General Eiffelland-Retalia has a large tradition in medical research and medical care. As a result, medical care is at a very high standard. Furthermore, a lot of pharmaceutical, biotechnological and medical devices producing companies are active in Eiffelland-Retalia, as well as companies supplying biological, biomedical and chemical laboratories. Eiffelloretalian hospitals are also internationally active. They offer medical treatments to foreigners who travel to Eiffelland-Retalia for medical care. When a patient has a disease or medical condition, which cannot be treated in his or her home country, Eiffelloretalian hospitals, will help. This accounts for both very rich and very poor patients. The quality of care is the same for all patients and always state-of-the-art, but there is a three-class system for the rooms where patients are lying (see next section). Curative medical care in Eiffelland-Retalia Every patient gets the same quality of medical care, which is the best care possible. Advanced treatments are available to everyone, thanks to an obligatory health care insurance for which insurance companies are not allowed to refuse people. Everybody pays the same base healthcare fee; the lower incomes are partly compensated for the fee. However, there is a class system in Eiffelloretalian health care, although this class system only differs in the kind of rooms people are placed in the case of an admission to a hospital. Third-class insurance (which you get for the base healthcare fee) gives the right to a placement in a more-person room (2 to 6 people); when your medical condition is very bad, however, you are placed in a one-person room. Second-class insurance gives the right to a placement in a one-person room by default; people pay the base healthcare fee plus an additional fee. First-class insurance gives the right to access to a very luxurious kind of hospital (often privately owned) or the very luxurious departments of university hospitals. In this class, all physicians are so-called Fachärzte (specialist-physicians). This is generally the place where wealthy Eiffelloretalians and wealthy patients from outside Eiffelland-Retalia are treated. A very high healthcare fee is needed for this class. Most important hospitals in Eiffelland-Retalia Eiffelland-Retalia has many universities, and many of them have medical faculties. It is policy in Eiffelland-Retalia to keep university education as constant as possible and as good as possible. As a result, there is not much difference in the quality of education, scientific research and patient care between the universities and the university hospitals. However, there are differences in size, and with that differences in prestige. The Pietas is the largest hospital in Eiffelland-Retalia. It is the university hospital of the Universität der Stadt Trier. Being the result of a merger of several university hospitals, it is spread over five locations: Trier-Mitte (the main one). Trier-Wedding (the building with the rooms for the first-class patients of the Pietas is located here, but also the department of infectiology). Trier-Steglitz. Trier-Buch (this is the biomedical laboratory, as well as a birthplace for biotechnological spin-off companies). Trier-Reinickendorf (the ''Karl-Ludwig Hoffmann Nervenklinik'', focused on neurological and psychiatric diseases). The Ospedale dell’ Università statale di Losena is the second-largest hospital in Eiffelland-Retalia. It is located in Losena, on the island Vallese. The Klinikum der Landesuniversität Altburg is the third-largest hospital in Eiffelland-Retalia. It is located in Altburg. The Klinikum der Robert Koch Universität Weissenfels is the fourth-largest hospital in Eiffelland-Retalia. These four hospitals are the most prestigious ones of Eiffelland-Retalia. They are constantly rivalling with each other to be the first with discovering something, but they are also sporting enough to congratulate the others with their achievements. Also worth to mention are the Klinikum der Staatsuniversität Bremen and the Ospedale dell’ Università Cattolica di Tibur for their departments of tropical diseases, the Klinikum der Landesuniversität Aachen and the Klinikum der Katholischen Universität Wettingen for their epidemiological institutes, the Klinikum der Katholischen Universität Köln for its research on asthmatic and allergic diseases, and the Ospedale dell’ Università Statale di Lugano for its research on gene-defect-induced metabolic diseases. Preventive medical care in Eiffelland-Retalia A large part of the medical care is focused on prevention. There is a general vaccination scheme for children against Diphtheria, Whooping Cough, Tetanus, Poliomyelitis, Measles, Mumps, Rubella, Meningococci and Human Papilloma Virus. Ten years after the last injections of the general vaccination scheme, people get a summon for the booster of the Tetanus vaccine. This vaccination scheme is not compulsory, but a lot of pressure is put on parents to let their children get their vaccinations. There are plans to make the vaccination scheme compulsory, with exceptions only for children who cannot undergo vaccination due to medical reasons. Vaccinations against Hepatitis A and B are offered to homosexuals, prostitutes, doctors, nurses and other people working as healthcare professionals for free. These vaccinations are also offered to other people, but not for free. Vaccinations against an enormous list of tropical diseases are offered as well, but not for free. Until far in the 1960s, Eiffelland and Retalia had government institutions specially for the fight against tuberculosis. This task was handed over to the municipal health care institutions when tuberculosis was banned from the countries and the new cases of tuberculosis were mainly patients who were infected abroad. The contraceptive pill is offered to girls and women for free. In addition, the morning after pill against pregnancies is offered for free. Another preventive measure is conducted against HIV. Schwarzenberg delivers the medication HPOST (a morning-after pill against HIV-infections) and HPREV (a maintenance therapy preventing HIV infections, made available to gay men, prostitutes and people working with HIV-positive people). These medications are part of the schemes HIVMDP (“HIV-Morgen-Danach-Pille”; HIV-Morning-After-Pill) and HIVPRÄV (“HIV-Prävention”; HIV-Prevention). Each Eiffelloretalian goes to the dentist every six months. As a result, Eiffelloretalians generally have very good teeth. There are very few people with dentures, mainly people above 80. Tooth coloured fillings are the standard, already since the 1980s. Crowns and bridges are relatively uncommon, but when they are needed, they are of perfect quality. History of medical care in Eiffelland and Retalia Eiffelland-Retalia has a large tradition in medical research and medical care. Historically, the Tiburan Catholic Church did a lot to take care of ill people. Furthermore, during the 16th, 17th and 18th century, the Kings, Grand-Dukes, Dukes and Counts ruling the lands that would form Eiffelland-Retalia later on stimulated scientific research to a large extent. As a result, many discoveries were done by Eiffellandian and Retalian people. Also many medical discoveries. The emphasis on scientific research has continued until present-day, fulminating in a.o. the development of molecular switches, molecular machines and even nanocars. Especially the molecular switches are important, because they can lead to medications being turned into the active form when they are at the location where they have to do their work, potentially reducing side effects of medications (which is important in oncology, where the medications generally have very severe and sometimes incapacitating side effects). In addition, the Tiburan Catholic Church played an important role in the development of medical care in Eiffelland and Retalia. During the 19th century, Eiffellandian and Retalian bishops on crucial positions pleaded for an intensification of medical care. The people in charge listened to that plea, extended the medical faculties of the universities and grounded hospitals, while the Church grounded hospitals as well. About 50% of the hospitals in present-day Eiffelland-Retalia were grounded in the 19th century, although of course most of them are not at their original locations any more. The final factor that stimulated the medical sector in Eiffelland and Retalia was the introduction of the general health care insurance in both countries in the 1880s, combined with free but compulsory primary and secondary education, as well as the introduction of stipendia to study at universities and other higher education institutions for intelligent children from poor families. History of medical research in Eiffelland and Retalia Ferdinand Sauerbruch discovered how thoracic surgery could be done in a safe way, and he also did a lot in the research for arm and leg prostheses. Robert Koch was important in the research of infectious diseases. Welchersohn and Krampf discovered the structure of DNA. Lukas Bergsteiger and Robert Gallian discovered HIV. Retalian physicians also did much of the fore work for transplantation medicine. Physicians from The Natal were the first ones to conduct a heart transplant, the first liver transplant and the first lung transplant were conducted in Westernesse, but the first kidney transplant was conducted in Retalia. And with that the first organ transplant ever. Retalia set the standard for post-transplant immune suppression. The first heart-lung-transplant was conducted in Eiffelland. Also many medications and biological treatments were developed for the first time in Eiffelland and Retalia. For instance, an Eiffellandian company (Boehrig Ingelheim) was the first to develop a short-acting bronchodilator (Salbutamol, trade name Ventalen), and later on the first one to develop a long-acting bronchodilator (Salmeterol, trade name Ventalong). On top of that came the inhaled corticosteroids to treat the chronic inflammation that is always part of asthma and chronic obstructive pulmonary disease (COPD; the end stage of many lug diseases). Eiffellandian pulmonologists and the Eiffellandian pharmaceutical industry defined the standard therapy for both allergic asthma and hyperreactive asthma (long-acting inhaled bronchodilators combined with inhaled corticosteroids), as well as for COPD. They also defined the standard the inhalation devices have to adhere to. The air disc is an Eiffellandian invention. Eiffellandian physicians and companies also set the standard for other allergic diseases, as well as autoimmune diseases (diseases where the immune system reacts against the own body). A wide range of inflammation inhibitors (a.o. corticosteroids, but also medications like aspirin and diclofenac) was developed in Eiffelland and Retalia. Retalian physicians set the standards in treating cardiovascular diseases. The most recent development there is the Renin inhibitor. The Renin-Angiotensin-Aldosterone-System (RAAS) is one of the systems that control the blood pressure. The more active this system is, the higher the blood pressure. Suppressing this system is a cornerstone in treating heart failure, as well as in controlling the blood pressure. The standard medications to inhibit RAAS are ACE-inhibitors, but they have some side effects, caused by the fact that they do not suppress RAAS at the top of the cascade, but in the middle. However, it took until the 2000s before the first good-working Renin inhibitor was approved for market release. This medication was developed by a Retalian company, which is already working on developing a new generation of Renin inhitibitors. But of course, the current field of medical research is in oncology. The classic chemotherapies are Eiffelloretalian, but an Eiffelloretalian company was also the first to develop a protein kinase inhibitor. Now the research focuses on therapeutic vaccines (triggering the immune system against the tumor cells) and monoclonal antibodies. A special type of monoclonal antibodies, the bispecific antibody, has a high potential in oncology. It has already proven its effectiveness in the treatment of Ebola. And of course, the treatment against infectious diseases is on the agenda again. With bacterial resistance to antibiotics becoming more and more problematic, not only new antibiotics but even a new class of medications is needed. Also here, new monoclonal antibodies and therapeutic vaccines are being researched. Also the Eiffelloretalian medical devices industry has done a lot. The pacemaker is an Eiffelloretalian invention, as well as the Iron Lung, the device that helped many polio patients through their disease during the 1930s, 1940s and 1950s. The X-rays are an Eiffelloretalian discovery; the X-ray photography was an Eiffelloretalian invention. Medictronics perfected MRI imaging and invented the PET scan. It was also Medictronics that developed the pacemaker leads that can be placed into the heart through the subclavian vein, so that patients needing a pacemaker do not need to undergo a sternotomy any more. The most recent Medictronics invention is the device facilitating the replacement of the aortic valve through the inguinal artery, making a heavy operation involving a sternotomy and cutting the heart open unnecessary. Thalidomide The most important black page in the history of Eiffelloretalian medical research has to be mentioned as well: Thalidomide, or Softenal. Developed by the Eiffelloretalian company Schwarzenberg, it was introduced as a sleeping medication that could be safely taken during pregnancy in 1957. The reason was that the laboratory animal investigations did not reveal any signs of damage to embryos and foetuses. Soon after Softenal was introduced, and pregnant women started to take it, the incidence of meromely (a disturbance in the growth of long arm and leg bones, so that hands and feet are more or less immediately attached to the torso) among newborn babies increased. It took several years to connect the increased incidence of meromely to softenal usage by pregnant women. Schwarzenberg took Softenal off the market in 1961. Of course the circumstances leading to this drama were investigated. In the 1950s, the standard way of investigating the effect of medications on unborn babies was looking at what happened in laboratory animals. In those days, people thought that such a laboratory animal experiment was a 1 to 1 comparison of what would happen in humans. That appeared not the case. Now the following question arose: Why did the ideal dose per kg body weight determined during the investigations did not lead to meromely in rats but did lead to meromely in humans? That question itself was not answered, but the scientists from Schwarzenberg decided to see what would happen if pregnant rats were injected with a higher dose of Thalidomide. That higher dose led to meromely among rats. Apparently, human embryos and foetuses are more sensitive to the negative effects of Thalidomide than the embryos and foetuses of rats. The next questions was: Could this effect of Thalidomide have been detected given the minimum legal requirements of the 1950s? The answer to that question was no. As a result, no criminal proceedings were started against the developers of Thalidomide. However, Schwarzenberg and the Eiffellandian government decided to pay the victims a compensation of 100,000 Eiffelland Mark each, which is roughly equal to 2 million Euromarks in 2019. Also the Eiffellandian government took measures. The legislation on clinical research and the legislation on the approval of new medications were tightened to a very large extent. This history is a compulsory part of the education in the first year of university and other higher education institutes in Eiffelland-Retalia, as an example of how things can go wrong in scientific research when you are not cautious enough.