CU Anschutz recently honored more than 25 faculty members for 25 years of service to the university. Those honored included:
School of Dental Medicine
Douglas Heller, DMD
School of Medicine
Arne Beck, PhD
Thomas Beresford, MD
Thomas Campbell, MD
Richard Dart, MD, PhD
Debra Dyer, MD
Satish Garg, MD
Michael Hall, MD
Joy Hawkins, MD
Barbara Helfrich, MSc
James Hill, PhD
Edward Hoffenberg, MD
Allison Kempe, MD
Susan Mandell, MD, PhD
Robert McIntyre, Jr., MD
Glenn Merritt, MD
Gregory Owens, PhD
Robert Quaife, MD
Jane Reusch, MD
Virginia Sarapura, MD
Isabel Schlaepfer, PhD
Jeanelle Sheeder, PhD
Ann Watlington, MD
Jonathan Woodcock, MD
Liping Yu, MD
Skaggs School of Pharmacy
Douglas Fish, PharmD
Cathy Jarvis, PharmD
CU Chancellor Don Elliman presented the faculty with commemorative medallions and thanked them with these remarks:
“Our faculty—your talent—makes this place what it is. Over the last 25 years, you have revolutionized the field of healthcare. Only 18 years ago, virtually everything here today, except for building 500, didn’t exist. You, quite literally helped build this campus from the ground up. I want to thank all of you for your many years of hard work and dedication to the university.”
One of history’s darkest periods – Germany in the 1930s and 1940s – took root during a propaganda-fueled march toward what were deemed imperative public health measures. The Nazis’ quest to create an “Aryan super race” led to thousands of innocents being killed, maimed and tortured.
This relentless pursuit, marked by a perversion of medical ethics, ultimately ended in the conviction of a handful of key players at the Nuremberg Doctors’ Trial. The 70th anniversary of the trial, where 23 Nazi physicians and administrators were brought to justice for heinous crimes against humanity, was remembered during a recent program at the CU Anschutz Medical Campus.
Matthew Wynia, MD, MPH, director of the CU Center for Bioethics and Humanities, said the annual Holocaust Genocide and Contemporary Bioethics Program was strengthened this year by a partnership with the Maimonides Institute for Medicine, Ethics and the Holocaust. The partnership allowed the program to bring in speakers from around the world, making it a “unique and important event for the entire university community.” Other contributions included a generous grant from the M.B. Glassman Foundation as well as from Dr. William Silvers. Wynia noted that the annual program, for the first time, touched all four CU campuses
A capacity crowd filled the Gossard Forum in the Fulginiti Pavilion to hear two experts on the landmark trial – Tessa Chelouche, MD, a physician and educator in Israel, and Susan Miller, MD, MPH, a research chair at the Houston Methodist Research Institute – speak on “Healing by Killing: Nazi Doctors and Modern Medical Ethics.” A panel also discussed the “Legacies and Lessons for Today’s Health Professionals” in a session after the lunch program.
Roots of cruelty precede Third Reich
In their talk, Chelouche and Miller gave chilling accounts of how leading physicians were behind the sterilization, euthanasia and human-experiment programs of that era. They also explained how the atrocities that came to light during World War II had roots that extended long before – and well beyond – the Third Reich, and they reverberate to this day.
A eugenics movement spread across the industrialized world in the early 20th century, including the United States, where sterilization laws were passed in more than 30 states. In the U.S., about 64,000 to 70,000 people – deemed by the medical profession as unfit to reproduce – were sterilized against their will, Chelouche said.
Hand in hand: Doctors and politicians
In early 20th century Germany, the “racial hygiene” movement grew and influenced Adolf Hitler, “giving him a scientific legitimacy for his racist political theories.” Fifty percent of German physicians joined the Nazi party, so “this wasn’t about a few crazy, mad doctors,” Chelouche said.
The symbiotic relationship of politicians and physicians in Germany – 400,000 Germans were sterilized against their will before the start of World War II – took an even more perverse turn after the war began in September 1939. Hitler launched his so-called euthanasia program, empowering doctors to kill patients deemed mentally or physically ill. Chelouche clicked to what she called her “most scary slide. This is a gas chamber,” she said. “It’s not a gas chamber in a concentration camp. It’s not a gas chamber at Auschwitz. This is a gas chamber in a hospital…. The ultimate decision to gas the Jews emerged from the fact that the technical apparatus already existed in the hospital.”
Miller expounded on the medical research conducted in the name of scientific advancement and nationalism. Nazi physicians collected tissues for research at the concentration camps, marking victims with an X on their back. “They were planning, through these experiments, for people to die; it was part of the design of the research experiment to see what happened to them,” Miller said.
After the trial, which ended in the conviction of 16 doctors (seven were sentenced to death), the medical world fell largely silent. The general feeling was that the Nuremberg code, which set the guidelines for medical research involving humans (the first being voluntary consent), was written for Nazi doctors, not for other physicians.
Miller listed several medical studies by U.S. researchers that occurred post-Nuremberg Doctors’ Trial (December 1946 to August 1947). The ill-gotten studies – into syphilis, radiation and mustard-gas exposure, hepatitis A – involved patients, including children, undergoing unethical procedures during the research.
Education is imperative
The experts noted how pre-World War II Germany was the global destination to learn the latest medical techniques. Prior to its research abuses, the nation boasted research ethics codes for both human and animal subjects. Germany, too, was the first country to teach medical ethics in medical schools. The students learned, though, as the “super race” objective intensified, to be loyal to the nation, not the patient. “They (learned they) should be biological soldiers – in charge of the future race health of their nation,” Chelouche said.
This propaganda machine led the nation’s health profession down a dark ethical road, Miller said. Besides its outright barbarism, research conducted on prisoners during the Nazi era lacked any institutional review or patient consent and some of it was further marred by fraudulent data, often spurred by blatant conflicts of interest. Conflicts of interest in research remain a problem today, Miller said, when they cause health professionals to care more about their research results than the safety and well-being of research subjects.
Both experts said human nature makes it possible for such atrocities to occur again. They said that’s why education is imperative to combat ignorance, prejudice and cruelty. “Given the right circumstances, we are all prone to cruelty and capable of blindly following a path to evil,” Chelouche said. “Doctors, as human beings, should do well to be reminded of this, as we hold the power of life-and-death decisions in our hands.”
In perhaps the largest national suicide intervention trial ever conducted, researchers at the University of Colorado Anschutz Medical Campus and Brown University found that phone calls to suicidal patients following discharge from Emergency Departments led to a 30 percent reduction in future suicide attempts.
The year-long trial, which involved 1,376 patients in eight locations nationwide, provided suicidal patients with interventions that included specialized screening, safety planning guidance and follow-up telephone calls.
“People who are suicidal are often disconnected and socially isolated,” said study co-author Dr. Michael Allen, MD, professor of psychiatry and emergency medicine at the Helen and Arthur E. Johnson Depression Center at CU Anschutz. “So any positive contact with the world can make them feel better.”
Allen is also medical director of Rocky Mountain Crisis Partners in Denver which has already implemented a similar program where counselors call suicidal patients following their discharge from Emergency Departments (EDs).
Suicide is the 10th leading cause of death in the U.S. In 2015, there were 44,193 deaths by suicide nationally. Over one million people attempt to take their own life every year.
Colorado routinely ranks among the top 10 states for suicide with about 1,000 deaths a year. Last year, it was number seven in the country. The state Legislature has set a goal of reducing suicides by 20 percent by 2024.
Allen said simply handing a suicidal patient a psychiatric referral when discharged isn’t enough.
“We call them up to seven times to check on them after discharge,” he said. “If they aren’t there we leave a message and call again. For many, this telephone call is all they get.”
The crisis center has worked with 17 of Colorado’s 88 EDs and is hoping to increase that number and eventually go statewide.
“We don’t need more brick and mortar buildings, we can reduce suicide risk by simply calling people on the phone,” Allen said.
His colleague and study collaborator Dr. Emmy Betz agreed.
“Telephone follow-up programs offer a great way to help bridge an ED visit to outpatient mental health care and hopefully save lives,” said Betz, an associate professor of emergency medicine at CU Anschutz who has conducted extensive research on suicide. “It would be great to see such programs become more widely implemented. Suicide is a leading cause of death, especially in Colorado, and a shortage of inpatient and outpatient mental health care options make innovative approaches like telephone counseling even more attractive.”
The study was led by Brown University and Butler Hospital psychologist Ivan Miller.
Miller, a professor of psychiatry and human behavior at the Warren Alpert Medical School of Brown University, said he was encouraged that they were able to impact suicide attempts among this population with a relatively limited intervention.
While suicide prevention efforts such as hotlines are well known, published controlled trials of specific interventions are much rarer, Miller said.
“We were happy that we were able to find these results,” he said.
This report was one of several from the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) study led by Miller, Professor Edwin Boudreaux of the University of Massachusetts and Dr. Carlos Camargo of Massachusetts General Hospital and Harvard University.
Dr. Betz was the principal investigator for Colorado’s ED-SAFE site.
The trial took place in three phases to create three comparison groups. In the first phase, 497 patients received each ED’s usual treatment as a control group. In phase two universal screening was implemented and 377 patients received additional attention in the ED. In the third phase, 502 patients received the experimental intervention.
Those patients received the same Phase 2 care including additional suicide screening from ED physicians, suicide prevention information from nurses and a personal safety plan they could fill out to prepare for times when they might begin harboring suicidal thoughts again.
Over the next year, they also received periodic phone calls from trained providers at Butler Hospital in Providence, R.I., who would discuss suicide risk factors, personal values and goals, safety and future planning, treatment engagement, and problem solving.
The number of suicide attempts and the proportion of people attempting suicide declined significantly in the intervention group compared to treatment as usual. The middle group, which received only additional screening, did not show a significant drop compared to the treatment as usual group.
“This is a remarkably low cost, low tech intervention that has achieved impressive results,” Dr. Allen said.