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The Friendship Strategy: Building Trust to Sustain Life

I believe the most important single thing, beyond discipline and creativity, is daring to dare.
—MAYA ANGELOU

The chief lesson I have learned in a long life is that the only way you can make a man trustworthy is to trust him, and the surest way to make him untrustworthy is to distrust him and show your distrust.
—HENRY L. STIMSON, speaking to Truman about the atom bomb

BY THE LATE 1960s I had moved away from the antinuclear struggle. It was psychologically numbing to continue as an apocalyptic evangelist. The moral depravity of the Vietnam War was overwhelming all other political issues in my mind. Yet the undiminished nuclear threat hovered as an inseparable shadow. It could not be otherwise after my experience in founding the Physicians for Social Responsibility. I read every issue of the Bulletin of the Atomic Scientists and kept file cabinets bulging with articles on every aspect of nuclearism. I followed the nuclear arms race with dread and with the mounting outrage that is the offspring of helplessness. It seemed as though in the nuclear arms race the American and Soviet lead runners had lost control of their limbs.

The Limited Test Ban Treaty signed by Kennedy and Khrushchev in 1963 brought a surge of optimism. It was a Pyrrhic victory. Instead of leading to disarmament, it accelerated the very process it had promised to quash. In fact, it was nothing more than an environmental measure addressing the problem of radioactive fallout from atmospheric testing rather than a restraint on the arms race.

By going underground and waylaying public oversight, the treaty was a curtain-raiser to an accelerated tempo in nuclear weapons modernization and acquisition. Making it invisible permitted an increase in the pace of testing. Since the treaty signing in 1963, about fifteen hundred underground nuclear explosions had been carried out, many times the number ever conducted in the atmosphere. The worldwide nuclear stockpile continued to mount exponentially, reaching an explosive power of around sixteen thousand megatons, a magnitude beyond the grasp of human imagination. By comparison, the weapons detonated in all the major wars of the bloody twentieth century, which claimed fifty million lives, were equivalent to a mere eleven megatons of explosive power.

When nuclear tests became invisible, public concern vanished as well. Physicians for Social Responsibility became an empty shell of an organization. In my view, the antinuclear movement had made a serious strategic mistake by focusing on radioactive fallout rather than the all-encompassing threat to human survival and the immorality of equating national security with the accumulation of genocidal weapons.

The price for such tactical opportunism continues to this day. A deeper lesson had to be learned: Politicians are often incapable of responding to the insistent beckoning of history when it does not suit their immediate political interests. With few exceptions, they rise to the challenge only when a mobilized public, comprehending an issue, clamors for change and forces them to do so.

In the mid-1970s, when the United States was forced out of Vietnam, we expected a huge peace dividend to address the many neglected social problems affecting education, health, housing, race relations, drug use, unemployment, and an aging population; in fact every sector of life was aching for an infusion of social investment. With the removal of Vietnam as a source of contention between East and West, it seemed likely that the inflated military expenditures for nuclear weapons would also be pared, thereby engendering a climate favorable for their abolition. But without a large mass movement to insist on demilitarization, those hopes floated like cobwebs and soon vanished from the political horizon.

The military-industrial complex, identified as such by President Eisenhower, adroitly maintained its hold on Congress and its fiscal purse strings. The media stoked fears of the mushroom cloud, thereby recruiting mass support for the Cold War.

I brooded about the unavoidable calamity. How could everyone go around doing business as usual? No one doubted that nuclear war would be an unprecedented catastrophe for humankind. Common sense indicated that when weapons are massively stockpiled, sooner or later they will be used. It was also evident that the arms race had exacted astronomical costs and had debilitated both superpowers. Why was this madness continuing? How was it possible that people turned away from economic self-interest and remained indifferent to the most basic of all the biological instincts, that of self-preservation—the survival of oneself, of one’s family, of one’s community?

I surmised that this deeply embedded psychopathology resulted from socially engineered public misperceptions that had gained ground with frequent repetition. In the intellectual climate of the day, facts had meaning only if they adhered to ideological preconceptions. If the facts did not fit the ideology, so much the worse for the facts.

At the time, the central element of the prevailing ideology was deterrence, the intellectual motor of the Cold War. In my mind, this policy was the quintessential deception of the nuclear age. If one asked someone on the street to justify having weapons for a massive nuclear overkill, the likely answer was that the sole intent was to threaten an unscrupulous enemy. Such threats were the only certain way to protect the United States. Unlike Russian nuclear weapons, our nuclear weapons were guarantors of survival, indeed peacekeepers.

The continued success of the policy of deterrence demanded that we never dismount from the nuclear merry-go-round: we were to stockpile ever-more-powerful arsenals. In short, deterrence was promulgated as an insurance policy to guarantee that nuclear weapons would not be used. For one who doubted this rationale, a rhetorical question ended the debate: “But have these weapons not kept the peace for these past thirty years?” My response to this question was the morbid joke of the man who fell off the Empire State Building. As he passed the thirtieth floor, he was overheard to mutter, “So far so good.”

The implicit assumption in the West was that without the threat of our nuclear might, all of Europe would long ago have been an occupied enclave of the USSR. It was as though Europe were a readily swallowed pastry puff, and the Soviets had the appetite and capacity to digest such a large morsel. Having traveled numerous times to the Soviet Union, I was of the view that the American perception was the mirror image of the Soviet perception. Without their ten-megaton bombs deterring Yankee madness, the United States would have turned Moscow into a radioactive moonscape.

I could not comprehend why a country would accumulate nuclear weapons unless the aim was to use them. Do we go on building houses in order not to occupy them, or manufacture automobiles only to garage them? A major objective of military research had been to resolve a dilemma, namely, how to justify the expansion of our arsenals and evolve a rational for the use of nuclear weapons. Henry Kissinger first gained worldwide recognition in 1957 with his book advocating a policy of waging limited nuclear war, made possible by new tactical weapons. Kissinger sought “to break down the atmosphere of special horror which surrounded the use of nuclear weapons” and “to overcome the trauma which attaches to the use of nuclear weapons.”

Yet if one critically examines the nuclear policies of the day, the doctrine of deterrence was merely an intellectual façade. Strictly speaking, deterrence should have set limits on the size of nuclear arsenals. A military policy based on deterrence requires but a finite number of weapons that can eliminate a dozen or more major urban centers on either side. If deterrence was the objective, what was the purpose of accumulating more than fifty thousand nuclear devices with an overkill equivalent in the aggregate to more than four tons of dynamite for every man, woman, and child on earth?

In the early 1960s, the American secretary of defense, Robert McNamara, concluded that if four hundred nuclear warheads were dropped on either the United States or the USSR, 30 percent of the population and 75 percent of the industrial capacity of each country would be destroyed instantly. This was deemed an adequate deterrent. Once, President Kennedy asked his science adviser how many nuclear bombs were necessary for an effective policy of deterrence. Dr. Jerome Wiesner responded that a single secure, deliverable bomb would suffice. He inferred that the Russians would deem no political or strategic objective to be worth sacrificing Moscow or Leningrad. The destruction from a single multimegaton device dropped on such major metropolitan areas would therefore inflict unacceptable damage.

In short, a policy of deterrence could not rationalize the military practice on either side of the global divide. So why the burgeoning nuclear arsenals? The available evidence led me to the view that preemption, or the ability to strike first with a decisive and crippling blow, was what the arms race was all about. With such an objective, there was no limit to the number of nuclear weapons required, or justifiable, under a strategic scenario. The proof that this was the intent of the arms race was confirmed by the size of the stockpiles, which had risen to more than fifty thousand nuclear weapons. The destructive force stored in world arsenals exceeds by a factor of more than a million the bomb exploded over Hiroshima, which killed more than a hundred thousand people.

If I could see the flawed logic in the nuclear arms race, why couldn’t everyone? How could a presumed increase in national security be achieved by enhancing world insecurity? History provides scant comfort for the view that peace is promoted by a preparation for war. The arms race cannot be a process without end; its terminus is inevitable: nuclear disaster.

Even more conducive to anxiety than the sheer growth in the number of weapons was the qualitative transformation in the dynamics of atomic arms and their delivery systems. Scientists were devising weapons more suitable to provoke than to deter nuclear war. Greater precision in the targeting of missiles made hardened silos vulnerable; those weapons then lost value for the purpose of retaliation. A symmetric instability ensued; the possibility that an enemy would attack became an inducement for one’s own preemption. Strategic policy was increasingly molded by technological innovation. Strategists spawned illusions: there could be a limited nuclear war; one nation could hold nuclear superiority; one nation could win such a war.

Military concepts about preemption provided further stimulus to the weapons race. The sheer speed—thirty minutes between launch and impact—of missiles traversing the distance between the United States and the USSR left no time for analysis and deliberation. It mandated a dependence on complex technologies to monitor, detect, and analyze signals of any presumed attack. The increased accuracy of guidance systems prompted the contemplation of preemptive strikes, augmented “hair trigger” readiness, and increasingly compelled a reliance on computers to sort out the real from the spurious.

As a physician involved in developing advanced technologies, I was aware in my daily work of their malfunctions. Whereas the failure of a pacemaker, a defibrillator, or an oxygenator may jeopardize a single life, the malfunctioning of military technology threatened the survival of humankind.

These deliberations were disquieting to the point of panic. On the basis of the deterrence policy, responsible governments were holding entire nations hostage with a suspended sentence of mass murder ready to be instantly carried out. Painfully won moral safeguards against human savagery were being jettisoned as computers simulated total war—unprincipled in method, unlimited in violence, indiscriminate in victims, uncontrolled in devastation, and certain as to a tragic outcome.

These plans had but few precedents in moral depravity. The world had been outraged at the Hitlerite industrialization of genocide. Having defeated the enemy of humankind, we in turn adopted his methods, to be implemented on a much larger scale. Once again the nexus of means and ends was sundered, sanctioning the search for peace to justify an overt flirtation with mass extermination. By acquiescing to such policies we were engaging in the most abysmal collective failure of social responsibility by humankind in its long, sordid history. Where was the unrelenting outcry against nuclearism from academic and religious world leaders? Where were the voices of moral outrage?

These ruminations drew me into an emotional tailspin. The less active I was in the antinuclear struggle, the higher the titer of my anxiety. I would look at my children and see superimposed dreadful images of Hiroshima and Nagasaki. Not only was it devastating for me, but it was also doing enormous harm to my young family, who could do little to defend against the perversities of an adult world running amok. Much later, when grown, they confessed that many a night they went to bed uncertain whether they would wake up.

I could not continue knowing what I knew and remain on the sidelines. To restore my own sense of moral well-being, and my self-respect as a doctor, I had to reengage my social conscience. But what could I do that would make a difference?

I recall the spring evening when everything changed. The year was 1978. Louise and I were luxuriating on our front lawn. We had much to be thankful for. We had three lovely, bright children. Louise was pursuing a fulfilling career in social work. My cardiovascular work was world recognized, and I was a popular lecturer on the medical world stage. My research was innovative. Clinical work was a source of daily renewal, and I was brimming with ideas for improving patient care. There was never enough time in the day for these pursuits.

Louise asked me an odd question: “Are you happy?” My reply came instantly, without a moment’s thought, “No!” It was not a mere negation, but an exclamation, denoting some despair. “And are you?” I inquired in turn. Her response was identical. We did not need to probe for the source of the discomfort. We knew. And then, as though I had been planning my response for years, I said, “I intend to do something about it.” The words tumbled out sounding pompous and pretentious, like an empty fluff of bravado, the shrill whistling of the small boy scared of the dark.

“What exactly do you have in mind?” Ever patient, Louise bore with me.

“Well, it is about time that Soviet and American physicians began to mobilize public opinion together and sow resistance to nuclear madness.”

The logic for such a movement was straightforward. A conversation with anyone on the street evoked a set of precooked platitudes. No matter how persuasive the arguments, how powerful the facts, how cogent the logic, discussions about the nuclear threat were stopped dead in their tracks by five simple words: “You can’t trust the Russians.”

The Cold War did not begin with the nuclear age. It began with the advent of the Bolsheviks’ October Revolution sixty years before. During this long interlude, Americans had been conditioned to regard the Soviet Union as an empire of evil, a country without the rudiments of the rule of law, with gulag prison camps where people were worked to death, a country characterized by heinous crimes. If such brutalities could be inflicted on their own people, nuclear-wrought genocide could be on their agenda as well. The only language Russians heeded was that of overwhelming nuclear might. By the late 1970s, most Americans regarded the Soviet Union with distrust and fear.

Two great nations that had enriched world culture were now locked like scorpions in a bottle engaged in a struggle to the death. In this danse macabre the outcome was certain—either both live or both die. There could be no victor. Despite the gibberish of the nuclear war planners, there were no strategies for winning, or even for surviving. The United States and the Russians were in the same boat. A leak at their end of the vessel was no cause for celebration, but for action and cooperation.

Russians and Americans obviously are not different biological species. We share the gift of life as well as a common ancestry shaped by a repertoire of emotions, feelings, and instincts. Governments, however tyrannical, however unsparing in brutality, cannot erase that common legacy. Therefore we had to expose our fragile human inheritance to a wide Soviet and American public in order to engender the trust that was essential to dismount from the fatal nuclear merry-go-round.

I believed the fundamental issue had little to do with blind trust in the Russians. Their own self-interest in surviving was far more compelling. For both sides to be assured of survival, we had to stop demonizing each other.

Over the ensuing days and nights I thought of little else. I became increasingly convinced that cultivating trust among Soviet and American medical professionals was an indispensable first step and the key to unlocking powerful forces. Once unleashed, such forces would draw on humanity’s deep-seated instinct for survival. I believed—as Jonathan Schell once wrote—that the most profound of all human desires is not that we personally survive, but that we be survived, “that when we die as individuals, as we know we must, mankind will live on.”

How to begin the dialogue? To even suggest a dialogue with the evil empire was a measure of granting them a moral equality that was theretofore taboo. There was no greater American sin than being soft-hearted on Communism. It occurred to me daily that I was jeopardizing my hard-won career. After all, I had been a victim of the McCarthyite witch hunt in the mid-1950s. It had left my career in shambles and required a decade of intense struggle to pick up the pieces, mend fences, and start afresh. I had no desire to relive that part of my life, and I knew that engaging the Russians carried risk. I visualized myself as a moth with one wing already singed, once again being propelled toward the fire.

The whole scheme seemed quixotic and foolhardy. But the little voice of reason held no sway. I surged ahead. I knew myself well enough to know that once I had moral certainty, nothing was likely to deter me.

At the time my goal was inchoate and fuzzy. My thinking progressed no further than trying to engage Russian doctors in some kind of dialogue on nuclear war; the aim was to find common ground. Had I thought it all through logically and rationally, I might never have taken the first step. It seemed preposterous that a doctor from suburban Boston could do anything to confront awesome global forces in a deadly arms race. At this incipient phase, my strategy was to use the personal friendships with Soviet physicians that I had acquired over more than a decade as stepping-stones to reach a broader community as well as the ruling elite. I knew it might take decades. However, if it was not possible to build trust, life was not sustainable.

The overarching aim was to change the paradigm, as Einstein had long ago suggested. The new manner of thinking precluded viewing the Cold War as a zero-sum game of winners and losers. We now stood at a historic bifurcation where global destiny could no longer be fractionated along ideological, national, or ethnic lines. The nuclear front was the most threatening. Looming on the close horizon were other formidable challenges, such as the global divide between rich and poor, the extinction of species diversity, diminishing supplies of freshwater, the exhaustion of energy resources, population growth, and on and on.

Even a small beginning with a single human connection, namely a Russian acquaintance, would be a hopeful first step. The candidate that came to mind was academician and cardiologist Eugene Chazov. I liked Chazov, respected his medical ability, and knew he was a leading figure in Soviet medicine. But the more I thought about him, the more I hesitated. In the years that I had known him, we had never once talked on any subject other than medicine and cardiology. He was a no-nonsense bureaucrat. His mastery of English was poor, making complex political discussion unwieldy if not counterproductive. At the time I deemed him an acquaintance rather than an intimate friend. I therefore gravitated to Dimitri Venediktov, a deputy minister of health. He was my first Soviet friend. Over the years we had far-ranging discussions and intensely honest intellectual arguments. He had visited and stayed at my home, and during my many trips to Moscow I had gotten to know his family well.

I first met Venediktov by accident in Boston sometime in 1962 at a meeting of the newly founded American College of Cardiology. I was strolling through a scientific exhibit and found myself standing next to this man with a strong, handsome high-cheekboned Russian face, a serious, almost dour, demeanor, and an easy conversational style. “This is quite extraordinary,” I said to him, making reference to the exhibit before us. He nodded as though unimpressed and said, with a slight Russian accent, “What do you mean?”

“Where are you from?” I asked.

“Moscow. We have all this in the Soviet Union.” What we were watching was an advanced technological apparatus. I knew this was not the case.

“Nonsense,” I said.

Venediktov got red in the face and visibly angry, but I continued: “I follow Soviet developments in cardiology, and you’re quite behind.” And off we went into a heated altercation even before we were properly introduced. I thought for certain this would be the end of our encounter.

The argument was leading nowhere, each of us adamant in a silly chauvinistic disputation. Impulsively, I offered that we resolve the argument with facts rather than with words. “You come and stay with me for a week as my guest, make rounds daily at the Peter Bent Brigham Hospital. You will witness our level of work. You can then judge for yourself. Since you are an honest man, you can issue a judgment based on personal observation as to the respective state of cardiology in our two countries.”

He was curious and I was eager. I had just invented the direct-current defibrillator, introduced cardioversion, and revolutionized the concept of coronary care units for patients suffering acute heart attacks. I was proud of this work and eager to show it off. Furthermore, I had never before encountered at close range a Soviet physician, so I was deeply intrigued.

To my surprise, he called my bluff.

“I accept!” said Venediktov.

“By the way,” I inquired, “what’s your name?”

This man had accepted an invitation to stay in my home, and I didn’t even know his name!

“My name is Dimitri Venediktov,” he said, “and if it is all right, I’d like my wife, Maria, to come along. She is a real doctor. I just pretend to be a doctor.” He turned out to be a surgeon from Moscow, stationed at the UN as a Soviet medical science attaché. We exchanged addresses. I thought that was the end of this particular charade.

A few weeks later, Maria and Dimitri moved into our home in Newton for a week. And so our friendship, extending over nearly two decades, began. Every day we got up at 6 A.M. for daily rounds in the coronary care unit, then continued with lectures, seminars, and research conferences. The evenings we spent arguing about politics. At the end of a week, Dimitri and Maria concluded that the Soviet Union indeed had much catching up to do.

As we grew comfortable with each other, Dimitri and I debated endlessly about Communism and capitalism, world politics and medicine. We argued about the Soviet treatment of Jews, a subject I cared deeply about, having lost close family members in the Holocaust. We argued about the extent of Stalin’s atrocities. He would become livid at times, and I was equally passionate. The discussions would carry forth until 2 in the morning, and then we would get up at 6 A.M. to head for the hospital and morning rounds. At the end of their stay, Dimitri asked if everyone in the United States worked as hard as I did. If this was the case, he said, “socialism will never overtake capitalism.” We stayed engaged over the years, and I watched as Dimitri advanced in the Soviet health bureaucracy. It was, as they say, the beginning of a beautiful friendship.

In 1978, when I determined to engage my energies in the antinuclear struggle, it seemed logical to reconnect with Dimitri. He was then chair of the executive committee of the World Health Organization and had been a leader in the global effort to wipe out smallpox. Indeed, Venediktov made a critical concession that allowed the smallpox effort go forward. With the United States and the Soviet Union wrangling over who would lead the project, it was Venediktov who saw that the greater good required compromise. He let the Americans take the lead, the vaccination project went forward, and smallpox was eradicated, one of the greatest achievements in global public health. I needed someone with that kind of mindset.

On February 22, 1979, I sent him a long, carefully crafted letter. I described the sheer insanity of the ever-accelerating nuclear arms race as defined by its acronym, MAD (for mutual assured destruction). “And it constitutes the inexorable road to mass genocide.” I asked, “How can physicians remain silent?” and urged that we meet to discuss a joint Soviet-American medical response.

My letter to him went unanswered. Even though Venediktov later became deeply involved in the IPPNW movement, I never asked for, and he never volunteered, an explanation for his failure to respond. Some months later I sent an abridged similar letter to Chazov and received no response. I suspected that both Venediktov and Chazov were fearful, that they were victims of a system that discouraged them from communicating with Americans in areas beyond their medical interest. I was despondent. The fog seemed impenetrable.

When I was uncertain how to proceed, puzzled as to the next step, a visiting Soviet cardiologist showed up in my laboratory at the Harvard School of Public Health. She turned out to be a veritable messenger from heaven. Dr. Nikolaeva indicated that she was the head of cardiac rehabilitation in the clinic of Professor Eugene Chazov at the All Union Institute of Cardiology, in the USSR.

I immediately invited Dr. Nikolaeva for brunch that Sunday and drafted a letter for her to hand-deliver to Eugene Chazov. The letter was dated June 29, 1979, and suggested that “a conference of Soviet, USA and Japanese physicians organized to discuss the medical consequences of the thermonuclear arms race will help rouse world public opinion.... The inclusion of Japanese physicians is logical since they know better than anyone else what thermonuclear bombing means.”

As I write, only a short time has passed since the Cold War ended, yet it is difficult to fathom the intense dread of that era. When I asked Dr. Nikolaeva to deliver the letter to Chazov, she became visibly uneasy. Though she agreed, I had visions of the letter being discarded in the nearest wastebasket. The distrust that permeated Soviet-American relations cascaded into every sphere of life. At the time the Cold War was in a bitter stage, and incriminating documents were handed to Soviets, which could implicate an innocent possessor in espionage. I surmised that she feared the letter was a provocative document that could land her in trouble with the FBI—or, worse, the KGB. To assuage her concern, I urged her to tear open the envelope and read the contents. As she read the letter, she began to cry. Her own fear of the nuclear arms race was quite vivid, and she promised to carry the letter personally and deliver it directly into Chazov’s hands as soon as she returned to Moscow.

Four months later I received a reply from Chazov. While he did not support the idea of a conference, he opened the door to continuing conversation. We had lit a small candle.