May 22, 2014 by David Taylor

At the recent SETAC (Europe) meeting in Basel the SETAC Pharmaceutical Advisory Group organised a workshop to consider environmental cost/benefit arising from the use of pharmaceuticals. The full title of the event was “Weighing up the environmental costs of pharmaceutical use against the benefits to human and animal health and costs of risk management”. I was invited by Novartis to provide an independent industry input into the workshop and my presentation can be found here.

There were five invited speakers providing different perspectives:

  • Bengt Jönsson (Stockholm School of Economics) Health Economics
  • Gerd Maack (UBA) Environmental Regulator
  • David Taylor (wca) Pharmaceutical Industry
  • Ruth Barden (WessexWater) Water industry
  • Caroline Whaley (UK DEFRA) Government Policy advisor

A well tempered discussion followed the presentations from which a number of conclusions emerged:

The tools to undertake environmental cost benefit analysis in situations like this are already well established. However, this cannot be satisfactorily undertaken because of the absence of any quantifiable environmental damage attributable to pharmaceuticals. Current concerns are precautionary in nature rather than explicit.

There appeared to be a growing acceptance that the issue was no longer about the presence of pharmaceuticals in general in the environment but only that some pharmaceuticals might be of concern.

Since environmental residues of pharmaceuticals are mainly derived from patient use there are only two mechanisms available to reduce environmental exposure levels a) end of pipe treatment at wastewater treatment facilities or b) restrictions on prescribing. Both are fraught with difficulties, especially if major reductions in exposure are deemed to be necessary.

Effluent treatment costs in terms of money and energy will be very large and such expenditure will need to be justified both to decision makers and to the public, who will eventually provide the money, e.g. €20b spent on removing ethinylestradiol from UK wastewaters is not then available to be spent on other things.

Restrictions on prescribing or over the counter availability will inevitably create tensions in the medical and patient communities. It will therefore be essential to be able to demonstrate significant environmental improvement arising from these measures.