Log Cabin Chronicles

Whither modern medicine in the days of Peak Oil?

JAMES BARSON, MD
Australia

POSTED: 08.01.08

Greetings from ASPO Australia

I'm an Australian anesthesiologist and the health sector working group convener of ASPO Australia. I've been speaking and writing on peak oil (PO) and health for a couple of years. The PO idea is certainly easier to sell these days -- after years of being an eccentric voice in the wilderness, I'm now having to knock back invitations to speak on the topic.

In the next month I'll speaking to a group of health care providers and consumers in Melbourne and then addressing a PO committee of the South Australian Parliament. Just tonight I received an e-mail request to take part in a two-hour documentary on PO being put together by South Korean national TV.

One of the ideas that I'm trying to expand upon is the critical dependence of modern medicine on the productive capacity and complexity of our modern industrial society.

Given the absolute dependence of our industrial economy on abundant cheap energy, I'm sure that PO means huge problems for high-tech medicine.

There is some evidence that high levels of interconnectedness and complexity increase instability and promote the chance of collapse. But the idea that progress is not a God-given certainty is, to many people, literally unthinkable. I remember Jim Kunstler's Clusterfuck Chronicles story about the bright young things in Silicon Valley who believed that technology trumped energy - has he managed to get anyone to abandon this delusion?

Looking at nature you can see the that in high-energy parts of the biosphere, such as tropical rainforests, there is a huge depth of diversity and niche specialization e.g. hummingbirds dependant one or two types of flower.

This is where we are now.

Whereas in low-energy areas, e.g. the sub arctic where then tundra meets the tree line, the level of biodiversity is low and the archetypal animal is the bear, a totally flexible and opportunistic omnivore. That's where we are headed.

I recently went a scientific meeting and saw a presentation on radio frequency ablation of aberrant conduction pathways in the heart to control arrhythmias. The imagery from the latest technology was breathtakingly beautiful, totally intuitive in its display, and stunningly informative but totally dependent very expensive, very small volume, very high technology manufacturing of single-use equipment.

With what I foresee as the economic impact of PO on the entire pyramid of our industrial economy with possible primary feedstock collapse, logistical collapse, financial collapse etc, I cannot see this sort of manufacturing and technical support being possible for much longer.

Am I wrong? Will it still continue for those who can afford it? There are so many levels at which problems will arise that I think it must fail. It doesn't have to disappear, it only has to become dangerously unreliable. I think we will have to move from the tropical rainforest towards the tundra. Probably a good idea with runaway global warming anyway,

I think that medicine is going to have to abandon its fixation with the latest and the best and move from the constant search for the newest cutting edge technology and instead start to think about rehabilitating viable trailing edge technologies that have been shown to deliver good enough results at lower levels of waste and energy consumption. (Hat tip to John Michael Greer.)

And in the process become less specialized, more generalist, with a broader preventative focus aiming for the maximum benefit for the maximum number and accept that, just maybe: 'Better is the enemy of good.'

We are already at the asymptotic plateau of the cost-benefit curve and on an unsustainable course towards impossible to meet expectations from aging baby boomers (like me), even if we had unlimited oil.

For example, even at today's level we are not able provide treatment for all. Not everyone with annoying but manageable atrial fibrillation who wants to be cured by megabucks radio frequency ablation can have the treatment -- it just costs too much.

They can be managed with a daily tablet and have a few blood tests. But the baby boomers want convenience, not common sense, and don't like to be told that they can't have what they want. However, with the advent of PO I think they will be doing well just to get the tablets and blood tests.

Our current health system has every doctor acting as advocate for each of his or her patients, working the system to their individual (patient's & doctor's) advantage.

What is best for the sum of all individuals is not always what is best for the community.

Some of my dilemmas are:

  • How to address these issues during a period of 'Slowly-unwinding-business-as-usual-with-perhaps-a-few-new-problems-every-month-but-we-can-still-cope. Can't we?' How do we get people to think ahead and plan for energy descent? The boiling frog problem.

  • How to get my techno-addict colleagues to accept the unthinkable, that our future will resemble our past more than our present?

  • How to get any level of social and political acceptance that the imminent reality of rationing healthcare is unavoidable?
In the past I've focused on the more mundane and still important practicalities of mobility, redistribution of physical resources etc. I will still cover these but I think the time has come to "Subvert the Dominant Paradigm!" (One of my favourite bits of 1970s graffiti.)

Or at least, send the listeners away with a philosophical 'stone in their shoe,' something that will slowly work away at them until they have to sit down and sensibly deal with it. Maybe then they will realize that: Business as usual is over...

I'm quite pessimistic and so far removed from where most of my colleagues that they just stare back with blank, blinking incredulity. Although as a result of parroting what Jim Kunstler has written and what I have read on TOD Canada and later Automatic Earth by Illagi and Stoneleigh, I have gained a few converts to pessimism, while the economic storm clouds have gathered as predicted.

Eventually I know that the grid will go down, the lights will go out, and if I'm still around I'll be making my own ether. We will then be on our way to .......?

It seems to me that both the long slow and short fast futures of energy descent have a common, nebulous, but not very reassuring end point. I would much rather be part of a planned power down with planned stepwise retreats than a crash landing which leaves us to try to rebuild from the rubble and unable to adapt.

Hopefully these retreats would, in effect, be long-lasting, sustained steady states with many functioning levels of treatment available and the ability to provide widespread relief from suffering. I would like to think that we could still do hip replacements for many years to come.

What do you think? James Barson barsonj@bigpond.comGreetings from ASPO Australia


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