Western Pills = Developing World Ills

When researchers analyzed vials of treated waste water taken from a plant near Patancheru, India-- where about 90 Western drug factories dump their residues-- they were shocked. Enough of a single, powerful antibiotic was being spewed into one stream each day to treat every person in a city of 90,000.

And it wasn't just ciprofloxacin being detected. The supposedly cleaned water was a floating medicine cabinet — a soup of 21 different active pharmaceutical ingredients, used in generics for treatment of hypertension, heart disease, chronic liver ailments, depression, gonorrhea, ulcers and other ailments. Half of the drugs measured at the highest levels of pharmaceuticals ever detected in the environment, researchers say.

Those Indian factories produce drugs for much of the world, including many Americans. The result: Some of India's poor are unwittingly consuming an array of chemicals that may be harmful, and could lead to the proliferation of drug-resistant bacteria.

Last year, the Associated Press reported that trace concentrations of pharmaceuticals had been found in drinking water provided to at least 46 million Americans. But the wastewater downstream from the Indian plants contained 150 times the highest levels detected in the U.S. While India's environmental standards are being met at Patancheru, screening for pharmaceutical residue at the end of the treatment process is not required.

Researchers are finding that human cells fail to grow normally in the laboratory when exposed to trace concentrations of certain pharmaceuticals. Some waterborne drugs also promote antibiotic-resistant germs, especially when — as in India — they are mixed with bacteria in human sewage. Even extremely diluted concentrations of drug residues harm the reproductive systems of fish, frogs and other aquatic species in the wild. In the India research, tadpoles exposed to water from the treatment plant that had been diluted 500 times were nonetheless 40 percent smaller than those growing in clean water.

Larsson's research, which has gained wide acceptance in the scientific community, has also created a stir among environmental experts. "That's really quite an incredible and disturbing level," said Renee Sharp, senior analyst at the Washington-based Environmental Working Group. "It's absolutely the last thing you would ever want to see when you're talking about the rise of antibiotic bacterial resistance in the world."

The more bacteria is exposed to a drug, the more likely that bacteria will mutate in a way that renders the drug ineffective. Such resistant bacteria can then possibly infect others who spread the bugs as they travel. Ciprofloxacin was once considered a powerful antibiotic of last resort, used to treat especially tenacious infections. But in recent years many bacteria have developed resistance to the drug, leaving it significantly less effective.

"It's a global concern," said Dr. A. Kishan Rao, a medical doctor and environmental activist who has been treating people near the drug factories for over 30 years. "European countries and the U.S. are protecting their environment and importing the drugs at the cost of the people in developing countries."