Forever Chemicals, or PFAS, pose troubling health risks

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For decades, the chemicals that make life easier—your eggs slide out of the pan, stains don’t stick to the sofa, rain bouncing off your jackets and shoes—have been touted as game-changers in our busy modern lives. “Better things for better lives… through chemistry,” was the optimistic motto coined by DuPont, the company whose Teflon invented the widely used chemical coating.

But this better living has come at a cost that is getting new attention. Dubbed forever chemicals for their ability to survive in the environment, these chemicals are proven to have a lasting impact on human health. A growing body of research links the group of chemicals widely known as PFAS, short for per- and polyfluoroalkyl substances, to conditions from unhealthy levels of fats in the blood to pregnancy complications and cancer.

The alarm about the health effects of these chemicals has prompted a flurry of recent action by public health and regulatory officials in the United States. The US Environmental Protection Agency warned in June that PFAS poses greater health risks than previously thought significantly lowered their recommended safe levels of chemicals in drinking water.

“The updated advisory levels are based on new science, including more than 400 recent studies indicating that negative health effects may occur at very low levels, much lower than previously understood,” said Radhika Fox, assistant director of the EPA’s Office of Water. . in june at PFAS Third National ConferenceHeld in Wilmington, North Carolina

Soon after, the National Academies of Sciences, Engineering, and Medicine issued a First clinical guidelines to determine blood concentration levels of PFAS It could endanger someone’s health. The 300-page report urges doctors to recommend regular blood tests for anyone exposed to high levels of chemicals and to provide information on how to reduce exposure, such as Install special filters Known to reduce PFAS in drinking water.

In the United States alone, by one measure, Medicare expense and productivity loss from PFAS exposure is associated with five medical conditions It amounts to at least $5.5 billion annuallyresearchers at New York University reported on July 26 in Exposure and health. These conditions include low birth weight, childhood obesity, hypothyroidism in women, and kidney and testicular cancer.

“We only looked at two of the more than 9,000 chemicals in the PFAS family, so we’re only seeing the tip of the iceberg,” says Leonardo Trasande, MD, a pediatrician and environmental health expert at NYU Langone Health.

Chemicals everywhere

Among the people most at risk of exposure are firefighters: PFAS makes protective gear more waterproof, and the chemicals are found in widely used fire suppression foam. But most people have a measurable level of PFAS in their bodies, according to the US Centers for Disease Control and Prevention. Exposure usually comes from Ingestion of drinking water contaminated with PFAS or food grown in soil treated with fertilizers made from sewage contaminated with chemicals (SN: 11/24/18, p. 18). An estimated 2,854 sites across the United States have PFAS contamination.

People and societies have been greatly exposed to these chemicals. says Ned Calonge, an epidemiologist at the Colorado School of Public Health in Aurora who chaired the committee that wrote the National Academies report. The panel linked PFAS exposure to a slightly different list of conditions than the NYU team did, and found “sufficient evidence” linking PFAS to four conditions: poor antibody response to vaccination, abnormally high cholesterol levels, reduced infant and fetal growth, and kidney cancer. The evidence was “suggestive” for breast and testicular cancer, as well as thyroid problems and ulcerative colitis, an inflammatory bowel disease.

The report calls for more research into the health effects of PFAS, noting that there are gaps in the evidence for everything from neurological problems to bone density. Calonge says these chemicals have a wide range of effects on multiple systems in the body. They are “ubiquitous in the environment.”

Newer, not safer

PFAS has been produced in the United States since the 1940s. Because they are good at repelling oil and water, withstanding high temperatures and reducing friction, chemicals have become useful for a wide variety of products, including carpets, upholstery, food packaging, and even dental floss. However, relatively few of the 9,000 or so versions of these synthetic chemicals have been studied for their toxic effects.

Many PFAS are now recognized as endocrine disruptors, which are chemical compounds that interfere with the normal functioning of the endocrine system or hormones. But PFAS has other effects that can increase the risk of cancer, such as weak immunity, excessive cell growth, and altered gene activity. one study Found a twofold increase in the risk of developing kidney cancer Researchers reported in 2021 at Journal of the National Cancer Institute.

The newer generation of PFAS was supposed to be safer because of the chemicals They are less likely to accumulate in the body. Structurally, Trasande says, these newer compounds are similar to the older compounds and could be just as harmful to health as their cousins. These newer molecules are “increasingly associated with diseases such as gestational diabetes. We are just beginning to see the bigger problem that may be there.”

The EPA’s new drinking water advisory aims to address both old and new PFAS. It targets two of the earlier and more common PFAS in the environment: PFOA and perfluorooctane sulfonic acid, or PFOS. This advisory reduces the level of drinking water contamination below which no harmful health effects are expected from 70 ppt to 0.004 and 0.02 ppt, respectively. These levels are based on routine exposure over a lifetime.

The EPA’s health guidelines also provided the first-ever recommendations for two of the newer types of PFAS: hexafluoropropylene dioxide and its ammonium salt HFPO, collectively known as GenX chemicals, and perfluorobutane sulfonic acid, or PFBS. The agency sets the drinking water safety threshold at 10 ppt for GenX chemicals and 2,000 ppt for PFBS. The agency says these newer chemicals have similar persistence in the environment.

Consumers can ask their municipal water provider for data on PFAS testing in their area. Testing is becoming more common, and providers should be able to list the PFAS they test for. Wells for PFAS can become contaminated if they are near manufacturers that produce or use the chemicals, as well as airports where PFAS is used in firefighting, fire training areas, and some waste disposal sites. People who have private wells near one of these facilities can test the waters. Environmental Protection Agency Giving grants To help disadvantaged small and underprivileged communities conduct household water quality tests and comply with drinking water regulations.

PFAS price

Because there is limited data available on the health effects of the newer generation of chemicals, NYU and National Academies reports focused on the effects of older PFAS.

First, the NYU team screened for PFAS chemicals in blood samples obtained from nearly 5,000 adults and children who participated in the US National Health and Nutrition Examination Survey. Then, building on previous studies linking PFAS to specific diseases and models that estimated medical costs and lost worker productivity for these diseases, the team came up with their own PFAS price.

The team estimates that childhood obesity, the largest contributor to the overall economic losses of PFAS exposure, costs about $2.7 billion annually, followed by hypothyroidism in women at $1.26 billion. When researchers looked at other PFAS-related diseases outside the top five, such as endometriosis and obesity in adults and pneumonia in children, the estimated economic burden rose to $63 billion annually.

risk assessment

The National Academies report focused in part on how to reduce that number by providing testing guidelines for clinicians to detect high levels of PFAS in the body and trying to reduce exposure.

The report provides the first clinical guidelines on how to assess a person’s disease risk. Anyone with a blood concentration of PFAS less than 2 nanograms per milliliter should not worry. But for patients with blood concentrations between 2 and 20 ng/mL, doctors should check for conditions such as unhealthy levels of blood fats, which can lead to heart problems. This screening is especially important for people who are most vulnerable to the effects of PFAS exposure, such as children, pregnant women, and those who are immunocompromised. For anyone checking for more than 20 ng/mL, the report encourages routine screening for certain cancers, thyroid problems, and ulcerative colitis.

“For nearly 20 years, we’ve been able to measure PFAS in people’s blood, but there has been no guidance to say what [those measurements] mean,” says National Academies report co-author Jane Hoppen, who heads the Center for Human Health and the Environment at North Carolina State University in Raleigh. “For the first time, this actually defines some ranges, some guidelines for what could be levels of concern, and types of anxiety. Health follow-up that may be appropriate.

She hopes the recommendations will increase the availability of tests and make doctors and patients more aware of these chemicals and their health risks. The report also encourages physicians to work with their patients to learn where they are exposed to PFAS and how to mitigate these risks, by reducing PFAS-containing products and filtering their water.

Researchers at Duke University and North Carolina State reported in 2020 that activated carbon filters, found in some surface filters or filters, don’t remove PFAS quite as well as reverse osmosis filters. Offers Technical details On filters that actually filter PFAS.

Efforts such as reducing PFAS in drinking water can help. While the EPA’s health advice is recommendations rather than actionable, Trasande is pleased that the agency acted quickly, particularly on newer chemicals like GenX. But he argues that in light of what we already know and are still learning about the disease burden caused by these chemicals, PFAS should undergo more testing before it can be approved. Better yet, they should be organized by class rather than following what he calls a whack-a-mole approach.

“Our environmental policy still takes a wait-and-see approach that we have to wait 20 to 30 years, which is the time it takes for people to develop diseases due to exposure to chemicals,” he says.

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