We need a healthcare Hirsch Report (or several many, really, from the smallest local hospital to the largest national health service).

A small group of individuals have begun agitating for just such a report(s), and I have decided to start this post as an initial attempt at keeping track of people, places and information.

If you are new to this idea you can read my post and press release about how one might conceptualise and conduct such a study. You could also see the original report or Wikipedia entry for further information. Hirsch has also published several more recent (but smaller) supplementary papers that I have reviewed:

• Hirsch’s ASPO-5 presentation.
• Economic impacts of liquid fuel mitigation options.
• The shape of world oil peaking: Learning from experience.

In addition to the ideas in the posts listed above, some other initial thoughts are:

1. One would need to break such a report up into sections, possibly making use of the 80/20 rule to consider the most important items / uses for each area (else we’ll get bogged down with thousands of individual items).

2. I think we would need to disregard transport fuels so we don’t “reinvent the wheel” of the original Hirsch report. The possible redesign(s) of the systems to reduce transport dependence and increase local reliance ARE (very) important however, but perhaps need their own separate report(s)?
3. As healthcare is synonymous with pharmaceuticals for many, I think they need their own section. Possible subdivisions could be on the basis of:

• Raw material replacement / substitution
• Top-selling 20 or 30 (or 50 or 100) drugs
• By condition with the top medications for each examined

4. I think perhaps we then need to subdivide the remainder into (a) plastics and (b) everything else. We especially should look at alternative plastic chemistry and feedstocks; also replacing plastic with glass, rubber, metal and other materials.

5. Of course all of this assumes business as usual ± current growth rates. One of the outcomes of a Hirsch4Health report might be that business as usual is untenable: A bit like saving energy through improved efficiency is better than investing in more power plants.

Please leave a comment below to add your voice and information to this project as we attempt to build a critical mass.

IMPORTANT: If you don’t know how to leave a comment (or are having trouble) you can see step-by-step instructions with pictures.

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Good Morning,
I am writing today to let you know about an Australian Senate enquiry that may consider the future of healthcare in Australia. The enquiry is examining the likelihood that the era of cheap and plentiful crude oil is drawing to an end, and what that may mean for our society.

I am a GP in Newcastle NSW, and a member of the local Hunter Urban Division of General Practice. I am concerned that medicine in particular (as well as society in general) will be ill-prepared for peak oil, especially as it is predicted to occur as early as 2010.

In collaboration with a Victorian anaesthetist (Dr James Barson), I recently co-authored an in-depth submission on the healthcare aspects of peak oil to the Senate enquiry. We submitted it on behalf of the Australian chapter of the Association for the Study of Peak Oil and Gas (ASPO-Australia), and it is available on their website: http://www.aspo-australia.org.au/

In brief, our submission covered:

• Ways that modern medicine is oil-dependent
• How Australian general practice is susceptible to peak oil, and how that might be changed.
• Why hospital medicine is vulnerable to peak oil, and how it might be remodelled.
• Ethical challenges of healthcare and peak oil
• Introduction to the methodology of oil vulnerability analysis
• Demonstration of the vulnerability of the health care system to fuel supply disruption
• Techniques of relocalised healthcare

I refer you to the Senate website for more information on peak oil: http://www.aph.gov.au/senate/committee/rrat_ctte/oil_supply/int_report/index.htm. Note that our submission was made after the release of the interim Senate report, but we hope that it will be considered for the final report.

Additionally, I have started a website called Peak Oil Medicine (www.peakoilmedicine.com) where I discuss these issues at depth.

Peak Oil Theory Background
The peak oil theory was formulated in the 1950?s by American geologist M King Hubbert. His theory states that sooner or later, oil production from any given field will reach a maximum (or peak) before turning downwards and declining.

He based his theory on what he observed occurring in US oil fields at that time, and accurately predicted the peak in Lower-48 US oil production in the early 1970?s.

His method has been validated by production patterns in other countries, and by extension has been applied to global oil production.

His theory shows that a peak in oil PRODUCTION typically follows the peak in oil DISCOVERY by about 30 years.

It also predicts that we will find progressively fewer new oil fields, and that they will be smaller, more technically challenging, cost more, and be located in more environmentally sensitive, climatically hostile, or geopolitically unstable areas.

In this context, the new US oil discovery in the Gulf of Mexico (called ?Jack-2?) is completely congruous with his theory (deeper water than ever before, much more expensive, in a ?hurricane zone?, and only has enough reserves to supply world requirements for six months).

According to his theory, world oil production will eventually peak and then enter a permanent decline. Back in the 1950?s world oil discoveries were around 30 billion barrels per year, while annual consumption was 4 billion barrels. Currently, these figures are roughly reversed: we now burn 7 or 8 barrels of oil for each one that we discover.

When global peak oil occurs, there will not be enough crude oil to satisfy progressively increasing world demand (especially from countries like China and India). Prices must then increase (due to supply and demand), and may reach relatively astronomical levels (US$200 a barrel has been suggested).

Such price increases will have a profound impact on our society, and are thought likely to trigger global recession or depression (akin to the 1930?s). Unfortunately, there are no ready oil-substitutes on the scale required: one US study (called the Hirsch Report) suggests that it will take 20 years of urgent and massive mitigation action to avoid significant economic impacts.

Summary
From the perspective of peak oil, modern medicine is clearly unsustainable. While there are many reasons for this assertion, I would draw your attention to two:

1. Many modern pharmaceuticals are based on crude-oil feedstocks.
2. Plastics are derived from oil, and modern medicine is pervasively dependent on them.

The implications of peak oil are such that even if one remains unconvinced about if and when it might occur, the consequences may be so devastating that not to consider how our system might respond to such a crisis would be foolhardy.




Yours faithfully,

Paul Roth

Open Letter to Australian GPs
Image Credits: Taken from Robert Hirsch?s peak oil report and subsequent work.

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Most peak oil studies to date have focussed on trying to predict when peaking might occur. There is one notable exception, however. In 2004 the US Department of Energy?s National Energy Technology Laboratory released their landmark Peaking of World Oil Production: Impacts, Mitigation and Risk Management.

Background
Unlike the others, this study (informally called The Hirsch Report after the lead author ? who coincidentally appeared on the recent ABC-TV Four Corners episode on peak oil) made no attempt to predict when a peak might occur.

After identifying that peak oil would cause a liquid fuels crisis, it looked at how long it would take to replace oil as a transport fuel. The authors calculated that it would take 20 years of ?crash? programs to produce enough facilities to significantly replace oil with artificial fuels. In contrast, if the US waited until peaking was obvious, there would be 20 years of significant economic hardship (similar to, or worse than, the Great Depression).

Medical Hirsch Report
I contend that a study with a similar purpose would be a useful tool for the each country?s health care system. It would provide useful information for planning and implementing mitigation programs, allowing us to manage the significant expected impacts of oil scarcity and energy descent.

Hirsch Report Methodology
The authors purposely kept the analysis simple. They did this so that their results would be transparent. They acknowledged that no study could infallibly predict the impacts, and used a semi-qualitative approach, rather than a rigidly quantitative one. In simple terms the approach was:

1. Describe the current situation and identify the scope of the problem.
2. Consider any examples or analogous situations that might shed light on the analysis (they used the peaking of US domestic natural gas supply).
3. Only consider commercial or near-commercial processes (to maintain realism).
4. Calculate the timeframes and capacities of the necessary number of fuel-production plants.
5. Repeat the process for each technology (eg coal-to-liquids; vehicle energy efficiency).

Applying Hirsch to health care
In order to think about how this process might be applied to the health care system, I chose the hypothetical example of plastic syringes (with a proposal to replace them with glass ones):

• How many single-use plastic syringes are used each year? What sizes? Where are they used (eg hospital versus community)? What are they used for? Who makes them? Which countries do they come from?

• What happened in Cuba when their oil supplies were cut off? How about Zimbabwe (a country that has been called the ?first casualty? of peak oil)? How do NGO aid-agencies like MSF currently handle this issue in third-world countries? The idea is to try to distil some generalized lessons. For example: What alternatives are there? If glass syringes will be used, how can they be made, packaged and shipped safely? How might they be cleaned, sterilized and reused? What are the infection control issues? And so on.

• What viable processes currently exist to manufacture precision glass instruments in our country? Who might do it (eg consider scientific instrument makers but also manufacturers of glass bottles and jars)? What is their current capacity? Do they have the technology or would it need to be bought from overseas and adapted here?

• Educated guesses about how long it would take to build and tool up enough factories to make them (in the format of ?Complete X factories per year, each producing Y syringes per year, Z years lead time until the first one is operational then 1 per year thereafter?).

• Repeat this process for each important oil-based component of the current health-care system ( I would suggest that there are at least several hundred such “critical” areas if we are to maintain a resonable semblance of the current system). Such a study would be much harder to do than the original one, because Hirsch et al only considered one output; we need to consider many.

One would also need to try and predict the increased sterilizing load (both in staff and equipment terms), infection control issues, financial costs and benefits, patterns of use, etc.

Outcomes
The possible outcomes of such a study include:

• A reasonable idea of the enormity of the problem and the scale of mitigation required.
• An estimate of the number of years needed to significantly reduce our current dependence on oil-based materials, allowing timeframes for implementation to be developed.
• Identification of the critical areas of the current healthcare system that need urgent attention.
• The realisation that perhaps a stockpiling strategy might be favoured over developing domestic manufacturing capacity.
• A complete redesign of the current system (really a paradigm shift) to new ways of delivering satisfactory health care - now there’s an area to discuss!

Summary
Unfortunately I quite scared myself as I thought about this and the enormity of the problem. Please tell me what you think.

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This study profiled a solo Robert Hirsch?s examination of the possible shape of the world?s peak-oil curve. He started by saying that world conventional oil production before, during and after peaking is almost certainly not predictable, because it depends on so many variables, including:

• Oil price changes in the 10 years before peaking
• EOR technologies
• Oil field damage from previous mismanagement
• Supply-demand expectations and oil company decision-making
• Government incentives, political events and stability in oil-producing regions
• Geology of major oil-producing regions

He stated that modeling all these factors is probably so complex that any such estimate would be of questionable value. (POM: It would also need to include an inherently inaccurate guess about Saudi reserves that would introduce so much uncertainty that the exercise is probably futile).

Because Hubbert used a bell-curve to model US peaking, the same type of curve has been applied to the problem of world oil peaking. Hirsch showed in this study that a bell curve may not be the best shape to use. He explained that Deffeyes fitted a bell curve to the US-48 peaking data and generated a broad and gently-sloping curve that showed that peaking occurred very slowly and gently over a 10 year period.

In this study, Hirsch set out to examine the validity of a bell-curve in modeling oil production peaking. He looked at the data from four oil provinces that had already peaked (Texas, North America, Norway, and the UK) in order to gain some insights into what might happen.
He selected these areas because they:

• Are large and geologically varied
• Had significant peak oil production (minimum 1MMbpd)
• Had accurate long term data
• Were managed for maximal oil production (ie they were unconstrained by cartel production quotas etc)

Hirsch found that peaking was not obvious just one year before it occurred; that each peak was sharp and triangular rather than a smooth and gently-sloping bell curve; that post-peak declines were up to 13% in the first year; and that three of the four regions showed a pre-peak spike.

POM Comment: This study highlights the probable folly of trying to accurately predict an exact date for the peak. I think that Hirsch showed incredible originality and drive to conceive and publish his ground-breaking report in 2005, and has continued to do so with this study. He once again provides incredibly useful information, suggesting as he does that peaking might appear suddenly, occur quickly, and be associated with a significantly faster drop-off than the 2% per year estimate used in his first study.

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This study was done by Bezdek, Wendling and Hirsch, and published by the US National Energy Research Laboratory in April 2006. It looked solely at the US situation, and was a follow-up of the Hirsch Report (2005). It emphasised the dual issues of energy security and balance of payments problems as justification for implementing mitigation options now.

It examined the four strategies (of the six in the Hirsch Report) most available to the US: improvements in vehicle fuel efficiency (VFE); coal-to-liquid conversion (CTL); oil shale; and enhanced oil recovery (EOR). It excluded gas-to-liquids and oil sands.

It assumed the following strategies were crash implemented:

• VFE: 50% increase after 8 years.
• CTL: Three new 100,000 bpd plants developed each year with a four year lead time.
• EOR: 175,000 bpd increase per year after four year preparation time.
• Oil Sands: None.
• Gas-to-liquids: None.
• Oil shale: Three new plants producing 100,000 bpd completed each year with an eight year delay.

Their modelling found that the costs will total several trillion dollars, and that the relative cost will be least for EOR and most for VFE. Benefits will increase continuously over the 20 year time-frame of the study. They will be relatively small in the first few years, and maximal in year 20. The strategies have widely different impacts, with CTL providing the most liquid fuel and VFE the least. They will create 1.4 million jobs. The character and timing of the jobs varies. Design and construction predominates in the first few years, progressively giving way to operations, maintenance and support as plants are completed and come on line.

There should be very significant economic benefits, including capital investment, import replacement, company profits, and government taxes. (POM: Not to mention the avoidance of a possible economic collapse if peak oil is imminent). If a crash program was initiated in 2006, it would produce 14 million barrels of liquid fuel per day in 2026. If implementation was delayed until 2016, there will only be 5 MMbpd in 2026. The strategies could decrease total US oil imports from the current 13 MMbpd to 5 MMbpd in 2026. The problem (apart from the fact that a crash program has not started yet) is that initiating them all now doesn?t even satisfy half of US liquid fuel requirements pre-2026.

They summarised by saying that if world oil production peaks before 2026, then the US will not have a choice about initiating these strategies. They also reiterated that such a program will cost trillions and take decades to have a significant impact.

POM Comment: More great research from Robert Hirsch et al. The most striking thing for me was the scale at which we currently use oil - despite a massive mitigation effort we would not even get close (for the US alone) to replacing current consumption, not to mention allowing for future demand growth in the US (and lets not forget skyrocketing demand from China, India, etc).

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As you probably know, Robert Hirsch is the author of a very influential and well-done report about peak oil mitigation options. It was published in February 2005 for the US Department of Energy’s National Energy Research Laboratory.

At the recent ASPO-5 conference, he presented an update of his findings. There were some interesting things in his presentation that I want to highlight here. The headings in bold are based on his talk, while the comments underneath are my own.

Peak oil will trigger a forced energy transition.
Each transition that has happened in the past (eg wood to coal; coal to oil) has evolved naturally and relatively slowly, allowing infrastructure and technology to grow naturally rather than being forced along in a crash program. For instance replacing horses with tractors took many years. The alternative movement, replacing tractors with horses for farm muscle, will be much more problematic (and maybe impossible?), because of the speed of the changeover. It is obvious that there just aren’t enough draught horses around for a rapid and world-wide switch (breeding enough will take decades) as well as relearning the almost-forgotten associated skills such as horse-shoeing, saddle and tackle-making, horse-drawn machinery manufacture, etc. So unless there is to be massive societal collapse, we are really looking at liquid fuel alternatives while we prepare for whatever comes after that.

Peak oil will last for decades.
Unlike the previous short-term “energy crises”, peak oil signals an absolute, geological end to cheap oil, rather than a politically-motivated shortage. Effective mitigation strategies must therefore also be on a multi-decade scale, and will require extensive planning.

Oil shortages will trigger depression
Hirsch has shown that economic growth and oil consumption are interlinked (because growth is currently fossil-fuel driven). Peak oil will cause a (significant ?) reduction in economic activity, decreasing demand somewhat in the short to medium term.

Inaccurate EIA natural gas forecasts 2002-2006
In his 2005 report, Hirsch analysed the peaking of US natural gas supply in order to gain some possible insights into peak oil. In this speech he shows a fantastic graph of EIA natural gas forecasts between 2002 and 2006, highlighting their inaccuracy. It is the same EIA that now predicts that peak oil is many years away.

Shape of the peak oil curve
Hirsch released a paper recently about the shape of the peak in four representative oil provinces: Texas, domestic USA, Norway, and the UK. In each, the peak was not able to be predicted just a year before it occurred, indicating that we will probably get minimal warning when the world oil supply peaks. He also shows that the shape of the graph at the peak is triangular rather than gently curving, suggesting that there could be a rapid fall in oil production after we go over the tipping point. A third finding is that oil production in the US continued to drop after peaking, despite modern exploration and production techniques, indicating that those who suggest that we will find more oil and be better at recovering it could be wrong.

Re-examination of report assumptions.
Hirsch reiterated that the 2005 report used a 2% per year decline rate in formulating the model. He presented data suggesting that the actual rate could be as high as 8%, making the situation “much worse”.

He also presented data from a follow-up study of the mitigation options that I will cover in the next post.

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