Issue Date: April 7, 2008
Polluting With Pharmaceuticals
I read with interest Bethany Halford's article on pollution caused by improperly discarded medicines (C&EN, Feb. 25, page 13). Having dealt with drug regulatory affairs for a substantial part of my career, I can offer a suggestion that might go a long way toward solving this problem.
For certain widely used classes of medicinals (nonsteroidal anti-inflammatory drugs are an example), the Food & Drug Administration requires that each prescription dispensed be accompanied by a medication guide, a leaflet that provides the user with salient information about the drug. A brief paragraph titled "How to Dispose of Unused Medicine" could be added to the medication guide by FDA fiat. This would be a relatively quick and inexpensive way to get authoritative information on proper disposal out to millions of people.
"Side Effects" is interesting and thought-provoking. When I worked as an automotive engineer I tried unsuccessfully in the mid-1980s to create interest in the airborne pollutant effects of the chemicals present in vehicles. The average automobile loses approximately 100 lb in the first year from the outgassing of chemicals from the car's components, particularly those in the interior. This includes the spare tire located inside many SUVs. One experiences this effect as a fogging on the inside of the windows and identifies it as the "new car smell."
Particularly for people such as police, truck drivers, delivery people, and others who make a living being in a vehicle for extended periods, this has the potential to be a hidden, unaddressed health issue. Of course, perhaps in comparison to the pharmaceutical chemicals entering the environment, this may not be as damaging or have as long-term an effect. However, it too is an example of our headlong plunge into introducing products without considering their individual and synergistic direct and indirect health effects.
By the way, the response I received from the auto companies, the trade organizations, the U.S. government (EPA and National Highway Traffic Safety Administration), and medical associations was "let sleeping dogs lie" and "don't make waves."
We welcome the discussion on assessing potential human health effects of bioactive compounds such as pharmaceuticals and other wastewater contaminants in drinking water (C&EN, Feb. 25, pages 3 and 13) and are happy to see surveys under way determining the concentrations of these compounds in finished drinking water (Awwa Research Foundation report No. 2758, 2007, page 372).
At the Silent Spring Institute we believe that these surveys should include conditions likely to result in higher level exposure, such as for owners of private wells located in regions where use of on-site septic systems prevail (Environ. Sci. Technol. 2006, 40, 4894) and for consumers of water drawn from heavily wastewater-influenced waterways like the lower Mississippi and Potomac Rivers. Although these examples may not represent average exposure levels, they are the situations where higher exposures and potential health impacts of drinking water contamination are more likely to occur.
We are also concerned about statements suggesting that human health effects are unlikely because concentrations in drinking water are well below therapeutic doses (Reg. Toxicol. Pharm. 2005, 42, 296). Comparison with therapeutic doses is inadequate for assessing these risks because it does not take into account sensitive life stages such as fetal exposure, side effects of the substance, effects of mixtures acting together, or effects on sensitive individuals. The study by Francisco Pomati and colleagues measuring inhibition of embryonic cell growth in mixtures of pharmaceuticals at ecological concentrations further indicates that the conclusion that health effects are unlikely may be premature (Environ. Sci. Technol. 2006, 40, 2442).
There may be situations, as mentioned above, where concentrations of mixtures of pharmaceuticals and other bioactive wastewater contaminants reach levels of concern. For example, in drinking water wells located in regions where use of on-site septic systems dominated, pharmaceuticals such as carbamazepine, trimethoprim, and sulfamethoxazole have been detected at concentrations up to several hundred parts per trillion (Montana Department of Environmental Quality 2006; Ground Water Monitoring & Remediation 2005, 25, 107 ). These values are in the range of concentrations for mixtures found by Pomati et al. to inhibit proliferation of human embryonic cells.
Finally, human health concerns cannot be considered separately from ecological effects. Effects on fish populations or other ecological receptors are ultimately tied to human health and welfare, and it is in our best interest to control what we release in our wastewater because wastewater is a high-volume pollutant that is widely distributed.
To ensure protection of public health, an adequate analysis of the potential health effects of pharmaceuticals and other wastewater contaminants in drinking water is essential, particularly as the population increases in number and age, thus generating a collision between dependence on freshwater resources for both drinking water and wastewater disposal.
Laurel J. Standley
Ruthann A. Rudel
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