Council on Environmental Health
Article Review

Prepared by: Kevin C. Osterhoudt, MD, MSCE
November 2009

TITLE
Occurrence of Pharmaceuticals and Personal Care Products (PPCPs) in Fish: Results of a National Pilot Study in the U.S.

AUTHORS
Ramirez AJ, Brain RA, Usenko S, Mottaleb MA, O’Donnell JG, Stahl LL, Wathen JB, Snyder BD, Pitt JL, Perez-Hurtado P, Dobbins LL, Brooks BW, Chambliss CK. 

FIND IT AT
As of May 1, 2009, this manuscript has been accepted for publication in Environmental Toxicology and Chemistry.

THE PROBLEM
The United States Safe Drinking Water Act (http://www.epa.gov/safewater/sdwa/index.html) was originally passed by Congress in 1974, and was amended in 1986 and 1996, to protect the public by setting standards relevant to the safety of the nation’s drinking water supply and its sources. Pursuant to this Act, the U.S. Environmental Protection Agency has set maximum permissible drinking water standards for 90 contaminants. However, in 2008, newspapers across the country ran sensational headlines highlighting the finding of detectable levels of unregulated pharmaceuticals in the drinking water supply of numerous cities (http://www.usatoday.com/news/nation/2008-03-10-drugs-tap-water_N.htm). While pollutants such as polychlorinated biphenyls (PCBs) and mercury have long been known to contaminate our fresh water lakes, streams, and aquatic life, there is newly focused concern on contamination of these resources by pharmaceuticals and human personal care products.

WHAT THEY DID
This was a national pilot study testing for the occurrence of pharmaceuticals and personal care products in fish. A geographically diverse group of rivers, each receiving effluent from human waste water treatment plants, were selected for study. The study sites were located near Chicago, IL; Dallas, TX; Orlando, FL; Phoenix, AZ; and West Chester, PA. Additionally, a reference site from the Gila River in New Mexico – relatively free of human waste contamination - was tested. Fish, conforming to standardized testing parameters, were collected from these rivers during the late summer of 2006. Fillet and liver tissue samples were dissected independently, and tissue homogenates were created. These samples were tested using advanced laboratory techniques for the presence of 36 target chemicals comprised of 24 pharmaceuticals and 12 personal care products.

WHAT THEY FOUND
Among the 24 pharmaceutical products analyzed, 7 were detected in ng/g quantities by the applied laboratory methods within the fish samples: diphenhydramine, fluoxetine, norfluoxetine, sertraline, diltiazem, carbamazepine, and gemfibrozil. Two fragrance-products were also detected: galaxolide and tonalide. No pharmaceuticals or personal care products were identified by the study methods in fish from the Gila River (expected to receive little human waste pollution).

DISCUSSION
This paper received a large amount of pre-publication publicity via numerous national media outlets (http://www.cbsnews.com/stories/2009/03/25/health/main4892005.shtml). We know that we live in a polluted world. The U.S. Centers for Disease Control is now collecting data on 148 environmental chemicals which can be found within the blood and urine of subjects of the National Health and Nutrition Examination Survey (http://www.cdc.gov/exposurereport/report.htm). Recent advances in analytical techniques now also allow us to detect small concentrations of pharmaceuticals and personal care products within rivers, lakes, oceans, drinking water, and fish. Studies such as this one help demonstrate the environmental persistence of pharmaceuticals which pass through our bodies, into our sewers, and into our environment. The environmental and medical impact of such low concentrations of these drugs remains to be elucidated, and it is hoped that technological advances in waste treatment will be able to help ameliorate this environmental concern.

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