Matthew Kroenig's argument for preventive military action to combat Tehran's nuclear program -- "Time to Attack Iran" (January/February 2012) -- suffers from three problems. First, its view of Iranian leaders' risk calculations is self-contradictory. Second, it misreads nuclear history. And third, it underestimates the United States' ability to contain a nuclear Iran. When these problems are addressed, it is clear that, contrary to what Kroenig contends, attacking Iran is not "the least bad option." 

Kroenig's view of the way Iranian leaders are willing to take on risks is deeply incongruous. In his view, a nuclear bomb will push Tehran to block U.S. initiatives in the Middle East, unleash conventional and terrorist aggression on U.S. forces and allies, and possibly engage in a nuclear exchange with Israel. This would mean Iranian leaders are reckless: given the United States' conventional and nuclear superiority, any of these actions would provoke considerable retaliation from Washington. And, of course, a nuclear exchange with Israel would invite annihilation. At the same time, Kroenig suggests that Tehran would remain remarkably timid after a preventive strike from the United States. Presented with clear redlines, Iran would not retaliate against U.S. troops and allies or attempt to close the Strait of Hormuz. Kroenig's inconsistency is clear: If Iranian leaders are as reckless as he seems to believe, a preventive strike would likely escalate to a full-blown war. If they are not, then there is no reason to think that a nuclear Iran would be uncontainable. In short, a preventive attack on Iran can hardly be both limited and necessary.

Kroenig's argument misreads nuclear history at least three times. First, he writes that a targeted preventive strike would likely wipe out the nuclear program in Iran, as strikes against Iraq in 1981 and Syria in 2007 did in those countries. These comparisons are misleading. Recent research based on captured Iraqi documents demonstrates that the 1981 Israeli attack on the Osirak reactor, near Baghdad, actually spurred a covert nuclear weapons program at other sites. Indeed, Iraqi President Saddam Hussein remained determined to revive his nuclear program until he was removed from power in 2003. What prevented him from achieving that goal was the decade-long U.S.-led containment regime put in place after the 1991 Gulf War. The Iraqi case suggests that any attacks that do not depose the Iranian regime, too, would cause it to accelerate its efforts to acquire nuclear weapons. Kroenig's prescription might therefore precipitate the very outcome he is trying to avoid. 

As for Syria, Damascus' nuclear program was just budding. The country boasted only one exploratory facility, which was shattered easily by a single aerial bombing carried out by Israel in September 2007 under the cloak of night. But Iran's nuclear program is much more advanced and is already of industrial proportions. Any attack on Tehran would involve destroying numerous nuclear-program and air-defense targets, making it far more costly and less likely to succeed than the Israeli raid against Syria's Deir ez-Zor reactor. More, Iran's advanced program reflects Tehran's greater resolve to develop nuclear capabilities, so, post-attack, Tehran would be ever more likely to double down on developing a weapon. Furthermore, although Kroenig hopes that a targeted strike would destabilize the Iranian regime, there is no basis for such optimism. Being a civilian, parliamentary, oil-rich theocracy, Iran is relatively stable. Put simply, a preventive strike against Iran can hardly be both limited and effective.

Kroenig misreads history again when he considers a nuclear exchange between Iran and Israel. In his view, they "lack nearly all the safeguards that helped the United States and the Soviet Union avoid a nuclear exchange during the Cold War." Yet the United States and the Soviet Union avoided a nuclear exchange even during the hottest crisis of the Cold War, the Cuban Missile Crisis, at a moment in which Soviet retaliatory capability was still uncertain, there were no clear direct communication channels between the two leaderships, and Soviet experience managing their nuclear arsenal was no longer than five years. Moreover, the historical record shows that even young and unstable nuclear powers have avoided nuclear escalation despite acute crises. Pakistan and India avoided nuclear war in Kargil in 1999, as well as after the terrorist attacks targeting the Indian parliament in 2001 and Mumbai in 2008. When national survival is at stake, even opaque and supposedly "irrational" regimes with nuclear weapons have historically behaved in prudent ways.

Kroenig's final abuse of history comes when he posits a cascade of nuclear proliferation across the Middle East in response to an Iranian bomb. He mentions Saudi Arabia, and implies that Egypt, Iraq, and Turkey might all follow suit. Yet none of these states, which can count on U.S. support against Iran, nuclearized in response to Israel's nuclearization (against which they cannot count on U.S. backing, mind you). And more generally, the United States has a successful record of preventing clients from acquiring nuclear weapons in response to a regional enemy, such as South Korea and Japan in response to North Korean nuclear acquisition. (Washington agreed with Pakistani nuclearization in response to India.) 

Taking the long view, Kroenig's argument reveals an unwarranted skepticism about Washington's ability to contain a nuclear Iran. This skepticism is all the more surprising considering Kroenig's work on the benefits of U.S. nuclear superiority. Existing U.S. security guarantees, based on current capabilities, give allies little incentive to nuclearize. Egypt and Saudi Arabia are among the largest recipients of U.S. military support, and Turkey is a member of NATO. Reinforcing U.S. ties with friends in the region would be easier, cheaper, and less risky than attacking the Iranian nuclear program. 

Instead, the United States should heed the lessons of the North Korean nuclearization. Not so long ago, Washington had to face an aggressive regime in Pyongyang intent on developing nuclear weapons. The United States rejected a preventive strike in 1994 for fear that the outcome would be worse than its target's nuclear acquisition. This was the right decision. After North Korea acquired nuclear weapons, none of the consequences that Kroenig's argument would predict materialized. U.S. security guarantees contained Pyongyang and persuaded South Korea and Japan not to acquire nuclear weapons. Nobody believes that the world is better off with a bomb in North Korea -- but the record shows that it hasn't brought the end of the world, either.

Military action against Iran would be a profound strategic miscalculation. For all the talk of retrenchment, the U.S. military might remains the most powerful in the world, and it can successfully minimize consequences of an Iranian bomb, should one come to pass, by containing Tehran's ambitions, dissuading regional proliferation, and providing security assurances to its allies.

OVER the last three years, as I delved into the world of American nuclear weapons, I felt increasingly as though I had stepped into a time warp. Despite the nearly total rearrangement of the international security landscape since the demise of the Soviet Union in 1991, the rise of Islamic terrorism and the spread of nuclear materials and technology to volatile nations like Pakistan, North Korea and Iran, the Defense Department remains enthralled by cold war nuclear strategies and practices.

Barack Obama took office determined to change that. He has made progress on many fronts. Last week, he outlined a new, no-frills defense strategy, downsizing conventional forces. He now needs to double down on his commitment to refashion nuclear forces. He should trim the American nuclear arsenal by two-thirds to bring it down to a sensible size, order the Pentagon to scale back nuclear war-fighting plans so they are relevant to contemporary threats, remove most American intercontinental, land-based missiles from high alert and drop the quaint notion that a fleet of aging B-52 bombers can effectively deliver nuclear weapons to distant targets.

This agenda is not only desirable, it is doable without undercutting American security. It would save tens of billions of dollars a year, a relatively small amount by Pentagon standards, but every billion counts as Leon E. Panetta, the defense secretary, trims his budget. And the steps can safely be taken without requiring reciprocal moves by Russia that must be codified in a treaty.

For the last few months, the Obama administration has been conducting a classified review of the doctrines and operations that determine the shape and potential uses of America’s nuclear armaments. If the president pushes back against the defenders of the old order at the Pentagon and other redoubts of the nuclear priesthood, he can preserve American security while making the United States a more credible leader on one of today’s most critical issues — containing the spread of nuclear weapons. Like a chain smoker asking others to give up cigarettes, the United States, with its bloated arsenal, sounds hypocritical when it puts pressure on other nations to cut weapons and stop producing bomb-grade highly enriched uranium, the key ingredient of a crude nuclear weapon.

American actions alone won’t end the proliferation danger, but American leadership is essential to any hope of containing the threat.

Sam Nunn, the former chairman of the Senate Armed Services Committee, and anything but a dove over the years, rightly warns that the spread of weapons and the means to make them may soon reach a combustible stage where New York, Washington, Moscow, Tokyo or London is at risk of a nuclear terrorist attack.

Mr. Nunn and other keepers of America’s cold-war armory, George P. Shultz and Henry A. Kissinger, former Republican secretaries of state, and William J. Perry, a former Democratic defense secretary, have banded together in recent years to press, among other things, for cutting nuclear forces, de-alerting missiles and, ultimately, eliminating nuclear arms. Mr. Obama has embraced their aims and welcomed them to the Oval Office. Their high-powered, bipartisan alliance, if adroitly employed by the White House, ought to provide some political cover as Mr. Obama reshapes nuclear policy while running for a second term.

There is no national security rationale for maintaining an arsenal of some 5,000 warheads, with nearly 2,000 arms ready to use on short notice and the rest in reserve. We don’t need thousands of warheads, or even hundreds, to counter threats from countries like Iran or North Korea.

The only conceivable use of so many weapons would be a full-scale nuclear war with Russia, which has more warheads than the United States. But two decades after the collapse of the Soviet Union, even Vladimir V. Putin, with his authoritarian bent, is not about to put Russia on a collision course with the United States that leads to nuclear war. China, equally unlikely to escalate tensions to the nuclear brink, probably has fewer than 400 warheads and a policy to use them only in self-defense. Pakistan has roughly 100, North Korea fewer than 10 and Iran, so far, zero.

The United States could live quite securely with fewer than 1,500 warheads, half in reserve. Defenders of the nuclear faith claim we need 5,000 weapons as a hedge against warheads that may become defective over time. But an elaborate Energy Department program to maintain and refurbish warheads, the Stockpile Stewardship Program, has proved highly effective.

Another oft-cited reason for increasing our arsenal is that the Pentagon’s nuclear war-fighting plans still call for striking hundreds of targets in Russia and China, as well as dozens of sites in a number of other publicly unidentified nations — presumably Iran, North Korea and Syria — considered potentially hostile to the United States and eager to possess unconventional weapons.

Washington’s current nuclear war plans remain far too outsize to deal with any plausible attack on America. Mr. Obama could remove some nations from the hit list, starting with China, and tell his generals to limit the number of targets in the countries that remain.

The oversize American nuclear arsenal features an equally outdated reliance on long-distance bombers. The days when lumbering B-52 bombers could play a central role in delivering nuclear weapons — memorably spoofed in Stanley Kubrick’s “Dr. Strangelove” — ended decades ago. Mr. Obama should ground the bombers and depend on land- and sea-based missiles.

The high-alert status of America’s intercontinental ballistic missiles is another anachronism. There are few circumstances that might require the United States to quickly launch nuclear-tipped missiles, and missiles on high alert are an invitation to an accident, or impulsive action. In the first year of his presidency, Mr. Obama outlined an ambitious nuclear weapons agenda. Absent new action, Washington will remain frozen in a costly cold war posture.

Philip Taubman is a former New York Times bureau chief in Moscow and Washington and the author of “The Partnership: Five Cold Warriors and Their Quest to Ban the Bomb.”

Political and economic transition is often blamed for Russia’s 40% surge in deaths between 1990 and 1994. Highlighting that increases in mortality occurred primarily among alcohol-related causes and among working-age men (the heaviest drinkers), this paper investigates an alternative explanation: the demise of the 1985-1988 Gorbachev Anti-Alcohol Campaign. Using archival sources to build a new oblast-year data set spanning 1978-2000, we find a variety of evidence suggesting that the campaign’s end explains a large share of the mortality crisis – implying that Russia’s transition to capitalism and democracy was not as lethal as commonly suggested.

Abstract

BACKGROUND:

Injection drug use (IDU) and heterosexual virus transmission both contribute to the growing mixed HIV epidemics in Eastern Europe and Central Asia. In Ukraine-chosen in this study as a representative country-IDU-related risk behaviors cause half of new infections, but few injection drug users (IDUs) receive methadone substitution therapy. Only 10% of eligible individuals receive antiretroviral therapy (ART). The appropriate resource allocation between these programs has not been studied. We estimated the effectiveness and cost-effectiveness of strategies for expanding methadone substitution therapy programs and ART in mixed HIV epidemics, using Ukraine as a case study.

METHODS AND FINDINGS:

We developed a dynamic compartmental model of the HIV epidemic in a population of non-IDUs, IDUs using opiates, and IDUs on methadone substitution therapy, stratified by HIV status, and populated it with data from the Ukraine. We considered interventions expanding methadone substitution therapy, increasing access to ART, or both. We measured health care costs, quality-adjusted life years (QALYs), HIV prevalence, infections averted, and incremental cost-effectiveness. Without incremental interventions, HIV prevalence reached 67.2% (IDUs) and 0.88% (non-IDUs) after 20 years. Offering methadone substitution therapy to 25% of IDUs reduced prevalence most effectively (to 53.1% IDUs, 0.80% non-IDUs), and was most cost-effective, averting 4,700 infections and adding 76,000 QALYs compared with no intervention at US$530/QALY gained. Expanding both ART (80% coverage of those eligible for ART according to WHO criteria) and methadone substitution therapy (25% coverage) was the next most cost-effective strategy, adding 105,000 QALYs at US$1,120/QALY gained versus the methadone substitution therapy-only strategy and averting 8,300 infections versus no intervention. Expanding only ART (80% coverage) added 38,000 QALYs at US$2,240/QALY gained versus the methadone substitution therapy-only strategy, and averted 4,080 infections versus no intervention. Offering ART to 80% of non-IDUs eligible for treatment by WHO criteria, but only 10% of IDUs, averted only 1,800 infections versus no intervention and was not cost effective.

CONCLUSIONS:

Methadone substitution therapy is a highly cost-effective option for the growing mixed HIV epidemic in Ukraine. A strategy that expands both methadone substitution therapy and ART to high levels is the most effective intervention, and is very cost effective by WHO criteria. When expanding ART, access to methadone substitution therapy provides additional benefit in infections averted. Our findings are potentially relevant to other settings with mixed HIV epidemics. Please see later in the article for the Editors' Summary.