I emailed the Land Institute’s Stan Cox once again to find out more:
What's your sense of the seriousness of active pharmaceutical ingredients showing up in U.S. water supplies? What's the greatest concern/danger?
S.C.: I know lots of people—and I'm one of them—who have begun taking any sort of prescription drug only as a last resort, because of growing concerns about side effects and interactions. And that's a simple system: one or a few drugs interacting with a human body. People are not going to be happy about possibly getting unknown combinations of many drugs in their water; furthermore, no one has any idea what the critical concentrations in the water supply are when a stew of dozens of drugs are being released into the environment, exposing all kinds of organisms.
The obvious worry, as in India, is emergence of bacteria resistant to multiple antibiotics. But the bigger worry could be what we don't know about the effects of pharmaceutical compounds in combination in nature.
How significant are the levels being reported in your estimation? How do they compare with those found near Patancheru in India?
S.C.: When the study was published on India, I naively thought, "I'm glad that doesn't happen here!" Now, the total mass of drugs being cited for the U.S. is staggering. I haven't seen information on specific quantities released at specific locations. The comment by a former EPA enforcement officer—“Is it as bad in the U.S. as it is in India? Probably not."—doesn’t fill me with confidence.
Who or what is to blame for the problem, and what should drug manufacturers be doing to ensure that they are not contributing to polluting the water?
S.C.: We all share the blame: the companies in India and the U.S. for (apparently) not expending the money and effort to ensure that drugs don't escape, and doctors and all the rest of us for pumping up demand, which creates a huge, hard-to-monitor flood of production. Clearly, far more testing of water-treatment outflow than what was reported in the news must be done, and effluents from domestic production facilities have to be tested as well. (I'm not in the business, so I don't know how that would work!) But because we cannot practically ascertain the effects of so many combinations of so many drugs on so many organisms, the tolerance level for pharmaceuticals must be set very, very low.