Disinfection & downstream effects

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Concerns about the human health effects of PPCPs in the environment are not restricted to endocrine disruptors, however. All pharmaceutically active compounds are developed to target specific biological activity and are not meant for dispersion into the environment. It is for good reasons that many pharmaceuticals are available only with a prescription, specifically because they are not appropriate for everyone, or for widespread or long-term use. In contrast to pharmaceuticals, personal care products are not designed for human consumption at all. Very little is known about the potential health effects of chronic ingestion of these compounds; as with pharmaceuticals, however, their presence in drinking water, even at very low levels, raises important questions for long-term population health.

Looking upstream: a neglected part of the solution

For some, the solution to PPCPs in drinking water rests with improved water treatment systems. While such technologies are an important element to control the levels of PPCPs in drinking water, they cannot be the only strategy, for several reasons. First, advanced treatment technologies such as ozonation are costly, and are therefore likely to remain inaccessible to most Canadians who continue to rely on chlorine to disinfect their water. Second, even the best technologies are unable to completely remove all contaminants, and worse, as noted above they can create additional by-products, seldom accounted for when assessing the merits of such treatments. Ozonation of the anti-convulsant drug carbamazepine, for instance, has been found to yield three new and previously unreported by-products. Given that new PPCPs are constantly becoming available in the marketplace, it becomes questionable whether treatment technologies will be able to keep pace.   
Rather, such “end of pipe” solutions should be coupled with strategies for reducing the load of PPCPs entering into the environment in the first place. Taking a preventative or “upstream” approach recognizes that while the risks posed by such substances may not be entirely known, it is better to err on the side of caution. Moreover, many upstream steps could be implemented immediately and relatively cheaply, when compared to the longer term investments required for broad scale improvements to drinking water treatment plants.

While many PPCPs serve essential, life-affirming ends, there are also cases where the use of some products could be curtailed or eliminated altogether. One example is the proliferation of antibacterial products such as hand soaps, many of which contain triclosan – a substance now found widely in the environment, including in drinking water. Despite their popularity, the use of antibacterial products for regular hand washing is not recommended by Health Canada, the Canadian Medical Association, or the Canadian Paediatric Society.        
     
And yet, current PPCP use and promotion trends point in the opposite direction.  Canadians are consuming more and more drugs each year. For their part, pharmaceutical companies are delivering drugs in more aggressive and ever inventive ways, often with specific campaigns that target women and exploit gender roles.

Some upstream strategies to consider might include:

• Reducing pharmaceutical use by strengthening the direct-to-consumer advertising ban in Canada. At present, enforcement is woefully inadequate;
• Stemming the tide of pharmaceutical inputs to aquatic systems by broadening consumer pharmaceutical take-back programs. Programs exist in a handful of provinces.  More should follow suit;
• Better education of consumers, including young people, patients, physicians and pharmacists about the environmental consequences of improper disposal and misuse of PPCPs; and   
• Judiciously curbing the use and promotion of some PPCPs.

Clearly, practical and realistic steps can be taken immediately to curb the release of PPCPs into the environment. A sex and gender based analysis reveals that attention to the impact on women is a critical aspect in such efforts.    

Sharon Batt is a founding member of Breast Cancer Action Montreal and author of Patient no More: The Politics of Breast Cancer.