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</o:shapelayout></xml><![endif]--></head><body lang=EN-US link=blue vlink=purple><div class=WordSection1><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>Hi Joel et al,<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>P2 and lifestyle medicine are very similar. Mr. Sabin’s article points out the deficiencies in our system that don’t support healthy lifestyles and good nutrition. The ACA does have preventative medicine has a key piece, it is not being substituted for our very heavily loaded chronic care based system. <o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>Very truly yours,<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>Catherine Zimmer, MS, BSMT<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>Zimmer Environmental Improvement, LLC<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>St. Paul, MN <o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>Ph: 651.645.7509<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><a href="mailto:zenllc@usfamily.net"><span style='color:blue'>zenllc@usfamily.net</span></a><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>From:</span></b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'> drkreisberg@teleosis.org [mailto:drkreisberg@teleosis.org] <b>On Behalf Of </b>Dr. Joel Kreisberg<br><b>Sent:</b> Wednesday, September 17, 2014 12:50 AM<br><b>To:</b> Catherine Zimmer<br><b>Cc:</b> Gilliam, Allen; pharmwaste@lists.dep.state.fl.us; Glassmeyer.susan@epa.gov<br><b>Subject:</b> Re: [Pharmwaste] excreted drugs & whole effluent toxicity?<o:p></o:p></span></p><p class=MsoNormal><o:p> </o:p></p><div><div><div><div><p class=MsoNormal>Hard to resist throwing this one in here, just as a reminder.<o:p></o:p></p><h1>The Absurd Economics of Nutrition and Exercise<o:p></o:p></h1><p class=MsoNormal style='margin-bottom:12.0pt'><a href="http://fontherapeutics.com/uncategorized/the-absurd-economics-of-nutrition-and-exercise/">http://fontherapeutics.com/uncategorized/the-absurd-economics-of-nutrition-and-exercise/</a><o:p></o:p></p></div><p class=MsoNormal style='margin-bottom:12.0pt'>of the nine key recommendations, this one caught my attention <br><br>7. <strong>Provide reimbursement for health services that target lifestyle factors such as nutrition and exercise.</strong><o:p></o:p></p></div><p class=MsoNormal style='margin-bottom:12.0pt'><strong>Our group calls it P2, that group calls is lifestyle medicine, are they the same? </strong><o:p></o:p></p></div><p class=MsoNormal>Joel<o:p></o:p></p><div><p class=MsoNormal style='margin-bottom:12.0pt'><o:p> </o:p></p></div></div><div><p class=MsoNormal><br clear=all><o:p></o:p></p><div><div><p class=MsoNormal><span style='font-size:13.5pt;font-family:"Garamond","serif";color:black'>Dr. Joel Kreisberg, DC, CCH, ACC</span><span style='font-size:13.5pt;font-family:"Garamond","serif"'> |Integrative Homeopathic Medicine |<span style='color:black'><a href="http://drkreisberg.com/" target="_blank"><span style='color:black'>drkreisberg.com</span></a> </span></span><span style='font-size:18.0pt;font-family:"Garamond","serif";color:black'>|</span><span style='font-size:13.5pt;font-family:"Garamond","serif";color:black'><a href="mailto:drkreisberg@joelkreisberg.com" target="_blank"><span style='color:#1155CC'>drkreisberg@joelkreisberg.com</span></a> |510-558-7285 Ext 102 | skype: Joel.Kreisberg</span><o:p></o:p></p><div><p class=MsoNormal><o:p> </o:p></p></div><div><p class=MsoNormal style='margin-bottom:12.0pt'><o:p> </o:p></p></div></div></div><p class=MsoNormal><o:p> </o:p></p><div><p class=MsoNormal>On Fri, Sep 12, 2014 at 11:57 AM, Catherine Zimmer <<a href="mailto:zenllc@usfamily.net" target="_blank">zenllc@usfamily.net</a>> wrote:<o:p></o:p></p><div><div><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='color:#1F497D'>Hi Allen et al,</span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='color:#1F497D'> </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='color:#1F497D'>Yep, P2 is the way—and not just reduced doses, but directed drugs (e.g. organ specific), less persistent rx and alternative therapies. For example a study that just came out of a Canadian university showed better results using weight loss, exercise and PT for knees rather than replacements. </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='color:#1F497D'> </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='color:#1F497D'>Regarding testing of API in WW, there are few accepted methods. Axys analytical laboratories is I believe one of the few commercial labs that does suites of API. Their methods have been developed with EPA oversight to be the standards. Unfortunately, there are a number of pharmaceuticals for which there are no standardized test methods, including controlled substances. </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='color:#1F497D'> </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='color:#1F497D'>And, Jim I agree waste body fluids from patients undergoing chemo, should be collected, not discharged to the sanitary sewer. </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='color:#1F497D'> </span><o:p></o:p></p><div><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='color:#1F497D'>Very truly yours,</span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='color:#1F497D'> </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='color:#1F497D'>Catherine Zimmer, MS, BSMT</span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='color:#1F497D'>Zimmer Environmental Improvement, LLC</span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='color:#1F497D'>St. Paul, MN </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='color:#1F497D'>Ph: <a href="tel:651.645.7509" target="_blank">651.645.7509</a></span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='color:#1F497D'><a href="mailto:zenllc@usfamily.net" target="_blank">zenllc@usfamily.net</a></span><o:p></o:p></p></div><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='color:#1F497D'> </span><o:p></o:p></p><div><div style='border:none;border-top:solid #B5C4DF 1.0pt;padding:3.0pt 0in 0in 0in'><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>From:</span></b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'> <a href="mailto:pharmwaste-bounces@lists.dep.state.fl.us" target="_blank">pharmwaste-bounces@lists.dep.state.fl.us</a> [mailto:<a href="mailto:pharmwaste-bounces@lists.dep.state.fl.us" target="_blank">pharmwaste-bounces@lists.dep.state.fl.us</a>] <b>On Behalf Of </b>Gilliam, Allen<br><b>Sent:</b> Friday, September 12, 2014 9:41 AM<br><b>To:</b> '<a href="mailto:pharmwaste@lists.dep.state.fl.us" target="_blank">pharmwaste@lists.dep.state.fl.us</a>'<br><b>Cc:</b> <a href="mailto:Glassmeyer.susan@Epa.gov">Glassmeyer.susan@Epa.gov</a><br><b>Subject:</b> [Pharmwaste] excreted drugs & whole effluent toxicity?</span><o:p></o:p></p></div></div><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'> <o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-family:"Arial","sans-serif"'>Fellow Pharma folks,</span><o:p></o:p></p><div><div><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-family:"Arial","sans-serif"'> </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-family:"Arial","sans-serif"'>Sorry for getting off the take-back programs for just a minute.</span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-family:"Arial","sans-serif"'> </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-family:"Arial","sans-serif"'>Maybe most of you have already seen this, but Dr. Christian Daughton recently authored this <u><span style='color:#262626'>Eco-directed sustainable prescribing: feasibility for reducing water contamination by drugs</span></u><span style='color:#1F497D'> @ </span><a href="http://dx.doi.org/10.1016/j.scitotenv.2014.06.013" target="_blank"><span style='color:#0563C1'>http://dx.doi.org/10.1016/j.scitotenv.2014.06.013</span></a> . Its abstract itself may take a few readings to understand (at least it did for me), but I believe the underlying concept of the manuscript is P2’s source reduction.</span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-family:"Arial","sans-serif"'> </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-family:"Arial","sans-serif"'>I only briefly scanned several pages of its content and is way above this mechanical engineer’s head. For those of you familiar with pharmacokinetics, you may be able to glean some important themes in the Dr’s contentions. </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-family:"Arial","sans-serif"'> </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-family:"Arial","sans-serif"'>Add another acronym to your vocabulary if you haven’t already because Biopharmaceutics Drug Disposition Classification System (BDDCS) runs throughout its core.</span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-family:"Arial","sans-serif"'> </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-family:"Arial","sans-serif"'>I would expect a brief synopsis from our dear friend, Dr. Charlotte Smith in a few weeks.</span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-family:"Arial","sans-serif"'> </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-family:"Arial","sans-serif"'>My original e-mail’s intent to several experts on this issue was mainly to discover which analytical methods could be used to measure low level APIs (which method measure what APIs or their metabolites?); therefore, helping to determine if their presence could potentially be the toxicant(s) in cities’ WET sublethality failures (growth and reproductivity). </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-family:"Arial","sans-serif"'> </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-family:"Arial","sans-serif"'>Dr. Susan Glassmeyer, e-cc’d above was suggested as a good source by Dr. Daughton. Dr. Glassmeyer? Would you please respond in some manner? I’d love for more cities to get involved with their own w.w. treatment plant’s effluent quality. Heretofore, most cities in the US are not sampling/analyzing for APIs or their metabolites. At least I have seen very few reports about them except through the USGS.</span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-family:"Arial","sans-serif"'> </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-family:"Arial","sans-serif"'>Ciao, </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-family:"Arial","sans-serif"'> </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-family:"Arial","sans-serif"'>Allen Gilliam</span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-family:"Arial","sans-serif"'>ADEQ State Pretreatment Coordinator</span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-family:"Arial","sans-serif"'><a href="tel:501.682.0625" target="_blank">501.682.0625</a></span><o:p></o:p></p></div></div></div></div><p class=MsoNormal style='margin-bottom:12.0pt'><br>---<br>Note: As a courtesy to other listserv subscribers, please post messages to the listserv in plain text format to avoid the garbling of messages received by digest recipients.<br>---<br>TO SUBSCRIBE, go to: <a href="http://lists.dep.state.fl.us/cgi-bin/mailman/listinfo/pharmwaste" target="_blank">http://lists.dep.state.fl.us/cgi-bin/mailman/listinfo/pharmwaste</a><br>TO UNSUBSCRIBE, DO NOT REPLY TO THE LISTSERV. Please send an e-mail to <a href="mailto:pharmwaste-unsubscribe@lists.dep.state.fl.us">pharmwaste-unsubscribe@lists.dep.state.fl.us</a> -- the subject line and body of the e-mail should be blank.<br>If you believe you may be subscribed with a different email address, please visit the subscriber listing at <a href="http://lists.dep.state.fl.us/cgi-bin/mailman/roster/pharmwaste" target="_blank">http://lists.dep.state.fl.us/cgi-bin/mailman/roster/pharmwaste</a><br>FOR PROBLEMS: Contact List Administrator <a href="mailto:Laurie.Tenace@dep.state.fl.us">Laurie.Tenace@dep.state.fl.us</a><br>SEND MAIL to the list server at: <a href="mailto:pharmwaste@lists.dep.state.fl.us">pharmwaste@lists.dep.state.fl.us</a><o:p></o:p></p></div><p class=MsoNormal><o:p> </o:p></p></div></div></body></html>