Green Alert

29 March 2009 (Last Updated March 29th, 2009 18:30)

Environmental concerns and sustainability issues are being pushed to the front of our minds. But how can the medical industry keep up? Nic Paton asks NCCT's Bill Roth what the next step should be.

Green Alert

Among the many hopes engendered by the inauguration of President Barack Obama has been that the world will now see a U-turn by the US from the Bush years on the whole issue of the environment and sustainability.

Certainly, President Obama made it clear in his inauguration speech in January that there will now be a step change when it comes to leadership on environmental issues. He spoke of the need to "harness the sun and the wind" to fuel America's cars and factories and of needing to work tirelessly to "roll back the spectre of a warming planet."

But for the medical devices industry, reliant as it is on energy-hungry technologies, gas-guzzling supply chains and the delivery and development of disposable devices that once used often end their days clogging up landfill sites, this new agenda rather poses a problem.

Industry keeps quiet

According to Bill Roth, president of San Francisco environmental and sustainability consulting firm NCCT, the silence up to now from the industry when it comes to sustainability and green initiatives has been deeply concerning.

"The industry is doing a fabulous job of putting money into research and products and of developing delivery streams for new drugs and technologies," he says. "That is not the issue. The issue is how effectively is it managing these processes in terms of its environmental impact.

"The medical community has been worryingly silent around questions of environmental responsibility."

"The medical community has been worryingly silent around questions of environmental responsibility. I follow this area, write on it and know of many, many examples around the country but I am really at a loss in terms of who is leading this area within the medical technology industry."

What's not clear, however, is whether this silence is simply a failure of communication about the industry's ongoing actions and commitments, something probably fairly easily rectified. Or is it the result of a more serious failure of leadership, direction and commitment to environmental issues?

There are no easy answers to this. Roth is concerned about the high levels of energy consumption within both the devices industry and the medical community more generally.

"The medical technology community is primarily delivered through hospitals, which are already very large consumers of fuels and resources," he argues. "Then there are issues about the industry's own use of resources for research and development, for manufacturing and its supply chain. I certainly do not hear any strong action or messages in this area from the industry."

Nevertheless, there are signs there is at least some recognition within the devices industry of the potential business benefits that might come from embracing sustainability, particularly around issues of better use of resources and energy and better waste disposal techniques.

What a waste

Medical devices and products, in their day-to-day use and during the R&D and manufacturing process, account for an enormous amount of the solid, industrial and chemical waste. In the US alone, it has been estimated that hospitals produce more than 6,600t of waste a day, including 800t of non-hazardous plastic parts. On top of this there is the industry's use of hazardous chemicals and solvents, during either the manufacture or disposal of devices.

According to Chris Kadamus, principal design engineer of Massachusetts firm Cambridge Consultants, the traditional risk-averse nature of the industry might actually be a help here when it comes to encouraging more take up of sustainable practices and policies. The fear of legal liability and an increasing emphasis on compliance could act as catalysts for change, he argued in an article last year for the website Medicaldesign.com.

Another key challenge for the industry is its focus over many years on the development and use of disposable devices.

"Approximately 90% of medical-device waste consists of items designated for one-time use," says Kadamus. "Fears of contamination, the high costs of sterilisation and reprocessing, and the desire for continuous revenue have firmly anchored the disposable products" business model in the minds of industry leaders."

"In the US alone, it has been estimated that hospitals produce more than 6,600t of waste a day."

American manufacturers are currently not constrained to the same extent as their counterparts within the EU when it comes to compliance around recycling, energy efficiency and waste disposal. But it is probably only a matter of time – particularly now the Obama administration is in place – before tougher standards are enacted in the US too.

If you look at the UK's National Health Service, for example, it has been governed for a number of years now by a central strategy on sustainable development that specifically looks at how the service can reduce its environmental impact. The NHS produces some 385,000t of waste a year, much of this again down to the increasing use of disposable medical supplies and devices.

"Forward-thinking companies that prepare their products to meet these standards will have a significant advantage over companies that will be forced to scramble and retrofit products to comply with new legislation," points out Kadamus. "Staying ahead of the regulations can decrease long-term costs."

Sustainability challenges facing the medical devices industry include:

  • curbing use of energy and resources in design and manufacture of devices and the supply chain
  • addressing the reliance on disposable devices as a revenue stream
  • ensuring it is not caught out by tougher regulation and compliance on energy, waste and recycling
  • moving from seeing sustainability as a cost burden to an opportunity
  • communicating its sustainability record to the wider community.

Incentives and initiatives

Similarly, many US group purchasing organisations and large hospital conglomerates are moving in the direction of encouraging the use of more environmentally-friendly medical products, with demand often being driven by patients, families and physicians themselves.

The devices industry is also already working with the US Environmental Protection Agency, in particular its Green Suppliers Network, a collaborative venture between industry, the EPA and Department of Commerce focused on helping small and medium-sized manufacturers remain competitive and profitable while reducing their impact on the environment.

Key areas of focus include promoting "leaner and cleaner" manufacturing processes, identifying cost savings alongside environmental opportunities, building greener supply chain relationships, developing benchmarks and encouraging partnerships.

Among its achievements so far, the network has helped to identify more than $9m worth of annual green cost-saving opportunities and carried out more than 26 technical reviews, including of a supplier to Johnson & Johnson. Its initiatives have also conserved 30.1 million kWh of energy and more than 24.9 million gallons of water and reduced more than 2.4 million pounds of solid waste, more than 111,000lb of hazardous waste, and the use of over 177,000lb of toxic and hazardous chemicals.

At a more practical level the network in 2007 also developed an "environmental benefits calculator" to help firms quantify their environmental results and therefore potential future savings.

"With sustainability rapidly moving up the agenda, the industry can ill afford to get out of step with the public mood."

Sustainability is clearly an issue the medical devices industry needs to address, particularly when seen against the industry's reliance on disposable devices as a revenue earner. According to Kadamus, a significant portion of medical device manufacturers generate the bulk of their revenue from the sale of disposable products or components.

It is therefore perhaps not too difficult to see how there might be an element of trepidation among manufacturers at upsetting this lucrative apple cart. Similarly, there has – at least in the past – sometimes been a perception problem, with sustainability dismissed as just another cost burden, a drag on design and R&D or a legislative cosh on innovation and growth.

But with a new administration in the White House that appears significantly more attuned to environmental and sustainability concerns, it is clear which way the wind is blowing. At the very least, if Roth is anything to go by, the industry now has a real challenge to catch up with changing public perceptions and to show it is genuinely committed to environmental and sustainable practices.

Medical devices is an industry where public trust is everything and, with sustainability rapidly moving up the political, public and economic agenda, the industry can ill afford to get out of step with the public mood.

"Those market segments or companies that do not realise that this is a big trend will in time start to face substantial threats to their business," warns Roth. "But first of all there has to be a vision, and that has to come from the top. I am not sure that the medical technology industry has even articulated what sustainability means to it or, if it has, it has not been very effective in communicating it to a wider audience.

"So they have to sit down at a senior level and work out their vision and the path they want to go along and what they want to achieve. That in turn will enable management teams to articulate and realise that vision and set the targets they need to be setting for achieving sustainable results."