The Pharmaceutical Journal
Vol 270 No 7251 p751
31 May 2003

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A small increase in waste is a reasonable trade-off for safety — the “green” view

By Richard Lawson

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Patient packs trade treatment concordance with the risk of a small increase in the waste stream. It is a reasonable trade-off. The modern myth is that the world will be saved by the recycling efforts of millions of individuals. It is a myth, because to develop sustainability will take more than the effort of individuals; it will require Governments and industry to take a more active interest in the fundamental laws that underpin our existence.

The inescapable fact is that we have to minimise the throughput of materials: the old linear process of mining, manufacturing, use and disposal is simply not sustainable, because we live in a finite world, and it is not possible to take forever from a finite source.

As a general practitioner with a long time interest in environmental affairs, I experience a tiny pang of conscience each time I throw away a used needle but, at the same time, I accept the imperatives that lie behind medical disposables. The environmental imperative is to reuse and recycle; the medical imperative is to use and dispose. In this case the environmental imperative gives way to the medical with grace and tolerance, not least because we have other battles to fight, with weightier outcomes. De minimis non curantur lex — the law does not worry about tiny things (although sometimes one wonders if the European Commission is familiar with that particular line of Latin).

Therefore the Green Party does not object to the general introduction of patient packs on grounds of increases in the waste stream, because of their obvious advantages in terms of the convenience and safety of patients. As a user of medicines myself, I know that I often miss out the morning aspirin because time is too short to twist off the lid, shake some out, put all except one back and replace the lid. It is so much easier to pop the pack and pop it down.

We would, however, greatly prefer single material packs rather than packs made of two or more materials. Simple aluminium foil packs are preferable to those made of a combination of cardboard, plastic and foil, because it is difficult if not impossible to recycle combined materials, whereas used aluminium foil packs can go straight into the aluminium waste stream. If plastic is preferred for other reasons, the packs should be redesigned so that they consist of only one type of plastic, clearly imprinted with its generic name to facilitate recycling in the future.

It may be objected that since we lag so far behind in the race for sustainability, the vast majority of waste in the United Kingdom will miss the recycling stream by miles, and so the practical effects of the greener choice is negligible. Here we come face to face with the eternal dilemma of green action: in doing the right thing, I am not going to have any relevant practical effect unless everyone else does the same thing. On the other hand, if I do not do it, why should anyone else do it?

There is another waste issue concerned with medication: if the law bans all bulk packaging of tablets and capsules, there is a waste of time and materials in the case of the growing numbers of elderly patient whose medicines are put out in monitored dosage system (MDS) boxes. It is quicker for the pharmacist to work from a bottle of tablets than to have to pop them out one by one from a patient pack. MDS boxes are a real boon to the patient, but a pain to the community pharmacist, who has extra work without a clear line of payment for it. It is typical of the inefficiency of the Department of Health that despite the trumpetings about their commitment to improved patient care, they have been unable to make payment available for this excellent patient service.

It is to be hoped that bottles filled with loose tablets and capsules will be available for professional use. New regulations often start out as immutable certainties, only to shake down into more practical ways of working as time wears on.

In the end, the bad news is that patient packs means that the waste stream will be swollen with mixed material rubbish that cannot be recycled; the good news is that the degree of swelling will be infinitesimally small, and that thousands of patients every day will have a direct answer to the question, "Now have I taken my pill today?".

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