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A single-use insulin pen changed Brian Brandel’s life.
Suffering from Type 1 diabetes in the 1970s, he had to carry glass syringes and insulin vials wherever he went. So in 1985, when Novo Nordisk introduced a disposable prefilled pen that contained multiple doses of the drug with a single syringe, Mr. Brandel immediately adopted the new device.
“They were a godsend,” he recalled.
But recently, they began to assess the effects of all the plastic present in discarded pens over the years and the potential harm it is causing to people and the environment around them.
“I’m using this life-saving product,” he said with frustration, “but to use it, I have to be willing to harm the environment.”
It’s no secret that the world has a plastic problem. The versatile, sustainable and affordable material is clogging the world’s oceans, accumulating toxins in its biomes and contributing to climate change. Some countries are drafting a treaty proposal that could ban select single-use products and set targets to reduce plastic production worldwide. But negotiations have stalled due to opposition from the fossil fuel and chemical industries.
Worldwide, the health care industry will use more than 24 billion pounds of plastic in 2023, and is projected to produce 38 billion pounds annually by 2028, according to global market research firm BCC Research.
Typically made from fossil fuels, plastic is also a major source of greenhouse gas emissions. In the United States, the health sector accounts for eight percent of the country’s carbon footprint.
Medical device companies say they are trying to reduce waste, whether by recovering and recycling products, reducing the amount of plastic in devices and packaging, or redesigning items with materials that do not replace petroleum. -are not based.
To the average person, the most visible health care items are disposable devices used at home, ranging from respiratory inhalers to syringes to tampon applicators to oxygen masks and tubing.
Mitch Ratcliff, publisher of Earth911, a website that maintains a large database of U.S. recycling facilities, said there is little hope of recycling these items right now. This is partly because of their irregular shape, safety concerns that non-sterile elements could spread disease, and because they are often made from materials that cannot be processed together. “We have an incredibly complex economy full of intricately designed goods. We never thought about separating it again.
Few devices are more ubiquitous than insulin pens. According to the Centers for Disease Control and Prevention, about a third of the 37 million Americans with diabetes manage the disease with insulin.
Novo Nordisk alone manufactured 750 million insulin pens in 2021, made up of more than 28 million pounds of plastic. The pen consists of a glass vial in a plastic frame, and is not designed to be separated into parts for the purpose of recycling. Almost all of it is believed to end up in household waste.
Mr. Brandel, of Oregon City, is trying to do something about the discarded equipment. A biomedical engineer, he spent his career developing pacemakers, defibrillators, and catheters. Semi-retired in 2021, he teamed up with a partner to design a hand-held gadget that neatly cuts insulin pens so they can be taken apart. It also works on plastic dispensers for the diabetes drug Ozempic, which millions of people are now taking for weight loss.
But Mr. Brandel acknowledged that destroying Penn was only the first step. The plastic in the pen is high quality, but not one that can be easily processed by municipal recycling sites. It will likely bundle up with other plastics and still end up in landfills or incinerators.
He is also exploring whether his gadget, which is made of plastic, can be manufactured from bamboo or some other sustainable material. “It’s very difficult to sell someone on the idea that I want you to buy this plastic device so you can save some plastic,” he said.
Global biomedical giants are facing increasing public pressure to change the life cycles of their products. Novo Nordisk has said it plans to redesign its products to meet its target of net zero emissions by 2045.
This is a change from the company’s history, when disposability was a desirable feature. “Nobody thought about designing it for circularity, or thinking about the materials we should use, or limiting the thickness of the plastic,” said Katrin DiBona, the company’s vice president. “
In 2020 the company launched a program in three Danish cities for recycling used insulin pens. It provided collection bags for pharmacists to give to patients picking up prescriptions, who could return the used devices at the next visit. A third-party recycling company then collected the pens for disassembly, sterilization, and processing.
Novo Nordisk has since expanded the program nationwide and opened it up to its competitors, and has launched pilot efforts in the United Kingdom, France, and Brazil. But changing public behavior is difficult. By the end of 2023, only 21 percent of the company’s pen users in Denmark had returned the devices.
GSK, which sells more than 200 million respiratory inhalers per year, ran into similar problems with a take-back scheme for the devices in the United Kingdom from 2011 to 2020. The plastic components of inhalers are recyclable by most curbside collection programs, but the aluminum canisters containing the medication are not. So the company collected used equipment in pharmacies, recycled the components it could, and incinerated the rest.
However, the program never generated much interest among consumers. Over nine years, only 24,000 pounds of plastic was recovered from the inhalers, which Claire Lund, the company’s vice president of sustainability, called “absolutely tiny” compared to the approximately five million pounds of plastic needed to produce inhalers each year.
Of greater concern to environmentalists is the propellant in many inhalers, usually a fluorinated gas that is a more powerful driver of global warming than carbon dioxide. In 2021, GSK began developing an alternative, suggested by Ms. Lund, that could significantly reduce carbon emissions.
But the company is still conducting trials on the new formulation, and estimates it will take several years to gain approval of a replacement in the 140 markets where the existing formulation is sold.
Ms. Lund said the company is working on creating a reusable product. “It’s been on the table several times and then kicked back in,” he said.
In contrast to Novo Nordisk’s boutique focus on recovering materials from a specific product, US waste management company Triumvirate Environmental is exploring commercial applications for repurposed medical waste.
In 2014, the company purchased machinery from a plastic lumber business and grafted it onto the back of a medical waste plant in Jeannette, PA, with the idea of converting some of the waste into useful products.
Company chief executive John McQuillan said that after a $70 million investment the plant was receiving waste from hospitals and pharmaceutical companies – “some of the most disgusting things on the face of the planet” – and putting it through a complex set of was being processed. Of machines.
Most trash is still burned, but items made of useful plastics, including containers filled with syringes and surgical instruments wrapped in packaging, are identified, shredded, and converted into construction materials. .
“It’s like a stinking Willy Wonka,” he said.
Mr. McQuillan estimated that the process is six to eight times more expensive than dumping the waste into a hole in the ground, although the Triumvirate recoups some of the costs from the sale of the final products.
There is no shortage of interest from health care companies, which provide far more plastic waste than the Triumvirate plant can process. Instead, the rate-limiting factor is the demand for the structural plastic lumber they produce, which is utilitarian and has to compete with alternatives made from cheaper plastics. “It comes in whatever color you want, as long as it’s black, and as long as your definition of black is liberal enough,” Mr. McQuillan said.
Still, the triumvirate sold 12 million pounds of the stuff in 2022, including to Menards and Home Depot, which market it as an underlay for landscaping and turf fields.
Like most recycling, this process is energy intensive. The plant receives plastic waste primarily from customers in the northeastern United States, because the materials are loosely packed, making them expensive to transport over long distances.
Scientists say that this expenditure of energy almost cancels out the environmental benefits. According to Dr. Andrea McNeil, founder of the Planetary Healthcare Lab at the University of British Columbia, recycling a product typically recovers less than 10 percent of its carbon footprint, because most of a product’s environmental impact occurs during its manufacturing. . “We’re never going to recycle our way to a healthy planet,” he said.
It is far more important that manufacturers design products capable of being reused for years, he said, adding that this will also require changing their business models. “At the moment, their profit margins depend on high volume consumption.”
The next advancement in sustainable medical device design may be happening in the brick-and-glass headquarters of Battelle, a nonprofit research and development institute in Columbus, Ohio. Although the organization primarily handles years-old projects for the U.S. Army and Department of Energy, hundreds of staff members work with name-brand medical companies to redesign their products.
Medical equipment teams dominate an entire floor of a building. Some scientists there are trying to turn soybeans into usable plastics that can replace traditional petroleum-based plastics. Others are using large stainless-steel reactors to study how substances degrade.
Eric Edwards, one of Battelle’s chief materials scientists, said the Food and Drug Administration’s review process for new devices has led the team to make changes to existing products rather than propose wholesale changes. For example, they are helping a pharmaceutical company redesign insulin devices to remove the single disposable plastic part. “The approach you take is worth a thousand small steps,” he said.
He said improving packaging could be an easy task. Several years ago, the lab received an order of palm-sized medical devices, and they came in boxes of several pallets. “All this air shipping was done just because the packaging took up more space than it needed,” he recalled.
Mr. Edwards said Battelle customers generally like changes that reduce costs or improve performance, but sustainability is becoming a factor.
Grace Lilly, a mechanical engineer, compared the development to changes in the way milk was sold over time. People once collected glass bottles from their doorstep and returned the empty bottles for reuse, but the introduction of disposable plastic jugs brought the milkman profession to an end. Reducing reliance on plastic may mean reimagining some processes and roles.
“You want people to do something different, but then you have to rely on the culture to accommodate,” he said.
