Caryl Johnston, M.Ed., M.L.S., Center for Research in Medical Education and Health Care, Jefferson Medical College

The electrical blackout of August, 2003, that left 50 million people without power in the states of Michigan, Ohio, Pennsylvania, New York, Vermont, Connecticut, Massachusetts and New Jersey, ought to have been a wake-up call for all Americans regarding the energy basis of industrial civilization. It was the largest blackout in U.S. history, with costs estimated at 6 billion dollars. Anecdotal reports from problems reported in New York hospitals included the following: significant trouble with back-up generators in three hospitals, numerous donor organs lost, many operations terminated or completed under flashlights, air conditioning suspended in order to reduce the load on backups, and emergency evacuations of patients.

The progress of medical knowledge and practice in the modern era has depended on the steady rise in fossil-fuel usage.[1] At the beginning of the 20^th century, oil made up less than 4% of world energy usage. By the 1970’s 2,500 million tons of oil were being consumed annually – a 200-fold increase in 70 years.[2] Yet medical educators have yet to make themselves and their students aware of how much medical practice and supplies depend upon the energy released in hydrocarbon fuels, specifically oil and natural gas. (Table 1: Petrochemicals in Medicine) If higher energy costs and even energy scarcity are to be in our future – and I will detail some of the researches of petroleum geologists later in this paper, researches which strongly suggest that they will --- an "energy literacy" component in the medical school curriculum may become necessary.

Following the oil shortages of 1973-74 and 1979, there was a brief moment in the United States in which attention was devoted to energy issues in the medical field. Not surprisingly, many of those who contributed to the medical and scientific journals on energy issues were Texans. One author wrote in 1973 that, "The medical profession must eventually be forced to consider whether in an age of fuel scarcity it will be possible to maintain at their present level hospital procedures consuming large quantities of energy." [3] But it is not only hospital procedures that are of concern. Petroleum is the key ingredient in the wide variety of plastic medical supplies used in medical and surgical life-support systems, such as airways, anesthesia, bags, catheters, dishes, drains, gloves, heart valves, needles, syringes, tubes, etc. Petroleum impacts on medical care at every level. As Burt Kline, a former director of the Division of Energy Policy of the Health Resources Administration put it back in 1981 --- "Advanced technology is worthless without the energy to run it." [4]

Remarkably, the estimates of the world’s ultimately recoverable oil endowment have changed little in fifty years. The figure quoted by John Loraine in 1973 – roughly 2000 billion barrels, or 2 trillion barrels, is the figure most often cited by oil geologists today.[5]

Industry and government figures for total petroleum reserves have not always proved to be reliable, since such figures are sometimes inflated for political reasons or to increase export quotas.[6] For instance, historical figures about the rates of consumption and extraction of resources published by the U.S. Department of Energy and the U.S. Geological Survey are generally accurate, but future projections published by these government agencies can be clouded by political considerations or even what can only be called wishful thinking. The track record of these agencies in reporting bad news has not always been stellar. In 1975 an irate Congress demanded an investigation because of the USGS failure to report that oil production in the United States had peaked.

As for industry, it is in the business to make money, not to educate the public about the facts of oil depletion. Shell Oil’s recent announcement that it had downgraded its reserves by 20% caused considerable shockwaves in the financial world. [7]

In their groundbreaking article, "The End of Cheap Oil, "Colin J. Campbell and Jean H. Laherrère write that the oil crunch of the future will not be like the shortages of the 1970’s, which were caused by price spikes of the Arab oil embargo. [8] They stress that geological constraints, rather than political events, will cause the shortages of the future. This is because production can only follow discovery, and about 80% of the oil being produced today comes from wells that were discovered before 1973. Also closely monitored by oil geologists are the declining production rates of older, larger basins and to what extent reliable oil production may be expected from newer and usually smaller deposits. Figures for declining production rates are dramatically illustrated in the historic comparison of average number of barrels of oil recovered per foot of drilling. In the 1930’s, oil was abundant, and just gushed out of American wells on average at 250 barrels per foot. By 1981, the work to recover harder-to-get oil had increased enormously and on average only 6.9 barrels were recovered per foot of drilling. [9]

The total daily world consumption of oil currently stands at about 77 million barrels. Americans consume about 19.7 million barrels of oil per day. Of this amount, about 13 million barrels per day are consumed in the transportation sector alone. Considering the many indispensable uses for petroleum in the medical field, there is a real need for medical personnel and educators to become aware of how oil resources are to be allocated, and possibly even to become active on behalf of more responsible stewardship. For even back in 1976, Dr. David Glenn mildly offered the suggestion that he hoped that "future government decisions will preserve a portion of our available oil and gas for their somewhat hidden, but essential raw material role as raw petrochemical products for medical use." [10]

Energy scarcity presents all of us with major challenges, but perhaps no sector of society will be more challenged than the medical field. Declining fossil-fuel resources present medical educators with a rare opportunity to take hold of the stewardship issue. Future generations will blame us for allowing so much of a valuable resource to be squandered in personal transportation. There are alternatives to cars; it is harder to find alternative for many other uses of petroleum.

There have been false alarms before concerning resource depletion. The story of oil in the 20^th century has been accompanied at times by a version of the story of the boy who cried wolf. Yet wasn’t the point of that story that, finally, the wolf did come? With escalating levels of consumption, and given the fact that the world consumes four barrels of oil for every barrel that is discovered, we now foresee a time in which supply will not be able to keep up with demand. Walter Youngquist bluntly states that "Reaching and passing the peak of world oil production will be the most important happening in human history to date, affecting more people in more ways than any other event. It will happen, and during the lives of most people now living." [11]

The reports from oil geologists like Campbell, Laherrère, Korpela, Youngquist, et al, follow upon the work of M. King Hubbert, a remarkable American geophysicist who in 1956 correctly predicted that American oil production would peak in 1970. Hubbert used a number of different methods in order to make this prediction. One of them was a technique adapted from population growth studies. Once the rate of increase in known reserves begins to decline, it is possible to extrapolate the declining rate to find the point where growth will cease altogether. As David Goodstein explains, "…we pump oil out of the ground at about the same rate that we discover it, but a few decades later. Thus the rate of discovery predicts the rate of extraction." [12]

Hubbert’s insight, that the discovery and extraction of the petroleum resource over time would follow a symmetric bell-shaped curve, and that the production would begin to decline when half the resource had been used up, has been known ever since as "Hubbert’s peak."

One of the most important conversations going on in the world today is predicting the date of the peak of world oil production. Very little of this vital conversation has penetrated the American media, nor are most Americans aware of the gravity of our national situation with respect to energy – although this is beginning to change. While there is some optimism among oil producers concerning deep water and other "unconventional" sources of oil, no one pretends that obtaining oil from such sources will be cheap. Nor does anyone deny that there will still be oil in the ground in 100 years. But the issue is the question of when, and to what degree, the quantities of oil that the world is in the habit of consuming will no longer be available. "The world is not about to run out of hydrocarbons, and perhaps it is not going to run out of oil from unconventional sources any time soon. What will be difficult to obtain is cheap petroleum, because what is left is an enormous amount of low-grade hydrocarbons, which are likely to be much more expensive financially, energetically, politically and especially environmentally." [13]

Embracing the notion of stewardship of the petroleum resource could represent a decisive turn for modern medicine. The cheap energy furnished by fossil fuels enabled great strides to be made in medical practice. But increasing scarcity and expense of fossil fuels will present medicine with great challenges, especially at its high-tech end. But petroleum-based products are used all throughout the medical sector. For this reason the medical sector needs to become alert to the energy issue now unfolding. First it would send a strong message to our political leaders, who seem unable to articulate realistic truths about energy. And secondly, the stature of the modern medical profession would be enhanced through a demonstrated concern not just for human life for all of life – for better stewardship and conservation of resources would help ease the strain on many biological systems. It would help to put medicine back in touch with its own natural sources and underscore the truth of the fact that the health of human beings cannot be considered apart from the question of the health of the Earth.

[3] Loraine JA. Medicine and the energy crisis. The Lancet (September 8, 1973).

[5] "In fact, 64 studies carried out since 1950 gives this as an average value." Seppo A. Korpela, "Oil Depletion in the United States and the World," article can be found on www.greatchange.org The author is a professor of mechanical engineering at Ohio State University, Columbus, Ohio.

1. Phenol, acids and anhydrides, alkanolamines and aldehydes:

   Used for: analgesics, antihistamines, antibiotics, antibacterials, sedatives, tranquillizers

2. Esters and alcohols:

   Utilized in process of fermentation to manufacture antibiotics.

3. Polyethylene glycols, hydroxyethyl celluloses and water-soluble ethylene oxide polymers:

   Used as tablet binders and pill coatings.

4. Other

Use of plastics in all disposables used for maintaining sterile conditions; specialized plastics used in heart valves; common items such as isopropanol (rubbing alcohol); polyethylene and poly-vinyl acetate used in tubing, sheeting, splints, prostheses, blood bags, disposable syringes and catheters.

Sterilization of equipment uses ethylene oxide; ammonium nitrate is a basic ingredient in "quick cold" applications.

Nitrogen mustards have provided a long-standing part of chemotherapy treatment for cancer; propylene glycol is used for obtaining specimens for sputum cytology.

Petrochemicals are used in radiological dyes and films, dermatological creams, sigmoidoscopes, speculum probes – in endotracheal tubes, intravenous tubing, syringes, and oxygen masks.