise as old questions are answered by the scientific approach. He closes his analysis by synthesizing what has worked in reducing the hazards of lead poisoning in America-"cooperation, supervision, and moral suasion" (p. 258). He ultimately charges industry to act responsibly for the greater good, while suggesting that we apply limited restrictions on that industry so that old abuses are not repeated or new ones generated.
In Deceit and Denial, Markowitz and Rosner weave a tale that would garner the attention of movie producers similar to those that cast Julia Roberts, Mel Gibson, and Patrick Stewart in conspiratorial roles on the big screen. Having previously authored a book on the lung disease, silicosis, and served as expert witnesses in related legal actions, Markowitz and Rosner revisited their method of using historical data to contradict claims that there was no way to foresee long-term consequences of inhaling or ingesting toxins that cause chronic problems for those exposed. Having been offered access to legal and corporate documents, Markowitz and Rosner trace the effects of vinyl chloride and lead to explain concerns with endocrine disruption, genetic damage, and behavioral changes that are vague and subtle.
Opening Deceit and Denial with a human interest story, the authors review the course of lead poisoning from the early 1900s to the 2000 presidential elections. Although the introduction is just eleven pages long, the authors quickly introduce the notion of a conspiracy emanating from industry and government to keep the American public in the dark. Markowitz and Rosner compare the "lying and obfuscation" (p. 11) associated with lead and vinyl chloride industries to that of the tobacco, automobile, asbestos, and nuclear power industries.
Using the first chapter to trace the initial effects of lead poisoning on industry workers and consumers, the authors devote the next two chapters to the plight of the children whose parents were charmed into believing that white lead paint was sanitary and "clean." In Chapters 4 and 5, Markowitz and Rosner transition from the emphasis on lead-related problems of the first half of the twentieth century to the chemical enhancements associated with the plastics industry during the last fifty years. Tiding Chapters 6 and 7 as "Evidence of an Illegal Conspiracy by Industry" and "Damn Liars," respectively, the authors quickly plunge into the murky and mysterious waters that surround their theory. They call up documents that they claim provide direct evidence of illicit agreements made among industry, business, and government in efforts to maintain the bottom line. Stating that reports were buried and decrying studies that supported "less than toxic doses" in clinical experiments, Markowitz and Rosner provide evidence for connections to cancer when sufficiently large doses of the toxin are inhaled or ingested.
Finally, the authors draw links between science, civil rights, pollution, and politics. They indicate that although toxic industry byproducts have been topics of discussion since the 1960s, they rose to new prominence during debates on global warning. In the end, the authors juxtapose the environmentalists against government regulation and the public against industry to suggest that the American public will not go quietly into that dark night of blind belief and passive responsibility for their health and well-being.
Deceit and Denial uses many old advertisements to demonstrate attempts to entice the American people to use toxic products. However, no graphs or tables exist to reinforce their premise of an overriding conspiracy. Markowitz and Rosner use many more primary sources in the form of industry communications, government documents, and old newspapers than Warren included. Secondary sources overlap between the two books at points, and a thorough index helps to spot check details in the book
Although both books address the primary sources of lead poisoning, in Deceit and Denial, Markowirz and Rosner also include vinyl chloride and plastic byproduct toxins. The authors of both books trace the history of lead poisoning in America from the early 1900s to the beginning of the current century. In Brush with Death, however, Warren takes a less accusatory approach toward industry, and he does not charge the government with participation in cover-ups or conspiracies. Markowirz and Rosner are quite adamant that action must be taken to regulate industry even more than it has been in the last forty years. While Markowitz and Rosner caution the reader about runaway science, Warren suggests caution in applying too many regulations to industry that would deny corporate icons the ability to strive for more in the form of scientific progress.
Both Brush with Death and Deceit and Denial would be valuable additions to the classroom in the study of Healthcare ethics or perspectives on the development of health policy in response to a modern "epidemic." They would also be valuable studies for the historian who is interested in the rise of technology or the development of regulatory mechanics. The two books together offer point and counterpoint on the history of lead poisoning in America, allowing readers to fill in their own picture of the complexity of the problem.
Warren focuses primarily on the attitudes to health, safety, and risks that have developed over time in American society. He offers the explanation that lead poisoning has given rise to modern environmentalism and judicial involvement in resolving industrial/ environmental controversies. On the other hand, Markowitz and Rosner focus much more on the lack of ethics that they have perceived in both the lead industry and the political structure that "classified" the information in an attempt to keep the consequences of progress from the American people. Two years' difference in the publication dates may not seem significant to the casual observer, but more unusual primary sources may have been available to Markowitz and Rosner. Still, the approach to history, whether social or political, provides the interpretive lens for each study.
In closing, the goal of each generation is to strive for the achievement that a decade or generation ago was deemed to be "impossible"-in other words, progress. Henry Ford could not possibly have imagined smog, ozone depletion, or the greenhouse effect attributed, at least in part, to automobile emissions, when he presented the Model T to the world. Yet, the last several generations can little imagine life without sports cars, minivans, SUVs, or any size of truck on our roads. Nor could John F. Kennedy dream of the Challenger explosion of the 1980s when he challenged Americans to reach for the stars and send a manned space vehicle into outer space by the end of the 1960s. Thus, progress has its costs. Yet few of us would wish to give up the achievements of science in the world, as we know it. Rather, we correct malfunctions or consequences along the way and continue to search for a better understanding of our world, striving to leave a better life on planet earth for the next generation.
QUINCEALEA BRUNK, RN, PHD
Valdosta State University College of Nursing