Monday, September 22, 2008

Meds Vs. Therapy: Drinking Water Safety

AP news story from September 11, 2008:
"46 million in U.S. have drugs in drinking water.”
“Testing shows traces of meds in water greater than previously reported."

Here is a link:
http://www.msnbc.msn.com/id/26662637/

If the link has expired, just enter the headline above to find the story.

Basically, we are filling prescriptions for medications to such an extent that these meds are showing up in drinking water supplies.

A quote:
"Many cities found the anti-convulsant carbamazepine. Officials in one of those communities, Colorado Springs, say they detected five pharmaceuticals in all, including a tranquilizer and a hormone."

Meds will end up in the water supply. There are legitimate situations for many meds. But also, we have gone greatly overboard with meds – taking meds for a great range of problems and situations where there are, simply put, better alternatives, and also, simply put, situations where the meds just don’t have the “benefits” to justify the “costs.” The degree that any unnecessary meds are contaminating our water is unknown, but – per this story and others – may be a serious problem. This contamination is yet another negative on the side of medications in the cases where therapy is a viable treatment. As I have said in at least one other posting, meds for psychiatric reasons are overprescribed. Meds are also overprescribed for other conditions, but I am just more expert in psychiatric treatment efficacy.

To the degree that carbamazapine, AKA CBZ, is being prescribed for seizures, then that is a clear situation of: meds wins. But CBZ is prescribed for psychiatric disorders as well. If prescribed appropriately, then meds wins again, and the challenge is just to figure out whether the CBZ in the water supply poses any threat to the rest of us, and how to deal with it. But to the extent the CBZ is inappropriately prescribed, that is a downside potentially affecting anyone drinking the water, thus a negative influence far beyond the usual circle of patient, physician, and payer.

Tranquilizers: generally, in my opinion, therapy almost always wins. Technically, the term “tranquilizer” almost always refers just to the “benzodiazepines,” such as Valium and Klonopin. In my opinion, therapy wins this one hands-down: the tranquilizers in any water supply are generally posing an unknown risk with benefits that can be conveyed by therapy. Tranquilizers may also include other “sedative / hypnotics” such as Benadryl and other antihistamines, as well as a range of other soporifics / somnalytics / whatever term-you-like-for-sleeping-pill. There are many.

Therapy wins for sleep, and therapy wins for antianxiety. So, all of those “tranquilizer” meds contaminating the water, at unknown risk, pose a largely avoidable risk.

“Hormone:” my guess is that this is related to birth control pills. The use of estrogen/progesterone type meds (“HRT”) for menopausal symptoms decreased greatly once everyone figured out that, in contrast to the belief that they had the side effect of protecting users from heart disease, they actually are associated with increased risk of heart disease. So, although HRT had been about the most widely prescribed and taken med for the span of several years, the past 6 years has seen that level of use decrease. [BTW: recent headline about menopausal symptoms where therapy beats meds:
"Yoga soothes worst symptoms of menopause"
http://www.msnbc.msn.com/id/26350420/]

So, my guess is that the “hormone” related to birth control pills (widely prescribed, but potentially may be greatly affected if I am correct in my suspicion that they generally cause blood clots despite various specific drugs and doses and dosing schedules).

This AP story also notes that traces of antidepressants can be detected in some water supplies. Again, in my opinion, a great deal of this is not beneficial, so the unknown risk posed is generally unnecessary.

What to do?
Well, obviously, the threats to health needs to be determined. This includes determining the level at which some med in the water can cause problems. This is obvious, but vey challenging to figure out scientifically.

Also, water authorities need to figure out what might be in the water, and test for these. Unlike other water contaminants, this may not be a “local” challenge:

Finally, maybe we just need to start ending our dependence upon meds, like we are talking about ending our dependence on foreign oil. Like the foreign-oil issue, there are just too many workable alternatives.

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