I have in my blogposts from January 28 and February 2, 2011, shown a somewhat blurry schematic I call ”4 steps to a sustainable use of pharmaceuticals”. The schematic has been developed by the so called ”Sustainable Development Task Force” within LIF (the research based pharmaceutical industry in Sweden).
I said that I would come back to the issue in more detail, and that is what I intend to do today.
Step 1: Promote Health and Prevent Illness
Resources in society are limited. Resources should therefore be used wisely, and hence it is preferable that illnesses that can be prevented should be prevented. If someone nevertheless become ill, patients have the right to be treated with effective and innovative medicines. Early and correct diagnoses is important in order to initiate treatment promptly. The pharmaceutical industry should contribute with its knowledge, services (e.g. patient support programs on life style changes) and products (e.g. vaccines, nutritional products and vitamins) to society in order to build good health and hence prevent illnesses.
This step is not discussed as often as it deserves in my opinion. I am a very strong believer that prevention and health promotion are not only the right things to do to help using the limited societal resources most wisely, but that prevention and health promotion also present really interesting business opportunities for us. See more details on such business opportunities around products and services such as Smart Heart in the blog post from June 9, 2010.
Step 2: Green Design
The medicines needed for illnesses that has not been successfully prevented should as far as possibly be designed to have minimal adverse impacts on the environment. A first and often very tricky part of the work is to make the API (active pharmaceutical ingredient) as “green” as possible, e.g. easily degradable. Biopharmaceuticals represent a good opportunity in general here.
I guess we all no that this step presents a lot of difficulties for us. I often say that it is extremely difficult to find medicines that have a valuable therapeutic effect and very low side effects. And to also secure that the design is ”green” (e.g. an easily degradable substance that do not show bio-accumulation potential and that has as low toxicity as possible) makes our task extremely challenging…
Step 3: Green Manufacturing and Supply Chain Management
Manufacturing and distribution of pharmaceutical products (i.e. API, excipients and packaging) should be done with minimal adverse environmental impact, no matter of where it is located in the world. This requires green chemistry initiatives around process development and upgraded on-site waste water treatment in order to secure low releases from manufacturing. Industry performs environmental audits of manufacturing operations, regardless whether it is done internally or by third-party manufactures. Proper choice of mode of transport and choice of packaging solutions are other important measures to minimize environmental impact in the global supply chain of pharmaceuticals.
As you are all aware of, a lot of the discussions the last few years regarding environmental impacts from pharmaceuticals has been around manufacturing releases in locations such as India. See for instance my blog post from August 16, 2010. Pharmaceutical manufacturers need to work with programs such as Green Chemistry and Third Party Audits / EHS External Supply to secure minimal environmental impact in the supply chain. Other important initiatives to minimize the environmental impact could be Green Packaging Programs for instance.
Step 4: Green Choices within Health Care and Society
For a sustainable use of pharmaceuticals it is crucial that the use is rational, i.e. not an over nor any under usage, and that patients follow the treatment with high compliance. Together with an increased focus on personalized medicine, such efforts should help keep cassation of pharmaceuticals down. Un-used medicines that nevertheless appear must be managed wisely in close collaboration between all stakeholders. It is also quite clear that health care (e.g. county councils, agencies, and other relevant stakeholders) has a very important role and responsibility to give industry positive incentives for “going green”. Market driven solutions has always shown to be the fastest way for real changes. Hence, green products and green services should be given incentives, e.g. not being substitutable to non-green alternatives within the generic reform, environmentally concerned patients should have the possibility to chose a green alternative without having to pay the full cost, or allowed to have a pricing premium.
Read more on the on-going debate on green pharmaceuticals and green incentives in my blog post from January 18, 2011.
I would appreciate comments from all of you out there in the ”blogosphere” regarding this proposal for a ”step-wise process ” to secure a sustainable use of pharmaceuticals. It can be a very interesting, and important, discussion!