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Greenhouse gases are changing the global climate, with serious implications for health and ecosystems. 1 2 All sectors of the economy, including the health sector, must act to reduce greenhouse gas emissions. 3 High income countries need to cut emissions by about 90% by 2030 to limit the global average increase in temperature to 2°C, and thus reduce the risk of the most serious consequences. 4
The Sustainable Trials Study Group was convened by the London School of Hygiene & Tropical Medicine to find ways of reducing greenhouse gas emissions from clinical trials. This international health research institution has an extensive research programme on the links between environment and health. A sustainability group was established to reduce the institution's carbon footprint, and this study is a product of its work.
Summary points
Clinical trials contribute substantially to greenhouse gas emissions
The main sources are energy use in research premises and air travel
Renewable energy sources and more efficient energy use would reduce emissions from premises
Simplified trial designs, reduced bureaucracy, and videoconferencing would reduce air travel
The CRASH trial case study
We conducted a carbon audit of the Medical Research Council (MRC) CRASH trial (www.crash.lshtm.ac.uk) with the Edinburgh Centre for Carbon Management (www.eccm.uk.com). The CRASH trial is a multicentre international trial of the effect of corticosteroids on death and disability in 10â[euro][per thousand]008 adults with head injury. 5 The trial was coordinated from the London School of Hygiene & Tropical Medicine, and patients were recruited in 49 countries over five years (1999-2004). The drug was made by Pfizer in the United States and the placebo was made in France. Drug and placebo were packed in Wales. Treatment packs were sent to London for distribution to hospitals around the world.
Emissions were estimated for a one year period (August 2003 to July 2004). We collected data on operational activities according to the greenhouse gas reporting protocol developed by the World Business Council for Sustainable Development. 5 6 7 This protocol provides a choice of three "scopes." Scope 1 covers direct emissions from company vehicles and facilities. Scope 2 includes indirect emissions from energy imports and exports. Scope 3 includes other indirect emissions such as employees' travel, transport by third parties, outsourcing of core activities, and off-site...