Research Ethics and Professionalism on the Line: A Critical Analysis of Rockefeller Foundation Support of Neurosciences in Nazi Europe, 1933-1945

The Nazi movement, heavily rooted in eugenics, caused the persecution and exile of hundreds of neuroscientists. Additionally, eugenic research took place in Nazi Germany with the motivation of improving the so-called "German race" through elimination of hereditary neurological diseases. With the advent of illegal killing of neuropsychiatric patients after World War II started, those patients could be used unethically as research subjects. Thus, neuroscience was at the heart of immoral and unethical activities in Nazi Germany from 1933 to 1945. The Rockefeller Foundation (RF) supported at least twenty exiled academic neuroscientists who either had prior RF support, or who showed "merit" to justify their being awarded limited funds to restart their careers abroad. The RF also supported eugenic neuroscientific research in Nazi Germany (and Denmark) despite escalating racial persecution in pre-war Germany. Some RF funds went to an institute which was also funded by the elite Nazi paramilitary group, the SS. And, an initially RF-funded project, a monkey farm in Würzburg, was used in unethical experiments to prove the cause of multiple sclerosis (MS) with subjects targeted for killing. Overall, the RF walked a fine line between supporting some victims of Nazi persecution, while ironically continuing to fund some neuroscientific research that could be linked to their persecution in the first place, or to destruction of neuropsychiatric patients. While supporting academic refugees was laudable, there was an undercurrent of supporting "best science" without regard for the ethical implications, from which current neuroscientists and others can learn valuable lessons

“Awaiting further brains!” Hans Jacob and Brain Research on Hamburg “Euthanasia” Victims

Several neuropathologists conducted brain research on victims of so-called “euthanasia” programs carried out by the National Socialist (Nazi) regime in Germany from 1940-45. Some published their results in German journals or books during and after the war. One of these neuropathologists was Hans Jacob of Hamburg, a former Nazi party member and the leader of the same laboratory previously run by Alfons Jakob (Creutzfeldt-Jakob disease). Though much has been published on the unethical actions of Jacob’s fellow neuropathologist from Berlin, Julius Hallervorden, Jacob’s actions were remarkably similar and have not been previously analyzed in the neuroscience literature. Jacob dissected at least 42 patient brains from euthanasia centers near Hamburg, and saved the specimens from at least 17 of them. He published a 1956 book chapter featuring two such specimens. Jacob was denazified, had a notable career, and never publicly addressed his actions during the war. His ethical violations may not have been on the same scale as Hallervorden’s, but the impact of his work echoes to the modern era. As responsible researchers we must always be conscious of the provenance of material provided and not succumb to opportunistic temptation despite the ethical consequences

Dr. Haakon Sæthre: A Norwegian Neuroscientist and his Resistance against Nazi Germany

Dr. Haakon Sæthre was a leader of Norwegian neurology and psychiatry. He was resourceful, compassionate, and had immense pride in his independent homeland. He described Sæthre-Chotzen syndrome (acrocephalosyndactyly type III). When Nazi Germany occupied Norway during World War II, Sæthre fearlessly and actively resisted, from revoking his medical association membership, to hiding persecuted Jews as patients in his psychiatric ward and aiding in their escape to Sweden, to managing the largest “illegal” food warehouse in Oslo with Danish humanitarian aid. As a prominent and noticeable citizen, he was arrested and executed by the Nazis in reprisal for the resistance’s assassination of a hated Norwegian Nazi. His legacy lives on in Norway, where he was honored by a scholarship fund, a portrait and multiple plaques at Ullevål Hospital, and a street and memorial statue in his hometown. He was a hero, and should be remembered by all who practice neurology

A carpal tunnel grading system including combined sensory index-diagnosed mild cases: Relation to presenting features and outcomes.

INTRODUCTION: Prior studies have demonstrated superiority of the combined sensory index (CSI) algorithm in diagnosing mild carpal tunnel syndrome (CTS) and have compared presenting symptoms to CTS grade. However, CTS symptoms, signs, and outcomes, including CSI-diagnosed cases, have not been compared with CTS grade. METHODS: We retrospectively studied 294 CTS hands from 2010 to 2013; stratified them into mild, moderate, and severe grades; and analyzed the association between CTS grade and presenting symptoms/signs and outcomes. RESULTS: Sensorimotor symptoms (P = 0.017) and signs (P < 0.001) were significantly associated with CTS grade. Regardless of CTS grade, 94% of hands improved with surgery compared with 42% with conservative treatment (P < 0.001). Even in mild CTS, 100% improved with surgery vs. 33% with conservative management (P = 0.011). DISCUSSION: These results corroborate prior studies that compared symptoms to CTS grade and suggest that more objective signs associate even better. CTS grades associate with outcomes, but additional studies are required

Declining Use of the Hallervorden-Spatz Disease Eponym in the Last Two Decades

There has been a movement to rename Hallervorden-Spatz disease to pantothenate kinase-associated neurodegeneration given Hallervorden and Spatz's complicity in murderous Nazi programs. Similar controversy surrounds Reiter syndrome, and 2 studies demonstrated decreased unqualified use of that eponym in the literature, but not in textbooks. There have been no similar studies regarding Hallervorden-Spatz disease. The authors performed a MEDLINE search (1990-2010) looking for unqualified use of Hallervorden-Spatz disease and performed statistical analysis. They defined "unqualified" as having no reference to the eponym's disfavored use. They then looked in 6 neurology textbooks. The authors identified 156 of 278 articles (56.1%) containing unqualified use of Hallervorden-Spatz disease. But there was a declining trend (P = .000), with 70/80 (87.5%) of articles from 1990 to 1999 and 86/198 (43.4%) from 2000 to 2010. There was also decreased unqualified use of the eponyms in textbooks, with all recent editions using pantothenate kinase-associated neurodegeneration instead. The significant decrease in unqualified use of Hallervorden-Spatz disease is reassuring

New revelations about Hans Berger, father of the EEG, and his ties to the Third Reich

Hans Berger was a German neuropsychiatrist and head of the neurology department at the University of Jena, who discovered the human EEG. Many sources state that Berger was forced into retirement and suicide by the Nazis because he was at odds with the regime. In fact, Berger helped select his Nazi successor Berthold Kihn (also complicit in “euthanasia” murders), financially supported the Nazi SS, and was a willing participant on Nazi genetic health higher courts that reviewed appeals for forced sterilizations of neuropsychiatric patients. His motivations may be related to avoiding Nazi harassment, indoctrination by Nazi ideology, or less likely, career opportunism. His actions stand in contrast to colleagues who partially resisted the Nazis, and hopefully will serve as an example to future generations of neurologists regarding the danger of allowing one’s professional standing to be used as a tool to support the policies of tyranny and oppression