Rising Energy Costs and the Future of Hospital Work

This is a talk given by Dan Bednarz to a group of nurses. The talk was given at the House of Delegates Meeting of the Pennsylvania Association of Staff Nurses & Allied Professionals (Pasnap) in Harrisburg, Pennsylvania on April 29, 2008.

Dan is a healthcare consultant who tries to get people in healthcare (including public health) to start thinking about peak oil and climate change issues and how to address them. In Dan's words, he is "a healthcare consultant building a consortium among public health and health care stakeholders and actors to address peak oil, climate change and related environmental issues". Dan posts on TOD under the name Danb.

Hello, it's nice to be with you today. My intent is to give you a realistic take on the future of your profession by explaining why healthcare and nursing will be transformed by rising energy costs. Is there danger ahead? You bet. It's going to be difficult, probably life-changing for all Americans. Here’s why: the scale of our energy predicament is enormous, unprecedented and grossly misunderstood by institutional leaders and most of the media.

I know some of you may be wondering, Energy scarcity? That's someone else's problem; put this guy in touch with geologists and politicians.

So let's step back for the big picture.


A few numbers to set the context:

• The amount of crude oil pumped out of the ground has been on a bumpy plateau since May of 2005. Until then oil production was steadily increasing about 2% a year-–with periodic declines--and the world had a daily surplus, or emergency cushion. That surplus is gone, everything produced, supply, is immediately purchased, demand. Whether or not the world has reached "peak oil"-–the point at which yearly total worldwide extraction cannot be increased--this 3 year plateau indicates that the era of cheap energy is over.

• Oil is now over $100.00 a barrel. It was $10.00 a barrel in November 1998.

• Oil powers 90% of all transportation and it is essential to food production and distribution; it is the primary ingredient in many products-–think plastics, petrochemicals, and clothing. It is fair to say that all our institutions, especially medicine, are dependent upon oil, the lynchpin resource that keeps the economy humming and allows it to grow.

• And it’s not just oil that’s getting scarce. Natural gas in Pittsburgh went up 30% on April 1st, to $12.50 per MCF (thousand cubic feet); it was $2.50 in 2001. Typically, the cost of natural gas drops after the winter but here we are facing higher prices during the summer.

• Coal is becoming scarce in many countries and more expensive here; its price has about doubled in the past year. It is our main source of electricity. In about 15 years the world may hit a peak in its production, and this combined with the fact that natural gas-–the secondary source of electricity generation--simultaneously will be at or past its peak, poses a threat to our supply of electricity.

• To put a human face on this, a polling agency found in December 2007 that 12% of Americans planned to put their winter energy bills on their credit card-–no wonder Christmas spending was down. An article in this past Saturday's New York Times details the rising number of people unable to pay their winter utility bills and now facing service cutoffs. Many hospitals in California are on the verge of bankruptcy; rising energy costs-–in tandem with other increasing costs--could be a breaking point for them. Further, we are merely at the beginning of what some of you recognize as Jim Kunstler's poetic phrase "The Long Emergency."

• The total amount of energy the world gets from fossil fuels is predicted to peak in 2010, so we’ve probably got about two years before systemic disruptions and breakdowns become commonplace and then worsen. Even now we see the airlines struggling, food prices soaring, and we have a fiscal/financial crisis of unknown scope that is connected to the price of oil in numerous ways I cannot delve into today.

Energy in Hospitals

Now let's look at energy use in hospitals and then use the issue of record keeping, a biggie for nurses, as one small but significant example of how energy scarcity will shape the future of healthcare. Then we’ll close with some comments on where medicine is heading and my claim that nursing stands to become a force in reforming the healthcare system.

The EPA estimates that hospitals use twice as much energy per square foot as do office buildings. Until recently hospital administrators have not paid attention to the cost of energy because they think-–mistakenly--that it represents less than 2% of their operating expenses. Therefore, they have considered rising energy costs a nuisance, not a threat. However, a few weeks ago a former AMA (American Medical Association) official told me hospital administrators are getting worried about energy costs because sharp increases are eating into profits. For example, all energy costs in the US rose 17% in 2007, with the cost of oil climbing 57%. The first quarter of 2008 shows no change in this trend. How many years can our society-–and hospitals--absorb these increases?

We should look a bit closer at that alleged 2% because it ignores hidden oil-related costs--also, this percentage is from 2005, when oil was $48.00 a barrel. Virtually every item consumed in a hospital is to some extent connected to fossil fuels, primarily oil. In medicine petrochemicals are used to manufacture analgesics, antihistamines, antibiotics, antibacterials, rectal suppositories, cough syrups, lubricants, creams, ointments, salves, and many gels. Processed plastics made with oil are used in heart valves and other esoteric medical equipment. Petrochemicals are used in radiological dyes and films, intravenous tubing, syringes, and oxygen masks. This could be a much longer list.
Finally, as the cost of oil, natural gas and coal rise in tandem their impact is surpassing that 2% of operating expenses just mentioned.

Now let's consider our example of how nursing will be changed.

Recently, I read a report which estimates the amount of paperwork (communication, medication administration, admission, discharge, transfer, supplies, equipment, and so on) is so burdensome that the average nurse devotes only 31% of the workday to direct care.

The American Academy of Nursing is pushing for fully electronic records. I won't get into whether or not this will increase patient contact hours. What is salient is that this is a solution based on an increasing amount of energy flowing into hospitals. Indeed, all across our society planning takes for granted an ever increasing supply of cheap and uninterrupted energy. My colleague, Gail Tverberg, an actuary with a good deal of experience in the medical industry, has been studying the economic ramifications of peak oil and notes:

I expect that electrical interruptions will become more common in the next 20 or 30 years. These may even become a problem early on, for a whole host of reasons, including lack of water for cooling, lack of fuel for power generation, and poor upkeep of the electrical grid. Healthcare providers would be wise to plan for the day when elevators and electronic records may not be available.

Wow. Imagine doing your work under these conditions. Needless to say, the healthcare professions have no inkling of--let alone are preparing for--this astonishing future. In fact, a recent study showed that the electricity used exclusively for medical records is rapidly increasing, by 400-800% in the past four years. Also, MRI usage is increasing, as are many technologies that rely on electricity. Add to this the inevitable shortages of other supplies and medicines that will simultaneously result from peak oil.

I would not be surprised if some of you are now thinking, "This is crazy; this simply cannot happen." To which I’d like to be confrontational and assert, fossil fuel costs will continue to rise and eventually the healthcare system will be forced to downsize-–just as the Baby Boomers and (possibly) climate change effects--inundate the system. Let me just mention our perilous national economic status and note that some commentators are claiming that the government has in effect nationalized Wall Street by bailing out Bear Stearns. Further, anyone who thinks the health sector is recession or nationalization-proof is confusing health-care, which is indispensable, with the current system, which is unsustainable.

This is a lot to lay on you in a few minutes of exposition, and I'm tempted to apologize; however, nursing-–unlike, say, public relations--is where the rubber meets the road. So let me make a few closing comments and then take your questions.


1. I feel safe observing that the vast majority of insurance companies, medical associations, HMOs and other hospital associations will resist facing the stark consequences of peak oil because they are benefiting from the status quo. On the other hand, those hospitals with a mission for stewardship of the earth and charitable activity are likely to be among the first to recognize the need for radical change in medical care.

2. In the same vein, it's obvious that nursing is not prospering even though it is in some ways the backbone of the system. Your profession's main themes for reforming the healthcare system should center-–I hate to use the word "should"--around radical resource conservation and efficiency, and the elimination of wasteful and environmentally harmful practices. In other words, reduce, reuse, recycle, and repair.

3. Simultaneously, there will be a political struggle for the soul of healthcare: We will look to other nations with decent health systems where three core values predominate: 1) no one goes bankrupt due to medical status; 2) no one is denied treatment for any reason, and 3) preventive and treatment medicine are integrated. This means one response to energy downturn leads to healthcare for all. The alternative to this is medicine becoming something for the wealthy few, with the rest of society receiving what amounts to triage-–or, alternatively, home care or "folk medicine." In some respects these alternatives represent the familiar themes of the Jeffersonian/egalitarian and Hamiltonian/elitist traditions.

4. By forming a coalition with public health and even some of the growing number of doctors who favor a "single-payer" system, nursing can shape the transformation of our healthcare system.

Rather than elaborate, let me thank you and open the floor for discussion.

Why even have hospitals? Minor medical treatments could be performed in small local clinics or in homes, and major interventions foregone altogether. I personally have sworn off doctors. I suppose that if I broke a bone I'd have it set but anything much worse than that I'd just OD on synthetic opiates & barbituates & die. I'm going to die anyway; I don't need bypass surgery or cancer chemotherapy and neither does anyone else. There are 6.7 x 10^9 humans infesting this wet space rock; any individual human life is next to worthless. Certainly not worth the vast health care infrastructure paid for directly or indirectly by us all. There's no point living with debilitation or to decreptitude. When the time comes, just die.

Oh my goodness! We homo saps, created by god in his very own image, are worth whatever it takes to keep us alive as long as possible. All other life on this planet was placed here just for our benefit. This is so obviously self evident.

Studies have shown that overall, hospital spending does not increase average life span. Diet, obesity, exercise, less driving fatalities, less alcohol abuse are all more important than hospital spending.

I agree with you. Our healthcare system is the most expensive in the world, but the outcomes are nowhere near the best. We spend an awfully lot of money on hospitalizing very elderly people who will die within a year or two, regardless of what is done.

Right. There's another aspect to this also, and that is that as peak oil develops basic overall health (prior to treatment for any health problems) may improve. In World War I, neutral Denmark was subject to the Allied blockade of the continent. They converted to a largely lacto-vegetarian diet and the mortality dropped by about 30%. In World War II, death rates for circulatory diseases and diabetes dropped dramatically in occupied Norway. In both cases, the death rates went back up when the wars ended (sources in my book "A Vegetarian Sourcebook").

A lot depends on how we react to the food situation. A lot of current health care expenses relate to degenerative conditions such as heart disease, cancer, diabetes, obesity, kidney disease, etc., all of which are strongly linked to diet and all of which tend to occur in the "civilized" nations but do not occur nearly as much in the less developed world.

In a world beset by all the other problems of a post-peak world (high prices, unemployment, etc.) switching the country to a vegetarian or largely vegetarian diet would not be either technically complicated and would not necessarily be that hard of a "sell."

Keith Akers

We'll need them for all the war casualties. So we can patch 'em up and send them back into battle.

Damn, Why didn't I think of that!

We'll need them for all the war casualties. So we can patch 'em up and send them back into battle.

"Soldiers' joy. Oh what's the point of pleasure
When pleasure only serves to kill the pain?
Lay down arms and take the coffin's measure, or
Take up arms and send me out to fight again..."
---Michelle Shocked

The Iraqi war in particular & war in general serves as evidence of the verity of my point: that any individual human life is next to worthless.

Coal is becoming scarce in many countries and more expensive here; its price has about doubled in the past year. It is our main source of electricity. In about 15 years the world may hit a peak in its production, and this combined with the fact that natural gas-–the secondary source of electricity generation--simultaneously will be at or past its peak, poses a threat to our supply of electricity.

I'm wondering where you get this figure. Is it just because of the current coal shortages we are experiencing??

There are a number of studies that indicate that coal production may peak in about 15 years. Chris Vernon has summarized some of them in this post.

Heading Out has argued that these studies may forecast a quicker end to coal than will really be the case. He believes that the decline in production in many cases occurred because cheaper (and/or better) alternatives became available. The forecasting method misses the fact that if the alternatives are no longer available, people may go back to these sources, and they will again become economic.

Coal prices are very much higher now than they were in the recent past. At one time China was an exporter; now it is an importer. There are many other countries that would like to increase the amount of coal they burn, since oil is very expensive. Prices have risen because demand is much greater than supply. This is one story talking about the higher prices.

We use a great deal more oil than coal. When there is a shortage of oil, there is pressure to ramp up coal to compensate. In practice, it doesn't really work, though. It is almost impossible to increase the amount of coal available for export very quickly. One needs to be able to extract more coal from the ground; then one needs railroad cars, barges, and ships to transport the coal on. Some exporters have recently had difficulty for a variety of reasons. South Africa has recently reduced its coal exports because it needs more internally.

OTOH it is possible Peak Coal could arrive before 2023-the studies summarized do not appear to clearly account for increased consumption caused by oil depletion and decreased oil exports.

Dan is a good man, and he should also be focusing on the reality that soon we won't have hospitals. When the power grid goes out, so do hospitals. Dan is aware of this.

Maybe it will be mostly intermittent problems. If the outages are for not too long, and enough diesel fuel is around, back-up generators can solve the problem temporarily.

If we have bigger problems than that, then you are right, it would be very difficult to have what we now think of as a hospital. I wonder what is happening to the hospitals around the world, where there is currently load shedding now.

The day will come when there is no power and no hospitals as we know them, but some medical people will be among the survivors. What I am suggesting is preserving technology. Penicillin and other antibiotics are not hard to make --- IF YOU KNOW HOW, and most medical people have no idea of how to do it. By only concentrating on the next phase of the catastrophe means you won't preserve technology. Suddenly, there will be no national communications -- permanently. I know how to make penicillin, do the nurses and doctors in the thousand of hospitals in the U.S.? I have a copies of "Where there is No Doctor" and "Where there is NO Dentist" -- this book is very useful for doctors and dentists. Do the hospitals have copies? How many medical people will have such stuff when the grid goes out for the last time. As soon as there is some emergency, all of the copies of all of these good books will disappear overnight. Time to plan ahead. Time to get a comprehensive risk management plan for what lies ahead. That is what educated public servants are suppose to do, and which the poor uneducated masses have no idea of.

The number of bacteria that are still susceptible to plain penicillin have been tremendously reduced since its introduction. It might make you feel better to know how to make penicillin, but I suspect its efficacy might be substantially less than you hope for.

When one has an intestinal infection, very common where I live in Mexico, and nothing else works, some cillan will work. Meanwhile, back at the ranch, what you say holds for nasty hospital infections, but most of the same old antibiotics work for intestinal and most infections here in Mexico for many years, like chloromycetin for intestinal infections. And this is something the medical professions can work on, versus the latest pharmaceutical innovation on how to keep someone who is dying of xyz alive for 10 more minutes.

Do you recommend a book for home-making penicillin? It should out-line quantities and the minimum refinement steps, and how to determine dosage and length of time for medicating and the strength of the penicillin. It should also talk about side effects, possible reactions, and other pitfalls that could occur such as breathing in the spores or contaminations.

Thanks, Ben

This site shows a fermentation process to make small quantities of penicillin. It doesn't address the problem of starting with a suitable penicillin strain or how to deal with the problem of foaming due to corn steep. Also make sure you have plenty of lactose on hand and don't forget the freeze dryer. Not as easy as making beer by any walk of the imagination.


And here's a pretty good history of its development. This shows how difficult making penicillin really was. Fleming who discovered it was unable to figure out how to extract and purify the penicillin. The penicillin was very unstable and freeze drying was the method used to obtain larger quantities. The first usage by the Oxford team showed very promising results, but the subject died 3 days after they ran out of their limited supplies.


Be sure to flip through all the pages on this latter site if this subject interests you.

Sorry, I just moved to the state of Veracruz, Mexico, and my books are still in boxes. In exactly month, June 11th, try searching: surviving peak oil and peak oil preparations. This is the name of a blog I am working on and it will have the penicillin info and many good books listed. If that doesn't work, email me then: clifford dot wirth at yahoo dot com

I'm not an expert, but plain penicillin may be quite useful in the future. There is generally some cost in robustness for an organism to adapt to anything, which is why most germs were NOT penicillin-resistant prior to WWII even though penicillin had evolved maybe a hundred million or more years ago (wild guess). Because the organisms using it were rare. By the same token, once most humans don't have it, regular strains of germs may get the upper hand over the so-called "supergerms" for the same reason they were more robust in the past. Stuff like MRSA is only "super" in the context of pervasive human antibiotic use, it's probably of lower efficiency than it was before to "buy" this adaptation.

The decentralization of medicine may not bode that well for "supergerms" and if few people have antibiotics, regular penicillin may well become quite useful again. It's a constant evolutionary tit-for-tat and microorganisms show it very directly due to their fast reproductive rate....

Indeed, it was recently found that some old "basic" antibiotics are useful against MRSA now... since they haven't been used much.

In nature, antibiotics are useful DUE TO BEING RARE, whether in bread mold, frog slime, etc. It is not energetically worth a germ's evolving to exploit the niche since it would pay a bigger cost in some other way. We know this is true because bread mold, frog skin, and all the other natural antibiotics still work after millions of years. They probably are periodically overwhelmed by bacteria if the owner gets too populous, and conserved within the organism's genome for later.

It's all about evolution.


Pinealone, the good news about antibiotic resistance is that it is usually temporary, not permenant. If al penicillin derivatives were withdrawn from a medical community for 1 year, the suscetibility to penicillin would skyrocket. Many bacteria would eject the plasmid containing the penicillinase gene as it would no longer convey a competitive advantage, and simply consume energy (on a cellular level) transcribing into proteins. Thus, resistance is lost (until the use of penicillin resumes as a therapeutic intervention).

I know how to make penicillin

:O You're a fungus that can type?!?!

Seriously tho, peak antibiotics arguably may be a bigger problem than peak oil. Another reason to shitcan hospitals: they're a factory for the selection of multiply antibiotic resistant bacteria.

Peak antibiotics

I'm surprised this issue is so far under the radar screen of most people and the media. In the 50's, 60's and 70's we came out with all sorts of entirely new classes of antiobiotics. The generally entered into broad use and were highly efficacious (generally bacteriocidal). In the last two decades, there have only been a few new antiobiotic classes. These drugs are often bacteriostatic rather than bacteriocidal, are incredibly expensive and are typically very narrow in scope. Even the old trick of barely modifying an existing antibiotic is drying up bc/ more recent ones have not fared well. Gatifloxicin (tequin) was pulled from the market 2 years ago, and another fluoroquinolone was pulled back in 2000 or 2001 (can't remember the name).

It is, and always has been, the "Age of Bacteria." Human ingenuity will never keep pace with selection operating over generation times of 20 - 30 minutes. We have been "blessed" (by what don't ask me) to have existed during the extremely narrow window of human history in which oil has been cheap & antibiotics actually worked.

I wonder about all the antibacterial soaps that are being used now days. And all of the antibiotics used on animals. It does not seem like they will help the usefulness of the antibiotics we have.

Me too, this obsession with antiseptic everything is crazy. Why does one need to sanitize the toilet bowl? No one that I know of, except the pets, drinks from the toilet. Why sanitize the shower? Does someone expect that germs are going to rise up and strangle them while taking a shower? Maybe the film PSYCHO had something to do with it. Do people sanitize the floors so their shoes don't get a cold? And air sanitizers and sprays are crazy and a waste of energy.

This does raise two important questions though:

1) Is the best strategy to avoid getting infected and needing antibiotics in the first place?

2) If so, what strategies does one employ to minimize one's risks of becoming infected?

I'd guess that most people would say that the answer to the first question is "yes". "An ounce of prevention is worth a pound of cure". If antibiotics become hugely expensive and rare, then an ounce of prevention might become worth a ton of cure.

So, that takes us to infection prevention strategies. I'm out of my league here, so I'll have to yield to others more knowledgeable than myself. I do tend to share cjwirth's scepticism toward the "sanitize everything" chemical warfare approach. It is almost certainly unsustainable, as antibacterial chemicals will become increasingly scarce and expensive along with everything else. Also, I believe that there is a school of thought to the effect that such an approach is actually counterproductive - that what we really need to do is to build up our natural resistance to germs that are ubiquitous in our environment, and that minimizing the exposure of our immune systems to these germs only causes the immune system to weaken.

There is also a school of thought that hospitals (and maybe medical care facilities generally) are actually iatrogenic - that they are breeding grounds for dangerous, antibiotic-resistant germs and pools of contagion. I am sure that any health care worker will confirm that extreme measures must be taken to prevent the health care workers themselves from becoming an unwitting vector for disease transmission; sometimes even those extreme measures are not enough.

Speaking of vectors, what can be worse than our modern system of transport, shuffling people, animals, foodstuffs, and other potential carriers of infection very quickly across the entire world?

Arguably, isolation and quarantine might remain the most effective and reliable tools to prevent the spread of infectious disease. That isn't something that most people want to hear, but it is true.

Given the above, might I suggest a few preliminary rules of thumb that might prove helpful for those that wish to minimize their risks of infection:

1) Stay put. The less travel one undertakes, the less likely one is to become exposed to an infectious agent not ubiquitous to one's local environment. Learn to be content with where you live, and arrange your affairs so you don't HAVE to travel.

2) Live in a small town or rural area. Large urban populations tend to be most susceptable to pandemics. Rub shoulders with fewer people and there is less chance of catching something from them. Small, isolated populations tend to eventually end up all sharing the same germ populations too, and build up natural immunity to those.

3) Avoid crowds. Don't attend mass spectator events, avoid shopping malls, etc. Try to establish oneself in a career where one works independently or in a small workplace instead of a large one.

4) Children are especially vulnerable to infectious diseases -- go to any cemetery more than 100 years old, and look for all the graves marked by very small headstones, or just rocks, it is a very sobering experience of the reality of childhood mortality due to infection. Many adults catch their illnesses from the kids that got them first. Large public schools are breeding grounds for infection. Transporting kids from a variety of distant neighborhoods and mixing them together only makes it that much worse. Home schooling or small neighborhood schools are preferable from an infection prevention perspective.

5) Try, if at all possible, to minimize the number of people that one must deal with personally - especially strangers and people from out of town. This presents a real challenge for people involved in sales and customer service; this might thus be another reason why, in a declining economy, these careers will literaly be "dying out". If you must interact with other people, try to keep your distance. Rural people are stereotyped and made fun of by city folks for standing far apart from other people and not facing them directly when speaking to them; there is actually unconscious, evolved folk wisdom in this practice - it reduces the risk of catching something from the person you are talking to.

6) WASH YOUR HANDS - FREQUENTLY! Fancy antibacterial soaps are not really necessary, plain soap and hot water will do if done frequently enough.

7) Try to be as healthy as possible. The stronger your general health, the better the human body is able to resist and to throw off infection. The Russians have a saying about the best friends of good health being fresh air, clean water and sunshine, and there is a lot of truth in that. One could add to that list: the consumption of a balanced and diverse diet of healthy (organic), whole foods in sufficient (but not excess) quantities; plenty of exercise and/or physical work, preferably outdoors; and a good night's sleep. Growing some of your own food is especially important; gardening in the local soil and eating what you grow will expose your body to the local population of germs and thus exercise and strengthen your immune system.

8) Avoid accidents & injuries. Anything which damages your body, even just a cut or a scrape, creates a potential opportunity for an infectious agent to gain a foothold. Equip yourself with the best possible safety equipment, exercise extreme caution in all that you do, and avoid undertaking any risky, hazardous activities unless absolutely necessary. Be equipped and prepared to administer effective first aid promptly for any type of injury that you do sustain.

9) Try to avoid the health care system, and especially hospitals, if possible. I say this not to demonize anyone in the health care system, but just to recognize the reality that one does risk exposing oneself to infection with each encounter with the health care system. Add to this the reality that a declining economy will be able to afford less health care, and it becomes obvious that we've all got to start now learning how to do with far less institutionalized health care than we've become accustomed to in the past. Learning to self-diagnose and self-treat is crucial; this won't eliminate 100% of your need for institutionalized health care, but it might cut it down substantially. If you must visit a health care facility, try to get an appointment for first thing in the morning - there will be fewer germs lingering in the air from other patients, and the health care workers will have interacted with fewer patients. Try to locate and utilize smaller facilities treating a smaller population of patients to further minimize your exposure. DO EVERYTHING YOU POSSIBLY CAN TO GET OUT OF THE HOSPITAL OR OTHER HEALTH CARE FACILITY AS QUICKLY AS YOU POSSIBLY CAN; the longer you stay there, the greater the risk of exposure. Advice #6 above becomes especially important - wash your hands extremely frequently while in the facility, and as soon as you have left. Also, NO VISITORS; I know this sounds like cruel advice, but why needlessly expose other people?

10) Be prepared to take more extreme measures during a pandemic. Have face masks stockpiled. Be prepared to seal oneself inside one's home and to have enough food, water, energy, medical supplies, and other essentials to ride it out for several weeks.

I am sure others can add to this list.

It might also be useful to rediscover World War II-era combat medicine, and the sulfa drugs. I remember making sulfa in undergrad organic chem lab. It was a quick one-step reaction: take a cooled solution of aniline (ArNH2) and add sulfonyl chloride. Get lots of yellow precipitate, and when you add enough SO2Cl, the precipitation stops, then you wash the sulfa with ether or hexane or something, and let it air dry, and you have the drug that saved millions of lives in WWII. I've got a bandage pack from WWII and it has a packet of sulfanilamide in it.

Allergic reactions are possible, apparently at a rate of 3% or so. HIV-pos people are allergic at a 60% rate, but if TSHTF, they're toast anyhow.

11) Considering adding the class of food now dubbed 'nutricuticals' to your diet.

Garlic, cinnimon, oregino, tumeric, various mushrooms,

http://www.sciencedaily.com/releases/1998/03/980305053307.htm Has a good list.
http://www.fungi.com/mycomeds/info.html The fungi list


This site is a good wack-job jumping off point - if it might work in some way and exists in a MLM form - he pimps it.
(Example - hypes yeast in the gut. Yet here:
http://www.nutraingredients.com/news/ng.asp?n=85161-nestle-research-cent... )

Yes, and I've also heard that echinacea is good for building up your immune system - I don't know if there is any truth to that or if it is just an unsubstantiated claim. I've also seen claims that eating naturally lacto-fermented foods can be good for you. For example, I make my own yogurt, using a culture that has a blend of bugs, including several that are supposed to be good for digestion. Apparently establishing a good set of bugs in your gut will help in fighting off some of the bad bugs that you happen to ingest.

Eating a balanced diet including plenty of fruits & vegies (forget "try for five", instead think in terms of "tend towards ten") will give you a full compliment of vitamins, minerals, and maybe even stuff you need that science doesn't even know about yet.

fermented foods

This is one of the things I intend to spend more time on - learing how to ferment various foodstuffs.

You have the pickling (cukes, cabbage, et la)
You have yeast (bread) and yeast+bacteria (sourdough)
You have fungi - in fact the fungi processing of soybeans may be the only 'safe' form of the product

A whole lot of our food used to be 'pre-digested' via fermentation.

That would be trovan. The fact that it was pulled from the market meant that trovan pens saw a significant increase in value on Ebay.

I thought it had more to do with indiscriminate use of antibiotics where they weren't really needed.

Feeding them to livestock just to make them grow faster is one practice that needs to come to an end...

"Another reason to shitcan hospitals: they're a factory for the selection of multiply antibiotic resistant bacteria."

You might want to add feedlots to your list. I do not know if they are more important than hospitals for generating resistant bacteria, but they might be.

A good reason to eat meat from animals not treated with antibiotics (which in turn requires better treatment of animals, preferably pasture fed), if one must eat meat at all.

Thanks, cjwirth. I just ordered a copy of each of these at Amazon:
Where There is No Dentist
Where There is No Doctor
Where Women Have No Doctor

They are also available for download here:


Thank you Gail and Dan.

As an RN, I see many upcoming challenges to our health care system. Certainly, the trend to electronic medical records is one. Although my employer has procedures for "down time" of the system, it will only work safely for short, infrequent periods with adequate staff to run paper forms to pharmacy, xray, etc.

You would not believe all of the "stuff" we use that is made from petrochemicals! I have only worked one place that recycled things like syringes and their sterile packaging and that was Emmanuel in Portland, OR.

In my unit, we use a lot of equipment: monitors, pumps, ventilators, the very beds our patients are in require a lot of power.

One of my big worries is that for the most part, telecommuting won't work for healthcare jobs.

In my area, housing is very expensive near the hospitals so many of us commute long distances. You'd think we would carpool - well I did until a few years ago, when our area hospitals reduced our notice of cancellation to 1 hour (and frequently they call late). That means you are already on the road when they call and say they are overstaffed for all or part of your shift and you are being given the next x-hours off. This can happen several times in one scheduled shift.

Hospital staffing will have to change, but the trend has been more and more to "just in time" staffing that precludes carpooling or mass transit. We already have some nurses who live very far out that stay a few days at a time with friends. There will be more of that before hospitals change their staffing practices.

I think Dan deserves 99% of the credit on this one. Most of what I did was the HTML.

I hadn't thought about hospitals suddenly changing nurses schedules because of just in time staffing, and this being a problem for carpooling or even public transit. I have run into this with when one of my children worked at a local grocery store, but hadn't thought about it being an issue elsewhere.

No power, no oxygen. Some thing else to worry about.

We have O2 tanks for power outages - granted, not a long term solution but we'd get by for a couple of days.

Great job, Dan & Gail! I went back to school in 2006 to become an RN for a host or reasons, peak oil being one of them, and have always wondered what exactly will happen to the health care industry post-peak. On one hand, it's essential for our continued survival, but on the other it consumes a huge amount of petrochemicals compared to its overall size. I wish we could go from the current for-profit private hospital system into a single-payer system where we don't have to worry about losing the shirts off our backs for pre-existing conditions and whatnot, and maybe we will, but from what I've seen it's about as hard to reform health care as it is to reform Social Security.

We're always going to need hospitals for the major cases, especially those requiring emergency surgery, but many other chronic problems can be resolved in smaller (and more local) clinics by professionals other than Doctors, such as Nurse Practitioners or Physician Assistants. It's also MUCH cheaper to treat stuff this way, on both the patient side and the caregiver side. I suspect once fuel costs to to high enough levels that this system will gain in popularity.


Last October I had our practice manager determine how many of the nine physicians in our office could remain in practice (neurology & neurosurgery) if we received Medicare rates for all of our patient's. Two of the nine physicians would still have viable practices. I don't what to imply that neurology or neurosurgery will be important in the future, but, before you wish for solutions like universal healthcare, you might wish to understand the implications of it.

I think rationing of healthcare and triage will become very important. Cardiac surgery on 90-year-old's, liver transplants for alcoholics, and even craniotomies for people with malignant brain tumors and 6 months to live, might be restricted to those who can pay for it out of pocket.

We have gotten used to a system where physicians make huge incomes relative to most of the population. We also expect that everyone will be treated, regardless of how little benefit it is likely to be.

To some extent, people are pressured to use the current system. I have had experience in dealing with elderly relatives. It is very difficult to decide not to treat an elderly person, because assisted living centers and all of the medical care centers expect that people will use/overuse care to the full extent available. Elderly usually end up in the emergency room, rather than some cheaper treatment option, because Medicare pays the full amount regardless, and because the elderly have so many other illnesses that "doc-in-a-boxes" are hesitant to treat something that looks like only a minor fall.


Medicare does not pay the "full" amount, it's about a two thirds discount. That was my point previously, that if I received Medicare fees for my services, I could not afford to practice. When you lose money on each patient, you don't make it up in volume.

There certainly is no question that many physicians are compensated to a higher level then much of the population. In our town of 450, 000, 5 neurosurgeons take call. There are around 5000 neurosurgeons in the nation. I wonder what their relative value for society is compared to hedge fund managers and NBA players? My own feeling is that the overall health of society would not be greatly changed if all of the neurosurgeons in the country died tomorrow. The farmers and plumbers probably contribute more to the overall health of the nation.

I don't know how I fit into westexas's ELP scheme. I can certainly can enconomize and localize, but I'm not sure I fit into the productive portion of society. I can do a quite useful carpal tunnel release with local anesthetic and suture, under fairly primitive conditions, but almost all other surgeries that I do, require a rather sophisticated environment. A remember once as a resident, a power failure occurred at the hospital, and the backup power generator failed. We were operating on a patient with an aneurysm at that time, when the OR became completely dark except for the trace on the EKG monitor, and stayed that way for several hours. Needless to say things weren't optimal, and neither was the outcome.

I suspect in times of future scarcity, society will prefer to spend funds on food and clean water rather than stereotactic radiosurgery.

"My own feeling is that the overall health of society would not be greatly changed if all of the neurosurgeons in the country died tomorrow"

Give yourself a little more credit! There's a reason we say "it ain't brain surgery", bc/ we know and respect what sort of training is really involved in brain surgery. You are among the most highly intelligent and skilled people in the entire world. Perhaps your ambivalence about the value of your training is bc/ you do too much spine! Far too much of what passes as neurosurgery today is expensive spinal fusions with questionable efficacay.

But the more traditional practice of neurosurgery will remain highly valuable. An emergency craniotomy for a subdural or an emergency aneurysm clipping can mean the difference between life and death or between severe disability and minor disability.

"I'm not sure I fit into the productive portion of society"

If the doomers are right and we slide back into a less sophisticated and agrarian society, your more traditional neurosurgery skills will be of great value. If more people in the future work in heavier labor and agriculture, we will again seen much higher levels of occupational head injuries and peripheral nerve injuries than we see today and your skills will remain greatly needed.

Physicians need to prepare for lower income in the future. I'm just 5 years out of residency and I have made more in each year than the one before but I expect my income to peak this year and then slowly decline. At least you recognize that this is coming which is better than 99% of our colleagues.

Phineas Gage, MD

A .22 long-rifle hollowpoint to the brainstem may be the most appropriate & effective "brain surgery" for those "occupational head injuries" you foresee occuring with increased frequency in an impending "less sophisticated and agrarian society." Of course, "peak .22 ammo" will befall us before long likewise. I suppose a sharp stick to the kidney will always be available, as a quick & benevolent remedy to severe trauma.

I don't know whether to take your comments as sarcasm or ignorance (I think most likely some of both). But since you've shown this side of yourself, I think you should google my nom de plume "Phineas Gage". You would probably find the story of the real Phineas Gage entertaining though for different reasons than I do.

Phineas Gage, MD

I don't know whether to take your comments as sarcasm or ignorance (I think most likely some of both).

Neither. I'm dead serious. I know the Gage story. And I'm anything but ignorant of biology. Your assertion a few weeks ago about 4 Kcal > 9 pegs you as the ignorant one. What are you, 5 yrs outuv residency? Come back when you've got some experience under your belt, boy. You're outuv your league here.

Cool it. Your remarks are inappropriate.

Just as a partially-related PS... yesterday I took my mom to her arthritis doctor and found that, like so many others, he is departing for the mainland due to not being able to make a living in a two-doctor family here. He noted that it's even worse on the outer islands here in Hawaii, said that the emergency room on the big isle isn't even staffed a lot of the time anymore.

This is BEFORE the weird stuff starts in earnest...

Ironic, since the big isle could be more sustainable than many other places; we will see migration of tech to urban hubs where the pay is highest, with little care in the boondocks. There may wind up being a migration of the old and infirm toward med tech, while the young head out to farm the boonies.

...her... doctor..., like so many others, ... is departing for the mainland...

LoL Can you say "Rapa Nui"?

Interesting! I am going to the big island to give a couple of talks in June, and plan to do some sightseeing afterward.

I will be extra careful about not breaking a wrist while hiking. I did that a year ago, and found that having an emergency room close by was helpful.

I've been told anecdotally that if someone gets a compound fracture or something there now, they'll stop the bleeding, give them a vicodin, and give them a ticket on Aloha to Honolulu. Except Aloha is now out of business, so I guess it's Hawaiian. They used to use cessna twin air ambulances for that, but they kept crashing so people stopped being willing to get on them. It's getting a bit third-world there in some ways. Not the place to have a heart attack... and once the last jet airline goes away, I think there will be a marked difference in life expectancy between there, oahu, and the higher-tech parts of the mainland.

Again, if one had a large enough group and took some doctors with them, it could be a helluva spot for a post-peak life. But you'd really want to have that stuff covered.

Enjoy your trip, it's a beautiful island. Feel free to drop me an email if you want any tips from a guy who has gone there often...


I am highly specialized in my field also, and it is one that will not be needed in a future of collapse. I figure I will just have to do some re-training to something more general to be of any use. Granted, after 20+ years of level III NICU (that's Neonatal not Neuro) I sure won't be as much use as even a brand new Med/Surg RN.

I'll bet you will be able to set bones and other more basic procedures and be very useful in many ways.

My father was a general practitioner quite a few year ago. He learned a lot of techniques that they don't teach in medical school now, because now it is assumed that there will always be X-rays and all kinds of medical tests. He learned to be very aware of the symptoms, use touch to tell how an area felt, and use the stethoscope a lot. He would get very disgusted with some of today's doctors, because he thought they weren't aware enough of what could be discerned without tests.

became completely dark except for the trace on the EKG monitor

Has the medical staff considered visiting say REI and buying the headlamps of, say, black diamond?

They may not be 'sterile' for operating rooms, but for getting about in the dark - they work great.

We have gotten used to a system where physicians make huge incomes relative to most of the population.

Some physicians in certain specialties make huge incomes, but it is really not so common these days.

I know our Docs don't make much more than experienced RNs in our area (low 6 figures) and one said just the other day that her husband (software engineer, I think) makes more than her but she enjoys her job more.

And the hours they work!!!

I currently work in IT for a large HealthCare provider. In the last 4 years only, we have implemented probably one of the largest Electronic Health Record systems in the US (if not the world) serving over 8 million members. About a year or two ago we had a power failure in our datacenter which housed our member records for the west coast. I cannot tell you the cost involved in this downtime and the risk that was presented to our patients. Our immature downtime procedures were enacted and we made it through but it exposed the vulnerability of the system. Since, we have made great strides to provide availability, acquiring additional datacenters and distributing more of the information capabilities. And of course, burning more energy to do so. But there is still more to do.

I guess my point is, we cannot go back. Back to manual non electronic record keeping. The healthcare industry is late in coming to electronic record keeping. But there is enormous activity on all fronts to computerize healthcare information. And I would say this is a really good thing if you know how healthcare providers had to work without this information readily available beforehand. They often examined patients with little knowledge of thier medical history. This is not to mention the ability now, with this information, to do population care management for chronic illnesses or the issues of healthcare insurance verification and the like. But how do we keep it going? And as the article itemizes...the scarcity of resources has much more implications than just the computerization of patient records.

I suspect if we went down the line, industry by industry, we can tell a similar impact story. But how will we prioritize the last of our energy resources. What can we do with development in renewable resources to keep our critical infrastructures going? I am sure most would agree, Healthcare needs to be way up on the list of priorities.

Thanks for this article.

I am glad that someone has tackled the issue of what to do about power outages related to medical records in your company. It seems like the future is so uncertain that we really need to have the capability to keep going, even if there is a power outage for several hours (or even days).

When there is a power outage at my local grocery store, a system has been set up so that business can continue, with or without power. A backup generator provides some lighting and power to run cash register. The less necessary things are not backed up, like the conveyor belts that move the food. It seems like medical offices need to plan for the same type of situation. It may mean that a summary of medical records needs to be kept in printed form, updated at regular intervals.

Yes Gail, we do have what you describe..."summary of medical records needs to be kept in printed form, updated at regular intervals.", although it is a specific PC based systems mostly in the inpatient setting right now. Consider the Medication administration information, how critical this is, in a hospital. We have computerized this information (what drug, in what amounts, and when to administer to a patient), so without this information...the clinical staff would be guessing on what medications and dosage, etc... We are still in the early stages (as an industry) with medical record keeping. Much more to do especially in light of our impending energy deficient future.

the clinical staff would be guessing on what medications and dosage, etc

Uh, no. No meds can be given without a complete order. We'd have to be in serious chaos to be "guessing" about dosages, etc.

Exactly my point. Patient safety is compromised big time should this information be compromised in the case where this information is kept electronically, and may not be available because a power outage. I don't know if you have worked in a hospital and are familiar with a Medication Administration report that a clincal staff uses (either manually maintained or automated as in our case). Certain hospitalized patients are given regular medication at timed intervals to treat what ails them...someone needs to track this information as well as administer the medications.

I am an IT guy..so I only support the information systems...but the medication scheduled information would not be there unless it had been ordered by the healhcare provider already.


No meds can be given without a complete order./

I have worked in hospitals as an RN for over 30 years. I would be really glad to go back to paper MARs (which is our procedure in a down time).

I don't know what software you are working with but the one we implemented 2 years ago is a mess. And I was the clinical superuser for our unit, so was very involved in the design (when they would listen to me) and implementation.

Nothin' like having a bunch of people who have no idea what really happens in your unit telling you how to do your job.

We actually had to transport patients out to another facility because we couldn't order emergency meds in the system and pharmacy couldn't/wouldn't fill the order since it couldn't be entered into the system correctly.

yes...the EHR is still young...but it is getting better. But there is no denying the accessability of information that it brings and its emerging capabilities. And I agree...the clinicians know there job the best and it is tough to merge this work , which is mainly done by people who have not seen the inside of a hospital, with the people who need to use it. I don't want to advertise any solution or software...but I think we can generally state whatever the solution is..it probably needs improving.

I think in a lot of cases, doctors these days spend too much time looking at the abstract on the computer screen and not actually seeing the patient. I recently helped diagnose my nephew via email, and despite no medical training did it quickly and accurately. His doctor was evidently a moron, and that was the first thing I told him. My nephew had gone in to see him and was given nexium and vicodin, and told it was an ulcer. I asked a few questions via email and told him to immediately head in to a medical lab and pee in a cup for them. He had jaundice and was pure yellow and peeing pure brown. His gallbladder was safely removed. The doctor is still practicing.

Learning a bit of medicine isn't just for post-crash, it can save your life now too. It has been 4 years now, and STILL my HMO's data screen deletes the drugs I have adverse reactions to and they have to manually re-enter them. If I ever go in there unconscious, I'm toast. I did get the data put onto a stainless steel bracelet, not being a total dip, but I'm not sure that HMO would bother to look at it....

You have touched on a very important point here: our general reliance on technology. Rather than learning to use technology as a tool, an extension of our skill, it is easy to instead become inured in it, and lost without it.

Your stories and Gail's description of her father's frustration are classic examples, but I find similar situations when trying to employ people in my industry. Publishing is becoming a techno-savvy business too, but it is disheartening to see the number of people who forget the importance of human skill and the craft, and become too enamoured by the technology side of things - except that it is good business for us. We take advantage of the fact that so few people can compete in both areas, and we are starting to make a killing because of it...

Technology should complement skill, not the other way around.

It may mean that a summary of medical records needs to be kept in printed form, updated at regular intervals.

Gail, that is exactly what my facility does - once per 24 hours current orders and some basic other info are printed out. This is a LOT of paper - especially for a system touted as "paperless". However, in my unit, patient status and therefore orders can change so much in a short period of time, that these printouts soon become useless.

Our facility's backup generator is tested weekly - I wonder how many days worth of fuel we have.

Every hospital I have ever worked in has special outlets that are switched over to generator power in an outage (they are red). All critical equipment is always plugged into them.

One place they deemed lighting was unnecessary is our staff restroom - woe be anyone in there when the power goes out!

Might be a good idea to get one of those hand crank powered flashlights and carry it in a pocket.

A battery-powered emergency light that charges itself from the mains ought to be sufficient for something like this. I have seen such systems, and they work well - they provide light for some period of time (perhaps an hour or so).


are you aware of any analysis of overall energy uses of electronic vs. paper medical records. The energy cost of an electronic record seems obvious, but huge energy inputs are involved in creating and shipping paper. I wouldn't be surprised if an electronic medical record reduced overall energy usage within the health care system (even if it increased the energy use of the end user, i.e. the given hospital or medical office).

I am not aware of any such analysis. But I think it is a worthy study if not done already. We have opened two new hospitals deemed as "paperless", i.e., there was not a medical chart room constructed. But even in the EHR world...there is still a lot of printing of paper...but I would say it most likely less than before the EHR system.


I agree that the cost of making and transporting and disposing of paper must be substantial, and that using computers to replace paper sounds like it might actually save energy. But of course I don't know for sure.

I do know that we will save much more energy when computer manufacturers begin to minimize the power requirements of their equipment. At the moment, most computers are built to run as fast as possible, which means they are dissipating (wasting) as much energy as possible.

Most of the technology already exists. Laptops currently use much less energy than desktop computers. I'm (almost) certain low-power computers are coming soon to a desk near you.

Someday, we hope not so soon, you will have no choice but to go back to interviewing patients and their families about their medical history, like they did in the old days before medical records were kept, even on paper. The next power failure could be just one of many, or it could be the last. A major power failure in winter could wipe out half of the U.S. population. Could we get the whole thing going again with most of the Northeast and North Central wiped out? I doubt it. Time for risk management planning.

"Someday, we hope not so soon, you will have no choice but to go back to interviewing patients and their families about their medical history..."

Yes, hopefully not soon. The typical person does not give very accurate medical information. Typical comments we hear every day are:

"I take some little white pill for my heart, don't know the name..."

"She had some kind of reaction (no idea what reaction) once and a doctor (don't know his name) said if it ever happens again come immediately to the hospital"

At least once a week I am told by someone that they used to have high blood pressure but not anymore. With accurate records I can see that what they mean is they do have the condition of hypertension, it's just that the medication is working.

Many studies have shown that when you closely examine (through allergy testing), most patients are not allergic to most of the medical allergies they report.

I see patients all the time whom I've not seen in three or four years and they have no recollection of whatever it was I saw them for back then. I wouldn't know either if we didn't keep accurate records.

"Someday, we hope not so soon, you will have no choice but to go back to interviewing patients and their families about their medical history..."

Yes, hopefully not soon. The typical person does not give very accurate medical information. Typical comments we hear every day are:

"I take some little white pill for my heart, don't know the name..."

"She had some kind of reaction (no idea what reaction) once and a doctor (don't know his name) said if it ever happens again come immediately to the hospital"

At least once a week I am told by someone that they used to have high blood pressure but not anymore. With accurate records I can see that what they mean is they do have the condition of hypertension, it's just that the medication is working.

Many studies have shown that when you closely examine (through allergy testing), most patients are not allergic to most of the medical allergies they report.

I see patients all the time whom I've not seen in three or four years and they have no recollection of whatever it was I saw them for back then. I wouldn't know either if we didn't keep accurate records.

"Someday, we hope not so soon, you will have no choice but to go back to interviewing patients and their families about their medical history..."

Yes, hopefully not soon. The typical person does not give very accurate medical information. Typical comments we hear every day are:

"I take some little white pill for my heart, don't know the name..."

"She had some kind of reaction (no idea what reaction) once and a doctor (don't know his name) said if it ever happens again come immediately to the hospital"

At least once a week I am told by someone that they used to have high blood pressure but not anymore. With accurate records I can see that what they mean is they do have the condition of hypertension, it's just that the medication is working.

Many studies have shown that when you closely examine (through allergy testing), most patients are not allergic to most of the medical allergies they report.

I see patients all the time whom I've not seen in three or four years and they have no recollection of whatever it was I saw them for back then. I wouldn't know either if we didn't keep accurate records.

"Someday, we hope not so soon, you will have no choice but to go back to interviewing patients and their families about their medical history, like they did in the old days before medical records were kept, even on paper."

Gee, I only see this done about 50 times a day. But then I am in a small hospital.

"....I currently work in IT for a large HealthCare provider..."

Yes thats Kaiser who changed horses in midstream dumping IBM and they went with a database based on the VA's MUMPS system from the 1970's, probably without realizing the huge technical differences. Then they found themselves without industry standard backup tools!

I see you have read the propaganda in the media. I can tell you that is not even close to accurate.

Well I wouldn't criticize anyone for dumping IBM, who would charge $1,000,000 to build a MySpace page, but did the Kaiser honchos not think there would be consequences in going from a mature relational database to a nonrelational database sold by a small vendor? It's a repeat of the nightmare scenarios in "Software Runaways."

WHY THE HELL do all the peak oil consequence discussions start off so logically laying out the problem in rational terms and then propose such blatantly idiotic "solutions"? In what way does a single payer system of healthcare allow a hospital to run better without power? Under what economic system is providing free and unlimited ANYTHING an answer to scarcity of the inputs of that commodity/service?

HOW does sociallism assist in mitigating peak oil?

"HOW does sociallism assist in mitigating peak oil?"

A "we society" is less energy and resource intensive than a "me society".


P.S. "sociallism" is spelled socialism

It should be interesting to see how the MRI industry copes with peak helium. Peak silver is no longer major problem as hospitals continue to replace 14 x 17 inch double coated silver rich xray films with digital images.
RW MD radiology ret.

Wow is that ever just a total lie.


You can see by this list that Canada (a "we" society) uses more oil per capita than the US. Also, Iceland, one of the definitive "we societies" uses the same.

Lets switch to co2 production since it gives a better overall picture of energy consumption and resource use.


You will see that co2 production has only *3* variables. Population density, per capita GDP and fraction of nuclear power. Nations with lower population density and high GDP emit more carbon per capita than nations with high population density for the same gdp. The only real out of line nations are the ones with high fractions of nuclear power, those emit far less co2 than their similar neighbors.

Economics is a science, science cares not for politics or philosophy.

Cold areas use a lot of fossil fuels for heating.

Yes. So you acknowledge that "we" societies do not trump reality. Now, perhaps you can explain why australia uses so much? And iceland while being in a cold climate, has vast quantities of hydropower and geothermal. so their fossil fuel consumption should be lower, but it isn't. That's because they have a high GDP and low population density. I said there are only 3 variables and 3 variables there are.

Now, perhaps you can explain why australia uses so much?

Because we're greedy and stupid.
Our glorious Dear Leader just handed down his first Budget. $500 million for Clean Coal. Spending on the railways has been lumped together with roads and ports, has been given just $20bn, and put off for two years. Inflation is straining at the economys leash, and he gives us tax cuts. The Baby Bonus stays.

We kicked out a cretin and elected a buerocrat.

Unfortunately, democracies are very very poorly suited to tough love and hard times. The thing is that anyone running for office who tells hard truths fails to get elected, populaces only vote for nice dreams and empty promises.

Yes, fordprefect's datapoints are insufficient to draw valid conclusions.

Being a Canadian, I can also tell you that Canada does a lot of mineral extraction and that takes a lot of energy, too.

To be accurate, one would have to identify and isolate the variables.

No offense, fordprefect, but to say that only three variables are involved is, um, let's just say I wouldn't hire you to do any analysis for me.


Well, it wasn't intended to be a rigorous analysis. It was more intended to be a refutation of the glorious conservationist "we" society. Frankly, looking at a list of posts, aproximately one in 20 posts is anything that could reasonably be called an "analysis", the rest are things like what I posted, pointing in the direction of reality, or statements of ideology like the "we society" thing.

I DO notice that the *only* time that rigorous analysis is demanded is when it contradicts dogma. For example, this instance where I was refuting a statement of ideology, there was no request anywhere for support of his "we societies use less" blanket statement, but instead, my more intensive (but still limited) response got a response objecting to my lack of data points (valid). However, if you will run down the lists, you will nonetheless see that the primary predictor of per-capita co2 emissions is per-capita GDP. The second is population density. The third is fraction of electricity produced by nuclear power. After that, there are many others, climate, industrial activity, urbanization, income disparity (high income disparity means more VERY poor people who do not emit co2), and others. I was however, as I said, writing a comment.

It was more intended to be a refutation of the glorious conservationist "we" society.

No "we" society exists in the modern world, certainly not Canada in spite of nationalized medical care. As long as individuals and families are independently seeking material security by 'storing up value' the drive for economic growth and consequent resource depletion will continue unabated. The problem is that society as a whole cannot store up value. Ideally my income represents the the value of the economic goods and services I produce (or at least the value of my relative contribution to such productions along with the other people I cooperate with). I can then take this income and trade it for the output that other people have produced. If I save money, I am not taking everything in return for my current output to which I am entitled. If society as a whole deferred consumption in this way a recession would immediately follow, and factories would close down and people would lose their jobs. We have to consume what we produce in order to keep the economy healthy. So when I forgo consumption someone else has to jump into the breach and buy the ouput which I declined. These alternate consumers can be people who 'saved' in the past who are now are making up for deferred consumption, or they could be businesses expanding or replenishing their capital stocks. But society as a whole saves nothing. Since one person's savings is another person's consumption, the effort to store up as much value as possible is really an effort to expand economic production as much as possible.

The only way to fix this growth producing, resource depleting tendency is to make our future security independent of storing up value. The only true store of value is a healty economic community supported by a sustainable resource base. We need a system of universal social security in which future security comes from the community which we have supported during our most productive years, and which will in turn support us when our productivity declines. Earning a living needs to be about earning living in the present and not about storing up value, except insofar as working to create a healthy community provides lasting value from which all of its member may benefit. If it is really impossible to create such a cooperative organization in groups larger than a hundred people or so, then neolithic technology here we come.

Economics is a science

Prove this. Scientifically.

Lies, Damn Lies,,,and Economics.


I note how fordperfect has made yet another unsupportable statement.

Economics is a science - how droll

Definition: economics

"1 a: a social science concerned chiefly with description and analysis of the production, distribution, and consumption of goods and services b: economic theory, principles, or practices "

"Economics is the branch of social science that studies the production, distribution, and consumption of goods and services. "

"# (used with a sing. verb) The social science that deals with the production, distribution, and consumption of goods and services and with the theory and management of economies or economic systems."

Scientific method in economics

Or does the word mean something different to you? Perhaps you are using some "other" definition of either science or economics that differs from the common usage?

Ford: I assume you feel that the trillions of taxpayer dollars wasted in Iraq does not qualify as "socialism" as only wealthy, connected individuals benefit.

The trillion dollar war in iraq is open to debate. It is not the open and shut case you would try to make it.

Jeez-that was easy-you gave yourself away with the Socialism reference-Liberal would have worked just as well. You guys hate taxes with a vengeance (unless some poor schmucks can be hurt or killed for your nickel).

You are not a deep thinker are you?

The iraq war...

Okay, Hussein was not a good guy. He was the only sitting world leader ever yo have used WMDs, a total totalitarian dictator. A supporter of terrorist organizations. An avowed enemy of the western world. Taking him out of the position of control of the last of the cheap oil (and the world as a whole) doesn't seem to me to be something that was exactly a bad goal.

Can you say with certainty for example that you know what the price at the pump of *your* daily fill-up would have been had shrub NOT gone to that war?

Can you say with certainty that you know the motivations for which the war was fought? Are you a mind-reader?

This crap is basically never as simple as it may seem on it's face.

As for the use of the word "socialist"... What else can single payer medicine be called? It is clearly a wealth redistribution system utilizing government and taxation to perform the redistribution. Therefore, the term fits. Socialism is not in all instances bad, for example, oil rich nations have little choice BUT to be fundamentally socialist, the wealth generated by oil fields fails utterly to be decently distributed by market forces. The opposite is true for heavy industrial societies, the high labor inputs of most industries does a very good job of distributing wealth and responds poorly to socialistic policies as they tend to distort and damage industrial economic systems.

An avowed enemy of the western world. You sound like McCartney's ex-wife. Would you mind telling us how many years your superiors supported this "avowed enemy". These guys-Hussein, Bin Laden, Noriega, etc. etc. are all so lovable and perfect (according to your MSM and guys like yourself) until there is a falling out and then you were never snuggled up in bed with them in the first place.

First of all, I don't listen to the MSM, nor do I like or support shrub or any other contestant in this game-show. I am not unaware that Hussein had support in the past from those who wear the same lapel pins as shrub. He ALSO had support from those who wear the same lapel pin as Obama.

The biggest thing here is that I do not think I know everything that is involved, nor do I assume that Moveon.org has the right of the situation any more than fox news does. I am not a mindless robot, I look at all sides before making blanket statements. If you had any brains at all, you would know that this situation is a little bit involved, not at all the straight black/white that is all your tiny little mind is capable of grasping.

It is not a we/they thing, that's just for idiots. There are involved causes on everything that happens in the world and it's quite possible that the real reasons never get publicized by either side.

Ford: You are a gem-that is the first time I have heard a supporter of aggressive invasion saying "It is not a we/they thing". At least you comprehend that the real reasons (as always, money and power) never get advertised.

Of course, if you were a thinking person, you would see that by a we/they thing I meant it isn't a liberal/conservative thing. Remember, both kerry and clinton voted for the war.

As for the money/power thing... Well, I have no particular problem with not sending our soldiers to die unless we have BOTH a moral reason AND a practical one (oil being the practical one, Hussein= genocidal monster being the moral one). But hey, if you want to go to war for purely moral reasons, I suppose Darfur would be a fine place to get some peeps shot.

Incidentally, look at the map and see where Clinton fought HIS wars, those were purely for strategic advantage in the middle east, just he lacked the fortitude to see it through.

The iraq war...

Okay, Hussein was not a good guy. He was the only sitting world leader ever yo have used WMDs, a total totalitarian dictator. A supporter of terrorist organizations. An avowed enemy of the western world. Taking him out of the position of control of the last of the cheap oil (and the world as a whole) doesn't seem to me to be something that was exactly a bad goal.

If we were going to take Hussein out of power, it should have been done when he invaded Kuwait not on a drummed up charge of creating WMDs to possibly strike Israel or anywhere else in the world. Attacking Iraq was a blatant attempt to one, to "finish" the job that was started in 1991, and two, secure access to that cheap oil you're talking about that would have been available on the open market anyway.

Can you say with certainty for example that you know what the price at the pump of *your* daily fill-up would have been had shrub NOT gone to that war?

No, and neither can you. My guess, however, is that it would be less than it is now. There would be less uncertainty in the region, and our military wouldn't be using up quite as much oil as they are right now. Both of those, regardless of increased demand, would tend towards lower prices.

Can you say with certainty that you know the motivations for which the war was fought? Are you a mind-reader?

This crap is basically never as simple as it may seem on it's face.

Regardless of the reasons and how simple they might be, the war was poorly conceived and its strategic execution leaves a whole lot to be desired. That isn't a criticism of our soldiers or even our generals. Instead, it's a criticism of the policy makers. They screwed up, and we're going to be paying for their screw ups for a very long time.

As for the use of the word "socialist"... What else can single payer medicine be called? It is clearly a wealth redistribution system utilizing government and taxation to perform the redistribution. Therefore, the term fits. Socialism is not in all instances bad, for example, oil rich nations have little choice BUT to be fundamentally socialist, the wealth generated by oil fields fails utterly to be decently distributed by market forces. The opposite is true for heavy industrial societies, the high labor inputs of most industries does a very good job of distributing wealth and responds poorly to socialistic policies as they tend to distort and damage industrial economic systems.

All taxes, for whatever purpose, are wealth redistribution systems without exception. If we take healthcare to be a vital part of our society, than it is completely reasonable to make it part of what we pay for with those taxes. Instead, we have a system where only those who are lucky enough to work for an employer who pays premiums, make enough to pay their own, or have so much money costs don't matter can afford to get health care without the possibility of bankrupting themselves. This is a product of our political system and its interaction with the health care industry.

Most everyone (DarwinsDog excluded of course) is willing to shell out as much money as they can to keep their one and only body working. Health insurance companies, drug manufacturers, hospitals, and doctors all take advantage of this. I do not begrudge them making money. Manipulating the system to the expense of people, however, is deplorable, and I believe that's what's happening in our country. I'm not sure that universal health care would fix that, but it stands a better chance of limiting the abuses.

I am not going to bother debating about when Hussein "should" have been taken out of power, it is pointless.

As for your conjectures about what would have happened to the price of oil had the US not gone in. it's really nothing more than that, conjecture. The oil in iraq might have been on the market, or it might not have been. Hussein might have destabilized the ME more or less than the US presence has. Fact is, we lowly civilians are NOT in possession of the facts, CIA does not report to me, neither does MI6.

The military consumption of oil resulting from the war is absolutely trivial. The total US military oil consumption is 800k barrels per day, and includes operations all over the world.

I certainly agree that the execution leaves a lot to be desired, but that is not really a moral issue and it has enormous benefit of hindsight. I have with the aforementioned benefit, come to the conclusion that unless support exists for the fighting of a "total war" that no possibility exists for successful outcomes. If your populace will not cheer the annihilation of populated cities, Stay home, all you will do is needlessly lose people and fail to accomplish meaningful objectives. As there is no possibility of total war gaining support, there really isn't much of a point in having all this military, we might just as well pull them home now and start cutting it down.

Coming back to health care, The question I asked was in what way does moving from a market health care system to a socialistic one mitigate the effects of peak oil? It really doesn't. A taxpayer funded hospital is no more likely to have power when the lights go out than is a market funded one. I am not debating the merits of a socialist health care system, clearly it has significant advantages and significant disadvantages. I rather doubt that it can be successfully implemented in the US due to the blatant incompetence of the US government in pretty much all respects, but clearly it works reasonably well in other places.

The military consumption of oil resulting from the war is absolutely trivial. The total US military oil consumption is 800k barrels per day, and includes operations all over the world.

Every day, the average GI in Iraq uses approximately 27 gallons of petroleum-based fuels. With some 160,000 American troops in Iraq, that amounts to 4.37 million gallons in daily oil usage, including gasoline for vans and light vehicles, diesel for trucks and armored vehicles, and aviation fuel for helicopters, drones, and fixed-wing aircraft. With US forces paying, as of late April, an average of $3.23 per gallon for these fuels, the Pentagon is already spending approximately $14 million per day on oil ($98 million per week, $5.1 billion per year) to stay in Iraq. Meanwhile, our Iraqi allies, who are expected to receive a windfall of $70 billion this year from the rising price of their oil exports, charge their citizens $1.36 per gallon for gasoline.

When questioned about why Iraqis are paying almost a third less for oil than American forces in their country, senior Iraqi government officials scoff at any suggestion of impropriety. "America has hardly even begun to repay its debt to Iraq," said Abdul Basit, the head of Iraq's Supreme Board of Audit, an independent body that oversees Iraqi governmental expenditures. "This is an immoral request because we didn't ask them to come to Iraq, and before they came in 2003 we didn't have all these needs."

WOW is there a lot of disagreement on THAT figure!

has it at 1.7 million gallons per day.

has total us military fuel consumption at half my earlier quoted number, or 363,000 bpd.

1.2 million barrels per month in iraq.

So, leaving off the differences in amount, lets take your number.
4.37 million gallons in daily oil usage, = 87,000 bpd. like I said, absolutely trivial on the world scale, not even one moderate sized oil field.

As we all know, "socialism" is a rhetorical device to end discussion. "There are more things ... than are in your philosophy" comes to mind here.


While his comments were combative, it's a fair question. I was also scratching my head at how your earlier comments led to:

"We will look to other nations with decent health systems where three core values predominate: 1) no one goes bankrupt due to medical status; 2) no one is denied treatment for any reason, and 3) preventive and treatment medicine are integrated. This means one response to energy downturn leads to healthcare for all."

It was just a total non sequitur, and you deliberately refrained from backing up your assertion then, just like you're not backing it up now. Why? Wouldn't resource limits put more, not less, constraints on the delivery of healthcare to all, where "no one is denied treatment for any reason"?

We will have to wait for Dan to comment on this one.

I think that one issue may be that people will be poorer. Many people will not be able to afford health care. It may be possible to provide some basic level of service sponsored by the government, including immunizations, treating of wounds, and some antibiotics. It might not be necessary to have continuous electricity for these basic services.

HOW does sociallism assist in mitigating peak oil?

Readers of FordPerfect's comments - Read some of her 1st comments about money and energy. Ms. fordperfect defined 'real money' as gold/silver and not the funny money of fiat currencies, then goes back to using 'non real money' as the definition of money.

Thus - whenever Ms. fordperfect uses a word where the meaning can be many and emotionally loaded - question her on what she means.

sociallism is a fine example.

Before one begins to 'talk' with Ms. fordperfect - one should agree on what the words used mean. Ms. fordperfect has demonstrated shifting word meanings in the past.

Actually it's MR. as you would know if you were cool and had read the hitchhikers guide :)

As for the word usages. I freely admit that I am inclined toward excessive use of superlatives, and that I am not always using the words in the usages that some others may be.

In the "money" example, Inflation adjusted would have worked just as well as gold. I was making the point that "money" is never printed, only paper is printed. "money" is purchasing power, the confusion of that is why the world economy is so hosed these days.

As for socialism, in what way is single payer health-care NOT socialism?

Actually it's MR.

I took a guess - what with English lacking a gender neutral pronoun.

as you would know if you were cool and had read the hitchhikers guide :)

I'm so much more cool than you. You could keep a side of beef fresh in me for 2 months. I'm so hip that I can't see over my pelvis.

In the "money" example,

Blah blah. *MY* point is that you opt for your own meanings for words, not to mention delusional.

Economics is a science

So I'm writing not to change YOUR view but to make sure others know that you have your own choices to what words mean, and act accordingly when interacting with you.

As for socialism,

What about it? You've yet to give a definition - so I'll ask now for one.

in what way is single payer health-care NOT socialism?

And in what way is the present system not socialism? Because here's one poster who thinks the present system is 'socialism'


In fact , Health Insurance is not insurance as defined and implemented in other ways, such as car or house insurance, but straight out socialism, where everyone pays in, and everyone takes out what they pretty much want.

De-computerizing hospitals is a realy dumb idea. Well run information systems are realy good for efficiency and the power use for a given function tends to lower over time since we still have continous development of electronics and that will continue for some time. Personally I think it will continue for a very long time in de well off regions that have plenty of power.

I cant imagine being withouth power for water purification, lights, medical systems, escalators, air conditioning etc as long as there is a grid since people allways have prioritzed medical services. But it is very wise to make all the support systems efficient to not waste expensive energy on primitive light systems or inefficient air conditioning.

Hospitals use a lot of plastic goods etc but its not a large percentage of the oil use. Peak oil will probably impact hospitals as a recession or depression. There will be enough goods but not enough money to pay with and something must be cut away.

In Sweden we have expensive and often bad management, what I have heard about the US is that you could cut legal services and overtreatment just to be sure to not be sued.

The next thing to go in bad times is probably the introduction of new experimental treatments and new very expensive medicines. This will hurt the development of new medical knowledge. How bad it will hurt it depends on the medical companies, will they cut management and marketing or development? We will quickly need new companies or government institutions to pick up the torch if they cut development and if development is cut and no new companies are formed the reason for honoring intellectual rights disappears.

If times are even worse the only thing to do is to stop treat people and the morally least bad choice is eldery and severely ill people that has the worst life quality and looses few weeks or months or years as a vegetable. Such decisions are political suicide but if times are realy bad they must be done.

I cant imagine being withouth power for water purification, lights, medical systems, escalators, air conditioning etc as long as there is a grid since people allways have prioritzed medical services.

Too bad reality isn't bound by the limits of your imagination.

...As long as there is a grid...

I live in a country where grid reinvestments has been on a realy healthy level for at least 5 years and they are increasing, I do not forsee a grid breakdown within decades. Advanced grid equipment such as large transformers, HVDC links, high voltage AC and DC breakers etc is a major export goods due to ABB, former Asea and there are some small new players such as a manufacturer of hexagonal core transformers. We got an ok grid, its being taken care of, we got the industry to do it for us and provide equipment for a lot more people and it would take decades for it to rot down if we were stupid and stopped maintaining the expensive parts.

The political support for hospital care for everybody is massive althogh not especially smart since it is bitch to improve the running of the system by decreasing the central planning part and increasing the parts were (public) money follows the treated patient. Hospitals will get power even if it means that the king freezes.

But is not perfect, the local university hospital fiddled with a bad emergency power for more then a decade before replacing it with one that can power the whole hospital. Prioritized power there is not diesel bower but on-line UPS power.

If your priorities are sane from my pow you can surely afford spare diesels and UPS:s with for instance second hand EV batteries at a far poorer level then the one you have now.

...As long as there is a grid...

All that grid infrastructure is pretty worthless without an electromotive force to drive electrons along it. It's the energy to boil the water to turn the turbine to power the generator that's the problem, not the grid. Whatcha gonna do when there's no more coal or methane or uranium coming outuv the ground, either cuz there's none left or cuz there's no one willing to produce it when their wages can't buy food or there's no more fuel to transport it or the cost of producing it is more than it's worth? Can your imagination wrap itself around all that?

Maybe 50% is too big a slice for the invaluable contribution the insurance companies are making to the health of the American public. I guess that 50% is untouchable because there aren't any poor benefiting from it.

Let me thank everyone for their comments. You've given me some new perspectives to ponder. The great uncertainty we face seems to go far beyond the standard use of this term, along with such other business school jargon as "turbulence" and "risk." And that is part of why we see such different possible futures and often attack or dismiss or go whole hog: I think we do it to soothe ourselves with some modicum of certainty.

At least that's how I approach this.


Very basic medical care


Getting rid of electronic record keeping is exactly the wrong thing to do. It makes the people using those systems much more efficient. So much so, that redundant employees can be eliminated, or not hired in the first place.
As an IT consultant, I see a lot of waste in my field. Deploying hundreds of workstations that generate heat that in turn must be removed by an HVAC system is silly. Most of those machines sit idle, doing nothing but wasting electricity. Moving to a low power or thin client computing environment makes much more sense. Both types of machines use as little as 20W of power, instead of the 200-odd watts it takes to run a 'normal' machine.

Hi damac,

It's even better than that. Sun's Sun Ray 2 terminals use as little as FOUR watts (LCD monitor extra). Thin clients are the perfect solution for basic data entry and retrieval (OK, so there's a VT220 in my closet... who's asking?). ;-)


I would love to see a 4-watt "VT-220" that was HTML aware and ran TCPIP.

I would ask it only to display what was sent to it, and return keyboard data. Same as the VT-220 used to do.

I am imagining a TCPIP book reader that will run hours on battery alone, but uses a TCPIP port which can feed the memory, and has a keyboard port.

Hi HH,

In case I've left everyone confused, I'm guessing a VT220/320 draws about 50-watts. The Sun Ray 2 pulls 4-watt (http://www.sun.com/sunray/sunray2/features.xml) and a 17-inch LCD panel would likely add another 30-watts.

For folks who require/prefer a Windows-based solution, this PC and monitor draws a maximum of 37-watts: http://www.hp.com/hpinfo/newsroom/press_kits/2007/yourlifeistheshow/ds_b...


Not exactly what you are looking for, but how about an Amazon Kindle?

It has a display, a keyboard and a web browser (so HTML and TCPIP). The wiki article says the 1370mAh battery lasts two days with wireless on, or a week with it off. Doubt you can easily load a vt220 emulator on it.

Another approach would be the Alix 1C: http://www.pcengines.ch/alix.htm
They say "Surf the web on about 5W of 12V DC power using ALIX.1C as a thin client !", but that doesn't include a display.

One laptop per child?

Thanks for the reply, justJohn and HereinHalifax.

I have been looking for very low power terminals to use with microcontrollers which I am using for various "home automation" type stuff - security, sprinkler control, environmental and lighting, that kind of stuff.

Its easy enough to use AVR microcontrollers and do anything I want for a pittance of power - it is that display which draws more power than everything else put together. So, I design it where I can just turn the whole terminal off when I do not need anything to or from the controller - just let it run.


thanks for the link!

Most of the concern of this excellent article and the related posts has been on the impact of energy shortages on hospitals. However, there is another very significant part of health care that will also be very negatively impacted, and that is the various forms of home health care, such as that provided by various hospice and home nursing organizations.

Visiting nurses put a great deal of mileage on their cars, and even though they are compensated on a per-mile basis, we are already beginning to see pressure to curtail various home health care services. And of course, if there are actual gas shortages, many visiting nurses will not be able to make their rounds simply due to an inability to get gas.

Then we have potential problems having to do with the fact that most home health care supplies are delivered via Fed-Ex and other carriers (as a matter of policy, visiting nurses generally do not carry pain-killing drugs with them while making their rounds, for obvious safety reasons).

I tend to think that the effects of PO are going impact home health care sooner and more severly than it will hospitals.

There is a lot of activity with self care via the internet. Including the ability for one to perform blood pressure readings and other self administered biomed input devices for review by your healthcare provider. Even Google and Microsoft are trying to tap into this market.

Additionally, and already available at our organization, is the ability to converse with your physician via email saving the trouble of office visits if not absolutely required.

While this does not remove hospice or home health care, these are the "little" things that can make a difference for reducing demand for energy resources. Of course, we always come back 'round that we need energy to power our communications infrastructure.

The short (nightmare) time I did home health, I certainly wasn't sent out to merely take a blood pressure. I mostly did blood draws, dressing changes and specialized pediatric parent education (with equipment).

Also, there were home health aides who helped with physical care and PT/OT folks. There wasn't much that could be done over the internet.

'Course, that was a long time ago - maybe we can do those blood draw and dressing changes remotely now.

Sorry...I wasn't really clear. I did not mean we could administer home health over the internet. What I meant...for a lot of ambulatory patients...we could reduce office visits and such...driving into the Doc's office, expending gas and time...by utilizing communications over the internet.

Problems with home care is a good point.

If we go back 75 years,or if we look at some of the lesser developed countries, it seems like there is quite a bit of home care. Going forward, we may still see it. Ultimately, it may mean that a nurse serves an area within walking distance around his/her home. If people don't have transportation to go to medical care, the medical care almost has to come to them.

Great article and responses!
A few thoughts:

1) We certainly are what we eat. Efforts must be redoubled IRT food quantity and quality. And bicycles look better by the day.

2) Anyone who has been to hospital has seen the unbelieveable mess medical billing has become. But every procedure is really a "canned job", with only quantities of expendibles added or deleted. Certainly, uninteruptable
power, both battery and diesel, will be required, as the day when a complete "paper trail" can be printed has probably passed.

3) There will always be "profit" and "not-for-profit" medicine. Sometimes, they can combine or dovetail, sometimes not. Some vaccines, for example, cost millions to develop, produce, store, distribute, and then may never be used and need to be safely disposed of. Should a profit be made at every step? Who pays?

4) Caribbean and Central American, even Canadian destinations are often less than an hour away from many US locations. A lot of competition is just what the American medical(and insurance) industry needs.

darwinsdog reminds me of my old hounddog swatting flies as he responds to the comments on this post. His opening comment to this thread summed it up perfectly. I've got a family full of doctors and i have frequently had this conversation with all of them. We agree mostly that "the resistance to death has to do with not knowing where you're going when you die." That probably has something to do with a religion of fear which permeates our society. "Survival is the second law of life. The first is that we are all one."

darwinsdog reminds me of my old hounddog...

"I'm kinda like my old bluetick hound
I like to lay around in the shade.
I may not have much money
But I damn sure got it made.
Cuz I ain't askin' nobuddy fer nuthin'
If I cain't get it on my own
And if you don't like the way I'm livin'
Then just leave this long-haired country boy alone."
---Charlie Daniels

Yep, people are scared of dying. Yet it's the one sure thing in life. Whatever else we may be on the planes of consciousness, we are first and foremost biological organisms. My own personal null hypothesis is that that's all we are. Of course, I don't know that for sure but then, neither does anyone else despite any & all protestations to the contrary. Hence, I have a pretty good idea where I'm going when I die: back to the soil and from there into the atmosphere & water table and eventually back into the biotia. To be scared of dying is adaptive but to realize that personal annihilation can occur at any moment, peak oil or not, is liberating. I've already passed on my genes. This ole phenotype has served its function. The up & coming generations can take on the worry burden - while I just kick back & laugh at their malaise.

Where does the light go when there's no electricity passing through the light bulb, because the bulb got broken or burned out? That's where we "go" when we die. Nowhere. We just stop, and no more light shines through us.

Fear of death and fear of the pain associated with dying could be solved through robust and resilient interpersonal connections, or community and strong relationships to each other and to our surrounding environments. These would offer comfort and emotional support not only to the dying, but also to those who survive.

But if we really had community and strong relationships, we wouldn't be in this global predicament in the first place.


That said, the flow of time is basically an illusion. There is a nontrivial sort of immortality in static block time, along the lines of the way Vonnegut had Tralfamadorians look at things.

And that doesn't even get into the fact that the only interpretation of quantum mechanics which doesn't invoke magic or privileged frames of reference, pretty much requires infinite copies of ourselves with minor variations existing "simultaneously" but unaware of one another.

There's room there for some pretty decent philosophical consolation, for those who might need it. We may only be experiencing a fraction of our own reality, if "we" are the multiversal version.

I reckon you are aware of these lines of discussion - your posts have great depth, always - but I throw it out here gratuitously anyhow.

Thanks, greenish.

But as to whether or not I'm "aware" ... I like to think that I may have a brighter flashlight, or better lenses through which to see, but like everyone else, independently, on my own, I'm still only bumbling around in the dark. I'm only as "aware" as the level of access I have to other people's observations and experiences which help me along as I continue to stumble through the inky blackness of existence, bringing my perceptions back for others to correct, modify, build on, and refine.

That is historically how all finite, mortal, imperfect, lumpen humans have accomplished anything, by working together.

"We're here to help each other get through this thing, whatever it is." -- Vonnegut

And thanks for sharing some of your observations about quantum mechanics, which I also see to be mostly blinkered and kaput.

"quantum mechanics, which I also see to be mostly blinkered and kaput"

I quite like quantum mechanics. It shows quite clearly the futility of trying to define the universe and break it into concrete bits. That's not to say that the exercise isn't useful, because it is. Let's juts hope more people see our attempts as tools/flawed but useful descriptions rather than actual reality...

Well done to Dan and Gail for posting this article, and broaching this subject formally here on TOD. A while ago I approached one of the TOD elite to do a post on the TOD with the heading " Medicine in a Resource Deprived Environment" but I "opted out" as I felt that I may really stir the pot.

I am not from US so my views will be slightly different from mainstream TOD and other posters however the gist will apply.

I concur whole heartedly with the views expressed here but I feel that there is a deeper problem which is lurking below the surface.

Medicine is really facing a very difficult future and in a nutshell the problems are:
- the whole energy debate which we have here on TOD and can be extrapolated to the medical environment; with issues which are deeper than merely lighting a room. There are legislated "energy" requirements which specialised medical environments have to comply with to run, be legal, and fulfil certain standards for procedures to occur.
- Large amounts of our basic everyday items which are used in a hospital are OIL based and it "will not be possible" to function with out them in the modern world. To illustrate this sterile items are usually packed in some form of plastic derived material in the modern age, or are disposable plastic items. I think most lay people would be amazed at the amount of "material" that is used in a hospital on a "once off basis" and discarded.
- the deeper problem is the ethical issues which are rearing their head and in my opinion would require a 180 deg turn in society thinking, and I don’t believe that will happen or be easy. To illustrate this starkly if you run a clinic in an impoverished area ( take your pick Sudan, Ethiopia)and one of the locals gets appendicitis, yes we can treat him for 3 days cure him and send him out to starve again. These issues will arise in the US on who you have the ability and knowledge to treat, but resources will constrain you. It is but a matter of time. The ethical dilemma will come in, in legislating these issues and how to deal with them - it will not be easy.

My 2 bits



Your comments are well taken. See Medicine after oil, http://www.orionmagazine.org/index.php/articles/article/314/, for a fuller discussion. And we had an excellent bio-ethicist participate in a recent webcast teach-in from Ohio State's College of Public Health.


...an excellent bio-ethicist...


As if biology was even ABOUT ethics... :))

I had never heard the term either...but...reading about it now:


and ... here is an article demonstrating an example of a bioethical issue:

You're supposing that biology isn't about ethics, I guess in the same way that biology isn't about hair or scales or feathers.

Well, no, ALL biology isn't about hair, scales, or feathers.

But humans are biological and humans do have morals and ethics.

So some biology IS about ethics. Just like some biologists specialize in cancers, epidemiology, or algae.


I read the link thanks for it;
I post a quote from it

Ironically, peak oil can be a catalyst for creating a health-care system that is cost-effective, ecologically sustainable, and congruent with a democratic social ethos

and I dont believe this is possible only a pipe dream - it is far too complex for this,
In advocating "your" ( the ) "Honda model" who says the "Ferrari model" can't be had( i.e. is to be denied to some citizen who demands it), there are already I believe not enough resources to deliver the " Honda model" to all people today.

And you still have not found a way to deal with all the activist groups who will have some axe to grind on all sides of the argument.

As I said it will come - and is not easy.


HappySurfer, I think that you are right on. If the grid goes down, you will not sit down and take a family history and ponder over allergies. You will do a visual assessment of the wound and see if it is something that can be repaired without anesthesia. You will have sutures for a little while (?6 months), but then those will be used up. Abcesses can be lanced. Babies can be caught and the umbilical cord tied off. Fingers will be crossed that the infants won't get neonatal tetanus. Salt and sugar solutions will be made and given in the fashion of intensive ral rehydration for diarrhea. If the grid goes down, there would be no way to do brain surgery because how will you run the electrical bone saw? A hamer and chisel won't work. Any idea of sterile will be a distant memory. Lifeboat ethics about rationing will become the norm. Scalpels will be reused, and saved for things other than carpal tunnel surgeries. Universal precautions will be unable to be followed. Med lists for diabetes and hypertension will be irrelevant. Documentation will be time wasted (once the grid goes down). That being said, I don't think that you will really want to be doing hosital work at that point. Look at what happened in New Orleans. If a catastrophe hit and you were on duty, you couldn't leave until your replacement arrived or all the patients died. If you were on duty for 96 straight hours and left, you could be nailed for "abandonment" and homicide regardless of the fact that your replacement had long since skipped town. Just some random cheery thoughts for a saturday night.

Great post, except the babies part - I don't see why we won't be able to boil some scissors to cut the cord with.

Man are you right about the "abandonment" and homicide stuff.

In the case of a pandemic, our county plans on locking down the hospitals once full - no one in or out. Whatever staff are there - - stay there (and one nurse per 20 patients). They also are not planning on stocking up on N95 masks.

I think the county planners think medical/nursing staff are not human...

Limited quantities of AC power are not difficult to obtain. In your "bone saw" example, a car battery, a $20 inverter from wal-mart, a car alternator and a crank and you've got your stryker saw.

Also to be noted here, it is very unlikely that the grid will simply crash one day and not come back for 6 months. That just isn't how it goes. The way it goes is that outages become increasingly frequent and long.

A complex collapse is permanent, like the death of an "individual", which is not really a single living organism, but trillions of them (individual cells) working in tandem, in concert.

hmm... There seems to be a constant issue in addressing post peak issues with the scale of the problem. I was addressing how to provide brain surgery in a 3-6 month relatively localized (say, canada) grid failure that still took place in an essentially functional world. Call it a moderately hard landing type situation.

Some here seem to take as a given that basic societal functionality will remain, those who point toward passive solar and rail as an example seem to be looking for a situation where everything will remain basically BAU, just with fuel getting expensive and forcing lifestyle changes. This is what I am going to call a soft landing case.

Others seem to take as a given that overarching societal structures will fail, that fuel will be simply unattainable as will all other products of any level of technology more advanced than the village blacksmith can produce. This is pretty clearly the hard landing.

The thing is, that preparing for the hard landing is effectively useless. It's a road warrior situation, stock up on food and ammo and get REMOTE, try for self-sufficiency and you have some remote chance. There's really no point in discussing medical care under those situations, it'll be a few generations before we're even stable enough to form dark ages villages and the old crafts do not resurrect easily. In addition to that, blacksmiths require coal, there are grossly inadequate draft horses around, and many other problems that aren't like to be solved by a few square feet of PV.

The soft landers all have as their mantra "if everyone did it". Essentially there is in this situation a break between "good" demand destruction (bicycles, passive homes, PV, PHEVs, etc.) which I will here call "demand reduction" and "bad" demand destruction (third world nations going dark because they cannot afford oil, mechanized farming ceasing due to fuel costs, etc.) which I will call "demand destruction". The soft landing situation essentially requires that production decline NO FASTER than demand reduction can proceed.

My anticipation is somewhere in between. Road warrior is a reasonably unlikely scenario as are most of the hard landing scenarios, they neglect inertia in their considerations and assume that no one does anything to avert the worst of the problems. Soft landing scenarios understate the scale of the problem and are excessively utopian.

Thanks for a very good guest post, from a UK angle there are problems with 'superbugs' in hospitals. In many cases it seems that the spread is caused in part by a lack of basic hygiene. IMO we are very vulnerable to an outbreak of an infectious disease, and they way this could play out along side PO and GW has quite frightening potential.

The converging crisis also seem to highlight a failure to teach the next generation the skills which will be required. Its funny how we live at a time when even the poorest of us have a higher standard of living and access to technologies that previous kings and emperors could only dream of but we still don't seem to be happy.

Maybe we are cursed

I am a fast crash realist, but hospitals have some major advantages for coping post peak. I think it is worth listing the assets and then brainstorming how to strengthen those assets.

1. Hospitals have a very well educated and affluent staff. They can make changes that others cannot understand or afford.

2. Hospitals are almost micro cities. They have their own power supplies. Food preparation. Facilities staff. Security staff.

3. They have an existing organizational structure that is independent of government. When the outside world breaks down, they have a separate method of decision making. (I am not claiming how well it works, just that it exists).

4. They have existing professional organization that allows them to work on a larger scale than most individuals. Doctors are widely respected.

5. The staff at hospitals deal with crisis situations on a daily basis. What reduces most people to helplessness, they work right through. This is a skill that should not be underrated.

Leanan often speaks of efficiency vs resiliency. Here are a few brainstorms from a total outsider about what could be done by hospital staff to improve resiliency.

A. Form discussion groups, counseling services, economic advice trading groups, for the hospital staff. Places where it is safe to talk about peak oil, economic decline, etc.

B. Investigate combined heat and power facilities. What is now backup power may need to become full time power generation. Make plans for it early.

C. Start a CSA program with surrounding farmers. A hospital could be a steady backbone customer for multiple CSA. And a possible distribution point.

D. Help staff understand the transportation issues and find a way for them to move close to the hospital.

E. I would think emergency preparedness would normally involve disposable items (use once in crisis, discard) but it could be possible to invest those funds into low tech long life instruments and rooms that will be usable post peak.

You have some good thoughts to think about. Hospitals are in some ways their own little mini-cities. They might be able to work around outages, as long as they were not too severe. Even they would have their limits--for example, city water and sewer not working would seem to be difficult to work around, with current emergency preparedness.

From a conference on pandemic preparation, I know that only one hospital in our area has more than a few days worth of food on hand and that the one "prepared" hospital's food is stored in a warehouse some distance away.

How hospitals will get food is a major concern.

I agree, with enough chaos, any organization will fail. Water and sewer are exactly what I had in mind when I said doctors and their professional organizations could give advice outside of their field. Clean water is so essential for good public health, that they should offer an opinion on the subject. Here in the Twin Cities (Minneapolis, St. Paul) we have a run of river hydro plant. With proper connections, that plant could power water and sewer through nearly any emergency.

I expect other cities could make similar arrangements. Didn't Willits setup a solar PV plant on top of their waste processing? Here is where the Mayor's Kyoto climate treaty could work towards peak mitigation. Use those promises to power the city using low carbon renewable energy to also power critical infrastructure with RELIABLE energy.

With a mental focus on resiliency, I think a lot can be done. That said, there is little hope for BAU. 1940's here we come.

Hospitals are in some ways their own little mini-cities

and say, just to give this a mad-max spin, under some circumstances I could see hospitals becoming economic hubs. That is, if money is still used - and presumably some sort will be for awhile - then the old may tend to have more of it. Clustering near to "the Hospital" would be a survival imperative for many of these, and thus they would be spending their other money near to the hospital as well. I wonder if, in 50 years, the word "hospital" will come to mean "rich town center".

Alternately, in warlord scenarious I could see doctors pretending not to be, since they could be captured, hobbled, and made one basis of commerce. Warlords would want doctors in the same way they wanted beautiful women - as possessions.

Might be a good plot sequel to "the Fugitive", in which Dr. Kimball seeks to get away from crowds of two-armed men...

You will reduce medical costs only if litigation problems are solved.

Lets work this out:

For a hypothetical $1000 paid as 'input' to health care:
How much of that goes to the insurance firms VS how much goes to the hospital side?

Answer that question - THEN one can ask your question.

Someone pays for the big fancy Insurance buildings.

Frequent blackouts mean:

Limited oxygen supplies for hospitals, either gas or liquid.

A lot fewer MRI machines.

Vaccines are going to be really, really expensive.

Some drugs are going to be an order of magnitude more expensive to make.

I'm guessing power for the computers may be the least of the worries.

One long blackout in the winter and most people will die of exposure, thus eliminating the need for hospitals north of the Mason Dixon line, and farther south too if it's particularly cold at the time.

We have a lot of coats and blankets. i don't think exposure is quite as bad a problem as you make it out to be. The lack of water if pipes freeze could be a bigger problem. The frozen pipes could also mean that houses would deteriorate quite quickly, because of water damage.

Hi Gail, Unfortunately, very few (1/10 of one percent) people have the necessary clothing to survive in the cold, even at say 35 degrees Fahrenheit/1.5 Celcius for several days. One would need an extra heavy down coat, polartec pants (200 or 300 weight best/some place in Alaska Internet sells 300 weight), a wool hat, wools socks, polartec gloves, and a very thick down comforter (it goes on top of other blankets so as not to be crushed down).

Hypothermia is the main cause of deaths in winter power outages, Internet search: hypothermia deaths power outages

It takes surprisingly little cold temperatures to cause deaths from
hypothermia. The body shuts down pretty fast in the cold. No agencies are advising people. FEMA should, but does not have a single TV announcement. Local governments should, but do not. Hospitals should, but do not. Hospitals now regularly ask women if they feel safe at home (in order to identify situations of domestic violence.) But, they don't tell people they need to have XYZ clothing, extra food, and jugs of water in case of a power outage. Most people don't know that one of the first things you do in an outage is fill the bathtub and jugs with water. This is a problem of a lack of knowledge among medical professionals. Lots of people learn what to eat to keep their weight down, but not many learn how to prepare for a major blackout of weeks or months.

See this Congressional testimony by one of the most knowledgeable experts on blackouts, and imagine it happening in the winter: http://www7.nationalacademies.org/ocga/testimony/Blackouts_America_Cyber...

Murphy's First Law: If anything can go wrong it will. Murphy's Second Law: It will go wrong in such fashion as to cause the most damage. The Boy Scout motto: BE PREPARED

cjwirth, you might compare your predictions (most people will die) with the historical record: http://en.wikipedia.org/wiki/1998_Ice_Storm

This is a recent example of an ice storm taking out power for 4 million people for days/weeks. Total deaths from hypothermia are reported as twenty-four.

And living in Michigan, I would be very surprised to find households that don't have good enough clothing to sit around inside and get by thru an extended power outage. If we have coats good enough to go outside in below zero conditions to play, wait for the bus, commute to work, etc it seems like that would be adequate in a 35 degree house, out of the wind.

Hey John, Thanks for the helpful information. I checked and there were some sub zero temperatures there, and relatively few died. One difference is that the ice storms did not take out all areas for long, so emergency efforts worked well, and there was one area, not the whole nation. Also, the ice storms occurred in many rural areas where people are more likely to have some ways to adjust, including Montreal, as they dress for the cold. If the power outages are for the whole nation, and include the major cities for an extended period, say a month, then the combined effects of hypothermia, lack of food and water will have more devastating impacts. But you've clearly improved my thinking. The photos of collapsed pylons in some photos I found are very useful. The maintenance of the power grid is clearly dependent on diesel, especially in the winter.

A long winter blackout in the Northern US will cause an over-abundance of wood-smoke particulates and a lot of overstuffed schools, homes, churches - and Hospitals. There would be deaths, possibly even a lot of deaths.. but not 'Most'. And there would be an overwhelming need for hospitals.

Afterwards, there would be a fantastic push to make homes resilient and far less dependent upon imported energy, to make independent power systems for remote towns, to use Glass and Copper to heat water, to grow 'winter gardens' and keep decent amounts of produce stockpiled.

Even a couple smaller 'warning shot' blackouts and fuel shortages are soon going to have this effect. It won't be PV that will save the Temperate Northlands, while it can play a part.. it will be an awareness of how abundant North America can be if we look to the essentials and start to forego the fripperies to which we have become accustomed.


umm.... not quite.

A long blackout in the north will not do too much to the wood particulates. Wood takes *time* to prepare for burning, wood stoves are not ubiquitous even here.

What it *will* cause is extremely high counts of death and hospitalization due to carbon monoxide poisoning. Kero-suns ARE ubiquitous and do not involve electricity. In addition, many propane heaters run fine with no power. The distribution centers like gas stations are usually among the first to lay hand to a generator to resume service.

Remember that extended winter blackouts happen here. (see watertown ice storm)

Hospitals will most certainly be needed, thus the diesels that almost all hospitals here have.

Now, if blackouts become regular occurrences THEN you may start to see the woodsmoke happenin!

Wood takes time to PROPERLY prepare for burning.. tables, chairs and oaken chests will be used, if need be.. scrap piles, standing dead wood, and of course smoky, uncured greenwood Would be put to the match as best as possible. But woodfires were not mentioned as if they would be the ONLY recourse. Winter storms are rough and CAN surely kill, but if you've got a building to stay somewhat dry inside, freezing to death is avoidable. Starvation takes weeks. Ice and Snow can be your essential water supply.

People would scout out their isolated neighbors.. they wouldn't sit there and wonder if Lady Hutchins up the road was dead yet. They wouldn't just sit in their own houses and wait to die, either. A Perfect Storm of events could be brutal.. but just not the way Cliff paints it. A roof-crushing snowstorm could kill many thousands.. another 'Long Island Express' '38 Hurricane could find a nasty path through tons of suburbs for a nice body-count. Pandemic would be a potential wildfire across our land.. but a grid-outage across the whole North of the Country, coinciding with bad enough weather to threaten almost everyone across a couple dozen states.. this just makes it silly.

Food stockpiles WOULD be a critical issue, and if a blackout that slammed the WHOLE northern half of the US (irrepairably, for weeks..?) were to receive a 'New Orleans FEMA Welcome', then the dice-throw would look pretty grim.. but at least in an icestorm you're not worried about refrigeration! I'm also thoroughly not convinced by Cliff's 99.9% idea of peoples' food storage. I know Boston or Scarsdale isn't Bangor, but we have food producers, farms, warehouses and such, too. He paints this picture as if the world outside would just sit there, and people in their towns/cities would just sit there and watch their own fingertips turn blue, and that there's NO food in the fridges or stores, NO gas in any Car or Lawnmower, NO way to survive in a house with a bunch of blankets, maybe packed in with ALL your neighbors and cousins. Come on. There ARE some dangerous scenarios, but this one is handwaving. Clif wants us to be done with electricity.

Mainly though, I'd say your final statement is the key. Increasing instability, whether it's blackouts or gas shortages or food prices, etc, will start making the causes be sought. With awareness already growing about our energy vulnerability, individuals and communities are starting to look to their resilience and survivability. Not much, not enough.. but wait till a couple actual 'events' (gas outages, blackouts) sit atop this thinning padding that we here are so focused on. It'll be a tipping point that we can't even convince ourselves that 5% of the country is capable of stepping up to.. I think we'll have that Apollo program, whether a politician initiates it or not.

Hospitals will get PV and UPS like you won't believe. PowerGrid Tech will be overturned with all haste- to make Multi-operator Interaction and Local Standalone operation both stable and dextrous. This buildout, and the residential one which Clif asked me How I would do it.. I wouldn't have to. It would be initiated from the 'warning shots' by more and more people realizing just how vulnerable they are. It's way too late.. it'll fall short and be far too expensive.. but it will happen. A great many fixes can be done with local materials.

(Do get a little PV while it's still cheap and on the shelves.. damn useful stuff -- if one of those 'Bumps' hits tonight, they'll be sold out by 9:15am on Monday.)

Less than 1/10 of one percent of the people have wood stoves. 99.9% of the people don't have food stored. There will be no communications for people to know what to do and where to go. Body heat in confined room has limitations. Water and sewage would be mostly non-existent. If FEMA advised local governments to get out the word, things might be different. How do you propose to accomplish what you have in the second paragraph above? Time for some serious Peak Oil risk management.

It's the usual conservationist thang. There is in the peak oil community a significant cadre that is under the delusion that hybrids/bicycles, passive solar homes, telecomuting, and absurdly minor conservation items like these can keep things on some odd hippie BAU while the evil consumers perish. Really, it's almost as funny as the ethanol/hydrogen thing.

A little quick math that I have posted before.
heat needed to heat a moderate sized home in the northeast = 30,000 btus /hr= 8.7 kw = 208 kwh/day.
Solar flux in the northeast in December = 2 kwh/m2/day. (from nrel)
area of 50% efficient passive solar paneling needed to heat one small home = (208kwh/2kwh)*2(50% efficiency) = 208 square meters of passive paneling. Anyone see that happening? Didn't think so.

That's clearly for the retrofit case, rather than the new construction case. Since we're talking about a time of resource scarcity, anyone think that we'll be replacing a decent fraction of existing homes with the new fancy-schmancy passive designs? Didn't think so.

In the real world, making homes more "energy independent and resilient" means installing a woodstove, replacing a few windows and hoping for the best. That's for the rural/suburban case. For the urban case, it means moving into an apartment instead of a SFH and hoping that your building has a plan.

Yep, and what do you do when there isn't any gasoline for chainsaws and trucks to get wood. Don't see many of those big old hand saws around, and not too many wagons and horses around either, except on TV westerns. And wood stoves don't last forever. So, after exhausting various contraptions for wood heating, it would be back to chimneys, which don't heat very well. Not too many folks know how to make cement these days, for making a chimney. This is one reason I moved from New Hampshire to the state of Veracruz, Mexico, not too cold and 2 meters of rain annually. Hey, come on down and visit me and my wife. clifford dot wirth at yahoo.com or give me a call (US number Vonage connects here 603-668-4207

I can run my chainsaw on home-brew ethanol and veggie oil (2 stroke). My woodstove will last a deal longer than I will, being basically solid steel. Push comes to shove, horse manure and sand makes a decent mortar. That's IF I don't feel like walking over to the limestone quarry 1/2 mile away and baking down some stone-dust. I live in Amish country, so plenty of the old crafts ready to hand here.

I think it's pretty fair to say that I am hard landing compliant. I have all the skillz I need to be self-sufficient, as well as all the infrastructure. Including off-grid power capabilities. mexico looks too hot for me, I'd rather deal with the heat than the cold. The only thing I can't do without outside input is pay my taxes :)

I'm here at 4,200 feet/1280 meters above sea level, the hottest would be 96 F/35.5 C and the coldest could hit 40 F/5 C at night.

I would add that all of the sterilizers in our hospital require electricity, and all of the OR drapes and gowns are disposable. It would be a very short time before all surgeries would stop because of lack of equipment and materials.

..Or at least they would start performing the critical ones without disposable drapes/gowns.


Thanks DanB and Gail for a thought-provoking issue. My wife works (admin asst) in Health Policy Research at a Northern US University, and I'm considering how to introduce this article to their department. The groups I am in contact with deal largely with People with Disabilities, and with Substance Abuse/Mental Health. I haven't even tried to apply this to those fields yet.. but I'm hoping these folks would put some attention on the issue.

Sorry to see how unhelpful some of the discussion became, but health and death do bring out the strongest emotions. The Med and IT professionals were great to hear from, to balance that out. It's easy to take them for granted and pick on the problems.. until you find you need one of them! Bless all you guys!

In terms of the 'Disposables' above and similar 'Essential Expendables', I wonder how challenging it will be to change the habits of modern practitioners who have been so accustomed to the Cadillac end of a throw-away society.

As was discussed above about Gail's dad (?) and the old perceptions and tests that many docs aren't taught anymore.. I have to expect that there will be a relearning of much of it, as well as a great reinventing of nutritional (growing/cooking/body-awareness) knowledge that will rebuild the immune systems of those in the Western Cultures that have been so ravaged by industrialized food-production, synthetic experiments and toxic surroundings. I did learn of one Hospital that had given the Cafeteria/Concession rights to a McDonalds.. (some high-schools have done this, too!) it almost played to my ear as a conflict-of-interest, if I didn't aready realize how ill-informed our whole society has been about Food and Health.

Thanks so much for opening the topic!

Bob Fiske

"..Or at least they would start performing the critical ones without disposable drapes/gowns."

"In terms of the 'Disposables' above and similar 'Essential Expendables', I wonder how challenging it will be to change the habits of modern practitioners who have been so accustomed to the Cadillac end of a throw-away society."

In regards to your first point, I for one will not be operating on patient's with my bare hands, no matter how critical the operation is! My own family has my first priority, and my desire to contract hepatitis C, or some other blood-borne pathogen is nil.

I think you are mistaken if you think physicians are the ones who choose what types of gowns and disposables are used in the operating room. Bean counters who work for the hospital make those decisions based on what is currently cheapest, and we have to suffer with them.

I don't mean to imply that the Docs and Med Staff are 'creating' this throwaway situation, not at all. It's endemic. Medicine AND the whole culture are awash in this mindset and 'it's worth generating a little trash-' Habit. I'm just saying that even the bean-counters, but especially those on the front lines will be facing situations (or foreseeing them) where the disposables will become increasingly unstockable, unavailable or unaffordable, and they will become subjects of 'bare essentials' scrutiny. The economics of laundering (for example) might overtake items which have up till recently been sterile paper/plastic/cotton-single-use items. Solar Concentrators can at least create high enough temps to deal with one level of washing/sterilization.

I don't know where latex gloves fit into that spectrum, or Hep-C for that matter. I just think many of the scales will be finding new balance points.

Leaves me wondering how many procedures have been able to move over to endoscopes, reducing a lot of exposure for both the Patient and the Doctors/Nurses. Any thoughts on the energy and durability of the technology that Endoscopy relies on?


IIRC, real latex comes from rubber trees, meaning that it is a renewable resource, just like paper. Because infection preventaion is such a huge issue, this is one case where I think that disposable latex gloves and various disposable paper medical supplies are justifiable, and should still be available for a long time to come.

Plastics are a bigger issue, I'm not sure what you are going to do about those.

IIRC, real latex comes from rubber trees,

And we can make rubber from alcohol.

Oil used to be a plant - so I'm guessing clever humans can, with the right application of tech, can make a grown-in-the-now plants substitute.

It just won't be as cheap as what we had in the before-time.

Northside Hospital in Atlanta has a McDonald's concession that is open long hours. The McDonald's concession has at least a couple of unusual item on the menu. If I remember correctly, it had vegetable soup on the menu. (The only thing I remember eating there is a bowl of ice cream.) There is also a separate full-sized cafeteria that is open at meal times.

I end all my public talks with a slide that shows areas in which an audience member could choose to take a leadership role.

One of the last points I raise concerns health care, particularly bringing universal health care to the U.S.

I mention that after WWII, the British chose to institute a national health care system. (They chose, did not decide, as that word and concept comes from the same family as homicide, fratricide, regicide, etc., all of which involve "killing off;" to decide means to "kill off" the alternatives until one is left with one option. Occasionally it's a useful technique but is, in my view, an over-used method to select among alternatives.)

Now I live in the U.S. (married to my American wife) but maintain my Canadian citizenship. I've been able to observe both medical systems up close. I've also read some of the worried comments about "socialized" medicine.

Although both systems have treated us well (we have excellent coverage here), there is at least one distinct difference in the Canadian system that I had no problem paying for while I lived there and would gladly do again: the fact that everyone was covered, no matter what.

There is so much worry here when I talk to colleagues and friends about their health coverage. Will coverage run out? Will a procedure be denied by a health company whose first allegiance is to the shareholder and not the patient? Will they go bankrupt?

With the millions about to be unemployed, there are going to be even more people without coverage. More medical conditions are going to fester before a person somehow gets to see a medical professional. I don't have figures, but in the Canadian system I would expect that the value of stopping something quickly, before it explodes into an expensive situation, far exceeds any extra money that might be spent on the few hypochondriacs who waste a general practitioner's time.

There is a health disaster coming in this country that will coincide with Energy Descent. I, for one, think that universal coverage would have a calming effect on society and make all the other things we have to deal with, if not easier, at least less filled with stressed individuals so that we can (relatively) calmly address the situation we face. Worried, ill people may feel they have nothing to lose and give themselves permission to make an already bad situation worse (break social norms, commit crimes, etc.).

I encourage everyone to think hard about universal coverage in the U.S. There are many, many benefits to living in a society that has it that aren't all related directly to money, although It doesn't hurt that the Canadian system is roughly half the cost and manages to cover everyone, too. When my father was in the hospital after a car accident (in Canada), I can't imagine having to worry about how to pay for the excellent care he received.


BTW, Frontline has a good piece on health systems:

I agree with you on universal coverage, but soon none of these plans will mean anything, including retirement, pensions, medical insurance, social security, long term health care. These are promises to be able to buy energy in the future. When there is less energy, the promises dissolve through inflation or bankruptcies. When there is no energy, what does a social security payment mean?? And when the power grid goes out, that's the end. Without communications and transportation, there is no government at the state or federal level, and little at the local level.

Yes, these systems will come crashing down, of that I have little doubt.

But fundamentally it is people who will provide care to other people in the communities that emerge during the descent. Perhaps doctors will find that they will be well taken care of by the community in exchange for their services and no money at all changes hands (or perhaps it will be chickens).

The medicines may be gone or severely restricted, but I do see it possible in my community to get a number of young people willing to learn medicine as their way to give back to the community. They also might be attracted to the stature a doctor would have post peak.

It may have to happen community by community, but I think it's quite possible to create some form of universal health care. It just may not look like what comes to mind now.


Once again I will ask the question. In what way does socialized medicine mitigate the impacts of peak oil on the medical field? In what way does a socialized hospital perform better without power compared to a private hospital? Why does every well-reasoned discussion of the impacts of peak oil always end in a poorly reasoned emotional appeal to institute socialized X?

There is clearly something BADLY broken in the US system of health-care. There is no denying that. However, I very much doubt that it will be solved...at all... It is my considered opinion that the US has moved beyond the period of time during which solving problems is possible. We are entirely too deeply divided and evenly matched. There is entirely too much opposition to any proposal based simply on who is doing the proposing. I don't see any real chance of initiating single payer health-care, there is just too much involved. It's a big change and it WILL ruffle feathers all over society. Just think of the number of insurance providers that would cease to exist under that plan! They will oppose any such plan with all the fire that people looking at the loss of millions of dollars can muster and they will have help from the government oposers as well as in all probability, the majority of the medical profession. Mayhaps we should all just move to Canada.

I am not much inclined to debate the relative merits of the 2 systems during normal times, clearly they both have their upsides and downsides. The point is, we have what we have. The time for systemic changes due to ethical considerations is OVER. It is now time to consider survival for ourselves and our children (our grandchildren will have to hope that our kids do a good job). That means that a period of time of record deficit spending, trade deficit and resource inflation is exactly the wrong time to be considering having the gov. pick up yet another trillion dollar annual bill and simultaneously annihilate an industry. This is the time to cut back, radically, on every aspect of our consumption, and one aspect of our consumption is medicine.

If one compares health outcomes of the US system with almost any other country with a more socialized system, the more socialized system does better. Our current system is amazingly inefficient. There are too many people who do not get treatment for easily treatable illness (including early cancer) because they do not have health coverage. Nobody is really concerned about better health though better diet. There tend to be few standardized procedures.

I have been a Kaiser member for years, because it gets a little closer to the system used in other countries. There is more of a tendency to look at what works, and use that approach on a standardized basis. It seems like something closer to a universal Kaiser approach would be a step up from what we have now. If we can't afford that much under peak oil, then a scaled back version would use our health care dollars in a relatively efficient manner.

On TOD there has been alot of talk about "Hard" and "soft" landings as a result of "Peak oil". If it turns out to be a hard fall,and you have been making soft landing contingency plans, you are in trouble. SO PLAN FOR A HARD LANDING. Talk to the old retired doctors who practiced during the 50's and 60's. MASH doctors from Vietnam should be good resourses. How they did things could give you alot of "work arounds" for alot of your potential problems. You will not like some "work arounds" but they will be better than nothing. View your planning as INSURANCE that will allow you to function instead of Panicing. It can give you a priceless advantage "TIME" to adapt to circumstances.

Given sufficient money and energy, perhaps most California Hospitals can be made to meet earthquake standards.
EDIT: To add link


Dan and Gail have brought out an issue I have been concerned about for some time. I am a physician and engineer, and I have been involved in medical devices and technology for a few decades now. My concern is that we have built a system based on cheap oil, and that our calculus will change slower than the reality of oil price and availability. Some examples:

Many surgical instruments have been made disposable because the costs of re-sterilizing stainless steel instruments was higher than buying nice new plastic ones.

Syringes, which are made in the millions per day, are manufactured in only a few locations around the world and shipped everywhere. The manufacturers have engineered that last fraction of a penny out of the process of making syringes, but the material cost is fairly linear with petroleum costs and the global supply chain costs will start being significant.

Clearly the practice of medicine has to change, and this will have detrimental effects on some patients: certain treatments will not be available to older and sicker patients. Most people would be shocked to see the volume of stuff - mostly polymer based - that is tossed out at the end of a major operation. I do not want to go back to the days (only a century ago) when people routinely died of infections that we easily treat today. We will need to do triage on our medical practice, saving those treatments that are of real value to humanity. Investors in high-tech medicine are going to fight that effort.

Many surgical instruments have been made disposable because the costs of re-sterilizing stainless steel instruments was higher than buying nice new plastic ones.

Syringes, which are made in the millions per day, are manufactured in only a few locations around the world and shipped everywhere. The manufacturers have engineered that last fraction of a penny out of the process of making syringes, but the material cost is fairly linear with petroleum costs and the global supply chain costs will start being significant.

Why worry? The peak oil downslope will take manny years and such reprioritizations are what a free market excells at. Hospitals will add more sterilization capacity and the percentage of single use tools will gradually go down.

Centralized manufacturers of equipment such as syringes will probably change the shipping from minimilized high speed "just in time" to larger slow batches and might even increase the production volume. And it would gradually be profitable to add smaller prodoction units closer to consumption.

The big problem is not the hospitals or their specilized equipment but the "bulk economies" efficiency.

As per all the "solutions" I come across, many of them will make up for the first few years of lost production after we fall off the production plateau we are currently on.

But what about year 5? Year 10?

I believe that the math would demonstrate that your suggestions above would have a short-lived impact.


5-10 years is enough for significant changes in infrastructure, travel patterns, business practices such as transport frequenze versus batch size and the location of manny kinds of production.

But this requiers societies that can change, those that cant change will become toast and that were also true with benign change such as the current globalization. But being toast is of course worse post peak then on the upslope.

My solution is living in a society that has very large ammounts of sustainable hydro, nuclear, wind and combined heat and power electricity available to run present and new business and thus get goods for trade and help stabilize the world post peak.

Yes, worry, because the peak oil back end will look nothing like the front end. It will more resemble a cliff, due to mounting and cumulative effects of staving off entropy: social chaos, war, supply line disruption, disease, water and food shortages, for 6.7 billion humans in extreme overshoot.

Increasing efficiency in a growing population only works if you can keep increasing the overall energy flow. Resiliency is what's needed when energy flow is uncertain, variable, or chaotic. Which is why, evolutionarily, we store fat on our bodies in times of feast to weather the times of famine.

On the way down, we will have so many more people than on the way up that the resources per person will drop very rapidly. Also, will the US be able to continue to use 25% of the world's oil for 4% of the world's population, if we cannot really pay for it? There could be big shifts geographically on who gets the oil.

There has been some comment here on the nature of blackouts. Someone indicated that blackouts come in series, getting worse and worse, not all at once for 6 months for example.The most knowledgeable expert says it can happen here suddenly, lasting for months:


Also, Gail posted regarding the grid: http://www.theoildrum.com/node?page=1
and there are many good comments there, including mine :)

And remember Murphy's Laws,"If something can go wrong it will and will happen in a manner so as to cause the most damage." My comments on that post focus on what if it happens in winter. Good idea for hospitals and everyone to think about risk management, to plan ahead, otherwise it is too late. The big blackout can occur as a result of a series of mistakes, hurricanes, tornadoes, or who knows what.

The way I read the testimony, it says if a terrorist attack took out several nodes at once, the outage could be long lasting. It then goes on to talk about parts of the grid gradually coming back up. The report really doesn't talk about outages for other reasons.

It seems like shorter outages are more likely than long ones, but with the difficulty in getting replacement transformers and other major equipment, I can see how outages might last a long time. They might also be quite widespread, if they hit a vulnerable area, like the Eastern Interconnection.

Here is what Gilbert says before he get to terrorist activities:

"""When operated near their capacity, these systems have little margin within which to handle power or load fluctuations. Thus they are quite vulnerable to being brought down by operating fluctuations that exceed their remaining margins. Shutting down becomes the only way a system element has of protecting itself from severe damage when load exceeds capacity. But the loss of a piece of the grid, a section of transmission line, does not end the problem. The line down takes with it the power it was transmitting. A connected power plant, having no connected load must also shut down. In these highly integrated grids, more lines have imbalance problems and more plants sense capacity problems and so also shut down. This cascading spreads very rapidly in many directions and in seconds, an entire sector of the North American grid can be down. We had a living example of this event, this past month, caused by an accident. We were fortunate to see the power return in so short a time."""

I don't know how big a "sector" is (all of the Northeast???). If Murphy is right, it will happen to 2 or more sectors simultaneously (Northeast and Midwest?????). Some people say that I'm paranoid, but I say better safe than sorry. Now it is called "risk management," but my grandmother called it "a stitch in time saves 9,"

This is a map I posted earlier, showing sectors and how soon utilities are expected to fall below the minimum required margin (required by their sector - each has its own rules), based on the NERC 2007 Long-Term Reliability Assessment. The second number is including uncommitted resources. (I think this is like natural gas plants that are under consideration, but aren't yet committed.)

Apparently there are some sub-sectors as well. For example, WECC covers the entire western part of the US. The Rocky Mountain part has a closer date for exceeding margin than the other portions. RFC(MISO) seems to Michigan / Indiana. It has a 2008/2008 date.

Making matters worse, the report talks about reduced capacity resulting from rulings related to the Clean Water Act:

A recent development that could adversely affect future capacity margins is the EPA’s July 2007 suspension of its Phase II, Section 316(b) of the Clean Water Act rules regarding cooling water intake structures and thermal discharges of once-through cooled power plants. While plant specific outcomes will vary, retrofitting existing power plants with cooling towers can reduce the capacity of those plants, which will exacerbate the supply concerns identified in the this assessment. In some cases, retrofits may prove so costly that plants are retired earlier than projected, with the consequent loss of the plant’s entire capacity.

These changes have not been taken into account in the map.

Another important aspect to keep in mind, as regards accurate diagnosis and treatment, is the role of the clinical laboratory. I work in a pediatric clinical laboratory and can tell you that NOTHING can happen in a modern laboratory without electrical power. Also, the instrumentation can be very sensitive to environmental conditions as relates to both temperature and humidity.

As was stated up the chain here, medical schools have forgone certain types of patient assessment in lieu of the advances in medicine. A large part of this advantage includes timely, accurate laboratory generated information to assist physicians and nurses in making proper care decisions. Often, laboratory information is taken for granted, but a return to much less information being available sporadically and the permanently should be kept in mind.

Since retiring from medicine I have had several volunteer jobs including medical librarian and law enforcement. I was also the internet liaison for the late L. F. Buz Ivanhoe http://hubbert.mines.edu but that preceeded retirement. There are similarities between hospitals and PD's. Both must function 24/7. Dispatch uses computers, radios, and highly trained personel. Like medical care LE is dependent on vehicles, particularly in suburban locations. Hospitals and police departments now use helicpoters for optimal service. PD's also have back up generators which must be fueled. A PD in Arizona was forced to suspend some services when a pipeline broke. Hospitals and PD's are vunerable to any economic downturns that peak oil may bring.
--It might be interesting to have a section dedicated to law enforcement.

Good point - we should think about law enforcement too.

That is good point, that is easy to miss.

Long ago, medical technology wasn't so electricity dependent. My mother was a medical technologist until I was born. We had a (non-electric) microscope at home and slides with covers. My mother would demonstrate in the kitchen how she used to make slides. She would talk about using stains and counting the number of certain types of cells. It seemed to me that many of the techniques she talked about could be done with or without electricity.

I’ve been a RN for about 7 years and have been shocked by the amount of waste. It’s unconscionable. Everything in the hospital is disposable and everything is made of petroleum by-products. After hurricane Katrina, I was fascinated by the ICU nurses who remained at the bedside hand bagging (i.e. doing the work of a respiratory ventilator with their own hands and ambu-bag) sick patients for 24 hours straight. There’s a culture of selflessness that’s imparted in the modern healthcare setting. There’s an expectation that the nurse keep the best interest of the patient as priority without regard to environmental or cultural impact. That’s been hard for me. I worked in labor and delivery for several years and became rather disgusted with the assumption that all American human life was sacred at all cost. That includes a nearly unending allocation of resources to make it happen regardless of the statistical probability of a “good” outcome. Americans have abdicated primary responsibility for their own well-being and have handed themselves over the pharmaceutical companies, doctors, hospitals, nurses, and advertisers.

Nurses are actively discouraged to join/create unions (which improve working conditions for nurses and have been associated with better patient outcomes). The insurance industry has lulled legislators into fearing the expense of a single-payer system (which by nature would favor ongoing health maintenance over emergent [resource intensive] treatment). “Ethics” in medicine has become a bad joke.

As we approach (if we aren’t currently at) peak oil, we will have to make community decisions for the allocation of resources. Do we provide extra coal, electricity, water, et cetera to the facilities that care for our sick? Or, do we take the time to make difficult ethical decisions that attempt to measure the allocation of care and resources to those most likely to have a positive outcome and actively contribute to the community at large? Are there some conditions that merely warrant comfort care? And will the rich get around our community decisions (as they always have been able to do) by showing up with a checkbook that re-writes our consensus? These are all questions that need conscious discussion, planning, and decision-making. Unfortunately, our history is one of reactionary action. And, I fear that modern-day healthcare will suffer as a result of its anesticized apathy.

There are some advantages to using disposible equipment. Disposable needles are always sharp. I can recall doing venepunctures with old dull needles. They had been sterilized but were still painful. And of course unsterilized needles in Africa and elsewhere have been implicated in the spread of HIV/AIDS and other diseases.

I became interested in this subject during the late 50's, following conversations with the McGill biologist N.J. Berrill and published a series of articles and letters on population, energy, recycling and minerals used in medicine during the 60's and 70's in the JAMA and elsewhere including Medicine Minerals and Malthus in the J Chronic Disease: http://www.ncbi.nlm.nih.gov/pubmed/6023227


Fortunately they are not easily accessible as they are extremely dated.

The W.H.O is also implicated in the spread of HIV in Africa (but few people like to talk about that). And, an unfortunate reality is that the pandemic of HIV/AIDS in africa has served to continue our exploitation of the natural resources of that region. Sick people aren’t as able to fight to protect their oil, diamonds, or human rights.

I have to agree that a sharp needle does make the job of veni-puncture easier but there’s been a shift with OR instruments (such as retractors and pickups) becoming disposable as Pakistan has gotten into the business of making them. These are stainless steel and could easily be sterilized but today there are just as likely to be placed in the contaminated sharps box. Linens at the facility where I work are sent 50 miles away to be washed by inmates. Pillows, mattress covers, pitchers, basins, travel sized personal care items, et cetera are all thrown away with shocking regularity. Patients and staff adjust the thermostat to negate our natural environment. But, all this will likely change as resources and distribution systems fail.

Interestingly, I haven’t seen anyone mention that there’s currently a nearly one million nurse shortage in the US. That said, to facilitate localized medical/nursing care, more people need to enter the profession. As for the posts about homecare nursing, historically speaking, the Frontier Nurse Midwives attended births on horseback and attended to indigent families in rural TN. Birth is relatively easy (and I might argue that it probably shouldn’t be occurring in the hospital even now…prior to massive energy instability) to “manage” at home. And so is death. It’s the in between events that cause us to panic and seek a “medical miracle” for the consequences of many of our own choices. But on the upside, it isn’t likely that we’ll maintain our health destructive consumer culture in the absence of the fuel that literally drives the whole system.

It has been more than a decade since I was inside of an operating room, other than as a patient, but nothing about disposables would surprise me. Years ago there was controversy when someone demanded that radiologists stop recycling the very expensive and easily sterilized catheters used for angiography.
I agree that it is easy to deliver babies, especially uncomplicated multiparas. My first rotation as a junior at Baylor was to a part pay OB ward at Hermann. I delivered 5 babies before the edict came down that juniors were to watch. Fortunately there had been nurses to tell me what to do. Later at Houston's 50's charity hospital, Jefferson Davis, the babies came more than one per hour. That was the middle of the baby boom. During the 80's at a small hospital I was called from radiology to OB twice to be the doctor in attendance. I asked the experienced nurses to do the deliveries but they were happy to have me as it eliminated the "no doctor in attendance" paper work.
--Anesthesia is so important. During the Civil War, amputation without anesthesia was common. Many fractures could not be otherwise treated. Modern casts are energy intensive.
--Nursing might be an excellent post peak profession for both woman and men.

The talk is really geared towards peak oil, in general, and saying that hospitals, just like everyone else, will be affected. Big deal! This is not news.

But perhaps readers would like to think through the implications. We seem to have a lot of readers in the medical field. For once, they would like to have a chance to talk about the issues that affect them.