To Your Health!

The Nazi War on Cancer, by Robert N. Proctor (Princeton, 380 pp., $ 29.95)

The title of this volume incorporates the words Nazi, war, and cancer. It's hard to get more serious than that. Yet Robert Proctor's book has been treated in certain quarters as something of a sick joke. It is easy to caricature this work, based on quotes taken out of context and promotional material emphasizing "the flip side of fascism," as an attempt to show that the Nazis weren't so bad after all: Despite their unfortunate genocidal tendencies, they were remarkably "progressive" and "socially responsible" in matters of public health.

But Proctor, a historian of science at Pennsylvania State University whose previous work includes a detailed examination of Nazi medical atrocities, is more subtle than that. He makes it clear at the outset that his intent is not to mitigate the horrors of Hitler's regime but to explore its complexity. He draws on a wealth of documents, illustrations, and biographical information to show that in some areas Nazi ideology not only permitted but actively encouraged good science, and what he takes to be good public policy based on it.

Thus, "it was in Germany in the late 1930s that we first find a broad medical recognition of both the addictive nature of tobacco and the lung cancer hazard of smoking. . . . The Nazi regime launched an ambitious antismoking campaign, involving extensive public health education, bans on certain forms of advertising, and restrictions on smoking in many public places." Hitler himself detested tobacco, which he called "the wrath of the Red Man against the White Man, vengeance for having been given hard liquor." But the antismoking campaign reflected "a national political climate stressing the virtues of racial hygiene and bodily purity" as well as the Fuhrer's personal prejudices. The same could be said of Nazi efforts to discourage drinking and encourage a better diet.

While Proctor provocatively emphasizes that "public health initiatives were pursued not just in spite of fascism, but also in consequence of fascism" (his italics), he shies away from exploring the evident common ground shared by fascism and the ideology of "public health." He is right to reject the unthinking equation of public-health activism with Nazism, including the use of epithets such as "NicoNazis" and "health fascists" (though he fails to note that such rhetoric is also common among tobacco's opponents, who liken cigarette makers to the Nazis and speak of "the tobaccoism holocaust"). But he is too quick to dismiss the totalitarian implications of a government commitment to minimize morbidity and mortality.

Part of the problem is Proctor's failure to distinguish between protecting people from external threats, such as disease carriers or environmental toxins, and protecting people from their own risky habits, such as smoking, drinking, sloth, and gluttony. The Nazis were indeed ahead of their time in viewing the latter sort of health hazard as a legitimate concern of government, but this is hardly surprising, given their disregard for individual freedom. As Proctor notes in connection with Nazi food propaganda, "the liberal distinction between public and private spheres was abandoned. As one Hitler Youth health manual put it, 'Nutrition is not a private matter!' The body of the German citizen, after all, was supposed to be the material property of the German state. . . . The state thereby acquired a stake in the maintenance of the individual body."

American statists echo this idea of "health as a duty" when they argue that the government should discourage risky behavior because it saps the nation's productivity and drains the public treasury. Taxpayer-funded health care, another area where the Germans, not coincidentally, were remarkably "progressive," has become a pretext for a wide variety of limits on personal freedom, including alcohol and tobacco taxes, advertising restrictions, and laws requiring people to use seat belts and motorcycle helmets. As Faith T. Fitzgerald, a professor at the University of California, Davis, Medical Center, observed in The New England Journal of Medicine a few years ago, "Both health care providers and the commonweal now have a vested interest in certain forms of behavior, previously considered a person's private business, if the behavior impairs a person's 'health.' Certain failures of self-care have become, in a sense, crimes against society, because society has to pay for their consequences. . . . In effect, we have said that people owe it to society to stop misbehaving."

Proctor does not seem disturbed by this development. Nor does he question the assumption that the government should protect "the public health" from individuals who choose to trade longevity for pleasure. Yet surely that collectivist imperative helps explain why public-health goals meshed so well with Nazism. As Proctor notes, "the ideology of prevention merged with the ideology of 'one for all and all for one' (Gemeinnutz geht vor Eigennutz) that was yet another hallmark of Nazi thought: as one anti-tobacco activist put it, nicotine damages not just the individual but the population as a whole."

Compare this with contemporary public-health doctrine, as summed up by no less an authority than former surgeon general C. Everett Koop: "The government has a perfect right to influence personal behavior to the best of its ability if it is for the welfare of the individual and the community as a whole." This principle gives the government the authority to judge "the welfare of the individual" and elevates "the community as a whole" above individuals.

Having set out to solve the puzzle of enlightened, scientifically grounded policies under an evil regime, Proctor is at pains not to taint public health by its association with the Nazis. "Movements can be disengaged from their ideological support strings," he insists, "however important those strings may be at any given time in history." True enough—but the public-health movement would be worrisome even if the Nazis had taken no interest in it at all.