Women education in the Soviet prophylactoria and the care homes for sexually transmitted disease patients in the Soviet Occupation Zone of Germany.

OBJECTIVES: In the 1920s, so-called prophylactoria were established in the USSR. In these institutions, sex workers with sexually transmitted diseases (STDs) were treated. After the end of World War II, care homes for patients with STDs were established in the Soviet Occupation Zone of Germany (SOZ). These institutions were also intended to treat people suffering from STDs. This article compares these two types of medical institutions. METHODS: Sources from the State Archive of the Russian Federation in Moscow, the German Federal Archives in Berlin and the City Archive Zwickau were used. The analysed sources were evaluated by using the historical-critical method. RESULTS: The prophylactoria were novel institutions that combined education and medical treatment of people with STDs. Similar strategies were followed in the care homes for STD patients. In both institutions, the sick persons had to follow a regular daily routine and work every day. The political indoctrination served to educate 'socialist personalities'. Nevertheless, various differences can be found between the facilities: the length of stay was different. The women in Soviet prophylactoria were cared for there for up to 2 years. However, the standard duration of stay in the care homes for STD patients was 3-6 months. CONCLUSIONS: The prophylactoria had a long-term programme not only to treat sick women but also to reeducate them. The aim was to enlighten and integrate them into the new Soviet society. The care homes for STD patients had a short-term programme of combating venereal diseases. Their main goal was to treat patients with STDs as quickly as possible, while education was an additional measure. Whether both institutions were successful in educating and treating these patients can hardly be assessed from today's perspective.

Policy Approaches Toward Combatting Venereal Diseases in the Soviet Occupation Zone in Germany (1945-1949), the German Democratic Republic (1949-1989), and the Polish People's Republic (1945-1989).

The spread of venereal diseases after the Second World War constituted a grave public health danger in Europe. Especially in all four occupation zones in Germany and the Polish People's Republic high morbidity rates were observed. In order to limit the spread of diseases, respective administrations adopted specific regulations. The aim of this research is the analysis and comparison of legal regulations for controlling and combating venereal diseases in these countries. We have analyzed legislative and administrative acts concerning combatting venereal diseases issued by the official organs of the Soviet Occupation Zone, the German Democratic Republic, and the Polish People's Republic from 1945 to 1989. Subsequently, the analyzed sources were evaluated in light of the existing literature on the topic. Our analysis shows that policy approaches in both countries were based the Soviet Union's model for fighting venereal diseases. Visible are similarities of the approaches. They include organization of anti-venereal services, compulsory hospitalization, and actions against social groups perceived as sources of venereal diseases. Beside the purpose of breaking the spread of the epidemics, the approaches had also a political aim of sanctioning behavior that diverged from prescribed socialist moral norms.

Cancer, the Media and Dealing with Knowledge.

Among the primary function of the media are conveying personal understanding and expanding the subjective knowledge of the recipient citizen. A particular challenge arising during this process is the mediation of medical knowledge. In addition to pure factual knowledge, it often involves subjective experiences, hopes and wishes. One example of this is media reports about cancer therapies. As a result of widespread media coverage since 2017, the public is under the impression that methadone is a promising treatment for cancer. This chapter analyzes the part played by the media and the ethical debate. The ethical issues that arise concern good scientific practice, patient autonomy and the media coverage of methadone. We conclude that, according to the current state of research, the promotion of methadone as a cure for cancer is ethically unacceptable. In this case the media are not fulfilling their task of imparting knowledge, because they are not communicating the current state of research or the associated ethical questions.

Content and Method of Information for Participants in Clinical Studies With Induced Pluripotent Stem Cells (iPSCs).

Research with induced pluripotent stem cells (iPSCs) involves specific ethical challenges, which should be addressed in the informed consent process. Up to now, little concern has been paid to the practice of information in iPSC-clinical studies. In order to fill this research gap, we have searched the documentation of the Research Ethics Committee at Ulm University from the years 2007 to 2019. In our previous research, we have identified 11 items for evaluation of the process of information in iPSC research. We used these items to analyze content and form of information provided for participants in the iPSC studies conducted at Ulm University and Ulm University Hospital in Germany. All analyzed studies provide general information regarding the study's aim, method, and collection of donor's personal data and specimen. The information for participants in these studies adheres to general guidelines for research involving human subjects; however, in several areas fails to take into account the specific nature of research with iPSCs. The majority of analyzed studies fail to provide information about possible individual consequences connected with genetic research, such as the possibility of re-identification of the donor or incidental findings acquired during research. Missing is also information about the possibility of future studies involving reproductive research or transplantation of cells and organs. The donor information process in all analyzed studies is conducted in form of the information sheet and oral information. The results of our research show that the process of informed consent in iPSC research should be updated as new developments emerge in this area. However, comprehension of information should not be jeopardized through information overload. Effective communication of essential information requires improved information methods tailored to the needs of participants, such as video animations, interactive consent modules or social media instruments.

Balancing public health and civil liberties in times of pandemic.

The ongoing COVID-19 pandemic constitutes not only a danger for public health, but may also threaten civil liberties. Looking at the examples of recent events in Poland and Hungary, the authors argue that governments may misuse pandemic for their political advantage, thus endangering public health. Political decisions taken to stem the spread of pandemics should be limited and strictly proportionate to the situation.

[Men in Closed Venerological Wards of the GDR illustrated by Examples of Berlin, Dresden and Erfurt]. / Männer in geschlossenen Venerologischen Stationen der DDR am Beispiel von Berlin, Dresden und Erfurt.

OBJECTIVES: While numerous research results are available on the treatment of women in closed venereological wards in the GDR, hardly anything is known about the forced admissions of men to these wards. The aim of this study was to analyse construction of the wards, the admission and maintenance in the wards as well as the extent of the compulsory admissions of men. METHODS: Unprinted sources were researched in the Federal Archive and State Archive Berlin and in the municipal archives of Erfurt and Zwickau and analyzed using a historically critical method. In addition, printed sources found in databases were researched and evaluated. RESULTS: In the GDR, the closed venereological wards for men were part of closed venereological facilities, each of which included a ward for women. Men and women were accommodated separately. Reasons for the admission of men were sexually transmitted diseases to be treated, suspicion of frequently changing sexual partners (HwG-Verdacht) and disciplinary measures. The medical care of the men corresponded to the contemporary medical standard. Only a few men were committed. CONCLUSIONS: The number of beds and compulsory admissions was considerably lower in the wards for men than in those for women. The men were compulsory committed due to having a venereal disease or due to being a sexually promiscuous individual (HwG-Person), while more than 50% of women were committed because of drifting. In addition, men were regarded as reliable subjects in medical care, while women were regarded as defaulting and unreliable. In this respect, the situation of men differs fundamentally from that of women.

Medical Students' Acquaintance with Core Concepts, Institutions and Guidelines on Good Scientific Practice: A Pre- and Post-questionnaire Survey.

German medical students are not sufficiently introduced to the ethical principles and pitfalls of scientific work. Therefore, a compulsory course on good scientific practice (GSP) has been developed and implemented into the curriculum of medical students, with the goal to foster scientific integrity and prevent scientific misconduct. Students' knowledge and attitudes towards GSP were evaluated by a pre-post-teaching questionnaire survey (n = 239). Most participants initially had startling knowledge gaps in the field. Moreover, they were not acquainted with core institutions on GSP, the office of ombudsperson and the nationally binding guidelines on GSP. The pre-post-teaching comparison showed statistically significant improvement in all areas tested; moreover, after the course participants confided more trust in GSP institutions. Applying ethical rules into practice can be challenging; therefore, students need to learn to work independently with guidelines on GSP and should be introduced to institutions providing further guidance. As our study has shown, students are very willing to pursue a scientific career based on integrity and honesty, however, they lack the knowledge how to do so. In light of our results, we therefore recommend to integrate courses on GSP already at an early time into the mandatory curriculum of medical students.

Donor information in research and drug evaluation with induced pluripotent stem cells (iPSCs).

BACKGROUND: The discovery of induced pluripotent stem cells (iPSCs) opened the possibilities for reprogramming cells back to a pluripotent state. Because of no apparent ethical issues connected with donation and derivation of biomaterial, iPSCs are considered as a research alternative to ethically highly disputed human embryonic stem cells (hESCs). However, the unique character of iPSCs leads to numerous ethical considerations, which mainly concern the issue of donor information and consent for the use of biospecimen in research and drug evaluation. METHODS: For the purpose of this analysis, we conducted a review of the literature in the PubMed/MEDLINE and Web of Science databases. The search algorithm led to the identification of 1461 results. After removing duplicates and screening of title and abstract, 90 articles were found to be relevant to the study's objective. Full texts of these articles were apprised and 62 articles were excluded at this step for not properly addressing the study's objective. In the final step, 28 articles were included in the analysis. Analyzed were both research and non-research manuscripts published in peer-reviewed journals. RESULTS: In the case of iPSC research, the information process should be guided by general frameworks established for research on human subjects but also by specific characteristics of iPSCs. We determined four main domains and 12 thematic subdomains that should be included in donor information. Our results show that majority of authors agree to the content of information with regard to the areas of general information, storage of cells, and protection of privacy. Two main issues that are discussed in the literature are donor's consent for use in future studies and the process of donor information. CONCLUSIONS: Given the unique character of iPSCs and the possibility of their various uses in the future, the content of donor information should contain specific information central to iPSC research. Effective methods of communicating information to donors should combine written and oral information with the possible use of multimedia.

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

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.

Clinical Ethics Consultation in the Transition Countries of Central and Eastern Europe.

Since 1989, clinical ethics consultation in form of hospital ethics committees (HECs) was established in most of the transition countries of Central and Eastern Europe. Up to now, the similarities and differences between HECs in Central and Eastern Europe and their counterparts in the U.S. and Western Europe have not been determined. Through search in literature databases, we have identified studies that document the implementation of clinical ethics consultation in Central and Eastern Europe. These studies have been analyzed under the following aspects: mode of establishment of HECs, character of consultation they provide, and their composition. The results show that HECs in the transition countries of Central and Eastern Europe differ from their western-European or U.S. counterparts with regard to these three aspects. HECs were established because of centrally imposed legal regulations. Little initiatives in this area were taken by medical professionals interested in resolving emerging ethical issues. HECs in the transition countries concentrate mostly on review of research protocols or resolution of administrative conflicts in healthcare institutions. Moreover, integration of non-professional third parties in the workings of HECs is often neglected. We argue that these differences can be attributed to the historical background and the role of medicine in these countries under the communist regime. Political and organizational structures of healthcare as well as education of healthcare staff during this period influenced current functioning of clinical ethics consultation in the transition countries.

Good Scientific Practice: Developing a Curriculum for Medical Students in Germany.

German medical schools have not yet sufficiently introduced students to the field of good scientific practice (GSP). In order to prevent scientific misconduct and to foster scientific integrity, courses on GSP must be an integral part of the curriculum of medical students. Based on a review of the literature, teaching units and materials for two courses on GSP were developed and tested in a pilot course. The pilot course was accompanied by a pre-post evaluation that assessed students' knowledge and attitudes towards scientific integrity and scientific misconduct. A syllabus was designed that comprised the following six topics: theoretical foundations of GSP; scientific publishing; empirical data; scientific supervision and teamwork; clinical research; personal interests. The comparison pre versus post-intervention yielded statistically significant changes in regard to the participants' knowledge and attitude toward all forms of scientific misconduct treated in the course. As the majority of participants was not familiar with the fundamental regulations or guidelines of GSP, it seems crucial to train students in actively applying such norms to real-world conflicts. Students' unfamiliarity with the fundamentals of GSP can be linked to the fact that many students have already experienced forms of scientific misconduct. Thus, GSP syllabi should be closely adjusted to a student's realm of experience. All in all, courses on GSP can be seen as a potential means to increase the number of young scholars.

Were All Compulsorily Committed Women Prostitutes? Closed Venereology Wards in East Germany.

Were the women that were compulsorily committed to closed venereology wards in the Soviet Occupation Zone (SOZ) and German Democratic Republic (GDR) prostitutes and sexually promiscuous individuals? 1,241 patient records of the closed venereology ward in Leipzig-Thonberg were researched in the Leipzig Municipal Archive and evaluated using the historical-critical method. Two periods were investigated: June 1946 to February 1961 (the period of validity of the Orders of the Soviet Military Administration in Germany - SMAG) and March 1961 to August 1990 (period of validity of the GDR regulation).During the two periods of investigation, 3% of the women compulsorily committed to the closed venereology ward Leipzig-Thonberg were prostitutes. 9% of women were compulsorily committed as sexually promiscuous individuals during the first period of investigation, and 13% during the second period. During the first period, mainly adult women with a venereal disease were compulsorily committed. These women were treated for gonorrhea or syphilis. In contrast, the majority of compulsorily committed individuals during the second period were underage girls without a venereal disease. In conclusions: 1) Whereas mostly prostitutes and sexually promiscuous individuals were compulsorily committed to venereology wards in the Federal Republic of Germany (FRG), the proportion of prostitutes and sexually promiscuous individuals in Leipzig-Thonberg was very small. 2) In the 1950s, mostly adult women with venereal diseases were compulsorily committed in the FRG and GDR. 3) A comparison with the closed venereology facility in Berlin-Buch (GDR) shows a similar age distribution among compulsorily committed women in the 1970s and a general decline of venereal diseases.

Implementation of Clinical Ethics Consultation in German Hospitals.

In order to build on the information that was obtained in the course of the first study, a follow-up survey was conducted first by phone and subsequently in a written form between August and October 2014. We contacted 1.858 hospitals in all of Germany for the follow-up survey by phone. In cases where a hospital had not participated in the first study, the willingness to participate in the follow-up survey was established in advance. The survey's dispatch was ensured in the case of acceptance. The same structured survey was used as a research tool. The data of the first study and the follow-up survey were merged and evaluated. 654 surveys (response rate 35.2 %) could be evaluated altogether. Our survey by phone revealed that 912 hospitals in all of Germany have at least one form of clinical ethics consultation available. The health care ethics committee is the most frequently implemented structure of clinical ethics consultation. The implementation of clinical ethics consultation is dependent on sponsorship and hospital size. Recommendations to deliver structures of clinical ethics consultations (ZEKO 2006, AEM 2010) have a smaller influence on the implementation compared to the certification by KTQ respectively proCum Cert. The rate of implementation in regard to the structures of clinical ethics consultation has steadily increased for years. The establishment of clinical ethics consultation in German hospitals should be further promoted. It would be desirable further to develop suitable juridical regulations in order to implement clinical ethics consultation as well as structural parameters.

Social Freezing in Medical Practice. Experiences and Attitudes of Gynecologists in Germany.

Surveys of the German public have revealed a high acceptance of social freezing, i.e. oocyte conservation without medical indication. Up to now, there are no investigations available on the experiences and attitudes of health professionals towards social freezing. Between August 2015 and January 2016, we surveyed gynecologists Germany-wide on the topic social freezing. Five gynecologists specialized in reproductive medicine and five office-based gynecologists in standard care were chosen for the survey. The survey was conducted with an explorative, qualitative research design. The demand for social freezing in Germany is low. With regard to their fertility age, most women attend consultations too late, they have only little previous knowledge and false expectations. The gynecologists consider it the duty of society and politics to provide for the compatibility of family and work. They relate late parenthood to disadvantages primarily for the children. A majority of the gynecologists interviewed tend to advise natural reproduction. Social freezing is often mistaken as a kind of fertility insurance. Thus, it is necessary that physicians inform women early about the possibilities and limitations of social freezing. In the first place, social freezing is not a medical or medical-ethical topic. Women consider the method as a possibility to ensure the compatibility of family and work. This compatibility should be mostly perceived as a political topic. It cannot be a medical task to solve this issue. In fact, a debate in society as a whole is necessary that includes all relevant actors.

Patient Autonomy and Quality of Care in Telehealthcare.

Telemedicine is a complex field including various applications and target groups. Especially telehealthcare is seen by many as a means to revolutionize medicine. It gives patients the opportunity to take charge of their own health by using self-tracking devices and allows health professionals to treat patients from a distance. To some, this means an empowerment of patient autonomy as well as an improvement in the quality of care. Others state the dangers of depersonalization of medicine and the pathologization of daily life. This paper examines the ethical implications of telehealthcare, focusing on patient autonomy and quality of care by analyzing metareviews, randomized controlled trials and narrative ethical analyses on the topic. As a result, we conclude that the technically enhanced encounter between patients and health professionals may mean an empowerment of patient autonomy when it goes along with a personal relationship based on trust, assistance and support. When it comes to the quality of care, telehealthcare may lead to an improvement as long it is adopted to the patient's individual needs.

The Application of Standards and Recommendations to Clinical Ethics Consultation in Practice: An Evaluation at German Hospitals.

The executive board of the Academy for Ethics in Medicine (AEM) and two AEM working groups formulated standards and recommendations for clinical ethics consultation in 2010, 2011, and 2013. These guidelines comply with the international standards like those set by the American Society for Bioethics and Humanities. There is no empirical data available yet that could indicate whether these standards and recommendations have been implemented in German hospitals. This desideratum is addressed in the present study. We contacted 1.858 German hospitals between September 2013 and January 2014. A follow-up survey was conducted between October 2014 and January 2015. The data of the initial survey and the follow-up survey were merged and evaluated. The statements of the participants were compared with the standards and recommendations. The standards of the AEM concerning the tasks of clinical ethics consultation (including ethics consultation, ethics training and the establishment of policy guidelines) are employed by a majority of participants of the study. Almost all of these participants document their consultation activities by means of protocols or entries in the patient file. There are deviations from the recommendations of the AEM working groups regarding the drafting of statutes, activity reports, and financial support. The activities of clinical ethics consultation predominantly comply with the standards of the AEM and recommendations for the documentation. The recommendations for evaluation should be improved in practice. This applies particularly for activity reports in order to evaluate the activities. Internal evaluation could take place accordingly.

[From the Auschwitz Syndrome to a Psyche Model--Life and Work of the Polish Psychiatrist Antoni Kepinski (1918-1972)]. / Vom Auschwitz-Syndrom zum Modell der Psyche--Biografie und Werk des polnischen Psychiaters Antoni Kepinski (1918-1972).

OBJECTIVE: Life and work of the Polish psychiatrist Antoni Kepinski (1918 - 1972) are barely known today, although his writings about the Auschwitz syndrome have had an impact all over the world. We present his biography and work. METHODS: Compilation and evaluation of literature about Kepinski's work and historical-critical analysis of his key texts. RESULTS: Kepinski's work about the Auschwitz syndrome formed the basis for his understanding of the psyche and his theory on information metabolism. Kepinski posited that the mind processes outside stimuli based on its own set of values and that it determines the subject's actions. In doing so, it affects its environment. If these interactions are disrupted, pathological disorders might result. The therapist should consequently empower the patient to get in touch with his own value-system. CONCLUSION: Kepinskis work serves as a foundation for research on disease patterns that are known today as post-traumatic stress disorder (PTSD). His theory on information metabolism is essential for the current treatment of patients. It is therefore important to further explore his work and adjust it to the requirements of medical practice.