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Not a priority

I consider the Agenda in the The Journal (24/31 May 2014, p545) “Time to act: pharmacists must be prepared for environmental changes” to be controversial.

This article is based on an assumption that global warming is a given. I believe the jury is still out. However, from what I read it seems to be highly contentious politicised arena, where disinformation and vested interests are not uncommon and opponents are routinely discredited and categorised as deniers. Having been so categorised they, the deniers, can find difficulty in having subsequent work published in certain learned scientific journals.

Concerning environmental damage, if India is capable of producing nuclear weapons and about 70% of our generic medicines, it should be able to safely dispose of diclofenac residues and so protect its vulture population.

The article states the carbon footprint of pharmaceuticals is huge. Well, energy is needed to operate inter alia, mixers, ovens, autoclaves, fluid bed dryers, tableting presses, coating equipment and high-speed packing lines. It is also required to produce water for injection and to create the environmental conditions required for the manufacture of sterile products and their terminal sterilisation. There is no alternative.

I have spent 40 years in pharmaceutical manufacturing and quality assurance and would estimate that less than 50 per cent of this industry remains today in the UK. Any further legislative burdens will further reduce this figure with consequent attrition on job opportunities. For instance, it is stated the cost of the UK complying with the EU Water Framework Directory for 17-a-ethinylestradiol alone would be £20bn. If the water companies have to finance this they will pass it onto their customer base. If charged direct to the pharmaceutical industry it will make our home manufactured products more costly to the NHS who will then source them from countries where legislation such as this does not exist.

The authors suggest that the National Institute for Health and Care Excellence considers environmental impact when appraising drugs for use. Surely efficacy and cost are the paramount considerations here.

They also refer to deaths from heatwaves, figures given as 4,800 in France during the exceptional summer of 2003. This was a tragedy but, at the other end of the scale, do they know how many die each winter in the UK from hypothermia largely because some people cannot afford to switch the heating on because of energy prices already inflated with “green tariffs”?

The article suggests that community pharmacists should educate and support care workers to help vulnerable patients to change routines to adapt to these new (climatic) conditions and to lobby the pharmaceutical industry to produce “green” pharmaceuticals. I would have thought these two items are fairly low on the agenda of a typical busy community pharmacist struggling to cope with dispensing, patient advice, advanced services like medicines use reviews and management duties. I am sure most patients awaiting diagnosis and treatment by their GP could not care less if the medicine is “green” or not as long as it works.

Finally, the authors mention bodies such as NHS Sustainable Development Unit and the Carbon Trust. I wonder how much these units and quangos cost the taxpayer and, in the case of the former, would this money not be better spent on more nurses and better facilities?

David L. Norris

Loughborough, Leicestershire

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2014.11139039

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