Nobel Lecture, December 11, 1985 by Yevgeny Chazov, USSR Cardiological Institute, co-founder of IPPNW

Tragedy and Triumph of Reason

Ladies and Gentlemen, Dear Colleagues,

Physicist Leo Szilard, one of those who persuaded Albert Einstein to appeal to President Franklin D. Roosevelt to go on with the development of A-bomb, in his last years wrote science fiction stories. In one of them he describes newcomers from a distant star who arrived to find the cities and towns of Earth destroyed and devastated. One of the visitors recalled he had observed a series of enigmatic explosions on the planet Earth; these must have been uranium explosions, he suggested, which annihilated every living thing. Another member of the crew objected it could not be possible. Uranium by itself is not an explosive; a very sophisticated technology is required to make it explode. Only highly intelligent beings, however, could have known this technology and built beautiful cities. It is hard to believe they made all these efforts and processed uranium for self-destruction.

That was written by one of those who was instrumental in the creation of the two-faced Janus of the chain reaction capable of solving mankind’s energy problem and at the same time being the basis of the weapon of genocide – the atom bomb.

Did you ever ponder upon the fact that the first active opponents of nuclear weapons were those who created or helped to develop it – Einstein, Szilard, Bohr, Joliot-Curie, Kurchatov and others?¹ The atom bomb was created by the reason of these men, but that same reason rebelled against it.

In medical science arguments are going on between behaviorists who perceive the function of brain as a multitude of simple and unconscious conditioned reflexes, and cognitivists who insist that humans sensing the surrounding world create its mental image which can be considered as memory of facts.

I do not intend to argue the essence of these processes, all the more so because it has been proved that both types of memory function in the brain. However, I am convinced that those who once saw a nuclear explosion or imagined the victims of Hiroshima and Nagasaki will forever maintain the mental picture of horror-stricken and dust-covered Earth, burned bodies of the dead and wounded and people slowly dying of radiation disease. Prompted by the sense of responsibility for the fortunes of the human race, Einstein addressed the following warning to his colleagues: “Since we, scientists, face the tragic lot of further increasing the murderous effectiveness of the means of destruction, it is our most solemn and noble duty to prevent the use of these weapons for the cruel ends they were designed to achieve”.

Unfortunately, this appeal, like the warnings voiced by many leading scientists, has not reached the public conscience or the conscience of political and state figures. Nuclear arsenals on our planet have been increasing with every year, with every day. Ten new nuclear warheads appear daily on Earth now.

Put forward by some state and military figures, the theory of preserving peace through “deterrence” led to the situation where nuclear might transcended the limits of human perception. Indeed, no one in this audience can really imagine one million Hiroshimas – a statistic designed to depict figuratively the destructive power of nuclear weapons stockpiled today.

Keep in mind that when the first A-bomb was developed as a defense against Nazism, moral objections and conscience of scientists and many others involved were lulled by assurances that everything would be over after production of a few bombs.

Is not the same rationale applied today when they speak about the research objectives of the space militarization program, about its defensive significance? Can we not discern that it is an attempt to gradually make us accept the idea of weapons over our heads, in outer space? The minds of honest scientists, of all men, cannot be reconciled with turning the vicinity of our planet, so far weapons-free, into an arena of military competition. The “space shield” will mean one more step toward nuclear catastrophe, not only because it would create the temptation to effect a first strike with impunity, but because any defense will inevitably lead to the creation of the means to overcome it. Thus the spiral of the arms race – nuclear, conventional, laser and other – will again soar steeply undermining strategic stability.

The peril from space should not be underestimated. In the late 1940s humanity entered the military-nuclear era, which for the first time in history confronted the human civilization with the threat of total annihilation. Can we allow the 1980s to become the starting point of the military-nuclear-space era which would lead the present-day brinkmanship to utmost unsteadiness? It is time we say a decisive “NO” to the arms race in space and stop it on Earth.

We do not fully know the material basis of the brain function, we do not know whether adrenalin, acetylcholine or opioid peptides determine human senses and behavioral reactions. However, we do know (such is, unfortunately, the nature of human consciousness) that most people, absorbed by anxieties of everyday life and with solving their daily problems tend to forget the global problems of life on Earth which concern all of us, all inhabitants of our beautiful Planet – first of all the problem of the nuclear arms race and the threat of nuclear war. Many people, even if they think about it, regard it as some kind of a fairy tale.

Let us recall the situation as it was five years ago when three American and three Soviet physicians met in Geneva to decide jointly what physicians should do to prevent the “final epidemic” – nuclear war. Like the songs of sirens who lured Odysseys, soothing voices of state figures and military leaders, commentators and even some scientists were heard from parliaments and congresses, from TV screens and periodicals. They created and disseminated nuclear illusions to the effect that nuclear war is just another war (they added diffidently that it might involve a larger scale of destruction); that a limited nuclear war is possible; that nuclear ware is not only survivable but also winnable. One could even hear assertions that there are things more important than peace.

It is difficult for me to speak about the feelings of our American colleagues and friends, but we, Soviet physicians, who know what a devastating war is like, not from history textbooks but from our own experience, who together with all our people imbibed hatred to war – we were troubled by the indifference demonstrated by many people towards these irresponsible statements justifying the nuclear arms race. It was necessary to arouse the indifferent and turn them into active opponents of nuclear weapons. It was not simply our obligation as honest men, it was our professional duty. As Hippocrates said: the physician must inform the patient about every thing that threatens his life.

In our medical practice we not infrequently come across patients who are careless about their own health. In such cases we appeal to their reason. If I receive a patient who is a smoker suffering from endoarthritis, I will tell him that if he does not give up smoking the outcome might be lethal. Likewise, we, participants in our movement of International Physicians for the Prevention of Nuclear War, appealed to the reason of humankind by drawing the real picture, without coloring the truth, of what would happen to our Earth if nuclear war is unleashed. In a way, it was a heroic deed on the part of tens of thousands of physicians from many countries of the world, adhering to different political and religious views and belonging to various nationalities, to raise their voice to defend life on Earth. We could not have acted otherwise. As Anton Chekhov^2, a remarkable author and physician, wrote about our profession: “The profession of physicians is an exploit, it requires self-confirmation and purity of soul and thought. One should be mentally lucid and morally pure”.

At the end of 1980 a meeting was held in Geneva, mentioned above, of Soviet and American physicians – Ilyin, Kuzin and myself, Lown, Muller and Chivian.³ In the course of a two-day discussion the representatives of the two countries that so often confront each other, were unanimous in supporting the creation of a broad-based international movement of physicians for the prevention of nuclear war. Despite their differences they came to the conclusion that physicians cannot and indeed have no right to stay silent and remain at the sidelines when the preservation of life and health of hundreds of millions is at stake.

Our movement, which has come to be called “International Physicians for the Prevention of Nuclear War” has grown rapidly: physicians from 11 countries participated in its first international congress in the USA in 1981; the fifth congress in Budapest in 1985 attracted delegates from over 50 countries. The small group of Soviet and American physicians grew to become a multinational army of 145.000 activists, who devote their free time to research on the possible consequences of nuclear war and to explain the data obtained to governments, politicians, scientists, the public and international organizations.

Our annual congress and regional seminars constitute important milestones of this research and information activities, which mobilize world public opinion to act against the unprecedented threat in our civilization’s history.

Over a million and a quarter physicians have signed the Amsterdam congress appeal against the nuclear arms race. We suggested the inclusion in the Hippocratic Oath a commitment to fight against the danger of a nuclear war (such an amendment has already been officially made to the Soviet physicians’ oath)⁴. A “Message to My Patients” is distributed in hospitals, clinics and physicians’ offices to help prevent nuclear war.

IPPNW is aware of the fact that wars start not from bombs dropped or shots fired – they start in the minds of people and are the result of political decisions. That is why our congresses regularly address world leaders, particularly of the USSR and the USA, calling upon them to do the utmost to exclude the very possibility of a nuclear war and to reverse the nuclear arms race. The messages received by us from these and other leaders show that the voice of physicians is being heeded.

We are aware that in order to eradicate nuclear illusions and impart hatred of war to the peoples, one should be based, like in our medical practice, on solid scientific data. I do not wish to dwell on the results of our studies confirmed by the authoritative expert group of the World Health Organization. Physicians have demonstrated to the whole world that not only would nuclear war spell the end of civilization, it would also prejudice the existence of life on Earth. My conscience, and I am sure the same applies to many of my colleagues in IPPNW, was staggered primarily by the total number of victims in nuclear war. The human mind finds it difficult to comprehend the figure of 2,000 million victims. As they say, one death is death, but a million deaths are statistics. For us, physicians, life is the aim of our work and each death is a tragedy. As people constantly involved in the care of patients, we felt the urge to warn governments and peoples that the critical point has been passed: medicine will be unable to render even minimal assistance to the victims of a nuclear conflict – the wounded, the burned, the sick – including the population of the country which unleashes nuclear war. Even rough estimates show it would require efforts of at least 30 million physicians, 100 million nurses and technical personnel. These, of course, are absolutely unrealistic figures. In the world today there are around 3.5 million physicians and about 7.5 million nurses. Treatment of a few hundred patients suffering from burns as a result of a major fire can rapidly exhaust the burn cure resources of a large city. Where, then, can the resources be found to treat thousands and millions of casualties? Physicians and hospitals will face an insoluble problem, even if we discount the appalling conditions of “nuclear winter” which is bound to cap the catastrophe. Besides, in a nuclear war many physicians and nurses will be killed and many hospitals destroyed.

Our data were widely circulated and produced a sobering effect the world over on a broad range of public, political and religious figures and common men who had underestimated the scale of a nuclear catastrophe. The threat to humanity posed by nuclear weapons is being perceived by hundreds of millions on our planet. Of course a lot of people are still under a delusion, consciously or involuntarily, as regards the significance of the arms race and its proliferation to outer space. However, as Cicero put it, “Each man can err, but only fools persist in their errors”.

Every morning tens of thousands of newly-born babies in Europe and America, in Asia and Africa for the first time see the sky and the sun, enjoy their mothers’ loving care. We, physicians, are to protect their health and life. But what is there ahead for them? What will their life be like? Will they live to see the twenty-first century? There is a nuclear bomb in stock for each of them. Back in 1951 French author André Maurois aptly expressed the aspirations of all honest men on Earth. He wrote: “Are we really deprived of all hope? Will the wretched human race destroy itself together with the planet that harbored it? I believe the catastrophe can be avoided… Salvation of the humankind is in its own hands… The strength of our convictious, the promptness of our decisions will disarm those who threaten the future of humanity… Will the globe live or die – that is the choice we face. Either we join hands, or we exterminate each other in an atomic war”.

These ideas are consonant with our views. Our intellect cannot be reconciled with the situation when the world is heading toward nuclear death. We physicians are neither politicians, nor military experts. However, we have analyzed the present uneasy situation thoroughly enough to suggest to governments our medical prescription for the survival of humankind. Our program has been elaborated, discussed and approved by IPPNW Congresses. It envisages a ban on tests of nuclear weapons and, as the initial step, a moratorium on nuclear explosions; a nuclear weapons freeze and the subsequent reduction and eventual liquidation of nuclear weapons; the non-proliferation of the arms race to outer space, no first use of nuclear weapons and the creation of an atmosphere of trust and cooperation.

It is not a political declaration of either communists or capitalists – it is what is demanded by reason, by people the world over who want to live. More than 400 years ago the Dutch thinker Erasmus of Rotterdam wrote about war: “By the way, what can be sillier than to join a competition for whatever reason, when each side would inevitably experience more awkwardness than it would receive benefits”⁵. Today we are talking not just about warring sides but about humanity at large. Any reasonable man finds it hard to believe that while hunger, diseases, social inequality, economic underdevelopment and illiteracy are in existence, hundreds of billions of dollars are wasted to feed the insatiable monster – the arms race.

On the other hand, I recall the days when the triumph of reason and political atmosphere of trust provided for close peaceful cooperation and joint studies by Soviet and American scientists. I cannot say about other spheres, but in cardiology, which is my province, this atmosphere contributed to accelerated study of such acute problems as atherosclerosis, myocardial infarction, sudden death and arrhythmia and facilitated introduction of new methods of diagnosis and therapy. A space bridge discussion of Soviet and American scientists on the problem of prevention and treatment of atherosclerosis will take place in the near future. This discussion will acquaint scientists the world over with achievements in this field. These achievements make it possible to assert that the problem of atherosclerosis will be largely solved within the next ten years. It will be a commendable example of cooperation between the USSR and the USA for the benefit of the peoples of the world. It is a vital necessity to continue and extend this cooperation. What we need is cooperation, not confrontation. Therefore, I was deeply satisfied with the Soviet-American arrangement arrived at during the recent meeting in Geneva between General Secretary Gorbachev and President Reagan, to extend exchanges and contact in the field of medicine and, in particular, to resume cooperation in combating cancer diseases. We are ready for such cooperation.

Today is a meaningful and festive day for over 140,000 physicians from 41 nations, those who united in the movement of International Physicians for the Prevention of Nuclear War. And not only for them but for all honest men and women dedicated to maintaining life on Earth as members of the most humane profession – medicine. The Nobel Prize awarded to our movement is not only a recognition of physicians’ services in denouncing the nuclear illusions and promoting a true perception of nuclear weapons and effects of their use, but also a symbol of international trust and belief in the infinite value and uniqueness of the human mind. As Ibsen⁶ wrote in Peer Gynt “Only he who has nothing to lose in life can risk it”. Nuclear war, unless it is prevented, would lead to the extinction of life on Earth and possibly in the Universe. Can we take such a risk?

In our medical practice when we deal with a critical patient in order to save him, we mobilize all our energies and knowledge, sacrifice part of our hearts and enlist the cooperation of our most experienced colleagues. Today we face a seriously ill humanity, torn apart by distrust and fear of nuclear war. To save it we must arouse the conscience of the world’s peoples, cultivate hatred for nuclear weapons, repudiate egoism and chauvinism, and create favorable atmosphere of trust. In the nuclear age we are all interdependent. The Earth is our only common home which we cannot abandon. The new suicidal situation calls for the new thinking. We must convince those who take political decisions.

Our professional duty is to protect life on Earth. True to the Hippocratic Oath, physicians will dedicate their knowledge, their hearts and their lives to the happiness of their patients and the well-being of the peoples of the world.

1. Albert Einstein (1879-1955), American, born in Germany; Leo Szilard (1898-1964), American, born in Hungary; Niels Bohr (1885-1962) of Denmark; Fredéric Joliot-Curie (1900-1958) of France; Igor Kurchatov (1903-1960) of the Soviet Union.

2. Anton Pavlovich Chekhov (1860-1904), Russian short story writer, dramatist and physician.

3. Dr. Leonid Ilyin, Director of the Institute of Biophysics of the Soviet Union; Dr. Mikhail Kuzin, Director of the Vishnevsky Institute of Surgery; Dr. James Muller of the Harvard Medical School, who had studied and done research in Moscow; and Dr. Eric Chivian, staff psychiatrist at the Massachusetts Institute of Technology.

4. Following the Nobel lectures, Dr. Dagmar Sørbøe of Norway led the assembled physicians in reciting the amended oath of Hippocrates:

Oath of Hippocrates

The regimen I adopt shall be for the benefit of my patients according to my ability and judgment, and not for their hurt or for any wrong. I will give no deadly drug to any, though it be asked me, nor will I counsel such.

Whatsoever house I enter, there will I go for the benefit of the sick, refraining from all wrongdoing or corruption, and especially from any act of seduction, of male or female, of bond or free. Whatsoever things I see or hear concerning the life of men, in my attendance on the sick or even apart there-from, which ought not to be noised abroad, I will keep silence thereon, counting such things to be as sacred secrets.

As a physician, I recognize that the only effective medical response to nuclear war is prevention. I believe that medical preparations for nuclear war increase its likelihood by strengthening the illusions of protection, survival, and recovery. Such measures promote the acceptability of a catastrophe which 1 will not accept. As a matter of individual conscience, I will refuse to participate in any medical preparations for nuclear war. I affirm my duty and willingness to provide care in all medical emergencies to the best of my ability. I commit myself to applying my medical knowledge and skills for the preservation of human life.

As a physician of the twentieth century, I recognize that nuclear weapons have presented my profession with a challenge of unprecedented proportions, and that a nuclear war would be the final epidemic for humankind. I will do all in my power to work for the prevention of nuclear war.

1. Albert Einstein (1879-1955), American, born in Germany; Leo Szilard (1898-1964), American, born in Hungary; Niels Bohr (1885-1962) of Denmark; Fredéric Joliot-Curie (1900-1958) of France; Igor Kurchatov (1903-1960) of the Soviet Union.

2. Anton Pavlovich Chekhov (1860-1904), Russian short story writer, dramatist and physician.

3. Dr. Leonid Ilyin, Director of the Institute of Biophysics of the Soviet Union; Dr. Mikhail Kuzin, Director of the Vishnevsky Institute of Surgery; Dr. James Muller of the Harvard Medical School, who had studied and done research in Moscow; and Dr. Eric Chivian, staff psychiatrist at the Massachusetts Institute of Technology.

4. Following the Nobel lectures, Dr. Dagmar Sørbøe of Norway led the assembled physicians in reciting the amended oath of Hippocrates:

Oath of Hippocrates

The regimen I adopt shall be for the benefit of my patients according to my ability and judgment, and not for their hurt or for any wrong. I will give no deadly drug to any, though it be asked me, nor will I counsel such.

Whatsoever house I enter, there will I go for the benefit of the sick, refraining from all wrongdoing or corruption, and especially from any act of seduction, of male or female, of
bond or free. Whatsoever things I see or hear concerning the life of men, in my attendance on the sick or even apart there-from, which ought not to be noised abroad, I will keep silence thereon, counting such things to be as sacred secrets.

As a physician, I recognize that the only effective medical response to nuclear war is prevention. I believe that medical preparations for nuclear war increase its likelihood by
strengthening the illusions of protection, survival, and recovery. Such measures promote the acceptability of a catastrophe which I will not accept. As a matter of individual conscience, I will refuse to participate in any medical preparations for nuclear war. I affirm my duty and willingness to provide care in all medical emergencies to the best of my ability. I commit myself to applying my medical knowledge and skills for the preservation of human life.

As a physician of the twentieth century, I recognize that nuclear weapons have presented my profession with a challenge of unprecedented proportions, and that a nuclear war would be the final epidemic for humankind. I will do all in my power to work for the prevention of nuclear war.

5. Desiderius Erasmus (1466?-1536), a Dutch humanist who wrote often on the folly and iniquity of war.

6. Henrik Ibsen (1828-1906), the Norwegian dramatist and poet.

* * *

Nobel Lecture, December 11, 1985 by Bernard Lown, Professor of Cardiology, co-president IPPNW

A Prescription for Hope

When Alfred Nobel drafted his final will in late 1895, providing this enduring and monumental legacy, the world was charged with anticipation and optimism for the twentieth century. Mind and hand, the distinctive attributes of our species, were at last finding their intertwined fulfillment in science and technology. Science, at the “fin de siècle”, promised mastery of a hostile environment and an end to chaotic societal relations punctuated by war and brutality. Advancing technology augured unlimited potential for human power, inspiring a dream for an end to drudgery and an age of abundance.

The hope of a benevolent civilization was shattered in the blood-soaked trenches of the First World War. The “war to end all wars” claimed sixteen million lives, and left embers which kindled an even more catastrophic conflagration.

Over the sorry course of 5,000 years of endless conflicts, some limits had been set on human savagery. Moral safeguards proscribed killing unarmed civilians and health workers, poisoning drinking waters, spreading infection among children and the disabled, and burning defenseless cities. But the Second World War introduced total war, unprincipled in method, unlimited in violence, and indiscriminate in victims. The ovens of Auschwitz and the atomic incineration of Hiroshima and Nagasaki inscribed a still darker chapter in the chronicle of human brutality. The prolonged agony which left 50 million dead did not provide an enduring basis for an armistice to barbarism. On the contrary, arsenals soon burgeoned with genocidal weapons equivalent to many thousands of World War II’s.

The advent of the nuclear age posed an unprecedented question: not whether war would exact yet more lives but whether war would preclude human existence altogether.

Every historic period has had its Cassandras. Our era is the first in which prophecies of doom stem from objective scientific analyses. Nearly a quarter of a century ago, a study by American physicians concluded that medicine, which in past wars mitigated misery and saved lives, had nothing to offer following nuclear war. This conclusion was extrapolated from the destruction wrought by blast, fire and radiation on Hiroshima and Nagasaki. Astonishingly, nearly 40 years elapsed before scientists first discovered additional ecologic consequences. Nuclear war, they found, could blanket the sky with smoke, dust, and soot, creating a pall of all-pervasive darkness and frigid cold. The impact on climate could last for several years, not sparing the Southern Hemisphere.

But there is more. Since cities are enormous storehouses of combustible synthetics, raging fire storms would release into the air a Pandora’s box of deadly toxins. When dust, poisons, and soot finally cleared, another plague would be visited on the unfortunate survivors; high levels of ultraviolet light caused by depletion of atmospheric ozone would take an additional toll.

Martin Buber¹ suggested that evil prevailed because of the inability of man to imagine the real. Yet human beings do have that capacity. Lord Byron, a poet favored by Alfred Nobel, captured the stark essence of a post-nuclear world in his poem “Darkness”:

“I had a dream, which was not all a dream.
The bright sun was extinguished, and the stars
Did wander darkling in the eternal space,
Rayless, and pathless; and the icy Earth
Swung blind and blackening in the moonless air;
Morn came and went – and came, and brought no day,…

All earth was but one thought – and that was Death
Immediate and inglorious; and the pang
Of famine fed upon all entrails – men
Died, and their bones were tombless as their flesh.

The world was void,
The populous, and the powerful was a lump,
Seasonless, herbless, treeless, manless, lifeless –
A lump of death – a chaos of hard clay…

And the clouds perished; Darkness had no need
Of aid from them – She was the Universe!”

Byron composed this poem in 1816, known as the “year without a summer”. Mt Tambora in the East Indies had erupted the year before, spewing 100 cubic kilometers of earth and rock into the atmosphere. The United States witnessed snow and ice in August. Worldwide crop failures induced mass starvation. A typhus epidemic in England, ascribed to cold and hunger, resulted in 65.000 deaths. The volcanic eruption lowered the earth’s surface temperature by a mere 0.6 of a degree centigrade, A twenty-fold greater cooling of the Northern Hemisphere has been predicted for a nuclear winter.

This scenario may not constitute a complete appraisal of the dire biologic and ecologic aftermath. We know little or nothing of the synergistic effects on our fragile ecosystem of subfreezing temperatures, darkness, high levels of radiation, massive release of toxins, excessive ultraviolet emissions, and other events still unforeseen. It is sheer hybris to pretend that there would be human survival after such a man-made catastrophe.

We know, therefore, that a nuclear war must never occur. Is this merely a hope or a certainty?

As no national interest would justify inflicting genocide on the victim and suicide on the aggressor, a prevalent misconception is that nuclear war will never be fought. But the realities of our age compel an opposite assessment. In no previous epoch were adversaries so continuously and totally mobilized for instant war. It is a statistical certainly that hair-trigger readiness cannot endure as a permanent condition. Furthermore, the unrelenting growth in nuclear arsenals, the increasing accuracy of missiles, and the continuing computerization of response systems all promote instabilities which court nuclear war by technical malfunction; by miscalculation, human aberration or criminal act. The ever decreasing time between missile launch and nuclear detonation relegates critical decision-making to computers programmed by fallible human beings.

The possession of these weapons has been justified by the theory of deterrence. Such a view of human affairs has held sway throughout the ages. But the Roman adage si vis pacem, para bellum has been consistently a prelude to war, not a guarantor of peace. No more untenable view of human affairs has ever gained such widespread public acceptance. In order to be effective, nuclear deterrence must operate perfectly and forever. No such expectations are permissible for any human activities. The pretension to inhibit aggression by threatening to inflict unacceptable damage is jarred with contradictions. How is one to account for an overkill capacity equivalent to more than one million Hiroshimas? Would annihilation of only a few major cities not inflict unacceptable damage? A single modern submarine has approximately 8 times the total firepower of World War II, sufficient to destroy every major city in the Northern Hemisphere. Why then the stockpiling of 18.000 strategic weapons? In this race the runners are no longer in control of their limbs.

This buildup is like a cancer, the cells of which multiply because they have been genetically programmed to do no other. Pointing nuclear-tipped missiles at entire nations is an unprecedented act of moral depravity. The horror is obscured by its magnitude, by the sophistication of the means of slaughter, and by the aseptic Orwellian language crafted to describe the attack – “delivery vehicles” promote an “exchange” in which the death of untold millions is called “collateral damage”. Bertrand Russell² called attention to the ethical bankruptcy that afflicts this era: “Our world has sprouted a weird concept of security and a warped sense of morality. Weapons are sheltered like treasures while children are exposed to incineration”.

How did we reach such a dangerous and tragic impasse? From the dawn of history the tools humans forged have imposed their laws on behavior. As tools were transformed into ever more complex machines, technology shaped our consciousness while providing mastery over our environment. This was not to be some Faustian bargain. Technology was intended to serve human interests, to enlarge the domain of freedom against life’s compelling necessities. Increasingly, though, as Thoreau³ observed, “We are becoming the tools of our tools”. Worse still, our tools are beginning to operate against our will and threaten our existence.

An additional misperception propels the arms race. Throughout human history, when confronted with what was deemed a deadly enemy, the fixed human response has been to gather more rocks, muskets, cannons, and now nuclear bombs. While nuclear weapons have no military utility – indeed they are not weapons but instruments of genocide-this essential truth is obscured by the notion of an “evil enemy”. The “myth of the other”, the stereotyping and demonizing of human beings beyond recognition, is still pervasive and now exacts inordinate economic, psychologic, and moral costs. The British physicist P.M.S. Blackett⁴ anticipated this state of paranoia: “Once a nation bases its security on an absolute weapon, such as the atom bomb, it becomes psychologically necessary to believe in an absolute enemy”. The imagined enemy is eventually banished from the human family and reduced to an inanimate object whose annihilation loses all moral dimension.

The nuclear threat haunts our age. Among the first to alert humanity to the peril were the physicists who let the atomic genie out of the bottle. Interestingly, though, the public is beginning to listen not to the military experts but to the physicians who are the custodians of public health. Now it may be argued that nuclear war is a social and political issue and we may address it only as concerned citizens. But we physicians have taken a sacred and ancient oath to assuage human misery and preserve life. This commitment imposes social and moral obligations for us to band together, to make our collective voices heard.

Furthermore, the medical profession cannot remain quiet in the face of the increasing diversion of scarce resources to the military compared to the meager efforts devoted to combating global poverty, malnutrition and disease. In 1984 world military spending exceeded 800,000 million dollars, or 100 million dollars every hour. This occurred at a time when life expectancy at birth in Africa is 30 years less than in Europe, when more than 40,000 children die daily from malnutrition and infection, when annually more than 3.5 million children die and an equal number are permanently crippled because they are denied inexpensive immunization. Two billion people have no access to a dependable and sanitary water supply. The litany of grief is long and painful to recite. Yet a single day’s diversion of profligate military spending would diminish and even resolve many of these miseries. We are already living in the rubble of World War III.

How has International Physicians for the Prevention of Nuclear War (IPPNW) addressed the grim realities of the nuclear age? Remarkable is the youth of our endeavor. This week we celebrate only the fifth anniversary of our founding. In this brief time we have helped penetrate the fog of denial. We have persuaded millions of people, for the first time, to confront the unthinkable. We have exposed to public view the long list of horrors. We have convinced a large public that there can be no useful medical response. We have demonstrated the deception implicit in nuclear war civil defense preparations. We have provided persuasive data that nuclear war would constitute the ultimate human and ecologic disaster.

Perhaps the signal accomplishment of the IPPNW has been the broad-based, free-flowing dialogue between physicians of the two contending power blocs. We heed Einstein’s words, “Peace cannot be kept by force. It can only be achieved by understanding”. In a world riven with confrontation and strife, IPPNW has become a model for cooperation among physicians from East and West, from North and South. Paranoid fantasies of a dehumanized adversary cannot withstand the common pursuit of healing and preventing illness. Our success in forging such cooperation derives largely from an insistent avoidance of linkage with problems that have embittered relations between the great powers. We have resisted being sidetracked to other issues, no matter how morally lofty. Combating the nuclear threat has been our exclusive preoccupation, since we are dedicated to the proposition that to insure the conditions of life, we must prevent the conditions of death. Ultimately, we believe people must come to terms with the fact that the struggle is not between different national destinies, between opposing ideologies, but rather between catastrophe and survival. All nations share a linked destiny; nuclear weapons are their shared enemy.

The physicians’ movement is contributing to a positive world outlook, rejecting the view that human life is merely the molecular unwinding of a dismal biologic clock. For the physician, whose role is to affirm life, optimism is a medical imperative. Even when the outcome is doubtful, a patient’s hopeful attitude promotes well-being and frequently leads to recovery. Pessimism degrades the quality of life and jeopardizes the tomorrows yet to come. An affirmative world view is essential if we are to shape a more promising future.

The American poet Langston Hughes⁵ urged:

“Hold on to dreams
For if dreams die,
Life is a broken winged bird
And cannot fly.”

We must hold fast to the dream that reason will prevail. The world today is full of anguish and dread. As great as is the danger, still greater is the opportunity. If science and technology have catapulted us to the brink of extinction, the same ingenuity has brought humankind to the boundary of an age of abundance.

Never before was it possible to feed all the hungry. Never before was it possible to shelter all the homeless. Never before was it possible to teach all the illiterates. Never before were we able to heal so many afflictions. For the first time science and medicine can diminish drudgery and pain.

Only those who see the invisible can do the impossible. But in order to do the impossible, in the words of Jonathan Schell⁶, we ask “not for our personal survival: we ask only that we be survived. We ask for assurance that when we die as individuals, as we know we must, mankind will live on”.

When questioned on his approach to sculpture, Michelangelo replied that he simply cut away the stone surrounding his vision. We in the physicians’ movement will not grow discouraged as we chip away at the granite mass if that obstructs our vision of a world freed from the specter of nuclear war.

If we are to succeed, this vision must possess millions of people. We must convince each generation that they are but transient passengers on this planet earth. It does not belong to them. They are not free to doom generations yet unborn. They are not at liberty to erase humanity’s past nor dim its future. Only life itself can lay claim to sacred continuity. The magnitude of the danger and its imminence must bring the human family together in common pursuit of peace denied throughout the century. On the threshold of a new millennium the achievement of world peace is no longer remote, for it is beckoned by the unleashing of the deepest spiritual forces embedded in humankind when threatened with extinction. The reason, the creativeness, and the courage that human beings possess foster an abiding faith that what humanity creates, humanity can and will control.

1. Martin Buber (1878-1965), a Jewish philosopher born in Vienna, who taught in universities in Germany and Israel.

2. Bertrand Russell (1872-1970), the British philosopher and mathematician who won the Nobel Prize for Literature in 1950.

3. Henry David Thoreau (1817-1862), the American author and naturalist.

4. Patrick Maynard Stuart Blackett (1897-1974) of Great Britain won the Nobel Prize for Physics in 1948.

5. Langston Hughes (1902-1967) was a central figure of the Harlem Renaissance.

6. Jonathan Schell (1943- ) wrote about the world’s “nuclear predicament” in The Fate of the Earth (New York: Knopf, 1982).