]]]]]]]]]]]]       INTERNATIONAL PHYSICIAMS FOR         [[[[[[[[[[[[[ 
            From THE LANCET (British medical journal), 
                     18 Nov. 1988, pp.1185-6

          By Jane M. Orient, MD   [Freeman 85716ORIE]

    Leaders of the Nobel Peace Prize winning group International
Physicians for the Prevention of Nuclear War (IPPNW) claim that
their struggle against the nuclear threat may be "one of the
significant contributions of our profession to the survival of
humankind" (1).  Citing their "unique knowledge and expertise"
as qualifications for working for the abolition of nuclear
weapons, IPPNW urges physicians to educate the public about
nuclear war and to offer sound prescriptions for nuclear war
prevention (1).
     In science, good intentions and noble sentiments do not
exempt one's work from critical scrutiny.  Because the advocacy
of IPPNW is cloaked in scientific authority, it should be (but
rarely is) subjected to the usual rigors of scientific
     IPPNW has indeed played a major role in educating the public
about nuclear war, and consequently in gaining widespread
acceptance of fallacious beliefs, some of which are repeated in
the Lancet (1).  For example, Lown speaks of nuclear winter as a
"discovery" rather than as a hypothesis.  IPPNW has pointedly
ignored the criticism (2-5) of the original nuclear winter
report, as well as the later, more sophisticated studies that
have debunked the doomsday scenario, while not ruling out the
possibility of some climatic effects (6), of which drought may be
the most important (7).   
     In referring to the Chernobyl disaster, Lown states that the
odds of a meltdown were estimated to be 1 in 10,000 years,
according to Soviet Life.  (A mere meltdown would have been a
trivial event in comparison with the graphite-fueled fire that
actually occurred.)  Yet American engineers recognized the danger
of reactors with a positive void coefficient (like the Chernobyl
reactor) as early as 1950 (8).  Why did the Soviets choose an
unsafe design for a reactor built quite recently?  One possible
explanation is that such reactors can be refueled while in
operation, permitting the production of weapons-grade plutonium
as a byproduct (9).
     At the time of the Chernobyl disaster, Soviet civil defense
proved its worth as a means of saving lives, even though it was
designed for a nuclear attack rather than a reactor accident. 
Engineers were safe in the bomb shelter while they shut down the
other reactors at the site, although the outside radiation dose
was up to 1000 rads per hour (10).  Within 12 hours, 3000
physicians and 2400 nurses, paramedical personnel, and laboratory
technicians had been transported from as far away as Moscow (11). 
Eventually, more than 135,000 citizens were evacuated from the
surrounding area (12).  The lesson drawn from the experience in
the Soviet Union is that civil defense needs to be improved,
especially in the area of population training (10).
     In the United States, on the other hand, civil defense
often is what Lown calls "a butt for social satire" (1), largely
because of the efforts of his own organization. 
     The assertion that civil defense might "foster illusions but
would not mitigate any of the dreadful consequences" (1) is in
conflict with the data.  Blast and fallout shelters have been
extensively tested and proven effective (13-14).  The Swiss, the
Soviets, the Chinese, and the Swedes have constructed shelters on
a massive scale.  Spokesmen for IPPNW and Physicians for Social
Responsibility do not discuss the shelter tests, but simply
dismiss the concept, citing the experience of the Hamburg
firestorm of 1943 as "proof" of the futility of shelters (15-
18), even though 85% of the population in the firestorm area
survived, including most persons who were in minimally adequate
bomb shelters (19-21).
     While predicting a high likelihood that nuclear war will
occur (a 40% probability over the expected lifespan of today's
young people (1),) IPPNW continues to promote a policy of
defenselessness.  This would assure the maximum number of
casualties in the Western world, should IPPNW fail in its noble
efforts to prevent war.  (In the Soviet bloc, there is no
evidence that IPPNW's ridicule of civil defense has hindered the
program to the slightest degree.)
     IPPNW's "sound prescriptions" (by its own assessment) are
all related to prevention of war through arms control. 
Unfortunately, the efficacy of such remedies is a matter of
faith.  Unlike a new drug or surgical procedure, they are not the
subject of research.  A study of the historical record gives
little cause for optimism; however, history is apparently not
among the areas of expertise claimed by IPPNW.  Its spokesmen
have yet to comment on the Washington Naval Treaty of 1922, the
Kellogg-Briand Pact of 1928 (for which Kellogg and Briand
received the Nobel Peace Prize), the Oxford Peace Resolution of
1934, the Munich Agreement of 1938, or the Molotov-Ribbentrop
Pact of 1939, and on the effectiveness of these measures in
preventing World War II.  Nor does IPPNW acknowledge the fact
that their current prescription, the cessation of all nuclear
explosions (1), was tried in late 1958, and lasted until the
Soviet Union surprised the U.S. with an extensive, well-planned
series of tests, even as a formal treaty was being negotiated
     Like their prescriptions, the rationale given by IPPNW has a
historical precedent.  Sir Norman Angell (also a Nobel Peace
Prize winner), in his 1910 best-seller entitled The Great
Illusion, showed that war had become so terrible and expensive as
to be unthinkable.  The concept of "destruction before
detonation" was not discovered by Victor Sidel (22), but was
previously enunciated by Neville Chamberlain, who warned his
Cabinet about the heavy bills for armaments:  "even the present
Programmes were placing a heavy strain upon our resources" (23).
     IPPNW does not represent a consensus among physicians. 
Most physicians recognize that their medical skills do not
necessarily qualify them as experts in nuclear weapons effects,
climate modeling, reactor safety, and diplomacy.  Furthermore,
even those who agree with IPPNW about the desirability of arms
control treaties might question the antidefense part of the
     Psychic numbing, denial, and "missile envy" (24) are some of
the diagnoses applied by IPPNW members to those who differ with
them.  However, for the threats facing the world, IPPNW does not
entertain a differential diagnosis, nor admit the slightest doubt
about the efficacy of their prescription, if only the world will
follow it.  So certain are they of their ability to save us from
war that these physicians seem willing to bet the lives of
millions who might be saved by defensive measures if a nuclear
attack is ever launched.
     Is this an omnipotence fantasy?


1.   Lown B.  Looking back, seeing ahead.  Lancet 1988;ii:203-
2.   Penner JE.  Uncertainties in the smoke source term for
     "nuclear winter" studies.  Nature 1986;324:222-226.
3.   Seitz R.  Siberian fire as "nuclear winter" guide.  Nature
4.   Seitz R.  In from the cold:  "nuclear winter" melts down. 
     National Interest 1986;2(1):3-17.
5.   Chester CV, Kornegay FC, Perry AM.  A preliminary review of
     the TTAPS nuclear winter scenario.  Oak Ridge, TN:  Oak
     Ridge National Laboratory, 1984 (ORNL/TM-9223).
6.   Thompson SL, Schneider SH.  Nuclear winter reappraised. 
     Foreign Affairs 1986;64:981-1005.
7.   Chester CV, Perry AM, Hobbs BF.  Nuclear winter: 
     implications for civil defense.  Presented at the annual
     meeting of The American Civil Defense Association, Mobile,
     AL, November 8, 1987.
8.   Teller E.  Better a shield than a sword: perspectives on
     defense and technology.  New York:  Free Press, 1987.
9.   Cohen BL:  The nuclear reactor accident at Chernobyl, USSR. 
     Am J Phys 1987;55:1076-1083.
10.  Goure L.  Comparison of Soviet and United States civil
     defense programs. Presented at the National Emergency
     Training Center, Professional Development Series Capstone
     Seminar, Emmitsburg, MD, May 17, 1988.
11.  Lushbaugh CC.  What we have learned from Chernobyl.  West J
     Med 1988;148:76-77.
12.  Wilson R.  A visit to Chernobyl.  Science 1987;236:1636-
13.  Beck C (ed).  Nuclear weapons effects tests of blast type
     shelters--a documentary compendium of test reports. 
     Washington, DC, US Atomic Energy Commission, June 1969 (CEX-
14.  Chester, CV, Zimmerman, GP.  Civil Defense Shelters:  a
     State-of-the-Art Assessment -- 1986.  Washington, DC,
     National Technical Information Service, 1987 (ORNL-6252).
15.  Ervin FR, Glazier JB, Aronow S. et al.  I.  Human and
     ecologic effects in Massachusetts of an assumed
     thermonuclear attack on the United States.  N Engl J Med
16.  Leaf A.  New perspectives on the medical consequences of
     nuclear war.  N Engl J Med 1986;315:905-912.
17.  Geiger HJ. Illusion of survival.  In:  Adams A and Cullen S,
     eds.  The final epidemic:  physicians and scientists on
     nuclear war.  Chicago: Educational Foundation for Nuclear
     Science, 1981:173-181.
18.  Leaning J:  Star Wars revives civil defense.  Bulletin of
     the Atomic Scientists 1987 (May);vol 43(4):42-46.
19.  US Strategic Bombing Survey, No. 154:  Public Air Raid
     Shelters in Germany.  
20.  Earp KA:  Deaths from Fire in Large Scale Air Attack -- with
     Special Reference to the Hamburg Fire Storm.  Whitehall,
     Home Office Scientific Advisory Branch (Report CD/SA 28),
     April, 1953.
21.  Kehrl:  Bericht des Polizeiprsidenten in Hamburg als
     rtlicher Luftschutzleiter ber die schweren
     Grossluftangriffe auf Hamburg im Juli/August 1943.  Hamburg,
     Dec 1, 1943.
22.  Sidel VW.  Destruction before detonation: the impact of the
     arms race on health and health care.  Lancet 1985;ii:1287-
23.  Minutes of the British Cabinet meeting, February 3, 1937. 
     Quoted in Fuchser, LW.  Neville Chamberlain and Appeasement: 
     a Study in the Politics of History.  WW Norton, New York,
24.  Caldicott H.  Missile envy:  the arms race and nuclear war. 
     New York:  William Morrow, 1984.

Jane M. Orient, MD
1601 N. Tucson Blvd. Suite 9
Tucson, AZ 85716

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