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PRESCRIPTION for SURVIVALA DOCTOR'S JOURNEY TO END NUCLEAR MADNESS
By BERNARD LOWN
Berrett-Koehler Publishers, Inc.Copyright © 2008 Bernard Lown
All right reserved.
Chapter OneThe Final Epidemic
Into the eternal darkness, into fire, into ice. —DANTE, The Inferno
The decisions that influence the course of history arise out of the individual experiences of thousands of millions of individuals. —HOWARD ZINN
ON REFLECTION, MY ENTIRE LIFE had prepared me for a moment of extraordinary challenge. I was already middle-aged when I began an emotional and intellectual journey through rugged and uncharted terrain. I risked credibility and even retribution when I joined forces with a perceived enemy to contain the unparalleled terror of nuclear war. The enemy became a friend, and together we launched a global movement.
This is both my story and the story of an organization founded to engage millions of people worldwide in a struggle for human survival. To a large extent my own identity and that of the organization became one. Building the organization became a preoccupation, even an obsession. Although I continued my professional work with fervor, as clinician, cardiologist, teacher, and researcher, the International Physicians for the Prevention of Nuclear War (IPPNW) absorbed even more of my energy.
I was born in Lithuania. As a child I had gained awareness of the evil that can pervade human experience. Lithuanian antisemitism preceded Hitlerism, and Nazi storm troopers followed. In the mid-1930s, when I was a teenager, my family migrated to the United States. The shock of acculturation inflicted pain and at the same time honed sensitivities. Secular parents instilled a conviction that the purpose of being was not self-enrichment but making life better for those who follow. Jewishness imparted deep moral moorings.
When I chose medicine as my career, I became deeply involved with the raw human condition. For me, medicine went well beyond the bedside. I believed then, and still do, that when doctors take the solemn oath to preserve health and protect life, they assume responsibility for the well-being of the human family.
My early life history was a basic training of sorts that prepared me for a plunge into deeper waters. Often, change comes in slow steps. In my case there was a moment of truth after which life was radically different forever. This occurred unexpectedly.
The year was 1961. I was an assistant professor at the Harvard School of Public Health preoccupied with research on the baffling problem of sudden cardiac death. My work was supported by Dr. Fredrick Stare, the maverick chair of the Department of Nutrition. He provided me with ample laboratory space, adequate funds, and freedom to roam in my medical investigations. At the same time, I was teaching medical students and house staff at the Peter Bent Brigham Hospital and working with the fabled clinician and pioneer cardiologist Dr. Samuel A. Levine. To support my family I also had a small private practice where I primarily saw patients for Dr. Levine. My marriage was happy, and our three active young children made life full. I was ambitious and optimistic.
I was approached by Dr. Roy Menninger, a postdoctoral trainee in psychiatry readying to return to Topeka, Kansas, where his family had founded the Menninger Clinic. Roy was a Quaker. He asked me to accompany him to a lecture by the British peace activist and parliamentarian Philip Noel-Baker, who was speaking in a private home in Cambridge. Two years earlier Baker had been awarded the Nobel Peace Prize. His topic in Cambridge was the nuclear arms race as a threat to human survival.
The subject of nuclear war held little interest for me, though I had read John Hersey's book Hiroshima more than a decade earlier. The horror that Hersey described stayed only in the back of my mind. My career was on a fast upward trajectory. I had recently invented a new method, the direct-current defibrillator, to restore a heartbeat in the arrested heart, and I had developed a novel instrument, the Cardioverter, to treat various rhythmic disturbances of the heartbeat. These methods helped revolutionize modern cardiology. Invitations to lecture poured in. Experimental findings and clinical observations had to be written up for publication. Medical work claimed my every spare moment. It seemed wasteful to spend a precious evening on a subject remote from my expertise or interest. Roy, who had been party to my humanitarian pretensions in several discussions, was insistent. Because he was unrelenting, I agreed to attend and invited the one cardiology fellow working in my laboratory, Dr. Sidney Alexander.
I remember little of the content of that evening's lecture except for the essential message: If the stockpiling of weapons of mass destruction continues, they will ultimately be used, and they will extinguish life on planet Earth. Those words were intoned as though by an ancient Hebraic prophet, a jeremiad about the end of civilized life.
I was shaken by an ironic paradox. I was spending every waking moment to contain the problem of sudden cardiac death, a condition that claimed an American life every ninety seconds and far greater numbers throughout the world. It dawned on me that the greatest threat to human survival was not cardiac but nuclear. After the lecture, this troubling thought rarely left me. My emotions ranged from dread to despair and helpless rage.
By profession I am a clinical cardiologist; by temperament I am a surgeon. Introspection and contemplation are not my antidote to simmering anxiety. Intellectual tweedling is not within my character. I had long been a social activist, involved in struggles for universal health care and against racial discrimination. But until the moment I heard Philip Noel-Baker speak, I had shut my mind to the implications of the nuclear age. I had no moral choice but to act. But what was to be done?
I called together a small group of medical colleagues from Harvard's hospitals: Peter Bent Brigham (now Brigham and Women's) Hospital, Massachusetts General, and Beth Israel. At forty, I was the oldest among about a dozen physicians in our group.
We met biweekly at my suburban home in Newton. Initially the meetings had no set plan. We knew next to nothing about atomic weapons and radiation biology, but we never questioned whether it was legitimate for doctors to enter a controversial political arena far removed from their medical knowledge.
Our gatherings had the quality of a book club, except that the book had yet to be written. We were accustomed to journal clubs where current medical publications were critically reviewed. But in the nuclear field much of the pertinent literature was classified. There was of course the experience of Hiroshima and Nagasaki. While the fission bombs dropped on those two cities were a thousand times more devastating than their chemical predecessors, hydrogen fusion bombs represented another thousandfold increase in destructive power.
We were confronted with many questions. Never before had man possessed the destructive capability to make the planet uninhabitable. This fact, though widely acknowledged, was not comprehended. Comprehension is generally defined by the boundaries of experience, but the world has not experienced multimegaton detonations.
Were these weapons likely to be used? What factors might predispose a country to wage nuclear war? Hypothetically, what would be the size, nature, and impact of an attack? What would be the medical consequences of (in the parlance of the day) a "nuclear exchange"? Did we have a special responsibility as doctors to speak out, or was the nuclear threat not only outside the domain of our expertise but also outside our social purview as physicians? How could we gather relevant data? What should be the focus of our discourse? What was a proper forum for our antinuclear struggle? Would our conclusions be discredited by those of the military establishment who were truly expert? Would anyone listen, and would our voices make a difference? How were we to address the broadening gulf between an uninformed citizenry and insulated decision makers? The questions were numerous, the answers few.
Doctors are ultimate pragmatists; confronted with a dangerously sick person, they are forced to act even when many pertinent facts are lacking. The essence of being professional is to be ready to reach conclusions and take action with inadequate information. This was the nature of the arena we entered.
Six months after the first meeting in my home, our group had expanded to about twelve consistent attendees. Nearly half were psychiatrists, including Victor Sidel and Jack Geiger, two community health specialists with long records of distinguished political activism on behalf of the poor and disenfranchised. The majority of us were academics, and our forte was to research, to analyze, to write, and to publish.
I do not recall who first proposed the idea that we should prepare a series of medical articles dealing with the health consequences of nuclear explosions on specific civilian populations. We aimed high: these articles were intended for the most prestigious journal in the country, The New England Journal of Medicine. Our goal seemed far-fetched, since the Journal was published by the then arch-conservative Massachusetts Medical Society. Were these articles indeed published, we anticipated engaging in a broad-ranging discussion to begin the arduous process of public education, a first step in the long path to rid the world of nuclear weapons.
We agreed that we meant to take the incomprehensible and give it scientific credibility and, more important, that we intended to present a realistic scenario that had been missing from public discourse about the nuclear threat. Once we settled on our objective, we surged ahead. More than forty years later, I'm still impressed with the penetrating intelligence of the small group of authors, their prodigious energy, their unstinting investment of time, and their skill in unearthing deeply buried, highly relevant information.
None were better attuned to those tasks than Victor Sidel and Jack Geiger. Vic was an insistent disciplinarian; like a Marine drill sergeant, he kept the small troop hopping and adhering to a taut schedule. A phone call from Vic produced results. It seemed easier to do the work than think up excuses to get him off the phone. Vic had a nose for unearthing facts and possessed the aptitude of an anthropologist in deriving deep insights from fragmentary shards of data. Our writing was burnished to a fine scientific shine by Vic's skill as a researcher.
Jack Geiger, more laid back, was also a workaholic, with the sharp sense of a consummate debater. A former Associated Press sports correspondent, he assimilated massive reams of diverse information and converted it to highly readable text.
I can still recall the scene: invariably late in the evening at the kitchen table, Jack was at the typewriter, a cigarette dangling from his left lower lip, while Vic and I paced the floor. The fast staccato typing continued as Vic and I argued fiercely about some formulation. Jack chain-smoked while playing the role of a court stenographer, taking down our sage observations—or so we believed. In fact the endless pages that poured forth were neither summation nor arbitration of the heated disputes, but innovative and much improved renditions, at times only loosely related to what we were arguing about. Yet each of us deemed it a distillate of his own ideas.
The paucity of precise data did not prevent us from piecing together a coherent and sobering picture. By December 1961, we had completed five articles in which we described the biological, physical, and psychological effects of a targeted nuclear attack on Boston.
We began the series by explaining why physicians needed to address this problem: "The answers are clear. No single group is as deeply involved in and committed to the survival of mankind. No group is as accustomed in applying practical solutions to life-threatening conditions. Physicians are aware, however, that intelligent therapy depends on accurate diagnosis and a realistic appraisal of the problem."
This first physicians' study was based largely on findings of the Joint Congressional Committee on Atomic Energy, the Holifield Committee, which had held hearings on the consequences of a thermonuclear attack against the United States. For our study we assumed that Massachusetts would be targeted with ten weapons totaling fifty-six megatons. We focused on the destruction of Greater Boston. To acquire data I exploited everyone around me, including my daughter Anne, then age twelve, who counted the number of hospital beds in the blast, fire, and radiation zones. Her nightmares endured for years.
We concluded that the blast, fire, and radiation would claim unprecedented casualties. From a population of 2,875,000 then residing in the metropolitan Boston area, 1,000,000 would be killed instantly, 1,000,000 would be fatally injured, and an additional 500,000 injured victims were likely to survive.
Ten percent of Boston's 6,500 physicians would remain alive, uninjured, and able to attend the multitudes of victims. In the postattack period, a single physician would be available for approximately 1,700 acutely injured victims. The implication of this ratio was that if a single physician spent only ten minutes on the diagnosis and treatment of an injured patient, and the workday was twenty hours, eight to fourteen days would be required to see every injured person once. It followed that most fatally injured persons would never see a physician, even to assuage their pain before an agonizing death.
Each ten-minute consultation would have to be performed without X-rays, laboratory instruments, diagnostic aids, medical supplies, drugs, blood, plasma, oxygen, beds, or the most rudimentary medical equipment. Unlike Hiroshima and Nagasaki, Boston could expect no help from the "outside." No functioning medical organization would remain, even to render primitive care.
We concluded that there could be no meaningful medical response to a catastrophe of such magnitude. Physicians who were able and willing to serve would confront injuries and illnesses they had never seen before. Patients would be afflicted with fractures, trauma to internal organs, penetrating wounds of the thorax and abdomen, multiple lacerations, hemorrhage and shock, and second- and third-degree burns. Many, if not all, would have received sublethal or lethal doses of radiation. Many would be emotionally shocked and psychiatrically deranged.
More than one-third of the survivors would perish in epidemics in the twelve months following a nuclear attack due to the combined impacts of malnutrition, crowded shelters, poor sanitation, immunologic deficiency, contaminated water supplies, a proliferation of insect and rodent vectors, inadequate disposal of the dead, a lack of antibiotics, and poor medical care. The rest would be ideal candidates for tuberculosis, overwhelming sepsis, and various fungi, which would constitute the ultimate afflictions for all the survivors.
Physicians would be unequipped psychologically and morally to handle the medical and ethical problems they would confront after a nuclear attack. We could not avoid questions we had theretofore not contemplated:
When faced with thousands of victims, how does the physician select those to be treated first, if any can be treated at all? How is one to choose between saving the lives of the few and easing the pain of many? When pain-relieving narcotics and analgesics are in scarce supply, what is the physician's responsibility to the fatally injured or those with incurable disease? Which of the duties—prolongation of life or relief of pain—takes precedence? How is the physician to respond to those who are in great pain and demand euthanasia? What then substitutes for the sacred oaths that have guided medical practice for several millennia? Modern medicine has nothing to offer, not even a token benefit, in the case of thermonuclear war.
We could provide no answers other than to restate an old medical truism: In some situations, prevention is the only effective therapy. We ended by issuing a call:
Physicians charged with the responsibility for the lives of their patients and the health of their communities must explore a new area of preventive medicine, the prevention of thermonuclear war.
Our work on these articles fired our resolve as antinuclear activists. We constituted ourselves as the Physicians for Social Responsibility (PSR). Our first goal was to disseminate our findings to the widest possible medical public.
Excerpted from PRESCRIPTION for SURVIVAL by BERNARD LOWN Copyright © 2008 by Bernard Lown. Excerpted by permission of Berrett-Koehler Publishers, Inc.. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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