Sustainable Environment

All of us are members of the same community of responsible individuals who understand that ecological support systems are vital to our societal relationships. Our personnel are committed to the longevity of natural ecosystems and therefore we encourage and sponsor an eco-friendly office. Dr. Fisher and his entire organization support active participation in a sustainable environment. He welcomes your involvement and contribution toward our future.

Plastic Surgery News interviewed Dr. Garth Fisher regarding sustainability in July 2008. The responses are below.

PSN: What are the top 5 things you?ve done in your office to make it more green friendly?

Dr. Garth Fisher: Let me begin by addressing the issue of responsible sustainability. All of us must come together and realize that supporting the environment is an essential responsibility at every level of society. For many of us these are new concepts and require increased awareness and an unwavering commitment.

As physicians and leaders in our communities, we must set an example. I have recently purchased a “Smart Car” and wish to be a visible participant in changing the way we conserve fuel and energy. We are placing a statement on our redesigned web site that announces our commitment and participation to an eco-friendly and sustainable environment. In the very near future all out-going e-mails from every member of our organization will have a “green message” in green print, so those we communicate with will share in our commitment. As an interesting aside, I received an e-mail from a professional colleague with just that message and my initial reaction was, “we should be doing that as well”. This is an example of sharing and adopting methods to promote such support. We are preparing an announcement for the waiting room which will alert all our patients of our desire to participate in eco-friendly behaviors and encourage them to do the same. We have begun to utilize environmentally protected products for supplies. Rather than address “5 things that we’ve done, I prefer to view this participation as an ongoing and committed endeavor to change the way we as a society communicate and act about vitally important societal matters. It’s just a beginning, but all sustained movements and challenges start from some point.

PSN: What kinds of issues have popped up that may be an issue for medical offices that are going green?particularly things like sharps disposal, use of so much paper for gowns and table tops, other device disposal or reuse, etc?

Dr. Garth Fisher: The medical profession is very highly regulated and as such the industry is based upon verifiable science and thus changes slowly as often such proof is arduously ascertained. Our office building has no program to affect re-cycled materials, thus one of our staff has volunteered to take shredding home and process them in her own re-cycled program. We are beginning to only re-order products that are eco-friendly including light bulbs, paper towels, re-cycled paper for the copier and printers, cups, napkins, file folders, plates and utensils. The staff has been asked to shut down all electric devices (computers) prior to leaving each evening. Many of our medical products (antimicrobial soaps) are loaded with chemicals or have not been produced in sustainable materials. These issues must be addressed with regulatory agencies (OSHA) so that compliance does not become synonymous with hindrance. This is an ongoing process and we must applaud those members of industry approaching this enormous change and challenge supportively.

PSN: Who has been the champion of this effort in your office and what have you done to get your staff to comply?

Dr. Garth Fisher: I prefer not to single out any one individual and simply mention that the entire staff has accepted these changes and challenges with a spirit and a zeal that makes me extremely proud. My staff has been with me for many years, some as long as 18 years, and while I have learned to expect the best from them, they always rise to challenges that are required. This has proven to be a blessing for me personally.

PSN: What?s been the biggest challenge in launching this effort?

Dr. Garth Fisher: Educating individuals and organizations about what can be done seems to be paramount. People are especially eager to participate in such a venture once they know what they can individually do. That is the difference between theory and action. We need the combination of the two. As I mentioned previously, the medical profession is so tightly regulated that professionally we must explore ways to augment many of our present use of chemicals and compounds in order to create sustainably viable products.

PSN: Are there any issues that are particularly key that plastic surgeons should be aware of?

Dr. Garth Fisher: Plastic surgeons are often professional leaders in the community and society and by personally embracing the principles of sustainability in their own lives they will set a strong example of continued leadership.

PSN: Are you purchasing different products and if so, what? Can you recommend green friendly supply vendors?

Dr. Garth Fisher: It’s a bit early in the process to assess economic variables. Often industry responds to increased desirability by raising prices, however, the byproducts of sustainability will dramatically reduce expenditure over time. Once society in its entirety embraces this movement, the economy will follow suit. For now, we replace previously used non sustainable products with sustainable ones as we re-order. Protecting the environment for future generations is a critical endeavor for all inhabitants of this planet and each of us make that one small step forward for mankind. We have all seen how such a courageous step has evolved our future.

The subject of sustainability and environmental responsibility is particularly challenging in the medical and surgical fields. The entire concept of product sustainability is an evolving one and producers of "material" have not specifically caught up with environmental issues in our profession. High degrees of regulation and chemical specificity in order to insure safety and sterility often compete with biodegradability.

Understanding materials can help optimize each stage of the product development cycle and deliver safe, easy-to-use product that poses the least environmental risk. Reviewing performance data enables companies to develop sound, effective medical products and packaging. Medical products must not be compromised after sterilization. Key to achieving this goal is matching the resin to a cost-effective sterilization process that reduces bio-burdens without negative effects such as a color shift or physical degradation. Medical-grade polymers used for devices such as syringes, tubing, pump housings, caps, and dialysis components are typically sterilized via EtO, gamma radiation, autoclave, low-temperature hydrogen peroxide gas plasma, or electron beam (E-beam). Most high-volume medical products are sterilized via gamma or EtO, the latter being more expensive and requiring a time-consuming quarantine.

Much of our ability as practicing physicians to reduce bio hazard exposure and go medically green depends in a large part on the companies that research and manufacture our products. Medical waste is also a regulated specialty as liposuction-ed fat must be disposed of properly and medications that are “wasted” (the term for excess medicated solution) must be disposed of properly.

One way individual practices might make a difference is to participate in local medical centers that have set recovery programs of usable surplus medical supplies and distribute them to areas of need overseas. This concept was originated at Yale University and several health centers around the country are beginning to offer programs modeled after the Yale concept.

Using the concepts developed by these programs thousands of dollars worth of usable medical surplus have been distributed to a variety of countries including Sri Lanka, Haiti, Cuba, Liberia, Thailand, Vietnam, Kenya, and Nicaragua. The program can be run by volunteers and thus would receive no financial profit from its activities.

Much of the world’s population does not have access to quality medical care. Shortages of basic medical supplies and equipment lead to needless suffering and deaths in these under served areas.

Meanwhile, hospitals and clinics throughout the US generate large surpluses of a variety of usable medical supplies and equipment. Due to the strict regulatory standards and liability concerns, it is impossible to recover and redistribute these items within the US health care system.

Such a program avoids a lot of waste while at the same time providing a good community service, saves lives while offering a cost-saving, charitable alternative to medical surplus disposal and storage. The program reduces waste while improving health care for severely under served populations.

As leaders in the community, physicians should encourage large medical centers in their geographic location to develop such programs.

Unlike residential programs, medical waste management and recycling efforts are significantly more complex and challenging due to the diverse materials generated by medical facilities. Waste separation for recycling white paper, mixed paper, cardboard, green waste is important. Large medical university settings may accept off-location waste for recycling as part of the community effort. As we begin to learn to rely upon each other as a community of individuals vested in protecting our resources, we learn that the words of Britain’s famous poet John Donne, “Ask not for who the bell tolls, it tolls for thee”, memorialized into a Hemingway novel, is truer now than ever.