[HN Gopher] Leaky sewers are likely responsible for large amount...
       ___________________________________________________________________
        
       Leaky sewers are likely responsible for large amounts of
       medications in streams
        
       Author : hhs
       Score  : 136 points
       Date   : 2021-08-18 14:43 UTC (8 hours ago)
        
 (HTM) web link (www.acs.org)
 (TXT) w3m dump (www.acs.org)
        
       | post_break wrote:
       | Shouldn't we be placing the blame on people flushing meds down
       | the toilet? Or are they leeching from peoples urine and waste?
        
         | [deleted]
        
         | sandworm101 wrote:
         | It is in the urine. Drug companies have long resisted any
         | investigation of the impact of their drugs once they have
         | exited the first patient. The necessary implication would be
         | that waste from patients on certain drugs should be treated as
         | hazardous, or even radioactive. That's Pandora's box.
         | 
         | A parallel question is whether the body of a deceased patient
         | should be treated as hazardous. We do tend to bury or cremate
         | them without a thought towards whether these drugs will survive
         | and impact the local environment.
        
           | gambiting wrote:
           | >> The necessary implication would be that waste from
           | patients on certain drugs should be treated as hazardous, or
           | even radioactive. That's pandora's box.
           | 
           | So here's the bit that I don't get. When my friend had to get
           | her cat a medical scan, the cat had to have radiactive
           | contrast ingested/injected. She was then told to carefully,
           | without touching it, collect all poop made by the cat in the
           | next 7 days, put it in this special container, then bring it
           | back to the vet for safe disposal.
           | 
           | However, when humans have the same procedure done....no one
           | cares? You drink radioactive contrast, then pee and poop as
           | normal, it all goes down our drains. How does that make any
           | sense?
        
             | fridif wrote:
             | If it's safe, then this is just a revenue scam for the
             | doctor/insurance companies.
             | 
             | If it's actually not safe, then they are irradiating humans
             | for fun.
        
               | unpolloloco wrote:
               | Why not both? It's not safe, but it's better than other
               | options! Why I don't get is why the cat owner can't just
               | flush the irradiated poop? Maybe litter in the pipes
               | isn't good?
        
               | fridif wrote:
               | Why would you flush what rightfully belongs in the
               | ground?
        
             | ceejayoz wrote:
             | Human waste gets heavily diluted, essentially immediately,
             | and even more so once it leaves the waste treatment plant
             | for the local river, lake, or ocean.
             | 
             | Cat shit stays intact when it goes to a landfill, and thus
             | would cause a potential hot spot that humans would not.
        
               | function_seven wrote:
               | That makes sense, but then why not then advise the pet
               | owner to flush the cat's poop down the toilet? Seems
               | simpler than having a special container and a return trip
               | to the vet.
        
               | spookthesunset wrote:
               | When our cat had a similar procedure, they advised that
               | it was okay to flush the cat poop (assuming you could
               | separate it from the litter).
               | 
               | I did think it seemed kind of silly though. Like the
               | state is really gonna hunt down whoever threw away
               | radioactive cat poop.
               | 
               | The whole thing was more about 9/11 / terrorism than
               | environmental damage.
        
               | andai wrote:
               | Wait, are you saying it's possible to construct a nuclear
               | device out of cat poop?
        
               | ceejayoz wrote:
               | It's not just the poop, it can be the urine, too.
               | 
               | Cat litter + indoor plumbing = not a good time.
        
               | circularfoyers wrote:
               | OP said the vet said to return the poop, not the entire
               | contents of the kitty litter box.
        
               | gambiting wrote:
               | Hey, it's me - my friend specifically told me about
               | collecting poop from the litter box, not the whole thing.
               | But maybe she got it wrong, I'm not sure.
        
             | jdavis703 wrote:
             | It's the same reason radiology technicians leave the room
             | before imaging a patient. You want to reduce exposure to
             | unnecessary radiation.
        
             | mh- wrote:
             | Humans don't poop in a box and have someone else handle it?
             | Or at least their caregivers assume they don't.
        
               | MichaelGroves wrote:
               | > Humans don't poop in a box and have someone else handle
               | it?
               | 
               | Well.. not usually. https://en.wikipedia.org/wiki/Bedpan
        
               | sandworm101 wrote:
               | Correct. We poop into a pipe that takes it to a
               | wastewater treatment facility where government employees
               | handle it.
        
               | toomuchtodo wrote:
               | Do wastewater plants use Geiger counters/data loggers on
               | waste streams?
        
               | nick__m wrote:
               | I don't think that there is a need for monitoring since
               | radiotracer usually have a short halflife, they usually
               | use fluoride-18 (half life 110min) to replace a -OH or a
               | well placed -H in a molecule that bind to the site of
               | interest (ex: glucose -> fluorodeoxyglucose, levodopa ->
               | fluorodopa).
        
           | thaumasiotes wrote:
           | > Drug companies have long resisted any investigation of the
           | impact of their drugs once they have exited the first
           | patient.
           | 
           | Not even drugs necessarily. The theory is out there that a
           | hidden but significant influence on society is large-scale
           | male consumption of estrogen via contamination from women's
           | urine.
        
             | ceejayoz wrote:
             | It's not a theory, it's a _debunked_ hypothesis. https://ww
             | w.sciencedaily.com/releases/2010/12/101208125813.h...
        
               | andai wrote:
               | > Contrary to popular belief, birth control pills account
               | for less than 1 percent of the estrogens found in the
               | nation's drinking water supplies
               | 
               | > Some research cited in the report suggests that animal
               | manure accounts for 90 percent of estrogens in the
               | environment. Other research estimates that if just 1
               | percent of the estrogens in livestock waste reached
               | waterways, it would comprise 15 percent of the estrogens
               | in the world's water supply.
        
               | tristor wrote:
               | It appears that article say the source being urine waste
               | of women taking birth control pills is debunked, it says
               | nothing about the long-term health impacts of drinking
               | water being contaminated with estrogen or what the
               | sources of the other 99% of estrogens found in drinking
               | water are. So while the causal link may be false, the
               | underlying claim is still a concern.
               | 
               | It's actually a massive problem in the West, especially
               | the US, that the average person is exposed to tons of
               | endocrine disruptors in the food and water supply,
               | everything from estrogens in the water to plasticizers in
               | your food wrappings on your take out or in the store.
        
           | triceratops wrote:
           | > The necessary implication would be that waste from patients
           | on certain drugs should be treated as hazardous, or even
           | radioactive.
           | 
           | I thought that was common for patients on chemotherapy drugs?
           | I remember seeing some sign in a hospital room's bathroom
           | about it, but the details escape me.
        
             | freeone3000 wrote:
             | Yes, but, this is sort of "priced in" so although your
             | waste is measurably radioactive it enters the same stream.
        
           | treeman79 wrote:
           | Get sick. Get put on a crap ton of medications. You found out
           | that most have all sorts of crazy effects on the body. Ones
           | not listed as side effects, or very rare, or even common but
           | doctor has never heard of. Or your fun ones where 2 conflict
           | in crazy ways.
           | 
           | Poor fish downstream don't stand a chance.
        
           | stainforth wrote:
           | What does a libertarian have to say about market players
           | preventing normal functioning of the market by restricting
           | knowledge like actively resisting studies on products?
        
             | fuzzer37 wrote:
             | Don't like it? Move where there isn't radioactive water. /s
        
         | flatline wrote:
         | A bigger question in my mind is whether this is a real problem,
         | or ever could be with higher concentrations likely to occur in
         | this way. Certainly not having medications in the tap water
         | seems safer than having any, but what amount of what specific
         | chemicals is likely to have a downstream effect? This poses a
         | much broader question about low dosage toxicity for any number
         | of chemicals in fresh water, ranging from agricultural run-off
         | to industrial waste and spillage. Hard to study.
        
           | sandworm101 wrote:
           | >> Certainly not having medications in the tap water seems
           | safer
           | 
           | Except for fluoride and chlorine. Small amounts of those
           | chemicals in water are a net health benefit. Society has to
           | be careful about adding anything, but 100% pure water isn't
           | the healthiest choice no matter what the commercials say.
           | 
           | Also iodine in salt.
        
             | giantg2 wrote:
             | It's possible water without chlorine is beneficial too.
             | Doesn't Paris use ozone and/or UVC instead?
             | 
             | I also wonder about fluoride's benefits if we use
             | toothpaste and mouthwash that has it. For example, I know
             | people on well water or city water without it that don't
             | have teeth issues.
        
               | sandworm101 wrote:
               | Paris still uses chlorine. It may also use UV but nothing
               | kills bacteria as effectively and constantly as bleach.
               | In a large population with lots of ancient pipes not
               | using chlorine would be very dangerous.
        
               | giantg2 wrote:
               | I wonder where I heard that, or if it's a different city.
               | 
               | Also, they are generally using chloramine, not sodium
               | hypochlorite.
        
             | MichaelGroves wrote:
             | I don't think chlorine in water is considered a medication.
             | Chlorine in water is added with the intention of
             | disinfecting the water, for human health reasons, but that
             | disinfection happens before the water is consumed. The
             | chlorine is treating the water, not the humans who drink
             | the water.
        
               | loa_in_ wrote:
               | Natural flowing water (in streams, rivers) contains ions
               | of calcium, magnesium, sulfur, sodium, chlorine,
               | potassium and fluor, with chlorine content around 10mg/l.
               | Tap water without chlorine treatment would be devoid of
               | most of those and that could be argued unhealthy.
               | 
               | That is - assuming the natural levels are healthy for us.
        
         | rootusrootus wrote:
         | Even if that was true, why should we shift the blame away from
         | an entity with plausible ability to solve it, and towards the
         | great mass of people who are impossible to hold accountable?
        
           | giantg2 wrote:
           | "entity with plausible ability to solve it"
           | 
           | I didn't see a mention of an overall solution in the article.
           | I see they mention that leaky pipes could be the cause for
           | that stream. Is there evidence to suggest that the sewage
           | treatment facility actually removes these chemicals?
        
             | rootusrootus wrote:
             | A quick google search suggests that a typical basic sewage
             | treatment plant doesn't do a great job of removing
             | pharmaceuticals. But we already do have some plants which
             | are pretty good at it. So this isn't even really an
             | engineering problem at this point, it's a
             | political(funding) problem.
        
           | post_break wrote:
           | So you're saying if it were coming from people throwing meds
           | down the toilet, we should blame the drug makers? Is that
           | what you're saying or am I misunderstanding?
        
             | rootusrootus wrote:
             | > we should blame the drug makers?
             | 
             | No, of course not.
             | 
             | What I am saying is that our best shot at getting
             | pharmaceuticals out of fresh water is better sewer & water
             | treatment. We can control that. It is implausible to
             | control people who are, within the privacy of their
             | bathroom, chucking random things down the toilet. The only
             | thing that would stop that behavior is immediate
             | consequences to them personally.
             | 
             | Edit: And this assumes it is all people chucking drugs down
             | the toilet. If it's coming through their urine, then we're
             | definitely back to water treatment being the only plausible
             | answer.
        
         | ceilingcorner wrote:
         | "You killed him."
         | 
         | "No, I shot him. The bullets and the fall killed him."
         | 
         | - Collateral (2004 film)
        
         | moate wrote:
         | Part of the idea of wastewater treatment plants is to address
         | things like chemicals in wastewater. If the pipes on the way
         | leak the tainted water, it can't be treated. Of course there
         | are also "forever chemicals" that we can't neutralize, but we
         | have no hope of dealing with chemically tainted water that
         | never gets to the locations capable of addressing it.
        
           | treeman79 wrote:
           | So we should all pee in bottles and ship them to waste water
           | plant.
           | 
           | Perhaps we could build some sort of hyper loop to send them
           | in bulk to speed up the process.
           | 
           | Diagram of the idea, reversed https://xkcd.com/1599/
        
             | moate wrote:
             | No, we fix the leaky pipes.
             | 
             | Where did your conclusion come from? Why would adding extra
             | waste (the bottles) to the equation result in less
             | contamination? What about my statement made you think "this
             | man wants people to bottle their waste, rather than
             | maintaining/improving existing infrastructure that
             | addresses the issue"?
        
             | jdavis703 wrote:
             | No, we should pay the taxes or user fees needed to maintain
             | our infrastructure in a state of good repair.
        
               | h_anna_h wrote:
               | Sadly it's not the taxpayer that decides where the money
               | goes. Getting new military airplanes, putting them in
               | their own pockets, and bribing the media with it seems to
               | be preferable for politicians.
        
               | jdavis703 wrote:
               | The federal government doesn't maintain sewer lines
               | anywhere in the US except maybe on military bases and the
               | like. At least in California we have special tax
               | districts that are managed by a voter-elected board. The
               | voters literally get to decide on infrastructure
               | spending, at least in California.
        
         | JohnWhigham wrote:
         | Do you want to go and stage some awareness campaign to tell
         | people not to flush their meds and hope they don't, or would
         | you rather we be proactive about the reality we're in and do
         | something about it now?
        
           | giantg2 wrote:
           | I don't know anyone who flushes their meds. Is this really a
           | big issue? I thought it's mostly waste based sources.
        
           | post_break wrote:
           | I have seen many news reports of free medication drops offs
           | and asking people not to flush them. Does that answer your
           | condescending question?
        
       | darig wrote:
       | Doesn't everything in the sewer eventually end up back in some
       | body of water that feeds the streams anyways?
       | 
       | It's all pipes, Jerry.
        
       | shadowgovt wrote:
       | If that's the case, we should be seeing correlation: higher
       | amounts of medication in the waterways of older US cities, where
       | sewer and stormwater systems were built to an earlier idea of
       | best-practices.
       | 
       | This should be relatively straightforward to investigate.
        
         | moate wrote:
         | Sure, assuming anyone has a desire to pump money into a large
         | comparative study like this.
         | 
         | It's an extremely reasonable hypothesis but you also have other
         | factors to deal with (size of city resulting in more wear and
         | tear on infrastructure, other environmental factors that could
         | cause deterioration of pipes, water hard/softness, quality of
         | wastewater processing facilities). Age would likely be a major
         | factor but not the only factor.
        
       | aurizon wrote:
       | Most is kidney passthrough into pee. Second is combined sanitary
       | AND rain runoff sewers - which bypass treatment when there is
       | high rain. Third is treatment plant pass through - many drugs are
       | not eliminated in sewage plants (it varies a lot with the drug)
        
         | MichaelGroves wrote:
         | > _Second is combined sanitary AND rain runoff sewers - which
         | bypass treatment when there is high rain._
         | 
         | This is a very difficult problem. If the sanitary sewers aren't
         | in great condition, rising ground water levels can leak into
         | the sanitary sewers. Sewers that were initially well made might
         | be damaged over time by people digging, the ground shifting, or
         | tree roots pushing things around. One way or the other, when
         | high ground waters get into a sanitary sewer, you now have a
         | situation where those sewers are overflowing. And what can be
         | done with that overflow? Let it pool up in the streets? Sending
         | it down the storm drains is about the best you can do at that
         | point.
        
           | xenadu02 wrote:
           | I think the original comment is referencing cities that built
           | early sewer systems where they do not have separate sanitary
           | and stormwater lines. That is by far the more pressing
           | problem: street drains (and often house gutters) dump
           | directly into the same lines. These systems are usually in
           | big cities and were built before sewage treatment existed.
           | Building enough capacity to handle stormwater surges is often
           | not practical: what was relatively clean rainwater is now
           | contaminated with sewage.
        
           | kube-system wrote:
           | Combined sewers that are in perfect maintenance include
           | provisions to overflow by design.
        
             | MichaelGroves wrote:
             | I'm not talking about combined sewers. Systems in which the
             | sanitary sewer and the storm sewer are completely separate
             | can _become_ combined sewers when the sanitary sewer is
             | inundated with more infiltration /inflow than it can
             | handle. When this happens, the sanitary sewer overflows
             | into the street or people's homes. That sewage overflowing
             | into the street will then make its way into the storm
             | sewer.
             | 
             | There is no easy solution to this. Building the sanitary
             | sewers bigger is the obvious solution, except that costs
             | more money and a lot of places don't have much money to
             | spare (corruption, poverty, etc.) Furthermore, just how
             | over-designed does a sanitary sewer have to be? Climate
             | change makes this difficult to predict decades in advance.
             | 
             | BTW [intentionally] combined sewers are problematic even
             | when they're not overflowing. Diluting sewage with a bunch
             | of water increases the cost and decreases the efficacy of
             | treatment.
        
       | saalweachter wrote:
       | So if I'm reading the article correctly:
       | 
       | 1. It doesn't say anything about whether the medications _would
       | have been_ removed if they went through a wastewater treatment
       | facility.
       | 
       | 2. It's basically saying we accidentally performed a tracking
       | experiment by adding compounds that don't occur (in those levels)
       | naturally to wastewater, and then seeing where we could find
       | those chemicals unexpectedly -- it's like dumping fluorescent dye
       | down your drains to see if you can find it spotting in the yard,
       | but with pharmaceuticals.
        
         | nerpderp82 wrote:
         | Caffeine is often used as that free "marker chemical" for
         | tracing where sewage ends up.
         | 
         | https://www.semanticscholar.org/paper/Determination-of-caffe...
        
           | arsome wrote:
           | Acesulfame potassium (an artificial sweetener commonly known
           | as Ace-K) which passes through in urine has also been used to
           | determine the concentration of urine in pool water.
        
             | tdeck wrote:
             | In case you're from the U.S. and wondering why you've never
             | heard of this particular sweetener, I looked it up. It
             | appears to be one of the ingredients in Equal, along with
             | aspartame.
        
             | Scoundreller wrote:
             | Wouldn't that depend a lot on the consumption of the pool's
             | entrants?
        
               | Johnny555 wrote:
               | For a private pool with a few users, sure, one person
               | could skew the results with a diet coke big-gulp, but for
               | a busy public pool with thousands of users, then I'd
               | think that some assumptions about average intake would
               | give reasonable results.
        
               | after_care wrote:
               | It's assuming the average pool goer consumes an average
               | amount of artificial sweetener. Even further it's making
               | assumptions about the average person that pees in a pool.
        
               | Johnny555 wrote:
               | If you're only interested in measuring increase over
               | time, then the only assumption you need to make is that
               | average consumption of Ace-K remains constant over time.
               | And, I suppose that people that consume Ace-K pee in
               | pools at the same rate as other people. As someone who
               | doesn't pee in pools (but has peed in the ocean), I don't
               | know how valid that is.
        
       | dyeje wrote:
       | Sometimes I wonder if placing all this important infrastructure
       | under ground was a big mistake. Seems like issues like this and
       | the Flint water crisis would be alot easier to remediate if the
       | pipes were easily accessible.
        
         | alistairSH wrote:
         | Not apples-to-apples, but having living in places with above-
         | ground and below-ground power supply, I know which one I've
         | found more reliable.
         | 
         | Yes, maintenance gets more expensive, but that maintenance
         | should be far less frequent. And hopefully more predictable
         | (true maintenance vs emergency repair).
        
         | jdavis703 wrote:
         | I'm not sure above-ground pipes makes a lot of sense. Now every
         | building has to maintain a pump to get sewage high enough off
         | the ground that vehicles can pass under the pipes. And if those
         | pumps fail (e.g. power outage), all of a sudden everyone is
         | dealing with sewage backflow.
         | 
         | Something I'd like to see more of is utility tunnels where all
         | utilities are undergrounded in a single tunnel with with easy
         | access. Yes it's expensive, but could work out in the long run.
         | Just look at how much utility relocation can drive up the cost
         | for simple projects like BRT.
        
           | NoSorryCannot wrote:
           | You don't necessarily even have to tunnel, like one would do
           | with a borer. I think that would be cost-prohibitive.
           | 
           | Trench and cover, probably with streets.
           | 
           | But it would create a lot of extra void to maintain that
           | would need its own drainage, maintenance to keep it free of
           | debris and pests, inspections to make sure they don't
           | collapse, and security to keep people out. Feasibility is
           | probably commensurate with urban density.
        
             | bobthepanda wrote:
             | There's also the issue of where you would put all the
             | spoils from tunneling. Historically that was in the ocean
             | and rivers to make more land, but this is frowned upon for
             | a variety of reasons now, the least being that not all
             | types of soil work well as landfill.
        
           | saalweachter wrote:
           | Let's not forget that the standard place to put water and
           | sewage pipes is "below the frost line".
        
           | athenot wrote:
           | > Something I'd like to see more of is utility tunnels where
           | all utilities are undergrounded in a single tunnel with with
           | easy access.
           | 
           | You've just described the Paris sewer system, where the
           | sewage tunels also house fresh water, power, comms...
           | 
           | https://lh3.googleusercontent.com/proxy/wRHK1kkKpNBXt4WWuCQW.
           | ..
        
           | xwdv wrote:
           | How do pipes work when terrain isn't leveled but rather very
           | sloped?
        
             | PicassoCTs wrote:
             | Sewage pumps in the pipes and
             | https://de.wikipedia.org/wiki/Hebeanlage (sorry do not know
             | the english word for that) Synthetic fibres in tissues are
             | a huge issues for these pumps..
        
               | GravitasFailure wrote:
               | Lift station or pump station, I believe.
               | 
               | https://htt.io/resources/lift-station-basics/
        
           | clipradiowallet wrote:
           | > And if those pumps fail (e.g. power outage), all of a
           | sudden everyone is dealing with sewage backflow.
           | 
           | While disgusting...this would have the side effect of those
           | being repaired _very quickly_ I imagine.
        
             | jdavis703 wrote:
             | I suppose it depends on the state. If you're in Texas or
             | California good luck.
        
               | satellite2 wrote:
               | https://en.m.wikipedia.org/wiki/Hedonic_treadmill
        
         | Dma54rhs wrote:
         | Doesn't the Michigan area get cold during the winters? There
         | are many reasons why pipes are underground, even in hotter
         | climates freak weather incidents do happen.
        
         | yupper32 wrote:
         | Pros and cons.
         | 
         | I'd imagine a lot more problems would occur if pipes were
         | exposed to the elements, for example.
         | 
         | And of course, the issue of where to put the pipes when they're
         | above ground.
        
         | sandworm101 wrote:
         | >> if the pipes were easily accessible.
         | 
         | Also more accessible to damage from vandals and car crashes.
         | And they would freeze in winter. And they would expand/contract
         | with temperature changes, leading to increased cracking etc.
         | The only places that use above ground water/sewer pipes are
         | those with unsupportive soils such as permafrost or deep sand
         | that would cause breaks.
        
       | erwolf wrote:
       | I've looked at countless sewer inspection videos--those pipes can
       | be up to 80 years old and are often in pretty bad shape. Sewage
       | leaking into the groundwater is a major problem but is very hard
       | to detect and locate unfortunately.
       | 
       | Shameless plug: We're a startup building AI to detect leakages in
       | sewers and tell cities when to fix their underground pipes. If
       | you want to help us solve this problem and make cities more
       | sustainable, let me know at ew@hades.ai :)
        
         | Thorentis wrote:
         | On the surface, this looks like just another "We're using AI to
         | detect X" cash grab. Are you just using image recognition for a
         | novel application or what?
        
           | tdeck wrote:
           | That's kind of a harsh way to express curiously, but I was
           | also interested. If you go to https://www.hades.ai/, you can
           | see that they use image recognition on videos. I can imagine
           | why that might be an improvement over manually watching hours
           | of sewer videos looking for cracks.
        
       | zabzonk wrote:
       | > Shouldn't we be placing the blame on people flushing meds down
       | the toilet?
       | 
       | Obviously, people shouldn't do that. But some antibiotics go
       | through the body almost unchanged. When penicillin was first
       | developed they used to recycle the antibiotic from the patient's
       | urine over and over because they had so little of it.
        
         | idealstingray wrote:
         | > Obviously, people shouldn't do that.
         | 
         | I'm not sure this is obvious or even particularly well-
         | publicized.
         | 
         | The "official recommendation" in the U.S. for many meds is that
         | they be flushed down the toilet, especially
         | scheduled/controlled substances. The FDA maintains a "flush
         | list" [1] of medications that you are specifically instructed
         | to dispose of by flushing. However, even for medications not on
         | the official flush list, it's common to be informed by
         | reasonable authorities that you should dispose of them by
         | flushing -- e.g. I had to sign paperwork at my doctor's office
         | affirming that I'd responsibly dispose of my unused ADHD meds
         | by flushing them down the toilet before my dr would write the
         | prescription. This was seconded by the drug/alcohol training I
         | was given as a condition of attending college, which stated
         | that you should flush _all_ unused medication.
         | 
         | [1]: https://www.fda.gov/drugs/disposal-unused-medicines-what-
         | you...
        
         | gumby wrote:
         | Typically > 90% of any drug taken orally is immediately
         | discharged through the first pass metabolism (urine primarily,
         | and breath and feces).* The body is good at disposing of
         | substances it isn't looking for, especially when ingested.
         | There are a lot of scare stories about the result (male fish in
         | the Great Lakes with ovaries; therapeutic levels of
         | antidepressants in the Edinburgh water supply, etc) but this is
         | the first article _I 've_ seen that talks about the path.
         | 
         | Because of this so-called "first path" effect you end up taking
         | enough that hopefully _some_ (and enough)  "gets to the
         | required location" and not too much gets where it's not wanted
         | (most of what counts as "side effects"). The approval process
         | focuses on this and ignores anything excreted, which shouldn't
         | be surprising: with few exceptions the process is #1 safety and
         | #2 minimal clinically effective dosing.
         | 
         | * former pharmaceutical scientist; have designed protocols
         | approved by the FDA.
        
           | Scoundreller wrote:
           | Uhhh, isn't first pass metabolism a metabolic pathway, not an
           | excretion one? In other words, it's the liver taking a first
           | crack at breaking things down enzymatically at anything
           | absorbed before it gets distributed around to post-liver
           | bloodstream?
        
             | gumby wrote:
             | gut -> liver yes, but the relevant comment I was responding
             | to was about how much dosage does not provide therapy and
             | how it ends up in the water.
        
         | [deleted]
        
         | Scoundreller wrote:
         | And if you didn't pee it out, it wouldn't get to the right spot
         | to treat a urinary tract or kidney infection.
        
           | sandworm101 wrote:
           | If you didn't pee it out it would remain in your system
           | longer, limiting treatment options if it is in any way toxic.
           | Or, if you don't pee it out it might over time break down
           | into more toxic substances.
        
             | Scoundreller wrote:
             | Or break down into less toxic substances, or things that
             | are more likely to get excreted.
        
             | thaumasiotes wrote:
             | > if it is in any way toxic
             | 
             | That's its whole purpose. Just look at the name
             | "antibiotic"...
        
               | dgoldstein0 wrote:
               | Toxic to bacteria is different than toxic to humans cells
        
             | moralestapia wrote:
             | There's only one way out*, so you always pee it out
             | somehow.
             | 
             | * Ignoring minute traces of minerals that are lost through
             | transpiration
        
       | 988747 wrote:
       | Medications in streams are good right? At least fish will be
       | healthy. /s
        
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