Nazi medicine ethics

[Guest guest]

Hi All,

I remember earlier posts about Nazi experiments being used in North American

medical

school anatomy books. Further perspective may be the below.

Lancet, 366, Iss 9488, Sept 3-9 2005,

Nazi medicine and the ethics of human research

Neuberger

Available online 1 September 2005.

On July 28, 2005, a moving memorial service was held at Westminster Abbey,

London,

UK, for the former British prime minister Lord Callaghan (Jim Callaghan) and his

wife Audrey. Their son-in-law, professor Adler, spoke of Callaghan's

outrage

at the Nazi atrocities carried out against the Jews before and during World War

II.

He had met, in the immediate aftermath of the war, a refugee journalist, Alfred

Wiener, who had amassed a huge collection of material about Nazi anti-Semitic

persecution, and argued that it needed to be stored as evidence of what had

transpired. Much was used at the Nuremberg trials, and Callaghan later

successfully

chaired the appeal for the Wiener Library in London, to ensure it a permanent

home.

However, even to this day, much evidence lies in the minds of survivors of the

most

barbaric medical experiments in the concentration camps. “Survivors of medical

atrocities are able to confront history and point to the inadequacies of care

and

compensation”, according to Weindling in the introduction to his masterly

volume, Nazi Medicine and the Nuremberg Trials. Although most victims were

murdered

in the name of perverted science, those who survive can make sure that what took

place is fully recorded, as can the historians of medicine who work in this

area,

such as J Lifton, Weindling, Pellegrino, and now Naomi

Baumslag,

with her new book, Murderous Medicine: Nazi Doctors, Human Experimentation and

Typhus.

Baumslag explores in impressive detail how typhus was characterised by Nazis as

the

Jewish plague. Those who suffered from it were killed in huge numbers or

isolated in

unsanitary conditions, with inadequate food and medicine. In the concentration

camps, typhus was allowed to flourish and prisoners were deliberately infected

with

the disease to test typhus vaccines.

The way typhus was used to kill Jews, Slavs, and gypsies epitomises Nazi

medicine's

deliberate disregard of those who took part in research, classing them as

subhuman.

Such thinking was wholly in accordance with Nazi ideology, but in total

contradiction of medical ethics. There are accounts from survivors that even

suggest

some doctors' positive delight in killing and maiming, and a desire to

experiment on

some of the victims to prepare for genocide. Weindling is particularly effective

in

nailing down the views of the postwar German medical establishment. He describes

as

a monster Eugen Haagen, who did experiments with a typhus vaccine that caused

damage

and frequent death to prisoners at Natzweiler concentration camp. Haagen's lack

of

concern for his research subjects was legendary. Yet Haagen, arrested and

released

by the Americans and then by the French, argued that he should have received the

Nobel prize (he had developed a yellow fever vaccine before the war), and that

his

“guineapigs”, including the hundreds transported from Auschwitz to Natzweiler

for

his research, served legitimate scientific ends.

Haagen's belief that anything was legitimate if it advanced scientific knowledge

was

all part of his and others' blindness to their own immoral behaviour and wilful

disregard for human life. The simple fact remains that doctors were easily

recruited, including from the highest echelons of German academic medicine, to

carry

out unspeakable trials and to injure, maim, sterilise, and kill other human

beings.

When it came to the Nuremberg trials, physicians argued that it was not their

fault,

since they had received their orders from on high, and that treating them as war

criminals would be disastrous for the reputation of medical research and

science,

especially as what they had done was in fact useful. Nor were other countries

immune

from morally questionable behaviour.

One telling example is that of Janet Vaughan, a haematologist who led the

Medical

Research Council's (MRC) team at Belsen in the immediate aftermath of the war,

and

whose work Weindling describes in an earlier book, Epidemics and Genocide in

Eastern

Europe (2000). The MRC wanted to experiment with Amigen, an American enzyme

product,

and with an “intravenous hydrolosyte”. Vaughan recorded that the research

terrified

patients, who believed they were about to receive a fatal injection. “When we

went

up to our patients with a stomach tube they would curl themselves up and say

‘nicht

crematorium’.” She soon realised that what these survivors needed was proper

care

and nursing. With hindsight, this is blindingly obvious. The research soon

ceased,

but one still cannot help wondering why the research personnel did not spend

their

time more humanely. Weindling notes that the camp became a sort of experimental

station for nutritionists studying starvation and the US Typhus Commission,

which

did chemotherapeutic and clinical studies in the US liberated camps.

Meanwhile, the Allies were concerned that the Nuremberg Trials should not

undermine

public confidence in medical science. Lord Moran, sent by Clem Attlee to look at

German human medical experiments, argued that the state, not the individual, was

the

main culprit of this unethical research. Mellanby, a medical

entomologist

who persuaded the British Medical Journal to designate him as its official

correspondent at Nuremberg, argued that “the victims were dead; if their

sufferings

could in any way add to medical knowledge and help others, surely this would be

something that they themselves would have preferred” (Human Guinea Pigs, 1945).

How

could he know?

Yet scientists continued to do terrible things in the name of research, although

on

nothing like such a scale. In 1966, Henry Beecher, professor of anaesthesiology

at

Harvard, published “Ethics and Clinical Research” in The New England Journal of

Medicine, and drew attention to 22 examples of unethical clinical research in

which

patients' lives had been put at risk. These trials included the Tuskegee

syphilis

experiments and other studies in which prisoners and those who were not free to

choose or give consent were experimented upon to their detriment. Soon after

Beecher's paper, Maurice Pappworth's Human Guinea Pigs: Experimentation on Man

(1967) was published. Pappworth's contention that research which put patients at

risk was not uncommon in the UK made him unpopular in medical circles; he did

not

get his Fellowship of the Royal College of Physicians until shortly before he

died.

This work by Beecher and Pappworth came out in the wake of a series of

revelations

about Nazi medical war crimes. But unethical trials have taken place since then.

Today, concern is expressed about research on children and those with mental

illness

or dementia and the extent to which they can—or should—give consent. Can

advanced

directives be used to allow researchers to conduct studies when the person is

unable

to give consent at the time it is needed? Despite the fact that nothing so

terrible

occurs now as it did in Nazi Germany, lessons still remain to be learned and

inwardly digested—of seeking informed consent, telling the patient what emerges

from

a study, and seeing the patient as a partner in a trial, not a subject to be

used.

With all our ethical guidelines and research ethics committees, good as they

are, we

still have a long way to go.

n Weindling, Nazi Medicine and the Nuremberg Trials: From Medical War

Crimes to Informed Consent, Palgrave (2004) ISBN 1-403-93911-X Pp 496. £60·00.

Naomi Baumslag, Murderous Medicine: Nazi Doctors, Human Experimentation, and

Typhus,

Praeger Publishers (2005) ISBN 0-275-98312-9 Pp 304. $49·95.

Al Pater, PhD; email: old542000@...

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