Monday, August 10, 2009

Medical tourism and superbugs

Here is another reason to reform healthcare: proliferation of superbugs. How are they related, you might ask. Well, a couple of days ago the British paper Telegraph reported that 22 cases of an antibiotic resistant bacterium imported from India have been discovered in 17 hospitals in the UK. These bacteria are in the family that commonly cause urinary tract infections, which themselves are exceedingly common among hospitalized patients.

What is medical tourism? It is a growing industry where patients from developed nations travel to the developing world for procedures that are elective, inaccessible or overpriced at home. I first read about it about 4 years ago in a magazine in a story that featured an American without health insurance traveling to India for a joint replacement surgery. While the surgery was performed by a team of US-trained specialists, the price of it was an order of magnitude lower than in the US. This disparity in cost, and therefore access, is driving the expansion of the industry, which is predicted by Deloitte to grow by a factor of ten over the ensuing decade. In fact, the numbers from the US alone are predicted to double from 750,000 in 2008 to 1.5 million in 2009. But these costs certainly do not incorporate the public health risks presented by the worldwide spread of antimicrobial resistance.

To be sure, we have not done so well in this country at curtailing the spread of superbugs. Why, hospitalizations with infectious diarrhea due to a bug called Clostridium difficile alone have increased at an annual rate of 23% in the US, not to mention the over 1 million hospitalizations every year involving resistant bacteria. So, while it is hard to blame the woes of resistance on medical tourism alone, what is of concern is how rapidly these organisms can infiltrate even those geographic areas that practice good antibiotic stewardship and other preventive measures.

I see this as yet another wake up call for the US. We can limit the growth of medical tourism by improving access to healthcare in the US. We can do this by reducing the egregious waste that is so rampant in the current system. And most importantly, we need to change our trajectory of over-medicalization that is not only driving the waste here in the US, but is now also sending our citizens abroad on ill-advised hunts for cheap snake oils laced with hidden peril.

Telegraph story via @EvidenceMatters


  1. Antibiotics are available OTC in India. So if you go to a Dr. and he prescribes you antibiotics for a cold the patient just keeps that prescription and purchases the antibiotics the next time he has a cold without even meeting his physician. Some times people just go to the pharmacy and ask them which medicines should we take for XYZ symptoms and the pharmacist prescribes antibiotics.

    A funny incident with medical tourism. A patient from the US was admitted for hip replacement at the hospital where I was working as a medical officer in India . She was HCV positive and knew it and didn't tell anyone. When detected in routine pre - operative screening she said her Dr. in the US said these screenings won't be done in India !

    Another thing I noticed was most of these patients flew alone for the surgery and had no family or friend support system to help them during the whole period. Some of them would go into depression and at times needed psychiatric counselling.

  2. NiKi,thanks for your insightful comment. It is critical for us to appreciate the potential scope for misuse of antibiotics and other therapies in a system such as India's.