Description
Introduction:
The health system has a significant environmental impact, constituting 5-10% of greenhouse gas emissions. Approximately 25-33% of the emissions can be attributed to prescribed drugs. In addition to their impact on climate change, drugs also play a role in causing biodiversity loss and bacterial multiresistance, which are also among the major threats to humanity in the 21st century.
Concurrently, choosing Wisely (CW) recommendations have identified several large categories of waste which cross-cut clinical specialties, including avoiding unnecessary medication overuse that may cause more harm than benefits to patients . The major mobilization effort of CW campaigns can be leveraged for climate co-benefits. Whether it concerns effects on human health or the environment, it is considered that the least harmful drug is one that is not produced nor prescribed. To the best of our knowledge, there is no published data combining the principles of CW campaign and of environmental health. For this reason, we decided to rely on both approaches in this pragmatic analysis about the double harm (low clinical value and high environmental impact) related to some categories of drugs
Methods:
We gathered the primary drug categories featured in the top five lists across all medical specialties associated with the Smarter Medicine Switzerland campaign . These drugs are identified as having minimal or low added clinical value in specific clinical settings. Then we started a pragmatic review of the main ecotoxicological data about these drugs by using the following MeSH terms on Pubmed and Google Scholar: ecotoxicology (or) environment (or) climate AND the name of each specific drug or category of drugs. Finally, we will categorize each of them depending of their level of environmental harm and publish a top five list of drugs of common use, with a low added clinical value and/or good alternatives, and a high environmental impact.
Results :
Through a rapid face validation process among the working group, we identified the following drugs that raise environmental concerns and offer either no or low added value for our patients. They can be readily substituted with similarly effective alternatives:
- Inhaled bronchodilators and corticosteroids
- Flurorinated anesthetics (desflurane, sevoflurane) and nitrous oxide
- Some antibiotics, in some indications (50%-90% of antibiotic presciptions in ambulatory medicine are inappropriate)
- Non steroidal anti-inflammatory drugs
- Benzodiazepines and antidepressants
Definitive results will be available in March 2024.
Conclusions :
After decades of remarkable development, medicine is facing new challenges, that include defining the values, objectives, and tasks of sustainable medicine. Reducing unnecessary drugs prescriptions impact individual patients’ quality of care by decreasing potential drug interactions and side effects, and can also decrease planetary harm by curbing pharmaceutical supply chain emissions and reduce ecotoxicity. To achieve this, it is imperative to shift away from siloed thinking and embrace collaborative models that consider not only effectiveness but also the human, social, environmental, and economic costs associated with drugs. An approach that integrates data from CW Smarter Medicine and environmental health serves as a paradigm for such a model.
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