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- [00:01]
Sleep Number Advertiser
There's a reason the sleep number smart bed is the number one best bed for couples. It's because you can each choose what's right for you whenever you like. Firmer or softer on either side. Sleep number does that. One side cooler and the other side warmer. Sleep number does that too. You have to feel it to believe it. Sleep better together. And now during our cyber week sale, save 20% on most sleep number smart beds plus free home delivery with any base limited time only at a sleep number store or sleepnumber.com c store. For details.
- [00:33]
Cleveland Clinic Advertiser
From all over the world, people turn to Cleveland Clinic for our expertise and our compassionate care as leaders in heart neurology and cancer. The future of specialty care is happening right now at Cleveland Clinic for every life saving treatment, for every next step, for every care in the world. Cleveland Clinic.
- [01:01]
Dr. Sanjay Gupta
You know you might be using a reusable water bottle. I certainly am. And probably because my wife encouraged me to make the switch from single use plastic bottles. It made a lot of sense. And now you've probably noticed the growing number of people carrying them around and figured it was time to join in. Now, you may be doing this for all sorts of different reasons. Maybe you're doing it to help the environment. And, and sure, there are lots of environmental reasons to opt for stainless steel or glass over plastic. Plastic waste is a big problem. I think we all know this. But there are also health reasons to make the switch. And some of these may surprise you. You may have recently heard about microplastics, which are exactly what they sound like. They are tiny fragments of plastic and they can make their way into our bodies.
- [01:49]
Dr. Leonardo Trisande
Those particles are about 400,000ths of an.
- [01:52]
Sleep Number Advertiser
Inch in size and can pass through.
- [01:53]
Dr. Leonardo Trisande
The bloodstream to reach almost every single organ. These microscopic pollutants have been found in.
- [01:58]
Cleveland Clinic Advertiser
Tissue in the human brain. Now, new research adds to concerns that they could be affecting male fertility.
- [02:04]
Podcast Host
But we're now learning that it's possible.
- [02:06]
Madeline Barron
To take in these particles through the air that we breathe.
- [02:10]
Dr. Sanjay Gupta
Microplastics have now been found in the brain, the arteries, lungs, placenta, even in breast milk and your blood. And these microplastics can come from all sorts of different sources, including those plastic water bottles. They can expose us to microplastics.
- [02:28]
Dr. Leonardo Trisande
It's much more pervasive than meets the eye.
- [02:31]
Dr. Sanjay Gupta
That's Dr. Leonardo Trisande. He's the director of Environmental Pediatrics and the Vice Chair for Pediatric Research at the NYU School of Medicine. For the last two decades, he's been studying how environmental exposures like to microplastics can impact our health and our wellbeing. The first thing he noticed was that plastics are everywhere.
- [02:54]
Dr. Leonardo Trisande
Plastic is much broader in its use than I had even imagined through my college and medical school training.
- [03:03]
Dr. Sanjay Gupta
So today we're gonna hear from him about what exactly is known about microplastics and human health, what they are, how they're getting into our bodies and the potential long term health effects, what we really know and what we don't know about that. And I think, perhaps most importantly, what does it mean for you? How can you actually reduce your exposure to Plastics? I'm Dr. Sanjay Gupta, CNN's chief medical correspondent, and this is Chasing life.
- [03:36]
Podcast Host
Just to set the table here, what is plastic?
- [03:41]
Dr. Leonardo Trisande
So plastic begins with fossil fuels. So ethane is turned into ethylene or propane is turned into propylene, either from oil or gas, respectively. And those are the core monomers. And then what happens is a big old chemistry reaction where these monomers are then made into chains. And then what has to happen from there are, there are additives that are intentionally added. So we think of the crinkly polyvinyl chloride plastic that we're so used to in food packaging as coming that way just on its own. But phthalates are added to polyvinyl chloride to make it softer. Then there are non intentionally added substances. So there are things that are impurities or other materials that get into the mix. And so when we think of that final product, that is our plastic water bottle, our food packaging, our paint, which is plastic.
- [04:44]
Podcast Host
Fascinating. This industry has been around a long time and I'm curious about how it's become so ubiquitous. But I think what's been in the news a lot lately, doctor, has been the concerns about microplastics and nanoplastics. So what are those?
- [04:59]
Dr. Leonardo Trisande
So you get that plastic product, it's this very well put together polymer made to absorb heat, substances that are added. But the reality is it breaks down and it breaks down into various sizes and shapes of the particles. What we're dealing with, when we're dealing with microplastic and nanoplastic are various sizes. The definitions get a little bit debated where you draw the line between a microplastic and a nanop. Nanoplastic. But we're talking about microplastic as microscopic size plastic. Things that you need to see under the microscope with nanoplastic being a little bit finer grain. But even some microplastics start to look visible. And that's where we start to talk about macroplastic materials. Even so, the Theme here is they've broken down with time in the process before it even gets to the trash or that recycling bin.
- [06:01]
Dr. Sanjay Gupta
So I want to underscore this point. Microplastics are tiny. They're often smaller than a grain of sand. Nanoplastics even tinier. But you might be wondering what exactly causes these plastics to break down in the first place. Dr. Tresande says there's a few ways this can happen. For example, it can happen with heat, like just leaving a plastic water bottle in a hot car, or microwaving leftovers in a plastic container, even putting that plastic container in the dishwasher. Those probably make sense to you. But it can also happen when plastic comes into contact with unexpected conditions. For instance, acidity. Perhaps you've stored tomato sauce in a plastic container. Sometimes that'll leave a red stain, which you can never quite get out. Well, that's because the plastic is porous. That means it can let chemicals and particles in as well as out. And there are other conditions, for example, scratches in the plastic, or unexpected friction, which can cause monomers, the building blocks of the polymer, to break off.
- [07:04]
Podcast Host
People have been hearing about microplastics a lot in the news. And I think what's gotten people's attention is this idea, which is very visual, of being able to imagine these microplastics in all these various organs in our body. How does that happen? I mean, how is it actually getting into our bodies?
- [07:22]
Dr. Leonardo Trisande
We eat a lot of plastic, we inhale a lot of plastic. We literally use cosmetics that resorb in our body sometimes. We've consciously used microplastic to literally scratch away dead skin. We've just come to accept plastic as normal, and it's not normal. It's so pervasive because there's so many ways we don't think something's plastic, but we realize it actually is. So our nonstick cooking pans are metal with a plastic covering in the form mostly unfortunately, of per and polyfluoroalkyl substances, those so called forever chemicals that have gotten a lot of attention lately because they contaminate the water supply too. Then we also have to think the entire life cycle of plastic. When we use plastic, it breaks down. And those absorbed into our bodies, some of it is actually in dust that we inhale and we ingest. They're in our carpeting, they're on our floors.
- [08:27]
Dr. Sanjay Gupta
And we are just beginning to learn about what microplastics can do to us, the human body.
- [08:34]
Dr. Leonardo Trisande
So what we know about microplastics and nanoplastics with respect to human health is still somewhat limited, I would say. The flash point most recently was a New England Journal of Medicine article that found that levels of microplastics and nanoplastics in the carotid artery, the artery that feeds our brain through the neck. Finding that the amount of microplastics in plaque was related steeply, a fourfold increase in the composite of heart attack, stroke and even death that really further caught people's attention. Microplastics can do two general things. They can irritate tissue, let's say in your gut. They can cause micro bleeding, if you will. They can sneak through little pathways in gut to get into the body, Just like they can be inhaled and get into the lungs. They can further cause irritation, enhancing their flow. The same could be said for skin microplastics. We were intentionally adding microplastics to cosmetics for many years, intentionally to get rid of dead skin. So that irritant effect is one of the key secret sauces about microplastic. But there's something even more insidious that's at play. Because these microplastics and nanoplastics are not just the polymer. They're things that are hitching a ride, if you will. And that's where there's this complexity that we have to consider. It's the chemicals that are along for the ride that may be the main problem.
- [10:15]
Dr. Sanjay Gupta
Those are chemicals like phthalates, bisphenols and pfas which are used in things like food packaging, nonstick cookware, stain resistant fabrics, water repellent, clothing, even our medicine. Think of time release capsules. Once you start to think about it, it gets concerning really quickly.
- [10:35]
Dr. Leonardo Trisande
I work with colleagues in the neonatal intensive care unit. We have plastic materials that save lives, Breathing tubes, feeding tubes and such. We probably need to take a step back and think about the design of those materials more broadly. But there's lower hanging fruit here and that lower hanging fruit are all these materials that were not designed directly for human good that are creating this peril.
- [11:06]
Podcast Host
I gotta tell you now, you know, just imagining a plastic breathing tube going into a neonate, into a tiny baby, I'm probably never gonna think about that the same way again. Just imagining those microplastics sort of shedding into that tiny baby's body is, it's, it's troublesome. And at the same time, I'm someone who, for example, worries about heart disease. So when I read that New England Journal article and it said my risk of having a cardiovascular problem can be dramatically affected by Microplastics.
- [11:38]
Dr. Sanjay Gupta
That got my attention.
- [11:39]
Podcast Host
I do all these things. I exercise, I eat right, I even take a statin drug for my cholesterol to try and mitigate my risk of heart disease. I had not really considered plastics, and it may be as big or close to as big a risk factor.
- [11:53]
Dr. Leonardo Trisande
And that's not to say the New England Journal study was completely definitive. It didn't consider phthalates in urine. It didn't consider other chemical exposures that derived from plastic. So there's been this steady drumbeat of science where I think we haven't maybe done as effective a job, and I blame myself in that way, is to really make that invisible visible. And now when you see microplastics in tissues, you have to immediately say, wow, that means there's a billion fold more of synthetic chemicals underneath that tip of the iceberg. We need to be curious as much about the invisible as the visible. It's just that the visible microplastics have really caught and gripped our attention.
- [12:45]
Dr. Sanjay Gupta
Next up, a closer look at what's best beneath the tip of the iceberg and what you can do about it. We'll be right back.
- [12:59]
Madeline Barron
It's Madeline Barron from In the Dark. I spent the past four years investigating a crime.
- [13:05]
Podcast Host
When you're driving down this road, all right, plan on killing somebody.
- [13:10]
Madeline Barron
A four year investigation, hundreds of interviews, thousands of documents, all in an effort to see what the US Military has kept from the public for years. Did you think that a war crime had been committed?
- [13:23]
Dr. Leonardo Trisande
I don't have any opinion on that.
- [13:26]
Madeline Barron
Season three of in the Dark is available now wherever you get your podcasts.
- [13:36]
Cleveland Clinic Advertiser
From all over the world, people turn to Cleveland Clinic for our expertise and and our compassionate care as leaders in heart neurology and cancer. The future of specialty care is happening right now at Cleveland Clinic for every life saving treatment, for every next step, for every care in the world. Cleveland Clinic.
- [14:07]
Podcast Host
The point you're making is that there's a lot more going on because if you're seeing the plastic, that means that there's all these other chemicals in the body by definition, because they sort of ride along with the plastic. What do those other chemicals do then? This is a big area of your work. These so called endocrine disruptors, is that what we're talking about here?
- [14:29]
Dr. Leonardo Trisande
Yes. We know that these chemicals, particularly the evidence, is strongest for phthalates used in personal care products, cosmetics, and food packaging. We're talking about bisphenols using aluminum can linings and thermal paper receipts. You've covered perfluoroalkyl substances, pfas, these forever chemicals that are in the water supply of Americans. Those come from non stick cooking and oil and water resistant clothing. And then we need to talk about flame retardants. But now we carry around electronic devices that have phosphorus based flame retardants that seem to be as problematic. What all these chemicals do is they hack our hormones. And I'm going to adapt a quote that's not really Vince Lombardi's quote. Winning isn't everything, it's the only thing. The endocrine system isn't everything, it's the only thing. And that's because endocrine is hormone. Hormone, our signaling molecules are master conductors of body communication from heart to brain, from gonads to heart to brain. The connections are diverse and many and they regulate everything from temperature, metabolism, salt, sugar and even sex. So when you mess with hormones, you end up having multiple effects at the same time. So people look at our research and say how can you have an effect on brain, ovary, testis, heart, all at the same time? That's nonsense. I say wait a minute. When you look at the laboratory studies, hormones that these chemicals affect, affect all these different organ systems at the same time.
- [16:22]
Podcast Host
In medicine and public health, it's always hard to draw these cause and effect relationships. More microplastics, more nanoplastics leading to X, Y or Z. But where are we with that? I mean, how good is the science around this?
- [16:37]
Dr. Leonardo Trisande
I'm going to make a distinction between the invisible and visible as a theme. So with respect to chemicals used in plastic materials, the phthalates, the bisphenols, the flame retardants, the per and polyfluoroalkyl substances. The evidence is really robust. This started with the Endocrine Society with its first scientific statement in 2009. Really the first landmark. 17,000 scientists, 120 countries saying hey, this is a problem, particularly in the laboratory. Then the World Health Organization United Nations Environment Program put out a report calling these chemicals a global public health threat. Those are their exact words. Report was endorsed subsequently by an international UN body on chemicals in 2015. The Endocrine Society came back six years after its first report. That takes a lot of work to do that. That had to really. People had to be really upset and worried. 1300 scientific references documenting, particularly in humans, the effect of these chemicals on a variety of course of effects from cradle to grave. The American Academy of Pediatrics in 2018 documented that chemicals intentionally and unintentionally added to food were having Those same kinds of effects ultimately from plastic, largely. So you have these multiple independent entities raising the alarm. So it's not just scientists like me who are documenting substantial burden of disease.
- [18:10]
Podcast Host
These microplastics can cross the placenta and get into the, into the womb. That was a study that I read as well. So, I mean, it's not even just cradle to grave. I guess it is womb to tomb, right? I mean, it is. You're born with these plastics. You can be.
- [18:26]
Dr. Leonardo Trisande
Yes. Years before, we had known that phthalates and bisphenols cross the placenta and are identified in the baby. And we've known that these chemicals have their effects on particularly brain development. So just back to phthalates for a moment. Phthalates mess with thyroid hormone through multiple different ways. And baby relies on mom's thyroid hormone through about the second trimester of pregnancy. The baby's thyroid hormone doesn't come online until second trimester. And this is the frightening part. Even within the clinically normal range of thyroid hormone, subtle shifts like those are being produced by phthalates are associated not just with cognitive deficits in kids followed up at age 7, but autism and attention deficit hyperactivity disorder. So these are long term clinical effects and the obstetrician can't do anything about it. Through the current kit and caboodle of interventions.
- [19:33]
Dr. Sanjay Gupta
And the fact that these chemicals in plastic are having a major effect on our endocrine system, our hormones, even, that might not be the complete picture.
- [19:42]
Dr. Leonardo Trisande
Particularly when we come to heart disease. There could be two things going around with microplastics and nanoplastics. One is that they are carrier pigeons for toxic chemicals that do direct damage to the linings of the heart. But they could also just be irritating and scratching and making lipids pop up and blood clots form that thereby contribute to narrowing of the coronary arteries even further, setting in motion a worsening of heart disease that could lead to stroke or even death.
- [20:17]
Podcast Host
So what with all, you know and all the work you've done for decades now, what do you do? I mean, how do you live your life based on all that?
- [20:26]
Dr. Leonardo Trisande
So the first thing I have done is to reduce my plastic footprint. So let's just take something simple as traveling or flying on an airplane. I've got my stainless steel water bottle in hand. It's empty before tsa, I get it through and I go right to fill it with water before I get on the plane so I can say no to that plastic water bottle. The point that I'm emphasizing at the top Line is there's a lot of non essential plastic out there in a house you can use glass and stainless steel. That's one step. Also reading the recycling number is still important because there are certain plastics still out there that are especially problematic. Three is for phthalates, six is for styrene, unknown carcinogen and seven includes the bisphenols. If you must use plastic, there are things you should avoid doing. Machine dishwashing and microwaving. Plastic is at the top of the list. The biggest thing is that heat and harsh conditions that you're creating that will wear that plastic. If it's etched or scratched, please throw it away. And many materials were not designed for reuse, particularly the single use plastic materials. But I try to avoid buying anything that's single use plastic when possible. We live in a rigged system, don't get me wrong, and that we need to work on system change. And I do want to talk about some hopeful messages that I've taken away as I've navigated this journey. Because companies are trying to do the right thing and are stepping into the void and they will win market share. Because people really are feeling this at a human and personal level.
- [22:16]
Podcast Host
It can feel overwhelming. It can feel overwhelming in our modern world that these plastics are unavoidable. So what do you say to those people who say what's the point?
- [22:27]
Dr. Leonardo Trisande
Well, there are studies that have proven you can rapidly reduce your levels of these chemicals used in plastic materials again through those safe and simple steps. They don't require a PhD in chemistry, they don't have to break the bank. They've worked in low income as well as high income populations. For example, one study did intervene to reduce the plastic contact with food reduced levels of phthalates and bisphenols in days. Just reading the label on cosmetics in a Latina population of adolescent girls reduced phthalates and phenols in three days. Now you need to sustain those interventions. So we've talked about short term you can reduce chemical exposures. Medium term you can change hormone levels. And then the long term you can change those chronic disease risk profiles that we've talked about. So it really is a journey in which we need to sustain benefits. Now some people come to me and I'm sure they come to you in this regard. I already have a problem. Why should I change my behavior? And that's, that's a teachable moment. Because the same disease processes that are leading to the origin story of a disease are those that contribute to the progression of disease. For example, we've shown that phthalates and bisphenols accelerate the decline of kidney disease. So it's not just that a lot of us epidemiologists tend to focus on the origins of disease as the main part of the story here. But if you have a chronic disease already, it's all the more important that you take these steps.
- [24:12]
Podcast Host
Let me just ask you one final question again, because I think about heart disease a lot. Should doctors, do doctors think about this generally the way that you think about it? Meaning in addition to telling me to exercise, eat right, possibly take a statin medication for cholesterol, will we start to hear from doctors that, look, plastic exposure is a risk factor for these things as well. So in addition to those things, here's a prescription on how to reduce your plastic exposure.
- [24:43]
Dr. Leonardo Trisande
Yes, they should. The endocrinologists and pediatricians have started to lead the march in the direction where there's broader awareness. But you and I know that continuing medical education with a generation of doctors and healthcare providers who've already been through their training is a slow change model. And we don't have a ready made prescription that we get reimbursed for, for suggesting, well, hey, you shouldn't use so much plastic in your life. So we're going to need continuing medical education. We're going to need to fundamentally change the mode of medical education to embrace environmental medicine at a deeper level and embrace the reality that plastics are an important platform for prevention in our leaders.
- [25:29]
Podcast Host
Yeah. And you know, I don't know that a medical establishment necessarily needs to wait for reimbursement to tell people to drink out of stainless steel water bottles, don't microwave your plastic, and don't, don't heat it up in a dishwasher either. You know, so simple things like that, as you say, can make a difference. And I'll just, you know, I'll end with something that I think came up in one of the papers, I think you were an author on, which I thought was hopeful in a way. The body is very biodynamic, which means that it can be affected badly, quickly, but it can also improve quickly as well. Which I think, you know, I think people tend to think about things like plastics and say, ah, that's, you know, 30, 40 years down the line. That may be affecting me. Maybe parts of it are 30, 40 years down the line, but some of it is much more immediate. You can get bad quickly and you can improve quickly. And I think, you know, maybe that inspires people to modify their behaviors more immediately.
- [26:25]
Dr. Leonardo Trisande
Yeah. And I just want to add that healthcare providers have historically been leaders in environmental prevention. Think of medical waste incinerators. Years ago we used to have metals spewing out of these hospitals and facilities, and now Healthcare Without Harm is leading the way with hundreds of healthcare provider institutions. So I agree we don't have to wait for reimbursement. And I also agree that we have as part of our mission a need to not just improve individual health, but think about a broader public health footprint.
- [27:05]
Dr. Sanjay Gupta
That was a really fascinating conversation with Dr. Chisande because even though this information about plastics and the chemicals that are added to them and how they can affect our health is alarming, maybe even difficult to process, it is important to challenge ourselves to learn as much as we can about the topic. We owe that to ourselves, and then we can make informed decisions based on that knowledge. As Dr. Tristande pointed out, and I think this is important, it does not mean we need to panic, does not mean we need to feel hopeless, because we can make small but at the same time very meaningful changes, like choosing to microwave leftovers on a plate or in a glass container instead of in plastic, or swapping out our nonstick pans for stainless steel when we're ready for an upgrade. The point is, we can control what's within our power and demand better from the companies and systems around us at the same time. That's what chasing life is all about. Taking charge where we can and always striving for better. All right, up next, our segment on call. I get to answer one of your questions. We'll be right back.
- [28:17]
Sleep Number Advertiser
This podcast is supported by Sleep Number. There's a reason the Sleep Number Smart Bed is the number one bed for couples. It's because you can each choose what's right for you whenever you like. Firmer or softer on either side. Sleep Number does that. One side cooler and the other side warmer. Sleep Number does that too. You have to feel it to believe it. Find the bed that's for both of you only at a Sleep Number Store Only Sleep Number Smart beds let you choose your ideal comfort and support your Sleep Number setting. Sleep Number Smart Beds learn how you sleep and provide personalized insights to help you sleep better. Shed stress by getting ahead of holiday shopping and then relax and enjoy. You'll sleep better and your partner will too. The new Sleep Number climate Cool Smart Bed lets you adjust up to 15 degrees cooler on either side. It's perfect for couples who struggle with sleeping too hot. Sleep better together and now during our Cyber week sale, save 20% on most sleep number smart beds plus free home delivery with any base limited time only at a sleep store or sleepnumber.com c store for details.
- [29:24]
Dr. Sanjay Gupta
Now it's time to answer a question from one of you. A listener named Dimple called in to ask about PFAS. PFAS in Drinking Water and Water Safety.
- [29:35]
Listener Dimple
Hi Dr. Sanjay Gupta. Thank you for taking our calls and I'm a long term listener. I was just struggling finding the right kind of water filter for our drinking water at home. Wanted to know if you have any suggestions on what small water filter that we can recommend that would be helpful. Thank you so much for all that you do.
- [30:01]
Dr. Leonardo Trisande
Bye bye.
- [30:01]
Dr. Sanjay Gupta
Thank you very much for taking the time to call in with your question. As you heard in this podcast, plastics and some of the chemicals added to plastics can be potentially harmful to our health and they can be very hard to avoid. Now, without recommending a specific product, keep in mind a couple things. A carbon filter or reverse osmosis system Carbon filter or reverse osmosis system. They're both good at removing PFAs. Those are the kind of things we use in our own home. Now, just to get into PFAS for a bit, that again is one of the chemicals added to plastics. PFAS stands for perifluorialkyl and polyfluoroalkyl substances and there are more than 9,000 PFAS related chemicals to date. You may have heard these chemicals referred to as forever chemicals because they take a long time to break down and leave the environment, and also a long time to leave the human body. According to the nonprofit Environmental Working Group, thousands of communities across the United states, potentially affecting 200 million Americans, have been drinking water contaminated with PFAS. Now, back in April, Dimple, you may remember this, the epa, the Environmental Protection Agency, finalized strict new regulations on six types of PFAS in public water systems. But to be fair, it's going to take years until they take effect and not every household is even going to be covered by the new rules. And that's why your question is such an important one. You can reduce your exposure to PFAS today in drinking water by switching to a stainless steel water bottle and then using one of those filters at home. If you want more information about this, you can visit the websites of either the Environmental protection agency at epa.gov or the environmental working group@ewg.org I really hope that helps. We can all raise a glass to clean drinking water and if you have a question for me, record a voice memo and email it to asksanjnn.com. or you can give us a call 470-396-0832 and leave a message. That's all for this week. Thanks for listening and of course, keep Chasing Life. We'll see you next Friday. Chasing Life is a production of CNN Audio. Our podcast is produced by Aaron Mathewson, Jennifer Lai, Grace Walker and Jesse Remedios. Andrea Cain is our medical writer. Our senior producer is Dan Bloom. Amanda Seeley is our showrunner. Dan Dezzulla is our technical director. And the executive producer of CNN Audio is Steve Lichtai, with support from Jamis Andrest, John Deonnora, Haley Thomas, Alex Manaseri, Robert Mathers, Lainey Steinhardt, Nicole Pesaru and Lisa Namorow. Special thanks to Ben Tinker and Nadia Kanang of CNN Health and Katie Hinman.
- [33:08]
Sleep Number Advertiser
There's a reason the Sleep number smart bed is the number one best bed for couples. It's because you can each choose what's right for you whenever you like. Firmer or softer on either side. Sleep number does that. One side cooler and the other side warmer. Sleep number does that too. You have to feel it to believe it. Sleep better together. And now during our Cyber week sale, save 20% on most sleep number smart beds plus free home delivery with any base limited time only at a Sleep number store or sleepnumber.com c store. For details.
- [33:41]
Cleveland Clinic Advertiser
From all over the world, people turn to Cleveland Clinic for our expertise and our compassionate care as leaders in heart, neurology and cancer. The future of specialty care is happening right now at Cleveland Clinic. For every life saving treatment, for every next step, for every care in the world, Cleveland Clinic.