A Lap in a Relay — or the End of the Race?

The Western Journal
By contrast, the Western Journal of Medicine has staggered to the end of its race. We grieve its end and treasure our memories.

The September 2002 issue was WJM's last, but the January 2002 issue said it best. A child in the future is asking about one of those "reading magazines" he had found, called WJM. His grandfather tells him they used to be called "medical journals" and were how doctors "kept up to date with new developments."

"How did it get to you?" asks the grandson.

"There used to be people called letter carriers...to deliver things like this right to your home."

"Weird."

The medical journal is too slow and awkward for disseminating research findings. Electronic peer review is complete in several weeks, but publication may take a year. Peer-reviewed articles should be available immediately using the Internet, WJM contends.

So why publish at all? WJM suggests that printed journals give a sense of belonging to a group of like-minded health professionals and students, a place for reflection on current medical practice, problems, frustrations and dilemmas; a source of refreshing information and education on demand.

We will miss WJM as a perk of CMA membership. In its death throes, it tried to streamline itself. It compactly, but provocatively, debated whether "extreme racism is a mental illness" or whether "continuity of care matters."

Its comments on studies — like how being uninsured affects managing chronic illness in ethnic minorities or of end-of-life decisions in a developmental center — were models of minimalist pertinence. Its culture and medicine collections highlighted subjects as varied as immigrant women's health, failures of the disease-based model of health care, a retrospective on masturbation, shaping North America's health care profession to serve a multiethnic generation X, and palliative care in the Islamic world. Its final issue highlighted behavioral health care of Asian Americans.

Even as its science value slipped, its literary value soared, informing and entertaining with grace and attractiveness. Its covers were inviting, although the editors told us too little about them. Notices about educational conferences replaced forbidden pharmaceutical advertising and all the advertising shrunk until the race ended.

How long will it be before no one remembers or misses WJM ?

Global Warming
Are the environmental changes in our lifetime a relay or the end of the race? The answer is infinitely more important.

President Bush has reluctantly acknowledged that the global climate is warming, but believes there is nothing we can do about it.

The United States has told the United Nations that global warming will likely raise sea levels and change precipitation. Forests, crop yields and water supplies will likely change. Deserts could expand into existing rangelands. Animals and ecosystems that cannot adapt quickly enough could disappear. Their race would end. The severe and permanent changes forecast in some of our National Parks could be a lap in a relay.

Human beings are not expected to do well. Death rates increase during extremely hot days, particularly among very old and very young people living in cities. Heat exhaustion and some respiratory problems increase. Warmer temperatures may reduce the number of people who die each year from cold weather, but only 1,000 people in the United States die from the cold each year, while twice as many die from the heat.

Warm temperatures can increase air and water pollution and raise concentrations of ground level ozone. That damages lung tissue. Some infectious diseases, particularly insect-borne diseases, like malaria, dengue fever, yellow fever and encephalitis, that only appear in warm areas, could become more prevalent as those insects spread farther north.

In the Central Valley, melting snow provides much of the summer water supply. Warmer temperatures would cause earlier snow melts, leaving our summer water supply low, even if spring rainfall increases. Reduced runoff and lower levels of rivers, lakes, and aquifers would likely increase concentrations of pollution. More frequent severe rainstorms would send more chemicals flowing from farms, lawns and streets into rivers, lakes and bays.

Similar temperature changes have occurred in the past — but over centuries or millennia, not decades. The ability of some plants and animals to migrate and adapt appears to be much slower than the predicted rate of climate change.

Along much of California's coast, sea level is already rising by 3 inches per century at Los Angeles, 5 inches at San Francisco, and 8 inches at San Diego. We already replenish beaches from Santa Barbara to San Diego at a rate that, if continued, would reach a cumulative cost through 2100 of $174 million to $3.5 billion, at present dollars.

San Francisco Bay contains the most extensive salt marshes on the West Coast. Most have been modified dramatically by dredging and filling. A 1—3 foot increase in sea level may shift the existing salt marshes in the bay to nearby lowlands and freshwater marshes and encroach on new areas of development.

Cold water species such as mountain whitefish and brook trout could lose all their habitat. Other cold water species, such as Chinook and Kokanee salmon, could lose most of theirs.

We already see these changes beginning; our children will see more. The report predicts the "very likely" disappearance of alpine meadows in the Rockies and some barrier islands, as well as the forest network in the Southeast, now the nation's largest timber producing region. How long before no one will know to miss them?

The report to the United Nations offers no alternatives, no rescue. It asks us to adapt, but not to sacrifice or change our habits, either personal or industrial. A recent effort to lower carbon dioxide emission standards for passenger cars and light trucks sold in California met stiff opposition from automakers and the oil industry. Full page ads and talk show babble warned of a plot to deprive us of our SUVs, increase the price of gasoline and otherwise damage our economy.

Nevertheless, California enacted the legislation. The federal EPA, though, proposed lowering industrial pollution standards, thereby hastening global warming.

When the Western Journal passes on and the Sierra meadows and Yosemite Valley transform themselves, some of us will miss them, but few of our grandchildren will know they were.

Carry on, John

edrudin@aol.com