Pharmaceuticals are pervading waterways globally, harming wildlife and presenting health risks when ingested by humans.
Environmental bioethics must engage with this issue to uncover solutions.
Key Facts:
- Over 600 pharmaceuticals have been detected in waterways worldwide. Common contaminants include cancer drugs, antidepressants, antibiotics, and more.
- 90% of medications pass through the human body and enter wastewater. Improper disposal also contributes.
- Wildlife ingestion of certain pharmaceuticals can alter behavior, decrease activity, and impair reproduction.
- The health impact of long-term human ingestion of low levels of dozens of drugs in drinking water is unknown.
- Current environmental ethics frameworks like green health centers, public health ethics, and environmental health ethics can address this issue.
Source: J Med Humanit. 2023
The Scope and Sources of Pharmaceutical Water Contamination
The presence of pharmaceuticals in rivers, lakes, and even drinking water has been documented since the 1970s.
However, significant concern did not arise until the 1990s when scientists confirmed these drugs were making their way into human water supplies.
Despite this early attention, over 600 varieties of medications have now been discovered in waterways across the globe.
One major route of entry is human excretion after ingestion.
A staggering 90% of oral drugs pass through the body unaltered before entering wastewater systems.
With millions using medications daily, this influx is constant.
Improper disposal also contributes significantly.
Surveys show it’s common practice for patients and even medical staff to dispose of unused pills or liquid medicines by flushing them down toilets and sinks.
One study found 43% of Germans disposed of liquid pharmaceuticals this way.
Similarly, 12% of British respondents and 39% of Canadian households reported flushing or burying medications.
The FDA and EPA have actually condoned drain disposal, making this habit hard to curb.
Impact of Pharmaceutical Drugs on Marine Life
With pharmaceutical contaminants present throughout the water cycle, they inevitably enter ecosystems and interact with wildlife.
Studies show certain drugs cause measurable harm even at low doses mimicking environmental levels.
For example, hormones like ethinylestradiol and levonorgestrel disrupt sexual development in frogs, leading to infertility.
Psychoactive medications like antidepressants alter fish behavior as well.
Exposed guppies exhibit less activity and repeatable behaviors compared to unexposed fish.
Other research finds antidepressants can also interfere with movement and migration in wild species.
Beyond behavior, pain relievers and anti-inflammatories prove especially toxic.
One survey showed drugs like ibuprofen and diclofenac were hazardous to bird species including storks, cranes, and owls.
Diclofenac has also caused devastating vulture declines on the Indian subcontinent.
Clearly, the effects of pharmaceutical pollution extend throughout the animal kingdom.
Potential Human Health Effects of Pharmaceuticals in Drinking Water
But what are the consequences for humans ingesting small amounts of dozens of drugs through contaminated drinking water?
One researcher initially suggested this mixture would only affect sensitive groups like fetuses, infants, and the elderly.
Healthy adults would supposedly clear the minute doses with no issue.
However, others counter that the synergistic effects of so many substances at once could pose risks even for general populations.
Drinking water today frequently contains cancer medications, antidepressants, antibiotics, pain relievers, anticonvulsants, and more.
The interactions between all these drugs, many of which are designed to be biologically active at low doses, are impossible to predict.
Invoking the precautionary principle, it seems wise to view chronic low-level polypharmacy exposure as potentially hazardous until proven otherwise.
After all, diclofenac and ibuprofen showed environmental toxicity at doses assumed safe for wildlife.
Furthermore, certain vulnerable groups like pregnant women and children would be disproportionately harmed by uncontrolled exposure.
Overall, while a firm connection between pharmaceutical water contamination and human health issues has not been established, there are credible reasons to be concerned based on preliminary research.
The possibility of harm from synergistic reactions, bioaccumulation over a lifetime, and impacts on fetal development deserve careful consideration and study moving forward.
Environmental Ethics Frameworks to Address the Issue
Although pharmaceutical water contamination has been recognized for decades, the environmental ethics field has yet to fully engage with the topic.
Existing frameworks like green health centers, public health ethics, and environmental health ethics could provide initial avenues for analysis.
These perspectives acknowledge medicine’s broad ecological footprint and provide principles to evaluate current practices.
Green health centers aim to reduce waste in building design, medical products and services, and resources used for care.
Cutting pharmaceutical pollution aligns with these conservation goals.
Public health ethics recognizes links between human health and planetary health, seeking improved population outcomes through justice.
Preventing medication contamination and human exposure upholds justice.
Finally, environmental health ethics focuses on the relationship between environments and biology to promote health.
Its principles include human rights, utility, justice, animal welfare, stewardship, sustainability, and precaution—all relevant to this issue.
Despite fit with these frameworks, examination of pharmaceutical water contamination has been limited for several possible reasons.
It may be perceived as just one facet of broader healthcare sustainability conversations.
However, the problem warrants targeted attention to fully characterize its nuances.
There is also a sense that reducing contamination requires addressing all pollution sources equally.
But making incremental progress in one domain remains beneficial.
Additionally, confronting physician prescription practices and patient expectations presents challenges, although environmental ethics has never shied away from questioning established healthcare models.
The Path Forward: An Ethical Imperative
Given the demonstrable impacts across species and plausibility of human health effects, pharmaceutical water contamination should be a priority for environmental ethicists.
This will require scrutinizing every step of the medication lifecycle from production to consumption to disposal.
New principles guiding responsible prescribing, patient expectations, and sustainable waste management will be needed.
This effort is unlikely to be simple or rapid. But the well-being of ecosystems, wildlife, and human populations may depend on engaging with this complex issue.
Environmental bioethics must bring its full toolkit to bear before pharmaceuticals expand their footprint even further through the world’s interwoven waterways.
References
- Study: Pharmaceuticals in the water: the need for environmental bioethics
- Author: Thomas Milovac (2023)
