Cutting emissions by drug industry is crucial to reducing NHS’s carbon footprint

BMJ 2012; 345 doi: (Published 03 December 2012) Cite this as: BMJ 2012;345:e8243

Re: Cutting emissions by drug industry is crucial to reducing NHS’s carbon footprint

Post-Industrial age, technological progress has enhanced the quality of our existential experience. At the same time the paradoxical extinction level risk posed by this progress is attracting scientific attention.[1] Anthropogenic climate change is one such offspring of the technological march, progress in artificial intelligence, biotechnology ( artificial life) and nanotechnology being its siblings.[1] An attempt to shrink the carbon footprint of medical practice as attempted by studying the drug manufacturing process is laudable given the dominance of drugs /devices and their manufacturing in the carbon shadow.

The dominant role of chemical engineering involved, exhorts us to think about the necessity of manufacturing molecules that are easily provided for by the nature and may not be necessary in our armamentarium i.e. nutraceuticals. Application of modern scientific methodology to quantify the proclaimed and perceived benefits of nutrients in food items is scientifically welcome. But, their commercial exploitation, by marketing the extracts of dubious therapeutic value, is unscientific.[2] Curcumin from turmeric, Peprin from black pepper, fenugreek seed extract and extract of cranberries are examples of some such nutraceuticals. Extract manufacturing of these must be as big a carbon concern as with the drugs, if not more. These molecules, a product of zero carbon technology i.e. photosynthesis, should not become the wheels reinvented, adding to the existing carbon concerns.

Medical scientists, need to study the relative benefits of delivering these nutraceuticals either as part of wholesome dietary advice or as a prescribed commercial molecule. Climate concerns of the evolving world call upon us to incorporate ‘holistic thinking’ approach in our practice in addition to the ‘Head, Heart and Hands’ trilogy of Cushing’s virtues.[3] Such an environmental consciousness will add more than a drop to the ocean of carbon-consciousness and keep us away from the sin of environmental pollution.[3] We must act, lest medicine becomes ‘medisin’[4] which itself seems to be a portmanteau, like nutraceutical is.

1.The Cambridge Project for Existential Risk.
2.Jepson RG, Williams G, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.: CD001321. DOI: 10.1002/14651858.CD001321.pub5
3.Agarwal BB. Journey of the carbon-literate and climate-conscious endosurgeon having a head, heart, hands, and holistic sense of responsibility. Surg Endosc. 2008 ;22(12):2539-40
4.Agarwal BB, Agarwal S. Surgical pilgrimage - the need to avoid navigation through drains, medicine or 'medisin': our notes on NOTES. Surg Endosc. 2008 ;22(1):271-2

Competing interests: No competing interests

14 December 2012
Nayan Agarwal
MBBS Student
Krishna A. Agarwal, Brij B. Agarwal
University College of Medical Sciences & Vardhman Mahavir Medical College, New Delhi, India.
Dr. Agarwal's Surgery & Yoga, F-81 Street# 4, Virender Nagar, New Delhi-110058. India