'Green' Resources for Smaller-Scale Medical Institutions

ENVIRONMENTALLY RESPONSIBLE RESOURCES FOR SMALL-SCALE MEDICAL INSTITUTIONS

In society's progress towards environmental sustainability, the healthcare industry will play a leading role. From major public institutions to smaller private practices, every contribution matters. How can the solo practitioner incorporate green projects into their practice and what are the benefits of going green. You are listening to ReachMD XM157, The Channel for Medical Professionals. Welcome to the Clinician's Roundtable.

I am your host Dr. Mark Nolan Hill, Professor of Surgery and Practicing General Surgeon and our guests are Mr. Gary Cohen, Co-Executive Director of Healthcare Without Harm, an international campaign in support of environmentally responsible healthcare and Dr. Ted Schettler, Science Director of the Science and Environmental Health Network and Science Advisor to Healthcare Without Harm.

DR. MARK NOLAN HILL:

Welcome gentleman.

GARY COHEN:

Thank you, it’s a pleasure to be here.

DR. TED SCHETTLER:

Thank you, it’s a pleasure to be here.

DR. MARK NOLAN HILL:

We are discussing environmentally responsible resources for smaller scale medical institutions, gentleman for our individual practitioners, what are some of the steps that they can take towards environmental sustainability.

DR. TED SCHETTLER:

I think that people in their own private medical offices can think about this much the same way that they might think about some of the same questions at home. So for example, we have found often that people are accustomed to recycling or thinking about various trash disposal options or doing things in the more green way at home and then somehow leave those ideas at home when they go to the office. So we can begin to think about how clinicians in their private offices can begin to look at their operations for example.

DR. MARK NOLAN HILL:

Well lets go through that. What could they really do?

DR. TED SCHETTLER:

Well you can start at the end, which is where we started, which is in waste disposal and think about where the waste is going and how to minimize the waste stream and using recycling and so forth, but then you can also begin to think upstream from that. Rather than focussing on the end of the pipeline, if you begin to go upstream and think about what's coming in the front door, what you are buying, which is what you are having throw out. You begin to see all kinds of opportunities emerge.

DR. MARK NOLAN HILL:

What do you mean by that?

DR. TED SCHETTLER:

Well you would probably look through your entire inventory of products that you are bringing in and ask yourself a number of questions. You could ask about the packaging that they are in. Do they need to be packaged in that way, are there ways that you could get your suppliers to minimize the amount of packaging. Could you be buying safer products for your operations whether it is cleaning supplies for the office or even medical products. Are there alternative that you might buy that in one attribute or another are greener and still perform just as well. What food is available in your office. If you go to a medical meeting in your conference room what is being served. Are you supporting local agriculture, are you serving food that you now is nutritious and raised in sustainable ways. How can you bring some of these ideas to the conferences that you go to when you go over to the hospital. So, I think that there are a number of ways that individual practitioners can begin to integrate some of these ideas into their own practice.

DR. MARK NOLAN HILL:

Well as healthcare providers, if we take this community lead on green initiatives. Does this lend credibility to the movement?

DR. TED SCHETTLER:

Well it certainly lends credibility to the movement because healthcare providers are generally trusted in their communities. I think that’s clear, but I also think that what its doing is demonstrating that clinicians are beginning to understand the link between their own health, their patients health, the health of the environment that they are creating in their practice and planetary health and that is a very useful set of connections to begin to recognize and address.

DR. MARK NOLAN HILL:

Well you know, I am sitting here as a private practitioner and I am sure many of our listeners are private practitioners thinking if we did some of these initiatives would our practice be able to afford it monetarily?

DR. TED SCHETTLER:

Well the economic dimension of this is often quite surprisingly good because it does not necessarily mean more money. In fact, there can be money saving. One of the things that at the beginning of our campaign work in Healthcare Without Harm that was the setting point was that when we began to really look carefully at the size of the waste stream and how it was being disposed. People were spending a lot of money unnecessarily and when the recycling efforts were put into place and the waste stream is minimized, hospitals and offices that began to integrate some of these ideas actually saved a lot of money and so there are going to actually be cost savings with some of these efforts.

GARY COHEN:

And we have also learned that from the hospitals is that in environments where they green their operations, where they made it healthier, where there is more natural light, where it is better designed, it actually helps with staff retention and satisfaction, and cuts down on various occupational-related illnesses, so turning out to be also winning item for maintaining people in your organization.

DR. MARK NOLAN HILL:

Are many small organizations and private practitioners following your guidelines?

DR. TED SCHETTLER:

There are certainly some practitioners, who are and are spreading the word about this, but I have no idea really about how comprehensively these are being adopted at this point.

DR. MARK NOLAN HILL:

If you have just joined us, you are listening to the Clinician's Roundtable on ReachMD XM157. I am your host, Dr. Mark Nolan Hill and our guests today are Mr. Gary Cohen Co-Executive Director of Healthcare Without Harm, an international campaign in support of environmentally responsible healthcare and Dr. Ted Schettler, Science Director of the Science and Environmental Health Network and Science Advisor to Healthcare Without Harm.

We are discussing environmentally responsible resources for smaller scale medical institutions. Gentleman talking about the community benefit, do we get tax breaks because of this.

GARY COHEN:

Nonprofit hospitals under the IRS rule will get tax breaks and in exchange they are supposed to make community-benefit investments as it were, and often that means providing free care to people in the community, who can't afford it and doing other programs related to that access issue. The IRS has recently passed new rules that allow for a broader definition of community benefit, that should include good environmental programs and other education and advocacy efforts that improve the environmental health of the community and I think that’s opening up some very interesting opportunities for hospitals to situate themselves within the broader healing that’s required in their communities and not just in their institutions.

DR. MARK NOLAN HILL:

Can you expand upon some of the specifics of that.

GARY COHEN:

Sure so we have been lot of working with lot of hospitals to begin sourcing buying organic fruits and vegetables from farmers in the community in which they operate and so that’s a really important effort because they can also support the education around that by saying we in the hospital are now starting to understand the connection between healthy food and healthy people and we are now going to spend some of our community benefit money to support education efforts in the larger community to increase awareness of the potential connection between healthy food and healthy people and the hospital then becomes a locus for support for a large transformation that needs to happen to society.

DR. MARK NOLAN HILL:

Do you think that some of the physicians or even some of the public may say, perhaps we are making a bigger issue out of this than it really is?

DR. TED SCHETTLER:

Well I don’t think there is any doubt that there will be some people, who might say that, but I think that we need understand that all of the information that’s coming our way in recent years about the way we are stressing planetary systems that’s resulting in climate change, that’s resulting in increasingly depleted fisheries and a growing dead zone in the Gulf of Mexico as a result of all the nutrients and agricultural wastes that are flowing down the Mississippi river, that we have serious problems in many places with air pollution both because of the way we generate energy and the way that we get rid of waste, that we are really stressing planetary systems now to a point that many scientists are deeply alarmed. So this is an opportunity for the healthcare industry to take responsibility of their contribution to that set of problems and do something about it. The science on this is clear. Whether or not people will step up to the plate is a matter of individual choice.

DR. MARK NOLAN HILL:

But will the healthcare industry stand up to the plate?

DR. TED SCHETTLER:

I think there is plenty of evidence that the healthcare industry is really beginning to do that. We are seeing exciting new developments in purchasing greener energy, energy conservation in hospitals, a lot of attention being paid to building design and operations to minimize the environmental footprint of the hospital operation, real efforts at trying to support sustainable agriculture for local communities, which not only brings in more nutritious food, but provides a real economic benefit to farmers that are farming in sustainable ways. We are starting to see a real sort of gathering momentum. I think that is inexorable, and I think this will be mainstream thinking within the next several years.

DR. MARK NOLAN HILL:

Where do the pharmaceutical companies stand in terms of this?

DR. TED SCHETTLER:

The pharmaceutical companies are quite an interesting part of the story. Historically pharmaceutical companies have been one of the major contributors to the waste stream. If you look at pharmaceutical companies among all chemical producers, they have had the largest waste to product ratio of any of the chemical sector and we are aware..

DR. MARK NOLAN HILL:

Really?

DR. TED SCHETTLER:

And we are aware of that and they are really trying to address it now by cutting back on their waste that they are discharging into the environment, and this is also part of a green chemistry movement that's beginning to emerge where we are beginning to think about how do we design chemicals in ways that are much less damaging to natural systems. That needs to include pharmaceuticals as well as other industrial chemicals. On the other hand, we have also learned that pharmaceuticals themselves or their metabolites are making their way in measurable quantities into our water ways now. So we are beginning to see the circle close and all of this is coming home to us. Major metropolitan areas that have detectable levels of a number of pharmaceuticals in the drinking water that people are now drinking in those cities, so we need to look at the pharmaceutical industry in a much broader way when we begin to think about how to address this.

DR. MARK NOLAN HILL:

Well talking about pharmaceuticals, do patients contribute to this by flushing their old or not used medications down the toilet?

DR. TED SCHETTLER:

Without question. That’s an important way that pharmaceuticals make their way into the waste stream, but also pharmaceuticals that are excreted by patients, who have taken them. So that it goes out in the sewage discharge, goes through the sewage treatment plant that many pharmaceuticals are not removed by the sewage treatment plant and then when the plant discharges the effluent into the waterways, the pharmaceuticals go out. So we need to begin to think about even our prescribing practices and just to give an example. In Sweden this is a priority for the physicians in Sweden to begin to think about when they write a prescription for a drug to think about its state and transport in the environment and then if they have a choice among drugs that are equally efficacious for treating the condition in that issue, they choose the one that is more environmentally benign and there are handbooks now published in Sweden that will help the physicians know that. You can have it sitting right on your desk like a Physician's Desk Reference and if you have a choice of antibiotics or antidepressants or diabetes medicines or anti-inflammatories, you can take a look at that and see which one is more environmentally benign when you are making your prescription choice.

DR. MARK NOLAN HILL:

I want to thank our guests, Mr. Gary Cohen and Dr. Ted Schettler. We have been discussing environmentally responsible resources for small-scale medical institutions. I am Dr. Mark Nolan Hill and you have been listening to the Clinician's Roundtable on ReachMD XM157, The Channel for Medical Professionals. Be sure to visit our web site at reachmd.com featuring on-demand podcasts of our entire library. For comments and questions, please call us toll free at (888-MD-XM157) and thank you for listening.

I am Dr. Bill Crowns, Worldwide Health Director for the Microsoft Corporation in Redmond, Washington. You are listening to the first national radio channel created specifically for medical professionals, ReachMD XM157.