Suchen und Finden
Foreword
5
Preface and Scope of the Book
6
Contents
9
Contributors
12
Part I General Aspects
15
1 Why Green and Sustainable Pharmacy?
16
1.1 How It Began
16
1.2 Why Green and Sustainable Pharmacy?
18
References
22
2 Pharmaceuticals in the Environment: Moving from a Problem to a Solution
24
2.1 Introduction
24
2.1.1 Problem 1: Many Pharmaceuticals Are Present in the Environment
25
2.1.2 Problem 2: Some Pharmaceuticals Have Been Shown to Have Adverse Effects on Wildlife
26
2.1.2.1 Feminisation of Fish by EE2
26
2.1.2.2 Acute Poisoning of Oriental Vultures by Diclofenac
28
2.1.3 Problem 3: Drinking Water May Be Contaminated with Human Pharmaceuticals
29
2.2 Possible Solutions to the Problems Created by Pharmaceuticals in the Environment
31
2.2.1 Solution-1: Develop ''Greener'' Pharmaceuticals
31
2.2.2 Solution-2: Prevent Pharmaceuticals Reaching the Environment
32
2.2.3 Solution-3: Improve the Efficiency of STWs
32
2.3 Conclusions
33
References
33
3 Pharmaceuticals in Society
36
3.1 Introduction
36
3.1.1 Global Challenges Require Global Cooperation
37
3.2 Tomorrows Pharmaceuticals: The Drug Discovery Process
37
3.2.1 Unrealized Potential
39
3.3 Tomorrows Drug Development: Alternative Models
40
3.3.1 No Money, No Drugs?
41
3.3.2 Supporting New Models
41
3.4 Alternatives to Pharmaceuticals: The Role of Public Health
42
3.4.1 Bad Habits as a Disease
42
3.4.2 The Expanding Scope of Lifestyle Drugs
43
3.4.3 Wealth and Health
43
3.5 The Road Ahead: Promises and Problems
44
3.5.1 Who Owns the Genes?
44
3.5.2 New Safety Concerns
45
References
46
4 Green(er) Pharmacy
49
4.1 Introduction
49
4.2 What Is a Pharmaceutical?
51
4.3 Standardised Methods of Measuring Greenness Across the Whole Lifecycle
52
4.4 Raw Materials and Pre-manufacturing
54
4.4.1 Raw Materials
54
4.4.2 Pre-manufacturing
55
4.4.2.1 Lead Identification
55
4.4.2.2 Lead Optimisation/Medicinal Chemistry
57
4.4.2.3 Candidate Selection
58
4.5 Manufacturing and Production
58
4.5.1 Process Chemistry
58
4.5.1.1 Process Chemistry: Clean Synthesis
58
4.5.1.2 Process Chemistry: Solvents
61
4.5.1.3 Process Chemistry: New Technologies
62
4.6 Product Use and Fate
63
4.6.1 Drug Efficacy and Delivery as Green Pharmacy
64
4.6.2 End-of-Life Issues
65
4.7 Engaging Key Stakeholders Across the Lifecycle
67
4.7.1 The Perceived Problem of Green Pharmacy?
67
4.7.2 The Opportunity of Green Pharmacy?
68
4.8 Conclusions
69
References
69
5 Creating a Sustainability Culture A (Human Resources) Management Perspective for Sustainable Pharmacy
72
5.1 Introduction: From Crisis to a New Business Platform
72
5.2 Clarifying Some Terms
73
5.2.1 CSR, CC, CS
73
5.2.1.1 Corporate Sustainability Management
74
5.2.2 Stakeholder Theory/Shareholder vs. Stakeholder Value
75
5.2.2.1 Pharma's Stakeholder Perspective
76
5.3 Business Case for Corporate Sustainability
76
5.3.1 Business Benefits as a Fact
78
5.3.2 Creating Win--Win
79
5.3.3 Testimonials
79
5.4 Implementation Challenges
79
5.4.1 Sustainability at the Core
80
5.4.2 Communications and Transparency
80
5.4.3 Metrics
80
5.4.4 Changing Behaviors and Attitudes
81
5.5 Creating a Sustainability Culture
81
5.5.1 Culture Change
81
5.5.2 Wanted: Role Models
83
5.5.3 Hard-Wire/Soft-Wire
83
5.5.4 Sustainability as Part of Company Fabric
84
5.5.5 Colleague Engagement
84
5.5.6 Feedback Loops
85
5.6 Going Forward
85
Bibliography
86
6 Reducing the Ecological Footprint of Pharmaceutical Usage: Linkages Between Healthcare Practices and the Environment
88
6.1 Introduction
88
6.2 Improving the Efficiency of Pharmacy
93
6.2.1 Mining of Healthcare Data
93
6.2.2 Electronic Systems
94
6.3 Personalized Medicine A Framework for a Sustainable Pharmacy
95
6.4 Pharmacogenomics (PGx)
97
6.5 Outlook for Personalized Medicine Extending the Focus from Treating Symptoms to Achieving Efficacious Therapeutic Outcomes
100
6.6 Improving Drug Delivery and Chemistry by Design
102
6.7 Pharmaceutical Care: An Avenue to Improved Health Care and Reduced Environmental Footprint
105
6.8 PharmEcovigilance: Vision for Optimal Integration of Medications Environmental Footprint, Healthcare Effectiveness, and Sustainability
107
References
108
Part II Development, Synthesis and Production and Distribution of Pharmaceuticals
114
7 Ecopharmacostewardship A Pharmaceutical Industry Perspective
115
7.1 The Stakeholders
116
7.2 Greener Drug Design
117
7.2.1 Degradable Pharmaceuticals
119
7.2.2 Current Improvements in Drug Design
120
7.3 Sustainability in Research, Manufacturing, Sales and Distribution
122
7.3.1 Sustainability in R&D and Manufacturing
123
7.3.2 Sales and Distribution
126
7.4 Product Use and Disposal
127
7.4.1 Unused Medicines
128
7.4.2 Excreted Medicines
129
7.4.3 Ecopharmacovigilance
131
7.5 Conclusions Reducing the Uncertainties
133
References
134
8 Protein and Peptide Therapeuticals: An Example of Benign by Nature Active Pharmaceutical Ingredients
137
8.1 Introduction
137
8.2 Materials and Methods
137
8.2.1 Substances Tested
138
8.2.2 Tests Performed
138
8.2.3 Results
138
8.2.3.1 Biodegradability
138
8.2.3.2 Ecotoxicity
140
8.3 Discussion
141
8.4 Conclusion
142
References
143
9 Rational Design of Molecules by Life Cycle Engineering
144
9.1 Introduction
144
9.2 Benign by Design
147
9.2.1 Safe and Sustainable Molecules
147
9.2.2 Stability of APIs
148
9.2.3 Stability vs. Reactivity
149
9.2.4 The General Approach
151
References
153
Part III Use and Disposal of Pharmaceuticals
156
10 Options for a More Environmentally Friendly Handling of Pharmaceuticals
157
10.1 Background
157
10.2 Objectives of Strategic Considerations
157
10.3 Approach
159
10.4 Results Strategic Approach of Behaviour Modification
160
10.4.1 Creating Parameters and Environmental Classification for Pharmaceuticals
161
10.4.2 Bringing About Change to Problem Awareness Amongst Doctors and Pharmacists
163
10.4.3 Avoidance and Reduction of Pharmaceutical Consumption
164
10.4.3.1 Controlling the Demand for Pharmaceuticals Through Transparent Costs and Quantities and via Co-payment
164
10.4.3.2 Prescribing Options that Don't Involve Drugs
165
10.4.4 Disposal of Medicines
166
10.5 Discussion and Consequences
167
10.6 Recommendations and Outlook
169
References
170
11 Disposal of Pharmaceutical Waste in Households A European Survey
172
11.1 Pharmaceutical Waste Reducing the Environmental Burden
172
11.2 Legislation
173
11.3 The EEA Questionnaire on Disposal of Unused Pharmaceuticals in Households
173
11.4 Educating and Informing Citizens
174
11.5 Amounts of Pharmaceutical Waste
176
11.6 Classification of Pharmaceutical Waste
178
11.7 Collection Points for Pharmaceutical Waste
178
11.8 Consumer Behaviour and Return Rate
180
11.9 Participation of Pharmacies as a Legal Duty?
182
11.10 Conclusions
183
References
184
12 Pharmaceutical Waste: The Patient Role
186
12.1 What Makes Pharmaceutical Waste a Problem?
186
12.2 Proper Pharmaceutical Waste Management
187
12.3 Objective and Methodology of This Review
188
12.4 Pharmaceuticals Wasted
189
12.4.1 How Are Pharmaceuticals Disposed of ?
189
12.4.2 Type and Volume of Disposed Pharmaceuticals
189
12.4.3 How Much Is Left in the Package After Use and How Old Are Pharmaceuticals that Are Disposed of ?
193
12.5 The Patient Behind the Wasted Pharmaceuticals
193
12.5.1 Return Patterns of Unwanted Pharmaceuticals
193
12.5.2 Reasons for Unwanted or Leftover Drugs
197
12.6 Sustainable Drug Use
202
12.7 Conclusion
202
References
203
13 Forecast of Pharmaceutical Consumption in the Netherlands Using Demographic Projections
208
13.1 Demographic Make-up of Population Influences Burden of Disease
208
13.2 Pharmaceutical Consumption in the Netherlands in 2007
208
13.3 Forecast of Pharmaceutical Consumption up to 2020 Based on Demographic Projections
210
13.4 European Perspective of the Dutch Forecasts
211
13.5 Discussion
214
References
214
Part IV Emission Management
216
14 Point Sources of Human Pharmaceuticals into the Aquatic Environment
217
14.1 Sources of Human Pharmaceuticals
217
14.2 Hospital Effluents
218
14.3 Manufacturing Sites
225
14.4 Conclusion
227
References
228
15 Pharmaceuticals for Human Use: An Integrated Strategy for Reducing the Contamination of Water Bodies
230
15.1 Introduction
230
15.2 The Current Legal Situation
231
15.3 Risk and the Precautionary Principle
233
15.4 Options of Action for Reducing the Contamination of Water Bodies
234
15.4.1 Sphere of Activity ''Drug Development''
234
15.4.2 Sphere of Activity ''Handling of Drugs''
235
15.4.3 Sphere of Activity ''Technical Emissions Control in Urban Water Management''
238
15.5 Discussion
239
15.5.1 Sphere of Activity ''Drug Development''
240
15.5.2 Sphere of Activity ''Handling of Drugs''
241
15.5.3 Sphere of Activity ''Emissions Control in Urban Water Management''
242
15.6 Towards an Integrated Strategy
243
15.7 Conclusions
244
References
245
16 Experiences with the Swedish Environmental Classification Scheme
247
16.1 Background
247
16.1.1 The Stockholm Model for Environmental Classification of Human Medicines
248
16.1.2 The Swedish Model for Environmental Classification of Human Medicines
249
16.2 Outcome and Experiences of the Risk and Hazard Assessments
251
16.3 Comments on the Experiences of the Swedish Model
252
References
253
Part V Incentives, Regulation and the Market
254
17 European Regulations
255
17.1 Introduction
255
17.2 Policy Framework at EU Level
255
17.2.1 Medicinal Regulations and Policies
256
17.2.1.1 Product Authorisation and Environment Risk Assessment
256
17.2.1.2 Drug Take-Back Schemes
260
17.2.2 Environmental Protection Regulations and Policies
261
17.2.2.1 Water Policies
261
17.2.2.2 Other Environmental Policies and Initiatives
266
17.3 Discussion of Current Policy Instruments
268
17.3.1 Policy Framework in the Light of the Precautionary and Prevention Principles
269
17.3.2 Policy Framework and End-of-Pipe Solutions
273
17.3.3 What Complicates Further EU Policy Development to Limit Discharge of PPs into Waters?
274
References
277
18 Regulation and the Market-Incentives
280
18.1 Introduction
280
18.2 Strategies for the Increased Development of Greener Pharmaceutical Products
280
18.3 Strategies for Integrating Education and Awareness of the Issues Surrounding the Environmental Impacts of PPs
284
References
285
19 Do Pharmaceuticals in the Environment Present an Investment Risk?
287
19.1 Bank Sarasins Sustainable Investments
287
19.2 Sustainability Aspects of the Pharmaceutical Industry
287
19.3 A New Theme: Pharmaceuticals in the Environment
288
19.4 Concentrations Very Low, Risks Not Adequately Researched
288
19.5 Activities of the Pharmaceutical Industry
289
19.6 Green Drug Design
289
19.7 Water Utilities Concerned About Higher Costs
290
19.8 No Plans for Tougher Legislation
290
19.9 Consumers Wear Different Hats
291
19.10 Drug Residues Are Still a Controversial Topic
291
19.11 Sustainably Minded Investors Should Keep an Eye on This Theme
292
References
292
Part VI Outlook
293
20 Sustainable Health Products and Service Solutions in the Year 2050
294
20.1 Introduction
294
20.2 Drivers
294
20.3 Criteria for Sustainable Health Products and Services in the Year 2050
295
20.3.1 Manufacturing
295
20.3.2 Prevention and Diagnosis
295
20.3.3 Services and Products
296
20.3.4 Post Treatment
296
20.3.5 Social Aspects
296
20.4 Environment
296
20.5 Conclusion
296
21 Summary and Outlook
298
21.1 The Presence of Pharmaceuticals in the Environment
298
21.2 Sustainable Pharmacy
298
21.3 Raw Materials
299
21.4 Synthesis and Manufacturing
299
21.5 Drug Targeting and Drug Delivery on Site
299
21.6 Benign by Design
300
21.7 Stakeholders
300
21.8 (Advanced) Sewage Treatment
300
21.9 Incentives
301
21.10 Outlook
301
Index
303
Alle Preise verstehen sich inklusive der gesetzlichen MwSt.