The Future of Medicine in a Time of Resource Deprivation?

This is a guest post by Dan Bednarz and Paul Roth.

Recently, Energy Bulletin posted a summary of a UPI story that described a WHO (World Health Organization) study projecting global mortality and disease patterns in developing countries to the year 2030. The UPI story is titled “Analysis: Wealth Brings New Health Threats,” and concludes:

As the level of development worldwide increases, the greatest threats to health will shift from infectious diseases to non-communicable health problems like smoking-related illness, obesity and depression.

At first glance, this story illustrates how economic growth and associated consumerism create “diseases of affluence” (such as heart attacks, stroke, obesity and diabetes). As these illnesses are already rampant in the Western world, their increasing prevalence supports the notion of a reduced marginal rate of return on health expenditure, once basic public health measures (such as sanitation, safe drinking water provision, and mass immunisation) are implemented.

But while this is a subject worthy of discussion in its own right, it is not what caught our eye about this study. Let us explain how peak oil and associated ecological crises are of the utmost importance to the future of global health.

WHO Study

The authors used a range of health and economic indicators to predict global patterns until 2030 for over 200 countries. They based their research on an earlier WHO paper that had attempted the same analysis.

Their basic premise was that continued economic growth would improve health in the same way as it had in Western countries, but also cause a swing away from infectious disease to what they term “non-infectious” ones (for example obesity or motor vehicle accidents).

Unfortunately they did not question their assumption of business-as-usual, nor did they acknowledge that currently developing countries might learn from, and avoid, some of the mistakes made in the past. There were several other methodological issues, which by themselves introduce significant uncertainty into the study conclusions:

  1. No consideration of the emergence of drug-resistance in HIV, necessitating the need for multi-drug regimens or newer (and more expensive) agents.
  2. Examples of both underestimation and overestimation of health burdens in the lead-up study suggests that the underlying methodology of this study could also be faulty.
  3. No real attempt to account for emerging bacterial antibiotic resistance.
  4. Quantitative and qualitative problems with mortality data from some countries (especially in Africa) were overcome with computer modelling, but while providing data for analysis, it also introduces potential bias into the results (as the quality of the modelling is uncertain).
  5. Undue reliance on improved living conditions in sub-Saharan Africa (if this does not eventuate, the main conclusions become negated).

The fallacy of continued economic growth

Allow us to explain how the premise of perpetual economic growth in the WHO report is placed in sharp relief by peak oil and related ecological threats. By this we mean that in a larger context, this study illustrates how public health is unable to conceptualize or address the pressing sustainability issues of our time.

By sustainability we refer to both:

  • The maintenance of appropriate technological and social complexity (including economic, political, and social institutions like healthcare); and
  • The health of the biosphere that humans are dependent upon for life, but which they are, at the same time, endangering through their current practices to continually increase said social complexity.

Since one of us (DB) works in the nascent field of energy and healthcare (which most public health academics regard as a “fringe” topic, but is obvious once one understands peak oil in the metaphorical senses of E.O. Wilson’s Bottleneck and Meadows’ Limits to Growth), we were astounded by the naïveté of the WHO to only construct scenarios of positive growth for the year 2030.

Couldn’t things be worse by then? Wasn’t one (or even several) bad-news scenarios worthy of consideration, given the sustainability issues the world faces?

As those who read Energy Bulletin or The Oil Drum know, by 2030 the energy picture looks grim - we almost assuredly will be at the end of the fossil fuel era as the mainstay of energy supply to human life.

At best, we assume, humanity will be struggling to create energy systems that maintain complexity and do no further harm to planetary ecosystems. At worst, sea level rises may be flooding cities around the world and literally force-relocating human and animal populations; and human society may be economically devolving.

Dan Bednarz emails the WHO

One of us (DB) decided to find out what the WHO knew about peak oil and climate change, and whether or not they had considered these factors in their study. What follows are excerpts from Dan’s investigations, including an email exchange with the study’s author.


I have read [the UPI story] “Analysis: Wealth brings new health threats,” … Can … you tell me if climate change and the coming scarcity of oil and natural gas were variables in this analysis?

Study author:

The projection methods primarily used historically observed relationships between economic growth and cause-specific mortality together with World Bank projections of income per capita. The coming scarcity of oil would only have been taken into account to the extent that it factored into the World Bank projections of income per capita.  Climate change was not explicitly modeled as an input.

He directed DB to the full report which reads:

[T]he researchers used projections of socio-economic development to model future patterns of mortality and illness for a baseline scenario, a pessimistic scenario that assumed a slower rate of socio-economic development, and an optimistic scenario that assumed a faster rate of growth.

Slow growth is “pessimistic” and, to repeat, negative growth is not considered. Why? Because the past is prologue:

These “aggregate models” …, use the previous trend of the variable of interest as the basis for predicting its future value.

If (probably when) peak oil and related “limits” issues damage the biosphere and human economies in the coming years, public health forecasters will no doubt exclaim, “We Never Saw It Coming.” Consider in this context this qualifying comment in the WHO report:

If the future is not like the past – for example, through sustained and additional efforts to address the [UN ] Millennium Development Goals, or through major scientific breakthroughs – then the world may well achieve faster progress than projected here, even under the optimistic scenario. On the other hand, if economic growth in low-income countries is lower than the forecasts used here, then the world may achieve slower progress and widening of health inequalities.

So the caveat is that the future might be even better than the report estimates.

The blind-spot of academic public health

Along with astonishment we felt despair about this report: Just a few weeks earlier at the American Public Health Association meetings in Boston, DB had discussed how the leadership of public health was conceptually blind to the unprecedented population-level health threats posed by peak oil. And here was yet another example purporting to be a guide to health policy-making for the next three decades.

Unfortunately, many academic public health researchers work in settings that encourage them to avoid the discontinuous change that awaits the world. Instead they are busy working away at “normal science” – some of them of great importance and merit – projections that literally ignore the driving forces of healthcare in the 21st century. In other words: They assume that technological progress and economic growth will always be positive.

Public health is supposed to use its foundational conceptual tools of epidemiology and biostatistics to perform its core functions of “assessment, policy development and assurance,” in plain English, to anticipate, detail and respond to threats. In the case of peak oil – and the “bottleneck” and “limits” matrix of related problems – the discipline is virtually silent. Why? Here’s what DB said at the APHA convention that also appears to fit this WHO study:

  • Brains: Humans appear to have a cognitive bias of attraction to optimism and repulsion from “worst-case” thinking and scenario building. For instance, only 20% of those who may carry the genetic predisposition for Huntington’s Disease take the test to find out – 80% would rather not know despite the consequences of remaining ignorant.
  • Beliefs: As social creatures we naturally participate in various institutions that establish our values and beliefs, and criteria of evaluation and judgment. It is quite difficult for an individual to “think independently” of these institutional memberships, especially about worst-case outcomes that run counter to cultural values, in this case that of economic growth and technological progress. Put differently, contemplating the limits to growth calls into question our national identity --belief in the American Dream and unbridled optimism. Nothing short of physical survival itself –which we humans collectively may face in the coming decades-- is more important to a human being than a sense of identity. This is a critical reason why so many people –even in public health and medicine-- dismiss such concerns as peak oil –typically without so much as a wit of evidence-- as the latest disaster trope or quasi-religious revenge fantasy.
  • Bureaucracy: Organizational hierarchies allocate status, power, rewards, and other incentives; and also control communication and information patterns. Bureaucracies tend to rigidify and lose sight of their mission. Studying bad news scenarios does not advance many careers; and it certainly increases the chances of derailing them. Hence the WHO study group issues a report about the future that ignores unavoidable driving forces: energy, global warming, and depletion of other resources such as water, forests, and so on.

Peak oil and third world health

So why does peak oil make it necessary consider negative scenarios for the of future global health? Consider the following points as you contemplate the fate of people living in Sub-Saharan Africa and other populous but relatively poor nations:

  1. Humanitarian aid is currently dependent on oil-based vehicles to transport materials and personnel.

  • Current Western agricultural surpluses that underwrite food aid efforts are subsidised by fossil-fuel dependent farming methods.
  • Increasing oil prices will decrease Western disposable incomes and government surpluses (thereby reducing donor funding).
  • Oil price increases in developing countries will consume progressively larger percentages of already meagre household incomes, thereby decreasing the amount of money available to buy food, medicine, and other essentials. This trend is nascent.
  • Construction of large-scale infrastructure (eg dams, bridges and roads) currently requires oil-fuelled machinery and materials with high embodied fossil energy.
  • Existing and currently planned large infrastructure designed around the availability of cheap oil will be rendered obsolete, and may fall into disuse or disrepair due to escalating operating and maintenance costs.
  • Natural resource development (like forestry or mining) will become more expensive and progressively more difficult for third world countries, as such activity is currently heavily subsidised by oil.
  • Resource wars may become more common.
  • War, water shortages and crop failures may prompt mass migrations.


    Whether due to peak oil, limits to growth, methodological issues or some combination of these factors, any project with an aim like this WHO study must contend with so many variables that the task becomes insurmountable if one wishes reasonably to consider the future.

    The only levelheaded, policy-relevant way forward is to develop a system that has flexibility to deal with an array of scenarios, from positive to negative. And since the current health care systems of many Western countries are cumbersome and handicapped by institutional inertia, they must somehow metamorphose if our society is to retain effective and affordable medical care.

    Acknowledging this web of complexity, as a first step we need to know how vulnerable our current medical systems are to oil scarcity, what we can do to reduce that vulnerability, and how long it will take to provide adequate and affordable health care to entire populations. To achieve those aims, we need a “Hirsch Report” for both public health and acute (hospital) care.

    ~~~~~~~~~~~~~~~ Editorial Notes ~~~~~~~~~~~~~~~~~~~

    Dan Bednarz, Ph.D., is a former Associate Director, Center for Public Health Practice, University of Pittsburgh Graduate School of Public Health (until 2005) and is now President of Energy & Health Care Consultants.

    Paul Roth, M.D., is a family doctor practising in an Australian city. He has postgraduate qualifications in acupuncture and integrative medicine, a diploma of medical hypnosis, and has practised reiki for several years. He is interested in peak oil and what it might mean for health care. He hopes to raise awareness in the community of these issues, and create a dialogue about possible futures for peak oil medicine.

    Check out Paul's new blog Peak Oil Medicine for some thoughts on health care options for a scarce oil future.

  • Consider this a reminder to positively rate this articles (using the icons under the tags in the story title) at reddit, digg, and if you are so inclined. (email me at the eds box if you have questions about this).

    Also, don't forget to submit this to your favorite link farms, such as metafilter, stumbleupon, slashdot, fark, boingboing, furl, or any of the others.

    I can assure you that the authors appreciate your efforts to get them more readers.

    Let me also suggest that we forward this essay to friends and colleagues who may be interested in the future of health care.

    A hearty thanks to Dan Bednarz and Paul Roth for putting this information together and relating their interaction with public health professionals. We all owe them a big debt of gratitude for their hard work laying a foundation for future debates on how to reform the health care system as energy depletion becomes more apparent. My apologies for a such belated thank you but I was too busy last week to keep up with TOD.

    We face much inertia in the area of substantive reform given the instutional biases that must be overcome. Jason Bradford provided excellent examples of two such problems: tunnel vision due to extreme comparmentalization/specialization; and a process whereby the pragmatic nonconformists tend to be weeded out and the strongest adherents of the status quo are promoted and go on to dominate policy making and the opinions of subordinates.

    I strongly agree with the principle that prevention and wellness should be the main focus of a revamped health care system. It is also the reason that I decided 5 years ago to add an MPH degree. As I have stated before, after an in-depth analysis, I concluded that in the U.S. it is paramount to change the entire way we look at health care and not attempt to fix the serious problems with endless hand-wringing, more ineffective subsidies, and a gatekeeping system that does more to ration that it does to delegate appropriate levels of care and prevention based on severity of illness.

    Advocacy for sustainable medicine may seem like an uphill for a group of health care mavericks, but sometimes mavericks succeed. Coincidently, in one of this weekend's drumbeats there was a brief mention of Barry Marshall, the once-reviled physician researcher who defied conventional wisdom proving the link between H. pylori infection and ulcer formation. There is also the case of Stanley Prusiner who, despite relentless criticism, was undaunted in his efforts to prove that prions were infectious proteins responsible for spongiform encephalopathies (e.g. BSE "madcow disease"). Pruisner went on to win the Nobel Prize in Physiology or Medicine for his work.

    Even now, there are quiet but important battles brewing in the field of medicine. IMO, the most important is the battled being waged by investigators who are doing brilliant work to prove that the cholesterol model is flawed and thus putting statins, the number one selling prescription medicine, at risk for losing market share. Seven years ago, Uffe Ravnskov M.D., Ph.D wrote a groundbreaking book, The Cholesterol Myths, on the topic and until very recently few researchers were intrepid enough to dip their big toe into the swirling debate. Now there is a growing segment in the medical community that understands statins appear to have their strongest effect due to their ability to arrest an enzyme involved in the inflammation process. If their efficacy in preventing the progression of cardiovascular disease does not lie it reduction of cholesterol, then we must acknowledge that there are other methods of reducing inflammation and platelet aggregation that offer fewer side effects and provide a greater cost benefit and such an acknowledgement will not bode well for pharmaceutical giants.

    Those of us who feel that the current medical model needs to be drastically altered both for sustainablity and a new paradigm based on wellness may be the mavericks of today but maybe in the not too distant future our pragmatism will be the driving force for a new more constructive dynamic.

    Brains: Humans appear to have a cognitive bias of attraction to optimism and repulsion from “worst-case” thinking and scenario building. For instance, only 20% of those who may carry the genetic predisposition for Huntington’s Disease take the test to find out – 80% would rather not know despite the consequences of remaining ignorant.

    This would seem to constitute objective evidence that cornucopians are more likely to be wrong than doomers.

    RE: ignoring possibility of 'paradigm' shift in future trends. I've alluded to the tendency of financial advisors to stick to the mantra of long term markets always go up. This is another assumption that may bite the dust as with WHO future projections.

    This would seem to constitute objective evidence that cornucopians are more likely to be wrong than doomers.

    Or worse, that even doomers are being too optimistic.

    The only levelheaded, policy-relevant way forward is to develop a system that has flexibility to deal with an array of scenarios, from positive to negative. And since the current health care systems of many Western countries are cumbersome and handicapped by institutional inertia, they must somehow metamorphose if our society is to retain effective and affordable medical care.

    But ... let's skip that, and agree on a sub-culture value that all predictions must be skewed as we wish.

    Well, crap. I was going to sit out tonight, listen to some Itunes and snack, and save myself some writing, but then I land on a sentence like,

    "Brains: Humans appear to have a cognitive bias of attraction to optimism and repulsion from “worst-case” thinking and scenario building. For instance, only 20% of those who may carry the genetic predisposition for Huntington’s Disease take the test to find out – 80% would rather not know despite the consequences of remaining ignorant.

    Replied to by Leanen and ET as "This would seem to constitute objective evidence that cornucopians are more likely to be wrong than doomers.(to quote Leanen)

    Well, the beginning premise would "constitute objective evidence" if there were any truth in it. There is however ZERO, NONE, NO, evidence that humans are predisposed to any"attraction to optimism".

    The one example given was "For instance, only 20% of those who may carry the genetic predisposition for Huntington’s Disease take the test to find out – 80% would rather not know despite the consequences of remaining ignorant."

    All that sentence demonstrates is the absolute elitism of the writer. Let us not discuss how many of those predisposed to Huntington's can afford testing. Let us not discuss how of them, even if they found they had it, could not afford treatment for it, and the fact that it is not curable, so many who (a) can not afford testing (b) once tested, cannot afford treatment, and (c) know that the treatment is not successful anyway, do themselves at least the small favor of reducing the emotional strain of trying to decide what to do with an ailment that cannot be treated in any real way EVEN if they could afford it, which many can't.

    Now, to human optimism. It is to be remembered that most doomsday scenarios throughout Western history have been associated with religion, since it was the central driving power of Western culture. Thus, the "Apocalypse" was the great terror. We know from reading the New Testament that many of Christ's followers at the time of his cruxifiction were convinced that he would return in thier lifetime, and it was only when he did not that the followers of the followers, so to speak, began recording the events of the New Testament. Now many assume that "end time" prophecies are reasonably new, but one website records a history of over 400 end time predictions since the 1700's, and many of them taken VERY seriously. The site goes further, however, in showing predictions of the end of time and the end of the world far preceding the Christian era. It was new even then.

    This is is just the tip of the iceberg showing that humans have a brain that is present to what I call "the theory of impending doom".

    This is only natural, given that almost all humans realize that they are going to die.
    Thus, it is more meaningful for the human brain to believe that if they die in an Apocalypse, it is more meaningful, and well, misery loves company.

    In the 1800's, we began to see something new, however. With the advance of science, and the American and European revolutions, we began to see "doom" scenarios based on the new scientific and "sociological" learning, and the rise of secular non fiction publishing.

    The great pioneer was Thomas Malthus (February 13, 1766 – December 23, 1834) with his doom predicting theory of population/food production.
    Malthus was very influential on the work of Charles Darwin, and many others who began to see the world as "survival of the fittest" and
    Love it or hate it, Malthus had no problem gaining influence and popular acceptance.

    On the philosophical and historical side, we have Oswald Spengler, May 29, 1880 – May 8, 1936,
    Spengler's most influential work, "The Decline Of The West"
    "Spengler created a worldview that resonated with the post WWI German culture. His grim view of an inexorable doom for western civilization implied acceptance of fate, but also offered a sense of freedom from the past. His historical idea influenced artists and architects, who used it as a justification for abandoning the historic styles, now no longer valid for the new era."

    His worldview also took a dim view of democracy as the type of government of the declining civilization. He argued that democracy is driven by money and therefore corrupt. The acceptance of this attitude by many readers hastened the failure of the Weimar democratic system and gave credence to the rise of Hitler as a dictator. Spengler initially supported the rise of a strong-willed leader type of government as the next phase after democracy fails.

    Gee, does any of this sound familiar to "peak oil" doomers? It only gets better...." Westerners being Faustian, and according to its theories we are now living in the winter time of the Faustian civilization. His description of the Faustian civilization is where the populace constantly strives for the unattainable—making the western man a proud but tragic figure, for while he strives and creates he secretly knows the actual goal will never be reached."

    I have stated that true "doomer" philosphy in the peak oil movement has NOTHING to do with oil, and everything to do with the modern philosophy of the Western nations, who suffer from guilt, feel the need to be punished, and have lost faith that the long awaited "Apocalypse" would occur to do the job.
    Thus, Western man has turned to science for punishment, and possible redemption, just as he/she turned to science to provide all the other advances in life. The belief in "impending doom" is built right into our cultural upbringing in a way that almost no other central driving force is.

    I will leave it here for now, and leave out the hundreds if not thousands of historical panics, financial panics, plague panics and fanciful tales of doom that CONSTANTLY preoccupy the human mind. Some are legendary (the great Martian invasion scare of 1938 created by a radio program!), the "red scares" of almost every decade of this century, the 1970's "Blad runner" and later "Mad Max" scenarios, the terror of nuclear war ("Dr. Strangelove"), and the more more modern "catastrophe" scenarios, from the fear of first a new Ice Age, to "global warmng", killer bees (where did they ever go?) the Y2K fear, the millinial end time, AIDS, the bird flu, the "comet strike" and "meteor strike" terrors, and on and on and on. The number and variety of humanities visions of catastrophe knows no bounds.

    This is of course normal. If we accept the "fight or flight" construction of the human brain, designed as was to protect us, we are a creature that must always be ON GUARD. Humanity has a weakness in the area of percieving complex solutions, interlocking technnical constructions, and "confluence of multiple option, multiple choice, layered design involving a mix of aesthetic and technical ideas. The human brian has tendency to thing "either or" not multiple and mixed options. This is why it is almost completely impossible for those who are most "doom" prone among the Peak oil aware to see any possibility of solution and change. In fact the idea that solutions can be reached annoy them to anger in many cases, because it requires DEEP, LONG RANGE, AND MULTI DISCIPLINARY THOUGHT. In other words, the solution is not "oil or nothing". (in the longer term, that has NEVER been the solution).

    I close with a story: In the mid 1990's, at the height of the "bull market" in U.S. stocks, and with energy prices low, in the period that many now look back on with longing (a college age child at that time could not recall a financial downturn IN THIER LIFE), I saw an interview with the investment banker Sir John Templeton (born 1912). Sir John was telling Louis Rukeyser on the old PBS show that there was no reason to believe that the next century would not be as good or better than the last, if we made the effort, used our science and skills, and worked together internationally. Recall, this was a man who remained an optimist through the Great Depression, the World War, the Cold War, the energy and economic crash of the 1970's....but in the LONG RUN he foresaw good things....but when asked about the short term, he showed no sign of panic, but stated firmly, "over the long term it is right to be invested, but in the short term, declines of 30% to even half or not to be considered out of the realm of possibility and are always to be considered." Recall, this was before the energy concerns, before 9/11, before the "tech crash" and before Gee Dub....

    If, IF, I had began betting as an optimist in the crash period of the 1970's, EVEN counting the oil crash of that period, the hyperinflation, the boom times of the 80's and 90's, the oil spike now, the 9/11 setback, and Gee Dub's "inspired" management of America (it's a joke, don't take me serious on that last one!), right now, if I had bet as an optimist then, I would be a multi millionaire. But my normal human brain was prone to buying into the doom and gloom panic stories, I was a normal human. So I held back. Make no mistake, optimist world view is NOT a human trained, it has to be TRAINED, and humans are the easiest animals to panic.

    Roger Conner known to you as ThatsItImout

    Good grief, what a diatribe!

    Responding to observations made in the field of neuroscience with an angry diatribe about doomsday religious cults and tidbits of the history of Western culture is not helpful.

    ET's example using Huntington's disease may not, by itself, prove the tendency for the frontal cortex to interpret things in a positive light, but accusing him/her of taking an elitist view is nonsensical. There are compelling reasons for carriers of the Huntington's gene to get tested. In my mind, the most compelling is the fact that Huntington's is autosomal dominant and thus carriers who opt to have children have a 50% chance of passing along the gene for a horrific disease. Indeed, most patients who opt out of testing say they just don't want to know because they will lose their sense of optimism for the future.

    While I would agree that extreme doomerism, and defeatism (basically a futilitarian approach) is irresponsible, I also think that flying off the handle in response to those who have examined the role of the central nervous system's architecture in shaping our world views is really the height of irony - an emotive response by one who has allowed his amygdala to get the best of him.

    Yes, the human brain is also hard-wired to be ever vigilant to possible threats. The reaction to the perceived threat is the old flight or flight reaction (a.k.a. acute stress response). The stress of this reaction on the body is tremendous, it eventually returns to homeostasis but continuous triggering of this reaction is detrimental to the organism given that repeated exposure to the cascades following epinephrine and norepinephrine release reek havoc with the vascular, digestive, and immune systems. This is precisely why we are predisposed to avoiding intense contemplation of potentially alarming situations. It is not until these situations are perceived as critical (very near crisis) that we become motivated to react decisively.

    I think the little snippet about Huntington’s Disease tests does show something irrational about human "risk management" but I certainly did not see a tight logical connection to the idea that therefore, [all] optimists are wrong, and [all] pessimists are right. I did not see evidence that pessimists should redouble their pessimism.

    Just to point to some scientific evidence pointing in other directions, this Time magazine article collects some studies that show [how] we see risk, and often overly focus on risks that seem "horrible."

    To be clear, those studies in Time are directly about risk and prediction, and do not ask people to make an indirect leap between a complex question (if I have Huntington's, how soon do I want to know it), to ... strategies for resource management?

    Shorter: The Time story has concrete examples of where we inflate the odds of dire outcomes.

    The idea that there is a tilt toward the optimistic is at a minimum, incomplete.

    Roger: Great rant.

    hey, it's what I do....

    But I was just surprised that the piece I wrote was considered a rant or a "tirade". I was in no way attempting to open with all rhetorical barrels blazing, and folks here must not be used to the real rhetorical flamethrowers I have heard and read....probably a good thing as we want to keep a civil forum, but still it is better to be ready for the real thing when it comes.....not to be like the lady who got complimented on the nice shape of her azz on the bus, and said in shock "I have never been so insulted in my life!!" To which the man doing the complimenting said, "Then you just don't get out enough, do you....:-)

    RC known to you as ThatsItImout

    In fact the idea that solutions can be reached annoy them to anger in many cases, because it requires DEEP, LONG RANGE, AND MULTI DISCIPLINARY THOUGHT.

    Thanks for this, Roger. I knew there must be a reason for continuing to read the comments on TOD. There often is hostility expressed when it is even suggested that our problems are solvable, collectively.

    Problems and dangers there are which cannot be ignored. Believing that they are completely intractable is perhaps one way of freeing the believer from the effort of trying to do something about them.

    Excellent piece, one more part of the puzzle.

    "It is quite difficult for an individual to “think independently” of these institutional memberships...." here is the crux of the problem, together with thinking that the immediate past is prologue of what is to come.

    How often are studies done based on a few decades of history? History is not cyclical or exactly repeatable. We cannot we make accurate projections if we do not examine first principles.

    I am reminded of the "gradualists" in geology and other disciplines: Change is slow, gradual; discontinuities are unthinkable. It was not until the discovery of the K-T boundary and later the plunge of Shoemaker-Levy 9 that we seriously thought about abrupt or cataclysmic change.

    Economists, whom I consider to be central players, often project growth well into mid-century, citing winners and losers in the great game of wealth. G.B.Shaw, that eternal optimist, still is alive and well. I am afraid we have not shed the optimism of the early 20th century for a more cautious and clear-headed examination of first principles.

    And, as the authors of this piece elegantly point out, thinking independently and across institutional and disciplinary lines is essential.

    gradualism was pretty much debunked by Steven J Gould and "punctuated equilibrium."

    The fact that the scientific establishment hasn't caught up with its pioneers is nothing new.

    Human beings don't really seem to have any more right to exist than any other species -- we have just been clever enough to fill virtually every ecological niche there is, so the dieoff will seem more extreme.

    Take the long view -- there will be oil again in the future. It will be made of people, this time around.

    doesn't the long view depend on the kind of punctuation in the equilibrium? :)

    It is especially important that we work on educating those working at high enough levels to be making policy decisions regarding the coming changes associated with climate chage and peak oil and gas.

    Each of us needs to work on educating people in our own field. If we have contacts at the university level or public policy areas, we need to work on them also. One avenue is writing articles in business magazines. Another is one-on-one contact with targeted individuals.

    I think one-on-one contact is, on an hourly basis, roughly one hundred times more effective than writing books and articles.

    As a teacher I had an impact on some 9,000 students over the decades--possibly a significant impact in a fair number of cases. As the author of an economics textbook that emphasized the importance of secondary effects, I had perhaps 100,000 readers--but with much less net impact. Several students have told me that what they learned in my classes was a life-transforming experience, and though I've gotten positive feedback on my book, nobody has ever told me that it was life-transforming.

    Don wrote: I think one-on-one contact is, on an hourly basis, roughly one hundred times more effective than writing books and articles.

    I was pleased to read this because locally in my little fish pond it is my impression.

    Good teachers are incredibly influential, and their input holds and endures. Books - particularly set or expert texts of the academic style - even when excellent, tend to be washed away by the next text, publishers hype, etc. and to be forgotten. (Again, this is commercial biz. Ask Elsevier.)

    Here (switz), if one asks students what books they hold dear or changed their lives or that they will keep as ‘sacred texts’ they always quote novels, biographies, philosophy, general discussion (those crappy books that eg. marry system analysis with personal relations - hydraulics and love - ! -) or, sometimes, religious texts, which are, at heart, nothing but dusty ethics and etiquette, or violent tales (respectively, the Koran and the Bible), symbols of adherence to a ‘community’. (I’m an atheist, apologies for the superficiality.)

    Still, it depends on the book. Maybe a new genre needs to be invented.

    Books have transformed my life; to a large extent I am what I read. However, I think for most people their lives are transformed almost entirely by their relationships with others--not by books or films or what they read on the Internet.

    Every great teacher I have known was fully aware of the life-transforming possibilities in the classroom; their influence goes on in a positive way for generations after they die. Much of what I try to model for or teach to my grandchildren comes from the outstanding teachers I was fortunate to have from the fifth grade all the way through graduate school.

    If you truly want to improve the world--and if you have the passion and the guts for it--go into teaching.

    Hello TODers,

    If the worst of Peakoil comes to pass: it is only logical for the medical system to institute triage on a ERoEI-human basis. A young teenager with a broken arm will be worth repairing, so he can push a wheelbarrow or install PVs--- a old-codger, after suffering a severe brain hemorrage, well, sad as it is: his family will be told that he is not worth the investment of brain surgery and expensive rehabilitation.

    A rational response to Peakoil will make it imperative to retain those youngsters that can best contribute physical labor and/or future mental prowess. If society is truly concerned for the future, even a wildly wealthy, and undeniably smart industrialist like Warren Buffet will be seen as disposable if his ailment is non-reversible.

    Nature does not allow a aging animal to survive for long; the tight feedback loop insures that a predator will cull this creature to increase the potential of younger animals. Cheap energy has allowed wildly expensive heroic healthcare to be expended on a very small % of the population. PostPeak, we should urge and expect the ever-declining amounts of healthcare funds to be spent in a manner to keep those most potentially fit & productive alive. I would expect 'medical justice' to optimize total human ERoEI, just as predator-prey systems do to other species in Nature. Admittedly, it is a very difficult issue to accept when a family member is injured or severely ill, but I think social norms will change until this is routinely accepted.

    Bob Shaw in Phx,Az Are Humans Smarter than Yeast?

    You're putting me in mind of the "smother parties" described by Burroughs in the preface to The Naked Lunch.

    I think it depends on the relationship between things and people. As long as we see and support ownership as an individual matter, the oldies who have the money will hog the resources and their slightly-younger children will support the expense to keep someone going (because they're next for a close shave from Time's scythe). The young are always expendable in an individualistic culture, as their deaths and failures mean the concentration of wealth and its' retention by the old.

    Societies with less egocentric behaviour are the ones where the old folk decide it's time to go for a long walk, or even volunteer for death when they recognise they're neither materially productive nor fun to be around. For obvious reasons, they tend not to be big on individual possessions.

    Or we could have the Fijian solution, described by Bill Mollison on his website. Anyone who stayed in bed for more than 3 days got buried, protesting or not.

    (edited for tense in last para.)

    Finally a post on TOD where I actually have a little bit of expertise!

    I've said before that with medicine we are reaching a point of diminishing returns combined with the law of unintended consequences.


    1) Antibiotics are an example of this. In the 50's and 60's new antibiotics were easily discovered and were brought to market very inexpensively. Several new classes were brought to market every decade. They were very effective at killing bacteria (bacteriocidal). A pharmaceutical company might have to test a few compounds to find one that worked well enough and safely enough that it could be brought to market. But returns are diminishing. First, and most obviously, bacteria have developed resistance to the antibiotics so the old standbys like penicillin are not as effective as they once were. Furthermore, it is becoming increasingly difficult to find new antibiotics. Only a couple of new antiobiotic classes have been brought to the market successfully in the last 20 years. A pharmaceutical company now has to test hundreds of compounds and spend at least 10's of millions of dollars to find a single medication that can be safely brought to market. These newer agents are often not as widely applicable and often only prevent bacterial growth (bacteriostatic) without actually killing the bacteria. They are much more expensive.

    2) Chemotherapy. Let's say that the old standby chemo for cancer X is agent A. The 5 year survival with untreated cancer X is 25%. With $1000 of agent A the 5 year survival with cancer X is doubled to 50%. Now a new treatment, agent B is tested. Treatment with agent B costs $10,000 but it does prove to be better than agent A bc/ 5 year survival is increased to 60%. So for $1000 of Agent A we got a 100% increase in the 5 year survival. For 10x that cost, Agent B was only able to edd an additional 20% from the previous cure rate. If it's me with Cancer X and I have the means ($ or insurance), I'm going to go with Agent B but as a society we are spending a lot more for only a little better return. The easy fruit was picked early.

    Also with cancer we have to keep in mind we often fool ourselves into thinking we're doing a better job than we really are. As detection methods get better (and more expensive), we diagnose cancer sooner. This is universally seen as good, but probably not as good as we think. First, if our new expensive methods allow us to start detecting cancer X one year sooner on average- even if we are no better at treating cancer X- it will appear that people are living a year longer after diagnosis than they used to. In other words, if average lifespan after diagnosis goes from 3 years to 4, are we better at diagnosing and treating the disease or did we just find it one year sooner than we would have with the older method?
    Secondly, we may be now detecting small tumors that we never would have detected before and these people might have lived with these tumors for another 10 years and died of something completely unrelated. So we now include in our research people who never would have had a problem with their cancer if we hadn't looked so hard for it. Prostate Cancer is a great example. If we look hard enough, most men in their 80's will have it, but the vast majority will never have any trouble with it. This is probably in part bc/ the types of cancer that are so hard to find just aren't very aggressive, and also in part bc/ odds are they'll die in the next 5 to 10 years anyway of something else before the cancer gets them.

    There are ways to statistically account for these artifacts, but it is difficult to know how much we are really getting out all the expensive tests and treatments that we do.


    Don't have time to finish this post right now. I'll try to address this part later.

    I used to fuss and fume about all the irrationality and waste in our medical "system." But now I sleep well

    I have learned to accept the reality-- medicine is not about curing disease or even helping people, although that is sometimes a side benefit. It is about creating JOBS and serving as an engine for circulating money.

    The medical system will be like every other system in our society -- it will adjust to conform to the available energy input.

    And of course, from a strictly Darwinian perspective, the existence or not of the medical system is irrelevant -- any gains that have been made in the past 75 years or so mainly accrue to people beyond reproductive age.

    "medicine is not about curing disease or even helping people


    What leads you to such profound cynicism about our medical system?

    As an insider, I am certainly cynical about medicine, but perhaps in a very different way. It's true that the on the institutional level (Insurance companies, pharmaceutical companies and even many hospitals) a patient's best interest is not usually the primary concern. But most nurses I know put up with urine, feces and other bodily fluids bc/ they actually care about people. I didn't work 100+ hour weeks and 36 hour (sleepless) shifts in residency just for the money. I'm smart enough and driven enough that I probably could be making a lot more money if I'd gone into business or law. Even now, I could more than double my income if I were to orient my practice around money. There is one physician in my area who has done exactly that- to the detriment of patients. But this is the exception not the rule. It may not seem like it to an outsider, but most physicians set up their practice with patient treatment as the primary concern. Perhaps I am less cynical bc/ I am fortunate enough to work at a hospital that truly is non-for-profit. The deed reads that the hospital is owned by the citizens of our city. I sit on committees and although we have to watch the bottom line (lest we go bankrupt and the whole community suffer) we approve measures all the time that we know are the right thing to do, even if we know they will lose the hospital money.

    There are hundreds of thousands, if not millions, of dedicated physicians, nurses, laboratory technicians, EMT's, radiology technicians, and many others who ask nothing but a chance to be helpful and do a little good for a fellow human being. Many of them really don't even care what they get paid, so long as they can feed and clothe their families.

    What is discouraging is the cancer-like growth of insurance companies and hospital management corporations, big pharma, and the like -- "the system" -- which truly is cynical, and stops at nothing in the quest for profits.

    It is said -- I can't verify it -- that the primary cause of personal bankruptcy in the US is medical debt.

    I'm not cynical -- whatever that is. I believe I am pretty realistic.

    OK, NeverLNG, I understand your point now, and I cannot disagree.

    medicine is not about curing disease or even helping people, although that is sometimes a side benefit. It is about creating JOBS and serving as an engine for circulating money.

    This is American medicine, most other medical practices are quite away from this, though not entirely of course.
    Yet this has some "side benefits" for everyone, fancy sophisticated cures may justify researches and incidentally bring some wider reaching improvements.

    "Paul Roth, M.D., is a family doctor practising in an Australian city. He has postgraduate qualifications in acupuncture and integrative medicine, a diploma of medical hypnosis, and has practised reiki for several years."

    May I say that these are not exactly "credentials" I would want to put on a publication of mine? They good doctor is certainly not one of those I would chose as my family physician. His various interests do explain the tone and rather wide "scope" of the article which seems to be more of an attack against "the system" than a level-headed analysis of the true problems. I don't think the WHO got it right, but after reading this I already know that the authors got it wrong thanks to their own zeal. A little more information and a lot less speculation about the brains cognitive bias would have been better. Much better, actually.

    May I say that you are narrow minded? The good doctor is an MD, maintains that distinction, has am ongoing practice and a license to do so. How do the frills and additions subtract from his credentials? Henceforth we shall know how to regard Infinite Possibilities and his so finite mind.

    Infinite would never have to go to see the "alternative" doctor. He would be grateful, I assume, to have the credentials clearly listed, however, so he could select the form of treatment he felt best suited his needs.

    One of the more distressing aspects of modern corporate medicine is the deliberate obfuscation of credentials, training, ability, etc., so that every element of the "system" is interchangeable. Makes everything so much easier to "manage" and administer. As if the practice of medicine were the same as building and selling widgets.

    Area of expertise

    The answer is simple: Peak oil is outside the area of expertise of a public health official, just as oil production is outside the area of expertise of an airport manager. You can´t ask a member of a highly esteemed agency like the WHO to publish outside his professional field as a lay person in the name of his agency.
    That´s why most predictions, which are just extrapolations of the status quo in a narrow field like medicine, without consideration of the changes society will undergo and has undergone, are garbage.

    Hello TODers,

    Do anyone forsee the likelihood of voluntary euthanasia being offered postPeak? I realize this is a morbid subject, but should this option be preferred to widespread violence and involuntary euthanasia like Hitler's deathcamps?

    If severe food and water stress sets in: should society prefer that a multi-generational family might dissolve into a nearly endless violent battle over who should get food and who will starve, or would it be better if society offered an outlet for the grandparents to quietly remove themselves from the contentious family resource equation?

    If you develop a severe illness, or get a severe injury, and future medical triage forbids coming to your aid, or even offering expensive painkilling therapy-- should society offer an early exit if a person so chooses?-->[they can still go naturally, if they prefer, from gangrene, diarhea, breath-taking pain, etc].

    Jay Hanson mentioned the possibility of govt. offering society a free 'death insurance policy' and medically supervised euthanasia as a way to incentivize peaceful population reduction. Obviously, this would be more attractive to potential volunteers than drinking pesticide, self-slashing your wrist and throat, jumping off cliffs, self-imolation, shotgun blast, and so on. It would also be less upsetting to those that would have to clean up the mess. I think it is important to consider that some % of the population may not want to wait to be culled by Nature or their fellow man if all Hell breaks loose postPeak. Consider Masada, WWII Saipan cliff-jumpers, 9/11 WTC free-fallers, and other past suicides.

    Attn: Gail the Actuary--has anything like this ever come up for discussion in the Life Insurance industry, or are they willing to see their business almost instantly go postPeak extinct vs adapting to administering 'death insurance' payouts?

    Bob Shaw in Phx,Az Are Humans Smarter than Yeast?

    What an absolutely horrible thought! When do you intend to start putting people down? When gas prices hit $7.50/gallon or well before that??? Will the relatives have to pay for the cost of the injections? How about setting up a few "soylent green" facilities, while we are at it?

    I find this totally disgusting and a very poor post. Even the Nazis had better reasons to kill Jews and other non-arians than rising gas prices, don't you think? But I guess some people will go down any road as long as they can keep driving their penis enlargement.

    Hello Infinite Possibilities,

    I have no intention of ever putting anybody down. In fact, if I reach desperation, I hope I have the gumption to somehow remove myself vs purposely starting a machete' dance with my neighbor for a morsel of food. Sadly, I think most will choose sides, like Iraq, Rwanda, Sri Lanka, Zimbabwe, and so on--which is the instinctive thing to do before accepting starvation, dehydration, severe political repression, and so on.

    Yeast don't waste energy by choosing sides, then waging group battles. They live, then die their fate at the ecologically-determined individual times and locations, like most other species. I think it is an admirable trait.

    What about you--have you pondered about your ability to resist your survival instincts? How far will you go? Are you willing to forego offspring like me?

    Recall the '70s gasoline fights and thefts--lethal for some--are you willing to start a fight, or just calmly go to the end of the long queue, or would you rather bicycle? My bet is that many Americans will go nuts and arm themselves if there is some kind of dire FFs shortage vs staying calm. I fully expect some punk to knife/shoot me for my little scooter in the future. He won't even give me a chance to get away uninjured because he will just assume I am carrying a bigger knife or a gun [I won't be], and he will just be seeking to get first-strike advantage.

    If the economy in your area fails: will you fight for the last beans & tortillas, or will you calmly accept a high-risk, possibly fatal migration across a blazing Arizona desert? Across a storm tossed, sharl infested sea in a leaky boat like Cubans and Haitians?

    Will you be like Tadeusz Borowski, #119198? Or will you rebel against the trillions of dopamine-fueled synaptic impulses to commit virtually anything for a stale crust of bread? Here is the heart-rending link:

    Bob Shaw in Phx,Az Are Humans Smarter than Yeast?

    Tough reading on that link you posted Tonto. About the death camp.

    I know an old WWII army vet down the road who marched in to free some of those death camps. He speaks proudly of doing it. He is an 'old timer'. He can tell you things you can't imagine and is the salt of the earth.

    I am doing this sorta like you of conscious ...writing.
    Hope it makes sense. We used to do it on an old company website for retirees way way back. Just let our thoughts telegraph right to the fingers on the keyboard. Anyway its been a day of little motivation here in Western Kentucky and I haven't done shit all day. Can't even seem to care to get my checkbook recconcilated.

    But the die off thing. Ok no more SOC then.

    When THSHTF , as they say so fiercely here, then all the rule books will be suddenly out of date. I don't foresee any controlling authority. This is fast crash scenario or maybe medium slow. Doesn't matter. No controlling authority so each man is a law unto himself. His own moral inner code will state what he will or will not do.

    Thats why I liked 'The Road'. Gave me this picture of the future and how each man must go his own way and forget the rules we lived by before. We/He lived by his personal code. Mostly his code involved his son. His death was appropriate to the events.

    How will I survive? Being of an older age? Only by my wits and experience and some friends who I have spoken to about the scenario.
    I will be at their mercy as well. When I get to the point that I can't protect myself then its time for me to fade. No problemo. I believe in the hereafter and I will step into it with no qualms. I had a near death experience a few months back. It was a wakeup call about death and since then death has not held great significance for me.

    As I drove down the road with utterly no control over my brain and little over my limbs I realized that the next second might be my last. I picked up the business/farm radio and called my buddy on the combine. He said "I am shutting down and coming to you". I said "don't bother for I will either make it there or die and you just stay there." I was serious. And so death has no hold over me. I don't long to put it off beyond its appointed time.I honestly could not control my vision and only my arms could steer with very great difficulty. I was all over the road and this lasted for several miles.

    It gave me a new perspective on life. It didn't make me crave life more or less. It just gave me a glimpse into the future. I survived. I rolled to a stop at the grain silo, almost crashing into it and practically fell out of the pickup onto the ground. Laid there a while and lived.

    It was not heart related as far as tests could determine.

    So my story on mortality.

    PS. I take no drugs nor medicines. I have never had an operation. I have never been a patient in a hospital. My vitals, blood work, heart and all my other parts pass all tests with ease. My BP is stable.My HDL, LDL is perfect. My glucose is fine. I am very healthy. I await whatever the future holds. I will play the cards dealt me.

    PPS. I read of your family situation and understand where you are coming from. Stay alive as long as possible if 'it' all comes down but don't flee or let it have at you. Do your best. Keep posting this crazy stuff. You got a knack with it.


    Thxs Airdale, and I hold your text-thoughts in high regard too. Keep keyboard banging when you can-- your mind flys much higher than your airplane.

    Bob Shaw in Phx,Az Are Humans Smarter than Yeast?

    One of my problems is, I think one of the other places I write or post or something, has the Reply button to the far right - hence, I hit it only here it's NEW THREAD.

    We need to have pictures or something. Until I can conquer this problem, I am restricting myself to one post a day, if that.

    OK when people are starving, I don't mean hungry but chronically malnourished, they don't have the kind of anger you guys are so scared of. They'll try to make do, eat new things like young leaves, paste, etc., and they may not have the sunniest dispositions, but they won't get into any "machete dances". I can imagine one half-starved person beaning another half-starved person with a rock to get the 2nd's bread and water, but it will be very dispassionate, no dancing and Rage Against The Machine dramatics about it. And a well-fed person without depleted muscles and nerve-fats in the brain would clean up the floor with 'im anyway.

    There are places in the world where the dieoff is happening, now. We're not hearing about it because it's either the USA's fault, or at least the USA's oil is not in danger, but we're also not hearing about it because it's very undramatic.

    Bob / tonto wrote: Jay Hanson mentioned the possibility of govt. offering society a free 'death insurance policy' and medically supervised euthanasia as a way to incentivize peaceful population reduction.

    Self euthenasia - in the shape of medically and legally assisted suicide - exists here and there. In Switzerland, for example (I write about what I know.) The conditions are clear if rather loosely applied; be afflicted with no hope of amelioration or cure; have an extremely poor quality of life; be compos mentis and capable of signing papers or otherwise communicating one’s desires, and do so consistently. Family members (if there are any) also have to show they have clean hands, that they had no indue influence and don’t stand to profit from the death beyond what would happen anyway one day.

    Assisted suicide by interested persons is a penal offense in Switz.

    In short, for ‘terminal’ patients or the direly handicapped, it can be done smoothly, at little cost. For non Swiss residents, the trip must be paid - the death has to occur under Swiss law on Swiss territory. The Swiss Gvmt. is terrified of death tourism, as they call it, but so far Parliament has held fast, everyone knows that the ‘people’ will react if this possibility is removed. The EU is scornful, of course.

    Health / other risk Insurance companies offer reductions (patchy, but they all exist) to people who reduce risks; non smokers, auto insurance if you sign the pledge, giving up extreme sports, or putting a ‘waiver’ on them, etc. Not if you agree to curtail you life ...

    The Netherlands also has an enlightened policy on euthenasia. I understand that the way it works is by agreement between physician and patient, where the doctor prescribes pills, and then every year the patient renews the prescription for a fresh supply until the time comes for a dignified exit.

    I wish the U.S. were as enlightened as is the Netherlands and Switzerland. Here everything is tied up by lawyers, and despite the most explicit language in my living will, when the time comes it will have to be one of my children who smuggles me the painkillers. However, I am only a middle-aged man now (at age 66 I hope to live in good health past the century mark through my regime of healthy habits and chronic good luck;-)

    airdale, well, after reading your post, I can say, glad to still have you with us....and I don't often go mystical, but let me just say it,
    ""There is more in heaven and earth, Horatio, than is dreamt of in your philosophy." Shakepeare's Hamlet Hamlet to Horatio, or, more to your experience, as we paraphrase here in the Bluegrass, "God looks after drunkards, fools and Kentuckians." :-)

    You said, "I believe in the hereafter and I will step into it with no qualms. I had a near death experience a few months back. It was a wakeup call about death and since then death has not held great significance for me."

    Airdale, if you can say that, the vicory is already yours. We will all step into it, qualms or no qualms. And for those who said "many will fight" this is true, but there is more ways to fight than with guns and knives. There is still a shot at destiny for us, those of us who did not hate the sight of new cars in Time Square, the art of BMW and Jaguar at thier height, lit cities, vacations, heated and air conditioned homes, women in stylish clothes at Broadway shows, good booze in nice bars after the show.....damm, I will have to leave, but I love the time I was born into....:-) Fight for it, use our BRAINS, yes. As I said yesterday, death, that will come to us all, destiny will not.... we have to create that...blessings and prayers to you to talk to someone who knows the game is bigger than than we can know, and it is still afoot. :-)

    Roger Conner known to you as ThatsItImout

    ThastItImoout said this
    "damm, I will have to leave, but I love the time I was born into.."

    Like you I hate to leave it. I was born into the rough and tough Kentucky backwoods life but ended up in the high tech arena. Aerospace,field engineering,programming,farming.

    I loved almost every minute of growing up , mid life and the retirement times. The technological advance, the parties,dancing the night away, drinking beyond good measure, living 4 years in Hawaii (paradise then) and the simple joy of life.

    Now I move 'back to the burbs'. I will still be gardening and trying to distill the joy out of life but will have that Kentucky long rifle standing by the backdoor(more like a M1A or M14). Flying and reloading and eating seafood and windsurfing at Jordan Lake in N. Carolina but I keep a big footprint in my home area here as well as the burial plot at the foot of my great great grandfather who as a sailor jumped ship and came up the Mississippi to the Ohio and to a wilderness in 1820.

    I love Ky and I will return. I hope to be observing this website til the electrons cease to flow ,or it all gets better. Its a crapshoot and we are all whistling past the graveyard I'm sure.



    Note the tone around here lately, "solar, cost too much, won't work, wind, not 'reliable enough" (compared to what, this claptrap internal combustion engine I own?!!! :-O, smaller hybrid cars, "nobody will buy them", energy efficient houses..."no one will live in hobbit houses", hydrogen and methane recapture, "it could be dangerous.....on and on and opposed to what???, putting granny to sleep, and collecting her check? I've had it....

    Beside, we already have a euthanasia's called crystal meth...

    Roger Conner known to you as ThatsItImout

    I can certainly see an increase in the use of the "double effect" principle. This principle says that it is ok to treat people with terminal or debilitating diseases with strong pain medication (usually morphine) even if the dose needed to control the symptoms will hasten death. This is done all the time in hospitals throughout the world.

    Secondly people need to become more realistic about prospects. We should insert fewer endotracheal and percutaneous gastostromy tubes in dying patients. Sometimes it's hard to know who will turn the corner and have 20 more high quality years if you just get them through this pneumonia, but many times it's obvious. There was a study showing that if a person over 80 had a cardiac or pulmonary arrest while in the hospital, only 1% of them ever were discharged from the hospital alive (most of those probably never made it out of a nursing home). With few exceptions, people in this age group should be a "do not resuscitate" if they have a true cardiopulmonary arrest.

    As evidenced by the Terri Schiavo case, everyone should have an advanced directive and power of attorney. write out your wishes, tell your family about them. Ask your family what they want done if something happens to them. Too often we are not so much prolonging someone's life, as we are prolonging their death.

    "Bio fuel is made from people!"

    yeah, yeah, well use thier shit first for methane, we sure produce enough of that....:-)

    RC known to you as ThatsItImout

    Bob Shaw-

    You asked whether the idea of medically supervised euthanasia had come up in the life insurance industry. I don't think that by and large the industry is sufficiently peak oil aware that there is any possibility of this idea. Even if they were peak oil aware, I can't imagine that they would think in these terms.

    I do think, however, that suicide is likely to become much more common. It is my understanding that if a person commits suicide, most life insurance policies pay benefits if the policy has been in place two years or more. I would expect insurance companies to try to change this, so they don't have to pay out as much in benefits.

    Demitry Orloff writes about the types of private enterprize that spring up after a country collapses. Based on the kinds of things he says are likely to happen, I wouldn't be surprized if a few enterprizing physicians begin offering euthanasia services - or sell pills that it would be easy to take an overdose of, without the life insurer knowing that there was an accomplice.


    Hello Gail,

    Thxs for your reply. BTW, I am very glad you, Leanan, and any other female TODers post as much as you can--I wish we had numerous Peaknik females--50-50 sex ratio would be ideal to get the full societal spectrum of PO + GW opinions and suggestions.

    Bob Shaw in Phx,Az Are Humans Smarter than Yeast?


    On the topic of voluntary euthanasia, I agree that there may be some cultural changes ahead that will reflect a recognition that extraordinary end of life measures have become too complex and expensive.

    Already, whether most people realize it or not, it has been estimated that the proximate cause of death for 70 to 80 percent of very ill patients is their decision or their family's decision to stop some form of treatment. Collectively, it seems, we do have a sense of when medical treatment has reached its limits and allow death to take its natural course.

    Incidently, I suspect that high level govt officials have agreed that it is time to sanction voluntary euthanasia for the terminally ill. Note that it was under the current "conservative" Supreme Court that Oregon's euthanasia law was held up. It is expected that CA will pass a similar law to Oregon's. If the prevailing view of TPTB was that euthanasia was a matter of inconsequence, then I think we would have seen many Republican politicians use the Supreme Court ruling to rail against the ruling in order to gain political points with their religious right base and Bush would have done a Shiavo type of grandstanding routine. But there was hardly a peep of protest.

    Having had a strong interest in euthanasia since my early teens and later in life taking medical ethics courses, I think a strong distinction must be made between a move away from extraordinary measures in the final stages of terminal illness and giving substandard care to the elderly and disabled. For euthanasia to be ethical it must be voluntary (no duress in any form or psychological impairment) and strict guidelines must be enacted to prevent abuses. To do otherwise is to risk a slippery slope wherein human life is debased.

    The philosophy of the reactionaries of the anti-euthanasia crowd is often akin to the doctrine of the vitalists such that all life, regardless of its quality or level of sentience must be preserved.
    To go to the other extreme of valuing life only for its relative fitness is not in keeping with our moral traditions and goes against what we all have experienced in our connections with family and friends. How does one measure the wisdom of the elderly through any type of human ERoEI? Too many intangible factors make it impossible to measure someone's relative worth using some type of human value equation. We should never go down that road.

    Best Regards, Southpaw

    I'm glad someone brought up the topic of health. There should be an equivalent of the oil drum examining healthcare (maybe Bandaid) The big problem in the western world is demographics. As the buddhist say "oldage, sickness and death." The boomers are hitting 60. Many are not as healthy as they think they are (obesity, heart disease etc) and will soon begin to feel the effects of a rich lifestyle. Society has grown used to elaborate end stage healthcare.

    Another problem is that an significant amount of doctors are of boomer age and many may actually be able to retire at a relatively early age. Given our complicated care it takes several years before a new doctor is trained a ready to fly solo. We need to open some additional medical schools within a couple of years.

    Even if CERA has it right about energy I think we are facing rationing of healthcare. Take care of your own health as much as you can. I hope some of the graphically and mathematically inclined folks out here can take a look at this and present it in a digestible format.

    This look at the WHO assumptions reminds me of what I encountered when researching climate change and the work of the IPCC.

    I had a National Science Foundation grant to do work in the Peruvian Andes, and a team of collaborators looking at me to lead the intergration of the various components. I decided to study the IPCC to see how they integrated economics, demographics, climate change and the impacts on natural and human systems.

    I started reading the SRES reports (Special Reports on Emmissions Scenarios) and went, "Oh my god, they are totally bogus!"

    It was deeply depressing and I couldn't have any serious conversations with colleagues about it because as soon as I questioned the wisdom of the work of this great collaborative institution they wondered if I was okay or had gone mentally derranged. Because this was mostly being done via email and phone calls, it became impossible for them to really sort out my capacity.

    Remember, I was NOT questioning the problem of climate change, only the underlying assumptions of economic models that are used by climate models. I would say something like, "Listen, you are ecologists and biologists. You base your work on the laws of physics and ecology. But SRES models are dismissive of these. They are monetary constructs and don't accept feedback from the natural world. You can't trust them! Now what are we going to do about this?"

    Nothing, as it turned out.

    I produced and was invited to give a talk on the problem and it is available here:

    Because of my experience with institutional inertia I then had to think hard about why folks responded to me the way they did. What Bednarz and Roth are describing rings totally true.

    Clicked through your powerpoint presentation.

    It seems to say that the UN scientific projects are clueless in your area.

    Not unexpected IMO.

    So let me ask. Your aware that your colleagues are unaware of impending crises. Have you convinced any of them otherwise? Have they been to TOD?

    What are you going to do in the future then if our scientists are doing bad science, paradigm wise?

    Have I got it right or did I read it wrong. You blew the whistle. You made a presentation. What happened after that? Give up? Move ahead? Become a doomer? What?


    P.S. Did you graduate from UNC? Go Tarheels.
    I am moving back. Close to Chapel Hill. Not too close.

    I am a population, evolutionary biologist and ecologist. The UN (and all governments and the general public as far as I can tell) do not apply biological rules to humans. Hence, their models and projections are, IMO, absurd.

    Some of my colleagues (or former colleagues since I don't do much science anymore) are nearly as aware of this stuff as I am. However, those with families, university labs with graduate students, grants to manage, etc., are constrained in what they can do about it.

    TOD wasn't around when I was dealing with this stuff originally.

    My friends were doing fine when dealing strictly within their own field. It was when they had to rely on work from fields such as economics that it got tricky. If an economist produces a model based on assumptions of perpetual economic growth through unlimited resource substitution, how can a biologist be justified in using it?

    It is the incompatibility of paradigms and the inability to work collaboratively across them that I got stuck on.

    Not many people paid attention to me, so I dropped out of academia.

    I am now working to be a small-scale farmer in a small town.

    Graduated from UCDavis and the Washington University. Chapel Hill a beautiful area!

    Wash U in St. Louie I take it,hence the Botanical Gardens notation?
    Been there many times in ye oldense dayse.

    Good luck on the farm. Long as one has the strength and means, small scale farming to me is a close to heaven as one gets IF you can do it right and don't listen to too much BS. The earth will talk to you if you get down on your hands and knees, dig into it, look at it and smell it.

    Example. You know the soil is in the right condition to till if you take a handful, squeeze it into a tight hard ball and toss over you left shoulder into the air(means not too much velocity is imparted nor too high) , turn around and watch as it hits the ground. If it explodes into disparate pieces easily then it is just right. If it doesn't then too moist to work, wait a day or two. When its just right the soil opens up and becomes mellow. Just right to insert seeds into. Never plow or till in a wind.

    I use hairy vetch as a ground cover. Same as my ancestor tobacco farmers did. Perfect nitrogen fixer. Perfect soil protector. Buckwheat is good too.

    Something about good dirt on a spring morning and its waiting for the seed to be sown. Maybe many have destroyed the soil and let it erode. You can vow you will not let this happen and each year the tilth and fertility improve under your hands. Great stuff.

    You erect a tent fly and setup your hammock near the waterfountain and the garden plot and read while you listen,watch and meditate. You set tobacco sticks in the ground through out the rows so the bluebirds light on them and then fly off to pick insects off the vines.

    Go to the woods and collect some black soil that has never known the plow since the dawn of time and if the cows have graced it with droppings better yet. Place a shovelful out of your wheelbarrow under your cucumber hills or whatever you choose and you will not believe what those vines can produce. It is black gold.

    The strawberries in spring are beyond imagination.Drip good Eyetalian balsamic vinegar on them and visit nirvana. Don't worry about life in the big cities. You have better food and riches. You are at the apex of what rapture the earth can give one. Man needs to be closer to the earth. He needs to treasure it and protect it. Genesis in the Torah says so I read. To protect and defend. Its all we got on this little multicolored ball, third planet out from a mediocre sun in some far off corner of the universe in a galaxy we call the Milky Way and is observable as a light band of starlight on a good dark night out on your farm standing in the yard.

    Sorry for the melodrama.

    airdale-Long days and good nights.

    We have a power down, PO group that meets in Chapel Hill and Raleigh. Very aware group.

    I won't be back over Black Mountain(16 miles of up/down grade) until spring or a bit later, depending. When I get settled and get my computers running I will touch base,,if we aren't already in powerdown/dieoff or whatever.

    I have always wanted to try my old Mother Earth blueprints for passive solar heating. Maybe get into PV.

    Hello Jason Bradford,

    I just wanted to briefly say that is an excellent presentation!

    What would be interesting to know is if youngsters viewing this get fired up for promoting change, or withdraw into greater denial.

    The simple thing for them to do is to promote very low births by high levels of recreational, non-procreative, consensual safe-sex. High dopamine rewards, minimal violence, maximum bonding/cooperation, physical fitness, but very little fossil fuel usage. This seems like the fastest way to traverse from high pop. to low pop.

    Govt, families, and churches should make sure birth control, honest sex education, condoms, free vasectomys, free STD screenings, etc, are everywhere, with pedophiles, rapists, abusive partners, and repeat STD spreaders ruthlessly incarcerated. Can we substitute sex as a replacement for striving for high reward material-mental feedback?

    That might be a difficult task: would you rather go for a ride in a F-15 fighter [or some other thrill-ride], or enjoy an equivalent amount of realtime with your fantasy partner? Are we now DNA hard-wired for more than just food, water, and companionship?

    Bob Shaw in Phx,Az Are Humans Smarter than Yeast?

    This is a subject that is always on my mind when I am thinking about Peak Oil. I have a six year old daughter with cerebral palsy, and if the intensive health care that she requires were to become unavailable, she would be in a very dire position.

    I am going to have to study how to synthesize or scam the required medications.

    Reply to Hans,

    God bless her, and yes, do study and try to prepare, but DON'T (and I am absolutely a zeolot on this issue, so let the doomers get mad at me if they want) DON'T let the wildest scenarios scare you, and I know it must.

    Just before Y2K, my mother was in the final stages of breathing distress, and relied on a weekly shipment of liquid oxygen to survive. The press stories of the coming "Y2K crash" terrified her, as she worried about what would happen to her if her oxygen was cut off. The strain on her nerves and the fear did her no good. Needless to say, it was a pointless exercise in fear, and the press never seemed to consider the way they were worrying the most vulnerable of America's people with outlandish scenario's.

    Peak, in the larger abstract picture may be real in upcoming years, but some of the hysterical rantings and outlandish scenarios are so idiotic if they are thought about even for a few minutes (and become more outlandish with more study) that they are irresponsible horror stories that are terrifying the elderly who read and listen to them, the ill, and those like you who are in care of a child in need of constant care. People are being VERY irresponsible in the things they say. We must understand that the difference between technical "peak oil", a real concern we must manage and mitigate, and "end of the world catastrophist theories" are the difference between a techncal issue (peak oil, liquid transportation oil in particular) and a belief, in some cases a desire, for a catastrophist collapse that may (or may not) occur, but almost certainly WILL NOT be caused by peak oil alone. Take all the wild rantings you hear with a grain of salt. And good luck and blessing to you and your daughter.

    Roger Conner known to you as ThatsItImout

    Hans, I don't know where you live not how severe your daughter's CP is, but I do have a fair amount of experience treating children and adults with CP, so I'll try to give you some general advice. My advice would be to try to find old-school type physicians for your daughter. the reason I say this is that younger physicians (and I confess I am in this category) have been taught to rely on technology whereas the older physicians developed greater low-tech skills. If that technology is stripped away due to PO or financial reasons, a lot of newer physicians will hardly know what to do. Problem is, most "old-school" physicians are probably within a few years of retirement.

    Your main concern should be whatever associated health problems she has, I'd be less concerned about being able to get good therapy and treatment for her physical problems. Even if we have a large-scale collapse of the medical system, you should still be able to get good physical rehab care for your daughter. There are all sorts of new technology's in this area (botox, selective dorsal rhizotomy, etc.) but in my opinion they don't offer much advantage over the tried and true therapies that we've been doing for decades. The old methods may be more work for the therapist and for you than the new technologies, but the ultimate outcome isn't much different. If your daughter goes to therapy, go with her as much as you can. A lot of what they do, you could do yourself with a little bit a training/ education.

    If your daughter requires a wheelchair, you may want to take a course in bicycle repair bc/ it's very similar and with a few basic tools, you can keep a wheelchair going for a long time, plus you'll have a great skill that will be useful post-peak.

    Phineas Gage, MD

    Lets say the fear of a lower energy world means less drugs/healthcare.

    Lets also assume that eating healthy/using herbs is what you feel will be a positive path for you to take.

    Here's the WHO's food (and animals as food) standards:

    And here are the people who think the WHO's plan is dangerous.

    Those are the guys who want to ban my Stresstabs and DMAE.

    I'm marginal at best but I really sink without my B's and DMAE is a big help too - gotta take 'em both.

    good luck and remember, that even before anybody ever heard of peak oil, the medical industry's inflation rate was higher than the inflation rate of oil, and their execs were making more get out of them what you can, they are not hurting (why does no one ever mention that, by the way, that oil and gas have gone up slower by a large margin than medical cost....can it be true that the cost of medical care IS NOT directly tied to the price of oil?

    In my case, I have extreme hypertension, an inherited disorder that my father, two uncles and at least a couple of aunts have. We are all on medication. If I go without medication (two types) for more than 48 hours, my blood pressure will begin to climb, reaching a point before the 36th hour of "hypertension crisis" (some 230/140 or so), meaning danger of stroke, heart or kidney failure and eye damage. I will get incoherent at this high level, and see halos around lights. Without medication this comes rather quickly, and my uncles and aunts suffer only slightly less. One of my aunts has suffered a stroke in recent years. Lifestyle matters almost none, as I have relatives with this disorder who have and have not smoked, one who walked great distance daily, some who drank alcohol (no alcoholics) and others who did not touch it, and some who ate well and attempted to eat well and correctly (two different things that), and the blood pressure readings remained the same high level despite lifestyle, unless treated by medication.

    There are some 56 million Americans with hypertension or high blood pressure, that is ONE IN FOUR AMERICANS

    While not all require constant medication as I do, many do, and at least a third of the above sufferers are chronic hypertensive, meaning they MUST HAVE dialy medication to control what is a very dangerous illness.

    This means that all the "powerdown" fantasy of Hienberg, Kunstler, etc., is a death sentence of a varying degree to some 14 million Americans at least on the hypertension issue alone, as they would see a massive increase in strokes, heart attack, blindness and kidney failure. You see, despite the slander of the American people by the "powerdown" types, for many of us, we are not really living that large (me in my 1981 Mercedes Diesel and '50's vintage frame house) but we do rely on the modern technical medical system to help keep us able to move about and function.

    The dream of back to the farm and back behind the plow, heating the house with a woodstove and riding a mule, even if we were able and decided to make all the above adjustments would still leave us in critical and life threatening condition.

    This is just one OF MANY examples of why the so called "non-negotiable way of life" for many aging Americans, and more to come very soon, really is non-negotiable. It will be fought for. The way we live is not merely a choice, although for me, it is that, but the way we live really is THE WAY WE ARE ABLE TO LIVE.

    Roger Conner known to you as ThatsItImout

    Hypertension? Just Go Ape!

    Those are the guys who want to ban my Stresstabs and DMAE.

    Assuming the WHO does not have the best interest of citixens at heart, how exactly do you plan to 'fight' them/stop it/get enough land to grow your own-make your own whatever?

    Its difficult to distill healthcare issues to simple graphs, but I will try to share some of what I know. First, a quote about end of life care.

    Writing in the New England Journal of Medicinein 1994, Ezekiel J. Emanuel and Linda L. Emanuel point out:

    "Expenditures at the end of life seem disproportionately large. Although the precise numbers vary, studies consistently demonstrate that 27 to 30 percent of Medicare payments each year are for the 5 to 6 percent of Medicare beneficiaries who die in that year. The latest available figures indicate that in 1988, the mean Medicare payment for the last year of life of a beneficiary who died was $13,316, as compared with $1,924 for all Medicare beneficiaries (a ratio of 6.9:1). Payments for dying patients increase exponentially as death approaches, and payments during the last month of life constitute 40 percent of payments during the last year of life. Identical trends and ratios have been found since the early 1960s.

    Many people believe that these expenditures are for the care of patients known in advance to be dying. The time of death is usually unpredictable, however, except perhaps when the patient has advanced cancer. There is no method to predict months or weeks in advance who will live and who will die. Consequently, it is difficult to know in advance what costs are for care at the end of life and what costs are for saving a life. Only in retrospect, after a patient’s death, can we identify the last year or month of life."

    Second, click on this link to understand the evolution of medicare payments in the USA over time.

    USA budget
    Realize that in 2004, almost 41% of the national budget (at that time, close to 2 trillion dollars) went to medicare, medicaid, and social security payments. That is up from 30% in 1984.

    Then, click on this link to see the future costs of promises made today only.
    Future promises

    In 2004, the government has promised 43 trillion dollars of promises in the form of programs in already in place without making any new promises in the form of new programs/benefits. Also realize that the federal budget for 2007 is around 2.7 trillion dollars of which about $1 trillion will be financed only by the sale of US treasury notes mostly to foreign investors. If they choose to stop buying them, our taxes are only covering ?60% of what our government spends each year. Could you stand a tax hike to pay the difference if foreigners stopped buying the treasury notes? For that matter, the current GNP is about $12 trillion.

    These links come from the US Government Accounting Office, which is the beast itself.

    Please also realize that we aren't even into the real medical expenditure that wil come with the retirement of the baby boomers in the next year. New medical advances are not cheap. Each new device or treatment costs tens to hundreds of thousands of dollars, so future costs are impossible to predict accurately. For example, they are coming out with a "left ventricular assist device" which is a mechanical gizmo that will help a failing heart pump blood a little easier. (Congestive heart failure is a common cause of death to older americans.) Prelimnary tests indicates that it can extand life by several years or so under ideal circumstances. Expect the device to cost $50,000, not including the surgery to install it, the extra office visits to monitor it, the repeat surgery to replace it when it starts to fail, and the extra medication required to be taken to prevent development of bloodclots, etc. Now realize that hundreds of thousands of older americans have congestive heart failure, and would benefit from this. In a few years, this will be yet another example of high priced medical care near the end of the life span that we will have to pay for. Because they will now live for a while (where as before they would have died somewhat sooner), they will also receive treatment for their other healthcare problems (i.e. chemo for their prostate cancer, hospitalization for their pneumonia, therapy for their depression becasue they've outlived their friends, hip replacement for their arthritis because now they can walk again because their heart is working better). By understanding how each new advance adds to the national cost of healthcare in other ways, you can now appreciate the dimension of the problem. That, incidentaly, is one reason why your healthcare premiums are skyrocketing.

    Ok, now for the other side of the coin, people's expectations.
    In Africa, people think that if something good happens to them (i.e. a doctor comes to the village and administers a vaccine to their child), they praise the Lord above as having received His special blessing. In america, we expect perfection, and its someones fault if something unfortunate happens. We demand the best at all times. I was recently involved in a case of a nice lady. The lady was in her 90's, and developed a lifethreatening infection with antibiotic resistance. She was hovering near death, and several specialists recommended comfort care, allowing her to pass peacefully. The family would have no part of that. They demanded treatment. This forced us to pull out the $1000/day drug, and son of a gun, it worked. Now it took a very lengthy hospitalization to achieve this. At the end of the hospitalitzation, she was to weak to lift her head off the pillow, and was eating perhaps 30% of what her body needed to live. However, she made it out of the hospital (at a huge cost to tax payers, but not the family). She got to the nursing home for "rehab" and promptly died soon thereafter. I was supicious that they were only holding the infection at bay as opposed to completely eliminating it. Sure enough, the infection came rushing back as soon as the medication was stopped. However, if you can't clear an infection with 1 month of treatment, it means that your system is too weak to sustain life in any meaningful way. There's no way to prove this besides trying to stop the antibiotic and see what happens.

    I have another family which refused hospice for metastatic cancer. They demanded chemo. The patient basically moved the dying process to the hospital (albeit at a slightly slower rate) for an incurable disease, running up the tab for Medicare. She had perhaps 1 week if she went to hospice, and perhaps 3-4 weeks by remaining hospitalized. However, family gets to decide (and not pay the bill) because the patient is on medicare. Why do I go along with family and patient wishes? Because they can demand top dollar services and shift the cost to the govenment. Despite my attempts to dissuade such healthcare choices as futile, they insisted on "trying" and "not giving up". I have no choice but to follow through due to a personal threat of lawsuits.

    These stories emphasize my following point. Americans feel entitled to the best of everything regarding healthcare, without concerning themselves about paying for any of it. Even if we can continue to grow our economy (i.e. no peak oil scenario), we won't be able to pay for the promises we've made to ourselves. Factor in peak oil, and it will get ugly much faster. Some will accept rationing, but many will not. As a doc, I will be pulling out of medicine at that point because too many patients will try to sue their way into demanding treatment in a system of declining resources. Of course, this will be the same across the country in that the majority of the remaining resources will be spent assigning blame via lawsuits instead of focusing on the problem. Soooooooo....... this will be a huge problem that people haven't even begun to consider (especially if many physicians pull out due to a hostile work environment).

    Finally, here's a link to a bunch of other graphs about the state of the american budget and deficit (to facilitate further reflection and research).
    USA deficit info

    Thanks for taking the time to formulate this excellent post of the real state of medicine in America. The US system is non-sustainable even without PO, and add high energy costs to it, and we are heading towards difficult choices going forward. I expect a combination of a nationalized system and individuals choosing alternative therapies over traditional medicine. How can we transition to providing medicine with a high EROEI, perhaps the values we had in the 50's while preserving the technological advances of the current time in America's non-negotiable, cadillac-medical-care-entitled, and litigious society? One thing's for certain. No lawmaker will attempt to make practical suggestions until the system is already in a break-down mode.

    Thank you Lothereu for adding some details. I know most physicians try to get their patients to try lifestyle changes for six months or so before starting with the drugs. Most patients can't heed the warning for a number of reasons. I don't look as this as a doomer thing, the rest of humanity has coped without such elaborate, drug inducted care. Its just going to be an enormous personal adjustment to make during a time with plenty of external stress. This is one change that is better to make volunarily.

    from the head post: They assume that technological progress and economic growth will always be positive.

    Yes. This kind of flat-earth outlook, that loses touch with reality, is best explained, I feel, within the sphere of organisational management, knowledge networks, and organisational failure. (Huge literature.)

    WHO is dependent on donor countries, like the UN. The impressive sums given to health internationally that are reported in the media from time to time, eg. Bill and Melissa Gates for eradication or dampening of AIDS, TB, malaria, don’t go to WHO, but to a ‘sister’ organization, the Global Funds.

    The WHO is thus poor, relatively speaking. Its donors are Gvmts. who prefer not to be interfered with - their politics, their health management, their human rights, their commercial practices, etc. etc. (China is a good ex. here. - chickens..) WHO’s employees (in part, but at top level certainly) come from...those Gvmts/countries, and are dependent on them, increasingly so.

    So, the general outlook, or the underlying ideology, the culture of the organisation is direly conventional, a scheme that becomes both a mantra and a cover, a life-line, a kind of double-speak or group-think that hurts or shocks no one, and particularly, does not offend the US, Big Pharma, and developing countries (who have a lot of votes.)

    In fine, the WHO is now guided by global business interests, international-geo politics, and the conservation of a status quo vis à vis developing countries. (Many would scream at me writing this, so scatter salt ..)

    Eg. ‘Poor’ country might happily accept new computers and a special program in what-not disease curing, but will not offer free condoms, let people into its prisons (TB, aids, human rights, torture, prison funding, etc.), take decisions that might allow children to be fed properly, or clean up its hospital hygiene, which is of course pristine. (Invented example to make the point.)

    My favorite example of consensual irrelevancy is one of the previous DGs (Gro Harlem Brundtland) crusade against smoking. The medical evidence is in; what is to be done next, while it is a public health issue, is a question that concerns individuals who make free choices, Gvmts and the tobacco industry. (Similar to fast motorbikes, gun ownership, alcohol abuse, heroin addiction, etc. etc.) The WHO cannot cure rich societies’ ills (and of course nothing happened about the smoking), it has no leverage there; its mandate is to create, support, implement, or advise on world-wide public health from a medical position (as many see it), eg. saving children with incredibly cheap cures/prevention, keeping close tabs, as world coordinator of info, on avian flu H5N1 development, etc.

    Gro also came out against violence - a completely non-medical issue. Naturally, everyone was very pleased: violence is terrifying, smoking is disgusting, we all agree and nod wisely and can spend a pile of money!

    The WHO mandate is an exercise in impossibility; health depends on such a wide variety of factors; the days where all could decide together to eradicate malaria are long gone.

    (i chose to make some points not made above, eg. diminishing returns by phineas, jobs by never, etc.)

    One comment about discussing WHO. It's annual budget of over $2 billion is being rivaled by the Gates Foundation's annual budget.

    From NPR
    Talk of the Nation, November 3, 2005 · The Bill and Melinda Gates Foundation spends billions of dollars each year on international health programs. Its contributions now rival the total annual budget of the United Nations' World Health Organization.