The Corpus Callosum

Peak Petroleum and Public Health
Howard Frumkin, MD, DrPH; Jeremy Hess, MD, MPH; Stephen Vindigni, MPH
JAMA. 2007;298:1688-1690.

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 that 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 be time-consuming.  

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 will be 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 inside.

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 scenarios.  

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 security.  

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.