Systems Medicine: hype or revolution?

Research and innovation in healthcare can change existing practices aiming at constant improvement of diagnosis, treatment and prevention. As a new holistic approach Systems Medicine (SM) may revolutionize the healthcare system. This paper analyzes ethical and economic obstacles of SMs development from a niche innovation to a standard solution.

[Memory in disciplinary cultures and "sites" of memory in medicine : Maximilian Nitze (1848-1906) and the establishment of urology].

The canon of material and immaterial references of the urological heritage must always be recognized as a part of a continous process of negotiation. Within German Urology the culture of remembrance on Maximilian Nitze reveals one of such processes.

[After the Action T4 : "Regionalized euthanasia" in the Günzburg Psychiatric Hospital].

Background: In Bavarian psychiatric hospitals approximately 15,000 people with mental handicaps and mental illnesses were killed after the so-called Action T4. The Heil- und Pflegeanstalt (psychiatric hospital) Günzburg was a so-called Zwischenanstalt (interim institution). The aim of the study was to analyze its role in carrying out "regionalized euthanasia".

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.

[German neurology and neurologists during the Third Reich: Preconditions and general framework before and after 1933].

This article focuses on the institutional development of neurology in Germany up to the rise to power of the National Socialists and the radical sociopolitical changes after 1933. A wide range of scattered secondary literature was assessed and evaluated. Additionally, some original sources are literally quoted and interpreted according to the context.

[German neurology and neurologists during the Third Reich: brain research and "euthanasia"].

The connection between systematic killing of the mentally ill and disabled, euphemistically called "euthanasia" in the National Socialism ideology, and German brain research has been thoroughly investigated and in detail; however, the impact of this criminal nexus on the image and self-perception of German neurologists as well as the status of neurology as a medical discipline is still the subject of controversial debates.Between 1939 and 1945 the Kaiser Wilhelm Institute (KWI) in Berlin along with other research centres were insofar enmeshed in the "euthanasia" program as brains of killed patients were dissected in the guise of "concomitant research" in order to generate medical knowledge. Affected were mainly individuals suffering from oligophrenia, early childhood brain atrophy, cerebral palsy and epilepsy.

[German neurology and neurologists during the Third Reich: the aftermath].

The article discusses the consequences for neurology as a discipline which resulted from neurologists' participation in the crimes committed under National Socialism (NS). Chronologically, the current literature distinguishes mainly four overlapping stages: (1) a first phase was characterized by legal persecution and "denazification", which was also the time of the Nuremberg doctors' trial in which no neurologists were on trial. A detailed documentation of the trial for the German medical profession was published by Alexander Mitscherlich.

[German neurology and neurologists during the Third Reich: exemplified by research on epilepsy].

There are only a small number of studies dealing with the impact of eugenic theories and practices on the research of particular neurological diseases during the Third Reich. Thus, this contribution to the special issue on neurology in Germany between 1933 and 1945 focuses exemplarily on epilepsy research. By drawing on primary sources and secondary literature the article tries to reconstruct the scientific discourse of the time and consider the implications for patients.

[Museum, library, and archives of the German Society of Urology as a corporate museum : A neglected, sizeable dimension of scientific collections owened by professional societies].

Corporate museums make important contributions to science history and daily life. They are an essential part of the historical marketing of organizations, including scientific associations. The museum for the history of urology organized and housed by the German Society of Urology (DGU) can be compared to a corporate museum, because the institution serves two purposes: it represents the society to a wider public and it helps to reconstruct and analyze the history of urology and the history of the society.

[Confusion about P. Schröder, W. Villinger and H. Heinze : The three chairmen of the German Society for Child Psychiatry and Therapeutic Education between 1940 and 1945].

On 5 September 1940, the German Society for Child Psychiatry and Therapeutic Education (DGKH) was founded. In order to secure sustainable impact, the young professional association aimed to: (1) Increase its scientific reputation through the organization of regular conventions and publications, (2) Attain continuity in its leadership (board) and membership growth, and (3) Establish itself in national socialistic politics and society for health care policy matters. Due to the unexpected death of the first chairman, Paul Schröder, only nine months after DGKH's foundation, these objectives were seriously put into question.

[Autologous Bypass to Pedal Side Branches to Avoid a Major Amputation].

In critical limb ischaemia (CLI), a pedal vein graft bypass offers good long-term results regarding function and limb salvage. However, some cases require bypasses to branches of pedal arteries based on angiographic findings. In a retrospective database we analysed all patients who received a vein graft bypass to branches of pedal arteries for treatment of critical limb ischaemia.

[Urology and Sexology in Berlin 1880-1933: Original citations for the establishment of this frontier of urology - protagonists as reflected in their publications].

The connections between urology and sexology are often not obvious today. At the end of the 19th century both specialties developed in parallel especially in Berlin and had a fruitful relationship. Urologic journals and books were an ideal forum for publication especially for sexologists.

[From the Auschwitz Syndrome to a Psyche Model--Life and Work of the Polish Psychiatrist 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.

Beyond victimhood. The struggle of Munich anatomist Titus von Lanz during National Socialism.

The article analyzes the life and career of the anatomist Titus von Lanz (1897-1967) of Munich focusing on the period of National Socialism (NS). Von Lanz lost his position as an associate professor at the Anatomical Institute of Munich University because of his marriage to a "half-Jewish" woman in 1938. In contrast to most of his colleagues affected by National Socialist measures, von Lanz had opportunities to save his career and made extensive use of them.

[CAM products as therapeutic placebos: theoretical and bioethical reflections].

In Germany as well as in many other countries the project of 'integrating' CAM interventions into conventional medicine is currently underway. It is a highly contested endeavour. One backdoor of justifying CAM interventions - even if, according to the scientific standards of conventional medicine, they have been proved to lack specific effectiveness - is their use as therapeutic placebos.

[The concept of complementary and alternative medicine from the perspective of the philosophy of science and bioethics].

Decisions about therapeutic interventions to be made by physicians, patients, and healthcare purchasers essentially depend on their classification in a credible context of justification, especially in a world dominated by contradicting experts. To some extent, this framing is done by sorting terms and their undertones, including the case of so-called CAM measures. In this paper, the authors reflect on ways to deal with the term CAM and the underlying supply-side approaches to healthcare from a primarily science-oriented perspective.

[Mental Health Professionals' Perspectives Towards Desire for Children and Family Planning Among Psychiatric Patients - Results of a Qualitative Study].

Analysis of mental health professionals' attitudes to reproductive issues among psychiatric patients. 31 problem-centered semi-structured interviews with psychiatric professionals were conducted and analyzed by content analysis methods. Outside of psychotherapeutic treatment the desire for children is generally assessed as less important in the context of mental health care, it is often limited to effective birth control with regard to drug treatment.

[Tyson's glands. On eponymic and discussion in urology and dermatology].

The use of eponyms in scientific terminology and particularly in medical terminology has a long tradition but discussion often arises especially since the involvement of the protagonists in the National Socialist regime which led to strong controversies (e. g. Clara, Stieve, Reiter, Wegener).

[Is the association between mental disorders and sickness absence independent of sociodemographic factors?].

Aim: Mental diseases are highly prevalent and of increasing meaning for absenteeism. The association of absenteeism with vertical and horizontal dimensions of socioeconomic status is well-known. Against this background we investigated the independent association between mental diseases and absenteeism or long-time absenteeism of socioeconomic aspects.

[Objects from scientific collections in demand: the value of the various collections of the Urologic History Center of the German Society of Urology for modern teaching purposes in urology].

The use of artifacts and objects from scientific medical collections and museums for academic teaching purposes are one of the main qualifying tasks of those institutions. In recent years, this aspect of scientific collections has again become on focus within academics. The collections offer a unique chance for visual and haptic forms of teaching in many fields.

[Criteria for an ethically adequate prioritisation of individualised treatment strategies].

Objectives: In view of the constant increase of biomedical innovations as well as the demographic change an explicit regulation of health services is inevitable in the German health-care system. Particularly, this applies to so-called individualised treatment measures, which so far only rarely show significant advantages over "classical" treatment measures with mostly substantially higher costs. Against this background, appropriate prioritisation criteria are developed and possibilities as well as limits of their application in the context of individualised medicine are shown.

[How to Define Good Health Care: An Ethical Framework for the Evaluation of Health Care for the Chronically Ill].

In Germany we face an increase in chronic illnesses and a health care system not adjusted to the specific needs of this patient group. Innovative health care management programmes (for example, disease management programmes) might be able to play an important role in overcoming the existing deficits. By developing and implementing such programmes we are, how-ever, implicitly touching upon normative issues, but only rarely are the ethical aspects of these programmes discussed explicitly and evaluated in a systematic way.