What Are Our Doctors Doing?

By Robert O'Neal. A 10-part series on what PFAS can do to our bodies, what doctors are supposed to do about it, and what's actually happening here in Darlington County.

Part 1 of 10: What about us?

Earlier we talked about how PFAS got into our ground and our wells, and who's checking our milk, meat, and vegetables. Now comes the question most of you have asked me in person: what about our health?

These chemicals don't just sit in the soil. They get into the water we drink and the food we grow, and from there into us. Scientists call them "forever chemicals" because they stay in the body for years.

So who is looking after the people? Over the next few parts, I'll go through:

• What the science says PFAS can do to the body, including the heart and thyroid
• The blood test, and how to get one
• What doctors are supposed to do with the results
• Whether most doctors even know about it
• What other states did for their people
• What South Carolina is doing for us

I'm a farmer, not a doctor. Everything here comes from public health agencies and published research, and the sources are listed under each part. Please talk to your own doctor about your own health.

(Part 1 of 10. Share it with your family. This one's about all of us.)

Part 2 of 10: What can PFAS do to the body?

The CDC's own guidance for doctors lists a set of health problems linked to PFAS. It also says these chemicals can stay in the body from a few days to 8 years or more, depending on the type.

What the CDC says PFAS is linked to:

• Higher cholesterol
• Lower birth weight in babies
• Weaker response to vaccines
• Kidney cancer and testicular cancer
• High blood pressure and preeclampsia during pregnancy
• Changes in liver enzymes

The National Academies of Sciences, the country's top independent science advisers, reviewed the same research. They found the strongest evidence for cholesterol, birth weight, vaccine response, and kidney cancer. They also found some evidence for thyroid disease, breast cancer, and ulcerative colitis.

The cancer question. In 2023, the World Health Organization's cancer agency classified PFOA as carcinogenic to humans, its highest category. PFOS, the chemical found most in our soil, was rated "possibly" cancer-causing.

To be fair about it: "linked to" isn't the same as "caused by." High cholesterol has plenty of causes. But the science is clear enough that these are the things to watch.

(Part 2 of 10.)

Part 3 of 10: Heart disease, stroke and blood pressure

The honest answer: the science is still split, but the newest studies of places with contaminated water are pointing toward a real risk.

Why doctors worry about it. One of the best-proven effects of PFAS is higher cholesterol. High cholesterol is one of the main roads to heart attacks and strokes. PFAS is also linked to high blood pressure during pregnancy.

How PFAS raises cholesterol. Scientists are still working out the details, but here's what they've found so far:

• PFAS look like fat to the body. Their shape is close to natural fatty acids, so they ride around stuck to proteins in the blood instead of being flushed out.
• They flip switches in the liver. The liver controls how much cholesterol is in your blood. In human liver cells, PFOA and PFOS turn on a control switch (called PPAR-alpha) that manages how the body handles fat and cholesterol.
• They jam the bile cycle. The liver gets rid of extra cholesterol by turning it into bile, which leaves through the gut. In animal studies, PFAS disrupted that cycle, so less was carried out and more cholesterol stayed in the blood.

The strongest evidence it's real: when people near the DuPont plant got clean water and their PFAS levels dropped, their bad (LDL) cholesterol came down too. The more their PFAS fell, the more their cholesterol fell.

What studies of contaminated towns found:

• Italy. About 150,000 people in the Veneto region drank PFAS-contaminated public water starting around 1985. Researchers found more deaths from heart disease than in the surrounding area, and called it the first formal showing of a link between PFAS and heart deaths.
• Sweden. In the town of Ronneby, one water plant was polluted by firefighting foam. Among more than 45,000 residents, those on the bad water had about 10% more heart attacks, 10% more strokes from clots, and 28% more bleeding strokes, and about 15% more heart deaths.

What other studies found:

• Around the DuPont plant in West Virginia and Ohio, a court-appointed science panel found a probable link to high cholesterol, but no probable link to coronary artery disease or stroke.
• A Swedish study of the general public found PFAS raised cholesterol but did not raise heart attack or stroke risk.

So no health agency lists heart disease or stroke as a proven PFAS effect yet. Studies that compare whole towns also can't prove what caused any one person's illness.

Blood pressure. High blood pressure is the biggest single cause of strokes, so this matters for everything above.

• In pregnancy, the link is the strongest. The CDC lists high blood pressure and preeclampsia during pregnancy among the health effects tied to PFAS.
• In middle-aged women, a federally funded study followed more than 1,000 women for up to 18 years. Women with the highest PFAS levels had about a 71% higher risk of developing high blood pressure than those with the lowest. A follow-up found that differences in PFAS exposure may help explain why Black women tend to develop high blood pressure earlier than white women. In a county where about 4 in 10 people are Black, that's worth knowing.
• The other side. The science panel near the DuPont plant found no probable link between PFOA and high blood pressure in the general population. The women's study only looked at women in midlife, so it may not apply to men.

The good news: blood pressure is easy to check. A cuff at the drugstore or a nurse visit will tell you where you stand.

Why it matters here. Heart disease and stroke are already among the leading killers in Darlington County. A 2019 state health report put our county's stroke death rate at 28.6 per 100,000, against 22.2 statewide. Smoking, weight, and trouble getting to a doctor all play a part. But nobody has ever checked whether the water does too.

If you drank from a well near the sludge fields, keep up with your cholesterol and blood pressure checks. And know the signs of stroke: a drooping face, a weak arm, or slurred speech means call 911 right away.

(Part 3 of 10.)

Part 4 of 10: Thyroid problems

The thyroid is a small gland at the front of your neck. It sets how fast your body runs. When it slows down, people often feel tired and cold and put on weight. During pregnancy, thyroid hormones also help a baby's brain grow.

What studies have found:

• Near the DuPont plant. The court-appointed science panel that studied nearly 70,000 people in West Virginia and Ohio found a probable link between PFOA and thyroid disease.
• Thyroid hormone levels. In more than 52,000 adults from that same community, both PFOA and PFOS were tied to changes in thyroid hormone levels.
• Ordinary Americans. A 2010 study using national health survey data found people with more PFOA in their blood had higher rates of thyroid disease.
• Mothers and babies. A Massachusetts study found that higher PFAS early in pregnancy went with lower thyroid hormone in mothers and in baby boys.

The other side. The CDC's guidance for doctors says it found no consistent evidence linking PFAS to thyroid disease, and the National Academies rate the evidence as limited. A 2025 review argued that newer studies weaken the old "probable link."

What it means for you. Even with the science still debated, the National Academies guidance says people with PFAS blood levels over 20 should get a thyroid test at every checkup. That test (called TSH) is a simple, common blood test. If you drank from a well near the sludge fields and you're often tired or cold for no clear reason, ask your doctor about it. If you're pregnant or planning to be, tell your doctor about your water too.

(Part 4 of 10.)

Part 5 of 10: The blood test

There is a blood test for PFAS. It's a regular blood draw, and it measures how much of these chemicals is in your blood right now.

What it can tell you: your levels, and how they compare to the rest of the country. Almost everybody in America has some PFAS in their blood. The question is whether you have a lot more than most people.

What it can't tell you: how you were exposed, whether PFAS caused a health problem you already have, or whether you'll get sick down the road.

How to get it. Your doctor can order it through Quest Diagnostics, and results take a few weeks. Ask for a panel that covers at least the nine PFAS the National Academies recommend.

What it costs. This is the hard part. Maine's health department puts the cost at roughly $525 to $620, and says insurance coverage varies. In Maine, people on contaminated farms can get the test for free through the state's PFAS Fund. In South Carolina, there's no such program that I know of.

The CDC guidance notes one more thing worth knowing: there is no approved medical treatment to remove PFAS from the body. The main thing you can do is stop taking more in.

A drug being tried: cholestyramine. There is one thing being tried. Cholestyramine is an old, cheap prescription cholesterol drug. It's a powder mixed with water that grabs bile in the gut so it leaves in the stool. PFAS ride along in that bile, so the drug carries them out too.

• In a 2024 Danish trial, 45 adults from a PFAS hot spot took it for 12 weeks. Their PFOS dropped about 60%, and PFOA and a few others dropped 15% to 44%. No serious side effects were reported.
• Two Maine hospitals now have protocols for using it to lower PFAS.

The catch: nobody has shown yet that lowering PFAS this way actually prevents disease, and it isn't approved for this use. It can cause constipation and bloating, and it can keep other medicines and some vitamins from being absorbed. It's a prescription, so talk it over with your doctor. Don't start it on your own.

(Part 5 of 10.)

Part 6 of 10: What doctors are supposed to do

In 2022, the National Academies of Sciences wrote the first real playbook for doctors. It says doctors should offer PFAS blood testing to anyone likely to have had high exposure. That includes people living near farms where sludge was spread, especially people on private wells. That's us.

The guidance sorts people by their total blood level (9 PFAS added up):

• Under 2 ng/mL: health effects not expected. Usual care.
• 2 to 20 ng/mL: possible health effects, especially in pregnancy. Cut exposure, check cholesterol, watch blood pressure in pregnancy, and keep up breast cancer screening.
• Over 20 ng/mL: higher risk. All of the above, plus thyroid testing, and checking for kidney cancer, testicular cancer, and ulcerative colitis at every checkup.

For perspective, about 9% of Americans are over 20. In places with contaminated wells, a lot more people are.

Here's the catch. The CDC's own guidance for doctors did not adopt these numbers. It says it has not developed health-based screening based on blood levels and tells doctors to follow their usual standards of care. So the best guidance out there is optional, and it's up to each doctor whether to use it.

(Part 6 of 10.)

Part 7 of 10: Do our doctors even know?

Most don't, and that isn't really their fault. Environmental health is a very small part of medical school. A Northeastern University professor who studies PFAS put it this way: the medical field doesn't know a lot about environmental health.

What it looked like in Maine. A couple whose well was ruined by sludge went to their doctors for help. They described it as hitting a brick wall: nobody knew anything. Another sludge farmer said his family doctor had never heard of PFAS and didn't know what the test was. When he finally got tested, his family's levels were around the top 1% in the nation.

What it looks like close to home. In Wilmington, North Carolina, which sits downstream from a big PFAS plant, a local internist estimates only about 1 in 100 highly exposed people get proper medical guidance. Even there, she said she didn't know of anyone routinely screening patients for it.

So if you bring this up and your doctor looks puzzled, don't take it personally. Bring the information with you. That's part of why I'm writing this series.

Where your doctor can get help. Your doctor doesn't have to figure this out alone. Here's who they can call or read:

• Southeast Pediatric Environmental Health Specialty Unit (PEHSU). Specialists who answer questions from doctors and families about environmental exposures, covering South Carolina. Call 877-337-3478. Their focus is children, but they're the closest regional experts we have.
• CDC's PFAS pages for doctors. Plain answers on testing, billing, and what to tell patients, plus an email line: pfas@cdc.gov.
• The National Academies guidance. The 2022 report from Part 6, free to read online.
• Maine's guide for doctors. It's for Maine, but it's the most practical one out there, with lab codes and step-by-step follow-up.
• Specialists. The CDC points doctors to occupational and environmental medicine doctors and medical toxicologists for harder cases. Poison control (1-800-222-1222) also has toxicology experts on call.

Print this list and hand it to your doctor along with Part 6.

(Part 7 of 10.)

Part 8 of 10: What other places did for their people

Some communities hit by PFAS got real help with their health. Here's what that looked like.

A national health study. The CDC is running the first national study of how PFAS in drinking water affects health. More than 5,800 adults and 700 children gave blood and health information. The communities are in California, Colorado, Massachusetts, Michigan, New Hampshire, New Jersey, New York, and Pennsylvania. None are in the South, and none are sludge farm communities like ours.

Maine. Maine found the same sludge problem we have, and it went furthest:

• Farm families on contaminated land can get the blood test for free through the state's PFAS Fund.
• The state health department wrote a guide for its doctors, with lab codes and what to do with results.
• Since June 2025, labs and doctors must report PFAS blood results to the state, so health officials can follow up with people who test high.
• Lawmakers voted for a bill to make insurers treat the blood test as preventive care. It was carried over to the next session.

New Hampshire. State law requires major health insurers to cover the PFAS blood test.

None of this is out of reach. It just took people asking for it.

(Part 8 of 10.)

Part 9 of 10: What's being done for our health here?

Here's where things stand in Darlington County, as best I can find.

The water: real work has been done. Wells were tested starting in 2018, and filters went on the worst ones. Then a $4 million federal-state project built about 21 miles of water line, connecting 59 homes and 110 people to clean public water. That matters, and I'm grateful for it.

Our bodies: almost nothing. Clean water from here on doesn't undo the years people already drank from those wells. When The State looked into it in 2023, it found few, if any, studies of how the sludge program has affected people in South Carolina. That story told about families out here, mine included, wondering whether the water had something to do with the sickness they'd seen.

As far as I can find:

• No state or federal blood testing has been offered to people living near the sludge fields.
• No health study has been done on our community.
• No guidance has gone out to local doctors.
• No law requires insurance to pay for the blood test.

The one PFAS blood testing bill I found this session, House Bill 5013, would give free tests and cancer screening to firefighters. Firefighters deserve that. So do farm families.

Since 2024, our public health work is handled by the SC Department of Public Health, separate from the environmental agency. If I've missed something they're doing for Darlington County, I'd honestly be glad to be corrected and will post it here.

(Part 9 of 10.)

Part 10 of 10: What you can do

We can't wait for somebody else to look after our health. Here's what you can do now.

Talk to your doctor. If you've lived near the sludge fields or drank from a well out here, tell your doctor that plainly. Then ask:

• Can you order a PFAS blood test that covers at least the nine PFAS the National Academies recommend?
• Will my insurance pay for it, and if not, what will it cost?
• If my level comes back over 2, or over 20, will you follow the National Academies guidance on screening?
• Should I be getting my cholesterol, blood pressure, thyroid, or kidneys checked more often?

Print out Part 6 of this series and take it with you. Many doctors simply haven't seen it.

Cut what you're taking in. The CDC's advice for doctors centers on reducing exposure:

• Drink and cook with water you know is clean. If you're still on a well, get it tested, and use a filter certified to remove PFAS.
• For home gardens on sludge ground, consider raised beds with clean soil.
• Eat a variety of foods instead of a lot of one thing from the same field.

Speak up to the state. Call the SC Department of Public Health and your state legislators, and ask:

• Will the state offer free blood testing to people living near sludge fields, like Maine does?
• Will it send guidance to doctors in Darlington County?
• Will lawmakers require insurance to cover the PFAS blood test, like New Hampshire?
• Will anyone study the health of our community, including cancer, heart disease, and stroke?

We were told the sludge was safe. Now it's on all of us to make sure the people who live with it get looked after.

(Part 10 of 10. Thank you for reading. Please share it with someone who drank the water.)