Research ethics, publication ethics and the dialectics of scientists trying not to behave badly: a comment on the advantages and limitations of Twin Assessment of Clinical Trials (TACT)

Aim: This comment addresses conflicts of interest in the publication of research results. Subject and Methods: Based on the concept of values in science, the problem of scientific misconduct related to publishing research results is treated hermeneutically. Franz Porzsolt’s approach to assessing studies and the implications for solving conflicts of interest are evaluated. Results: It is argued that conflicts of interest reflect the difficulty of balancing values in science and that science would become arbitrary and worthless for sponsors of research if it lacked its traditional values. Conclusion: Keeping scientific values and coping with conflicts of interest are essential for the future credibility and accountability of scientific endeavors. The communitarian approach to Twin Assessment of Clinical Studies might answer both demands

Evidenzen der Bilder

Evidenz beschreibt etwas, das unmittelbar einleuchtet. Wissenschaftliche Abbildungen erheben zwar den Anspruch, evident zu sein, aber ihre Evidenz ist nicht natürlich. Sie ist nur mittelbar für diejenigen einleuchtend, die sie lesen können. Das gilt auch für Bilder in der medizinischen Diagnostik: Im Visualisierungsprozess diagnostischer Abbildungen werden zum einen Strukturen und Zusammenhänge sichtbar gemacht, die zuvor unsichtbar waren. Zum anderen muss über Lese- und Denkprozesse die Evidenz in das Bild implementiert werden. Allerdings sind diese Bilder primär durch Mehrdeutigkeit und Unbestimmtheit geprägt, was Strategien der Evidenzproduktion erfordert. Hierzu gehören der Einsatz geschulter Zeichner am Mikroskop, die Produktion von Diagrammen auf Basis von Messwerten, der versierte Einsatz von Endoskopen sowie die physikalisch-chemische Erzeugung von Radiogrammen zur Sichtbarmachung des Körperinneren. Die Evidenz diagnostischer Abbildungen unterliegt also immer bestimmten Verfahren und Strategien der Evidenzzuschreibung. Sie bleibt eine nützliche Fiktion, die überaus vielfältig und immer kontextabhängig ist. Heiner Fangerau und Michael Martin sprechen deshalb statt von Evidenz im Singular von den Evidenzen diagnostischer Bilder im Plural

Evidenzen der Bilder

Evidenz beschreibt etwas, das unmittelbar einleuchtet. Wissenschaftliche Abbildungen erheben zwar den Anspruch, evident zu sein, aber ihre Evidenz ist nicht natürlich. Sie ist nur mittelbar für diejenigen einleuchtend, die sie lesen können. Das gilt auch für Bilder in der medizinischen Diagnostik: Im Visualisierungsprozess diagnostischer Abbildungen werden zum einen Strukturen und Zusammenhänge sichtbar gemacht, die zuvor unsichtbar waren. Zum anderen muss über Lese- und Denkprozesse die Evidenz in das Bild implementiert werden. Allerdings sind diese Bilder primär durch Mehrdeutigkeit und Unbestimmtheit geprägt, was Strategien der Evidenzproduktion erfordert. Hierzu gehören der Einsatz geschulter Zeichner am Mikroskop, die Produktion von Diagrammen auf Basis von Messwerten, der versierte Einsatz von Endoskopen sowie die physikalisch-chemische Erzeugung von Radiogrammen zur Sichtbarmachung des Körperinneren. Die Evidenz diagnostischer Abbildungen unterliegt also immer bestimmten Verfahren und Strategien der Evidenzzuschreibung. Sie bleibt eine nützliche Fiktion, die überaus vielfältig und immer kontextabhängig ist. Heiner Fangerau und Michael Martin sprechen deshalb statt von Evidenz im Singular von den Evidenzen diagnostischer Bilder im Plural

COVID-19 in different cultures : East and West

陶徳民教授古稀記念

Esteem in the sciences made visible: How bibliometry receives new impulse from social network analysis

The article intends to show how a way of combining methods of social network analysis with methods of classical bibliometry meaningfully may be applied within historical studies. Going beyond bibliometry the argument is supported that a set of driving forces which build relationships among scientific actors via scientific activities might be subsumed in the pluri-dimensional term ‘esteem’ (Anerkennung) which should be distinguished from pure reputation. The method of a historical reconstruction of scientific networks seems to be especially useful for representing esteem within the sciences and implementing it as a sort of “currency system“ or social capital in the sense of Pierre Bourdieu. The concept of network serves as an abstract model in this context. The history of eugenics is uses as an example for data collection, data processing, data visualization and data interpretation. Three textbooks (including translations) are selected for analysis, the German Erwin Baur, Eugen Fischer, Fritz Lenz, Grundriß der menschlichen Erblichkeitslehre und Rassenhygiene (1st ed. 1921); the US-American Charles Davenport, Heredity in Relation to Eugenics; and the Swedish Gunnar Dahlberg, Arv och Ras. The proposed approach shows not only differentiated picture of the structure of the reception of these works but also the shift of interest from a variety of fields of medical research to the history of sciences.The article intends to show how a way of combining methods of social network analysis with methods of classical bibliometry meaningfully may be applied within historical studies. Going beyond bibliometry the argument is supported that a set of driving forces which build relationships among scientific actors via scientific activities might be subsumed in the pluri-dimensional term ‘esteem’ (Anerkennung) which should be distinguished from pure reputation. The method of a historical reconstruction of scientific networks seems to be especially useful for representing esteem within the sciences and implementing it as a sort of “currency system“ or social capital in the sense of Pierre Bourdieu. The concept of network serves as an abstract model in this context. The history of eugenics is uses as an example for data collection, data processing, data visualization and data interpretation. Three textbooks (including translations) are selected for analysis, the German Erwin Baur, Eugen Fischer, Fritz Lenz, Grundriß der menschlichen Erblichkeitslehre und Rassenhygiene (1st ed. 1921); the US-American Charles Davenport, Heredity in Relation to Eugenics; and the Swedish Gunnar Dahlberg, Arv och Ras. The proposed approach shows not only differentiated picture of the structure of the reception of these works but also the shift of interest from a variety of fields of medical research to the history of sciences

A New Medical History Journal

This is the first issue of the European Journal for the History of Medicine and Health (ehmh), a new platform of scholarly research and exchange in the vibrant, diverse and expanding field of history of medicine and health. The intention of the journal is to offer a platform to scholars interested in all possible aspects of the history of medicine and health. The journal is a joint undertaking of the Swiss Society for the History of Medicine and the European Association for the History of Medicine and Health. It is a continuation of Gesnerus: Swiss Journal for the History of Medicine and Science, which was published between 1943 and 2020

Individual risk assessment of adverse pregnancy outcome by multivariate regression analysis may serve as basis for drug intervention studies: retrospective analysis of 426 high-risk patients including ethical aspects

OBJECTIVE: To identify patients at very high risk for adverse pregnancy outcome (APO) at the 20- to 23-week scan and to assess the effectiveness of Aspirin (ASS) and low molecular weight heparin (LMWH) starting after this examination. PATIENTS AND METHODS: By applying an algorithm based on multivariate logistic regression analysis using the parameters maternal age, parity, body mass index (BMI), mean pulsatility index of both uterine arteries (meanPI), presence of uni- or bilateral notch, and depth of notch (mean notch index (meanNI), we retrospectively calculated the individual risk for APO of 21,302 singleton pregnancies. We isolated a subgroup of 426 patients with the highest calculated probability for APO (cpAPO > 27.8 %). 147 had been treated with ASS; 73 with LMWH, 15 patients with a combination of ASS and LMWH, and 191 patients had not received anticoagulants. RESULTS: Administration of ASS starting after 20 gestational weeks in comparison to non-treated patients significantly reduced the frequency of intrauterine/neonatal death (IUD/NND), preeclampsia <33 weeks (PE < 33), and preterm delivery <33 weeks (PD < 33), while the frequency of IUGR showed a tendency to be elevated (P = 0.061). The subgroup of high-risk patients treated with LMWH was characterised by a higher a priori risk for APO and showed no significant reduction of any form of APO but an increased frequency of PE. CONCLUSION: Individual assessment of risk for APO by applying a simple algorithm based on biometrical/biographical as well as sonographic parameters may serve as basis for drug intervention studies. The administration of ASS in high-risk patients starting after 20 gestational weeks reduced the frequency of most of the severe forms of adverse pregnancy outcome in high-risk patients. A complication-reducing effect of LMWH starting after 20 weeks of gestation in patients could not be proven. From an ethical point of view, it may not be justified any more to preclude high-risk patients from administration of ASS or to perform studies of ASS against placebo

Chapter 9 – Health Apps and Ethics

Das Thema der gesundheitlichen Selbstvermessung stellt kein neues Thema der Medizin dar, vielmehr haben Menschen schon lange ein Interesse daran, den Körper mit seinen Funktionen, Einschränkungen und Erkrankungen genau zu beobachten, zu messen und zu dokumentieren. Der aktuell boomende Bereich der mobilen Gesundheits-Applikationen, die eine Vielzahl von Anwendungsgebieten aufweisen, fußt auf diesem Trend. Die neue Technik allerdings bringt einige Besonderheiten mit sich, wie z.B. die Umfänglichkeit und Ubiquität der erhobenen Daten, so dass sie nicht nur einer wissenschaftlichen und juristischen Diskussion ihrer Chancen und Risiken bedarf. Vielmehr erscheint auch eine Debatte über die moralischen Dimensionen von mHealth Anwendungen notwendig. Der Beitrag geht der Frage nach, welche medizinethischen Standards derzeit im mHealth Bereich diskutiert werden und prüft anhand eines Fallbeispiels die reale Repräsentation der diskutierten Werte und Normen. Der Text benennt dabei die in der Literatur derzeit diskutierten spezifischen ethischen Grundproblematiken im Bereich der mHealth Applikationen, die vor allem in den Zielkonflikten zwischen Privatheit und Transparenz sowie Autonomie und Kontrolle angeordnet zu sein scheinen, und schlägt auf dieser Grundlage Eckpunkte für mögliche zukünftige medizinethische Richtlinien im Umgang mit mHealth Systemen vor.Measuring the body of man is by far not a new topic in the history of medicine. Body functions and structures have been measured since the beginning of medicine. The current boom of mobile health apps follows this tradition. However, the associated new technologies as well as the concept of mHealth bear with them new chances and risks that have not existed before (like the mass and ubiquity of data collected). These risks include moral hazards resulting in a debate about the ethics of mHealth. The text addresses the current discussion of the ethical aspects of mHealth. We reconstruct the current standards of medical ethics put forward in the debate and analyse with the help of a case study in how far these standards are addressed or challenged in existing applications and their contexts. The main goal conflicts discussed in today’s moral debates include the tensions between privacy and transparency as well as between autonomy and control in the use of data collected via mHealth apps. On the basis of the reconstruction of the main values considered in the existing discussion of the ethical implications of mHealth-applications we finally offer a starting point for the development of ethical guidelines for their further use and development

Consanguinity and pregnancy outcomes in a multi-ethnic, metropolitan European population

Objective: The aim of the present study was to assess the risk of major anomalies in the offspring of consanguineous couples, including data on the prenatal situation. Methods: Over 20years (1993-2012), 35391 fetuses were examined by prenatal sonography. In 675 cases (1.9%), parents were consanguineous, with 307 couples (45.5%) related as first cousins, 368 couples (54.5%) beyond first cousins. Detailed information was retrieved on 31710 (89.6%) fetuses, (consanguineous 568: 1.8%). Results: Overall prevalence of major anomalies among fetuses with non-consanguineous parents was 2.9% (consanguineous, 10.9%; first cousins, 12.4%; beyond first cousins, 6.5%). Adjusting the overall numbers for cases having been referred because of a previous index case, the prevalences were 2.8% (non-consanguineous) and 6.1% (consanguineous) (first cousin, 8.5%; beyond first cousin, 3.9%). Further adjustment for differential rates of trisomic pregnancies indicated 2.0%/5.9% congenital anomalies (non-consanguineous/consanguineous groups), that is, a consanguinity-associated excess of 3.9%, 6.1% in first cousin progeny and 1.9% beyond first cousin. Conclusions: The prevalence of major fetal anomalies associated with consanguinity is higher than in evaluations based only on postnatal life. It is important that this information is made available in genetic counselling programmes, especially in multi-ethnic and multi-religious communities, to enable couples to make informed decisions