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Making Health Care Greener

This column was originally published in AMA eVoice on April 24, 2008. Dr. Davis is president of the American Medical Association.

Did you know that seven of every 10 Americans die each year of a chronic disease? A number of diseases such as asthma, non-Hodgkin's lymphoma, and breast cancer are on the rise, and many conditions are linked to toxic pollutants.

A 2005 report by the Centers for Disease Control and Prevention found that we're making progress on decreasing Americans' exposure to 148 potentially toxic chemicals that are prevalent in the environment. But our ongoing exposure to these toxins remains a serious health concern.

Our health care system does a good job in diagnosing and treating illness and alleviating pain and suffering. But, like other sectors of society, its actions in regards to the environment have a ways to go. Medical waste incinerators, used by many hospitals to burn garbage ranging from reception-area trash to operating-room waste, are a major producer of dioxin, a particularly potent carcinogen. In the mid-1990s, the U.S. Environmental Protection Agency found medical waste incinerators to be the leading source of dioxin and responsible for 10 percent of mercury emissions in the United States. A 2006 report by the AMA Council on Science and Public Health spells out the dangers of mercury.

Many of the concerns surrounding incinerators are based on what is being put into them. Dioxin can form when polyvinyl chloride (PVC) plastic (also known as the "poison plastic") is manufactured and incinerated. PVC plastic is the most widely used plastic in medical devices such as intravenous bags and tubing. PVC also can be found in many health care facilities' furnishings (such as flooring, carpet backing, and wall coverings) and in their doors and windows.

PVC plastic also exposes patients to the phthalate DEHP, which is used to soften medical devices made of PVC plastic. Phthalates are known to cause damage to the liver, kidneys, lungs, and reproductive system, according to animal studies.

Medical devices made of PVC plastic can leak DEHP, and several government reports state that some patients likely are exposed to potentially unsafe amounts of DEHP while receiving medical care. Additionally, researchers at the Harvard School of Public Health found that infants in neonatal intensive care units experience a high exposure to DEHP. The good news is that a number of health care institutions are working toward eliminating the use of medical and building materials that include PVC and DEHP, and several already have stopped using them.

Using alternatives to PVC and DEHP is one way for hospitals and health care facilities to become "greener." Another is by serving fresh, local, or organic foods to patients, staff members, and visitors. Hospitals should buy meat and poultry raised without non-therapeutic antibiotics, use milk produced without recombinant bovine growth hormone, and replace unhealthy snacks found in many vending machines with healthy choices. Hosting farmers markets, either on hospital grounds or nearby, is another appealing option.

Some health care systems, including my employer, Henry Ford Health System, understand the need for more eco-friendly hospital settings and have formed the Global Health and Safety Initiative, a unique partnership to green the health care industry and improve patient safety.

Health care systems aren't the only part of the health care sector that can better support the environment. All stakeholders, including physicians, should work toward making health care greener. With Earth Day being observed earlier this week (on Tuesday), and with a strong consensus in the scientific community about climate change and global warming, this is an especially timely topic.

Physician organizations can find inspiration from the Canadian Medical Association (CMA), which last week announced that it will add environmentally preferable features and practices to all aspects of its meetings, events, and activities. Whenever possible, left-over food will be donated to food banks; waste will be reduced, and eliminated if possible (bottled water is not served at most CMA meetings); energy consumption will be reduced by turning off lights and escalators during off hours); and paper reports and agendas will be replaced by Web-based directories.

This decision comes on the heels of the CMA's first green annual meeting in Vancouver last year (which I attended). The meeting resulted in a significant reduction in the amount of garbage produced, in part because a number of delegates used laptops instead of paper reports. Attendees also received a ball-point pen with a biodegradable encasing made from Mater-Bi, a cornstarch-based "bioplastic" material that breaks down into carbon dioxide, water, and organic humus when discarded into a bacteria-containing environment. The cap on each pen contained a tomato seed that will sprout when the cap enters the soil.

The Florida Medical Association's (FMA's) annual meeting last year (which I also attended) included an educational session on ways physicians can institute energy-saving (and money-saving) practices into their offices. Suggested modifications include furnishing offices with eco-friendly lamps and light bulbs, turning off lights, and recycling. The FMA also published an article in the October 2007 issue of Florida Medical Magazine that addresses climate change and suggests ways for physicians to serve as community leaders in supporting the environment.

The AMA has policy that encourages physicians to be spokespersons for environmental stewardship and urges the medical community to cooperate in reducing or recycling waste. The AMA also partners with publishing vendors that are environmentally sensitive and use a combination of recycled material, recyclable paper, and reusable material whenever possible. And on May 1, the building that houses the AMA's Chicago headquarters will launch a new recycling program that includes specific containers on each floor for bottles, cans, and plastics.

In a recent commentary in the Journal of the American Medical Association, Paul S. Auerbach, MD, of the Stanford University School of Medicine noted other ways in which physicians can become more aware and involved in environmental issues. One suggestion I'd highlight is for medical schools to offer an elective course on the connection between environmental issues and human health. Taking that a step further, I believe environmental awareness also should be part of physicians' professional development, perhaps with a continuing medical education tie-in.

Dr. Auerbach also called for physicians to look into various environmental organizations and consider supporting them with their medical expertise. Many of these organizations are doing terrific work, and I'm one of the keynote speakers for a conference-CleanMed 2008-that two of them are co-sponsoring on May 20-22 in Pittsburgh. Health Care Without Harm and Practice Greenhealth are among several health care groups supporting the conference.

As physicians, we pledge to "do no harm." With that in mind, I urge you to make your practice greener in ways that are ecologically sustainable, are safe for public health and the environment, and promote good patient care.