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Transcript: Podship Earth Episode 60: DOCTOR

JARED BLUMENFELD: Welcome to Podship Earth. This is your host, Jared Blumenfeld. The World Health Organization just declared that climate change is the greatest threat to global health in the 21st century and yet until very recently, the medical profession has been firmly on the sidelines when it comes to defining the roles doctors, nurses, and health researchers play in treating, explaining and combating the impacts of climate change. Last month, that all changed when the August American Medical Association joined with scores of other health associations including the American Academy of Nursing all the way through the California Conference of local health officers to agree to a climate health and equity call to action, which declares that climate change is one of the greatest threats to health America has ever faced and declares it's a true public health emergency. It goes on to say that the health, safety, and well-being of millions of people in the US have already been harmed by human caused climate change, and the health risks are dire without human action to fight climate change. The policy recognizes that climate change exacerbates health inequities disproportionately harming the most vulnerable among us - children and pregnant women, people with low income, marginalized people of all races and ethnicities and outdoor workers. The American Medical Association followed up by adopting a policy to ensure physicians and physicians in training have a basic knowledge of the science of climate change and an awareness of the associated health risks. Today we talked with two doctors, Bruce Paccar, who just retired from a career as an ObGyn to focus on climate change advocacy and Ashley McClure, a young doctor working hard to integrate climate change into her practice. Let's start with Bruce, who I met in line for registration at the Global Climate Action Summit. Dr. Paccar graduated from USC Medical School in 1989, and then practiced as an obstetrician gynecologist or an ObGyn in San Diego for the next 24 years. I start by asking Bruce what it was like being a doctor. 

DR. BRUCE PACCAR: I did a lot of counseling of patients and really enjoyed the interaction. The biggest thing about ObGyn that sets it apart from other specialties on multiple levels is the fact that we're dealing with pregnancy, and people are bringing new lives into their family. And so, it has a lot of layers of emotion and meaning. There are tremendous highs and lows. And frankly, every single time I saw a baby come out of a mother and begin a new life, I experienced it as a miracle. It's something I never got over and something that I felt really privileged to be a part of, and also, just kind of overwhelmed by. I mean, there were times when I delivered a baby by c-section, and they asked whether it was a boy or a girl, and I got it wrong because I was just so completely flustered by the fact that I was holding this new life in my hands. I did get it right once I looked again, and we all laughed about it. But that happened a few times. And I think it just points out that there's this amazing thing that goes on that obstetricians get to take part in. One of the profound experiences of being an obstetrician is to be reminded over and over again in the most amazing way, that we are in fact, animals living on this planet amongst the rest of nature. Because we see ourselves, our bodies reacting and performing in ways that are exactly like the rest of nature around us in our own way. 

JARED BLUMENFELD: I remember in class, in school, looking at classifications of animals and then the teacher saying, of course we're mammals. And people in the class were like, we're mammals too? And they're like, yeah, we're hot blooded and we breastfeed. And people are like, what? 


DR. BRUCE PACCAR: I saw over and over again that we are in fact mammals, and it reinforced my own view that we're part of life. And that really is what led me ultimately to get involved with the climate crisis, this experience that we're part of nature and we cannot take it for granted. 


JARED BLUMENFELD: What was it that I'm that turned you from a doctor into an eco-doctor? 


DR. BRUCE PACCAR: I remember vividly, it was one September evening, when I got home after a long day of seeing patients in the office, and I got an alumni newsletter from UC San Diego with an article about climate change. The article was called “The End of The World as We Know It.” And I realized that this has to be my priority because we're not doing enough about it. 

JARED BLUMENFELD: So, what is the perspective that a physician brings? Because to date, you have activists and scientists doing climate studies, doctors and physicians seem directly concerned with human health. You're a trusted voice. When you look at polls and where people get their information from, who they trust, how are doctors in a good position to be messengers around climate change?

DR. BRUCE PACCAR: The nurses actually are more trusted than doctors are.  I can help translate what the science means when you talk about temperatures warming by one or two degrees. I can understand that a lot of people don't find that very alarming or something that they need to be thinking about. But if we translate that to the human body and if your temperature goes from 98 degrees to 101 this is not a huge change in your body temperature, but it makes a huge change in the way that you feel. And on the one hand, we're incredibly resilient. Somebody can go into an ICU and be sick and pumped full of medications and drugs and pumps and machines, and they can walk out a week later like nothing ever happened. But at the same time someone far younger, if they get sick in the wrong way and too fast, their bodies can just completely collapse and unravel, and you can lose somebody at 25 or 30 years old in the wrong circumstances. So, we're both incredibly resilient and also fragile at the same time. And I really think that that's important for people to understand about nature. 


JARED BLUMENFELD: So, tell us a little bit about the studies that you've been doing and looking at the direct relationship between climate change, especially impacts here in California, and human health. 


DR. BRUCE PACCAR: I have gotten a group of real academics together and we are about to submit an article about the impact of climate on pregnancy in the US. And there are a number of individual studies that have been done, probably hundreds by this time, of heat impacts and air pollution and infectious disease and extreme weather. All of these having impacts on women and many of them on pregnancy, but no one's put a review together to look at the impacts of the most common exposures. Things like heat waves and warmer than average temperatures and lack of nighttime cooling.  And also, there are a couple of types of air pollutants, ozone and fine particulate matter, that are closely related to climate change. The great majority of studies that have been done on U.S. populations right now are showing a significant risk of bad birth outcomes, premature birth, low birth weight, and even stillbirths where babies don't survive their time in the uterus. And babies that are born premature or smaller than average have a lot of challenges including an increased risk of dying in their first year of life. But if they survive that, they are much more likely to have certain problems neurologically and also physically in their first few years of life. And then we're finding that these kids also as they grow into adults have major risks of heart disease and diabetes and even cancer going forward into life. So, we're looking at common exposures that are becoming increasingly severe due to climate change and then seeing these impacts weakening potentially an entire generation and generations that follow. 

JARED BLUMENFELD: Which is terrifying, right?


DR. BRUCE PACCAR: The good news is, and this is really important for people to know as they kind of grapple with these issues, is that those same things that we need to do to stop climate change have an immediate, very substantial list of benefits to people's health, and not just women who are pregnant, who I certainly I think we need to protect, but for lots of sensitive groups. The more that we transition to clean energy and the sooner we do it, the more we get immediate protective benefits in terms of reducing the risk of asthma attacks and heart attacks, premature deaths. 


JARED BLUMENFELD: Tell us a little bit about the direct impacts of wildfire smoke. There was news suggesting that it had some pretty direct health effects even on pregnant women. 


DR. BRUCE PACCAR: Well, we were talking a bit about the kinds of air pollution that seemed most closely tied to climate change. We're talking about ozone and fine particulate matter. Both of those increase in the area around a wildfire. And it's also important to realize that wildfire pollutants, including carbon monoxide, which is a poisoned gas, travel for hundreds or even thousands of miles from wildfires. So, people are affected not just right in the vicinity of a wildfire, but often times at quite a distance. And the World Health Organization has already told us back in 2015, that over 85% of the disease burden related to climate changes is going to fall on kids under the age of five. And that's a very sobering statistic. 


JARED BLUMENFELD: So, in 2013, you retired from being a full-time doctor. What have the last six years looked like for you? 


DR. BRUCE PACCAR: The last six years have been really interesting. First of all, I had no idea what my life would look like. I just knew that I needed to follow my concern and my passion. And what I have found is that I as a physician have been welcomed to work alongside of a lot of nonprofit organizations. And I've also testified before city councils and before state environmental committees in Sacramento. And so, it's been an amazing experience. It feels like a direct extension of the healthcare work that I did my whole life. The surgery and the prescribing and the counseling to be involved in the climate movement is a natural extension of that work. It's just with a different focus.


JARED BLUMENFELD: I was reading about Denmark, and even in the UK, that doctors are now actually prescribing time outdoors, nature as a prescription. You know, you may not need all these medicines, just spend a little bit of time outside. 


DR. BRUCE PACCAR: Absolutely. And it's something that I follow a lot and it makes a lot of sense. If we look at our species evolutionarily, we have spent most of our time being active and being outdoors, and we've used most of our brains doing that. And I think this idea that we can sit at our desk and move only our fingers and our wrists and use only our prefrontal cortex and get the best out of our minds and our hearts, I think is a fallacy. And one of the ways that that reinforces itself is when you go for a walk outside, most people I've spoken to, certainly me, are energized by that and inspired. And I think it's just the way that our brains work the best. 


JARED BLUMENFELD: Do you think it's easier if for people to hear the messages from you about climate change than it is general people that they hear it from advocates and environmental groups? Does the messenger make a difference? 


DR. BRUCE PACCAR: Yes, I think the messenger makes a difference. One of the lessons we're learning is to not overwhelm people, to not paint vivid apocalypse type pictures because amazingly, people don't seem to gravitate towards that when they wake up the next day. I think we also need to learn to laugh at ourselves a little bit and the extremes that we go to, and we need to find humor and joy in this work if only to energize us and make us better at it. 


JARED BLUMENFELD: So, how do you do that? 


DR. BRUCE PACCAR: I wrote 15 minutes of stand-up comedy a few weeks ago, and I'm kind of dying to put it up on stage. 


JARED BLUMENFELD: Do you want to try out any of your 15-minute routine? This could be the beginning of it. It's a safe environment Bruce. Do you have any lines for us? 


DR. BRUCE PACCAR: Oh God. Stand up does not work when you're sitting down and we're sitting down. 


JARED BLUMENFELD: Well, when you do, invite me. So, switching to the slightly more serious, we heard in the intro how doctors and are getting trained to be better climate communicators. How's that happening? 

DR. BRUCE PACCAR: There is a nonprofit called Eco-America that's based in Washington, D.C. that's put together a climate for health ambassadors training to train doctors and nurses. Not only about the science of climate change and how it impacts health, but also about how to communicate, how to write a letter to the editor, and how to speak at a city council meeting. 


JARED BLUMENFELD: What advice would you give to young doctors starting out? 


DR. BRUCE PACCAR: I would say if you step back and look at the big picture, climate change is something we have to solve, or all the great work we're going to do is not going to be enough. So, you can, and I don't want to say should, but I think it's a missed opportunity if you don't include some sort of activism and involvement in your practice of medicine. It certainly is consistent given all the different ways that climate impacts health. There's virtually no specialty that doesn't have patients at risk from the ongoing and unfortunately increasing impacts of climate change. I think the more that you are involved with this fight that we're in to transition to a clean energy economy, to improve the safety of public health, and to stabilize the climate, the more you get involved, the more energy and inspiration you will find from it. There's an immense amount of excitement around the future and what we could create in terms of not only just better public health, but better living for all of us as well. And I think if we can get past our fears and begin to get involved, it's like a gateway drug. You'll find yourself more and more excited the more that you do. This is not about a heavy, serious gloom and doom, and we all ought to go live in a yurt and give up our iphones. This is really about what the future could be, and I'm completely inspired by the things that I'm seeing and experiencing and hearing from people. 


JARED BLUMENFELD: Next up, I meet with Dr. Ashley McClure, who practices internal medicine in Oakland, California. Dr. McClure received her medical degree from Oregon Health Services University School of Medicine in Portland. I start by asking Ashley what it was like going to medical school. 

DR. ASHLEY MCCLURE: When I was interviewing with medical school, one of the interviewers asked me kind of what I was doing and I was like, oh, I'm waitressing. You know, it has nothing to do with medicine. And he said, well actually I think it might have more to do with it. I think what he meant is that it is customer service, and it's connecting with people and having a positive exchange. And so, it is much more than we learned in medical school. And I think it's just helping people cope, helping people not feel alone, helping people be emotionally healthy because that leads to so much of the chronic illness that we're seeing today. So, it is a lot more about interpersonal interactions than anything else. And I think that's the hardest part, because you're taking care of the medical part, the health part, the science part, but then also in the same moment under time constraints, really trying to connect with the person energetically. 


JARED BLUMENFELD: That sounds so exhausting. 


DR. ASHLEY MCCLURE: It is really demanding. You can't just like go on cruise control ever. 


JARED BLUMENFELD: And what kind of medicine do practice? 


DR. ASHLEY MCCLURE: Adult primary care. I'm an internal medicine physician, internist.


JARED BLUMENFELD: I thought that's just someone who's an intern. 


DR. ASHLEY MCCLURE: Yeah. So, I was an intern for a year, and it was really hard. 


JARED BLUMENFELD: So, what kinds of people you seeing every day? 


DR. ASHLEY MCCLURE: So, in a typical day I will see a 22-year-old with concerns about an STD. I'll see a 68-year-old with high blood pressure who just came out of the hospital after a heart attack, I’ll see a 4-year-old who has pneumonia symptoms. I'll see lots of diabetics. I'll see lots of people with anxiety, somebody needing a kidney transplant for severe kidney disease, all sorts of things. 

JARED BLUMENFELD: How do you emotionally fortify yourself? What are your coping mechanisms that allow you to get through the day and deal with all these really serious situations? 

DR. ASHLEY MCCLURE: I think it's a work in progress. The coping exercise is a key part of it. Eating good food, trying to sleep enough, talking to other people, but definitely still learning all the time. Also, kind of the beauty of it is that everybody is usually talking about some kind of suffering and I can be witness to their suffering and I can share that we're humans and we go through suffering for different reasons and not take it on, but just kind of witness it. 

JARED BLUMENFELD: And how does it inform your view of mortality, seeing the cycle of life in front of you every day? 

DR. ASHLEY MCCLURE: I mean, on a personal note, I definitely will probably not want a lot of medical interventions because I see just the quality of life goes down significantly. I think about mortality a lot more in terms of my daughter and what she's going to face than my own personal mortality. I think the stressors on the future of humanity actually is something that I think a lot more about than my own personal death. 


JARED BLUMENFELD: So, tell us about your daughter. 


DR. ASHLEY MCCLURE: She's 13 months old and has totally kind of rearranged my priorities in life in a really good way. I was on maternity leave for six months and somewhere on that six months I came across Al Gore's “An Inconvenient Truth sequel.” And during one of her naps I watched that, and I just had an awakening, this like reminder of, what have I been focused on? Like the minutia, meanwhile, the house is on fire. It was just magnified so many times over by the fact that I had this little human who is going to be living the consequences of what happens to greenhouse gas emissions. 

JARED BLUMENFELD: Dr. Tony Eitan did this landmark study of births and deaths in Alameda county. And it turns out that by zip code there's a twenty-two-year difference between people who are poor and living in polluted, harmed environments in Alameda County and rich people. And so, by your zip code, just within that one county, you can either live with outcomes, like he describes it like Scandinavia or like Afghanistan. And I'm just wondering like how you see that every day given your job in Oakland?

DR. ASHLEY MCCLURE: There was a recent study on Kaiser patients over five or ten years, like 40,000 patients they looked through, and they looked at their actual address block by block and then they overlaid that with traffic related air pollution. So, if you live on the eightieth corridor, right by the port of Oakland, you are at some significant percent higher in risk for having heart attacks than if you live farther away from the freeway. And that's diesel exhaust and that's particulate matter, and that's killing us now. And not only does it directly kill us through heart attacks and strokes and asthma exacerbations, but it is what is contributing to the bigger picture of global warming. That combustion, that exhaust is creating the particulate matter, which directly harms us as we inhale it, but also is warming the planet. It is causing worse allergies because pollen is growing for longer and is more potent, and the degree of heart attacks and strokes and heat illness also is just going to continue to go up along with our emissions until we start to curb them. Because right now they're still going up. The American Lung Association just produced their State of the Air Report, and 8 of the 10 worst air pollution cities are in California, and there's lots of reasons for that. Primarily it is fossil fuel burning and combustion, so it's not far away. It's now and it's affecting our kids. 

JARED BLUMENFELD: Less than a year ago, we had the big fires, historically the worst fires in California's history, and the air pollution was really bad. Did you see people coming into the hospital and were there effects of that? 


DR. ASHLEY MCCLURE: Absolutely. So many of my patients with lung disease or heart disease who are already very vulnerable had flares of their diseases and had to use like steroid inhalers or had to take steroids as pills because of the worsening from the quality of the air. So, there was absolutely an uptick. Studies show that when populations are exposed to wildfire, there is a higher risk of strokes and heart attacks. So, that's not what we usually think about being a risk factor. Like it's diabetes, it's high blood pressure, it's that you smoke, but it's also wildfire exposure contributing to heart attacks and strokes. There's a direct correlation between higher rates of particulate matter exposure, especially pm 2.5, which is smaller than a human hair which gets not only into our lungs but into our blood vessels and deep into our bodies. The higher the level of particulate matter, the greater the risk of heart attack, strokes and asthma. 

JARED BLUMENFELD: What is the culmination of being a doctor and living in the time of climate change? 


DR. ASHLEY MCCLURE: So, the Hippocratic Oath, as most people know, one of the biggest parts of that oath is first doing no harm. And kind of a modern interpretation is if we can't cure something, we have to work to prevent it. So, I could tell, and I do tell all my patients, when we have the higher wildfire particulate matter levels to protect themselves with masks and treat asthma exacerbations with steroids. But the much more useful leverage of being a physician, and I would say of the whole entire medical community, is to lower the emissions that are fueling all these different problems. So, just like helping somebody to not ever start smoking is much more effective than treating their lung cancer. The whole field of medicine, all the physicians and nurses of the country, I think the more that we all articulate to our patients and to policy makers, that the climate change is a health crisis, and in order to protect the public's health, we need to implement policy to lower emissions.


JARED BLUMENFELD: Your message that this is a health crisis seems both new and important. 


DR. ASHLEY MCCLURE: Climate change is a public relations’ marketing disaster because it is so slow and complex and plays out over a timeline that we aren’t very good at thinking along. But the medical voice of the country is starting to realize that the harms to health obligate physicians and the medical community in general to engage in this conversation. That's part of why the American Medical Association, the American Public Health Association, the American Heart Association, all just co-signed along with many others, a call to on climate, health and equity, and it's a policy action agenda that was released a couple of weeks ago, and they're basically saying it's not just about polar bears, it's about our communities’ health. Healthcare is going to be bankrupted by the health harms from climate change if we don't reduce emissions. So, when my daughter is 72 years old, the health harms alone will cost America hundreds of billions of dollars a year. Just health, that's not even talking about agriculture or labor losses. 

JARED BLUMENFELD: So, when you're talking to a patient, does climate change ever come up or is it, and if it does, kind of, what's the patient's reaction? 

DR. ASHLEY MCCLURE: So, the first time I tried to kind of include the impact of climate change in counseling a patient, she was a Spanish speaking patient, and she was in to talk to me about asthma and allergies. And I said, did you know that climate change is making allergies and asthma worse? And she said, yeah, totally. Every year, I'm seeing it get worse. I was surprised that it was already on her radar, that she'd already identified this. And it is surprising for a lot of people when you do bring it in as a physician. But I think that's an opportunity. And I think that's really the opportunity that we need to seize is to help people connect it to their personal health, which is the role of physicians and nurses is to connect it to personal health. In America, roughly two thirds of physicians see and think that climate change is already harming their patient's health. In contrast, only about a third of patients think that it's already harming their health. That's the opportunity of the medical community to use that trusted voice to make this about now and health and our kids and our own wellbeing. 

JARED BLUMENFELD: How much do you talk to your patients about the connection between diet, climate change, and their health? 

DR. ASHLEY MCCLURE: There's a term that's also kind of new called planetary nutrition. There was a book written in the 70’s called “Diet for a Small Planet.” So, eating a salad with lentils, for instance, versus a hamburger, has a very different carbon footprint. So, if all of America chose to eat a plant-based diet tomorrow, the greenhouse gas emissions reductions would be one of the third or fourth highest things that we could do to lower the country's emissions. The science for patients with heart disease, reversing heart disease with a plant-based diet, and exercise and other things, avoiding diabetes or treating diabetes with a plant-based diet is very powerful. So, I am a big proponent. 

JARED BLUMENFELD: So, as someone that's a trusted health professional, a doctor, does it matter if you talk about climate change, namely if you get someone who's at risk of diabetes or obesity to switch to a plant-based diet because of their health? The outcome is great, irrespective of whether you've mentioned climate change or not. 

DR. ASHLEY MCCLURE: I usually counsel about it primarily for the individual patient's health benefit. But as a society, the more we move in that direction, the greater the impact for slowing climate change. 

JARED BLUMENFELD: How has the healthcare industry itself both responding and adapting to climate change? 

DR. ASHLEY MCCLURE: Healthcare as a whole in America produces about 10% of the greenhouse gas emissions of the country. So, there's a lot of work to do and that has to do with, you know, hospitals are very energy intensive buildings and we use anesthetic gases, which again are much more potent for greenhouse gas warming than CO2. In our internal operations, greening that and walking the walk to do no harm is very important. And there's a bigger picture conversation that the medical field and medical professionals need to be a part of is it's not just about our operations, it's about society. And it's about advocating for policies to protect the public's health, which has to do with reducing emissions. 

JARED BLUMENFELD: What is it that's preventing us from taking action given the scientific certainty that we have? 

DR. ASHLEY MCCLURE: I think what's preventing us is profits. There's no question, there are billions of dollars of misinformation being promoted by companies, industries who have a lot to lose by a transition away from fossil fuels. I mean that's why, you know, big tobacco had to kind of be checked with policy also because of the profits. They didn't want to lose by having to put disclaimers on their boxes of causing cancer. So, anytime there's a lot of money involved, of course there's going to be a lot of misinformation promoted because they don't want to lose that income. But the truth, the voice of truth needs to be promoted more strongly, and part of that, I think is the medical voice. And we're trusted because we aren't as easily swayed by profit and financial incentive. We're trusted because we do what's best for people and what's best for people is to start addressing climate change by reducing emissions so that we can all breathe without masks in 30 years. 

JARED BLUMENFELD: It seems like the inclusion of doctors and nurses in this debate can have a big impact on making climate change just more personal.


DR.  ASHLEY MCCLURE: Everybody knows a physician or a nurse, but not everybody knows a climate scientist, you know? And so really getting people to connect this big kind of slow-moving concept of climate change into their own personal, their own family's health and safety. That's the role of the medical field is to make it personal. So, doing everything I can to all physicians because I think a lot of my colleagues right now don't feel, you know, we didn't learn about this in medical school and who am I to talk about climate change? I think there's really a sense of that, like who am I? It's kind of not my expertise. I'm a cardiologist. But it turns out we have a professional obligation to engage on the discussion in the discussion to lead the public's understanding of this health threat. The Lancet Commission called climate change the greatest public health opportunity of the century.   And the opportunity is to activate to slow climate change. There's a recent study saying that 80% of the burden of global warming is going to land on kids less than five. That makes me feel just awful. You know, every generation is supposed to get better, but we're leaving them with a harder life than what we had. And I feel so responsible, and I hope that other people feel that responsibility because this is a tractional problem. This is very solvable. We have the technology. We don't have the political will, and I think we don't have the political will because politics are driven by finances and by big money profit, specifically big oil and coal. But the health protection is much more important than their profits. And that's what this is about. It's about protecting people. 


JARED BLUMENFELD: A huge thank you to both Dr. Bruce Paccar and Dr. Ashley McClure for the work they're doing to highlight the significant health impacts we are already suffering because of climate change. It’s only said to get worse if we don't take bold and swift action to reduce greenhouse gas emissions. For too long, the debate about climate change has been focused on abstractions rather than on our health. By doctors standing up, we're learning that everything from asthma to strokes to diabetes can be helped today if you reduce fine particulates and other emissions that come from burning oil and gas. The next time you visit your doctor, don't be surprised if they prescribe you a fossil free future. On the next episode of Podship earth, I visit my favorite pie shop, San Francisco's Mission Pie, which after selling locally sourced sustainable food for 12 years is closing because of a changing business climate. I investigate why there are still so many obstacles to doing the right thing. Thank you so much for being part of the Podship Earth journey. From the entire Podship Earth crew, sound engineer Rob Speight, executive producer David Kahn, and from me, Jared Blumenfeld, have a week filled with good health. 

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