Commentary on J Gen Intern Med. 2025 May;40(7):1609-1616. doi: 10.1007/s11606-025-09441-6
By Douglas DeLong, MD, MACP, FRCP
"Most internal medicine specialists recognize that climate change is the public health crisis of our time but often feel frustrated by the enormity of the challenge. Yet, given that 8% of the greenhouse gas [GHG] emissions in the US are attributable to our healthcare delivery system we all have a special obligation and opportunity to address the issue.
When a recent issue of the ACP Hospitalist [3/12/25] referenced a Canadian article, proposing a number of discrete actions to reduce GHG emissions, it caught my eye. What I particularly appreciated was that it was built on the ACP inspired Choosing Wisely campaign. I suspect that many of the recommendations are familiar to the internal medicine community but with the added impetus of also having an environmental benefit that one might not appreciate it on first review. For example, when recommending the use of oral anticoagulants over heparin products, I learned that the only FDA approved source of heparin is from pigs, and that raising a “heparin pig” requires 6.1 kg of CO2 per kilogram of pig, not counting the processing, transportation and packaging. At 1.1 billion pigs per year, that’s a lot of CO2! I would encourage you to peruse the original publication for other such examples that will ideally reinforce your current Choosing Wisely efforts with the added benefit of reducing our collective large carbon footprint. As someone always looking for “two fers”, it’s a win-win."