WHILE I was writing my previous article on disasters at a global scale, I wondered what kind of responses would be generated from the medical community by the suggestion that global climate change could disrupt our health systems with catastrophic consequences.

Interestingly, only seven comments have been posted to date and none objected to the central proposition. In the absence of other evidence, I think that I can conclude that most doctors recognise the potential for human activity to generate global instability beyond our control.

I am not surprised that as a group we would hold such beliefs. The practice of medicine is built on a foundation of scientific evidence that supports our ability to make decisions. Every day in our work, we weigh the balance of probabilities for each patient, and take actions founded on an acceptance of the validity of the evidence produced by scientific research across a broad range of fields including physics, chemistry, biochemistry, molecular biology, pharmacology, psychology, anthropology, sociology and physiology. Without science we are nothing.

We combine such scientific evidence with the accumulated wisdom of our colleagues and our own personal experiences. While at times we may struggle when a small sample of our personal experience clashes with the accumulated wisdom of our peers, we don’t get to accept only the science that doesn’t confront our beliefs.

Generally, we have a bit of time to gather information before we can or must act (eg, tissue biopsy), sometimes we act while still gathering information (eg, community acquired pneumonia), and occasionally we have to act on scanty information (eg, tension pneumothorax or meningococcal septicaemia) because to delay can be fatal.

We are able to make decisions about how we treat our patients because the knowledge that we have gained from science allows us to gauge the likelihood of desired and undesired outcomes. While it is not possible to understand fully all of the risks for any one patient or guarantee a particular outcome for any one individual, we proceed in the scientific understanding of the hazards and act on the balance of probabilities across the group of patients we are treating.

We would never find it acceptable that one of our colleagues would not act to prevent harm because they had refused to set aside a personal bias in the face of information sufficient to demand action. At best a failure to act might be considered procrastination, and at worst malpractice.

The growing scientific understanding of the physics, chemistry and dynamic behaviour of the atmosphere, the land and the oceans, along with the vast quantity of evidence of change, supports predictions of significant disorder in the global climate systems and environments on which we are dependent and for which we have designed our global societies. In fact, recent evidence suggests that some of the worst-case scenarios predicted years ago are those that are happening now, as in a recent article from The New York Times:

“For decades, most scientists saw climate change as a distant prospect. We now know that thinking was wrong. This summer, for instance, a heat wave in Europe penetrated the Arctic, pushing temperatures into the 80s (27-32C) across much of the Far North and, according to the Belgian climate scientist Xavier Fettweis, melting some 40 billion tons of Greenland’s ice sheet.

Had a scientist in the early 1990s suggested that within 25 years a single heat wave would measurably raise sea levels, at an estimated two one-hundredths of an inch, bake the Arctic and produce Sahara-like temperatures in Paris and Berlin, the prediction would have been dismissed as alarmist. But many worst-case scenarios from that time are now realities.”

Just as we are unable to be sure of the outcomes for our individual patients, we cannot know the exact details of how the world will change until those changes have played out. The release of huge amounts of carbon dioxide through the burning of fossil fuels is a gigantic unblinded, single-armed N of 1 trial and recent results indicating harm require that the experiment be halted.

The science that we accept as underpinning our work is the same science by which we understand our world. In his seminal work What is life?, the Nobel Prize winning physicist Erwin Schrödinger described the organisation and functioning of life as being “maintained by extracting order [negative entropy] from the environment” at the expense of increased disorder (entropy) in the surrounding world. Although he was writing about the function of individual lives, this applies equally to how we function as a species and, to continue within the terminology of physics, demands consideration of how to establish a sustainable and stable equilibrium between human behaviour and a finite world.

As individuals, we vary greatly in the evidence threshold that will change our views and a touch of caution as scepticism is not a bad thing. Serious sceptics are perhaps the slowest to change their opinions, but will do so when the facts are clear. On the other hand, denialists, such as anti-vaxxers and flat-earthers, are not open to persuasion, regardless of the evidence. The denial of the extensive evidence of human-induced climate change and environmental degradation, and the projections of their broader consequences, reminds me of the attitude of those who deny that vaccination could have prevented the deaths in the recent measles epidemic in Samoa.

It is very interesting to speculate on why people close their minds to science when it confronts their beliefs. I suspect that for some it may be about their locus of control. In order to accept the science and understand the consequences of climate change, an individual has to let go of any sense that we are in control and adopt a very different relationship with the natural world – we can suddenly feel very small and without individual power. To subvert a sentence from a review in The New Scientist, our world is “indifferen[t] to any relationship that we may try to strike up with it”.

Others cannot see beyond themselves. Leaving aside people for whom global climate change offers an end-of-days Armageddon opportunity, much of the resistance to the evidence of global climate change comes from those who focus on the very real short-term risks of action over the far greater long-term harm of inaction, those who have a personal ideology and/or world view that resists consideration of scientific evidence that threatens those beliefs, or the stubborn and inflexible who double down on untenable views.

A range of influential organisations and wealthy people have spent a lot of time and money driving the denialism.

The Heartland Institute from the US built on the tactics they developed in their work with the tobacco industry to undermine the evidence that cigarettes cause industrial scale death and disease. They are now driving a strong campaign that is trying to white-ant the very clear scientific consensus on anthropogenic climate change. As Paul Krugman wrote in The New York Times recently:

“And the anti-environmental extremism of conservative politicians has, if anything, become even more intense as their position has become intellectually untenable. The right used to pretend that there was a serious scientific dispute about the reality of global warming and its sources. Now Republicans, and the Trump administration in particular, have simply become hostile to science in general.”

And we all know the prominent denialists here in Australia – generally conservative politicians and well known media performers and business people – who have been so effective in obstructing any response to the widespread and growing community understanding of the threats from, and support for action on, climate change.

Given that denialists are immune to evidence, perhaps it is time to reverse the onus of proof and insist that they provide scientific evidence to demonstrate that the climate is not changing.

Interestingly, most businesses, financial organisations and academic institutions across the globe that might generally be regarded as conservative, take a long-term view based on facts and science. They acknowledge the reality of the problem and are now integrating strategies for dealing with the risks from climate and environmental change into their short- and long-term planning. For example, the Bank of International Settlements (owned by 60 of the world’s central banks — including the Reserve Bank of Australia, the US Federal Reserve, and the Bank of England) has produced a short book – The green swan: central banking and financial stability in the age of climate change – that summarises its position:

“Our framing of the problem is that climate change represents a green swan: it is a new type of systemic risk that involves interacting, nonlinear, fundamentally unpredictable, environmental, social, economic and geopolitical dynamics, which are irreversibly transformed by the growing concentration of greenhouse gases in the atmosphere. Climate-related risks are not simply black swans [ie, tail risk events]. With the complex chain reactions between degraded ecological conditions and unpredictable social, economic and political responses, with the risk of triggering tipping points, climate change represents a colossal and potentially irreversible risk of staggering complexity.”

This document is worth reading in its entirety, as are the references in my previous article on disasters.

The scientific evidence for disruptive climate change is sufficient to warrant urgent action. Even though the issues are hugely complex (as described in the Bank of International Settlements report), failure to acknowledge the magnitude of the threat is inexcusable. The longer we put off acting decisively to minimise global climate change, the more draconian the fix and lower the likelihood of success. Is it unreasonable to conclude that a lack of urgent action in the face of overwhelming evidence by so many governments suggests that they have been captured by denialists, have not been able to comprehend the global scale of the challenge looming up behind short-term concerns, or are unwilling to accept their responsibility to address a complex problem with no painless solutions?

The scientific evidence and predictions for our future cry out for urgent action. With diminishing patience, we are, as a community, waiting for leadership from those who sold us on the idea that we should elect them as being the most able leaders for good times and bad. We should accept nothing less than that they justify their claim on leadership by taking the lead for the long and difficult journey of addressing the looming catastrophe of human-induced climate change. As with so many of our patients, inaction will only make the problem worse.

Dr Will Cairns is loitering on the brink of retirement from his role as a palliative medicine specialist based in Townsville.


The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.

10 thoughts on “Doctors and climate change: embrace science and complexity

  1. Anonymous says:

    Why is MJA still providing a platform for deniers of anthropogenic climate change? Or for rubbish about climate science predictions being made by averaging over consensus? Why is MJA editorial policy not to delete this crap like any reputable physics journal would?

  2. Michael C says:

    What I find frustrating is that discussions regarding the reality of anthropogenic climate change usually are very heavy on qualitative statements and light on quantitative information, usually centering around how it is mad that “deniers” can ignore science. I think most people would agree that it is plausible scientifically that we as humans have the ability to do things on planet Earth that may affect its climate. But this qualitative statement is not at all useful to us. For every human activity that is implicated in causing climate change, we need to know fairly accurately the amount of that activity that will cause a specific amount of a particular type of climate change over a specific time-frame, so we can determine how specifically altering that activity will affect things. But unfortunately, the modelling undertaken by climate scientists produces widely varying results, so to be able to make solid predictions (e.g. the Earth’s average temperature will rise x degrees in x years’ time, or the sea level will rise x mm in x years) climate science has resorted to using consensus statements which kind of “average out” all the widely varying results of studies.

    Having to reach a consensus in science betrays how poor the data behind it really is. In medicine, when various health bodies have to reach a consensus about something (e.g. how to apply a particular screening test), it means we don’t know for sure what the right thing is – the studies vary or are inconclusive – but this is our best guess. The consequences of getting a public health consensus wrong is that some people may suffer and/or die. But the consequences of getting a climate change consensus wrong is that we deny billions of people living in underdeveloped regions of the world the chance to increase their standard of living, which history has shown can only be done through the availability of reliable power.

    Remember that if one climate model predicts a global temperature rise of 1 degree C in 50 years, and another predicts 2 degrees C, that is a disagreement of 100%. It is not accurate to simply say in a consensus statement “on average it will be 1.5 degrees” because it ignores the fact that if the results of two studies vary by 100%, one or both the studies are simply not reliable. These sorts of results are not so surprising when we think about the nature of climate modelling. It is analogous to long-term weather modelling, which, although being useful, is also notoriously inaccurate. We as a planet would never bet the future well-being and prosperity of its inhabitants on long-term weather predictions, and so we must not on climate predictions, unless the modelling science improves dramatically and starts producing quantitatively consistent and reproducible results between different studies.

    Until this happens, it is not useful for us flap our arms and say “We must do SOMETHING, because surely doing SOMETHING is better than doing NOTHING!” because in this case doing something may indeed be harmful to billions of people living in underdeveloped conditions.

  3. Edwin knight says:

    I must apologise, I got carried away. Water is, of course, dihydrogen monoxide, not hydrogen dioxide. Silly me!

  4. Edwin Knight says:

    I believe in climate change as the evidence shows that the climate does change. I accept that the climate shows evidence of warming. What I find difficult to accept that that climate change is mostly anthropogenic and that the emission of carbon dioxide from the burning of fossil fuels is solely or mostly the cause of global warming.
    Now the talk is about carbon. But it not carbon, the element, but carbon dioxide, the molecule which is held to be responsible. This gas is what we breathe out with every breath.. It is the gas that plants take in and by the action of photosynthesis , take the carbon and discard the oxygen into the atmosphere.
    We do not talk about hydrogen in the atmosphere. it is hydrogen dioxide or water vapour we talk about and this is also a factor in retaining heat.
    Science is never settled- new discoveries lead to new evidence and new theories. New discoveries are based on observation of raw data. If the data is unreliable, it has to be discarded not modified. Computer modelling is always suspect- remember the adage: “rubbish in -rubbish out”. Consensus is not a scientific concept.
    Listen to the experts, but their advice should always be taken “cum grano salis!”

  5. Ian Hargreaves says:

    Will, you refer to “extensive evidence of human-induced climate change”, but the glaciers started to retreat over 20,000 years ago, with the ice sheets leaving Manhattan around 11,000 years ago.

    Back then the Europeans were huddled in Southern caves like Altamira and Lascaux, the Africans were muddling on with megafauna they could not control, the Asians had not yet developed their great cities and civilisations, and the Americas were unsettled.

    In many commentaries on the recent bush fires, aboriginal land practices were mentioned, including the deliberate use of fire. When you have not invented a hose, all fire is by definition uncontrolled. Only one group of people in the entire world had access to vast quantities of flammable old-growth bush land, and are known to have used fire to release the CO2 within. So if climate change is human induced, only the aborigines could have initiated it. The Hills Hoist pales in comparison as an Aussie achievement.

    Furthermore, your article refers repeatedly to science and scientists. When I was a kid they warned about the risk of another ice age, which would devastate humanity. Nuclear winter was a pressing threat. Volatile men like JFK and Kruschev had their fingers on the button, unlike today with Donald and Vladimir and Jinping and Jong Il. Having learnt of the many, vast temperature swings of the entire planet, I remain agnostic as to whether human influence is as relevant now as in the Silurian.

    But it was scientists who invented the coal fired power station, the oil rig, the steam engine, the internal combustion engine, the diesel engine, the jet engine. The greatest science prizes are named after Nobel, whose industrial explosives turbo-charged the industrial revolution, making possible the huge open-cut coal and ore mines. And as a corollary, made weapons of mass destruction feasible.

    The scientists who didn’t realise that the CFCs they invented would deplete the ozone layer, or that DDT or PCBs or Dieldrin or 2,4,5T were bad for the environment. The massive group of Nobel-Prize-winning scientists who gave nuclear weapons to politicians, not thinking they might actually use them. Just like the scientists who invented crossbows, cannons, machine guns, napalm, weaponised anthrax… The scientists who industrialised agriculture so our country could rape the entire island of Nauru for guano, and give it a catchy name like ‘superphosphate’ when it ran off onto the Barrier Reef. The scientists who knew that the cane toad was the ideal solution to the cane beetle.

    Putting scientists in charge of fixing the problem for which they are principally responsible, is like putting a rapist in chart of the women’s refuge, with some reassuring slogan like ‘all our staff have personal experience in sexual assault’. “We caused all earth’s problems – so now trust us to fix them”.

    But it is one thing for doctors to believe in anthropogenic climate change, and another to do something about it. My CPD program gives me more points for attending an international meeting than a national meeting, which is in turn worth more than a state meeting, which is worth more than a local or regional meeting. Last year, the RACS chose to hold its annual meeting in Bangkok, and I do not think many participants joined Greta Thunberg on a sailboat. Banning physical attendance at medical conferences is a tiny start. Or like my old boss described, re-using the needle till it got blunt, then sharpen it and dip it in alcohol, no wasteful disposables.

    So Will, what is the “urgent action” you urge for “addressing the looming catastrophe of human-induced climate change”? When tiny numbers of even the most simply-living palaeolithic aborigines started the climate change.

    Like Marvel’s Thanos, a random cull? Does palliative care experience cause you to propose a voluntary option, like Groening’s Futurama with its Suicide Booths? Or perhaps, to misquote Shakespeare, “The first thing we do, let’s kill all the scientists”?

    Sorry for being a simple surgeon, but so many people believe humans are the problem, yet so few actually consent to being excised.

  6. Lyn Allen says:

    I was in Stockholm last winter and the ferries were still running as the seawater had not frozen,This meant that no maintenance was able to be done on the buildings as the trucks are usually driven across the ice as most of the bridges are very old and not wide or strong enough for trucks Stockholm is made up of 14 islands..Northern Sweden where my son lives had its usual heavy snowfalls keeping the snow ploughs busy at night clearing footpaths/bicycle tracks and roads clear-the hardy swedes ride all year and just change tyres. This year there was little snow in Stockholm and Northern Sweden had some snow but then a week above 0 which melted it all and with refreezing is now dangerous ice People are only going out if they have to for as short a time as possible making winter even more miserable than normal The climate has changed quickly

  7. Anonymous says:

    I have read extensively about both sides of the argument. The Fear of changing climate has been around for a long time. I am more worried about the anxiety it causes and the distraction from other important local issues.
    Some people need a cause to believe in and something to be afraid of. It just doesn’t seem to resonate with me despite my university degrees.

  8. Anonymous says:

    If Australia takes the maximal possible action and reverts to an Aboriginal subsistence ” Zero Carbon ” (sic) economy tomorrow ie no flights, cars, power,batteries, aircon, shops,hospitals,medications, or fires to cook our kangaroo etc then what difference will be noted in the climate tomorrow and in 10 years and 100 years?
    “But we’ve just got to do something!” is ridiculous.
    If the response is that “Australia needs to lead by example to show China and India that they too need to revert to subsistence economies to save the climate” then please consider that Australia abolished capital punishment in 1973 and China and India have not followed Australia’s leading by example 47 years later.
    To the smug doctors who continue to fly everywhere and feel absolved by paying “carbon offsets” to Nigerian princes maybe if you were serious you would stop all flying,stop using any coal or gas fired power,sell your car and spend your carbon offsets on planting trees.
    No.It’s only the proletariat who can least afford it who should suffer.

  9. Dr Rosemary Stanton says:

    Dr Cairns – this is an excellent article. I think it’s especially likely that some people find it hard to accept that they need to fit in with the natural world rather than being able to manipulate everything to suit them.

    We so need to take action fast or as you say, everything will be much harder, not only for our children and grandchildren, but for us.

  10. James Hurley says:

    Hi Will,
    Agree with your comments and despair about the continuing disbelief in the reality of climate change expressed by several honourable members on television talk shows.
    Is it that we lack accountability in the Australian media? Increasingly, (as in the US) people can purchase the views that suit them at the news stand.

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