***** The New England Journal of Medicine -- July 29, 1999 -- Vol. 341, No. 5
The Nazi War on Cancer
By Robert N. Proctor. 380 pp. Princeton, N.J., Princeton University Press, 1999. $29.95. ISBN 0-691-00196-0
This book presents a powerful case for the primacy of German medical research, including research on cancer and epidemiologic studies of the link between tobacco and cancer, during the Nazi period. The book is very well written and makes an important contribution to the social history of medicine and medical research.
The first war on cancer was initiated not by Richard Nixon in the United States in the early 1970s but by Adolf Hitler and Joseph Goebbels in Germany in the early 1940s. Hitler was known to be a vegetarian who abstained from alcohol and tobacco and did not tolerate the consumption of these substances in his presence (except by an occasional woman). Nazi culture, Proctor tells us, was "a curious blend of the modern and the romantic" -- Jeffrey Herf described it as "reactionary modernism" -- and there was a romantic view of nature and a holistic approach to health. In August 1933, Hermann Goring announced the end of the "unbearable torture and suffering in animal experiments" and threatened to commit "those who still think they can treat animals as inanimate property" to concentration camps -- where, ironically and tragically, humans were soon to be used in medical experiments instead.
Hitler's enlightenment (by today's standards) with respect to his personal habits, as opposed to his political practices, may remind us of the words Shakespeare's Julius Caesar uses about one of the assassins-to-be: "Let me have men about me that are fat;/Sleek-headed men, and such as sleep o' night:/Yond Cassius has a lean and hungry look;/He thinks too much: such men are dangerous." Hitler and Goebbels did not sleep on the night of June 21-22, 1941. While launching Operation Barbarossa, the invasion of the Soviet Union, which within a matter of weeks would kill more than 1 million people, they also had time to review recent German advances in cancer research.
It is easily and readily forgotten that at first National Socialism was viewed by many in Germany and around the world as a progressive movement. The progressivism of Germany in the area of public health during the 1920s and 1930s was tempered by the connection between health and productivity (and ultimately, in the 1940s, war-fighting capability). As early as the 1870s, Otto von Bismarck had explicitly linked vital statistics ("state-istics") with the national capacity for sustained industrial production and warfare in the struggle for dominance among European nations. It is disturbing to our concept of National Socialism in Germany to realize that Nazi doctors and public health activists were involved in activities that many today would consider progressive and socially responsible. In this context, the Nazi war on cancer was launched.
The first two chapters of Proctor's book consider the background of the German campaigns against cancer, citing the great efforts made under Kaiser Wilhelm and during the Weimar Republic, when Germany led the world in medicine and public health. Chapters 3 and 4 review genetic and racial theories of cancers, the persecution of Jewish cancer researchers, and pioneering efforts to identify carcinogens in the workplace. Chapter 5 discusses Nazi views on food and the body. Tobacco is the focus of the longest chapter in the book (chapter 6). Nazi Germany had the strongest antismoking campaign and the most sophisticated epidemiologic studies of tobacco-related disease that the world had yet seen. German leaders worried that tobacco might prove a "hazard to the race." Antitobacco activists pointed out that Churchill, Stalin, and Roosevelt all used tobacco, whereas Hitler, Mussolini, and Franco were all nonsmokers.
Despite claims by historians such as Daniel Kevles that American and British scientists first proved the link between tobacco and lung cancer, in the 1950s, Proctor demonstrates that the link was originally established in Nazi Germany, in the 1930s. Although the United States was quick to capitalize on Nazi advances in aeronautics, armaments, and pharmaceuticals after World War II, this public health achievement was apparently ignored. In 1995, Philip Morris ran an advertisement in Europe -- titled, "Where Will They Draw the Line?" -- which identified antismokers with Nazis. The final chapter of the book describes how early public health optimism was compromised by wartime urgencies.
Proctor challenges the comfortable assumption that Nazi Germany was unique and defies comparison. He makes a case that the Nazification of German science and medicine was more complex than commonly imagined, embracing both forcible sterilization and herbal medicine, both genocidal "selection" and bans on public smoking.
To some extent, the social intolerance of contemporary progressive movements, such as animal rights, antitobacco activism, temperance efforts, and enthusiasm for natural foods, may be seen as similar to the "progressive" aspects of Nazi Germany, not only in their goals, but increasingly and alarmingly also in some of the methods used to impose collective solutions on individuals. For example, some scientists believe that although the harmful effects of habitual cigarette smoking are clear, the putative effects of passive smoking on morbidity and mortality, though less clear, have been far more powerful in motivating public policy against individual rights. As Proctor states, appreciating these complexities may open our eyes to new kinds of continuities between the past and the present and may lead to a better understanding of how fascism temporarily triumphed in the first place.
Marc S. Micozzi, M.D., Ph.D. College of Physicians of Philadelphia Philadelphia, PA 19103
Copyright © 1999 by the Massachusetts Medical Society. All rights reserved. *****