Cardiac Events and Nuclear war: Prevention by Cardiovascular Specialists

James E. Muller, MD; John O. Pastore, MD; Amir Lerman, MD


Circulation. 2019;139(25):2597-2599. 

In This Article

Reducing the Nuclear Threat in the 21st Century

The nuclear threat has waxed and waned over the decades (Figure). Nuclear risk, which began with the first nuclear explosion in 1945 in Alamogordo, NM, peaked with the Soviet hydrogen bomb, the Cuban Missile Crisis in 1962, and the Cold War in the 1980s. In 2017, Presidents Trump and Kim Jong Un exchanged threats of nuclear war and accurately described the devastation that would ensue. Their rhetoric broke through the widespread denial of the problem and alerted younger generations of the nuclear threat.


Nuclear risk over decades.
An historical summary of the estimation of nuclear risk depicted by the Doomsday Clock of the Bulletin of the Atomic Scientists from 1947 to 2017. The extreme risk experienced in 1962 during the Cuban Missile Crisis is not shown because it emerged and was resolved in the interval between settings of the clock.1 US indicates United States; and USSR, Union of Soviet Socialist Republics. Figure prepared by Noy Kaufman and James Muller, MD.

Health professionals can make the unimaginable imaginable (and hence preventable), alerting the public to the chance of an accidental nuclear war and educating about the cumulative probability aspect of the threat. Now, professionals of the 21st century and beyond are needed in the struggle for survival in the nuclear era. Many college-aged students are now aware of the problem, contributing youthful energy to the successful effort by International Campaign to Abolish Nuclear Weapons to obtain a United Nations vote in favor of the Treaty on the Prohibition of Nuclear Weapons.

For health professionals new to the nuclear threat, an excellent introductory book is The Seventh Decade: The New Shape of Nuclear Dangerby Jonathan Schell.[2] For those already committed to action, there are many ways through which to contribute: International Physicians for the Prevention of Nuclear War, Physicians for Social Responsibility, and International Campaign to Abolish Nuclear Weapons.

The campaign titled Back From the Brink[3] is advocating 5 steps to reduce the threat:

  • Renounce the first use of nuclear weapons;

  • End the sole, unchecked authority of any president to launch a nuclear attack;

  • Take US nuclear weapons off hair-trigger alert;

  • Cancel the trillion-dollar program to build replacement weapons with enhanced capabilities; and,

  • Pursue an agreement with nuclear-armed states to eliminate all nuclear weapons.

Although the nuclear threat to the life and health of humanity is terrible to contemplate, it is an artificial threat created by human ingenuity. We must now harness the ingenuity that brought us 21st century medical science to reduce nuclear danger. With an energetic, worldwide educational effort by health professionals on the nuclear threat, we can join our colleagues in moving the hands of the Doomsday Clock back from the midnight hour.