Issue 8 / 9 March 2015

“We must be prepared to take more risks” — this is what Clive Hamilton, an Australian professor of public ethics, said to me when I asked him how should we respond to the threats of human-induced climate change.

Climate change represents the biggest evolving threat to human health.

Our backs are against the wall. If we want to survive in a stable and healthy world, we need to embark on a new social experiment — an experiment because much of what we face and what we need to face, is new territory for us.

Indeed, it may entail new territory for biological psychology. What are our species’ capacities to modify our current behaviour in the light of a threat that is diffuse and extends beyond our own lives?

What are the social and regulatory changes that are needed to address this? These changes would not be minor. They would not be business as usual with a bit of green energy stuck on the side. Living sustainably is a full paradigm shift.

There’s the rub.

The Doctors for the Environment Australia (DEA) comprises doctors and medical students committed to addressing ill health resulting from damage to the natural environment.

The main focus of the DEA’s national conference — to be held in Sydney this year on 14‒15 March — will be, appropriately, climate change.

I will be speaking at the conference about my experiences working literally at the coalface in Lithgow, a town in the NSW western coalfield district. Here the realities and complexities of any shift away from coal are direct and perceived as threatening.

In terms of the ABC of emergency resuscitation, responding to climate change is the airway. If we can’t kick our carbon-burning habit, then most of the other agendas will be trashed — be they public health, social transformation, stable and flourishing cultures, a rich natural environment, technological utopias … the dreams we dream.

But burning carbon is no easy habit to kick. It has offered us cheap industrial power and with that has come political power. We have many and vexed tensions to grapple with — social, political, globalist, economic … the list goes on — if we are to shift away from our carbon dependency.

The climate scientists and environmentalists have pressed hard to get their concerns out into the public arena. Even a few politicians have stuck their noses into this dangerous wind.

But what about the medical profession? What are we doing?

By and large, I’d say not much. We are commonly more focused on individual care, on treating people’s immediate health issues.

Yet the health and social impacts of climate change will be massive. If we are seriously interested in the full picture of health, including intergenerational health, then this is an area that needs our serious attention.

Medicine does have a long tradition of trying to improve society more broadly using the prism of health. As a result of our dedicated care, we earn our place as a leading social stratum of professional respect and authority.

We need to use all our leadership capacities, all our creative energy, all our deep and broad social connectedness to make our contribution to the massive social shift that is required to address climate change. Multidisciplinary medical advocacy on this issue will have an impact, possibly a big one.

We need to act and influence now.  The science — our Holy Grail — is suggesting we are fast running out of time.

For us, individually and collectively, to seriously engage with this threat will possibly bring us into new, challenging territory.  I have been threatened at public meetings in Lithgow for daring to discuss alternatives to coal mining.

New territory can be threatening, but we must be prepared to take those risks.

If we don’t, it’s just going to get even riskier.

Dr Richard Stiles is a rural GP/surgeon in Lithgow, NSW. He is a public advocate on the health and environmental effects of the coal industry and a member of Doctors for the Environment.

29 thoughts on “Richard Stiles: Take a risk

  1. Mark Wilson says:


    Thanks for your thoughtful, discussion provoking piece. Doctor means teacher, and the Australian medical students of today are taught that they are expected to commit to community leadership roles in tomorrow’s world.  It would be a tragedy if these intelligent young people who have been taught to use critical thinking to apply the weight of evidence in promoting health for individuals and society were to join the company of skeptical, “slowly boiling frogs” who just do not wish to consider external threats to human wellbeing.



  2. Chris Tuckfield says:

    To the deniers: how exactly are you going to do a RCT as we only have one planet?  That is armchair thinking of the worst kind. And to the colleague who apparently cant see the link between climate and health – frankly you need to get out more and start doing some reading. Read Mark Lynas ( for an uncontested summary of what 1,2 ,3 ,4, 5, 6 degrees actually means based on scientific evidence, so you know what the numbers mean when they are glibly tossed around. Ignorance on this issue is not OK any longer.  If you aren’t thinking scientifically then what emotion/fundamentalist belief exactly is driving your thinking?

  3. Marcus Aylward says:

    Oh Joseph(19.58)! You KNOW that’s not true. 97% of homeopathy papers support a positive benefit from homeopathy: and you know we doctors are homeopathy deniers.

    It’s not the number, nor is it the content: what is important is WHO has written the paper. That’s why in the current discussion we only heed the views of climate scientists deemed reputable by other climate scientists.

    Like Nicholas Stern, Ross Garnaut, Tim Flannery et al….

  4. Farmey Joseph says:

    I have to commend George Crisp on an exciting innovation that will revolutionise the world of evidence base medicine.

    No more of that tedious appraisal of evidence.  No more hours spent purusing the evidence and examining the temporal relationship, the dose-response gradient, sources of selection and measurement bias, etc. etc.

    Instead of all of that, from now on we only need to look at “the basis of publication”.  We merely need to COUNT the studies in favour and against a hypothesis.  Whichever side of the argument has MORE STUDIES must be true! 

    After all, if it works for climate science, why shouldn’t it work for medicine?

    Thanks, George.  You’ve made my life as a doctor so much easier.  I’ll just count studies from now on.


  5. Dr John Crimmins says:

    Why do we who have had the luxury of an extended education in critical thinking throw all that out the door when we threatren our position of comfort.


    As critical thinkers we have no trouble defending alot of health therapies that have little real impact on patient haelth as measured in quality years on the earth. The actial NNTs for most mediactions are quite poor including prevention and cancer care but we persist and not question their use as ‘it makes sense’ to do something than not..

    Based on that same critical gut feeling we all know that we cannot keep poluting the environment in the name of affluence without consequence. Well the real science is in and it does and will impact on our environment which is a pillar of our holistic look of health. 

    Luckily the silent majority are paring back wasteful consumerism to build a future for everyone.  Global growth of GDP is thankfully slowing over the past century.


  6. Marcus Aylward says:

    Anonymous (12.10)….and Bashar al-Assad and Radovan Karadzic are doctors who were also ‘social reformers’. 2-all; not sure how the name-dropping advances the discussion (but playing the Che card is, I agree, always usually a winner). Having thought that medicos were on the periphery of the climate change discussion, we can now see that even reducing miners’ lung disease and avoiding tectonic instability are among the disparate threads to be harnessed to the cause. Marvellous stuff. Any potential ill, no matter how tenuous, constitutes a further moral case for ‘action on climate change’. That the action should be efficacious is of no concern; the mere high-minded churning is enough. Instead of blather and posturing, how about a practical exercise to get the ball rolling?: STEP 1. Set up a supra-national body (no, the UN – being ineffectual – does not count) to which all governments will cede powers to compel cessation of use of fossil fuels in light of the availability of adequate alternative energy sources to provide equivalently reliable, cheap baseload power. STEP 2. Actually, get back to me once you’ve sorted Step 1…

  7. Richard Stiles says:

    Thanks everyone for making your comments on my article – and I really mean that, everyone.

    I must say I’m surprised at the flow of the dialogue.  I would have well envisaged that what I had to say could be critiqued from a variety of perspectives – but I wasn’t expecting that in a journal with a medical audience that it would revert to a debate between climate change denialism (all but one, under pseudonyms!) and climate change ‘acceptism’.  It clearly shows the challenges that this issue faces.

    An analogy might be an article in an engineering journal that riased Harvey’s notion of blood circulation – that generated a string of comments from the engineers about how Harvey had got it all wrong!

    Rather than climate change being an environmental shift that constitutes a social/health/even survival threat, it is suggested as a ‘lefty’ or ‘greeny’ political, even ‘quasi-religious’, agenda!

    Which again leads me to the psychological challenge this issue presents.  In my view, we are powered by our emotions – and when we have a tensioned dysjunction between our emotions/general ‘worldview’ and our rationality, it is common for our emotions to re-configure our reasoning to suit their aims, rather than the reverse.

    However surveys generally demonstrate that most people want our leaders to productively engage with addressing climate change.  I thus presume most doctors do also – irrespective of the role of reason.

    And even if this majority thinks they have a more productive means of engaging with climate change than the line I have chosen, I am fine with that.  We just need more public engagement than is generally being offered by health professionals currently.

  8. George Crisp says:

    It is intersting that (here as elsewhere) most of those that refuse to accept the science on climate change opt to comment anonymously. Perhaps it is easier to snipe from the shadows.

    In reply to “Joseph”; the consensus which you dispute is not just expert opinion, it is a reflection of published science. In fact on the basis of publication, the consensus is over 97%.

    It is also the case that the theory (as in scientific theory) is suported by multiple lines of evidence including  current and recent observations, paleoclimate data and computer models and of course consistent with our understanding of atmospheric physics. With regard to the later we’ve known what would happen with addition of greenhouse gasses for a very long time ( Svante Arrhenius predicted that a doubling of CO2 would raise atmospheric temperatures by about 5 degrees at over a century ago (ie climate sensitivity) not far off what climate scientists currently think the correct value is.


    You really should get with the times.

  9. Farmey Joseph says:

    As doctors, we should all be committed to evidence-based medicine.  That includes a strong appreciation of the hierarachy of evidence, with systematic reviews of randomised controlled trials at the top of the hierarachy, and “expert opinion” at the VERY BOTTOM.

    Yet when it comes to climate science, so many doctors turn that upside down.  Suddenly, our climate alarmist colleagues imply that expert opinion is the very pinnacle of evidence, and there’s no need to look at the actual evidence because “97% of climate scientists” agree with the athroprogenic theory of climate change.

    (Incidentally, that 97% statistic has been thoroughly debunked.  Anyone can see that if he or she takes 5 minutes to examine the source of the statistic, instead of just brainlessly repeating it.)

    I don’t mean to pick on commenter Bill Carseldine, but he provides a good example of this mindset.  His entire comment contains no actual evidence for his assertion that greenhouse gases will cause “massive ill health”.  But he does proudly cite that “97%” figure, and treats that as evidence.  Meanwhile, he disparages the opinions of many of his colleagues who have actually invested the time to examine the actual scientific evidence (not merely the opinions of self-professed experts) and arrived at a different conclusion.

    Is it too much to ask that doctors apply the same standards of evidence to climate science as they do to medicine?

    Expert opinion is no substitute for examination of the evidence.  Not in medicine, and not in climate science.

  10. Dr. Balaji Bikshandi says:

    To the people thinking we are out of our depth: doctors have been the most significant of social reformers – che Guevara type to Marmot type! So are you saying it’s OK to dig 10 km deep holes everywhere, shift land masses with billions of tonnes from one tectonic plate to other and still have absolutely no health effects? Not even pneumoconiosis ??  It is very relevant to our profession – if we don’t discuss it who do you think is the right group??

  11. Marcus Aylward says:

    Doctors pontificating, out of their depth; earnest entreaties; running on the spot…

    ..”full of sound and fury, signifying nothing”

  12. Dr Miriam Brooks says:

    Courageously written.

    Paradigm shifts can make us feel disoriented, vulnerable and defensive, like the ground has been pulled out from under us. All the important social changes in history must have felt this way to many people. From our historical perspective we look back in human history at previously accepted social practices like slavery, women having no voting rights or rights to ownership of property, appalling child labour, the absence of democracy and rule by monarchs who could behead anyone who didn’t conform to their priorities and we find it hard to fathom how any group of people could have tolerated such terrible injustices as were embedded within their societies at that time. And yet at that time people said that kings ruled by divine right, that the end of slavery would cause economic collapse, and there were many who felt the social order would be totally disrupted by women having the vote. The social change movements that brought an end to those injustices took many years of hard unpaid work by diverse people who sensed that as a human race we must be capable of better than this

    At this point in human history we have to ask ourselves what are the rights of future generations of people on this planet and how will they look back at us? What is our responsibility as health care professionals to the wellbeing of today’s generation of children, whose health depends on a safe climate and healthy environment? How can we as a human society learn to live within the terms of the earth?

    Thankyou for starting this conversation Dr Stiles.

  13. Dr Brian Marshall says:

    The comments to date are fascinating.  They show that the medical profession mirrors the spectrum of views in society – from ignorance, through too busy to bother, to being actually informed by the views of the vast majority of climate scientists!  Yet the profession’s responsibility to pursue preventive medicine, in addition to healing ailments, demands a more enlightened approach.

    Several of those providing critical comment seem unable to distinguish between climate change resulting from long-term geotectonic processes and the relatively recent impact induced by the industrial revolution and ballooning global population; that is the human-induced component of climate change.  Similarly, at least one commentator fails to appreciate the difference between weather and climate change.  It is sad that, like far too many people, those criticising Dr Stiles seem to be in denial and remain unreceptive to anything which might impinge on their immediate energy-consuming lifestyles.

    Dr Stiles should be congratulated for acknowledging the elephant in the room.  Far from being an idealist, he  realistically identifies the need for the medical profession to look beyond the end of its collective nose!

  14. Farmey Joseph says:

    Don’t worry Richard. 

    Even if your articles get torn to pieces by commenters more informed than you are, you and the “Doctors for the Environment” can always count on our wonderful MJA editors to provide a free and uncritical platform for you to morally lecture the rest of us.

    All courtesy of our AMA membership fees of course.

  15. Bill Castleden says:

    Well written.

    Those of our colleagues who deny the science that says that greenhouse gas pollution of the earth’s atmosphere will cause massive ill-health as detailed by the World Health Organisation will, most likely, never be able to analyse climate science dispassionately. They are victims of a fixed political ideology. It is as if they hold some fundamentalist religious belief. Their ideological belief system compels them to counter all the rational arguments of 97% or more of the earth’s climate scientists with one that better suits their ideological framework. Some of them are our friends with whom we have debated for years and others are near the pinnacle of their professional lives and near to retirement. Understand their particular belief problem and move on, just as the rest of the world is moves on and changes all the time.

    In many countries GDP continues to advance, albeit slowly, just as these countries’ carbon dioxide emissions are starting to fall in response to their investments in renewable energy. Within a few years it will become apparent to those who are able to undertake dispassionate analysis that the argument that burning fossil fuel is the only way to keep the world’s economic wheels turning, are incorrect.

    Richard, whatever you do, don’t stop writing beautifully crafted and thoughtful articles such as this one.

  16. George Crisp says:

    For all those non-expert commentators who doubt climate change is happening or is caused by our activities, you might consider this; do you expect your patients and your colleagues to accept your expertise and advice in your field or specialty? If so you might like to reflect on your position and why you feel it is acceptible to dismiss the consensus of opinion of climate scientists who are collectively in no doubt at all.

    It is not for doctors to decide about climate science just as it is not for any other scientist to decide about medical decisions. But it is our role to review and interpret the resulting health implications.

    We already know that climate affects health, directly, through heat extremes and associated changes in precipitation and indirectly through changes in the biological and physical world, resulting in food and water insecurity and ecological changes affecting disease transmission. To ignore this or pretend it is a political issue would be contrived negligence and it would be absolutely inexcusable.



  17. Sue Ieraci says:

    For those commenters who don’t accept that climate change could be anthropogenic, could anyone explain whether they think there is ANY impact from industrialisation? Can we really fell huge areas of forest, replace vegetation with high-rise cities, have huge-scale farming and grazing, and burn fossil fuels without any impact on the biosphere at all? How could that happen?

    In the 1970’s, there was general agreement that industrial “pollution” was a bad thing, and we did things like removing the lead from petrol and paint, and removing hydrofluorocarbons from spray cans and refrigerants, to name just two factors. Are people who don’t accept that human activity has an impact on climate still concerned about industrial emissions? 

  18. Chris Tuckfield says:

    Its amazing but sadly predictable  that the climate denialist trolls are here as well. I find it hard to believe that scientifically trained medical people could doubt the scientific certainty (because thats all we ever have) of human induced climate change. How can they practice contemporary medicine which is so science dependent? But the game is up deniers. Worldwide, large scale action is starting  (see for a quick summary) , not generally for reasons of heart but under the force of naked economic imperative, unstoppable, just like divestment. Boo-hoo to the trolls and congratulations to Dr Stiles


  19. Marcus Aylward says:

    Alex (15.35), others have opted for big statements, so let’s try a few:

    * one can accept the science of global warming without accepting the proposed solution

    * you will never succeed in “de-carbonising” energy provision 

    * this is in part because of a refusal to “uraniumise” energy provision

    * in the attempt to decarbonise, you will cripple the capacity of economies that might lead mitigation efforts

    * you will similarly commit less developed countries to a return to the poverty from which cheap energy has just allowed them an escape, with an associated return to earlier mortality rates

    * if you think the need to re-locate the residents of Tuvalu and the Maldives is a logistic challenge in the face of rising sea levels, try banning carbon based energy forms and then relocating the Canadians to the Southern USA, and the Chinese to India

    * the presumption of left/green bias arises from the punitive measures that are to be directed against the evil polluters (i.e.capitalists) who have dragged us into this mess and who must be made to pay (PS I am typing this on an iPad; did you use one too?)

    The planet will warm; it will be different. We will adapt.

  20. Alexander Gordon says:

    What I find so hard to comprehend is how climate change/global warming is painted as a leftist/green issue. It isn’t at all. People with those underlying ideologies are far more open to accept its presence, but the effects will be felt by all. The questions asked in scientific studies do give their answers a bias, but to disregard the answers seems foolhardy.

    “Reductions in global greenhouse gas emissions would increase the chance of constraining future global warming. Nonetheless adaptation is required because some warming and associated changes are unavoidable.”  from the CSIRO.

    By the time any science got close to 100% proving that human activity is the main cause of climate change, it would be too late to intervene. It isn’t Green, it isn’t Leftist, it is just Sensible. There is a significant likelihood that increased CO2 is contributing to global warming, and as such we should try to stop it, because the consequences of inaction are grave.

  21. Greg Hockings says:

    Climate change has been occurring over many millions of years. Our planet has been through ice ages, enormous floods and periods where the Sahara desert was green and fertile. Our species has survived all these events and changes, some of which resulted in near-extermination of our ancestors, as shown by genetic bottlenecks from our past which have been detected in modern research.The Earth is in fact overdue for another ice age. So by all means, let’s destroy the economy of the developed world to support the climate change religion of the left. It is one thing to believe that humans are contributing to climate change. It is another matter altogether to think that we can or should interfere in our planet’s long-term climate cycles.

  22. University of Sydney says:

    It’s hard not to have some admiration fot the sheer chutspah of my medical colleagues who think they can figure out the science of climate change better than climate scientists.

  23. Dr. Balaji Bikshandi says:

    To the people questioning climate change – it is debatable. But, let’s not forget that we are plundering our environment for coin chips. This is an indisputable fact. Besides the coal that goes outside only helps some countries that are very different in their core values to us. I mean the coal is only used to violate human rights!! Look at the quality of products that come out of burning it – cheap and low quality. This mindless mining should stop. 

  24. Martin Bailey says:

    Thank goodness for young idealists like Dr Stiles, unafrad to speak up despite the  cries of the political far right- who just cannot accept the ever increasing evidence of global warming.

    From memory I think the death toll  in the Victorian Bushfires a couple of years ago was about 120, however the excess deaths in the heatwave that preceeded it was three times that number -and the best  predictions-except from fossil fuel execs,and the far right- is for longer hotter drier periods in future

    Climate change is a matter of health concern

    Climate change is a matter of national security

    Climate change is a concern for ecology, loss of biodiversity,rising seas, and ultimately of human survival.


  25. Dr. Balaji Bikshandi says:

    Well done! Capitalism has denigrated to collectivism, corruption and undermining meritocracy. In this country we value freedom. If free speech is faced with threat, it should be faced with more free speech! Although there may be cowardice among some members of the medical profession, I think Aussie doctors, regardless of their country of origin, are brave – inspirations like you exist. My best regards for success. 

  26. Dr. Adrian R. Clifford says:

    Dr. Stiles asks what is the medical community doing to prevent global warming? A great many of us as scientists don’t believe that global warming is affected by human endeavours. As doctors, our main interest is healing the sick and preventing sickness where we can, not giving unproven commentary on why the weather is changing! Global weather change is influenced by many factors most of which are beyond the control of man. The slight increase of CO2 released into the atmosphere due to the burning of fossil fuels makes so little difference that it can be excluded as a cause of global warming. More to the point, deforrestation, increasing the number of methane producing animals for food and increase in human population all contribute to the increased green house effect of global warming. We can’t change the weather, but we can control other factors. In the mean time let’s educate the populations towards birth control and tree planting. Trying to change the weather is like King Canute trying to change the tide.

  27. Marcus Aylward says:

    Lots of big statements, infused with the naive idealism typical of climate religionists.

    Alternatively, you could present some actual data, such as the increase in numbers of deaths of people now unable to afford heating because of the distorting effects (and pure posturing in terms of actual efficacy) of energy pricing policies.

    Unfortunately – particularly so in the case of activist medical practitioners – love of the environment seems necessary to entail a misanthropy with regard to the well-being of the earth’s extant 6 billion or so inhabitants.

  28. taylorr@amamember says:

    I’ve spent a lot of time since 2009 researching climate change patterns for myself and talking to University of Adelaide Environment Institute staff about the issues I’ve come across, and interpreting  them.

    I started out somewhat sceptical about the human contribution because so much of the early argument for human causation was being based on the meteorological data which began to be kept between 1890 and 1910,  just after the end of the recent mini ice age from around 1100AD to the late 19th century, and was thus bound to show a rise in temperature and CO2 levels. The longer term records demonstrate a persisting cycle of change over millennia consistent with the Milankovitch Cycles and orbital accretion variations, and there are historical records of Greenland once being green not white (about 900AD), and of Romans growing grapes in Yorkshire around 200AD.

    I’m now convinced there is a significant human contribution to the current trend, but not convinced ending that will end climate change and its consequences. We need to plan for ongoing climate cycles and not kid ourselves that reducing our carbon use will make it all go away.

    And in the meantime we are ignoring other important issues like the carcinogens in diesel fuel because it is economically too hard to tackle as so much of our economy depends on transport.

  29. Malcolm Brown says:

    In fact there has been no global warming this century and climate scientists are completely baffled. There are many suggested explanations ( but the important thing is that the climate models have been shown to be wrong and there is no way to predict future climate trends. In those circumstances the opportunity costs of CO2 emssion reductions are huge, and we should spend our time and effort on the myriad of real, recognised health issues.

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