Original post published 7 September 2011
“the vast majority of drugs — more than 90 percent — only work in 30 or 50 per cent of the people”.
This statement from a vice-president of a major US pharmaceutical producer should be regarded in the light of the drawbacks of current pharmaceutical management and use: development of resistance to antibiotics, appearance of negative adverse effects in patients under treatment, severe water pollution, and poisoning of the fauna.
It is a common misconception that all human medicines are live-saving or indispensible. This misunderstanding, supported discretely but efficiently the pharmaceutical producers, lies behind the fact that pharmaceutical products are exempt from all legal requirements which apply to other chemicals in our society. Today many politicians also share this misconception as lobbyists from the pharmaceutical producers continuously feed them with arguments showing that medicines are always for patients and have no adverse effects for the non-treated flora or fauna (including people).
Around 10 years ago the European Medicines Agency (the medical products agency of the EU) circulated a document indicating that environmental restrictions to authorisation of new medicinal products could not be introduced “for obvious reasons”. There was no specification which these “obvious reasons” were.
The statement given above that “the vast majority of drugs – more than 90 % only work in 30-50 per cent of the people” (given by a professional with deep insight into the world of pharmaceuticals) demonstrates that many patients take medicines which do not help them.
We must recognise that the major driving force for development of new medicines is commercial - a new drug must sell well. The costs for development of new drugs are astronomical, and the patent time for a new product entering the marked is short. Therefore, mainly medicines which will rapidly become used by a large number of patients can be brought all the way from idea to marketing due to good investment returns.
The majority of drugs are not life-saving but are allowed to be marketed because their advantage to the patient is considered favourable in comparison to the negative adverse effect to the patient. This may e.g. imply that a large number of patients have to be treated under certain conditions to achieve a 10-20 % reduction in risk for a certain disease. Some, but not all, of the treated patients will benefit by the treatment, while all of them will face the risk of adverse effects. There are no accepted methods to evaluate the balance between the good and bad effects of such drugs in a scientifically accepted way. Furthermore, adverse effects in the environment or in the society in general are not included in this evaluation.
The impact of manufacturing
The contemporary manufacturing and consumption of human medicines is not sustainable. A large fraction of the global production of human medicines takes place in India or China, and this production is not accurately controlled by the respective national authorities. This results in large emissions of drug residues into local water streams, yielding health and water supply problems to the local population. It has also been reported that new resistance mechanisms develop in these streams due to high concentrations of antibiotic residues (Dumped drugs lead to resistant microbes. Published online 16 February 2011 | Nature | doi:10.1038/news.2011.46). People in the industrialised world who buy these pharmaceuticals thus enjoy low prices for their medicines, while at the same time contributing to environmental and human health problems in the manufacturing country.
The way forward
What can we do to change manufacturing practices and drive the use of human medicines in a more sustainable direction? Improved legal requirements may be one solution, but this is usually a very slow process. These changes can be facilitated by national or international opinions, by feeding decision makers with accurate information, and by supporting selected interested politicians in votes.
But the most rapid step to take is probably to increase consumer pressure on the pharmaceutical producers. No company can afford to develop products that do not sell.
If healthcare organisations, patients and citizens put questions to the producers about a sustainable manufacturing process, and about the necessity to diminish the environmental burden caused by their products after they have been used, the producers will react.
Furthermore, if society and the healthcare system educate all citizens that every person has the primary responsibility to his/her own health, we may be able to move towards a society with lower consumption of drugs and more healthy behaviour.
No tobacco consumption, moderate intake of alcoholic beverages, light or moderate physical exercise at least half an hour per day, and safe weight are important steps towards a long and healthy life, in which regular intake of medicines is not a necessary ingredient.
Suggestions for further reading:
Kümmerer, K. (ed.) Pharmaceuticals in the environment.(1-521) Springer Verlag Berlin Heidelberg (3rd ed. 2008)
Ruden , Christina; Liljelund, Karin; Hagerman, Helene (eds) Towards sustainable pharmaceuticals in a healthy society. MistraPharma 2010(distrib) ISBN978-91-978836-0-3. To be ordered from firstname.lastname@example.org.
Prof Ake Wennhalm works for SustainPharma, a Swedish health care consultancy which works to promote a sustainable pharmaceutical industry. Prof Ake has 10 years experiecen as a university professor of Clinical Physiology at Sahlgrenska Academy, University of Gothenburg. He has also spent 10 years as the Environmental Director at the Stockholm County Council. In this position he was responsible for all aspects of environmental management, including developing environmental performance programmes, supporting their implementation in the different working arenas (including public health care and public transportation) and follow up of the results of the environmental achievements. The environmental impact of pharmaceuticals was identified as a significant target already in 2001.