explained away, as the price the West must pay to hold annuclear dialogue with the Soviets.nThe notion of symmetry, whose absence Dr. Lownndecried in media questioning of his Soviet counterpart,nconstitutes the essential problem in IPPNW. Dr. Lown andnhis American compatriots can speak in their own voices,nwhereas Dr. Chazov and his Soviet colleagues must speaknin the voice of their political masters in the Kremlin. Thus,nall accommodations must be unidirectional: from West tonEast.nThe obvious asymmetries between the two parties tonIPPNW is significant because its entire organizational andnideological structure is based precisely on the myth thatnIPPNW represents one side to an ongoing debate; that itsnmembers are somehow single-handedly withholding thenarms clock from striking midnight, or as the currentnrhetorical fashion has it, the nuclear winter from descendingnon mankind. As a result, platitudes reign supreme,nrepeating, as theological incantations, the dangers of nuclearnconflict, as if a nuclear-war party (invariably identifiednwith the Western democracies) is waiting to unleash nuclearnterror upon an innocent and unsuspecting world populace.nBy keeping discussion at an extremely high level of abstraction,nthe politics of simplicity replaces any serious analysisnof nuclear competition at the level of arms buildup; worsenyet, pious platitudes mask the exacting punishment creatednby everyday, ongoing warfare.nIt is not without significance that IPPNW is an “East-nWest” effort, since were one to look at a “North-South”ncontext, or more bluntiy, a Third World context, it wouldnbecome clear that this concern for preventing nuclearndestruction has been isolated from the very real subnuclearnor “conventional” mechanisms of military and paramilitaryndestruction that has become an everyday concern for poornpeoples in poor nations. A Western conceit has led us tonbelieve that the problem of development is uniquely restrictednto the Third World, whereas the problem of war andnpeace is confined to the First and Second Worlds. Nothingncould be further from the truth. The question of war asnpracticed is precisely the concern of the Third World—notna question to be solved in the postponable future, but as anubiquitous contemporary threat. Eight violent conflicts innthe world during the past decade were fought in ThirdnWorld nations. By far, the most devastating has been thenKampuchean civil war, in which estimates of death rangenfrom between 500,000 to 4,000,000 (or no less than halfnthe Kampuchean population). The Afghanistan civil war,nbegun only in 1978, has claimed the lives of betweenn100,000 and 250,000 people by 1980. A similar number ofndeaths resulted in the East Timor war. The bitter wars innLebanon, Vietnam, the Philippines, Guatemala, and Zimbabweneach claimed anywhere from 20,000 to 50,000 lives.nThe sobering conclusion is that war may be a big powern”game,” but it is one played by small nations.nThose who inveigh most against employing a worst-casenscenario with respect to the stealing of nuclear secrets bynterrorist groups think nothing about using similar worst-easenscenarios in justifying their essential organizational tasks.nThus, the development of a medical response to nuclearnholocaust proceeds along with the need to face up to an”reality of Hiroshima,” to avoid the mistake of “denial” andn”disassociation” of the danger of nuclear warfare and thenwinter to follow. Facing “reality” comes to mean that evennmodest nuclear explosions could spell a Martian atmospherenon earth. The explosion of 5,000 megatons ofnnuclear exchange would generate fires and create thicknclouds of dust, soot, and smoke, which would obliterate thensun in the Northern Hemisphere. The average temperaturenwould drop to below freezing temperatures for at least anthree-month period following such a series of explosions.nOver a billion people would perish, fresh water wouldnfreeze, and medical services would be paralyzed, and lifenfor another billion people would in all probability come to angrinding halt.nScenarios in which one side wins or loses by surprise, ornboth sides employ nuclear weapons on a symbolic scalenonly, or in which a preponderance of advantage accrues tonone side or another are treated as nefarious or Utopianndreams. They are seen as evasions or even lunatic suggestionsnof Strangelove-like proportions. Hence, all approachesnto civfl defense or civil evacuations are regarded as an”cruel hoax.” But invariably, the hoax is said to benperpetrated by the United States, while the Soviet Union,nwhich has a much more advanced system of civil defensenand evacuation plans thoroughly in place, is remarkablynspared such critiques. Thus, any program of action notnbased on a worst-case scenario is said to be a deceptive effortnto reduce public awareness and anxiety. The possibility thatnsuch worst-case scenarios are themselves the cause ofnanxieties and hoaxes is either dismissed or more frequentlynnot considered.nTypical of the IPPNW position are statements like: “Onenmfllion children can be immunized against the preventablencommunicable diseases for about a million dollars, the costnof one Pershing II missfle.” The irritating habit of alwaysnmentioning U.S. weapons, and never mentioning theirnSoviet equivalents, is constant. But when another spokesdoctornfor IPPNW, Dr. Howard Hiatt, dealt with specifics,nhe let the cat out of the bag: the Soviet Union ranks 28th inninfant mortality, compared to the United States and thenUnited Kingdom and France with less than half the rate ofndeaths per thousand. Although Dr. Hiatt tries to gloss overnthese startiing differences by noting that nonnuclear nationsnlike Finland and Sweden and Japan rank lower still, henmade no effort to draw the obvious parallel between anSoviet budget for military expenditures twice that of thenUnited States with an infant mortality rate also twice that ofnthe United States.nThe equation of the United States and the Soviet Unionnsimply misrepresents and suppresses the work done bynMurray Feshbach, Mark Field, and Nick Eberstadt (eachnindependent of each other) documenting the growingnSoviet health crisis, traced to a bloated military budgetnwithin the framework of an economic performance lessnthan half as capable as that of the United States. The keynpoint that the IPPNW apologists fail to make is that infantnmortality in the USSR has risen steeply from 1960 ton1985—to the point that it is now two-and-one-half-timesnlarger than it was in 1960. This stands in marked contrast tonthe stable-steady condition of this key health indicator innthe United States over the same period of time. What kindnof “science” will guide further probes into East-WestnnnMARCH 1386 / 29n