"If the civil defense budget were in my hands, I would spend all $120 million on morphine," says one scientist who has studied the effects of nuclear war. "Civil Defense money is worse than wasted now. It misleads. It may let people believe they can get away in a nuclear war. They can't."
In a movement reminiscent of earlier decades, an increasing number of doctors around the country, through speeches, demonstrations, workshops, and other media events, have determined to put the nation on notice that in the event of nuclear war, medicine -- indeed, any form of civil defense -- will be hopeless.
Previous concepts of civil defense were based on the lower power and the relative inaccuracy of nuclear warheads. In the early 1960s, weapons aimed at the White House might hit in the Washington suburbs. To compensate for this, these weapons were usually set to explode in the air. This maximized physical destruction, but reduced radiation. Thus, large numbers of people in shelters could be expected to survive. Today, warheads are much more numerous, powerful and accurate, and may be expected to explode at ground level, generating vastly greater levels of radiation.
"Treatment programs would be virtually useless and the costs would be staggering," writes Dr. Howard Hiatt, dean of the Harvard School of Public Health and one of the leaders in the movement, in an article in today's issue of the Journal of the American Medical Association. "When treatment of a given disease is ineffective or costs are insupportable, attention must be given to prevention. Both conditions apply to the effects of nuclear war."
To make his point that medical treatment would be virtually nonexistent in the aftermath of a nuclear war, Hiatt recalls a recent burn victim and his treatment in an unusually well-equipped Boston hospital:
"A 20-year-old man was recently hospitalized . . . following an automobile accident in which the gasoline tank exploded, resulting in very extensive third-degree burns. During his hospitalization, he received 281 units of fresh-frozen plasma, 147 units of fresh-frozen red blood cells, 37 units of platelets, and 36 units of albumin. He underwent six operative procedures. . . .
"Throughout his hospitalization, he required medical ventilation and monitoring. . . . Despite these heroic measures which stretched the resources of one of the country's most comprehensive medical institutions, the man died on his 33rd hospital day."
Two hundred severe burn cases would saturate all the existing facilities in the United States, Hiatt points out. A nuclear war might cause as many as 25 million. They would come at a tiem when three-quarters the doctors in the nation would be dead or severely wounded, and half the hospital facilities destroyed.
"If the medical community were to break the virtual silence on this issue we might help interrupt the nuclear arms race," Hiatt says.
"Talking about Civil Defense, I think, raises hopes inappropriately. It is counterproductive. The only answer is prevention, and so we should not distract ourselves with Civil Defense," Hiatt said in a telephone interview.
Officials of the Federal Emergency Management Agency disagree.
The old bomb shelter plan for Civil Defense, with its basementfuls of rancid biscuits and rusting water cans, has been abandoned, but the government now argues that mass evacuation of large American cities could still save large numbers of people. Planners believe this can work because they think it very unlikely that the country will have no warning of impending attack, and quite possibly that a crisis will deepen to war over a period of days or even weeks.
Without evacuation, FEMA now estimates that 60 percent of the population would not survive a nuclear attack. With it, they believe only 30 percent would die.
"Of course we believe a nuclear war will be horrible beyond description," said William Chipman, FEMA official. "But it is totally irresponsible to make no preparation for it at all."
U.S. evacuation plans, however, are only about 10 percent complete, and it will take between 10 to 20 years before all of them are ready.
Kosta Tsipis, an MIT physicist, finds the evacuation plan not only useless, but bad enough that it may even kill more people than would die if they remained in the cities.
"In the case of Boston, all the streets would be made one-way out of the city and everyone would pack their cars with people, who would then drive out to camping sites in New Hampshire and Maine for a week." Tsipis said. "If the nuclear attack on the country concentrates on our strategic assets [military bases, missile silos and the like] then the bombs will be groundburst weapons, which generate far more radioactive particles. . . . Such an attack would be far more damaging to people out camping in tents than in houses and concrete buildings."
For people in tents, the amount of radiation generated would be fatal to between 50 to 100 percent, he said.
Adds Hiatt: "A physician attempts to make a persuasive case for prevention without frightening the patient by describing in clinical detail the most unpleasant aspects of the disease in question. . . . Our 'patients' at present include the political leaders of the principal nations of the world. Many appear not to understand the medical realities of a nuclear confrontation."