David Kerr: Geoenvironmental medicine and technology

David KerrThe world did not end last month after all. Harold Camping, the founder of the Family Radio Network purchased space on 1,200 billboards across the United States proclaiming doomsday for May 21st. This is the third time he has been caught offside in his predictions for the end of the world. However, around that time an unpronounceable Icelandic volcano once again threatened to play havoc with major European airline timetables. Also in the past two weeks the American Mid-west has been reeling from the devastation of severe tornadoes and other freak weather.

Over recent years we have grown accustomed to receiving streaming news and twitter feeds from eye witnesses to major disasters. In the immediate aftermath of such events, we invariably see and hear reports from the various multinational rescue teams established to respond immediately to these events.  However, less well covered is the impact of a natural disaster on the healthcare of people living with chronic disease.  Obvious consequences include disruption to medical supplies, problems with access to healthcare providers, and a negative impact on psychological well-being. What is sometimes not appreciated is also the potential risk of living in areas of the world where extreme weather is the norm. Curtis Cooke from the Mayo Clinic, recently coined the term “geoenvironmental medicine” to describe the interface of the environment and health. He should know as he looks after patients with diabetes in the seering heat of the desert of Arizona where leaving insulin in a car for even a few moments can be very problematic.

In contrast medical care can affect directly on the environment. One obvious interaction relates to the consequences of improving medical care and reducing premature mortality and the overall burden of disease, which impacts on population growth. At another level the technology associated with medical practice, and devices in particular, could potentially add an environmental burden. For example in diabetes care there is about to be an explosion in the use of technology – from insulin patch pumps, easier to use continuous glucose monitoring systems, a growth in the number of injectable therapies, and novel insulin delivery systems that allow insulin to be released in proportion to the prevailing glucose concentration. However most of these devices are likely to be disposable but not necessarily recyclable. The question is whether the environmental cost of a new device should be considered in its health economic evaluation as well as the clinical value. Another approach would be to count the carbon cost of a new medical device and encourage the manufacturer to offset this by investing the carbon credits in public health. These calculations will not be easy as much of the emphasis on the forthcoming diabetes technology will be to create biofeedback loops using consumer electronic platforms. The aim is behaviour change leading to more exercise, healthier lifestyles, and less obesity – with the carbon benefits coming from less dependence on motor vehicles.

One of the peculiarities of the medicine and environment interface is that the epicentre of global technology innovation, Silicon Valley, sits astride two major faults in the earth’s crust and statistically is due another large earthquake. Silicon Valley is also not too many miles away from Mr Camping on the East San Francisco Bay. In order to explain the failure of the world to end last month, Camping said he believed that a “spiritual” judgment had occurred and the new date for doomsday is October 21, 2011, simultaneously with the destruction of the universe. As far as I can tell there is no sign of any exodus from the valley yet.

David Kerr is the managing editor of the Journal of Diabetes Science and Technology.