Sex selection in Turkey

Parents who want to pick the sex of their babies need only to travel to Turkey and pay for in-vitro fertilization there, an undercover BBC report has found.

As in Canada, sex selection is illegal in Britain is illegal, unless for medical reasons. For instance, if your family has a genetic disorder affecting only males, you can chose to have a girl.

Ironically, similar rules apply in Turkey, and yet the Jinemed Center, a fertility clinic in Istanbul, has proven a popular destination for patients wanting to pick the gender of their baby.

BBC reporter Colette McBeth took her husband and a hidden camera to a meeting with representatives from the centre and made it clear they wanted to have a girl. A video of the meeting shows the couple discussing with the representative ways to get around the law by pretending a heriditary desorder runs in their family.

The Turkish government is now investigating the centre, but the incident shows the ease with which medical tourism allows people to flout health laws in their own country.

Kidney sales considered in Singapore

Singapore's health minister, Khaw Boon Wan, says his city-state could become the second country in the world -- after Iran -- to allow the sale of live kidneys for transplant.

"We should not reject any idea just because it is radical or controversial. We may be able to find an acceptable way to allow a meaningful compensation for some living, unrelated kidney donors without breaching ethical principles or hurting the sensitivities of others."

The Singapore Medical Association has come out against the idea. Professor A. Vathsala, director of adult renal transplantation program at Singapore's National University Hospital, says the practice is wrong.

"It is not a good idea to legalize payment for organ donors as such payment institutionalizes the belief that the wealthy ill have property rights to the body parts of the poor."

Supporters say paying donors for their kidneys could help solve a severe shortage in Singapore, where the waiting list for a kidney transplant is up to nine years. Lee Wei Ling, director of the National Neuroscience Institute and daughter of Singapore founder Lee Kuan Yewm, supports the idea.

"If monetary incentive makes a potential living donor more willing to save another life, what is wrong in allowing that?"

The World Health Organization opposes commercial sale of organs, says Luc Noel, a WHO coordinator for essential health technologies.

"Rich people have no reason to sell a kidney. That is the flaw that is unacceptable in any scheme involving purchasing a kidney: it's exploitative."

Last February, police in India broke up a black-market organ ring that may have taken as many as 500 kidneys from poor laborers and sold them to foreigners from the U.S., the U.K. and elsewhere. A Canadian doctor, Amit Kumar, is at the centre of that investigation.

Noel said any legalizing of kidney sales would hurt Singapore's carefully crafted image as a high-end provider of care for medical tourists.

"That sounds like a nightmare. I seriously do not think Singapore would like to create this image. They don't want to be the place where you can obtain the parts of another person."

Wombs for rent, eggs for sale, in India

Lax rules governing fertility services in India are leading to a boom in medical tourism catering to foreign couples wanting a custom-order baby.

Advertisements openly solicit Indian women to sell their eggs to childless foreign couples, or become surrogate mothers.

"We are actively recruiting egg donors! Our patients are happy to pay generously for your generosity! They pay you up to rupees 40,000 ($800 US) every time you donate."

The in-vitro fertilization clinics then charge foreign couples up to $4,500, including medicines, to implant the embryos in the mother. Some clinics cost half that. "Nearly half of our patients come from overseas. Of them, nearly half are of Indian origin," said Aniruddha Malpani, whose IVF clinic in Mumbai is considered among the country's best.

The Indian Society for Assisted Reproduction says there are some 400 IVF clinics in the country, providing an estimated 30,000 assisted reproductive treatments a year.

Most egg donors are housewives paid between 6,000 and 40,000 rupees ($120 to $800), depending on their education level. Many are poor.

Critics like Puneet Bedi, a specialist in foetal medicine at New Delhi's Apollo hospital, say the absence of regulation poses health dangers, as well as ethical issues about "rent-a-womb" exploitation.

"This business is like any other outsourcing industry. The only difference is the treatment offered here is very poor. Doctors here take short cuts, they implant more embryos than needed which multiplies risk to the mother."

A draft bill on assisted reproduction is expected to be tabled in parliament soon, but women's health activists argue that it is aimed more at promoting a lucrative business than addressing health and ethical concerns.

Medical companies are offering deals that bundle health and travel services for foreigners, from arranging the medical visa to making clinic appointments to providing recuperation holidays.

Malpani said the industry can regulate itself and spread benefits to many. "It's a market economy. The bad doctors will be weeded out and benefits will trickle down to people in smaller towns."

The dangers of medical tourism

Going abroad for a kidney transplant increases you chances of getting an infection or of the new organ being rejected by your body, a new study has found.

"Researchers from UCLA compared 33 patients who went to other countries to receive kidney transplants to 66 patients treated in the United States. They found that 30 per cent of medical tourists had kidney rejection compared with 12 per cent of those treated at UCLA."

As well, 27 per cent of medical tourism patients were hospitalized for infection after their surgery, compared with 9 per cent of U.S. patients. The tourists also reported higher rates of other complications.

The study is in the Clinical Journal of the American Society Nephrology.

Hospital apartments, and political unrest

Bangkok Hospital Medical Centre is now offering full-service apartments for the families of medical tourist who travel to Thailand for medical help.

In the latest move to up the ante in the increasingly competitive market of international medical care, the hospital says the apartments -- complete with cooking facilities -- will make it easier for families to travel to Bangkok for treatment. Rates start at $77 (US) a night for a studio. The apartments are located within the hospital complex, making visitations easier.

Bangkok Hospital serves almost half the 1.2 million medical tourists who visit Thailand each year. It also offers complimentary visa extensions, should a patient's hospital stay extend longer than expected.

Meanwhile, Bangkok's other major international hospital, Bumrungrad, has posted a notice on its website in the wake or recent political turmoil there asking and answering the question, "Is it safe to travel to Bumrungrad now?" Their answer:

We believe it is. The recent political demonstrations are taking place in another section of the city and have not impacted our hospital’s operations nor access to our hospital from the airport or from nearby hotels. We agree with advisories issued by some embassies recommending that visitors to Bangkok avoid the areas where demonstrations are taking place. However, we know of none of our international patients who have been impacted by these demonstrations.

The fact that they felt the need to address the issue, however, shows one of the risks of medical tourism: it can involve travel to less-stable countries for care.

Babies abroad

France is revisiting its limits on in vitro fertilization, or IVF, in the wake of stories about a 59-year-old woman who sidestepped national regulations by going to Vietnam for the treatment.

She is expecting triplets.

IVF in France is only available to women 43 years old and younger. Unwilling to accept that, the woman went to Vietnam for the treatment. She is now being treated under France's medicare system at Cochin Hospital in Paris.

French bioethicists condemned the woman's actions.

"Certainly we are seeing a change in society where the age to get pregnant naturally is rising but everyone must understand that you cannot have a child at any age," said Sadek Beloucif, president of the ethics board of the l'Agence de la Biomédecine.

"This is important for the health of the mother and for the health of the baby."

Beloucif called for a standard age across Europe for providing IVF, saying Cypress and Ukraine are also popular destinations for older women wanting IVF.

France's bioethics laws are to be re-examined next year -- with IVF, surrogate mothers (currently banned in France) and gay rights among issues to be debated.

Dental Tourists

The East European country of Hungary has sent a team of dentists to Britain -- complete with a mobile, blow-up dental office -- to drum up business for their country's fledgling dental tourism industry. With cutbacks in the British medicare system's dental plan pushing more into the private system, there seems to be plenty of demand.

The dentists use their make-shift inflatable examining room to assess the teeth of potential patients, who can then book a trip to Hungary to get any needed work done -- for about a third of the cost as in Britain.

In North America, Mexico is the primary destination for dental tourists.

Promoting medical tourism

Israel is hosting a group of German health officials this week in hopes of promoting their country as a destination for medical tourists. The three-day visit is meant to help make it easier for Germans to travel to Israel for care, but is also a step in the continuing mainstreaming of medical tourism -- once  exclusive to only the richest in society.

Meanwhile, India's smallest state seems to be feeling left out of the new phenomenon, even though the country is a leader in medical tourism. Goa plans to begin promoting medical tourism, as well as build amusement parks, golf courses and improve infrastructure.

Catching up

After a two-week hiatus, there's lots to catch up on in the field of medical ethics. But rather than try blogging on each issue, I will do a quick roundup. In no particular order, here's a few things that happened in the world the medical ethics in the past couple of weeks:

* Drug maker Merck & Co. came under criticism after it was revealed that the company had sponsored a clinical trial of its painkiller Vioxx in 1999 to support a marketing campaign. ``They went about this in a very analytic way, picking doctors who would be most influential, who will talk to other doctors and recommend Vioxx to them, and thus increase prescriptions in the area, planting the seeds of additional Vioxx use,'' Kevin Hill of Harvard Medical School and lead author of a study in the journal Annals of Internal Medicine, told Bloomberg. Merck, which pulled Vioxx from the market in 2004 after a study linked it to heart disease, denied the allegations. The drug maker has agreed to pay $4.85 billion (US) to settle patient claims that Vioxx, used by 84 million people worldwide, caused heart attacks or strokes.

* Wired magazine took a look at a looming issue once the US presidential election is over: the future of stem cell research funding south of the border. It's an issue this blog looked at recently, as well.

* The US secretary of veterans affairs apologized to the family of a 74-year-old vet who was denied medical treatment after he refused to take part in an Alzheimer's study. Joe Fitzgerald died of Creutzfeldt-Jakob disease - the human form of mad cow disease - less than a month after he was dismissed without diagnosis or treatment at James J. Peters VA Medical Center in the Bronx, The Washington Times reported. The paper also reported that the VA has come under criticism over its human-subject experiments amid allegations it failed to quickly notify participants in a smoking-cessation study about potentially dangerous side effects of a drug some participants were taking and an Arkansas veterans hospital uncovered rampant violations, including missing consent forms, secret HIV testing and failure to report more than 100 deaths of subjects participating in studies.

* A new book, Body Shopping, by Oxford ethicist Donna Dickenson looks at the world of medical research and commercialization of the human body. Australia and Dubai are looking to join the fast-growing medical tourism industry.

* Federal Health Minister Tony Clement questioned the medical ethics of doctors who support safe injection sites for addicts. The Canadian Medical Association says 79 per cent of Canadian doctors support such programs.

* The California Supreme Court ruled that doctors cannot deny treatment to homosexuals due to their own religious convictions. In Canada, meanwhile, the Ontario Medical Association is asking the College of Physicians and Surgeons of Ontario to change a draft policy that says doctors who deny treatment on moral or religious grounds might be contravening the Human Rights Code and committing professional misconduct.

Globalization and health care

A lengthy article in the most recent Economist takes a detailed look at medical tourism, predicting the number of medical tourist from the US alone could grow tenfold by 2012, creating an industry worth $21 billion (US) a year in just four years' time.

It attributes the growth to a development noted on this blog and in Toronto Star newspaper articles last May, the ability of the middle class to afford what was once the preserve of the wealthy: 

Some wealthy patients have always traveled for fancy medical care. Denis Cortese, head of the Mayo Clinic, in rural Minnesota, observes that “we have been global for a hundred years.” A few years ago Britons fed up with waiting for elective surgery started heading overseas to get joints replaced or cosmetic surgery—sometimes at government expense. Recently, shorter queues in the National Health Service and restrictions on reimbursements have undermined this trend.

However, globe-trotting patients only ever occupied a niche. What is getting people excited today is the promise of a boom in mass medical tourism, as a much bigger group of middle-class Americans prepares to take the plunge.

The Economist notes that much of the growth can be attributed to American companies changing their employees health plans to offer overseas surgery as an option, creating a larger customer base. Because getting major surgery can be performed in Asia for a fraction of the cost in the US -- including airfare -- insurance premiums can be slashed if foreign surgery is an option. Employees at Hannaford, a major grocery chain in New England, for example, can save up to $3,000 on their insurance co-payments by agreeing to go overseas if they need surgery.

In Canada, the big incentive to become a medical tourist is the chance to skip waiting lists for orthopedic or cardiac surgery. But like the US, the growth of the industry can be attributed to such options no longer being the preserve of the wealthy.

Today, a new hip or knee can be had in India for about the cost of a family vacation -- opening the industry up to a big new group of people.