The concept of low-carbon care seeks to minimize the environmental toll exerted by healthcare systems, which have been shown to have significant carbon footprints. The healthcare sector’s contributions to greenhouse gas emissions stem from various factors, including energy consumption, the use of medical products, waste management, and travel. Acknowledging these impacts, the authors of the article argue for a model of care that balances patient needs with ecological considerations. This holistic view of health recognizes that human health is inextricably linked to the health of the planet, and as such, offers a framework for physicians to lead the charge toward sustainable medicine.

The recommendations detailed in the article revolve around practical adaptations and guidelines for internists. By adopting these strategies, general practitioners can not only enhance the quality of care they provide but also reduce their practice’s carbon footprint. The goal is to create a paradigm shift where low-carbon care becomes an integral part of healthcare delivery rather than an afterthought. The authors emphasize the importance of interdisciplinary collaboration, encouraging healthcare professionals to learn from environmental scientists and sustainability experts to integrate ecological wisdom into medical practice.

One of the key recommendations revolves around the rationalization of diagnostic testing and procedures. The authors advocate for a careful assessment of the necessity of various tests, with an emphasis on avoiding unnecessary interventions that not only burden patients but also consume resources. By focusing on high-value care—which prioritizes interventions that provide the most benefit for patients relative to their costs—physicians can significantly reduce waste and associated carbon emissions.

Reduction of unnecessary medical interventions extends beyond traditional diagnostics; it also encompasses the use of medications and treatments that may be environmentally damaging. The paper discusses the importance of medication stewardship, where physicians can opt for medications that have a fewer environmental impact. This entails choosing therapies that come from sustainable sources and have lower emissions throughout their lifecycle—from production to disposal.

Moreover, the authors highlight the critical role of telemedicine in promoting high-value, low-carbon care. The rise of telehealth services has reshaped how medical consultations occur, allowing patients and healthcare providers to interact without the need for travel. This shift not only enhances accessibility to healthcare but also reduces greenhouse gas emissions resulting from transportation. Telemedicine can facilitate effective patient care while streamlining resource use, making it a key component of the low-carbon healthcare model.

The article addresses how healthcare facilities can implement energy-efficient practices, thus mitigating their environmental impact. It underscores the potential to use energy-efficient equipment, optimize energy consumption, and invest in renewable energy sources to power medical facilities. Hospitals and clinic operations can significantly lower their carbon emissions through structural changes and improved operational practices, contributing to a greener healthcare landscape.

Furthermore, the importance of waste reduction is explored extensively in the paper. Healthcare generates an enormous amount of waste, much of which is non-biodegradable. By encouraging the recycling of materials and reducing single-use products, healthcare providers can minimize their operational footprint. The article calls for the establishment of waste diversion programs and training for staff to foster a culture of sustainability within healthcare organizations.

A salient point made in the article revolves around community engagement. It posits that internists, as trusted figures within their communities, can educate and mobilize their patients toward sustainable lifestyle choices. By fostering a dialogue about environmental health, physicians can empower patients to make informed decisions that prioritize sustainability in their daily lives, further amplifying the positive impact of low-carbon care.

The challenges of implementing these recommendations are not insignificant. Resistance to change, ingrained habits, and limitations in available resources can thwart the adoption of low-carbon practices in traditional healthcare settings. However, the authors argue that through education, leadership, and advocacy, these barriers can be surmounted. The paper encourages internists to advocate for policies that support sustainable practices, thus contributing to a healthcare system equipped to tackle the dual crises of climate change and public health.

The intersection of environmental and human health is increasingly gaining recognition in academic literature. As practitioners begin to bridge these domains, the implications for medical training are profound. Future physicians will need to be equipped with the understanding and skills to integrate climate-conscious practices into their healthcare approach. Educational institutions must respond to this need by revising curricula to reflect the importance of sustainability in medicine.

Looking towards the future, the article posits that the healthcare community holds a pivotal role in addressing climate change. By embracing the recommendations set forth by the authors, general internists can become frontline advocates—not just for patient health but for planetary wellbeing. This shift represents an evolution in medical ethics, one that values the health of our environment as integral to the health of individuals and communities.

In conclusion, the integration of high-value, low-carbon care into internal medicine is not merely a progressive movement—it is essential for the longevity and health of both patients and our planet. The recommendations laid out by Gaudreau-Simard, Stoynova, Silverstein, and their colleagues provide a blueprint for transforming medical practice. Through mindful and conscious decision-making, general internists can lead the way in building a sustainable healthcare system that places equal importance on human health and the health of the planet.

Subject of Research: Low-carbon care practices in general internal medicine.

Article Title: Eight Ways General Internists Can Practice High-Value, Low-Carbon Care: The Canadian Society of Internal Medicine’s Climate Conscious Choosing Wisely Canada Recommendations.

Article References:

Gaudreau-Simard, M., Stoynova, V., Silverstein, W.K. et al. Eight Ways General Internists Can Practice High-Value, Low-Carbon Care: The Canadian Society of Internal Medicine’s Climate Conscious Choosing Wisely Canada Recommendations.
J GEN INTERN MED (2025). https://doi.org/10.1007/s11606-025-10054-2

Image Credits: AI Generated

DOI: https://doi.org/10.1007/s11606-025-10054-2

Keywords: climate change, sustainable healthcare, low-carbon care, internal medicine, high-value care, telemedicine, medication stewardship, energy efficiency, waste reduction, community engagement.

According to the findings, inhalers have been responsible for emitting over 2 million metric tons of carbon dioxide annually over the last ten years. To put this into perspective, the emissions generated by these devices are comparable to those produced by approximately 530,000 gasoline-powered cars operating on American roads each year. This startling equivalence highlights the vast scale at which inhaler emissions impact the environment and compels healthcare systems to reconsider current treatment paradigms.

The researchers meticulously analyzed emissions across the three inhaler types approved for asthma and COPD: metered-dose inhalers (MDIs), dry powder inhalers (DPIs), and soft mist inhalers (SMIs). Their results indicate that MDIs are overwhelmingly responsible for the carbon burden, accounting for 98 percent of the total greenhouse gas emissions during the decade under study. This dominance is primarily driven by the hydrofluoroalkane (HFA) propellants used in MDIs—substances well-known for their potent global warming potential relative to carbon dioxide.

HFAs, which replaced chlorofluorocarbons (CFCs) following environmental regulations, remain potent greenhouse gases themselves. While essential for delivering medication effectively in MDIs, their environmental footprint is significant. In contrast, DPIs and SMIs operate without propellants, utilizing the patient’s own breath to disperse medication particles. This critical distinction results in markedly lower emissions for these devices, positioning them as key candidates for greener respiratory care solutions.

Dr. William Feldman, a pulmonologist and lead author affiliated with the David Geffen School of Medicine at UCLA, contextualizes these findings within the broader healthcare landscape. He emphasizes that the carbon footprint of inhalers adds to the already substantial environmental impact of the U.S. healthcare system. Importantly, Feldman highlights that patient care need not be compromised, as there exists substantial opportunity to adopt greener inhaler technologies without sacrificing therapeutic effectiveness.

The team’s approach involved leveraging a comprehensive U.S. prescription database, capturing detailed National Drug Code (NDC) level data to estimate inhaler usage patterns. Their methodology integrated validated academic models to calculate emissions associated with different device types, propellants, therapeutic classes, branded products, manufacturers, payers, and pharmacy benefit managers. This data-driven analysis provides a granular understanding of emission sources across the inhaler ecosystem, from prescription to patient use.

Their analysis reveals disparities in emissions linked to product branding and manufacturer choices, indicating potential leverage points for policy interventions and market incentives. For example, branded inhalers often rely heavily on MDIs with high-albedo HFAs, suggesting pharmaceutical companies might lead the transition to low-emission alternatives by modifying their product portfolios or investing in innovative propellant technologies.

Looking ahead, the research team aims to deepen their investigations by focusing on specific patient populations, such as individuals covered under Medicaid, to explore both environmental and health outcome correlations. Additionally, they plan to undertake comparative effectiveness research examining clinical results between low-emission and conventional inhalers within identical therapeutic classes, further elucidating the balance between sustainability and patient well-being.

Another critical facet of future work includes dissecting the economic dynamics surrounding inhalers. Patent strategies and pricing models employed by pharmaceutical firms may influence the pace of adoption for greener inhaler technologies. Understanding these market forces will be instrumental in crafting regulatory frameworks and incentives that accelerate the shift toward environmentally responsible respiratory treatments.

Dr. Feldman underscores the essence of this investigation as a vital step in comprehending the magnitude of emissions driven by inhalers. Awareness and data transparency form the foundation upon which targeted mitigation strategies can be constructed, fostering synergy between public health goals and environmental stewardship. This dual-benefit approach aligns with escalating global concerns about climate change and the healthcare sector’s role in sustainable practices.

Inhaler emissions, while comparatively overlooked, represent a tangible contribution to anthropogenic greenhouse gases, spotlighting the intersection of medicine and climate policy. The UCLA findings suggest that shifting clinical practice toward wider adoption of DPIs and SMIs could serve as a pragmatic approach to reduce carbon footprints without compromising therapeutic efficacy or patient adherence.

By quantifying inhaler-related emissions at such scale and detail, this study sets the stage for multi-disciplinary dialogue among healthcare providers, environmental scientists, policy makers, and industry stakeholders. Collective action informed by robust scientific evidence will be critical to balancing urgent patient needs with the imperative of minimizing environmental harm inflicted by medical devices.

Ultimately, the UCLA Health study signals a pivotal moment for respiratory care, emphasizing innovation and responsibility. As the healthcare community grapples with the challenges posed by climate change, inhalers—once seen solely as life-saving tools—must now also be assessed through an environmental lens to ensure a healthier future for both patients and the planet.

Subject of Research: Not applicable

Article Title: UCLA Health Study Finds Inhalers for Asthma and COPD Drive Significant Greenhouse Gas Emissions

Web References: http://dx.doi.org/10.1001/jama.2025.16524

References: JAMA, 2025

Keywords: Greenhouse gases