Posted to TheOIlDrum.com by Gail the Actuary on May 10, 2008 - 10:00am
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=92s 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.
Overview
A few numbers to set the context:
=95 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-=96with 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"-=96the point at which yearly
total worldwide extraction cannot be increased--this 3 year plateau
indicates that the era of cheap energy is over.
=95 Oil is now over $100.00 a barrel. It was $10.00 a barrel in November
1998.
=95 Oil powers 90% of all transportation and it is essential to food
production and distribution; it is the primary ingredient in many
products-=96think 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.
=95 And it=92s not just oil that=92s 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.
=95 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-=96the
secondary source of electricity generation--simultaneously will be at
or past its peak, poses a threat to our supply of electricity.
=95 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-=96no 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-=96in 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."
=95 The total amount of energy the world gets from fossil fuels is
predicted to peak in 2010, so we=92ve 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=92ll 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-=96
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-=96and 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=92d like to be
confrontational and assert, fossil fuel costs will continue to rise
and eventually the healthcare system will be forced to downsize-=96just
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-=96unlike, say, public relations--
is where the rubber meets the road. So let me make a few closing
comments and then take your questions.
Summary
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-=96I 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-=96or,
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.
Following are 88 comments on Rising Energy Costs and the Future of
Hospital Work
[-] darwinsdog on May 10, 2008 - 12:08pm | Permalink | Subthread |
Comments top
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.
-] Reed on May 10, 2008 - 12:54pm | Permalink | Subthread | Comments
top
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.
[-] BrianT on May 10, 2008 - 1:29pm | Permalink | Subthread | Comments
top
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.
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[-] Gail the Actuary on May 10, 2008 - 2:23pm | Permalink | Subthread
| Comments top
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.
[-] Leanan on May 10, 2008 - 1:11pm | Permalink | Subthread | Comments
top
We'll need them for all the war casualties. So we can patch 'em up and
send them back into battle.
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[-] Reed on May 10, 2008 - 1:30pm | Permalink | Subthread | Comments
top
Damn, Why didn't I think of that!
[-] darwinsdog on May 10, 2008 - 3:59pm | Permalink | Subthread |
Comments top
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.
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[-] MadMaster on May 10, 2008 - 12:18pm | Permalink | Subthread |
Comments top
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-=96the
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??
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[-] Gail the Actuary on May 10, 2008 - 1:56pm | Permalink | Subthread
| Comments top
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.
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[-] BrianT on May 10, 2008 - 2:16pm | Permalink | Subthread | Comments
top
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.
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[-] cjwirth on May 10, 2008 - 12:26pm | Permalink | Subthread |
Comments top
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.
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[-] Gail the Actuary on May 10, 2008 - 1:26pm | Permalink | Subthread
| Comments top
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.
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[-] cjwirth on May 10, 2008 - 4:00pm | Permalink | Subthread |
Comments top
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.
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[-] pinealone on May 10, 2008 - 4:10pm | Permalink | Subthread |
Comments top
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.
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[-] cjwirth on May 10, 2008 - 4:39pm | Permalink | Subthread |
Comments top
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.
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[-] greenish on May 10, 2008 - 4:45pm | Permalink | Subthread |
Comments top
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.
ymmv
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[-] darwinsdog on May 10, 2008 - 4:18pm | Permalink | Subthread |
Comments top
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.
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[-] phineas gage on May 10, 2008 - 4:52pm | Permalink | Subthread |
Comments top
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).
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[-] darwinsdog on May 10, 2008 - 5:11pm | Permalink | Subthread |
Comments top
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.
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[-] Gail the Actuary on May 10, 2008 - 5:15pm | Permalink | Subthread
| Comments top
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.
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[-] CSS on May 10, 2008 - 12:27pm | Permalink | Subthread | Comments
top
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.
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[-] Gail the Actuary on May 10, 2008 - 2:29pm | Permalink | Subthread
| Comments top
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.
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[-] crouse on May 10, 2008 - 12:43pm | Permalink | Subthread |
Comments top
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.
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[-] pinealone on May 10, 2008 - 2:10pm | Permalink | Subthread |
Comments top
Crouse,
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.
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[-] Gail the Actuary on May 10, 2008 - 2:43pm | Permalink | Subthread
| Comments top
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.
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[-] pinealone on May 10, 2008 - 3:43pm | Permalink | Subthread |
Comments top
Gail,
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.
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[-] phineas gage on May 10, 2008 - 4:38pm | Permalink | Subthread |
Comments top
"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
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[-] darwinsdog on May 10, 2008 - 5:05pm | Permalink | Subthread |
Comments top
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.
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[-] phineas gage on May 10, 2008 - 5:55pm | Permalink | Subthread |
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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
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[-] darwinsdog on May 10, 2008 - 6:06pm | Permalink | Subthread |
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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.
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[-] greenish on May 10, 2008 - 4:52pm | Permalink | Subthread |
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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.
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[-] darwinsdog on May 10, 2008 - 5:19pm | Permalink | Subthread |
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...her... doctor..., like so many others, ... is departing for the
mainland...
LoL Can you say "Rapa Nui"?
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[-] Gail the Actuary on May 10, 2008 - 5:23pm | Permalink | Subthread
| Comments top
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.
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[-] Peak_a_Boo on May 10, 2008 - 12:46pm | Permalink | Subthread |
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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.
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[-] Gail the Actuary on May 10, 2008 - 2:12pm | Permalink | Subthread
| Comments top
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.
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[-] Peak_a_Boo on May 10, 2008 - 2:27pm | Permalink | Subthread |
Comments top
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.
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[-] CSS on May 10, 2008 - 2:38pm | Permalink | Subthread | Comments
top
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.
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[-] Peak_a_Boo on May 10, 2008 - 2:51pm | Permalink | Subthread |
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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./
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[-] CSS on May 10, 2008 - 2:31pm | Permalink | Subthread | Comments
top
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!
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[-] WNC Observer on May 10, 2008 - 4:01pm | Permalink | Subthread |
Comments top
Might be a good idea to get one of those hand crank powered
flashlights and carry it in a pocket.
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[-] phineas gage on May 10, 2008 - 4:44pm | Permalink | Subthread |
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Peak-a-Boo,
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).
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[-] Peak_a_Boo on May 10, 2008 - 5:17pm | Permalink | Subthread |
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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.
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[-] cjwirth on May 10, 2008 - 4:50pm | Permalink | Subthread |
Comments top
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.
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[-] phineas gage on May 10, 2008 - 5:02pm | Permalink | Subthread |
Comments top
"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.
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[-] phineas gage on May 10, 2008 - 5:04pm | Permalink | Subthread |
Comments top
"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.
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[-] phineas gage on May 10, 2008 - 5:05pm | Permalink | Subthread |
Comments top
"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.
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[-] Wharf Rat on May 10, 2008 - 5:31pm | Permalink | Subthread |
Comments top
"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.
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[-] fordprefect on May 10, 2008 - 12:55pm | Permalink | Subthread |
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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?
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[-] shastatodd on May 10, 2008 - 1:22pm | Permalink | Subthread |
Comments top
"HOW does sociallism assist in mitigating peak oil?"
A "we society" is less energy and resource intensive than a "me
society".
Todd
P.S. "sociallism" is spelled socialism
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[-] robert wilson on May 10, 2008 - 1:39pm | Permalink | Subthread |
Comments top
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.
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[-] fordprefect on May 10, 2008 - 2:45pm | Permalink | Subthread |
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Wow is that ever just a total lie.
http://www.nationmaster.com/graph/ene_oil_con_percap-energy-oil-consumpt...
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.
http://www.nationmaster.com/graph/env_co2_emi_percap-environment-co2-emi...
http://www.nationmaster.com/graph/geo_pop_den-geography-population-densi...
http://www.nationmaster.com/graph/eco_gdp_percap-economy-gdp-per-capita
http://www.nationmaster.com/graph/ene_nuc_rea_ope_percap-nuclear-reactor...
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.
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[-] Gail the Actuary on May 10, 2008 - 5:28pm | Permalink | Subthread
| Comments top
Cold areas use a lot of fossil fuels for heating.
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[-] BrianT on May 10, 2008 - 1:34pm | Permalink | Subthread | Comments
top
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.
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[-] fordprefect on May 10, 2008 - 2:07pm | Permalink | Subthread |
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The trillion dollar war in iraq is open to debate. It is not the open
and shut case you would try to make it.
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[-] BrianT on May 10, 2008 - 2:21pm | Permalink | Subthread | Comments
top
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).
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[-] fordprefect on May 10, 2008 - 2:41pm | Permalink | Subthread |
Comments top
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.
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[-] BrianT on May 10, 2008 - 2:57pm | Permalink | Subthread | Comments
top
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.
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[-] fordprefect on May 10, 2008 - 3:18pm | Permalink | Subthread |
Comments top
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.
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[-] BrianT on May 10, 2008 - 3:37pm | Permalink | Subthread | Comments
top
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.
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[-] fordprefect on May 10, 2008 - 4:36pm | Permalink | Subthread |
Comments top
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=3D
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.
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[-] artaxt on May 10, 2008 - 3:33pm | Permalink | Subthread | Comments
top
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.
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[-] fordprefect on May 10, 2008 - 4:54pm | Permalink | Subthread |
Comments top
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.
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[-] danb on May 10, 2008 - 1:40pm | Permalink | Subthread | Comments
top
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.
Dan
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[-] Gail the Actuary on May 10, 2008 - 2:19pm | Permalink | Subthread
| Comments top
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.
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[-] Magnus Redin on May 10, 2008 - 1:55pm | Permalink | Subthread |
Comments top
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.
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[-] darwinsdog on May 10, 2008 - 2:33pm | Permalink | Subthread |
Comments top
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.
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[-] Magnus Redin on May 10, 2008 - 3:11pm | Permalink | Subthread |
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=2E..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.
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[-] darwinsdog on May 10, 2008 - 3:43pm | Permalink | Subthread |
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...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?
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[-] BrianT on May 10, 2008 - 2:25pm | Permalink | Subthread | Comments
top
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.
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[-] danb on May 10, 2008 - 2:47pm | Permalink | Subthread | Comments
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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.
Dan
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[-] robert wilson on May 10, 2008 - 3:05pm | Permalink | Subthread |
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Very basic medical care
http://www.ddponline.org/medkit.htm
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[-] damac on May 10, 2008 - 3:27pm | Permalink | Subthread | Comments
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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.
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[-] HereinHalifax on May 10, 2008 - 4:29pm | Permalink | Subthread |
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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?). ;-)
Cheers,
Paul
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[-] Peak_a_Boo on May 10, 2008 - 4:20pm | Permalink | Subthread |
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thanks for the link!
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[-] joule on May 10, 2008 - 3:06pm | Permalink | Subthread | Comments
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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.
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[-] Peak_a_Boo on May 10, 2008 - 4:14pm | Permalink | Subthread |
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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.
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[-] Gail the Actuary on May 10, 2008 - 5:44pm | Permalink | Subthread
| Comments top
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.
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[-] dzlsabe on May 10, 2008 - 4:10pm | Permalink | Subthread |
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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.
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[-] rube cretin on May 10, 2008 - 4:12pm | Permalink | Subthread |
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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."
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[-] darwinsdog on May 10, 2008 - 4:47pm | Permalink | Subthread |
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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.
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[-] HappySurfer on May 10, 2008 - 4:38pm | Permalink | Subthread |
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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=92t 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
Happysurfer
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[-] danb on May 10, 2008 - 5:28pm | Permalink | Subthread | Comments
top
Happysurfer,
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.
Dan
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[-] darwinsdog on May 10, 2008 - 5:51pm | Permalink | Subthread |
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...an excellent bio-ethicist...
ROFLMAO !!!
As if biology was even ABOUT ethics... :))
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[-] Peak_a_Boo on May 10, 2008 - 5:55pm | Permalink | Subthread |
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I had never heard the term either...but...reading about it now:
http://www.bioethics.uwo.ca/what_is_a_bioethicist.htm
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[-] Peak_a_Boo on May 10, 2008 - 6:01pm | Permalink | Subthread |
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and ... here is an article demonstrating an example of a bioethical
issue:
http://www.worldnetdaily.com/news/article.asp?ARTICLE_ID=3D51963
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[-] HappySurfer on May 10, 2008 - 6:08pm | Permalink | Subthread |
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Dan
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
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[-] OMGlikeWTF on May 10, 2008 - 6:32pm | Permalink | Subthread |
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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
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[-] JonFreise on May 10, 2008 - 6:48pm | Permalink | Subthread |
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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.
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