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The Sudden Cardiac Death Task Force: US-Soviet Collaboration

I don’t rule Russia. Ten thousand clerks rule Russia.
—CZAR NICHOLAS I

There is nothing harsher and more soulless than a bureaucratic machine.
—VLADIMIR LENIN

IT WAS SEVERAL YEARS before I had another encounter with Soviet society and its mind-numbing bureaucracy. In August 1972 I received an unexpected telephone call from the US State Department. The message was crisp. “Moscow has requested your medical consultation. Patient unknown. Expect to hear from the Soviet Embassy.” A call from the embassy two hours later was similarly unrevealing. All they would confirm was that the patient was female. Neither age, medical problem, nor the gravity of her illness was communicated by Moscow.

Rather than an invitation, it was a command performance: “Fly to Washington. Bring three photographs for a visa not all the same, such as one at age 20, 30, and 40, one of which must be in color.” A Russian Embassy staff person would make flight arrangements. I was not eager to go just then, as my son was getting married that week. As a delaying tactic I requested more medical information, and it worked.

A week later a call from the White House urged me to respond, since Nixon and Brezhnev had recently signed an accord for exchanging medical consultants. My chief of medicine cautioned in mock dread that if the patient did poorly, a Siberian gulag would be a lifetime experience worthy of a book. I flew to Washington to meet up with the embassy staff person, a Soviet bureaucrat with a no-nonsense American-type demeanor. When I complimented him on his businesslike efficiency, he beamed as though he had received the ultimate accolade.

He placed me on a Pan Am flight to Moscow via London. Just as we were gliding to a landing at Sheremetyevo airport, the flight stewardess, looking out of a porthole, exclaimed that an important dignitary must be on board because there was a sizable delegation on the tarmac. The delegation was for me and was led by my old friend Dimitri Venediktov. I was impressed with the urgency of the consultation; no time was spent on greetings or small talk.

Without stopping at the terminal, without transiting customs, without passport control, and without my baggage I was whisked off in a large black limo with curtained windows to the CKB Hospital. The car raced at sixty miles an hour through busy city streets without stopping for red lights, heightening my sense of self-importance and the urgency of my mission.

In the hospital I was met by a large assemblage of physicians, including Eugene Chazov. They provided a comprehensive story of terminal kidney failure in an elderly woman with a long history of hypertension and coronary artery disease who had recently experienced a stoke. The more I learned about the patient, the greater my uneasiness. Why fetch a cardiologist from around the globe to consult on what was primarily a kidney problem? What was the purpose of flying ten hours to attend a dying patient? The Soviet professors made it clear that they had no expectations of her recovery, nor did they anticipate any unique insights from the American cardiologist. The patient was the wife of an important member of the ruling Politburo. The deeper political implications, if any, eluded me.

When I came in to examine the patient, I expected to enter an intensive care unit full of apparatus with crisscrossing multiple lines and wires, as is customary for someone critically ill in a similar American facility. There was nothing of the sort. The patient occupied a single large room with sunshine streaming from uncurtained windows. The linens were immaculate; several nurses were in attendance. She was not intubated, nor being monitored, nor receiving any oxygen or intravenous infusions. This could have been a woman sleeping in her private bedroom. The patient was semi-stuporous, a uremic foamy froth around her mouth. Occasionally she opened her eyes, looked at no one in particular, and muttered what sounded like “Ya charosh kommunist” (“I am a good Communist”). For an atheistic country, genuflecting to ideology appeared to be the last rite of passage. My examination confirmed what the Russian doctors had already described.

When a consulting physician has nothing to offer a critically ill patient, my great medical teacher, Dr. Samuel Levine, advised the consultant to stop all drugs. I indulged in that ploy. In any case, the patient was receiving far too many medications. Her stupor may have been related to drug toxicity, since many medications are excreted by the kidneys, which in her case were failing. I urged discontinuing all medications as a flimsy justification for my presence. The doctor in charge accepted the suggestion. It was curious that instead of crossing out all the prescribed drugs, he skipped some. When I asked why some were being continued, he looked perplexed. “You mean we should discontinue the Swedish drugs as well?”

The Russian doctors wanted me to sign a statement to certify that everything medically appropriate had been done and that renal hemodialysis was not justified. A note to that effect was cosigned by a number of the professors in attendance. Thus having fulfilled the reason for my mission to Moscow, I was taken to a hotel. It was now 3:30 on Saturday afternoon. Bone weary, I realized that I had been in motion for forty-eight hours since departing Boston.

The air in Moscow was cool, auguring winter though it was only early September. The hotel suite was spacious in the stodgy, pre-twentieth-century Sovietskaya Hotel. The lobby, the rickety elevator, and the rooms emanated an unkempt look of neglect with glimmers of former elegance. Czar Nicholas II had banqueted here. I was accommodated in five rooms with two television sets and a grand piano. There were thick carpets, and heavy, unmovable curtains hung on shoddy hardware. The place seemed ransacked; there were closets with but one hanger; the bathroom had one diminutive cake of soap, one meager roll of toilet paper, and a single bath towel.

It was too early to sleep, and in a few hours I was scheduled to attend a performance of the Bolshoi Ballet. I felt homesick and lonely. In part I was frustrated by an asinine mission; I had been consigned to act in a theater of the absurd. It was also the first time I had traveled abroad without Louise. My sense of loneliness was amplified by utter stillness, no sound of traffic, no overflying planes. One might have been in a Russian village rather than in a huge metropolis, the center of an empire. I did not encounter other guests. The place appeared bereft of life except for the surly attendant at the front desk and the ever-present woman on every floor, sitting in front of the elevator, whose sole ostensible function was to hand out room keys.

A troubling question recurred: why was I here? From the discussion with the doctors it was evident they did not need or welcome my input. I reflected on Russia’s rich tradition in science and medicine. After all, it was Dmitri Mendeleev who had discovered the periodic table of elements, one of the vital advances in physics, and Ilya Mechnikov, a Nobel laureate in medicine, discovered the role of white blood cells to fend off infection. Ivan Pavlov, a household name, had put a permanent stamp on modern physiology with his revolutionary work on the conditioned reflex, and he too was recognized with a Nobel.

In my own field of cardiology a Russian was the first to call attention to cholesterol as the source of the fatty substance that clogs arteries. While we Americans credit Dr. James Herrick as first to diagnose a heart attack in 1912, two Russian doctors preceded him in defining the clinical syndrome of acute coronary thrombosis. Why then did the Soviet government put pressure on the United States to get me to Moscow?

The program presented to me for the following four days resembled a cultural extravaganza more than a medical mission.

On Sunday, Chazov and Venediktov showed up with several other doctors and matter-of-factly resolved the mystery of my visit. When I asked how the patient was faring, they didn’t seem to know or care. Instead, they discussed the problem of sudden cardiac death in the Soviet Union. Plans had already been made to meet the next day at the Ministry of Health and sort out issues. I remonstrated that had they informed me of their interest, I would have brought up-to-date information. Chazov indicated that there would be many future occasions when contemporary data could be shared. This was to be a preliminary exploratory meeting.

It was now possible to reconstruct events that had brought me to Moscow. Apparently, Chazov and his colleagues became newly aware of the massive problem of sudden cardiac death in the Soviet Union. No doubt, they recalled my visit four years earlier to address this very problem. Furthermore, they must have been following American cardiology journals and realized that this was an emergent field in which they were being left far behind. They may also have surmised that they could make up some distance by learning from our experience over the past decade.

This, as I learned much later, was their problem-solving style. They waited until the flood waters were lapping at the door, only then mobilizing as though doing battle with an implacable foe. I experienced many an ulcer pain watching helplessly as a critical deadline was ignored for months while my Russian colleagues told me “not to worry.” When the deadline was nearly upon them, everyone became a heroic Stakhanovite worker (a Stalinist-era term for “extraordinarily productive”); they overcame exhaustion and battered away at the clock.

Once an alarm was sounded about the sudden death problem, all stops were pulled. The problem had to be addressed instantly. I can imagine someone suggesting, “Let’s bring Lown from Boston.” But how to circumvent the heavy-handed bureaucracy that stifled initiative and delayed action? There was one sure way to bypass the apparatchiki. This required a critically ill VIP patient, the insistence that Soviet medicine had no answer, and the follow-through identification of a physician in a capitalist country with the required expertise. While deals between individuals were avoided and even proscribed, government-to-government transactions were welcomed. The Brezhnev-Nixon accord paved the way to implement such arrangements.

Once the doctors had located the dying wife of a Politburo member, it would not have mattered if she had had terminal cancer; a cardiologist would have to be consulted. No one would dare question the logic. Because of the byzantine nature of the power structure, one could not know whether a cockamamie scheme had originated from an important official. The patient’s condition was incidental; the system kicked into fast gear to capture the imagined high ground.

Monday I spent the entire day at the Ministry of Health. The Russians had become keenly aware that sudden arrhythmic death claimed more than half the fatalities from heart disease in the Soviet Union. The numbers they presented were staggering, and the problem was growing. They needed our input to kick-start a solution.

At this meeting, I realized for the first time that Chazov was near the top of the political pecking order. Though a number of other high officials from the Ministry of Health were in attendance, his manner had the finality of authority. He spoke with executive certainty as he synthesized the best opinions of those around the table. I learned that the United States and USSR had an ongoing collaborative program in cardiology. Each country had four task forces dealing with varying facets of heart disease. Chazov headed up the Soviet program.

In Chazov’s opinion, a fifth task force was needed to deal exclusively with sudden cardiac death. He indicated that he would make this recommendation to Dr. Theodore Cooper, the director of the National Heart Institute. Chazov confided to me later that he was a close friend of Ted’s, and he would urge that I be appointed head of the new American section for Task Force 5. The day in the Ministry of Health turned out to be the real purpose for my hurried trip to Moscow.

The remaining two days were payback time, involving an overflow of culture and a shopping spree in Moscow. For culture I had a translator, Helena Zeitlin, a petite, tightly wound professor of English. Unlike easygoing Nadia, Helena was determined to avoid anything remotely political. Since she was Jewish, I hoped to gain some insight on the refuseniks. She was articulate on issues of weather, the early settlement of Moscow, the Napoleonic wars, and any subject a century or more preceding the Bolshevik Revolution. When I maintained that the persecution of Jewish intellectuals was a blot on Soviet pretensions of equality among its diverse peoples, she vehemently insisted that I was engaging in calumny and fabrication. Nothing about the USSR was to be criticized, though she acknowledged one problem, an acute housing shortage. To minimize even this shortcoming, she rhetorically asked, “Don’t you wish us to help an impoverished beleaguered country like Cuba?” Soviet largesse to the developing world presumably accounted for belt-tightening in daily life.

In fairness, there was another dimension to Helena: she shared an enduring love affair with the great pre-revolutionary cultural figures. She introduced me to a number of homes transformed into museums to commemorate the giants of Russian literature. Poets and writers such as Pushkin, Dostoevsky, Gogol, Tolstoy, Chekhov, and Turgenev are revered with the adulation we reserve for baseball players or movie stars.

In a home exhibiting memorabilia of Mikhail Lermontov, the Russian Romantic poet of the early nineteenth century, I heard a blood-curdling shriek from the woman in charge. Her rage was directed at me as I innocently looked at some descriptions of the Caucasus housed under glass on a table. I understood her expletive, beskulturny (uncultured boor). My sin had consisted of putting my hands on the glass shielding Lermontov’s sketches. She was quick with a rag to wipe away the fingerprints.

My shopping guide, Yuri, was more forthcoming. Divesting visiting dignitaries of their currency was his primary responsibility at the Ministry of Health. He needed to help me spend six hundred rubles presented by the Soviet government as payment for the consultation. I felt guilty about accepting reimbursement for a useless medical visit. On the contrary, Yuri assured me, after all the drugs were stopped, Mrs. S. roused from her stupor.

Shopping in Moscow was an exercise in trivial pursuits. Surly clerks, replicas of the waiters we encountered, were angered at customers for interrupting their yogalike trances. I did buy something costing $19. 20 and presented the clerk an American Express traveler’s check for $20. The cashier refused to give me my purchase since she had no precise change. I offered to make a contribution of the 80 cents to the USSR. She indignantly refused. This would unbalance her accounts. I spent the next half hour searching the store for an item that would make up the difference. Eventually she grudgingly accepted a tiny porcelain horse for 72 cents.

Some months later I met Dr. Cooper in Washington. Without mentioning any prompting from Chazov, he offered me the leadership position of a new US task force on sudden cardiac death. Perhaps one of the great perks of the Soviet connection was getting to know Ted Cooper. I have never encountered a more creative civil servant. Ted had been a cardiac surgeon as well as an outstanding medical scientist. Forthright in manner, he had a scalpel-like probing intelligence and a reputation for integrity. He impressed me with the importance he placed on US-USSR cooperation in cardiology. He intimated that the consequences of effective collaboration extended far beyond the cardiovascular field.

After specifying guidelines and objectives, Ted indicated that I had complete authority to select the working group, except for one member he would appoint. This was Dr. Isadore Rosenfeld, a New York heart specialist who was remotely known to me. Rosenfeld was neither an academic researcher nor involved in the area of the new task force.

Ted was blunt about why Rosenfeld was chosen: “You are known in Washington as a radical, the effects of McCarthyism are not yet out of our system, and relations with the Soviet Union are potentially flammable. You need someone who could run political interference should the occasion arise. Izzy is very well connected. He has a remarkable roster of high-brow, politically important patients.” It was good to know that at least my left flank would be guarded.

A word of explanation is in order about the level of knowledge at that time regarding sudden cardiac death. The teaching was that sudden cardiac death was totally unpredictable, a veritable bolt from the blue. My own theorizing and early research had led to a different conclusion. Essentially, a subject at risk could be identified long before the fatal event. Recognition of specific heart rhythms could lead to effective preventive measures. A decade earlier I had pioneered twenty-four-hour monitoring of the heartbeat with portable mini-recorders as well as the use of exercise stress testing to help capture transient abnormal rhythms. My hope was that Russian collaboration would hasten the acquisition of meaningful data on this urgent enterprise. Such collaboration was likely to yield very significant data, since the Soviets had evolved a first-rate emergency ambulance system that picked up victims in the very early throes of a heart attack. Thereby they could help define the heart rhythm disturbances that augured sudden death.

If we were to collaborate with the Soviets, we needed to share similar technologies. I spoke with Ted Cooper, suggesting that as a goodwill gesture we should help the Russians acquire such monitoring instruments as either loan or gift. The expedited accumulation of data would more than recompense for the money we had invested. After some deliberation Ted saw the logic and approved the initiative. I felt triumphant that we would shorten the time to obtain some key answers and help salvage lives.

The first group to journey to the Soviet Union consisted of seven medical scientists with a diversity of expertise. The electronic equipment obtained for the Russians was air-freighted to Moscow a month before our visit. To make certain that there was no delay in getting the instruments operational, I invited Dr. Paul Axelrod, a member of my Harvard research group, who was both cardiologist and electronic engineer. He would expedite the application of the then-novel electrocardiographic monitoring technology. I felt sure that the equipment would be all set up awaiting us, since the airlines informed me of its arrival in Moscow several weeks before our departure.

Arriving in Moscow, I was dismayed that the monitoring equipment was nowhere in sight at the Myasnikov Institute of Cardiology. Nor could I obtain a coherent answer as to where it was housed. It would arrive at the institute tomorrow, they assured me, with the equivalent of the Latin American mañana.

I protested that we were in Moscow only for a week; there was much to learn about how the electronic equipment worked; we needed a Russian engineer to become promptly informed in case of the inevitable technological glitches. No engineer was necessary until the equipment was unpacked, they insisted, but the engineer could be briefed by Axelrod. An expression that dinned endlessly and irritatingly was “Niechevo charosho”—crudely translated, “Not to worry, never mind, all will be well.” We were to give lectures and partake of the abundant culture.

The second day, when the equipment had not arrived, I turned to my Soviet counterpart, a cardiac pathologist of distinction. He was imperturbable. “If they do not arrive tomorrow, they will arrive some day. The important fact is that they are in Moscow.” He did not even add “not to worry.” Being a pathologist of the old school, he intimated that the equipment was a costly yet worthless American toy. What was needed instead was more careful dissections of the hearts of sudden death victims.

Paul Axelrod was growing restless and understandably irritable. He was a workaholic and had not been eager to travel to Moscow. The importance of making the complex apparatus work was what had persuaded him to accompany the mission. He felt that I had clout and needed to threaten the Russians. He did not indicate what threatening weapon I was to unsheathe. Little did he recognize that I was helpless in confronting a mammoth bureaucracy.

On the fourth day I turned to Professor Igor Shkhwartsabaia, a very sympathetic human being who spoke English fluently and possessed a courtly elegance antedating the Bolshevik era. He was the Soviet specialist on hypertensive disease and the former director of the Myasnikov Institute, the premier such institute in the USSR. I was sure he could wield decisive influence.

Once Igor learned of the problem, he behaved like a psychotherapist responding to an emotionally troubled patient. He was more concerned with allaying my anxiety than solving the problem. “Bernard, why are you so disturbed?” was his recurrent question. I explained that in addition to enormous personal frustration, I was letting my colleagues down. I kept returning to vexing questions. These were medical instruments, not contraband, and they were sitting but a few kilometers away. Why were the Soviets intent on undermining the project?

“That is not the case at all,” Igor reassured me. “It is merely a matter of a few silly documents.” Yet the clock was ticking and every day was a lost opportunity. We could not undertake joint studies if we did not share the same methodology, since the Russians had no alternative technologies for monitoring the heartbeat. The delay defeated the major purpose of our journey; we could have no common protocols, no joint research, no meaningful results. There would no doubt be repercussions for Ted Cooper, undermining his efforts to foster collaboration.

Igor emphasized that the importance of our visit lay in our coming to Moscow to collaborate; the instruments were incidental. “What happens when anti-Soviet politicians in Washington, who are in the large majority, learn what has transpired?” I responded. After all, the US government had invested more than $50,000 to acquire and express air-freight the monitoring equipment and would sooner or later require an accounting. “Can you imagine the headlines, ‘Medical gift from USA quarantined by Soviets to impede their own scientists’?” I asked.

If sympathy was anxiety allaying, Igor provided it in abundance. I can still hear his gentle voice telling me that I was taking the matter far too seriously and that in the end it would work out. “You see, there are twelve ministries that have to put their stamp of approval, and they have to be approached in the right sequence. If you happen to go to the fourth before the third, it won’t do.” So what is to be done? “One must be patient.” Finally, as though seeing light at the end of this dark tunnel, he said, “Perhaps you should raise the issue with Eugene Chazov.”

On the fifth day I decided to go to the top and connect with Chazov. It was not easy. Russian colleagues other than Igor discouraged that move since it could reflect on their competence. When I reached Chazov, he was very businesslike; he listened carefully, promised nothing, but assigned a co-worker, Alec Koschechkin, a no-nonsense former Red Army man, to solve the problem. Alec immediately ordered a subordinate, Sasha, to obtain the equipment and threatened to do him bodily harm if he did not deliver it the next day. Next morning, triumphant with a wad of twelve stamped documents in hand, Sasha went to Sheremetyevo airport. In the early afternoon, Sasha returned empty handed. The explanation was bizarre. They would not accept the documents, so he did not think it was legal to accept the equipment.

Koschechkin’s wicked temper exploded. He grabbed a broomstick and began to chase Sasha, a veritable scene out of a Keystone Cops comedy. He ordered Sasha to go back and not return without the equipment. He threatened to bring his service revolver and shoot him like some rabid dog if once again he returned empty handed.

Friday afternoon, the ill-fated crates arrived. Since it was too late in the day to begin the unpacking, we were to do so on our return from a visit to Leningrad Monday afternoon. We would then have less than twelve hours to pass the baton of knowledge to our Russian colleagues. I asked for an engineer to be present as soon as we returned so we could at least convey some of the essential principles.

When we returned from Leningrad, an engineer was awaiting us. He spoke fluent English, but his specialty was heavy pumping machinery. He was not an electronic engineer; he did not work for the Ministry of Health, nor did he evince the slightest interest in our project. In fact, he had not been assigned to work with us, merely to make an appearance for a few hours. As it turned out, as soon as we unpacked, everyone disappeared, as their quitting time was 4 P.M., SO no time was available to convey information. We left Moscow without having monitored a single patient. It took more than two years to get the apparatus operational and another few years to obtain data. By then I was no longer involved.

This frustrating experience provided more insight into the Soviet system than several descriptive tomes could have done. Though some thirty years have elapsed, recalling the events still speeds my heart rate and raises my blood pressure.

With each successive trip I got to know a number of doctors more intimately, and in turn they came to know me. I was increasingly included in family events and in frank discussions. I learned that fostering personal connections was critical to developing working relationships. Perhaps most important for the future emergence of the US-Soviet antinuclear movement, the International Physicians for the Prevention of Nuclear War, was my growing friendship with Eugene Chazov.

A smaller yet meaningful personal connection was made during this otherwise frustrating visit when I was asked by the minister of culture to see the great violinist David Oistrakh in medical consultation. About three months earlier he had sustained a heart attack. Oistrakh was forbidden to practice his violin, the one activity that gave meaning to life. He appeared deeply depressed and complained of utter exhaustion. At my urging a graduated exercise program was instituted with prophylactic nitroglycerine against recurring angina, and he resumed violin practice. He fared well and sent me an autographed photo with a treasure trove of his long-playing recordings.

I participated in three more trips to the Soviet Union as part of the sudden cardiac death task force, including visits to Georgia, Lithuania, and the Crimea. One aspect of these travels was exposure to the enormity of the alcohol problem in Russia. Some of our Russian co-workers began downing vodka or cognac as soon as they awakened. The inevitable toasts led to much merriment and at times drunkenness. In one such party I was sitting next to the chief coroner of Moscow. She had become quite inebriated. I jokingly asked, “I assume since you have solved the alcohol problem, you no longer obtain any blood alcohol levels during autopsies?” She responded that this practice continued, and presented the astounding figure that 70 percent of the victims of sudden cardiac death had toxic blood alcohol levels.

These remembrances of early experiences would be incomplete without mentioning my meeting with Dr. James Muller in Moscow. This occurred in the spring of 1975, during one of my junkets on behalf of our collaborative work on sudden death. Jim later became a critically important member of the small group that helped me launch IPPNW. He had rounded on my service at the Peter Bent Brigham Hospital. At the time he projected an image of youthful idealism, guided by an ambitious intelligence and an immense talent as an organizer. It was evident that bedside medicine was a stepping-stone to an academic career in research. He did well by associating closely with a distinguished professor of medicine at Harvard, Dr. Eugene Braunwald, who was one of the world’s leading cardiovascular investigators.

Their research needed patients at the very onset of a heart attack. Jim, then a postdoctoral fellow with Braunwald, had the bright notion of doing a collaborative project with Soviet cardiologists. Russia offered a number of advantages. Their remarkably well-organized centralized medical emergency system quickly transported heart attack victims to several large city hospitals.

Jim was eminently suited to direct the investigative studies in Russia. As an undergraduate student at Notre Dame University he had mastered the Russian language. In 1968 Jim spent five months of his junior year in Moscow as the first American medical student to participate in an official student exchange program. Two years later when a US government health delegation to the USSR needed a translator, Jim, then a public health service officer, was chosen. He accompanied HEW’s assistant secretary to the Black Sea for talks with the Soviet health minister. Jim told me proudly that while working as an interpreter he drafted some of the key documents to promote medical exchange. This was the very agreement that had enabled me to travel to Moscow for that fateful consultation.

When I met Jim in Moscow, he had been pursuing his study in a number of Moscow hospitals. Overcoming a bureaucracy impenetrable for most other foreigners, Jim arranged the seemingly impossible collaboration in record time. He was able to recruit more subjects in a week than was possible at the Brigham Hospital in several months. Yet he did not appear content. On the contrary he had lost twenty pounds and was suffering from a bleeding peptic ulcer. He acknowledged it was due to a stressful situation.

The stress resulted when Peter Osnos, a correspondent for the Washington Post, reported on his project. Jim had arranged for the publicity in order to promote the joint endeavor. The article praised Jim for innovative research that transcended national borders and credited him with adhering to the highest ideals of the medical profession. The report maintained that the findings were likely to save both American and Russian lives.

One paragraph in the article upset the apple cart. When Jim was asked why he had to travel five thousand miles to carry out investigations on a commonplace problem, he was quoted as saying that Russians had a different regard for human life. They permitted investigations that were difficult, if not impossible, to conduct in the States because of our humanitarian standards and our respect for individual patients’ rights. When the Russian physicians learned about the Washington Post article, they halted the project and wanted to expel Jim. Chazov, who had been a staunch supporter, was no longer friendly. Doctors at his hospital were enraged.

Jim protested vehemently that he had been misquoted, that he would never say something so stupid. I asked how well he knew the correspondent who had written the article. Jim said that he did not know him well and should not have trusted him with an interview, knowing from past experience how ready the press was to fuel the Cold War.

Jim wanted me to convince Chazov that the uproar was due to a misunderstanding, that he had been misquoted and that he was not anti-Soviet. On the contrary his life’s work was to promote friendship between our two peoples. Jim, of course, was aware of my long relationship with Chazov.

When I spoke to Chazov the next day, he intimated that the interview in the Washington Post was a carefully orchestrated provocation. When I asked who had orchestrated it, Chazov shrugged. He refused to provide any enlightenment and suggested that there was more than met the “naive eye.”

The Russians did not force Jim to leave. They took his automobile away for several days as a warning. For me this was an alert that stood me in good stead in the difficult IPPNW days ahead. It taught me that the medical profession was not exempt from being a battleground in the intense life-and-death struggles of the Cold War.

The six trips to the Soviet Union offered an education that no academic study could have provided. One could not spend extended time in the USSR without growing aware of the colossal devastation to the body and soul of the Russian people by the German Nazis. The nation had come close to extinction. The events of 9/11 were monumentally consequential for the United States. During WWII, the Soviets experienced the equivalent in casualties and destruction of ten thousand World Trade Center attacks.

That Russia survived is a testament to the unmatched fortitude and heroism of its long-suffering people. WWII brought the people together and gave Soviet power some legitimacy. Another legacy of the so-called Great Patriotic War was that much of the Russian industrial machine was integrated into a vast military complex. Technological innovations and social productivity were based on a massive, all-pervasive military-industrial complex. This complex made the clocks run, enabled the system to function, and required the Cold War as its justification.

Many enterprises were in secret cities, off limits to foreigners. If the Russians could not equal us in economic and social development, they could equal us in the destructiveness wrought by awesome military power largely based on thermonuclear weapons. Possessing nuclear overkill affirmed their status as a global superpower.

My journeys to the Soviet Union convinced me that Russians were in for a substantial transformation of their social order in the foreseeable future. The seeming stability of their system was a mythical product of the Cold War, promoted as much by us as by them. I based this conclusion on the profound restlessness of the younger generation of Russians I was encountering, who were its future leaders.

Many recognized the deep malady in their system. Their ideas were molded by increasing contact with western views, interaction with growing numbers of visitors, and most importantly by travel abroad. What they witnessed at first hand did not jibe with the drumbeat of propaganda about the superiority of the Soviet system.

Many were proficient in foreign languages, especially English, and the BBC was an important source of provocative information. Some younger people were embarrassed and even angered by having to dissimulate and lie to save face. (“Oh yes, we have had this same technology in the USSR for some years.”) Their system was a continuation of czarism, imperfectly concealed by the socialist sloganeering of a more equitable social order than that existing in the capitalist world encircling them. But there was nothing remotely socialist about their values or practices.

I did not believe the transition would be peaceful. Given the Russian nuclear might, I was worried that if cornered they were capable of a Sampson-like biblical act to pull the temple down with them. Like others, I could not foresee the emergence of a Gorbachev.