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First Person

EPs Uniquely Positioned to Push the Nuclear Clock Back from Doomsday

Bivens, Matt, MD

Emergency Medicine News: May 2019 - Volume 41 - Issue 5 - p 25
doi: 10.1097/01.EEM.0000558190.76864.b6
First Person



Emergency physicians take more time deciding whether to give thrombolytics for a possible stroke or whether to send a possible STEMI to the cath lab than some world leaders are given to decide whether to kill tens of millions in an afternoon.

What's more, we emergency physicians actually train to make life-or-death decisions, and our success or failure usually only affects one person's life. However we spend our free time, we don't show up for work impaired by alcohol.

Can we say the same for political leaders? Few formally prepare for the day they must decide whether to launch nuclear weapons. After a hard day's work, many leaders may reach for a stiff drink, forgetting they carry the metaphorical on-call pager for nuclear war. (Read these articles in The Guardian about how being intoxicated influenced President Richard Nixon's handling of several potential nuclear crises: and

Physicians have historically played an influential role in nuclear weapons policymaking, and have been associated with two Nobel Peace Prizes for that work. It is important for us to speak out, and emergency physicians in particular have a unique perspective on making critical decisions, rapidly and with limited information.

The situation is dire. The Doomsday Clock ticked forward again in 2018, and it is now just two minutes to midnight, two minutes till Armageddon. ( This is only a symbolic representation, of course, of the Chicago-based Bulletin of the Atomic Scientists, but it is sobering that this is the closest these experts have ever judged us to self-annihilation.

The United States and Russia continue to maintain hundreds of nuclear weapons on hair-trigger alert, poised for a launch in just minutes. ( This has been criticized by everyone from George W. Bush to Barack Obama as extremely risky and unnecessary, particularly in an era of nuclear-armed submarines.

Instead, each country's military demands a president make rapid, irreversible decisions immediately based on limited (and often horrifyingly incorrect) data. ( Think about the last equivocal acute MI patient you treated. You gathered some data, talked to a cardiologist, and maybe got a second ECG before you were convinced and hit the STEMI button. You started heparin, maybe gave nitroglycerin, consented the patient, organized transport, and considered it a win if you achieved a door-to-balloon time under 90 minutes.

Now imagine that at the exact same time, the U.S. president was sorting through confusing data about a possible military attack, with the Pentagon arguing for an immediate nuclear response. The president would have launched a nuclear war before the emergency physician even got that second ECG.

What if a (possibly intoxicated) world leader decided to launch after one of these panic-inducing briefings? An exchange of just 100 nuclear weapons, less than one percent of the world's arsenals, would whiplash our warming climate back in the opposite direction. Burning cities would throw so much soot into the high atmosphere that it would reverse decades of global warming, depress world agriculture, and cause up to two billion people to die of starvation. (International Physicians for Prevention of Nuclear War. November 2013.

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Spree on Nuclear Weapons

India and Pakistan, which have fought frequent wars, could in an afternoon trade nuclear strikes and kill tens of millions, more deaths in one day than in all of World War II, and then over the next several months kill hundreds of millions of citizens of other nations from abrupt global cooling.

Despite all of this, nations are building instead of shrinking arsenals. Russian President Vladimir Putin spent much of his 2018 State of the Union address before a hall of applauding Moscow elites boasting about new nuclear weaponry in a presentation that included an animation of missiles weaving through defenses to strike Florida.

President Donald Trump is overseeing a similar U.S. spree on nuclear weapons that foresees spending $1.7 trillion in the next 30 years, $345 billion of that over the next seven years. ( In trading insults with North Korea, President Trump spoke of unleashing “fire and fury the likes of which the world has never seen,” and that is accurate: The bombs used at Hiroshima and Nagasaki are a fraction of the size of today's thermonuclear weapons.

Yet there is real cause for optimism. The Treaty on the Prohibition of Nuclear Weapons was passed by the United Nations in July 2017. More than 120 countries voted in favor. Once the home governments of 50 nations ratify the treaty, which usually involves parliamentary discussion and approval, it will be legally binding like bans on other weapons of mass destruction such as chemical or biological weapons. At this writing, 19 states have formally ratified, and parliaments around the world are debating. (

This is in no small part thanks to physicians and other health care professionals who have led the drive to cure humanity of this species-threatening public health danger. Physicians for Social Responsibility was relaunched in the 1980s by a new generation of Boston physicians, including pediatrician Helen Caldicott, MD, emergency physicians Ira Helfand, MD, and Jennifer Leaning, MD, psychiatrist Eric Chivian, MD, cardiologist James Muller, MD, and several others.

Physicians are used to the idea that a disease, like hypertension or cancer, can be invisible and silent but still an imminent life-threat. Fortunately, this deadly disease is curable. Remember, the UN already passed a treaty outlawing these weapons. They likely will be dismantled in your lifetime!

Want to get involved in making that happen? Join Physicians for Social Responsibility or make a donation at Sign and advocate for the “Back from the Brink” pledge, which can be found at This fast-growing grassroots effort aims to put nuclear weapons on the agenda for the 2020 presidential election.

A longer, more comprehensive version of this article is available in the March 20 EMN enews at

Dr. Bivensis an emergency physician at Beth Israel Deaconess Medical Center in Boston and at St. Luke's Hospital in New Bedford, MA. He is on the board of directors of Physicians for Social Responsibility ( He can be reached

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