A long-anticipated report released July 28 by an ad hoc committee appointed by the National Academies of Sciences, Engineering and Medicine provides guidance to the Centers for Disease Control on per- and polyfluoroalkyl substances, or PFAS, which are chemicals with almost ubiquitous exposure in the U.S.

Michigan State University professor Kevin Elliott, one of the 16 scholars from across the country invited to serve on the committee, helped to produce an objective and authoritative review of current evidence regarding the human health effects of the most widely studied PFAS. It offers information on who, when, how and what to test, as well as the benefits and harms of testing for the chemicals.

Elliott is a member of MSU’s leading Center for PFAS Research, and has served on the Guidance on PFAS Testing and Health Outcomes committee since February 2020. He is a philosopher who studies the role of values in science as well as a range of ethical issues related to science and technology, and is jointly appointed in MSU’s Lyman Briggs College, the Department of Fisheries and Wildlife and the Department of Philosophy. Following is a Q&A with Elliott on the impact of the report.

Can you mention any highlights from the report that stand out to you?

There are four items I’d like to point out:

• Our report recommends that clinicians offer blood testing for PFAS to patients who are likely to have a history of elevated exposure to PFAS. This is significant because many people in contaminated communities have wanted to get their blood tested and have felt that testing was difficult to obtain. The report also helps clinicians understand how to interpret blood test results and what follow-up care is appropriate for different PFAS blood levels. This is significant because many clinicians don’t know much about PFAS and other environmental health threats.
• The report also assesses the current research on how PFAS exposure affects human health. The committee concluded that there is sufficient evidence of association between PFAS exposure and decreased antibody response, abnormally high cholesterol, decreased infant and fetal growth, and increased risk of kidney cancer. It also concluded that there was limited or suggestive evidence for a number of other effects.
• It provides advice to the CDC and the Agency for Toxic Substances and Disease Registry on how they should update their guidance for clinicians on treating patients with PFAS exposure.
• Finally, I think it’s valuable that the report provides a model for engaging with communities and trying to develop an understanding of their perspectives, values and concerns. For example, the committee received input from a number of community members and community liaisons through town halls and written materials, and this helped to inform the committee’s deliberations.

Why is PFAS a health issue that all Americans should be paying attention to?

PFAS is an important issue because: 1) there is evidence that elevated exposure to PFAS can have significant health effects; 2) PFAS exposure is extremely widespread — our report estimates that almost everyone living in the U.S. has been exposed to at least one PFAS; and 3) PFAS are very persistent in the environment — they are sometimes called “forever chemicals” because they contain carbon-fluorine bonds that do not break down naturally.

Even beyond just the issue of PFAS, the committee found that clinicians need greater knowledge about environmental health issues and the effects of chemical exposures on people’s health. We heard in our town halls about patients whose clinicians were fairly dismissive of their concerns and who knew very little about PFAS, even in communities that were dealing with PFAS contamination. Previous NAS reports have discussed the importance of providing greater education for clinicians about environmental health issues, and our report also indicated that this issue needs to be addressed.

Do you have any observations related to this report that will be important to Michiganders?

The state of Michigan includes a number of communities where PFAS contamination has been identified, so this topic is highly relevant to our state. MSU’s Center for PFAS Research is studying many issues related to PFAS, and I was really pleased that Courtney Carignan, a member of our center who has been actively involved in working with many of these communities, served as one of our community liaisons.

Can you explain your expertise as it relates to PFAS and the link between your research in philosophy and science?

I am a philosopher of science who specializes in studying the ethical and social dimensions of scientific research. Much of my research has explored how values of various sorts can and should influence research, especially on topics related to environmental health. My expertise in philosophy was especially relevant to the report because part of the statement of task was to develop principles for biological testing and clinical evaluation “given substantial scientific uncertainty about the health effects or the value of such measures in informing care.” Thinking about how to respond to uncertainty is an important philosophical question, especially because so many threats to environmental health involve a great deal of uncertainty.

Two of the principles that I think are especially important for handling uncertainty and that the report really emphasized are justice and autonomy. The principle of justice calls for balancing benefits and harms fairly across at-risk individuals, and striving to enable everyone to lead healthy lives, regardless of their social circumstances. I’m also pleased that the report emphasized the importance of considering environmental justice, which involves understanding how environmental risks are distributed unequally, and thinking about the social and historical forces that contribute to this problem and that can help in identifying solutions. The principle of autonomy affirms that health care decisions should respect patients’ individual values. For example, the report consistently emphasized the importance of fostering shared, informed decision-making between patients and clinicians to decide whether to engage in PFAS testing, and how best to follow up on the results.