Spring 2018

Chain Reactions

Generations of physicians have taken “do no harm” beyond the clinic by advocating for nuclear disarmament

The Cost of Conflict Issue

  • by Jake Miller

Titan II intercontinental ballistic missile in a launch duct at the Titan Missile Museum, outside Tucson, Arizona.

It’s not uncommon for a physician to tell a patient that she’s facing a health crisis. It’s something Ira Helfand does regularly in his role as a primary care and urgent care physician in Springfield, Massachusetts. But outside of his clinical practice, Helfand talks more broadly about the troubling symptoms facing a different kind of patient: the global population.

As a longstanding leader of Physicians for Social Responsibility (PSR) and International Physicians for the Prevention of Nuclear War (IPPNW), and as a member of the steering committee of the International Campaign to Abolish Nuclear Weapons (ICAN), Helfand is often asked to talk about the dangers that nuclear weapons bring to global health. Whether addressing large audiences or discussing the issue one-on-one with an international leader, Helfand usually has to start by presenting the listener with a new, more realistic perspective on nuclear conflict.

“They feel they know,” he says. “They’re like young cigarette smokers who tell you, ‘Doc, you don’t have to talk about this. I know cigarettes are bad for me.’”

“But when I begin to spell out the details of what would happen in a nuclear attack, I can see their pupils dilate,” he adds.

Helfand thinks it’s critically important that physicians tell their patients, and the broader community, about the extraordinary danger of nuclear weapons.

“This is the greatest public health threat in the world today,” he says, “and we, the medical community, are uniquely positioned to help people understand this.”

Helfand is one in a long line of physicians who look outside the clinic to advocate on issues that could affect the health of the world’s populations. The roots of this far-reaching activism can be traced to the fundamental “do no harm” pledge all physicians take as they begin their careers as healers. At HMS, this responsibility is augmented by the rich tradition of skepticism, empiricism, and leadership in which Harvard physicians are steeped.

Medical activists at HMS and elsewhere feel that if they speak publicly about the danger of nuclear conflict, they can mobilize people to take appropriate action to lessen that danger. If they don’t speak, they worry, their silence will be as good as saying that no problem exists.

The Prepared Mind

The story may not be widely known, but HMS was the epicenter of the mid-century nuclear disarmament movement in the United States and, perhaps, globally, says Paula Michaels, an associate professor at Monash University in Melbourne, Australia. Michaels, who is researching the history of physician activism in the disarmament movement, has been drawing on the collections at the Francis A. Countway Library of Medicine for her work.

“There is a kind of collective amnesia around the role that physicians have played in the peace movement, and that they continue to play,” Michaels says.

Part of the history Michaels worries will be forgotten took place in the early 1960s in Massachusetts, when a group of physicians and residents from HMS and a handful of other medical and research institutions in the Boston area began meeting for research and study sessions at the Newton home of Bernard Lown, then an assistant professor of medicine at the former Harvard School of Public Health.

“A nuclear bomb is not just a bigger bomb. It leaves a residue of radiation that causes genetic changes, a pathology that is passed from generation to generation.”

Lown, a cardiologist, had been comfortably engaged in inventing the DC defibrillator while also researching causes and possible treatments for sudden cardiac death when a friend invited him to attend a speech by peace activist Philip Noel-Baker, recipient of the 1959 Nobel Peace Prize. Noel-Baker was to speak on the dangers of nuclear war.

Lown walked out of the event a changed man. “I realized that sudden nuclear death was even more important than sudden cardiac death. I felt compelled to do something about it.”

Seated in the same living room where that ad hoc group began meeting more than five decades ago, Lown, now Professor of Cardiology Emeritus at the Harvard T.H. Chan School of Public Health and a retired senior physician at Brigham and Women’s Hospital, still feels compelled to emphasize the dangers of nuclear weapons.

Portrait of Bernard Lown Yevgeny Chazov
Bernard Lown (left) and Soviet cardiologist Yevgeny Chazov, co-recipients of the 1985 Nobel Peace Prize, awarded to International Physicians for the Prevention of Nuclear War (IPPNW).

“A nuclear bomb is not just a bigger bomb,” he says. “It’s something else entirely. It kills everything, not just humans. And it pollutes everything. It leaves a residue of radiation that causes genetic changes, a pathology that is passed from generation to generation.”

Local to Global

When the group of physicians began meeting, a nuclear war between the United States and the Soviet Union was considered likely, yet very little was known about what the real consequences of such a war would be. At their gatherings, the doctors discussed what they might do to understand and help raise awareness of the potentially catastrophic health effects of a nuclear war.

Together with Lown, several of the regular attendees—Victor Sidel, MD ’57, who, at the time, was an HMS teaching fellow; H. Jack Geiger, then an instructor in preventive medicine, and David Nathan, MD ’55, then an HMS research associate in medicine—decided to tackle the issue as only they could: as physician-scientists. They would research the medical ramifications of a nuclear explosion and then seek to publish their findings in a reputable journal. In addition, they would accomplish this collaboratively and collectively, now as members of a new group, Physicians for Social Responsibility.

They achieved their goal. The May 31, 1962, issue of The New England Journal of Medicine featured a series of papers on the medical consequences of nuclear conflict. Using Boston as their example, the papers summarized the medical and environmental consequences of a nuclear attack on the city and addressed the specific challenges that the local medical community would face in the aftermath of such an attack.

The attack scenario the researchers presented was a simplified version of what the Subcommittee on Radiation of the Joint Committee on Atomic Energy, a U.S. congressional committee, considered a likely estimate of the weapons that the Soviet Union would aim at Boston. One of the articles in the series laid out the human and ecologic effects of a thermonuclear attack involving ground-level explosions of an assumed 20-megaton bomb in Boston and an 8-megaton bomb at Hanscom Air Force Base in Bedford, Massachusetts, approximately 20 miles northwest of Boston.

Drawing on published data from the nuclear attacks on Japan and the firestorms generated by conventional bombs in Hamburg, Germany, the researchers projected that “the area of total destruction, in which even the most heavily reinforced-concrete structures and deep blast shelters would be demolished, would have a radius of 4 miles. This would [include] … most of the medical facilities and personnel in the Boston area.”

According to the researchers, if you lived in the metropolitan Boston area, a region that then had a population of between 3.3 and 3.7 million, you could be among the estimated two million people who would die immediately from the blast and heat generated from the explosion or among the additional one million who would be injured and in need of medical care.

People in shelters located within 15 miles of the blast center also would likely die either from being crushed by collapsing buildings or from asphyxiation as fires ignited by the blast consumed the oxygen in the shelters.

The researchers went on to detail additional medical concerns, such as the consequences of long-term radiation exposure.

Another paper in the series discussed the role physicians would have in such an attack. Authored by Lown, Sidel, and Geiger, the paper focused on the logistical, ethical, and moral challenges of treating those injured in the same hypothetical attack on Boston. How should physicians best respond to the challenges of caring for a million severely injured people?

“Regardless of his own professional training and convictions, the physician will daily face demands from patients for euthanasia on a scale and with an intensity unparalleled in his past experience,” they wrote. “Neither the Hippocratic Oath, the published codes of ethics of the American Medical Association nor the personal morality on which every physician relies provides an easy answer to these questions.”

“In fact,” they continued, “a review of these trusted and cherished guides in the light of the problems of thermonuclear war makes them seem curiously and sadly obsolete, as if they reflected the human innocence of an earlier era.”

Because of the devastating medical consequences of such an attack and the limited capacity of surviving physicians to respond effectively, the authors concluded that physicians “must also explore a new area of preventive medicine, the prevention of thermonuclear war.”

“There is a mythology,” says Michaels, “that medicine and science are above politics or outside of politics, but in fact they are utterly entwined.” Choosing to ask whether bomb shelters will help people survive or counting the number of doctors who will live to care for the wounded is a political act, she says, just as choosing not to ask those questions is a political act.

Preventive Medicine

Glimmers of how physicians could focus on preventive measures and political questions to promote the health of populations can be found in the mid-nineteenth-century writings of Rudolf Virchow, a Prussian physician. Virchow thought that improvements in social conditions would be much more effective than medical interventions in prolonging human life, an opinion that won him few friends in the medical establishment. Similarly, his political activities did little to endear him to Otto von Bismarck and others in the political structure: In 1869 he presented a motion in the Prussian parliament in which he noted that expenditures on education had stagnated because of excessive defense spending.

Between the two world wars, antiwar movements initiated by physicians sprang up in Europe. In the aftermath of World War II, many physician-activist groups began to turn their attention to testifying about the grim realities of nuclear weapons.

PSR’s step onto the stage of medical activism continued these efforts, escalating the conversation to counter growing global tensions. That same mission went international when, in 1980, several U.S. and Soviet physicians banded together to form IPPNW. The U.S. founders were based at HMS: Lown, radiologist Herbert Abrams, psychiatrist Eric Chivian, MD ’68, and cardiologist James Muller. Within five years of its founding, IPPNW had grown to include 145,000 members from affiliated physicians’ organizations in forty countries. These members had come together “to explain the medical and scientific facts about nuclear war to policy makers and to the public.” PSR in the United States became one of those affiliates.

Non-Nuclear Option

When the concept of nuclear winter was first introduced, physicists and climatologists predicted that a full-scale nuclear war between the United States and the Soviet Union would hurl enough soot and particulate matter skyward to darken the Northern Hemisphere, leading to crop-killing cold that might pose a threat to the very survival of humans.

“What we now understand is that a much more limited nuclear war could cause enough climate disruption to end civilization as we know it,” Helfand says.

A 2012 report from IPPNW, Nuclear Famine: Two Billion People at Risk?, analyzed several years’ worth of research on climate disruption and associated effects on agricultural output that would result from a limited and regional nuclear war.

Using a nuclear conflict between India and Pakistan as an example, research showed that firestorms would loft nearly 7 million metric tons of black carbon aerosol particles into the upper atmosphere, an amount of light-absorbing soot that would lead to climate effects with global ramifications: massive corn, wheat, and rice crop failures in the United States and China. The IPPNW report concluded that such an event could result in famines that would threaten the lives of more than two billion people worldwide.

Lown likes to point out how militarism, climate change, pollution, economics, and other societal factors are connected with one another and not only can lead to potentially catastrophic health effects but also drive the risk for nuclear conflict. He thinks that medical schools and physicians must continue to work hard to prevent these potential public health crises.

Helfand, too, says that physicians have an incredible opportunity to continue to contribute to change.

“It’s very scary looking at this,” he says. “It’s not clear that we are going to successfully stop catastrophic climate change. It’s not clear that we’re going to successfully eliminate nuclear weapons and prevent nuclear war. But there’s every reason to believe that we could be successful if we work very hard and do the right things.”

Past achievements of these physician-activists indicate that Helfand may be correct. In 1984, IPPNW received the UNESCO Prize for Peace Education; a year later, it received the Nobel Peace Prize. In 2017, ICAN, a coalition of IPPNW and similar organizations, was awarded the Nobel Peace Prize for its work to galvanize global support for the Treaty on the Prohibition of Nuclear Weapons.

Jake Miller is a science writer in the HMS Office of Communications and External Relations.

Images: Courtesy of the Titan Missile Museum (top); Bruce Davidson/Magnum Photos