Regenerative Medicine & Medical Tourism in Greece

1. Stem Cell Medical
Tourism
Stavros A. Alevrogiannis MD, MSC, PhD
Senior Consultant in Orthopaedics & Sports Medicine

2. Definitions / Scope
• Medical tourism – usual use
• Travel to a foreign country (especially exotic
locations) to obtain medical care
• Medical tourism – less common uses
• Physicians engaging in unapproved medical
activities while travelling to remote locations
for tourism (imprompt roadside clinics)
• Medical students / physicians travelling for
the purposes of elective experiences,
volunteer medical work

3. Terminology
• Alternate terms
• Health tourism
• Medical journeys
• Global healthcare / Cross border healthcare
• Medical value travel
• More specific terms
• Surgical tourism
• Transplant tourism
• Regenerative Medicine tourism
• Dental tourism
• Suicide / Euthanasia tourism

4. Medical Tourism: not a new phenomenon
• Renowned centres / physicians have always attracted
patients from afar
• Healing shrines
• Spas
• Pilgrimages
• Wealthy citizens of countries with limited health resources
travelling to access care / expertise that cannot be
obtained locally
• Desperate patients with incurable conditions seeking
miracle cures

5. Statistics …
• $60 billion / yr industry*
• USA 2006: >½ million people travelled overseas for care
• Thailand 2006: 36.4 million baht (USD: 1.15 million)
• Israel 2006: $40 million, 15,000 health tourists
• Singapore 2005: 374,000 health tourists
• India: 2005: >150,000 medical tourists
• Costa Rica 1993: (CMAJ)
• 14% tourists came for medical reasons
• 10% of hospital beds in 1 private hospital occupied by
foreigners
*Crone, Academic Medicine, Vol 83, No 2, Feb 2008, 117-121

6. MEDICAL TOURISM MARKET IN
RUSSIA (140.000.000 citizens) FOR
• The rapidly emerging middle class
• The funky young professionals
• The upper income class
• The golden youth
• Russian’s filthy rich

7. LIST OF MOST POPULAR COUNTRIES FOR
M.T FOR THE RUSSIANS
• Germany (32%)
• Israel (22%)
• Hungary (6%)
• Spain (5%)
• Switzerland (5%)
• Czech Republic (4%)
• Bulgaria,Austria,Turkey (3% each one)
• S.Korea,Singapore (2%, each one)

8. WHAT AMOUNT OF MONEY WOULD A RUSSIAN
PATIENT PAY FOR MEDICAL TOURISM
• 11% declared more than 25.000 euros
• 36% between 10-25.000 euros
• 53% up to 10.000 euros
TOTAL AMOUNT FOR MEDICAL TOURISM IS
MORE THAN 1 BILLION EUROS !!!!

9. Why do patients want medical tourism?
• Lower cost
• Timely alleviation of pain and disability
• Access to innovative procedures
• Exotic locations and travel ‘mystique’
• Privacy – particularly for some cosmetic
procedures

10. Why do countries promote medical
tourism?
• Money!
• Boost tourism revenues
• Generate foreign exchange
• Increase gross domestic product
• Improve medical services
• Upgrade services / resources available to citizens
• Stem ‘brain drain’ to other countries

11. What makes a country attractive for
medical tourism
• Low cost consultancy & treatment
• No waiting period for treatment
• Availability of medical experts
• Luxurious accommodation
• State of the art medical equipment
• Exotic scenary
• Specialty treatment
• Personalized treatment
• Packages
• Treatment cum leisure destinations

12. 12.06.2015
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Drivers
Medical
Tourism
2
7
4
5
8
Globalization
of Healthcare
Improvements in
Technology and
Transportation
Increasing
Healthcare
Expenditure
Qualified Human
Resources
Regulations
Accredited
Healthcare
Organizations
6
1
Cost
Differences 3
Quality
Network

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Challenges
Selection of physician
Communication Issues
Legal resource and
malpractice law
Critical issues
for medical
tourists
Follow-up difficulties and
complication risk
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14. Advantages and Disadvantages for MT
destination
• Advantages
• Shows the leverage effect for the economy.
• Contribute to the related industries.
• Acquisition of advanced technology and powerful
infrastructure.
• Improve public healthcare sector as well as private
sectors.
• Increase employment
Disadvantages
• Low physician to patients ratio for local people
• Domestic brain drain from public to private sector
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15. So, what’s new?
• Average citizens
• Range of procedures available
• Third world / emerging economies destinations
• Development of an industry catering to medical tourists
• Travel agencies and brokers
• Journals
• Conferences
• Systematic government support of industry
• Insurance company promotion of medical tourism

16. ISSUES FOR MEDICAL TOURISM
• Strong government support & investment
• Smooth cooperation between the various players of
the industry (airlines, hotels, private clinics, medical
& nursing personnel)
• Proper accreditation & regulatory standards for
private clinics
• Uniform prizing policies between clinics
• Competition from other countries (Malaysia, China,
India )

17. CONSIDERATIONS FOR MEDICAL
TOURISM
• Costs & implementations
• Potential for no patient’s harm
• Quality of services
• Modern equipments & uses
• Keen attentions in hygiene
• Infrastructure development

18. Stem Cell Tourism
• In what is called “stem cell tourism” patients travel to
other countries with less restrictions to receive stem
cell therapies.
• Sometimes experimental and can be dangerous
• There are many legitimate therapies going through national
regulatory processes in these countries.
• December 2008 study of stem cell clinic web sites
• Sites claimed to treat a range of diseases that go beyond
the scope of the early evidence on stem cells' efficacy
• Played up the benefits and talked little about risks
• Each treatment costs around $21,500

19. Regenerative medicine & medical tourism
• Part of a private clinic campus
• Shop in shop
• Stand alone clinic
depending on amount of investment and in full
collaboration with
• Ministry of Health
• Ministry of Culture and Tourism
• Ministry of Economy
• Ministry of Finance
• Some initiatives such as Foreign Economic Relation Board (DEIK), Accredited
Hospitals Association

20. Regenerative Medicine
• Process of creating living, functional tissues to repair or
replace tissue or organ function lost due to age, disease,
damage, or congenital defects, with the use of autologous
adult stem cells
• It helps to produce extended healthy longevity.

21. Potential of Adult Stem Cells

22. Benefits of Adult Stem Cell
Research
• Easy to obtain
• Potentially limitless in supply
• Patients can use their own stem cells for treatment
and therapy
• Adult stem cells are politically neutral
• Not offensive to any major interest group nor do
they generate controversy.

23. What is the role of a “regenerative (travel)
clinic”?
• Provide usual general pre-travel advice
• Vaccinations
• Malaria prophylaxis
• Pre-travel counselling
• Make traveller aware of key issues in medical
tourism
• Effects of commoditization of care on medical decision
making
• Consider potential risks specific to medical tourism

24. Stem Cell Clinical Trials Map
Dr. Paul Knoepfler UC Davis School of Medicine (2013)

25. Mesenchymal Stem Cell Clinical Trials Map
Dr. Paul Knoepfler UC Davis School of Medicine (2013)

26. Stem cell transplants - China
• Tiantan Puhua Stem Cell Centre
• Applies stem cell treatments to a wide range of neurologic
disorders
• Stroke, Parkinson's, cerebral palsy, hereditary degenerative
conditions
• Unique stem cell treatments
• Self stem cell activation and proliferation program
• Stem cell delivery by lumbar puncture or stereotactically
• Use of autologous bone marrow stem cells (to boost the immune
system) and fetal stem cells in combination
• Claim a “high level of recovery”

27. Stem Cell Transplants - China
• Parkinsons:
• Human retinal epithelial cells from adults
• No immunosuppression required
• Cells injected stereotactically into putamen
• Daily cocktail of drugs to ‘fertilize the area’
• Stem cell activation and proliferation treatment (to enhance
the body’s own neural stem cells)
• ~20 patients treated
• No published RCTs

28. Stem Cell Transplants - China
• Stroke
• ‘self stem cell activation and proliferation’
• 50 patients treated
• Minor to significant improvements
• Cerebral plasy, Degenerative neurologic disorders,
Epilepsy, Brain infections
• Neural (fetal) stem cells
• Bone marrow stem cells (autologous)
• Recommended because the immune system is ‘weak’
• Both types of cells delivered by lumbar puncture – cells are said
to flow through the CSF into the brain

29. WHAT ARE THE MAIN AREAS REGENERATIVE
MEDICINE CAN BE APPLIED
• NEUROLOGICAL DISEASES
• CARDIOVASCULAR DISEASES
• OPTHALMOLOGICAL DISEASES
• ORTHOPAEDICS
• SPORTS MEDICINE
• PLASTIC SURGERY & REJUVENATION
• ANTI-AGING
• DIABETES MELLITUS
• INFERTILITY RELATED DISEASES
• LUNG DISEASES

30. Neurological diseases

31. Amyotropic Lateral Sclerosis (ALS)
Symptoms:
________________________________________________________
 Rapid Progressive Weakness
 Fasciculations
 Muscular Atrophy
 Muscle Spasticity
 Difficulty Speaking
 Difficulty Swallowing
 Difficulty Breathing
Aim of the treatment:
___________________________________________________
Reducing and slowing down the
disastrous affects of ALS.
Results:
_____________________________________________
Out of the 32 patients who took
the treatment, 50% patients
reported to have improved in
terms of muscular strength,
sensory function and motor
function.

32. Autism
Symptoms:
________________________________________________________
Autism may occur in any part of the
brain. Children with autism generally
have problems in three crucial areas of
development-
 Social interaction
 Language
 Behavior
Aim of the treatment:
___________________________________________________
Aims in regenerating the affected
brain cells.
Results:
_____________________________________________
Over 70% of the total autism
patients who took stem cell
treatment reported positive
signs of improvement in
cognition, social contact,
language, eye contact and
coordination, motor skills and
consciousness.

33. Alzheimer’s Disease (AD)
Symptoms:
________________________________________________________
A very serious form of dementia
associated with
 Senility
 Gradual progression of
Neuron loss
 Degradation of nerve
contacts
During the final stage of AD, the person
is completely dependent upon
caregivers.
Aim of the treatment:
___________________________________________________
A regenerative and drug-free
alternative to conventional
treatments. It involves administration
of stem cells into the CNS to bring
about regeneration.
Results:
_____________________________________________
Approximately 50% patients
responded to the treatment
with improvements in motor
functions, communications and
general awareness.

34. Cerebral Palsy
Symptoms:
________________________________________________________
Non-progressive and non-contagious
motor conditions that cause-
 Physical disability
 Orthopedic problems
 Arthritis
 Osteoporosis
 Disordered motor
functions.
Aim of the treatment:
___________________________________________________
A regenerative and drug-free
alternative to conventional
treatments. It focuses on the
restoration of the mental faculty of
the patient.
Results:
_____________________________________________
Out of the 116 patients who
took the treatment, 66.4%
showed improved motor
functions, decreased spasm
problems, better
communication and
improvement in the ability to sit
and stand.

35. Parkinson’s Disease
Symptoms:
________________________________________________________
Caused due to degeneration of the
neurons. Critical movement disorder
resulting in –
 tremors of the body
 Rigidity
 Gradually slowing down the
body movements
 Disordered speech and
motor functions of the
body.
Aim of the treatment:
___________________________________________________
A regenerative and drug-free
alternative to conventional
treatments. It focuses on the
regeneration of the degenerated
cells.
Results:
_____________________________________________
Out of the 75 patients who took
the treatment, 36 confirmed no
progression of the disease and
reported improved stability,
motor functions, speech,
swallowing.

36. Multiple Sclerosis
Symptoms:
________________________________________________________
Acute neurological disorder affecting
the CNS –
 Weakened movement
 Thinking
 Other nervous system
related processes.
Aim of the treatment:
___________________________________________________
A regenerative and drug-free
alternative to conventional
treatments.
Results:
_____________________________________________
Out of the 50 patients who took
the treatment, 25 showed
improvement, 18 showed no
improvement and remaining
showed natural disease
progression. Improvements
were reported in muscle
strength, spasticity of limbs,
better co-ordination of the
limbs.

37. Spinal Cord Injury (SCI)
Symptoms:
________________________________________________________
Caused due to a sudden blow of
trauma resulting in fracture or
dislocation of the vertebra.
Blockage for the nerve parts in relaying
the messages between the brain and
other parts of the body.
Aim of the treatment:
___________________________________________________
It aims at improving the patients life
by repairing the damaged tissue and
restoring the function of the spinal
cord.
Results:
_____________________________________________
Out of the 184 patients who
took the treatment, 162 showed
improved clinical functions,
improved bowel and bladder
function, less muscular spasm.

38. Stroke
Symptoms:
________________________________________________________
 Caused due to insufficient
Oxygen supply to the brain.
 Causes bleeding in and
around the brain
 Loss of consciousness
 Headache
 Vomiting
Aim of the treatment:
___________________________________________________
Focused on humoral and corporal
changes occurring in the brain. It is
a drug free option.
Results:
_____________________________________________
55% patients reported of
having positive improvements.

39. Cardio-vascular Diseases

40. Coronary Heart Disease (CHD)
Symptoms:
________________________________________________________
 Constriction of blood
vessels
 Chest pain
 General fatigue
 Breath shortening
 Heart failure due to weak
cardiac muscles.
Aim of the treatment:
___________________________________________________
Improving the oxygenated blood
supply to the heart by repairing the
cardiac muscles.
Results:
_____________________________________________
A whooping 88% of the 21
patients who took stem cell
treatment showed clinical
improvements reporting less
weakness, less tiredness, less
shortness of breath and
decreased medication.

41. Critical Limb Ischemia
Symptoms:
________________________________________________________
 Arthrosclerosis causes
severe blockage of arteries
of leg
 Reduced blood flow
 Acute pain in the feet
 Sores and wounds in legs
or feet
 Can lead to amputation of
the leg if untreated
Aim of the treatment:
___________________________________________________
Focuses on restoration of adequate
blood flow in and around the
affected limb.
Results:
_____________________________________________
4 out of 6 patients, who were
advised for amputation of the
affected leg, did not require
amputation after the stem cell
treatment.

42. Ophthalmological Diseases

43. Macular Degeneration
Symptoms:
________________________________________________________
Chronic degenerative disease of the
retina which may lead to blindness.
Aim of the treatment:
___________________________________________________
The retrobulbar injection of the
autologous stem cells can prevent
wet and dry macular degeneration. It
reduces the drusen deposits in the
retinal pigment epithelium which is
beneath the macula. It may also
prevent the photoreceptors from
getting destroyed in the dry as well
wet macular.
Results:
_____________________________________________
It is expected that the vision
improves by 30-50%.

44. Orthopedic Diseases

45. Osteoarthritis
Symptoms:
________________________________________________________
Degenerative joint disease affecting the
cartilage causing breakdown and an
eventual loss of cartilage in the joints.
 Aching and soreness of
joints.
 Feeling of pain.
 Stiffness after prolonged
movement of joints.
 Enlargements of
bones around the middle
or the end joints of the
fingers.
Aim of the treatment:
___________________________________________________
The stem cell treatment induces
profound healing affect in the joints
as the cartilage formation is induced.
Results:
_____________________________________________
Instant pain relief is expected in
almost all the patients. The
therapy can also be expected
to stability the disease and not
let it progress further.

46. Sports medicine
•Optimal Sports Health &
Performance
•Cartilage repair
•Faster tendon recovery (Cell
Secretomics)
•Optimal Cell Biochemistry
•Muscle Strengthening
•Avoid muscle fatigue

47. Life style Diseases

48. Liver Cirrhosis
Symptoms:
________________________________________________________
Serious ailment characterized by the
degeneration of three effectual liver
tissue causing scars
 Eliminating the functions of
the liver
 Weakness
 Loss of appetite
 Yellowing of skin.
Aim of the treatment:
___________________________________________________
It’s a drug free treatment aiming to
recover the lost functionality of the
liver.

49. Diabetes Mellitus
Symptoms:
________________________________________________________
 Hyperglycemia and
hypoglycemia
 Serious degenerative effects
 Cardiovascular problems
 Kidney failure
 Eye problems
 Nerve damage
 Erectile dysfunction
Aim of the treatment:
___________________________________________________
A simple and drug free method to
treat the root causes of diabetes and
also treat the Hyperglycemia as
well as Hypoglycemia and their
associated outcomes.
Results:
_____________________________________________
Almost 34% of type 1 patients
and 67% of type 2 patients
improved post-treatment.
Improvements stated greater
stability in level of blood
glucose, lower level of blood
glucose after fasting,
decrement in leg pain, lowered
hypertension and complete
elimination of episodes of
hypoglycemia.

50. Infertility related Diseases

51. Impotency and Erectile dysfunction
Symptoms:
________________________________________________________
Impotence is used to describe sexual
problems of human being related to
reproduction. The lack of sexual desire
and problems related to orgasm or
ejaculation is also considered under the
term Impotence.
Aim of the treatment:
___________________________________________________
It’s a drug free treatment aiming to
recover its lost functionality.

52. Chronic Obstructive Pulmonary Disease (COPD)
Symptoms:
____________________________________________
____________
 Emphysema
 Chronic bronchitis
 Shortness of breath
 Progressively gets worse
over time.
Aim of the
treatment:
_________________________________________
__________
Drug free treatment
aiming to repair the
lungs.

53. Anti Aging Treatments
Look Fit:
_______________________________________________________
 Cells from the fat of the
body are taken, processed
and infused into the
wrinkled parts of the face.
 Long lasting effect.
 No hard lines as seen in
Botox treatment.
Feel fit:
___________________________________________________
 Cells from the bone
marrow are taken,
processed and released
into the patient’s blood
stream.
 Rejuvenates the entire
body.

54. So, why Greece for stem cell medical
destination?
• Greece is a "destination of destinations"
• Greece is "shovel ready", with regards to destination development - practically
everything required is in place - or easily acquired
• More than 5 stem cell labs are accredited in Greece
• FDA & EU regulations are applied (same day procedure)
• Skilled and well-known scientists, experts in biologic therapies, are present
• Lower cost of service
• Easy transportation from many countries
• Mild climate
• High accomodation facilities
• Greece has the preconditions to acquire and have in place the Characteristics of
the "Ideal Health Tourism Destination"
• Greece is already offering Services in most of the 8 Health Tourism Segments
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55. What needs to be known
...about Greece and Health Tourism
The Specific “basic” Steps
• Implementation of the Master Plan
 Implement Industry Shaping
 Segmentation
 Integration
 Administration
 Development
 Promotion (Role and Contribution of the Diaspora
…Good Will Ambassadors, Consumers, Providers and Investors)
• Implement Destination Enhancement
 Differentiation (unique design)
 Accreditation
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56. The Latecomer's Advantage
• Greece, up to now, has not been on the Health Tourism Map,
so the same happens with stem cell medical tourism also.
• Greece is a “late comer” to Health Tourism.
• But Greece has the “late comer's advantage”:
• Can avoid the mistakes of others
• Is carrying no “legacy baggage”
• Is free and ready to implement the Contemporary Industry-
shaping Model (Health Tourism Pentad)
• Can immediately become a health tourism destination
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57. Conclusion
• Greece has potential to be one of the biggest medical tourism
centers of the world in stem cell therapies, due to its accredited
organizations, well-qualified and well-educated physicians, modern
technologic infrastructure, geographic and climatic superiority and
natural and historical beauties.
• Greece is making progress in this direction with the collaborative
support of government and private sector in order to supply high-
quality and lower cost medical treatment for its citizen and medical
tourists.
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