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In Reply: Dr Sherman expresses concern about the environmental impact of medical waste on landfill and toxic pollutants. My Commentary focused on one particular clinical microsystem, but I appreciate and agree with his comments.

As Sherman asserts, Toyota Motors emphasizes environmental sustainability in its Environment Vision ("Toyota promotes environmental initiatives that take into consideration the entire lifecycle of a vehicle by implementing thorough environmental management at all stages [sic] production, logistics, use, disposal and recycling."¹) and its third guiding principle ("Dedicate ourselves to providing clean and safe products and to enhancing the quality of life everywhere through all our activities."²). This is further developed in their philosophy, the Toyota Way ("We aim for growth that is in harmony with the environment throughout all areas of business activities. We strive to develop, establish and promote technologies enabling the environment and economy to coexist harmoniously and to build . . . [Full Text of this Article]

Roger W. Bush, MD
roger.bush@vmmc.org
Virginia Mason Medical Center
Seattle, Wash

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