Show HN: PFAS.report – Measure the forever chemicals in your blood via Quest

/s

This is highly misleading. CLIA and the associated federal regulations are the standard to which diagnostic clinical laboratories are held, not an "older" or "loophole" regulation. All laboratories in the US that provide patient results for clinical use are regulated by CLIA. There are FDA-approved test systems and "Lab-developed tests" (LDTs) that are BOTH subject to CLIA obligations, which are unbelievably complex (and in my opinion are a source of regulatory capture in laboratory medicine, but that's not directly relevant). Most high complexity lab tests are LDTs.

FDA-approved tests go through a formal FDA process such that the performing lab only has to "verify" the performance characteristics prior to patient testing. An LDT requires a much more stringent lab-level validation plan prior to patient testing. Both requiring strict ongoing quality control and quality assurance. And while the validation plan for an LDT can be self-designed, there are still strict requirements for what it most contain.

Compliance is NOT "self-certified," instead there are routine, extremely intensive compliance inspections (scheduled and unscheduled), either by a regional CLIA office, or by an organization accredited by CMS to provide such verification of compliance (such as CAP or COLA). These are not cursory inspections but a deep dive into all lab operations and personnel, equipment, maintenance and quality records, and other documentation.

I'm not a huge fan of Quest or Labcorp's presence in the field, and I don't know the specifics of NMS and this PFAS testing (CLIA compliance isn't required for research or non-clinical). If NMS has CLIA certification and they state the methodology and limitations of their LDT it's generally perfectly valid to provide the test, and the burden is generally on the downstream physician or provider to ensure the results are properly interpreted and applied.

If your level is significantly elevated (>20 ng/mL), you can audit your environment by testing your tap water and installing a reverse osmosis whole house filter (expensive). If your level is low, you don't need to do any of this. By eliminating point source exposure, your PFAS levels would naturally decline in time.

Lastly, I bring up therapeutic phlebotomy as interesting emerging research because it points in a concrete direction to something that is very actionable (pending more study).

Edit: grammer

Emerging research is not something actually concretely actionable for most people. Worse, because most people are "arm-chair experts" without clear guidance, your average person is more likely to harm themselves with doing their own research into things like this than otherwise.

For the additional thing about "reverse osmosis whole house filter" most people likely can't do afford to do this. Even if they can, there would need to be much better guidance here to have any certainty that someone wasn't selling you snake oil. The only things I can find on these systems in searches is that the companies that sell them recommend them, and won't even say they can filter out PFAs on their own, that's a major red flag to me that this is poorly regulated and likely dangerously marketed for things they can't do anything about.

A thought experiment, if I offer you two glasses of water, and tell you one has PFAs and the other doesn't how could you actually test that assumption? How could you have certainty in that test? I'm not saying it can't be done, but knowing what companies you can trust in a brand new space is not something obvious, and especially in a low-regulation space can be a major opportunity for companies to use meaningless words to try and convince you they're doing more than they are.

I had an insect exterminator come to my door and tell me the "eco" in their company name meant that they were eco-friendly with 0 data to back that up. They also said that all of their chemicals for killing animals were "plant-based" and didn't expand on that any further. Companies can make a lot of money making up BS terms to try and sell you the same thing you've been buying for years. That's a lot easier than finding a new thing to sell you.