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PageI      PageI Front Matter (R1-R20) Understanding and Preventing Nuclear War: The Expanding Role of the Scientific Community (1-12) Part I: Nuclear War with Modern Weapons: Physical Effects and Environmental Consequences (13-14) 1 Possible Fatalities from Superfires Following Nuclear Attacks in or near Urban Areas (15-72) 2 A Review of the Physics of Large Urban Fires (73-95) 3 Recent Assessments of the Environmental Consequences of Nuclear War (96-116) 4 Nuclear Famine: The Indirect Effects of Nuclear War (117-135) 5 Nuclear Winter: The State of the Science (136-140) 6 Atmospheric Perturbations of Large-Scale Nuclear War (141-154) 7 Possible Toxic Environments Following a Nuclear War (155-166) 8 Radioactive Fallout (167-204) Part II: Health Consequences of Nuclear War (205-206) 9 Casualties Due to the Blast, Heat, and Radioactive Fallout from Various Hypothetical Nuclear Attacks on the United States (207-232) 10 Acute Radiation Mortality in a Nuclear War (233-250) 11 Burn and Blast Casualties: Triage in Nuclear War (251-283) 12 Food and Nutrition in the Aftermath of Nuclear War (284-289) 13 Psychological Consequences of Disaster: Analogies for the Nuclear Case (290-316) 14 The Immunological Impact of Nuclear Warfare (317-328) 15 Expected Incidence of Cancer Following Nuclear War (329-336) 16 Genetic Consequences of Nuclear War (337-346) Part III: Medical Resource Needs and Availability Following Nuclear War (347-348) 17 Medical Supply and Demand in a Post-Nuclear-War World (349-380) 18 The Consequences of Nuclear War: An Economic and Social Perspective (381-410) Part IV: Images and Risks of Nuclear War: Psychosocial Perspectives (411-412) 19 Children's and Adolescents' Perceptions of the Threat of Nuclear War: Implications of Recent Studies (413-434) 20 Scandinavian Youth View the Future: A Preliminary Report of a Large Questionnaire Survey (435-443) 21 Adult Beliefs, Feelings, and Actions Regarding Nuclear War: Evidence from Surveys and Experiments (444-466) 22 Hope and the Denial of Stress in the Nuclear Age (467-473) 23 The Nuclear Arms Race and the Psychology of Power (474-484) 24 Managerial Demands of Modern Weapons Systems (485-489) 25 Sources of Human Instability in the Handling of Nuclear Weapons (490-528) 26 The Impact of Crisis-Induced Stress on Decision Making (529-552) Part V: Long-Term Consequences of and Prospects for Recovery from Nuclear War: Two Views (553-554) 27 View I (555-565) 28 View II (566-580) Concluding Remarks (581-582) Summary and Perspective: With Some Observations on Informed Consent (583-588) Glossary (589-598) Biographies of Contributors (599-606) Index (607-620) [ Top of Page ] [ Home ] [ Contact Us ] [ Help ] [ The National Academies Home ] Copyright © 2008. 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Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.OCR for page R1The Medical Implitations ofNUtIEAR WARINSTITUTE OF MEDICINENATIONAL ACADEMY OF SCIENCESFredric Solomon, M.D., and Robert Q. Marston, M.D.EditorsWith a Foreword by Lewis Thomas, M.D.NATIONAL ACADEMY PRESSWashington, D.C. 1986OCR for page R2NATIONAL ACADEMY PRESS 2101 CONSTITUTION AVENUE, NW WASHINGTON, DC 20418NOTICE: The symposium reported in these proceedings was approved by the Governing Boardof the National Research Council, whose members are drawn from the councils of the NationalAcademy of Sciences, the National Academy of Engineering, and the Institute of Medicine. Themembers of the committee responsible for the symposium were chosen for their special competencesand with regard for appropriate balance. These proceedings have been reviewed by a group other than the authors according to proceduresapproved by a Report Review Committee consisting of members of the National Academy ofSciences, 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 necessarilyrepresent those of the program sponsor, the Institute of Medicine. The Institute of Medicine was chartered by the National Academy of Sciences to enlist distinguishedmembers of appropriate professions in the examination of policy matters pertaining to the health ofthe public. In this, the Institute acts under both the Academy's congressional charter responsibilityto be an adviser to the federal government and its own initiative in identifying issues of medicalcare, research, and education. The National Academy of Sciences was established in 1863 by Act of Congress as a privatenonprofit, self-governing membership corporation for the furtherance of science and technologyrequired to advise the federal government upon request within its fields of competence. Under itscorporate charter the Academy established the National Research Council in 1916, the NationalAcademy of Engineering in 1964, and the Institute of Medicine in 1970.Library of Congress Cataloging-in-Publication DataThe medical implications of nuclear war. Based on papers presented at a symposium held at the National Academy ofSciences, Washington, D.C., Sept. 20-22, 1985 and organized under the auspicesof the Institute of Medicine.Includes index. 1. Nuclear warfare-Hygienic aspects-Congresses. 2. Emergency medicalservices Congresses. 3. Nuclear warfare Environmental aspects Congresses.4. Nuclear warfare-Psychological aspects Congresses. 5. Nuclear warfareSocial 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 86-18134ISBN 0-309-03692-5ISBN 0-309-03636-4 (pbk.)Copyright @) 1986 by the National Academy of SciencesNo part of this book may be reproduced by any mechanical, photographic, or electronic processor in the form of a phonographic recording, nor may it be stored in a retrieval system, transmittedor otherwise copied for public or private use, without written permission from the publisher, exceptfor 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 ofthe sunlight. The narrow path, along which the wounded are being carried on stretchers, leads toNagasaki Railway Station. (Photograph by Yosuke Yamahata.) Copyright @) 1981 by HiroshimaCity and Nagasaki City. Reprinted by permission of Basic Books, Inc., Publishers.A videotape digest of symposium highlights is available. For information, write the Institute ofMedicine, Office of Information, at 2101 Constitution Avenue, NW, Washington, DC 20418.Printed in the United States of AmericaFirst Printing, September 1986Second Printing, September 1988OCR for page R3INSTITUTE OF MEDICINESteering Committee for the Symposium on theMedical Implications of Nuclear WarROBERT Q. MARSTON, M.D. (IOM), Chairman, President Emeritus,University of Florida, GainesvilleHERBERT L. ABRAMS, M.D. ATOMS, Visiting Professor, Department ofDiagnostic Radiology, Stanford University School of Medicine, andStanford Center for International Security and Anns ControlWILLIAM R. BEARDSLEE, M.D., Clinical Director, Department ofPsychiatry, Children's Hospital Medical Center, and Assistant Professor,Harvard Medical SchoolK. SUNK D. BERGSTROM, M.D., Ph.D. (IOM, NAS), Professor ofChemistry, Karolinska InstituteTHOMAS C. CHALMERS, M.D. (IOM), Distinguished Service Professor ofMedicine, President and Dean Emeritus, The Mount Sinai MedicalCenter, New York CityDAVID S. GREER, M.D. ATOMS, Dean of Medicine and Professor ofCommunity Health, Brown UniversityALEXANDER LEAF, M.D. (IOM, NAS), Ridley Watts Professor ofPreventive Medicine, Harvard Medical School, and Chairman,Department of Preventive Medicine and Epidemiology, MassachusettsGeneral HospitalJENNIFER LEANING, M.D., Chief of Emergency Services, HarvardCommunity Health PlanGILBERT S. OMENN, M.D., Ph.D. (lOM), Dean, School of Public Healthand Community Health, and Professor of Medicine and EnvironmentalHealth, University of WashingtonJEANNE PETERSON, United Nations Office of PopulationCHESTER M. PIERCE, M.D. ATOMS, Professor of Education and Psychiatryin the Faculty of Medicine, the Graduate School of Education, and theFaculty of Public Health, Harvard UniversityTHEODORE A. POSTOL, Ph.D., Science Fellow, Stanford Center forInternational Security and Anns ControllOM, Member of He Institute of MedicineNAS, Member of the National Academy of Sciences. . .lZZOCR for page R4IVSTEERING COMMITTEEFREDERICK C. ROBBlNS, M.D. (IOM, NAS), ex officio President, instituteof Medicine ~ 1980- 1985), University Professor, Department ofEpidemiology and Biostatistics, Case Western Reserve School ofMedicineARTHUR C. UPTON, M.D. STOMP, Professor and Chairman, Department ofEnvironmental Medicine, New York University School of MedicineFRANK VON HIPPEL, Ph.D., Professor, Woodrow Wilson School of Publicand International Affairs, and Center for Energy and EnvironmentalStudies, Princeton UniversityInstitute of MedicinePresidentSAMUEL O. TH1ER, M.D.Project StaffFREDRIC SOLOMON, M.D. (Project Director), Director, Division ofMental Health and Behavioral Medicine, Institute of MedicineMARC MESSING (Deputy Project Director), Staff Consultant, institute ofMedicineNANCY WINCHESTER, Editor, National Academy PressOCR for page R5ContentsForeword . e · ~Lewis Thomas, M.D. Preface e xRobert Q. Marston, M.D., and Fredric Solomon, M.DUnderstanding and Preventing Nuclear War: The ExpandingRole of the Scientific Connnnunity ................................David A. Hamburg, M.D.Part ~Nuclear War with Modern Weapons:Physical Effects and Environmental ConsequencesPossible Fatalities from Superf~res Following Nuclear Attacksin or near Urban Areas .............................................Theodore A. Postol, Ph.D.A Review of the Physics of Large Urban FiresH.~. Brode, Ph.D., and R.D. Small, Ph.Dv. . .11573OCR for page R6VlRecent Assessments of the Environmental Consequences ofNuclear War ...........................................Richard P. Turco, Ph.D.Nuclear Famine: The Indirect Effects of Nuclear War .......Mark A. HarweR, Ph.D., and Christine C. Harwell, ].DNuclear Winter: The State of the ScienceGeorge F. Carrier, Ph.D..Atmosphenc Perturbations of Large-Scale Nuclear WarRobert C. Malone, Ph.D.Possible Toxic Environments Following a Nuclear WarJohn W. Birks, Ph.D., and Sherry L. StephensRadioactive Fallout .........................Charles S. Shapiro, Ph.D., Ted F. Harvey, Ph.D., andKendall R. Peterson, M.S.Part I}Health Consequences of Nuclear WarCasualties Due to the Blast, Heat, and RadioactiveFallout from Various Hypothetical Nuclear Attackson the United StatesCONTENTS ............. 96.. 117136 ....... 141 ....... 155167 ................. 207William Daugherty, Barbara Levi, Ph.D., and Frank vonHippel, Ph.D.Acute Radiation Mortality in a Nuclear WarJoseph Rotblat, Ph.D.233 Burn and Blast Casualties: Tnage in Nuclear War - 251Jennifer l caning, M.D.Food and Nutrition in the Aftermath of Nuclear WarAlexander Leaf, M.D. .......... 284OCR for page R7CONTENTSPsychological Consequences of Disaster: Analogies forthe 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 .......................... 337Part IIIMedical Resource Needs and AvailabilityFollowing Nuclear WarMedical Supply and Demand in a Post-Nuclear-War WorldHerbert L. Abrams, M.D.The Consequences of Nuclear War: An Economic andSocial Perspective .......................................Hal Cochrane, Ph.D., and Dennis Mileti, Ph.DPart IVhnages and Risks of Nuclear War:Psychosocial Perspectives.Children's and Adolescents' Perceptions of the Threat of NuclearWar: Implications of Recent Studies ......................William R. Beardslee, M.D.Scandinavian Youth View the Future: A Preliminary Reportof 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.OCR for page R8· · ~VlllHope and the Denial of Stress in the Nuclear AgeShiomo Breznitz, Ph.D.The Nuclear Arms Race and the Psychology of PowerJerome D. Frank, M.D., Ph.D.Managerial Demands of Modern Weapons SystemsJohn D. Steinbruner, Ph.D.Sources of Human Instability in the Handling ofNuclear Weapons ..Herbert L. Abrams, M.DCONTENTS ............. 467 ........ 474485490 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 RemarksSummary and Perspective: With Some Observations onInformed Consent ..................................................Herbert J. Abrams, M.D.566583 Glossary 589 Biographies of Contnbutors Index607OCR for page R9Foreword I was in Europe at the time of the Institute of Medicine's symposium, andI 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 immunedeficiency 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 intosomething the writers could lay hands on. Something to sit down and thinkabout, and compose a front page story about; something different from allthose unthinkable matters. To be sure, there were some lines at the bottomof the stories, continued on inside pages, giving some new estimates of thenumbers of people to be killed outright by blast and burns, the utter impos-sibility of any health care system doing anything even marginally useful, andsome mention of the "nuclear winter" scenario. But it was AIDS that caughtthe attention of the press, AIDS that made the story. When I got back to New York a few days later, the whole story had vanishedfrom the papers, but I found clippings from most of the earlier reports thathad 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 andweeks 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, treatyviolation talks, editorials saying that neither side can trust the other or everIXOCR for page R10xFOREWORDwill, endless bewildering columns on the SDI and the talk about SDI. Wretched,dishonest, evasive talk, political talk, with no mention anywhere of burntblasted vaporized human beings in the billions and half the planet frozen andirradiated. The same turning away from real life and real death danger thatwe have all been tolerating, some of us even encouraging, since we and theRussians began building our "arsenals," as we like to call the things to makeit seem like old times, same old clash of arms, same excitements. The Britishand the French with theirs, and the Chinese and Indians and God only knowswho else with theirs, all of humanity caught up in the craziness like lemmingsrunning headlong toward the cliff, everyone muttering unthinkable. We behave as if we really believe these are weapons even, burn ourtongues, weapons of "defense." We brandish them, display them like thespears 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. Maybeholding 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 pagestories every day about the world coming to an end, they say. People won'tread things like this, they say. I raise my voice, yell sometimes, what the hell are newspapers for? You'resupposed 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'stoo 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, runit and run it. I say all that, and things like that, and they look at me withembarrassment. But AIDS ! And then nothing. And in that one day of stories, down at thebottom, winding things up, a short paragraph saying 56 million Americanswould be killed outright in a 100-megaton attack on cities; not much betterin an attack on military targets (our "assets," we call them), 38 million ifthey do that. That's from 100 megatons, the equivalent of a warning shotover the heads of a crowd considering that we and the Soviets have betweenus 20,000 megatons or whatever the number now is. I complain to my journalist friends in a voice as reasonable as I can makeit, even good-natured, can't you at least do more to get the public thinkinghard about nuclear winter? Too much uncertainty, they say, you can't be sureabout the weather, can't predict it until it really happens. Anyway, peopledon'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? Theyask me that, then say, that's the closest estimate available for the deaths ina really full-scale nuclear war, when everything is let fly. How can you getOCR for page R11FOREWORDXlipeople (the "reading public," they say) to think about a lot of clouds, eventhe extinction of some other kinds of life on the planet, when you've got anumber that is at least half the human species? Then they use the word thathas become the cliche of late twentieth century statecraft: unthinkable. That is the center of the trouble, I see that. Nuclear war is for sure, beyondquestion, dead certainly, literally, figuratively, any way you don't want tothink about it: unthinkable. If we go on this way, unthinking, putting it out of our minds, leaving itto statecraft of the kind we've got all over the world, or leaving it to theeditorial writers, the columnists, the TV newsmen, or the military people,first thing you know some crafty statesman or some other crafty unbalancedmilitary personage, one side or the other, is going to do something wrong,say something wrong, drop something, misread some printout, and there willgo 30,000 years of trying ever since Lascaux right up to Bach and beyondinto this benighted century all civilization, gone without a trace. Not evena thin layer of fossils left of us, no trace, no memory. Pay attention to George Kennan and Solly Zuckerman and their books alongwith this one. They have thought longer and more clearly than most peopleclose to the complexities. Solly Zuckerman, with years of experience asscience adviser to the British cabinet, says we're in trouble because of theweapons-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, ormore importantly what not to do. Tell them: that's enough now, don't improvethe technology, don't make anything technically sweeter or smarter, go homeand we'll pay you to stay there. Unthinkable is the word for whatever is in front of our eyes but too big tofigure out, too frightening. Pay attention, in this book, to the doctors and thescientists here assembled. Everything needed for thinking clearly, wincing all the way but thinkinganyway, is written down in these chapters. Anyone, any age, can read what'shere and understand what we could be in for if we stay on this road. Whatto 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 EmeritusMemorial Sloan-KetteringCancer CenterOCR for page R12OCR for page R13Preface On August 6, 1945, a 15-kiloton atomic bomb ignited the center of theJapanese 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, manysurvivors developed symptoms that puzzled doctors: blood cell abnormalities,high fevers, chronic fatigue, diarrhea, vomiting, and depression. Physiciansbegan to term these symptoms "radiation sickness." It would eventually berevealed that survivors were experiencing an increased incidence of certainforms 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 destructiveweapons continues, scientific examination of the effects of nuclear weaponsupon 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'satmosphere 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 monthsafter a nuclear war. This led to a fundamental reassessment of postwar en-vironmental conditions, especially those affecting food production. The early1980s also saw Me beginning of new efforts by physicians and by scientistsfrom many disciplines and many nations to examine the indirect health-related· · .x'''OCR for page R14XIVPREFACEeffects of nuclear war, including intermediate-term consequences for survivorsand effects on persons living far away from anticipated war zones. Morecomprehensive appraisals were produced of the catastrophic social, economic,and psychological sequelae of nuclear war. Scholars began anew to examinethe psychosocial dimensions of nuclear arms competition, international con-flict, and the threat of nuclear war. The time seemed propitious, therefore, to convene an international groupof scholars in the autumn of 1985 to review the medical implications of theseand other new studies. In addition to considering the direct and indirect healtheffects of nuclear attack, these physicians and scientists were asked to examinethe availability of medical resources and the psychological issues surroundingnuclear weapons and war. It was fitting that this conference was organizedunder the auspices of the Institute of Medicine in Washington, D.C. Sincebeing chartered by the National Academy of Sciences in 1970, the Institutehas devoted itself to examining developments in science, health care, andpublic policy that affect the health of the public. Indeed, it has asserted thatnothing can have greater potential impact on health than a nuclear war. Astatement adopted by the IOM membership in 1982 reflects that concern:"Nuclear war is the single event that could terminate all our efforts to improvethe human condition. That possibility seems particularly ironic at a time whengreat strides are being made in alleviating human ills, and even greater ad-vances are in prospect.... The only preventive medicine we know that canavoid the medical consequences of nuclear war is to prevent nuclear waritself. " It is also fitting that this symposium occurred during Frederick Robbins'stenure as president of the Institute of Medicine. Dr. Robbins has long beenconcerned with the threat of nuclear war, and this symposium last fall wasan appropriate tribute to his five years of leadership. In fact, the symposiumhas had the support and guidance of three Institute presidents. David Hamburg,who was Fred Robbins's predecessor, contributed in several ways to thesuccess of the symposium-through the support of the Carnegie Corporationof New York, which he now heads, through his advice on the program as itwas being developed, and through the extraordinary chapter that opens thisbook. Finally, Samuel Thier, the current president of the Institute, has directedthe review and dissemination of the results of the symposium, including thisvolume. In his opening remarks to the conferees, Frank Press, president of theNational Academy of Sciences and chairman of the National Research Coun-cil, emphasized the value of vigorous scientific debate on this topic: "Theprofundity of the consequences of nuclear war are such that symposia of thistype-building up momentum for these issues and for public concern anddisseminating the kind of information and knowledge that is generated at aconference like this are a most valuable public service."OCR for page R15PREFACEXV Moreover, Dr. Press reminded the audience that, despite the level of internalgovernment activities, many of the best ideas for the control of nuclear weap-ons and the best estimates of the consequences of nuclear war have comefrom scientists and scholars working outside official circles. Indeed, duringthat September weekend, more than 80 scientists from nine countries werejoined by concerned members of the general public. Thirty papers were pre-sented which, after subsequent refinement, have become the contents of thisvolume. The authors come not only from government laboratories but alsofrom 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 nuclearpower plant have dramatized an important point: there are difficulties inherentin the design, maintenance, and operation of complex fail-safe systems. Thetragedies 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 goodluck 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 complexand permit so little margin for human error or misunderstanding in a time ofcrisis, that even the most sophisticated efforts of crisis management mightfail us in a nuclear confrontation. In the long run, strategic military crisesmust be prevented from developing among the nuclear powers of the world,because neither human judgment nor technology can be relied upon to avoidnuclear war in the event of a prolonged and complex confrontation. This volume is divided into five parts. The first provides an overview ofthe physical and environmental effects of nuclear war, setting the stage forlater sections that address the medical impact of various types of nuclearattack. Among the papers in Part I is a disturbing report by Theodore Postolfrom the Stanford Center for International Security and Anns Control. Basedon the properties of modern nuclear weapons, he estimates that firestormstriggered by nuclear explosions would kill two to four times as many peoplein or near cities than have been predicted by standard government studies.Unlike Hiroshima and Nagasaki, where many of the survivors were able towalk out of the blast zones and seek help, contemporary weapons wouldproduce vast "hurricanes of fire," making escape impossible over wide areas. Other contributors to Part I review the physics of large urban fires andupdate projections of nuclear winter. "Nuclear famine" is also described,drawing on the very recent work of SCOPE (The Scientific Committee onProblems of the Environment of the International Council of Scientific Unions).Because of the dependence of third-world countries on rice, wheat, and cornharvests, as well as on agricultural support from the world's superpowers, anuclear attack that destroyed crop harvests and stockpiles and interruptedOCR for page R16XVIPREFACEdistribution systems might kill more people in noncombatant nations than incombatant ones. And new ecological concerns are raised for example, thetoxicity of an environment laden with the by-products of burning plastics andother man-made materials. In Part II, the consequences of nuclear war are considered from a standpointof deaths, injuries, and, especially, the health of survivors. In preparation forthis symposium, a Princeton University research team developed the firstdetailed computer model outside the classified literature for calculating U.S.casualties from a nuclear war. This model was then used to examine thesensitivity of casualty estimates to various assumptions about nuclear weaponseffects. The work indicates that if some heretofore standard assumptions arerevised as proposed in several of the other papers in this volume (e.g.,greater lethality of firestorms or of radiation exposure) a "limited" attacksolely on strategic nuclear targets would kill tens of millions, a figure muchgreater than earlier government estimates. The Princeton group also dem-onstrates that it is virtually meaningless for military analysts to distinguishbetween attacks in which nuclear weapons are used on military-related in-dustries but not on civilian targets and attacks in which cities are targeted perse: the toll is nearly as great in either case because such industries are sofrequently located within or adjacent to major population centers. Also in this section, physicians and scientists describe problems of triageand care of the injured survivors of nuclear war. They provide new estimatesof the lethality of radiation exposure under wartime conditions, consider theeffects of food shortages and malnutrition on the prospects for survival, anddiscuss the psychological consequences of surviving major disasters. Scien-tists from Norway and the Soviet Union offer estimates of the long-termgenetic and carcinogenic effects of nuclear weapons use. In a provocativenew synthesis, the combined effects of high levels of ionizing and ultravioletradiation, burns and physical trauma, malnutrition, and psychological stressupon human immunology are examined; investigators from Brown Universityargue Mat these multiple insults would impair the cell-mediated immunecapability of a great many survivors, making them likely to succumb todiseases such as pneumonia, tuberculosis, and cancer diseases that are prev-alent among today's victims of the virus-caused immune deficiency knownas AIDS. Part III reviews the demand for medical resources after a nuclear attackand estimates the actual supply likely to be available. If a single one-megatonbomb were exploded over the city of Detroit, for example, it is calculatedthat survivors would need about forty times the number of burn beds currentlyavailable throughout the entire United States. They would also need twicethe number of intensive care beds currently available, and the need for bloodtransfusions would exceed the existing supply many times over. A moreOCR for page R17PREFACE. ~XV11extensive nuclear exchange involving the United States, Europe, and theSoviet Union and its allies would wipe out most of the world's supply ofpharmaceuticals, medical equipment, and food. Also in Part III, two socialscientists offer an economic and social perspective on the consequences ofnuclear war. Contributors to Part IV address the nuclear arms race from a psychosocialpoint of view: How does the threat of nuclear war affect the attitudes andbehavior of adults and children? Studies provide evidence that many youngchildren are worried about the possibility of nuclear war; most learn aboutnuclear war from television or the media and rarely discuss it with theirparents. One study indicates that people in their late teens are somewhat lessconcerned than younger children; and surveys of adult attitudes consistentlyindicate that although most people believe a nuclear war has a moderate chanceof 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 nuclearage are also discussed in Part IV. Furthermore, a review of the demands onmanagers of nuclear weapons systems leads to serious concern that theremight be a breakdown of leadership in the case of a nuclear attack. Theattitudes of world leaders toward war and power are examined, as is thehistory of decision-makers' behavior under the stress of international crises. Finally in this section is a call for improving the screening system used toselect nuclear weapons handlers. Although psychological problems are sup-posedly discerned before candidates are chosen, a psychiatric interview forweapons handlers is not required, and more than 3,000 previously screenedarmed forces personnel are removed each year from weapons handling becauseof 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 nuclearwar and on the use of scientific information in policy-oriented discussions inthis area. Many scientists, like Sagan, emphasize the importance of assuming"worst-case" analyses as the basis for policy discussions much as militaryplanners assume worst-case scenarios in projecting defense needs whileothers agree with Anspaugh that the uncertainties in any discussions of theconsequences of nuclear war are so numerous, and so fundamental, that theypreclude the application of these studies to policy debates. There seems tobe wide agreement that the biological and environmental effects of nuclearwar are not fully understood and that our knowledge of these issues willcontinue to grow as research continues; however, compared with researchexpenditures on the physical aspects of nuclear weapons effects, biological,psychosocial, and ecological studies appear to be underfunded and late instarting.OCR for page R18. . .XV111PREFACE Herbert Abrams, a member of the symposium's steering committee, closesthe volume with a powerful, personal summary of lessons to be learned fromthe Institute of Medicine's conference. The value of this symposium is, in large part, a credit to the steeringcommittee, which worked many long, hard hours despite ongoing responsi-bilities at universities, hospitals, and research facilities. All the members ofthe committee, along with the authors of these chapters, share a deep com-mitment to the importance of this work and made many extraordinary effortsto make the symposium successful. Special recognition is due Marc Messing,who served as symposium coordinator, and the staff of the National AcademyPress, 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 havebeen published without the generous support of the Carnegie Corporation ofNew York. We also want to thank the National Research Council for itsfinancial assistance. We believe that the papers presented here constitute the most comprehensiveand authoritative review to date of health-related issues associated with modernnuclear weapons and the threat of nuclear war. Moreover, as a result ofpreparation for the symposium and interaction at the conference itself, newcalculations and hypotheses emerged that are potentially of far-reaching im-portance. It is our hope that this volume will increase public understandingof the risks and consequences of nuclear war and will inspire scientific effortsand government actions designed to avoid such a catastrophe.Robert Q. Marston, M.D.ChairmanFredric Solomon, M.D.Project DirectorOCR for page R19The Medical ImpIkellons of"V([~' -'OCR for page R20 |
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