Books, Journals, New Media - May 13, 1998

Nazi Medicine


In the Shadow of the Reich: Nazi Medicine, written, produced, and directed by John Michalczyk, one videocassette, 54 min, $29.95, ID No. FRS-206V, First Run Features, 153 Waverly Pl, New York, NY, 10014, 800-488-6652, 1-212-989-7649 (fax); 1997.

American understanding of the events and cataclysms that engulfed Europe in the 20th century, including the Holocaust, is generally meager and narrow. As living memory dies, and as the magnitude of those events continues to defy comprehension, many Americans, including physicians, remain notably unaffected.

Although perhaps shocked and incredulous about this period, they are also deluded by the belief that this horror was uniquely a Nazi problem or, perhaps, a European catastrophe, but nothing that Americans, ultimately, can truly relate to. Professor John Michalczyk, Director of Film Studies at Boston College, sharply and forcefully shatters that delusion with In The Shadow of the Reich: Nazi Medicine, a 1-hour documentary completed for the 50th anniversary of the Nuremberg Physicians Trial of 1946-1947. The film informs us that, in fact, America in the early 20th century also fell under National Socialism's shadow, and, in some ironic and incredible ways, reflected and even inspired racist theories with social practice and scientific study. The common ground—or quicksand—was the eugenics movement, a form of social Darwinism, which argued that undesirable biologic and even social behaviors could be eliminated genetically, primarily through sterilization.

The eugenics movements in both countries were disturbingly and eerily parallel until the mid-1930s. Mental retardation, mental illness, neuromuscular disease, criminality, and antisocial behavior were lumped together with the overarching societal goal of producing a vibrant, healthful, and disease-free society. America was actually the first country to sanction sterilization, and, eventually, 23 states passed mandatory sterilization laws for the biologically and socially afflicted. In Lynchburg, Virginia, 7500 persons were systematically sterilized over 40 years' time. German and American writers trumpeted the cost-saving benefits of a disease-purged society. American academia and philanthropy entered the scene with Andrew Carnegie, the Rockefeller Foundation, and others providing for genetic and anthropologic research that largely reinforced the prejudices shared on both sides of the Atlantic: that the Caucasian race was the manifestation and fruition of a genetic and cultural ideal. African Americans and non-Northern European immigrants, particularly from Slavic countries, were now found "scientifically" to be innately inferior.

By the late 1930s, German National Socialism, including now many physician disciples, had left American racial policies and practices far arrears. Within 6 to 7 years, Hereditary Health Courts had mandated the sterilization of 300,000 to 500,000 inhabitants, including many native Germans. In 1939, the first of six medical centers to "terminate undesirables" was opened, and the slippery slope of euthanasia now impelled an avalanche into the abyss. The film also depicts the later willing involvement of physicians in the processing, selection, and treatment of concentration camp prisoners. Some physicians, with horrifying enthusiasm, helped organize more efficient means of execution and coordinated and conducted monstrous medical experiments upon selected prisoners.

Cinematographically, the documentary is well done. Archival film footage is merged with still photographs, artwork, and interviews, primarily with writers and authorities in the field. The narration is articulate and forceful but not shrill or bombastic and allows the personages and events to speak for themselves. Unlikely to be selected for a "Blockbuster Video evening," this work is primarily intended for educational settings.

I would show part of it, perhaps in conjunction with a panel consisting of a physician, ethicist, geneticist, and social scientist, to stimulate discussion and awareness among medical students or graduate students in clinical research. Fortunately, the last decade has also seen a blossoming of literature in the same field. Writers like Michael Kater (Doctors Under Hitler), Robert Lifton (The Nazi Doctors), and Michael Grodin (with George Annas, The Nazi Doctors and the Nuremberg Code) also provide commentary during the film, and their works are excellent supplementary references.

The take-home lessons of this documentary—even for American health care professionals—are poignant and substantive. First, our entire current moral underpinnings of clinical research involving the protection of human subjects are fundamentally rooted in the experiences and lessons of the time of the eugenics movement. The fascination of German medical science with an alleged objectivity and distance that largely excluded the concept of human worth produced an amoral scientism as a residue, where true medical science used to flourish. Perhaps most disturbing to physicians is that the Nazi doctors as a group were not amoral but, in fact, allowed their moral compass, which had been fixed on patient-centered medical care, to be realigned by a state-centered power, in which the health of the nation usurped the needs of the individual.

America in 1998 is much different from Germany in 1939. But in these times, when managed care organizations speak of the need to consider the "greater good" of the population served, physicians must remember to once again calibrate their moral compass to focus first and foremost upon the patient.

Eugene V. Boisaubin, MD
University of Texas Medical Branch

(JAMA. 1998;279:1496)