Scientists recommend cholesterol drug to remove PFAS from islanders’ bodies

The ‘PFAS Scientific Advisory Panel‘ met on Wednesday morning to discuss treatment options and costs for the 50 St Ouen residents who have been heavily exposed to PFAS through their water supply.

The area of known contamination is located near the Airport, where fire-fighting foam containing PFAS made by 3M was sprayed before entering nearby streams and private borehole supplies. 

In 2004, the foam’s manufacturer, US multinational 3M, struck a £2.6m secret deal with the States of Jersey, which went towards cleaning up the contaminated ground, as Express revealed in 2021.

The Explainer | PFAS: The Secret Deal – Bailiwick Podcasts

But islanders who live and previously worked in the area remain deeply concerned about impacts on their health today.

While the expert PFAS panel had previously suggested exploring bloodletting for removal, as Express first reported in 2023, yesterday they explained why they felt this should only be a potential “second line” option, as opposed to cholesterol drugs known as bile acid sequestrants.

Medication recommended

These medications bind to substances in the intestines, preventing their reabsorption, and are commonly prescribed to lower cholesterol.

The panel – consisting of Chair Steve Hajioff, Tony Fletcher, and Ian Cousins – explained that sequestrants are safe, well-tolerated, and the most practical solution available. 

They recommended prioritising them for women of childbearing age who might become pregnant to reduce prenatal exposure, explaining that lowering PFAS levels in this group is about “preventing another human being from being exposed.”

The treatment costs range from £8,760 to £23,255 per year, depending on the specific type of medication used. 

The panel used colesevelam, the most expensive option, in their cost analysis as a worst-case scenario. 

While sequestrants can interfere with vitamin and drug absorption, side effects are generally mild, with constipation and gastrointestinal discomfort being the most common.

The panel’s cost-effectiveness analysis concluded: “Bile acid sequestrants outperform other interventions in terms of efficacy significantly; they are thirty per cent more effective than the next most effective intervention in the real world and have more than double the efficacy of any viable intervention. 

“Bile acid sequestrants are marginally cheaper than any other form of intervention but are markedly more cost-effective than any other option, more than an order of magnitude better than the next best, in terms of cost-effectiveness.”

Could high-fibre or vegan diets be key?

Psyllium husk, a natural fibre supplement typically used to relieve symptoms of constipation, was also discussed as a relatively simple and low-cost alternative. 

At a meeting in November, the panel’s Chair Dr Hajioff, noted three options for administering the intervention – generic powder, branded powder or capsules – and said costs could range from £30 to £434 per patient per year.

However, the panel noted that while diets high in fibre are associated with lower PFAS levels, there is insufficient evidence to confirm that fibre supplements alone would have the same effect.

The panel went on to discuss how high-fibre diets could be encouraged as a lifestyle change to help manage PFAS levels in affected residents. 

Dr Hajioff explained: “We’ve talked about fibre and probiotics as not really having the right evidence to be the primary treatment, but they are things that we might suggest that people do as an adjunct or as a lifestyle change to help them manage their PFAS levels. 

“So we have a recommendation around a high-fibre diet, and potentially the use of prebiotics or probiotics or fibre supplementation might be something that you consider as part of your lifestyle.”

While one panel member suggested they would “recommend a vegan diet because that would also be very effective”, the Chair admitted that he would be “a bit worried about how people might react to that.”

Alternatives dismissed

Alternative treatments were dismissed – due to cost, risk, or lack of evidence – or considered as secondary alternatives. 

Haemodialysis, a method used for kidney failure that filters blood through a machine, was deemed too expensive and unsafe. 

Setting up a haemodialysis programme would require over £100,000 in initial costs, with annual operating expenses estimated at £1.38 million for 50 patients.

The panel described it as “crazy expensive and really quite dangerous for people.”

Probenecid, a gout medication that prevents kidneys from reabsorbing certain substances, was also considered but rejected due to a lack of supporting evidence – with Panel Chair Dr Hajioff saying “it doesn’t work” for PFAS removal. 

Plasma removal therapies, which involve filtering PFAS out of the blood, were deemed too costly and impractical.

First-year costs were estimated at £300,000, with annual costs around £250,000 thereafter.

The panel also noted that plasma removal requires significant hospital resources, is not well tolerated, and carries risks. 

However, the scientists left open the possibility of considering plasma removal as a second-line option for a few individuals who cannot use bile acid sequestrants for some reason.

Could blood-letting still happen?

In October 2023, the PFAS panel recommended that the Government offer a programme of ‘therapeutic phlebotomy’ for residents affected by PFAS as an interim measure, pending the group carrying out a detailed review of the health effects of PFAS and the effectiveness of different types of potential interventions.

Literature reviewed by the experts found evidence to suggest that therapeutic phlebotomy – which is, in essence, taking blood to derive benefit for the donor –might help reduce the amount of PFAS in people’s bodies without great additional risk, and may also help increase knowledge on the subject.

They discussed it as a relatively simple and lower-cost option compared to plasma removal, but still felt it should only be considered as a potential option for those unable to tolerate sequestrants, not as a primary recommendation.

Dr Hajioff said: “Phlebotomy is potentially recommendable as a second line, but very much the first line is bilateral sequestrants.”

More islanders could be tested

The panel also discussed setting thresholds for PFAS exposure. They recommended offering bile acid sequestrants to women of childbearing age with PFAS levels above 10 ng/mL and making them available through normal healthcare channels for those with levels above 20 ng/mL.

They also suggested widening testing for traces of the so-called “forever chemical” among those who were exposed to PFAS as a result of their occupation, such as firefighters and other airport workers.

The panel will hold a public meeting on 11 February with their next formal meeting scheduled for 27 February. 

Catch up: PFAS and Jersey… a brief history

PFAS (perfluoroalkyl and polyfluoroalkyl substances) are a group of man-made chemicals, often referred to as ‘forever chemicals’ due to their inability to break down in the body or the environment.

PFAS was an ingredient added to everyday items such as frying pans, outdoor jackets and floor tiles because of its ability to repel water, heat, and oil. 

Mains drinking water in Jersey contains only trace amounts, and a report recently published by Jersey Water said that 99.95% of water samples across the island meet regulatory standards, although some islanders disagree with the current limits.

The chemicals can, however, be found in higher concentrations in some parts of the island. 

One type of these ‘forever chemicals’, called PFOS, was an ingredient of firefighting foam sprayed at Jersey Airport for several years until the chemical was banned in the 1990s.

Concerns that this may be affecting the private supplies and health of St Ouen residents living under the runway were first raised publicly by Sarah Simon, who suffers from skin, thyroid and autoimmune disorders, as well as joint and nerve pain and revealed to Express how she had tested her own blood to prove that she had elevated levels. 

Her concerns were backed by others living in the area. She also received the support of US lawyer Rob Bilott, whose own battle against a corporate giant found contaminating water supplies was made into a Hollywood film starring Mark Ruffalo, Dark Waters.

After sharing details of Ms Simon’s plight, an Express investigation in 2021 uncovered a secret contract between the Government and the foam’s manufacturer, US multinational 3M.

Agreed by the States Assembly two decades ago after a behind-closed-doors debate, the deal resulted in 3M giving the government of the day £2.6m, which went towards cleaning up the contaminated training ground and building a new rig on the site.

It also meant the Government was legally bound to help the manufacturer defend any claims made against it, including by islanders who believed their health had been damaged.

Two years later in 2022, 78 islanders volunteered to have their blood tested for PFAS as part of a Government-sponsored programme. Every one of them was found to have it in their blood, with 80% having at least one type of PFAS at a high concentration.

The PFAS Scientific Advisory Panel was set up the following year to explore options to support approximately 50 islanders affected by elevated exposure to PFAS and make recommendations to Ministers and the Director of Public Health.

While much of the focus to date has been on the contamination of private supplies in St Ouen, campaigners have more recently turned their attention to mains supplies and are questioning whether current regulations should be tightened.

Paul Le Claire, a former Deputy who took part in the behind-closed-doors debate which culminated in the secret deal with 3M, has created a petition calling for investment in a water treatment plant. It has been backed by more than 1,000 islanders, meaning Ministers will have to respond.

With growing global recognition of the potential health impacts of PFAS exposure, international standards are due to change, with EU and UK regulations tightening in 2030.

Jersey Water CEO Helier Smith told Express last year: “Once those UK regulations come into place, it’s always going to be our intention to be fully compliant.” 

The company has also conducted promising trials of treatment technologies, with one filtration system which separates PFAS from water using small air bubbles called SAFF being trialled back in 2022.

Mr Smith said the trial of SAFF had been “widely successful”, though Jersey Water clarified that this was a small-scale laboratory test and that they had not yet made a decision on which treatments to use.