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Bone Lead Levels and Delinquent Behavior-Reply

Herbert L. Needleman, MD; Julie A. Riess, PhD; Michael J. Tobin, PhD; Gretchen E. Biesecker
JAMA. 1996;275(22):1728. doi:10.1001/jama.1996.03530460029026.
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In Reply.  —Dr Sachs and Dr Sayres are skeptical; they have treated lead-poisoned children but have not observed antisocial behavior. Both relied on personal behavioral observation in a clinic setting; we used structured behavioral inventories from 3 separate informants, all of whom had the benefit of prolonged, close-up observation. Sachs notes that 69 subjects she treated with extreme elevations in blood lead levels (>4.83 μmol/L [>100 μg/dL]) seemed to be doing well on follow-up. She actually treated 105 children with lead levels in this dangerous range, but she ignores 36 subjects who were not located. Subjects not located after treatment generally have worse outcomes than those who are located. It is reasonable to ask how many of her missing lead-poisoned subjects are in special schools, are homeless, are in prison, or are dead.Dr Ernhart criticizes our report because the CBCL delinquency clusters did not reach statistical significance when classified


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