MEDICAL RESEARCH EFFECT ON ENVIRONMENT

1. INTRODUCTION
The progress made by medical science during the last century and its positive impact on
society are well known. Medicinal products are an important element of the medical practice and
their beneficial effects (and side-effects) on human and veterinary health are widely
acknowledged. However, the area where we lack a global view is understanding what happens
when these medicinal products are discharged into the environment, either through consumption
or as unused or expired products. Residues of various types of medicinal products (hormones,
anti-cancer, antidepressants, antibiotics, etc.) Have been detected in various environmental
compartments, such as surface water, groundwater, soil, air, and biota. Such widespread
occurrence obviously begs the question whether a concentration of medicinal products in the
environment poses a risk for exposed biota or humans.
Recent pharmacovigilance legislation in the EU acknowledges that the pollution of
waters and soils with pharmaceutical residues is an emerging environmental issue. The European
commission was asked to deliver a report on the scale of the issue, the causes, and possible
policy options to mitigate such impacts. More recently, in the framework of the adoption of the
directive regarding priority substances in the field of water policy, the commission has been
asked to develop, instead of the report, a strategic approach to pollution of water by
pharmaceutical substances by the end of 2015.
This study, together with other relevant studies and reports, will provide the basis to develop that
strategic approach. The study covers both human and veterinary medicinal products but personal
care products are excluded.
The consumption phase is considered to be the biggest contributor to the emissions of
medicinal products into the environment, notably through excretions and incorrect disposal of
unused medicines through sinks and toilets. Between 30 and 90% of the orally administered dose
is generally excreted as active substance in the urine of animals and humans. However, the
nature and amount of medicinal residues mainly depend on the volumes and nature of the
administered substances, their modes of administration, and metabolisation rates.

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2. HOW DO MEDICINAL PRODUCTS ENTER THE

ENVIRONMENT?
The key steps (from an environmental perspective) in the life cycle of a medicinal
product are manufacturing, consumption and waste management. Contamination pathways along
the life cycle depend upon the life-cycle step during which the emissions occur. In the EU, the
contribution of manufacturing facilities to emissions of medicinal products and/or their residues
is generally considered as negligible, even though pollution downstream of manufacturing plants
has been sporadically observed while monitoring specific sites (e.g. The Rhine, Lake Leman).
The consumption phase is considered to be the biggest contributor to the emissions of medicinal
products into the environment, notably through excretions and incorrect disposal of unused
medicines through sinks and toilets. Between 30 and 90% of the orally administered dose is
generally excreted as active substance in the urine of animals and humans.

FIG : 1
However, the nature and amount of medicinal residues mainly depend on the volumes and
nature of the administered substances, their modes of administration, and metabolisation rates.
Medicinal products can also directly enter the environment through feed surplus, notably in the

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case of aquaculture: a recent survey measured up to 2.2 g of teflubenzuron / kg of dry weight

sediment coming from a marine fish farm in Scotland. Once in wastewater, treatment can partly
eliminate or remove medicinal product residues, but some traces are still detectable in effluents
as well as in the receiving surface and groundwaters. The residues remaining after wastewater
treatment depend on the composition of the medicinal product, wastewater treatment process,
and initial concentrations in the influent. For example, ibuprofen, which is present in significant
amounts in wastewater influents, is reduced by 60 to 96%, while carbamazepine removal rates
are much lower. As for landfills accepting medicinal products, sewage sludge can produce
leachates containing concentrations similar to or even higher than those found in wastewater
treatment plant influents.

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3. HOW DO MEDICINAL PRODUCTS BEHAVE IN THE

ENVIRONMENT?
Once in the environment, medicinal products are transformed and transferred among
different compartments, depending on the nature of the compounds and the characteristics of the
host compartment. There exist voluntary initiatives for monitoring environmental concentrations
of medicinal products in some member states, particularly in the aquatic environment. These data
suggest that several medicinal products are detectable in the environment, and their
concentration depends on the geographical location, season, local administration practices, and
specific environmental factors (t, humidity, etc.). The detected concentrations could be in the
range of sub-ng/l levels to more than several g/l.
Medicinal products can degrade biotically or abiotically in soils and water, a process that
in general reduces their potency, even if some degradation products might be persistent and thus
of concern. For instance, according to a monitoring campaign performed in France, the
molecules most frequently found in freshwaters are carbamazepine (an anti-epileptic medicinal
product) and its main metabolite, and oxazepam (an anxiolytic) which is both a parent product
and a metabolite of another pharmaceutical (benzodiazepine). Highly lipid-soluble medicinal
products may also have the ability to accumulate in the fat tissues of animals and can be thus
introduced into the food chain (e.g. Ethynilestradiol could be a potential candidate for
bioaccumulation in higher predators).
3.1 EMISSIONS FROM MANUFACTURING
In the eu and in north america, the direct contribution from production facilities to
emissions of medicinal products and/or their residues have been considered negligible so far
according to the european environment agency, despite manufacturing facilities being known to
produce substantial amounts of waste23 (eea, 2010). The assumption that, with the exception of
accidental releases, the production of medicinal products plays a minor role in their discharge
into the environment (gace, 2007), is generally based on the high economic value of the active
substances (heberer, 2002) (kmmerer, 2009) (efpia, 2012) . Efpia estimates that only 2% of the
total emissions of medicinal products to the environment occur because of pharmaceutical
production24. However, the empirical evidence underlying these assumptions and estimations is

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not explicitly illustrated or presented. Moreover, a recent study showed that the discharges of a
pharmaceutical manufacture could have adverse effects on the fish living downstream of a river.

3.2 EMISSIONS FROM CONSUMPTION

Of the different steps of the life cycle, the consumption stage is the most important
contributor to the emissions of medicinal products into the environment (gace, 2007)
(schwarzenbach, 2007) (bound, 2005). It may sometimes be difficult to attribute human or
veterinary origins to the residues detected in the environment (eea, 2010) (knappe, 2008),
because some medicinal products can be used in both humans and animals, according to either
product usage specifications or inappropriate use25 (e.g. Products for human use specifically
which end up being used for animals).
The consumption step contributes to the emission of medicinal products into the
environment mainly through human and farm animal excretions26 (gace, 2007) (eea, 2010)
(haya, 2000) (hecktoen, 1995) (boxall, 2004) which are continually released in raw sewage or
soil (for animals) via urine and/or faeces27. Figure 5 presents a schematic diagram of the known
contamination pathways related to the use phase for both human and veterinary medicinal
products. Although excretion is the main pathways to the environment for both human and
veterinary products, significant quantities of human or pet medicinal products dermally applied,
such as gels containing anti-inflammatories, can be washed off the skin during
showering/bathing.

FIG : 2

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3.3 EMISSIONS DUE TO DISPOSAL AND WASTE TREATMENT

This section focuses on the emissions from the disposal of medical waste (including e.g.
Contaminated packaging and unused medicines) and from the treatment of sewage and solid
waste, including waste streams from the manufacturing stage to the consumption stage (e.g.
Excretions).
Different facilities (households, hospitals, health care centres, manufacturing facilities,
waste treatment plants, etc.) Contribute to the occurrence of medicinal products in waste streams
that need to be treated, although there is little information about their respective contributions
and the available information generally covers only a part of the process or specific active
substances.

The consumption of both veterinary and human medicinal products significantly

contributes to the emission of medicinal products through excretions, either entering directly the
environment (diffuse contamination) and/or released into the sewage network (point source
pollution). Excretions are the major known contamination pathway. Veterinary medicinal
products can also enter directly the environment through food/feed surplus, notably in
aquaculture.

Releases of medicinal products also occur through the incorrect disposal of unused
medicines through the sinks and toilets. Although contamination does not seem to reach the same
extent as pollution from excretions, it is not negligible and a large share can be avoidable.

Some substances tend to adsorb to sewage sludge, of which subsequent use for soil
amendment results in further risks of emissions into the environment. More precisely, the risk
concerns the persistent medicinal products that resist biodegradation during the aerobic or
anaerobic treatments of the sludge. The hydrophilic nature of some compounds can lead to
transfers of active molecules from soils to surface water or groundwater by the phenomenon of
mobility.

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4. ENVIRONMENTAL HAZARDS
Exposure to hazardous health-care waste can result in disease or injury. The hazardous nature
of health-care waste may be due to one or more of the following characteristics:
It contains infectious agents.
It is genotoxic;
It contains toxic or hazardous chemicals or pharmaceuticals;
It is radioactive;
It contains sharps.

4.1 HAZARDS FROM CHEMICAL AND PHARMACEUTICAL WASTE

Many of the chemicals and pharmaceuticals used in health-care establishments are
hazardous (e.g. Toxic, genotoxic, corrosive, ammable, reactive, explosive, shock-sensitive).
These substances are commonly present in small quantities in health-care waste; larger quantities
may be found when unwanted or outdated chemicals and pharmaceuticals are disposed of. They
may cause intoxication, either by acute or by chronic exposure, and injuries, including burns.
Intoxication can result from absorption of a chemical or pharmaceutical through the skin or the
mucous membranes, or from inhalation or ingestion. Injuries to the skin, the eyes, or the mucous
membranes of the airways can be caused by contact with ammable, corrosive, or reactive
chemicals (e.g. Formaldehydeand other volatile substances). The most common injuries are
burns.

FIG : 3

4.2 HAZARDS FROM GENOTOXIC WASTE

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The severity of the hazards for health-care workers responsible for the handling or
disposal of genotoxic waste is governed by a combination of the substance toxicity itself and the
extent and duration of exposure. Exposure to genotoxic substances in health care may also occur
during the preparation of or treatment with particular drugs or chemicals. The main pathways of
exposure are inhalation of dust or aerosols, absorption through the skin, ingestion of food
accidentally contaminated with cytotoxic drugs, chemicals, or waste, and ingestion as a result of
bad practice, Such as mouth pipetting. Exposure may also occur through contact with the bodily
uids and secretions of patients undergoing chemotherapy.
4.3 HAZARDS FROM RADIOACTIVE WASTE
The type of disease caused by radioactive waste is determined by the type and extent of
exposure. It can range from headache, dizziness, and vomiting to much more serious problems.
Because radioactive waste, like certain pharmaceutical waste, is genotoxic, it may also affect
genetic material. Handling of highly active sources, e.g. Certain sealed sources from diagnostic
instruments, may cause much more severe injuries (such as destruction of tissue, necessitating
amputation of body parts) and should therefore be undertaken with the utmost care. The hazards
of low-activity waste may arise from contamination of external surfaces of containers or
improper mode or duration of waste storage. Health-care workers or waste-handling or cleaning
personnel exposed to this radioactivity are at risk.

FIG:4

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5. HUMAN EXPOSURE THROUGH THE ENVIRONMENT

AND POSSIBLE IMPACTS
5.1 HUMAN EXPOSURE THROUGH THE ENVIRONMENT
The detection of low levels of medicinal products in rivers and streams, drinking water,
and groundwater has raised questions as to whether these levels may have consequences to
human health. Humans are unintentionally exposed to very low concentrations of medicinal
products via daily intakes of drinking water, leaf crops, root crops, fishes, dairy products, and
meat.

FIG : 5
Depending on the different use rates of organic fertilisers such as manure or sewage
sludge and of treated surface water as drinking water, the potential exposure of humans to
medicinal products may vary among eu countries. Organic fertilisers transport medicinal
products to food, and medicinal products in surface waters may end up in fish and drinking
water.
Furthermore, the indirect environmental exposure of antibiotics and medicinal products
having anti-bacterial, anti-viral or disinfectant properties may create antimicrobial or anti-viral
resistance in human gut flora leading to less effective antibiotics or anti-viral medicinal products
in the future. The biggest issue is the transport and spread of resistance around the globe from
human to human. If a person from europe is exposed to an antibiotic compound in a third

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country, this person will take back the resistance genes in infected bacteria to europe and be able
to spread the bacteria (resistant genes) to other individuals here. Today it may take humans more
than 1 year to lose resistance gut bacteria again. Therefore, the possibility to spread them to
vulnerable individuals during this period is high. It is important to realise that incorrect
application of antibiotics or anti-viral pharmaceuticals is a global problem that can affect
vulnerable individuals many thousands of miles away. A minor exposure pathway might result
from recreational activities (e.g. Open water swimming, or children eating contaminated soil).

5.2 EXPOSURE THROUGH THE CONSUMPTION OF PLANT BASED

PRODUCTS
Humans may be exposed to contaminants from sludge or manure through eating crops
cultivated on soil where sludge or manure has been applied, if contaminants absorbed in the soil
are transferred in plant roots, leaves, etc. The exposure of humans from plant-derived food
materials has been estimated using consumption data from a national dietary survey (norkost,
1997) combined with estimated or measured plant concentrations of medicinal products for
different model plants (boxall, 2008). Boxall and co-workers (2008) studied the potential for a
representative range of veterinary medicinal products to be taken up from soil by plants (lettuce
and carrots) and to assess the potential significance of this route of exposure.
Comparison of the actual calculated daily intakes for veterinary medicinal products with
the corresponding acceptable daily intake (adis) (figure 8) suggests that for the study compounds
exposure of consumers to veterinary medicinal products in soils via plants is likely to be
considerably below the adi and that the direct risk to human health is thus probably low. The
most bioaccumulative compounds (insecticide), levamisole (insecticide) and trimethoprim (anti-
infective drug) via non-green food only accounted for less than 10% of the adis. This simplistic
risk assessment is very conservative, because it assumes that all plant material consumed in the
diet is derived from crops grown with manure containing veterinary medicinal products.

5.3 EXPOSURE THROUGH WATER CONSUMPTION

Humans may be exposed to contaminants dissolved in drinking water (schricks, 2010) or
adsorbed to particles. As concentration levels of medicinal products in drinking water produced
from surface water are generally higher than in drinking water produced from ground water
(debroux, 2012; stuart, 2012), it can be discussed whether exposure is higher via the drinking

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water produced from surface sources. Higher levels of concentrations in surface water does not
necessarily result in a higher level of human exposure to medicinal products in countries using
predominantly surface water, since the actual exposure will mostly depend on the quality of
drinking water treatment. The environmental occurrence of medicinal products in surface water
have been evaluated and generally found to be low if the waste water is treated before release to
the environment, as a large proportion of the contaminants may be removed during filtration
processes in drinking water treatment plants.for example, sanderson (2011) collected data
showing trace amounts of medicinal products in surface waters in the nano- to microgram per
litre range, but only in the nanogram per litre range and in drinking water. No difference between
surface and groundwater sources were reported in terms of human health risks.
The human health risks of trace amounts of medicinal products in drinking water have
been evaluated in a report edited by the world health organisation (who, 2011)46 as well as in a
few countries such as in the uk and the netherlands (boxall et al., 2011; boxall, 2012b; schricks,
2010; versteegh, 2007). All reports conclude that, based on available evaluations, the majority of
compounds a substantial margin of safety exists between the maximum concentration in drinking
water and the concentrations likely to trigger adverse effects, and then that adverse health effects
from targeted medicinal products occurring in european water are not expected to individually
pose any appreciable risks to human health. However, although preliminary screening level
assessments suggest the exposure to be low, they are often based on the use of proxy indicators
such as the lowest therapeutic doses as points of departure for the risk assessment (e.g. In boxall
et al., 2011), which does not reflect the specificities of pharmaceutical exposures through
drinking water. Therefore, uncertainties remain, in particular with regards to the particularly
active nature of the molecule, concerning mixture effects, chronic long-term effects at low doses
and sensitive sub-populations. These aspects should be investigated further to verify whether the
current exposure leads to a significant risk.

5.4 EXPOSURE THROUGH THE CONSUMPTION OF MEAT, DAIRY AND

FISHERY PRODUCTS
Medicinal products can bioaccumulate in cattle anf fish, either through direct exposure
for therapeutic purposes (use as growth promoter may still occur but is an illegal practice in the
eu) or through the presence of pharmaceutical residues in the environment (e.g. In surface water

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for fish). Humans can then be exposed to the contaminants through the consumption of meat,
dairy and fishery products.
Fao, who, the international office of epizootics (oie) and a number of national
governments have lately raised the issue of irresponsible use of antibiotics in all production
sectors, including fish industries, with particular concern for the potential risks to public health.
Many governments around the world have introduced, changed or tightened national regulations
related to the use of veterinary medicines, and in particular of antibiotics. In order to protect the
health of consumer of foodstuff of animal origin, the eu legislation now foresees that foodstuff
obtained from animals treated with veterinary products must not contain residues of the medicine
or its metabolite which might constitute a hazard health for the consumer, and maximum residue
levels (mrls) were set in this respect. In europe, there is therefore a comprehensive control of
residues of veterinary pharmaceuticals in products issued from farming and aquaculture, and
most production is considered of high quality, not containing antibacterial agents, which are the
most used in animals, over the mrl levels. While the level of antibiotic residue is low in most
cases, this kind of low and constant exposure can lead to antibiotic resistance in both the animals
fed the antibiotics and the humans who consume the food. Eu) highlighted that consuming foods
containing antibiotics could have a direct effect on an individuals own intestinal bacteria and
could contribute directly to the bacteria in the bowel becoming resistant to later antibiotic
treatment. The risk for resistance and gi-tract disturbances are among the parameters considered
when setting mrls for antibacterial substances.
However, environmental exposure to medicinal contaminants (human or veterinary) of
animals is not considered within the mrl regulation. This pathway of exposure is currently poorly
characterised. Additional research into deriving methods for assessing these pathways and better
quantifying mrl for all medical products as well is suggested to be initiated.

FIG : 6

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6. LEGISLATIVE FACTORS OF INFLUENCE

A developing country like India has seen healthcare sector slowly unfold into an industry
and an unavoidable side effect of such a situation is the generation of huge quantities of bio-
medical wastes. There has been an increase in the volume of services rendered in healthcare
sector and consequently increased volumes of such waste,273 which is the subject of this study.
A large section of the healthcare sector has not given importance to the proper management and
handling of bio-medical wastes.
The state of goa, being an international tourist destination and a hotspot for medical
tourism, has got an exceptional number of patient turnovers and has therefore faced the brunt of
the ill-effects of improper bio-medical waste management to a large extent.274 hence, this study
was undertaken with several objectives, ranging from analysing the problem of bio-medical
waste mismanagement in the state of goa to, examining the nature of legal control for its overall
efficacy in the context of the existing situation. As a result, the researcher has collected
voluminous data and arrived at relevant findings, evaluated the problem and offered suggestions
and recommendations, including a proposal for a specific legislation for the state of goa, which
are the contents of this chapter.
The researcher has put forth two hypotheses; viz. Firstly, that the healthcare institutions function
in gross violation of the existing rules, thereby posing danger to in-patients, visitors and the
public at large and secondly, that these rules themselves suffer from certain basic shortcomings
and as a result, the existing rules have become ineffective in protecting the environment
generally and health of the people in particular. After having traced the growth of the legal
mechanisms, both international and domestic, as seen in the second and third chapters
respectively, the researcher perused the latest rules governing the subject of bio-medical waste
management, namely, the bio-medical waste (management and handling) rules, 1998, which
have been notified by the government of india in the exercise of power conferred by sections 6, 8
and 25 of the environment (protection) act, 1986.

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6.1 BIO-MEDICAL WASTE MANAGEMENT POLICIES

In a majority of the areas of this study, the scene is dismal and calls for serious and
immediate amelioration. Since more than half (59%) of the respondents280 were not aware of
the legislation or rules applicable to bio-medical waste management and only five of the
respondents were able to list the legislative act and/or rules when asked, it means that the
government has not done enough to sensitize the personnel who are employed in healthcare
establishments that generate bio-medical wastes. Less than half (38%) of the respondents281
reported that their healthcare settings followed a waste management plan of too small a
percentage in an area of risk-prone environment. Merely including waste management
responsibilities in the job description of employees appears to be only for the record and even
this has been reported as being done by 63% of the respondents,282 which again is not a
satisfying figure. Vast majority (78%) of the respondents283 were not even aware that
authorization by the goa state pollution control board reflects the starting point of the disconnect
in the system between the prescribed authority under the rules and the occupiers.

6.2 ADMINISTRATIVE REQUIREMENTS

Every occupier of an institution generating, collecting, receiving, storing, transporting,

treating, disposing and/or handling bio-medical waste in any other manner, shall make an
application in form i for authorization.284 annual reporting by every occupier/operator,
maintenance of records by authorized persons and accident reporting by authorized persons
whenever necessary are also laid down. However, it is observed that vast majorities (72.68%) of
occupiers are unauthorised to function in terms of bio-medical waste management285 and even
greater majorities (90.84%) do not maintain any records286 and hence there is very little
information related to the generation, collection, reception, storage, transportation, treatment,
disposal and/or any form of handling of bio-medical waste . Further, no accidents have been
reported till date in prescribed format to the prescribed authority287. In respect of mandatory
annual reporting, meant to be furnished to the prescribed authority by 31st january annually, only
12 of the 133 occupiers under study (9.02%) had submitted such reports.288 the goa state
pollution control board has not undertaken any measures due to non-receipt of such reports,289
even though the central pollution control board has to be compulsorily be intimated by 31st
march annually

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6.3 SEGREGATION AND TRANSPORTATION

Segregation, packaging, transportation and storage are equally important in the

management and handling of bio-medical waste. Segregation is the first step and it is clearly
prescribed that bio-medical waste should not be mixed with other wastes. In the rules laid down
for segregation, schedule ii prescribes a certain type of container with a particular colour coding
to be adopted and schedule iii prescribes the symbols to be used on such containers.291 however,
alarming amounts (85.58%) of occupiers do not segregate wastes in accordance with the rules of
segregation292 and equally high amounts (81.79%) do not observe the colour coding
scheme293.
The rules also laid down that in case of transportation, containers shall also carry
information prescribed in schedule iv and such vehicle used in transportation has to be
authorized.294 further, untreated bio-medical waste should not be stored for more than a period
of 48 hours at the premises, unless it is unavoidable and with permission being sought by the
authorized person from the prescribed authority.295 almost all the occupiers responded as failing
to comply with the rules regarding transportation of untreated wastes (95.99%) which includes
the label for transportation and authorized vehicles296 and relatively small numbers (8.73%)
responded to having kept untreated bio-medical waste on the premises beyond the stipulated
period of 48 hours.297
Lastly, the role of the municipality in picking up duly treated bio-medical waste is provided for
in rule 6(6) of the bwm rules. However, the information provided by the chief officers of
municipal bodies identified by the researcher, that the municipal bodies collect wastes from all
the healthcare institutions in their jurisdiction and carry the same to a disposal site for dumping,
where all wastes were collectively disposed and that they were not aware if the same were
treated wastes, shows the failure of this particular rule.

6.4 TOWARDS A GOA-SPECIFIC LAW FOR BIO-MEDICAL WASTE

MANAGEMENT

Primarily, the prevalent rules on the subject of bio-medical waste management owe their
existence to the environment (protection) act, 1986 - the parent act. Therefore these rules are in
the nature of delegated legislation and do not amount to supreme legislation. Consequently,

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the force of legislation is not present in these rules independent of the force of the parent act.
Consequently, in the event of amendment of areas of the parent legislation, the rules will be also
faced with the same treatment. In the given circumstances, the researcher feels that considering
the healthcare scenario of the state of goa and the bio-medical waste management practices, there
is a need for the legislature of the state of goa to enact legislation for the purpose of
independently managing and handling such wastes in an effective manner. The researcher has
therefore examined the legal basis by which such a law can be enacted in the light of the
constitution of india and suggested a comprehensive law for the purpose of bio-medical waste
management in the state of goa.

6.5 CONSTITUTIONAL IMPERATIVES

The legislative relations or distribution of legislative powers between the centre and the
states is provided for in part xi of the constitution of india and it provides for the legislature of
the state making law for the whole or any part of the state.345 it provides further, in article
246(3) that the legislature of the state has exclusive power to make laws for such a state or any
part thereof with respect to any of the matters enumerated in list ii in the seventh schedule of the
constitution of india.346 the researcher further submits that since entry no. 6 of list ii is on the
subject of public health and sanitation; hospitals and dispensaries, the legislature of the state of
goa has legislative competence in enacting legislation for the management of bio-medical waste
generated from any establishment within its territorial limits.

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7. NEEDS FOR FURTHER RESEARCH

Very few data are available on the health impacts of exposure to health care waste
particularly in the case of developing countries. Better assessment of both risks and effects of
exposure would permit improvements in the management of health-care waste management and
in the planning of adequate protective measures. Unfortunately, the classical application of
epidemiology to the problem is difficult because of methodological complications and
uncertainties regarding evaluation of both exposure and health outcome. The great diversity of
hazardous wastes that can be involved and of circumstances of exposures is a particularly
problematic feature of all such evaluations. It prevents not only the development of a unied
analytical approach to the assessment of exposure and health outcome but also the generalization
of any statistical inferences drawn about a specic waste-exposed population. Nevertheless,
suspected cases of adverse health effects of health-care waste should be adequately documented,
with precise descriptions of exposure, exposed
individuals or populations, and outcome.
Within health-care establishments, the surveillance of infection and record-keeping are
important tools that can provide indications of inadequate hygiene practices or of contamination
of the immediate environment (including that caused by health-care waste). Surveillance allows
an outbreak of infection to be recognized and investigated and provides a basis for introducing
control measures, for assessing the efcacy of those measures and of the routine preventive
measures taken by the establishment, and for reducing the level of avoidable infection. It will
also ensure that the control measures have maximum effect and are as cost-effective as possible.

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8. CONCLUSION

The solution of environmental pollution on bio-medical waste management solicits

concerted multi-disciplinary endeavours. Therefore proper environmental health requires the co-
operation and service of public health and medical professionalism apart from educating people
about the menace. As far as policy and legal framework, the relevant provisions should provide
for the respective standards, formalities and procedures to be complied by all people concerned.
However, it is crucial to understand that despite enunciation of law dealing with pertinent
standards, formalities and procedures as detailed above, unless appropriate efforts are made to
translate the same into action, law will remain more on paper; an act of futility, when it comes to
achieving the contemplated objective in practice. This is the precise reason why, appropriately
structured and customized strategies need to be identified for the purpose of meaningful
implementation of the law. One such strategy is the effective dissemination of provisions of law
among those who are either directly or indirectly obligated under the act for its proper
implementation. Inclusion of bio-medical waste management component in the curriculum of
medical, dental and nursing courses will contribute towards improvement. The environmental
issue is slowly gaining ground in the indian society.

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9. REFERENCES

1. Study on the environmental risks of medicinal products, Executive Agency for Health and
Consumers.
2. Basic Principles of Risk Management for Medical Device Design, Ganeshkumar
Palanichamy
3. http://www.health24.com

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