By Lotfi Belkhir
Rarely does mention of the pharmaceutical industry conjure up images of smoke stacks, pollution and environmental damage.
Yet our recent study found the global pharmaceutical industry is not only a significant contributor to global warming, but it is also dirtier than the global automotive production sector.
<p>It was a surprise to find how little attention researchers have paid to the industry's greenhouse gas emissions. Only two other studies had some relevance: one looked at the <a href="https://www.doi.org/10.1001/jama.2009.1610" target="_blank">environmental impact of the U.S. healthcare system</a> and the other at the <a href="https://doi.org/10.1098/rstb.2013.0571" target="_blank">pollution (mostly water) discharged by drug manufacturers</a>.</p><p>Our study was the first to assess the carbon footprint of the pharma sector.</p>
<h2>More Polluting</h2><p>More than 200 companies represent the global pharmaceutical market, yet only 25 consistently reported their direct and indirect greenhouse gas emissions in the past five years. Of those, only 15 reported their emissions since 2012.</p><p>One immediate and striking result is that the pharmaceutical sector is far from green. We assessed the sector's emissions for each one million dollars of revenue in 2015. Larger businesses will always generate more emissions than smaller ones; in order to do a fair comparison, we evaluated emissions intensity.</p><p>We found it was 48.55 tonnes of CO2e (carbon dioxide equivalent) per million dollars. That's about 55 percent greater than the automotive sector at 31.4 tonnes of CO2e/$M for that same year. We restricted our analysis to the direct emissions generated by the companies' operations and to the indirect emissions generated by the electricity purchased by these companies from their respective utilities companies.</p><p>The total global emissions of the pharma sector amounts to about 52 megatonnes of CO2e in 2015, more than the 46.4 megatonnes of CO2e generated by the automotive sector in the same year. The value of the pharma market, however, is smaller than the automotive market. By our calculations, the pharma market is 28 percent smaller yet 13 percent more polluting than the automotive sector.</p>
<h2>Extreme Variability</h2><p>We also found emissions intensity varied greatly within the pharmaceutical sector. For example, the emissions intensity of Eli Lilly (77.3 tonnes of CO2e/$M) was 5.5 times greater than Roche (14 tonnes CO2e/$M) in 2015, and Procter & Gamble's CO2 emissions were five times greater than Johnson & Johnson even though the two companies generated the same level of revenues and sell similar lines of products.</p><p>We found outliers too. The German company Bayer AG reported emissions of 9.7 megatonnes of CO2e and revenues of US$51.4 billion, yielding an emission intensity of 189 tonnes CO2e/$M. This intensity level is more than four times greater than the overall pharmaceutical sector.</p><p>In trying to explain this incredibly large deviation, we found that Bayer's revenues derive from pharmaceutical products, medical equipment and agricultural commodities. While Bayer reports its financial revenues separately for each division, it lumps together the emissions from all the divisions. The company also reports and tracks its emission intensity in terms of tonnes of CO2e produced for each tonne of manufactured goods, whether fertilizer or Aspirin, for example.</p><p>This level of opacity makes it not only impossible to assess the true environmental performance of these kind of companies. It also raises questions about the sincerity of these companies' strategies and actions in reducing their contribution to <a href="https://www.ecowatch.com/tag/climate-change">climate change</a>.</p>
<h2>Climate Compliance</h2><p>We also estimated how much the pharmaceutical sector would have to reduce its emissions to comply with the <a href="https://unfccc.int/sites/default/files/english_paris_agreement.pdf" target="_blank">reduction targets in the Paris agreement</a>.</p><p>We found that by 2025, the overall pharma sector would need to reduce its emissions intensity by about 59 percent from 2015 levels. While this is clearly a far cry from their current levels, it is interesting to note that some of the 15 largest companies are already operating at that level, namely Amgen Inc., Johnson & Johnson and Roche Holding AG.</p><p>If those performance levels are achievable by some, why can't they be achieved by all?</p><p>These three leading companies are also the ones with the highest level of profitability and revenue growth in the whole sector. Indeed Roche, Johnson & Johnson and Amgen showed revenue increases of 27.2 percent, 25.7 percent and 7.8 percent respectively between 2012 and 2015, while managing to reduce their emissions by 18.7 percent, 8.3 percent and eight percent respectively. This supports the premise that environmental and financial performance aren't mutually exclusive.</p><p>The pharmaceutical industry is responsible for some serious environmental impacts beyond greenhouse gas emissions. For example, the wastewater from drug manufacturers in Patancheru, India has left river sediment, ground water and drinking water polluted. Researchers estimated that <a href="https://royalsocietypublishing.org/doi/full/10.1098/rstb.2013.0571" target="_blank">in a single day, 44 kilograms of ciprofloxacin, a broad-spectrum antibiotic, was released</a> — enough to treat everyone in a city of 44,000 inhabitants.</p><p>Clearly, there is a dire need for more extensive and sustained research as well as more scrutiny of the pharmaceutical industry's environmental practices and performance. Healing people is no justification for killing the planet.</p>
<blockquote class="twitter-tweet"><p lang="en" dir="ltr"><a href="https://twitter.com/hashtag/Wastewater?src=hash&ref_src=twsrc%5Etfw">#Wastewater</a> Treatment Plants Could Contribute to a ‘Post-Antibiotic World,’ Study Warns <a href="https://t.co/LRyIdqd04d">https://t.co/LRyIdqd04d</a> <a href="https://twitter.com/saveantibiotics?ref_src=twsrc%5Etfw">@saveantibiotics</a> <a href="https://twitter.com/hashtag/AntibioticResistance?src=hash&ref_src=twsrc%5Etfw">#AntibioticResistance</a></p>— EcoWatch (@EcoWatch) <a href="https://twitter.com/EcoWatch/status/1103807624859054080?ref_src=twsrc%5Etfw">March 8, 2019</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script>
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<em>Lotfi Belkhir is an associate professor & chair of eco-entrepreneurship at McMaster University.<br/></em><em>Disclosure statement: Lotfi Belkhir does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond his academic appointment.</em></p><p>
<em>Reposted with permission from our media associate <a href="https://theconversation.com/big-pharma-emits-more-greenhouse-gases-than-the-automotive-industry-115285" target="_blank">The Conversation</a>.</em>
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By Jonathan Hahn
In 1991, the Bay Area Air Quality Management District launched a Spare the Air program to keep residents in the San Francisco Bay Area informed of high ozone-level days, when air is smoggy and exposure to poor air quality poses health risks. Now, the air district might need to update its alert system for something other than just ozone: antibiotic-resistant genes (ARGs).
<p>A team of researchers from the U.S., China, South Korea, Switzerland, and France examined air samples from nearly two dozen cities, including San Francisco, Paris, Warsaw, Zurich, Beijing, Brisbane, and Seoul. They discovered airborne concentrations of antibiotic-resistant bacteria in each of the cities at varying levels, produced by concentrated animal feeding operations, hospitals, wastewater treatment plants and other sources. </p><p>Their findings indicate that antibiotic-resistant genes can spread from one bacterium to another, and that this bacteria has the ability not only to travel through the air, but to travel across continents, even across the globe—exposing millions of people to antibiotic-resistant genes whether they live in proximity to those sources or not. </p><p>"Common everyday human activities such as car traffic can kick up the bacteria and make them airborne," Dr. Maosheng Yao, a collaborating author of the study, <a href="https://pubs.acs.org/doi/abs/10.1021/acs.est.8b02204" target="_blank"><em>Global Survey of Antibiotic Resistance Genes in Air</em></a>, and professor of environmental sciences and engineering at Peking University, told Sierra. "Natural winds can also suspend these biologicals into the air."</p><p>For wastewater treatment, there is an aeration process that can make biologicals airborne. They are prevalent in areas where human consumption of antibiotics is widespread, such as in hospitals, or where agricultural practices rely heavily on the use of antibiotics. </p><p>San Francisco topped the list of the cities with the highest readings of antibiotic-resistant genes in the air. </p><p>"We used a novel protocol to get enough air samples from different world cities," Yao told Sierra. "That way we could tell where there were significant differences in levels of ARGs." </p><p>The report was published July 25 in Environmental Science & Technology.</p><p>Air quality indexes that evaluate how safe the air is to breathe focus on ozone, particulate matter (PM) such as the noxious pollutants emitted from power plants, carbon monoxide and other factors. Those indexes do not include information about antibiotic-resistant genes. </p><p>Yet a growing body of research increasingly points to pharmaceutically-polluted environments in cities worldwide, not just involving water or soil pollution, but air pollution as well. According to the new report, airborne pathogens in hospital environments have been found to be multidrug-resistant; indoor air samples taken in communities near animal-farming operations, where the use of antibiotics on animals is widespread, have been found to be rife with antibiotic-resistant bacteria. </p><p>For the latest study, Yao and collaborating researchers profiled 30 known genes that are resistant to common antibiotics, including tetracyclines and amingoglycosides, and examined air samples in 19 cities in 13 countries, each with different climate zones. To get their results, researchers employed an automobile air conditioning filter method to collect samples. </p><p>Beijing was found to have the highest complex mix of ARGs, with up to 18 different subtypes detected in the air. The most commonly detected antibiotic-resistant genes in all 19 cities were those with a resistance to β-lactams and quinolone antibiotics, with the highest prevalence found in San Francisco, which Yao speculated could indicate heavy use of antibiotics in hospitals there without the proper systems in place to control for airborne emission. The most powerful antibiotics on the market, which are supposed to be reserved for only the most serious medical cases, were detected in six of the 19 cities. </p><p>One of the most surprising discoveries from the study, Yao said, was the low level of ARGs in Hong Kong, possibly attributable to that city's high humidity level. </p><p>Infections from antibiotic-resistant bacteria including gonorrhea and MRSA pose a significant public health risk, with growing fears of the rise of so-called "super bugs." Public health warnings such as from <a href="https://www.cdc.gov/antibiotic-use/community/about/antibiotic-resistance-faqs.html" target="_blank">the CDC</a> often focus on the overuse and misuse of antibiotics, providing guidance on the most appropriate practice for prescribing and consuming those drugs. </p><p>These sources, however, provide little to no guidance around the possibility of exposure to antibiotic-resistant genes in the air.</p><p> <em>Reposted with permission from our media associate <a href="https://www.sierraclub.org/sierra/antibiotic-resistant-genes-are-airborne-exposing-millions" target="_blank">SIERRA Magazine</a>.</em></p>
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If you're like many busy Americans, you may feel the need for an extra boost of energy to stay focused and perform at your best throughout the day. Whether you experience the age-old 3 p.m. slump at your desk, or you need an extra jolt to power through a morning workout, you may be looking for a natural way to increase your energy levels.
<p>Caffeine happens to be the most-consumed energy booster in the world. From coffee to tea to chocolate, about 90% of Americans consume caffeine in some form every day. And increasingly, people are turning to energy drinks to satisfy their energy needs. </p><p>Energy drink consumption is especially high among young adults. In a 2016 <a href="https://supplements101.net/energy-drink-statistics/#:~:text=In%202016%2C%20the%20sales%20of,drinks%20on%20a%20regular%20basis." rel="noopener noreferrer" target="_blank">survey</a>, over one-third of 18- to 29-year-old respondents said they consumed energy drinks on a regular basis. </p><p>There are dozens of energy and sports drink companies out there to meet this growing demand for a regular energy boost. From flashy cans packed with bold flavors to all-natural alternatives, it can be difficult to cut through the noise and choose the right caffeine source for you. </p><p>That's why we're reviewing the top five healthy energy drinks that will give you a moderate level of caffeine without added sugars and artificial ingredients. </p><h2>The Downside of Mainstream Energy Drinks</h2><p>Step into most gas stations, and you'll find a fantastically colorful, shiny, and attention-grabbing display of canned energy drinks. These cans and bottles are slapped with powerful names like "Rockstar" and "Red Bull!". But often, hidden behind the neon graffiti-scribbled cans are ingredients best avoided for the sake of your health. </p><p>Most mainstream energy drinks are packed with high amounts of caffeine, sugar, and other undesirable ingredients. According to the <a href="https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/caffeine/art-20045678#:~:text=Up%20to%20400%20milligrams%20(mg,widely%2C%20especially%20among%20energy%20drinks." rel="noopener noreferrer" target="_blank">Mayo Clinic</a>, adults should aim to consume no more than 400mg of caffeine a day. </p><p>To put that into perspective, a 1-ounce shot of espresso contains about 64 milligrams of caffeine. A regular cup of coffee has about 70 to 100 milligrams. Some energy shots contain more than 400 milligrams of caffeine in a single serving.</p><p>Overdoing your caffeine intake can have negative impacts on your health. The extent to which you experience side effects will depend on your tolerance for the drug, age, and genes. Signs of too much caffeine include headaches, anxiety, an elevated heart rate, muscle jitters, irritability, and frequent urination. </p><p>Added sugar is another common unhealthy ingredient in mainstream energy drinks. The American Heart Association recommends that adult men consume no more than 37 grams of sugar per day and women consume no more than 25 grams. However, a single serving of many mainstream energy drinks can easily contain 27 or more grams of added sugars per serving. </p><p><a href="https://www.health.harvard.edu/heart-health/the-sweet-danger-of-sugar" rel="noopener noreferrer" target="_blank">Studies</a> show that consuming excess added sugars (those that aren't naturally occurring in fruits and vegetables) can have serious health implications. For most Americans, these added sugars come from flavored drinks, cereals, baked goods, and other processed foods, including energy drinks. </p><p>All of this sugar adds up to an increased risk for obesity, diabetes, and heart disease. In one 15-year Harvard study, participants who consumed 17-21% of their daily calories from added sugars increased their risk of death from cardiovascular disease by 38% compared to individuals who consumed 8% of their calories from added sugar. </p><p>Obesity, heart disease, high blood pressure, and cardiovascular disease are all leading causes of death in the US. By choosing no- to low-sugar healthy energy drinks without large amounts of caffeine, you can reduce your intake of added sugars and avoid overdoing your caffeine intake. </p><h2>What to Look for in a "Healthy" Energy Drink</h2><p>So how can you be sure your daily pick-me-up is a healthier option that will still sustain your energy levels? Start by reviewing the caffeine and sugar content. Many natural energy drinks on the market are sugar-free and made with natural caffeine sources. For example, matcha green tea is an herbal source of caffeine that has other nutritional benefits for overall wellness like antioxidants. </p><p>In addition to the caffeine and sugar content, many healthy energy drinks are fortified with essential nutrients that have positive health effects. You may get the added benefit of antioxidants from black tea, for example. </p><p>As always, be sure to read the label of any energy drink carefully and with an eye to added sugars, preservatives, and other artificial ingredients. And remember that caffeine is a natural diuretic, so it's important to watch your hydration and drink plenty of water. </p><h2>Best Healthy Energy Drinks</h2><p class="media-headline"><strong>Zevia Soda Zero Calorie </strong><br></p>
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<p><br></p><p>We like that this Zevia's zero-calorie option is made with clean ingredients. You won't find artificial colors, preservatives, soy, or sodium in these cans. With six simple ingredients, including carbonated water, you can rest assured that every sip is wholesome and good for you. Zevia offers a higher caffeine content than other healthy energy drinks, so it's a good option for someone with a higher caffeine tolerance or who reaches for just one serving of caffeine a day. </p><p><strong>Strength: </strong>120mg of caffeine per can</p><p><strong>Why buy:</strong> Sugar-free; Zero calorie; Non-GMO Project Verified; Kosher; Vegan</p><p><br></p><p class="media-headline">
<strong>Sambazon Organic Amazon Energy Drink</strong></p><p><strong><br></strong></p><div class="rm-shortcode amazon-assets-widget" data-rm-shortcode-id="85c4853615e47cd7cbb10a107aacb6a2" contenteditable="false">
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<p>We love that this drink is both low in calories and sugar (with only 6 grams per serving) while providing other important vitamins. The green tea and yerba mate that give each can its 120 mg of caffeine come with potent antioxidants and vitamin C. This is another slightly more caffeinated option if you're looking for a stronger jolt from your healthy energy drink without the excess sugars and artificial ingredients you'll find in mainstream high-caffeine options. With fruity Amazon-inspired flavors like acai berry and pomegranate, Sambazon ensures every sip is delicious and refreshing. </p><p><strong>Strength: </strong>120mg per can </p><p><strong>Why buy:</strong> Made with guarana, yerba mate & green tea; USDA-Certified Organic; Non-GMO; Vegan; Gluten-free; Kosher</p><p><br></p><p class="media-headline">
<strong>Sunshine Good Energy Drink</strong></p><p><br></p><div class="rm-shortcode amazon-assets-widget" data-rm-shortcode-id="6eb3213e344554c1cf64811f99368be2" contenteditable="false">
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<p>This brightly colored can is not only enticing, but it's also good for you. It has a moderate amount of caffeine (about the same amount as a cup of coffee) for a light buzz that won't cause a crash. This low-calorie option (60 calories per can) is especially great for plant-based diets, which can often lack essential b vitamins, especially vitamin B12. Sunshine Energy Drinks are fortified with B12, and the clementine flavor also offers 100% of your daily Vitamin C requirements.</p><p><strong>Strength:</strong> 70mg caffeine per can</p><p><strong>Why buy:</strong> Made with organic green coffee beans; Added B12; Contains electrolytes; 100% of your daily Vitamin C</p><p><br></p><p class="media-headline">
<strong>GURU Lite Organic Low Calorie Energy Drink with Green Tea</strong></p><p><br></p><div class="rm-shortcode amazon-assets-widget" data-rm-shortcode-id="4ab4b338d9d1410089b9f5d9f9be8a35" contenteditable="false">
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<p>GURU's Lite Energy drink is brewed with antioxidant-packed green tea and hydrating carbonated water. This vegan energy drink includes the added bonus of natural sweeteners and vitamin sources. Every can is made with ginseng, echinacea, guarana, and sweetened with stevia and monk fruit for a lightly sweet, nutrient-packed sip. Plus, GURU has an environmentally-friendly commitment to using natural, organic ingredients in this low-sugar, lightly caffeinated energy drink.</p><p><strong>Strength:</strong> 100mg caffeine per can</p><p><strong>Why buy: </strong>Non-GMO; Vegan; No artificial sweeteners; Organic</p><p><br></p><p class="media-headline">
<strong>Raspberry Sparkling Yerba Mate </strong></p><p><br></p><div class="rm-shortcode amazon-assets-widget" data-rm-shortcode-id="425712ca3a2ade8e1f15a1ad7241b81c" contenteditable="false">
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<p>Clean Cause donates 50% of its profits from sales of this USDA Certified Organic energy drink to support addiction recovery. The company's mission is to support recovery from alcohol and drug addiction through sustainable funding. Clean Cause brews its energy drinks from the dried leaves of yerba mate, a vitamin-rich South American plant that is naturally high in caffeine and antioxidants. Every serving offers plant-based polyphenols, a group of antioxidants shown to reduce inflammation and reduce the risk of many chronic diseases.</p><p><strong>Strength: </strong>160mg per can (two servings)</p><p><strong>Why buy:</strong> USDA Certified Organic; Natural caffeine from yerba mate; Four fruity, sparkling flavors</p>
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It's no surprise that chemicals can get flushed into our water supply from the pills we take. But as the world's population grows, the rampant consumption of pharmaceuticals has become an emerging threat to the world's freshwater ecosystems, researchers said.
The research, presented at the European Geosciences Union General Assembly on Tuesday, warns that if no action is taken to mitigate the flow, the amount of drug waste entering waterways such as rivers and lakes could increase by 65 percent by 2050, endangering fish and other species' health.
<p style="">
Francesco Bregoli, a postdoctoral researcher at the
<a href="https://www.un-ihe.org/" target="_blank">IHE Delft Institute for Water Education</a> in the Netherlands, and his international co-hort developed a model showing global "hotspots" of water with high concentrations of pharmaceuticals.
</p><p style="">
To do this, the researchers analyzed the global consumption of diclofenac, a common painkiller used by millions across the globe, and its occurrence in freshwaters.
</p><p class="shortcode-media shortcode-media-rebelmouse-image" style="">
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8xNzU0MDA1Ny9vcmlnaW4ucG5nIiwiZXhwaXJlc19hdCI6MTY2Mjg2MTcwMH0.V4zne9dN9gix0_rT0MezQkNsTFOX8ohoFx__s8G7FKo/img.png?width=980" id="da795" class="rm-shortcode" data-rm-shortcode-id="64ae896ff364103376fc720fd6ffa051" data-rm-shortcode-name="rebelmouse-image">
<small class="image-media media-photo-credit" placeholder="add photo credit...">Francesco Bregoli et al.</small>
</p><p style="">
Diclofenac has been identified as an environmental threat by the European Union and the U.S. Environmental Protection Agency. Its use as a livestock drug has been
<a href="https://www.nature.com/news/2006/060130/full/news060130-2.html">linked to</a> the collapse of vulture populations in South Asia. Scientists have <a href="https://www.ecowatch.com/prescription-drugs-entering-the-great-lakes-at-alarming-rate-1881830609.html" target="_blank">also observed</a> the anti-inflammatory drug bioaccumulating in fish in the Great Lakes, but its impact is unclear.
</p><p style="">
According to the <a href="https://www.theguardian.com/environment/2018/apr/11/drug-waste-clogs-rivers-around-the-world-scientists-say" target="_blank">AFP's</a> report on the new study, more than 10,000 kilometers (6,200 miles) of rivers around the world have concentrations of diclofenac above the EU "watch list" limit of 100 nanograms a liter.
</p><p style="">
In the U.S., <a href="https://www.ecowatch.com/prescription-drugs-entering-the-great-lakes-at-alarming-rate-1881830609.html" target="_blank">only half</a> of the prescription drugs in sewage are removed by treatment plants. Contamination levels are higher in Latin American, African and Asian countries, where wastewater is not widely treated and filtering drugs can be technologically unavailable or expensive.
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<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8xNzUzOTkwMi9vcmlnaW4ucG5nIiwiZXhwaXJlc19hdCI6MTYzMDQxMjc2NX0.m2ZPF99XbcFpXnoE6nzbDk1xqW-DGXDp9IZieUAr-OQ/img.png?width=980" id="c75a0" class="rm-shortcode" data-rm-shortcode-id="f7d5b4fb255d2edafe1f615150104c41" data-rm-shortcode-name="rebelmouse-image">
<small class="image-media media-photo-credit" placeholder="add photo credit...">Francesco Bregoli et al.</small>
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The research team's model can also be applied to the presence and spread of other drugs besides diclofenac.
</p><p style="">
"Diclofenac emissions are similar to any of thousands of pharmaceuticals and personal care products," Bregoli explained.
</p><p style="">
The scientists suggested feasible mitigation strategies on consumption reduction, sewer connection and improvements of water treatment technology. However, Bregoli noted that improved water treatment will not be enough to solve the growing problem.
</p><p style="">
"We found out that technological improvements alone will not even be enough to recover from the current concentration levels," he said. "If a substantial consumption reduction is not implemented, a large part of the global river ecosystems will not be sufficiently secured."
</p>
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Superbug Risk Rises as Big Pharma Fails to Disclose Antibiotic Waste Leaked From Factories
24 January 2018
Popular
Pharmaceutical waste in Hyderabad, India. Christian Baars
By Madlen Davies and Sam Loewenberg
Many of the world's leading drug manufacturers may be leaking antibiotics from their factories into the environment, according to a new report from a drug industry watchdog. This risks creating more superbugs.
The report surveyed household-name pharmaceutical giants like GSK, Novartis and Roche as well as generic companies which make non-branded products for the NHS and other health systems.
<p>None of the 18 companies polled would reveal how much antibiotic discharge they release into the environment, according to the independent report from the not-for-profit body, the Access to Medicine Foundation. Only eight said they set limits for how much could be released in <a href="http://www.ecowatch.com/tag/wastewater">wastewater</a>.</p><p>Only one disclosed the name of its suppliers—a move which is seen as important as it would make companies accountable for their environmental practices.</p><p>Commenting on the report, Dr. Mark Holmes, a veterinary scientist at the University of Cambridge, said, "Antibiotic resistance is complex but if we are to deal with this challenge every sector must do their bit. The pharmaceutical industry has been a key player in improving public health but a failure to address environmental impacts of antibiotic pollution could undo much of their good work."</p><p>Changing Markets, an NGO which has campaigned on the issue of pharmaceutical waste, said, "Pharmaceutical companies have a clear responsibility to tackle pollution in their supply chains, not least because of the considerable human health impacts associated with untreated waste from pharma manufacturing, prime among the creation of drug-resistant bacteria. From our own research in India and China, where most of the world's generic drugs are made, we know this is an ongoing problem and that very little progress is happening on the ground.</p><p>"As the report also highlights, there is a crying lack of transparency about pharmaceutical supply chains which means that we know practically nothing about where our drugs are made. This is a scandal and pharmaceutical companies will face increasing calls to do something about it."</p><p>Antibiotic waste from pharmaceutical manufacturing leaking into the environment is a neglected driver of antimicrobial resistance—or AMR—according to a global report published in 2016 by ex-finance minister Lord Jim O'Neill. This is because residues of antibiotics in the environment expose bacteria to levels of the drugs that fuel the emergence of resistance. The "superbugs" that form as a result can spread all over the world. To tackle the problem, Lord O'Neill called for regulators to set minimum standards around the release of waste and for manufacturers to drive higher standards through their supply chains.<br></p><p>AMR has been described as one of the greatest health problems facing the world. Without effective antibiotics, infections become more difficult to treat and common medical procedures like joint replacements, C sections and chemotherapy care for cancer—which rely on the drugs to kill infection—could become too risky to carry out.</p><p>Last year the Bureau of Investigative Journalism <a href="https://www.thebureauinvestigates.com/stories/2017-05-06/big-pharmas-pollution-is-creating-deadly-superbugs-while-the-world-looks-the-other-way" target="_blank">reported on a study</a> which revealed "excessively high" levels of antimicrobial drugs—as well as superbugs—in wastewater from a major drug production hub in the Indian city of Hyderabad. The quantities found were strong enough to treat patients, scientists said. This followed an earlier report of resistant bacteria in the wastewater of a factory there which supplies the NHS with antibiotics.</p><p><br></p>
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<p>The <a href="http://amrbenchmark.org/" target="_blank">Antimicrobial Resistant Benchmark 2018</a> report—released Wednesday at the World Economic Forum conference in DAVOS—evaluated how a cross-section of the pharmaceutical industry are responding to the threat of AMR.</p><p>It found none disclosed their actual discharge levels—information the authors said is "valuable and vital" as it could allow governments and researchers to understand the relationship between discharge and the development of superbugs.</p><p>Three generic drug companies—Cipla, Lupin and Sun Pharma—did not show any evidence of a strategy to minimize the impact of their antibiotic manufacturing on the environment, the report found, although Cipla promised to develop one this year.</p><p>Of particular concern were external companies that work for the main drug companies. Third-party companies manufacture and supply most drug firms with the key components of antibiotics, known as active pharmaceutical ingredients (APIs); and external waste treatment plants, which many drug companies use to process their discharge from antibiotic manufacturing. Some companies have on-site wastewater treatment.</p><p>Only eight companies set discharge limits for antibiotic waste, and for half the companies these limits only apply to their own sites, rather than their suppliers' too. Only two companies—GSK and Novartis—require their external waste treatment plants to follow their limits. Sanofi and Roche, for example, do not monitor the discharge made by their external waste treatment plants, the report noted.</p><p>The Medicines Company was the only one willing to identify its third-party manufacturers, a move the report said would enable governments and researchers to assess the impact of individual manufacturers on antibiotic resistance. The report noted that pharmaceutical companies that sell antibiotics "may be able to exert considerable influence over the environmental risk management of their suppliers."</p><p>The large pharmaceuticals polled were GSK, Johnson and Johnson, Merck & Co, Novartis, Pfizer, Roche, Sanofi and Shinogi. The generic companies were Aspen, Aurobindo, Cipla, Dr Reddy's, Fresenius Kabi, Lupin, Macleods, Mylan, Sun Pharma and Teva.</p><p>Access to Medicine is an Amsterdam-based NGO that receives funding from the UK Government, the Bill & Melinda Gates Foundation and the Dutch Ministry of Foreign Affairs.</p>
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Here's Why Most Most of the Meat Americans Eat Is Banned in Other Industrialized Countries
09 July 2017
Food
Thinkstock
By Martha Rosenberg
Recently, Organic Consumers Association, along with Friends of the Earth and Center for Food Safety filed suit against chicken giant Sanderson Farms for falsely marketing its products as "100% Natural" even though they contain many unnatural and even prohibited substances.
Specifically, Sanderson chicken products tested positive for the antibiotic chloramphenical, banned in food animals, and amoxicillin, not approved for use in poultry production. Sanderson Farms products also tested positive for residues of steroids, hormones, anti-inflammatory drugs—even ketamine, a drug with hallucinogenic effects.
<p>This is far from the first time unlabeled human drugs have been found in U.S. meat. The New York Times <a href="http://www.nytimes.com/2012/04/05/opinion/kristof-arsenic-in-our-chicken.html" target="_blank">reported</a> that most chicken feather-meal samples examined in one study contained Tylenol, one-third contained the antihistamine Benadryl, and samples from China actually contained Prozac. The FDA has caught <a href="http://www.huffingtonpost.com/martha-rosenberg/big-pharma-secrets_b_1257150.html" target="_blank">hatcheries</a> injecting antibiotics directly into chicken eggs. Tyson Foods was caught injecting eggs with the dangerous human <a href="http://www.beasleyfirm.com/blog/2012/february/the-antibiotic-gentamycin-can-cause-hearing-loss/" target="_blank">antibiotic</a> gentamicin.</p><p>The Natural Resources Defense Council has <a href="https://www.counterpunch.org/2015/04/03/dangerous-herbs-may-be-in-your-food-unlabeled/" target="_blank">reported</a> the presence of the potentially dangerous herbs fo ti, lobelia, kava kava and black cohosh in the U.S. food supply as well as strong the antihistamine hydroxyzine. Most of the ingredients are from suppliers in China.</p><p><strong>"Animal Pharma" still mostly under the radar</strong></p><p>Many people have heard of Elanco, Eli Lilly's animal drug division, and Bayer HealthCare Animal Health. But most big Pharma <a href="https://www.thebalance.com/of-the-largest-animal-pharmas-2663221" target="_blank">companies</a>, including Pfizer, Merck, Boehringer Ingolheim, Sanofi and Novartis operate similar lucrative animal divisions. Unlike "people" Pharma, Animal Pharma largely exists under the public's radar: drug ads do not appear on TV nor do safety or marketing scandals reach Capitol Hill.</p><p>Still, conflicts of interest abound. "No regulation currently exists that would prevent or restrict a veterinarian from owning their own <a href="http://www.ecowatch.com/animals/">animals</a> and/or feed mill," <a href="http://www.centerforfoodsafety.org/reports/4069/americas-secret-animal-drug-problem-how-lack-of-transparency-is-endangering-human-health-and-animal-welfare" target="_blank">says</a> the Center for Food Safety. "If a licensed veterinarian also owns a licensed medicated feed mill, they stand to profit by diagnosing a flock or herd and prescribing their own medicated feed blend."</p><p>Because the activities of Animal Pharma are so underreported, few Americans realize that most of the meat they eat is banned in other industrialized countries. One example is <a href="https://www.organicconsumers.org/blog/drugging-animals-factory-farms%E2%80%94enough-already" target="_blank">ractopamine</a>, a controversial growth-promoting asthma-like drug marketed as Optaflexx for cattle, Paylean for pigs, and Topmax for turkeys and banned in the European Union, China and more than 100 other countries. Also used in U.S. <a href="https://www.centerforhealthjournalism.org/2015/09/30/controversial-growth-drug-removed-some-pork" target="_blank">meat production</a> is Zilmax, a <a href="https://www.agweb.com/article/merck-animal-health-provides-update-on-zilmax-five-step-plan-announces-next-steps-news-release/" target="_blank">Merck drug</a> similar to ractopamine that the FDA <a href="http://www.reuters.com/article/us-zilmax-merck-study-idUSBREA2B23720140312" target="_blank">linked</a> to 285 cattle deaths during six years of administration. Seventy-five animals lost hooves, 94 developed pneumonia and 41 developed bloat in just two years, Reuters <a href="http://www.reuters.com/article/us-zilmax-merck-cattle-special-report-idUSBRE9BT0NV20131230" target="_blank">reported</a>.</p><p>The European Union boycotts the U.S.'s hormone-grown beef. The routinely used synthetic hormones zeranol, trenbolone acetate and melengestrol acetate pose "increased risks of breast cancer and prostate cancer," <a href="https://ec.europa.eu/food/sites/food/files/safety/docs/cs_meat_hormone-out21_en.pdf" target="_blank">says</a> the European Commission's Scientific Committee on Veterinary Measures. "Consumption of beef derived from Zeranol-implanted cattle may be a risk factor for breast cancer," according to an <a href="https://www.ncbi.nlm.nih.gov/pubmed/21617224" target="_blank">article</a> in the journal Anticancer Research.</p><p>The European Union has also traditionally boycotted U.S. chickens because they are dipped in chlorine baths. In the U.S. it's perfectly legal to 'wash' butchered chicken in strongly chlorinated water, according to a <a href="https://www.theguardian.com/environment/2017/jan/29/britain-us-trade-deal-gm-food-eu-rules" target="_blank">report</a> in the Guardian:</p><p> These practices aren't allowed in the EU, and the dominant European view has been that, far from reducing contamination, they could increase it because dirty abattoirs with sloppy standards would rely on it [chlorine] as a decontaminant rather than making sure their basic hygiene protocols were up to scratch.</p><p>Other germ-killing or germ-retarding chemicals routinely used in U.S. <a href="http://www.ecowatch.com/tag/factory-farming">food production</a> <a href="http://www.intrepidreport.com/archives/17734" target="_blank">include</a> nitrites and nitrates in processed meat (declared carcinogens by the World Health Organization in 2016), the parasiticide formalin <a href="https://www.organicconsumers.org/news/contemporary-shrimp-production-poses-risks-consumers-and-environment" target="_blank">legally used</a> in shrimp production, and carbon monoxide to <a href="http://www.thehealthyhomeeconomist.com/why-supermarket-meat-is-always-unnaturally-red/" target="_blank">keep meat</a> looking red in the grocery store no matter how old it really is. Many thought public revulsion at the ammonia puffs used to discourage E. Coli growth in the notorious beef-derived "pink slime" in 2012 forced the product into retirement. But the manufacturer is <a href="http://www.foodsafetynews.com/2017/06/jury-trial-begins-today-in-bpi-v-abc-on-the-saga-of-pink-slime/#.WU1uv1syefQ" target="_blank">fighting back</a> aggressively.</p><p><strong>Antibiotics—the least of the unlabeled animal drugs</strong></p><p>According to the Center for Food Safety, Animal Pharma <a href="http://www.centerforfoodsafety.org/reports/4069/americas-secret-animal-drug-problem-how-lack-of-transparency-is-endangering-human-health-and-animal-welfare#showJoin" target="_blank">uses</a> more than 450 animal drugs, drug combinations and other feed additives "to promote growth of the animals and to suppress the negative effects that heavily-concentrated confinement has on farm animals."</p><p>The revelations about Sanderson Farms should come as no surprise given that despite new antibiotic regulations rolled out in 2013, and even more recently, antibiotic use in farm operations is <a href="http://articles.mercola.com/sites/articles/archive/2016/03/19/antibiotic-use-agriculture.aspx" target="_blank">on the rise</a>. Sanderson Farms revelations are no surprise.</p><p>Last year I asked Senior Staff Scientist at Consumers Union Michael Hansen how the 2013 FDA <a href="https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm378100.htm" target="_blank">guidance</a> asking Pharma to voluntarily restrict livestock antibiotics by changing the approved uses language on <a href="https://foodrevolution.org/blog/food-and-health/antibiotics-livestock-production/" target="_blank">labels</a> was working out. Dr. Hansen told me "growth production" had been removed from labels but the drugs are still routinely used for the new indication of "disease prevention."</p><p>After the guidance was published, a Reuters <a href="http://www.reuters.com/investigates/special-report/farmaceuticals-the-drugs-fed-to-farm-animals-and-the-risks-posed-to-humans/" target="_blank">investigation</a> found Tyson Foods, Pilgrim's Pride, Perdue Farms, George's and Koch Foods using antibiotics "more pervasively than regulators realize." Pilgrim's Pride's feed mill records show the antibiotics bacitracin and monensin are added "to every ration fed to a flock grown early this year." (Pilgrim's Pride threatened legal action against Reuters for its finding.) Also caught red-handed using antibiotics, despite denying it on their website, was Koch Foods, a supplier to Kentucky Fried Chicken restaurants. Koch's Chief Finanical Officer, Mark Kaminsky, reportedly said that he regretted the wording on the website.</p><p>But antibiotics are the least of the unlabeled drugs and chemicals lurking in meat. <a href="http://thehealthguide.org/2017/01/08/fda-admitted-chicken-meat-filled-cancer-causing-arsenic/" target="_blank">According</a> to the Associated Press, U.S. chickens continue to be fed with inorganic arsenic to produce quicker weight gain with less food (the same reason antibiotics are given) despite some <a href="https://www.opednews.com/populum/page.php?f=A-Little-Arsenic-Never-Hur-by-Martha-Rosenberg-130621-227.html" target="_blank">public outcry</a> a few years ago. Arsenic is also given to turkeys, hogs and chickens for enhanced color. Such use "contribute[s] to arsenic exposure in the U.S. population," says according to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5332189/" target="_blank">research</a> in Environmental Health Perspectives.</p><p>The appealing pink color of farmed salmon is <a href="http://www.truth-out.org/speakout/item/16383-beware%E2%80%93the-meat-and-seafood%E2%80%99s-healthy-glow-may-be-artificial" target="_blank">also</a> achieved with the chemicals astaxanthin and canthaxanthin. In the wild, salmon eat crustaceans and algae which make them pink; on farms they are an unappetizing and unmarketable gray.</p><p>There are legitimate reasons to use drugs, primarily to treat disease. Cattle host <a href="http://www.alternet.org/personal-health/6-nasty-drugs-your-meat?" target="_blank">stomach-churning</a> liver flukes, eyeworms, lungworms, stomach worms, thin-necked intestinal worms and <a href="http://www.alternet.org/personal-health/turkey-alert-beware-lies-about-natural-growth-chemicals-and-humane-treatment" target="_blank">whipworms</a>, all of which are treated with parasiticides. Turkeys suffer from aspergillosis (brooder pneumonia), avian influenza, avian leucosis, histomoniasis, coccidiosis, coronavirus, erysipelas, typhoid, fowl cholera, mites, lice, herpes, clostridial dermatitis, cellulitis and more for which they are also treated with unlabeled drugs. (The Federal Register says the anti-coccidial drug halofuginone used in turkeys "is toxic to fish and aquatic life" and "an irritant to eyes and skin." Users should take care to "Keep [it] out of lakes, ponds, and streams.") The endocrine disrupter Bisphenol A (BPA) has even been found in fresh turkey meat.</p><p>Food animals are also routinely given antifungal drugs and vaccines. Porcine epidemic diarrhea, which killed millions of animals in <a href="https://www.opednews.com/articles/Rewarding-Flu-Farmers-Wi-by-Martha-Rosenberg-Eggs-150424-570.html" target="_blank">recent years</a>, is treated with a vaccine. And a vaccine for the flock-killing bird flu is in the works. In fact, <a href="https://www.ecowatch.com/tag/big-food">Big Food</a> is working with Big Pharma to replace the widely <a href="http://www.ageofautism.com/2016/11/goodbye-antibiotics-in-meat-hello-vaccines-or-how-the-human-microbiome-meets-animal-pharm.html" target="_blank">assailed</a> antibiotics <em>with</em> vaccines.</p><p><strong>Drug use in food animals will get worse, not better</strong></p><p>There are two reasons drug residues in food animals will soon grow worse, not better. In exchange for China agreeing to accept U.S. beef after a long hiatus, the U.S. <a href="http://www.theepochtimes.com/n3/2251832-us-beef-exports-to-china-will-resume-if-the-us-will-import-chinas-chickens/" target="_blank">agreed</a> to import cooked chickens from China. China's food safety record is abysmal, including rat meat sold as lamb, gutter oil sold as cooking oil, baby formula contaminated with melamine and frequent bird flu epidemics. Globalization dangers already exist with seafood, most of which comes from <a href="https://www.organicconsumers.org/news/contemporary-shrimp-production-poses-risks-consumers-and-environment" target="_blank">countries</a> that use chemicals and drugs banned in the U.S.</p><p>The second reason is the U.S. meat industry's increasing move toward privatization and corporate self-policing—phasing out U.S. meat inspectors in favor of the "honor system." USDA's "New Poultry Inspection System" (NPIS) shamelessly <a href="http://www.foodsafetynews.com/2017/06/watchdog-group-sues-usda-for-names-of-poultry-companies/#.WU1rJ1syefQ" target="_blank">allows</a> poultry producers to switch to a voluntary program that allows for non-government poultry inspections. Such privatization deals are the wave of the future as federal meat inspectors are <a href="https://foodrevolution.org/blog/meat-inspectors-speak-out-but-government-doesnt-want-to-hear-them/" target="_blank">ignored</a> and phased out by the government.</p><p>After all, we are living with an administration that sees regulations as nothing more than an impediment to Big Ag's cheap meat agenda.</p>
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Pollution in Hyderabad. Christian Baars / NDR
By Madlen Davies
Industrial pollution from Indian pharmaceutical companies making medicines for nearly all the world's major drug companies is fueling the creation of deadly superbugs, suggests new research. Global health authorities have no regulations in place to stop this happening.
<p>A <a href="https://link.springer.com/article/10.1007/s15010-017-1007-2" target="_blank">major study</a> published May 6 in the prestigious scientific journal Infection found "excessively high" levels of antibiotic and antifungal drug residue in water sources in and around a major drug production hub in the Indian city of Hyderabad, as well as high levels of bacteria and fungi resistant to those drugs. Scientists told the <a href="https://www.thebureauinvestigates.com/" target="_blank">Bureau of Investigative Journalism</a> the quantities found meant they believe the drug residues must have originated from pharmaceutical factories.</p><p>The presence of drug residues in the natural environment allows the microbes living there to build up resistance to the ingredients in the medicines that are supposed to kill them, turning them into what we call superbugs. The resistant microbes travel easily and have multiplied in huge numbers all over the world, creating a grave public health emergency that is already thought to kill hundreds of thousands of people a year.</p><p>When antimicrobial drugs stop working common infections can become fatal, and scientists and public health leaders say the worsening problem of antibiotic resistance (also known as AMR) could reverse half a century of medical progress if the world does not act fast. Yet while policies are being put into place to counter the overuse and misuse of drugs which has propelled the crisis, international regulators are allowing dirty drug production methods to continue unchecked.</p><p>Global authorities like the Food and Drug Administration (FDA) and the European Medicines Agency strictly regulate drug supply chains in terms of drug safety—but environmental standards do not feature in their rulebook. Drug producers must adhere to <a href="https://www.fda.gov/drugs/developmentapprovalprocess/manufacturing/ucm169105.htm" target="_blank">Good Manufacturing Practices (GMP) guidelines</a>—but those guidelines do not cover pollution.</p><p>Even the World Health Organization (WHO)—a global public health body which has repeatedly called for concerted international action to tackle the dangerous threat of antibiotic resistance—buys <a href="http://www.ecowatch.com/tag/antibiotics">antibiotics</a> from companies whose drug ingredients are made in Hyderabad without carrying out environmental checks.</p><p>The international bodies say the governments of the countries where the drugs are made are the ones responsible for stopping pollution—but domestic legislation is having little impact on the ground, say the study's authors. The lack of international regulation must be addressed, they argue, highlighting the grave public health threat faced by antibiotic resistance as well as the rampant global spread of superbugs from India, which has become an epicenter of the crisis.</p><p><strong>"Unprecedented Antimicrobial Drug Contamination"<br></strong></p><p>A group of scientists based at the University of Leipzig worked with German journalists to take an in-depth look at pharmaceutical pollution in Hyderabad, where 50 percent of India's drug exports are produced. A fifth of the world's generic drugs are produced in India, with factories based in Hyderabad supplying Big Pharma and public health authorities like World Health Organization with millions of tons of antibiotics and antifungals each year.<br></p><p>The researchers tested 28 water samples in and around the Patancheru-Bollaram Industrial zone on the outskirts of the city, where more than than 30 drug manufacturing companies supplying nearly all the world's major drug companies are based. Thousands of tons of pharmaceutical waste are produced by the factories each day, the paper says.</p><p>Almost all the samples contained bacteria and fungi resistant to multiple drugs (known as MDR pathogens, the technical name for superbugs). Researchers then tested 16 of the samples for drug residues and found 13 of them were contaminated with antibiotics and antifungals. Previous studies have shown how exposure to antibiotics and antifungals in the environment causes bacteria and fungi to develop immunity to those drugs.</p><p>Environmental pollution and poor management of wastewater in Hyderabad is causing "unprecedented antimicrobial drug contamination" of surrounding water sources, conclude the researchers—contamination which appears to be driving the creation and spread of dangerous superbugs which have spread across the world. Combined with the mass misuse of antibiotics and poor sanitation, superbugs are already having severe consequences in India—an estimated 56,000 newborn babies die from resistant infections there each year.</p><p>German broadcaster NDR, which contributed to the study, identified 19 companies operating inside the area tested as suppliers of antibiotics to the European market. Of those 19, the Bureau has identified at least four companies which supply the UK and five which supply the U.S.</p><p>The companies in question strongly deny that their factories pollute the environment, and the sheer number of factories operating in Hyderabad means it is impossible to identify exactly which companies are responsible for the contamination found in the samples tested.</p><p>What is clear is one of the world's biggest drug production hubs is producing dangerous levels of pharmaceutical pollution, and the international bodies tasked with ensuring drug safety are doing little to address it.</p><p>Health regulators have to take action, said Prof. Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics & Policy and a leading voice on antibiotic resistance. "We need to take environmental contamination from bulk manufacturing facilities seriously and put an immediate end to the practice," he said. "This should be a part of GMP without question and pharmaceutical companies throughout the world should be subject to an audit to ensure that they are compliant with what the industry has promised to do."</p><p><strong>The Epicenter of a Global Crisis</strong></p><p>The densely populated and increasingly prosperous city of Hyderabad in southern India was once an international trading centre for diamonds and pearls. Today, it is a major international hub for the pharmaceutical and biotech industries, producing millions of tons of medicines, chemicals and pesticides each year.<br></p><p><a href="http://environmentclearance.nic.in/writereaddata/Online/TOR/21_Oct_2016_1324557208HQGVQ7SAnnexureVIHydPharmaCityPFR.pdf" target="_blank">Around 170 companies</a> making bulk drugs like antibiotics operate in and around Hyderabad, the majority clustered in sprawling industrial estates along the banks of the Musi river. Companies in Europe and the U.S., as well as health authorities like WHO and the UK's NHS are reliant on drugs being produced in these factories.</p><p>The area has long been criticized for its pollution, which has continued unabated despite decades of campaigning by Indian NGOs, say the report authors. In 2009 the Patancheru-Bollaram zone was classified as "critically polluted" in India's national pollution index and construction in the area was banned. But the government relaxed the rules in 2014 and building was allowed to begin again.</p><p>Last year India's Supreme Court ordered the country's pharmaceutical companies to operate a zero liquid waste policy, but "massive violations" have reportedly occurred, says the Infection report.<br></p><p>As India's drug production industry has grown, so has the prevalence of superbugs—a national crisis intensified by the widespread overuse and misuse of antibiotics, which are easily bought over the counter, and poor sanitation Alongside the creation of individual superbugs, genes and enzymes have developed which can pass between multiple types of bacteria, making them resistant to drugs. </p><p>India has become the epicenter of the global drug resistance crisis, with 56,000 newborn Indian babies estimated to die each year from drug-resistant blood infections, and 70 to 90 percent of people who travel to India returning home with multi-drug-resistant bacteria in their gut, according to the study.</p><p><span></span>The bacteria can remain in the gut without causing problems, but if they travel from there into a patient's bloodstream or urinary tract they can cause serious infections. They can also pass on resistance to other bacteria in the gut—so if a patient gets food poisoning the bacteria that caused it could acquire the resistance and become hard to treat.</p><p><strong>An AMR Nightmare: David Ricci's Story</strong></p><p class="shortcode-media shortcode-media-rebelmouse-image"><img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy85ODYxMDU1L29yaWdpbi5qcGciLCJleHBpcmVzX2F0IjoxNjI0NjQ4NjY5fQ.pUOn-lXcgJF8xJGXaPA-sv8lTzSTsQtw12nKv-S5OKk/img.jpg?width=980" id="32274" class="rm-shortcode" data-rm-shortcode-id="1518ed42c555e95502fcd4cc489ce83e" data-rm-shortcode-name="rebelmouse-image"><small placeholder="add caption..." class="image-media media-caption">David Ricci.</small></p><p>David Ricci was just 19 when his life changed dramatically. He was hit by a train while walking through the slums of the Indian city of Kolkata where he was helping care for orphaned children. He was left screaming in agonizing pain on the pavement until he blacked out. Later, at a local hospital, a surgeon took a bundle of knives wrapped in a dirty cloth and amputated his leg without any anesthetic—a traumatic event that was just the beginning of his ordeal.<br></p><p>Back in Seattle his wound became infected. Doctors pumped him with antibiotics with little effect until eventually they were forced to perform further surgery to cut out parts of his infected stump. Finally, he was told he had caught two superbugs, which the doctors struggled to treat. He was lucky the bugs were confined to the wound, doctors said. If they had got into his blood he would have died.</p><p><span></span>The bugs were immune to standard antibiotics so doctors had to to turn to stronger drugs used sparingly in modern medicine because they have nasty side effects. David was drip-fed colistin, a toxic antibiotic reserved for emergencies, but had to be taken off it after a week because his organs began to shut down. He was then given tigecycline, a new antibiotic developed for resistant infections. He had to inject the drug for six months, the dose bumped up whenever the infection returned. It made him feel so nauseous he could barely watch television or make a cup of coffee; he had to spend his days lying around in pain, hoping this course would finally kill the bacteria. "It felt like I was being treated for cancer," he said. "I would wake up thinking 'Please take me off it, please make this stop.'"</p><p>David had picked up various bugs in India that contained a gene known as NDM-1, named after New Delhi where it was first discovered in 2008. NDM-1 gives bacteria ability to produce enzymes which break down carbapenems, a group of powerful antibiotics which are used to treat infections that have become resistant to other drugs. Bacteria that are able to resist carbapenems have been called the "nightmare" bacteria by the U.S. Center for Disease Control and Prevention because half of all people who contract a bloodstream infection from them die. </p><p>NDM-1 has spread across the world since it was discovered. At least 175 people in the U.S. have been treated for an NDM-1 infection since 2009, although there are likely to have been many more cases as hospitals are not required to report it. While many cases come from abroad, infections in patients who have not left the U.S. are now being reported.</p><p>NDM-1 is also starting to appear in the UK. There have been 1,129 reports of the bacteria in England since 2003 and this is thought to be a conservative figure. </p><p>David eventually recovered, but antibiotic resistance has changed the course of his life. he works with campaigning organizations and talks to members of congress about the issue, and wants to work in medicine in the future.</p><p>"I feel like I have a purpose," he said. "The whole experience has made me feel lucky to be alive."</p><p><strong>Antimicrobials Found at Levels Thousands of Times Higher Than the Safe Limit</strong></p><p>Many <a href="https://www.thebureauinvestigates.com/stories/2016-09-15/how-big-pharmas-industrial-waste-is-fuelling-the-rise-in-superbugs-worldwide" target="_blank">previous studies</a> have highlighted pharmaceutical pollution in India and China—which together produce most of the world's antibiotics—and shown how such pollution fuels the proliferation of superbugs worldwide. The authors of the new Infection study set out to provide a detailed picture of the levels and types of pollution in Hyderabad and its links to drug resistance.<br></p><p>Researchers took water samples from rivers, lakes, groundwater, drinking water and surface water from rural and urban areas in and around the industrial estate, as well as pools near factories and water sources contaminated by sewage treatment plants. Four were taken from taps, one from a borehole, and the remaining 23 were classed as environmental samples.</p><p>The samples were tested for bacteria resistant to multiple drugs (known as MDR pathogens, the technical name for superbugs). The researchers then tested 16 of the samples for the antibiotics and antifungals used to treat infections.</p><p>All samples apart from one taken from tap water at a four star hotel were found to contain drug-resistant bacteria. All 23 environmental samples contained carbapenemase-producing bacteria—a group of bugs dubbed <a href="https://www.thebureauinvestigates.com/stories/2017-04-21/worse-than-mrsa-experts-call-for-action-on-deadly-new-superbug" target="_blank">the "nightmare bacteria"</a> because they are virtually untreatable and kill 40-50 percent of people whose blood gets infected with them.</p><p>Of the 16 samples then tested for drug residue, 13 were found to be contaminated with antibiotics and antifungals, some in disturbingly high levels. The researchers compared the levels of residue to limits recommended by leading microbiologists; once levels exceed those limits it is likely that superbugs will develop.</p><p><span></span>A sample taken from one sewer contained concentrations of the antifungal drug fluconazole—a drug used in ointments for fungal infections such as thrush and athlete's foot or given intravenously for more serious infections—at levels 950,000 times higher than the recommended safe limit. The researchers repeatedly analyzed this finding to make sure it was correct. "To our knowledge, this is the highest concentration of any drug ever measured in the environment," wrote the authors.</p><p class="shortcode-media shortcode-media-rebelmouse-image"><img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy85ODYxMDYwL29yaWdpbi5qcGciLCJleHBpcmVzX2F0IjoxNjM2MTIxMzQ3fQ.V8VzwH4FN6QdkDgYEnm2EJMp2WxF0pNEKnxf0Sh9LEo/img.jpg?width=980" id="33225" class="rm-shortcode" data-rm-shortcode-id="9d44495bcdf29c5aca461818334829aa" data-rm-shortcode-name="rebelmouse-image"><small placeholder="add caption..." class="image-media media-caption">A member of the inspection team looks at a pond connected to a sewer in the industrial zone. Christian Baars / NDR</small></p><p>Samples from sewers in the industrial area were also found to contain "extremely high concentrations" of nine different antibiotics. Levels of moxifloxacin—used to treat lung, skin and sinus infections as well as tuberculosis—were up to 5,500 times higher than the recommended limit, while another common antibiotic ciprofloxacin was found at levels up to 700 times above that recommended. Concentrations of the antibiotics clarithromycin and ampicillin were found at levels more than 100 times higher than the safe limit.</p><p class="shortcode-media shortcode-media-rebelmouse-image"><img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy85ODYxMDY4L29yaWdpbi5qcGciLCJleHBpcmVzX2F0IjoxNjY5OTU2ODYxfQ.bzVdPN57t_OI3EIg0XIbbSzSdhRp6VGrZ0gek76ZiZQ/img.jpg?width=980" id="374b6" class="rm-shortcode" data-rm-shortcode-id="c33bb68c92b1dbbbb7d3df7d17f33feb" data-rm-shortcode-name="rebelmouse-image"><small placeholder="add caption..." class="image-media media-caption">"Excessively high" concentrations of antibiotic and antifungal residue were found in the natural environment. Christian Baars / NDR</small></p><p>The amounts of antimicrobials found in the new tests were "eye-wateringly high," said Dr. Mark Holmes, a microbiologist at the University of Cambridge. "The quantities involved mean the amount in the water is almost the same as a therapeutic dose," he said, calling on the Indian authorities to investigate immediately by testing each factory's effluent. "That's not just getting rid of a few tablets down the toilet."<br></p><p>Pharmaceutical pollution is not the only way in which antibiotics get into the Indian environment—excrement from people and animals and waste from hospitals and farms also contain residues of the drugs. But some of the levels detected in the recent testing mean the residues can only have come from bulk manufacturing, according to scientists.</p><p>Prof. Joakim Larsson, of the University of Gothenburg believes the levels of antimicrobials found could not be explained by anything else other than industrial discharges. "So it tells us that the problem is still there, it needs to be solved," he told German journalists who worked on the report.</p><p>The pharmaceutical industry in Hyderabad produces "enormous amounts" of waste each day, says the Infection report. Effluent is transported in trucks to one waste treatment plant, it says, where it is treated before being sent to a mega sewage plant. There, it is mixed with sewage and further treated then discharged into the nearby Musi river.</p><p><span></span>Adhering to the zero liquid waste policy ordered by the Supreme Court requires expensive technology, and some waste is still clandestinely sent to the waste treatment plant or dumped straight into the surrounding environment, according to the report.</p><p><strong><span></span>Links to U.S. and UK Markets</strong></p><p>Virtually all of the world's major drug companies are supplied by production plants in Hyderabad. Various companies whose factories are located next to or near sites where the water samples were taken supply the U.S. and UK markets, though with such huge amounts of antibiotics present throughout the Indian environment it is impossible to concretely link specific factories to specific test results.</p><p>Using the Bulk Drug Manufacturing Industry's 2015 manual, which lists all Indian drug manufacturers, their locations and their products, journalists at NDR were able to identify 19 companies operating in the Patancheru-Bollaram area which produce the antimicrobial drugs found in the water samples. (There may be other unnamed manufacturers operating in the area or companies which do not advertise which antimicrobials they produce).</p><p>The Bureau of Investigative Journalism has linked a number of these companies to the U.S. and UK markets. MSN Pharmachem is one of the fastest growing drug manufacturers in India. It makes the raw ingredient of the antibiotic moxifloxacin on behalf of international drug companies Macleods and Sun Pharmaceuticals, which then turn it into a finished product supplied to the World Health Organization.</p><p>Other major companies operating in the zone which supply the U.S. and UK markets include Aurobindo, a leading Indian producer which exports to more than 150 countries around the globe and Mylan, a company which claims its products fill one out of every 13 prescriptions dispensed in America. Mylan also supplies the European Union market, and says it is the fourth biggest supplier of generic (non-branded) drugs in the UK.</p><p>The companies strongly refute suggestions that their factories are responsible for pollution.</p><p>MSN Pharmachem said it conformed to the highest industry standards, applicable laws and regulations and operated a zero discharge policy at its factories.</p><p>"Our sites are regularly monitored internally and inspected externally," said a spokesperson. "We are committed to a clean environment, health of all our employees, neighbors, partners and customers."</p><p>Aurobindo said it was impossible any pollution could have originated from its factories as it also operated a zero liquid waste policy—all waste is treated and recycled within the plants. It also said the topography and water flows of the relevant locations meant not even rainwater or drain water would be able to flow from its factories to the sample collection sites.</p><p>Mylan also said its factory could not have contributed to the residues identified by the researchers, as all its plants operated a zero liquid waste policy whereby all effluent is recycled and reused on site. It has its own wastewater treatment systems at all its Hyderabad plants, said a spokesperson, which use advanced technology to eliminate harmful waste. "These plants are operated 24 hours a day, seven days a week by qualified individuals," said the statement.</p><p>Macleods and Sun Pharmaceuticals did not respond to requests for comment.</p><p>A WHO spokesperson said the organization did not buy the drug ingredients, just the final medicine, and had no contact with ingredient manufacturers. "Manufacturing sites are typically inspected for Good Manufacturing Practice (GMP) which focuses on ensuring consistent quality for the product in question from the perspective of human health risk," said a statement. "GMP does not address waste management and environmental management measures vis-à- vis emissions and pollution control—as here relevant domestic environmental and industrial regulations would apply."</p><p><strong>Food Poisoning Turned Into a Near-Death Experience</strong></p><p>Andrew, 57 and his wife Sally fell ill with upset stomachs soon after arriving in New Delhi to take up a new job.<br></p><p>While his wife quickly recovered, Andrew took weeks to get better. He had another bout of severe sickness and diarrhea a few months later, and kept getting ill sporadically for the rest of the year. </p><p>"What we didn't know then was that he'd contracted a serious bacterial infection that was now living in his body," said Sally. "His personality changed. He became extremely anxious, he couldn't relax, felt ill and was distracted. I was so worried, our life was really deteriorating in every aspect."</p><p>His condition got worse over time, and Andrew was admitted into hospital where he was told he had a urinary tract infection.</p><p>The hospital prescribed powerful intravenous antibiotics, which initially seemed to work, but a few weeks later he woke up with a fever. He was rushed back to hospital, where doctors said dangerously ill with sepsis—his organs were shutting down.<br></p><p>He recovered enough to return to the UK, where doctors at the London School of Hygiene & Tropical Medicine said his infection contained NDM-1. Tests showed it was resistant to all antibiotics save one, fosfomycin. Andrew and Sally got their affairs in order, fearing he would die if the infection returned. </p><p>Friends began to avoid him believing they might catch the bacteria. Now retired and under the care of specialists, he and his wife worry that NDM-1 is so widespread in India it is only a matter of time before it becomes more common in the UK.</p><p>"Unless companies are called for account for their distribution of waste, until the Indian government starts teaching hand hygiene in hospitals and in catering facilities like hotels and restaurants, the possibility of this infection spreading worldwide is huge," said Sally. "It's a cliché to say 'I don't want people to go through what we went through' but it's true. It's changed our life."</p><p><em>Names have been changed to protect identities</em></p><p><strong>No Mention of Pollution in Global Regulations</strong></p><p>There are reams of regulations and stipulations that manufacturers have to adhere to in order to export their products to the U.S. and Europe—known as the Good Manufacturing Practices (GMP) framework. These focus on making sure drugs are safe, pure, and effective.</p><p>Stringent inspections by the FDA, WHO and European authorities check that these rules are being followed.</p><p>However these regulations do not address environmental concerns. Inspectors have no mandate to sanction a factory for polluting, failing to treat its waste or other environmental problems—this falls within the remit of local governments.</p><p>Within India, there are environmental regulations covering what ingredients factories are allowed to produce, how they use water and how they dispose of their waste. In Hyderabad, the Telangana State Pollution Board inspects factories based on these.</p><p><span></span>However these inspection have been <a href="https://www.nordea.com/Images/35-107206/impacts%201-20.pdf" target="_blank">labeled toothless</a> by local and international campaign groups. In November 2015, an <a href="http://www.downtoearth.org.in/news/supreme-abuse-51876" target="_blank">analysis of Telangana State Pollution Board inspection reports</a> by the Centre for Science and Environment in Delhi found that 15 bulk drug manufacturers within the Patancheru Bollaram industrial area were producing ingredients for which they did not have permission, using more water than the permitted limit, and dumping more effluents and hazardous waste than allowed.</p><p class="shortcode-media shortcode-media-rebelmouse-image"><img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy85ODYxMDcyL29yaWdpbi5qcGciLCJleHBpcmVzX2F0IjoxNjE2ODAyNTg1fQ.vMmlOLZPKPdPXKHMTDAdSiPJHmI1YvkQpP-8A2abP2Y/img.jpg?width=980" id="d4170" class="rm-shortcode" data-rm-shortcode-id="5fc2530ce9a9cfd2d2f735c67ffc0ef9" data-rm-shortcode-name="rebelmouse-image"></p><p>Lots of promises have been made. More than 100 drug companies (including Mylan) signed a declaration at the World Economic Forum in Davos at the beginning of last year pledging to clean up production; commitments which were repeated in an industry roadmap released by 13 major manufacturers in the run-up to the first ever high-level United Nations meeting on antimicrobial resistance last September.<br></p><p>Last week the European Commission also <a href="http://ec.europa.eu/info/law/better-regulation/initiatives/ares-2017-2210630" target="_blank">published a roadmap</a> acknowledging the release of antimicrobial ingredients into the environment during manufacture "may pose a risk." It promised it would explore how to address the challenge in 2018, but fell short of committing to actual policy.</p><p>The UK government promised to take action on pollution in NHS supply chains following <a href="https://www.thebureauinvestigates.com/stories/2016-10-18/revealed-how-dirty-production-of-nhs-drugs-helps-create-superbugs" target="_blank">a previous Bureau report</a> last October, but could not comment on whether this had been followed up due to purdah rules prohibiting any policy announcements in the run-up to an election.</p><p>And WHO, along with sister UN agencies, <a href="http://www.who.int/mediacentre/news/releases/2016/environmental-social-procurement/en/" target="_blank">signed a "Statement of Intent"</a> last December aimed at "advancing environmental and socially responsible procurement" of their health products. Just this week, WHO director-general Margaret Chan warned the world was moving towards a "post-antibiotic era" and <a href="http://www.who.int/publications/10-year-review/health-guardian/en/index3.html" target="_blank">called once again for concerted global action</a>. She listed actions which were urgently needed, including cutting antibiotic prescriptions, developing new drugs and coordinated government policies around the world. She did not mention pharmaceutical pollution.</p><p>The European Public Health Alliance, an umbrella group for more than 90 non-profit organizations, lambasted the failure of international regulators to do anything about the "rife" pollution which was a "clear cause" of AMR.</p><p>"This glaring omission must be rectified by including legally binding environmental standards in GMP protocols, particularly with regard to contamination with antimicrobial substances—as a condition for authorization and import of drugs," said a spokesperson. "Voluntary agreements are not enough to stop a race to the bottom, where pharmaceutical companies exploit weak links in global supply chains, in places where there is little or no enforcement of vital environmental standards." </p><p>Tighter regulations on pollution must be introduced, said Dr Yohei Doi, associate professor of Medicine at the University of Pittsburgh School of Medicine, and it was up to international buyers of drugs such as the FDA to make this happen. "It's the buyers in the U.S. that pay for these things," he said. "As long as people buy these drugs, the companies will keep making them in this way."</p><p><span></span><em>The documentary by NDR, WDR and SZ, The Invisible Enemy—Deadly Superbugs</em> <em>from Pharma Factories, will air on May 8 at 10:45 p.m. on the channel ARD. An English</em> <em>version will appear on the channel's YouTube feed.</em></p><p> <em>Reposted with permission from our media associate <a href="https://www.thebureauinvestigates.com/stories/2017-05-06/big-pharmas-pollution-is-creating-deadly-superbugs-while-the-world-looks-the-other-way" target="_blank">The Bureau of Investigative Journalism</a>.</em></p>
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