Publications: Articles, Lectures, and Interviews with Michael Lerner
Health Care Without Harm: Cleaning Up Healthcare's Act
Michael Lerner, PhD interviewed by Steve Heilig, MPH
Cambridge Quarterly of Healthcare Ethics (1999),8,561-563.
"Health Care Without Harm" is a new campaign devoted to reducing the environmental harms - namely, pollutants and unnecessary waste - generated by the health care industry. One of the leading local proponents of this effort is Michael Lerner, founder of Commonweal, a Bolinas, California - based health and environmental institute best known for its innovative programs for cancer patients and clinicians. Lerner is author of Choices in Healing: Integrating the Best of Conventional and Complementary Approaches to Cancer, published by the Massachusetts Institute of Technology Press in 1994, and the recipient of a MacArthur Prize Fellowship (the well-known "genius grant").
Interview
Cambridge Quarterly (CQ): You've recently become active in the environmental side of the healthcare equation. Why is this an important issue?
Lerner: We live in an era in which environmental factors are known to be growing contributors to a wide variety of health problems, including cancer. For example, we are pumping enormous amounts of 75,000 industrial chemicals into the environment, hundreds of which we carry trace levels of in our bodies, and for most of which we have no safety data on at all. Some of these chemicals are carcinogens and, even more troubling, some are endocrine disrupters, implicated in a wide range of diseases. We are engaged in a great uncontrolled toxicological experiment with our children and grandchildren as the subjects. Mothers' breast milk now often contains disturbingly high levels of some of these endocrine-disrupting chemicals. I believe that mothers should have a right to give birth to toxic-free babies and to breastfeed without concern that this truly sacred act is harming their babies. That is why I believe that environmental health will inevitably be one of the great human rights issues of the new millennium. We don't really know at this point to what extent these chemical exposures are involved in the incidence of various cancers. Traditional estimates are considered low by many authorities. We do know that endocrine disrupting chemicals are being implicated in a very wide range of deleterious health outcomes, so a single-minded fixation on cancer can actually distract us from the more serious threat of these chemicals.
CQ: So it seems you would support the contention that we are in the midst of an environmental crisis. How does healthcare fit into this?
Lerner: I've recently written an essay titled "The
Age of Extinctions and the Emerging Environmental Health Movement."
We're now living in the midst of the fifth great spasm of extinctions
in the history of the planet. The diversity of species is being
driven back to its lowest level since the end of the age of the
dinosaurs - the extinction rate is roughly 10,000 times background
level. The public and healthcare professionals are becoming increasingly
aware that extinction is not something that happens just to spotted
owls, but that the degradation of the biosphere is affecting human
health. There are four widely recognized drivers of this degradation
of the biosphere - climate change, ozone depletion, toxic chemicals,
and habitat destruction. Three of those four are related directly
to our flagrant abuse of the precious treasurehouse of carbon
fuels. So a fundamental issue for us is coming to terms with the
fact that since World War Two we have rebuilt our civilization
on a petrochemical backbone in a rather thoughtless way.
We now have to reconstruct an advanced industrial system that
does not destroy the precious envelope in which all life on earth
must exist. To accomplish this, we must reform the existing industrial
system industry by industry. Recognizing that, a growing number
of us involved in healthcare felt that it would be useful to clean
up our own house - the healthcare system - so that hospitals are
no longer a source of dioxin and mercury exposure. So we've helped
to start a national (and international) initiative called Health
Care Without Harm to reduce the iatrogenic toxins in the medical
waste stream. We now have over 150 member organizations, and the
American Hospital Association and Environmental Protection Agency
have just signed an agreement to remove virtually all mercury
from medical waste in five years. That agreement does not have
enforcement provisions, and it does not yet include dioxin, which
comes from burning of PVC plastics, so another major effort is
to encourage hospitals and materials suppliers to replace PVC
materials with other less harmful plastics that can be disposed
of safely.
In choosing this focus on "greening" healthcare in the
service of public health, we were aware that historically the
major public health advances have succeeded when physicians and
nurses have joined with other concerned citizens in combating
great dangers -- infectious diseases in the 19th century, and
nuclear weapons, lead in gasoline, tobacco and now handguns in
recent decades. A primary purpose of Health Care Without Harm
is to engage the health care community in leadership on the enormous
threat to public health of endocrine-disrupting chemicals and
other fetal contaminants that threaten the health of our children.
CQ: A cynic might point out that the increasing focus on the "bottom line" of managed care would make environmental goals even less likely to be adopted.
Lerner: There's some good news there. Many healthcare leaders have found that adopting environmentally sound materials management processes actually save them a great deal of money - Beth Israel Hospital in New York is saving hundreds of thousands of dollars, for example. So it doesn't have to cost money. The deeper point is that managed care is a system in transition. Look at how medical organizations, like the California Medical Association in this state, are raising many concerns that an overemphasis on profit is hurting patients. At a time when the public and professions are increasingly skeptical about managed care, we should point to the need for healthcare to join with many other industries which have become more environmentally responsible. Major healthcare groups like Catholic Healthcare West and Kaiser Permanente are making serious commitments to ending mercury pollution and reducing their contributions to dioxin in the environment, and again, finding it makes financial sense to do so.
CQ: Healthcare represents a drop in the bucket in the scale of environmental degradation - are you optimistic in the broader sense of turning things around?
Lerner: Healthcare is a drop in the bucket, but a fairly
significant one. I like what Vaclav Havel, the great Czech writer
and statesman, said. He said there is a distinction between hope
and optimism. Optimism is the assumption that everything is going
to go well. Hope by contrast is a deep orientation of the human
soul, which can be held in even the darkest of times. Right now,
we have eight people with cancer here at Commonweal on one of
our week-long Cancer Help Programs. My experience is that it is
very difficult for people with cancer to do well without a sense
of hope. They may not have the capacity to be optimistic, but
they intuitively understand the enormous importance of hope. I
think its very fair to say that all life on earth is living with
a life-threatening condition right now, as a result of the human-driven
mass spasm of extinctions. It is not helpful to respond to this
predicament with a pessimistic attitude. The constructive response
is a hopeful one, and my experience is that, as you take this
attitude, life is more interesting. We aren't wholly responsible
for the outcome, but if we do everything we can, at least in our
corner, things will be a little better, and we may contribute
to the emergence of a better world.
So I would not say that I am optimistic about the future, but
I am deeply hopeful, because it seems to me that we have been
able to re-engineer human society in the past - think of public
hygiene in the 19th century - and there is no good reason, given
our understanding of what's going on in the biosphere, that we
cannot create a far more sustainable global system. History shows
us that, as Margaret Mead said, important changes are only made
by small groups of committed people. To me, Health Care Without
Harm represents a powerful opportunity for physicians and other
health professionals to engage with one of the greatest threats
to our families and communities by demonstrating our commitment
to cleaning up our own house. If we "green" healthcare,
we can help lead the effort to green other industries, and roll
back the tide of toxic chemicals in which we are all immersed.
That is the great promise that this initiative holds.
Health Care Without Harm is headquartered at the Citizens Clearinghouse for Health, Environment and Justice in Falls Church, VA: (703)237-2249, and can be contacted on the web at www.noharm.org.