The Algorithm Will See You Now
There's a quiet revolution going on in medicine. It's driven by artificial intelligence, but paradoxically, new technology may put a more human face on healthcare.
AI's usefulness in healthcare ranges far and wide.
Artificial intelligence is software that can process massive amounts of information and learn over time, arriving at decisions with striking accuracy and efficiency. It offers greater accuracy in diagnosis, exponentially faster genome sequencing, the mining of medical literature and patient records at breathtaking speed, a dramatic reduction in administrative bureaucracy, personalized medicine, and even the democratization of healthcare.
The algorithms that bring these advantages won't replace doctors; rather, by offloading some of the most time-consuming tasks in healthcare, providers will be able to focus on personal interactions with patients—listening, empathizing, educating and generally putting the care back in healthcare. The relationship can focus on the alleviation of suffering, both the physical and emotional kind.
Challenges of Getting AI Up and Running
The AI revolution, still in its early phase in medicine, is already spurring some amazing advances, despite the fact that some experts say it has been overhyped. IBM's Watson Health program is a case in point. IBM capitalized on Watson's ability to process natural language by designing algorithms that devour data like medical articles and analyze images like MRIs and medical slides. The algorithms help diagnose diseases and recommend treatment strategies.
But Technology Review reported that a heavily hyped partnership with the MD Anderson Cancer Center in Houston fell apart in 2017 because of a lack of data in the proper format. The data existed, just not in a way that the voraciously data-hungry AI could use to train itself.
The hiccup certainly hasn't dampened the enthusiasm for medical AI among other tech giants, including Google and Apple, both of which have invested billions in their own healthcare projects. At this point, the main challenge is the need for algorithms to interpret a huge diversity of data mined from medical records. This can include everything from CT scans, MRIs, electrocardiograms, x-rays, and medical slides, to millions of pages of medical literature, physician's notes, and patient histories. It can even include data from implantables and wearables such as the Apple Watch and blood sugar monitors.
None of this information is in anything resembling a standard format across and even within hospitals, clinics, and diagnostic centers. Once the algorithms are trained, however, they can crunch massive amounts of data at blinding speed, with an accuracy that matches and sometimes even exceeds that of highly experienced doctors.
Genome sequencing, for example, took years to accomplish as recently as the early 2000s. The Human Genome Project, the first sequencing of the human genome, was an international effort that took 13 years to complete. In April of this year, Rady Children's Institute for Genomic Medicine in San Diego used an AI-powered genome sequencing algorithm to diagnose rare genetic diseases in infants in about 20 hours, according to ScienceDaily.
"Patient care will always begin and end with the doctor."
Dr. Stephen Kingsmore, the lead author of an article published in Science Translational Medicine, emphasized that even though the algorithm helped guide the treatment strategies of neonatal intensive care physicians, the doctor was still an indispensable link in the chain. "Some people call this artificial intelligence, we call it augmented intelligence," he says. "Patient care will always begin and end with the doctor."
One existing trend is helping to supply a great amount of valuable data to algorithms—the electronic health record. Initially blamed for exacerbating the already crushing workload of many physicians, the EHR is emerging as a boon for algorithms because it consolidates all of a patient's data in one record.
Examples of AI in Action Around the Globe
If you're a parent who has ever taken a child to the doctor with flulike symptoms, you know the anxiety of wondering if the symptoms signal something serious. Kang Zhang, M.D., Ph.D., the founding director of the Institute for Genomic Medicine at the University of California at San Diego, and colleagues developed an AI natural language processing model that used deep learning to analyze the EHRs of 1.3 million pediatric visits to a clinic in Guanzhou, China.
The AI identified common childhood diseases with about the same accuracy as human doctors, and it was even able to split the diagnoses into two categories—common conditions such as flu, and serious, life-threatening conditions like meningitis. Zhang has emphasized that the algorithm didn't replace the human doctor, but it did streamline the diagnostic process and could be used in a triage capacity when emergency room personnel need to prioritize the seriously ill over those suffering from common, less dangerous ailments.
AI's usefulness in healthcare ranges far and wide. In Uganda and several other African nations, AI is bringing modern diagnostics to remote villages that have no access to traditional technologies such as x-rays. The New York Times recently reported that there, doctors are using a pocket-sized, hand-held ultrasound machine that works in concert with a cell phone to image and diagnose everything from pneumonia (a common killer of children) to cancerous tumors.
The beauty of the highly portable, battery-powered device is that ultrasound images can be uploaded on computers so that physicians anywhere in the world can review them and weigh in with their advice. And the images are instantly incorporated into the patient's EHR.
Jonathan Rothberg, the founder of Butterfly Network, the Connecticut company that makes the device, told The New York Times that "Two thirds of the world's population gets no imaging at all. When you put something on a chip, the price goes down and you democratize it." The Butterfly ultrasound machine, which sells for $2,000, promises to be a game-changer in remote areas of Africa, South America, and Asia, as well as at the bedsides of patients in developed countries.
AI algorithms are rapidly emerging in healthcare across the U.S. and the world. China has become a major international player, set to surpass the U.S. this year in AI capital investment, the translation of AI research into marketable products, and even the number of often-cited research papers on AI. So far the U.S. is still the leader, but some experts describe the relationship between the U.S. and China as an AI cold war.
"The future of machine learning isn't sentient killer robots. It's longer human lives."
The U.S. Food and Drug Administration expanded its approval of medical algorithms from two in all of 2017 to about two per month throughout 2018. One of the first fields to be impacted is ophthalmology.
One algorithm, developed by the British AI company DeepMind (owned by Alphabet, the parent company of Google), instantly scans patients' retinas and is able to diagnose diabetic retinopathy without needing an ophthalmologist to interpret the scans. This means diabetics can get the test every year from their family physician without having to see a specialist. The Financial Times reported in March that the technology is now being used in clinics throughout Europe.
In Copenhagen, emergency service dispatchers are using a new voice-processing AI called Corti to analyze the conversations in emergency phone calls. The algorithm analyzes the verbal cues of callers, searches its huge database of medical information, and provides dispatchers with onscreen diagnostic information. Freddy Lippert, the CEO of EMS Copenhagen, notes that the algorithm has already saved lives by expediting accurate diagnoses in high-pressure situations where time is of the essence.
Researchers at the University of Nottingham in the UK have even developed a deep learning algorithm that predicts death more accurately than human clinicians. The algorithm incorporates data from a huge range of factors in a chronically ill population, including how many fruits and vegetables a patient eats on a daily basis. Dr. Stephen Weng, lead author of the study, published in PLOS ONE, said in a press release, "We found machine learning algorithms were significantly more accurate in predicting death than the standard prediction models developed by a human expert."
New digital technologies are allowing patients to participate in their healthcare as never before. A feature of the new Apple Watch is an app that detects cardiac arrhythmias and even produces an electrocardiogram if an abnormality is detected. The technology, approved by the FDA, is helping cardiologists monitor heart patients and design interventions for those who may be at higher risk of a cardiac event like a stroke.
If having an algorithm predict your death sends a shiver down your spine, consider that algorithms may keep you alive longer. In 2018, technology reporter Tristan Greene wrote for Medium that "…despite the unending deluge of panic-ridden articles declaring AI the path to apocalypse, we're now living in a world where algorithms save lives every day. The future of machine learning isn't sentient killer robots. It's longer human lives."
The Risks of AI Compiling Your Data
To be sure, the advent of AI-infused medical technology is not without its risks. One risk is that the use of AI wearables constantly monitoring our vital signs could turn us into a nation of hypochondriacs, racing to our doctors every time there's a blip in some vital sign. Such a development could stress an already overburdened system that suffers from, among other things, a shortage of doctors and nurses. Another risk has to do with the privacy protections on the massive repository of intimately personal information that AI will have on us.
In an article recently published in the Journal of the American Medical Association, Australian researcher Kit Huckvale and colleagues examined the handling of data by 36 smartphone apps that assisted people with either depression or smoking cessation, two areas that could lend themselves to stigmatization if they fell into the wrong hands.
Out of the 36 apps, 33 shared their data with third parties, despite the fact that just 25 of those apps had a privacy policy at all and out of those, only 23 stated that data would be shared with third parties. The recipients of all that data? It went almost exclusively to Facebook and Google, to be used for advertising and marketing purposes. But there's nothing to stop it from ending up in the hands of insurers, background databases, or any other entity.
Even when data isn't voluntarily shared, any digital information can be hacked. EHRs and even wearable devices share the same vulnerability as any other digital record or device. Still, the promise of AI to radically improve efficiency and accuracy in healthcare is hard to ignore.
AI Can Help Restore Humanity to Medicine
Eric Topol, director of the Scripps Research Translational Institute and author of the new book Deep Medicine, says that AI gives doctors and nurses the most precious gift of all: time.
Topol welcomes his patients' use of the Apple Watch cardiac feature and is optimistic about the ways that AI is revolutionizing medicine. He says that the watch helps doctors monitor how well medications are working and has already helped to prevent strokes. But in addition to that, AI will help bring the humanity back to a profession that has become as cold and hard as a stainless steel dissection table.
"When I graduated from medical school in the 1970s," he says, "you had a really intimate relationship with your doctor." Over the decades, he has seen that relationship steadily erode as medical organizations demanded that doctors see more and more patients within ever-shrinking time windows.
"Doctors have no time to think, to communicate. We need to restore the mission in medicine."
In addition to that, EHRs have meant that doctors and nurses are getting buried in paperwork and administrative tasks. This is no doubt one reason why a recent study by the World Health Organization showed that worldwide, about 50 percent of doctors suffer from burnout. People who are utterly exhausted make more mistakes, and medical clinicians are no different from the rest of us. Only medical mistakes have unacceptably high stakes. According to its website, Johns Hopkins University recently announced that in the U.S. alone, 250,000 people die from medical mistakes each year.
"Doctors have no time to think, to communicate," says Topol. "We need to restore the mission in medicine." AI is giving doctors more time to devote to the thing that attracted them to medicine in the first place—connecting deeply with patients.
There is a real danger at this juncture, though, that administrators aware of the time-saving aspects of AI will simply push doctors to see more patients, read more tests, and embrace an even more crushing workload.
"We can't leave it to the administrators to just make things worse," says Topol. "Now is the time for doctors to advocate for a restoration of the human touch. We need to stand up for patients and for the patient-doctor relationship."
AI could indeed be a game changer, he says, but rather than squander the huge benefits of more time, "We need a new equation going forward."
Can tech help prevent the insect apocalypse?
This article originally appeared in One Health/One Planet, a single-issue magazine that explores how climate change and other environmental shifts are making us more vulnerable to infectious diseases by land and by sea - and how scientists are working on solutions.
On a warm summer day, forests, meadows, and riverbanks should be abuzz with insects—from butterflies to beetles and bees. But bugs aren’t as abundant as they used to be, and that’s not a plus for people and the planet, scientists say. The declining numbers of insects, coupled with climate change, can have devastating effects for people in more ways than one. “Insects have been around for a very long time and can live well without humans, but humans cannot live without insects and the many services they provide to us,” says Philipp Lehmann, a researcher in the Department of Zoology at Stockholm University in Sweden. Their decline is not just bad, Lehmann adds. “It’s devastating news for humans.
”Insects and other invertebrates are the most diverse organisms on the planet. They fill most niches in terrestrial and aquatic environments and drive ecosystem functions. Many insects are also economically vital because they pollinate crops that humans depend on for food, including cereals, vegetables, fruits, and nuts. A paper published in PNAS notes that insects alone are worth more than $70 billion a year to the U.S. economy. In places where pollinators like honeybees are in decline, farmers now buy them from rearing facilities at steep prices rather than relying on “Mother Nature.”
And because many insects serve as food for other species—bats, birds and freshwater fish—they’re an integral part of the ecosystem’s food chain. “If you like to eat good food, you should thank an insect,” says Scott Hoffman Black, an ecologist and executive director of the Xerces Society for Invertebrate Conservation in Portland, Oregon. “And if you like birds in your trees and fish in your streams, you should be concerned with insect conservation.”
Deforestation, urbanization, and agricultural spread have eaten away at large swaths of insect habitat. The increasingly poorly controlled use of insecticides, which harms unintended species, and the proliferation of invasive insect species that disrupt native ecosystems compound the problem.
“There is not a single reason why insects are in decline,” says Jessica L. Ware, associate curator in the Division of Invertebrate Zoology at the American Museum of Natural History in New York, and president of the Entomological Society of America. “There are over one million described insect species, occupying different niches and responding to environmental stressors in different ways.”
Jessica Ware, an entomologist at the American Museum of Natural History, is using DNA methods to monitor insects.
Credit:D.Finnin/AMNH
In addition to habitat loss fueling the decline in insect populations, the other “major drivers” Ware identified are invasive species, climate change, pollution, and fluctuating levels of nitrogen, which play a major role in the lifecycle of plants, some of which serve as insect habitants and others as their food. “The causes of world insect population declines are, unfortunately, very easy to link to human activities,” Lehmann says.
Climate change will undoubtedly make the problem worse. “As temperatures start to rise, it can essentially make it too hot for some insects to survive,” says Emily McDermott, an assistant professor in the Department of Entomology and Plant Pathology at the University of Arkansas. “Conversely in other areas, it could potentially also allow other insects to expand their ranges.”
Without Pollinators Humans Will Starve
We may not think much of our planet’s getting warmer by only one degree Celsius, but it can spell catastrophe for many insects, plants, and animals, because it’s often accompanied by less rainfall. “Changes in precipitation patterns will have cascading consequences across the tree of life,” says David Wagner, a professor of ecology and evolutionary biology at the University of Connecticut. Insects, in particular, are “very vulnerable” because “they’re small and susceptible to drying.”
For instance, droughts have put the monarch butterfly at risk of being unable to find nectar to “recharge its engine” as it migrates from Canada and New England to Mexico for winter, where it enters a hibernation state until it journeys back in the spring. “The monarch is an iconic and a much-loved insect,” whose migration “is imperiled by climate change,” Wagner says.
Warming and drying trends in the Western United States are perhaps having an even more severe impact on insects than in the eastern region. As a result, “we are seeing fewer individual butterflies per year,” says Matt Forister, a professor of insect ecology at the University of Nevada, Reno.
There are hundreds of butterfly species in the United States and thousands in the world. They are pollinators and can serve as good indicators of other species’ health. “Although butterflies are only one group among many important pollinators, in general we assume that what’s bad for butterflies is probably bad for other insects,” says Forister, whose research focuses on butterflies. Climate change and habitat destruction are wreaking havoc on butterflies as well as plants, leading to a further indirect effect on caterpillars and butterflies.
Different insect species have different levels of sensitivity to environmental changes. For example, one-half of the bumblebee species in the United States are showing declines, whereas the other half are not, says Christina Grozinger, a professor of entomology at the Pennsylvania State University. Some species of bumble bees are even increasing in their range, seemingly resilient to environmental changes. But other pollinators are dwindling to the point that farmers have to buy from the rearing facilities, which is the case for the California almond industry. “This is a massive cost to the farmer, which could be provided for free, in case the local habitats supported these pollinators,” Lehmann says.
For bees and other insects, climate change can harm the plants they depend on for survival or have a negative impact on the insects directly. Overly rainy and hot conditions may limit flowering in plants or reduce the ability of a pollinator to forage and feed, which then decreases their reproductive success, resulting in dwindling populations, Grozinger explains.
“Nutritional deprivation can also make pollinators more sensitive to viruses and parasites and therefore cause disease spread,” she says. “There are many ways that climate change can reduce our pollinator populations and make it more difficult to grow the many fruit, vegetable and nut crops that depend on pollinators.”
Disease-Causing Insects Can Bring More Outbreaks
While some much-needed insects are declining, certain disease-causing species may be spreading and proliferating, which is another reason for human concern. Many mosquito types spread malaria, Zika virus, West Nile virus, and a brain infection called equine encephalitis, along with other diseases as well as heartworms in dogs, says Michael Sabourin, president of the Vermont Entomological Society. An animal health specialist for the state, Sabourin conducts vector surveys that identify ticks and mosquitoes.
Scientists refer to disease-carrying insects as vector species and, while there’s a limited number of them, many of these infections can be deadly. Fleas were a well-known vector for the bubonic plague, while kissing bugs are a vector for Chagas disease, a potentially life-threatening parasitic illness in humans, dogs, and other mammals, Sabourin says.
As the planet heats up, some of the creepy crawlers are able to survive milder winters or move up north. Warmer temperatures and a shorter snow season have spawned an increasing abundance of ticks in Maine, including the blacklegged tick (Ixodes scapularis), known to transmit Lyme disease, says Sean Birkel, an assistant professor in the Climate Change Institute and Cooperative Extension at the University of Maine.
Coupled with more frequent and heavier precipitation, rising temperatures bring a longer warm season that can also lead to a longer period of mosquito activity. “While other factors may be at play, climate change affects important underlying conditions that can, in turn, facilitate the spread of vector-borne disease,” Birkel says.
For example, if mosquitoes are finding fewer of their preferred food sources, they may bite humans more. Both male and female mosquitoes feed on sugar as part of their normal behavior, but if they aren’t eating their fill, they may become more bloodthirsty. One recent paper found that sugar-deprived Anopheles gambiae females go for larger blood meals to stay in good health and lay eggs. “More blood meals equals more chances to pick up and transmit a pathogen,” McDermott says, He adds that climate change could reduce the number of available plants to feed on. And while most mosquitoes are “generalist sugar-feeders” meaning that they will likely find alternatives, losing their favorite plants can make them hungrier for blood.
Similar to the effect of losing plants, mosquitoes may get turned onto people if they lose their favorite animal species. For example, some studies found that Culex pipiens mosquitoes that transmit the West Nile virus feed primarily on birds in summer. But that changes in the fall, at least in some places. Because there are fewer birds around, C. pipiens switch to mammals, including humans. And if some disease-carrying insect species proliferate or increase their ranges, that increases chances for human infection, says McDermott. “A larger concern is that climate change could increase vector population sizes, making it more likely that people or animals would be bitten by an infected insect.”
Science Can Help Bring Back the Buzz
To help friendly insects thrive and keep the foes in check, scientists need better ways of trapping, counting, and monitoring insects. It’s not an easy job, but artificial intelligence and molecular methods can help. Ware’s lab uses various environmental DNA methods to monitor freshwater habitats. Molecular technologies hold much promise. The so-called DNA barcodes, in which species are identified using a short string of their genes, can now be used to identify birds, bees, moths and other creatures, and should be used on a larger scale, says Wagner, the University of Connecticut professor. “One day, something akin to Star Trek’s tricorder will soon be on sale down at the local science store.”
Scientists are also deploying artificial intelligence, or AI, to identify insects in agricultural systems and north latitudes where there are fewer bugs, Wagner says. For instance, some automated traps already use the wingbeat frequencies of mosquitoes to distinguish the harmless ones from the disease-carriers. But new technology and software are needed to further expand detection based on vision, sound, and odors.
“Because of their ubiquity, enormity of numbers, and seemingly boundless diversity, we desperately need to develop molecular and AI technologies that will allow us to automate sampling and identification,” says Wagner. “That would accelerate our ability to track insect populations, alert us to the presence of new disease vectors, exotic pest introductions, and unexpected declines.”
Your surgery could harm yourself and the planet. Here's what some doctors are doing about it.
This is part 1 of a three part series on a new generation of doctors leading the charge to make the health care industry more sustainable - for the benefit of their patients and the planet. Read part 2 here and part 3 here.
Susanne Koch, an anesthesiologist and neurologist, reached a pivot point when she was up to her neck in water, almost literally. The basement of her house in Berlin had flooded in the summer of 2018, when Berlin was pummeled by unusually strong rains. After she drained the house, “I wanted to dig into facts, to understand how exactly these extreme weather events are related to climate change,” she says.
Studying the scientific literature, she realized how urgent the climate crisis is, but the biggest shock was to learn that her profession contributed substantially to the problem: Inhalation gases used during medical procedures are among the most damaging greenhouse gases. Some inhalation gases are 3,000 times more damaging for the climate than CO2, Koch discovered. “Spending seven hours in the surgery room is the equivalent of driving a car for four days nonstop,” she says. Her job of helping people at Europe’s largest university hospital, the Charité in Berlin, was inadvertently damaging both the people and the planet.
“Nobody had ever even mentioned a word about that during my training,” Koch says.
On the whole, the medical sector is responsible for a disproportionally large percentage of greenhouse gas emissions, with the U.S. as the biggest culprit. According to a key paper published in 2020 in Health Affairs, the health industry “is among the most carbon-intensive service sectors in the industrialized world,” accounting for between 4.4 percent and 4.6 percent of greenhouse gas emissions. “It’s not just anesthesia but health care that has a problem,” says Jodi Sherman, anesthesiology professor and Medical Director of the Program on Healthcare Environmental Sustainability at Yale University as well as co-director of the Lancet Planetary Health Commission on Sustainable Healthcare. In the U.S., health care greenhouse gas emissions make up about 8.5 percent of domestic greenhouse gas emissions. They rose 6 percent from 2010 to 2018, to nearly 1,700 kilograms per person, more than in any other nation.
Of course, patients worry primarily about safety, not sustainability. Yet, Koch emphasizes that “as doctors, we have the responsibility to do no harm, and this includes making sure that we use resources as sustainably as possible.” Studies show that 2018 greenhouse gas and toxic air pollutant emissions resulted in the loss of 388,000 disability-adjusted life years in the U.S. alone. “Disease burden from health care pollution is of the same order of magnitude as deaths from preventable medical errors, and should be taken just as seriously,” Sherman cautions.
When Koch, the anesthesiologist, started discussing sustainable options with colleagues, the topic was immediately met with plenty of interest. Her experience is consistent with the latest representative poll of the nonprofit Foundation Health in Germany. Nine out of ten doctors were interested in urgently finding sustainable solutions for medical services but lacked knowhow and resources. For teaching purposes, Sherman and her team have developed the Yale Gassing Greener app that allows anesthesiologists to compare how much pollution they can avoid through choosing different anesthesia methods. Sherman also published professional guidelines intended to help her colleagues better understand how various methods affect carbon emissions.
Significant traces of inhalation gases have been found in Antarctica and the Himalayas, far from the vast majority of surgery rooms.
A solution espoused by both Sherman and Koch is comparatively simple: They stopped using desflurane, which is by far the most damaging of all inhalation gases to the climate. Its greenhouse effect is 2,590 times stronger than carbon dioxide. The Yale New Haven Hospital already stopped using desflurane in 2013, becoming the first known healthcare organization to eliminate a drug based on environmental grounds. Sherman points out that this resulted in saving more than $1.2 million in costs and 1,600 tons of CO2 equivalents, about the same as the exhaust from 360 passenger vehicles per year.
At the Charité, Koch claims that switching to other anesthesiology choices, such as propofol, has eliminated 90 percent of the climate gas emissions in the anesthesiology department since 2016. Young anesthesiologists are still taught to use desflurane as the standard because desflurane is absorbed less into the patients’ bodies, and they wake up faster. However, Koch who has worked as an anesthesiologist since 2006, says that with a little bit of experience, you can learn when to stop giving the propofol so it's timed just as well with a person’s wake-up process. In addition, “patients are less likely to feel nauseous after being given propofol,” Koch says. Intravenous drugs might require more skill, she adds, "but there is nothing unique to the drug desflurane that cannot be accomplished with other medications.”
Desflurane isn’t the only gas to be concerned about. Nitrous oxide is the second most damaging because it’s extremely long-lived in the environment, and it depletes the ozone layer. Climate-conscious anesthesiologists are phasing out this gas, too, or have implemented measures to decrease leaks.
Internationally, 192 governments agreed in the Kyoto protocol of 2005 to reduce halogenated hydrocarbons – resulting from inhalation gases, including desflurane and nitrous oxide – because of their immense climate-warming potential, and in 2016, they pledged to eliminate them by 2035. However, the use of inhalation anesthetics continues to increase worldwide, not least because more people access healthcare in developing countries, and because people in industrialized countries live longer and therefore need more surgeries. Significant traces of inhalation gases have been found in Antarctica and the Himalayas, far from the vast majority of surgery rooms.
Certain companies are now pushing new technology to capture inhalation gases before they are released into the atmosphere, but both Sherman and Koch believe marketing claims of 99 percent efficiency amount to greenwashing. After investigating the technology first-hand and visiting the company that is producing such filters in Germany, Koch concluded that such technology only reduces emissions by 25 percent. And Sherman believes such initiatives are akin to the fallacy of recycling plastic. In addition to questioning their efficiency, Sherman fears such technology “gives the illusion there is a magical solution that means I don’t need to change my behavior, reduce my waste and choose less harmful options.”
Financial interests are at play, too. “Desflurane is the most expensive inhalation gas, and some think, the most expensive must be the best,” Koch says. Both Koch and Sherman lament that efforts to increase sustainability in the medical sector are entirely voluntary in their countries and led by a few dedicated individual professionals while industry-wide standards and transparency are needed, a notion expressed in the American Hospital Association’s Sustainability Roadmap.
Susanne Koch, an anesthesiologist in Berlin, wants her colleagues to stop using a gas called desflurane, which is by far the most damaging of all inhalation gases to the climate.
Adobe Stock
Other countries have done more. The European Union recommends reducing inhalation gases and even contemplated a ban of desflurane, except in medical emergencies. In 2008, the National Health Service (NHS) created a Sustainable Development Unit, which measures CO2 emissions in the U.K. health sector. NHS is the first national health service that pledged to reach net zero carbon by 2040. The carbon footprint of the NHS fell by 26 percent from 1990 to 2019, mostly due to reduced use of certain inhalers and the switch to renewable energy for heat and power. “The evidence that the climate emergency is a health emergency is overwhelming,” said Nick Watts, the NHS Chief Sustainability Officer, in a press release, “with health professionals already needing to manage its symptoms.”
Sherman is a leading voice in demanding action in the U.S. To her, comprehensive solutions start with the mandatory, transparent measurement of emissions in the health sector to tackle the biggest sources of pollution. While the Biden administration highlighted its efforts to reduce these kinds of emissions during the United Nations Climate Conference (COP27) in November 2022 and U.S. delegates announced that more than 100 health care organizations signed the voluntary Health Sector Climate Pledge, with the aim to reduce emissions by 50 percent in the next eight years, Sherman is convinced that voluntary pledges are not enough. “Voluntary measures are insufficient,” she testified in congress. “The vast majority of U.S. health care organizations remain uncommitted to timely action. Those that are committed lack policies and knowledge to support necessary changes; even worse, existing policies drive inappropriate consumption of resources and pollution.”
Both Sherman and Koch look at the larger picture. “Health care organizations have an obligation to their communities to protect public health,” Sherman says. “We must lead by example. That includes setting ambitious, science-based carbon reduction targets to achieve net zero emissions before 2050. We must quantify current emissions and their sources, particularly throughout the health care supply chains.”