Marine plastic pollution is a symptom of an inherently wasteful linear plastic economy, costing us more than US$ 2.2 trillion per year. Of the 6.3 billion tonnes of fossil fuel-derived plastic (FFP) waste produced to date, only 9% has been recycled; the rest being incinerated (12%) or dumped into the environment (79%). FFPs take centuries to degrade, meaning five billion tonnes of increasingly fragmented and dangerous plastics have accumulated in our oceans, soil and air. Rates of FFP production and waste are growing rapidly, driven by increased demand and shifting strategies of oil and gas companies responding to slowing profit growth. Without effective recycling, the harm caused by FFP waste will keep increasing, jeopardizing first marine life and ultimately humankind. In this Perspective article, we review the global costs of plastic pollution and explain why solving this is imperative for humanity's well-being. We show that FFP pollution is far beyond a marine environmental issue: it now invades our bodies, causing disease and dysfunction, while millions of adults and children work in conditions akin to slavery, picking through our waste. We argue that an integrated economic and technical solution, catalyzed through a voluntary industry-led contribution from new FFP production, is central to arrest plastic waste flows by making used plastic a cashable commodity, incentivizing recovery and accelerating industrialization of polymerto-polymer technologies. Without much-needed systematic transformation, driven by a contribution from FFP production, humanity and the oceans face a troubling future.

BackgroundPatients with rare and ultra-rare diseases make heavy demands on the resources of both health and social services, but these resources are often used inefficiently due to delays in diagnosis, poor and fragmented care. We analysed the national service for an ultra-rare disease, Alstrom syndrome, and compared the outcome and cost of the service to the standard care.MethodsBetween the 9th and 26th of March 2014 we undertook a cross-sectional study of the UK Alstrom syndrome patients and their carers. We developed a semi-structured questionnaire to assess our rare patient need, quality of care and costs incurred to patients and their careers. In the UK all Alstrom syndrome patients are seen in two centres, based in Birmingham, and we systematically evaluated the national service and compared the quality and cost of care with patients’ previous standard of care.ResultsOne quarter of genetically confirmed Alstrom syndrome UK patients were enrolled in this study. Patients that have access to a highly specialised clinical service reported that their care is well organised, personalised, holistic, and that they have a say in their care. All patients reported high level of satisfaction in their care. Patient treatment compliance and clinic attendance was better in multidisciplinary clinic than the usual standard of NHS care. Following a variable costing approach based on personnel and consumables’ cost, our valuation of the clinics was just under £700/patient/annum compared to the standard care of £960/patient/annum. Real savings, however, came in terms of patients’ quality of life. Furthermore there was found to have been a significant reduction in frequency of clinic visits and ordering of investigations since the establishment of the national service.ConclusionsOur study has shown that organised, multidisciplinary “one stop” clinics are patient centred and individually tailored to the patient need with a better outcome and comparable cost compared with the current standard of care for rare disease. Our proposed care model can be adapted to several other rare and ultra-rare diseases.