David Roberts has a point here:

Adding to this: a list of your favored policies is not a “plan.” A plan involves a way of inspiring thousands of people to organize & take action & drive your policies onto the national political agenda & scare politicians who dare to vote against it. https://t.co/S2PQO740a2

— David Roberts (@drvox) February 17, 2019

Anyone with a 3-digit IQ can do a bit of googling and come up with a set of policies to reduce carbon emissions. But a plan—now that’s a different thing. A plan has to be an actual course of action with both a goal and a chance of success. We should be able to line up your plan with all the others and extract two numbers about each one: (1) emission levels in 2050 if the plan works, and (b) consensus probability that the plan will work.

I don’t have such a plan in mind, of course, but I do have a few guidelines that I think could help someone win this game:

• Think international. Yes, yes, the Republican Party is hopeless right now and that makes America a non-player. But you shouldn’t obsess about America anyway. Any plan that’s worth the paper it’s written on will focus on things that are most likely to work all around the world.
• Focus on getting the biggest bang for the buck. “Biggest bang” is pretty obvious: it just means reducing carbon emissions as much as possible as fast as possible. But “for the buck” means more than just the lowest possible price tag. “Price” should be seen as both dollars and as personal sacrifice. The more sacrifice you ask of people, the bigger the cost. The lower the sacrifice, the better chance you have of getting widespread buy-in.
• Forget the free market. There’s no profit in addressing climate change. In fact, the profit is almost entirely on the other side. This means that any plausible plan has to include lots of government subsidies: subsidies for solar, subsidies for wind, subsidies for electric cars, subsidies for reforestation, etc. Basically, you should accept that virtually every policy you support will happen only to the extent that the government subsidizes it.
• Lots of shared R&D. We could address climate change solely with existing technology. The problem is that even with truckloads of subsidies, it would demand more sacrifice than people are likely to accept. That means that we desperately need new and better technology on all fronts as soon as possible. This should be a Manhattan Project kind of thing, and in this case it’s OK to be America-centric. Obviously other countries do scientific research as well, but America does the most. What’s more, a project like this really would motivate other countries to get on board with R&D of their own.

And how will all this be paid for? The obvious answer is a whopping big progressive carbon tax. This would provide plenty of money for all those subsidies and would provide a tailwind for all the other carbon-reduction policies you come up with. However, a whopping tax means a big sacrifice, and that probably dooms it to fail. A carbon tax that starts small but steadily increases is one compromise that might work. A carbon tax that pays for more than just climate change might also reduce opposition.

There are plenty of other possibilities. The main thing is to be rigidly realistic at all times. If you ask too much of people, they won’t support your ideas no matter how great they are. And even if they do, they aren’t likely to respond appropriately to the scale of the problem on their own. I haven’t, after all. Neither have you. But that’s OK: climate change won’t be affected much by personal action anyway. It’s too big. Like a war, it requires action on a governmental scale. Unlike a war, however, it has no human enemy to spur citizens to accept the sacrifice it takes to win. It’s up to us to come up with an alternative.

I don’t know for sure if the rural/working class revolt in France is more about fuel taxes, reduced speed limits, or just a general dislike for that city slicker Emmanuel Macron. But higher diesel prices are part of it, so yesterday Macron backed off his new fuel taxes, which were explicitly imposed as a way of reducing fuel use in response to climate change. This all happened in a country that’s pretty progressive on environmental issues.

Meanwhile, Canada is one of the greenest countries you could imagine. But does that mean they’re going to stop drilling for oil in their famous tar sands? Oh my no. Just the opposite. Likewise, Jerry Brown is America’s greenest governor, but that doesn’t mean he’s willing to put limits on oil drilling in California.

Hypocritical? Sure. But keep in mind that this is about as good as it gets. In the less developed countries, they’re barely even willing to adopt a veneer of caring about climate change if it requires any sacrifice at all. China is still all-in on coal and India has little interest in doing anything that might hurt economic growth by a tenth of a percentage point.

And the United States—well, I hardly have to say anything about the United States, do I? We’re the richest big country in the world, and we probably have the strongest capacity of any nation on earth to generate huge amounts of solar and wind power with only modest sacrifice. But we don’t. We had a green president for a few years, but Republicans in Congress refused to consider even a limited plan to raise the cost of dirty energy. Today we have a president who actively prefers coal mining and oil drilling to clean energy because his base works in those industries.

I could go on. But what’s my point? Just this: the danger of future climate change is now about as clear as it’s going to get. It’s not a matter of computer models anymore. Just look around you and the evidence is all there: wildfires, droughts, hurricanes, desperate migrants, the Northwest Passage opening up. Those will get slowly worse over the next few decades, but they’re already bad enough to be clearly visible. And yet there’s still no real willingness to reduce fossil fuel use anywhere. Not if it costs more than a trivial few cents anyway, and even at that it’s hard to get the public to approve it unless that cost is buried somewhere.

Like most of you I want to keep fighting to reduce fossil fuel use, but at the same time I’ve come to recognize the reality that it’s not going to happen. Not via carbon taxes or lots of hectoring, anyway. As Chris Hayes has pointed out, there’s about $20 trillion worth of fossil fuels still left in the ground right now. Knowing what you know about human nature, what are the odds that anyone is going to leave all that money there? About zero, right? Hayes compares it to the $10 trillion economic value of slaves in the South on the eve of the Civil War, and points out that this is why the South would never, ever voluntarily give up chattel slavery. It took four years of the bloodiest war in history to finally force their hand.

I would say the same is true today: the owners of fossil fuels will never, ever voluntarily give their reserves. Something on the order of World War II might force them to do it, but who would be fighting whom? There are no opposing sides in this war.

Bottom line: there is no feasible way to keep all that carbon in the ground merely through regulation or fuel taxes or whatnot. It might help a bit, which means we should keep trying, but in the end it won’t work except on the margins. I don’t like this conclusion any better than anyone else, but I think it’s correct.

So what’s the answer, aside from frying the planet? That’s simple: we need a miracle. And we should be spending vast sums of money to get one.

The “miracle,” in this case, is anything that either (a) produces cheap, clean energy in abundant quantities, or (b) safely removes carbon from the atmosphere at scale. That’s it. The former would keep fossil fuels in the ground by reducing its economic value, while the latter would halt global warming even if we burn every last gram of coal and oil on the planet.

That’s what we should be spending our money and emotional energy on—and not in our current nickel-and-dime way. I’d say we need a Manhattan Project-like commitment and annual spending of around 1 percent of GDP. And that’s global GDP I’m thinking of. Call it $500 billion in round numbers. The US share would be around $200 billion or so. Every. Single. Year.

We’ve already made significant progress on wind and solar, and there are other renewable energy sources out there too. But they aren’t enough. There are theoretical limits to how much solar power we can harness and practical limits to how much wind power we can capture. What we need is some kind of massive breakthrough that we can barely imagine yet. I have no idea what it might be, but I’m willing to bet it’s out there.

And there’s actually a chance of this working. The public hates higher taxes and stricter regulations, but they love spending money. If world leaders got together and declared this a war, everyone would cheer. And both national leaders and their publics would adore the idea of hundreds or thousands of huge research projects springing up all over the world to invent valuable new technologies.

It might even work. That’s the best I can honestly say about it. But even at that, it’s still a lot better odds than trying to keep all those fossil fuels in the ground.

An article on the BBC News site today reports on a minor celebrity who is making a stir with a stance against vaccination. The celebrity is so minor that the author readily admits that we might not have heard of her. Nevertheless, make-up and tattoo guru Kat Von D says that her forthcoming child will not be vaccinated.

The story centres on Kat Von D’s Instagram post, and it’s worth analysing this. She says:

My husband @prayers and I are NOT anti-vaxxers.
We are not against vaccines. Just because we have hesitancies and valid concerns about injecting our baby with specific chemicals and toxins does not mean we are anti anything.

Isn’t the use of the words “chemicals and toxins” a bit of a give-away? This is the lexicon of the anti-science movement. Anyway, let me address Kat’s points in order:

1. “Do my research” does not mean trawling the web until you find inflammatory sites that reinforce your prejudices.
2. ” There are plenty of studies that show some vaccinations can work wonders. And there are also studies that show some people [including mothers, and babies] may be more susceptible to vaccine injuries more than others”. False balance. The risk:benefit ratio is very firmly in favour of vaccines.
3. “It’s unfair for anyone to expect me [or any parent] to take the word of the pharmaceutical companies….”. We don’t, we are guided by independent bodies such as WHO, Cochrane, and national bodies such as the Centers for Disease Control in the US.
4. “Our personal medical records are no one’s business…” Excuse me? Who went public with this in the first place?
5. “I hope you would try and understand that this is our first child together, and we are simply just trying our best”. Trying your best would be using the best evidence for decisions. You are not.

She concludes by turning off comments. Nothing like lobbing a grenade and running away to create a stir. Now let me return to the BBC piece. It’s very heartening to see the level of reaction against Kat’s silly statements. But the author missed a trick with this bit:

But in recent days some had praised her for speaking out – asserting her, and their right, to choose how they raise their children.

Parents do not own their children. They do not have the right to make decisions that are potentially harmful to their children. This is the central ethical point of the story that the BBC has totally missed. The article cites another parent Gina Frattini who says:

We’re bringing our children into this world, and we’re trying to do the absolute best we can with the information we have and the information we’re given.

Like Kat Von D, no Gina you are not. You have not a shred of excuse for not having all the right information – it’s available to anyone. You have undoubtedly been told that vaccination is on balance overwhelmingly beneficial, but you choose to ignore it. Gina reinforces this error with:

It’s her uterus, it’s her body, it’s her child – it’s their child together and it’s 110% her choice”.

Apart from her lack of numeracy, Gina is wrong again. The child has rights. It has nothing to do with the mother’s health.

Some will say that I am being too harsh, as the article is well balanced, giving ample coverage to pro-vaccination arguments. But missing the central ethical point is I think inexcusable.

So, 1 year & 43 weeks after EU referendum, with 300 days until UK becomes a third country under EU law, Government can’t decide between 2 options already rejected by the other side of the negotiation, and not backed by business, and for which it may not get Parliamentary support

Last week the UK officially ratified membership of a new supranational European court, staffed by judges from EU members, subject to elements of Article 267 treaty on ECJ jurisdiction - the signatory with a wax seal - someone called Boris Johnson.... the Unified Patent Court. pic.twitter.com/YCYg8RZeFx

Homeopathy prescriptions on the NHS in England fell by another 25% in 2017

England

Continuing its decline, the number of prescriptions for homeopathy products dispensed in community pharmacies in England plummeted 25% in 2017 to just 5,105. The cost to the NHS of these prescriptions dropped 32% from £92,412 to £62,124, according to data published two weeks ago by NHS Digital, further cutting the income and profit of manufacturers.

The number of prescriptions is now just 3% of what it was at the height of its popularity in the mid-1990s.

The decline is to be expected given the ending of funding by CCGs in Liverpool, the Wirral, Enfield and elsewhere.

The effects of more recent guidance to CCGs by NHS England to end the funding of homeopathy will add to the woes of homeopaths this year. CCGs in Bristol are currently consulting (for a second time) on the ending of funding of homeopathy, but we would expect them to follow the same path as other CCGs and NHS England. NHS England has also recommended that the Department of Health add homeopathy to the blacklist of products the NHS provides.

The admission a few weeks ago by the Royal London Hospital for Integrated Medicine that they would no longer be providing homeopathy consultations or dispensing NHS homeopathy prescriptions can only be a further source of acute embarrassment to what used to be homeopathy's NHS flagship.

Scotland

The NHS in Scotland collects their data on a different timescale, publishing data for the previous financial year rather than the calendar year of the NHS in England. The latest data for Scotland was published last September, covering the year to April 2017 (in the chart, the data are assigned to the year of the start of the period).

Wales

Primary Care Services Wales also publish prescription data. Selecting homeopathy (by BNF chapter, section, subsection 19, 02, 03) gives:

Curiously, in 2017, the only item categorised as homeopathic is called Zota Swedish Bitters. This appears to be a herbal product, not homeopathic, but it is the only item listed last year (and the few other months' data going back to 2015 we checked) under the BNF section for homeopathy products. This appears to be an error by the NHS in Wales: either this herbal product has been wrongly categorised as homeopathic or they have simply used Zota Swedish Bitters as some kind of a default text for this field in their database. It could be that they have no homeopathic products at all, but we will assume these are homeopathic — because of the relatively low numbers compared to England and Scotland, they won't make much difference to the overall totals below.

Northern Ireland

The Business Services Organisation of the Department of Health in Northern Ireland publish their own similar data on prescriptions. There was a massive increase in the number of homeopathic prescription items in 2016 compared to previous years: from 2000 to 2015 there had been precisely zero items but this jumped up to two in 2016! These were packets of 'Teetha Homeopathic Granules 7G Sachets Sugar Free Homeopathic Granules 6c'. This is a product manufactured by Nelsons that used to have a Product Licence of Right, but that has now been cancelled by the MHRA. At least this product only contained Chamomile (in a declared dilution of one part in 1,000,000,000,000) and not the Belladonna found in some US products. (A future newsletter will cover suspected adverse events in the UK from homeopathic teething products.)

The United Kingdom

Now we have the data from all the constituent parts of the UK, what does the overall picture look like?

Ignoring the slightly different annual periods, the number of prescription items for the whole of the UK is:

The total cost of these prescriptions amounts to £113,729 in 2017. That is just the cost of the prescriptions themselves and does not include any other costs such as salaries and fixed and variable overheads that the NHS has to bear just to provide these products.

Homeopathy, and the legitimacy given to it by its provision on the NHS, has been diluted and diluted over the years. It's difficult to see how it can ever recover from this decline.

Additional reading

If you are interested in many of the regulatory aspects of homeopathy in the UK as well as in Ireland, the US and India, the blog UK Homeopathy Regulation is an excellent resource and fount of detailed information.

29 March 2018