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“It’s a global concern,” he said. “European countries and the U.S. are protecting their environment and importing the drugs at the cost of the people in developing countries.”

While the human risks are disconcerting, Sharp said the environmental damage is potentially even worse.

“People might say, ‘Oh sure, that’s just a dirty river in India,’ but we live on a small planet, everything is connected. The water in a river in India could be the rain coming down in your town in a few weeks,” she said.

Patancheru became a hub for largely unregulated chemical and drug factories in the 1980s, creating what one local newspaper has termed an “ecological sacrifice zone” with its waste. Since then, India has become one of the world’s leading exporters of pharmaceuticals, and the U.S. which spent $1.4 billion on Indian-made drugs in 2007 is its largest customer.

A spokesman for the Pharmaceutical Research and Manufacturers of America, representing major U.S. drugmakers, said they could not comment about the Indian pollution because the Patancheru plants are making generic drugs and their members are branded. A spokesman for the Generic Pharmaceutical Association said the issues of Indian factory pollution are “not within the scope of the activities” of their group.

Drug factories in the U.S. and Europe have strictly enforced waste treatment processes. At the Patancheru water treatment plant, the process is outdated, with wastewater from the 90 bulk drug makers trucked to the plant and poured into a cistern. Solids are filtered out, then raw sewage is added to biologically break down the chemicals. The wastewater, which has been clarified but is still contaminated, is dumped into the Isakavagu stream that runs into the Nakkavagu and Manjira, and eventually into the Godawari River.

In India, villagers near this treatment plant have a long history of fighting pollution from various industries and allege their air, water and crops have been poisoned for decades by factories making everything from tires to paints and textiles. Some lakes brim with filmy, acrid water that burns the nostrils when inhaled and causes the eyes to tear.

“I’m frustrated. We have told them so many times about this problem, but nobody does anything,” said Syed Bashir Ahmed, 80, casting a makeshift fishing pole while crouched in tall grass along the river bank near the bulk drug factories. “The poor are helpless. What can we do?”

AP National Writer Martha Mendoza contributed to this report from California.