‘Think again’ about the climate diagnosis and treatment plan

Climate’s Big Picture, Part 2

We medical school professors teach our students to “Think again,” to regularly reconsider both the patient’s diagnosis and the treatment plan. One must repeatedly search for new players and for better treatment combinations.

Such meta-level re-evaluation has not been happening for climate disease, even though the 21st-century has seen the rapid onset of serious climate impacts — some of which seem likely to preempt those long-term projections that we scientists find easier to explain and defend.

Unfortunately, to the public and the legislators they vote for, long-term thinking often allows postponing immediate action. Even such safety issues as seatbelt adoption and the smoke-free workplace took a quarter century before meaningful action was taken. Inaction still characterizes areas with a big stockpile to draw down, such as 1.3 guns per person in the US and the 50% excess carbon dioxide overhead.

The physician’s mindset is what I hope to convey here, to assist others in rethinking the treatment plans for our climate crisis. For example, the ocean acidification and climate problems that result from atmo­spheric accumulation of excess carbon dioxide may not auto­matic­ally decline once you stop feeding the excess. Once you have a dental abscess, better brushing is unlikely to keep the infection from going systemic and killing you. Long-term generalities may prove insufficient for surviving what happens in the meantime.

So, what is our current mindset regarding the climate threat? Here I am not addressing what the public understands but what our leaders aim to convey to everyone — both the scientific leaders and those political leaders most outspoken about the need for climate action. To oversimplify, they say “Overheating bad. Fossil-fuel emissions are the cause, so zero them.” This fifty-year-old mindset, influenced by the 1970s success in reducing smog via catalytic converters, has become an inadequate framing for the 21st-century climate threats. Here I am attempting a reframing.

Back before surface temperatures began ramping up in 1976, promot­ing emissions reduction was the logical framing for climate action. Now we are already overheated and must quickly clean up a half-century’s annual CO2 contributions in order to back out of the danger zone. Cleanup, with shade in the meantime, are the climate actions where we have too little leadership — or even regular media coverage.

Emissions reduction, furthermore, was already a good idea for economic (LED lighting requires 80% less power) and environmental reasons (cleaning up urban air pollution). But we also saw a lot of re-branding as one group after another claimed that their focus was also relevant to the climate cause. Some vegetarians claimed relevance to “climate solutions” even though uneaten grass would promptly rot, turning back into CO2.

Most of this was not greenwashing or publicity-seeking; people were eager to contribute what they could to solving climate, putting their own knowledge to work. Even if something would amount to less than one percent of the climate action need, it was still claimed to be a “climate solution” on the “Every little bit counts” principle endorsed by their leaders.

Some “climate solutions,” however, are only relevant to what might have helped prevent the present climate crisis. That is because the need for cleanup-sized actions grew so fast. We now need to clean up the 50-year accumulation created while emissions reduction efforts failed to do the job.

It does not help that the public is being distracted by claims of “climate solutions” that are miniscule, the sort of case that a judge might throw out using the de minimis rule. The FDA has rules restricting overclaiming for medical “solutions” but there are no such rules for climate claims and greenwashing has flourished.

Unfortunately, some of the major players have turned out to be minor players — even the most obvious scheme for cleaning up the excess carbon dioxide, planting a trillion trees to store some of the CO2 excess in wood. How much does that reduce the overheating? Three percent max, and only by the end of the 21st century. It is the same for biochar.

A caution: the role of emissions reduction is no longer primary but is still useful in a secondary way, once we actually start doing a big cleanup. It has become what, in medical Latin, would be called an adjuvant, a supplementary treatment that is ineffective by itself but augments a more effective treatment. The familiar example is chemotherapy following surgical removal of a tumor, one too big to reduce with chemo alone but where chemo is still useful for speeding recovery and getting at the smaller scattered metastases where chemo may suffice. Zero emissions is an adjuvant that will speed up the cooling from a CO2 cleanup — that is, provided a serious cleanup is in progress. (It is not.)

Indeed, until about 2018, one would have thought that CO2 cleanup was a taboo topic like shade geoengineering has been treated. The only climate actions ever mentioned were mitigation and adaptation — which would be new words to learn for many legislators. Diet, shade, and cleanup are more widely understood.

In an emergency, one does not stand around speculating on the ultimate cause of the problem and only doing what once might have headed off the threat. Or so we teach medical students, from the accumulated wisdom (and mistakes) of the 2,500 years since Hippocrates.

Watching the pro’s climate thinking developing over the past forty years, I have been searching for comparisons to the mistakes made in the history of medicine via over­generalization and via the frequent failures to statistically test a promising treatment for actual effectiveness using control groups. Those were the very issues addressed early in the Scientific Revolution (1600s, Shakespeare’s generation) by Francis Bacon, English philosopher and statesman for the first Queen Elizabeth. For various reasons, reality testing took another 400 years to creep from scientific thinking into medical thinking.

The modern medical mindset now includes staged strategic think­ing, all while keeping an eye on the clock and regularly re-evaluating. hysicians must daily deal with the triple combination of complexity, incomplete understanding, and urgency. Most Ph.D. basic researchers (including me, including climate scientists) get little education for it, nor for the “get ahead of the problem” part of the medical mindset that is so important in emergency medicine, needed to stay hours ahead of possible disease developments before they create a slippery slope toward death.

Emissions reduction is reminiscent of the 1960s medical advice to smokers to “Cut back to one pack per day.” Since diets frequently fail, it is surprising that so many leaders have continued to only speak of emissions-rate reductions. Were this “carbon diet” succeeding, the yearly bump-up in carbon dioxide (CO2) accumulation would be declining. Instead, it is now rising 50% more rapidly than in the 1990s.

That is not progress on climate, though seeking emission reductions proved quite useful on economic and some environmental criteria. In medicine today, however logical such a treatment seemed, it would be called an inadequate treatment — perhaps even a harmful failure, such as bleeding and purging were.

Yet today’s climate messaging fails to convey the immediate need for stronger medicine. A quote from one of the IPCC scientists: “In 2021 the world spent a total of $755b on reducing emissions. We should probably aim to spend about 1% of that money on carbon removal technologies.” Damning with faint praise, indeed. Most climate scientists do not think like our medical students, nor like professional engineers concerned with failure modes.

When scientists got started on the emerging climate problem in the 1960s, the carbon dioxide concentration was 320 parts per million, 14% above the preindust­rial high of 280 ppm (also the high during the warmup from the last two ice ages). Today at 420 ppm, there is a 50% excess, halfway to doubling the CO2 concentration to 560 ppm.

That half-century accumulation has now created a climate emergency, the price of those decades of delay and denial. That accumulation, not just our current rate of making things worse, is what we must now address.

We have known for decades that net zero emissions, even if achieved, would provide insufficient relief from overheating during the next fifty years. Even after Jared Diamond’s book Collapse came out in 2005, analyzing how most past civilizations collapsed when hit by big environ­mental challenges, we did not get a reassessment of 21st-century threats and a major search for better treatment plans, complete with prototypes and field trials to evaluate.

Now we must face up to the possibility of a massive collapse of the global economy and, in many regions, a disorganization similar to the collapse of civilization’s institutions, such as education and a judiciary that can enforce contracts and settle disputes. Such things have happened many times before; this is not speculation. “Failed states” are merely the recent examples.

This institutional collapse could occur even before heatwaves start killing millions of people every summer. That threat comes not so much from more fractional degrees of overheating as from the recent surges in extreme weather caused by the existing excess of carbon dioxide overhead.

Figure 2–5. Globally averaged Sea Surface Temperatures (SST), above the pre-1976 baseline; monthly values this time, and (heavy line) their three-year sliding average. SST contributes 71% of the global average surface temper­ature; the 29% continental contribution exhibits much more variability (droughts reduce evaporative cooling of the surface), so I have chosen SST to identify the hiatus.

Step-arrows mark start times for the Big Five. “Severe” means >$1b damage per US event, per NOAA’s database. “6x” means the average annual rate of >$1b events is now six times the post-1980 baseline’s average rate before the step. My criterion for inclusion in the Big Ones was three times or more increase; the extreme weather runner-up was severe drought at 1.6x.

Lower: The Multivariate ENSO Index Version 2 shows the lack of a big El Niño during the hiatus.

Link to Part 3.



The focus here will be on 21st-century surges in global weirding occurring atop the creep in global warming. Indeed, extreme weather surge-and-stay may collapse our civilization before the creep up in temperature does. We must back out of the danger zone and its slippery slope.

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William H. Calvin

President, CO2Foundation.org. Professor emeritus, University of Washington School of Medicine in Seattle. Author, many books on brains, human evolution, climate