Moxa – a Field Medicine for a less-than-certain Future?

Seven years ago back in 2008 Royal Dutch Shell PLC published two possible “scenarios” –their alternative extrapolations as to how the world might see fit to respond to Climate Change over the coming decades until 2050. (This multi-national conglomerate permanently employs a team of big-thinking futurists whom they call ‘scenario planners’). Their two scenarios were both predicated on what the company called “three hard truths” - one of which was that Climate Change is both real and dangerous.

They called one of their scenarios ‘Scramble’ and the other ‘Blueprints’. The one they preferred (‘Blueprints’) imagined a coordinated global effort to cut emissions and develop cleaner technologies - carbon taxes, cap-and-trade schemes, electric cars, solar panels, carbon-capture technology etc, etc. They made no predictions that these would actually stop climate change – the seas would still rise and hurricanes wreck cities – but under this first scenario the results weren’t seen to be nearly as catastrophic as they might otherwise be for those most at risk from a changing climate.

Their alternative scenario,‘Scramble’, imagined a world which would continue to balk at any proper response to the threat because (as they put it) “curbing the growth of energy demand – and hence economic growth – is simply too unpopular for politicians to undertake.” Coal and bio-fuels would continue to drive the growth of low- and middle-income countries, choking air and driving up global food prices and, while countries like Indonesia and Brazil would continue to mow down rain-forests for palm oil and sugarcane, others like Canada and the United States would turn to more unconventional oil projects like tar sands – and more recently, of course, fracking.

Back then in 2008 Shell were quite explicit: they stated that their greener ‘Blueprints’ scenario would be better, not just for the world, but also for the company itself. 

The same year, unfortunately, the banks went belly-up and our national governments have yet to find their way out of global recession. They've been serially failing to properly prioritise, let alone agree, on any meaningful climate policies. Meanwhile global carbon emissions have continued to increase whilst any serious efforts to invest in clean energy is still being mocked in most industrialised countries' media as being uneconomical. The world’s leaders hang back, waiting for someone else to make those critical first concessions, with no-one yet prepared to take the risk of taking the vital leadership role.

Four years after Shell’s Scenarios 2008 publication McKenzie Funk (the author of a book about the profits that some companies are looking to make from climate change), asked Shell’s top scenario planner if the future now looked more like ‘Scramble’ than ‘Blueprints’. “Yeah,” was the blunt reply “that’s the view.” Three years further on and Shell is today visibly in full scramble mode in the Arctic (even after their Directors recommended accepting a shareholders resolution at their AGM  earlier this year demanding that the company takes more responsibility for its contribution to Climate Change and adapts its business over the long term to a low-carbon economy).

Under the ‘scramble’ scenario everyone is basically out to profit and protect themselves as best they can, particularly the multi-national conglomerates and the super-rich. Unfortunately these actions come at the expense of the most vulnerable – specifically of the poor. As Funk summarises: “the hardest truth about climate change is that it is not equally bad for everyone.”

2008 also happened to be the year that the seeds of the Moxafrica project were both sown and germinated. Since then we’ve been learning a lot, not just about moxa, but also about biomedical research, the politics of global medical provision, about tuberculosis and its drug-resistant strains, and a little about what it’s like to be born and live in low-income countries (or indeed to be poor in middle-income countries where 70% of the world’s poorest are living).

Meanwhile the world has been becoming ever more clearly divided between the ‘haves’ and the ‘have-nots’ with wealth discrepancies widening almost everywhere. This phenomenon can be seen having an effect as plainly in the world of bio medicine as anywhere – it was one of the crucial themes we tried to develop in 'Blowing in the Wind'. In fact with DR-TB we see this differentiation already acutely established, manifesting as its core intransigence. Moxa may realistically present not much more than a raft in this inevitable flood of lethal DR disease – but it still looks to be potentially as appropriate as anything else we can yet see on the horizon because it's so low-tech, cheap, potentially sustainable and accessible.

Actually if we care to consider the more recent story of TB we can learn a lot about how the world we live in operates  - it simultaneously suggests the broader scenario that is faced in the coming decades by these same vulnerable people. Back in 1993, after decades of neglect, the WHO declared an unprecedented Global Emergency relating to tuberculosis. In the 21 years since then at least fifty million more have died from what is largely still a curable disease (and we think probably it’s more). Meanwhile, because the dangers of drug-resistance have been so shamefully ignored, the war against tuberculosis has already passed a tipping point. There is still no coherent strategy for those who are most at risk from the disease (largely those same unfortunate two billion poor who are also at most risk from climate change) to see the disease eradicated by 2050 as is still the target (by coincidence the same year as the end-out date for the Shell futurists with their Climate Change scenarios). Nothing allows adequately for the inevitable rise of drug-resistant strains. 

This growing threat from drug-resistant TB makes the problem immense. A team of economists commissioned by the UK government recently predicted that 74 million souls will have cumulatively died from drug-resistant TB between now and 2050 (most in Africa and South Asia). And by then half the disease and well over half of all TB deaths will likely be in drug-resistant cases. 

The core of the problem is unquestionably financial What it really boils down to is this – exactly who will bear the cost of making our world a fairer place to live in?
 
With Climate Change added into the mix these demarcation lines separating the ‘haves’ and ‘have-nots’ make things look more appalling still. As its effects begin to really hit it’s not difficult to foresee another scenario still, with the draw-bridges into the developed from the less developed ones being raised far more obviously than they have been already – and with the world’s poorest being left to face the full front of climatic assault as best they can on their own. 

Since 2002 the number of people globally living in ‘extreme poverty’ (at less than US$1.25 per day) and in ‘moderate poverty’ (less than US$5 per day) is reported to have been reducing, but it’s not difficult to predict that these recent trends are going to reverse because of climate.  According to Dr Jim Yong Kim (the President of the World Bank) “…if the world warms by 2°C (warming which may be reached in 20 to 30 years) – that will cause widespread food shortages, unprecedented heat-waves, and more intense cyclones.” This arbitrary 2°C rise in temperature was pegged in 2009 as a so-called ‘safe’ limit for climate change that was still a realistic goal of containment: that year all the major polluting governments merrily signed a nonbinding pledge to keep global temperatures beneath this. Since then emissions have continued to rise, we’ve already seen a rise of 0.8°C, and yet there are still no signs of governments actually committing themselves to any serious responses. 

In fact even the World Bank reckons that this 2°C target is optimistic and that “we’re already on track for a 4°C  warmer world”. This is a much higher temperature hike. In the chilling words of Kevin Anderson of the Tyndall Centre for Climate Change Research it is “incompatible with any reasonable characterisation of an organised equitable and civilised global community.” 

According to the World Bank even the more modest (and probably inevitable) 2°C rise will result in:
•    shifting rain patterns in South Asia leaving parts under water and others without enough water for power generation, irrigation or drinking 
•    degradation of reefs in South East Asia, resulting in reduced fish stocks 
•    coastal communities and cities becoming more vulnerable to increasingly violent storms
•    regular food shortages in Sub-Saharan Africa including 40-80% losses in crop growing areas.

With a larger rise in temperature these effects will predictably be a lot more extreme. It’s not difficult to see who are by far the most at risk from Climate Change – exactly those whose health provision is already insufficient - those who are already the most vulnerable, and those whose recent socio-economic progress is almost certainly going to be switched into reverse.

What this implies in terms of medical provision worrying. It means, for instance that the wonderful goal of “Health for All” that was originally declared in 1978 and has been being serially re-declared ever since) is fast becoming no more than a pipe dream for those most in need of it (i.e. the poor) and a sacred privilege for the few. In fact proof of this is already out there in the current state of diagnosis and treatment of DR-TB: it already doesn’t exist in the countries where the disease is rife – while it does so in those countries where there is little infection incidence. 

Medical provision globally is already paradoxically available in an inverse proportion to its real need, but this mismatch is looking to get much worse in the coming years. It's is no fantasy – even in richer countries health care costs have been rising faster than both growth and wages for the last two decades, and they are predicted to double again in the coming one.

Under such circumstances, the health ministries of every middle- and low-income country on the planet are facing impossible challenges as they battle to provide health provision for all of their citizens as part of their social contracts. And all of this, we think, has to make the consideration of any low-tech cheap sustainable type of medicine a matter of some priority. 

We now are realising that where resources are short moxa shouldn’t be considered as just offering possible help TB sufferers. Those who are more familiar with moxibustion will agree that the treatment has a far wider range of application than most of the acumoxa community realises, so might offer help for millions with other health problems as well. Acupuncture may have similar potentials but, whilst it's also relatively low tech, it’s far more skill-based and comes with serious risks of cross-infections if treatment isn’t very well-managed. 
 
We increasingly suspect that moxa may hold real promise for the ‘Scramble’ scenario that we now contemplate. Last year we published an e-book of clinical moxa treatments based on the research we did for ‘the Moon over Matsushima’. The intention was that its sales might help raise funds for the ongoing TB investigations, but we realised that we’d referred to over 250 disorders in it – covering almost all types of human affliction. We know well that moxa was used as a lay treatment in a quite unique way in Japan in the past, but we also know that it hasn’t really flourished in the country’s more affluent era. Wherever resources remain poor, however, its potentials remain just as they were in Japan prior to its Pacific war – so if the ‘Scramble’ scenario continues to unravel as the Shell futurists visualise then this relevance surely will increase. 

We are realising that there’s a fresh task presenting itself  – but that it’s not just ours alone. It’s a moral imperative for all of us to consider: to help figure out whatever may or may not help a sizeable proportion of mankind in the coming decades as climate change and social iniquities bite more mercilessly – that is unless fundamental political principles radically change. 

Moxa certainly should never be promoted as any sort of proper answer. In fact today’s heroes of medicine who tirelessly fight for the right of all to decent medical health care would see it as an extremely poor one – and they would surely be right.  Shell even have this aspect of the challenge covered however - in the acryonym their futurists coined in their 2008 document: TANIA - that “There Are No Ideal Answers”. They’re right. Unfortunately it really doesn’t look like there are any. We're going to make the most of everything we've got.

During the coming year we are going to be looking long and hard about ‘less-than-ideal’ answers to the approaching problems of health provision in our changing world – and see how we might help turn any ideas we come up with into some sort of reality. Frankly our ideas are still very vague. We envisage some kind of collaboration in the development of a type of user-friendly resource – some sort of ‘manual of field medicine for the excluded’ perhaps. But for which complaints, and on which treatment points should we most focus? This is what we think we  need to discuss together. The concept need not just relate to moxa of course – in fact we don’t think it should – but moxa is where we intend to start with.

What we are imagining is a field medicine that might be adapted and integrated in any country in which it might be introduced – to be taken in and moulded by local cultures and by local traditions entirely as they see fit.  The best name we’ve come up with for it so far has been ‘field medicine’. There may not even be a better one because it so strongly resonates with the spirit of Doctor Shimetaro Hara whose lifework has been the inspiration for us at Moxafrica. We like to believe that if he were alive today he would approve of this huge idea and even smile at the name - ‘Hara’ after all means ‘field’ in Japanese – so what name could possibly be more appropriate?

If you think you might like to engage with us on this venture, please do get in touch so we can begin to develop our ideas as a collective. Just email us. We sincerely look forward to hearing from you.