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It is also unclear how, in the age of next-generation sequencing and the standardizing digitalization of medicine and society, it will be possible to counteract the cultural bias in favour of knowledge, even outside the law.This article is a revised version of our proposal for the establishment of the legal concept of risk-adjusted prevention in the German healthcare system to regulate access to risk-reduction measures for persons at high and moderate genetic cancer risk (Meier et al. Risikoadaptierte Prävention'. Governance Perspective für Leistungsansprüche bei genetischen (Brustkrebs-)Risiken, Springer, Wiesbaden, 2018). The German context specifics are summarized to enable the source text to be used for other country-specific healthcare systems. Establishing such a legal concept is relevant to all universal and free healthcare systems similar to Germany's. Disease risks can be determined with increasing precision using bioinformatics and biostatistical innovations ('big data'), due to the identification of pathogenic germ line mutations in cancer risk genes as well as non-genetic factors and their interactions. These new technologies open up opportunities to adapt therapeutic and preventive measures to the individual risk prdical needs of persons with genetic cancer risks and goes on to develop the healthy sick model which is able to integrate the problems of the different disciplines into one scheme and to establish criteria for the legal acknowledgement of persons at high and moderate (breast cancer) risks. In the German context, the social-legal categories of classical therapeutic medicine do not adequately represent preventive measures as a regular service within the healthcare system. We propose risk-adjusted prevention as a new legal concept based on the heuristic healthy sick model. This category can serve as a legal framework for social law regulation in the case of persons with genetic cancer risks. Risk-adjusted prevention can be established in principle in any healthcare system. Criteria are also developed in relation to risk collectives and allocation (Sects. 3, 4, 5).Human and animal cell cultures are indispensable model systems for the biomedical research and pharmaceutical industry and already represent one of the most important alternatives to animal experiments. The development of mammalian cell culture started in the first half of the last century when fundamental questions of genetics were unresolved and the pioneers of cell culture did not care about individual personality rights of donors of biomaterials. However, cultivation of primary and continuous cell cultures was and still is usually associated with the use of FBS, which-almost universally applicable-is questionable in terms of extraction and quality variations measurably affecting reproducibility of results. The history of the cell line HeLa is a prime example for the development of biomedical research with its great successes in the fight against cancer and development of Polio Virus vaccinia, but also for limitations in the public and scientific applications of cell lines in the age of digitization and bioinformatics. HeLa leads from the establishment of the first human continuous cell line to initial cancer research using tumor cells, from disastrous cross-contaminations by HeLa cell cultures to legal and ethical controversy by reading out the individual genome and the commercial use that continues to this day.Human papillomavirus (HPV) vaccination of young adolescent girls as a part of primary prevention of cervical cancer is now a routine practice in many countries. Bangladesh, a lower-middle income country, observed a successful HPV vaccination demonstration program recently. As much as the benefits of the vaccination programs are well-recorded, the ethics of administration of it is not focused highly; rather the focus tends to be on the most efficient method to get it done. In countries like Bangladesh, vaccination-related ethical issues are often overlooked. Thus, addition of HPV vaccination to the existing immunization programs calls for logical discussion and consideration to preserve the highest ethical standard in administering this vaccine to a sensitive age group of adolescence. This chapter summarizes some ethical concerns related to the HPV vaccination implementation in Bangladesh.Cancer is the second leading cause of death globally. Malignant tumours are responsible for about 9.6 million deaths in 2018 (Ritchie H (2019) How many people in the world die from cancer? https//ourworldindata.org/how-many-people-in-the-world-die-from-cancer ). Worldwide, about 1 in 6 deaths is due to cancer. BX471 This confronts researches with the question of their origin and doctors with treatment options. It is common sense that great efforts should be done in order to reduce the number of cancer-specific deaths. In recent years, in lots of countries a variety of cancer screening programs have been developed, investigated and improved. The basic idea of this approach seems to be quite simple Tumours will be detected at a very early stage when patients do not yet feel clinical symptoms. Thus, using an appropriate therapy, progression of the disease can be prevented and, concerning a whole population, disease-specific mortality should be reduced. Actually, after the introduction of screening programs, an increasing number of new cancer cases can be observed associated with an apparent reduction of the case fatality rate (i.e. the proportion of deaths due to cancer). Partly, the increasing number of cancers may be explained by the fact that people have a higher life expectancy. Under this aspect, the decreased case fatality rate could be considered as a success which may be attributed to screening efforts. However, there is still insufficient evidence affirming benefits of screening programs for crucial outcomes, i.e. all-cause mortality. In this narrative review, the phenomenon that probabilities and risks are rather often interpreted in an inadmissible way will be described. Furthermore, conceptual issues and inconsistencies between evidence and opinion about screening will be explored.

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