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IN the national debate on carbon emissions and climate change many and varied opinions are promulgated — some that fly in the face of science.
Since degradation of the environment is the greatest public health hazard of all, we in the medical profession have a responsibility in this. Although some of our colleagues, such as Doctors for the Environment Australia, have already taken a stand, it would be timely now to see a position statement from the whole profession.
That statement might start by acknowledging that even though we are not climate scientists, our work in medicine gives us an understanding of risk analysis. We make decisions about health and wellbeing by considering the available data — usually this means assessing probabilities or risks rather than certainties.
Not everyone who smokes cigarettes develops lung cancer; not everyone who is overweight develops diabetes. We cannot predict these diseases with certainty, but we can point to overwhelming scientific evidence that to continue smoking or overeating is to heavily stack the odds.
Similarly, with the health and wellbeing of the planet, the weight of scientific evidence suggests that we are stacking the odds against survival if we continue to pollute the environment at the present rate.
We might address the issue of CO2 in medical/physiological terms: that although CO2 is not a pollutant in the sense that both asbestos fibres and the carcinogens in tobacco smoke are — there are no safe levels of exposure to either of those — it is still hazardous, albeit in a different way. Breathing pure CO2 would end life within minutes; it is a question of safe levels.
Water, too, is toxic to human life if not regulated —overhydration and underhydration are both potentially lethal. It is the same with our body temperature — as little as two degrees up or down is sufficient to cause illness and, thereafter, death from heat stroke or from hypothermia. This is also the case with blood pressure, heart rate, blood sugar levels, blood cell counts, and so on — too low or too high, and there is risk of illness and, eventually, death.
These are questions of regulation. In the same way, life as we know it on this planet depends on a narrow set of conditions: regulation of our environment is critical.
It has always been the case that the big public health issues are environmental: clean air and water, food, sanitation and education are utterly fundamental to health and survival. In developing countries diarrhoeal diseases from unclean water continue to kill millions while in developed countries the scourge is respiratory cancers and cardiovascular disease from smoking and obesity.
Vested interests and their powerful lobby groups may tell us differently, but they are driven by short-term profits rather than concern for human survival. Tobacco companies have waged a campaign against the scientific data on cancer since the 1950s, as have asbestos companies.
In developed countries, junk food is promoted despite an obesity epidemic; in developing countries, formula was promoted over breastmilk and this, without clean water or sterilisation procedures, led to malnutrition, infant diarrhoea and death. The multinational multibillion dollar industries involved in such promotions generate their own “science”.
This has occurred in my field, psychiatry, where big business — the pharmaceutical industry — has manipulated scientific data to show that their drugs are beneficial, while suppressing data that show they are not. Medications have been promoted that cause diabetes and premature death with little improvement in mental health. In the face of such bogus science it can be difficult to establish the truth of scientific claims and the consensus of opinion among experts may be critical.
In medicine we cannot defer intervention to await some final truth — in the face of an unacceptable risk to life, action is required and we are generally guided by consensus. So, given the consensus of scientific opinion that warns of the dangers of rising carbon levels and climate change, we in the medical profession regard the risks of inaction as too great and we must urge the community to heed this warning.
Finally, we might clarify that in making a statement on this issue, we are not politically aligned: we support policy that promotes the health and wellbeing of the community and speak out against policy that does not — regardless of the government that proposes it.
Dr Carolyn Quadrio is an associate professor in the School of Psychiatry at the University of NSW.
Posted 19 September 2011
This week the MJA features articles looking at the health impacts of climate change.
Carolyn Quadrio in her article asks that a position statement should be produced by the whole profession. I am sure that this is an impossible dream. The climate has been changing for aeons but the present differences are how much is due to human activity. If we agree we should do something to reduce carbon dioxide then let us look at what Australia can do. We use 257 TWh per year (2008) of electricity producing 209755.8 x 109 g CO2. This is 1.92% of the world total. Even if our carbon tax stopped all such pollution there would be little effect on climate change. What are the available means for a 20% reduction?
Nuclear for coal would require 46.93 TWh per year change over. We are so short of water that hydroelectric is not feasible. Solar thermal would require 9.24 TWh or 2310 times what we have, Solar PV 22.75 TWh or 113 times, wind 7.1 TWh or 1.8 times. The main problem of solar and wind is their intermittent nature.
We know of the problems of nuclear electricity but if we look how stable the ground is in most of Australia and look at how by putting small dams below large dams to use hydroelectricity at peak times and the excess (as nuclear stations can’t be turned off) to pump the water back to be used again then it becomes even more practical. As a bonus when we have spare electricity those rarely used desalination plants can be activated.
A carbon tax is patently unacceptable so where would the agreement lie?
The way I read Carolyn’s article is that, as practitioners of a science-based profession, we should support the promotion of evidence over ideology in every area of science. I don’t think we are being called on to use political pressure so much as to stand up for the principle that those people who are trained and experienced in a particular profession should hold the most credibility.
Of course there is debate in every scientific community – just like we have had debates about good and bad fats, optimal control of diabetes, treating BP in the elderly. Just because there is debate in a complex area, it doesn’t follow that we should allow individual lay opinion to have equal validity with the trained scientists in the field.
I think the writer is drawing a pretty long bow in suggesting that doctors using political pressure regarding climate change could improve health outcomes. It would certainly antagonise a large number of Australians and people might view us as aligned with goverments or corporations with a specific self-interested agenda instead of simply there to help people.
A well written and timely article. We need more enlightened doctors to speak up. A similar anti-science theme also exists among vaccine scare mongers. Would Michael care to promote one of their books too?
Climate changes. Sea levels change (just have a look at the evidence of different sea levels on the Sydney sandstone shoreline). No argument there. But the proportion of change in climate due to carbon dioxide in the atmosphere from industralisation-sourced emissions is scientifically debated. And should be. Despite this the main argument in Australia is over how to abate carbon dioxide emissions – carbon tax or direct action. This is an economic and political decision rather than a scientific one. And of course doctors have a responsibility to speak out on matters that affect public and patient well being. The survey seems redundant.
Professor Ian Plimer, Professor of Earth Sciences has published a book titled Heaven+Earth Global Warming: the missing science. It is well worth the read. Here is a scientist discussing the actual science but labelled a “denier” due to his dissension from the accepted views.
Equally as valid in this context is the statement in the previous writer’s post: “Anything that doesn’t fit into the political appointees’ ideological, theological or political agenda is ignored, marginalized or simply buried”, he stated.”
In the book Merchants of Doubt, science historians Oreskes and Conway write that a handful of politically conservative scientists, with strong ties to particular industries, have “played a disproportionate role in debates about controversial questions”.
The book states that these scientists have challenged the scientific consensus about the dangers of smoking, the effects of acid rain, the existence of the ozone hole, and the existence of anthropogenic climate change.
The authors write that this has resulted in “deliberate obfuscation” of the issues which has had an influence on public opinion and policy-making.
In the 2009 documentary “Obesity: Killer at Large” the former US surgeon general Richard Carmona testifed before congress that he was prevented by the Bush Administration from speaking out about the obesity epideimic.
Carmona also testified that the administration had attempted for years to “water down” his report on the dangers of secondhand smoke and pressured him not to testify in the tobacco industry’s racketeering trial: “Anything that doesn’t fit into the political appointees’ ideological, theological or political agenda is ignored, marginalized or simply buried”, he stated.