The furor caused by the 1985 Nobel Peace Prize to the International Physicians for the Prevention of Nuclear War, represented by its two leading sponsors and leaders. Dr. Bernard Lown of the United States and Dr. Yevgeny Chazov of the Soviet Union, provides a fine opportunity to review the revival of the politics of nuclear weapons in the mid-1980’s. The impulse to public service on the part of professional servants runs deep, despite the fact that respectability, or better, professional legitimacy, afforded by good work in one area does not readily translate into other areas. This is a constant source of irritation to people who rise high and are mighty in their own fields, but who are not able to translate such elite status into generalized recognition.

This is not to suggest that the more than 100,000 physicians said to be members of the IPPNW are self-serving or ambitious. Rather, it is to remember that talent, even scientific expertise, in one area, does not guarantee a valid political perspective in another. The most obvious lacuna in the debate over nuclear weapons is the absence of any significant body of public opinion. East or West, which argues the case for the use of nuclear arms. Despite occasional bluster, in most real crisis situations, both sides in the Cold War are extremely careful to limit the scope of a given conflict to a nonnuclear range of options. However heated the rhetoric about Nicaragua, Angola, or Afghanistan, there is widespread acceptance that nuclear options are unrealistic. Indeed, nothing so took the wind out of the sails of the Solidarity Movement in Poland as the creeping widespread recognition that nuclear retaliation in support for the workers’ movement was simply out of the question.

The award of the Nobel Peace Prize to the IPPNW and the two cardiologists who serve as its cochairmen—Dr. Lown of the Harvard School of Public Health and Dr. Chazov, Soviet Deputy Health Minister responsible for the health care of Kremlin leaders—has nonetheless created a furor. The reason for the concern is a letter dated September 26, 1973, denouncing, in typical Stalinist terms, the peace efforts of Andrei Sakharov, a previous Nobel Laureate. In a tragicomedy played out in front of Western reporters, Dr. Chazov responded to an inquiry about his signing the letter by saying: “I did not expect questions addressed to me to start with this topic.” Immediately thereafter, a Soviet reporter. Lev Novikov, suffered a heart attack (from which he is recovering). The two physicians rushed to his aid (Dr. Lown in tears), and the press conference came to a merciful end. Doubtless it was the last such occasion that would embarrass the great Soviet court physician and champion of peace.

The strange taint to the award stems from Chazov’s assault on Sakharov, authorized if not written by his Kremlin masters. Protest against Chazov’s 1973 letter provided the high drama for last year’s peculiar award, one supposed to be noncontroversial because “no one can attack an organization like they can a person.” But quite apart from the merciless attack on a previous recipient of the Nobel Peace Prize, there remains the question of just what the IPPNW stands for.

To begin with, the name of the organization was chosen with extreme care. The group aims to mobilize the social conscience of medical doctors. The use of a preventative rather than curative language strikes a deep chord with many doctors the world over. On principle most doctors believe that the best medicine is prevention rather than cure. But the operative word is prevention of nuclear war—not just war in general. Otherwise, the reality of everyday nonnuclear war would intrude in this organization of social conscience, and the good doctors might become involved in the dirty politics of dirty little wars, like those being waged in Afghanistan, Angola, Cambodia, Nicaragua, and in other parts of the Third World. More to the point, hard questions might be raised about Soviet behavior.

Indeed, some of these questions have been frankly raised and answered by Sergei Batovrin, a founding member of the Moscow Trust Group, former inmate of Soviet psychiatric hospitals, who was expelled from the Soviet Union in 1984. He summarizes Chazov’s pro forma peace efforts succinctly:

In June 1982, he appeared on Soviet television on an oft-cited broadcast discussing the consequences of atomic warfare. It was an extremely cautious and superficial program, aired in such a way as to guarantee the minimum number of viewers: it was broadcast once, without any advance notice, in the middle of the working day. Much the same thing happened to Dr. Chazov’s book, The Danger of Nuclear War, published in 1982. The English translation was widely distributed in the West. But the single press run, a symbolic 7,000 copies, printed in Russian, was also exported, insuring the absence of the book from Soviet libraries and book stores. . . . Apart from these two efforts. Dr. Chazov’s group has not distributed a single book or published a single leaflet. It has not held a single public lecture or organized a single seminar for ordinary citizens.

Because IPPNW has well-oiled propaganda machinery, we do not have to guess at the reasons for its self-imposed limits, no less than its self-defined scope. Its goals include: (1) An immediate and verifiable freeze upon the production and deployment of nuclear weapons; (2) Sharp reductions and redeployment of military expenditure and usage of such funds for research, immunization against diseases, and solution to health and food needs of poorer areas; (3) An ultimate ban on nuclear research for military production, and in the short-term, working to create nuclear-free zones in various parts of the world. Its program has the support not only of medical personnel, but of such ardent antinuclear leaders as Andreas Papandreou, the Greek prime minister, who has lent his support and even his reputation to the IPPNW efforts. Papandreou’s belief in a socialist state, his condemnation of NATO and support for the PLO, his permissive attitude to terrorism—all of these become irrelevant in the wonderful world of single-issue nuclear disarmament.

The central tenet of the IPPNW position, one constantly reiterated by Bernard Lown, who is not so much a “dupe” of Soviet machinations as chief architect of its organizational program, is to emphasize single-issue politics. That is to say, Dr. Lown’s position is to distinguish the issue of peace from that of freedom, and to establish peace as the priority. “We are not indifferent to other human rights and hardwon civil-liberties, but first we must be able to bequeath to our children the most fundamental of all rights, which preconditions all others: the right to survival.” While such big words like peace and freedom can easily degenerate into empty sloganeering, the fact remains that the linkage of the two is an essential cornerstone of Western foreign policy in the 1980’s, and the heart and soul of Andrei Sakharov’s public appeals. The linkage between peace and freedom is precisely what Dr. Lown and Dr. Chazov aim to negate. Indeed, their single-mindedness on the issue equals that of Aleksandr Solzhenitsyn, who argues against Sakharov, that the primary if not exclusive question of the moment is freedom. Thus the IPPNW position strikes at the essentially centrist position of American foreign policy. It is this, not [list idle chatter about preventing a nuclear wasteland, that defines IPPNW’s primary message to American society.

Dr. Lown speaks with great feeling of the lack of symmetry in the critique of Chazov and the defense of Sjkharov: the “unlinking” of peace and freedom is vital for IPPNW. “Whenever one points a finger, he should look in the mirror . . . asymmetry is what gets Russian goats.” But of course, this issue of symmetry is at the heart of the matter. No one dares to suggest that Dr. Lown speaks as a U.S. policy representative. No one dares suggest that Dr. Chazov does not speak with the full authority of the Soviet government. Indeed, his “hard line” speech given when he accepted his portion for the Nobel Prize suggests that once the charade of neutrality became unraveled as a result of the queries about his petition against Sakharov, it became pointless to take a soft line. And with the gloves taken off, the iron fist of Soviet policy was clearly delineated by the Soviet cardiologist cum politician. His attack on the United States’ Strategic Defense Initiative was blunt: “Can’t we discern it as an attempt to gradually make us accept the idea of weapons over our heads in outer space? The ‘space shield’ will mean one more step forward toward nuclear catastrophe.”

The lack of symmetry inheres in the very essence of the two systems: in the United States tens of thousands of voluntary associations flourish, but in the Soviet Union voluntary organizations (save perhaps the Russian Orthodox Church) are tolerated but not officially sanctioned. Indeed, the lack of symmetry is nowhere more clearly underscored than in the arrest and disbanding of antinuclear protestors in Moscow at the time of the awards ceremonies in Oslo. Whereas “grassroots” politics are simply not tolerated in the Soviet Union, they are at the core of the American IPPNW effort. This utter lack of real symmetry is explained, and explained away, as the price the West must pay to hold a nuclear dialogue with the Soviets.

The notion of symmetry, whose absence Dr. Lown decried in media questioning of his Soviet counterpart, constitutes the essential problem in IPPNW. Dr. Lown and his American compatriots can speak in their own voices, whereas Dr. Chazov and his Soviet colleagues must speak in the voice of their political masters in the Kremlin. Thus, all accommodations must be unidirectional: from West to East.

The obvious asymmetries between the two parties to IPPNW is significant because its entire organizational and ideological structure is based precisely on the myth that IPPNW represents one side to an ongoing debate; that its members are somehow single-handedly withholding the arms clock from striking midnight, or as the current rhetorical fashion has it, the nuclear winter from descending on mankind. As a result, platitudes reign supreme, repeating, as theological incantations, the dangers of nuclear conflict, as if a nuclear-war party (invariably identified with the Western democracies) is waiting to unleash nuclear terror upon an innocent and unsuspecting world populace. By keeping discussion at an extremely high level of abstraction, the politics of simplicity replaces any serious analysis of nuclear competition at the level of arms buildup; worse yet, pious platitudes mask the exacting punishment created by everyday, ongoing warfare.

It is not without significance that IPPNW is an “East-West” effort, since were one to look at a “North-South” context, or more bluntly, a Third World context, it would become clear that this concern for preventing nuclear destruction has been isolated from the very real subnuclear or “conventional” mechanisms of military and paramilitary destruction that has become an everyday concern for poor peoples in poor nations. A Western conceit has led us to believe that the problem of development is uniquely restricted to the Third World, whereas the problem of war and peace is confined to the First and Second Worlds. Nothing could be further from the truth. The question of war as practiced is precisely the concern of the Third World—not a question to be solved in the postponable future, but as a ubiquitous contemporary threat. Eight violent conflicts in the world during the past decade were fought in Third World nations. By far, the most devastating has been the Kampuchean civil war, in which estimates of death range from between 500,000 to 4,000,000 (or no less than half the Kampuchean population). The Afghanistan civil war, begun only in 1978, has claimed the lives of between 100,000 and 250,000 people by 1980. A similar number of deaths resulted in the East Timor war. The bitter wars in Lebanon, Vietnam, the Philippines, Guatemala, and Zimbabwe each claimed anywhere from 20,000 to 50,000 lives. The sobering conclusion is that war may be a big power “game,” but it is one played by small nations.

Those who inveigh most against employing a worst-case scenario with respect to the stealing of nuclear secrets by terrorist groups think nothing about using similar worst-ease scenarios in justifying their essential organizational tasks. Thus, the development of a medical response to nuclear holocaust proceeds along with the need to face up to a “reality of Hiroshima,” to avoid the mistake of “denial” and “disassociation” of the danger of nuclear warfare and the winter to follow. Facing “reality” comes to mean that even modest nuclear explosions could spell a Martian atmosphere on earth. The explosion of 5,000 megatons of nuclear exchange would generate fires and create thick clouds of dust, soot, and smoke, which would obliterate the sun in the Northern Hemisphere. The average temperature would drop to below freezing temperatures for at least a three-month period following such a series of explosions. Over a billion people would perish, fresh water would freeze, and medical services would be paralyzed, and life for another billion people would in all probability come to a grinding halt.

Scenarios in which one side wins or loses by surprise, or both sides employ nuclear weapons on a symbolic scale only, or in which a preponderance of advantage accrues to one side or another are treated as nefarious or Utopian dreams. They are seen as evasions or even lunatic suggestions of Strangelove-like proportions. Hence, all approaches to civil defense or civil evacuations are regarded as a “cruel hoax.” But invariably, the hoax is said to be perpetrated by the United States, while the Soviet Union, which has a much more advanced system of civil defense and evacuation plans thoroughly in place, is remarkably spared such critiques. Thus, any program of action not based on a worst-case scenario is said to be a deceptive effort to reduce public awareness and anxiety. The possibility that such worst-case scenarios are themselves the cause of anxieties and hoaxes is either dismissed or more frequently not considered.

Typical of the IPPNW position are statements like: “One million children can be immunized against the preventable communicable diseases for about a million dollars, the cost of one Pershing II missile.” The irritating habit of always mentioning U.S. weapons, and never mentioning their Soviet equivalents, is constant. But when another spokesdoctor for IPPNW, Dr. Howard Hiatt, dealt with specifics, he let the cat out of the bag: the Soviet Union ranks 28th in infant mortality, compared to the United States and the United Kingdom and France with less than half the rate of deaths per thousand. Although Dr. Hiatt tries to gloss over these startling differences by noting that nonnuclear nations like Finland and Sweden and Japan rank lower still, he made no effort to draw the obvious parallel between a Soviet budget for military expenditures twice that of the United States with an infant mortality rate also twice that of the United States.

The equation of the United States and the Soviet Union simply misrepresents and suppresses the work done by Murray Feshbach, Mark Field, and Nick Eberstadt (each independent of each other) documenting the growing Soviet health crisis, traced to a bloated military budget within the framework of an economic performance less than half as capable as that of the United States. The key point that the IPPNW apologists fail to make is that infant mortality in the USSR has risen steeply from 1960 to 1985—to the point that it is now two-and-one-half-times larger than it was in 1960. This stands in marked contrast to the stable-steady condition of this key health indicator in the United States over the same period of time. What kind of “science” will guide further probes into East-West differences on key measures of health and welfare, particularly as these differences are affected by nuclear expenditures and other military spending.

It is the oft-repeated presumption of IPPNW that medical personnel have a unique charge to raise the banner of antinuclearism because doctors have made the preservation of life their essential task. The assumption by IPPNW that preventing disease in the first place is infinitely preferable to treating disease rests on a still further metaphysical premise that every illness can be prevented by foreknowledge; which in turn would make life eternal and death infinitely postponable. But these sets of assumptions, however worth exploring in their own right, are rather beside the point.

Doctors no more or less than any other professional group in modern society are charged with the prevention of total destruction. It is no less a charge for lawyers, physicists, or economists (indeed, some other professions have developed their own rationale for pacifism and functional isolation). The moral prerequisites of a profession are operationally limited to the maximum functioning of that profession for the general good. But this does not mean that the general good is uniquely the charge of a single profession. And herein lies the central flaw in IPPNW reasoning: its notion that a concern for the general welfare magically translates into a particular strategy for the conduct of foreign policy. The participation of a select group of physicians in public discourse on the inadvisability of nuclear conflict has no more special weight, and a lot less special knowledge, than the same sort of public discourse undertaken by physicists. Indeed, in the postwar antinuclearism of the 1950’s, it was precisely the physicists who made special claims of possessing policy knowledge. These earlier professionals served to split rather than unite the scientific community around the nuclear weapons issue. That the same outcome awaits the present efforts to medicalize the nuclear issue seems a foregone conclusion—even more so since the 1985 Nobel Peace Prize.

It is a measure of the intellectual carelessness of key figures in the IPPNW that they not only insist upon the propriety of the award being shared by a Soviet counterpart, but go so far as to claim that such an act has the implicit sanction of Andrei Sakharov himself Dr. Loring Conant Jr., one of the key American figures in the IPPNW, noted that “our cooperation with the Soviets through the IPPNW does not imply that we condone their policies on dissidents or human rights abuses.” But he further suggested that even Sakharov shares the view that “the human rights issue has to be put into a larger context.” Dr. Conant went on to quote from Sakharov’s statement (of 1975, not 1980 as he claims) to the effect that: “Despite all that has happened I feel that the question of war and peace and disarmament are so crucial, they must be given absolute priority even in the most difficult circumstances.” What Sakharov said immediately after that sentence is conveniently omitted by Conant. And since Conant himself is attempting to enlist the former Nobel Laureate to his position, it seems fitting to give the full citation from Sakharov’s “four-stage plan for cooperation”:

Saving mankind from the threat of thermonuclear destruction undoubtedly takes priority over all other problems. But this task cannot be separated from other problems of a political, economic, humanitarian, and ethical nature—and above all from the questions of the openness of a society, of international trust, and overcoming the disunity of the West. Any real solution to the problem of disarmament must include (a) a perfected system of verification, including inspections; (b) a reduction of armaments on the basis of parity to a sufficiently low level (this refers both.to negotiations on limiting the strategic weapons of the superpowers and to regional negotiations); (c) elimination of the factors contributing to the arms race; and (d) elimination of the factors fostering strategic instability.

In contrast to the simpleminded, one-sided proposals ex tended by Lown and Chazov, Sakharov’s position strikes a rational, multilateral balance that stamped him as an enemy of the Soviet Union and a pariah to American unilateralists who could not bring themselves to consider Soviet power as no less—and in all likelihood more—of a problem to nuclear disengagement than American strength.

The actual text of the 1973 letter denouncing Sakharov signed by Chazov deserves to be quoted in full. For only in this way can the magnitude of the task in reaching a nuclear rapprochement across political-ideological barriers be properly evaluated.

We, Soviet medical scientists, are outraged by Academician A. D. Sakharov’s behavior, which is a discredit to the honor and dignity of a Soviet scientist, and, together with scientists of the Academy of Sciences of the U.S.S.R., resolutely condemn his activity aimed against the Soviet Union’s peaceful policy. Academician A.D. Sakharov’s irresponsible statements to foreign correspondents and his slander against our people and the Soviet Government’s foreign and domestic policy have made us feel indignant. We, representatives of the most humane profession, have devoted our lives and activity to the struggle for public health. Any statement aimed against the strengthening of peace and the easing of international tensions sounds blasphemous to us. Together with all the Soviet people, we wholly and completely approve and support the Soviet Union’s foreign policy course aimed at the implementation of the peace program. We are proud of the Soviet Union’s successes in all fields of the economy, science and culture. The fulfillment of the plans for the development of our state that were outlined by the 24th congress is creating the necessary basis for a further rise in the living standards of the Soviet people and serves the interests of the “strengthening of peace throughout the world. Academician A.D. Sakharov, who has lost contact with his own people, does not want to understand this. His activity is fundamentally alien to all Soviet scientists.

Just what did Sakharov say that prompted such a collective condemnation by Soviet officialdom? Here, too, it might be best to have Sakharov speak in his own voice. For in Sakharov’s words one can detect the dilemmas which confront Soviet society in its efforts to establish a global nuclear-free environment. If the doctors of IPPNW have done nothing else, they have given us a deeper focus on the prospects for international peace and freedom-and why it is so hard to attain peace without a parallel effort in the Soviet Union and so necessary to retain freedom in the United States. Sakharov has said:

If an all-encompassing scientific and technological revolution, promising uncounted benefits for mankind, is to be possible and safe, it will require the greatest possible scientific foresight and care and concern for human values of a moral, ethical, and personal character, Such a revolution will be possible and safe only under highly intelligent worldwide guidance, The foregoing program presumes: (a) worldwide interest in overcoming the present division; (b) the expectation that modifications in both the socialist and capitalist countries will tend to reduce contradictions and differences; (c) worldwide interest of the intelligentsia, the working class, and other progressive forces in a scientific democratic approach to politics, economics, and culture; (d) the absence of insurmountable obstacles to economic development in both world economic systems that might otherwise lead inevitably into a blind alley, despair, and adventurism. Every honorable and thinking person who has not been poisoned by narrow-minded indifference will seek to insure that future development will be along the lines of the better alternative. However, only broad, open discussion1 without the pressure of fear and prejudice, will help the majority to adopt the correct and best course of action.

That such a modest program was able to generate a rhetorical cascade in defense of Soviet national interests on the part of this year’s co-recipient of the Nobel Peace Prize is a painful reminder of the road ahead in the search for nuclear peace and personal freedom.