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To the Editor in Chief:

The review by Hanefeld and colleagues nicely summarized some aspects of medical tourism based on the published literature from September 2011 to March 2012 and brings attention to an important area. 1 We would like to alert the readers to additional perspectives that are relevant to travel medicine practitioners. 2 In addition to the papers published in the medical literature, a number of recent books explore some of the broader issues related to medical tourism. 3,4

Other critical issues include cross‐border movement of infections, particularly multidrug‐resistant microorganisms, associated with medical tourism. 2 Challenges also include the lack of regulation of medical tourism companies, inconsistent accreditation of care providers, and the absence of a system to document the flow of medical tourists and to assure informed follow‐up care. 2

Medical tourism is complicated by financial, legal, and ethical issues, as well as by health‐related risks. Obtaining a medical procedure or treatment abroad that lacks scientific evidence clearly raises ethical concern. Lack of communication from providers to the medical tourist's home health care system results in fragmented care. Lack of oversight is associated with poor standards regarding patient privacy and confidentiality, suboptimal care, lack of liability/recourse for poor outcome, and low likelihood to effect improvement. Finally, medical tourists may not be sufficiently prepared for diseases that are endemic in the destination countries, for example, vaccine‐preventable diseases, travelers' diarrhea, malaria, and other vector‐borne diseases. 5,6

Issue Section:
Correspondence
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