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266    Cha pte r  F o u r tee n

               the life-cycle impact of a pharmaceutical product; using green engi-
               neering Pfizer was able to cut the amount of dichloromethane sol-
               vent used at its three main research sites by almost two-thirds, while
               use of di-isopropyl ether was eliminated entirely.
                   One example of systematic application of DFE is the Eco-Design
                     ©
               Toolkit  developed by Glaxo-Smith-Kline to integrate eco-design prin-
               ciples and practices into new product development. The toolkit in -
               cludes material selection guides, a green chemistry and technology
               guide, and several life-cycle-based tools for packaging, materials,
               and process assessment. These tools are being integrated into R&D,
               Global Manufacturing, and appropriate business-level or corporate
               communities across the company [2].
                   The following sections describe selected DFE programs imple-
               mented by leading medical and pharmaceutical companies, in -
               cluding Johnson & Johnson, Baxter International, and Eli Lilly, but
               certainly do not provide a complete picture of the global activities
               in these industry sectors.


          Health Care Without Harm
               A nongovernmental organization called Health Care Without Harm
               (HCWH) has had a substantial influence on DFE in the medical field.
               It consists of an international coalition of hospitals and health care
               systems, medical professionals, community groups, health-affected
               constituencies, labor unions, environmental and public health organi-
               zations, and religious groups. The mission of the organization is to
               transform the health care sector worldwide, without compromising
               patient safety or care, so that it is ecologically sustainable and no
               longer a source of harm to public health and the environment [3].
               HCWH has focused on a number of issues related to product safety
               and waste management in health care:

                    • Mercury. HCWH promotes the use of alternative products
                      that do not contain mercury, which is a potent neurotoxin that
                      can affect the human brain, spinal cord, kidneys, and liver,
                      and can have adverse ecological effects as well. Examples of
                      medical devices that may contain mercury are thermometers
                      and sphygmomanometers, or blood pressure devices. In ad -
                      dition hospitals and medical research facilities may utilize
                      mercury-containing fluorescent lamps, batteries, or fixatives
                      in the laboratory. HCWH has urged pharmacies to phase out
                      the manufacture, distribution, and sale of mercury-containing
                      devices and, as a result, virtually all the major chain pharma-
                      cies have stopped selling mercury fever thermometers.
                    • PVC  plastic. Polyvinyl chloride (PVC) is the most widely
                      used plastic in medical devices, but many health advocates
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