Climate change and clinical practice

This issue covers such topics as how internists can address climate health issues in their practice, what internists can do for patients with fibromyalgia, and how to identify and manage resistant hypertension.

Although some may debate the potential causes of climate change, its effects have undeniably been felt worldwide, and it will most likely continue to play a role in health and wellness. In a position paper released earlier this spring, ACP argued that climate change has potentially dire public health implications and that physicians are well placed to help combat both the problem itself and its effects on patients. Our story in this issue looks at the actions recommended in the position paper and offers advice on how internists can address climate health issues in their practice, including such topics as heat-related disorders, respiratory problems, and vector-borne diseases.

Fibromyalgia, as a contested illness, also has some debate surrounding its origins. Some researchers believe that it's based on abnormal pain amplification, while others believe it to be a bio-psycho-cultural disorder with multiple causes. Our story in this issue goes beyond the controversy to examine what internists can do for patients with fibromyalgia, who are undeniably suffering. The FDA has recently approved 3 drugs to treat the condition, but their effect sizes are small. Behavior changes like exercise and sleep can often have a greater impact, experts say, and managing social stressors can play a big role, too.

Our conference coverage in this issue tackles resistant hypertension, which was the subject of a session at the American Society of Hypertension's annual meeting this May in New York City. One expert discussed ways to tell whether a patient truly has the condition, beginning with assessment of his or her drug regimen. Physicians should also consider whether white-coat hypertension is present and look into ways to monitor medication adherence, the expert said. A second speaker discussed possible potential treatments on the horizon, including renal denervation, central iliac arteriovenous anastomosis, and neuromodulation, among others.

Finally, this month, Darilyn Moyer, MD, FACP, takes the helm as the College's new EVP/CEO, replacing Steven E. Weinberger, MD, MACP. Dr. Moyer, who will be the first woman to serve in this role, is a well-known medical educator who was most recently assistant dean for graduate medical education and director of the internal medicine residency program at the Lewis Katz School of Medicine at Temple University in Philadelphia. Read our Q&A with Dr. Moyer, covering such topics as her previous ACP involvement, what excites her most about the future of health care, and how her background and interests will influence her leadership of ACP.

Do you talk to your patients about the health effects of climate change? Are patients with fibromyalgia common in your practice? Let us know.


Jennifer Kearney-Strouse
Executive Editor, ACP Internist