11 MUST-READ PAGES OF GOOD HEALTH

As a top sci­en­tist warns of the po­ten­tial health time­bomb from drugs washed down drains . . .

Daily Mail - - Front Page - By JONATHAN GOR­NALL

THERE’S some­thing in the wa­ter and Pro­fes­sor Michael de­pledge, one of the UK’s lead­ing sci­en­tists, has an earthy ex­pla­na­tion for how it got there. The ‘some­thing’ is the broad range of medicines we ‘pass’ via the loo into the en­vi­ron­ment and, in­di­rectly, into our drink­ing wa­ter — from heart drugs to de­pres­sion and hor­mone pills.

‘We are be­ing ex­posed to a grow­ing num­ber of chem­i­cals, and mix­tures of chem­i­cals dur­ing our in­creas­ingly lengthy lives,’ the former chief sci­en­tist at the En­vi­ron­ment Agency told Good health.

‘Low con­cen­tra­tions of highly ac­tive phar­ma­ceu­ti­cals and phar­ma­ceu­ti­cal residues are be­ing ex­creted into sewage works, where one would hope they would be bro­ken down into harm­less sub­stances. But in fact they are not,’ says Pro­fes­sor de­pledge, now chair of en­vi­ron­ment and hu­man health at Ex­eter Univer­sity med­i­cal school.

Some drugs found in wa­ter sup­plies are more wor­ry­ing ‘be­cause of their po­ten­tial to af­fect wildlife or peo­ple’, said a report pub­lished this year by the Royal Phar­ma­ceu­ti­cal So­ci­ety. It iden­ti­fied an­tibi­otics, an­tide­pres­sants, anti-in­flam­ma­to­ries and painkillers, beta-block­ers, oral con­tra­cep­tives and hor­mone re­place­ment ther­a­pies as the worst cul­prits.

Traces of many of these drugs find their way into the sewage sys­tem through our urine, but it’s not the only way medicines get into wa­ter sup­plies.

Some have been found down­stream from phar­ma­ceu­ti­cal plants, while drugs such as an­tibi­otics given to farm an­i­mals can find their way into lakes and rivers.

NEVER PUT TABLETS DOWN THE LOO

UN­KNOWN amounts of un­used drugs are also dis­posed of down our loos ev­ery day, even though the NHS says they should be re­turned to phar­ma­cies for safe dis­posal.

But are the drugs in our wa­ter do­ing us any harm? The wor­ry­ing an­swer, says Pro­fes­sor de­pledge, is that no one re­ally knows. ‘ Most of this de­bate has been con­ducted in a sea of ig­no­rance,’ he told Good health.

how­ever, there are grow­ing fears that while, say, your morn­ing cuppa might not prove fa­tal, the build-up of chem­i­cals in our bod­ies could be re­spon­si­ble for many of the health prob­lems that plague us as we grow older.

And now a Un body — which rep­re­sents coun­tries, the drug in­dus­try and other non-gov­ern­men­tal groups — has just passed a res­o­lu­tion that for the first time recog­nises ‘ en­vi­ron­men­tally per­sis­tent phar­ma­ceu­ti­cal pol­lu­tants as a new emerg­ing pol­icy is­sue’ that de­mands greater un­der­stand­ing.

In its report pre­pared for the In­ter­na­tional Con­fer­ence on Chem­i­cals Man­age­ment in Oc­to­ber, the watch­dog’s of­fi­cials warned that such drugs were al­ready found in wa­ter all over the world, and ‘may pose a threat of im­por­tant mag­ni­tude for pub­lic health’.

FISH AND CROPS CON­TAM­I­NATED

EV­I­DENCE that these drugs can have a se­ri­ous im­pact on the en­vi­ron­ment and wildlife can be found in re­search dat­ing back more than 30 years. An­glers fish­ing near a sewage dis­charge pipe in north Lon­don on the River Lea, which joins the Thames, no­ticed that roach they were catch­ing were ‘in­ter­sex’ — nei­ther male nor fe­male.

The cul­prit was nat­u­ral and syn­thetic oe­stro­gens used in the Pill. Since then, many more ex­am­ples have been found around the world af­fect­ing other fish. A study pub­lished in the jour­nal Sci­ence in 2013 re­ported that con­cen­tra­tions in wa­ter of the anti- de­pres­sant ox­azepam al­tered the be­hav­iour of wild perch, caus­ing ‘in­creased ac­tiv­ity, re­duced so­cial­ity, and higher feed­ing rate’.

As re­cently as April this year, a study by the Univer­sity of Wis­con­sin-Mil­wau­kee found that met­formin, a com­mon treat­ment for type 2 di­a­betes, now found in fresh­wa­ter sys­tems around the world, was stunt­ing the growth and chang­ing the sex of fish in Lake Michi­gan.

And it’s not just fish. An­tibi­otics given to hu­mans and an­i­mals can travel from wa­ter sup­plies to the soil, and have been found to re­strict growth, pre­vent ger­mi­na­tion and even kill off a range of plants and crops.

A 2011 study by Ger­many’s Fed­eral En­vi­ron­ment Agency re­ported that the an­tibi­otics en­rofloxacin, used on an­i­mals, and ciprofloxacin, pre­scribed for res­pi­ra­tory in­fec­tion in hu­mans, were toxic to var­i­ous fresh­wa­ter plank­ton and plants. In 2012, a lab study at the Univer­sity of Padova, Italy, found sul­fa­di­azine, an an­tibi­otic used to treat uri­nary in­fec­tions, ac­cu­mu­lated in maize plants, killing them off.

ARE WE AT SE­RI­OUS RISK?

WHILE we are un­likely to suf­fer the same fate as sex- chang­ing fish, says Pro­fes­sor de­pledge, equally dis­as­trous prob­lems could be head­ing our way.

A wor­ry­ing ex­am­ple, he says, is the rise of an­tibi­otic-re­sis­tant or­gan­isms, caused by the over-use of an­tibi­otics. In 2011, the chief med­i­cal of­fi­cer Sally davies pre­dicted that by 2050 ten mil­lion peo­ple world­wide would be dy­ing ev­ery year from in­fec­tions as­so­ci­ated with such bugs.

Pro­fes­sor de­pledge and his col­leagues at Ex­eter are look­ing at whether an­tibi­otics in the en­vi­ron­ment are ca­pa­ble of pro­duc­ing an­tibi­otic-re­sis­tant bugs which can then in­fect peo­ple.

Any such bugs ‘may not cause an im­me­di­ate prob­lem’, he says. ‘But they may be liv­ing within and on our bod­ies for years — un­til you get a dis­ease that sup­presses the im­mune sys­tem, such as cancer, and that’s when you run into prob­lems.’

And, he says, with an age­ing pop­u­la­tion, the prob­lem is only go­ing to get worse as many more peo­ple will be tak­ing drugs to treat con­di­tions such as di­a­betes, choles­terol, high blood pres­sure and cancer.

‘These chem­i­cals aren’t killing us,’ he says. ‘But are they in­flu­enc­ing the kinds of ill­nesses we live with as we get older and older? Are there go­ing to be more peo­ple liv­ing with di­a­betes, neu­ro­log­i­cal disor­ders, all the things that higher body bur­dens of chem­i­cals may be contributing to?’

The story of the Ori­en­tal white­backed vul­ture may prove salu­tary. In 2004, the rea­son this bird was dy­ing in large num­bers in In­dia was found: they were eating car­casses of an­i­mals treated with a vet­eri­nary ver­sion of the drug di­clofenac, a non- steroidal an­ti­in­flam­ma­tory or painkiller, and their kid­neys were pack­ing up.

Pro­fes­sor de­pledge says the fate of species such as the vul­ture should be treated as ‘a red flag, be­cause what other phar­ma­ceu­ti­cals are out there, wip­ing out stuff we don’t even know about?’

di­clofenac is also widely used in hu­mans — in 2014, it was one of the ten most com­monly pre­scribed drugs in Eng­land.

A DAN­GER­OUS COCK­TAIL

IS IT in our tap wa­ter? Alarm­ingly, no one seems to be check­ing reg­u­larly. The reg­u­la­tor, the drink­ing Wa­ter In­spec­torate (DWI), has looked at drug residues in wa­ter just twice in the past eight years.

The first in­ves­ti­ga­tion, in 2007, was a ‘desk-based’ re­view of cur­rent re­search, so no new sam­ples of wa­ter were taken for anal­y­sis. The re­view con­cluded that, in view of ‘the dearth of mea­sured data’ on con­cen­tra­tions of phar­ma­ceu­ti­cals in UK drink­ing wa­ters, ‘it would be pru­dent to carry out a small-scale sur­vey’.

That was un­der­taken in 2011, when sam­ples were taken from just four sites in the UK ‘ex­pected to be at high risk’. Ex­actly where these sites are has not been dis­closed.

Two of the study’s au­thors told Good health they were ‘ not al­lowed’ to name them. There are more than 3,000 ac­tive phar­ma­ceu­ti­cal in­gre­di­ents in use in the UK — the In­spec­torate looked for traces of only 17 drugs, cho­sen partly be­cause they were in com­mon use.

di­clofenac was one and was found in rivers and reser­voirs — ‘source wa­ter’ — at the sites, along with nine other com­monly pre­scribed drugs, in­clud­ing atenolol, a betablocker used to treat angina and high blood pres­sure; furosemide, a di­uretic; and trimethoprim, an an­tibi­otic for blad­der in­fec­tions.

One of the sci­en­tists who con­ducted the study told us that they were ‘pretty con­fi­dent’ the di­clofenac re­sults would be echoed across the coun­try.

Four other drugs among the 17 were de­tected in source wa­ter and drink­ing wa­ter, although usu­ally in lower con­cen­tra­tions. These were ben­zoylec­go­nine, a pre­scrip­tion painkiller; car­ba­mazepine, for epilepsy and pain; ibupro­fen and anti-in­flam­ma­tory drug naproxen.

The report’s con­clu­sion seemed re­as­sur­ing. Be­cause con­cen­tra­tions of the drugs in drink­ing wa­ter were much lower than doses pre­scribed to pa­tients, their pres­ence ‘[does] not pose an ap­pre­cia­ble risk to

hu­man health’. But there was a ma­jor caveat. Ad­mit­ting this com­par­i­son was ‘a very sim­ple ap­proach’, the au­thors said that ‘more de­tailed eval­u­a­tion of the tox­i­co­log­i­cal risks’ was needed. Such a study, they said, should also recog­nise ‘the ex­po­sure will be long-term and that con­sumers will be ex­posed to a mix­ture of sub­stances in their drink­ing wa­ter’.

This is the ‘cock­tail’ ef­fect — where com­bi­na­tions of drugs may have an ef­fect where each drug sep­a­rately would not.

The fol­low-up to the In­spec­torate’s study, car­ried out last year by en­vi­ron­men­tal con­sul­tants Ri­cardo En­ergy & En­vi­ron­ment, ap­pears not to have ad­dressed these two crit­i­cal is­sues. It looked at only the four drugs in the 2011 report. It, too, con­cluded there was no ‘ap­pre­cia­ble risk to pub­lic health’.

UN­CLEAR EV­I­DENCE

ON THE sur­face, the Govern­ment, wa­ter com­pa­nies and phar­ma­ceu­ti­cal in­dus­try all seem pretty re­laxed about the is­sue. On its web­site, in­dus­try body Wa­ter UK ad­mits that ‘phar­ma­ceu­ti­cal residues may be found in very low quan­ti­ties in wa­ter used as sources for drink­ing wa­ter’, but says the lev­els are ‘hun­dreds of thou­sands of times be­low hu­man ther­a­peu­tic doses’.

The As­so­ci­a­tion of the Bri­tish Phar­ma­ceu­ti­cal In­dus­try (ABPI) told Good Health the Drink­ing Wa­ter In­spec­torate had ‘con­cluded that any ap­pre­cia­ble ad­verse health im­pacts on hu­man health . . .are ex­tremely un­likely’, adding ‘there is no ev­i­dence of pop­u­la­tion level ef­fects in fish in the en­vi­ron­ment that can be solely at­trib­uted to phar­ma­ceu­ti­cals’.

Its ev­i­dence? A pa­per pub­lished last year in the Royal So­ci­ety’s jour­nal Philo­soph­i­cal Trans­ac­tions, which states that, with ‘the lit­er­a­ture on phar­ma­ceu­ti­cals and fish . . . dom­i­nated by lab­o­ra­tory and caged fish stud­ies’, the risk to fish pop­u­la­tions ‘re­mains hy­po­thet­i­cal’.

But it warned that the ‘ap­par­ent ab­sence of ev­i­dence’ for dam­age to fish pop­u­la­tions from phar­ma­ceu­ti­cals ‘should not . . . lead us to com­pla­cency’. The au­thors say: ‘The ev­i­dence may be there, but we have not col­lected it in a sys­tem­atic way’.

631 ROGUE CHEM­I­CALS

WOR­RY­INGLY, they also re­ported that no one seems to be tak­ing into ac­count the com­bined ef­fects of cock­tails of drugs.

And if there re­ally is noth­ing to worry about why, as the De­part­ment for the En­vi­ron­ment, Food and Ru­ral Af­fairs (De­fra), re­vealed, are wa­ter com­pa­nies ‘re­view­ing the lev­els of phar­ma­ceu­ti­cals at wa­ter treat­ment works to de­velop an un­der­stand­ing of what the sit­u­a­tion is’?

De­fra is also ‘do­ing some re­search to con­sider the so­cial and eco­nomic im­pact’.

The drugs in­dus­try body, the ABPI, says: ‘The sub­stan­tial safety mar­gins in­volved with these prod­ucts mean that even with a dou­bling of the hu­man pop­u­la­tion and us­age, the risk of any ad­verse im­pact on drink­ing wa­ter which would be harm­ful to hu­mans would still be ex­tremely low’.

But that’s not how the UN’s In­ter­na­tional Con­fer­ence on Chem­i­cals Man­age­ment sees it. Its Oc­to­ber report on re­search find­ings from 71 coun­tries iden­ti­fied 631 dif­fer­ent chem­i­cals de­tected in the ‘aquatic en­vi­ron­ment’, in­clud­ing an­tibi­otics, painkillers and statins. The most com­mon drug was di­clofenac, the vul­ture killer.

And while con­cen­tra­tions of chem­i­cals might now be low, added the report, ‘they may per­sist for long pe­ri­ods of time, contributing to chronic and per­sis­tent ex­po­sure’.

WHAT CAN BE DONE?

THE tech­nol­ogy to clean up waste wa­ter ex­ists, says Pro­fes­sor De­pledge, ‘but it in­creases the cost of sewage treat­ment’.

What is needed now, he says, is for the Govern­ment ‘to take a longer term view of emerg­ing prob­lems’. But he warns: ‘This prob­lem is likely to be­come worse and worse, grad­u­ally and in­sid­i­ously.’

Pic­ture: ALAMY

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