Will Peak Oil Result in an Increased Incidence of Scurvy?

Scurvy....... Ar har, me maties. I said scurvy. For most people who are even aware of scurvy, that is the limit of their familiarity, that scurvy was the scourge of sailors in the old days of European sailing ships exploring and colonizing the world. My concern is that it may well become the scourge of Post Peak man as well.

Scurvy, to put it simply is a disease resulting from a deficiency of vitamin C. The scientific name for vitamin C, ascorbic acid, is, in fact, derived from the Latin word for scurvy, scorbutus.[1] Scurvy is an ancient disease. Egyptians recorded the symptoms of scurvy as early as 1550BC.[2]

Symptoms of scurvy include the formation of liver spots on the skin, particularly on the thighs and legs, spongy gums, loose teeth, bleeding gums, bleeding from mucous membranes.[1] It can also manifest itself as soreness and stiffness of the joints and lower extremities, a general state of tiredness and depression, bleeding under the skin and in deep tissues, slow wound healing, and anemia.[2]

Although the symptoms of scurvy have been known for thousands of years, the exact cause of the disease was not finally and definitively established until 1932. The connection between vitamin C and scurvy was, in fact, a key part of Nobel Prize winner Linus Pauling's research and his serious dedication to spreading the vitamin C story. The British Navy focused on citrus fruit in the diet of their sailors, despite the fact the reason for the benefit achieved was not fully understood. It was, in fact, thought that somehow the acid in citrus fruit was itself the source of the benefit. This led to the consumption of other mild acids as substitutes when the fresh fruits ran out on long voyages. It was this practice, it is believed, that first led to the term Limies to describe the English. It is also believed that the German belief in Sauerkraut as a solution, which it was not, led to the derogatory WWII term Krauts.[3]

Basically a vitamin C deficiency results in an impairment in the formation of collagen in the body. Collagen formation is heavily dependent on the unstable FE2 form of iron ion. Vitamin C is one of the few organic substances that contains this form rather than the more stable FE3 form. It is this impairment of collagen formation that is responsible for the majority of physical symptoms associated with scurvy.[4]

Humans are one of the only mammals that do not possess a functional, intact gene for the synthesis of the gulonolactone oxidase (GLO) enzyme that is responsible for the continual synthesis of vitamin C in the body, as most other mammals do.[5] Somehow, during the course of human evolution, that gene, though still present, has been damaged and is no longer functional. The last item in the reference list, "Synthetic Biology: Creating New Life Forms by Rearranging DNA"[5] makes a strong plea, in fact, that this is one legitimate genetic engineering project that should be undertaken, restoring the gene for GLO enzyme synthesis to working order.

What has all of this to do with peak oil? Am I one of those who thinks everything is pertinent to peak oil? I do believe that peak oil will impact much of human life as we know it, but not everything. So, what does this have to do with peak oil?

Scurvy, though rare and definitely treatable (today at least), is not unknown. Scurvy is a growing problem among today's teens in industrialized societies.[2] Scurvy in infants is a common problem, particularly with the decline in breast feeding. Pasteurization destroys the vitamin C in milk so infants fed a diet based on pasteurized milk are at risk of developing a vitamin C deficiency. This is the reason that all infant formulas contain added vitamin C, and why vitamin C is frequently added to pasteurized and homogenized milk.[3] Scurvy is also common among seniors due to progressive changes in diet and an all too common elimination of fresh fruits and vitamin-enhanced products like fruit juices from the diet.[1, 3] But scurvy is also very prevalent among large numbers of malnourished people in the third world.[1] It is common for people to assume that the Inuit, who had no fresh fruits in their diet, would commonly suffer from scurvy. Their penchant for eating their meat and fish raw, however, provided them sufficient vitamin C from the tissues of the fish and animals they ate.[1]

The high incidence of scurvy among 3rd world malnourished people is a significant red flag for the future. The gradual break down of the global food production/ distribution system, the gradual breakdown of the chemical/ pharmaceutical technology and industry that produces vitamin supplements, the increasing food shortages due to loss of agrochemicals and the yield problems arising from globally depleted soil fertility, the high concentration of population in areas unable to produce citrus fruits, the potential problems of over-winter storage of fresh fruits as the energy to drive refrigeration becomes a chronic problem, and many other factors which will be exacerbated by peak oil, suggest that there will be a potentially major increase in the incidence of scurvy on the other side of peak oil. This problem may only persist for a decade or so while we adjust to the very changed demands of food production and distribution, or it may become a chronic societal problem as it was in times past.

It is an area that nutritionists looking forward to the needs of the post-peak era clearly need to concentrate on.

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1. Scurvy - From Wikipedia, the free encyclopedia
2. Scurvy Isn't Cool!
3. Diseases Info - Scurvy
4. e-Medicine - Scurvy
5. Synthetic Biology: Creating New Life Forms by Rearranging DNA

The High Cost of that Last 2% of Certainty

It is odd for me how one personal event can draw into crystal clarity both what is terribly wrong with the current medical systems (specifically here in Canada but, in general, all western nations), and the terrible medical risks before us as we slide down the downslope on the other side of peak oil. It is also odd to me the extreme contrast between how I viewed this event over the past few days and how I would have viewed it even five years ago. But five years ago I still hadn't evolved myself and my view of the world as much as I have now.

A little over a week ago I was developing what I thought were cold or hay fever symptoms; inflamed sinuses, difficulty breathing, dry raspy cough. Been there, done that, may times. By this past weekend, however, it blew way past being annoying and started to develop into a bit of a crisis. That shortness of breath was now into the extreme range. I was severely weakened. I had pains in my chest, which I assumed were from the dry cough. I was having difficulty sleeping at night because of the laboured, shallow breathing.

At 9:00am on Monday morning I walked (under considerable duress) into Emergency at the local hospital. I sat down in Emerg-Triage and, between frantic attempts at taking a breath, explained what was happening and answered all the questions of the Triage nurse. The very fact that Emergency has a Triage function is a sign of one of the things that is seriously with our medical system. They are there to sort out the sore toes and runny noises and overindulgent gassiness (all of those who should have gone to their family doctors or one of the numerous available walk-in clinics) from those small percentage of people who really do need Emergency services.

I was fast-tracked and deep into the bowels of middle earth Emergency by 9:30am. Over the next one and a half hours I was attended or examined by two doctors, three nurses, had been X-rayed, had my blood pressure checked three times, my blood sugar and blood oxygen levels checked twice, and had given up three vials of blood for them to run blood work. All of this was done by 11:00am. It was not until nearly ten hours later, around 9:00pm, after mildly displaying my impatience at the length of the wait, that a new doctor finally deigned to come talk to me about the results of the tests that had been completed ten hours earlier. About 8:00pm the night shift ER nurse had come and given me an injection in my stomach with no explanation as to why.

The doctor, when he arrived, explained that there was either a blood clot or fluid in my right lung and that they were going to have to run several more diagnostic tests the next morning. He told me he wanted to keep me in overnight so we could get right to those tests in the morning. I explained that unless there was a medical reason for me to stay in overnight, like maybe they wanted to keep me under observation, I would prefer to go home. I lived just five minutes away, after all, and was up by five every morning. Unless their diagnostic labs were up and running at 4:00am I would be up and ready long before they were ready for me. He quickly retreated from the suggestion that I stay overnight, said the lab would call me in the morning when they were ready. He prescribed me a water pill (because of the fluid build up in my lower legs) to be started in the morning.

I received two phone calls from two different departments before 8:30am. Over the next several hours I was put through a CT-cardiograph scan, an echo-cardiogram, an ultrasound, a PFT (Pulmonary Function Test) and had three more vials of blood drawn for more analysis, had my blood pressure checked a couple more times, as well as my blood sugar and blood oxygen levels, then had to go back through Emergency Triage and check-in (because I had gone home for the night and was now classed as an outpatient). A close friend of the family who is in hospital services (not at the same hospital) estimates that all of the tests I was put through add up to more than $8,000.

Another ER doctor sat down with me when the results of all of these tests were completed. He explained that they were still not certain what we were dealing with, that he had set me up with the hospital's Urgent Care Clinic for ongoing testing and observation and that they would be contacting me over the next couple of days to come in for a consultation.

Now after two days, several doctors and nurses and technicians and over $8,000 in diagnostic testing, I still knew no more than what the Triage nurse hinted at five minutes after I entered the doors of Emergency, a hint that conformed to the same uninformed self-diagnosis I had made before I even headed for the hospital. And I still very strongly suspect in the end, when they finally do make a diagnosis, it will pretty much conform to my own pre-hospital self-diagnosis made on Monday morning, actually Sunday afternoon.

Here's the rub. We have already spent close to $10,000 trying to close that gap between 98% certainty and an actual diagnosis. The best of a physician's diagnostic skills (assuming they are even taught true diagnostic skills in medical school) seems now to simply serve as a basis for deciding which expensive diagnostic equipment and technicians need to be scheduled to help close that 2% gad to arrive at a diagnosis. When did skilled hands and training of the physician go from being the difference between life and death to being just a part of the input stream to a technological process where machines are the trusted end authority in the diagnosis?

And here's the real rub? As we pass peak oil and the availability of energy begins to get prohibitively expensive, erratic, and increasingly unavailable, and all of that technology becomes an expensive pile of wires and electrodes that can't be run for want of power, where are the doctors that have the diagnostic skills to diagnose a patient's condition without all of those technological inputs? Just as modern day business farmers have lost touch with the soil and no longer know traditional, non-mechanized farming skills, our modern doctors have lost touch with the patient and the traditional, non-mechanized diagnostic skills that has made medicine such an important force in our lives since the Industrial Revolution. Health care has become the greatest single social cost we have and the bill has been growing at a super-exponential rate for the past half-century. Doctors have become slaves to all that technology that is intended to close that last 2% gap and in the process have been losing the skills responsible for that first 98% of the diagnosis.

As the technology begins to go dormant for want of energy there is going to be a dangerous and growing gap in our medical coverage that will, in my opinion, be exacerbated at a rate much more rapid than the rate of decline in energy. Medical dependence is going to prove a very risky condition.

End of rant.

Mud Pies and Dunce Caps

We are experiencing an epidemic rise in childhood diseases. What are the implications for their survival as we slide past peak oil and go into permanent energy decline?

Every parent wants to do the best they possibly can to prepare their children to deal with and overcome the obstacles and struggles they will face in adult life. That is the best they can do. They can't fight their battles for them. They can only ready them to fight their own then set them free to do so. The simple reality at this crucial point in human history, however, is that by preparing our children for the world in which we now live, for the struggles we have had to face in our own lives, we are in no way preparing them for the world in which they will live most of theirs.

It is our children who will bear the brunt of the devestating impact from the world we and the hydrocarbon generations before us have created. They will have to survive the fallout from peak oil, resource depletion, climate change and global warming, aquifer depletion, global pollution, species destruction, top soil loss, critical overpopulation, rampant globalization, the probability of economic and social collapse including a progressive decline in our health care system, the increasing possibility of resource wars using nuclear and biological weapons and more. The evolving world they will be thrust into in their adult lives will be as different from today as our world is, not from that of our parents but rather from that of our great-great-grandparents.

We must not fall into the easy trap of teaching our children or allowing them to be taught to become dependent on our current high-energy, resource-wasting lifestyle which is both unsustainable and will not be available to them possibly for the greater part of their lives. The insidiousness of advertising, among other factors, that targets our children and tries to lure them into that world means the battle to prepare them for a very different world will be doubly difficult. But it must be done. A chip off the old block otherwise will very likely end up as kindling for the fire of societal destruction.

Probably never in the course of human history has there been the possibility of such a tumultuous change in global society from one generation to the next. Another comparable dramatic shift resulted in the cargo cults when primitive, stone-age societies suddenly met the modern world and built crude idols of the flying machines that landed in their forest clearings and disgorged into their midst strangely clad white men with talking boxes and fire sticks. These are, of course, comparisons of opposites. The cargo cultists were suddenly thrust forward toward the modern world. Our children will be just as suddenly disenfranchised from it like Adam and Eve being banished from the Garden of Eden.

So just how do we prepare our children? What if we prepare them for the wrong world? How will they fit in then? No one knows exactly how the future will unfold or when. We never do. Our children spend twelve to twenty years getting an education to help them make their way in the world. There are no guarantees that the education they receive will be suitable to the world as it exists when they graduate and take their first steps into the job market. I have met a lot of college and university graduates driving cabs and standing behind retail counters. There is even less guarantee that it will sustain them through a long life dominated by energy decline and global warming.

Iin a future that will be shaped by oil and energy decline and global warming, the greatest preparation that our children are going to need is good health. And that is an area where we are failing them badly. We are, sadly, experiencing an epidemic rise in childhood diseases over the past several decades despite massive increases in health care expenditures. Most of these conditions will have serious health implications as our children mature and age. It is almost guaranteed that as they progress through their adult lives deeper into the post-peak-oil/energy world the high-tech, high-energy health care system and various levels of social safety net that we take so much for granted will go into serious decline.

This is not restricted to one or two health conditions. Type 2 diabetes, formerly considered adult onset diabetes, is becoming increasingly prevalent among children as young as ten and even younger [(1) (2) (3) (4)]. Childhood obesity, an underlying condition to many other diseases and debilitating health conditions, is still increasing at epidemic rates [(6) (7)]. Childhood asthma has been increasing dramatically now for several decades [(5) (15) (16)]. Autism is reaching the level of a national emergency [(9)]. Pediatric MS (Multiple Sclerosis) has been termed a silent epidemic [(20) (21) (22)]. An icreasing incidence of birth defects has been linked to pesticides, herbicides and industrial chemicals [(11)]. There are arguments that our ubiquitous use of flouride, primarilly in our drinking water, is a contributor to an increasing incidence of Down's Syndrome [(10)]. These are some of the main culprits but by no means all.

Considered together, these represent a dramatic increase in the numbers of those who are going to have an increasing difficulty coping in a world changing dramatically
due to oil and energy decline and global warming. As the global economy falters and perhaps collapses during their lifetimes, the medical system on which they will most certainly continue to be dependent will also falter and may also collapse. In a society increasingly fighting a struggle for survival the desire to support the medically needy will probably be stressed to the limit.

This trend, however, can, in my opinion, be reversed. There are clear underpinnings to these dramatic increases in juvenile health problems. Corrective action can be taken for most of these underlying contributors. One of the primary contributors is the dramatic rise in childhood obesity [(6) (7)]. Much corrective action is already being undertaken but clearly much more needs to be done since this problem is still on the increase. In "The spread of childhood obesity epidemic" [(7)] the core of the concern is spelled out. "A major concern regarding childhood obesity is that obese children tend to become obese adults, facing an increased risk of diabetes, heart disease, orthopedic problems and many other chronic diseases."

Another primary contributor, unfortunately, has very few options that we can pursue as individual parents. That is pollution [(5) (10) (11)]. That does not mean that we should do nothing. Much of the contributing pollution is caused by our use of fossil fuels. That contribution will begin to decline when we reach peak oil and peak energy but clearly there are strong arguments for beginning to scale back our use of fossil fuels now. That burning of fossil fuels is also the primary contributor to human induced global warming so scaling back our use of fossil fuels can help reduce the potential impact of global warming for our children and grandchildren.

Our fixation on women's breasts as sex objects and the attendant reduction of breast feeding is also a serious contributor to this dramatic increase in childhood health problems [(12) (13) (14)]. The confered immunity made possible by colostrum has already been largely lost to several generations. Those generations thus far, however, have had the benefit of antibiotics and a very advanced medical system to keep them healthy. Our children and grandchildren will not be as fortunate.

Perhaps the most serious contributor, however, and potentially the most controversial, is our misguided attitude toward bacteria. We are sterilizing our children to death. We are seriously degrading the development of their immune systems through our attempts to protect them from germs and bacteria [(15) (16) (17) (18) (19) (23) (24)]. The bacteria that children encounter making mudpies in the back yard and rolling around in the dirt and playing on the floor at home are, in fact, major and often primary agents in developing our children's immune systems. When we use antibiotics, whether as medicine or in the form of cleaning agents, we kill far more good, beneficial bacteria than we do bad bacteria. And in striving for that sterile environment and our overuse of antibiotics we weaken the very immune response that antibiotics are intended to strengthen, leaving our children more vulnerable to the impact of pollution, chemical toxins and more.

We can undo much of the damage that we are doing to our children's health that is making them increasingly vulnerable in the face of the serious impact energy decline and global warming are going to have on our society. If we truly want to prepare them as best we can for their future it behooves us to start doing so now. Too many of these health problems will endure and possibly worsen in their adult lives seriously affecting their future survivability.

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References

Type 2 Diabetes in Children and Adolescents
1) http://care.diabetesjournals.org/cgi/reprint/23/3/381.pdf
2) http://www.cdc.gov/diabetes/projects/cda2.htm
3) http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9726592&dopt=Abstract
Type 2 diabetes increasing dramatically among kids
4) http://www.cbc.ca/health/story/2005/05/11/obesity050511.html
Asthma and Air Pollution
5) http://www.arb.ca.gov/research/asthma/asthma.htm
Childhood Obesity
6) http://www.cofbc.ca/
The spread of the childhood obesity epidemic
7) http://www.cmaj.ca/cgi/content/full/163/11/1461
Increasing Incidence of Autism Spectrum Disorders
8) http://www.iidc.indiana.edu/irca/generalinfo/increasing.html
Autism 99: A National Emergency
9) http://www.garynull.com/Documents/autism_99.htm
Fluoridation & Down's Syndrome
10) http://fluoridealert.org/downs-syndrome.htm
Birth Defects Caused by Herbicides, Insecticides, and Industrial Chemicals that Disrupt the Endocrine System
11) http://consumerlawpage.com/article/endocrine.shtml
What is colostrum? How does it benefit my baby?
12) http://www.lalecheleague.org/FAQ/colostrum.html
Substances: Colostrum
13) http://www.asada.gov.au/substances/facts/colostrum.htm
What's colostrum?
14) http://www.babycenter.com/expert/baby/babybreastfeed/8896.html
Mimicking microbial 'education' of the immune system: a strategy to revert the epidemic trend of atopy and allergic asthma?
15) http://respiratory-research.com/content/1/3/129
National Jewish Medical and Research Center Expert Says Bacteria By-Product Found in Household Dust May Protect Infants from Asthma Later in Life
16) http://www.njc.org/news/y2000/news65.aspx
Bacteria: The Good, The Bad, and The Ugly
17) http://www.beyondbooks.com/lif72/2b.asp
Good Bacteria Gone Bad
18) http://www.las.uiuc.edu/alumni/news/fall2005/05fall_bacteria.html
How 'good' bacteria could counter overuse of antibiotics
19) http://www.news.cornell.edu/stories/Aug05/WCMC_probiotics.mh.html
A 50-year follow-up of the incidence of multiple sclerosis in Hordaland County, Norway
20) http://www.neurology.org/cgi/content/abstract/66/2/182
Pediatric (Childhood) MS
21) http://www.nationalmssociety.org/Pediatric_and_Childhood.asp
Childhood MS: A silent epidemic?
22) http://www.usatoday.com/news/health/2002-12-03-ms-usat_x.htm
Beyond Antibiotics
23) http://www.drlwilson.com/Articles/antibiotics.htm
The Antibiotic Alternative
24) http://www.authorsden.com/visit/viewwork.asp?id=4576

Of leeches & midwives?

What will be the implications for medicine and health care following peak oil as we slide down the oil and energy downslope into a low-tech/no-tech world?

The leap forward in health care and medicine in Europe and North America as we moved into the then high-tech world of the industrial revolution and the Victorian era was earth-shaking. Medicine came of age, became a science and a profession and an industry driven by methodical research and development aided by amazing new advances
in chemistry, diagnostic procedures and instrument technology. It was still, by our modern standards, crude and seemingly barbaric in many ways. But those new developments opened the door to the modern high-tech medicine that has become such a vital driver to the improvements in general health we enjoy today.




The impact in the last fifty years that modern medicine has had on saving and extending lives has been little short of miraculous. The incidence of infant deaths in this country has dropped from twenty-six per thousand live births as recently as 1960 to under five today. The average life expectancy has climbed from sixty-eight to over eighty-one years in the same time. Procedures such as bypass surgery and organ transplants have saved countless thousands of lives over the past few decades. New medicines and gene therapies have given us life-extension control of many formerly terminal conditions. In these past fifty years decreased infant deaths, improved medical survival rates and increased life expectancy rates have helped the human population triple to over six and a half billion people. And all of this has been achieved in the developed nations with a piddling 278,000% increase in the cost of providing health care since the end of WWII. That is two-hundred-seventy-eight-thousand percent.

Data released by the Canadian province of British Columbia show that in 1947 the province expended 1.2% of its annual budget on providing health care at a cost of $4.6-million. Fifty- eight years later in 2005 providing health care services was consuming 35% of the province's annual budget for a total outlay of over $12-billion. (http://www2.news.gov.bc.ca/news_releases_2005-2009/2006OTP0140-001167-Attachment3.htm). Even with a tripling of the province's population that is nearly a 1000-fold increase in the cost of health care services per person. Health care budgets have mushroomed by 400-1000% every ten years over this interval.

And yet there seems to be no end in sight, no suggestion of cutting back or slowing down. There are always new diseases to conquer, new disabilities to overcome, new medical conditions to bring under control, new surgical procedures developed around emerging technology, new surgical justifications based on newer and better diagnostic capabilities. A recent medical technology article suggested that if we totally eradicated arthritis, which the article suggested was possible, we could add another 35 years to the average life expectancy. That's a little over four months. But at what cost? And to what benefit?
(http://www.phac-aspc.gc.ca/publicat/ac/ac_5e.html).


The dozen or so most developed countries in North America and Western Europe expend more directly and indirectly each year on health care and medicine than the combined GDP of the fifty poorest nations on the planet. Clearly these expenditures do not benefit all peoples equally, and seemingly never will. While the average life expectancy in these wealthy nations is increasing by about 1 year every five years the life expectancy in the poorest third world nations is steadily declining. The medical technology of which we are so proud and on which we are so dependent has not yet become the medicine of the people. It remains the medicine of the wealthy.

But how much of our general improvements in health are due to these miracles of medicine? It is widely acknowledged and proclaimed that the greatest impact to human health and longevity since the Victorian era has been in the areas of hygiene and nutrition. This would seem to be born out by the wide disparity between rich and poor nations in life expectancy and infant mortality rates. This pattern is also borne out in the wealthy developed nations with the disparities in infant mortality and life expectancy between the poorest and richest in our own society. This, of course, begs the question that if our improved longevity has been so critically dependent on hygiene and nutrition why have health care budgets exploded by over 250,000 percent in the past fifty-eight years with only very marginal improvements (and in many cases declines) in general health?

One of the clear though debatable answers is that our affluent lifestyle is killing us, offsetting some of the gains that would have been made by those grotesque budget increases. Obesity, and especially childhood obesity, and the health risks associated with it has reached epidemic proportions. Health problems associated with chemical toxicity, such as the alarming increase in childhood asthma, childhood diabetes, childhood arthritis, and more, are increasingly a major contributor to our skyrocketing rises in health care costs. The costs continue to rise for treating diseases and medical conditions due to smoking, drugs and alcohol and other substance abuse. And the preponderance of our health care efforts and costs continue to be directed toward cures rather than focusing on or even encouraging prevention and mitigation.

What has all of this to do with peak oil? Simply this. As we pass peak oil and peak energy all of that medical technology will at first get increasingly more expensive and then start to go away, become increasingly unavailable. The health care disparity between rich and poor nations and rich and poor people will begin to narrow until, eventually, there will be no gap at all. Our modern medicine is critically dependent on high technology and that technology is critically and still increasingly dependent on the high consumption of energy from research to application. The energy on which it depends is becoming increasingly expensive and soon will become increasingly unreliable and increasingly unavailable. We saw in New Orleans after Hurricane Katrina hit how useless that technology becomes when the energy supply goes away. We saw how poorly trained and hard pressed the medical practitioners were to adapt to the reality of having to practice medicine without the support of that energy hungry technology. If we look at the state of health care in poor third world nations today, and if we remember the realities of New Orleans in the wake of Katrina, we get a glimpse of the level of health care we will over time be sliding toward on the energy downslope. When the grid goes away emergency generators kick in. When the emergency generators go away reality kicks in.


The impact on medicine of the approaching decline in oil, other fossil fuels and other sources of energy goes far beyond the visible and obvious things like MRI machines, CAT scans, X-ray equipment and laser surgery equipment. It will affect the cost and availability of energy to separate air into its component parts like medical grade oxygen, the availability and production of the plastics and the high purity metals from which medical implements are manufactured, the equipment for screening blood supplies, the ubiquitous electronic equipment that monitors patients' vital signs, the air ambulances that shorten that critical time to get seriously injured and ill patients to treatment facilities, the high tech ambulances that are never more than a few minutes away, the home treatment and support equipment that allows patients to get the treatment they need in the home environment, the anaesthetics, the antibiotics and sterilization products that are so critical to disease management in hospitals, the EKGs and other equipment in your family doctor's office. All of these things and so much more are critically dependent on that steady, reliable flow of energy that we have come to take so much for granted in our modern world.

The impact on all of these things won't have the immediacy of flipping off a switch. We won't suddenly wake up one day and find ourselves in the hands of witch-doctors treating our medical problems with leeches, potions and incantations. We won't suddenly have to call on a midwife when the baby is due, though an increasing number of women are choosing that approach today. Society will, for some time, continue to try to absorb the escalating costs of health and medical care. In peak oil discussions, however, it has long been suggested that among the first casualties
on the other side of peak oil will be those who are medically dependent, those dependent on medical technology and on high-tech medications. When escalating cost is replaced with increasing scarcity, however, when dependability gives way to an increasing decline in reliability and availability, the impact will begin to be felt across the totality of our society. At some point even the rich will no longer be able to get the best health care because money will not be able to get what is no longer available at any price.

We are beginning to see the leading edge of these problems even today. It is getting beyond just the horrendous escalation in cost. Wait times are increasing for surgery, much of it critical, and even for getting an appointment to see the family doctor. An increasing number of smaller communities no longer have resident
doctors, patients having to travel ever-increasing distances to doctors in other communities, many relying on the services of circuit doctors who visit their community at ever-widening intervals as these doctors must serve an ever-growing number of communities. Medical and surgical electives are no longer as readily offered or approved as they were even ten years ago. Doctors and nurses are increasingly having to work longer hours, see and deal with more patients, and more and more mistakes are happening as a result. The cost of medical malpractice insurance is skyrocketing beyond the reach of many doctors. The shortage of doctors continues to grow as older doctors retire and fewer and fewer young people choose to pursue medical careers in the face of the workloads and the cost of malpractice insurance and lawsuits. This is all indicative of a situation that will deteriorate ever more rapidly over the coming decades.


Consistently in election after election when polls are taken health care is at or near the top of people's lists of concerns. We no longer view good health as an aberration but rather as a right. If we are to continue to enjoy good health into and beyond the energy decline we are going to have to refocus on those areas of prevention that were so key to health improvements in the Victorian era, hygiene and nutrition. An ounce of prevention, says the old saying, is worth a pound of cure. When that pound of cure is no longer available that ounce of prevention may be the only road to good health still open to us.