Why climate change matters to GI

In this special bonus episode of Small Talk Big Topics, hosts Drs. Matthew Whitson and CS Tse are joined by Drs. Nitin Ahuja, assistant professor of clinical medicine at the University of Pennsylvania and Amit Patel, an esophagologist and associate professor of medicine at Duke University, for a conversation about the impact of gastroenterology and the environment.

To kick off the episode, Drs. Ahuja and Patel introduce themselves and share how they became interested in the convergence of GI and climate change. Dr. Patel became interested in green endoscopy when he learned about the topic in his cohort in the AGA Future Leaders Program. (It was during the AGA Future Leaders Program that Dr. Whitson and Dr. Patel connected and first began examining the connection between climate change and GI.) For Dr. Ahuja, he initially became interested in the topic outside of his professional work and has since tied in his work in GI and authored numerous papers on the subject. The professional connection came when he realized there are real stakes for health in climate change that nobody was talking about.

The guests start off the conversation by discussing how GI interacts with climate change. They point out the intersections of the two realms with clean water availability, nutrition and food security and healthcare infrastructure and access. Healthcare is a significant contributor to climate change because of its own massive carbon footprint. Upwards of 20 million endoscopies are performed each year and every procedure utilizes single use products, chemical waste and more. There is a lot of overuse in the endoscopic procedures and minimizing unnecessary procedures based on guidelines and evidence is one of the most important first steps to take as an industry. Even just the chemicals used to sterilize the scopes often generate lots of waste. Having more robust and granular data will help us generate more evidence-based roadmaps and approaches for best practices for reducing our carbon footprint while delivering quality care to patients.

After outlining the various ways endoscopy and hepatology are influencing climate change, our guests share how climate change will affect patients. Aside from clean water availability and food security, mental health is also associated with GI diseases. Gastroenterologists are physicians first and foremost and should be thinking of health as a collective good. The downstream negative effects of climate change include microbial changes, respiratory illnesses, heat-related illness, cardiovascular disease and various others.

There are already efforts underway to implement a sustainable roadmap forward for GI, which includes the strategic plan put forward by the four major GI societies: AGA, ACG, AASLD and ASGE. The most exciting thing about the efforts has been embracing creative collaborations with industry to drive decision making. Even the smallest acts of mindfulness in the endoscopy space, such as minimizing single use jars and choosing deliberately between tools, are great and should be backed by society-based guidelines. Compared to years prior, there is now a spotlight being placed on this issue.

Before wrapping up, Drs. Ahuja and Patel pitch why people should care about GI and climate change. They remind listeners that if we do not care and do our part, then we will not be able to practice GI in the future, and while it might not affect our generation, it absolutely will affect those coming after us.