Medicopolitical

Rheumatologist urges colleagues to ‘consider the planet’ in patient care


Dr John Van Der Kallen

Could specialists be the key to tackling Australia’s carbon emissions?

Rheumatologist Dr John Van Der Kallen believes they may be – not least because the health system is currently a major part of the problem.

The chair of Doctors for the Environment Australia (DEA), he says the evidence on this is clear, with research published four years ago finding healthcare accounted for 7% of Australia’s total carbon emissions.

If global healthcare was a country, it would rank as the world’s fifth largest emitter in absolute terms – after the United States, China, India and Russia, but ahead of Japan and Brazil.

Published in Lancet Planetary Health, the study showed nearly half Australia’s health emissions (44%) were generated by hospitals, while one fifth came from pharmaceuticals. Some 6% was the direct result of specialist medical services.

“What we don’t really know in rheumatology is the carbon footprint of the various medications we use,” he tells the limbic.

“But when you considered some of the things that are manufactured overseas and must be kept in a cold chain, it is likely to be substantial.”

Based in Newcastle, NSW, Dr Van Der Kallen says there is nonetheless some reason for optimism, pointing to the DEA’s growth in recent years as evidence of a desire among doctors to become part of the solution.

Starting with just five doctors two decades ago, the organisation currently boasts over 2,600 members – about 400 of whom are specialist physicians.

“And we have moved beyond the discussion of whether climate change is relevant for us as doctors,” he says.

“When I first started, I remember receiving a fax from one physician telling me to stay in my lane, stick to what I know as a rheumatologist, but there is growing acceptance this is another core part of our role.”

“And the solutions for our climate conundrum are actually good for health. In rheumatology, we are often dealing with people who have excess weight and a lack of exercise etc. So they will benefit from driving less and using active transport and they’ll benefit from cleaner air.”

Planetary vs patient care

However, there has been some pushback to a slightly more controversial idea he has been promoting: that doctors should factor the planet in when making decisions on prescribing medicines or other potential treatment.

With so many other polluters in the world, is it really ethical for doctors to balance the immediate needs of the planet with broader goals on carbon emissions? Should anyone be denied a scan because fossil fuels will be burnt in the process?

“It can be challenging at times to try to work out what is low value care and where we can reduce our emissions, but we’re talking about our existence here,” he says.

“According to the most recent report by the Intergovernmental Panel on Climate Change, there is still a one-in-10 chance that we’re looking at six degrees of warming. That would be catastrophic.”

Reducing low-value care has other obvious upsides in terms of savings to the health system, but Dr Van Der Kallen says he’d like some other reforms as well.

Low hanging fruit include hospitals shifting to renewable energy and moving away from carbon-intensive anaesthetic gases where possible. Pharmaceutical companies should also be required to publish information on the emissions associated with all medicines produced to enable clinicians and patients to make informed choices, he says.

“Of course there will pushback when I say we should factor in emissions as part of clinical decision making, but it is all common sense and it’s very achievable,” he says.

“Obviously a lot of people get very depressed and anxious about climate change, and one of the best ways to deal with it is to find practical solutions we can act on now. And the important thing is ultimately it will make a huge difference.”

Dr Van Der Kallen was speaking ahead of the DEA’s national conference, to be held in Melbourne at the beginning of next month.

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