Adaya Gonzalez |
Madrid (EFE).- Much cheaper prices, endless bariatric surgery waiting lists and the desperation to find a miracle at low cost are pushing obese people to seek a solution in Turkey, even at serious health risks. Botulism has been the last to jump, but it is not the only one.
Until today, the European Center for Disease Control (ECDC) has reported a total of 67 cases -12 in Germany, 1 in Austria and Switzerland and 53 in Turkey- of iatrogenic botulism -the one that appears after the administration of the toxin for therapeutic or cosmetic purposes – in patients who have been treated in this country to lose weight between February 22 and March 1.
Although no such cases have come to their offices, the experts consulted by EFE warn that the Spanish obesity units are filling up with patients with complications derived from bariatric interventions performed in Turkey, some with fatal results, such as the 17-year-old minor from Seville who died just a year ago during the operation.
an experimental treatment
In Spain, three types of botulinum toxin type A are marketed; Beyond its aesthetic use, especially for facial wrinkles, it is administered to treat migraines or muscular dystonia, for example, and always in hospitals, although it is contraindicated for patients with neurodegenerative diseases such as myasthenia.
Applied to obesity, “it has only been used in research studies, adequately controlled and approved by the corresponding ethical committees” and using adequate techniques and amounts without significant adverse effects having been reported, explains Sergio Valdés, from the Obesity Area of the Spanish Society of Endocrinology and Nutrition (ObesitySEEN).
Hence, for now, “should be considered an experimental treatment.”
Unlike its other uses, in obesity it requires an endoscopic procedure that must be performed by a specialist in digestive medicine: with this technique, the toxin is injected into various areas of the stomach, thus inducing its paralysis to delay its emptying, with which the feeling of satiety lasts longer, which may imply a potential reduction in intake and weight loss.
But its effectiveness has not been verified by studies that have yielded conclusive results, so “it should not be administered to any patient outside the framework of a research study,” says the expert.
Turkey drinks the black market
It has not yet been clarified whether these 67 cases are the result of a misapplication of the technique, an excess of injected toxin units, or the product itself.
“In our sector, Turkey is famous because many batches of toxins come from there that are not authorized here, but they enter through the black market because it is much cheaper,” says Petra Vega, an aesthetic doctor from the Spanish Society of Aesthetic Medicine (SEME). ).
The most common in his field is to use 50 units, maximum 100, depending on the area and the gender of the patient; for obesity, the most standardized injections have been 200, an amount that can be exceeded in neurology for spasticity, but in these amounts it is “extremely difficult” to develop botulism and, in fact, no cases have been described.
In any case, its effects are temporary, of no more than six months, another of the factors that condition its validation: “to what extent, having other much more effective treatments such as the drugs that are already available, does it pay to have an endoscopy, that requires sedation, every six months?” Vega wonders.
While it is clarified what has led to this situation, which the ECDC expects to worsen with more cases, experts ask to be very attentive to the symptoms, which can range from mild to fatal if not treated in time.
“Diagnosing botulism is quite a challenge,” says Andrea Ciudin, coordinator of the Comprehensive Obesity Treatment Unit of the Vall D’Hebron Hospital and member of the Board of Directors of the Spanish Society for the Study of Obesity (Seedo); Its symptoms are varied and non-specific, so when it appears, the patient should immediately report that they have undergone one of these treatments.
Problems breathing or swallowing and weakness are some of them: “the toxin paralyzes the muscles closest to the stomach, such as those in the throat; if more than the right amount has been put in or where it was not meant to, it causes paralysis of all the muscles, including those involved in breathing, the diaphragm and the intercostal muscles”. Which is what has happened with several of these patients who have ended up in the ICU.
The other risks of medical tourism
The aggravating factor is that this problem is not reduced to this treatment, points out this expert in bariatric surgery, but rather they go there to undergo these major operations.
Food or water intolerances because they have very tight sutures, severe malnutrition because they have not followed the vitamin and mineral supplementation that these patients need for life, nor have they been monitored by a multidisciplinary team, or bleeding caused by the stitches from surgery, which jump even on the plane in which they get on just a few hours after surgery, are the most common.
“We have 30% of the adult population obese and the one that needs surgery can reach 10%, but the waiting lists are eternal”, Ciudin censures; in fact, bariatric surgery is the one that accumulates the most days of delay in Spain, more than 400.
Among those who need surgery, not all meet the criteria for public surgery, where the questioned Body Mass Index (BMI) continues to be the main requirement. Cases of eating disorders are ruled out.
So these people turn to Turkey out of “sheer desperation”. “They do not find solutions here or anywhere in the world to their disease, because obesity is a disease for which the only treatment that is given is to send them to walk and eat less.”
Having surgery in Turkey costs practically three times less than in Spain, with figures that sometimes do not even exceed 3,000 euros.
“I think that human beings seek the miracle and, furthermore, that it be cheap”, adds Vega; The doctor points out that the risks of these trips are not exclusive to people with obesity – “men with HIV have come to us after getting hair grafts,” she comments -, but in her case “they have a very bad time” seeing how they fail in their innumerable attempts to lose weight on a diet.
Scientific societies strongly advise against this health tourism and call on the authorities to act: “these people have to assess whether their health has to be on a discount. Here, doctors, we complain about all the rules that they set, but in the end it is for the safety of the patient. And that has a price, because it is our health that we are risking ”, Vega concludes.