and a documentation of patient-harming frauds in medical research
Rigged studies in preemie treatment
and their continuing cover-up
My letter to Dr. Feinstein, continued from page 1
It was the medical idea of "prevention by selection of parents" that had led to the core of the Nazi ideology. This idea was obviously not yet dead. The openly published recommendation in the discussion of Reese's paper, in the journal he edited, against preserving potential "defectives" was reinforced by the suggestive quote marks around the word "fate" and by the equally suggestive lumping together of the blindness with the entirely unrelated dementia. This recommendation shines a spotlight on the persistence of that medical group's traditional belief in active eugenics, the secret medical elimination of the "defectives".
The attitude which this 1948 recommendation reveals is the same pro-euthanasia attitude that Robert N. Proctor, Associate Professor of History at Penn State University, described as having prevailed just a few years earlier among American physicians, in his contribution to a book on "The Nazi Doctors and the Nuremberg Code -- Human Rights in Human Experimentation" :
However, the reports of these Nazi horrors had plainly not changed the mindsets of Reese and the physicians around him. The above advice to not preserve "defectives" who might become blind is consistent with other telltale clues to the strong influence of eugenics ideas on the medical approach to ROP of that time.
For instance, a historian writing about the origins of the Holocaust in the eugenics movement tells us that a prominent trait of that movement was its opposition to social legislation intended to aid the poor, with the argument that such a social net prevented the operation of natural selection8.
The anti-oxygen advocates in the early 1950s clinical literature on ROP copied their language straight from those speeches: for instance, they called for a "less indulgent" care of premature infants without "a prolonged subsidy [that] paralyzes the ability to struggle" (see pages 26 and 27 in my book, or click here).
The roots of this attitude in the education of those 1950s nursery doctors are not hard to trace. One of your former colleagues at Yale, the late Dr. Howard W. Haggard, described in his 1989 book "The Doctor in History" how the views of physicians get shaped:
You state similarly, on Santayana page 80, that the "patterns of thought and behavior [of medical leaders] are usually fixed before leadership arrives", and many other medical writers bemoan the same sorry state of affairs10. Unfortunately, few seemed able to do much about it until you diagnosed this root cause of the Santayana Syndrome so well in your essays. The damaging deeds of Reese et al. are a case that illustrates your description:
The senior physicians of the 1940s and 1950s had studied their trade in the 1920s and 1930s, a period when many medical scientists actively and then still openly supported the eugenics movement11. The students absorbed these theories as part of their medical education and then, conditioned to the typical blind faith of doctors in their medical authorities, continued to think and speak the way they had been taught.
German medical trends are said to have been extremely influential in American medicine of that time, and many American doctors had augmented their education by study in Europe12. Reese, for instance, had studied in Vienna13 in 1921 and again in 1925-26, an indication that he agreed with what he learned there.
The belief in eugenics in Vienna was so strong at that time that even the physicians allied with Austrian Social Democracy proposed that abortion decisions should be made only on "medical, social, and eugenic" grounds14.
On both sides of the Atlantic, the medical teachers for Reese's generation of physicians had been accustomed to refer to preemies as "weaklings" and to dismiss them as products of a hereditary "diseased maternal environment" who would suffer from "atrophy and wasting" if they survived at all15.
Add to this that as the first cohort of children blinded in preemie nurseries reached the age to go to school, the American pupils of these eugenics- preaching medical teachers came under pressure to end the epidemic which was then "overwhelming the country's facilities for blind children".
Their reaction confirms the necessity of your warning on page 76 that political pressure leads to violations of ordinary scientific precautions because the nursery doctors involved did indeed violate all scientific as well as ethical standards.
Their "solution" for reducing the number of children blinded by ROP was the same that their German colleagues had initiated a few years earlier to reduce the number of people with handicaps such as hereditary blindness. But Reese et al. improved on their method.
Those German doctors had tried to keep their euthanasia program secret whereas Reese and his group wrapped it with a candy- coating of bogus science that hid the equally distasteful substance of the American version: the systematic but unadmitted medical killing of those whom those few prejudiced doctors deemed at risk to be "defective".
An "intellectual autopsy" of the 1953/54 oxygen withholding study:
Shortly after the above quoted euthanasia advice to not preserve the babies at risk for ROP had appeared in that leading mainstream medical journal, and this trial balloon had not been challenged in print anywhere I could find in the clinical literature of that time, Reese and other nursery doctors took the next step in acting on their idea for ending the epidemic: as I show on my pages 26 to 29, they began to disparage the supplementary oxygen that was used to preserve these babies.
Once their trumped-up accusations and insinuations against this life-saving gas had been widely published, they designed the "Cooperative Study of Retrolental Fibroplasia" as their subterfuge to covertly prevent the survival of babies who might wind up with the eye damage.
The signs that this study was a deliberate fraud are numerous. For instance, Reese had predicted long before any data from the study came in that oxygen would be "successfully incriminated"16, exhibiting thereby a bias in favor of this outcome that ruled out all objectivity in the evaluation.
When the preliminary results did arrive, Reese led the meeting in September 1954 where he introduced as well as closed the lenghty presentation of the pre-arranged outcome from that study17. Yet, his writings on this subject show that he did not believe a word of his own accusations against the oxygen scapegoat.
Until then, Reese had consistently maintained that the blinding was "without doubt" due to prenatal causes. Even as late as 1952, he had written a lengthy paper in which he claimed to have found ROP in the eyes of stillborn infants and concluded that the disease may be present at birth although demonstrable evidence for it at this early age was the exception.
The writer who wrote these words could thus not honestly blame postnatal oxygen administration for a condition he so firmly believed two years earlier to exist at birth, but he and his like-minded colleagues condemned it anyway.
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