Patient: Planet Earth by Dr Michael Stein

Vivienne and Climate Revolution have been supporting the Trillion Fund since its founding by Michael Stein and Julia Groves over a year ago. Trillion is opening up opportunities for everyone to invest directly in clean energy infrastructure, not just high net worth individuals  but any one with as little as £5 to invest. They can help people do something important with their money and, at the same time, generate more clean energy for us all to use. We asked Michael to write some of his thoughts on our environment.

Chronic Obstructive Pulmonary Disease (COPD), commonly known as emphysema, is one of the common and destructive consequences of long term smoking. It is one of the worst ways to die; the smoker slowly “drowns in air”.

COPD creeps up on the smoker in much the same way that the effect of carbon dioxide emissions is creeping up on planet earth. Our planet has unequivocally developed symptoms of long term smoking as a result of the burning of fossil fuels. And just like the inexorable decline of the emphysema sufferer, as long as the smoking continues, we will witness the acceleration of planet earth’s symptoms while we are burning fossil fuels.

To a doctor, the earth’s plight is all too similar to the smoker slowly developing COPD. There are months without problems, then the seasonal acute exacerbation (bronchitis) strikes, usually in winter, to remind the smoker that all is not well.  With climate change, it is seasonal extremes with record snow falls, floods or winds. The effects are now obvious to us all, wherever we may live in the world, yet still the smoking continues.

In the beginning, the smoker hardly notices the impact on their health and even over two or three decades, they seem to be OK other than the occasional cough or periods of cough plus low grade fever from a rumbling infection. This is because you can lose half of your lung function without much noticeable effect.

Many smokers with chronic bronchitis will develop a particularly nasty form of the disease in which the very small pipes of the lung, called the bronchioles are chronically inflamed (due to the low grade irritant effect of cigarette smoke) and they produce excess mucus together with thickening of the lining of the lungs – so the ability to exchange gases (mainly oxygen and carbon dioxide) across the lung lining is affected.

In addition, the lungs become less elastic, making the job of breathing harder. The combination of the mucus, the thickening and the increasing stiffness of the lungs means they cannot get enough oxygen into the blood stream and similarly cannot get rid of carbon dioxide, an important waste product of respiration. This is the same gas that is the major contributor to the greenhouse effect and one of the causes of climate change.

Just like our bodies are made up of a complex constellation of interacting organs and buffer systems, so too the earth is a constellation of interconnected systems: the atmosphere (with different zones), the oceans (with many seas and depths), various forest and vegetation types and all manner of animal species each with their own connected ecology, chemistry and buffer systems.

Our planet is a living and breathing thing that must be held in constant and delicate balance; and the consequences of small changes to the concentration of carbon dioxide in the lungs of a smoker is very similar to the small changes in the concentration of carbon dioxide in the atmosphere – the “lung space” of the planet. The planetary consequences of a rise in carbon dioxide concentrations would be acidification of the oceans and seas; exactly as our oceanographers are beginning to see.

But how serious a symptom is a little bit of acidification?
To answer that we return to the smoker with emphysema: they cannot move enough air in and out of their lungs and slowly start to become more and more short of breath. In addition, those with underlying chronic bronchitis start to retain more and more carbon dioxide and finally, after all the body’s buffer systems are exhausted, they start to acidify their blood – the medical term is acidosis.

This only happens once over half the lungs’ function has been destroyed. Serious damage will have occurred once the patient becomes symptomatic, with a low grade fever, cough and shortness of breath and a little bit of acidosis – all of which may come and go but overall will become worse. This is generally true of changes to any living system, which typically has excess capacity and effective buffer systems that allow it to cope with damage and changes in its particular environment. For example, you can lose well over 70 per cent of your kidney function before it has an impact on your blood chemistry.

The analogy to planet earth’s current condition here should be clear. But let’s go into some more depth and describe in a bit more detail the pathogenesis of emphysema: the process by which the patient gets sicker and sicker.

With emphysema, at first there are subtle changes that only specialist respiratory tests would detect. Then over a relatively short period (a few years compared with the decades of previous smoking) they start to become short of breath when doing minor exercise, then just climbing stairs becomes a problem until finally they feel like they are “drowning in air” and start to become blue from a lack of oxygen in the blood.

These smokers are called “blue bloaters” because not only are they cyanosed; they are also bloated because they cannot breath out easily. Imagine an elastic balloon; it’s very easy to let the air out – the balloon does all the work. But with chronic emphysema, the lungs become less and less pliable and elastic so that breathing out takes great effort and they slowly start to retain carbon dioxide, a by-product of human metabolism and respiration.

The very slow build-up of carbon dioxide eventually causes the acidity of the blood to increase as carbon dioxide dissolves in water (plasma) to form carbonic acid. The pH (a measure of acidity) typically drops a small amount (e.g. from 7.36 to 7.31) but this is enough to cause major systemic consequences for the rest of the body[1]. Indeed, the concentration of carbon dioxide within the airspace of the lungs does not change that much at first. It rises slowly so the body has time to adapt its overall chemistry until eventually, the buffer systems of the blood and the renal system cannot cope and bang, the pH of the blood itself starts to fall; with major consequences for the body’s enzymes. This is a strong indication of advanced disease.

To understand a buffer system, you might recall doing a school chemistry experiment with a pH meter or litmus paper – dipping it into a beaker of alkaline solution; and watching as drop by drop, very little changes, until one single drop of acid suddenly exhausts the solutions buffer system (its buffering capacity) and causes dramatic precipitation of salts out of solution because they cannot stay dissolved in the water once the pH has flipped from being alkaline to acidic. That is true of most chemical buffer systems – once the buffer is exhausted the resulting changes are catastrophic.

So let’s compare this to the acidification of the oceans. Nothing controversial here. All well-trained scientists from the world’s oceanographic institutions agree that on average, the pH of our oceans (think blood or tissue fluid) has dropped from 8.14 to 8.11, a drop of 0.03. That seems so little – yet it is enough to indicate serious problems (as in our patient with emphysema) and to initiate the early “melting” of our coral reefs (the engine house of our marine ecosystems) which are made up of a substance called calcium carbonate which is acutely sensitive to changes in acidity.

What has this got to do with carbon emissions into the atmosphere? The chemistry is simple:  CO2 in the air reacts with water vapour to form carbonic acid which is then “rained” into the oceans and seas, causing acidification. Drop a piece of chalk (mostly calcium carbonate) into soda water and watch what happens. The chalk fizzes and dissolves. Soda water is water with carbon dioxide dissolved in it; similarly our oceans have slowly but surely absorbed over 50 per cent of the excess CO2 we have dumped into the atmosphere over the past hundred years – that’s more than 500 billion tonnes of the stuff. And at the current rate of emissions – over 90m tonnes per DAY – the acidification is accelerating.

Now let’s look at another very common sign of trouble in emphysema – cough and low grade fever. Acute exacerbations of emphysema are most often due to a bacterial infection caused by the disturbance of the lungs’ defence mechanisms. The patient will typically have a low grade fever – which leads us to the importance of the earth’s current low grade fever. The steady state temperature of the human body is 37 degrees Celsius (^oC) versus about 14 ^oC for planet earth (as measured between 1950 and 1981). Having increased this past century by 0.8 ^oC, it is now closer to around 15 ^oC. The margin of error is very similar to the margin of error for the human body temperature: the range of normal body temperature is 36.5 – 37.5 ^oC. So compared to a starting baseline of 15 ^oC versus a human baseline of 37 ^oC, a 0.8 ^oC increase is the equivalent to a human body having a fever running just under 39 ^oC. The earth’s teeth are chattering.

In addition, acute exacerbations of emphysema are marked by a higher fever, an awful cough often with production of sputum. Thus may be compared to acute exacerbations in our climate i.e. extreme weather events such as heat waves. The increased frequency and intensity of planetary heat waves are now well described by Hansen’s paper (July 2012) in the Proceedings of the National Academy of Sciences[2] – this described the increasing frequency (75 per cent up) and intensity of heat waves decade on decade from 1950 – 2010. The increase is on a par with the increased frequency and severity of advanced state of lung cancers within patient with emphysema, who also face a decade on decade increase in the diagnosis of lung cancer.

Doll and Hill’s paper in the British Medical Journal in 1950 showed the strong statistical correlation between smoking and lung cancer yet it took 50+ years to ban smoking in public places. We simply cannot wait even 5 years before acting to ban carbon emissions. All our lives depend on it.

And wild fires, while not more frequent, are certainly more devastating because the vegetation in these areas is so much dryer due to climate change, leading to more extensive damage per fire. Other symptoms are the increasing intensity of hurricanes due to the loss of forestation (and hence water vapour) across the equatorial regions causing increased circulatory turbulence. Basically, as more energy is trapped within our atmosphere by the Greenhouse Effect, there is increased turbulence in our planet’s systems.

And insurance data has long indicated the increased damages due to floods – akin to the sputum production in our patients. The floods are almost certainly due to the massive increase in the carrying capacity of water vapour in the atmosphere as the Greenhouse Effect is magnified by the increasing amounts of carbon dioxide emitted each day and the atmosphere continues to absorb more heat. One only need look at the torrential rains and the size of the rain drops hitting the pavements in most big cities around the world.

So why has the world leadership been so slow to act? I believe this is because very few leaders understand complex physiology of biological systems (let alone climate science); and are not seeing the earth as a living biosphere that is showing multiple signs of serious distress. If they could understand the points made in this article perhaps they might – but they all need to understand it and then act together. In addition, I believe they are being lobbied hard and in subtle ways by vested fossil fuel interests. The tobacco companies did the same – and continue to do the same in many parts of the world.

And why are we, the people, complacent? To the doctor the explanation is clear. We are all like the smoker. We are addicted to fossil fuels. Ask any smoker slowly developing emphysema – they know in their heart of hearts that it is very bad for them yet they will avoid the trauma of quitting smoking – unless forced to by legislation that makes it horribly expensive (tax) and inconvenient (bans) to smoke.  So too, we need to force ourselves – all of us – to quit the burning fossil fuels and to lobby our leaders to enact a global carbon tax (as severe as the tax on cigarettes in the UK).

Then anyone who pollutes is paying for the privilege and paying enough to extract their carbon mess out of the atmosphere – it can be done albeit at a high price. The polluters – all of us – need to pay that price in exact proportion to the number of “cigarettes” we smoke. Americans – North and South, Chinese, Indians, Africans and Europeans. And forget about the past – the patient is ill and needs saving. Now.

We also need to appreciate that the fossil fuel companies – all of them no matter what lip service they pay to climate change – either must be put out of business or be forced to pay their share of the cost of clean-up – starting now if we are to survive our disease.

The tobacco companies spent millions trying to obfuscate and whisper falsehoods into our leaders’ ears (money talks) – until they lost a land mark lawsuit in the USA when the people affected by smoking filed a class action lawsuit against the tobacco companies and won. So too the fossil fuel companies are obfuscating the true situation – which is that the patient: planet earth, is facing a medical disaster that will make Hurricane Sandy look like a walk in the park. It is already upon us in many parts of the world – low lying island nations like Bangladesh, the Maldives, the Philippines and Africa, where desertification has destroyed Somalia with the resulting piracy off the East coast of Africa, and in Australia, where the Australian Tennis Open tournament was halted due to unprecedented heat. We are all affected by the mining and burning of fossil fuels – coal, oil and gas.

We can live without fossil fuels – there is more than enough renewable energy and nuclear capability. But we all now need to act closely together – it’s not about one leader but about us all being leaders; all being heroes.

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[1] Note that the pH appears to fall only ever so slightly at first because pH is measured on a logarithmic scale where an apparently minor change actually reflects a major change in the number of hydrogen ions (H+) in the blood. The normal pH range of a healthy body must be maintained between 7.36 – 7.44. So a fall of 0.03 from a starting pH of say 7.36 to a pH of 7.33 might look like a minor change but in reality it indicates a serious underlying problem with knock on effect on other systems like the renal system, which has been working over-time for years keeping the balance by getting rid of the excess H+ until it simply gets overwhelmed.

[2] Perception of climate change – by James Hansen, Makiko Sato and Reto Ruedy, Contributed March 2012 and published July 2012. National Aeronautics and Space Administration Goddard Institute for Space Studies and Columbia University Earth Institute, New York, NY 10025; and Trinnovim Limited Liability Company, New York, NY 10025. http://www.pnas.org/content/early/2012/07/30/1205276109.full.pdf+html