Quite rightly, there is great concern about the presence of trace concentrations of certain  – and realistically, about the presence of any – pharmaceuticals in drinking water. Taking the broader view, and with concern for the environment, we should be worried also about pharmaceutical residues in all natural waters including lake and river water, and ultimately in discharges to sea. 

The US Government Accountability Office (GAO) has now released a Report to Congressional Requesters entitled “Environmental Health: Action Needed to Sustain Agencies’ Collaboration on Pharmaceuticals in Drinking Water.” It is a comprehensive and to some extent authoritative review that provides few answers but raises many questions. As such, it should be a road map for research, though perhaps not yet for intervention.

Key sources of pharmaceutical contamination are summarised, entirely in accord with those previously identified here in the Clinical Waste Discussion Forum. Similarly, the proposed key steps at reduction are listed, again entirely as we had proposed some years ago, though they don’t go quite as far as criticising the water companies’ lack of development and reluctance to move on from Victorian systems of wastewater treatment and drinking water purification.

One matter is important. The GAO document addresses the key pollution streams. Though wastewater from hospitals and nursing homes is listed – once more, excretion of administered drugs is the significant route – not once do clinical (medical) wastes appear and this list nor indeed do solid wastes from residential sources. These secondary routes for contamination are real, but it is likely that their impact is infinitesimally small.

Though there is a need for evidence to confirm this lack of effect, this should not be made into a requirement for permitting. To do so, creating in this way a barrier to permitting, is a foul misinterpretation and mis-use of science and an abuse of position that must come close to misconduct in public office.