Kelly: This is a risk to human health, to environmental health. How do I then as a scientist say, okay, I have this evidence that there's a risk. How do I translate that to real world change? And also I was working in Bangladesh and obviously. I had very young children at that time and I started saying, okay, well here I am. Working with people in Bangladesh and we are looking at this, are we actually doing the right thing back home? Um, you know, are we in a good position to be saying, oh, well these, these ponds, these are pretty polluted. And so I started looking at, um, pharmaceutical pollution in UK waters and asking questions about how bad is the situation here? How well are we mitigating the risks in the uk? And the answer is. Actually, we are not in a hugely better situation than they are in Bangladesh. Um, that's when I really got into, okay, what's the situation in the UK and how do we really address it?

Frederik: Hello and welcome to the Sustainable Healthcare Podcast. My name is Frederik Dam van Deurs and I am your host. Today, day-to-day, I work as a management consultant. I consult global pharma companies on sustainability strategy and implementation. But today I have a guest in the show who's working on pharmaceutical pollution and tackling the problem head on, and I first came across this paper on LinkedIn. And it was in my feed, and I figured, this is really interesting. Then I wondered who wrote this? It was Kelly. So I wrote to Kelly and said, Kelly, do you wanna come on the Sustainable Healthcare Podcast? And Kelly said, yes. So here we are. Kelly. Welcome to the show.

Kelly: Thank you. Thanks. Thanks very much. Yeah, delighted to be here.

Frederik: Kelly, before we dive into the paper that you've written, I think it's an, an amazing piece of work. So I'd love to unfold it a bit more. But before we dive into it, can you please tell us about yourself and what you do when you're not working to change healthcare for the better?

Kelly: Yeah. So, as a person, I think probably my most important thing that I do in life is I'm a mom. I have four wonderful children. Um, they're all at school at the moment. But then outside of being a mom and working in farm pharmaceutical pollution, I love the sea. I love water sports, so I'm very lucky. I live in the very beautiful southwest of the uk, so we have lots of. Beautiful beaches and mm-hmm. The water's. The water's pretty cold, but, um, but if you've got the right gear, I love long distance swimming and surfing, so, yeah, that, that's what I love. Ah,

Frederik: wow. Lovely. What, what makes long distance swimming? Long distance, how, for some 50 meters is a long distance, but what, what is a long distance in your world?

Kelly: Well, I do, you know what? I don't know what the official limit of what makes a long distance swim. There probably is a long distance, but you know, if it's more than maybe two or three kilometers, then uh, that's, for me, that's long distance. Um, that's definitely

Frederik: a long distance.

Kelly: Yeah. Something where, you know, you swim from one bay to the next bay or something like this. Yeah, I love it. So it's fun.

Frederik: Super cool. Do you have the little, uh, blow up boy? Uh,

Kelly: you,

Frederik: you swim with? Nice.

Kelly: Yep. Yeah. Well, you have, yeah, it, it's safety and you know, people can see you with those things and then if you, if you get in any trouble, it's a, it's a flirtation. So Yeah, it's quite handy.

Frederik: Yeah. That I can imagine that I, I used to do competitive swimming myself actually, but, uh, in a warm pool, so, uh, that's, uh, not the same thing.

Kelly: Yeah.

Frederik: At all.

Kelly: I, I, I'm pool at the moment. Yeah, it's winter at the moment, so I'm not going in at the moment, but, um, yeah.

Frederik: It's a very antisocial sport and I, I think it was, uh, it was a, a fun sport to have as a young kid. 'cause you're basically not talking to anyone while you're swimming. Right. So it's a, I as grown up. I find it to be quite meditative still when I go in the pool, but lovely four kids, that's, how do you get up in the morning? Busy. I have three. And that's so much work.

Kelly: Yeah, it's busy. Then the older they get, the more busy they seem to get. Yeah, which is not what you expect, but that's how it seems.

Frederik: That's impressive. Four kids. That's one. Yeah. One of the things I tell myself when I, when I, I think parenting is hard. I'm like, some people have four or five kids and then it gives me a little bit of ease. Um, thanks a lot for sharing. Kelly. Can, um, can you tell us a bit more about the paper and how it came about?

Kelly: Yeah. Oh, so the paper, um, it's actually, we've been looking at this for about six or seven years now. It started off because I was actually working on looking at, I was as a scientist, looking at pharmaceutical pollution in, um, actually in Bangladesh on, in fish farms and shrimp farms, and collecting data. Yeah, that's where I started. Well that was about 10 years ago. And as a scientist collecting data evidencing that, oh, this is pretty polluted. This is a risk to human health, to environmental health. How do I then as a scientist say, okay, I have this evidence that there's a risk. How do I translate that to real world change? And also I was working in Bangladesh and obviously. I had very young children at that time and I started saying, okay, well here I am. Working with people in Bangladesh and we are looking at this, are we actually doing the right thing back home? Um, you know, are we in a good position to be saying, oh, well these, these ponds, these are pretty polluted. And so I started looking at, um, pharmaceutical pollution in UK waters and asking questions about how bad is the situation here? How well are we mitigating the risks in the uk? And the answer is. Actually, we are not in a hugely better situation than they are in Bangladesh. Um, that's when I really got into, okay, what's the situation in the UK and how do we really address it? So that's where this

Frederik: pollution org and then farm pollution.org was.

Kelly: So what happened was I started, I brought together, I had a little bit of funding, research funding to bring some stakeholders together as a researcher and say, Hey, let's map the pharmaceutical system from the uk in the uk. And by that I mean. When you look at the whole of the life cycle of the pharmaceuticals, all the way from manufacture and design through to distribution and then procurement in the healthcare sector, prescribing consumption by patients, excretion, and then wastewater treatment, and then enters the environment. So you look at the whole of the life cycle and you look at, okay, what are the factors influencing this? So we, we started looking at this and then realized, okay, this is really complicated. Complicated, complex. And we can look at the system and look at how unsustainable it is, but then how do we, how do we then identify interventions? And so as we started developing the research we realized that there's a real need for an independent body. There's so many different stakeholders across the whole system. We have. The government, for example, they're a big stakeholder, but they have their own priorities, most of which re revolve around a five year political cycle. Or ensuring that we have, resilient supply chains, for example or economic growth. And then we have the pharmaceutical industry who have their own agendas and their own priorities, which are, you know, making money, designing new drugs. And then we have the healthcare sector and we have all these different stakeholders, but nobody is really looking at this from an independent you know, what's the best thing for the greater good, if you like? And that's when we said, okay, actually we, we need an independent body. So the idea was that we set up this, the Pharma Pollution Hub as a, a new charity.

Frederik: Neat, and it's actually something we see a lot in our work with the big pharma companies is that a lot of the problems that occur when you start applying sustainability and planetary health as a lens with which to view the world, there's a lot of misalignment in the incentive structures. Just like what you just described, that the governments have their priorities. The healthcare system have their priorities, the private entities have their priorities, and this lack of incentive alignment, direct incentive alignment is, is quite often what makes sustainability so difficult.

Kelly: Yeah.

Frederik: That it's for the greater good. There's a lot of common sense behind it, but most structures and organizations are designed with a different. Purpose in mind than the greater good. Even the healthcare system where we're supposed to keep patients healthy and make sure everyone's in good health, the incentives are not aligned with planetary boundaries yet. And I've, I so I, I definitely find that you have, you stumbled across across a really interesting problem, and I just love that you started off in Bangladesh thinking these ponds are quite polluted. Huh? That's a problem here in Bangladesh. And then going, well, what about the uk? Oh my God, it's really bad in the UK as well. And then diving into it. So, um, so yeah, the, the anthropologist and me is just, uh, really excited to, to have this sort of research journey folded out. But if, if we're trying to sort of roll it back a little bit. There's a paper out, there's a charity organization, farmer pollution.org. You can go and check it out if you want to. I'l leave a link for the paper in the show notes. But if, if you were to really sort of, in Danish we say bend it in year lights, what is the problem that you're trying to solve and why is it a systems problem?

Kelly: Yeah, so I think, so like I said, I came to this thinking that the problem that I was. Exploring as a scientist was the problem of pollution. And just to explain why this is a, this is a concern. So pharmaceuticals are now found extensively across global waterways. And. Often they're actually in low concentrations compared to some other chemicals. Not always, but often. And the difference is between these and other chemicals that we find in the environment is that these are designed to be biologically active. So these are chemicals that we design to be active on in. Our bodies at very low concentrations because we dont want them to have side effects in our bodies. And we design them to cross biological membranes to get to where they need to get to in our bodies, and we design them to hit targets. Now, obviously that means that. These are, can be active in the environment as well. And a lot of the targets, many of the targets that they are designed to hit in our bodies are conserved across evolution. So these targets are also present in fish and amphibians and birds invertebrates. And so that's why even though these con these, uh, chemicals are being found at low concentrations, they still pose a risk. And of course. As our population is increasing we are using more and more medicines globally because we know that obviously the more people are on the planet, the more medicines we're likely to use, but also. We are getting older, and as we get older, we suffer from more chronic diseases and we know that age is associated with increased medical usage. And in addition to that, in low middle income countries, they're developing and as they're developing, they're getting better access to drugs, which is obviously a good thing. Um, but also they are then suffering from more chronic diseases and they are increasingly. Demanding more medicines as well. So we know that pharmaceutical pollution is already extensive. We know that this is having an impact. So things like we might have heard about, um, estrogens, um, that's one of the most famous examples, which are causing fish and other organisms in the environment to change sex and, and that affects their reproduction and survival. We know that antidepressants are. Uh, changing the behavior of animals, and this is in, in the long term, impacting on biodiversity. And then in addition to that, we know that pharmaceuticals in the environment, and particularly antimicrobial pharmaceuticals, are driving the increased rates of antimicrobial resistance. And that is where microbes are becoming resistant to the drugs that we use to kill them. And that's a human health risk as well. So. This is why we want to address pharmaceutical pollution. So going back to your question, what am I actually solving? So this is, this is what I thought I was researching now when we started looking at. Okay, so what is, how do we find solutions to this? So you start asking, okay, well what is driving the increasing rates of pharmaceuticals, being supplied, being used and importantly entering our environment and persisting in the environment? What is driving this? And when you start looking at that, you realize, well, actually, um, and that's what the paper's all about actually. That is one symptom of an unsustainable system, and that means you know, all the different factors. So social factors, economic, political cultural, these are all, um, working together and it's just not sustainable the way it works. Not only is it not sustainable, it's pharmaceuticals are deep rooted in our society. The way we use them has evolved with our society over centuries or thousands of years. And therefore our society sort of is reliant on them, if you like, particularly our healthcare sector.

Frederik: Mm-hmm.

Kelly: And, and all these different stakeholders, like you said before, have very different. Interests and needs, and that that's gat makes this a really complex, deep rooted system that's very resistant to change, and that's why there's no simple solutions. You have to instead. I think, and that's what the paper argues, we have to take a systems approach. And that means instead of looking for the sort of the golden bullet that that, or the magic bullet I think they call it, where you know, one solution fit is gonna fix the problem. We have to take the whole system. So all the stakeholders, all the factors, and we have to. Target action at all different points across the system, and together we can collectively evolve the whole system towards becoming more sustainable.

Frederik: And I, and I think thank, thanks a lot ki for rolling this out like that. I think you're really hitting the nail on the head here, and this is what I like so much that you're really emphasizing that you cannot isolate it as a cultural problem. You cannot isolate it as an incentive problem. You cannot isolate it as a governance problem. It is all of it all at once.

Kelly: Yeah.

Frederik: And um, what, what I find inspiring is that you have identified 37 intervention points. Where would it be meaningful to start the next coming Monday?

Kelly: That's a good question. I think I think, well, there's a couple of ways to answer that. So there are no simple solutions is, like I said, so if it was as simple as right. You can fix this on Monday. Um, obviously people would already be doing that. I think there are things that people can do now, and I I don't want to focus too much on individual. Or individual action, because I feel like there's an awful lot of focus on saying, right, this is the responsibility of individual people, or you know, whether they're a patient, a prescriber,

Frederik: classic diversion tactic to, to dive responsibility. It's, it's as old as the tobacco industry, so let's not go there. I like that approach. Yeah, exactly. Let's

Kelly: not go there with

Frederik: individual response.

Kelly: But so I think, but what we do have as an individual is, you know, I think that the. The most powerful stakeholder in the whole system potentially is the public. And that is because as a collective, you know, we are the voters, the political voters. We are the patients, we are the prescribers, we are the people that work in the pharmaceutical industry. We are the people that buy drugs from the supermarket. We are. We as a collective, we are very influential and so I think if there's something that you can do on Monday, apart from obviously make sure you take your unused drugs back to the pharmacy, don't throw them down the toilet. Things that everybody gets told. I think the most influential thing that we can en encourage people to do is start asking questions. Start raising awareness. You know, tell people, Hey, I heard about this issue with pharmaceutical pollution. What, you know, ask your company or your organization, what are we doing about this? Do we have a strategy? If I, if I'm in the pharmaceutical industry, what is our farm pollution strategy? I think, you know, asking, asking these sort of questions, I think, or, you know, even things like as an investor we have pension. We all, most of us have pensions. Our, our. Pension providers? Are we investing in companies that are green or are we investing in companies that are, have unsustainable practices? You know, there's all these things that we can be doing to try and drive systems change. I think.

Frederik: I am so glad you bring up the pension funds. It's been, uh, it's a dead horse that I've been beating for 10 years straight and we really should be contentious of where we place our pension funds. But if, um, if we roll it back and away from the individual responsibility and assuming that in our audience, there's a few people that are in positions with agency to change things here, I think if. There's one thing that we see a lot when we work with large pharmaceutical organizations is that there's a growing interest in transparency and having a line of sight on the lifecycle assessments of the products that they're putting in the market. And of course if you are having a really good. Steep LCA in front of you for a drug product. You would also have the end of life as being the end of the drug, exiting the patient again, um, oftentimes through, through urine and into the sewage system. So, so I'm just curious how have you. Assess the maturity of the producers and figure it out if, how good is their line of sight to sort of the, the exit route for the drug products in the other end, and how they end up in our ecosystems because they, as far as I'm concerned with the manufacturers that we've spoken to and worked with on this for the production sites. It's quite heavily regulated and the amount of chemicals that are exiting a factory going into the ecosystem from the factory without going through a commercial arm and the patient arm that's. Comparatively low, I imagine, compared to all of the drugs that are being filtered through the hospital systems and the patients, and then going into, uh, the wastewater systems and the ecosystem. So, so I'm curious to, to hear if you gauge this with the manufacturers or not.

Kelly: Um, do you mean have we. Spoken to manufacturers about this? Is that what you mean? Or gauged how,

Frederik: yeah, what, what, yeah, how, how do they view it? Are they talking about sort of the end of life of the product as in post patient, or are they talking about their responsibility to not pollute as a factory?

Kelly: Yeah, so I think yeah, there's some really important points here. Firstly, I think it's important to note that the manufacturers, as far as I understand, manufacturers. Adhere to all the regulations we impose upon them. So where we I dunno if impose is the right word, but where we have regulations of what emissions they should be adhering to. They do that. And so the question is, are the regulations strong enough or are the regulations fit for purpose? I think where the manufacturers do have emissions and there are regulations, I mean now there's recently been a new anti-microbial manufacturing emissions standard and certification process, which has been developed. But I don't think the regulations are necessarily, sufficient. Is the general consensus we certainly got from our consortium of when we were looking into this. I think the other question here is, you are right. When we, so in some ways looking at manufacturing emissions, it's simpler to resolve because it's in a very sort of, it's localized. So it's one, one. What you call it, one manufacturing plan. It's a

Frederik: single point of

Kelly: Yeah, it's a single point. Yeah, exactly. They can. There might be very high levels. I mean, there's, in some places there's really high levels downstream of manufacturing facilities. For example, one of the most famous ones in India there's an area where there's quite a few antibiotic manufacturing facilities in the same place. And the, the water downstream of these facilities had antibiotics in the water at levels that are higher than you find in a patient's blood. So some of these can be really high, but. It's consistent, you know what's there. It's typically not so many drugs maybe, or chemicals in, in the mixture, and it's localized. So there are solutions to this like wastewater treatment. However it's generally thought, and there isn't a huge amount of research on this, that overall the, the overall volume of pharmaceuticals entering the environment, most of it comes from patient excretion.

Frederik: Yeah,

Kelly: and this is much more difficult to control because of course we don't know patients are excreting drugs into septic tanks in their garden, into the, the wastewater treatment plants. You know, it's, it's coming out all over the. All over in different, all over the country. And it's in a mixture of all these different chemicals. It varies through by season. And so the question then is, well, whose responsibility is this? So going back to the manufacturer is this the manufacturer's responsibility and this new, um, new legislation through the Urban Wastewater treatment directive in the EU about how. Pharmaceutical manufacturers and cosmetics manufacturers are expected to cover the costs of some of this wastewater treatment. And, but this is, you know, it started a whole discussion about, okay, well whose responsibility is it? Is it their responsibility or should the healthcare sector take some responsibility for this? So my an basically, I don't have an answer to you there, um, in that I don't think at the moment the pharmaceutical industry. And I don't really wanna talk for the industry because I haven't extensively talked to 'em about this, but I think, I don't know if they believe that it should be their responsibility to look at pollution post consumption. Yeah. I'l stop there. Have I answered we a little way?

Frederik: The way I would see that playing field is that it, it also depends a little bit, and I, I think if you're ahead of the curve on sustainability, on and on manufacturing governance, it could become a competitive parameter to be on top of this.

Kelly: Yeah.

Frederik: But at the end of the day, what we're looking at for pharmaceutical pollution in our natural environments as a problem as a whole, what you're seeing now is that the majority. Of the pollution is post patient. So the good thing about the manufacturing pollution is that it's a single point of emission. It's comparatively easy to put a plug in it. Yeah. And you can add wastewater processes on, on top of the manufacturing facilities. And then you're addressing that part of the problem. But the purpose of the production of the actual pharmaceuticals is to get them inside patients. And once they're inside the patient, they'll also need to get out somehow. So it's, it is what I would call a very sticky problem. Yeah. And that also makes the problem interesting, of course. And, and something that if we're looking a little bit further down the line. As we, as a species and as a society, we're getting smarter. We know more, we have more intelligence, uh, we are getting more sophisticated. This is a problem that that needs solving and it needs addressing. So there could be a positional game coming up. For particularly pharmaceutical manufacturers to, uh, to claim that stage of being a first mover on it. And I'm, and I'm sure when, when we start scratching the surface, a lot of the big access in this stage will have one or several positions on it that may or may not be seeing too much light of day because it's also a really sensitive area. So. I'm really curious to, to dive into this and, uh, and to bring this to the industry and, and figure out where are there areas where the industry can actually come together and, and design for solutions? 'cause at the end of the day, if you're looking at it as a systems problem, one of the things we need to do is to distribute. Less medicine, and the best way to do that is to get sick less. Then we're back in the prevention scheme. That's another dead horse that we are beating a lot here, where the company that we're currently working in is, is called Cap Pathway Consulting. So it's all about early diagnosis, prevent treatment, and of course preventing disease onset as the most definitive, sustainable ways of addressing disease. The least polluting patient is the one that's not a patient. So, um, so, so I think that applies here as well on, on pharmaceuticals. But if we're, if we're circling back to, uh, to what you're doing with the Pharma Pollution hub, what, from your point of view, what does good governance look like?

Kelly: So, yeah, and just to say, I, I agree with everything you just said. I think this is a big theme that keeps coming up in our has come up throughout our studies is that, I talked about economic sorry, environmental and human health risks, but because of the increasing demand for regulation and investor demand and patient demand and consumer demand. This is also an economic risk, like you say, for the pharmaceutical sector and the healthcare sector because they, you know. Their models are not sustainable at the moment, and in particular the generics industry is is incredibly unsustainable. They, they operate a very low profit margins, so it's very, very difficult for them to change. You know, they've, they've built this very successful industry. That's really unsustainable. But then, you know, we all rely on sus, these supply chains. And so yeah, I think there's a huge, there's a huge need for the industry to really look and say, what are the solutions? And this is something that we are trying to support as well. For example, there's a new standard of, you know, it's from the British Standards Institute. It's called PAS 2090. And it's a standard that says this is how we define a sustainable pharmaceutical. And at the moment it's really focused on carbon. But we're, one of the things we really want to do is say, okay, well how can we integrate ECOT toxicology, which is. Essentially pollution into this. So yeah, just to say I totally agree with you and the need for business models that look at service based versus treatment based, but, um, so you said your question was, sorry, I went off on one then. What does good, good governance look like? Um, I think good governance really is about, serving everybody's needs. And so, serving the need, the best interests of everybody, um, and both now and in the future. And I think as we talked about at the start. The everybody, this is such a big problem. It's, you know, it's an unsustainable system, inherently unsustainable. Everybody has their own priorities, their own needs, their own interests, and so nobody is really governing this properly, I think because nobody is looking for the best interest of everybody, and I think. When you think about the definition of sustainability, which is, well, one of the terms that's used, meeting the needs of the present without compromising the ability of future generations to meet their needs. So essentially, if we don't, what we are doing right now the way we use pharmaceuticals, we are compromising, and this is one of the, the drivers for me, you know, with children. My children are gonna have a poorer environment, potentially poorer access to drugs, especially things like antibiotics. Mm-hmm. Um, because of resistance because of the way we have our healthcare and the way we use pharmaceuticals now. And so I think. Good governance is serving everybody's best interests, both now and in the future. And this is a, this is something which is nobody's fault. There's nobody in particular whose fault is pharmaceutical pollution. This has just evolved over many years, but it's everybody's problem. And so I think what we want to do as a pharma pollution hub is we want to help. Identify solutions, but could, but we have to identify solutions together because we, there is so many different priorities and needs. We have to listen to each other and accept that we all have these different needs and interests. How can we find solutions that benefit everybody as much as possible? And how can we make decisions that are fair? So at the moment when the government makes decisions, you know, there's some powerful. Influential stakeholders who are having a stronger voice than others. And they obviously meeting their own needs, but are they meeting are, is the government considering all these other aspects of the problem as well? So I think that's, you know, we want to make sure that decisions are made fairly inclusively. We need to manage our environmental resources and be accountable. So I think that's what we wanna help. We just wanna help. Everybody take action fairly and inclusively.

Frederik: I, I think that's, uh, that, that's a really good summary of it. So basically we're talking about a higher degree of transparency and having a line of sight to where, where are the pollutants actually, um, emitted to the environment. A lot of it through patients, and we're talking about utilizing standards as the ones that are developed by British standards and many of their cyst organizations across the world to have good manufacturing practices and and hold manufacturers to a high standard for manufacturing. And then last but not least, figuring out more at a systems level how the incentives for the distribution. And development of drugs can be to everybody's benefit.

Kelly: Yeah. And also, you know, like I think you, you said this before, the, the most sustainable patient is the patient that is healthy, um, and doesn't need any drugs. And I think a big part of this is saying, okay, um. When we look at the, the pharmaceutical system, the less drugs that we use, the less come out in the environment. That's fairly straightforward. And but then at the moment when I talk to people that work in public health they don't necessarily see themselves as part of the problem. Um, not them individually, I think when you look at this as a systems problem. You see it be, it changes the framing of the problem. So rather than this being a problem of waste management, it becomes a problem of sustainable pharmaceutical usage. And if we can keep ourselves healthy, like you said, if we can prevent disease, or even if we can get early diagnosis to prevent long-term pharmaceutical usage. This is a way of preventing disease, uh, preventing, um, excessive pharmaceutical usage. If we can change business models, either in the pharmaceutical sector for example can we get pharmaceutical industry to somehow profit from prevention? And similarly, the pharmacy a lot in the uk a lot of pharmacies get paid. For every drug they dispense and it, there's no incentive for them to reduce waste. And so, you know, we need to start looking across the whole system and looking at prevention a lot more as well as manufacturing regulation. Yeah. And so there's, there's, there's lots to do. But yeah,

Frederik: we definitely do need a stronger business model for prevention.

Kelly: Yeah.

Frederik: It seems like no one has really quite nailed it yet, but I'm sure it will occur in, uh, some, sometime in the future. But, uh, Kelly, um, as a last question, when, uh, we're working with sustainability, there's loads of reasons to be put down and to have a grim outlook on the world When, uh, when you are in your line of work and, uh, in the depth of, uh, of what you do, what gives you hope? The future.

Kelly: I think, you know what, I think I actually have more hope now in a way than I did when I was in a scientist looking at, collecting these samples and it's pretty dire. And I think there's so many stories out there. All this is terrible. This, pollution's going up. The hope that I see is actually being, when I suggested, and, you know, we started working on this and we started approaching people and saying, Hey, you know, we're looking at this problem. We, I don't think we've had anybody that has said no to taking part, and that's across policy. Industry with the water industry and the pharmaceutical industry. Obviously academics are really keen. We've had so much interest and it, it gives me hope that everybody wants solutions. I think the time is right now that people see this is a problem that needs solving, and it it, you know, it's, everybody needs to address this for whatever their reasons are, whether they're, it's a competitive industry reason or a policy reason because the. The public are demanding, increased sustainability, whatever the reason. There's so much interest and enthusiasm and. And I, so that's what gives me hope is the fact that actually I see that people want things to change, but what they don't have are, is a direction of how to get there in the real world. And so that's what we want to provide is just say, look, if everybody takes small steps together. Rather than act expecting one person to do something enormous, which is totally unrealistic, really expensive actually. If everybody just slowly works together and does their bit, hopefully we can change things. So that's, that's my hope.

Frederik: Amazing. Thanks a lot for sharing that. Kelly and I, and I think building off of that, I've never met anyone who got into the pharmaceutical industry with the purpose of doing harm. I mean, it is literally an in an industry that attract people that want to do good and do what's best for everyone. So, so think with that in mind, it's a really strong candidate for an industry to start because there's a lot of really, really smart people with the best of intentions, and that also makes it quite inspiring to work in this field, frankly. Thanks a lot, Kelly, for, for. Listening to an episode of the Sustainable Healthcare Podcast, today's guest was Kelly Thornberg. I'm sorry if I'm butchering your name, Kelly.

Kelly: That's

Frederik: good. Kelly is. Kelly is representing pharma pollution.org, a charity based out of the UK trying to tackle the problem of pharmaceutical pollutions in the environment, uh, humongous systems. Problem that we will need to address with a lot of different interventions. She has identified 37 intervention points in a paper that we will link to in the show notes. So thank you so much for listening. Thanks for sharing the episode for suggesting future guests. Please remember to like and subscribe and download the episodes. That is what builds the momentum for us to keep on going with this podcast. We're soon to hit a hundred episodes. This will be number 98, so very soon we will hit a full century. Thank you so much for listening and for making this possible. I was your host today. My name is Frederik Dam van Deurs. It's been a pleasure.