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All things Pharma

How green is your medical device?

The Department of Health recently stated its commitment to reducing the carbon footprint of the NHS. In the interests of ongoing market viability, the medtech industry needs to reduce the environmental impact of its products and manufacturing. Martin Goldman considers some ways of making medtech more green, and we follow his article with two UK case studies.Anyone working in hospitals in the later part of the 20th century would have thought the last thing that mattered was the conservation of resources. The aftermath of any major medical intervention, such as the resuscitation of a cardiac arrest patient, was a sea of debris and packaging: a testament to the throwaway mentality.

Admittedly there were exceptions to this attitude. A hospital would have a central sterile supplies department, where surgical instruments and other equipment items were subject to intense sterilisation processes and reused as many times as possible, usually by heating them. Hospitals were, and still are, very warm places: cockroaches were so numerous that one got the impression they had to compete for the snuggest crevices.

The patient or the planet?

In the 21st century, things are a little different. While a greater variety of expensive items of equipment (from wheelchairs to whole-body scanners) are now legally designated as medical devices, the focus is minimum spend and minimum impact on the environment. Recyclability is also a component of the equation, and there may be an expectation that part or the whole of a device will be used again.

There are two schools of thought on this. The old guard operate on the philosophy that the life and health of patients is so important that any impact on the environment is justified. The classic example of this was the sustained use of CFCs in medical systems and the delay in implementing the Montreal protocols. Nevertheless, even these devices are now pretty much extinct.

The alternative viewpoint is that is the duty of the healthcare sector to operate in an energy-efficient and sustainable consumables environment. If we forget the green politics of recycling and climate change, there is still an imperative on the healthcare industry to recognise legislation, guidelines and customer demands. Medical device companies need to be aware of current and future thinking, appraise how closely their products comply, and adapt to keep up to date.

The unfortunate fact is that a high proportion of medical devices need lots of energy to manufacture, have non-renewable components such as plastics or metals, and depend on substantial packaging. Being ‘consumable’ does not mean they are biscuits. But there is a deeper agenda: procurement and purchasing organisations may have no option but to look at each purchase and examine closely how much attention has been paid to green issues.

Top 10 environmental tips

Here are some key questions that may affect customer decisions in the future, and hence need to be kept in mind from a commercial perspective:
1. How safe are the materials – not only now, but in the future if they decompose?
2. Are there safer options for materials, and if so, why were these not used?
3. Is the product wholly disposable – and if so, who is responsible for disposing of the used items? Does the company have a policy for dealing with them? This is an important question because if the user does not have the responsibility for disposal, the hidden costs to the user are less. According to one survey, American hospitals produce over 6,600 tons of waste per day, and someone has to pay for the disposal of that problem.
4. Can a product be disassembled and part of it reused? This may present an additional engineering problem, as any device that can be taken apart is inherently less resilient, and may also present security problems if tampering is a potential issue.
5. What raw materials went into a product, and are they from a finite pool rather than being renewable? Oil-derived materials have been important in the plastics industry, and the increasing price of oil has knocked onto the cost of many finished products. If the current trend in oil prices continues and component manufacturers cannot find cheaper alternatives, they may simply call it a day.
6. Is there evidence that the manufacturer is operating in an energy-efficient and conserving way? This is a bit of no-brainer, as the less energy is used in the manufacture and distribution, the lower the cost of the goods will be: both sides are winners. I have hesitated to use the term ‘carbon footprint’ here, as the energy involved is probably directly calculable and easier to express in terms of units of energy per device manufactured. Whether or not a particular company gets involved in carbon trading to offset its own energy use pattern is a further dimension of complexity that is outside the scope of this article.
7. Are there aspects of the packaging that can improve the ‘greenness’ of the product? We are not suggesting that anyone should sell a wheelbarrow full of unwrapped injection ports – but if the packaging can be reduced, everyone is a winner. The issue is complicated where the packaging is an integral part of the validation of the product (e.g. vacuum packing with whoosh of air as user proof that the product is truly virgin).
8. Does your device contain a battery, and if so, what chemical process is used? Batteries are notoriously difficult to dispose of, and often contain wonderfully toxic elements such as nickel and cadmium.
9. How much water was used in the production of the device, where did it come from, was it reused, and did the product originate from an area of relative water shortage? While most of the device-producing countries have temperate climates at the moment, it will not be long before there is a shift of manufacturing base to the developing world – and while such issues may not be high on those countries’ agendas, they will be high on the agendas of the purchasers.
10. How prepared are you for audit and validation? With some organisations and countries drawing up guidelines for ‘green’ procurement of medical devices, it should not be expected that they will take the company’s word for it that the product is green – and simply colouring the equipment or its packaging green only fools people for a few seconds. Having green credentials will be proof of a company’s prudence with resources at its manufacturing plants. This may go as far as looking at the type of pallets used in the warehousing, or the way the cooking is done in the cafeteria. Evidence of reworking of faulty stock and reconditioned units may add to a company’s credibility, as well as bringing down the product price.

With some organisations and countries drawing up guidelines for ‘green’ procurement of medical devices, it should not be expected that they will take the company’s word for it that the product is green – and simply colouring the equipment or its packaging green only fools people for a few seconds.

Better phthalate than never

A specific case of this agenda being put into action in the medtech sector is a published report from the organisation Healthcare Without Harm titled ‘Preventing Harm from Phthalates, Avoiding PVC in Hospitals’ (June 2004). (See www.noharm.org/europe/greenPurchasing/goals#pvc.) In the summary of their authoritative report, the authors conclude:

Dr Martin Goldman
Dr Martin Goldman qualified in Medicine and practised initially in hospitals. He has worked in the pharmaceutical industry for over 25 years, and has been involved in a wide variety of medical department activities.
“Health care providers have a unique chance to take precautionary action by eliminating the phthalate DEHP from use in hospitals. The experience of the Vienna Hospital Association, Sweden’s Karolinska University Hospital, Prague’s Hospital Na Homo Ice and Kaiser Permanente in the United States show that such change is possible. The initial higher cost of PVC-free products is justified by the avoidance of potential adverse health effects in high-risk patient groups. As health care professionals pledge to first do no harm, it is their responsibility to avoid the use of reproductive toxicants during medical care if safer alternatives perform equally well and exist on the market.”

The green light

The ‘greening’ of the medical device industry is a complex process: a mixture of initiatives from suppliers and users. What is clear is that there is a growing groundswell of activity that will make such activities the norm, even if they do not actually achieve the hoped-for significant benefits.

Instead of a single authoritative publication outlining the various strategies that purchasers have bought into national policy, there is a plethora of documents. For example, the Swedish Environmental Management Council publishes procurement criteria for a variety of equipment. (See www.msr.se/en/green_procurement/criteria/.) It’s likely that initiatives of this kind will become the norm in the future.

The overwhelming conclusion is that there is and will continue to be a green medtech, and that all companies involved in this sector must take the initiative or lose opportunities for sustainable market access.

Green medtech case study 1: Kimal plc

Kimal plc is a UK medical device company based in Uxbridge. Its international business encompasses imagining, intervention, filtration (renal and access) and endovascular products.

Kimal has recently adopted a number of policies designed to reduce the environmental impact of its manufacturing processes. It has:
• Removed excessive lighting and implemented the use of timers on its clean rooms.
• Designed its new warehouse to be low energy use, including motion sensor lighting.
• Converted its product container to include 75% recycled material.
• Developed a new, tested bowl to include 90% recycled material.

Potential new initiatives include: reducing product size; using more biodegradable, compostable and recycled materials; reducing overall energy consumption; and using more materials from ‘sustainable sources’.

Ken Findlay, Marketing & Communications Manager at Kimal plc, said: “Environmental management is core to any responsible medical device manufacturer’s ethos. At Kimal, we are striving not only to meet Government and social objectives in this important area, but also to do this within our own overall corporate strategy.

“It is not necessarily an easy road, as we must be equally aware that maintenance of quality, sterile infection reduction products is a major priority to us and to our customers. However, we remain confident that our goals will be achieved and that the environmental challenge will be met.”

A Kimal fluid collection device made            primarily from recycled materials

Green medtech case study 2: Heinz

Heinz is a major international food corporation based in the USA. Its product range includes many specialised nutrition products, including the Farley’s baby food brand.

In the UK, Heinz is an active participant in The Carbon Trust, which was established by the Government to reduce carbon emissions. Its Kitt Green food processing facility has reduced CO2 emissions by approximately 13% over the past three years by adopting energy-efficient cooking methods.

The Infant Nutrition Division at Heinz in the UK has provided its new Medical Detailing Team with Toyota Prius cars, which have low-emission hybrid engines. The hybrid system uses an electric motor to augment the petrol engine, and to replace it in high-density traffic situations. Its reduced emissions mean a stronger fuel economy performance. The latest model gives an estimated 48 miles to a gallon in city driving.

John Brooks, Managing Director of the FLE Group (which contracted the new team), said: “Heinz and FLE are both committed to reducing the environmental impact of their personnel, and this move towards low-emission vehicles, coupled with FLE’s paperless reporting system for their Contract Sales teams, is a major step forward.”

Toyota Prius


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