Packaging Our Pills in Plastic

Plastic is the horror product of our times. A relatively recent innovation, plastic penetrates every aspect of our lives. Scientists have estimated 8,500,000,000 kilograms of plastic waste is ending up in our oceans every year (source “How Much Plastic Is In Our Oceans”, second video below).

That is a lot of plastic in anyone’s language. Plastic shopping bags, plastic drink bottles, product wrappings. Although there has been much furor recently in Australia over the banning of single use plastic shopping bags at supermarkets, I have been noticing other uses of plastic that we could surely rethink.

Product wrappings: I have been on a linen buying spree of late and the amount of plastic in which sheets sets and doona sets are packaged is quite amazing. Not really reusable either.

Fresh fruit and vegetables: this is one of my biggest gripes. If they are not prepackaged, then we use those silly little plastic bags in the fruit and vegetable section of the supermarket. We get home and into the rubbish they go. There are paper bags for the mushrooms – why can’t we use recycled paper bags for buying our vegetables?

There are many examples. My focus today is medication packaging. Not just prescription medicines either. This first came to my notice when I bought a fish oil supplement.

Red line added to indicate the wasted space

That’s a lot of plastic serving no good purpose.

Then, a month or two later I picked up a prescription for some new medication. The bottle seemed rather large to me for 15 tablets – I was thinking these must be “horse tablets” and was not looking forward to the swallow challenge. Nothing could be further from the truth!

Itsy bitsy teenie weenie yellow tablets that did not even cover the bottom of the plastic bottle. OK, a one-off, I thought to myself. Then that medication got replaced in my regime by another one. These are a bit harder to see, being white in white. At least there are 30 tablets in this bottle, not quite as bad as the bottle above, but really?

I have other medication. Predisolone. Let’s compare the pair.

The bottle on the left in the above picture has 100 – yes, that’s right ONE HUNDRED tablets in it. The bottle on the right has 30. Just 30.

Just to tie up loose ends, let us compare the actual tablets from the above bottles.

Not much difference in size, is there? The tablet on the left is from the little bottle, the one on the right is from the big bottle. But you can’t tell how big the tablets actually are, you say? I thought of that. So here they are below with a five cent piece for scale.

How big is the pill bottle compared with a standard household object? Here it is compared to a coffee jar.

Comparison with a common coffee jar.

I am just one person out of the 7.6 billion people on this planet and I have looked at only THREE pill bottles: two prescription and one a supplement. Extrapolate that out over the world. How much plastic waste is coming from our pharmaceutical industry? Worse, how much of it is superfluous? Containing nothing more than air.

How are these bottles disposed? It varies: the itsy bitsy teenie weenie yellow tablets had to be returned to the pharmacy for controlled destruction. What happened to the bottle itself I do not know, but I trust my pharmacist took the responsible recycling option. But what do most of us do with most of our empty pill bottles? All the bottles I have carry a recyclable symbol. Do we all recycle? Privacy concerns have been mentioned to me: the information on the dispensing label is personal. We can and should return them to the pharmacy, but how many of us do?

Not only are there a lot of them, surely if we have to use plastic we could at least use appropriately sized bottles, not these humongous monstrosities.

Other medications come in blister packaging. While I am focusing on plastic today, there are surely waste concerns around blister packaging as well. At least there doesn’t appear to be as much superfluous plastic involved.

Blister packaging

One suggested explanation for the size of the bottles was that the dispensing label needs to fit. Yet the pharmacy managed to adhere a dispensing label quite well to the smaller prednisolone bottle above. The larger bottle didn’t even get a dispensing label attached as the bottle came in a cardboard box and the label was affixed to the box, not the bottle.

Other patient-centred considerations driving size might be:

  • The need to have a child proof or child resistant cap. None of the examples cited here had child resistant or child proof caps.
  • Larger bottles for ease of use by the patient – yet all those bottles are for me and I have to say ease of use is about the same for all of them.
  • The need to print information on the bottles. Medications come with Consumer Medication Information leaflets. These contain far more information than could be fitted on any size bottle. There are minimum requirements for “on bottle” information.
  • Differentiation so patients don’t get medications confused.

That last one would seem logical if it wasn’t disproved by the following example. These two bottles are exactly the same, but contain different strengths. As you will see I’ve written the strength in large letters on the caps because yes, I have accidentally taken the wrong strength in the creeping morning light when in a hurry. The labels are different colours, but who notices that at 6:30 am?

There are of course cost and manufacturing considerations. The above example, using the same bottle, reduces production costs. Yet if I go look in my medicine cabinet those are the only two that are the same. BioCeuticals, a company producing a wide range of supplements, do use the same bottles for many products. It is cheaper to print and adhere different labels than it is to manufacture a wide range of bottle sizes.

We are concentrating on plastic shopping bags and single use drink bottles. Yet many of us would dispose of more medication and supplement plastic bottles than plastic drink bottles. I might buy a disposable bottle of water once or twice a year only. Yet I have a considerable number of health related bottles in my cupboard.

The other consideration is leachate. Leachate is discussed in the Ted Ed video below. Not all medication bottles are discarded empty. I mentioned above one medication that was required to be returned to the pharmacist for destruction because of the toxicity of the medication. We’ve heard of estrogen ending up in rivers and streams. Other drugs excreted by humans do too.


Medications such as antidepressants, painkillers, antibiotics and estrogen are excreted by humans, and they wind up in treated sewage that is released into the environment, where fish and aquatic animals, even humans, can be exposed.

Source: Scientific American

Over time, discarded, unused medications are going to become part of the leachate from landfill where they have been discarded into the general waste bin OR the recycle collection has ended up in landfill due to contamination, which is more frequent that we like to think about. How dangerous is that over time?

If a bottle still has medication in it, does that contaminate the recycling collection?

How can we encourage the pharmaceutical industry to rethink packaging so we don’t end up with five or six times the amount of plastic needed to dispense a few tablets? It may not be as big a problem as plastic shopping bags, but it is contributing to the global plastic problem.

REFERENCES:

Department of Health, Therapeutic Goods Administration medicine labelling and packaging review, 2012

The videos below discuss plastic pollution generally. Both have been referenced in the above article.

Here is a video with lots of facts and figures from November 2017 – and the situation is only getting worse.

If you are too young to recognise the “itsy bitsy teenie weenie yellow” reference, here it is, just for you.

R

Environment

Why Do Our Bodies Attack Us?

Why our bodies attack us in the form of autoimmune (AI) diseases is still unknown. There has been much research and there are correlations, links, hypotheses……but no definitive cause has been found.

Some of the studies I have read over the years have looked at:

  • gut bacteria
  • smoking
  • stress
  • genetic predispositions
  • pollution
  • diet
  • processed foods
  • links to medications we may have been on for other conditions
  • lack of exercise
  • B lymphocytes
  • environment

Some AI diseases are local (i.e. single organ involvement), others are systemic. Co-morbidity (patient has more than one condition) is reasonably common, about 25% of patients. The rate of co-morbidity is increasing, as is the number of conditions a patient may develop.

Although it does me absolutely no good to ponder about WHY I have the conditions I do, I ponder anyway. Most patients probably do!

I can tick off several items on that list: I’ve had a reasonable amount of stress in my life, I used to smoke (quite heavily by today’s standards), I may have a genetic predisposition but am unable to confirm that, I live in a major city so am certainly exposed to pollution. Like everyone else, I am exposed to our rapidly changing environment.

“Our gene sequences aren’t changing fast enough to account for the increases,” Miller says. “Yet our environment is—we’ve got 80,000 chemicals approved for use in commerce, but we know very little about their immune effects. Our lifestyles are also different than they were a few decades ago, and we’re eating more processed food.” Should prevalence rates for heart disease and cancer continue their decline, Miller says, autoimmune diseases could become some of the costliest and most burdensome illnesses in the United States.

Source: Questions Persist: Environmental Factors in Autoimmune Disease

It isn’t just the chemicals. We are destroying our soil and our water. Both vital aspects of our food chain. Pop across to my book review earlier this year of Julian Cribb’s Surviving the 21st Century for more details. The Adani mine proposal in Queensland is most likely a health disaster waiting to happen. I look at the photo above: which environment might be healthier?

Yet many people do not develop AI diseases. Do they have a natural resistance?

Are all the different diseases really just different expressions of one disease?

So many unanswered questions.

I do think we have changed our natural world so much and so fast. We live entirely different lives than we did a hundred years ago: faster paced, less exercise, exposure to many things that didn’t exist a hundred years ago.

We also died younger: perhaps these diseases did exist, we just didn’t recognise them or live long enough for them to bother us. Yet many of these diseases do not worry about age: young or old, so many succumb to an out of control immune system irrespective of age. Consequently I’m not a fan of that theory.

It is estimated a hundred years ago humans got five times more exercise that they do today, just from living their lives. Office jobs were a rarity, not the norm. Movement was a natural part of life, not something we were encouraged to do for thirty minutes a day.

“Sitting is the new smoking” has been a mantra for a while, but now studies show standing is not the solution either. Movement is the key to good health, but we have developed a civilisation in which movement is not happening enough. We sit or stand without movement in so many jobs.

Sleep is another lifestyle concern. Most of us don’t get nearly enough. We watch too much TV, have the iPad or our phone on our bedside table so go to sleep way after sundown, yet get up at 5:30am to get that 30 minutes of mandated movement in the gym before 8 hours sitting (or standing). Rinse and repeat.

For those of us already managing AI conditions, (the pain, the financial impost, the lifestyle restrictions) finding the cause may be too late for us personally. For those coming after us, I do hope science finds a solution. Soon.

I do recommend counteracting as much as we possibly can. Eat healthily, sleep well, MOVE, avoid processed foods, give up smoking, minimise stress. Science has given us ways to manage many of these conditions reasonably well, however we can help. There is no point in my taking my prescribed medications every morning if I undermine the efficacy by my lifestyle choices.

While the scientific jury is still out, I’m looking at AI diseases as having a multi-factorial cause. I don’t believe I can rid myself of my conditions, but I can sure as hell give my body the best help I can.

Resources:

Multiple autoimmune syndrome

Autoimmune diseases (a good intro from the Australian Society of Immunology and Allergy)

Recent insights in the epidemiology of autoimmune diseases: Improved prevalence estimates and understanding of clustering of diseases