M&A Group

Who goes abroad for fertility treatment and why?

manager — Mon, 03 May 2010 10:40:20 GMT

A substantial number of European patients travel to other countries for fertility treatment, both because they think that they will receive better quality care abroad and in order to undergo procedures that are banned in their home country says a study of the subject launched at the 25th annual conference of the European Society of Human Reproduction and Embryology today (Monday June 29). Study co-ordinator Dr. Françoise Shenfield, from University College Hospital, London, UK, said that this was the first hard evidence of considerable fertility patient migration within Europe. "Until now we have only had anecdotal evidence of this phenomenon", she said. "We think that our results will be of considerable value to patients, doctors, and policymakers." During a one-month period, the ESHRE Task Force analysed data from participating clinics in six European countries: Belgium, the Czech Republic, Denmark, Slovenia, Spain and Switzerland. Clinics were asked to provide questionnaires to patients coming from abroad for treatment. The questionnaires asked about their age, country of residence, reasons for travelling to another country for treatment, which treatment they had received, whether they had received information in their own language, how they had chosen the centre they were attending, and whether they had received reimbursement from their home country's health system.

Almost two-thirds of the patients surveyed came from four countries, with the largest number coming from Italy (31.8%), followed by Germany (14.4%), the Netherlands (12.1%) and France (8.7%). In total, people from 49 countries crossed borders for fertility treatment.

The main reason for going abroad for fertility was to avoid legal restrictions at home. 80.6% of the German patients surveyed have this as their primary reason, 71.6% of Norwegians, 70.6% of Italians, and 64.5% of French. Difficulties of access to treatment were cited more by patients from the UK (34.0%) than those from other countries.

Age also played an important part in the decision to travel for treatment. The average age across all countries was over 37.5, but German and UK patients tended to have a much higher age profile with 51.1% of Germans being aged over 40 and 63.5% of British. Civil status also varied between countries; overall 69.9% of all women were married and only 6.1% single. But 82% of Italian women were married, while 50% of French women were cohabiting (often in same sex couples), and 43.4% of Swedish women were single.

source: http://esciencenews.com

Obama’s Healthcare reforms bill will boost Medical Tourism

manager — Mon, 03 May 2010 10:30:15 GMT

President Obama’s health care reform bill was passed by US House representatives. The bill would provide health coverage to an estimated 32 million additional Americans, meaning 95% of those who are legally in this country would have health insurance, up from 83% today.

At present it is estimated that there are more than 47 million Americans without health insurance coverage. President Obama is trying to provide health insurance coverage to another 30 million US residents through different reforms and policies.

Will this end booming of Medical Tourism industry? Will patients from US stop coming to India and other Asian countries for equal quality, less expensive medical treatments? Will US insurance companies and US employers stop looking at medical tourism options?

The answer is no, it will not stop outbound medical tourism but it might even give a boost to medical tourism industry.

Mr Naresh Jadeja, President, IWHTA explains why:

1. There will be still 17 million uninsured and more than 25 million under insured people in America after this reform. Under insured’s are more likely to opt for medical tourism and more and more insurance companies will target this group to offer them overseas health insurance options.

2. Play or Pay mandate through which President Obama is trying to force US employers to provide health insurance to their employees or else face penalty, will have a negative impact and many employers will not be able to keep employee because of rising healthcare cost and will result in layoffs. Study shows that 54 % of total work force will be still without health insurance and there might be huge round of layoffs.

3. Availability of insurance does not mean availability of care. Many urban hospitals in USA have 3 or more hours of waiting period for their emergency department. If suddenly, there are 30 million more insured patients coming to the hospital then imagine the situation in USA hospitals. Same healthcare model of UK and Canada can be somewhat repeated. People from UK and Canada is not looking for treatment outside their countries because of being denied of healthcare insurance or financial constraints, it is because of high cost of care and extensive waiting times for elective surgeries. There will be similar problems due to healthcare reforms and you will see a regular no of people leaving US for better healthcare overseas.

4. Health care reform will be in full implication from 2014 onwards. There is few more years and some analysts predict it takes more than a decade to fix such a big system.

5. There is very poor dental coverage in many state run insurance programs. More than 82 million people does not have dental coverage, and it not being a priority dental tourism will not have any effect from this health care reform bill.

source: www.free-press-release.com

American patients choose Eastern Europe

manager — Mon, 03 May 2010 10:20:37 GMT

Recognizing the new opportunity, Eastern European countries such as the Czech Republic, Poland, Lithuania, Romania, and Hungary, many patients from the United States, Great Britain, Stan Scandinavia, Germany, France, Italy, Russia and Ukraine have begun to travel here for medical services. In a survey conducted by British magazine Cosmetic Surgery Answers, 17% of readers chose Eastern Europe as their favored destination for surgery. Whereas the average cost for a rhinoplasty in the United States is $5,500, the same procedure can be had for $2,600 in the Czech Republic or $1,400 in Hungary.

For example, cost for nose jobs in USA is $5,200, in Hungary cost just $990. Dentistry in Hungary about 75% less then in the U.S. (example of dental clinic in Nevada) and 30% cheaper than in elite Moscow clinic. For example the insurance costs for some Nancy Carothers 9USA, Nevada) was supposed to be $11,150, but treat 26 teeth in the Hungarian dental clinic, she spent the whole (including crowns, bridges and two implants) $2,900, and all costs (including airfare, hotel and transport) - $6000. The cost of similar treatment in the U.S. is 43,000!

The Czech Republic has become a notable destination for women seeking In-Vitro Fertilization (IVF) treatments. To date, the Czech Republic has 23 high quality IVF centers which all offer high rates of success and significant cost savings. While IVF centers in the United States charge as much as $18,500 for one cycle of IVF treatments, centers in the Czech Republic average between $2,400 and $2,850, including medication.

Prospective medical tourists interested in plastic surgery may consider Poland and Lithuania as Eastern European options. Whereas breast augmentation with a silicone implant averages between $6,000 and $8,000 in the United States, IQ Medica, a company that arranges specialized medical tourism packages to Poland, advertises the same procedure for $2,500. In Kaunas, Lithuania, Dr. Saulius Viksraitis offers tummy tucks for $2,000 and face lifts for $2,500. In the United States, these same procedures average $7,000 and $8,000 respectively.

Services in Romania are broad as well. According to Marshal Turism, a tour operator located in Bucharest, Romanian cosmetic and dental surgery clinics offer "solutions at international standards." Liposuction (including a pre-consultation, anesthesia, 24 hour in-clinic supervision, a personal nurse, meals, bandages, a 14 day stay and 6 month checkup) is quoted to cost between $1,300 and $2,600. In the United States, one could expect to pay between $2,500 and $4,500 for the same procedures- sans exciting European getaway.

Medical tourists have many resources available to them including web based service that allows people to compare the service and prices they would get from different companies. They are also on the verge of launching a price watch service which will compare the procedural costs of 300 providers in 20 countries. Healthbase, another medical tourism site, provides information on hospitals and destinations as well as allows users to plan a complete medical travel itinerary online.

Transplant Tourism Poses Ethical Dilemma For U.S. Doctors

manager — Thu, 28 Jan 2010 09:11:35 GMT

A recent case study by doctors at Mount Sinai Hospital in New York examined the ethical issues posed by transplant tourism, an offshoot of medical tourism, which focuses solely on transplantation surgery. Many American transplant professionals frown on the practice of transplant tourism where patients travel to countries such as China, India, and the Philippines for their transplantation. These transplant tourists may be subject to sub-standard surgical techniques, poor organ matching, unhealthy donors, and post transplant infections, prompting U.S. health care institutions to refuse treatment of these patients upon return to the U.S. Medical associations have responded with transplant tourism policies and guidelines to advise clinicians on the ethics of caring for transplant tourists. Full details of the study appear in the February issue of Liver Transplantation, a journal published by Wiley-Blackwell on behalf of the American Association for the Study of Liver Diseases (AASLD).

Some might think of transplant or medical tourism as merely a fictional plot from one of Robin Cook's medical thriller books (Foreign Body). However, given the critical shortage of available organs in the U.S., transplant tourism has grown in popularity among patients awaiting transplantation. Currently, the United Network of Organ Sharing (UNOS) reports there are more than 105,000 Americans on the transplant candidate waiting list with more than 15,000 patients awaiting a liver transplant. Furthermore, UNOS data shows a decline in donorship with living donor numbers decreasing by 1.7% and deceased donors down by 1.2% in 2008.

In the current case, a 46-year-old Chinese accountant (HQ) was placed on the UNOS transplant registry with a Model for End Stage Liver Disease (MELD) score of 18 that increased to 21 while on the candidate waitlist for over a year (MELD scores range from 6 for those least ill through 40 for those most sick). HQ then traveled to the People's Republic of China (PRC) and was transplanted two weeks after arrival. After transplantation, HQ returned to the Mount Sinai program requesting follow-up care, which was provided. HQ then developed biliary sepsis requiring hospitalization and re-transplantation seemed to be the only viable option.

"While the patient was a medically suitable candidate, team members disagreed if it were indeed, morally right to provide him with a transplant," said Thomas Schiano, M.D., one of the case clinicians and lead author of this study. Ultimately, the transplant team proceeded with a liver transplant for HQ and he is currently doing well. "Our consensus to transplant was based on the relevant principles of medical ethics - non-judgmental regard, beneficence, and fiduciary responsibility," added Dr. Schiano.

The study authors estimate that more than 400 patients received transplants abroad with 75% of those taking place between 2004 and 2006. Of those transplant tourists, 40% reside in New York and California, and the majority these patients traveled to the PRC, where organs from executed prisoners have been used in transplantations. Although transplant tourism is not held in high regard, the practice violates neither current U.S. law nor the National Organ Transplant Act. Current UNOS policies allow a small percentage of each center's transplants to be allotted for foreign nationals, essentially allowing for transplant tourism within the U.S.

Over the last few years, professional associations have established transplant tourism policies to provide guidance to clinicians and uphold the principles of medical ethics. The AASLD and International Liver Transplant Society (ILTS) have positions against the exploitation of donors, the recovery of organs from executed prisoners, and condemned the use of paid living donors. Similarly, the American Society of Transplantation declares that optimal medical care should not be withheld from those recipients who have chosen to receive transplants as "tourists" from abroad.

"Unfortunately, little guidance from societal statements are provided to transplant centers and the professionals in the trenches dealing with transplant tourists seeking care," Dr. Schiano stated. Given the shortage of available organs, more patients may resort to transplant tourism as an option. "Although we do not condone all of the practices associated with transplant tourism, it is our duty to provide all transplant patients with the same compassionate care and support, whether their transplantation was performed in the U.S. or abroad," concluded Dr. Schiano.

To build awareness of the need for organ donors, February 14, 2010 is designated as National Donor Day in the U.S. The Department of Health and Human Services provides further information on National Donor Day.

Article: "The Dilemma and Reality of Transplant Tourism: An Ethical Perspective for Liver Transplant Programs." Thomas D. Schiano, Rosamond Rhodes. Liver Transplantation; Published Online: January 26, 2010 (DOI: 10.1002/lt.21967); Print Issue Date: February 2010.

Source: Dawn Peters
Wiley-Blackwell

Smooth And Integrated Movement Patterns Can Help Individuals With Back Pain

manager — Tue, 26 Jan 2010 15:29:43 GMT

Many people with back pain do not know what is causing it and they do not receive effective treatment, but learning to move in a more integrated way makes a big difference, reveals research from the Sahlgrenska Academy at the University of Gothenburg, Sweden.

"People with long-term back pain often protect themselves by unconsciously limiting their movements," says physiotherapist Christina Schön-Ohlsson. "Such inefficient movement patterns gradually become habituated even though the original injury or strain is no longer present."

The answer to the problem is sensory motor learning, where patients are guided to find out how they are moving and how they can free themselves from self-imposed limitations. This process leads patients to develop their bodily awareness and to trust in their bodily sensations again.

In one of the studies 40 patients were randomly divided into two groups to compare experiences of two different types of treatment: exercise therapy and sensory motor learning.

"The patients in the sensory motor learning group said that they had learned to trust in themselves and now felt able to handle their low back pain themselves without seeking further medical help," says Schön-Ohlsson.

This contrasted with the patients in the exercise group, who expressed insecurity and felt dependent on advice from back-pain experts.

The overall purpose of the thesis was to evaluate how sensory motor learning, which has its roots in the Feldenkrais method, affected patients with long-term back pain who had previously not been helped by any treatment. The patients' subjectively experienced positive physical and psychological changes coincided with objectively assessed improvements in movement capacity.

Schön-Ohlsson draws the conclusion that sensory motor learning helps patients to learn to listen to their body so that they can take care of their back problems themselves.

Back Pain

As many as one in five Swedes suffer from back pain at some point each year, and although the pain often disappears, it turns into a long-term problem for around 200,000 people. In 80 per cent of these cases the pain cannot be attributed to a specific injury or illness. When the pain can be traced it is most often caused by a slipped disc, stenosis or osteoporotic fractures, and occasionally other conditions.

Source: University of Gothenburg

1 In 5 Hospital Patients In The UK Has Diabetes

manager — Tue, 26 Jan 2010 15:26:28 GMT

The first ever diabetes audit of 200 NHS hospitals has found that 20 per cent of patients on hospital wards have diabetes - twice the proportion previously estimated. In addition, the audit, which is due to be published later this year, will also show that people with diabetes stay in hospital longer than other patients.

Access to specialist advice

The Government's diabetes tsar Dr Rowan Hillson, who is leading the audit, wants to see all patients admitted to hospital with diabetes be given access to specialist advice and believes that having diabetes specialist nurses on wards can reduce readmissions of patients with diabetes, as well as drug errors, and length of stay.

Ensuring the best outcomes

"When they are in hospital it is crucial that people with diabetes have access to the right advice and support from healthcare professionals who have a specialist knowledge of the condition to ensure the best possible health outcomes," said Cathy Moulton, Care Advisor at Diabetes UK.

"In addition, as more and more people are diagnosed with Type 2 diabetes and put more pressure on NHS spending, we must do all we can to raise awareness of Type 2 diabetes and its risk factors in the general public by encouraging people to make lifestyle changes enabling them to reduce the risk of developing the condition."

Source
Diabetes UK

The Good Surgeon Guide, UK

manager — Mon, 25 Jan 2010 14:36:31 GMT

GoodSurgeonGuide.co.uk, regulated by BAAPS (British Association of Aesthetic Plastic Surgeons) was launched in September 2009 and is the first website of its kind. The site is the UK's only Cosmetic Surgery review website and should be the first port of call for anyone considering cosmetic surgery, aesthetic treatments or cosmetic dentistry. The site can also play an important role for surgeons and treatment providers.

The website was created by Christiana Clogg and good friend, Jennie Bassett. Both women had considered cosmetic surgery in the past and were overwhelmed by the amount of choice but the lack of guidance. The decision to undergo surgery was not an easy one, yet finding reviews and experiences from fellow cosmetic surgery patients was becoming the hardest part. It became clear that there needed to be a site that was honest, informative and completely independent from any other, a simple yet totally effective guide for all those that were considering surgery.

Getting listed on GoodSurgeonGuide.co.uk is completely free and, by doing so, clinics, cosmetic surgeons, cosmetic dentists and aesthetic treatment providers can get their own profile, complete with contact details, and information about qualifications and the procedures they offer. The profile has a review and ratings section, which can be used by people who have gone to them for procedures in the past; this will help raise the profile of the professional and show that they are reputable and respected.

Since the launch the site has been a huge success. With over 10,000 new visitors a month, the ladies are well on their way to making the site the first port of call when researching cosmetic surgery.

Source
British Association of Aesthetic Plastic Surgeons

The "Chocolate Cure" For Emotional Stress

manager — Mon, 25 Jan 2010 14:28:54 GMT

There may well be another important reason for giving your sweetheart sweets for Valentine's Day besides the traditional romantic one: The "chocolate cure" for emotional stress is now getting new support from a clinical trial published online in ACS' Journal of Proteome Research. It found that eating about an ounce and a half of dark chocolate a day for two weeks reduced levels of stress hormones in the bodies of people feeling highly stressed. Everyone's favorite treat also partially corrected other stress-related biochemical imbalances.

Sunil Kochhar and colleagues note growing scientific evidence that antioxidants and other beneficial substances in dark chocolate may reduce risk factors for heart disease and other physical conditions. Studies also suggest that chocolate may ease emotional stress. Until now, however, there was little evidence from research in humans on exactly how chocolate might have those stress-busting effects.

In the study, scientists identified reductions in stress hormones and other stress-related biochemical changes in volunteers who rated themselves as highly stressed and ate dark chocolate for two weeks. "The study provides strong evidence that a daily consumption of 40 grams [1.4 ounces] during a period of 2 weeks is sufficient to modify the metabolism of healthy human volunteers," the scientists say.

Source: American Chemical Society (ACS)

Healthcare In London Heading Towards Financial Crisis, Say Doctors

manager — Mon, 25 Jan 2010 14:16:00 GMT

Hospital services in London could close or be down-graded as healthcare in the capital heads towards "a major financial and organisational crisis", with the imposition of real term cuts of £5 billion by 2017, according to a new BMA report launched yesterday (Wednesday 20 January 2010).

The report, 'London's NHS ON THE BRINK', written by health expert John Lister2, was commissioned by the BMA's London Regional Council. In the report, Lister surveys board papers and other published material from primary care trusts (PCTs) in London.

It is expected that from 2011 there will be a freeze on NHS budgets, says the report, but the brunt of the cuts will fall on London.

London faces unique challenges - it has 14.8% of the English population, but could face a much higher share of the expected cutbacks. There are more mental health patients per head of population in London than other English regions, the capital has rising patient activity and it has a number of very expensive Private Finance Initiative (PFI) hospital schemes. The repayments for London's twenty PFI hospital projects will have a lifetime cost of around £16.7 billion - more than six times the basic cost of the buildings.

In the report, John Lister highlights some of the proposals that NHS London has made public, including:

- The aim to reduce the number of people going to hospital accident and emergency departments by 60% and the number going to hospital outpatients by 55%.

- Millions of patients would be diverted to unproven "polysystems" or clinics that have not yet been built. These changes would cut upwards of £1.1 billion from hospital budgets in London, forcing wide scale cutbacks and closures, according to the report.

- A 66% reduction in staffing of non-acute services, these include community services for older people and district nurses.

- A 33% cut in the length of GP appointment times.

- Slimming down London's hospital network, reducing many district general hospitals to lesser "local hospitals", and leaving just a handful of "major acute" hospitals.

- Annual reductions in the "tariff" that determines how much hospitals are paid per item of treatment.

The study emphasises a lack of transparency in the way NHS London has drawn up its plans to respond to the expected freeze on NHS budgets. NHS London has refused Freedom of Information Act requests to release a confidential report drawn up for them by US-based consultancy McKinsey's, effectively denying interested parties any opportunity to scrutinise its underlying assumptions or supporting evidence, says the report. However, some published reports have indicated that London PCTs will face a funding gap in the region of £5 billion by 2017 (the health budget for London in 2009/2010 was around £13 billion).

Chairman of the BMA's London Regional Council, Dr Kevin O'Kane, said today:

"While we recognise that there are problems with healthcare delivery in London, we are extremely worried that plans to cut services are being kept secret. We are calling for full disclosure of the proposals so that there can be a public debate. This is vital so that Londoners can have their say about local cuts and take a wider view of what is happening to the NHS.

"The truth is that most Londoners have no idea of what is happening to their health service. If people realised that we are heading towards financial meltdown involving cuts in bed numbers and hospitals closing or being down-graded, they would demand the opportunity to make their voices heard about these plans.

"London's doctors want to provide patients with world class healthcare but this is virtually impossible when doctors and patients are being kept in the dark about proposals. Lord Darzi pledged that all changes would benefit patients, be locally led and that existing services will not be withdrawn until new and better services are available to patients so they can see the difference. He also said that health professionals would be engaged in the plans. London's doctors are not opposed to change, but we would like to see Lord Darzi's principles applied meaningfully to the process."

The report analyses the financial situations of the six sectors, formed in March 2009, that cover PCTs in London - North West London, North Central London, Outer North East London, Inner North East London, South East London and South West London.

The London Regional Council believes that NHS market reforms are partly to blame for the damage to the health service in London and elsewhere. The BMA's campaign, Look After Our NHS, is calling for an NHS that:

- Provides high quality, comprehensive healthcare for all, free at the point of use.

- Is publicly funded through central taxes, publicly provided and publicly accountable.

- Significantly reduces commercial involvement.

- Uses public money for quality healthcare, not profits for shareholders.

- Cares for patients through co-operation, not competition.

- Is led by medical professionals working in partnership with patients and the public.

- Seeks value for money but puts the care of patients before financial targets.

- Is fully committed to training future generations of medical professionals.

Source
The British Medical Association

China A Rising Star In Regenerative Medicine Despite World Skepticism Of Stem Cell Therapies

manager — Mon, 25 Jan 2010 13:43:47 GMT

Chinese researchers have become the world's fifth most prolific contributors to peer-reviewed scientific literature on clock-reversing regenerative medicine even as a skeptical international research community condemns the practice of Chinese clinics administering unproven stem cell therapies to domestic and foreign patients.

According to a study by the Canadian-based McLaughlin-Rotman Centre for Global Health (MRC), published by the UK journal Regenerative Medicine, China's government is pouring dollars generously into regenerative medicine (RM) research and aggressively recruiting high-calibre scientists trained abroad in pursuit of its ambition to become a world leader in the field.

And its strategy is working: Chinese contributions to scientific journals on RM topics leapt from 37 in year 2000 to 1,116 in 2008, exceeded only by the contributions of experts in the USA, Germany, Japan and the UK.

The accomplishment is all the more astonishing given that China's international credibility has been and still is severely hindered by global concerns surrounding Chinese clinics, where unproven therapies continue to be administered to thousands of patients.

New rules to govern such treatments were recently instituted but need to be strictly enforced in order to repair China's global reputation, according to MRC authors Dominique S. McMahon, Halla Thorsteinsdóttir, Peter A. Singer and Abdallah S. Daar.

They drew their conclusions after having gained unprecedented access to almost 50 Chinese researchers, policy makers, clinicians, company executives and regulators for interviews. The research was made possible by funding from the Canadian Institutes of Health Research.

"When you look at the issue of stem cells in China, you see the Yin-Yang of a scientific powerhouse mixed with controversial clinical application of stem cell therapies," says Dr. Singer, MRC's Director. "The overall picture at the moment is ambiguous but in the future, given the measures that have been put in place, the science can be expected to rise and the controversy to fall."

Regenerative medicine an interdisciplinary field of research and clinical applications focused on the repair, replacement or regeneration of cells, tissues or organs to restore impaired function resulting from any cause, including congenital defects, disease, trauma and aging. It uses a combination of several converging technological approaches, both existing and newly emerging, that moves it beyond traditional transplantation and replacement therapies. The approaches often stimulate and support the body's own self-healing capacity. These approaches may include the use of soluble molecules, gene therapy, stem cell transplants, tissue engineering, and the reprogramming of cell and tissue types.

MRC researchers report that until May 2009 clinical trials to determine the effectiveness of stem cell therapies were not required. Now proof of safety and efficacy through clinical trials is required by China's Ministry of Health for all stem cell and gene therapies.

The change was made after international experts, joined by top Chinese researchers, protested that treatment centers were acting "against commonly accepted principles of modern scientific research" and successfully called on China to regulate new treatments and ensure patient safety.

Despite the new rules, however, stem cell treatments are still available at over 200 hospitals across China to patients of diseases such as ataxia, Lou Gehrig's disease, traumatic brain and spinal cord injury, diabetes, Parkinson's, multiple sclerosis, autism, cerebral palsy, stroke, optic nerve hypoplasia and many others.

"To our knowledge, Chinese policy makers and ethicists are working out the regulation details," says Ms. McMahon, the study's lead author. "Once that is accomplished, we still expect a delay, during which the therapies currently administered by clinics and hospitals will be evaluated individually to determine whether they meet the criteria of China's Ministry of Health."

"It is hard to say what impact these new clinical regulations will have in China, although certainly they show the government's commitment to changing the way things are done," she adds.

Beike Biotechnology Inc. (Shenzhen) is the largest of the Chinese therapy centers and claims to have treated over 5,000 patients to date, including more than 900 foreigners, offering stem cell injections into spinal fluid, for example.

The Stem Cell Center affiliated with Tiantan Puhua Neuroscience Hospital in Beijing, meanwhile, claims to activate and multiply the body's own neural stem cells through oral and intravenous medications and rehabilitation. It also offers a lumbar puncture or brain injection of bone marrow stem cells, fetal neural stem cells, or other stem cell types to allegedly improve symptoms of stroke, cerebral palsy, spinal injury, Parkinson's disease or other neurological diseases.

Controversial stem cell therapies provided at Beijing Xishan Institute for Neuroregeneration and Functional Recovery, involve injecting cells from aborted fetuses to treat spinal cord injury and a variety of central nervous system diseases. About 1,500 patients have received this treatment, including roughly 1,000 foreigners.

MRC authors say this latter stem cell therapy is the only one discussed in high-impact peer-reviewed academic journals. One study documented a spinal cord injury patient's early motor and sensory improvement, another found no improvement in seven spinal cord injury patients. Another recent publication found the therapy improved some spinal cord injuries in animals but its effectiveness in humans "is not yet established."

Despite the absence of randomized clinical trial evidence that these stem cell therapies work, an "increasingly popular but controversial" tourism industry has grown up around them.

"This is a matter of international importance, as increasing numbers of foreign patients travel to China to seek unproven stem cell therapies not available in their home countries," according to the MRC. "The International Society for Stem Cell Research (ISSCR) strongly condemns the administration of unproven stem cell therapies … and has written a handbook to help doctors and patients make informed decisions about available stem cell therapies."

As for advice to last-resort patients considering Chinese clinic stem cell treatments: "This is not a medical study," says Dr. Singer. "Instead we urge such patients to consult their own medical professionals. The International Society for Stem Cell Research has certainly made their stance clear."

"These therapies are sought out by desperate, no-option patients seeking marginal improvements in their quality of life. People should get as much information as possible before committing to any procedures. Each clinic provides a different therapy for a variety of different ailments and there is no systematic evidence that these therapies work."

Chinese firsts

While unorthodox activities at Chinese clinics and controversial drug approvals have raised eyebrows both in and outside China, dedicated researchers in the country's labs have been making remarkable contributions to the field.

Among the country's scientific firsts:

By transferring the nucleus of a human skin cell into the immature ovum cell of a rabbit, researchers from a Shanghai hospital successfully produced embryonic human cells (a finding popular scientific journals held off publishing for two years due to skepticism and mistrust of Chinese scientific integrity).
China to date has created at least 25 human embryonic stem cell lines (some estimate over 70 stem cell lines), four of which are of a specialized type that at that time only two other groups worldwide had managed to create.
A Shanghai hospital cultivated and reintroduced human brain tissue in 2002 after taking a sample from the end of a chopstick implanted in a patient's frontal lobe following a disagreement at a restaurant.
Several human tissue types created artificially include blood vessel, tendon, bone, cartilage, skin, cornea and muscle fiber.

Notable research underway

Current research of note includes the efforts of ChinaSCINet, a consortium of 27 medical facilities, starting phase 2 clinical trials to test the efficacy and safety of using cord blood stem cells and oral lithium to treat about 40 patients with spinal cord injuries.

Other clinical trials are underway on the use of stem cell therapies to treat patients of heart attacks, artery obstruction, and liver and neural diseases.

Elsewhere in China, studies are underway on the potential use of stem cells to treat Type 1 diabetes, Parkinson's disease, heart, liver and blood diseases, eye cataracts, and to combat aging.

Liberal research rules

Guidelines governing Chinese research are liberal but common to other countries as well.

Chinese regulations prohibit reproductive cloning, the use of human embryos past 14 days post-fertilization, the fusion of human and non-human gametes (cells that fuse during fertilization), or the implantation of research embryos into human or animal uterus.

Researchers are required to obtain informed consent from subjects and institutes must have an ethics review board to approve research involving human embryonic stem cells.

Chinese fertility clinics serve as a source of discarded embryonic stem cells for some research, and cord blood banks may serve as a source of stem cells for clinical applications.

Therapeutic cloning is allowed, as is the use of surplus embryos or discarded fetal cells from abortions as well as embryos created with artificial help.

"What sets China apart from most of the rest of the world is that these regulations do not prohibit the fusion of human genetic material with nonhuman oocytes (cells from which an egg or ovum develops)," the MRC authors say.

As well, the rules for embryonic stem cell research in China are criticized internationally as having limited authority over researchers because they are not legally binding. Adherence is enforced only for those who receive government funding, which applies to most researchers, but financially independent researchers or hospitals must simply answer to their own institution's ethical review board.

MRC authors say that while there is no indication embryonic stem cell research rules are being broken, greater regulatory oversight would help ease international concerns.

Interviewees agreed that regulation enforcement is a key concern. According to one, a lack of inspection capacity cast doubt on regulatory implementation.

Huge Chinese investment in RM

Chinese data show the country now generates 400,000 graduates in science and medicine each year and recruits many high caliber scientists from abroad.

China's gross domestic expenditure on R&D in science and technology has grown from $5.9 billion in 1996 to $44 billion today. Stem cell research, tissue engineering and gene therapy are key areas receiving priority funding, largely centralized in the universities, hospitals and research institutes of China's main urban centers, especially Beijing and Shanghai.

Approximately 78% of China's R&D funding in RM is reserved for product development, with an additional 16.8% for applied research. And China has developed large primate colonies for preclinical testing, and begun clinical trials for a number of therapies.

According to the MRC, China's push for clinical applications, which has allowed it to produce new scientific knowledge quickly, has come at the expense of basic research aimed at, for example, overcoming technical challenges such as controlling how stem cells behave and differentiate.

Only 5.2% of China's budget for research and development is allocated to basic research, compared with 13 to 19% in Japan, Korea and the USA. Even the funds allocated for basic research favor 'strategic basic research' designed to encourage application.

China's recruitment policy a model for other developing countries

"China has catapulted itself into the field of regenerative medicine in a relatively short time," says Dr. Thorsteinsdóttir. "The government's policy of attracting highly educated Chinese nationals back to China has contributed significantly to the country's success in the field."

"I was amazed that almost all the top Chinese researchers the regenerative medicine field had been educated in the US and the UK and gained extensive working experience there in cutting edge research," she adds. "This is a policy other countries lacking relevant human resources should consider."

"New regulations may in time help restore international confidence in Chinese stem cell innovations, but it will take time to evaluate their impact," says Dr. Daar. "The creation of new RM therapies needs a clear regulatory path. There should also be a closer connection between applied research and those providing therapy."

"China is an important player in regenerative medicine," says Ms. McMahon, "Despite the media's focus on stem cell tourism, the international community needs to recognize that Chinese researchers are making important contributions to the science of this field, and China should be included in international discourses on standards and regulations."

"Regenerative medicine research in China is a source of national pride," she adds. "The Chinese rightly feel their research discoveries can achieve solutions to many global health problems. If China continues to build on its strengths and overcomes its challenges, successful, internationally acclaimed regenerative medicine treatments and therapies are more than likely."

This release is available in Chinese.

Source: Terry Collins
Program on Life Sciences, Ethics and Policy,McLaughlin-Rotman Centre for Global Health