The Nazi Physicians as Leaders in Eugenics and "Euthanasia": Lessons for Today.

This article, in commemoration of the 70th anniversary of the Doctors' Trial at Nuremberg, reflects on the Nazi eugenics and "euthanasia" programs and their relevance for today. The Nazi doctors used eugenic ideals to justify sterilizations, child and adult "euthanasia," and, ultimately, genocide. Contemporary euthanasia has experienced a progression from voluntary to nonvoluntary and from passive to active killing. Modern eugenics has included both positive and negative selective activities. The 70th anniversary of the Doctors' Trial at Nuremberg provides an important opportunity to reflect on the implications of the Nazi eugenics and "euthanasia" programs for contemporary health law, bioethics, and human rights. In this article, we will examine the role that health practitioners played in the promotion and implementation of State-sponsored eugenics and "euthanasia" in Nazi Germany, followed by an exploration of contemporary parallels and debates in modern bioethics. 1.

"Forgotten" Chapters in the History of Transcervical Sterilization: Carl Clauberg and Hans-Joachim Lindemann.

Transcervical sterilization is a non-surgical method of permanent female sterilization that is widely used and critically discussed. A review of the historiography of the method reveals that instances of its coercive use are not included in the historical account. This study offers a reexamination of the work of Carl Clauberg and Hans-Joachim Lindemann, to more deeply contextualize within the framework of current usage the coercive use of transcervical sterilization during the Third Reich and in postwar Germany. This inquiry is based on postwar criminal trial records on Clauberg, and on archival documents detailing Lindemann's activities in 1979. A comparative analysis examines arguments by medical historian Karl-Heinz Roth, and identifies shared characteristics and differences between Clauberg and Lindemann, their methods and scientific connections. The results demonstrate that the technique of transcervical sterilization has an abusive potential that may be explained as a function of the person of the physician, of the scientific method itself, and of societal and political influences. The analysis supports the argument that insights from the cases of Clauberg and Lindemann are transferrable geographically and over time, and have the potential to inform current medical practice, such as transcervical sterilization with the Essure device, whose historiographic exploration remains a desideratum.

Public health in the Vilna Ghetto as a form of Jewish resistance.

We describe the system of public health that evolved in the Vilna Ghetto as an illustrative example of Jewish innovation and achievement during the Holocaust. Furthermore, we argue that by cultivating a sophisticated system of public health, the ghetto inmates enacted a powerful form of Jewish resistance, directly thwarting the intention of the Nazis to eliminate the inhabitants by starvation, epidemic, and exposure. In doing so, we aim to highlight applicable lessons for the broader public health literature. We hope that this unique story may gain its rightful place in the history of public health as an insightful case study of creative and progressive solutions to universal health problems in one of the most challenging environments imaginable.

Ethical considerations in the use of Pernkopf's Atlas of Anatomy: A surgical case study.

The use of Eduard Pernkopf's anatomic atlas presents ethical challenges for modern surgery concerning the use of data resulting from abusive scientific work. In the 1980s and 1990s, historic investigations revealed that Pernkopf was an active National Socialist (Nazi) functionary at the University of Vienna and that among the bodies depicted in the atlas were those of Nazi victims. Since then, discussions persist concerning the ethicality of the continued use of the atlas, because some surgeons still rely on information from this anatomic resource for procedural planning. The ethical implications relevant to the use of this atlas in the care of surgical patients have not been discussed in detail. Based on a recapitulation of the main arguments from the historic controversy surrounding the use of Pernkopf's atlas, this study presents an actual patient case to illustrate some of the ethical considerations relevant to the decision of whether to use the atlas in surgery. This investigation aims to provide a historic and ethical framework for questions concerning the use of the Pernkopf atlas in the management of anatomically complex and difficult surgical cases, with special attention to implications for medical ethics drawn from Jewish law.

Oral health status of refugee torture survivors seeking care in the United States.

We assessed the oral health status of 216 refugee torture survivors seeking care at an urban torture treatment center in the United States. Results showed that patients' dental health ranged from poor to fair; 76% had untreated cavities, and approximately 90% required immediate or near-immediate dental care. Torture treatment centers, in addition to offering safe environments for educating and examining patients, are ideal settings to provide basic oral health services without the risk of retraumatization.

Prevalence of torture survivors among foreign-born patients presenting to an urban ambulatory care practice.

BACKGROUND: The prevalence of torture among foreign-born patients presenting to urban medical clinics is not well documented. OBJECTIVE: To determine the prevalence of torture among foreign-born patients presenting to an urban primary care practice. DESIGN: A survey of foreign-born patients. PATIENTS: Foreign-born patients, age > or = 18, presenting to the Primary Care Clinic at Boston Medical Center. MEASUREMENTS: Self-reported history of torture as defined by the UN, and history of prior disclosure of torture. RESULTS: Of the 308 eligible patients, 88 (29%) declined participation, and 78 (25%) were not included owing to lack of a translator. Participants had a mean age of 47 years (range 19 to 76), were mostly female (82/142, 58%), had been in the United States for an average of 14 years (range 1 month to 53 years), and came from 35 countries. Fully, 11% (16/142, 95 percent confidence interval 7% to 18%) of participants reported a history of torture that was consistent with the UN definition of torture. Thirty-nine percent (9/23) of patients reported that their health care provider asked them about torture. While most patients (15/23, 67%) reported discussing their experience of torture with someone in the United States, 8 of 23 (33%) reported that this survey was their first disclosure to anyone in the United States. CONCLUSION: Among foreign-born patients presenting to an urban primary care center, approximately 1 in 9 met the definition established by the UN Convention Against Torture. As survivors of torture may have significant psychological and physical sequelae, these data underscore the necessity for primary care physicians to screen for a torture history among foreign-born patients.

A preliminary comparison of primary care use by refugees before and after acupuncture.

BACKGROUND: Limited research exits on utilization and cost-effectiveness of acupuncture among underserved communities, and virtually no evidence has been published with respect to refugee populations. In this study, we examined the relationship between acupuncture and the total utilization of primary care services in a cohort of refugee patients with chronic pain. METHODS: We retrospectively reviewed the medical records of 16 refugee patients with chronic pain at Boston Medical Center (BMC). The research was IRB-approved. Demographics and total charges associated with primary care over 18 months were collected. RESULTS: Total charges associated with primary care services decreased by 50.2% in our refugee cohort in the 12 months following acupuncture treatment, equivalent to a savings of $691 per patient per month. CONCLUSIONS: This preliminary review demonstrated a statistically significant decrease in total charges associated with primary care following acupuncture treatment (p=0.0308). This study suggests the need for further investigation of the relation between acupuncture and refugees with chronic pain, as well as the financial implications of this relationship. It is unclear why refugees may seek fewer primary care services after acupuncture treatment. Additional study is needed to further explore whether this relationship is generalizable to other hospital services and to other patient populations.

Acupuncture and traditional Chinese medicine for survivors of torture and refugee trauma: a descriptive report.

Refugees with trauma histories are a difficult medical population to treat. Acupuncture care has gained acceptance in many mainstream hospitals in the United States, but research on acupuncture and refugee populations is limited. Herein, we report our experiences with 50 refugees (total acupuncture treatments = 425) at a major tertiary teaching hospital. Patients often reported extreme trauma including physical torture, rape and witnessing the same in family members. Patients represented 13 different countries, with about half the patients being Somali. The primary complaint of all patients was pain (100%). Using the Wong-Baker Faces Pain scale, 56% patients reported pain decreases. Patient acceptance of acupuncture was high. We provide three case histories as illustrative examples. Further research is warranted.

The use of complementary and alternative medicine among refugees: a systematic review.

Little is known about the use of Complementary and Alternative Medicine (CAM) among refugees, despite the common practice of CAM in many non-Western countries. We performed a systematic review of peer-reviewed literature using nine electronic databases. We included articles pertaining to refugees and CAM (whole medical systems, mind body medicine, herbal remedies, manipulative therapies, energy medicine). Qualitative and quantitative data were compiled and analyzed through descriptive statistics and chi square distribution tables. We reviewed 237 abstracts, and 47 publications met our inclusion criteria. Twenty-six papers documented whole medical systems; 11 mind-body medicine; 5 biologically based practices; 4 manipulative and body-based therapies; and 1 study documented the use of energy medicine. There were 3 clinical trials, 20 surveys, 12 case reports, 2 participant-observer qualitative papers, and 10 review papers. Most studies focused on Asian refugee populations (66%; n = 31). Mental problems related to trauma accounted for 36% of CAM use (17). Among included articles, methodological quality was extremely low. Our results show evidence that type of CAM used by refugees may vary based on ethnicity, yet this is most likely due to a bias in the medical literature. Efforts are needed to further explore these results and expand research within this field.

Clinical issues in caring for former chattel slaves.

Over the centuries, slavery has become embedded into the social fabric of Mauritania with generations of abid and bizan (Mauritanian slaves and slave masters, respectively) born and raised knowing nothing but the institution of chattel slavery. Abid fleeing their station in Mauritania come to the USA with unique psychological needs that will affect all of their interactions with the medical community. This paper aims to assist health professionals and others concerned with the welfare of former chattel slaves in competently serving this vulnerable population. Discussion includes an overview of Mauritanian chattel slavery, deduced sequelae of chattel slavery, preliminary recommendations for mental health and medical treatment protocols, and suggestions for future research. A confidential Institutional Review Board (IRB)-approved case report will be used to illustrate these objectives.