A major report from the National Academies recommended that individuals with significant exposure to toxic chemicals, known as PFAS, get a blood test and ongoing medical monitoring. The guidance covers a wide range of people, including those who live near commercial airports, military bases and farms where sewage sludge may have been used.
Yet, many doctors don’t know how to order a PFAS blood test — nor how to interpret the results when the test is done.
“Clinicians in the state are really at a loss. And I'm sure people are asking left and right to have this test,” said Brita Lundberg, chair of the Environmental and Occupational Health Committee at the Massachusetts Medical Society. “We've had our own members approach us saying, ‘what should we be doing here?’”
Lundberg is drafting a resolution that, she said, would help her organization advocate on PFAS at the statehouse and with the American Medical Association.
As physicians begin to field more questions about PFAS chemicals — which are ubiquitous and associated with a host of health concerns — there are new efforts to get the medical community up to speed on the topic. But there’s also pushback, as some experts question whether blood testing is the best approach.
In collaboration with others, Phil Brown, director of Northeastern University's Social Science Environmental Health Research Institute, has compiled resources for individuals and medical professionals, detailing things like which labs doing PFAS blood testing are reliable and what diagnosis code to use.
Brown said there's a "vacuum of knowledge" among physicians, so he’s preparing to launch a continuing medical education course on PFAS in partnership with Children's Mercy Hospital in Kansas City.
These efforts come as more communities across Massachusetts deal with PFAS or ‘forever chemicals’ that are found in everything from firefighting foams to common household products, such as outdoor gear and nonstick cookware. Elevated exposure has been linked to various health problems, including reduced immune and thyroid function and an increased risk of certain cancers.
"I don't think this is on the radar screen of most physicians, even those next to sites with PFAS contamination."Elsie Sunderland
More than 90% of communities in Massachusetts have detectable amounts of a PFAS chemical in at least one drinking water source, according to a recent analysis by the Sierra Club. In 2020, when the Massachusetts Department of Environmental Protection sampled 27 rivers, it found PFAS chemicals in all 27. And, Cambridge is the latest community to temporarily switch its water supply due to PFAS levels.
In New Hampshire, state law requires that major health insurers cover the cost of PFAS blood testing. However, in Massachusetts, there is no such requirement and the test can cost several hundred dollars. That’s left some physicians and experts questioning whether testing is the best approach.
Is testing best?
“If you get the test, then what do we do with this result?” said Rose Goldman, a physician in occupational and environmental medicine at the Cambridge Health Alliance.
She said the National Academies report, for the first time, offered her guidance on how to interpret the results, tying levels of PFAS in the blood to general risk levels.
However, she pointed out, there is no treatment and her medical recommendation would likely be the same regardless of the lab results.
“There's no way we can get this stuff out [of your body] in any legitimate, evidence-based way,” she said. “And the advice that we're going to give you is: Stop the exposure. Get a filter on your water. Stop using the pan that’s nonstick, if you think that’s the source.”
Goldman, who has worked through PFAS test results with several patients, acknowledged it can be an unsatisfying experience. “There are many knowledge gaps,” she said. “That makes for a very frustrating situation for patients.”
Some experts argue the testing recommendation is unnecessarily worrying the general public — and those who are concerned should focus their energy elsewhere.
“The whole discussion is getting quite confused,” said Elsie Sunderland, an environmental chemist at Harvard who has been studying PFAS for about a decade. She said the health effects of PFAS are still being studied and, for an individual, the impact is mediated by other factors like a person’s age, diet and stress levels.
“I think that's going to be quite challenging to communicate,” Sunderland said. “And I don't think this is on the radar screen of most physicians, even those next to sites with PFAS contamination.”
She said those in highly contaminated communities should seek out site remediation but the general public would be better served by reducing future exposure and advocating for regulations to curb the continued production and use of PFAS chemicals.
“If we decide we don't want these chemicals and they're not essential to the functionality of many products, we can get rid of them [through regulations],” said Sunderland. “And that will dramatically reduce exposures for the general population.”