QJM Advance Access published online on June 22, 2009
QJM, doi:10.1093/qjmed/hcp076
Would that we had the energy
It was back in the early 1980s. My thoracic surgical colleague asked if I could help him with one of his patients who had developed breathing problems after a lobectomy. The man was on a respirator, the consequence (it turned out) of a post-operative attack of asthma. By the time he had recovered, the pathologist reported the resected lobe to have contained not cancer but pneumoconiotic massive fibrosis. By chance, I happened to be researching miners’ diseases, so I asked him which coalmine he had worked in. He replied that he had been a shale miner, an occupation in which pneumoconiosis was thought not to have occurred. Well, now it seemed it had, and a trawl through the pathology records of the local hospital led to the discovery of a number of other examples, some of which had been associated with lung cancer.
This coincided with the early-1980s oil crisis. The US government was looking towards exploiting the vast oil reserves locked in shale in the Rocky Mountains in Colorado and was anxious to make an assessment of any risks to workers. Exploitation of oil shale had started after the discovery of deposits in Scotland in the mid-19th century by James Young, a Glasgow chemist. This had led to the 1876 description by Joseph Bell, an Edinburgh surgeon and Conan Doyle's model for Sherlock Holmes, of shale oil as a cause of skin cancer among the workers producing the paraffin and, later, among spinners exposed to it in the Lancashire cotton industry. Could inhalation of shale dust be a cause of lung cancer? A carefully worded case report was drawn to the attention of the US National Institute of Occupational Safety and Health. A search through the archives of the oil industry revealed the presence, in large boxes, of manuscript records of the original oil shale industry's Provident Fund set up in 1960 before the industry finally closed; these included names, addresses and dates of birth of all employees together with records of their jobs within the industry—the answer to an epidemiologist's prayer. A programme grant from the US Department of Energy followed, and the health consequences of working in the industry were described, 20 years after it had ceased to exist. It did not cause lung cancer.
I was reminded of this story, which illustrates an advantage in epidemiology to having one foot in clinical medicine, by recent debates on the price of oil. The discovery of shale oil in Scotland was the start of the mineral oil industry and of oil's rise to importance as an energy source. Shale oil was never very profitable, since liquid oil was discovered in natural gas deposits in North America within a decade. Coal remained the dominant energy source in Europe until the discovery of oil in the North Sea and it still is in the rising economies of China and India. Each year through the late 1970s and 1980s, I reported the results of our research on mining diseases to the Board of British Coal as my fellow directors of that industry's other research institutes reported theirs on matters such as pollution reduction and efficient coal production and utilization. In all these areas, Britain was a world leader. But this period coincided with a political desire to close the industry down. Little now remains other than the Institute of Occupational Medicine, a self-funding research charity.
Thomas Malthus in 1798 pointed to the mathematical relationships between population and food supply and drew attention to the problems attendant upon insufficiency of the latter, when faced with exponential population growth. The agricultural revolution, in its early stages as he was writing, allowed much greater population growth than he believed possible, while both the natural constraints he predicted in the poor world and voluntary limitation of family size in developed economies have allowed a balance between the two to be maintained. The other great change in society that began as Malthus was writing was the industrial revolution, using machines, fuelled first by water then by coal, oil and gas. These resources are still abundant (though not necessarily cheap to exploit), and even into the 1990s our main concerns were the health effects of atmospheric pollution from their combustion. From the 1950s, great progress had been made in reducing urban pollution, to the point when it now requires very large studies indeed to demonstrate any health effects in European cities. But over the last decade of the 20th century, it became increasingly obvious that the major issue with fossil fuel combustion was its effect on the earth's climate. Indeed, it now seems likely that the widespread and severe particulate pollution of the first half of that century had acted as an insulator to reduce somewhat the sun's incoming radiation and thus to mitigate the climb in global temperatures associated with the greenhouse effect.
The fact that the earth's atmosphere acted like the glass of a greenhouse in trapping the sun's heat was first shown by the mathematician Fourier in 1824, and in 1860 Tyndall showed that this effect was attributable to the compound gases carbon dioxide, hydrocarbons and water vapour. The potent effects of CO2 and methane are now well known and concentrations of both have risen exponentially over the last century. Ice core records show that CO2 concentrations are now considerably higher than they have been at any time in the last 500 000 years. Melting ice and permafrost, dying rainforests and oceanic algae, all consequences of rising temperatures, provide positive feedback. The planet is truly in a dire situation, close to a point at which change becomes irreversible. Yet, in order to develop, economies need energy and the most available sources are still coal and oil. It is not realistic to expect China and India to renounce development, nor to deny the opportunity to the world's poor. It is time for us in the rich world to be realistic about whether we need more of everything, and we, individually and collectively, have an obligation to reduce dramatically our carbon footprints. But for now the world needs coal and oil as much as it needs food, and this is where the advanced technological economies can make a real impact. The solutions are not simple and cover changing dietary and agricultural practices (major sources of methane), switches to non-carbon energy sources including nuclear, substantial reduction in personal energy usage and technological fixes, such as smart electricity grids and carbon capture and storage. Among these are real opportunities for industry in areas where Britain could have led the world. Perhaps we still can.
Just in case you hadn’t realized, etymologically petroleum was oil from rock while its transatlantic equivalent, gasoline, was oil found while drilling for natural gas.
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