Medical Tourism in Developing Countries

110 ● Medical Tourism in Developing Countrieshave more than doubled their R&D investments in developing countriesover the past decade ($30 billion in 1993 to $67 billion in 2003), most ofit has gone to East Asia, India, and Eastern Europe. 56In order to be effective, expenditure on R&D must have the followingcharacteristics. It must be ongoing and increase over time in order to keepup with relentless technological change (as Cetron et al. stated, “Half of whatstudents learn in their freshman year about the cutting edge of science andtechnology is obsolete, revised, or taken for granted by their senior year” 57 ).R&D expenditure must also take place in the context of well-defined intellectualproperty rights that are respected by all. Finally, cooperation betweensectors and entities is imperative in order to eliminate duplication of efforts.Specifically, public universities and research centers must work with the privatesector as that is where much of the funding originates (even China getsmost of its R&D money from the private sector 58 ).Given the importance of technological change for the medical tourismindustry, destination countries under study are compared with respect toindicators of R&D (table 5.3). The number of patents awarded per millioninhabitants is an indication of local innovation and only Costa Rica has apositive number. All countries spend a positive amount of money on researchand development, as measured by R&D expenditure as a percent of totalGDP. With respect to the number of researchers involved in R&D permillion people, only Jordan stands out. However, these results are not veryinformative since data are not available for many countries under study, soperhaps indirect evidence can shed more light on the research reality incountries promoting medical tourism. Indirect indicators of technology creationmight be the quality of scientific research institutions and the collaborationbetween industries and universities. With respect to the former, Indiaranks the highest among the countries under study. In fact, it ranks seventeenthglobally—only one less developed country, Taiwan, ranks above it. 59It is followed closely by Malaysia, which leads in terms of the R&D collaborationbetween industries and universities. Incidentally, for comparison purposes,Jordan and Italy have identical values for collaboration (2.8).There are successes in research and development that are not reflected inthe data in table 5.3. For example, Cuba has made very significant stateinvestment in the biotechnology industry and now has the most advancedmedical technology in the area. 60 Its first success in medical research was thediscovery and patenting of the meningitis B vaccine in the 1980s (that isnow licensed to GlaxoSmith Kline for marketing in Europe). 61 Moreover,Havana’s Center for Molecular Immunology developed two crucialvaccines—Thera CIM, an antibody effective for certain head and neckcancers resistant to chemotherapy, and the SAI-EGF lung cancer vaccine 62