Viewpoint
Dec 2017

The Importance of Physician Climate Advocacy in the Face of Political Denial

Andrew Jameton, PhD
AMA J Ethics. 2017;19(12):1222-1237. doi: 10.1001/journalofethics.2017.19.12.sect1-1712.

Abstract

Most physicians accept the general scientific discoveries about anthropogenic global warming and its dangers. Occasional denial by individual physicians of climate change can be readily answered by reference to the scientific consensus. But widespread, organized, political denial of climate change is hazardous to physicians’ advocacy for an effective public health and health care response to climate change. This article assumes that physician climate advocacy is ethical and celebrates the many forms of health climate advocacy already under way. It concludes by drawing attention to measures that can scale up and strengthen the health care system’s organized response to growing climate health hazards.

Introduction

During the last half century and even before, the globe has been warming rapidly while climate science has grown in precision and evidentiary support [1-5]. Meanwhile, physicians and health care organizations have been advocating policies to respond to climate change. However, there remain some clinicians who deny the science and consequential implications of climate change, which raises questions about how to handle climate denial by physicians and others. I first outline some issues in identifying climate denial and responding to it. I then examine and celebrate climate advocacy by physicians. A third section identifies a type of denial—“political denial”—inimical to progress in mitigating climate change. Finally, I note a few action items for strengthening health care climate advocacy and response.

Climate Change Denial

The main conclusions of scientific climate theory and observation are straightforward [6-9]:

  1. Average global atmospheric, ocean, and soil temperatures are rising rapidly.
  2. This warming is almost entirely attributable to human activity.
  3. As emissions continue, rising temperatures are causing increasingly widespread and harmful consequences. Among the consequences that have been identified and attributed to climate change are: ocean level rise and acidification, strong storms, floods, epic excessive heat events, drought and famine, forest fires, spreading vectors and diseases, human and other migration, armed conflicts, governance crises, and species extinctions [10-19]. Climate and health disasters in recent years show that health consequences are significant and growing [11, 17, 18].

Climate skeptics and denialists claim that at least one of the three elements of the scientific consensus is false. Very few still claim that temperatures are not rising [20]. A few others deny that science proves that temperatures will continue to rise. Others understand that the warming is real but think it has not been shown to have a significant anthropogenic component. Still others admit that scientists are right on both points but claim that the warming is inconsequential, in the balance beneficial, easily manageable, or unfixable [21, 22]. I don’t count among denialists those who hold that it is unreasonable to try to do much about climate change at present because our energies should be devoted to more immediate priorities including social justice and international poverty [23]. Similarly, some think that continued economic growth will solve the problem and that environmental harms far in the future should not be regarded as significant now. Such arguments have been refuted [24-27], but they go beyond the science of climate change.

Are there denialists among physicians? The George Mason University Center for Climate Change Communication 2014 and 2015 surveys of physicians in three national medical organizations showed that most physicians accept all three consensual points about climate change; few physicians confidently deny elements of climate science [28]. Notably, one such denialist was Michael Crichton [29]. The Journal of American Physicians and Surgeons published a notorious denialist article by four nonmedical scientists that was widely circulated [30]. When American Family Physician published an article on physician climate communication with patients [31], several physicians replied with fierce denial [32-36]. One physician leads organizations that have posted denialist materials [37]. Several physician denialists are named on websites [22, 38, 39].

Since most physicians accept the scientific consensus and medicine is a scientific profession, it is not difficult to reply to deniers when addressing medical audiences. In my experience, physician denial of the third conclusion of climate science is rare. Once the first two points are grasped—that warming is occurring and is manmade—the connections to health and welfare follow readily. For those who assert skepticism, probably all that is needed is to remind the audience that the consensus is well established and has only increased over the decades [2, 3, 40-42]. It might also be useful to compare the functions of skepticism in medical practice with skepticism regarding climate science. Imbued with their everyday need to consider nuanced human bodily, social, and moral complexities when treating individual patients, some clinicians and medical educators maintain a spirit of doubt and uncertainty in clinical reasoning and evidence [43-46]. They might then transfer their habitual skepticism to climate science. But the main points of climate science are based on fundamental thermodynamic and geophysical principles and supported by a vast body of evidence from many scientific disciplines [1, 7]. Weather forecasting is analogous to cancer survival prediction in that prediction is uncertain for a given scenario [47, 48], but the three main points of climate science listed above, much like some of the basics of physiology, describe reliable categories of evidence [2, 7].

As far as the ethics of denial goes, a personal reaction of denial by individual physicians, if transient, is ethically unproblematic. Such a reaction warrants compassion rather than criticism, because the three points of climate science constitute very bad news indeed [4, 49-52]. Physicians, like patients, might react to bad news with denial. Later, we move on through other psychological stages toward acceptance and hope [53, 54]. There remains, however, a dangerous form of denial that I call here political denial. Before discussing it, I outline the good news about medical advocacy for climate change mitigation.

Medical Advocacy

The health professions have been proactive regarding climate change since 1989 [55, 56]. The American Medical Association (AMA) issued a 2008 statement, “Global Climate Change and Human Health,” supporting climate science; it recommends research regarding health impacts of climate change, climate education in medical school curricula, physician policy advocacy, public and patient education, role modeling, and cooperation with public health agencies and officials [57]. In the decade since, the World Medical Association, various medical specialty organizations, and others have made statements underlining the urgent need to reduce fossil fuel consumption, to switch to alternate energy sources, and to take additional climate change mitigation steps [58-68]. Activist health professional organizations, such as Physicians for Social Responsibility, the Medical Society Consortium on Climate and Health, the Center for Climate Change and Health, Health Care Without Harm, and others [69-76] are advocating for urgent mitigation of what the Lancet and University College London Institute for Global Health Commission termed “the biggest global health threat of the 21st century” [77].

Prominent climate change mitigation activities undertaken by health professions organizations and others include:

  • Promoting public and legislative support for international, national, and regional policies to mitigate climate change [57, 63-76, 78];
  • Promoting a “co-benefits” approach, which promotes policy and lifestyle measures that improve public health while reducing carbon dioxide emissions [79-81];
  • Promoting the use of the social costs of carbon in decisions to estimate climate change costs [81-84];
  • Expanding medical school curricula on climate and global change [65, 85, 86];
  • Promoting climate awareness among health professionals [76];
  • Greening health care facilities, especially with regard to energy efficiency, and switching from fossil fuels to alternative energy sources at these facilities [87-90];
  • Preparing health care facilities to withstand extreme weather events [91].

Health professions climate advocacy organizations have developed an extensive body of expertise, evidence, measures, efficiencies, communication techniques, tools, designs, and the like. Any organization new to these issues will find ample resources for moving ahead [65, 92-95].

Political Denial of Climate Science

Political denial is the denial of climate science by business, government, and policy organizations for political and economic reasons. This denial is sometimes intended to hinder the development of alternative energy sources and to promote continuing use of fossil fuels, that is, to defend vested interests [21, 22, 96-101]. Sometimes these organizational views are associated with political and economic ideologies that require local, national, and international management regimes to solve problems [97, 100, 102, 103]. Some of these organizations have been aggressive in their attacks on scientists and in their propaganda efforts [103-108].

Also dangerous are the current US administration’s moves to close down government climate science research programs and remove posted evidence [109-112]. Some recent high-level cabinet appointees are deniers (and among them the physician Ben Carson) [113]. This process echoes George Orwell’s 1984 dystopia, which featured the “memory hole” as a major tool for destroying information to maintain political oppression [114, 115]. These Orwellian practices, together with the president’s announced plan to withdraw the US from the United Nations 2015 Paris climate change mitigation agreement [116-118], constitute a highly dangerous political configuration. Since climate change mitigation and adaptation are urgently needed, and failure to act is likely to kill millions of people over the next decades, some term current US climate policy a “crime against humanity” [119].

Political denial threatens the commitment of health professionals to widen and strengthen their advocacy because:

  • Administrators and legislators are more likely to avoid mentioning climate change and to withhold support from policies to prepare for and mitigate climate change.
  • Health care advocates, administrators, lobbyists, and fund-raisers who promote improvements in access, funding, and public resources for health care are less likely to dilute the immediacy of their primary message with long-term climate concerns [120].
  • Preparations for the climate disasters ahead require foresight and investment. If an agency denies climate change, it can allow disaster preparation to slide. When the disaster comes, administrators can say, “Who knew?” Denial thus prepares the irresponsible to shrug off blame [36, 121].

More Work to Do

There is so much research and advocacy regarding climate and health that it is impossible for anyone to keep track of it all. One might then ask, If health care professionals are committed to advocating for mitigating and adapting to climate change, why does more need to be done? Unfortunately, the high level of activism among health professionals may foster unwarranted optimism.

For all the efforts of activists globally, business and government efforts are far from on track to achieve sufficient emission reductions [122-124]. Moreover, despite the good examples and leadership of some health care systems [86, 125, 126], the vast majority of health care systems have a long way to go to implement similar policies [127]. Bringing good ideas up to scale is challenging. And when challenging measures are needed, denial takes its toll by weakening our resolve [21, 99].

What more needs to be done? Here are a few concrete suggestions:

  • If they have not done so already, the academic accrediting and examining agencies can review medical curricula for climate content.
  • Hospitals and clinics can examine the range of their offerings to emphasize therapies that have the best ratio of patient benefit to environmental and climate cost. They can also begin to eliminate environmentally costly therapies with significant side effects, controversial efficacy, or overly wide and unproven indications [128-133].
  • Physicians who wish to lead as role models can move into smaller quarters, live nearer work, and bicycle or walk to work [57].
  • Those in health care philosophy and ethics can connect and harmonize principles of environmental ethics with those of health care ethics [134-137].
  • Associations can hold more virtual national meetings (this includes ethics associations [138]) and, in any case, limit professional air travel [139].
  • Innovative research can engage in precautionary prior evaluation of its likely environmental impact once scaled up to widespread use [140].

The AMA, like other medical associations, can devote more attention to promoting climate change mitigation. The AMA should appoint at least one climate sustainability specialist to coordinate work on scaling up the health care system’s response to climate change. Its sustainability division could include climate change in its existing programs on practice sustainability and physician satisfaction. It could advocate reducing environmental, material, and energy costs in specifying its responsibilities to promote scientific knowledge, competent practice, and public health improvement as expressed in its Code of Medical Ethics [141]. And it could cooperate regionally, nationally, and locally with other appropriate medical professional organizations in devoting resources to climate change mitigation advocacy.

Political denial creates obstacles, but political winds shift over time while climate change is here to stay. Physicians should remain hopeful about fulfilling their strong ethical obligation to address public health risks [142-144]. There is much good work under way, and exciting endeavors remain ahead for those concerned about the health hazards of climate change [145, 146].

Read More

References

  1. Weart S. The Discovery of Global Warming. 2nd ed. Cambridge, MA: Harvard University Press; 2007.

    PubMed Google Scholar

  2. Oreskes N. The scientific consensus on climate change. Science. 2004;306(5702):1686.

    View Article PubMed Google Scholar

  3. Stocker TF, Qin D, Plattner GK, eds; Intergovernmental Panel on Climate Change. Climate Change 2013: The Physical Science Basis. Working Group I Contribution to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change. New York, NY: Cambridge University Press; 2013. http://www.climatechange2013.org/images/report/WG1AR5_ALL_FINAL.pdf. Accessed October 9, 2017.

  4. Wuebbles DJ, Fahey DW, Hibbard KA, et al. Executive summary. In: Wuebbles DJ, Fahey DW, Hibbard KA, Dokken DJ, Stewart BC, Maycock TK, eds. Climate Science Special Report: Fourth National Climate Assessment. Vol 1. Washington, DC: US Global Change Research Program; 2017:12-34. https://science2017.globalchange.gov/downloads/CSSR2017_PRINT_Executive_Summary.pdf. Accessed November 11, 2017.

  5. Melillo JM, Richmond T, Yohe GW, eds; US Global Change Research Program. Climate Change Impacts in the United States: The Third National Climate Assessment. Washington, DC: US Global Change Research Program; 2014. http://nca2014.globalchange.gov/system/files_force/downloads/high/NCA3_Climate_Change_Impacts_in_the_United%20States_HighRes.pdf. Accessed August 18, 2017.

  6. Alley RB. Earth: The Operators’ Manual. New York, NY: Norton; 2011.

    Google Scholar

  7. Archer D. The Long Thaw: How Humans Are Changing the Next 100,000 Years of Earth’s Climate. Princeton, NJ: Princeton University Press; 2009.

    Google Scholar

  8. Schmidt G. The CO2 problem in 6 easy steps. RealClimate. August 6, 2007. http://www.realclimate.org/index.php/archives/2007/08/the-co2-problem-in-6-easy-steps/. Accessed October 9, 2017.

  9. Houghton JT, Ding Y, Griggs DJ, Noguer M, van der Winden PJ, Dai X, eds. Climate Change 2001: The Scientific Basis. Contribution of Working Group I to the Third Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge, UK: Cambridge University Press; 2001.

    Google Scholar

  10. McMichael AJ. Climate Change and the Health of Nations: Famines, Fevers, and the Fate of Populations. New York, NY: Oxford University Press; 2017.

    Google Scholar
  11. 2018;

    US Global Change Research Program. The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment. Washington, DC: US Global Change Research Program; 2016. https://health2016.globalchange.gov/. Accessed October 9, 2017.

  12. Hunter DJ, Frumkin H, Jha A. Preventive medicine for the planet and its peoples. N Engl J Med. 2017;376(17):1605-1607.
    View Article PubMed Google Scholar

  13. Kolbert E: The Sixth Extinction: An Unnatural History. New York, NY: Henry Holt; 2014.

    Google Scholar
  14. Tibbetts J. Driven to extremes health effects of climate change. Environ Health Perspect. 0007;115(4):196-203.
    Google Scholar

  15. Klinenberg E. Heat Wave: A Social Autopsy of Disaster in Chicago. Chicago, IL: University of Chicago Press; 2015.

    Google Scholar

  16. Luber GK, Knowlton K, Balbus J, et al. Human health. In: Melillo JM, Richmond T, Yohe GW, eds; US Global Change Research Program. Climate Change Impacts in the United States: The Third National Climate Assessment. Washington, DC: US Global Change Research Program; 2014:220-256.

  17. Field CB, Barros VR, Dokken DJ, et al, eds; Intergovernmental Panel on Climate Change. Climate Change 2014: Impacts, Adaptation, and Vulnerability. Part A: Global and Sectoral Aspects. New York, NY: Cambridge University Press; 2014.

    Google Scholar
  18. Patz JA, Frumkin H, Holloway T, Vimont DJ, Haines A. Climate change: challenges and opportunities for global health. JAMA. 2014;312(15):1565-1580.
    View Article PubMed Google Scholar

  19. Klare MT. The Race for What’s Left: The Global Scramble for the World’s Last Resources. New York, NY: Metropolitan Books; 2012.

    Google Scholar

  20. Romm J. September sets alarming global temperature record and negates a favorite denier talking point. ThinkProgress. October 5, 2017. https://thinkprogress.org/september-climate-records-488cfe1703f9/. Accessed October 9, 2017.

  21. Oreskes N, Conway EM. Merchants of Doubt: How a Handful of Scientists Obscured the Truth on Issues from Tobacco Smoke to Global Warming. New York, NY: Bloomsbury Press; 2011.

    Google Scholar

  22. Hoggan J, Littlemore R. Climate Cover-Up: The Crusade to Deny Global Warming. Vancouver, British Columbia, Canada: Greystone Books; 2009.

    Google Scholar

  23. Lomborg B. The Skeptical Environmentalist: Measuring the Real State of the World. New York, NY: Cambridge University Press; 2001.

    Google Scholar
  24. Caney S. Climate change and the future: discounting for time, wealth, and risk. J Soc Philos. 2009;40(2):163-186.
    View Article Google Scholar
  25. Stern N . Economics: current climate models are grossly misleading. Nature. 2016;530(7591):407-409.
    View Article PubMed Google Scholar

  26. Stern N. Economic development, climate and values: making policy. Proc Biol Sci. 2015;282(1812):20150820. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4528513/. Accessed October 9, 2017.

  27. Hsiang S, Kopp R, Rasmussen DJ, et al. American Climate Prospectus: Economic Risks in the United States. New York, NY: Rhodium Group; 2014. https://gspp.berkeley.edu/assets/uploads/research/pdf/American_Climate_Prospectus.pdf. Accessed October 9, 2017.

  28. George Mason University Center for Climate Change Communication. Physician surveys on climate change and health. http://climatehealthconnect.org/wp-content/uploads/2016/09/PhysicianSurveys.pdf. Published September 2016. Accessed November 2, 2017.

  29. Crichton M. State of Fear. New York, NY: HarperCollins; 2004

    View Article PubMed Google Scholar
  30. Robinson AB, Robinson NE, Soon W. Environmental effects of increased atmospheric carbon dioxide.  J Am Physicians Surg. 2007;12(3):79-90.
    View Article Google Scholar
  31. Parker CL. Slowing global warming: benefits for patients and the planet. Am Fam Physician. 2011;84(3):271-278.
    PubMEd Google Scolar

  32. Lessens DM. Responses to article on benefits of slowing global warming. Am Fam Physician. 2012;85(5):428.

    PubMed Google Scholar

  33. Sealand J. Responses to article on benefits of slowing global warming. Am Fam Physician. 2012;85(5):427.

    PubMed

  34. Congdon D. Responses to article on benefits of slowing global warming. Am Fam Physician. 2012;85(5):427.

    PubMed
  35. 2018;

    Sulik G. Responses to article on benefits of slowing global warming. Am Fam Physician. 2012;85(5):428.

    PubMed
  36. Imperial C. Responses to article on benefits of slowing global warming. Am Fam Physician. 2012;85(5):427-428.
    PubMed

  37. Heartland Institute. Jane M. Orient. https://www.heartland.org/about-us/who-we-are/jane-m-orient. Accessed October 9, 2017.

  38. Ron Paul: it’s “business as usual” in Washington, but Americans are waking up [transcript]! Fox Business. November 4, 2009. https://www.ronpaul.com/2009-11-04/ron-paul-on-fox-business-its-business-as-usual-in-washington/. Accessed October 9, 2017.

  39. Atkin E. Rand Paul goes full-on climate science denier. ThinkProgress. November 12, 2015. https://thinkprogress.org/rand-paul-goes-full-on-climate-science-denier-8b6458690c24/. October 9, 2017.

  40. Kaelin WG Jr. Climate change: what would Lincoln do? JAMA. 2017;318(7):611.

    View Article PubMed Google Scholar
  41. van der Linden S, Maibach E, Leiserowitz A. Improving public engagement with climate change: five “best practice” insights from psychological science. Perspect Psychol Sci. 2015;10(6):758-763.
    View Article PubMed Google Scholar

  42. van der Linden SL, Leiserowitz AA, Feinberg GD, Maibach EW. The scientific consensus on climate change as a gateway belief: experimental evidence. PLoS One. 2015;10(2):e0118489. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0118489. Accessed October 9, 2017.

  43. Witte MH, Kerwin A, Witte CL, Scadron A. A curriculum on medical ignorance. Med Educ. 1989;23(1):24-29.
    View Article PubMed Google Scholar

  44. Proctor RN, Schiebinger L, eds. Agnotology: The Making and Unmaking of Ignorance. Stanford, CA: Stanford University Press; 2008.

    Google Scholar

  45. Loughlin M, Bluhm R, Buetow S, Borgerson K, Fuller J. Reasoning, evidence, and clinical decision-making: the great debate moves forward. J Eval Clin Pract. 2017;23:905-914.

    View Article PubMed Google Scholar

  46. Wieringa S, Engebretsen E, Heggen K, Greenhaigh T. Has evidence-based medicine ever been modern? A Latour-inspired understanding of a changing EBM. J Eval Clin Pract. 2017;23:964-970.

    View Article PubMed Google Scholar
  47. Mackillop WJ, Quirt CF. Measuring the accuracy of prognostic judgments in oncology.. J Clin Epidemiol. 1997;50(1):21-29.
    View Article
  48. Thai V, Ghosh S, Tarumi Y, et al. Clinical prediction survival of advanced cancer patients by palliative care: a multi-site study.  Int J Palliat Nurs. 2016;22(8):380-387.
    View Article PubMed Google Scholar

  49. Wallace-Wells D. Scientist Michael Mann on “low-probability but catastrophic” climate scenarios. New York Magazine. July 11, 2017. http://nymag.com/daily/intelligencer/2017/07/scientist-michael-mann-on-climate-scenarios.html. Accessed October 9, 2017.

  50. McMichael AJ, Dear KB. Climate change: heat, health, and longer horizons. Proc Natl Acad Sci U S A. 2010;107(21):9483-9484.
    View Article PubMed Google Scholar
  51. Sherwood SC, Huber M. An adaptability limit to climate change due to heat stress. Proc Natl Acad Sci U S A. 2010;107(21):9552-9555.
    View Article PubMed Google Scholar

  52. Lynas M. Six Degrees: Our Future on a Hotter Planet. Washington, DC: National Geographic; 2008

    Google Scholar

  53. Kübler-Ross E. On Death and Dying: What the Dying Have to Teach Doctors, Nurses, Clergy and Their Own Families. London, England: Routledge; 2008.

    Google Scholar

  54. Becker E. The Denial of Death. New York, NY: Free Press; 1997.

    PubMed Google Scholar
  55. Leaf A. Potential health effects of global climatic and environmental changes. N Engl J Med. 321(23):1577-1583.
    View Article PubMed Google Scholar
  56. McCally M, Cassel CK. Medical responsibility and global environmental change. Ann Intern Med. 113(6):467-473.
    View Article PubMed Google Scholar

  57. American Medical Association. Global climate change and human health H-135.938. https://policysearch.ama-assn.org/policyfinder/detail/climate%20change?uri=%2FAMADoc%2FHOD.xml-0-309.xml. Updated 2014. Accessed October 9, 2017.

  58. Figueres C, Schellnhuber HJ, Whiteman G, Rockström J, Hobley A, Rahmstorf S. Three years to safeguard our climate. Nature. 546(7660):593-595.
    View Article PubMed Google Scholar
  59. Frumkin H, Hess J, Luber G, Malilay J, McGeehin M. Climate change: the public health response. Am J Public Health. 98(3):435-445.
    View Article PubMed Google Scholar

  60. Hansen J. Storms of My Grandchildren: The Truth about the Coming Climate Catastrophe and Our Last Chance to Save Humanity. New York, NY: Bloomsbury; 2009.

    Google Scholar

  61. Rahmstorf S, Levermann A. Why global emissions must peak by 2020. RealClimate. June 2, 2017. http://www.realclimate.org/index.php/archives/2017/06/why-global-emissions-must-peak-by-2020. Accessed July 1, 2017.

  62. Sibbald B. Physicians’ roles on the front line of climate change. CMAJ. 2013;185(3):195.

    View Article PubMed Google Scholar

  63. World Medical Association. WMA Declaration of Delhi on Health and Climate Change. https://www.wma.net/policies-post/wma-declaration-of-delhi-on-health-and-climate-change/. Adopted October 2009. Updated October 2017. Accessed October 23, 2017.

  64. Crowley RA. Health and Public Policy Committee of the American College of Physicians. Climate change and health: a position paper of the American College of Physicians. Ann Intern Med. 164(9):608-610.
    View Article PubMed Google Scholar
  65. Friedrich MJ. Medical community gathers steam to tackle climate’s health effects. JAMA. 317(15):1511-1513.
    View Article PubMed Google Scholar
  66. Lang T, Rayner G. Beyond the golden era of public health: charting a path from sanitarianism to ecological public health. Public Health. 129(10):1369-1382.
    View Article PubMed Google Scholar

  67. Ahdoot S, Pacheco SE; Council on Environmental Health. Global climate change and children’s health. Pediatrics. 2015;136(5):e1468-e1484.

    View Article PubMed Google Scholar
  68. Wahowiak L. Climate change to take center stage at APHA 2017 in Atlanta: registration open. Nations Health. 47(6):1-19.
    Google Scholar

  69. Center for Climate Change and Health website. http://www.climatehealthconnect.org. Accessed October 9, 2017.

  70. Health Care Without Harm website. http://www.noharm.org. Accessed October 9, 2017.

  71. Health Professionals for a Healthy Climate website. http://www.hpforhc.org. Accessed October 9, 2017.

  72. Healthier Hospitals website. http://www.healthierhospitals.org. Accessed October 9, 2017.

  73. Medical Society Consortium on Climate and Health website. http://www.medsocietiesforclimatehealth.org. Accessed October 9, 2017.

  74. Physicians for Social Responsibility website. http://www.psr.org. Accessed October 9, 2017.

  75. Practice Greenhealth website. http://www.practicegreenhealth.org. Accessed October 9, 2017.

  76. US Climate and Health Alliance website. http://www.usclimateandhealthalliance.org. Accessed October 9, 2017.

  77. Costello A, Abbas M, Allen A, et al. Managing the health effects of climate change: Lancet and University College London Institute for Global Health Commission. Lancet. 2009;373(9676):1693.

    View Article PubMed Google Scholar

  78. Hanna K, Coussens C, eds; Institute of Medicine. Rebuilding the Unity of Health and the Environment: A New Vision of Environmental Health for the 21st Century. Washington, DC: National Academy Press; 2001.

    PubMed Google Scholar

  79. Smith KR, Haigler E. Co-benefits of climate mitigation and health protection in energy systems: scoping methods. Annu Rev Public Health. 2008;29:11-25.

    View Article PubMed Google Scholar
  80. Remais JV, Hess JJ, Ebi KL, et al. Estimating the health effects of greenhouse gas mitigation strategies: addressing parametric, model, and valuation challenges. Environ Health Perspect. 2014;122(5):447-455.
    View Article PubMed Google Scholar

  81. Smith KR, Woodward A, Campbell-Lendrum D, et al. Human health: impacts, adaptation, and co-benefits. In Field CB, Barros VR, Dokken DJ, et al, eds; Intergovernmental Panel on Climate Change. Climate Change 2014: Impacts, Adaptation, and Vulnerability. Part A: Global and Sectoral Aspects. New York, NY: Cambridge University Press; 2014:709-754. http://www.ipcc.ch/pdf/assessment-report/ar5/wg2/WGIIAR5-PartA_FINAL.pdf. Accessed October 9, 2017.

  82. Adler M, Anthoff D, Bosetti V, Garner G, Keller K, Treich N. Priority for the worse-off and the social cost of carbon. Nat Clim Chang. 2017;7:443-449.

    View Article Google Scholar

  83. Pizer WA. What’s the damage from climate change? Science. 2017;356(6345):1330-1331

    View Article PubMed
  84. Shindell DT. The social cost of atmospheric release. Clim Change. 2015;130(2):313-326.
    View Article Google Scholar

  85. Bell EJ. Climate change: what competencies and which medical education and training approaches? BMC Med Educ. 2010;10:31. https://bmcmededuc.biomedcentral.com/articles/10.1186/1472-6920-10-31. Accessed October 9, 2017.

  86. Gómez A, Balsari S, Nusbaum J, Heerboth A, Lemery J. Perspective: environment, biodiversity, and the education of the physician of the future. Acad Med. 2013;88(2):168-172.
    View Article PubMed Google Scholar
  87. Brown LH, Buettner PG, Canyon DV. The energy burden and environmental impact of health services. Am J Public Health. 2012;102(12):e76-e82.
    View Article PubMed Google Scholar

  88. Kaplan S, Sadler B, Little K, Franz C, Orris P. Can sustainable hospitals help bend the health care cost curve? Issue Brief (Commonw Fund). 2012;29:1-14.

    View Article PubMed Google Scholar

  89. World Health Organization; Health Care Without Harm. Healthy hospitals, healthy planet, healthy people: addressing climate change in health care settings. http://www.who.int/globalchange/publications/climatefootprint_report.pdf. Published 2009. Accessed October 9, 2017.

  90. Bouley T, Roschnik S, Karliner J, et al. Climate-smart healthcare: low-carbon and resilience strategies for the health sector. World Bank; January 1, 2017. http://documents.worldbank.org/curated/en/322251495434571418/pdf/113572-WP-PUBLIC-FINAL-WBG-Climate-smart-Healthcare-002.pdf. Accessed October 9, 2017.

  91. Balbus J, Berry P, Brettle M, et al. Enhancing the sustainability and climate resiliency of health care facilities: a comparison of initiatives and toolkits. Rev Panam Salud Publica. 2016;40(3):174-180.
    PubMed Google Scholar

  92. American College of Physicians. Climate change toolkit. https://www.acponline.org/advocacy/advocacy-in-action/climate-change-toolkit. Accessed October 9, 2017.

  93. Maibach EW, Nisbet M, Baldwin P, Akerlof K, Diao G. Reframing climate change as a public health issue: an exploratory study of public relations. BMC Public Health. 2010;10:299. https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-10-299. Accessed November 3, 2017.

  94. Maibach EW, Roser-Renouf C, Leiserowitz A. Communication and marketing as climate change-intervention assets: a public health perspective. Am J Prev Med. 2008;35(5):488-500.
    View Article PubMed Google Scholar
  95. Werner A, Steihaug S. Conveying hope in consultations with patients with life-threatening disease: the balance between supporting and challenging the patient. Scand J Prim Health Care. 2017;35(2):143-152.
    View Article PubMed Google Scholar

  96. Farrell J. Network structure and influence of the climate change counter-movement. Nat Clim Chang. 2016;6:370-374.

    View Article Google Scholar

  97. Hayhoe K. I was an Exxon-funded climate scientist. Conversation. August 24, 2017. http://theconversation.com/i-was-an-exxon-funded-climate-scientist-49855. Accessed October 9, 2017.

  98. Kaplan K. When it comes to views on climate change, liberals and conservatives are still worlds apart. Los Angeles Times. October 4, 2016. http://www.latimes.com/science/sciencenow/la-sci-sn-climate-change-political-views-20161004-snap-story.html. Accessed October 9, 2017..

  99. Proctor RN. Golden Holocaust: Origins of the Cigarette Catastrophe and the Case for Abolition. Berkeley, CA: University of California Press; 2011.

    Google Scholar
  100. Schlichting I.  Strategic framing of climate change by industry actors: a meta-analysis. Environ Commun. 2013;7(4):493-511.
    View Article Google Scholar

  101. Toomey D. Climate change and the human mind: a noted scientist weighs in. Yale Environment 360. October 26, 2017. https://e360.yale.edu/features/climate-change-and-the-human-mind-a-noted-psychiatrist-weighs-in. Accessed November 2, 2017.

  102. Jacques PJ, Dunlap RE, Freeman M. The organisation of denial: conservative think tanks and environmental scepticism. Env Polit. 2008;17(3):349-385.
    View Article Google Scholar

  103. Leiserowitz A, Maibach E, Roser-Renouf C, Rosenthal S, Cutler M. Politics and global warming, May 2017. New Haven, CT: Yale Program on Climate Change Communication; 2017. http://climatecommunication.yale.edu/wp-content/uploads/2017/07/Global-Warming-Policy-Politics-May-2017.pdf. Accessed October 9, 2017.

  104. Deaton J. Courts back climate scientists, but right-wing attacks are disrupting research. ThinkProgress. October 2, 2017. https://thinkprogress.org/climategate-repercussions-2ce159248af2/. Accessed October 9, 2017.

  105. Funk C, Kennedy B. The politics of climate. Pew Research Center. http://www.pewinternet.org/2016/10/04/the-politics-of-climate/. Published October 4, 2016. Accessed October 10, 2017.

  106. Krisberg K. Regulatory changes ignore science, threaten public health: new administration eroding progress. Nations Health. 2017;47(8):1-20.
    Google Scholar

  107. Kusnetz N. Industry lawsuits try to paint environmental activism as illegal racket. Inside Climate News. October 5, 2017. https://insideclimatenews.org/news/04102017/greenpeace-rico-racketeering-lawsuit-environmental-activism-resolute-dakota-access-. Accessed October 10, 2017

  108. Mann ME, Toles T. The Madhouse Effect: How Climate Change Denial Is Threatening Our Planet, Destroying Our Politics, and Driving Us Crazy. New York, NY: Columbia University Press; 2016.

    Google Scholar
  109. Rosner D. Webs of denial: climate change and the challenge to public health. Milbank Q. 2016;94(4):733-735.
    View Article PubMed Google Scholar

  110. Foran C. Donald Trump and the triumph of climate-change denial. Atlantic. December 25, 2016. https://www.theatlantic.com/politics/archive/2016/12/donald-trump-climate-change-skeptic-denial/510359/. Accessed October 10, 2017.

  111. Romm J. We aren’t doomed by climate change. Right now we are choosing to be doomed. ThinkProgress. July 11, 2017. https://thinkprogress.org/climate-change-doomsday-scenario-80d28affef2e. Accessed October 10, 2017.

  112. Popovich N, Albeck-Ripka L. 52 environmental rules on the way out under Trump. New York Times. October 6, 2017. https://www.nytimes.com/interactive/2017/10/05/climate/trump-environment-rules-reversed.html. Accessed October 10, 2017.

  113. Sidahmed M. Climate change denial in the Trump cabinet: where do his nominees stand? Guardian. December 15, 2016. https://www.theguardian.com/environment/2016/dec/15/trump-cabinet-climate-change-deniers. Accessed September 24, 2017.

  114. Orwell G. 1984. New York, NY: Houghton Mifflin Harcourt; 2017.

  115. Arendt H. The Origins of Totalitarianism. New York, NY: Schocken Books; 2004.

    Google Scholar

  116. Medical Society Consortium on Climate and Health. Statement on President Trump’s decision to withdraw from the Paris Agreement. https://medsocietiesforclimatehealth.org/latest-news/statement-on-president-trumps-decision-to-withdraw-from-the-paris-agreement/. Published June 1, 2017. Accessed October 10, 2017.

  117. National Medical Association. National Medical Association condemns US pullout of Paris climate agreement. http://www.nmanet.org/news/348160/National-Medical-Association-Condemns-US-Pullout-of-Paris-Climate-Agreement.htm. Published June 1, 2017. Accessed October 10, 2017.

  118. World Medical Association. World Medical Association condemns President Trump’s climate change announcement. https://www.wma.net/news-post/world-medical-association-condemns-president-trumps-climate-change-announcement/. Published June 2, 2017. Accessed October 10, 2017.

  119. Smith WD. Climate change denial is a crime against humanity on a planetary scale. Planet Experts. http://www.planetexperts.com/climate-change-denial-crime-against-humanity-on-planetary-scale/. Published January 5, 2016. Accessed October 10, 2017.

  120. Ioannidis JPA. Defending biomedical science in an era of threatened funding. JAMA. 2017;317(24):2483-2484.
    View Article PubMed Google Scholar

  121. Grey B. The Houston flood disaster: a social crime of the American oligarchy. World Socialist Web Site. https://www.wsws.org/en/articles/2017/08/29/pers-a29.html. Published August 29, 2017. Accessed October 1, 2017.

  122. Anderson K, Bows A. Beyond “dangerous” climate change: emission scenarios for a new world. Philos Trans A Math Phys Eng Sci. 2011;369(1934):20-44.

    View Article PubMed Google Scholar

  123. Larkin A, Kuriakose J, Sharmina M, Anderson K. What if negative emission technologies fail at scale? Implications of the Paris agreement for big emitting nations. Clim Policy. 2017:1-25.

    View Article Google Scholar

  124. Millar RJ, Fuglestvedt JS, Friedlingstein P, et al. Emission budgets and pathways consistent with limiting warming to 1.5° C. Nat Geosci. 2017;10:741-747.

    View Article Google Scholar

  125. Gundersen Envision. Energy conservation. http://www.gundersenenvision.org/envision/our-programs/energy-conservation/. Accessed October 10, 2017.

  126. Klettke R. Geisinger goes more efficient. American Builders Quarterly. http://americanbuildersquarterly.com/2016/geisinger-health-system/. Published September 15, 2016. Accessed October 1, 2017.

  127. Sheehan MC, Fox MA, Kaye C, Resnick B. Integrating health into local climate response: lessons from the US CDC Climate-Ready States and Cities Initiative. Environ Health Perspect. 2017;125(9):094501. https://ehp.niehs.nih.gov/EHP1838/. Accessed October 10, 2017.

    View Article PubMed Google Scholar

  128. Callahan D. False Hopes: Why America’s Quest for Perfect Health Is a Recipe for Failure. New York, NY: Simon and Schuster; 1998.

    Google Scholar

  129. Callahan D. Health care costs and medical technology. In: Crowley M, ed. From Birth to Death and Bench to Clinic: The Hastings Center Bioethics Briefing Book for Journalists, Policymakers, and Campaigns. Garrison, NY: Hastings Center; 2008:79-82.

    Google Scholar

  130. Ulmer C, Ball J, McGlynn E, Hamdounia SB, eds. Essential Health Benefits: Balancing Coverage and Cost. Washington, DC: National Academies Press; 2012.

    Google Scholar

  131. Rosenthal E. An American Sickness: How Healthcare Became Big Business and How You Can Take It Back. New York, NY: Penguin Press; 2017.

    View Article PubMed Google Scholar

  132. Simbruner G. Ecological impact of pediatric intensive care. Crit Care Med. 1993;21(suppl 9):S399.

    PubMed Google Scholar
  133. Wolfson D, Santa J, Slass L. Engaging physicians and consumers in conversations about treatment overuse and waste: a short history of the Choosing Wisely campaign. Acad Med. 2014;89(7):990-995.
    View Article PubMed Google Scholar

  134. Gruen L, Ruddick W. Biomedical and environmental ethics alliance: common causes and grounds. J Bioeth Inq. 2009;6:457. doi:https://doi.org/10.1007/s11673-009-9198-6.

    View Article PubMed Google Scholar
  135. Lee LM. A bridge back to the future: public health ethics, bioethics, and environmental ethics. Am J Bioeth. 2017;17(9):5-12.
    View Article PubMed Google Scholar
  136. Macer DRJ. We can and must rebuild the bridges of interdisciplinary bioethics. Am J Bioeth. 2017;17(9):1-4.
    View Article PubMed Google Scholar

  137. Potter VR. Bioethics: Bridge to the Future. Englewood Cliffs, NJ: Prentice-Hall; 1971.

    Google Scholar
  138. Dwyer J. On flying to ethics conferences: climate change and moral responsiveness. Int J Fem Approaches Bioeth. 2013;6(1):1-18.
    Google Scholar
  139. Bows-Larkin A. All adrift: aviation, shipping, and climate change policy. Clim Policy. 2015;15(6):681-702.
    View Article Google Scholar

  140. Favaro B. A carbon code of conduct for science. Science. 2014;344(6191):1461.

    View Article PubMed Google Scholar

  141. American Medical Association. Code of Medical Ethics. https://www.ama-assn.org/delivering-care/ama-code-medical-ethics. Published 2016. Accessed October 10, 2017.

  142. Jonsen AR, Jameton AL. Social and political responsibilities of physicians. J Med Philos. 1977;2(4):376-400.
    View Article PubMed Google Scholar
  143. Sarfaty M, Abouzaid S.. The physician’s response to climate change. Fam Med. 2009;41(5):358-363.
    VIew Article PubMed Google Scholar

  144. Sarfaty M, Gould RJ, Maibach EW. Medical alert! Climate change is harming our health. Fairfax, VA: Medical Society Consortium on Climate and Health; 2017. https://medsocietiesforclimatehealth.org/wp-content/uploads/2017/03/gmu_medical_alert_updated_082417.pdf. Accessed October 10, 2017.

  145. Bloomberg M, Pope C. Climate of Hope: How Cities, Businesses, and Citizens Can Save the Planet, New York, NY: St. Martin’s Press; 2017.

    Google Scholar
  146. Watts N, Adger WN, Ayeb-Karlsson S, et al. The Lancet countdown: tracking progress on health and climate change. Lancet. 2017;389(10074):1151-1164.
    View Article PubMed Google Scholar

Citation

AMA J Ethics. 2017;19(12):1222-1237.

DOI

10.1001/journalofethics.2017.19.12.sect1-1712.

Acknowledgements

I am grateful to the editorial staff of the AMA Journal of Ethics and Elliott Crigger for their attentive comments and helpful thoughts.

The viewpoints expressed in this article are those of the author(s) and do not necessarily reflect the views and policies of the AMA.