Doctors have a duty to evaluate the risk to one, but not to prevent beneficial outcomes to all.

I am writing in response to commentary by Drs. Albert Aniel and Michael Nissenbaum, published in the Sun Journal on May 10 and also made before the Public Health Committee of the Maine Medical Association, in which they propose a moratorium on development of wind power in Maine.

As a physician, I very much support their interest in primum non nocere, that is, do no harm. But that primary principle of medical ethics cannot be taken literally, as they seem to do. We, as physicians, routinely “do harm” in small ways (cutting into patients, injecting medications, prescribing medications with significant side effects) in the interest of a greater good.

The doctors seem to advocate taking no action until absolute safety is guaranteed, but this is incorrect and would stifle virtually any medical response. Physicians are trained to choose courses of action, knowing there is a need to balance risk and benefit. If the outcome were clear, there would be no need for judgment, no need for physicians. The physician must balance risk and benefit, and thus advise the patient.

Applying this to the question at hand, it’s notable that a major resource, MD Consult, lists only one reference to health effects of turbines. Both Dr. Dora Anne Mills, head of the Maine Centers for Disease Control, and Dr. Charles Danielson, chairman of the MMA Public Health Committee, spoke of their fruitless effort to find significant material supporting a moratorium on the Internet, leading Dr. Mills to conclude there is no need to delay development.

Dr. Nissenbaum’s work at Mars Hill, as he said during the MMA committee hearing of March 25, consisted of interviews with 15 residents (one percent of the population) who had in fact, he said, invited him to meet with them. All had some level of complaint and most complaints were those seen in anxiety, related, it was thought, to the presence of the turbines.

With this in mind it would seem that the assertion is valid, that the complaints noted are related to the turbines. But are the complaints of significance? Here the answer is, in my opinion, no, except for the one percent affected. It is unfortunate that in almost any situation there will be a small number who find it intolerable. Their needs should be met, as possible, but should not dictate the outcome.

To assist physicians with making decisions like this, we have a four-level tree. We start with a treatment, or, in this case, an assertion, that wind turbines may have adverse health effects. The first level is to decide if the assertion is valid. If invalid, there is no further consideration. If it is valid, the next level is significance.

If the assertion is not significant, that’s the end. If it is significant, we go to level three: Are the risks/health effects of wind turbines less than, or greater than the benefits? If the risks of health effects are less, there is no need for further concern, and the process – considering a moratorium – stops. If the risks are greater, one reaches level four, where a decision must be made whether or not to proceed even with major risk.

We can end, in this case, at level three. If there were adverse health effects related to turbines, do they outweigh the benefits of wind power? There is no reliable evidence that low-frequency sound from wind turbines is a health problem. (There is a great deal of evidence that listening to MP3 players is a far greater hazard).

Yet the health benefits of alternative energies, including wind power, are multiple: with less particulate matter from fossil fuels air quality is much improved; climate change pollutants are diminished; for the majority, wind farms are not excessively noisy; and technological improvements are continuing. And, as an alternate energy source, our dependence on oil is greatly reduced.

Of particular concern is the op-ed’s statement that “the Maine Department of Environmental Protection and the Department of Health and Human Services are currently unprepared and largely unaware of noise and health issues related to wind factories.” Quite to the contrary, Dr. Mills demonstrated her awareness, preparation, as well as concern, by her presentation before the MMA Public Health Committee on March 25.

And Andrew Fisk, director of Bureau of Land and Water Quality at the DEP, is on record with testimony before the Governor’s Wind Power Task Force from February 2008, that the DEP has, since 1979, been aware of and dealing with noise issues, and, more recently with matters such as flicker from turbines.

In conclusion, while I respect the doctors’ adherence to medical ethics in this case, I feel their failure to consider the long-term negative effects of a moratorium to be regrettable.

Dr. Richard K. Jennings, of Fayette, is a psychiatrist. E-mail: [email protected]