Theological Framing and the Problem of Medical Waste - an Op-Ed article

 

Imagine that someone you love or care about has an illness that requires regular disposable single-use medical supplies. They are sent home from the hospital after a serious injury or illness, and have a tracheostomy, a colostomy, a chest drain, or need to be catheterized to relieve their bladder. Now imagine that you live in a place like I do, where your state has not taken the Medicaid expansion and so your insurance premiums are very high, and so is your deductible. You may have to pay as much as $15,000 out of pocket before your insurance company starts paying for your loved ones' medical supplies. Because of this high deductible, you can’t afford to fill the prescription for the supplies in a timely manner, and so, you just kind of fudge things, you leave a catheter in a bit longer than you should, or you don’t change the wound dressing as often as they told you to, and then, your loved one gets an infection. This infection is a really serious problem, and because of it, your loved one goes back to the hospital and has to be admitted for another 2-week stay while they get the infection under control. While in the hospital, your loved one contracts another infection, this time, it’s an antibiotic-resistant infection, and they end up passing away, 2 months later. Simply because your family could not afford a simple single-use medical supply. This scenario might sound grim, but it is something that can, and does happen all the time in our medical system. Now, just imagine, that the hospital where your loved one was cared for, threw thousands of the supplies you needed into the dumpster every month. And not used supplies… brand new, in the package, still in shrink-wrap, sealed, sterile, and not even expired. How would you feel?

I wish I could say that the last part was not true, but sadly it is. Truly massive amounts of disposable, multi- and single-use, and durable medical supplies and equipment are thrown away in the US every year. These are not supplies that are damaged in any way, they are not expired, they are not open or partial packages (Allen, 2017). 

Each year in the U.S., billions of dollars worth of medical supplies are discarded, and sent to landfills. Supplies as various as sealed, unexpired boxes of sutures for surgical procedures, ostomy and diabetic supplies (insulin pumps, infusion sets, continuous glucose monitor sensors), catheter and feeding tube supplies, wound dressings, splints and braces, mobility and home safety equipment such as shower chairs, bedside potty chairs, wheelchairs and walkers, and uncountable doses of medications from steroids to cancer/chemotherapy drugs(Diven et. al. 2015, Allen 2017, GOA, 2008). Hundreds of thousands of tons of medical supplies that are still sterile, unexpired, perfectly usable, and most importantly NEEDED by someone…it is estimated that the total cost of these supplies exceeds $765 billion dollars PER YEAR alone (Allen, 2018, Cantrell et. al. 2012). Sources of this waste include Hospitals, Nursing homes, surgical and outpatient clinics, and urgent care centers, doctors' offices, occupational therapy clinics, and rehabilitation facilities, and private consumers homes which often serve as ad-hoc hospice and rehab facilities for the elderly and chronically ill (Chen 2010). 

Much like other types of waste, medical waste and in particular single-use medical supplies are mostly made from plastic and other synthetic materials, and include copious amounts of packaging that are also largely made of plastic - this is a somewhat “hidden” source of plastic - no one really argues or fights about how much of our medical supplies are made of plastics and synthetics, it is just assumed that these items should be excluded from our criticisms of plastic usage because they are needed for medical purposes, however, studies have shown that sterilization of multiple-use items is also safe in many cases, and could reduce our use, and subsequently the amount that gets thrown away (GOA 2008, Diven 2015, Allen, 2017). The carbon footprint of these single-use medical supplies is very high, especially when almost half of the supplies produced never get used at all and just end up in a landfill! (Allen, 2017, 2018, Kwakyae, 2010) 

This is problematic on a number of levels: someone could use those and probably needs them, it’s more polluting plastics going into our landfills, and additionally - these plastics and synthetic materials like PVC and Vinyl are most often produced in areas that are inhabited by people of color and/or low income families. Also, this wastefulness that is just kind of “baked into” our current medical system has numerous impacts. It raises the costs of insurance for the average American, in addition to raising health care costs in general, from doctor visits to hospital and rehabilitative services (Allen 20187). For many people this means that the supplies, services and medications that they need to survive, or to provide them with an adequate quality of life are out of their price range. Many individuals are forced to ration their care, ration medications, take lower dosages or go without medications that they need, use single use supplies more than once, or for longer periods of time than they are intended to be used (such as a diabetic using an infusion set/site for more than the recommended 3 days, etc) (Cantrell et. al. 2012, Diven 2015).  The high cost of medications and supplies, while affecting most Americans to some degree, have a disproportionate impact on low income families, people of color, and people with disabilities and chronic conditions. 

Theoretical framing - helpful analytical tools for justice

Bayard Love and Deena Hayes-Greene offer us a helpful approach to analyzing this multidimensional problem with what they call the “Groundwater Approach” (Hayes-Greene & Love, 2018). The idea is this: if one person is suffering from some issue, we might want to examine that person in depth to figure out the source of their issue, but if the entire community is suffering the same problem, it would make sense to examine the conditions of that community, things such as contaminated groundwater may be the cause of everyone’s problem. In the case of health care, we know that people of color have much worse health outcomes than their white counterparts, across almost all medical conditions, ages, and socioeconomic brackets. I think that this approach in conjunction with an eco-womanist approach would be helpful for defining and understanding the ways that structural racism is really at the heart of this problem, which in turn makes life worse for all of us, and also is terribly harmful to the environment. An eco-womanist approach to this problem would approach it not from the perspective of environmental hazards or degradation, but from the need to remediate the unequal impact that environmental hazards have on communities of color (Betancourt 2016). This issue, as explained above fits this approach perfectly. Not only are communities of color disproportionately impacted by the lack of affordable health care, prescriptions, and medical supplies, but they are also disproportionately impacted by the continual need to produce more new products, despite the fact that there are plenty of them already made to meet the needs. This issue perfectly illustrates the ways that thinking about the good of communities of color (and in particular women of color and disabled people of color) can lead to justice for not just their communities, but for everyone, and the earth as well. 

References: 

Betancourt, Sofia. 2016. “Between Dishwater and the River.” Worldviews 20: 64–75.

Allen, Marshall. 2017. “Want to Cut Health-Care Costs? Start with the Obscene Amount of Waste.” The Washington Post, December 28, 2017. https://www.washingtonpost.com/news/posteverything/wp/2017/12/28/want-to-cut-health-care-costs-start-with-the-obscene-amount-of-waste/.

Allen, Marshall. 2018. “The Myth of Drug Expiration Dates.” ProPublica. 2018. https://www.propublica.org/article/the-myth-of-drug-expiration-dates.

Allen, Marshall. 2017. “America’s Other Drug Problem.” ProPublica. 2017. https://www.propublica.org/article/americas-other-drug-problem.

Allen, Marshall. 2017. “What Hospitals Waste.” ProPublica. 2017. https://www.propublica.org/article/what-hospitals-waste.

Bourdieu, Pierre. 1993. “The Field of Cultural Production.” Sociology The Journal Of The British Sociological Association, 340. https://doi.org/10.2307/4200901.

Cantrell, Lee, Jeffrey R. Suchard, Alan Wu, and Roy R. Gerona. 2012. “Stability of Active Ingredients in Long-Expired Prescription Medications.” Archives of Internal Medicine 172 (21): 1685. https://doi.org/10.1001/archinternmed.2012.4501.

Chen, Ingfei. 2010. “In a World of Throwaways, Making a Dent in Medical Waste.” The New York Times. 2010.

Diven, Dayna G., Diana W. Bartenstein, and Daniel R. Carroll. 2015. “Extending Shelf Life Just Makes Sense.” Mayo Clinic Proceedings 90 (11): 1471–74. https://doi.org/10.1016/j.mayocp.2015.08.007.

Hayes-Greene, Deena, and Bayard P. Love. The Groundwater

Approach: Building a Practical Understanding of Structural Racism. The Racial

Equity Institute. 2018.

Kwakye, Gifty, Peter J Pronovost, and Martin A Makary. 2010. “Commentary: A Call to Go Green in Health Care by Reprocessing Medical Equipment.” Academic Medicine 85 (3). https://journals.lww.com/academicmedicine/Fulltext/2010/03000/Commentary__A_Call_to_Go_Green_in_Health_Care_by.10.aspx.

Redett, Richard. 2017. “Study Documents Millions in Unused Medical Suplies in U.S. Operating Rooms Each Year.” 2017. https://www.hopkinsmedicine.org/news/media/releases/study_documents_millions_in_unused_medical_supplies_in_us_operating_rooms_each_year.

United States Government Accountability Office. 2008. “Reprocessed Single-Use Medical Devices: FDA Oversight Has Increased, and Avalaible Information Does Not Indicate That Use Presents an Elevated Health Risk.” Washington, DC. https://www.gao.gov/assets/gao-08-147.pdf.

Weber, Max, and Talcott Parsons. 1905, 2003. The Protestant Ethic and the Spirit of Capitalism. Courier Dover Publications.