Intended for healthcare professionals


Apocalypse soon: doctors needed

BMJ 2000; 321 doi: (Published 02 December 2000) Cite this as: BMJ 2000;321:0

It isn't easy being green.

Editor - In response to your editorial "Apocalypse soon: doctors
needed", I would add some caveats:

BMJ: " One consequence of limited government powers is that business
flourishes, and America's superpower status stems primarily from its
economic pre-eminence. Another consequence is that big, complex problems
cannot be fixed. "

Now, it may be true that big, complex problems cannot be fixed, but
it may be because of the inherent bigness or complexity - the one implying
the application of massive resources which must be diverted from other
uses, the other implying that the available solutions themselves entail
problems which are liable to be as unwanted as the current (this means
that Hitler or Stalin also could not fix them). The ensuing economic,
psychological, and logistical unhappiness, combined with the uncertainty
of the fix and the unknown side effects, may be entirely unacceptable for
very rational reasons.

But it is perhaps equally likely that big complex problems do not
need to be fixed, either because they are perceived to be more important
than they are, or because the fixes will evolve in a free market provided
there is no interference from planners and beaurocrats. An example would
be the inability of American "to solve its health care problems." Not
that there aren't problems, but they are not necessarily those commonly
presented, nor necessarily as important as presented. It is currently
being surreptitiously acknowledged that the major problem with American
health care is that it is not being paid for in a satisfactory manner.
The 40 million without health insurance are not in fact without health
care, but their health care providers are and have been screaming bloody
murder because they're not being paid. These days, if you hear about
someone suffering damage by being turned away from a hospital or doctor's
office, it's because somebody's being sued. And if you subtract the urban
ghetto population from the health statistics - not permanently, now, just
for the moment - you see that america's statistics are equal to or better
than the rest of the first world. Yes, the urban ghetto is a problem, but
not merely from the standpoint of health care: also from that of
education, employment, crime (especially violent crime), nutrition, and
addiction. Therefore it deserves to be addressed holistically, with
procedures that seem likely to affect the entire mix in a beneficial way.

BMJ: "The US itself suffers primarily from its inability to solve its
health care problems, but the whole world is likely to suffer from its
inability to act on climate change."

Very unlikely, that last. As long as China and India and South
America (they will get automobiles, you know) are excluded from the
strictures of the Kyoto agreement, it's impossible for a rational person
to believe that America's participation makes a particle of difference.
And that's assuming that human behavioral changes can affect a geological
process (the cycle of warming and cooling) that's been going on for
billions of years, implausible on the face of it.

BMJ: "Americans make up 4% of the world population but emit a quarter
of the greenhouse gases that are causing global warming. Americans consume
amountsof energy per head orders higher than the rest of the world. Unable
to ratify what was agreed at Kyoto in 1997, the Americans went to the
hoping to avoid a commitment to change their extravagant lifestyles. They
succeeded. Worse, George Bush (the presidential candidate who at 2345
hours GMT Monday 27 November looks most likely to win) has described the
treaty as unfair to Americans."

You're right: he should have described it as stupid. Compare Al
Gore, who still might at this moment become president. Here is Pat
Michaels, climatologist at the University of Virginia (Electronic
Telegraph, 1997):
"Back in Virginia, Michaels slams the IPCC scientists for manipulating
data, then settles into an explanation of how the key to Vice-President Al
Gore's challenge for the presidency next time round will be corrupt
environmental journalists whom he will use to peddle a fraudulent version
of climate change."

BMJ: "But every day that goes by without action the
problem of climate change becomes harder to solve. "

Not exactly. Every day that has gone by for the last 15,000 years
has contributed stochastically to the global warming taking place since
the last Ice Age. Even during this gradual warming, the earth has been
warmer than today 1,000, 3,000, and 6,500 years ago (Baliunas 1998). The
world, in fact, may not be more than half-way toward its long-term cyclic
maximum. Now, if there were something to be done to slow or stop this
process - without risking a move back to the Ice Age, please! - that would
clearly be a Good Thing, as I am definitely opposed to change. But
exempting the movement of 2 billion people from the bicycle to the
motorcycle to the automobile is certainly not the rational approach.

BMJ: "Many governments --- particularly from countries
likely to be drowned by rising sea levels --- have tried to lead on this
issue. But governments face great difficulties in encouraging their
citizens to get out of their cars and change their lifestyles --- despite
the fact, as WHO said last week (p 1367), that such changes could bring
immediate benefits to health. A push from the people would help
governments, and environmentalists across the globe, including in the US,

You are, of course, asking for a push from the people who are
refusing to get out of their cars and to refrain from cigarets and animal
fat, despite a lot of encouragement.

I am myself excessively fond of Venice, and hardly less fond of
Holland. And I am not that enthusiastic about farming returning to
Greenland. But just because something must be done doesn't mean something
can or should be done. And if you want to find out what can be done, you
must start by eliminating wishful thinking, such as: "We can change the
world by speaking up and acting[---]together and individually[---
]internationally, nationally, and locally and by changing our own
lifestyles" (BMJ 1997; 315: 1326). Instead, spend some time looking at
the ecochemical and geothermal processes involved and probably at solar
cycles. The likelihood is that we need to know a lot more before choosing
our technique, and that we have a lot of time to do it right, whatever it
is. As the Economist said in 1998: "Global warming may turn out to be
such a catastrophe that it is worth spending a lot to reduce the use of
fossil fuels - or perhaps it will not. But at the very least it seems
sensible to invest in better thermometers."

BMJ: "But why can't doctors take the lead? Climate change is a health
issue of stupendous importance. Doctors with their scientific training can
understand the problems, and they are trusted."

Well, actually, there are good reasons why doctors shouldn't take the
lead. Mostly, it's because they're as prone to wishful thinking as anyone
else, and better equipped to make it sound good. It might be well to
remember that ice ages on average last 90,000 years and warming periods

BMJ: "American and Russian doctors led the movement to
reduce the danger from nuclear weapons. Now we need
similar leadership, particularly from US doctors."

Interestingly, there may be more danger from nuclear weapons now than
20 years ago. And doctors have as much to do with changes in the interim
as politicians do with the invention of the Internet.

Competing interests: No competing interests

05 December 2000
James Whiting
Asst Prof OHSU
Portland, OR, USA