Human Subject Experimentation
The Nazis
Lessons for Contemporary Research
The Role of the Physician in Society
Martin Donohoe
“When a doctor [goes] wrong, he is the first of criminals. He has nerve and he has knowledge.”
- Sherlock Holmes to Dr. Watson, Arthur Conan Doyle
Nazi Medicine
• Guiding philosophy = Hegelian (rational utility)
• Social Darwinism - parallels in American and British Eugenics Movement– medical journals relatively silent
• Ethics reduces morality to efficiency, economics, and aesthetics
Nazi Medicine
• An arm of state policy
• Focus on racial purity– from eugenic sterilization (370,000)– to involuntary euthanasia (70,000)– to large-scale genocide (over 6 million)
Nazi Medicine
• Individual worth stated in economic terms; propaganda re obligations to the state
– “I Accuse”
– “Mathematics in the Service of Political Education”
Nazi Medicine
• Doctoring the nation more important than doctoring individuals - Nazism as “applied biology” (Rudolph Hess)
• Focus on preventive medicine and public health: anti-tobacco and anti-alcohol campaigns, environmental toxins, organic farming -to improve Aryan stock
• Nazi soldiers given anabolic steroids to increase aggresiveness
Nazi Physicians
• 52,000 physicians
• National Socialist Party Members
• Jews ostracized; replaced by young Aryans– today 0.2% of German physicians are Jews, c/w
17% pre-Nazis– 5% of non-Aryans committed suicide; 25%
murdered
Nazi Physicians
• Economic hard times, physicians salaries rise, academic perks
• Blutkitt (“blood cement”)
• Rare resistance – Catholics– Marxists– Dutch
Nazi “Physician-Researchers”(Torturers)
• Dr. Sigmund Rascher - coagulation/amputation studies; hypothermia experiments
• Dr. Karl Gebhart: heteroplastic transplantation experiments– c.f. Stalin’s attempts to create interspecies
(half-men/half-apes) “super-warriors”
• Drs. Karl Clausberg and Viktor Brack: X-irradiation/sterilization
Nazi “Physician-Researchers”
• Drs. Joachim Mrugowsky, Erwin Ding-Schuler, and Waldemar Hoven: IV phenol and gasoline executions
• Dr. Joseph Mengele: Septicemia/twin vivisection studies
• Dr. Hans Eppinger - “father of modern hepatology”
“Indirect Participants”
• Prof. J Hallevorden: “Look here now, boys, if you are going to kill all these people at least take the brains out so that the material could be utilized … the more (brains) the better….I accepted these brains of course. Where they came from and how they came to me was really none of my business.”
Doctors and Resistance
• German invasion of Poland (1939)• Drs Eugene Lazowski and Stanislaw
Matulewicz created a fake typhus epidemic, using a harmless bacterium to innoculate non-Jews, knowing that infected Jews would be summarily executed
• Germans fooled, quarantined area, many Jews escaped death
Nuremberg Doctors’ Trial
• 23 German physicians tried
• 16 found guilty– 7 hanged (incl. Gebhardt, Brack, Hoven, and
Mrugowsky)
• Rascher died before trial; Mengele fled for Argentina (remains verified 1985); Hallevorden committed suicide before trial
Nuremberg Code
• Voluntary consent is absolutely essential
• Avoidance of unnecessary physical and mental suffering
• Option to quit/responsibility to terminate
• Other safeguards
Declaration of Geneva
• “I will not permit considerations of religion, nationality, race, party politics or social standing to intervene between my duty and my patient”
• “I will not use my medical knowledge contrary to the laws of humanity.”
• “It is unethical for physicians to employ scientific knowledge to imperil health or destroy life.”
Post-WW II
• Over 700 Nazi rocket scientists and their families brought to the U.S. (including Werner von Braun) to help build nuclear missile program– Operation Paperclip
• Japanese scientists brought to Fort Detrick, MD, to help establish U.S. biological/chemical weapons program
Post-WW II Human Subject Experimentation
• Tuskegee Syphilis Study
• Willowbrook Hepatitis Experiments
• Henry Beecher
• U.S. govt.-sponsored radiation expts.
Post-WW II Human Subject Experimentation
• Ongoing sterilization programs– WI, NJ, CA, IN, OR, others– Alabama’s Governor Graves vetoed law
in 1930s law citing “hazard to personal rights
– Oregon governor Kitzhaber apologized in 2002 for the over 2500 state-forced sterilizations that occurred between 1917 and 1983
Post-WW II Human Subject Experimentation
• Elementary school race experiment (good or bad?)
• Milgram’s obedience studies
• Soviet psychiatry
• US military/pharmaceutical vaccine and medication trials in the developing world
Research on Prisoners
• 1905: cholera experiments on “volunteers”
• 1915: Joseph Goldberger – pellagra studies
– Parole in exchange for participation
• WW II: gonorrhea, gas gangrene, dengue fever, malaria
Research on Prisoners
• >90% of pharmaceutical industry research in early 1970s
• Rapidly curtailed by state/federal laws and new university regulations
• 2006: IOM approves with safeguards
Contemporary Issues and Ethical Dilemmas
• 90% of research dollars spent on diseases affecting 10% of the world’s population
• Research on special populations (cultural minorities, prisoners, developing world, etc.)
• Role of institutional and for-profit IRBs• Use of placebo controls
Contemporary Issues and Ethical Dilemmas
• Uninsured become research subjects to receive needed care
• Informed consent for treatment – physician/patient negotiation vs. unilateral decision-making when treatment options limited
• 2003: NAS advisory panel considering ban on industry experiments testing safety of pesticides/other potentially toxic chemicals in humans
What to do with data acquired via unethical means?
• Eduard Pernkopf’s Atlas; Dachau Hypothermia Experiments; Phosgene gas experiments; biological weapons data (offensive vs. defensive)
• Japan’s Unit 731 and biological warfare experiments
What to do with data acquired via unethical means?
• Move to rename “Hallevordan-Spatz syndrome”: “pantothenate kinase-associated degeneration” or “neurodegeneration with brain iron accumulation”
• Breast cancer cure scenario
Ethical Perspectives on Scientific Research and War
• Denial of moral responsibility for consequences
• Recognition of moral responsibility but competing obligations
• Recognition of moral responsibility and refusal to participate
• Responsibility to inform or lead public opinion
Scientists and War Research
• Archimedes, da Vinci, Galileo, Haber, Fieser
• Farraday
• Nobel, Einstein, Szilard
Doctors as Terrorists
• George Habas – founder of Popular Front for the Liberation of Palestine– Behind aircraft hijackings of Black September
• Mohammed al-Hindi – founder of Islamic Jihad
• Ayman Al-Zawahiri - #2 in Al Qaeda
Doctors as Terrorists
• Ikuo Hayashi – chief of circulatory medicine at a leading Japanese hospital– Pleaded guilty to planting sarin gas on Tokyo
subway
• Radovan Karadzic (psychiatrist)
Primo Levi
“A country is considered the more civilized the more the wisdom and efficiency of its laws hinder a weak man from becoming too weak or a powerful one too powerful.”
(US – largest maldistribution of wealth of any industrialized country)
The role of the doctor in society
• Public health versus individual health
• Roles, responsibilities, and obligations– patients– society– institutions– families– government– world
The role of the doctor in society
• Theodore Billroth:
– “If the whole of Social Medicine needs to be part of the curriculum of the medical student, it must not take more than two hours per semester … during the last two semesters; otherwise, it will surely be detrimental to his other studies”
The role of the doctor in society
• Rudolph Virchow:
– “Doctors are natural attorneys for the poor … If medicine is to really accomplish its great task, it must intervene in political and social life…”
The role of the doctor in society
• World Health Organization:
– “The role of the physician … in the preservation and promotion of peace is the most significant factor for the attainment of health for all.”
Ethical Issues Relating to Mixed Agency of Military Physicians
• Triage and return to combat
• Confidentiality
• Communication
• Loyalties/Command
• Experimentation
• “The Sea and Poison”
Ethical Issues Relating to Mixed Agency of Civilian Physicians
• Physician participation in torture and executions
• Pharmaceutical company provision of agents used in lethal injection executions
Contact Information
Public Health and Social Justice Website
http://www.phsj.org
