Felix Sommer

Between 1987 and 1995, the Kennedy Institute of Ethics held a number of training courses specifically addressing German physicians and scholars engaged in the establishment of medical ethics in West Germany. These courses were linked to the annual Intensive Bioethics Course the institute had been organizing since 1975. During the 1980s, the perspective of bioethical training began to shift toward an international audience. Through the fundraising skills and organizational efforts of Hans-Martin Sass, a German philosopher and senior research scholar at the institute, the focus eventually shifted toward the situation in Germany, where interest in bioethics was emerging but infrastructure and knowledge were lacking. Based on extensive archival research in the US and Germany, this paper retraces the history of German participation in the Kennedy Institute's bioethical training courses and analyzes the impact this experience had on the institute's outlook as well as on the development of German medical ethics.

Definition of the problem The article presents a historical analysis and interpretation of the construct “History, Theory and Ethics of Medicine” (abbreviated as GTE in German) in German medical education. This construct, which was included in the new licensing regulations for physicians in 2002 and which led to an almost comprehensive institutionalization of GTE at German medical schools, has now disappeared from the drafts of new licensing regulations. Arguments This development provokes the question whether the disappearance reflects a fundamental feature of GTE: The question if, notwithstanding the university chairs and textbooks that have been established since 2002 under the label of GTE, its components showed an insufficient, if not absence of integration, especially the components of medical history and medical ethics. The question about an institutionalization without integration is explored here by presenting the historical genesis, the interpretation and the elaboration of the construct, not least through the analysis of contemporary sources of two protagonists of this process, the professional association for medical history and the academy for ethics in medicine. Conclusion Hereby, it becomes clear that, despite significant personnel overlap and repeated efforts to foster collaboration between medical history and medical ethics, the distinct disciplinary autonomy of each field ultimately prevailed, shaping the process of institutionalization.

Interactions between the host and its associated microbiota differ spatially and the local cross talk determines organ function and physiology. Animals and their organs are not uniform but contain several functional and cellular compartments and gradients. In the intestinal tract, different parts of the gut carry out different functions, tissue structure varies accordingly, epithelial cells are differentially distributed and gradients exist for several physicochemical parameters such as nutrients, pH, or oxygen. Consequently, the microbiota composition also differs along the length of the gut, but also between lumen and mucosa of the same intestinal segment, and even along the crypt‐villus axis in the epithelium. Thus, host‐microbiota interactions are highly site‐specific and the local cross talk determines intestinal function and physiology. Here we review recent advances in our understanding of site‐specific host‐microbiota interactions and discuss their functional relevance for host physiology.