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The Medical Implitations of
NUtIEAR WAR
INSTITUTE OF MEDICINE
NATIONAL ACADEMY OF SCIENCES
Fredric Solomon, M.D., and Robert Q. Marston, M.D.
Editors
With a Foreword by Lewis Thomas, M.D.
NATIONAL ACADEMY PRESS
Washington, D.C. 1986
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NATIONAL ACADEMY PRESS 2101 CONSTITUTION AVENUE, NW WASHINGTON, DC 20418
NOTICE: The symposium reported in these proceedings was approved by the Governing Board
of the National Research Council, whose members are drawn from the councils of the National
Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The
members of the committee responsible for the symposium were chosen for their special competences
and with regard for appropriate balance.
These proceedings have been reviewed by a group other than the authors according to procedures
approved by a Report Review Committee consisting of members of the National Academy of
Sciences, the National Academy of Engineering, and the Institute of Medicine.
Conclusions and views expressed by the authors of papers are their own and do not necessarily
represent those of the program sponsor, the Institute of Medicine.
The Institute of Medicine was chartered by the National Academy of Sciences to enlist distinguished
members of appropriate professions in the examination of policy matters pertaining to the health of
the public. In this, the Institute acts under both the Academy's congressional charter responsibility
to be an adviser to the federal government and its own initiative in identifying issues of medical
care, research, and education.
The National Academy of Sciences was established in 1863 by Act of Congress as a private
nonprofit, self-governing membership corporation for the furtherance of science and technology
required to advise the federal government upon request within its fields of competence. Under its
corporate charter the Academy established the National Research Council in 1916, the National
Academy of Engineering in 1964, and the Institute of Medicine in 1970.
Library of Congress Cataloging-in-Publication Data
The medical implications of nuclear war.
Based on papers presented at a symposium held at the National Academy of
Sciences, Washington, D.C., Sept. 20-22, 1985 and organized under the auspices
of the Institute of Medicine.
Includes index.
1. Nuclear warfare-Hygienic aspects-Congresses. 2. Emergency medical
services Congresses. 3. Nuclear warfare Environmental aspects Congresses.
4. Nuclear warfare-Psychological aspects Congresses. 5. Nuclear warfare
Social aspects Congresses. I. Solomon, Fredric. II. Marston, Robert Q.,
1923- . III. Institute of Medicine (U.S.)
[DNLM: 1. Nuclear Warfare congresses. 2. Radiation Injuries congresses.
3. Radioactive Fallout-adverse effects congresses. WN 610 M4865 1985]
RA648.3.M445 1986 363.3'498 86-18134
ISBN 0-309-03692-5
ISBN 0-309-03636-4 (pbk.)
Copyright @) 1986 by the National Academy of Sciences
No part of this book may be reproduced by any mechanical, photographic, or electronic process
or in the form of a phonographic recording, nor may it be stored in a retrieval system, transmitted
or otherwise copied for public or private use, without written permission from the publisher, except
for the purposes of official use by the United States government.
Cover photo: Nagasaki, 10 August 1945, 11 A.M. The heavy overcast of smoke from fires cut of
the sunlight. The narrow path, along which the wounded are being carried on stretchers, leads to
Nagasaki Railway Station. (Photograph by Yosuke Yamahata.) Copyright @) 1981 by Hiroshima
City and Nagasaki City. Reprinted by permission of Basic Books, Inc., Publishers.
A videotape digest of symposium highlights is available. For information, write the Institute of
Medicine, Office of Information, at 2101 Constitution Avenue, NW, Washington, DC 20418.
Printed in the United States of America
First Printing, September 1986
Second Printing, September 1988
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INSTITUTE OF MEDICINE
Steering Committee for the Symposium on the
Medical Implications of Nuclear War
ROBERT Q. MARSTON, M.D. (IOM), Chairman, President Emeritus,
University of Florida, Gainesville
HERBERT L. ABRAMS, M.D. ATOMS, Visiting Professor, Department of
Diagnostic Radiology, Stanford University School of Medicine, and
Stanford Center for International Security and Anns Control
WILLIAM R. BEARDSLEE, M.D., Clinical Director, Department of
Psychiatry, Children's Hospital Medical Center, and Assistant Professor,
Harvard Medical School
K. SUNK D. BERGSTROM, M.D., Ph.D. (IOM, NAS), Professor of
Chemistry, Karolinska Institute
THOMAS C. CHALMERS, M.D. (IOM), Distinguished Service Professor of
Medicine, President and Dean Emeritus, The Mount Sinai Medical
Center, New York City
DAVID S. GREER, M.D. ATOMS, Dean of Medicine and Professor of
Community Health, Brown University
ALEXANDER LEAF, M.D. (IOM, NAS), Ridley Watts Professor of
Preventive Medicine, Harvard Medical School, and Chairman,
Department of Preventive Medicine and Epidemiology, Massachusetts
General Hospital
JENNIFER LEANING, M.D., Chief of Emergency Services, Harvard
Community Health Plan
GILBERT S. OMENN, M.D., Ph.D. (lOM), Dean, School of Public Health
and Community Health, and Professor of Medicine and Environmental
Health, University of Washington
JEANNE PETERSON, United Nations Office of Population
CHESTER M. PIERCE, M.D. ATOMS, Professor of Education and Psychiatry
in the Faculty of Medicine, the Graduate School of Education, and the
Faculty of Public Health, Harvard University
THEODORE A. POSTOL, Ph.D., Science Fellow, Stanford Center for
International Security and Anns Control
lOM, Member of He Institute of Medicine
NAS, Member of the National Academy of Sciences
. . .
lZZ
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IV
STEERING COMMITTEE
FREDERICK C. ROBBlNS, M.D. (IOM, NAS), ex officio President, institute
of Medicine ~ 1980- 1985), University Professor, Department of
Epidemiology and Biostatistics, Case Western Reserve School of
Medicine
ARTHUR C. UPTON, M.D. STOMP, Professor and Chairman, Department of
Environmental Medicine, New York University School of Medicine
FRANK VON HIPPEL, Ph.D., Professor, Woodrow Wilson School of Public
and International Affairs, and Center for Energy and Environmental
Studies, Princeton University
Institute of Medicine
President
SAMUEL O. TH1ER, M.D.
Project Staff
FREDRIC SOLOMON, M.D. (Project Director), Director, Division of
Mental Health and Behavioral Medicine, Institute of Medicine
MARC MESSING (Deputy Project Director), Staff Consultant, institute of
Medicine
NANCY WINCHESTER, Editor, National Academy Press
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Contents
Foreword . e · ~
Lewis Thomas, M.D.
Preface e x
Robert Q. Marston, M.D., and Fredric Solomon, M.D
Understanding and Preventing Nuclear War: The Expanding
Role of the Scientific Connnnunity ................................
David A. Hamburg, M.D.
Part ~
Nuclear War with Modern Weapons:
Physical Effects and Environmental Consequences
Possible Fatalities from Superf~res Following Nuclear Attacks
in or near Urban Areas .............................................
Theodore A. Postol, Ph.D.
A Review of the Physics of Large Urban Fires
H.~. Brode, Ph.D., and R.D. Small, Ph.D
v
. . .
1
15
73
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Vl
Recent Assessments of the Environmental Consequences of
Nuclear War ...........................................
Richard P. Turco, Ph.D.
Nuclear Famine: The Indirect Effects of Nuclear War .......
Mark A. HarweR, Ph.D., and Christine C. Harwell, ].D
Nuclear Winter: The State of the Science
George F. Carrier, Ph.D.
.
Atmosphenc Perturbations of Large-Scale Nuclear War
Robert C. Malone, Ph.D.
Possible Toxic Environments Following a Nuclear War
John W. Birks, Ph.D., and Sherry L. Stephens
Radioactive Fallout .........................
Charles S. Shapiro, Ph.D., Ted F. Harvey, Ph.D., and
Kendall R. Peterson, M.S.
Part I}
Health Consequences of Nuclear War
Casualties Due to the Blast, Heat, and Radioactive
Fallout from Various Hypothetical Nuclear Attacks
on the United States
CONTENTS
............. 96
.. 117
136
....... 141
....... 155
167
................. 207
William Daugherty, Barbara Levi, Ph.D., and Frank von
Hippel, Ph.D.
Acute Radiation Mortality in a Nuclear War
Joseph Rotblat, Ph.D.
233
Burn and Blast Casualties: Tnage in Nuclear War - 251
Jennifer l caning, M.D.
Food and Nutrition in the Aftermath of Nuclear War
Alexander Leaf, M.D.
.......... 284
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CONTENTS
Psychological Consequences of Disaster: Analogies for
the Nuclear Case ...........................................
James Thompson, Ph.D.
. .
V11
....... 290
The Immunological Impact of Nuclear Warfare 317
David S. Greer, M.D., and Lawrence S. Riflcin
Expected Incidence of Cancer Following Nuclear War
Nikolai P. Bochkov, M.D., and Per Oftedal, Ph.D.
Genetic Consequences of Nuclear War
Per Oftedal, Ph.D.
........ 329
.......................... 337
Part III
Medical Resource Needs and Availability
Following Nuclear War
Medical Supply and Demand in a Post-Nuclear-War World
Herbert L. Abrams, M.D.
The Consequences of Nuclear War: An Economic and
Social Perspective .......................................
Hal Cochrane, Ph.D., and Dennis Mileti, Ph.D
Part IV
hnages and Risks of Nuclear War:
Psychosocial Perspectives
.
Children's and Adolescents' Perceptions of the Threat of Nuclear
War: Implications of Recent Studies ......................
William R. Beardslee, M.D.
Scandinavian Youth View the Future: A Preliminary Report
of a Large Questionnaire Survey ............
Magne Raundaten, Ph.D., and Ole Johan Finnoy
.. 349
........... 381
....... 413
..................... 435
Adult Beliefs, Feelings, and Actions Regarding Nuclear War:
Evidence from Surveys and Experiments 444
Susan T. Fiske, Ph.D.
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· · ~
Vlll
Hope and the Denial of Stress in the Nuclear Age
Shiomo Breznitz, Ph.D.
The Nuclear Arms Race and the Psychology of Power
Jerome D. Frank, M.D., Ph.D.
Managerial Demands of Modern Weapons Systems
John D. Steinbruner, Ph.D.
Sources of Human Instability in the Handling of
Nuclear Weapons ..
Herbert L. Abrams, M.D
CONTENTS
............. 467
........ 474
485
490
The Impact of Crisis-Induced Stress on Decision Making 529
Alexander L. George, Ph.D.
Part V
Long-Term Consequences of and Prospects for
Recovery from Nuclear War: Two Views
View I
Car! Sagan, Ph.D.
View II
Lynn R. Anspaugh, Ph.D.
Conclutl~ng Remarks
Summary and Perspective: With Some Observations on
Informed Consent ..................................................
Herbert J. Abrams, M.D.
566
583
Glossary 589
Biographies of Contnbutors
Index
607
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Foreword
I was in Europe at the time of the Institute of Medicine's symposium, and
I read the accounts of the meeting in the headlines of the French, German,
and British newspapers. Banner headlines, lead stories, front pages every-
where. The announcement was that a nuclear war would cause AIDS.
No matter that the real AIDS is caused by a virus. The concept of immune
deficiency as a consequence for the survivors of radiation, malnutrition, burns,
grief, and other assaults of nuclear bombardment was compelling.
It was as though the problem of hydrogen bombs had suddenly turned into
something the writers could lay hands on. Something to sit down and think
about, and compose a front page story about; something different from all
those unthinkable matters. To be sure, there were some lines at the bottom
of the stories, continued on inside pages, giving some new estimates of the
numbers of people to be killed outright by blast and burns, the utter impos-
sibility of any health care system doing anything even marginally useful, and
some mention of the "nuclear winter" scenario. But it was AIDS that caught
the attention of the press, AIDS that made the story.
When I got back to New York a few days later, the whole story had vanished
from the papers, but I found clippings from most of the earlier reports that
had appeared in the national papers and news magazines. Same story: AIDS.
And then that was the end of the matter. No more stories in the days and
weeks that followed, not about the medical consequences of nuclear war.
Back to normal: the stuck inconclusive Geneva talks, the harangues by states-
men hungry for television, the talk of new talks, arms control talks, treaty
violation talks, editorials saying that neither side can trust the other or ever
IX
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x
FOREWORD
will, endless bewildering columns on the SDI and the talk about SDI. Wretched,
dishonest, evasive talk, political talk, with no mention anywhere of burnt
blasted vaporized human beings in the billions and half the planet frozen and
irradiated. The same turning away from real life and real death danger that
we have all been tolerating, some of us even encouraging, since we and the
Russians began building our "arsenals," as we like to call the things to make
it seem like old times, same old clash of arms, same excitements. The British
and the French with theirs, and the Chinese and Indians and God only knows
who else with theirs, all of humanity caught up in the craziness like lemmings
running headlong toward the cliff, everyone muttering unthinkable.
We behave as if we really believe these are weapons even, burn our
tongues, weapons of "defense." We brandish them, display them like the
spears and banners of primitive tribes shouting insults across a river boundary,
getting ready to fight, to defend, to burn up the earth for the honor. Maybe
holding back, but only for the moment, at the thought of catching AIDS.
And then, next day, that thought gone.
When I complain, as I bitterly do, to my journalist friends about all this,
they say what on earth do you expect us to do? We can't run front page
stories every day about the world coming to an end, they say. People won't
read things like this, they say.
I raise my voice, yell sometimes, what the hell are newspapers for? You're
supposed to provide information, real news, and this is the news of the world,
the news of the end of the world, print more of it for God's sake before it's
too late, I say. Put the nuclear winter up there on the front page every day,
give it the biggest blackest headlines you've got, make it the main story, run
it and run it. I say all that, and things like that, and they look at me with
embarrassment.
But AIDS ! And then nothing. And in that one day of stories, down at the
bottom, winding things up, a short paragraph saying 56 million Americans
would be killed outright in a 100-megaton attack on cities; not much better
in an attack on military targets (our "assets," we call them), 38 million if
they do that. That's from 100 megatons, the equivalent of a warning shot
over the heads of a crowd considering that we and the Soviets have between
us 20,000 megatons or whatever the number now is.
I complain to my journalist friends in a voice as reasonable as I can make
it, even good-natured, can't you at least do more to get the public thinking
hard about nuclear winter? Too much uncertainty, they say, you can't be sure
about the weather, can't predict it until it really happens. Anyway, people
don't want to read about it, be told about it. Not a good thing to think about.
And anyway, what can be worse than 2.2 billion sudden human deaths? They
ask me that, then say, that's the closest estimate available for the deaths in
a really full-scale nuclear war, when everything is let fly. How can you get
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FOREWORD
Xl
i
people (the "reading public," they say) to think about a lot of clouds, even
the extinction of some other kinds of life on the planet, when you've got a
number that is at least half the human species? Then they use the word that
has become the cliche of late twentieth century statecraft: unthinkable.
That is the center of the trouble, I see that. Nuclear war is for sure, beyond
question, dead certainly, literally, figuratively, any way you don't want to
think about it: unthinkable.
If we go on this way, unthinking, putting it out of our minds, leaving it
to statecraft of the kind we've got all over the world, or leaving it to the
editorial writers, the columnists, the TV newsmen, or the military people,
first thing you know some crafty statesman or some other crafty unbalanced
military personage, one side or the other, is going to do something wrong,
say something wrong, drop something, misread some printout, and there will
go 30,000 years of trying ever since Lascaux right up to Bach and beyond
into this benighted century all civilization, gone without a trace. Not even
a thin layer of fossils left of us, no trace, no memory.
Pay attention to George Kennan and Solly Zuckerman and their books along
with this one. They have thought longer and more clearly than most people
close to the complexities. Solly Zuckerman, with years of experience as
science adviser to the British cabinet, says we're in trouble because of the
weapons-scientists ("technicians," he calls them, with austere and adult con-
tempt), and the lack of anyone with the authority and power and real brains
(brains, not easy cleverness or clever craziness) to tell them what to do, or
more importantly what not to do. Tell them: that's enough now, don't improve
the technology, don't make anything technically sweeter or smarter, go home
and we'll pay you to stay there.
Unthinkable is the word for whatever is in front of our eyes but too big to
figure out, too frightening. Pay attention, in this book, to the doctors and the
scientists here assembled.
Everything needed for thinking clearly, wincing all the way but thinking
anyway, is written down in these chapters. Anyone, any age, can read what's
here and understand what we could be in for if we stay on this road. What
to do is another matter, but at least the facts of the matter are laid out here.
You'd better bet your life it's thinkable.
Lewis Thomas, M.D.
President Emeritus
Memorial Sloan-Kettering
Cancer Center
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Preface
On August 6, 1945, a 15-kiloton atomic bomb ignited the center of the
Japanese city of Hiroshima, flattening it and killing more than 100,000 people.
Just three days later, a second bomb was exploded over the city of Nagasaki,
resulting in the deaths of another 70,000. For months after the attack, many
survivors developed symptoms that puzzled doctors: blood cell abnormalities,
high fevers, chronic fatigue, diarrhea, vomiting, and depression. Physicians
began to term these symptoms "radiation sickness." It would eventually be
revealed that survivors were experiencing an increased incidence of certain
forms of cancer.
Now, forty-one years later, the destructive power of a 15-kiloton bomb
(equivalent to 15,000 tons of TNT) is dwarfed by weapons of megaton force
(1 million tons of TNT). Although development of ever more destructive
weapons continues, scientific examination of the effects of nuclear weapons
upon the short- and long-term health of survivors, as well as upon the en-
vironment, has lagged until very recently.
In 1981, Paul Crutzen and John Birks calculated the effects on the Earth's
atmosphere of large-scale fires that would result from a major nuclear ex-
change. A subsequent series of analyses expanded on the concept of a mid-
day twilight or "nuclear winter" that might follow in the weeks and months
after a nuclear war. This led to a fundamental reassessment of postwar en-
vironmental conditions, especially those affecting food production. The early
1980s also saw Me beginning of new efforts by physicians and by scientists
from many disciplines and many nations to examine the indirect health-related
· · .
x'''
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XIV
PREFACE
effects of nuclear war, including intermediate-term consequences for survivors
and effects on persons living far away from anticipated war zones. More
comprehensive appraisals were produced of the catastrophic social, economic,
and psychological sequelae of nuclear war. Scholars began anew to examine
the psychosocial dimensions of nuclear arms competition, international con-
flict, and the threat of nuclear war.
The time seemed propitious, therefore, to convene an international group
of scholars in the autumn of 1985 to review the medical implications of these
and other new studies. In addition to considering the direct and indirect health
effects of nuclear attack, these physicians and scientists were asked to examine
the availability of medical resources and the psychological issues surrounding
nuclear weapons and war. It was fitting that this conference was organized
under the auspices of the Institute of Medicine in Washington, D.C. Since
being chartered by the National Academy of Sciences in 1970, the Institute
has devoted itself to examining developments in science, health care, and
public policy that affect the health of the public. Indeed, it has asserted that
nothing can have greater potential impact on health than a nuclear war. A
statement adopted by the IOM membership in 1982 reflects that concern:
"Nuclear war is the single event that could terminate all our efforts to improve
the human condition. That possibility seems particularly ironic at a time when
great strides are being made in alleviating human ills, and even greater ad-
vances are in prospect.... The only preventive medicine we know that can
avoid the medical consequences of nuclear war is to prevent nuclear war
itself. "
It is also fitting that this symposium occurred during Frederick Robbins's
tenure as president of the Institute of Medicine. Dr. Robbins has long been
concerned with the threat of nuclear war, and this symposium last fall was
an appropriate tribute to his five years of leadership. In fact, the symposium
has had the support and guidance of three Institute presidents. David Hamburg,
who was Fred Robbins's predecessor, contributed in several ways to the
success of the symposium-through the support of the Carnegie Corporation
of New York, which he now heads, through his advice on the program as it
was being developed, and through the extraordinary chapter that opens this
book. Finally, Samuel Thier, the current president of the Institute, has directed
the review and dissemination of the results of the symposium, including this
volume.
In his opening remarks to the conferees, Frank Press, president of the
National Academy of Sciences and chairman of the National Research Coun-
cil, emphasized the value of vigorous scientific debate on this topic: "The
profundity of the consequences of nuclear war are such that symposia of this
type-building up momentum for these issues and for public concern and
disseminating the kind of information and knowledge that is generated at a
conference like this are a most valuable public service."
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PREFACE
XV
Moreover, Dr. Press reminded the audience that, despite the level of internal
government activities, many of the best ideas for the control of nuclear weap-
ons and the best estimates of the consequences of nuclear war have come
from scientists and scholars working outside official circles. Indeed, during
that September weekend, more than 80 scientists from nine countries were
joined by concerned members of the general public. Thirty papers were pre-
sented which, after subsequent refinement, have become the contents of this
volume. The authors come not only from government laboratories but also
from private consulting firms, hospitals, and academia.
In the months that have passed since the symposium, the failures of U.S.
and European space launch vehicles and the accident at the Soviet nuclear
power plant have dramatized an important point: there are difficulties inherent
in the design, maintenance, and operation of complex fail-safe systems. The
tragedies at Cape Canaveral and Chernobyl seem to underscore certain con-
clusions in David Hamburg's opening chapter and in Part IV of this volume:
namely, we cannot depend indefinitely upon technology, prudence, or good
luck to safeguard mankind from the risk of nuclear war. In fact, it is argued,
the hazards of nuclear weapons and modern strategic systems are so complex
and permit so little margin for human error or misunderstanding in a time of
crisis, that even the most sophisticated efforts of crisis management might
fail us in a nuclear confrontation. In the long run, strategic military crises
must be prevented from developing among the nuclear powers of the world,
because neither human judgment nor technology can be relied upon to avoid
nuclear war in the event of a prolonged and complex confrontation.
This volume is divided into five parts. The first provides an overview of
the physical and environmental effects of nuclear war, setting the stage for
later sections that address the medical impact of various types of nuclear
attack. Among the papers in Part I is a disturbing report by Theodore Postol
from the Stanford Center for International Security and Anns Control. Based
on the properties of modern nuclear weapons, he estimates that firestorms
triggered by nuclear explosions would kill two to four times as many people
in or near cities than have been predicted by standard government studies.
Unlike Hiroshima and Nagasaki, where many of the survivors were able to
walk out of the blast zones and seek help, contemporary weapons would
produce vast "hurricanes of fire," making escape impossible over wide areas.
Other contributors to Part I review the physics of large urban fires and
update projections of nuclear winter. "Nuclear famine" is also described,
drawing on the very recent work of SCOPE (The Scientific Committee on
Problems of the Environment of the International Council of Scientific Unions).
Because of the dependence of third-world countries on rice, wheat, and corn
harvests, as well as on agricultural support from the world's superpowers, a
nuclear attack that destroyed crop harvests and stockpiles and interrupted
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XVI
PREFACE
distribution systems might kill more people in noncombatant nations than in
combatant ones. And new ecological concerns are raised for example, the
toxicity of an environment laden with the by-products of burning plastics and
other man-made materials.
In Part II, the consequences of nuclear war are considered from a standpoint
of deaths, injuries, and, especially, the health of survivors. In preparation for
this symposium, a Princeton University research team developed the first
detailed computer model outside the classified literature for calculating U.S.
casualties from a nuclear war. This model was then used to examine the
sensitivity of casualty estimates to various assumptions about nuclear weapons
effects. The work indicates that if some heretofore standard assumptions are
revised as proposed in several of the other papers in this volume (e.g.,
greater lethality of firestorms or of radiation exposure) a "limited" attack
solely on strategic nuclear targets would kill tens of millions, a figure much
greater than earlier government estimates. The Princeton group also dem-
onstrates that it is virtually meaningless for military analysts to distinguish
between attacks in which nuclear weapons are used on military-related in-
dustries but not on civilian targets and attacks in which cities are targeted per
se: the toll is nearly as great in either case because such industries are so
frequently located within or adjacent to major population centers.
Also in this section, physicians and scientists describe problems of triage
and care of the injured survivors of nuclear war. They provide new estimates
of the lethality of radiation exposure under wartime conditions, consider the
effects of food shortages and malnutrition on the prospects for survival, and
discuss the psychological consequences of surviving major disasters. Scien-
tists from Norway and the Soviet Union offer estimates of the long-term
genetic and carcinogenic effects of nuclear weapons use. In a provocative
new synthesis, the combined effects of high levels of ionizing and ultraviolet
radiation, burns and physical trauma, malnutrition, and psychological stress
upon human immunology are examined; investigators from Brown University
argue Mat these multiple insults would impair the cell-mediated immune
capability of a great many survivors, making them likely to succumb to
diseases such as pneumonia, tuberculosis, and cancer diseases that are prev-
alent among today's victims of the virus-caused immune deficiency known
as AIDS.
Part III reviews the demand for medical resources after a nuclear attack
and estimates the actual supply likely to be available. If a single one-megaton
bomb were exploded over the city of Detroit, for example, it is calculated
that survivors would need about forty times the number of burn beds currently
available throughout the entire United States. They would also need twice
the number of intensive care beds currently available, and the need for blood
transfusions would exceed the existing supply many times over. A more
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PREFACE
. ~
XV11
extensive nuclear exchange involving the United States, Europe, and the
Soviet Union and its allies would wipe out most of the world's supply of
pharmaceuticals, medical equipment, and food. Also in Part III, two social
scientists offer an economic and social perspective on the consequences of
nuclear war.
Contributors to Part IV address the nuclear arms race from a psychosocial
point of view: How does the threat of nuclear war affect the attitudes and
behavior of adults and children? Studies provide evidence that many young
children are worried about the possibility of nuclear war; most learn about
nuclear war from television or the media and rarely discuss it with their
parents. One study indicates that people in their late teens are somewhat less
concerned than younger children; and surveys of adult attitudes consistently
indicate that although most people believe a nuclear war has a moderate chance
of occurring within their lifetime (and also believe they will not survive it),
they take no action toward preventing it.
The maintenance of hope and the denial of responsibility in the nuclear
age are also discussed in Part IV. Furthermore, a review of the demands on
managers of nuclear weapons systems leads to serious concern that there
might be a breakdown of leadership in the case of a nuclear attack. The
attitudes of world leaders toward war and power are examined, as is the
history of decision-makers' behavior under the stress of international crises.
Finally in this section is a call for improving the screening system used to
select nuclear weapons handlers. Although psychological problems are sup-
posedly discerned before candidates are chosen, a psychiatric interview for
weapons handlers is not required, and more than 3,000 previously screened
armed forces personnel are removed each year from weapons handling because
of alcohol or drug abuse, mental disorders, and other psychosocial problems.
Rounding out the book are remarks by Carl Sagan and Lynn Anspaugh,
who offer contrasting viewpoints on the prospects for recovery from nuclear
war and on the use of scientific information in policy-oriented discussions in
this area. Many scientists, like Sagan, emphasize the importance of assuming
"worst-case" analyses as the basis for policy discussions much as military
planners assume worst-case scenarios in projecting defense needs while
others agree with Anspaugh that the uncertainties in any discussions of the
consequences of nuclear war are so numerous, and so fundamental, that they
preclude the application of these studies to policy debates. There seems to
be wide agreement that the biological and environmental effects of nuclear
war are not fully understood and that our knowledge of these issues will
continue to grow as research continues; however, compared with research
expenditures on the physical aspects of nuclear weapons effects, biological,
psychosocial, and ecological studies appear to be underfunded and late in
starting.
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. . .
XV111
PREFACE
Herbert Abrams, a member of the symposium's steering committee, closes
the volume with a powerful, personal summary of lessons to be learned from
the Institute of Medicine's conference.
The value of this symposium is, in large part, a credit to the steering
committee, which worked many long, hard hours despite ongoing responsi-
bilities at universities, hospitals, and research facilities. All the members of
the committee, along with the authors of these chapters, share a deep com-
mitment to the importance of this work and made many extraordinary efforts
to make the symposium successful. Special recognition is due Marc Messing,
who served as symposium coordinator, and the staff of the National Academy
Press, which transformed the symposium papers into this attractive volume.
It was our pleasure to work with them.
The symposium could not have taken place nor could this volume have
been published without the generous support of the Carnegie Corporation of
New York. We also want to thank the National Research Council for its
financial assistance.
We believe that the papers presented here constitute the most comprehensive
and authoritative review to date of health-related issues associated with modern
nuclear weapons and the threat of nuclear war. Moreover, as a result of
preparation for the symposium and interaction at the conference itself, new
calculations and hypotheses emerged that are potentially of far-reaching im-
portance. It is our hope that this volume will increase public understanding
of the risks and consequences of nuclear war and will inspire scientific efforts
and government actions designed to avoid such a catastrophe.
Robert Q. Marston, M.D.
Chairman
Fredric Solomon, M.D.
Project Director
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The Medical ImpIkellons of
"V([~' -'
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