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David Povey

(1)

Hi - great article on an important interesting topic. I'd like to defend the barber/surgeons though - the guilds were barbers and surgeons, but specialisation was the common practice. No surgeons would also be barbers - and very few barbers were surgeons. Access to sharp-edged blades was common to both skill-sets though, in a time when sharp edged tools were difficult to procure. Barbers would however, often do tooth pulling. I was recently reading of a Buddhist monk in Perth Australia who always extracts his own teeth - a serene sense of detachment required! Interestingly, a common anaesthetic was drumming and shouting - while some commentators believed it was to drown out the screams of the patient, its use in all circumstances suggests instead there was some other purpose - perhaps distraction for the patient. The drumming was not rhythmic but percussive.

James Simpson

(2)

A well-argued, useful and rare contribution to the solutions we need. As the authors point out, there is little or no debate about the impact of high-tech medicine on the climate and the natural world - it's assumed to be vital and therefore immune from criticism. This has answered many of my own questions about how we can drastically reduce our energy use and our effects on the environment whilst still living healthy and satisfying lives. There are many more to be asked and answered, such as: sanitation systems in the wealthy nations are resource-intensive. Can we learn from how indigenous societies of the past and present deal with their waste products, or is our population density too great? If we reject oil as a resource, what will we construct medical equipment with, as plastics are an essential component?

The same applies to the glib, facile assertions I've read elsewhere claiming that we could all forage for food or return to a hunter-gatherer lifestyle but those societies practised severe forms of population control such as infanticide in order to be sustainable.

Kostas

(3)

Some extra or reiterating points you may want to consider for the problem of modern medicine:

1) It does not look at root causes of disease but at treating symptoms:
https://onlinelibrary.wiley.com/doi/pdf/10.1111/ijcp.12509

This is a reflection of the general dominant social system attitude toward solving problems (e.g. putting people in jail for a 'crime', that need not exist under different social conditions).

2) Although seemingly scientific, modern medicine practitioners do not follow the body of scientific evidence:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3442191/

https://pubmed.ncbi.nlm.nih.gov/24238959/

3) Modern medical "treatment" constitutes the 3rd leading cause of death after cardiovascular disease and cancer:
https://hub.jhu.edu/2016/05/03/medical-errors-third-leading-cause-of-death/

kris de decker

(4)

@ Kostas

Those are very useful references, thanks a lot.

@ James

Sanitation is a good example indeed. Modern sanitation improved health and longevity, but is that also true in the long term? It may be a temporary gain. Our sanitation systems do a lot of damage to the environment.

Our problems are consumption and population. Each can be solved at the expense of the other. If we reduce our consumption, the planet can host more people (or can host people with longer life expectancy). If we reduce the number of people, or their life expectancy, we can afford more consumption. I vote for reducing consumption, which aligns with preventive medicine.

@ David

Great details !

The article focuses mostly on the present, and I only read a few general works on the history of medicine. But I would love to dig deeper in historical medicine for a future article.

Liam Jones

(5)

As always, excellent and illuminating. I'll have to send a while reading up on all those citations.

That said, while I agree with most of this, I find the focus of the final paragraph a little troubling. Given everything else mentioned in the article, is there any reason to suppose there's a significant trade off between life expectancy now and living free of climate disaster in the future?

Going by the first citation, and putting aside the US as an outlier, it seems we can get a "modern" and "developed" healthcare system with a healthcare carbon footprint (compared to national) of around 5%. That suggests that before looking at healthcare, there's 95% of carbon emissions we can hew away before doing anything that impacts health care.

If we compound that with the preventative measures that come with living in a low energy society (more exercise, less processed food, lower levels of environmental toxins, and less stress), and savings that come with safe equipment re-use, the final footprint could be quite a bit smaller than that. That seems to me a low enough figure that renewables could take the burden (and to the degree that it can't, the carbon emissions thereof would be more manageable).

Or, in other words, diminishing returns also apply on the carbon savings end: we can get most of the carbon savings without reducing anyone's lifespan.

Conversations with fellow XR protesters once spurred me to observe that if we have to reduce high-tech consumption, I'd rather give up smartphones, video games and televisions so I can keep MRI machines.

*

That's a rather more verbose criticism than I intended. I've also got a few things you might find interesting:

Chemical sanitation in hospitals does little to stop re-contamination and may select for resistant strains. Using probiotic bacteria may be better than sterilisation:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5609343/
and
https://journals.sagepub.com/doi/abs/10.1177/0040517517741163


Babies born at home have a more diverse, beneficial microbiome:
https://www.sciencedaily.com/releases/2018/10/181031080557.htm


And Szreter's piece on the importance of public health rather than economic growth as driving Britain's mortality decline between 1850 and 1914:
https://academic.oup.com/shm/article-abstract/1/1/1/1663150?redirectedFrom=fulltext

kris de decker

(6)

Hi Liam,

Indeed, we could radically go low-tech in all other sectors of society and keep the health care system as it is.

Still, even then, we would need to talk about limits. Because the problem is not only that energy use is high (5% of a lot is still a lot) but also that energy use keeps growing.

It's not that the evolution of medical technology has come to a end in 2021. In another 20 years time, most of what we see now will be outdated again.

Gaia Baracetti

(7)

Very interesting, thank you, many very good points.

Our society is obsessed with measuring things, with giving a number to everything. While this is often useful, it can also be an impediment to seeing things for what they are. Life expectancy, for example: in the rich world, we KNOW that the last few years of a very long life are mostly very low quality, plagued by disease, limited mobility and independence, pain... but we congratulate ourselves on having achieved such high life expectancy. Now, in Italy, we are watching the grotesque example of vaccinations to triumphant-looking 100-year olds, who will probably die soon anyway, while younger people, who've had less of a chance at life, go unvaccinated and untreated for most things that aren't Covid (and sometimes for Covid too).

I've observed that there are a lot of instances of very old people that are ready to die, that it would be more charitable and respectful (and environmentally friendly...) to accompany to their natural end, but who keep receiving stressful and invasive treatments because the doctors don't want to be sued and the relatives are terrified of mourning.

Let's talk about this. Death is natural. Quantity is not always superior to quality. Even if we lost a couple years on average of extreme old age, but the rest of our life became better (less work to support this system and more free time, less environmental damage, less age-based inequality) for it, I'd take it. And I suspect a lot of people would too.

Susan B Green

(8)

I would like to add another source of unsustainable pollution and waste to the list in this article; the un-monitored waste and pollution in pre-clinical research. Whilst peer-reviewing a paper on the Toyota laboratory animal cage-washing system at the Seattle Childrens Hospital I learnt that there are large volumes of water involved in this procedure which is extensive with hundreds of cages per day going through it. I asked the authors of the paper where the water went and was shocked to learn that it went down the drain and into the local municipal waste facility. There is also the waste produced from the incineration of the 'sacrificed' animals, blood, tissue and the soiled bedding. Not to mention the sterilisation proceedures of the large inventory of laboratory equipment used.

Joseph

(9)

Great article! Thanks for another good one Kris. I had no idea about any of this.

I'd also be very interested in learning about the impact of the buzzier or newer high-tech healthcare, stuff like genome sequencing, telemedicine, remote/robotic surgery, wearables and frequent diagnostics, brain modelling, brain interfaces, etc.

jr23

(10)

ussr the dr who developed radial keratotomy did surgery on assembly line. all in row going from patient to patient same scalpel no gloves or wash between. but never saw data on infection rate

and hospitals did not have a/c so windows open noise restrictions only helped so much. and cases of infections from not properly sterilized endo scopes was found sometimes barely whipped and still doctors caught using needles over and over even with spinal injections. and do we really want to go back to exploratory surgery instead of ct and mri. and even without anesthesiology or pain meds. and reusing requires labor and skilled at that costly. yes we can do better but not by going backwards

Jonathan Fuchs

(11)

I think this Australian Professor raises some interesting points.

15 minute version: https://www.youtube.com/watch?v=jF3d059QBkM
1 hour 7 minute version: https://www.youtube.com/watch?v=IzueFu1cq5U

- Not all surgical procedures performed are necessary.

- Oftentimes surgical procedures are more risk than they are worth. Especially in geriatric patients, the sedation and the wound inflicted by the surgery are a higher risk than any improvement that is to be expected from surgery.

- Most surgical procedures have not been verified in Placebo controlled studies.

- When Placebo controlled studies are performed they often show no improvement over the control group or even show better improvements in the control group.

- To determine which surgical procedures are worth the risk we need more Placebo controlled studies.

A point I want to raise myself: If the initially reported improvement from surgeries comes from the Placebo-Effect and the control group noticed an improvement as well, then we need ways to harness this, for example with cheap mock surgeries.

But the most important takeaway from this is: This seems like a problem. We need to modify the criteria for studies in this field of research, we need to allocate funds to redo faulty studies and to verify existing research and we need to be willing to let our health-care-policy be influenced by these studies.

Darin Wick

(12)

Might also be worth looking into the (former) hospital at Las Gaviotas, Colombia. I believe it operated off-grid, largely thanks to custom-built solar energy systems. I doubt they were doing MRIs, but even a hospital that has all the modern high-tech and high-energy equipment could still use lower-tech systems where appropriate.

A bit about Las Gaviotas: https://en.wikipedia.org/wiki/Gaviotas

I believe there's more info about the hospital in the book "Gaviotas: A Village to Reinvent the World" by Alan Weisman.

My partner says Cuba's medical system could also be a good resource - strong focus on preventative & simple approaches to health.

Lucas

(13)

This was a massively interesting article! It had me thinking about the carbon emissions of a sector I hadn't even thought about before and allowed me to appreciate the full implications of massively reducing emissions. It seemed, if nothing else, massively ahead of it's time though, and I think that wasn't something reflected in the writing. It seems rather silly to be seriously arguing for compromising health care results in order to reduce carbon emissions for a long term advantage, while we are at the same time releasing an unimaginable amount of carbon for no gain in cryptocurrency mining, unnecessarily relying on personal automobiles etc. Perhaps it would have been better framed as 'the next big thing to consider'?

Spice

(14)

This article touches on some concerns I've had about the sustainability of high-tech health care. My own place of concern came regarding the intensive use of petroleum products, but you've shown that it goes beyond that. It's truly concerning, and the lack of numbers even moreso.

When discussing what aspects of health care to keep and which to potentially jettison, I do think it's important to query the people most affected by them. If one is young, it's easy to say that the elderly should be glad to sacrifice their supposedly lower quality lives so young people can live. But will we feel the same way when it's our turn?

Additionally, disabled people have complicated relationships with the medical system. Is it possible to rein in spending on the medical system without hurting disabled people or taking away things that give them freedom? Should they be prioritized over different sorts of spending, then? How can we avoid sliding into eugenicist thinking when decreasing spending on medical care?

Lots of difficult questions that don't have easy answers. But it's important to ask them and think about them. Thanks for covering this.

- Spice

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