What if, every time we picked up a product, an image would flash before our eyes of the life of that product—the manufacturing process, where and under what conditions it was made, what chemicals were produced, the impact those chemicals had on the workers and the surrounding community, where that product ends up after we’ve used it?

Most of the time, we forget that everything we use has a life before it reaches us and continues to have an impact after we’re finished with it. When it comes to products made from or containing toxic chemicals, we are only one stop in their toxic voyage.

Take the vinyl IV bag: the image would be of a poly vinyl chloride (PVC) manufacturing plant and the dioxin formed as a result of production. We would hear the voices of the families that had to relocate their homes due to toxins in the air.

Now, consider the “death” of the bag—what happens after it has fulfilled its use? In many cases, it ends up in an incinerator where it will release more dioxin when it is burned. Or it could end up in a landfill, where it will dwell intact for the next several thousand years. We are not connected to these realities. Not only do we not see them, but many of us don’t even know they exist.

Where does the mercury from a broken mercury thermometer go? Try to picture the silver, liquid metal traveling from your garbage bag to the waste storage container, to the incinerator, to the air, to the water, to the sediment, to the fish, to the bigger fish, to the woman, to the developing fetus inside her womb.

These are extreme, though common examples. But the reality is, many of the items we use in our professional and personal lives have environmental impact before and after they reach us. These truths are often hidden behind convenience, or fashion. They are the realities behind PVC medical supplies, fashionable “pleather” clothing, and bright-colored plastic frogs in a birthday party goody bag.

When our choices directly impact our own lives, we notice it most. Maybe if we had to collect our own waste and transport it to the waste storage area, or if we had to live near the incinerators or landfills, we would be more vested in reducing that waste and making its composition safer.

Most of us want to make the right choices for our families, our workplaces, and our communities. But determining what is “right” is not always clear. When we choose a health care product we make sure the product is safe, effective, easy-to-use, clean, and cost effective. Let’s add to that equation waste disposal fees, safety, liability, JCAHO compliance training, regulatory compliance and environmental impact. If you factor in the hard costs such as spill cleanup and waste disposal fees, it is not too hard to see that less toxic is not only healthier, it is also cheaper.

As physicians, you have tremendous purchasing power. You have the power to say, “No.” You have the power to ask the vendors for alternatives. You have the power to look closely at your most-used or most costly items and make a few changes with a big impact.

The two most common toxins associated with ordinary medical practice are mercury and dioxin related to PVC disposables. Make a commitment to eliminate mercury from your medical practice. Purchase mercury-free sphygmomanometers, digital thermometers, and mercury-free batteries. Find out how your fluorescent bulbs (yes, they contain mercury) are removed, and look for opportunities to recycle them. Look for ways to reduce PVC whenever possible. PVC is used for gloves, dialysis fluid bags, IV bags, 3-ring binders, and clinic ID cards and bracelets, to name but a few.

To help you learn about alternatives to these products, as well as find vendor information, and much more, go to the U Mass–Lowell’s Sustainable Hospitals Project at: www.uml.edu/centers/LCSP/hospitals. This valuable website offers everything you need to get started. Also check out the American Hospital Association and the Environmental Protection Agency’s How-to Guide on Environmentally Preferable Purchasing at www.geocities.com/EPP_how_to_guide/

Thank you for your emails. It is great to hear from concerned health care professionals. Forward any specific questions to my attention at: jbrown@bethisraelny.org

Janet Brown is the Medical Waste Manager for Beth Israel Medical Center, New York City. Beth Israel is firmly committed to reducing the volume and toxicity of its waste stream. Many of the strategies that work for Beth Israel can also work for you.