You Are What You Breathe: Dr. Ethan Sims Talks About the Environment and Your Health

In this episode of Skincredible, Dr. Lisa Swanson sits down with ER physician and climate health advocate Dr. Ethan Sims for an engaging, wide-ranging conversation that connects climate change directly to human health—right here in Idaho and across the globe.

They kick things off with lighthearted “two likes and two dislikes” (including a surprising anti-chocolate stance and a shared love of dogs), before diving into the serious reality that climate change is not just an environmental issue—it’s a healthcare issue.

Dr. Sims shares how a smoky, record-breaking summer sparked his journey into climate advocacy and walks listeners through the many ways climate change is already affecting our bodies. From extreme heat—which doesn’t just cause heat stroke but worsens heart disease, kidney disease, and even increases rates of violence—to intensifying storms that leave long-term mental health scars, this episode unpacks how environmental shifts ripple through every aspect of health.

They explore worsening air quality and the hidden dangers of microscopic pollutants. The conversation also covers the spread of mosquito-borne illnesses into new regions, the growing threat of water scarcity in the Mountain West, and how changing environments may be contributing to the rise in autoimmune and inflammatory diseases.

Beyond the challenges, Dr. Swanson and Dr. Sims highlight solutions—from improving indoor air quality and reducing food waste at home to rethinking healthcare practices that contribute significantly to carbon emissions. They discuss practical changes already making a difference, like switching anesthetic gases, reducing medical waste, and simple energy-saving strategies within hospitals. The episode also touches on innovative (and sometimes imperfect)—emphasizing that there is no single fix, but rather millions of “small buttons” we can all push.

Blending science, personal stories, humor, and actionable insights, this conversation balances honest discussion of risks with a sense of empowerment. The takeaway: while the problem is big, meaningful change starts with awareness, conversation, and everyday action.

Because when it comes to the future of our health—and our planet—we’re choosing hope.

Keywords

Dermatology, climate change, health, environment, wildfire, heat, medical impacts, sustainability, public health, Idaho, global warming, human health, air quality, extreme weather, infectious diseases, regenerative agriculture, cloud seeding, water scarcity, mental health, autoimmune diseases climate change, carbon removal, regenerative farming, seaweed farms, carbon capture, sustainability, environmental solutions, healthcare sustainability, climate tech, individual action

Links, Attachments

What you can do according to Project Drawdown

Chapters

00:00 Intro and Welcome

01:19 2 Likes 2 Dislikes

11:40 How Climate Change Impacts Health

12:57 How Dr. Sims Got Interested in Climate

15:33 Age 47.3 is the Unhappiest?

21:00 Heat, Exposure and Violent Crimes

23:00 Extreme Weather

25:00 Chronic Mental Health Impacts

26:00 Least Vulnerable Places

27:45 Air Quality, Filtration

32:15 Mosquitoborne Illnesses

34:20 Water Scarcity, Desertification

39:00 Cloud Seeding

41:00 Regenerative Agriculture

43:00 Autoimmune & Inflammatory Diseases

47:22 Carbon Emissions

56:30 Electric Cars

57:00 Action is the Antidote to Despair

01:00:00 Hospital Efforts

01:08:00 Biggest Threat to Humanity Question

01:10:10 Closing on a Positive Note

The information shared on this podcast is for educational purposes only and is not a substitute for personalized medical advice. Always consult your  physician regarding your health.

Transcript

SPEAKER_01 0:16

Hello, everybody, and welcome to another wonderful episode of this incredible podcast. I'm your host, Dr. Lisa Swanson, and I'm thrilled to introduce you guys to Dr. Ethan Sims, ER physician, extraordinaire, mountain biker, and climate expert. Welcome, Dr. Ethan Sims.

SPEAKER_02 0:38

Thanks so much, Dr. Swanson. Great to be here.

SPEAKER_01 0:40

Go ahead and tell the audience a little bit about yourself.

SPEAKER_02 0:43

So as Lisa mentioned, I'm an ER doctor uh working at St. Luke's with EMI. Um and I'm the executive director of the Idaho Clinicians for Climate and Health, which is a nonprofit that we started in 2021, focusing on how uh climate change is impacting human health in Idaho and around the world, and focusing on educating uh our peers in healthcare as well as our communities that we serve about these impacts and how climate change really is a healthcare issue, not a political issue, and should be treated as such.

SPEAKER_01 1:14

I also thought it would be fun to let the audience get to know you a little bit better by sharing two likes and two dislikes, something that I have learned from the um Love on the Spectrum show on Netflix, which is a good one. And we were talking before, you haven't watched it yet.

SPEAKER_06 1:30

Correct.

SPEAKER_01 1:31

You should. It is like heartwarming and wonderful, and I can't say too many good things about it. But one of my favorite things is when people are introduced and they announce there are two likes and there are two dislikes, and so I'll start. My two likes are cheese. Can't get enough cheese. Love cheese, pretty much any kind of cheese. I'll eat cheese. Um, number two, watching people interact with their doggies. Like if you're just like driving down the road and you see a human and a doggy interacting in such a sweet way, that reaffirms my faith in humanity and the human race when I see them interacting together. Do you have doggies?

SPEAKER_02 2:15

I do. We have an embarrassingly large number of dogs. We have four dogs.

SPEAKER_01 2:20

Four dogs.

SPEAKER_02 2:21

Yes, and dogs was actually on my list of things to bring up as things I like, but now I'll pivot to something else.

SPEAKER_01 2:26

Okay, okay, okay.

SPEAKER_02 2:27

But yes, we have kind of dogs. Uh we've got the full gamut. We've got uh my father-in-law moved into memory care, so we have his little old dog, who is a small 14-year-old. Um, we have a uh mini burnadoodle, cute, who is not that mini. Um, and then we have a mutt from the Warm Springs Reservation out in uh eastern Oregon.

SPEAKER_03 2:49

Oh my god.

SPEAKER_02 2:49

And then we have a yellow lab. Oh uh so uh uh one of every size, one of every color. Um just can't get enough dogs.

SPEAKER_01 2:58

I love it. And do they all get along?

SPEAKER_02 3:01

For the most part. The the dog who came from the res is a bit uh of a reactive, nervous guy. Yeah, uh, but if you're in his pack, uh he's really the sweetest dog that we have. But uh I love it. He doesn't like to share us with anyone else.

SPEAKER_01 3:16

No, I bet. Oh my gosh. And then my two dislikes. Number one, prior authorizations. Hate them. I just can't, it's gotten to be too much. Do you deal with that in the ER?

SPEAKER_02 3:29

Not at all. It's one of the good things about my job. I do.

SPEAKER_01 3:32

Because everything's an emergency.

SPEAKER_02 3:33

Everything's an emergency.

SPEAKER_01 3:34

So just like do it.

SPEAKER_02 3:36

But uh, that's a relief for me, but I think there's still downstream effects to people that I don't have to deal with where uh emergency care gets questioned as to whether it was truly emergent. Um I think this is really sort of the next frontier of uh insurance battles is did you really need to go to the ER?

SPEAKER_01 3:55

As opposed to going to urgent care or calling your primary care or whatever. Oh my gosh. I mean, that's so hard. Uh uh somebody with no medical background feels a certain way and feels like it's an emergency, that's an emergency.

SPEAKER_02 4:08

That's that's how we've always treated it. But uh, you know, they're pushing more and more to not reimburse for things, um, even hospitalizations for things that they the insurance companies are determining um didn't need inpatient care, but they're not looking at the 90-year-old who can't stand and walk um as a risk for falling and breaking their hip. They're looking at a 90-year-old with pneumonia who's not hypoxic, doesn't need oxygen, doesn't need IV antibiotics, doesn't need to be in the hospital, don't reimburse for it.

SPEAKER_00 4:37

Whoa.

SPEAKER_02 4:38

Yeah, it's pretty crazy.

SPEAKER_00 4:39

Oh my gosh.

SPEAKER_02 4:40

Oh, these are these are people without medical degrees making decisions like this. Right.

SPEAKER_01 4:45

Scary, so scary. Drives me insane. And then my other dislike pajamas in the airport. Pajamas in the airport. Yeah. I'm not a fan.

SPEAKER_02 4:53

I mean, SpongeBob PJ pants in the airport, hard no.

SPEAKER_01 4:57

Maybe if you're three. If you're three, we give you a pass. Yeah.

SPEAKER_02 5:00

Um I'll go under five. You can tolerate anything under five.

SPEAKER_01 5:04

Yes, yes. Um, especially right now. I mean, there's so much good athleisure wear. You can be comfortable during travel and still not be in your pajamas.

SPEAKER_02 5:15

Even my jeans I'm wearing today are stretchy jeans. Come on.

SPEAKER_01 5:18

I mean, yeah, there's comfort all around us. The materials these days are so comfortable. We can do it without being in our PJs.

SPEAKER_02 5:24

So that's because they're all got plastic in them, which we shouldn't enjoy. So let's get back to natural fibers.

SPEAKER_01 5:29

Yes, natural fibers all the way. And so, Dr. Sims, what are your two likes and dislikes?

SPEAKER_02 5:36

So uh I'm wearing one of my likes today. And if you're watching uh on on I'm not sure where this is shown, you YouTube's? Yeah, YouTube. The YouTubes? If you're watching on the YouTube, uh the Arsenal badge on my sweatshirt. Uh I'm a huge soccer fan. Um and Arsenal Football Club is my team. Um, my sister moved to England uh about 22 years ago and sparked my passion in English football.

SPEAKER_01 6:00

Did she move there for the football?

SPEAKER_02 6:02

No, she moved there for the school and has met a man and stayed in England and has two little very British children who have the cutest little accents. So now they're getting to be too big and their accents are less cute. My 13-year-old nephew is as tall as me, so that's all but I did get to go to England this year and take each of my niece and nephew to a game. I love it. That was really amazing.

SPEAKER_01 6:26

Forgive my ignorance. Arsenal, the team plays where?

SPEAKER_02 6:29

In London.

SPEAKER_01 6:30

In London. They're a London team. Yeah. London-based team. Are they the only London-based team?

SPEAKER_02 6:34

Oh no, there are lots of London-based teams. Yeah. And in North London, where my sister lived, uh, there are two big teams, Arsenal and Tottenham, that are deadly rivals. Um, but then, you know, there are lots of other teams in and around London.

SPEAKER_01 6:48

The only thing I really know about that is from Ted Lasso. Yes. That's my entire knowledge bank of, you know, football in the UK.

SPEAKER_02 6:56

That's okay. Ted Lasso is another thing I could have on my list of likes because I know it's like that is one of my favorite shows too much. Yeah.

SPEAKER_01 7:03

So good.

SPEAKER_02 7:04

My other like, I like I said, I had dogs on here.

SPEAKER_01 7:07

Yeah.

SPEAKER_02 7:07

Um, but I think I shouldn't have dogs since we've already talked about it so much. So I'll go with travel um and talk about how excited I am to go to France this summer uh and hike what's called the Tour de Mont Blanc, uh, which is a circuit hike around the the peak of Mont Blanc with my daughter who's graduating from high school.

SPEAKER_01 7:29

Wow. So it's a high. How long will it take you? Yeah, like uh eight days, seven nights.

SPEAKER_02 7:34

It's like a hundred and five miles. Wow. Um, it's gonna be super fun.

SPEAKER_01 7:38

You're like sleeping on the ground?

SPEAKER_02 7:40

No, uh, there are huts along the way. Um uh so in Italy they call them refugios. Uh in France, I think they just call them huts. Um, but uh you hike through France, uh Italy, and Switzerland in the loop. Wow. Um and you stop at these places and they have breakfast and dinner, and then if you're nice, they pack you a sack lunch.

SPEAKER_03 8:01

Wow. Yeah.

SPEAKER_02 8:02

So it's super uh easy because you don't have to bring food.

SPEAKER_03 8:05

Yeah.

SPEAKER_02 8:05

Uh you don't have to bring bedding. Um you just bring what you wear and what you're gonna change into, um, you know, cell phone charger, that kind of stuff.

SPEAKER_01 8:15

That'll be awesome. I can't imagine the views you're gonna have on this expedition.

SPEAKER_02 8:21

Yeah. One of the one of the good things about climate change is that you know the uh if you go earlier in the summer, usually there's snow. Um, but we're gonna go in the beginning of June, and there has not been any snow, so I think it'll be okay.

SPEAKER_01 8:33

They're having a winter like we've had here in Idaho.

SPEAKER_02 8:36

Very much so.

SPEAKER_01 8:36

Yes. Um, and then your dislikes.

SPEAKER_02 8:39

So, number one, I'm gonna say, well, climate change is on there, but climate change driving allergies. My allergies are killing me right now. Um and that is definitely something that we have seen that climate change drives these hotter, drier temperatures, um, extend the growing season for pollen producing plants and allergens, um, you know, increases the uh ozone trapping that leads to smog. Um, all those things increase uh the intensity of your allergies. Um, and mine have been terrible these past couple of days.

SPEAKER_01 9:12

Are you gonna do shots?

SPEAKER_02 9:14

I don't think so. No, yeah, yeah. I'm just gonna take as much Zertec as the human body can tolerate. Um, I've got nasal sprays, eye drops, all the things. All the things um to to avoid having to do anything real. I don't want to go see a doctor. Yeah, I don't want to go see a doctor. I see a doctor every day. I would need to see another one.

SPEAKER_01 9:33

I understand. I understand. Doctors make the worst patients or the worst.

SPEAKER_02 9:37

I think nurses might be worse.

SPEAKER_01 9:38

No, really?

SPEAKER_02 9:39

Oh yeah, oh yeah. I think nurses might be worse.

SPEAKER_01 9:41

We love you, nurses out there. We love you. Yeah.

SPEAKER_02 9:44

You just don't listen to anything we say. My second uh dislike is controversial. Uh I don't like chocolate.

SPEAKER_01 9:52

You don't like chocolate.

SPEAKER_02 9:54

Yeah.

SPEAKER_01 9:54

You know, you are actually the second guest on the pot.

SPEAKER_02 9:58

Maybe I'm not the only one.

SPEAKER_01 10:00

He doesn't like chocolate. And his origin story for that was that his parents told him when he was young that he was allergic to it, and so he just never ate it. And so now he doesn't have the taste for it, and he just has no interest in it at all.

SPEAKER_02 10:14

Yeah, I think mine is similar. Okay. Um my parents started a co-op when I was a little kid, and we were always into like the crunchy foods. We had lots of carob in our house, which is not chocolate, no, but it is and is disgusting. It is pretty gross. Um, and is a fake chocolate. Yes. Um, and so I I feel like I got fed a lot of carob as a kid, and um maybe I just developed a negative association. But I I try chocolate every now and then. Yeah, just to see repulsive to me. I just like I don't see what the fuss is all about.

SPEAKER_01 10:46

That's so funny. That's so funny. I worked at an ice cream and yogurt shop in high school, and um, it was family run. And sometimes if there was an opportunity to save money, they opted to do that. And so instead of chocolate chips to put on the frozen yogurt, they had carob chips. So I know exactly what you're talking about. I remember for the first time I was like, I'm gonna try a hand, I'm gonna have a handful of chocolate chips. And then I ate them. I was like, oh boy, no, these are not chocolate. Yeah. So I can understand if that was your only kind of view into the chocolate world, how it didn't uh resonate with you. I get that. I get that. Um, well, we are here to talk about a very important topic: climate change, how it affects the health of human beings and animals on the planet as well, everybody, dogs, everybody. Um, and I wanted to start by sharing a statement that I got from the WHO website, the World Health Organization website about climate change. And because I thought it was powerful, they said the WHO has declared that climate change presents a fundamental threat to human health. All aspects of health are affected by climate change, from clear air, water, and soil to food systems and livelihoods. Further delay in tackling climate change will increase health risks, undermine decades of improvements in global health, and contravene our collective commitments to ensure the human right to health for all. 3.6 billion people already live in areas highly susceptible to climate change. And total on the planet, last time we checked, was 8.3 billion. So more than a third of the people on the planet are already living in an area that's really vulnerable and susceptible to this change. I also saw that they predict between the years 2030 and 2050, 250,000 additional deaths will occur each year due to climate change. So that kind of sets the stage for where we're at and and what we're gonna talk about. And for the listener and for the watcher, there will be a little bit of doom and gloom in this episode, but it's not all doom and gloom. We can find some positivity in this. And I think the importance is getting the information out there so that people understand what's going on and how it affects them and their family, and then how are some ways that we can go about as a society and as human beings to try to fix it or mitigate it or handle it as best we can? Now, there are various aspects. Oh, I wanted to ask before I get in there, what kind of got you interested in climate change? You're going through your ER career, you're an emergency medicine guru, and then you decide to take your career in this slightly different direction with climate change. Was it one of our famous inversions here in Idaho, here in Boise, Idaho?

SPEAKER_02 13:30

It was not. It was the opposite season. So uh we had a really hot, really smoky summer in 2021.

SPEAKER_01 13:38

Yes, I remember it.

SPEAKER_02 13:39

And uh I do this thing called the Boise Trails Challenge every summer, uh, where there's a set number of trails that you try to link up and ride or run um within a one-month period. Uh, it's usually like mid-June to mid-July. Um, and uh that summer it was so hot uh and the fires came earlier than usual, and it was so smoky that it was just like impossible to find a time where it felt good to be on your bike.

SPEAKER_03 14:06

Yeah.

SPEAKER_02 14:07

Um, and I just had no knowledge from medical training as to like what this was actually doing to my body, yeah. Um, being out riding in like terrible wildfire smoke, yeah, um, or really bad heat um that like really made you feel sick when you were exercising in it.

SPEAKER_03 14:23

Yes.

SPEAKER_02 14:24

And uh, you know, that same summer, you know, my kids are in day camps all day, outside playing, going camping, like, and you start worrying, is this safe for my kids to be outside? Like if it feels like I'm smoking a pack of cigarettes to ride my bike, right? Am I exposing my kids to a pack of cigarettes every day that they're a camp outside playing? Yes. Um and then like what is it doing to my parents who we'd just moved here? Um, you know, they're outside in just this 105, 110 degree heat every day. Um, and medical school doesn't really prepare you for this, or at least it didn't when we trained. Yeah, yeah. Um, I mean I learned nothing about about these kind of climactic impacts.

SPEAKER_01 15:04

Well, and I'm older than you, so I we learned even less when I went to medical school.

SPEAKER_02 15:08

I don't know that that's true, but uh but I'll take the I'll take the win.

SPEAKER_01 15:11

I'm 47.

SPEAKER_02 15:12

I'm older than you.

SPEAKER_01 15:13

You are? You look great. Yes. Yes, yes. That's a dermatologist telling you. You look great. Yes.

SPEAKER_02 15:19

You've been good with your sun protection while you're out on your I mean I I have like this giant thing on my forehead that would say no. Uh so I just turned 48 and Oh, so just a smidge all the time.

SPEAKER_01 15:31

Yeah. Just a smidge.

SPEAKER_02 15:32

But I did see an article uh after turning 48 that said that 47.3 is the least happy time in a human's life. Um and my friend whose birthday is the day before me, uh, who turned 47, said, Hey, if this is as bad as it gets, we're doing pretty good.

SPEAKER_01 15:49

You know, I think he I mean, I guess I don't know what the future holds for me, but I think it has been in the past year that like my age has like started, it's something I feel more and think about more than I ever have before.

SPEAKER_02 16:04

I think it's because you hear it more, like when you straighten your legs, your knees make crunching noises.

SPEAKER_06 16:09

Yes.

SPEAKER_02 16:09

But I mean, I it's off topic a bit, but I think it's because we're in that like true sandwich generation where like our parents are getting older, yeah, and we're having to provide more assistance to our parents.

SPEAKER_03 16:20

Yeah.

SPEAKER_02 16:20

Um, and our kids are getting older, and we're having to like really provide more like uh preventative uh care to our teens. Um and it's just it's a really taxing time of life, and I think that's what makes it so stressful.

SPEAKER_01 16:33

Because you have two girls.

SPEAKER_02 16:34

I have two girls, uh junior and senior in high school.

SPEAKER_01 16:37

Oh wow.

SPEAKER_02 16:37

Um big change about to happen. Big changes everywhere that that creates all sorts of questions about what what's the house gonna be like when the people who talk all the time aren't there anymore?

SPEAKER_01 16:48

Yes, yes, yes, yeah. And so your senior, is she headed off to college in the fall?

SPEAKER_02 16:54

Yep, she's off to Middlebury, uh which is in rural Vermont.

SPEAKER_01 16:57

That sounds beautiful.

SPEAKER_02 16:58

It is sounds like picturesque. It's just gorgeous. Yeah.

SPEAKER_01 17:02

How did she choose that?

SPEAKER_02 17:03

Um, she has always been a big uh skier and runner, and uh so we looked at schools that she could uh find easy access to trails, uh, but also had a lot of language because she's really interested in studying French.

SPEAKER_01 17:17

I love it.

SPEAKER_02 17:17

Um, and also have strong biology programs because that's her other big interest. Uh, and Middlebury ticked all the boxes. Um we just went and looked at a bunch of places, and uh, you know, it's like one of those things where like meeting your partner, yeah, where we were on campus and immediately she turns around and said, This is the one.

SPEAKER_01 17:35

You know, it's so funny you say that. I just got goosebumps because I had the similar reaction. I went to University of Colorado Boulder and I had considered other places, and actually CU Boulder was like the one place I hadn't crossed off my list. And so I went there, I enrolled sight on scene because it was the one left on the list, and I was like, sure, I'll be a Buffalo, and showed up to orientation, and I was like, yes, this is the feeling that I wasn't getting anywhere else. Fortunately, it worked out for me that I had just kind of stumbled across it and ended up there. But you do just get a feeling, and I feel like I have let that guide me through all my big decisions in life where I went to medical school, where I went to residency, um, choosing to move here. Like it was just like the feeling of it that did it for me.

SPEAKER_02 18:23

Yeah, and I mean, I think I can bring us back on topic with that idea because that's kind of how climate and health was for me. Um when I started thinking about it, you know, I I'd I didn't have a uh like an environmental background, so to speak, but I'd always thought that I would grow up, uh, be a doctor, and then retire and move to the center of the great uh Pacific garbage patch and scoop plastic out of the ocean. And that was going to be like my big contribution to the world was picking out little pieces of plastic from the ocean and uh reducing the amount of plastic waste in the ocean. I love that. Um and then it you know, you you get hit with this overwhelming sense of despair from climactic changes. And I I mean I wonder if people in Idaho are included in that WHO number of people. I know. I think we should be because our air quality suffers. Yeah.

SPEAKER_01 19:12

Um we're a valley. For those of you that aren't familiar with uh Boise, Idaho, we're in a valley, and so wildfire smoke settles here. Um and so we have some very smoky summers. Last summer was beautiful. This next summer I'm very worried because we have not had nearly enough snow and water. Um I wanted to quickly go over kind of the various aspects of climate change that affect health and have you kind of explained to the audience how these things affect human beings. So, first heat. We've been having hotter summers. I'm from Arizona. They've already set several records this year in Phoenix for the temperatures that have already occurred here in April. Um and so how does heat affect human beings' health?

SPEAKER_02 19:53

Uh so I think people, when they hear about climactic impacts, they want to think about the the thing. And you know, for heat, people think of like heat stroke or heat exhaustion, and that's certainly an acute exposure-related illness that we see in the ER. People come in with cramps and confusion and lightheaded and they're passing out. But really, uh climate change is what we consider to be sort of a uh a great magnifier of kind of everything. Um, and heat plays out that way in the human body. Uh, it increases stress on your heart because your skin vasodilates as it tries to cool your body off, and that makes your heart work harder to pump blood uh to the distal parts of your body. Um, so your heart rate and your uh stroke volume, the amount of blood your heart's pumping forward get get higher when it's hot. Um, and for someone who's young and healthy, you can tolerate that a lot better than someone who's got congestive heart failure or or chronic kidney disease. Um, and it's these organs that start to get really most impacted. So people with heart failure are more likely to have heart failure exacerbations, people with heart disease are more likely to have a heart attack, people with a history of uh cerebrovascular disease are more likely to have stroke, um, and people with chronic kidney disease are more likely to have acute exacerbations, and then we see even in people without kidney disease, uh, especially people that are exposed to heat working in fields or on roofs, uh, we see a ton of people that develop kidney disease that have no other reason to do it other than that they work outside in the heat.

SPEAKER_01 21:25

The other thing I heard you talk about at a conference was the impact of heat and violence.

SPEAKER_02 21:31

Yeah.

SPEAKER_01 21:32

Tell the audience that was eye-opening to me.

SPEAKER_02 21:35

So uh I mean I think everyone can empathize with the idea that when it's hot outside you're more cranky and irritable.

SPEAKER_01 21:42

I certainly am.

SPEAKER_02 21:42

Uh but studies have shown that rates of violent crime, um, including things like suicide, um, including things like sexual assault, including uh, you know, drug use uh and uh uh physical assault, uh, all go up when the heat is high. Um, and it's not just that the temperature itself is hotter because uh people who live in Arizona um are used to a temperature of a hundred and ten degrees. So it's the percentage change from what you're exposed to uh that really increases their proportional effects on people. So if we in Idaho have a 115-degree day, that is a lot harder for us to tolerate than someone who lives in Phoenix, uh, where 115 is not that far out of the norm. Um so we're much likely to see people behaving inappropriately.

SPEAKER_06 22:31

Yeah.

SPEAKER_02 22:31

Um, and you know, there are other reasons for those impacts. Uh people that have psychiatric illnesses have more difficulty with uh regulating temperature because of how their brain works, uh, and some of the medications that we use to treat psychiatric illnesses and other illnesses in general um can increase your body's or decrease your body's ability to cope with heat.

SPEAKER_01 22:52

Yeah, interesting. Um yeah, I I would also throw in there menopause. I'm hot all the time, Dr. Simps. I'm hot all the time. Okay. Extreme weather events, all the storms, hurricanes, tornadoes, blizzards, snow cyclones, um, you know, freaky hurricanes uh striking New York City and the Northeast. Storms are everywhere. They're occurring outside of what has typically been storm season, and they're much more destructive on like a whole other level. Talk about that impact.

SPEAKER_02 23:32

Yeah. So I mean you think about the if you want to think about the dollar cost of climate change, this is where I think people find it easiest to make a direct connection because we have seen that um climate change is driving higher numbers of hurricanes. And when we have hurricanes, they're more uh destructive than they were before, um, and they're occurring in places and times they don't normally occur. Um so we're seeing hurricanes migrate further north, uh push further inland, where you see places like Asheville, North Carolina have uh complete devastation from flooding associated with a hurricane.

SPEAKER_03 24:07

Yeah.

SPEAKER_02 24:08

Um, not typically in the time of year we'd expect it to be there.

SPEAKER_01 24:12

Right.

SPEAKER_02 24:12

Um, you know, I have a And Asheville's very inland. Very inland.

SPEAKER_01 24:16

I've been to Asheville.

SPEAKER_02 24:16

My brother-in-law uh lives in LA or lived in LA, um, and one of his friends was so sick of all the threats of climate change on California that he was like, I'm moving to North Carolina and no one's ever gonna get me there. Um, but the reality is like the the earth is finding a way to get us no matter where we try to hide. Um so I think the from a human health standpoint, uh the you know, injuries associated with these disasters uh get uh more frequent, uh, and we see more people getting killed from uh things like bad tornadoes and hurricanes. Um but we also see the uh chronic mental health impacts of being a survivor of one of these conditions, where you know, if you're in a bad wildfire or you're in um a town that has to get evacuated because of flooding related to a hurricane, um, that doesn't just have immediate impacts on you, those impacts on your mental health and ability to concentrate and focus and do well on tests, because I looked at kids' test performances years after being exposed to an event like this, and they all drop and stay down. Um, so it really is uh something that impacts us for years and years, not just in the immediate aftermath of an event like that.

SPEAKER_01 25:30

We use we're starting to use the term in pediatric dermatology, cumulative life course impairment. And we think about like eczema has a big cumulative life course impairment. And so I think that's alluding to the same thing here. If you are if you have gone through one of these horrendous events, that's a big clump of cumulative life course impairment that's gonna impact you for the long run. So fascinating. I did look up which states are least vulnerable to climate change. Vermont is number one least vulnerable. Did you know that when your daughter selected Middlebury?

SPEAKER_02 26:08

Uh I knew it before she selected Middlebury. Um but uh I think one thing that is interesting about that is you know, Vermont's just verdant landscape, yeah. Uh lots of water, yeah. Um and drought hasn't really like taken over that part of the country yet.

SPEAKER_03 26:24

Yeah.

SPEAKER_02 26:24

Um, so I do think that is like gives it a lot of resilience in the in the face of climate change.

SPEAKER_03 26:30

Yeah, yeah.

SPEAKER_02 26:31

Um, but we've seen Canadian forests uh further north of Vermont um on that same uh longitude starting to burn. Right. And that makes me worry that like eventually it's gonna creep down into the US.

SPEAKER_01 26:46

But and I remember that summer that there were the wildfires in Canada and New York. Like they showed on the news, New York City was like red orange because of all the smoke in New York City.

SPEAKER_02 26:56

Yeah, we happened to be in Boston that summer, and uh it was like that in Boston as well. I mean, just the East Coast is so much more connected than the West.

SPEAKER_03 27:05

Yeah.

SPEAKER_02 27:06

Um but uh also totally had been isolated from these wildfires before.

SPEAKER_03 27:12

Yeah.

SPEAKER_02 27:12

And I honestly think that having New York and Boston and Philadelphia have these exposures and see what climate change is doing.

SPEAKER_01 27:20

Eye opening.

SPEAKER_02 27:21

See what wildfire smoke is like, trying to live in that.

SPEAKER_01 27:24

It's horrible.

SPEAKER_02 27:24

Yeah, I think it really was an eye-opener. Um and you know, it's one of those things where you need to have direct experience with it, I think, to believe it. Yeah, and to have a personal vested interest in doing something about it.

SPEAKER_01 27:36

Yeah, yeah.

SPEAKER_02 27:37

I think that's just how humans work.

SPEAKER_01 27:38

I think that is true. And that segues nicely to the next thing air quality. Air quality. You my life was changed when I saw you give a lecture on climate change and health, and I became obsessed with air quality. And you know I emailed you several times because I wanted to know all the products to buy from my home. You enlightened me that air quality you think inside is safer and better, but it actually tends to be worse because you're not getting any sort of breeze and the air is recycled. And so I like there were some smoky days. I think it was that summer 2021 or maybe 2022. It was horrible outside. And you feel like, okay, I'll just work out inside, but no, that's not any better. And so I got an air filtration system for my house that you helped me guide me a little bit in the choices there, and an air quality detector for my home, which I really like. It's called purple, right?

SPEAKER_06 28:37

Purple air, yeah.

SPEAKER_01 28:38

Purple air. And it's colorful and it turns the color based on you know how your air is doing in your house, and green is good. And then it goes like green, yellow, orange, red, like kind of a purple magenta sort of color. And when I bought it that summer, it was purple magenta. And then we put in the air filtration systems in the house. I put separate little ones in each bedroom, and we got it to yellow in the midst of like severe wildfire smoke outside. So talk to us about air quality. Open the eyes of all the listeners and watchers, like you did for me.

SPEAKER_02 29:12

Yeah, I mean, uh air quality is another thing like heat that really touches every part of your body uh because you're breathing air in, and wildfire smoke, especially, is these mice microscopic particles that we call PM 2.5, so 2.5 microns in diameter. Um so you could fit like 150 of them across the width of a human hair. Um, so tiny, tiny little things that get into your lungs and then get into your bloodstream through your lungs after you breathe them, and then get deposited in solid organs, get deposited in your skin, um, and can really just wreak havoc inside your body because they cause inflammation that leads to disease. Um we see this with your brain because they can cross the blood-brain barrier. Uh, we see it in placental tissue, because they can cross into the placenta. Uh, we see it in basically every organ of the body. Um, and uh Dr. Swanson is right, you know, the indoor air should be the safest, uh, but we have to do a good job of making sure that it can be. Um, and air filtration is a great way to do that. Um, but uh that was kind of the one good thing that came out of COVID to my mind was that a lot of schools um and a lot of public utility buildings uh started caring about what their air filtration was like.

SPEAKER_01 30:27

Yeah.

SPEAKER_02 30:27

I think they have stopped caring as much as they did then.

SPEAKER_01 30:30

But at least maybe they installed certain things that will help us.

SPEAKER_02 30:35

Right.

SPEAKER_01 30:35

Yeah.

SPEAKER_02 30:35

And a lot of schools did. And so especially in Boise, uh, a lot of our schools got better. Yeah. Um, but still not enough. And I think one thing that's important is that you can use your nose to identify uh when it smells like a barbecue in your house, the air quality is probably poor. Um, but that's not good enough to really know is it safe to be indoors. And I think one thing you brought up was that um you got a home filtration system um and you were able to go from purple to yellow, yeah, not purple to green.

SPEAKER_03 31:06

No.

SPEAKER_02 31:06

Because there's nothing that's that efficient that you're gonna be able to get to completely clean air.

SPEAKER_03 31:12

Yeah.

SPEAKER_02 31:12

So there may be some times where it's just not safe to to exercise indoors.

SPEAKER_03 31:17

Right.

SPEAKER_02 31:17

There may be some times where you just can't get your home safe enough, but it's better, it's all about that relative improvement and doing the best that you can.

SPEAKER_04 31:25

Yeah, yeah.

SPEAKER_02 31:26

Um, so I mean, air quality uh, you know, touches your brain uh through the rest of your body. There are higher rates of dementia, higher rates of stroke, higher rates of preterm delivery, and low birth weight babies. Um cradle to grave, there are big uh damages to the human health uh from degraded air quality. And for us in Idaho, uh wildfire smoke is definitely the biggest contributor to that.

SPEAKER_01 31:50

It's a big one. And we see it in our dermatology clinic. Um, a lot of kids will have eczema flares when it's really smoky outside, uh, because it's a tremendous, a tremendous irritant because it's you know making contact with their skin, their skin is sensitive to begin with. And so that's even been documented in the literature, like horizon eczema flares during smoky months and smoky places. Um, mosquito-borne illnesses. Tell us about this.

SPEAKER_02 32:15

Uh so a lot of these mosquito-borne illnesses have scary names like chicken gunya um or dengue fever or breakbone fever. Yeah. Um, these things are these are things that you learn about in like a tropical medicine block in in med school, and then you work in the US and so you never think about them again.

SPEAKER_03 32:33

Yeah.

SPEAKER_02 32:33

Uh but now we're seeing cases of native transmission of dengue fever in New Mexico.

SPEAKER_01 32:40

Meaning those mosquitoes are here. Those mosquitoes are. It used to be something that you had to travel to acquire, but now those mosquitoes are moving out of their ordinary habitats or other mosquitoes are adapting and able to carry the parasite that is causing the diseases.

SPEAKER_02 32:56

But they're usually like some subspecies of like the Anopheles mosquitoes. So we may not have the same one that carries malaria in West Africa, but we've got another kind of Anopheles mosquito that's carrying the uh malaria parasite because we've seen native transmissions. So people that haven't traveled outside of Washington, D.C. in Maryland that have had cases of malaria. Um Florida has had the most cases of all of these things, uh, which is not too hard to see why, given that it's you know so close in proximity to Central and South America. Yeah. Um, but again, it's not because uh people are traveling, it's because the diseases are traveling because the environment that we're creating now is more hospitable to um these tropical diseases in the U.S.

SPEAKER_01 33:40

Yes. Now, I believe that every creature on planet Earth serves some purpose, but I struggle with the mosquito.

SPEAKER_02 33:46

Oh, me too, I mean. There was that Time magazine. There was a Time magazine that had um like a picture of a giant mosquito once that was like the the world's greatest predator. Yes. Uh because it really is. It really is.

SPEAKER_00 34:00

Yes. And it's like, what what good does the mosquito do? Does it do any good?

SPEAKER_02 34:06

It feeds the spiders? I don't know.

SPEAKER_00 34:08

But do we want I don't know. I don't know.

SPEAKER_02 34:10

We want spiders because they eat mosquitoes.

SPEAKER_01 34:16

Um and then water scarcity, which is something that's um a real big issue in Idaho right now. We had in the Mountain West, the entire Mountain West had historic low snowfall this winter. And that's making everybody really nervous. Nervous about water to feel it feed the crops. Snowpack is at an all-time historic low. What are we going to do? And we're probably going to have a really bad wildfire season. So talk about water scarcity and how it affects people's health.

SPEAKER_02 34:48

Uh so I think our neighbors to the south in Salt Lake City can speak volumes about how water scarcity impacts human health.

SPEAKER_03 34:55

Yeah.

SPEAKER_02 34:56

The Great Salt Lake is drying up. I know. As the Great Salt Lake dries, uh, it becomes desertified and the uh lake bed becomes exposed. Um the lake bed of most lakes uh you know has minerals. Um Salt Lake has seen a lot of mining, so there's a lot of toxic minerals, uh, things like arsenic and lead uh that are in the crust that dries out underneath the lake bed. And then every spring in Salt Lake is really windy. Yeah um and so the wind is blowing this desertified lake beds, toxic dust into a city that's growing every year.

SPEAKER_04 35:32

Right.

SPEAKER_02 35:32

Um, and so you know, one of the things that we have seen happen in the past uh when lake beds dry up is that the air in a city can become so toxic that people can't live there anymore.

unknown 35:44

Right.

SPEAKER_02 35:44

Um, so there's a town in Southern California outside of Lake Owens, um, which dried up when California diverted the river for more water for LA.

SPEAKER_03 35:54

Yeah.

SPEAKER_02 35:54

Uh and in the 1930s, this town just became a ghost town because people couldn't tolerate living there because the air quality was so bad from desertification of Lake Owens.

SPEAKER_06 36:03

Wow.

SPEAKER_02 36:04

Um, and I fear that's what we're starting to see in Salt Lake. Um, so that I mean that's that's a huge scary thing risk.

SPEAKER_04 36:11

Yeah.

SPEAKER_02 36:12

But then there's also things like you mentioned, not you know, not enough water to irrigate the crops. Yeah, crops become less nutritious, yeah, people's uh nutritional status gets worse. Yeah. Um, and I think it's things like that that make people fear that, you know, fresh water supplies are going to be the cause of the next great war. Uh, because as the world dries out, um, that water really is going to be our most valuable resource. And fresh water is not something that we have in great abundance. I mean, you look at places like the Middle East where they're already using desalination plants to provide water, but they're also not growing a lot of crops, even though they're pumping tons of water through these desalination plants just to provide drinking water for the people.

SPEAKER_01 36:54

Yeah.

SPEAKER_02 36:55

Um, but I don't think we could keep up with our crop demands and food nutrition um with desalination plants.

SPEAKER_03 37:02

Yeah.

SPEAKER_02 37:03

Um and you know, the the problem is uh we end up getting these extremes that keep getting more extreme where we're not just having droughts, we're having mega droughts.

SPEAKER_04 37:15

Yeah.

SPEAKER_02 37:15

Um and then when we don't have a drought, we have floods. Um and uh, you know, we have places like the um the Midwest where the Mississippi River is flooding.

SPEAKER_03 37:27

Yeah.

SPEAKER_02 37:27

Um, and every summer we get these hundred-year rains that we happen to get every summer now.

SPEAKER_03 37:32

Yeah.

SPEAKER_02 37:32

Um that just lead to the Mississippi River overflowing.

SPEAKER_03 37:36

Yeah.

SPEAKER_02 37:37

Um, and then the West Coast is completely dried out. Right. Um, and so it the climatic changes are leading to an ill distribution of water resources that I think is going to take some real ingenuity to figure out how to resettle that balance.

SPEAKER_01 37:54

I was thinking somebody really smart and innovative who thinks outside the box needs to come up with a way to transport snow from places that are getting too much to places that aren't getting enough. Because the n the Northeast got hammered this winter with so much snow. And here in the Mountain West, we're struggling. Can't somebody come up with a way to like bring it out here?

SPEAKER_02 38:17

I mean, I think a a water pipeline would be amazing, but I think it would have to be running water, not snow.

SPEAKER_01 38:23

Not snow. Um But melting snow could maybe feed it?

SPEAKER_02 38:27

I just don't think the East Coast. So I think that that was an anomalous winter. Yeah. Um and the East Coast is not as much as my daughter wishes, Vermont got a ton more snow than Idaho does. That's not the usual.

SPEAKER_03 38:37

Yeah.

SPEAKER_02 38:37

Um and this was a very uh atypical year. Um though, I mean, we are seeing every year the atypical years come more frequently.

SPEAKER_03 38:46

Yeah.

SPEAKER_02 38:46

Um it seems to me that if you could somehow divert water, uh that would be a an easier way to to ship water from one side to another. Uh another idea that's really interesting to me um is cloud seeding. Right.

SPEAKER_01 39:00

Oh my gosh, I'm so glad you're talking about this. Because they do this in China. They did it before the Olympics so that it would snow for the winter Olympics. And I I was at Winter.

SPEAKER_02 39:10

They also did it for air quality because the air quality was so bad they made it rain over cities to clear out the air so it wasn't so smoggy.

SPEAKER_01 39:18

So let's do that. Why can't we do that? Is cloud seeding bad in any way?

SPEAKER_02 39:22

Um so cloud seeding requires certain conditions to be effective. It requires a certain amount of humidity in the air. So you can't just make rain happen. Um, there have to be certain conditions that are primed for clouds to be seeded.

SPEAKER_03 39:37

Gotcha.

SPEAKER_02 39:38

Um, I don't know enough about this, but I'm really excited. I'm gonna share an event that's coming up. Yeah. Idaho Environmental Forum um IEF uh does these elemental series talks. Yeah. Um and they have one, I think it's on May 4th, May 5th.

SPEAKER_01 39:52

Coming May the 1st.

SPEAKER_02 39:53

That's that's about cloud seeding. Oh, yeah. So I'm really excited to go learn some more about cloud seeding.

SPEAKER_00 39:58

That's here in Boise?

SPEAKER_02 39:59

It's here in Boise. It's at White Dog Brewing.

SPEAKER_00 40:01

Okay.

SPEAKER_02 40:02

Um, and it's on a Tuesday, so it may not be the fourth, it may be the fifth.

SPEAKER_01 40:06

I'm gonna check that out because I I'll Tuesday the fifth. Tuesday the fifth. Because I I have wondered, I have told several people, like, why don't we cloud seed? Like above a big wildfire, but you probably can't above a the conditions probably aren't right.

SPEAKER_02 40:20

Yeah, I mean there has to be enough humidity in the air that you can activate rain to droplets to form.

SPEAKER_04 40:26

Yeah, yeah.

SPEAKER_02 40:27

Um because that's that's really what they're doing, is they're activating uh water molecules to combine, um, which then helps them drop to the ground.

SPEAKER_04 40:37

Yeah.

SPEAKER_02 40:37

Um so it's it's a it's a really interesting science.

SPEAKER_04 40:40

Yes, yes.

SPEAKER_02 40:41

Um it feels like something that could be a potential help.

SPEAKER_04 40:45

Yeah.

SPEAKER_02 40:45

And I mean, there are examples of places that have just um changed their microclimate by how they're uh working with the land. Um so there uh is uh this practice called regenerative agriculture, yeah, um, which has really like taken farming back to the olden days.

SPEAKER_03 41:04

Yeah.

SPEAKER_02 41:05

Um and people have shown really great uh crop yields, improvement in the soil quality, improvement in soil uh moisture retention by not tilling, right? Um, by not spraying their crops with pesticides and fertilizers, um, by having sort of more traditional farming practices. And there's a place in central Mexico um that it's really I can't remember the name of the town, but it's um like out in the middle of nowhere in in a desert. Yeah. And there's this like green lush patch where this guy has gone regenerative with his farming practices and he has changed the microclimate to be uh holding more moisture. Um so this one little patch in a much drier area now has a lot more moisture. So um when I see things like the foothills getting dry and grassy, and I wonder did those used to be covered in trees, I don't I don't know that that's the case, but I also know that we can manage lands in a way that helps them uh cool the planet, yeah, retain more moisture. Um and you know that takes a lot of ingenuity and a lot of community commitment, but I think it's something that's achievable.

SPEAKER_01 42:22

Yeah, yeah. And I think it's something that we've got it, we've got to do. Otherwise the future looks pretty bleak.

SPEAKER_02 42:28

Yeah, and if you hear uh regenerative agriculture uh like farmers talk about it, um uh the reasons not to do it are because the government gives subsidies for uh Monsanto-based uh seeds that require Monsanto-based Roundup to work with them. They're Roundup ready crops that you get funding to do these to buy these things. Um but farmers that have gone away from that are spending less money, doing less work, and getting higher crop yields with soil that's healthier, yeah. Which is ultimately what determines how fertile your fields are, is how healthy your soil is.

SPEAKER_03 43:04

Yeah.

SPEAKER_02 43:04

Um, so it really takes you know initiative from the government to stop pushing these old practices and uh knowledge for the current group of farmers, which I'm certainly not and certainly um speaking about my pre-grade here. Yeah. But um, I've seen enough regenerative farmers speak um that it's one of those things that as soon as you hear someone talk about it, you're like, why isn't it?

SPEAKER_01 43:27

Why don't I do that? Like, why don't we all do that? Yeah, yeah. And I think having the government incentives perhaps shift to supporting more of those practices. Absolutely. Yeah, yeah. Um before we move on, I wanted to talk about uh uh dermatologically, we're seeing a lot more autoimmune and inflammatory skin diseases. Rates of psoriasis, especially in kids, have gone up and up and up worldwide. It's not just in the United States. Rates of allopigiriata, hydrogenitis separativa, and we're even seeing it with escalations of risk of inflammatory. Bowel disease and inflammatory arthritis in the rheumatologic world. And so all of these autoimmune and inflammatory conditions are on the rise. And I've read that there are two leading hypotheses for why this is. One is climate change, especially with skin disease, that as air quality decreases, oxidative stress on our skin, our largest organ increases and creates a more pro-inflammatory state. And then the other is that our gut microbiome as a species of human beings has changed over the past 20, 30 years and is creating a more pro-inflammatory state. And I happen to think it's both, and I think they're playing off of one another because I think climate change is having this impact on the food that we eat and the crops that are grown, which in turn affects our gut microbiome. Any thoughts on that at all?

SPEAKER_02 44:48

Yeah, I mean, I I think if you just took a sample of the stuff that's in the air now, um, you know, like I said, allergy seasons getting longer and more intense. PM 2.5 from wildfire smoke uh is bathing the air sometimes. Um and that doesn't just blow away and go away. It lingers and sticks around. And what's in that wildfire smoke is hugely variable depending on what's burning. So, you know, if there's a fire that destroys a town, um, there are all these flame retardants and plastics uh that are melting and getting into the air. Um, and these are things that never go away. Um so that when it does get windy and when things get kicked up, um, they're more likely to be in the air. And so uh, as you mentioned, your skin's the biggest organ in the body. Um a lot of these things are very lipophilic, uh, so they like fats, um, they can get through the skin barrier um and get into our bodies that way, or they can get in through your lungs and through your uh bloodstream can uh kind of migrate into your skin itself.

SPEAKER_03 45:51

Yeah.

SPEAKER_02 45:52

Um so you know, we're just surrounding ourselves with things that are uh very inflammatory, yeah, um and and not natural. Um and all of these chemicals that are in plastics uh I think are a real big problem um that we don't have an easy solution to to switching away from.

SPEAKER_01 46:11

Right. Yeah. I have started doing my little part. I now I I like Diet Coke and Diet Pepsi, and I always do a can now.

SPEAKER_02 46:19

So uh we at the Ido Clinicians for Climate and Health have a um climate and health learning series. Yeah. Um and our last speaker came in person and talked to us about plastics. Yeah. Uh this guy Leo Trasande, really amazing speaker. Um, unfortunately, cans have a plastic liner in them. No, they don't. Yes, they do.

SPEAKER_00 46:39

No, they don't.

SPEAKER_02 46:41

Yes, they do. Um, so they're better and aluminum, aluminum is infinitely recyclable. Okay. Um, but there is still a little uh it used to be BPA, but now BPA is no good, so I don't know what it is now. But there's a little plasti like thin plastic lining on on the inside of cans, especially canned foods. Oh canned foods have uh are are just you know sitting aluminum plastic liner to keep food from leaching in and rusting the aluminum.

SPEAKER_01 47:10

Whoa. Yeah, it hides plastics everywhere.

SPEAKER_02 47:13

Everywhere.

SPEAKER_01 47:14

Um as we've talked about climate change is happening, carbon emissions play a big role in this. And of course we're trying as a society in a world to reduce carbon emissions, but reduction might not be the only thing we have to do to get back on track. We might have to try to take the CO2 that's already in the air and try to reduce it. And I was reading online about a few strategies. I wanted to get your thoughts. Number one, and this might have something to do with the regenerative farming, putting basalt powder on crops.

SPEAKER_02 47:45

Yeah, that was one I was not that familiar with. So I just don't know enough to speak intelligently about that strategy.

SPEAKER_01 47:52

It said that it absorbs the CO2 without damaging the crops. And yeah, so I was kind of interested in that. Number two, planting more trees, of course, because they remove and store CO2. Um, seaweed and kelp farms can absorb CO2.

SPEAKER_02 48:08

So seaweed and kelp farms, uh basically the idea with seaweed, uh well, there are there are two ways. I mean, you're if you're growing something green in the ocean, it's gonna pull CO2 in through photosynthesis. But um the the big thing with seaweed is that people have found that if you put seaweed or kelp on food for cows and other ruminants, um, they emit less methane. Um and and it's also healthier for the cows. Um so uh but uh like with I mean we're I think we're gonna talk about some other strategies, but um there's no one strategy that's gonna make everything go away. Right. Um but I am very much a yes and um all of the above strategy kind of guy when it comes to to carbon emission reduction.

SPEAKER_03 48:54

Anything we can do.

SPEAKER_02 48:55

Um and I think that's true for um like how we should approach this problem holistically. Yeah. Um there's no one person that's gonna solve it.

SPEAKER_00 49:04

Right.

SPEAKER_02 49:04

There's no one person that's the cause of the problem.

SPEAKER_00 49:07

Will this podcast solve it?

SPEAKER_02 49:09

Okay. I think once we leave today, uh we're gonna walk outside.

SPEAKER_01 49:12

Proof, everything's better. Yeah, that's what we're here for. Yeah, yeah, yeah.

SPEAKER_02 49:16

But I I think, especially as doctors who tend to think of things as, you know, solvable.

SPEAKER_04 49:22

Yeah.

SPEAKER_02 49:22

Like I feel like I came into this thinking this is a problem, I can fix it. And um like the the scope of this problem is so tremendous, yeah, that it gets overwhelming. Yes, but uh the solutions are also as broad and overwhelming.

SPEAKER_03 49:38

Yeah.

SPEAKER_02 49:39

Um, and I think one thing we run into trouble with is trying to find the solution to pin things on. And the reality is we need to be doing every everything we can. Yeah, we need to be switching from plastic bottles to aluminum cans because where did that plastic come from? It came from oil. Um, so plastic bottles are made out of fossil fuels, made out of petroleum. Um, that's another way that we're creating a lot of emissions. Um, I'm still helping with my can.

SPEAKER_01 50:07

You're still helping. You're still there's plastic liner. I'm still helping. Okay.

SPEAKER_02 50:10

But the the the kelp, uh, so you know, we think of food and agriculture as probably 10 to 15 percent of global carbon emissions. Methane from cattle is probably somewhere in like the three-ish percent range of emissions for CO2 total uh in the world.

SPEAKER_03 50:26

Yeah.

SPEAKER_02 50:26

Um, and kelp on cattle feed can reduce methane emissions from cows by maybe 60 to 70 percent. Whoa. So we're looking at like a 60 to 70 percent of a three percent, yeah, um, of a 12%. Yeah. Uh and it's like it's not gonna fix everything, but why wouldn't you do it?

SPEAKER_00 50:45

Why wouldn't you do it? It's a little seaweed.

SPEAKER_02 50:46

It's good for the cows.

SPEAKER_01 50:47

They like it.

SPEAKER_02 50:48

We we have more seaweed than we know what to do with. Right. Um, and growing seaweed also helps uh absorb CO2 because it's got photosynthesis pulling in carbon dioxide.

SPEAKER_00 50:58

I love it.

SPEAKER_02 50:59

Um, I mean, I think you know, uh, we go up to Cascade and uh McCall, and Lake Cascade in the summer is so shallow and so warm, you get lots of plants growing in the lake.

SPEAKER_01 51:09

Yeah.

SPEAKER_02 51:09

Why aren't we just going up there and trimming those things down and taking them to the cows?

SPEAKER_01 51:14

Yeah. Snake River Farms just take them down there. Yes, yes.

SPEAKER_02 51:17

Um, because I I think uh, you know, it's something that farmers are looking more into because it's cost effective. Yeah, um, it helps with cattle health.

SPEAKER_03 51:25

Yeah.

SPEAKER_02 51:26

Um, and you know, we can have a byproduct uh from our standpoint that it reduces the amount of methane that they're emitting.

SPEAKER_01 51:32

Yeah, no, I love that. And then the last thing I read about was carbon removal farms where machines and filters are able to literally suck the CO2 out of the air and put it in underground storage.

SPEAKER_02 51:43

Yeah. So I think sinks like this, you know, we think of like sources and sinks.

SPEAKER_01 51:47

Yeah.

SPEAKER_02 51:48

Um so sources of CO2 emissions, and then where can we hide it once it's been emitted so it's not causing problems in the atmosphere?

SPEAKER_03 51:53

Yeah.

SPEAKER_02 51:54

Um, trees are a big sink that you mentioned. Right. Um, the problem with trees and planting trees is we would have to plant uh enough trees uh to cover the state of New Mexico every year to keep up with the US uh carbon emissions.

SPEAKER_03 52:09

Oh boy.

SPEAKER_02 52:10

So if we could plant New Mexico every year, every year, um, we could offset the US government's emissions.

SPEAKER_01 52:17

That'd be hard.

SPEAKER_02 52:17

That'd be hard. Does that mean we shouldn't plant trees?

SPEAKER_01 52:20

No, we should plant trees.

SPEAKER_02 52:21

Uh yeah, and then trees uh are a temporary source of carbon storage because they get old and die, um, and then they release their CO2 as they biodegrade uh or as they're burned. Um so trees aren't a permanent carbon dioxide storage solution.

SPEAKER_03 52:39

Right.

SPEAKER_02 52:39

Some of these uh CO2 capture systems are trying to make it so it's more permanent.

SPEAKER_03 52:44

Yeah.

SPEAKER_02 52:44

Um so uh they're trying to turn CO2 into some sort of hard stone um or inject it into the planet um subterranean space um to kind of lock away carbon dioxide forever.

SPEAKER_03 52:59

Yeah.

SPEAKER_02 52:59

But the they're just not effective uh at a scale that is really gonna make an impact. Gotcha yet.

SPEAKER_01 53:06

Yes.

SPEAKER_02 53:06

That doesn't mean they won't be. Right. Um, but uh there's a lot of concerns that these uh carbon capture systems are being developed by fossil fuel companies as a way to say, look, we're doing something, we're gonna fix the problem, keep burning fossil fuel. Um when the reality is like I don't care who funds the research as long as the research is leading to good solutions. Yeah. Um but I'm not convinced that these are gonna be good solutions um, at least in the short term. So they may in the future, they may, they may be more effective, and we may be able to scale them up. Um you know, I think it would one of the really interesting places to like go explore is Iceland.

SPEAKER_03 53:47

Yes.

SPEAKER_02 53:47

Um where yeah, they have tons of these carbon capture technologies that are being developed, and it's a country that runs on geothermal. Um and uh there's just a lot of like cool uh alternative power, alternative carbon solutions, but it's because that country cannot function if global warming continues to happen. Um, you know, they're seeing their glaciers completely melt. Yeah, um, you go on like a boat tour in a uh lake in Iceland, and they can tell you this is where the ice was 20 years ago, this is where it was 10 years ago, and you just see climate change marching. Um, and the Icelandic people feel it, yeah, um, and they're doing everything they can to try to you know reverse the the changes that are happening to their country.

SPEAKER_01 54:33

But it's so hard because it's a world problem.

SPEAKER_02 54:35

It's a world problem. Yeah. And um, you know, the countries that are most affected are the ones that are doing contributing the least dry.

SPEAKER_01 54:43

Yeah, well, the or the ones that are yeah, yeah, yeah.

SPEAKER_02 54:46

So you think of you know, places like Vanuatu, um uh Pacific Island that's sinking. Oh, um, you know, that's not just the waters rising. Right. That's not a country that's generating a lot of carbon carbon emissions. Um, you know, it's the US and China um that are driving a lot of the carbon emissions. It's emerging uh mega populations like India that are driving uh carbon emissions. Um and these uh countries that really are contributing the least are getting impacted tremendously. Um and so that's where you really see kind of the the um like the disparity, the unfairness of climate uh problems in in the world. Um yeah.

SPEAKER_01 55:27

We make the mess and then these smaller countries have to deal with the mess. Yeah.

SPEAKER_02 55:32

And I mean they they can't clean it up, and so they're being affected, but no matter what they do, um, they can't turn the the tap off. You know, they have to convince someone else who's living living lush off of the um luxuries of single-use plastics and gas cars and built our uh whole economy up on um the system.

SPEAKER_03 55:54

Yeah.

SPEAKER_02 55:54

Um they're relying on us to walk away from that. Right. But I think the the promising thing to me is that the future of these alternative uh energy solutions is really bright. And like it's not just that you're reducing the amount of CO2, yeah, it's that uh air quality will be better. Yes, it's that temperatures will be nicer, yes. Um, you know, there are so many side benefits to climate tech that I think even if they weren't like good for the climate, they're good for us in so many other ways.

SPEAKER_03 56:31

Yeah.

SPEAKER_02 56:31

Um, and one example is you know, driving an electric car.

SPEAKER_03 56:34

Yeah.

SPEAKER_02 56:35

Um, I mean, they're so much fun to drive. Yeah. Uh they're more responsive, they're very zippy. Um, you know, it's five dollars a gallon for gas right now.

SPEAKER_03 56:43

Yeah.

SPEAKER_02 56:43

The price of my electricity hasn't gone up so much. So my, you know, and if you had solar panels on your roof, the price of your electricity wouldn't have changed at all. Yeah. Um, so like we can get it for cheaper. We can drive something that's more fun. Yeah, um, it's quiet, it's nice. Um, there's no like I I I I have a gas car and an electric car. Sure. And when I turn my gas car on, I always see this plume now coming out of the back of the exhaust pipe that may have been there forever. But now you're now I notice it. Um, and it's it's one of those things that like I never have to worry about with my car. Yeah.

SPEAKER_01 57:16

Um yeah, your electric's nice and clean. Yeah. Um in our closing moments, I wanted to turn to some positives about what we can do. And so I kind of broke it down into like, what can hospital systems do? What can clinicians and practitioners do in our prescribing choices? And what can individual humans do?

SPEAKER_02 57:37

Yeah, I think um there the quote's been attributed to a lot of people, but I think the idea that action is the antidote to despair is very true. Um and you know, doing is greater than doom. Yeah.

SPEAKER_01 57:51

Um, doing is greater than doom. Yeah.

SPEAKER_02 57:53

Let's let's all just do a little bit. And if we all do a little bit, then we can make the world a better place. Yeah. And um, you know, I think it starts at home.

SPEAKER_06 58:01

Yeah.

SPEAKER_02 58:01

And uh one resource I would really recommend is looking at um this organization called Project Drawdown, okay. Um, which has a great list of top 20 ways that you can reduce your carbon emissions at home.

SPEAKER_03 58:12

Wow.

SPEAKER_02 58:13

Um, and you know, the number one thing you can do to be more resourceful, less carbon impactful at home is uh generate less food waste. Um so I think we tend to buy in bulk, yeah um, you know, see things rot and throw them away.

SPEAKER_04 58:29

Yeah.

SPEAKER_02 58:30

Um, and you know, we're fortunate in the city of Boise that we have composting uh at the curb side. Yeah.

SPEAKER_01 58:35

So yeah, just like crash and recycling and composting.

SPEAKER_02 58:38

Yeah, really being uh a good composter, yeah, but not generating compost to begin with by buying only what you need and using everything you buy is a huge way that you can decrease the carbon emissions that come out of your house.

SPEAKER_00 58:51

I love that.

SPEAKER_02 58:52

Um so check out Project Drawdown, um look at their top 20 list. Um it's easy to find on their website. Um so you start at home and then you start in your community. Yeah. And the most effective way, I think, to work in your community is to talk about it.

SPEAKER_06 59:06

Yeah.

SPEAKER_02 59:06

So you educate yourself, you learn a little bit more about what climate change is doing, um, and then you just make it part of your normal conversation with people so that people can normalize this discussion and it's not some hot button issue that uh sets people on edge and saying climate and change in the same sentence are uh immediate uh you know cause for this. Yeah.

SPEAKER_01 59:28

For some people, yeah. Yeah.

SPEAKER_02 59:29

Just, I mean, the conversation shuts down almost immediately when you say those two things together. Um, but the reality is this is a human health problem. Yeah. Um, that I hope we've illustrated some of the human health issues that are um, you know, coming from climate change without creating too much doomerism.

SPEAKER_06 59:45

Yeah.

SPEAKER_02 59:46

Um so just normalize the conversation around climate change and things you can do to make the world a better place. And then uh, you know, you can do so much at your home, you can do a little bit more if you talk to your to your family and friends about it. Yeah. But if you do something at your place of employment, um, that's where I really think you can have the biggest impact.

SPEAKER_06 1:00:04

Yeah.

SPEAKER_02 1:00:04

Um, and you know, me as a healthcare worker, uh, hospitals uh and healthcare in the US are responsible for about eight to ten percent of greenhouse gas emissions.

SPEAKER_01 1:00:14

You taught me that.

SPEAKER_02 1:00:14

So eight to ten percent of greenhouse gas emissions. Like uh that's not that's not nothing. That's pretty good numbers.

SPEAKER_01 1:00:20

Yeah.

SPEAKER_02 1:00:20

And we have healthcare systems in the US that have already become net zero. Um so like Kaiser Permanente in California.

SPEAKER_01 1:00:27

Really, they're net zero.

SPEAKER_02 1:00:28

Net zero. Uh they do it with a lot of offset purchasing. Yeah. Um, but there are other health systems like Providence that are aiming to get to net zero without offsets by 2030.

SPEAKER_03 1:00:39

Wow.

SPEAKER_02 1:00:40

Um, and you know, we see that healthcare can do this, yeah. Um, and other industries that uh have been very cost concerned um have done this for cost reasons. And that's how we have to talk about it in healthcare.

SPEAKER_01 1:00:54

It's you know, this is a it has to be a cost savings and then also good for the planet Earth.

SPEAKER_02 1:00:59

Uh, because that like in my world, that's what motivates uh leadership decisions, yeah. Uh is you know, how can we save money? And you know, we have started instituting things in uh the healthcare system where we're focusing on turning off lights when we're not using spaces, yeah. Um, that uh are just good common sense, yeah. Uh reducing the temperature that we eat heat or cool things to uh when people aren't occupying the spaces, yeah. Um, especially places like operating rooms, uh, which are one of the most intensive energy spaces of any building in the world.

SPEAKER_03 1:01:32

Yeah.

SPEAKER_02 1:01:33

Um, because they have to be, you know, have these high air exchange, air filtration rates, they have to have the exact temperature and humidity uh for operating conditions to be right and for sterility to be be preserved. But a lot of times we'll leave these operating rooms running like that 24-7, 365, and we have operating rooms that are really only being used four or five days a week, Monday, you know, Monday through Friday, eight to five.

SPEAKER_03 1:01:59

Yeah.

SPEAKER_02 1:01:59

And outside of that, we could turn the temperature back down. Yeah. Uh we could, you know, stop generating all this energy to cool this building that no one's in.

SPEAKER_01 1:02:09

Well, and you even talked about the anesthesia, the gas that they use for anesthesia, that there's uh one that's most commonly used and then one that's cheaper and emits far less carbon emission or greenhouse gases. Yep. And so talk a little bit about that.

SPEAKER_02 1:02:25

Uh so two inhaled anesthetics, one's called desfluorine, the other's called sevofluorine. Um, they have fairly similar clinical properties. Um and the argument for using desfluorine has always been that it's less lipophilic. Um, so in kids and overweight people, it's less likely to cause delayed wake-up times. Um, but studies have shown in places that have eliminated desfluorine um that they're not having increased time to wake people up from anesthesia. Um, and because of that, uh and the fact that it costs less, yeah, uh people have switched, uh, including the St. Luke system, has now completely switched from dust fluorine to sevofluorine. Yeah. And in a year and a half of switching from dust fluorine to sevofluorine, we've saved enough carbon emissions to drive around the earth 115 times. That's amazing. Um, and we saved close to $300,000 in cost differences.

SPEAKER_01 1:03:16

Win-win.

SPEAKER_02 1:03:17

Uh so win-win for everybody. And we haven't seen any impacts on patient care. Yeah. And that's in healthcare sustainability, that's sort of the the tr triumvirate that we're looking for is we want to maintain or improve patient care uh while reducing costs, while reducing impacts on the planet. Um, and I think, you know, we spend a lot of time hand-wringing about things that are sort of pie in the sky, developing technology, um, not hating, but uh like carbon capture is still on that, like it's not ready for prime time.

SPEAKER_03 1:03:50

Yeah.

SPEAKER_02 1:03:50

Uh, but there are things like turning off the lights, turning down the temperature, switching a few medications that you're using that make huge impacts.

SPEAKER_03 1:03:58

Yeah.

SPEAKER_02 1:03:58

Um, there is no one button you can push to turn off climate change.

SPEAKER_03 1:04:03

Right.

SPEAKER_02 1:04:03

But there are, you know, 10 million buttons and we need to push them all. And what we should look for are the ones that take the least effort, that make the most impact, and do those first.

SPEAKER_03 1:04:13

Yeah.

SPEAKER_02 1:04:13

Um, and you know, we call them low-hanging fruit all the time.

SPEAKER_03 1:04:16

Yeah.

SPEAKER_02 1:04:16

Uh, but you know, the trees are still bulging with low-hanging fruit in healthcare.

SPEAKER_03 1:04:21

Yeah.

SPEAKER_02 1:04:21

Um, and I bet that case is true with a lot of other industries. And if you're not in healthcare and you're listening to this, yeah, look around and see what you can do to um, you know, reduce the climate impacts of where you work because there are tons of things that will make your employer happier because you're saving the money and make your community happier because you're reducing the rate of climate change.

SPEAKER_01 1:04:42

Yeah, and maybe just like bringing it up, bringing it up to your employer or the facility or your institution and saying, you know, hey, climate change is important to me. I I've learned that there are some simple ways that we could do some things, turning lights off. That seems pretty easy for any business to adapt to. Um, you know, what can we do around here to make to you know, make it better here at least? Um, the one thing I've been focusing on, a lot of our biologic medications for eczema, psoriasis, et cetera, are shots that are delivered in these cooled, often styrofoam boxes. And the packaging is enormous. You know, the package is as big as a television box, and then the shot is like this big. And um, and it has to be cooled the whole time, which I've heard also those cooling trucks, there's something with them that's also bad. Um, and so I've been trying to talk with companies like, is there any like what can we do better with this? Because the styrofoam also, styrofoam like never degrades, it just sits in landfills. Yep.

SPEAKER_02 1:05:46

And it's not, I mean, there are so many plastics that are not truly recyclable, but they get branded as recyclable. Yeah, you know, they've got the little triangle with the numbers. Right. Um, and outside of one, three, and five, there's really not much recycling for any of the other things that are on there. Yeah. Again, the city of Boise has done a great job trying to partner with uh organizations like Hefty that do this renew program where you can put the other plastics in an orange bag and they get shipped off and turned into fuel for cement plants or uh for um there there's a company in California that's taking some of our thin film plastic and compressing it into building blocks. Oh wow uh that's cool that we're using in uh construction in places like Mboise.

SPEAKER_04 1:06:25

Right.

SPEAKER_02 1:06:26

Um which is which is pretty cool. But uh, you know, if you could not use it, it'd be even better.

SPEAKER_03 1:06:30

Yeah.

SPEAKER_02 1:06:31

Um and you know, one one big change people can make in medicine um is switching from IV to oral medications wherever possible. Yeah. Um, because the benefit of an IV medication versus an oral medication is pretty small for most medications. Um it's the you know bioavailability of something if it's administered intravenously versus orally. Um, how quickly do you need to get into your system and get your system up to uh a therapeutic level of the medication? And for a lot of medications, the uh time is almost the same orally versus intravenously.

SPEAKER_03 1:07:04

Yeah.

SPEAKER_02 1:07:05

And the amount of plastic and energy and waste that comes out of an IV medication versus an oral medication is huge.

SPEAKER_03 1:07:12

Huge.

SPEAKER_02 1:07:13

And then we s have seen places uh that have looked at liquid versus pill medications. And um, you know, if you're giving a kid liquid Tylenol in a hospital, yeah, um, it's in a plastic bottle. Actually, it's in a little plastic cup.

SPEAKER_04 1:07:27

Yeah.

SPEAKER_02 1:07:28

Um, and then you open the little plastic cup, you draw it up with a plastic syringe, um, and then you give it to the patient. Um, and so it's like a plastic cup plus a plastic syringe to give a single dose of medication for every kid that gets a dose of Tylenol in the hospital.

SPEAKER_04 1:07:43

That's a lot.

SPEAKER_02 1:07:44

But they're chewable Tylenol that they found that kids older than three um can almost a hundred percent take a chewable uh tablet. Yeah um and that's in a little aluminum blister pack.

SPEAKER_04 1:07:56

Yeah.

SPEAKER_02 1:07:57

Um that you know makes a little tiny square of waste instead of two big pieces of plastic that um are never gonna break down, not recyclable, just go sit in a landfill and off-gas methane.

SPEAKER_03 1:08:06

Yeah.

SPEAKER_02 1:08:07

Um so you know, little things like that add up. And uh I mean I think it's just it's all we can do to do the little things because there's not one easy button to turn climate change off.

SPEAKER_00 1:08:18

And little things add up. They do. Little things add up.

SPEAKER_02 1:08:20

They do.

SPEAKER_00 1:08:21

Um in closing, I have a multiple choice question for you.

SPEAKER_02 1:08:26

What is I I did get into med school and then I graduated med school and passed my board, so multiple choice is my uh expertise.

SPEAKER_01 1:08:35

What is the biggest threat to humanity? Number one, climate change. Number two, AI. Number three, zombie apocalypse.

SPEAKER_02 1:08:45

I mean, I I do like movies, so I'd like to go with number three. Um, but uh, I think climate change, uh you know, there's a uh study that was or not a study, but a a commentary, an editorial that was published during the peak of the COVID pandemic, um, with more than 200 medical journals uh all signing on to this one editorial saying that climate change is the greatest threat to human health.

SPEAKER_04 1:09:07

Yeah.

SPEAKER_02 1:09:08

Um at the peak of the COVID pandemic, when the world was freaking out and shutting down and people were dying left, right, and center, um, the medical community still recognizes that climate change is the greatest threat to our health. There's only one planet that has conditions that are suitable for humans. If we continue to mess it up to a point that we can't correct the mistakes, um, you know, we don't have anywhere else to go. And uh, you know, we really need to work together to preserve the planet that we've been given.

SPEAKER_01 1:09:36

Well, and climate change even can affect the risk of having more pandemics.

SPEAKER_02 1:09:39

Absolutely.

SPEAKER_01 1:09:40

Because the forests go away and the creatures change and they start to mix together, and then the virus that started in the rat or the um bat um is transferred to the pig, and then the pig is something that humans interact with, and then we have our next pandemic.

SPEAKER_02 1:09:56

Yeah. So don't deforest.

SPEAKER_01 1:09:58

And don't eat lunch in a um, you know, a wet a wet lab in the um well, this has been enlightening for me. It you've grown, I I learned so much from you the couple times I've seen you speak, and this has even grown my knowledge base from that. I hope the audience really enjoyed it. I bet they did. And I think I want to close on a positive note. Like, I think it's so important that we're talking about this because you know, like you said, talking about is like the number one thing you can do to help fight climate change. And so just getting the word out that climate change is real, it's having these effects, it's going to continue to get worse. We love our planet. We would like to stay here, and we need to continue to make it habitable for us. And so we need to focus on it and understand there's some doom and gloom, but see the positivity and the changes that we can make and the you know positive things that can occur as a result of that. Any other closing comments that you would say?

SPEAKER_02 1:10:54

No, I would echo that uh, you know, the the future um that we choose to create um is the future we'll get. Um and if we choose to utilize clean technology and new advances and the way we generate energy and uh transport ourselves, um, you know, we'll have things like high-speed rail that's uh quiet and clean, um, and we'll have uh air that's healthier and easier to breathe. We'll have more green, fertile, lush spaces, um, or we can continue to do what we're doing and we're gonna drive ourselves into hotter, smokier, smellier environments. Um, and I just don't see why we would choose that future uh over this hopeful future that I think really exists.

SPEAKER_01 1:11:38

Yeah, yeah. We're gonna choose hope. Choose hope. We're gonna choose hope. Thank you guys so much for joining us for this wonderful episode of Skin Credible. Keep tuning in. I guess.