Parker Gillian, Miller Fiona A
Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M6, Canada.
Collaborative Centre for Climate, Health & Sustainable Care, University of Toronto, Toronto, ON M5T 3M6, Canada.
Pharmacy (Basel). 2024 Nov 22;12(6):173. doi: 10.3390/pharmacy12060173.
Pharmaceuticals produce considerable environmental harm. The industry's resource-intensive nature, coupled with high energy costs for manufacturing and transportation, contribute to the "upstream" harms from greenhouse gas emissions and ecosystem pollution, while factors such as overprescription, overuse, and pharmaceutical waste contribute to the "downstream" harms. Effectively addressing pharmaceutical pollution requires an understanding of the key roles and responsibilities along the product lifecycle. In this commentary, we argue that three actors-producers, regulators, and prescribers-have unique and interdependent responsibilities to address these issues. Producers and market access regulators are upstream actors who can manage and mitigate harms by both shifting manufacturing, business practices, and regulatory requirements and producing transparent, robust data on environmental harms. By contrast, prescribers are downstream actors whose capacity to reduce environmental harms arises principally as a "co-benefit" of reducing inappropriate prescribing and overuse. Potentially complicating the prescriber's role are the calls for prescribers to recommend "environmentally preferable medicines". These calls continue to increase, even with the sparsity of transparent and robust data on the impact of pharmaceuticals on the environment. Recognizing the interdependencies among actors, we argue that, rather than being ineffectual, these calls draw needed attention to the critical responsibility for upstream actors to prioritize data production, reporting standards and public transparency to facilitate future downstream efforts to tackle pharmaceutical pollution.
制药行业对环境造成了相当大的危害。该行业资源密集的性质，再加上制造和运输所需的高昂能源成本，导致了温室气体排放和生态系统污染带来的“上游”危害，而过度开药、过度使用和药品废弃物等因素则造成了“下游”危害。有效应对药品污染需要了解产品生命周期中各关键角色及其责任。在本评论文章中，我们认为生产商、监管机构和开处方者这三个行为主体在解决这些问题上有着独特且相互依存的责任。生产商和市场准入监管机构是上游行为主体，它们可以通过改变生产方式、商业行为和监管要求以及提供有关环境危害的透明、可靠数据来管理和减轻危害。相比之下，开处方者是下游行为主体，他们减少环境危害的能力主要源于减少不当开药和过度使用所带来的“附带效益”。要求开处方者推荐“对环境更友好的药物”可能会使开处方者的角色变得复杂。即便关于药品对环境影响的透明、可靠数据稀少，但此类要求仍在不断增加。认识到各行为主体之间的相互依存关系，我们认为，这些要求并非毫无作用，而是促使人们关注上游行为主体的关键责任，即优先开展数据生产、制定报告标准并提高公众透明度，以便为未来下游解决药品污染的努力提供便利。
