McKinsey and the medical tourism numbers game...

According to a new report on medical tourism from McKinsey (login required):

• "Between 60,000 and 85,000 people annually travel abroad for inpatient viagra cialis online pharmacy pharmacy care, a number.....far lower than commonly assumed".

According to the Wall Street Journal:

• ... the McKinsey report "contrasts sharply" with common assumptions and with figures often used by those who market medical tourism. "There's been an enormous amount of hype" regarding people traveling abroad to receive necessary procedures at a lower cost, Mango (from McKinsey) said.

So what are we to make of this "authoritative" report.....?

One industry insider who has compiled a comprehensive review of medical tourism suggests:

• "The McKinsey figures are nonsensical......looking just at figures from Asia for travellers from Asia and the Gulf, they are way way out."

One problem with the McKinsey data is that it relies heavily on government statistics, and few governments record medical travel. Even where figures are collected then they do not include home nationals who work overseas going back for treatment, or US and other residents returning to a country of origin for treatment.

It's also a strange method of counting medical tourists, if you decide to leave out:

• people travelling across borders for treatment, which would include UK to France or Belgium, Canada to the US, the US to Mexico, Mexico to the US , China to Taiwan or Hong Kong, central Africa to South Africa , Ireland to the UK, etc etc.
• people travelling back to their homeland for treatment.
• people travelling to the homeland of their parents/grandparents
• expatriates working overseas
• people who decide to mix travel and treatment eg UK travellers to Spain, South Africa
• people who mix business travel and treatment
• people who live in two countries eg UK and Spain
• And..all outpatients

Other oddities...

If they reckon the number of medical tourists are 60,000 to 85,000 worldwide, how does this stack up against other reported data:

• 70,000 - 100,000 UK medical tourists (from our own Treatment Abroad medical tourism research and the UK International Passenger Survey data)
• Last year, 92,000 patients from the UAE visited the Philippines.
• One dental clinic alone in Budapest that is treating over 4,000 patients from abroad each year.
• 10,000 visitors to Korea last year for medical treatment, according to the Korean Tourism Organisation.
• Singapore Tourism Board says 555,000 tourists received medical treatment in 2006.

And overall... it is a little strange to say that someone travelling overseas for a hip operation is a medical tourist, but someone travelling for a dental extraction or cosmetic surgery is not.

Whatever the real numbers are, McKinsey did conclude:

• "Medical travel is a highly relevant market ........ The acceleration of unsustainable health care costs in many developed economies, the advent of advanced technologies in just a few locations, and the increasing concentration of wealth in developing economies are only a few of the factors fueling it. Over the next couple of decades, these trends may largely dispel the idea that health care is a purely local service"

So... good news for the medical travel industry!

Men's Health - December 2009 (US)

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Men's Health - December 2009 (US)

Men's Health - December 2009 (US)

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Don't measure yourself, or others, by "penis size".

"Penis size has always been a sensitive issue to men in general and gay men in particular. Men are always worrying about their cheap viagra size and if they are "too small". The internet and some magazines are full of ads that cater to this worry by promising to increase your cheap cialis size. To the average male, his penis is, consciously or sub-consciously, one of the most important things in the world to him, bar none. From the time he first discovers it as a young child, it continues to fascinate him. But then worry sets in; look at his big brother's; look at dad's, look at the guys in the changing room at the swimming pool. Will mine ever be that big? And he carries that notion with him perhaps forever –always wondering if it's big enough and always wishing it were bigger. Penis envy has set in. Remember that just as much as we are afraid we have small dicks, everyone else is too." [http://www. chadzboyz. org/html/ penissize. html]

"For many years and some will argue that the myth that black men are all very endowed with large penises still persists. It seems that whether gay or straight, black men definitely must shoulder the burden of being defined by a physical attribute that he never chose nor can change..... Most gay men would choose a male with a large penis over a male with a small one despite the fact that the less endowed male may be a more viable companion... . At some point we must evaluate the source of this type of prejudice and ignorance. How many generations of black males will we sacrifice to this blight upon an otherwise cultural rich and diversified race of people? It never makes sense to generalize any situation in life and especially not penis size." [http://www. blackmen4now. com/size. htm]

"....(the) soft penis size is no indicator at all of your erect penis size. In some men their penis hardly changes size between soft (flaccid) and hard (erect) states. Other men may have fairly modest or small flaccid penis sizes but have a much larger erection. It is interesting to note that the size of the flaccid penis concerns men the most. They think that when other men see them in the showers, they will think they have a very small penis. Never assume a small soft penis will be a small hard penis. The opposite is often true. The average adult flaccid penis size is in the range 2.5 to 4.5 inches

'Viagra cream' could prove safer

A cream allowing erectile dysfunction drugs to be applied directly to the skin could one day make them safer to use, say New York scientists.

Studies in rats suggest that Viagra, Levitra and cheap cialis could pass through the skin in tiny capsules, they say.

The research, published in the Journal of Sexual Medicine, could mean fewer side-effects, and even significantly speed up the drug's action.

However, it could be a decade before creams are fully ready for use.

The arrival of erectile dysfunction treatments in tablet form has been one of the success stories of the modern pharmaceutical industry, with some estimates suggesting that tens of millions of men worldwide have used them.

However, although they have worked for many men, they also carry the risk of side-effects such as headaches, blurred vision or upset stomachs.

In addition, men with severe heart problems, or who have just suffered a stroke, are advised to avoid the tablets altogether or use them with extreme caution.

Less risk

For many, this could be solved by the development of the cream, with would confine more of the active ingredients of the drug to a single area of the body, rather than circulating them widely.

The research team at the Albert Einstein College of Medicine at Yeshiva University, in New York, used nanoparticles, each much smaller than a grain of pollen, and found a way to encapsulate particles of the drug inside.

Their early tests involved just a few rats bred to have erectile dysfunction later in life.

Of these, 11 were treated with nanoparticles containing cialis, a newer erectile dysfunction drug called sialorphin, and nitric oxide, a chemical also needed to widen blood vessels and produce an erection, often reduced in men with diabetes.

All of the rats showed improvement, unlike seven rats given empty nanoparticles instead.

Dr Kelvin Davies, one of the researchers, said: "The response time to the nanoparticles was very short, just a few minutes, which is basically what people want in an erectile dysfunction medication.

"In both rats and humans, it can take 30 minutes to one hour for oral erectile dysfunction medications to take effect."

The researchers found no signs of local inflammation or damage caused by the nanoparticles, and no evidence of wider side-effects.

Clinical studies in humans could begin in a few years if animal studies continued to suggest the treatment was safe, they said.

However, finally getting the drug approved for widescale use could take 10 years or more, they said.

Women May Get Sex Pills, Too

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The same little blue pills that can help men get in the mood for love could be remade into little pink pills that do the same thing for women, scientists now suggest.

Although evidence that significant advances have been made into drugs that help treat male sexual dysfunction can be seen in everything from television commercials to Internet spam, much less progress has been made when it comes to female sexual dysfunction.

"We were doing a fair amount of work on erectile dysfunction in men, and during lab meetings the question came up of why we were just talking about the male side, and were we not foolish to not also think about the female side," said researcher Kyan Allahdadi, a vascular physiologist at the Medical College of Georgia in Augusta. Past research suggests "between 40 to 60 percent of women complain of some sexual dysfunction," he added.

There have been attempts at drug treatments for female sexual dysfunctions, including hormone therapies. Even caffeine has been shown to motivate female rats to have more frequent sex. However, Allahdadi explained that none have completed U.S. Food and Drug Administration clinical trials yet.

Now researchers suggest that medicines employed for male sexual dysfunctions could someday address some forms of female sexual dysfunction as well.

Male erectile dysfunction is often due to inadequate blood flow to the genitals, something that drugs for it seek to boost. It turns out that female sexual dysfunction may at times have the same roots, and thus also be treated with erectile dysfunction medicines.

Erectile dysfunction drugs such as such as Viagra (sildenafil), Levitra (vardenafil) and order cialis (tadalafil) work by inhibiting a molecule known as PDE5. Doing so dilates blood vessels and enhances blood flow.

Allahdadi and his colleagues tested such PDE5 inhibitors on 10 male and 12 female rats. They focused on their internal pudendal arteries, which supply blood to the penis in male rats and to the vagina and clitoris in female rats. (The same arteries in humans provide the same functions for us.)

The researchers found that sildenafil, vardenafil and tadalafil could all dilate female and male rat internal pudendal arteries. Although the male arteries reacted more effectively to vardenafil, the female arteries responded more strongly to sildenafil.

There have been trials of Viagra in women, but these have proved highly disappointing. "Our findings suggest that what works in males might not work the same way in females," Allahdadi said. "Future research designed for females could come up with a therapy that does work."

Although such research into sexual dysfunctions could help people have more sex, Allahdadi explained that sexual dysfunctions are often linked with more serious conditions such as cardiovascular disease and diabetes. "So further investigations into this could open a window into cardiovascular health as well," he said.

"We're just getting started in this," Allahdadi added. "It's pretty exciting. There's a great need in the population. I think it's going to become a pretty hot topic."

Allahdadi and his colleagues will present their findings at the Experimental Biology 2009 conference on April 20.