TLC Reference Library

Treatment of Lead‑Exposed Children Trial Repository

A public repository of trial records, publications, archival material, and policy documents concerning the NIEHS-funded Treatment of Lead-Exposed Children Trial.

This repository brings together records of the trial's planning, design, conduct, results, interpretation, and implementation into policy. Documents are organized so readers can review the source record directly.

The Treatment of Lead-Exposed Children Trial was a randomized, double-blind, placebo-controlled study of succimer in toddlers with blood lead levels (BLLs) of 20 to 44 µg/dL.

Background

The TLC Trial

Design and Primary Results

The Treatment of Lead-Exposed Children (TLC) trial was a landmark randomized, double-blind, placebo-controlled study conducted between 1994 and 2003, funded by the National Institute of Environmental Health Sciences and the Office of Research on Minority Health. The trial investigated whether succimer (meso-2,3-dimercaptosuccinic acid), the first oral FDA-approved lead chelating agent, could prevent cognitive decline in toddlers with moderate lead poisoning — at the time defined as blood lead levels (BLLs) of 20–44 µg/dL.

In 2001, the primary results were published in the New England Journal of Medicine, reporting that although succimer significantly lowered BLLs in the short term, no long-term increase in IQ was detected.

  • NEJM · 2001 The effect of chelation therapy with succimer on neuropsychological development in children exposed to lead. PDF
  • NIEHS · 1992 Request for Proposals NIH-ES-92-31, Amendment of Solicitation. PDF
  • NIH · 2016 Walter J. Rogan Oral History, Office of NIH History and Stetten Museum. PDF

Planning & Deliberation

Protocols

Trial Forms

All trial forms →

Publications

Core publications

Site-specific: Baltimore

Site-specific: Newark

Site-specific: Philadelphia

Site-specific: Cincinnati

Post-hoc: IQ and blood lead

Post-hoc: cadmium and mercury

Commentary

All publications →

Archives

Media

Audio, video, and document images: the 2016 Walter Rogan oral history, the audio report “Succimer Found Ineffective for Removing Mercury,” a video of Walter Rogan, courtroom video from Dylan Sumpter vs City Homes, and page images of the solicitation, planning, and contract records.

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Archives

Court Records

Court documents from KKI lead research litigation, including Grimes v. Kennedy Krieger, Featherstone, White, Jones, Ervin, Heckstall, and Deshields (1999–2018).

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Archives

NIH Records

NIH Record articles, NIH Guide notices, NIEHS intramural annual reports, NIEHS contract listings, the Walter J. Rogan CV and oral history, and NIH RePORTER funding data.

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Archives

Archived TLC Website

A Wayback Machine reconstruction of the NIEHS Treatment of Lead-Exposed Children (TLC) trial website (1998–2007): the trial site, investigator and Epidemiology Branch pages, NIEHS-hosted publications, and the IRB / conflict-of-interest records — each linked to its valid archived snapshots.

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Policy

Guidelines

ACCLPP and AAP guidelines on childhood lead poisoning from 1975 to 2019, with notes on how each cites or relates to the TLC trial.

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Policy

ACCLPP Records

Advisory Committee on Childhood Lead Poisoning Prevention (ACCLPP) meeting minutes, rosters, agendas, and CDC guidance records (2001–2013), with cross-references to the TLC trial.

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Policy

Congress & Federal Records

Congressional hearings, reports, bills, and testimony, NIEHS council minutes, White House environmental policy files, and GAO decisions on childhood lead poisoning policy and the TLC trial, 1989–2018.

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Policy

Timeline

All 135 events in the TLC trial chronology, from the 1975 CDC threshold through 2021.

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We proposed to Dr. Olden that we do a clinical trial, because lowering blood lead might be a good thing, but it might not be a good thing in the sense of reversing any effect that lead had already had.

— Walter Rogan, NIH Oral History, 2016

The costs for regulatory compliance as well as for health care costs are enormous, and it seems to me that it would be a wise policy to make the investment to do the science. And as soon as that could be done, with a fraction of the resources that it would take to enforce regulations that may or may not be required, we could rehabilitate or treat humans who have disabilities or diseases as a consequence of these exposures.

— Kenneth Olden, House Appropriations Hearings, 1995