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Jenny Griffiths, Alison Hill, Jackie Spiby and Mike Gill, Robin Stott
Ten practical actions for doctors to combat climate change
BMJ 2008; 336: 1507 [Full text]
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Rapid Responses published:

[Read Rapid Response] Advocate stabilising population
James G Danaher   (30 June 2008)
[Read Rapid Response] Practical actions for doctors to combat climate change
J Michael Henk   (1 July 2008)
[Read Rapid Response] Sermonising
Michael Schachter   (1 July 2008)
[Read Rapid Response] Re: Sermonising
Mark Struthers   (4 July 2008)
[Read Rapid Response] Ten Commandments
Ivan P. Hudecek   (11 July 2008)
[Read Rapid Response] Governments, not individuals have the power to combat climate change
Jackie Applebee   (13 July 2008)
[Read Rapid Response] Re: Re: Sermonising
Michael Schachter   (18 July 2008)

Advocate stabilising population 30 June 2008
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James G Danaher,
Retired NHS GP
33 Ashby Road, Ravenstone, Leicestershire LE67 2AA

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Re: Advocate stabilising population

The population of Africa and the Middle East to Pakistan was 300 million in 1950, 600 million in 1976, 1,200 million in 2002, and an estimated 2,400 million in 2050, when the population – in sheer numbers - will be increasing very rapidly. www.esa.un.org/unpp (The United Nations estimates for this region for 2050 are: Low Variant 2,340 million, Medium Variant 2,726 million, and High Variant 3,143 million.)

It is reassuring to find that the authors of this excellent article believe that doctors should advocate stabilising world population. Perhaps we could start with Africa and the Middle East to Pakistan where – except for a few countries - family planning is not easily available.

Gerald Danaher
Retired NHS GP
jgd@gerrydanaher.com

Competing interests: None declared

Practical actions for doctors to combat climate change 1 July 2008
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J Michael Henk,
retired oncologist
Sutton, Surrey SM2 7BS

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Re: Practical actions for doctors to combat climate change

Jenny Giffiths and colleagues set out ten actions for doctors to fight climate change. I have recently been following action 1, i.e. informing myself about the basic science of climate change. My reading so far has placed me firmly in the 60% of the population who believe that the contribution from human activity remains in doubt. Data are conflicting on global temperatures, atmospheric carbon dioxide levels, and the correlation (or otherwise) between the two.

Actions 2 to 6 and 8 are excellent advice regardless of climate. However, we should beware of measures that could do economic harm with little or no prospect of an effect on global climate, e.g. the European target on renewable energy. Younger doctors would be better advised to advocate the building of more nuclear power stations to keep the lights on in their hospitals and surgeries in 15 years time.

Competing interests: None declared

Sermonising 1 July 2008
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Michael Schachter,
Senior Lecturer in Clinical Pharmacology
St Mary's Hospital,London,W2 1NY

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Re: Sermonising

I very seldom travel to large meetings because they tend to be unrewarding and over-commercialised. But like many others,not just doctors,I am heartily sick of sanctimonious preaching about what is or is not "good for the planet". This looks increasingly like the efforts of rather insignificant individuals to arrogate to themselves the right to tell others how to live their lives. Many grown ups can manage this for themselves.Only my innate courtesy prevents me telling these people what I really think they can do with their advice.

Competing interests: None declared

Re: Sermonising 4 July 2008
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Mark Struthers,
GP
Bedfordshire

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Re: Re: Sermonising

What would Jesus do? (WWJD?)

Dr Michael Schachter would do well to imagine how Jesus will be travelling when He comes again for His second round with humanity.

Will He be riding a bicycle?

And will the good doctor Schachter be following Him on His rounds? Somehow I think not!

Competing interests: None declared

Ten Commandments 11 July 2008
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Ivan P. Hudecek,
Consultant Anaesthetist
Manor Hospital,Walsall,WS2 9PS

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Re: Ten Commandments

There seems to be a new fashion to compare the consequences of smoking with consequences of climate change-1. Whilst the increase in mortality in smokers can not be challenged-2, we do not have any figures for mortality or morbidity directly(not by proxy) due to climate change-3 (this should not be mistaken for air pollution).

Just compare Doll’s paper with the health section in the latest IPCC report. The former is a concise exercise in clarity and irrefutable evidence, the latter is a verbose and confusing account full of assumptions and predictions with hardly any relevant statistics. AR4 does not explain why the horrors of malaria, heat waves and dengue fever do not apply for example to Florida.

Do Griffiths et al assume that doctors and their patients live in a different world? They just rehash what we have heard many times before, including the usual misconceptions i.e. buy “local” food (perhaps from a heated greenhouse)-4. They somehow seem to suggest that carbon (carbon dioxide) is the most poisonous substance known to man. Let me quote from their article:” a low carbon diet is a healthy diet.” As the lowest proportion of carbon is in fats we are left with either nuts or butter. But nuts are not “local”. So we are left with butter. Cows supply the main ingredient. We have a problem.

1. BMJ 2008;336:1507 (28 June), doi:10.1136/bmj.39617.642720.59
Ten practical actions for doctors to combat climate change
Jenny Griffiths, Alison Hill, Jackie Spiby, Mike Gill, Robin Stott

2. BMJ, doi: 10.1136/bmj.38142.554479.AE, (Published 22 June 2004) Mortality in relation to smoking: 50 years' observations on male British doctors
Richard Doll, Richard Peto, Jillian Boreham, Isabelle Sutherland

3. Fourth Assessment Report (AR4),Section 8 – Human Health pp 391 – 432 Oxford University Press 2007, also available on line

4. Fruit and Vegetables & UK Greenhouse Gas Emissions. Tare Garnett Centre for Environmental Strategy, University of Surrey 2006

Competing interests: None declared

Governments, not individuals have the power to combat climate change 13 July 2008
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Jackie Applebee,
GP
Tredegar Practice, 35, St Stephens Road London E3 5JD

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Re: Governments, not individuals have the power to combat climate change

The articles concerning climate change in recent editions of the BMJ are to be welcomed in that they signify a rising awareness of this catastrophic issue, the effects of which are already devastating low lying areas of the globe.

However, I take issue with the author’s emphasis on individual responsibility. It is Government that should be taken to task for their abject failure to deal with the issue.

Gordon Brown does nothing but pay lip service to tackling climate change. Investment in renewable energy is woeful, and the targets New Labour have set are totally inadequate, should they even meet them. Past experience dictates that this is unlikely.

It is all very well to suggest that individuals should do their utmost to cut their carbon footprint. However, welcome though this is, focusing on individual effort lets Governments off the hook.

To really tackle climate change, world leaders need to stop using the increasing carbon dioxide emissions of developing nations as an excuse for inaction on the part of the developed world. China may well emit more greenhouse gases than any other nation, but in far more meaningful per capita terms they are still way down the pecking order. The US top the league by a long way.

Individuals, who would love to decrease their carbon footprint need the infrastructure to do so. Only Government can provide this.

Governments need to massively invest in renewable energy and in a cheap, reliable, integrated and frequent public transport system. They need to legislate, with teeth, that all new buildings should be carbon neutral and to institute an urgent programme of making existing buildings energy efficient, with grants for insulating homes. Cities need to be organised so that we can work, shop and take leisure near to our homes, dedicated cycle lanes would go a long way to abolishing the fear that puts many off taking to two wheels. A good local school for every child would do away with the absurdity of the school run. Governments need to curb air freight.

These are just a few measures that need to be taken, but without them, all of the energy efficient light bulbs in the world are not going to stop global warming.

Yes doctors should use their collective voice to campaign against climate change, but this voice would be better directed at Governments and not the individual

Competing interests: None declared

Re: Re: Sermonising 18 July 2008
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Michael Schachter,
Senior lecturer in clinical pharmacology
St Mary's Hospital London W2 1NY

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Re: Re: Re: Sermonising

I would probably be walking or on a bus, but not for international travel I think. But "what would Jesus do?" is not a question that comes to my mind regarding this or any other topic.

Competing interests: None declared