There has been an increasing concern that pollution from pharmaceuticals used in human medicine and agriculture can be a threat to the environment [1, 3, 4, 7, 8, 11–13, 15, 18]. Little is known, however, about people’s perception of the environmental risk of pharmaceuticals.
In the present study, consumers’ evaluations of various risks to the natural environment indicated that people seem to be aware of the risks associated with the use of pharmaceutical products in agriculture. In contrast, drugs used in human medicine were considered as a less severe problem (Table 1). This is likely related to the fact that respondents see more benefits related to pharmaceuticals used in human medicine. It is well established that risk perception is strongly connected to benefit perception [27, 28]. Both benefits and risks are closely linked to affective responses (i.e., the specific quality of “goodness” or “badness”, which is experienced as a feeling state and which demarcates a positive or negative quality of a stimulus), specifically arousal in our case. Using affective responses to stimuli as a mental shortcut is referred to as the affect heuristic [27–30].
Results of the present study suggest that people also use an affect heuristic  when they must balance health and environmental considerations. Two scenarios relevant for human health were compared: One scenario dealt with treatment decisions related to a very severe health risk, while the other scenario illustrated a rather benign health risk. The results indicated that people seem to be willing to consider environmental consequences when making decisions about pharmaceuticals for a harmless, but not for a severe disease. When the decision is about life and death, effectiveness is of vital importance. We suspect—in line with previous research —that the cancer scenario elicited a strongly negative affective response, e.g., a strong feeling of dread, which guided the decision and choices between the pharmaceuticals. It should be noted, however, that affect was not measured directly in this study, and further studies should provide more direct evidence that supports this hypothesis.
Our results have consequences for pharmaceutical risk management. In cases where the drug is used for the treatment of a rather harmless disease, people value environmentally friendly options or prefer to refrain from taking medication at all when they realize that the drug has a considerable environmental impact. For OTC drugs, people also tended to be supportive of labels that aimed at recognizing environmentally friendly drugs. However, in the cancer scenario, it was demonstrated that a policy requiring doctors to prescribe the drug with the lowest environmental impact was not supported and probably perceived as too paternalistic.
When weighting human health and environment, people seem to feel that the patient’s health should be considered first, which is also in line with the general ethical standards of physicians [cf. . It should be noted that the environment label developed by the Swedish Stockholm County Council is intended for treatment decisions only when drugs of similar action and efficiency are available in order to select the most environmentally friendly treatment [1, 18]. Thus, in one respect almost all the stakeholders are unanimous: Priority should be given to the best possible strategy for curing or palliation of a disease .
Concerning pharmaceuticals used in agriculture, respondents generally preferred the more environmentally friendly options. They also reported a high level of satisfaction for a policy requiring farms to limit their use of antibiotics. However, when we asked people about the characteristics they take into account when they buy food in a grocery store, taste and price were the most important drivers for food choices. It must be stressed that abandoning or limiting antibiotics in agriculture may lead to higher prices for some foods, because antibiotics used for growth promotion affect production efficiency and profitability . Hence, limiting the use of antibiotics in agriculture is partly in contradiction to people’s preferences regarding food choices. Risk communicators as well as risk managers are therefore well advised to inform the public that policies aimed at abandoning or limiting antibiotics in agriculture may not be possible without a rise in food prices.
We suspect that the same may be true of OTC drugs, where price signals may interact with other variables in terms of consumer choices. Specifically, more expensive OTC drugs may cause consumers to downplay environmental considerations when making choices about which products to buy. However, in the case of pharmaceuticals for the most serious of ailments, we suspect that price would not be a key driver of choice; here we might expect effectiveness of the drug to be the key driver of choice. Each of these possible interactions should, in our view, be the focus of subsequent research.
We also found considerable differences in risk perception and choices between the two age groups. Compared to older respondents, younger participants seem to be less aware that pharmaceuticals used in human medicine and agriculture can be a threat to the environment. In addition, younger adults (and males) also seem to rely more heavily on information about effectiveness of a drug. A similar pattern was found for pharmaceuticals used in agriculture. Knowing about these demographic differences may help to target communication materials to specific subgroups, such as younger adults and/or males.
Besides sociodemographic variables, it is possible that other interindividual factors might account for differences in risk perception and choices. One of these is the respondents’ health status. A recent study suggests that people with a poor health status would rather choose branded drugs instead of generic drugs for severe ailments , likely because they believe that only the best or priciest treatment is appropriate for their health. It is, therefore, likely that people with a poorer health status would be less willing to accept a drug with lower effectiveness. Inclusion of this factor may explain further variance in trade-off-decisions and in drug regulation acceptance.
Related, we expect that some of the respondents in this study will have been better informed, and more knowledgeable, about the deleterious environmental effects of pharmaceutical products than others. It is reasonable to hypothesize that these more knowledgeable people would have been more careful about their decisions to use pharmaceuticals, especially when they were accompanied by negative environmental consequences. Because we survey a random sample of adults, we are confident in the general findings drawn from this study; namely that the environmental impact of a drug is discounted in decisions about treating severe ailments. However, in a future study, it would be interesting to explore interactions between risk perception, decisions, knowledge, and—as alluded to above—respondents’ health status.
It is important to note also that our study only surveyed people living in the United States. Risk regulation of pharmaceuticals as well as handling of drugs is likely to differ between various countries. Furthermore, in contrast to many other countries, it is possible in the U.S. to buy pharmaceuticals not only in pharmacies but also in locations such as supermarkets and gas stations. Hence, U.S. residents should be quite familiar with evaluating different drug options that are available to them. Thus, it is not clear whether the results from this study can be transferred one-to-one to other countries.