Novel Reflections on the Autonomy and Responsibility of Science.

This paper explores how cultural understandings of the autonomy and responsibility of science in modern society are manifested in two contemporary science novels about research misconduct in biomedical research. In doing so, it looks at several facets of the societal impact of and on public and private biomedical research, especially with respect to changing authority relations and their epistemic and institutional consequences. The analysis focuses on the multi-layered ways in which social and epistemic interests are treated in Allegra Goodman's Intuition and Jennifer Rohn's The Honest Look. Goodman's novel demonstrates how, intensified by the economization of science, internal cultural and institutional aspects of the scientific field enable social configurations that, among others, encourage scientific malpractice and lead to the delay of research projects epistemically and socially worth pursuing. In contrast, Rohn's novel exemplifies the corrosion of the ideal scientific ethos by profit-driven practices in private-sector biomedical sciences. The concluding discussion juxtaposes these findings with pertinent contemporary phenomena in modern science systems to provide a more substantial understanding of the interpenetration between science and other social spheres.

Prosthetic treatment patterns in the very old: an insurance database analysis from Northeast Germany.

OBJECTIVES: We assessed dental prosthetic services utilization in very old Germans. METHODS: A comprehensive sample of 404,610 very old (≥ 75 years), insured at one large statutory insurer (Allgemeine Ortskrankenkasse Nordost, acting in the federal states Berlin, Brandenburg, Mecklenburg-Vorpommern), were followed over 6 years (2012-2017). Our outcome was the utilization of prosthetic services, in total and seven subgroups: (1) Crowns/partial crowns, (2) fixed dental prostheses (FDPs), (3) partial removable prostheses (RDPs), (4) full RDPs, (5) temporary services, (6) relining/rebasing/repairing/extending RDPs, (7) repairing FDPs. Association of utilization with (1) gender, (2) age, (3) region, (4) social hardship status, (5) ICD-10 diagnoses and (6) German diagnoses related groups (G-DRG) was explored. RESULTS: The mean (SD) age of the sample was 81.9 (5.4) years; mean follow-up was 1689 (705) days. The mean utilization of any prosthetic service was 27.0%; the most often utilized service type were total RDPs (13.2% utilization), crowns (8.1%), and partial RDPs (7.1%). Utilization decreased with age for nearly all services (except relining/rebasing/repairing/extending RDPs). Utilization of prosthetic services was significantly higher in Berlin and most cities compared with rural municipalities and in individuals with common, less severe conditions according to ICD-10 and DRGs compared with life-threatening conditions or dementia. In multivariable analysis, gender (OR; 95% CI: 0.95; 0.93-0.98), social hardship status (1.19; 1.17-1.21), federal state (Brandenburg 0.57; 0.56-0.59; Mecklenburg-Vorpommern: 0.66; 0.64-0.67) and age significantly affected utilization (0.95; 0.95-0.95/year). CONCLUSIONS: Patient-related and healthcare factors determine the utilization of prosthetic services in very old Germans. Interventions to maintain sufficient prosthetic care up to high age are required. CLINICAL SIGNIFICANCE: The utilization of prosthetic services in the very old in Northeast Germany showed significant disparities within populations and service types. There seems to be great need to better understand the drivers of utilization, and to develop and evaluate interventions to maintain sufficient prosthetic care up to high age.