Showing papers by "Jeremy Snyder published in 2019"

Health Misinformation and the Power of Narrative Messaging in the Public Sphere

Abstract: Numerous social, economic and academic pressures can have a negative impact on representations of biomedical research. We review several of the forces playing an increasingly pernicious role in how health and science information is interpreted, shared and used, drawing discussions towards the role of narrative. In turn, we explore how aspects of narrative are used in different social contexts and communication environments, and present creative responses that may help counter the negative trends. As traditional methods of communication have in many ways failed the public, changes in approach are required, including the creative use of narratives.

Spatially exploring the intersection of socioeconomic status and Canadian cancer-related medical crowdfunding campaigns

Abstract: Objectives Medical crowdfunding is a rapidly growing practice where individuals leverage social networks to raise money for health-related needs. This practice has allowed many to access healthcare and avoid medical debt but has also raised a number of ethical concerns. A dominant criticism of this practice is that it is likely to increase inequities in access to healthcare if persons from relatively wealthy backgrounds, media connections, tech-savvy and educational attainments are best positioned to use and succeed with crowdfunding. However, limited data has been published to support this claim. Our objective in this paper is to assess this concern using socioeconomic data and information from crowdfunding campaigns. Setting To assess this concern, we present an exploratory spatial analysis of a new dataset of crowdfunding campaigns for cancer-related care by Canadian residents. Participants Four datasets were used: (1) a medical crowdfunding dataset that included cancer-related campaigns posted by Canadians, (2) 2016 Census Profile for aggregate dissemination areas, (3) aggregate dissemination area boundaries and (4) forward sortation area boundaries. Results Our exploratory spatial analysis demonstrates that use of crowdfunding for cancer-related needs in Canada corresponds with high income, home ownership and high educational attainment. Campaigns were also commonly located near city centres. Conclusions These findings support concerns that those in positions of relative socioeconomic privilege disproportionately use crowdfunding to address health-related needs. This study was not able to determine whether other socioeconomic dimensions such as race, gender, ethnicity, nationality and linguistic fluency are also correlated with use of medical crowdfunding. Thus, we call for further research to explore the relationship between socioeconomic variables and medical crowdfunding campaigning to explore these other socioeconomic variables and campaigns for needs unrelated to cancer.

"Tremendous financial burden": Crowdfunding for organ transplantation costs in Canada

Abstract: Online crowdfunding platforms such as GoFundMe are used to raise funds for health-related expenses associated with medical conditions such as organ transplantation. By investigating crowdfunding in Canadian organ transplantation, this study aimed to increase understanding of the motivations and outcomes of organ transplantation crowdfunding. Canadian liver and kidney transplantation campaigns posted to GoFundMe between May 30 & 31 2018 were identified and after exclusion, 258 kidney and 171 liver campaigns were included in study. These campaigns were coded for: worthiness of the campaign recipient, requested financial and non-monetary contributions, how monetary donations would be spent, and comments on the Canadian health system, among others. Results suggest Canadian organ donors, transplant candidates, recipients, and their families and caregivers experience significant financial difficulties not addressed by the public health system. Living and medication costs, transportation and relocation expenses, and income loss were the expenses most commonly highlighted by campaigners. Liver campaigns raised nearly half their goal while kidney campaigns received 11.5% of their requested amount. Findings highlight disease burden and the use of crowdfunding as a response to the extraordinary costs associated with organ transplantation. Although crowdfunding reduces some financial burden, it does not do so equitably and raises ethical concerns.

What Is Known about the Factors Motivating Short-Term International Retirement Migration? A Scoping Review

Abstract: It is known that older persons from many countries often enjoy living abroad for weeks or months of the year, often to avoid periods of harsh weather at home. However, there has been little attempt to synthesize existing knowledge of this practice, often called retirement migration. Scoping reviews are a widely accepted form of research synthesis. In this article we present the findings of a scoping review that asks: what is known about the factors motivating short-term international retirement migration? Using the guidance of a reference librarian, we searched 17 databases to identify pertinent academic articles. We read 110 articles in full, following an initial abstract review stage, ultimately including 44 in the review. The included articles primarily reported on studies that were qualitative in nature and heavily focused on the lived experiences of short-term international retirement migrants. Four synthesis themes summarize existing knowledge about the factors that motivate this transnational mobility: (1) the destination (e.g., climate, natural and cultural environment); (2) the people (e.g., social networks, language); (3) the cost (e.g., cost of living abroad, affordability of health care and housing); and (4) the movement (e.g., ease of travel, visa and residency requirements). Research to date mainly focuses on short-term international retirement migrant destinations in affluent countries or destinations chosen by seasonal migrants from relatively wealthy Global North nations. Based on these findings we identify several pressing research gaps and directions for future research.

Narratives of a “Dental Oasis”: Examining Media Portrayals of Dental Tourism in the Border Town of Los Algodones, Mexico

Abstract: The dental tourism industry situated along the northern Mexican border provides care primarily to American and Canadian tourists crossing the border to access dental treatments that cost less than ...

Medical Crowdfunding for Unproven Medical Treatments: Should Gofundme Become a Gatekeeper?

Abstract: Medical crowdfunding has raised many ethical concerns, among them that it may undermine privacy, widen health inequities, and commodify health care. One motivation for medical crowdfunding has received particular attention among ethicists. Recent studies have shown that many individuals are using crowdfunding to finance access to scientifically unsupported medical treatments. Recently, GoFundMe prohibited campaigns for antivaccination groups on the grounds that they "promote misinformation about vaccines" and for treatment at a German clinic offering unproven cancer treatments due to "the need to make sure people are equipped to make well-informed decisions." GoFundMe has not taken any additional actions to regulate the much larger presence of campaigns seeking to fund unproven medical interventions on the platform. In this article, we make the ethical case for intervention by GoFundMe and other crowdfunding platforms.

Crowdfunding for stem cell-based interventions to treat neurologic diseases and injuries

Abstract: Objective To characterize the marketplace for direct-to-consumer (DTC) unproven stem cell-based interventions (SCBI) for neurologic diseases and injuries using crowdfunding data. Methods Search terms were developed from previous empirical studies of DTC businesses and the International Classification of Diseases–11 for neurologic diseases and used to query GoFundMe9s internal search engine. Campaigns initiated November 2017–2018 and seeking SCBI for neurologic diseases and injuries (n = 1,030) were reviewed to identify the number of donors, number of Facebook shares, recipient location, funding pledged, funding requested, underlying neurologic condition, treatment location, and treatment facility name. Results A total of 1,030 crowdfunding campaigns for SCBI for neurologic diseases and injuries requested $33,449,979 and received $5,057,069 from 38,713 donors. The most common neurologic condition identified was multiple sclerosis (MS) (n = 404, 35.5%). Of campaigns naming specific destination facilities (n = 392), the most common clinical settings identified were the Stem Cell Institute in Panama City, Panama (n = 91, 23.2%), StemGenex in San Diego, California (n = 44, 11.2%), and Clinica Ruiz in Puebla, Mexico (n = 36, 9.2%). Conclusions MS dominated the total number of crowdfunding campaigns. Most campaigns were linked to individuals from regions geographically proximal to destination facilities advertising SCBI for particular neurologic diseases. Most of the clinical destinations were located in comparatively high-income countries such as the United States, Mexico, and Panama. These findings provide considerable insight into the DTC marketplace for SCBI. Analysis of crowdfunding campaigns can be used to develop more targeted patient education initiatives and health policies related to domestic and international travel for unproven SCBI.

“Medical tourism will…obligate physicians to elevate their level so that they can compete”: a qualitative exploration of the anticipated impacts of inbound medical tourism on health human resources in Guatemala

Abstract: Medical tourism, which involves cross-border travel to access private, non-emergency medical interventions, is growing in many Latin American Caribbean countries. The commodification and export of private health services is often promoted due to perceived economic benefits. Research indicates growing concern for health inequities caused by medical tourism, which includes its impact on health human resources, yet little research addresses the impacts of medical tourism on health human resources in destination countries and the subsequent impacts for health equity. To address this gap, we use a case study approach to identify anticipated impacts of medical tourism sector development on health human resources and the implications for health equity in Guatemala. After undertaking an extensive review of media and policy discussions in Guatemala’s medical tourism sector and site visits observing first-hand the complex dynamics of this sector, in-depth key informant interviews were conducted with 50 purposefully selected medical tourism stakeholders in representing five key sectors: public health care, private health care, health human resources, civil society, and government. Participants were identified using multiple recruitment methods. Interviews were transcribed in English. Transcripts were reviewed to identify emerging themes and were coded accordingly. The coding scheme was tested for integrity and thematic analysis ensued. Data were analysed thematically. Findings revealed five areas of concern that relate to Guatemala’s nascent medical tourism sector development and its anticipated impacts on health human resources: the impetus to meet international training and practice standards; opportunities and demand for English language training and competency among health workers; health worker migration from public to private sector; job creation and labour market augmentation as a result of medical tourism; and the demand for specialist care. These thematic areas present opportunities and challenges for health workers and the health care system. From a health equity perspective, the results question the responsibility of Guatemala’s medical education system for supporting an enhanced medical tourism sector, particularly with an increasing focus on the demand for private clinics, specific specialities, English-language training, and international standards. Further, significant health inequalities and barriers to care for Indigenous populations are unlikely to benefit from the impacts identified from participants, as is true for rural-urban and public-private health human resource migration.

Medical Tourism in Guatemala: Qualitatively Exploring How Existing Health System Inequities Facilitate Sector Development.

Abstract: This article explores how existing health inequities in the Guatemalan health system facilitate the emergence of its medical tourism industry. We report on our thematic analysis of 50 key informant...

Availability without access? Globalization and socio-political cleavages in emerging economies

Abstract: Scholars argue that globalization is reconfiguring socio-political cleavages. No longer do class divisions dominate. Rather, the argument goes, societies are increasingly divided between ‘cosmopoli...

Exploring isolation, self-directed care and extensive follow-up: factors heightening the health and safety risks of bariatric surgery abroad among Canadian medical tourists

Abstract: Purpose: This article explores first-hand accounts of Canadian bariatric patients’ experiences of seeking and obtaining weight loss surgery abroad through the practice of medical tourism. While res...

Exploring Informal Caregivers’ Roles in Medical Tourism through Qualitative Data Triangulation

Abstract: When Canadian medical tourists go abroad, they are often accompanied by friends and family, referred to as caregiver-companions, who provide informal care. These individuals play a role in patient decision-making and are stakeholders in medical tourism, yet little is known about their participation in this consumer health practice. To examine the roles that Canadian caregiver-companions play while accompanying medical tourists abroad, and to identify how multi-perspective qualitative data can augment our understanding of these roles, primary and secondary analysis was undertaken on datasets generated from multiple qualitative studies: semi-structured interviews with medical tourists, caregiver-companions, and international patient coordinators, and a survey with medical tourism facilitators. The findings from the triangulated analysis of these qualitative datasets serve to better understand the multiple, overlapping perspectives of different stakeholders in medical tourism. Results show that medical tourism caregivers act as companions, providing physical and emotional care; navigators, providing logistical assistance; and knowledge brokers, participating in decision-making and information exchange between medical tourists and professionals. Using data triangulation to examine the narratives of multiple stakeholders confirmed, altered, and augmented our knowledge of caregiver-companion roles. The unique perspectives offered by each participant group augment our understanding of caregiver roles and the practice of medical tourism.