On Psychological Coping

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MacLeod and Maxwell indirectly raise the fundamental ... Maxwell C:Hospital organizational re- sponse to the ... Samuel Ingraham led a PHS team which, inĀ ...
LETTERS TO THE EDITOR

ar power is neither cost-effective nor cost-beneficial now or in the future. MacLeod and Maxwell indirectly raise the fundamental question of whether we should allow any nuclear power plants in the country at all. A valid role for public health in the nuclear age is to question the value of nuclear power. Michael L. Kenney, MPH, MCP 3040 Smyth Road Apt. 20 Berkeley, CA 94720

REFERENCES 1. MacLeod GK: A role for public health in the nuclear age. (editorial) Am J Public Health 1982; 72:237-239. 2. Maxwell C: Hospital organizational response to the nuclear accident at Three Mile Island: implications for future-ofiented disaster planning. Am J Public Health 1982; 72:275-279. 3. State of California, Government Code,

Chapter 956, Section 8610.5, enacted 1979.

patients from nine health care facilities were evacuated, serves to illustrate this point.3 Mr. Kenney's focus of concern upon the disposal of nuclear waste is shared by all of us, but he would deny us the opportunity to enjoy the fruits of an energy rich society if and when we devise a system to dispose of nuclear wastes safely. Gordon K. MacLeod, MD Professor and Chairman Department of Health Services Administration University of Pittsburgh Graduate School of Public Health Pittsburgh, PA 15261 and Christopher Maxwell, BA, RRT Director, Respiratory Therapy Community General Osteopathic Hospital Harrisburg, PA 17105

REFERENCES

Response by MacLeod And Maxwell While we agree that Mr. Kenney's concerns for the public health cost of modern disaster planning are valid, they are somewhat flawed by an honest expression of bias. His concern is limited to nuclear disasters, whereas ours continues to include other disasters as implied in the opening paragraph of MacLeod's editorial' and mentioned in the summary of Maxwel!'s paper.2 Unfortunately, Mr. Kenney does not address the larger issue of charging individuals as well as offending agencies for public health costs other than for nuclear power. A consistent logic would suggest that those who refuse immunization against polio, for example, should pay for the transmission of that disease and its subsequent costs as in the case of previous outbreaks among Christian Scientists and the Amish. Hospitals, as well as other agencies, institutions, and communities need to explore disaster planning further. In particular, hospitals should be prepared to evacuate as well as to receive patients during an area-wide emergency. The November 1979 chemical disaster at Mississauga, Canada, in which 240,000 citizens including 2,059 AJPH August 1982, Vol. 72, No. 8

1. MacLeod GK: A role for public health in the nuclear age. (editorial) Am J Public Health 1982; 72:237-239. 2. Maxwell C: Hospital organizational response to the nuclear accident at Three

Mile Island: implications for future-oriented disaster planning. Am J Public Health 1982: 72:275-279. 3. Report on Mississauga Train Derailment and Evacuation. Emergency Planning Canada (Ontario), 1979.

The Plane Left 20 Years Ago In the March issue of the Journal, Dr. MacLeod stated that "some 25 years ago, Americans enthusiastically welcomed the nation's commitment to nuclear energy . . . we assumed that nuclear energy was safe." For the record, a few public health figures had their doubts. Under direction of Mark D. Hollis and M. Allen Pond in 1951, the US Public Health Service produced a book on environmental health which warned against rising levels of radioactivity. Next, Dr. Samuel Ingraham led a PHS team which, in 1954, published "Concepts of Radiological Health," a thin paperback classic which PHS allowed to perish almost without obituary notice. Because of the demand for such basic information, an APHA commission

headed by Dr. Daniel Bergsma produced a popular pamphlet with the message that all unnecessary exposure to radiation should be avoided. The American Journal of Public Health also published several editorials calling for safeguards against radiation. But the pamphlet Bergsma produced was replaced quickly by one approved by the US Atomic Energy Commission. The few who deplored the hazards of nuclear reactors could not compete with the political, military, and economic interests that had something less than public health in mind. Even at Oak Ridge, Tennessee, K. Z. Morgan fought vainly to set up a controlling authority over the haphazard methods of shipping radioactive materials. Now in 1982, all life on earth is at risk of nuclear weapons because these early Cassandras were disregarded. Now, as in the past, the threat of nuclear forces calls for something more than restrictinTg x-rays of expectant mothers or monitoring emissions from nuclear stacks. PHS did its bit by discouraging use of x-rays in shoe-fitting machines. APHA now worries about clinics in communities downstream from nuclear power plants. Public health officials have left to volunteer outfits like Physicians for Social Responsibility the duty to zero in on the basic challenge: the production and deployment of nuclear weapons. It can't hurt others to speak out against the prospect of a limited nuclear war or the dubious advantage of a first strike: they have nothing to lose but everything. Marcus M. Rosenblum 1707 Flower Drive Sarasota, FL 33579

On Psychological Intervention and Patients' Coping Both the Westermeyer editorial' and the Mumford article2 in the February Journal endorse expanding programs to assist hospital patients with coping skills. It has long been recognized that patients who received needed counseling and/or education realized enhanced satisfaction and compliance. The article raises two important issues. The 857