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Karl Lauterbach – die „rollende Kanonenkugel“

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• Christian Teevs  

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Der Mann mit der Fliege ist ein Exot in der bundesdeutschen Politikerlandschaft. Seine politische Karriere nahm in den letzten Jahren eine erstaunliche Entwicklung. Vom Berater der rot-grünen Bundesregierung ist er seit seinem Einzug in den Bundestag 2005 zu einem der schärfsten Kritiker der Großen Koalition geworden. Von den Medien seit jeher gerne befragt und zitiert, ist er für die Parteiführung der SPD zum Störenfried und Ärgernis geworden. Spätestens seit seiner scharfen Kritik an der Gesundheitsreform 2006 gehört Karl Lauterbach zu den unbeliebtesten Abgeordneten seiner Fraktion – aber auch zu den spannendsten.

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Teevs, C. (2009). Karl Lauterbach – die „rollende Kanonenkugel“. In: Lorenz, R., Micus, M. (eds) Seiteneinsteiger. VS Verlag für Sozialwissenschaften. https://doi.org/10.1007/978-3-531-91569-2_17

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From evidence to impact

Epidemiology—and turning research findings into policy—are both key to improving public health, says German health minister Karl Lauterbach at Cutter Lecture

December 15, 2022 – One day in the mid-1980s, when then-medical student Karl Lauterbach was learning the ropes in the operating room at the University of Texas–San Antonio, he came to the realization that for every ten patients, eight or nine of them had diseases or injuries that could have been prevented.

“That’s actually how I made up my mind to leave surgery and move forward into epidemiology,” Lauterbach told a packed audience in Harvard T.H. Chan School of Public Health’s Snyder Auditorium on December 9. “We know so much, but so little of it gets worked into practice.”

Lauterbach, an adjunct professor of health policy and management at Harvard Chan School who is currently serving as the federal health minister of Germany, was on hand to deliver the 174 th Cutter Lecture, the oldest lecture in epidemiology and prevention, established by the bequest of John Clarence Cutter in 1912. In his address, Lauterbach examined how to improve the implementation of epidemiological research so as to provide greater benefit to patients and the public.

“From the very beginning of my career, I have always felt the tension between the beauty of science and the necessity to bring science into practice,” said Lauterbach, who earned three degrees at Harvard Chan School in the 1990s before going on to advise politicians in Germany, eventually becoming a member of the German Bundestag himself.

As health minister, Lauterbach has been involved in multiple efforts to translate health research into policy, such as shortening hospital stays so they don’t last longer than what is medically necessary, and enacting minimum volume laws for surgeries, in keeping with research showing that death rates decline when surgeons have more familiarity with procedures. Germany has also enacted disease management programs based on the latest evidence about best practices, and has tied hospital reimbursements in part to how closely these practices are followed.

For his talk, Lauterbach focused on three areas— aging , climate change , and environmental health —that could see improved outcomes if evidence-based practices were more widely implemented. In both Europe and the U.S., he said, doctors and public health officials are dramatically underprepared for the health challenges that will emerge when boomers age out of the workforce and develop multiple chronic conditions . “[The boomers] will basically switch sides from currently being the most important providers of medical care to being the recipients of medical care,” Lauterbach said. As the population ages there will be increasing cases of cancer and dementia , he noted. One good option for cancer patients could be the creation of more specialized centers for treatment, as evidence has shown that such centers are associated with longer lifespans and better quality of life, he said.

Discussing climate change, Lauterbach noted that people don’t necessarily focus on its potential health impacts but there are plenty of them, including drought, hunger, storm damage, increased conflict, and more pandemics. By drawing attention to these effects, health advocates may be able to sway public officials to focus on concrete steps they can take to lower emissions, including policies supporting zero-emission buildings and sustainable agriculture practices.

Lauterbach also spoke about the importance of applying evidence to policies around other environmental health issues, such as air pollution , particularly in developing countries. As an example, he noted that one of the major drivers of fine particle–related cardiovascular diseases in Africa is cooking with wood. “If cooking was done with electrical sources, then many of those patients would simply never develop the disease,” he said. Often, he added, this kind of intervention don’t take huge amounts of cash to implement. “These are not expensive investments,” he said. “It is simply putting knowledge into practice.”

Bridging the gap between existing research and the policymakers who have the power to implement it could help save countless lives, according to Lauterbach. “I truly believe epidemiology is the key science for the problems we are facing,” he said. “Policy expertise and epidemiology are the twin sciences in order to make a better world.”

– Michael Blanding

Photo: Osa Igiede

Lauterbachs Doktorarbeit: Theoretische Ethik

Lauterbachs doktorarbeit : theoretische ethik.

Dissertationen von Politikerinnen und Politikern werden mittlerweile vorzugsweise gelesen, um Plagiate zu entdecken. Da ist es schon eine willkommene Abwechslung, wenn der Berliner „Tagesspiegel“ aus Anlass von Karl Lauterbachs wenig glücklicher Amtsführung fragt, wie der Bundesgesundheitsminister eigentlich zu seinem Professorentitel kam.

Seinem Lebenslauf zufolge ist Lauterbach seit 1998 Leiter des Instituts für Gesundheitsökonomie und Klinische Epidemiologie der Universität zu Köln. Rufe auf Lehrstühle in Greifswald und Tübingen lehnte er ab. Lauterbach, geboren 1963, erwarb den Grad des Doktors der Medizin 1990 am Institut für Nuklearmedizin der Kernforschungsanlage Jülich und reichte 1995 eine zweite Doktorarbeit an der Harvard School of Public Health ein, die ihn seit 2008 als „Adjunct Professor“ (Lehrbeauftragten ohne Vergütung) führt. Die eher schmale, einschließlich des Literaturverzeichnisses 118 Seiten umfassende Arbeit ist auf seiner Homepage veröffentlicht. Nicht ohne Stolz verweist der Autor darauf, dass die Arbeit, die das Teilhabekonzept des Wirtschafts-Nobelpreisträgers Amartya Sen auf eine gerechte Verteilung von Gesundheitsleistungen anwende, von Sen selbst mitbetreut worden sei.

Am Anfang der Arbeit steht, nachdem Lauterbach in wenigen Sätzen das Spannungsfeld von ökonomischen Zwängen, mo­ralischer Intuition und individueller Selbstbestimmung skizziert hat, die schwer zu beantwortende Frage, ob unsere Verpflichtung, Gesundheitsversorgung bereitzustellen, gegenüber anderen sozialen Verpflichtungen vor- oder nachrangig ist. Dass Lauterbach diese Frage am Ende seiner Ausführungen nicht beantwortet, erscheint eher angemessen bescheiden als irritierend.

Auseinandersetzung mit moralphilosophischer Theorie

Irritieren kann dagegen die inhaltliche Zielsetzung, die der heutige Minister als Promotionsstudierender auf Seite 11 seiner Dissertation formulierte: Eines der wichtigsten Ziele von Gesundheitspolitik solle es sein, die Zahl derer zu verringern, die vorzeitig versterben oder die frühzeitig im Leben behindert würden. Als schwere Behinderungen, die es zu vermeiden gelte, benennt Lauterbach Formen erheblicher Beeinträchtigung durch psychische oder physische Faktoren wie Psychosen, Blindheit, Querschnittlähmungen oder dauerhafte Schmerzen. Zwar erscheint es sehr gut nachvollziehbar, dass frühzeitiges Versterben, soweit prinzipiell möglich, durch eine gute Gesundheitsversorgung verhindert werden sollte. Die Zielsetzung, Behinderung zu vermeiden, ist dagegen problematisch, vor allem wenn nicht klar unterschieden wird zwischen einerseits Behinderungen, die durch Unfälle, Arbeitsbelastung, ärztliche Behandlungsfehler oder Gewalthandlungen im Verlauf des Lebens erworben werden, und andererseits solchen Behinderungen, die genetisch bedingt sind. Erst recht ist es fragwürdig, Behinderung konsequent und selbstverständlich mit „frühzeitigem Tod“ gleichzusetzen.

Lauterbach führt aus, dass vorzeitiger Tod und Behinderung üblicherweise als besonders tragisch wahrgenommen würden, weil sie laufende Projekte und bestehende Beziehungen beeinträchtigten. Daher verfolge jede moralphilosophische Theorie, die dem allgemeinen Wohlbefinden Bedeutung zumesse, den Zweck, die Belastungen, die aus vorzeitigem Tod und Behinderung erwüchsen, zu verringern. Dass sehr unterschiedliche Mittel zu diesem Zweck diskutiert werden, wusste Lauterbach. Er konnte auch wissen, dass die Gleichsetzung von Tod und Behinderung charakteristisch für ethische Konzepte ist, die Menschen mit Behinderungen aus der Gesellschaft ausgrenzen. In seinem Literaturverzeichnis finden sich zwei Titel des australischen Ethikers Peter Singer , neben einem Titel zu Hegel auch dessen 1979 erstveröffentlichte „Praktische Ethik“, die auch die Tötung von „missgebildeten Säuglingen“ und von Kindern, deren Leben nicht „lebenswert“ erscheint, rechtfertigt, weil Singer die Belastungen, die aus solcher Behinderung für die Eltern und die Gesellschaft insgesamt erwachsen, für zu groß hält.

Lauterbach führt Singers Werke, die er in sein Literaturverzeichnis aufgenommen hat, im Text an keiner Stelle an. Sie scheinen ihn dennoch beeinflusst zu haben – und er hielt es für unnötig, sich mit den extrem diskriminierenden Auswirkungen dieser auf eine Umsetzung in die Praxis zielenden Ethik auseinanderzusetzen, obwohl er gleichzeitig „Behinderung“ beziehungsweise deren Vermeidung zu einem zentralen Thema seiner Arbeit machte.

In der Triage-Debatte, die sich Karl Lauterbach im Unterschied zum Gegenstand der Doktorarbeit nicht ausgesucht hat, holt ihn das Thema Verteilungsgerechtigkeit und Behinderung jetzt wieder ein. Nun geht es nicht um die Vermeidung von Behinderung, sondern um die diskriminierungsfreie Zuteilung von Ressourcen. Als Regierungsmitglied könnte er jetzt das versuchen, was er als Wissenschaftler versäumt hat. Er könnte die Betroffenen einbeziehen, deren Erfahrungen und mögliche Schlussfolgerungen aus diesen Erfahrungen beachten. Vielleicht käme dabei sogar ein politisches Projekt heraus.

clock This article was published more than  2 years ago

Germany’s ‘Fauci,’ a Harvard-educated doctor, gets ready to tackle the pandemic

BERLIN — After the chancellor himself, one of the most scrutinized positions in Germany’s new government is the health minister, a doctor who is a household name and has received death threats for his stern advice on handling the coronavirus pandemic.

Karl Lauterbach, a 58-year-old with Harvard degrees in public health and epidemiology, became a kind of Anthony S. Fauci equivalent as the pandemic unfolded and he was constantly in the public eye on German TV and in social media. He became known for his strict prescriptions for how Germany could protect itself from the spread of the disease.

There was even a “wewantkarl” Twitter hashtag supporting his candidacy in the run-up to his appointment.

Germany tightens rules that target the unvaccinated and mulls vaccine mandate amid covid spike

Now he oversees the sprawling, $56 billion Health Ministry as the country faces another surge of coronavirus infections and hospitalizations, and the prospect of more omicron cases. On Friday, the parliament passed a vaccine mandate for all health-care workers starting March 15.

“Such a vaccine mandate is necessary because it is completely unacceptable that at the end of the second year of this pandemic, people who live in care homes die unnecessarily because workers there are unvaccinated,” he told the Bundestag.

Lauterbach’s immediate task is seeing to 30 million more vaccinations by year’s end — whether first, second or booster doses — a goal set under the previous government that he confirmed he will carry out.

The hoped-for result is a question of logistics — the ministry is responsible for getting supply to the states — and also willingness. With uptake flagging well below what many scientists say is needed to reach herd immunity, a vaccine mandate for the general public is still in the cards.

So far, 71 percent of Germans have received at least one dose of a vaccine, but there remains a vigorous anti-vaccine movement that stages regular protests. There are opinion polls, however, that show increasing support for mandatory vaccinations, including one suggesting that some 57 percent of the population is in favor.

Mandates are controversial in Germany, and Lauterbach’s critics say his pandemic predictions can be overblown — and they sometimes have been. He has had to walk back his opposition to sporting events, even without crowds, which was just one of the stringent measures he advocated for.

Despite Lauterbach’s expertise and prominence, it wasn’t originally clear he would even get the job, with the local media full of reports that party leaders feared that his uncompromising style meant he wouldn’t be a team player.

Yet Lauterbach showed his ability to toe the line in November when he supported a bill that did away with the existing legal basis for lockdowns and closures, replacing it with new vaccination and testing requirements for much of public life — in contradiction to his past stances.

“The law that ends the health emergency has many measures that will help states tackle the pandemic,” he said at the time on Markus Lanz’s political talk show.

The change led to some confusion and delays in rolling out new rules, leaving state leaders scrambling to find the legal authority to respond to a record-breaking fourth wave of infections that has seen tens of thousands of new daily cases. Many of those measures were restored with Friday’s legislation.

At a news conference after his swearing-in on Wednesday, Lauterbach promised that policy would be dictated by science. “Health policy, as I see it, can only be successful when it’s anchored in evidence-based medicine,” he said.

Jonas Schmidt-Chanasit, a virologist at the Bernhard Nocht Institute for Tropical Medicine, however, cautioned against stressing Lauterbach’s scientific background over his political present.

“It’s important to know that he’s a politician. He argues with political intentions,” Schmidt-Chanasit said. “The separation between science and politics is extremely important because there are, of course, conflicts of interest.”

Lauterbach may end up backing positions that his Social Democratic Party (SPD) supports even if they don’t square with his scientific background, Schmidt-Chanasit warned.

The pandemic is just one of the serious health challenges confronting Germany. It faces an aging population, a nursing shortage, financially burdened hospitals, a lack of resources for research and public health, and a need to digitize, not to mention issues of pay and working conditions in the health sector.

“When you’re [health] minister, everything gets unloaded on you. Other than the chancellor, it’s one of the most challenging jobs — and not only because of the pandemic,” said Ulla Schmidt, a retired SPD lawmaker and the party’s last health minister, serving from 2001 to 2009.

CDC moves Germany and Denmark to ‘do not travel’ list

Eastern Europe, facing coronavirus pandemic surge, also battles vaccine hesitancy

Germans have coined more than 1,200 words to talk about coronavirus

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