Reducing the Environmental Footprint of Chronic Illness
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Kara Wada, MD: Welcome back everyone to this week's episode of the Becoming Immune Confident Podcast. My name is Dr. Kara Wada. I am a board certified pediatric and adult allergy immunology lifestyle medicine doc, systemic, Sjogren's patient and certified life coach. Today I am so excited to invite a guest in honor of a lot of things this month where you're celebrating Primary Immune Deficiency Awareness month, and it is the month we celebrate our mother Earth on Earth Day. So, I'm really excited to invite Joanna Maltese. Joanna and I met recently at the American Academy of Allergy Asthma and Immunology meeting. It is the premier meeting that allergist immunologists attend in the United States, and she is a nurse. She's been a nurse for the last 27 years. She worked in multiple specialties, but the past four years, she's been a clinical nurse educator at Octapharma, a company that manufactures plasma derived therapies. While we were talking, I learned some really cool things that their entities are doing.
We're gonna talk all about how that all comes together, and we had so much fun talking. I was like, "We need to record this as a podcast". So, thank you so much for joining us, Joanna.
Joanna Maltese and Octapharma
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Kara Wada, MD: Can you share a little bit with our community about how you are doing what you're doing, what you're doing?
Joanna Maltese, RN: Sure. Thank you for having me. It's exciting. I became a nurse. I graduated in 1995, which I try not to think about how long that is. Luckily, I'm not good at math, so I don't think about how long ago that's been. Nursing has been my passion and then education really became my passion, both families and other healthcare professionals.
So after years of increasing levels of education and clinical leadership, I found myself at Octapharma which is just a fantastic company and when I was interviewing for the position, I saw what their core values were, and one of them was sustainability and that was really important to me.
I've always been this mad recycling person. I lived in a city, believe it or not, when I was probably like nine or 10 years old, so I just turned 50 so we're going back like 40 years, the city initiated a recycling program.
I can remember going to college and nobody else knew what I was talking about of like this home service. With our regular garbage pickup, they would send these plastic barrels and you would sort your garbage. So for me, just growing up, it was normal, you know, went to college and they started doing recycling. We had these continuous use plastic cups that we would all clip on our backpacks rather than using single use plastic.
So, it's always been something that's been really important to me. And then just kind of did what I can all those years and tried to do the best and then found this company that is really trying to do their best as well. Thinking about things like wastewater, contamination, and pharma. Pharma has not historically been kind to the environment. Just the manufacturing of our products takes a lot of energy and there's a lot of chemicals that are used. So, trying to shift that is one of the goals that Octapharma has, trying to be kinder to the environment, a lot more cognizant of what our manufacturing sites can do to make things better.
And then in the United States, for one of our products, we have this program called IgCares and there is a recycling service, which is what we bonded over.
The Trash Issues of the Medical System
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Kara Wada, MD: So let's take maybe a couple steps back and just talk a little bit about all of the trash that is created within the medical system. It's not something that we talk about that often.
Joanna Maltese, RN: Think about the last time any of us was in a hospital having our blood drawn. Anything that you do in medicine, think about how everything is made of plastic. Everything. And those of us who use those products know that everything comes in a plastic package because it has to be sterilized, right?
So, there's a lot of plastic waste, a lot. I figured when I worked in hospitals that all of the sharp container contents were incinerated. But everything else just went in the regular trash. And then when I started doing home infusion, that's when I started giving immunoglobulin, and especially subcutaneous immunoglobulin, which is a medication that a lot of patients with Primary Immune Deficiency are on for their entire lives. And so, at that time these patients were infusing subq Ig every week, and at the end of every single infusion, they were left with a tall kitchen garbage. bag full of unrecyclable material. The only thing that was recyclable in the whole shebang was the little cardboard box that the vials came in and I had patients who tried to bring the glass vials themselves to recycling centers. They won't take them. So, my patients were upset about it, I was upset about it and at the time, I didn't think there was anything you could do. about it And I can remember at my interview for Octapharma one of the things they said to me was, "How would you feel about recycling some of that stuff?"
And I went off and I was like, "Oh no, you can't recycle it. It's terrible for the environment, blah, blah, blah". And then someone said, " But what if you could?" And I was like, "That would be a game changer. Just a game changer". And when you think about again, the amount of waste that's generated by each patient each week, it makes a lot of difference.
How Octapharma Handles Medical Trash
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Joanna Maltese, RN: So, when I came on board at Octapharma, they let me peek behind the veil and told me about this recycling service that they were rolling out and Octapharma pays for it. It's completely free to our patients. And they get a big cardboard box with a specialized sharps container and absolutely everything that they use for their infusions goes in that box.
All of the medications are shipped in a Styrofoam cooler. So Styrofoam is not recyclable. The Styrofoam goes in the box. All the plastic packages, the plastic bags, everything in addition to the used medical equipment goes in that box. They slap a prepaid label on it, and it gets taken away, again, for free.
Octapharma has subcontracted with a company that repurpose all medical waste into a material that's kind of like a battery and generates energy for homes.
Kara Wada, MD: As I think, and take a couple steps back, you think from the standpoint of we have sometimes these limiting beliefs of what the world looks like and we forget that sometimes you can disrupt and blow things up from how they have been to really make a difference.
Joanna Maltese, RN: Absolutely. That's the thing, to our knowledge, Octapharma is the only company in the world that offers something like this, and I would challenge all of our fellow plasma fractionators, to think about doing the same thing. Talk to all medical professionals to think a little bit more about what we do with our medical waste.
Kara Wada, MD: Well, in little note to self, I helped out earlier this year a group of our fourth year medical students at Ohio State. Worked with some faculty and put together a, I can't remember if it was a two week or a four-week elective, for graduating medical students who were really interested in the impact of climate change and how that interfaced with medicine. And so how I got involved was talking about global warming, pollen, worsening allergies sort of thing, right?
But here is another element that I would never have thought of bringing up in the conversation at that time, but just as directly has an impact in my little niche of care for a group of patients that, that I care for day in and day out, and really can also have this substantial impact in this great big web of the world and life and mother nature that we all live within.
Progress, not perfection
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Joanna Maltese, RN: Right and I liked what you said when we met the whole thing of "Progress, not perfection". If we all just do our part, like none of us can solve this, right? Octapharma is not going to solve the climate crisis. But they're doing something.
Kara Wada, MD: If we have values that we feel strongly about and if we're in the position and able to make decisions to support or bring light or give voice to folks who are trying to be the change that we want to see, like this program that Octapharma is doing. My associate, we talked a little bit about Beauty Counter and sharing how they're trying to be leaders within the clean beauty and sustainability side of things from skincare and makeup and those sorts of things.
The hope being that others will follow those leaders when they see that it is successful and that there is a market for these services or these products.
Doing our part
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Joanna Maltese, RN: Right, absolutely. We all have to do our part. The last family vacation I planned, I chose a resort that doesn't use any single-use plastic and takes care of their water and maintains a small reef. Buy sustainable shoes. Like again, it seems like little stuff, but it adds up.
Kara Wada, MD: We're in the early stages of thinking about solar panels. Is it feasible? Does it make you know where we are and with trees and those sorts of things,
Joanna Maltese, RN: Yeah. I love my solar panels. I have not paid an electric bill in at least four years.
Kara Wada, MD: That sounds glorious.
Joanna Maltese, RN: Yeah. Cause I make all of my own power.
From Plasma Donors to Immonoglobulin in Octapharma
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Kara Wada, MD: So maybe we can switch gears a tiny bit to just talk about immunoglobulin, like how do we get it? You mentioned we used it very commonly and I prescribe it for my patients with Primary Immune Deficiency. Patients who, for one reason or another, their bodies don't make these immune system proteins, and I'll guess I'll give a little plug. If you wanna learn more about how that works in your immune system, you can go back to some episodes from the beginning of this year where we walked through how your immune system works and how it cannot work. But how do we get that, how do I get that to order it for my patients.
Joanna Maltese, RN: That's a great question. So, everything starts with our plasma donors and if I can plug something else, any of you who are healthy enough please donate plasma because it saves people's life. That's not being hyperbolic, that's the truth.
So, plasma donors go to one of our centers. You can go on the octapharma website and find a center near you, we have over 150 in the United States. They have to be healthy. They are very rigorously screened. All of our donors have to have a social security number because all of the regulatory agencies mandate that if you are to sell a plasma derived therapy in the United States that all of your plasma has to be sourced in the United States. So that is something that we chose to do at Octapharma. So, donors rather are screened very rigorously for any sort of communicable viruses mostly. But then also it's a health screening if they're not healthy enough to donate plasma. Then the plasma donation process takes about 90 minutes.
They put a needle in your arm, like if you were gonna go donate blood. But then there's a machine that's attached that separates the plasma out from the red blood cells. So, we only collect the plasma portion and the patients get their red blood cells back at the end of the donation.
Patients can donate two to three times a week, usually about two, twice a week because your plasma replaces itself, regenerates itself that fast, right? But donors also have to donate consistently. if you go into a plasma donation sensor and you donate one time and then you never go back, they throw your plasma away because they want to continually test your plasma as you continue to donate to make sure that it's still safe and they don't find anything in it. So, the plasma that's donated is stored in a warehouse and tested again and again and then at Octapharma, all of our products are manufactured overseas. So they're shipped to Europe, they go through a very rigorous Series of manufacturing processes. A lot of chemistry and technical stuff. Octapharma actually was a leader in the plasma fractionation world. We, not we, I had nothing to do with it developed or started using the solvent detergent treatment, which basically, for lack of a better word, cleans the plasma, deactivates or inactivates the potential viral contaminants.
That's one of the things that makes plasma drive therapy safe. At Octapharma, when Zika virus came out on the scene, remember? They did some tests and spiked some bags of plasma with Zika virus and then put it through the solvent detergent treatment manufacturing process, and then saw that it was gone at the end. So really continuously working on those manufacturing processes to make sure that we're developing the safest product possible Then when it's done, it gets shipped back to the United States where the FDA tests it again. So, it's very, very rigorous to make sure that these products are safe and then they get to your patient after you prescribe it and they infuse it.
Primary immunodeficiency and Immonoglubolin
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Joanna Maltese, RN: Primary immunodeficiency is a group of well over 450 rare diseases that make patients either have recurrent infections or autoimmunity or a combination of both. Immunoglobulins work to either replace the antibodies that patients can't make or that don't work properly or for some autoimmune conditions, they also take immunoglobulin.
Kara Wada, MD: Yeah. And that's what I find so fascinating about immunoglobulin is that it can be used both to turn up our ability to fight off infection so replacing what's missing. But then in the autoimmune space, essentially the dose we would prescribe is actually much higher than what we would use to replace and it actually then down regulates the immune system to behave a little better. It's one of those things that when you're learning about it in fellowship, it's like, "Oh wow, that's really bizarre and cool". We're kinda taking advantage of some of the mechanisms that the body has. Built in to try to go back to homeostasis so that balance point or that kind of happy place, which is never like stagnant, right? It's always moving, but there are all these different mechanisms that our immune system has to turn on to turn off, turn the thermostat up, or turn it down and immunoglobulin is one of the ways we can do that.
What started Octapharma: Screening & Safety
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Kara Wada, MD: I guess maybe just to provide a little context, of why that screening and safety is so important is a lot of that stemmed out of the AIDS epidemic back in the early eighties and just making sure, things don't happen like the Ryan White type story a certain age may remember.
Joanna Maltese, RN: That's really what started Octapharma literally. Our founder, Wolfgang Marguerre. Octapharma by the way, is still a family-owned company. It's the only privately held plasma manufacturer in the world. We're about the fourth largest plasma manufacturer, so certainly not the largest. But he got involved with the New York Blood Center in the early eighties, and at that time, like you said, with Ryan White, hemophilia patients were the ones who were immediately affected. I've heard statistics that up to 75% of the hemophilia population was wiped out. In the early eighties with AIDS, with Hepatitis C, which they couldn't test for, for many, many years after from getting tainted factor. Depend on factor that they, their bodies don't make, or they don't have enough in order to keep them from bleeding and some of those bleeds obviously can be very, very serious. That was something that Mr. Marguerre really felt passionately about, that we needed to develop a system of manufacturing to make these products safe and that's how Octapharma was born 40 years ago right at the time that the AIDS crisis was at its peak.
Kara Wada, MD: And it's interesting because these questions of safety rarely is there much additional conversation aside from me saying it's safe with my younger patients that are, diagnosed in their teens, early twenties. But there's another cohort of patients that will be diagnosed with, for instance, common variable immune deficiency, one of the most common primary immune deficiencies, those folks being maybe in their fifties or sixties when it's identified.
Those are the folks that are like, "Oh, wait a sec". Talk about this safety issue because they remember it. Yeah. This was front page type news.
Joanna Maltese, RN: Absolutely. Absolutely. I remember it too. It was a big deal. Yeah, it was a big deal.
What does Becoming Immune Confident mean to Joanna?
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Kara Wada, MD: One of the questions that we have been trying to end each of our conversations about or ask is, what does the idea of becoming immune confident mean? How does that resonate with you and your role within, within the Primary Immune Deficiency space?
Joanna Maltese, RN: Healthy living, whatever that means to each individual patient, I think is really important. And I know that you've talked about this a lot in on your podcasts and you know, nobody can do everything, but whether your diet is something that will help you. We all know that everything we put into our bodies, everything we expose ourselves to has the potential to make us ill. So whether that is an exercise program or, filtering your water or choosing a diet that is full of nutrients that will help your immune system and just help your body in general. Trying to give patients some sense of control I think is really, really important because when you're diagnosed with a condition that you didn't ask for and you didn't do anything to bring it on, right? It's important to have some control because your life is so affected by this illness.
And you need to be able to control something. Even stuff like subcutaneous immunoglobulin versus IV immunoglobulin, right? Being able to do it yourself. Go wherever you want to go. Go on vacation, go hiking or backpacking and bring your immunoglobulin with you. I think that's really one of the biggest things that I try to convey to patients and healthcare providers who are educating patients, is really to try to empower them and to give them knowledge.
I'm a nurse educator, and knowledge is power and I think knowledge can give you that confidence about how to better help yourself and help others.
Kara Wada, MD: And to be able to take that agency and have, and make an informed decision is incredibly powerful. As I learned through kind of some of the trauma training that helps mitigate some of the trauma.
Joanna Maltese, RN: Absolutely.
Kara Wada, MD: Effects of a life altering diagnosis. It's not the end all be all, but it helps.
Joanna Maltese, RN: Right and the trauma that's imposed upon you when you become a patient, whether that trauma is some sort of medical intervention that you have to take to help your body or psychological trauma from dealing with the healthcare system. Let's face it, I've had to do it. It's not always pleasant. That's another part of being a healthcare professional, is just trying to have that compassion and think about where people are coming from.
Kara Wada, MD: Thank you so much. It's so easy for us sometimes for anyone like to become the villain, right? In this broken system. We know the system is broken and needs a lot of help, right? And we're all trying to function within it and it's easy for us sometimes to point out villains because having a scapegoat is a good way for us to deal with things and the reality is that becomes pharma many times. But let's be real, without pharma, we don't have so many of these big medical advances that we have and so realizing that there's a lot of nuance, there's a lot of discussion, there's a lot of good that's coming out of things too. And if we don't have these conversations as humans to humans and understand the complexity of everything going into this, we're just gonna continue to flounder within the broken system.
Joanna Maltese, RN: That's right. Absolutely. We just have to make sure we don't have our blinders on.
Kara Wada, MD: Thank you, thank you. Thank you for this really cool work you're doing.
Joanna Maltese, RN: Thank you.
Kara Wada, MD: I'm just even thinking the O.R. waste, goodness. I'm not a surgeon, but I, I...
Joanna Maltese, RN: Right. I mean, at least they use some metal things, right? Yeah, some metal stuff that can be sterilized, but yeah, it's everywhere. We have to do better.
Kara Wada, MD: Our yearly trips for our OB GYN visits, everything plastic there now too.
Joanna Maltese, RN: Absolutely, it's everywhere. And from what I've heard, I don't have numbers. It's not expensive to do this. So this is something that when you think about the money making machine that the medical system has become, If a little of that was donated to doing something like this, where could we go?
Kara Wada, MD: It's exciting to think about.
Joanna Maltese, RN: Yes. Happy Earth Day.
Kara Wada, MD: Happy Earth Day. Yes. Thank you again. We are going to make sure to link to your LinkedIn, but then also maybe we can figure out what other links we're allowed to put up for maybe the recycling program and for donation to maybe look up the locations if you are wanting to go donate plasma afterwards,
Joanna Maltese, RN: I will definitely send you a link for that. And then our recycling service lives on www.igcares.com, so ig like immunoglobulin and then care, c a r e s.
Kara Wada, MD: Perfect. Thank you so much Joanna. I hope you have a wonderful weekend and I can't wait till we speak again soon.
Joanna Maltese, RN: Yeah, thank you so much.
Kara Wada, MD: Hey, everyone. I am going to ask you once again to go into Apple podcasts and submit a review of the podcast for me.
But first I'm going to share a review from Dr Lex RX.
"Dr Wada's unique perspective is amazing considering she's both an auto-immune patient and physician. Her experience, expertise and insight make this podcast so valuable. Keep them coming."
One other from Amanda Katherine.
"Wow. So informative. Thank you for bringing more attention to autoimmune diseases. Each podcast is so informative and well thought out. Very impressed with all that you do."
Thank you so much, Dr Lex Rx and Amanda Katherine. I really appreciate the feedback and the review.
If you aren't subscribed yet head over to drkarawada.com and in the upper right corner, you can hit the subscribe button.
Thank you so much because apple podcast reviews are one of the ways to increase how many people are able to access and see all of this education and information we're putting out into the world.
