Peak Oil and Sustainable Medicine, Part 1

Dan Bednarz, PhD, left his position as Associate Director of the Center for Public Health Practice at the University of Pittsburgh in 2005 to devote himself full-time to speaking and writing on the topic of peak oil and how it affects health care. His website is

He is interviewed here by Didi Pershouse, CCH, LAc, founder of the Center for Sustainable Medicine, and author of the Sustainable Medicine Manifesto. Her website is

A complete audio version of this interview can be heard at:

Didi Pershouse: Can you explain a little bit about the concept of “Peak Oil” and what it means?

Dan Bednarz: Peak oil simply means the point at which the maximum amount of oil being extracted from the earth peaks. It peaks, and then there’s a plateau, which is where we have been at for the past four years, and then it declines. It’s called a “Gaussian curve” in statistics. So that’s where we are now, in the world, at that peak point. We have hit the physical limits of growth. Oil just happens to be the first major resource that we are running low on. The larger issue is sustainability. That puts together peak oil, economic conditions, degradation of the environment, the insults we are subjecting onto nature, dying oceans, climate change. These things are all connected and they all have the same solution.

The reason oil prices ran up this time a year ago is that spare capacity was basically used up. Historically there were 4-6 million barrels a day that was spare in case of hurricanes or earthquakes etc. but that capacity got used up. And the world economy was still trying to grow. Because oil was becoming scarce, and the amount of oil coming into the world was not increasing, the price went up. And what happened after the price hit $147 a barrel is the economy started to crash.

Didi Pershouse: Can you explain why, when the economy started to crash the price of oil went down? It’s counter-intuitive in some ways.

Dan Bednarz: It’s called “demand destruction” by economists. Basically the price goes so high, that whatever you were doing with that oil, you can’t afford to do it anymore, so you withdraw from the market.. Purchasing started to tumble because people became very worried about paying off debts and losing their jobs. So the demand for oil fell, and the demand for its products.

Didi Pershouse: So in that sense, the worse the economy is, the more oil we have?

Dan Bednarz: Yes, until the lines cross again, when the amount of oil available starts to decline. That’s something that people in peak oil are really concerned about . The expectation is that this time next year in 2010 we will no longer be able to produce 74-75 million barrels of crude oil a day. It’s going to start dropping.

If we are going to have 50% of the oil in 10-15 years then the world is going to have to look different from what it does now, especially the United States.

Didi Pershouse: Is that the number we are looking at?

Dan Bednarz: Yes. One of the implications in the crash of oil prices is that a lot of the exploration for more oil has been halted. They are basically looking at the bottom of the barrel, and it’s harder to get to, and more expensive to get to it. So those projects have been halted. If the prices had stayed relatively high there might be [more money for more exploration and so] more oil coming in 2010 or 2011, and that would make the decline less steep. Now it looks like the decline is going to be steeper. So then you get into what are governments going to do? Are they going to start wars? Are they going to cooperate? The first question is: will they level with the public that this is what’s going on?

It affects our standard of living, what we can do, what we can build, especially in the United States, because we are a car culture. After doing some reading on it personally, I made the connection between peak oil and health. One of things I try and do in my work is to keep people from saying “My issue is more important.” Or “Peak oil is not an ecological issue.” I try to bring it home saying “how is this going to affect health care?”

Didi Pershouse: In the day-to-day practice of medicine, say in a hospital setting how much of what we see there is oil based or oil dependent?

Dan Bednarz: Basically, everything. If you walk into an emergency room you are going to see plastic or oil derivatives everywhere. The tubing, the catheters, the salves, the pharmaceuticals, the tables they put you on, they are all made from petroleum. People say that’s incidental but as oil becomes scarce, the cost of all of these things increases.

Didi Pershouse: And then what happens?

Dan Bednarz: And then the already unbearable cost of health care continues to accelerate. Also a lot of those products are being shipped thousands of miles to get into this country using fuel oil. So it’s all connected. It’s astounding, the pervasiveness of energy and especially crude oil. In essence modern medicine is entirely dependent upon cheap affordable energy, especially oil.

Basically oil allows for complexity. The more oil you have the more specializations you can have, the greater number of techniques you can perform, the more procedures you can perform. They all require more separate discrete amounts of energy to keep them going. And then other things like transportation. Last year I talked to people in the red cross and trauma, who were driving ambulances. They are all saying the same things. The Red Cross says donations are down because people don’t want to drive, they are asking to be paid fuel allowances. Ambulance drivers, when diesel was $5 a gallon, were on the verge of bankruptcy. And of course ambulance drivers, with trauma, they have to go when people get hurt, they can’t let people queue up. So they have to make unique trips to each place. They were all wondering how they were going to survive.

Didi Pershouse: If we didn’t’ do anything now, how would peak oil affect health care?

Dan Bednarz: I’m glad you asked it that way, because we didn’t do anything, we haven’t done anything, and what is going on right now is that [because of the relationship between oil supplies and the economy] many more people are unemployed. So I’ve been talking to doctors, and reading things and here’s what seems to be going on in health care already because of that.

1: People are postponing elective surgery,

2: People are going in increasing numbers to the emergency room because they don’t have health care, or money for treatment

3: People are purchasing lower and lower coverage kinds of insurance so they are getting minimum treatment because they are concerned about out-of-pocket costs.

But other effects that are appearing are that a lot of medical schools and hospitals are imposing wage freezes and wage cuts, grant monies are drying up. In a year or two another danger here is that the financial crisis we are in will overwhelm the nation and it will either take down or do serious damage to the health-care system. In public health that’s already happening. I know of a number of local health systems that will be closed in two years. They have been cut so much there is literally nothing left to cut. They are saying “We are at the bones, and if any more is taken away there will literally be no one here”

Didi Pershouse: So can you play out the worst case scenario?

Dan Bednarz: The worst case scenario is that the health care system will collapse. That is possible. Collapse doesn’t mean it goes poof and it’s gone, it means the ability of the system to function is greatly reduced, it’s disturbed, interrupted. What happens becomes chaotic, the system might break down for a week or two and then the supplies show up. It’s kind of like all hell breaks loose. But the people running the system are really unaware of these problems. So the biggest problem I see is a lack of preparation and anticipation for what is beginning to happen as well as the massive changes that are imminent.

There is no doubt that the amount of resources– not just oil, but other resources too– flowing into health care is going to start shrinking. But here is mainstream health care with this vociferous appetite to grow and grow and do more and more research for arcane and esoteric technological improvements. A lot of that stuff is going to go away. The med schools are highly dependent on grants from foundations and government funding. As endowments shrink, and the government tax base shrinks, it’s inevitable that health care is going to shrink. A lot of leadership in health care has no idea how to manage for zero growth or retrenchment and contraction. Most of them are planning that next year their budgets are going to start growing again, but what if you tell them “no, your budget is going to reduce by 5 percent a year for ten years until we get this stabilized.” You would have to start talking openly about how to ration, and on what basis. The ethics of scarcity.

But the other part here is the sustainability part. It really is to our benefit not to insult the earth anymore. Medicine creates so much waste, so much toxicity, and of course the focus in medical ethics is almost entirely on the patient. It’s like “Here’s this patient, he needs this treatment, and we don’t care how much it costs or what damage it does to the environment or ecology, the patient must be taken care of.” People are also thinking about profits, and there are large swaths of medicine where doing unnecessary treatment and giving unnecessary care is considered a good thing because it’s raising revenue. That has to be dealt with too.

Didi Pershouse: Talk a little more about sustainability and what you see as the positive aspects of this.

Dan Bednarz: Well, if we get through this—and we will get through this, the question is how much pain and how much damage there will be along the way— ultimately we will have a sustainable society. The question is: will it be an egalitarian society or an elitist society? My hope is that we will move towards an egalitarian society. The federal government may not hold together and we may break up into regions, groups of states that have things in common, like New England. Or we may be even more highly localized. This all used to be highly speculative, but now I think these are real possibilities.

I’m not sure the government really understands whats going on. I’m not much of a conspiratorialist, but I do think stupidity is the norm in bureaucracy, even with smart people. Bureaucracy is fairly stupid. So will they level with the public and say “Look, this is the situation….”? What we have to do is build a safety net so people don’t starve, so people can stay in their houses, and people can be warm in the winter. And give people work that builds a new society, and doesn’t try to perpetuate the one that basically is starting to fall apart on us.

Didi Pershouse: What are you seeing as some of the solutions?

Dan Bednarz: That will call for very radical forms of localization. The first thing you have to do is secure food, so you’d be growing a lot of food locally, transportation systems, railroads, rivers, those kinds of things. Certainly not diesel trucks hauling things, and not flying in food from Chile in January. So it would be focused on a localization effort, building these communities—the ethic of taking care of your neighbor, which I think is there and dormant. But that has to be built up, its lying dormant now.

Didi Pershouse: You think that most people will cooperate rather than look out for themselves?

Dan Bednarz: I do, I really do. It will vary from locale to locale. There may be some Mad-Max types, but I think it’s our human nature to live in groups and cooperate. I’m hopeful that when this all shakes through, this sense of community will develop. It will be a lot harder life, with a lot more physical labor. Most people will be involved in some aspect of agriculture. We have to have food, we have to have shelter, we have to have safety, and then we have to have health care. This goes back to current mainstream medicine. There is a belief among most people in these large hospitals, insurance companies and medical schools that medicine is the most important thing, but it’s not. It is now because people have these other building blocks in place, they are not worrying about where are they going to sleep tonight or whether they are going to have enough heat and food. A good public health system will keep the population alive.

Didi Pershouse: How does population growth play into this?

Dan Bednarz: I’m really glad you asked. I rarely talk about that. It turns so many people off. But the equation has population in it. If we had 500 million people on the earth, everyone could drive a hummer and it probably wouldn’t affect the earth. But we have 6 billion people. From the ecological perspective, if humans don’t plan and reduce the population, mother nature does it, through disease usually. It’s called a “population die-back” or die-off. In the situation we are in now the best response is to lower consumption and lower our standard of living, otherwise people eventually start dying.

Didi Pershouse: Is it possible with 6 billion people that we can have a sustainable lifestyle?

Dan Bednarz: I don’t know. I read all kinds of things. That topic is so sensitive. My feeling is that there are a lot of wishes going into the estimates people are making. It’s a fairly low standard of living, like a shower once a week. Most Americans say “That is crazy, everyone should come up to OUR standard of living, we are not going down there.” But that’s because the ecological perspective is profoundly lacking. It is as lacking now as the notion of washing your hands was to doctors in the middle of the 19th century. You say “oil,” you say “climate change” and people say, “Someone in a white coat is going to solve those things.”
They really don’t understand how ecosystems function. I don’t understand them that well, but thats the educational piece that people really need to learn. One of things we are trying to do in public health is to introduce an ecological paradigm into medicine and public health, so that people working in those fields would be part of sustainability, not working against it.

Didi Pershouse: How have people responded to this when you have spoken in public, how has it affected your work life?

Dan Bednarz: It did help drive me out of the university. My boss came in one day and said “I don’t want you working on this.” You have to understand that public health in academia exists on government money so if there is no funding for a problem, its really is “not” a problem. So I left and went out on my own.

It’s kind of like the innovation S- curve, a paradigm shift. The problem is that the old paradigm really holds on until it goes into extreme crisis. So we’ve gotten some elements of the CDC interested in what we are doing. They funded a conference at John’s Hopkins in March. And we’re going to try for another one coming up in the fall. Most practitioners of mainstream medicine know nothing about this, or if they do it’s just a little blip. To say you have “heard of peak oil” is not to say you understand the socioeconomic implications of it, or the sustainability issues. Health care frankly could be a leader in this, but unfortunately it’s way behind and that gets into the issues of vested interests, and money, and who runs the system. So basically the system has to go into extreme crisis before it’s going to hear this message.

Didi Pershouse: Are there any hospitals working on this?

Dan Bednarz: There are a few, but none that are really taking it as seriously as I think they should, because they can’t. They are trapped in trying to make money. All these sustainability issues get compromised by money. They are not going to do anything to jeopardize the already tight budgets they are on. I’m not saying it’s graft or corruption, it’s just the way they are set up, with the hands that are out there, and the mouths that they are feeding, there is not a lot of room to take sustainability seriously. There is always this idea of: “That’s going to take care of itself, and we are going to put a garden on the roof.” But they don’t see the imminently threatening position the health care system is in right now.

Didi Pershouse: Who is working on it? Where are you seeing change happening or people thinking hard about it?

Dan Bednarz: It’s coming more from public health than from mainstream medicine. I hear from individual doctors periodically who say “Look, I understand what you are saying but I am in this giant bureaucracy. What do I do?” So we start talking and I put them in touch with others. The higher up you go in administration, the less acceptable it is to address this. There are these little pockets of people. Where I think the changes need to come from are foundations, and maybe places like the CDC and a couple of schools of public health and some med schools. Those are the ones who need to start really talking about this, and as the crisis unfolds then they will have a story and a narrative, and when things start breaking down then people are going to listen.

Didi Pershouse: At what point do people actually shift from thinking about themselves to looking at the bigger picture?

Dan Bednarz: Well, I think about this all the time. We do know that you can build a sense of community. That’s probably the most important thing. Most people follow social cues, and they follow what the leadership is telling them, unfortunately. They don’t investigate independently for themselves, and that is both good and bad. But I do think the health care industry in particular is very brittle, and very resistant to change, because there are so many vested interests and so many pockets where people are making a killing on somebody’s health. So it’s going to take a series of crises, and we are in one now, but it could get worse.

With a financial crisis all the countries could come together and decide to write the debt down. But you can’t do that with energy. Oil is there, or it’s not. That is a real limit. And then the consequences of global warming are beginning to be felt, and water. Few people talk about water. You can’t hold a meeting and create more fresh water or fewer people or more crude oil. Those are just limits. So the paradigm has to shift—that we are living in a world of limits and so how are we going to live? And how are we going divide things up?

I try to remain optimistic but those are formidable questions, which really are only beginning to be framed on the margins right now. But at least they are beginning to be framed. Crisis can bring issues to the fore. For example, the Transition Town movement started in England, and now there are 25 towns in the U.S. It’s a movement about making the transition and the core assumption is that life is going to become localized and what you need is a community and through that community you will have meaning, shelter, and a certain amount of health care. But without that community you are on your own.

Sometimes people tell me“gold gold gold” and I say “What are you going to do if you are sitting out there in a cabin with all this gold and you get sick? What are you going to do? You can’t eat gold.”

There have been several articles in the national media recently. It’s good because they are planting this idea that this is really happening. What is happening is not a recession, it’s a transformation, and we are transforming out of the age of oil.

Didi Pershouse: Are there resources you think people should know about?

Dan Bednarz: Well I think your website and blog is a good resource. And we have one, If people want to read about the health-care piece of this, it would be places like yours and mine.

If they want to read more generally about peak oil there’s, The energy bulletin has a good primer on peak oil for those who want some basics. And then there is, which is more technical. If someone really wants to learn these issues and they are more analytical and from an engineering background, the oil drum is a good place to look, especially in the comments. You have a lot of physicists, geologists, doctors, and other smart people writing there and you can get a lot of information.

There is a book called The Ethics of Environmentally Responsible Health Care, by Jessica Peirce and Andrew Jameson. That’s a really good book that came out in 2004 with a lot of references and resources—an excellent place for people to start.

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