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.

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.

http://www.abhota.info/end1.htm

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.
http://en.wikipedia.org/wiki/Thomas_Malthus
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"
http://en.wikipedia.org/wiki/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

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.

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.

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.)

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.

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.

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.

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!"

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.

Gail

Totoneila,

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

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?

airdale

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

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?

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

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.

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.