Earth day healthcare

This post is a continuation of the series looking at the cross-roads of peak oil and healthcare.


Happy anniversary of Lenin's birth, everyone! Yes, the Communist Revolution's leader was born on this day in 1870!

But much more seriously and importantly, happy Earth Day! No matter how cynical you may be about what this day has turned into, you can personally take this time to reflect on your interaction with our Mother. The Buddha felt that we are not distinct from anything, including the earth and the rest of the Universe. So, if you are an intermediate-to-advanced Buddhist, this is a good day to practice oneness. For the rest of us, perhaps we can engage our thoughts to be mindful and notice throughout our day how our actions impact the environment.

And this, as everything does eventually, brings me to healthcare. As I mentioned in my recent post, healthcare system is a tremendously heavy consumer of our natural resources and, as a result, a huge producer of the greenhouse gases. "But it is all in the name of health", you say! Is it really? Dig deep down and ask yourself why you ordered that EKG on the perfectly healthy asymptomatic guy who is starting an exercise regimen, or why you got an MRI for that chronic low back pain? "But look at the strides we have made diagnosing and curing disease", you say! Is this progress not a fair trade-off for the little energy expenditure and a slightly enlarged carbon footprint?

OK, so I have a couple of problems with this argument. First of all, some people would say that the vast majority of the strides we have made in health and longevity are due to such public health interventions as water and sewage treatment, municipal solid waste removal, and the advent of antibiotics. Most of the progress we are making today comes in minute increments at the cost of not only exorbitant dollar amounts, but also of the environmental resources. Not only does this "innovation" require an input of energy and materials, but the waste that its development and manufacturing produces can be staggering, counting not only the green house gas emissions, but also the garbage it yields on the back end. Similarly, the utilization of so much technological "advancement" requires materials, energy, as well as the means of waste disposal. And just because once the trash is hauled away we do not see it does not mean that there is no environmental toll from it.

At this time of healthcare reform, we as a nation are beginning to ask some questions previously regarded as heresy: Are the effects of this intervention worth the healthcare dollars spent on it? I believe that we must go way upstream from the technology being in use on the market, and must start factoring in the environmental toll of its evolution from the genesis of the idea itself. Only this way can we understand the true worth of what we are proposing to use in the name of healthcare.

I know that for most of us to feel one with the world around us is not feasible or desired at this moment. So if chanting Om does not unite us the Universe even for a moment, let us use our well developed minds. The resources of this earth are finite. And even it you do not believe in climate change (though it is difficult for me to imagine how one can believe in God and yet not see the verity of the science behind global warming), perhaps you can start to cultivate a little doubt in your conviction that we can continue as we are with impunity. Perhaps by using our resources mindfully, by asking ourselves several times whether opening that extra needle or ordering that extra head CT is really necessary prior to plunging into action, we can not only forestall the impending oil and climate crises, but also develop a closer relationship with the planet that is ours and our children's home.        

     

Imagining post-peak oil healthcare

This post is the first in a series that will examine some ideas on the potential impact of peak oil on healthcare, as well as some solutions for meeting this change in a prepared way. 

As you all know, I do believe in the peak oil theory. Think about it: in a closed system nothing is infinite. Since oil is a product of millions of years of decay, unless we use it at the same rate that is it produced, we will run out. I do not have a crystal ball any more than anyone else I know, so I will not hang my hat on when, but will commit to whether: yes, it will happen. And while a lot of people have conjectured about what the world will look like post-peak oil, there is a surprising paucity of hypotheses or suggestions about healthcare. So, I will try to use my imagination to start to fill this gap.

First, a few facts.
Fact 1: The world, including the healthcare system, runs on cheap oil. The world's daily use is 80 million barrels, 20 million barrels of which is used in the US, and 70% of those 20 million goes to the transportation sector.
Fact 2: The healthcare sector is a super-user of energy. The US Department of Energy estimates that

...hospitals use 836 trillion BTUs of energy annually and have more than 2.5 times the energy intensity and carbon dioxide emissions of commercial office buildings, producing more than 30 pounds of CO2 emissions per square foot.

As we know, hospitals are incredibly technology-heavy institutions. In addition, literally tons of medicines and plastic disposables made from petroleum are the cornerstone of our healthcare model.
Fact 3: There is no imminent technological solution for the impending oil shortage.

Now, why should you take my predictions of such doom and gloom seriously? Well, for one I am not prophesying doom and gloom. Rather, since forewarned is forearmed, I am reiterating a warning still with time enough for us to start preparing for a different way of life. You don't believe me that it is coming? Do you believe the US military? Their recent report clearly points to a drop in production and impending shortages of oil. They ought to know, being the biggest global consumer of this resource!

But back to medicine. What will it look like post-peak oil? I am happy to say that you still do not have to trust me, but perhaps Howard Frumkin's of the CDC thoughts on this topic (subscription required) in JAMA can make you scratch your heads a bit:

Petroleum scarcity will affect the health system in at least 4 ways: through effects on medical supplies and equipment, transportation, energy generation, and food production.

It is worth reading the entire editorial to get the flavor for what is likely to come. At the same time, one can easily engage one's not too wild imagination to start visualizing the situation. Taking it item by item, medical supplies and equipment are not only manufactured from or with petroleum, but they need oil to get to our hospitals and to run. Transportation needs very little explanation, given our reliance on emergency transportation by such modalities as ambulances and helicopters, as well as the need for regional and national referral centers based on expertise and availability of services. Frumkin does a nice job talking about energy generation, and the concern here is an increased reliance on coal with its propensity for green house gas emissions, and so on, and so on. Finally, our industrial food production, having moved away from local integrated traditional farming to monocultures supported by automation which runs on oil, relies on additional oil for pesticides and fertilizers and transportation from the farm to the table.

So, what will medicine be like under these circumstances? The reality is that, if we as communities fail to prepare for this change gradually, we will be hit with it abruptly, and, you have to admit that sudden and unplanned changes are tougher to deal with than anticipated ones. I myself do not have all the answers, but I would like to challenge everyone, clinicians, administrators, patients and public alike, to begin this conversation. It would behoove us all to keep this idea in the backs of our minds as we move through our days, so that we can mindfully note what changes have to be made and what infrastructures need to be built to optimize our collective future.

Your participation in this discussion and comments with specific solutions will be greatly appreciated.

        

      

  

Gossip: an untapped renewable energy source

Just out of curiosity I Googled news on "peak oil" and got 3,397 hits. Then, I Googled "Tiger Woods", and got a staggering 57,134 hits! What does this mean?

I have spoken of peak oil before, so will not belabor the issue right at the moment. On the other hand, this is the first time the name Tiger Woods is appearing on this blog. Why? Because a celebrity's personal life is none of my business, it is none of my children's business, and none of my community's business. I prefer to engage in life itself rather than waste my time on voyeuristic destruction of another life (actually several lives).

But here is my question: how can we harness this endless and renewable resource of gossip to power our post-peak lives? Why is the Department of Energy not exploring this abundant energy source? Oh, yeah, you are right, it is toxic to the environment.

Destruction of lives in the name of cheap entertainment has become a staple of "journalism" in America. If news outlets would only focus as much attention on the real issues that we are facing as a society as they do on meaningless infotainment, we might not be a nation of overgrown adolescents habituated to a steady diet of mindless pablum. That would be pretty subversive, would it not? I wonder what it would be like if we just said "No thanks, not today. Not any longer."

The wheels of corporate journalism are lubricated by oil. What would happen if the truth came out? The bottom would fall out of the market, as all of it is inextricably dependent on oil. You can press your nose to the glass of familiar narrative of someone else's fame, fortune and destruction and be content to live in the fairy tale being sold to you. Or you can demand the truth, so that you can make your own decisions within your community. The choice is yours.  

USPSTF recommendations: Demanding manipulation from science

The recent uproar over the new screening mammography recommendations got me thinking about a lot of stuff. One of the lessons cited by some journalists and pundits is on how potentially volatile information should be presented to the public. The USPSTF was excoriated by critics not only for what it said, but how it said it. While the objections over the former can be dismissed as ravings of loud and poorly informed voices deliberately trying to hijack public opinion, the latter criticism is more insidious.

Some intelligent and balanced observers noted that the USPSTF really should have foreseen the fallout and laid the groundwork to make the sting of the recommendation less pronounced. In the corporate world this is called "making the rounds". This means that, when you have an idea, it is not enough just to present it on its merits in a group forum. Indeed, you must go around to those whose opinions matter and get them to sign on to your idea before you make it public. In this way, by furthering your relationships, you manipulate the outcome in your favor. This can take countless hours, but this is how things generally get done in the world of business.

The world of politics is similar, in that many reforms and decisions are dependent on behind-the-scenes deal-making between politicians. These clandestine transactions, the theory goes, assure the appearance of a successful outcome in the light of day. And a victory necessarily begets other victories.

Well, to be sure, science and academia are not immune from such politicking and manipulation. In fact, I have heard some assert that our academic institutions are the most politically charged enterprises, even more so than business and politics. So, in that respect, it is not unreasonable to expect some round-making prior to spilling the mammography beans. But what if we question this premise? What if we insist that science remain the last frontier shielded from political influences? I would argue that this should be our only stance on science, be it climate science or medicine. Science should be judged on its merit only, and not on its political ramifications.

In a society where business and political message machines spend countless dollars on market research surveys to package their manipulations to get us to follow their political and consumerist directions, the public is now angry that the USPSTF, a scientific body, did not take the time to effect an elaborate manipulation scheme to get the loud dissenters, and the rest of us, on board with their recommendations. Is it not outrageous that we, American adults, expect, and even demand, such manipulation instead of the straight unadulterated truth?

This is a sad reality of our time, following decades of indoctrination by marketers, educators and other "experts", to become compliant little consumers that we are today. How easily we are stirred into a rage by callous reporting and special interest demagoguery is telling. We are a mirror-mirror-on-the-wall society: we will not tolerate any truth that does not fit our conveniently preconceived notions of specialness and entitlement. And while this attitude gives us a peaceful soporific feeling one gets following a psychotic rage, it will make it that much more painful when this consumerist fog is replaced by the reality of shortages, as our cheap energy supply dwindles. Unfortunately, by then, it will be too late for the truth to set us free.

There is still time, though! Turn off the television, stop listening to and reading mass-produced messages designed to make you a quiet lemming on its way off the cliff. Focus closer to home, build your local community. And, yes, talk to your doctor about your mammography concerns -- you will surely walk away with a more satisfying conclusion and a feeling of self-determination.

The century of unintended consequences

Where to begin? The phrase "unintended consequences" has been making rounds in healthcare, politics, and other venues of late. It appears most pronounced in healthcare, and has been clearly brought out by the cancer screening debate last week: while taking for gospel that early detection saves lives, we have been subjecting countless people to unnecessary, invasive and sometimes deadly interventions. Oooops, we say, an unintended consequence of our good intentions. You do not have to look far to see others. The mounting problem of antimicrobial resistance due to egregious overuse of antibiotics, mounting data on the downsides of the widespread use of proton pump inhibitors, manifest as an increased risk for C diff diarrhea, pneumonia, and most recently, because of heretofore unappreciated interaction with Plavix, strokes and heart attacks.

Unintended consequences can also be seen in other areas of our lives. The thoughtless experiment of mortgage-backed derivatives and their implosion, the nearly irreversible effects our thirst for fossil fuels on the environment can on the one hand be attributed as unintended consequences. But I have to say, I am not buying it. Letting us all off the hook with this innocent statement is as simplistic as it is dishonest. It is like letting your kid off the hook for stealing a candy from the store because he did not foresee being caught. In fact, even the expression itself, "unintended consequences", is seemingly designed to demonstrate our sudden passive and victim-like situation. "But I did not intend for this to happen, so I am an innocent victim here". Pshaw! Much of what we call unintended could have been foreseen, if we had the will to plan ahead. The issue is that we are not, and are steamrolling ahead from moment to moment with no thought given to long-term consequences.

It is a fact that Nobel laureate Joshua Lederberg predicted in the 1970s that bugs would evolve resistance in response to our antibiotic warfare on them; even then he cautioned against overusing these agents. It is a fact that you cannot keep building a house of cards with imaginary assets without having it collapse. It is a fact that you cannot expect to keep drilling and emitting with one hand, while with the other eliminating vast carbon sinks, without noticeable climate change. It is also absurd to call our lack of viable fossil fuel alternative an unintended consequence: in what closed system can a resource be infinite? And once this resource is inevitably exhausted, what then?

In truth, the entire 20th century has been a cruel experiment in consumerism. Decisions made in the 1920s and the 1950s about converting the US citizens into a race of single-minded consumers were deliberate and well planned. And of course, the intention was clear: to increase the wealth of the few. I am confident that no one explicitly intended for this accumulation of wealth in a few hands to result in an ever-widening gap between the haves and have-nots. But is it so difficult to imagine that this is a not unexpected result of single-minded pursuit of wealth? Over the decades of industrialization, farmers and small-scale merchants, able until then to support themselves independently, abandoned their country seats and their communities to move to the cities to fulfill the shining promise of wealth and happiness unscrupulously promulgated in the name of this relentless pursuit of wealth. When the internal combustion engine became a reality, and as the city populations expanded, the suburban dream was born, isolating people further into their cookie-cutter homes away from organic communities of their ancestors. The last 30 years of the 20th century brought with them the proliferation of technology that has allowed us to work 24/7, be connected (only virtually), and, more importantly, to buy stuff any time of day and night from anywhere in the world. This American dream has left 80% of the US population behind economically, our main fuel source on the brink of disappearance, and American society more unhappy and fractious than any other time in the past century. Our politicians and business leaders unabashedly preach selfishness, greed and lies. All in the name of money and power. Unintended consequences? I think not.

Today, when divisive politics are playing out on Capitol Hill for all the world to see unequivocally our degraded values around social support and responsibility, it is worth pausing to contemplate what we are undertaking today that will result in "unintended consequences" tomorrow. Is it honest to say that the poverty, crime, disease and deprivations in migrant worker shanty towns in Mumbai and Namibia and China and countless other places in the third world, migrants who abandon their rural communities in search of the Western promise, are all truly unintended consequences? Or are they really collateral damage of our sick zero-sum economic game? And just because these consequences were not our primary intent, we cannot wrap up in their cloak of innocence: these consequences were and are entirely foreseeable, convenient or not. We are guilty!

So, while we in-fight about who should have access to healthcare, whether abortion or gay marriage is morally tenable, and what Jesus would do, we have been made accessory to the real catastrophic atrocities -- a growing local and global economic apartheid in the service to our corporate masters. The ones that are bleeding are we and our children. But of course, these are just unintended consequences.

The good news is that we can each do something to mitigate this overwhelming disaster: stop buying crap you do not need! Stop buying it because it is on sale -- you already have enough crap. Think about it: some of the sale prices are not even enough to pay for the fuel it takes to run the machines that made the piece of crap in the first place. And it will probably end up in your trash within the next 12 months anyway. How is this living with the future in mind? Really, before you make your next purchase of anything, think hard: there is no such thing as a free lunch. Chances are, your purchase will only better the bank account of a small minority of people who have produced the item, and in the process contribute to the environmental and spiritual devastation for many. Stop being helpless, stop pressing the lever and stop being a cooperative slave to this insidious juggernaut of consumerism. You will feel better if you can claim intentionality in building a better and more lasting world.                                        

Our children's future: healthcare vs. peak oil

Do you believe in peak oil? What is peak oil? Peak oil, also referred to as Hubbert's peak, is a projection, based on our historic patterns of consumption, of when the demand for oil will outstrip its supplies. The world uses about 80 million barrels of oil per day, mostly in the transportation sector. So, to keep up with this demand, at least this much oil needs to be excavated from the ground daily. In reality, even more is needed to keep some in reserves. Hubbert was a geophysicist who in the 1950s predicted that, based on the current patterns of oil consumption, we would reach peak oil sometime early in the 21st century (see graph).

How is this possible, you ask? A better question is how can it be otherwise? If you really think about it, oil is the product of the earth's development and evolution. It is an alchemy of dead organic matter and glacial and volcanic catastrophes brewed slowly over hundreds of millions of years. In this sense, oil is not a renewable resource, at least not within the human time frame. And as you can see, the curve of the production until the peak appears mostly exponential, with some stops and starts. Exponential growth, by virtue of its accelerated trajectory, is unsustainable in a closed biological system, where the production of resources cannot keep up with their consumption.

So, peak oil is not hard to imagine, given our gluttonous consumption of it. So, why is it that the international body, the International Energy Agency (IEA), responsible for forecasting our oil situation has been so reluctant to admit to the impending peak oil? Turns out, according to a report in today's Guardian, that it has been cooking its numbers because of the pressure from the US. An unnamed whistle-blower has come forth to indicate that

"...the US has played an influential role in encouraging the watchdog to underplay the rate of decline from existing oil fields while overplaying the chances of finding new reserves."

Why would the US encourage such deception? Apparently because we are worried about the implications of this revelation to the markets. So, while shouting loudly about fiscal restraint and sloganeering about the impact of universal healthcare coverage on our children's financial future, our nation, with its eyes shut tightly, has been on a collision course with a very real and close wall of peak oil. This is simply unwise.

We can make up all kinds of stories about the potential reserves. I am not sure why these stories seem more plausible to the same people that energetically deny human contribution to the climate change, except to say that we believe what is convenient for us to believe. Everything you see on the graph below beyond the real oil reserves is imaginary. But, even if it were feasible to get at these potential resources, they would be fraught with an enormous carbon footprint, not only while mining, but also when used as fuel.

And, by the way, haven't we learned our lesson about investing in imaginary assets? Is that not what our investment banks were doing with the mortgage-backed derivatives?

Come on, people, the writing is on the wall. Fossil fuels are on the brink of exhaustion. And we have more "stuff" than we can use in multiple lifetimes! Let's stop for a moment and take the toll of what we have done to the planet. Let's really consider our children's future, and their children's and theirs. In fact, perhaps we can remind ourselves of this old Iroquois philosophy:

"In every deliberation, we must consider the impact on the seventh generation... even if it requires having skin as thick as the bark of a pine."

This is our opportunity to consume less and to tell President Obama to make a real difference in Copenhagen!