In 1882, Norwegian playwright Henrik Ibsen wrote An Enemy of the People. It tells the story of a doctor who becomes concerned about contamination of the water supply for his town. When he speaks out publicly, he is condemned by the political and business leaders – who know about and profit from the tainted water – and eventually run out of town. He, rather than those who are poisoning the water, is branded an enemy of the people. Abandoned by family and friends, the doctor stays true to his principles and refuses to back down.
It sounds (and in fact is) a bit melodramatic; Ibsen himself wasn’t sure whether to label it a tragedy or a comedy. Either way, it is fiction. Or is it? Fast forward to 21st century America and you can find a similar, and true, story. In October 2015, the water supply in Flint, Michigan was determined unfit to drink and a public health emergency was declared. While the ending is happier for the public than in Ibsen’s play, it followed vigorous denials by the authorities. As in the play, it was a physician – a Flint pediatrician – who first raised the concerns and was dismissed and criticized.
Dr. Mona Hanna-Attisha had been hearing complaints about the smell and taste of the Flint water since 2014, when the supply was changed from Lake Huron to the Flint River. Many of her patients’ families suspected the water was making their children ill. After learning of a similar problem in Washington DC in the early 2000s that resulted in high levels of lead toxicity, Dr. Hanna-Attisha reviewed the results of lead testing in Flint and found that the rate of lead poisoning had more than doubled after the change in water supply. Working with an environmental toxicologist from Virginia Tech, who had discovered the lead problem in DC, she learned that the new water supply was more caustic, allowing lead to leach out of the aging pipes in Flint’s water distribution system.
State officials responded with criticism, calling the findings “unfortunate” and accusing Dr. Hanna-Attisha of “near hysteria.” Like the doctor in Ibsen’s play, she refused to back down. She convinced the state to re-analyze their data, which demonstrated that the rate of lead poisoning had in fact increased. At that point, the state conceded and declared the water emergency. The Flint water supply has now reverted to Lake Huron, with anticorrosion measures in place to prevent the lead leaching.
It’s a thin line between advocacy and subversion. Pediatricians and other pediatric professionals, as advocates for children, are often skating along that line. Lead in the water in DC or Flint, injuries and deaths from gun incidents both intentional and accidental, climate change that threatens the health of this next generation and the ones that follow: all of these and many others are issue on which we must, and do, stick out our necks. At times, that means being an enemy of the powerful.