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Lessons From the Third Reich: Ethics and Economics

Ralph Crawshaw, MD
JAMA. 1997;277(9):710. doi:10.1001/jama.1997.03540330032018.
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To the Editor.  —The timely warning to our profession from Dr Barondess1 might have been stronger and more to the point if its conclusion, "a central lesson... is that medical ethos... can be severely distorted by social and political forces and by perversions in the application of science and technology," had included economic forces as well.Our profession is currently being ethically subverted by an economic ideology that viciously parallels the political ideology that corrupted German medicine. It was not made clear that our lesson needs forceful translation from a German political example into US economic reality.The fine article by Barondess is replete with examples of how economic coercion, fear of unemployment, promise of preferential income, and academic status compromised the ethics of front-line German practitioners. It is not intimidation by a totalitarian political force that grips US physicians but, like German physicians in the 1930s, fear of


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