"World on brink of nuclear war" was a familiar headline in the 1960s when the USA and USSR rattled their nuclear weapons. This headline did not reappear when events as likely as any in the past 50 years to lead to nuclear war--the test firing of nuclear weapons by India and Pakistan--were reported last month. The reason is, of course, that the western world thinks of itself as the only world worth consideration, and the threat of nuclear war in the east is seen as a political irritation rather than a potential disaster, an impertinence warranting rebuke and immediate imposition of sanctions on the nations concerned. The hypocrisy of this reaction does not need to be laboured. Suffice it to say that western nuclear powers have been promising for over 20 years to decommission their nuclear weapons. Yet these promises have proved to be empty. In the wake of such duplicity, it is no surprise that other nations have sought to join the west's nuclear-weapons club.
The only two nuclear bombs exploded in warfare so far were dropped on Japan during the last world war. A Lancet editorial in the week that the war ended (Aug 18, 1945) voiced concerns that have been widely shared ever since: "...half a dozen Lancasters can carry enough bombs to wipe out the whole population of the British Isles in the space of a few seconds and leave the land desert and uninhabitable, possibilities that we have not as yet been able or dared to comprehend". That no country has used nuclear weapons in warfare since then is remarkable but it is inevitable that one day, as more nations achieve a nuclear capability, they will, and no amount of tut-tutting by the nuclear-armed western powers or impotent speech-making at the United Nations will stop this happening.
Of what relevance are these events to physicians? Surely, there is little physicians can do to prevent the spread of nuclear weapons or to minimise the likelihood that they will be used. Not so. Physicians, by the nature of their profession, are accustomed to having their judgments and opinions respected by the public at large, and were physicians worldwide to exercise their influence against the development and deployment of nuclear weapons public, and hence political, opinion might follow. We do not expect physicians to take a united stand against war itself , but is it too much to hope that all physicians would unequivocally denounce the development of nuclear weapons, as many, individually or through membership of pressure-groups, already have?
National medical associations have been nervous of coming out openly against nuclear armaments; and the World Medical Association (WMA), although it condemned the use of chemical and biological weapons in 1991, has yet to declare itself against nuclear weapons. The co-president of the International Physicians for Prevention of Nuclear War (http://www.healthnet.org/IPPNW ), Ron McCoy, intends to submit a proposal to the WMA meeting in Hamburg this November, calling on the WMA to "condemn the development, testing, production, deployment, threat and use of nuclear weapons". Let us hope that delegates in Hamburg seize this opportunity to make the profession's revulsion plain for all to see.
The arguments against nuclear weapons are familiar and, except to those people with a vested interest in making war, incontrovertible. Since the end of the cold war, the anti-nuclear-war lobby has lost impetus. The testing of nuclear weapons by India and Pakistan, a deplorable exercise in brinkmanship, should revitalise the campaign and physicians should be open in their support. This is not a matter for political compromise, even if, as some complacent commentators seem to think, the world would be safe because nuclear conflict would not spread beyond the borders of the two countries involved. There is no middle ground, the issue is stark: the consequences of the use of nuclear weapons are too dreadful to contemplate.
Recent events on the Indian subcontinent should accelerate that global objective and the nuclear-weapons club should not be allowed to have its membership swollen with the half-dozen other nations who have the technical capacity to develop and test nuclear weapons (or who already have, in secret, done so).
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