Nuremberg lamentation: for the forgotten victims of medical science.

Fifty years after the Nuremberg medical trial there remain many unanswered questions about the role of the German medical profession during the Third Reich. Other than the question of human experimentation, important ethical challenges arising from medicine in Nazi Germany which have continuing relevance were not addressed at Nuremberg. The underlying moral question is that of the exercise of professional power and its impact on vulnerable people seeking medical care. Sensitisation to the obligations of professional power may be achieved by an annual commemoration and lament to the memory of the victims of medical abuse which would serve as a recurring reminder of the physician's vulnerability and fallibility.

Whither Nuremberg?: medicine's continuing Nazi heritage.

The medical crimes of the Hitler regime are commonly perceived to have been committed by a few demonic physicians working in isolation from the mainstream of the German medicine. The success of this myth has imperiled the value system of medicine today. The World Medical Association (WMA), established to address the ethical challenges arising from the German tragedy, has itself been compromised by this legacy. The leadership of the WMA has included doctors once associated with the Nazi SS terror organization and linked to crimes prosecuted at Nuremberg. Despite these recent revelations the WMA has yet to address the ethical issues raised by its own Nazi heritage or to pay homage to the victims of the Nazi regime.

Rapid, on-site diagnosis of chlamydial urethritis in men by detection of antigens in urethral swabs and urine.

First-void urine (FVU) sediments of 240 men were tested for Chlamydia trachomatis antigens by two enzyme immunoassays, TestPack Chlamydia (15 min) and Chlamydiazyme (3.5 h), and the results were compared with urethral swab culture results. The sensitivity and specificity on FVU sediment for TestPack Chlamydia were 76.2% (32 of 42 specimens) and 95.5% (189 of 198 specimens) versus 81.0% (34 of 42 specimens) and 96.5% (191 of 198 specimens) for Chlamydiazyme, respectively. Rapid, on-site detection of chlamydial antigen in male FVU would shorten the infectious period by hastening diagnosis and treatment.

Medical selection: Auschwitz antecedents and effluent.

Medical selection in Auschwitz represents the penultimate application of the traditional paradigm of medicine: the physician as gatekeeper and decision maker. The historical evolution of that role is considered in the context of public health, medical police, quarantine, and immigration. In Nazi Germany the physician was assigned responsibility for selection on behalf of the state. The ethical implications of medical selection are considered in the context of medicine today in an age of sophisticated biotechnology, constrained resources, and an aging population; an age in which the medical profession has yet to establish a fundamental system of values.

Detection of Chlamydia trachomatis antigens in urine as an alternative to swabs and cultures.

By using commercially available spectrophotometric and immunofluorescent immunoassays, Chlamydia trachomatis antigens were detected in first-void urine (FVU) sediments from 224 men attending a sexually transmitted disease clinic at a frequency of 81.6%-86.8% compared with 86.8% (33/38) positive by urethral swab culture (P less than .05). Endocervical cultures from 228 women attending a gynecology clinic yielded 92.3% (12/13) positive compared with 61.5%-76.9% for urine samples in three antigen-detection assays. Culturing urine from either gender yielded low positivity rates (23.7% for men, 15.4% for women). Defining truly infected patients as positive by culture or by any two of the three antigen tests, all assays were 100% specific. Immunodiagnostic testing of male FVU sediment appears to be a reliable, rapid, nontraumatic method for diagnosing chlamydia infection.

In memoriam: medicine's confrontation with evil.

The proposed public burial of anatomical specimens derived from victims of the Nazis provides an occasion for the medical community worldwide to confront this legacy and the profession's ongoing potential for evil.

Diagnosis of Chlamydia trachomatis genital infections by cell culture and two enzyme immunoassays detecting different chlamydial antigens.

The enzyme-amplified immunoassay IDEIA (CellTech Diagnostics), which measures lipopolysaccharide antigen, and Chlamydiazyme (Abbott Laboratories, North Chicago, Ill.), which measures several antigenic components of Chlamydia trachomatis, were compared for specimens from urethral swabs from 235 men attending a clinic for sexually transmitted diseases (culture prevalence of 14.9%) and 458 endocervical swabs from women attending planned parenthood and obstetrics-gynecology clinics (culture prevalences of 5.9 and 7.7%, respectively). Compared with cell culture, the percent sensitivites, specificities, and positive and negative predictive values for IDEIA were 62.5, 99.5, 95.2, and 94.3%, respectively, for specimens from men and 96.3, 97.9, 74.3, and 99.8%, respectively, for specimens from women; results for Chlamydiazyme for specimens from men were 81.8, 99.5, 96.4, and 97.1%, respectively, and for specimens from women, results were 85.2, 99.3, 88.5, and 99.1%, respectively. Although the specificities of IDEIA and Chlamydiazyme were comparable, the sensitivity of IDEIA appeared higher for women (96.3%) than for men (67.5%), while the sensitivities of Chlamydiazyme were similar for men (81.8%) and women (85.2%). Western blot (immunoblot) analysis of the detector reagents from the two immunoassays indicated that the differences in performance observed for the two immunoassays may be due to measurement of different antigens.

Medical selection: Auschwitz antecedents and effluent.

Medical selection in Auschwitz represents the penultimate application of the traditional paradigm of medicine; the physician as gatekeeper, and decision maker. The historical evolution of that role is considered in the context of public health, medical police, quarantine and immigration. In Nazi Germany the physician was assigned responsibility for selection on behalf of the state. The ethical implications of medical selection are considered in the context of medicine today in an age of sophisticated biotechnology, constrained resources, and an aging population; an age in which the medical profession has yet to establish a fundamental system of values.

Value of the gram-stained urethral smear in the management of men with urethritis.

The value of the gram-stained urethral smear in clinical decision-making was assessed in a study of 250 men attending a clinic for sexually transmitted diseases. Of the 250 men, 132 (52.8%) had objective evidence of urethritis. Neisseria gonorrhoeae and/or Chlamydia trachomatis was isolated from 94 patients (37.6%). No pathogens were isolated from 38 patients (15.2%) who were diagnosed as having urethritis. Although the specificity (0.95) and positive predictive value (0.95) of the gram smear for culture-proved urethral infection was high, the relatively low sensitivity (0.66) and negative predictive value (0.63), led us to conclude that the test was of limited value in diagnosis and therapeutic decision-making when the patient was first seen. The decision to treat a patient should be based on a reliable history of dysuria and/or a urethral discharge in a patient at risk of infection, with or without an observable urethral discharge. Nevertheless, a gram smear should be done for all patients who are diagnosed presumptively as having urethritis, because it may be the only objective evidence of urethritis.