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<p><a name=LETTER.BLOCK7><b><font size=2 color=black face=Verdana><span
style='font-size:10.0pt;font-family:Verdana;color:black;font-weight:bold'>Bathing
and showering: Underappreciated sources of water pollution from medicines</span></font></b></a><font
size=2 color=black face=Verdana><span style='font-size:10.0pt;font-family:Verdana;
color:black'><o:p></o:p></span></font></p>
<p><font size=2 color=black face=Verdana><span style='font-size:10.0pt;
font-family:Verdana;color:black'>That bracing morning shower and soothing
bedtime soak in the tub are potentially important but until now unrecognized
sources of the hormones, antibiotics, and other pharmaceuticals that pollute
the environment, scientists reported here today at the 239th National Meeting
of the American Chemical Society. The first-ever evaluation, they said, could
lead to new ways to control environmental pollution from active pharmaceutical
ingredients (APIs), which has been the source of growing concern.<o:p></o:p></span></font></p>
<p><font size=2 color=black face=Verdana><span style='font-size:10.0pt;
font-family:Verdana;color:black'>Ilene Ruhoy, M.D., Ph.D., who co-authored the
study, said that scientists have long known that bathrooms are a portal for
release of APIs into the environment. An active ingredient in a pill is the
medicine, usually combined with binders to hold the pill together, stabilizers,
and other inactive ingredients. However, scientists and pollution control
officials assumed that toilets were the main culprit, with APIs excreted in
urine and feces and flushed into sewers and sewage treatment plants. APIs may
go right through the disinfection process at those plants, and enter lakes,
rivers, and oceans. Some also end up in the environment when people flush
unused drugs down the toilet. Scientists have found traces of the active
ingredients of birth control pills, antidepressants, and scores of other drugs
in waterways. Some end up in drinking water - at extremely low, trace levels. <o:p></o:p></span></font></p>
<p><font size=2 color=black face=Verdana><span style='font-size:10.0pt;
font-family:Verdana;color:black'>"We've long assumed that the active
ingredients from medications enter the environment primarily as a result of
their excretion via urine and feces," said Dr. Ruhoy. She directs the
Institute for Environmental Medicine at TouroUniversity in <st1:City w:st="on">Henderson</st1:City>,
<st1:State w:st="on">NV</st1:State>, and did the research with Christian
Daughton, Ph.D., of the U.S. Environmental Protection Agency's National
Exposure Research Laboratory in <st1:City w:st="on"><st1:place w:st="on">Las
Vegas</st1:place></st1:City>. "However, for the first time, we have
identified potential alternative routes for the entry into the environment by
way of bathing, showering, and laundering. These routes may be important for
certain APIs found in medications that are applied topically, which means to
the skin. They include creams, lotions, ointments, gels, and skin
patches."<o:p></o:p></span></font></p>
<p><font size=2 color=black face=Verdana><span style='font-size:10.0pt;
font-family:Verdana;color:black'>Ruhoy and Daughton identified this potential
new source of APIs through a comprehensive review of hundreds of scientific
studies on the metabolism and use of medications. They focused on APIs in
medications that are applied to the skin or excreted from the body via sweat
glands. These two sources can result in residues being washed off the body and
down bathroom drains. These include steroids (such as cortisone and testosterone),
acne medicine, antimicrobials, narcotics, and other substances. Another
previously unrecognized route by which APIs may reach the environment includes
perspiration (many APIs are released in sweat) and laundering of clothing that
has come into contact with topical medications from their dermal application or
from sweating. <o:p></o:p></span></font></p>
<p><font size=2 color=black face=Verdana><span style='font-size:10.0pt;
font-family:Verdana;color:black'>Ruhoy cited steps by which consumers can
reduce the potential environmental impact of these skin-based pharmaceuticals
by following directions and applying only the recommended amount, rather than
thinking that "if a little is good, more must be better." Doctors can
help by prescribing the lowest possible dose for the shortest period of time
necessary. Scientists should continue efforts to develop better drug delivery
systems for topical medications so that APIs, for instance, are absorbed faster
and more completely, she said. Design of dermal patches so that less API
residue remains after use would be particularly helpful in reducing accidental
poisonings from carelessly discarded patches and the quantities of APIs flushed
down toilets. </span></font><font size=2 color=black face=Verdana><span
style='font-size:10.0pt;font-family:Verdana;color:black'><a
href="http://r20.rs6.net/tn.jsp?et=1103248504774&s=32927&e=001UjMQvd4EFU3dXd2L6pG6bkPF8uNyqUT3c1owqhpCELeXbhUYkzKXb3DvVhhuv2_Eln2p1xQwm9L27dwhKTyl03Z5eDvFgzTb3ha3cS1rTi0UbTFSWkzm-J7XmHQ1EEGZ8Plw75Qi7UO_s05ntx44zJC8YX7OJd3R-1r5M5Mpl0_vR_PrmCfaRM-Sf4fHExDit7cDiwxWe5xMgcqbw54nOZXmV_ZeWhCL591ef0wiXu9qAWs55M8aAP2B7e56Z8IVhq_5LVb8zJE="
target="_blank"
title="http://r20.rs6.net/tn.jsp?et=1103248504774&s=32927&e=001UjMQvd4EFU3dXd2L6pG6bkPF8uNyqUT3c1owqhpCELeXbhUYkzKXb3DvVhhuv2_Eln2p1xQwm9L27dwhKTyl03Z5eDvFgzTb3ha3cS1rTi0UbTFSWkzm-J7XmHQ1EEGZ8Plw75Qi7UO_s05ntx44zJC8YX7OJd3R-1r5M5Mpl0_vR_PrmCfaRM-Sf4fHExDit7cDiwx"
shape=rect linktype=link track=on>Visit here for the article</a>. <o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:11.0pt'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:11.0pt'><o:p> </o:p></span></font></p>
<p class=MsoNormal><strong><b><font size=2 face="Arial Narrow"><span
style='font-size:10.0pt;font-family:"Arial Narrow"'>Firouzan 'Fred' Massoomi,
Pharm.D., FASHP</span></font></b></strong><o:p></o:p></p>
<p class=MsoNormal><st1:place w:st="on"><st1:PlaceName w:st="on"><font size=2
face="Arial Narrow"><span style='font-size:10.0pt;font-family:"Arial Narrow"'>Nebraska</span></font></st1:PlaceName><font
face="Arial Narrow"><span style='font-family:"Arial Narrow"'> <st1:PlaceName
w:st="on">Methodist</st1:PlaceName> <st1:PlaceType w:st="on">Hospital</st1:PlaceType></span></font></st1:place><o:p></o:p></p>
<p class=MsoNormal><font size=2 face="Arial Narrow"><span style='font-size:
10.0pt;font-family:"Arial Narrow"'>Pharmacy Operations Coordinator</span></font><o:p></o:p></p>
<p class=MsoNormal><font size=2 face="Arial Narrow"><span style='font-size:
10.0pt;font-family:"Arial Narrow"'>Department of Pharmacy Services</span></font><o:p></o:p></p>
<p class=MsoNormal><st1:Street w:st="on"><st1:address tabIndex="0"
style="BACKGROUND-POSITION: left bottom; BACKGROUND-IMAGE: url(res://ietag.dll/#34/#1001); BACKGROUND-REPEAT: repeat-x"
w:st="on"><font size=2 face="Arial Narrow"><span style='font-size:10.0pt;
font-family:"Arial Narrow"'>8303 Dodge St</span></font></st1:address></st1:Street><font
face="Arial Narrow"><span style='font-family:"Arial Narrow"'>.</span></font><o:p></o:p></p>
<p class=MsoNormal><st1:place w:st="on"><st1:City w:st="on"><font size=2
face="Arial Narrow"><span style='font-size:10.0pt;font-family:"Arial Narrow"'>Omaha</span></font></st1:City><font
face="Arial Narrow"><span style='font-family:"Arial Narrow"'>, <st1:State
w:st="on">NE</st1:State> <st1:PostalCode w:st="on">68114</st1:PostalCode></span></font></st1:place><o:p></o:p></p>
<p class=MsoNormal><font size=2 face="Arial Narrow"><span style='font-size:
10.0pt;font-family:"Arial Narrow"'><a href="mailto:fred.massoomi@nmhs.org">fred.massoomi@nmhs.org</a></span></font><o:p></o:p></p>
<p class=MsoNormal><font size=2 face="Arial Narrow"><span style='font-size:
10.0pt;font-family:"Arial Narrow"'>(402) 354-4340
office (402)
354-3139 fax</span></font><o:p></o:p></p>
<p class=MsoNormal><strong><b><font size=2 color="#ff8000" face="Arial Narrow"><span
style='font-size:10.0pt;font-family:"Arial Narrow";color:#FF8000'>A proud supporter
of the Multiple Sclerosis Society<o:p></o:p></span></font></b></strong></p>
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style='font-size:18.0pt;font-family:Webdings;color:green'>P</span></font><font
color=green><span lang=EN-GB style='color:green'> </span></font><font
color=green face="Arial Narrow"><span lang=EN-GB style='font-family:"Arial Narrow";
color:green'>Think Green & </span></font><font color=green
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color:green'>Think before <strong><b><font face="Arial Narrow"><span
style='font-family:"Arial Narrow"'>YOU</span></font></b></strong> print.</span></font><font
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