JPRS ID: 9192 EAST EUROPE REPORT SCIENTIFIC AFFAIRS

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JPRS L/9192
15 July 198Q
East Euro e Re ort
p p
SCIENTIFIC AFFAIRS
CFOUO 6/80)
FBIS FOREIGN BROADCAST INFORMATION SERVICE
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JPRS L/9192
15 July 1980
EAST EUROPE ~EPORT
$CIENTIFIC AFFAIRS
(FOUO 6/80 ) ~
CONTENTS
BULGARIA
Determination of the Contours of Lower and Upper
Sections of Convective Cloud Hail Nucleus
(R. Petrov, et al.; KHIDROLOGIYA I METEOROLOGIYA,
~ No 1, 1980) 1 _
CZECHOSLOVAKIA
Health Program Prospe.cts for Seventh Five-Year P1an in CSR
(Jaroslav Jirous; CASOPIS LERARU CESKXCH, Apr SO) g
Virological Program in CSR for 1981-1985
(Dana Zuakova; CASOPIS LEKARU CESRYCH, Apr 80) 25 ~
Briefs ~
Desulfuration Project 32
ERRATUM: In JPRS L/9115, 2 June 1980 (FOUO 5/80) of thia
seriea p 1, please change, in the eubslug, College of
Special Sciences and Research to read College of the
National Security Corpa.
GERMAN DEMOCRATIC REPUBLIC
Moral, Ethical Aapecta of Genetic Engineering Evaluated i
(Erhard Geiasler, et al.; WISSENSCHAFT UND
FORTSCHRITT, May 80) 33
" a - . [III - EE - 65 FOUO]
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BULGARIA
_ ~
DETERMINATION OF THE CONZOURS OF TAWEEt AND UPPER SECTIONS OF CONVECTNE
CLOUD HAIL NUCLEUS
Sofia KHIDROLOGIYA I METEOROIAGIYA in Russian No 1, 198o pp 3-9
[Article by R. Petsov, S. Stoyan~v and P. Boyev, submitted for publication
12 Mar 1979]
Abstract. An attempt has besn made to find by calcu-
lation a relationship between the radar -locational
reflectivity multiplier Z and some internal char ac-
- teristics as cloud water and velocity of the upd.raft
in a cloud, which ase of consider able importance for
hail p~ocesses developmer~t in the convective cloud.
- Two cloud. axeas ase examined: lower (with a height of
the isotherm t'p= 0�C~to t'1= -20�C) and upper (f`rom a
height of the isotherm t'2= -35~C to the level of con-
vection). The evaluations are made by a~ssuming that
the first area is charG,cterized by radar-locational
reflectivity from supercooled water drops and water-
covered hailstones, and the second area is chasacter-
ized by radar-locational reflectivity from dry hail-
stones. The calculation results coincide adequately
enou~;h with the experimental data for radas-locational
reflectivity from cumulonimbus clouds.
A value l~~ =3.2+0.3 has been chosen to~ descr ibe the
contours of the lower and upper sections of the poten-
- tial hail nuclei in the convective cloud.
LText] According to the currently extant methods of research and oper a-
tional work on hail prevention, the hail-dangerous section of the convec-
tive cloud is identified as the zane of increased reflectivity (ZIR~, that
is defined by the coni;our, f`rom which the multiplier of ~radar-locational
_ reflectivity
I -Z~ - -
( ) ZZ~R- io '
1
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where Z is the maximum value of the raflectivity multiplier Z. Numerous _
studiesmon hail clouds, however, indicatQ that Z is chan~e~d from case �to
case in broad limits--from 103 to 107 mmb~m3 Ll-~~. This fact demonstrates
that c3etermination of the potentially hail zone of the convective cloud
_ based on the equality i:.:~ot physically entirely valid, and one should
_ review certain concepts on the hail nuclei in cumulonimbus clouds.
In order to determine the contours of the convective cloud hail nucleus
this study attempted to find ~y calculation a link between the radar-
- locational reflectivity multiplier and certain intracloud char acteristics
a that are i~nportant for hailstone growth, for example~ water content of the
cloud q and velocity of updraft in the cloud w. As yet we do not have the
poss'ibility of computing the value of radas-locatir~nal reflectivity for _
the entire mass of the convective cloud, and in this work we:.will restxict
- ourselves to an examintion of two individual regions of the cloud: the
lower and the upper. The first region is chasacterized by the radar-loca-
tional reflectivity from the supercooled dxops and from the water-covered
hailstones, while the second region is char acter ized by rada~c-locational
reflectivity from dry hailstones. We will assume that the lower stud.ied
region encom~asses the cloud layer from the height of the zero isother m
Ht~ to the height Htl, the isotherms t'1 -20� C, without examining ~ere
the question of where and in what manner the hailstones are formed. We
selected the value of the temper ature boundary t'l based on the for med
concepts that hail formation even with stx ong haiI damage occurs as a
resu7_t of freezing of an insignificant numbez (roughly 1-0.1 m'3) of large
cloizd cirops, that d~ing theit gr~wth do not compete among themselves for
the supercoole3 water [1,4,5~. One can consider that in the layer Ht0-Ht
this c~~ndition is fulfi~led, since ~om certain meas~ement data [6] and
f`rom certain calculation results [5,7~, intensive crystallization of thick
convective clouds begins below the cloud temperature -25~C. We will assume
in relation to the upper examined region that it is located in the crystal-
lized section of the cloud, i.e.~ above the isotherm level t�2 -35�C, where
hail growth can be ignored.
As is known fr om the many theoretical and experimental works~ growth of -
ice crystals in a stream of supercooled asrosol occurs in two patterns: _
in a dr y and in a wot [8,9]. In convective clouds, with other conditions _
equal, the growth pattern of ice par ticles is determined by the water con-
- tent of the cloud q, while the value ~o_r the water content qg that deter mine
mi.nes the first pattern, is called the critical. As appliedPto the ~xco-
cess of hail formation, one should note that in the dr y pattern~ the effec-
= tiveness of hailstone growth is low, the capture of ice particles by the
growing crystal is rare~ and the capture of supercooled drops results in
the formation of ~orous ice of slow-like stxucture. We will ignore dry
hailstone growth in this work.
~ In the calculations of the critical water content qk that sepasates the
wet pattern of cloud crystal growth from the dry, wepwill use the formula
obtained in [10] for qkp that is written in the form
2
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~ ~2~ k,(1-0,01 t~
9~P - - p L~ - s
= 3r;~'Y P I~r�-~-I~
- where kl is tha coefficient that links some of the physical characteristics
fo~ the growth of ice crystals that are included in the original heat
balance equation [10], ,~--coefficient for capture of the water drops by
tha growing crystal with radius r*, p--ais p~essure at given level, P--
air pressure under standard conditions, L~---latent heat of ic~ melting,
t'--air temperatura in cloud. The critical water content qk computed with
the help cf formula (2) makes it possible to isolate the firs~ region we
examined of the cumulonimbus cloud, by comparing the values q and the
water content value q of the cloud. kP
By definitinn, the water content
, . . ~
- 13) 9 � 3 ~eN ~J~T)radr~
- , . ~ ,
_ where Q--water density, N--number of water drops in a unit of air volume,
'1~(r)--i'unction of drop di.stribution according to sizes The type of -
the ~(r) function has ~eat importance for further calculations. As shown
in L11], the function
f
(4) n (r) = 4 ~ exp -2
m ,
where rnl -mode of function 'Y~ (r) approx~mates fairly ~well the typical cloud
pasa.metexs and is applicable to hail. When it is used, it is necessa~cy to
know the link between the modal r adius r and the intr acloud chax acter is-
tics. For the region of wet hailstone g~owth that we ase interested in~
from the contour that satisfies the condition
~5~ 9 = 9rD~
~his link can be found after the critical water content q is computed.
Than the ex~ession for the modal ra,dius rm is written in~he form
. 9KP
~6~ ~ni = Its N ~
where k2 is the coefficient obtained f`rom (3) with regaxd for (4~~ .
The distribution function of hydrometeors according to dimensions (4) was
used in this work and in the calculations of the radar-locational reflec-
tivity ~ from the potentially hail nucleus in the cumulonimbus cloud. We
made the estimates of reflectivity Y~* in the R ayleigh approximation. As is
known, for the Rayleigh scattering the radar-loca,tional rsflectivity
3
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L'VL~ Vl'1 tl~ll~L UJf. V1VLI
m '
~l~ sx~
5 No I ma+l I''~~r)rs d~~ -
where ~.--wavelength of radar~ m--complex xefractive index of cloud paxticle
substance. During radar in the micxowave regi4n(from 3 to 10 cm) in the
- practical calculations one can consider for water m'-I z 0.93 and for
z
dense ice I~z+2 I2== 0.20 [l, 6]. Then, with assigne wavelength 7~ the
reflectivity ~
(7'1 * = 6~k 4 -
a ,~y~(~)red~~
or for further replacement ot~ u~,,..~ ~n by summing
r~ �
= 64 kaN f ~7~~)rs dr, ~
0
where s m'-1 z
k3- x~ Im2+2 I~ while r' separates that part of the spectxal distri- _
bution of cloud dxops according to sizes that can be ignored due to its
unimportant contribution to the water content o~' the convective cloud. -
In this study r' is accepted as equal to the maximum value of hydxometeor
rar.~ius maintained at the given level by vextical curxents in the cloud.
We will further employ the radar-locational reflectivity multipli6r
(8) Z= 64N~ ~(rj~e dr,
that with the assigned cor.centration of cloud pax ticles depends only on
their distribution according to sizes.
An i.mportant factor for the hail process developmont is the updxaft velo-
city in the convective clouds. Following [10], this study will consider
that a cr itical value of ver tical velocity exists in the cloud w that is
- neaessar y for hail growth. This makes it possible to evaluate t~~ dimen-
sions of the ha~lstones r* that can be supported by the updr aft, and to
link the radar-locational reflectivity multip~.ier with the internal char ac-
teristics of the cumulonimbus cloud. The intensity of the radar-locational
scattering and the attenuation of r adar-locational radiation in the hail
clouds~ however., depends to a considerable degrae on the condition of the
hailstone surface. In the first region of the cloud that interests us,
where the primary hailstone growth occurs i.n the monocrystalline pattern,
and the thickness of the water f ilm on the hailstones can reach 0.1 cm and
more [12], the rada..~-locational reflectivity is computed on the a,~sumption
_ that all the hailstones scatter electromagnetic energy like equally-great
aqueous spheres.
ZI.
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Certain calculation resul.~s in re ation to the first region we examinad
with changing according to [6~] ~om 10 to 12 m~s, ase p~esented in
table . The estimates were made with thrse critic al values for the
vertical velocity of the hailstone radii corresponding to this range r*=
0.15 cm, 0.20 cm and 0.25 cm; for three levels deter mined by the air tem-
perature in the cloud t'= -S~C, -10�C and -15�C~ and respectively with
the avexage ais press~e values for these levels P=600 mbar, 500 mbar and
450 mbar characteristic for our summer cond.itions. For the concentration
of cloud dsops the value N=105 m 3 was selected [1], and the values of
coefficients ~=0.8; kl 1.12.10'S; k=0.32; k=2,71 (~=3~2 cm). The table
shows the results of calculations o~ critic~ water content qk , modal
radius r, and the multiplier of radar-locational reflectivityPZ, 1gZ.
Judging ~rom tha computations,the ap~oach we selected gives a correct idea
about the hail-danger of the lower section of the cumulonimbus cloud; the
computed values lg2 correspond to the values 1gL ~btained experimentally.
Thus~ for example, the minimum value of this radar-locational pasameter
of h.a,il clouds, obtained based on observatians and measu~ements by the
ra3ar with ~=3.2 cm is 7gL=3,4~ [13,14], which agrees quite satisfactorily
with the estimates made in the given work.
The sscond region of the convective cloud that we examined, as was noted,
is located above the isotherm t2= -35~, where the vertical currentls
- support only ice particles. The next task of this study is to compute tho
xadar-locational reflectivity from this region. For this we will use
formula (7") in which the coefficient k is computed a7seady with the
assigned valua of the complex ice ret~ae~tive index, and the distribution of
hailstones according to sizes is again described by formula (4). The link
between the modal radius r and other chaxacteristics in the hailstone
spectrum now can be obtained by assigning the maximum value for the radius
r' of the hailstones supported by ~the updraft in the cloud~ Then it is
possible to use the link between r' and the average cubic radius of ths
hailstones r3 [12]
_ ~9~ f, _ k~~e ~
on whose basys from the known correlation
~ ~ ~a = ( ~ ~~r) ra d~) ~
~o
with rega~d for (4~~, we obtain the sought for link
(1 ~ ~ rm = ILbI
y.
Certain results of the calculations in relation to the second. region we
examined are p~esented in table 2. The estimates were made with three
maximum ra,d.ii of hailstones r'~.20 cm, 0.25 cm and 0.30 cm corresponding
to the classification of the WMO commission to study clouds and. hydrometeors,
, and for 5 concentrations of hailstpnes N=5,10, 15, 20 and 25 m-3~
5
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6
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cori:esponding to these maximum hailstone dimensions [12~, and the values
of the coeff icieni;s k3=0.58; k=2.11 [12~; k5~.51. The calculations indi-
cate that the computed values ~~L ~ in the saA~e way as for the first
examined region, agree quita satisfactorily with the experimental data for
the radar -locational reflectivity from the cumulonimbus clouds [13,14~~.
- Based on the results of the computations presented in tables 1 and 2, we
s~slect the value 1gZ=3.2+0.3 to describe the contours of the lowex and upper
_ sections of the convective cloud hail nucleus. The next goal of our study
is to compute the contour of the hail nucleus for the entire mass of the
convective cloud,and compare the calculatad contours with the contours of -
such nuclei in the clouds of varying degcee of hail danger that were meastared
meas~ed with the help of radar stations.
BIBZIOGRAPHY
; l. Atlas, D."Uspekhi radarnoy meteorologii" [Ad.vances in Radar Meteorology~
Leningr ad, Gidx ometeoizdat, 1967.
- 2. Abshayev, M, T. "Results of Experimental Verification of Radar Method
of indicating Hail Foci," TR. VGI, No 14, 1969.
3. Stanchev, K,; Petx ov~ R.; and Boyav, p. "physical-Statistical Method of
Hail C loud Indication," KHIDROLOGIYA I MErEOROLOGIYA, Bk 2, 1975�
Sulakevelidze, G. K. "Livnevyye osadki i~a~t" [Showers and Hail~,
= Lenin~r ad, Gidrometeoizdat~ 1rj-67.
5. Kach~ in, L. G.; Arttemyeva, ri. D. ; Kartsivad.ze, A. I. ; Stoyanov,
S.; and Tekle, M. "Simulation of the Natural Process of Hail Formation
and Its Transformation under the Influer.ce of Axtificial Crystalliza=
~ion,""proc. WMO~IAMAP Sci. Conf. on Weath. Modif.,"Geneva, 197~.
h. Eydinova, G. Z.; and Kirkita,dze, D. D. "Natural Crystallization of To s
of Thick Cumuli~""Sb. Fizika oblakov" [Collection. Physics of Clouds~,
Tbilisi, Metsniyereba, 1975.
7. Stoyanov, S.; and Boyev, P. "Physica.l and Statistical Ap~oach to
Analyzing Hail ~henomena Based or~ Calculations with a J~t Model of
Co.nvective Clouds," KHIDROIpGIYA I METEOROI~OGIYA, Bk 5, 19?$,
8. Macklin, W, C.; and Payne, G. S. "A Theoretical Study of the Ice
Accretion Process," QUART. JOURN. ROY. METEOR. SOC., Vol 93, No 396,1967~
9. Kachurin, Z, G.; and Gashin, T,. I. "Density and Structure of Ice
Growing in a Supercooled Aerosol Stream," IZy~ AN SSSR~ FAO, Vol 4,
No l, 1g68,
7
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, 10. Petrov R. "Cr~tical Value Z(Reflectivity Multiplier) to Determine
Area o~' Convec ive Cloud Subject to Seeding with Cryszallizing -
Rea,gonts," KHIDROI~OGIYA I METEOROT~OGIYA, Bk 4, 1977. -
11. Kachurin, L. G. "Fizicheskiye osnovy vozdeystviya na atmosfernyye
protsessy [Physical F undamentals of Modi.fication of Atmospheric Pro-
cesses~, Isningrad, Gidrometeoi.zdat, 1973�
12. Rozenberg, V. I. "Rasseyaniye i oslableniye elektromagnitnogo izlu-
cheniya atmosfernymi chastitsami" [Scatter ing and Attenuation of
Electromagnetic Radiation by Atmospheric Particles], Isningx ad, Gidr~-
_ meteoizdat, 1972.
- 13. Gayvoronskiy, I. I. ; Dinevich, I,. A. ; and Khrustitskaya, I. L. "Certain
Results of Studies on Hail Processes," TR. TsAA, No 104, 1976.
14. Petrov, R. ; and Boyev, P. "Indication of Hail Clouds Using Ra.dar Sta-
tion with ~.=10 cm," KHIDROZOGIYA I METEOR07AGIYA, Bk 3~ 1977.
COPYRIGHT: Glavno upravleniye "xhidrologi;~a i meteorologiya'~ 1980
[9~35-8144/1z37]
CSO: 8144/1237
8
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_ CZECHOSLOVAKIA
HEALTH PROGRAM PROSPECTS FOR SEVENTH FIVE-YEAR PLAN IN CSR
Prague CASOPIS LEKARU CESKYCH in Czech Apr 80 No 4 pp 104-110
[Article by Doce:it Jaroslav Jirous, M.D., candidate for doctor of science,
first deputy minister of health of the CSR: "Achievements in General Public
Health Programs and Prospects for the Seventh Five-Year Plan"]
[Text] General public health programs embody one of the main missions _
of the health policy of a socialist state--development and intensification
of the preventive character of the health care provided for the nation.
They were formulated on the basis of analysis of the main trends of
morbidity, disability and mortality of the population and focused on the
most serious health and social economic problems of our present society.
Their goal is to progressively provide outpatient care for the entire
population. This concept is in accord with the principles defined by the ~
25th CPSU Congress and the conclusions adopted at the 18th conference
of the ministers of health of the socialist countries.
It is my duty to report on achievements in the four fundamental, general
public health programs which were specified by the 15th CPCZ Congress and
fal 1 into the sphere of preventive care, namely:
care of women and youth;
the fight against vascular and cardiac diseases (cardiovascular program);
the fight against cancer (oncologic program);
care of the aged and chronically ill.
The program of care for the younger generation has its basis in one of the
fundamental principles of socialist public health care; in the Sixth
Five-Year Plan it was mainly directed at improving the general health status
of the population, mostly by intensification of the currently provided care
for mother and child.
9 _
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r~c~K u?~htcinL usL oN~.Y '
In the field of gynecology the program called for:
--completion of the district system of gynecologic service; in particular,
realizarion of the planned ratio of gynecologists in the district service
with a simultaneous increase of the corresponding number of gynecologic
nurses;
--increasing of the number of beds in gynec~logic dep artments by 423;
--r.ompletion of the network of specifically alloted b eds for women with
complicated pregnancies in gynecologic departments co vering larger areas
(populat~un of about 250,000, i.e., especially in hospitals with type III
- policlinic~ and selected hospitals with type II policlinics), where such
special care will be concentrated, and equipping them with modern technologic
means.
- Compared to the end of 1975, the number of physician slots in gynecologic
outpatient care rose from 649.71 to 722.51 in relation to the population;
i.e., from 0.64 to 0.70 physicians per 10,000 people, with district service
showing the increase from 0.50 to 0.54. In this period, however, the
number of gynecologic nurses in the outpatient service rose by only 27
positions and the ratio of the nurses per physician thus became more
un f avo r. ab le .
The higher number of physician positions was reflected in expanded care
for pregnant women, especially those with complicated pregnancy. The
number of women treated for threatened pregnancy rose from 27.8 percent in
1976, the starting year of such records, to 28.7 percent of all pregnant
women. The percentage of pregnant women prepared for deliveries by
psychological instruction r_ourses rose from 27.3 to 28.9. The percentage
- of women of childbearing age (14 to 44) using some kind of contraceptives -
also increased from 18.5 to 20.9, and the choice of hormonal contraceptives ~
was likewise expanded and updated. During the transient decline in the
years 1973-1976 the numb er of requested abortions showed a slight increase
and amounted to 46.7 per 100 live births. The highes t share of the requests
was from women having two children. -
The number of beds was increased by 124; i.e., by the end of 1978 the gyne-
cologic departments of hospitals had a total of 11,27 7 beds. Lagging
_ investment buildup was the main reason for the slower meeting of the plan.
The gynecologic departments of hospitals with type III and selected hospita ls
with type II policlinics are setting aside sections fo r the hospitalization
of women with threatened pregnancies. Specialists fo r threatened and
pathologic pregnancies have been assigned so far to 1 0 departments of
gynecology and obstetrics, mostly in hospitals with type III policlinics.
Equipment of these sections with the necessary medical technologic means
has been limited to only a few places, because for the most part it must
be imported from the capitalistic countries. Pre~onception care was
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strengthened by treatment of in�ertility and sterility � but the shortage
of staff and beds did not allow substantial improvement in prevention of
fertility disorders.
The achievements can be documented statistically: the rate of stillbi~ths,
which is one of the lowest in the world, was 6.1 per 1,000 in 1976; perinatal
r?x~rtality dropped to 17.3 per 1,000 and maternal mortality in 1978 was .09
per 1,000.
In the field of child care we adopted measures for improved general health
status of the population by providing differentiated care for the newborn,
especially those with a low birth weight and congenital abnormalities. For
this purpose we are gradually building intensive-care units for the newborn
with pathologic states and supplementing the number of beds for the underweight
- newborn, and modern equipment and necessary staff are being provided for
the existing sections. These steps in the field of care for the newborn
c~ontributed to the decline of infant mortality from 19.4 per 1,000 in 1975
to 16.9 per 1,000 in 1978, with the mortality of the newborn showing in
this period a drop from 14.8 to 12.6 per 1,000.
In the field of care for older children, the quality of so-called complex
care taas also raised: systematic preventive care for children up to the age
of 15 and for children of all ages with abnormal physical and mental
development has been improved and expanded. Children with chronic diseases
are under the care of outpatient clinics; and children with abnormalities
are receiving special attention. The network of speciaZized pediatric
centers, especially cardiologic, cardiosurgical and other, is being gradually
enlarged. Medical genetics, which will be on the agenda at the session of
the Collegium of the Minister of Health in February, also play an important -
role in the improvement of the general health status of the population. In =
the course of this five-year plan we have already begun to establish
appropriate centers and provide personnel and materiel resources.
Meeting the plan for nursery spaces is also an important component of this
program; in the course of the Sixth Five-Year Plan the net of nurseries was -
enlarged by 151 centers with a capacity of 7,666 places and by 322 mininur-
series with a capacity of 1,578 places. By the end of the Sixth Five-Year
Plan (the end of 1980) we assume that 61,662 places will be available in
the nurseries and that the plan will thus be exceeded by 2,23.: places, which
would allow for placement of about 14.4 percent of children of nursery
age. Such an increase in nursery openings is still insufficient to meet
the demand, however. At the end of 1978, there were 20,667 unprocessed
requests for placement of children under the age of 3 in these centers.
As far as care for mother and child in local health districts is concerned, '
it is realistic to assume that the number of gynecologists assigned to
local and plant facilities will meet the plan. As far as district pedia-
tricians are concerned, however, 166 physician positions still need to be
filled before the end of 1980 to meet the plan. In view of the expected
number of graduates of the School of Pediatrics, one may expect that the
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planned complement will be realized at the beginning of the next five-year
plan, unless we resort to assignments of the graduates of the Schools of
General Medicine to pediatric specialties.
Realization of the cardiovascular program called for:
1� Introduction of proven methods of care in all regions of the CSR in accord-
ance with results achieved in the model districts; increase of health awareness
of the population and achievement of better familiarity of the population with
administration of first aid in sudden-onset forms of heart disease, such as
acute cardiac infarction, for example.
We introduced unified procedures in all regions of the CSR for diagnosis,
treatment (including medical first aid) and rehabilitation of patients with
conditions following acute myocardial inarct. In particular, we succeeded
in shortening the time between the occurrence of the cardiac infarction and
hospital admission of the patient. On the average, 50 percent of patients
are admitted to the hosg~tal within 3 hours, compared to 10 hours formerly.
Heightened health awareness of the population, including better knowledge of
administration of first aid in sudden forms of heart disease, has contributed
to this improvement.
2� Completion of special facilities in accordance with the concept of the
~ internal medicine branch--intensive-care units (and coronary units)
provided with monitoring and operative equipment--as a part of the network
of specialized centers capable of insuring immediate qualified and effective
medical emergency treatment for patients with acute heart disorder; and in
this connection insuring the development of quick treatment consistent with
the principles of the organization of the emergency service.
� The number of beds in intensive-care units, including caronary, was increased.
BY the end of 1978, there were 629 beds in internal medicine intensive-care
units and 152 beds in coronary units, but their disposition is not equitable.
More than 80 percent of the patients with acute myocardial infarcts are
treated during the first phase in the intensive-care centers. The hospital
r.w rtality for persons with acute cardiac infarct is 18 percent. Compared
to the period preceding the cardiovascular program, this represer,ts a 50-
percent reduction of hospital deaths. The number of districts in which quick
emergency service was established also increased.
As a result of concentrated care, the average time of hospitalization of
patients with uncomplicated courses of cardiac infarct was shortened by 14
days, i.e., to 3 weeks compared to the previous 5 to 6 weeks.
The effect of the consistently administered concentrated care, including
rehabilitation, also has a positive economic value. From the group of
patients of the productive age with complicated heart attacks, 70 percent
returned to the work forr_e, 54 percent of them to their original emplo}ment.
The recuperative treatment of these patients in specially designated spas
plays an important role here.
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3. A gradual increase of the present number of physicians specializing in
cardlology (training of 30 new specialists).
So far we have only 19 physicians who have passed the qualification tests
and acquired additional specialization in the field of cardiology, but
several other doctors are currently training in this specialty. Educational
programs (topical courses) have been set up by the Institute for Continuing
= Education of Physicians and Pharmacists in Prague and at the regional level,
and professional lectures are used to raise the level of competence of the
physicians and other health personnel involved in diagnosis, treatment and
eval.uation of patients with heart diseases.
4. The direction of inedical research toward improved diagnosis, treatment
and evaluation of severe cardiac and vascular diseases and the accelerated
application of new scientific knowledge in the medical practice.
The complex research project P 17 specified tasks whose goal was to acquire
new knowledge concerning the causes and factors leading tc~ the development
of severe cardiac and vascular diseases and influencing their course,
and to evolve new, more effective methods of prevention, treatment and
evaluation of patients with cardiovascular diseases and their complications.
Through the progressive establishment of a network of specialized centers
- for cardiac surgery in Prague, Hradec Kralove and Brno we also provided
effective treatment for congenital and acquired heart defects.
In four model districts which are identical with the districts of the
ongoing oncologic program, we have been checking the methods of inedical
examinations for timely and systematic identification of patients with
essential hypertension with the aim of preventing and delaying the occurrence
of cerebral complications.
The work of the hygienic service and research in the field of primary
prevention was directed particularly at the development of procedures for _
the study of the influence of individual factors of the home and work
environments on the development of cardiac and vascular diseases.
Investigation of the influence of these factors on ischemic heart diseases
among professionals was started in selected research institutions.
Furthermore, there is an ongoing study of the influence of individual
factors of the home and especially work environments on the development
of these diseases among workers in heavy industry.
Realization of the oncologic program has called for:
l. The necessary review and evaluation of the present results of the
s~reening carried out in the model districts.
The first stage of a 3-ye3r model, the testing of preventive oncologic
examinations which were integrated with preventive examinations in the
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iramework of thc~ cardiovascular program, wa5 completed in the four selected
. districts of the CSR by 31 December 1978. In these 3 years, 149,227 indi-
_ viduals were examined in the model regions; the findings revealed 231 malig
malignant tumors, 2,828 preblastomas, 7,354 hypertensions and 2,748 diabetics.
The referral of ttie preblastoma cases to outpatient care means a true
reductiun oE the risk of tumors in the given localizations. The present
findings have shown that preventive cancer examinations are advisable even
in the younger age groups, i.e., starting with the 30-year-old, especially
so for women. Experience from the experimental districts has revealed that
4 to 5 percent of all malignant tumors found were diagnosed at a clinical
stage at which the prognosis was relatively favorable with a properly selected
treatment and that a higher number of cases were discovered at a treatable -
stage (1.5 years earlier, on the average, than if the patient consulted
the physician without this examination).
The current state of cancer researcli does not offer a basis for an essential
change of therapy prior to the year 2U00 and we must, therefore, continue
to develop and perfect the methodology of screening. Review of the screening
program has also confirmed some problems, especially in the summoning of
the youagPr people for examinations, because a younger person who feels well
sees no r2ason why he should be examined. Health education must assume a
greater role in the organization and issuing of invitations for such
examinations. We must also expand the spectrum ofneeded c;~tostatics and
health tect~niques, especially for endoscopic diagnosis and radiation therapy.
2. Gradual development of the specialty of clinical oncology and related
legal regulations, and Especially strengthened staffing of the centers of
clinical oncology in the hospitals with type II and III policlinics.
Advisory boards for clinical oncology were established in the regional
institutes of public health, and centers of clinical oncology were set
up in all hospitals with type II and III policlinics. The level of
personnel assignments to these centers has generally been met but not the
required specialized qualifications of the workers. Specialists for
chemotherapy of malignant tumors were nominated for all hospitals with
type III and some hospitals with type II policlinics; and stocks of
conrrolled cytostatics were organized for all regions. Specialists for
clinical oncology are gradually being nominated at specialized departments -
of the hospitals with type III and some hospitals with type II policlinics
and these should successfully provide the foundation for interdisciplinary
_ team cooperation.
3. Creating conditions for systemat~'c education of health personnel at
all levels of clinical oncology with special emphasis on first-line workers.
On the basis of experience with the training of physicians in the Soviet
Union, in 1977 the Minister of Health of the CSR established the chair of
clinical oncology in the Institute for Continuing Education of Physicians
and Pharmacists in Prague. Every year since 1977, the training programs of
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- the Institute for Continuing Education of Mid-Level Health Personnel have
provided special courses, training positions and discussion seminars for
nurses of the centers of clinical oncology in hospitals with type III
policlinics and selected hospitals with type II policlinics.
4. Developing the most important diagnostic procedures for early stages of
malignant tumors, cytological, biachemical, immunochemical and endoscopic,
for example, which in the course of the Seventh Five-Year Plan would allow
substance and capacity coverage o� the examination needs in screening actions -
and in clinical practice; reinforce at the same time other examination
procedures to support clinical diagnosis, i.e., X-ray, isotope and biopsy
diagnoses.
Despite systematic attention, this did not materialize in the expected scope ~
because of limited capacities for laboratory and clinical diagnostics. Some
places already managed to unite the needed elements into larger entities,
broadened the range and increased the number of the examination procedures
in the indicated cases. During the implementation of the oncologic and
cardiovascular programs, the number of procedures per 100,000 people rose
considerably; for example, in the past 7 years to 164 percent in the field
of roentgenology and to 194 percent in clinical biochemistry.
5. Developing therapeutic preventive care so as to eliminate, in the
course of the sixth and seventh five-year plans, the differences between
individual regions in overall cancer treatment and its individual components,
i.e., surgical treatment, radiotherapy and chemotherapy.
In the field of therapeutic preventive care, there continues to be inadequate
capacity in the surgical and radiotherapy departments, and there is no network
of radiotherapy departments in the policlinics. Cancer chemotherapy has not
yet been properly managed organizationally and particularly with regard to
its methodology.
6. At the close of the Sixth FivF~-Year Plan, formulation of a proposed
network of institutes of concentrated care for patients with malignant
tumors, on the basis of conceptual, substantive, prospective and operational
aspects, so that we can start with the buildup of the proposed network in -
the seventh and eighth five-year plans.
The present proposal of the prospective network of health care centers of the
regional national committees to the year 2000 has considered the establish-
ments of only two such institutes, in the southern Moravian and eastern
Bohemian regions. An institution for the central Bohemian region is now
also under consideration. I believe that three such institutes with a
total capacity of 1,000 beds would be sufficient to meet the needs.
The program of care for the aged and chronically ill whose basic tasks in the
public health field were set forth by CSR Government Resolution No 252/1972,
has shown this progress during the Sixth Five-Year Plan: From the beginning
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" of the Sixth Five-Year Plan to 30 September 1979 the number of beds in the
facilities for chronically ill rose by 753, in the units for recuperative
trea~ment of patients by 158 and the number of nurses positions in the
care for the aged and chronically ill rose by 383.38 [as published].
Regional national committees expect that by the end of the SiXth Five-Year
Plan, the number of beds in facilities for the chronically ill will increase
by 1,348; this will t~ot, however, meet the goal of 1,561 beds for the
Sixth Five-Year Plan, which was approved by the councils of the regional
national committees. The capitol city of Prague, and the central and
western Bohemian regions are mostly accountable for this deficiency.
Reorganization of underutilized health centers for the benefit of the aged
and chronically ill is proceeding very slowly. In most cases this is due
to both personal and group interests--very often of the directors of
these health facilities.
Small, inadequate hospitals thus continue to vegetate, although the change
in utilization of their beds would solve one of the burning problems of the
present and future health care, i.e., institutional nursing care for the
aged and chronically ill who on account of the state of their health can no
longer be cared for in their homes. Hospitalization of such patients in
clinical departments of university hospitals, for example, is unproductive
because their diagnosis is known and because. of the nature of their illness
the patients do not need highly qualified diagnostic and medical attention,
but need nursing and rehabilitation care. Because of the shortage of beds ~
in facilities for the chronically ill, these patients are occupying hospital
beds designed for treatment of acute states with a planned higher turnover
of the bed, and they thus block a certain percentage of such beds. This also
leads to unnecessary economic losses; for example, in 1978 the cost of
operational expenses alone for 1 day of care and bed in the hospitals with
type III policlinics was Kcs 248.00 and in university hospitals Kcs 300.00,
but only Kcs 105.00 in facilities for the chronically ill.
It was expected thatin the Sixth Five-Year Plan the sector of care for~the aged
and chronically ill would meet the allocations of nurses charged with care
for these citizens in the local health districts with the average of 0.5
nurse slot per district. As of 30 September 1979 tnis standard was met by
60.b percent and it is assumed that by the end of the five-year plan it might
be met by about 80 percent. Work plans at some places make the attainment
of 100 percent impossible, although middle-level health workers might be -
available there for day service.
The government of the CSR and the Public Health and Social Committee of the
CSR and the Public Health and Social Committee of the Czech National
Council dealt with the current state of fulfillment of the missions of
these general social programs. The conclusive and indisputable achievements
in mother and child care, which are related to the strong tradition of this
service that has existed from the start of the socialist public health service,
were evaluated. Emphasis was also placed, however, on the need for modern
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equipment and the fact that this program cannot be viewed merely as a narrow
medical matter.
- The public health and social committee of the Czech National Council also
evaluated the achievements in the cardiovascular program and the relationship
of intensive care treatment to rehabilitation and convalescence treatment in
the spas. At the same time emphasis was placed on the need for a greater role
of health education to bring about changes of life style and thus prevent
such diseases.
When evaluating the program of care for the aged, the Public Health and
Social Committee of the Czech National Council has found that no leading
research clinical center participates in this program, and that even such a
step as the establishment of the network of nurses specializing in geriatric
care faces serious difficulties because of the limited feasibility of the
work plans in public health facilities.
Concerning the oncologic program, the public health and social committee
of the Czech National Council called attention to the fact that without test
procedures, even if imperfect, timely detection of malignancies has little
success and that the results of the present treatment methods are not good
enough to dispel fear of this disease among people.
Concept of Further Development of General Social Programs in the Seventh
Five-Year Plan
The basic trait will remain further emphasis on the preventive character of
our public health service. We shall therefore continue to insure on a
priority basis the care of the younger generation, provide healthy conditions
f.or the development of children, especially in collective facilities, and
insure concern about the care of workers and their home and work environments.
In the field of gynecologic care, in the Seventh Five-Year Plan we shall
continue to identify infertility and sterility and arrange more intensive
care of women with risk pregnancy and women using contraceptives. The
influence of the life style of girls and young women on premature births
and miscarriages will be investigated. For this purpose it will be necessary
to :
--fill the medical positions in the outpatient service in the discipline
of gynecology and obstetrics;
--continue with the buildup of a network of specifically alloted beds for
women with threatened pregnancies in hospitals with type II policlinics _
and assign specialists for such care;
- --insure the necessary number of beds in gynecologic departments of all types
of hospitals;
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--supply departments for threatened pregnancies in hospitals with types III
and II policlinics with modern medical technology;
_ --further develop specialized gynecologic services (gynecologic endocrinology,
clinical oncology, prevention of female cancers, child gynecology).
Research should be directed at:
--prevention, timely diagnosis and therapy in the field of perinatal medicine,
and the lowering of perinatal mortality, perinatal morbidity and genetic
congenital development defects;
- --prevention and treatment of female infertility and acquisition of new
knowledge indispensable for control of human fertility (both in the positive
and negative sense);
--testing of interruptions of early pregnancies using vacuum aspiration
(mini-interruption) at selected centers and, depending on the results,
eventual introduction into nationwide practice.
In the sector of child care it will be necessary to:
--supplement the intensive-care units for treatment of pathological
cond~irions of the newborn, and increase the number of beds for newborn
with low birth weights in al]. regions; and provide gradually modern medical
technology for these t~ao areas;
--devel.op a network and activity of the departments of inedical gene~ics in -
hospitals with type III policlinics and eventually in selected hospitals with
type II policlinics, and gradually equip these departments with needed -
instruments;
--in primary pediatric care, achieve a ratio of 1,100 children under the age
of 15 per pediatrician slot in the district;
--strengthen with personnel the specialized services in the pediatric wards
of hospitals with types III and II policlinics;
--continue the gradual establishment of highly specialized centers (e.g.,
nephrologic, gastroenterologic, hematologic) in pediatric departments of
university hospitals and type III policlinic hospitals;
--expand pediatric psychiatric care;
--increase the number of beds in facilities for long-term psychiatric pediatric
care and for mentally ill children;
--establish sanatoria for chronically ill children where they can stay for
days and weeks, especially for the group of abnormal children, and achieve
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this principally through reorganization of unutilized pediatric hospital
wards;
--complement the network of institutes for infants;
--insure further development of nurseries so that at least an average of 17
percent of children of nursery-school age could be placed there;
--improve therapeutically preventive care for adolescents and recruits
(apprentices, working youths and students).
Research should be aimed at:
in the field of care for the newborn:
--problems of adaptation of the newborn and its disorders;
--respiratory disorders of the newborn;
--problems of the newborn with low birth weight;
in the field of care for infants and preschoolage children:
--development of defense mechanisms of the infant;
--increased quality o� infant and child nutrition;
- --development of the nervous system of the child and its disorders;
--metabolic disorders, their diagnosis and treatment;
--prevention of recurrent chronic respiratory ailments;
--development of ch~ldren at risk (early detection and rehabilitation);
in the field of care for schoolage children:
--sound physical and mental development of the child in the pedagogic
process;
--reaction of children to changes in physical and mental stress;
in the field of institutional care for children~:
--prevention of nosocomial illnesses;
--diagnosis, treatment and prevention of diarrheal diseases;
--development of children under various living conditions; -
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- --child care ou~side the family (nurseries, mininurseries, kindergartens,
infant institutions, children's homes);
in the field of care for adolescents research should be aimed at:
--diagnosis, treatment and prevention of the mosr. frequent health problems
of adolescents;
--functional diagnosis;
--evaluations concerning the possibilities of productive life of handicapped
adolescents.
In the sector of the cardiovascuiar care the Seventh Five-Year Plan will
concentrate on:
--achievement of outpatient care for all persons threatened with or having
hypertension in the age-risk group 40 to 60, and study of the decline of
morbidity and mortality due to complications of hypertension;
--continuation of the present way of treatment of heart attack patients,
especially expanding possibilities of rehabilitation to achieve a
reduction of the short-term work incap3city and a decline of premature
disabilities;
--fi~rnishing centers of cardiovascular surgery so that the number of children
and adults for whom surgical treatment of congenital or acquired heart
defects and diseases is indicated may be raised;
--increasing the number of major vascular surgeries and start of timely
surgical treatment of poststroke conditions in indicated patients;
--creation of neurosurgical centers for larger population areas.
The research should:
--continue development of inethods for the study of the individual components
of the home and work environments in the development of cardiovascular
diseases, study their influence on the development of ischemic heart
diseases in selected groups (especially professionals and workers engaged
in ttie heavy machine industry) ;
--study in greater depth the risk factors of atherosclerosis, its pathogenesis
and possibilities of prevention;
--investigate more intensively the diagnostic methods and treatment of
embolism of large vessels to have them available within 3 years;
--continue kTith research on artificial hearts and aids to blood circulation.
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In care for cancer patients it will be necessary to:
--heighten watchfulness for detection at all levels and in all specialties;
--search actively especially for the early stages of cancers and precancerous
states in selected localizations (cervical, laryngeal, rectal and skin
carcinomas) and tumors of the digestive tract; -
--evaluate breast self-examination an~ong women from the aspect of its effect
on detectio n of the clinical stages of breast carcinoma and on the number
of identified dysplasias;
--insure a sufficient number of beds in departments of surgery for surgical
treatment of cancer patients; provide modern technology needed for radiation
� treatment and adequate choice of cytostatics, thus achieving further
improvement of the short-term and long-term results of treatment, prolongation
of useful life and fitness for work;
--establish centers for complex treatment of cancer patients in large
population areas (several regions) to improve the qual ity of this care and
utilize more effectively medical technology and staffs of specialists;
--Utilize positive experiences from the 3-year trial study of preventive
oncologic examinations and incorporate their principles into the system
of a single preventive examination; and introduce it speedily into the
practice; .
--direct the health education cf the population toward education of a
generation of nonsmokers as a preventive measure against certain environ-
mental diseases.
Research in the field of oncology should be aimed at:
--relationship of individual factors of the home and work environments to the
genetic risk, their role in primary prevention, determination of the
mutagenesis of these factors, investigation and determination of the
involvement of professional exposure and possible conveyance of these
factors to the individual;
--determination of the characteristics signaling increased risk of a
malignant transformation (cytogenetic examinations of peripheral
lymphocytes, immunologic examinations, changes of the activity of enzymes
in the blood);
--analyses of the influence of individual factors of the home environment
on the body with the aid of epidemiologic studies utilizing short-term
tests for detection of mutagenic action and thus poten tial carcinogenic
risk;
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_ --standardized methodology of objective evaluation oi: the risk level of the
development of malignancies; _
--effective forms of detection of malignancies in thF population groups
}~aving a definite risk of development of malignant tumors.
jdith regard to the develop ment of cancer, beside the genetic basis, negative
factors of the external environment and the way of life which also correspcnd
to the factors that influence the development of atherosclerosis, play their
role here. The trial prog rams of the fight against cardiovascular diseases
and cancer, and against so me other socially important diseases, have been
clinically conceived more or less separately and are linked together, beside ~
these external factors acting on the organism, mostly by corresponding
laboratory and clinical examinations needed for evaluation of the health of
the citizen or the seriousness of his illness. Moreover, it is not desirable
that a person be called by individual medical departments for uncoordinated,
frequent, preventive or o ther examinations which repeatedly interrupt
the work process.
_ For the Seventh Five-Year Plan therefore, we are considering integration
af preventive examinations and ~uch programs into a single program of the
fight against socially important diseases, setting up a model of a single
preventive examination with subsequent outpatient followups of selected
groups of people, especially workers, in the risk categories; detection wi11
be directed at selected, e conomically and medically mo,t serious diseases
and on those stages of such diseases which are controllable by the currently
available means of inedical science. We want to concentrate particularly
on identification and treatment of individuals with hypertension to prevent
heart attacks and apopletic strokes; on the screening of selected
localizations of cancers; and on detection of diabetes and selected diseases
of the respiratory, tr.otor and digestive tracts. At the same time we shall
place greater emphasis on coordination of the work of all components of
therapeutic preventive care with the work ~f the hygienic-epidemic service.
The success of such an eff ective work process has naturally an essential
- requirement: fully equipp ed and properly functioning local and industrial
p11D11C- health districts, common examination and treatment components,
specialized policlinical departments and secrions of the hygienic-epidemic
service, and an appropriat e system of inedical records and mutual exchange
of information among all p articipants.
The realization of this program, however, still requires elaboration of
a detailed implementation p roject dealing with the questions of management
and staffing at the indivi dual levels, questions of the supply of materials,
instruments, drugs and funds, and intensification of the postgraduate training
of the physicians (local, industrial and other specialists) who would be
responsible for this unified preventive program.
In accordance with the recommendation of the Public Health and Social
Committee of the Czech Nat ional Council we will have to insure that the
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individual components of this unified public health program have their -
- clinical and research centers which at the same time would serve as a base
for postgraduate and undergraduate training. These centers should also be
closely tied to international cooperation, especially with the USSR and the
socj.alist countries.
_ In the field of care for the aged and chronically ill in the Seventh Five-
Year Plan we shall:
--continue to increase the number of beds in the facilities for the
chronically ill as charged by the Czech National Council Resolution No 252/72,
particularly through a reorganization of the existing bed capacities in the
regions ;
--complete the staffing of local districts with visiting nurses for the aged
and chronically ill (geriatric service nurses);
- --increase the number of beds for recuperative treatment of patients in
hospitals of all types;
--utilize the possibilities of combining the resources of the public health
and social care services to build common facilities of a new type for the
aged and chronically ill;
--improve technically the management of the service for the aged and
chronically ill by separating it from the service for the Fighters against
Fascism; and, at the regional and district levels, one physician will be
assigned the responsibility for this project and at the same time for
coordination and control of the public health and sor_ial services provided
in the facilities of the public health administration and in the social
care facilities in the area under the jurisdiction of the pertinent national
committee;
--establish the specialty of geriatrics as a part of the policlinic structure
in the department of internal medicine for special consultations needed by
' district physicians, and perhaps also for other branches, and for outpatient
care of selected patients with a pathologic aging process.
Research in the field of geriatrics and gerontology should be aimed at:
--the study of the partial mechanisms of aging at the cellular and subcellular
levels (genetic code);
--pharmacologic possibilities of influencing the functional and structural
_ changes of collagen macromolecule (i.e., geriatrics proper);
--determination of the functional age, elaboration of principles and
procedures; _
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--preventive interventi.ons Eor peop]e of the retirement age who are in the
wurk force;
--methodology of objective testing of self-sufFiciency and social dependency
as a l~asis for planning, management and active identification of the needs
in public health social service;
--research and development of aids making the life of the aged and chronically
ill easier;
--determination oE therapeutic measures for the most f requent disorders of
the aged, including utilization of geriatric medicine.
These fot~r general public health programs will also be interrelated with
continuation of the projects of the virological program and the fight against
disabilities due to accidents. All activities will be carried out in the
f ramework of the existing regional system of our public health facilities,
based on the principles of differentiated care and with effective integration
of personnel and material resources, which are being provided for public
health service in a rising volume by our developed socialist society.
COPYRIGHT: AVICENUM, ZDRAVOTNICKE NAKLADATELSTVI, Prague 1980
9562
CSO: 2402
21~
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CZEC ~SLOVAKIA
VIROLOGICAL PROGRAM IN CSR FOR 1981-1985
Prague CASOPIS LEKARU CESKYCH in Czech Apr 80 No 4 pp 110-113
[Article by Dana Zuskova, M.D., Chief Public Health Officer of the CSR: `
"Virological Program of the Fight against Viral Diseases in CSR for 1981-
1985"J
[Text] The virological program was adopted and approved by the Collegium
_ of the Ministry of Health on 14 April 1977 as a series of preventive
measures for the gradual reduction of morbidity caused by viral diseases
of the upper respiratory tract, influenza in particular. It was formu-
lated in conformance with directions and goals of the main program to
realize the conclusions of the 15th Congress of the CPCZ in the health
field. In the period 1977-1980 it focused on viral respiratory diseases,
especially influenza, because this group of diseases is an unsolved,
serious worldwide problem and ranks among the most serious of all diseases, -
both from the ecanomic and the health aspects. Several concrete tasks
both in the field of hygienic service and therapeutic-preventive care, _
and medical research and production, were formulated within the framework
- of this program, and the chiefs of the public health departments of Re-
gional National Committees, the director of the Institute of Hygiene and
Epidemiology and the general director of the Institute of Serums and
Vaccines were charged with the further elaboration of these measures and
their realization. The defined tasks were fulfilled according to plan
and the various results created conditions for the further development
of this program in future years and a further reduction in the morbidity
caused by these infections.
The problems of viral respiratory diseases are not the only difficult
problems in the fight against contagious diseases. In past decades, fol-
lowing the incorporation of scientific achievements into medical practice,
the prevention and treatment of bacCerial infections reduced significantly
the morbidity and mortality due to these infections (diphtheria, whooping
cough, tuberculosis, tetanus, abdominal typhus and other typhoid fevers,
etc.}, but the fight against viral infections has not shown such marked
achievements. Throughout the world there is no specific drug to combat
such infections, which means that the fight against them is limited today
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to prevention ~?nd prophylaxis, either specific (where a vaccine is avail-
able) or nonspecific measures against epidemics.
~ Despite the problems cited, however, one must note that in the past years
virological research throughout the world has broadened the knowledge of
the origin, pathogenesis and epidemiology of a number of serious viral
diseases to such an extent that practical application of the findings is
now possible. Viruses causing hepatitis and methods to detect them were
discovered, and this opened the way for exact diagnosis, effective pro-
phylaxis and specific treatment of such diseases. New virological, immuno-
chemical and ottier procedures considerably enhanced the possibility of -
defining and utilizing micromethods and automation of such tests. Vaccines
for certain serious diseases (rubella, mumps) for which no specific pre-
vention has existed, can now be produced and intensive work continues on
_ develeping other vaccines (type B viral hepatitis).
In our country, as a result of the proper channeling of work in the field
of public health after 1948, and especially as a result of a proper selec-
tion of tasks in the sector of health care after the 14th and 15th CPCZ
Congresses, we were able to show concrete positive achievements; in par-
, ticular, morbidity of infectious infantile paralysis was reduced practically '
to zero, morbidity and mortality due to ;;carlet fever was significantly
~ reduced and finally, conditions were created for the gradual reduction of
, morbidity due to other viral diseases.
The tasks of the virological program for the period of the Seventh Five-
Year Plan, i.e., for the years 1981-1985, are based on the achievements
made so far and on the present needs of our society and crucial public
health priorities. Particularly in setting the directions of research,
the long-term program of virological research respects equally the current
and prospective cooperation and division of labor at the woric centers
wiChin the CSSR and CEMA countries for maximum effectiveness of research
and acceleration of the cycle of "research-production-application." The
solution of many problems is directly related to possibilities for importing
diagnostic aZd prophylactic preparations from abroad, which wi11 not be
possible unless the import ceilings are raised. It appears that higher `
ceilings will already be needed for the Seventh Five-Year Plan. To achieve
the tasks stated in the program we must also insure higher deliveries to
ttie public health facilities of technical sterilization equipment, injec- '
tion syringes and needles, and other materials produced by other sectors.
At present, problems of sickness due to viral diseases of the respiratory
tract remain from the point of view of health and economics in first place.
As far as this group is concerned, one of every four citi2ens still has
a respiratory infection on the average of three times a year, and pre-
school-age-children four to five times. Our health authorities report
an annual average of about 3 million cases of respiratory tract diseases.
It is evident from domestic and foreign data that respiratory infections
constitute one-half to two-thirds of all illnesses, and 80 to 85 percent
of them are of viral origin.
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Recurrent diseases of the respiratory tract have many sequels for the
child population. About four percent of all children so afflicted continue
to have recurrent and often serious chronic respi-ratory ailments throughout
their lives. Inf.luenza and certain other viral diseases of the respiratory
tract are one of the five main causes of death in our population. The
annual number of deaths from these infections in the CSSR is between
- 8,000 and 10,000. The age groups which are most affected are the oldest
(over 65) and children under one year of age. Viral infections of the
respiratory tract and especially influenza are also of fundamental economic
importance. They are the main cause of absenteeism at work and schools.
The individual with respiratory disease is unfit for work for an average
of 5 days; during influenza epidemics 7 to 10 days; and in case of complica- -
tions, for as long as 21 days. The rate of viral respiratory infections
_ in work incapacitations amounts to 25 percent on the average, but in times
of epidemics it rises to 75 percent and above.
Thanks to the fulfillment of the tasks of the virological program we have
succeeded in increasing the production and improving the quality of influ-
enza vaccine, and by introducing intranasal application of this vaccine
- we have succeeded in increasing almost three-fold the number of persons
vaccinated; through the activation and expanded activity of the district
and regional anti-influenza committees we were able to mitigate the course
of epidemics, and on an experimental basis we have succeeded in producing
sub-units of influenza vaccine intended for the vaccination of children;
and studies testing the effectiveness and possible use of other agents
against viral respiratory infections (Impulsin) have continued.
Intensified surveillance of the epidemiological program has confirmed the
health-related and economic seriousness of influenza. It was found, for
example, that the sum of economic losses in one region in the course of
one epidemic was more than Kcs 0.5 billion; at the same time it was estab-
lished that the lowering of morbidity by a single percent would bring about
in this region the reduction of economic losses by Kcs 5.2 million. -
Virological study ~f botn influenza viruses and other viruses causing
respiratory infections has been expanded. Current strains could thus be
incorporated in time into the influenza vaccine, which has insured a fully
effective vaccine in the given period. Thanks to the intensification
of immunological studies we were able to identify in the individual periods
the age groups most exposed to infections with various antigen variants
of the influenza types A and B and other respiratory viruses, and thus
perfect the system of predicting influenza epidemics in our population.
The health service was thus prepared with medicines, sufficient beds and
the organization to cope with a higher incidence of influenza cases with
bacterial complications. New laboratory techniques suitable for a quicker
and more exact laboratory diagnosis of infections caused by influenza and
other respiratory viruses were introduced within the public health service.
Standard laboratory procedures for diagnosing infections caused by influ-
enza viruses, para-influenza viruses and RS virus were elaborated and
issued, and the spectrum of viral diagnostic preparations was expanded in
accordance therewith. The Central Commission for Effective Pharmacotherapy
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r~n ~rr 1l.lAL U~L ULVLY
issued a basic .instruction on the prevention and treatment of acute respira-
tory infections of viral origin, including influenza; it also included
the protocol for. effective pharmacotherapy of these infections insofar
as the indicated use of antibiotics is concerned. -
Many important tasks nevertheless remain to be solved. We are faced with
limiting factors which influence the fight against these diseases, primarily
for the reason that beside the influenza viruses, more than 150 other
known agents and many others, still unidentified, cause the upper respira-
tory ailments. The artificially induced resistance is naturally also of
short duration and the influenza viruses periodically change their charac-
teristics. The difficult and expensive process required to produce vac-
cines and other known means of irnmuno- and chemoprophylaxis is a barrier
to their mass employment. Transmission of infection through the air
facilitates mass ~,preading and this cannot be controlled by the current
antiepidemic measures.
Even in the period 1981 to 1985 emphasis therefore will have to be placed
, on the development of preventive, therapeutic and organizational measures
to limit the incidence of these infections. Hence, prevention of their
occurrence and spread cannot be expected. Even with the optimum exploita-
tion of the present system of prophylaxis and treatment, mortality and
morbidity due to these infections can be reduced only gradually.
The iight against viral hepatitis is anothex� important and highly topical
problem. In the CSR, as elsewhere in the world, viral hepatitis repre-
sents a serious health and economic problem both on account of long hos-
pitalization during the acute phase of the disease (average 35 days) and
long convalescence, and on account of the incidence of frequent chronic
illness as a sequel to the acute phase (average loss of working capacity
of about 80 days; in 10 to 15 percent of patients the acute illness changes
to the chronic associated with incapacitation lasting ovQr one year and in
. some instances leads to permanent disability). The rising trend of parent-
eral procedures in the health facilities coupled with the current inade-
quate guarantees of proper sterilization and lack of single-use disposable
supplies, has increased particularly the risk of the dangerous type B
viral hepatitis.
Both types of viral hepatitis, type A(previously called infectious hepa-
titis) and type B(previously called serum hepatitis) occur in Czecho-
slovakia. Type A affects children predominantly, especially those of
school age, while type B is more common among adults and occurs especially
as a hospital infection of an occupational disease of health personnel.
- The annual incidence of viral hepatitis in the CSR ranged in recent years
around 10,000 cases, and type B hepatitis constituted almost one-half of
this number. In 1979 however, we witnessed how the morbidity of type A
hepatitis can increase during an epidemic and the consequences of such a
widespread epidemic in the further spreading of this infection by contact.
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Viral hepatitis, espe c ially type B, accounts for a significant number of
the occupational disea s?s in our country. Of 5,617 cases of occupational
diseases reported in t he CSSR in 1977, 716 cases, i.e. 12.7 percent, were
due to viral hepatitis. Health personne:L are affected with viral hepa-
titis three to four t imes as often as the general population of the same -
age.
~conomic losses due t o the incidence of viral hepatitis are considerable,
r.anging around Kcs 80,000 for each case. In recent years (with the excep-
tion of 1979 which was the year of the epidemic) the CSR suffered an annual
loss of about Kcs 800 million of national income directly related to the
incidence of viral hep atitis, Hence, if the effective steps which are
the final goal of the virological program should manage to reduce the
morbidity by a mere 10 percent, the economic saving would be considerable.
Epidemiological study of viral hepatitis and epidemiological practice have
- a long tradition in our country. In the areas of laboratory research and
laboratory diagnosis, however, work fe11 below the world level mostly
because of inadequate equipment stocks. QualitaLi.ve changes in laboratory
diagnosis of viral hep atitis have recently taken p:i~.ce worldwide. The
_ adoption of more sensi tive micromethods has insured a high detection rate
of various antigens of type B hepatit3s and the pertinent antibodies.
Using these methods we must accelerate the testing of blood donors (passive
reverse hemaglutination) and insure the quality control of manufactured
blood derivatives (mixed fraction I plasma with methods of radioimmunoassay -
and enzymeimmunoassay) . Employment of su~.h diagnostic means is of course _
directly related to in creased material demands.
Tt~e planned development of laboratory research and practice wi11 make
possible the improved diagnosis of viral hepatitis, a greater scope for
epidemiological studies and epidemiological practice, the evaluat3on of
passive and later also active immunization, the identification of carriers
among blood and plasma donors, as we11 as the control of blood derivatives
that are produced. Many important tasks have already been accomplished.
in this area. Methodo logical direcCives were issued, which have unified
and, according to the current state of scientific knowledge, have revital-
ized the fight against hepatttis. Steps were taken ro make it possible
in 1980 to start production of our hyperimmune globulin against type B
hepatitis; and preparat ion of a new, more sensitive agent for diagnosi:~g
type B hepatitis using the method of passive reverse hemaglutination was
scientifically researched. Another program was based on the suppositian
that the accelerated development of inedical practice and laboratory re-
search wi11 raise the level of the fight against hepatitides and thus
reduce their morbidity. It is in consonance w3.th the program adopted in -
this sector by CEMA.
The important problem of possible damage to development of the fetus, if
the mother contracts infections caused by rubella, herpes, megalocyte and
other viruses in the ~ourse of pregnancy, has been highlighted. In the
interest of protecting the health of the younger generation, we must pay
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attention to viral infections from this aspect as well. First of all,
we must utilize the effective specific prophylactic possibilities that
alreadq exist in the world, such as vaccination against rubella. At the
same time we must increase the quality and scope of laboratory tests
which make the clinical diagnosis more precise and facilitate the diag-
nosis of the disease. Because only vaccines imported from the rapitalistic
countries are now available against rubella (they are not produced in the
CEMA countries and their production is not included in the Seventh Five-
Year Plan), we are considering introducing this vaccination in our country
in the most economical way possible. This means that only those girls
who are not immune would be vaccinated. They constitute about 30 percent.
_ To reduce expenditures `or imported vaccines we must first provide the
laboratories of the hygienic stations with facilities so that, using quick
and accurate micromethods of automated processing, the girls of each
population year could be examined. When we consider that about 30 percent
of the women who are not immune and who come into contact with the rubella
virus in the first trimester of pxegnancy give birth to a child with a
_ congenital development defect, the health-related importance of such
vaccination is clear. Even the economic view speaks in favor of such
vaccination; for example, expenditures for the institutional care of one
person with a congenital development defect to the age of 40 amounts to
roughly Kcs 1.2 million. If ten similar cases were prevented annually
as a result of vaccination (and this is the minimum estimate of the actual
effer_t of the rubella virus in our country), this would mean a saving of
Kcs 12 million. ~
Another unresolved problem is that of mumps which because of its frequency
(about 60,000 cases annually on the territory of the CSR) and the fre-
quency of complications affecting the central. nervous system and pancreas
(about 5 t~o 10 percent of all cases), ranks as a serious problem. Here
again we will have to intensify work concerning the preparation and testing
of our vaccine which has been produced in a few experimental batches, but
is not yet effective enough and is thus not suitable for wide use. At
the same time we must create conditions for controls, from the laboratory
side, of such vaccination in the field. This means introducing into
practice sensitive methods for diagnosing the infection and the disease.
Introducing such a vaccination would likewise represent a benefit both from
the health and the economic standpoints. According to calculations, at
thepresent time the annual incidence of mumps in the CSR represents a loss
of national income of about Kcs 85 million (including losses due to the
absence of mothers caring for the child). This means that expenditures
for the introduction of a vaccination program, compared to the losses
mentioned, clearly speak in favor of the measure.
In addition to the infections for which we are considering vaccinations,
we must continue to devote great attention to the study of the incidence .
and resistance to infections against which we have been vaccinating for ~
years, to maintain the attained level of resistance o~f the population to
these infections also in the future. This applies specifically to scarlet
fever and poliomyelitis where, ar_cording to the findings of the epidemio-
logical surveys and further studies, vaccination wi11 have to be comple-
mented and ad~usted as needed. 30
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~ All this is possible only when the effectiveness of laboratory virological
_ diagnostics and the centralization of certain examination s, especially
immunological screenings are simultaneously intensified. This can be
done, however, only by better outfitting these work centers with the needed
instruments and diagnostic preparations, particularly in the Inatitute of
Hygiene and Epidemiology. We will also have to continue to supplement the
standard equipment of laboratories with modern instruments, by utilizing
micromethods, dose dispensers, etc. To meet the tasks in the aector of
immunological production, we will also have to supply gradually the facili-
ties of economic production units of the Institute of Sera and Vaccines
with the needed equipment so that such production wi11 be modern, efficient
and at the same time meet the required quality standards of Che products.
COPYRIGEIZ': AVICENUM, ?.dravotnicke nakladatelstvi, Prague, 1980
9562
CSO: 2402
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CZECHOSLOVAKIA
BRIEFS
DESULFURATION PROJECT--Czechoslovakia has considered two methods of removal
of sulphur dioxide from flue gas at coal-fired power plants; the Soviet
NIIOGAS magnesite method and the West German Bergbau-Forschung method. It
has selected the Soviet method which is expected to be implemented on an
experimenta~, basis at one of the 200 megawatt blocks of the Tusimice II
power plant by 1986. This experiment will be necessary prior to installa-
tion of desulfuration equipment at two coal-fired power stations in North
Bohemia Kra~ by 1990. [Prague CHEMICKE LISTY in Czech Apr 80 No 4 p 359]
CSO: 2402
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GERMAN DEMOCRATIC REPUBLIC
MORAL, ETHICAL ASPECTS OF GENETIC ENGINEERING EVALUATED
East Berlin WISSENSCHAET UND FORTSCHRITT in Gernr.an Vol 30 No 5, May 80,
pp 18 8-191
[Article by Prof Dr Erhard Ge~SSler, Central Institute for Molecular
Bialogy, GDR Academy of Sciences, Berlin-Buch; Prof Dr Helga E Hoerz,
Section for Marxist-Leninist Philosophy, Humboldt University, Berlin,
and Prof Dr Herbert Hoerz, Central Institute for Philosophy, GDR Academy
of Sciences, Berlin: "Interference with Man's Heredity?"]
[Text] The very rapid development of molecular and
cell genetics, and in particular the methc~ds used by
genetic engineers, have marked the start of a new qua-
litative stage in th~ discussions concerning possible
interference with man~s heredity. While these questions--
raised primarily by the notoriously famous 1962 Ciba
symposium, "Man and His Future," where (following the
rules of conferences dealing with ccncepts) no subject
was taboo, although ~any were labeled as not serious
in the western przss-~have been discussed around con-
ference tables for almost two decades, experts have
determined, among others at the Seventh Kuehlungsborn
Colloquium on philosophical and ethical proble~r~s in ~
modern biosci~nces,l which took place in 1979, that
systematic experiments aimed at interfering with man's
heredity are now possible.
The moral and ethical evaluation of this type of research
has given rise to many discussions--among others at the
Fifth Congress on Philosophy of the GDR, at the end of
last year. The following article presents our point of
view on these questio~s.* It is based on the principle
' * This article is based an a l~cture presented at the Co~i~erence on "Social
Effectiveness of Natural SciQnces, Mathematics and Techn~logical Sciences
. in the 19th and 20th Centuries" (Berlin, 23-25 January 1980), adapted for
publication in WISSENSCHp,FT ~ FORTSCHRITT.
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that we can comply with the requirements of humanity ~
without designing social norms so narrow that they would
hinder research beneficial to man.
With the discovery of important molecular structures and processes, biology
is increasingly becoming a fundament of biotechnologies. It also involves
potential dangers for man. In principle, we want to state the following:
1. In the /social/ [in italics] development of man, there are /more genetic
bi.ological possibilities/ [in italicsJ than have been realized until now
under concrete social conditions. Against the genetic improvement of man
as a social being, there is the often confirmed experience th.at a purpose-
ful change in /one/ [in italics) element of a system cannot materially -
change this system. The relation between the law of the system and the
behavior of its elements must be reckoned with, just as the existence of
objective accidents which prevent us from attaining all the possibl.e ends
we had contemplated.
- The social nature of man calls for social activities. These, howE�ver, also
include genetic bioloqical measures and all their consequences. Just as
we influence biologi.cal mechanisms with antibiotics, hormones, vaccines,
etc., just as contraception has an effect on population structure and demo-
graphy, genetic measures can lead to an improvement in man's way of life.
2. Man's freedom also includes the freedom to control his own behavior to
a large extent. A humane science will help man assimilate reality can-
sciously and actively and change it, it opens up possibilities to imprcve
man's conditions of existence. In a humane sense, however, conditions of
existence are better only when they increase the freedam of the individual.
3. From a philosophical and ethical point of view, expFriments involving
man require the proof that they are necessary to fulfil a humane task,
that the risk has been minimized, and that those involved car. decide freely
with full knowledge of the risk incurred. The responsibi.lity of the
scientist is to examine the possible consequences of his research, to pre-
vent consequences harmful to man, to promote those that are useful, to make
knowledgeable and humane decisions, and to evaluate and, if need be,
correct his actions.
It is on the basi.s of these considerations that we should examine the
possibility of interfering with man's genetic material.
Already a Possibility: Gene Therapy
Thanks to the very rapid development of gene technology and other molecular
and cytogenetic techniques,l it has now become possible, among others:
- to introduce genetic information not only into bacteria, but also into �
isolated animal cells, with isolated DNA;
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- to implant selected genes in mammal cells, u sing appropriate carriers,
for instance viruses or plasmids,2 and to demonstrate: the:ir biological
activity there;l
- to eliminate a potentially lethal genetic defect which, at least now,
~ cannot be removed in any other way,l by an artificial infection of human
cells (for the time being in cell cultures) with a given virus.
In theory, gene therapy for selected gene-linked diseases is possible in
principle. This is true above all of diseases which--like phenylketonuria3--
result from the simultaneous occurrence of two abnormal recessive alleles.
In these cases, it is enough to introduce /one/ [in italics] normal allele,
and to make sure that the information he carries is realized. We have
chosen here the example of phenylketonuria on purpose, although many will
argue that this disease is just one of the genetic defects which do not
need therapeutic treatment becau~e, in its case, early diagnosis and treat-
ment of the symptoms are possible. However, this treatment does not work
- in all cases, or not always to the extent desired;l in addition, it is
- expensive and very inconvenient.3
h'e are of course fully aware that numerous fundamental questions and pro-
cedural details will have to be clarified before genetic therapeutic me-
thods can be used in practice, and this is probably not for today or to-
morrow. Nevertheless, attemgts have already been made a few years ago
to cure argininemia in man (a condition resulting from an arginase defi-
ci.ency) through gene therapy. It was known that Shope's papilloma virus
will code a viral arginase which, for instance, is synthetized in the or- .
ganism of laboratory workers unknowingly infected by the virus, and also
in cultures of virus-infected human cells. Therefore, sick children were
given injections of Shope's papilloma virus--h~owever without any therapeutic
effect. Presumably, the virus preparation used contained inactive viruses.
_ These attempts were then interrupted because the parents of the children
~ involved objected.
Most scientists are of the opinion that such methods and, above all, the
preliminary experimental work involved,~ are not objectionable, either
from a bioscientific point of view, or for philosophical, or ethi.cal and
moral reasons--especially when what is at stake is gene therapy for dis-
eases which cannot be controlled in other ways.
Not Unconceivable: Eugenic Gene Therapy
The gene therapy discussed is a euphenic measure; i.e., the manifestation
of the symptoms is prevented, but the patient involved retai.ns his genetic
defect and transmits it to his offspring with his qerm cells. Of course,
the offspring will be clinically sick only if the patient's partner is a
carrier of the same defective reces~ive allele; nevertheless, we already
. know over 1,000 such recessive hereditary diseases.
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This is why an individual form of eugenic gene therapy--i.e. one in which
no demograph~c genetic effect is aimed at, bt:t which is only intended to
enable car.riers of harmful alleles to conceive healthy children--is indi-
cated only in rare exceptional cases, for instance when two phenylketonuria
patients wish to have a child of their own. Such a eugenic gene therapy, -
therefore, would answer not so much a social, than a rare individual need.
Considering the abundance of pressing bioscientific tasks, we do not think
that we would be justified, at present, in undertaking investigations which
would help so few people.
In our reflections, however, we are much less concerned w~ the feasibility
of certain given operations as with their evaluation--wi~ the question of
whether research aimed at modifying man's genetic material is humane and
therefore legitimate, or inhumane, and trerefore taboo.
In this connection, we would like to point out th~t similar experiments
are of great practical importance in livestock raisine and animal produc-
tion, and are being prepared today, if not already carried out here and
there. If it works for cattle or hogs, in principle it should also work
for man--at least as far as methods are concerned.
Al1 this, of course, presupposes extensive experin?enting on the subject.
Tn addition, not only will experiments on animals be necessary, but also
experiments with human germ cells--in the laboratory only, of course, and
without the intention of subsequently implantir.g these manipulated egg
cells, or their early division stages, in a female organism. In our opin-
ion--and the majority af our knowledgeable colleagues in the GDR probably
share that opinion--it should be permitted in principle, at least in the
laboratory, to experiment also with human germ cel.ls once scientific and.
social objectives are sufficiently documented. Eugenic therapy focussing
on the individual and his offspring would be impossible from the start
without s.uch experiments.
If we can genetically reprogram human body cells (at least for medical
reasons), why should we not also attempt to carry out similar laboratory
- experiments on human germ cells--if only to find out if genetic inter-
ventions have any chance of success? ,
Besides, exgeriments on human germ cells have been carried out in practice
for years--also in our country. These are experiments, for instance, on
the separation of sperm into male and female sex determining cells, the
_ results of which are important for animal produr.tion but, in principle,
can also be used for man, and are easier to perform with human than with
animal sperm. To our knowledge, no ethical ob~ections against such ex-
periments have yet been raised.
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In addition, mutagenicity studies on human germ cells are already being
perfarmed in foreign occidental countries. In the end, this is also the
only way to make a realistic evaluation of the mutagenic effect of physi-
cal and chemical agents. Thus, a discussion among experts concerning the
detection of potential mutagens harmful to man (which took place last year
in Cold Spring Harbor) has shown that, among others, experiments are beir,g
made in which male germ cells are treated in vitro with a suspected muta-
gen.6 Also, sperm from a man who had inadvertently been exposed to high
mutagen doses has also been investigated. Such sperms are used to fertilize
hamster egg cells. Pronuclei are formed, and we are told tr.at the intEr-
specific hybrids obtained even survive one or two divicions, so that two-
celled and four-celled embryos are obtained. It is then possi.ble to ob- _
serve directly any existing damages to thE: human chromosomes.
Apart from the eugenic gene therapy discussed, there already exist to~ay
experiments which are socially quite necessary and morally and ethically
unquestionable, in which human germ cells are used as a biological object. -
For all that, there is nothing objectionable, in our opinion, in fertilizing
hamster eqg cells with human sperm, i.e. in producing interspecific hybrids.
The objective here is not to breed some sort of man-hamster hybrid (which,
anyhow, is probably impossible), but to test tr.e sensitivity of man's gene-
tic material to external factors by a cleverly chosen methoc?! In addition,
we have known for a long tivee that, in laboratories all o~rer the world,
human body cells have been fu sed with those of all possible sorts of
other orqanisms (including that of the mosquito),and the resulting hybrids
used to investigate problems of gFne localization, of cancer genesis, of
virus therapy, etc.
For all these reasons, we believe that laboratory experiments with such
biological. material, including human germ cells, can serve perfectly humane -
objectives and should not be made taboo!
Conceivable, But Not Yet Possible: Controlled Biological Evolution of Man
If it is conceivable that, one day, man will interfere with his heredity
to repair important defects, then, in this connection, we must also con- _
sider whether man could not one day use these methods to lead his own
biological evolution in a given direction.
When, occasionally, people demand that we do not use human germ cel.ls for
genetic experiments because, in principle, man cannot be improved biologi-
ca11y or genetically,4 what is meant by that should be stated more clearly.
But we would like to make clear from tY;e start, first, that the probl.ems
involved here cannot find a practical solution today or tomorrow, in spite
of the very rapid development of gene engineering, and that. we do not have
to start arguing now about whether they are morally justifiable or warrant-
able; because, if such experiments can actually be carried out, both humane
requirements and moral standards will have to be defined more precisely. But
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already toda}�--and unfortunately sometimes openly--specters ar~d distorted
' representations are depicted to arouse the fear of a misuse of genetics,
which then are sometimes excessivel.y publicized by journalists and writers
who are technically poorly informed but can express themselves with power.
Second, the quPStion is not to interfere with mari's heredity to overcome -
problems which can and nust be solved socially. And, third, we he:rdly need
to mention, in this connection, that all inhumane and improper interferencE
with man's heredity must be condemned just as strongly as al.l oi:her crimes
aga.inst man.
HoweveY, we believe that genetic engineering methods can solve any problem~
which cannot be solved socially. For instance, it ls concei.vable that we
- will attempt to reduce the rate of spontaneous mutations, or the rate of
spontaneous cancer occurrence by interfering with human heredity. These
- though~s were alrea.dy expressed in 1972.5 That at least one of these pro-
posals is not fully unrealistic became apparent in 1979 when H. L. Robinson,
at the Cold Spring Harbor Symposium, under stormy applause from the audience,
presented a white Leghorn hen which had beer: freed from all ten known en- `
- dogenous (tumor) viruses thr~ugh a lengthy genetic cross-breeding program.
This result shows that at least one hen can live ar:d be raised without ;
_ any cancer gene. Whether it w.ill remain cancer-free all its life remains
to be seen. And, naturally, it is still a very ].or.g way before similar
experiments are made on human cell cultures, or even only on animal models
_ somewhat more similar to man than a hen--although this is already feasible,
in principle, with the methods of genetic engine.ering.
_ It shoiild be clear, therefore, that experi.ments are guite conceivable, in
wtiich we would examine whether one day it might be possible to improve
man's typical individuaiity entirely, even genetically and biologically--
- primarily by removing the internal causes and the conditions conducive to
disease. We would like to point out here, right from the start, that etY:.ic-
_ al and moral cox~siderations prompt us to accept as improvements only those
genetic and biological modificaticns which increase the potential of the
individual, and therefore his freedom. These could be measures which im- .
prove his resistance to diseases or his ad~.ptability to unfavorable en-
virorunental conditions, but in no case those which would amount to breeding
specialists (for instance, mathematicians, musicians, astronauts, divers,
high-performance athletes) or the like--quite apart from the fact that we
do not tiave the slightest experimental starting point for that. That means,
of course, that overall social conditions all over the wor.ld will have been
shaped so as to enable a full development of man's positive genetic traits. -
But why should we not start experimental investige,tions already now, for
instance in a laboratory, to determine whether the sensitivity of human
cells to cancer-causing chemical or physical irritants, or to tumor viruses .
can be altered, whether such modifications are geneticaLly permanent, and
whether this can i~e reproduced on other human cells using methods of genetic
engineering? For instance, it is actu.ally possible to isolate variants of
th.e human Hela cell line whi.ch show increased re~istance.
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:4e do not believe that the interventions in man's heredity which we have
just mentioned will reduce the multiplicity of human traits whi.ch are
always further enhanced by social development. On the contrary: we should
not retain any harmful allele in the human genetic pool if realistic alter-
natives are available.
Humanity and dialectic requir.~e that we examine all possibilities which
could lead to an improvement in man's assimilation of reality through gene-
tic and biological modifications. Here too, improving our control over _
chance by knowing the laws is the fot;ndation for an increased freedom. All
measures which violate the integrity of the person--i.e. its potential for
making free and responsible decisions (including those concerning itw own
body)--are morally condemnable.
BIBLIOGRAPHY
1. Geissler, E.; and Scheler, W. (editors), "Genetic Engineering and Man,"
Seventh Kuehlungsborn Colloquium, 1979; Berlin, 1981 (in the press).
2. See: Goldfarb, D.M., "Bacterial Plasmids," WISSENSCHAFT UND FORTSCHRITT,
Vol 27, No 1, 1977, p 9; and ICrueger, D.H., "DNA Restriction and
Modification," WISSENSCHAFT UND FORTSCHRITT, Vol 29, No 1, 1979, p 24,
4th US
3. See Knapp, A., "Phenylketonuria Female Patients, Too, Can Give Birth
to Healthy Children," WISSENSCHAFT UND FORTSCHRITT, Vol 29, No 5, 1979,
p 187.
4. Rosenthal, S.; Rosenthal, H.A.; Fuchs-Kottowski, K., "Molecular Biology
and Society--Perspectives and Ethical Problems of New Genetic Techno-
' logies," ETNHEIT, Vol 34, No 7, 1979, p 722.
5. Geissler, E.; Kosing, A.; Ley, H.; Scheler, W. (editors), "Philosophical
and Ethical Problems of Molecular Biology," Third Kuehlungsborn
Colloquium, 1972; Berlin 1974. .
COPYRIGHT: 1980 by Akademie-Verlag Berlin '
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CSO: 2302 END -
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