Preventing Sudden Unexpected Death on a Massive Scale

Hello and welcome. I am Dr George Lundberg and this is At Large at Medscape.

The single most harmful action that any one human being could take is the initiation of a nuclear war, which would cause the sudden, unexpected death of massive numbers of infants, children, adults, entire societies—even human civilization as we know it.

This is a column about two books that describe decades of efforts to control nuclear weapons, one from 2008 and one from 2015. First, let me provide background and context.

The United States won the race to build an atomic bomb, succeeding before Japan and Germany in the 1940s. On August 6, 1945, an American B-29 exploded an atomic bomb over Hiroshima, Japan, destroying the city. On August 8, 1945, Dr Taro Takemi, physician to the emperor, "diagnosed" the atomic bomb, using a radioscope of bones brought to Tokyo from Hiroshima.^[1] He quickly informed the emperor. The emperor, understanding that Japan could not win the war now, decided to accept the terms of the Potsdam Declaration and end the war. [Editor's note: The acceptance declaration was not recorded until August 14, 1945.]^[2] That decision was broadcast simultaneously in London and New York. On August 9, 1945, another American plane exploded a second atomic bomb, destroying most of Nagasaki, Japan. Japan formally surrendered on September 2, 1945.

The nuclear age was born.

Harry Truman, in 1950, and Dwight Eisenhower, in 1953, considered using nuclear bombs in Korea, and Richard Nixon considered such use in Vietnam in 1972. None did so. In 1981, Ronald Reagan spoke and acted aggressively by increasing the US capability to wage nuclear war.

An End to Nuclear Madness?

Revolted by these actions, two cardiology experts in the occurrence of sudden unexpected death, Bernard Lown of Boston, Massachusetts, and Evgeny Chazov of Moscow, Russia, put their heads together to endeavor to prevent the potential massive, sudden, unexpected death from nuclear war. In 1980, they founded International Physicians for the Prevention of Nuclear War (IPPNW), involving more than 100,000 physicians worldwide, and somehow got to Mikhail Gorbachev and Ronald Reagan with effective education and persuasion. These leaders softened their antagonistic positions and prevented nuclear war. Lown and Chazov accepted the Nobel Peace Prize in Oslo in 1985 on behalf of IPPNW. These initiatives are described in detail by Bernie Lown in his 2008 book, Prescription for Survival: A Doctor's Journey to End Nuclear Madness.^[3]

On August 5, 1983, JAMA began a tradition of publishing an annual "Hiroshima Issue" during the first week of August, dedicated to the prevention of nuclear war. The same cover art was used each year. In that inaugural theme issue, Dr Takemi described the historic events for the first time in English.^[1] He ended his illustrated commentary by saying, "Japanese and American physicians should join together to prevent the use of nuclear bombs." In addition to being the emperor's personal physician, Takemi was the president of the Japan Medical Association for 25 years, the father of the "Japanese JAMA," and highly influential with socialized medicine in Japan. This successful Japanese healthcare delivery system continues to the present time, and Japanese life expectancy remains the highest in the world.^[4]

On August 5, 1998, in the annual Hiroshima issue, JAMA published an editorial^[5] coauthored by the presidents of both the Indian and Pakistani medical associations, joined by Lown, Chazov, and former CDC Director William Foege. This editorial called on the prime ministers of India and Pakistan (both of which became nuclear powers in May 1998 and were contemplating war) to not use nuclear weapons. They did not.

Back at the Brink

William Perry's 2015 book, My Journey at the Nuclear Brink,^[6] describes his beginning involvement in the nuclear field in 1962 with the Cuban Missile Crisis. It chronicles a career in the military, academia, entrepreneurial industry, and government, in which he served as President Clinton's secretary of defense, among other key roles. Perry has dedicated his life to national security. His book gives the inside story of more than 50 years of international efforts at nuclear control, enunciating a giant question mark about the future.

Nuclear weapons are owned, controlled by, or stationed in 15 countries: Canada, the United Kingdom, France, Israel, Russia, India, Pakistan, China, North Korea, Belgium, Germany, Italy, The Netherlands, Turkey, and the United States.^[7] What human is likely to break the nuclear calm? A deranged leader, a power-mad despot, an amoral paranoid, a suicide bomber, a terrorist, one engaged in a brinksmanship game of "chicken" spun out of control, a child-emperor, a thin-skinned hothead?

To the greatest extent possible, physicians should endeavor to assure that the leaders who could authorize the first strike be mature, sane, cool under pressure, loving humanity and their lives and families, capable of exercising self-control, crisis-tested, and who fully comprehend the enduring consequences.

Think about that. Think hard about that. There is no adequate medical response to nuclear war. Prevention is the only option.

Be afraid; be very afraid.

That is my opinion. I am Dr George Lundberg, at large for Medscape.

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