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Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Without the Wilderness, There Can Be No Wilderness Medicine: An Open Letter to the Presidential Candidates

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In this 2008 United States presidential campaign, as the two main candidates, Barack Obama and John McCain, are being scrutinized by voters and analysts for their strengths and weaknesses, largely related to the war in Iraq and the U.S. economy, we wish to remind the candidates that we are at a defining moment for the environment. Population growth, climate change, consumption of fossil fuels, air and water pollution, and loss of biodiversity, to name a few, are not going to abate without concerted efforts, sacrifice, and political will. If either candidate wishes to fulfill his responsibility to America and the rest of the world, then he will need to make significant progress on these issues without concern for special interests, popularity, or re-election. Obama professes to be the candidate for change, and McCain says that he has wisdom bred of experience. Either way, they both need to halt the destruction of our planet and promote active environmental preservation, or they will continue to lead future generations to a precipice from which they cannot retreat.

True wilderness is a surrogate for every blade of grass, tree, or pond in a park. Wilderness medicine is medicine for the outdoors, predicated upon the notion that there will be unspoiled, unpolluted, and unencumbered forests, mountains and oceans to support our physical and emotional needs. We cannot conceive of wilderness medicine without the wilderness. The wilderness is shrinking at an alarming rate, and the most unnecessary causes are created by the activities of man. Every president since Richard Nixon has spoken to the nation about our concerning oil addiction, yet we continue to consume irreplaceable natural fuels, generate unprecedented tons of pollutants, ruin natural habitats, and endanger species. To ignore this situation or attribute it to natural cycles is dishonest, self-serving, uninformed, or ignorant.

Let us briefly review some of the environmental records and key environmental positions of these men, so that it can be clear that despite the rhetoric spun by their speechwriters, neither man should lay claim to having been a champion of the environment. At best, their past efforts have been helpful, but certainly not heroic, at a time when our world needs heroes.

Barack Obama

1. Introduced the Healthcare for Hybrids Act, which would have the federal government help cover health care costs for retired U.S. autoworkers in exchange for domestic auto companies investing at least 50 percent of the savings into production of more fuel efficient vehicles.
2. Co-sponsored the Coal to Liquid Fuel Promotion Act, supporting liquefied coal only if it emits 20 percent less carbon over its lifecycle than do conventional fuels.
3. Passed legislation with Senator Jim Talent (R-MO) to give gas stations a tax credit for installing E85 ethanol refueling pumps.
4. Worked with Senator Jim Jeffords (I-VT) to introduce the High Performance Green Buildings Act, which would increase the energy efficiency of federal buildings and schools.
5. Sponsored an amendment that became law providing $40 million for commercialization of a combined flexible fuel vehicle/hybrid car within five years.
6. Introduced legislation to enact a National Low Carbon Fuel Standard that will reduce lifecycle greenhouse gas emissions of passenger vehicle fuels sold in the U.S. by 10% in 2010 and require additional reductions of 1% annually thereafter.
7. Has opposed a summer “gas tax holiday” proposed by other candidates. However, Obama has recently proposed releasing 10% of the Strategic Petroleum reserve in order to lower oil prices. It is not clear whether or not he supports offshore drilling.
8. Calls for cutting U.S. carbon dioxide emissions 80% below 1990 levels by 2050 through a cap and trade system that would auction off 100% of emissions permits to finance development of clean energy technology; 25% of U.S. electricity to come from renewable sources by 2025; investment of $150 billion over 10 years for renewables, biofuels, and other “clean tech”; all new buildings in the U.S. to be carbon neutral by 2030; reducing U.S. oil consumption by at least 35% by 2030.
9. Advocates U.S. re-engagement with the U.N. Framework Convention on Climate Change (UNFCCC) and leadership of a new Global Energy Forum (G8 members plus five of the world’s largest emitters) to combat global climate change.

Summary: Obama states, “I believe that global warming is not just the greatest environmental challenge facing our planet – it is one of the greatest challenges of any kind. It is an issue that we ignore at our peril and at even greater peril for our children, grandchildren, and many impoverished global populations. Combating global warming will be a top priority of my presidency, and I will attend to it personally.” Obama’s words are strong, but he has not yet been in office long enough to establish a significant track record. If he is elected, we can only hope that actions will follow.

John McCain

1. Championed legislation to limit aircraft flights over the Grand Canyon.
2. Was absent for key votes on fuel efficiency, wildlife preservation, and mining.
3. Has sponsored or co-sponsored environmental protection bills related to protecting whales, improving fuel efficiency, and awarding tax credits for energy efficiency.
4. Held balanced, scientific climate hearings; has admitted the presence of anthropogenic climate change.
5. With Senator Joe Lieberman, drafted the first economy-wide cap and trade bill for carbon emissions (Climate Stewardship Act), which did not pass in 2003.
6. Re-introduced the climate bill in 2005, with added subsidies for nuclear energy; this was voted down.
7. Opposed drilling in the Arctic National Wildlife Refuge, but supports offshore oil and natural gas drilling.
8. Filibustered to oppose the 2003 energy bill, which advocated use of fossil fuels.
9. Suggested suspending the federal gasoline tax.

Summary: John McCain can best be characterized as inconsistent. He has had moments of appearing to be concerned about the environment, but these do not mesh well with his voting attendance record. He still is guided to a certain extent by partisan considerations. He appears to be somewhat enlightened in comparison to other Republicans, but is in no sense an expert on environmental issues, and has not made an extraordinary effort to surround himself with thought leaders. He has at least one strategist who understands the importance of environmental issues with voters, but McCain himself is a wild card on matters pertaining to land and conservation issues.

The League of Conservation Voters (LCV) provides objective, factual information about the most important environmental legislation and the corresponding voting records of all members of Congress. It offers a consensus of experts from more than 20 respected environmental and conservation organizations. Congressional members are graded on key votes, with 100 representing a perfect score. Obama’s lowest LCV score was 67 and highest 100 (2006), with a lifetime score (career average during years in office) of 86. McCain has scored as low as 0 (2007) and as high as 67, with a lifetime score of 24.

One of these men will be elected the next President of the United States. Because we hope that both are sufficiently intelligent and perceptive to recognize the truth and be cognizant of the urgent need for environmental remediation, we respectfully ask our next President to not only honor his campaign promises to prioritize the environment, but to consider the following bipartisan course of action:

1. Create an independent commission to gather the science and report each year to the nation the state of the global environment. Within that report, the following, at a minimum, should be addressed: global warming, depletion of stratospheric ozone, destruction of forests, polar melting, deficiencies in water production and sanitation, human population growth and dynamics, and the economic, social, and medical impacts of all of the aforementioned issues.
2. Create a National Institute for the Environment (NIE) with a budget sufficient to support epidemiology, basic science, and applied research in environmental science.
3. Create an Environmental Corps for college graduates, who will serve a paid 2 to 4-year tour of public service duty in exchange, year for year, for college education funding.
4. Pass legislation that will definitively create alternate (to fossil fuels) energy sources for the U.S. no later than a decade from now, integrating the principles of a Renewable Portfolio Standard, such that the consumption of fossil fuels can be decreased to a situation of net energy gain from all sources by the year 2018.
5. Eliminate financial support for any federal or state entity, program, or business, without exception, that does not have a neutral carbon footprint by the year 2013.
6. Codify and institute a progressive carbon cap and trade policy.
7. Remove all tax breaks from fossil fuel-consuming industries.
8. Adjust utility regulation to promote fuel efficiency.
9. Provide federal dollars to subsidize free fuel-efficient public transit.
10. Impose an average 40 mile-per-gallon minimum for all newly manufactured passenger cars driven in the U.S. by the year 2018.
11. Provide dollar for dollar tax credits to persons who retrofit or construct fuel-efficient dwellings.
12. Consider it the obligation of the U.S. to take a leadership position and collaborate with other nations to eradicate potable drinking water deficiencies worldwide by the year 2018.
13. Cease and desist on drilling for oil, mining for coal, logging for lumber, or any other environmental predatory practice in any current and future protected natural habitat, including the Arctic National Wildlife Refuge.


These are difficult mandates that will require inspirational efforts and political fortitude, and sacrifice on the part of all citizens. The President of the United States leads the greatest free nation in the world, and as such, carries more obligation than do other world leaders. If other nations are not yet willing to “step up to the plate” and do their fair share, then our country must lead by example. There will undoubtedly be inconvenience and economic reconfiguration, such that certain industries will mount mighty challenges to these proposals. We are used to that sort of thinking – after all, the tobacco industry has been killing people for years with little remorse, despite all the evidence about the health effects of tobacco. But killing millions of smokers with cigarettes does not pose irrevocable harm to mankind, only to the unfortunate victims and their families of cancer and cardiovascular disease. War and pandemics are serious matters, but in our estimation, environmental issues are of a far greater magnitude, perhaps of a permanent catastrophic nature over a relatively short period of time. We do not see a requirement to unequivocally predict the future, because preserving the planet can only be good, whether or not it is absolutely necessary at this particular moment. When we see a patient with accelerated hypertension, we control it before we are called upon to treat that same patient’s heart attack or stroke. A climber who has a headache and cannot walk a straight line is brought to a lower altitude before his brain swells further and he cannot be saved. We call upon our next President to assemble the very best clinicians to treat our planetary patient, before every nation is forced to be put on life support.

Paul S. Auerbach, MD, MS, FACEP, FAWM
Luanne Freer, MD, FACEP, FAWM


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Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.

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