Hailey Romano

Article Annotations

Article 1; Pharmaceutical Pollution from Human Use and the Polluter Pays
Principle

Malmqvist, E., Fumagalli, D., Munthe, C., & Larsson, D. G. J. (2023). Pharmaceutical Pollution from
Human Use and the Polluter Pays Principle. Public health ethics, 16(2), 152–164. https://
doi.org/10.1093/phe/phad012

● What is the main purpose of this article, from the authors’ perspective?

The main purpose of this scientific article is to analyze the relationship between
pharmaceutical consumption, wastewater contamination and the legislative aspect.
Using a variety of sources and quotes from the Water Framework Directive, Waste
Framework Directive, Extended Producer Responsibility Principle along with direct
quotes from Polluter Pays Principle and Ability to Pay Principle to prove ideas. The
author compares Polluters Pays Principle (PPP) and Ability to Pay Principle (APP)
which are both organizations in the EU that hold those who produce pollution
accountable (PPP) and compares income to tax (APP). This article analyzes the
limitations and benefits of each organization. And concludes that PPP has a good
framework, and that its policy may need to be amended in other ways such as
improving wastewater treatment and distributing costs between water consumers or
taxpayers. .

● What were the key findings of the paper or the main arguments the authors
make?

The author's main argument was that pharmaceutical pollution is caused by the
inappropriate disposal of unused drugs, excessive human-use, and medically
inappropriate use. The authors also argue that PPP should target original waste
producers or current/ previous waste holders. The Polluter Pays Principle Organization
needs more pressure on polluters as they hold responsibility but don’t make a great
enough change to address it. Some solutions mentioned are the reduction of medicines,
higher costs, addressing pollution from both manufacturing and use of pharmaceuticals,
investments in APIs, and substitution of active ingredients associated with
environmental risk. There are limitations with this because it's difficult to determine
who's actually responsible, the process of drug approval is difficult (and it's a long one),
there may be side effects from the substitution of harmful ingredients, no green
alternatives even exist yet.
 ● What shortcomings do you notice in the methods or the main argument? What
limitations do the authors identify?

The mention of APP made me confused about their overall argument as they’re
comparing PPP to another organization. They identify the setbacks with making
pharmaceutical pollution less prevalent. With every solution there is always a drawback
and the author includes this.

● In what ways does this article help you address your researchable question?

This article shows me the policy aspects towards making pharmaceutical pollution less
of an issue. Usually I like to focus on the environmental and science aspect of things but
this shows me the governmental side of this environmental issue.

Article 2; Pharmaceutical Pollution of the World’s Rivers

Wilkinson, J., & Boxall, A. (2022). Pharmaceutical pollution of the world’s rivers. Web of
science. https://www.webofscience.com/wos/woscc/full record/WOS:000766924200012

● What is the main purpose of this article, from the authors’ perspective?

This article wanted to prove that pharmaceutical ingredients are emitted into the
natural environment via manufacture, use, and disposal. This causes negative
effects on the environment such as antibiotic resistant bacteria, feminizing fish
and increasing the susceptibility of fish predation. This author uses data and
actual research to prove the idea of this. Collecting water samples from 1,052
sample sites all over the world along 258 rivers and testing over 61 APIs. This
was more of a quantitative research article which is something I needed to further
strengthen my idea that wastewater management has a direct impact on
pharmaceutical pollution.

● What were the key findings of the paper or the main arguments the authors
make?

High concentrations of APIs were associated with untreated sewage discharge and
disposal of rubbish along the banks of rivers. Another trend that the research found was
that a lot of the contaminated samples were obtained from areas of low-middle income
countries with little to no monitoring of APIs in the aquatic environment. Observations
also found that the highest API concentrations were found at sites with sampling sites
receiving inputs from pharmaceutical manufacturing, sites receiving discharge of
untreated sewage, locations in arid climates and sites receiving sewage exhaust truck
emissions and waste dumping. Having a minimal use of modern medicines, limited
anthropogenic influence and sophisticated wastewater treatment infrastructure also
impacted concentrations. Affordability and accessibility of medicines also had an impact
on concentration, which makes sense considering low income areas didn’t have as high
of an API concentration compared to low-middle income countries.

- In Europe there is technology that does ecotoxicological testing that is required

for marketing - tests the growth of green algae, cyanobacteria and the growth
and reproduction of invertebrates and fish on the effect of APIs.
- high concentrations of APIs found were associated with untreated sewage discharge and
disposal of rubbish along the banks of rivers
- Highest API concentrations were found at sites with sampling sites receiving inputs from
pharmaceutical manufacturing, sites receiving discharge of untreated sewage, locations in arid
climates and sites receiving sewage exhaust truck emissions and waste dumping.
- Affordability and Accessibility of medicines also has an impact on API concentrations
● What shortcomings do you notice in the methods or the main argument? What
limitations do the authors identify?

I also wanted to see data on how the different APIs negatively affect each area. Water
quality was tested but how this impacts the environment around the site or any sort of
observations weren’t recorded which is something that I’m curious about. The author
didn’t exactly include any limitations but they do include what affects the different API
levels such as income. Mainly low-middle income areas experienced the highest levels
of APIs.

● In what ways does this article help you address your researchable question?

This article includes actual data and numbers that shows there is a direct relationship
between income and pharmaceutical usage. Including data from all over the country
and all over the world, with or without the use of modern medicines and of populations
of all kinds of densities. This article had an extremely widespread area of site testing
which will greatly support my idea that wastewater management and pharmaceutical
pollution go hand-in-hand with each other.

Article 3; Comparing Environmental Policies to Reduce Pharmaceutical Pollution

and Address Disparities

Desai, M., Njoku, A., & Nimo Sefah, L. (2022). Comparing Environmental Policies to Reduce
Pharmaceutical Pollution and Address Disparities. International journal of environmental research and
public health, 19(14), 8292. https://doi.org/10.3390/
Ijerph19148292

● What is the main purpose of this article, from the authors’ perspective?

This article compares pharmaceutical pollution in Canada, the United States and
European Union along with using other countries to compare studies. Different
solutions, limitations and current policies are mentioned from each region and Ideas are
contrasted, making arguments towards what should be considered for the future. This
article focuses more on the waste disposal aspect of pharmaceutical pollution.

● What were the key findings of the paper or the main arguments the authors
make?

The inappropriate disposal of pharmaceuticals has posed a large issue towards

pharmaceutical pollution but little is known on proper disposal. With time,
pharmaceutical pollution has caused “renal failure in vultures, impairment of
reproduction in fish or inhibition of certain aquatic species.” Along with the development
of antimicrobial resistance. Some countries use incinerators to manage medical waste,
however, this produces even more uncontrollable emissions - they are known to pollute
the air, soil and surface water. There are several solutions currently in place such as
Guidance #213, a policy finalized by the FDA that limits antibiotics for veterinary use.
The Canadian government has also created a framework to limit antimicrobial
resistance. Some solutions mentioned in the article are upgrading wastewater
management systems or drug-take back programs, “green chemistry” to educate and
train healthcare personnel, a set of legislative guidelines to limit PPCP waste, making
ERA data publicly available, and regulating manufacturing to reduce waste at the point
of production.

● What shortcomings do you notice in the methods or the main argument? What
limitations do the authors identify?

I’m having trouble identifying any shortcomings, I like that the author includes
limitations, future solutions and current policies that are implemented in several global
locations. Not only does the author mention pollution based on pharmaceuticals but also
of the waste of packaging it comes in. The author mentions a limitation of uneven
enforcement, regulation and monitoring environmental risk, pharmaceutical
manufacturers not prioritizing ERAs in their market authorization applications,
healthcare domains focusing on infection prevention or cost reductions rather than
environmental pollution, no publicly available record of ERAs causing manufacturers,
regulators and healthcare with no clear awareness of data collected in order to reduce
pharmaceutical pollution.

● In what ways does this article help you address your researchable question?

This article addresses my research question because it reviews different policies on a

global level that relate to pharmaceutical pollution. Not only this but it also reviews
solutions and limitations on multiple aspects.

Article 4; Pharmaceuticals in the Environment; Scientific Evidence of Risks and

its Regulation

Küster, A., & Adler, N. (2014). Pharmaceuticals in the environment: scientific evidence of risks and
its regulation. Philosophical Transactions: Biological Sciences, 369(1656), 1–8.
http://www.jstor.org/stable/ 24501918

● What is the main purpose of this article, from the authors’ perspective?

The main purpose of this article is the idea to improve the ERA framework. The ERA
means Environmental Risk Assessment which touches on risk associated with the
environment. The author argues that the framework could be improved by including the
environment in risk-benefit analysis for human pharmaceuticals, improving risk
management options, generating data on existing pharmaceuticals and improving
accessibility of ERA data. New legislation needs to be put in place, pharmaceuticals
need to be more environmentally friendly and the availability of pharmaceutical data
must also be improved.

● What were the key findings of the paper or the main arguments the authors
make?

Based on current data (not on past drugs or unpublized data) there are known side
effects to non-target organisms, for example impaired reproduction, changed behavior,
effects on hormones, inhibiting serotonin uptake, change in growth and feeding
behavior, and affecting endocrine function. This data was found within fish, crustacean
and mollusc species. Due to the lack of data for pharmaceutical products that entered
the market before guidelines came into force, it makes it difficult for any reliable
environmental changes to be made. Another issue is that the ERA databases aren’t
published so no one but EU agencies has access to the ERA data, this means that
environmental risk may be misleading and contradict ERA results.
 ● What shortcomings do you notice in the methods or the main argument? What
limitations do the authors identify?

I’m having a difficult time identifying any shortcomings in this article. The author
mentions that although new pharmaceuticals can be added to market, old
pharmaceuticals aren’t environmentally considered in databases making it difficult to
change any negative environmental effects. Another limitation is that it is difficult to
target a single product's effect on the environment (it's difficult to detect). This makes
the product overlooked.

● In what ways does this article help you address your researchable question?

This article addresses my research question because it mentions more of the

environmental aspect of things. Including why not enough change is made regarding
pharmaceutical pollution and what negative effects pharmaceuticals have on aquatic
populations. Includes plenty of information on policy and what they hold for the future in
the manufacture, recycling and marketing processes.

Article 5; Antidepressants Make for Sad Fish

Raloff, J. (2019, August 8). Antidepressants make for sad fish. Science News. https://
www.sciencenews.org/article/ antidepressants-make-sad-fish

● What is the main purpose of this article, from the authors’ perspective?

This article uses an array of studies to prove that pharmaceuticals have a negative
effect on fish populations. From infertility, stunted appetite, avoidance of predators and
even overall movement under high doses. This author uses articles from research
performed in Japan, South Carolina and Minnesota. This is a very aware issue but
researchers wanted to see the effects of pharmaceuticals on fish with both low and high
doses applied.

● What were the key findings of the paper or the main arguments the authors
make?

The author makes the point that pharmaceuticals don't only change the behavioral
effect of fish but also the physical effect of fish. Making males less attractive towards
females, decreasing reproductive success. Specifically this was shown in minnows.
When fluoxetine was applied to a minnow population, facial bumps and coloration that
attracts females diminished. Most of the contamination to blame falls on patients
inappropriately discarding unused pills and waters located near wastewater treatment
sites. Wastewater treatment plants aren’t designed to remove pharmaceuticals, leaving
drug residues behind.

● What shortcomings do you notice in the methods or the main argument? What
limitations do the authors identify?

Some shortcomings of the article is that the author doesn’t include many limitations or
reasons as to why change isn’t being made and shows more of the effect side of the
pollution. The only thing the author mentions as a setback is that wastewater treatment
sites don’t have the right technology to remove these pharmaceuticals making this issue
even larger.

● In what ways does this article help you address your researchable question?

This article, unlike most I’ve found, purely shows the side of pharmaceutical pollution.
This is great because it backs up the idea that pharmaceuticals are extremely negative
and it continues to prove this through several studies that have been performed in
different locations.

Article 6; A Review on Constructed Wetlands-based Removal of Pharmaceutical

Contaminants Derived From Non-point Source Pollution

Ravikumar, Y., Yun, J., Zhang, G., Zabed, H., & Qi, X. (2022, March 28). A review on
constructed wetlands-based removal of pharmaceutical contaminants derived from
non-point source pollution. Environmental Technology & Innovation. https://
www.sciencedirect.com/science/article/pii/S2352186422001201

● What is the main purpose of this article, from the authors’ perspective?

This article mentions the issue of pharmaceutical compounds such as analgesics,

antibiotics, and hormones being present in soil and water resources. The author
mentions several solutions to pharmaceutical pollution such as plant presence in
constructed wetlands, phytoremediation and the use of different substrates in CS. All of
these solutions are affected by temperature, pH, oxygen, redox potential, climatic
conditions.

● What were the key findings of the paper or the main arguments the authors
make?

This article mainly mentioned ideas on NPS pollution that has led to the
excessive supply of inorganic compounds such as phosphorus, nitrogen, and
metals along with organic compounds such as pharmaceutical compounds and
pesticides. These pollutants damage food chains and food webs, cause male fish
to be feminized, impairment of fish gills, liver and renal organs and causes a
drastic reaction to planktonic communities. The main source of PCs flowing into
water systems is wastewater treatment effluent discharge, domestic and animal
wastes, hospital wastes, landfill leachate, and industrial wastes. The article also
explores possible solutions to be implemented into constructed wetlands or that
can be used in current filtering. Some examples are biological or chemical
treatments such as ultraviolet irradiation, ozonation, nanomaterials, ultrafiltration
and membrane biological reactors. This article focused more deeply on
phytoremediation, using plant roots and tissues to absorb PCs, plant-microbial
relationships, and the use of different soils and substrates within CWs. Each of
these solutions are influenced by pH and temperature as it affects the absorption
and metabolism of the effectiveness of removing PCs.

● What shortcomings do you notice in the methods or the main argument? What
limitations do the authors identify?

I didn’t notice many shortcomings with the methods in this argument. I actually liked the
approach this author had. Some limitations that the author identified were the cost
factor. To be more specific, the cost factor of absorbents is a costly deal. Activated
carbon is extremely expensive but it also happens to be reusable and effective.

● In what ways does this article help you address your researchable question?

This article helps address my research question because it includes environmentally

friendly ways to tackle pharmaceutical pollution. Using constructed wetlands and
making them more efficient for pharmaceutical absorption in several methods like using
plant tissues, phytoremediation… etc. Most of the other articles mention more of the
issues or policy aspects of the situation rather than finding effective environmentally
friendly solutions.