Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Time for greener hospitals
- David A King (30 November 2007)
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Do You Believe climate change is caused by man activity?
- Jose L Quevedo Soriano, Skegness, PE25 2An (1 December 2007)
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Some food for thought.
- David R Warriner (2 December 2007)
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What Utter Nonsense
- Dr. Herbert H. Nehrlich (3 December 2007)
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Lets not die of atmospheric insufficiency
- Adrian A Pierry (4 December 2007)
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Time to think
- Takeharu Koga, Haruki Imaoka (5 December 2007)
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Doctors, population and climate change
- John Guillebaud (5 December 2007)
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A fanciful leap.
- Duncan H Wilson (5 December 2007)
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The BMJ's role in climate change
- John Brady (7 December 2007)
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remember mrs jellaby
- muir gray (10 December 2007)
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The debate is heating up.
- Gregory Gardner (28 December 2007)
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Our effect
- James Pringle (1 March 2008)
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David A King, FY1 Doctor St James University Hospital, Leeds, LS9 7TF
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Editor, The recent editorial highlighted the importance of health professionals in taking a lead on tackling climate change. This is a laudable aim and it is certainly true that individuals, as well as organisations and governments, have a key role to play in preserving our planet for future generations. However, I found it disappointing that little practical advice was offered in how doctors could make a difference in their everyday lives, since this is where it is easiest for changes to be made. On walking around any hospital in the UK a cursory glance will reveal lights and appliances left on unnecessarily, rooms which are heated all year round regardless of the weather, and a total absence of double glazing and any form of recycling. It is perhaps surprising that this issue has received scant attention in either the lay or medical press, as small changes could undoubtedly lead to large financial and environmental benefits. Indeed, a small study in 2002 suggested that in one hospital in Ireland, energy consumption could quite easily be reduced by 20%, water consumption by 15% and proper waste segregation could result in reductions of up to 40% of healthcare waste (1). The argument that the activities of humans have led to changes in our climate has been won and we have now reached the stage for action, not words. It is surely time that both governments and health professionals now take steps to ameliorate the environmental impact of hospitals and put in place the necessary changes to bring about real and long-lasting improvements. (1) Duputie S, Farrington N. The road to a greener hospital. Ir Med J.2002.95(3):75–7. Competing interests: None declared |
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Jose L Quevedo Soriano, GP Beacon Medical Practice, churchill Av, Skegness, PE25 2An
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Dear Sir, Doctors demand the most solid and robust evidence. Climate change has been happening during millions of years. The earth has experienced glaciations and draughts. In the 70s green parties announced the end of the world because a glaciation. Then on the 80s was the ozone problem, and now is too hot. From the 70s we know we are not in a glaciation. Also we know now that the ozone problem is not a problem but a cyclic variation on its size. And now is too hot. Green house gases are essential for life as they keep the Earth warm, If they were absent life were not possible. From the total CO2 produced in the Earth only 3% is produced by men. CO2 is essential for photosynthesis, subsequently necessary for plants. There is evidence supporting that higher levels of CO2 were present in periods when temperatures were lower that present temperatures. Dr Willie Soon compared the radiation originated by the Sun with the records of the Earth Temperature. Curiously during the more active periods of the Sun the Earth temperature increased, and during the periods of lower Sun activity the Earth temperature lowered. Just a though. Collection of temperature data is a problem too. If we observe the temperature data offered by Al Gore and friends we noticed that the temperatures do increase on the 90s. In the 90s, after the fall of the Soviet Union around 2000 weather observatories were closed in Siberia. Just a though. Regarding glaciers some of they are getting smaller( or melting) and the biggest ones in South America are getting bigger. There is not increment of temperatures on the South of the Equator. Regarding polar bears, from the 13 colonies known to men only one is failing to increase or maintain the number of individuals, the other 12 colonies are getting bigger. Regarding malaria, might I remind you the epidemics of malaria in siberia (not many decades ago)? Malaria is a disease associated with low development and the not use of DDT( shall I remind you that where green parties who lobbied for the not use of DDT in Africa and for extension they are the responsables of the death of millions of people? shall I remind you recently the use of DDT has been reapproved?). Are the sea levels raising? yes of course. During the XX century 0.1 to 0.2 milimetres. Jay Zwally (NASA) studied changes in the balance of ice and the potential effects on sea levels. He and his team concluded that the lost of the total masse of ice from Antartida and Greenland would account for an increment of sea levels of 0.05 milimitres per year between 1992 and 2002. It will be necessary 1000 years for a raise of 5 cm. All this can be found in Christopher C Horner book ( The politically incorrect guide to global warming) who uses an extensive authors reference illustrating the subject. Mr Gill paper lacks of authority and evidence when uses sentences as "climate change leads to the extintion of the species", " the present climate related extintion event". He uses the languaje of fear, like in the Middle Ages priest theatrened with the end of the world...The use of this languaje in a serios publication like the BMJ is incorrect. Kioto as a program will be useless. The agreed variation of temperature, if Kioto agreement is fully implemented, will be of 0.7 C in 50 years, 1.4 C in 100 years. Not enough to save the world. Apart it is the subject of the control of the state on individuals and the lost of freedom to achieve the Kioto's goals (no overseas hollidays, no 4X4) and the increment of prices in almost everything related with energy, and therefore increasing the gap between rich and poor.. Then you mention the United Nations. Please let me not trust an organization which majority (near 70% of state members) are not democratic states but dictatorial regimes. I won't comment on the former leader and familly. I would advice any body interested in joining The climate and Health Concil to read Christopher C Horner book and then make an informed decision (Book and Chose, in this case). Competing interests: None declared |
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David R Warriner, F2 Paediatrics Scarborough, YO12 6QL
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Ancient Proverb "Only after the last tree has been cut down, only after the last river has been poisoned, only after the last fish has been caught, will you find that money cannot be eaten" Competing interests: None declared |
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Dr. Herbert H. Nehrlich, Private Practice Bribie Island, Australia 4507
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I wholeheartedly agree with Dr. Soriano. Climate change is neither caused by man nor can we (in spite of all posturing and arrogant outpourings) do much to alter its course. It is a very good point (as Dr. Soriano does) to bring up the big scare campaign of the seventies predicting the doom and gloom of an ice age. The world's best experts were convinced. They were wrong then and they have learned little. Where would we be without CO2?It is essential to life. Politicians and special interest groups, all with ulterior motives based on greed, are beating the drum of climate change. Al Gore, suddenly expert and father of a revolution that is supposed to save mankind.It's a bit comical. In addition to those who have been misled (and that includes otherwise lucid scientists) there is a movement that wants to establish permanently and very firmly as well as irrevocably, the Nuclear Industry. A reactor on every street corner. An industry that is neither clean, nor safe, nor will it EVER be able to compete ECONOMICALLY. It is rather cute how its proponents never tire of pointing out that the nuclear industry produces no greenhouse gases. Frankly, I would rather be subjected to methane and other natural gases from cows, plants and high fibre eaters than breathe in radioactive substances. There is no doubt that solar will have a huge future and it is assured a steady supply of fuel in the shape of sunshine. Australia's high grade uranium supplies will run out in 30 years or less and that is assuming we don't sell any to other countries. I predict that the cardhouse of climate change activism now considered so crucial, will collapse very soon and leave a lot of people with carbon-rich egg on their faces. Incidentally, the other contributor, Dr. Warrina, called his quoted sentence an ancient proverb. In fact, this was uttered by Chief Sealth, a Suquamisch Indian chief after whom the city of Seattle was named.He made the statement less than 200 years ago. Competing interests: None declared |
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Adrian A Pierry, Sessional General Practitioner South Glamorgan
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Your editorial about doctors and climate change does not recognize that the increase in the planet’s population is causing emission of dangerous levels of carbon dioxide into the atmosphere. Poor people living in countries that are undergoing or have yet to undergo, the social and economic transition that fossil fuel has enabled the rich Western world are demanding access to the same polluting technologies. Lobbing to constrain carbon dioxide emissions coupled with transfer of resources to those countries is unlikely to be part of the solution within the time framework required. Health professionals can contribute to control fertility, moralising against it without awareness of the consequences makes us part of the problem. Dr. Adrian Pierry Sessional General Practitioner Competing interests: None declared |
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Takeharu Koga, Vice-director Amagi-Asakura Medical Association Hospital, Haruki Imaoka
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There is no doubt that health professionals should take part in reducing carbon dioxide production. As is stated by the Climate and Health Council (www.climateandhealth.org), avoiding disposables and reusage are key elements what we can do for our purpose. Nevertheless, single-use devices are getting more and more common in medical care, mainly because of safety and convenience, and have become a major hospital budgets1. Although the feasibility and consequence to reduce disposables in medical care has to be balanced carefully with alternatives, it is time to think if our current practice and conception have alternatives in terms of reducing carbon dioxide. 1. Abreu EL, Haire DM, Malchesky PS, Wolf-Bloom DF, Cornhill JF. Development of a program model to evaluate the potential for reuse of single-use medical devices: results of a pilot test study. Biomed Instrum Technol 2002;36(6):389-404. Competing interests: None declared |
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John Guillebaud, Emeritus Professor of Family Planning and Reproductive Health, University College London Margaret Pyke Memorial Trust, 73 Charlotte Street, London W1T 4PL
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Neither the editorial by Mike Gill et al[1] nor the letter by Alan Maryon-Davis et al[2] mentioned the taboo word ‘population’. My Cambridge tutor, the Biologist Colin Bertram, taught that population increase by any species is always ultimately unsustainable: when they overshoot the finite limits of their environment, their numbers crash. Though by our powerful technology we humans could appropriate the whole world as our habitat, for a while: on a finite planet unremitting population growth could only end in tears. So began my lifelong concern[3] for global environment issues, including climate. There are now over 6700 million humans. Despite c59 million deaths, c139 million births ensure an annual increment of c80 million[4]. Each week the world therefore houses the equivalent of a city for 1.5 million. Obviously in the rich suburbs the greenhouse gas (GHG) production is greater per-person (and must reduce[1,2,5]). But though GHGs are produced at a lower per-person rate by the poor, their vast number ensures that the global GHG impact of relieving world poverty will be enormous. Rich or poor, then: "Climate Change is caused by the Number of Climate ChangERS" Or in Professor Chris Rapley’s words (House of Commons, Jan 2007), only "an absent human has no (carbon) footprint". The costs of much-needed greener technology, measured in trillions of dollars, are insurmountable unless world energy consumption also drastically reduces. Will this happen? Most improbably: sustained GHG- production is assured, since all consumers who are affluent wish to stay so and the burgeoning numbers of poor aspire (as is their right) to exit their poverty. There is no unmet need to reduce consumption. However, as I have first-hand experience in Africa, there is considerable unmet need for family planning. Poor women welcome fully accessible and available contraception, to give everyone the choice to control their fertility [6]. If the many barriers and taboos related to worldwide family planning were removed this is both do-able and cheap – estimated by the UN’s conference on population and development at a mere $17 billion dollars per year at 1994 prices. Population should feature in any Editorial entitled ‘Doctors and climate change’ because: • What more relevant medical specialty could there be, than
contraception?
References 1 Mike Gill, Fiona Godlee, Richard Horton, and Robin Stott. Doctors and climate change. BMJ 2007; 335: 1104-1105 2 Maryon-Davis A, Gilmore I, Hamilton P. We must all act now. BMJ 2007; 335: 1110-1112 3 Guillebaud, J. Environment time capsule and Letter of Apology to the future, 1994. www.ecotimecapsule.com 4 Population reference bureau. www.prb.org/pdf07/07WPDS_Eng.pdf 5 Declaration of the Climate and Health Council. www.climateandhealth.org/getinvolved 6 Guillebaud J. Youthquake. Optimum Population Trust, 2007. www.optimumpopulation.org/Youthquake.pdf Competing interests: None declared |
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Duncan H Wilson, G. P. Rotherham S66 9LP
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Dear Sirs, I have no intention of getting in to the ludicrous anomaly to common sense and scientific truth that is the political convenience tool labelled "climate change" (such a gentle phrase with such a vague connotation). However, I feel I must express my view as to whether it is really the place of the BMJ to promote an extremely controversial view of scientific theory and political rhetoric, and present it as "fact by implication". This is lazy science, lazy journalism, and has little to do with influencing MEDICAL developments. We are about medicine, research, authenticity and verification, not the promotion of bad science, misleading hypothesis and politically-motivated hyperbole. Shame on you! The BMJ is not the tool of the chattering classes, nor the hand- wringing apologists who dominate our popular cultural landscape. Competing interests: None declared |
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John Brady, Consultant Psychiatrist Rossdowney House, Derry, BT47 6BG
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The editorial by Gill et al was a well-intentioned and well-timed piece on mankind's effect on the environment. Unfortunately, before I ripped open the plastic wrapper on my BMJ this week, I noticed a sticker telling me that my BMJ had apparently come from Auckland. Even if it hadn't, it was clear that the wrapper, or at the very least, the sticker itself, had come from the Auckland Mail Centre. To make matters worse, the sticker was covering up the usual notice asking the postman to return my BMJ to Zurich if it was undeliverable. Perhaps the BMJ should look a little closer to home before its editoer lectures the rest of us? Competing interests: None declared |
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muir gray, director soundshealthy oxford ox2 7lg
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The Climate and Health Council is of great importance but we need to put our own house in order. In the twenty years since we ran the first conference on Greening the NHS (1) the NHS has continued to use more energy, tarmac more land, consume more resources and produce more waste.Like Mrs Jellaby in Bleak House we are in danger of focusing all our attention on the shortcomings of others while overlooking our own We are planning a conference ,with a tiny carbon footprint, in 2008 on what health professionals can do now to reduce the footprint of the NHS; in labs and wards, in health centres and hospitals , in board rooms and consultations(2). We do need to lobby for political change but our voice would be more powerful if we were achieving reductions in our contribution to the problem muir gray 1) Gray M and Keeble B (1989) Greening the NHS Brit Med J 299; 4-5 2) http://soundshealthy.org/green/default.asp Competing interests: publisher of www.soundshealthy.org |
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Gregory Gardner, GP Principal Cape Hill Medical Centre, Raglan Rd., Smethwick B66 3NR
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The recent editorial in the BMJ is about as good an example as one can find of why we should not believe the hyperbole of the environmentalists. The claim is made that the earth is 5000 million years old and that dinosaurs died out 65 million years ago.1 Humphreys has identified at least 14 natural phenomena which conflict with the idea that the earth is millions of years old.2 Among the most compelling are the presence of radiocarbon in deep geological strata, the decay in energy of the earth’s magnetic field and the amount of Helium still trapped in rocks. Humphreys’ estimate of a maximum age of the earth extrapolating from magnetic field decay is about 20,000 years. With regard to the dinosaurs, fresh (not fossilised) specimens of dinosaur bone have been found in Canada and Alaska.3,4 In one of these, fragments of blood cells have been found3 – a discovery completely at odds with millions of years. The editorial suggests that the duties of a doctor ‘should extend to working to prevent climate change’. Climate change is a fact of life whether we like it or not and is part of the earth’s history. The earth has always - and will continue - to go through cycles of warming and cooling. Co2 levels have been higher in the past than now as the sea releases Co2 when it gets warmer. A warming sea is a cause of increased Co2, not the other way round. The debate about the cause of global warming, far from being settled is only just getting going. There is far from a consensus about this. A recent report from the U.S. Senate showed how much dissension there is in the scientific community. Over 400 scientists, many of whom are current and former participants in the UN IPCC have raised objections to major aspects of the so-called "consensus" on man-made global warming. Many of the scientists featured in this report consistently stated that numerous colleagues shared their views, but they will not speak out publicly for fear of retribution.5 It is not the duty of a doctor to work to prevent climate change (as if such a thing were possible) but it should be the duty of scientific journals to promote balance, scientific rigor and a resistance to trendy theories. 1 Gill M, Godlee F, Horton R, Stott R. Doctors and climate change. BMJ 2007;335:1104-1105 2 http://static.icr.org/pdf/imp/imp-384.pdf 3 Schweitzer M, Wittmeyer JL, Horner JR, Toporski JK. Soft-Tissue vessels and cellular preservation in Tyrannosaurus Rex, Science 2005;207:1952-55. 4 Davies, K. Duckbill dinosaurs (Hadrosauridae, Ornithischia) from the North Slope of Alaska. Journal of Palaeontology 1987;61:198-200. 5 http://epw.senate.gov/public/index.cfm?FuseAction=Minority.Blogs&ContentRecord_id=f80a6386 -802a-23ad-40c8-3c63dc2d02cb Competing interests: None declared |
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James Pringle, Medical Student Royal Hallamshire Hospital, Sheffield, S10 2JF
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Dear Sir, I found your article on climate change both interesting and stimulating. There can be no doubt that the health of our environment effects the health of the people within it(1). Climate change is obviously a part of this but as health professionals we damage our environment in other ways. I am a final year medical student currently doing a placement at a community Mental Health unit in Rotherham (a post industrialised town with a population of about 115,000). Your article sparked a discussion between myself and my consultant in which we discussed the impact of this unit. It is a small community Mental Health hospital with an attached Assertive Outreach team, Early Intervention Team and a small ward of 20 beds. We estimated that the AOT and EIT alone probably have well over 50 staff. The nature of the work means that all of the staff on the teams and the doctors visit patients by car in the community. In a typical visit to a patient a doctor and an AOT member will meet at the patient’s home along with, potentially, family members, other health professionals or members of social services. This typically adds up to 2 or 3 cars visiting a single patient. This clearly has a large impact on local pollution due to the increased traffic. The increased congestion is also obviously a threat to local people and pedestrians. Current thinking in medicine over many specialities, but especially Mental Health is that better care can be given in the community than in larger central units. Obviously the first priority is the level of the care that patients receive, but the impact that such methods have on our environment and hence people’s health should be considered as well. I would be interested in knowing your thoughts on how great the impact of such policies are and what methods could be used to minimise the impact without degrading the quality of care patients receive. Yours, James Pringle 1) Chen TM, Shofer S, Gokhale J, et al. (2007), ‘Outdoor air pollution: overview and historical perspective’, American Journal of the Medical Sciences. 333(4):230-4 Competing interests: None declared |
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