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To determine how physicians might participate in the prevention of nuclear war in the post-Cold War era, we review, from a medical perspective, the history of the nuclear weapons era since Hiroshima and the status of today's nuclear arsenals and dangers. In the 1950s, physicians were active partners in governmental civil defense planning. Since 1962, physicians have stressed prevention of nuclear war as the only effective medical intervention. Public advocacy by physicians helped end both atmospheric nuclear testing in the 1960s and superpower plans for fighting a nuclear war in the 1980s. Today's dangers include nuclear arms proliferation, an increasing risk of nuclear terrorism, and the 35000 warheads that remain in superpower-nuclear arsenals, many still on hair-trigger alert. Physicians have recently joined with military and political leaders and over 1000 citizens' organizations in calling for the complete elimination of nuclear weapons. Global medical collaboration in support of a verifiable and enforceable Nuclear Weapons Convention would be a major contribution to safeguarding health in the 21st century.

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There is more to modern health than new scientific discoveries, the development of new technologies, or emerging or re-emerging diseases. World events and experiences, such as the AIDS epidemic and the humanitarian emergencies in Bosnia and Rwanda, have made this evident by creating new relationships among medicine, public health, ethics, and human rights. Each domain has seeped into the other, making allies of public health and human rights, pressing the need for an ethics of public health, and revealing the rights-related responsibilities of physicians and other health care workers.

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Physicians for Global Survival (Canada), formerly known as Canadian Physicians for the Prevention of Nuclear War, has changed its name and broadened its mission in an effort to increase membership. The group's international interests include banning antipersonnel land mines and having the threat or use of nuclear weapons declared illegal. In Canada, it has supported gun-control legislation and been involved in assessing the effect of military training flights on the Innu of Labrador. The president-elect Dr. Konia Trouton of the University of Calgary, says the association is the "ethical voice of the medical profession in its concern for social justice."

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International Physicians for the Prevention of Nuclear War has had an impressive public impact in the 1980s, helping to shatter the myths of surviving and medically responding to a nuclear attack. The 1990s present a new challenge for the medical community in a different social and international context characterized by increasing global interdependence. Another view of physician activism is presented to complement advocacy for nuclear disarmament in the promotion of peace. A framework for analysis is provided by "fateful visions"--accepted policy views of prospective superpower relations--drawn from practitioners of foreign policy, international relations, and security affairs. A perceptual gap may exist between physicians who wish to address underlying ethical and public health concerns on security issues and policy practitioners who are accustomed to discussion within existing policy frames of reference that can be pragmatically used. A strategy is proposed for physicians to use their specialized training and skills to evaluate trends in global health interdependence. The international physicians' movement may contribute substantively to the formulation of policy by expanding and interpreting an increasingly complex database on interdependence, and by creating a dialogue with policy formulators based on mutual recognition of the value and legitimacy of each professions' expertise and complementary contributions to international security policy.

KIE: The organization International Physicians for the Prevention of Nuclear War (IPPNW) was instrumental in the 1980s in alerting the public and policy makers to the realities of surviving and medically responding to nuclear war. Gellert looks to the future role the international physicians' movement may play in formulating health policy in an era of globalization and interdependence. He proposes a strategy with which physicians may use their training and skills to evaluate global health interdependence brought about by trends in economics, environmental deterioration, and demography and population, as well as in medicine and public health.

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KIE: Dyer reports on the ninth World Congress of International Physicians for the Prevention of Nuclear War (IPPNW), held in Hiroshima, Japan, in October 1989. Taking as their theme "No more Hiroshimas," IPPNW participants visited the sites of the only acts of nuclear war -- the 1945 U.S. bombings of Hiroshima and Nagasaki that ended World War II. Scientific sessions updated information on the health effects of radiation. The congress issued an appeal for "a new agenda of moral priorities" that urges the implementation of five measures: the immediate cessation of all nuclear testing; a halt to the production of bomb-grade fissile material; conversion of secret weapons laboratories to open scientific institutes addressing environmental issues; reallocation of 50% of military spending to health and environmental projects; and the establishment of a U.N. Peace Research Centre at Hiroshima and a scholarship program to educate future world leaders about nuclear war.^ieng

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