The lead industry and public health.

In 2003, the Association of Occupational and Environmental Clinics (AOEC) formed a panel to develop consensus guidelines for the treatment of lead-exposed adults. However, a consensus was never reached due to interference from lead industry representatives. Lead industry interference in the AOEC panel is one instance of a long history of industry opposition to occupational and public health measures to prevent lead poisoning because of potential costs to the industry. At the time the AOEC panel was formed, no published guidelines existed for the medical management of lead exposure in adults comparable to the Center for Disease Control and Prevention (CDC) guidelines for managing lead exposure in children. Representatives of the lead industry frustrated the AOEC panel by insisting that "feasibility" (economic issues) be part of the medical decision-making process.

Recommendations for medical management of adult lead exposure.

Research conducted in recent years has increased public health concern about the toxicity of lead at low dose and has supported a reappraisal of the levels of lead exposure that may be safely tolerated in the workplace. In this article, which appears as part of a mini-monograph on adult lead exposure, we summarize a body of published literature that establishes the potential for hypertension, effects on renal function, cognitive dysfunction, and adverse female reproductive outcome in adults with whole-blood lead concentrations < 40 microg/dL. Based on this literature, and our collective experience in evaluating lead-exposed adults, we recommend that individuals be removed from occupational lead exposure if a single blood lead concentration exceeds 30 microg/dL or if two successive blood lead concentrations measured over a 4-week interval are > or = 20 microg/dL. Removal of individuals from lead exposure should be considered to avoid long-term risk to health if exposure control measures over an extended period do not decrease blood lead concentrations to < 10 microg/dL or if selected medical conditions exist that would increase the risk of continued exposure. Recommended medical surveillance for all lead-exposed workers should include quarterly blood lead measurements for individuals with blood lead concentrations between 10 and 19 microg/dL, and semiannual blood lead measurements when sustained blood lead concentrations are < 10 microg/dL. It is advisable for pregnant women to avoid occupational or avocational lead exposure that would result in blood lead concentrations > 5 microg/dL. Chelation may have an adjunctive role in the medical management of highly exposed adults with symptomatic lead intoxication but is not recommended for asymptomatic individuals with low blood lead concentrations.