What affects the final cost? Table of Contents Introduction What affects the final cost? Submit Request Find Hospitals. Hospital Treatment. Need Help? Send Request. Enquire 2. Enquire 3. In , Italian researcher Dr. The theory is that veins bringing blood from the brain and spine back to the heart become too narrow, causing some of that blood to leak into the brain tissue.
Zamboni and his colleagues figured that might trigger inflammation, eventually leading to the balance and muscle problems seen in MS.
Zamboni did not respond to requests for comment. Arata theorizes that the vein-opening treatment may help patients with a range of neurological conditions through its effect on the segment of the nervous system that controls involuntary actions. The Cleveland Clinic is studying how best to diagnose CCSVI and whether dehydration has an impact on vein status, with some trial data due later this month at a conference in Lyon, France.
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Stem Cell Rev Rep. Science communication reconsidered. Nat Biotechnol. YouTube as a forum for the generation of evidence and patient advocacy. Patient Educ Couns. Download references. Funders had no role in study design, data collection, analysis, and interpretation, or in drafting the manuscript.
Interview data are not publically available to protect the privacy of research participants. Inquiries about the dataset may be directed to the first or corresponding authors. All direct quotations of raw data used in the manuscript may be re-utilized with proper attribution.
You can also search for this author in PubMed Google Scholar. SB conducted all interviews. All authors contributed to analysis of the transcripts and drafted the manuscript. All authors read and approved the final manuscript. Correspondence to Judy Illes or Anthony Traboulsee.
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As a result, some Canadians with MS have decided to travel abroad in order to access this care, thus circumventing restrictions placed by their domestic government [ 3 ]. MS is a disorder of the central nervous system with undetermined causes.
It leads to damage to the central nervous system through an autoimmune response, resulting in a variety of symptoms including vertigo and changes in vision, sensory sensation, energy levels, and motor function [ 4 ]. Treatment for this proposed condition is available, involving expanding the blocked or narrowed vein typically the jugular using venoplasty or stents [ 6 ].
A cross-sectional study by Zivadinov et al. However, no randomized control trials have provided evidence of the efficacy of CCSVI treatment for the relief of the symptoms of MS [ 8 — 13 ]. Canada has one of the highest incidences of MS in the world, with over 95, cases diagnosed in [ 15 , 16 ]. Despite the lack of evidence linking CCSVI treatment with symptom relief in individuals with MS, there has been considerable pressure within Canada to make this intervention available to interested individuals [ 17 , 18 ].
Treatment of CCSVI for Canadians with MS has not been approved in the public system due to the lack of clear evidence of efficacy, though some Canadian provinces and the federal government have funded clinical trial participation for their residents both in Canada and abroad [ 20 ]. The Canada Health Act heavily restricts the provision of private medical care in the country, meaning that CCSVI treatment cannot be offered domestically for Canadians wishing to pay privately for such care.
While federal and provincial funding for clinical trials on CCSVI has been approved, these trials currently provide very limited opportunities for Canadians to receive CCSVI treatment domestically [ 18 ]. As a result, Canadians with MS wishing to access CCSVI treatment are left with the options of seeking to become one of the few individuals allowed to enroll in clinical trials on CCSVI treatment or privately seeking interventions outside of the country as medical tourists.
Those Canadians who choose to travel abroad to obtain CCSVI treatment must arrange for this intervention on their own and pay for it out-of-pocket [ 21 , 22 ]. In the province of British Columbia, for example, half of those persons participating in a registry for CCSVI treatment recipients reported symptom relief [ 24 ]. This symptom relief is often not permanent, however, requiring individuals to travel abroad repeatedly for CCSVI treatment [ 24 ]. Other Canadians who have already gone abroad for treatment have faced complications and difficulties obtaining follow up care for their MS from their regular health care providers [ 25 ].
For example, one Canadian man died following CCSVI treatment received in Costa Rica after experiencing difficulty obtaining treatment for complications following the procedure upon return home to Canada [ 26 ]. Nonetheless, MS advocacy groups have become highly organized through social media and have been successful in influencing the Canadian political debate on the funding of CCSVI treatment in Canada [ 3 ].
We specifically examine issues central to their decisions to go abroad for this intervention. This paper serves to shed light on the experiences of Canadians who have received CCSVI treatment as medical tourists and will serve to augment research on the global health services practice of medical tourism.
This analysis is part of a larger study aiming to develop an informational tool for better informing Canadians about ethical concerns related to medical tourism [ 28 ]. As part of this study interviews were conducted with Canadians who had previously gone abroad as medical tourists to examine their decision-making processes and the usefulness of such a tool.
This paper presents a secondary analysis that examines the cases of only those 15 interviewees who had gone abroad for CCSVI treatment. Their age ranged from 28 to 65 with a median age of Following receipt of ethical approval from the Office of Research Ethics at Simon Fraser University, we recruited former Canadian medical tourists to participate in these interviews using: 1 advertisement on Craigslist; 2 advertisement in a Vancouver-based newspaper; 3 posting invitations to participate in online medical tourism fora; and 4 snowball sampling through interview participant networks and past research participant networks.
Interested individuals were asked to contact either a toll-free number or email address for more information about the study and assessment of eligibility. Those deemed eligible for participation were provided with a consent form to read and sign before beginning the interview. Verbal confirmation of informed consent was also obtained at the beginning of the interview and participants were assured of their anonymity.
Interviews were conducted between October and December On-going recruitment occurred during these months with the intention of completing as many interviews as possible before ceasing recruitment at the end of this time period. Interviews lasted on average 45 minutes, with the shortest lasting approximately thirty minutes and the longest lasting approximately one hour and a half. This range in interview times is due to their semi-structured nature, wherein a standard guide for interview questions was used but participants were also invited to discuss ideas that were not otherwise asked that may provide meaningful insight to a broader understanding of the topic at hand [ 29 ].
All interviews were conducted over the phone, a technique that enabled interviews to be completed with Canadians from across the country.
Transcripts of interviews conducted with participants who had gone abroad for CCSVI treatment were hand coded for four broad categories identified through transcript review by the authors: 1 why CCSVI treatment was sought and where it was obtained; 2 the role of having hope for a cure in seeking CCSVI; 3 the impact of MS on everyday life; and 4 the role other people played in the decision to go abroad.
Coding extracts were next independently reviewed by all authors. Following review of these extracts, all authors met to discuss emerging analytic themes, paying particular attention to patterns and outliers in the discussions. During this meeting, consensus was reached on three themes central to participants' decisions to go abroad and the scope of each of these themes was established.
In this paper we present a thematic analysis that examines the breadth and depth of these themes. Thematic analysis necessitates identifying themes based on patterns in a qualitative dataset and comparing these emerging themes to established findings in existing literature to help identify their importance or novelty [ 29 ]. Following identification of these themes, the first and fourth authors reviewed the full transcripts again to ensure that all relevant data had been captured. The first author then selected the quotes that best illustrated the nature of these themes.
All authors independently reviewed these selected quotes and met again to confirm their interpretation along with the scope of each theme and also to discuss the findings as they relate to the existing literatures on medical tourism, patient decision-making, and health care rationing.
This study adheres to the RATS guidelines on qualitative research. These individuals first experienced a loss of faith in the Canadian health system by virtue of their frustration with domestic health care providers and health system administrators who would not accommodate their desires to access unproven interventions at home.
Following this loss of faith, these individuals nurtured hope that access to CCSVI treatment abroad could eliminate or lessen some of their symptoms of MS, though they were generally measured in their expectations. Once hope for better quality of life through travel abroad was established they finally embarked on their trips abroad, forming trust and through it confidence in the credentials and personalized service of their caregivers.
Faith, hope, and trust were thus central to their decisions to ultimately go abroad and seek CCSVI treatment in another country as medical tourists.
In the sub-sections that follow we examine these three thematic findings in depth. The participants described a loss of faith with different aspects of the Canadian health system due to their inability to access CCSVI treatment at home. They felt their diagnosis with MS marked them out as different from the rest of the population and subject to inferior treatment.
Blame for feelings of unfair treatment by the Canadian medical system was largely targeted at neurologists who serve as gatekeepers to specialized treatment. This antagonism toward neurological specialists complicated care within the Canadian system for the participants. Because once again a neurologist has domain over my disease. Connected to this loss of faith in Canadian medical specialists, many participants felt a loss of faith in the Canadian health system as a whole and felt pushed into the health systems of other countries as medical tourists.
This loss of faith took the form of a violation of the expectation that the Canadian health system would be responsive to their perceived health needs given a lifetime of supporting this system through their taxes and viewing the health system as an important part of their Canadian identity. The refusal of specialists, health system administrators, and government officials to provide access to this intervention forced them to go abroad for care at significant personal cost, resulting in an overall loss of faith in the Canadian health system in addition to specific health care providers.
The participants regularly described their decision to travel abroad for an unproven medical intervention as driven by a range of emotions, but particularly as a result of hope for relief of the progressive decline in their health brought on by MS. For example, a participant described how hope combined with excitement shaped her interactions with the doctor she saw while abroad. Worsening health and the loss of quality of life brought on by MS was a significant factor driving participants abroad.
Despite this lack of guaranteed success, doing nothing was not seen as an option. For these participants, staying in Canada would be equivalent to accepting as permanent the loss of function from MS, and so any response was desirable. And so I was going to do something. Their measured hope was in some cases informed by the cautions of the physician providing the intervention.
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