Thepatients_prot

druweklein

THE INTERNATIONAL PATIENT MAGAZINE IN GLOBAL HEALTHCARE

Chocolate

Therapy

The dernier cri

for happiness

and beauty.

Chocolate Spa Resorts

Prototype Issue, Monaco, 22nd March 2013


T h e P a t i e n t s . c o m

THE INTERNATIONAL PATIENT MAGAZINE IN GLOBAL HEALTHCARE

2


LETTER FROM THE EDITORIAL BOARD

The Patients.com

Launching a New Global Magazine

consumers and professionals in a popular

style. Quarterly issues will follow,

with a monthly publishing schedule

planned beginning May 2014.

Dear Reader

We would like to ask for your support

for our new magazine The Patients.com

For some years, we have seen the

development of a medical travel industry

which lacks focus and exploits the

patient’s interests, often in the pursuit

of commercial gain.

Consider a patient who wants to make

a decision about treatment abroad by

browsing the internet and using social

media. Even we as professionals can be

easily confused by the information

overload.

The Patients has a mission: connecting

consumers to well researched and

balanced information which allows our

readers to develop their own opinions.

We assist patients converting information

in healthcare into knowledge.

Content

The content structure and style addresses

the educated reader. We are

aiming at a critical and informed readership;

the kind of reader who also

buys “Der Spiegel” , “Newsweek” or

”TIME”.

The content will address global

health issues from all aspects and report

in a consumer-friendly style in

areas such as:

Prevention, treatment solutions, healthcare

systems and trends, care, health

technology, high-end medicine, hospitals

and doctors, wellness and spa, new

health discoveries, media and health,

arts & culture& health, healthy in- and

out-door environments, health in social

networks, VIP health and also: the nonsense

of the month...

The magazine is designed to become

the voice of serious medical services,

health providers and leading thinkers

on a global scale.

The Beginning

We are providing you with a prototype

copy which enables you to get an

impression of the content, the structure,

the look and feel. We believe that patients

are poorly informed and in fact

partly misled by the abundance of selfpromoting

medical travel articles

which leave the reader with lots of

positive impressions but not necessarily

with a set of well-informed and

balanced opinions. We strictly separate

editorial and commercial content to

allow two things to happen in unison:

you the reader can make up your

mind based on neutral and objective

information and

you can then select from the commercial

offerings of the providers as

the next step.

An educated, well-informed and

critical patient is a better customer in

the medical tourism world than an enthusiastic

believer.

Advertising

The advertiser will find with The

Patients.com a platform which is distributed

to the end customer in business

clubs, lounges, hotels, spa resorts,

international clinics and doctor offices,

conferences, 50+ fairs and at newspaper,

magazine and airport kiosks.

The premiere issue will be produced

in July with approx. 15.000 copies.

This first edition for the public will run

80-100 pages with in-depth articles for

As soon as the brand and style of

The Patients has begun to establish

itself, online and mobile edition will be

launched to complement the print edition,

extend its reach and begin to interact

directly with our readers.

We think it is better to market a good

thing by talking about it… and not by

talking it up. Health and medical services

often fall into this category.

The financial and commercial risk is

at the moment with Health Care Strategy

Int. in Munich. The project is open

to partners and investment.

The Readership

Web based information about treatments

and medical solutions which are

provided under the umbrella of marketing

is overwhelming and confusing

even to the experts – and certainly for

the end consumer, the patient. He or

she needs information, guidance and

training in critical thinking to make

sensible and safe decisions.

Having The Patients.com in the market

will serve as a global trigger to

align knowledge, opinions, and promote

innovations. This will help global

health industry stakeholders to learn

from one other, implement improvements

and lay the basis for standards

which we are expecting unavailingly to

be set by higher forces over the next

half century.

Your voice counts—together we

make it audible!

Monaco, the 22nd March 2013

The Editorial Board

Constantin Constantinides, Greece

Uwe Klein, Germany

Claudia Mika, Germany

Keith Pollard, United Kingdom

Maria Todd, USA

Ruben Toral, Thailand

Josef Woodman, USA

3


TABLE OF CONTENTS

Chocolate Treatments -

The dernier cri for happiness and beauty

TITLE STORY

Modern Spas offer chocolate treatments as the solution

against stress, aged skin and body weight.

Page 7

Epilepsy Surgery

High tech medicine for children

MEDICAL SOLUTIONS

In the Munich area available since 2002. Children can live

a normal life after delicate and high tech brain surgery.

Page 10

Harvard Experts on Stem Cell

Stem cell tourism in the focus

SPECIAL EVENT

Rising stem cell tourism neglects major concerns about

the efficacy and legitimacy. Stem cells are experimental.

Page 24

The Healing Power of Arts

Following slow food cooks and Spanish geniuses

CULTURE - ARTS - HEALING

Health and wellness tourism comes up with wellbeing and

relaxation tours, boostering creativity and regeneration. .

Page 28

4


TABLE OF CONTENTS

The Patients.com

LETTER FROM THE BOARD

The Start of a New Magazine

3

PANORAMA

News from the world

6

TITLE STORY

Chocolate Treatments

Hotel Sacher Vienna

Indigenous Treatments

7

8

9

MEDICAL SOLUTIONS

Epilepsy Surgery

Lokomat - Computerized Gait Training

10

12

HEALTH TRAVEL

Free Choice of Doctor

14

SPA AND WELLNESS

Where Germans Go

16

LEGAL VIEWPOINT

Medical Tourism, Law and Ethics

Can Business Lead the Way?

18

19

ALTERNATIVE MEDICINE

Sinusitis: Like the Plague

20

COMMUNICATION — MEDIA

HON and Cyberchondria

21

SPECIAL EVENT

The Rise of Stem Cell Tourism

24

COUNTRY FOCUS

Medical Travel to Poland

26

CULTURE - ARTS - HEALING

Paintings, Food and Creativity

28

HEALTH TECHNOLOGY

Cyberknife in Ankara

30

MY SAY - DENTISTRY IN TURKEY

Developments in Turkish Healthcare

My Say: Dr. Betul Gofteci

31

32

ESSAY

Ruben Toral: Forget Love

33

FACEBOOK DIGEST

Wrapping Women

33

THE PATIENTS.COM - IMPRINT

Call for Cooperation

34

5


PANORAMA

The pursuit of happiness

The feeling of happiness leads to a

chain reaction and seems to be contagious.

This feeling can then spread to

people around you, even if you do not

know them directly. The American

researchers, Christakis from Harvard

and Fowler from the university of San

Diego, California, have discovered

this recently.

They evaluated the social relationships

of around 50,000 people. The

results were surprising: even a friend

of a friend of a friend can have a noticeable

influence on ones own well

being. The individual feeling of happiness

can spread as far as a third

chain in a social network. The report

can be found in the “British Medical

Journal”. This effect seems to be associated

with the distance the two

friends are apart from each other.

When the distance is more than one

American mile the effect decreases

significantly.

So how do you explain this? It is a

challenging idea and underlines the

importance of the perception of how

near two people are to each other from

a terrestrial point of view. Humans are

terrestrial animals and have a perfect

bio- and socio- monitoring system.

The nearer a person is in reality, the

more important the feelings that are

shared between the two subjects become.

Facebook and other social media

sites might be interested in how to

effectively transport this terrestrial

perception into the virtual world? But

isn´t that already happening?

The pursuit of happiness seems easier

than expected. Socializing—the traditional

way.

Comics for continuous

medical education (CME)

Comics, or graphic

narratives,

may be an effective

way to share

important medical

experiences

with physicians

in training, according

to a new

article in Annals

o f I n t e r n a l

Medicine. The

article shows

how creative lear

-ning tools, like

the graphic novel

format, can

enhance medical

training by adding

an emotional

and visual component. In this issue,

the article uses the classic cartoon

Dentists becoming

bio-engineers

In all industrialized nations people

understand that scientific revolutions

have the power to change their jobs

and lives forever. Dentistry is a field

where the use of technologies is advancing

rapidly to help patients wanting

implants and prosthesis. Maybe in

the future a good dentist will need to

become a good bio-engineer. The day a

new "biotooth" can be grown in the

gap left by a missing tooth, as an alternative

to having a false one implanted,

came a step closer recently when UK

researchers revealed how they have

developed a way to bioengineer new

teeth from a person's own gum cells.

However, it may be some years before

the results achieved in the lab are

available to patients sitting in a dentist's

chair. The researchers had to combine

the human gum cells with a type

of embryonic mouse cell in order to

instruct the gum cells to start forming

teeth. The next challenge is to find a

human adult cell that can be coaxed to

do the same.

format to tell the story of a missed

diagnosis that haunts a physician

throughout his professional

life. Two

slightly provocative

questions emerge:

“Can non-professsionals

also use cartoons

to learn more

about diseases and

treatments without

becoming a victim

of self-induced cyberchondria?”

And: “Will comic

reading find its way

into professional

CME systems?” So

if you catch your

doctor reading a

comic, don’t just

think he is wasting

his time with junk,

he may actually be studying the solution

to your illness or condition…

6


TITLE STORY

Chocolate Treatments -

The dernier cri for happiness and beauty

A new trend for beauty

Chocolate: the dream of melting

away. Who would not get weak at the

thought of a good piece of chocolate.

To eat, yes...but to put on your skin?

Chocolate has a high affinity to “hip

gold” and that is what is limiting its

use in oral therapy. These days we

know that dark chocolate (bitter

chocolate) can be protective against

myocardial heart infarction when

taken in the right “dosage”. Antioxidants

and flavonols found in the cocoa

butter are the active substances.

So what about beauty? For quite

some time now wellness resorts and

spas have tried to attract high end

customers with the promise of special

treatments with brown gold. “The

Patients.com” decided to look behind

the curtains and find out exactly how

chocolate face masks, massages and

baths work.

Cacoa Plantation

The first effect of getting in touch

with chocolate is the release of a

blissful feeling. The flavor in particular

leads to a very comfortable state of

mind. The scent also helps to wake up

fond childhood memories. Tryptophane

is then released which is a precursor

of the happiness hormone Serotonine.

The molecular skeleton of

the amphetamine phenylethylamino

acid and the anandamide (a cannabinoid)

complete the mood lifting effects

that are associated with chocolate

contact. Many people experience

the feeling that they are doing some-

thing particularly beautiful and unique

with their body. This creates the fundamentals

for relaxation and the next

step is the release of the happiness

hormones.

But the effects of chocolate therapy

are not just limited to psychological

reactions. The university of Münster

in Germany has found in a scientific

study that cocoa aids the healing of

wounds (but not if applied straight to

an open wound!). The substance N-

phenylprobenoyl-L-amino acid has a

positive effect on skin wounds. In

addition to this the substance also

catches the free radicals which are

accountable for the aging process of

the skin and the radicals are then neutralized

by the chocolate. This is the

process that helps repair skin damage

and prevent wrinkles. The butter part

of cocoa also nourishes the skin and

protects it against becoming dry

(dehydration). This means the polyphenols

found in cacao become active

skin conservation compounds. What’s

more, the theobromin, which is similar

to caffeine, contained in chocolate

leads to an increased capillary blood

flow in the skin, transporting more

oxygen and nutrients in to the skin

cells. So a health treatment with

chocolate is in fact a first class antiaging

therapy.

When selecting a suitable product

for the health treatment there is one

basic rule: the darker the chocolate

the more suitable it is for the treatment.

More ingredients in dark chocolate

are micro and trace elements such

as potassium, phosphorus, calcium,

iron, nickel, fluor, magnesium, sodium,

copper, zinc, iodine and others.

Critics looking superficially at

chocolate therapy may argue:

“Another hype in the world of the

famous and notorious…” But there is

a scientific basis behind the therapy

that has been discussed, praised and

attacked. So the question still remains:

which theory is right? It may

well turn out that chocolate not only

causes no damage but actually aids

the natural healing process, thanks to

several smart substances, and also

improves the psychological well being

of the patient. The editorial team at

least plays with the idea to test a wellness

spa for a personal chocolate experience.

The world cocoa price

is recovering after a low in the last 20

years. Health investors may speculate

for an increase not because of the

amount demanded but due to the quality

and high end chocolate products

which drive the selling price.

Cacao price in $ / tons

Source: Bloomberg

MICHAELA SEEBACHER

7


TITLE STORY

Chocolate in Vienna -

The Spa of Hotel Sacher

What is mixed for you at

Hotel Sacher?

The guaranteed calorie-free body

treatment is based on the same cocoa

beans used for the chocolate icing of

the Original Sacher Torte. “This

creamy pampering programme with

the scent of chocolate promises just as

lasting a feeling of happiness as eating

a slice of Original Sacher-Torte”. The

cocoa butter used in these products

also nourishes and rejuvenates the

skin, reducing wrinkles and ensuring a

radiant look.

It comes better: the superb treatments

of the Ligne St. Barth exude a touch

of the Caribbean. These feel-good

elixirs contain natural active ingredients

from exotic plants, blossoms and

fruits combined with fresh ingredients

individually blended to match your

skin type.

Take a chocolate time….

[PROMOTION]

Escape the hustle and bustle of the urban jungle and enter a world of peace and

relaxation where you can just forget your worries for a couple of hours. At the

heart of Vienna, on the fifth floor of the superior five-star Hotel Sacher Wien, you

will find the exclusive Sacher Spa. Covering an area of 350 m², Vienna’s sole

“Leading Spa of the World” offers its guests a wellness experience for all the

senses, inviting them to tarry for a few hours – or just take a short break. By arrangement,

the doors of the spa are open to hotel guests around the clock. However,

the Sacher also extends a warm welcome to daytime spa guests.

The chocolate side of the

Hotel Sacher, which

skilfully combines the

traditional and the modern,

can also be found at

the Sacher Spa: besides

the world-famous Original

Sacher-Torte cake,

whose recipe is a closely

guarded secret, this luxury

establishment also

serves its guests another

chocolate dream at the

Sacher Spa, which

opened in the year 2005. “Time to Chocolate” is the name of Sacher’s exclusive

line of care products entirely in the chocolate tradition of the house. “When people

are travelling they often need to be well and truly pampered and find mental relaxation,”

explains Sacher owner Elisabeth Gürtler. As a much-travelled manager she

knows what makes hotel guests happy.

8


TITLE STORY

Indigenous Treatments

Wrapped into lemons

Besides chocolate then: are there

It gets even better

any other foods and fruits to get

wrapped into? There are. People go

bathing in wine and Cleopatra started

the whole trend with goat milk bathing

for beauty. Getting in direct touch

with fruit ingredients needs sometimes

a good and healthy skin. The

doses of certain substances which can

This could be

your advert in

the next issue

be absorbed are much higher compared

when taken orally. One hardly

would resist in comfort the power of

20 lemons at once. In a body wrap one

has to…

See a few examples here of what is

becoming the next hype after chocolate:

* The Arizona Biltmore Resort & Spa

Size

136 x 56 mm

offers a Cactus Flower Wrap that uses

prickly pear cactus extract to soften

your skin, and a Sedona Mud Wrap

that uses local mud to detoxify your

body and nourish your skin.

1/6 portrait

* Hawaiian spas offer Lomi Lomi, a

healing type of Hawaiian massage

derived from ancient Polynesian traditions.

It usually begins with a blessing,

and the massage is given with

very fluid motions using the forearms.

* Mohonk Mountain House in upstate

New York has a Mohonk Red massage

that uses towels infused with a

witchhazel that only grows in the Sha

wangunk Mountains.

* The Cliff House in Maine has a

Blueberry Body Wrap and Blueberry

Smoothie Pedicure and offers hot

stone massage with stones it collected

from its own beach.

The Cotton House in the Caribbean

island of Mustique uses tropical fruits

in its Lime and Pineapple Extravanza.

Fresh lime is mixed with sea salt for a

body scrub, followed by a pineapple,

yogurt and honey wrap to soothe and

soften the skin.

Source: http://spas.about.com/od/

massage/a/indigenous.htm

When you are out for finding the

suitable spa for you: Spafinder.com, a

global spa portal finds you in Europe

292 locations, in US 217. So it can be

regarded as a widespread phenomenon

to dive into chocolate.

See also our “FACEBOOK DIGEST”

on page 33

9


MEDICAL SOLUTIONS

Epilepsy Surgery

High-Tech Medicine for Children

Since 2002 in Munich area

“A thunderstorm in my head.” That

is how patients describe what they

experience during an epileptic seizure.

Worldwide, approximately 40 million

people suffer from epilepsy. “In many

cases, we can offer good treatment

options for this chronic disease”, says

Prof. Dr. Martin Staudt, Head of the

internationally renowned pediatric

center for epilepsy and epilepsy surgery

at the Schön Klinik Vogtareuth.

This institution is dedicated to the

treatment of children and adolescents,

and, since recently, also adults with

this disease. Generally speaking: three

out of four patients respond well to

medical treatment. But there are patients

in whom medication does not

help and the seizure-frequency cannot

be reduced. In some of these cases,

however, an operation can be a valuable

option. Thanks to modern medical

technology and computer-support,

epilepsy surgery has become a wellestablished

therapy option. Brain surgeries

in specialized clinics are very

safe procedures. They offer patients

like little Tanja a realistic chance for a

significantly improved quality of life.

from which the epileptic seizures

originated. But such an operation

bears great risks, in the worst case

paralysis or disturbed language functions

can be caused by such procedures.

“Both the pediatricians and Tanja’s

parents were in an almost unsolvable

dilemma before they came to us” says

Prof. Staudt. “Either one dares to operate

and risks that the girl might become

wheel-chair bound, or she will

suffer from epileptic seizures for the

rest of her life.”

In Vogtareuth, on the basis of a year

-long experience, the family was offered

a very detailed treatment plan.

As a pediatric epilepsy center, this

institution is dedicated exactly to such

patients with difficult-to-diagnose and

difficult-to-treat epilepsies like in

Tanja. It is part of the Vogtareuth philosophy

to involve the parents very

tightly in all diagnostic and therapeutic

steps. During the hospital stay,

Tanja’s mother slept every night together

with her daughter in the same

room. “We want to win the parents as

partners in order to achieve an optimal

decision based on a realistic and honest

benefit-risk analysis together” says

Prof. Staudt.

An example how accurate and careful

the teams in the Schön Klinik

work can be seen late one afternoon: a

difficult case of a five-year-old boy is

discussed. All previous medical reports

and findings are collected in a

thick folder, on its first page a boy

smiles from a photograph. On the

many monitors on the wall, the boy’s

brain is shown in a three-dimensional

fashion.

Over several days, the electric cur-

Six-year old Tanja has already met

more physicians than many adults in

their entire life: epileptic seizures

started at the age of three years, many

drugs were tried, but none could help.

Seizures usually start with pain in her

tummy, then her left arm twitches and

her hand contracts, and she cannot do

anything about it. For a couple of

minutes she is unresponsive.

In Tanja’s head, a tumor had grown

in a brain region controlling motor

functions of the left side of her body.

During an epileptic seizure, the activity

in the central nervous system increases

dramatically, and electric impulses

induce uncontrollable jerks,

like in Tanja’s left arm. Since antiepileptic

drugs offered no amelioration,

the only solution was brain surgery to

remove the tumor and thus the focus

10


MEDICAL SOLUTIONS

rents in the boy’s brain had been recorded

via electrodes. During a dramatic

increase of these currents, a

simultaneous video-recording shows

how the boy wakes up during the

night, holds his ears, and hits his

belly with his hands – an epileptic

seizure.

The team, consisting of child neurologists,

neurosurgeons, neuropsychologists,

nurses and a coordinator discusses

for almost an hour about this

patient. Again and again, a child neurologist

enlarges the 3D-visualization

of the brain on a monitor, which

clearly shows the suspicious spot in

the brain: a focal cortical dysplasia,

i.e. a malformation of the cerebral

cortex, from which the epileptic seizures

originate. Finally, the team

reaches a consensus that an operation

will be the best solution. A 4.5 cm cut

will be necessary.

“A wrong movement, a wrong cut

during brain surgery can have deleterious

consequences. We must always

be aware of this responsibility”, says

Dr. Manfred Kudernatsch, Head of the

Clinic for Neurosurgery and Epilepsy

surgery. “This is why we continuously

extend our high-tech equipment for

the sake of our patients”. Already

now, the latest technology is available

at the Schön Klinik Vogtareuth: microscopes

support the neurosurgeons

during complicated procedures.

Computer-assisted imaging and 3Dvisualizations

including functional

magnetic resonance imaging and fiber

-tracking enable pediatric neurologists

and neurosurgeons to identify important

functional brain structures preoperatively.

For stereo-EEG procedures,

neurosurgeons can implant depth electrodes

into the brain, guided by a robot

assisting in finding the precise

position and trajectory of the electrodes.

All these procedures allow a

sub-millimeter precision during the

operation. Thus, the risk for functional

deficits or other negative consequences

of the operation can be minimized.

And that is exactly what happened

with little Tanja: Her operation went

very well. She has only a little scar as

a reminder. Today, she is an alert primary-school

student. Only months

ago, attending a normal school would

have been unthinkable. “Our goal is to

help the patients and their families”,

says Prof. Staudt. “Medical technology

and our year-long experience

help us to design these complex procedures

as safely and effectively as

possible.”

CLINIC FOR NEUROPEDIATRICS AND

NEUROREHABILITATION, EPILEPSY

CENTER FOR CHILDREN AND ADOLES-

CENTS, SCHÖN KLINIK VOGTAREUTH

http://www.schoen-kliniken.com/ptp/

kkh/bhz/

Prof. Dr.

med.

Martin

Staudt

is Head of the

Clinic for Neuropediatrics

and Neurorehabilitation,

Epilepsy

Center

for Children and Adolescents at the

Schön Klinik Vogtareuth, Germany. He

also holds a position as a professor at the

Eberhard Karls University, Tübingen,

Germany, dedicated to research on

“Developmental Neuroplasticity”. He

received his medical degree at the Technical

University Munich and was researcher,

assistant doctor and senior physician

at the Department of Pediatric

Neurology and Developmental Neurology

of the University Children’s Hospital

in Tübingen, where he also received

his Ph.D degree. His research interests

include neuroimaging and neuroplasticity

research in particular in the fields of

early brain lesions and epilepsy. Prof.

Staudt is author of numerous original

papers and book chapters, was awarded

for his research by German and international

societies, and is an active member

of renown scientific and medical societies.

11


MEDICAL SOLUTIONS

“Wait until I get back up and running.

Just wait!” Philip´s story

Phillip’s life changed dramatically

on January 8, 2011 when he had a

serious car accident on his way home

from work. After initially being pronounced

dead at the scene of the accident,

Phillip stayed in a coma for five

weeks. “When I woke up I couldn’t

feel anything from my chest below.”

Phillip had a complete spinal cord

injury at the vertebra T10 with no

motor or sensory function as well as

nine fractured vertebrae and a spine

fusion from vertebra T7 to L4. His

doctors told him that he would never

be able to walk again. Three and a

half months after the accident, Phillip

was told that his therapy was over and

that he had to adjust to a life in a

wheelchair. But he didn’t want to put

up with it. Also for the sake of his 10

months old daughter.

“After I got home, I bought parallel

bars and braces online and just went

for it”, says Phillip. He worked as

hard as he could and managed to stand

and take a few steps in the parallel

bars. That’s when his doctor suggested

him to try out the therapy with

the Lokomat, a robotic rehabilitation

device. The Lokomat consists of a

robotic gait orthosis, a body weight

support system and a treadmill. It reduces

the weight carried by the patient

and guides their legs on the treadmill

according to a physiological gait pattern.

It also provides challenging and

instructive feedback in virtual environments

that enhances the patient’s

motivation and active participation.

After the second therapy session with

the Lokomat, Phillip started to feel his

calf muscles pulsating. “I couldn’t

explain it, but I felt that it was doing

something good”, he says. “I fell in

love with the Lokomat that day!” After

16 therapy sessions Phillip’s own

force measured by the Lokomat sensors

and the Assessment Tool L-Force

improved greatly from 8 % to 44 %,

and he decided to move closer to the

hospital in order to be able to continue

the Lokomat therapy.

In the Lokomat

“I noticed that my steps got easier”,

explains Phillip and ads “I’ve continued

home therapy besides the Lokomat

and now I’m doing leg presses

pushing 30 pounds”. In June 2012 he

was standing on the beach as the best

man on his friend’s wedding.

Improving his motor function day by

day, his biggest motivation is his baby

daughter. “I have to get myself together

for the sake of being a father.

Cause I do want to walk her down the

aisle one day. And I will!” Besides his

own therapy goals, Phillip wants to

help and pass on his strong motivation

and spirit to as many other patients as

he can. “I want to give them hope. It’s

not only about being able to walk, it’s

about where your heart is.”

SHELLEY JAMBRESIC

The Lokomat

Developed by the Swiss-based company

Hocoma, the Lokomat is a

driven gait orthosis that automates

locomotion therapy on a treadmill. It

improves the therapy outcome by

providing highly intensive, individualized

training. The Augmented Performance

Feedback of the Lokomat

provides motivating, challenging

and instructive functional feedback

in virtual environments. As virtual

reality enhances the patient’s active

participation, the Augmented Performance

Feedback encourages and

helps improving the patient’s compliance.

The Lokomat is used to

improve mobility of gait-impaired

patients following stroke, spinal

cord injury, cerebral palsy and multiple

sclerosis as well as other neurological

diseases and injuries. The

Lokomat has been on the market

since 2001 and has been developed

working closely with leading clinics

and research centers worldwide.

http://www.hocoma.ch

This could be

your advert in the

next issue

Size 70 x 100

mm

1/9 portrait

12


13


HEALTH TRAVEL

Free Choice of Doctor

National regulations and the global challenge

Selecting a doctor

It is the basic right in most, but not

all, European countries for a patient to

select a doctor according to their own

free will. The insurance companies or

cost bearers do not have the right to

recommend or direct patients to a particular

doctor or clinic.

The reality is quite different of

course, as the patient is not left alone

by his General Practitioner with the

statement: “Its completely up to you

where you want to go! Here is the

yellow book of hospitals for your cancer

treatment…!” The GP counsels

the patient on where and whom to be

treated by.

Selling the patient

This situation is a bit of a two sided

coin. There have been recent scandals

in Germany where the referral against

payments between doctors have been

brought to the government’s attention.

Doctors in Germany who send patients

to colleagues, in order to receive

financial compensation for the

referral, can lose their license from

the chamber and face a law suit. The

whole procedure is a criminal act and

many cases are currently under investigation.

The best part about a doctor to doctor

referral is that in more than 85%

of cases there is quality control: the

patient is helped to meet an informed

decision and guided to the best medical

solution available to them in their

particular area, irrespective of commercial

advantages. These days patients

often try and find out health

information through the internet. In

almost all the cases where a patient

uses the internet for their health information

there is one simple piece of

advice: “Go and talk to your doctor!”

A patient cannot decide which professional

therapy to choose—not even

when they are a doctor!

International healthcare opens new

dimensions but also highlights new

gaps in counseling quality. Many

print magazines and newspapers offer

to close these gaps. Some of them

even try to attract readers by coming

up with a list of the “100 best doctors

in town” or the “500 top physicians in

the country”. These reports are then

repeated on a yearly basis with the

names and addresses constantly

changing. One suspects that the flexibility

of these lists is not just down to

the the normal fluctuation of doctors

in towns. Meanwhile the periodical

appearance of such reports are not

taken very seriously by the readers.

Institutes that refer patients from

abroad to high quality destinations

often seem to love these gazettes as

they serve them with a quick and easy

reference of where to send their patients.

The informed patient

Treatment Abroad, a provider of

neutral patient information, offers

guidelines for patients on what to

check before making a decision. For a

patient the question of “where to go”

before they appoint a doctor is a very

Source: Haderer, Dealing with malpractice

important one. It is not simply a question

of “Who is the best doctor?”

They need to consider the answers to

a complex set of questions.

We have asked Keith Pollard from

Treatment Abroad, what he recommends

a patient should consider before

making their choice. He says:

“Making the right choice of clinic or

surgeon for a treatment abroad involves

asking questions. Lots of

them! The responses will help them

make the right decision. If one is not

happy with the answers or the clinic

even avoids answering specific questions:

go somewhere else…” “Our

checklists may offer you 50 questions

or more. We still regard this as by no

means an exhaustive list but it gives

the patient an idea of the sort of questions

to ask”, says Pollard. Detailed

check lists for various conditions can

be retrieved from Treatment Abroad /

Intuition directly.

Hints and Tips

The Treatment

- is there a waiting list to be seen?

- what policies do you run to reduce

risks?

- what is the teatment methodolgy?

The Doctor

- detailed profile and background?

- qualifications and trainings?

- member of which associations?

- can I speak to the doctor directly?

The Clinic

- accreditations?

- level of fluency in English/home

language

- post operative infection rate

- documentation system for surgeries?

Quality and Track Record

- success rates on medical outcomes?

- can I speak to past patient´s expe

riences?

- are there patient satisfaction records?

- complication rates?

If something goes wrong…

- backup facilities inhouse? ICU?

- what kind of malpractice insurance?

- complications are covered with the

price?

- guarantees for treatment/materials?

Cost and Paying Arrangements

- total cost proposal, what is included?

- payment methods? Paying upfront?

Source: www.treatmentabroad.com

UWE KLEIN

14


15


SPA AND WELLNESS

Destinations: Where Actually Do

Germans Go?

Evidence from a market study

Germans like “kuren”

Germans take “kuren” very seriously.

“Kuren” can be translated as “going

for a regeneration trip with thermal,

massage, nature, good food and exercises

for the body, mind and soul,

usually for a period of two weeks or

more and only for health reasons”. It’s

not for fun—it is taken very seriously.

So seriously that a patient needs a

prescription for “kuren” from a general

practitioner or specialist, in which

it is written that the “Kur” (the spa

and medical stay) is needed to improve

their overall health condition or

just to treat certain chronic diseases.

Once the patient has this paper they

may then go and ask their insurance

company for complete or partial compensation

for the proposed cost of

such a stay. The insurance company

will then approve the compensation

according to their policies and the

patient can start organising their

travel arrangements.

The “Kurwesen” (the culture around

this type of German medical wellness)

began in the 19th century when German

aristocrats tried to spend their

vacation near to the “Kaiser” who

selected a “Kurort” for his stay. During

the summer time many celebrities

could be found at these places. The

“Kurort” - the location of the resorts—received

a special suffix: the

“Bad” (bath). As soon as healing

powers were found within the environments

of small towns and villages

they were almost immediately promoted

as “baths”.

Cost Compensation

In the modern era many Germans

travel abroad to visit the most highend

spa facilities and other similarly

famous destinations to find a cure.

The EU cross-border laws make it

possible for German insurance companies

to compensate these people,

but only in a small amount of countries.

So why not in all the destinations

of the world: such as India,

Thailand, and other high end resorts?

16


SPA AND WELLNESS

The reason is simple: the therapies

offered in these countries must be of a

similar standard to the German understanding

of what is a “proper” medical

wellness intervention.

We investigated where Germans

like to visit and what makes them

select a particular spa resort:

In Portugal, Spain and Italy S & W

(spa and wellness) is predominantly

used for holidaying purposes. These

hotels have a limited offering of S &

W, with much less emphasis on the

medical benefits. They are seen as

places of relaxation rather than medical

wellness or rehabilitation centres.

The exception is Abano Terme, which

is still a major meeting point for elderly

Germans with joint problems

(Fango therapy).

Eastern Europe

In Czech Republic, Poland, Hungary

and in the traditional S & W regions

(Marienbad, Abano Terme) the

definition of what is meant by the

term “wellness” has a much broader

scope. Most of the hotels in these areas

have their own medical department

and hold a larger portfolio of

treatments, as well as providing the

classic massage and the usual wellness

offers.

The average stay is for 1—2 weeks.

Modern spa complex’s also attract

Germans for a shorter recuperation

period of around 3 days, usually over

a weekend to “reload the batteries”

and to balance stress and avoid the

risk of burnout.

Looking at the results it is evident

that elderly people over 60 years of

age often select Poland as their preferred

destination, mainly for the improvement

in their health. Marienbad

in the Czech Republic is also a particularly

well known location for

treatment, with the average stay at the

health resort being 7 days or more.

The overseas spa and wellness market

covered around 72% of the total spending

on health costs abroad, totaling up

to €713M in 2012. This market is also

predicted to grow but to say by how

much or how fast would be speculating.

The countries where patients are

free to choose their treatment are listed

in the table. The criteria is based on

how travelers revealed that these criteria

were the most important for the

general satisfaction of the patient and

the willingness for them to want to

come back. The recreational factors or

improvements in their health conditions

were not as important.

Combinations

There is now a desire for the combination

of spa and wellness offers combined

with some outdoor or cultural

excursions. Staying in a spa both during

the day and night is seen as boring...In

fact the combination of medical

well being, treatments and holidaying

is the greatest interest among insurance

members. One reason for this is

due to the fact that the vacation period

is now increasingly seen as a time to

do something for ones health. The

stresses of day-to-day life offer a very

limited time to actually attack these

major problems. The alternative would

be a period of sick leave from work, as

it can not be emphasised enough the

amount of stress work places people

under.

Countries eligible for cost remuneration

by German health insu-

Rances for medical spa travel:

Austria, Czech, Denmark, France,

Greece, Hungary, Italy, Liechtenstein,

Poland, Portugal, Romania,

Slovenia, Switzerland

17


THE LEGAL VIEWPOINT

Medical Tourism, Law and Ethics

Patients with passports

BY GLENN COHEN

Korea

Harvard Law School (HLS) Assistant

Professor I. Glenn Cohen lay on a table

in a South Korean hospital and tried to

relax as a worker wearing a white shirt

and black pants methodically drove his

elbow into Cohen’s back.

The massagelike form of chiropractic

therapy was anything but relaxing,

Cohen recalled. “It was the most rigorous

massage I’ve ever had. There was

no informed consent. I remember

thinking, ‘Oh, my God, are they going

to break my back?’ ”

Fortunately, Cohen, who recently

visited the hospital while researching a

new book and was a willing test subject,

left with his back intact and with

fresh insights about medical tourism.

The hospital, one of many springing up

worldwide to attract foreign clients,

specializes in combining Eastern and

Western approaches to medicine.

On the sixth floor, hundreds of pots

of customized herbal teas simmered,

ready to treat a range of maladies.

Other floors

were filled

with state-ofthe-art

operating

rooms

and office

suites offering

patients

more conventional

therapies.

Cohen, codirector

of

HLS’s Petrie-

Flom Center

for Health

Law Policy, Biotechnology, and Bioethics,

said that globalization and advances

in technology have transformed

health care in the past decade, making

procedures such as remote diagnoses

and telesurgery — in which a surgeon

can operate on a distant patient by using

a robotically controlled arm — a

more common practice. As part of that

trend, cheaper travel has led to increasing

numbers of people crossing the

globe for medical care.

American medical travel

Americans have begun traveling to

Mexico for a range of medical procedures.

The border towns of Tijuana and

Mexicali offer tummy tucks, facelifts,

and dental surgeries for a fraction of

what such treatments cost at home.

And towns on the northern U.S. border

have become destinations for Canadians

unwilling to wait months to be seen

by a doctor in their own country. Medical

tourism can come with benefits, but

it also raises a serious a host of ethical

and legal questions.

Illegal services

Those issues are at the heart of

Cohen’s new book, “Patients with

Passports: Medical Tourism, Law, and

Ethics.” The focus of his year as a fel

I. Glenn Cohen, Harvard

low at the Radcliffe Institute for Advanced

Study, the book examines three

categories of medical tourism: services

that are legal in the home and destination

countries (e.g., hip replacement,

cardiac bypass); services that are illegal

in the home country but legal in the

destination country (e.g., abortion, assisted

suicide, reproductive technologies,

stem cell treatment); and services

that are illegal in both places (e.g., organ

sale).

“Growing up in Canada, everybody

is obsessed with health care, it’s always

the main topic of every election,”

said Cohen, adding that Canada’s system

offers universal coverage but is

plagued by long wait times for non-life

-threatening treatments. As a teen, he

helped his elderly grandmother navigate

increasingly frequent hospital

stays and cumbersome forms as her

health declined. The experience piqued

his interest in health policy and its intersection

with legal and philosophical

issues, and was a springboard to his

career path.

Projections

The numbers are difficult to quantify.

A survey by Deloitte Consulting

Services in 2009 estimated that

750,000 Americans traveled abroad in

2007 for medical care, though other

estimates contend the number is likely

much closer to 150,000. What is clear

is that there has been a rise in medical

tourism involving Americans in recent

years, said Cohen. And many medical

travelers leave the country in search of

cost savings.

The intersection of medical tourism

and ethical and legal questions are

the heart of I. Glenn Cohen´s new

book, “Patients with Passports:

Medical Tourism, Law, and Ethics,”

the focus of this year as a fellow at

the Radcliffe Institute for Advanced

Study.

It is published in

the edition “The

Globalization of

Healthcare” at

Oxford University

Press.

Note of the editor:

30% of all

Americans possess

a passport

18


PATIENT RIGHTS

The Legal Environment for Medical Tourism

Can business lead the way?

The complexity of rules

The laws applicable to an international

patient program are voluminous.

Health care providers are subject to

local rules and regulations regarding

safety, licensure, controlled substances,

business relationships, participation

in government health programs,

negligence and malpractice

standards, privacy, patient consent,

and many other issues. Some of those

rules and regulations create patient

rights – rights that

set patient expectations

and potentially

provide a patient a

cause of action

against a provider

that fails to satisfy

the standards of

those rules and

regulations. Others

of those rules and

regulations create

obligations enforceable

by government

agencies, and some

can even subject

violators to criminal

prosecution.

In the context of

an international

patient program the

application of those

rules and regulations

can be obscure.

For example,

if a hospital in Malaysia is treating a

patient from Germany, must the hospital

in Malaysia satisfy the requirements

of German and EU privacy

laws? What must the German provider

do to satisfy its obligations under

the privacy laws if that provider is

administer pre or post care for the

traveling patient? Can a Florida doctor

receive a commission from a foreign

provider for a patient referral?

What about one from Nigeria? If an

Indian doctor provides a consult by

telephone to a patient in Sri Lanka,

can the Indian doctor prescribe a drug

treatment? Can a patient receiving

care in Thailand travel back to Saudi

Arabia with drugs prescribed in Thailand?

These questions are sometimes

difficult to answer, and they are limited

in number only by the extent of

health care interactions.

Right now, health care providers,

medical travel facilitators and international

patients engage with each other

without complete clarity as to the application

of law.

Patient rights, government

enforcement

and business

relationships can

all be affected by

the multiplicity of

laws of the various

jurisdictions that

may be involved in

a medical travel

encounter.

The lack of clarity

and lack of

uniform global

standards has not

stopped the development

of the

medical tourism

industry. And

there is a good

reason for this.

Even though there

is a great diversity

in legal standards, legal rules are jurisdictional,

and rarely extend beyond

national borders. Accordingly, a provider

in Thailand, for example, that

treats a patient from Ireland generally

need not concern itself with the laws

in Ireland.

But these are assumptions. In very

few instances have laws been created

to address the particular issues raised

by the development of medical tourism;

and the analysis we may apply to

a circumstance has likely not been

Dale C.

Van Demark

is a partner in the

I n t e r n a t i o n a l

Health Industry

Advisory Practice

of McDermott

Will & Emery

LLP, one of the

world’s leading

law firms. Mr.

Van Demark advises health systems

on strategic affiliation and merger

transactions, international patient program

development, telemedicine, and

governance and business matters. Mr.

Van Demark works with both US and

non-US clients in their global health

care development efforts.

tested by the courts or other government

agencies.

Is this a sustainable

environment?

Some governments have begun to

address medical tourism, but it is

unlikely that uniform standards or

even compatible structures will be

developed. In addition, government is

generally reactive, and works to correct

a perceived problem. Accordingly,

regardless of whether the current

mish-mash of laws represents an

efficient environment for the development

of the medical tourism industry,

it is what we have.

In this environment, the medical tourism

industry would be well-advised to

pay careful attention to applicable law

and not create issues for governments

to try to address. By demonstrating

that the industry is addressing the fundamental

policy concerns of safety,

protection of patient data, and sufficient

transparency for informed decision

making and showing a respect for

local law, the industry can establish an

environment where the development

of law will be rational and supportive,

rather than reactionary and destruc-

19


ALTERNATIVE MEDICINE

A Never Ending Plague

Chronic Sinusitis

A flash light on alternative remedies

A widespread disease

About 15% of the population in

Western industrialized countries suffer

from a chronic inflammation of

the sinuses. The symptoms include a

headache, fever and a congested nose.

Acute rhinosinusitis is defined as an

inflammatory process within the nasal

sinuses which takes a maximum of 12

weeks to clear. The reason for the

illness is due to a nasal infection

which results in a concomitant blocking

of the sinus drain and disturbed

ventilation.

With “chronic sinusitis” the symptoms

last longer and can continue beyond

the 12 week period. The creeping

obstruction is due to an increased

tissue growth inside the sinuses and a

complete inflammation of the mucous

membranes.

Sinusitis should be seen in a systemic

context and not as an isolated

disease. 25 to 30 % of all allergic patients

have sinusitis. 43% of Asthma

patients suffer from sinusitis, 37% of

organ transplant patients are affected

and 54—68 % of all AIDS patients

suffer from the condition.

Antibiotics

For many years the therapy of

choice has been antibiotics, with the

assumption that bacteria was the main

cause of the infection. More recent

research has shown that the “wrong

criminals” may have been chased. The

main reason for the infection now

seems to be down to a virus and not

bacteria.

The first reaction of most doctors is to

offer an antibiotic therapy to tackle

sinusitis, without considering the fact

that many germs have multiple resistances

to this form of treatment. This

results in many patients having no

reaction to the first therapeutic approach.

The second choice is then a

combination of steroids: aminopenicillin

plus a beta-lactamase-inhibitor.

Decongestion

Naphazolin, xylometazolin and other

similar substances help to significantly

alleviate the ventilation of the nose.

The aim is to facilitate the decongestion

between the nasal area and the

throat. The secretion needs room to

flow and the overloaded pressure in the

sinuses needs to be released. Although

this method aids the recovery and

helps reduce the individual symptoms

there is no proof that the course of the

disease is actually shortened. It is important

to remember that benzalkonium

chloride should not be added as

a preserving agent, as this dries the

mucous membranes and can quickly

damage the sensitive ciliated epithelium.

This is an essential part of the

mucous membrane and acts as an active

draining system, so any damage

caused to this system can result in prolonged

problems.

Plants beat chemistry

Expectorants are an indispensable

element of any sinusitis therapy. The

therapeutic guidelines published in

Germany found that substances such as

ambroxole, bromhexin and acetyl cysteine

do not shorten the duration, yet

an efficacy is attributed to a botanical

remedy (5 different ingredients): Myrtol

is an effective expectorant.

Orthomolecular

infusion

therapy

A study of the Charité (Berlin University

clinic) revealed that an intravenous

high dose procaine therapy leads

to a significant fall in the inflammation

parameters of interleukin 6 and CRP.

In combination with high dose of vitamin

C, given intravenously, one can

see an augmentation of the results.

A strong duo

A combination of Horseradish and

pepper weed has been used for many

years as a supportive therapy for infections

of the urogenital and airways.

The active agents are mustard oils

(isothiocyanate), which are highly effective

against many kinds of bacteria.

Nasal douches

Nasal douches—to be applied two

times per day with salt added to the

rinse water — this helps to dissolve

dry mucus and leaves the membranes

with the necessary humidity. This

method is both cheap and effective,

especially when applied regularly. It

can also be used preventively.

MICHAELA SEEBACHER

20


COMMUNICATION — HEALTH — MEDIA

And the Internet Has it All….Even

Cyberchondria

The web has it all

Throughout the whole world, the

internet is increasingly being used to

search for health information. Seeking

for health information on the Internet

can be very beneficial for the lay users

(non-medical professionals), but

due to the overwhelming

quantity and uneven quality

of online health information,

it could also be time consuming,

unable to provide unsuitable

and poor information.

Studies have highlighted that

search engine use can actually

increase cyberchondria

among users, and that the

search results are not always

trustworthy nor reliable.

When patients get

lost by internet devoutness

From the common cold to the

rarest and most exotic diseases,

the Internet is filled

with information about every

possible ailment. For some people, by

the time they see the doctor they think

the worst based on what they’ve read

online.

“I think it’s most common when patients

develop a new symptom, and

they’re worried about a new diagnosis,”

Allegheny General Hospital Internist

Dr. Marc Itskowitz said. It’s

called cyberchondria and it’s a growing

trend that has sufferers spending

hour after hour online reading, selfdiagnosing

and stressing out. “My left

arm was getting quite numb and sore.

I looked that up and the first thing that

shows up, heart attack,” said a young

patient. “Understanding what they’re

worried about is really critical, because

if you don’t address it, they’re

going to continue to worry about it,”

Dr. Itskowitz said. Lisa Lok, 28, said

she can’t stop. With each symptom

she reads about, there’s another right

behind it and more behind that.

“I’m hoping to find a sense of relief,

but usually the exact opposite thing

happens. I’m stressing myself, do I

have this? Do I have that?” Lok said.

Lisa has diagnosed herself with every

thing from heart disease to melanoma,

but there’s never been anything wrong

with her other than the stress and

anxiety she suffers from selfdiagnosing.

“I’ve gotten yelled at by numerous

people in my family because I’m

stressing myself out for no reason and

that’s bad for health in the first

place,” Lok said. “If you spend a lot

of time online, looking up your ailments,

you may wind up with the

wrong diagnosis, and it may cause a

lot of emotional distress. A simple 15

or 30-minute office visit can eliminate

all that stress,” Dr. Itskowitz said.

Cyberchondria can even cause some

people to delay treatment or avoid

preventive health care and that can

have deadly consequences.

“I think the information is generally

accurate on reputable websites. But,

there are a lot of crazy websites out

there, spewing out information that is

just completely outrageous,” Dr. Itskowitz

said. When looking at health

websites, one should look for information

that is supported by scientific

studies, and for material that is peerreviewed.

One should get suspicious

if the source is anonymous, if there’s

profit to gain, or if there’s a claim for

a miracle cure. Often this is not easy

to find out. Guidance may be given by

HON.

The HON code

The Health On the Net Foundation

(HON) promotes and

guides the deployment of useful

and reliable online health

information, and its appropriate

and efficient use. Created

in 1995, HON is a non-profit,

non-governmental organization,

accredited to the Economic

and Social Council of

the United Nations. For 15

years, HON has focused on

the essential question of the

provision of health information

to citizens, information

that respects ethical standards.

To cope with the unprecedented

volume of healthcare

information available on the

Net, the HONcode of conduct

offers a multi-stakeholder

consensus on standards to protect citizens

from misleading health information.

HON is funded by the State of Geneva,

several European projects, the

French National Health Authority

(HAS) and the Provisu foundation.

How Do General Public

Search Online Health

Information

HON conducted a survey in 2011 focused

on understanding the preferences

and needs of general public

regarding the use of search engine for

health and medical purposes. 385 answers

were collected, representing

mostly the opinions of highly educated

users from the healthcare and IT

fields.

The main findings revealed that the

21


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Internet was reported to be the second

source of health information after

physicians, due to its accessibility and

“easiness” of use. Most of the users

were WiFi connected and using smartphones

or laptops. The most commonly

searched types of online health

information are treatment/therapy

(62% rated it as always or often), detailed

(58%) and general (53%) disease

descriptions, drug information

(51%), side effects (51%) and scientific

articles (50%).

The most important characteristics of

a search engine are relevance and

trustworthiness of results. It seems

that the main problem is that results

currently retrieved using a general

search engine do not satisfy these requirements.

Smart search

The Health On Net foundation offers

an internet search tool which shows

you only HON approved information

sources on the web. One need to enter

a search string for

example like “knee

surgery” and selects

the category of information

according to

your user status: patient,

publisher,

medical professional

and other. The search delivers links to

trusted content in the web. All patients

should be informed about this valuable

tool by their doctors before they start

searches by themselves and getting

confused or mislead by web publishers

on health solutions with commercial

interests.

Especially in Medical Tourism quite

often a medical information is being

marketed by different channels which

lead back to some providers with a

promotional interest behind. HON offers

also with its toolbox a specified

search for only HON approved websites.

Web publishers can apply to get the

certification by fulfilling the strict criteria

.

Sources: HON and CBS local Pittsburgh

http://www.hon .ch

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issue

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next issue

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23

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SPECIAL EVENT

The Rise of Stem Cell Tourism

Panel decries overseas clinics that provide treatments

devoid of scientific validity

Experts gathered at

Harvard

Internet sites offer help for people

suffering from a dizzying array of

serious conditions, including: Alzheimer’s,

Amyotrophic lateral sclerosis,

atherosclerosis, autism, brain

damage, cancer, cerebellar ataxia,

cerebral palsy, chronic obstructive

pulmonary disease, Crohn’s, diabetes,

diseases of the eye, genetic disorders,

Huntington’s, kidney disease,

lupus, muscular

sclerosis, muscular dystrophy,

Parkinson’s, rheumatoid

arthritis, spinal

cord injury, spinal muscular

atrophy, stroke, and

Tay-Sachs disease.

There are clinics all

around the world — but

especially in China, India,

the Caribbean, Latin

America, and nations of

the former Soviet Union

— that will provide stem

cell treatments for those

long-intractable conditions.

Never mind that

cancer is the only disease category on

that list for which there is published,

scientifically valid evidence showing

that stem cell therapy may help. Thousands,

if not tens of thousands, of desperate

people are flocking to clinics

that charge tens of thousands of dollars

for every unproven treatment.

Stem cell tourism

That “stem cell tourism” was the

subject of a panel discussion titled

“Stem Cell Therapy and Medical

Tourism: Of Promise and Peril?” presented

by the Harvard Stem Cell Institute

(HSCI) and the Petrie-Flom Center

for Health Law Policy, Biotechnology,

and Bioethics.

Brock Reeve, HSCI executive director,

introduced the topic by pointing

out to those attending the session in

Harvard Law School’s Austin Hall

that there is medical tourism, and then

there is medical tourism. After all,

Reeve noted, patients flock from all

over the world to the Harvardaffiliated

Massachusetts General Hospital,

Brigham and Women’s Hospital,

Dana-Farber Center Institute, and

other Boston research hospitals for

cutting-edge, scientifically validated

treatments for a host of diseases.

Stem cell

But then there is the other kind of

medical tourism, and every member of

the panel agreed with speaker Timothy

A. Caulfield, the Canada Research

chair in health, law, and policy at the

Timothy A. Caulfield

University of Alberta, when he said

that the stem cell tourism phenomenon

“hurts the legitimacy of the entire

field” of stem cell science and medicine.

While adult stem cells have been

used for decades to treat a number of

malignancies — bone marrow transplants

are, in fact, blood stem cell

transplants — those treatments,

said George Q. Daley, the Samuel E.

Lux IV Professor of Hematology/

Oncology and director of the Stem

Cell Transplantation Program at Children’s

Hospital Boston and Dana-

Farber Cancer Institute, are the only

stem cell treatments that are not experimental.

It may take decades

Daley, a member of the

Harvard Stem Cell Institute’s

executive committee

and past president of the

International Society for

Stem Cell Research, added

that “we are seeing a growing

number” of legitimate

clinical trials, “but all such

uses are experimental … and

there is great skepticism as

to whether we have” the

scientific knowledge and

basis even to “predict that

these will be effective.” It

may, he said, take decades

before there is certainty.

But the overseas clinics selling stem

cell therapy for a sweeping catalog of

diseases aren’t offering patients places

in clinical trials. They are touting

what they claim are established treatments,

with proven results. Caulfield

and his colleagues in Alberta have

conducted a number of studies on

what is being offered at the overseas

clinics, what claims are being made,

who is seeking the treatments, and

why. He said that the treatments are

offered as safe, routine, and effective,

but “none of what is being offered

matched what the scientific literature

said.” He accused the clinics of

“financial exploitation” of desperate

people, and said those who raise

money to finance pilgrimages to them

are “raising money to turn over to a

fraud.”

24


SPECIAL EVENT

I. Glenn Cohen, an assistant professor

at Harvard Law School and codirector

of the Petrie-Flom Center,

suggested that one way to

slow stem cell tourism could

be to prosecute for child

abuse when the treatment

involves minors. “This falls

under existing child-abuse

and neglect statutes,” Cohen

said.

“I am sympathetic to parents”

who believe they are

helping their children, he

said, suggesting that pediatricians

in the United States

should first try to convince

parents to agree to the use of

proven therapies, next try to dissuade

them from using unproven therapies,

then threaten to report them to the authorities,

and, when all else fails, report

them.

One member of the panel was at a far

remove from stem cell research, patient

treatment, and science. So it came as

little surprise that Jill Lepore, David

Woods Kemper ’41 Professor of

American History and chair of Har-

George Q. Daley: Stem cell tourism is

financial exploitation of desperate people

vard’s History and Literature Program,

came at the issues from a very different

perspective. “I don’t have patients,”

Lepore said, “I have characters.” She

then proceeded to tell the story of

Robert Ettinger, who for decades ran

the Cryonics Institute outside Detroit,

which offered its clients the hope of

eternal life by freezing their brains

after death until some future time when

the condition that claimed

their lives could be cured.

die.”

B.D. COLEN

Lepore pointed out that the

institute recently was reclassified

a “cemetery” by the

state of Michigan. She said

there is a kind of “faith in

science that draws” some

people to any promise of a

cure for disease, no matter

how specious. What fuels

this false hope, she said, is

“one of the most dangerous

elements of our culture: that

we have forgotten how to

This article was first published in the

Harvard Gazette, November 2012

Reprint with friendly permission.

http://news.harvard.edu

25


Supported by the EU

Medical tourism in Poland is now

seen as having considerable export

potential and is to be developed as a

new tourism product. In 2011 it was

estimated that 300,000 foreign

patients were treated in Poland

and in 2012 this figure rose to more

than 500,000. Poland is already a

popular medical tourism destination

for patients seeking, for example:

dental treatment, cosmetic surgery

and orthopedic treatment. Poland

also places great emphasis on cardiac

care, both invasive and non-invasive.

The country has a very modern medical

infrastructure especially in oncology,

e.g. cyberknife treatment. So

what more does Poland have to offer?

Poland has a long tradition in health

care that dates back centuries and has

been very successful in health improvements

through both health resorts

and medical spa treatments.

These traditions have now

been both revitalised and modernised.

Governmental attention

In 2012 medical tourism was selected

by the Ministry of Economy as

one of the 15 priority sectors in a pro-

COUNTRY FOCUS

Medical Tourism Is on the Rise in Poland

What Poland offers to patients from abroad

Medicover Hospital

ject for the promotion

of Polish exports.

The project for

the promotion of

medical tourism

started in 2012 and

will last until March

2015. The project is

part-financed by

funds from the European

Union and is

part of the overall

project that was implemented

by the

Polish Ministry of

Economy - “The

Promotion of Polish

Economy on International

Markets”, Submeasure

6.5.1 of the

Innovative Economy

O p e r a t i o n P r o -

gramme."

The promotional

activities are implemented

by a consortium

consisting of the Polish Agency

for Foreign Investment (PAIiIZ), the

European Center for Enterprise

(EuCP) and Ameds Centrum. The

consortium has great experience in

both medical tourism and organising

promotional campaigns. The leader of

the consotium is EuCP, which has

long term experience in supporting the

development of Polish enterprises

financed by the European Union. The

promotion of medical tourism will be

focused on the following countries:

Denmark, Sweden, Norway, Germany,

Russia, the UK and the USA.

The promotional programme is an

initiative from the Ministry of Economy.

Medicine in Poland

Poland is home to a number of innovative

treatment technologies and

can also offer a high quality

of services at up to 80% lower costs

then the rest of Europe and America.

Poland also benefits from an excellent

location in the heart of Europe and

offers superb tourist attractions for

people who are looking to extend

their stay after recovering from treatment.

26


COUNTRY FOCUS

There is also an opportunity to enter

the medical travel market with a visit

to an international fair. Visitors are

given the opportunity to talk to Polish

clinic and healthcare providers and set

up meetings with potential business

partners. The closest fairs are the:

“Moscow International Travel &

Tourism Exhibition” which will be

held from March 20 th -23 rd , 2013 and

“The International Medical Travel

Exhibition and Conferences” (also

called IMTEC) which will take place

in Monaco on March 22 nd -23 rd , 2013.

At the Moscow fair Polish healthcare

will be represented by 3 companies,

while at the IMTEC fair, which is

more popular among Polish facilities,

8 clinics and healthcare providers will

be present in the 72sqm arena. The

Polish stand will be situated at location

D12. Anyone interested in Polish

healthcare will have the chance to

visit a number of polish companies

and speak directly with potential business

partners.

Back in December there was an organised

inbound programme held in

Poland and aimed at foreign intermediaries.

It was an excellent opportunity

for Polish clinics and hospitals to

collect information about marketing

opportunities and potential sources to

attract more patients.

Combining treatments plus

vacation

It is important to emphasize that

Poland views medical tourism as a

bonus of being able to visit a number

of interesting tourism attractions in

Poland.

According to the findings of the

CBHCC study for German Outbound

Medical Travel combining treatments

with vacation found the highest interest

of German medical travelers to

destinations abroad. Costs are partly

taken by German insurance compaies.

KAROLINA DRESLER

MICHAELA SEEBACHER

Interested parties who want to visit

Polish facilities please contact

Karolina.dresler@paiz.gov.pl.

Pictures with friendly permission

from the Polish National Tourism

Board.

Fishing boats at Baltic Sea beach

complementary service. Visitors to

Poland can access health care services

and improve their aesthetic appearance

while also being able to relax, recooperate

and improve their physical

well being. There is also the added

27


CULTURE - ARTS - HEALING

The Healing Power of Arts

Looking for new ways

Arts and healing

For many centuries different cultures

have discovered and used many

different powers of healing. This

knowledge has already managed to

fill many libraries: more than 19,000

entries appear on Amazon when you

search for “Art & Healing”. The literature

alone would justify a special

department at any university or school

of medicine.

Placing paintings in hospitals makes

sense. Cedars-Sinai Hospital in Los

Angeles underlines this point with its

exceptional collection of masterpieces:

“The Art of Healing.” When

her husband was hospitalized in 1966,

Marcia Simon Weisman saw the healing

power of art first hand. After her

husband Frederick had made a full

recovery, they decided to launch the

Cedar-Sinai´s prized collection – now

thousands of masterpieces are displayed

in the hospital , allowing both

doctors and patients to enjoy the displayed

works.

We were interested in finding out

what other medical treatments use art

as a healing process. The journey led

us to Spain in search of some examples.

Painting is said to have a therapeutic

effect on the painters themselves.

Healing music and the use of music in

therapy is well known, but are there

healing pictures? Does it work by a

combination of colours and messages

Have arts healing powers?

or by the scene itself? Many artists in

our health classes have discovered the

potential of art and started to investigate

this very question. We were curious

about what they were offering in

Spain, especially in Catalonia, where

so many famous painters have

worked. Barcelona itself is full of

designers and artists and is a city with

a long tradition in the arts.

MAPE in Barcelona runs

the organisation where people

can find a number of

services that are connected

to both Spanish tourism

and a healthy lifestyle. A 7

day tour will get you in

touch with Mediterranean

cooking, as well as learning

skills from both painters

and moviemakers that explain

the healing components of the

arts.

“ The main interest for our customers

is to get to experience the same

places and activities

that were the

source of inspiration

and crafted the

character and creative

genius of our

artists”, says Eva

Martinez, Oficina

Técnica ´El Paisaje

de los Genios`.

“The most common

reaction is one

of complete surprise

when they

discover the places

that are related to

this genius.”

It is also good to

know what influenced

the famous

painter Picasso and

helped him to become

so inspired.

Picasso lived in

Horta de Sant Joan

on two separate

occasions. On his

first stay (1898-

1899) he arrived in

ill health, but after spending some

time in the natural surroundings of the

pristine Els Ports mountains, he be-

The tour of geniuses

Pablo Picasso: La Fabrica de Horta

came filled with energy again. He returned

to Horta for a second time in

1909, during the beginnings of the

Cubist movement.

One of the effects of the tour may well

28


CULTURE - ARTS - HEALING

be an increase in curiosity. Wendy Star,

the founder of “Good Clean Love”

writes about the healing powers of Curiosity:

“Curiosity is the seed of wonder

in us and provides the easiest doorway

to a positive outlook. It requires our full

presence and, like a good friend, will

guide our attention with high awareness

and intelligent questions.”

Marios Kyriazis, Biomedical Gerontologist,

writes in “Quora”: “By exposing

yourself to new questions, new

points of view and new mental challenges,

you increase the amount of

meaningful information that reaches

the brain, and this has several positive

biological effects such as improving

immunity. The process is based on

general hormesis via environmental

enrichment which has been studied in

hundreds of published peer-review

papers.”

Slow food cooking

So MAPE, the organiser of the

tours, seems to have discovered a new

niche: combining arts and culture and

surrounding yourself with active elements

of healing and well-being. A

relaxed stay in a spa resort is also a

modern way of increasing the powers

of regeneration, but more active activities

during a health vacation are

also of great interest to a lot of travelers.

It seems that this new way of experiencing

healing powers and learning

more about oneself will have a

very bright future.

And what’s more, it will also taste

great: the following are the dishes the

group prepared in several sessions

during the journey:

1st session: Vegetables, salads, fish

‘suquet’ (fish with sauce), romescos

(sauce), and pastry coated with oil.

2nd session: Appetizers pica-pica, rice

cooked in different styles: casserole,

paella, fideus rossos (noodles paella),

And fruit desserts.

3rd session: Tapas: classical bar

tapas: patates braves (fried potatoes in

a spicy sauce), pops picants (hot octopus),

bombes de potato (potato bomb),

mussels, clams, esqueixades (cod

salad)… Home made ice creams.

4th session: Traditional dishes with

meat and vegetables, innovated.

The teacher during these sessions is

Catalan cook

Mariona Quadrada

M a r i o n a

Q u a d r a d a ,

who has more

than 25 years

experience in

Catalan slow

food cooking.

She was the

chef at the

C a t a l a n

C o o k i n g

show in Madrid

at the

Ritz Hotel. “I

am most enthusiastic

about my work when I see

how much fun the tourists have in

these cooking classes. You can see

from their eyes and cheeks that their

immune system is being boosted!”

Another part of the health tour is the

discovery of healing powers in a spiritual

way. Spiritual Tourism is the realisation

that there are activities that

allow us to learn about our real inner

selves and our inner well-being. People

can find motivation in the path

between religious tourism and health

tourism, as well as sports tourism and

creative tourism. The main objective

of spiritual tourism is to bring about

reflection: all the activities are routed

to the goodness of inner peace, mysticism

and peace of mind in a quiet environment.

The Cister route

In Spain you can find this in the CIS-

TER ROUTE. The name comes from

the fact that each shire in the Tarragona

region has a Cistercian monastery:

Santes Creus, Poblet and Vallbona

de les Monges. The tour explores

the monasteries, which are both

monumental and sombre, and lets you

discover their own traditions and landscapes.

Visitors can discover a land

rich in culture, heritage, nature, wines

and cava (champagne), festivals and

age old traditions - A much healthier

option than simply sun bathing for 2

Cooking Holidays

Duration: 7 days

Who: Individual or for groups

When: Available upon request year

round

Cost: From 2400€ per person

Where you go - What you do:

6 nights accommodation

Breakfast daily

Domestic transportation

Welcome drink

7 Lunches - Dinner

4 Cooking Lessons

1 Wine tasting in cellar

1 Olive oil tasting in mill

All culinary and cultural excursions

English speaking guide

Local taxes

Entry fees as per the itinerary

A Culinary present

hours at high noon....

Pedro, the initiator of the Tourism and

Health service, adds: “We have found

out that health tourism is the big sister

of medical tourism for our region…

There are so many locations which, in

combination with the healing impact of

arts on individuals, should be brought

to the attention of the active medical

wellness traveler.”

MAPE is a company that specialises

in tourism and health services. These

new services not only promote and

improve health but also give the opportunity

for people to visit special

tourist attractions and get in touch

with both culture and the arts. MAPE

TyS has created a tailor made health

tour by offering excellent value and

great services for tourists visiting our

country, while also managing to cater

to their specific profile and needs.

This new type of tourism has opened

a niche market where there is both

collaboration and coordination between

experts who can supply specific

services and innovative

products.

Contacts for MAPE:

Pedro Mª González. pedro@turismosalud.com

Margarida Colet. marga@turismosalud.com

Phone: +34 606 374 138

www.tourism-health.com

29


HEALTH TECHNOLOGY

Cyberknife Now

in Ankara

How it works

Scanning

Prior to treatment with the Cyber-

Knife System, the patient undergoes

imaging procedures to determine the

size, shape and location of the tumor.

The process begins with a standard

high-resolution CT scan, or for certain

tumors other imaging techniques,

such as MRI, angiography or PET,

may also be used. The CyberKnife

treatment planning software helps

integrate CT scans and other imaging

data into the pre-treatment planning

process.

Cyberknife advantages

Treats tumors anywhere in the body

Continuously tracks, detects and corrects

for tumor and patient movement

throughout the treatment

Delivers high-dose radiation with sub

-millimeter accuracy, minimizing

damage to surrounding healthy tissue

Treats tumors from virtually unlimited

directions with flexible robotic

mobility

Provides an option for patients diagnosed

with previously inoperable or

surgically complex tumors

Treats patients in as few as one to

five visits

Improves patients quality of life during

and after treatment

Non-invasive alternative to surgery

Pain free and requires no anesthesia

Minimal side effects

Outpatient procedure with little or no

recovery time

Allows for an immediate return to

normal activities

Source: www.ankarascene.com

Planning

Following the scanning, the image

data is then digitally transferred to the

CyberKnife System's treatment planning

workstation, where the treating

physician identifies the exact size,

shape and location of the tumor to be

targeted and the surrounding vital

structures to be avoided. A qualified

physician and/or radiation oncologist

or physicist then uses the CyberKnife

software to generate a treatment plan

to provide the desired radiation dose

to the identified tumor location while

avoiding damage to the surrounding

healthy tissue. As part of the treatment

plan, the CyberKnife System’s

proprietary planning software automatically

determines the number, duration

and angles of delivery of the

radiation beams.

Treatment

During a CyberKnife procedure, a

patient lies comfortably on the treatment

table, which automatically positions

the patient. Anesthesia is not

required, as the procedure is painless

and non-invasive. The treatment,

which generally lasts between 30 and

90 minutes, typically involves the

administration of between 100 and

200 radiation beams delivered from

different directions, each lasting from

10 to 15 seconds. Prior to the delivery

of each beam of radiation, the Cyber-

Knife System simultaneously takes a

pair of X-ray images and compares

them to the original CT scan. This

image guided approach continuously

tracks, detects and corrects for any

movement of the patient and tumor

throughout the treatment to ensure

precise targeting. The patient typically

leaves the facility immediately upon

completion of the procedure.

The technology cannot be applied

to all kind of surgical interventions.

According to the Northern Germany

Cyberknife Center the method needs

to fulfill the criteria for radiosurgery

which is listed below.

Cyberknife indications

- primary and secondary brain tumors

and metastases

- pain syndromes (trigeminus)

- meningeoma

- pituitary gland adenoma

- spinal neurinoma and meningeoma

- chordoma and primary sarcoma

- liver cell carcinoma and singular

liver metastatses

- certain lung carcinomas

- limited lung metastases

Within studies:

- carcinoma of the pelvis

- renal carcinoma

- pancreas carcinoma

- craniopharyngeoma

Cyberknife at Medicana International Ankara Hospital

Cyberknife technology is available in

32 countries. Check for worldwide

availability at:

http://www.cyberknife.com/

CyberKnifeLocations.aspx

30


MY SAY - DENTISTRY IN TURKEY

Dentistry in Turkey

BY DR. ELIF ÇIFTÇIOĞLU

The perspectives

A basic dentistry degree in Turkey

lasts 5 years. People who graduate

with a specific degree from a dentistry

faculty (numbering 48 in total) take

their first steps into this field of work

by taking the title “Dentist”. There are

currently around 24 thousand dentists

working actively in our country. Considering

the total population of Turkey

is around 74 million people, this

works out at 1 dentist for every 3,000

people.

The potential of up to 3,000 patients

often leads to many newly graduated

dentists considering the idea of opening

up their own clinic. Dentistry services

in Turkey receive around 80-

85% of work from clinics. The clinics

play an important role in informing

patients about relevant illness and

health subject material and also help

create a personal relationship between

the patient and the dentist.

However, this low dentist to patient

ratio has started to change as a result

of the policies applied under “The

Change in Health” Act. The increase

in dentists working in public health

centres, and the increase in these

health centers themselves, has resulted

in changes to the clinics. Basic dentistry

courses have now started to be

taught in these public centres. There

were around 1,500 dentists working in

public centres in the year 2000 but

this number has now climbed to

around 7,000.

The number of dentists per thousand

people in Turkey stands at 0.3, while

in OECD countries the average figure

is 0.7. This highlights the low number

of dental products and services in Turkey

and also highlights the potential

for growth. The Turkish Government

wants to increase the number of dentist

per person to the figures seen in

other EU countries. They aim to have

50,000 dentists working in this area

by the year 2023. The rise in the numbers

of Dental Health Centers

(ADSM) and Dentistry Faculties highlights

their determination in reaching

this target.

Dental hygiene

However, toothpaste consumption in

Turkey stands at just 110 gr and

toothbrush consumption is still under

1 unit per person per year. The frequency

in which Turkish people see a

dentist is also below one visit per

year. I believe that doubling the number

of “dental health centers” and dentists

will still not be enough to solve

dental health problems in this country.

Unless Turkish society is made more

aware of dental health care, I can only

see the number of unemployed dentists

increasing.

In more positive news, the number of

special dental branches in Turkey has

increased to 8 in total in 2011. Orofacial

and Maxillofacial Surgery, Maxillofacial

Radiology, Pedodontics, Endodontics,

Orthodontics, Periodonthology,

Prosthetic Dentistry and

Restorative Dentistry have all become

new specialties. There is also the option

to complete a post-graduate dentistry

education of 3 or 4 years by

passing the “Examination for Specialty

in Dentistry.” This is in addition

to the original 5 year basic dentistry

education.

Demand of services

There has been a rise in patient demand

for more policlinics and hospitals

that have international quality

standards and have more than one

dentist/specialist working together.

These clinics and hospitals have a

wide range of dental services all under

one roof and provide patients with all

their dental health needs.

These centres also provide the option

for general anesthesia, which is often

the preferred choice for children, patients

who feel scared or anxious, patients

with a mental health issue, or

patients with low pain tolerance. General

anesthesia operations are performed

by a qualified anesthesiologist

in secure operating room conditions.

They are often used in order to

shorten the period of treatment or to

make a patient who needs a complicated

operation more comfortable.

The increase in population, life quality

and high health service costs in

many countries has resulted in people

wanting to get a higher quality service

for a cheaper price. This has led to the

increase of health tourism. Extra factors,

such as improved medical technology,

low transportation costs and

on-line marketing has also led to the

development of health tourism.

Many areas of dental health, as well

as other branches of health care, have

been affected positively from health

tourism in Turkey. The main reasons

for this positive impact seem to be

down to the fact treatments are now

being performed at a lower cost but

with higher quality, along with the

fact doctors and specialists have been

educated to the high standards of

Western Europe and America. Both

the dental health service and health

insurance in Turkey make the country

an attractive option for patients.

I believe that Turkish dentistry will

enjoy great success over the coming

years thanks to the improved quality

of education, studies related to international

accreditation, the use of high

tech specialist equipment and the improvement

in overall quality of service.

Med. Dent.

Dr. Elif Çiftçioğlu

Born in 1978

(Istanbul/Turkey),

Dr Çiftçioğlu graduated

from the

Dentistry Faculty

of Istanbul University

in 2000. She completed her

PhD degree in Endonontics in 2008

at the same university. She has been

working as part of the Dentistanbul

Dental Group as the MD of Dentistanbul

Beşiktaş Dental Hospital

since 2008.

31


MY SAY - DENTISTRY IN TURKEY

Interview with Dr. Betul Gofteci

Dentistry in Turkey

THE PATIENTS:

When you look back to the last 10

years of dentistry in Turkey: what

improvements have been achieved in

the quality and range of services?

DR. BETUL:

In the last ten years many conditions

have changed in Turkey regarding

healthcare. We have developed a high

class implant and prosthesis technique

in dental medicine. Just as an example:

When I was still studying 24

years ago we had 9 dental faculties at

the Turkish universities. Now we have

49! The development of technologies

has seen a boom in recent years. We

now use ultramodern technologies

and, as always, when new technologies

are brought to a region you have

the latest developments. This has contributed

to the overall improvement in

quality in this country. If I speak for

our clinic we do have all the latest

technologies to serve better to the

patients. While we work multidisciplinary,

as a dental team we have opportunities

to use 3D x-ray (Dental Tomography),

Er-Yag and diode laser in

our clinic.

THE PATIENTS:

What developments do you expect to

see in the upcoming

years?

DR. BETUL:

Even more dental

clinics will open and

the quality in the system

will expand. We

are continuing our

intensive medical

education together

with the university

dental networks and the industry. I

think Turkey is getting more and more

attractive for patients.

Laser device for dentistry

THE PATIENTS:

Turkey is investing a lot in Medical

Tourism. Has this already led to more

customers from abroad?

DR. BETUL:

It needs to! And in fact we have patients

here from Netherlands, Belgium,

France and lots of Germany:

these are mainly people who have

come from Turkish roots.

THE PATIENTS:

Is the same level of dentistry in Turkey

cheaper when compared to Northern

European countries?

DR. BETUL:

Yes, we can provide better offers regarding

the cost. There are also nice

trip packages available.

THE PATIENTS:

How do patients from abroad find

you?

DR. BETUL:

They find us by using the internet ,

with the help of our agent or with our

partner clinics.

THE PATIENTS:

Do you think that cross border provider

networks are a good solution to

providing international patients with

more safety and quality?

DR. BETUL:

In fact we have a partner clinic in

Germany which is a private dental

practice. Also we have been planning

to open a dental clinic soon with the

dental department of the University of

Aachen in Germany. Patients from

this region go there for after care and

control. This helps us as doctors to

optimize our dentistry results.

THE PATIENTS:

Do you hire agencies in other countries

to send you patients or promote

your services?

DR. BETUL:

We are cooperating with agents in

Istanbul and also in the destination

countries.

Dr.

Betul Gofteci,

DD, PhD.

is working as

specialist on

periodontology

and implantology

at

Medicadent in

Istanbul.

Dr. Betul has worked in dental care

practices in different countries like

Turkey, USA and Cyprus. I had

worked at the Gazi University, Dental

Faculty, Periodontology Department

in Ankara, at the Health Ministry,

Dental Hospital in Ankara, at the

private dental clinic in New Orleans,

USA and at the private hospital in

Famugosta, Cyprus. Her specialties

are periodontal esthetics and implant

dentistry.

www.medicadent.com

THE PATIENTS:

What is your special offer?

DR. BETUL:

Our special offer is a one day dental

implant prosthesis. Patients come in

the morning, the implants are set and

in the afternoon we use our technology

to adjust the new teeth. The patients

leave us the same day with new

teeth and can eat and chew fully after

three weeks. We call this program

“fast and fixed”.

THE PATIENTS:

Thank you Dr. Betul for the interview.

The interview was held by phone on

8th March 2013

32


FACEBOOK DIGEST

Health Trends on Facebook — A Digestiory

Surfing for health….

What happens when you enter

“chocolate massage” on Facebook? At

first it seems that 1,277 pages are registered

but not all the entries are specifically

for “chocolate massage”. The

results also show sex pages with black

women and gay sites. It seems that

“chocolate massage” has many different

interpretations.

I continue with my search and click

on a page titled “chocolate day spa”.

Great: 2,335 people “like it”. When I

first enter the site I stumble upon advice

for weight loss: “Body contour

wrap” is highlighted as a option for

dropping pounds. Having no idea

about anything, I ask myself: what the

heck is this? And what has it got to do

with chocolate massage?

Weight loss?

The site promises: 14 inches of girth

loss in just 1 hour. Nice, I think, and

prepare myself a hot chocolate. While

drinking my hot chocolate I start to

calculate: 14 inches girth loss equates

to 11 kg in weight. Hold on…11 kg in

one hour? That simply cannot be fat,

it must be body water. Didn’t the old

Egyptians also use chocolate when

they prepared their mummies? During

the 18 th century women were wrapped

in corsets to contour their bodies.

They often fainted in a series due to

shortness of breath. Nowadays maybe

they faint due to the extensive water

loss in such a short space of time. It

seems history repeats itself, but not

always in the same way…

While I’m thinking “alright” I come

across another supposed sensation:

Congratulations to Mr.Miguel, who

is down 9.5 pounds his first week!

IDEAL PROTEIN makes it easy to

All that really matters these days

is how many people “like” you on

Facebook and your page ranking

on Google. Of course, that’s today.

Tomorrow it will be something

else. We move when we’re

told or you are out in the cold.I

have been advised by smart types

to “boost my web

presence”. It’s the

only way to get seen

and heard, I’ve been

told. Tweet, tumble,

broadcast, syndicate,

post. Do it! Do it now!So off I go

to Elance, the online outsourcing

website, to see who can help

“boost” me. It seems everyone

can. There is a virtual army of

people out there just waiting to

help me optimize, spin and link my

way into Facebook fame and

Google glory. I contact a couple of

elancers and they all seem super

perky to help. Every email starts

with a casually excited “Hi!”.As I

scroll though the thousands of experts

neatly divided into business

categories that did not exist 10

Forget love—I just want to be “liked”

I told a friend over lunch recently that

we are all working for two companies

— Google and Facebook.

years ago, I think to myself, “there

has got to be a better

way.” Apparently not. The algorithms

that drive the machines that

determine your cyber fate is a very

dark art. It’s part science, part

alchemy. Mix five parts tweet

with one part daily blog and syndicate

frequently to get one page

higher on Google.

How do you know it will

work? You don’t. That’s what

keeps us all running through the

maze looking for the cheese.

This has me reminiscing about the

Farah Fawcett poster I had on my

wall growing up. She could have

sold me anything and I would have

followed her anywhere. There was

nothing magic about it. It was old

school and it worked and it was

good.

But everything has changed, and

that’s that. I need to stick to the

regimen. So in addition to exercising

and eating right, I

am blogging, tweeting, posting,

syndicating, flickering all in the

hope that you will “like” me.

Ruben

Toral

With over 17 years g

experience in e

healthcare marketing,

Ruben has built businesses,

brands, and physician networks in

Asia, Latin America and North America.

Formerly Group Marketing Director

for Bumrungrad International

hospital in Bangkok, Thailand, Ruben

is widely credited for pioneering

medical tourism in Asia and positioning

Bumrungrad as the world’s leading

medical tourism destination.

www.medeguide.com

33


FACEBOOK DIGEST

get off those unwanted pounds and

excess weight! Inquire at The Chocolate

Spa today!!!“ A question comes

to mind: who is this Mr. Miguel?

As I scroll further down the page I

read that Juli Ellis has lost 27 lbs

within 8 weeks. Oooops? I just came

here to get information on Chocolate

Treatments and yet I find myself

swamped with stories about all kinds

of people that I don’t even know. I

know one thing for certain: I want to

learn about Chocolate Treatments, I

do not want to jump into a discussion

about calories!

I double check to be sure: yes, I am

still on the Chocolate Day Spa page

on Facebook.

After I read more postings about infrared

light saunas, botox therapy and

watched a movie about cellulitis, I

decide I’m fed up. This Facebook

page was a waste of time and taught

me nothing about chocolate.

I am so frustrated I decide I need to

buy myself some chocolate. A thought

springs to mind: should I ever feel the

desire to learn anything about coffee

on Facebook, I will start by searching

for the word: “Valium”.

PAULINE PAULSEN

Note of the editors:

If you have had any facebooks digestions,

please feel free to send to the

editors. We may publish them and are

interested in any experiences with

other social media.

Our questions are: how do they help us

in our daily life? Do they contribute to

the quality of work and/or private well

being?

Write an email to:

info@the-patients.com

Body wrapping in the 18th century

This could be your advert in the next issue

Size 210 x 137 mm

1/3 landscape

34


THE PATEINTS.COM - IMPRINT

The Patients.com

This new magazine will express the views and opinions of the patient. The

Patients.com aims to give the patient a forum where their voice can be heard

and a platform where they can express their opinions and share their experiences.

We understand that Healthcare is an industry and needs to make

money but we are also constantly looking for ways to improve our service

and need insights, motivation and ideas on which directions to move in. The

Patients.com is written by professional journalists, medical professionals,

philosophers and businessmen. Our aim is to close the gap between commercial

reality and the challenge of medical ethics. The magazine will not only

benefit patients but everybody who is interested in the developments of

global healthcare.

Launch

After the prototype of the magazine has been presented in Monaco we will

begin the process of sourcing for advertisers. We will offer all our clients a

well written and content rich magazine that will be published on a monthly

basis, after an initial one year build up period. For the first edition, scheduled

for July 2013, we will print approximately 15,000 copies and will offer a

world-wide distribution service to selected countries. This will ensure The

Patients.com is available to a worldwide audience through both newspaper

kiosks and a subscribers list. We expect to attract both a professional and

health educated international readership. The 1 st issue is due in July 2013, the

2 nd issue is due in October 2013, the 3 rd issue is due in January 2014 and the

4 th issue is due in March 2014. From May 2014 we plan on going monthly.

Multilanguage versions of the magazine are also planned.

Involvement

We are open to talk with potential partners, investors and sponsors. Can you

produce great content? Are you very knowledgeable on the subject of healthcare?

Let The Patients.com help get your voice heard. We are looking for:

neutral, objective and in-depth writers. We want to report on current issues,

problems and offer an outlook on the future. New views, not-established

opinions are welcome.

Point of sale

Issues 1 and 2 of the magazine will be distributed for free, and financed by

advertisers. We then aim to have a payable magazine at newspaper kiosks,

bookshops and by subscription. Sale locations will include hotels, business

clubs, lounges, clinics, hospitals and malls.

Writers

We are looking for skilled writers who have a modern edge to their writing.

We are looking for style and content that reflects the spirit of the time and anticipates

future events. The ideal candidate should write in a style which allows

the readership to make up their own minds.

Imprint

Responsible according to German press

law and published by:

Health Care Strategy International

Dr. Uwe Klein GmbH (Ltd.)

Registered in Munich with the registration

no. HRB 114653 at Amtsgericht

Munich.

Legal domicile: Lenbachstr. 8

82166 Gräfelfing, Germany

Munich office: Lenbachplatz 8

80333 Munich, Germany

Phone +49 89 1011 9222

FAX + 49 89 1011 9221

Email: hcsi@healthcsi.de

info@the-patients.com

The opinions in the articles express the

view of the authors.

„The Patients.com“ is a registered

Trade Mark.

July 10th 2013

Delivery of the first internationally

distributed

issue with 15.000 copies.

Become globally visible,

become a partner of

„The Patients.com“

Advertisments

We are searching for companies to place adverts in our very first 1 st magazine issue. Feel free to get in

touch with us to discuss your involvement with the first issue, due to be dispatched in July 2013.

For the first issue we allow 30 % discount for early advertisers who sign up their intial interest during

the conference time of IMTEC. Fax or email the Early Advertiser Sheet (inserted in this issue) latest by

31st March to: FAX +4989 1011 9221 or email: info@the-patients.com

35


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