Episode 060 | June 12, 2023 | 47:22
Guest: Nazneen Rahman, Frederik
Published: June 12, 2023
Duration: 47:22
Description
Molecular geneticist Nazneen Rahman discusses her passion for creating sustainable healthcare solutions and the urgent need to reduce the carbon footprint of medicine. She emphasizes collaboration and intentionality, and highlights the issue of effective medicines being made but never used.
Full transcript
About this transcript
This transcript was automatically generated and may contain inaccuracies, typos, or mistranslations. Episodes recorded before 2024 were transcribed by an on-site model and may have a higher error rate. The content reflects the original conversation to the best of our ability. For the authoritative version, please listen to the audio episode.
Conservatively, tens of billions of effective medicines are made but never used. It happens at every part of the supply chain.
Welcome to the Sustainable Healthcare Podcast. Today: Nazneen Rahman — Oxford medicine, PhD in molecular genetics, 13 years in cancer research, non-exec at AstraZeneca, founder of YouMaker, and a musician.
Nazneen: What drives me is making things that are useful and beautiful, often through simplicity. Currently passionate about the broad sustainability agenda. YouMaker’s central ambition is making healthcare more sustainable for people, business and healthcare. We’re in a decade of action — we have to get that trinity working together.
Two things: technology (data and leveraging data was core) and partnerships (radical new way of collaborating). The technology is the MCF Classifier — Medicine Carbon Footprint Classifier — practical ways of building medicine carbon footprints into how we optimize medicine use and procurement. The partnership is the Sustainable Medicines Partnership — an action collaboration focused on reducing waste of and from medicines.
Pillars of Sustainable Medicines: reducing waste. 4.5 trillion medicines made every year — billions never used, hidden in plain sight. Underlying it, making things more cost effective ties to making things more carbon effective. Everyone hates waste.
Why so much waste? Some surplus is needed (no break in supply). But conservatism about surplus persists. Predictive science can do for the food industry what hasn’t been done for medicines. Expiry dates are massively conservative — they’re regulatory approval points, not when medicines stop being effective. Robust science shows 90% are conservative by years.
Frederik: Expiry dates seem to me like one of the most impactful single levers — could prevent the largest quantity of waste in healthcare.
Nazneen: The conceptual change could happen overnight; the actual policy change would take longer. Original regulations were set up around risk to the individual taking the medicine. They did not include risk to that same individual from healthcare’s contribution to climate change, or risk to the planet. A re-evaluation of risk-benefit considering all that could happen quickly; the practical change is slower because each health system has different rules. Today every incentive is against re-evaluating — going back to a regulator with “can we extend?” adds time, money, delay.
COVID lessons: as a vaccinator we found every arm to use up every dose in a vial — society voted with its feet against waste. Same ethic could apply to staple cancer drugs where lots of value gets thrown away. COVID also showed: a crisis right in front of us = collaboration, speed, ingenuity. A future crisis = apathy. Climate is the future-crisis pattern.
MCF Classifier — how it helps: medicines are about a quarter of the NHS’s footprint, mostly in manufacturing. We have to have medicines, so the question is informed choices between them. Two existing approaches don’t work: top-down spend-based gives a high-level number but not actionable choices; bottom-up LCAs are exquisitely detailed but not comparable. Our middle-out approach uses molecular structure (which we know for medicines), 20 years of green-chemistry science, and validated drug-development metrics to apply at scale to existing medicines.
For tablets and capsules (synthetic medicines, 90% of what’s used) we can compute a footprint. Greener solvents are huge low-hanging fruit — swapping is much easier than changing the manufacturing process. NHS leads with binding net-zero-by-2045 legislation and the supplier roadmap. By 2028 the footprint of every product sold to NHS should be available.
We present results as a 1-5 star high-medium-low rating because people overweight precise numbers. A bigger more complicated medicine will always have a bigger footprint — don’t penalize a manufacturer who happens to make an insulin or inhaler especially if they’ve already moved to renewable energy and electric fleets. Have to think in context. Raise the floor for all manufacturers; the ceiling can go as high as it likes.
Prevention and the triple win: we use a “3 Cs” framework — clinical effectiveness, cost effectiveness, carbon effectiveness. A triple win serves all three. Over-prescription and polypharmacy work perfectly: tackling them was already driven by clinical safety; now we add the carbon win. Anesthetics — swap desflurane for a lower-impact equivalent (equally effective, cheaper). Inhalers — sometimes better asthma management beats just swapping the inhaler.
Example: program in the US Veterans hospital system tackling over-prescription for opioids — already justified on clinical and cost savings, now we add the carbon savings. Multiple boxes ticked, easier to scale.
Thank you Nazneen. Three Cs: clinical, cost, carbon. Looking forward to your return on board responsibilities.