Are We Accidentally Medicating Ourselves Into a Mind-Numbing, Body-Weakening Stupor?

The Chairman of the Department of Medicine at Cedars-Sinai, Glenn D. Braunstein, M.D., noted Wednesday:

In a ... study by the United States Geological Survey that tested for 95 contaminants in water supplies nationwide, 80 percent of the samples from 139 streams in 30 states had at least one of the substances being tested for, with an average of seven contaminants in each sample. These findings included traces of anti-anxiety medications in the drinking water delivered to approximately 18.5 million Southern Californians. In western Montana, the study found aquifers had been penetrated by waste water from a high school, and contained trace elements of acetaminophen, caffeine, codeine, antibiotics and warfarin, in addition to a mood-stabilizing drug for bipolar disorder and nicotine.

***

Is Bottled Water the Solution?

Not necessarily. Tap water suppliers are required to perform regular water quality tests and publish the findings; makers of bottled water aren't. In fact, in a survey by the Environmental Working Group (EWG), 38 contaminants were found in 10 big-selling brands.

The United States Geologic Survey reports:

In streams and rivers across the Nation, scientists are finding detectable concentrations of pharmaceuticals and other organic wastewater chemicals. For example, a recent study of the water-quality of streams in the Boulder Creek Watershed, Colorado, found a diverse set of pharmaceuticals and organic wastewater chemicals in water samples. In fact, U.S. Geological Survey (USGS) scientists found 12 of the 22 (55 percent) pharmaceuticals, and 32 of the 47 (77 percent) organic wastewater chemicals looked for in the watershed. Many of the water samples contained a complex mixture of pharmaceuticals, wastewater chemicals, pesticides, and trace metals .... The scientists found that:

• The concentration of many of these chemicals, such as sulfamethoxazole (an antibiotic used to treat a wide range of bacterial infections), triclosan (an antimicrobial agent commonly used in soaps), and caffeine, increased dramatically downstream from the first major wastewater treatment plant .... However, some organic wastewater indicators (such as triclosan) were also found in much lower concentrations in the relatively pristine upper part of the watershed, and scientists attributed their occurrence to home septic systems and other sources on the landscape.
• Few of the detected compounds exceeded water-quality standards; however, many do not have water-quality standards.... Native fish populations were found to exhibit endocrine disruption, including low male-to-female sex ratio and fish having both female and male reproductive organs (gonadal intersex).

And in a webpage entitled "Antidepressants in Stream Waters! Are They in the Fish Too?", the U.S. Geological Survey points out:

For some fish living downstream of sewage treatment plants the answer is yes. U.S. Geological Survey (USGS) scientists and their colleagues published a paper in Environmental Science and Technology documenting that specific antidepressants and their degradates found in wastewater discharged into streams by municipal wastewater treatment plants are taken up into the bodies of fish living downstream of the plants. The antidepressants were found in fish collected over 8 kilometers (approximately 5 miles) downstream of the location of the wastewater discharge. The scientists detected several commonly used antidepressants in water, streambed sediment, and the brain tissue of white suckers, a native fish species. Fish collected upstream from the wastewater discharge did not have antidepressants present in their brain tissues....

AP reported in 2009:

U.S. manufacturers, including major drugmakers, have legally released at least 271 million pounds of pharmaceuticals into waterways that often provide drinking water — contamination the federal government has consistently overlooked, according to an Associated Press investigation.

***

Last year, the AP reported that trace amounts of a wide range of pharmaceuticals — including antibiotics, anti-convulsants, mood stabilizers and sex hormones — have been found in American drinking water supplies. Including recent findings in Dallas, Cleveland and Maryland's Prince George's and Montgomery counties, pharmaceuticals have been detected in the drinking water of at least 51 million Americans.

Most cities and water providers still do not test. Some scientists say that wherever researchers look, they will find pharma-tainted water.

***

Researchers have found that even extremely diluted concentrations of drugs harm fish, frogs and other aquatic species. [This may be part of the reason that amphibians are disappearing.] Also, researchers report that human cells fail to grow normally in the laboratory when exposed to trace concentrations of certain drugs. Some scientists say they are increasingly concerned that the consumption of combinations of many drugs, even in small amounts, could harm humans over decades.

A year earlier, the Associated Press noted:

A vast array of pharmaceuticals — including antibiotics, anti-convulsants, mood stabilizers and sex hormones — have been found in the drinking water supplies of at least 41 million Americans, an Associated Press investigation shows. [The estimate was raised to 46 million a couple of months later.]

***

Bottlers [i.e. bottled water producers], some of which simply repackage tap water, do not typically treat or test for pharmaceuticals, according to the industry's main trade group.

***

There's growing concern in the scientific community, meanwhile, that certain drugs — or combinations of drugs — may harm humans over decades because water, unlike most specific foods, is consumed in sizable amounts every day.

Our bodies may shrug off a relatively big one-time dose, yet suffer from a smaller amount delivered continuously over a half century, perhaps subtly stirring allergies or nerve damage. Pregnant women, the elderly and the very ill might be more sensitive.

Many concerns about chronic low-level exposure focus on certain drug classes: chemotherapy that can act as a powerful poison; hormones that can hamper reproduction or development; medicines for depression and epilepsy that can damage the brain or change behavior; antibiotics that can allow human germs to mutate into more dangerous forms; pain relievers and blood-pressure diuretics.

The University of Arizona College of Agriculture and Life Sciences wrote in 2000:

Certain pharmaceuticals are now attracting attention as a potentially new class of water pollutants. Such drugs as antibiotics, anti-depressants, birth control pills, seizure medication, cancer treatments, pain killers, tranquilizers and cholesterol-lowering compounds have been detected in varied water sources.

Where do they come from? Pharmaceutical industries, hospitals and other medical facilities are obvious sources, but households also contribute a significant share. People often dispose of unused medicines by flushing them down toilets, and human excreta can contain varied incompletely metabolized medicines. These drugs can pass intact through conventional sewage treatment facilities, into waterways, lakes and even aquifers. Further, discarded pharmaceuticals often end up at dumps and land fills, posing a threat to underlying groundwater.

Farm animals also are a source of pharmaceuticals entering the environment, through their ingestion of hormones, antibiotics and veterinary medicines. (About 40 percent of U.S.-produced antibiotics are fed to livestock as growth enhancers.) Manure containing traces of such pharmaceuticals is spread on land and can then wash off into surface water and even percolate into groundwater.

***

Researchers Christian G. Daughton and Thomas A. Ternes reported in the December issue of “Environmental Health Perspectives” that the amount of pharmaceuticals and personal care products entering the environment annually is about equal to the amount of pesticides used each year.

***

In the United States, the issue might have attracted earlier notice if officials had followed up on observations made 20 years ago. At that time, EPA scientists found that sludge from a U.S. sewage-treatment plant contained excreted aspirin, caffeine and nicotine. At the time, no significance was attached to the findings.

***

Europeans, however, took the lead in researching the issue. In the mid-1990s, Thomas A. Ternes, a chemist in Wiesbaden, Germany, investigated what happens to prescribed medicines after they are excreted. Ternes knew that many such drugs are prescribed, and that little was known of the environmental effects of these compounds after they are excreted. He researched the presence of drugs in sewage, treated water and rivers, and his findings surprised him.

Expecting to identify a few medicinal compounds he instead found 30 of the 60 common pharmaceuticals that he surveyed. Drugs he identified included lipid-lowering drugs, antibiotics, analgesics, antiseptics, beta-blocker heart drugs, residues of drugs for controlling epilepsy as well as drugs serving as contrast agents for diagnostic X rays.

***

At the recent American Chemical Society conference, Chris Metcalfe of Trent University in Ontario reported finding a vast array of drugs leaving Canadian sewage treatment plants, at times at higher levels than what is reported in Germany. Such drugs included anticancer agents, psychiatric drugs and anti-inflammatory compounds. North American treatment plants may show higher levels of pharmaceuticals because they often lack the technological sophistication of German facilities.

***

Scientists generally agree that aquatic life is most at risk, its life cycle, from birth to death, occurring within potentially drug-contaminated waters.... For example, recent British research suggest that estrogen, the female sex hormone, is primarily responsible for deforming reproductive systems of fish, noting that blood plasma from male trout living below sewage treatment plants had the female egg protein vitellogenin.

Discovery News pointed out last year:

Scientists are particularly concerned about a class of pharmaceuticals known as endocrine-disruptors. Traces of estrogen from birth control pills, for example, are now known to affect animals at really tiny concentrations.

Antibiotics are another concern, because once they are unleashed in the environment, they can prompt the development of dangerously drug-resistant bacteria.

Even drugs that don't fit into those categories have been shown to cause problems in some cases, especially when levels get high enough, said Bryan Brooks, director of the Environmental Health Science program at Baylor University in Waco, Texas.

A 2004 paper in the Journal Nature, for example, documented a catastrophic vulture die-off in India. It turned out that the birds were eating the carcasses of cows that had been given a type of non-steroidal anti-inflammatory medication, similar to ibuprofen or naproxen. The drug was making the birds sick.

In a paper published earlier this year in the journal Environmental Toxicology and Chemistry, scientists reported that minnows exposed to certain antidepressants were slower to flee from predators. Another paper in the same journal issue found that tadpoles exposed to antidepressants -- at levels similar to what might show up in the environment in some places -- ate less and grew more slowly.

As the New York Times' Lede notes:

"We recognize it is a growing concern and we’re taking it very seriously,” said Benjamin H. Grumbles, the Environmental Protection Agency’s water chief. But the government has not established any safety limits for pharmaceutical drugs in drinking water, as it has for many other chemicals; the agency is just learning how to detect low concentrations of drugs in water, let alone assess the risk posed by them.

And see this, this, this, this, this and this:


As If That's Not Bad Enough ...

As if that's not bad enough, some well-known public figures have suggested intentionally adding drugs to water to prevent heart disease, prevent suicidal depression, and to combat other illnesses.

For example, the American psychiatrist Peter Kramer - best known for his work Listening to Prozac - has suggested that lithium be added to the water supply to reduce the number of suicides. Fox News medical expert Dr. Archelle Georgiou seems to like the idea as well:

And as Paul Joseph Watson writes:

Drug companies claim that statins have been proven to lower cholesterol and help prevent heart disease and strokes, leading many health experts to insist that they be artificially added to public water supplies, but dangerous side-effects buried by drug companies conducting statin trials have now come to light, in addition to the fact that “for three quarters of those taking them, they offer little or no value.”

A new study published in the Cochrane Library, which reviews drug trials, examined data from 14 drugs trials involving 34,000 patients and found evidence of “short-term memory loss, depression and mood swings,” that had been deliberately underplayed by the drug companies funding the research.

The researchers warn that, “Statins should only be prescribed to those with heart disease, or who have suffered the condition in the past. Researchers warn that unless a patient is at high risk of suffering a heart attack or stroke, statins may cause more harm than good.”

However, despite the fact that statins have also been linked to a greater risk of liver dysfunction, acute kidney failure, cataracts and muscle damage, health authorities have been pushing for the drug to be added to public water supplies as part of a mass medication program that is not only illegal without consent, but also threatens a plethora of unknown consequences.

Only last week, George Lundberg, MD, the editor of MedPageToday..., wrote an op-ed entitled, Should We Put Statins in the Water Supply?

In May 2008, renowned cardiologist Professor Mahendra Varma called for statins to be artificially added to drinking water.

Putting statins in the water supply was also considered during a November 2008 discussion which featured Robert Bonow, M.D., of Northwestern University in Chicago, Gordon F. Tomaselli, M.D., of Johns Hopkins University in Baltimore, and Anthony De Maria, M.D., of the University of California at San Diego.

Also in November 2008, CNBC aired a segment lauding the effectiveness of statins, after which one of the hosts remarked, “Why don’t they just put statins in the water supply,” to which CNBC’s medical expert replied, “A lot of people have said that and they are in the water in fact.”

And bioethicist and medical historian Jacob M. Appel wrote in the Huffington Post in 2009:

Lithium may actually be the tip of the fortification iceberg. The cholesterol-lowering agents known as statins might also be good candidates for inclusion in the water supply ....

Other possible agents are still in development. If researchers could effectively isolate a chemical that safely blocks pleasure pathways involved in the use of toxic substances, such as tobacco and cocaine, those blocking agents might also be added to the water supply. Preventing nicotine highs through such a novel distribution mechanism would save millions of lives annually.

***

Some nay-sayers will inevitably argue that medically fortifying the public water is a violation of individual liberty. Of course, nobody is forcing those dissident individuals to drink tap water. They are welcome to purchase bottled water, as do a few hold-outs who still fear the pernicious effects of fluoride, or to dig their own wells.

***

Unfortunately, some opponents will likely attempt to hold the public water hostage, arguing that because drug-free water is natural, is it somehow better. However, if the vast majority of people gain health benefits from fortifying the public water, and particularly if these benefits are life-saving, then there is nothing unreasonable about placing the burden not to drink upon the resistant minority. One person's right to drink lithium-free water is no greater than another's right to drink lithium-enhanced water. As long as the negative consequences or inconveniences are relatively minor, water fortification seems to be one of those cases where the majority's preference and interest should prevail.

Time will reveal whether lithium is indeed the next fluoride. Far more important is the revolutionary prospect of harnessing the common water supply to deliver life-saving and health-enhancing therapies to the public at low cost. The water belongs to the public, after all, and should be used for the collective good. As someone who treasures my freedom immensely -- including, I should emphasize, my inalienable right to commit suicide -- I look forward to the day when I can sacrifice whatever specious "liberty" claim I might have in consuming "natural" tap water in order to help save the lives of my neighbors and fellow human beings.

However, as discussed above, bottled water may contain the same pharmaceuticals as tap water, and many water filters do not effectively remove pharmaceuticals.

In addition, because a healthier lifestyle of exercise and a low-fat diet leads to less cardiac disease and less suicidal tendencies, those who are more responsible in their health habits would be penalized by being exposed to drugs they don't need, or incurring the extra cost of digging a well or buying an expensive filter to secure non-medicated drinking water.

Fluoride as Poster Child for Adding Chemicals to Water

Fluoride is - of course - the example everyone uses when discussing the safety of adding chemicals to drinking water. It should be the example everyone uses.

The U.S. government has itself now expressed concerns about fluoride's health effects and the possibility that it impairs brain function.

And as the president of Environmental Working Group - a highly-respected environmental group which has been quoted some 1,400 times by the New York Times -recently said:

For decades, people who raised concerns about fluoride being added to tap water or food were dismissed as crazy. All of a sudden we have two federal regulatory actions, announced just days apart, that tell us what was really crazy all those years: a government bureaucracy that ignored strong scientific evidence and clear warning signs of the threats fluoride has posed to public health all along.

And the Sierra Club and other leading environmental groups oppose mandatory fluoridation as well.