A new article in the New England Journal of Medicine, one of the oldest and most esteemed publications for medical research, criticizes the journal for paying only “superficial and idiosyncratic attention” to the atrocities perpetrated in the name of medical science by the Nazis.

The journal was “an outlier in its sporadic coverage of the rise of Nazi Germany,” wrote the article’s authors, Allan Brandt and Joelle Abi-Rached, both medical historians at Harvard. Often, the journal simply ignored the Nazis’ medical depredations, such as the horrific experiments conducted on twins at Auschwitz, which were based largely on Adolf Hitler’s spurious “racial science.”

In contrast, two other leading science journals — Science and the Journal of the American Medical Association — covered the Nazis’ discriminatory policies throughout Hitler’s tenure, the historians noted. The New England journal did not publish an article “explicitly damning” the Nazis’ medical atrocities until 1949, four years after World War II ended.

The new article, published in this week’s issue of the journal, is part of a series started last year to address racism and other forms of prejudice in the medical establishment. Another recent article described the journal’s enthusiastic coverage of eugenics throughout the 1930s and ’40s.

“Learning from our past mistakes can help us going forward,” said the journal’s editor, Dr. Eric Rubin, an infectious disease expert at Harvard. “What can we do to ensure that we don’t fall into the same sorts of objectionable ideas in the future?”

In the publication’s archives, Dr. Abi-Rached discovered a paper endorsing Nazi medical practices: “Recent changes in German health insurance under the Hitler government,” a 1935 treatise written by Michael Davis, an influential figure in health care, and Gertrud Kroeger, a nurse from Germany. The article praised the Nazis’ emphasis on public health, which was infused with dubious ideas about Germans’ innate superiority.

“There is no reference to the slew of persecutory and antisemitic laws that had been passed,” Dr. Abi-Rached and Dr. Brandt wrote. In one passage, Dr. Davis and Ms. Kroeger described how doctors were made to work in Nazi labor camps. Duty there, the authors blithely wrote, was an “opportunity to mingle with all sorts of people in everyday life.”

“Apparently, they considered the discrimination against Jews irrelevant to what they saw as reasonable and progressive change,” Dr. Abi-Rached and Dr. Brandt wrote.

For the most part, however, the two historians were surprised at how little the journal had to say about the Nazis, who murdered some 70,000 disabled people before turning to the slaughter of Europe’s Jews, as well as other groups.

“When we opened the file drawer, there was almost nothing there,” Dr. Brandt said. Instead of discovering articles either condemning or justifying the Nazis’ perversions of medicine, there was instead something more puzzling: an evident indifference that lasted until well after the end of World War II.

The journal acknowledged Hitler in 1933, the year he began implementing his antisemitic policies. Seven months after the advent of the Third Reich, the journal published “The Abuse of the Jewish Physicians,” an article that today would most likely face criticism for lacking moral clarity. It appeared to be largely based on reporting by The New York Times.

“Without providing any details, the notice reported that there was some indication of ‘a bitter and relentless opposition to the Jewish people,’” the new article said.

Other journals saw the threat of Nazism more clearly. Science expressed alarm about the “crass repression” of Jews, which took place not only in medicine but also in law, the arts and other professions.

“The journal, and America, had tunnel vision,” said John Michalczyk, co-director of Jewish Studies at Boston College. American corporations avidly did business with Hitler’s regime. The Nazi dictator, in turn, looked favorably at the slaughter and displacement of Native Americans, and sought to adopt the eugenics efforts that had taken place across the United States throughout the early 20th century.

“Our hands are not clean,” Dr. Michalczyk said.

Dr. Abi-Rached said she and Dr. Brandt wanted to avoid being “anachronistic” and viewing the journal’s silence on Nazism through a contemporary lens. But once she saw that other medical publications had taken a different tack, the journal’s silence took on a fraught new meaning. What was said was dwarfed by what was never spoken.

“We were looking for strategies to understand how racism works,” Dr. Brandt said. It seemed to work, in part, through apathy. Later, many institutions would claim that they would have acted to save more of the Holocaust’s victims had they known the extent of the Nazis’ atrocities.

That excuse rings hollow to experts who point out that there were enough eyewitness reports to merit action.

“Sometimes, silence contributes to these kinds of radical, immoral, catastrophic shifts,” Dr. Brandt said. “That’s implicit in our paper.”

Historically speaking, it’s not a bad time to be the liver of a teenager. Or the lungs.

Regular use of alcohol, tobacco and drugs among high school students has been on a long downward trend.

In 2023, 46 percent of seniors said that they’d had a drink in the year before being interviewed; that is a precipitous drop from 88 percent in 1979, when the behavior peaked, according to the annual Monitoring the Future survey, a closely watched national poll of youth substance use. A similar downward trend was observed among eighth and 10th graders, and for those three age groups when it came to cigarette smoking. In 2023, just 15 percent of seniors said that they had smoked a cigarette in their life, down from a peak of 76 percent in 1977.

Illicit drug use among teens has remained low and fairly steady for the past three decades, with some notable declines during the Covid-19 pandemic.

In 2023, 29 percent of high school seniors reported using marijuana in the previous year — down from 37 percent in 2017, and from a peak of 51 percent in 1979.

There are some sobering caveats to the good news. One is that teen overdose deaths have sharply risen, with fentanyl-involved deaths among adolescents doubling from 2019 to 2020 and remaining at that level in the subsequent years.

Dr. Nora Volkow has devoted her career to studying use of drugs and alcohol. She has been the director of the National Institute on Drug Abuse since 2003. She sat down with The New York Times to discuss changing patterns and the reasons behind shifting drug-use trends.

What’s the big picture on teens and drug use?

People don’t really realize that among young people, particularly teenagers, the rate of drug use is at the lowest risk that we have seen in decades. And that’s worth saying, too, for legal alcohol and tobacco.

What do you credit for the change?

One major factor is education and prevention campaigns. Certainly, the prevention campaign for cigarette smoking has been one of the most effective we’ve ever seen.

Some of the policies that were implemented also significantly helped, not just making the legal age for alcohol and tobacco 21 years, but enforcing those laws. Then you stop the progression from drugs that are more accessible, like tobacco and alcohol, to the illicit ones. And teenagers don’t get exposed to advertisements of legal drugs like they did in the past. All of these policies and interventions have had a downstream impact on the use of illicit drugs.

Does social media use among teens play a role?

Absolutely. Social media has shifted the opportunity of being in the physical space with other teenagers. That reduces the likelihood that they will take drugs. And this became dramatically evident when they closed schools because of Covid-19. You saw a big jump downward in the prevalence of use of many substances during the pandemic. That might be because teenagers could not be with one another.

The issue that’s interesting is that despite the fact schools are back, the prevalence of substance use has not gone up to the prepandemic period. It has remained stable or continued to go down. It was a big jump downward, a shift, and some drug use trends continue to slowly go down.

Is there any thought that the stimulation that comes from using a digital device may satisfy some of the same neurochemical experiences of drugs, or provide some of the escapism?

Yes, that’s possible. There has been a shift in the types of reinforcers available to teenagers. It’s not just social media, it’s video gaming, for example. Video gaming can be very reinforcing, and you can produce patterns of compulsive use. So, you are shifting one reinforcer, one way of escaping, with another one. That may be another factor.

Is it too simplistic to see the decline in drug use as a good news story?

If you look at it in an objective way, yes, it’s very good news. Why? Because we know that the earlier you are using these drugs, the greater the risk of becoming addicted to them. It lowers the risk these drugs will interfere with your mental health, your general health, your ability to complete an education and your future job opportunities. That is absolutely good news.

But we don’t want to become complacent.

The supply of drugs is more dangerous, leading to an increase in overdose deaths. We’re not exaggerating. I mean, taking one of these drugs can kill you.

What about vaping? It has been falling, but use is still considerably higher than for cigarettes: In 2021, about a quarter of high school seniors said that they had vaped nicotine in the preceding year. Why would teens resist cigarettes and flock to vaping?

Most of the toxicity associated with tobacco has been ascribed to the burning of the leaf. The burning of that tobacco was responsible for cancer and for most of the other adverse effects, even though nicotine is the addictive element.

What we’ve come to understand is that nicotine vaping has harms of its own, but this has not been as well understood as was the case with tobacco. The other aspect that made vaping so appealing to teenagers was that it was associated with all sorts of flavors — candy flavors. It was not until the F.D.A. made those flavors illegal that vaping became less accessible.

My argument would be there’s no reason we should be exposing teenagers to nicotine. Because nicotine is very, very addictive.

Anything else you want to add?

We also have all of this interest in cannabis and psychedelic drugs. And there’s a lot of interest in the idea that psychedelic drugs may have therapeutic benefits. To prevent these new trends in drug use among teens requires different strategies than those we’ve used for alcohol or nicotine.

For example, we can say that if you take drugs like alcohol or nicotine, that can lead to addiction. That’s supported by extensive research. But warning about addiction for drugs like cannabis and psychedelics may not be as effective.

While cannabis can also be addictive, it’s perhaps less so than nicotine or alcohol, and more research is needed in this area, especially on newer, higher-potency products. Psychedelics don’t usually lead to addiction, but they can produce adverse mental experiences that can put you at risk of psychosis.