BJD Talks
The official podcast of the British Journal of Dermatology
BJD Talks
Episode 6: Climate Dermatology
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The climate crisis is both an immediate and long-term threat, and dermatologists are starting to recognise just how important a role climate plays in our practice, as well as our responsibility to practice 'green' dermatology. To discuss the climate emergency and its implications for dermatology research, Dr Jonny Guckian is joined by Dr Misha Rosenbach and Dr Caroline Nelson, experts in climate dermatology.
Hi there and welcome to BJD Talks, the official podcast of the British Journal of Dermatology. In this podcast, we look well beyond published studies and explore the real world implications of dermatology research in an accessible way. So this podcast is designed for anyone with an interest in skin health research. That's whether you're a dermatology professor, researcher, registrar, patient, or simply a skin enthusiast. We'll hope you'll join us as we build on our world-leading research through friendly discussion. My name is Dr. Johnny Guccian, and I'm a dermatology registrar in Leeds in the UK, as well as being the BJD's podcast associate editor. Together we'll dive into a huge range of issues important to dermatology, including patient and public involvement in research, artificial intelligence, global dermatology, and social media in dermatology scholarship. The BJD is a global journal, and in previous episodes we've touched on some of the most important issues facing global dermatology. One perhaps under-research domain within our specialty is our relationship with the climate. The climate crisis is both an immediate and long-term threat, and dermatologists are starting to recognize just how important a role climate plays in our practice. Luckily for our listeners, I have two enlightened dermatologists here with me today. I'm delighted to first of all welcome uh Dr. Misha Rotenbach, Associate Professor in Dermatology at Penn. Great to speak to you again, Misha.
SPEAKER_01Uh Johnny, thanks so much for uh having me. I'm really looking forward to our conversation.
SPEAKER_02I'm also really happy to welcome Dr. Carline Nelson, Assistant Professor of Dermatology at Yale. Hi, Carline.
SPEAKER_00Hi, thank you for having me.
SPEAKER_02So, guys, it's climate change. Let's let's get started and let's talk a bit about this huge, seemingly existential threat to humanity, probably the most urgent and pressing conversation we've had in BJD Talks so far. But what has this got to do with dermatology and dermatologists? Why does it matter to us?
SPEAKER_01That's such a great question. So, first, thanks for highlighting this issue. And there's so many things we can touch on. You know, first, dermatologists are people, right? We live in the world and the changing climate impacts the world we live in. And the choices we make right now as a society are committing the world to having a certain amount of CO2 and emissions in the atmosphere that will set the threshold for what the climate is for generations to come. So we're we're at a tipping point and we have a special obligation to future generations. But I mean, this is a medical podcast. So you're asking about dermatologists. And so, one, physicians in general deal with patients who are sick and population-based health, and climate change impacts both the population health and individual diseases. And we can get into the the nitty-gritty of that, and I'm sure we'll touch on some of those germ diseases, but also through providing health care and education and traveling to meetings and patients traveling to our offices, we contribute to emissions and impact the climate. And we have a role to play as healthcare organizations in terms of the provision of medical care contributing to CO2 emissions and an ongoing addition to climate change.
SPEAKER_00I think I would just also add to those excellent points from Misha. Infectious diseases, for example, are one area in which we can really see how dermatology is tied in with the global climate crisis. And many of these factor-borne infectious diseases are on the rise and their epidemiology is shifting. And that's just one example. We'll get into other uh diseases where I think that the skin is particularly involved and we need to have special expertise as dermatologists in this area. I think another reason that it matters for us is that we're humans, our patients are humans, and they are asking us questions at this point frequently about is this cream that you're recommending going to be good for my skin? Is it going to harm the planet in some way? And so I think we're starting to field questions from our patients who care about these topics, and we need to be fully up to date on the state of the literature and public policy.
SPEAKER_02That's really interesting. So we you could look at it two ways. So we have how the climate affects us and our patient population, our practice, but then also how we affect the climate and our responsibilities and duties when it comes to that, and then how we inform our patients too. So that's uh a really interesting um kind of responsibility dichotomy. Carlin, you you touched on um, well you both actually touched on emerging diseases or diseases on the rise. And Misha, I I think just either earlier on today or or yesterday I saw a series of tweets about monkeypox, but um, I I think that's we'll do one crisis at a time. Um so I'll not talk about that particular emergen emerging disease because I think I'll just get too scared. But let's talk about any particular dermatologically relevant diseases that might be on the rise due to the climate emergency. Would you be able to talk me through some of those?
SPEAKER_01Uh Johnny, that was a good tease for a future BJD talks on monkeypox, I think. But um I will say, you know, I'm not going to spend the whole podcast talking about my co-guest here, uh Dr. Caroline Nelson, but she actually gave a great talk at the AAD meeting, including on um emerging infections that we might see more of. And, you know, monkeypox is not something that I think dermatologists were anticipating seeing, but we do know that there is a balance between man and nature. And as people are moving into wild spaces or as as people are expanding into diminished natural spaces, there is an increased risk of zoonotic spillover. Uh, I don't want to like, you know, be alarmist. It's not fair to say like COVID is related to climate or or even monkeypox is related to climate, but they are reminders that we live in a global world where things that happen in one area impact people elsewhere. And I think that's really the helpful framework to keep in mind for this. Derminologic diseases, you know, the skin is the biggest environmental interface of the body. And so there are a lot of diseases that are manifest in the skin related to climate change. There are a couple of review articles I can point readers to later as we highlight some things, but you know, some of the early data was with viral illnesses like hand, foot, and mouth disease being more transmissible and more common or moving into um unusual populations, um, other vector-borne um viral diseases, uh like things that we normally think about as tropical illnesses, like dengue and chicangunya, and zika, uh, which are carried by a mosquito that that typically lived uh in the equatorial zone. But as the earth is warming, what's considered tropical is expanding and what's considered subtropical is expanding. And uh I won't make fun of um the weather in Leeds. I don't know if you qualify as subtropical yet, uh Johnny, but technically parts of America do. Um and I'm sure it's it's changing rapidly depending where your listeners are. And then there's other vector-borne illnesses like leishmaniasis that you know, we if you if you took a board exam 10 years ago, you had a question that started with patient goes to Costa Rica, and then you stop reading and click leishmaniasis. That was like the lead-in to that question. But, you know, there there were mathematical models that suggested that the sand flat, which is the vector that carries that infection, would be able to move into new habitats, including on the continental US within the next decade. And then eight years later, um, endemic human cutaneous lepaniasis was published in Jamma dermatology in patients who had no travel. They would just lived in Texas and Oklahoma and they were getting leishmaniasis. But I don't want to drone on, but even beyond infections, you know, inflammatory diseases, etopidermatitis, psoriasis, there are some studies with air pollution and lupus and pemphagus. There's also a number of studies about wildfire smoke triggering atopic dermatis, too.
SPEAKER_00Yeah, and I just building on something that's a little bit closer to home for me in Connecticut and might be a little more similar to your climate in Leeds. We have a really increasing population of ticks and Lyme disease. And it's interesting when you look at the epidemiological modeling of where Lyme disease is headed. Uh, there is an increased incidence of Lyme disease, and it seems to be moving out of the south over time and further into the north and into the Midwest. And so we can see the we can track the population of ticks and deer and rodents, and we can see how that's impacting the epidemiology of that particular disease, which is a dermatologic disease that certainly affects dermatologists and their likelihood to see it.
SPEAKER_02I don't think we've ever described leaves as tropical. Um people do wander around with their tops off from from from time to time, perhaps thinking it's a bit more tropical than it actually is. So climate change, naturally, because it's a global event, will affect different people in different ways, different dermatologists in different ways, and different patients in different ways. What would you say the impact of climate change would be upon um health uh inequalities? Um, Caroline, um perhaps could you provide some insights on that?
SPEAKER_00Absolutely. So one of the dermatologic conditions that has received a lot of attention in this regard is uh atopic dermatitis. And there's been a lot of really uh compelling research on this. So Kim and colleagues published a study in the Journal of Allergy and Clinical Immunology that showed that the symptoms of atopic dermatitis were influenced by outdoor air pollution. And this was a longitudinal study that was looked over 18 months and showed that air pollutants when they rose, such as particulate matters and toluene and these volatile organic compounds, and then they actually saw that there was an increased risk of atopic dermatitis uh symptoms in children. And what they showed also is that children who lived closer to a main road had increased incidence of atopic dermatitis. And there's even some questions about epigenetic changes in utero that can influence risk of atopic dermatitis down the line. So we know that if you are exposed to increased air pollution, there seems to be mounting data that you could have an increased risk of atopic dermatitis and increased symptoms of atopic dermatitis. And so, for in terms of when you're asking about health inequalities, one of the concerns is that if you are at a lower socioeconomic status, you may be more likely to live in areas where there's a power plant or there's a high degree of industrial activity, and therefore you and your children could be at an increased risk of atopic dermatitis. So that's just one way in which the pollutants which are contributing to climate change also circle back and impact your risk of dermatologic disease.
SPEAKER_01This is great because uh that was such a great lead-in. And I was taking notes while you were talking about so many things that I one wanted to read more about and two wanted to expand on. And so you wrapped around to some of these environmental risks. You know, there's there's a again a paper in, I think, Jamaderm uh earlier this year looking at systemic sclerosis or scleroderma near um uh industrial waste sites. And, you know, that this is one of those, like there's the stuff we know and there's the stuff we don't know, and sort of, you know, how many diseases might have an environmental trigger and how much of those environmental triggers might be traced back to, you know, fossil fuel burning or disposal of waste or byproducts and things like that. You know, that there's the big picture answer also to that question, which is just that from disparities, uh, wealthy people in countries have historically admitted the most CO2, and poor people in countries will suffer the most impacts. So that's like the biggest brush you could paint. Um, and that goes from droughts and migration and refugees, but but even just looking at heat, like, you know, we don't think about the skin as a thermoregulatory organ on a day-to-day basis, but you know, sweating is a way that you adapt to heat. And if you look at deaths from heat-related illness or heat waves, there's there's been an argument that we should start naming heat waves like we do hurricanes and cyclones and kind of devastating storms, because there are clusters of deaths when there are heat waves that uh really are rival those of other natural disasters, but we don't yet think of it like that. But in the European heat waves of, I think maybe last year or two years ago, um, there was a huge spike in deaths. I don't know when listeners are going to be hearing this, but the relatively recent to when we're recording this heat waves um in India uh certainly recall things like um there's a book called Ministry for the Future that starts basically with uh the near-term future, a devastating um loss of life from from heat waves in due due to climate change in places like India where there's a lot of population, not a lot of air conditioning, and and and at risk for some of these uh consequences.
SPEAKER_00I I think that's those are such excellent points. You know, one thing just to add to that, we've talked about pollution, we've talked about heat. I think another element is food scarcity. And as dermatologists, we see nutritional deficiencies. Um, just in this past year, I've seen phrynoderma, I've seen vitamin C deficiency. And currently a lot of what I'm seeing is related to, you know, alcoholism or lack of nutrition. But ultimately, if you have a climate crisis that, you know, causes a famine or causes populations to move and disrupts food chains or food supplies, you could also, as dermatologists, be seeing uh that problem as well and seeing more of that surface in our clinics.
SPEAKER_02I mean, wow, this it's truly global uh implications um for a variety of different types of populations. And you mentioned some really useful studies, which I've uh now written down to go and do some homework on. Speaking about the scholarship and the research around um this, because it's it's not something that I had encountered too much before, um, make sure I read your uh editorial in the BJD relatively recently about the climate emergency. Do you think we're doing enough as dermatology academics to try to understand the impact of climate change upon our patient communities? That's kind of a leading question. Um, and if not, what can we do better?
SPEAKER_01I mean, first of all, you're doing a great job because you you're hosting a podcast on this, right? So you, you know, one of the things that science communicators who work in the climate space say is one of the most important things is to normalize talking about it. So we did a dialogues and dermatology uh podcasts like five years ago or so, and we got actually a lot of disgruntled listeners who said, you know, climate change is controversial or has nothing to do with medicine or nothing to do with dermatology. I think that the literature has certainly moved things forward. Um and you you alluded to the BJD um sort of editorial piece. There's also a study in the BGD citing um a survey of dermatologists showing how many of them, you know, understand, recognize, see, worry about climate change, have seen climate impacts on their patients. And it's you basically over 85 or 90 percent of international dermatologists, including in the UK, feel like climate change is affecting their patients. But you asked a different question, which is like, are we doing enough scholarship? Are we doing enough research? And I think this is a new area that should be really interesting and exciting for young investigators. There is a ton of data out there and so much that we don't know, you know, in terms of looking for triggers of diseases and recognizing that the skin is exposed to the environment all the time. There are some really fascinating papers. Uh, I should do conflict of interest disclosure because BJD talks, but I'm a Jamma Derm editorial board member. So I'm going to cite a Jamma Derm paper here. But there was uh Raj Fadadu and um uh Professor Maria Wei at UCSF did a really nice study looking at upticks in visits for flares of atopic dermatitis or itch in California in the weeks after one of the California wildfires nearby. So they looked at like particulate matter emitted from wildfire and over the subsequent weeks whether there was an uptick in visits for you know flares of skin disease, and they showed a very sort of like tight exposure-dependent link. And you wonder how many things like that were missing or are intervenable, where this is just something we we haven't even figured out if this is a thing. We haven't figured out for what diseases it's a thing, and we haven't figured out how to counsel patients or what to do to help them or stop it. So that it's it's a ripe area, very important area. And again, I don't want to be doomist. There's a lot of reasons for hope, but that the climate that we have now is the hottest it's ever been and the coldest it will ever be. And so, like, this is it's it's right now the the most CO2 and the hottest temperatures, and it's not going to get better for generations. So this is the the best it will be. So we really have to start investigating and studying and understanding the health impacts of it.
SPEAKER_02Why do you think this is so controversial? You alluded to this being you know controversial-ish podcast amongst dermatologists. Why do you guys think that this is a such a controversial area?
SPEAKER_00I think in terms of the controversy, there's really two elements to it. The first aspect of the controversy is whether the climate change is real and is happening. I think at this point most dermatologists accept the science of climate change. I think that where the controversy still rests is what does this have to do with our field specifically in dermatology? Should we be involved when there's so many priorities to focus on? And I think I would say that first of all, we should be involved because as we're hoping to convince you, there's a direct impact of climate change on the skin and on the dermatologic diseases that we're seeing. But there's also our own contribution to carbon emissions through our clinical practice. And therefore, I think we have a responsibility to focus on that.
SPEAKER_01Carolyn, that was great. And I would agree with everything you said. I think it it also has to be said that there's also intentional misinformation and disinformation that's out there. And I actually I know Johnny mostly actually from Durham Twitter, which um I think is a vibrant and healthy community. But there's a lot of climate scientists who suffered sort of um attacks, like malicious attacks, to try to um discredit the work. And a lot of the sort of false narratives, if you follow the back, have been funded by fossil fuel-based think tanks or organizations or op-eds that are published by um people embedded in the fossil fuel community. And I'm not going to constantly reference articles, but um, we we published something um in the Jad. So now I think I've hit many, but not all, of the key DERM journals. I apologize, JEADV, you guys are doing great work. And there's other stuff in there that I will mention. But in the JAD in 2018, we published a paper called Dermatology, Climate Change and the Perils of Attacks on Expertise. And we talked about that, you know, there for a long time were sown controversies about health impacts of lead, health impacts of tobacco, um, gun safety here in the US, the tanning bed industry. Uh, you know, that there's a lot of um examples of of controversy that's pushed by people who have vested interests in one side of the narrative. And I think that's an important part for for people to be aware of and and understand when they're reading things and what they're listening to, where that material is being generated.
SPEAKER_02Absolutely. And I think it's uh particularly on social media, it's important to um I think I'm quote quoting the wire when you say follow the money, because uh often that is where the political agenda is pushed from. Whereas actually what should be happening is as Caroline alluded to, is that is that the the agenda should be set by patients and their needs and what they're asking from us. And I am very grateful you brought up your own dermatology journal, bingo. Um I think I've got through everything in my card now. Uh but we didn't we never judge anyone based on the journal, the journal editorial boards that they're part of uh here on the podcast. So we we welcome, we welcome all journals here. This is an inclusive BJD talks. So you mentioned, Misha, uh earlier on, um, there's a lot for the next generation of dermatology uh researchers to to kind of sink their teeth into. Um what do you guys think that the the next big research questions should be centering around uh regarding climate dermatology?
SPEAKER_01That's I think a a good question, a hard question. Um, in fairness, I'm not going to mention all journal articles, but if someone really wants to learn a lot about what's known, the International Journal of Women's Dermatology published an entire themed issue on climate change and dermatology. So it's 123 pages of what's known now. And I think, you know, some of the big questions that I get asked are: if I'm outside in San Francisco during a wildfire, I know I should put on an N95 mask because I see ash and smoke. What should I do for my skin? You know, is there an SPF for air quality index? And that's that's a whole future direction that might be a billion-dollar industry or a big scam. I mean, who knows? You need to understand and study that. And, you know, the the health impacts of pollution on photo aging is an area of really robust research. With papers in the JID, if we're doing uh derM journal bingo, uh, we're getting there by uh Gene Kruitman, and um uh who's a European dermatologist, done fascinating work looking at um UV and air pollution and pigmentation and photoaging. So I I always think it's it's easy to look at the stuff that we know, but you know, really looking more at skin cancer and climate change is I think going to be an important area to get really robust epidemiologic data. But um, I'd love to hear Carolyn's thoughts for this. It's a great question.
SPEAKER_00No, I think speaking of that billion-dollar industry, the photo aging question, I also found that study fascinating in the JID, looking that at the impact of traffic-related air pollution on the development of facial lentigenies. And that just use um NO2 as a marker. But as they alluded to in that study, we still don't know exactly which pollutants are contributing to this and what is the best way to shield the skin from the development of photo aging and all of the other impacts that um were referred to. So I think that that is a major research question and one where high quality research is being done. And so that's important. And I also think the health equities, returning to that topic that you brought up earlier, how is this affecting people in different communities as we think more about diversity, equity, inclusion, as we think more about health equities in general? That's a really important area of research as well.
SPEAKER_02Absolutely. It's so sprawling, isn't it? Everything links together, I guess, is because it's so ubiquitous. As we're we're kind of mentioning different um kind of initiatives and studies, uh uh one initiative I should flag up is that the British Association of Dermatology um launched their first ever Green Prize for Sustainable Dermatology this year. I think the winners of that will be announced at the at the BAD conference in July. Again, I don't know when this podcast is gonna probably this podcast probably will be out by then. Um so we'll know a winner then. Um, but that is a really good and promising way to empower the kind of um I think it's designed for like the next generation um of scholars. So I think that initiatives like that, especially maybe with I think they've got financial awards potentially, or um well, I think maybe they get they get a trophy. Everyone likes a trophy in dermatology.
SPEAKER_01That's great. A title, an award, a trophy, money. It's it's all of it's good.
SPEAKER_02Yeah, exactly. Um so yeah, so I think initiatives such as that will. will be really powerful. One thing I want to talk about just briefly is education. I know in your BJD study, Misha, you mentioned you talk about educating dermatologists. If more education is so important, how can we communicate those messages more effectively to the current generation and the next generation of dermatologists?
SPEAKER_00Well perhaps I'll take this one because I am very passionate about the topic of climate change education. And there's a few educational initiatives that are already underway. So one of them is a collaboration with the American Academy of Dermatology, which has a basic dermatology curriculum that's maintained and is accessible to medical students and also just the general population of medical professionals who want to learn more about dermatology. So they reached out to our expert resource group on climate change and we're developing a module with them on climate change dermatology, which is really exciting. But another thing that we're doing is we're working on giving information to residents. We want to develop a curriculum that is designed for residents, which has different components to it, resources to develop materials there as well as virtual lectures, as well as lists of experts who could potentially come and give a talk. And so we're hoping that you know enriching the materials for dermatology residents to learn about climate change dermatology will ultimately generate those young researchers who write a grant on this and get funded and maybe go after one of those trophies that you're offering. So we're hoping to really start from the ground up with the educational initiatives. It is so important.
SPEAKER_01Yeah, Caroline, that's great. And you're doing such great work with that. And uh my answer should just be that I I taught Caroline that now she goes and teaches everyone, which is actually unfairly claiming far too much credit for Carolyn and who who basically has been fully formed superstar from the beginning. But if you think about um as a medical student, you know, how much climate content did you get? And if you approach medical schools too, a lot of them will say we have so much to teach, you know, that there's medicine has expanded a lot. There's only so much time. And I had asked this question uh many years ago and basically the flippant answer from from um someone who's somewhat dismissive was well should we not teach the heart? And I was like, no, but like you should integrate climate into lectures. So air pollution and and lung disease go hand in hand and asthma exacerbation. So you know if you're talking about asthma and you're not talking about that that's a problem. Same thing obviously as we talked about dermatology and infectious disease there's impacts in psychiatry and child development there's many impacts in pregnancy. And so integrating climate into into medical school education is important. But also communicating with patients which is one of the harder things that and I I know you have a broad audience for this podcast. And if there are non-medical people there, you know, we have to make sure this information is accessible so people know you know what they should be worried about, what questions they should be asking their providers. And it's sort of easy to capture medical students and residents, but it's also harder to capture people who are maybe in their 50s or 60s. And so continuing medical education and post-residency training education, there's a lot of content at the AAD. I know there's a lot of content at some of the international and European dermatology meetings. And so really it it's essential that when something new is learned in the literature that it translates into textbooks and it translates into practice in a quick way and and and that has to happen for climate too.
SPEAKER_00I would just add to that that we talked about earlier how our patients are driving us to know more about climate change. And I think our medical students are driving us to do more and teach more about climate change. I have a medical student who Misha also knows Annika Belzer here at Yale who She's mine. She came to me and she said I want to work with you. I want to do everything I can in climate change. And she has been a major driving force of a lot of the work that we've been doing on climate change at Yale, including she was sort of the engine behind the first ever carbon offsets that were offered for the Medical Dermatology Society meeting this year. And so I actually think it's our young people that are driving this movement in a really inspiring way. And they are going to be our future and they are also going to be really important to reach out so that they're they know that we also care about the priorities that matter to them.
SPEAKER_02I mean fantastic and I completely agree with the with those with that those values of um kind of appreciating the the next generation and and and lift lifting them up and making sure that that they they're helping set the agenda. What I've I've noticed is really interesting parallels between this kind of phenomenon with also with the movements in um within dermatology for uh diversity and inclusion obviously they have there there are there are star differences but um the parallels of being pushed by I mean I I've noticed anyway from a lot of medical students and and residents who are extremely passionate about about this this area and really driving the specialty forward on it to modernize as well as obviously listening to our patients too. So I think that with these ubiquitous overarching phenomena which I think can traverse the curriculum as as as you've said that it can be integrated across the the the various different specialties in what is a very crowded curriculum. We know this but as these things are transcend the the the topics that we discuss, they pass through all of the the the these different specialties um so they should be mentioned uh all the time really um so yeah I I think that's a type of movement that we should be really we we probably will see continue on um uh going forward.
SPEAKER_01I think you're exactly right and that uh I think it's been interesting to see how um groups have coalesced to affect change. So in the US there's something called Medical Students for Sustainable Future um and they they sort of offer planetary health curriculum scorecards for for medical I mean they do many things so I don't I don't want to like focus on one thing. But you know for for one faculty person to try to um impact the curriculum can be hard but when surveys show 80 or 90% of medical students really want to learn about this stuff, certainly if if it's going to become a decision-making part of where people want to train, you know, are you up to date in teaching about things that I'm gonna need to know in the future. And you know if you're a school that sort of has a more fossilized curriculum versus a more modern curriculum, that's certainly going to impact um matriculation. And and again this is a big area of research with a lot of opportunities and also going to bring research funding which is going to really get more attention from high levels at institutions too.
SPEAKER_02Absolutely it's it's an opportunity for institutions to express that value of being future focused isn't it um as well as being enabling. Speaking of institutions and Caroline I know you mentioned earlier you were you were keen to discuss this so I'm not I'm not gonna to I'm not going to to hold back anymore. What do you think the institutions and individuals um can do uh in terms of being greener dermatologists absolutely happy to speak to that.
SPEAKER_00So it's multi-layered because it comes down to the source, how you source your energy, how you use your energy and then waste. And so I'll just touch briefly on those points and then Misha will definitely jump in and give his thoughts as well. But in terms of the source, obviously if you can purchase or even in some cases practices will generate their own renewable energy, but I think that that's helpful. And then use really comes down to energy efficiency. And that is both in terms of the technology that you invest in as well as reducing standby energy use. So one of the initiatives that can be easy way to accomplish this is simply to have an automatic entry into a hibernating state after a period of inactivity which can be programmed into devices and dramatically decreases energy consumption. And then waste is really important in medicine because we obviously think about recycling and having trained with Misha, I know how passionate he is about eliminating styrofoam cups and that is important and one cup at a time Misha is helping the world and planet be a better place. But I also think it comes down to this issue called regulated medical waste. So a regulated medical waste essentially takes five to 10 times more to get rid of than regular waste. And we typically will have a regulated medical waste container and then we'll have a regular trash can and they're often sort of the same size and the regulated medical waste container might happen to be closer to you as you're doing your procedures and other things. And so as you know people are busy they're moving rapidly in clinic they just toss lots of things in the regulated medical waste not realizing that that again has a five to 10 times bigger impact because it has to be buried or incinerated. So a simple task of switching the regulated medical waste container making it harder to get to is going to improve your waste and energy use.
SPEAKER_01That was so good. I love it. It's actually I should have thought to answer this question first because your answer was so good. It's hard to build on it. But you know sometimes I think it gets overwhelming for people and and there is this little bit of doomism or or or kind of frustration or feeling powerless. And so you know sometimes it's helpful to tell people like you know yes if you walk instead of drive or certainly if you're in in medicine eliminating red bag waste is huge. Also actually impacts disparities too because a lot of times that red bag waste is actually driven leading to more CO2 emissions to a poorer neighborhood where then it's incinerated and the waste from that releases dioxin which can be carcinogenic. And so it contributes to this like climate crisis and inequalities in some ways. But um a lot of people want like manageable things. And so if you say you shouldn't eat meat immediately people are going to be like I'm not listening to this podcast. But you know reducing your beef consumption does impact the climate. Reducing how much you personally emit in your vehicle impacts the climate. Taking a train instead of a plane is actually a big good decision that that helps the climate a little bit easier to do on your side of the pond than than over here. And so infrastructure and and um large scale impacts really matter. So voting um matters and so being educated in terms of you know which political parties are are going to be doing climate conscious things is a bigger way to have an institutional change. But healthcare itself is a huge emitter of carbon. So if you took all of the healthcare industry around the world it would be a top 10 emitting nation. The US is the worst um but US healthcare emissions are as much as all of UK's as a country's emissions. And now I don't want you to feel superior to us because your emissions are not great, but the the NHS actually to its credit, I think has committed to being carbon neutral by 2050 and I think is taking steps in that direction. The current uh Admiral uh Secretary Rachel Levine has um stated and published in New England Journal that the the US healthcare industry uh also has to reduce its carbon emissions and there are organizations that are now trying to take real meaningful steps there. But I you know I think listeners are like what can I do next? Like Caroline said make sure you know where your energy is coming from and switch it to renewable energy. That's that's actually probably the the fastest and easiest thing. And if you're in medicine, you know an easy thing to do is fix your red bag and your and your your trash use and you'll you'll have a big impact. You know one's one's a a really big thing uh in terms of putting out stuff and and one's a pretty um a big thing in terms of waste management in in medicine.
SPEAKER_02What I find was um interesting just having um been to the AAD um recently you know you've got a collection of of our community got coming from from around the world. I flew there um and you know I I had a great time in Boston um but you know when I came back I I was doing a bit of work for a medical education book chapter about conferences and and meetings and I read a paper that um from the American Psychiatric association and they did a study where they noted that that when they in 2020 they had their in twenty I think it was twenty nineteen they had their conference uh face to face in the States um and in twenty twenty they had their conference virtually and they they noted that they saved uh in twenty twenty the estimated equivalent of burning five hundred acres of dense forest or twenty two million pounds of coal. So that's a law.
SPEAKER_01And is there an argument there that we should be having all of our conferences virtually now the answer is you know conferences are important for networking and for mentoring and for connecting the next generation. You know it's actually pretty easy for me to have virtual things because like you know enough people know who I am and I'm doing fine and whatever. But for someone who's just starting out their career, yeah, I know a little humble brag or whatever. But I I it's actually much harder I think for for junior faculty who are just starting um to really get established. But um I do think we should be thoughtful about it and and find ways to minimize it as much as um is appropriate. So um it would be silly for me to fly there to do this interview with you in person. Like that certainly shouldn't happen. A once a year meeting is maybe acceptable, but like traveling for grand rounds on on an airplane when you can do it just the same virtually is something we should rethink. And same thing with you know the interview season and medical school interviews and residency interviews and you know minimizing unnecessary travel and then the travel that we have to have making it as carbon unintensive as possible is very reasonable. And Caroline, the reason I jumped to answer this is she's doing a lot of really interesting work with this and she'll have a really smart answer to add to this. So I don't know if you want to share any of that Carolyn.
SPEAKER_00No, I think everyone has different thresholds for what they think is important in terms of in-person interaction. I think it is really important for us to have those um communications and in-person relationships within our dermatology community. But I do think that when we think about how we get somewhere, we can make smart choices, choose methods of travel that are less carbon intensive and I also think that carbon offsets, which I alluded to earlier are a promising area and carbon offsets, it's important that we understand that there are some carbon offsets that have been controversial. They're controversial one because are they doing what they're supposed to be doing in all cases andor is it more advertising and two are they just giving us sort of carte blanche to proceed with emitting carbon I think those are the controversies but the reality is that there are now more independent certifications that have looked at the integrity of carbon offsets and have tried to make sure that there is integrity in these carbon offset programs. And so if you are going to travel to a conference that is another option to consider is trying to balance the carbon that you emit with taking that out of the atmosphere. So I think that's another way to approach it.
SPEAKER_01I will even go one step beyond that is that if there are meeting organizers in dermatology who are listening to this podcast, we have data and and we've done research actually Caroline and John Barbieri and Annika named earlier, they've done a lot of work with this and we did offer carbon offsets for the Medical Dermatology Society meeting this past year. If there's a meeting that's organized and and wants to investigate this, I think this is the perfect partnership for you know a pharma sponsor that really cares about this and doesn't necessarily know how to do sustainability in dermatology or make this a big part of their kind of industry support for meetings. There's a lot of opportunity here to try to find new ways to partner that make things more sustainable and more eco-friendly in ways that allow everyone to continue their mission of providing care and education, but doing it in a way that helps prevent harm to populations and future generations.
SPEAKER_02Really yeah really interesting and it it's it's about that individual approach and the collective approach but also strategic approach um as well and well there you go um listeners there's an there's an invite for anybody who's got the power um to form that kind of collaboration get in touch uh with with with with either Caroline or Misha and that and I'm sure I'm sure they will uh help change the world I was gonna say do you want us to start naming specific organizations like we named specific journals? I feel like there could be organization Bingo where we can really just start going after I mean go for it yeah plug plug whoever you want and give it give a shot I guess give a shot to whoever you want.
SPEAKER_01I do think that these are all really important things for us to think about. Also um you know we we didn't touch on some of the other ways to make make a change but you know uh if if you were to heavily invest your retirement portfolio in Exxon, I'd have questions, you know, are uh is that a good long-term investment um from a financial standpoint or or from an ethical standpoint, both of which are separate questions. And it turns out there's there's data on this but medical organizations might want to think about that too you know are are your retirement plans or investment portfolios uh positioned in such a way that your money is supporting things that are aligned with your mission and and you know it's very hard to get into the concept of like socially responsible investing and then people are going to roll their eyes and turn off this podcast and say that guy's crazy. But these are other areas where if people really are motivated to learn more about some of the movements in this space, there's a lot more to talk about in in that area. But um I did interrupt your very nice wrap up of our conversation.
SPEAKER_02Oh it's all it's it's it's all right I can always do I've got another I've got a backup wrap wrap up so it's fine. And I I think I think that yeah that that's that's interesting. And there's a the obviously the question of we could go on for for days about this, but the question of transparency as well as the ethics um and we talked about following them on the earlier and social responsibility is is something that's again you wouldn't think it should be controversial but in this pandemic era apparently it is controversial. But I think if we've got um people to what we're in 45 minutes worth of this podcast and they're turning off now you know I'm I'm happy enough. Um so that does bring us to the end of today's special episode of BJD Talks uh we've touched on the scholarly steps taken so far in climate dermatology and tackled personal and collective responsibility in ensuring our specialty is greener. There is so much more that we can do so much more that we can say we might have to do another one of these um so watch this space. We look forward to sharing our next episode of BJD Talks so in the meantime please do let us know if there's any hot topics in dermatology you think that we should discuss. We're really really busy on social media so you can reach us uh via at brjdermatol on Twitter and at brjdermatology on Instagram or by using the hashtag hashtag BJDTalks.
SPEAKER_01Thank you Misha thank you Caroline thank you so much Johnny and thanks Caroline thank you thanks so much guys bye for now