American Association for Anatomy recommendations for the management of legacy anatomical collections

Collections of human remains in scientific and private institutions have a long tradition, though throughout history there has often been variable regard for the respect and dignity that these tissues demand. Recent public scandals around the use of human remains, coupled with an increasing community awareness around accountability in such instances, forces scholars to confront the ethical and moral concerns associated with these collections. This includes specific focus on the acquisition, storage, use, and disposition of these remains, which were often collected with no consent and with little knowledge, or concern, about the individual or their respective culture and practices surrounding death and postmortem treatment. As a response, the American Association for Anatomy convened a Legacy Anatomical Collections Task Force to consider these issues and to develop recommendations to assist those working with these tissues in education, research, and museum collections. This has culminated with the development of Recommendations for the Management of Legacy Anatomical Collections. The recommendations provide both an ethical foundation and practical considerations for the use, storage, and disposition of legacy collections of human tissues, and deliver guidance for establishing appropriate management and oversight, investigating provenance, and engaging with communities of care. While these Recommendations are considered a living document which will change over time as ethical principles concerning human tissue evolve, they currently represent 'best practice' recommendations that can guide researchers, teachers, and museum associates as they consider the future of legacy anatomical collections in their care.

Ethical concerns surrounding artificial intelligence in anatomy education: Should AI human body simulations replace donors in the dissection room?

The potential effects of artificial intelligence (AI) on the teaching of anatomy are unclear. We explore the hypothetical situation of human body donors being replaced by AI human body simulations and reflect on two separate ethical concerns: first, whether it is permissible to replace donors with AI human body simulations in the dissection room when the consequences of doing so are unclear, and second, the overarching ethical significance of AI use in anatomy education. To do this, we highlight the key benefits of student exposure to the dissection room and body donors, including nontechnical, discipline-independent skills, awareness and interaction with applied bioethics, and professional identity formation. We suggest that the uniqueness of the dissection room experience and the importance of the key benefits accompanying this exposure outweigh the potential and so far unknown benefits of AI technology in this space. Further, the lack of engagement with bioethical principles that are intimately intertwined with the dissection room experience may have repercussions for future healthcare professional development. We argue that interaction with body donors must be protected and maintained and not replaced with AI human body donor simulations. Any move away from this foundation of anatomy education requires scrutiny. In light of the possible adoption of AI technologies into anatomy teaching, it is necessary that medical educators reflect on the dictum that the practice of healthcare, and anatomy, is a uniquely human endeavor.

Anatomy From Nazi Germany to Today

This viewpoint reviews the anatomical body procurement used in Nazi Germany, notes the continued use of those images, and calls for disclosure of the biographical history of the people whose bodies and tissues are now studied.

Racism, structural racism, and the American Association for Anatomy: Initial report from a task force

In 2021, the American Association for Anatomy (AAA) Board of Directors appointed a Task Force on Structural Racism to understand how the laws, rules, and practices in which the Association formed, developed and continues to exist affect membership and participation. This commentary is the first public report from the Task Force. We focus on African Americans with some comments on Jews and women, noting that all marginalized groups deserve study. Through much of its 130 year history, some members were an essential part of perpetuating racist ideas, the Association largely ignored racism and had some practices that prevented participation. The Task Force concluded that individual and structural racism within the AAA, combined with the broader social context in which the Association developed, contributed to the current underrepresentation of African Americans who constitute 4.1% of the membership even though 13.4% of the U.S. population is Black. Intentional efforts within the AAA to reckon with racism and other forms of bias have only begun in the last 10-20 years. These actions have led to more diverse leadership within the Association, and it is hoped that these changes will positively affect the recruitment and retention of marginalized people to science in general and anatomy in particular. The Task Force recommends that the AAA Board issue a statement of responsibility to acknowledge its history. Furthermore, the Task Force advocates that the Board commit to (a) sustaining ongoing projects to improve diversity, equity, and inclusion and (b) dedicating additional resources to facilitate novel initiatives.

Nerve Surgeons' Assessment of the Role of Eduard Pernkopf's Atlas of Topographic and Applied Human Anatomy in Surgical Practice

(Reprinted with permission from NEUROSURGERY, Volume 84, Number 2, February 2019).

An Excerpt from The Anatomy of Murder: Excerpted from the Section: "The Pernkopf Controversy" (pages 278 - 281, 287, 288)

(Reprinted with permission from The Anatomy of Murder: Ethical Transgressions and Anatomical Science During the Third Reich. "The Pernkopf Controversy," pages 278-281; excerpted from Berghahn Books, 2016).

Anatomy in Nazi Germany: The Use of Victims' Bodies in Academia and Present-Day Legacies

After decades of denial, German academic medicine was reluctant to accept responsibility for its complex collaboration with the Nazi regime. Consequently, much of this history needs further detailed exploration, as legacies from this history still exist in the form of "Books, Bones and Bodies." Specifically, this concerns the legacies of anatomists' use of bodies of Nazi victims in teaching and research, as "data" have become anatomical knowledge and specimens from victims continue to be discovered.

Books, bones and bodies: The relevance of the history of anatomy in Nazi Germany for medical education today

The history of anatomy in Nazi Germany highlights the consequences to humanity when the destructive potentials immanent to all science and medicine are enabled by an anti-democratic, totalitarian regime. Anatomy presents an example of ethical transgressions by scientists and health care professionals that were amplified in the criminal political climate of the Nazi regime. This can happen anywhere, as science is never apolitical. This article gives a short account of anatomy in Nazi Germany, which is followed by an outline of the tangible and intangible legacies from this history, to then discuss implications for anatomy education today. While Jewish and politically dissident anatomists were forced out of their positions and country by the Nazi regime, the majority of the remaining anatomists joined the Nazi party and used bodies of Nazi victims for education and research. Some anatomists even performed deadly human experiments. Patterns and legacies that emerge from this history can be traced into the present and concern research ethics in general and anatomical body procurement specifically. They shed light on current practices and controversies in the anatomical sciences, including anthropology. It will be argued here that the history of anatomy in Nazi Germany can inform current anatomy education in a concept of anatomy as the first "clinical discipline." By integrating insights from the history of anatomy into the learning process, anatomy education can model an approach to medicine that includes a full appreciation of the shared humanity of medical practitioners and patients.

Anatomy as a Model Environment for Acquiring Professional Competencies in Medicine: Experiences at Harvard Medical School

Anatomy education provides students with opportunities to learn structure and function of the human body, to acquire professional competencies such as teamwork, interpersonal skills, self-awareness, and to reflect on and practice medical ethics. The fulfillment of this wide potential can present challenges in courses that are part of an integrated curriculum and shorter than traditional courses. This new reality, together with students' increasing concern about the stresses within medical education, led to efforts at Harvard Medical School to implement practical steps toward an optimal learning environment in anatomy. These were based on core elements of ethical anatomy education and principles of trauma-informed care. Anatomy is conceptualized here as the "first clinical discipline," with relational interactions between anatomical educators, medical students, and body donors/patients. Essential prerequisites for the implementation of this work were support by the medical school leadership, open partnership between engaged students and faculty, faculty coordination, and peer-teaching. Specific interventions included pre-course faculty development on course philosophy and invitations to students to share their thoughts on anatomy. Student responses were integrated in course introductions, combined with a pre-dissection laboratory visit, an introductory guide, and a module on the history and ethics of anatomy. During the course, team-building activities were scheduled, and self-reflection encouraged, for example, through written exercises, and elective life-body drawing. Students' responses to the interventions were overall positive, but need further evaluation. This first attempt of a systematic implementation of an optimal learning environment in anatomy led to the identification of areas in need of adjustment.

Oral and maxillofacial surgeons' assessment of the role of Pernkopf's atlas in surgical practice

BACKGROUND

The use of the Pernkopf atlas of human anatomy in surgery presents ethical challenges due to the author's association with the Nazi regime and the potential depiction of victims of this regime. The atlas was of particular utility to two surgical specialties: nerve surgeons and oral and maxillofacial surgeons. The representation of peripheral nerves and complex head and neck anatomy is probably unequaled in any other atlas of anatomy. While the ethical implications of the use of Pernkopf's atlas among nerve surgeons have been previously assessed, this study focuses on the volume dedicated to detailed images of head and neck dissections, and the ethical implications of using this atlas by oral and maxillofacial surgeons.

OBJECTIVE

To (1) assess the role of the Pernkopf atlas in oral and maxillofacial surgeons' current practice and (2) determine whether a proposal of four conditions would provide ethical guidance for use in surgery and education.

METHODS

Members of three American oral and maxillofacial surgical societies (ACOMS, ASTMJS, AAOMS) were surveyed and 181 responses collected. The survey introduced the historical origin of the Pernkopf atlas, and respondents were asked whether they would use the atlas under specific conditions that could be a recommendation for its ethical handling. An anatomical plate comparison between Netter's and Pernkopf's atlases was performed to compare accuracy and surgical utility.

RESULTS

Forty-nine percent of respondents were aware of the Pernkopf atlas, and 9% of respondents were currently using it. Amongst those aware of the historical facts, 42% were comfortable using the atlas, 33% uncomfortable, and 25% undecided. The four conditions involving disclosure, bioethical and religious considerations, and remembrance led to 75% of those "uncomfortable" and "undecided" becoming "comfortable" with use.

CONCLUSIONS

Amid recent developments and controversy regarding the Pernkopf atlas, a proposal detailing conditions for an ethical approach may provide guidance in surgical planning and education. Furthermore, this approach has implications for the future preparation and publication of anatomical atlases and their use.

The Role of History and Ethics of Anatomy in Medical Education

While time spent on anatomical education in medical school curricula has been diminishing over the last decades, the recognized role of anatomical dissection has expanded. It is perceived by many students and faculty not only as the means of learning the structure and function of the human body, but also as an opportunity for the acquisition of professional competencies such as team work, patient-doctor interaction, medical epistemology, self-awareness, and an understanding of medical ethics. This viewpoint article proposes that this learning process can be supported effectively through studying examples from the history of anatomy, as insights from this history can help illuminate contemporary ethical issues in anatomy and medicine. Anatomical education can thus provide not only the opportunity of gaining awareness of ethical questions, but also a chance to practice these new insights within the protected environment of the laboratories, in interaction with the dead and the living. Consequently, a new role has developed for anatomists, which includes the interweaving of the scholarly exploration of the history and ethics of anatomy with the practical application of research results into a reframed concept of anatomical education. Anatomy, as a foundational discipline in the medical curriculum, can thus provide a first step on the educational path of empathetic and humane medical caregivers.

Ethical considerations in the use of Pernkopf's Atlas of Anatomy: A surgical case study

The use of Eduard Pernkopf's anatomic atlas presents ethical challenges for modern surgery concerning the use of data resulting from abusive scientific work. In the 1980s and 1990s, historic investigations revealed that Pernkopf was an active National Socialist (Nazi) functionary at the University of Vienna and that among the bodies depicted in the atlas were those of Nazi victims. Since then, discussions persist concerning the ethicality of the continued use of the atlas, because some surgeons still rely on information from this anatomic resource for procedural planning. The ethical implications relevant to the use of this atlas in the care of surgical patients have not been discussed in detail. Based on a recapitulation of the main arguments from the historic controversy surrounding the use of Pernkopf's atlas, this study presents an actual patient case to illustrate some of the ethical considerations relevant to the decision of whether to use the atlas in surgery. This investigation aims to provide a historic and ethical framework for questions concerning the use of the Pernkopf atlas in the management of anatomically complex and difficult surgical cases, with special attention to implications for medical ethics drawn from Jewish law.

BODIES R US: Ethical Views on the Commercialization of the Dead in Medical Education and Research

With the ongoing and expanding use of willed bodies in medical education and research, there has been a concomitant rise in the need for willed bodies and an increase in the means of supplying these bodies. A relatively recent development to enlarge this supply has been the growth of for- profit willed body companies ("body brokers") in the United States. These companies advertise for donors, cover all cremation and other fees for the donor, distribute the bodies or body parts nationally and internationally, and charge their users for access to the body or body parts. In doing so, they generate substantial profits. This review examines the historical development of willed body programs, the legal and economic aspects of willed body programs, and then provides an ethical framework for the use of willed bodies. The ethical principles described include detailed informed consent from the donors, comprehensive and transparent information about the process from the body donation organizations, and societal input on the proper and legal handling of willed bodies. Based on the ethical principles outlined, it is recommended that there be no commercialization or commodification of willed bodies, and that programs that use willed bodies should not generate profit.

"Forgotten" Chapters in the History of Transcervical Sterilization: Carl Clauberg and Hans-Joachim Lindemann

Transcervical sterilization is a non-surgical method of permanent female sterilization that is widely used and critically discussed. A review of the historiography of the method reveals that instances of its coercive use are not included in the historical account. This study offers a reexamination of the work of Carl Clauberg and Hans-Joachim Lindemann, to more deeply contextualize within the framework of current usage the coercive use of transcervical sterilization during the Third Reich and in postwar Germany. This inquiry is based on postwar criminal trial records on Clauberg, and on archival documents detailing Lindemann's activities in 1979. A comparative analysis examines arguments by medical historian Karl-Heinz Roth, and identifies shared characteristics and differences between Clauberg and Lindemann, their methods and scientific connections. The results demonstrate that the technique of transcervical sterilization has an abusive potential that may be explained as a function of the person of the physician, of the scientific method itself, and of societal and political influences. The analysis supports the argument that insights from the cases of Clauberg and Lindemann are transferrable geographically and over time, and have the potential to inform current medical practice, such as transcervical sterilization with the Essure device, whose historiographic exploration remains a desideratum.

Alfred Pischinger (1899-1983): An Austrian career in anatomy continuing through National Socialism to postwar leadership

Despite intensified research efforts on the history of anatomy during National Socialism (NS), many aspects of this story still need further investigation. This study explores the life, work and politics of Alfred Pischinger, Chairman of the Institute for Embryology and Histology in Graz from 1936 to 1945, and in Vienna from 1958 to 1970, and is an addition to previous reports on careers in anatomy continuing through the Third Reich to the postwar period. Pischinger was an illegal NSDAP member in Austria, joined the SA in 1938, served as expert in racial hygiene, and as judge on the Genetic Health High Court of Graz. His research focus was histochemistry, but he became part of a scientific network at the University of Graz, which from 1939 on experimented on the bodies of pregnant women and their fetuses under the leadership of gynecologist Karl Ehrhardt. The researchers were among the many who took actively part in the complete exploitation and physical destruction of those considered to be "the enemy" by the NS regime. After the war, Pischinger received publicity for his work on the "scientific basis" of alternative and holistic approaches of medicine. His NS past and fetal experiments seem to have vanished from public knowledge. As systematic studies of the influence of the NS period on postwar medical education and the science of anatomy itself are still missing, this critical investigation of Alfred Pischinger's life within the relevant historic background aims to contribute to this body of knowledge.

Tuning the redox properties of the titanocene(III)/(IV)-couple for atom-economical catalysis in single electron steps

Radical-based transformations are an attractive target for the development of catalytic processes due to ease of radical generation, high functional group tolerance and selectivity of bond-forming reactions. In spite of these appealing features, the potential of radicals as key intermediates in catalysis remains largely untapped. Herein we present recent work that exploits the innate ability of titanocene-based catalysts to undergo both oxidative addition and reductive elimination in single electron steps. We further demonstrate that tuning the redox properties of the titanocene-based catalyst can be used to develop efficient catalytic free radical processes including tetrahydrofuran synthesis, and radical arylation.

Insights into the Freiburg Anatomical Institute during National Socialism, 1933-1945

The Anatomical Institute at the Albert-Ludwigs-Universität Freiburg is among the anatomical departments for which a comprehensive account of its history during National Socialism (NS) is still missing. Previous investigations (such as in: Grün et al., 2002) have revealed the political activities of some anatomists, but, in the absence of relevant body-registers, a more comprehensive examination of the anatomical body procurement has not been attempted. The inspection of records in university and municipal archives allows insight into the activities in the institute within the historical context. The Freiburg Institute shared the experience of the impact of NS politics with other German anatomies. Four anatomists were dismissed because of NS racial discrimination, and chairman von Möllendorf left for political reasons. His successor Nauck's appointment was politically motivated, as he was a staunch Nazi. His colleagues were also members of NS political organizations. Body procurement was controversial between the public and the anatomists in Freiburg prior to and following the Third Reich, and much of the anatomists' efforts focused on the improvement of the body supply. In 1935, and, again during the war, the number of bodies was sufficient for anatomical education. Among the traditional sources of body procurement were increasing numbers of NS victims. Forty-four of them can be identified, among them 21 forced laborers and their children who died of so-called natural causes, and 22 men who had been executed at Stuttgart prison on April 6, 1943. While the victims' names have been ascertained, their biographies still need restoration to ensure an appropriate commemoration.

Posthumous Testimony for Dr. Leo Gross and his Family / Restoration of the 'Lost' Biography of a Physician Victim of the Holocaust

At a time when the last direct witnesses of the Holocaust are passing, new approaches to the restoration of 'lost' biographies of victims need to be considered. This investigation describes the potential of an international collaboration including surviving family members. Archival documents discovered in Jerusalem in 1983 concerned a discussion on the cancellation of a medical licence for a German Jewish physician, Dr. Leo Gross of Kolberg, who had been disenfranchised from medical practice under Nazi law. After applying for a medical licence during a 1935 visit to Palestine, Gross remigrated to Germany, where he was imprisoned in a concentration camp. No further information was found until 2014, when a group of scholars linked a variety of archival and internet-accessible sources and located a nephew of Gross. The nephew's testimony, cross-referenced against data from other sources, enabled the reconstruction of the 'lost' biography of his uncle and family, in fact a posthumous testimony. The resulting narrative places Dr. Leo Gross within his professional and social network, and serves his commemoration within this context of family and community. The restored biography of Dr. Leo Gross presents an exemplary case study for the future of Holocaust testimony.

Public health in the Vilna Ghetto as a form of Jewish resistance

We describe the system of public health that evolved in the Vilna Ghetto as an illustrative example of Jewish innovation and achievement during the Holocaust. Furthermore, we argue that by cultivating a sophisticated system of public health, the ghetto inmates enacted a powerful form of Jewish resistance, directly thwarting the intention of the Nazis to eliminate the inhabitants by starvation, epidemic, and exposure. In doing so, we aim to highlight applicable lessons for the broader public health literature. We hope that this unique story may gain its rightful place in the history of public health as an insightful case study of creative and progressive solutions to universal health problems in one of the most challenging environments imaginable.

Drinking motives in alcohol use disorder patients with and without social anxiety disorder

The high comorbidity of alcohol use disorders (AUD) and social anxiety disorder (SAD) is often explained by excessive drinking in social situations to self-medicate social anxiety. Indeed, the motive to drink alcohol to lower social fears was found to be elevated in socially anxious persons. However, this social anxiety specific motive has not been directly investigated in primarily alcohol dependent individuals. We explored social anxiety, the motivation to drink alcohol in order to cope with social fears, and social anxiety as a consequence of drinking in AUD with and without comorbid SAD. Male AUD inpatients with (AUD+SAD group, N=23) and without comorbid SAD (N=37) completed a clinical interview and a questionnaire assessment. AUD+SAD patients reported higher levels of depression and an elevated motive to drink due to social anxiety but did not experience more social fears as a consequence of drinking. Previous results concerning alcohol drinking motives in order to relieve social fears could be replicated in a clinical AUD sample. Additionally, our findings suggest comorbid AUD+SAD patients to be more burdened regarding broader psychopathological symptoms. Thus, accessibility to SAD-specific screening and treatment procedures may be beneficial for primary AUD patients.