The future of humankind is not a zero-sum game—a gain for one people must not be equated with the loss for another. Nationalistic agendas for coping with projected climatic changes will not only be ineffective, but also divisive and counterproductive. Humankind now faces different problems. If relentless global chemicalization and poisoning of human habitat continue unabated—global warming, without doubt, will explode the scale of oxygen crises—the threat to human health and survival will increase exponentially. There is no evidence that planet Earth is preoccupied with its own stability. The study of the known aspects of the history of the planet does not yield any evidence to support notions of its self-preserving or self-stabilizing abilities. It does not seem likely to me that humans—just one of its innumerable creatures, notwithstanding our self-exalted status—can be in a position to materially alter the planetary geological events. In this context, the following three quotes, expressing differing viewpoints, are sobering:

"On climate change, we need to build on Kyoto but we should recognize one stark fact: even if we could deliver on Kyoto, it will at best mean a reduction of one percent of global warming."
Tony Blair, British Prime Minister, September 1, 2002

"With all of the hysteria, all of the fear, all of the phony science, could it be that man-made global warming is the greatest hoax ever perpetrated on the American people? It sure sounds it is."
James Inhoff, US Senator. July 28, 2003

"The Intergovernmental Panel on Climate Change (IPCC) has grossly underestimated the challenges of reducing and stabilizing greenhouse-gas emission, according to an influential group of climate policy experts."
Nature. 2008;452:2008

The dark message of the above three statements—each disturbing in a unique way— underscores a core point of my theme of the supremacy of oxygen issues over carbon issues: it is not clear how an individual can address planetary carbon issues. A realist would consider the large known geological upheavals of the past and recognize the planetary limits on human endeavors. An optimist would counter that in terms of the contemporary civilization, individuals and the society can make definite differences—and should. I was born an optimist, so I persist. I assert that, in contrast to addressing carbon issues, an individual can do much to address oxygen issues, for personal benefit, as well as for the community. Indeed, this was my main purpose in writing the Darwin Dysox Trilogy ^1-3 (the tenth, eleventh, and twelfth volumes of The Principles and Practice of Integrative Medicine).

Primacy of Oxygen Issues Over Carbon Issues for Aquatic Species
A new record for a fish kill was set in 1969. Over 41 million fish were killed, including the largest single recorded fish kill ever in one year, 26 million in Lake Thonotosassa, Florida alone.⁴ Many causes were suspected—toxic efflux from farms and industrial waste, toxic algal blooms, low oxygen levels in the water. However, no single cause was agreed upon. That was the usual outcome of investigations of such aquatic mortalities at that time. Later, technologic advances made it possible to pin down the culprits. For example, in late August 2000, there was a massive fish kill off the northern coast of the Persian Gulf. Some angry Arabs claimed the deaths were caused by toxins released by ballast water from a US tanker in the area. Some of them suspected the US had avenged the attack on the USS Cole by pouring poisons into the waters to rob Omanis of their livelihood. Sober Omani scientists suspected the real culprit might be a toxic algal bloom. Eventually, using data from two NASA Earth Observing System (EOS) satellites, American and Omani scientists proved that the fish kill was due to natural ecologic event changes that caused severe anoxia in the Gulf surface waters.⁵

Oxygen is the organizing principle of aerobic aquatic life. Dissolved oxygen is expressed as a percentage of the oxygen that would dissolve in the water under specific temperature and salinity conditions; warmer and saltier waters hold less oxygen. An aquatic system is considered anaerobic, reducing, or anoxic when it lacks dissolved oxygen (0% saturation), whereas a system with a low concentration of dissolved oxygen—the range between one percent and 30% saturation—is called hypoxic. An aquatic environment is considered "healthy" when it generally does not experience a dissolved oxygen concentration of less than 80%. Most fish cannot survive oxygen saturation levels below 30%.

Enormous volumes of hypoxic waters occupy intermediate depths of eastern tropical oceans. Diverse species of mobile macroorganisms do not survive in such hypoxic waters. Recent climate models predict that global warming will significantly decrease oceanic dissolved oxygen.⁶ Fifty-year time series of dissolved-oxygen concentration for select tropical oceanic regions have been constructed by augmenting historical database with recent measurements. These studies show vertical expansion of the intermediate-depth, low-oxygen zones in the eastern tropical Atlantic and the equatorial Pacific during the past 50 years. Such reductions in the ocean are expected to have dramatic consequences for ecosystems and coastal economies.

The planet Earth is now febrile, becoming more puerile by the year. In recent decades, spectacular displays of color—red tides, orange waves, and others—produced by toxic algal blooms have been observed along all three US coasts.^7,8 In recent decades, the frequency and size of toxic red-tides have increased in many other parts of the world as well. A direct relationship between the outbreak of red tides and anoxia in the bottom water has been observed in the Seto Inland Sea and Ohmura Bay regions of Japan. Tomotoshi Okaichi's book Red Tides (2004)⁹ is an excellent resource for detailed information on this subject. A common related problem concerns Pfiesteria, a family of one-celled organisms that have earned the designation of fish-eaters due to their appearance in the open sores of fish, especially during times of large fish kills.¹⁰ Many people exposed to the fish infested with Pfiesteria describe symptom-complexes that suggest neurotoxicity. In this context, the conclusion of one North Carolina School of Public Health task force is amusing. It recognized the toxicity of Pfiesteria toxins and then declared that the general population should not worry about these toxins. Since the task force did not test unwell people for such toxins, one wonders about the basis of their pronouncement.

I close this section with the plight of polar bears. The summertime Arctic hunting grounds of these animals have been drastically reduced by a warming climate. After years of denial, on May 14, 2008, Interior Secretary Dirk Kempthorne announced that the bears will be placed under the protection of the Endangered Species Act.

Primacy of Oxygen Issues Over Carbon Issues for Land Animals
In Part II of this column, I included accounts of the battered butterfly population of the world, collapsing colonies of honey bees, and brain-fogged bats. Here I include brief comments about extinction of amphibian species. The story of disappearing amphibians of Costa Rica seemed complete when, in 2006, Nature pronounced that it had clinched the diagnosis: global warming.¹¹ After 20 years of die-offs and unanswered questions, the Nature report, disheartening as it was, seemed to provide the answer. However, I could not understand how a difference of one or two degrees Fahrenheit in ambient temperature could have caused the demise. Now more people are joining me in questioning Nature's conclusions. Consider the following quotes:

"Here we show that a recent mass extinction associated with pathogen outbreaks is tied to global warming."⁸
Nature. January 12, 200611

"Other researchers have been questioning that connection. Last year, two short responses in Nature questioned facets of the 2006 paper...Now, in the March 25 issue of PLoS Biology, another team argues that the die-offs of harlequins and some other amphibians reflect the spread and repeated introductions of the chytrid fungus."
The New York Times. March 25, 2008

So, the real culprits are fungi—fermentative metabolizers that grow profusely in hypoxic and anoxic environments. Again, we recognize the primacy of oxygen issues over carbon issues. The true issue here is oxygen deficit and not carbon excess.

Primacy of Oxygen Issues Over Carbon Issues for Plants
On the surface, carbon issues should have primacy over oxygen issues in the context of rising levels of atmospheric carbon dioxide. In general, excess carbon in the atmosphere means excess growth of trees and vegetation. In addition, global warming, whether caused by the greenhouse effect of carbon dioxide build-up or by other factors, initially favors the growth of plants and trees in tropical and subtropical conditions. However, these positive effects on plant growth are lost with continuing rises in temperature and carbon dioxide when soil begins to desiccate. I presented the subject of desertification in Part II of this column.

Primacy of Oxygen Issues Over Carbon Issues for Humans
In human metabolism, oxygen is the actor, carbon the substrate. This basic order persists in all phases of the human food chain, beginning with aquatic phytoplankton and extending to land animals and vegetation. In earlier columns, I marshaled extensive evidence for the central role of disrupted oxygen signaling and impaired oxygen-driven mitochondrial ATP generation in the pathogenesis of various clinico-pathologic entities, including diabetes, cardiovascular disease, renal failure, inflammatory disorders, asthma, and children's growth disorders (see citations in Part I of this column and consider Darwin and Dysox Trilogy for full discussions and long-term clinical outcome studies^1-3).

The Age of Mystery Maladies
We live in an age of mystery maladies—from enigmatic fibromyalgia to the mysterious chronic fatigue syndrome, from baffling brain fog among teenagers to threatening memory lapses among the middle-aged, from spreading epidemics of asthma to those of obesity.

On January 9, 2006, The New York Times projected the rising incidence of diabetes with the following words: "If unchecked, it is expected to ensnare coming generations on an unheard-of scale: One in every three Americans born five years ago. One in two Latinos." One in two Latinos! That is likely to surprise only those unfamiliar with the sad story of the galloping incidence of diabetes among the Pima Indians of the Southwestern United States. In 1908, a traveling physician recorded a single case of diabetes among the tribes. By mid-1990s, the prevalence of diabetes among the Pima Indians had risen to over 60%.12 A 2008 study reported doubling of the rate of gestational diabetes in just six years.¹³

Life at the Edge—a Metaphor for Dysox
A photo essay, "Life at the Edge," in the June 2007 issue of National Geographic described vanishing life at the melting edge of large ice sheets of the world.¹⁴ That title is a perfect metaphor for all imperiled life on the planet—from autistic children to brain-fogged adolescents to women with fecundity problems to men with azoospermia and vascular dementia, from disappearing frogs to dead bats to collapsing honey bee colonies, from poisoned manatees to dying Steller sea lions. Despite an allocation of enormous research funds to find the cause of these phenomena, scientists remain unsure about the underlying causes of all threatened forms of life of that phenomena. I assert that the common denominator in all causes suspected so far is dysox, a state of disrupted oxygen signaling and impaired oxygen-driven mitochondrial ATP generation.

In Greenland, ice previously anchored life and determined its biology.¹⁴ The summers used to steal snow and lift ice; winters do that now. Ice used to be there; now, it stirs and its meltwater create lakes that vanish into unknown drains. The thick ice sheet used to spurn the sun's light and heat. Now, the bedrock beneath thinned ice absorbs both light and heat. Meltwaters that do not drain beget more meltwater. In the Ilulissa region, the spring often experienced -20 degrees Fahrenheit freezes. Now, it sees showers on some days. Phytoplankton used to thrive on the undersurface of the ice sheet. Microbes dined on phytoplankton. Larvae of some aquatic species, like those of Arctic cod, hung in finger-thin channels in ice. Amphipods—shrimp-like crustaceans and others—fed on microbes and the larvae. The amphipod populations sometimes formed grey clouds in pristine waters and attracted larger fish. Beluga whales visited and so did bowherd whales, the species whose members often lived for 200 years. That order of life endured for thousands of years. Now all that is changing.

Glaciers everywhere are evaporating or sliding into oblivion. They race toward the ocean, fracture to spawn flotillas, clog sea waters, and form "edges of life." Greenland's Jakobshavn iceberg is melting at a faster rate than anybody had anticipated. In 1939, Chacaltaya Ski Area, Bolivia began its operations. In 2007, the skiers could expect only artificial snow, if any. As newsworthy as stories of vacant snowless ski areas may be, their significance pales before that of the events occurring at the polar ice helmets of the planet.

Humans Are Not the Apex Predators
Biology is an equalizer. We humans position ourselves at the top of the food chain, and then celebrate that delusion in many ways. I do not see the so-called food chain as a chain, nor do I recognize any exalted positions in the hunter-hunted dynamics. In the eternal predator-prey dance of life and death, the predator often becomes a prey and the prey, a predator. Based on extended clinical experience, morphologic observations, and biochemical findings in patients with diverse clinical disorders, I consider mold allergy, overgrowth of yeast species in the bowel, and mycotoxicosis to be the most significant threats to human health. Considering the myriad roles of fungi in the etiology of human and animal diseases, these "lowly" oxyphobic microbes can hardly be delegated to the bottom of the so-called food chain. Nor can humans be assigned the top position. I cite the case of Staphylococcus aureus to support my larger point here. In 1958, I learned that S. aureus was a nuisance, present on the skin of up to 40% of healthy individuals. In 2008, I learned that the microbial species killed more citizens of the United States than the HIV/AIDS complex.¹⁵

What Next? A World Order of Ethics
Biology is my preoccupation; history, my hobby. Biology is race-neutral. History is nation-neutral. Biology informs, enlightens, and teaches oneness of humans with other planetary life—ecology, in a larger sense, is the name of this discipline of study. History also informs, enlightens, and underscores the need for "oneness thinking." It teaches the effects of intolerance and conflict. History is also the study of the consequences of actions of one group of people on other people; ethics is the appropriate designation for this discipline. Ethics is also the study of inaction in times when action is sorely needed. Biology has no agenda, except to delineate the boundary between confusion and understanding. History provides accounts of the deeds of cults of craven men who covet control of everyone and everything in their paths. It gives us stories of unenlightened men with confused and cruel agendas. The planet Earth also has a history—increasingly uncovered by advances in geosciences—that can teach much about oneness. The history of oxygen on the planet fascinates me most. I find oxygen's message of oneness to be most compelling.

My interests in biology and history developed randomly, and not from any well-considered plan of life. As I studied climatic changes—those documented in this section and others projected by geoscientists—the lessons of biology and history melded together to generate a compelling case for a "new world order of ethics." I imagined a time when a child would be respected because of being human. A child would be taught to respect others because of their humanness and not for reasons of race, creed, or faith. I envisioned a time when a child would be loved because of her/his uniqueness. A child would be taught to love others because of their uniqueness. I conceived an epoch beyond nationalism, a time when no one would be deemed superior to others because of being German, French, American, or Chinese.

Charles Robert Darwin developed his central ideas of ecologic connectivity and natural selection to define his theory of origin of species. Herbert Spencer hijacked that idea and introduced the expression survival of the fittest to advance his social manifesto, an unfortunate choice of words that fostered self-centeredness, abuse of power by the spiritually sclerosed, and oppression of people. Humankind now faces different problems. If predictions about the looming climatic chaos come true—evidence to the contrary is non-existent—there will not be any "fittest" left among us. What poisons some now will poison all with time. Is there a more compelling reason in support of the core notion of oneness of the human species and, by extension, oneness of all planetary life? Is there a more cogent and forceful argument for accepting and fostering this notion of a shared planet?

I end this column with four hopes. First, in the context of impending climatic chaos, the readers will consider the evidence for—and the broader implications for all humankind of—the primacy of oxygen issues over carbon issues. Second, the information presented and arguments marshaled will meaningfully broaden the current debate on climatic issues. Third, the readers, clinicians as well as non-clinicians, will develop a sharper focus on the immediacy of oxygen issues that will precede and/or be exaggerated by carbon issues. In patient advocacy, they will pursue ways to make their contributions, no matter how small, to raise consciousness about the crucial health issues of our time: toxic environments, toxic foods, and toxic thoughts. Finally, the preceding consideration will promote the development of a new order of ethics based on our shared oneness and complete integration with all aspects of the planetary condition.

Notes
1. Ali M. The Principles and Practice of Integrative Medicine Volume X: Darwin, Oxygen Homeostasis, and Oxystatic Therapies. 2nd edition. New York: Canary 21 Press; 2007.
2. Ali M. The Principles and Practice of Integrative Medicine Volume XI: Darwin, Dysox, and Disease. 2nd edition. New York: Canary 21 Press; 2007.
3. Ali M. The Principles and Practice of Integrative Medicine Volume XII: Darwin, Dysox, and Integrative Therapies. New York; Institute of Integrative Medicine Press; 2008 (in press).
4. Hillsborough County Water Atlas. Available at: www.hillsborough.wateratlas.usf.edu/lake/default.asp?wbodyid=5383&wbodyatlas=lake - 26k.
5. Fish kill in the Gulf of Oman - A space-based diagnosis. Available at: www.earthscape.org/l2/ES17259/EO_FishKill.pdf. (Access requires log in.)
6. Stramma L, Johnson GC, Sprintall J, et al . Expanding oxygen-minimum zones in the tropical oceans. Science. 2008;320:655-658.
7. Adams NG, Lesoing M, Trainer VL. Environmental conditions associated with domoic acid in razor clams on the Washington coast. J Shellfish Res. 2000;19:1007–1015.
8. Lam CWY, Ho KC. Red tides in Tolo Harbor, Hong Kong. In: Okaichi T, Anderson DM, Nemoto T, eds. Red Tides, Biology, Environmental Science, and Toxicology. New York: Elsevier; 1989:49–52.
9. Okaichi T. Red Tides. Terrapub, Kluwer Academic, Springer; 2004.
10. Magnien RE. State monitoring activities related to Pfiesteria-like organisms. Environ. Health Perspect. 2001;109 Suppl 5: 711–4. PMID 11677180. And: Rublee PA, Remington DL, Schaefer EF, Marshall MM. Detection of the Dinozoans Pfiesteria piscicida and P. shumwayae: A review of detection methods and geographic distribution. J. Eukaryot. Microbiol. 2005;52 (2): 83–9.
11. Pounds JA, Bustamante MR, Coloma LA, et al. Widespread amphibian extinctions from epidemic disease driven by global warming. Nature. 2006;439:161-167.
12. Lillioja S, Mott DM, Spraul M, et al. Insulin resistance and insulin secretory dysfunction as precursors of non- insulin-dependant diabetes mellitus: Prospective studies of Pima Indians. N Engl J Med. 1993;329:1988-1992.
13. Mailloux L. Available at: http://patients.uptodate.com/topic.asp?2008, gestational diabetes. Accessed February 13, 2007.
14. Nicklen P. Life at the edge. National Geographic. June 2007:32-55.
15. Sack K. Deadly bacteria found to be more common. The New York Times. October 17, 2007.