Doctors and climate change: embrace science and complexity

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.