Researchers led by Neele Puhlmann and Oliver Olsson of the Institute of Sustainable Chemistry at Leuphana University of Lüneburg, together with colleagues from the Ecologic Institute in Berlin, the Dutch National Institute for Public Health and the Environment (RIVM), and the University of Helsinki, set out to gauge how prepared Europe’s healthcare sector is to embrace so-called “greener” active pharmaceutical ingredients, or APIs. These are drug molecules deliberately designed at the molecular level to combine therapeutic efficacy with inherently lower environmental risk — for instance, by degrading more readily after excretion or by binding less persistently in sediments. The work, published in BMC Health Services Research, forms part of the wider PREMIER initiative, a public-private project funded through the Innovative Medicines Initiative that examines the environmental and health impacts of medicines across their life cycle.

The team conducted semi-structured interviews with 16 healthcare professionals working across Europe between February and April 2024. The deliberately diverse group included three doctors, three pharmacists, three procurement experts, and specialists in reimbursement, market authorisation, healthcare provision and industry sustainability reporting, as well as one professional from an environmental non-governmental organisation. This breadth was central to the study’s design: pharmaceuticals pass through many hands before reaching a patient, and each actor along that chain — from the regulator who approves a drug to the hospital manager who signs a purchasing contract — holds some influence over which molecules ultimately enter the environment. The researchers analysed the transcripts using qualitative content analysis, a systematic method for identifying recurring themes, opportunities and obstacles within unstructured interview data.

The central message emerging from the interviews was one of cautious but genuine enthusiasm. According to the study, there is clear interest among healthcare professionals in minimising the environmental impacts of the medicines they prescribe and purchase. Crucially, this is not merely an abstract sentiment. Some practical strategies already exist, the interviewees noted, such as incorporating environmental criteria into the public tenders issued by procurement agencies. In several European healthcare systems, hospitals and regional authorities purchase medicines through competitive tendering, and adding environmental specifications to those tenders is one of the few immediate levers available without new legislation. The participants expected that environmental properties of APIs will play a more significant role in healthcare decision-making in the future, moving from a niche concern to a standard consideration alongside efficacy, safety and cost.

Yet the study also makes clear that good intentions collide with hard practical constraints. The most frequently voiced obstacle was a lack of reliable scientific data. Healthcare professionals cannot weigh the environmental footprint of one drug against another if manufacturers do not disclose ecotoxicity profiles, persistence and bioaccumulation data in a comparable, accessible form. The interviewees said that access to robust evidence on the environmental impacts of APIs is a prerequisite for any systematic consideration of greenness in prescribing or purchasing decisions. Without such data, environmental criteria risk remaining vague aspirations rather than measurable benchmarks.

A second, equally fundamental barrier is conceptual: how does one balance a molecule’s benefits and risks for patients against its properties in the environment? The researchers found that interviewees considered this balancing act inherently product-specific. A life-saving cancer therapy with few alternatives may justify a heavier environmental burden than, say, a widely prescribed medicine for which greener substitutes exist. This means that a simple “green score” for all pharmaceuticals is unlikely to be appropriate. Instead, the weighing of patient benefit against environmental risk must be embedded in structured, centralised frameworks — something individual prescribers and pharmacists cannot and should not do alone at the bedside or in the pharmacy.

That observation points to the study’s most consequential finding: the marketing authorisation process is viewed as the main intervention point in the pharmaceutical life cycle for strengthening environmental risk considerations. Every medicine sold in Europe must pass through regulatory assessment before it reaches the market, making this the single checkpoint where all stakeholders converge. The interviewees called for legislative and regulatory frameworks, and practical guidance documents, to ensure that environmental properties are assessed and weighed in a centralised and harmonised manner across Europe. A patchwork of national rules, they suggested, would fragment the market and dilute incentives for manufacturers to invest in greener molecular design. The timing is notable, as the European Union’s pharmaceutical legislation is currently undergoing its most substantial revision in two decades, and environmental considerations have featured prominently in the debate.

The authors also identified a plausible pathway from awareness to action. The evident interest among healthcare professionals, they conclude, may stimulate data sharing by pharmaceutical companies in the short term. If procurement agencies, hospital pharmacies and prescribers begin explicitly requesting environmental information, manufacturers will face commercial pressure to publish it. In the long term, this demand signal could cascade upstream into research and development, encouraging medicinal chemists to design APIs that retain their clinical potency while breaking down more readily in wastewater treatment plants or natural waters. This is the essence of sustainable chemistry thinking, championed in the study by co-author Klaus Kümmerer: environmental benignity should be an intrinsic design property of a molecule, not an afterthought remediated at the end of the pipe.

The technical challenges involved should not be understated. Designing a greener API requires balancing multiple molecular properties that often pull in opposite directions. A compound must be stable enough to survive storage, gastric acid and plasma circulation, yet labile enough to degrade once excreted. It must be potent at low doses, which reduces the mass released into the environment, but selective enough to avoid harming non-target organisms. Degradation products themselves must be benign, since transformation in the environment does not guarantee detoxification. Quantitative frameworks for evaluating such trade-offs — combining predictive toxicology, biodegradability screening and environmental fate modelling with traditional pharmacological assessment — are still maturing, which is precisely why the study’s participants emphasised the need for shared evidence and harmonised guidance.

The study’s methodology has clear boundaries that the authors themselves acknowledge. Sixteen interviews cannot capture the full diversity of European healthcare systems, and qualitative content analysis identifies themes rather than measuring their statistical prevalence. The participants were also, by definition, professionals interested enough in the topic to discuss it, which may inflate the apparent enthusiasm. Nevertheless, the qualitative approach is well suited to mapping the decision landscape: it reveals how actors reason, where they feel empowered or blocked, and which interventions they consider legitimate. The authors explicitly conclude that future research should target the barriers identified and their potential solutions, translating the expressed willingness into concrete instruments — validated environmental criteria for tenders, standardised data formats from industry, and regulatory guidance for market authorisation.

What makes the study resonate beyond academic circles is its reframing of responsibility. Pharmaceutical pollution has often been portrayed as a problem of individual behaviour — patients flushing unused medicines — or of inadequate wastewater technology. This research shifts the focus to the professionals and institutions that decide which medicines enter the market and the clinic. Doctors, pharmacists, procurement officers and regulators collectively wield enormous leverage, and the study suggests they are prepared to use it. The transition to greener APIs will ultimately be won or lost in the chemistry itself, but the demand side, this research shows, is no longer waiting passively. If Europe’s regulatory reform aligns with the appetite its healthcare professionals have expressed, the next generation of medicines may be designed not only to heal patients, but to spare the environment that receives them.

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.

The article emphasizes a dual approach of optimizing healthcare delivery while concurrently minimizing carbon footprints. Over the years, healthcare systems have largely operated within a framework that prioritizes immediate patient care without adequately considering the environmental ramifications of medical practices. McAlister argues that as the medical community confronts rising carbon emissions associated with healthcare operations—everything from hospital energy consumption to the lifecycle of medical devices— there is a pressing need to embrace sustainable healthcare practices.

The first recommendation made by McAlister is centered around the importance of adopting evidence-based clinical pathways. These pathways streamline patient care while reducing unnecessary interventions that often lead to greater emissions. By focusing on high-value care, physicians can ensure that resources are allocated efficiently, ultimately benefiting both patient health and the environment. This approach embodies a paradigm shift away from quantity-driven care towards a model prioritizing quality and efficiency, which could lead to substantial decreases in healthcare-related carbon emissions.

Additionally, the article highlights the necessity of embracing telemedicine as a routine practice. The rise of telehealth demonstrates the capacity of technology to bridge gaps in patient access while simultaneously reducing carbon output linked to transportation. By facilitating virtual consultations, internists can not only maintain continuity of care but also diminish the carbon footprint associated with patient travel. McAlister notes that such integrations are not merely beneficial; they represent an ethical obligation in the face of the climate crisis.

As the article unfolds, it draws attention to the significance of preventative care. By emphasizing proactive health interventions, general internists can reduce the onset of chronic diseases that frequently lead to extensive and resource-heavy medical treatments. This conscientious shift not only fosters an environment of health but also curtails the emissions that health crises contribute. The long-term implications of prioritizing preventative care extend beyond individual patient outcomes; they encompass a broader societal responsibility to foster sustainable health systems.

The article further delineates the imperative of education and advocacy among healthcare professionals. McAlister stresses that general internists have a unique position to combat misinformation and instigate change in their communities. As influential figures, they can advocate for policies that promote environmentally friendly practices within healthcare institutions while encouraging patients to make informed choices about their health that consider both personal and planetary well-being.

One notable aspect of McAlister’s thesis is the call for interdisciplinary collaboration within healthcare settings. Clinicians from various specialties must work together to design integrated care plans that emphasize sustainability. By fostering an environment of collaboration, healthcare providers can share insights and strategies that not only enhance patient care but also advance vital ecological goals. This collective effort could serve as a model for the entire healthcare system, leading to holistic changes that resonate throughout the industry.

Moreover, the article discusses the role of medical education in shaping the future of healthcare practice. The existing curriculum must evolve to include training on sustainable practices, imprinting the values of climate-conscious care firmly into the next generation of physicians. By embedding these principles into medical education, future internists will be better equipped to navigate the complexities of patient care in an era marked by environmental challenges.

McAlister’s outlook extends to the importance of research and innovation in developing low-carbon technologies. The healthcare sector must invest in research directed towards sustainable solutions, such as biodegradable materials for medical use or energy-efficient hospital systems. Innovation not only aligns with healthcare goals but also contributes to a larger movement towards global sustainability, coordinating efforts across multiple sectors to address climate issues head-on.

As the narrative progresses, McAlister highlights the responsibility of healthcare institutions to adopt sustainable practices in their operations. From energy consumption to waste management, hospitals and clinics should implement strategies that reduce their environmental impact. This commitment to sustainability can inspire the entire community to acknowledge the role every individual plays in mitigating climate change, thus encouraging a ripple effect throughout society.

The discussions in the article culminate in a clarion call for adherence to ethical practices in medicine. Transparency in health care operations regarding environmental impacts is essential for fostering trust among patients and the public. As the healthcare sector grapples with the implications of its practices, embracing ethical standards aligned with sustainability will be crucial in solidifying the profession’s credibility and commitment to the greater good.

In conclusion, McAlister articulately lays out a transformative vision for healthcare that intertwines patient care with ecological responsibility. By emphasizing high-value, low-carbon practices, general internists can not only enhance patient health but also contribute meaningfully to the global effort of combating climate change. In an era defined by environmental urgency, the healthcare industry stands poised to make significant strides towards sustainability while simultaneously providing exemplary care. The road ahead will require dedication, innovation, and a collective commitment to change, but the potential rewards—both for patients and the planet—are immeasurable.

In the face of mounting evidence highlighting the dire state of the planet, McAlister’s insights serve as a pivotal reminder of the healthcare sector’s influential role in steering society toward a more sustainable future. The commitment to integrating low-carbon care principles challenges the status quo, encouraging a collective re-envisioning of what healthcare can and should accomplish.

Subject of Research: Sustainable Practices in General Internal Medicine

Article Title: Eight Ways General Internists Can Practice High-Value, Low-Carbon Care — A Missing Caveat

Article References:

McAlister, F.A. Eight Ways General Internists Can Practice High-Value, Low-Carbon Care — A Missing Caveat.
J GEN INTERN MED (2025). https://doi.org/10.1007/s11606-025-09954-0

Image Credits: AI Generated

DOI: https://doi.org/10.1007/s11606-025-09954-0

Keywords: Sustainability, General Medicine, Low-Carbon Care, High-Value Care, Climate Change, Healthcare Innovation, Preventative Care, Interdisciplinary Collaboration

The System for Change Award, one of the three accolades received, distinguishes health systems that have exhibited substantial leadership and commitment to embedding sustainability deeply within their organizational culture and daily operations. Out of nearly 400 hospital systems nationwide, Mount Sinai stands as one of a select group of 15 honored for this milestone. This award is not simply a badge of recognition but a reflection of the systemic transformation occurring at Mount Sinai, where sustainability principles are ingrained at all levels, from administrative practices to clinical protocols.

In parallel, several of Mount Sinai’s campuses were recognized with the Emerald Award, reserved for hospitals showcasing exceptional, advanced sustainability programs paired with tangible environmental performance outcomes. This accolade was conferred upon The Mount Sinai Hospital, Mount Sinai West, and Mount Sinai Brooklyn for their exemplary initiatives. These hospitals have implemented cutting-edge strategies that not only reduce their carbon footprint but also create healthier, more sustainable environments for patients, staff, and the surrounding communities.

The Partner for Change Award further highlights specific campuses within the Mount Sinai network exhibiting superior performance in environmental sustainability. Mount Sinai Morningside, Mount Sinai Queens, and the New York Eye and Ear Infirmary each received this honor for their commitment to continuous improvement in sustainability metrics. These distinctions collectively portray a health system-wide culture of innovation and responsibility toward ecological impact reduction.

Mount Sinai Green initiatives encompass a broad array of environmental priorities. Central to these efforts are waste reduction programs designed to minimize landfill contributions through comprehensive recycling and repurposing protocols. Simultaneously, energy efficiency programs leverage data-driven technologies to optimize resource use, including the integration of waste heat recovery systems in data centers—a pioneering step in reducing overall energy consumption and greenhouse gas emissions. These technical implementations showcase Mount Sinai’s investment in scalable, innovative solutions that marry operational efficiency with environmental goals.

The synergy between Mount Sinai’s sustainability agenda and its scientific research is notable. Scientists at the Icahn School of Medicine at Mount Sinai are actively investigating the intricate relationships between environmental exposures and human health outcomes. This research informs clinical and organizational practices that prioritize environmental determinants of disease, underscoring the interconnectedness of planetary health and patient care. By aligning sustainability with cutting-edge biomedical research, Mount Sinai sets a model for evidence-based environmental stewardship in healthcare.

Leadership voices at Mount Sinai emphasize that environmental responsibility transcends regulatory compliance—it is intrinsic to delivering high-quality patient care. The Medical Director of Sustainability, Dr. Muoi A. Trinh, articulates a vision where safer and healthier environments promote healing while reducing risks associated with environmental hazards. This philosophy guides new sustainability initiatives aimed at enhancing indoor air quality, reducing harmful emissions, and implementing greener procurement policies.

Mount Sinai’s executive leadership is also propelling the system forward by committing to ambitious climate targets. Signing the New York State Insurance Fund Climate Action Pledge, the health system is dedicated to halving its emissions by 2030 and achieving net-zero status by 2050. This strategic framework encompasses not only emission reductions but also bolstering campus resilience to climate impacts, a crucial consideration given the increasing frequency of extreme weather events that threaten healthcare infrastructure.

Future efforts will include a refined supplier engagement program, in which carbon emissions embedded in the supply chain will be rigorously tracked and scored. The emphasis on addressing upstream environmental impacts represents a sophisticated understanding that healthcare sustainability must extend beyond direct facility operations to encompass the full lifecycle of medical products and pharmaceuticals. Particularly innovative is Mount Sinai’s intention to promote the use of lower carbon medications, a frontier in sustainable clinical pharmacology.

Technology-driven solutions remain a cornerstone of Mount Sinai’s approach. The innovative application of waste heat recovery systems—capturing and reutilizing thermal energy generated by data center operations—is an example of the hospital’s commitment to integrating advanced engineering solutions for environmental gains. These cutting-edge technologies not only reduce operational costs but also position Mount Sinai as a leader in sustainable healthcare infrastructure design.

Moreover, Mount Sinai Health System actively participates in collaborative networks, such as Practice Greenhealth, which provide platforms for sharing best practices and benchmarking sustainability progress. This membership facilitates ongoing learning and leadership within the healthcare sector’s climate action movement, further amplifying the impact of Mount Sinai’s initiatives on a national scale.

The comprehensive sustainability strategy Mount Sinai pursues resonates beyond environmental benefits; it directly interfaces with equitable health outcomes. By fostering greener, healthier hospital environments and communities, the institution champions a model where ecological and social determinants of health converge, driving improved wellness and resilience for vulnerable populations.

Ultimately, Mount Sinai’s environmental achievements signify an essential evolution in healthcare philosophy—a shift toward embracing ecological responsibility as a foundational element of medical excellence and public health advocacy. As climate change continues to pose unprecedented challenges, Mount Sinai exemplifies how healthcare systems can lead transformative change, not only healing patients but also healing the planet.

Subject of Research: Environmental sustainability and climate action initiatives in healthcare systems

Article Title: Mount Sinai Health System Sets National Benchmark with Triumphant Environmental Excellence Awards

News Publication Date: June 9, 2025

Web References:

• Mount Sinai Facebook
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Keywords: Environmental issues, Sustainability, Greenhouse gases, Climate change, Environmental impact assessments, Environmental policy