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Between the Bundestag and Biomedicine


Can one really clone a human embryo? If so, what arguments stand against it? Would those arguments necessarily forbid the use of cloning for therapeutic purposes as well? Even if therapeutic cloning saves a considerable amount of money for the health care system? And who should decide how the health care budget is spent? Which underlying principles could be used for such decisions? ? Wouldn't we like to have simple answers to these questions?

Unfortunately such answers are not easy to come by--not for the scientist, the doctor, or the ethicist. And these answers are not obvious for political decision makers either, whether administrative or legislative, national or international. That's what makes my current position--stuck firmly between these two worlds--so challenging. My training was in the first set of occupations, my clients belong to the second.

Typically, when asked about my occupation, I feel a need to justify my decision to move into the world of politics. The easiest way to do this is simply by explaining what it takes to fulfil the obligations that come with such a position. My job as a Referent (Senior Science Advisor) in the Ministry of Health and Social Security relies on the skills I have acquired in medical science, clinical medicine, and bioethics. In my division I am responsible for the so-called "sexy technologies" of biomedicine.

A rather complex science policy review process results in specific challenges for the trained scientist. First, research results must be understood in the context of the current political climate, and, second, issues must be presented to the respective decision maker in a straightforward and understandable format. The facts, options, and assumed consequences must be explicitly laid out so legislators can make informed decisions in the minimal amount of time typically available.

Intellectually, the greatest thrill comes from working in emerging scientific fields. The early debates about therapeutic cloning, the value of national regulations in the global information era, or how to define best practices in decision making regarding new and emerging health-related technologies are just a few examples.

Not every task is as controversial or comprehensive as interpreting the legislation on stem cell research. The less glamorous part of a ministry routine includes project budgeting under financial constraints, routine oversight of ongoing research or education programs, or de-escalating the effect of a misleading tabloid report on public opinion. Then there are the support functions for the legal departments of the ministry--explaining technical issues, providing definitions for law making purposes, etc. These tasks might not be the ones that truly tantalize the scientific mind, but they definitely widen one's perspectives about the functioning of government in general and the health care/science system in particular. Over time, I have developed a "tool kit" of skills--ranging from project design to budgeting, from communication in national and international arenas to team management--that have proven useful well beyond the government setting.

When I started my medical training at the University of Leipzig in 1987, I did not dream of a career in the political sector. On the contrary, my interest in combining environmental and epidemiological statistics in a scientific project attracted unwanted attention from the East German political authorities, and it was only after a long search for a courageous tutor that I finally arrived at the door of the research directorate at the Humboldt University in Berlin. My work at the Research Centre for Biotechnology in Berlin in 1989 had already initiated three long-lasting affairs--one with Berlin, one with biomedicine, and another with bioethics. So, following my heart, I transferred to Humboldt University in Berlin and started a research project on risk assessment in gene technology. During my term at the Charité I discovered that my scientific and medical training was sufficient to permit me to confront the technical questions of the benefits and risks associated with the emerging biomedical technologies, but that my humanistic education was lacking. So I took up philosophy alongside my medical studies to fill this gap.

A Fulbright scholarship allowed me to do a master's degree in bioethics at the Kennedy Institute of Ethics at Georgetown University in Washington, D.C., one of the two founding institutions in the field. The Kennedy Institute affiliation also gave me the opportunity to participate in the clinical training programs of Georgetown's Medical Center and in the University of New Mexico's highly ranked family practice program.

These experiences had several effects on my subsequent career. On the one hand I had expanded my knowledge in medicine, but at the same time I had acquired knowledge about efficient training programs for physicians and the need to incorporate bioethics into medical practice, science, and education. It became increasingly important to me to foster these ideas, so it was frustrating to learn that my dream of combining work in clinical medicine and bioethics was not supported by the German system of academic medicine--in contrast to the Anglo-American system and that in other advanced countries. So, after having achieved full approbation as a German practitioner, I decided to leave clinical medicine behind and to move onto an administrative path. I have stayed there ever since, seeking to interpret the experiences from the development of biomedical techniques and their political treatment for the German political arena.

With "Dolly" and "Baby Eve", but also as a result of German federal spending on prevention programs, the public and political interest in this field are growing--and with that the number of positions in the field as well. During the 14th legislative period of the German Bundestag, I successfully applied for a position as Staff Scientific Consultant in the office of the Study Commission "Law and Ethics in Modern Medicine". Here my responsibilities included drafting the report that became the basis of the German legislation on embryonic stem cell research. Furthermore, I co-ordinated the issues--cloning, gene therapy, organ transplantation--of the respective working group, consisting of Members of Parliament and selected experts.

This position had many benefits. It gave me an insider's view of the work of the German Bundestag, and it gave me a chance to be involved in shaping an entirely new field of biomedicine at a time when public interest in to the issue skyrocketed. Not only did I hone my presentation skills, but more importantly, it gave me the opportunity to work in the company of a crew of excellent young scientists. I learned that there is a great need for accurate and well-prepared scientific knowledge in the political arena. I also developed a few skills necessary for survival in administrative structures that have subsequently proven useful in the Ministry.

Here are the basic rules I would like to pass on to readers and people potentially interested in a similar career: To derive satisfaction from the work of scientific consulting in the political arena, one has to enjoy a continuous change of content. Topics change about as quickly as the interest of the public in them does, or as quickly as the political mindset shifts. At the same time stamina and perseverance are also necessary, and the memory of an elephant helps enormously with the long-term projects, which are the most difficult, but in the end also the most satisfying because they are the ones that can make a difference in the system. An open mind is also helpful. I personally have benefited a great deal from the fact that I have lived and worked in three different political, and hence three different health care, systems.

The rule of thumb is: Knowledge is an absolute necessity, but it is not everything. The ability to know how to find information in no time is just as valuable. For this, being able to establish and maintain connections to relevant organisations and individuals is crucial. And even when the facts are on your desk, they have to be customised and "politicised". Did you ever try to explain something as technical as the different ways to derive stem cells and as tricky as the ethical questions accompanying these to a laymen? Assume what it might take to do so, then factor in the need to account for differing political sensibilities, and you will have a good estimate of the effort it takes to prepare such an issue for political debate. This is not a career for an individual on an introspective voyage of philosophical discovery.

One truly enjoyable aspect of my work is the contact that a position like this offers beyond one's own field of expertise. Even a young specialist can have the opportunity to represent the Ministry in external expert bodies. In my case these comprise a diverse group, including on the international level the Organisation for Economic Co-operation and Development and the Council of Europe's Steering Committee on Bioethics, and on the national level the Robert-Koch-Institute and the Chamber of Surgeons. Add to this the direct co-operation with institutions such as the EU, UNESCO, WHO, or other ministries, and the job just described becomes a challenge worth taking on.

Still, I have to deal with an entirely different personal challenge: the ongoing loss of no longer dealing directly with patients. What makes that loss acceptable is the fact that, in a political position like mine, one still has the feeling of being able to make a difference in the long term.