I Meetings

IPPNW conference: "If we ever had a reason to join together, this is it"

Thomas Perry, Jr., MD

"The splitting of the atom has rectly linked to the crippling in a direction few in the West changed everything except our health and social problems of would have predicted. thinking, and thus we drift to- developing countries and the The medical prescription for wards unparalleled disaster. We need for the superpowers to the prevention of nuclear war shall require a substantially new change their priorities from mili- that was adopted by IPPNW at manner of thinking if mankind is tary rivalry to peaceful coopera- Budapest in 1985 (and published to survive." tion if such problems are ever to by Canadian Physicians for the be solved. Prevention of Nuclear War - Albert Einstein Since receipt of its Nobel (CPPNW) as an advertisement in Peace Prize in 1985, IPPNW CMAJ and Canadian Family Phy- T hose oft-quoted words membership has grown to more sician early in 1986) called for assumed a new mean- than 150 000 physicians in 60 unilateral but reciprocating su- ing when more than countries. More than 55 countries perpower initiatives for arms 2500 physicians assem- were represented in Moscow. It is control, the crucial element being bled in Moscow from May 29 to now the world's fastest growing a halt to nuclear-weapon tests. June 1 for the seventh world medical organization, after start- Although Soviet physicians congress of International Physi- ing with a mere 50 doctors from initially opposed this policy, their cians for the Prevention of Nu- a dozen nations at its first meet- eventual support appears to have clear War (IPPNW). This year's ing in Virginia in 1981. been instrumental in convincing theme - "A substantially new Despite its growth and grow- the Soviet government to initiate manner of thinking" - was di- ing public recognition, this year its unilateral test moratorium was also a time of reassessment. which lasted from Aug. 6, 1985 Delegates faced the sobering real- - the 40th anniversary of the Thomas Perry, Jr., a past president of the ization that the world arms race Hiroshima bomb - BC Chapter of Canadian Physicians for to Feb. 27, the Prevention of Nuclear War, is current- has continued to escalate and 1987. Unfortunately, delegates ly taking fellowship training in clinical that IPPNW's impact has been from the United States and other pharmacology in Sweden. both limited and lopsided - but western countries could point to no similar accomplishments. Plenary sessions at Moscow dealt with such topics as Chan- nelling Resources from the Arms Race: Prospects for Worldwide Medical Cooperation, while speakers ranged from Dr. Enrique de la Mata, the Spanish minister of labour and president of the International Red Cross and Red Crescent societies, and Dr. Theo- dore Hesburgh, former president of the University of Notre Dame in Indiana. Canada's Gwynne Dyer, producer of the National Film Board's "War" and "The Defence of Canada", nearly stole the show with his call for in- Dr. Jan Christelaw (R) with two Russian medical students at the IPPNW dependent leadership from mid- congress. dle powers. 322 CMAJ, VOL. 137, AUGUST 15, 1987 arms race is the almost complete zation coverage for the major militarization of US-Soviet rela- preventable diseases has in- tions. Even though all the under- creased from 5% to 40% in the lying conflicts are political, both Third World. Twenty percent of nations have abandoned the po- the world's families now have litical component of national se- access to oral rehydration thera- curity and sought security only py, compared with only 2% to through military means". 3% in 1981, and Grant said this Citing Mikhail Gorbachev's measure alone saves the lives of recent statement that "the task of 1.5 million children annually. ensuring security is increasingly a Professor Carl Sagan, direc- political problem and can only be tor of the Laboratory of Planetary solved by political means", Studies at Cornell University in Cohen stated that this "new way Ithaca, New York, contrasted the of thinking" has generally been potential for superpower collabo- dismissed in the United States as ration in water reclamation and a propaganda trick. "Everything I antistarvation programs in Ban- have learned in 20 years as a gladesh and the Sahel, the Saha- Sovietologist suggests the pro- ra's semi-desert fringe, with the posals are authentic", he argued. arms race. He estimates that by "Reform at home and detente the time President Ronald Rea- Sagan: Once secure, the US is now abroad are part of the same indis- gan leaves office early in 1989, subject to instant annihilation. soluble policy, and the thinking American military expenditures of those who cannot understand since 1945 will total more than A core curriculum covering this has become hopelessly, irre- $10 trillion, with more than half the medical effects of nuclear versibly militarized." being spent in the last 8 years. weapons, psychosocial impacts of Many speakers cited Presi- That's "sufficient to buy every- the arms race and the current dent Dwight Eisenhower's con- thing in the United States except state of nuclear arsenals featured tention that "every dollar spent the land". Dr. John Dawson, scientific secre- on the arms race is, in the last The result? "At the end of tary of the British Medical Asso- analysis, a theft from those who World War II the US was secure. ciation, and Dr. Donald Bates, hunger and are not fed, those Now it is subject to instant anni- professor of humanities and so- who are sick and not healed". hilation." cial studies in medicine at McGill Dr. Olukuye Ransom-Kuti, Recalling President Ronald University in Montreal. Thirty- Nigeria's minister of health, Reagan's comment to General four special colloquia and work- noted that total financial assis- Secretary Gorbachev at the 1985 shop sessions covered topics as tance to developing countries de- Geneva Summit that the US and diverse as International Law and clined from $37.4 billion in 1981 USSR could unite to face a com- Nuclear Weapons and Inadver- to $33.6 billion in 1984. A mere mon threat from outer space, tent Nuclear War. An Experien- 0.5% of the total health budget in Sagan remarked that this "de- tial Workshop on Assumptions the developing world is supplied means extraterrestrials", but and Perceptions which Fuel the by rich countries, and only three noted more seriously: "We do Nuclear Arms Race was comode- -Denmark, Norway and Swe- not need an external threat. We rated by American and Soviet den - have surpassed the United already have an existing threat. If psychiatrists. Nations' target of allocating 0.7% we ever had a reason to join Most speakers emphasized of gross national product to de- together against a common that the purely medical role that velopment assistance. enemy [nuclear weapons], this is was adopted by IPPNW and James Brant, executive direc- it." most of its affiliates, such as tor of the United Nations Chil- Several speakers highlighted CPPNW, at their inception is no dren's Fund, recalled that pre- the frailty and fallibility of high- longer sufficient - physicians ventable deaths in children under technology military systems and and other health care profession- age 5 take a toll equivalent to one their vulnerability to human error als must move beyond their mes- Hiroshima bomb every 3 days. as a potential cause of accidental sage of imminent doom to pre- He suggested that a "health revo- nuclear war. The point was em- cribe and work for practical mea- lution" could be achieved in the phasized by the landing of a sures to reduce the risk of nuclear developing world by following rented Cessna in Moscow's Red war and to channel military simple measures whose promo- Square on the eve of the con- funds to constructive ends. tion is currently limited by a gress. Sagan pointed out that this Stephen Cohen, professor of shortage of funds: universal im- breach of supposedly invulnera- Soviet studies at New Jersey's munization, oral rehydration ble defences is hardly unprece- Princeton University, stressed in therapy for diarrheal diseases, dented, as many "low-flying air- a keynote speech that "the fun- breast feeding and birth spacing. planes penetrate the US every damental cause of the nuclear In the last 4 years, immuni- day carrying marijuana'. 324 CMAJ, VOL. 137, AUGUST 15, 1987 Soviet speakers, including by last fall, although the Ameri- Dr. Evgeni Chazov, the IPPNW cans were told to shut it off for cofounder who recently became the Soviet resumption of testing minister of health for the USSR, in February 1987. emphasized Gorbachev's recent In contrast, the American references to Einstein's "new government refused to give Sovi- way of thinking". Dr. Georgi Ar- et scientists visas that would batov, director of the Institute of allow them to inspect possible USA/Canada Studies in Mos- monitoring sites in Nevada that cow, suggested that "the role of had been suggested by the doctors has been very significant NRDC team, offering instead the in making politicians recognize rather insulting alternative of the fact that there can be no watching a nuclear test as guests winners in a nuclear war, that the of Washington. Not surprisingly, old maxim 'if you want peace, the offer was refused. prepare for war' is as hopelessly "If the Soviets can't come to outdated as the geocentric idea of Nevada, we will take Nevada to the universe". them", Cochran said, announcing He cautioned, however, that plans to transmit telemetric seis- "time is against us. Many people mic data by satellite directly from are terrified of the prospect of a the Scripps Observatory in Cali- Cochran: We'll take Nevada to the non-nuclear future. This is a real fornia to the Academy of Sci- Soviets. paradox. The ideas of the physi- ences in Moscow. Thus bilateral, cians have failed to reach the independent monitoring of nucle- ed, agreed with the psychiatric minds of politicans in the West". ar tests or verification of a future diagnosis, and then said bther- Reviewing recent Soviet ini- test ban is now a reality, little wise when they returned home". tiatives such as the unilateral test more than a year after the NRDC What seemed significant, moratorium of 1985, the 1983 took the initiative of contacting however, was his public state- unilateral moratorium on weap- the Soviet Academy of Sciences. ment that: "We are prepared to ons tests in space, and Gorba- Dr. Oleg Schepin, deputy show any patient and open the chev's 1986 proposal to eliminate minister of health for the USSR, doors of any clinic in the Soviet all nuclear weapons by the year reviewed the record of Soviet- Union for our guests from abroad 2000, Arbatov challenged west- American cooperation and ex- to receive authoritative informa- ern delegates with a quotation changes in medical science. Most tion about the situation in the from West German politician notable was the World Health Soviet Union today." Egon Bahr: "Instead of testing Organization's (WHO) 10-year A striking and encouraging nuclear weapons, test Gorbachev campaign to eradicate smallpox, feature of the congress was the and his proposals." which had achieved complete large number of young Soviet At least two interesting ex- success by 1977. Originally pro- and eastern European physicians amples of the new openness in posed by a Soviet physician at a and medical students in atten- the Soviet Union were cited, sug- WHO assembly in 1957, the idea dance. Some had been "drafted" gesting that Gorbachev means became reality when the Ameri- from various scientific laborato- business and has the clout to cans accepted it in 1967, and ries and medical institutes to implement his "new thinking". ultimately it became a model of serve as ushers and translators, Thomas Cochran, a physicist at multilateral cooperation in solv- while others were activists in the the Natural Resources Defense ing an age-old scourge. Since Soviet Committee of Physicians Council (NRDC) in Washington, then, Schepin noted, medical sci- for the Prevention of Nuclear described a nongovernmental entific exchanges "have not lived War. American-Soviet nuclear-test ve- up to expectations", but he was I was impressed by the rification---project negotiated be- optimistic that collaborative re- openness of these younger dele- tween the NRDC and the Soviet search with the US would soon gates, who struck me as being Academy of Sciences. (This proj- expand in cardiology, virology, better informed about world af- ect has been the subject of de- experimental oncology and artifi- fairs and the facts of the arms tailed reports in Science and Na- cial organ research. Canada, it race than their Canadian counter- ture within the past year.) seems, still lacks a formal agree- parts. Several whom I talked The American scientists re- ment with the Soviet Union for with in depth manifested a keen ceived unexpectedly rapid per- academic medical exchanges. awareness of the extent to which mission from the Soviet academy Responding to a comment military expenditures have to drill seismic holes and install from the audience about treat- drained the Soviet economy. state-of-the-art American moni- ment of political prisoners in So- From a shortage of pipettes in the toring equipment near the Soviet viet psychiatric hospitals, Sche- laboratory to limited access to nuclear test site at Semipalatinsk. pin criticized foreign psychiatrists computed tomography scanners The equipment was operational who have, he contended, "visit- in clinical practice, the effects are CMAJ, VOL. 137, AUGUST 15, 1987 325 and American medicine was up dancing in the aisles. Sadly, the western press was less in evi- dence, although more so than at past IPPNW meetings. The most positive aspect of this congress was a sense of .... heightened understanding that people on both sides of the East/West political divide share common interests, not least of which is a desire to alleviate suffering in less fortunate parts of the world. At times this revela- tion seemed almost trivial and sadly belated. Ralph Earle, the I F 1- chief American negotiator during SAGE spokesmen: "Most politicians . don't know what they're talking 7 years of strategic arms limita- abouit." tion talks, related this observa- tion at the Moscow Circus: "So- obviously resented within the Nobel Peace Prize award. viet children laugh at exactly the health care sector. Without question, Canada's same things American children At the same time, these greatest impact was made by four laugh at." young Soviet physicians and stu- high school graduates represent- Often the understanding was dents seemed indignant, almost ing the Montreal group SAGE more profound. humiliated, by the failure of (Students Against Global Exter- Dr. Martin Vosseler, a Swiss western leaders to respond con- mination). Allison Carpenter, psychiatrist and mountain climb- structively to recent Soviet arms- Maxim Faille, Desiree McGraw er, described in moving poetry, control initiatives. In personal and Seth Kline have just com- music and slides how he, 15 contacts, the sincerity of their pleted an improvised, year-long American and 10 Soviet doctors desire to end the arms race and tour of Canadian high schools in and medical students overcame get on with improvements to So- which they discussed the threat technical, interpersonal and viet society and the economy of nuclear war in give-and-take cross-cultural difficulties last year emerges as both obvious and em- sessions with more than 100 000 to climb Europe's highest peak inently practical. students. They also helped the USSR's Mount Elbrus. Group Asked whether they would launch some 300 local peace members have established lasting be allowed to attend next year's groups. friendships and two of the Amer- IPPNW congress in Montreal, all The four, who were about to icans took the year off to travel Eastern Europeans I spoke with embark on another hastily impro- across the US with a slide show answered that the key limitation vised tour of Soviet schools, left about their experience. is a shortage of hard currency. It delegates gasping at their energy Appropriately, the closing appears that although political and enthusiasm during a special- words of the congress went to restrictions may have lessened ly organized workship in which renowned Russian poet Yevgeni greatly, the only way to ensure a they summarized their year's Yevtushenko: "The illness of one substantial East Bloc delegation conclusions with a devastating country can never be the medi- in 1988 may be for Canadian and line that would likely strike a cine of another country. Relax- American physicians to sponsor resonant chord with physicians: ation of tensions must be only a their counterparts or medical stu- "Most politicians aren't mean. step to the heights where people dents from Warsaw Pact coun- They just don't know what will live without fear." tries. they're talking about." Next year's June 2-6 IPPNW Canada was represented in The entire congress was congress in Montreal will take Moscow by 70 delegates from six heavily publicized in the Soviet the theme Healing Our Planet: A provinces; many were medical media, both print and television. Global Prescription. It will focus students. Canadian physicians A closing concert for delegates on North-South issues and the also sponsored two delegates was broadcast live to an audience potential for constructive East- from Tanzania. Dr. Mary-Wynn that probably exceeded 100 mil- West cooperation to replace the Ashford, a Victoria family physi- lion viewers. By the end of the arms race. Ideas and assistance cian, was named one of three evening, when American rock from Canadian physicians and "Nobel emissaries" who will musicians Stephen Stills and medical students would be wel- carry IPPNW's message to Graham Nash joined the Lenin- comed by the IPPNW Congress France, Switzerland and Belgium grad group Aquarium on stage, Organizing Committee, 1110 Ave during the next year. Their travel an audience of 2000 that includ- des Pins ouest, Montreal, PQ, will be financed through the ed the leading lights of Soviet H3A 1A3.-

328 CMAJ, VOL. 137, AUGUST 15, 1987