It’s possible that I shall make an ass of myself. But in that case one can always get out of it with a little dialectic. I have, of course, so worded my proposition as to be right either way (K.Marx, Letter to F.Engels on the Indian Mutiny)
Tuesday, July 15, 2025
Medical tourism for bariatric/weight reduction surgery needs urgent regulation
Especially as data show tourist numbers increasing despite advent of weight loss drugs
Medical tourism for bariatric and weight reduction surgery needs urgent regulation to protect recipients’ health, especially as the data show that tourist numbers are increasing despite the advent of weight loss drugs, say experts in a commentary published online in BMJ Global Health.
The high prevalence of obesity coupled with healthcare resource constraints and increased globalisation have resulted in more people accessing obesity treatment abroad, amid the rapid growth of services to meet this demand, note Dr Jessica McGirr of the Obesity Research and Care Group RCSI University of Medicine and Health Sciences, Dublin, Ireland and Imperial College London, and colleagues.
Despite its size, this industry is largely unregulated, point out the authors. Although reliable data are in short supply, the wider medical tourism industry is worth more than U$400 billion annually, with anticipated year on year growth of 25%, they highlight.
And while it’s anticipated that access to weight loss drugs may curb some of the demand for weight reduction surgery, the numbers of medical tourists in search of bariatric surgery continues to rise, particularly as this is often cheaper overseas, they add.
The out-of-pocket cost for this type of surgery done privately in the UK is around £10, 000–£15,000, but £2500–£4500 in countries, such as Turkey, they say.
The largest global survey to date of providers of bariatric and weight reduction surgery shows that most patients (71%) self-refer. They may therefore not have appropriate medical indication to undergo major surgery: ineligibility for this type of surgery in their home country is often cited by patients as a reason for accessing it overseas, say the authors.
And there are other risks in opting for this type of surgery overseas, they suggest. Providers may not always be clear about the potential complication rates; there’s no preoperative and long-term nutritional, psychological, or other medical follow-up; and there’s often no multidisciplinary care, which is integral to appropriate case selection, they argue.
“When considering adverse outcomes, including anastomotic [surgical tissue join in the gut] leakage, sepsis, and even death, equally concerning is the absence of regulation to ensure that only accredited procedures are performed by appropriately qualified providers,” they highlight.
“Further concern arises in the context of medical tourism ‘packages’ in which patients are offered multiple procedures within the same trip,” which are often accompanied by financial incentives, they add.
And there are also ethical issues to consider, they point out. They highlight the results of a provider survey, showing that nearly a third of respondents believed the consent process was “inappropriate” while 14% believed that patients were personally responsible for surgical complications.
“The need to regulate the [bariatric and metabolic tourism] industry to mitigate these safety, ethical, and legal risks for patients is essential,” urge the authors.
The financial and resource impacts of dealing with postoperative complications in returning medical tourists–and in those countries offering this type of surgery—of disinvesting in public health services to boost private sector trade, raise ethical questions, they add.
The current situation “highlights the need for transnational collaboration among all sectors to implement regulation,” explain the authors, suggesting that bodies, such as the World Trade Organisation, the World Health Organization, and the European Union, among others, should be involved in a global forum designated with this task.
They conclude: “This unregulated industry presents opportunity for quicker access to effective treatment for individuals with obesity but carries potential safety, ethical, and legal risks.
“The economy and healthcare resources of both home and destination countries may benefit financially from [bariatric and metabolic tourism], but the potential for unintended negative consequences and widening health inequity are significant.
“Establishing regulation through transnational collaboration is essential to protect health and health equity.”
Bariatric and metabolic surgery medical tourism: the compelling need for regulation through transnational collaboration
Article Publication Date
15-Jul-2025
Funding for lifesaving global health programs forecasted to reach 15-year low, threatening to reverse decades of progress
Most up-to-date report estimates that development assistance for health (DAH) will further decline by 2030, following steep cutbacks from major donors in 2025, including the US, UK, France, and Germany
Institute for Health Metrics and Evaluation
Most up-to-date report estimates that development assistance for health (DAH) will further decline by 2030, following steep cutbacks from major donors in 2025, including the US, UK, France, and Germany.
The drop comes after DAH fell more than 50% in 2025 from an all-time high of $80 billion in 2021.
Sub-Saharan Africa could be hardest hit by cuts in 2025.
The potential increase in infectious diseases in low- and middle-income countries poses a global health concern that could impact all nations, including those in high-income regions, due to the risk of triggering economic, political, and security crises.
SEATTLE, Wash., July 15, 2025 – After 30 years of health improvements around the world, funding cuts to global health could put lifesaving health care at risk between now and 2030, according to the latest annual report, Financing Global Health (FGH), released today by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington School of Medicine in Seattle.
The report incorporates an additional shortfall that’s expected due to another proposal under consideration by the US that would immediately cancel previously allocated funds that were approved for the U.S. Agency for International Development (USAID) and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), created 22 years ago by former President George W. Bush. The estimates also factored US cuts to Gavi, the Vaccine Alliance that were announced in June 2025.
The new figures track current and future donor contributions toward health improvement and maintenance in low- and middle-income countries, known as development assistance for health (DAH). In 2021, total DAH reached a record $80 billion due to the COVID-19 pandemic, when the world was unified in pouring resources into health systems to protect all populations. Since then, DAH has steadily declined: it plummeted by 51% to $39 billion by 2025, marking the lowest in 15 years. If current policies remain unchanged, total DAH is forecasted to decline by another 8% to $36 billion by 2030.
“These funding cuts are detrimental to global health, particularly for the most vulnerable populations where DAH has saved countless lives,” said lead author Dr. Angela Apeagyei, research assistant professor at IHME. “The drastic and abrupt reduction to DAH could compromise the progress in health that has been achieved globally.”
Global financial assistance is critical in regions where resources are limited, and disease burden is high. Enacting cuts to global health initiatives could reduce the treatment and prevention of infectious diseases such as HIV/AIDS, malaria, and tuberculosis, as well as curtail access to maternal, neonatal, and child health services. The budgetary consequences could also impact water safety, sanitation, and food security, which are interconnected and possibly lead to high mortality rates, especially among children.
Since United Nations agencies have been tracking DAH since 1990, the US has been the largest source of funding overall. This year, the US led the way in making the largest reduction of 67%, followed by the UK, France, and Germany. In contrast, Japan increased its DAH by 2%, while Canada made no changes.
The impact of the cuts in low-income countries is substantial, with the greatest reductions to those that heavily rely on DAH funds, mainly in sub-Saharan Africa, which is estimated to face the largest drop of 25% since last year. Forecasts expect another 7% drop in that region over the next five years.
Global health is an issue for all countries, including high-income regions, due to the potential threat of economic, political, and security crises that could arise from an outbreak of infectious diseases. As the world has seen with the COVID pandemic, international boundaries are permeable, and migration and travel can facilitate the rapid spread of disease.
Credit: Courtesy of the Master and Fellows of Peterhouse / University of Cambridge
University of Cambridge media release
Lost English legend decoded, solving Chaucerian mystery and revealing a medieval preacher’s meme
A medieval literary puzzle which has stumped scholars including M.R. Jamesfor 130 years has finally been solved. Cambridge scholars now believe the Song of Wade, a long lost treasure of English culture, was a chivalric romance not a monster-filled epic.The discovery solves the most famous mystery in Chaucer's writings and provides rare evidence of a medieval preacher referencing pop culture in a sermon.
The breakthrough, detailed today in The Review of English Studies, involved working out that the manuscript refers to ‘wolves’ not ‘elves’, as scholars previously assumed.
Dr James Wade and Dr Seb Falk, colleagues at Girton College, Cambridge, argue that the only surviving fragment of the Song of Wade, first discovered by M.R. James in Cambridge in 1896, has been “radically misunderstood” for the last 130 years.
“Changing elves to wolves makes a massive difference,” Seb Falk said. “It shifts this legend away from monsters and giants into the human battles of chivalric rivals.”
James Wade said: “It wasn’t clear why Chaucer mentioned Wade in the context of courtly intrigue. Our discovery makes much more sense of this.”
“Here we have a late-12th-century sermon deploying a meme from the hit romantic story of the day,” Seb Falk said. “This is very early evidence of a preacher weaving pop culture into a sermon to keep his audience hooked.”
“Many church leaders worried about the themes of chivalric romances – adultery, bloodshed, and other scandalous topics – so it’s surprising to see a preacher dropping such “adult content” into a sermon,”said James Wade.
For the first time, the researchers have identified the great late-medieval writer Alexander Neckam (1157–1217) as the most likely author of the Humiliamini sermon. The 800-year-old document is part of MS 255, a Peterhouse Cambridge collection of medieval sermons.
Discoveries made 130 years apart
In 1896, M. R. James was looking through Latin sermons from Peterhouse’s library in Cambridge when he was surprised to find passages written in English. He consulted another Cambridge scholar, Israel Gollancz, and together they announced that these were verses from a lost 12th-century romantic poem which they called the Song of Wade. M. R. James promised further comment but this never came.
Nearly 130 years passed with no new evidence coming to light. Several scholars have attempted to work out the meaning of the sermon’s Wade quotation and speculated on what the full legend might have been like.
“Lots of very smart people have torn their hair out over the spelling, punctuation, literal translation, meaning, and context of a few lines of text,” said James Wade.
James Wade and Seb Falk argue that three words have been misread by scholars, because of misleading errors made by a scribe who transcribed the sermon. Most problematically, the letters ‘y’ and ‘w’ became muddled. Correcting these and other errors transforms the translated text from:
‘Some are elves and some are adders; some are sprites that dwell by waters: there is no man, but Hildebrand only.’
to:
‘Thus they can say, with Wade: ‘Some are wolves and some are adders; some are sea-snakes that dwell by the water. There is no man at all but Hildebrand.’
Hildebrand was Wade’s supposed father. While some folk-legends and epics refer to Hildebrand as a giant, if the Wade legend was a chivalric romance, as this study argues, Hildebrand was probably understood to be a normal man.
Chaucer and Wade
The Song of Wade was hugely popular throughout the Middle Ages. For several centuries, its central character remained a major romance hero, among other famous knights such as Lancelot and Gawain. Chaucer twice evoked Wade in the middle of this period, in the late 1300s, but these references have baffled generations of Chaucer scholars.
At a crucial moment in Troilus and Criseyde, Pandarus tells the ‘tale of Wade’ to Criseyde after supper. Today’s study argues that the Wade legend served Pandarus because he not only needed to keep Criseyde around late, but also to stir her passions. By showing that Wade was a chivalric romance, Chaucer’s reference makes much more sense.
In ‘The Merchant’s Tale’, Chaucer’s main character, January, a 60-year-old knight, refers to Wade’s boat when arguing that it is better to marry young women than old. The fact that his audience would have understood the reference in the context of chivalric romance, rather than folk tales or epics, is significant, the researchers argue.
“This reveals a characteristically Chaucerian irony at the heart of his allusion to Wade’s boat,” said James Wade.
The sermon
To make sense of the fragment, the researchers gave more attention to the Humiliamini sermon in its entirety than scholars have previously.
“The sermon itself is really interesting,” said Seb Falk. “It’s a creative experiment at a critical moment when preachers were trying to make their sermons more accessible and captivating.”
“I once went to a wedding where the vicar, hoping to appeal to an audience who he figured didn’t often go to church, quoted the Black Eyed Peas’ song ‘Where is the Love?’ in an obvious attempt to seem cool. Our medieval preacher was trying something similar to grab attention and sound relevant.”
The sermon offers a lesson in humility, a central concern of medieval theologians, but does so in unusual ways. It focuses on a debased Adam and compares human behaviours to animal traits. It presents powerful men who become like wolves because they plunder what doesn’t belong to them. And it compares the actions of cunning, deceitful and rapacious people to those of adders or water-snakes.
“This sermon still resonates today,” James Wade says. “It warns that it’s us, humans, who pose the biggest threat, not monsters.”
The preacher brings in a second topical reference to underline this point, telling the story of a real-life knight and crusader named Hugh of Gournay, who switched sides four times between England and France. The story doesn’t appear in any other surviving source, but the way the preacher tells it, he must have known his listeners would recognise it.
“It’s a bold image”, said Seb Falk: “the repentant Hugh wrapping a noose around his neck and throwing himself on the mercy of the French king is a powerful and really fresh symbol of chivalric humility.”
The researchers noticed multiple similarities in the arguments and writing style of Alexander Neckam, leading them to believe that he probably wrote the sermon.
But whether Neckam himself or an acolyte, the author must have been familiar with Wade and confident that his intended audience would get the reference.
Seb Falk said: “This sermon demonstrates new scholarship, rhetorical sophistication, and inventiveness, and it has strategic aims. It’s the ideal vehicle for the Wade quotation which served an important purpose.”
Seb Falk is a scholar of medieval history and history of science. James Wade is a scholar of English literature from the Middle Ages forward. Both are Fellows at Girton College, Cambridge.
Notes to Editors
Extract from the new translation of the sermon referring to Wade:
‘Dear [brothers], as to the fact that he says, ‘humble yourselves’, etc. – it could be considered that humility which is against the mighty hand of God is of a particular kind. For there are three kinds of humility: the humility of guilt; the humility of punishment; and the humility of penance.
Now, by the humility of guilt our first parent [Adam] was so humbled that, although he was made master of the whole world before his sins and ruled over everything that was in the world, after his sin, on the other hand, he could not even defend himself from a worthless worm, that is, from a flea or louse. He who was similar to God before sin, was made dissimilar through sin; since ‘by this poison a rose is sometimes turned into spikenard.’
Thus Adam was, from a human, made as if he was non-human; not only Adam, but almost everyone becomes as if non-humans. Thus they can say, with Wade: ‘Some are wolves and some are adders; Some are sea-snakes that dwell by the water. There is no man at all but Hildebrand.’
Similarly, today some are wolves, such as powerful tyrants, who if they can justly take the things of those subject to them, take them; but if not, [do so] by any means. Some imitate serpents, of which there are three kinds. Others become lions, like the proud ones whom God opposes; enough has been said of pride in the art of preaching. Others are foxes, such as cunning detractors and flatterers who speak with a double heart, who have honey in their mouth but bile in their heart. Others are gluttons like pigs, of whom the prophet says ‘their throats are open graves’; and thus each is judged similarly. Indeed, this humility is bad and perverse.’
Part of the sermon mentioning Wade in Peterhouse MS 255. The word 'Wade' appears 4 lines up, 3rd word from right. 'Lupi' (wolf) appears in the bottom line, 5 words from the left.
Credit
Courtesy of the Master and Fellows of Peterhouse / University of Cambridge
Peterhouse MS 255 open at the sermon's mention of Wade
Part of the sermon mentioning Wade in Peterhouse MS 255
James Wade (left) and Seb Falk (right) with Peterhouse MS 255 open at the sermon, in the University Library in Cambridge.
Credit
Courtesy of the Master and Fellows of Peterhouse / University of Cambridge
Reference
S. Falk & J. Wade, ‘The Lost Song of Wade: Peterhouse 255 Revisited’, The Review of English Studies (2025). DOI: 10.1093/res/hgaf038
The stigma of having alopecia causes more depression and anxiety than the disease itself, new research has found.
The study, led by King’s College London is the largest of its kind and published in the British Journal of Dermatology, found that the impact on the quality of life on people with alopecia is determined by the negative perceptions and stigma associated with having the illness.
Supported by an academic research grant by Pfizer, the study surveyed 596 adults with alopecia areata and found that over 80% reported that they have symptoms of anxiety or depression.
Over 50% felt embarrassed about their condition and more than one-third of patients reported problems with their usual activities such as work, study, housework, family relationships or leisure activities.
The research found that those with more positive perceptions of the disease had lower anxiety symptoms.
Alopecia areata is a complex autoimmune condition, where a person’s immune system mistakes their hair follicles as a foreign body and attacks them.
It often starts with isolated patches of hair loss, commonly in one or more coin-sized (usually round or oval) patches on the scalp and/or across the body. In severe cases, it can progress to complete loss of scalp hair (alopecia totalis) or total body hair loss (alopecia universalis).
It is thought that over 2% of UK population will be affected at some point in their lives by the condition but the paper authors emphasise that it is still often not taken seriously as a medical condition and treated as ‘cosmetic’.
The researchers hope that by assessing patients’ illness perceptions and stigma in routine check-ups can enable health professionals to better understand the impact of the illness. Implementing appropriate interventions early can then help target negative perceptions and reduce stigma in order to help patients cope better.
The team are now launching the global Alopecia+us study which is funded by the Pediatric Dermatology Research Alliance (PEDRA)and supported by King’s Health Partners. The research aims to understand the real-life impact of adolescent alopecia on the young sufferer and the family.
Dr Christos Tziotzios, lead author, Consultant Dermatologist and adjunct Senior Lecturer at St. John’s Institute of Dermatology at King’s College London, said: “Alopecia can significantly affect an individual’s quality of life, affecting not only their physical appearance but also their self-esteem and overall mental well-being.
“Despite this, it is a condition that is often overlooked by healthcare professionals. By identifying the underlying causes of poor mental health in individuals with alopecia, we can provide earlier and more targeted support. We are now hoping to research the impact of alopecia on adolescent patients and their families via the global collaborative Alopecia+us study and very much hope for as many participants to come forward and contribute.”
Dr Lorna Pender aged 41 and from York, is an ex-NHS doctor and medical affairs professional who participated in the study.
She was first diagnosed with alopecia areata when she was eight years old and as a result describes herself as becoming “very shy, socially withdrawn and really disliking my appearance; believing that the hair loss was my fault.”
As her alopecia worsened throughout her teenage years, she describes how this led to a severely adverse impact on her mental health. She withdrew from socialising, swimming, orchestra and developed eating disorders and agoraphobia.”
She describes how in her working life “alopecia has severely negatively impacted my mental health, and I lost my clinical medical career in the NHS as a result.”
She goes on to describe her experience of trying to access support when she lost every hair on her body, face and scalp in 2019. “I spent four years trying to navigate to an alopecia expert in the NHS who would entertain having a high-level scientific consultation with me, and two dermatologists in Yorkshire whose response was indifference and indignance that there was nothing they could offer me. Importantly there was no focus on my mental health. “This was traumatising to experience, making further self-advocacy even more challenging. If it had not been for a national alopecia expert in London answering my emails, I would not still be here.”
She goes on to reflect on her experience, saying that: “If I, a medical doctor struggled to access alopecia expertise, and yet still have no NHS-provided psychological support, how must the entire alopecia community continue without alopecia expertise and psychological support inclusion in the standard of care and clinical guidelines for alopecia?
“This is exactly why Alopecia + me research is vital for driving this paradigm shift in the way dermatology and alopecia care incorporates the person living with the psychological impact of alopecia. As we see in this research, this is not linked to alopecia severity, demonstrating how psychological support is vital for all people with alopecia.”
For the first time, a new study has revealed how and when we make eye contact—not just the act itself—plays a crucial role in how we understand and respond to others, including robots.
Led by cognitive neuroscientist Dr Nathan Caruana, researchers from the HAVIC Lab at Flinders University asked 137 participants to complete a block-building task with a virtual partner.
They discovered that the most effective way to signal a request was through a specific gaze sequence: looking at an object, making eye contact, then looking back at the same object. This timing made people most likely to interpret the gaze as a call for help.
Dr Caruana says that identifying these key patterns in eye contact offers new insights into how we process social cues in face-to-face interactions, paving the way for smarter, more human-centred technology.
“We found that it’s not just how often someone looks at you, or if they look at you last in a sequence of eye movements but the context of their eye movements that makes that behaviour appear communicative and relevant,” says Dr Caruana, from the College of Education, Psychology and Social Work.
“And what’s fascinating is that people responded the same way whether the gaze behaviour is observed from a human or a robot.
“Our findings have helped to decode one of our most instinctive behaviours and how it can be used to build better connections whether you're talking to a teammate, a robot, or someone who communicates differently.
“It aligns with our earlier work showing that the human brain is broadly tuned to see and respond to social information and that humans are primed to effectively communicate and understand robots and virtual agents if they display the non-verbal gestures we are used to navigating in our everyday interactions with other people.”
The authors say the research can directly inform how we build social robots and virtual assistants that are becoming ever more ubiquitous in our schools, workplaces and homes, while also having broader implications beyond tech.
“Understanding how eye contact works could improve non-verbal communication training in high-pressure settings like sports, defence, and noisy workplaces,” says Dr Caruana.
“It could also support people who rely heavily on visual cues, such as those who are hearing-impaired or autistic.”
The team is now expanding the research to explore other factors that shape how we interpret gaze, such as the duration of eye contact, repeated looks, and our beliefs about who or what we are interacting with (human, AI, or computer-controlled).
The HAVIC Lab is currently conducting several applied studies exploring how humans perceive and interact with social robots in various settings, including education and manufacturing.
“These subtle signals are the building blocks of social connection,” says Dr Caruana.
“By understanding them better, we can create technologies and training that help people connect more clearly and confidently.”
The HAVIC Lab is affiliated with the Flinders Institute for Mental Health and Wellbeing and a founding partner of the Flinders Autism Research Initiative.
The article, The temporal context of eye contact influences perceptions of communicative intent by Nathan Caruana (Flinders University), Friederike Charlotte Hechler (Macquarie University and Universität Potsdam, Germany), E.S Cross (ETH Zurich, Switzerland) and Emmanuele Tidoni (University of Leeds, UK) was published in Royal Society Open Science journal. DOI:10.1098/rsos.250277
Acknowledgements: Authors were supported by an Experimental Psychology Society small grant.
