Abstract
To the Editor:
We read with interest the recent letter to the editor, “The Use of Unethical Research in Wilderness Medicine Education.” 1 This letter has raised an important issue about medical history. The letter was in response to a presentation on hypothermia at a recent wilderness medicine meeting. A data figure from the infamous Dachau experiments by the Nazis in World War II (published in the Alexander Report and then again by Molnar)2,3 was presented for historical perspective and with the caveat that these experiments were “highly unethical.”
The sensitivity of some to even the mention of this work seems to surface every generation or so of researchers. Our colleague, the late John Hayward, studied hypothermia during the 1970s and 80s and often referred to the Dachau studies with the usual “unethical” caveat. 5 This created some controversy, and some articles have addressed the topic.6,7 The first author of this letter started his career the year after Dr Hayward retired, and he met with similar, though less intense, debate when he referenced the Dachau experiments in several papers solely to provide a full historical context.8,9 In fact, after submitting one manuscript for publication, one referee suggested the reference be left out, whereas the other referee insisted the reference be left in; it was indeed left in. Now the concern has risen again for a new generation of medical researchers and practitioners.
At the core of the issue are two opposing views: 1) we should not give validity to these atrocious studies by even referring to them in any way; and 2) if the data can be used for any positive use, it should be, so that the tragic victims would not have died in vain.
One important question is, “What does it mean to ‘use’ the data?” It certainly does not mean using it to inform clinical guidelines, although it has informed some mathematical modeling of core cooling (see below). We feel there is some value in providing an important historical record of cold research, specifically, and all World War II atrocities in general.
Hayward and his colleagues carefully considered how some results of the Dachau studies related to their own work. In one example, they noted that once a prisoner’s core temperature started to drop, it followed a linear pattern to low core temperatures that could never again be studied (Martin Collis, personal communication, June 2022). Therefore, Hayward’s group created prediction equations that extrapolated linear cooling rates below their ethically obtained lowest observed core temperatures. 5 This principle of linear cooling rates is now commonly accepted.
As we review our own research careers, we have noted that in addressing a natural progression of questions, we have addressed many of the questions posed in the Alexander report, with the caveat that our studies were all ethically approved and safely conducted on willing healthy volunteers. Notably, many of our conclusions were qualitatively similar. Now we have a new generation of medical practitioners and researchers, some of whom will focus on the human in the cold. We suspect that very few are familiar with the Dachau experiments and even fewer have knowledge of the Alexander report.
Thinking about this issue in more detail, we have come to a startling conclusion. Instead of burying these atrocities in the historical dustbin, we might do well to provide a detailed historical summary of what went on in that horrendous prison camp during that dark period of history. In almost all other areas we ardently revisit atrocities (eg, all concentration camp experiences) and tragedies (eg, slavery) with two goals in mind: “never forget” and “never again.” One publication on this topic asked a relevant question about these cold research atrocities with a section heading titled “A Futuristic Scenario: Can It Happen Again?” 4 We think it would benefit many, especially our new generation of researchers and practitioners, to provide such a historical review at some future medical meeting. We would be willing to provide such a review to support these two important goals: “never forget” and “never again.”