THE NAZI WAR ON CANCER
By Robert N. Proctor
Princeton. 380 pp. $29.95
Reviewed by David Brown
The history of science is peppered with examples of discoveries that were made and then forgotten, only to be discovered anew in a more receptive era. Gregor Mendel's description of genetic inheritance, unrecognized from 1866 until three biologists recapi-tulated it in 1900, is perhaps the best example. Rarely, though, does a whole scientific movement fall through a hole in history, the victim of semi-intentional suppression and amnesia.
That appears to be what happened to the work of hundreds of scientists, physicians, bureaucrats and proselytizers described in Robert N. Proctor's fascinating book, The Nazi War on Cancer. In this case, however, it's not hard to figure out why.
Comprehending what happened in those 12 short years of German history is probably easier if Nazi evil is unmitigated, relentless, untainted by beneficent, or even useful, works. Acknowledgment that the Third Reich was "progressive" in certain matters of public health appears to mitigate the enormity of everything else that happened in its name. Consequently, Nazi medicine has come to be symbolized by experiments on concentration-camp prisoners -- the apotheosis of inhumane and unethical science -- and nothing more.
But of course there was a whole lot more. Germany entered the Nazi period with a century of accomplishments in medicine (also in chemistry, physics and engineering) behind it. The trajectory of that achievement was bent (and often warped) by Nazi ideology, but not instantly transformed into some Frankensteinian nightmare.
"Do we look at history differently when we learn that Nazi leaders opposed tobacco, or that Nazi health officials worried about asbestos-induced lung cancer? I think we do," writes Proctor, who teaches the history of science at Pennsylvania State University. "We learn that Nazism was a more subtle phenomenon than we commonly imagine, more seductive, more plausible. We learn that the barriers which separate `us' from `them' are not as high as some would like to imagine."
Proctor's account of medical research and public health under Nazism is long and encyclopedic. Although the focus is on cancer, the book actually includes a discussion of many of the government's policies on occupational hygiene, radiation safety, prenatal care, diet and personal habits, notably smoking.
As mortality from infectious diseases (especially tuberculosis) waned, cancer loomed as an increasingly serious health problem, and nowhere more obviously than in Germany, which had one of the highest death rates from the disease in the world. (Stomach cancer was most prevalent, followed by lung cancer.) Nazi Germany had the medical infrastructure to address this problem, along with "a health-conscious political party with unprecedented police powers allowing it to combat the growing threat." The preoccupation with bodily cancer also neatly reflected the obsessions about Jews, Gypsies, the handicapped and other "malignancies" on the state. Cancer was seen as a disease of modernity -- a good target for an ideology that, along with its cruelty and intolerance, had a romantic strain that harked back to a "purer" past. More mundanely, Nazis also had an aptitude for record-keeping, which is helpful in research on diseases of long incubation. In all, cancer-fighting and German fascism were a good fit.
These forces brought forth a flowering of ideas that are familiar and, in some cases, creepily contemporary. Elaborate cancer "registries" were created, including the first ones to note new cases (incidence) and not just fatal cases (mortality), which makes such records far more informative in epidemiological terms. Advertising campaigns urged women to have free, regular screening exams for cervical cancer, and posters instructed them in breast self-examination. Seventy "cancer counseling centers" opened throughout the country, teaching prevention.
On the work front, the national health care system required that all accidents and occupational illnesses be reported. Radon gas had been recognized as a compensable cause of lung cancer in miners before Hitler came to power, and asbestos was similarly recognized in 1943 -- both firsts. Workers exposed to rock dust had to undergo regular medical exams in an effort to detect silicosis early. Arsenic-containing pesticides, which can cause cancer, among other problems, were banned in 1942.
On the home front, Nazi ideology promoted diets with less fat, sugar, meat and canned food, and with more fresh fruit and vegetables. By law, bread had to contain a minimum percentage of whole-grain flour. Several influential health officials decried the raising of meat as a waste of agricultural resources.
Adolf Hitler and Heinrich Himmler were largely vegetarian (and also non-smoking teetotalers). One of Hitler's worries was that "the increasing consumption of whale oil was diminishing the population of whales," Proctor notes. Himmler once wrote about contemporary food: "The artificial is everywhere; everywhere food is adulterated, filled with ingredients that supposedly make it last longer, or look better, or pass as `enriched,' or whatever else the industry's admen want us to believe." The Reich Health Office spent 48,000 marks in 1940 and 1941 researching possible carcinogenic effects of food dyes. Lead-lined toothpaste tubes were banned in Germany long before they were in the United States.
Holistic health movements also flourished. Himmler and Rudolf Hess were devotees of homeopathy. Dachau had greenhouses where medicinal plants were grown. Some of the experiments done on prisoners tested herbal remedies.
No movement, however, is more striking to today's sensibilities than Nazi Germany's campaign against tobacco. For starters, German researchers were the first to establish -- beyond clinical anecdote -- the causal link between smoking and lung cancer. Two studies, one published in 1939, the other in 1943, compared the smoking habits of people with lung cancer and those without it. Although there are some methodological complaints about each, the studies nevertheless convincingly showed a strong and "dose-dependent" link between the habit and the disease. American and British researchers didn't prove the same connection until after the war.
Outside the academic world, smoking came under withering attack by Nazi officialdom. The hazards of smoking were taught in elementary schools. Posters and propaganda decried the economic drain of smoking and the "alien allegiance" the addiction fostered. Starting in 1938, smoking was banned in many offices and hospitals. Smoke-free restaurants opened. Sixty cities banned smoking on streetcars in 1941. That same year, regulations took hold banning tobacco advertisements "that create the impression that smoking is a sign of masculinity," as were all advertisements targeting women.
Joseph Goebbels, Hitler's propaganda chief, "tried to confine his habit to his home [though] some film clips from the era show him trying to hide his cigarette as the camera pans in his direction," Proctor reports. The University of Jena opened what was probably the world's first Institute for Tobacco Hazards Research. Another institute bred nicotine-free tobacco plants, and the latter accounted for five percent of the German crop in 1940.
Proctor's account is astounding. Yet, lest the catalogue seem incongruously high-minded, he also shows how medical research was corrupted by Nazi ideology. Race-consciousness led some scientists to spuriously dismiss the importance of environmental risk in certain ethnic groups, which were thought to be cancer-resistant. (It goes without saying that whole populations fell entirely outside any concern for their health or welfare.) The campaigns against radiation hazards and tobacco served state interests, namely protection of the national "germ plasm" and the fertility of German women, who were urged to produce as many Aryan offspring as possible. Occupational safety helped enforce each man's "moral duty" to work -- usually for the good of the state, and ultimately, for its war effort. So, too, with dietary recommendations. One Hitler Youth manual declared: "Nutrition is not a private matter!"
What are we to make of all this? "The story of cancer research and policy under the Nazis has tended to elude the attention of historians for various reasons," the author writes near the end of the book, "the most important being, perhaps, that it may not seem to be in anyone's interest to dredge up such things." He convincingly explains, however, why it is.
Science is not value-free. "Passions are often involved in the pushing of science in one direction rather than another -- for better or for worse," he writes. Ideology does not fundamentally corrupt scientific inquiry any more than "good" research guarantees good behavior. Ignoring the Third Reich's scientific accomplishments, he further (and, I believe, more importantly) argues, also isn't very helpful in coming to terms with Nazism. "Nazism has to be seen as more than a demonic caricature, a straw man fabricated to efface the links to other times and places. . . . We need to challenge the comfortable notion that Nazi Germany was unique and defies comparison."
A generation ago, Hannah Arendt increased the world's understanding of Nazi behavior (and caused a lot of controversy) by talking about the "banality of evil." Robert N. Proctor has now brought us a concept nearly as unsettling, the "banality of good."
David Brown is a science reporter for The Washington Post.