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Sydney Morning Herald
Sydney, Australia, August 28, 1999

BOOKS, by Mark Ragg



By Robert N. Proctor, Princeton,
380pp, $58.50 ISBN 0 691 00196 0
Reviewed by MARK RAGG

IN MAY 1988, Dr Robert Pozos, a hypothermia researcher at the University of Minnesota, said he planned to analyse and republish a contemporary 56-page report on infamous Dachau experiments in which almost 300 male prisoners were placed in vats of freezing water.

The men were observed, measured and analysed, sometimes to the point of death; sometimes they were warmed up again with boiling water. Pozos said he could learn how to treat people with hypothermia better if he understood what went on at Dachau.

This sparked off a passionate debate about the ethics of knowledge. Conferences, seminars, letters and speeches the world over have struggled with what to do about Pozos's approach. Some argued the knowledge should never be used because it was gained immorally. Others asked: "Should we not look at the pyramids because they were built using slave labour?" Eventually, Pozos used the knowledge, but the debate continues. The New England Journal of Medicine, for example, does not publish citations of the work.

The Nazi War on Cancer was written in this milieu. Robert Proctor, professor of the history of science at Pennsylvania State University, searched not just Nazi Party records but the medical literature and popular press of the time to construct a detailed history, the sort that makes an exciting summary, if a dull read.

Proctor argues that between 1930 and 1945, the Nazis were among the world leaders in public health. They were the first government to encourage breast self-examination. They promoted regular check-ups. They had cancer-awareness months. There were mass screenings of women for cervical and breast cancer, of children for holes in their teeth, of students for TB, of factory workers for silicosis and lung cancer ... on it goes. Strict occupational health and safety regulations protected Aryan workers. Germany pioneered the use of alarming health statistics for political purposes. The Nazis banned alcohol advertising aimed at children and declared Coca-Cola "unsuitable for children".

Mass murder and other aspects aside, they did many things that we, in Australia, 60 years on, could admire.

Proctor says the regime's obsession with health reflected the personality of the teetotal, non-smoking, mostly vegetarian Führer. The quest was economic, too -- a healthy worker is a productive worker. And there was the fear of dilution of German germ plasm, a passion for genetic purity that drove so many other policies in disastrous directions.

But so what? What does this mean for us today? Proctor makes no effort to relate public health policies of the day with our own. And he brushes aside the Dachau experiments and others with the tart observation: There are scholars today who worry about the unreflective citation of "Nazi data"; our present-day concerns with criminal scientific citation, however, may simply reflect the status we have invested in displays of debt and credit.

This may involve committing the reviewer's cardinal sin of reviewing a book not at issue, but it is unfortunate The Nazi War on Cancer does not give the question of morality any weight. It should, not just because better historians connect us to our past, but because the book raises so many questions and leaves them unanswered.

Look at the strength of the statement by Dr Franz Muller in 1939. He studied 86 men with lung cancer and declared that "the extraordinary rise in tobacco use" was "the single most important cause of the rising incidence of lung cancer". But Anglophones took notice only when British researchers made the link in 1950. It took the Americans until 1964 to take note of their Surgeon-General.

To the original question: should we use knowledge gained from a murderous regime such as the Nazis? This book, had Proctor wished, could have made a strong "yes" case. Nazi endeavour gave us small cars (pioneered by Volkswagen), pethidine and methadone. Where would anti-smoking campaigns, mobile vans for breast-cancer screening and other preventive health measures be without Nazi groundwork? If we had used Nazi knowledge more wisely, if we had not waited until the '60s to start acting against tobacco, how many millions of lives might have been saved?

Perhaps a better question might have been: do we have the right to use knowledge gained illegally or unethically?

If we decide the answer to all such inquiries is "no", then we should avoid Pozos's research. We should also avoid knowledge gained from experiments in which treatment was withheld from poor black Americans with syphilis in Alabama from 1932-72, and the research from the early '60s to the early '80s involving New Zealand women with cervical growths, who received no treatment and later developed cancers. The question is not academic -- courts in Western democracies will not consider knowledge gained illegally by police.

But what horrors of tomorrow are simply our contended wisdom of today? How about the US Government's decision to fund research into treatment of people with HIV in the developing world? Most of the trials use new drugs, or combinations of AZT with other drugs. People in control groups do not receive AZT, which is standard treatment in the US. They receive no treatment at all. This, the researchers argue, allows answers to be gained more quickly. That thousands of people in the control groups will soon die, when treatments are available, is a small price to pay for knowledge, they suggest.

The World Medical Association's Declaration of Helsinki, which governs the ethics of medical research and arose partly out of concern over Nazi experiments, says: "In any medical study, every patient - including those of a control group, if any - should be assured of the best proven diagnostic and therapeutic method." AIDS research that denies AZT to control groups is unethical, the association says.

But in October, the association will consider a proposal developed by its ethics committee to add the words, "that would otherwise be available to him or her", requiring only that patients receive treatment generally available in their countries. Retrospective ethical approval may be on its way. It makes you wonder what, from all the horrors of the Nazis, we have learnt.

Mark Ragg is a senior writer for the Herald.

[Related story: A US scholar has assembled evidence that Nazi Germany was 20 years ahead of the rest of the world in nailing tobacco as the cause of lung cancer]
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