In 2001, Cincinnati attorney Robert Bilott sent a letter to EPA Administrator Christie Whitman, U.S. Attorney General John Ashcroft, and state officials, warning them about a little-known chemical that was turning up in the environment near Parkersburg, West Virginia.
Trying to discover what was causing cows in a town near his grandmother's home to die at an unusually high rate, Bilott had noticed perfluorooctanoic acid, or PFOA, on a list of substances that DuPont, the area's largest employer, had dumped in a landfill.
PFOA was not only in the land, Bilott eventually discovered, but also in the water supply.
The story is the basis of the movie "," in which Bilott is played by Mark Ruffalo. The film dramatizes the 20-year battle Bilott and West Virginia citizens fought against DuPont's environmental contamination. Bilott also published a book about his battle, called , in October.
"We were dealing with something completely unregulated at the time, this chemical called PFOA," Bilott said in an interview with ľֱ.
In the past decade, PFOA has been linked to six diseases: kidney cancer, testicular cancer, thyroid disease, high cholesterol, pre-eclampsia, and ulcerative colitis.
Also known as C8 (for its eight-carbon chain chemical structure), PFOA had been used in Teflon and other non-stick coatings since just after World War II, decades before the EPA existed.
Documents in DuPont files showed "the company had been studying it for years and found all kinds of toxic effects," Bilott said. "But the folks being exposed to it hadn't been told, and the government regulators hadn't been told."
A class action suit against the company resulted in a settlement, but DuPont "still held the position that they did not believe the chemical presented any risk of harm to humans," he noted.
"We thought their documents said just the opposite."
In the settlement, both sides agreed to develop an independent to assess PFOA risks. DuPont would fund an led by a local primary care doctor, Paul Brooks, MD, to interview and collect blood samples from about 69,000 people in the area.
"At 69,000 people, it probably was an unprecedented size for an environmental study," said Alan Ducatman, MD, MS, professor emeritus at West Virginia University in Morgantown. "What also was unusual was that, if you looked at the total eligible population, the estimated participation rate was around 80%."
It took 7 years for members of the C8 Science Panel to analyze the data and release their findings. In the end, they confirmed a "probable link" between PFOA and , including two types of cancer.
A group of physicians -- the C8 Medical Panel -- then worked to determine for these diseases so they could be detected early.
"We did this because we saw many doctors in local communities [who] didn't know anything about the chemical or its potential health effects," Bilott said. "We had doctors at the cancer hospital in Columbus [Ohio] who were treating these people, but had never heard of this exposure. We wanted to do whatever we could to get this information out to the medical community."
Beyond the six diseases, people exposed to PFOA may face other health problems, noted Ducatman, who's worked on PFOA epidemiology studies.
"Vaccine response is less in children who have had relatively high levels of exposure," he told ľֱ. "At an individual level, that's a concern. At a population level, it becomes a public health issue."
Sex hormones and fertility also may be affected by PFOA levels, he said. Data linking PFOA concentrations to liver cancer and breast cancer are "worrisome," and uric acid levels are higher in exposed people, he added. "And there's a lot of animal and emerging human evidence that PFOA causes steatosis, or fatty liver," he stated.
In the U.S., PFOA is no longer on the market, but the problem isn't over, Ducatman noted: "Our exposures are going down, but we still are importing products from places that use C8."
And PFOA is just of per-and polyfluoroalkyl substances () that resist heat, stains, oil, and water, and one of several tied to health concerns.
"There are so many different slippery products, or water-resistant products, or stain-resistant products we don't think about, but they're all around us," said Ducatman.
"These things are so amazingly useful," he continued. "Products depending on this class of chemicals have been used in firefighting foams, house wrap, water-resistant breathable garments, rugs and upholstery, bicycle chain lube, coated paper for microwave popcorn and dog food bags ... it just goes on and on."
PFAS are now popping up in drinking water and blood samples throughout the planet, Bilott observed. "People are becoming aware that the problem is not just one chemical, in one community. It's a family of chemicals being found all over," he said.
Nearly in the CDC's National Health and Nutrition Examination Survey have PFAS in their blood. And as of October 2019, the Environmental Working Group reported that had confirmed PFAS contamination.
"It took us 20 years to bring out the facts and confirm the health effects of PFOA and make that information available to everybody. And, unfortunately, what's happening now with these related chemicals is that companies say there's just not enough known about the health effects to regulate or limit these," he continued.
"It's almost like we're back to the beginning again, that we're where we were with PFOA 20 years ago."
Bilott hopes to expand the PFOA model of a science panel and a medical panel to the larger group of PFAS chemicals on a national scale. Late last year, he in Ohio federal court "on behalf of everyone in the country who has this broader group of chemicals in their blood, to require the establishment of new studies and testing to confirm what these chemicals will do -- and to have the companies that are exposing us pay for those studies, not taxpayers," he said.
Education is the key, Bilott added: "Most of us didn't know we were exposed to this."
But if people are given information about what these chemicals are and how they might be exposed, "I'm hoping some will have the ability to make choices to avoid it, or at least switch to products or do things that could help minimize their exposure going forward," he said.