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Manley

Traumatic Brain Injury: UCSF Neurosurgeon Calls For More Research, Improved Treatment Standard

(Vocus) March 20, 2009

But when the headlines shift to other topics and the current flurry of public interest in TBI subsides, there will remain a pressing need for increased awareness and improved treatment of these potentially life-altering — but also often treatable — injuries, says UCSF professor and internationally recognized neurotrauma expert Geoff Manley, MD, PhD, professor of neurological surgery, co-director of the UCSF Brain and Spinal Injury Center and chief of neurotrauma at UCSF-affiliated San Francisco General Hospital.

The majority of TBI victims — who number about 1.4 million annually — are treated and released from the emergency department, but TBI remains a major cause of death and disability. The Centers for Disease Control and Prevention (CDC) estimates that 5.3 million Americans are currently living with long-term or permanent mental and physical impairments as a result of a TBI.

“Studies over the past two decades have revealed much about the biological mechanisms behind TBI, but there has been a serious lag when it comes to translating that knowledge into a successful clinical trial and improved patient care,” said Manley.

“There have been more than two dozen failed clinical trials, and no substantial progress in taking the kind of research we do at UCSF and translating it to the clinical arena,” Manley said. “Even the way we classify TBI is completely outdated.”

The current classification system, known as the Glasgow Coma Scale (GSC), divides a patient’s TBI into the extremely broad categories of mild, moderate and severe, and fails to take into account the specifics of each patient’s condition, Manley said.

What is needed is a new classification system and an overall standardization of treatment and research efforts, he said.

“If we can start to standardize, we can really change the field,” Manley said. “Only by standardizing can we make things more efficient, streamlined and economical.”

Manley and other TBI experts from nearly 50 agencies and institutions will be tackling these issues at a consensus conference in Silver Spring, MD, on March 23-24. The conference is co-sponsored by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, the National Institutes of Health, and the U.S. Department of Veterans Affairs.

Manley said he hopes the conference will produce real results that can be immediately applied to TBI clinical trials, including one scheduled to take place at UCSF later this year — the ProTECT trial — that will study the use of progesterone in the treatment of acute brain injury.

Increasing Awareness

In the long term, he said, overhauling the way TBI is currently studied and treated could prevent tragedies like the one that befell Richardson.

Manley called Richardson’s condition “totally treatable” and said if she had received prompt medical attention and surgery, she likely would have survived.

“It’s truly a matter of awareness,” he said. “Everybody believes cancer or heart disease could happen to them, but nobody really believes they’re going to walk across the street and someone is going to run them over. For whatever reason, people don’t want to believe they are going to sustain a head injury despite the fact that TBI remains one of the leading causes of death under the age of 45.”

Appreciating the potential danger of head injuries and taking the proper precautions “is just not part of the fabric of our culture,” Manley said. “That’s something that has to change.”

Related Links:

UCSF Expert Discusses Traumatic Brain Injury, Natasha Richardson

Manley Laboratory at UCSF

UCSF Research at SFGH Helps Critically Injured Neurotrauma Surgeon Geoff Manley

School of Medicine, May 22, 2007

Pushing the Limits to What Is Medically Possible–Patient Story: Crystal Elmendorf

School of Medicine, May 22, 2007

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Medical tourism is an increasingly growing industry where people travel to receive significantly less costly medical treatment, including dental, cosmetic, surgical, and general medical care. Although traveling for health goals extends back to long-gone civilizations, ‘medical tourism’ is a relatively new term coined by the mass media to promote the burgeoning industry. It is commonly used interchangeably with medical travel, health tourism, healthcare travel, healthcare abroad, and overseas healthcare.

The history of medical tourism dates back to 4,000 B.C., when the Sumerians erected health centers around thermal springs that were frequented by health travelers. In Greece, a temple was built for Asclepius, the god of medicine, and the Temple of Asclepius was one of the pioneering health centers in the entire world. This led to the erection of other Grecian health facilities, such as Epidaurus, the most famous of all ancient health complexes. Epidaurus had a gymnasium, a snake farm, a dream temple, and thermal baths. Similarly, on the other side of the world was India, where healers were also enticing the first medical travelers to receive the advantages of yoga and Ayurvedic medicine.

Different people have different reasons for wanting to travel to another country to receive medical treatment. The most compelling reason, however, is that medical procedures in other countries cost markedly lower than those done in the United States and in the United Kingdom. For example, heart surgery in India may cost only $12,000, but in the U.S., the total can go up to $200,000. And even when the price is economical, the quality of medical care that is received meets international standards enforced by the Joint Commission International (JCI). Health facilities and equipment are state-of-the-art and the specialists, of whom many are educated in Western countries, are usually the very best in their own country. At the same time, the level of service is higher than the usual given in the U.S. and U.K. Private rooms, lavish accommodations, and a very friendly and attentive staff are often only on hand to those who can pay for them in the West. There is also the bonus of mixing recuperation with a vacation, which allows patients to receive the recreation they should get.

The costs of receiving treatment in other countries are greatly lower than having the procedure done in the U.S. For instance, in India, a heart valve replacement surgery can be executed for $12,000. That is significantly lower than the $200,000 price tag American health providers put on this complicated heart surgery, so that even when other costs are included, there still is a sizeable amount of savings that remains. These other costs include airfare, accommodations, local transportation, meals, tours, souvenirs, etc. In South American countries, such as Brazil, Panama, and Costa Rica, treatment costs are commonly a bit higher than in Asian countries, such as India, Thailand, and Malaysia, being only 50% lower than costs in the U.S. This is balanced, however, by the lower travel costs such as airfare.

There are many medical tourism destinations to pick from. India, indubitably, is at the top of the list when speaking of the lowest prices and highest quality of healthcare services. India’s health workers are among the best in the world and they do a vast variety of treatments, from tummy tucks to dental cosmetics to knee replacements to heart bypass surgeries. Other notable Asian countries are Thailand, Singapore, Malaysia, and the Philippines. The industry is also flourishing in South America, which pride themselves with the finest cosmetic surgeons and facilities in the entire world. It is not new, since this alluring land is widely regarded for its obsession for beauty and physical appeal. In Europe, other countries are catching up. Hungary, Belgium, and Germany are ideal destinations for Europeans who wish to receive less costly treatments without flying across oceans or entire continents.

Medical tourism facilitators, also named medical tourism agents, assist people in making the engagements for their overseas treatments. They work much like tourism agencies. They organize the travel plan, make reservations, book tickets, arrange schedules, etc. The main difference is medical tourism facilitators also ease the communication between their clients and the chosen healthcare provider and specialist. A medical tourism facilitator is like a one-stop shop for all your healthcare travel needs.

Choosing a medical tourism company that is sure to be worth your money can be taxing because many dubious outfits have easily mushroomed on the Internet, taking advantage of the swelling popularity of this new medical movement. When searching for a facilitator, one of the first things to look for is certification from the Medical Tourism Association (MTA). The MTA is the first and only international not-for-profit organization that promotes high-quality medical tourism services. It is also the only body that awards certification to facilitators that meet the standards of outstanding service. It is also recommended to conduct research on the healthcare providers that your chosen facilitator is associated to. Reliable international hospitals are those that have been recognized by international bodies, such as the Joint Commission International.

One of the defining features of medical tourism is the use of telemedicine. Telemedicine, which was legitimately began in the late 1980s, involves the transfer of medical information via technological devices. Talking to the phone to discuss your symptoms with your medical provider is considered telemedicine, and so are transferring medical records via the Internet and holding two-way videoconferences with your doctor. This enables the continuation of healthcare even after the procedure and rest period have passed and the patient is back in his/her home country.

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