UO > Sep/Oct 2008 > Sustainable Medicine

Lawrence Rosen, MD, was “a fairly conventional pediatrician” when he finished his residency and began practicing medicine in New Jersey about a decade ago. But his years of training at Mt. Sinai Medical School did not quite prepare him for what he encountered in his new practice. “I started to realize pretty quickly that there were many children with chronic health care illnesses who were not being served well by conventional medicine. I was seeing an increase in developmental disorders like ADHD and autism, rising rates of asthma and allergies. I felt inadequate to care for these kids with the conventional tools I had.”

Rosen’s search for solutions that would help his patients and their families led him to look at how the environment was affecting children’s health. He quickly came to an unsettling realization: he was part of the problem. The health-care system itself often has a negative impact on the environment. How to deal with all this? That’s when Rosen discovered the world of sustainable, or green, medicine.

Rosen says, “Sustainable medicine is practicing in a way that takes care of people, helps reduce our impact on our environment, and recognizes the impact of the environment on our health. We are sustaining health and we are sustaining the Earth.”

Green medicine, once a small niche comprised of alternative-minded physicians, has gone mainstream. Major hospitals around the country are enthusiastically embracing and investing in sustainability, physicians are greening their practices, and pharmacists are trying new approaches to keeping drugs out of the environment.

“Because nearly 25 percent of preventable illnesses are environmentally related, as estimated by the World Health Organization, improving the environment is one of the most important sustainable medicine practices we can advocate,” says Joel Kreisberg, DC, the founder and the executive director of the Teleosis Institute, a non-profit organization based in Berkeley, California, that is dedicated to sustainable medicine and a healthy environment. “We cannot afford to wait until we see devastating consequences to human health before we act. If we’re going to create a sustainable culture, we’ll need the medical industry to join the general ‘greening’ of our world.”

Ronald Davis, MD, the immediate past president of the American Medical Association, editorialized this spring in eVoice, the AMA’s online weekly news summary, “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.”

One of the issues fueling this green revolution is climate change. “The health care industry is second only to the food industry in their impact and contribution to global warming. The health care sector is a huge consumer of energy, water, and food,” says Anna Gilmore Hall, the executive director of Health Care Without Harm (HCWH), an international coalition of health-care groups working to promote ecologically sustainable practices with North American headquarters in Arlington, Virginia. “If we continue to see health impacts from climate change, it is going to continue to stress the health-care industry.”

Is the health-care industry making people sick? Many physicians think so, and they are exploring alternatives to help their patients, and the environment, get well again.

Healing patients and the world

As Rosen confronted the chronic diseases that he and his fellow pediatricians were increasingly seeing, he realized the “disease care system” that he had been trained in offered too little, too late. He decided to focus on preventive medicine. “What we are doing in a very busy primary care pediatric practice is paying attention to a model of health care as a true wellness prevention model. So I spend lot of time discussing preventive guidance measure, focusing on development and nutrition.

“My education was from my patients,” he says. “They were interested in diet or nutrition, or in complementary therapies like homeopathy and acupuncture. So I started learning more about these different fields. I realized there was a whole world out there I was not familiar with. I thought it could be very helpful with kids, especially with stress-related conditions and pain. I just started very simply. If I had a child who had migraine headaches for six months, rather than talk about medication as a frontline therapy, we’d

talk about hypnosis, yoga, or biofeedback.”

Rosen was stunned by the results. “Not only did the kids get better, they stayed better—and they were happier, there were fewer side effects, and the parents were happier. This is a lifelong tool. This is self-care—there is great power in this. It’s about control. I really felt empowered and could really see the results,” he says.

One impetus for seeking alternatives to drugs was the revelation published in March 2008 in an exposé by the Associated Press that “a vast array of pharmaceuticals—including antibiotics, anti-convulsants, mood stabilizers, and sex hormones—have been found in the drinking water supplies of at least 41 million Americans.” For many physicians, it was a shock to realize that their routine reliance on prescription drugs may be poisoning the environment.

The implication is clear to Calista Hunter, MD, a retired Bay Area endocrinologist. “If we can keep people healthy by keeping pollutants out of the environment, by having water that is not loaded with pharmaceuticals, by having air that is free of pollution, everyone is going to be healthier,” she says. “Medicine has basically focused on keeping the individual patient healthy. Of course we have to do that, but we have done that with no concern for what health effects the environment might be having on our patients. I think that’s where we can step in.”

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