Common blood tests for lead can give falsely-low results in certain cases, according to a new warning from the Food and Drug Administration.

The tests, manufactured by Magellan Diagnostics, are commonly used in doctors’ offices and clinics, and on its website the company calls itself “the most trusted name in lead testing.” But the FDA now says that its tests can give inaccurate results when used to test blood drawn from a vein.

The majority of lead tests are not conducted with that kind of blood sample, but rather blood from a heel or finger prick, says Dr. Jeffrey Shuren, director of the FDA’s Center for Devices and Radiological Health.

“We have no evidence that Magellan’s tests, when used with blood obtained from a finger or heel stick, are impacted,” says Shuren. “We believe most people will not be affected by this issue.”

For example, in 2016, the Centers for Disease Control and Prevention recommended that all children under the age 6 years in Flint, Mich., get re-tested as part of the response to the crisis there. Patrick Breysse, director of the CDC’s National Center for Environmental health, says they have a lot of information about that testing, and have determined that “less than one percent, perhaps, might be at risk for being under-estimated because they were a venous draw that were tested on the Magellan system.”

Officials are recommending retesting for certain children, pregnant women and nursing mothers who did get tested using blood from a vein.

And the FDA says it’s aggressively investigating why these tests can give inaccurate results.

Officials say the company first became aware of a potential problem through complaints received in the fall of 2014, and developed a mitigation plan, which was to basically just delay processing of the sample for 24 hours.

“And that completely resolved the problem. They communicated with their customers, their customers acknowledged receipt, and that was it,” says Shuren.

But earlier this year, when FDA officials became aware of the problem, Shuren says the agency believed that the company had underestimated the risk to the public, and that the data supporting the mitigation plan wasn’t sufficient.

Between the beginning of 2014 to today, officials say, an estimated 8 million blood lead tests have been run using the Magellan systems, and the majority of those were for capillary blood from finger or heel sticks.

“From a coverage perspective, particularly for those kids on Medicaid, we would expect that the Medicaid programs in those states would be covering and paying for the retesting,” says Timothy Hill, the Acting Director for the Center for Medicaid and CHIP Services, which is part of the Centers for Medicare and Medicaid Services. “For those who are covered privately, we would encourage folks to consult with their health plan.”

Asked why taxpayers or insurance companies should have to pay for retesting, Hill said the first priority is to get kids retested if they need retesting, and officials do not want reimbursement to hold that up.

“It’s my understanding that the, sort of, conversations with Magellan are ongoing,” says Hill. “Speaking as to whether or not Magellan has liability or not is not something I can speak to.”

In response to NPR’s inquiries, a spokesperson with Magellan pointed to a letter to its customers that the company published this morning.

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Many Democrats are hoping the GOP health care bill that narrowly passed the U.S. House of Representatives is going to push political momentum their way, and result in big gains in the 2018 midterm elections. A special election next week in Montana may be an early test for this theory.

President Trump won Montana by 20 points in the November 2016 election, and the May 25 special election is being held to replace the state’s only congressman, Rep. Ryan Zinke, whom Trump nominated to be interior secretary.

Montana resident Jim Lynch plans to vote for the Republican candidate, Greg Gianforte. Lynch is a member of the Glacier Country Pachyderm Club and members get together once a month in Kalispell, Mont., to talk about advancing Republican values.

Lynch says health care is a top issue for him. He hates the Affordable Care Act. He’s 63 and says he maintained good health insurance coverage throughout the Obama administration. But, he says, “There’s a lot of people in my shoes who aren’t that lucky. I do know, personally, that they’ve seen huge increases in health care costs, to the point that they don’t even have it anymore.”

Indeed, people who are 55 to 64 can be charged as much as three times what a younger person can be charged for health insurance. Subsidies are available based on income, but older people may earn more than young people just starting their careers.

Under the GOP bill that’s now before the Senate, however, older people can be charged five times as much as younger people, and the subsidies are decreasing in aggregate.

Lynch says he doesn’t think the House health care bill is perfect, but he’s confident that, as President Trump shepherds it through Congress, it will be modified into something much better than the Affordable Care Act.

About a hundred miles south in Missoula, Mont., restaurant owner Molly Galusha dreads the idea of Obamacare being repealed. She says the current health care law’s subsidies have made it possible for her employees to afford health coverage on the wages she can afford to pay them.

Galusha is 62 and gets her health coverage through her husband’s job. She says she doesn’t know what they’d do if their insurance went away.

“We’re old and broken,” she laughs.

The Affordable Care Act’s protections for people with pre-existing conditions are also likely to affect older people, because the likelihood of having a pre-existing condition increases with age.

“We are uninsurable as a couple, so we’re very grateful,” Galusha says.

Republican candidate Gianforte says he won’t vote for a health care bill that doesn’t work for Montana.

“I need to know that, in fact, it’ll bring premiums down, preserve rural access and protect people with pre-existing conditions,” he says.

He also says he would have voted against the House health care bill, because there wasn’t enough time to read and understand it before the House voted.

Democrats, however, accuse Gianforte of being disingenuous. They point to a recording of a phone call he had with lobbyists on the day the House bill passed, which was leaked to The New York Times. On the tape he can be heard saying, “Sounds like we just passed a health care thing, which I’m thankful for, that we’re starting to repeal and replace.”

Democratic candidate Rob Quist pounced on those words. Quist needs Republican votes to win, so he’s trying to convince Republicans that their candidate will sell out the state’s interests on health care.

“Montanans want a Congressman who’ll shoot straight, not a dishonest politician who says one thing to Montanans and another to the millionaires behind closed doors,” he says. Quist says he wants to build on the ACA and thinks the country should eventually move to a single-payer health insurance system.

This story is part of a reporting partnership with NPR, Montana Public Radio and Kaiser Health News.

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The Greek poet Archilochus wrote, “the fox knows many things, but the hedgehog knows one big thing.”

There are many different interpretations of this parable, but psychologist Phil Tetlock argues it’s a way of understanding two cognitive styles: Foxes have different strategies for different problems. They are comfortable with nuance, they can live with contradictions. Hedgehogs, on the other hand, focus on the big picture. They reduce every problem to one organizing principle.

“The hedgehogs are more the big idea people, more decisive. In most MBA programs, they’d probably be viewed as better leadership material,” Tetlock says.

This week, we have the story of a hedgehog by the name of Don Laub: a young surgeon who was eager to make his mark. In his words, he wanted to “do a big thing, and help a lot of people.”

One day, Don got his chance when a colleague asked him if he could help with a surgery. The patient was a child from Mexico with a cleft lip and palate, and the surgery was simple. Don says it gave the child, who had been ostracized in his community, a real chance in life.

The experience inspired him to organize trips for surgeons to travel to Mexico and help other children with similar injuries. “Everybody jumped on it,” he said. “I had to hide when I would go into the hospital because people wanted to get in on this.”

His story is one of many triumphs — and a tragedy that he continues to dwell on many decades later. This week on Hidden Brain, we explore his story, and what it can tell us about how we view our roles in the world.

The Hidden Brain Podcast is hosted by Shankar Vedantam and produced by Maggie Penman, Jennifer Schmidt, Renee Klahr, and Rhaina Cohen. Our supervising producer is Tara Boyle. Follow us on Twitter @hiddenbrain, and listen for our stories each week on your local public radio station.

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