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NHMRC Draft Information Paper: evidence on the effects of lead on human health submission

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Q1. Is the draft Information Paper presented and written in a manner that is easy to understand?: 

generally YES, but NO in the critical area of interpretation of harm from blood lead levels of 10ug/dL and moderately above.

For you to understand my opinion it is essential for me to give some background of my involvement with lead matters and children. I was a member of NHMRC Working Groups on Lead in Petrol and Lead in Air, 30-odd years ago, and was involved in assessing and treating children with clinically manifest lead poisoning from 1967 to 2009. In addition, as a clinical toxicologist/paediatrician I have been asked to advise on dozens of children found to have blood lead levels in the range 10-40ug/dL, without symptoms attributable to lead toxicity and not requiring chelation therapy, but where both parents and involved professionals were anxious and were convinced the child had problems attributable to lead toxicity. I have also been involved as an expert witness giving advice in legal proceedings over lead toxicity in children, and in teaching on the subject up to postgraduate levels. Via all of the above, I am aware of the evolution in knowledge on the subject over the past 50 years, and not least on how information is provided to the public and professionals on the subject. 

I am certain, then, that some lay and professional readers will, upon reading the first parts of Part B, p. 11, and viewing fig. 1 p. 12, interpret lead levels of the order of 10-15 ug/dL as responsible for significant intellectual handicap +/- serious behavioural changes, depression or anxiety, etc. as due to that level of blood lead. Better,  more accurate content is needed here, I believe, and could be achieved by re-writing some of the material, by a different legend to fig. 1, or by other means. I note that the first half of p. 17 gives more realistic notions, but won't 'neutralise' the impression already given earlier.

As there is no other location in this submission format for it, I would like to make a 'plea' in regard to the revision of the briefer information paper, Blood lead levels for Australians (2009) (for practitioners and policy makers). I have previously found this document very useful in trying to get both clinicians and legal people (including a High Court judge) to understand that evidence from cross-sectiional studies cannot be applied to individual children. This appears to be hard to understand even for intelligent professionals. So both the longer and shorter papers need to explain this concept, as clearly as possible.                              







Q2. Does the draft Information Paper clearly outline how the evidence was reviewed and interpreted by the Lead Working Committee?: 


Q3. Is there additional evidence on the health effects in humans of exposure to lead that needs to be considered? : 

None that I'm aware if.

Q4. Is there additional evidence on the management of exposure to lead in humans in non-endemic areas that needs to be considered? : 

Not that I'm aware of.

Page reviewed: 19 May, 2015