If the guy is only crazy and not stupid, he might think in terms of the fallout that would be carried to his own shores. While it's unlikely there would be any direct measurable effect in lives lost, us baby boomers got a s---load of radiation from the various tests back in the 50s/60s. While no single case of cancer is likely to be ascribed to those tests, the epidemiologists probably have a pretty good idea how many of us will have a shortened FIRE (or none at all) due to that time period. There's some anecdotal evidence that John Wayne and many of the cast and crew of the movie THE CONQUERER received significant radiation by filming downwind of the test site in SE NV. It's certainly one of the trade-offs one would need to consider before going all out in a first strike attack. Of course, YMMV.