We just did a Google check entering the words "lung threshold values" in German. After 0.39 seconds, approximately 226,000 results were spat out. The first six titles, which we translate from German, were as follow:
The list of signatures initiated by ex-DGP President Prof. Dieter Köhler (DGP: German Respiratory Society, in German: Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin) has made media waves and put the profession of pulmonary physicians in the public spotlight. The topic provided and provides further discussion material and several comments with frequently clear positioning for or against threshold values.
What are we missing? Perhaps a concrete sustainable strategy in favor of a healthier living environment? Bans on diesel driving cannot be taken seriously as a solution can it? It is also clear that the environmental advantage of petrol over diesel is by no means clear. Diesel cars are more environmentally friendly, especially on long journeys, while new, more economical petrol engines generate plenty of air particles. The main problem is likely to be that modern and cleaner technologies are rarely used. The discussion is beautifully summarized in a question raised by the German news portal WDR: Is petrol really the better diesel? (link in German).
The question of particles measurement is difficult, also because this monitoring is limited to individual streets, which can lead to lower values at the measuring station, but to a higher, but not measured air pollution in any bypassed area.
Epidemiologists and pulmonary physicians have been delivering the professional exchange of blows among themselves. The DGP position paper published in November 2018 in favor of compliance with the threshold values was prepared under the leadership of lung epidemiologist Prof. Holger Schulz from Helmholtz Zentrum Munich and environmental epidemiologist Prof. Barbara Hoffmann from Heinrich Heine University in Düsseldorf. The signatories around Prof. Köhler have publicly opposed this official DGP line. The professional association has again publicly distanced itself from the renegade pneumologists.
The whole world of pneumologists, it seems, is now looking at Germany: "In the German dispute over threshold values for air pollution control, lung medicine associations from all over the world are now taking a stand," reads the fine dust debate in the Frankfurt-based newspaper FAZ. This is a statement by the Forum of International Respiratory Societies (FIRS), motivated by an article by FAZ editor Joachim Müller-Jung, who is responsible for "Nature and Science". Under the title "What drives the pulmonary physicians?" Müller-Jung, not exactly free of contradictions in his text (to which also some of the reader comments refer), rumbles against the signature action and complains that "of all people, physicians who are supposed to keep an eye on the health of even the weakest, misjudge this development in their very own area of responsibility".
According to the portal “Ärzte Zeitung online” (Medical Daily Online), FIRS is currently headed by Prof. Tobias Welte, who is currently European Respiratory Society (ERS) President. Perhaps this has something to do with the prompt international reaction.
The latest public contribution to the discussion from the lung physician's side comes from Lower Saxony's Medical Association President, Dr. Martina Wenker, who also serves as Vice President of the German Medical Association (In German: Bundesärztekammer). The pneumologist has just been quoted in the German Medical Journal (In German: Deutschen Ärzteblatt) with the demand for a comprehensive concept to contain the negative health effects of climate change and environmental pollution. Wenker pointed out that air pollution cannot be solved by banning diesel driving in cities alone.
True! This should also be the core of the poodle of the debate. Nobody will deny that the air we breathe should be polluted as little as possible, not even Prof. Köhler and his undersigned colleagues. Common sense dictates a commitment to improved air quality without the need for a great deal of scientific evidence. On the other hand, both common sense and evidence also make actionist individual measures appear to make little sense due to politically set limits. Just by the way, looking at the particularly vulnerable group of asthma patients, many of whom are professionally active. How does it fit together that far higher threshold values are permitted in the workplace than in road traffic?
According to the Federal Environment Agency (In German: Umweltbundesamt), a long-standing downward trend in particulate matter and nitrogen oxides can be observed in Germany. However, firstly, there is still air up here, secondly, this is far from being the case for all potentially toxic substances and, thirdly, new climate-related challenges are coming our way. We - and by this we mean you and all (pulmonology) medical colleagues - should try with all our expertise and within the bounds of our possibilities to contribute to healthier handling of the air quality issue.
A petty, politically and/or lobbyistic and/or ideologically motivated scramble for unilateral measures and their existing or missing scientific basis is not enough. There is a real need for a discussion in society as a whole in which a framework for attitude and action is drawn up that deserves the term "strategy".
In the reader comments to the news article about the Köhler statement, it is mentioned that the more than 100 signatories make up less than 3% of the more than 4,000 DGP members who were contacted. That's right. But does this also mean that the silent masses are convinced that the threshold values make sense and that driving bans are the best way to comply with them?
And what's your opinion?