Practicing Policy Without a License

The saga of Dr. David Swann’s Kyoto Prescription neatly illustrates the dangers that doctors and the public face when physicians practice policy without a license.

In early October, with policymaker Alberta sentiment raging against Prime Minister Jean Chrétien’s promise to ratify the Kyoto Protocol on climate change, Dr. David Swann, Medical Officer of Health for the Palliser Health Region of Southern Alberta came out in favor of ratifying the Kyoto protocol on climate change. For his outspokenness, the board of the Palliser health authority quickly fired Swann, sparking a firestorm over the question of free speech, and the autonomy of medical officers. The board reconsidered, and later offered Swann his job back, though he declined the offer despite guarantees of his right to speak out as he sees fit.

Nobody wants to see physicians and public health officers gagged on issues that legitimately pertain to medicine or public health. Medicine is often heroic, requiring physicians to buck the tide of public opinion, and the history of public health has had several such heroic incidents. But that doesn’t mean that physicians are omniscient: leaf through most any newspaper and malpractice stories leap off the page. Fortunately, society has mechanisms for dealing with malpractice, mechanisms that range from legal settlements, to administrative punishment, to outright revocation of licensure.

But in scribbling out his prescription for public health on the subject of Kyoto, Dr. Swann was well outside of his specialty, and well outside of the institutional constraints that would make him responsible for the adverse consequences of his prescription. Dr. Swann’s invocation of medical training as sufficient expertise to opine on global warming from a position of governmental authority is absurd. A plumber could make an equivalent case that since both plumbing and heart disease involve blocked pipes, plumbers should be able to write prescriptions for heart medicine.

The thing is, global warming isn’t a neatly diagnosable disease. It isn’t a condition that can be tested for readily, easily observed under a microscope, circled with marker on an x-ray, or otherwise diagnosed with the kind of clarity that we demand from physicians before taking their pills, or going under their knives. A better analogy is that global warming is like a mild fever of largely unknown cause, for which the proposed ‘treatments’ are akin to having ones legs amputated.

Consider the highest-level “diagnosis”: that man-made global warming is already occurring. What test results support that contention? Well, there’s the temperature record, purportedly showing an increase in the average temperature of the atmosphere at the Earth’s surface. But how accurate is that record? Humans have only been measuring the climate for about 150 years, and greenhouse gases for only about 50 years. Global temperature has only been measured with scientifically rigorous methods for about 23 years. And the evidence linking observed warming to human activity is mixed: the most accurate set of available temperature readings – temperatures taken with satellites – disagree with those taken on land or at sea. Furthermore, the changes in temperature observed do not necessarily match up with the periods of highest or fastest greenhouse gas emissions, and don’t match up with what computer models say they ought to be.

When it comes to differential diagnosis – pinning observed climate changes to specific human activities – the situation is even worse: no climate model breaks out the impact of the different gases, in terms of assigning a specific impact in climate change to a changes in specific greenhouse gas levels. The United Nations climate panel, rather than put specific numbers on such putative causes of climate change is reduced to stating that “most” of the warming of the last 50 years is likely due to human activity, and even that statement was generated not by hard scientific testing or statistical analysis, but rather by polling the opinion of a small number of climate scientists working for the United Nations! That’s not the kind of hard differential diagnosis that Dr. Swann would take to an operating table, one hopes.

Meanwhile, there is far better evidence regarding the impacts of the proposed “cure” for climate change, the Kyoto protocol. The government’s own economic modeling suggests that implementing the Kyoto protocol could cost Canadians 200,000 jobs, consume tax revenues needed for health services, deprive Canadian’s of the economic health that underpins their quality of life, and decrease Canadian competitiveness with the United States. Would that make current or future Canadian’s ‘healthier’?

The Dr. Swann climate saga has played itself out. Dr. Swann has chosen the martyr’s role, and declined to resume his job after being temporarily fired for his Kyoto prescription. But the moral of his story has yet to be written. The Palliser board’s decision to guarantee Dr. Swann a public policy prescription pad nearly left us with a moral that “An M.D. should be a license to make public policy.” A far better moral would be more balanced: “if physicians don’t want policymakers practicing medicine without a license, they should not be practicing policy without a license.”