Big Medicine's Malignant Growth

Andrew Jameton dug through the clutter of his bookshelf and pulled out a flexible plastic ventilator circuit. "This is used by a patient for two days, and we throw it away," he said. "In the past, they were used for just one day, so we're making progress, I guess."

He handed me a thin, colorful cardboard box, about half the size of a sheet of paper. "Pharmaceutical samples came in this. It holds three pills."

Jameton is a professor and section head in the University of Nebraska Medical Center's Department of Preventive and Societal Medicine. He's not a medical doctor but a philosopher, and he's tackling a subject few dare discuss: how to shrink medicine's big ecological footprint by shrinking the medical industry itself.

He showed me a diagram illustrating the vicious circle that he sees as the heart of the problem: "Big Medicine: Big Economy: Death of Nature: Poor Public Health: Big Medicine."

"But," he told me, "if you try to talk about ecological limits in the medical professions, it's not a welcome conversation."

Growing pains

From 2001 to 2004, the U.S. health care industry grew at an annual rate of 3.6 percent, easily outstripping the rest of the economy's 2.1 percent rate. And as 2006 began, the medical industry had $22 billion worth of buildings under construction or renovation -- the biggest boom in half a century, predicted to last through the coming decade.

A hospital bed in America, on average, generates an estimated 16 to 23 pounds of waste every day, seven days a week. That includes office paper, food, IV bags, gauze, syringes, human body parts, drugs, toxic agents used in chemotherapy, heavy metals, radioactive wastes and much more.

Then there are "upstream" eco-costs; for example, the long, toxic history of one pair of latex or vinyl gloves that may be used for only a few seconds and discarded. U.S. hospitals used 12 billion such gloves back in 1994 alone -- almost one pair for everyone on earth.

And despite some environmentally friendly construction projects in recent years, the current hospital-building frenzy is having an environmental impact like that of any construction boom. A 2006 report in the trade magazine Health Facilities Management summarized a nationwide survey of the "red-hot construction market that's reshaping the face of health care delivery." It extolled trends toward larger, more soundproof patient rooms, nurses' computers in every room, wireless infrastructure plus extra cabling and conduit, and of course, more and bigger electric power plants. But read through the report's 2,700-plus words, and you'll find not a single mention of energy conservation or other environmental issues.

In medicine, as in war, urgent questions of life and death can lead the participants to overlook the resulting ecological impact, or to treat it as a necessary evil. But Jameton insists there is no real conflict between saving lives and preserving the planet. Rather, he says, it's money hunger that's making medicine unsustainable. "Rescue can be a beautiful thing. We all need heroism. But people in the back room are gaming that system."

Economic fairness, Jameton says, aligns with ecological responsibility in demanding that we cut back: "Each year, we spend $5,500 to $6,000 per person in this country on health care. Who in the world can afford that?"

"Everyone has to learn to live on less -- and the rich will have to give up more than the poor. I looked at the global distribution of wealth and income and calculated that I'm something like the 50 millionth richest person in the world!" he said. "But does that entitle me to any treatment I demand, whatever the cost to the earth?"

Curbing medical pollution

A growing number of medical professionals recognize the irony of an industry dedicated to health that threatens the natural environment on which human health depends. Among the impressive array of groups working to address the problem is the network Health Care Without Harm, which is in the forefront of the longtime battle to eliminate use of the neurotoxin mercury.