Transcription
Medical tourism has long been associated with countries like South Korea or Thailand. You don't often think China, but China is fast developing a medical niche: cutting edge cell therapy for overseas cancer patients, and it's doing it at a much lower price than in the West. China has a very, you know, relatively easy regulation process to make China really the place where a lot of clinical trials are happening in the world. So how is China crunching the costs and the treatment times for patients? I'm Mariko in Singapore, and this is Asia Specific from the BBC World Service. Twice a week we bring you Asia Pacific stories unpacked by those who know them best.
Well, the more we learned about the story, the more fascinated we became. Cancer patients from countries like Australia and New Zealand flying all the way to China to undergo cutting edge cell therapy because it's cheaper and faster than doing it back home. And someone who has done just that is Amanda Harvey from Brisbane, who travelled to Shanghai in 2025 for treatment for blood cancer myeloma.
Amanda, thank you so much for joining me on Asia Specific.
Thank you for asking me to come on your program.
Firstly, there's a bit of a twist, isn't there? You're not just a patient, so can you just introduce yourself to our audience, how you came to a position where you were looking for this treatment in China?
Well, I was diagnosed with multiple myeloma seven years ago, and by the end of last year, I had run out of treatment options that were available in Australia. But as well as being a patient, I'm also a doctor, and I have a degree in cellular pathology. So I guess I was well placed to start searching for Car-T cell therapy in other parts of the world.
You just mentioned Car T cell therapy. I think it's fair to say that many of our listeners and viewers wouldn't be too familiar with it. So can you just explain what exactly it is?
What it is, is a way of taking a patient's T cells, which are basically your white cells which are involved in your immune system. And they are manufactured and programmed to then recognize and attack certain proteins that are on the cells of myeloma cells. So they harvest your own cells, they manufacture them, and then they infuse them back in, and your immune system gets to work. And the manufactured T cells hunt out your myeloma cells, attach themselves to them, and then kill them.
Why did you decide to go to China instead of doing it at home or elsewhere? Was it about the price? What was it about?
Well, unfortunately, last year Car T-cell therapy was not available either publicly or privately in Australia. It had been considered by the government for quite a few years, but we were still waiting for the funding to come through. So it wasn't an option in Australia. I looked at going to the USA and to the UK, but they were so prohibitively expensive it wasn't possible. So I got on good old Doctor Google and started working out where else in the world I could go. And I came across some stories of New Zealanders going to China for Car T-cell therapy. So I contacted one through Facebook. We chatted, I got in contact with Professor in Shanghai, and arranged to go there. So when I arrived, the next day, I was straight into straight into the hospital for three days of investigations, which include bone marrow aspiration, which I will add is not done under sedation in China. A lot of blood tests and CT PET. They then decide if you're suitable and if your bloods are suitable for the treatment. And once they've decided that, they have to harvest the T cells, and then you've basically been hooked up to something that's essentially a little bit like a dialysis machine for four or five hours. There's a filter in there, and that filters off your T cells. I then was discharged from hospital the next day. The T cells were sent off. Once they know that they're ready, I was contacted. I went into one of the big haematology hospitals in South Shanghai. I had three days of chemotherapy. And then the manufactured T cells were flown down from Beijing. Funnily enough, the reinfusion takes 45 minutes, and it's really quite an anti-climax. But I can tell you, 12 hours after that, I started to get sick with temperatures, feeling unwell. And you just have to put up with that, treat it, you know, paracetamol or whatever. Be mindful of infections. I think I felt really unwell for the first week, but by two weeks I was feeling really not too bad at all. After two weeks, I had another bone marrow aspiration, and that actually amazingly came back as completely negative for myeloma cells. So they were very happy. I was very happy. I was discharged from hospital. I spent another two weeks in Shanghai, where I went to the outpatients department to be checked over. And then when that was all right, I flew home to Australia. Fortunately, my trip to China had been done with the full collaboration of my haematologist in Brisbane. So I went home, as you would after any hospital discharge, with a good discharge summary. My hospital and haematologist took over my ongoing treatment in Australia. But obviously we keep in contact with the team in Shanghai.
If I may. Can you tell me, you said the China's treatment was a lot cheaper than the one that you would have got in the United States. Can you give us kind of the price difference that you personally witnessed when you were doing your research?
So I worked out that to go to either the USA or the UK would probably cost me about one million AUD. And that was assuming that I had no complications, no prolonged stay, no admissions to intensive care. If I had no complications, then it was probably going to bankrupt us. When I added up what we'd spent in China, I'd spent 110,000 AUD on the hospitals and the treatment. And then on top of that, there was obviously the travelling costs and the hotel costs and the cost of living. So it's about ten times cheaper. I was in China for a total of seven weeks last year, from October to December. Some of that time was taken up with investigations before I was accepted for the treatment. But the thing that seems to be much faster in China than it is in Australia, and certainly is reported in the United States, is once they've harvested your T cells and they send them off for manufacturing. Mine were back from Beijing ready to go within eight days. Now, looking at the USA, they report it takes between two to three months to manufacture Car T cells. And unfortunately, what that means is some people's myeloma develops so quickly that they are not able to receive the manufactured T cells because they're already too sick.
And how successful is this treatment? Obviously for your case, but also, you know, generally speaking, in terms of the success rate of this treatment to treat this blood cancer.
For me personally, it's been very successful. I was lucky enough to get out there with a low tumor load, which statistically makes the treatment more successful. But after seven months of being back in Australia, I'm now in complete remission. I've kept in contact with the person I contacted in New Zealand, and he was there six months before me, and he is also doing extremely well. For actual trials, I don't think the data is out there yet. Certainly we have the trials from America and from Europe to compare it with. But this treatment, which is slightly different in the way it works in Shanghai, really we don't have the longitudinal data to compare it with the other trials yet. But from a personal experience, it's been fantastic. I haven't felt this good since before I was diagnosed.
But if it's such an effective treatment, why is it not more commonly used? It may seem like a really silly question, but, you know, I would think of chemotherapy and other treatments instead of this one. So why is it not more commonly used? Is this about just the cost that you talked about?
I think it's very much about the economics of it. I can only speak for Australia, but I know that it has been proposed and asked for as a treatment for quite a few years, and it's taken a lot of negotiation to get it now publicly funded for multiple myeloma. And even then, there are the restrictions that you have to fail four other treatments. Unfortunately, the economics of healthcare means that the actual funding of a treatment runs far behind what is discovered in clinical trials.
I think many of us think of other countries in this part of the world, like Thailand, South Korea, for medical tourism. In your view, do you think China could possibly become a future destination for medical treatment, especially for this kind of cancer treatment?
I think it's already become a bit of a destination, but I think people don't think of China because that's not often how it's portrayed. It's portrayed as difficult to get to, not like going to other Asian countries, but there certainly seem to be positioning themselves for quite high end treatments. So they do provide a lot of top end or breaking groundbreaking oncology treatments. Apparently people that go there for cardiac surgery and orthopedic surgery. People do think, oh, I go to China for treatment, although I think I was very happy with it. I was very happy traveling with China. There are some differences between the way healthcare is in China and what you've come to expect. I've come to expect in Australia or maybe Europe. And that doesn't mean the standards are any less. It just means that the way their healthcare system runs is a bit different. Now, obviously, China has developed a healthcare system that has to cater for 1.3 billion people. And it is what I would describe as brutally efficient, fantastic. But there's no fluffiness. And in that, I mean, your nurses, they're very medical. They are brilliant at taking blood, giving treatment, but you have to bring your own relative with you if you want someone to help you share, feed you, clear away your sick. Nurses don't do that in China. And that's actually the same in other parts of Asia. So, you know, if you don't expect to be offered counselors or social workers or anything like that, they're there. They do the medical treatment. They're very efficient at it. But it's not necessarily the same as you would get in Australia.
This question is you more as a doctor instead of as a patient. But we talked about how Car T cell therapy is not, I guess, the first treatment that patients receive. It's kind of seen as the last measure, after chemotherapy and other things didn't work. But do you think in the future this could actually become the first treatment that patients of this type of cancer would receive?
I think definitely, it's going to move up in the amount of treatments that you have to have before you have it. Typically at the moment, when you're diagnosed, if you're suitable for stem cell transplants, then you have four to six months of chemotherapy or some sort of therapy to get your tumor count as low as possible before you get a stem cell transplant. I think what might happen in the future is instead of working towards stem cell transplants, they'll work towards Car-T cell therapy. With both of them, you need a low tumor load. So always the first thing with multiple myeloma is to get immunotherapy or chemotherapy to make your tumor load as low as possible. Certainly I think it would be good to have it, to have not to have to fail at four different therapies before you get it.
Amanda, thank you so much for sharing such a personal story with us.
Thank you. It's been a pleasure.
And it's important to note that while this podcast discusses cancer treatment and patient experiences, it's for information only and should not be considered medical advice. If you have concerns about your health or treatment options, please seek guidance from a qualified healthcare professional.
So how did China become a leader in this cutting edge treatment? I have Karoline Kan, who is a health reporter for Bloomberg News here in Singapore. Thank you so much for joining me on this podcast.
Thank you for having me here today.
So you recently wrote an article about China becoming this niche medical tourism destination. So can you just explain how that happened?
For many years, China has been trying to basically promote China as a medical tourism destination. Like first about like ten years ago, more than ten years ago, there's a special zone called Hainan. They designated it as China's first and only international medical tourism zone. Hainan is an island in the south of China. It's separate from the mainland. The government tried to make it like a free zone, special economic zone. And what you can get is like you. If you, for example, you want a particular drug that is available in the US, approved by FDA, but not in mainland China, but probably you could get one from Hainan. And the aim was to attract foreign patients to China. But I have to say that it hasn't been very successful. And then, like, you know, we had Covid and China was closed from the outside world for several years. And then like during that time, something interesting happened: like China's pharmaceutical industry grew so much. After China opened after 2023, so many tourists coming to China. And since like last year, we saw a lot of people sharing on social media about their positive experience.
So when those people share experiences in China, what kind of treatments were they talking about?
I think it's a combination of everything, really. Like you, so you see people are going to see a dentist, go to have like their body check, and sometimes even like share experience of like AI assisted diagnosis process. And also there are people going for more complicated treatment, like cancer treatment.
So you mentioned cancer treatment, and your article was about Car T cell therapy, wasn't it? So how did China become kind of a leader in this cutting edge therapy in comparison to other countries?
Car T started. The first product was approved in the US in 2017. So like ten years ago. And China's first product was approved in 2021. Just in the past few years, the approved products in China is the same as in the US. So that shows like how fast the progress is in China. And China's Car-T clinical trial, if you just look at the numbers, is leading in the world. China has a very, um, you know, relatively easy regulation process to make China really the place where a lot of clinical trials are happening in the world. And in fact, a lot of foreign companies now are moving their clinical trials to China.
Is that why they can offer it at much lower cost? Because I was just speaking to a former patient who traveled to China to receive this particular treatment, and she was telling me how the price that she paid in China in comparison to the US is almost like, you know, 85% lower. So how can China offer it at such an affordable rate, even though, as you say, it is still quite expensive?
Yeah, I think there are a few things. Like first, let's say like a drug you take in the US, even it's the same product by the same company, that always like put a different price. Like they have the companies, pharmaceutical company has the power, have the power to negotiate when they enter into a market with the government. It really depends on the countries like GDP and the income. And second, as I said, Car T is more like a personalized medicine in a way. So you need the patients to be there and have your own team. And you arrange a time to go to the hospital, to have the lab be ready to do something with the cell, and then provide you the treatment, the product. In this whole process, like when you have the manufacturing capacity that is like ready and big and strong, then it will lower the price in every step in the process.
You also talked about how in China, there are quite a lot of clinical trials. Can you just explain how that works? Why are there more? Why can they do more clinical trials in China in comparison to other countries? Is this about regulations or what is this about?
I think both regulation and the policy wise, like China encourages the sector to boom and even like take over some other countries. And also, as I said, China has enough patients. A lot of the advanced hospitals, they can just carry out the clinical trials much more easily than in other countries.
You said China has been trying to become this medical tourism destination for quite some time. So do you think it could one day maybe compete against the likes of Thailand and South Korea? Is that the goal, do you think?
Uh, I think the government definitely wants to do that. And in fact, the Chinese government has been trying very eagerly to kind of like shift the country's image from a traditional, like, a manufacturing hub to one that can innovate and create and lead sectors. And we saw that in other sectors like EV, like AI. That is what exactly China is doing. And medical tourism can be very profitable. I think it's still too early to say China is definitely going to be like that. But China has the ambition, and I think it depends on how committed it wants to make this happen. But right now there are a lot of obstacles still.
It's really interesting to hear what you have discovered in your reporting. Thank you so much for sharing your insights, Karoline.
Thank you.
You've been watching Asia Specific from the BBC World Service with me, Mariko Oi in Singapore. If you have any questions or thoughts on what we covered in this episode or any other stories from the region, please leave us a comment below. You can also get in touch with us on email: Asia-pacific@bbc.co.uk. And click like and subscribe so you never miss an episode. See you next time.