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State and federal public health agencies often understate the scientific evidence surrounding the toxicity of per- and polyfluoroalkyl substances (PFAS) in their public communications, according to an analysis published today in the journal Environmental Health. Particularly notable was the failure of most messaging to address the greater risks and needs of highly exposed populations.
“As a physician who has had to advise many people whose drinking water has been contaminated with PFAS—sometimes for decades—I know only too well the distress and confusion felt by hard-hit communities,” said lead author Alan Ducatman, a physician and professor emeritus at West Virginia University. “Patients and doctors in PFAS-contaminated neighborhoods need accurate information on how to protect their health.”
Ducatman notes that patients with high exposure often worry about whether their exposure will impact their health or their family’s health, and what they can do about it. For example, patients with newborns are often concerned about breastfeeding, given that PFAS is passed to infants through breastmilk. “We recommend breastfeeding even for highly exposed patients. We simply have more information about the many benefits of breastfeeding than we do about the risks of PFAS in breastmilk. But most of the government websites we reviewed ignored these difficult and complicated situations,” Ducatman said.
The research team reviewed local, state, and national agency webpages, fact sheets, and other online materials about PFAS intended for the public and healthcare providers. They also reviewed similar communications by professional societies and non-governmental organizations. Overall, they noted a failure to differentiate between the risks faced by highly exposed communities versus the general population, failure to distinguish levels of evidence for different health outcomes, overemphasis on the uncertainty of health harm, and failure to discuss how to reduce exposure and risk of harm.
For example, many of the materials reviewed limit the discussion of PFAS health risks to equivocal statements about the existence of “some studies” showing certain PFAS “may” lead to health effects. Community leaders report that health providers predictably read these messages to imply across-the-board low evidence. For certain immune, liver, reproductive, and cancer outcomes such as kidney or testicular cancer, most or nearly all studies have found harm from PFAS exposure.
“The experimental and observational evidence supporting the links between exposure to certain PFAS and adverse outcomes like reduced vaccine responses and liver damage is robust,” said co-author and East Carolina University professor Jamie DeWitt. “Agency websites and fact sheets that use weak language like ‘may cause’ and ‘some studies’ across health outcomes are misleading the public.”
In its heavily cited guidance for clinicians, the Agency for Toxic Substances and Disease Registry (ATSDR) not only uses equivocal language, but also provides examples of ways to dismiss concerns of the exposed patient. It includes little discussion of how patients and doctors can collaborate to reduce exposure and risk. It also ignores the clinician’s interest in community actions that can decrease exposure.
The researchers did find positive examples of communications from some state agencies and nonprofit groups that can serve as models for improvement. They recommend the Connecticut Department of Public Health’s fact sheet, the Association of State and Territorial Health Officials Clinician FAQ, and the clinician guidance on Silent Spring Institute’s PFAS-REACH Exchange website.
Ten leading PFAS researchers, as listed in the paper, are calling on government agencies to update their communications to align with the science and better serve people in heavily contaminated communities.
“Community members, healthcare providers, policymakers, and others consult government websites for unbiased information on PFAS,” said co-author Rebecca Fuoco, science communications officer at the Green Science Policy Institute. “It’s important that trusted agencies accurately communicate the science and provide practical guidance for people who want to protect themselves, their families, and their communities. Using unreasonably dismissive and obtuse language to communicate the risks isn’t just unhelpful, it’s harmful.”
Green Science Policy Institute