BMJ 2014;348:g1997 doi: 10.1136/bmj.g1997 (Published 6 March 2014)
Page 1 of 1
Views & Reviews
VIEWS & REVIEWS PERSONAL VIEW
We should start to quantify the environmental impact of different treatments It’s only a matter of time before the public asks for greener medical care, says Luke Harper Luke Harper consultant paediatric surgeon, Department of Pediatric Surgery, University Hospital of Saint-Denis de La Réunion, Reunion Island, France As treatments have evolved, several therapeutic options have become available for most pathologies. Because of the need to choose between these different options, we have developed tools to evaluate them according to their efficacy, adverse effects, and cost. These essential criteria are used not only when deciding on a treatment for an individual patient but also when planning healthcare programmes.
Concurrently, public concern about environmental matters has grown—for example, the use of alternative sources of energy and the production of toxic substances. Public and private sector policies are gradually reflecting this.1 The food, automobile, and clothing industries have modified their practices in response to growing concern from consumers about climate change and sustainable development.1
This concern has also begun to penetrate the medical world, providing us with an impetus to make our practice “greener.” At the moment this includes waste disposal and reducing energy consumption in the sector but does not yet deal with the therapeutic aspects of medicine. Therapies have environmental impacts. Drug production implies energy consumption, waste disposal, and in some cases air and soil pollution—for example, oestrogens. Though currently no system has been agreed to evaluate the potential effects of drug production on the environment, public awareness of this issue is growing, and the health industry will have to respond to these concerns just as other industries have.2 3
Better assessment of the ecological impact of therapeutic modalities might also help us retrieve some of the loss of confidence in traditional medicine, which has led many patients to turn to alternative forms of medicine.
Methods already exist to evaluate the ecological impact of products and services consumed in Western countries. One of these is the ecological footprint, which is defined as the biologically productive land and water that a population requires to produce the resources and absorb the waste related to a
specific activity. It has been used as a screening indicator for the environmental performance of various products and can be applied to the drug industry.4 Recently, a Belgian team has developed a method that quantifies the environmental impact of specific pharmaceutical production processes.5 This method, coupled with measures of the impact of toxic waste generated by drug production and drug byproducts, could be used to calculate a drug’s ecological footprint. This notion could be extended to the fabrication, disposal, or reprocessing of surgical materials and single use medical devices, for instance. An ecological footprint could then be determined for each specific therapy just as treatment efficacy and cost are assessed.
Obviously, this would require drug companies to open the doors to their production facilities. They may be initially reluctant, but industries that can boast environmentally friendly therapies will have a new and powerful sales argument. Whether or not we agree that this is the right thing to do, sooner or later it is something that public opinion will demand of healthcare. So we might as well get started soon. Competing interests: I have read and understood the BMJ Group policy on declaration of interests and have no relevant interests to declare. Provenance and peer review: Not commissioned; not externally peer reviewed. 1 2 3 4 5
Bringing action on climate and human development together. Lancet 2013;382:1154. Endocrine-disrupting chemicals: how much of a health threat? Lancet 2013;381:700. Holmes D. Endocrine disruptors cause toxic fallout. Lancet Diabetes Endocrinol 2013;1:93-4. Huijbregts MAJ, Hellweg S, Frishknecht R, Hungerbühler K, Hendriks AJ. Ecological footprint accounting in the life cycle assessment of products. Ecological Economics 2008;64:798-807. Van der Vorst G, Dewulf J, Aelterman W, De Witte B, Van Langenhove H. A systematic evaluation of the resource consumption of pharmaceutical ingredient production at three different levels. Environ Sci Technol 2011;45:3040-6.
Cite this as: BMJ 2014;348:g1997 © BMJ Publishing Group Ltd 2014
[email protected] For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
Page 1 of 1
Views & Reviews
VIEWS & REVIEWS PERSONAL VIEW
We should start to quantify the environmental impact of different treatments It’s only a matter of time before the public asks for greener medical care, says Luke Harper Luke Harper consultant paediatric surgeon, Department of Pediatric Surgery, University Hospital of Saint-Denis de La Réunion, Reunion Island, France As treatments have evolved, several therapeutic options have become available for most pathologies. Because of the need to choose between these different options, we have developed tools to evaluate them according to their efficacy, adverse effects, and cost. These essential criteria are used not only when deciding on a treatment for an individual patient but also when planning healthcare programmes.
Concurrently, public concern about environmental matters has grown—for example, the use of alternative sources of energy and the production of toxic substances. Public and private sector policies are gradually reflecting this.1 The food, automobile, and clothing industries have modified their practices in response to growing concern from consumers about climate change and sustainable development.1
This concern has also begun to penetrate the medical world, providing us with an impetus to make our practice “greener.” At the moment this includes waste disposal and reducing energy consumption in the sector but does not yet deal with the therapeutic aspects of medicine. Therapies have environmental impacts. Drug production implies energy consumption, waste disposal, and in some cases air and soil pollution—for example, oestrogens. Though currently no system has been agreed to evaluate the potential effects of drug production on the environment, public awareness of this issue is growing, and the health industry will have to respond to these concerns just as other industries have.2 3
Better assessment of the ecological impact of therapeutic modalities might also help us retrieve some of the loss of confidence in traditional medicine, which has led many patients to turn to alternative forms of medicine.
Methods already exist to evaluate the ecological impact of products and services consumed in Western countries. One of these is the ecological footprint, which is defined as the biologically productive land and water that a population requires to produce the resources and absorb the waste related to a
specific activity. It has been used as a screening indicator for the environmental performance of various products and can be applied to the drug industry.4 Recently, a Belgian team has developed a method that quantifies the environmental impact of specific pharmaceutical production processes.5 This method, coupled with measures of the impact of toxic waste generated by drug production and drug byproducts, could be used to calculate a drug’s ecological footprint. This notion could be extended to the fabrication, disposal, or reprocessing of surgical materials and single use medical devices, for instance. An ecological footprint could then be determined for each specific therapy just as treatment efficacy and cost are assessed.
Obviously, this would require drug companies to open the doors to their production facilities. They may be initially reluctant, but industries that can boast environmentally friendly therapies will have a new and powerful sales argument. Whether or not we agree that this is the right thing to do, sooner or later it is something that public opinion will demand of healthcare. So we might as well get started soon. Competing interests: I have read and understood the BMJ Group policy on declaration of interests and have no relevant interests to declare. Provenance and peer review: Not commissioned; not externally peer reviewed. 1 2 3 4 5
Bringing action on climate and human development together. Lancet 2013;382:1154. Endocrine-disrupting chemicals: how much of a health threat? Lancet 2013;381:700. Holmes D. Endocrine disruptors cause toxic fallout. Lancet Diabetes Endocrinol 2013;1:93-4. Huijbregts MAJ, Hellweg S, Frishknecht R, Hungerbühler K, Hendriks AJ. Ecological footprint accounting in the life cycle assessment of products. Ecological Economics 2008;64:798-807. Van der Vorst G, Dewulf J, Aelterman W, De Witte B, Van Langenhove H. A systematic evaluation of the resource consumption of pharmaceutical ingredient production at three different levels. Environ Sci Technol 2011;45:3040-6.
Cite this as: BMJ 2014;348:g1997 © BMJ Publishing Group Ltd 2014
[email protected] For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
