[The "Fight over the Protein Minimum". The conflict between scientific nutrition teaching and food reform in 19th and 20th century Germany]. / Der "Kampf ums Eiweissminimum". Zum Konflikt zwischen wissenschaftlicher Ernährungslehre und Ernährungsreform--in Deutschland im 19. und 20. Jahrhundert.

In 1877 the German physiologist and nutritionist Carl von Voit published diet parameters which included minimum intakes of carbohydrates, proteins and fats. As a minimum daily intake of protein Voit arrived at a figure of 118 g. This figure was questioned mainly by supporters of the so-called food reform, because the required protein intake would hardly be feasible without substantial meat consumption. To disprove this claim and to show that the vegetarian way of life was justified, reformers such as Mikkel Hindhede and Carl Röse conducted experiments demonstrating that the long-term adherence to diets with a daily protein intake of less than 30 g was possible without causing a negative protein balance. It was, however, only after the famines of the First World War that the concepts of the diet reformers met with greater interest. As they promised a better, from imports independent supply of food, the national socialist regime after 1933 made it the centre of a new food policy that aimed at autarky. Thus, the history of the "protein minimum" provides insights into effects and limits of nutrition research under the restrictions of economic requirements, moral considerations and prevailing traditions.

[Predictive genetic testing for hereditary breast cancer and hereditary nonpolyposis colorectal cancer]. / Prädiktive Gentests bei familiärem Brust- und nicht-polypösem Darmkrebs. Wissenschaftliche Grundlagen--klinische Studien--versicherungsmedizinische Aspekte.

Genetic tests are no longer used exclusively for diagnostic purposes, but they serve in increasing numbers to assess the predisposition for illnesses. Predictive genetic testing of this kind includes screening for genetic predispositions towards tumours. Of special significance are familial breast and ovarian cancer caused by BRCA1 - and BRCA2- mutations and hereditary nonpolyposis colorectal cancer (HNPCC). The observation of such conditions constitutes a considerable burden for the individuals concerned as well as their families. So far it has not been sufficiently established to what extent methods of prevention and early diagnosis can offer effective protection against the risk of tumours. While prophylactic organ resections lower the morbidity and mortality associated with cancer, they are also responsible for a loss of physical and emotional well-being. Therefore, an awareness of hereditary predispositions towards tumours causes considerable need for competent medical advice and clinical research. Interdisciplinary projects can offer the suitable organisational base for these tasks. Doctors, universities and health insurances are faced with the challenge of developing and financing corresponding structures of medical care and research.

[Interspinous decompression as treatment for lumbar spinal stenosis]. / Interspinöse Dekompression als Therapie der lumbalen Spinalkanalstenose.

Interspinous process distractors are an effective operative tool for treating patients with lumbar spinal stenosis. Lumbar stenosis with minor secondary instabilities due to degenerative changes in the segment can also be treated successfully with these devices. In case of failure, these devices can easily be revised or removed. As this operative procedure is not very time-consuming, it is a reasonable option for elderly patients with various medical problems and increased anaesthetic risk. There are reports of implanting these devices in certain cases under local anaesthetic. A prospective randomised trial has shown promising results for up to two years postoperatively. There are no long-term results available.

[Maximilian Mehl and the treatment with concentrated sunlight]. / Maximilian Mehl und die Behandlung mit konzentriertem Sonnenlicht.

In 1889, a chance observation made by Maximilian Mehl, an officer of the Berlin police force, lead him to develop a new method of treating Lupus Vulgaris with concentrated sunlight. Although first therapies proved the efficacy of this method, scientific medicine showed little interest. But Mehl found recognition among supporters of natural healing methods who saw their principles confirmed by his discovery. Mehl's tentative therapy was superseded by technological methods of sunlight treatment, as developed by the Danish doctor Niels Ryberg Finsen. In 1903 Finsen was awarded the Nobel Prize for his work while Mehl's discovery remained practically unknown. This episode in the history of medicine demonstrates how the recognition of a new method not only depends on criteria of its efficacy, but equally so on the degree of its conformity with preconceived notions and accepted standards.

[Intradiscal electrothermal therapy (IDET)]. / Intradiskale elektrothermale Therapie (IDET).

Low back pain is a major physical and socioeconomic problem. A significant percentage is attributable to internal disc disruption (IDD). The management of IDD has been limited to conservative treatment or to operative treatment. Intradiscal electrothermal therapy (IDET) is a new minimal-invasive therapy. In carefully selected patients, it could be an effective treatment alternative. Further studies with long-term follow-up are necessary.

[Orthokin as new therapeutic option for orthopedic diseases]. / Orthokin als neue Behandlungsoption bei orthopädischen Leiden.

The synthesis and introduction of interleukin-1 receptor antagonists established a promising strategy in the treatment of inflammatory diseases. This kind of therapy is claimed now to be available for osteoarthritis and other orthopedic disorders also. In the case of "orthokin", the interleukin-1 receptor antagonist is produced by stimulation of own blood-cells. It is not possible, to evaluate the practicability of this therapeutic approach because there are no published experimental data. We also found no results of clinical studies, which would allow an estimation of the effectiveness and the risks of this method. Therefore treatment with "orthokin" cannot be recommended at present.

[Development and current status of non-specific enzyme therapy]. / Entwicklung und aktueller Stellenwert der unspezifischen Enzymtherapie.

Non-specific enzyme therapy does not intend the catalysis of definite steps of metabolism, but claims to stimulate regenerative processes in general. Initially, non-specific enzyme therapy had been considered to be a promising approach. The growing knowledge in basic research and the lack of evidence for clinical effectiveness rendered the predominantly oral application of enzyme preparations for non-specific treatment outdated by the 1960s. In Germany, however, the absence of strict legal regulations prevented the deregistration of drugs designed for non-specific enzyme therapy. Furthermore, numerous clinical studies were initiated by the leading producer of enzyme preparations in Germany in order to provide the scientific confirmation missing so far. Our critical and systemic review of the published trials shows that neither the mechanism of action could be enlightened, nor the clinical benefit of non-specific enzyme therapy proven on an acceptable level of scientific standards.

[Subarachnoid hemorrhage as life-threatening complication of neural therapy. Case report]. / Subarachnoidalblutung als lebensbedrohliche Komplikation nach Neuraltherapie. Fallbericht.

In Germany, neural therapy is a frequently used method of complementary medicine. It is based on the hypothesis, that pathologically altered regions may cause symptoms in other, distant localizations and that this process can be interrupted by the local injection of anesthetic drugs. Since the pathogenetic acting regions are supposed to occur in any part of the body, neural therapy is not limited to superficial injections, but also includes injections into deep structures and internal organs. Supporters of this therapeutic approach always claim that these procedures are free of risk if carried out by an experienced therapist. We report the case of a young woman, who suffered subarachnoidal bleeding caused by an attempt to infiltrate the tonsilla pharyngea during a neural therapeutic treatment. The analysis of this incident shows that severe and even life threatening complications cannot be ruled out in all neural therapeutic injections, even if they are performed strictly according to the rules given in the textbooks of neural therapy.

[Definition of "chronic fatigue syndrome" (CFS)]. / Definitionen des "Chronic Fatigue Syndrome" (CFS).

The definition of "Chronic Fatigue Syndrome" (CFS) in 1988 was an attempt to establish a uniform basis for the previously heterogeneous approaches to research of this severe and inexplicable state of fatigue. At the same time, researchers wished to narrow down a pathogenetically founded disease entity a priori by specifying precise disease criteria. The empirical data gathered in accordance with the CFS definition, however, have failed to confirm the assumption that the disease entity is pathogenetically uniform. Furthermore, the originally selected criteria have proven to be impracticable ore theoretically questionable. In the period that followed, modifications that permitted a more comprehensive and yet more differentiated classification of fatigue states of unclear etiology were proposed. The new research approach avoids postulation of causal entities and puts CFS back in a category with other descriptive states of fatigue.

["Control of symbiosis" or "microbiological therapy"--an immunological therapy principle?]. / "Symbioselenkung" oder "Mikrobiologische Therapie"--ein immunologisches Therapieprinzip?

"Flora modulation" or "microbiologic therapy"-- an immunologic method of treatment? "Microbiologic therapy" includes the methods of quantitative measurement of the intestinal "microbial flora", the oral or parenteral application of microbial pharmaceutics and the preparation of autovaccines from excretions of the treated persons. Initially a "flora modulation" was supposed to be the mechanism of "microbiologic therapy". After the failure of this hypothesis, some physicians claim the "microbiologic therapy" to be a special form of immunomodulation or -stimulation. Most influential in this immunologic foundation of "microbiologic therapy" was the "Institut für Mikroökologie" in Herborn, Germany. A detailed analysis of the available publications however reveals, that all methods of "microbiological therapy" are based on theoretically untenable presumptions. Furthermore, up to now there is no scientific evidence for the effectiveness of this form of therapy.

[Levels and criteria for evaluation of primary preventive interventions and their relevance for the cholesterol problem]. / Ebenen und Kriterien der Evaluation primärpräventiver Interventionen und ihre Bedeutung für das Cholesterinproblem.

Before medical interventions are implemented, they should be evaluated for their effectiveness, benefit and acceptability. The effectiveness of a measure does not guarantee its usefulness. And even the proof of a benefit, although an indespensable precondition, is not always sufficient for the intervention's acceptability. A decision about the latter can only be the result of a complex ethical discussion. Acceptability is the most important criterion and overrules effectiveness and benefit during evaluation of a treatment. More stringent criteria than those for the evaluation of therapeutic actions must be used for primary preventive interventions, because these relate to healthy people. When various criteria for the evaluation of extensive cholesterol prevention are used in light of the previously mentioned analytical levels, one must conclude that the particular intervention is not warranted.