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Growing medical tourism raises ethical issues
By the Medical Vacation in Costa Rica wire services
One of the fastest growing businesses around the world, particularly in Asia, is medical tourism.
How fast is medical tourism growing? David Vequist, a physician who heads the Center for Medical Tourism Research in San Antonio, Texas, says one medical research organization predicts explosive growth.
“According to Fox and Sullivan, by 2012, it’s expected to be worldwide about a $100-billion business, and it’s growing worldwide from 20 to 30 percent. There was a recent estimate that in Asia alone, it was growing as much as 17 percent," he said.
And Vequist says many of the medical facilities around the world are giving the best medical facilities in the United States a run for their money.
“The Johns Hopkins, the Mayo Clinic, the Texas Medical Center, MD Anderson, Cedar Sinai, these really great facilities in the United States that arguably are among the best in the world are receiving more and more competition from best in class facilities in places like Turkey at Parkway Hospital or Bumrungrad in Thailand or Severance in Korea. These locations around the world are getting very good," he said.
But then there is the down side. Glen Cohen, co-director of the Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics at the Harvard University Law School says there is evidence that profitable medical tourism is taking away medical services from the poor in some host countries.
“In India, for example, there have been a number of anecdotal claims that the existence of the medical tourism industry has siphoned doctors away from treating poor Indian patients and has basically resulted in a net loss for India’s poor. There are others who say no, it’s quite the opposite, that there is an infusion of technology, there is trickledown economics. Again, it’s a contested empirical claim. But beyond that, there is an ethical claim about whether you’ve done something wrong," he said.
Much of China’s medical tourism industry has focused on transplants, reportedly about 10,000 of them a year, mostly kidney and other organ transplants. The Chinese government has admitted that some of the organs for transplantation have come from executed prisoners.
Nancy Scheper-Hughes, a professor of medical anthropology at the University of California at Berkley and a co founder and director of the medical rights organization Organs Watch, says many of those have lead to very bad results.
“I am in touch with a number of families who have had disastrous transplants in China because it was so unregulated." A family from Israel went to China in 2009, and the father had a botched transplant with a 15-year-old village girl. He died and the young donor died, she said. "It was just a horror show," she said.
That has recently changed as China has enacted new regulations surrounding transplants. One proposed law would give the death penalty to anyone found guilty of illegal organ trafficking. However Ms. Scheper-Hughes says the entire process brings up troubling consequences.
“It does turn doctors and ministries of health into brokers because you still have to find people and it’s not going to be your children or my children. It’s going to be ethnic minorities, the poor, the desperate, the imprisoned people, the people who are looking for visas, the displaced populations of the world, the refugees," she said.
China is also moving forward on plans to set up and market treatment using stem cell therapy. It’s a therapy that, for the most part, is unavailable in the United States.
Cohen of Harvard said, “Many scientists think in the next 50 years or so, many of the breakthroughs in medicine may be related to stem cell therapies. So obviously this is promising and obviously with terminally ill patients who have exhausted all approved therapies or clinical therapies in the U.S., the calculus is quite different in terms of the safety and efficacy. But there are significant risks when you engage in any experimental therapy and stem cells are no different. And I’m not really aware of too many success stories in this regard.”
Cohen says in addition to ethical concerns, there are at least three concerns that must be addressed.
“One is the quality of service that’s being provided to you abroad. The second concern is that if something does go wrong, what is your ability to recover a medical malpractice by suing the doctors abroad, and the third maybe is the willingness to get a doctor in your home country to engage in follow up care, the availability of health records and what the quality of care will be back home," he said.
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