NEJM Leads the Cleanup

“Neither the gravity and enormity … nor the unfortunate politicization of this health emergency should cause us to shy away from action.”  I cut the specific issue from this sentence to make the point that as in practically all else, everything in health care is political.  The sentence is ironic, bemoaning “politicization” even as it politicizes.

I don’t know who funds The New England Journal of Medicine, but like JAMA, the publication’s core mission now seems agenda-oriented.  It is “launching a new NEJM Topic to keep readers informed about the myriad effects of climate change on our health and health care systems.”

Their kickoff editorial, “Prioritizing Health in a Changing Climate,” immediately cranks up the scare-mill with predictions of more heat-related illnesses, more heat waves, more pollen, more insect-borne diseases, and so help me, more “hospital flooding.”  If rising seas were actually flooding hospitals, does anyone doubt there would be 24/7 wall-to-wall coverage?  Like the old joke about the Washington Post headline announcing a nuclear war, NEJM assures us that the young and elderly will be the most vulnerable. 

The NEJM introductory editorial reassures “that physicians of the past have successfully taken ‘off their white coats and wade[d] into the fray in which actions are taken and decisions made.’ These previous political mobilizations, to address such public health threats as tuberculosis and nuclear war, carry applicable lessons for today.”  As a physician and former participant in the Cold War, I can assure you that the International Physicians for the Prevention of Nuclear War (IPPNW) were a complete joke, and that their receipt of the 1985 Nobel Peace Prize merely validated their political agenda.

“The timeline for action to avert some of the most catastrophic health outcomes of climate change has been estimated to be a little over a decade … We, as a medical community, have the responsibility and the opportunity to mobilize the urgent, large-scale climate action required to protect health — as well as the ingenuity to develop novel and bold interventions to avert the most catastrophic outcomes.”  This is institutionalized BS, designed to gain grants, burnish bona fides for preferred circles, and further enlarge the presumed attitudes which will be demanded of all future med techs.  This is not Lister and handwashing, nor Reed combatting yellow fever.  This is public hand wringing with the full, cynical knowledge that doctors cannot do one damn thing about the “crises” they claim to discern.

The next NEJM article leads off, “With a rising death toll from chronic kidney disease of unknown origin (CKDu) — also known in Central America as Mesoamerican nephropathy — and with greenhouse gas emissions driving global temperature increases…” 

The NEJM authors describe how the death toll from CKD is rising in Central America, note that “the true global burden of disease is unknown, because affected areas tend to have a poor health care infrastructure,” and that, “after nearly three decades, the causation of CKDu remains enigmatic.”  Reminding us that overheating and dehydration are bad for kidneys, it follows that rising temperatures would be bad for the beans, as would “exposure to agrochemicals, heavy metals, and infectious agents, as well as genetic factors and risk factors related to poverty, malnutrition, and other social determinants of health…”  In other words, they are only hypothesizing about multiple factors and have proven nothing.

“While average global temperatures have risen nearly 1°C, there has been a more drastic increase in heat waves accompanied by increased humidity…We may have now reached a physiological limit, in terms of heat exposure, at which acclimatization and behavioral modifications can no longer overcome the biologic stressors … We are now living in an era when climate change is no longer a distant, existential threat. It is happening now, and it is affecting human health in profound ways.”  Alright, trying to keep an open mind here. 

“CKDu disproportionately affects socially and economically vulnerable populations, further exacerbating poverty and eroding mental health.”  Got it, no one would prefer to be poor and live in the Third World where most things except real estate values would be suboptimal.  And then the authors mention regional poverty and food security, and I get the foreshadowing.  And bingo, they start warning about increased costs due to immigration.  More politics. 

“If we expand our focus to address upstream determinants of health that cross country boundaries and advocate for safe working practices and living environments, we can help to mitigate the impact of CKDu as well as that of climate change.”  If busybody academics want to go pester tropical dictatorships on improving their labor laws, I’m sure their parent institutions will keep their tenured chairs warm for them, as these are not latter-day Albert Schweitzers by a long shot.   “We can also increase awareness within our communities and support climate-health literacy in medical schools and residencies.”  And agitate for new state-mandated climate change CMEs to ensure that all licensed doctors will have the proper attitudes while running room to room, reminding patients to recycle and switch to all-plant diets.

Article three in the NEJM climate awareness rollout starts with:  “Science tells us that the harms of climate change will worsen with time if we fail to take substantial actions now to reduce carbon pollution. In the United States, the growing burden of atmospheric carbon pollution has already fueled searing heat waves that have triggered bouts of asthma, heart attacks, and kidney failure…unleashed unprecedented rains in the Midwest that have jeopardized health for thousands of people… stoked wildfires in the West that have taken lives, razed homes and hospitals, and sent toxic plumes of smoke across the continent… fueled powerful hurricanes, like Maria and Harvey, that have enfeebled hospitals and clinics and forced rationing of critical medical supplies such as IV fluids nationwide.”  This is an open question, and for a so-called scientific journal to parrot one side of the debate as a basis for diagnostic, treatment, and policy recommendations is … more politics.

The rest of this article is about how doctors should oppose budget cuts to the EPA.  “If these EPA rollbacks are successful, they will diminish our ability to mitigate health effects and diseases related to the burning of fossil fuels and the immense toll they take on our families.”

The sanctimony seems like the only truly renewable resource:  “Many health care systems, including Kaiser Permanente, Gundersen Health System, and Partners HealthCare, have been responding to the climate crisis. Recognizing that climate change is already harming patients, they are reducing their own greenhouse-gas emissions from hospitals and clinics to ensure that their facilities are not part of the problem.”  I’d call this marketing childish, but of course the article counts support for their virtuous climatology from the American Academy of Pediatrics, as well as the American Academy of Nursing, and of course the ever-malleable AMA. 

“Together, we can transform climate change from a politicized problem for polar bears into an opportunity to improve human health — and act to create a healthier, more just, and sustainable world.”  And here we return to a more turbo-charged version of the ABFM’s cultural competency requirements.  Did you really sign up for this?

I am not against physicians pursuing long-term research or trying to better the world around them, nor do I want to see the world gunked up any more than it already is.  But pushing collective economic solutions and nebulous social justice measures are purely political, and denigrate what should have been a serious profession.  How exactly do doctors convince India and China to stop dumping plastic into rivers that foul up the Pacific Ocean?  How do doctors make the case for more wind farms when there is ample evidence they are not as energy efficient as combustion engines?  What will the long-term heavy metal effects on kidneys be when huge mountains of discarded batteries disrupt the horizons of a magically fossil fuel free landscape?  Do we presume that doctors have automatic credibility to address so many issues for which they have no training, and in which they have no expertise?  Is not intuitively likely that so much of climate change proven to be manmade would be the cumulative effect from 7 billion humans?  Should doctors then start advocating for population control, and how would that look translated into government policy?  Which doctors are ready to start advising patients to get fixed in service to the planet?  Should a vasectomy earn carbon-offset tax credits?

The climate change issue is fueling the expanded use of doctors as political pawns, playing to the ego of academicians, encouraging them to promote semi-science to publicly adopt fashionable stances.  I am NOT questioning the prevalence of CKD, nor that working long hours in sugar cane fields makes it worse.  But none of that is proof of manmade climate change, and does not lend itself to doctors offering fanciful solutions whose effectiveness cannot be proven, nor even enforced.  The presumption of the NEJM initiative is that any climate change is manmade and can be altered by the right policies, justifying its tone that doctors have a moral obligation to adopt these points of view.  These are open questions at best, and should not be examined through a lens of coercion, which is the real goal of all these…politics.  

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