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Overview of German, Nazi and Holocaust Medicine

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Early before the Nazi era and even during the early Nazi period, Germany led the world in various aspects of medicine including epidemiology, clinical medicine, occupational health laws and basic sciences. It’s worth mentioning that, Germany held half of noble prizes by the 1930s [1]. 

Nazi regime, and the reign of Hitler beginning in 1933 brought with it the term of “racial hygiene” which was based on the concept of “social Darwinism” a theory that presumed that nations just like animals fight for the survival of the best ,and the best nation would be considered the purist, this concept opened the door for racial inequality and medical racism [2]. 

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Based on this many concentration camps and prisons were engaged in extensive medical research, subjects of these projects were often participated unwillingly without informed consents, and many of these studies were designed in a way that the subject would die at the end of the study [3].

Approximately, 60 research projects were conducted in these camps, freed from medical transitions and ethical obligations, the heads of these research projects were often SS-doctors [4]. Research questions explored in these centers were considered primarily with war necessities: surviving cold water, prevention of certain infectious diseases, stopping bleeding in injuries [3]. 

After the fall of the Nazi regime and the end of world war II, trials were held between 1945 and 1949 in the city of Nuremberg, for former Nazi leaders including officers and 20 doctors tried in the trial know as the doctors’ trial [5]. This trial shocked the world with the horrific deeds of the Nazi regime and highlighted the importance of ethics in conducting medical research, this work will explore some of the Nazi’s human experimentations and their implications on the future of medical ethics. 

Human experiments of the Nazi often involved systematic and ferocious interventions in which demise was the intentional endpoint. The participants in these experimentations were prisoners in concentration camps, most of them were Jews, Slavs and Gypsies, and these experimentations were conducted in different specialties of medicine [6]. 

Many experiments were conducted in the field of neuroscience, one of them was performed to determine a potential viral cause of multiple sclerosis (MS) by intra-cisternal injections of cerebrospinal fluid from monkeys into 45 mentally ill patients and vice versa, which resulted in death among the patients. Anther experiment included performing air encephalography in children which resulted in the death of at least106 of them. Numerus studies was also performed to test the difference between spontaneous and induced seizures among humans, hydrogen and induced hypoxemic status on epilepsy patients. 

Cruel experiments were conducted among gypsy prisoners to test the ability of seawater as an only source of drinking, they died of sever dehydration within 6-12 days [7]. Mentally ill patients were vastly considered as inferior humans and they were being subjects euthanasia programs and neuropathological studies, these programs included a variety of methods of death including: starvation and reduction of food, administration of barbiturates with low doses which resulted in pneumonia, closing the heating systems during winter, carbon monoxide, various drugs (opiates and scopolamine), its estimated that that more than 500,000 died as a results of these euthanasia programs including children. The brains of the dead subjects were taken for further neuropathological studies in research centers [8]. 

Additionally, prisoners in concentration camps were forced to participate in drug trials without informed consent in which a number of pharmacological agents were tested mostly as a potential treatment for infectious diseases such like paratyphoid diarrhea, scarlet fever, erysipelas or typhus, previously inoculated in the prisoners, and mortality rates were tremendously high, these pharmacological agents include: arsenic, sulfamide and un know derivatives. Furthermore, psychopharmacological studies were also used to test the effects of methamphetamine, phenobarbital, and mescaline. Also, anesthetic drugs effects like sodium hexobarbital and chloral hydrate were tested while conducting surgeries on normal prisoners. Additionally, lethal injections of apomorphine and aconitine were also used [9].

The Nazi experiments stunned the world and made all researchers conscious of the mayhems that could be committed for the cause of medical science. And since then there have been determined efforts at both the nationwide and global level to develop guidelines to protect the rights and welfare of subjects of human research. These efforts have focused chiefly on protecting the welfare of subjects, and codifying their rights by prior peer review of research protocols [6].

The trials of the Nazi doctors in Nuremberg city and the terrifying stories that have been told, produced what is known as – despite its limitations – the most authoritative document governing international research practices, and one of the foremost human rights documents in world history, the Nuremberg code. Formulated by the sitting judges in the trials and conceptualized from the natural law theory and derived from ethical, legal, and universal moral, and by this the code protects the subjects of experiments first by protecting their rights in 9 principles [10]. 

The first principle of Nuremberg code is the consent, and every subject should be participating in the experiment after giving and informed consent, and this consent should be competent, with understanding of the experiment, informed and voluntary. In addition to consent, by its 9th principle the code insured that any subject can withdraw form the experiment at any time. Moreover, the other 7 principles focused on protecting the welfare of the participating subjects, insisting on the evasion of any needless mental or physical injury or harm that might result to the subject, the presence of research design that is valid to obtain information significant for the benefit of society that cannot be gained by any other method, the absence of any risks that never exceed benefits, the absence of any prior reason to believe that disabling injury or death will occur as a result of the experiment, a qualified researcher should be present and should be prepared to abort the experiment of any harm is anticipated [6].

Researchers especially physicians criticized the code extensively as being inapplicable and restraining to their practices, because it is a human rights document produced by judges and judges had no experience in dealing with clinical research in real life patients. That why several attempts have been made to replace the Nuremberg code and marginalize it, these attempts succeeded with The Declaration of Helsinki, which was developed by the world medical association. The major difference between the declaration of Helsinki and the Nuremberg code is that it divided research primarily into therapeutic which include professional care and non-therapeutic which doesn’t, and hence no obligation of informed consent in some situations. The 1975 version of the Declaration of Helsinki succeeded in this by introducing a new basic principle and that is: each experimental research involving human subjects should be formulated in protocol which should be presented to a specially selected independent committee for guidance, comment and consideration, and these committees are known nowadays as the institutional review boards (IRBs). 

 

The Nazi experiments have taken attention and opened they eye of the world on the rights of human research subjects and their dignity, and have provided a chance to new regulations, codes and guidelines to control human experimentation. Motivated by racial supremacy, social Darwinism and poisoning ideology these experiments have murdered hundreds of thousands. They included various aspects of horrific acts against humanity in the name of medicine and progression of science.

After world war II and the trials of the Nazi leaders, including some of the doctors that were involved in these acts, a document was formulated, the Nuremberg code, which was Fundamental to establishing what constitutes the essence of medical ethics and standard guidelines of conducting human experimentations, ensuring the welfare of experiments subjects and protecting their rights. The code insists that Participation in a study requires voluntary, informed, and “educated” consent by the subject and that the subject has the right to withdraw at any time.

It also stated that the benefits of the experiments should outweigh the risks, and the experiment should be well design and should be conducted by a well-trained researcher. However, this code was subject to criticism by researchers especially physicians for being restraining and unpractical, which lead to the development of the Declaration of Helsinki which eliminated the obligation of informed consent in some cases and introduced the concept of institutional review boards to review the protocols of human experiments. 

References: 

1- Cohen Jr MM. Overview of German, Nazi, and holocaust medicine. American Journal of Medical Genetics Part A. 2010 Mar;152(3):687-707.

2- Kater MH. Doctors under Hitler. Chapel Hill: University of North Carolina Press, 1989.

3- Ernst E. Commentary: The Third Reich—German physicians between resistance and participation. International journal of epidemiology. 2001 Feb 1;30(1):37-42.

4- Lifton RJ. The Nazi doctors. Boston Mass: Basic Books, 1986.

5- Gottesman II, Bertelsen A. Legacy of German psychiatric genetics: hindsight is always 20/20. American journal of medical genetics. 1996 Jul 26;67(4):317-22.

6- Annas G. The changing landscape of human experimentation: Nuremberg, Helsinki and beyond. Medicine, Ethics and the Third Reich: Historical and Contemporary Issues, edited by John J. Michalczyk. 1994:106-14.

7- Panush RS, Paraschiv D, Dorff RE. The tainted legacy of Hans Reiter. InSeminars in arthritis and rheumatism 2003 Feb 1 (Vol. 32, No. 4, pp. 231-236). WB Saunders.

8- von Cranach M. The killing of psychiatric patients in Nazi Germany between 1939-1945. Israel journal of psychiatry and related sciences. 2003 Jan 1;40(1):8-28.

9- López-Muñoz F, Alamo C, García-García P, Molina JD, Rubio G. The role of psychopharmacology in the medical abuses of the Third Reich: From euthanasia programmes to human experimentation. Brain research bulletin. 2008 Dec 16;77(6):388-403.

10- Perley S, Fluss SS, Bankowski Z, Simon F. The Nuremberg Code: an international overview. The Nazi Doctors and the Nuremberg Code. 1992;153.

 

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