It was an obscure 68-page report, printed by a federal agency some 40 years ago, but when it arrived on his desk, the document haunted physiologist Robert Pozos.
All that data, he thought. The things he could do with this information.
Here was a report that showed how humans responded to freezing cold and to lifesaving methods of rewarming. The data was unique and unavailable elsewhere. The figures on the page promised so many answers. Pozos, a renowned hypothermia expert at the University of Minnesota medical school here, had spent his career looking for such answers.
All the same, Pozos was horrified. What he held in his hands, after all, was a report on brutal experiments conducted by Nazi doctors at the Dachau concentration camp.
The document kept drawing Pozos back to his desk. Week after week, repelled and attracted, he reread its pages. We could save lives, he thought. But would this be ethical? Could we use this information? What did other people think? Why not raise this issue openly?
In this fashion, Pozos last spring found himself igniting a ferocious debate that still rages. It is a debate full of people offering intensely felt, passionately expressed opinions about issues loaded with the imponderables of faith and philosophy.
Can objective, value-free information be gleaned from an immoral source? Can good be derived from evil without legitimizing that evil?
"The suffering is done--let someone benefit from all the pain," insists Lucien A. Ballin, who helped unearth the Nazi data in 1945 as part of a military intelligence assault force.
"The real question is whether we can simultaneously repudiate and benefit from evil. I believe this is impossible," argues Jay Katz, a physician on the Yale Law School faculty.
In the end, Pozos' questions reach beyond the issue of Nazi data, for more than a few scientists in this country have faced similar quandaries in other contexts. Some have decided they could indeed traffic with and thereby transform evil.
For this reason, Pozos finds the vociferous response from his colleagues particularly curious.
"Why such a strong response?" Pozos mused one recent morning. "It's like I had found out something bad about someone in your family."
The document that so haunts Pozos carries a misleadingly placid title. "The Treatment of Shock from Prolonged Exposure to Cold, Especially in Water" was written in 1945 by Maj. Leo Alexander, then a U.S. Army doctor.
Alexander's report is as much a detective story as a scientific account.
As medical investigator for the U.S. secretary of war and aide to the chief counsel at the Nuremberg war crimes trial, Alexander's task after the war was to find out just what had happened in the concentration camps.
Alexander began interviewing some of Germany's top scientists. They willingly displayed their lab equipment while describing their hypothermia experiments on animals. Alexander listened at length, then posed his question:
Had these experimental findings ever been applied to men in emergencies? Had the experiments ever been carried out on human beings?
No, no, the scientists answered. They knew nothing of that.
Alexander did not believe them. Rather than coerce these scientists or make arrests, though, he kept searching.
On June 14, 1945, Alexander later wrote, "a curious coincidence played into my hands."
He happened to meet an Army chaplain at dinner in the officers' mess in Rennerod, Westerwald, in what is now West Germany. The chaplain was talking about cruel experiments conducted at Dachau by a Dr. Sigmund Rascher--prisoners dumped in icy vats of water, their death throes monitored. He had learned of this just days before from an Allied radio broadcast. Freed Dachau prisoners were talking.
Alexander wondered: How could all this be verified?
Just then, as it happened, American soldiers were busy excavating a salt mine in Hallein, Austria. Gestapo Chief Heinrich Himmler's papers reportedly were buried there in a mountainside.
The soldiers, after days blasting through wooden bulkheads, reached an underground room filled with large metal lockers. Inside the lockers they found mountains of paper.
The documents were quickly trucked to Berlin. On June 18, Alexander and five assistants arrived at the 7th Army Document center. What he found there, Alexander would later report, "contained a wealth of most revealing material."
Here were the raw data and inner workings of the Dachau experiments. Here were charts, graphs, letters, memos, detailed descriptions--everything.
Here was Rascher's letter to Himmler dated May 15, 1941, first proposing the use of Dachau inmates for experiments. Here were dozens of other letters exchanged between the two men--plans, proposals, results, suggestions, orders.
Alexander could not avoid noting what he later called the "scrounging and chiseling nature" displayed by Rascher.
Rascher filled his letters with obsequious requests for money, tax reductions, fresh fruit, furniture, fruit juices, slave servant girls and a new apartment. There were denunciations of various people in and out of the German air force, the Luftwaffe. There were assorted personal intrigues, animosities, maneuvering for promotion and position. There were shameless self-advertisements--Rascher often dispatched more than one letter a day promoting his work.
In one letter, Rascher proposed relocating the experiments to Auschwitz because "it is colder there and the greater extent of open country within the camp would make the experiments less conspicuous (the experimental subjects bellow (!) when they freeze severely) . . . ."
The documents also showed that Rascher had not operated alone. He had made the formal application to Himmler, but the ideas originated with and were supervised by a handful of high-ranking and respected medical men connected with the Luftwaffe and the Air Ministry.
These doctors' interest in cold-treatment tests was practical. Ever since the Battle of Britain over the English Channel in 1940-41, valuable German pilots had been dying of cold after parachuting out of stricken planes. On land, countless German soldiers faced freezing conditions during winter on the Russian Front.
The Nazis wanted to know how to protect them, and how to treat them.
The cold experiments started at Dachau in mid-August, 1942. Rascher submitted his first preliminary report to Himmler on Sept. 10 and a final report in mid-October.
For all his labors as an investigator and his personal horror at what he had uncovered, Alexander could not help but examine this final report as a doctor and scientist. Here was information, it seemed to him--useful information. Alexander carefully gleaned all the data he could from the Nazi experiments.
In 400 experiments, the Nazis used some 300 prisoners--Jews and Gypsies, Poles and Russians--dressing them in aviator outfits or leaving them naked, immersing them in vats of icy water at temperatures ranging from 36 to 53 degrees, or leaving them for hours in the freezing outdoors.
As the prisoners foamed at the mouth, writhed in pain, emitted death rattles and slumped into drowsy semi-consciousness, the Nazis measured their changes in blood, urine, spinal fluid, muscle reflexes, heart action and body temperature.
When the prisoners' interior temperatures fell to 79.7 degrees, the Nazis tried assorted methods of rewarming: rapidly by hot bath; more slowly by light cradle, heated sleeping bag, blankets, diathermy of the heart, pharmaceuticals and body-to-body contact with naked women recruited from the camps. Not everyone rewarmed--some 80 to 100 died in the process.
Most Effective Method
Rapid rewarming in hot water proved by far the most effective method of resuscitation. Slow rewarming methods helped much less. Alcohol, contrary to popular belief, actually hastened cooling.
These results completely reversed the conventional wisdom, which held you must rewarm hypothermia victims slowly to avoid death by internal bleeding. What's more, the results provided unprecedented raw data useful for all sorts of calculations. Here were curves of falling temperatures during exposure, curves of rising temperatures during warming, charts of internal physiological reactions.
Alexander's conflicted conclusion:
"Dr. Rascher, although he wallowed in blood . . . and in obscenity . . . nevertheless appears to have settled the question of what to do for people in shock from exposure to cold . . . . The final report satisfies all the criteria of objective and accurate observation and interpretation . . . . The method of rapid and intensive rewarming in hot water . . . should be immediately adopted as the treatment of choice by the Air-Sea Rescue Services of the United States Armed Forces."
(Rascher, as it happened, could take no satisfaction in this evaluation of his work, for he no longer was alive.
(Near the war's end, he had fallen into disfavor with Himmler. The reported reasons were several. Himmler felt Rascher talked too much, and might continue that habit with the Allies. Rascher, in his quest for notoriety and reward, had resorted to claiming anti-infection properties for a faked preparation he produced and named "Polygal." Rascher's wife, in order to obtain the usual monetary present from Himmler, after a miscarriage had faked continuation of a pregnancy and substituted a child not her own.
(At least one of these provocations apparently took its toll. Two weeks before the liberation of Dachau, Himmler ordered that Rascher and his wife be shot.)
Alexander submitted his report in mid-1945, and for a time it remained a classified document. The next year the Army and Navy Office of the Publication Board declassified it, with "hopes that it will be of direct benefit to U.S. science and industry." Eventually, the report found its way into the Library of Congress and a handful of major university libraries, largely settling into obscurity.
When a colleague sent him Alexander's report 42 years later, Pozos' conflicted response was understandable.
Pozos works in a frigid climate, in a land with a lot of water, his office not far from the shores of frigid Lake Superior. People fall into these waters and into snowbanks and freeze. All told, some 1,000 people die each year in the United States from exposure. Pozos, chairman of the physiology department at the University of Minnesota's medical school, focuses on how to treat them.
There are no fixed, certain methods. Pozos, after all, cannot match the Nazi's experiments. He has dipped hundreds of volunteers into vats of icy water here at the Hypothermia Laboratory he founded in 1977, but he cannot let a subject's temperature drop more than 3.6 degrees. Pozos must simply extrapolate from limited data.
There was no way to avoid the horrible fact: Only the Nazis offered actual data on what really happens to humans.
But just how good was that data?
Scientists disagreed. Some saw the data as flawed but still valuable. Some flatly insisted no good science could come from such evil doings. Some objected to the data for more practical reasons--for example, they felt the prisoners were too ill and emaciated to yield accurate readings.
Pozos did not know who was right, but wanted to find out. He wanted to look at the quality of the data, the quality of the scientists. He wanted to critique the experiments. What if some parts of the data were good, some lousy? Should we use the good parts? Or should we use none, no matter what?
Last March, Pozos posed this question to the bioethicist Arthur Caplan, director of the University of Minnesota's Biomedical Ethics Center in Minneapolis.
Caplan at first recoiled. He had lost relatives in concentration camps. His father was among the American troops who liberated Dachau.
Then Caplan started to think. Could you transfer horror into something good? Could you redeem good from evil? Yes, Caplan felt, yes you could. That was what organ transplants were all about--from death, a heart or kidney saves a life.
Caplan decided to discuss Pozos' dilemma and his own thoughts in the column on bioethics he writes for the local St. Paul Pioneer Press Dispatch. Make it hard to locate the data, he wrote in late April. Do not give identifying credit to Nazi scientists. Make those who use the data explain where it came from. Apply a moral judgment. But let the data be used.
"The prevention of a death outweighs the protection of a memory," he wrote. "The victim's dignity was irrevocably lost in vats of freezing liquid 40 years ago. Nothing can change that."
The reaction was immediate and full of intensity.
Letters and phone calls poured in to Pozos, to Caplan, to the newspaper. They came from doctors, scientists, ethicists, historians and general readers. Extended handwritten personal accounts arrived from concentration camp survivors, lawyers who prosecuted cases at Nuremberg, military officers who liberated Dachau, investigators who uncovered Himmler's cache in the salt mine.
There were those who argued that the data absolutely must be used and those who argued that the data's use would be obscene and unthinkable. Pozos was applauded and invited to speaking engagements, denounced and told he was risking his career.
Everyone's opinion was unequivocal.
Those who favored use of the data talked of redemption.
"If Pozos dedicated his study to the memory of those victims of the Nazis, it would serve as a nice way of reminding people about the horrible experiments," said the Israeli representative to the Simon Wiesenthal Center, Ephraim Zuroff.
"I wore a number in Dachau," one concentration camp survivor wrote. "I have two Belgian friends who went through the procedures of Dr. Rascher . . . I see no reason why the results obtained should not be used for further research."
"As a research physiologist with the U.S. Air Force, I saw those Dachau papers," wrote Edwin S. Fetcher. "We debated the same questions that Dr. Pozos confronted and we came to the same conclusions, but with few qualms and no guilt. We were doing the best we knew to make amends for the sacrifices of those wretched victims."
"As a child of survivors of the Holocaust, I have strong empathy for those opposed to the data's use," wrote a medical doctor. "Nevertheless, as a physician who deals with children and has seen them comatose, brain damaged and dead from hypothermia, my sense is that to save one child through the use of this information is worthwhile."
Those against the data's use spoke just as passionately--and seemed to include a much larger share of the most prominent, respected names in science, ethics and the Jewish organizations.
"There's just no two ways about it," said Dennis Klein, director of the International Center for Holocaust studies for the Anti-Defamation League of B'nai B'rith. "No way should they be used . . . I cannot accept the results as legitimate . . . one has to draw the line."
"It goes to legitimizing the evil done," said Abraham Foxman, national director of the Anti-Defamation League.
"I don't see how any credence can be given to the work of unethical investigators," said Dr. Arnold S. Relman, editor of the New England Journal of Medicine. "Given the source of the information and the way in which it was obtained, how can anyone believe it? How can anyone want to believe it?"
One of the most passionate of the negative comments came from a man whose grandmother was led off to die in a concentration camp.
"I offer this challenge to the hypothermia researchers," wrote Rod Martel. "As you page through the research, have next to it actual photos of Jews being tortured in the name of research and see how long you are able to analyze data. Better yet, think of your mother or father floating in that tank and see if your beliefs about this subject hold up."
An arm of the federal government soon found itself forced to take sides in this argument. Just as the debate was swirling around Pozos last spring, a similar one happened to confront Lee M. Thomas, the head of the Environmental Protection Agency in Washington.
In figuring risk assessment and dose-response calculations involving use of lethal phosgene gas, an EPA project manager and an outside consulting firm had made use of data from other Nazi experiments, on prisoners of war in France. An alarmed letter from 22 EPA scientists soon landed on Thomas' desk.
In truth, the letter was moderately worded--the scientists expressed concern, but could not agree among themselves whether such data ever should be used. All the same, Thomas wanted no part of this controversy--within three days, he had banned the use of the Nazi data in the phosgene report.
"The source of that information is so morally repugnant that I can't think of a situation where we would want to use it," Thomas told a reporter.
The speed and ferocity and certainty of all these opinions were understandable. The issues involved, after all, were so elemental and raw--redemption and brutal horror, life and death, good and evil. All the same, for anyone looking at this affair from a distance, the response still had to seem puzzling.
Everyone was treating Pozos' dilemma and the EPA issue as singular, newly risen quandaries, never asked before, never faced. This was not so.
American scientists, with little notice or discussion, have been referring to and citing the Nazi data for years, ever since Alexander's report became public.
According to the Hastings Center Report, at least 45 research articles published since World War II have drawn upon or cited data from Nazi experiments, and most of these articles involved hypothermia research.
The prestigious Journal of the American Medical Assn. (JAMA) published the first such article in July of 1946, authored by G. W. Molnar, a University of Rochester physiologist, who expressed no sense of moral dilemma while writing about hypothermia survival rates.
Nor did a team of physicians at Children's Hospital in Washington in March of 1955, when they appreciatively cited Alexander's report at length--and even urged expanded review of captured Nazi documents--in an article about the use of body cooling in pioneering open heart surgery experiments.
In 1983, John S. Hayward at the University of Victoria in British Columbia used the Dachau data as part of his work testing survival suits carried in fishing boats in the Canadian Arctic.
Pozos had simply been the first scientist to ask publicly whether all this was ethically acceptable. That, the bioethicist Caplan believes, partly explains the nature of the response Pozos drew.
By raising the Nazi data issue, Caplan argues, Pozos has poked a stick at a sore spot in the scientific community's psyche. What's more, Caplan says, the source of the tenderness reaches well beyond the specifics of the Nazi hypothermia data.
After all, American scientists in modern times have themselves more than once subjected involuntary or unaware human subjects to experiments that risked death.
In the Tuskegee syphilis experiment, the U.S. Public Health Service tracked the effects of untreated syphilis in some 400 black men in Alabama for 40 years, from 1932 to 1972--years in which penicillin emerged as an effective treatment, years in which the Nuremberg trials produced a code of ethics for biomedical research.
In the Willowbrook hepatitis experiments from the mid-1950s to the early 1970s, a New York University research team systematically infected groups of new residents at a Staten Island institution for the mentally retarded with hepatitis viruses, in order to monitor the disease's course and search for a cure.
In 1966, the distinguished Harvard Medical School professor Henry K. Beecher published a landmark article in the New England Journal of Medicine that described 22 such dubious human experiments conducted in the United States since World War II--a list that he considered only a sampling of the problem. Data from those experiments still floats through scientific literature--they were never banned or purged.
Yes, Caplan reasons, the American experimenters were respected scientists, with ethical arguments for their actions--but so, too, were the Nazis. Rascher had been put into motion by eminent German scientists who hoped to save the lives of German soldiers and pilots--and full of the sort of cost-benefit arguments that Caplan still hears all the time in 1988.
"The idea behind the negative reaction now is that the Nazis were criminals; we are decent," Caplan said recently. "That's not true. What we've done is not as evil, but it's in the ballpark. I could be said to slander scientists and trivialize Nazis, but I don't think so. It's part of the same continuum. The tendency by scientists now to flatly denounce use of the Nazi data is an attempt to get distance from the Nazi experiments, to put a boundary around this. Well, I'm not saying they are like Nazis, but I am saying we have to think about this."
So Caplan and Pozos, who recently left Minnesota for administrative and research posts at the University of Washington, have decided to continue forcing their issue.
Caplan's Biomedical Ethics Center at the University of Minnesota next spring plans to stage an international conference on "the legacy of the Holocaust for bioethics." There Pozos intends to present his evaluation of the Nazi hypothermia data to a host of scientists, historians, philosophers and ethicists. For the first time, the Nazi experiments will get this type of intense scrutiny.
It is uncertain, though, what will result.
How, finally, to measure whether good can be redeemed from evil?
Caplan and Pozos have considerably different expectations.
To Caplan, the conference promises a chance to look beyond Pozos' particular dilemma.
"The hardest thing I have to do is keep Pozos on track," he said. "The Pozos case touches past itself to much more, to questions about what science is capable of."
Pozos, on the other hand, remains as focused as the day he first opened the haunting and horrible Alexander report.
"Ethicists never answer a question," Pozos said. "They raise one question, which raises another question and another. I want guidelines. I want to know if the data is good, should we use it? Or should the data forever be banned?"
Times researcher Nina Green contributed to this story.