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On the social responsibility of scientists.

The author outlines the history of genetics in the United States, looking at all the social and political implications of it, too often underestimated by the geneticists themselves. In contrast to physicists, who were forced to recognize the consequences of their role in the development of the atomic bomb and who openly carried a historical burden from their past, geneticists had no historical memory and were essentially ignorant of their own "atomic" history: the Eugenics movement in the first half of 20th century, which significantly affected social policy in the United State and Europe. Few geneticists, in fact, until recently, were aware of the Eugenics movement itself. It was only with the extreme misuse of genetics by German scientists and the Nazi Government that some English and US geneticists began to speak out more openly. The author sees in this lack of awareness the major responsibility of geneticists for the misrepresentation and misuse of science and also calls for a better interaction between scientists and those who work in other social fields; a communication gap between the two cultures holds dangers for us all.

Eugenics↗

The historical contingency of bioethics.

The principles of bioethics have been historically contingent, a product of social values, circumstances, and experience. During the early twentieth century, they rested on a doctor-knows-best autonomy that permitted physicians to perform research on human subjects with a minimum degree, if any, of informed consent. The eugenics movement of the period embraced an implicit bioethics by presuming to sterilize individuals for the sake of a larger social benefit, a practice and doctrine that helped lead to the Nazi medical experiments and death camps. After World War II, the promulgation of the Nuremberg Code failed to halt eugenic sterilization and risky human experimentation without informed consent either in civilian or military venues. However, beginning in the 1960s, these practices came under mounting critical scrutiny, partly because of the increasing attention given to individual rights. By now, it is widely understood that concern for individual rights rather than an appeal to some national good belongs at the heart of bioethics.

Bioethical Issues↗

[From genetics to law, the viewpoint of the physician].

OF ALL SCIENCES: Genetics, science of the transmission of hereditary characteristics, is probably that which interferes most with the Law. However, it was not genetics that provoked the ideological, social and political upheaval at the end of the 19th and during the 20th century; it was the theory of evolution, which preceded the discovery of genetics that was to provide the substratum of evolution mechanisms. Most of the lethal ideologies of the 20th century were based on this. As was the case of eugenics, with the participation of scientists, legislators and judges. GENETIC ENGINEERING: The logical application of the theory of evolution and universality of the genetic code, led to the development of the genome program. Today, sequencing of the human genome is almost finished, but many years will be needed before details of the physiological genetic manifestations will be known. Genes themselves would not generally be concerned by patenting rules. However, there is an international tendency towards envisaging the patenting of genes. DEVELOPMENT OF GENETIC TESTS AND THEIR INCREASING USE FOR MEDICAL PURPOSES: Are among the ethical problems raised by genetics. Genetic diagnosis, conducted before embryo transfer is called "pre-implantation". This raises the problem of an eventual pre-implantation eugenic selection and therefore requires strict control. Reinforcement of the right to knowledge of genetic origins is also one of the socio-legal problems raised by the progress in genetics.

Attitude of Health Personnel↗

Human gene therapy: scientific and ethical considerations.

The term "gene therapy" encompasses at least four types of application of genetic engineering for the insertion of genes into humans. The scientific requirements and the ethical issues associated with each type are discussed. Somatic cell gene therapy is technically the simplest and ethically the least controversial. The first clinical trials will probably be undertaken within the next year. Germ line gene therapy will require major advances in our present knowledge and it raises ethical issues that are now being debated. In order to provide guidelines for determining when germ line gene therapy would be ethical, the author presents three criteria which should be satisfied prior to the time that a clinical protocol is attempted in humans. Enhancement genetic engineering presents significant, and troubling, ethical concerns. Except where this type of therapy can be justified on the grounds of preventive medicine, enhancement engineering should not be performed. The fourth type, eugenic genetic engineering, is impossible at present and will probably remain so for the foreseeable future, despite the widespread media attention it has received. There are four potential levels of the application of genetic engineering for the insertion of gene into a human being. Somatic cell therapy: this would result in correcting a genetic defect in the somatic (i.e.,body) cells of a patient. Germ line gene therapy: this would require the insertion of the gene into the reproductive tissue of the patient in such a way that the disorder in his or her offspring would also be corrected. Enhancement genetic engineering: this would involve the insertion of a gene to try to "enhance" a known characteristic; for example, the placing of an additional growth hormone gene into a normal child. Eugenic genetic engineering: this is defined as the attempt to alter or "improve" complex human traits each of which is coded by a large number of genes; for example, personality, intelligence, character, formation of body organs, and so on.

Adenosine Deaminase↗

[Termination of pregnancy during or after treatment of carcinoma of the breast. A review (author's transl)].

The problems of medical, eugenic and social or psycho-social indication are discussed on the basis of the literature published during the past 40 years. Prognosis is not as unfavourable as generally assumed, especially during the lactation period. The processes of gestation have no clearly identifiable unfavourable influence on prognosis. On the contrary, in cases of completed carcinoma therapy, the survival rates in women who became subsequently pregnant and stood through the entire period of gestation, are distinctly improved. There is no medical indication for an abortion. A eugenic indication may be present especially in early pregnancy, if percutaneous subsequent irradiation and adjuvant chemotherapy are considered necessary. A social or psycho-social indication can be present if the individual prognosis and situation of the patient in question is taken into consideration. The decision becomes particularly difficult if the carcinoma is diagnosed during the second half of the period of gestation. In that case, prognosis deteriorates to the negative side. The fate as such, however, cannot be influenced by performing an abortion. To achieve viability of the child, adjuvant therapy must be delayed for a period of not longer than 12 weeks. Whether such a waiting period is justified or not, can only be decided from case to case by mutual consultation between the mother and the doctor.

Abortion, Eugenic↗

[Medicolegal aspects of abortion].

An increasing number of the doctor's decisions in connection with legal abortions require a knowledge of current legislation. The physicians who conduct induced abortion have to decide by themselves if legal requirements are fullfilled. According to the laws of the German Federal Republic, these include the consent of the patient, taking for granted her capability to decide. This is important especially for minor. Comprehensive instruction is imperative. The doctor should emphasize the right of the unborn to live. The doctor is also obliged to state whether an indication is given or not. Here are difficulties with eugenic and social indications. A definition of the eugenic indication is the probability that the child will either live only for a short period or that non-reparable physical, or psychical, damage is to be expected. A risk of below 50% is not considered. Concerning the social indication, the distress must be comparable. Here a lot of possibilities of social support for mother and child are to be considered.

Abortion, Eugenic↗

["Patients with genetic diseases can, by surgical intervention, be sterilized..." Mandatory sterilization in Germany during the era of national socialism].

The ethical problem of permissibility of sterilisation for eugenic reasons is being discussed since the end of the last century. For many years restriction and rejection were the predominant opinions. A bill passed July, 1933--"Gesetz zur Verhütung erbkranken Nachwuchses" ("Act of prevention of heredopathic progeny")--imposed juridical regulations to prevent offspring with inherited diseases in National Socialist's Germany. No major protests had been made against such compulsion put upon the medical profession. Papers dealing with questions of surgical techniques had been published in Zentralblatt für Gynäkologie predominantly in 1935 and 1936. The significance of the scientific analysis of mandatory sterilisations for so-called eugenic reasons performed in almost 400,000 women and men in Germany between 1933 and 1945 has only recently began to be recognised by the scientific community in the last decade addressing predominantly the regional impact of this jurisdiction.

Eugenics↗

Medical genetics and scientific expertise in Switzerland in the 1940s.

In Switzerland, the first course in human genetics for physicians was organized during World War II. The topic had less to do with human genetics than with eugenics, however. After this course, bitter opposition was forthcoming from physicians. The second course was held in quite a different context. The war was almost over and the Swiss authorities had to prove that they were on the side of the Allies. As eugenics was deemed to be a Nazi science, opposition to it became stronger. Given this context, the proponents of human genetics changed their discourse. This article explores how this debate on human genetics influenced not only the discourse on this science, but also human genetics practices in postwar Switzerland.

Biomedical Research↗

New methodology for viability testing in environmental samples.

Environmental samples can be complex and are comprised of microorganisms and a matrix of decaying organic matter as well as an inorganic phase such as sand or precipitated material (waste water, sludge, soils, etc.). Nucleic acid dyes have recently been developed to address the growing need for environmental analyses (cell staining, counting, viability testing and specific organism identification). However, certain dyes may not be ideally suited for testing of environmental samples, because they readily adhere to the substrate material as well as their target molecule, resulting in increased non-specific binding and background fluorescence. The aim of this study was to address the limitations of the widely used and commercially available Live/Dead BacLight Bacterial Viability kit (Molecular Probes, Eugene, OR). A new combination of nucleic acid dyes, i.e. SYTO13 and SYTOX Orange (Molecular Probes, Eugene, OR), was proposed as an alternative. The dyes were carefully chosen for their spectral separation and increase of fluorescence quantum yield. A protocol for this combination was first designed and optimized and the two staining assays were compared against suspensions of live and dead E. coli, mixed in different proportions and it was shown that both protocols performed equally on pure cultures. However, when testing activated sludge samples, the commercial kit showed greater background fluorescence and non-specific binding than the alternate combination. Therefore, the proposed dye combination and its corresponding protocol are deemed more suitable for use on complex environmental samples than the Live/Dead BacLight Bacterial Viability kit.

Environmental Microbiology↗

Human genome and philosophy: what ethical challenge will human genome studies bring to the medical practices in the 21st century?

A human being or person cannot be reduced to a set of human genes, or human genome. Genetic essentialism is wrong, because as a person the entity should have self-conscious and social interaction capacity which is grown in an interpersonal relationship. Genetic determinism is wrong too, the relationship between a gene and a trait is not a linear model of causation, but rather a non-linear one. Human genome is a complexity system and functions in a complexity system of human body and a complexity of systems of natural/social environment. Genetic determinism also caused the issue of how much responsibility an agent should take for her/his action, and how much degrees of freedom will a human being have. Human genome research caused several conceptual issues. Can we call a gene 'good' or 'bad', 'superior' of 'inferior'? Is a boy who is detected to have the gene of Huntington's chorea or Alzheimer disease a patient? What should the term 'eugenics' mean? What do the terms such as 'gene therapy', 'treatment' and 'enhancement' and 'human cloning' mean etc.? The research of human genome and its application caused and will cause ethical issues. Can human genome research and its application be used for eugenics, or only for the treatment and prevention of diseases? Must the principle of informed consent/choice be insisted in human genome research and its application? How to protecting gene privacy and combating the discrimination on the basis of genes? How to promote the quality between persons, harmony between ethnic groups and peace between countries? How to establish a fair, just, equal and equitable relationship between developing and developed countries in regarding to human genome research and its application?

Bioethics↗

Cultivating the cortex in German neuroanatomy.

The cerebral localization of mental functions is one of the centerpieces of modern brain research. Though the localization paradigm in its cultural and social interwovenness has been characterized as successful in the last third of the nineteenth century by a variety of historians of the neurosciences, there is also general agreement that localization came under threat around 1900. Besides the so-called holistic protest against the localization of mental functions, the neuroanatomical approach itself was challenged by experimental psychology, psychiatric nosology, and psychoanalysis. This story underestimates the fact that anatomically-based localization remained powerful in response to these multiple challenges. This meant a neuroanatomical revision of tools, concepts, and practices. But this meant also a shift in the cultivation of the cortex from a more philosophical agenda to rather concrete political claims. More specifically, the idea of the cortext as the noblest part of man was supplemented by suggestions concerning its "Höherzüchtung." I will analyze this re-orientation and radicalization in two steps. First, I briefly discuss the anatomical and philosophical account of Theodor Meynert and then turn to Paul Flechsig who in the late nineteenth century inscribed the ability to create culture and civilization into the cortext. Second, I focus on the neuroanatomists Oskar and Cécile Vogt, who began their careers around 1900 and expanded the cultivation of the cortext. Even before World War I, they proclaimed a "cerebral hygiene." Consequently, the Vogts linked their innovative neuroanatomical researches with the rising field of genetics, racial hygiene, and eugenics. In the early Weimar Republic, the Vogts openly supported socialist ideas and were engaged in establishing an Institute for Brain Research in Soviet Moscow, where Lenin's brain was analyzed. By the end of the Weimar Republic, the rhetoric of the Vogts was bluntly authoritarian. Based on a few anatomical examinations of so-called elite brains and the brains of criminals, they made concrete suggestions for eugenics and the breeding of "one-sidedly gifted leaders." Given the remarkable popularity of the Vogts around 1930, their program is an important example of the hubris of predicting and guiding future developments on the basis of scientific authority. It can be regarded as an ironic nemesis that the Vogts - never sympathizing with the political aims of the National Socialists - were forced to finish their careers as influential Kaiser Wilhelm scientists in Nazi-Germany.

Cerebral Cortex↗

[Interruption of pregnancy in alcoholic women (author's transl)].

Basing on previous experience, with alcohol embryopathy the authors recommended interruption of pregnancy in three chronic alcoholics, two of whom were in the chronic phase and one in the critical phase of alcohol addiction. All the three fetuses were hypertrophic, two severely malformed. In the authors' opinion there is eugenically speaking an absolute indication of interruption of pregnancy in alcoholics in the chronic phase of addiction. In women who are in the critical phase of addiction, each case requires close scrutiny, whereas interruption is not indicated from the eugenic aspect in women in the prodromal stage.

Abnormalities, Drug-Induced↗

The ethics of pornography in the era of AIDS.

Since the inception of sexology as an academic discipline a century ago, the boundary between sexology, the science, and sexosophy, the philosophy of sex, has been poorly demarcated, especially with respect to the principles of sex-reform movements. Several early 20th centruy sexologists overtly espoused the principles of eugenics reform, which, in the 1930s, Hitler used against them. A large proportion of today's sex therapists, researchers, and educators are among "those who cannot remember the past" and are, therefore, according to Santayana, "condemned to repeat it." That is to say, they follow the example of eugenics reformers by adhering to explanatory principles as if they were apolictically indisputable; whereas, they are, in fact, dangerously political professional platitudes for the criminalization of sex. One such platitude is that pornography is dehumanizing and a socially contagious criminal offense. Social-contagion theory had its origin in Tissot's 18th century revival of semen-conservation theory. In America, Tissot's antisexual health-reform ideas were transmitted by Graham to Kellogg and Comstock. The Comstock Laws of 1873 are still extant and are the basis of contemporary judicial, academic, and public misconceptions regarding the social contagiousness of pornography. These misconceptions render the nation incapable of using pornography constructively in a program of sex-safety to prevent AIDS infection, especially among newly pubertal adolescents and young adults. The model to follow has already been provided by gay JACK and JO masturbation clubs.

Acquired Immunodeficiency Syndrome↗

New perspectives in the epidemiology of schizophrenia.

It was with great pleasure that I accepted the invitation to contribute to the present symposium in honour of my friend Jules Angst. It gives me the opportunity to pay tribute to his outstanding scientific work. The topic of my presentation has been inspired by the genius loci. In his foreword to a proceedings volume entitled 'Die Entstehung der Schizophrenie' (The Origin of Schizophrenia), which he edited on the occasion of the 100th anniversary of the Psychiatric University Hospital Zurich in 1970, Jules Angst pointed out that two former heads of the 'Burgholzli', Eugen and Manfred Bleuler, who had held that office longest, had dedicated their life's work to schizophrenia, which had received its name from Eugen Bleuler. Jules Angst's most successful research field has been psychiatric epidemiology. I therefore thought it appropriate to talk about new perspectives in the epidemiology of schizophrenia.

Adult↗

Japanese experience with micropremies weighing less than 600 grams born between 1984 to 1993.

The viability limit defined by the Japanese Eugenic Protection Act was amended from 24 to 22 completed weeks of gestation in 1991. To testify if the amendment is appropriate, we conducted a survey on the mortality and morbidity rates of infants less than 600 g born in Japan between 1984 to 1993. Questionnaires were mailed to 205 hospitals with neonatal intensive care units (NICUs) and 165 (80%) responded. Of 1655 infants <600 g birth weight and admitted to the NICUs included in this survey, 457 (28%) survived to hospital discharge. The survival rates of infants born <24 weeks and >==24 weeks of gestation were 17% (128/748) and 36% (329/903), respectively; and of infants <500 g and 500 to 599 g at birth were 16% (82/510) and 32% (375/1145), respectively. None of the infants <==20 weeks of gestational age and <==350 g at birth survived, but 4% (2/49), 12% (27/218), 21% (99/474), and 34% (131/381) born at 21, 22, 23, and 24 weeks of gestation survived, respectively. The majority (68%) died within 1 week after birth and only 10% died after the neonatal period. The main causes of death were: acute respiratory failure (33%), intraventricular hemorrhage (20%), infection (16%), and heart failure (10%). Of 457 survivors, 65% were free from handicaps. The incidence of mental retardation (DQ < 70), visual disturbance, and CP were 15%, 14%, and 11%, respectively. Admission of micropremies to NICU increased markedly after the amendment of the Eugenic Protection Act, despite a marked decline in birth rate. The survival rate increased from 22% to 33% after generalized use of surfactant in 1988, but the handicap rate (35%) among survivors remained unchanged. The new viability limit of 22 complete weeks of gestation was feasible, since survival of less than 22 weeks was exceptional while survival of 22 to 23 weeks was 18%.

Cause of Death↗

[Illnesses as racial concepts: political and scientific dimensions of a biomedical research program by Cécile and Oskar Vogt between Tiflis and Berlin (1919-1939)].

In the research of Cécile and Oskar Vogt during the 1920s at the Kaiser Wilhelm Institute for Brain Research, the notion of race had a double function. Firstly, it integrated the mapping of brain functions, the classification of psychiatric diseases, genetics, and evolutionary biology. Secondly, it proved useful in attracting funding for the creation of research facilities in Germany and the USSR. After 1933, C. and O. Vogt stopped using the term race for political reasons, but tried to offer their work as a contribution to eugenics. Bernhard Patzig, their collaborator, continued their approach during National Socialism. Distancing his research from Rüdin's statistics on heredity, but working within the paradigm of eugenics, he established the hereditary nature of certain neurological diseases and psychotic disorders such as schizophrenia.

Genetic Diseases, Inborn↗

[The quality-of-life doctrine and the sanctity of life].

The term "quality of life" might be used to qualify external circumstances with regard to the life of human beings (A). It also can be used to define the quality of a human life itself (B). Then it replaces the idea of "sanctity of life" by an eugenic idea that can be abused as a notion of discrimination. The B-position implies that life is only an instrument in order to serve a separable purpose (i.e. "the quality of being a person"). This specific quality articulates itself in so-called "indicators of humanhood/personhood". In consequence this "quality" is an eugenic expression including a dangerous power of definition and a selective anthropology that does not seem to be convincing theoretically and that can never serve as the basis of a reasonable and good social life of man.

Ethics, Medical↗

[Genodermatoses as an indication for the interruption of pregnancy: hereditary epidermolysis].

From a medical point of view, an eugenic indication is under consideration when the fetus is suffering from a lethal, semi-lethal or subvital congenital disease. Of the different types of hereditary epidermolysis, Herlitz syndrome and recessive dystrophic epidermolysis bullosa including the inverse form, are indications for interruption. In all three diseases inheritance is autosomal-recessive. Eugenic postulates for interruption are realized only partly or not at all by the remaining types of epidermolysis. A prenatal examination being impossible in epidermolysis, genetic counseling after the birth of an ill child is of great importance.

Abortion, Therapeutic↗