Well, here we are ninety years after the Nazis began persecuting Jews in Germany, and I guess the prestigious New England Journal of Medicine (NEJM) is feeling guilty for having completely ignored that persecution until the war was nearly over (1944). No matter that none of the editors of the journal back then are still active, much less alive: they still feel that a long apology is in order.

I guess I don’t mind their late mea culpa (it’s five pages long), and I’m not even sure a medical journal should take political stands, but in this case the Nazis affected the practice of medicine in Germany. For one thing, they fired more than 3,000 Jewish doctors, and, of course, later sent them to the camps. And the Nazi doctors were, of course, often complicit in medical outrages, like the euthanasia of the mentally ill and the gruesome and torturous experiments on inmates in concentration camps.  One could, I suppose, make a Kalven-like case that the Nazis were indeed hurting the practice of medicine (though in a different country), and so their crimes fall under the ambit of NEJM.

And so the NEJM editors, recognizing that other journals, like the Journal of the American Medical Association and Science, did call out Nazi atrocities, are trying to catch up. Unfortunately, they coopt the language of DEI to explain the journal’s ignoring of Nazi atrocities.

Here’s how the journal begins its admission of ignorance, willful or otherwise. I’ve put links to key articles they reference that are on the Internet rather than their footnotes:

Hitler was first specifically mentioned in the Journal in 1935, in an article by Michael M. Davis, a noted American health expert and reformer, and his collaborator Gertrud Kroeger, a leading German nurse. Yet between this article and 1944, when Nazi war crimes were first explicitly acknowledged in an editorial, the Journal remained all but silent regarding the deeply antisemitic and racist motives of Nazi science and medicine and the threat to the “ideals” of civilization. . . .

Articles on Germany or Nazis in the 1930s and 1940s are overwhelmingly about the compulsory and oversubscribed sickness insurance system, “socialized medicine,” and “quackery,” not the persecution and mass extermination of Jews. In fact, when it did address Nazi “medical” practices, the Journal enthusiastically praised German forced sterilization and the restrictive alcohol policies of the Hitler Youth.

Finally, the Nazi Reckoning after 14 years:

But when the Allied powers liberated the concentration camps, it became clear, as the so-called Doctors’ Trial (1946–1947) categorically demonstrated, that the medical profession in Germany embraced Nazism’s antisemitic and eugenic ideology⁸ and was deeply complicit in the implementation of mass extermination. The crimes of the Nazi state could no longer be ignored. The first Journal article explicitly damning Nazi medical atrocities is a 1949 article by Leo Alexander, a Viennese-born American neuropsychiatrist, who gathered evidence for the trial of the Nazi doctors at Nuremberg.More articles would be published from the 1960s onward, as scholars started documenting the atrocities committed by medical doctors, and especially after the Declaration of Helsinki of 1964, which established a number of ethical principles regarding human experimentation.¹²

The journal admits that it was an “outlier” in this respect, but then goes into excruciating and tedious detail into the one article it wrote in 1935 by Davis and Kroeger—an analysis of German “socialized medicine”. Click on screenshot below to get the pdf. Be warned, it’s a snoozer, even though it approves of socialized medicine.  I’m not sure why NEJM even mention this article save that it was attacked two weeks after publication in a letter to the editor, whose author, Joseph Muller, claimed that the Davis and Kroeger piece was propagandistic and “unworthy to appear in our periodical”.

The criticism:

Davis and Kroeger’s article did not go unchallenged. In a letter to the editor published 2 weeks later, Joseph Muller, a dermatologist and an active member of the Massachusetts Medical Society (which owned and still owns the Journal), complained about the Journal using Davis and Kroeger’s article “as a propaganda organ for half cooked world improvers.”²¹ The article, he claimed, was “neither medical nor scientific, but contains plenty of propaganda and is therefore unworthy to appear in our periodical. It is remarkable by omission of facts rather than by its statements.” Moreover, he wrote, the omission “that more than three thousand medical men were deprived of their means of supporting themselves should open the eyes of the American medical profession to one great danger of State Medicine.” Though Muller showed sympathy for the Jewish doctors, however, the real crux of his critique was not Nazi genocidal atrocities but — remarkably — the danger that socialized medicine could hold sway over the profession, a long-held concern among American physicians about “state medicine.”

As we see below, first author Davis answered Mueller’s criticism in a very brief response that basically swept away Nazi atrocities (Kroeger didn’t answer; the journal said she was a Nazi sympathizer). Its heart is this:

The deplorable repressive policy of the Hitler government in respect to Jewish physicians had no bearing on the main point which the article was intended to bring out, namely, that the organized medical profession of Germany has, by the actions described in the article, been placed in a more responsible position than ever before with respect to the medical services under German health insurance.

In other words, “who cares about the Jews, we were talking about medical insurance”.

Well, what we have is medical history, and of course it wasn’t just doctors who ignored what the Nazi regime is doing. Many people had no idea about the camps, though ignorance of the persecution of the Jews should have been evident to any thinking person.  But the apologia could have occupied but a single page, saying just what I said above.  Sadly, the piece goes on and on, and finally drags in DEI-like elements in trying to explain the exchange of letters above as well as the journal’s failure to cover the medical atrocities of the Nazi regime (bolding is mine):

Davis’s brief response to Muller’s attack is important in that it reveals what have come to be understood as critical elements of structural racism: unconscious bias, denial, and compartmentalization. In his rejoinder, Davis tried to bring some clarification to his omission by denying the relevance to his argument of discrimination against and persecution of Jews.  , , For Davis, the expansion of medical power was thus more important than the fact that this gain in power came at the expense of thousands of Jewish physicians. Moreover, it did not matter to Davis that the doctor whom he described as the “guardian of the health interest” of the German people had to be “Aryan” to be able to practice.¹ As we now know, however, this reliance on the benevolent and altruistic physician to act in accordance with the Hippocratic Oath was insufficient to prevent the atrocities committed by physicians in the Nazi death camps.

And later, there’s this, called “moral blindness”:

And beyond Davis, how do we account for the virtual silence of the Journal about these issues over the ensuing decade? Part of the answer lies in denial, compartmentalization, and rationalization, all of which depend on structural and institutional racism — deep historical, often unrecognized, bias and discrimination that serve the status quo.

Well, we don’t know whether Davis’s (or the NEJM’s biases) were unconscious, and is it really news that many Americans didn’t like Jews in the 1930s and 1940s? Those were the years of the popular antisemitic radio broadcasts of Father Coughlin, and of the equally popular antisemitism of Charles Lindbergh, American Hero. And yes, there was structural and institutional racism, most familiar to academics as the “Jewish quotas” in many universities instituted in the 1920s, and lasting for at least three decades.

This history is well known and well documented, save for the possibility of “unconscious” bias, a dubious concept that remains controversial. Regardless, I find it somewhat bizarre that the NEJM feels the need to apologize so many years afterwards, when during WWII it was simply following the American Zeitgeist that preferred to ignore the plight of European Jews. And equally bizarre is that it coopts the language of DEI to implicate structural and institutional racism, which of course was simply the racism put in place by Hitler and many Germans after they whipped up sentiments against the Jews. Is anything accomplished by using modern concepts that are arguable (“structural racism” and “unconscious bias” as a cause of inequities) rather than what’s really at issue here: the fact that not many people cared about the Jews during WWII?  I’m just glad they didn’t mention “the inequities affecting Jewish doctors due to structural racism and unconscious bias.”