It was a virtual session and perhaps not as enlightening as some might have wished, but the Pennsylvania Department of Health offered residents of Bucks and Montgomery counties an update on the multi-site federal study being conducted on PFAS-contaminated water and its effect on health.
PFAS, or per- and polyfluoroalkyl substances, are a toxic class of manmade compounds used in everything from dental floss, to nonstick kitchenware, to stain-repellent clothing. They don’t break down naturally in the environment or the human body — a quality that’s earned them the dubious title of “forever chemicals” — and exposure through contaminated drinking water has been linked to high cholesterol and thyroid problems, certain cancers, and suppression of the immune system.
In Horsham, Warminster, and Warrington Townships, where firefighting foam containing PFAS was used at now-decommissioned military air bases, the chemicals seeped into the ground and contaminated neighborhood drinking water for decades. Neighbors of those bases say they are concerned for their own health, and for those who come after them.
Thursday night’s Zoom meeting provided an opportunity for the 149 community members participating to pose questions and offer comments about the study, which was announced last year. The Q&A period lasted more than an hour after the formal presentation ended.
Some wanted more clarification on the research parameters of the study. Others were frustrated at the perceived delay, or distrustful of the military bases’ self-reported data.
Locally, 1,000 adults and 300 children exposed to PFAS-contaminated drinking water will be recruited in Horsham, Warminster, and Warrington for a federally funded health survey and blood and urine sampling. Together, Bucks and Montgomery counties are among seven sites chosen by the Agency for Toxic Substances and Disease Registry and the Centers for Disease Control and Prevention to participate in the study, which nationally will recruit at least 2,000 children and 6,000 adults who were exposed to PFAS-contaminated drinking water.
The project received approval from the Office of Management and Budget only a few weeks ago, and plans are to establish an on-site office and operational headquarters (as well as recruit local staff for that office) by spring 2021. Data collection will begin that summer and continue until fall 2021, with an estimated end date for analysis and reporting the following spring. The national study’s final results will be released in 2023 or 2024, assuming all sites can move forward despite COVID-19-related study complications.
Many participants at Thursday’s virtual meeting asked about cancer impacts, which the federal agencies’ study does not specifically address. Other researchers on the team, including state Department of Health representative Dr. Sharon Watkins and Temple University epidemiologist Dr. Resa Jones, said they hope to raise outside funding to study that issue.
The Philadelphia region is particularly critical to study because of a multitude of factors, Watkins said: its dense population and highly engaged community; a long history of residential exposure to PFAS; and an array of high-quality data sources from the Navy and the National Guard that make historical reconstruction of PFAS levels more feasible.
“This is a long time overdue, because our area has been kind of sitting in the dark for such a long time,” said former Warminster resident Hope Grosse, who is working with the study as a partner with the Buxmont Coalition for Safer Water. “The community, they’re eager, but I’m not sure they trust in what’s happening.”
For Grosse, it’s personal. She grew up across the street from the now-closed Naval Air Warfare Center in Warminster, and she remembers playing in the creek that ran from the naval base property down the side and toward the back of her childhood home. Her family drank from the well in their front lawn for years and never suspected that the water could be toxic. It was only when she was diagnosed with cancer at age 25 that she began to wonder what was going on.
“I was working in real estate at the time … I had some clients at the Bucks County Department of Health,” Grosse said in an interview. They showed her a map of the area, where she recalls seeing dozens of red dots — each one signifying a person who had died of cancer. One of them was her own father.
“So that sticks in my head really closely.”
It is her hope that the study will prompt accountability on the government’s part, and change in the regulation of PFAS.
“They’ve never really looked at the health and wellness of our communities — they’ve only ever talked about cleanup, cleanup, cleanup, and cleanup consists of the Navy base only, but not the neighborhoods around,” she said.
When it comes to PFAS, how much is too much?
Numerous participants at Thursday’s meeting expressed concern about current PFAS-related regulations, with one person mentioning installation of a reverse-osmosis filtration system to reduce PFAS in that household’s drinking water. The Environmental Protection Agency currently has a recommended limit of 70 parts per trillion for PFOA and PFOS, two of the most commonly researched PFAS chemicals; most water tests in the area have indicated levels under that limit.
But environmental advocates say the EPA’s limit is still too high to protect public health. They are backed up by several state authorities, including New Jersey’s Department of Environmental Protection, which in April approved maximum contaminant levels at 14 ppt for PFOA and 13 ppt for PFOS — among the most stringent standards in the country.
Even so, scientists haven’t yet mined the depths of PFAS exposure and long-term health effects.
“The understanding is incomplete; we know enough to be concerned, we know enough to want to minimize exposure. But we don’t know enough to know fully how to respond with empirical data [and] good evidence, to address how much of a concern, at what levels of exposure a concern exists, and so on,” environmental epidemiologist David Savitz explained at the Thursday night session. Though lab studies and animal testing can point to likely adverse affects, he said, “more research is needed … there’s always a challenge expanding from studies in the lab to studies in the human population.”
That’s partly why the federal government is conducting the five-year national study on PFAS exposure and its possible connection to certain human health conditions.
But studies like this are often limited, said Kyle Steenland, professor of environmental health and epidemiology at Emory University. Steenland conducted a similar study on PFOA exposure, a specific compound within the category of PFAS chemicals, in West Virginia.
“These studies are primarily cross-sectional … and the problem with cross-sectional studies is you don’t know which came first, the chicken or the egg,” said Steenland. In other words, has PFAS exposure affected a particular health condition, or could that health condition simply be showing up at the same time? “It’s what we call, in fancy terms, ‘inferring causality.’”
That issue can be minimized both by surveying large groups of people and tracking exposure and effects over time, both through historical reconstruction and recurring testing — which requires a lot of resources. And because research on PFAS is still limited, the desire to expand research needs to be balanced with the importance of maximizing study accuracy, he said.
“It can go both ways. People can get concerned about something that the science is still pretty murky [on], or they can get concerned about this thing they’ve been drinking for years,” Steenland said. So as community members express frustration and fear, and in the absence of more research, scientists have to use the precautionary principle — limiting exposure whenever possible until they can investigate all potential effects.
Grosse agreed. The maximum contaminant level she’s willing to tolerate is zero.
“A year ago, I might have said 14 [parts per trillion],” she said. But the prevalence and combination of toxic compounds is no longer something she wants to compromise on.
“There’s no room for error in our children’s lives,” Grosse said.
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