Three days after his kidney transplantation, saxophonist Andy Williamson was performing an impromptu lunchtime concert in the atrium at Guy’s Hospital in London, accompanied by a piano player who also happened to be the donor. The dynamic duo were even doing requests, playing Take the A-Train for one of their surgeons.1 Still a successful jazz musician, Williamson has embarked on another line of work in the years since his transplant operation: he’s at the cutting edge of a new form of patient activism that is pushing the public, professionals, and policy makers for an urgent and comprehensive greening of medicine.

“Having kidney failure suddenly brings you into uncomfortable proximity with our disposable culture,” says Mr Williamson, who developed end stage kidney failure in early 2006. A turning point came when he started dialysis at home, and a lorry would arrive regularly with a palette full of plastic and cardboard to be used once and then thrown away. “In a household geared to recycling and minimising packaging it was all a bit of a shock.” Well aware that an ultra-cautious culture has driven a lot of the excess for good safety reasons, Mr Williamson, like others pushing for a sustainable health system, has become increasingly convinced of the need for change, and the possibility that it can come without doing harm. “There is so much unthinking waste that happens in hospitals, as it does in our everyday lives,” says Mr Williamson. “It’s just that it’s writ large in the healthcare system.”