Is the study of the medical consequences of nuclear war a pointless undertaking? Is the convening of a conference on the subject prima facie evidence of "politics masquerading as science?"
Science writer Stephen Budiansky, in his recent review of the Institute of Medicine's new book, "The Medical Implications of Nuclear War" (National Academy Press, Washington, D.C., 1986), assures us that "virtually no one . . . wants a nuclear war or is blind to the possible consequences."
As the editors of the book in question, we take strenuous exception to the point of view that everyone already knows how awful nuclear war would be.
In 1985, when the IOM hosted the international meeting at the National Academy of Sciences, there was not unanimous agreement on the consequences of nuclear war. Military planners had for many years attempted to predict losses of missiles from various kinds of nuclear attacks, but there had been few serious assessments of the full range of human casualties. While most agree that an "all-out" exchange between the United States and the Soviet Union would mean certain annihilation of both countries, much less information has been available on casualties from various "limited" attacks and so-called "counterforce scenarios" directed primarily at military targets. These are the types of attacks for which the current generation of weapons (and defenses) are being designed.
The IOM conference generated new research on the likely immediate casualties from nuclear warfare, as well as on the delayed impact of radiation, climate changes and psychological trauma.
One of the most disturbing findings reported at the symposium pertained to firestorms that probably would be triggered by nuclear explosions near cities. Such firestorms have been left out of standard government studies, which have projected casualties based on experience with the atomic weapons used in World War II. At Hiroshima and Nagasaki, many survivors were able to walk out of the blast zone to seek help. Contemporary thermonuclear weapons, in contrast, are likely to produce vast "hurricanes of fire," making escape impossible over wide areas. The new estimates show that each one-megaton nuclear weapon could promptly kill two to four times more people than had previously been estimated.
In addition to the destruction by blast and fires, nuclear weapons take a large toll because of the radiation they generate.
New calculations presented at the symposium suggested that under wartime conditions -- with the virtual absence of any medical help -- it takes half as much radiation to kill a human as previously thought; hence twice as many would die. A Princeton research team, using the new information on both firestorms and lethal radiation levels, demonstrated that tens of millions of people would die from various "limited" attacks -- many more than previously estimated by the U.S. Department of Defense.
Scientists at the IOM symposium also took a look at the long-term effects, which are virtually never considered in official assessments of the consequences of nuclear war. Medical scholars from Brown University examined the extended impact of high levels of ionizing and ultraviolet radiation, burns and physical trauma, malnutrition and psychological stress upon human immunology. In a provocative new synthesis, they argued that these various factors would combine to impair the immune capability of a great many survivors, making them likely to succumb later to infectious diseases and cancer. The process would resemble the virus-caused immune deficiency of AIDS.
Other scientists described how dependent the Third World is upon northern hemisphere countries for foodstuffs and resources to support agriculture (machinery, fertilizer, seed, etc.). A nuclear attack that destroyed crop harvests and stockpiles and interrupted worldwide distribution systems would indirectly result in starvation so massive that more people might be killed in Third World nations far away from the conflict than in the combatant countries themselves.
As for "nuclear winter," the controversy in the scientific community now bears on the extent of, rather than the fact of, climatic disturbances in the wake of the huge amount of smoke generated by nuclear weapons exploded near cities or oil storage facilities. And even if the average temperature drop were slight -- one or two degrees -- Asia's rice crop and other sensitive agriculture could be wiped out.
Detailed studies reported at the conference showed that medical resources to aid survivors (doctors, nurses, intravenous fluids, hypodermic needles, etc.) would be overwhelmed by even the smallest "exchange" of strategic nuclear weapons. The "Medical Implications of Nuclear War" documents for political leaders, defense strategists and ordinary citizens the full range of health-related consequences likely to follow the use of modern nuclear weapons in war. The papers represent original research and scholarly analysis by respected scientists -- not political hyperbole.
The report demonstrates that if even 1 percent (or less) of the nuclear warheads now possessed by the United States and the Soviet Union reach their targets, it would be enough to doom our two countries and inflict enormous damage on the rest of the world. If official studies continue to underestimate the human costs of nuclear war, this could lead to inappropriate assumptions about surviving and "prevailing" in such a conflagration.
As physicians, we feel an obligation to generate, clarify and disseminate information that may be significant for human survival -- no matter how distressing the news may be. As David Hamburg writes in the book's opening chapter, "The tendencies to wishful thinking, to complacency in the face of hard reality, to avoidance of facts, to denial of the significance of facts -- these are perhaps our worst enemies in the nuclear arena."
Fredric Solomon, MD, is director of the division of mental health and behavioral medicine at the Institute of Medicine. Robert Q. Marston, MD, is president emeritus of the University of Florida. Second Opinion is a forum for points of view on health policy issues.