Water conducted through earthen pipes is more wholesome than that through lead; indeed that conveyed in lead must be injurious, because from it white lead is obtained, and this is said to be injurious to the human system. Hence, if what is generated from it is pernicious, there can be no doubt that itself cannot be a wholesome body. This may be verified by observing the workers in lead, who are of a pallid colour; for in casting lead, the fumes from it fixing on the different members, and daily burning them, destroy the vigour of the blood; water should therefore on no account be conducted in leaden pipes if we are desirous that it should be wholesome.
They also allowed detritus to build up in lead pipes to insulate the water from the lead.
Unfortunately, all these tricks and knowledge didn't stop them from boiling down grapes into their favorite condiment/syrup specifically in lead vessels because the lead made it taste sweeter.
And I am sure that there were other Romans writing treatises that said that lead was healthy. Because they didn't have the scientific method or any sort of modern scientific equipment, so expecting them to truly understand the dangers of lead piping compared to today is silly.
Doesn't take much. Lead is pretty poisonous - people working lead get sick, people who use lead cosmetics too often get sick, people who eat lead-flavored syrup get sick. Eventually even the thickest morons begin to notice a pattern, so long as they don't have an information box blaring all day telling them not to trust their woke liberal eyes instead of the Job Creators(tm).
They let a sediment coating form on the lead. We do that too, and it's why the lead removal programs are only a top priority, and not an active emergency.
It actually works, because it's less a lead pipe, and more a "crusty mineral" pipe, with a lead coating.
Downside being that if you damage that buildup everything goes to shit, hence the decades of working to replace the pipes.