In Our Control (47 page)

It should come as no surprise that synthetic hormones prove particularly impervious to breakdown. When the creators of various hormone compounds were first creating these pharmaceutical wonders, they worked hard to make sure that the chemicals would not be easily destructible. They were designed to be strong, to express gastric durability and withstand the harsh digestive fluids in the stomach.

The Grain of Sand in the Swimming Pool

The levels of all pollutants are said to be small, “trace” amounts of chemicals that could be dangerous in larger quantities but likely have little impact in their diluted states. According to the US Geological Survey and others, this means that most are found in amounts that are less than one part per billion or even trillion, equivalent to a grain of sand in an Olympic-sized swimming pool.
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But all these little bits of pollution may add up to a larger health hazard for animals: “When all the substances in some streams were tallied, levels were similar to those that in other studies appeared to harm fish and other aquatic life.”
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Herbert T. Buxton, a member of the Survey’s toxic substances hydrology program who helped conduct the 2002 study of American waterways, says he hopes research like theirs will “help people understand that the chemicals they use and consume on a daily basis and their behavior can affect our environment and water resources.”
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In this study, 80 percent of sampled waters contained
between one and ninety-five of the chemicals scientists were screening for and included not just drugs, but industrial chemicals and detergents, which have been shown to have hormonelike effects as they break down. Michael Thurman of the University of Colorado cautions that even small amounts may yet prove dangerous: “Low concentrations of parts-per-billion or parts-per-trillion generally aren’t considered dangerous over the short term, but no one knows about the long-term human and ecological effects.”
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Some scientists even argue that pollution hasn’t gotten worse—it’s that we’ve gotten better at detecting it. They say that the reason we are becoming aware of contaminants is because our ability to test for them has improved. This may be true; just because we lacked the ability to test for chemicals in previous decades doesn’t mean they weren’t harmful. And while many tests don’t reveal a violation of any antipollution or clean water laws, that may be because many potentially harmful substances are not currently subject to regulation.

The blame for this lies in part with the Environmental Protection Agency, which was required by Congress in a 1996 law to begin screening for endocrine disruptors. Close to fifteen years later, little progress has been made. As Barbara Seaman explained in 2003, the EPA and the National Institutes of health “spent several years and several million dollars investigating natural and synthetic chemicals that mimic hormones. Shockingly, both these massive multimillion-dollar studies ignored the proverbial elephant in the room: the pharmaceutical and veterinary estrogens and other hormones that humans and animals have been eating and depositing into the environment for years—hormones that have been proven to be linked to hormone-dependent breast, uterine, ovarian, and testicular cancers.”
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Instead, the EPA spent time giving reasons why more progress had not been made. As Christian Daughton puts it, “The United States is a late bloomer on the issue of these emerging organic wastewater contaminants, particularly pharmaceuticals.”
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Astoundingly, even as more was being demanded of the EPA in the nineties, less was being asked of drugmakers. In 1997, the Food and Drug Administration slashed the number of drugs required to demonstrate environmental safety.
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This happened in part because the FDA reviewed hundreds of environmental assessments and found no problems. Of
course chemicals like hormones, because they occur in some form naturally in the body, were left out of this review.
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But by 2005 the FDA was reconsidering this stance, noting that the potential health hazards of various chemicals remain unknown.
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It is past time to reconsider old ways of thinking that deem synthetic hormones “natural.”

While regulatory agencies struggle to catch up, some towns are taking steps to clean up their acts, creating drug collection programs where citizens turn in unused pills rather than flush them.
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Because many prescriptions are controlled substances, they must be turned in to the police or other law enforcement professionals. In one pilot program in Maine, the police watched in amazement as fifty-two people turned in fifty-five thousand pills.
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Not surprisingly, the Vatican has been vocal in promoting the association of oral contraceptives and pollution. Seizing on global interest in the environment, the Vatican newspaper
L’Osservatore Romano
reported in early 2009 that the Pill “has had devastating effects on the environment for some years by releasing tons of hormones into nature.”
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Accusing the drug of causing male infertility in the West, the Vatican in dramatic tones called for people to give up pharmaceutical contraception. It is only fair to point out that church leaders failed to voice active concern for the multitude of other drugs found in waterways whose effects are unknown; there was no cry to give up Advil, for example, or antidepressants, or to stop washing or using sunblock. It is a mistake to isolate the Pill and blame women for using birth control rather than examining the very serious and complicated issues of pharmaceutical pollution facing our society.

Drugmakers, while denying that their products are pollutants, have cautiously offered financial support for efforts to determine the nature of the risks that exist and develop methods to contain them. While this can be viewed as hypocritical, it is also important that scientists working to make pharmaceuticals more environmentally friendly have the support of funders with deep pockets.

Taking the First Step: The Long Journey to Understanding Environmental Carcinogens

It is clear that all of these hormones and hormonelike chemicals are causing problems for wildlife, but the effect on humans remains unknown. As the
Washington Post
notes, “For now, no connections to human ailments have been proved. But some studies have provided hints that people might be affected by crossed hormones, and activists wonder if this kind of pollution could contribute to diabetes, birth defects, and infertility.”
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Many activists are concerned that, especially in areas of high population concentration, women are, in essence, taking the Pill simply by drinking water.
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As scientists contemplate the quadrupling of infertility rates since the 1960s, such possibilities seem particularly poignant and worthy of exploration.

One person who is trying to navigate the murky waters of the pharmaceutical and chemical contamination of our world is Devra Davis. Davis was the founding director of the world’s first center for environmental oncology at the University of Pittsburgh and she now heads the Environmental Health Trust, a nonprofit dedicated to conducting research on preventable environmental causes of cancer. I first met Davis in 2007 while she was promoting her groundbreaking and terrifying book
The Secret History of the War on Cancer
. In the book, Davis argues that cancer research in the United States has been tragically slowed by an approach that overemphasizes treating the disease while not working hard enough to prevent it. In chronicling the history of this ongoing “war,” Davis argues compellingly that when it comes to cancer and our environment, we know less than we should: powerful political and industrial players have worked to ensure that scientific challenges are not the only barriers to our knowledge.

Davis explains that a radical reexamination of what causes cancer is necessary to begin making real progress in research on prevention. We know that estrogen can cause cancer, so whether small exposures, such as those to trace amounts in water supplies, can cause the dreaded disease is a subject worthy of further scientific research, especially given the dramatic rise in reproductive cancers in recent decades that point to hormonal culprits. She notes that until something can be shown beyond
the shadow of a doubt to cause certain cancers, the companies that make potentially dangerous products will continue to deny that they cause problems, brandishing doubt “like a cross in front of a vampire.”
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It is very difficult to collect the sort of data that can stand up against these protests for a number of reasons, the biggest of which is the difficulty of studying chemicals and their dangers individually.

Davis stresses the importance of looking at all the pollutants and potential carcinogens together in real-world contexts; we encounter multiple chemicals every day, and they can impact or compound each other. Cumulative exposures are part of reality. And she insists we can’t wait for perfect evidence before taking action: “Requiring proof of sick or dead people before acting to prevent harm is a fundamentally wrong approach to public health.”
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This can seem like an overwhelming dilemma. We have a host of potential pollutants, limited science, and companies with vested interests in concealing known dangers and inhibiting the discovery of new ones. Davis recommends taking a cue from an old Chinese proverb: “A long journey begins with the first step.” For consumers, this can mean making sensible changes when you suspect a certain chemical or product of harboring dangers. Making these changes is not about overreacting or becoming paranoid that every drug or chemical will kill you; it is about making smart decisions based on the best information we have. It’s about not waiting so long for proof that you become it.

Going Green: What Can We Do?

Synthetic hormones are an important piece of the larger problem of chemical omnipresence. For women who care strongly about this issue or for those who don’t like hormonal contraception, the environmental burden of the Pill is a great reason to try another method.

For those who choose to stay on the Pill, an important step toward going green will need to be technological: our current sewage treatment systems aren’t designed to screen out hormones and so are relatively ineffective at doing so. Some water treatment plants are responding to the demands of a chemical-infused world. Others balk at the high cost of testing
water for such contaminants—around $1,000 per sample—and note that until the EPA requires such screening, it simply doesn’t make sense.
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But the cost of doing nothing may prove higher still. Joel A. Tickner of the University of Massachusetts points to cautionary tales: in cases of health hazards like asbestos and lead, America waited too long to take action.
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The reason, of course, was that it can take many years and much experimentation to prove conclusively that a certain pollutant causes, or even exacerbates, a deadly health problem. By the time this happens, both the financial cost of undoing the damage and the social cost of unnecessary suffering and death are inevitable.

Lest you suppose that you can avoid this problem by simply drinking packaged water, think again. One German study found that the majority of tested bottled water contained estrogen, probably from chemicals in the plastic container.
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And again, while contaminated water is a major problem, it is only one of many hormonal exposures. Day-to-day interaction with cleaners, beauty products, foods, supplements, pesticides, plastics, and other products that act as estrogen on our bodies compound the potential danger. Birth control pills and hormone replacement drugs are part of an environmental problem that affects us all, and even if giving them up isn’t the answer, having conversations about their impact is an important way to start finding the right questions.

Scientists at Sweden’s Goteborg University are worried that newer hormonal contraceptives—namely the contraceptive patch and the vaginal ring—may be even bigger polluters than the Pill if not disposed of properly. When a woman throws away her monthly patches, each one still contains around 600 of ethinyl estradiol.
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If that patch is then flushed down the toilet, it continues to release hormones into the environment at rates higher than they occur in urine as by-products or in discarded pills. While most women don’t flush their old patches, scientist Joakim Larsson figures that even a few could cause big problems for fish and pollute water supplies: “Just a single patch flushed every 3 days into the catchments of a Swedish sewage plant serving 3,500 people would release enough hormone to impair fish downstream.”
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The vaginal ring may be even worse: NuvaRing has around 2.4 milligrams of estrogen by the time it is thrown away, 33 percent more than three discarded patches and six times more than a full cycle of oral contraceptives.
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Even though package instructions advise women not to flush the rings down the toilet, sometimes it happens anyway, either because the instructions are ignored or because the device is accidentally expelled because of muscle straining (for example, during a bowel movement). While women should, of course, avoid throwing either rings or patches into the sewage system, other solutions need to be developed. One might be encouraging device makers to distribute disposal bags or creating collection programs through pharmacies where used devices could be returned for more environmentally friendly discarding.