J Med Ethics: first published as 10.1136/jme.20.4.207 on 1 December 1994. Downloaded from J7ournal of medical ethics 1994; 20: 207-211 Ethics in scientific communication: study of a problem case Robert L Berger Harvard Medical School, USA Abstract should verify the integrity of the material prior to The hypothermia experiments performed on humans engaging in a dialogue. during the Second World War at the German concentration camp in Dachau have been regarded as Towards the end of the Second World War the allied crimes against humanity, disguised as medical research. armies came across an extensive network of barbaric For almost 50 years, scientists maintained that the medical experiments that had been conducted on study produced valuable, even if not totally reliable, humans by German physician investigators. One of information. In recent years, the results from the these projects dealt with immersion hypothermia Dachau hypothermia preject were glamorized with and was carried out at the Dachau concentration life-saving potential and a heated ethical dialogue was camp. The work was directed by Dr Sigmund activated about the use oflife-saving but tainted Rascher, an air force (Luftwaffe) medical officer. scientific information. In the wake ofthe debate, an According to available information approximately copyright. in-depth examination of the scientific rigour ofthe 300 male prisoners were forced into iced water baths project was performed and revealed that neither the during 400 experiments so that many of the men science nor the scientists from Dachau could be trusted were cooled more than once (1). Postwar testimony and that the data were worthless. The body of medical indicates that 80 to 90 victims died during the opinion accepted the unfavourable determination but a freezing and attempted re-warming. Only a handful few scientists and ethicists have continued to endorse the of those who survived the experiments lived to see validity, of at least parts, of the Dachau hypothermia the end of the war. data. http://jme.bmj.com/ The conduct of the scientific communications about the Dachau hypothermia experiments by the scientific Reception and reporting of the Dachau and ethical communities invites serious consideration of hypothermia experiments a possible ethical misadventure. It appears thatfor After conclusion of the hostilities, a US army almost 50years, the results of the study had been neuropsychiatrist, Leo Alexander, was assigned to endorsed without careful examination of the scientific investigate the medical experiments performed on base ofthe experiments and that secondary citation of prisoners at the Dachau concentration camp. The on September 25, 2021 by guest. Protected relevant original material may have been commonly records of most concentration camp medical studies employed. These infractions contributed to a myth that on humans were destroyed by the Germans prior to good science was practised by the Nazis at Dachau. The capture of the camps by the allied forces. However, a more recent emphasis on the life-saving potential of the 56-page scientific report about the Dachau human Dachau data, without citation ofcredible supporting hypothermia experiments, submitted by Rascher to evidence, has also been misleading. Similarly, Heinrich Himmler (commander of the SS and in acceptance of a determination by an in-depth charge of the concentration camps), was found by a examination that the 'whole' Dachau project is flawed US army unit, hidden in a salt mine near Hallein, with simultaneous endorsement of the validity of 'parts' Austria along with Himmler's massive files. In 1946, of the results, poses an ethical problem. Alexander submitted a 228-page report on the It is advisable that before seeking ethical results of his extensive investigation. The document consultation about the use of unethically obtained incorporated the complete Rascher to Himmler data, scientists should examine the quality of science report and has since served as essentially the sole behind the controversial information and ethicists original source material about the Dachau hypothermia experiments (2). Alexander concluded in his report, that even Key words though the experiments 'wallowed in blood', the Ethics in scientific communication; Dachau hypothermia work produced useful information (2). However, in experiments. a 1949 article, Alexander changed his earlier J Med Ethics: first published as 10.1136/jme.20.4.207 on 1 December 1994. Downloaded from 208 Ethics in scientific communication: study ofa problem case assessment and revealed that some of the data from art. Thus, in spite of cogent reasons for scepticism Dachau had proved fraudulent and the results of the about the quality or value of the Nazi hypothermia study could not be trusted (3). Similarly, at the data, the reliability of the work that produced the Nuremberg trials of major medical war criminals, information was not examined. both the prosecution and Dr Andrew Ivy, a Some scientists defended the use of the Dachau representative of the American Medical Association, data on the grounds that similar information would maintained that the concentration camp human not be available from other sources, as the inhumane experiments were of no medical value (4). experimentation performed in the concentration Moreover, scattered comments appeared in the camps had been unprecedented and in all likelihood medical literature about the unreliability of the would not be repeated (7,10). These investigators Dachau data (5). acknowledged that the science produced in Dachau Despite the scepticism expressed about the was flawed and that the chief investigator's integrity of the Dachau results, scientists in Canada, credibility was severely compromised but they also the United States and Great Britain have referred to insisted that selected results should be regarded as the study repeatedly. Moe noted that by 1984 more valid because they were consistent with observations than 45 scientific articles had cited the Dachau published by other reputable scientists (5,7,11). It hypothermia experiments (5). Frequent citation of was further argued that no conclusive evidence had the data from Dachau in reputable medical journals been presented to show that the data were defective eventually helped create an impression that, in spite and therefore there was no reason to reject the of the deplorable inhumane methods, the work was information. A detailed endorsement of the scientific scientifically correct. In the late 1 980s, Robert health of the Dachau hypothermia experiments was Pozos, a hypothermia physiologist, turned to the issued by Robert Pozos in 1989, through a recorded media and to the ethical community with his formal lecture (7). concern about using tainted data from Dachau. He acknowledged that the methods of the Dachau experiments were unethical but also expressed Re-evaluation and the response confidence in the scientific integrity of the study and Because of lingering doubts about the scientificcopyright. maintained that the use of the results could advance validity of the Dachau data and my scepticism about hypothermia research and improve on available the probability that such relatively obsolete treatment of hypothermia victims, with the potential information could be useful, I embarked on a of saving lives (6,7). thorough examination of the scientific quality of the A public debate ensued. Both the ethicists and the Dachau hypothermia experiments. In this effort, I media embraced the debate and dramatized the studied the Alexander report, reviewed his collected issue as a moral dilemma about saving lives by using papers and the scientific literature about http://jme.bmj.com/ data obtained through unethical experiments. The hypothermia, relied on the knowledge gained from controversy was heated and intense (7,8,9). Along my experience with cooling several thousand with the promise of advancing science, the life- patients for heart surgery, and examined available saving potential of the data was heavily emphasized documents about medical experiments in Nazi but never in my view convincingly documented concentration camps (12). To my surprise, access to (8,9). Two critical premises about the data produced the Alexander report proved most difficult. The by the Nazis in Dachau were apparently taken for volume was not available in any of Boston's several granted and rarely discussed by the participants in medical libraries and only two copies circulated on September 25, 2021 by guest. Protected the recent dialogue. First, it was assumed that the through the nationwide interlibrary loan system. results from the hypothermia experiments were Parts of Alexander's report were also published in scientifically sound and secondly, the claim was the more readily available volumes entitled Trials of accepted that the data had the potential of advancing War Criminals before the Nuremberg Military Tribunals medical science and of saving lives. In spite of the but this source offers only an incomplete gross ethical violations and the doubts expressed reproduction and has rarely been cited in the about the scientific integrity of the study, the medical literature (1). The difficult access to the reliability of the data had not been investigated Alexander report combined with the undeserved (8,9). Moreover, the probability that the data from favourable reception of the Dachau hypothermia Dachau had become obsolete with the passage of data, raised the suspicion that not all who cited almost a half