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Rapid Responses: Rapid Responses published:
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global warming
- peter l loveridge (9 June 2006)
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Are you serious, Mum?
- Balaji Ravichandran (9 June 2006)
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Climate Change and the BMA
- John R Cherry (10 June 2006)
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Please don't use plastic wrapping
- Anoop D Shah (11 June 2006)
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MOM is throughly innocent herself let the child ask others such as ...
- M.I Shaikh (12 June 2006)
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Decline of a great medical journal
- Nancy Reyes (12 June 2006)
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Better start doing something
- Iñigo Romón-Alonso (12 June 2006)
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Dying throes
- Hugh E Montgomery (13 June 2006)
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Climate change - let us work together to put the brakes on it
- Arun Natarajan (13 June 2006)
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Editorial responsibility
- Michael Goodyear (13 June 2006)
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What this Mum did for climate change!
- Pip Hayes (13 June 2006)
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Leadership by Doctors Urgently Required
- Geoffrey J Barnes MFPH (13 June 2006)
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Re: Leadership by Doctors Urgently Required
- John R Cherry (14 June 2006)
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Re: Climate change - let us work together to put the brakes on it
- Stephen McG Barratt (15 June 2006)
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Re: What did you do about climate change
- David Bossano (15 June 2006)
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Re: Re: Leadership by Doctors Urgently Required
- Geoffrey J Barnes (16 June 2006)
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Reduce population to reduce carbon dioxide emissions.
- David Carr (16 June 2006)
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Keep it up BMJ
- Ahmad A. Sabri, Muhammad A. Qayyum (16 June 2006)
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No more excuses
- Simon Gates (16 June 2006)
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Practice what you preach
- Vadivelu Saravanan (17 June 2006)
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Climate change: a manifesto for public health professionals
- Alison Hill, Geoff Barnes, Jackie Spiby, Harry Rutter, Lindley Owen, Carolyn Lester, Aldo Mussi, Cathy Read, Andrew Furber, Cameron Stark, Alex Stewart, Jenny Griffiths, John Middleton, and Jeremy Wight (26 June 2006)
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Carbon Columns in the Atmosphere- Availability and Useage
- John R Moloney, Richard Robinson PhD retired science teacher (13 February 2007)
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peter l loveridge, family physician glenwood nova scotia B0W1W0
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I am surprised to see such an unscientific rant about this subject as
an editorial in the BMJ, an organ I prized as an unbiased source of
evidence based medicine
there are three questions need to be asked on this subject
With regard to question 1, there is little doubt that warming exists, but it has to be compared to a baseline. The period 1400-1750 was the coldest in the last five thousand years, and we are clearly warmer than that, We would be in dire straits were it colder. Warming is, however, less than the more sensationalist reports. There are overestimates of warming because of the siting of recording stations ( they have become more urbanised, and it is well known that urban areas are islands of heat). Ther are also periods when the earth was much warmer than it is now, and not that long ago. In the medieval warm period with a peak at around 900AD, global temperatures were a couple of degrees higher than now. There has been very little warming of the upper atmosphere, if any, and sea levels of mid-oceanic islands have not changed much, there has been subsidence of many coastal agricultural areas, but warming doesn’t have a lot to do with it. There was a more recent period of global cooling, 1920-1955, which like most of the other climate variations cannot be explained by the computer programs used to predict warming. or the level of atmospheric CO2. We are very much in need of real evidence , rather than predictions made with a lot of “ fudge factors” that are used to make observations fit the current theories In regard to 2. carbon dioxide is not the most important greenhouse gas, water is. Methane has 40 times the effect per molecule than C02. Agriculture is probably more important than driving your car if you are looking at anthropic generation of greenhouse gas. One has to remember that every fossil fuel carbon atom was once in the atmosphere. I’m not sure if the world is ready to kill off its billion cows. It is far from unanimous that anthropic greenhouse gas generation is really the cause of global warming, and a balanced editorial should reflect this. As to the last question, I would point out that there is unanimity that every mass extinction in the fossil record was accompanied by global cooling, not the other way round. Times like the carboniferous and cretaceous era, where there was bounding biological diversity, were substantially warmer than the present climate. I cannot pretend that I am a climatatologist, but it is clear that I have a better overview of this subject than our editorialist, who should offer us more than wishful thinking and hand-wringing Peter Loveridge Competing interests: Dr. loveridge is the author of " a cruising guide to Nova Scotia" in which matters of meteorology are given considerable attention |
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Balaji Ravichandran, Medical Student Chennai, India
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Carbon trading, Mum? I can't really understand... Every summer, temperatures go up to 42 degrees celsius in our town, and hundreds die of sun-stroke... In a country like ours, even in metropolitan cities, not a day goes without power cuts... We have to cut down our electricity bills further? How? Switch off the only fans and lights in our home? We can't even afford a motor-bike or a car... I take the public transport system to my hospital every day - it's an hour and a half journey; there is no place to sit in my bus, considering that it is perenially crowded. I'm drenched in sweat by the time I arrive at my over- crowded hospital (where if doctors don't use their cars, half the patients would be dead by then). And the government here increases fuel prices everyday. Does cutting down on private transport make any sense to you, Mum? Sure, I can walk or cycle for dozens of kilometres... You'll see me in the mucky hospital bed tomorrow. How can we not travel by train? Our father lives 500 kilometres away from us. We travel but once a year. And we cannot afford the flight costs. The train costs are high enough, considering that we cannot even sit in them comfortably for hours together. Are we to forget his existence and not travel at all? Or be satisfied through occasional bouts of telephonic conversation? Hang on, how much carbon does that cost me? Let me see, Mum. I've grown up all my life in this place - overcrowded and poor, without any knowledge of what life on the other side of the fence looks like. I've seen nothing but suffering and deaths, and make no mistake, the cycle is but perpetual. Now, I've got to reduce my carbon emission? How? Where and when did I cause so much carbon emission in the first place? Is it not unfair? And suppose I get the opportunity to travel, abroad, to places I can only dream of... London, Paris, Lisbon or Amsterdam... I should be carbon conscious and not travel? Are you kidding me, Mum? I have suffered enough. Now, its my turn to enjoy the world for what it is. After all, my life is short... There are those who still believe that the earth is flat, and go on wasting carbon every minute of every day - let them trade carbon. I won't. Don't get me wrong, Mum. I do understand the dangerous problems of global warming. But, don't ask me to take the responsibility when it is not my responsibility in the first place. Ask the murderous governments and regimes who flounder resources in the name of war to save our planet for the future, and then I will... (The military budget around the world, any one?) Ask the politicians who have 20 cars of security following them ceaselessly to cut down their carbon emissions, and then I will... Ask the presidents and the prime ministers who fly effortlessly across continents for no good reasons to cut down their emissions, and then I will... Ask the business magnets and entertainment companies who waste valuable public resources for selfish self-gratification, and then, I will... It may already be too late, Mum. But, I'm not the one yet to realise. Competing interests: I care about climate change too |
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John R Cherry, Hon Consultant ENT Surgeon Blackburn Royal Infirmary BB2 3LR
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One excellent rapid response has already made clear how simplistic the editorial really is, and how complex the science. I really do not think that an ex-doctor editing a medical journal is qualified to pontificate on this subject. More to the point, this is another example of the degeneration of the BMJ from a serious medical journal into a political magazine vaguely resembling The Guardian (this is NOT meant as a compliment). Any political topic which might perhaps one day have a bearing on the health of any citizen of the world is dragged in, kicking and struggling, by its ears. Two or three years ago, I picked up a copy of The Lancet in our Consultants' Dining Room. It was full of MEDICINE! In ten minutes, I learned all about Torsade de Pointes (vaguely relevant to ENT since it can be induced by certain H1 receptor blockers). This was refreshing, but doubtless the BMJ's response would be to castigate me for being a politically incorrect individual who uses so socially divisive and elitist an establishment as a Consultants' Dining Room, and is so obsessed with trivia as to know where to put the possessive apostrophe in the plural. Here's a suggestion: could I not remain a member of the BMA without having to unwrap and recycle the extremely feeble journal every week? Then I could have the benefit of Medline and representation without having to skim through the junk masquerading as science which you print. It would be such a relief. Oh, and by the way, since you are so concerned about the environment, if you MUST send me your apology for a Journal, could you possibly wrap it in paper? My Council cannot recycle plastic, and I'm sure your wrappers are damaging the ecosphere! Yours, etc., John R. Cherry, M.B., F.R.C.S. Competing interests: None declared |
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Anoop D Shah, House officer Lister Hospital, Stevenage SG1 4AB
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If the BMJ wants to reduce its environmental impact, I suggest that it should be sent in a paper envelope which is much easier to recycle than the plastic wrapping used currently. (I notice that the National Geographic magazine uses unbleached paper envelopes, which are always welcome in my compost bin.) Competing interests: None declared |
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M.I Shaikh, Geriatrician M.T. R. O (Medical Testing and research organization)
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As far as the question to the "mom" is concerned , the child knows better that many moms have already given up Cooking , opted for Careers and are also dependent like the child on factory making crisps and fast foods . So question is somewhat misplaced may be he/she should ask the unemployed dad who is not guilty of the sin of cooking and factory work . On a more political note he should ask a certain George .W.Bush who refuses to even consider the project of cleansing the air, rather he has already exploded millions of tons of TNT and sulphur enough to kill whole nations to support democracy and more in on the way till depleted uranium becomes the most abundant material on the planet after silkicone . But then lets not politisize our children too soon . May be we turn the gas less often , drive less often , smoke less often and bomb less often , in that case we might have a future , but then "ICE AGE" is a good movie for the children to learn the impact of temperature and another followon movie "NEW ICE AGE!" to see the results of global Warming . As far as competitions and prizes are concerned that is laudable if not forgotten ,overall I am pessimistic about the future of this Earth even without global warming it has too many violent and armed parasites glued to it . Competing interests: Yes , do own car , use airconditioner and incite others to do the same . |
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Nancy Reyes, retired physician Gapan City Philippines 3105
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Can you tell me why a MEDICAL journal has fuzzy articles on why hospitals should decrease their green imprint? There is a lot of preaching, but no hard information. You don't like hospitals with heat and air conditioning? Fine. Suggestions please. Should we let patients sweat and develop bedsores and heat stroke? (been there, done that) Without heat, do you suggest going back to hot water bottles and four blankets? (Been there, done that too). You complain about large car parks: but do you really expect grandmom who has COPD and Congestive heart failure to stand outside in the rain and wait for a bus to take her to the hospital? Or have a mom carry her two year old a mile to the dispensary? Get real. Get a civil engineer or blue collar expert in from Popular Mechanics to write articles on alternative energy, not an activist who preaches but wouldn't know a thermostat from a fuse box. At least the engineer will be able to tell you how to make a solar heater that is cost effective. (been there, done that too). Competing interests: None declared |
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Iñigo Romón-Alonso, Head of Criobiology Blood and Tissues Bank of Cantabria, Santander, SPAIN.39008
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I´m surprised at the virulence of the answers to this BMJ editorial. The core, remind you is "People with low energy use can then trade their surplus to those with high energy use. This policy offers a way forward which is globally just and produces many health benefits, such as encouraging more physical activity among people in industrialised societies. Trading in carbon will also transfer money from rich to poor countries, and help deliver the millennium health goals". We may dissent in the scientifical qualtiy of the information, but the proposal has a strong rationale: while there's a "first" world, devouring energy and resources, theres a "last" world, which has no acces to those advantages, even if it produces oil in huge amounts. So let's quantify, and trade. Let's make a better distribution. Global warming may not be so exhaustively demonstrated, or might not be caused by carbon dioxide only. But at the same time, we could prevent this happening and derive other benefits. I think that prevention is much better, particularly in this worldwide problem. If global warming models are right, countries in Africa, and South East Asia will be the worst affected. They should be the most interested that measures are taken. I don´t agree theres´s an opposition between rational energy use and well being. This reminds me strongly of the debate about CFC and the ozone layer: when finally action was taken ,the Antartic hole was there to stay for 50 years or more. Skin cancer peaks in the Southern Hemisphere. Do we whant to repeat the experience with carbon emissions? Even if the data about global warming are not due to human activity (which I think there´s enough scientifical evidence to start worriying) I think that our lifstyle is increasingly unhealthy, expensive and in the end ruinous. The fact that an USA citizen uses much more energy than a european, without a real increase in life standards or well being should make us think why this glorification of energy wastage. Our cities are hot, polluted, noisy, and expanding. Urban planning depends exclusively on cheap petrol so that urban sprawl can be sustained only if petrol prices don't change substantially, because people have to use their cars. This has led to a sedentary lifestyle, with obesity as a new and devastating epidemic. And at the same time, inner city areas degenerate and decay. Many of my favourite coast landscapes have been "developed" by real state agents, city corners cannot be recongnised, my childhood playing grounds no longer exist. Spain, where I live, is highly dependent on turism. But at the same time, turism is responsible for the degradation of natural areas, those that made our country so likable for tourism. How will we recover them? Not to mention the "money laundry" by organised crime which uses tourist resorts. Car accidents cause thousands of deaths and chronic health impairment. Oil prices reach heaven and at the same time the benefits of this industry don't reach the countries which produce that oil. The proposal is not to stop using a refrigerator or an air cooler, particularly in countries which need them badly. It´s a matter of efficiency and lifestyle. Reducing our electricity bill by high efficiency lamps or devices, or water usage by increasing pipeline efficiency is not a stupid thing to do, but a sound economical practice. Local energy sources (solar plants, sustainable wood cropping) help local developement without landscape damage and help to anchor population in their ancestral homes, instead of favouring migration to main towns. Using bikes, renewable energy sources, bio fuel, engaging local suppliers, recycling materials, etc do no harm but much good. We must be aware that our happiness cannot depend on weekend holidays 3000 km away, or buying a new car every two years. This is unnecessary, stressing and in the end leads us nowhere. I think the BMJ plays a great role in making doctors aware of that, and should set an example by making its own adjustment. Competing interests: None declared |
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Hugh E Montgomery, Director, UCL Institute fro human Health and Performance UCL, N19 5LW
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I read Fiona Godlee's editorial- and those others published in the same issue- with relief. At last a mainstream science medical journal has put a line in the sand. The bulk of our breathable atmosphere is less than 5km thick. How far down the road is that for you? And every day, North America burns enough oil to flood a tennis court to a depth of >10km, while the world burns 97 tonnes of coal.... as second. The resulting climate change is desperately dangerous: we face temperature rises in 50 years which have previously taken 18,000 years to occur. Past warming events have been of lesser magnitude, yet have extinguished the bulk of all species on the planet. When ecosystems collapse, so too will human civilisation. Disease patterns will change. Crops will fail (hard to moderate cultivation in a volatile climate) and starvation will ensue. Resource wars are anticipated by many major governments. The horsemen of the apocalypse will ride. The timescale? Perhaps a matter of decades. The solution? Many feel it already too late. Some feel that there is still hope of at least damping the impact. Whatever, serious action now has a moral imperative. Dr. Godlee is thus right. We may well be the only species to have carefully documented their own extinction, and for this future generations - no matter how few- will judge each and every one of us- but expecially those who knew and understood, but who did nothing. Competing interests: None declared |
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Arun Natarajan, DRWF Clinical Research Fellow Newcastle University, Newcastle upon Tyne, UK
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Editor - The BMJ has not exactly committed the crime of the century by publishing an issue on the malevolence of global warming (I have read the acerbic responses). The BMJ is a platform for debate on international health as clearly stated in its agenda in the “About the BMJ” web page. Global warming is indeed an issue with colossal implications on the very survival of humans on this planet. We have retracted so much into the shell of modern luxuries that we find it difficult to objectively weigh their apparent benefits against potential harm. True, nature can sometimes be its own enemy – the degrading peats of the Peak district produce enormous amounts of greenhouse gases. But, why should we compound its travails, for instance, by driving 4.0 litre 4x4s? We, as doctors and academics possess the ability to set an example. So let us not quibble, but work towards making the world a safer place. I am sure our children will thank us someday for it. Competing interests: None declared |
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Michael Goodyear, Assistant Professor Department of Medicine, Dalhousie University, 1278 Tower Road, Halifax, Nova Scotia Canada B3H 2Y9
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Many of the responses to Dr Godlee's "Editor's Choice" seem to miss the point not only of editorial writing (and the Editor's Choice is not strictly an editorial) but also of the issues raised. All too often dissecting the minutiae obscures the message. Environmental concerns cannot be easily equated with Torsade de Pointes. First we should acknowledge that editorials should not merely be reiterations of what we already know, but should be provocative, stimulating and thought provoking. An Editor’s Choice also draws our attention to issues that deserve our attention and tries to make sense of our world. On these grounds I find that Godlee and her team have performed admirably since she took over Auntie BMJ. Rather than a 'rant' I find Godlee's editorial style to be full of warmth and humanity, and to display a real feeling for the person behind the story. Secondly health care like all other sectors of society must be socially responsible and accountable. In health this is especially cogent, since health care is about far more than electrophysiology, but is equally about the determinants of health, and hence the environment in which humans operate, and which influences their health, social, psychological and physical. Godlee has merely asked us to think more carefully about what we are doing and to exercise individual responsibility for the world in which we live. That is socially responsible and in the best interests of those we care for. Thank you Mum, and three cheers for the BMJ. Competing interests: I walk to work |
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Pip Hayes, GP Exeter St.Leonards Medical Practice,34 Denmark Road,Exeter,EX11SF.
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Dear Editor, In order to limit climate change I took definite steps to ensure that my husband and I only replaced our number of two climate changers! Humans are climate changers- there are 1 million more of us every 5 days. I had a laparoscopic sterilisation after I had had 2 children. For some reason the BMJ regards discussion of limiting the rise in human numbers as a taboo subject. We have no chance of reversing climate change until editors are willing to discuss this. Pip Hayes, GP and mother. Competing interests: None declared |
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Geoffrey J Barnes MFPH, Public Health Specialist Ground Floor, Ergon House, Horseferry Road
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The attitude of Dr Cherry and some other responders to the BMJ article on climate change is disappointing but all too predictable. Dr Cherry ignorantly laments that any political topic is dragged ‘kicking and struggling’ into the journal but this is not any political topic. This is a topic that broad scientific opinion and increasingly broad political opinion, has concluded threatens the future stability of the planet and therefore puts the health and lives of present and future generations of people at risk. It may be that there remain considerable uncertainties about exactly what the course of climate change will be but there is enough evidence out there that the consequences may be truly terrible to demand that policies and practices change considerably if only to abide by precautionary principles. It is therefore his and all medical doctors responsibility as people who have committed themselves to abide by ethical standards to do what they can to prevent this from happening. As representatives of a middle class elite, medical doctors carry an enormous influence in western societies in particular, yet hitherto have remained largely outside the debate on climate change. I guess Dr Cherry’s attitude would be that if there isn’t a pill for it then it has got nothing to do with him. It is attitudes like that that this article seeks to change. If he wants complex scientific articles on the subject then he need only turn to a broad range of non-medical scientific journals which are covering this issue on a weekly basis. What this article and others in this week’s BMJ are seeking to do is to wake up the medical establishment to think about the health of people in other parts of the world being affected by climate change now and the health of people in our own country which will probably be affected a generation from now. As a fan of the Lancet Dr Cherry will no doubt have read the article on the health impacts of climate change that was included in that journal a few months ago (ref below). If that did not wake him up then I doubt anything will. Hopefully there are a few BMJ readers out there who will seek to use their influence for positive change as a result of this week’s edition. McMichael AJ, Woodruff RE, Hales S. Climate change and human health: present and future risks. The Lancet; 2006; 67: 859-69. Competing interests: I work for the UK Sustainable Development Commission |
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John R Cherry, Honorary Consultant ENT Surgeon Blackburn Royal Infirmary, BB2 3LR
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I should have been disappointed not to have provoked controversy with my tongue-in-cheek response, but Dr. Barnes has not got it quite right: after all, I am a surgeon (and, by the way, I call myself “Mr.”, not “Dr.”), so it’s not just a question of pills. In fact, though, as regards my profession, my view is indeed that if there is no preventative treatment, surgery or medication nor any possibility of palliation, then it falls outside my area of interest. I stand by my criticism of the BMJ, which I have made privately for a long time. The journal is supposedly a medical publication. Now, an asteroid strike would have some pretty serious consequences for public health, but I don’t expect a lapsed doctor to write editorials about the possibility, seeing it as a topic for astrophysical journals and thereafter for general public interest and discussion. Of course, I may yet find a whole issue of the BMJ devoted to asteroids, meteors and comets, and their potential effects on human health, but I don’t think it would be a worthwhile exercise. I think that Dr. Barnes’s rather predictable comments about middle class elites are sad, and the bit about doctors committing themselves to abide by ethical standards is patronising to the rest of society (not to say middle class and elitist). When it comes to waking me up, as Dr. Barnes so kindly puts it, I suppose I shall have to declare my opinions about climate change, irrelevant as they are, in my view, to medicine, otherwise Dr. Barnes’s failure to understand my point (which was nothing to do with global warming) may misrepresent my position. Here we go, then. First of all, I think that human society is always under some form of major threat, and that some people are naturally inclined to make more noise about it than others who are naturally more optimistic. Thirty years ago, we were all waiting for the planet to be polished off by an intercontinental ballistic nuclear exchange followed by radioactivity and a nuclear winter. Twenty years ago, we were waiting for decimation by AIDS (no, Dr. Barnes, I don’t underestimate the seriousness of the situation in sub-Saharan Africa, and, this being a medical problem, I do think it has something to do with my professional work.) Fifteen years ago, it was going to be NVCJD (and those working in the field still tell us it may be.) I think climate change is happening, although perhaps faster, perhaps no faster than it has done on other occasions within the last two hundred years. Whether it really results from human activity, or can be altered by changes in human activity, seems to me to be equivocal, but both are certainly possible. When it comes to changing the “carbon footprint” of hospitals in Britain, I doubt this will have much impact at all bearing in mind the current and projected use of fossil fuels in the USA, India and China. I believe, however, that we should in any case be reducing our use of fossil fuels, because they are a finite resource and cause pollution. There is no reason not to look for alternatives at present, and if such action benefits the climate, excellent. The way for me to influence this, however, is not to lecture society from my exalted position as a doctor (I think even those who are not doctors have an interest in preserving the human race), but to study, discuss, put forward ideas, and vote. And I’ll cheerfully vote for any party which puts forward the following plan: Build ten new nuclear power stations and use them to generate electricity and hydrogen. Go for public and private vehicles fuelled by hydrogen, biodiesel or bioethanol. Subsidise the fitting of solar panels to all houses, and small wind generators to all chimneys. Invest in wave and tide power, concentrating particularly on the areas undergoing rapid coastal erosion at present. But why put this forward in a medical journal? And what would be the response if I did? Just as mixed as it has been to my earlier rapid response, I suppose. Some at least would castigate me (as a doctor) for wanting to use nuclear fission, and would assume (wrongly, as Dr. Barnes was wrong in thinking I was not in favour of reducing fossil fuel usage) that I don’t understand the risks. They would remind me of Windscale, Three Mile Island, Chernobyl and the pollution of the Irish Sea, and generally urge me to, er, wake up. The place for scientific articles about climate change is in the relevant journals. The place for debate is politics. The job of a medical journal is to disseminate research and information about medicine. Which is where I came in, and where I still stand. I shan't make any further response on this subject, you will all be relieved to hear. Cheerio, chaps. Competing interests: I am in favour of reducing the use of fossil fuels and in favour of nuclear power generation |
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Stephen McG Barratt, Anaesthetist St Leonards 2065 Australia
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It is with interest that the BMJ should select the topic of global warming as a subject of an editorial with no immediate health implications. One could argue that it is similar to public health campaigns such as controlling smoking and drink driving which have had measureable health outcomes. However global warming is disconnected even further. Frankly I think it is a manifestation of a problem increasingly facing doctors. The partial collapse of religion in the west and the communities general disdain of politicians, suspicion of corporations and other professional groups (eg lawyers) has resulted in us being expected to comment about things other than medicine. Success in other health campaigns and continuing advances in medicine only amplify this problem. The responses to the editorial, however vigorous they are, highlight the balanced nature of our profession and the increasing expectations society places on us. Unfortunately though the subject of 'global warming' has become hopelessly politicised. As far as to the reality of 'global warming', we only need to look at corporations central to it. Both Shell and BP have jumped the fossil fuel lobby ship but whilst now recognising the problem have no clear plan on what to do. Historcally they have behaved like the tobacco companies in both denying the problem and obfuscate any effective debate. American oil companies such as ExxonMobil continue to do so. There is a long term liability issue here in that the insurance, agriculture, tourist and finance industries have potentially a lot of money to lose and are starting to make serious noise about much needed action on climate change. Nuclear has raised its head in Australia but is not financially viable without substantial government subsidies. Even the coal admits there is a problem in that CO2 sequestration has been proposed but cannot work commercially for at least ten years. At an individual level its fairly easy to install a PV electricity and solar hot water system on your roof (as we have done). This works well in Australia. The difference in electricity you need can be purchased carbon neutral. Most here though prefer to spend their money on 4x4 SUVs and plasma TVs and buy cheaper electricity from coal fired power stations. These are much sexier choices. It is also why Australia is almost as bad as the USA in CO2 production per capita. This is what it comes down to really, the needs and rights of the individual versus that of the group. Competing interests: None declared |
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David Bossano, GP The Robert Darbishire Practice, Manchester
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Editor: Thank-you for starting this important debate. I want to contribute 4 comments to various threads. One change that is simple to make and does have a measurable impact on CO2 footprint (though is not in isolation a solution) is to switch to a green electricity supplier. For example Good Energy (formerly unit:e)guarantees that 100% of its supply is sourced from renewables. This could also be done at organisational level and it would make a huge impact if a large health or education organisation switched it entire supply to a renewable. I suggest that those who can lobby their organisation to do so! Re: Dr Hayes - The Hardinian taboo - The BMJ does occasionally publish debate on population/reproduction - see the reference below: http://bmj.bmjjournals.com/cgi/content/full/315/7120/1441 I must admit, despite being convinced by the debate, I was persuaded to be involved in producing 2 climate changers myself, which just goes to show how difficult it is to make changes in accordance with one's principles, despite the seriousness of the consequences. Re: Carbon offsetting by tree planting - I dont claim to be an expert, but my understanding is that the carbon dioxide cycle is essentially carbon neutral; i.e. if you plant a tree today and cut it down in 10-20 yrs (and decompose it in some way) - the carbon is released again. In that sense off setting by planting trees could only work if the trees are not cut down or decomposed for, say 100 years. Conversely, I assume that agroforestry, that is using farmed trees to make paper, wood products etc, is at worst carbon neutral. (Unlike cutting down virgin rainforest). So another small thing you can do is always use FSC certified products. Re: Dr Reyes contribution - the point is that the majority of people in the world DO use facilities that are unheated or uncooled, often without electricity and usually without carparks too (though most probably don't own a car). It is interesting that this has presumably changed for some of the people in the Philippines, though not all I would guess. The reason that this cannot change for everybody, is that the earth cannot support air conditioning, heating, personal motor transport, TVs in every room, etc etc for for every person on the planet. Therefore this issue is vitally important because it is not just about climate change, it is about social justice. Our present system is obliged to maintain the poor living standards of the majority of the world's population, unless the privileged minority in developed countries and the elite of every country are prepared to accept a lower standard of luxury than they currently enjoy so that the entire human race can experience some of these benefits. David Competing interests: Concerned about the planet. |
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Geoffrey J Barnes, Public Health Specialist Ground Floor, Ergon House, Horseferry Road
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Apologies to Mr Cherry for getting his title wrong, though he was similarly mistaken with me. I too am a Mr, albeit of the non-surgical variety- public health is now happily a multidisciplinary profession. Mr Cherry is though right to compare climate change with concerns about AIDS and nvCJD. In both instances the health establishment acted before there was absolute scientific proof about the epidemiology of these diseases. By erring on the side of caution, they helped to prevent, in this country at least, a more severe health impact than would otherwise have been the case. All we ask is that this same caution is applied to climate change where the ultimate health impact could be much worse. Competing interests: I work for the UK Sustainable Development Commission |
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David Carr, Consultant physician University Hospital of North Tees, TS19 8PE
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The articles on climate change (BMJ 10-6-06) are a welcome, if belated, addition to the wake-up calls we seem to need on this topic. As in so many articles on this subject the emphasis is on personal behaviour that leads to increased carbon emissions, and very important this is. But there is scant reference to the other hugely important variable in the equation – the growing world population (1). In 1955 the world population was 2.8 billion. The current population of 6.5 billion is projected to rise to 9 billion by mid-century (2), and unless this is recognised as part of the problem our efforts to make modest cuts in domestic and travel -related carbon dioxide production will fail to halt global warming, and moreover will fail to halt the depletion of many other vital resources. In Europe the total fertility rate (number of children per woman) has fallen from 2.66 to 1.40 in the last 50 years. Without having introduced draconian laws to limit family size, and without net inward migration, the European population would now slowly decrease. Surely we should be aiming for a steady reduction in world population so that each nation can be self -sufficient in the key resources of food, water and energy. The United Kingdom, with its very high population density (246 people per sq. km. compared with Europe's 32 people per sq. km.) will be particularly vulnerable to pressure on resources as world population increases. Rules regarding trade in carbon allowances should be designed to encourage countries to reduce their populations, by rewarding those countries that succeed in doing so. Otherwise we are in danger of creating a perverse incentive by which countries are encouraged to increase their populations in order to obtain bigger allowances. Health services will be crucial in providing incentives for population reduction; universally free family planning services come to mind, and no doubt good public health and child health services will play important parts. There are enormous political and economic barriers to achieving acceptably a sustainable population, and overcoming them is probably the greatest challenge facing the human race today. References: 1) Optimum Population Trust: http://www.optimumpopulation.org/index.html 2) United Nations Department of Social and Economic Affairs; Population Division: The 2004 Revision: http://www.un.org/esa/population/unpop.htm Competing interests: None declared |
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Ahmad A. Sabri, Doctor Faisalabad, Pakistan. 38090, Muhammad A. Qayyum
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This debate makes it crystal clear, how different minds interpret same thing. I really appreciate the thinking and effort of the editor. Editorials are meant to be thought provoking and intellectually instigating. This piece certainly fulfills this criterion. It’s very easy to criticize but criticisms should be after understanding the essence of talk. Many of us raised fingers by giving so irrational reasons that it’s hard to believe that they are health professionals (who live to serve the humanity). Mr. Cherry argued that if an asteroid is causing problem for mankind, should this issue be raised in a medical journal. There is no comparison between environmental change and an asteroid strike. This issue of environment is raised in a medical journal because health professionals are part of society and they can effectively contribute to solve this problem by their individual efforts. Contrary to this in case of an asteroid strike, nuclear war, drawbacks of WTO or nuclear proliferation, there is hardly any thing which health professionals could do. You can not ask Dr. Fiona Godllee to make a laser gun that could destroy the asteroid in the air, but you can ask her to save electricity or prefer materials that can be recycled. Mr. Balaji Ravichandran argued that why should I do something when others are not doing their part. I am sorry to say that this pathetic thinking is the biggest obstacle in the progress of third world countries. Change does not come all of a sudden, it takes years and decades. It will not happen that one day you wake up and read the headline “2 million people in USA and 1 million in UK have announced to cut their energy use to save the environment”. Everybody must change its way individually without caring what others do, then we might some day wake up and read the headline “A study was conducted showing 2 million people in USA and 1 million in UK are doing efforts to save the environment”. Why we look at others for examples? We should set good examples by taking the first step. Somebody criticized that giving the ideas is not sufficient, give suggestions how can we replace current air conditioning and heating systems etc… My point is that, this is the stuff not to be asked to a health professional and should not be published in a medical journal. It’s true that engineers and scientists should answers these questions but criticizing a health professional for not answering these questions in quite unfair. If you think that the same editorial in a newspaper will have the same impact and credibility, then I am afraid you are wrong. Medical journals are meant to provide credible information and journals like BMJ are doing it responsibly. It’s the credibility of the journal/newspaper in which the article is published that makes the real difference. I believe all topics concerning human health directly or indirectly, about which health professionals could do positive measures at individual levels must be taken up in medical journals. Competing interests: None declared |
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Simon Gates, Principal Research Fellow Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL
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There will always be a few people who cling to their beliefs despite overwhelming scientific evidence that they are wrong (for example, that the MMR vaccine causes autism, or that HIV does not cause AIDS). With the evidence we now have, it is very difficult not to conclude that global warming is human-induced, and our ever-increasing energy use is wrecking the planet. The good (ish) news is that it may not be too late, if we all act now and we all act decisively. There is much that each of us can do to reduce our energy use, especially those of us who live in rich developed countries. Read Mayer Hillman's article and excellent book. We must each take individual responsibility for our impact on the environment, and stop expecting the government, or the Americans, or anyone else, to sort this problem out for us. We may have to accept that life will become a bit more expensive or a bit less convenient, but that is surely a small price to pay for securing the planet's future? Competing interests: None declared |
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Vadivelu Saravanan, Consultant Rheumatologist Queen Elizabeth Hospital, Gateshead, NE9 6SX
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Will the BMA and BMJ do their bit to save the forests by 1. Stop sending the print version of the journal to BMA members who never open the plastic wrapper (many of my colleagues don't). 2. I and many of the members do not need the bmj careers either so that will be some more trees saved. 3. Use only recycled paper to print the BMA newsletter and the annual reports. And in return for these a small discount in our BMA membership fees would be great, thank you. Competing interests: I am a BMA member who forks out a fortune every year on membership fee |
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Alison Hill, Director, South East Public Health Observatory Oxford OX4 2GX, Geoff Barnes, Jackie Spiby, Harry Rutter, Lindley Owen, Carolyn Lester, Aldo Mussi, Cathy Read, Andrew Furber, Cameron Stark, Alex Stewart, Jenny Griffiths, John Middleton, and Jeremy Wight
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Dear editor We are delighted to see that the BMJ is taking a stand on and we commend the actions you are taking on climate change. We the undersigned are a group of public health professionals who believe that climate change is posing a huge threat to human health. However we consider that there is still time to reduce the threat. The reduction of carbon emissions by countries, organisations and communities must become as legitimate a priority for public health as tackling smoking. We believe that through advocacy and influence, in our work and our personal lives, we can show how much difference we can make. We have drawn up a manifesto to which we are all signatories. Through this we are developing a practical programme of work to make environmental sustainability centre stage within the NHS and the broader public health world. We intend to: • work with the English Department of Health and other Government Departments, the Welsh Assembly Government, the Scottish Executive, the Department of Health for Northern Ireland, to push for stronger government action; • take action, in partnership with others, to ensure that existing opportunities to promote environmental sustainability are used to best effect; • take action nationally and locally to ensure that environmental sustainability is reflected in public health workforce development ; and • last but not least, to ‘practise what we preach’. We will be encouraging our colleagues and our organisations to adopt the manifesto and intend to take forward the actions we have set out. We know we will be more influential working together than individually. If you think you might be interested in becoming a signatory to the manifesto please contact alison.hill@phru.nhs.uk Competing interests: None declared |
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John R Moloney, retired ENT Consultant Leicester Royal Infirmary LE1 5WW, Richard Robinson PhD retired science teacher
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Our Carbon Footprint is often measured in terms of the number of tonnes of CO2 we emit a year. It might be easier to visualise the damage in terms of an area of ground and/or a volume of atmosphere 'filled'with CO2, to a generally accepted upper limit (with regard to its greenhouse gas effect). One way of doing this is to consider the number of Carbon Columns of atmoshpere we 'fill' each year and the area of ground they cover. A Carbon Column is defined (by us) as the column of atmosphere stretching up into space above 1 square metre of ground. Given the density of air (1.225kg/cu metre) and mercury (13,593kg/cu metre) and an atmospheric pressure of 0.76 metres of mercury, we can calculate that a Carbon Column is 8433 metres high. (In fact, as we know, the atmosphere strestches upwards for more than 100km but the density of course reduces). Present CO2 levels are 378 parts per million (ppm). A generally agreed (but debatable) upper limit is 450 parts per million. We can therefore put an extra 72ppm in the atmosphere before catastrophe strikes (we appreciate that a certain amount of CO2 will be reabsorbed). 72ppm equates with 72cc of carbon dioxide in 1 cubic metre. 72cc of CO2 has a mass of 0.14g and therefore a Carbon Column 8433 metres high can have an extra 1.9kgs put into it before it is 'full'. For rough calculations 1 tonne of CO2 fills 838 Carbon Columns of atmosphere (at the present level of 378ppm);this equates with the atmosphere standing on a square piece of land with sides 29 metres. In the UK we emit about 10 tonnes of CO2 a year each on average; all 60,000,0000 of us. We therefore 'fill' the atmosphere 'standing' on a piece of land twice the area of the UK(and complain about rainforest loggers). A car emitting 140g of carbon dioxide per km 'fills' a Carbon Column every 8.433km that is driven. Most cars produce significantly more than 140g of CO2 per km. Given a world population of 6.6 billion and the fact that there are 5.1 x 10 to the fourteen Carbon Columns, it follows that there are about 77,000 Columns available to each of us. We hope that this concept (which is probably open to a great deal of refinement) may help people to visualise the limited atmospheric resources available and how much they are using. Competing interests: None declared |
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