At the core of the position statement is the argument that many of today’s most urgent health threats share common roots. Climate change, biodiversity loss, environmental pollution, and the global rise of chronic diseases such as type diabetes, cardiovascular disease, and obesity are typically addressed by separate institutions, separate research fields, and separate policy agendas. The authors contend that this fragmentation is itself a barrier to progress, because the drivers behind these problems—industrial food systems, sedentary lifestyles, car-dependent urban design, and resource-intensive models of care—overlap to a remarkable degree. Solutions that target one domain, they argue, frequently generate benefits in the others, making integrated approaches more efficient than siloed ones.

Lead author Neha Pathak, MD, FACP, DipABLM, frames the connection in explicitly ecological terms. Human health, she notes, depends on stable environmental systems that supply clean air, clean water, nutritious food, and safe communities. When those systems degrade, the clinical consequences appear in clinics and hospitals as asthma exacerbations, heat-related illness, food insecurity, and the metabolic diseases linked to ultra-processed diets. Lifestyle medicine, in her view, addresses the root causes of chronic disease while simultaneously offering co-benefits for community and planetary well-being, a framing that reframes prevention as an environmental intervention rather than merely a personal one.

The technical backbone of the statement is lifestyle medicine’s six pillars: optimal nutrition, physical activity, restorative sleep, stress management, positive social connectedness, and avoidance of risky substances. Each pillar is presented as a point of leverage that operates on both individual physiology and environmental systems. Plant-predominant dietary patterns, for example, are associated in the clinical literature with reduced cardiometabolic risk, while diets lower in animal products and ultra-processed foods generally carry smaller greenhouse gas footprints, require less land and water, and generate less agricultural pollution. The statement does not claim that diet alone solves the climate crisis, but it argues that the direction of the effect is consistent and clinically meaningful.

Physical activity receives a similarly dual treatment. Active transportation—walking, cycling, and the urban infrastructure that supports them—reduces emissions from motor vehicles while directly lowering the risk of cardiovascular disease, several cancers, and depression. The authors point out that community-based health initiatives, such as walkable neighborhood programs and local food networks, can improve health outcomes at the population level while cutting pollution and resource consumption. In this framing, the prescription pad and the city planning office become complementary instruments, and clinicians are encouraged to see built-environment advocacy as an extension of preventive care rather than an activity outside their professional remit.

One of the statement’s most striking sections turns the lens on healthcare itself. The authors cite estimates that the health sector accounts for approximately 8.5 percent of United States greenhouse gas emissions, a figure that places medicine among the most carbon-intensive industries in the country. Beyond emissions, hospitals and clinics generate substantial volumes of preventable medical waste, including chemical and plastic pollution that enters waterways and ecosystems. The argument advanced here is that a healthcare system capable of treating, reversing, and preventing chronic disease through lifestyle intervention would reduce demand for resource-intensive care—imaging, pharmaceuticals, surgical procedures, and long hospital stays—thereby shrinking medicine’s own environmental footprint while improving patient outcomes.

This feedback loop between prevention and sustainability is, according to the authors, one of the most underappreciated opportunities in modern medicine. Chronic diseases currently consume the majority of healthcare spending in the United States and other high-income nations, and much of that spending funds management of conditions rather than their resolution. If lifestyle-based interventions can put type 2 diabetes into remission, reverse early coronary artery disease, or reduce the need for polypharmacy in hypertension, the downstream savings are not only financial. Fewer medications mean less pharmaceutical pollution in wastewater; fewer procedures mean less single-use plastic and anesthetic gas emissions; fewer hospital admissions mean smaller energy and supply chains. The position statement treats these cascading effects as a core rationale for scaling lifestyle medicine nationally.

Translating this vision into practice, the statement issues a set of recommendations aimed at the structural levels of medicine. It calls for integrating lifestyle medicine and planetary health principles into medical education, so that future physicians are trained to recognize the environmental determinants of disease alongside the biological ones. It urges the incorporation of these principles into clinical practice, public health initiatives, and health policy, with the goal of building a prevention-focused healthcare system that advances resilience, sustainability, and long-term population health. The recommendations implicitly acknowledge that individual behavior change, however powerful, cannot succeed in environments that make healthy choices difficult or unaffordable, and that policy is therefore an inseparable component of clinical prevention.

Kathy Pollard, MS, a research information specialist with ACLM, summarizes the organization’s ambition in blunt terms: healthcare must evolve beyond simply managing disease. In her view, embracing lifestyle medicine offers an opportunity to improve health outcomes and restore health while helping safeguard the environmental systems on which future generations depend. The language of restoration, rather than mere management, marks a notable rhetorical shift for a professional society representing clinicians, and it signals an intent to position lifestyle medicine as a systems-level reform movement rather than a niche specialty.

The publication of the position statement comes against a backdrop of growing attention to the health dimensions of climate change within mainstream medicine. Professional societies across specialties have increasingly issued warnings about heat-related mortality, the expansion of vector-borne disease, and the mental health toll of environmental disasters. What distinguishes the ACLM statement is its constructive orientation: rather than cataloging threats, it proposes a specific clinical toolkit with documented efficacy and argues that deploying that toolkit at scale produces measurable environmental dividends. Whether the statement’s integrated vision gains traction will depend on whether medical educators, policymakers, and health systems are willing to treat the chronic disease epidemic and the ecological crisis as what the authors insist they are—interconnected problems that demand, and reward, a single coordinated response.

Subject of Research: A position statement linking lifestyle medicine interventions to chronic disease prevention and planetary health sustainability

Article Title: American College of Lifestyle Medicine issues new position statement linking human health and planetary health

Article References: American College of Lifestyle Medicine issues new position statement linking human health and planetary health. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: lifestyle medicine, planetary health, chronic disease, climate change, plant-predominant diet, physical activity, healthcare emissions, medical waste, prevention, public health policy, medical education, sustainability

The study, conducted by researchers affiliated with Georgetown University School of Medicine and the Department of Dermatology at MedStar Washington Hospital Center in Washington, DC, and approved under Georgetown’s institutional review board, addresses an issue that sits at the intersection of clinical practice, health economics, and environmental sustainability. The work arrives at a moment when medicine broadly, and dermatology specifically, is being asked to account for its environmental footprint. Health care is a major contributor to greenhouse gas emissions, and outpatient specialties have increasingly turned their attention to the waste generated by everyday procedures, from single-use instruments to discarded medications.

Triamcinolone acetonide is typically supplied in small vials that are labeled for single-dose use, even when the vial contains far more medication than a single injection requires. Regulatory guidance discourages the reuse of vials designated as single-dose because of the risk of contamination, which means that whatever remains after a patient’s injection is discarded. The scale of that discard is easy to underestimate. A clinic that injects a fraction of a milliliter into a hypertrophic scar may open a vial containing several milliliters, use a small portion, and consign the rest, along with the vial itself, to the waste stream. Multiplied across thousands of patient encounters, the arithmetic becomes sobering.

The problem is not unique to dermatology, and the authors situate their work within a broader policy conversation. A 2021 report from the National Academies of Sciences, Engineering, and Medicine examined the implications of discarded drugs from single-dose vials, highlighting how weight-based dosing and conservative vial sizing combine to produce systematic waste across medicine. That report noted that the issue is structural rather than a matter of individual carelessness: clinicians follow labeling and infection-control rules, and the waste follows from how products are packaged and regulated. The dermatology research letter brings that structural analysis down to the level of a single, ubiquitous injection practice.

To quantify waste, the researchers drew on established methodologies from the emerging field of sustainable health care. Their reference list points to a carbon footprint analysis of an outpatient dermatology practice at an academic medical center, published in JAMA Dermatology, which demonstrated that routine clinical activities carry measurable emissions when materials, energy use, and waste streams are tallied. It also cites the United Kingdom Government’s greenhouse gas conversion factors for electricity, accessed through the Climatiq emissions database, and the United States Environmental Protection Agency’s greenhouse gas equivalencies calculator, tools that allow researchers to translate consumption and waste into carbon terms that can be compared across settings.

The technical logic of such analyses is worth unpacking, because it explains why a seemingly trivial injection can carry a nontrivial footprint. Each vial of medication embodies not only the active pharmaceutical ingredient but also the glass, rubber stopper, aluminum seal, packaging, sterilization processes, and cold-chain or ambient transport that brought it to the clinic. When a fraction of a vial is used and the remainder discarded, all of that embedded material and energy is written off. Add the syringe, needle, alcohol prep pad, gauze, and gloves used for the injection itself, and each procedure generates a stream of single-use items destined for regulated medical waste, which is often autoclaved or incinerated, processes that themselves consume energy and generate emissions.

Crucially, the authors also looked toward solutions rather than merely documenting the problem. Their references include a 2023 study on vial-splitting and repackaging into aliquot-specific syringes as a cost-effective and waste-decreasing strategy for sugammadex, an anesthesiology medication. That approach, in which a larger vial is divided under sterile conditions into pre-measured aliquots matched to typical doses, has been proposed as a way to use more of each vial’s contents while preserving safety. Adapting such strategies to dermatology, where triamcinolone injections follow fairly predictable dosing patterns, offers a concrete pathway for reducing both pharmaceutical waste and the per-injection carbon burden.

The broader context for this work is a growing sustainability movement within dermatology. A 2025 review in the Journal of the American Academy of Dermatology’s sister journal, titled Going Green in Dermatology, surveyed the specialty’s environmental impact and the strategies available to shrink it, from waste segregation and recycling programs to rethinking supply chains and medication use. Dermatology clinics are well positioned for such efforts because much of their work is procedural and outpatient-based, meaning that changes in practice patterns can be implemented locally without the complex infrastructure changes required in operating theaters or intensive care units. The triamcinolone study adds a granular, medication-specific data point to that agenda.

What makes the research letter notable is its framing of waste as a quantifiable, and therefore manageable, quantity. By measuring how much triamcinolone is discarded under current practice and modeling what could be saved under alternative approaches, the authors convert an abstract concern into a set of numbers that clinic managers, pharmacy committees, and professional societies can act upon. The methodology also demonstrates that such analyses can be carried out with publicly available emissions factors and standard calculators, lowering the barrier for other departments and specialties to replicate the approach for their own high-volume medications and procedures.

The implications extend beyond one drug or one specialty. Single-dose vial policies exist for good reasons, and any strategy to reduce waste must navigate infection-control standards, regulatory constraints on compounding and repackaging, and the practical realities of clinic workflow. The National Academies report made clear that meaningful change will likely require action at multiple levels, including manufacturers, regulators, payers, and professional bodies, rather than relying solely on individual clinicians to squeeze more use from each vial. Studies like this one supply the evidence base that such systemic conversations require, showing where the waste concentrates and which interventions offer the greatest return.

For clinicians, the message is that sustainability and good stewardship can align with patient care rather than compete with it. Reducing discarded medication lowers costs, shrinks the waste stream, and cuts emissions, all without altering the dose a patient receives. For patients, the sight of a syringe drawn from a vial is unlikely to change, but the systems behind it may. As health systems face increasing pressure to decarbonize, the humble triamcinolone injection has become an unlikely case study in how careful measurement, borrowed techniques from other fields, and attention to the full life cycle of a medication can turn routine practice into an opportunity for meaningful improvement. The Georgetown and MedStar team’s work suggests that even the smallest procedures, examined closely enough, reveal both the scale of medicine’s waste problem and the practical routes out of it.

Subject of Research: Quantifying and reducing pharmaceutical waste in dermatologic triamcinolone injection practices

Article Title: Quantifying and reducing waste with triamcinolone injection practices

Article References: Bui, J. K., Chow, C., Greer, M., Lindberg, M., & Stringer, T. (2026). Quantifying and reducing waste with triamcinolone injection practices. Archives of Dermatological Research, 318(1), Article 492. https://doi.org/10.1007/s00403-026-04988-8

Image Credits: AI Generated

DOI: 10.1007/s00403-026-04988-8

Keywords: triamcinolone acetonide, dermatology, pharmaceutical waste, single-dose vials, vial-splitting, carbon footprint, sustainable health care, greenhouse gas emissions, medical waste, corticosteroid injections, health care sustainability, National Academies report

The study, published as a short report in the Archives of Dermatological Research, examined every skin biopsy performed across the Penn State Dermatology clinic network between January 1 and December 31, 2024, a total of 11,284 specimens. Rather than running a new laboratory experiment, the research team, led by Rachel Anderson of the Department of Dermatology at Penn State College of Medicine, conducted a theoretical cost and waste assessment built on real institutional biopsy volumes and pricing. They compared three commonly available sizes of prefilled formalin containers: a 20 mL cup filled with 10 mL of formalin, a 40 mL cup filled with 20 mL, and a 60 mL cup filled with 30 mL. The arithmetic behind the comparison is straightforward but consequential, because most skin biopsies are tiny, typically a few millimeters across, and require far less preservative than even the smallest standard container provides.

The numbers reveal a striking mismatch between container size and clinical need. At Penn State’s biopsy volume, the 20/10 mL container carried the lowest annual cost at $5,303.48, compared with $6,996.08 for the 40/20 mL option and $6,883.24 for the 60/30 mL container. Notably, the 60/30 mL container is currently the standard across the clinics, meaning the institution has been paying a premium of roughly $1,580 per year for the privilege of buying and disposing of formalin that never touches a specimen. Extrapolated over ten years, the researchers project that switching to the smallest container would save approximately $17,000 while eliminating 2,256.8 liters of formalin waste. For a single academic dermatology department, those figures are modest; scaled across the thousands of clinics and offices that perform skin biopsies worldwide, they hint at a substantial and largely overlooked reservoir of chemical waste.

The case for change rests on more than accounting. Formalin is an aqueous solution of formaldehyde, a small, highly reactive molecule that cross-links proteins and nucleic acids, which is precisely why it fixes tissue so effectively and why it is so hazardous to people. Formaldehyde is classified as a human carcinogen, and chronic occupational exposure is associated with respiratory irritation, sensitization, and elevated cancer risk. In anatomic pathology workflows, airborne formaldehyde monitoring is a recognized component of occupational health programs, and regulatory frameworks govern both the handling of the concentrated solution and the disposal of used and unused volumes as biomedical waste. Every milliliter of formalin that a clinic buys but does not need becomes a milliliter that must be poured out, transported, and treated as hazardous waste, with all the environmental and financial burdens that entails.

Why, then, do oversized containers persist? The answer lies partly in habit and partly in the logistics of clinic design. Prefilled containers arrive from suppliers in a limited range of sizes, and once a particular format is stocked in procedure rooms, it tends to remain the default. Larger containers also carry a psychological margin of safety: clinicians and staff may feel that a bigger volume guarantees full immersion of the specimen and adequate fixation. Yet fixation chemistry does not demand generous excess. For the small tissue samples typical of dermatologic practice, a 10 mL fill provides ample volume to submerge the specimen and maintain the formalin-to-tissue ratio needed for complete penetration and cross-linking. The study’s central insight is that the standard container size, rather than any biological requirement, is what drives the waste stream.

The Penn State team also addressed the practical concerns that might accompany a downsizing effort. Smaller containers are lighter and more prone to tipping on crowded procedure trays, and a spilled cup of formalin in a clinic is both a safety hazard and a cleanup burden. To counter this, the researchers describe new clinic racks designed to secure the smaller containers upright, reducing the risk of tipping and potential spills and thereby enhancing, rather than compromising, workplace safety. The intervention, in other words, is not merely a swap of one product for another but a small redesign of the physical workflow, pairing the smaller vessels with holders that keep them stable during procedures and transport to the laboratory.

The financial analysis was structured to project costs and waste over one, five, and ten-year horizons using institutional pricing, giving administrators a realistic picture of the cumulative effect of a seemingly trivial procurement decision. Over a single year the savings of roughly $1,700 may look like rounding error in a large health system’s budget. Over a decade, the compounded effect of lower purchasing costs, reduced hazardous waste disposal fees, and diminished staff exposure to a carcinogenic chemical becomes harder to dismiss. The study frames this as a model of environmentally conscious clinical decision-making, an argument that sustainability initiatives in medicine need not involve expensive technology or sweeping policy changes but can begin with something as mundane as the cup on the procedure tray.

The report also points toward a further step: formalin recycling. The authors note that additional gains could be realized through the adoption of formalin recycling systems, an approach that has begun attracting attention in surgical pathology more broadly. Recent work published in the journal Pathology evaluated recycled formalin as a tool to mitigate the environmental impact of routine practice, suggesting that used fixative can be reprocessed and returned to service without sacrificing diagnostic quality. Combined with right-sized containers, recycling could shrink the formalin footprint of a busy dermatology or pathology service even further, closing the loop on a chemical that is currently purchased, used once, and discarded in enormous aggregate quantities.

The broader context is a growing movement within laboratory medicine to confront its environmental toll. Dermatopathology laboratories have been identified as sites of significant opportunity for green initiatives, and audits of biomedical waste in laboratory medicine have long emphasized that waste reduction begins with choices made long before a specimen reaches the bench. Alternative fixatives that avoid formaldehyde altogether are under investigation, including efforts to prolong the fixation performance of formalin-free agents using standard laboratory protocols, though formalin remains deeply entrenched because of its reliability, low cost, and compatibility with decades of diagnostic experience. Against that backdrop, the Penn State proposal stands out for its pragmatism: it changes nothing about the fixative, the fixation protocol, or the diagnostic pathway, only the volume of the same chemical that flows through the clinic.

For clinicians and clinic managers, the message is unusually actionable. The researchers, who declare no competing interests and received no external funding for the work, describe the switch to smaller containers as a simple, effective intervention to cut costs, reduce toxic waste, and improve safety in dermatology practice. The analysis was deemed not human subjects research by the Penn State College of Medicine Institutional Review Board, reflecting its focus on operations rather than patients, and no datasets were generated or analyzed beyond the institutional biopsy counts and pricing that underpin the projections. That simplicity is the point. In a field where sustainability proposals often stall under the weight of cost, complexity, and clinical inertia, the humble 20 mL formalin cup offers a rare example of an intervention that is simultaneously cheaper, safer, and greener, waiting only for clinics to think small.

Subject of Research: Reducing formalin waste and cost in dermatology clinics through smaller prefilled biopsy containers

Article Title: Think small: a smarter approach to formalin use in dermatology clinics and offices

Article References: Anderson, R., Washington, A., Multani, S., Anderson, B., & Helm, T. (2026). Think small: a smarter approach to formalin use in dermatology clinics and offices. Archives of Dermatological Research, 318(1), Article 470. https://doi.org/10.1007/s00403-026-04900-4

Image Credits: AI Generated

DOI: 10.1007/s00403-026-04900-4

Keywords: formalin, dermatology, skin biopsy, formaldehyde, medical waste, sustainability, dermatopathology, specimen fixation, healthcare costs, occupational safety, green initiatives, clinical practice