Greenwashing and Limiting Supplies in the EP Lab

Everybody In Healthcare Wants Environmental Sustainability - Industry’s Response Is Embarrassing

A recent study published by the European Society of Cardiology found that physicians are highly motivated to reduce the environmental impact of EP procedures. A total of 278 physicians from 42 hospitals were polled and 62% were motivated to work towards more sustainable solutions - and re-use of catheters was the most commonly cited potential sustainability solution by physicians. This is great news in labs where more than half of catheters used are discarded to medical waste, and less than 20% of catheters are re-used. There are two ways to increase re-use in the EP lab: Manufacturers can design and market reusable catheters instead of single-use catheters - or hospitals can work with companies like Innovative Health to use reprocessed single-use catheters.

So, how are manufacturers responding to this desire from physicians to become more sustainable?

Sana Kliniken Lübeck in Germany recently announced that it has become a pilot partner of Biosense Webster and Resourcecify, a platform for sustainable waste management, under the program, “Zero. Waste. Vision – Sustainability in the Heart Catheter Laboratory”. The Head of Section at the German hospital explains that, "[…] for electrophysiological examinations, for the treatment of cardiac arrhythmias in the heart, we use ablation and diagnostic catheters that were previously simply disposed of in hospital waste and then burned in a waste incineration plant. The pilot project by Biosense Webster and Resourceifyoffers the opportunity to recycle contained valuable materials such as metals and return them to the raw materials market.”

At Innovative Health, we fully expect that Biosense Webster will introduce similar sustainability initiatives in the US to deliver on its commitment to “reduce expenses and decrease environmental impact while maintaining the ability to provide excellent patient outcomes by embedding sustainable practices related to Johnson & Johnson MedTech devices into health system operations.” The announcement from Sana Kliniken Lübeck in Germany certainly sounds like this is the focus here: “For Resourceify and Biosense Webster, it is important to contribute to the sustainability of healthcare, as the impact of healthcare on the pollutant emissions emitted is large, even greater than that of air travel.” In the US, we have yet to see a similar program, although at some hospitals, Biosense Webster do offer to “buy back” used ultrasound catheters for $100 a piece…

It seems like Biosense Webster is responding to an increased demand for environmental sustainability in the EP lab. However, the problem is that these types of programs work counter to the intention and further exacerbates some rather serious problems in the supply chain. They do, however, ensure that the company can continue to grow its revenue.

Let’s start with the environmental aspects of these recycling programs. From an environmental perspective, recycling is a far less valuable circular solution than reprocessing. Devices from Sana Kliniken Lübeck will not be re-used, but rather broken apart, and the recyclable parts (about 30% of residual hospital waste) will be used in the manufacture of other products. If, instead, the catheters were being reprocessed, the entire catheter is salvaged and made available for another use with the use of very few resources. Since most single-use EP catheters can be reprocessed and re-used, putting in place a recycling program simply means that the environmental benefit is lessened. A reprocessed catheter has less than half the carbon emission impact than a new device, and the average EP lab can reduce their CO₂ emission by more than 2,200 pounds CO₂ equivalent per year through reprocessing. This impact is lost with a recycling program which implies that a new catheter will be needed. In other words: Every time a catheter is recycled rather than reprocessed, the EP lab increases CO₂ emissions by almost 2 pounds. I am guessing this is not what the doctors in the European Society of Cardiology study had in mind.

Every time a catheter is recycled rather than reprocessed, the EP lab increases CO₂ emissions by almost 2 pounds.

Recycling programs in place of single-use device reprocessing has another rather important impact: When devices are recycled, they are “taken out of circulation”, meaning that device is no longer available for use. As mentioned, this means the lab will have to buy another (new) catheter for the next procedure. It is common knowledge that there are severe supply shortages in healthcare today, and we hear every day of manufacturers putting EP devices on backorder – they are short on components such as chips, etc. Reprocessing catheters means at least one more use of the catheter, and labs can utilize this re-use methodology to supplement their reduced allotments from the manufacturer and ensure they stay at 100% capacity (meaning they can actually provide the procedures to those who need it).

So why would one of the largest suppliers of catheters to EP labs put a program in place that increases CO₂ emissions and makes supplies scarce? I don’t know, but math might help. Every time an ultrasound catheter (for example) is recycled rather than reprocessed, the manufacturer increases its revenue by approximately $2,500 and the hospital loses about $1,250. This is because the hospital cannot buy a reprocessed catheter at the lower price but must buy a new one. Possible supply shortages, environmental harm and hospital economics are collateral damage. Getting back to the $100-a-catheter buy-back programs: The only thing surprising here is how low the price is. The rep could pay the hospital $200, and the company would still be ahead.

Every time an ultrasound catheter (for example) is recycled rather than reprocessed, the manufacturer increases its revenue by approximately $2,500 and the hospital loses about $1,250.

So, this is how recyling programs in the EP lab make a lot of sense. For the manufacturer. Not so much for the environment and the hospital – and the patient.