SETAC Pharmaceuticals Advisory Group Workshop Summary
Thomas Backhaus, University of Gothenburg, Alistair Boxall, University of York, Andreas Hartmann, Novartis, Silke Hickmann, UBA, Mike Williams, CSIRO
During the SETAC Europe 24th Annual Meeting in Basel, Switzerland, the SETAC Pharmaceuticals Advisory Group (PAG) held a half-day workshop titled “Weighing Up the Environmental Costs of Pharmaceutical Use Against the Benefits to Human and Animal Health and Costs of Risk Management.” The purpose of this workshop was to look at the issue of pharmaceuticals in the environment in a broader context and particularly to reframe the discussion around this issue in terms of weighing the overall benefits and potential costs that the presence of these compounds in ecosystems present. That is, while pharmaceuticals have an enormous societal benefit by improving the quality of life through the treatment of disease, there are a number of potential costs that also need to be considered following their post-therapeutic discharge into the environment. For example, management of the issue may lead to monetary costs related to employing advanced technologies for the treatment of wastewater or drinking water.
The workshop was well-attended with approximately 50 people. The majority of participants were from academia and the pharmaceutical industry. This was an excellent means of beginning the general SETAC meeting and gave a valuable broader context to consider when viewing the more technically driven pharmaceuticals stream on Tuesday, 13 May.
The invited speakers were representative of a broad range of interests, including health economics (Bengt Jönsson), government environmental agencies (Gerd Maack), the pharmaceutical industry (David Taylor), the wastewater industry (Ruth Barden) and government policymakers (Caroline Whalley). Unfortunately, the late withdrawal of an environmental economist meant a detailed assessment of potential environmental costs was not discussed to complete the overall perspective.
Bengt Jönsson with the Stockholm School of Economics, however, was able to give a valuable primer on the principles of environmental economics to a largely scientific audience. Jönsson showed how a cost–benefit analysis in the environment is essentially composed of a balance between an environmental damage function and the cost of reducing the release of and exposure to pharmaceuticals. While there is a reasonable straightforward approach (if you are an economist!) for assessing the societal and financial costs and benefits of the use of pharmaceuticals and mitigating their release into the environment, the environmental damage function is considerably more difficult to quantify. This is clearly an area where expertise within the SETAC community can help to define the extent of environmental effects to contribute to an understanding of this multifactorial (and harder to quantify) environmental damage function.
In light of the unknowns surrounding the ecological consequences of pharmaceuticals in the environment, Gerd Maack (UBA) highlighted a number of strategies for reducing inputs into the aquatic environment. Maack argued that despite our understanding of global concentrations in the environment and the potential consequences of these levels, there are a number of areas that could be targeted to reduce the amount of pharmaceuticals consumed, the way in which they are consumed and the routes into the environment post-therapy. For example, promoting rational use to consumers, education of healthcare providers, implementation of disposal schemes, targeted upgrades of wastewater treatment facilities and more careful application of veterinary medicines would greatly reduce environmental exposure.
David Taylor presented a thought-provoking counterpoint in which he provided a broader context of pharmaceuticals as environmental contaminants and their relative importance as environmental stressors. The main issue with pharmaceuticals seems to be related to our ability to detect lower and lower levels in recent years (analytical advances) without necessarily demonstrating this would be ecologically detrimental. Furthermore, Taylor reiterated a concept highlighted by Jönsson which emphasizes the need to define what we consider “acceptable environmental degradation” in a world largely modified through human influence and whether the presence of pharmaceuticals will push the limits of this definition.
Ruth Barden gave an overview of the water industry perspective in the UK. One overarching point was that the removal of pharmaceuticals through conventional wastewater treatment is highly variable and often poor. To consistently remove a larger proportion of pharmaceuticals, it requires higher-level treatments, which has associated costs to implement the technology. Also, more intensive treatments would carry higher environmental costs such as a considerably greater energy inputs. This raises the question about who will pay for such increases in costs and what treatment level gives an ecologically appropriate removal of pharmaceuticals; the industry is still highly receptive to good quality data that can provide answers to these questions!
Caroline Whalley finished the formal session by outlining the number of factors that are taken into consideration for developing policy on environmental protection. In short, there are many! And where there is a substantial amount of money and a number of other socioeconomic, human health and environmental health factors to consider in decision-making, the availability of evidence relating to impacts of pharmaceuticals in the environment becomes even more critical.
A discussion session following the presentations suggested that workshop participants had a good appreciation of the need for balancing the obvious human health and socioeconomic benefits with mitigating the inputs of pharmaceuticals into the environment. It became more apparent during the discussion session that our role in conducting high-quality research on pharmaceuticals in the environment, which can effectively inform policymakers in conjunction with industry, is becoming even more critical to ensure the effective use of public and private money to protect the environment.
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