Skip to main content
SpringerLink
Log in

Reducing the Ecological Footprint of Pharmaceutical Usage: Linkages Between Healthcare Practices and the Environment

  • Chapter
  • First Online:
Green and Sustainable Pharmacy

Abstract

The design of pharmaceuticals and the practices surrounding the lifecycle of their manufacture and usage are central to minimize their impacts on the environment and increase the sustainability (see Kümmerer, Chaps. 1 and Chaps. 9, this book) of healthcare. Cradle-to-cradle design, as conceptualized by McDonough and Braungart, could play a key role in redesigning healthcare and reducing its environmental footprint (Daughton 2003). This chapter examines the following thesis involving the environmental sustainability of medication usage: “When actions designed to reduce the potential for environmental impact are integrated within the existing systems of pharmacopeia, pharmacy, and healthcare, significant natural collateral outcomes include improvements in the quality and efficiency of healthcare and in human well-being.” The major factors that could shape the future for sustainability of healthcare are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Adam GIR, Sanders R, Jonsson J (1999) The development of pharmacogenomic models to predict drug response. Trends Biotechnol 17, 30–33

    Article  Google Scholar 

  • Anonymous (2008) List of withdrawn drugs. Wikipedia. http://en.wikipedia.org/wiki/List_of_withdrawn_drugs

  • Baird D (2003) Veterinary medicines in natural ecosystems: Assessing the risks. J Vet Pharmacol Therapeut 26, 28–29

    Google Scholar 

  • Bajcar JM, Kennie N, Einarson TR (2005) Collaborative medication management in a team-based primary care practice: An explanatory conceptual framework. Res Social Adm Pharm 1, 408–429

    Article  Google Scholar 

  • BCG (December 2003) The hidden epidemic: Finding a cure for unfilled prescriptions and missed doses. The Boston Consulting Group. http://www.bcg.com/impact_expertise/publications/files/Hidden_Epidemic_Finding_Cure_Unfulfilled_Rx_Missed_Doses_Dec2003.pdf

  • Berenguer B, La Casa C, de la Matta MJ, Martin-Calero MJ (2004) Pharmaceutical care: Past, present and future. Curr Pharm Des 10, 3931–3946

    Article  CAS  Google Scholar 

  • Bernini P, Bertini I, Luchinat C, Nepi S, Saccenti E, Schäfer H, Schütz B, Spraul M, Tenori L (2009) Individual human phenotypes in metabolic space and time. J Proteome Res 8, 4264–4271

    Google Scholar 

  • Borisy AA, Elliott PJ, Hurst NW, Lee MS, Lehár J, Price ER, Serbedzija G, Zimmermann GR, Foley MA, Stockwell BR, Keith CT (2003) Systematic discovery of multicomponent therapeutics. Proc Natl Acad Sci USA 100, 7977–7982

    Article  CAS  Google Scholar 

  • Boxall ABA (2002) The environmental side effects of medication – How are human and veterinary medicines in soils and water bodies affecting human and environmental health? Embo Reports 5, 1110–1116

    Article  Google Scholar 

  • Carbone AL, Song M, Uhrich KE (2008) Iodinated salicylate-based poly(anhydride-esters) as radiopaque biomaterials. Biomacromolecules 9, 1604–1612

    Article  CAS  Google Scholar 

  • Clark J, Summerton L, Smith E, Kampa E, Vidaurre R, Touraud E (2007) Discussion document on eco-pharmacostewardship. KNAPPE: Knowledge and Need Assessment on Pharmaceutical Products in Environmental Waters. http://www.knappe-eu.org/fichiers/47-D5.1%20Ecopharmacostewardship%20disc%20doc.pdf

  • Clayton TA, Baker D, Lindon JC, Everett JR, Nicholson JK (2009) Pharmacometabonomic identification of a significant host-microbiome metabolic interaction affecting human drug metabolism. Proc Natl Acad Sci U S A (in press: 10.1021/pr900344m)

    Google Scholar 

  • Connor S. Glaxo chief: Our drugs do not work on most patients. The Independent, Independent News and Media Limited, London, England, 8 December 2003 http://http://www.independent.co.uk/news/science/glaxo-chief-our-drugs-do-not-work-on-most-patients-575942.html

  • Constable DJC, Dunn PJ, Hayler JD, Humphrey GR, Leazer JLJ, Linderman RJ, Lorenz K, Manley J, Pearlman Ba, Wells A, Zaks A, Zhang TY (2007) Key Green Chemistry research areas – a perspective from pharmaceutical manufacturers. Green Chem 9, 411–420

    Article  CAS  Google Scholar 

  • Costa LG, Eaton DL (eds.) (2005) Gene-Environment Interactions: Fundamentals of Ecogenetics. John Wiley & Sons, Hoboken, NJ

    Google Scholar 

  • Crimmins WF (2001) Disposing of expired drugs: A matter of policy. J Am Vet Med Assoc 218, 10

    CAS  Google Scholar 

  • Daemmrich A, Bowden ME (2005) Emergence of pharmaceutical science and industry: 1870–1930. Chem Eng News 83

    Google Scholar 

  • Daughton CG (2002) Environmental stewardship and drugs as pollutants. The Lancet 360, 1035–1036

    Article  Google Scholar 

  • Daughton CG (2003) Cradle-to-cradle stewardship of drugs for minimizing their environmental disposition while promoting human health. I. Rationale for and avenues toward a green pharmacy. Environ Health Perspect 111, 757–774

    Article  CAS  Google Scholar 

  • Daughton CG (2004) PPCPs in the environment: Future research – beginning with the end always in mind. In: Kümmerer K (ed.) Pharmaceuticals in the Environment: Sources, Fate, Effects and Risks, 2nd edn. Springer, Berlin, Germany

    Google Scholar 

  • Daughton CG (2007) Pharmaceuticals in the environment: Sources and their management. In: Petrovic M, Barcelo D (eds.) Analysis, Fate and Removal of Pharmaceuticals in the Water Cycle. Elsevier Science, Amsterdam

    Google Scholar 

  • Daughton CG (2008) Pharmaceuticals as environmental pollutants: The ramifications for human exposure. In: Heggenhougen K, Quah S (eds.) International Encyclopedia of Public Health. Academic Press, Oxford, England

    Google Scholar 

  • Daughton CG (2009) Chemicals from the practice of healthcare: Challenges and unknowns posed by residues in the environment. Environ Toxicol Chem 28, 2490–2494

    Google Scholar 

  • Daughton CG, Brooks BW (2011 – tentative) Pharmaceutical active ingredients in aquatic organisms. In: Beyer WN, Meador J (eds.) Environmental Contaminants in Biota: Interpreting Tissue Concentrations, 2nd edn. Taylor and Francis, Boca Raton, FL

    Google Scholar 

  • Daughton CG, Ruhoy IS (2008) The afterlife of drugs and the role of pharmecovigilance. Drug Safety 31, 1069–1082

    CAS  Google Scholar 

  • Daughton CG, Ruhoy IS (2009) Environmental footprint of pharmaceuticals – the significance of factors beyond direct excretion to sewers. Environ Toxicol Chem 28, 2495–2521

    Google Scholar 

  • DBU (2008) Strategies and perspectives for development, use and emission management of pharmaceuticals. 1st International Conference on Sustainable Pharmacy. Osnabrück, Germany, Deutsche Bundesstiftung Umwelt, 24–25 April. http://www.dbu.de/359.html

  • Ebi KL, Kovats RS, Menne B (2006) An approach for assessing human health vulnerability and public health interventions to adapt to climate change. Environ Health Perspect 114, 1930–1934

    Article  Google Scholar 

  • Eckerman I, Martineus J-C (1997) Medicines and the environment – what do we know today? In: Gray M (ed.) Swedish Association of Physicians for the Environment. Stockholm, Sweden. http://www.dnsy.se/_upload/lfm/medicines%20and%20the%20environment.pdf

  • eHealth Initiative (2008) eHealth Initiative. eHealth Initiative, Foundation for eHealth Initiative. Washington, DC. http://www.ehealthinitiative.org/

  • Ekedahl A (2002) Statistics on local drug sales: A tool to identify problem areas and to follow effects of education on drug use. Doctoral Dissertation, Department of Community Medicine, Malmö University Hospital, Lund University, Lund, Sweden, 54 pp, http://www.lub.lu.se/luft/diss/med638.pdf

  • Fichana D (2005) Green Engineering and Gate-to-gate Life Cycle Assessments for Pharmaceutical Products. Masters Dissertation, Rowan University, 142 pp, http://www.rowan.edu/library//rowan_theses/RU2005/0045GREE.PDF

  • Fugh-Berman A (2009). Speaking of Medicine: Medicine Community Blog, PLoS. http://speakingofmedicine.plos.org/2009/08/07/ghostwriting-101/

  • Galagan Y, Su WF (2008) Fadable ink for time-temperature control of food freshness: Novel new time-temperature indicator. Food Res Int 41, 653–657

    Article  CAS  Google Scholar 

  • Giacomini KM, Krauss RM, Roden DM, Eichelbaum M, Hayden MR, Nakamura Y (2007) When good drugs go bad. Nature 446, 975–977

    Article  CAS  Google Scholar 

  • Gorard DA (2006) Escalating polypharmacy. QJM 99, 797–800

    Article  CAS  Google Scholar 

  • Gunnarsson B, Wennmalm A (2008) Drug design should involve consideration of environmental risk and hazard. Lett Drug Des Discov 5, 232–235

    Article  CAS  Google Scholar 

  • HapMap (2008) International HapMap Project. The International HapMap Consortium. http://www.hapmap.org/

  • Haskell SRR, Ormond CJ, Occhipinti LP, Powers EL (2003) Waste management: Expired drugs. J Am Vet Med Assoc 223, 51–52

    Article  Google Scholar 

  • Henderson RK, Jimenez-Gonzalez C, Preston C, Constable DJC, Woodley JM (2008) EHS & LCA assessment for 7-ACA synthesis. A case study for comparing biocatalytic & chemical synthesis. Ind Biotechnol 4, 180–192

    Article  CAS  Google Scholar 

  • Hepler C, Strand L (1990) Opportunities and responsibilities in pharmaceutical care. Am J Health Syst Pharm 47, 533–543

    CAS  Google Scholar 

  • HHS (2009) Nationwide Health Information Network (NHIN). U.S. Department of Health & Human Services. Washington, DC. http://healthit.hhs.gov/portal/server.pt?open=512&mode=2&cached=true&objID=1142

  • Hoekstra AY, Chapagain AK (2007) Water footprints of nations: Water use by people as a function of their consumption pattern. Water Resour Manage 21, 35–48

    Article  Google Scholar 

  • Hudson KL, Holohan MK, Collins FS (2008) Keeping pace with the times – the genetic information nondiscrimination act of 2008. N Engl J Med 358, 2661–2663

    Article  CAS  Google Scholar 

  • IMS (2008) IMS Health Forecasts 4.5 – 5.5 Percent Growth for Global Pharmaceutical Market in 2009, Exceeding $820 Billion. IMS Health Incorporated. http://www.imshealth.com/portal/site/imshealth/menuitem.a46c6d4df3db4b3d88f611019418c22a/?vgnextoid=9e553599b554d110VgnVCM100000ed152ca2RCRD&vgnextfmt=default

  • IOM (2008) Knowing What Works in Health Care: A Roadmap for the Nation. Committee on Reviewing Evidence to Identify Highly Effective Clinical Services, Board on Health Care Services, Institute of Medicine, The National Academies Press, Eden J, Wheatley B, McNeil B, Sox H (ed). Washington, DC. http://www.nap.edu/catalog.php?record_id=12038

  • Joly BM, Polyak G, Davis MV, Brewster J, Tremain B, Raevsky C, Beitsch LM (2007) Linking accreditation and public health outcomes: A logic model approach. J Public Health Manag Pract 13, 349–356

    Google Scholar 

  • Kaitin KI, (ed.) (2005) Drug safety withdrawals in the US not linked to speed of FDA approval. Tufts CSDD (Center for the Study of Drug Development) Impact Report 7, 1–4

    Google Scholar 

  • Katsanis SH, Javitt G, Hudson K (2008) A case study of personalized medicine. Science 320, 53–54

    Article  CAS  Google Scholar 

  • Keil F (2008 – August) Pharmaceuticals for Human Use: Options of Action for Reducing the Contamination of Water Bodies: A Practical Guide. Institute for Social-Ecological Research (ISOE) GmbH and Research Project start (“Management Strategies for Pharmaceutical Residues in Drinking Water”). Frankfurt/Main, Germany. https://http://www.start-project.de/downloads/start_Practical_Guide.pdf

  • Khetan SK, Collins TJ (2007) Human pharmaceuticals in the aquatic environment: A challenge to green chemistry. Chem Rev 107, 2319–2364

    Article  CAS  Google Scholar 

  • Korobkin R, Rajkumar R (2008) The genetic information nondiscrimination act – a half-step toward risk sharing. N Engl J Med 359, 335–337

    Article  CAS  Google Scholar 

  • Krutzfeldt J, Rajewsky N, Braich R, Rajeev KG, Tuschl T, Manoharan M, Stoffel M (2005) Silencing of microRNAs in vivo with ‘antagomirs’. Nature 438, 685–689

    Article  Google Scholar 

  • Kuehn BM (2008) Traces of drugs found in drinking water: Health effects unknown, safer disposal urged. J Am Med Assoc 299, 2011–2013

    Article  CAS  Google Scholar 

  • Kümmerer K (2007) Sustainable from the very beginning: Rational design of molecules by life cycle engineering as an important approach for green pharmacy and green chemistry. Green Chem 9, 899–907

    Article  Google Scholar 

  • Kümmerer K, Velo G (2006) Ecopharmacology: A new topic of importance in pharmacovigilance. Drug Saf 29, 371–373

    Article  Google Scholar 

  • Kuspis DA, Krenzelok EP (1996) What happens to expired medications? A survey of community medication disposal. Vet Hum Toxicol 38, 48–49

    CAS  Google Scholar 

  • Levy W (2008) Peptide progress: Refined manufacturing and delivery promises more advanced drug offerings. Pharm Formulation & Quality 10, 28–30, 32

    Google Scholar 

  • Markle Foundation (2008) Connecting for Health. The Markle Foundation. http://www.connectingforhealth.org/

  • Martin-Calero MJ, Machuca M, Murillo MD, Cansino J, Gastelurrutia MA, Faus MJ (2004) Structural process and implementation programs of pharmaceutical care in different countries. Curr Pharm Des 10, 3969–3985

    Article  CAS  Google Scholar 

  • Mayer LD, Janoff AS (2007) Optimizing combination chemotherapy by controlling drug ratios. Mol Interv 7, 216–223

    Article  CAS  Google Scholar 

  • Microsoft (2009) Microsoft Amalga Unified Intelligence System 2009. Microsoft. http://www.microsoft.com/amalga/products/microsoftamalgauis/default.mspx

  • Mihelcic JR, Zimmerman JB, Ramaswami A (2007) Integrating developed and developing world knowledge into global discussions and strategies for sustainability. 1. Science and Technology. Environ Sci Technol 41, 3415–3421

    Article  CAS  Google Scholar 

  • Moynihan R (2008) Key opinion leaders: Independent experts or drug representatives in disguise? British Medical Journal 336, 1402–1403

    Article  Google Scholar 

  • NIH (2008) NIH Roadmap Initiatives. Office of Portfolio Analysis and Strategic Initiatives, National Institutes of Health Bethesda, Maryland. http://nihroadmap.nih.gov/initiativeslist.asp

  • Patz JA, Campbell-Lendrum D, Holloway T, Foley JA (2005) Impact of regional climate change on human health. Nature 438, 310–317

    Article  CAS  Google Scholar 

  • Pearson GJ (2007) Evolution in the practice of pharmacy–not a revolution! CMAJ 176, 1295–1296

    Article  Google Scholar 

  • Phillips DP, Barker GEC, Eguchi MM (2008) A steep increase in domestic fatal medication errors with use of alcohol and/or street drugs. Arch Intern Med 168, 1561–1566

    Article  Google Scholar 

  • Pinheiro C (2008) Drug donations: What lies beneath. Bull World Health Organ 86, 580–581

    Article  Google Scholar 

  • Pollack A. Pricing Pills by the Results. New York Times, New York Times, 14 July 2007 http://www.nytimes.com/2007/07/14/business/14drugprice.html?ref=health&pagewanted=all

  • PricewaterhouseCoopers (2005) Personalized medicine: The emerging pharmacogenomics revolution. PricewaterhouseCoopers GTC, Health Research Institute. http://www.pwc.com/techforecast/pdfs/pharmaco-wb-x.pdf

  • Rahman SZ, Khan RA (2006) Environmental pharmacology: A new discipline. Indian J Pharmacol 38, 229–230

    Article  Google Scholar 

  • Rees WE (1992) Ecological footprints and appropriated carrying capacity: What urban economics leaves out. Environ Urban 4, 121–130

    Article  Google Scholar 

  • Rosenberg J, Schilit S, Nathan J (2008) Which oral solid medications should be protected from light and/or moisture? Drug Topics 12 May, 25–27

    Google Scholar 

  • Ruhoy IS, Daughton CG (2008) Beyond the medicine cabinet: An analysis of where and why medications accumulate. Environ Int 34, 1157–1169

    Article  CAS  Google Scholar 

  • SACGHS (May 2008) Realizing the Potential of Pharmacogenomics: Opportunities and Challenges. Secretary’s Advisory Committee on Genetics, Health, and Society, chartered by U.S. Department of Health & Human Services (ed). http://www4.od.nih.gov/oba/sacghs/reports/SACGHS_PGx_Report.pdf

  • Sanderson K (2009) Big interest in heavy drugs. Nature 458, 269

    Article  CAS  Google Scholar 

  • Siddiqui IA, Adhami VM, Bharali DJ, Hafeez BB, Asim M, Khwaja SI, Ahmad N, Cui H, Mousa SA, Mukhtar H (2009) Introducing nanochemoprevention as a novel approach for cancer control: Proof of principle with green tea polyphenol Epigallocatechin-3-Gallate. Cancer Res 69, 1712–1716

    Article  CAS  Google Scholar 

  • Sismondo S (2007) Ghost management: How much of the medical literature is shaped behind the scenes by the pharmaceutical industry? PLoS Med 4, e286

    Article  Google Scholar 

  • Smolensky MH, Peppas NA (2007) Chronobiology, drug delivery, and chronotherapeutics. Adv Drug Deliv Rev 59, 828–851

    Article  CAS  Google Scholar 

  • Stockholm City Council (2008) Environmentally Classified Pharmaceuticals. http://www.janusinfo.se/imcms/servlet/GetDoc?meta_id=10205; via http://www.janusinfo.se/environment

  • Stoughton M, Votta T (2003) Implementing service-based chemical procurement: Lessons and results. J Cleaner Production 11, 839–849

    Article  Google Scholar 

  • Surescripts (2009) 2008 National Progress Report on E-Prescribing. Alexandria, VA: Surescripts LLC. http://www.surescripts.com/downloads/NPR/national-progress-report.pdf

  • Thayer AM (2008) Filling a highly potent niche: Drug companies want to create conjugates of potent drugs and biological molecules, and custom manufacturers are complying. Chem Eng News 86, 28–32

    Article  Google Scholar 

  • Tinetti ME (2008) Over-the-counter sales of statins and other drugs for asymptomatic conditions. N Engl J Med 358, 2728–2732

    Article  CAS  Google Scholar 

  • Trusheim MR, Berndt ER, Douglas FL (2007) Stratified medicine: Strategic and economic implications of combining drugs and clinical biomarkers. Nat Rev Drug Discov 6, 287–293

    Article  CAS  Google Scholar 

  • Tucker JL (2006) Green chemistry, a pharmaceutical perspective. Org Process Res Dev 10, 315–319

    Article  CAS  Google Scholar 

  • Tudor TL (2007) Towards the development of a standardised measurement unit for healthcare waste generation. Resour, Conserv Recycling 50, 319–333

    Article  Google Scholar 

  • UNIDO (2008) Chemical Leasing. United Nations Industrial Development Organization. Vienna, Austria. http://www.chemicalleasing.com/

  • US Congress (24 June 2008) H.R. 6357: PRO(TECH)T Act of 2008 (“Protecting Records, Optimizing Treatment and Easing Communication through Healthcare Technology Act of 2008”) 110th Congress, 2D Session, Washington, DC

    Google Scholar 

  • US EPA (2008a) Pharmaceuticals and Personal Care Products (PPCPs): Relevant Literature. US Environmental Protection Agency. http://www.epa.gov/ppcp/lit.html

  • US EPA (2008b) Green Chemistry Program at EPA. U.S. Environmental Protection Agency. http://www.epa.gov/gcc/pubs/epa_gc.html

  • US FDA (2008a) Table of Valid Genomic Biomarkers in the Context of Approved Drug Labels. Center for Drug Evaluation and Research, U.S. Food and Drug Administration. Rockville, MD. http://www.fda.gov/cder/genomics/genomic_biomarkers_table.htm

  • US FDA (2008b) FDA’s Sentinel Initiative: National Strategy for Monitoring Medical Product Safety. US Food and Drug Administration. http://www.fda.gov/oc/initiatives/advance/sentinel/

  • van Mil JWF, Schulz M, Tromp TFJD (2004) Pharmaceutical care, European developments in concepts, implementation, teaching, and research: A review. Pharm World & Sci 26, 303–311

    Article  Google Scholar 

  • Venhuis BJ, Barends DM, Zwaagstra ME, de Kaste D (2007) Recent developments in counterfeits and imitations of Viagra, Cialis and Levitra: A 2005–2006 update. RIVM Report 370030001/2007. Bilthoven, the Netherlands: RIVM (Netherlands National Institute for Public Health and the Environment). http://rivm.openrepository.com/rivm/handle/10029/16459?mode=full

  • Warner S (2004) Diagnostics + therapy = theranostics. The Scientist 18, 38

    Google Scholar 

  • White EV, Latif DA (2006) Office-based pharmacy practice: Past, present, and future. Ann Pharmacother 40, 1409–1414

    Article  Google Scholar 

  • WHO (1999) Guidelines for safe disposal of unwanted pharmaceuticals in and after emergencies. World Health Organization. http://www.who.int/water_sanitation_health/medicalwaste/pharmaceuticals/en/index.html

  • WHO (2007) WHO core principles for achieving safe and sustainable management of health-care waste. World Health Organization, Department for Public Health and Environment, Assessing and Managing Environmental Risks to Health, WHO/SDE/WSH/07.10. http://www.who.int/water_sanitation_health/medicalwaste/hcwprinciples.pdf; http://www.who.int/water_sanitation_health/medicalwaste/hcwprinciples/en/index.html

  • WHO (2008a) “World directory of poisons centres (Yellow Tox)” International Programme on Chemical Safety (IPCS). The World Health Organization. Geneva, Switzerland. http://www.who.int/ipcs/poisons/centre/directory/en/

  • WHO (2008b) About the ATC/DDD system. The WHO Collaborating Centre for Drug Statistics Methodology. Oslo, Norway. http://www.whocc.no/atcddd/atcsystem.html

  • Woodend K (2003) Medication management: The future of pharmaceutical care? Can Pharm J (CPJ) 136, 29–31, 46

    Google Scholar 

  • Woodley JM (2008) New opportunities for biocatalysis: Making pharmaceutical processes greener. Trends Biotechnol 26, 321–327

    Article  CAS  Google Scholar 

  • Woodward KN (2005) Veterinary pharmacovigilance. Part 3. Adverse effects of veterinary medicinal products in animals and on the environment. J Vet Pharmacol Therapeut 28, 171–184

    Article  CAS  Google Scholar 

  • Zed PJ, Abu-Laban RB, Balen RM, Loewen PS, Hohl CM, Brubacher JR Wilbur K, Wiens MO, Samoy LJ, Lacaria K, Purssell RA (2008) Incidence, severity and preventability of medication-related visits to the emergency department: A prospective study. CMAJ 178, 1563–1569

    Article  Google Scholar 

  • Zuccato E, Calamari D, Natangelo M, Fanelli R (2000) Presence of therapeutic drugs in the environment. The Lancet 355, 1789–1790

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Environmental Chemistry Branch, National Exposure Research Laboratory, US Environmental Protection Agency, Las Vegas, 89119, NV, USA

    Christian G. Daughton

  2. Basic and Clinical Sciences, College of Osteopathic Medicine, Touro University Nevada, Henderson, NV, 89014, USA

    Ilene S. Ruhoy

Authors
  1. Christian G. Daughton
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ilene S. Ruhoy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christian G. Daughton .

Editor information

Editors and Affiliations

  1. Institut für Umweltmedizin und, Krankenhaushygiene, Universitätklinikum Freiburg, Hugstetter Str. 55, Freiburg, 79106, Germany

    Klaus Kümmerer

  2. Deutsche Bundesstiftung Umwelt, An der Bornau 2, Osnabrück, 49090, Germany

    Maximilian Hempel

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Daughton, C.G., Ruhoy, I.S. (2010). Reducing the Ecological Footprint of Pharmaceutical Usage: Linkages Between Healthcare Practices and the Environment. In: Kümmerer, K., Hempel, M. (eds) Green and Sustainable Pharmacy. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-05199-9_6

Download citation

Publish with us

Policies and ethics

Search

Navigation