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Healthcare Sustainability: Aligning Health and Environmental Ethics · Health Ethics Podcast

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  Speaker 1: Welcome to Health Ethics, a series of conversations with leading
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  Speaker 1: experts about ethical considerations associated with health and healthcare, both
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  Speaker 1: locally and globally. I am Brian Pilkington, Professor of Bioethics
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  Speaker 1: in the Department of Medical Sciences at the Hackensack Meridan
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  Speaker 1: School of Medicine. This series, like its predecessor, which focused
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  Speaker 1: on the COVID nineteen pandemic, relies on the idea that
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  Speaker 1: challenging ethical issues are best addressed by folks from diverse
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  Speaker 1: backgrounds practically reasoning together, and complements the Health Ethics series
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  Speaker 1: with its panel of leading experts from medicine, nursing, politics, economics, philosophy,
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  Speaker 1: and the law. Thank you and enjoy the episode. In
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  Speaker 1: today's episode on sustainability and Medicine, I speak with Kyle Tafoti,
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  Speaker 1: Vice President of Sustainability at the Hackensack Meridian School of Medicine.
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  Speaker 1: Mister Traffouri is a nationally recognized sustainability the leader whose
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  Speaker 1: work connects considerations and population, health prevention, quality, cost reduction,
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  Speaker 1: and wellness. Mister Jeffoury has been recognized by NJBIZ forty
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  Speaker 1: under forty a few years ago. NJBIZ next generation of
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  Speaker 1: Leaders recently and named one of the thirty under thirty
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  Speaker 1: people to watch in the Sustainable and Sustainable business by
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  Speaker 1: Green Biz Group. It is a pleasure to have mister
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  Speaker 1: Foroury on the show. Welcome everyone to the Health Ethics Podcast.
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  Speaker 1: I am Brian Pilkington and it is my great pleasure
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  Speaker 1: to be speaking with Kyle Teffoury. Kyle, thanks so much.
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  Speaker 2: For joining me today. Now thank you for having me.
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  Speaker 1: So we're going to get right into your wheelhouse, which
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  Speaker 1: is sustainability, and we're really thinking about sort of sustainability
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  Speaker 1: in terms of healthcare and medicine. Most folks who listen
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  Speaker 1: to the podcast, I suspect are familiar generally with these topics,
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  Speaker 1: are probably not sort of with the.
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  Speaker 2: Nitty gritty details.
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  Speaker 1: So what does sustainability mean for a health system in
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  Speaker 1: your view?
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  Speaker 2: I think the main aspects of sustainability and a health
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  Speaker 2: system everything's in line the missions of both. So we
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  Speaker 2: break it down to there are three basic pillars of
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  Speaker 2: health that you would need clean air, clean water, healthy soil.
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  Speaker 2: Without those, how do you have health? And I think
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  Speaker 2: when you look at overall healthcare, we like to frame
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  Speaker 2: it this way. Who wants to spend twenty percent of
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  Speaker 2: their money sick on being sick. And you know, in
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  Speaker 2: the United States, we're we're on our way to twenty
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  Speaker 2: percent of GDP being spent on healthcare. And we just
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  Speaker 2: feel that, you know, we got to get really towards
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  Speaker 2: prevention and looking at the health of our environment is
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  Speaker 2: right in line with that.
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  Speaker 1: That makes a lot of sense, I mean, and the
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  Speaker 1: aims whenever you talk to physicians, you know, you talk
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  Speaker 1: to medical students both at the Hackensack Runian School of
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  Speaker 1: Medicine HMH and just sort of across the globe. I mean,
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  Speaker 1: folks are working toward health. And so as you mentioned,
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  Speaker 1: it seems like the missions are exactly in line. If
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  Speaker 1: what physicians really want is to aid patients in terms
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  Speaker 1: of their health, this is a mechanism whereby they can
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  Speaker 1: do that, right. It's not just prescribing X, it's not
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  Speaker 1: just operating on why. It's also attending to clean air,
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  Speaker 1: clean water, and clean soil. Excellent. So do you think
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  Speaker 1: and I've sort of maybe I stacked the deck of
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  Speaker 1: it saying what physicians are the email, But do you
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  Speaker 1: think that health systems, the medical establishment writ large sort
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  Speaker 1: of folks working in healthcare. Is there an obligation to
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  Speaker 1: work in a sustainable manner or is this just something
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  Speaker 1: that's a nice mission fit.
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  Speaker 2: Well, you know, it's it's interesting. When I first started
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  Speaker 2: in healthcare, I always heard first do no harm. That's
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  Speaker 2: the oath that really everyone in medicine takes. So you
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  Speaker 2: do have an obligation, I think. I mean, it's kind
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  Speaker 2: of though it depends what aspect of health care that
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  Speaker 2: you're in. You know, some folks just want to you know,
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  Speaker 2: they look at their little peace and whether it's just
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  Speaker 2: treating whatever symptoms a patient has, or when you look
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  Speaker 2: at these larger systems when there's more risk from a
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  Speaker 2: payment perspective and you really want to look at the
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  Speaker 2: holistic totality of things. I mean, we have an obligation.
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  Speaker 2: We're the largest employer in the communities. I mean, we
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  Speaker 2: have to get upstream because when you look at healthcare
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  Speaker 2: in the United States, you know, pretty good at taking
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  Speaker 2: care of you if you're very sick and have a
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  Speaker 2: complex issue. But too many people are getting sick and
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  Speaker 2: we have way too many, too high levels of disease.
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  Speaker 2: So I think as time moves on, people have to evolve,
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  Speaker 2: professions have to evolve, and we have to start really
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  Speaker 2: getting back to the root causes of disease and doing
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  Speaker 2: our part to prevent them.
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  Speaker 1: What I appreciate about your framing, right is you very
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  Speaker 1: quickly went to one of the largest employers, are the
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  Speaker 1: largest employer in the community.
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  Speaker 2: Right.
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  Speaker 1: So when we're thinking more broadly about healthcare, we're not
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  Speaker 1: just thinking about particular interactions between one physician when that
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  Speaker 1: physician seees one patient. Right, it's public health considerations, population
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  Speaker 1: health considerations, and as you said, if we can get upstream,
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  Speaker 1: it's a system really working for the health of the community,
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  Speaker 1: just by you know, a different mechanism, but still with keeping.
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  Speaker 2: It benefits everyone, you know, it just it's in all
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  Speaker 2: of our you know, people are self interested. You know,
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  Speaker 2: we care a lot of people. You know, they care
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  Speaker 2: about themselves. So no matter what your thought process is,
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  Speaker 2: this benefits everyone. Yeah.
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  Speaker 1: So, and I think that's a very persuasive point. And
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  Speaker 1: we can get into detractors if there's time, but you
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  Speaker 1: will run into climate skeptics or climate change staff. They're
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  Speaker 1: just folks who seem less on board with sustainability. And
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  Speaker 1: an exercise that we run at the School of Medicine,
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  Speaker 1: it's an old rollsy and move where we have students
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  Speaker 1: think through making rules where they don't know particular features
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  Speaker 1: about themselves. And so if you're not aware that you
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  Speaker 1: might end up living in a place next to a
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  Speaker 1: landfill or a dump or a new data farm and
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  Speaker 1: you don't know where you'll be, it seems like at
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  Speaker 1: least our students are much more inclined to set up
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  Speaker 1: rules that will benefit everyone, even if they don't know
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  Speaker 1: who they are. And so the point about I appreciate
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  Speaker 1: that framing of even if you are just looking at yourself,
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  Speaker 1: your family, if you're more self interested, this is going
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  Speaker 1: to benefit you.
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  Speaker 2: Yep. It's it takes back to the old saying not
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  Speaker 2: in my backyard. You know, everybody's fine with certain things.
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  Speaker 2: It's like oh yeah, we support this or that, or
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  Speaker 2: we want this cheap energy and so on and so forth.
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  Speaker 2: But then when you say, okay, we're going to put
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  Speaker 2: in your backyard, and it's like, well, well hold on here,
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  Speaker 2: hold on here. You know that's not you know, government's
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  Speaker 2: overstepp there or this is that, and it's like, well, hey,
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  Speaker 2: you were just all on board when it wasn't impacting
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  Speaker 2: you directly.
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  Speaker 1: So yeah, I mean and this is one of the
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  Speaker 1: big One of the areas I working with with our
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  Speaker 1: students is research ethics, and this is the big research
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  Speaker 1: ethics question too, right, So folks within healthcare, within the
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  Speaker 1: medical establishment are very familiar with it. Some persons are
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  Speaker 1: going to bear great costs and other persons are going
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  Speaker 1: to benefit and sort of thinking about that, sustainability seems
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  Speaker 1: like a slam dunk because it's a way in which
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  Speaker 1: everyone will benefit and it seems like we can work
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  Speaker 1: together in ways that the costs are minimized. So we've
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  Speaker 1: talked a bit about health systems. We talked a bit
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  Speaker 1: about physician in terms of the oaths and obligations and
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  Speaker 1: how this how sustainability efforts really fit well with the
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  Speaker 1: aims to deliver good health care to folks. As a
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  Speaker 1: leader in this space, are the determinants of health which
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  Speaker 1: we talk about a bunch at the medical school and
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  Speaker 1: at HMH. Do you find those useful sort of in
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  Speaker 1: sharing more about sustainability with others? Does that fit with sustainability?
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  Speaker 1: Is it just another set of language? Could you put
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  Speaker 1: your efforts in sustainability and the systems efforts in conversation
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  Speaker 1: with considerations of the determinants of health.
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  Speaker 2: Yes, I think there's so many different types of language
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  Speaker 2: and sayings and principles you know, throughout the entire healthcare
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  Speaker 2: sphere that one of the keys to success that we've
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  Speaker 2: had is we have aligned all of this with our
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  Speaker 2: organization strategic priorities and try to frame it within health
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  Speaker 2: the best way, because, let's face it, folks are overwhelmed
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  Speaker 2: really when you look at the amount of information that's
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  Speaker 2: out there, especially even like when you're a patient, you
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  Speaker 2: know you're being told tent that you know, you got
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  Speaker 2: to take this medication, do this, don't do this, call
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  Speaker 2: the doctor if this happens. What we do is we
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  Speaker 2: try to just align this and integrate this into as
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  Speaker 2: many components of the fabric and DNA of our health system.
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  Speaker 2: So when you talk about health equity and really health
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  Speaker 2: for everybody, and what I said before about that self interest,
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  Speaker 2: clean air, clean water, healthy, So how do you have
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  Speaker 2: health without that? So you know, whatever the determinants are
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  Speaker 2: health of health are, you know, they all intertwine together.
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  Speaker 2: It's like all of us, you know, it's all linked
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  Speaker 2: together somehow. So the it's just how you frame it,
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  Speaker 2: how you talk about it, how you execute on it,
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  Speaker 2: and we've found the most success that we've had is
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  Speaker 2: just making it a part of what we do. And
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  Speaker 2: I think what's so exciting about working with the School
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  Speaker 2: of Medicine is really getting more upstream and the physicians
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  Speaker 2: and the clinicians' journey that it's not telling somebody that's
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  Speaker 2: twenty five years into their career, oh, hey, you have
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  Speaker 2: to change how you do X, Y and Z now.
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  Speaker 2: And I'm sure you see this in every aspect of medicine.
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  Speaker 2: That's why you have more folks that are innovating in
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  Speaker 2: healthcare and the more folks that just are looking to
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  Speaker 2: do the same thing that's been done forever. But it's
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  Speaker 2: just about trying to align it the best way and
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  Speaker 2: saying like, hey, we got to change the system. Clearly
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  Speaker 2: is not functioning well. Otherwise we wouldn't have the rates
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  Speaker 2: of chronic disease we have, we wouldn't have the costs
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  Speaker 2: that or lack of affordability. So we just do what
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  Speaker 2: we can. So we tell physicians, all right, hey, you know,
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  Speaker 2: do you want more like how would you like our
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  Speaker 2: money to be invested? I mean, all of this money
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  Speaker 2: that we save by being more efficient by doing things
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  Speaker 2: better we're reinvesting it back into the system so to
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  Speaker 2: get you the newest equipment or newest thing. So that's
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  Speaker 2: how we really frame it on that side for the patients,
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  Speaker 2: when you're looking at the overall determinants of health, Like
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  Speaker 2: I said, there's so many different things to focus on,
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  Speaker 2: and we get that you want to hit the main
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  Speaker 2: top issues when you have that interaction that you want
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  Speaker 2: them to remember about the right now within healthcare. So
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  Speaker 2: we're just hopefully behind the scenes pushing to create that
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  Speaker 2: healthier environment for them to go back into into their communities.
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  Speaker 2: A bit of a long winded answer, but healthcare is complex,
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  Speaker 2: you know, so we we really try to hit it
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  Speaker 2: from as from many angles into this very complex system.
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  Speaker 1: I mean, it's a great answer, and the way you
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  Speaker 1: sort of helpfully wove the determinants of health into how
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  Speaker 1: folks in your position are able to do the back
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  Speaker 1: end work so that when patients return to their communities
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  Speaker 1: from their hospital interactions, right they're in a better hopefully
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  Speaker 1: in the future, in a better situation than they were.
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  Speaker 1: And it's I mean, at some point, you know, there's
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  Speaker 1: only so many skeptics you can push back on, so
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  Speaker 1: I want to jump us to the medical students and
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  Speaker 1: some of the forward thinking considerations for physicians. But as
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  Speaker 1: you know, as a sustainability expert, I mean a lot
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  Speaker 1: of this is not new ideas around clean water and
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  Speaker 1: clean air and healthy soil. I mean these are the
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  Speaker 1: kinds of things that environmental activists and even environmental ethicists
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  Speaker 1: have been arguing for for GAIDS, and so working that
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  Speaker 1: in I think is important.
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  Speaker 2: Yes, And I will tell you this as time has
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  Speaker 2: gone on and I've been you know, in healthcare for
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  Speaker 2: twelve or thirteen years now.
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  Speaker 1: And.
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  Speaker 2: From early on to today, the amount of skeptics has
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  Speaker 2: reduced greatly. But I think that one of the very
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  Speaker 2: I don't know. I say it's funny, but any of
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  Speaker 2: the skeptics that I do run into, it's driven from
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  Speaker 2: a political lens and it's just regurgitating something that they
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  Speaker 2: heard their party may mention or talk about. So, you know,
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  Speaker 2: to your point, we don't focus on changing every single
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  Speaker 2: skeptics of mine. I mean, common sense is and as
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  Speaker 2: common as we would all like it to be. So
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  Speaker 2: we just stick to what's our mission and what we
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  Speaker 2: know best, and we know healthcare, so we're just going
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  Speaker 2: to do what's right for our team members, for our patients,
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  Speaker 2: and for our communities. So the skeptics can do whatever
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  Speaker 2: they you know, whatever they want, but we're going to
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  Speaker 2: do what's right and what's in the best interest that
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  Speaker 2: we feel for all of us.
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  Speaker 1: So yeah, I mean, it's it's refreshing as somebody who
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  Speaker 1: has their finger on the pulse of this to know
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  Speaker 1: that the overall number of skeptics is reducing and I
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  Speaker 1: can't I mean, the loudest folks in the room occasionally
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  Speaker 1: suggest you might think right here, the lot of think there's.
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  Speaker 2: A lot of people.
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  Speaker 1: But so that's helpful. It's also helpful understand that the
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  Speaker 1: reasons that seem to be motivating some of the some
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  Speaker 1: of the claims in this space are actually other kinds
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  Speaker 1: of reasons, whether they be political or due to certain
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  Speaker 1: kinds of affiliations that folks have and not really thinking
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  Speaker 1: through the relevant science and healthcare needs. So put that
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  Speaker 1: to the side for the moment. Do you have recommendations
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  Speaker 1: for our future physicians, future healthcare professionals who are already
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  Speaker 1: on board, right, they're all for clean air, clean water,
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  Speaker 1: and healthy soil. Anything they should be doing, should be
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  Speaker 1: thinking about doing, not you know, retrofitting offices that have
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  Speaker 1: been running for thirty years. But what's you know, sort
• 15:30
  Speaker 1: of best recommendations, advice, things they should consider for their practice.
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  Speaker 2: I think the main thing, and you had alluded to
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  Speaker 2: it when you said the loudest voice in the room
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  Speaker 2: a lot of times influences or has heard obviously, But
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  Speaker 2: I think it's just being aware and educating themselves. And
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  Speaker 2: I'm not saying you know, read you know all these
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  Speaker 2: different books and journal articles, although I mean they're used
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  Speaker 2: to doing that through medical school, reading a lot more
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  Speaker 2: than I would. But I think it's just becoming aware
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  Speaker 2: and then taking a step back and looking at how
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  Speaker 2: they operate and what can they change. I mean, there
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  Speaker 2: are simple steps that they can do, but not being
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  Speaker 2: scared because you know, as healthcare has evolved and more
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  Speaker 2: of these practices have kind of aligned themselves within, whether
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  Speaker 2: it's health systems or different private equity backed ventures. However
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  Speaker 2: it is as a physician you can be the voice
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  Speaker 2: for driving change within that system. And I think sometimes
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  Speaker 2: people say, oh, it's such a big problem, what can
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  Speaker 2: I do. I'm just one physician, and that's bs. I mean,
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  Speaker 2: that's just putting something off. Everything starts with taking one step,
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  Speaker 2: you know, and just take that step, or find the
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  Speaker 2: like minded folks and just do something, make some switch
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  Speaker 2: and at the end of day, I mean changing the
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  Speaker 2: light bulbs, Yeah, that's something, But I think getting to that,
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  Speaker 2: looking more towards that prevention, keeping people healthy at the
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  Speaker 2: end of the day is more sustainable. I mean, we
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  Speaker 2: can add solar and do all these things, but there's
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  Speaker 2: only so many solar panels you can add. You know,
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  Speaker 2: we got to get to prevention. I think everyone can
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  Speaker 2: agree not being sick is a hell of a lot
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  Speaker 2: better way to live than being sick and managing all
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  Speaker 2: these different chronic illnesses. So I think it's just about
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  Speaker 2: becoming aware and you know, you don't have to be
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  Speaker 2: a tree huggers. It's just I mean, we all want
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  Speaker 2: to live in a better world. I mean who doesn't,
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  Speaker 2: So it starts with your actions, and I think just
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  Speaker 2: making a change, looking at things, or finding the leaders
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  Speaker 2: in the space, the physicians that are you know, more
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  Speaker 2: forward along the curve of make you know, sustainable healthcare
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  Speaker 2: or whatever it may be, finding them out and saying hey,
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  Speaker 2: you know, like just looking at what your peers are
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  Speaker 2: doing and how to make it better. It's simple. I mean,
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  Speaker 2: it's it's not as simple whe everyone would be doing it.
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  Speaker 1: But no, I think that's I mean, I really appreciate
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  Speaker 1: the answer. I've said this on other sessions. Will she
• 18:23
  Speaker 1: gets like a great climate skeptic or something in here
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  Speaker 1: to like really push on this stuff, because this seems
• 18:28
  Speaker 1: exactly right to me. I mean, do something small when
• 18:31
  Speaker 1: you can. And also for folks who listen to the
• 18:34
  Speaker 1: podcast regularly, hearkens back to our previous episode with doctor
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  Speaker 1: Larry Rosen, the great professor of the School of Medicine,
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  Speaker 1: who I'm sure you know, and it's a big sustainability advocate,
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  Speaker 1: and in my conversation with him, he's talking through the
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  Speaker 1: importance of advocacy for medical students and future physicians. But
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  Speaker 1: make sure, I mean, he's super clear that you can
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  Speaker 1: only do so much. So this idea of taking a
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  Speaker 1: small step of finding me sort of putting words in
• 19:03
  Speaker 1: your mouth. But if you find the sustainability inclined practicing
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  Speaker 1: physician right as a as a new physician, if you
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  Speaker 1: find a good mentor in this space, someone who sort
• 19:12
  Speaker 1: of knows how to how to navigate it, I mean,
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  Speaker 1: these just seem like good moves and who doesn't want
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  Speaker 1: to be sick less or not sick. I mean these
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  Speaker 1: are yeah, I mean I think the I think the
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  Speaker 1: case is really persuasive.
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  Speaker 2: Yeah, And you know it's with everything, whether it's just
• 19:29
  Speaker 2: in general solving the healthcare challenges today. You don't want
• 19:34
  Speaker 2: to try to boil the ocean. I mean I heard
• 19:36
  Speaker 2: that cliche a million times, and it would always piss
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  Speaker 2: me off every time I heard it because it's like, oh, Okay, whatever,
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  Speaker 2: hear it again. But you know, just from a general
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  Speaker 2: sense of if you look at trying to solve every
• 19:50
  Speaker 2: single issue, you're going to get discouraged. You're not going
• 19:52
  Speaker 2: to want to. I mean you're gonna it's going to
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  Speaker 2: affect how you how you live each day. So it's
• 19:59
  Speaker 2: taken those simple steps and really acknowledging that the system
• 20:04
  Speaker 2: we're in is broken, but you can be a part
• 20:07
  Speaker 2: of it. You can be the change that's that's necessary.
• 20:12
  Speaker 2: And doctor Rosen, I mean he's fantastic. And I think
• 20:16
  Speaker 2: you look at somebody that's lives what he speaks and
• 20:20
  Speaker 2: and and practices in his practice what he does. You
• 20:25
  Speaker 2: can't even get an appointment there. I mean it's so backlogged.
• 20:27
  Speaker 2: I mean there's so many everybody wants to see him
• 20:30
  Speaker 2: as a physician, and it's just it's that holistic sense,
• 20:33
  Speaker 2: because you don't feel like somebody's just treating a symptom
• 20:37
  Speaker 2: but not getting at Okay, you know there's something else
• 20:41
  Speaker 2: going on here. So yeah, I mean doctor Rosen is
• 20:44
  Speaker 2: a perfect case in point of somebody that does it
• 20:47
  Speaker 2: and he sees a lot of patients and impacts a
• 20:51
  Speaker 2: lot of lives. So it's it's great. Yeah, oh yeah,
• 20:56
  Speaker 2: And this is what I mean.
• 20:57
  Speaker 1: I'm not a doc, right, You're not a This is
• 20:59
  Speaker 1: what as a patient, this is what I want as
• 21:02
  Speaker 1: a parent of little patients. This is what I want
• 21:05
  Speaker 1: if you tell me, hey, it's whatever, penicillin, it's a moxicillan,
• 21:10
  Speaker 1: it's clean water. I just want my kids to be healthy.
• 21:13
  Speaker 1: I want to be healthy, right, And a lot of
• 21:15
  Speaker 1: this I think the move is an unfair general Like
• 21:18
  Speaker 1: many of us know this, right, we know the importance
• 21:20
  Speaker 1: of clean water. The medical School, our phenomenal commencement ceremony
• 21:25
  Speaker 1: had Hannamona right, who discovered the lead in Flint, Michigan,
• 21:28
  Speaker 1: and the water really harming kids Like this is I
• 21:33
  Speaker 1: think you said it best at the beginning, right, all
• 21:35
  Speaker 1: of these missions align, right, these align, So I want
• 21:39
  Speaker 1: to shift to another sort of new move or the
• 21:43
  Speaker 1: move that is all the rage in medical education. And
• 21:45
  Speaker 1: for folks who listen to the podcast will have heard
• 21:48
  Speaker 1: Gabrielle Finn, the internationally renowned medical educator from the UK
• 21:53
  Speaker 1: on previously and even she in working through Magicate Medical Education,
• 22:01
  Speaker 1: is talking about the huge influences of AI, both for
• 22:04
  Speaker 1: good and for bad in healthcare. So the potential for
• 22:08
  Speaker 1: the role of artificial intelligence in healthcare is huge, the
• 22:11
  Speaker 1: chance to make folks healthier bad. I mean, this is
• 22:13
  Speaker 1: just it's a really exciting time. That said, the resources
• 22:20
  Speaker 1: that are used in you know, and there's a little
• 22:22
  Speaker 1: slobby but in sort of rolling out and working with
• 22:26
  Speaker 1: artificial intelligence in healthcare are also huge. Right, So data,
• 22:29
  Speaker 1: there's a bunch of stuff. As a sustainability expert, do
• 22:33
  Speaker 1: you bump into folks doing work in AI?
• 22:36
  Speaker 2: Is there?
• 22:36
  Speaker 1: Are their collaborations, are their recommendations?
• 22:39
  Speaker 2: How do you think about as.
• 22:42
  Speaker 1: This question has become really long, let me put it
• 22:44
  Speaker 1: this way, how do you think about no and emerging
• 22:46
  Speaker 1: technologies which might have a negative impact on environments and
• 22:52
  Speaker 1: climate considerations?
• 22:54
  Speaker 2: Yeah, you know, I think there's externalities and there's unintended
• 22:57
  Speaker 2: consequences with everything and any new thing. You know, nothing's perfect.
• 23:01
  Speaker 2: Everything just there's always something that you know, maybe a
• 23:07
  Speaker 2: negative or an unintent like I mentioned, unintended impact. But
• 23:11
  Speaker 2: I think a lot of it and we're seeing it
• 23:14
  Speaker 2: in general with AI is just responsible the responsible use
• 23:18
  Speaker 2: of it. But yeah, I don't I don't think people
• 23:21
  Speaker 2: realize how intensive it is when you just type that
• 23:24
  Speaker 2: one thing into chat, GBT or whatever you're using. I mean,
• 23:29
  Speaker 2: nothing comes out of thin air, you know, like nothing,
• 23:32
  Speaker 2: It just just doesn't appear. It takes a lot of
• 23:35
  Speaker 2: energy to run these data centers that are you know,
• 23:37
  Speaker 2: pumping out all this information. But yeah, I mean at
• 23:40
  Speaker 2: the end of the day, I think AI has magnificent
• 23:45
  Speaker 2: opportunities to help us, and there are people working on
• 23:49
  Speaker 2: I mean, the companies that are out there are mindful,
• 23:54
  Speaker 2: you know, most of them are mindful of the amount
• 23:58
  Speaker 2: of energy and resources to roll out this technology and
• 24:02
  Speaker 2: to sustain it. So I think that there are groups
• 24:06
  Speaker 2: that are talking about it. We just see it as
• 24:10
  Speaker 2: a health system. When we're trying to buy you know,
• 24:13
  Speaker 2: energy and for these off site clean energy deals that
• 24:17
  Speaker 2: we're looking at and you know, they're very competitive, and
• 24:22
  Speaker 2: when you find out the companies that keep buying them
• 24:25
  Speaker 2: all up, it's you know, the Googles and Microsofts. It's
• 24:29
  Speaker 2: the ones that are you know, at the center of
• 24:32
  Speaker 2: a lot of the AI boom. So it's simple. I
• 24:38
  Speaker 2: think there's so many ethical discussions to be had about
• 24:43
  Speaker 2: AI and whether their biases going into all these different
• 24:48
  Speaker 2: topics that you know, my head would only spin if
• 24:51
  Speaker 2: you tried to boil them all. But it's just doing
• 24:56
  Speaker 2: what you can. I mean, we're still we haven't gotten
• 24:58
  Speaker 2: to experience full AI yet. I mean, obviously so much
• 25:02
  Speaker 2: is changing day in and day out. But yeah, I know,
• 25:06
  Speaker 2: I think as time goes on, hopefully we get more
• 25:08
  Speaker 2: efficient with the resources required to run it, and you know,
• 25:12
  Speaker 2: we use it at the appropriate times. So yeah, it's
• 25:16
  Speaker 2: a it's a fully loaded question with probabe and one
• 25:20
  Speaker 2: that doesn't have a direct answer yet or there's just
• 25:24
  Speaker 2: so many components of the answer that we could take
• 25:27
  Speaker 2: up days talking about it. But yeah, we're still figuring
• 25:30
  Speaker 2: it out. But it's definitely it's a topic, especially in
• 25:33
  Speaker 2: the energy world. It's a topic that has been talked
• 25:37
  Speaker 2: about at great lengths. Just can our grid handle the
• 25:42
  Speaker 2: amount of increased energy, and you know it's it could
• 25:46
  Speaker 2: drive up costs, you know, when we have to add
• 25:48
  Speaker 2: the capacity and update the grid, and people don't realize
• 25:51
  Speaker 2: who do you think pays for that? The consumer? All
• 25:55
  Speaker 2: of us. So it's something that definitely, you know, out
• 26:01
  Speaker 2: of sight, out of mind, that's what people how we
• 26:04
  Speaker 2: are as a society. But I think when it starts
• 26:07
  Speaker 2: to impact other areas, you start to become more attuned
• 26:11
  Speaker 2: to it. So probably not the best answer because it's
• 26:15
  Speaker 2: it's a it's a loaded one.
• 26:17
  Speaker 1: No, I think actually, I think that was really helpful
• 26:20
  Speaker 1: given both the complexity of the space and what we
• 26:24
  Speaker 1: don't yet know. So two things that struck me in
• 26:28
  Speaker 1: the answer. One, this is the best language, but awareness.
• 26:32
  Speaker 1: I was gonna say mindfulness, but will mean something else
• 26:35
  Speaker 1: to other folks. General awareness of a person's behavior.
• 26:39
  Speaker 2: Right.
• 26:40
  Speaker 1: So, and there's a common theme throughout like the sustainability
• 26:43
  Speaker 1: literature and environmental ethics. When you're going to go do
• 26:47
  Speaker 1: that a search and all the state is going to
• 26:50
  Speaker 1: be pulled self reflection on the costs, right, which might
• 26:55
  Speaker 1: mean a great amount of energy for X. Right, So
• 26:57
  Speaker 1: I think if that's fair, all the still out sort
• 27:00
  Speaker 1: of the importance of awareness for future healthcare professionals and
• 27:04
  Speaker 1: all of us. And also, you know, we don't know
• 27:08
  Speaker 1: a lot, right, so I forget how you framed it.
• 27:10
  Speaker 1: We're not sort of fully AI in medicine yet, right,
• 27:13
  Speaker 1: there's great potential, So we're gambling, right, We're taking a
• 27:17
  Speaker 1: risk on this could be great in aiding the health.
• 27:20
  Speaker 2: Of members of our communities.
• 27:22
  Speaker 1: Right, and again, whether it's penicillin, or it's clean water
• 27:25
  Speaker 1: or it's well, this might be a mechanism that gets
• 27:27
  Speaker 1: us there, but we have to be aware of potential
• 27:30
  Speaker 1: costs and the great energy that's used and sort of
• 27:33
  Speaker 1: folks that might be more directly affected by being proximate
• 27:36
  Speaker 1: to data farms and all that kind of stuff. So, yeah,
• 27:38
  Speaker 1: it's a lot because at the end of the day,
• 27:41
  Speaker 1: we're aiming at health and I think you've made that
• 27:44
  Speaker 1: case persuasively.
• 27:47
  Speaker 2: But and I think one of the big at the
• 27:49
  Speaker 2: end of the day, it's on us, like we we
• 27:53
  Speaker 2: have a choice to make in every action that we take.
• 27:56
  Speaker 2: And it's something that when you look at AI, how
• 28:03
  Speaker 2: I mean, it could be used for everything, but it
• 28:06
  Speaker 2: is AI. Are we just going to use it to
• 28:09
  Speaker 2: treat sick people, you know, let people get to that
• 28:12
  Speaker 2: point where they're very sick and then start using the
• 28:14
  Speaker 2: technology to try or are we going to use it
• 28:16
  Speaker 2: upstream to say, Okay, how can we take all this?
• 28:19
  Speaker 2: How can we really get towards this prevention state? And
• 28:23
  Speaker 2: AI can be a great tool to help us maybe
• 28:27
  Speaker 2: boosts us along that journey to more prevention and total health.
• 28:31
  Speaker 2: But at the end of the day, it's on all
• 28:33
  Speaker 2: of us have a choice to make in our day
• 28:36
  Speaker 2: to day lives and how we do things, so we
• 28:39
  Speaker 2: can do so responsibly.
• 28:43
  Speaker 1: Well said, Well said, I see we're almost running out
• 28:46
  Speaker 1: of time. Two quick questions and I'll get you out
• 28:48
  Speaker 1: of here. One for current medical students future physicians, any
• 28:52
  Speaker 1: take home advice. Lots of medical students listen to the podcast.
• 28:56
  Speaker 1: If you can tell them one thing in terms of
• 28:58
  Speaker 1: sustainability and to just be on their minds, what would you.
• 29:02
  Speaker 2: Say they can do it? I mean it's I think
• 29:05
  Speaker 2: there's going into the healthcare field, it can be overwhelmed.
• 29:10
  Speaker 2: Mean you see all the issues and especially I mean
• 29:14
  Speaker 2: just listening to the news today can be pretty depressing,
• 29:20
  Speaker 2: whether it's global conflicts and you know, bills being introduced
• 29:24
  Speaker 2: that would extremely impact rural hospitals and everything. Time goes forward,
• 29:30
  Speaker 2: You're like, oh, be the change that you want to see.
• 29:33
  Speaker 2: It's really true and it if you can't solve every issue,
• 29:38
  Speaker 2: just do one thing. And I think having that mentality
• 29:43
  Speaker 2: helps sustain you know, themselves over the long term. But yeah,
• 29:49
  Speaker 2: I mean sustainability. What I said all along, all of us,
• 29:54
  Speaker 2: who wants to go out into a dirty environment and
• 29:56
  Speaker 2: you know, think of nature and its healing properties and
• 30:00
  Speaker 2: just the health impacts of just going for a walk
• 30:03
  Speaker 2: out in nature. I mean, who wants to go walk
• 30:06
  Speaker 2: outside like through you know, and not see anything green?
• 30:10
  Speaker 2: And I you know, it's it's one of those issues
• 30:15
  Speaker 2: that you know. There's this guy, Ray Anderson who had
• 30:19
  Speaker 2: passed away. He was the CEO of interface of a
• 30:22
  Speaker 2: of a carpet company major you know, impacts on the environment.
• 30:27
  Speaker 2: But he would he would say to everybody, he said,
• 30:30
  Speaker 2: close your eyes and picture where you want to be.
• 30:35
  Speaker 2: And I'm paraphrasing. I haven't looked at it in a while,
• 30:38
  Speaker 2: but it always stuck with me. The gist of it.
• 30:40
  Speaker 2: He's like, close your eyes and look at where you
• 30:43
  Speaker 2: want to be in your time of peace or where
• 30:46
  Speaker 2: do you want to go? You want to go to
• 30:48
  Speaker 2: a beach or to the mountains or to you want
• 30:51
  Speaker 2: to be outdoors in nature. You don't want to be indoors,
• 30:54
  Speaker 2: you know, looking at what I mean maybe some people
• 30:58
  Speaker 2: do looking at monitors and screen and tell you want
• 31:01
  Speaker 2: to be outside in nature, and just remember that, and
• 31:05
  Speaker 2: remember we have an obligation to take care of this
• 31:08
  Speaker 2: for future generations, for their kids and for all moving forward.
• 31:12
  Speaker 2: And that's what I would say.
• 31:15
  Speaker 1: I mean, again, a very persuasive answer, and I appreciate
• 31:20
  Speaker 1: the forward looking nature of how your actions might impact
• 31:25
  Speaker 1: future generations. All right, last question for folks who are
• 31:28
  Speaker 1: interested sustainability fans like your work, interested in how sustainability
• 31:33
  Speaker 1: rolls through healthcare, what's the next big project for you?
• 31:38
  Speaker 1: What's the next thing you're doing. For folks who are interested,
• 31:40
  Speaker 1: what can they go check out after they hear the podcast?
• 31:43
  Speaker 2: So the next big project? Really, I don't know if
• 31:49
  Speaker 2: we can say that there's one big overall. It's it's
• 31:52
  Speaker 2: many projects in many different areas. I think that's what
• 31:55
  Speaker 2: makes sustainability from working in the area fun and exciting
• 31:59
  Speaker 2: but at the same time frustrating and you know, driving
• 32:02
  Speaker 2: your charge me crazy. But you know, we're looking at food. Obviously,
• 32:07
  Speaker 2: food is a big topic right now, especially when you
• 32:10
  Speaker 2: talk about artificial dies and you know, I think a
• 32:12
  Speaker 2: lot of people are making that connection. Where how come
• 32:15
  Speaker 2: in the US certain ingredients that have been banned in
• 32:18
  Speaker 2: other countries who when it comes to chronic disease might
• 32:22
  Speaker 2: have some to do not have the levels that we have.
• 32:25
  Speaker 2: You know, there's all these questions being out. So it's
• 32:28
  Speaker 2: about being you know, involved in that healthy I mean,
• 32:32
  Speaker 2: the food is a continuous journey. Obviously. All of this
• 32:35
  Speaker 2: is because people love their choices and you know sometimes, yeah,
• 32:39
  Speaker 2: food is a hot topic that can cause a lot
• 32:41
  Speaker 2: of anger a lot of people. But at the same time,
• 32:45
  Speaker 2: if you have X, Y, and Z, you can't eat
• 32:47
  Speaker 2: certain things like it's just that's how it is. You've
• 32:49
  Speaker 2: got to until you get healthy. So food is a
• 32:53
  Speaker 2: big one that we're that we're always working on. But
• 32:56
  Speaker 2: then energy, you know, how do we reduce our footpa
• 33:00
  Speaker 2: in that realm? You know something I didn't mention early on.
• 33:04
  Speaker 2: We're the largest energy user, We're the largest water user,
• 33:07
  Speaker 2: We're the largest user of stuff, We're the largest waste producer.
• 33:10
  Speaker 2: As a big large health system, with over thirty eight
• 33:13
  Speaker 2: thousand team members, we have an impact. We have a
• 33:18
  Speaker 2: big impact on that community. So we don't want to
• 33:20
  Speaker 2: be creating a new set of patients as we put
• 33:23
  Speaker 2: let healthy people leave the hospital and putting them into
• 33:26
  Speaker 2: a sick environment that just puts them back in. That's
• 33:29
  Speaker 2: no good. So we're looking at everything. But I think
• 33:32
  Speaker 2: one of the big aspects that we've been looking at
• 33:35
  Speaker 2: internally is getting more upstream in that waste reduction piece.
• 33:39
  Speaker 2: So not just talking about recycling cans and bottle you know, No,
• 33:43
  Speaker 2: we're looking at all of these unnecessary supplies that are
• 33:47
  Speaker 2: just being thrown out not utilized. You can look at
• 33:51
  Speaker 2: it for many areas, but this is what I said
• 33:53
  Speaker 2: before about how it all aligns and it's framed up.
• 33:55
  Speaker 2: But all that money could be spent on so many things,
• 34:00
  Speaker 2: and just a medical device that is brought into an
• 34:03
  Speaker 2: operating room opened up, Oh we don't need it. We're
• 34:06
  Speaker 2: just gonna chuck it because you know, it's got to
• 34:08
  Speaker 2: throw it out. I mean, once the deal is no
• 34:10
  Speaker 2: longer sterile, a lot of these supplies can't just be
• 34:14
  Speaker 2: I mean they're they're chucked. So really, an emphasis on
• 34:18
  Speaker 2: just cutting the waste. I mean, it's stupid to spend
• 34:20
  Speaker 2: money on stuff that's not even used. And some people
• 34:23
  Speaker 2: are like, well I don't care, I just need to
• 34:24
  Speaker 2: take care like whatever. But it's like, well, all right,
• 34:27
  Speaker 2: well it's the same people that are asking us, well
• 34:29
  Speaker 2: I need this equipment, I need that, I need this,
• 34:31
  Speaker 2: I need that. And it's like, when isn't just grow
• 34:32
  Speaker 2: off trees here? If we cut all if we cut
• 34:35
  Speaker 2: that unnecessary waste, we put that money back into getting
• 34:38
  Speaker 2: technology A, B and C and all the newest gadgets
• 34:41
  Speaker 2: and all that. So it's just it's really changing that
• 34:44
  Speaker 2: mindset and docs are surgeons are competitive, so showing like, hey,
• 34:50
  Speaker 2: how come this cost of cases X for the same procedure,
• 34:54
  Speaker 2: same outcomes it's yours is you know, triple the costs.
• 34:58
  Speaker 2: It's it's just having these conversations and changing that. And
• 35:00
  Speaker 2: we've we've seen a lot of engagement from these physicians
• 35:04
  Speaker 2: when we show that in a you know, not in
• 35:07
  Speaker 2: a threatening way, to say hey, these are the facts,
• 35:09
  Speaker 2: these are outcomes, these are this, this this we gotta
• 35:12
  Speaker 2: gotta change something. So yeah, you know, I would say
• 35:16
  Speaker 2: that's a big area that we're making more progress on
• 35:19
  Speaker 2: than we have again a lot of different areas. But
• 35:21
  Speaker 2: the good news is there's there's an issue for everybody
• 35:24
  Speaker 2: to tackle, so endless opportunity to make things better. That's
• 35:30
  Speaker 2: a great note, UH, to leave us on.
• 35:34
  Speaker 1: Hearkens back to the earlier considerations of holistically addressing a
• 35:37
  Speaker 1: problem tied in a variety of topics connected up with sustainability, UH,
• 35:43
  Speaker 1: food considerations, I know, a hot topics, and also the
• 35:45
  Speaker 1: efficiency I mean, the one use items all of this.
• 35:48
  Speaker 1: So it's a it's a big project, and I know
• 35:50
  Speaker 1: folks listening UH will be interested in tackling at least
• 35:53
  Speaker 1: part of, uh, part of the big problem.
• 35:55
  Speaker 2: UH.
• 35:56
  Speaker 1: Kyle, thank you so much for speaking with me today.
• 35:58
  Speaker 1: I really really appreciate it.
• 36:00
  Speaker 2: Oh, you're welcome.
• 36:01
  Speaker 1: This podcast series is a production of the Health Ethics Lab,
• 36:04
  Speaker 1: and I am grateful to colleagues in the Department of
• 36:06
  Speaker 1: Medical Sciences, the IHS Library, and the Hackensack bridy In
• 36:10
  Speaker 1: School of Medicine for making this collaboration possible. To learn
• 36:13
  Speaker 1: more about our work or to engage with the series content,
• 36:17
  Speaker 1: reach out to me Brian Pilkington at Brian dot Pilkington
• 36:21
  Speaker 1: at hmh N dot org.