Should we worry about carbon footprint of medical interventions?

I had never thought of the carbon footprint of medical interventions till I read the perspective article “Carbon-Footprint Analyses in RCTs – Toward Sustainable Clinical Practice” in the New England Journal of Medicine just now [1]. As an extreme example, they have cited the difference in carbon footprint between two anesthetic gases sevoflurane and desflurane which have been shown to have similar effectiveness in many randomized controlled trials. They mention that while 1 kg of sevoflurane has a global warming potential equal to emission of 130 kg of carbondioxide, desflurane has a potential equivalent to 2540 kg of carbon dioxide, partly because of the much longer atmospheric lifetime. This was quite an eye opener to me. They go on to mention that desflurane is one of the most-used anesthetic agent in many countries. The authors of the paper pointed out that if carbon footprint was part of the endpoints assessed in RCTs, desflurane might not have been cleared for marketing or widely implemented!

I went through an earlier article cited in the paper [2]. That article published in 2012 mentioned that even though halogenated organic compounds are present only in 100,000 times lower concentration than carbon dioxide, they contribute to 10 to 15% of the warming effect induced by human beings. They noted that family of anaesthetic gases includes several halogenated organic compounds that are strong greenhouse gases which can contribute to global warming. The authors of the NEJM article mentioned that they have started evaluating carbon footprint of the medical interventions being tested in clinical trials which they have initiated and are ongoing. Only the rigorous methods followed in clinical trials will be suitable for measuring carbon footprint of interventions. They have recommended that it should be made part of all clinical trials so that data can be used by policy makers appropriately to reduce global warming in the long run.

References

1. Nordberg LB, Pohl H, Haavardsholm EA, Lillegraven S, Bretthauer M. Carbon-Footprint Analyses in RCTs – Toward Sustainable Clinical Practice. N Engl J Med. 2024 May 15. doi: 10.1056/NEJMp2402018. Epub ahead of print. PMID: 38749030.
2. Sulbaek Andersen MP, Nielsen OJ, Wallington TJ, Karpichev B, Sander SP. Medical intelligence article: assessing the impact on global climate from general anesthetic gases. Anesth Analg. 2012 May;114(5):1081-5. doi: 10.1213/ANE.0b013e31824d6150. Epub 2012 Apr 4. PMID: 22492189.