Medical care or clinical research on humans? Contaminated anti-D immunoglobulin in the GDR and its consequences

2020 ◽  
Vol 58 (02) ◽  
pp. 127-132
Author(s):  
Maximilian Schochow ◽  
Florian Steger
Keyword(s):  
Hepatitis C ◽  
Clinical Research ◽  
Medical Care ◽  
Point Of View ◽  
Medical Attention ◽  
Sufficient Information ◽  
Historical Sources ◽  
Ethical Point ◽  
Disease Diagnostics ◽  
Liver Biopsies

Abstract Background In 1978 and 1979, contaminated anti-D immunoglobulin was used in the German Democratic Republic (GDR). As a result, several thousand women were, in the end, infected with hepatitis C. These women received medical attention, part of which was research on hepatitis C. Up to now, results of the research and data are being published in international journals. It remains unclear whether the affected women were asked to be subjects of the clinical research. Methods The authors analyzed historical sources and conducted interviews with contemporary witnesses. Results In the GDR, these women were compulsorily treated by physicians without sufficient information about the disease, diagnostics, and therapy. If the women refused medical care, they were coerced into it by the physicians. Medical care and research were inseparable. Without the knowledge of the women and without their consent, research was carried out on the blood samples and liver biopsies acquired from them.After the German reunification, the same physicians continued to conduct research on the same group of patients. Beginning in 1990, interferon therapy was offered to the women. Parallel to the medication with interferon, studies on the effects of the therapy were carried out. In this case as well, the women were not informed about the use of collected data, nor did they agree to it. Conclusions Physicians should clearly define the border between medical care and scientific interest. Exclusively, data obtained from studies performed correctly under ethical point of view should be accepted for publication.

Grenzen des medizinischen Fortschritts aus ethischer Sicht

1994 ◽  
Vol 38 (1) ◽  
pp. 41-53
Author(s):  
Wolfgang Huber
Keyword(s):  
Medical Treatment ◽  
Medical Care ◽  
Organ Transplantation ◽  
Medical Practice ◽  
Point Of View ◽  
Ethical Reflection ◽  
Medical Progress ◽  
Ethical Point ◽  
The Individual ◽  
Human Death

Abstract When discussing the Iimits of medical progress from an ethical point of view, medical progress must neither be glorified nor rejected. Ethical reflection rather has to consider the different kinds of Iimits of medical practice and research. Starting from an ethics of dignity, that refuses to define human being and dignity only by the fact of human cerebration, the article argues for extending the Iimits of medicine in order to fight against the epidemics, and for correcting new Iimits of medical care, that result from the over specialisation of medical technics and the division of medical labour. Above all however medical treatment has to respect those Iimits, that are given by the dignity of the individual. Therefore for example the criteria for organ transplantation must be very strict in order to avoid any commercialization of donating organs, and in order to respect the process of human death.

“Product Not Available in Pre-War Quantities – but Quality Remains the Same”: Remarks on Advertisements as Historical Sources

2019 ◽  
Author(s):  
Magdalena Saryusz-Wolska
Keyword(s):  
Social Norms ◽  
Economic History ◽  
Second World War ◽  
Point Of View ◽  
World War ◽  
Historical Sources ◽  
The Past ◽  
German Press ◽  
Post War ◽  
Second World

The article focuses on advertisements as visual and historical sources. The material comes from the German press that appeared immediately after the end of the Second World War. During this time, all kinds of products were scarce. In comparison to this, colorful advertisements of luxury products are more than noteworthy. What do these images tell us about the early post-war years in Germany? The author argues that advertisements are a medium that shapes social norms. Rather than reflecting the historical realities, advertisements construct them. From an aesthetical and cultural point of view, advertisements gave thus a sense of continuity between the pre- and post-war years. The author suggests, therefore, that the advertisements should not be treated as a source for economic history. They are, however, important for studying social developments that occurred in the past.

scholarly journals The Difficult alliance. Military cooperation between the ruthenian king Daniel and the Piasts of Mazovia

2020 ◽  
Vol 1 (1) ◽  
pp. 104-112
Author(s):  
Michał Skoczyński
Keyword(s):  
Scientific Literature ◽  
Point Of View ◽  
Armed Conflicts ◽  
The Other ◽  
Political Strategy ◽  
Military Cooperation ◽  
Historical Sources ◽  
Other Hand ◽  
Historical Methodology ◽  
The Military

Abstract The article presents the military cooperation between the King of Galician-Volhynian Ruthenia, Daniel Romanowicz, and the Dukes of Mazovia, Konrad and his son Siemowit. The alliance, based as a counterweight for the cooperation between the King of Hungary and the Piast princes of Lesser Poland, who were trying to conquer Ruthenia and dominate all Piast principalities in then fragmented Poland. It lasted for several decades from the 1220’s to the 1260’s and was primarly aimed at mutual protection against the invasions of the pagan Yotvingians and supporting each other in armed conflicts. The text contains an analysis of war expeditions, tactics and ways of support that were given by both sides of the allianace. It is a new point of view on this aspect of political strategy of both sides that in some ways defined the regional situation. Ruthenians granted masovian Piasts some mobile and political uncommited support in fight with their relatives in Poland, and also secured their border with the Yotvingians. On the other hand, masovian knights were an additional strike force in ruthenian plundering expeditions to Yotvingia. The research was based on the analysis of preserved historical sources and scientific literature using historical methodology.

The ethics of pandemic preparedness revisited - autonomy, quarantine, transferability and trust

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
P Schröder-Bäck ◽  
T Schloemer ◽  
K Martakis ◽  
C Brall
Keyword(s):  
Crisis Management ◽  
Ethical Issues ◽  
Lessons Learned ◽  
Point Of View ◽  
Ethical Challenges ◽  
Pandemic Preparedness ◽  
Ethical Aspects ◽  
Outbreak Management ◽  
Ethics Framework ◽  
Ethical Point

Abstract Background The outbreak of SARS in 2002 lead to a public health ethics discourse. The crisis management of that time was ethically analysed and lessons to be learned discussed. Scholarship and WHO, among others, developed an ethics of pandemic preparedness. The current “corona crisis” also faces us with ethical challenges. This presentation is comparing the two crises from an ethical point of view and a focus on Europe. Methods An ethics framework for pandemic preparedness (Schröder et al. 2006 and Schröder-Bäck 2014) is used to make a synopsis of ethical issues. Ethical aspects of 2002 and 2020 that were discussed in the literature and in the media are compared. For 2020, the focus is on interventions in Italy, Germany, Switzerland, and the Netherlands. Results Topics that emerged from the 2002 crisis were, among others, revolving around aspects of stigmatisation and fair distribution of scarce resources (esp. vaccines, antivirals). Currently, most urgent and ethically challenging aspects relate to social distancing vs. autonomy: Isolation and quarantine are handled differently across Europe and the EU. Questions of transferability of such interventions prevail. Contexts vary vertically over time (2002 vs. 2020) and horizontally (e.g. between Italy and Germany at the same time). Furthermore, trust in authorities, media and health information is a key issue. Conclusions Ethical aspects are key for good pandemic preparedness and management. The context of the crises between 2002 and 2020 has slightly changed, also based on “lessons learned” from 2002. This has implications on ethical issues that are being discussed. New lessons will have to be learned from the 2020 crisis. Key messages Pandemic preparedness and outbreak management entail many ethical tensions that need to be addressed. Currently, questions of trust and transferability are key to the crisis management, further ethical issues could still emerge.

THE ROAD AHEAD TO BETTER MEDICAL CARE FOR CHILDREN

PEDIATRICS ◽  
1950 ◽  
Vol 6 (3) ◽  
pp. 553-556
Keyword(s):  
Child Health ◽  
Medical Care ◽  
Medical Center ◽  
Point Of View ◽  
Medical Services ◽  
High Quality ◽  
The Road ◽  
Provide Child Care ◽  
Ultimate Objective ◽  
The Many

THE road to better child health has been discussed in relation to the doctor and his training, health services and their distribution. We have dealt with the unavoidable question of costs. Particular attention has been given to some of the advantages and dangers of decentralization of pediatric education and services. Each of the various subjects has been discussed from the point of view of its bearing on the ultimate objective of better health for all children and the steps necessary to attain this goal. Now, we may stand back from the many details of the picture, view the whole objectively and note its most outstanding features. First is the fact that the improvement of child health depends primarily upon better training for all doctors who provide child care, general practitioners as well as specialists. This is the foundation without which the rest of the structure cannot stand. The second dominant fact is the need for extending to outlying and isolated areas the high quality medical care of the medical centers, without at the same time diluting the service or training at the center. The road to better medical care, therefore, begins at the medical center and extends outward through a network of integrated community hospitals and health centers, finally reaching the remote and heretofore isolated areas. Inherent in all medical schools is a unique potential for rendering medical services as well as actually training physicians. The very nature of medical education—whereby doctors in training work under the tutelage of able specialists in the clinic, hospital ward, and out-patient department—provides medical services of high quality to people in the neighboring communities.

scholarly journals Serum Aspartate Aminotransferase Level and Previous Histopathological Findings Enable Reduction of Protocol Liver Biopsies after Liver Transplantation for Hepatitis C

2013 ◽  
Vol 27 (3) ◽  
pp. 131-136 ◽  
Author(s):  
Tomohiro Tanaka ◽  
George Therapondos ◽  
Nazia Selzner ◽  
Eberhard L Renner ◽  
Leslie B Lilly
Keyword(s):  
Liver Transplantation ◽  
Hepatitis C ◽  
Antiviral Therapy ◽  
Aspartate Aminotransferase ◽  
Aminotransferase Level ◽  
Fibrosis Stage ◽  
Protocol Biopsy ◽  
Serum Aspartate Aminotransferase ◽  
Histological Activity ◽  
Liver Biopsies

BACKGROUND: Hepatitis C virus (HCV) infection remains the leading indication for liver transplantation (LT) worldwide. Recurrent hepatitis C following LT is universal, and significant fibrosis (SF, Metavir fibrosis stage ≥2) apparent on protocol biopsy typically prompts antiviral therapy.OBJECTIVE: To determine the optimal timing of protocol liver biopsies in this setting.METHODS: A total of 151 patients who underwent LT related to HCV infection between July 2004 and December 2009 were analyzed retrospectively. Data regarding protocol liver biopsies at six, 12 and 24 months post-LT, conventional laboratory parameters and demographic information were obtained.RESULTS: The 151 patients included in the present study had significantly lower serum aspartate aminotransferase (AST) levels than the four patients who progressed to receive antiviral treatment for SF before six months post-LT (P<0.001). AST level, but not alanine aminotransferase level, histological activity or fibrosis stage at the six-month biopsy was independently associated with the progression to SF at 12 months (P<0.05). However, AST level, histological activity and fibrosis stage at the 12-month biopsy emerged as independent parameters associated with progression to SF at 24 months (P<0.05).CONCLUSION: The protocol liver biopsy at six months could be eliminated, especially in patients who consistently exhibit low AST levels. Histological activity, the presence or absence of fibrosis, and AST values at the 12-month biopsy may lead to the decision to defer the protocol biopsy at 24 months or result in earlier introduction of antiviral therapy.

Sign in / Sign up

Export Citation Format

Share Document