The Journal of the American Medical Association
has a sort-of-surprising article on the subject of peak oil.
Oil” is a catchphrase that denotes the phenomenon of
declining oil production that is anticipated to occur in a matter of
some years. The “some” part of that is hotly debated.
There are well-informed people who think we already are
there; others project a peak around 2030.
The point of the article is that health care delivery will be
profoundly impacted by any decline in the supply of oil. This
presents a number of challenges, which the authors discuss.
Petroleum and Public Health
Howard Frumkin, MD, DrPH; Jeremy Hess, MD, MPH; Stephen Vindigni, MPH
Petroleum is a unique energy source; it is
energy-dense, relatively stable, portable, and abundant. Since
large-scale production began about 150 years ago, petroleum has become
central to modern life. It is the precursor of nearly all
transportation fuel, the source of heating oil, propane, and other
fuels, and the starting point for chemical-building blocks such as
ethylene, propylene, and xylene, which become polymers, resins, and
other compounds, which in turn form products as diverse as plastics,
solvents, textiles, lubricants, pesticides, and medications.
Petroleum is also a finite resource. Because it formed over millions of
years and is being used faster than it is being formed, petroleum is
nonrenewable on any human time scale; supply will at some point fall
short of demand. The point at which petroleum production reaches its
maximum is known as peak petroleum. Thereafter, perhaps following a
plateau of a year or more, production inevitably declines…
…A global Hubbert peak is inevitable, but its timing has been the
subject of debate. Hubbert predicted the peak would occur between 1996
and 2006.1 Most current estimates place the peak before 2030 (many
before 2010), and some authorities believe that it is occurring now.2
The varied estimates reflect scientific uncertainty in measuring
petroleum reserves, lack of standard protocols for reporting, and
incentives for governments and private firms not to report their
reserves accurately.3-4 Advances in petroleum extraction technologies,
such as high-pressure steam extraction, and techniques that allow
production from unconventional sources such as tar sands and oil shale,
have increased recoverable reserves, modestly delaying the peak.
Nevertheless, the peak is not far off…
…Petroleum scarcity will affect the health system in at least 4 ways:
through effects on medical supplies and equipment, transportation,
energy generation, and food production…
Regarding medical supplies and equipment, they anticipate
declining oil supplies will lead to a modest increase in the price of
pharmaceuticals. However, that is not the real problem.
The problem stems from the fact that it will be necessary to
develop alternative synthetic pathways for many drugs. By
itself, that is not the challenge. We have chemists who can
do that. The problem is that each pathway for the synthesis
of a drug must be approved by the FDA. The authors alertly
anticipate that such approval will not only be expensive, but it will
I suppose the bright side of this, is that the job market for
pharmaceutical chemists ought to be pretty good in the next few decades.
In contrast to the issues with pharmaceuticals, the issues with medical
supplies could be worse. The problems with pharmaceuticals
are tractable. The authors do not think the price increases
dramatic, because the cost of the raw material is only a small part of
the cost of a drug on the shelf. However, things such as
syringes, IV tubing, and the like, have a different cost structure.
For such supplies, the cost of the raw material is a large
part of the cost of the finished product.
Sure, we can make plastic from corn; polylactic
acid is an example. As with pharmaceuticals, the
various steps in the production will have to be reworked.
That can be done, but there is no getting around the cost
problem. Shortages of medical supplies could occur, and that
is something that modern US doctors are not accustomed to dealing with.
Physicians in underdeveloped nations deal with these problems
as a matter of course; those in the US and other developed nations may
have to develop an entirely new skill set.
The authors point out that such shortages occurred as a result of the
1973 OPEC oil embargo. Thus, it is plausible to assume that
such things could happen again.
Moving to the second topic, transportation, the authors point out some
obvious changes, and some less obvious. Transport such as
helicopters, or organ procurement flights, may become prohibitively
expensive. Furthermore, public health activities such as
restaurant inspections, visiting nurses, etc., may become less
feasible. This is important, because public health activities
often give us the biggest positive impact for the smallest cost.
Anything that interferes with them could be expected to have
a serious negative impact on the effectiveness of our health system.
The third topic, energy generation and heating, is just as grim.
Hospitals utilize a huge amount of energy. They
operate 24 hours a day. (Sometimes it seems much longer than
that, even.) Proper heating and cooling are essential to the
productivity of hospital staff, and to the health of the patients
Their fourth category is: food production. Food, obviously,
is critically important to health. Moreover, the best way to
promote health is to have people eat fresh, high-quality, well-prepared
food. All of those aspects of food and food production will
become more challenging. The authors point out that this “may
threaten the health of poor people and others with insecure access to
food.” I would be more pessimistic. It is not just
poor people who will be affected. Everyone will be affected.
Regarding the topic of preparedness, the authors do have some
suggestions. They point out that forecasting and modeling
will be important. These activities can be divided into
planning for acute shortages, and planning for chronic shortages.
Adaptive planning thus would take place for the four
categories of problems that they defined, in both acute and chronic
The authors state: “Extensive health research related to peak petroleum
is needed.” Yes, pretty much every medical journal article
ends with a call for more research. But this one is more
serious than most, in that the public health implications are universal.
One of the perverse things about our current public policy is that we
tend to focus on the “One
Percent Doctrine:” Catastrophic outcomes with a low
probability are treated as though they are certain to happen.
But what about catastrophic outcomes that really are certain
to happen? Peak oil will happen, it will happen soon, and it
will have dramatic effects on our health care system. People
will die because of it. It is a threat to our national
But as Kevin
Drum points out, the One Percent Doctrine is not merely a
justification for a cowboy mentality to war: “the One Percent Doctrine
is actually a justification for ignoring unwanted analysis.”
More than a broad rationalization of mere
hawkishness, the One Percent Doctrine is actually a justification for
ignoring unwanted analysis. After all, nearly anything has a one
percent chance of happening, and if that’s the threshold for action, it
means we can take action anytime we want. Under the OPD, there is
literally no reason to waste time with analysis or policy discussions.
Well, I’m afraid we do have to spend time of serious analysis, as
distasteful as it may be. If you define national security as
the set of policies and actions that safeguard life, health, property,
and prosperity, then you have to acknowledge that public health is a
large part of national security. Where should we put our
resources? How to we apportion resources between the low
probability/high-impact scenarios, and the high-probability ones?
My advice: change zoning regulations to allow residential raising of
chickens. And eat a lot of peaches. When a
conservative, mainstream publication such as JAMA sounds an alarm, that
means we better take it seriously.
By the way, I am not joking about the chickens and the peaches.