By that time, Gregg Victor, 65, had suffered from Parkinson's for seven years. Her right hand trembled so much that she couldn't write anymore; feeling in the toes of her right foot would fade in and out; and she couldn't twist that ankle. When she walked, her right leg moved more slowly than her left.

Frustrated by the lack of treatment options in the U.S., she was willing to gamble on a $10,000 procedure involving the injection of 3 million of her own stem cells, extracted from bone marrow in her hip, into the fluid surrounding her spinal cord.

Unlike other cells, stem cells have the power to replicate, making them potentially powerful weapons against all manner of pathologies, from Alzheimer's to diabetes. The cells can be harvested from numerous sources--often from a patient's own bone marrow or from umbilical cord blood of healthy newborns. Once multiplied and conditioned, the cells can be injected intravenously into the blood stream or directly into injured sections of the body, depending on the ailment.

Gregg Victor is one of the 1.5 million Americans who traveled abroad to get medical treatments last year. Most of these so-called medical tourists sought quicker access to health services, care for non-covered procedures like dental surgeries and cheap elective procedures like face lifts. More than a few were pursuing new stem-cell-based treatments unavailable in the States and rarely covered by American insurance companies. In March, President Barack Obama issued an order removing the limitations on stem-cell research set by George W. Bush, but real movement on this issue, if any, is still many years away.

In the meantime, patients are paying up. Adult stem-cell treatments, often arranged by American-based intermediaries, run between $10,000 and $35,000, depending on the treatment. Airfare and hotel stays are extra.

Never mind that scientists say this is risky, unproven stuff. "I believe that [stem cells] will give us some new way to heal diseases, but for now [success] is anecdotal," says Dr. Donald Kohn, researcher with the Broad Stem Cell Research Center at UCLA. "I believe [any healing] is more a psychological effect."

Irving Weissman, director of the Institute for Stem Cell Biology and Regenerative Medicine (ISSCR) at Stanford University, is more blunt: "I've have worried about [stem-cell related medical tourism] for a long time," he says. "Every reputable doctor or scientist worries about it."

But desperation is compelling. "I am not waiting for the FDA to rule to get treatments," says Gregg Victor, who chose her clinic in Germany after spending a year and a half looking into stem cell treatments available all over the world. It's an inefficient process: Neither the U.S. Food and Drug Administration nor the National Institutes of Health track this stuff. For now, hospital Web sites, blogs and patient Facebook groups remain the research routes of choice.

The Xcell-Center has performed 1,500 stem-cell treatments since opening in 2007, says Ruud de Jong, the center's business development manager. De Jong claims Xcell's representatives in the States receive thousands of requests a month and end up scheduling eight to 10 procedures a week for American patients, who mostly are looking for treatment of neurological diseases. The Xcell-Center has a licensing agreement with the German government, but is not yet certified by the European Medicines Agency, the European Union body that evaluates medicines and supervises public health, although de Jong expects to snag that cert in the next few months.

Five months after her procedure, Gregg Victor is underwhelmed by her improvement. While she says she has more control over her feet, and the pain in her stomach that made it hard to sit has abated, her walking has not improved, her right arm still shakes, her wrist hurts continuously and her right foot still tends to numb up.

As for how her experience stacks up to the rest, it's hard to tell. De Jong says that one-third of Xcell's patients don't see any response to the treatment, one-third have a good response and one-third registers "excellent results." But the problem with those statistics is that they are based on what the patients themselves report--after they return home and cannot be monitored directly.

"The biggest problem is separating the facts from the fiction," said Ralph Dittman, a former surgeon and professor at Baylor College of Medicine in Houston. Dittman suggests that the ISSCR agree on a standardized format for treatment results.

Aubra Lee Phillips wasn't about to wait. Phillips met Gregg Victor in the lounge of the Xcell-Center. Just 50 years old, Phillips had suffered from Parkinson's for 22 years. "I felt like committing suicide," he says. "I could not get my brain to work with my mouth. I could not hold my grandchildren for the fear to drop them."

Phillips says his stem-cell treatments have worked from the very beginning and that now he's "60% to 70% better" than he was. He used to drag his legs and have trouble mustering the strength to sign credit card bills; post stem-cell treatment, he can jog and take notes. His stutter is gone too. Says Phillips, "If I can improve the quality of my life for what I have left to live, that is all I am after."

When Nashville resident Anderson Jordan, at age 72, said he wanted to fly to Bangkok to treat his congestive heart failure in July 2008, his internist of 22 years balked. But Jordan was fading fast: His ventricles were only managing to pump at 19% capacity--a healthy person's "ejection fraction" is between 50% and 65%--and he could not get another bypass.

Surfing the Internet, Jordan happened upon TheraVitae, a Bangkok-headquartered biotechnology company that markets "VesCell stem cell treatments" via licensing agreements with four clinics in Thailand, one in Singapore and one in the Dominican Republic. These procedures involved using a patient's own stem cells to build new blood vessels and heart muscle. The fact that the therapy would use his own blood excited Jordan. He contacted prior patients whose stories were chronicled on the company's Web site. One patient from Oregon told Jordan of the miraculous effects of the treatments on his angina.

Thai doctors injected 25 million of his own stem cells into Jordan's heart. Twenty thousand miles, 22 days, a cardiac arrest and $43,000 later, he came home to his wife with an ejection fraction between 30% and 35%. Even Jordan's doctor had to admit he was happy with the results.

"There simply are no domestic studies with control groups," says Dr. William E. Baucom, Jordan's internist. "There is no way to know the exact reason, but [Jordan] has improved and he does look good today."
 

Central Florida hospitals have begun encouraging patients from abroad to come to Orlando for medical treatment. To increase the area’s reputation as a medical destination, Florida cities are also looking to increase their share of the lucrative medical meetings market. Orlando, the nation’s top-ranked medical meeting hub for the past decade, played host to more than 215 medical meetings with 170,000 attendees in 2008.

While the new research reveals global challenges faced in 2009, particularly within the high-end luxury resort spa sector, it also shows the strength and resiliency of the industry in fast-growing markets like Asia-Pacific and across the world. The economy also appears to be accelerating an ongoing macro trend: the expansion of an industry focus on preventative health and wellness, and a shared perception that opportunities lie in a collaborative future with the health and medical industries.

Commenting on the extensive research findings, Susie Ellis, member of the Global Spa Summit Board of Directors and president of SpaFinder, Inc. noted that, “Rather than the economy causing largely adverse affects, it appears that new economic challenges are sharpening a shift that was well underway—with the industry today thinking far beyond „mere luxury‟ to new markets, new consumers, and new offerings that now make spa a key player in the health industry, in addition to being part of the travel and luxury markets.”

Research has been the hallmark of the Global Spa Summit since its inception, as evidenced by the groundbreaking 2007 Global Spa Economy Report, released at the 2008 Summit. The depth and diversity of research introduced this year solidifies the Summit as the resource center of the global spa industry, whose leaders are exploring a wide range of data that quantifies and properly segments this $251 billion global market.

Original industry reports presented at this year’s Summit included:

1. A live poll of Summit delegates on the current performance and future directions of their companies and the industry
2. Intelligent Spas 2009 Global Spa Summit Spa Benchmark Report, presenting global and regional spa industry benchmarks specifically for the GSS (as this years premier sponsor)
3. Global hotel data provider Smith Travel Researchs (STR) first-ever luxury hotel-spa benchmark report, gauging the luxury resort sectors recent performance
4. A collaborative report between Cornell School of Hotel Administration, US and École hôtelière de Lausanne, Switzerland graduate students: Contribution of Spas to Hotel Operating Performance – An International Study

In addition, ISPAs Global Consumer Data 2008 was presented; Diagonal Reports shared their latest beauty industry data; and Ernst & Young contributed their first spa benchmarking initiative, the Middle East Spa Benchmark Survey report for January through March 2009. Summit delegates also received a 100-plus-page briefing paper, which included individual briefings from 28-countries (each written by a delegate from that country). The briefing paper provides overviews of the spa landscape through May 2009, and specifically addresses the effect of the global economy on each nation, including current and future spa projects, consumer spending patterns, and micro-trends.

Responding to the Summits 2009 theme, ”The Power of Collaboration,” delegates also forged new global initiatives, including a Hydro-thermal Spa Association and a medical consortium dedicated to aggregating research that establishes the efficacy of spa treatments from across the world. A new communication platform will also be designed to facilitate dialogue among the sixty-plus spa associations across the globe.

Key Findings from GSS Delegate Survey*

• 48% of delegates reported revenue gains in 08 over 07, with 34% having seen no change, and only 18% reporting declines
• Despite the severe economic downturn in 09, 39% of spa companies report they actually expect revenue to increase this year; 30% expect it to stay the same; with 31% anticipating declines
• Delegates report that the preventative health segment has the biggest opportunity for their future business (37%), more than twice those that named a luxury spa focus, and significantly outranking day spas, cosmetic medical spas, chain/branded spas or real estate
• The Internet along with preventative healthcare rank as the two forces predicted to have the most influence on spas‟business moving forward, significantly outranking sustainability and an aging population across all regions
• When asked which industry they would be most interested in collaborating with, healthcare (46%) largely outranked the next sector, travel and tourism
• (20%) - which trumped information technology (13%), construction/real estate (10%), consumer goods (7%), and media/entertainment (4%)
• Delegates report the two most critical factors in the expansion/profitability of the industry are marketing (28%) and healthcare insurance regulations (25%), followed by emerging consumer markets (19%), public policy/government (14%), and the hotel construction pipeline (14%)
• 51% of delegates report sustainability and environmental responsibility will have a significant influence on their business - 36% somewhat - and only 13% „very little
• Three in four delegates report the current economy has either significantly or somewhat improved the labor shortage problem, which ranked as the #1 issue facing the spa industry in both 2007 and 2008 GSS polls
• „Definitions/standards/best practices issues ranked as the #1 problem facing the global spa industry today (29%), followed by training and education (21%), low margins (15%), labor costs (11%), lack of benchmarks (7%), oversupply of spas (6%), labor shortage (4%), technology (4%), medical liability (2%) and funding limitations (2%)

Key Findings from Intelligent Spas Report**

• The average rate for a spa treatment in 2008 was $90. Europe was the highest at $111, and Asia-Pacific the lowest, at $77
• In 2008, the average size of a spa was 8,847 square feet/788 meters, featuring nine treatment rooms. Employees per spa averaged 22.9, with the Americas averaging the most (33.8) and Europe the fewest (13.6). 50% of total spa revenue is spent on salaries and employee benefits, by far the most significant expense category. Spas spend, on average, 9% on operations/maintenance, and only 4% on marketing, and 2% on training
• The day spa guest has become critical for hotel spas: 38% of total spa visits at hotel spas now come from non-hotel, local community guests. In some regions (such as Europe and the Middle East/Africa) this is approaching the 50/50 mark. (53% hotel/47% non-hotel guests for both regions)
• In terms of the outlook for 2009, Asia-Pacific spas report the most optimism, with annual spa revenue expected to grow 24% from 2008 to 2009. While Middle Eastern/African spas show the most pessimism, expecting revenue to fall roughly 20%
• The region with the largest percentage of outsourced spas (using a management company) was the Americas at 32%, three times higher than any other region
• Spa revenue figures originally forecast in the last quarter of 2008 needed to be trimmed by 9.4% after the economic downturn in the first quarter of 2009

Key Findings from Smith Travel Research***

• Global luxury hotel occupancy fell 13.2% in Q1, 2009
• The average luxury hotel spa treatment revenue rose from roughly $138 per customer in 2007, to $149 in 2008, and then fell to $113 in Q1, 2009
• Similarly, average salon treatment revenue grew from $66 per customer in 2007, to $73 in 2008 - but fell to $61 in Q1, 2009
• A bright spot showed the average retail revenue per spa treatment rose from $18 to $25 when comparing January 2008 to January 2009

About Global Spa Summit

The Global Spa Summit is an annual event that attracts top-level business executives from all over the world with interest in the spa and wellness industry. Representatives from diverse sectors including hospitality, investment, finance, real estate, medical, manufacturing, technology, consulting, product and other related industries attend this intimate, high-level gathering focused on moving the spa and wellness sector forward. With representatives from all continents and myriad countries from all over the world attending its yearly Summit, the Global Spa Summit and its website have become the hub for industry research worldwide, a connection for spa associations and educational resources around

It marked the first time that a Taiwanese medical team has performed a liver transplant for an American, according to Chen Chao-long, superintendent of the hospital's Kaohsiung branch who headed the medical team that performed the transplant.

Chen, an eminent liver transplant surgeon, told local news media that the 55-year-old American artist, identified as Eileen Dreizin, had terminal stage cirrhosis when she approached Chang Gung hospital for a liver transplant.

According to Chen, Dreizin's son suggested to his mother to undergo a liver transplant in Taiwan after he discovered through an extensive Internet search that Chen's surgical team has the world's highest survival rate, even higher than counterparts in many advanced countries, including the United States, Japan and major European Union countries.

Another incentive was the relatively low cost of liver transplants in Taiwan, Chen said.

In Dreizin's case, Chen said, the total cost was NT$2 million (US$61,350), far lower than the roughly US$300,000 needed in the United States.

Stressing that Taiwan's organ transplant skill has long been acknowledged in the global medical community, Chen said he believes that Dreizin's case is just a beginning. "We believe that more people from advanced countries will choose to receive liver transplants in Taiwan given its lower cost, " Chen said, adding that the procedure could be a major asset in Taiwan's bid to develop medical tourism.

Chinese scientists have given cells from adult pigs the ability to turn into any tissue in the body, just like embryonic stem cells.

They hope the breakthrough could aid research into human disease, and the breeding of animals for organ transplants for humans.

It may also enable the development of pigs that are resistant to diseases such as swine flu.

The study appears online in the Journal of Molecular Cell Biology.

Lead researcher Dr Lei Xiao, of the Shanghai Institute of Biochemistry and Cell Biology, said many other attempts had been made to transform adult cells from animals such as pigs into "pluripotent" stem cells, but they had failed.

He said: "Therefore, it is entirely new, very important and has a number of applications for both human and animal health."

Dr Xiao's team reprogrammed cells taken from a pig's ear and bone marrow, using a cocktail of chemicals introduced into the cells via a virus.

Tests showed that the reprogrammed cells were capable of becoming any of the cell types that make up the three layers in a developing embryo.

Ideal source

Dr Xiao said pigs were a potentially ideal source of organs for transplant, as their organs were similar in function and size to those found in humans.

He said reprogrammed stem cells could potentially be used to make a pig organ compatible to the human immune system, minimizing the risk of rejection.

The cells could also be used to mimic human disease in pigs, allowing scientists to test new therapies without requiring human volunteers.

In addition to medical applications, Dr Xiao said his discovery could be used to improve animal farming, by making the animals healthier, and regulating the way they grow.

However, he warned it could take several years before some of the potential medical applications of his research could be used in the clinic.

Professor Chris Mason, an expert in regenerative medicine at University College London, said: "This breakthrough to produce pig stem cells potentially reinvigorates the quest to grow humanised pig organs such as pancreases for diabetics and kidneys for chronic renal failure.

"The clinical use of humanised porcine tissues and organs (xenografts) has moved a long way forward in recent months with successful small-scale clinical trials.

"Whilst the xenograft approach may not necessarily be the long-term solution, it may represent a major step change in the treatment of organ failure, which potentially could deliver real benefit to millions of patients within a decade."

Dr Sebastien Farnaud, science director of the Dr Hadwen Trust for Humane Research, said: "Persisting with highly speculative research that would see us use sentient animals as little more that living organ grow-bags, is not only ethically unsupportable but also scientifically dubious.

"Creating pig stem cells does not necessarily remove the risk of organ rejection but even more worrying is the risk of infecting patients and the wider public with pig viruses."