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Discussions about pulmonary, critical care, and sleep medicine from our Assemblies & Sections.
You're listening to the Assembly on Environmental, Occupational, and Population Health podcast.
Hello, and welcome to this podcast from the ETS Environmental,
Occupational and Population Health, Assembly, EOPH. I'm the podcast host, Joanne McKell, MD,
from Case Western Reserve University School of Medicine and Web Director of the EOPH Assembly. And
I am pleased to introduce Dr. Erica Moseson, MD, MA, creator and host
of the Air Health, Our Health, our health podcast, and its companion bilingual blog. She's a pulmonary
section here at the Legacy Emanuel Health Medical Center. A member of the ATS Environmental Health Policy Committee,
podcast host for a breath easy, the ATS podcast, full-time pulmonary and critical care physician,
and member of the EOPH Assembly. And this probably should not be mentioned last, a wife and mother of three children.
So welcome Dr. Moseson to the EOPH Assembly podcast. Thank you so much for joining us today. Well, I'm excited
to be here. I love the EOPH Assembly. Totally, actually. Tell me about yourself, your background,
how you decided to pursue medicine, you know, the background, the big picture. Yeah, well, so I grew up
in the beautiful Pacific Northwest. I was actually born at the hospital where I currently am the pulmonary section chair,
which was Emanuel. So when I used to attend the ICU there as well, and now I do my ICU with a community hospital,
that's more community hospital, but I'd always tell them, "My local, the locals, you know, in Oregon, were very into people being local." Well, my mom
was in the ICU here before I was born. So wow. So yeah, I grew up in
the Pacific Northwest, loved it. I was always kind of like the humanities and the
sciences. I went to, you know, college and was a little bit torn on humanities and sciences. And
I had some very good advice from actually my, at one point in my life thought I was going to be doing a degree in
religious studies. And I had some good advice from a religious studies professor, Arnie Eisen,
who I'm sure does not listen to this podcast. We told me that I was somebody who needed to do something during the day that was concrete.
And that he thought that academic humanity is may not be very
helpful for someone who needs to have something concrete at the end of the day. And
I realized that that was very true and very insightful, and it was one of many conversations
that kind of swung my interest back to the science. And so I had done a minor in
human biology and I did had been doing cancer research throughout
doing CML research at the Drupary Lab in Portland, Oregon. And then I went to Germany and did CML research
in Germany. It had a work while I was applying to medical school.
I went to medical school, loved it. At New York and the medicine residency at UCSF and then
pulmonary critical care back in my hometown of Portland, Oregon. Wow.
I think that does count as being concrete. So, you speak German as well as Spanish,
is that? Yes, so my mother's family, you know, I used to say she's Mexican-American.
It's actually, it's a little interesting. I mean, her family's been living in the same part of the United States for over 200 years, which initially
was part of an area of the world colonized by Spain, so people spoke Spanish, and then the border crossed
them. And now people speak English, but she grew up speaking Spanish in a little town called Deming
New Mexico. And then she had moved to Oregon. She was an OBGYN, fell in love with the beauty of the Pacific Northwest. That's
where she went with her dad. And so, yeah, then we also speak Spanish at home, my kid, sometimes
make fun of my accent, because I did learn it. My parents didn't really speak it that much growing up, but so I did learn it later.
But yeah, we tried to speak Spanish at home. They're definitely in a phase of not wanting to speak Spanish at home. Yeah,
well, being bilingual at all works very well and in terms of developing
those concrete deals that you use during the day. That's great. So, that's fascinating. And other
than your concrete accomplishments, you also now wear multiple hat, multiple administrative hats, multiple
professional hats, you fulfill multiple roles, and personal roles, as mentioned in the introduction.
So, how does this work to you, does your family see you? Do you just
have a lot of caffeine involved in your life? I do have a lot of caffeine.
Actually, yeah, here with my mom on duty mug that my dad gave me, that has a coffee, and then it came with
a companion wine glass, I think that said mom off duty. Yeah, so I think one of the
things that I learned early, again from a very good mentor, who's actually
at ATIT, who's actually, he's in the thoracic oncology section, is the interest of the story. But
he told me I needed to learn to say no a lot more. And he taught me a phrase that
I teach liberally, which is, "I do not currently have the bandwidth to give that project the attention it deserves." Because you
are not undermining the project of somebody else, there's so many worthy things to do, but you have to kind of constantly be assessing what you can do.
And I think he was mostly like, "Hey, you're my fellow, I get you for a limited time for research, I want you to say no to everybody else, so you can get my stuff
published." I want you to share. But it's been really helpful. So like, I want my podcast episode. It's clean air and climate
advocacy for busy people. It was based on a talk I gave at chess called Clean air and climate advocacy for the busy clinician, which
is, it's impossible. Like, there's so much to do. There's so much work that's important to do. There's
so much education that can happen. That one person can't do everything. But if you can't take care of yourself
and be saying, "No, you know, to all the times you really can't do something," and it's not because it's not worthy, and it's not because it's
not good, and it's not because it's not important. But what you do is you think about where, why am I here? Where am
I where I am? And where can I be most effective? And again, you have to have your kind of concentric
circles of organizing your life, right? Like you, and your relationship to whatever
higher power, internal commitments has to kind of come centrally, and then you're a family, and you're, you know,
because if that immediate circle isn't safe and well, you know, you can't, you're not going to be effective, right? I think
you can't sacrifice your family for your career, like those are things you will end up not having either,
right? And so it's like you find like, what can I do and how can I serve as my whole cell,
right? And I think that's a thing that I think is really important because then, you know, it's kind of like putting on your oxygen
mask, you know, before you put your kids mask on, you know, same thing. And then you think about, like, okay, well, I,
you know, care about, you know, your baby people, but climate change, I see it's impact on my patients, you know, how am I affected here, you know, really the world's on
fire sometimes outside the door. So, you know, I can speak more coherently about, like, you know, wildfire. So as a physician
and a pulmonologist, I can, you know, kind of try to teach people about what the health effects may be, what you can do to mitigate them. And often the
people who are like, right on the bright edge and about it, that's all they can do, right? And then maybe if you have policy, like, policy makers, people have,
like, a little more, you know, organizational cloud, or people who can think about, you know, supply change and trying to decrease the ultimate
root cause of climate change, that's really important. But, you know, you can't have someone like fleeing a fire, you know, to say, like,
"Oh, hey, like, is that a diesel engine?" Like, you know, you're just like, "Oh, just go, get out!" You know? So I think there's
a lot of-- That's right. You also have to be, like, kind of comfortable with electricity now. Yeah, exactly, actually. That's an EV, you know?
It's just like, "Well, there's no charger." It's on-- the charger's on fire. So we're even-- you know, so I think it's, I think, you know, kind of coming
with the spirit of, you know, this is what I have to offer it. This is where my nexus of expertise is. And then
being OK letting go, not doing everything, not being an expert in everything, like I'm certainly, you know, not an expert on a
lot of things. But I think a lot of physicians and scientists and clinicians and people in healthcare get paralyzed
by not being the ultimate expert on something. So they think they're an expert on nothing. And that's one thing where I feel like as a clinician,
and all we do every day is translate the vast mess of science
and medical science and research and like all these things we understand into practical reality in everybody's
life. So actually, probably everybody at the ATS, who is patient facing in any way, is an expert
in that. And then I would say that probably scientists are also an expert in like, I understand this whole big giant messy field
that my niche and then I still have the ability to explain to somebody else who's in this completely other field, right? So
I think those are human skills that computers can't reply necessarily, but you know, we can have and cultivate and use, I think,
to communicate. Yeah, that's actually, that was actually something I wanted to address. It
seems like you really started really working at it in 2020 about the time of the wildfires. Yeah, well, that's when
I launched the blog, so I kind of got and started in advocacy a bit. So I had just finished
fellowship and I was a member of Oregon thoracic society. So shout out, everyone, if you
have a state chapter, you should join it. And if you don't have a state chapter, you should look into maybe starting one. So that was my first,
I mean, kind of real, I mean, I think I technically gone to ATS as like a resident or a fellow, but, you know, you're kind of walking, you know,
you're attending told you to go and there's like thousands of people and you just kind of boil lost and you stagger in and out. It's training and you're like, well, okay,
I guess that's what you do. But the way I actually really got involved was through my local chapters, organ thoracic society and
I had been put on the executive committee kind of fallen told for the position while I was looking for jobs, so
I felt like I couldn't say no. But so that I found myself on the executive committee. When the American
Language Association, who was our longstanding partner, had kind of come and said, hey, there's these bills in the organ legislature. This is around 2017,
where it was another area at time where the federal government was less interested in enforcing or maintaining climate and clean
air regulations and like vehicle standards and everything. And then potentially less so on tobacco. And so the ALA had
come and said, hey, organ is considering raising the tobacco purchase age 21. And they're also considering some regulation
on these diesel engines. Because we actually had this problem in Oregon, where California, you know, got the less carb was,
you know, doing all these laws, which were making all these diesel engines, you know, expire based on state of California.
California, so there was like this fire sales ending of North to the state of Oregon. So unfortunately, our diesel fleet, I was at very high risk, we're just getting
a lot of dirtier. And we have some very vulnerable populations in our, you know, we have a lot of areas that are very vulnerable to
diesel exhaust. Not just in the Portland metro area, or like the metro areas, but there's also these areas where there's frequent inversions and
horrific air quality, you know, even in more rural areas. And so, you know, the American language association was
really encouraging the Oregon State Legislature to, you know, to really consider, hey, like kind of putting a purchase a year date, like a heart attack. Like, like, kind of putting a purchase a year date,
like a heart like 2007, you know, purchase your date for some of these diesel engines and then also kind of doing a task
force. And so, um, they just said, hey, we'd like to have a lug doctor kind of wander around and explain to legislators about,
um, you know, diesel and tobacco. And so, I would go meet with legislators and it was funny because, you know, I'd go, you know, I'd just go with a L.A.
to, you know, walk in and to anybody and, you know, and they'd say, oh, we're like, we're like, we're the doctor. It was here about smoking and now you're
talking about trucks, like, you know, my, my, my, my, my truckers, you know, we had this giant, like, lighter truck manufacturer in Portland, where they just basically taken an old diesel engine. And put, like, a fancy new body
on it. And so, of course, I was an employer and everyone's like, well, why, like, we don't want to squash any businesses.
And then I kind of have to explain, you know, about diesel particular, so it meant I had to educate myself a lot on it. The more I learned, I was realized, I so gosh, this
is pretty bad. And then, um, but then that's where I kind of came up with the tagline of my podcast
of it, don't like things on fire and breathe them into your lungs, you know, and just said, like, actually it's smoking, right, we're kind of all smoking. We don't want
the kids smoking when they're like, these little trucks are riding by their schools. We don't want our, you know, driver, like our excited,
so many drivers and truck drivers and construction workers and stuff in my practice. And it's not just like the two cigarettes they smoked on their smoke break,
you know, it's also this like chronic hip closure. And, you know, so, you know, talking to them about that. And I'm just trying to
help them understand, and then when the pandemic, and I've been kind of toying with again being
a busy mom was, um, then I get asked to go talk it, you know, a town hall about diesel or something. And that's
fine. The only thing is, I'm a busy mom and I have three kids and, you know, full-time clinical practice. And so, you know, going
and talking to 10 people, ear or 20 people there, or even, um, you know,
a committee hearing or something, you know, whether it was the Montlomal County. I, you know, I just said, like, hey, I don't want to become like the Lorax, the speech for the trees, and I'm like the
one doctor showing up and saying the same thing because, honestly, this is very well published. I don't do any. I didn't, I wasn't reviewing
anything edgy. I was just doing like a big mainstream publication, like New England Journal of Medicine. You're like stuff like those kind of studies,
and so I just said, you know, what I wanted to do was find a way to kind of automate that or like automate people's ability to speak
to it or to kind of understand something without me having to just talk myself through in the face all the time. That was kind of, I've been toying with the
idea of, you know, I bought the domain for health, our health. I've been toying with the idea of doing a podcast because I love podcast. I just didn't
really want to listen to my own voice and I felt weird about it and being on the internet seemed really weird. And
so that had been holding me back. And then the pandemic happened and I realized, I was, you know, just seeing the
world shutting down and I realized. We, I was worried that I see you doctors were, well, pulmonary
critical care doctors were basically just going to become I see you doctors. And we were going to have no pulmonary clinics that cleanse were shut down. You know, like,
I just didn't know. And I was thinking, you know, oh, my gosh, like, what would be the most important thing. Like, especially for all people for less protected days. I'm like, well, if
everybody could quit smoking, you know, quit vaping and like start working on cleaning up the air, then hopefully
we will need fewer patients in pulmonary clinic and fewer people land up in the ICU. And that's like the one little thing I could put out into the world. You
know, thinking I was just never going to see the inside of a pulmonary clinic again. And so that's kind of what launched it and it's been
going ever since. That's a big technical jump to take from, you know, putting settings
into a ventilator. You know, it's, it's, it's, how did you learn how to do that? Well, I would say learning to podcast is ways you're the learning
pulmonary critical care. So I think if you learn pulmonary critical care, whatever a fancy thing whoever is listening to this from
the OPH assembly, I'm sure there's some assay in the lab you can do or some atmospheric chemistry modeling that you can do. If anybody else can do, podcasting is
ways you're you plug a microphone into a computer and you hit play. So yeah, this weirdly happened in a different
way through much information probably. But the other thing that happened in the pandemic is I don't know if this
happened to you but it definitely happened to me. Is one of the flaws of American healthcare is that nobody actually, you
know, can keep themselves in the black by, you know, caring for actual sick people
who actually need it. Sometimes there's all these like elective procedures and things that need to be happening. >> Right.
>> You know, I mean, critically ill patients, sorry, like, you know, to kind of keep the engines running. >> Right. >> So, you know, if you're not doing all the, you know, joint replacements
and, you know, all this other kind of volume that has a much more predictable pay or flow, the hospital really starts to struggle,
right? So, you know, just only caring for patients who are like critically ill, who have, who often will run
up, you know, significant, you know, bills, and then, you know, maybe the insurance pay or
mix doesn't work out for the hospital. I don't actually understand these things. I'm not, you know, so we very well, but I do understand that we sat in a meeting one time where
they're like, "We're cutting all your paint." I knew it was in the pandemic, and I was excited
about it. I'm a pulmonary critical care doctor in the middle of a respiratory critical care pandemic. Like, my husband's
going insane trying to educate three young kids at home. I'm worried I'm gonna like kill my immune to suppressed mother. And we're getting
a pay cut. Like, I don't know what to do. Like, we're like scrambling to like suddenly like, full-time, you know, I was
like, "Uh, and again, I know, I'm so privileged because I was getting a pay cut from a physician salary."
And so I'm sure this was happening everywhere. I, you know, and so I realized, you know, I don't know that much about money. Like, I need to learn about
finances. So I went down this like rabbit hole of like listening to all these financial podcasts and reading all these financial blogs. And
then I started to notice them like some of these blogs aren't that fancy, you know? And I was listening to someone, one person who I thought
was helpful, who was a physician who did some stuff on physician movement finances. And she was like, "Well, you know, like WordPress is easy." So
I just like started a blog and did some WordPress and I was like, "Well, she can do what I can do it." That's that easy. My, my website doesn't have a search feature
because I couldn't figure out how to get the text. Correct, this is your feature but that's, you know, the world will be saved by D+ work, right? So,
that's why my website, my sister who works in computers is like, "Your website looks really clunky and I'm like,
"Huh, it's what I can do." And I can spend a lot of time figuring out how to make it fancy. And it's free. Like, give me some free. I have to
do the hosting fees and all that sort of stuff but I don't have to pay for anyone to do it. I mean, I'm sure I could update it or I'm sure
I could hire somebody but I mean, they doesn't make it money. So I'm trying to put a negative poor more money into,
like mostly it's just, you know, because it's just, you know, figures and references about studies on air pollution. Yeah, well,
if what you do this all year, I mean, I'm fortunate I have ETS backing me up. Who are the people
you're speaking to when you're creating your kids? I try to keep it for a general audience and that
can sometimes be challenging when I'm having, you know, highly technical, like, expert
people on because, you know, sometimes people kind of kind of go into jargon. But I do try to keep it for a general audience because
I do, I mean, honestly, a lot of the people who listen to my patients, you know, because they'll have a gas stove and I'll say, well, we have 15 minutes, I can't launch
it until all the nuances of a gas stove. You know, but here's an episode with Laura Paulin, who is
an expert in the ETS, EOPH assembly about gas stoves, and here you go. Right? Because the other thing is you have to
help meet people where they are, they're just going to tune you out. Right? You can't just say, you must go to your landlord and insist that they rip off the
gas stove and install an induction. And you don't even, like, it's just not real. So it's like, there's things you can do if you have a home of the gas stove. And the patient
who should know about that are the ones with their airway disease, because they may not know it's an issue, they may learn a little more. And I think there's also, the more
you kind of understand something, the more you can just do common sense that way, you can open the window if it's not too cold outside. I mean,
you can just, I think that's where the idea of air health are health. Like this is really the stuff we breathe in and comes into our bodies and changes our bodies
in our chemistry. And I think the more people can generally understand that that's an issue.
And then they can kind of adjust things themselves, because that's one of the reasons I kind of focus on the trigger diary and talk to people about
twitchy airways. And it's just saying, like, you know, I know it seems kind of cheesy, but you are going to get much more insight living your
own life. If you start to pay attention to kind of what's setting you off, and then like me in a 20 minute
clinic as it. Like, you know, I'm just not, I don't live with you. You know, versus, you know, honestly, I think home visits are actually
now that telemedicine is covered. And hopefully that continues. I mean, I find telemedicine visit sometimes with my patients very helpful, because all the big,
I don't smoke. And I'm like, looking at three cigarettes, you know, floating in the background, and they're like, "Oh no, no, that's my husband." And you're like, "Okay, well, all
right, time to talk about the second in smoke." So there's a lot you can, you know, you can do, or you know, you can say,
"Show me your hat that's altar." And you know, they show it to me and I'm like, "We'll open it." And the plastic still wrapped around the phone. So the filter, and you're
like, "Well, let's stick that up." You know, or they'll show me the box. It's not open to like, "It doesn't do anything until you plug it in." Or it has ozone in
it instead of ozone. Oh, yes, sorry, it's got an ionizer in ozone. And the other thing is, one of the ways I pick up says it's like, "I don't understand something."
And I think that's the other thing is, I try to be very, I think it's okay to say you don't know. And you're like, "You know, I don't get this."
Like, you know, I remember when the pandemic was happening and there's like, "I unwave and plasma wave." And like, all these like
things were coming out and people are like, "What's about that?" And I'm like, "I don't know." And so, but there are people studying them and you know
what, I've been found so far, you know, raises some concerns. But, you know, again, look,
you know, we can use the things that we know work, you know. So, yeah.
I mean, I actually was looking quite a bit into the twitchy airways club thinking, "Wow, I'm going to steal some of this."
Yeah. Yeah. I'm totally fine. People can-- like, there's
no-- I don't actually-- it's not an end of its copyrighted. So, my lawyer, I remember 'cause I-- funny-- I initially wanted
to set up as a non-profit, it was a.org. And I talked to all my friends who had been involved in starting non-profits and they're like, "Oh, my gosh, if there's
any way you could make it not a non-profit." Like, you're going to go insane. It's just so to paint. And then I-- and so I was talking to this lawyer
and, you know, he said, "Well, what are you-- what are you trying to get out of it?" I was almost like, I don't want something like, fill
it more as, you know, astroturfing something through some, like, local, quarter-store to, like, sue me and try to take my house or something,
you know, and he was like, "Hey, just need an LLC." So, it's technically a for-profit company, but I don't hate anything that comes--
I've been-- I lose money on my gifts every year, because of, like, website hosting fees, but any time I get, like, a speaker
for years, I'm like, "Oh, there we go." I'm like, "All right, yeah." I-- you know, I think that-- we sell, like, I sell, like, sweatshirts
and bugs and stuff like that, and then I-- I mean, I don't hate the proceeds-- the American-lang Association, but I think that-- - Oh, that's great. - My lawyer says that count.
Oh, but he was saying, well, you know, we need to do copywriting or, you know, stuff like that, and I was like, "My dream would be if people
go, like, steal it and disseminate it," you know? I mean, you can do-- so I was telling people, you know what I'm always saying. You can just take the audio from any
of my podcast. I fill daily in ATS that. If you just want to, like, repackage them up and ship them out to some other feed and go nuts, you know?
- Well, that's-- points to spread the word. - Yeah, and I-- and you know what? This is-- I mean, I-- my younger patient
are-- would be all over. Now I have a lot of geriatric patients. What do your patients say? I mean, do they-- have feed back?
Do they-- - It's a similar spread. So, I have some patients who will, like, listen to all of them, even once that
I don't really apply to them. But, you know, you should just ask people, you know, because we live in, you know,
Oregon, which is, like, OPB territory. So, there's often-- you know, it's not like an age thing. You know, often find, you know,
80-year-olds who regularly listen to podcasts and are delighted by it. And then they'll find, you know, younger patients
who are like, "What's a podcast?" I do-- are you on TikTok? Oh, I'm not on TikTok. Oh, I've been told I should get on TikTok,
anyway. But I'm just like, you know, I've only got so much bandwidth. So, you know, so, you know, I-- it's
really age. You can't really rely on age. Just sometimes you can tell based on the phone, someone pulls out in a visit, you know, my flip phone, have
a user probably that advocate, you know, but sometimes
they are, you know, so I'll just ask, you know, I'll just kind of-- so I put it like a link in my after visit summary to, like, you know, different episodes and stuff. And I'll often just ask, like, are
you-- because not all the podcasts are necessarily for them. I mean, although I guess everyone could be a cleaner
and climate advocate. And I've definitely had patients who were spontaneously varying to ad vacancy, especially as they've recognized, you know, how things
might affect them, you know. And so, but, you know, sometimes they can just say,
you know, you can kind of scroll through episodes and, you know, if you have a gasto, for example, or if you, you know, are vaping or using
e-cigarettes or, you know, I've had patients who've had e-cigarette long injury and, you know, like, well, find those episodes, you can germ with your friends, you know.
And so I think it's just helpful, you know, to spend a lot of time doing, like, a 20 or 30 minute educational
thing that you can just then just share. And I mean, I can talk very quickly, but if I just like, repeat the
same thing over and over and you know, get blue episodes, I guess. Well,
I mean, I, I show videos, like, sometimes I have to run off and I have to run
off and get supplies from my patients. Here is respearing containers and a flutter valve. And so I just put on a video for
them while to entertain them while I'm gone. Oh, that's a great idea. And they're like, oh, I, you know, they usually,
it's like, how do you flutter? But sometimes it's other things. And so these, there's little things, also
my fellows use, when they have to go staff with me, they'll actually put on videos to entertain
there. This is where I got the idea actually. They put on videos that their patients can watch while they're off waiting and lying to staff. That's super smart.
Like from American Lug Association or something or something. Yeah, that's a great idea. I'm going to start doing that. I mean, I don't want
to go staff at anything. Yeah, or well, or run off. I mean, you might have to run off. Or what are we doing next for? Or something?
Yeah, that's a good idea. I give, give credits to my fellows. They're the ones that you're all right. Good job fellows.
What would you be your first step? The thing that can be really hard is feeling like you have to do everything. And realizing
that even just taking 15 minutes or 10 minutes,
you know, and whatever time interval you can do, can actually have an outsized influence. And so I, you know, and I also think the closer
to where you are, the more powerful your impact will be, right? And I think a lot of times people
think of advocacy and they immediately think of like the federal government or like the global, you know, and they're like, well, I don't have any, you know, I don't
have a tumor or something, you're like, well, I don't have this like global reach and all this stuff, but you can actually
do a lot where you are, right? So I think that's where kind of getting a familiar with what are the laws that regulate the
air we breathe, right? And what are, and the thing is, and you're going to know your community, but like you're actually
already an expert in your own community and what its values are. And because one thing I have learned when my favorite
podcast episodes, I did was with a behavioral scientists on an understanding, you know, who, you know, are concerned about vaccines and
how to talk about vaccines. And that episode really changed away. I approach it because a lot of people are more interested in shared values.
And the thing nice thing about being interested in cleaner and climate advocacy and helping decrease tobacco use and helping
people break free of nicotine addictions is there's very little downside. Like, it's very little
downside to helping people quit smoking. Like, there's not many bad side effects from helping people quit smoking or quit vaping or,
you know, to have less pollution in the air. Right? It's generally really, really going to be good, right? And so, um,
and the thing is there's a lot of low hanging fruit, right? So I think a lot of people are, you know, think the minute they have to talk about cleaning up the air,
you're going to be taking the one family car away from a family who needs it to commute. And it's like, no, no, no, no. Like, how can we help with, um,
you know, kind of like idling rules? Or how can we make sure there's more, you know, bike lanes and, you know, chargers in areas that are dense enough to have
that happen? And you can do a lot, even outside of regulation, right? Right?
You know, so right now is maybe a time where people are nervous about getting engaged in government or getting, you know, just there's,
you know, people, you should recognize what your personality type is and what you're comfortable with. And then do things that align with that because I think sometimes
people picture advocacy and they picture, you know, marching in the streets and, you know, doing all the stuff that doesn't feel
right, but advocacy is really just hearing your voice, right? So that's what it means, right, as you're carrying your voice
and you're carrying the voice of your patients. So whether it's, you know, showing up or if you have counties considering banning, you know, gas powered lawn equipment
or even not even banning it, but just helping with a program to incentivize, transitioning to like cleaner quieter options,
you can just show up and say, like, let me tell you what these particles do to people. Like, let me tell you that, you know, running a gas powered leaf blower for 30 minutes is like, you
know, driving a 4 to 150 from Texas to the last gut, right? Like, that's a lot of pollution in a short period of time compounded
on the people who could at least afford to be breathing that pollution, right? Right. Right. And so it's like, you
can, you can do that and explain it, you know, in normal language, which clinicians are experts at translating,
you know, fancy science talk into, like, don't like things on fire and inhale them, right? And you can just say, like, and then it's like, you know,
better is good, right? So it's like, if right now, everyone's using them all the time, all day, every day, you know,
it would be better if half the people were, you know, using gas equipment, or if there were more electric options available. You know,
and if there's just different ways to engage that may not be so scary, because I think people get scared when they hear advocacy,
or they think of just form letters. You know what I mean, where it's like, oh, I'm just clicking on the box, I like, add my name to a thing.
But the other thing to do is, you know, even I also really think you should talk to your most local
elected official. Because they are probably someone who is overworked and wants to make their
community better. They're probably not getting paid a lot. It depends where you are. I'm sure there's, you know, very experienced on this, but it's like your county
commissioner, your, you know, your city council. Because I think sometimes we forget that people actually
live in cities and communities, right? And towns and whatever, and air pollution is generated. And it's generated
all over, but there's a lot generated locally. And so, if whatever you can do locally to clean up the air or,
you know, get environmental toxins, you know, out of the water, out of, you know, anything. That's, that's really moving things forward.
And people are much more responsive to something that local, that they can understand. One of the podcast
episodes I did was was this year with Tony Gerber from National Jewish.
She came involved in air quality in his state of Colorado and he came a resource for them to help understand how
to, you know, make the air cleaner and safer for the communities at the state level. And he, you know, would talk about examples of, you know,
very politically, you know, diverse or, you know, communities or even communities that seem that, you know,
politically has not seemed to historically have much of an interest in, you know, air quality and they, you know, kind of came together to shut down
a cold pipeline because they recognize it was making their kids sick, right? So I think a lot of the times there's, um, we assume
an advance that people are going to resist something at the level that is just actually not the case. Because most people
want their kids to breathe cleaner and drink clean water, right? You know, and I think coming together is like community
can be pretty potent. Another podcast that was what I did was with Catholic climate covenant, right? So they
actually are going around trying to help all these different churches, um, you know, install solar panels and help, you know, kind
of move, you know, really take climate on as an environmental justice issue, which was, you know, if something that
had become increasingly focused on the US Catholic offensive bishops and are most famously with our most recent pope. Um,
uh, and so, you know, they were kind of taking it on that way, you know, they just did a pilgrimage to take copies
of Low-Dotto C, which is this, um, climate and cyclical, it's all the Catholic members of Congress, right? So, and that
exists in multiple faith traditions and non-faith traditions and, you know, this is just a thing where there is a version of it,
close to you. If you just can find it, and then that's going to be something that's most satisfying to you in multiple dimensions,
right? It's something you can bring your kids to. You can be active there, you know, I brought my kids to a climate protest on the steps of Washington DC at ATS. You know, so
it's just like bring your whole self, bring your family, and then it makes everything more sustainable. And then you're going to
have more of an impact if people know you, right? If you're actually taking an impact in a lead where you're
known. That's right, talking to your neighbors. Yes, yeah, exactly. Because they know you, they
see a multi-dimensional person, rather than just this face filter, this post, you know. I would say
very limited utility probably in doing it all in face book and social media,
right? All right, now this might, this is a little bit outside of your general expertise, but I think you
probably have some good opinions. You've wrote on your website that you did not learn enough about the importance of clean air and medical
school residency fellowship. What can undergraduate and graduate medical education institutions change
to better improve air pollution education? I think, you know, I'm hoping I'm hearing
more that it's starting to change, but I think, you know, I honestly think it should be something in pretty much every
module of, of, that school because climate change is just one of the biggest global threats to health right now and peace
and national security all sorts of things. But I think, and then understanding how things are going to change over time, I think, is helpful.
So, you know, if you're doing the allergy section, understanding how like pollen and, you know, this changing with carbon dioxide and heat, you know,
increasing, you know, understanding that heat stress and, you know, cardiovascular outcomes, especially as climate emergencies
are happening more, I think there's a real, it's not just a long-term thing, it's a short-term thing, right? You need to know how vulnerable your patients,
cardiovascular disease are to heat events, right? You need to know how vulnerable they are when there's, you know, to your respiratory patient. So, you know,
unfortunately right now, it kind of seems like it's a lot of the times it's student-driven or learner-driven, which really
does risk, which is great, I mean, it's better to be driven by somebody. But it does risk, you know, maybe having holes
that we don't see versus if someone's kind of taking it from like a systematic global standpoint. So I'm hoping it's something that, you know, program directors
and fellowship directors and we'll take on and take more seriously And I know there's members of the ATS that are working on this for the pulmonary
critical care community. But my advice would be learners really want to know about it. And I think one of the things
that's a little bit of the sociology of medicine is attending some professors want to be expert. And so they feel a little uncomfortable
if they didn't learn about it, then how can they teach it? And I think this is one of those things where it's like you just got to roll up your sleeves and learn about it.
Like there's plenty of learning and then teach it, you know, see when do you want to teach them? Or you know, maybe, and so I think I do really think
it's something that, you know, because I think sometimes when you're really busy and you're coming out, you're like, well, I didn't know when taught me about it. So I can't be that important
and I think we need to kind of flip that and say, hey, this is important, I really need to learn about it so that I can be effective. And I think
the other thing that really happens in the, you know, western medical model is that we often put all the burden of maintaining
health at the individual level. And so we also just look at its individual behaviors at Sherman Health, right? So that's why
we focus a lot on like eating and smoking and all those things are super important, but there's so much environmental, there's so much of like where we grow up that
really determines our health, right? And I think, you know, we classically think about things like lead and other forms
of pollution and air pollution, but even, you know, social bonds, right? I think, you know, and again, loneliness.
I think there's a lot of stuff with like loneliness being a massive crisis right now. So I've actually got a loneliness stop phrase for my patients who are kind
of alone and, you know, working on, you know, trying to help connect them to other members of the community,
which helps in a whole host of ways. So I think that's the part where I think, we also need to look at our, you know, we're rugged
individualists in America, which is, you know, part of our, you know, part of our charm, I guess, but on the other hand,
it really is distorting because, you know, we really can't, you know, you can't separate yourself
from literally the air you breathe and the water you drink and the food you put in your body. And so we do really need, and I think that's
also something that is not as politically black and white as I think people think it is. Right,
I think there's a lot of people that share that belief and they come to different kind of conclusions, or they put make different enemies or
allies or whatever, you know, at the upper level, but the more you can just bring things down to a specific problem and avoid logins, or ism's,
right, or this is the same route that is, yeah, rather just being like, okay, I want there to be left, you know,
carbon monoxide and like, you know, particular matter going into the lungs and make it, like, I want there
to be less elastic in our water, you know what I mean? Like, and then you can have people who, you would
probably wildly divergent views on a whole host of other things can maybe come together to work on that, which
could also potentially be a bridge to come together on other things, right, in the Paulian of you of things. Well,
it's a whole hope, right? You have, yes, if you, if you
don't do anything because you're feeling like this is already a lost cause, then nothing has. So, yeah, and things actually make you feel better. It's also good for your mental health.
That's right. That's right. So, multiple reasons. And so, if anybody wants to learn more,
they can look into allied, which belongs club, which you heard here first,
anybody's welcome to steel, and finally, just keep looking into
the environmental health policy committee, and what they've been producing, and Dr.
Moson is involved with that. And we also look for greater things from you to come. Thank
you so much for all of your work, and for all of your enthusiasm. You really are an inspiration. Well, that's
very sweet. I find, I mean, I go into the OPH assembly, and I'd have this massive, you know, imposter syndrome, because I'm looking at all
these amazing people doing all this cool research. Then, just following around with a microphone being like, "Can you talk about it on my podcast?"
So I can understand what you do because it's really cool. Now, it's important. You're the person,
you're like the researcher whisperer, and getting it all out to everybody else. So this is very
important. Thank you so much. And thank you very much. It's an honor to be here today. Thank you for joining us today.
To learn more, visit our website at thoracic.org, find more podcasts from the ATS assembly on YouTube.
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