When reflecting on Clinical Correlations from start to finish, I can see there has been a change in how I think. In the beginning, I remember feeling a sense of being lost. It was challenging to me since I was unsure what should be done in the presented cases, and my thought process was lacking organization. However, as the sessions went on, I started to get a grasp on how providers should think when evaluating their patients, what should be focused on, as well as what are red flags that require immediate action. I believe that I learned how to better obtain a patient history, as well as focus on what will be pertinent in treating the patients.

I feel that as a whole, my Clinical Correlations group has gotten stronger in our interview skills and formation of differentials. I think our approaches vary sometimes, but it seems like that is the reality in medicine, where different clinicians will have their own thought processes and preferences in workflow. There are group members who have natural authority and confidence when they speak; which is something I would like to work towards.

In the clinical year, I will need to continue developing my interview skills and organization of thoughts. It will be another challenge since I will have to apply my knowledge from didactic year, and use it to treat real patients! Additionally, there will be the variables of establishing rapport with patients, working with new people, and dealing with real-life timing and medical events.

For the future Clinical Correlations groups, I think its helpful for them to continue getting the at-home assignments. The prompts required us to utilize different resources, and expand our medical curiosity and knowledge. I also liked when the professors would ask us questions regarding treatment plan, and go around the room so everyone contributes to the conversation. Another “pro” was when our professors would share their personal experiences in medicine. These antidotes helped bring real-life medicine into the classroom. As for the future groups, I would like to encourage them to try to get the most out of this class. We are given a unique opportunity to learn from different clinicians, who each have their own experiences, stories, strengths, and practice!

Problem Statement

Plastic is part of our daily lives, yet not many people know about the dire consequences these materials have on our environment, and ultimately our health. As one of the top cities in the world, we need to be leaders. Currently, our city only recycles 17% of our waste, meaning the rest ends up in our landfills or as litter (1).

Background

Plastic is being used everywhere.

• • It is cheap to produce, versatile, and oftentimes overly used in order for convenience.
  • According to the Earth Policy Institute, close to a million single-use plastic bags are used every minute, which adds up to nearly a trillion per year. (2)
  • Over half a billion plastic straws are used per day. (3)
  • Nearly half a trillion plastic cups are used a year. (3)

According to the National Oceanic and Atmospheric Administration, plastic will never decompose. (4)

• • It is estimated that there are 269,000 tons of plastic in the ocean. They will degrade, meaning it will be continuously broken into smaller pieces, and ultimately become “microplastics” (5, 4).
  • Microplastics have the ability to absorb toxins. These plastic pieces end up in our consumed seafood, as well as drinking water (6).

Plastics result in economic and health consequences.

• • Over $8.2 billion worth of plastic materials is wasted due to failing to recycle. (7)
  • There is an estimated 269,000 tons of plastic in our oceans. This amount is expected to increase ten-fold by 2020, with 8 million metric tons added each year. (5, 8)
  • A study published by The Lancet in 2016 researched endocrine-disrupting chemicals (e.g. BPA and phthalates), which are commonly found in plastics. These chemicals are linked with health issues including hormone disruption, calorie metabolism issues, neurological and behavioral issues, birth defects, and cancer. US spends an estimated $340 billions of health care and disability costs related to these endocrine-disrupting chemicals. (9)
  • A study conducted by the CDC of 2517 urine samples (from a representative group of US subjects from the age of 6 and up) found BPA in 93% of the samples. (10).
  • Phthalates and BPA, which may be found in plastic food wrap and plastic containers, may transfer onto the food contents, and ultimately be consumed (11).

Landscape

Greenpeace organization

• • They work to spread awareness and call out companies to replace plastic products with sustainable alternatives. In 2018, they organized 239 plastic clean up events and brand audits across 42 countries. It was discovered that that the top three brands found in the plastic pollution collection were Coca-Cola, PepsiCo and Nestlé. (12)

 Companies that manufacture and use plastic

• • Dow Chemical, one of the leading plastic manufacturing companies, is joining in on preventing plastic waste in oceans and recycling. They helped start the Alliance to End Plastic Waste to find resolutions to managing plastic waste and recycling. They have started 55 cleanup efforts around the globe, and are working to make plastics that are recyclable. (13)
  • Coca-Cola, a large contributor to the plastic pollution issue, currently makes 100% recyclable bottles, but they are not made from 100% recycled materials. They believe that one of the most impactful ways to recover plastics is by households recycling, recommending increasing public awareness and information about how to recycle. (12, 14)
  • Switching from plastic to glass bottles can lead to rise of costs for the producer and consumers. Transporting glass comes with more risk of breakage and a heavier transportation load, which leads to more CO₂ It is estimated that the transportation costs can rise up to 5 times per bottle with this switch. (15)
  • Studies show that plastic wrapping helps to reduce food waste by expanding shelf life. For example, individual packing of grapes can reduce 75% of its waste, and beef with vacuum packed plastic can last up to 45 days. (15)

Ocean conservationists, Fishermen, and Community members

• • Plastics have been found in stomachs of sea animals that live 7 miles-deep in the sea. (16)
  • Sea creatures mistake plastic as food and ingest them. They can get poisoned and/or have their intestinal system clogged by them, causing starvation and death. This plastic pollution is one of the reasons for the depletion of fish caught by fishermen. (16, 17)
  • Plastics ingested by sea creatures make their way up the food chain, and ultimately into our food. Plastics can negatively impact our health by causing cancer, respiratory, cardiovascular, pregnancy, gastrointestinal issues, etc. (18, 17)

Options

• • Enforce a ban for establishments and companies from selling and distributing one-time use plastic items. These will include plastic bags, cups, utensils, plastic wrapping, etc.
    • Advantages: This will prevent plastic waste from continuing to collect in our city. It will also stimulate innovations on finding plastic alternatives. For example, items that typically require packaging (e.g. saran wrap) may get a non-toxic biodegradable alternative wrap instead. Another example may be that businesses will start to sell and distribute biodegradable items (e.g. utensils and bags).
    • Disadvantages: Compliance for the ban may be difficult to enforce. Technology and materials to make viable alternatives to plastic may not be on the market yet.
  • Place a tax on items that are made of plastic or uses it in its packaging. Then offer incentives to save money by properly recycling plastic.
    • Advantages: This tax may discourage consumers from purchasing plastic-included products and seek other alternatives. Also, money saving incentives may influence people to recycle more.
    • Disadvantages: This would allow the continued purchase and use of plastic. People may still gravitate towards using these products out of habit and convenience.
  • Allocate funds to educate NYC on plastic pollution, and proper recycling techniques. Part of those funds for this project will come from the implementation and enforcement fees from individual’s failure to recycle.
    • Advantages: Educating NYC about plastic pollution may make people more conscious of their choices. Also getting proper instructions on recycling techniques will eliminate confusion and increase confidence in recycling. The threat of getting fees for failing to recycle will discourage people from littering and choosing not to recycle.
    • Disadvantages: There may be difficulties in methods for reaching out and educating every person in NYC. People may also not be affected by noncompliance fees if the amount owed is too low. This plan would also allow for the continued purchase and use of plastic.

Policy Recommendation

With the amount of plastic used every second of the day, this consumption needs to be halted promptly. Instituting and enforcing a ban for establishments and companies from selling and distributing one-time use plastic items is the most effective step for New Yorkers to counter this issue. It will cease plastic waste from continuing to collect in our city, and allow us to be leaders for innovation.

Although our current technology and materials to make alternatives to plastic may not be available on the market yet, this new demand will inevitably lead to the invention of sustainable, non-toxic, biodegradable alternatives to plastic. To ensure compliance, the city can be given a notice of this ban a year in advance, in order to use up the rest of their plastic supplies and to seek other alternatives. Measures can also be taken to stop the shipment of these plastic materials into our city.

This change will be our stride towards the goal of improving our city, state, nation, and world’s health. This ban will be for the benefit of our future, and generations to come. It will help lower healthcare costs, improve the safety in materials used in our society, and reduce the amount of toxins and waste consumed in our food.

References

1. 1. https://www.grownyc.org/recycling/facts
      
   2. http://www.earth-policy.org/press_room/C68/plastic_bags_fact_sheet
   3. https://www.earthday.org/2018/04/18/fact-sheet-how-much-disposable-plastic-we-use/
   4. https://marinedebris.noaa.gov/sites/default/files/Gen_Plastic_9-20-11%281%29.pdf
   5. https://www.nrdc.org/experts/peter-lehner/fast-food-trash-nation-time-cut-down-packaging-waste
   6. https://www.sciencedirect.com/science/article/pii/S0048969718330663
   7. https://static1.squarespace.com/static/59a706d4f5e2319b70240ef9/t/5a7e426ff9619ab1a90b004d/1518223990918/REPORT-2012-UnfinishedBusiness_TheCaseforEPR.pdf
   8. https://www.earthday.org/2018/04/05/fact-sheet-plastics-in-the-ocean/
   9. https://www.voanews.com/a/everyday-chemicals-cost-us-billions-in-health-care-disability/3555700.html
   10. https://www.niehs.nih.gov/health/topics/agents/sya-bpa/index.cfm
   11. https://www.health.harvard.edu/staying-healthy/microwaving-food-in-plastic-dangerous-or-not
   12. https://www.greenpeace.org/international/story/18876/these-10-companies-are-flooding-the-planet-with-throwaway-plastic/
   13. https://www.apnews.com/fe8eea1b31a14b8eaa899dc38bbb7e0f
   14. http://data.parliament.uk/WrittenEvidence/CommitteeEvidence.svc/EvidenceDocument/Environmental%20Audit/Packaging/written/70675.html
   15. http://www.bbc.com/capital/story/20180705-whats-the-real-price-of-getting-rid-of-plastic-packaging
   16. https://www.naturalnews.com/2018-02-04-plastic-pollution-is-threatening-fish-populations.html
   17. http://www.worldbank.org/en/topic/environment/brief/oceans
   18. https://www.researchgate.net/publication/321906991_Toxic_effects_of_plastic_on_human_health_and_environment_A_consequences_of_health_risk_assessment_in_Bangladesh