The Medical Implications of Nuclear War Institute of Medicine, National Academy of Sciences; Edited by Frederic Solomon, MD, and Robert Q. Marston, MD (National Academy Press: Washington, D.C., 1986) 579 pp. $33.50

This just in from the Institute of Medicine of the National Academy of Sciences: Nuclear war is bad. For those who have not yet appreciated this fact, perhaps because their consciousness has not yet been sufficiently raised (to use the words that actually appear in this volume), the institute has produced 579 pages' worth of sober analysis of the post-apocalypse.

To summarize: A lot of people will be killed, a lot of people will get sick, a lot of people will be upset, and there won't be enough food -- or, worst of all, doctors -- to go around. Does this surprise anyone? Probably not, and therein hangs a curious tale of politics masquerading as science.

The purpose of the papers collected here (all were originally presented at a symposium organized by the institute in 1985) is, according to Dr. David A. Hamburg's introduction, "to stimulate public awareness of the harsh facts of nuclear war."

Many of the symposium participants have also been active in the organization called Physicians for Social Responsibility, which has conducted a similar effort, again in Hamburg's words, to "reduce the risk of nuclear war" through public education about the effects of nuclear weapons, as well as through a campaign for a nuclear weapons freeze. In exhaustive detail, readers are taken through the physics of large urban fires, statistics on radiation-induced genetic damage, case studies of the psychological effects of natural disasters.

Besides the immediate deaths of hundreds of millions in the initial blasts and firestorms, millions more would die from radiation poisoning, cancer, epidemics. Survivors of a single one-megaton blast over Detroit would need 40 times the number of hospital beds available in the entire United States for burn patients, twice the number of intensive-care beds, many times the existing supply of blood. There is undoubtedly a value in documenting such facts, if only to put to rest once and for all the notion that with a few shovels and an adequate supply of USDA bulletins civilization could be back on its feet in no time following a major nuclear war. Yet that has never really been more than a fringe view.

Virtually no one who today argues that nuclear weapons are a necessary evil in deterring a massively armed totalitarian state wants a nuclear war or is blind to the possible consequences. So just whom are the physicians taking on in their crusade?

Before there was Physicians for Social Responsibility or Carl Sagan and nuclear winter, did anyone ever doubt that nuclear war would be the ultimate catastrophe? How many people ever thought that they would personally survive an all-out nuclear war? (A colleague of mine suggested the headline, when Sagan's nuclear winter theory was first presented, "Inclement Weather to Follow Nuclear Annihilation.")

In fact, for all the effort to cloak these papers and symposia in the mantle of pure science, there is a political intent underneath. The underlying assumption is that the only obstacle to abolition of nuclear weapons is a lack of sufficient appreciation of the objective scientific fact that nuclear war is bad.

On one level, this is simply nai ve. On another, it is much more insidious; consider this bit of objective science from social psychologist Susan T. Fiske of the University of Massachusetts: "Most people simply do not write antinuclear letters to the editor or to their elected representatives, they do not join or financially support the relevant organizations, and they do not sign petitions . . . Many observers have wondered publicly about the ordinary citizen's apparent indifference when confronted with the potential annihilation of humankind. These contrasts have prompted the enduring puzzle variously called fear suppression, psychic numbing, denial . . ."

Even in the papers that appear at first to be merely tedious scientific argument, there is insidious intent. By focusing exclusively on the effects of the weapons and ignoring the political realities of how nuclear weapons came to be relied upon for deterrence -- and the political realities of what can substitute for nuclear deterrence -- the conclusion perforce is that disarmament is worth any price. Forget about deterrence, forget about the political obstacles to improving conventional defense, forget about verification of arms control treaties: Science says nuclear bombs are bad; therefore get rid of them -- it doesn't matter how.

Precisely the same argument can be made, of course, about any weapon at all. No humane person is in favor of bullets ripping through human flesh, as an abstract proposition. But to all except extreme pacifists, the moral issues of war and self-defense go beyond such narrow reasoning.

Again, it is in one of the psychological papers of this collection that the political message finally is made explicit, with Dr. Jerome D. Frank of Johns Hopkins depicting the confrontation between the United States and the Soviet Union as the result only of "mutual fear and mistrust": "The major psychological instigator of the accumulation of weaponry . . . has always been another group perceived as an enemy . . . Each group attributes its own violent acts to irresistible environmental forces, while similar actions by the other are attributed to innate evil qualities, a phenomenon psychologists have termed the attribution error."

Interestingly, the journalist hired by the Institute of Medicine to write a popular version of this material, Nicholas Wade of The New York Times, ran into considerable opposition from the institute when he attempted to include some material about deterrence and the political realities of how the West came to rely upon nuclear weapons in the first place.

"That they could not stomach," Wade says; having failed to reach agreement with the institute, he has written his own book on the subject, due out this month, "A World Beyond Healing" (Norton).

Stephen Budiansky is a science writer for U.S. News & World Report.