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For Hunter, practicing preventive medicine made both medical and environmental
sense. “I was trained strictly as a conventional western medical doctor to use drugs and
procedures. For me to forego that was bit of a shift. But for a primary care
doctor, if you simply shift your practice to one that’s more focused on preventive medicine rather than acute care or disease care,
you are practicing sustainable medicine. If you convince your patients to lose
weight and get more exercise, then they are not going have to take drugs and
have costly disease states. For primary care doctors, the most significant
thing you can do is to really practice preventive care. That sounds kind of
simple, but that’s really at the heart of sustainable medicine: to enable people to stay healthy,
rather than take care of them when they get sick. There’s not much more sustainable than that from a health care perspective.”
Rian Podein, MD, an assistant professor of family medicine at the University of
Wisconsin School of Medicine and Public Health, says that treating patients in
the university clinic is just one part of promoting health; community activism
is the other. He has campaigned to eliminate the use of pesticides on
university property and is working to make his clinic more environmentally
friendly. “We hope the small things—reducing paper, energy, and pesticides—lead to bigger changes down the line.”
For Podein, working for social justice is part of his definition of
sustainability. He works with Physicians for a National Health Program
(pnhp.org), which advocates for a national single-payer health-care system. “Sustaina-bility and social justice are definitely interconnected,” he says. “If people are not providing for their basic needs, they will be forced into
unsustainable actions. If people don’t have food or water or health care, we know they’ll be more sick, and that will be more costly as far as interventions needed and
societal costs,” Podein says. “We know that the majority of bankruptcies in this country are caused by medical
bills. You can imagine what kind of instability and unsustainability that has
on people’s lives and communities.”
According to Podein, sustainable medicine has benefits for everyone involved. “When we focus on our practice as interconnected with our communities and our
values of compassion, then I think people find a lot more joy in their
practice. Sustainable medicine is one way people can reconnect with their
community, with the environment, and with their spirituality.”
Good values
In the mid-1990s, the Environmental Protection Agency revealed that medical
waste incinerators contributed 10 percent of mercury emissions and were the
leading source of dioxin, one of the most potent carcinogens. This revelation
sparked soul searching and the formation of Health Care Without Harm
(noharm.org), which seeks to make the health-care sector environmentally
sustainable.
“It was ironic: the health-care industry was inadvertently doing things that
could result in people coming down with cancer,” says Hall. Health Care Without Harm promptly spearheaded efforts to shut down
medical waste incinerators at hospitals. When the campaign began in 1996, there
were about 5,000 incinerators; today there are only 83. Another focus of the
group was to make medicine mercury free. Now, 97 percent of hospitals say they
are almost mercury free. HCWH is now working to make hospitals non-toxic by
promoting greener cleaners and reducing pesticide use.
Hospitals are in an unusually powerful position to effect change. About nine
medical products companies do 80 percent of the purchasing for hospitals. Eight
of these companies now work with HCHW to provide safer, greener materials to
hospitals. Among the environmental initiatives that HCHW is leading through
hospital purchasing is eliminating mercury from the medical supply and
eliminating polyvinyl chloride (dioxin is formed during the manufacture of PVC)
and DEHP, a phthalate used to soften PVC, that is linked to reproductive birth
defects and other illnesses. Because of the vast leverage that hospitals have
through their purchasing, manufacturers are developing DEHP-free products for
the growing number of hospitals that now request it.
Hospitals are also a huge buyer of food, another key component of sustainable
living and green medicine. HCHW is now working to get hospitals to buy
antibiotic-free meat, locally grown organic foods, and helping hospitals adopt
menus that contain fewer processed foods. To date, 127 health-care facilities
in 21 states, including some that serve more than 9,000 meals per day, have
pledged to source local, nutritional, sustainable food.
These initiatives are catching on. “Twelve years ago, Health Care Without Harm was pounding on doors to be heard,” says Hall. “Now we are overwhelmed with opportunities.”
Green initiatives are not just politically correct; they are also financially
sound. “The idea that being green costs more is a myth,” says Kathy Gerwig, the vice president and environmental stewardship officer at
Kaiser Permanente, the nation’s largest not-for-profit health plan, serving 8.7 million members. “We have many examples at Kaiser Permanente of how doing the right thing for the
environment is cost-neutral or saves money.” Gerwig offers several examples:
• By using non-toxic and recycled building materials in construction of its new
buildings, Kaiser Permanente’s building costs are 9 percent lower per square foot than conventional market
rate construction in California;
• Kaiser is saving about $10 million annually in energy costs through a variety
of energy conservation measures it has taken, thereby significantly reducing
the carbon footprint of the company;
• By placing large orders for PVC-free analgesia pumps, Kaiser has driven down
the cost of the less polluting product, which now costs 10 percent less than
the conventional PVC version;
• It saves about $300,000 annually in tipping and landfill fees as a result of
expanding its recycling efforts;
• It saves $750,000 annually by reusing covered totes for internal shipping to
its own facilities. Savings are realized in avoided purchasing and disposal
costs;
• Devices once considered single- use are now reprocessed, saving $3.5 million
annually and reducing waste by about 46 tons.
Gerwig says that it is important to look at the “total cost of ownership”—what you pay over the entire life of a product. She cites as an example KP’s investment in mercury-free blood pressure devices: the per unit cost is
higher, but the total cost of devices, factoring in the expense of
environmental safeguards around handling mercury and the cost of cleaning up
mercury spills in clinics and hospitals, makes the mercury-free products much
less expensive over the long haul.
“Being in health care, our primary concern is the health of the communities we
serve,” Gerwig says. “Whatever we can do to create a healthy environment is core to our mission and
part of preventive medicine. If we can reduce dioxin pollution, that removes a
carcinogen and that has a positive impact on the health of our communities. We
can also help set a standard within the health-care sector.”
A drug-free environment
There is a hidden cost to prescribing medication: it may heal the body, but it
hurts the environment. That conclusion was driven home by the results of a
study undertaken by the Teleosis Institute’s Green Pharmacy program in 2007. The program set up 12 “take-back” sites in the San Francisco area for unused medicine, which operated in
partnership between Teleosis Institute and area pharmacies, health-care
offices, public and private associations, and local communities. The result:
the program diverted nearly 700 pounds of pharmaceutical and over-the-counter
drugs with a retail value of nearly $400,000 from San Francisco waterways
between June 1 and December 31, 2007. Data from the Green Pharmacy program
showed that, on average, 40 to 50 percent of a prescription goes unused. Drugs
targeting the central nervous system—including amphetamines, anticoagulants, anti-inflammatories and anti-seizure
medications, as well as acetaminophen and ibuprofen—topped the list of medications returned by patients in the Bay Area.
In the past, many of these unused drugs ended up in drinking water. A study by
the United States Geological Survey in 2002 revealed that more than 80 percent
of waterways that were tested in the United States showed traces of common
medications such as acetaminophen, hormones, antidepressants, blood pressure
medicines, codeine, and antibiotics.
One reason drugs enter the environment is that patients have historically been
advised to flush unused medications down toilets or sinks to prevent accidental
poisonings or overdoses. This has resulted in millions of pounds of drugs being
virtually mainlined into the public water supply each year. Drugs that end up
in landfills can leech into the ground water, and the residues are not removed
by conventional water treatment.
The Green Pharmacy program is attempting to address this problem. “If a prescription is going unused, we want to know why and try to reduce the
waste before it becomes waste,” says Evin Guy, the director of the Green Pharmacy program. Instead of
prescribing in bulk or ordering 90-day supplies, Guy urges physicians to
prescribe starter packs and to regularly review patients consumption of
medicine. In a nutshell, says Guy, “We recommend to doctors that they prescribe less.”
Drug take-back sites, which collect unused drugs and safely dispose of them, are
starting to appear in different locales around the country. According to Guy,
states that are launching or considering drug take-back and safe disposal
programs include Washington, Maine, Illinois, and Indiana.
Unfortunately, other than returning unused prescription medication to physician
offices or pharmacies, there are no real guidelines for patients outside of
take-back sites.
Finding alternatives, making a difference
Rosen the medical student, might not have recognized the pediatrician he has
become. Rosen is now the medical advisor to the Dierdre Imus Environmental
Center for Pediatric Oncology (dienviro.com), a research center that studies
environmental causes of pediatric cancer and advocates for solutions, located
at the Hackensack University Medical Center. Just this year, Rosen left his
practice of 10 years to open the Whole Child Center (wholechildcenter.org), an “integrative and ecologically sustainable” pediatric practice in New Jersey. The office is constructed with non-toxic
building materials, uses natural cleaning products, utilizes paperless
electronic record-keeping, and the office will take back unused drugs to
dispose of them properly. The practice will offer a range of complementary
therapies, including hypnosis, acupuncture, and massage therapy, in addition to
conventional medical treatments. Rosen intends the Whole Child Center to be a
resource for a range of environmental and health issues.
“Patients can talk to us about the environment and about kids health. We are
going to provide information on our sustainable building so that families
thinking of doing work in their own homes can look at how we did it. We are
putting together resources for parents about locally grown food so we can
connect similar-minded organizations in the community. These are all things
that the typical medical practice probably doesn’t do, but we think is a crucial part of a comprehensive practice.”
Rosen is quick to add that the Whole Child Center “is not a boutique practice. We accept insurance. My argument is that we don’t have a choice. The great majority of families are interested in environmental
health. In order to have the best quality of care, the bulk of conditions we
are seeing are chronic care conditions that are not well addressed by the acute
care system. If you look at new morbidity—chronic conditions—integrative medicine addresses those issues well.”
Rosen predicts, “In 25 years, we should not be talking about integrative or sustainable medicine,
just good medicine.” END
Journalist David Goodman’s latest book is the national bestseller, Standing Up to the Madness: Ordinary
Heroes in Extraordinary Times (Hyperion, 2008).
