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Clinical Guidelines: Jamie K. Waselenko, Thomas J. MacVittie, William F. Blakely, Nicki Pesik, Albert L. Wiley, William E. Dickerson, Horace Tsu, Dennis L. Confer, C. Norman Coleman, Thomas Seed, Patrick Lowry, James O. Armitage, and Nicholas Dainiak Medical Management of the Acute Radiation Syndrome: Recommendations of the Strategic National Stockpile Radiation Working Group Ann Intern Med 2004; 140: 1037-1051 [Abstract] [Full text] [PDF]

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Prevention of acute radiation emergencies

Martin T Donohoe   (6 July 2004)

Prevention of acute radiation emergencies 6 July 2004
Martin T Donohoe, MD, FACP Old Town Clinic and Portland State University Send rapid response to journal: Re: Prevention of acute radiation emergencies martin.donohoe{at}verizon.net Martin T Donohoe	Waselenko et al.’s otherwise comprehensive review (1) neglects to mention how changes in United States government policies could decrease the risk of nuclear accidents and terrorism and the role of physicians in preventing major radiation events. The US possesses the world’s largest stockpile of nuclear weapons, enough to destroy civilization many times over. We have spent little to upgrade and protect our aged, accident-prone nuclear power plants, and have failed to develop an environmentally-sustainable, fiscally- responsible energy policy. We plan to bury 100,000 tons of high-level nuclear waste on Native American land at Yucca Mountain, near an earthquake fault and major aquifer. Much of the transported waste will travel through major population centers, risking an accident or terrorist attack. Current administration policies which increase risk of an acute radiation event include: Nuclear Posture Review (consideration of first strike nuclear weapons use), Anti-Ballistic Missile Treaty withdrawal, and boycotting the Comprehensive Nuclear Test Ban Treaty conference, risking another nuclear arms race and sending a message to foreign governments that they too can develop and produce nuclear weapons; funding development of “mini-nukes”; spending billions of dollars to support research and development of a so-called “Missile Defense Shield,” despite opposition from most reputable scientists and spectacular failures in highly structured tests; and allocating inadequate sums for disposal and safe- keeping of nuclear weapons in former Soviet block countries and for halting nuclear materials trafficking. Prevention should include efforts to reverse these policies, as well as enhanced medical education regarding: 1) The political, cultural, economic and religious contributors to environmental destruction, war, and human suffering (2, 3), factors which lead to disenfranchisement, discontent, desperation, and the kind of hopelessness which impels terrorists to consider the use of radiation weapons, such as dirty bombs; 2) The horrifying short- and long-term health consequences of nuclear explosions and accidents (South Pacific weapons testing, Hiroshima, Nagasaki and Chernobyl) (4); 3) The shameful involvement of physicians in the development, dissemination, and use of weapons of mass destruction (e.g., Nazi and Japanese scientists who conducted biological weapons “experiments” in World War II) and human rights abuses (e.g., Serbia’s Radovan Karadzic and Al Qaeda’s Ayman Al-Zawahri); 4) How medical students and physicians can create peace and justice in the world; and 5) Medical organizations working for peace and justice (e.g., Physicians for Social Responsibility and Physicians for Human Rights). Regrettably, these subjects are almost entirely absent from medical school and residency curricula. (5) References: 1) Waselenko JK, MacVittie TJ, Blakely WF, et al. Medical management of the acute radiation syndrome: Recommendations of the strategic national stockpile radiation working group. Ann Int Med 2004;140:1037-1051. 2) Donohoe MT. Causes and health consequences of environmental degradation and social injustice. Soc Sci and Med 2003;56(3):573-587. 3) Donohoe MT. Individual and societal forms of violence against women in the United States and the developing world: an overview. Curr Women’s Hlth Reports 2002;2(5):313-319. 4) Donohoe MT. Remember Hiroshima and Nagasaki: the legacy of nuclear weapons. The Oregonian 2001 (August 6), editorial - web publication: www.oregonlive.com/opinion. 5) Donohoe MT. Bioterrorism curricula too limited. Acad Med 2004 (Apr 14). Available at http://www.academicmedicine.org/cgi/eletters/79/4/366 Conflict of Interest: None declared