Drugs As a Pollutant; Watch What You Excrete!

Alex Prud’homme has provided a comprehensive overview of the issues associated with our water supplies in his book: The Ripple Effect. What we are concerned with here is his discussion of pharmaceuticals and the potential risks involved with introducing them into our water systems.

Pharmaceutical drugs have always been a concern. Prud’homme tells us that they aroused so much fear over contamination that the obvious disposal approaches of burying or burning them became so restricted that many hospitals resorted to the simplest method of all—flushing them down the drain. He quotes an AP study which claims that “the healthcare industry sends at least 250 million pounds of pharmaceuticals down the drain every year.”

That sounds like an enormous amount of drugs, but Prud’homme claims that is not the major source of pollution.

“While reducing the amount of drugs dumped into our water systems by health-care facilities is a good policy, far more pharmaceuticals end up in our tap water when people excrete the small percentage of a drug that doesn’t metabolize in the body. Nearly all Americans excrete man-made chemical compounds or wash them off in the shower or flush them down the toilet.”

These chemicals are not effectively removed by standard waste processing systems, and they are unregulated and usually unmonitored. Concentrations are allowed to grow with unknown results.

“The study of these new compounds is a scientific frontier, one that is raising complex new questions about water quality: How does antibacterial soap impact the algae fish feed on? What effect do Prozac, heroin and perchlorate have on insects, crabs, and bass? What is the cumulative effect of a ‘cocktail’ of such pollutants on humans?”

“....consider that over sixty thousand different types of chemicals are used in America each year, yet the EPA has assessed the toxicity of only a few of them. By 2000 the EPA’s list of regulated chemicals had steadily climbed to ninety-one, but then the list suddenly stopped growing. Since then, roughly seven hundred new chemicals have been introduced to the marketplace every year, but the agency has not added a single new substance to its restricted list.”

As an interesting aside, Prud’homme tells of the adventures of an Italian scientist who, in the mid-1990s set out to measure the concentration of pharmaceuticals in the Po, Italy’s largest river. He was Ettore Zuccato of the Mario Negri Institute for Pharmacological Research in Milan. He looked for thirteen compounds and found all of them. He further validated his measurements by showing that the concentrations of the various chemicals were consistent with the known usage patterns in the communities feeding the river.

Given his success at finding legal drugs in the river, the question was asked: “Could he find illegal drugs?” As with other drugs, cocaine leaves a definite chemical marker when it is metabolized. Given the normal size of a dose and the output from the average human and the river flow characteristics, they were able to draw conclusions from their measurements.

“Italian officials had estimated that 5 million inhabitants of the Po river valley used about fifteen thousand doses of cocaine per month....But Zuccato’s test revealed that the real number is over forty thousand doses per day.”

High times in the Po River valley! For those who tend towards paranoia, and for those who tend toward guilt, you not only have to be worried about your phone being tapped, or your voice mail being broken into, now you have wonder if someone might be monitoring your sewer line. What might one call the team that has acquired that duty?

Back to more serious business arising from the Zuccato measurements:

“They also identified metabolites of clofibrate, a powerful drug that had been withdrawn from the market years earlier yet still lingered in the ecosystem. After further study, the Negri team concluded that even trace elements of pharmaceuticals in drinking water—present at only a few parts per trillion—‘can significantly inhibit embryonic cell growth in vitro’.”

The general result seems to be that these chemicals are detected in water systems when they are looked for. We do not know what levels are harmful, but we should be concerned. There are at least three modern epidemics that cry out for explanations: the rise in diagnosed mental illness, the increasing incidence of autism, and the prevalence of food allergies in children. I suspect that one could find a correlation between the growth in the production of pharmaceuticals and the increased incidence of these three conditions. The growth of other chemicals in our water systems might show a similar correlation. Correlation, to the degree it exists, does not determine causality, but it certainly should arouse some suspicion. I hope there is a student out there who will pick up this assignment.