Area Tap Water Has Traces of Medicines

Tests Find 6 Drugs, Caffeine in D.C., Va.

By Carol D. Leonnig
Washington Post Staff Writer
Monday, March 10, 2008; B01

The Washington area's drinking water contains trace amounts of six commonly used drugs that typically turn up in wastewater and cannot be filtered out by most treatment systems.

The pharmaceuticals -- an anti-seizure medication, two anti-inflammatory drugs, two kinds of antibiotics and a common disinfectant -- were found in very small concentrations in the water supply that serves more than 1 million people in the District, Arlington County, Falls Church and parts of Fairfax County. But scientists say the health effects of long-term exposure to such drugs are not known.

Pharmaceuticals, along with trace amounts of caffeine, were found in the drinking water supplies of 24 of 28 U.S. metropolitan areas tested. The findings were revealed as part of the first federal research on pharmaceuticals in water supplies, and those results are detailed in an investigative report by the Associated Press set to be published today.

In addition to caffeine, the drugs found in water treated by the Washington Aqueduct include the well-known pain medications ibuprofen and naproxen, commonly found in Aleve. But there were also some lesser-known drugs: carbamazepine, an anti-convulsive to reduce epileptic seizures and a mood stabilizer for treating bipolar disorders; sulfamethoxazole, an antibiotic that can be used for humans and animals in treating urinary tract and other infections; and monensin, an antibiotic typically given to cattle. In addition, the study uncovered traces of triclocarban, a disinfectant used in antibacterial soaps.

That the drugs were found so commonly nationwide highlights an emerging water dilemma that the public rarely considers. The drugs we use for ourselves and animals are being flushed directly into wastewater, which then becomes a drinking water source downstream. However, most wastewater and drinking water treatment systems, including Washington's, are incapable of removing those drugs.

And although the chemicals pose no immediate health threat in the water, the health effects of drinking these drug compounds over a long period is largely unstudied. Some scientists said there is probably little human health risk; others fear chronic exposure could alter immune responses or interfere with adolescents' developing hormone systems.

Washington's water regulators and utility officials say they are not alarmed by the findings because the drugs are found at such low levels -- parts per trillion, a tiny fraction of the amount in a medical dose. But they do view these "emerging contaminants" with concern.

"What concerns me is we're finding pharmaceuticals in the river that we rely upon for drinking water," said Thomas P. Jacobus, general manager of the Washington Aqueduct. "If we can't get them out, we have to find a way to neutralize them if we find there's a health effect from them."

Jacobus said the aqueduct leadership will recommend in the next few months likely upgrades for water treatment to deal with an array of newly identified and increasing contaminants in the water. The aqueduct uses chlorine, which kills a wide group of bacteria and breaks down some chemicals but cannot disrupt pharmaceuticals. Studies show ozone water treatment is the most effective in zapping such drugs.

The U.S. Geological Survey and the U.S. Department of Agriculture have been screening Washington's and other cities' water supplies for pharmaceuticals in the first research project on pharmaceuticals in the water. The Washington Aqueduct, an arm of the U.S. Army Corps of Engineers, does not regularly screen for caffeine or pharmaceuticals, nor do most water utilities.

The drugs discovered in testing over the past two years typically get into the water supply because they pass through a user's body and are flushed downstream. The U.S. Environmental Protection Agency is studying some pharmaceuticals for their impact on public health but has not set safety standards for any of the drugs.

"We recognize it is a growing concern, and we're taking it very seriously," Benjamin H. Grumbles, the EPA's assistant administrator for water, said of the drugs' presence.

There is no clear evidence of a human health threat from such low levels of pharmaceuticals. But scientists warn that, because there has been very little study of the long-term or synergistic effects of this kind of drug exposure, water providers and regulators need to exercise caution. Although experts agree that aquatic life are most at risk from exposure to the drugs in rivers and streams, researchers are concerned about what they don't know about human health effects.

In other findings from its reporting, the AP said officials in Montgomery County and Fairfax have found numerous pharmaceuticals in their environmental watersheds but do not test their drinking water supplies for the same chemical compounds.

Nationwide, the AP reported that researchers found anti-depressants, antacids, synthetic hormones from birth control pills, and many other human and animal medicines in the water. In San Francisco, tests found a sex hormone. In New York, the water tested positive for heart medicines and a prescription tranquilizer.

The Associated Press contributed to this report.

FDA Approves Cloned Meat for Consumption

Someone tell me, why do we need this?

Critics Worry About Secondary Effects of Genetically Modified Foods

Jan. 16, 2008 —

It could be years before meat from cloned animals hits store shelves now that the Food and Drug Administration has given producers permission to sell it, but the milk from cloned offspring could hit the markets sooner.

"The milk and meat for cattle, swine and goat clones are as safe to eat as the food we eat every day," said Randall Lutter of the FDA.

Currently, only a few hundred clones exist, and they'll likely be used for just breeding.

Some genetically modified food already is available in American groceries. In fact, the food industry says that if a product has corn or soybean in it, it probably has been genetically modified.

"We would not be using those ingredients unless the authorities had evaluated them and determined them to be, to be safe," said Mark Nelson of the Grocery Manufacturers' Association.

Other countries have moved more slowly and been more cautious in giving the green light to cloned food. In Europe, where a more activist consumer culture exists, recent reports said it "is very unlikely" there's any difference in the safety of cloned or genetically modified products and natural products.

But Europe remains divided about food that contains genetically modified plants and grains, while in the United States genetically modified food is so common most people don't even realize they're eating it.

In the United States, determining which foods have been genetically modified can be difficult because they don't have to be labeled as such. The FDA also doesn't plan to require the labels for cloned animal products.

Critics worry the cloned and genetically modified foods still may be unsafe for consumption.

"It is really a huge, uncontrolled experiment on the American people," said Andrew Kimbrell of the Center for Food Safety.

They also worry about secondary health effects of eating cloned meat, such as a circumstance in which clones develop health problems later on and need more antibiotics and drugs.

"We think there are consequent effects the FDA has not yet looked at that could impact human health," said Joseph Mendelson of the Center for Food Safety.

What the FDA may do in the future is allow producers of regular meats and milks to put a label on their products saying they are not from cloned animals.

Meanwhile, the government has asked food producers to honor a voluntary moratorium on selling cloned meat animal products while marketing plans are worked out.

Shoppers who want to avoid genetically modified food should search for labels that say "100 percent organic," because by law those cannot contain biotech ingredients.

Antidepressant Studies Unpublished

January 17, 2008

By BENEDICT CAREY

The makers of antidepressants like Prozac and Paxil never published the results of about a third of the drug trials that they conducted to win government approval, misleading doctors and consumers about the drugs’ true effectiveness, a new analysis has found.

In published trials, about 60 percent of people taking the drugs report significant relief from depression, compared with roughly 40 percent of those on placebo pills. But when the less positive, unpublished trials are included, the advantage shrinks: the drugs outperform placebos, but by a modest margin, concludes the new report, which appears Thursday in The New England Journal of Medicine.

Previous research had found a similar bias toward reporting positive results for a variety of medications; and many researchers have questioned the reported effectiveness of antidepressants. But the new analysis, reviewing data from 74 trials involving 12 drugs, is the most thorough to date. And it documents a large difference: while 94 percent of the positive studies found their way into print, just 14 percent of those with disappointing or uncertain results did.

The finding is likely to inflame a continuing debate about how drug trial data is reported. In 2004, after revelations that negative findings from antidepressant trials had not been published, a group of leading journals agreed to stop publishing clinical trials that were not registered in a public database. Trade groups representing the world’s largest drug makers announced that members’ companies would begin to release more data from trials more quickly, on their own database, clinicalstudyresults.org.

And last year, Congress passed legislation that expanded the type of trials and the depth of information that must be submitted to clinicaltrials.gov, a public database operated by the National Library of Medicine. The Food and Drug Administration’s Web site provides limited access to recent reviews of drug trials, but critics say it is very hard to navigate.

“This is a very important study for two reasons,” said Dr. Jeffrey M. Drazen, editor in chief of The New England Journal. “One is that when you prescribe drugs, you want to make sure you’re working with best data possible; you wouldn’t buy a stock if you only knew a third of the truth about it.”

Second, Dr. Drazen continued, “we need to show respect for the people who enter a trial.”

“They take some risk to be in the trial, and then the drug company hides the data?” he asked. “That kind of thing gets us pretty passionate about this issue.”

Alan Goldhammer, deputy vice president for regulatory affairs at the Pharmaceutical Research and Manufacturers of America, said the new study neglected to mention that industry and government had already taken steps to make clinical trial information more transparent. “This is all based on data from before 2004, and since then we’ve put to rest the myth that companies have anything to hide,” he said.

In the study, a team of researchers identified all antidepressant trials submitted to the Food and Drug Administration to win approval from 1987 to 2004. The studies involved 12,564 adult patients testing drugs like Prozac from Eli Lilly, Zoloft from Pfizer and Effexor from Wyeth.

The researchers obtained unpublished data on the more recently approved drugs from the F.D.A.’s Web site. For older drugs, they tracked down hard copies of unpublished studies through colleagues, or using the Freedom of Information Act. They checked all of these studies against databases of published research, and also wrote to the companies that conducted the studies to ask if specific trials had been published.

They found that 37 of 38 trials that the F.D.A. viewed as having positive results were published in journals. The agency viewed as failed or unconvincing 36 other trials, of which 14 made it into journals.

But 11 of those 14 journal articles “conveyed a positive outcome” that was not justified by the underlying F.D.A. review, said the new study’s lead author, Dr. Erick H. Turner, a psychiatrist and former F.D.A. reviewer who now works at Oregon Health and Sciences University and the Portland Veterans Affairs Medical Center. His co-authors included researchers at Kent State University and the University of California, Riverside.

Dr. Turner said the selective reporting of favorable studies sets up patients for disappointment. “The bottom line for people considering an antidepressant, I think, is that they should be more circumspect about taking it,” he said, “and not be so shocked if it doesn’t work the first time and think something’s wrong with them.”

For doctors, he said, “They end up asking, ‘How come these drugs seem to work so well in all these studies, and I’m not getting that response?’ ”

Dr. Thomas P. Laughren, director of the division of psychiatry products at the F.D.A., said the agency had long been aware that favorable studies of drugs were more likely to be published.

“It’s a problem we’ve been struggling with for years,” he said in an interview. “I have no problem with full access to all trial data; the question for us is how do you fit it all on a package insert,” the information that accompanies many drugs.

Dr. Donald F. Klein, an emeritus professor of psychiatry at Columbia, said drug makers were not the only ones who can be reluctant to publish unconvincing results. Journals, and study authors, too, may drop studies that are underwhelming.

“If it’s your private data, and you don’t like how it came out, well, we shouldn’t be surprised that some doctors don’t submit those studies,” he said.

US Slipping in Life Expectancy Rankings

By STEPHEN OHLEMACHER

The Associated Press
Sunday, August 12, 2007; 5:02 AM

WASHINGTON -- Americans are living longer than ever, but not as long as people in 41 other countries.

For decades, the United States has been slipping in international rankings of life expectancy, as other countries improve health care, nutrition and lifestyles.

Countries that surpass the U.S. include Japan and most of Europe, as well as Jordan, Guam and the Cayman Islands.

"Something's wrong here when one of the richest countries in the world, the one that spends the most on health care, is not able to keep up with other countries," said Dr. Christopher Murray, head of the Institute for Health Metrics and Evaluation at the University of Washington.

A baby born in the United States in 2004 will live an average of 77.9 years. That life expectancy ranks 42nd, down from 11th two decades earlier, according to international numbers provided by the Census Bureau and domestic numbers from the National Center for Health Statistics.

Andorra, a tiny country in the Pyrenees mountains between France and Spain, had the longest life expectancy, at 83.5 years, according to the Census Bureau. It was followed by Japan, Macau, San Marino and Singapore.

The shortest life expectancies were clustered in Sub-Saharan Africa, a region that has been hit hard by an epidemic of HIV and AIDS, as well as famine and civil strife. Swaziland has the shortest, at 34.1 years, followed by Zambia, Angola, Liberia and Zimbabwe.

Researchers said several factors have contributed to the United States falling behind other industrialized nations. A major one is that 45 million Americans lack health insurance, while Canada and many European countries have universal health care, they say.

But "it's not as simple as saying we don't have national health insurance," said Sam Harper, an epidemiologist at McGill University in Montreal. "It's not that easy."

Among the other factors:

_ Adults in the United States have one of the highest obesity rates in the world. Nearly a third of U.S. adults 20 years and older are obese, while about two-thirds are overweight, according to the National Center for Health Statistics.

"The U.S. has the resources that allow people to get fat and lazy," said Paul Terry, an assistant professor of epidemiology at Emory University in Atlanta. "We have the luxury of choosing a bad lifestyle as opposed to having one imposed on us by hard times."

_ Racial disparities. Black Americans have an average life expectancy of 73.3 years, five years shorter than white Americans.

Black American males have a life expectancy of 69.8 years, slightly longer than the averages for Iran and Syria and slightly shorter than in Nicaragua and Morocco.

_ A relatively high percentage of babies born in the U.S. die before their first birthday, compared with other industrialized nations.

Forty countries, including Cuba, Taiwan and most of Europe had lower infant mortality rates than the U.S. in 2004. The U.S. rate was 6.8 deaths for every 1,000 live births. It was 13.7 for Black Americans, the same as Saudi Arabia.

"It really reflects the social conditions in which African American women grow up and have children," said Dr. Marie C. McCormick, professor of maternal and child health at the Harvard School of Public Health. "We haven't done anything to eliminate those disparities."

Another reason for the U.S. drop in the ranking is that the Census Bureau now tracks life expectancy for a lot more countries _ 222 in 2004 _ than it did in the 1980s. However, that does not explain why so many countries entered the rankings with longer life expectancies than the United States.

Murray, from the University of Washington, said improved access to health insurance could increase life expectancy. But, he predicted, the U.S. won't move up in the world rankings as long as the health care debate is limited to insurance.

Policymakers also should focus on ways to reduce cancer, heart disease and lung disease, said Murray. He advocates stepped-up efforts to reduce tobacco use, control blood pressure, reduce cholesterol and regulate blood sugar.

"Even if we focused only on those four things, we would go along way toward improving health care in the United States," Murray said. "The starting point is the recognition that the U.S. does not have the best health care system. There are still an awful lot of people who think it does."

Not Made in China

Amid growing awareness of food perils, companies that spotlight where ingredients originate are enjoying new demand

Earlier this year, Swiss ingredient maker DSM Nutritional Products launched a "premium" Vitamin C. The marketing gambit: It comes from tidy Scotland instead of sprawling China, which provides 80% of the world's supply. But it was a tough sell. "We were struggling to get the price we thought was justified by the quality," says communications chief Alex Filz.

No more. Not after contaminated products from China ended up on supermarket shelves. Suddenly, "Not Made in China" has become a major selling point. DSM's Quali-C brand is flying out of its Scottish factory at more than double the price for bulk Vitamin C. "It's a tremendous business opportunity for us," says Filz (see BusinessWeek.com, 7/13/07, "China: Due for a Reality Check?").


In the midst of the imported food crisis, companies are finding clever ways to cash in. Some, like DSM, are playing the "not from China" card. Upscale New York grocery Fairway reassures consumers that none of its seafood is Chinese. Others see a growing business in making this global supply chain safer. One big player: IBM, which is pushing systems to trace the food supply from source to market. "Whenever there's a crisis, there will always be a silver lining for someone who can help alleviate whatever pain is out there," says crisis consultant Gene Grabowski, senior vice-president of Levick Strategic Communications.

Secaucus (N.J.) specialty dog food producer Freshpet found that silver lining. At the end of last year, it was selling its premium all-natural blend of meat and vegetables in a mere 200 stores. Most retailers said the idea was "interesting" but didn't bite, recalls co-founder Scott Morris.

Then pets began dying and, beginning in March, dozens of products were recalled because they might contain melamine from China, an industrial chemical. Freshpet threw out its only overseas ingredient, a protein component from Europe, and quickly ramped up its marketing. It printed big stickers for retailers to put on the refrigerator cases where its products are stocked, highlighting that the food was made daily with fresh, local ingredients. All of a sudden, the retailers who had given Freshpet the cold shoulder "started calling," says Morris. Now, roughly 1,000 stores offer its dog food, with another 1,000 coming by yearend. Projected 2007 sales have more than tripled to nearly $50 million. "Sometimes you're good--and you get lucky," he adds.

With today's global food supply, however, eliminating every particle from China is impossible for most major food companies. Even a simple product like a cereal bar contains ingredients from India, the Philippines--and China, which now supplies the bulk of the world's vitamins, apple juice, and other goods. "I think most people are surprised by the diversity of the sources," says ingredient consultant Peter Kovacs.

Instead, the latest woes have many food giants scrambling to ratchet up efforts to ensure the safety of imported ingredients. That's providing a big boost to a host of companies aiming to help with the task. While Kellogg's has long had systems in place to monitor its global food chain, for example, it has arranged additional third-party audits of its suppliers. Many companies are also broadening the list of things they're analyzing. "One of the reasons melamine slipped through is that no one knew to test for it," says Grabowski.

This increased scrutiny is good news to Gene Rider, North American consumer goods vice-president of Intertek Group PLC. Operating in 110 countries, with headquarters in London, the company offers a complete quality system for clients ranging from Kraft Food Inc. and Unilever to Nike and Microsoft Corp. Intertek will evaluate and train suppliers, test products, and provide other services. Since the latest bans and recalls, inquiries have more than doubled, says Rider. "Companies are increasingly asking to outsource their quality programs," he says. "It's tremendous for us."

IBM also sees a big opportunity in this market. One of the key steps to putting safe food on the dinner table is tracing the entire path of ingredients and products from fields and factories to grocery store shelves. Such a system sounds like a no-brainer, but in practice it's difficult, requiring sophisticated markers and software. "It's a global-information management problem," says Guy A. Blissett, head of consumer products at the IBM Institute for Business Value. The tech giant is trying to capitalize on that demand by providing the tracking tags and sensors to monitor shipments or processes, as well as the computers and software to make sense of it all.

Not only does such a system help boost safety and quality, says Blissett, it enables a company to offer up premium products. It's possible to document, for instance, that beef was grown without hormones, or that yogurt contains the advertised bacteria--and thus be able to charge a higher price.

Already, retailers overseas have found big profits by giving consumers just that kind of information. After outbreaks of Listeria bacteria and other tainted food in Europe, French hypermarket chain Carrefour created Quality Line products, which come from local farmers who have agreed to tough quality standards. The products are now offered in 15 countries and are increasingly popular. In Belgium, where feed contaminated by dioxin was fed to livestock, 98% of beef and 56% of pork carry the Quality Line stamp. Shoppers appreciate the extra assurance. "Whenever there is a crisis, our performance ends up being much better than that of competitors," says Roland Vaxelaire, director for quality, responsibility, and risk management at Carrefour in Paris.

For now, big U.S. chains are just beginning to move in that direction, with certified organic foods and produce labeled with the country of origin. But Blissett says a high level of interest is fueling his business. "Consumer product companies are realizing that, to be competitive, they need to have a robust traceability system." And IBM isn't just waiting for the market to develop. Recently it has tried aggressively to drum up customers with the help of a survey showing that nearly 40% of consumers are already changing what food they buy because of safety concerns.

In recent years, food producers have been under relentless pressure to buy ingredients at the lowest price. That, inevitably, led them to China. Now, says DSM's Filz, they increasingly are "moving away from decisions made just on price to something like a stamp or seal." No surprise then that DSM is creating such a seal, which would guarantee the quality, reliability, and traceability of its products. That's good for safety--and for DSM's business.

BP gets break on dumping in lake

Refinery expansion entices Indiana

By Michael Hawthorne

Tribune staff reporter

July 15, 2007

The massive BP oil refinery in Whiting, Ind., is planning to dump significantly more ammonia and industrial sludge into Lake Michigan, running counter to years of efforts to clean up the Great Lakes.

Indiana regulators exempted BP from state environmental laws to clear the way for a $3.8 billion expansion that will allow the company to refine heavier Canadian crude oil. They justified the move in part by noting the project will create 80 new jobs.

Under BP's new state water permit, the refinery -- already one of the largest polluters along the Great Lakes -- can release 54 percent more ammonia and 35 percent more sludge into Lake Michigan each day. Ammonia promotes algae blooms that can kill fish, while sludge is full of concentrated heavy metals.

The refinery will still meet federal water pollution guidelines. But federal and state officials acknowledge this marks the first time in years that a company has been allowed to dump more toxic waste into Lake Michigan.

BP, which aggressively markets itself as an environmentally friendly corporation, is investing heavily in Canadian crude oil to reduce its reliance on sources in the Middle East. Extracting petroleum from the thick goop is a dirtier process than conventional methods. It also requires more energy that could significantly increase greenhouse gases linked to global warming.

Environmental groups and dozens of neighbors pleaded with BP to install more effective pollution controls at the nation's fourth-largest refinery, which rises above the lakeshore about 3 miles southeast of the Illinois-Indiana border.

"We're not necessarily opposed to this project," said Lee Botts, founder of the Alliance for the Great Lakes. "But if they are investing all of these billions, they surely can afford to spend some more to protect the lake."

State and federal regulators, though, agreed last month with the London-based company that there isn't enough room at the 1,400-acre site to upgrade the refinery's water treatment plant.

The company will now be allowed to dump an average of 1,584 pounds of ammonia and 4,925 pounds of sludge into Lake Michigan every day. The additional sludge is the maximum allowed under federal guidelines.

Company officials insisted they did everything they could to keep more pollution out of the lake.

"It's important for us to get our product to market with minimal environmental impact," said Tom Keilman, a BP spokesman. "We've taken a number of steps to improve our water treatment and meet our commitments to environmental stewardship."

BP can process more than 400,000 barrels of crude oil daily at the plant, which was built in 1889 by John D. Rockefeller's Standard Oil Co. Total production is expected to grow by 15 percent by the time the expansion project is finished in 2011.

In sharp contrast to the greenways and parks that line Lake Michigan in Chicago, a string of industrial behemoths lie along the heavily polluted southern shore just a few miles away. The steady flow of oil, grease and chemicals into the lake from steel mills, refineries and factories -- once largely unchecked -- drew national attention that helped prompt Congress to pass the Clean Water Act during the early 1970s.

Paul Higginbotham, chief of the water permits section at the Indiana Department of Environmental Management, said that when BP broached the idea of expanding the refinery, it sought permission to pump twice as much ammonia into the lake. The state ended up allowing an amount more than the company currently discharges but less than federal or state limits.

He said regulators still are unsure about the ecological effects of the relatively new refining process BP plans to use. "We ratcheted it down quite a bit from what it could have been," Higginbotham said.

The request to dump more chemicals into the lake ran counter to a provision of the Clean Water Act that prohibits any downgrade in water quality near a pollution source even if discharge limits are met. To get around that rule, state regulators are allowing BP to install equipment that mixes its toxic waste with clean lake water about 200 feet offshore.

Actively diluting pollution this way by creating what is known as a mixing zone is banned in Lake Michigan under Indiana law. Regulators granted BP the first-ever exemption.

The U.S. Environmental Protection Agency has been pushing to eliminate mixing zones around the Great Lakes on the grounds that they threaten humans, fish and wildlife. Yet EPA officials did not object to Indiana's decision, agreeing with the state that BP's project would not harm the environment.

Federal officials also did not step in when the state granted BP another exemption that enables the company to increase water pollution as long as the total amount of wastewater doesn't change. BP said its flow into Lake Michigan will remain about 21 million gallons a day.

In response to public protests, state officials justified the additional pollution by concluding the project will create more jobs and "increase the diversity and security of oil supplies to the Midwestern United States." A rarely invoked state law trumps anti-pollution rules if a company offers "important social or economic benefits."

In the last four months, more than 40 people e-mailed comments to Indiana officials about BP's water permit. One of the few supportive messages came from Kay Nelson, environmental director of the Northwest Indiana Forum, an economic development organization that includes a BP executive among its board of directors. She hailed the company's discussions with state and community leaders as a model for others to follow.

Nearly all of the other comments, though, focused on the extra pollution in Lake Michigan.

"This is exactly the type of trade-off that we can no longer allow," wrote Shannon Sabel of West Lafayette, Ind. "Possible lower gas prices (I'll believe that when I see it!) against further contamination of our water is as shortsighted as it is irrational."

Schools aid and abet kid's bad health

Removing Schools' Soda Is Sticky Point
Bottlers' Contracts Limit Cash-Strapped Districts

By Annys Shin
Washington Post Staff Writer
Thursday, March 22, 2007; D03

Less than a year after the nation's largest beverage companies pledged to remove high-calorie drinks and limit sugary beverages in all schools, districts across the country are finding that they may not be able to afford the switch because of contracts they signed several years ago with bottlers for the companies.

When Portland, Ore., recently wanted to remove diet soda and sports drinks from high school vending machines and cafeterias, school officials found that they would have to pay the local Coca-Cola bottling company $600,000 to do so. In Racine, Wis., officials decided not to remove high-calorie drinks from high schools earlier this year after they learned they would have to pay the local Pepsi bottler $200,000.

A majority of schools have exclusive marketing agreements with bottling companies -- almost 75 percent of high schools, 65 percent of middle schools, and 30 percent of elementary schools.

The contracts, which can last up to 10 years, typically grant the exclusive right to market a company's brands in school vending machines, on scoreboards and on cups at sporting events in exchange for a large upfront payment followed by yearly payments. There are penalties if a school does not meet sales targets or if a school changes the mix of beverages sold.

In the Washington area, most school districts have not had to choose between money from soda sales and meeting tougher nutrition standards because they did not enter into exclusive beverage contracts.

In Maryland, sodas are only sold after school and, thus, are not subject to new federal or state nutrition requirements, said district spokeswoman Katherine O'Malley-Simpson. Therefore, the contract did not require changing. An exception is in Charles County, where the public schools signed a 10-year contract with Coca-Cola that ends in 2010.

Last May, Coca-Cola, Pepsi and Cadbury Schweppes, the three largest companies in the industry, signed a voluntary agreement to remove high-calorie sodas from schools by 2009.

The agreement, brokered by the Alliance for a Healthier Generation, a project sponsored by the William J. Clinton Foundation and the American Heart Association, came in response to a tripling of child obesity rates among school-age children since 1980. Children consume 35 to 50 percent of their calories during the school day, the alliance said.

The three major beverage companies, which operate separately from local bottlers, said they would make "diligent efforts" to ensure that current and future contracts with bottlers abide by a set of voluntary guidelines.

The guidelines include offering elementary school students milk, water and fruit juice instead of high-calorie soda; and offering high school students water, no-calorie or low-calorie drinks, such as diet soda, milk and light juices, including sports drinks.

In most cases, carrying out the guidelines requires altering existing beverage contracts. Wisconsin's Racine Unified School District, for example, had to change its agreement with its Pepsi distributor.

After years of budget problems, school closings and teacher layoffs, the Racine school system signed a 10-year marketing agreement with the Pepsi bottler in 2000, which came with an upfront payment of $450,000 and an annual payment of about $200,000, which included a percentage of drink sales and $25,000 for items such as scoreboards.

The district wanted to apply its new nutrition guidelines to beverages in September but found that required repaying about $200,000 of the upfront payment, said Nicholas Alioto, the district's chief operating officer.

"Fiscally we're not in a position to give the money back," he said, and the school system would wait until the contract ends in 2010.

In Oregon, the Portland school district had received a $1.2 million payment in 2002 and would have had to repay about $600,000 if it changed the contract. The district has been in negotiations with the Coca-Cola Bottling Co. of Oregon about the contract.

Some consumer advocates contend that the contracts make the industry's voluntary agreement meaningless.

"Many school districts are stuck with a deal with the devil. . . . The schools could buy out the contract, but this is about kids and school districts that are strapped for cash" said Deborah Pinkas, a Portland lawyer who, along with another lawyer, Nicola Pinson, wrote a study on beverage contracts.

Kevin W. Keane, a spokesman for the American Beverage Association, said bottlers could not be expected to take a financial hit to implement the guidelines. "Schools ask for money upfront," Keane said. "So companies have made an investment. If you're going to alter that dramatically, the one side is going to bear the brunt of the financial pain, which isn't fair."

The industry is aware that changing existing contracts would take time and gave itself three years to implement the voluntary agreement, Keane said. The Alliance for a Healthier Generation estimates high-calorie sodas and drinks would be removed from 75 percent of school vending machines and cafeterias by the start of the 2008 school year and from every school by 2009.