[Ethics of AI in medicine]. / Ethik der künstlichen Intelligenz in der Medizin.

Artificial intelligence (AI) is increasingly finding its way into medicine, and it is not yet clear how it will change the practice of medicine and the way doctors see themselves. This article explores the ethical limits of AI by (1) discussing the reductionistic elements inherent in AI, (2) working out the problematic implications of algorithmisation and (3) highlighting the lack of human control as an ethical problem of AI. The conclusion is that although AI is a useful tool to support medical judgement, it is absolutely dependent on human decision-making authority in order to actually prove beneficial for medicine.

The Impact of Vitamin D on Immune Function and Its Role in Hashimoto's Thyroiditis: A Narrative Review.

Vitamin D, an essential nutrient, plays a crucial role in numerous biological functions, acting as a hormone and being important for the proper functioning of the immune system. This review illustrates the interactions between adequate vitamin D levels and an appropriate immune response, highlighting the implications for Hashimoto's thyroiditis (HT), a chronic inflammation of the thyroid characterized by the production of autoantibodies. A comprehensive review of the existing literature shows that vitamin D inhibits the secretion of pro-inflammatory cytokines, leading to an improvement in the clinical picture in HT by switching from a pro-inflammatory to immune balance. Vitamin D supplementation has been shown to reduce elevated serum levels of thyroid peroxidase antibodies, a key marker of HT. Although the results are conflicting, the evidence suggests that an adequate vitamin D intake supports the immune function and counteracts autoimmune conditions such as HT by improving their symptoms. There is evidence of vitamin D's key role in supporting the immune system function and managing autoimmunity, such as in HT. An adequate vitamin D intake is crucial for improving the clinical picture and the symptoms of HT.

Can help for patients be too expensive? Ethical considerations and end-stage lung disease.

The treatment of patients with end-stage lung disease is very expensive. In an era of cost containment, the physician could be forced to restrict his therapy in order to spend less. But does the physician really have the right to restrict a reasonable therapy for economic reasons? It is argued that the mission of medicine is to help people in need and that any confidence is shaken if the physician is forced to be both physician and gatekeeper at the same time. It is argued that medicine as a central form of care will only be able to survive if it has the chance to remain a free profession, a profession which has the liberty to help each individual patient even if this help is expensive. However, it remains a duty of the physician to accept limits and to learn that for a good death it is necessary to be honest and to talk early enough about the possibilities of palliative care.

[Should modern medicine become a service industry? An ethical appraisal of a market-oriented medicine]. / Die moderne Medizin als Dienstleistungsunternehmen? Eine ethische Kritik der Marktorientierung in der Medizin.

Currently, modern medicine is undergoing fundamental transformation. Care for the patient has transformed into a client service delivery where patients are perceived as customers. It's not just simple semantics. Rather, such changes reflect a fundamental shift in human and social values and, in particular, in human self-awareness. Health has become the absolute and natural human condition which can and must be claimed and it has become the epitome of an individual's potential. In turn, these changes have a sensitively responding addressee. They affect the moral values and the sense of identity of health care workers and especially of physicians. Thus, it is a network of interlinked external and internal factors that are reshaping the core values and professional identity of medicine. In these times of change it is pivotal to ponder about the basic task of medicine and what medicine is actually meant to be. Replacing health care providers for patients by economically focused traders serving the needs of demanding clients constitutes a shift in paradigm. It is medicine as a health care profession and the specific needs of suffering patients and disabled individuals what is at stake here.

[The dentist between medicine and cosmetology. Ethical shortcomings of the esthetics boom in dentistry]. / Die Zahnmedizin zwischen Heilkunde und Beauty-Industrie. Zu den ethischen Unzulänglichkeiten des Asthetik-Booms in der Zahnheilkunde.

Dentistry has evolved from a genuine medical practice to a mere business. From an ethical point of view it is asked whether this evolution creates more problems than it solves. The paper elaborates four arguments against this evolution and shows that aesthetics in dentistry which works only according to market categories runs the risk of loosing the view for the real need of patients. Dentistry which comprehends itself as part of a market will be nothing else than a part of a beauty industry which has the only aim to sell something, but not the aim to help people. Such a dentistry makes profit from the ideology of a society which serves only vanity, youthfulness and personal success and which is losing the sight for real values. The real value of man cannot be reduced to his appearance and medicine as an art should feel the obligation to resist these modern ideologies and should help people to get a more authentic attitude to themselves. If modern dentistry fails to think about these implications it will lose its identity as medicine, which would be too great a loss.

[From service of charity to profit center? An ethical critique of commodification of medicine]. / Vom karitativen Dienst am Menschen zum Profitcenter? Zu den ethischen Grenzen der Marktorientierung in der Medizin.

This paper wants to reflect the actual transformations of modern medicine. The implementation of the market into medicine is only possible by presupposing at least three implications: (a) the patient as consumer, (b) medical care as commodity, (c) competitiveness as criteria for good medicine. All three implications seem to be inadequate if the core identity of medicine is considered. If medicine is regarded as a human service for suffering people, it becomes clear that what medicine has to offer must be more than mere commodity. It is suggested to see medicine as a social institution which is linked to the obligation of the whole society to give medicine the possibility and the economic independence in order to remain an institution of charity which assures help for every man in need and which cannot be reduced to a mere enterprise.

[The situation of elderly patients]. / Situation des alteren Patienten.

Elderly and old tumour patients differ very much individually and a broad range of variation is even to be observed in patients of the same age group. But these patients differ from younger patients in many respects: This concerns the process of treatment decision and the expectations of the therapy on the one hand. Relevant differences with regard to younger patients exist also because of the age-related physiological changes and frequent age-typical comorbidities which may increase the toxicity of a therapy and the surgery-associated morbidity and lethality because of a decreased functional reserve capacity.

Acute acalculous cholecystitis during the course of primary Epstein-Barr virus infection: a new case and a review of the literature.

OBJECTIVE: The aim of this study was to describe a case of acute acalculous cholecystitis occurring in the course of primary Epstein-Barr virus (EBV) infection. METHODS: The clinical features of the case were analyzed and compared to those of three other similar cases reported in the international literature. RESULTS: All cases occurred in European females with cholestatic hepatitis, presented with gallbladder wall thickening, and recovered uneventfully without the need for surgical intervention. CONCLUSIONS: Acute acalculous cholecystitis may occur during the course of acute EBV infection, especially in patients with cholestatic hepatitis. Clinicians should be aware of the possible involvement of the gallbladder during EBV infection to avoid unnecessary invasive procedures or the overuse of antibiotics.