We now know better. The profession, not just a handful of physicians, was implicated in the gross offenses that occurred under Nazi rule. Beginning in the 1980s, many historians, German and American, have shown how pervasive the corruption was and the full extent to which Nazism permeated German medicine [3-7]. Fully 45% of German physicians belonged to the Nazi party, a percentage higher than that for any other profession [8]. Dissenters were scarce.

German physicians began to elevate service to the state above medical ethics well before the Final Solution was implemented in 1942, and even before the Nazi party took power in 1932. In the opening years of the 20th century, German physicians promoted policies of racial hygiene and eugenics in their eagerness to limit the reproduction of persons believed to have hereditary deficiencies. Between 1933 and 1939, they sterilized an estimated 400 000 Germans with mental disturbances [9]. German psychiatrists designed and implemented the notorious T-4 program, in which so-called euthanasia was done on handicapped or retarded children and adults [10, 11]. In effect, the goal of producing a pure Aryan race took precedence over such fundamental ethical principles as the integrity of the body and commitment to the well-being of the individual patient.

During the war years, Nazi propaganda—with the active cooperation of physicians—depicted Jews as a metaphor for disease, thereby legitimating the horrors of the Final Solution [12]. Physicians also put to death psychiatric patients to free up hospital beds for military purposes [13], and they were critical to the operation of concentration camps, doing grisly experiments on prisoners and deciding who was fit enough to work and who should be exterminated. As Bruno Muller-Hill has concluded [14], Germans saw Auschwitz as a "shrine to science and technology," and it was the medical profession that promoted this perversion.

The article by Ernst in this issue [15] adds to our understanding of the role of the medical profession and Nazism in two important ways. First, we learn that the corruption of physicians was not unique to Germany. Ernst illuminates the events that occurred in the Vienna Faculty of Medicine, beginning with the Nazi takeover in March 1938. As in Germany, we find the expulsion of Jewish faculty members, the filling of vacated posts with former colleagues willing to swear loyalty to Hitler, and the subsequent participation of these persons in "euthanasia" programs and human experimentation.

Second, Ernst's story reminds us how critical self-interest was in shaping the events that occurred. Like their German counterparts [16], Austrian physicians were not so much ideologues as petty opportunists. Getting rid of Jewish faculty promised not only more paying patients but also academic advancement. The shame of the profession was not only that it succumbed to noxious ideas but that it could not withstand simple and straightforward greed and ambition.

The prominent role of Jews in medicine in Vienna made the events in the Faculty particularly dramatic. Seventy-eight percent of the Faculty was forced out, a percentage larger than that in any other European university faculty. Ernst notes that the remaining professors "turned a blind eye, were afraid, or converted to Nazism" [15]. These events left the Faculty, once home to numerous Nobel Laureates, depleted of outstanding researchers and teachers—a situation that persisted for years after the war. But they created vacancies for those who otherwise would not have qualified for positions.

The conspiracy of silence characteristic of the German medical profession in the immediate postwar period [7] was no less powerful in Austria. Viennese Faculty members who had "indisputably committed atrocities," such as exposing Dachau inmates to freezing seawater, were allowed to resume their careers; anatomical specimens from the corpses of executed persons remained (and still remain) in use. That Ernst's account is the first to outline this history shows how thoroughly memory was repressed.

Why should we revisit these events years later? Not because we anticipate another Holocaust but because the medical profession must be ever alert to challenges to the integrity of its ethics, particularly when they emanate from state authority. The record of the U.S. medical profession is, on the whole, commendable, but important lapses have occurred in the United States as well as in other countries. Between 1907 and 1941, U.S. physicians sterilized nearly 40 000 persons, almost all of them mentally disabled and incapable of giving consent [17, 18]. Routine reports of Nazi sterilization and "euthanasia" programs in the Journal of the American Medical Association generated little response [19]. During the "hot war" of 1940 to 1945, U.S. investigators often ignored consent in their clinical experiments to discover antidotes for dysentery or malaria [20]. Later, physicians during the "cold war" ignored consent when researching the effects of radiation on the body [21]. Indeed, between 1945 and 1965, physicians in their "war against disease" often allowed the needs of research to trump individual well- being [22].

Today, U.S. medicine confronts new ethical challenges. These include the stance of the profession toward state-sanctioned capital punishment (should the physician be anywhere near the execution chamber?) and toward legislative approval for physician-assisted suicide or aid-in-dying (can an ethic of "do no harm" be reconciled with such an act?) [23, 24]. At the same time, as U.S. medicine undergoes its most profound reorganization to date, physician self-interest is directly pitted against the well-being of patients (what medical services may primary care gatekeepers limit or withhold to receive financial rewards?) [25].

Medicine's role in the Holocaust is now being explored with commendable vigor. The decision by Ernst to tell a story heretofore only whispered about is altogether praiseworthy. It is incumbent on the medical profession to read these findings closely, not only to get the record right, but to remind itself of the perils that follow when its ethics take second place to external demands. The Hippocratic Oath has lost none of its relevance: "I will use my power to help the sick to the best of my ability and judgment; I will abstain from harming or wronging any man by it."