Countering the Fallacy of a "Bomb Shelter"
by Robert M. Gould, MD
Physicians for Social Responsibility (PSR) was founded in 1961 at a time of escalating danger posed by the world’s burgeoning capacity for global nuclear annihilation. Over a half century later, this ever-present threat of nuclear extinction is now forged to the Trump administration’s full-scale assault on planetary health. As we witness the current unraveling of health-protective public policy and seek strategies for resistance and resilience, it may be instructive to revisit the irrationality of a “building bomb shelters” approach to securing a future for current and next generations to come.
From its inception, PSR advanced a precautionary health-centered, primary prevention approach, in recognition of the still-relevant scientific fact that there can be no adequate medical response to a thermonuclear war between major nuclear powers. This was vividly demonstrated in a series of groundbreaking articles published in the New England Journal of Medicine (NEJM), entitled “The Medical Consequences of Thermonuclear War.”
The NEJM articles posited that given the impossibility of an adequate medical response to nuclear warfare, it was incumbent upon physicians to prevent such a catastrophe from occurring. PSR was especially prominent in countering omnipresent and false government assurances that open-air nuclear weapons tests caused no harm to the population. To document the pervasive and dangerous levels of radioactive fallout resulting from such testing (decades later estimated to have produced at least 430,000 fatal cancers by the year 2000 around the world), PSR-connected physicians participated in national efforts to gather the baby teeth of children. Tests on these teeth demonstrated the presence of strontium 90, an exclusive by-product of nuclear testing. This finding helped build public support for primary prevention: a halt to U.S. atmospheric tests and for the Partial Test Ban Treaty, which in 1963 ended above-ground nuclear tests by the United States, the Soviet Union, and Britain.
Almost 20 years later, the Reagan administration embraced particularly aggressive nuclear weapons policies including resurrecting earlier strategies of “winnable nuclear war” made possible “with enough shovels.” These policies spurred mass movements in the United States and worldwide that coalesced around the heightened dangers of the nuclear age. The rise of the Nuclear Freeze movement in the United States galvanized a revitalization of PSR, which expanded to tens of thousands of health professionals across the country.
PSR did its part by organizing medical symposia featuring the showing of “The Last Epidemic” in more than 30 cities throughout the country. These symposia built activist networks across the nation and helped to foster widespread public support for nuclear disarmament that was exemplified by the one million people participating in the 1982 anti-nuclear demonstration in New York City organized around the theme “Freeze the Arms Race—Fund Human Needs.”
In a pioneering act of citizen diplomacy, PSR physician leaders worked together with Soviet counterparts to found the International Physicians for the Prevention of Nuclear War (IPPNW), which was awarded the Nobel Peace Prize in 1985 for its singular efforts educating health professionals, political leaders, and the general public about the need to end the nuclear arms race—based on “prevention is the only cure.”
The primary prevention strategy was also foundational to the birth of the Peace Caucus in Affiliation with the American Public Health Association (APHA) by PSR leaders in 1985. Since its inception the Peace Caucus has brought issues of nuclear abolition and anti-militarism to the forefront of the discourse of thousands of public health professionals. In 1986, the Peace Caucus co-organized a major demonstration involving hundreds of health professionals at the Nevada Test Site against the continued testing of nuclear weapons, at the time a linchpin in the development of nuclear weapons. This and other mass demonstrations throughout the decade contributed greatly toward ending the Cold War and fostering various diplomatic efforts and treaties to reduce nuclear dangers, as well as movements advocating for the abolition of nuclear weapons.
During the late 1980s, environmental threats to public health stemming from the operations of the nuclear weapons complex were revealed when the safety of U.S. nuclear weapons-related reactors was scrutinized after the explosion and meltdown of the Chernobyl nuclear reactor in Ukraine. In response, PSR called for a comprehensive and independent evaluation of health and safety problems in the nuclear weapons production complex of the Department of Energy (DOE), subsequently publishing Dead Reckoning, a critical review of the DOE’s epidemiologic research on the health risks of nuclear weapons production. These efforts helped prompt improvements in the oversight of research on the public and environmental health hazards of making and testing nuclear weapons.
In the early 1990s, this work provided a natural bridge for many PSR leaders to advocate for expanding the organization’s focus beyond nuclear weapons and related dangerous technologies to the health threat of ubiquitous environmental chemical pollution. In so doing, it joined a powerful movement of advocacy groups that had over decades provided the mass popular pressure for enforcing and expanding the scope of the health-protective regulatory and legislative accomplishments of the 20th century.
PSR’s early work to mobilize the medical community on broader environmental health issues included collaboration with the Massachusetts Institute of Technology, the Harvard School of Public Health, Brown University, and PSR’s Greater Boston chapter to convene more than 700 physicians and environmentalists to assess environmental health issues. This process made a major contribution to the publication of Critical Condition, a pioneering work on human health and the environment.
Leading PSR physicians also produced a series of groundbreaking publications that: documented the evidence for how widespread environment exposures harm human health; articulated the role of health professionals in preventing harmful exposures; and examined the linkage between public policy and these health harms. These works included: Generations at Risk, which addressed reproductive and developmental health; In Harm’s Way, which examined attention deficit hyperactivity disorder and other neurodevelopmental problems; and Pesticides and Human Health: A Resource for Health Professionals, which explored pesticide exposures.
Moreover, PSR has worked for decades with health and community partners to address our climate emergency through advocating for health protective public policy. Early efforts included letter sign-on campaigns enlisting the names of Nobel Laureates in Medicine, deans of medical schools, and hundreds of prominent physicians for a strong climate-protective treaty. PSR developed various Death by Degrees state-specific reports that publicized the regional health consequences of climate change predicted in ongoing reports from the Intergovernmental Panel on Climate Change, focusing outreach to health and university audiences to champion strong legislative and regulatory measures to address such threats.
These efforts were coupled with work to advance numerous policies adopted by state medical associations and the American Medical Association calling for stronger regulations protecting climate health and defending our patients and communities against multiple sources of air, water, and soil pollution, including those from fossil fuel and other industrial sources, as well as from hospital systems. To this end, PSR and its chapter network have contributed to systemic upstream changes within our own health sector to address global warming and environmental pollution through active participation in sustainability programs initiated by Health Care Without Harm and Practice Greenhealth.
Such work provided the basis for the development and ongoing work of the Medical Society Consortium on Climate and Health (MSCCH), which has brought together numerous medical specialty organizations and affiliated health professional partners, including PSR and APHA, to work proactively on these issues, increasingly informed by equity considerations exemplified by the declining socioeconomic status of so many that we serve.
Our current political climate, characterized by cruel attacks on our most vulnerable people and heightened global militarism that inflicts misery and death on countless people while smashing our life support systems poses formidable challenges for all of us.
As with fallout shelters during the Cold War, there never was, and surely is not now, any place to hide from the rampant destruction of planetary health. The unprecedented dismantling of public health protective policies that we are witnessing has placed us in a new “critical condition.”
In this context, with the weakening and abrogation of nuclear arms control treaties that were considerable accomplishments of our historic work, we in PSR and IPPNW have been refocusing our work on the immanent dangers of a new nuclear arms race. Potential nuclear flashpoints ranging from the current wars in the Middle East through a possible all-out nuclear war between the major nuclear powers escalating from confrontations in places such as Ukraine or the Taiwan Straits, threaten all of us with catastrophic dangers ranging between global malnutrition from unfolding “nuclear winter,” through more immediate omnicide.
In the United States, PSR works within the grassroots Back from the Brink (BftB) campaign to firmly oppose U.S. policy plans to modernize and increase the lethality of our nuclear arsenal that provides a constant stimulation of reciprocal global nuclear weapons programs. The five major planks of BftB were adopted by the American Public Health Association in 2020 within its Toward a World Free of Nuclear Weapons policy, which also called for all nuclear weapons states to join the majority of the world's nations in supporting the Treaty on the Prohibition of Nuclear Weapons. Such vital nuclear disarmament steps are also supported by the U.S. Conference of Mayors, and many U.S. municipalities. Recalling PSR/IPPNW efforts of long ago, numerous Nobel Prize winners and nuclear experts, meeting last July in Chicago to commemorate the 80th anniversary of the Trinity Test that initiated the nuclear age, signed a Declaration for the Prevention of Nuclear War including many recommendations for world leaders to reduce the increasing risk of nuclear conflict.
Since co-signed by well over 100 Nobel Laureates, the declaration echoes the stirring keynote address that Dr. Joseph Rotblat, himself a Nobel Laureate, presented to a joint IPPNW/PSR World Congress held in Washington, D.C. in May 2002.
Dr. Rotblat mesmerized our audience with words that resonate with those of us committed to ridding our world from the daily twinned threats of nuclear annihilation and climate catastrophe: “A colossal effort will be required… the courage and the will to embark on this great task, to restore sanity in our policies, humanity in our actions, and a sense of belonging to the human race.”
May his words inspire those of us seeking to rescue our planet from all the profound existential challenges we face.
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Robert M. Gould, MD is an Adjunct Assistant Professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at the University of California San Francisco (UCSF) where he works as a Collaborator with the Program on Reproductive Health and the Environment (PRHE). From 1981 until 2012, Dr. Gould worked as a pathologist at Kaiser Hospital in San Jose, California. He has been President of San Francisco-Bay Physicians for Social Responsibility (PSR) since 1989, and was a member of the National Board of PSR from 1993 through 2022, serving as President in 2003 and 2014. Dr. Gould currently shares the North American Regional Vice-Presidency of the International Physicians for the Prevention of Nuclear War (IPPNW), recipient of the 1985 Nobel Peace Prize. Dr. Gould also serves as Co-Chairperson of the Peace Caucus in Affiliation with the American Public Health Association (APHA), and has co-authored more than a dozen APHA policy statements related to nuclear weapons, peace, and social justice. For his overall contributions, the APHA awarded Dr. Gould the prestigious Sidel-Levy Peace Award in 2009. Dr. Gould has authored numerous book chapters on the health impacts of nuclear weapons including War and Public Health, and Terrorism and Public Health (Oxford University Press).