A new report finds that bills to loosen restrictions on so-called “chemical recycling” are on the rise.
US government health agencies need to move quickly to launch broad testing of people exposed to types of toxic chemicals known as PFAS to help evaluate and treat people who may suffer PFAS-related health problems, according to a report issued today.
The report recommends that the Centers for Disease and Control and Prevention advise clinicians to offer PFAS blood testing to their patients who are likely to have a history of elevated exposure to the toxins. Those test results should be reported to state public health authorities to improve PFAS exposure surveillance, according to the report, issued by the National Academies of Sciences, Engineering, and Medicine, or NASEM.
The testing should be done for people with occupational exposure, as well as those who have lived in communities with documented contamination, and those who have lived where contamination may have occurred — such as near commercial airports, military bases, wastewater treatment plants, farms where sewage sludge may have been used, or landfills or incinerators that have received waste containing PFAS, according to the report.
“Our report shows that we are going to need robust and effective collaboration between local communities, states, and federal agencies in order to respond to the challenge of PFAS exposure,” Ned Calonge, chair of the NASEM committee that authored the report, said in a statement.
“We need to continue to identify communities with elevated PFAS exposure, learn more about specific health impacts, make testing available to patients, and give clinicians more strategies for counseling patients and providing preventive medical care,” Calonge added in the press statement. Calonge is associate professor of family medicine at the University of Colorado, Denver and associate professor of epidemiology at the Colorado School of Public Health.
NASEM acts as the collective scientific national academy of the United States and its recommendations typically are highly regarded. It was created to provide independent and objective guidance that informs American policy.
The report released today is sponsored by US Department of Health and Human Services.
PFAS is an acronym for a class of chemicals known as per- and polyfluoroalkyl substances. PFAS are also often referred to as “forever chemicals” because they do not break down in the environment and bioaccumulate, persisting in the bodies of humans and animals. There are more than 4,000 man-made PFAS compounds used by a variety of industries for such things as electronics manufacturing, oil recovery, paints, fire-fighting foams, cleaning products and non-stick cookware.
People can be exposed through contaminated drinking water, food and air, as well as contact with commercial products made with PFAS. Some PFAS have been linked to cancer, immune deficiencies, thyroid disease, and other health problems.
How PFAS enters the environment
Credit: Evich et al., 2022
Last year, the US Environmental Protection Agency identified more than 120,000 locations around the United States where the agency believed people may be exposed types of PFAS. The scope of the list underscored that virtually no part of America appears free from the potential risk of air and water contamination with PFAS.
The Biden Administration has announced a series of steps to try to restrict PFAS from contaminating water, air, land, and food as well as to clean up PFAS pollution and speed up research on other PFAS issues.
Last month, the administration started the process of designating two types of PFAS – PFOA and PFOS – as hazardous substances under the law, which would allow the EPA to deploy recover clean-up costs from companies responsible for contamination and take other steps to address contamination.
NASEM said a large body of scientific literature on PFAS shows there is “sufficient evidence” of association between exposure to PFAS and increased risk of decreased antibody response in adults and children, abnormally high cholesterol in adults and children, decreased infant and fetal growth, and kidney cancer in adults.
The report found there was “limited or suggestive evidence” of increased risk of breast cancer in adults, liver enzyme alterations in adults and children, pregnancy-induced hypertension, increased risk of testicular cancer in adults, thyroid disease and dysfunction in adults, and increased risk of ulcerative colitis in adults.
The NASEM report warned that people with PFAS in their blood above 2 nanograms per milliliter (ng/mL) but below 20 ng/ml may face the potential for adverse effects, especially “sensitive populations,” such as pregnant women. Clinicians should encourage reduction of PFAS exposure for these patients and prioritize screening for a range of health problems that include hypertensive disorders of pregnancy, breast cancer, signs of kidney and testicular cancer and of ulcerative colitis, according to NASEM.
People found with PFAS in their blood at levels higher than 20 ng/ml potentially face a higher risk, the report states.
The report noted that more information is needed on how PFAS affects children and pregnant women, and recommends the gathering of data to address those groups.
The report notes that systemic racism and issues of environmental justice could compound the “challenge of responding clinically" to PFAS contamination.
The report notes: “While environmental justice research specific to PFAS contaminants has been limited, place-based factors that may put individuals at greater risk of exposure (siting of chemical companies, refineries, and industrial sites), coupled with insufficient access to environmental screening, information, and adequate health care, have disproportionate impacts on Black, Hispanic, and Indigenous communities, as well as low-income populations.”
“PFAS contamination did not just randomly occur in rural communities serviced by well water that happened to be near industrial sites. Rather, the locating of certain industrial sites and decisions to dispose of PFAS with limited regard for the surrounding community’s access to safe water are rooted in the relationship and history of these industries and communities.
The disposal of these chemicals did not occur as single events lacking context, but reflected a pattern of decisions made over time. Understanding the historical and social context influencing how and where PFAS are distributed is an essential part of identifying effective mitigation strategies.”
This story was originally published in The New Lede, a journalism project of the Environmental Working Group, and is republished here with permission.
Dr. Max Aung joins the Agents of Change in Environmental Justice podcast to discuss the dangers of some everyday chemicals to our health—and how regulation hasn’t kept up with these threats.
Aung, an assistant professor at the University of Southern California Keck School of Medicine and assistant director at the Agents of Change in Environmental Justice program, also talks about how pregnant people and babies are most vulnerable to these pervasive exposures.
The Agents of Change in Environmental Justice podcast is a biweekly podcast featuring the stories and big ideas from past and present fellows, as well as others in the field. You can see all of the past episodes here.
All right, today's guest hanging out is Dr. Max Aung, an assistant professor at the University of Southern California Keck School of Medicine and assistant director at the Agents of Change in Environmental Justice program. Aung talks about the mix of insidious pollutant exposures we all face, how these exposures impact the most vulnerable among us, and how policy can catch up to the ever growing list of concerning chemicals. Enjoy.
So Max, it is good to see you. But I will full disclosure for the listeners, I see you quite a bit now, you are part of the agents of change program, you are now an assistant director. And you were also part of our first cohort, and you wrote an essay about oil and gas development where you grew up. So I just want to start there, if you could tell me a little bit about what that experience was like, as a researcher being out there with your views and thoughts, what the reception was, to your article and a little bit about the work you're doing now with us?
Yeah, so, you know, the article was such a great opportunity for me to reflect on the sort of environmental issues that are facing communities that have high oil and gas production. But it was also interesting, because having grown up there, you know, I've, I've had friends that work in the oil and gas fields, that's like their first job out of high school, it pays really well. You know, it's it's basically the source of economic growth for a lot of folks in those communities. So, in my essay touched on that a bit – thinking about, you know, sort of how even though these have environmental impacts these different industries, there's also this issue of like, how do you deal with folks that rely on this for their everyday lives? So I think, you know, when I wrote the essay, it was largely, you know, well received from I had some folks, you know, reach out to me, and, tell me that, that they found the article to be an important reflection on that balance. I've had, we got this article invited to be like in a undergraduate textbook chapter, which was really exciting, you know, that new scholars will be reading this as they think about creative writing and reflecting on environmental issues. And, yeah, so, you know, I think that's sort of been a great foundation, as I've sort of navigated this next stage of my career and thinking about ways to incorporate communities and think about communities inputs, as we tried to shape policy, environmental policy. And so that's been a huge factor, especially with some of my work at UCSF, which, you know, we can talk a little bit more about later on. In terms of the [Agents of Change] program, so I joined the leadership here in March. And it's been really exciting because I've been working really closely with Dr. Ami Zota, you and Yoshi as well, and just thinking through different ways that we can engage existing scholars in the program, but also ways that we can, you know, galvanize the new cohorts towards different focus groups and thinking about how can we leverage that skill in terms of outreach and in terms of getting our Agents of Change fellows out there to you know, communicate with important stakeholders. So that's been really exciting so far.
Good. And it's so awesome to be part of the program and already a few years in have people like yourself who are part of it, who have now grown in your career and have new positions, and then come back. I mean for me when I started this, to already see people like you coming back and being a part of it after being in the first cohort, is just, it's just wild how kind of fast time flies, but it's been really excellent. And just for people listeners who maybe didn't read your essay, so it was focused in Kern County, California, right?
You're right. And I really appreciated the idea of thinking about the economic ramifications. I thought that was one of the aspects of your essays that was crucial when we think about weaning off oil and gas or just trying to get rid of polluting, polluting industries, thinking about the people that rely on these for their livelihoods.
Yeah, and it was, you know, it's so great. Like, during our sessions, like in that first fellowship year, just, you know, getting the feedback from you, workshopping it with the other fellows was such a great experience. Because I felt like, I was consistently challenged to think about every single word I put into that essay, and like the impact, you know, and not being afraid to say, radical, social justice oriented things. And I did feel like that was such a great learning experience, sort of go through that exercise.
Well, that's great to hear. And I hope future folks feel the same way. That's definitely the spirit of the program. And so you went to University of California, Santa Cruz for your undergrad, and I believe you're at University of Michigan over here for your masters and your PhD – I love Ann Arbor, is such a fun town. What drew you to public health? And how did you come to start researching environmental exposures?
Yeah, so okay, at Santa Cruz, I'd say I gained a really diverse set of research and education experiences. So you know, my undergraduate training was in molecular biology. And so I was just really drawn to some of my more advanced coursework around immunology, and thinking about the different mechanisms that underlie various different health conditions. And that's was sort of, you know, my bedrock in terms of the coursework. On the other end, I was doing research in a stable isotope laboratory, in the ocean sciences department, which is totally, you know, not, you know, totally different in terms of science, but like, just a totally different direction in terms of how to apply scientific research. And so in that lab, I was working with an exciting team to reconstruct past sea surface temperatures over the course of several thousands of years. So we...the Paleo climatology lab is very focused on trying to understand past climate conditions so that we have data to inform future climate models. So there's this, you know, this duality between the molecular Health Sciences and more environmental, climate-change focused research. And I think, you know, trying to think through these two different experiences, it was a little bit next, like, after undergrad, you know? I struggled a little bit with trying to find my path forward.
And after undergrad, I actually, I took two years, where I wasn't in school, I was teaching full time for a STEM diversity program that focus on retaining undergraduates from historically marginalized backgrounds in the STEM fields. And so during that time, it gave me a little bit more breathing room to like, think through sort of what are my next steps, and, I got involved with the Society for the Advancement of Chicanos and Native Americans in Science, so I was working with them in the summer. And through that, I started networking with all of these different – because they're so well connected with all of these universities across the country – and, and through that I sort of got connected with different professors from different schools of public health. And as I was brainstorming through potential graduate training, and really tried to lean in on those background experiences. It became clear to me as I was learning about grad programs that something that would fulfill me is a blend of environmental research, plus Health Sciences, plus policy, right? And so I kind of converge it to like environmental health policy is like sort of where I was thinking. And then so when I was looking at different programs, you know, Michigan really stood out to me. They had a super strong Department of Environmental Health. And when I spoke to different faculty and different current students, it seemed like there was a lot of opportunity if you came in with environmental health to sort of branch out, and also gain skills in policy and some of the more data analysis, epidemiology heavy coursework.
So that's the way, that's the sort of path that brought me to Michigan. And at Michigan, you know, I don't think any of this was planned, but I was able to receive this really exciting fellowship from the Robert Wood Johnson Foundation, it was called the Health Policy Research Scholars fellowship. And that really just amplified my health policy training. And it basically allowed me to integrate that type of training into my more science-heavy applications in environmental health. And so, you know, that's sort of like my entry point into public health and the way I've been navigating it in terms of like, career trajectory.
What's one place that you miss in Ann Arbor?
Oh. I love ramen. I think anybody that knows me really well knows that I'll always, you know, go find like, the best ramen shop in any city I'm in. So there's actually like a pretty, you know, delicious ramen place in downtown Ann Arbor called Slurping Turtle. And so that's one place I miss. Where I was living most recently in Ann Arbor it's in the middle of the campus and my home, or my former home. So like, you know, on the walk back, I had been known to just like, be like, alright, canceling dinner, cooking dinner, I'm just gonna get ramen.
Yeah, there's, there's a lot, there's a lot in a town, that's not huge. There's a lot of super good food and good music and good places to get a drink. So, before we get on to how you've taken that environmental research and what you're doing with it now, I wanted to ask you, what's the defining moment that shaped your identity?
Oh, yeah, um, you know, I, so I think I can, you know, I could time travel back to a lot of different moments long, longer times ago, but I actually, I think, like in terms of something that's really defined me, it's like, for me, one of the experiences, most recently was, I was working at UCSF, and I had the opportunity to, basically, you know, co-lead my first big R1 proposal. And I think what was really exciting about this proposal was, I was focusing on basically trying to better understand mental health disparities among immigrant women, and focus on how environmental exposures are potentially impacting mental health disparities in this population. And I think what was like really pivotal for me as, as a scholar was, this is sort of a moment where, after I've developed all of the training, earned the PhD, got to this point in my career, I'm able to now develop research questions and research proposals that literally converge my identity as an immigrant scholar, but also focus on important salient problems that are impacting these communities. You know, I will say that grant hasn't been funded yet. So we didn't get it on the first try. But I, I will be persisting on it and trying again, and, reshaping it in different ways. But nonetheless, I still look back at that experience and think that it's been a huge moment for me to I'm really just feel empowered to use my skills to, you know, and my lived experiences to pursue research that, that not very many folks are doing and I think is really important.
Yeah. And hopefully bettering science and shaping what environmental science looks like. And then take it one step further, hopefully making lives better, right?and in the communities you're researching, or are looking into, in some way, having a positive impact. So that's definitely a defining moment. I think that's great. And hopefully it gets funded at some point.
Yeah, eventually I'm trying, I'm trying, you know, different ways to sort of get it funded. So crossing fingers.
So now you're really broadly your focus now is on what we're exposed to that impact our health and human development. So just just kind of a 10,000 foot view, walk me through some of the things that we're exposed to that kind of keep you up at night? What are you looking at, exposure wise, that we should be concerned about?
Yeah, so. So, you know, historically, in terms of what I've done research on so far, I've focused a lot on endocrine disrupting chemicals. And this includes, for example, a lot of different chemicals found in plastics and different personal care products that you use on a daily basis, like lotions, shampoos. So you know, some chemicals include phalates, phenols, parabens, I've done a lot of research on these endocrine disrupting chemicals. Particularly, I've focused on how they're influencing maternal health conditions, and potentially, what implications that has for infant health later in life. And sort of my core research applications in that space is to try to disentangle biological mechanisms, right? So that's, that's sort of in the bedrock of my PhD dissertation: identifying different biological pathways that might be affected by these chemicals, and trying to illustrate that in these different studies that that we've published, so that so that different scholars can learn about those mechanisms, and build on those when they think about risk assessment, and trying to identify high-risk scenarios with these high exposures and thinking about what pathways might be influenced by those exposures.
Can you talk a little bit about... so I think when we historically think about environmental pollution and things that harm us, we think of... let's use lead for an example, the more lead that I'm exposed to, or that my nephew is exposed to, the more toxic it is. With endocrine disrupting compounds, it doesn't always work that way, there can be very tiny amounts of exposure that that wreak havoc on the body and maybe at a higher exposure, it's not the same. So can you talk a little bit about first of all, when we say endocrine disrupting compounds, what what we mean, and also kind of the challenge of identifying how toxic they are, because they don't always behave like traditional toxics.
Yeah, that's a good point. Yeah, so, just to set the baseline. So when we say endocrine disrupting chemicals, essentially, what that means is that these chemicals, especially, based on in vitro, mechanistic laboratory experiments, these chemicals have been shown to have properties where they can mimic hormone signaling, and they can essentially alter concentrations of different hormone production. And this has, I mean, even though we call them endocrine disrupting chemicals, this has wide implications for various different pathways, because not only can they affect the endocrine system and hormone production, but because the endocrine system is so intimately connected to the immune system, for example, these chemicals can also elicit inflammatory responses, so, they can, you know, cause immune cells to regulate these proteins that are involved with inflammation and this can have downstream effects on cardiovascular function on tissue damage. So, all sorts of different downstream effects. And that's what makes these chemicals you know, very tricky to understand. Because if they're affecting various different pathways, there's all sorts of feedback loops that might be occurring. And disentangling those different feedback loops, and those different mechanisms is really challenging. In terms of the dosage, you know, what you're saying is about the concentrations, and different levels of concentrations being important, that's also a huge consideration, right? Because, you know, there's some evidence that, you know, particular endocrine disrupting chemicals can have nonlinear relationships. So it's like, even low doses can have effects, and maybe you might not see effects in the middle range, but then you might see effects in the higher range. And, you know, that's really tricky, especially when you're trying to investigate these chemicals in a large, prospective cohort, an epidemiology study, where you have a huge distribution of these chemicals, and the distribution might be different based on which study population you're focusing on. So, yeah, all of those things are incredibly challenging. And, a lot of the research and collaborations I'm working on now, is these, you know, multi center, multi cohort investigations, where we're integrating data across different birth cohorts. And that's one of the ways that we can sort of tackle this problem is having a larger sample, a larger, diverse sample that we can have a better understanding of the different distributions of these exposures.
So, as you mentioned, a lot of your work is focused on babies, pregnant people, kind of fetal exposures. Can you talk about the specific vulnerabilities for these groups? And what we know about environmental exposures during this really critical window of development?
Yeah, so basically, a huge piece of my research is built on the developmental origins of health and disease hypothesis, which proposes that early life exposures can have, can be affecting key biological processes in utero, that can essentially influence the trajectory of infant development for many, many years. So this could be metabolic health, this could be neurodevelopment. So particularly, I've been focused on neurodevelopment, and that's where my research program is shifting towards right now, in terms of my funded projects. And what we're seeing so far is that, from preliminary data, that maternal biomarker profiles that we've measured in some of our pilot studies are associated with early measures of infant neurodevelopment. So after pregnancy. And those same biomarkers are also associated with environmental chemicals, such as the phalates from the consumer products. And so you know, our running hypothesis is that these chemicals are influencing different biomarker profiles in the mom during pregnancy, and that's potentially influencing key neurodevelopmental features in the developing fetus, and that's persisting into infancy. And so that's one of the major pieces that I'm trying to work on. And so right now, we're building on that preliminary work, and we're expanding it into multiple different cohorts measuring these biomarkers. And the idea is that, from the study, we'll be able to characterize these early mechanisms of neurotoxicity, potential neurotoxicity, but then also, hopefully use these biomarkers as you know, potential predictive tools that we can help to identify potential neurodevelopmental outcomes later in life.
So just so I'm clear that the basic idea is that the mother is exposed to, or the pregnant person is exposed to a compound, and you're seeing... and by biomarkers, what do you mean, what are you looking at?
Yeah, so there's all sorts of biomarkers that you know that we, that I've been researching over the past few years. But most recently, I've been focusing on these targeted bioactive lipids, so this includes, you know, parent fatty acid compounds that folks get from, you know, essentially their diet like arachidonic acid, linoleic acid. And these fatty acid compounds are essential, and you know, you need them for key biological processes. And as a component of their essential function and role in physiology, they are metabolized into secondary molecules that can stimulate different things like immune responses, cardiovascular function, they're also important for, you know, kidney function. So, these secondary molecules are really key signals of biological processes. And so, when you measure them, and then you see that there are altered levels, or different concentrations associated with higher concentrations of phalates, then you start to be concerned, because, you know, that essentially suggest that perhaps, that the chemicals are influencing that metabolism of those bioactive lipids, and if they're influencing that metabolism, they might be influencing all those downstream processes that I just laid out. And that's, you know, that's when we start to find that there might be a problem with that, because those downstream processes could be influencing the developing fetus.
So using a lotion that has too much phalates could make your child have delayed development, maybe some kind of behavioral issues. I mean, are these the kinds of downstream impacts you're looking up?
Well, we're trying to disentangle that. It' still very early stages in terms of those outcomes, but some of my colleagues in that I collaborate in these cohorts have found associations with dilates and altered infant neurodevelopmental parameters. And so we are seeing evidence so far that there are some associations. And so now that we've seen those relationships with dilates and neurodevelopment, this next stage that I'm proposing is trying to find these linking pathways, with these bioactive lipids that might be explaining some of these relationships.
And of course, as humans, we're all eating perhaps produce that has pesticides, we're putting on these lotions, we're eating out of plastic containers, we're walking outside where there's heavy traffic, so we're exposed to mixtures of pollutants all the time. So can you outline, you know, first, why that's a challenge for researchers like yourself, and how folks like you try to best capture what these mixtures might be doing to us, or disentangling them? If that's what you're doing.
Yeah. So yeah, so thanks for bringing that up. You know, there's, there's hundreds of thousands of chemicals that were exposed to, and like you said, pesticides, and some pesticides have been shown in mechanistic models to be neurotoxic. So when you think about, you know, the cumulative exposures of pesticides, phthalates, toxic metals like lead, and, what is so challenging about understanding any single chemical class is that they're not acting alone, right? You have these different exposures that are also influencing these biological pathways. And they're also, through that mechanism, potentially influencing those outcomes like neurodevelopment. And so you know, what I'd say, in that space of disentangling the mechanisms. I think what's really challenging is, you know, one of the studies I published like a couple of years ago is we looked at like four different chemical classes, you know, dilates, included toxic metals included, and we saw that they're having these, in some cases, divergent associations with these biological pathways and these biomarkers, and so when you see divergent pathways, it's really tricky because it's hard to understand what that implication is in terms of the downstream effects. Like are they acting sort of against each other? like antagonistically? Is this an issue of temporality, where we've only measured the exposures once and the biomarkers once so we're not capturing the bigger picture, right? So there's a lot of unanswered questions in terms of like these mixture effects. But I think, in that chaos and confusion of all these different divergent relationships, I think there's something really compelling in terms of this really emphasizes the need to look at chemicals as a whole mixture, because you're going to miss things if you don't, right? if you focus on just one chemical class, you're really going to miss the fact that other chemical classes are having. And it's, it's really not conducive for risk assessment, you know, when you think when you're ignoring those different chemical classes. And so, you know, in terms of taking the risk assessments and thinking of downstream policy implications, I think it's really critical that we start to evolve from this one chemical at a time policy approach and thinking about all of these chemicals, cumulatively.
So that leads me nicely into my next question, and maybe that's in part your answer. I was thinking about, I've been, personally, I've been writing about BPA for more than a decade now. And the bad news keeps coming. And the studies keep finding impacts, whether it’s animal studies, or correlational, human epidemiological studies, and it's still not regulated, right, nothing happens. And one of the things I realized as a journalist pretty early on that I think is was surprising to me, and I think it's surprising to other people is that everything on the shelf isn't tested to the extent that you think it is. So, you know, we you're talking about phalates and things that are probably in my shower right now. So, where's the regulation failing? So maybe one one aspect you mentioned, is not looking at things as classes rather trying to look at them individually, but what else? What else could we or should we be doing?
That's a, that's a big question. You know, I think there's so many different things we could be doing better. But, you know, one of the things for sure is, you know, in addition to looking at the cumulative effects is thinking about better capturing different routes of exposure and integrating that holistically – especially thinking about different historically marginalized communities as well, because there is historic exposure that needs to be accounted for in marginalized communities. So, you know, some communities are exposed to not only the phalates, but high levels of air pollution, toxic lead, there's PFAS in the drinking water. So thinking about historical exposures as well is really important, because that really contextualizes the current state of the problem that those communities might be facing. Whereas if you just look at the chemical class in isolation, without thinking about those historic exposures, you're going to underestimate the risk that those communities are experiencing.
What would you tell someone who's an expecting mother?
That's, you know, I think, what I would tell them is that, you know, well... I think in general, what I would tell folks is that a lot of the solutions, the really big impact solutions are going to come at the regulatory policy level, we can try to limit our exposures as a consumer by, you know, not using this product or that product. You know, avoiding different products, but that's really so marginal in terms of exposure reduction. I think the onus should really be on regulators and industry to not use these chemicals and to use safer alternatives or if some of these chemicals are not essential, basically, yeah, like they shouldn't be produced. So in terms of what I tell folks when they asked me about reducing things like, in addition to, you know, avoiding certain products, I would say, it's really, also going to take a lot of civic engagement to push policymakers to make responsible decisions on reducing these harmful exposures. That's really where the big-impact, exposure reduction is going to come from. And so, you know, I think that's where we really have to invest our energy and our effort, as scientists as activists, and sort of pushing policymakers and industries to sort of do better.
Was there an "aha!" moment for you or something that you learned when you were researching these exposures that you don't think most people would know about? Something kind of surprising, interesting, shocking.
You know, I think like, for me, it's, it's been... Well, the first part was just seeing how many chemicals we're exposed to. It's pretty alarming. And there's estimates that there's like, hundreds of thousands of registered and, you know, thousands of unregistered chemicals too, and that is really problematic, because as a scientist, it's really, it's really challenging to investigate the health effects of these chemicals, when there's like such a large mountain of chemicals. And so I think that was been sort of a huge moment, in terms of the way I think about the problem. And it's also compelled me to not only investigate them, to the best I can with these epi cohorts –we're very limited in those cohorts on what we can measure, right, just because of costs– So that's compelled me to, you know, in addition to focusing on those, also think about how we can drive policy forward. And one of the things I've been working on in my role at UCSF, in my past, while at UCSF and I'm still carrying it forward, is thinking about developing a framework to inform policy action when there's limited research, and to sort of, how can we drive decision making forward? so that we can reduce exposures without having to necessarily conduct these large epi cohorts that will take many, many years to do. So finding that balance has been really tricky. And that's, you know, something sort of that I've been focusing on a lot recently, and it's really great in terms of bridging my policy bug right into my science hat.
I wonder if that might be the answer to my next question. I was thinking about a lot of everybody in the Agents of Change program, there's a, there's a real importance placed on using your research to spur positive change in communities. And I think in some instances, I've seen this with reporting, when we report on a fence-line community, and there's a power plant, it's a very clear link: these people are being harmed by this thing, how can we make that known and spur action? It's easy, it's local. Whereas what you're looking at is so ubiquitous and big. And really, we're all exposed to these compounds and in some communities more than others, but being such a big, unwieldy problem. I'm wondering how you go about trying to make that change happen?
Yeah, so that's definitely an ongoing workshopping and brainstorming process. In terms of like, how I've been approaching it with my collaborators at UCSF, we're developing thi framework for Environmental Health Policy. And the goal of the framework is to develop a process, a very transparent process for evaluating scientific evidence to inform policymakers to take action on an environmental contaminant. And so in that process, it requires the integration of key decision criteria, right? Like how will you balance the costs and benefits of an intervention? How do you balance environmental injustice and the potential to essentially push back against systemic racism? you know, how can the intervention do that in terms of environmental hazards? And in this process, like, I think the way that we've sort of started to approach it is bringing in key stakeholders, from NGOs, from the government, from different community organizations, and really listening, trying to listen on their input. And so that's one of the most recent things we did in this project: [it] was to bring together a workshop of different key stakeholders. And so now going forward, you know, we're synthesizing through that information. And as we develop future case studies and applications for our policy framework, I think, will continue to sort of bring in community engagement and really trying to get their input every step of the way, so that we're impacting a potential intervention with their ideas in mind and very integrated into how we're approaching the potential intervention or recommendation.
I remember talking to Dr. Reginald Seeley, who who spoke to the Agents of Change at some point. And he mentioned when he worked on The Hill for a little while, how incredibly busy policymakers are. This idea of you doing some of the work for them and taking the studies and running them through this project and giving them different outputs of "this would do this, And this would do that. And there's benefits here cost saving here," I think is brilliant.
Yeah, absolutely. It's a big, it's a big hill, but I think that, you know, I'm optimistic. And I think we have a stellar team of collaborators. And we've brought together a great steering committee to help guide us. It's really exciting. So I'm hopeful that we can continue that work and really influence policymakers in the future.
Excellent. I just have a couple more questions for you, Max. And this has been a really good time it is there anything else that you want to mention that you are optimistic about? Some of these topics are just heavy. What else out there gets you excited or hopeful?
Yeah, I think, you know, in terms of like, the science, I am pretty, I'm getting optimistic about how some of the funding opportunities that have been announced through the NIH, I'm starting to see more and more emphasis on important research that has implications for environmental justice. And not just NIH but also the EPA. There's an environmental justice intent in some of these opportunities. So, I'm cautiously optimistic that they can influence positive change and promote social justice. You know, and hopefully, the folks that get these different funding mechanisms can incorporate community input, and really drive environmental justice forward. And I think there's also a lot of potential in terms of a lot of initiatives that the Biden administration is doing, in terms of trying to integrate social justice into a lot of their regulatory frameworks. And so I think, I'm optimistic about that. I really hope it can be sustained after like the midterm elections, and hopefully in the next four years, but, we'll see.
of living. Yeah, article, political realities. Yeah, unfortunately, sometimes But you know, I what I will say is the fact that there is an awareness, you know, easy for me to say I'm not a member of a community that is dealing with these things. But I think the fact that there is awareness right now is a positive step in itself. And hopefully that continues to bring about change. So Max, I have three rapid fire questions where you can just give me one word, or phrase and then we can, we can move on, get me out of here and the rest of your day. So one of my all time favorite movies
When I have downtime, I am most likely
Oh, gosh, me too. I'm taking one as soon as we get done here. And I cannot I cannot start my day without
Perfect. We are two for three on matching each other there. And Max. My last question, what is the last book that you read for fun?
I just started reading this book called "On Earth we're briefly gorgeous." And I haven't finished it yet. So I'll let you know what when I finished it, but so far, it's really poetic.
And who is the author on that?
I hope I'm pronouncing their name right. Ocean Vuong.
Yeah. "On Earth We're briefly gorgeous." I love the title.
Yeah, it's a beautiful title. And their background is largely in, you know, in creative writing and poem. So it's got that sort of that vibe in there quite a bit.
Excellent. Well, Max, thank you so much for taking time today. I really mean it that I am so excited that you're part of the team and I get to see you and talk to you and brainstorm with you on how to grow this program. So thank you so much for today.
Yeah, thanks so much for inviting me.
We've been reporting on environmental health for 20 years. But what is environmental health? You've got questions, and we have answers.
Environmental health is a branch of public health that monitors the relationship between human health and the environment, examining aspects of both our natural and man-made environment and their effect on human wellbeing.
Living near factories or heavy traffic worsens air quality and leads to health impacts on the lungs and heart.
Environmental health is a broad area of study — everything from the climate to the food we eat to the air we breathe plays into environmental health. A few specific examples include:
The role of environmental health research is to examine areas of the environment that impact our health so that we can make personal and policy changes to keep ourselves safe and improve human health and wellbeing.
Environmental health impacts every one of us.
We reap the benefits of clean air, clean water, and healthy soil. If our environment is unhealthy, with toxic chemicals saturating our resources and pollution abundant, then our health also suffers.
It is also an important field of study because it looks at the “unseen” influences on your health.
Many individuals may not associate their health problems with air or water quality, or with what clothes they wear, makeup and household goods they use, or food they eat.
That’s because not every example of environmental health problems are obvious: some chemicals, for example, build up slowly over time in your body: a small dose may not seem to bring harm, but repeated small doses can lead to later impacts.
Also, individual susceptibility can differ: for example, one member of a household can experience illness, asthma, migraines, etc. from chemicals found in their water supply while another member of the same household is just fine, such as the case in a young girl’s reaction to benzene in her water from living near fracking wells.
Certain variables play a role in susceptibility and level of adverse health effects such as age, gender, pregnancy, and underlying health conditions. Studies suggest fetuses, infants and children are much more at risk to experience lifelong health problems from toxic chemical exposure.
Rate, duration, and frequency of exposure to toxic chemicals and other influences from our environment all factor into our health.
Good environmental health = good human health.
Two women extracting from a well in Senegal.
There are many environmental health issues that affect human health. These include:
Air pollution — nine out of 10 people currently breathe air that exceeds the World Health Organization’s guideline limits for air pollution worldwide. This mainly affects people in low and middle-income countries, but in the United States, people that live in cities, or near refineries or factories, are often affected as well.
Air pollution also ramps up during wildfire season.
Water pollution — as of 2014, every year more people die from unsafe water than from all forms of violence, including war. Water is the ‘universal solvent’, meaning it can dissolve more substances than any other liquid on Earth. Thus, it is too easy for toxic chemicals to enter our water supply.
Lack of access to health care — yes, this is an environmental health issue! Having an accessible health care system is part of one’s environment. Difficulty getting health care can further impact one’s health.
Poor infrastructure — from “food deserts” to lack of transportation services, living in an area with poor infrastructure can impact your health.
Climate change — climate change-induced heat waves, increased frequency and severity of large storms, droughts, flooding, etc. have resulted in health problems and even death.
Chemical pollution — chemical pollution can be sneaky: the chemicals in your everyday products, from shampoo to deodorant to your clothing to the food you eat, can directly affect your health. These chemicals are often not on the label or regulated at all.
Educate yourself. Environmental health is a broad topic, so this can seem overwhelming. Start by taking stock of your own personal environment. Look up air pollution monitoring in your area. Get your water tested to see its chemical makeup. Evaluate the products you use in your life — personal products like shampoo and deodorant, household cleaners, air fresheners, the foods that you eat — and see what you’re bringing into your home.
Explore the Environmental Working Group's guides to check your products for toxic chemicals.
We have additional guides to help you learn more about environmental health. Find guides to plastic pollution, environmental justice, glyphosate, BPA, PFAS and more in the Resources tab at the top of our website.
As individuals we have the power to improve some of our environmental health, but there is a pressing need for systemic change and regulation on a policy level.
We’re actively working with scientists to share their research and knowledge with politicians to advocate for science-backed policy change. But we need your help. Contact your representatives to let them know that environmental health is important to you — whether it’s air pollution in your area, contaminated water, plastic pollution, food deserts in your area, or chemicals in consumer products.
Subscribe to Above the Fold, our daily newsletter keeping you up-to-date on environmental health news.
When Dr. Rob Sargis sees a patient struggling with obesity, his recommendations go beyond diet and exercise. He may advise them to stop heating things in plastics, or to avoid congested roads during rush hour.
Sargis, a practicing doctor and professor of medicine at the University of Illinois, is one of a number of doctors incorporating the science of obesogens — endocrine-disrupting chemicals that spur obesity — into their clinical practice.
Obesogens are a subset of endocrine-disrupting chemicals — man-made compounds that alter hormone activity. They are generally defined as any chemical that can cause the human body to produce more fat than it normally would, and can include substances we usually think of as fattening, like sugars or artificial sweeteners.
However, obesogens are not only found in food, rather entering the body through other consumer products, like makeup, shampoos, soaps, plastics, and food packaging. People are exposed through contact with the chemicals and through ingestion of contaminated foods. The chemicals are also shed from such products and can accumulate in household dust, which people breathe in. PFAS, or per- and polyfluoroalkyl substances (toxic chemicals used in many consumer and industrial products) are another example of obesogens, as is bisphenol- A (BPA).
By disrupting hormone activity, these chemicals can spur obesity in a number of ways. They can alter metabolism, cause the body to produce new fat cells, alter eating behavior, and even change the way food is digested.
To Sargis, incorporating an understanding of obesogens into clinical practice is part of the goal of medicine as a whole: to build a healthier society. Obesogenic chemicals have other harmful health impacts too — for example, PFAS and BPA are also linked to certain cancers and reproductive problems. Reducing obesogen exposure is beneficial across the health spectrum.
“What we’ve seen in medicine over the last few years is this shift from individual factors, like genetics, lifestyle and diet, to an embracing of the social determinants of health, including things like food, environment, exercise and education,” Sargis told EHN.
However, Sargis and other doctors interested in using the obesogen framework face barriers, such as difficulties gathering data on obesogens, a bias toward focusing on diet and exercise, and inadequate medical school training in environmental exposures.
In addition, a lack of regulation of obesogens makes it hard to reduce the exposures — even for patients who are aware of the risks. “The challenge is that there are systemic forces that you have to fight, and a lot of that's policy, and a lot of that policy is embedded in politics,” Sargis said.
Doctors are hesitant of incorporating obesogens in their clinical practice as there's no data showing that if a person reduces their obesogen exposure, they can lose more weight.
A major obstacle to incorporating an understanding of obesogens into clinical practice is that doctors are sometimes not convinced by the data available. While plenty of data exists to show a correlation between obesogen exposure and obesity, there is less data that shows that if a person reduces their obesogen exposure, they can lose more weight.
Gathering that data is difficult, but possible, said Sargis. However, the ubiquity of obesogens in everyday products, as well as the lack of transparency from companies about the chemicals in their products, makes designing such a study difficult. The sheer number of chemicals that would need to be tested — there are more than 9,000 types of PFAS, for example — also adds to the challenge.
Jerry Heindel, a biochemist and founder and director of HEEDS*, a coalition of researchers advocating for better regulation of chemicals, told EHN that doctors and patients could benefit from an accessible and cheap way to measure exposure to obesogens. That way, patients could hypothetically see if their exposure levels drop over time as they worked to eliminate obesogens from their daily life. For now, he said, patients would need to pay for the tests themselves, but he hopes insurances would cover the tests in the future.
Jenna Hua, a doctor-turned-CEO of medical testing company Million Marker, thinks her company’s product could play a role. Million Marker offers at-home test kits that measure the levels of 13 common endocrine-disruptors, some of which also act as obesogens, in a person’s urine. The tests are able to detect BPA, two BPA alternatives, five types of phthalates, four types of parabens, and oxybenzone. It’s “quite empowering,” Hua told EHN, when someone using the tests can see their exposure levels drop as they swap out products they’re using that include obesogens.
The type of testing that Million Marker offers would be another tool in managing weight loss. “It would not be possible to tease out what part of weight gain is due to obesogens,” Heindel said. “The doctor would have to explain to the patient all the possibilities and how to address each of them to reduce their weight.”
As more patients recognize that obesogen exposure is a threat to their health, Hua said, the public may be more inclined to pressure governments to regulate endocrine-disrupting chemicals. Most obesogens are not currently regulated in the U.S., for example, the Food and Drug Administration does not restrict the use of BPA in food packaging, and there are no federal standards limiting PFAS discharges in drinking water.
One of the reasons that obesogens have been overlooked, Sargis said, is that treatment of obesity is biased toward individual factors like diet and exercise. “There’s an inherent bias that this is somehow a personal failing,” he said.
That kind of thinking, he said, might be rooted in conventional beauty standards and the idea that obesity is an aesthetic problem more than a health problem. Research has shown that in the U.S., obese individuals are often highly stigmatized and labeled as lazy, unmotivated, and lacking in self discipline. Medical students themselves can perpetuate these stigmas — one study of third-year medical students at Wake Forest University found that more than one-third of the future doctors associated obesity with negative attributes, with the majority of students, 72%, reporting that they preferred “thin” people to “fat” people.
A lack of training in environmental exposures in medical schools is a major obstacle.
There is still a huge gap in medical school training when it comes to obesogens, Sargis said. The sheer volume of knowledge medical students are required to learn leaves little room for discussions about environmental exposures. The end result is that doctors often leave environmental exposures out of their practice — for example, a 2015 study of maternal and child physicians found that environmental health assessments were “infrequently” part of routine counseling of patients.
Dr. Jamaji Nwanaji-Enwerem, a 2021 graduate of Harvard Medical School and current resident at the Emory University School of Medicine, said he got very little training in environmental exposures in medical school. “Medical students across the nation are not being extensively exposed or trained formally on the effects of the environment on a patient's health,” he said. Rather, Nwanaji-Enwerem, who is also an assistant professor of environmental health at Emory, gained his expertise in learned about environmental exposures through classes outside of the medical school and through his own practice.
One patient suffering from hypertension and respiratory problems inspired Nwanaji-Enwerem to write a paper about the importance of considering environmental risks. In the paper, Nwanaji-Enwerem writes that other doctors should ask their patients about the chemicals they come into contact with at work, and whether they wear proper personal protective equipment to protect them from chemical exposures.
To supplement medical school training about obesogens, Heindel said, professional societies, like the Endocrine Society, Obesity Society and Pediatric Society, could be a good starting point to help young doctors learn about obesogens. For example, East Carolina University professor and pediatrician David Collier first learned about environmental exposures at a conference for academic practicing pediatricians. According to Collier, there need to be “many touch points” where researchers and doctors can have such conversations.
Additionally, Sargis said, doctors get very little time with patients. It’s difficult to squeeze in a conversation about the risks obesogens pose during a 20-minute consultation. To help, he said he’d like to see more educational materials available to patients after their visit, such as short videos explaining obesogen exposure.
Part of the solution, too, could be getting doctors to care more about the environmental health of the neighborhoods where their patients live, Sargis said. While doctors might not want to engage in political discussions, they might play a key role in decreasing the chemical exposure of their patients. Getting doctors involved in discussions about housing, city planning, building codes, policing, water use, and environmental policy could make a difference for the health of people living in those communities, he said.
“When you have physicians that aren’t willing to step out of the clinic and into these discussions, it becomes difficult,” he said. “We really need physicians, scientists, and health policy experts at the table.”
*HEEDS is a program of Environmental Health Sciences, which publishes EHN.org.
*Editor's note: An earlier version of this article quoted Bruce Blumberg, professor of Developmental and Cell Biology, and Pharmaceutical Sciences at the University of California Irvine, asserting there is no evidence that lowering obesogen exposure reduces weight. Blumberg has published multiple scientific papers and a book, The Obesogen Effect, consistent with the role of obesogens in controlling weight.
A recent global study found almost 90% of free-range egg samples from contaminated sites in developing nations exceeded the European Union (EU) maximum food limits for toxic pollutants. Plastic waste is a major contributor to the pollution.
Dioxins and dioxin-like polychlorinated biphenyls, commonly known as PCBs, are persistent organic pollutants, or POPs, that spread easily in the environment, accumulate in the food chain, and take years to biodegrade. They are linked to health effects such as cancer, hormone disruption, and alterations on brain development. While the global Stockholm Convention has regulated these kinds of chemicals since 2004, this study illustrates that dioxins and PCBs still pose major health threats to children and families around the world. The new study comes on the heels of a report that found most countries are failing to manage PCBs, and are far from achieving the Stockholm Convention goal of safe PCB management by 2028.
Food is the most common exposure pathway for POPs to humans. People are often exposed through fatty foods such as poultry, seafood, meat, milk, and eggs. Being the cheapest animal protein source with the lowest environmental impact, eggs are an important source of nutrition for poor people around the world. Yet, at the same time, the researchers describe them as the most sensitive exposure pathway because chickens feed on contaminated soil and ash every day, and transfer POPs to their eggs. People, especially children, eating just one egg a day, can easily exceed health-based values set by the World Health Organization and the EU.
For the study, researchers analyzed 113 groups of egg samples from free range chickens living near commercial and dump sites in developing countries, using sampling data from the International Pollutants Elimination Network and Arnika, a Czech environmental non-profit. “We have been collecting egg samples and mapping hotspots for almost 20 years with the International Pollutants Elimination Network, a network of more than 120 countries around the world,” Jindrich Petrlik, the lead author and director of Arnika, told EHN.
About 88% of sampled eggs exceeded the EU regulatory limit for dioxins and PCBs. In addition, 14% of egg samples exceeded the EU food limits by more than 10 times. The sample with the highest contamination came from eggs produced near an e-waste site in Ghana, at 264-times the EU food limit for dioxins. A child eating one egg from this site is exposed to more dioxins than the tolerable limit for five years.
Contaminated ash in Kendalsari.
Credit: Jindrich Petrlik (Arnika & IPEN)
The researchers found extremely high egg contamination at sites that burned plastic. For example, the e-waste site in Kenya with the overall highest contaminated egg samples openly burns plastic. Samples from a tofu factory in Indonesia that uses plastic as fuel for burners yielded very high contamination levels as well. There were also two sites in Java with high levels, in all of these cases,e chickens consumed ash from the burning plastic waste.
When burned, plastics release a large amount of dioxins because they have chlorinated compounds, like PVC, which is used to insulate copper cables. Burning PVC with copper and other metals speeds up the reaction and releases a large amount of these toxins. Furthermore, burning plastic can release more than 2,400 other hazardous chemicals, as well as greenhouse gasses that contribute to climate change.
The Stockholm Convention suggests substituting PCV in plastic to prevent creation of dioxins. However, after 20 years of the treaty, no major replacements have been introduced. According to Petrlik, this is because the chlorine industry is powerful enough to influence policy and avoid PVC substitutions.“This needs to be an important part of the new treaty on plastics,” Petrlik told EHN, “if we forget to talk about contamination from plastic disposal, then the treaty definitely won’t address the whole problem.”
The authors also offer several solutions including: