Medicine and nuclear war: from Hiroshima to mutual assured destruction to abolition 2000

Pharmacy Preparedness for Incidents Involving Nuclear, Biological, or Chemical Weapons

Recent worldwide terrorist attacks and hoaxes have heightened awareness that more incidents involving weapons of mass destruction (WMD) may occur in the United States. With federal funding assistance, local domestic preparedness programs have been initiated to train and equip emergency services and emergency department personnel in the management of large numbers of casualties exposed to nuclear, biological, or chemical (NBC) agents. Hospital pharmacies will be required to provide antidotes, antibiotics, antitoxins, and other pharmaceuticals in large amounts and/or have the capability for prompt procurement. Pharmacists should become knowledgeable in drug therapy of NBC threats with respect to nerve agents, cyanide, pulmonary irritants, radio-nucleotides, anthrax, botulism, and other possible WMD.

Educating public health physicians for the future: a current perspective from Aotearoa New Zealand

Persisting, and in some cases widening, inequalities in health within and between countries present significant challenges to the focus and practice of contemporary public health, and by association, to public health education. As public health physicians and academic educators of medically- and non-medically trained public health practitioners, we call for a radical re-think of current approaches to public health medicine education and training in order to address these challenges. The public health physicians of the future, we argue, require not merely technical knowledge and skills but also a set of values that underpin a commitment to ethical principles, social equity, human rights, compassionate action, advocacy and leadership. Furthermore, while they will need to have their action firmly grounded in local realities they should think, if not speak and act, from an informed awareness of global issues. Drawing from our experience in Aotearoa New Zealand, as well as with marginalised communities overseas, we proffer our suggestions for the process and content of public health physician education and training for the future, with the intention of stimulating debate.

Plutonium from above-ground nuclear tests in milk teeth: investigation of placental transfer in children born between 1951 and 1995 in Switzerland

BACKGROUND

Occupational risks, the present nuclear threat, and the potential danger associated with nuclear power have raised concerns regarding the metabolism of plutonium in pregnant women.

OBJECTIVE

We measured plutonium levels in the milk teeth of children born between 1951 and 1995 to assess the potential risk that plutonium incorporated by pregnant women might pose to the radiosensitive tissues of the fetus through placenta transfer.

METHODS

We used milk teeth, whose enamel is formed during pregnancy, to investigate the transfer of plutonium from the mother's blood plasma to the fetus. We measured plutonium using sensitive sector field inductively coupled plasma mass spectrometry techniques. We compared our results with those of a previous study on strontium-90 ((90)Sr) released into the atmosphere after nuclear bomb tests.

RESULTS

Results show that plutonium activity peaks in the milk teeth of children born about 10 years before the highest recorded levels of plutonium fallout. By contrast, (90)Sr, which is known to cross the placenta barrier, manifests differently in milk teeth, in accordance with (90)Sr fallout deposition as a function of time.

CONCLUSIONS

These findings demonstrate that plutonium found in milk teeth is caused by fallout that was inhaled around the time the milk teeth were shed and not from any accumulation during pregnancy through placenta transfer. Thus, plutonium may not represent a radiologic risk for the radiosensitive tissues of the fetus.

Taking a stand against nuclear proliferation: the pediatrician's role

Nuclear weapons pose a grave threat to the health of children. The Nuclear Nonproliferation Treaty, which for almost 40 years has limited the spread of nuclear weapons, is in danger of unraveling. At the 2000 Nuclear Nonproliferation Treaty Review Conference, 180 countries, including the United States, agreed on 13 practical steps to implement Article VI of the treaty, which calls for nuclear disarmament. However, the United States has acted in contravention of several of those disarmament steps, with announced plans to develop new nuclear weapons and to maintain a large nuclear arsenal for decades to come. Pediatricians, working individually and through organizations such as the American Academy of Pediatrics and International Physicians for the Prevention of Nuclear War, can educate the public and elected officials regarding the devastating and irremediable effects of nuclear weapons on children and the need for policies that comply with and strengthen the Nuclear Nonproliferation Treaty, rather than undermining it. For the children of the world, our goal must be a nuclear weapons convention (similar to the chemical and biological weapons conventions) that would prohibit these weapons globally.

Proliferation of nuclear weapons: opportunities for control and abolition

Nuclear weapons pose a particularly destructive threat. Prevention of the proliferation and use of nuclear weapons is urgently important to public health. "Horizontal" proliferation refers to nation-states or nonstate entities that do not have, but are acquiring, nuclear weapons or developing the capability and materials for producing them. "Vertical" proliferation refers to nation-states that do possess nuclear weapons and are increasing their stockpiles of these weapons, improving the technical sophistication or reliability of their weapons, or developing new weapons. Because nation-states or other entities that wish to use or threaten to use nuclear weapons need methods for delivering those weapons, proliferation of delivery mechanisms must also be prevented. Controlling proliferation--and ultimately abolishing nuclear weapons--involves national governments, intergovernmental organizations, nongovernmental and professional organizations, and society at large.

How the Radiologic and Nuclear Medical Communities Can Improve Nuclear Security

Highly enriched uranium (HEU) is used to manufacture technetium-99m, the most widely used medical radioisotope in the world. Highly enriched uranium is also used to make nuclear bombs; 50 kg of HEU is enough to make a Hiroshima-type bomb. It is generally agreed that this technology is within the reach of a terrorist group; the main obstacle is acquiring HEU. Currently, as a legacy of the US and Soviet Atoms for Peace Program, there are civilian users of HEU in 40 countries, and about 1,000 kg are still being shipped each year. Unfortunately, the major international manufacturers of technetium-99m have been refusing to convert their production facilities to use low-enriched uranium (LEU), which cannot be used to make a nuclear bomb. Only 1% to 2% of the HEU is consumed in the process of producing technetium-99m. The remainder is accumulating in radioactive waste storage facilities. The radiologic and nuclear medical communities could make a tremendous contribution to a safer world by supporting the replacement of HEU with LEU in the production of technetium-99m. Low-enriched uranium is just as cost effective as HEU for the manufacture of technetium-99m and does not contribute to the risk for nuclear terrorism.

Terrorism in Japan

Although the 1995 Tokyo subway sarin attack probably was the most widely reported terrorist event in Japan to date (5,500 injured, 12 dead), the country has suffered numerous other large terrorism-related events in recent decades, including bombings of the headquarters of Mitsubishi Heavy Industries in Tokyo in 1974 (207 injured, 8 dead), the Hokkaido Prefectural Government office building in Sapporo in 1976 (80 injured, 2 dead), and the Yosakoi-Soran Festival in Sapporo in 2000 (10 injured, none dead). Japan also has experienced two other mass-casualty terrorist events involving chemical releases, including the 1994 Matsumoto sarin attack (600 injured, 7 dead) and the 1998 Wakayama arsenic incident (67 injured, 4 dead). Until 1995, emergency management in Japan focused on planning and preparedness at the local level for the frequent disasters caused by natural events. Since that time, substantial progress has been made in advancing emergency planning and preparedness for terrorism-related events, including the designation of disaster centers in each prefecture, the implementation of several education and training programs for nuclear, biological, and chemical terrorism, and the establishment of a national Anti terrorism Office within the Ministry of Health, Labor, and Welfare.

Physicians as violence prevention activists--a qualitative study

Few studies have examined the challenges facing physician activists: health care providers who engage in unpaid, non-clinical work to effect change in social issues pertaining to public health. We conducted focus groups with 19 health care providers active in violence prevention; data were analyzed using qualitative methods. Five themes emerged: (1) personal experience had generated participants' activism; (2) physicians believed they were uniquely qualified as violence prevention activists; (3) violence prevention inside the health care setting often overshadowed outside activism; (4) they feared being overwhelmed by demands of activism; and (5) they felt isolated and valued networking, especially locally, to relieve isolation. Findings illustrate the complex demands of violence prevention work on today's busy physicians.

Causes and health consequences of environmental degradation and social injustice

Worldwide the greatest effects on the health of individuals and populations results from environmental degradation and social injustice, operating in consort. This paper describes the national and global causes and health consequences of these phenomena. Causes include overpopulation, pollution, deforestation, global warming, unsustainable agricultural and fishing practices, overconsumption, maldistribution of wealth, the rise of the corporation, the Third World debt crisis, and militarization and wars. Consequences include increased poverty, overcrowding, famine, weather extremes, species loss, acute and chronic medical illnesses, war and human rights abuses, and an increasingly unstable global situation that portends Malthusian chaos and disaster. Because of their scientific training, and due to their privileged socioeconomic status, physicians are in a unique position to recognize these phenomena and to act at all levels, from interactions with their patients, to volunteerism, to service and intervention in areas of great need, to direct political activism and involvement. Specific suggestions for action are discussed.

Disaster medicine in the 21st century: future hazards, vulnerabilities, and risk

The prediction of future disasters drives the priorities, urgencies, and perceived adequacies of disaster management, public policy, and government funding. Disasters always arise from some fundamental dysequilibrium between hazards in the environment and the vulnerabilities of human communities. Understanding the major factors that will tend to produce hazards and vulnerabilities in the future plays a key role in disaster risk assessment. The factors tending to produce hazards in the 21st Century include population growth, environmental degradation, infectious agents (including biological warfare agents), hazardous materials (industrial chemicals, chemical warfare agents, nuclear materials, and hazardous waste), economic imbalance (usually within countries), and cultural tribalism. The factors tending to generate vulnerabilities to hazardous events include population growth, aging populations, poverty, maldistribution of populations to disaster-prone areas, urbanization, marginalization of populations to informal settlements within urban areas, and structural vulnerability. An increasing global interconnectedness also will bring hazards and vulnerabilities together in unique ways to produce familiar disasters in unfamiliar forms and unfamiliar disasters in forms not yet imagined. Despite concerns about novel disasters, many of the disasters common today also will be common tomorrow. The risk of any given disaster is modifiable through its manageability. Effective disaster management has the potential to counter many of the factors tending to produce future hazards and vulnerabilities. Hazard mitigation and vulnerability reduction based on a clear understanding of the complex causal chains that comprise disasters will be critical in the complex world of the 21st Century.

Working together for health and human rights

The right to a standard of living adequate for health and well-being is being denied to vast numbers of people all over the world through increasing disparities in income and in wealth. In the name of economic development, a number of international and national policies have increased the grossly uneven distribution of income, with ever-growing numbers of people living in poverty as well as in increasing depths of poverty. Globalization, crippling levels of external debt, and the 'structural adjustment' policies of international agencies have expanded the numbers and the suffering of people living in poverty and have resulted in the neglect of government-funded social programs, of regulations protecting the environment, and of human development. Access to medical care, an essential element in the protection of health, is difficult for many, including the 44 million people in the United States who lack insurance coverage for the cost of medical care services. Working together for health and human rights also requires promotion of the right to peace. The right to life and health is threatened not only by the existence and active deployment of weapons of mass destruction, including nuclear, chemical and biological weapons and anti-personnel landmines, but also other weapons. The twentieth century has been the bloodiest in human history, with an estimated 250 wars, more than 110 million people killed, countless people wounded and at the least 50 million refugees. Health workers must work together with people in our communities for the promotion of health and human rights, which, in Sandwell and elsewhere, are inextricably intertwined.

Nuclear weapons, a continuing threat to health

32,000 nuclear weapons, with a destructive force equivalent to several thousand megatons of conventional explosive, are still deployed. The risk of nuclear war by accident may have increased and new threats include war between newly declared nuclear-weapon-states and the construction by terrorist groups of crude but effective devices. Health workers have drawn attention in the past to the likely major health consequences of the use of nuclear weapons. An opportunity for their global elimination under a nuclear weapons convention arises with the current review conference in New York of the nuclear Non-Proliferation Treaty--a crucial event for efforts to bring about a world free of nuclear weapons.

Pharmacy Preparedness for Incidents Involving Weapons of Mass Destruction

Recent worldwide terrorist acts and hoaxes have heightened awareness that incidents involving weapons of mass destruction (WMD) may occur in the United States. With federal funding assistance, local domestic preparedness programs have been initiated to train and equip emergency services and emergency department personnel in the management of large numbers of casualties exposed to nuclear, biological, or chemical (NBC) agents. Hospital pharmacies will be required to provide antidotes, antibiotics, antitoxins, and other pharmaceuticals in large amounts and/or have the capability for prompt procurement. Pharmacists should become knowledgeable in drug therapy of NBC threats with respect to nerve agents, cyanide, pulmonary irritants, radionucleotides, anthrax, botulism, and other possible WMD.