VIEWS: 12 PAGES: 2 CATEGORY: Medicine POSTED ON: 6/3/2010
Lead in drinking water is still an important health issue in Germany. There is concern about the association of lead exposure with neurologic and intellectual deficits as described by Mark Payne1 and with hearing impairment in infants; higher levels of lead exposure have been associated with increased morbidity in adults and with cognitive decline in older people.2,3 Although the maximum allowable lead concentration in tap water will be reduced from 0.025 mg/L to 0.01 mg/L by December 2013 in Germany, a 2005 test of 237 000 random samples of tap water showed that the lead concentration in more than 5% of the samples exceeded 0.025 mg/L in several regions.4 In Germany it is recommended that pipes be flushed to reduce lead levels by running water for at least 5 minutes every morning, as also suggested by Payne.
Letters CMAJ ure to lead in drinking water. In Ham- to be correlated, but in others they Letters burg alone, all plumbing systems con- would not, for a number of valid rea- taining lead will be replaced for 28 000 sons. When these 2 types of measures • Protecting children from lead households. produce different results, we should not in tap water treat the process measures as the gold • Hospital standardized Heide B. Schneider MD PhD standard against which a “big dot” (i.e., mortality ratios Department of Family Medicine broad-based) outcome measure like the • Smoking cessation trials University of Leipzig, Leipzig, Germany hospital standardized mortality ratio Competing interests: None declared. should be assessed. Both types of measures have strengths and limitations Protecting children from and as such it is important that both be REFERENCES considered when examining the quality lead in tap water 1. Payne M. Lead in drinking water. CMAJ 2008;179: of health care within a hospital. 253-4. 2. Schober SE, Mirel LB, Graubard BI, et al. Blood The authors also criticized the preci- Lead in drinking water is still an impor- lead levels and death of all causes, cardiovascular sion of the hospital standardized mortal- disease, and cancer: results from the NHANES III tant health issue in Germany. There is mortality study. Environ Health Perspect 2006; ity ratio on the basis that “random vari- concern about the association of lead 114:1538-41. ation likely accounts for much of the exposure with neurologic and intellec- 3. Weisskopf MG, Wright RO, Schwartz J, et al. Cu- observed differences in mortality among mulative lead exposure and prospective change in tual deficits as described by Mark cognition among elderly men: the VA Normative institutions.” In our report of hospital Payne1 and with hearing impairment in Aging Study. Am J Epidemiol 2004;160:1184-93. standardized mortality ratios,3 we pre- 4. Schneider PA, Schneider HB. Risk assessment of infants; higher levels of lead exposure lead in drinking water. MMW Fortschr Med 2008; sented the hospital standardized mortal- have been associated with increased 21:19. ity ratios results and confidence intervals 5. Wilhelm M, Dieter HH. Lead exposure via drink- morbidity in adults and with cognitive ing water — unnecessary and preventable. only for large hospitals and regions to decline in older people.2,3 Although the Umweltmed Forsch Prax 2003;8:239-41. minimize the effect of random variation maximum allowable lead concentration DOI:10.1503/cmaj.1080107 and to inform users of the level of preci- in tap water will be reduced from sion associated with a given hospital 0.02
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