Health care is Pittsburgh’s economic anchor, employing thousands in hospitals, research units, clinics and related facilities. As goes the medical industry, so goes Pittsburgh.

Medical executives center their attention on "cost, quality and coverage" while considering rising energy prices, especially oil, a minor concern. This is a colossal misjudgment of medicine’s dependence on fossil fuels and the fact that the "hydrocarbon era" is entering its final stages.

Directly, petrochemicals are used to manufacture analgesics, antihistamines, antibiotics, antibacterials, rectal suppositories, cough syrups, lubricants, creams, ointments, salves and many gels. Processed plastics made with oil are used in heart valves and other medical equipment. Petrochemicals are used in radiological dyes and films, intravenous tubing, syringes and oxygen masks. In all but rare instances, fossil fuels heat and cool buildings and supply electricity.

Ambulances and helicopter "life flights" depend on gasoline, as do personnel who travel to and from medical workplaces in motor vehicles. Supplies and equipment are shipped in petroleum-powered carriers. In addition there are the subtle consequences of fossil fuel reliance. A recently retired doctor informs me, "In orthopedics we used to set fractures mostly by feel and knowing the mechanics of how the fractures were created. I doubt that many of the present orthopedists could do a good job if you took away their [energy-powered] fluoroscope or X-ray."

Recently, oil tycoon T. Boone Pickens was asked when we will hit peak oil. "We have already peaked," he said, adding, "Everyone is going to have to come to grips with this in the next two or three years." Simply put, oil is the linchpin resource of modern economies, reaching far beyond gasoline prices.

When production begins to decline, expect the following chain of economic consequences: price increases affecting a variety of products and goods, especially food and medical costs; reduced consumption, with lower income people facing "heat or eat" decisions; the economy slows or goes into recession, which leads to unemployment and less tax revenues for government.

The health of the nation will be at risk as demand for health care from people unable to pay increases. The potential for a vicious circle ensues.

Medicine must overcome its conservatism, bureaucracy and ethos of uniqueness to recognize and then respond to the challenge of peak oil. To illustrate this, a brilliant medical executive told me, "If things get tough, we can requisition oil and other resources because we’re in the business of saving lives. Right along with the military, police and fire we’ve got priority."

This is unrealistic. The current system of health care, which commands 16 percent of GDP and 70 percent of the public finds unsatisfactory, will not continue as is in the midst of economic distress. For example, the Environmental Protection Agency estimates that hospitals use twice as much energy per square foot as office buildings. Hospitals are Cathedrals of Consumption. Who is going to pay for — and morally justify — them as presently operated in an energy-constrained world? Something will have to give. I wish I had been quick-witted enough to tell this executive that the military, police and fire are public goods run by government.

Some medical institutions are nibbling at the margins of the energy issue with "environmentally sustainable" market-based solutions. The market will resolve oil scarcity, of that there is no doubt. It is the manner in which this will occur that is at issue.

With rare exceptions health-care professionals consider only two of the market’s three solutions. For oil these are one, discovery, and two, developing alternatives. The third solution, the one society faces at this late date, is demand destruction — price rises pushing buyers out of the market.

Health-care leaders are surprised when I inform them that in testimony to the Senate in 2006 Alan Greenspan said we should not explore for more oil, a view consistent with peak oil. When I go on to note he suggested developing substitutes, they smile in contented relief. Mr. Greenspan, rarely a bearer of bad news, was silent on the possibility of demand destruction.

Nonetheless his advice to forgo exploration in lieu of substitutes is sound economics. Unfortunately, by "doing the math" we find that present substitutes are of little avail. Tar sands, ethanol and biofuels, among others, are not providing adequate liquid fuels for economic growth. In addition, each is fraught with environmental, economic and health concerns.

The stark truth is that medicine — along with government and society — has no Plan B for peak oil. It looks as though socioeconomic and related hardships — caused by demand destruction — will force a transition to, one hopes, environmentally sustainable energy sources.

Despite this gloom, there are options open to Pittsburgh’s health-care leaders. For example, medical administrators admit to substantial "fat" in the system. Massive conservation and efficiency could lower consumption, especially in hospitals. This is an orderly option that can save jobs — and lives.

Further, medical leaders should highlight the connection between fossil fuels and climate change, and also speak authoritatively about the health consequences of various alternative fuels. They could point out that tar sands, biofuels and ethanol are dead ends and also use their enormous lobbying powers to pressure government to get serious about alternatives and public transportation. A health care perspective on conservation and sustainable energy is, paradoxically, ripe for job growth.

Currently, Pittsburgh health-care executives have extensive infrastructure, human capital and fiscal resources at their disposal. They face a choice: draw down these advantages to prop up a status quo that cannot hold or innovate to deal with peak oil.

Dan Bednarz is a health-care consultant building a national collaboration on energy, climate and the future of health ([email protected]).