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"In 2014, my world changed forever when I learned my family was exposed to contaminated drinking water containing high levels of PFAS. Since then, I haven't stopped worrying about my family's health," says Andrea Amico, a New Hampshire resident and PFAS community advocate turned national activist.
<p>"Impacted communities didn't get a choice in their exposure. We were contaminated without our knowledge or consent. And now we have to grapple with anxiety and worry that our immune systems could be harmed by PFAS contamination that could make us more vulnerable to COVID-19."</p><p>Andrea isn't alone. She's one of many leaders across the country who live in <a href="https://pfas-exchange.org/resources/" target="_blank">PFAS-exposed communities</a> that fear for the lives of their families and how their PFAS exposure will affect their ability to fight COVID-19.</p><p>PFAS are per- and polyfluoroalkyl substances, a class of chemicals used since the 1940s to make products non-stick, waterproof, and stain-resistant. They're used in rain jackets, carpets, upholstery, cookware, fast food packaging, dental floss, and much more. </p><p>Dubbed 'forever chemicals' due to extreme environmental persistence, they've been found in environmental samples worldwide. An estimated 110 million American residents have PFAS in their tap water, partly due to widespread use in certain firefighting foams; the <a href="https://www.cdc.gov/biomonitoring/PFAS_FactSheet.html" target="_blank">Centers for Disease Control and Prevention</a> has found PFAS in the blood of most Americans.</p><p>PFAS also have been linked to many <a href="https://www.atsdr.cdc.gov/toxprofiles/tp.asp?id=1117&tid=237" target="_blank">health effects</a> including high cholesterol and cancers, even at low levels of exposure.</p><p>Most concerning during this global pandemic, however, is that exposure to PFAS suppresses the ability of the <a href="https://ntp.niehs.nih.gov/ntp/ohat/pfoa_pfos/pfoa_pfosmonograph_508.pdf" target="_blank">immune system</a> to make antibodies—the part of the immune system critically important in fighting COVID-19 and other infectious agents. </p><p>Exposed children have been reported to have decreased responses to common childhood vaccines, an impairment that lingers into teenage years. Studies of adults exposed to PFAS also have shown diminished responses to flu vaccines.</p><p>Our studies have found that laboratory animals exposed to PFAS have decreased antibodies, verifying what we have seen in PFAS-exposed people and making us confident that PFAS are toxic to the immune system. </p><p>Just last month, the Agency for Toxic Substances and Disease Registry issued a statement about the potential intersection between <a href="https://www.atsdr.cdc.gov/pfas/PFAS-health-effects.html" target="_blank">PFAS exposure and COVID-19</a> and cited findings linking PFAS exposure to reductions in antibody responses to vaccines and resistance to infectious diseases. </p><p>Unlike other synthetic chemicals that affect the immune system, such as polychlorinated biphenyls and trichloroethylene, PFAS are unregulated by the U.S. government; currently there are no federal drinking water standards for PFAS.</p><p>As well as being 'forever chemicals' in the environment, PFAS can remain in human bodies for days, weeks, months, or years. This means that as we take PFAS into our bodies each day, through the water we drink, the food we eat, and the products in our homes and workplaces, some remain behind and build up in our bodies over time.</p><p>The U.S. Environmental Protection Agency (EPA) has a drinking water "<a href="https://www.epa.gov/ground-water-and-drinking-water/drinking-water-health-advisories-pfoa-and-pfos-questions-and-answers" target="_blank">health advisory level</a>" of 70 parts per trillion for two individual PFAS, but this advisory isn't an enforceable standard, so public water supplies aren't required to monitor or treat water to remove PFAS. Furthermore, this guideline only addresses two of more than 5,000 individual PFAS and is not low enough to protect the sensitive immune system, especially in children.</p><p>The public needs to be protected from PFAS in their drinking water with a legally enforceable federal standard. We support the <a href="https://www.epa.gov/newsreleases/aggressively-addressing-pfas-epa" target="_blank">EPA's efforts</a> in moving forward with such standards for PFAS.</p><p>Current policies that allow these chemicals to remain in the environment, drinking water, and commonly used products are putting human health, and our future, at risk. The chemical industry continues to add these chemicals to products despite knowing that they're toxic and the EPA still approves <a href="https://www.epa.gov/assessing-and-managing-chemicals-under-tsca/risk-management-and-polyfluoroalkyl-substances-pfas" target="_blank">new PFAS formulations</a> for the market.</p><p>But together we can create a better future.</p><p>The responsible thing to do is shift to healthier products through changes in <a href="https://pubs.rsc.org/en/content/articlelanding/2019/em/c9em00163h#!divAbstract" target="_blank">policy</a> and <a href="https://pubs.acs.org/doi/abs/10.1021/acs.estlett.0c00255" target="_blank">management</a>, consumer <a href="https://pfascentral.org/pfas-basics/pfas-free-products/" target="_blank">demand</a> and <a href="https://silentspring.org/detox-me-app-tips-healthier-living" target="_blank">education</a>, investment in <a href="https://www.turi.org/Our_Work/Alternatives_Assessment/Alternatives_Assessment/TURI_Alternative_Assessments" target="_blank">safer alternatives</a>, and <a href="http://www.testingforpease.com/" target="_blank">community action</a>. These shifts require bold, coordinated action, but if we work together, we can create a healthier and more resilient future.</p><p>Andrea Amico's family was exposed to high levels of PFAS through drinking water contaminated by firefighting foam at a former Air Force Base. </p><p>She stays awake at night worrying about long term effects PFAS will have on her family's health, but now has the added burden of worrying if they're more at risk of contracting COVID-19, of experiencing symptoms longer, and when a vaccine is available, if it will be effective enough to protect her family due to the potential impacts of PFAS exposure on their immune systems.</p><p>"This global pandemic is scary for everyone and it's even scarier knowing your family has been exposed to chemicals that may hurt the immune system when it's needed most."</p>
<p> <strong><em>Author's affiliations: </em></strong><em>Jamie DeWitt, East Carolina University; Phil Brown, Northeastern University; Courtney Carignan, Michigan State University; Shaina Kasper, Community Action Works; Laurel Schaider and Maia Fitzstevens, Silent Spring Institute.</em> </p><p><em>Andrea Amico of <a href="http://www.testingforpease.com/" target="_blank">Testing for Pease</a> contributed as well.</em></p><p> <em>Their views do not necessarily represent those of Environmental Health News, The Daily Climate or publisher, Environmental Health Sciences.</em> </p><p><em>Banner photo: Air Force meeting on PFAS contamination. (Credit: </em>AFCEC/<span style="background-color: initial;">Malcolm McClendon)</span></p>
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Exposure to endocrine-disrupting chemicals in medicine and medical devices is grossly underestimated, and physicians have an ethical obligation to talk about these exposures with their patients, according to a new study.
<p>Authored by researchers at the University of Illinois at Chicago, the paper synthesizes scientific literature on the presence and potential health impacts of endocrine disruptors in medication and in the many plastic devices (e.g., catheters and blood bags) used in medical procedures. Such chemicals can mimic the body's hormones and have been linked to multiple health impacts, including infertility, cancer, heart disease and stroke, neurodevelopmental problems and immune system dysfunction. </p><p>The study, published today in the Endocrine Society's<em> <a href="https://academic.oup.com/jcem/article-abstract/doi/10.1210/clinem/dgaa358/5862419?redirectedFrom=fulltext" target="_blank">Journal of Clinical Endocrinology & Metabolism</a>,</em> finds strong evidence that these chemicals found in health care might not only be promoting disease, but antagonizing the efficacy of treatment, and concludes that failure to disclose this information to patients violates core medical ethics. The authors acknowledge the life-saving and health promoting benefits of these medicines and treatments, but say the risks must be weighed against the benefits.</p><p>"There's this ethical obligation for physicians to actually do something about it," said lead author Robert Michael Sargis, an endocrinologist in the Department of Medicine at the University of Illinois at Chicago. </p><p>"Health care becomes this exposure paradigm," he added. "It's not just pollutants in the air and water, and it's not [just] personal care products. Now it's something that physicians are actually doing to patients." </p><p>Many physicians, however, remain unaware of the risks of endocrine disruptors, or the extent of the problem in medical care, Sargis and colleagues warned. </p><p>"They're so right, there's an ethical issue here," said Ted Schettler, Science Director of the Science and Environmental Health Network, which was not involved in the study. </p><p>The chemical dangers in medical devices is "a story that doesn't seem to want to end," he added, recalling his work with Health Care Without Harm 20 years ago to remove polyvinyl chloride tubing from medical devices because it contained the plasticizer diethylhexyl phthalate (DEHP). </p><p>Among the findings of the new research review:</p>
<ul><li>Dibutyl phthalate (DBP) and diethyl-phthalate (DEP) were found in a broad spectrum of over-the-counter and prescription medication, and are commonly added to drugs for gastrointestinal disorders, such as omeprazole.</li></ul><ul><li>Parabens are added to drugs for their antimicrobial activities and were similarly found in many medications, including fluoxetine (Prozac), ibuprofen and acetaminophen.</li></ul><ul><li>Parabens are incorporated in intravenous solutions, ultrasound gels and heparin lock solutions for their broad-spectrum antimicrobial activity. </li></ul><ul><li>Phthalates were found in some strengths of the drug Cardizem CD, but not all, and one butterfly blood draw kit released significantly higher levels of parabens than others, suggesting that safer options are possible. </li></ul><ul><li>Studies document the release of phthalates, bisphenol A (BPA), parabens, perfluoroalkyl substances (PFAS) and triclosan from medical supplies, such as syringes, endotracheal tubes, blood bags and catheters. Phthalates account for 30 to 40 percent of the weight of medical use plastics.</li></ul><ul><li>A 2019 study on 52 common neonatal intensive care unit (NICU) items found that three-fifths contained BPA and four-fifths contained parabens.</li></ul>
<p>Many of the studies detected endocrine disruptor metabolites in urine following medical interventions.</p><p>Given the complex, and oftentimes delayed, ways in which these chemicals impact health, few studies have been able to connect those exposures to health endpoints. However, Sargis did point out one study that found thyroid hormone changes when people were put on a certain set of medications.</p><p>Exposure to endocrine disruptors in neonatal intensive care units is "most concerning" said Sargis, "because the children are some of the most vulnerable patients that we ever see," and they receive a lot of medical interventions that use plastic devices found to contain endocrine disruptors. Low levels of exposure to endocrine disruptors during development is associated with impacts years later in life. </p><p>The authors stress that the risk from these medical exposures is likely understated because our knowledge is restricted to a few known classes of endocrine disruptors and a limited set of medical devices. </p><p>They call on physicians to learn about their role in exposing patients to these chemicals, and urge them to live up to their ethical mandates to discuss the risks with their patients. They also call on regulatory agencies and manufacturers to identify and eliminate endocrine disruptors in medications and medical devices and develop safer alternatives. </p><p>While Schettler agrees that raising awareness is important, he said, "there's only so much you can do in that regard and, at some point, the regulatory agencies really need to step in and do their job."</p><p>Sargis emphasized the importance of proper medical care. "These devices and [medicines] … save life and improve health. This is really meant to be a moment to reflect on what we're doing, and try to identify ways to move forward in a better way."<br></p><p>Our goal is "to ensure that we're doing best by our patients…in essence what we're asking for is a shift in the system such that we can ensure that the meds and medical devices we use protect endocrine health," he added. </p>
<p><em>Banner photo credit: </em><em><a href="http://homedust.com/" target="_blank">Homedust.com/flickr</a></em><a href="http://homedust.com/" target="_blank"></a></p>
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