– The AP

AP IMPACT: Pharmaceuticals found in drinking water, affecting wildlife and maybe humans

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Doc: 00337363 DB: research–d–2008–1 Date: Mon Mar 10 00:03:33 2008

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AP IMPACT: Pharmaceuticals found in drinking water, affecting wildlife and maybe humans

Eds: UPDATES headlines. An abridged version is available. Multimedia: A 3D interactive on the cycle of drugs in drinking water supplies, along with a review of major metropolitan areas where pharmaceuticals have been found in drinking water supplies, is in the –national/drugs–water folder. This item moved previously as an advance and is now available for use.

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AP Graphics PHARMAWATER LOGO, PHARMAWATER MAP, PHARMAWATER EXPLAINER

EDITOR'S NOTE –The nation's drinking water supplies are not as pristine as might be expected – traces of pharmaceuticals are all too common, an Associated Press investigation finds. First of a three-part series.

†By JEFF DONN, MARTHA MENDOZA and JUSTIN PRITCHARD

†Associated Press Writers

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.

To be sure, the concentrations of these pharmaceuticals are tiny, measured in quantities of parts per billion or trillion, far below the levels of a medical dose. Also, utilities insist their water is safe.

But the presence of so many prescription drugs – and over-the-counter medicines like acetaminophen and ibuprofen – in so much of our drinking water is heightening worries among scientists of long-term consequences to human health.

In the course of a five-month inquiry, the AP discovered that drugs have been detected in the drinking water supplies of 24 major metropolitan areas – from Southern California to Northern New Jersey, from Detroit to Louisville, Ky.

Water providers rarely disclose results of pharmaceutical screenings, unless pressed, the AP found. For example, the head of a group representing major California suppliers said the public "doesn't know how to interpret the information" and might be unduly alarmed.

How do the drugs get into the water?

People take pills. Their bodies absorb some of the medication, but the rest of it passes through and is flushed down the toilet. The wastewater is treated before it is discharged into reservoirs, rivers or lakes. Then, some of the water is cleansed again at drinking water treatment plants and piped to consumers. But most treatments do not remove all drug residue.

And while researchers do not yet understand the exact risks from decades of persistent exposure to random combinations of low levels of pharmaceuticals, recent studies – which have gone virtually unnoticed by the general public – have found alarming effects on human cells and wildlife.

"We recognize it is a growing concern and we're taking it very seriously," said Benjamin H. Grumbles, assistant administrator for water at the U.S. Environmental Protection Agency.

Members of the AP National Investigative Team reviewed hundreds of scientific reports, analyzed federal drinking water databases, visited environmental study sites and treatment plants and interviewed more than 230 officials, academics and scientists. They also surveyed the nation's 50 largest cities and a dozen other major water providers, as well as smaller community water providers in all 50 states.

Here are some of the key test results obtained by the AP:

–Officials in Philadelphia said testing there discovered 56 pharmaceuticals or byproducts in treated drinking water, including medicines for pain, infection, high cholesterol, asthma, epilepsy, mental illness and heart problems. Sixty-three pharmaceuticals or byproducts were found in the city's watersheds.

–Anti-epileptic and anti-anxiety medications were detected in a portion of the treated drinking water for 18.5 million people in Southern California.

–Researchers at the U.S. Geological Survey analyzed a Passaic Valley Water Commission drinking water treatment plant, which serves 850,000 people in Northern New Jersey, and found a metabolized angina medicine and the mood-stabilizing carbamazepine in drinking water.

–A sex hormone was detected in San Francisco's drinking water.

–The drinking water for Washington, D.C., and surrounding areas tested positive for six pharmaceuticals.

–Three medications, including an antibiotic, were found in drinking water supplied to Tucson, Ariz.

The situation is undoubtedly worse than suggested by the positive test results in the major population centers documented by the AP.

The federal government doesn't require any testing and hasn't set safety limits for drugs in water. Of the 62 major water providers contacted, the drinking water for only 28 was tested. Among the 34 that haven't: Houston, Chicago, Miami, Baltimore, Phoenix, Boston and New York City's Department of Environmental Protection, which delivers water to 9 million people.

Some providers screen only for one or two pharmaceuticals, leaving open the possibility that others are present.

The AP's investigation also indicates that watersheds, the natural sources of most of the nation's water supply, also are contaminated. Tests were conducted in the watersheds of 35 of the 62 major providers surveyed by the AP, and pharmaceuticals were detected in 28.

Yet officials in six of those 28 metropolitan areas said they did not go on to test their drinking water – Fairfax, Va.; Montgomery County in Maryland; Omaha, Neb.; Oklahoma City; Santa Clara, Calif., and New York City.

The New York state health department and the USGS tested the source of the city's water, upstate. They found trace concentrations of heart medicine, infection fighters, estrogen, anti-convulsants, a mood stabilizer and a tranquilizer.

City water officials declined repeated requests for an interview. In a statement, they insisted that "New York City's drinking water continues to meet all federal and state regulations regarding drinking water quality in the watershed and the distribution system" – regulations that do not address trace pharmaceuticals.

In several cases, officials at municipal or regional water providers told the AP that pharmaceuticals had not been detected, but the AP obtained the results of tests conducted by independent researchers that showed otherwise. For example, water department officials in New Orleans said their water had not been tested for pharmaceuticals, but a Tulane University researcher and his students have published a study that found the pain reliever naproxen, the sex hormone estrone and the anti-cholesterol drug byproduct clofibric acid in treated drinking water.

Of the 28 major metropolitan areas where tests were performed on drinking water supplies, only Albuquerque; Austin, Texas; and Virginia Beach, Va.; said tests were negative. The drinking water in Dallas has been tested, but officials are awaiting results. Arlington, Texas, acknowledged that traces of a pharmaceutical were detected in its drinking water but cited post-9/11 security concerns in refusing to identify the drug.

The AP also contacted 52 small water providers – one in each state, and two each in Missouri and Texas – that serve communities with populations around 25,000. All but one said their drinking water had not been screened for pharmaceuticals; officials in Emporia, Kan., refused to answer AP's questions, also citing post-9/11 issues.

Rural consumers who draw water from their own wells aren't in the clear either, experts say.

The Stroud Water Research Center, in Avondale, Pa., has measured water samples from New York City's upstate watershed for caffeine, a common contaminant that scientists often look for as a possible signal for the presence of other pharmaceuticals. Though more caffeine was detected at suburban sites, researcher Anthony Aufdenkampe was struck by the relatively high levels even in less populated areas.

He suspects it escapes from failed septic tanks, maybe with other drugs. "Septic systems are essentially small treatment plants that are essentially unmanaged and therefore tend to fail," Aufdenkampe said.

Even users of bottled water and home filtration systems don't necessarily avoid exposure. Bottlers, some of which simply repackage tap water, do not typically treat or test for pharmaceuticals, according to the industry's main trade group. The same goes for the makers of home filtration systems.

Contamination is not confined to the United States. More than 100 different pharmaceuticals have been detected in lakes, rivers, reservoirs and streams throughout the world. Studies have detected pharmaceuticals in waters throughout Asia, Australia, Canada and Europe – even in Swiss lakes and the North Sea.

For example, in Canada, a study of 20 Ontario drinking water treatment plants by a national research institute found nine different drugs in water samples. Japanese health officials in December called for human health impact studies after detecting prescription drugs in drinking water at seven different sites.

In the United States, the problem isn't confined to surface waters. Pharmaceuticals also permeate aquifers deep underground, source of 40 percent of the nation's water supply. Federal scientists who drew water in 24 states from aquifers near contaminant sources such as landfills and animal feed lots found minuscule levels of hormones, antibiotics and other drugs.

Perhaps it's because Americans have been taking drugs – and flushing them unmetabolized or unused – in growing amounts. Over the past five years, the number of U.S. prescriptions rose 12 percent to a record 3.7 billion, while nonprescription drug purchases held steady around 3.3 billion, according to IMS Health and The Nielsen Co.

"People think that if they take a medication, their body absorbs it and it disappears, but of course that's not the case," said EPA scientist Christian Daughton, one of the first to draw attention to the issue of pharmaceuticals in water in the United States.

Some drugs, including widely used cholesterol fighters, tranquilizers and anti-epileptic medications, resist modern drinking water and wastewater treatment processes. Plus, the EPA says there are no sewage treatment systems specifically engineered to remove pharmaceuticals.

One technology, reverse osmosis, removes virtually all pharmaceutical contaminants but is very expensive for large-scale use and leaves several gallons of polluted water for every one that is made drinkable.

Another issue: There's evidence that adding chlorine, a common process in conventional drinking water treatment plants, makes some pharmaceuticals more toxic.

Human waste isn't the only source of contamination. Cattle, for example, are given ear implants that provide a slow release of trenbolone, an anabolic steroid used by some bodybuilders, which causes cattle to bulk up. But not all the trenbolone circulating in a steer is metabolized. A German study showed 10 percent of the steroid passed right through the animals.

Water sampled downstream of a Nebraska feedlot had steroid levels four times as high as the water taken upstream. Male fathead minnows living in that downstream area had low testosterone levels and small heads.

Other veterinary drugs also play a role. Pets are now treated for arthritis, cancer, heart disease, diabetes, allergies, dementia, and even obesity – sometimes with the same drugs as humans. The inflation-adjusted value of veterinary drugs rose by 8 percent, to $5.2 billion, over the past five years, according to an analysis of data from the Animal Health Institute.

Ask the pharmaceutical industry whether the contamination of water supplies is a problem, and officials will tell you no. "Based on what we now know, I would say we find there's little or no risk from pharmaceuticals in the environment to human health," said microbiologist Thomas White, a consultant for the Pharmaceutical Research and Manufacturers of America.

But at a conference last summer, Mary Buzby – director of environmental technology for drug maker Merck & Co. Inc. – said: "There's no doubt about it, pharmaceuticals are being detected in the environment and there is genuine concern that these compounds, in the small concentrations that they're at, could be causing impacts to human health or to aquatic organisms."

Recent laboratory research has found that small amounts of medication have affected human embryonic kidney cells, human blood cells and human breast cancer cells. The cancer cells proliferated too quickly; the kidney cells grew too slowly; and the blood cells showed biological activity associated with inflammation.

Also, pharmaceuticals in waterways are damaging wildlife across the nation and around the globe, research shows. Notably, male fish are being feminized, creating egg yolk proteins, a process usually restricted to females. Pharmaceuticals also are affecting sentinel species at the foundation of the pyramid of life – such as earth worms in the wild and zooplankton in the laboratory, studies show.

Some scientists stress that the research is extremely limited, and there are too many unknowns. They say, though, that the documented health problems in wildlife are disconcerting.

"It brings a question to people's minds that if the fish were affected ... might there be a potential problem for humans?" EPA research biologist Vickie Wilson told the AP. "It could be that the fish are just exquisitely sensitive because of their physiology or something. We haven't gotten far enough along."

With limited research funds, said Shane Snyder, research and development project manager at the Southern Nevada Water Authority, a greater emphasis should be put on studying the effects of drugs in water.

"I think it's a shame that so much money is going into monitoring to figure out if these things are out there, and so little is being spent on human health," said Snyder. "They need to just accept that these things are everywhere – every chemical and pharmaceutical could be there. It's time for the EPA to step up to the plate and make a statement about the need to study effects, both human and environmental."

To the degree that the EPA is focused on the issue, it appears to be looking at detection. Grumbles acknowledged that just late last year the agency developed three new methods to "detect and quantify pharmaceuticals" in wastewater. "We realize that we have a limited amount of data on the concentrations," he said. "We're going to be able to learn a lot more."

While Grumbles said the EPA had analyzed 287 pharmaceuticals for possible inclusion on a draft list of candidates for regulation under the Safe Drinking Water Act, he said only one, nitroglycerin, was on the list. Nitroglycerin can be used as a drug for heart problems, but the key reason it's being considered is its widespread use in making explosives.

So much is unknown. Many independent scientists are skeptical that trace concentrations will ultimately prove to be harmful to humans. Confidence about human safety is based largely on studies that poison lab animals with much higher amounts.

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.

For several decades, federal environmental officials and nonprofit watchdog environmental groups have focused on regulated contaminants – pesticides, lead, PCBs – which are present in higher concentrations and clearly pose a health risk.

However, some experts say medications may pose a unique danger because, unlike most pollutants, they were crafted to act on the human body.

"These are chemicals that are designed to have very specific effects at very low concentrations. That's what pharmaceuticals do. So when they get out to the environment, it should not be a shock to people that they have effects," says zoologist John Sumpter at Brunel University in London, who has studied trace hormones, heart medicine and other drugs.

And while drugs are tested to be safe for humans, the timeframe is usually over a matter of months, not a lifetime. Pharmaceuticals also can produce side effects and interact with other drugs at normal medical doses. That's why – aside from therapeutic doses of fluoride injected into potable water supplies – pharmaceuticals are prescribed to people who need them, not delivered to everyone in their drinking water.

"We know we are being exposed to other people's drugs through our drinking water, and that can't be good," says Dr. David Carpenter, who directs the Institute for Health and the Environment of the State University of New York at Albany.

––––

The AP National Investigative Team can be reached at investigateap.org

AP IMPACT: Pharmaceuticals found in drinking water

AP Photo NY459, NY441, NY442, NY445, NY446, NY444, NY443, NY447, NY448, NY449, NY451, NY450, NY452, NY453, NY454, NY455, NY456, NY457, NY458

AP Graphics PHARMAWATER LOGO, PHARMAWATER MAP, PHARMAWATER EXPLAINER

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Doc: 00335779 DB: research–d–2008–1 Date: Sun Mar 9 14:27:28 2008

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AP IMPACT: Pharmaceuticals found in drinking water

Eds: Also moved in advance. A longer version also moved. Multimedia: A 3D interactive on the cycle of drugs in drinking water supplies, along with a review of major metropolitan areas where pharmaceuticals have been found in drinking water supplies, is available in the –national/drugs–water folder, embargoed for noon Eastern on March 9. Note Oklahoma interest in 21st graf.

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AP Graphics PHARMAWATER LOGO, PHARMAWATER MAP, PHARMAWATER EXPLAINER

EDITOR'S NOTE – The nation's drinking water supplies are not as pristine as might be expected – traces of pharmaceuticals are all too common, an Associated Press investigation finds. First of a three-part series.

†By JEFF DONN, MARTHA MENDOZA and JUSTIN PRITCHARD

†Associated Press Writers

How do the drugs get into the water?

"We recognize it is a growing concern and we're taking it very seriously," said Benjamin H. Grumbles, assistant administrator for water at the U.S. Environmental Protection Agency.

Here are some of the key test results obtained by the AP:

–Anti-epileptic and anti-anxiety medications were detected in a portion of the treated drinking water for 18.5 million people in Southern California.

–A sex hormone was detected in San Francisco's drinking water.

–The drinking water for Washington, D.C., and surrounding areas tested positive for six pharmaceuticals.

The situation is undoubtedly worse than suggested by the positive test results in the major population centers documented by the AP.

Some providers screen only for one or two pharmaceuticals, leaving open the possibility that others are present.

Rural consumers who draw water from their own wells aren't in the clear either, experts say.

Veterinary drugs also play a role. Pets are now treated for a wide range of ailments– sometimes with the same drugs as humans. The inflation-adjusted value of veterinary drugs rose by 8 percent, to $5.2 billion, over the past five years, according to an analysis of data from the Animal Health Institute.

Some scientists stress that the research is extremely limited, and there are too many unknowns. They say, though, that the documented health problems in wildlife are disconcerting.

So much is unknown. Many independent scientists are skeptical that trace concentrations will ultimately prove to be harmful to humans. There's growing concern in the scientific community, though, 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.

––––

The AP National Investigative Team can be reached at investigate (at) ap.org

Pharmaceuticals found in drinking water of 24 major metro areas, 34 say no testing

By The Associated Press

With BC-PharmaWater I

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Doc: 00337354 DB: research–d–2008–1 Date: Mon Mar 10 00:03:22 2008

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Profiler Categories: Environment

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Pharmaceuticals found in drinking water of 24 major metro areas, 34 say no testing

Eds: A list of major metropolitan areas and test results, in alphabetical order. This item moved previously as an advance and is now available for use.

With BC-PharmaWater I

By The Associated Press

At least one pharmaceutical was detected in tests of treated drinking water supplies for 24 major metropolitan areas, according to an Associated Press survey of 62 major water providers and data obtained from independent researchers.

Only 28 tested drinking water. Three of those said results were negative; Dallas says tests were conducted but results are not yet available. Thirty-four locations said no testing was conducted.

Test protocols varied widely. Some researchers looked only for one pharmaceutical or two; others looked for many.

Some water systems said tests had been negative, but the AP found independent research showing otherwise. Both prescription and non-prescription drugs were detected.

Because coffee and tobacco are so widely used, researchers say their byproducts are good indicators of the presence of pharmaceuticals. Thus, they routinely test for, and often find, both caffeine and nicotine's metabolite cotinine more frequently than other drugs.

Here's the list of metropolitan areas, with the number of pharmaceuticals detected and some examples of specific drugs that were found, or where tests were negative, not conducted or awaiting results:

Albuquerque, N.M.: tests negative

Arlington, Texas: 1 (unspecified pharmaceutical)

Atlanta: 3 (acetaminophen, caffeine and cotinine)

Austin, Texas: tests negative

Baltimore: no testing

Birmingham, Ala.: no testing

Boston: no testing

Charlotte, N.C.: no testing

Chicago: no testing

Cincinnati: 1 (caffeine)

Cleveland: no testing

Colorado Springs, Colo.: no testing

Columbus, Ohio: 5 (azithromycin, roxithromycin, tylosin, virginiamycin and caffeine)

Concord, Calif.: 2 (meprobamate and sulfamethoxazole)

Dallas: results pending

Denver: (unspecified antibiotics)

Detroit: (unspecified drugs)

El Paso, Texas: no testing

Fairfax, Va.: no testing

Fort Worth, Texas: no testing

Fresno, Calif.: no testing

Honolulu: no testing

Houston: no testing

Indianapolis: 1 (caffeine)

Jacksonville, Fla.: no testing

Kansas City, Mo.: no testing

Las Vegas: 3 (carbamazepine, meprobamate and phenytoin)

Long Beach, Calif.: 2 (meprobamate and phenytoin)

Los Angeles: 2 (meprobamate and phenytoin)

Louisville, Ky.: 3 (caffeine, carbamazepine and phenytoin)

Memphis, Tenn.: no testing

Mesa, Ariz.: no testing

Miami: no testing

Milwaukee: 1 (cotinine)

Minneapolis: 1 (caffeine)

Nashville, Tenn.: no testing

New Orleans: 3 (clofibric acid, estrone and naproxen)

New York City: no testing

Northern New Jersey: 7 (caffeine, carbamazepine, codeine, cotinine, dehydronifedipine, diphenhydramine and sulfathiazole)

Oakland, Calif.: no testing

Oklahoma City: no testing

Omaha, Neb.: no testing

Orlando, Fla.: no testing

Philadelphia: 56 (including amoxicillin, azithromycin, carbamazepine, diclofenac, prednisone and tetracycline)

Phoenix: no testing

Portland, Ore.: 4 (acetaminophen, caffeine, ibuprofen and sulfamethoxazole)

Prince George's and Montgomery counties, Md.: no testing

Riverside County, Calif.: 2 (meprobamate and phenytoin)

Sacramento, Calif.: no testing

San Antonio: no testing

San Diego: 3 (ibuprofen, meprobamate and phenytoin)

San Francisco: 1 (estradiol)

San Jose, Calif.: no testing

Santa Clara, Calif.: no testing

Seattle: no testing

Southern California: 2 (meprobamate and phenytoin)

Suffolk County, N.Y.: no testing

Tucson, Ariz.: 3 (carbamazepine, dehydronifedipine and sulfamethoxazole)

Tulsa, Okla.: no testing

Virginia Beach, Va.: tests negative

Washington, D.C.: 6 (carbamazepine, caffeine, ibuprofen, monensin, naproxen and sulfamethoxazole)

Wichita, Kan.: no testing.

Pharmaceuticals found in drinking water of 24 major metro areas, 34 say no testing

By The Associated Press

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Pharmaceuticals found in drinking water of 24 major metro areas, 34 say no testing

Eds: A list of major metropolitan areas and test results, grouped by findings. This item moved previously as an advance and is now available for use.

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By The Associated Press

Only 28 tested drinking water. Three of those said results were negative; Dallas says tests were conducted but results are not yet available. Thirty-four locations said no testing was conducted.

Test protocols varied widely. Some researchers looked only for one pharmaceutical or two; others looked for many.

Some water systems said tests had been negative, but the AP found independent research showing otherwise. Both prescription and non-prescription drugs were detected.

Here's the list of metropolitan areas, grouped by categories – those with positive test results, including the number of pharmaceuticals detected and some examples of specific drugs found, locations where tests were negative, locations where tests were not conducted and a location with pending results:

TESTED POSITIVE

Arlington, Texas: 1 (unspecified pharmaceutical)

Atlanta: 3 (acetaminophen, caffeine and cotinine)

Cincinnati: 1 (caffeine)

Columbus, Ohio: 5 (azithromycin, roxithromycin, tylosin, virginiamycin and caffeine)

Concord, Calif.: 2 (meprobamate and sulfamethoxazole)

Denver: (unspecified antibiotics)

Detroit: (unspecified drugs)

Indianapolis: 1 (caffeine)

Las Vegas: 3 (carbamazepine, meprobamate and phenytoin)

Long Beach, Calif.: 2 (meprobamate and phenytoin)

Los Angeles: 2 (meprobamate and phenytoin)

Louisville, Ky.: 3 (caffeine, carbamazepine and phenytoin)

Milwaukee: 1 (cotinine)

Minneapolis: 1 (caffeine)

New Orleans: 3 (clofibric acid, estrone and naproxen)

Northern New Jersey: 7 (caffeine, carbamazepine, codeine, cotinine, dehydronifedipine, diphenhydramine and sulfathiazole)

Philadelphia: 56 (including amoxicillin, azithromycin, carbamazepine, diclofenac, prednisone and tetracycline)

Portland, Ore.: 4 (acetaminophen, caffeine, ibuprofen and sulfamethoxazole)

Riverside County, Calif.: 2 (meprobamate and phenytoin)

San Diego: 3 (ibuprofen, meprobamate and phenytoin)

San Francisco: 1 (estradiol)

Southern California: 2 (meprobamate and phenytoin)

Tucson, Ariz.: 3 (carbamazepine, dehydronifedipine and sulfamethoxazole)

Washington, D.C.: 6 (carbamazepine, caffeine, ibuprofen, monensin, naproxen and sulfamethoxazole)

TESTED NEGATIVE

Albuquerque, N.M.: tests negative

Austin, Texas: tests negative

Virginia Beach, Va.: tests negative

DID NOT TEST

Baltimore: no testing

Birmingham, Ala.: no testing

Boston: no testing

Charlotte, N.C.: no testing

Chicago: no testing

Cleveland: no testing

Colorado Springs, Colo.: no testing

El Paso, Texas: no testing

Fairfax, Va.: no testing

Fort Worth, Texas: no testing

Fresno, Calif.: no testing

Honolulu: no testing

Houston: no testing

Jacksonville, Fla.: no testing

Kansas City, Mo.: no testing

Memphis, Tenn.: no testing

Mesa, Ariz.: no testing

Miami: no testing

Nashville, Tenn.: no testing

New York City: no testing

Oakland, Calif.: no testing

Oklahoma City: no testing

Omaha, Neb.: no testing

Orlando, Fla.: no testing

Phoenix: no testing

Sacramento, Calif.: no testing

San Antonio: no testing

Prince George's and Montgomery counties, Md.: no testing

San Jose, Calif.: no testing

Santa Clara, Calif.: no testing

Seattle: no testing

Suffolk County, N.Y.: no testing

Tulsa, Okla.: no testing

Wichita, Kan.: no testing

TESTED, RESULTS PENDING

Dallas: results pending

Drug traces turn up in source waters for nation's biggest city

By JEFF DONN

AP National Writer

With BC-PharmaWater I

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Drug traces turn up in source waters for nation's biggest city

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By JEFF DONN

AP National Writer

NEW YORK (AP) – Locals say this city makes the world's best bagels from the best water, piped in from rustic reservoirs up to 150 miles north. Yet few know of a secret ingredient in their source water: a dash of pharmaceuticals.

Research studies have turned up minute amounts of more than 15 drugs or their byproducts in several pristine-looking rivers, a reservoir, and aqueducts feeding the country's biggest water system.

Though barely measurable, these pharmaceuticals are present in a variety worthy of a medicine cabinet: drugs for aches, infections, seizures and high blood pressure; hormones for menopause; the active ingredient in a popular sedative; and caffeine – all bound for the city that never sleeps.

How did they reach waterways? The vast watershed, while mainly rural, stretches almost from Pennsylvania to Connecticut and encompasses lots of human activity. Human and veterinary medicines are excreted or discarded, and eventually enter source waters mostly through residential sewage or farm runoff.

And while these waters are processed at wastewater treatment plants upstate, much of the pharmaceutical residue passes right through, studies show.

It's unknown how much lingers each day by the time 1.1 billion gallons reach the faucets of more than 9 million people in the city and northern suburbs via a century-old network of aqueducts and tunnels.

The New York City Department of Environmental Protection, which runs the city's water system, responded to an Associated Press survey of water utilities, saying it has not tested its drinking water for pharmaceuticals, despite the findings in its watershed.

The tests that detected pharmaceuticals in the upstate source waters were conducted by the U.S. Geological Survey and New York State Department of Health.

City water officials declined repeated requests for an interview and issued only a brief general statement: "New York City's drinking water continues to meet all federal and state regulations regarding drinking water quality in the watershed and the distribution system" – regulations that do not address pharmaceuticals in trace amounts.

As in other cities, human health risks from trace pharmaceuticals are uncertain, since concentrations in New York source waters are way below medical doses and undergo dilution as they mix with fresh water en route to the city.

Already, though, troubling studies indicate that traces of pharmaceuticals may be harming fish in New York City's Jamaica Bay, within sight of Manhattan's skyscrapers. Researcher Anne McElroy at Stony Brook University has found feminized male flounder there, and she links them to high levels of the female hormone estrone or other estrogenic chemicals discovered in the waterway.

Estrogen also has been found in the city's watershed in recent years. Upstate, the geological survey and state health agency also detected the heart medicine atenolol; anti-seizure drugs carbamazepine and primidone; relaxers diazepam and carisoprodol; infection fighters trimethoprim, clindamycin, and sulfamethoxazole; pain relievers ibuprofen, acetaminophen and codeine; and remains of caffeine and nicotine.

Despite all that, the federal government considers the New York City system to be so clean that it need not filter most of its water, as most big cities are required to do. When the filtering waiver was extended last year, Mayor Michael R. Bloomberg exulted: "I've always thought that New York City has some of the best water around, and now we've got confirmation from Washington."

However, filtration is meant mainly to remove germs, and the federal government hasn't required any testing of pharmaceuticals in source or drinking water. Though it lacks conventional treatment plants with filtering processes, New York City does disinfect and add chemicals to its drinking water. Plus, it is building a filtration plant for water from its Croton watershed – its smallest and closest source.

Patrick Phillips, a geological survey hydrologist who has studied drugs in the city's watershed, says recent sewage treatment upgrades probably catch some, though the systems aren't designed to. The city also is building a plant to disinfect with ultraviolet radiation the water taken from the major, upstate sectors of the watershed. Research shows that ultraviolet can degrade some pharmaceuticals.

"I think both the state and the city are aware that these things could be an issue and you could be proactive about it," Phillips says.

Few New Yorkers seem aware of their possible presence. The AP contacted more than two dozen water-testing companies across the metropolitan area, and none had ever been asked to check for pharmaceuticals.

Douglas LeVangie, a sales executive at Simpltek, says even the company's home water tests for disease-causing germs sell modestly in New York City, with its global reputation for wholesome water.

–––

National Writer Martha Mendoza and writer Justin Pritchard also contributed to this report.

Tests of Philadelphia's drinking water reveal the presence of 56 pharmaceuticals or byproducts

Around the world, research shows pharmaceuticals in water could impact human cells

By JEFF DONN

AP National Writer

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Around the world, research shows pharmaceuticals in water could impact human cells

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By JEFF DONN

AP National Writer

Troubled by drugs discovered in European waters, poisons expert and biologist Francesco Pomati set up an experiment: He exposed developing human kidney cells to a mixture of 13 drugs at levels mimicking those found in Italian rivers.

There were drugs to fight high cholesterol and blood pressure, seizures and depression, pain and infection, and cancer, all in tiny amounts.

The result: The pharmaceutical blend slowed cell growth by up to a third – suggesting that scant amounts may exert powerful effects, said Pomati, who works at the University of New South Wales in Sydney, Australia.

Taken alone, this was a modest study. But in fact Pomati's work is part of a body of emerging scientific studies that indicate that over time, humans could be harmed by ingesting drinking water contaminated with tiny amounts of pharmaceuticals.

In another recently published study, Pomati discovered that some of those pharmaceuticals could amplify – or reverse – the effects of some others.

For example, the cholesterol drug bezafibrate and asthma drug salbutamol each seem to stimulate cell growth. Combined in the laboratory, they slowed it way down. The same cholesterol drug appeared to make cells more sensitive to harm from the antibiotic fluoroquinolone.

And Pomati's work indicates some drugs cause cellular effects at scant concentrations that – strangely – cannot be seen at higher levels.

Such findings are preliminary; they alone cannot demonstrate the same effects within the human body. But they provide scientific hints, just like cellular experiments that routinely guide discovery of new drugs.

They also heighten worry about the possible effects on especially vulnerable groups, like the very young, old or sick. "My wife is pregnant, and I don't let my wife drink the water ... where I know that there are pollutants like pharmaceuticals in concentrations that are detectable and in mixtures that are complex," said Pomati.

Elsewhere in the world, other researchers are finding results similar to Pomati's.

In research awaiting publication, human breast cancer cells grew twice as fast when exposed to estrogens taken from catfish caught near untreated sewage overflows in Pennsylvania, compared with other fish.

The University of Pittsburgh researchers didn't calculate how much effect came from pharmaceuticals instead of natural hormones, but their earlier work points to birth-control pills and hormone treatments as important contributors, said lead researcher Conrad Volz.

"There is the potential for an increased risk for those people who are prone to estrogenic cancer," said Volz, who studies environmental hazards at the university's Cancer Institute.

He said people who regularly drink water containing low levels of hormones may be at higher risk, since they would presumably consume more of these drugs than those who only occasionally eat such fish.

Scientists at the Helmholtz research center in Leipzig, Germany, linked low levels of the pain reliever diclofenac to an inflammatory-like response in human blood cells, according to biologist Kristin Schirmer. Inflammation at the wrong time and place plays a role in conditions ranging from infections and arthritis to heart disease.

Sandra Steingraber, a biologist at New York's Ithaca College, adds that many efforts to determine how trace drugs affect humans don't fully consider the whole range of pharmaceuticals in the environment and whether someone has been exposed at more susceptible times, like during childhood or old age.

"The timing makes the poison as much as the dose," she said. "And the dose itself is not the dose from just any one thing – it's from this whole kaleidoscope of chemicals."

Taking notice of accumulating evidence, the drug industry has backed studies of its own in recent years that have found very slight, if any, risk to humans.

But these studies haven't used water samples analyzed for drugs. Instead, the studies estimate danger from what's known about how much of a drug is sold and how toxic it is to animals. Then, safety margins are added for unknowns, such as possible effects of decades of exposure.

Those margins are just educated guesses. Also, the studies usually ignore what might happen to people exposed to the complex combinations of medicines that are often found in drinking water.

Then, there are the byproducts of the drugs. When medications are digested and processed through water treatment plants, they may take a new metabolic form.

"They miss some of the big issues. Our research shows mixtures are so prevalent," said Dana Kolpin, a U.S. Geological Survey water expert who launched a plethora of research in 2002 after finding pharmaceuticals in most samples taken from 139 streams in 30 states. "If there are any cumulative or additive issues, you can't just dismiss things so quickly."

Even if Kolpin is right, the industry may be focusing on the wrong pharmaceuticals, said chemist James Shine at the Harvard School of Public Health, who oversaw what's probably the broadest risk review yet, a yet-to-be-published study covering scores of the most common drugs sold in the United States.

As suspected, some chemotherapy drugs turn up high on that list. But blood-pressure diuretics, though rarely considered, appear to pose more risk than many drugs more often evaluated.

Even when researchers downplay risk, that may not be the final word.

People "are going to be concerned about being medicated by mandate when you turn on the tap," said Dr. Stevan Gressitt, a psychiatrist who's led a push for a program in Maine that allows consumers to turn in unused pharmaceuticals for secure disposal or destruction. "And that's going to be seen if the level is (only) one molecule in 100 taps."

–––

National Writer Martha Mendoza and writer Justin Pritchard also contributed to this report.

AP investigation details pharmaceuticals found in watersheds of 28 major metro areas

With BC-PharmaWater I

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Doc: 00337360 DB: research–d–2008–1 Date: Mon Mar 10 00:03:28 2008

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AP investigation details pharmaceuticals found in watersheds of 28 major metro areas

Eds: UPDATES with number of unspecified drugs for Arlington and names of specific drugs for Southern California; CORRECTS Omaha entry to change the number found to 2, dropping cholesterol. This item moved previously as an advance and is now available for use.

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By The Associated Press

AP investigation details pharmaceuticals found in watersheds of 28 major metro areas

At least one pharmaceutical or byproduct was detected in testing within the watersheds of 28 major metropolitan areas, according to an Associated Press survey of 62 major water providers and data obtained from independent researchers.

Test protocols varied widely. Some researchers tested for more drugs than others. Thirty-five areas said they tested. Four said tests were negative and three said they were awaiting results. Twenty-seven locations said they had not tested watershed supplies.

Here's the list of the 28 areas with pharmaceuticals detected, with the number found and some examples.

Arlington, Texas: 5 (unspecified drugs)

Atlanta: 10 (including caffeine, sulfamethoxazole, diltiazem, acetaminophen, trimethoprim, cotinine and paraxanthine)

Cincinnati: 4 (gemfibrozil, ibuprofen, sulfamethaxazole and ethinyl estradiol)

Columbus, Ohio: 15 (including azithromycin, erythromycin, roxithromycin, tylosin, ciprofloxacin, ofloxacin and caffeine)

Concord, Calif.: (unspecified drugs)

Denver: (unspecified antibiotics)

Detroit: (unspecified total; including carbamazepine, caffeine, cotinine)

Fairfax, Va.: 8 (erythromycin, lincomycin, trimethoprim, tylosin, ciprofloxacin, ofloxacin and sulfamethoxazole)

Indianapolis: 2 (caffeine and cotinine)

Las Vegas: 9 (including sulfamethoxazole, atenolol, trimethoprim, meprobamate, phenytoin, carbamazepine and gemfibrozil)

Long Beach, Calif.: 9 (unspecified drugs)

Los Angeles: 9 (unspecified drugs)

Louisville, Ky.: 2 (ibuprofen and naproxen)

Milwaukee: 1 (cotinine)

Minneapolis: 3 (acetaminophen, caffeine and cotinine)

New York City: 16 (including atenolol, trimethoprim, carbamazepine, ibuprofen, estrogen, acetaminophen and diazepam)

Northern New Jersey: 13 (including acetaminophen, carbamazepine, codeine, dehydronifedipine, erythromycin, lincomycin and sulfadimethoxine)

Oklahoma City: 12 (including acetaminophen, fluoxetine, gemfibrozil, ibuprofen, iopromide, sulfamethoxazole and iopromide)

Omaha, Neb.: 2 (caffeine and sulfamethoxazole)

Philadelphia: 63 (including amoxicillin, aspirin, atorvastatin, bacitracin, diclofenac, phenytoin and fluoxetine)

Prince George's-Montgomery counties, Md.: 3 (caffeine, carbamazepine and cotinine)

Riverside County, Calif.: 9 (unspecified drugs)

San Diego: 12 (clofibrate, clofibric acid, ibuprofen and nine unspecified)

San Francisco: 1 (estrone)

Santa Clara, Calif.: (unspecified drugs)

Southern California: 9 (including atenolol, phenytoin, fluoxetine, gemfibrozil, meprobamate, naproxen and trimethoprim)

Virginia Beach, Va.: 4 (fluoxetine, estradiol, acetaminophen and ibuprofen)

Washington, D.C.: 5 (monensin, ibuprofen, caffeine, carbamazepine and sulfamethoxazole)

AP survey of 52 smaller cities show no testing for pharmaceuticals in drinking water

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AP survey of 52 smaller cities show no testing for pharmaceuticals in drinking water

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By The Associated Press

The Associated Press surveyed 52 small water providers that serve communities with populations generally around 25,000 – one in each state, and two in Missouri and Texas.

All but one said their drinking water had not been screened for pharmaceuticals; officials in that community, Emporia, Kan., refused to answer AP's questions, citing post-9/11 security concerns.

Here's the list of the 51 cities that told the AP its drinking water has not been tested.

Anniston, Ala.

Fairbanks, Alaska

Prescott, Ariz.

Jacksonville, Ark.

Santa Paula, Calif.

Grand Junction, Colo.

Norwich, Conn.

Newark, Del.

Homestead City, Fla.

LaGrange, Ga.

Hilo, Hawaii

Lewiston, Idaho

Freeport, Ill.

Michigan City, Ind.

Fort Dodge, Iowa

Paducah, Ky.

Houma, La.

Bangor, Maine

Annapolis, Md.

Agawam, Mass.

Burton, Mich.

Fridley, Minn.

Pascagoula, Miss.

Kirkwood, Mo.

Sedalia, Mo.

Butte-Silver Bow, Mont.

Grand Island, Neb.

Carson City, Nev.

Dover, N.H.

Millville, N.J.

Hobbs, N.M.

Watertown,N.Y.

Sanford, N.C.

Minot, N.D.

Shawnee, Okla.

Zanesville, Ohio

Lake Oswego, Ore.

Lebanon, Pa.

Bristol, R.I.

Florence, S.C.

Rapid City, S.D.

Oak Ridge, Tenn.

Denison, Texas

Kingsville, Texas

Midvale, Utah

Burlington, Vt.

Salem, Va.

Puyallup, Wash.

Huntington, W. Va.

New Berlin, Wis.

Laramie, Wyo.

The ins and outs of drug metabolism

By The Associated Press

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Doc: 00337359 DB: research–d–2008–1 Date: Mon Mar 10 00:03:27 2008

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The ins and outs of drug metabolism

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By The Associated Press

A furnace can't burn a whole lump of coal; some is wasted. Your body can't use all the medicine you take either; some is excreted.

How much of a drug passes through the body depends on the particular medicine.

Some drugs are very efficient performers, according to data collected by chemist James Shine at the Harvard School of Public Health. The body metabolizes, or uses up, more than 80 percent of the pain reliever acetaminophen and the antidepressant fluoxetine. These metabolized portions are used by the body to make you feel better.

Other drugs are harder to metabolize, but at least half is used. That's true of the antibiotic ciprofloxacin and of digoxin for heart problems.

Yet other drugs, like metformin for diabetes and atenolol for high blood pressure, are not metabolized as much, and at least 80 percent of those pills end up in the toilet.

Once waterborne, the remains of pharmaceuticals find their way into sewers and streams – and eventually into drinking water.

The concentration of a particular drug in water supplies also is determined by how much is taken and how readily the specific drug breaks down in the environment.

AP INVESTIGATION: Fish and wildlife showing adverse effects of drug contamination in waterways

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AP INVESTIGATION: Fish and wildlife showing adverse effects of drug contamination in waterways

Eds: Second of a series. Multimedia: A 3D interactive on the cycle of drugs in drinking water supplies, along with a review of major metropolitan areas where pharmaceuticals have been found in drinking water supplies, will be available in the –national/drugs–water folder, EMBARGOED for noon Sunday, March 9.

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EDITOR'S NOTE – Second of a three-part series on drug traces in America's drinking water supplies – and growing concerns about their effects.

†By JEFF DONN, MARTHA MENDOZA and JUSTIN PRITCHARD

†Associated Press Writers

LAKE MEAD, Nev. (AP) – On this brisk, glittering morning, a flat-bottomed boat glides across the massive reservoir that provides Las Vegas its drinking water. An ominous rumble growls beneath the craft as its two long, electrified claws extend into the depths.

Moments later, dozens of stunned fish float to the surface.

Federal scientists scoop them up and transfer them into 50-quart Coleman ice chests for transport to a makeshift lab on the dusty lakeshore. Within the hour, the researchers will club the seven-pound common carps to death, draw their blood, snip out their gonads and pack them in aluminum foil and dry ice.

The specimens will be flown across the country to laboratories where aquatic toxicologists are studying what happens to fish that live in water contaminated with at least 13 different medications – from over-the-counter pain killers to prescription antibiotics and mood stabilizers.

More often than not these days, the laboratory tests bring unwelcome results.

A five-month Associated Press investigation has determined that trace amounts of many of the pharmaceuticals we take to stay healthy are seeping into drinking water supplies, and a growing body of research indicates that this could harm humans.

But people aren't the only ones who consume that water. There is more and more evidence that some animals that live in or drink from streams and lakes are seriously affected.

Pharmaceuticals in the water are being blamed for severe reproductive problems in many types of fish: The endangered razorback sucker and male fathead minnow have been found with lower sperm counts and damaged sperm; some walleyes and male carp have become what are called feminized fish, producing egg yolk proteins typically made only by females.

Meanwhile, female fish have developed male genital organs. Also, there are skewed sex ratios in some aquatic populations, and sexually abnormal bass that produce cells for both sperm and eggs.

There are problems with other wildlife as well: kidney failure in vultures, impaired reproduction in mussels, inhibited growth in algae.

"We have no reason to think that this is a unique situation," says Erik Orsak, an environmental contaminants specialist with the U.S. Fish and Wildlife Service, pulling off rubber gloves splattered with fish blood at Lake Mead. "We find pretty much anywhere we look, these compounds are ubiquitous."

For example:

–In a broad study still under way, fish collected in waterways near or in Chicago; West Chester, Pa.; Orlando; Dallas; and Phoenix have tested positive for an array of pharmaceuticals – analgesics, antibiotics, antidepressants, antihistamines, anti-hypertension drugs and anti-seizure medications.

–That research follows a 2003 study in northern Texas, where every bluegill, black crappie and channel catfish researchers caught living downstream of a wastewater treatment plant tested positive for the active ingredients in two widely used antidepressants – one of the first times the residues of such drugs were detected in wildlife.

–In several recent studies of soil fertilized with livestock manure or with the sludge product from wastewater treatment plants, American scientists found earthworms had accumulated those same compounds, while vegetables – including corn, lettuce and potatoes – had absorbed antibiotics. "These results raise potential human health concerns," wrote researchers.

–Blood and liver samples of bull sharks in Florida's Caloosahatchee River, a nursery area for juvenile bullsharks and home to six wastewater treatment plants, are being tested for the presence of an array of medications this winter. Of the first ten sharks sampled, nine tested positive for the active ingredient in an antidepressant.

–And in Colorado's Boulder Creek, 50 of the 60 white suckers collected downstream of Boulder's wastewater treatment plant were female, compared to about half of them upstream.

Elsewhere in the world – from the icy streams of England to the wild game reserves of South Africa – snails, fish, even antelope, are showing signs of possible pharmaceutical contamination. For example, fish and prawn in China exposed to treated wastewater had shortened life spans, Pacific oysters off the coast of Singapore had inhibited growth, and in Norway, Atlantic salmon exposed to levels of estrogen similar to those found in the North Sea had severe reproductive problems.

More than 100 different pharmaceuticals have been detected in surface waters throughout the world.

"It's inescapable," said Sudeep Chandra, an assistant professor at University of Nevada, Reno who studies inland waters and aquatic life. "There's enough global information now to confirm these contaminants are affecting organisms and wildlife."

While some researchers have captured wildlife and tested it for pharmaceuticals, many more have brought wildlife into their laboratories and exposed them to traces of human pharmaceuticals at levels similar to those found in water, aquatic plants and animals.

The results have been troubling.

Freshwater mussels exposed to tiny amounts of an antidepressant's active ingredient released premature larvae, giving the next generation lower odds of survival; in a separate lab study, the antidepressant also stunted reproduction in tiny fresh water mud snails.

When researchers slid hydras – a tiny polyp that under a microscope looks like a slender jellyfish – into water tainted with minute amounts of pharmaceuticals, their mouths, feet and tentacles stopped growing. While the hydras are minuscule, the implications are grave: Chronic exposure to trace levels of commonly found pharmaceuticals can damage a species at the foundation of a food pyramid.

Tiny zooplankton, another sentinel species, died off in the lab when they were exposed to extremely small amounts of a common drug used to treat humans suffering from internal worms and other digesting parasites.

In a landmark, seven-year study published last year, researchers turned an entire pristine Canadian lake into their laboratory, deliberately dripping the active ingredient in birth control pills into the water in amounts similar to those found to have contaminated aquatic life, plants and water in nature.

After just seven weeks, male fathead minnows began producing yolk proteins, their gonads shrank, and their behavior was feminized – they fought less, floating passively. They also stopped reproducing, resulting in "ultimately, a near extinction of this species from the lake," said the scientists.

While the Canadian study was prompted by human intervention, similar die-offs have occurred in the wild.

In Pakistan, the entire population of a common vulture virtually disappeared after the birds began eating carcasses of cows that had been treated with an anti-inflammatory drug. Scientists, in a 2004 study, said they eventually determined that the birds' kidneys were failing.

"The death of those vultures – the fact that you could get a complete collapse of a population due to pharmaceuticals in the environment – that was a powerful thing," said Christian Daughton, an EPA researcher in Las Vegas. "It was a major ecological catastrophe."

In November, at the annual Society of Environmental Toxicology and Chemistry meeting in Milwaukee, 30 new studies related to pharmaceuticals in the environment were presented – hormones found in the Chicago River; abnormalities in Japanese zebra fish; ibuprofen, gemfibrozil, triclosan and naproxen in the lower Great Lakes.

Many of those studies refer to the heralded research at Lake Mead. There, on a recent morning, Steven Goodbred struggled to hold a large wriggling carp with both hands. On the outside, the carp looked fine, vibrant and strong, but the U.S. Geological Survey scientist assumed the worst.

"Typically we see low levels of sex steroids, limited testicular function, low sperm count, that kind of thing," he said slipping the fish into a holding tank and closing the lid. "We'll have to wait and see about this fellow."

These carp live, eat, reproduce and die at the mouth of what amounts to a 30-mile-long drainage system that starts within the toilets and sinks of the casinos, hotels and homes of Sin City.

Some 180 million gallons of effluent are discharged into the channel each day from three wastewater treatment plants. The daily sewage discharge is expected to increase to 400 million gallons a day by 2050.

The USGS and U.S Fish and Wildlife Service tracked the channel from its origins, before the inflow from the sewage plants, to where it empties into Las Vegas Bay in the lake. Their findings: The amount of endocrine-disrupting compounds (including hormone treatments and other chemicals affecting reproduction) increased more than 646 times.

Not far from the mouth of the drainage channel – amid the fishing boats and sightseeing tours – water is sucked into a long pipe, destined for a drinking water treatment plant, then Las Vegas – thus beginning the cycle all over again.

Other communities in Nevada, as well as locales in California and Arizona, also draw on Lake Mead.

"Lake Mead is a fortuitous worst-case scenario" for study, said environmental toxicologist Greg Moller, holding a bottle of Lake Mead water he planned to take back to his lab at the University of Idaho. "You've got the wastewater, you've got the documented impact on wildlife, and you have drinking water uptake."

Although more than eight million tourists, including 500,000 anglers, visit the reservoir annually, there are no warnings about the contaminants. No signs. No advisories.

That's not unusual. Scientists have been finding pharmaceuticals in hundreds of other public waterways across the nation and throughout the world – almost always without public fanfare, as documented in the AP investigation.

At the same time, scientists are looking for remedies. In Las Vegas, just off the Strip at the Desert Research Institute, microbial biologist Duane Moser optimistically held a tray of increasingly murky test tubes.

"We put a little bit of estrogen in here, and then we added a particular bacteria, and guess what? The bacteria are consuming the estrogen," he said. Someday, perhaps, scientists will be able to use these special bacteria to clean estrogen out of contaminated water.

"It's early, but it's promising," he said.

––––

National Writer Martha Mendoza reported from Lake Mead, while writers Jeff Donn, based in Boston, and Justin Pritchard, based in Los Angeles, also contributed. The AP National Investigative Team can be reached at investigateap.org

Water providers and researchers rarely release full test results to the public

By MARTHA MENDOZA

AP National Writer

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Water providers and researchers rarely release full test results to the public

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When water providers find pharmaceuticals in drinking water, they rarely tell the public. When researchers make the same discoveries, they usually don't identify the cities involved.

There are plenty of reasons offered for the secrecy: concerns about national security, fears of panic, a feeling that the public will not understand – even confidentiality agreements.

"That's a really sensitive subject," said Elaine Archibald, executive director of California Urban Water Agencies, an 11-member organization comprised of the largest water providers in California.

She said many customers "don't know how to interpret the information. They hear something has been detected in source water and drinking water, and that's cause for alarm – just because it's there."

As The Associated Press documented in a five-month investigation, drinking water provided to at least 41 million people living in 24 major metropolitan areas has tested positive for trace amounts of pharmaceuticals.

Most Americans probably think they have a good idea of what's being detected in their water. Federal law requires water providers to distribute annual "consumer confidence reports" that reveal levels of regulated contaminants. Providers are not, however, required to tell people if they find a contaminant that is not on a U.S. Environmental Protection Agency list. And there are no pharmaceuticals on the EPA list.

In Philadelphia, the water department has not informed its 1.5 million users that traces of 56 pharmaceuticals or their byproducts – like the active ingredients in drugs to treat depression, anxiety, high cholesterol, fever and pain – have been detected in the drinking water, and that 63 pharmaceuticals or byproducts had been found in the city's source watersheds.

Initially balking at the AP's request to provide test results, Philadelphia Water Department spokeswoman Laura Copeland said, "It would be irresponsible to communicate to the public about this issue, as doing so would only generate questions that scientific research has not yet answered. We don't want to create the perception where people would be alarmed."

New York City water officials declined repeated requests for an interview and waited more than three months before participating in an AP survey, supplying information only after being informed that every other major city in the nation had cooperated.

The AP learned that the New York state health department and the U.S. Geological Survey detected heart medicine, infection fighters, estrogen, anti-convulsants, a mood stabilizer and the active ingredient in an anti-anxiety medication in the city's watershed upstate. And the city's Department of Environmental Protection ultimately said that it does not test its downstate drinking water.

Officials in Arlington, Texas, said pharmaceuticals had been detected in source water but wouldn't say which ones or in what amounts, citing security concerns. Julie Hunt, director of water utilities, said to provide the public with information regarding "which, if any, pharmaceuticals or emerging compounds make it through the treatment process can assist someone who wishes to cause harm through the water supply."

Mayor Robert Cluck later said a trace amount of one pharmaceutical had survived the treatment process and had been detected in drinking water. He declined to name the drug, saying identifying it could cause a terrorist to intentionally release more of it, causing significant harm to residents.

"I don't want to take that chance," Cluck said. "There is no public hazard and I don't want to create one."

Ron Rhodes, water treatment plant supervisor in Emporia, Kan., explained why he wouldn't disclose whether his community's source water or drinking water had been tested for pharmaceuticals. "Well, it's because of 9/11. We want everybody to guess."

How, Rhodes was asked, could it endanger anyone to know if Emporia's water has been screened for traces of pharmaceutical compounds?

"We're not putting out more information than we have to put out," said Rhodes. "How about that?"

Milwaukee's water department is an anomaly, posting on its Web site an 11-page detailed drinking water quality report that includes test results for 450 unregulated contaminants, including pharmaceuticals. While they found minute concentrations of cotinine, a nicotine derivative, they didn't detect hundreds of other contaminants including estrogens and other hormones, acetaminophen and ibuprofen.

When asked what power the EPA had to require public disclosure when pharmaceutical contamination is discovered in a water provider's supplies, Benjamin H. Grumbles, the agency's assistant administrator for water, said, "We work very closely with utilities across the country and we encourage them to share with their community information they find out about their source water."

But there's no such requirement if the detected contaminant is not regulated under the Safe Drinking Water Act, he said in response to a question.

Grumbles was asked how he thought water providers have been responding to the EPA's "encouragement."

"I think we have more work to do," he said.

Several hours after the interview, Grumbles issued a statement: "As head of the National Water Program, I will do everything in my authority to make certain that public water suppliers inform their consumers if they detect pharmaceuticals in the drinking water."

It's not just the water departments that have failed to disclose such information.

The AP spoke with many scientists, federally funded researchers, university professors and private drinking water experts who have detected pharmaceuticals in drinking water, but would not say where they had obtained their samples.

Archibald said her organization joined an American Water Works Association Research Foundation study with the understanding that secrecy would be assured.

"We agreed ahead of time that no specific agency would be mentioned in terms of which place had detections," Archibald said. She insisted that even she didn't have the test results. "It's all being held very carefully. Water agencies were assigned numbers so none of us would even know what was detected in each other's water."

Robert Renner, the foundation's executive director, said AWWARF study participants are routinely promised anonymity. "Being involved in a study, they don't want this information blown out all over," he said.

Citing confidentiality agreements, he declined to name the 20 different drinking water treatment plants around the U.S. where pharmaceuticals have been detected in water heading to more than 10 million people.

"It's a hard topic to talk about without creating fear in the general public," Renner said.

Some said those fears could lead to much larger problems than the actual contamination.

Doctors "don't want people to be afraid to take their medicine because of environmental concerns," said Virginia Cunningham, an environmental executive for drug maker GlaxoSmithKline PLC.

Utilities also generally only allow scientists to test their water if they ensure confidentiality. In order for research to progress, scientists "need the confidence of utilities and other public/private stakeholders to allow us access to waters which we can study without any negative implications for those stakeholders," said Howard Weinberg, an environmental chemist at University of North Carolina. "Without this confidence, such research could not be undertaken."

John Vargo, program manager at the University of Iowa's University Hygienic Laboratory, said he found traces of pharmaceuticals in the finished drinking water of several major Midwestern cities but, under terms of those contracts, he could not disclose their identity.

Peter Rogers, Harvard University professor of environmental engineering, said improvements in detection techniques could help fuel fears among the general public.

"We're chasing this down to molecular-sized measurements, so the more you look, the more you find," said Rogers. "I think the government and utilities are quite right to be very skittish about telling people their results. People will claim it is causing all sorts of problems. If I were a water utility, I would stop those measurements right away because if you measure something, it will get out, and people will overreact. I can just imagine a whole slew of lawsuits."

–––

National Writer Jeff Donn and writer Justin Pritchard also contributed to this report. The AP National Investigative Team can be reached at investigateap.org

AP INVESTIGATION: No standards, no mandates to test, treat or limit pharmaceuticals in water

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AP INVESTIGATION: No standards, no mandates to test, treat or limit pharmaceuticals in water

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EDITOR'S NOTE – Despite evidence that traces of pharmaceuticals can be found in much of America's drinking water supplies, government and suppliers are doing little, according to this final part of an Associated Press investigative series.

†By JEFF DONN, MARTHA MENDOZA and JUSTIN PRITCHARD

†Associated Press Writers

PHILADELPHIA (AP) – Just a century ago, this historic city notched by the Delaware and Schuylkill treated these rivers as public sewers, but few cared until the waters ran black with stinking filth that spread cholera and typhoid. Today, municipal drinking water is cleansed of germs – but not drugs.

Traces of 56 human and veterinary pharmaceuticals or their byproducts – like the active ingredients in medicines for pain, infection, high cholesterol, asthma, epilepsy, mental illness and heart problems – have been detected in Philadelphia's drinking water. Starting their winding journey in medicine cabinets and feed bins, they are what's left of drugs excreted or discarded from homes and washed from farms upriver.

Is Philadelphia worried? Not so far. Tens of millions of Americans here and elsewhere drink water that has tested positive for minute concentrations of pharmaceuticals, and they don't even realize it, The Associated Press learned during a five-month investigation.

Though U.S. waterways coast to coast are contaminated with residues of prescription and over-the-counter drugs, there's no national strategy to deal with them – no effective mandates to test, treat, limit or even advise the public.

Benjamin H. Grumbles, the U.S. Environmental Protection Agency's assistant administrator for water, told the AP the agency recognizes that this contamination in water supplies is a growing concern and that government has some catching up to do: "Our position is there needs to be more searching, more analysis."

He said the EPA has launched a four-pronged approach: to identify the extent of the problem, to "identify what we don't know and close the gap," to take steps using existing science and regulatory tools, and finally, to increase dialogue and awareness with water providers and state and local agencies.

But none of those goals has any regulatory firepower.

Some researchers, environmentalists, health professionals, water managers and bureaucrats say it's time for government to do more.

"The onus has been on the scientific community to provide the research, but at this point the evidence is conclusive," says U.S. Geological Survey scientist Steven Goodbred, who has studied carp in drug-tainted waters. "Now it's up to the public and policy makers to decide what they want to do about it."

Yet water regulators are barely budging:

–The government has set no national standards for how much of any pharmaceutical is too much in waterways or taps. Drugs in the environment are "not currently a priority" of the National Center for Environmental Health, says spokesman Charles L. Green, at its parent U.S. Centers for Disease Control.

–Though the Food and Drug Administration can review the environmental impact of new drugs, it has never rejected one on this basis, according to Raanan Bloom, an FDA environmental officer. Most pharmaceuticals are excluded from environmental review on the basis of their presumed low concentrations in water.

–Even though residues of many types of prescription and over-the-counter drugs have been discovered in scores of watersheds and drinking water systems nationwide, the EPA says it awaits more survey data before considering action. The agency has little information "that goes into whether these substances are occurring in the environment ... and at what level," says Suzanne Rudzinski, a manager at EPA's Office of Water.

But even when the EPA says it's taking action, little is accomplished. The agency analyzed 287 pharmaceuticals for inclusion on a draft list of contaminants to be considered for regulation. Only one, nitroglycerin, which can be used as a drug for heart problems, has been nominated. Asked to explain, an EPA spokesman acknowledged the primary reason for inclusion was its use in making explosives.

–Though pharmaceutical sales are rising, plants that cleanse sewage or drinking water are not required to remove drugs. They aren't even required to monitor for them.

When contacted directly by the AP, many water utilities confirmed whether they had tested for the presence of pharmaceuticals in their water. But federal agencies and industry groups declined to identify the cities and treatment plants where traces of pharmaceuticals had been found during independent studies, citing confidentiality concerns.

Philadelphia has found more pharmaceuticals in its source and drinking waters than any of the other 61 big water providers surveyed by the AP. It tested for more drugs and byproducts than other utilities – a total of 72 – and it found 56, or three-quarters of those checked, in its drinking water. It found 63 – almost 90 percent of those checked – in its source waters. More study is planned.

However, water managers detected scant concentrations similar to other places, suggesting they found so much largely because they tested for a larger list of pharmaceuticals – not necessarily because their watersheds are more contaminated. David A. Katz, a deputy water commissioner for the city, said the water was tested so heavily out of vigilance: "We choose to know; we choose to look."

Under no obligation to tell, Philadelphia keeps it quiet when tests show that drugs have reached its drinking water, the AP found. Philadelphia Water Department spokeswoman Laura Copeland provided the findings for an AP survey but added: "We don't want to create any perception where people would be alarmed."

John Muldowney, who oversees the city's three drinking water treatment plants, said no immediate upgrades are planned to filter out pharmaceuticals. "Based just on the data that's available now ... we would be risking spending a lot of money, a lot of public funds, for very little health benefit," he explained.

Government leaders seem largely to share that attitude. "We're not really doing anything on this right now," says a spokesman for U.S. Sen. Harry Reid, D-Nev., though he has earmarked funds in the past to study environmental drugs in his state.

Congress held hearings in 2006 on endocrine-disrupting compounds after researchers discovered that the Potomac River, dotted with sewage treatment plants, contains feminized male bass which create egg yolk proteins, a process usually restricted to females. But the hearings produced no new proposals.

In Boston, drug makers, state representatives and water managers have been grinding through their third year trying to craft a compromise approach to dealing with the problem on a national scale. Scott Cassel, director of the Product Stewardship Institute, which is hosting the dialogue, says controlling waterborne pharmaceuticals will make the disposal of old computers "seem simple by comparison."

"There's definitely a growing movement and a growing concern, but at this point there isn't a lot of direction from the federal government," adds Susan Frechette, a policy expert at the institute.

Grumbles, the EPA's top water pollution official, said the agency has embarked on four studies specific to the presence of pharmaceuticals and personal care products in wastewater and fish tissue. One "national study," expected to be completed next year, will look at the inflow and outflow at nine sewage plants; another will study sludge from 74 randomly selected sewage treatment plants.

The fish tissue study will focus on five streams where the flow primarily originates at a sewage treatment plant.

Just two months ago the agency developed three new methods to detect and quantify about 160 different pharmaceuticals and personal care products, including steroids and hormones, in wastewater and sewage sludge, Grumbles said.

A year ago, the federal government put out its first consumer guidelines for discarding leftover or expired medicines. The goal was to slow the flow of drugs flushed down the toilet. Though Grumbles acknowledged that human excretions are the major factor in spreading pharmaceuticals through the waste stream, he said it is important for all Americans to realize "the toilet is not a trash can."

But the guidelines immediately drew criticism from some environmentalists, water treatment experts and pharmaceutical researchers who say they are contradictory, confusing, and don't solve the problem.

The guidelines say that about a dozen specific drugs should still be flushed down the toilet to keep others from finding and abusing them. The rest should be mixed with something unsavory like coffee grounds and tossed into the trash. That just moves the problem, though: The drugs end up at landfills, where they can slowly seep into the groundwater.

The EPA is also engaged in a national study – expected to be completed by the end of the summer – to examine how long-term health care facilities and nursing homes dispose of pharmaceuticals.

"We don't really know what to do with waste pharmaceuticals," acknowledges Laura Brannen, executive director of the professional group Hospitals for a Healthy Environment.

The government barely oversees drugs spilled or tossed by hospitals and drug makers. Discharge limits for drug makers concentrate on chemicals used in manufacturing, not the drugs themselves; Virginia Cunningham, an environmental executive at drug maker GlaxoSmithKline PLC, says the industry spills very little of the drugs that turn up in waterways.

At hospitals, the EPA flags about three dozen specific drugs as hazardous waste. Though their dangers are acknowledged, the rules for special disposal have been casually observed, according to environmental specialists in the industry. They say many hospitals still dump some of those hazardous pharmaceuticals into their other garbage.

Also, the list hasn't been updated for years and ignores scores of troublesome newer drugs, including toxic chemotherapy agents.

"It has not been practical or economical to keep pace with the large number of pharmaceuticals developed, approved ... and marketed each year," explains EPA spokeswoman Roxanne Smith.

And what of the drug waste generated by millions of U.S. households? It's exempt from these rules. The EPA again says it would be impractical to act.

In fairness, even those pressing for action realize that regulators must strike a hard balance between potential benefits and costs. Several recent studies indicate that even very dilute pharmaceuticals can harm human cells, but scientists are still unsure if there's a significant health risk from drinking water with trace drugs.

Environmental standards focus on better-understood contaminants from disease-causing germs to manmade dioxins. The government also is pondering a raft of newly identified water contaminants in many products from cosmetics to vitamins – not just in pharmaceuticals.

The government has tried to narrow the focus of much of its drugs-in-water research to powerful hormones that orchestrate reproduction and development and omnipresent antibiotics that strengthen the very germs in the environment that they're meant to kill in the body.

"This is a complex issue because each and every one of us is a part of this problem. But there's no doubt we need a new standard of wastewater treatment. If the limits were there, believe me when I say it could be done," argues environmental toxicologist Greg Moller, at the University of Idaho.

As with global warming, some cities and states have tried to forge ahead, even without strong federal direction. Small pilot programs and one-day pickups of unused drugs have popped up in the Northeast, California, Washington state, Florida, and elsewhere.

Maine is preparing to accept unwanted pharmaceuticals on a grander scale. The federal and state governments have split the $300,000 cost to launch a four-county trial in coming months. Pharmaceutical buyers will take home prepaid mailers to send drug leftovers to a way station, where most will be picked up for transport to incinerators. Organizers intend eventually to roll out the program statewide.

Drug pollution stirs more anxiety in Europe, Canada and Australia, and officials in those places have acted more aggressively to reclaim unused drugs. A French program recaptured about 6,500 tons at drug stores in 2005, managers estimate. Two-thirds of the French say they participate, according to one poll.

That program is run by Jacques Aumonier, an environmental officer for Cephalon, Inc., a Pennsylvania-based biopharmaceuticals firm. He said pharmaceutical levels in water may be modest now, "but with more and more drug use, it can become more important."

Some researchers and activists want to catch and stop drugs from entering waterways at both types of water treatment plants – those for sewage and for drinking water. Standard techniques allow many to slip through, research shows. It seems possible to remove virtually all detectable pharmaceutical traces with an advanced treatment known as reverse osmosis, and hotter incinerators also could burn more drugs.

But all that is viewed as too expensive and maybe unnecessary, at least until the threat is better understood.

"When there's no regulation or limit, and no evidence of human health impacts, it's very hard to justify putting in energy and money to test for it," said Shane Snyder, research and development project manager at the Southern Nevada Water Authority in Las Vegas. Never mind spending much more to remove it.

Some critics want drug companies to design medicines that break down more easily into safer byproducts. "In the long run ... we can at least make some of the compounds greener," says chemist Klaus Kuemmerer, at the University of Freiburg Medical Center in Germany.

However, that would come "a distant third" after designing drugs for effectiveness and safety, says Cunningham of GlaxoSmithKline.

In coming years, public pressure is likely to grow, as more pharmaceuticals find their way into less water. Drug use is expanding in many countries, and more communities will need to recycle treated wastewater for drinking to cope with increased demand, drought, and global warming.

At the same time, today's chemical tests that reveal pollutants in parts per trillion will no doubt be able to detect even finer levels in the future. The added knowledge may not equal bliss, though.

"There isn't such a thing as 100 percent pure water," said EPA scientist Christian Daughton, one of the first to sound warnings over pharmaceutical pollution. "Yet people have a tough time with the idea that water contains all kinds of chemicals."

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National Writer Jeff Donn reported from Philadelphia; writers Martha Mendoza, based in Santa Cruz, Calif., and Justin Pritchard, based in Los Angeles, also contributed. The AP National Investigative Team can be reached at investigateap.org

Bottled water industry faces same federal standards for pharmaceuticals as tap water – none

By JUSTIN PRITCHARD

Associated Press Writer

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Bottled water industry faces same federal standards for pharmaceuticals as tap water – none

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By JUSTIN PRITCHARD

Associated Press Writer

The federal standards for acceptable levels of pharmaceutical residue in bottled water are the same as those for tap water – there aren't any.

The Food and Drug Administration, which regulates the $12 billion bottled water industry in the United States, sets limits for chemicals, bacteria and radiation, but doesn't address pharmaceuticals.

Some water that's bottled comes from pristine, often underground rural sources; other brands have a source no more remote than local tap water. Either way, bottlers insist their products are safe, and say they generally clean the water with advanced treatments, though not explicitly for pharmaceuticals.

Nestle Waters North America Inc., an industry leader whose brands include Arrowhead, Poland Springs and Ozarka, said it selects sources that are removed from human activity, increasing the chances that the water will be pure. It then runs the water through three cleansing stages.

"We know that our multiple barrier process is effective," said Kevin Mathews, the company's director of health and environmental affairs.

Absent a regulatory mandate, however, Nestle follows the industry norm and does not test for pharmaceuticals. And given that testing can detect extremely small concentrations, Mathews would not rule out the presence of traces of pharmaceuticals in its water.

"I don't think anybody could say anything is free" from pharmaceuticals, Mathews said.

Annual bottled water consumption in the United States has increased about 50 percent, to 30 gallons per person, according to the Beverage Marketing Corporation.

"The industry is monitoring it," said Bob Hirst, a vice president at the International Bottled Water Association, which represents dozens of brands. "But we haven't seen anything to alarm us at this point."

By JEFF DONN

AP National Writer

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Tests of Philadelphia's drinking water reveal the presence of 56 pharmaceuticals or byproducts

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By JEFF DONN

AP National Writer

PHILADELPHIA (AP) – A total of 56 pharmaceuticals or byproducts have been detected in this city's drinking water, largely in tests conducted last year, according to the Philadelphia Water Department.

The list of drugs is the longest among 62 major water providers surveyed by the Associated Press. However, this city's water officials say they probably found more drugs simply because they did more testing. They say their water is safe to drink.

Researchers found trace concentrations of drugs including antibiotics, pain relievers, heart and psychiatric drugs, and veterinary medicines. Here's the list of drugs and some of their uses:

ANTIBIOTICS

Amoxicillin – for pneumonia, stomach ulcers

Azithromycin – for pneumonia, sexually transmitted diseases

Bacitracin – prevents infection in cuts and burns

Chloramphenicol – for serious infections when other antibiotics can't be used

Ciprofloxacin – for anthrax, other infections

Doxycycline – for pneumonia, Lyme disease, acne

Erythromycin – for pneumonia, whooping cough, Legionnaires' disease

Lincomycin – for strep, staph, other serious infections

Oxytetracycline – for respiratory, urinary infections

Penicillin G – for anthrax, other infections

Penicillin V – for pneumonia, scarlet fever, infections of ear, skin, throat

Roxithromycin – for respiratory, skin infections

Sulfadiazine – for urinary infections, burns

Sulfamethizole – for urinary infections

Sulfamethoxazole – for traveler's diarrhea, pneumonia, urinary and ear infections

Tetracycline – for pneumonia, acne, stomach ulcers, Lyme disease

Trimethoprim – for urinary and ear infections, traveler's diarrhea, pneumonia

PAIN RELIEVERS

Acetaminophen – soothes arthritis, aches, colds; reduces fever

Antipyrine – for ear infections

Aspirin – for minor aches, pain; lowers risk of heart attack and stroke

Diclofenac – for arthritis, menstrual cramps, other pain

Ibuprofen – for arthritis, aches, menstrual cramps; reduces fever

Naproxen – for arthritis, bursitis, tendinitis, aches; reduces fever

Prednisone – for arthritis, allergic reactions, multiple sclerosis, some cancers

HEART DRUGS

Atenolol – for high blood pressure

Bezafibrate – for cholesterol problems

Clofibric acid – byproduct of various cholesterol medications

Diltiazem – for high blood pressure, chest pain

Gemfibrozil – regulates cholesterol

Simvastatin – slows production of cholesterol

MIND DRUGS

Carbamazepine – for seizures, mood regulating

Diazepam – for anxiety, seizures; eases alcohol withdrawal

Fluoxetine – for depression; relieves premenstrual mood swings

Meprobamate – for anxiety

Phenytoin – controls epileptic seizures

Risperidone – for schizophrenia, bipolar disorder, severe behavior problems

OTHER HUMAN DRUGS

Caffeine – found in coffee; also used in pain relievers

Cotinine – byproduct of nicotine; drug in tobacco, also used in products to help smokers quit

Iopromide – given as contrast agent for medical imaging

Nicotine – found in tobacco, also in medicinal products to help smokers quit

Paraxanthine – a byproduct of caffeine

Theophylline – for asthma, bronchitis and emphysema

VETERINARY

Carbadox – for control of dysentery, bacterial enteritis in pigs; promotes growth

Chlortetracycline – for eye, joint, other animal ailments

Enrofloxacin – for infections in farm animals and pets; treats wounds

Monensin – for weight gain, prevention of severe diarrhea in farm animals

Narasin – for severe diarrhea in farm animals

Oleandomycin – for respiratory disease; promotes growth in farm animals

Salinomycin – promotes growth in livestock

Sulfachloropyridazine – for enteritis in farm animals

Sulfadimethoxine – for severe diarrhea, fowl cholera, other conditions in farm animals

Sulfamerazine – for a range of infections in cats, fowl

Sulfamethazine – for bacterial diseases in farm animals; promotes growth

Sulfathiazole – for diseases in aquarium fish

Tylosin – promotes growth, treats infections in farm animals, including bees

Virginiamycin M1 – prevents infection, promotes growth in farm animals

Water cleaning technologies present challenges – some work better than others

By JUSTIN PRITCHARD

Associated Press Writer

With BC-PharmaWater III

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Water cleaning technologies present challenges – some work better than others

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By JUSTIN PRITCHARD

Associated Press Writer

FOUNTAIN VALLEY, Calif. (AP) – Shivaji Deshmukh drinks water extracted from raw sewage. He knows the water is clean because his job is to help make it so as an engineer at the Orange County Water District.

"It's an efficient, cheap water supply – and it's the best quality," says Deshmukh, amid the hiss of machines at the state-of-the-art facility.

Performing the recycling transformation requires a battery of treatments.

Wastewater strained and disinfected at an adjacent sewage treatment plant is first filtered through tiny straws. Then, in a process called reverse osmosis, the water is forced across a spiraled sheet of plastic with holes so small that little else can slip through. In the final phase, the water is zapped with ultraviolet light.

The three-step operation is one of the most sophisticated cleansing systems anywhere. While the incoming water contains minuscule levels of prescription