What has changed and what has stayed the same? There is still a plausible risk that environmental release of genetically modified organisms may lead to the emergence of new pathogens. What may be different includes the understanding that more and different stressors on the bacteria may create increased pressures to swap genes and create such new bugs. Genetic engineering has created some of these stressors: souped up vectors and promoters, poured down the drain into sewage as some inevitably must be, may facilitate such gene swapping. The mandate that sewage be “treated” has produced a more concentrated problem: sewage sludge. This is a sticky, stinking substance variably filled with bacteria and nutrients from human excreta as well as hospital and laboratory waste—including from biotech production. Into this mix also go household chemicals, industrial wastes, heavy metals, synthetic organic chemicals, pharmaceuticals , and anything anyone can dispose of down any drain. . Sludge, consisting of the concentrated pollutants removed from sewage during treatment, traps toxins in tight proximity with bacteria including pathogens, and is therefore very likely to be mutagenic. Ocean dumping of sewage was banned in 1992, and the EPA in 1993 approved the spreading of sewage sludge on agricultural lands as "fertilizer," which delivers this risky mixture right into our food supply and to the environment at large. Whether the eight-fold increase in food-borne illnesses since 1994 is a coincidence or related to spreading sludge on agricultural land and other ill-conceived waste-disposal methods has not been investigated. And this type of negligence is something that has not changed in two decades: risks are dismissed or not frankly acknowledged, the enhancement of gene swapping in a sewage and sludge environment has not been carefully studied, and no serious monitoring programs are in place.

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