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Evolutionary Medicine and its Holistic Concept of Health. Recent years have seen tremendous advances in our understanding of biological processes on genomic, cellular, and evolutionary levels.We owe this progress in great part to modern genetic techniques, steady improvements in imaging technology, and ground-breaking molecular tools.These findings not only helped turning Darwin’s hypothesis on the origin of species into an exact science, they also require us to integrate the complex interactions between biology, environment, and behavior into our ways of thinking. As a result, a new scientific rationale for a holistic concept of health and disease emerged: Evolutionary Medicine. The holistic approach of Evolutionary Medicine provides a new perspective on human biology: Why are people so frail, why do we get sick? Most importantly, it helps us comprehend how to better preserve health – as opposed to merely focusing on the treatment of diseases. For example, it is the misalignment between our evolutionary ‘old’ biology and our fast-changing, man-made environment (e. g., urbanization and nutrition with processed food) that helps to comprehend the emergence of civilization diseases.
The Concept of Health in Immunology and Infection Biology: Nine Opportunities for the Future. Looking at our individual immune systems, one might get the impression that health is mostly a personal matter. However, infection biology immediately points to the fact that health is the outcome of a global joint effort undertaken not only by all humans, but actually by all living beings. From the very large to the very small, health is based on a fragile balance and the successful collaboration of numerous single entities in a highly sensitive and complex network that connects our innermost world with that of the outside. Diseases have been with us forever, and in the course of time, they shaped our political and cultural community. Yet, they also are one of the main drivers of evolutionary development. In that capacity, they have promoted progress from simple life forms to complex beings, i. e., ourselves. Thus, health can also be seen as the product of innumerable tiny coincidences. Politics, academia and society should ensure prevention of future detrimental (or harmful) coincidences with such tragic outcomes.
One Health and Human-Animal Relationships: Do We Make Our Animals Sick? Since the very beginning of human-animal relationships, humankind took advantage of animals, as of nature in general. While many people today perceive themselves as animal-loving, in reality we tend to systematically deprive our farm animals and pets of their own nature and health. On our quest to perfect our exploitation of the animal world, we reached a dimension that started to profoundly worry veterinary professionals, animal welfare activists, and also the informed public. Ultimately, this destructive relationship leads to detrimental consequences for both parties: e. g., the extinction of wild animals, or the transmission of diseases from one to the other. However, one could argue that the suffering we cause to animals clearly and by far exceeds the harm caused by, for example, the animal-derived COVID-19. Is this a too provocative hypothesis? This article is an invitation to take a closer look at various facets of our current humananimal relationship with its consequences for both.
The Feeling of Being Healthy: New Perspectives on Modern Medicine. „Well-being“ and mental health have become increasingly important in the definitions of health since 1945. Has this also changed the feeling of being healthy? The chapter demonstrates that the intuitive feeling of being healthy when the body does not cause any discomfort has been increasingly delegitimized in the last hundred years. It identifies three developments as responsible for this shift: the establishment of the risk factor model, the reconceptualization of health as result of a constant process of rebalancing health and illness, and the emphasis on the subjective component of health.
Concepts of Health in Psychiatry. In talking about concepts of health in psychiatry,we are not talking about an essentialist concept of health, where there is some essential thing that health might be. There is a straightforward sense in which psychiatric „health“ simply means the absence of psychiatric disease. Marking out our concepts of health in psychiatry would then involve marking out the boundaries between normal and abnormal psychic phenomena. However, there is no single, neat concept of health in psychiatry; nor are there concepts of health that neatly cohere into one overarching theory of health. This is not because psychiatry is vague. It is because psychiatry reflects the complexity of the whole person.
Physician Health in the Workplace. Physicians are exposed to a variety of risks in their everyday work. There is an obvious risk, especially in view of the current pandemic, of contracting communicable diseases like COVID-19, HIV and Hepatitis C. The commercialization of healthcare and associated cost-saving measures – particularly in the field of human resources – lead to unhealthy workloads and, correspondingly, an increased risk of suffering from psychological disorders like burnout and depression. Scientific studies reveal a correlation between psychological stress and the quality of patient care. The health of medical personnel must be given high priority in the interest of both patients and those working in the healthcare system. This requires adequate funding with staffing that is appropriate to the patient and the task at hand, thus ensuring humane and high-quality patient care. In addition, physicians must be relieved of performing non-medical tasks, and their resilience must be strengthened through individual and operational measures.
Taming the European Leviathan: Health as Politics. A Research Project. This article outlines the research project „Taming the European Leviathan: The Legacy of Post-War Medicine and the Common Good“. It is funded by a Synergy Grant of the European Research Council and unites European researchers comparing health policies (from drug research to prevention) in West- and East-European countries, e.g., Bulgaria, Germany, France, Czechoslovakia, Hungary, and the United Kingdom. The common goal is to provide a different perspective on post-war Europe, a perspective that emphasizes commonalities rather than differences.
Health Data as a Public Good. Routine health data, which are collected by health insurers and other agencies in the health care system, offer enormous potential for health monitoring and research. Germany has been slow to make such data available for socially beneficial purposes, partly due to concerns about privacy and data protection. Against this background, we discuss some of the most important potential uses of routine health data and call for a broader societal debate about the benefits, risks, and appropriate regulation of routine health data usage.We then review theWestern Australian Data Linkage System as an example of a data infrastructure that is characterized by high levels of stakeholder and patient involvement and a sophisticated method of privacy protection. While Germany does not need to copy this approach, we hope that the experiences of Western Australia and other countries will stimulate and inform the overdue debate about a modern, responsible, and sustainable approach to socially beneficial health data usage in Germany.
Prevention: The Concept of Preventive Risk Reduction, Illustrated by the COVID-19 Pandemic. Risk assessment and risk management based on the precautionary principle are instruments to protect humans and the environment against uncertain threats and risks. At the same time, however, trade-offs must always be made in order to maintain cultural, economic and social objectives and to honor the principle of proportionality. Notwithstanding the need for continuous risk reduction, society must distance itself from the idea that science can predict all dangerous events and developments and exclude them through preventive action. At best, risk analyses are able to identify the possible threats and uncover weaknesses in the system. In addition, risk assessments help us to make better decisions in the conflict of objectives between the secondary consequences of taking risks (such as exposure in the event of a pandemic) and the secondary consequences of the protective measures taken (economic, social, cultural consequences). In this sense, decisions about acceptability of risks or risk reduction measures always reflect a combination of scientific knowledge with balancing judgments.
The World Health Organization (WHO), Pandemics, and COVID-19: How to Proceed With a Multilateral Concept of Global Health? The WHO grew to 194 member states, and with globalization, geopolitical shifts, and internal reorganizations, the lines of influence have become more complex. In 2020, the United States severely endangered multilateralism in health. Recently, the Biden administration has revived US commitment as a major global health player. Yet, the lack of coherence in supporting collective action on global health remains a problem. Global health geopolitics are shifting and China and India have acquired enough power to shape the global health agenda. At the instigation of Germany, health has become a regular topic at Group of Twenty (G20) and G7 meetings – a critical factor during the COVID-19 pandemic. The WHO’s director general frequently states that health is a political choice. Many countries made unfortunate, if not questionable political choices in their responses to COVID-19. But as a matter of fact, they took the wrong turn much earlier when they neglected investments in pandemic preparedness and in the WHO. Countries have the political choice right now to seriously strengthen the WHO, its funding, and its legal power, or to weaken or even destroy one of the most important agencies in the UN system.
Ein Teil der Gemeinschaft
(2021)
Keine Regionalgruppe vor Ort? Dann gründe ich halt eine – fand eine Betroffene mit Lupus erythematodes. Ein Erfahrungsbericht. Im Jahr 2000 bekam ich im Alter von 28 Jahren die Diagnose „Systemischer Lupus erythematodes“ (SLE) – mit Beteiligungen der Haut, des Zentralen Nervensystems, der Niere und des Herzens. Im Krankenhaus bekam ich zwar Informationen zur weiteren Therapie, nicht aber elementare Informationen über die Krankheit. Weil ich noch kein Internet hatte, ging ich in die Bibliothek und fand nach einigem Suchen auch ein medizinisches Nachschlagewerk aus den 60er Jahren. Darin wurde einiges über die Krankheit erklärt, auch, dass meine Lebenserwartung nur bei drei bis fünf Jahren liegen würde.
Images of Health and Disease: the Example of HIV/AIDS. There are two phases in the history of HIV/AIDS in the 1980s and 1990s. In the first of them, which lasted until the mid-1980s, HIV/AIDS was constructed as a disease of the (sexual) other. The second phase began around 1985 when the focus of AIDS prevention programs gradually shifted from „risk groups“ to „risk behavior“. This transformation came along with a reframing of the sexually active individual as self-reliant and socially responsible. Furthermore, the emergence of the risk discourse was accompanied by an iconography of a healthy and athletic „prevention body“. In the 1990s it increasingly replaced the emaciated „AIDS body“ that had dominated in the early years.
Sepsis and the COVID-19 Pandemic: Challenges and Chances for Developing a Better Health System in Germany. Sepsis is the most serious complication of infectious diseases including patients critically illwith COVID-19. In 2017, sepsis was estimated to affect close to 50 million people and to cause or contribute to 11 million deaths, with over 3 million of those deaths being in children or adolescents.The WHO considers that most deaths from sepsis are preventable and therefore urges all member states to integrate sepsis in their national health strategy. However, this is not yet the case for Germany, although – compared to other western industrial countries – sepsis mortality rates in Germany are very high. The COVID-19 pandemic has presented the world with the most serious health threat in living memory, which until July 2021 resulted in more than 4 million deaths and unprecedented social and economic disruption. It has reminded us that infectious diseases still present a major global health threat. In contrast to the poor recognition of sepsis from other infections, the response to the pandemic has also been unprecedented in most countries in terms of instituting effective public health measures, and the global scientific community has come together to produce robust research evidence and novel vaccines in record time. Thus, a positive legacy for the COVID‑19 pandemic in Germany and around the globe would reduce the global burden of sepsis by making pandemic preparedness, infection prevention and control, sepsis and antimicrobial resistance integral parts of national infection control and management strategies.
Controversies Over the Concept of Mental Disorders. Just like persons suffering from somatic diseases, those experiencing mental disorders, maladies, or diseases should be provided with care and protection from certain social demands. Yet, any disease concept should be precise enough to avoid classification of behavior as pathological while it is merely socially undesirable in the current political system. This paper reviews various conflicting concepts of disease, illness and sickness. In addition, it provides a narrower definition of a so-called clinically relevant mental malady. This definition is characterized by a) an impairment of mental functions relevant for human life (the disease aspect of a mental malady) and b) personal harm either due to suffering (the illness aspect) or impaired activities of daily living that severely limit social participation (the sickness aspect). This chapter claims that any definition of disease-relevant mental dysfunctions should be critically reflected regarding its philosophical and anthropological foundation and ethical consequences. Criteria of disease, illness and sickness should no longer be defined by groups of professionals selected by the WHO or other institutions, but instead require public debates that include organizations of patients and relatives.
Patients’ Perspectives on Health. The following chapter presents a number of patient statements on health and disease provided by several German patient associations. In these statements, patients describe their personal experience with health and disease and how they cope with their situations. Some also emphasize what they have done to improve their wellbeing. These first-hand reports offer a glimpse of the factors that support and inhibit individual people in their everyday struggles to create and maintain their own understanding of health.
Mein Blutdruck steigt unter anderem durch Stress. Mein Hausarzt hat bei einer Routineuntersuchung die erhöhten Werte festgestellt – zu meiner Überraschung. Ich war 58 Jahre alt und schlank, am Gewicht lag es daher wohl nicht. Und Zigaretten habe ich immer schon verschmäht. Als ich die Diagnose bekam, war das für mich ein Signal, mich intensiver um meine Gesundheit zu kümmern. Ich wollte mehr über die Ursachen für Bluthochdruck wissen und habe recherchiert. Dabei stieß ich darauf, dass ungesunde Ernährung ein Grund sein kann. Und ich beschloss – auch im Sinne meiner Familie –, in der Küche etwas zu ändern. Das Risiko, dass nicht nur ich, sondern auch die anderen eine Herzerkrankung oder einen Schlaganfall erleiden könnten, wollte ich auf jeden Fall vermeiden. Ich änderte meine Einkaufsliste und machte mich mit den typischen Rezepten der Mittelmeerküche wie einem französischen Ratatouille (Gemüsegericht mit Tomaten, Auberginen, Zucchini und Gurken) vertraut. Glücklicherweise kann ich gut kochen und spezielle Kochbücher haben die Umstellung noch gefördert. Außerdem schaue ich mir gern die „Ernährungsdocs“ an, die montags um 21 Uhr im 3. Programm des NDR „praktizieren“. Sie haben öfters Bluthochdruckpatienten mit erheblichem Übergewicht als Betroffene und verordnen ihnen viele Gemüsegerichte, viel Bewegung. Danach geht es ihnen besser.
Wohin mit uns?
(2021)
Jährlich erkranken etwa 16.500 junge Menschen im Alter von 18–39 Jahren an Krebs. Und so wenig, wie man selbst darauf vorbereitet ist, so wenig ist es die Gesellschaft an sich. Mich traf es das erste Mal mit 26 Jahren. Zu diesem Zeitpunkt befand ich mich in der Vorbereitung auf das zweite Staatsexamen der Humanmedizin. Einer längeren Phase mit Infekten folgte schließlich eine auffällige Bildgebung und eine Woche vor dem Examen dann eine OP am Brustkorb, um Lymphgewebe zur Diagnostik zu gewinnen. Am zweiten Tag des Examens erfuhr ich, dass es tatsächlich Krebs war – und genau eine Woche später begann schon die Therapie. Das Examen wollte ich unbedingt schreiben, da ich nicht auch noch ein halbes Jahr an Vorbereitung einfach verlieren wollte, und bin froh, dass ich es geschafft habe. Diese erste Therapie habe ich psychisch sehr gut verkraftet und es ist mir eher zugutegekommen, selbst Mediziner zu sein, da ichwusste, dass die Prognose sehr gut war. Was ich nicht wusste: dass man als Student keinerlei finanzielle Absicherung im Krankheitsfall hat. BAföG bekam ich nie, es würde aber eh nach drei Monaten ausgesetzt werden und Anspruch auf ein Krankengeld besteht als Student nicht – man fällt also auf Hartz IV bzw. Sozialhilfe oder hat das Glück, dass man von den Eltern unterstützt wird. In meinem Fall Letzteres. Aber ich habe über meine Erkrankung andere Betroffene kennengelernt, die akut in existenzielle Nöte geraten sind – ich finde das unerträglich und doch ist es eine Realität in Deutschland.
Adequate Health Care – Appropriate Care. The understanding of health is highly relevant in ethical as well as health policy terms because it is linked to entitlement to health services. In addition, conclusions can be drawn from what we consider to be appropriate health care to the current prevailing understanding of health and illness. The article describes the conceptual complexity of the normative concept of adequate health care and the opportunities and challenges of its effective operationalization.
Ich stand im Badezimmer und hatte plötzlich das Gefühl, doppelt zu sehen. Beunruhigt ging ich zum Arzt, der mich gleich in die Klinik weiterleitete: Ich hatte einen kurzen Schlaganfall erlitten, dessen Folgen anschließend nicht mehr festgestellt werden konnten. Was die Ärzte bei den Tests aber sehr wohl sahen: Mein Blutdruck war erhöht, wenn auch nur leicht. Und das, obwohl ich mich doch einmal pro Woche im Sportverein fit hielt. Aber es reichte nicht, das wurde mir klar. Und ich beschloss, etwas zu ändern.
Jahrelang wurde ich von einem Facharzt zum anderen geschickt. Mein Körper spielt mit mir Katz und Maus – er stellt schubweise wichtige Organfunktionen ein und zwingt mich dadurch zwischenzeitlich sogar in den Rollstuhl. Ich bin ein menschliches Stehaufmännchen geworden und begreife, dass die „Götter in Weiß“ auch nur Menschen sind und ratlos meinem Zustand gegenüberstehen. Pillen und Spritzen missbilligtmein Körper und reagiert mit allergischen Schocks. Die meisten Ärzte werfen das Handtuch, wenn ich als Patient nicht in die Schublade passe, die das Krankheitsbild ihnen scheinbar vorgibt. Oft werde ich wie eine Außerirdische bestaunt – nur um zu guter Letzt in die Psychoschiene geschoben zu werden.