Many of these microplastics and nanoplastics are known to be carcinogens, neurotoxins, and endocrine disruptors. They are likely to increase cancer and cardiac disease. A steady stream of research finds correlations between plastic pollution in our bodies and increased cancer risks, asthma, diabetes, obesity, autism and other neurodevelopmental disorders, infertility, heart disease, and increased pregnancy risks.^8-9 All of this is multifactorial, with highly processed foods on the rise at the same time, but we have more than enough information to act. In public health, we use the precautionary principle all the time, avoiding therapies that have potential harm. How can we do that in medicine without changing our quality of care?

Clearly there are plastic items that we need for patient care like an endotracheal tube or an IV. But are there areas in which we can reduce our use of plastic, switch back to reusables, or adapt to a more sustainable material? What is unnecessary? The low-hanging fruit: plastic pill and water cups, disposable blood pressure cuffs, plastic utensils, and Styrofoam food trays. Use PO medications when as effective as IV. Chewable tabs for kids over age two instead of a syringe with liquid?

What about just better plastic? A large quantity of IV fluids is made with the chemical DEHP, or phthalate.^10,11 This chemical has been linked with all sorts of problems, including an increase in testicular cancer, hypertension in the neonate, premature birth, obesity, and more.^{12, 13,14} Yet we are dripping this into our patients. There are IV bags without phthalates. Find out what you were using and demand it be switched.

Take a look around on your next shift. Where can you reduce the use of plastic? If we consider our plastic footprint with everything we are doing, we can adjust our habits to give our patients and our world healthier care. Please consider it.

Dr. Bridget Lee has been an emergency physician in community hospitals for her career.  She is now increasing her focus on sustainability in medicine, and lectures on plastic in health care, the toxicity of plastic, and why health care practitioners need to be leaders in reducing the use of plastic.

References

1. Healthcare Plastics Recycling Council. Hospital Waste Characterization. https://www.hprc.org/resources/hospital-waste-characterization/.
2. Hsu S, Thiel CL, Mello MJ, et al. Dumpster Diving in the Emergency Department. West J Emerg Med. 2020; 21(5): 1211-1217.
3. Seervai S, Gustafsson L, Abrams MK. How the U.S. Health Care System Contributes to Climate Change. The Commonwealth Fund. April 19, 2022. https://www.commonwealthfund.org/publications/explainer/2022/apr/how-us-health-care-system-contributes-climate-change.
4. Health Care Without Harm and Arup. Health Care’s Climate Footprint: How the Health Sector Contributes to the Global Climate Crisis and Opportunities for Action. https://global.noharm.org/resources/health-care-climate-footprint-report. September 2019.
5. The Environmental and Energy Study Institute.  The Climate Consequences of Plastics. Briefing Series: Reduce and Reuse: How to Cut Greenhouse Gas Emissions of Building Materials, Plastics, and Food. https://www.eesi.org/briefings/view/120921waste. December 9, 2021.
6. Lalakea ML, Noel JE, Meiklejohn DA. Reducing Glove Overuse in Outpatient Specialty Clinics: Cost Reduction and Environmental Benefit. OTO Open. Published March 27, 2025.
7. The Last Beach Cleanup and Beyond Plastics. The Real Truth About the U.S. Plastics Recylcling Rate. Published May 2022.
8. Landrigan PJ, Dunlop S, Treskova M, et al. Countdown on Health and Plastics. The Lancet. 2025; 406(10507):1044-1062.
9. Landrigan PJ, Raps H, Cropper M, et al. The Minderoo–Monaco Commission on Plastics and Human Health. Ann Glob Health. https://annalsofglobalhealth.org/articles/10.5334/aogh.4056. First published March 21, 2023.
10. Tickner JA, Schettler T, Guidotti T, McCally M, Rossi M. Health risks posed by use of Di-2-ethylhexyl phthalate (DEHP) in PVC medical devices: a critical review. Am J Ind Med. 2001;39(1):100-111.
11. Getting Harmful Chemicals Out of IV Bags and Tubing: New Report Released by Breast Cancer Prevention Partners. Breast Cancer Prevention Partners. Published August 15, 2024.
12. Jenkins R, Farnbach K, Iragorri S. Elimination of Intravenous Di-2-Ethylhexyl Phthalate Exposure Abrogates Most Neonatal Hypertension in Premature Infants with Bronchopulmonary Dysplasia. Toxics. 2021;9(4):75.
13. Lucaccioni L, Trevisani V, Passini E, et al. Perinatal Exposure to Phthalates: From Endocrine to Neurodevelopment Effects. Int J Mol Sci. 2021;22(8):4063.
14. Bräuner EV, Lim YH, Koch T, et al. Endocrine Disrupting Chemicals and Risk of Testicular Cancer: A Systematic Review and Meta-analysis. J Clin Endocrinol Metab. 2021; 106(12):e4834-e4860.