In Our Control (46 page)

During the course of writing this book I attended a friend’s birthday party on a warm June night, one of the few in an otherwise wet, dismal summer. When a new acquaintance heard I was researching birth control, her eyes lit up. “Did you hear?” she asked me, excitement building in her voice. “They finally made a male pill. I heard it on the news yesterday!” I didn’t want to disappoint her, so I smiled and said, “Yeah—that’s great.”
I didn’t tell her that if you Google “male birth control” or “pill for men” you will get results boasting a breathless story from a major media outlet that has been claiming this same breakthrough for years. Sensing my hesitation, my new friend pressed the point: “I mean, don’t you think it will happen?”

“Yes,” I said, and I do. It will probably happen when we are least expecting it, when we have stopped looking for stories about it. And when it does, men will have to face the same problems and live with the same caveats that women have struggled with for decades. They will have to decide if the health risks are too great and if they are willing to live with annoying side effects. There will undoubtedly be preventable tragedies and even deaths. Men will have to read between the lines of studies that try to hide risks, and perhaps they will have to argue with doctors who insist that the ailments they complain about are all in their heads. I don’t wish these problems on the men in my life. But expanding birth control technologies creates more options for
all
of us and helps us to understand the responsibilities and dilemmas of pregnancy prevention in new ways.

Chapter Eleven
Going Green: The Environmental Burden of Contraception

It’s not so much we’ve got the answers … it’s that we’ve got some of the questions
.
—Patricia Colsher, West Virginia Cancer Registry

Most people who live in cities don’t like pigeons, but they are a fact of urban life, like paying too much money in rent and using public transportation. Still, as the city of St. Paul prepared to host the Republican National Convention in 2008, they wondered if perhaps there wasn’t an easy way to limit the bird population. Maybe the prolific pigeons simply needed to be put on the Pill.
¹
The summer before the convention, officials placed feeders around the city laced with OvoControl P, a drug that would cause the eggs of the unwanted winged city dwellers to develop incorrectly so that they would be unable to hatch.
²
The contragestational drug, made by a California company called Innolytics, LLC, had already been put into use in other cities including Hollywood, El Paso, and Denver. It was also considered by New York City when the birds invaded the newly renovated $124 million St. George terminal of the Staten Island Ferry. Councilman James S. Oddo was quick to dismiss health concerns, noting, “The reproductive rights of pigeons comes in a distant second to my constituents and their commute.”
³

While some did worry about the health of the birds, this sort of prevention seemed to be a step up from electric fences, spikes designed to impale the birds, and poisons. But the greater worry for many people was, of course, the environmental impact of putting a chemical with such dramatic effects on avian reproduction into general use. Drugs designed to curtail the fertility of wild animals—by preventing conception or disrupting gestation—have been used on geese and even larger animals like deer. It’s possible that, as Innolytics claims, the drugs are harmless to humans and not dangerous to other birds and animals. But the great push in recent years to put pigeons on birth control highlights the larger problems
of releasing pharmaceuticals and chemicals into the environment without sufficient data on their mechanisms and potential harms. Chemicals used to control wildlife are small potatoes next to the massive quantity of hormones used on farm animals. And, of course, there are the drugs we take on a daily basis, which also end up back in our water.

We are coming to understand the importance of considering the unintended consequences of dumping medicines into our natural environment and the impact of doing it on such a massive scale. We live in a world that is awash in pharmaceuticals. Even if civic engineers and farmers had never schemed to put animals on drugs, the ones taken by people every day would have already caused this problem. Our waterways are full of the residues of drugs that have been taken by patients and peed out or simply dumped unused into the toilet. Our factories use chemicals to process and make products that also find their way into our water. And our farms use them to fatten animals for slaughter.

What danger does this pharmaceutical soup pose to animals and humans? And what is the role of hormone products, such as oral contraceptives and hormone therapy pills, in causing it? As environmental concerns of every manner dominate national and international conversations, has the issue of making birth control green been overlooked?

Something Fishy in the Potomac: Intersex Bass and Prescription Drugs

Scientists around the Potomac River were noticing something strange: male smallmouth bass had started to act like females. Specifically, they were producing a protein that preceded egg development, and in some cases they were actually growing eggs. Vicki S. Blazer, a scientist who works at a fish laboratory in West Virginia, was one of the first to notice the phenomenon in 2003.
⁴
By 2004 the problem had spread downstream 170 miles to Maryland, very close to the nation’s capital.

There had been disturbing evidence of this kind of problem before: in the 1980s and 1990s, scientists observed problems in the reproductive organs of birds in the Great Lakes region and in alligators in the Florida Everglades. Female songbirds in California began singing songs usually reserved for males.
⁵
In 1995, Arizona scientists observed sexual changes in
fish downstream from Las Vegas.
⁶
Such problems are caused by chemicals called endocrine disruptors, which, like birth control pills, work by blocking or interfering with a body’s hormones in ways that change sexual functioning.

How do chemicals and pharmaceutical agents make their way into the water system? When it comes to prescription drugs, they are usually flushed down the toilet, either in urine or as a way of disposing of unused medicines. A powerful chemical like a synthetic hormone isn’t completely broken down by the body and survives in human waste. On the way to sewage treatment plants, the drugs are further dismantled by bacteria and further still by treatment at facilities. Still, some survive and flow into lakes and rivers. Journalist Dawn Fallik explains it this way: “People drink and flush and wash, and the water has to go somewhere—and mostly it goes into the sewer system, into the wastewater treatment plant, and then into a river or stream. Drinking water plants take up water from the rivers and streams, treat it, and send it into the taps.”
⁷

Part of the problem with figuring out which drugs have been causing occurrences of intersex fish around the world has been that there are so many different chemical contenders. Tests conducted on the St. Lawrence River found a pharmacopeia, including trace amounts of ibuprofen, antibiotics, epilepsy drugs, Alzheimer’s drugs, and even caffeine.
⁸
While clearly hormonal mechanisms are at work in the fish, what isn’t clear is whether industrial or farming chemicals or everyday human pill and product use are responsible. When asked what causes intersex fish, Vicki S. Blazer says, “I feel comfortable saying human activity … The question is, which human activity? And is it something we can do anything about?”
⁹

When looking at the chemical soups that are US and international waterways, hormones stand out as a particular problem, despite the fact that it is often a matter of pulling apart a consommé, not a chowder. The US Geological Survey noted in the first comprehensive study of chemical contaminants in American waters in 2002 that fish and aquatic wildlife were particularly at risk for health problems in water that showed traces of hormones and hormonelike compounds.
¹⁰
For this reason scientists tend to see illnesses or physical changes in fish, frogs, or other animals that live in waterways as warning signs of a bigger problem.

There are three major categories of environmental hormones. The first
is synthetic, and it exists because people and farm animals on such drugs either excrete or dump the chemicals into the sewage and water systems. In addition to the many chemicals humans rely on, there are those used to produce our food. Professor and food writer Michael Pollan has chronicled the overuse of agricultural hormones from firsthand experience. Visiting a massive factory farm in 2002, Pollan watched as cows were “funneled into a chute, herded along by a ranch hand wielding an electric prod, then clutched in a restrainer just long enough for another hand to inject a slow-release pellet of Revlar, a synthetic estrogen, in the back of the ear.”
¹¹
Pollan noted that approximately two thirds of the 36 million beef cattle raised in the United States receive hormones. The reason, of course, is to get the animals’ weight up: humans aren’t the only animals who can respond to outside hormones by packing on pounds. Pollan notes that drugs like Revlar can get “a beef calf from 80 to 1,200 pounds in 14 months.”
¹²
Of course, in addition to the hormones entering the ground through the urine of livestock, people who eat meat are often consuming small amounts of the chemicals when they eat beef, pork, or poultry that have been treated with the compounds.

The second category of environmental hormones is natural estrogens—called phytoestrogens—that enter the environment through plants and foods that act like estrogens on the body. Soy, for example, is a popular phytoestrogen. The chemicals in this plant act on estrogen receptors in the body and cause some of the same changes that a pharmaceutical estrogen would.

The third major type comes from industry. It involves compounds and products that release chemicals that act like estrogens. Certain plastics, for example, have fallen under scrutiny in recent years for causing this sort of unintentional pollution. Industrial chemicals such as Bisphenol A—a chemical added to plastic to make it harder, which has recently gotten attention for its presence in some baby bottles, and phthalates—additives used to make plastic flexible and keep chemicals like perfume from evaporating—have been studied for their dangers to humans who come in contact with them. Shanna Swan, director of the Center for Reproductive Epidemiology at the University of Rochester, notes that one study found that children of mothers whose bodies showed high levels of phthalates were more likely to be “undermasculinized.”
¹³

Pharmaceutical estrogens are one of the most widespread contaminants. A study out of Villanova University tested twenty-one streams in one Pennsylvania county and found that all contained synthetic hormones.
¹⁴
Ten of those streams contained ethinyl estradiol (the compound used in most birth control pills) in quantities thirty times greater than those shown to damage fish. Despite this sort of evidence, the sheer volume of different chemicals makes it difficult to assess both which compounds are causing the worst damage and where they’re coming from. Christian Daughton, head of the EPA’s National Exposure Research Library explains, “No organism is exposed to one toxicant at a time. What’s happening here involves multiple chemicals at a time, and naturally occurring toxic chemicals as well.”
¹⁵
Science works best when it can isolate one variable and test it. This often becomes difficult in real-world contexts and requires scientists to think creatively when designing studies.

In one innovative experiment, a team of Canadian scientists set out to test whether synthetic estrogens could cause male fish to show female characteristics. A team led by Professor Karen Kidd of the University of New Brunswick has spent years observing what happens when chemicals like those in oral contraceptives are released into the environment. Because most waterways are already polluted by different kinds of drugs, Kidd and her colleagues chose a small, isolated lake in northwestern Ontario. The area is so remote and the bodies of water so numerous that the lakes have never been given names. Instead, the target pond, chosen for its purity, is known only by the number 260. Because it is tiny and far away from other bodies of water, 260 was as close as the scientists could come to finding a pristine body of water suited for experimentation; it allowed them to feel with some certainty that if fish started showing female characteristics, it was because of the specific chemicals they were putting into it.
¹⁶
The study, called “the most controlled experiment ever to look at the effects of estrogen on ecosystems,”
¹⁷
cost a million dollars, provided mostly by the Canadian government but also by funds from the Environmental Protection Agency (EPA). Over the course of seven years, Kidd and her colleagues added synthetic estrogen to the lake at levels lower than or equal to the concentration of the chemicals in many waterways. The experiment used the amount of hormone that would result from six thousand women taking the Pill.
¹⁸

What they found was that within the first year, male minnows had problems developing sex organs and female fish grew eggs too slowly.
¹⁹
Minnow populations started to decline dramatically, and in later years the population failed to recover even after Kidd and her team stopped putting hormones in the lake. This fact contradicts those who argue that the variability of estrogen content—and the fact that it can be cleared out of water with haste—means that contamination isn’t dangerous. While the minnow population was affected right away because of its short lifecycle, scientists theorize that fish with longer life spans, such as trout, would experience similar problems with more prolonged exposure. In areas where hormone concentrations are sustained, multigenerational exposure may enhance this problem.