A Hydrogen Economy

In 2003, MIT released The Future of Nuclear Power, a study of the energy needs for now and the future. The report suggested several subsidies and a new carbon tax. Also in 2003, President Bush made a State of the Union address that pledged more than a billion dollars towards hydrogen research and a move towards a hydrogen-based economy. This report strives to tie together several hydrogen production methods and possible solutions for moving towards a hydrogen-based economy. Background, production methods, and finally a revised carbon tax idea specifically aimed at jumpstarting hydrogen production are addressed in this report

"It Was the Best Decision of My Life": A Thematic Content Analysis of Former Medical Tourists\u27 Patient Testimonials

Background Medical tourism is international travel with the intention of receiving medical care. Medical tourists travel for many reasons, including cost savings, limited domestic access to specific treatments, and interest in accessing unproven interventions. Medical tourism poses new health and safety risks to patients, including dangers associated with travel following surgery, difficulty assessing the quality of care abroad, and complications in continuity of care. Online resources are important to the decision-making of potential medical tourists and the websites of medical tourism facilitation companies (companies that may or may not be affiliated with a clinic abroad and help patients plan their travel) are an important source of online information for these individuals. These websites fail to address the risks associated with medical tourism, which can undermine the informed decision-making of potential medical tourists. Less is known about patient testimonials on these websites, which can be a particularly powerful influence on decision-making.   Methods A thematic content analysis was conducted of patient testimonials hosted on the YouTube channels of four medical tourism facilitation companies. Five videos per company were viewed. The content of these videos was analyzed and themes identified and counted for each video.   Results Ten main themes were identified. These themes were then grouped into three main categories: facilitator characteristics (e.g., mentions of the facilitator by name, reference to the price of the treatment or to cost savings); service characteristics (e.g., the quality and availability of the surgeon, the quality and friendliness of the support staff); and referrals (e.g., referrals to other potential medical tourists). These testimonials were found either not to mention risks associated with medical tourism or to claim that these risks can be effectively managed through the use of the facilitation company. The failure fully to address the risks of medical tourism can undermine the informed decision-making of potential medical tourists, particularly given the considerable influence on decision-making by patient testimonials.   Conclusions Regulation of these global companies is difficult, making the development of testimonials highlighting the risks of medical tourism essential. Additional research is needed on the impact of patient testimonial videos on the decision-making of potential medical tourists

Medical Treatment not Approved yet? No Problem! Welcome to Circumvention Tourism

China, Russia and countries in the Caribbean are positioning themselves as destinations for a new kind of medical tourist: the circumvention tourist. Increasingly people are traveling abroad for care that is unapproved by regulators in their home countries. In some cases, these so-called circumvention tourists may be seeking unproven and untested medical interventions.But why would someone want to skirt domestic regulations aimed at protecting patient safety? Our research about medical tourism in the Bahamas offers some insights

Regulating Medical Tourism

Letter to Lancet on need for regulation of medical tourism

Examining the Practice of Informal Caregiving in Medical Tourism

Medical tourism refers to the process whereby patients purchase health care abroad, outside of their home health care systems, and pay privately for care. Some reasons patients engage in this form of private health care include: real or perceived wait times, desire to obtain experimental procedures not available at home, and mistrust of the domestic health care system. While the literature provides accounts of the experiences of medical tourists and industry facilitators, the friends and family who accompany medical tourists abroad as informal caregivers are under-researched. In this study, funded by the Canadian Institutes of Health Research, we have uncovered these caregivers\u27 experiences through four datasets collected from different stakeholder groups: i) 32 former Canadian medical tourists interviewed between July and November 2010; ii) 7 Canadian medical tourism facilitators surveyed in 2012; iii) 21 international patient coordinators in destination facilities interviewed in 2012; and iv) 20 Canadian caregivers interviewed between September 2013 and February 2014. Data triangulation enabled us to compare, contrast and augment the results from these separate datasets to arrive at the following findings and recommendations

Guidelines for Reducing the Negative Public Health Impacts of Medical Tourism

Étude de cas / Case studyLes voyages internationaux pour des soins médicaux, ou le tourisme médical, créent des problèmes d’éthique et de sécurité pour les patients. Des lignes directrices pourraient être développées et distribuées pour aider à répondre à ces préoccupations, mais ils peuvent en même temps sembler entériner cette pratique.International travel for medical care, or medical tourism, creates ethical and safety concerns for patients. Guidelines could be developed and distributed to help address these concerns, but they may at the same time appear to endorse this practice

Canadian Research Ethics Board Members’ Attitudes Toward Benefits From Clinical Trials

Background While ethicists have for many years called for human subject trial participants and, in some cases, local community members to benefit from participation in pharmaceutical and other intervention-based therapies, little is known about how these discussions are impacting the practice of research ethics boards (REBs) that grant ethical approval to many of these studies. Methods Telephone interviews were conducted with 23 REB members from across Canada, a major funder country for human subject research internationally. All interviews were digitally recorded and transcribed verbatim. After coding, the data was analyzed to identify central themes and topics. Themes were identified, application of the themes was confirmed, and these themes were then used to populate the findings of this manuscript. Results Our analysis of the interviews identified two primary themes when considering what benefits are owed to research participants and their communities. 1) Most study participants felt that given that these studies are led by persons in the role of researcher rather than health care provider, they had a limited obligation to provide benefits to study participants. 2) These REB members were all working in Canada, a high income country where most residents enjoy high levels of access to health care. As a result of this context, the study participants tended to focus on ethical concerns including obtaining informed consent and avoiding undue inducement to participate in research rather than ensuring that study participants directly benefit from successful trials. Conclusions Research on REB members’ attitudes toward what benefits are owed to study participants and community members is needed in other countries in order to determine how context affects these attitudes

“Best Care on Home Ground” Versus “Elitist Healthcare”: Concerns and Competing Expectations for Medical Tourism Development in Barbados

Introduction Many countries have demonstrated interest in expanding their medical tourism sectors because of its potential economic and health system benefits. However, medical tourism poses challenges to the equitable distribution of health resources between international and local patients and private and public medical facilities. Currently, very little is known about how medical tourism is perceived among front line workers and users of health systems in medical tourism ‘destinations’. Barbados is one such country currently seeking to expand its medical tourism sector. Barbadian nurses and health care users were consulted about the challenges and benefits posed by ongoing medical tourism development there. Methods Focus groups were held with two stakeholder groups in May, 2013. Nine (n = 9) citizens who use the public health system participated in the first focus group and seven (n = 7) nurses participated in the second. Each focus group ran for 1.5 hours and was digitally recorded. Following transcription, thematic analysis of the digitally coded focus group data was conducted to identify cross-cutting themes and issues. Results Three core concerns regarding medical tourism’s health equity impacts were raised; its potential to 1) incentivize migration of health workers from public to private facilities, 2) burden Barbados’ lone tertiary health care centre, and 3) produce different tiers of quality of care within the same health system. These concerns were informed and tempered by the existing a) health system structure that incorporates both universal public healthcare and a significant private medical sector, b) international mobility among patients and health workers, and c) Barbados’ large recreational tourism sector, which served as the main reference in discussions about medical tourism’s impacts. Incorporating these concerns and contextual influences, participants’ shared their expectations of how medical tourism should locally develop and operate. Conclusions By engaging with local health workers and users, we begin to unpack how potential health equity impacts of medical tourism in an emerging destination are understood by local stakeholders who are not directing sector development. This further outlines how these groups employ knowledge from their home context to ground and reconcile their hopes and concerns for the impacts posed by medical tourism

A Qualitative Exploration of how Canadian Informal Caregivers in Medical Tourism use Experiential Resources to Cope with Providing Transnational Care

Canadians travelling abroad for privately arranged surgeries paid for out-of-pocket are engaging in what  has come to be known as medical tourism. They are often accompanied by friends or family members, who we call caregiver-companions. Caregiver-companions provide care in and across a variety of formal and informal settings, such as in hotels, airplanes and at home. This qualitative study examines the experiences  of informal caregivers in medical tourism to learn more about the lived experiences or ‘experiential  resources’ they draw upon to cope with providing care and avoiding caregiver burden. The care-giving literature has demonstrated that such burden can negatively impact caregivers’ well-being. The unique, transnational context of care-giving in medical tourism and recent growth in popularity of this practice means that there are few supports or resources currently in place to assist informal caregivers. In this article, we report on an analysis that sought to detail how caregiver-companions draw upon their previous lived experiences to cope with providing transnational care and to minimise or avoid the onset of caregiver burden. We conducted semi-structured telephone interviews with 20 Canadians who had accompanied their friends or family members abroad for surgery between September 2013 and January 2014. Thematic analysis revealed the ways that participants had developed practical strategies to deal with the challenges they faced in medical tourism. The interviews revealed three important experiential resources drawn upon by participants: (i) previous experiences of international travel; (ii) previous experiences of informal care-giving; and (iii) dimensions of the existing relationship with the care recipient. Differences in access to and use of these experiential resources related to participants’ perspectives on medical tourism and the outcomes of the trip. By identifying the experiential resources drawn upon by informal caregivers in medical tourism, we  can more effectively identify supportive interventions