Robert N Proctor, Princeton, NJ, Princeton University Press, 1999, x+380 pages, $29.95 (hb), £17.95 (hb).

It is interesting, that with the notable exception of the Cologne-based geneticist Benno Müller-Hill, German historians of medicine have not bothered a great deal with looking into German medical history during the Third Reich. We owe Pennsylvania State University's Robert N Proctor a great deal of gratitude for uncovering more and more of this history, and for making it accessible in a highly readable format. Proctor has established himself rapidly as the pre-eminent US American historian of science on all aspects of Nazi medical research and health policy. In this most recent book Proctor looks at Nazism's pioneering contributions in public health research and policy, as well as in environmental health, occupational health, and preventive medicine. This book holds some disturbing lessons for those who hold the view that basically good people will undertake ethical research, and support good health policies, while bad people will conduct medical research in an unethical manner, and will work against good health policies. We will all probably be able to agree that Nazis basically were bad people. Racists, mass murderers and ideologues propagating the superiority of the German “race” are not likely to find many friends amongst biomedical ethicists or the wider community. Yet, as Proctor shows, Nazi scientists were the first to establish conclusively links between smoking and lung cancer. The Nazi regime's leading figures ran bitter campaigns against smoking. The regime also established progressive occupational health policies designed to reduce the number of cancers caused by occupational exposure to asbestos, radium and uranium and other carcinogens. Unsurprisingly, perhaps, these policies did not apply to prisoners of war, who were often forced to undertake the most hazardous work without adequate protective clothing. Reich Health Führer Leonardo Conti, the leading anti-tobacco campaigner of the Third Reich, committed suicide after the war, while awaiting his execution for another leadership role he took up during the Third Reich, the murder of intellectually and otherwise disabled people—euphemistically described as the “euthanasia campaign”.

Much of this book recounts battles between Nazi quacks and Nazi scientists, wrangling for the political elite's favours and support, medical researchers creating ideologically suitable rhetorical frameworks to assure that their work finds continuous financial support. The reader also learns how progressive policies (for example the anti-smoking campaigns) were undertaken out of less than savoury motives (ie to prevent the “Aryan” genetic material from deteriorating, or in order to keep soldiers fit for combat). Hundreds of Germany's leading cancer researchers lost their university positions, and often their lives, because they were Jewish.

Proctor's book serves as a timely reminder that the Nazi regime wasn't a monolithic evil empire. He forces us to recognise that different interest groups fought each other both with regard to the direction of cancer research, and with regard to the “right” direction of public and occupational health policies.

It is widely accepted today that ideology inevitably corrupts scientific inquiry in some fundamental sense. However, it is also important to recognise that ideologically corrupted inquiries can still yield scientifically sound research and research results. As Proctor says: “Nazi inspired research was often idiotic, but not always” (page 257).

One last point Proctor makes is addressed toward pro-life Christian bioethicists. He warns them not to compare Nazi “euthanasia” with “current efforts to allow people to choose the manner and timing of their death”. “Bioethical discussions”, he writes, “are full of facile identifications of Nazism with everything from abortion and rationalised medicine to doctor-assisted suicide”. This reviewer at least couldn't agree more.

This book is a rich source of historical information. Analytical ethicists in particular, would be well advised to have a closer look at the information provided in this book. Flippant remarks such as roads are roads are roads, no matter whether a Nazi or someone else built them, turn shallow when one looks at the broader historical and social context in which roads were built by the Nazi regime, progressive cancer research took place in the Third Reich, and progressive occupational health policies were introduced to protect the health of the German people. So, even though this is not explicitely a “bioethics” book, it undoubtedly holds many valuable lessons for anyone with an interest in bioethics and/or the history of medicine.