A NEW MANNER OF THINKING

1383 is either

International Physicians for the Prevention of Nuclear War A NEW MANNER OF THINKING We shall

require a substantially new manner of thinking if mankind is to survive.-Albert Einstein

INTERNATIONAL Physicians for the Prevention of Nuclear War (IPPNW) continues to grow, and to develop. Its 7th World Congress, in Moscow, was the biggest yet, and increased participation this year by delegates from less

developed

countries

was

particularly

welcome.

Although

medical workers in such countries might be forgiven for the threat of nuclear war in favour of their immediate local concerns, IPPNW makes a direct link between arms spending and lack of development. IPPNW’s American co-president, Dr Bernard Lown, told the congress that "The Third World is already living in the rubble of World War III". For the first time, IPPNW has had to face a change in its

neglecting

leadership. Dr Yevgeni Chazov, the Soviet cardiologist who was the original co-president along with Lown, was earlier this year appointed Minister of Health of the Soviet Union. His place has been taken by Mikhail Kuzin, director of the Vishnevski Institute of Surgery, USSR. The charismatic combination of Lown and Chazov had an important appeal in IPPNW but Kuzin’s evident warmth and openness suggested that this factor is not going to be lost.

From

Symptoms to Disease The opening session included

an honouring of five doctors associated with the eradication of smallpox, which was accomplished over a decade ending 10 years ago in 1977, at a cost equal to 1 hour’s spending on the arms race. The doctors included the Soviet microbiologist Dr Victor Zhdanov who led a delegation to WHO in 1956 which first suggested a global campaign to eradicate smallpox. IPPNW has previously used the metaphor of infectious agents to describe the proliferation of nuclear weapons and has held up the smallpox campaign as an accomplishment of international cooperation. But it is well aware that eradication of nuclear weapons demands attention to a much broader range of political, social, and psychological issues. The congress applauded Canadian journalist Gwynne Dyer

when he changed the medical metaphor and told delegates that nuclear weapons were only symptoms, not the disease itself, and that arms control alone would not cure it. Unless the basic disease was tackled, there would simply be symptom substitution with the deployment of some other means of mass destruction. "The real problem is not weapons but war, and the international system that produces war. The institution of warfare is simply not compatible with a technologically advanced civilisation because the levels of destruction it can create are too great. Nuclear weapons now dominate our reality only because they are the cheapest method of mass destruction." He identified two aspects of the basic disease which required treatment and which were mutually reinforcinginternational political and military structures, and perception of the

"other". IPPNW has for some years been issuing a "prescription" for a moratorium on nuclear testing pending the completion of a Comprehensive Test Ban Treaty. Sad to say, of the five official nuclear powers only the Soviet Union, with its nineteen-month moratorium on nuclear testing which ended in February this year, acted in accordance with this advice. IPPNW may take comfort, however, in the growing evidence that changes in thinking in the Soviet leadership bring it even more strongly into sympathy with the "new way of thinking" which the organisation promotes, as summarised by Lown: "In the nuclear age, security is indivisible, it

common or

non-existent". Martin Walker noted in

an

important Guardian article on Feb 18, 1987, that "A consensus has been achieved within the Soviet Government that says not only is nuclear war unthinkable, but that the very idea of war continuation of politics by other means must be rethought".

as

a

Mr Gorbachev, in his speech to the Moscow Peace Forum in February, said: "The nuclear powers must step out from the nuclear shadow, and enter a nuclear free world, thus ending the alienation of politics from the general human norms of ethics". He expressed similar views in a message to the congress, and stated the willingness of the Soviet Union to resume a test moratorium as soon as it could be mutual and to see the reciprocal removal of all nuclear weapons before the year 2000. President Reagan, in a less philosophical message, expressed his desire for a reduction in nuclear weapons while still relying on nuclear deterrence, and his enthusiasm for "defensive systems that threaten no-one".

Space

War and Peace

President Reagan’s view of "Star Wars" was certainly not shared at the Congress by Robert Bowman, President of the Institute for Space and Security Studies, USA, and director of star wars research under Presidents Ford and Carter. There was some sympathy for American Ambassador Jack F. Matlock, who was deployed to intercept the verbal missiles fired by the powerful retired USAF colonel-such as, "The only believable use of ’star wars’ weapons against ballistic missiles would be in the hands of an aggressor to protect him from the few missiles he missed in his first strike". They would be easily deployed against satellites, which were sitting ducks. Destroying opposing satellites would allow military control of space. The weapons could be used offensively; for example, laser battle stations could directly incinerate cities. Deployment would "drive the golden spike through the heart of the Anti-Ballistic Missile Treaty, killing off the entire arms control process and ensuring an unfettered arms race". As well as promoting a test ban that would halt "Star Wars", IPPNW is planning a symbolic countermeasure to the threatened militarisation of space-Space for Health. At the 5th Congress, in Budapest, Bernard Lown put forward the idea of using satellite telecommunications to assist the international sharing of medical knowledge, as a demonstration that space technology can be used for peaceful purposes. Since then working groups have been exploring and shaping up the idea. It emerged in Moscow that IPPNW is to be the catalyst in the formation of an international corporation called SATELIFE which will promote the Space for Health idea, beginning with a small-scale demonstration project such as using a low-orbit satellite with pocket radio communications and ground stations in various locations to permit transmission of information by "electronic mail" to and from regions with poor local communications. Uses might include monitoring of spread of AIDS in Africa, helping to disseminate material for health education, or providing communications to assist disaster relief by use of portable ground stations set up at disaster sites. Remote conferencing might also be feasible. The need to involve Third World contributors in deciding what their health priorities are, and for communication to be interactive rather than one-way, is recognised. The plan has not escaped criticism within IPPNW; some delegates have yet to be convinced that such a "high-tech" approach is of major relevance to Third World needs and claim that the scheme is a solution in search of a problem. Lown has nevertheless gained support for the idea: WHO has examined it and expressed interest; and the Soviet

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Union in October 1986, through Dr Velikhov, vicepresident of the USSR Academy of Sciences, has offered to provide a satellite. A further step was taken at the congress by a statement of intent to launch a "health satellite", signed by Dr Velikhov and the IPPNW co-presidents Lown and Kuzin.

Images of the Other Achieving mutually assured security rather than mutually assured destruction, so that more resources could be channelled to health and development rather than arms, is inhibited by the "enemy image". How can one trust an offer made by the "enemy"? This topic was given particular attention in the Moscow congress. A crammed session on Popular Culture and the Arms Race heard Nicholas Humphrey, psychologist and writer, review psychological experiments which show how perception of ambiguous or changing material is heavily influenced by previous experience or mental set. He described an experiment with a room with distorted walls and floor that make it look as though two people of similar size in the two farther comers are very different in height. Even if a person walks from one corner to another the illusion of changing height is maintained against common sense. It is only broken if the person used is of emotional significance to the observer. The moral, in terms of east/west travel and friendship helping to break down stereotyped views is obvious, and IPPNW energetically promotes east/west visits and medical collaboration. In the animated discussion that followed this session a Russian cardiologist declared that the press carried a high responsibility for the ways in which we view each other and that journalists should adopt the medical tag primum non nocere.

The Russian poet Yevgeni Yevtushenko told the closing session that a deficit of idealism is a tragedy of the 20th century. IPPNW does not suffer from a deficit of idealism, though it would claim to approach it through practical steps. Bernard Lown told the meeting "We draw courage from the historic fact that many of the starry-eyed, seemingly unrealistic proposals of yesteryear, have become the indispensable conditions of contemporary life". The 8th World Congress will be in Montreal next year and the 9th, in 1989, in Hiroshima.

Royal Edinburgh Hospital, Edinburgh EH10 5HF

JIM DYER, Psychiatrist

CHILDREN AND THE THREAT OF NUCLEAR WAR

psychiatrists, and community the largest specialty groups within the physicians and I suspect that this is anti-nuclear movement, physicians’ because these specialties are concerned with health as much as with disease. Nuclear weapons are a global threat to health but do not cause a disease. As a public health issue they are different from water and sanitation, cigarette smoking, and water fluoridation and dietary sugar. For doctors who are interested in disease, nuclear weapons and the threat of war are seen as irrelevant to medicine, as "political", and as a spurious diversion from our real duties—curing illnesses and treating the sick. Most paediatricians will accept that health has a political component and will feel that an interest in prevention leads us to look more broadly at the roots of health problems in society. Nuclear weapons pose a threat of mass destruction which would be more devastating than any current epidemic-whether it be malnutrition, diarrhoeal disease, or AIDS. Anything we can do to prevent this happening will increase the chance of children round the world surviving to have a future. But, as the congress in Moscow clearly pointed out, nuclear weapons are already PAEDIATRICIANS, are

harming children in the real world today-in poor countries through the socioeconomic effects of the arms race, and in rich countries through the fear and anxieties which they implant in children’s minds. Much was reported at the congress on the relations between health and defence spending and the facts presented were not new. Reiteration of these facts does not prove a causal association but does spur us to action. A memorable summary of statistics and a key reference’ was given by Stephen Farrow from the UK. These facts (which are worth keeping to hand for when we run into our neighbourhood politician) are shown below: World Arms Spending 1986 900 000 million 2500 million 105 million 1-8 million 30 000

($) 1 yr 1d 1 h 1 min 1 s

Child Deaths Globally 15 million 40 000 1700 30 1 every 2

s

In terms of "opportunity costs", 1 h of world arms spending could fund the whole 20-year smallpox eradication programme of WHO; 3 h the entire annual budget of WHO ; and 12 h full immunisation for all the world’s children. A final comment on costs came from Carl Sagan, who pointed out that of the 10 trillion dollars spent in the US on defence since the Second World War, one-third has been spent by President Reagan. This sum would buy all material goods in the US except the land. No doubt similar figures could be provided for the USSR-though since they have fewer possessions, the price might be lower ....

These figures create anger but do not lend insight into the effects of nuclear weapons on children in the industrialised countries. Do children really worry about nuclear war? If they do, does it matter? Some insight has been gained from the International Children’s Project, a collaborative study on the psychological impact of the threat of nuclear war on adolescents. This study, which has just been completed in the USA, USSR, New Zealand, Sweden, and Hungary, is a follow-up to earlier work.2 The project has been jointly organised by Dr Eric Chivian, of the Center for Psychological Studies in Cambridge, Massachusetts, and Dr Nikolai Popov of the Institute of USA/Canada Studies, Moscow. It is an excellent example of the kind of cooperation between east and west that IPPNW is encouraging and the joint presentation of data at the congress by Chivian and Popov typified this spirit (using the English language, let it be said). The study was a questionnaire delivered to a sample of several thousand children aged between 12 and 18 years in randomly selected secondary schools in each country. The survey was post-Chemobyl but children were not told of the topic and the word nuclear was not introduced until mid-way through. The questionnaire covered knowledge about nuclear weapons, attitudes and fears about the future, and feelings about what can be done. The main areas of difference between east and west lay in attitudes to the future. 70% and 79% of children in the USA and USSR, respectively, knew of the effects of nuclear war including the nuclear winter. The mass media were the main source of information in both countries: 91 % in the Soviet Union and 71 % in USA watch an evening news TV programme. Parents and schools were only a minor source of information. In the Swedish part of the survey, students commented that nuclear issues were ignored in the classroom despite their desire for discussion. The teenagers were asked to rank their fears in a list that 1. Sidel VW. Destruction before detonation: the impact of the

arms race on health and health care Lancet 1985; ii 1287-89. 2. Chivian E, Mack JE, Waletsy JP, Lazaroff C, Doctor R, Goldenring JM. Soviet children and the threat of nuclear war: a preliminary study. Am J Orthopsychiatry

1985, 55: 484-502.