Post Peak Medicine

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Introduction

PART 1: FRAMEWORK AND BACKGROUND

Three possible futures

Peak what?

Historical perspective

Awareness and denial

Medical literature review

Legal and ethical issues

Financing a practice

Armed conflict

Peak population and dieback

Personal preparation

Further reading

PART 2: SPECIALTIES

Anesthesiology

Dentistry

Dermatology

Emergency medicine

Family medicine

General surgery

Internal medicine

Midwifery

Nursing

Obstetrics and gynecology

Optometry

Orthopedic surgery

Otolaryngology

Pediatrics

Pharmacy

Psychiatry

Psychology

Public health

Radiology

Urology

 

 

 

 

 

 

 

 

 

 

 

Peak population and dieback

"Dieback" or "dieoff" of the human population is one of those taboo subjects which you never hear politicians talk about as there are no votes in it.  But it is important that we discuss it and form some ideas about what it is, what causes it, how likely it is to occur and what we should do about it.

The fundamental underlying concept is that there is a maximum human population which an ecosystem can carry sustainably.  The ecosystem in question can be a local ecosystem, such as Easter Island or the formerly Mayan inhabited region of Central America, both of which experienced profound dieback as a result of environmental degradation.  Alternatively, it can be the entire planet.

At the beginning of the industrial revolution (around 1800) the global human population was around 1 billion, and these people were on the whole living sustainably and using only small amounts of non-renewable resources.  Today, the human population is around 6.7 billion and we are using very large amounts of non-renewable resources, in particular oil, natural gas and fossil water, to produce our food.  A population of 6.7 billion humans may therefore be an unsustainable number, which can only be maintained for a relatively short time until the non-renewable resources are used up.  At that point, a correction must take place and the population must be reduced once again to a sustainable level. 

Let's say, for the sake of argument, that the maximum sustainable number of humans which the planet can support is 2 billion - twice as many as the number alive at the beginning of the fossil fuel age.  In order to make the necessary correction, 4.7 billion people would have to disappear, and this is what is sometimes referred to as "dieback" or "dieoff".  How might this happen?

In earlier, simpler times, a failure of the harvest resulted in dieback by starvation.  There is archaeological evidence of this happening, for example, on Easter Island, and it still happens in Third World countries.  In wealthy industrialised countries with more complex societies, factors other than simple starvation may play a role.  To get some idea what to expect when a modern industrial society collapses, we can look at the example of the collapse of the Soviet Union in the early 1990s and what happened to the population of Russia during this period.

The population of Russia hit a historic peak at 148,689,000 in 1991, just before the breakup of the Soviet Union, but then began a decade-long decline, falling at a rate of about 0.5% per year due to declining birth rates and rising death rates.  The cause of the rising death rates is widely debated.  Very little if any was due to starvation, mainly because the former state-run bakeries continued to function and to distribute bread as they had done pre-collapse.  The death rate peaked at around 17 per 1000 in 2003 and the birth rate bottomed out at around 8 per 1000 in 1999, but subsequently both of these indices moved towards a more normal level of 14 per 1000 per annum as the Russian economy improved.  Alcoholism was a significant contributing factor, although this had been a pre-existing trend in the population prior to collapse.  Rates of heart disease in Russia were higher than the European average both pre and post collapse.  The increase in mortality was from multiple causes. (http://en.wikipedia.org/wiki/Demographics_of_Russia)

A similar increase in all cause mortality has long been observed in people subjected to psychological stress.  A recent study found that after the loss of a spouse, all cause mortality increases by 27% per annum (citation needed).

If psychological stress is a significant contributing factor to all-cause mortality then the high rates of psychological stress apparently being experienced by populations of post-industrial societies are cause for concern.  In 2005 10% of Americans were taking antidepressants and 16% of Americans were taking benzodiazepines.  The levels today are probably higher.  The reasons for these widespread high levels of psychological discomfort are unclear but may be related to societal factors such as fast-paced lifestyles, insecurity of employment and fragmented families and communities.

A shortage of fossil fuels may result in an enforced simplification of life (less commuting to work, more tending vegetable gardens) which in the long term may reduce psychological stress.  However, in the short term many people will experience a profound increase in psychological stress because they are unprepared for the changes being forced upon them.  An increase in all cause mortality may follow.

Diabetes is another factor which may increase mortality in the coming decades.  The current epidemic of type 2 diabetes is largely an unintended consequence of our fossil fuel dependency, as a result of which there have been simultaneous increases in the availability of high fat food and personal transportation, resulting in people eating more, exercising less and becoming obese.  As a rough estimate, if the onset of diabetes occurs some 10-20 years after the onset of obesity, and the onset of complications of diabetes (renal failure, blindness, gangrene of extremities) occurs some 10-20 years after the onset of diabetes, and "peak obesity" is likely to coincide with peak oil, then that puts "peak diabetic complications" about 30 years from now.  Couple that with a possible decreased availability of medical care due to oil shortages and economic recession, and one can reasonably expect that in 30 years from now diabetics may be even more numerous than they are today, and their life expectancy may be shorter.