The Nazi War on Cancer

Robert N. Proctor · 1999

Thesis

Nazi Germany produced some of the most advanced cancer research and the most aggressive public health campaigns of its time, including the first strong evidence that smoking causes lung cancer, and these achievements grew from the same vision of a pure, healthy racial body that drove its crimes, which shows that good science is not a guarantee of good politics or morals.

The main ideas

German scientists under the Nazis produced early, strong evidence that smoking causes lung cancer.
The regime ran the most forceful anti-smoking campaign of its era.
Nazi health authorities recognized occupational causes of cancer, including asbestos.
They promoted whole-grain bread and opposed harmful food dyes and pesticides.
These policies grew from an ideal of a healthy national body that also justified racial persecution and genocide.
Good science can flourish under a murderous regime, so science is not inherently virtuous.

The flip side of fascism

Robert N. Proctor is a historian of science at Stanford University, known for his work on how ignorance is produced, a field he has called agnotology, and for testifying as an expert witness against the tobacco industry. He first described Nazi anti-tobacco research in an article in the BMJ in 1996. The Nazi War on Cancer, published by Princeton University Press in 1999, expanded the subject.

The book's argument is uncomfortable. Nazi Germany, best known for racial persecution and genocide, also pursued cancer research and public health measures that were, in several respects, ahead of those of other nations. Proctor insists that he is not trying to soften the regime's crimes, and that modern anti-smoking campaigns do not have fascist roots. His point is that the two sides of Nazi medicine came from the same place.

Implication: do not assume that a regime's scientific achievements and its moral character must match.

The tobacco research

German scientists in the Nazi period established a link between smoking and lung cancer years before the British and American studies of 1950 that are usually credited with the discovery.

In 1939, Franz Hermann Müller in Cologne published what is described as the first case-control study of smoking and lung cancer, comparing the smoking histories of lung cancer patients with those of healthy people and finding a strong association. In 1943, Eberhard Schairer and Erich Schöniger published a larger study from Jena with similar findings. Their work came from an institute for tobacco research at the University of Jena, headed by Karl Astel, a racial hygienist and the university's rector, which received funding from Hitler, who personally loathed tobacco.

The mechanism is that research directed and funded by the state, for ideological reasons, can still produce valid findings if its methods are sound.

Implication: judge a scientific finding by its methods and evidence, not by the motives of those who funded it.

The war on tobacco

Proctor describes the Nazi anti-smoking campaign as the most aggressive of its time. Smoking was banned in some public places, tobacco advertising was restricted, and women's access to cigarettes was limited through rationing.

The campaign drew on medical findings but also on ideology. Tobacco was cast as a poison that harmed the national body, and opposition to it was mixed with racial and nationalist themes.

Its effects were limited, and cigarettes were still handed out to soldiers and other favored groups.

The mechanism is that sound public health goals can be pursued through an ideology that values individuals only as parts of a collective body.

Implication: when a public health campaign succeeds or fails, look at the reasons given for it, as well as the evidence behind it.

Occupational cancer

Nazi health authorities paid attention to cancers caused by work. In 1943, a Reich ordinance made asbestosis together with lung cancer a compensable occupational disease, at a time when the asbestos industry elsewhere was still resisting recognition of its dangers. Asbestosis itself had been compensable in Germany since 1936.

German researchers also studied cancers caused by radiation and other workplace hazards.

The mechanism is that a state committed to the health of its workforce, for productive and ideological reasons, can act on evidence that a profit-driven industry would prefer to ignore.

Implication: recognition of occupational hazards depends less on the evidence than on who has the power to act on it and whether they want to.

Diet and the environment

Proctor describes campaigns for healthier food. Nazi health officials promoted whole-grain bread and soybeans and restricted the use of food dyes and pesticides suspected of causing cancer.

These campaigns fit a broader vision of a natural, healthy German people, protected from the poisons of modern industrial life, an ideal that blended concern for public health with romantic nationalism.

The mechanism is that concern for purity, whether of food, the body or the nation, can motivate genuinely protective policies and violent exclusion at once.

Implication: be alert when a language of purity and contamination moves from food and medicine to people.

The healthy body of the nation

The book's deepest argument concerns the metaphor of disease. Nazi propaganda spoke of the German people as a single body, and of Jews and other groups it persecuted as tumors or infections within it. The same vocabulary of hygiene, purification and removal applied to tobacco, food dyes and human beings.

Proctor shows that the regime's health benefits were reserved for those it considered racially fit. The same medical establishment that pursued cancer prevention took part in forced sterilization, the killing of disabled people and the Holocaust.

The mechanism is that a vision of collective health that values people only as parts of a racial whole can justify both care and murder, depending on which side of the line a person falls.

Implication: ask whom a health policy is designed to protect, and whom its logic might exclude.

Limits

Its picture of a coherent anti-tobacco policy has been questioned. A 2008 study by Eva Bachinger, Martin McKee and Anna Gilmore found strong anti-smoking sentiment in Nazi Germany but no consistent national policy, ambivalence among leaders, weak enforcement and measures that built on earlier ones.
Its argument is strongest on tobacco. Its claims about good science in other areas, such as diet and environmental hazards, rest on thinner evidence, and some reviewers found its framing of the flip side of fascism too neat.
It can be misused. Opponents of modern public health measures have cited the history to suggest they have fascist roots, an inference Proctor explicitly rejects.

Agnotology — Proctor on how the tobacco industry later manufactured doubt about the same science.
The Emperor of All Maladies — the wider history of the fight against cancer, including the tobacco evidence.
Brave New World — a fictional state that manages its citizens' bodies for the good of the collective.