1 00:00:03,800 --> 00:00:07,800 Greetings and welcome to EHA Unplugged, the official podcast 2 00:00:07,800 --> 00:00:11,680 channel of the European Hematology Association EHA. 3 00:00:12,960 --> 00:00:15,640 I'm Sarah Deflecker and I'm here today in London with Steven 4 00:00:15,640 --> 00:00:17,640 Hibbs. Steven, would you please 5 00:00:17,640 --> 00:00:19,200 introduce yourself? Yeah, sure. 6 00:00:19,200 --> 00:00:21,920 So I'm up the road in London, in East London. 7 00:00:21,920 --> 00:00:25,800 I'm a hematology registrar and a clinical research fellow, mostly 8 00:00:26,240 --> 00:00:29,760 researching sickle cell disease care, but here to talk about 9 00:00:29,760 --> 00:00:31,040 something different. Yeah. 10 00:00:31,040 --> 00:00:34,480 So we're here to talk really about the environmental impacts 11 00:00:34,480 --> 00:00:37,280 of hematology. But before we get into that, how 12 00:00:37,280 --> 00:00:40,120 do you see that climate change is impacting hematology already? 13 00:00:40,520 --> 00:00:41,960 Yeah. So I think there's probably 14 00:00:42,920 --> 00:00:45,000 often a conversation about climate change that thinks this 15 00:00:45,000 --> 00:00:47,200 is something that's going to happen in the future and it can 16 00:00:47,200 --> 00:00:49,600 be sort of end of the world scenarios. 17 00:00:49,600 --> 00:00:51,240 And those are real, you know, those are real. 18 00:00:51,240 --> 00:00:54,040 But I think what's often missed is that climate change is 19 00:00:54,040 --> 00:00:56,040 happening now and the effects of it are now. 20 00:00:57,040 --> 00:00:59,320 Probably one really important thing to say before I answer 21 00:00:59,320 --> 00:01:02,280 that directly is that the the worst effects of climate change 22 00:01:02,280 --> 00:01:05,120 are felt by those who've contributed least to emissions 23 00:01:05,280 --> 00:01:08,920 and who are least equipped to to deal with those consequences 24 00:01:08,920 --> 00:01:12,800 because they're in parts of the world that have already been 25 00:01:12,840 --> 00:01:15,440 impoverished by the way the global financial system works. 26 00:01:15,560 --> 00:01:17,400 So that's really important just to say to start with. 27 00:01:17,400 --> 00:01:20,200 And so many of our colleagues who listen to this in countries 28 00:01:20,360 --> 00:01:25,840 like the Maldives or Bangladesh or around the Sahara will know 29 00:01:25,840 --> 00:01:28,840 far better than any of us do that climate change is real and 30 00:01:28,840 --> 00:01:32,560 it's happening now. But I think for those of us who 31 00:01:32,560 --> 00:01:34,880 perhaps have felt less of the impact of that so far, we're 32 00:01:34,880 --> 00:01:37,040 going to start seeing it in these big ways. 33 00:01:37,680 --> 00:01:40,960 But perhaps it's just worth pointing out a few ways in which 34 00:01:40,960 --> 00:01:43,680 this is affecting specific parts of hematology practice. 35 00:01:43,680 --> 00:01:44,720 So I'll give a couple of examples. 36 00:01:44,720 --> 00:01:49,200 When we think about blood transfusion, one key part is to 37 00:01:49,200 --> 00:01:51,880 ensure blood safety, thinking about transfusion transmitted 38 00:01:51,880 --> 00:01:53,800 infections. But something that we're seeing 39 00:01:53,800 --> 00:01:58,000 is that as climate changes, the vectors that spread particular 40 00:01:58,000 --> 00:02:00,640 diseases that can be transmitted in infections change. 41 00:02:00,800 --> 00:02:03,240 So West Nile virus is a good is a good example of that. 42 00:02:03,240 --> 00:02:06,480 That's already changing and we'll see more of this in the 43 00:02:06,480 --> 00:02:09,039 years to come. That's perhaps more of an 44 00:02:09,039 --> 00:02:12,640 obvious consequences of things as well, like disruption to 45 00:02:12,920 --> 00:02:18,960 logistical lines or some mass casualty events from severe 46 00:02:18,960 --> 00:02:20,680 weather events. Those are the sort of obvious 47 00:02:20,680 --> 00:02:22,760 things, but I think there's going to be an awful lot of 48 00:02:22,760 --> 00:02:24,160 things that are less predictable as well. 49 00:02:24,160 --> 00:02:27,000 So one really good example of this paper published earlier 50 00:02:27,000 --> 00:02:30,960 this year in Lancet Planetary Health, showed that mothers who 51 00:02:30,960 --> 00:02:35,120 exposed to extreme heat in the first trimester pregnancy, their 52 00:02:35,120 --> 00:02:38,520 children were significantly more likely to go on to develop acute 53 00:02:38,520 --> 00:02:41,080 lymphoblastic leukaemia. Now, I could not have predicted 54 00:02:41,080 --> 00:02:44,200 about that, but that is not, to me, a an obvious link. 55 00:02:44,320 --> 00:02:46,840 And I still don't think anyone fully understands what that is. 56 00:02:47,280 --> 00:02:51,800 But I think it's a good example of how because systems are so 57 00:02:51,800 --> 00:02:56,480 interconnected, all of the planetary health of humans, but 58 00:02:56,480 --> 00:03:00,040 also animals, plants, every part of the planet is deeply 59 00:03:00,040 --> 00:03:01,920 interconnected. And we're going to see many, 60 00:03:01,920 --> 00:03:05,200 many ways in the coming decades in which hematology practices 61 00:03:05,200 --> 00:03:07,400 that we take for granted are going to be affected and 62 00:03:07,400 --> 00:03:10,760 disrupted by climate change. And you've been doing some 63 00:03:10,760 --> 00:03:14,680 research into the impact of hematology on climate change. 64 00:03:14,840 --> 00:03:17,280 Can you maybe sort of tell our audience what you've been 65 00:03:17,280 --> 00:03:18,840 looking into? Yeah. 66 00:03:18,840 --> 00:03:20,600 So just take a bit of brief background. 67 00:03:21,680 --> 00:03:24,840 Healthcare related activities contribute 5% of global 68 00:03:24,840 --> 00:03:26,680 emissions. So of all CO2 emissions from 69 00:03:26,880 --> 00:03:29,160 anything in the world, 5% of it is related to healthcare. 70 00:03:29,160 --> 00:03:32,640 It's quite a big amount and there's a method called life 71 00:03:32,640 --> 00:03:35,760 cycle assessment which is looking at cradle to grade 72 00:03:35,760 --> 00:03:38,680 assessments of a particular practice or a particular item. 73 00:03:38,680 --> 00:03:40,880 So it's originally developed in construction, but it can be 74 00:03:40,880 --> 00:03:42,120 applied to healthcare activities. 75 00:03:42,600 --> 00:03:45,320 So if I start with what kind of inspired the work and then I'll 76 00:03:45,360 --> 00:03:47,760 move on to transfusion. And there's been some really 77 00:03:47,760 --> 00:03:50,560 practice changing work looking at things like anaesthetic gases 78 00:03:50,560 --> 00:03:52,840 and inhalers that showed that you could take an anaesthetic 79 00:03:52,840 --> 00:03:54,440 gas that does exactly the same thing. 80 00:03:54,600 --> 00:03:56,840 So there's one called desflorine does exactly the same thing as 81 00:03:56,840 --> 00:04:00,040 something called Seba fluorine, but the first has 26 times the 82 00:04:00,040 --> 00:04:02,680 environmental impact of the 2nd. And so the first has now been 83 00:04:02,680 --> 00:04:06,000 outlawed, reduced from practice, removed altogether and Seba 84 00:04:06,000 --> 00:04:08,080 fluorine is used instead. And the same with moving from 85 00:04:08,080 --> 00:04:09,800 one type of inhaler to another type. 86 00:04:10,360 --> 00:04:12,760 So we wanted to ask the question, well, what about in 87 00:04:12,760 --> 00:04:15,280 hematology practices? And specifically we were looking 88 00:04:15,280 --> 00:04:18,480 at transfusions. Was there a sort of smoking gun 89 00:04:18,480 --> 00:04:20,959 that we could identify to say there's something about the way 90 00:04:20,959 --> 00:04:24,080 in which we're collecting or processing or giving blood 91 00:04:24,080 --> 00:04:26,840 transfusions that could quickly be changed and lead to a 92 00:04:27,400 --> 00:04:29,440 reduction in its impact? So we wanted to ask the 93 00:04:29,440 --> 00:04:32,760 questions, what is the impact of a blood transfusion on the 94 00:04:32,760 --> 00:04:34,680 environment in terms of its carbon emissions? 95 00:04:35,080 --> 00:04:37,480 And secondly, we wanted to ask the question where along the 96 00:04:37,480 --> 00:04:40,720 cycle are those emissions generated and what can we do 97 00:04:40,720 --> 00:04:43,720 about it? So it's a cut. 98 00:04:43,720 --> 00:04:45,520 Long story short, a lot of work went into it. 99 00:04:45,520 --> 00:04:49,720 We collaborated with some environmental engineers based in 100 00:04:50,120 --> 00:04:52,720 in America, lots of people throughout NHS blood and 101 00:04:52,720 --> 00:04:56,880 transport plant in the UK measured many machines, many 102 00:04:56,880 --> 00:05:00,800 chemicals, many tests, looked at transport surveys, even metered 103 00:05:00,800 --> 00:05:03,480 fridges and how much electricity they were used to come up with 104 00:05:03,480 --> 00:05:05,960 an overall figure. And So what I can tell you is 105 00:05:05,960 --> 00:05:11,040 that one unit of red blood cells in England generates about 7 1/2 106 00:05:11,040 --> 00:05:17,480 kilograms of CO2 equivalent, and most of that is transportation, 107 00:05:17,680 --> 00:05:20,840 refrigeration and the plastic blood bags themselves. 108 00:05:21,080 --> 00:05:23,120 And you said that this is in England. 109 00:05:23,160 --> 00:05:26,800 Do you think that this is, you know, can we extrapolate from 110 00:05:26,800 --> 00:05:28,600 this to other geographies as well? 111 00:05:29,040 --> 00:05:31,360 So I think there's a few factors that are going to change things 112 00:05:31,360 --> 00:05:36,200 in different places. So one is what's the electricity 113 00:05:36,240 --> 00:05:37,680 generation mixes in that country? 114 00:05:37,680 --> 00:05:40,320 So the UK has actually moved a lot to things like wind energy, 115 00:05:40,320 --> 00:05:42,240 renewable energy. And so actually the amount of 116 00:05:42,240 --> 00:05:44,640 carbon that's generate that's that's used to generate 117 00:05:44,640 --> 00:05:47,000 electricity in the UK is quite small compared to a lot of other 118 00:05:47,000 --> 00:05:48,640 countries where it could be two or three times bigger. 119 00:05:49,080 --> 00:05:50,400 So that's one factor we've got to think about. 120 00:05:50,680 --> 00:05:52,120 Another is the distance is involved. 121 00:05:52,120 --> 00:05:55,360 So if you're in a blood system, so your blood provider who's 122 00:05:55,360 --> 00:05:59,200 providing over a huge kind of rural area or area where there's 123 00:05:59,200 --> 00:06:02,680 just big distances, then it's going to go up there and NHS 124 00:06:02,680 --> 00:06:07,040 blood and transplant the UK or sorry, the England's blood 125 00:06:07,040 --> 00:06:10,800 provider, they've already done quite a lot of work to do things 126 00:06:10,800 --> 00:06:14,080 like move to an electrified transport, transport fleet. 127 00:06:14,520 --> 00:06:18,320 And so I think all of those things mean that I expect the 128 00:06:18,320 --> 00:06:24,840 other, the other blood providers might find that their red blood 129 00:06:24,840 --> 00:06:28,320 cells generate even more carbon. I guess another question here 130 00:06:28,320 --> 00:06:31,880 is, well, what is 7 1/2 kilograms of CO2 equivalent, 131 00:06:31,880 --> 00:06:33,560 right? Because we're not used to 132 00:06:33,560 --> 00:06:36,080 dealing with this particular unit. 133 00:06:36,520 --> 00:06:38,160 And I find it really hard to answer that question because 134 00:06:38,360 --> 00:06:41,880 depending on the answer I give you, it really sounds more or 135 00:06:41,880 --> 00:06:43,360 less significant. So I could tell you that it's 136 00:06:43,440 --> 00:06:45,680 about the equivalent of 100 COVID tests. 137 00:06:46,160 --> 00:06:48,000 Sounds quite a lot, You know, you think, well, that's, that's, 138 00:06:48,000 --> 00:06:50,320 that's a decent amount. I could also tell you that it's 139 00:06:50,400 --> 00:06:56,360 an 8 oz beef steak in a higher welfare cow or that you'd for 140 00:06:56,360 --> 00:06:58,400 one person going to an international hematology 141 00:06:58,400 --> 00:07:01,240 conference. So flying out to ASH or AABB or 142 00:07:01,240 --> 00:07:04,520 whatever. The amount of emissions 143 00:07:04,520 --> 00:07:08,080 generated by that trip is the same as 150 red blood cell 144 00:07:08,080 --> 00:07:11,880 transfusions. So what do you say? 145 00:07:11,880 --> 00:07:16,160 It's significant, but modest compared to some other things. 146 00:07:16,960 --> 00:07:19,920 I read somewhere that it's equivalent to about driving 40 147 00:07:19,920 --> 00:07:23,240 kilometers in a, you know, in a petrol car. 148 00:07:24,640 --> 00:07:27,680 So what would you say to people who say, well, you know, what's 149 00:07:27,680 --> 00:07:29,840 the harm in that? It's it, you know, it's a life 150 00:07:29,840 --> 00:07:31,880 saving procedure in many cases, yeah. 151 00:07:32,080 --> 00:07:34,320 Yeah. I mean, in no way is anything 152 00:07:34,320 --> 00:07:36,800 we're trying to say we should use less blood on the basis of 153 00:07:36,800 --> 00:07:39,960 its environmental impact. I guess it's more saying are 154 00:07:39,960 --> 00:07:44,480 there are there clear ways in which we can reduce the we can 155 00:07:44,480 --> 00:07:46,320 reduce now the impact that it does generate? 156 00:07:47,440 --> 00:07:50,840 I think when we, when we think about the scale of one blood 157 00:07:50,840 --> 00:07:53,000 transfusion, it's not very much. But when we, when we sort of 158 00:07:53,000 --> 00:07:56,160 scaled it up to 1.3 million units transfused each year, it 159 00:07:56,160 --> 00:07:58,120 really does start to become a significant amount. 160 00:07:58,440 --> 00:08:01,680 And so any saving that can be made across that is significant. 161 00:08:02,040 --> 00:08:05,040 I think that some of the things actually might be quite 162 00:08:05,040 --> 00:08:09,080 practical, like modernizing fridges or consolidating things 163 00:08:09,080 --> 00:08:12,360 into one larger fridge rather than several smaller fridges is 164 00:08:12,480 --> 00:08:13,840 1 quite practical thing that can be done. 165 00:08:13,840 --> 00:08:16,400 Now we need to look at some of the plastic that's used in the 166 00:08:16,400 --> 00:08:18,280 blood bags that could improve things as well. 167 00:08:18,920 --> 00:08:23,600 But I think that the other thing here is that actually what this 168 00:08:23,600 --> 00:08:26,000 method shows us is that there's many other practices in 169 00:08:26,000 --> 00:08:28,920 hematology, transfusion and elsewhere where we might also 170 00:08:28,920 --> 00:08:32,440 apply such a method. Is there any indication on, you 171 00:08:32,440 --> 00:08:35,960 know where that might lie within hematology at this point? 172 00:08:36,559 --> 00:08:38,880 So it's not been done very much so far. 173 00:08:38,880 --> 00:08:42,280 A colleague of mine in in Harvard, Andrew Hantel, has 174 00:08:42,280 --> 00:08:47,080 looked a bit at doing remote or local consultations for cancer 175 00:08:47,080 --> 00:08:51,240 follow up rather than bringing people into centres some of the 176 00:08:51,240 --> 00:08:54,440 far away from their homes. There's a little bit of work 177 00:08:54,440 --> 00:08:56,560 looking at things like for blood counts and basic other 178 00:08:56,640 --> 00:08:58,960 hematology tests, but I think there's some really important 179 00:08:59,000 --> 00:09:01,000 work to be done looking at things like anticoagulation 180 00:09:01,000 --> 00:09:03,520 strategies. There really might be quite 181 00:09:03,520 --> 00:09:07,040 significant carbon footprint there that we've not seen. 182 00:09:07,320 --> 00:09:09,360 I think when we think about transfusion, some of the frozen 183 00:09:09,360 --> 00:09:12,440 products we use, So if you put plasma in a freezer for two 184 00:09:12,440 --> 00:09:15,680 years, there's a huge amount of electricity generation and also 185 00:09:15,680 --> 00:09:18,640 refrigerant leakage there. Where now we've got 186 00:09:18,720 --> 00:09:21,400 possibilities of things like freeze dried products that don't 187 00:09:21,400 --> 00:09:22,920 need to be kept in a freezer that whole time. 188 00:09:23,120 --> 00:09:24,960 There really might be a significant saving there to 189 00:09:24,960 --> 00:09:28,240 make. So I think quoting Antonio 190 00:09:28,240 --> 00:09:31,640 Guterres, who's the UN secretary general, he says when we think 191 00:09:31,640 --> 00:09:33,840 about the climate, when we think about climate change, it needs 192 00:09:33,840 --> 00:09:36,480 to be Everything, Everywhere, all at once. 193 00:09:37,040 --> 00:09:40,400 So are there any things that like an individual hematologist 194 00:09:40,400 --> 00:09:42,880 can do in order to reduce their impact? 195 00:09:43,080 --> 00:09:45,920 I think probably some of the stuff that makes sense already 196 00:09:46,000 --> 00:09:49,840 in when we think about economic and just patient care, things 197 00:09:49,840 --> 00:09:52,480 like challenging tests that don't make sense. 198 00:09:52,520 --> 00:09:55,160 I think reducing waste is going to be a big one. 199 00:09:56,080 --> 00:09:57,960 I think probably thinking about some of our professional 200 00:09:57,960 --> 00:09:59,600 practices as well. I mentioned things like 201 00:09:59,600 --> 00:10:01,320 international conferences and meetings. 202 00:10:01,800 --> 00:10:03,560 I think there's, there's been some good suggestions about 203 00:10:03,560 --> 00:10:06,360 maybe using hub and spoke models rather than bringing everyone in 204 00:10:06,360 --> 00:10:09,880 the world to 1 central place. Could we have a few smaller 205 00:10:09,880 --> 00:10:12,600 local gatherings that then link in in different ways that that 206 00:10:12,600 --> 00:10:14,920 could be big? I think also just looking up at 207 00:10:14,920 --> 00:10:17,560 some of the things like our organisations we work for, I can 208 00:10:17,560 --> 00:10:20,880 say because I've already spoken to people on the E Hard board 209 00:10:20,880 --> 00:10:24,680 that E Hard does not have any investments in fossil fuels, but 210 00:10:24,680 --> 00:10:26,160 actually a lot of organisations might. 211 00:10:26,440 --> 00:10:28,240 And so looking at the organisations that you're part 212 00:10:28,240 --> 00:10:31,880 of to see the impact they have. So I think the final thing I'd 213 00:10:31,880 --> 00:10:33,720 say is that if it's if there's someone who's listening to this 214 00:10:33,960 --> 00:10:36,680 and who is interested in the research aspect of this, there 215 00:10:36,680 --> 00:10:39,760 is a huge amount of work to be done to understand what our 216 00:10:39,760 --> 00:10:43,680 footprint even is and to look for some strategies how we might 217 00:10:43,680 --> 00:10:46,360 reduce that. You're obviously very passionate 218 00:10:46,360 --> 00:10:48,440 about this. Why should other hematologists 219 00:10:48,440 --> 00:10:54,240 get passionate about this? For those who haven't looked at 220 00:10:54,240 --> 00:10:58,320 the sort of wider conversation on climate change, it might seem 221 00:10:58,400 --> 00:11:01,120 quite a niche issue. I think for those who have 222 00:11:01,120 --> 00:11:05,320 looked at the sort of wide issues about climate change, it 223 00:11:05,320 --> 00:11:10,280 can be overwhelming. We're really looking at, you 224 00:11:10,280 --> 00:11:13,920 know, possibilities of millions of people dying within the next 225 00:11:13,920 --> 00:11:17,160 couple of decades of man made climate change. 226 00:11:18,120 --> 00:11:21,880 And for me, I can often feel a bit overwhelmed by that and feel 227 00:11:21,880 --> 00:11:23,680 a bit paralyzed. Just it's too big, it's 228 00:11:23,680 --> 00:11:25,320 happening. What what can we do? 229 00:11:26,280 --> 00:11:28,760 I think what's not talked about enough are some of the good news 230 00:11:28,760 --> 00:11:31,960 stories and a question that I really like that one of my 231 00:11:31,960 --> 00:11:34,280 favorite podcasts about climate change often says is what would 232 00:11:34,280 --> 00:11:35,480 it look like for this to go right? 233 00:11:35,480 --> 00:11:37,120 What if, what if this goes right? 234 00:11:37,840 --> 00:11:41,720 And I think leading on from that question, if we look at some of 235 00:11:41,720 --> 00:11:45,480 the good news, like I think last week, the last ever coal power 236 00:11:45,480 --> 00:11:48,360 generation in the UK was shut down after 142 years of coal 237 00:11:48,360 --> 00:11:49,120 power. That's happened. 238 00:11:49,240 --> 00:11:51,880 If we look at the last three years in the UK, we've gone from 239 00:11:51,880 --> 00:11:55,320 15% of electricity as wind power to 35%. 240 00:11:55,360 --> 00:11:57,760 I mean, there's incredible upscale and there's incredible 241 00:11:57,760 --> 00:11:59,360 good news stories around the world. 242 00:11:59,480 --> 00:12:01,120 I mentioned about anesthetic gases, I mentioned about 243 00:12:01,120 --> 00:12:04,480 inhalers. I think that it is possible it 244 00:12:04,480 --> 00:12:06,720 might not happen. We might fail, we might face 245 00:12:06,720 --> 00:12:10,320 human extinction in the next decade, in the next century. 246 00:12:10,320 --> 00:12:13,840 That that is a possibility. But I think part of the reason 247 00:12:13,840 --> 00:12:18,480 about being about really trying to think about what we can do 248 00:12:18,480 --> 00:12:22,520 with as hematologists is both about feeling like we've got 249 00:12:22,520 --> 00:12:27,000 some agency, some power in this, but also about as, as Antonio 250 00:12:27,000 --> 00:12:30,760 Gutierrez says, being part of that, Everything Everywhere all 251 00:12:30,760 --> 00:12:33,520 at once. OK, thank you very much. 252 00:12:33,520 --> 00:12:36,240 This is a very interesting conversation and I implore our 253 00:12:36,240 --> 00:12:39,880 listeners to have a look into this in their own time and look 254 00:12:39,880 --> 00:12:42,760 up some of the research and the position papers that have 255 00:12:42,760 --> 00:12:45,840 already been published on this. Thank you, Steven for being here 256 00:12:45,840 --> 00:12:49,680 with us today and TuneIn for the next episode of EHA Unplugged.