Turism medical

Medical Tourism

Or, for the politically correct…..

Cross Border Health Care

 

Definitions / Scope

  • Medical tourism – usual use
  • Travel to a foreign country (especially exotic locations) to obtain medical care
  • Medical tourism – less common uses
  • Physicians engaging in unapproved medical activities while travelling to remote locations for tourism (impromptu roadside clinics)
  • Medical students / physicians travelling for the purposes of elective experiences, volunteer medical work

 Terminology

Alternate terms

  • Health tourism
  • Medical journeys
  • Global healthcare / Cross border healthcare
  • Medical value travel

More specific terms

  • Surgical tourism
  • Transplant tourism
  • Reproductive tourism
  • Dental tourism
  • Suicide / Euthanasia tourism

 Medical Tourism: not a new phenomenon

Renowned centres / physicians have always attracted patients from afar

  • Healing shrines
  • Spas
  • Pilgrimages

Wealthy citizens of countries with limited health resources travelling to access care / expertise that cannot be obtained locally

Desperate patients with incurable conditions seeking miracle cures


So, what’s new?

Average citizens

Range of procedures available

Third world / emerging economies destinations

Development of an industry catering to medical tourists

  • Travel agencies and brokers
  • Journals
  • Conferences

Systematic government support of industry

Insurance company promotion of medical tourism


Regenerative Medicine

  • Process of creating living, functional tissues to repair or replace tissue or organ function lost due to age, disease, damage, or congenital defects
  • It helps to produce extended healthy longevity.

 Potential of Adult Stem Cells

potential_celule_stem


 Benefits of Adult Stem Cell Research

  • Easy to obtain
  • Potentially limitless in supply
  • Patients can use their own stem cells for treatment and therapy
  • Adult stem cells are politically neutral
  • Not offensive to any major interest group nor do they generate controversy.

Why do countries promote medical tourism?

Money!

  • Boost tourism revenues
  • Generate foreign exchange
  • Increase gross domestic product

Improve medical services

  • Upgrade services / resources available to citizens
  • Stem ‘brain drain’ to other countries

Why do patients want medical tourism?

  • Lower cost
  • Timely alleviation of pain and disability
  • Access to innovative procedures
  • Exotic locations and travel ‘mystique’
  • Privacy – particularly for some cosmetic procedures

 What makes a country attractive for medical tourism

  • Low cost consultancy & treatment
  • No waiting period for treatment
  • Availability of medical experts
  • Luxurious accommodation
  • State of the art medical equipment
  • Exotic scenary
  • Specialty treatment
  • Personalized treatment
  • Packages
  • Treatment cum leisure destinations

ISSUES FOR MEDICAL TOURISM

  • Strong government support & investment
  • Smooth cooperation between the various players of the industry (airlines, hotels, private clinics, medical & nursing personnel)
  • Proper accreditation & regulatory standards for private clinics
  • Uniform prizing policies between clinics
  • Competition from other countries (Malaysia, China, India)

 CONSIDERATIONS FOR MEDICAL TOURISM

  • Costs & implementations
  • Potential for no patient’s harm
  • Quality of services
  • Modern equipments & uses
  • Keen attentions in hygiene
  • Infrastructure development

Regenerative medicine & medical tourism

Part of a private clinic campus

Shop in shop

Stand alone clinic depending on amount of investment and in full collaboration with

  • Ministry of Health
  • Ministry of Culture and Tourism
  • Ministry of Economy
  • Ministry of Finance
  • Some initiatives such as Foreign Economic Relation Board (DEIK), Accredited Hospitals Association

 What is the role of a “travel clinic”?

Provide usual general pre-travel advice

  • Vaccinations
  • Malaria prophylaxis
  • Pre-travel counselling

Make traveller aware of key issues in medical tourism

  • Effects of commoditization of care on medical decision making

Consider potential risks specific to medical tourism


Buyer Beware

Joint Commission International accredits hospitals (US standards)

Trent International Accreditation Scheme

  • UK accreditation scheme
  • Beginning to accredit overseas institutions
  • Accreditation standards adjusted to reflect local standards and culture
  • Local staff conduct accreditations
  • No inspections

Healthcare Tourism International


 The Transplant Mappolitical_map

  • India, Pakistan
  • Turkey
  • Romania
  • Moldova
  • China
  • Philippines
  • Egypt

Philippines: only 10% of transplants are supposed to go to foreigners according to government regulations but new health policies would make organ sales open and legal.  One slum in Philippines is known as Kidneyville  – 3,000 living kidney donors.


Stem Cell Clinical Trials Map
Dr. Paul Knoepfler UC Davis School of Medicine (2013)

setm_cell_map

The total number of stem cell clinical trials registered in the database has risen in the last 10 months or so from 4,316 to 4,775, a 10.6% increase. The U.S. continues to dominate total stem cell clinical trial numbers (see map above). It is unclear whether some of this could be an inherent bias of the clinicaltrials.gov registry to be underutilized by non-American clinical trial coordinators. The European Union (EU) is a strong second followed by China, Canada, the Middle East region, and Australia.


Mesenchymal Stem Cell Clinical Trials Map
Dr. Paul Knoepfler UC Davis School of Medicine (2013)

mesenchymal_stem_cell_map

The number of mesenchymal stem cell (MSC) clinical trials rose from 281 to 354, a whopping 26% increase (see map immediately above). This suggests that the rate of growth of MSC trials is substantially faster than that of stem cells overall. Here the geographic trends are quite different with China leading the way, then the EU, and the U.S. in third followed by the Middle East region. Some of this difference in geography as compared to total stem cell clinical trial numbers could reflect variable regulatory approaches in countries and regions.  It may also reflect mis-definition of mesenchymal stem cell.


Statistics …

$60 billion / yr industry*

USA 2006: >½ million people travelled overseas for care

Thailand 2006: 36.4 million baht (USD: 1.15 million)

Israel 2006: $40 million, 15,000 health tourists

Singapore 2005: 374,000 health tourists

India: 2005: >150,000 medical tourists

Costa Rica 1993: (CMAJ)

  • 14% tourists came for medical reasons
  • 10% of hospital beds in 1 private hospital occupied by foreigners

*Crone, Academic Medicine, Vol 83, No 2, Feb 2008, 117-121


MEDICAL TOURISM FROM RUSSIA

medical_tourism_russia


MEDICAL TOURISM MARKET IN RUSSIA (140.000.000 citizens) FOR

  • The rapidly emerging middle class
  • The funky young professionals
  • The upper income class
  • The golden youth
  • Russian’s filthy rich

 LIST OF MOST POPULAR COUNTRIES FOR M.T FOR THE RUSSIANS

  • Germany (32%)
  • Israel (22%)
  • Hungary (6%)
  • Spain (5%)
  • Switzerland (5%)
  • Czech Republic (4%)
  • Bulgaria,Austria,Turkey (3% each one)
  • S.Korea,Singapore (2%, each one)

WHAT AMOUNT OF MONEY WOULD A RUSSIAN PATIENT PAY FOR MEDICAL TOURISM

  • 11% declared more than 25.000 euros
  • 36% between 10-25.000 euros
  • 53% up to 10.000 euros

TOTAL AMOUNT FOR MEDICAL TOURISM  IS MORE THAN 1 BILLION EUROS !!!!


Stem cell transplants – China

Tiantan Puhua Stem Cell Centre

  • Applies stem cell treatments to a wide range of neurologic disorders
  • Stroke, Parkinson’s, cerebral palsy, hereditary degenerative conditions

Unique stem cell treatments

  • Self stem cell activation and proliferation program
  • Stem cell delivery by lumbar puncture or stereotactically
  • Use of autologous bone marrow stem cells (to boost the immune system) and fetal stem cells in combination

Claim a “high level of recovery”

Parkinsons:

  • Human retinal epithelial cells from adults
  • No immunosuppression required
  • Cells injected stereotactically into putamen
  • Daily cocktail of drugs to ‘fertilize the area’
  • Stem cell activation and proliferation treatment (to enhance the body’s own neural stem cells)
  • ~20 patients treated
  • No published RCTs

Stroke

  • ‘self stem cell activation and proliferation’
  • 50 patients treated
  • Minor to significant improvements

Cerebral plasy, Degenerative neurologic disorders, Epilepsy, Brain infections

  • Neural (fetal) stem cells
  • Bone marrow stem cells (autologous)
  • Recommended because the immune system is ‘weak’
  • Both types of cells delivered by lumbar puncture – cells are said to flow through the CSF into the brain

 WHAT ARE THE MAIN AREAS REGENERATIVE MEDICINE CAN BE APPLIED

  • NEUROLOGICAL DISEASES
  • CARDIOVASCULAR DISEASES
  • OPTHALMOLOGICAL DISEASES
  • ORTHOPAEDICS
  • SPORTS MEDICINE
  • PLASTIC SURGERY & REJUVENATION
  • ANTI-AGING
  • DIABETES MELLITUS
  • INFERTILITY RELATED DISEASES
  • LUNG DISEASES

 Neurological diseases

neurogical_diseases

Amyotropic Lateral Sclerosis (ALS)

Symptoms: Aim of the treatment: Results:
– Rapid Progressive Weakness
– Fasciculations
– Muscular Atrophy
– Muscle Spasticity
– Difficulty Speaking
– Difficulty Swallowing
– Difficulty Breathing
Reducing and slowing down the disastrous affects of ALS. Out of the 32 patients who took the treatment, 50% patients reported to have improved in terms of muscular strength, sensory function and motor function.

Autism

Symptoms: Aim of the treatment: Results:
Autism may occur in any part of the brain. Children with autism generally have problems in three crucial areas of development- Social interaction
– Language
– Behavior
Aims in regenerating the affected brain cells. Over 70% of the total autism patients who took stem cell treatment reported positive signs of improvement in cognition, social contact, language, eye contact and coordination, motor skills and consciousness.

Alzheimer’s Disease (AD)

Symptoms: Aim of the treatment: Results:
A very serious form of dementia associated with- Senility
– Gradual progression of Neuron loss
– Degradation of nerve contacts
During the final stage of AD, the person is completely dependent upon caregivers.
A regenerative and drug-free alternative to conventional treatments. It involves administration of stem cells into the CNS to bring about regeneration. Approximately 50% patients responded to the treatment with improvements in motor functions, communications and general awareness.

Cerebral Palsy

Symptoms: Aim of the treatment: Results:
Non-progressive and non-contagious motor conditions that cause:- Physical disability
– Orthopedic problems
– Arthritis
– Osteoporosis
– Disordered motor functions.
A regenerative and drug-free alternative to conventional treatments. It focuses on the restoration of the mental faculty of the patient. Out of the 116 patients who took the treatment, 66.4% showed improved motor functions, decreased spasm problems, better communication and improvement in the ability to sit and stand.

Parkinson’s Disease

Symptoms: Aim of the treatment: Results:
Caused due to degeneration of the neurons. Critical movement disorder resulting in:- Tremors of the body
– Rigidity
– Gradually slowing down the body movements
– Disordered speech and motor functions of the body.
A regenerative and drug-free alternative to conventional treatments. It focuses on the regeneration of the degenerated cells. Out of the 75 patients who took the treatment, 36 confirmed no progression of the disease and reported improved stability, motor functions, speech, swallowing.

Multiple Sclerosis

Symptoms: Aim of the treatment: Results:
Acute neurological disorder affecting the CNS:- Weakened movement
– Thinking
– Other nervous system related processes.
A regenerative and drug-free alternative to conventional treatments. Out of the 50 patients who took the treatment, 25 showed improvement, 18 showed no improvement and remaining showed natural disease progression. Improvements were reported in muscle strength, spasticity of limbs, better co-ordination of the limbs.

Spinal Cord Injury (SCI)

Symptoms: Aim of the treatment: Results:
Caused due to a sudden blow of trauma resulting in fracture or dislocation of the vertebra.Blockage for the nerve parts in relaying the messages between the brain and other parts of the body. It aims at improving the patients life by repairing the damaged tissue and restoring the function of the spinal cord. Out of the 184 patients who took the treatment, 162 showed improved clinical functions, improved bowel and bladder function, less muscular spasm.

Stroke

Symptoms: Aim of the treatment: Results:
– Caused due to insufficient Oxygen supply to the brain.
– Causes bleeding in and around the brain
– Loss of consciousness
– Headache
– Vomiting
Focused on humoral and corporal changes occurring in the brain. It is a drug free option. 55% patients reported of having positive improvements.

 Cardio-vascular Diseases

 cardio-vascular_diseases

Coronary Heart Disease (CHD)

Symptoms: Aim of the treatment: Results:
– Constriction of blood vessels
– Chest pain
– General fatigue
– Breath shortening
– Heart failure due to weak cardiac muscles.
Improving the oxygenated blood supply to the heart by repairing the cardiac muscles. A whooping 88% of the 21 patients who took stem cell treatment showed clinical improvements reporting less weakness, less tiredness, less shortness of breath and decreased medication.

Critical Limb Ischemia

Symptoms: Aim of the treatment: Results:
– Arthrosclerosis causes severe blockage of arteries of leg
– Reduced blood flow
– Acute pain in the feet
– Sores and wounds in legs or feet
– Can lead to amputation of the leg if untreated
Focuses on restoration of adequate blood flow in and around the affected limb. 4 out of 6 patients, who were advised for amputation of the affected leg, did not require amputation after the stem cell treatment.

 

Ophthalmological Diseases

ophthalmological_diseases

Macular Degeneration

Symptoms: Aim of the treatment: Results:
Chronic degenerative disease of the retina which may lead to blindness. The retrobulbar injection of the autologous stem cells can prevent wet and dry macular degeneration. It reduces the drusen deposits in the retinal pigment epithelium which is beneath the macula. It may also prevent the photoreceptors from getting destroyed in the dry as well wet macular. It is expected that the vision improves by 30-50%.

 

Orthopedic Diseases

orthopedic_diseases

Osteoarthritis

Symptoms: Aim of the treatment: Results:
Degenerative joint disease affecting the cartilage causing breakdown and an eventual loss of cartilage in the joints.
– Aching and soreness of joints.
– Feeling of pain.
– Stiffness after prolonged movement of joints.
– Enlargements of bones  around the middle or the end joints of the fingers.
The stem cell treatment induces profound healing affect in the joints as the cartilage formation is induced. Instant pain relief is expected in almost all the patients. The therapy can also be expected to stability the disease and not let it progress further.

 

Sports Medicine

sports_medicinea

  • Optimal Sports Health & Performance
  • Cartilage repair
  • Faster tendon recovery (Cell Secretomics)
  • Optimal Cell Biochemistry
  • Muscle Strengthening

 

Life style Diseases

life_style_diseases

Liver Cirrhosis

Symptoms: Aim of the treatment:
Serious ailment characterized by the degeneration of three effectual liver tissue causing scars
– Eliminating the functions of the liver
– Weakness
– Loss of appetite
– Yellowing of skin.
It’s a drug free treatment aiming to recover the lost functionality of the liver.

Diabetes

Symptoms: Aim of the treatment: Results:
– Hyperglycemia and hypoglycemia
– Serious degenerative effects
– Cardiovascular problems
– Kidney failure
– Eye problems
– Nerve damage
– Erectile dysfunction
A simple and drug free method to treat the root causes of diabetes and also treat the Hyperglycemia as well as Hypoglycemia and their associated outcomes. Almost 34% of type 1 patients and 67% of type 2 patients improved post-treatment. Improvements stated greater stability in level of blood glucose, lower level of blood glucose after fasting, decrement in leg pain, lowered hypertension and complete elimination of episodes of hypoglycemia.

 

Infertility related Diseases

infertility_related_diseases

Symptoms: Aim of the treatment:
Impotence is used to describe sexual problems of human being related to reproduction. The lack of sexual desire and problems related to orgasm or ejaculation is also considered under the term Impotence. It’s a drug free treatment aiming to recover its lost functionality.


Lung diseases

lung_diseases

Chronic Obstructive Pulmonary Disease (COPD)

Symptoms: Aim of the treatment:
– Emphysema
– Chronic bronchitis
– Shortness of breath
– Progressively gets worse over time.
Drug free treatment aiming to repair the lungs.

Anti Aging Treatments

Look Fit: Feel fit:
– Cells from the fat of the body are taken, processed and infused into the wrinkled parts of the face.
– Long lasting effect.
– No hard lines as seen in Botox treatment.
– Cells from the bone marrow are taken, processed and released into the patient’s blood stream.
– Rejuvenates the entire body.