May/June 2019 Bulletin: Environmental Health Issues

May / June 2019

Volume 25 | Number 3

GEARING UP FOR YOUR FINANCIAL SUCCESS

Balancing your financial goals and beginning your practice is challenging, especially in the Bay Area.

We've brought a specialist who has both knowledge and expertise in designing strategies to help you overcome your financial challenges and help you achieve your financial goals.

Topics to be discussed: Fundamental keys to your financial success.

Student loans and their repayment options Principals to be a successful investor Case study of a new in practice physician Q&A Our expertise is helping make your biggest and most difficult financial questions simple and solvable. Our focus of working with physicians gives us the unique perspective to know your challenges and our experience allows us to design solutions to help you accomplish your financial goals.

IT PAYS TO GET DIRECTIONS IN ADVANCE, SO JOIN US Thursday, July 25th from 6 to 8 pm Hors D'oeuvres Provided Hosted by the Santa Clara County Medical Association 700 Empey Way San Jose, CA 95128 Presented By: R. Anthony DiRegolo II, CFP®, CLU® anthony.diregolo@sgc-financial.com

Get moving on your ROUTE TO SUCCESS! RSVP today to Sameera Manucher at Sameera@sccma.org or (408) 998-8850 ext. 3011

R. Anthony DiRegolo II is a registered representative and investment advisor representative of Securian Financial Services, Inc. Securities and investment advisory services offered through Securian Financial Services, Inc. Member FINRA/ SIPC. SGC Financial Services is independently owned and operated. CA license number 0F66862. *Santa Clara County Medical Association is not affiliated with SGC Financial or Securian Financial Services.

TR #2403509 and DOFU 02-2019

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The Bulletin May / June 2019

Regenerative Farming for the Future MEMBER BENEFITS

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Collections CME Tracking Discounted Insurance Financial Services Health Information Technology Resources

In This Issue

House of Delegates Representation Human Resources Services Legal Services/ Health Law Library Legislative Advocacy/MICRA Membership Directory APP for the iPhone Physicians’ Confidential Line Practice Management Resources and Education Professional Development Publications Referral Services With Membership Directory/Website Reimbursement Advocacy/ Coding Services

Featured Articles 7 Medical schools must prepare students to work in a world altered by climate change 8 House on Fire: The 10-Year Plan for the Climate CrisisClimate Action and Climate Justice 13 Individual Choices: What are the Most Effective Actions to Combat Climate Change?

14 The Medical Society Consortium on Climate Change 18 Regenerative Farming for the Future 25 California Legislation on Climate Change 26 Physicians' Guide to Climate Change

Departments 2 Gearing Up For Your Dream Retirement Workshop 6 Message From the SCCMA President 29 Classified Ads 30 In Memoriam

May / June 2019  The Bulletin

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The Santa Clara County Medical Association OFFICERS

CHIEF EXECUTIVE OFFICER

COUNCILORS

President

April Becerra, CAE

El Camino Hospital of Los Gatos:

President-Elect

CMA TRUSTEES - SCCMA

El Camino Hospital:

Past President

Thomas M. Dailey, MD (District VII)

Good Samaritan Hospital:

VP-Community Health

Kenneth Blumenfeld, MD (District VII)

Kaiser Foundation Hospital - San Jose:

Kenneth Blumenfeld, MD Seema Sidhu, MD Seham El-Diwany, MD Cindy Russell, MD

Lewis Osofsky, MD Gloria Wu, MD

Vinit Madhvani, MD

Hemali Sudhalkar, MD

VP-External Affairs

Kaiser Permanente Hospital:

VP-Member Services

O’Connor Hospital:

VP-Professional Conduct

Regional Medical Center:

Secretary

Saint Louise Regional Hospital:

Treasurer

Stanford Health Care / Children's Health:

Erica McEnery, MD

Open

Randal T. Pham, MD Faith Protsman, MD Martin Wong, MD Anh Nguyen, MD

Cathy Angell, MD

Heather Taher, MD

Scott Benninghoven, MD John Brock-Utne, MD

Santa Clara Valley Medical Center:

Clifford Wang, MD

The Monterey County Medical Society Printed in U.S.A.

OFFICERS

Managing Editor

Maximiliano Cuevas, MD

Sameera Manucher

Opinions expressed by authors are their own, and not necessarily those of The Bulletin, SCCMA, or MCMS. The Bulletin reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted in whole or in part. Acceptance of advertising in The Bulletin in no way constitutes approval or endorsement by SCCMA/MCMS of products or services advertised. The Bulletin and SCCMA/MCMS reserve the right to reject any advertising.

Address all editorial communication, reprint requests, and advertising to: Sameera Manucher, Managing Editor 700 Empey Way San Jose, CA 95128 408/998-8850, ext. 3011 Fax: 408/289-1064 sameera@sccma.org © Copyright 2019 by the Santa Clara County Medical Association.

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President

President-Elect

Vacant

Past-President

Craig Walls, MD PhD Secretary

Alfred Sadler, MD Treasurer

Steven Harrison, MD

CHIEF EXECUTIVE OFFICER April Becerra, CAE

DIRECTORS E. Valerie Barnes, MD David Holley, MD Jeffrey Keating, MD William Khieu, MD

Walter Mills, MD James Ramseur, MD Stephen Saglio, MD

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Surprise!

President, Santa Clara County Medical Association

KENNETH S. BLUMENFELD, MD, FAANS

MESSAGE FROM THE

SCCMA PRESIDENT

W

Kenneth S. Blumenfeld, MD, FAANS is the 20182019 president of the Santa Clara County Medical Association.

He is a board-certified Neurological Surgeon with Sutter Health/Palo Alto Medical Foundation and is currently practicing with South Bay Brain and Spine. He also is adjunct clinical professor in Neurological Surgery at UCSF.

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hen I started my career, I, like any other professional or contractor, would submit a bill for services rendered. Payment was expected and deserved. For those that couldn’t afford the bill, I would arrange a payment plan, reduce the bill and in some cases simply write off the costs altogether.

Then came insurers. After all, everyone needs a “middle man” and a plan B catastrophic plan. That worked for a while until the middle man became the main man. It’s one thing to agree to a contracted rate, it’s another to be told what your services are worth.

So along came the practice of billing patients for services rendered not covered by insurers or provided by the doctors with whom they contracted.

While it is true that some doctors chose to avoid contracts and overbill, most sought only fair reimbursement – either through contracts negotiated in good faith or researched and validated fair balance billing of out of network and emergency services.

With market consolidation and the evolution of insurance oligopsony, the tables have finally tipped beyond survivability for many doctors. Insurers complain loudly of risk, which in reality translates not to risk of loss but rather to how much profit and margin they will appreciate. Hospitals who have enjoyed regular increases in reimbursement from CMS and private payors continue to cost shift and reap profits.

But doctors, particularly those in private practice, have no cover or recourse. The result is not unfair or unjust; it is unsustainable. Physicians have become victimized by bureaucracy, price fixing, and untenable and blatantly skewed antitrust regulations. When two to three insurers that control 80% of the market can conspire, and two doctors can’t collectively negotiate without being guilty of collusion, something is wrong.

Many might interpret this editorial as selfserving, but in truth, it’s not. It is driven by the deep belief that it is the doctors of California, and across this nation, who truly care about patients. It’s a sad and irreconcilable day when we agree to trust insurance companies and the government more for our health

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than physicians. I’ve heard people accuse physicians of being “in it for the money.” In rare cases it may be true. But let me ask how many insurance company executives are motivated to improve the health and well-being of its members? I would argue they are primarily interested in margins, profits, and happy shareholders.

Perhaps most importantly, this editorial is a reaction to the current push in Washington, DC to tackle the “surprise billing issue.”

Front and center in the media have been a three-way finger-pointing drama made for TV involving insurance companies, the American Hospital Association and doctors largely represented by the American Medical Association. From this doctor’s perspective, it is clear where the true and righteous path lies.

It is also clear where political power nests and campaign contributions arise.

I am convinced that organized medicine and their grassroots physicians need to mount an all-hands-on-deck approach to the rising threat of federal legislation that will irreparably tip the scales beyond repair in favor of those that seek only for profit. We cannot, and must not, be misrepresented. While we can all agree on keeping insured patients out of the middle of reimbursement disputes, we shouldn’t accept current proposals for “network matching” or single bundled hospital payments. I would similarly question proposals for payments based on average innetwork contracted rates or a percentage of Medicare, especially for emergency care. Allowing insurers this leverage is paramount to giving the fox the keys to the hen house. As California physicians, we have seen first-hand the abuses that came in the wake of AB 72.

Thankfully we have had the help of the California Medical Association and its Center for Economic Services.

I would urge all physicians, regardless of their mode of practice, to wake up and be vocal on this issue. We cannot go quietly into the night on this one. We may have lost the narrative on balance billing for services rendered now renamed “surprise billing” but can’t afford to lose the battle. Generally, I like surprises but not this one.

Medical schools must prepare students to work in a world altered by climate change

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By Anna Goshua

s a medical student fumbling with the fundamentals of interviewing patients and taking medical histories, the realities of being a doctor seem like a far-off dream. My colleagues and I work hard to prepare ourselves to be equipped to address the increasingly complex health care issues that will affect the lives of our future patients, from inequities in access to quality care to multidrug resistance.

The most pressing of these issues is climate change, a growing environmental emergency that will have devastating health impacts. Food shortages induced by climate change are alone expected to account for more than 500,000 additional deaths globally by 2050. Regardless of their personal interest in climate change or their belief that advocacy about it is within the scope of medical practice, physicians will be on the front lines of confronting its effects.

Action on climate change has been paralyzed by denial, misunderstanding of its urgency, and a sense of powerlessness in the face of an existential threat. This is why it is especially important for medical schools to integrate climate change into their curricula so future physicians understand the challenges and are prepared to use their positions as care providers, educators, and advocates to tackle this threat.

Yet a recent search of the Association of American Medical Colleges Curriculum Inventory showed that no medical schools report including content related to climate change.

Some schools have begun to address this gap. The University of California, San Francisco, for example, has introduced elective courses covering topics such as food security and sustainability. It also integrated case studies on global climate change into a mandatory first-year course.

“Global warming is the biggest public health threat of the 21st century and is going to change life on earth as we know it. It is an essential part of any 21st century medical school curriculum,” said Dr. Thomas Newman, co-founder of a Climate Health and Inquiry course launched in 2017, in a UCSF article about the course.

Medical schools already have what some see as overloaded curricula. It is difficult to argue that they should add more material. Yet the medical curriculum lends itself to promoting eco-medical literacy and sustainability over all four years of education. During the preclinical years, this could take the form of connecting pathophysiology to climate, such as how climate change contributes to cardiovascular disease. A health policy course could be an opportunity to discuss relevant climate change policy action and opportunities for student engagement. During clerkships, the focus could be on how to identify and communicate with patients who are especially vulnerable to the effects of climate change, as well as diagnose and manage climate-related physical and mental health issues.

There are at least three major ways that climate change will affect the practice of medicine and for which medical education must prepare future physicians.

First, climate change will directly and indirectly affect individual and population health. Extreme weather events like drought affect physical and mental health, but also affect social determinants of health such as water and food security, air quality, and housing. Given that marginalized communities are most susceptible to the effects of climate change, it will widen existing health disparities. Physicians will need to work with patients to manage climate-induced health burdens, educate them about their risk factors, and help them develop contingency plans in case of environmental emergencies.

Second, climate change will require an unprecedented degree of adaptation to unexpected and changing threats. Diseases previously thought to be unrelated to climate, like chickenpox, are turning out to be climate sensitive. The geographic distribution and seasonality of various infectious diseases will change. Extreme weather events of increasing severity will strain our capacity to deliver care. Future physicians must be prepared to handle these challenges in both the clinical setting and, more broadly, work collaboratively within their communities to plan and implement preemptive strategies.

Third, physicians and the rest of the health care sector must be aware of and accountable for their collective contributions to climate change. The U.S. health system is the seventh-largest producer of carbon dioxide globally. It released 614 million metric tons of carbon dioxide equivalents in 2013, which would generate between 123,000 and 381,000 disability-adjusted life years of adverse health effects in the future.

My generation of physicians must envision a new sustainable health system to reduce its substantial carbon footprint. Possibilities include expanding telemedicine, integrating environmental impacts into cost-benefit analyses of health services, and committing to carbon neutrality. Future physicians must also advocate for changes to health infrastructure that make health care facilities more resilient to climate damage. Without physicians lobbying for the greening of the health system, the good we accomplish could be outpaced by the damage we inflict.

Climate change is the context in which today’s medical students will practice medicine. This threat will intersect with every facet of our patients’ lives and impose barriers to health delivery we will have to navigate. Medical students can’t afford the luxury of choosing to be interested in climate change the way we will select our medical specialties. It is an urgent reality we must confront with the knowledge and skills we acquire in order to innovate, advocate, and care for patients and communities affected by climate change.

Anna Goshua is a first-year medical student at Stanford University School of Medicine.

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Cindy Russell, MD, SCCMA VP of Community Health

“We must never forget that the natural environment is a collective good, the patrimony of all humanity and the responsibility of everyone.”

Pope Francis

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limate change is upon us and evident by most who are witnessing extreme weather events, shifting habitats of species on land and in the seas, spring flowers that bloom weeks earlier and unusual disease outbreaks. It is now a climate crisis. Who is sounding the alarm?

Many people, but in particular, Swedish teenager Greta Thunberg, whose astonishing “House on Fire” speech at the 2019 World Economic Forum went global. Although less well publicized, physicians in the House of Medicine have agreed for some time that the house really is “on fire”. They are taking steps to address this issue on a large scale. After all, the U.S. health care system is the fifth-largest economy ($3.5 trillion annually just above the UK) and the seventh-largest producer of carbon dioxide in the world according to a Commonwealth Fund study.

We are a large part of this problem and we can have a large impact in solving it. Groups that have brought awareness to this issue include the AMA, the CMA, The Medical Society Consortium on Climate and Health, the American Lung Association, Physicians for Social Responsibility and passionate medical students who will be in the front lines of this crisis soon. Respected organizations such as Health Care Without Harm and Practice Green Health have been calling for consideration of a full cradle-to-grave life cycle evaluation of sources of greenhouse gases (GHG) including material inputs, manufacturing, transportation, emissions and disposal, evaluating often overlooked embedded energy and fossil fuel use.

“AMA TO PROTECT HUMAN HEALTH FROM THE EFFECTS OF CLIMATE CHANGE BY ENDING ITS INVESTMENTS IN FOSSIL FUEL COMPANIES”

The Board of Trustees recommends that 1. Our American Medical Association, AMA Foundation, and any affiliated corporations work in a timely, incremental, and fiscally responsible manner, to the extent allowed by their legal and fiduciary duties, to end all financial investments or relationships (divestment) with companies that generate the majority of their income from the exploration for, production of, transportation of, or sale of fossil fuels; and 2. that our AMA choose for its commercial relationships, when fiscally responsible, vendors, suppliers, and corporations that have demonstrated environmental sustainability practices that seek to minimize their fossil fuels consumption; and 3. that our AMA support efforts of physicians and other health professional associations to proceed with divestment, including to create policy analyses, support continuing medical education, and to inform our patients, the public, legislators, and government policy makers.

SCHOOL STRIKE FOR CLIMATE: A 10-YEAR TIME PLAN FOR DRASTIC CHANGES

Who else has a large stake in climate change action and “A climate crisis is also a health crisis…” is getting widespread press?

A teenager who has become Linda Rudolph, MD, a symbol of hope as well as a New York Times Letter to the Editor, May 2014 timekeeper over the next 10 Leadership at the AMA years, the most critical period level has done much to supto make dramatic societal changes in how we do everything port the effort to educate and accelerate action to combat to address climate change. climate change. With input from other medical societies the Swedish schoolgirl Greta Thunberg, at age 15, decided American Medical Association in 2008 adopted the following that no adults were in the room when she began protesting resolution outside the Swedish parliament, sitting alone on the steps 1. endorse the findings of the 4th Intergovernmental with a simple message, “School Strike for Climate”, painted on Panel on Climate Change; a wooden board. Since that summer of 2018 her eloquence, 2. support research to explore the human health effects clarity, and passion has ignited a fire among those in her genof climate change; eration and beyond to honestly address climate change and 3. support state, federal and international policy make all of us aware of the truly short timeframe we have to coordination to develop adaptive strategies to make bold changes to preserve our living planet. We have respond to the predicted human health effects of 10 years left. The Intergovernmental Panel on Climate Change climate change; and 4) encourage Congress and the (IPCC) 2018 report made it clear that drastic reductions (50% President to adopt national and international policies to 85%) in CO2 need to be in place by 2030 to prevent the to reduce the emissions of greenhouse gasses.”

More recently the AMA voted to end divestment in fos- worst scenario of climate change which is a global rise in temperature above 1.5 degrees Celsius. sil fuels, joining the Canadian Medical Association, the British After learning about the realities of climate change in 8th Medical Association and the World Medical Association. The grade, Greta asked herself why this was not the only topic of following resolution was passed in 2018.

THE AMA FIGHTING CLIMATE CHANGE AND ENDING DIVESTMENT IN FOSSIL FUELS

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conversation in the news and date 93 co-sponsors of the “The American Medical Association played in government chambers. Her non-binding resolution. While sit in’s led to media attention a crucial role in changing public perception politicians are in a not uncomand then to speaking engagemon state of disagreement, of the tobacco industry, and now they’re ments at the 24th Conference the American public seems of the Parties (COP24) UN doing it again. They know that the greatest to be more on the same track.

Climate Summit in Poland in The Yale Program on Climate threat to public health in the 21st century Dec 2018, the European EcoChange Communication pernomic and Social Committee formed a public opinion poll is a fast-heating climate. ” in Feb 2019 and the European of elements of the GND in Bill McKibbon, Founder of 350.org Commission in April 2019. Her December 2018 without indispeeches are now extensively cating which political party quoted. She even met Pope the policy recommendations Francis in St Peter’s square in Rome April 17, 2019 to thank him came from. It found that 92% of Democrats and 64% of Refor his efforts on climate stabilization. publicans were in favor of the policy goals as stated. Another intriguing finding was that 82% of registered voters had never FRIDAYS FOR THE FUTURE heard of the GND. Greta has inspired youth around the world to participate WHY THE GREEN NEW DEAL? in Fridays for the Future school strikes. She has vowed to conThe Green New Deal introduced in congress notes that tinue skipping school herself every Friday, asking others to “climate change is a threat to national security “ and, without join her protest against inaction, until Sweden is in line with drastic action in 10 years we will suffer; the Paris agreement.

■■ Loss of coral reefs One of the largest Friday school strikes went worldwide ■■ Expose 350 million people to heat stress by 2050 March 15, 2019, when students in over 100 countries participat■■ $500 Billion annual loss of economic output in the US ed, according to news reports. In San Francisco, the “Youth vs by 2100 Apocalypse” rally brought together over 1,000 students from ■ ■ $1 Trilion dollar loss of public infrastructure and real the Bay Area who marched to the Federal building and Nanestate damage in the US cy Pelosi’s office to call for a “Green New Deal”. They asked WHAT IS THE GREEN “We are School striking because we have leaders to understand the curNEW DEAL? done our homework.” rent crisis, listen to scientists The 2018 Green New Deal and take action. Greta has Greta Thunberg is a 10-year plan to tackle now completed a book, “Join climate change with rapid Us”. The now 16-year-old climobilization of projects that mate activist was recently nominated for a Nobel Peace Prize. combine carbon neutral thinking with equity and environIt is both shocking and inspiring to hear her speeches. Rarely mental justice. The proposal calls for new infrastructure, new do we hear such unvarnished truth. I recommend watching national standards for energy efficient appliances, increased her speech at the UN Climate Summit. renewable energy, increased public transportation, zeroemission vehicles, restoring ecosystems, agricultural shifts to THE GREEN NEW DEAL: IMPROVING THE sustainable farming practices and raising wages PLANET’S PROGNOSIS In Washington, some lawmakers are looking at strategies to immediately address this issue by transforming society economically. The Sunrise Movement leaders put the New Green Deal on the map and then the real conversation began in communities and in congress on how this would be done.

The goal is to transition our society to a clean energy future without fossil fuels and produce truly “Green businesses” that provide “Green jobs” that will put our planet on a drastic carbon reducing diet. Win-win situation for business, the planet and the people who depend on it.

GND: ENVIRONMENTALISTS AGREE TO PHASE OUT FOSSIL FUELS BUT DISAGREE ON CARBON SINK

There are many aspects of a New Green Deal to work out and, as expected, there are a variety of opinions as to how this should be done. One thing environmental groups agree on is ending coal, gas and oil use, which is a centerpiece of the GND. In a letter to congress they ask to: ■■ End fossil fuel subsidies ■■ End selling or leasing of public lands, public water and minerals for oil and gas exploration and extraction HOUSE RESOLUTION 109 –“RECOGNIZING ■ ■ Stop approval of fossil fuel power plants THE DUTY OF THE FEDERAL GOVERNMENT ■ ■ Expand public transportation TO CREATE A GREEN ■■ Expand the Clean NEW DEAL” Air Act to reduce vehicle House Resolution 109 was “Denial is Not a Policy” emissions introduced to congress on ■ ■ Reinstate the 40Student Climate Strike sign Feb 7, 2019. There are as of this year ban on crude oil exports

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Phase out gas powered vehicles by 2040 Transition to 100% renewable, zero emissions energy sources Uphold indigenous rights

ENVIRONMENTAL GROUPS AND LEADERS SPLIT ON CARBON CAPTURE AND STORAGE

“The only solution that matches the scale of our multiple crises, including global warming, corporate control of our food system, income inequality, and the general decline of our environment and our democracy...”

Ronnie Cummins, Organic Consumers Association, commenting on the GND

to continue to explore and develop gas and oil projects rather than using these funds to subsidize the conversion to renewables. The oil and gas industry has already left us a toxic legacy of environmental pollution with contamination of water, air and soil, as well as habitat loss in the pursuit of fossil fuels. This will continue even if CO2 is captured and stored.

WILL CARBON CAPTURE AND STORAGE

The IPCC 2018 indicates that just reducing CO2 released EVEN WORK? into the atmosphere is not enough. They state that we need to There are challenges to removing carbon dioxide from capture CO2 back into the earth. This could be done through the atmosphere. CO2 is not very reactive and is very dilute in changes in forestry and agriculture practices, which are the the atmosphere, thus a large amount of energy is needed to second largest sources of GHG after transportation. Indusremove it. A true life-cycle analysis is needed to make sure try however has already started capturing and storing some more CO2 is removed in the process than CO2 created tryof this man-made CO2 underground, with 4 major industrial ing to solve the problem. It is argued that CO2 may also make scale projects now operating in the world. They have created its way back up to the surface pipelines to transport the CO2 both in stored formations and and put it back in oil wells in in oil wells drilled using CO2 “We are faced not with two separate crises, a process called “enhanced for “enhanced recovery.” one environmental and the other social, oil recovery” to drive the proUnfortunately, much of duction of even more oil. They but rather with one complex crisis which is oil and gas drilling occurs on can also sink it deep into the public lands. About 90% of both social and environmental. Strategies ground or ocean. The CarBureau of Land Management bon Capture and Storage Asfor a solution demand an integrated (BLM) land is open for drilling, sociation (CCSA) states, “The with almost 3 out of 4 leases approach to combating poverty, restoring International Energy Agency obtained anonymously.

(IEA) estimates that energy dignity to the excluded, and at the same demand could increase by as CAPTURING CARBON time protecting nature.” much as 45% by 2030. Much IN THE SOIL: of this will be met by fossil REGENERATIVE The Pope’s Encyclical Chapter 4, paragraph 139 fuels. Carbon Capture and FARMING AND FORESTRY Storage (CCS) will allow us to Sequestering carbon can be a relatively inexpensive vencontinue using fossil fuels while also substantially reducing emissions of greenhouse gas emissions to the atmosphere.” ture spread out among all farmers. Regenerative farming is a new term for farming that combines aspects of organic farmThe soda industry also uses CO2 released from fossil fuels for ing, sustainable farming and biodynamic farming that build soft drinks. the soil structure, capturing carbon in living soil biomass. It CARBON CAPTURE: A GREEN LIGHT FOR contrasts with large factory farming which uses synthetic inINDUSTRY TO USE PUBLIC LANDS TO DRILL puts and causes top soil losses as well as water and air polluFOR OIL AND GAS? tion.

Within the 2018 Bipartisan Budget Act (45Q) passed by The use of fossil fuels is the number one driver of climate congress are increased tax credits for companies to capture change. If we do not adopt policies and actions to switch to loand store carbon as well as removal of the 75 million-ton cap cal or regional renewable energy alternatives we will just conon the total amount of CO2 injected underground. Major envitinue to frack our farms, our families and our future. ronmental groups such as the Sierra Club, NRDC, Greenpeace and the Center for Biological Diversity originally were in favor REFERENCES ■■ Disseminated of the bill but later withdrew coccidioidomycosis as their support of industrial a harbinger of climate “If we are to keep global warming below carbon capture and storage Coates and Fox. for several reasons. This will 1.5°C, we must act aggressively and quickly.” change.

JAAD Case Rep. 2018 Jun; be a green light incentiviz4(5): 424–425. https://www.

IPCC ing the fossil fuel industry

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ncbi.nlm.nih.gov/pmc/articles/PMC6031605/ Spring Came Early. Scientists Say Climate Change Is a Culprit. White and Fountain. NYT. March 8, 2017. https://www.nytimes.com/interactive/2017/03/08/ climate/early-spring.html Union of Concerned Scientists. Climate Hot Map. Global Warming Effects Around the World. https:// www.climatehotmap.org/global-warming-effects/ ocean-temperature.html Health Care’s Climate Footprint. https://noharmglobal.org/issues/global/health-care’s-climatefootprint Global Carbon Atlas. Healthcare Contribution to CO2 emissions. http://www.globalcarbonatlas.org/en/CO2emissions Estimate of the Carbon Footprint of the US Health Care Sector. November 11, 2009. JAMA Research Letter. Chung and Meltzer. https://jamanetwork.com/ journals/jama/fullarticle/184856 U.S. national health expenditure as percent of GDP from 1960 to 2019. Statista. https://www.statista.com/ statistics/184968/us-health-expenditure-as-percentof-gdp-since-1960/ The US Health Care Sector’s Carbon Footprint: Stomping or Treading Lightly? Howard Frumkin.

Am J Public Health. 2018 April; 108(Suppl 2): S56– S57. https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC5922200/ Estimated Global Disease Burden From US Health Care Sector Greenhouse Gas Emissions. Matthew J. Eckelman, PhD and Jodi D. Sherman. Am J Public Health. 2018 April; 108(Suppl 2): S120–S122. https:// www.ncbi.nlm.nih.gov/pmc/articles/PMC5922190/ 350.org Applauds American Medical Association Decision to Divest Financial Holdings from Fossil Fuels. https://350.org/press-release/americanmedical-association-divests/ Life cycle greenhouse gas emissions of anesthetic drugs. Sherman J1, Le C, Lamers V, Eckelman M. Anesth Analg. 2012 May;114(5):1086-90. https://www. ncbi.nlm.nih.gov/pubmed/22492186 Carbon Footprinting of North American Emergency Medical Services Systems. Blanchard and Brown.

Prehospital Emergency Care. 16 Feb 2011. https://www. ncbi.nlm.nih.gov/pubmed/20874502 The World’s Top 20 Economies. 2019. Investopedia. https://www.investopedia.com/insights/worlds-topeconomies/ Center for Medicare and Medicaid Services. https://www.cms.gov/research-statisticsdata-and-systems/statistics-trendsand-reports/nationalhealthexpenddata/ nationalhealthaccountshistorical.html Climate Change: Ocean Heat Content. LuAnn Dahlman and Rebecca Lindsey. https://www.climate. gov/news-features/understanding-climate/climatechange-ocean-heat-content 10 Years In, Has California’s Climate Law Really Lowered Emissions? https://www.kqed.org/ science/1010716/10-years-in-has-californias-climatelaw-really-lowered-emissions

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H.Res.109 - Recognizing the duty of the Federal Government to create a Green New Deal. https:// www.congress.gov/bill/116th-congress/houseresolution/109/text The Green New Deal Hits Its First Major Snag. A key activist group has quietly dropped its support for carbon-capture technology, which scientists say will be crucial to fighting global warming. Jan 18, 2019. Robinson Meyer. https://www.theatlantic.com/ science/archive/2019/01/first-fight-about-democratsclimate-green-new-deal/580543/ The Green New Deal has Strong Bipartisan Support.

Yale program on Climate Change. Dec 14, 2019. https:// climatecommunication.yale.edu/publications/thegreen-new-deal-has-strong-bipartisan-support/ Explore 10 years of climate change opinion. Yale Program on Climate Change communication. 10 years of climate change opinion data. https:// climatecommunication.yale.edu Letter to Congress from 626 Environmental Organizations to support a Green New Deal. https:// www.eenews.net/assets/2019/01/10/document_ daily_02.pdf Carbon Capture and Storage Association(CCSA).

Industry experience. http://www.ccsassociation.org/ why-ccs/industry-experience/ Tackling climate change. CCSA. http://www. ccsassociation.org/why-ccs/tackling-climate-change/ Why Green Groups Are Split on Subsidizing Carbon Capture Technology. April 9, 2018. Richard Conniff. https://e360.yale.edu/features/why-green-groups-aresplit-on-subsidizing-carbon-capture-technology WWF. Forests and climate Change. http://wwf. panda.org/our_work/forests/climate_change_and_ forest/ The Causes of Climate Change. https://climate.nasa. gov/causes/ An FAQ on 45Q: What federal carbon storage tax credit means for Midwest. https://energynews. us/2018/07/10/midwest/an-faq-on-45q-what-federalcarbon-storage-tax-credit-means-for-midwest/ Carbon Capture and Sequestration (CCS) in the United States. https://fas.org/sgp/crs/misc/R44902. pdf Will Carbon Capture and Storage Ever Work?

Scientific American. May 25, 2017. Umair Irfan. https:// www.scientificamerican.com/article/will-carboncapture-and-storage-ever-work/?redirect=1 7 ways oil and gas drilling is bad for the environment https://www.wilderness.org/articles/ article/7-ways-oil-and-gas-drilling-bad-environment Who’s nominating your public lands for oil and gas leasing? Most of the time, there’s no way to tell.

Nov 5, 2018. https://medium.com/westwise/whosnominating-your-public-lands-for-oil-and-gas-leasingd68af59a7025 Fracking Our Farmland, Our Families and Our Future: A New Toxic Legacy Cindy Russell, M.D. http://www.sccma-mcms.org/Portals/19/assets/docs/ fracking.pdf

Individual Choices: What are the Most Effective Actions to Combat Climate Change?

“Be the change that you wish to see in the world.”

- Mahatma Ghandi Cindy Russell, MD VP of community Health SCCMA While we all are aware that action is needed to reduce our carbon footprint, just what are the best and most effective changes we can make? Is it up to governments or individuals?

Although there are a variety of opinions, all acknowledge both are necessary… and we need to fill gaps in education to address them.

Seth Wynes and Kimberly Nicholas from the University of British Columbia-Vancouver tackled the question of the most impactful lifestyle changes one can adopt to reduce greenhouse gas emissions. They categorized them into high impact, medium impact and low impact measures people could incorporate into their everyday lives. Considering that a rapid shift in GHG is needed, the researchers also examined how many of the high impact measures are taught in high schools, when lifestyle choices and long term patterns could most easily be established.

The authors recommended four easily applicable high impact carbon reduction actions that individuals can take. These are 1) Having one fewer child 2) Living car free 3) Avoiding airplane travel and 4) Eating a plant based diet. Individual actions do make a difference if most people actually do them. Another important aspect of “doing the right thing” is that people inspire others to make similar changes. As Mahatma Ghandi said “Be the change you wish to see in the world”.

EDUCATING ABOUT CLIMATE CHANGE

The researchers also looked at how many of these high impact changes are discussed in high schools and by government agencies. They found that government resources in the EU, USA, Canada, and Australia focus recommendations on lower-impact actions, such as recycling rather than flying less. They also analyzed 10 Canadian textbooks and found only 4% contained high impact recommendations and none mentioned having one less child, the most impactful action. It is thought that people may take action earlier if they start with efforts that are easier for them to implement, and then adopt more powerful measures. Their results indicate, however, that opportunities exist to promote early adoption of more effective strategies, to close the education gap in climate change. Teen climate activist Greta Thunberg would agree.

REFERENCE

The climate mitigation gap: Education and government recommendations miss the most effective individual actions. Wynes and Nicholas. Environmental Research Letters 12(7):074024 · July 2017. https://www.researchgate.net/publication/318353145_The_climate_mitigation_gap_Education_and_ government_recommendations_miss_the_most_effective_individual_actions

HIGH IMPACT

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Have one fewer child Live Car Free Avoid one transatlantic flight Buy green energy Switch electric car to car free Eat a plant based diet

MEDIUM IMPACT

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Replace typical car with hybrid Wash clothes in cold water Recycle Hang dry clothes

LOW IMPACT

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Upgrade lightbulbs Eat less meat Compost Buy organic food

May / June 2019 The Bulletin

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The Medical Society Consortium on Climate Change and Health

C

limate change is one of the most important issues of our time and has major health and healthcare implications. As some of the most respected professionals in America, doctors and nurses have a crucial part to play in raising awareness of the public about these issues. To facilitate the medical community’s awareness raising efforts, the Medical Society Consortium on Climate Change and Health (the Consortium) brings together associations representing approximately 500,000 clinical practitioners to carry three simple messages: ■■ Climate change is harming Americans today and these harms will increase unless we act; ■■ The way to slow or stop these harms is to decrease the use of fossil fuels and increase energy efficiency and use of clean energy sources; and ■■ These changes in energy choices will improve the quality of our air and water and bring immediate health benefits.

This is especially important to vulnerable Americans and communities who are experiencing a disproportionate impact today from climate change.

The 2015 Lancet Commission on Health and Climate Change concluded that addressing climate change is the greatest public health opportunity of the 21st century, and failure to adequately address it could undo most of the progress in global

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health over the past century. Our recent surveys demonstrate that most physicians are aware of the adverse health effects of climate change and feel a responsibility to inform the public, patients and policymakers about them. A majority of survey respondents report that they are already seeing health harms from climate change among their own patients – most commonly in the form of increased cardiorespiratory disease (related to air quality and heat), more severe and longer lasting allergy symptoms, and injuries attributed to extreme weather. Many indicated their own personal interest and nearly all indicated they would like to see their societies educate policymakers about these harms and risks. They also support education for their colleagues through CME and wish to provide leadership on environmental sustainability in their own workplaces.

American medical societies and their state chapters have a significant and influential membership nationwide, and they routinely educate legislators on health issues (tobacco control, opioids, obesity, etc.) and other policy concerns. Medical society members have an important opportunity to weigh in to help ensure that the health risks of climate change and the health benefits of climate solutions, especially clean energy, are clearly understood. The voices of America’s medical societies have the potential to help reframe the dialogue – putting human health and wellbeing front and center in the conversation.

MISSION STATEMENT

The mission of the Consortium is to organize, empower and amplify the voice of America’s doctors to convey how climate change is harming our health and how climate solutions will improve it.

CONSENSUS STATEMENT

We – the undersigned medical societies – support the international scientific consensus, as established in multiple national and international assessments, that the Earth is rapidly warming, and that human actions (especially burning of fossil fuels) are the primary causes. As established in the 2016 U.S. Climate and Health Assessment – The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment – the resulting changes in our climate are creating conditions that harm human health through extreme weather events, reduced air and water quality, increases in infectious and vector-borne diseases, and other mechanisms.

While climate change threatens the health of every American, some people are more vulnerable and are most likely to be harmed, including: infants and children; pregnant women; older adults; people with disabilities; people with pre-existing or chronic medical conditions, including mental illnesses; people with low-income; and indigenous peoples, some other communities of color, and immigrants with limited English proficiency.

As medical professionals, many of our members know firsthand the harmful health effects of climate change on patients.

We know that addressing climate change through reduction in fossil fuel use will lead to cleaner air and water, to immediate health benefits for Americans, and will help to limit global climate change.

We support educating the public and policymakers in government and industry about the harmful human health effects of global climate change, and about the immediate and longterm health benefits associated with reducing greenhouse gas emissions (i.e., heat-trapping pollution) and taking other preventive and protective measures that contribute to sustainability. We support actions by physicians and hospitals within their workplaces to adopt sustainable practices and reduce the carbon footprint of the health delivery system.

We recognize the importance of health professionals’ involvement in policymaking at the local, state, national, and global level, and support efforts to implement comprehensive and economically sensitive approaches to limiting climate change to the fullest extent possible.

Our organizations are committed to working with officials at all levels to reduce emissions of heat-trapping pollution, and to work with health agencies to promote research on effective interventions and to strengthen the public health infrastructure with the aim of protecting human health from climate change.

MEMBERS:

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American College of Physicians (ACP) American Academy of Family Physicians (AAFP) American Academy of Pediatrics (AAP) American College of Obstetricians and Gynecologists (ACOG) National Medical Association (NMA) American Academy of Allergy, Asthma, Immunology (AAAAI) American College of Preventive Medicine (ACPM) American Podiatric Medical Association (APMA) American Geriatrics Society (AGS) Society of General Internal Medicine (SGIM) Academy of Integrative Health and Medicine (AIHM) American Association of Community Psychiatrists (AACP) California Chapter of American College of Emergency Physicians (ACEP) American Telemedicine Association (ATA) Society of Gynecologic Oncology (SGO) American Medical Women’s Association (AMWA) American College of Lifestyle Medicine (ACLM) American Medical Association (AMA) American Psychiatric Association (APA) American College of Osteopathic Internists (ACOI) American Academy of Dermatology (AAD) American College of Occupational and Environmental Medicine (ACOEM) Infectious Diseases Society of America (IDSA)

May / June 2019 The Bulletin

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May / June 2019  The Bulletin

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Cindy Russell, MD

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The Bulletin  May / June 2019

“Cultivars of the earth are the most valuable citizens. They are the most vigorous, the most independent, the most virtuous and they are tied to their country and wedded to its liberty and interests by the most lasting bands.”

Thomas Jefferson

T

he roots of human civilization are based on farming the land, saving seeds (for future generations), protecting biodiverse ecosystems that nourish the soil and pollinate crops. Our founding fathers had a deep connection with their farms and felt this country’s national identity and economy should be agrarian based. Almost everyone had at least a kitchen garden. Liberty equaled self-sufficiency and selfreliance. Things changed with the introduction of large factory farms that allowed us to work in cities and have the convenience of packaged food. This transition, however, resulted in our separation from physical knowledge of the land and our stewardship of it. Rather than the majority of us being involved with growing food, we have now become consumers of packaged food

sent around the world. Plastic waste and candy wrappers clog our oceans and marine life. Global food transportation creates a heavy footprint on our commonwealth. We have become ignorant about the human and environmental harm from conventional farming, as well as the plight of small farmers, struggling to survive.

NO SURPRISES: AGRICULTURE IS A LARGE CONTRIBUTOR TO CLIMATE CHANGE

Humans have a regular appetite for food and we have learned how to grow excessive amounts of it. Clearing natural forests, intense mono-cropping, and use of synthetic chemicals have put a lot more greenhouse gases in the atmosphere in the last 50 years. Modern agriculture, forestry and land use now

May / June 2019 The Bulletin

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”If you’ve never heard about the amazing potential of regenerative agriculture and land use practices to naturally sequester a critical mass of CO2 in the soil and forests, you’re not alone. One of the best-kept secrets in the world today is that the solution to global warming and the climate crisis… lies right under our feet, and at the end of our knives and forks.”

-Ronnie Cummins, Regeneration International Steering Committee Member account for at least 24% of greenhouse gases, according to the IPCC. This is second to electricity and heat production at 25%.

Scialabba (2010) points out that by 2050 all agricultural systems worldwide will be affected by climate change. He among others have examined the impact of mitigation and adaption methods of farming to have high yields along with meaningful reductions in GHG. He notes that large changes in the way we farm that regenerate soil and capture carbon in the land, could alter the path of climate change by 40% to 72% depending on how much is implemented. Smith (2008) estimated that organic agriculture alone could offset 12% of GHG emissions.

Limiting external inputs such as synthetic pesticides and fertilizers reduces GHG in the atmosphere by about 20% (Scialabba).

Scientists at UC Berkeley looked at isotopes of nitrogen in the air and found that the sharp rise in nitrous oxide emissions in the last 50 years is due to nitrogen fertilizers (Boering 2012) Excessive nitrogen use also stimulates plant growth at the expense of nutrients with runoff polluting streams, stimulating algae growth and choking fish populations. CO2 emissions rise from the manufacturing and transport of fertilizers.

Some argue that reducing synthetic nitrogen fertilizers reduces yield, however, studies of organic farming methods used here and abroad showed either no change or a substantial increase in yields up to 180%. Animal husbandry is tailored to the needs of the organic farmer, as excess nitrogen fertilizer from manure can also contribute to nitrous oxide emissions.

Where there are fewer animals to provide manure as fertilizer, other methods are incorporated such as nitrogen fixing plants State University and crop diversification consistent with local soil and climate.

“We currently have very degraded soils physically, chemically, but mostly biologically. Microbes restore this balance.”

David Johnson, New Mexico

CROPLAND MANAGEMENT: BIODIVERSITY

FARMING FOR THE CLIMATE

Agricultural scientists have looked at three areas to slow or reverse climate change: farming system design, cropland management and livestock management. All, feed the rich soil food web from bacteria, fungi and protozoa to earthworms, nematodes, and other beneficial organisms. (Ingham, NRCS)

FARMING DESIGN

In farming design several factors reduce carbon emissions.

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The Bulletin May / June 2019

Organic agriculture uses crop diversification rather than the conventional farm method of mono-cropping. Not only can a farmer feed his family with a variety of crops, this biodiversity is now known to be integral to maintenance of ecosystem functioning in nature and agriculture. A diverse range of plants, especially those local robust varieties, are chosen to improve soil health and resiliency against extreme weather patterns and variable water availability. Natural habitats with a diversity of native trees attracts beneficial insects to counter pests. Complex ecosystems provide “natural-enemy abundance”, as described by Langellotto and Denno (2004), who looked at 43 published studies. Although there are economic incentives to mono-cropping, Lin (2011) notes, “In agricultural systems, crop biodiversity may provide the link between stress and resilience because a diversity of organisms is required for ecosystems to function and provide services.”

CLIMATE CHANGE: A REASON TO ROTATE… CROPS

Two important agricultural practices that help to restore soil health are crop rotation and no-tillage. A 20-year study at the Northwestern Illinois Agricultural Research and Demonstration Center revealed that these practices not only increased yields but they also reduced greenhouse gas emissions significantly.

In their research these techniques accounted for a 20% increase in yields and a reduction in nitrous oxide emissions by 35%. Crop rotation also offers livestock mixed grazing pastures. (Behnke 2018)

“Biodiversity—which allows for the coexistence of multiple species, fulfilling similar functions, but with different responses to human landscape modification—enhances the resilience of ecosystems.”

Lin 2011

LIVESTOCK: MOBILE METHANE

About a quarter of the Earth’s land surface consists of rangelands and pasture obtained through deforestation (with loss of a large carbon sink). Livestock generates about 14% of global greenhouse gas emissions with cattle being the primary source. Enteric fermentation in animals produces methane gas, an important GHG, which is emitted directly. Cattle manure also generates methane, along with nitrous oxide when it decomposes. While reducing cattle ranching and meat consumption is important, natural manure can be a substitute for synthetic nitrogen fertilizers on farms (which contribute to nitrous oxide emissions). Many farms integrate livestock as a source of nitrogen for their crops. Techniques used to reduce greenhouse gases include managed rotation of livestock on pasture crops.

Brazil is committed to lowering GHG emissions and to prevent further deforestation for grazing, they are examining intensive pasture grazing on already cleared land. Bogaerts et al (2017) looked at 40 cattle ranches in the Amazon and how altering grazing styles could reduce GHG emissions. They found that frequent rotation of pasture lands, similar to patterns of wild animals that roam and eat, preserves the soil structure and water content, helping to sequester more carbon in grasslands, at least in the short run. Several studies show a reduction of overall GHG of 20 to 60% with these more sustainable grazing methods.

WHAT ARE THE HIDDEN COSTS OF INDUSTRIAL ANIMAL FARMING?

Farming impacts can be a complex and other scientists point out that we should question any rise in production of food from animal products due to their much higher climate change potential, in addition to other indirect impacts. (Garnett

2017). For large producers of cattle, and accompanying manure in concentrated factory feed lots, aka CAFOs (confined animal feeding operations), there are accompanying environmental and human health problems. The excess manure contaminates local waterways with anitbiotics, pesticides, and heavy metals along with ammonia leading to algae overgrowth and “deadzones” in rivers.

MANURE MANAGEMENT: TOXIC FUMES

Thousands of manure pits in the US create an air pollution nightmare in the form of hydrogen sulfide, methane, ammonia and carbon dioxide, as well as novel viruses and bacteria laden dust as manure decomposes. Oxygen is displaced by these gases and those entering manure pits can be overcome by the fumes. Several farm deaths have been reported from toxic emissions. For the workers and millions of residents living nearby these farms there is the more insidious threat of respiratory diseases and neurotoxicity from the airborne pollutants.

FROM FARM TO TABLE TO...THE HOSPITAL: ANTIBIOTIC RESISTANCE

The overuse of antibiotics in farm animals has been identified as a major cause of antibiotic resistance. Considering farm animals take many more antibiotics throughout their life than humans, it is no wonder that antibiotic resistance is now a public health threat. Researchers in the Netherlands determined in 2007 that 20% of human MRSA bacterial infections originated from Dutch livestock.

LIVESTOCK ASSOCIATED MRSA

In 2015 they set out to determine what percent of MRSA in-

“All food webs are fueled by the primary producers: the plants, lichens, moss, photosynthetic bacteria, and algae that use the sun’s energy to fix carbon dioxide from the atmosphere.”

Elaine Ingham, Soil Food Web May / June 2019 The Bulletin

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“Regenerative agriculture provides answers to the soil crisis, the food crisis, the climate crisis and the crisis of democracy.”

have caused a new form of pollution- genetic pollution. Gressell (1999) warned of this as GMO’s were being broadcast in the 1990’s. Escape of transgenes has now been scientifically documented in Japan, Switzerland, Mexico (where GMO’s are illegal), Canada, Oregon and even the Aloha state. (Ryffel 2014) (Benbrook 2018) (Boyd 2008). The promised increase in yields have not been realized while the ecological consequences now are.

GMO’S NOT SUSTAINABLE

GMO’s are thus not a part of a sustainable food system. Furthermore seeds cannot be saved, as these are hybrids and Vandana Shiva, Regeneration International Co-Founder owned solely by large agribusiness, who have sued farmers for their land if these plants are found on their property, even if they never planted them(MEN 2013). 29 fections derived from livestock in high density farming areas. Of states have used an industry friendly 2013 ALEC (American Legthe close to 4,000 patients sampled in 2 hospitals about 10% had islative Exchange Council) model law that bans cities and counMRSA. Of these patients 78% originated from livestock. (van de ties from adopting their own rules with regards to saving seeds Sande-Bruinsma 2015) In Iowa, closer to home, MRSA has been and banning GMO’s.

(Johnson 2017) found in a substantial number of livestock as well (10%) but none found in the antibiotic free herds. (Smith 2013).

Dr. Smith researched further and found that 64% of workers in a large hog farm had MRSA with air quality studies showing airborne MRSA. Other bacterial contamination can occur from farm animals to produce. In 2006 the FDA reported that the same deadly strain of E Coli O157:H7 that contaminated a spinach crop in San Juan Bautista, California was found in feral pigs and in manure on a cattle ranch in the Salinas Valley, within a mile of the spinach fields. This highlights food safety as another important factor in farming.

PESTICIDES AND BIODIVERSITY

Pesticides are intended to kill target pests, however, they also destroy beneficial insects (bees) as well as earthworms, beneficial bacteria and fungi in the soil that cycle nutrients into plants, build roots and capture carbon. The use of pesticides diminishes overall biodiversity that protects crops from environmental stressors. Non-target wildlife are caught in the crossfire and are also harmed, including frogs, reptiles, birds and mammals that are essential to healthy ecosystems. Rachel Carson eloquently described these effects in her classic book, “Silent Spring”. Persistent pesticides can act as endocrine disruptors, mutate DNA and suppress the immune system of wildlife and humans.

GMO’S: FROM EARLY WARNINGS TO REALITY

Genetically modified foods (GMO’s) that are herbicide resistant (Roundup Ready) use up to 5 times more pesticide (glyphosate) that cycles into our soil, water systems and air. Herbicide resistance in non GMO plants is now widespread as GMO genes

REGENERATIVE FARMING FOR CLIMATE HEALTH AND HUMAN HEALTH

Regenerative farming is a sustainable approach to feed the world, as it considers environmental protection, social equity and economic viability. It is a new term with a variety of definitions, but combines aspects of organic farming, biodynamic farming, family farming, indigenous knowledge that builds the soil structure, capturing carbon in living soil biomass.

SOIL: THE FINAL FRONTIER

Regenerative farming methods can be used to restore degraded or desertified soils, sink carbon from the atmosphere back into the soil, increase microbial content of the soil, increase yields, provide food security and more jobs. It will also enhance habitat for wildlife and mitigate climate change with a reduction of GHG. Methods include: ■■ No till ■■ No synthetic chemical input ■■ Diverse non-GMO crops ■■ Cover crops/crop rotation ■■ Manuring ■■ Mixing trees and crops (prevent soil and wind erosion) ■■ Efficient water use ■■ Re-establish smaller family farms and support rural communities ■■ Restore grasslands and forests

UNDERSTANDING AND HONORING THE EARTH, NOT DOMINATING IT

The evidence is all around us that we are not masters of our environment but victims of our attempts to dominate it. Ecosys-

”He has this sort of totally visceral connection with the soil” Abigail Adams

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The Bulletin May / June 2019

tems are more complex, biology more fragile and nature more necessary to our survival than we have been led to believe, especially with 7.7 billion people living and moving around on this small planet. The more detached and inconsiderate of natural systems we are, the farther away from solving the climate crisis we will travel. The rapid shift to carbon capturing regenerative agriculture is a necessary path to climate health, human health and environmental health. Along the way, we will we may find not only harmony but perhaps some of the happiness our founding fathers, such as John Adams, knew working in the garden and connecting with the land.

REFERENCES

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Founding Gardeners. The Revolutionary Generation, Nature and the Shaping of the American Nation.

Andrea Wulf. 2011.

Greenhouse gas mitigation in agriculture.

Smith P et al. 06 September 2007. Philosophical Transactions of the Royal Society Biological Sciences. https://royalsocietypublishing.org/doi/abs/10.1098/ rstb.2007.2184 Organic agriculture and climate change. NE Scialabba and M Muller-Lindenlauf. Renewable Agriculture and food Systems: 25(2);158-169. 2010. http:// www.fao.org/3/a-al185e.pdf Agroecology and the design of climate changeresilient farming systems. Altieri M et al. Agronomy for Sustainable Development. Agronomy for Sustainable Development July 2015, Volume 35, Issue 3, pp 869–890 Green Agriculture: foundations for biodiverse, resilient and productive agricultural systems. Koohafkan P et al. International Journal of sustainability. 2011. https://ensser. org/wp-content/uploads/fileadmin/ files/2011_Koohafkan-etal.pdf The Environmental Legacy of James Madison: Pursuing Stability in a World of Limits.

Franklin Kalinowski. America’s Environmental Legacies. pp 253283. 2016. https://link.springer.com/ chapter/10.1057/978-1-349-94898-7_8 WWF. Forests and climate Change. http://wwf.panda.org/our_work/forests/ climate_change_and_forest/ An Essay on the Principle of Population. Thomas Malthus. 1798.

London. St. Paul’s Church-Yard. http://www.esp.org/books/malthus/ population/malthus.pdf Common pesticides kill frogs, say scientists. PANNA. Jan 2013. http://www.panna.org/blog/commonpesticides-kill-frogs-say-scientists Fertilizer use responsible for increase in nitrous oxide in atmosphere. April 2, 2012. Nature Geoscience.

Kristie Boering. https://news.berkeley.edu/2012/04/02/ fertilizer-use-responsible-for-increase-in-nitrous-oxidein-atmosphere/ Substantial nitrogen pollution embedded in

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international trade. Oita A et al. Nature Geoscience.

25 January 2016. https://www.nature.com/articles/ ngeo2635 What Is Your Nitrogen Footprint, and Who Is it Impacting? Jan 25, 2016. The Guardian. http://www. earthisland.org/journal/index.php/articles/entry/what_ is_your_nitrogen_footprin Global metaanalysis of the nonlinear response of soil nitrous oxide (N2O) emissions to fertilizer nitrogen. Proc Natl Acad Sci U S A. 2014 Jun 24; 111(25): 9199–9204. Shcherbak L. https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC4078848/ The Hidden Dangers of Chemical Fertilizers.

Dec 07, 2017. EPA Online. https://eponline.com/ Articles/2017/12/07/The-Hidden-Dangers-of-ChemicalFertilizers.aspx?Page=2 Can the World Find Solutions to the Nitrogen Pollution Crisis? Feb 6, 2018. https://e360.yale.edu/ features/can-the-world-find-solutions-to-the-nitrogenpollution-crisis Resilience in Agriculture through Crop Diversification: Adaptive Management for Environmental Change. B.B. Lin. BioScience, Volume 61, Issue 3, March 2011, Pages 183–193. https://academic. oup.com/bioscience/article/61/3/183/238071 Responses of invertebrate natural enemies to complex-structured habitats: a meta-analytical synthesis. Langellotto and Denno. Oecologia.

2004 Mar;139(1):1-10. https://www.ncbi.nlm.nih.gov/ pubmed/14872336

Nitrous oxide emissions from rice farms are a cause for concern for global climate. Sept 18, 2018. https:// www.edf.org/media/nitrous-oxide-emissions-ricefarms-are-cause-concern-global-climate High nitrous oxide fluxes from rice indicate the need to manage water for both long- and shortterm climate impacts. PNAS. Kritee K et al. Sept 25, 2018. https://www.pnas.org/content/115/39/9720 Long-term crop rotation and tillage effects on soil greenhouse gas emissions and crop production in Illinois, USA. Behnke G et al. Agriculture, Ecosystems

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and Environment. July 2018, vol 261:62-70 https:// www.researchgate.net/publication/324524406_Longterm_crop_rotation_and_tillage_effects_on_soil_ greenhouse_gas_emissions_and_crop_production_in_ Illinois_USA Can Soil Microbes Slow Climate Change? Scientific America. John Berger. March 26, 2019. https://www. scientificamerican.com/article/can-soil-microbes-slowclimate-change/?redirect=1 Soil Biology and the Landscape. Dr. Elaine Ingham.

Natural Resources Conservation Soils. https://www. nrcs.usda.gov/wps/portal/nrcs/detailfull/soils/health/ biology/?cid=nrcs142p2_053868 Development of soil microbial communities for promoting sustainability in agriculture and a global carbon fix. David Johnson et al. Peer J Preprints. Open Access. 13 Jan 2015. https://peerj.com/preprints/789v1. pdf Impacts of crop rotational diversity and grazing under integrated crop-livestock system on soil surface greenhouse gas fluxes. May 22, 2019.

Abagandura GO et al. PLOS online. https://journals.plos. org/plosone/article?id=10.1371/journal.pone.0217069 Climate change mitigation through intensified pasture management: Estimating greenhouse gas emissions on cattle farms in the Brazilian Amazon. Journal of Cleaner Production. Bogaerts M et al. 20 September 2017, Pages 1539-1550. https://www.sciencedirect.com/science/article/pii/ S0959652617313008 Grazed and confused? Food climate Research Network. Garnett T. 2017. https://fcrn.org.uk/sites/ default/files/project-files/fcrn_gnc_summary.pdf Life cycle assessment of beef cattle production in two typical grassland systems of southern Brazil.

Dick M et al. Journal of Cleaner Production Volume 96, 1 June 2015, Pages 426-434 Alternative Technologies /Uses for Manure. EPA. https://www3.epa.gov/npdes/pubs/cafo_report.pdf Cleaning Up the Air, Down on the Farm. PEW. March 21, 2008. https://www.pewtrusts.org/en/about/newsroom/opinion/2008/03/21/cleaning-up-the-air-downon-the-farm The Pew Commission on Industrial Farm Animal Production http://www.pcifapia.org/_images/PH_ FINAL.pdf Why factory farming is not just cruel – but also a threat to all life on the planet. Oct 4, 2017. Bibi van der Zee. https://www.theguardian.com/environment/2017/ oct/04/factory-farming-destructive-wasteful-cruelsays-philip-lymbery-farmageddon-author Hidden Costs of Industrial Agriculture. Union of Concerned Scientists. https://www.ucsusa.org/food_ and_agriculture/our-failing-food-system/industrialagriculture/hidden-costs-of-industrial.html How Drug-Resistant Bacteria Travel from the Farm to Your Table. Scientific America. Dec 1, 2016. Moyer MW. https://www.scientificamerican.com/article/howdrug-resistant-bacteria-travel-from-the-farm-to-yourtable/?redirect=1 Antibiotic resistance patterns of methicillin-

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resistant Staphylococcus aureus (MRSA) isolated from livestock and associated farmers in Anuradhapura, Sri Lanka. Germs. 2017 Sep; 7(3): 132–139. Jayaweera J et al. https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC5601096/ Impact of livestock-associated MRSA in a hospital setting. van de Sande-BruinsmaS et al. Antimicrobial Resistance and Infection Control. Oct 10, 2015. https:// aricjournal.biomedcentral.com/articles/10.1186/s13756015-0053-8 Expert Panel Highlights Threats to Public Health and Environment from Industrial Animal Agriculture Wastes. PEW. Feb 29, 2008. https://www. pewtrusts.org/about/news-room/press-releases-andstatements/2008/02/29/expert-panel-highlightsthreats-to-public-health-and-environment-fromindustrial-animal-agriculture-wastes Methicillin-Resistant Staphylococcus aureus in Pigs and Farm Workers on Conventional and AntibioticFree Swine Farms in the USA. Smith T et al. PLOS One. May 7, 2013. https://journals.plos.org/plosone/ article?id=10.1371/journal.pone.0063704 Tandem constructs: preventing the rise of superweeds. Gressel J. Trends Biotechnol. 1999 Sep;17(9):361-6. https://www.ncbi.nlm.nih.gov/ pubmed/10461182 Transgene flow: Facts, speculations and possible countermeasures. Gerhart U Ryffel. GM Crops Food.

2014 Oct-Dec; 5(4): 249–258. https://www.ncbi.nlm.nih. gov/pmc/articles/PMC5033179/ Why Regulators Lost Track and Control of Pesticide Risks: Lessons From the Case of Glyphosate-Based Herbicides and Genetically Engineered-Crop Technology. Benbrook C. Curr Environ Health Rep. 2018; 5(3): 387–395. https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC6132568/ Genetically Modified Hawaii. Scientific American.

Robynne Boyd. Dec 8, 2008. https://www. scientificamerican.com/article/genetically-modifiedhawaii/ CDC- NIOSH Warns: Manure Pits Continue To Claim Lives. 1992-2013. https://www.cdc.gov/niosh/ updates/93-114.html Food Safety: Federal and State Response to the Spinach E. coli Outbreak. Nov 13, 2006. Congressional Research Service. https://nationalaglawcenter.org/wpcontent/uploads/assets/crs/RL33722.pdf 29 States Just Banned Laws About Seeds. August 21, 2017. Kristina Johnson. https://www.motherjones.com/ food/2017/08/29-states-just-banned-laws-about-seeds/ Monsanto Lawsuits Pile Up as American Farmers Demand Rights. Mother Earth news. Feb 13, 2013. https://www.motherearthnews.com/homesteadingand-livestock/sustainable-farming/monsanto-lawsuitsfrom-family-farmers-zwfz1302zkin Neuropsychological and psychiatric functioning in sheep farmers exposed to low levels of organophosphate pesticides. Ross SJ et al.

Neurotoxicol Teratol. 2010 Jul–Aug; 32(4): 452–459. https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC3042861/

California Legislation on Climate Change Cindy Russell, MD

T

VP of community Health SCCMA

he landmark AB 32, California’s Global Warming Solutions Act of 2006, established California as the leader in climate change. The law set forth a comprehensive program to progressively reduce greenhouse gas (GHG) emissions from all sources. The ambitious plan called for a reduction of GHG to 1990 levels by 2020 and then to a level 80% below 1990 levels by 2050. Since 2006, many other pieces of legislation have been enacted that advance greenhouse gas reduction and support a livable planet. These include initiatives to support green building, electric cars and an increase in renewable energy.

In 2018, the California Building Standards Commission initiated a requirement for solar on all new home construction (unless excessively shaded). Early opponents turned into supporters as they realized the long term cost savings. A new bill SB 288, The Solar Bill of Rights, was just introduced to help consumers to make, store and use clean energy on their property without interference from the utility and allow easier connection to the grid without penalties.

Challenges remain. SB 288 faces opposition from utility companies, and while California has hit its greenhouse gas reduction target early for electricity generation, there is more pollution from cars and trucks. Electric cars, however, are on the move and now considered more conventional, rather than a novelty. Here are a few of the most noted laws.

(2018) SB 100 California Renewables Portfolio Standard Program: emissions of greenhouse gases.

Energy legislation requiring the state to procure 60% of all electricity from renewable sources by 2030 and 100% from carbon-free sources by 2045; double the energy efficiency of existing buildings; and allow greater electric utility investment in electric vehicle charging infrastructure.

(2016) SB 32 Greenhouse Gas emission reduction target for 2030 Establishes a statewide greenhouse gas (GHG) emission reduction target of 40 percent below 1990 levels by 2030.

(2015) SB 350 Clean Energy and Pollution Reduction Act of 2015 Establishes targets to increase retail sales of renewable electricity to 50 percent by 2030 and double the energy efficiency

savings in electricity and natural gas end uses by 2030.

(2014) SB 1275 Charge Ahead California Initiative Establishes a state goal of 1 million zero-emission and nearzero-emission vehicles in service by 2020.

(2014) SB 1204 California Clean Truck, Bus, and Off-Road Vehicle and Equipment Technology Program Creates the California Clean Truck, Bus, and Off-Road Vehicle and Equipment Technology Program funded by the Greenhouse Gas Reduction Fund for development, demonstration, precommercial pilot, and early commercial deployment of zeroand near-zero emission truck, bus, and off-road vehicle and equipment technologies, with priority given to projects benefiting disadvantaged communities.

(2011) SB X1-2 Renewable Energy Resources Program Codifies the CPUC Renewable Energy Resources Program to increase the amount of electricity generated from eligible renewable energy resources per year to an amount that equals at least 20% of the total electricity sold to retail customers in California per year by December 31, 2013, 25% by December 31, 2016 and 33% by December 31, 2020.

(2006) SB 1 California’s Million Solar Roof Directs the California PUC and CEC to expand this program to more customers, and requiring the state’s municipal utilities to create their own solar rebate programs. This bill requires beginning January 1, 2011, a seller of new homes to offer the option of a solar energy system to all customers negotiating to purchase a new home constructed on land meeting certain criteria and to disclose certain information.

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California Climate Change. ttps://www.climatechange California Climate Policy Dashboard. https://www.law. berkeley.edu/research/clee/research/climate/climatepolicy-dashboard/ California hit its climate goal early — but its biggest source of pollution keeps rising. LA Times.July 23, 2018.

Barboza and Lange. https://www.latimes.com/local/ lanow/la-me-adv-california-climate-pollution-20180722story.html California Gives Final OK To Require Solar Panels On New Houses. Dec 6, 2018. NPR. Bill Chappell. https:// www.npr.org/2018/12/06/674075032/california-givesfinal-ok-to-requiring-solar-panels-on-new-houses

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Physician Action Guide “A climate crisis is also a health crisis, and we must first direct solutions and resources to our most vulnerable and already affected communities.”

–Linda Rudolph, MD, New York Times Letter to the Editor, May 2014

As a physician, you play a vital role in protecting the health of patients and communities, especially in the era of climate change. There are many ways that you can act as a Climate and Health Champion at home, in your practice, in your local community, and more widely. While action at all levels is important — from your own home to advocacy for national action — physicians have an especially important role to play in influencing community leaders and policy-makers who make decisions with larger impacts.

Personal Action • Take steps to reduce your own carbon footprint. ° Walk or bike instead of driving; drive a low- or no-carbon vehicle. ° Reduce meat consumption; purchase local, fresh and seasonal food. ° Be energy efficient at home and in your office: use energy efficient appliances, electronics, and light bulbs. ° Purchase renewable energy if you can.

As a physician, you play a vital role in protecting the health of patients and community, especially in the era of climate change.

Patient Care • Place climate change educational materials in your office. ° Brochures, fact sheets, posters about climate change and health • Look for appropriate ways to incorporate climate change and health into patient education materials (e.g, disease management plans, discharge materials, medication sheets, etc). ° Educate patients on the effect of heat on storage and dosing of insulin.

• Make sure climate change impacts are addressed in disease management and care protocols.

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© 2016 Public Health Institute/Center for Climate Change and Health

° Advise asthma patients to check the Air Quality Index whenever it is hot or windy, or there are wildfires in the region.

• Incorporate a climate change assessment into home visits or home environment assessments. and refer patients for appropriate resources. ° Heat vulnerability: lack of air conditioning, ventilation or shading within home; tree cover around the home: refer for weatherization, energy efficiency, tree planting and inform about places to stay cool in a heat wave.

• Connect patients to community resources for climate resilience. ° LIHEAP: Low-income home energy assistance program

Organizational & Professional Action • Speak with your clinic and hospital facility operators about energy efficiency and procurement strategies for climate change mitigation and adaptation. ° Minimize landfill and incineration use for waste disposal.

DID YOU KNOW? Physicians have an especially important role to play in influencing community leaders and policy-makers who make decisions with larger impacts.

° Procure supplies locally to reduce transport-related emissions. ° Source clinic or hospital food locally and sustainably.

• Speak on the health impacts of climate change, and strategies to address them, with colleagues at brown bag lunches, grand rounds, professional meetings, conferences, etc. ° Present what your clinic is doing to address the problem.

• Urge your professional organizations and affiliations to take up climate change as a priority health topic via a resolution, position paper or conference theme. ° American Academy of Pediatrics, American College of Physicians, and others have papers and reports on climate change.

Community Involvement • Speak on the health impacts of climate change, and strategies to address them, at your local churches, clubs, or community meetings. ° School board, city council, parent-teacher association and chamber of commerce • Include climate change and health information when your clinic participates in community events ° Community health fairs, National Night Out, seasonal festivals • Support action for healthy communities ° Safe Routes to School, bike lanes ° Community gardens ° Local climate action plans ° Local zoning for walkable and bike-able neighborhoods

© 2016 Public Health Institute/Center for Climate Change and Health

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Policy & Advocacy Action • Write to and visit your local state legislator and city council members to help them understand that climate change is a health equity issue, and to form relationships for ongoing advocacy.

• Provide testimony or comments on the health benefits of bills that take action on climate change, including relevant housing, transportation, water, agriculture bills.

• Participate in writing a Legislative Brief on Climate Change and Health.

Media opportunities • Pen an Op-Ed in your local or regional newspaper on the connections between climate change and health equity.

Write to and visit your local state legislator and city council members to help them understand that climate change is a health equity issue, and to form relationships for ongoing advocacy, Speak on local radio or television programs about climate change and health.

• Capitalize on current events: Write letters to the Editor after relevant events, such as extreme weather events, about the connection between events, climate change and health.

• Speak on local radio or television programs about climate change and health.

Page 1 photo: AV 15-33 World Bank; page 2: Ted Eytan/flickr.com; page 3: Ms. Jane Campbell / Shutterstock.com.

COPYRIGHT INFORMATION© 2016 Public Health Institute/Center for Climate Change and Health. Copy and distribution of the material in this document for educational and noncommercial purposes is encouraged provided that the material is accompanied by an acknowledgment line. All other rights are reserved.

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Classifieds OFFICE SPACE FOR RENT/LEASE MEDICAL OFFICE SPACE FOR LEASE • SANTA CLARA Medical space available in medical building. Most rooms have water and waste.

Reception, exam rooms, office, and lab.

X-ray available in building. Billing available.

2,500–4,000 sq. ft. Call Rick at 408/2280454.

1100 SQ. FT. • MTN VIEW-CUESTA PARK Recently remodeled modern - 3 Exams - 4 Work Stations - Parking - Partnership, LLC - Cat 5 Wiring - Kitchenette - Workroom/ Lab. Light - High Ceilings - Storage. Contact greatoffice2017@gmail.com.

BEAUTIFUL MENLO PARK OFFICE TO SHARE New office, upscale and modern – to share with existing pain management practice.

Ideal for psychologist or psychiatrist. Contact Dr. Maia Chakerian at 408/832-3930.

OFFICE SPACE FOR LEASE AND OR SALE Medical office space 1,969 sq. ft. on Jackson Avenue opposite to Regional Medical Center for sale or lease, with option to buy. Very well maintained office building.

Please call 408/926-2182 or 408/315-4680.

EMPLOYMENT OPPORTUNITY OCCUPATIONAL MEDICINE PHYSICIANS • PRIMARY CARE, ORTHOPEDICS, & PHYSIATRY Our occupational medical facilities offer

• • • • • •

METRO MEDICAL BILLING, INC.

Full Service Billing 25 years in business Bookkeeping ClinixMIS web based software Training and Consulting Client References

Contact Lynn (408) 448-9210 lynn@metromedicalbilling.com Visit our Website: metromedicalbilling.com

a challenging environment with minimal stress, without weekend, evening, or “on call” coverage. We are currently looking for several knowledgeable and progressive primary care and specialty physicians (orthopedist and physiatrist) interested in joining our team of professionals in providing high quality occupational medical services to Silicon Valley firms and their injured employees. We can provide either an employment relationship including full benefits or an independent contractor relationship. Please contact Rick Flovin, CEO at 408/228-0454 or e-mail riflovin@allianceoccmed.com for additional information.

WANTED FAMILY PHYSICIAN Family medicine physician needed to share a growing outpatient practice. Start at 16 hours/week and share patient load.

Practice caters to 75% PPO, rest Medicare and HMO. Contact ntnbhat@yahoo.com / 408/839-6564.

FOR SALE OFFICE SPACE FOR LEASE AND OR SALE Medical office space 1,969 sq. ft. on Jackson Avenue opposite to Regional Medical Center for sale or lease, with option to buy. Very well maintained office building.

Please call 408/926-2182 or 408/315-4680.

PRIVATE PRACTICE AND BUILDING FOR SALE Family Practice for sale, including inventory, equipment and Real Estate (can also be leased). Great downtown San Jose location. Financing may be available. Minor Laser Surgery performed as well. Call 415/308-3064.

GREAT BUSINESS OPPORTUNITY • PART-TIME OR ADD-ON TO YOUR EXISTING PRACTICE Medically-supervised weight loss program with 30-year track record. Cash, no insurance. Practice obesity medicine and help patients overcome their weight problems and improve their health. Seeking an associate to train with eventual sale. Contact me at southbayweightloss@gmail.com.

SJSU IS HIRING Job Title: Psychiatrist Job ID: 24928 Full/Part Time: Full-Time Regular/Temporary: Regular Job Code: 7750/ Range 1 Department: Student Health Center ABOUT THE POSITION The SHC Psychiatrist works independently in performing assigned student services and consultations with SHC medical staff and CAPS counseling staff. Consultation could involve advice regarding psychiatric diagnostic treatment and psychotherapeutic activities and are in accordance with the overall operation of the SHC and within the scope of the program established by the Board of Trustees.

The incumbent may provide highly specialized advice regarding planning, coordinating, and evaluating ongoing psychiatric care of students. All staff are expected to conform to CSU, State, and Federal regulations and laws. Although unlikely, there may be an occasion of brief evening or weekend work.

Working collegially and collaboratively to support student success is the bottom line purpose of this and all SHC positions.

To apply, please visit: http://www. sjsu.edu/hr/careers/jobs and search for Job ID: 24928.

EQUAL EMPLOYMENT STATEMENT: SJSU is an Equal Opportunity Affirmative Action employer. We consider qualified applicants for employment without regard to race, color, religion, national origin, age, gender, gender identity/expression, sexual orientation, genetic information, medical condition, marital status, veteran status, or disability.

It is the policy of SJSU to provide reasonable accommodations for applicants with disabilities who self disclose.

May / June 2019 The Bulletin

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In Memoriam Arthur M. Brown, MD *Obstetrics & Gynecology 7/2/1927 – 2/15/2019 SCCMA member since 1959

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NOT ALL HEROES WEAR CAPES‌ SOME WEAR DOCTORS’ COATS Your priority is protecting your patients.

Our priority is protecting you.

For more than 40 years, the Cooperative of American Physicians, Inc. (CAP) has provided our physician members with superior medical malpractice coverage.

Our mission is to help independent California physicians deliver the best care possible, while realizing personal and professional success.

Sarah E. Pacini, JD Chief Executive Officer

CAP members also receive proactive risk management services, in-house legal and claims support, practice management resources, and so much more. Find out what makes CAP different.

CAPphysicians.com 800-252-7706

Medical professional liability coverage is provided to CAP members by the Mutual Protection Trust (MPT), an unincorporated interindemnity arrangement organized under Section 1280.7 of the California Insurance Code.

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