The healthcare sector is responsible for large greenhouse gas emissions. Now two leading research groups in Norway are taking an international initiative to calculate the climate footprint in advance of medical treatments. The goal is to offer healthcare services that are beneficial for both the patient and the planet. These ambitions have recently been published in the highest ranked medical journal internationally, The New England Journal of Medicine.
Measuring and comparing the carbon footprint of different treatments already at the research stage can lead to us adopting treatments that result in lower greenhouse gas emissions from the health sector. From left, Head of the REMEDY Center, Professor Espen A. Haavardsholm, researcher and physician Lena Nordberg, deputy head of the REMEDY Center and physician Siri Lillegraven and Professor Michael Bretthauer, head of Clinical Effectiveness Research. Photo: REMEDY, Nicolas Tourrenc
Today, we do not know the carbon footprint of different treatment options, and how this compares to the benefits patients receive from the treatments.
– Before new treatments are introduced, we conduct clinical studies to assess the advantages and disadvantages of different treatment options. With our plan, we bring analyses of the carbon footprint of medical treatments into clinical studies. This will provide new knowledge that can contribute to more sustainable healthcare services, says researcher and physician Lena Bugge Nordberg at Diakonhjemmet Hospital, who is leading the work.
Leading research communities in partnership for climate
The calls are a collaboration between REMEDY Center at Diakonhjemmet Hospital and Clinical Effect Research at Oslo University Hospital and the University of Oslo, two leading environments within clinical treatment research in Norway. Together, REMEDY and Clinical Effect Research are leading a number of large clinical studies with several hundred thousand patients in areas such as rheumatology, orthopedics and cancer in Norway and Europe.
The health sector's climate footprint today
Climate change is the greatest threat to human life and health. Paradoxically, the healthcare sector accounts for a significant share of greenhouse gas emissions. With a share of 4-5% of global emissions, the healthcare sector has twice the emissions of the world's air traffic. In recent years, the UN has urged the healthcare sector to make major emission cuts.
Need for informed decisions
By including carbon footprint analyses in treatment studies, it will be possible to choose the most climate-friendly of otherwise equivalent treatments, the researchers explain in the new article in The New England Journal of Medicine.
As an example, Nordberg mentions the two anesthetic gases sevoflurane and desflurane, which have been compared in several studies. The studies showed that both gases are effective and safe for patients, and both gases have therefore been used worldwide. Carbon footprints have never been measured in such treatment studies.
– Emissions of 1 kg of sevoflurane correspond to emissions of 130 kg of CO2, while emissions of 1 kg of desflurane correspond to 2540 kg of CO2. If the carbon footprint had been measured in the studies, desflurane would probably not have been used, says Nordberg.
Climate footprint as a new endpoint in clinical treatment studies
REMEDY and Clinical Effect Research have included carbon footprint as one of the factors considered in their clinical studies from 2023.
In an ongoing study, REMEDY researchers are comparing the effects of cortisone injections with surgery for patients with carpal tunnel syndrome. The carbon footprint of the two treatments is calculated and compared in the study. This will be part of the assessment of the advantages and disadvantages of the two treatments. The study is explained in more detail here: https://classic.clinicaltrials.gov/ct2/show/NCT05306548
In another large study, led by Clinical Effectiveness Research, a new method for non-surgical treatment of early bowel cancer is being compared with the current method of surgery and removal of the colon. It is expected that the new treatment method can help patients without surgery, but also that the new method will be able to reduce the carbon footprint of bowel cancer treatment. The study is described in more detail here: https://classic.clinicaltrials.gov/ct2/show/NCT06057350 .
Randomized clinical trials are the gold standard for assessing the efficacy and safety of new medical treatments. If researchers and the pharmaceutical industry integrate carbon footprints into such studies, the environmental impact of interventions can be calculated – and health policymakers, clinicians and patients can take the environmental aspect into account when choosing treatments.
*Clinical studies are conducted to generate data on the safety, effectiveness, benefits, and side effects of drugs, treatment methods, and medical devices.
*The New England Journal of Medicine (NEJM) is the most cited scientific journal in the world, regardless of subject, with an impact factor of 158.5.
