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“Not only is there the danger of antibiotic-resistant bacteria evolving; the entire biological food web could be affected,” said Stan Cox, senior scientist at the Land Institute, a nonprofit agriculture research center in Salina, Kan. Cox has studied and written about pharmaceutical pollution in Patancheru. “If Cipro is so widespread, it is likely that other drugs are out in the environment and getting into people’s bodies.”

Before Larsson’s team tested the water at Patancheru Enviro Tech Ltd. plant, researchers largely attributed the source of drugs in water to their use, rather than their manufacture.

In the U.S., the EPA says there are “well defined and controlled” limits to the amount of pharmaceutical waste emitted by drug makers.

India’s environmental protections are being met at Patancheru, says Rajeshwar Tiwari, who heads the area’s pollution control board. And while he says regulations have tightened since Larsson’s initial research, screening for pharmaceutical residue at the end of the treatment process is not required. But even in the U.S., drug makers are only required to test their wastewater for three specific pharmaceutical compounds, not the myriad discovered in domestic drinking water.

Possibly complicating the situation, Larsson’s team also found high drug concentration levels in lakes upstream from the treatment plant, indicating potential illegal dumping an issue both Indian pollution officials and the drug industry acknowledge has been a past problem, but one they say is practiced much less now.

In addition, before Larsson’s study detected such large concentrations of ciprofloxacin and other drugs in the treated wastewater, levels of pharmaceuticals detected in the environment and drinking water worldwide were minute, well below a human dose.

“I’ll tell you, I’ve never seen concentrations this high before. And they definitely … are having some biological impact, at least in the effluent,” said Dan Schlenk, an ecotoxicologist from the University of California, Riverside, who was not involved in the India research.

And even though the levels recently found in Indian village wells were much lower than the wastewater readings, someone drinking regularly from the worst-affected reservoirs would receive more than two full doses of an antihistamine in a year.

“Who has a responsibility for a polluted environment when the Third World produces drugs for our well being?” Larsson asked scientists at a recent environmental research conference.

M. Narayana Reddy, president of India’s Bulk Drug Manufacturers Association, disputes Larsson’s initial results: “I have challenged it,” he said. “It is the wrong information provided by some research person.”

Reddy acknowledged the region is polluted, but said that the contamination came from untreated human excrement and past industry abuses. He and pollution control officials also say villagers are supposed to drink clean water piped in from the city or hauled in by tankers water a court ordered industry to provide. But locals complain of insufficient supplies and some say they are forced to use wells.

Larsson’s research has created a stir among environmental experts, and his findings are widely accepted in the scientific community.

“That’s really quite an incredible and disturbing level,” said Renee Sharp, senior analyst at the Washington-based Environmental Working Group. “It’s absolutely the last thing you would ever want to see when you’re talking about the rise of antibiotic bacterial resistance in the world.”

The more bacteria is exposed to a drug, the more likely that bacteria will mutate in a way that renders the drug ineffective. Such resistant bacteria can then possibly infect others who spread the bugs as they travel. Ciprofloxacin was once considered a powerful antibiotic of last resort, used to treat especially tenacious infections. But in recent years many bacteria have developed resistance to the drug, leaving it significantly less effective.

“We are using these drugs, and the disease is not being cured there is resistance going on there,” said Dr. A. Kishan Rao, a medical doctor and environmental activist who has treated people for more than 30 years near the drug factories. He says he worries most about the long-term effects on his patients potentially being exposed to constant low levels of drugs. And then there’s the variety, the mixture of drugs that aren’t supposed to interact. No one knows what effects that could cause.

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