1474
McCarthyism
in East German universities
SIR,-We wish to draw the attention of the international medical community to the campaign of dismissals of prominent medical scientists and physicians from universities of the former German Democratic Republic (GDR), solely because of their political convictions-their "closeness to the political system" of the former GDR. From a large number of cases, we present three examples: Prof H. Klinkmann (University of Rostock), Prof K. Jahrig (University of Greifswald), and Prof P. Schwartze (University of Leipzig). The Commission of Honour of the University of Rostock, has found Klinkmann guilty of "improper conduct" and recommended the termination of his contract for "lack of personal qualifications". This verdict was justified by Klinkmann’s general attitude towards socialism, as evidenced by some of his speeches at political gatherings. No accusations were put forward with respect to his conduct as a physician, scientist, or university teacher, or as head of a clinical department. Klinkmann is an internationally renowned expert in nephrology and artificial organs. He holds several honorary degrees from universities in Europe, Japan, and the USA. He has to his credit substantially improved the care of patients with renal diseases in the former GDR. He has never abused his political connections to promote his professional career or that of any protege and has never harmed anyone. Jahrig has been head of the department of paediatrics of the University of Greifswald for 17 years and dean of the medical faculty for 4 years. He was the elected president of the Paediatric Society of the GDR for several years. He is widely esteemed as an academic paediatrician and he has participated in several international research projects. The Commission of Honour of the University of Greifswald found him guilty of "improper conduct". In the commission’s statement it is admitted that complaints against Jahrig of having hampered or harmed any person or of having yielded to political pressures in his conduct of office are baseless. Membership of a committee of the ruling party (SED), as evidence for his acceptance of the former political system, is the sole reason given for this verdict. Schwartze was for 12 years head of the department of physiology of the University of Leipzig. His work on the vestibular system is widely known. The charges against him consist of his memberships of the parliament of the former GDR, where he was on the health committee, and of the Advisory Council on the Medical Research of the Ministry of Health . These persons and many others are being defamed for seeing the former GDR, the state they lived in, as a society aspiring a humanistic social order. This attitude, which is based on their political convictions, is being stamped as improper conduct. The dismissals are in clear contradiction to the constitution of the Federal Republic of Germany, in which it is stated that no one should be discriminated against or punished because of their political convictions. The proceedings against Klinkmann and others are entirely comparable to the infamous McCarthy period in the USA.
presentations of patients by clinicians, showing films and videos of clinical problems as well as a living anatomy course, which involves small groups of students identifying ligaments, testing muscle groups, arterial pulses, palpation of organs, and so on.l Monkhouse also asks who should make the decisions about what
topics anatomists should teach and in how much detail. In a recent survey, I asked fmal-year medical students to assess the relevance of their anatomy course five years ago.2They were asked to grade ten regions of the body that they had dissected as being superfluous, too detailed, adequate, or too brief. Only 3 of the 203 students’ replies indicated one region as superfluous. About 70% thought that all regions were adequate, and variable numbers would have liked less detail. About 90% of the students were for integrating anatomy of the clinical curriculm, and about 70% expressed interest in additional dissection during their clinical studies for specific topics-eg, ligaments of joints because they planned to become orthopaedic surgeons. The students obviously did not feel that they had been confronted with outdated anatomical details but had learnt facts of clinical relevance. A department of anatomy should aim for a balanced mix of medically qualified and basic science anatomists. I also agree with Monkhouse that the anatomical societies of the various countries should not restrict themselves to presenting new research data at their annual meetings, but should take time to discuss new ideas to improve the teaching of clinically relevant anatomy. more or
some
Centre of Anatomy, Medical School of Hannover, D-3000 Hannover 61, Germany
1. Pabst R, Westermann J, Lippert H. Integration of clinical problems in teaching gross anatomy: living anatomy, X-ray anatomy, patient presentations and films depicting clinical problems. Anat Rec 1986; 215: 92-94. 2. Pabst R. Makroskopische Anatomie—ein entbehrliches Fach in der Vorklinik? Med Klin (in press).
Ginkgo biloba SIR,-The drug profile on Ginkgo biloba (Nov 7, p 1136) highlights an important problem of future European Community licensure of medicines: should traditonal preparations be assessed with the same criteria as new chemical entities? Or might statistically significant effects be the same as clinically relevant efficacy? The obvious discrepancy that Ginkgo biloba extracts are among the most prescribed medicines in France and Germany (287 million DM in 1991) but not licensed in Anglo-American and Scandinavian countries suggests widely differing standards of acceptance. Would it not be advisible to base any therapeutic conclusions on the criteria of leading regulatory agencies-ie, evaluation of all published and unpublished studies and use of established standards for clinically relevant efficacy? This evaluation is even more important because the supplement of Mtinchen Medizinische Wochenschrift, 1991, which contains five of the cited studies, is not even listed in the journal’s twice yearly index. Develgonne 92c, Hamburg, Germany
K. H. KIMBEL
D 2000
Kuckhoffstr 45, 0-1110 Berlin,
S. M. RAPOPORT I. RAPOPORT
Germany
Teaching of anatomy SIR,-Dr Monkhouse (Oct 3, p 834) discusses how much anatomy should be taught in medical schools, by whom, and at what point in the curriculum. These issues are not unique to British medical schools, but need to be raised in Germany and many other countries. In the USA increasing numbers of medical schools no longer have a department of anatomy, because these are being replaced by departments of cell biology, some of which have few medically qualified teachers. Perhaps the European countries missed their chance to change course and follow this trend in teaching morphological subjects. I wholeheartedly support Monkhouse in his belief that teaching gross anatomy should not be restricted to lectures and dissection courses but extended to surface and living anatomy. For several years
we
have
successfully complemented
gross anatomy with
R. PABST
Euthanasia SIR,-Dr Bihari’s letter (Oct 31, p 1104) has renewed my sense of shame that geriatric medicine does so little to ease the suffering of patients with terminal illness. Apart from palliative care teams and hospices, we probably care for more dying patients than any other specialty (a quarter of all admissions compared with 15 % of patients aged over 75 in the general medical wards, as shown at an audit in our District General Hospital in 1990). Yet it was a department of intensive care, not geriatrics, that supported Dr Cox’s courageous action in responding to an elderly patient’s request for euthanasia ("an easy death") by admitting that it too helps hopelessly ill patients by providing large doses of opioids and sedatives to ease suffering and hasten death. Meanwhile, in dealing with more natural and less contentious death in old age, physicians for the elderly are content to merely look on at old people in severe distress, sometimes lasting for weeks or months, or possibly to worsen it by "withdrawing active measures", usually without even supplying the
McCarthyism
in East German universities
SIR,-We wish to draw the attention of the international medical community to the campaign of dismissals of prominent medical scientists and physicians from universities of the former German Democratic Republic (GDR), solely because of their political convictions-their "closeness to the political system" of the former GDR. From a large number of cases, we present three examples: Prof H. Klinkmann (University of Rostock), Prof K. Jahrig (University of Greifswald), and Prof P. Schwartze (University of Leipzig). The Commission of Honour of the University of Rostock, has found Klinkmann guilty of "improper conduct" and recommended the termination of his contract for "lack of personal qualifications". This verdict was justified by Klinkmann’s general attitude towards socialism, as evidenced by some of his speeches at political gatherings. No accusations were put forward with respect to his conduct as a physician, scientist, or university teacher, or as head of a clinical department. Klinkmann is an internationally renowned expert in nephrology and artificial organs. He holds several honorary degrees from universities in Europe, Japan, and the USA. He has to his credit substantially improved the care of patients with renal diseases in the former GDR. He has never abused his political connections to promote his professional career or that of any protege and has never harmed anyone. Jahrig has been head of the department of paediatrics of the University of Greifswald for 17 years and dean of the medical faculty for 4 years. He was the elected president of the Paediatric Society of the GDR for several years. He is widely esteemed as an academic paediatrician and he has participated in several international research projects. The Commission of Honour of the University of Greifswald found him guilty of "improper conduct". In the commission’s statement it is admitted that complaints against Jahrig of having hampered or harmed any person or of having yielded to political pressures in his conduct of office are baseless. Membership of a committee of the ruling party (SED), as evidence for his acceptance of the former political system, is the sole reason given for this verdict. Schwartze was for 12 years head of the department of physiology of the University of Leipzig. His work on the vestibular system is widely known. The charges against him consist of his memberships of the parliament of the former GDR, where he was on the health committee, and of the Advisory Council on the Medical Research of the Ministry of Health . These persons and many others are being defamed for seeing the former GDR, the state they lived in, as a society aspiring a humanistic social order. This attitude, which is based on their political convictions, is being stamped as improper conduct. The dismissals are in clear contradiction to the constitution of the Federal Republic of Germany, in which it is stated that no one should be discriminated against or punished because of their political convictions. The proceedings against Klinkmann and others are entirely comparable to the infamous McCarthy period in the USA.
presentations of patients by clinicians, showing films and videos of clinical problems as well as a living anatomy course, which involves small groups of students identifying ligaments, testing muscle groups, arterial pulses, palpation of organs, and so on.l Monkhouse also asks who should make the decisions about what
topics anatomists should teach and in how much detail. In a recent survey, I asked fmal-year medical students to assess the relevance of their anatomy course five years ago.2They were asked to grade ten regions of the body that they had dissected as being superfluous, too detailed, adequate, or too brief. Only 3 of the 203 students’ replies indicated one region as superfluous. About 70% thought that all regions were adequate, and variable numbers would have liked less detail. About 90% of the students were for integrating anatomy of the clinical curriculm, and about 70% expressed interest in additional dissection during their clinical studies for specific topics-eg, ligaments of joints because they planned to become orthopaedic surgeons. The students obviously did not feel that they had been confronted with outdated anatomical details but had learnt facts of clinical relevance. A department of anatomy should aim for a balanced mix of medically qualified and basic science anatomists. I also agree with Monkhouse that the anatomical societies of the various countries should not restrict themselves to presenting new research data at their annual meetings, but should take time to discuss new ideas to improve the teaching of clinically relevant anatomy. more or
some
Centre of Anatomy, Medical School of Hannover, D-3000 Hannover 61, Germany
1. Pabst R, Westermann J, Lippert H. Integration of clinical problems in teaching gross anatomy: living anatomy, X-ray anatomy, patient presentations and films depicting clinical problems. Anat Rec 1986; 215: 92-94. 2. Pabst R. Makroskopische Anatomie—ein entbehrliches Fach in der Vorklinik? Med Klin (in press).
Ginkgo biloba SIR,-The drug profile on Ginkgo biloba (Nov 7, p 1136) highlights an important problem of future European Community licensure of medicines: should traditonal preparations be assessed with the same criteria as new chemical entities? Or might statistically significant effects be the same as clinically relevant efficacy? The obvious discrepancy that Ginkgo biloba extracts are among the most prescribed medicines in France and Germany (287 million DM in 1991) but not licensed in Anglo-American and Scandinavian countries suggests widely differing standards of acceptance. Would it not be advisible to base any therapeutic conclusions on the criteria of leading regulatory agencies-ie, evaluation of all published and unpublished studies and use of established standards for clinically relevant efficacy? This evaluation is even more important because the supplement of Mtinchen Medizinische Wochenschrift, 1991, which contains five of the cited studies, is not even listed in the journal’s twice yearly index. Develgonne 92c, Hamburg, Germany
K. H. KIMBEL
D 2000
Kuckhoffstr 45, 0-1110 Berlin,
S. M. RAPOPORT I. RAPOPORT
Germany
Teaching of anatomy SIR,-Dr Monkhouse (Oct 3, p 834) discusses how much anatomy should be taught in medical schools, by whom, and at what point in the curriculum. These issues are not unique to British medical schools, but need to be raised in Germany and many other countries. In the USA increasing numbers of medical schools no longer have a department of anatomy, because these are being replaced by departments of cell biology, some of which have few medically qualified teachers. Perhaps the European countries missed their chance to change course and follow this trend in teaching morphological subjects. I wholeheartedly support Monkhouse in his belief that teaching gross anatomy should not be restricted to lectures and dissection courses but extended to surface and living anatomy. For several years
we
have
successfully complemented
gross anatomy with
R. PABST
Euthanasia SIR,-Dr Bihari’s letter (Oct 31, p 1104) has renewed my sense of shame that geriatric medicine does so little to ease the suffering of patients with terminal illness. Apart from palliative care teams and hospices, we probably care for more dying patients than any other specialty (a quarter of all admissions compared with 15 % of patients aged over 75 in the general medical wards, as shown at an audit in our District General Hospital in 1990). Yet it was a department of intensive care, not geriatrics, that supported Dr Cox’s courageous action in responding to an elderly patient’s request for euthanasia ("an easy death") by admitting that it too helps hopelessly ill patients by providing large doses of opioids and sedatives to ease suffering and hasten death. Meanwhile, in dealing with more natural and less contentious death in old age, physicians for the elderly are content to merely look on at old people in severe distress, sometimes lasting for weeks or months, or possibly to worsen it by "withdrawing active measures", usually without even supplying the
