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.
Showing posts with label climate. Show all posts
Showing posts with label climate. Show all posts
Thursday, April 22, 2010
Wednesday, November 25, 2009
Differential diagnosis of climate change
When I was in medical school, I learned that the differential diagnosis was the cornerstone of any medical encounter. Differential diagnosis involves taking a detailed history of the patient's complaint, followed by a physical exam, to arrive at a few possible reasons for the person's symptoms. Once developed, this list of potential etiologies guides the doctor's further testing, so that there is little excuse for a shot-gun approach where every conceivable test is ordered.
Through training and practice I honed my differential diagnosis skills. I developed a risk stratification approach, where I had in mind about top 5 things that could likely underlie the patient's presentation, but also included 2-3 other possibilities that, if unaddressed promptly, could prove deadly. This list would serve as the roadmap for my investigation.
I am reminded of this approach as I read the developing story of the climate debate e-mails in the mainstream press. The manufactured magnitude of the furor is certainly good for news as entertainment. It is also prompting climate change skeptics to cry vindication. What has been missing from this coverage is the weight of the evidence that supports this as our current reality. While we can argue all we want about what our earth will look like in 50-100 years, what is clear is that the temperatures are on an overall rising trajectory, the glaciers are melting, and the green house gas emissions are accelerating. Put together, these facts beg the development of a sober differential diagnosis for what is causing this presentation. I would argue that in this list we need to include not only the most likely culprits, but also those that, if not stopped promptly, will result in irreversible and deadly changes in the near future. So, even if one is willing to ignore the broad scientific agreement with regard to the future of climate change or the likelihood that human activity is driving it, common sense of safeguarding against the worst case scenario demands we nevertheless do something about these factors.
And here is the contradiction of our human psyche. Take the mammography recommendations maelstrom and compare it to our attitude toward climate change. The outraged reactions to the new evidence-based recommendations are a reflection of our better-safe-than-sorry attitude toward a deadly disease, no matter what the cost to the individual or the society. So, why do we not adopt the same stance when it comes to climate change? Why not open our eyes to the possibility that, despite the poor judgment of the scientists involved in the e-mail scandal, there is a very real possibility that our climate is changing. Once this becomes a possibility, it matters little whether it is human activity that is driving it or just the natural order of things: the only modifiable risk factor that can affect this trajectory is human activity.
So, the debate becomes simply about two choices. First is to consider the idea of climate change honestly in the context of what we know to be the truth. Second is to keep our blinders on and continue to be condescended to by those whose financial interests would be affected by the resulting societal behavior change. The right choice is obvious.
Through training and practice I honed my differential diagnosis skills. I developed a risk stratification approach, where I had in mind about top 5 things that could likely underlie the patient's presentation, but also included 2-3 other possibilities that, if unaddressed promptly, could prove deadly. This list would serve as the roadmap for my investigation.
I am reminded of this approach as I read the developing story of the climate debate e-mails in the mainstream press. The manufactured magnitude of the furor is certainly good for news as entertainment. It is also prompting climate change skeptics to cry vindication. What has been missing from this coverage is the weight of the evidence that supports this as our current reality. While we can argue all we want about what our earth will look like in 50-100 years, what is clear is that the temperatures are on an overall rising trajectory, the glaciers are melting, and the green house gas emissions are accelerating. Put together, these facts beg the development of a sober differential diagnosis for what is causing this presentation. I would argue that in this list we need to include not only the most likely culprits, but also those that, if not stopped promptly, will result in irreversible and deadly changes in the near future. So, even if one is willing to ignore the broad scientific agreement with regard to the future of climate change or the likelihood that human activity is driving it, common sense of safeguarding against the worst case scenario demands we nevertheless do something about these factors.
And here is the contradiction of our human psyche. Take the mammography recommendations maelstrom and compare it to our attitude toward climate change. The outraged reactions to the new evidence-based recommendations are a reflection of our better-safe-than-sorry attitude toward a deadly disease, no matter what the cost to the individual or the society. So, why do we not adopt the same stance when it comes to climate change? Why not open our eyes to the possibility that, despite the poor judgment of the scientists involved in the e-mail scandal, there is a very real possibility that our climate is changing. Once this becomes a possibility, it matters little whether it is human activity that is driving it or just the natural order of things: the only modifiable risk factor that can affect this trajectory is human activity.
So, the debate becomes simply about two choices. First is to consider the idea of climate change honestly in the context of what we know to be the truth. Second is to keep our blinders on and continue to be condescended to by those whose financial interests would be affected by the resulting societal behavior change. The right choice is obvious.
Tuesday, November 10, 2009
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
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:
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.
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!
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