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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Pat Conrad MD

Pat Conrad is a full-time rural ER doc on the Florida Gulf Coast. After serving as a carrier naval flight officer, he graduated from the University of Florida College of Medicine, and the Tallahassee Family Medicine residency program. His commentary has appeared in Medical Economics and at AuthenticMedicine.com . Conrad’s work stresses individual freedom and autonomy as the crucial foundation for medical excellence, is wary of all collective solutions, and recognizes that the vast majority of poisonous snakebites are concurrent with alcohol consumption. 

  14 comments for “NEJM Leads the Cleanup

  1. Rick
    September 2, 2019 at 11:20 am

    Well, think about this, WHO is to say that our current temperatures are optimal. Temps have varied throughout the history of the planet.
    We simply cannot say that how it is now is the ideal.
    So, let the earth be. It is what it is. We can’t change it.
    If everyone hasn’t seen the comedy routine by George Carlin on the earth, please watch it. He nails it.

  2. September 2, 2019 at 9:55 am

    Bridget, maybe the trivial efforts are working. Moscow had a record cold summer. If we imposed energy starvation on the world, it might get colder still–at least in people’s houses. After $2 trillion in subsidies, it is doubtful that wind turbines have generated any net energy, while despoiling the land and slaughtering birds and bats. There is no way to quickly replace the 80% of the world’s energy that comes from coal, oil, and natural gas. Maybe in a few decades–if we go nuclear.

  3. Steve O'
    September 1, 2019 at 11:36 pm

    Perhaps it is as simple as what researchers might note if they did real research.
    I have noticed in my clinical practice that Central Americans have about a 10% lower average daily creatinine production per kilo. This overestimates their eGFR. Clinical renal failure ensues with “normal GFR”

  4. Steve O'
    September 1, 2019 at 11:03 pm

    In order to promote Fascism and totalitarianism, it is very useful to get the intelligentsia on board, not that one needs their intellectual input, but for the very opposite – to shut them up with thirty pieces of silver, massage their egos, and pretend that they will be part of the New Ruling Class. The following treatment of the intelligentsia is canonical, out of the book of opening moves – smash them in the mouth when the time comes. They are soft and have delicate mouths, and will not fight back when cornered. They will whine; that will be stopped readily. They are nowhere near as tough as the Hong Kong protesters, who are risking violence and death willingly. Intellectuals can be subdued easily.
    I am in the top one-in-a-thousand of citizens who understand the details of climate change. I say this not to be an arrogant “smartie.” You see, the average Joe doesn’t really trust the smarties anyway. I cannot come up with a consistent opinion on my own whether climate change is real, or not real. The game is to get people to line up with “Obviously climate change is fact,” or slightly worse, “obviously, climate change is a fraud.” Those are both nitwit positions, and the intellectuals, rather than trying to figure it out on their own, try to recruit the average Joe to assert one of these positions.
    I have tried very hard to figure out whether climate change is credible or not. When I offer the positions I am stuck on, I am ridiculed by those who find it a certainty or a fraud.
    The key to uncertainty is Planck’s law on radiation. E=t^5; emitted radiation by a body is proportionate to the temperature to the fifth power. Small changes in temperature cause a massive change in energy emitted; and massive changes in energy flux lead to a small change in temperature. Objects are massively conservative with their temperature. A 1% change in temperature causes a 5% change in emitted energy. This seems trivially small, but think of it.
    Another is that climate, BY ITS DEFINITION, is chaotic, meaning it follows laws of chaos theory. We are in an ice age, an interstadial part of the ice age, the warm part, “a subdivision within a glacial stage marking a temporary retreat of the ice.” M-W Temperatures are chaotic, and we measure changes over the last 100-200 years of our record-keeping. The temperature may be the highest on record. What does this mean, in a chaotic system? Very little.
    The “other side” of our climate is the stadial side – being in an ice age. That is our greatest “risk,” as though we could do something about that.
    We are prancing about hurling nonsense, demanding action, in the way that the good People of Salem demanded an answer to the Witch Crisis. They got it. We’ll get ours, too.
    The most effective way to reduce carbon emissions is for the powerful “islands” to eliminate the less powerful from the carbon-producing party. The 80% of the population which produces 20% of the carbon can be easily eliminated – a lot more so than the 20% of the most powerful.
    I even call to mind the Eden Project, which is to return South America and its Amazon to the days before human settlement. Salted nuclear weapons, judiciously used, could extinguish most of the population of Homo sapiens, and all of the cultural resources, if we really need to produce a solid and reliable carbon sink for the planet. It is a perfectly rational solution. I just would not want to be the advocate explaining it to God in whatever form he/she/it might be.

  5. Steve O'
    September 1, 2019 at 9:59 pm

    enormity …
    Merriam-Webster excerpt:
    enormity noun
    enor·​mi·​ty | \ i-ˈnȯr-mə-tē
    \
    plural enormities
    Definition of enormity
    1 : an outrageous, improper, vicious, or immoral act the enormities of state power— Susan Sontag; other enormities too juvenile to mention— Richard Freedman
    2 : the quality or state of being immoderate, monstrous, or outrageous especially : great wickedness the enormity of the crimes committed during the Third Reich — G. A. Craig
    3 : the quality or state of being huge : immensity the inconceivable enormity of the universe
    4 : a quality of momentous importance or impact the enormity of the decision
    In my impression, the latter two definitions have become associated with it due to misuse of the word. The traditional meaning are the first ones.
    Neither the gravity and enormity … nor the unfortunate politicization of this health emergency should cause us to shy away from action.” Climate change has been turned into another instrument of disagreement within our playpen society.

  6. September 1, 2019 at 5:23 pm

    Remember, life is carbon pollution. It is made of carbon that was once in atmospheric CO2. So, let’s suck it out of the atmosphere until the level is low enough to kill all the plants: https://www.ddponline.org/2017/10/11/climate-change-iq-question-5-what-would-happen-if-atmospheric-co2-concentration-dropped-by-half-say-to-less-than-200-ppm/

    No, “climate change” as slight warming is not the #1 global public health problem. But the proposed “solution”–energy starvation–would be: https://www.ddponline.org/2017/12/17/climate-change-iq-question-10-is-climate-change-the-most-urgent-global-health-threat/

    Now, if we have another ice age, that would be a real killer. Consider the dearth of sunspots and record colds occurring now, and worry about that.

    The NEJM is a disgrace.

    • Steve O'
      September 2, 2019 at 12:19 pm

      You forgot to mention that Life on Earth evolved under much higher CO2 pressures than now. And most life forms managed with an ice-free Arctic.

      • September 2, 2019 at 8:21 pm

        So it did. Concentration of CO2 has reportedly fallen steadily from 2,500 ppmv to about 400 ppmv over 160 million years. This is perilously close to starvation levels.

  7. PW
    September 1, 2019 at 3:15 pm

    I find it funny that certain liberals are buying waterfront island properties ( and not cheap ones either) in the face of predicted catastrophic sea level rise.

  8. Rick
    September 1, 2019 at 12:52 pm

    Did Bridget just call me stupid for knowing that Climate Change is the biggest fraud perpetrated on society since the deathly climate cooling of the 1970s?
    And if it were real she wants the GOVERNMENT to fix it??
    Get the hell off this board, Bridget.
    Don’t you dare refer to we that know it is a hoax as stupid. Don’t you dare.

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    • Bridget Reidy
      September 1, 2019 at 10:50 pm

      No I didn’t. I was referring to people who believe it is happening and make no or trivial efforts to try to stop it. My comment about stupidity and self centeredness was about the average human, which we as physicians are more aware of than most people because we see all comers. (Example: patients who self diagnose and can’t be corrected essentially say “If A can cause B, it must follow that A is the cause of B, or demanding more and more marginally effective or ineffective care for themselves in the last few years of life while the youth go without, or expect a lot of unpaid time and effort from their doctors.) I would never call anyone stupid just because they disagree with me on how data should be interpreted, especially when neither of us are experts.

  9. Bridget Reidy
    September 1, 2019 at 10:51 am

    The climate crisis will one day be so severe that people will laugh sadly at all these attempts to fiddle while Rome burns. If crops fail in a way that affects not just the powerless people will migrate or steal, forcibly if necessary, and that’s called war. War has more “health” consequences than any heat wave or the increased incidence of any disease and is beyond physician expertise. As physicians, the only expertise we have in what really matters is due to our understanding of humanity that comes from serving all: A vast number are self centred and/or stupid, and will change their behaviour only if it is easy. We need rules that change culture as in WW II, or making the fruit in the school cafeteria attractive and easiest to see and reach. So quit the individual and trivial efforts and simply vote. Vote as if preventing extinction or wars due to near extinction is your only issue, or be prepared to tell the next generation why you didn’t. They won’t be forgiving if you tell them you flew less, sorted your trash, or wrote articles and editorials about one small part of the problem.

  10. Thomas David Guastavino
    September 1, 2019 at 8:02 am

    The Climate change debate is like a patient screaming at the doctor that they have a poorly understood illness and the doctor prescribes a very expensive and experimental treatment with nasty side effects and with no idea what the actually outcome will be..
    …..and if the patient is a liberal they would demand that the taxpayer pay for it.

  11. Ben Van Raalte
    September 1, 2019 at 7:32 am

    Climate change is not the basis for the ills in central America. The basis for the ills of Central America is the lack of birth control. The population in Ecuador, Guatemala and the Honduras has tripled in the last 25 plus years. In an agricultural base societies there are not enough jobs and not enough land to support this rapidly growing population. Immigration of these peoples leads to further worsening of any climate change as they now assume the higher energy habits of a more affluent society. No one is going to cut down their lifestyle as evident by the Hollywood types flying their private jets to climate conferences.
    If we want to be serious about climate change we need massive birth control and reduction of the world population not illegal immigration to solve the problem.

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