You guys are very compliant disembodied male voices. Welcome, everybody. I'm Helen Burstyn, CEO of Council of Medical Specialty Societies, and we are delighted to have you with us today as we officially open our annual meeting. We did have our professional peer groups and CEO Council meeting this morning that went incredibly well. And this is how we're going to open our program. I just have a few opening slides, then I'll introduce Sue Sidori, our current president, and then we'll get on with the opening keynote. So first, a little bit about who we are and what we do. For those who don't know, we are now at 55 specialty societies. I will say when I started seven years ago, it was 41. So it's been a pretty significant growth. I'm really excited to have our new members with us today. Representing about 800,000 physicians, and we need to update those numbers, but it's at least that, we think. And we really believe that specialty societies have a unique role. We talked about this a lot this morning at the CEO Council in terms of some of the assault on science and evidence, and what our role is in terms of defending some of that. High quality, evidence-based health care, accessible to all, the power of a diverse, shared learning community, and a unified voice when appropriate, and a really broad perspective across specialties. And this is all of you. These are your logos, and again, we are really delighted to have all of you here today. And this meeting represents a significant increase in our registration as well. So we're really pleased about that as well. For those of you who haven't seen it, we updated our strategic plan last year, updated our mission, our vision, strategic priorities, and core competencies. And really importantly, I want to emphasize that our mission is to advance the expertise and collective voice of specialty societies in support of physicians and the patients they serve. And I want to emphasize and the patients they serve as being really our true north and a really important element of CMSS. And really, we do view that by working together, we can make health care better for all. And that as we think about our strategic priorities, some of which we've already done this morning, which is engaging community, building capacity, shared learning and innovation, and then really addressing critical issues together, like we're going to do very shortly around the issue of climate and health. Our core competencies, very much quality, equity, education as being at our core. And if you would look at our website, and I hope you do, and thanks to Julie Peterson and our team for updating our website, which is quite lovely now. You'll see that it's really laid out in this way that I think is a great way to describe who we are. By working together, we can advance health care for patients and physicians because we provide that community that allows us to really address those issues together. We can accelerate the skills and the impact of specialty societies to face these new challenges. We can amplify the reach and influence of specialty societies. And we can connect, importantly, with research, funding opportunities. Really delighted, for example, our leadership of PCORI is here with us today and helping to support this meeting in light of a lot of our engagement work and interest in working with all of you. So if you look at our website again, we've really broken down a really enormous number of programs and resources that we now have for you into those core areas of quality, equity, education, public health, patient engagement, and professional standards. And I'll just say a moment about professional standards. If you haven't heard, we are updating the code for interaction with companies, a resource that CMSS put out a decade ago. Some updates over the years by our general counselors who we greatly appreciate. But boy, is it time to figure out what a company is in 2024, almost 2025, and thinking about what our interaction with those groups look like. So really excited to do that work. And this was just literally from this morning. So this was the real time for those of you who were in your professional peer group or CEO council meeting earlier. We specifically asked what was the most valuable insight or takeaway from the PPG session that you attended. And of course, I didn't bring my notes with me. But I have a lavalier mic, so I think I can see it. But for example, in the CPD group, the conversations about funding and ACCME and accreditation for the DEI PPG, understanding what we're doing in our new initiative around encoding equity in clinical research and practice. The CEO summit, boy, that was a lot of conversation today. But in particular, we had a conversation with somebody who joined us from the American Society of Association Executives. So we understand the implications of tax reform and what they may potentially impose on nonprofits. Important part of us being able to do our work in addition to so, so, so many issues, Sue. CPD group, always boisterous, full group who meet at that meeting, talked about the broader issues that impact CME, commercial support, reaccreditation, the CMSS code of conduct, and just so helpful to connect with colleagues. CEO Council, again, many things, especially appreciate the discussion. Jerry Penso's here from AMGA who we invited, one of our associate members, who talked about the changing landscape of physician payment and health systems, important issues. Again, the CPG, our clinical practice guidelines group, topics highly relevant to my day-to-day strategic responsibility. Everyone in the room has the same professional experience I do. And that's part of the secret sauce, I think, of what CMSS brings to the table. All of you get to sit with peers who do similar work to push on innovation, identify where there's opportunities to take on complex topics, and really move to a new and exciting strategic level. So with that, I'm going to take this opportunity to thank and turn the microphone briefly over to Sue Sidori, who's been our president for the last year. Sue. Thank you, Helen. I really wanted to just kind of give another shout out to the staff for helping to pull this meeting together, bring this all together. You'll see them throughout the next day and a half. I hope you get a chance to get to know some of the CMSS staff and have a chance to thank them as well. Thank you all for being here. It's really important that we have these chances to come together like this. As Helen said, the PPG meetings this morning are always just one of the highlights and the strengths of what we do when we come together in person. But really, it's the fact that CMSS at its core is all about making each of our organizations stronger. And that happens at the CEO level all the way down to everybody who's here. But then finding a way to take that voice and bring it together and make it stronger for our organizations. And I think we all feel that there is never a time when that's not important. But we certainly feel that that is a time when it is even more important right now, so that we are protecting the important work that we do as we kind of look toward the future. So again, thank you for being here. Lots of great sessions over the next day and a half. I hope you have lots of opportunity to learn and to connect and to really learn from each other. Thank you. Thank you so much, Sue. And I, again, just can't thank Sue enough for her incredible leadership over the last year. And also, as this morning at our CEO Council, we also have our new slate of officers. I just want to personally thank Dr. Patricia Turner, who is our incoming president, CEO of the American College of Surgeons for taking on this role, and Cliff Huttis, the CEO of the American Society of Clinical Oncology, ASCO, as our president-elect, in addition to others. And our new board member is also here, Manuel Paniagua, from the American College of Physicians. So really delighted that we've just had robust interest in being on our board and engaging with us in our committees. And we are so delighted to have their voices at the table. In addition to our new public member, Susan Gaffney, who is the executive vice president of the National Health Council, one of our partners on the patient side. So with that, I have the great pleasure of transitioning on time to our keynote, Dr. Mary Rice, who will give us a really important discussion about how we can protect patient health in a changing climate and what's the imperative for us as leaders in medicine. And since I met Mary, thanks to Karen Kalasha, who suggested that we reach out to Mary. She has changed positions. She is now the director of the Center for Climate, Health, and the Global Environment at the Harvard Chan School of Public Health. Go Chan School, where I went. And also our associate professor of environmental respiratory health, as well as professor of medicine. She will give us an overview of what we now know about the impact of health on the impact of climate on health, both pollution as well as extreme heat. And then we will have a brief discussion to follow, a discussion that will include our two panelists, Dr. Ann Edwards, the chief medical officer of the American Academy of Pediatrics, to provide another society's view, and a society who has, in fact, done a lot in this space. And Jennifer Jones, the vice president of the American Association of Kidney Patients, who will bring a patient voice to this discussion about what kind of guidance patients need as we face these crises. So without further ado, Mary, it is all yours. Thank you. Thank you for that introduction. It's truly a pleasure to be here speaking to all of you today as part of this keynote and panel discussion on protecting patient health in a changing climate. So here are my objectives. I aim to identify direct impacts of fossil fuel burning and climate stressors on respiratory health, which is my area of expertise. Then I aim to enhance understanding of the direct and indirect impacts of climate stressors on all human health. And then I aim to, and this is really the meat of the discussion, outline possible actions by clinicians and medical specialty societies to respond to these threats. And I have nothing to disclose. My sources of funding are all from the NIH currently. So a little bit more about myself. I am a pulmonary and critical care physician and primarily an air pollution researcher. And as of October 1, I am now the director of the Center for Climate Health and the Global Environment. I continue to see patients in clinic. This is a picture of me in Chelsea seeing one of my patients. And my research is focused on air pollution. And for example, I run a clinical trial on air purifiers for patients with lung disease. But importantly for me, I have been very involved in the American Thoracic Society and the incoming chair of the Assembly for Environmental, Occupational, and Population Health. And for almost 10 years, I was on the Environmental Health Policy Committee of the ATS. And through that, I had the opportunity to engage on air quality and climate policy discussions at the national level on behalf of the ATS. So I want to begin by talking a bit about the greenhouse gas effect. The science on this is actually not new. It was first described over 100 years ago in, I think it was 18, let's see. I wrote it down, I can't read it from where I'm standing. But it was in 1872, 76 by the Swedish physicist Svante Arrhenius, who described here the influence of carbonic acid on the air upon the temperature of the earth. The problem is that emissions of carbon dioxide and other greenhouse gases are driving the surface temperature of the earth to dangerously high levels. And at the present time, we're actually already experiencing more days with an average temperature above 1.5 degrees of warming compared to pre-industrial levels than days that are below that threshold. And if you take into account all the current pledges and policies that are in place, we are on track to attain 2.8 degrees Celsius of warming by the end of the century. Now, the current global energy mix, which is primarily dependent on fossil fuels, including coal, oil, and natural gas, harms human health through climate change, as you can see here at the top of the image, so through effects like extreme heat and extreme weather events. But at the same time, when we burn fossil fuels, air pollutants are emitted into the air. And even though these air pollutants are invisible to the naked eye, they impair the health of the entire population that breathes the air. And that means that everybody's affected, especially children and especially adults with chronic health conditions. We actually know a lot scientifically about how fossil fuel pollution affects human health. Decades of research, including epidemiologic studies, animal studies, in vitro studies, have elucidated how fossil fuel-derived pollution causes inflammation and oxidative stress, not only inside the lung, but also systemically, which explains the extensive disease burden associated with particulate matter air pollution. And ground-level ozone, which is another fossil-fuel-derived pollutant, it's formed secondarily through atmospheric reactions, when inhaled at the ground level, is a very powerful respiratory irritant. And it's been shown to cause eosinophilic inflammation that over time leads to airway remodeling. And ozone pollution is especially relevant when it comes to climate change because it's formed through these secondary reactions. So on hotter days and sunnier days, in the presence of UV light, those reactions that form ground-level ozone smog are enhanced, leading to a higher incidence of high ozone events, all else being equal when it's hotter and sunnier outside. So here I wanna show you some evidence. This is just as an example of how particulate matter and ozone pollution harm respiratory health. It's especially concerning for people with asthma. And here is a study that was done in Atlanta looking at hospital admissions for asthma. And you can see that relationship between child asthma admissions in each of those combustion-related pollutants, all the way across the spectrum, all across the range of exposure experienced in the city of Atlanta. And you can see the red arrows pointing to the current EPA standards for each of those pollutants. And you can see that that slope continues down within the current air quality standards. This is a picture of a little girl. Her name was Ella Kesey-Debra. And she was nine years old and lived in a very busy part of the city of London. And she died in the year 2013 on a high air pollution day. And the reason why her case drew so much attention globally is because she was the first person to have air pollution listed on her death certificate as a cause of death. And air pollution is generally not listed on the death certificate or in our medical records, even though it is very clear that air pollution is a cause of death and a cause of many chronic diseases. Here is an example showing that. This is a publication, actually, through the American Thoracic Society and the European Respiratory Society. And it's showing all the different organ systems for which there's compelling evidence that air pollution is a cause of worsening disease. And you can see that it includes not only pulmonary conditions and lung cancer, but it also includes cardiovascular conditions, endocrine, diabetes, in that category, hypertension, neurologic conditions, impaired fetal growth, among other causes. And you can see that the bolded conditions are all included in the Global Burden of Disease Report, which ranked air pollution as the fourth leading cause risk factor for death. So I mentioned that the evidence is quite strong that air pollution is a cause of premature mortality. It's actually been accepted by the US EPA for a long time and is included in the cost-benefit analyses that the EPA conducts when it's looking at decisions around air pollution. And this is work that was done by my colleagues at the Harvard Chan School. And it shows, again, that that positive slope between particulate matter exposure and mortality extends all the way across the range of exposure. And you see the confidence intervals are narrowest where you have the most data. And you can see that it goes down to very low levels, all the way down to zero. In fact, the WHO has determined that there's no evidence of a safe threshold for PM2.5 exposure, that any increase in PM2.5 exposure is harmful. It's been estimated that air pollution is worse for global lifespan than cigarettes or alcohol. And that's because everybody's exposed, right? Everybody breathes the outdoor air. And I'm giving a very US-focused talk here, but here you can see the global picture here of deaths attributed to exposure to PM2.5 and ozone with really dark colors in India and China and Africa. Now, there is some good news. PM2.5 levels, foreign particulate matter, has actually improved in many parts of the country over the last several decades. And largely, it was a result of regulatory action and improved technologies that have reduced the emission, emissions by motor vehicles, for example. But those air quality benefits have not been experienced everywhere. And so if you look at this example of the year 1988 to 2016, the blue zone on the east coast of the United States have experienced an improvement in air quality during this time period. But in that red zone, air quality actually got worse. And that's primarily due to wildfire smoke from the US and Canada that increased during that time period. We've all experienced this, this increasing incidence of large, destructive wildfires in the US. And that is in part due to the longer wildfire seasons, the drier biomass. There's also an accumulation of biomass that predisposes many parts of the US to wildfires. And wildfire smoke, those air quality, those pollution levels are orders of magnitude greater than the pollution levels that I just showed you for that PM 2.5 slope that is linked to mortality. And the smoke travels really, really far. So here's just an example of that, really poor air quality days on the east coast that were due to smoke and wildfires on the west coast. And here you can see that order of magnitude difference in particulate matter in areas that are really close to fires. And lots of studies showing increases in respiratory emissions in association with wildfire smoke. There's also evidence of cardiovascular health effects. Seems to be especially bad for kids with asthma. But one thing that we don't really know, this study is showing what happens before and after a fire. What we don't really know is what is the long-term effect on children's health or adult health who have chronic disease of repeated exposure to these smoke events over time. I just want to mention that the pollen seasons are also getting worse. I don't know if I see some heads nodding in case anyone, because we have earlier blooming and later frost, that's when the ragweed season ends. And plants actually grow more when carbon dioxide levels are higher. So here you can see a chamber experiment of ragweed at different carbon dioxide levels. And I just looked up this morning what today's level is, 422, so we're between the second and the third bar. So under controlled conditions, that is the effect on the production of the ragweed plant. And so this is a concern for a large portion of the population that has environmental allergies. So climate change is a big issue. And as this graphic from the World Health Organization shows the impact of climate change on health is broad. And it includes direct effects, such as injuries from extreme weather, cardiovascular, renal, and non-communicable disease effects through heat and air pollution, as I showed you. Waterborne and vector-borne illnesses, malnutrition and foodborne diseases, effects on mental health. And to add to this, climate change exploits those factors that make patients vulnerable to poor health and makes them even worse. Climate change also interferes with our ability to deliver care and respond to these threats. And I'll give you some examples of that. So I think many of us, when we think about the health effects of heat, we think of heat stroke, which is definitely associated with heat exposure, but it's not the only effect. And when we looked at why people are coming into the hospital during heat waves, it's not just for heat stroke, it's also for things like urinary tract infections, renal failure, sepsis, that people may not be able to handle as well in the setting of extreme heat. Another complicating factor that affects many of our specialties is that certain medications can predispose patients to risk of heat-related illness. And those include diuretics, antihistamines, and a really important one is antipsychotic medications that treat psychiatric and neurologic illnesses. And that's especially concerning because heat itself impairs mental health, it interferes with sleep, it increases risk of substance abuse and the risk of psychiatric symptoms in people with mental illness. Extreme weather events impair our ability to deliver care and for patients to access their medications and can also interfere with medical supply chains. Many of you might have read about the Baxter plants being affected during various storms and interfering with our access for normal saline in the emergency room in the ICU. And this map shows extreme weather events just for the year 2024, as an illustration. Wildfires interrupt health care delivery and access as well. So now, I've been a real Debbie Downer. I can tell you that. But I wanna talk about what we can do. And it's not just about advocacy and policy. There is so much that we can do to help our patients manage these threats. So I put this into three categories, patient care and clinical practice, things that we can do through hospitals and the health care system. And lastly, through government industry or regulatory action. And I would add, and this is really important, for specialty societies as a convener of research, that research is needed in each of these areas, right, to inform decision making to address climate and health. So I think it's important for doctors to tell their patients about hazards that affect their health. I'm not talking about long conversations, but we need to inform them about hazards that they can take action for, things like wildfire smoke or allergens in an allergic patient, just like we counsel our patients about smoking. Importantly, physicians are really trusted voices across the political spectrum. And in fact, this has been studied specifically for questions about information about global warming. And I think it's somewhat surprising, not global warming in health, there's information about global warming. Physicians, primary care doctors, and the American Medical Association are at the top of the list in all of these categories. Here's just an example of work that the American Thoracic Society has done to put forth materials that patients can use to educate themselves and protect themselves against some of these risks. There's a need to develop clinical guidelines. I mentioned medication interactions with heat. What should doctors do? Can we put a stake in the ground to give some guidance for how physicians should guide their patients? And we need to educate our physicians in how to have these clinical discussions about climate change. Medical schools have started to update their curricula. In fact, when I last read about it, the majority of US medical schools cover the subject of climate change in their formal curriculum in some fashion, but that's not true for residencies, fellowships, and CME for medical professionals. Another gap that we can fill. Now I wanna talk about hospitals and healthcare systems. Clinics and healthcare systems need to develop action plans for extreme weather and pollution events, because we know that they're happening with an increasing frequency, sometimes in areas that aren't expected, expecting to experience flooding or wildfire smoke, for example. And so we can anticipate things. Here is one example. This study was done looking at Medicare patients in the states of New Jersey and York during Hurricane Sandy, and there actually was a concerted effort for patients to receive early dialysis. So more than half of patients in that region actually got dialysis a bit early, and those who did had a lower odds of emergency room visits and hospitalizations, and even mortality. Another area where clinicians and healthcare professionals can have impact is looking at the practice of medicine itself. Healthcare accounts for five to 10% of all greenhouse gas emissions in the U.S., and that's through patient care, through the medical supply chain, through research and development, and employs a large commuting workforce. And so there are opportunities for medical leaders to improve efficiency and to reduce the carbon emissions of their work. And lastly, I wanna talk about government, industry, and regulatory ways to make a difference. The American Thoracic Society has been, and many others, and my colleagues in the Academy of Pediatrics and others have been involved in advocating for policies that protect patient health at the national level. Examples for policies that we can advocate for are clean air, reductions in fossil fuel use, resiliency of the healthcare system against climate stressors, including wildfire smoke. And there's opportunities to collaborate with other medical professional societies. For example, one forum is the Medical Society Consortium on Climate and Health, which can help medical societies work together on these issues. We need to promote research that tests solutions. Research at all levels. So this is one of the things that I'm pushing for in my new role as Director of the Climate and Health Center is for solutions-oriented research that answers questions about what the health costs and benefits are of different decisions at the government level, at the city or community level, around healthcare and disaster preparedness, around clinical guidance. So for me, as a pulmonologist, this cartoon illustrates this. What strategy, what should patients actually do and what actually works to reduce risk from combustion-related pollution? So are air quality warnings enough? Should people be wearing N95s? When should they be wearing them? Should everyone go out and buy an air purifier, for example? Another research topic is the health consequences of various green energy and technology solutions. This is my own study of air purifier for COPD, for example. And studies like this could eventually be adopted into clinical care and as DME equipment, for example, for high-risk patients. One more example of research, community level and city level. The city of Atlanta famously during the Olympics in the 90s had a traffic reduction program. This study has been cited so much because I think it so clearly showed that the traffic levels went down, the air quality got better, the asthma emissions went down, and then when the traffic went back up again, the asthma emissions went back up again. So it was really easy to see how a city-level intervention can make a difference for patients. And here's another example looking at a bus electrification and what those benefits would be for kids. So I'm going to end with an analogy. The relationship between tobacco use, which I think is fair to say, is considered by many, if not most medical professions as relevant to their discipline and expertise, and fossil fuel use. So both are associated with mortality, as I've shown you. And it took some time for the medical community to realize that fossil fuel burning was a cause of death. And the same was true for tobacco. But in both cases, the evidence is now clear. Both cause lung cancer, as declared by the World Health Organization. Both cause asthma and COPD attacks. Both exposures impair fetal development. And in both cases, kids are especially vulnerable, both to tobacco and fossil fuel pollution. And the adverse health effects of early life exposure can have lifetime implications. In both cases, powerful economic interests are at play and have sowed doubt about these health effects. And for tobacco, the medical community ultimately came together with a resounding and clear message that tobacco is deadly. And I would say that for fossil fuel pollution, these powerful economic interests are still in charge of the messaging. And in both cases, there is often a rationalization for not trying to quit. And with that, look forward to discussing with my other panelists and with all of you. Thank you so much for having me and thank you especially to the American Thoracic Society, Karen Koleshaw, Gary Ewert, who has been my partner at the ATS for many years, and Helen Burson for inviting me. Thank you. That's our panelists for joining us, we're going to have plenty of time for you guys to ask questions. We're going to start first with a little discussion, and then we'll go from there. That was extraordinary, Mary. I learned a lot. I think we all did, just in terms of thinking about what's known and what's not known, and really struck by where there is evidence, and evidence we can act on, and where there is clear need for research. I guess I just want to start with maybe just some reflections from both Ann and Jennifer, and in particular, from the perspective of a specialty society who has taken this on as an issue, as you saw all the issues Mary raised around the impact on kids, and in particular, Jennifer, from your perspective as a patient, what guidance you feel like you need and maybe you don't have. Ann, do you want to begin? Sure. Thank you for having me. I have to say, when you invited me to be on this panel, I actually was on a call with the CDC talking about something called Oropush. Why does that matter? It's a vector-borne illness that's actually transmitted by midges that were found in South America. This is not going to become a virology lecture, trust me, but it's an impact of climate change. Why are we worried about it in the United States? It's because it's warmer. These midges that have really lived at the equator are now marching into cooler climates. That impact is real, and it's impacting pregnant people and children. In 2007, the American Academy of Pediatrics had its first policy and called climate change an urgent issue for the health of children. Now we're 18 years later, and we've just issued a new policy, and guess what? It is still an urgent issue for children. Thank you, Mary, for highlighting the reasons there. There's some basic reasons for that. Children breathe faster, so they're going to take in more of this air. The World Health Organization, if you go to their website, they will note that 90% of the children globally live in an environment with toxic air, so 9 out of 10 children. Eighty percent of climate change disproportionately impacts children's health. This was an issue for us, first and foremost. We started with a policy statement just outlining what the impact is on health for children. That really has expanded. We've had other policy statements around how do we build environments that could mitigate some of these climate changes, and then we've had to build policy around disasters and how do we respond to these disasters, how do we support families and children when these disasters happen from hurricanes to all the weather events that were on your slides. Policy like that becomes a basis for our education. We think about it as a medical society. Once we have the policy, how can we share that information, provide educational opportunities for our pediatricians, for our community partners, for working with other partners? We continue to do that in a variety of spaces. We have a council on environmental health. It is as simple as providing a space for people to come together, to talk about the issues, to share education, to teach one another. That council has really informed a lot of our ongoing advocacy and also become an organization and a centering for what we do. We have chapters throughout the country. Each of our chapters have a local climate champion to think about this on a community level because when we think about advocacy, there are a lot of opportunities federally, but I like to think of advocacy as what can I do with a patient? What do I need to think about with this unique patient when I'm in exam room? What do I need to advocate for for them to have their medicines and have continuous access? I think about it at a community level. This is where these state champions come in. How can I work with partners in the community in my environment? As much as this is global, it's also hyperlocal. What does my community need to access food, water, medicines? And then we can come together on the federal level. I think that we've really been fortunate to work together with a lot of partners and other medical societies to think about how we can advocate on all these levels and come together. Those are my opening thoughts. A lot to talk about. I'm really interested, Jennifer. Thank you. Well, first of all, thank you so much for allowing me as a patient to be included in this space and to be able to share my perspective. I am a two-time kidney transplant recipient. And fortunately for me, I haven't been severely affected by climate change other than the heat because I appreciate you, Mary, for including how medications such as diuretics can affect patients during a heat stroke or something like that because so many of us in the stages coming up to renal failure, we experience swelling and all of that. And I'm sure that most patients don't even consider climate change as an issue or how it affects them physically and emotionally. Excuse me, I'm a note taker. So I don't think I've ever heard a patient say, wow, CO2 can really affect my life and it can negatively impact how I am and can possibly develop chronic illness. It was actually fascinating for me to see how CO2 can cause diabetes and high blood pressure, which are the two leading causes of kidney disease. I was in awe when there was discussions about individuals who work outside, they're unable to take breaks and cool off, but they were just getting barreled into renal failure and not receiving the support that they need in regards to that. So it's fascinating that so many different climate issues can affect us as patients, but we don't really know about it. And so I really appreciate that this is being discussed in here. For AAKP, excuse me, for AAKP in regards to climate change, we want to ensure that patients have what they need, because it's also considered a socioeconomic issue. Because if a patient doesn't have the ability to ensure that they have access to water, or if they're in a situation where, you know, they could be in an older apartment or a house and something could happen with their AC, they're not able to maintain the materials that they need for peritoneal dialysis, for example, or if there's droughts and that affects their ability to receive dialysis at the clinics or home chemo, that could cause detriment because as you all know, dialysis is a life and death situation. In regards to emergency preparedness, I'm more knowledgeable about that because AAKP has led the way in regards to advocating for our patients in regards to emergency preparedness. I can give you an example. Our past president and current chair of policy and Global Affairs, Paul Conway, he assisted in the evacuation of patients during Hurricane Katrina. And we realized that a lot of patients didn't have the concept of patient choice. They didn't receive patient choice. So many of them were in the dialysis clinics, but a lot of them want to do home hemodialysis, which would have been safer for them and easier for them to be able to manage. And there was one point about that I wanted to include. Yes. But it can negatively affect individuals when having to worry about being evacuated out of the area and going to another dialysis clinic. So this was very enlightening. And it was very enlightening for me as a patient and being able to educate fellow patients on that. And I appreciate that there are materials that are already in place. And please feel free to rely on the organizations such as AAKP in regards to providing educational materials so that patients can understand how to address those issues and how to be able to effectively communicate that with their physicians. That's absolutely wonderful, Joan. I think having the conduit to the patient community to share those resources is key. I worry, though, and you certainly, I think, shared this, Mary. I think there's a lot of guidance that isn't actually available. So as I think about the folks in this room, you mentioned diuretics, as you pointed out. Many of our societies have guidelines, clinical practice guidelines, for example, that include the use of diuretics for a variety of conditions. Anhistamines, we have our allergy and immunology folks in the room to say nothing of primary care. Antipsychotics. How do we think about what it takes to really embed some of this thinking about known risks into the way we actually do the work we do around clinical guidance? And I'll come back to you on that, Anh, as well. Sorry, was my son calling? Because when he gets home at three, he has to call me. Was that for me? That was for you. I'm sorry. Okay. So how do we think about clinical guidelines? So I think, you know, with my scientist catalog, well, I think the COVID pandemic was a great example, right? Where we had to come up with guidance. And the CDC had to come up with guidance as fast as it could. And as we all remember, that guidance changed a little bit as more evidence accumulated. But, you know, that's okay. You gotta start somewhere. And so I think even though we don't have the perfect randomized control trials telling doctors exactly how diuretics should be titrated by the temperature on the day, right? We still can put out guidance where it's needed. We can anticipate that patients who are on diuretics are gonna be at higher risk of getting dehydrated and potentially ending up in the hospital, just to use that as an example. So I think oftentimes, speaking very generally about environmental health, it can be daunting, I think, to put out guidelines because generally there aren't a lot of randomized control trials compared to other kinds of guidelines that we can more easily just, you know, agree on and put on paper. But I think that's certainly an area where every medical specialty can play a leadership role and where there's a real need. And clinicians are looking for that kind of guidance. I know NHLBI did a meeting on this specifically just a few months ago making the case that there's just a tremendous amount of research we need to do. And I think about how many patients are on beta blockers or diuretics, and I don't routinely mention these issues to them when they come to see me, and it really makes me think at least they should be aware those are issues. So I guess there's also a difference of is it a clinical practice guideline or even just guidance? And I know you guys put out stuff about the heat of the playground floor, right? Just some really practical guidance that I think we still owe our patients that people like Jennifer can pass along. Yeah, I think sometimes it's about raising awareness, right? As a clinician or for our members, right, there are a list of things. And the time we'd have to spend with each patient to go through the list can feel overwhelming for us. And oh my gosh, if you're the patient, what are you gonna remember of all of this? So I think to say how can we raise awareness and understand what we need to do at that moment? I mean, COVID is a good example, right? We learned how to prioritize because we needed to prioritize certain issues. But for example, on these high heat days, it is shifting the dialogue we have with children and families. Yes, the playground equipment is gonna be hot and burns do happen, and that's the unfortunate reality. But we also think about when there are wildfires. This is a moment of opportunity to educate. So we've done some work to kind of promote and share through a variety of channels. What do we know about wildfires? What do we know about the impact on the air when these disasters occur? So I think sometimes it can become really complicated. And when we don't know the answers, it's still not a reason to not lift it up and partner with a family. I mean, okay, what are we gonna do is this child needs to be active, wants to be active, and they have asthma, and it's a day that we know it's warm. The air quality is less. So how do we think about that and proactively partner to come up with a solution? Because at least from our perspective, we think activity is good too. So that's an important part of this. Yes, I really appreciate that we're having this discussion for physicians being able to talk to patients. I definitely want to include, please meet the patients where they are because there is a plethora of education, a plethora of knowledge, but please recognize that when patients are undergoing treatments, they have these medications and also the patient's education level. You know, a whole lot of information, just as you said, can be extremely overwhelming. So please don't forget to meet patients where they are because as I said, I don't think many realize how climate change can affect their condition. And I think that another thing is we should include talking to patients about how would they go about, if they feel that something is affecting them, how would they go about talking to their healthcare providers about that? Or what should they be looking for in regards to symptoms or anything that's affecting them? Like for example, with wildfires, if their eyes are burning and they're not feeling well, they could just chop it off as, oh, it's just smoke, no big deal, but they don't understand how it could be affecting them internally. So I was wondering, like how would physicians be able to address things like that so patients could have an understanding of when to seek help and guidance? Yeah, I think you've raised a really good point that, and not all of this would happen necessarily in the context of a one-on-one visit with the doctor. A lot of this is about public health messaging and letting patients know when they should be concerned, what symptoms to look out for, just as you said. Yeah, I think also really taking advantage of the remarkable peer networks that go on in patient communities, right? If the kidney patient community really recognized these issues and started to have peer discussions about, hey, what works well for you on days of extreme heat, it would just add to our evidence base as well. A lot of those solutions we may not know, but I think patients oftentimes are the first to do it. We have to raise that awareness, I think, among patients that these are issues that even need that peer-to-peer learning as you were talking about. Absolutely, because it's very important that we receive this guidance from our healthcare professionals because when we don't receive the guidance, there are a lot of misconceptions and things that are relayed throughout the patient network that may not be true. And so being able to receive the source from our healthcare team, that ensures that we receive the accurate information that we can relay along to other patients. Great. I'm gonna ask one more question and then I'm gonna let you guys ask questions. So be thinking. We've got mics set up in the two aisles. That's what they're called, aisles here. So my question is, and some of you may have seen, just a report this morning, for example, that looked at what issues specialty societies are focusing on and they specifically, so it's from the Do No Harm Medicine Group, specifically highlighted climate change that where specialty societies are doing this work, as they said, was out of their lane. I think you made a compelling case that these are really issues that dramatically affect health. How do we frame this issue? And I'll start with you, Mary. How do we frame this issue as being about this is in our lane, this is about avoiding patient harm, this is about improving health outcomes, but not necessarily getting into the, there's a lot that needs to happen in the policy space, but I think there is a piece here that's just clinical and science and evidence, which is the core of what specialty societies do. How do we sort of walk that line? I'd love your take on that. So I wish I had the answer on how to walk this line, given that I just took this new job as climate director. But my thinking is that we need to focus on the here and now. So I did talk a bit about Svante Arrhenius and the science of the greenhouse gas effect and trends, but what really matters and what our expertise is is what's happening now to our patients. We know that wildfires are happening now. Nobody would dispute that. We know that air pollution has a host of adverse health effects. There is so much evidence showing that at every level. We know that flooding can impair healthcare delivery. And so those issues are absolutely within our lane. And so I would say, let's focus on how to find solutions for the climate stressors that our patients are experiencing and that's part of our mandate as public health professionals. Agree. Anne or Jennifer, thoughts? Yeah, I'm sitting here struggling to think how it isn't in our lane, just especially as a pediatrician and caring for children and that pictorial that you had of the human body and all the impacts that climate change has on health. So I think it is in our lane. I do wanna add that as we talk about this, part of this gets to, it seems all-encompassing and overwhelming. And I wanna acknowledge that, especially for children, there is a lot of anxiety in mental health. It's not just about the treatment medicines, but I think what's really in our lane is how do we help people see how they are empowered to improve their health, right? We tend to, and maybe this is the pediatrician in me, we think about disease states, but I think we have an equal responsibility to think about how do we promote health. And how do we take this discussion around climate and proactively partner with patients to think about what are solutions for themselves and in their communities that really enrich our lives. All right, well, I can't necessarily speak from the clinical perspective, but I can speak about the patient perspective and what patients want. Patients want innovation and they want new therapies and modalities that can improve their quality of life. So encompassing everything about climate change and how it can affect patients, especially with emergency preparedness during hurricanes and wildfires and such, patients want to be able to have a peace of mind that if a hurricane hits or if there's something that causes them to leave their area, that they will still be able to receive the treatments and modalities that they deserve. And so I know I'm deviating from a clinical perspective, but often. It's all about patient care. But as physicians advocating for innovations and technologies, innovation and modalities for patients is extremely beneficial because as an advocate, that's what we do. We push the needle that we, especially in the kidney disease community, we need more modalities, we need more treatment options. And so I recommend that that's something to consider in regards to advocating. Yeah, so there's an important research base here as well that might have implications for that. And please include patients with research as well because patients are right there in their environments, in their communities, and they know what's affecting them the most. So we always recommend that, we always recommend including patients every step of the way in regards to research so we can ensure that not only you are gaining the patient perspective in regards to the research and guidance, but also if you intend on engaging with members of the community, you will know how to properly address them and you'll have that patient advocate with you to be able to explain at a layman's terms what is the need for the clinical trial and how it could benefit them and the rest of the community. Yeah, absolutely. And in fact, being able to broaden some of those outcomes. We don't have a lot of outcomes beyond some of the sort of hard, fast numbers, right? We don't know how function changes. We don't know if your fatigue is higher, if all those other issues kind of come into play in ways that have never been explored. That's the work we can only do with patients in collaboration, so I couldn't agree more. All right, we're gonna begin. Shazia Siddique, please. Thank you so much for a really informative session. My name is Shazia Siddique, as Helen said. I'm a gastroenterologist at the University of Pennsylvania here on behalf of the American Gastroenterological Association. So I think you all did a really wonderful job of enlightening all of us. So all the things that we can do as clinicians and professional societies from patient awareness, clinician education, and really just emphasizing that environmental health affects so many different clinical conditions and it's not just about one or two. And so I think it's really allowed us to take a step back and think about how are the ways we can incorporate this into the processes and the work that we do as professional societies. So one of the efforts that I recently was involved with and it's making me think about is there something that we could do at the professional society level, and I'd love to hear your thoughts, is an AHRQ-funded study where we're looking at the effect of all of the gear that we wear to prevent healthcare-associated infections like our reusable gowns, sometimes not reusable gloves, masks, all of that, and not just looking at traditional clinical outcomes, but also looking at environmental outcomes and understanding like the red bag wastage that we have in our endoscopy suite and all of that. And so it's making me think, do you think that even outside of just what is the direct effect of climate change on certain clinical conditions or patient education material, is there a way that we can be looking for these outcomes, collecting it, and even if they don't exist, defining evidence gaps when we look at different types of interventions across our professional society guidelines. Thank you. That's a great question. Yeah. Start with you, Mary. Sure. Thank you for that excellent question. I agree with you 100% that I think that that's a really important area. There is work being done, as you pointed out, looking at the full life cycle of medications in terms of the impact on the environment, including carbon emissions, different medical equipment, and trying to figure out ways to factor that into either hospital purchasing or medical decision-making in some cases. As a pulmonologist, one of the issues that comes up for us is that some of the inhalers that we use, the HFA inhalers, the propellant, is powerful greenhouse gas. How do you incorporate that into medical decision-making, or should we? Absolutely, I think that's an important area of research in terms of estimating those impacts and also trying to evaluate different kinds of interventions on how we can incorporate it. What's the right level? Is it a clinical level for doctors to be thinking about, or is it hospital level or insurance? I think there's a role for the associations, too, right, as a convener. So I know that our surgeons and anesthesiologists, when they started to think about the impact of climate change, well, what can I do? What's empowering, right? There's something about doing something rather than just having it be done to us. And so to be able to come together through a medical society and start to share the innovation, maybe we're not gonna have the outcomes, but maybe there's an energy by coming together. I agree. Thanks so much, Jessica. I can't see the lights, but please introduce yourself. Steve Fleishman, I'm Obituarian in Connecticut from ACOG. I'm just curious, you mentioned it briefly, about 8.5% of the sort of carbon emissions comes from the healthcare sector. In some places, it's probably higher than that, specifically in the US. How do we address it? I mean, we create more waste in a hospital setting. I think it's 25 pounds per patient per day, which is, I mean, like a household in like four months. We burn through more electricity than any industry on a per square foot basis. And we use more water for things than almost anything, all the things that contribute to carbon emissions. And so I appreciate us talking about the healthcare of our patients, but I feel like we're like causing the problem more than anyone else. And how do we address that on a bigger scale? So we give lip service to it, but if you look outside of healthcare, there's lead building, there's all this stuff, corporate social responsibility, there's sustainability projects. Every industry is like measuring them on that. And I feel like we have sort of not fallen into line. Yes, thank you for that. I know I touched on it only very briefly. So there is a lot happening in that area in the sense of, so at the global level of the climate, the COP conventions, there's a health declaration that was signed by many countries to focus specifically on this issue of the energy emissions, the energy use of the healthcare sector and the carbon footprint of healthcare sector, starting at the national level to then trickle down into national policy. So that's a big picture of stuff. There is an organization called Practice Green Health that many of you might have heard about that has a way of, through which hospitals can report their practices, their emissions, and there's awards that they can receive. And it's a way to kind of compare institutions against each other. There's so much more that can be done there. I think when people talk about what can I do, one place where you could have impact locally is your own institution. So many hospitals have sustainability committees, for example, but I'll allow other panelists to join. I mean, absolutely, that's a huge issue. And an area where there could be a lot of. And I see Matt standing behind you, and I know ASA, for example, has done a fair amount of work on the single use piece. Were you gonna mention any of that, Matt? I was. Good, can Matt answer for us then, quickly? Oh, you have an answer? Oh, great. Sure, but single use for anesthesiology, I mean, that's a huge issue for us right now with the waste, and it's how, we know the anesthesiologists are aware of it, but working with sustainability committees, it comes down to cost, right? And so that's been a huge factor where our members are getting stuck at the hospital level. But it's an important topic for us to consider. Great, thank you so much, Matt. May I? Please, absolutely. Yes, patients are concerned about waste as well. Like for example, when I was on peritoneal dialysis, I think about three days, I would have a whole garbage bag full of the one-time use, all the tubes and everything that we need to be able to sustain PD. And I was appalled. I felt like my carbon footprint was the size of a city after just being on peritoneal dialysis for such a long time. And I know myself and many others are wondering like, well, what can we do to improve that? And I know from the kidney space, one of the things that patients are advocating for is artificial kidney because that would reduce so much waste and water and other resources, even though we know that's a very long time. Yeah, innovation. You're at the end. But again, advocating for innovation and ways to reduce the waste and refuse will be extremely beneficial for patients because we care about the environment as well. And it's like, of course, we need this to stay alive, but at the same time, we feel guilty that we're using all these plastics and everything to be able to sustain our longevity. Yeah, that's a great point. Did you have a question, Matt? I'm sorry, since I just like called on you. Thank you. Hi, thanks for the great panel discussion. My name is Elise Kwaben, and I'm with the American Society of Hematology. I guess my question is for all of the panelists. As associations that have international constituencies and certainly climate change is not an issue that is unique to the US, I wonder if other associations in other parts of the world have been thinking about this and there are any lessons that we can learn from them. Perhaps even the WHO as well. Are there any lessons that we can learn from there that could inform potential solutions that associations within the US can try to explore and implement as well? That's a great question. I think that's for you, Mary. Sure. I imagine that there are a lot of lessons that could be learned. I can speak on behalf of the respiratory societies and I know the best. The European Respiratory Society has been very involved as well. Issues related to climate and respiratory health. The Pan-African Thoracic Society, the Asia-Pacific APSR. We've worked actually, the ATS has worked together with these different societies. One thing we did actually a few years ago, we have a forum for international respiratory societies. And we put out two statements together involving societies from the global community. First on the health effects of air pollution that wasn't even just focused on the lungs. It was the whole body. It was sort of a review. And then we did another one about benefits. So talking about solutions and the different benefits that have been shown from different interventions to address climate change. But absolutely, there must be so much we can learn from talking to others. Great idea. Thank you. Now I have my question. Yes, please. I'm Matt Popovich. I'm with the American Society of Anesthesiologists. I'm very proud to work with our committee on environmental health. I also take notes. So I do have a couple of things to say. One of the things that happened last year is that the ASA released a press release about low flow seboflurane. And that got out and Fox News said, anesthesiologists are not providing enough anesthesia to patients. And the issue there is how do you translate something that is very specific and very important into something that patients can understand and that patients will know that they're safe. You just mentioned that you were appalled by the amount of waste that those lifesaving procedures provided for you. I think of the patients that are out there who want to do the right thing and want to be aware of it, but also want to make sure that they're safe and want to make sure that they're receiving quality care. So what would be beneficial for patients, but also at the hospital level that you reassure patients that you will be safe, you will be taken care of, but there is that trade off with these lifesaving equipment? Well, I believe the best start is just being able to engage with patients and having that discussion. You know what they say, you don't know what you don't know. So if a patient is unaware of this and then something occurs, that's when the fear arrives. That's when the mistrust arrives. Like why did my doctor not tell me about these things until it's too late? And so I feel that it's very important, as I said before, that whatever educational materials that you offer for patients, that you meet them where they are and that it's easy for them to understand. And it's something that they can consume in a short amount of time because they could be tired, they could be dealing with negative side effects of their medications or whatnot, having to take care of their families and all of that. So having too much information can be a hindrance because the patient might say, I'll read this later, and then they forget about it. So being able to provide the information that they need to be aware of how the climate change can affect them based off of their condition is very beneficial. But also in extending that there's no such thing as a dumb question. So if a patient is curious about, okay, well, we had wildfires this week. How could that negatively affect me? What do you think that I should do in regards to that? Should I stay indoors more? Should I get a respirator or something like that? Being able to provide those answers to the questions that a patient may think of after they understand how climate change can affect them medically. And I think so. Can I add a little bit? Oh, please go ahead. I was gonna say, just a lot of the work that we've done in the last few years at CMSS with the National Academy of Medicine and WHO for YouTube and Google has been about trying to make sure that those credible sources like ACP, AAP, and all of us around here are the ones patients see first when you go seeking information. So really being partnering with our patient groups to make sure they know where those credible sources are as opposed to hearing what I assume was just a lot of miss and disinformation that was put forward on that issue, Matt. And also, as was mentioned, being able to disseminate that information out to the community as well so that individuals can see it elsewhere so that could take a little bit of the load off of the healthcare providers. Yes. Thank you. Thanks, Matt. Stephen, did you have a question? You had one and you stood up. Okay, Belinda then, Stephen. Hi, I'm Belinda Alvalos from the American Society of Hematology. And this is obviously a global problem. And I think we as physicians haven't done a good enough job in getting data out there. I think a lot of the data is mixed up with politics and people don't want to accept what's going on. And I think if we did it as a multidisciplinary group, we could make a really strong statement. I do have one question about one of the slides that was shown in terms of the major contributors to pollution. And was food number one, the food industry? Is that correct? The major contributor to pollution? I don't believe so. Or are you talking about the slide looking at the different sectors in patient care? That was looking at trends of, historical trends of looking at the different sectors and their CO2 emissions. I don't know if it means that the food industry is number one. I'd have to confirm that. Because nutrition is very important to health. And I think it would be interesting to know what the food industry or what is meant by that. Yeah, thank you for that. Absolutely really important issue is food. Not just the energy use of actually transporting food and getting food, but the meat-based diets. Methane is another powerful, very, very powerful greenhouse gas. There's so much that could be done. And when we're thinking about solutions, I talked a lot about how air quality gets better when we cut down on burning fossil fuels. But food is another example where the health benefits of transitioning towards plant-based diets away from red meat are immediate and have climate co-benefits, but the health benefits are immediate. Thank you. Great, thank you. And thank you all for a great discussion. Thank you. Thank you. Welcome back. Yeah, actually just to follow on the food thing, I don't know if that's referred to in the slide, but certainly I think it's pretty well established that in terms of landfill, food is the industry just ahead of healthcare in landfill. And that actually leads into one of the things I did want to address, which is two issues. Number one, what are we doing as specialty societies? And then also how do we engage the global community? And certainly in the ophthalmology space, we are dreadful, dreadful perpetrators. You're talking about very, very short surgical cases done at a high volume, tremendous turnover, tons of plastic, tons of reuse, tons of single use. And so ophthalmology carbon footprint, the world around, really, really, really high. But the issue is that if you look at the way that things are done in so many other places. So you look, for example, at a cataract surgery that's done in India, which generates a tiny bit of landfill. And then one done in the United States, it's a truck versus a bucket. And so there really is an enormous amount to be learned. So one of the initiatives that we put together was the American Academy along with the European Society of Cataract Refractive Surgeons and the American Society of Cataract Refractive Surgeons came together to form this society called iSustain. And the whole point of iSustain was really to try to bring the global community together. So essentially, there's a charter and people have to sign on to these things that you're gonna try to promote as a society. But not only does it serve as a way of politically organizing advocacy around the space, it also becomes a best practices. It also has helped to start to generate the kind of information that is needed to make a compelling case to legislators. I mean, you're not gonna be able to get away from single use unless you're able to get away from a lot of labeling issues that have to do with FDA issues and so on. But a credible case is made in support of that if you can show that you can do exactly the same number of cases in India and have no cases of endophthalmitis with a completely different footprint. The last thing I'll say is that we have found this to be one of the most compelling engaging issues for our young physicians who care a great deal about it. So it's an aggregator both globally, but also across that particular demographic that really, I think, is very, very passionate about the space. But there's a lot of opportunity for us to aggregate a global cooperation in what is a global problem. That's great, thank you so much, Stephen. I have some questions. I appreciate the effort to collaborate with other healthcare providers globally. AAKP hosts a global summit every year where we have subject matter experts and patients from across the globe tuning in in person or virtually alongside our American subject matter experts to discuss what has been working and what has not been working, what we have and what we need, what we're lacking. And being able to come together like that and including patients, it brings together that we have similarities, but we have differences, and like you said, being able to collaborate and see how one can assist the other. And also including patients in it so then they can share their perspectives and how it's affected them on a global scale in comparison to how we're being treated in America. So I really appreciate that. That's a great point. Looks like you have a topic for an upcoming global summit. Sign Mary up. All right, speaking of Mary's, Mary Post. Hi, I'm Mary Post with the American Academy of Neurology. Thank you for this great presentation and discussions. My question actually is for Dr. Edwards. Specifically, I'm curious, I'm impressed actually, you've had a position at the Academy of Pediatrics, I think you said since 2007, 2008. So my question is, have you been able to move the needle? What impact have you had in that period of time? And I heard you say now you've revisited your position. It still remains a critical issue. What can we learn from you? And what opportunities can we as a society think about how we can make some change and have some positive impact? Great question. It's the outcomes question, right? So optimally, right, we wouldn't be sitting here talking about it if we'd moved the needle as far as we'd hoped. But I wasn't part of the 2007, that policy. I think we are in a different place right now in terms of moving the needle, in terms of attention and engagement. So if you go back 15 years, we were the first and we were just gathering attention. And now, just from this discussion, people are engaged in saying, how can I participate? It's not only a curiosity about, tell me more about this. It's what can I do? Who do I need to learn from? Who do I need to partner with? I think the point about people earlier in their careers, yes, they're absolutely coming in and expecting that this is part of what they want to do is their career, is to move the needle on this. And I think where we, if you look at it, we want to move the needle globally. We want to move the needle nationally. I'm gonna come back to community. I think where we have moved the needle is community efforts where people have come together, knowing their own community, understanding what they could do. And maybe it is around the example you gave about how there are shared days. You read about people walking to school or doing some of these community events to raise efforts. Or you hear about a state chapter really working with the health systems in the state to say, what can we do? What happens if we come together and we talk about this medical waste and come up with, I'll say, best practice or best ideas that we can share and start to measure? So I think you gotta stick with it. This is a marathon that I think the biggest progress is that we have more people at the table. And I would say that I don't walk into rooms anymore where people, this is the first time they've heard this. They're ready to engage in a new and different way. Our challenge is to set enough tables and to have all the lanes to be able to come in and work where people are interested. That's great. All right, I think probably our last question. I'm Brian McNama out of UCSF, but here representing DocMatter. I heard one mention of disinformation and misinformation. And I kind of wonder, you can produce data that generates guidelines, talk to patients in certain ways, but if large swaths will never believe what you say, then should disinformation and misinformation itself be kind of its own public health problem that's kind of tackled more directly? Yeah. I'm happy to start. I completely think it is. And I think there's been a lot of efforts. There's a coalition for trust in health and science that many of us participate in. There is a medical misinformation coalition as well that many of us are working on. And I do think it is separate and apart. I think this is just one example where, for example, you know, Matt's example of the misinformation presented on the anesthetic, for example, on the news is something we have to counter. And that's where I think in many ways our ability to sort of come forward as the credible source and then learn how to, in fact, share that information in ways patients understand and trust us. I mean, I'm really struck by the chart you showed that regardless of party, people sort of look to their primary care clinician as the person, and I would expand that out, if you're a patient with COPD, they're looking to you, right, like they look to you for that information. So how do we help break that cycle? And at least the work we did, for example, with YouTube now creates these shelves. If you search for information on YouTube on a health issue, it'll put in information, the very first sources of information that will come up will be from what's considered a credible source in the way that we defined it with NAMI and WHO. And it won't just be the thing that's viral. And I think those are the kind of strategies that we need to continue to build on. The disinformation piece is harder. The disinformation piece is when people spread misinformation intentionally to achieve their aim. And that, I think, often needs broader input and strategies than we can do. We can certainly, I think, help by making sure that the credible information is front and center from our societies, but it's a great question, thanks. Excellent question. That is why I had pushed that analogy of the cigarette smoking. It used to be controversial. Remember, I'm sure you've seen those old ads saying with doctors recommending cigarettes, and if you go back, buckling seatbelts, the idea that doctors would talk to their patients about buckling seatbelts was a big hula bala like back in the day, apparently. So we can fight disinformation by sticking with the evidence-based recommendations, explaining that to our patients in a way that's relevant to them, right? That helps them make decisions to protect their health. And so I really think if we can talk about these environmental exposures and climate change in the clinical setting to protect our patients, incorporate that into clinical guidance, I think that'll go a long way in overcoming some of the political challenges that we're talking about. And also, I would like to include, if you're able, please engage with patient organizations and ensure that we receive all of the materials and guidance so that we can spread awareness to the patients as well. So if we are in the kidney community and we hear disinformation, we can say, oh, I'm sorry, that's not true, this is what's really going on. And patients will listen to other patients, and then they will be able to spread awareness also. I think that's very necessary. Absolutely, I think if you think about the core roles of what specialty societies do, we have journals, we have educational conferences, we have clinical guidelines, all of those can be both clinician-facing and patient-facing. So I love when journals sort of say, here's the article that's in this journal for the clinicians, here's how this translates into what you would, in a way that's understandable for patients. So I think there's just huge opportunities for our societies to be doing educational programs here, clinical guidance, as well as partnering. Absolutely, patient engagement is so very important. And being an advocate and being able to be in these spaces is very, very important, because it lends us credibility also. I love the term credible messengers, and that's how I see patient advocates, when we're allowed to be in these spaces and being able to learn and engage from all of you. So then when we go back to our communities, we can say, hi, we went to this event and we learned this, and this is how it's gonna be able to improve the patient's quality of life. You can be able to talk to your healthcare provider about this, ask questions, and be able to learn more about how they can take care of themselves and their families. Wonderful, thank you so much. We're actually just about out of time, so please join me in thanking Mary and Jennifer and Anne. Thank you. And...

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fossil fuel pollution

strategic plan

carbon footprint

respiratory health

clinical guidelines

environmental hazards