Table 1.

Suggested principles of medical therapeutics with an ecological concern.

Replacement	substitution of a drug by a nondrug alternative
Refrainment	avoidance of the use of drugs with uncertain effects
Reduction	in the quantity of drugs used to attain a given clinical outcome, including in the duration of treatment
Refinement	use of drugs with a more favorable ecological profile
Research	regarding the environmental impact of drugs used in medical therapeutics

Adaptation and increment of the “replacement, reduction, and refinement” concept, developed by Russell and Burch, concerning animal experimentation (for reference see text).