Docs Need Better Guidance on Patient Exposure to ‘Forever Chemicals,’ Group Says

Doctors need updated guidance from the federal government for recognizing and treating the effects of “forever chemicals” on their patients, according to the Environmental Working Group (EWG).

“In early 2024, the Agency for Toxic Substances and Disease Registry released guidance for clinicians about how to address individuals’ exposure” to per- and polyfluoroalkyl substances (PFAS), said EWG — a nonprofit organization focused on environment-related health concerns — in its 2025 PFAS Roadmap released last week. “The guidance failed to fully incorporate recommendations from a 2022 National Academies of Sciences, Engineering, and Medicine (NASEM) report. The agency should expeditiously update the guidance in line with the report’s recommendations.”

On a larger scale, the next administration “must do more to reduce industrial releases of PFAS in order to address this contamination crisis,” and needs to speed up efforts to set PFAS limits under the Clean Air Act and the Clean Water Act, Melanie Benesh, EWG’s vice president of government affairs, said during a press webinar last week. “We need to use those laws to address the PFAS problem where it starts, which is with the polluters.”

“We also need to do much more to hold these polluters accountable for the harms that they have caused, including increased enforcement when polluters break the law, and also greater access to justice for the harms that they have caused for people in those communities that have been most greatly affected by the PFAS contamination crisis,” she said.

Exposure to PFAS typically comes from contaminated food or water. Their chemical make-up allows them to reduce friction and resist oil and water, leading them to be commonly used in nonstick cookware, water-resistant fabrics, stain-resistant coatings, and personal care products.

Studies have linked exposure to these chemicals to a slew of health conditions, such as increases in cholesterol levels, decreases in birth weight, lower antibody responses to vaccines, kidney and testicular cancer, pregnancy-induced hypertension, preeclampsia, and changes in liver enzymes. Other research has also suggested a link between PFAS and thyroid disease, breast cancer, and ulcerative colitis.

The CDC issued guidance in January based on the NASEM report; the agency suggested that clinicians consider testing patients’ blood for PFAS in order to assess community-wide exposure. In February, the FDA announced that fast-food wrappers and other grease-proofing materials containing PFAS would no longer be sold for use in food packaging in the U.S. And in April, the Biden administration finalized strict limits on PFAS levels in drinking water.

“The most significant action that’s been taken to address PFAS is setting a drinking water standard for six [types of] PFAS, which will provide safer drinking water to 100 million people,” said Scott Faber, senior vice president of government affairs at EWG. “But the next administration should take an equally important step by setting action levels for PFAS in the food we eat.”

“The Biden administration has followed through on many promises, but much more needs to be done,” said John Reeder, EWG’s vice president of federal affairs.

Other recommendations in the report included:

• Double Environmental Protection Agency funding for PFAS
• Protect drinking water from additional PFAS
• List PFAS as hazardous air pollutants
• Make sure new PFAS are safe before they enter the marketplace
• Halt the use of PFAS for oil and gas extraction
• Order industry to report how much PFAS are manufactured, imported and used, as well as their potential risks
• Ban incineration of PFAS-firefighting foam and other PFAS wastes until proven safe
• Fully fund the FDA Office of Food Chemical Safety
• Permanently end the use of PFAS in food packaging

Faber blamed industries who use PFAS for not wanting to respond to the problem. “These companies who make PFAS and use PFAS have understood that PFAS are toxic going back to the 1950s,” he said. “In the 1950s they did their own animal studies. In the 1960s they saw their own workers becoming contaminated and getting sick in the 1970s, and despite knowing about these risks, they failed to notify their regulators, their neighbors, their workers, or anyone else, and that’s one of the reasons we’re having this conversation today.”

“The same companies are now fighting the drinking water standard … through their trade associations,” he added. “They’re fighting efforts to designate PFAS as hazardous substances under our federal clean-up laws … It’s disgusting, is the only word to describe it.”

One piece of good news is that some states have started taking action against PFAS, said Benesh. “After a state has taken action, then you see industry start to fall into place. So after states started banning PFAS and packaging, the industry agreed to a voluntary withdrawal of certain PFAS from food packaging.”

“There has also been some pressure coming from the retailer level, where consumers have told retailers like Lowe’s and Home Depot that they don’t want PFAS in their carpet,” she said. “Some of those retailers have implemented policies that have helped push the marketplace, but I don’t think you’ve seen a lot of industries that are using PFAS coming forward independently to stop their use.”