BY BRITA E. LUNDBERG, MD, AND MICHAEL BADER, MD
PFAS, short for per- and polyfluoroalkyl substances, are a class that includes over ten thousand chemicals that contain at least one fully fluorinated carbon atom. The carbon-fluorine bond, the strongest chemical bond known, is exceptionally rare;
moreover, nothing in nature can break this bond down. This makes PFAS compounds exceptionally resistant to degradation, leading them to be called “forever chemicals.”
According to the EPA, there is no safe level of exposure to PFAS.
The associated health harms of the chemical class are broad: epidemiologic and toxicologic studies have linked PFAS to reproductive, endocrine, and neurodevelopmental diseases, as well as to some cancers. The chemicals are known to be associated
with infertility, preeclampsia, low infant birth weight, Type 2 diabetes, early-onset puberty, thyroid disease, impaired vaccine response, neurocognitive impairment in children (decreased IQ), and malignancies that include kidney and testicular
cancers.
High-risk populations include children, pregnant women, industry workers, and those who live or work near high-risk facilities such as military bases, shipyards, chemical plants, refineries, or airports.
At the December 2022 Interim Meeting of the MMS House of Delegates, the Society approved a new policy that calls for the MMS to educate Massachusetts clinicians regarding sources of exposure to PFAS, their health effects and potential toxicities,
and mitigation and prevention strategies by increasing awareness of existing educational resources.
In response, the MMS Committee on Environmental and Occupational Health, with expert input and review from the new policy’s co-authors, created an informational report for Massachusetts clinicians, available now on the MMS website.
PFAS are ubiquitous: they are used in thousands of products, including weapons manufacture, nonstick cookware products, paints, clothing, food packaging, pesticides, wastewater sludge, and biosolids that are spread on agricultural crops, and more.
PFAS are also used in medications, breast prostheses, contact lenses, IV tubing, cannulas, and joint spacers. Today, humans are exposed to PFAS via air, soil, food, and water; the latter is thought to be the most common source of exposure.
Over 97% of the US population has detectable PFAS blood levels.
PFAS also pose an important equity issue. A 2023 Harvard TH Chan study showed that Hispanic and non-Hispanic Black populations are more likely to have community water systems contaminated
with PFAS. The cost of mitigating this contamination is extremely high. Hyannis, which formerly had the highest PFAS levels in Massachusetts, spent $10 million in 2015 on a water filtration system; since then, the cost for mitigation has more
than doubled. This can represent a financial obstacle to mitigation for less wealthy communities, further exacerbating health inequities.
PFAS are the lead of our time. Like lead, PFAS are ubiquitous and represent a costly public health and health equity issue. However, the host of illnesses they spawn are not inevitable; they are preventable diseases. Increased public education
around this issue is critical, as is advocacy for more stringent regulations on products containing PFAS. Addressing PFAS contamination using a systematic public health approach — education, mitigation, prevention, and advocacy — will benefit
all communities across the Commonwealth. We hope you will take a moment to review this short informational report.
Brita E. Lundberg, MD, and Michael Bader, MD are members (and Dr. Lundberg is the former Chair) of the MMS Committee on Environmental and Occupational Health.
