Medicine and Economy in an Ever-Changing World

15] with a far-reaching change in the physician-patient relation, rendering patients lump sum cases [16]. Even an increased patient mortality was found due to this development [17]. Additionally, a change in medical students’ behavior toward patients was noticed due to a shift toward market norms [18]. Moreover, a decline in US students’ empathy during medical school was found to be affected by resource allocation, emphasis on technology, and lack of positive social role models [19]. Only now, after about 20 years, medical associations proclaimed ‘medicine before economy’ as a codex for the physician-patient relationship [20, 21] and received support from the German Ethics Council [16]. Meanwhile, the number of hospitals having been privatized has doubled up to more than 30%. Ironically, some aspects of the dreaded cost explosion in healthcare, which had to serve as a justification for privatization, might turn out to be quite different than assumed [22, 23]. Of course, economic feasibility is crucial for good healthcare. But a mere profit-and-loss orientation is inappropriate to ensure a patientcentered medical treatment. The increased economic pressure on hospitals and doctors’ offices affects the number of personnel and the time available in diagnostic or therapeutic encounter. One could get a notion that meanwhile we tend to produce our future patients, as stress has been recognized to contribute to the development of chronic diseases. The circle seems to be closed [24, 25]. Recently, digitalization and digitality are about to change education at schools and universities (e.g., education 4.0 [26]) and patient-physician relationships in the medical field (e.g., big data analyzing) [27]). And again, we are calmed by the majority of politicians and health economists – and probably we calm ourselves that these changes would allow for an affordable health system or an ‘ever-flourishing health economy’ [28]. While the technical side of digitalization brings innovation for data storage or data transmission, the protagonists of a ‘New Digital World’ [29] foster ideas about digitality that have a far-reaching impact on social human life. The term ‘social media’ seems almost unrelated to historical developments, as if books, newspapers, telephones, or television With this editorial, we invite you to follow our considerations on values in medicine. When the rock band ‘U2’ released the Hollywood remix of their song ‘Desire’, the lyrics were about voodoo economics – referring to a kind of trance-like (mass) behavior based on group expectation to make money – and the beat expressed the aggressive and accelerating mode of it [1]. Well, this is the privilege of art: speaking about the dark side of human behavior while offering the pleasure of music. In contrast, the reflection of human behavior in science is usually more theoretical and might elicit intellectual pleasure. However, values are freely praised in songs, but does a value-free science exist [2, 3]? Values in medicine, as in any other discipline, are shaped by our actions. In former times, we were used to misuse in medicine being more predictable. Let us reflect some examples which attracted attention: scientists, generally known for advancing their discipline or patient care by new research methods, became noted for receiving money from an industry that in return demanded far too positive study outcomes (e.g., A.R. Feinstein and his alliance with the tobacco industry [4]). Or publishing houses, famous for issuing latest results to foster mankind, but one of them, for example, once got mixed up in arms trades with cluster bombs (e.g., Elsevier [5, 6]). How is it today? Misuse like this is not our main problem – even though all this can still happen despite efforts to prevent the worst by publishing disclosure statements [7, 8]. However, misuse of the above-mentioned kind might be seen as peanuts compared to what is going on today and might come tomorrow. Are we aware of the impact of new conflicting developments in medicine? After rapid developments in medicine in the last decades, we are confronted with complex changes at high speed. To give some examples, we see the change from social to neoliberal economy with privatization of clinics, implementation of diagnosis-related groups (DRGs) and promotion of digitalization/digitality [9–12]. All this obviously exceeds our imaginations of predictable ways of use and misuse. In some countries, Germany for instance, it took a long time until the negative effects of the privatization of clinics were realized [13], e.g.: the process of market making in medicine [14, Published online: August 17, 2018