The Wake

Illustration by Dixon Bordiano

When you drink a big glass of water from the tap, you probably don’t assume that it’s 100 percent pure H2O; you know there is fluoride in there for healthy teeth and other various chemicals used to kill bacteria and improve taste. What you don’t know is that you are probably also drinking a big, cold glass of the remnants of someone else’s medicine.

On March 9, the Associated Press released a report finding traces of pharmaceuticals including antibiotics, anti-convulsants, mood stabilizers, and sex hormones in the drinking water of 24 major cities including Minneapolis. In Minneapolis, only caffeine was detected in the tested tap water; however, caffeine is a common contaminant that many scientists use as an indicator for the presence of other pharmaceuticals. Acetaminophen and cotinine, a chemical made by the body when nicotine is metabolized, were found in the Minneapolis watershed. Other cities fared far worse: 56 pharmaceuticals or byproducts were found in treated drinking water in Philadelphia and 63 were found in Philadelphia watersheds.

“It’s probably been as long as we have been in the pharmacological revolution that these medicines have been making their way into our lakes rivers and streams and into drinking water sources,” says Paul Schwartz, the National Policy Coordinator for the advocacy group Clean Water Action. “It’s just been over the last decade that we have started to look for them in the water and have developed instruments that are capable of detecting them because they’re available in very small amounts in the water supply.” However, as Americans become increasingly medicated—the number of prescriptions filled annually has risen 12 percent in the last five years to 3.7 billion, and 3.3 billion nonprescription drugs are purchased annually—more pharmaceuticals are appearing in waterways, according to IMS Health, a market research firm for the pharmaceutical industry.

Pharmaceuticals get into waterways and drinking water in a variety of ways. Prescriptions thrown in the trash can leach out of landfills and into groundwater. The vast cocktail of antibiotics and hormones given to animals on feedlots gets into water systems. However, they can also make their way into waterways through people. When people take prescription drugs, some of it is absorbed into the body, but the rest passes through the body and is flushed down the toilet. These chemicals are rarely removed during wastewater treatment and go directly into lakes and streams when wastewater is discharged. Some of this contaminated water is pumped back out of lakes and streams, treated, and piped to consumers. Depending on the sophistication of the drinking water treatment plant, traces of pharmaceuticals are removed. However, removal is technologically advanced, extremely expensive, and the federal government does not require water providers to test for pharmaceuticals or remove them. The Associated Press National Investigative Team contacted 62 major water providers and found that only 28 tested their water for pharmaceuticals, many screening for only one or two.

“There are no standards for these chemicals,” Schwartz says. “These are what the EPA would class as emerging contaminants. This is true both for sewage systems and it’s true also for drinking water systems.”

Certainly, pharmaceuticals found in drinking water and in waterways are at very low levels, measured in parts per billion. The Environmental Protection Agency does not consider pharmaceuticals to be harmful at these very low doses, and the Minnesota Department of Health has assured consumers that the caffeine found in Minneapolis water is not harmful. However, Schwartz disagrees.

“Just because they’re only detectable in very small amounts doesn’t mean they’re not issues for our aquatic ecosystems and for human health,” he says. The truth is that no one really knows what the potential long-term effects are for being exposed to very low doses of various pharmaceuticals over an entire lifetime. This seems to be a recurring theme for the myriad of chemicals we’re exposed to on a daily basis. “We really don’t understand how it is they interact and we don’t have a fundamental understanding of them chemically in our bodies,” Schwartz says. However, if the health of aquatic animals living in polluted areas is any indicator, the future does not look bright. Male fish are being feminized, producing egg yolk proteins, and cases of intersex fish and other reptiles are becoming increasingly frequent.

One of the larger concerns is the potential effect on reproductive function. Estrogens and other endocrine disrupting compounds, which interfere with the function of natural hormones found in the body, have been discovered in many U.S. waterways, and the affects have already been observed in aquatic animals. “It leads to all sorts of subtle and not so subtle health effects,” Schwartz says. Exposure to estrogen and estrogenic compounds has been linked to a multitude of health problems, including reduced fertility, the feminization of genetic males and cancer. They can also shift the male-to-female ratio towards females.

Birth control pills have received much of the blame for estrogen contamination. The estrogen in birth control pills was long thought to be rendered inactive by the kidneys, which add a sugar molecule before estrogen is excreted. However, according to toxicologists researching estrogen patches for Proctor and Gamble, the bacteria used in wastewater treatment remove this sugar molecule, reactivating the estrogen. The discovery that estrogen from birth control contributes to estrogen contamination and problems associated with estrogen exposure has created a small but significant backlash against hormonal birth control. A group on Facebook called the Anti-Estrogens Campaign has recently received a lot of press for explicitly blaming estrogens from birth control pills for problems associated with estrogen exposure such as lowered sperm count and advocating that women discontinue use of the pill when they’re not in a relationship. However, estrogen from birth control is not the only source of contamination. Certain plastics produce estrogenic compounds, and estrogen used in the production of cattle is a large source of contamination.

Still, all is not lost. “There are lots of nodes of bright promise that are out there,” says Schwartz, pointing to new technologies in wastewater treatment. “One of the things we’re looking at with our sewer systems is getting away from big centralized sewer systems that use lots of water to convey our waste to them and try to separate everything out to using much smaller systems that are neighborhood scale or part of a city scale, and in that using things like soils to remediate a lot of the sewage. Or not even using water at all, looking at waterless toilets and things like that where you’re actually treating the waste products right in the home… It’s sort of a paradigm shift, just like we’re doing on energy.” Pollution prevention, Schwartz says, is a far better solution than trying to remove chemicals during drinking water treatment. Processes such as reverse osmosis can remove pharmaceuticals from drinking water, but are costly due to the amount of energy necessary and also create several gallons of wastewater for every gallon of clean water.

By changing their behavior, people can also help prevent pollution. “If we didn’t take the old drugs and flush them down the toilet, that’s one source,” Schwartz says. “If big firms and hospitals that have lots of old drugs hanging out dispose of them properly, that would be better as well. There are a lot of things that we can do to make a difference.”

The argument over whether or not exposure to traces of pharmaceuticals is harmful, and what should be done if they are, has divided into two camps. Government and industry are on one side, and advocacy groups such as Clean Water Action and the Sierra Club are on the other while each have scientists backing up their point of view. According to Schwartz, progress has been made in creating programs to clean up waterways and regulate pollution. “Those [programs] are working highly variably, from very well to not at all. And the basic laws that spin those out are under attack by polluters,” he says. And while they duke it out, fish continue to grow ovaries and consumers continue drinking their eight glasses a day of whatever the hell comes out of their tap.