Health Turkey / November'15

ENGLISH EDITION

2016 Top Markets Report of Medical Devices MEDICAL Ä°MAGING

Turkish healthcare industry realized revolutionary transformations ROBOTIC SURGERY

Fibroline to display its dry powder impregnation technology at the MEDICA 2016

Turkish medical sector prepares for the MEDICA Fair IKMIB will represent our country in the health fair in Düsseldorf with the national participation organization

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Murat Akyuz Istanbul Chemicals and Chemical Products Exporters’ Association (İKMİB) Chairman of the Board

he health sector, which has been developing rapidly in recent years, will participate in the MEDICA Fair with eighth national participation organization of Istanbul Chemicals and Chemical Products Exporters’ Association (IKMIB). Representatives of the sector, which gained an important acceleration in exports as well as product and systems, prepare for new collaborations.

In the fair, where 38 companies will participate with the national participation organization of IKMIB; many product groups such as single use products, medical devices, orthopedic equipment, personal care and health products, hospital equipment used in the medical sector will be exhibited.

MEDICA, which brings together the sector’s professionals, is important as a platform, where the latest innovations in medical and medicine fields are exhibited. The fair hosting thousands of visitors and health professionals from many countries of the world is visited by about 100 thousand visitors every year, which consist of decision makers in health and medical sectors.

Murat Akyüz, president of Istanbul Chemicals and Chemical Products Exporters’ Association (IKMIB), stating that they support all works to increase the sector’s exports said, “The national participation organization in Medica, which is the largest health and medical products fair in the world, is one of our studies. This has a special place for us as one of the longest running national participation events of IKMIB. We prepare to represent our country in Medica for the 8th times. Growing interest and wishes of our companies to national participation are also pleasing.”

We believe that our sectoral representatives must be at the most important medical fairs in the world and we encourage them in this regard. The fairs are a great opportunity to see the developments and innovations in the sector as well as to open up to the emerging markets. Medical is an area with very high value-added export potential. We have very successful producers in our country and consider it’s necessary that they have to introduce themselves abroad.

We think that we will return with new export links from Medica this year as it is in the past years.”

Turkish healthcare industry realized revolutionary transformations There is considerable potential in the medical devices market for domestic manufacturers as well as for importers

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he government aims to make Turkey one of the world’s top ten economies by 2023 while increasing the share of R&D expenditures to 3% of the GDP and total exports to USD 500 billion. There is a strong correlation between economic welfare and the level of healthcare spending. As economic welfare increases, so do expectations for readily accessible and higher quality healthcare. The Turkish economy

rapidly expanded in the last decade with per capita GDP expanding at a CAGR of 25.1% between 2002 and 2012 from USD 3,439 in 2002 to USD 10,550 in 2012. In line with increased economic welfare, healthcare spending per capita also grew at a CAGR of 30.6% between 20022012 from USD 186 to USD 707. The Turkish economy is expected to continue its rapid expansion with GDP per capita reaching USD 13,303 in

2017. GDP per capita is projected to grow at a CAGR of 4.3% between 2012-2017, registering an increase of around USD 2,500.

Across the globe, the healthcare sector is expanding as increasing economic prosperity, a changing disease profile, a growing global population along with a large demographic of senior citizens are resulting in a higher demand for healthcare services.

2012 saw conservative growth in numbers, with total healthcare spending rising by an estimated 1.9%. Yet, growth in healthcare spending is projected to pick up and reach an annual average of 5.3% between 2013-2017.

The very same drivers for growth globally are shaping the development of the healthcare sector in Turkey. The Turkish healthcare sector has been expanding and is expected to continue its expansion as changing population ratios; higher incidences of chronic disease, wider health insurance coverage and increasing incomes create upsurges in healthcare spending.

According to the Economist Intelli-

gence Unit forecasts, the healthcare sector in Turkey is set to boom as healthcare spending per capita will increase at a CAGR of 5.6% between 2013 and 2017, while most developed countries will be experiencing relatively lower growth rates.

The expansion in the healthcare sector was led by private healthcare institutions as the number of private hospital beds grew at a CAGR of 23.6%, a figure much higher than the growth rate of hospitals under the auspices of the MoH. Similarly, the number of private hospital visits also grew at a rate of a remarkable 63.5%.

There is also considerable potential in the medical devices market as

Turkey strives to decrease its dependency on imports. The Turkish medical device sector is expected to expand at a CAGR of 8.5% over the 2013-2018 period.

The European Bank for Reconstruction and Development (EBRD) is preparing to finance a further four infrastructure PPP projects for hospital complexes located in Kocaeli, Izmir, Bursa and Gaziantep.

In providing loans amounting to EUR785mn (USD844.1mn) for the four projects, the EBRD will enable developments to take place that may otherwise struggle to attract funding. Demand for medical devices will increase when the large complexes are equipped.

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Slow economic growth in the aftermath of the failed coup and the depreciation of the Turkish lira will hinder import growth in US dollar terms in 2016. In the 12 months to August 2016, imports fell by 10.8% to USD1.9bn.

It is expected that the Turkish medical device market to increase considerably in 2017, although growth will be lower in US dollar terms due to local currency depreciation. Market growth will be constrained by the domestic and external economic headwinds that have arisen since

the failed coup and the UK’s vote to leave the EU, which has slowed eurozone growth. However, the expansion of healthcare facilities such as the city hospital complexes will help to drive market growth.

The percentage of the world population above the age of 65 is projected to reach 10.3% in 2017. In line with this increase, healthcare spending per capita is also growing from USD 1,154 per capita in 2008 and is expected to reach USD 1,620 in 2017.

The Turkish population is expected to grow at a CAGR of 4.3% between

2012 and 2050 to an estimated 93.5 million in 2050. While Turkey’s population has characteristics resembling a developing country including the large portion of the population still between 15-64 years of age, its disease profile has started to resemble that of developed countries with huge advances in the fight against infectious diseases.

It should also be noted that because of the growing global population, total healthcare spending will grow at a much faster pace than healthcare spending per capita.

2016 Top Markets Report of Medical Devices As expected, the European Union (EU), Japan and Canada are extremely large and lucrative export markets for medical devices. These stable, mature markets, however, have relatively low (3 to 5 percent) annual growth rates. In order to facilitate expansion, medical device companies recognize that they must also look at developing countries for future growth

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he global medical devices market offers tremendous opportunity for U.S. manufacturers, as well as significant challenges, for government policymakers seeking to support U.S. export competitiveness in overseas markets. Creating new and sustained export opportunities for U.S. companies will require a concerted effort to remove or diminish market access barriers, helping U.S. firms to capture a larger share of the world import market. Encouraging and fostering U.S.-based healthcare

industries is critical to the future of the U.S. economy, which is why medical technology is a National Export Initiative priority. Despite uncertain economic conditions in key markets around the world, large and small players in the U.S. medical device industry show adaptability and tenacity, and companies are optimistic about the future. Medical device companies have found new opportunities for development in the face of uneven international economic growth and continuallychanging regulatory systems.

Top Markets: Key Findings and Methodology This Top Markets Report examines 57 different markets in terms of U.S. export history, forecasted market risk and rewards for exporters of medical technology; per capita spending in markets; and market size.

Methodology This report uses a widely accepted definition of medical devices, similar to that used by the World Health Organization (WHO) and the Unit-

ed States Food and Drug Administration (FDA). A medical device is defined as any piece of equipment or apparatus used to treat or diagnose an illness and comes into direct contact with the patient.

Pharmaceuticals and laboratory equipment are not within the scope of this report. International industry information and market profiles have been provided by the International Trade Administration’s (ITA) Global Health Team.

ITA’s Global Health Team, consisting of international trade experts at United States Embassies and Consulates worldwide, as well as in all fifty states, and industry experts in Washington, D.C., is dedicated to enhancing the global competitiveness of the U.S. health industry, expanding its market access and increasing exports. It accomplishes this through in-depth research and a variety of resources and services for U.S. companies, such as seminars,

webinars and Gold Key and Platinum Key Services.

Data for current and forecast sales values of medical devices are sourced from statistics collected by the Census Bureau, the International Trade Commission (ITC) and Business Monitor International (BMI).

Near-Term Medical Device Export Market Rankings 1. Germany 5. Belgium 9. France 13.

Norway 17. Denmark 2. Japan 6.

Switzerland 10. Australia 14. Sweden 18. Singapore 3. Netherlands 7.

United Kingdom 11. Mexico 15. Italy 19. Ireland 4. Canada 8. China 12.

Austria 16. Korea 20. Israel.

Market size and forecasts have been estimated using a trade-based approach, as most countries are reliant on imports. Estimates have been derived by looking at imports while considering domestic production, including exports. For practical purposes, we define a generally-accept-

ed range of HTS codes as the entire market.

HTS codes are used for export forecast calculations in this report as they most accurately encompass international trade in medical devices.

This report uses trade data through the end of 2015.

Projections were based upon the current estimate size and conditions, considering factors such as expected need, propensity of lifestyle disease, proposed spending, regulatory developments and other social factors, such as international health projects, economic performance, trends in import levels, size and performance of domestic manufacturing sector, national healthcare development plans and currency issues. Because of remarkable advances in science and technology, including those in the health care industry, life expectancy in many countries has been steadily growing. As a result, the expanding proportion of elderly people promises further growth of demand for medical devices. The total combined quantitative rankings reflect the degree to which they are existent in each market; aging populations in developing economies now tend to expect therapies for health conditions that previous generations simply endured or that were life-ending.

Aging populations worldwide, coupled with extended life expectancy, create a sustainable demand for medical devices. As elderly populations’ healthcare is frequently government-subsidized in markets around the world, home healthcare is also becoming of increased importance, as related technologies become more effective, and healthcare budgets are more closely scrutinized.

Industry Overview and Competitiveness U.S. medical device companies are highly regarded globally for their innovations and high-technology products.

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Investment in medical device research and development more than doubled in recent decades, and research and development investment in the domestic sector remains more than twice the average for all U.S. manufacturers.

The United States is expected to continue to play a leading role in medical device research and development. After declining in 2009, research and development spending rebounded to $2.9 billion in 2010 and $7.3 billion in 2011. From 2013 to 2020, larger medical device companies are expected to increase their research and development budgets by approximately 3 percent, while the rest of the industry is expected to increase spending for this element by more than 5 percent.

The U.S. medical device industry is highly diversified and produces a variety of products to diagnose and treat patients, ranging from tongue depressors to complex programmable pacemakers. The United States medical devices industry is known for producing high quality products using advanced technology resulting from significant investment in research and development.

During the last decade, the United States medical device industry experienced unprecedented advancement in innovative and developed technologies, leading to the birth of new therapies and growth in overall healthcare industry.

Cost Efficiency Increased competition, developed and cross-bred therapies, and cost containment have more keenly focused the medical device industry’s attention on creating value for payers and patients rather than the traditional means of mining revenue by investing in research, development and innovation. Companies are looking toward holistic, coordinated therapies and healthcare solutions to shift to value based healthcare, providing value with efficiency. By addressing therapies as an all-inclusive treatment package, medical device companies can better assist providers in delivering on their obligations to patients, controlling costs and simplifying transactions.

Export Market Mixture As expected, the European Union (EU), Japan and Canada are extremely large and lucrative export markets for medical devices. These stable, mature markets, however, have relatively low (3 to 5 percent) annual growth rates. In order to facilitate expansion, medical device

companies recognize that they must also look at developing countries for future growth. In some of these, demand for medical devices is growing at double digit growth in contrast to certain larger, slower growing markets in more developed countries. Significant yet underserved populations in developing markets often grow steadily, face similar aging populations and increasing lifestyle diseases and have an increased awareness of health technology development. Furthermore, many markets deemed as “developing� have highly urbanized population centers with rising expendable wealth, making certain sectors of markets interesting to exporters. A U.S. exporter would be best served by investigating both larger developed markets as well as emerging, raw markets in order to find the best export.

Global Industry Landscape Besides leading the world in the production of medical devices, the United States is the largest medical devices consumer.

The United States medical device market is valued at more than $140 billion in 2015, which accounts for approximately 45 percent of the global market according to the U.S. Government Accountability Office’s (GAO) 2014 statistics. U.S. exports of medical devices were valued at approximately $45 billion in 2015, and imports were valued at $54 billion.

Over the past decade the value of imported medical devices has stead-

ily increased, gradually eroding the previous trade surplus. The majority of imports are lower-tech products, such as surgical gloves and instruments. Continuing shifts in trade patterns have resulted in China and Mexico becoming significant exporters of mid to lower-tech equipment and supplies to the United States.

The surgical and medical instruments category (NAICS 339112) represents the subgroup with the

most activity in the United States medical device sector. This category includes numerous price sensitive lower-technology devices which can be more easily substituted with higher technology medical device products. While exports of surgical and medical instruments grew by 27.5 percent from 2007 to 2012, imports grew by almost an identical rate.

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Meet the new Expomed Being the leading and indispensable showcase of hospital equipment, medical devices and medical technology expomed Eurasia has already become the strategic meeting point of the Balkans, CIS, North Africa and the Middle East for the industry. Connecting Central Eurasia’s growing healthcare industry in Istanbul every year, the medical show’s 24th edition is going to take place between March 30 – April 2, 2017 in Tüyap Fair Convention and Congress Center organized by Reed Tüyap Fairs Inc

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s of 2017 exhibitors and visitors are going to experience a brand new expomed. All of the product groups that form expomed show are going to be displayed in product specific halls for the first time. This sectoral segmentation will not only create a center of attraction for the visitors but also allow them to easily spot the products and services they are looking for within the fairground.

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A unique show experience awaits you at the new expomed New expomed consists of 3 main product groups, which are

• Electro-Medical Equipment & Medical and Laboratory Technology • Orthopedics & Consumables • Hospital Build & Medical Facility Management & Medical Components.

The show will not only contribute to the medical industry in general but also let the exhibitors and visitors have a unique experience with B2B meetings, seminars and workshops.

Turkey, a great opportunity for medical investments By the end of 2017, the Ministry of Health of Turkey will open new hospitals with a total bed capacity of 70 thousand.

Turkey’s new strategy is to launch a period of long-term purchasing guarantee. This will provide regular purchases for new hospital tenders and healthcare centers. No more than 4 years from now, Turkey will have healthcare centers equipped with advanced medical technologies. In this process expomed Eurasia plays a key role in Turkey’s healthcare enterprise where most of these transactions will take place at this show.

Fibroline to display its dry powder impregnation technology at the MEDICA 2016 Fibroline at the MEDİCA 2016 trade fair in düsseldorf the company continues to diversify in the medical market through its dry powder impregnation technology.

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THE ADVANTAGES OF DRY IMPREGNATION: SIMPLICITY, FLEXIBILITY AND PROFITABILITY “The process we have developed allows impregnating the textile structure, foam or paper, ensuring perfect uniformity of the active powder in the substrate. The flexibility of this process, which adapts equally to the production of both large and small series, offers a customized solution to meet very specific requirements, such as localized or gradient impregnation”, asserts Laurence Caramaro, R&D Manager at Fibroline. This process also allows the creation of completely new products as well as lower production costs by eliminating all solvents and near-zero energy consumption.

A VARIETY OF APPLICATIONS FOR FIBROLINE TECHNOLOGY The medical sector presents a wide range of applications, from dressings (textile structures or foams), wipes and pads to absorbent products. “In the ongoing developments-products we produce for the medical sector, our customers are sensitive to the benefits of reproducibility and flexible technology, but above all opening up to new applications that cannot be achieved through conventional technologies”, states Jérôme Ville, Business Development Manager at Fibroline. The business model developed by FIBROLINE provides customers with a technological edge and differentiation through exclusive licensing agreements for each area of application.

FIBROLINE: AN “INNOVATIVE” EUROPEAN COMPANY Fibroline is a young European company founded in 2003. Its product development centre is located in France as is its pre-series or shortrun production unit. It sells its know-how and patents to industries through exclusive or non-exclusive licenses. Fibroline has spent over 14 million euros developing the company since 2003. The company currently has a workforce of 10.

MEDICA 2016 MEDICA 2016 MEDICA 2016 MEDICA 2016 MEDICA 2016 MEDICA 2016 MEDICA 2016 MEDICA 2016

Medical device manufacturers want more information from FDA about 3D printing Medical device manufacturers want the US Food and Drug Administration (FDA) to provide more clarity on its guidance on 3D printing.

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he FDA has approved 85 3D printed devices as of December 2015 and device manufacturers are calling on the FDA to be more specific on guidelines, operating procedures, regulatory issues and a host of other criteria.

Earlier in 2016, FDA provided a “leap-frog” draft guidance outlining

the agency’s initial thinking about technical considerations for the manufacture of 3D printed devices, in addition to general information on characterising and validating such devices. The guidance also focused on the design, manufacturing and testing of 3D printed devices.

Trade group the Advanced Medical

Technology Association (AdvaMed) submitted three general comments to the FDA and released the following statement: “Clarifying regulatory expectations for point-of-care establishments in this guidance is of paramount importance.”

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Turkey health expenditure statistics Turkish Ministry of Health revealed “General Health Statistics� report. According to the report, number of cases in infection diseases has decreased while birth rate with cesarean has increased.

Number of Emergency Health Ambulances has increased by 13.3% in 2015 over the number of 2014; from 3,740 to 4,237.

Health expenditure was 94 billion 750 million TL Health expenditures reached to 94 billion 750 million TL with an increase of 12.3% in the year 2014.

The proportion of current health expenditure to total health expenditure was 94.4% for the year 2013 and 93.8% for the year 2014.

Health expenditures by service providers, 2013-2014

Health expenditure was 5.4% of gross domestic product (GDP) The proportion of total health expenditure to GDP stayed at the level of 5.4% in the year 2014 without changing as compared to previous year. Similarly, this proportion for general government was 4.2% without changing as compared to previous year. This proportion for private sector was calculated as 1.2%.

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General government provided 77.4% of health expenditures The proportion of general government health expenditure to total health expenditure was 78.5% in the year 2013 and it decreased 77.4% in the year 2014.

Households provided 17.8% of health expenditures Out-of-pocket health expenditures made by households for treatment, pharmaceuticals etc. reached to 16 billion 819 million TL with an increase of 18.8% in the year 2014. The proportion of household health expenditure to total health expenditure increased to 17.8% in the year 2014.

Health expenditure per capita was 1 232 TL Health expenditure per capita was 1 110 TL in the year 2013 and then it reached to 1 232 TL with an increase of 11% in the year 2014. When health expenditure per capita based on US Dollar ($) was evaluated, it was 583 $ in the year 2013 and 563 $ in the year 2014.

Basic indicators on health expenditures, 2013-2014

SOURCE: TUIK, TURKISH STATISTICAL INSTITUTE

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Turkey on the way to be the leader of health tourism It is as an advantage to choose Turkey in the health tourism which includes medical tourism, geriatrics, thermal tourism and tourism of the disabled. According to the evaluations of WTO of the UN in 2014, Turkey ranks sixth in incoming tourists and 12th in tourism revenues. The tourists who prefer Turkey for health tourism, insures the treatment offered by experienced docs who use advanced technologies. The visitors who can find accommodation at close areas to health centers can enjoy the urban living pleasure of four seasons of Turkey with unmatched nature. At the four main categories of health tourism in Turkey, quality service, advanced technology and competitive prices are offered together.

Target is health, destination is Istanbul The general objective of the project is contributing the development of health tourism in Istanbul. The specific objective is to increase cooperation among stakeholders within the industry. In the scope of the project, TURSAB and its partners (Ekonomistler Platformu and Istanbul Ticaret University) will develop web tools and database of all cliniques and hospitals engaged to health tourism in Istanbul. The project also includes marketing activities of Istanbul in international markets.

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Turkey:Discover the new destination for healthcare Patients of several fields of medicine from foreign countries prefer Turkish healthcare establishments in almost every branch of healthcare which is offered at higher quality and technologic standards including, hair transplantations, plastic and aesthetic surgeries, ophthalmic surgeries, test-tube baby processes, open hearth surgeries, skin diseases, general check-ups, cancer treatments, ear-nose-throat problems, dialysis, heart and vein operations, gynecology, brain surgeries, orthopedic, Spa, physical treatments and rehabilitations.

Ophthalmology Healthcare businesses in this field offer services for every folks of life with their higher standards, up-to-date surgical equipment, and expert surgeons having international certificates. Hospitals in Istanbul run for the leadership in ophthalmologic care, hosts and serves several thousands of people from all over the world.

Cataracts Glaucoma Strabismus

Applied treatment methods Excimer Cornea transplant Oculoplasty

Retina diseases Yellow spot disease Pedi-ophthalmology

Plastic and aesthetic surgery One of the most attractive fields of health tourism. Turkey is a sure destination for those who want the best service at the most favorable conditions in this field. Most of the surgeries are known worldwide.

Popular applications in the fields of aesthetic and plastic surgery Rinoplasti Face-lift Blepharoplasty Scoop ear surgery Aesthetic mammal operations Body shaping operations Medical skin care PRP root cell supported skin refresh Weigh loss and cellulite care An attraction center for hair plants It is one of the fast growing fields of health tourism. More than five thousand people come to Turkey for hair plant from all over the world annually, for highly expert staff and more favorable prices.

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Up-to-date methods in dentistry in Turkey Costs of dentistry problems, which are common problems for aging people, are remarkably high in the Europe. Insurance companies do not cover most of the costs, so, people have to pay for them. With its specialized cliniques and competitive prices, which is almost one fourth of the prices in Europe, Turkey is an indispensable destination for dentistry care services.

Methods developed in dentistry Implant Aesthetic dental operations Mouth, dental and chin surgery Orthodontia Periodontology 3D chin and dental tomography Total dental care Organ transplant is also important in Turkey It is one of the most challenging and important fields of medicine. Demand for organ transplantations is growing fast, since the cadavers are becoming hard to find and the age of population is rising. Turkey has emerged as one of the rare locations that successful programs have been started that combines health tourism and organ transplants thanks to the famous Turkish surgeons. 59 hospitals for kidney transplant, 34 hospitals for liver transplant, 16 hospitals for heart and lung transplant have had certificate for legal operations in Turkey. The first hand and face transplant operation carried out in Akdeniz University in 2011 has become a worldwide event in this field.

Intra-Vaginal Fertilization Need for IVF and infertility problems is seen one fifth of the spouses and grows with age. This is a long lasting healthcare problem and has been carried out by experts at every stage by using latest medicinal techniques in Turkey.

Applications in treatment of intra-vaginal fertilization

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IVF, ICSI, Blastocyst transfer IMSI in sperm selection Endometrial Co-culture Assisted hatching Sperm kriyoprezervation Blastocyst and oosit vitrification Pre-implantation genetic diagnostics Micro-dissection TESE Embryo cryopreservation Controlled ovarian hiperstimulation and intrauterine insemination Ovulation indication Infertility surgery Diagnostic laparoscopy – hysteroscopy

Geriatrics and Handicapped tourism Elderly people now living in Europe having more holiday than their peers have 25 years ago. This reminds the words of Goethe, that says, “People should prove themselves that they want to live more when they are old.” Istanbul hosts all their visitors by having felt themselves as younger than their ages. Turkey is approaching geriatric tourism with its powerful infrastructure having the latest philosophy of aging in the world. The saying of late Margraret Thatcher, “Life starts at the age of 65”, is famous.

Water is health Means living for humanity, water has many kinds in Turkey. Historical Turkish hamams, spas, mud baths, drinking cures, breathing cures, sea cures and many other forms of water is meant for health. Water for health, healthy waters are found at every corner of Turkey. More than 80 thermal facilities are known as the first choices for foreign tourists coming to Turkey for their health with water.

Alternative treatments with water Spa therapies, and physical therapies Talosso-therapies Hydrotherapies Drinking cures Balneo therapies Peloido therapies Climatic therapies Destination Turkey Tourism is one of the fastest growing industries in the world. Only 35 million people were travelling internationally in the fifties’. In 2015 one billion and 184 million people travelled as tourists. All projections about the future of the industry indicate an accelerated growth.

UNWTO, United Nations World Tourism Organization, predicts that 1.8 billion of people will be on the move in 2030.

There are more than 1200 hospitals capable of

providing services to their guests that come from all corners of the world. Many of these establishments have strong ties with major healthcare brands such as John Hopkins, Mayo Clinic, Harvard Medical International, Memorial Sloan-Kettering and New York Presbyterian, etc.

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Robotic surgery era Robotic surgery can be safely applied to many diseases in thoracic surgery

Prof. Dr. Gokhan Yuncu, Liv Hospital Thoracic Surgery Specialist

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ung cancer, the leading cause of cancer death; is a cancer type that can be successfully treated in the early stages. Prof. Dr. Gokhan Yuncu, Liv Hospital Thoracic Surgery Specialist, said it’s used increasingly more in the USA and Europe because of the significant technical advantage of robotic surgery (closed surgery with robot assistance) in open and video assisted/closed surgeries, explains the facts about the robotic surgery in lung surgery diseases.

What is the difference of the robotic surgery compared to open and other closed surgeries?

“In surgical lung diseases and lung cancer, especially robotic surgery or robot-assisted surgery allows surgeons to perform many complex operations in a more precisely, more flexibly, more controlled and more secure manner than traditional methods. Because lymph nodes are cleaned more successfully compared to video assisted surgeries, it provides an oncologic superiority. Robotic surgery is under closed surgeries group performed through small incisions called minimal invasive surgery.

It has been proven in thoracic surgery that closed sur-

geries, which we call video assisted or thoracoscopic, are superior in appropriate patients than open surgeries.

After the Da Vinci Robot was approved by FDA in the USA in 2000, it became widespread in the USA and Europe hospitals to be used in treatment of many diseases.

Robotic surgical system includes a camera arm and mechanical arms where surgical instruments are attached.

While the surgeon sits on a computer console next to the operation table, he controls the arms and performs the operation. The console gives the surgeon a high resolution, enlarged, 3D image of the surgical field. The surgeon manages the other operation team assists during surgery from the console.”

What are the advantages?

“Surgeons using the robotic system have the advantage of a better view of the surgical field with higher sensitivity, flexibility and control during the operation compared to the traditional methods. The instruments used in the robotic system provide the flexibility of movement in the chest as same with the wrist.

Surgeons using the robotic surgical system can perform precise and complex operations that can be difficult or impossible with other methods. The benefits of minimally invasive surgery provided by robotic surgery include: less complication rate (for example, wound site infection), less pain, less blood loss, faster recovery, smaller and less visible incision scars.”

Do they have risks?

“Similar complications in traditional methods are seen in robotic surgery at lower rates. Robot equipment provide minimal damage to the surrounding tissues within the chest cavity and thereby reducing the complication rate.”

Can it be applied to every patient?

“Robotic surgery may not be an option for every patient.

The surgeon tells the patient whether the robotic surgery is suitable for that patient, the benefits and risks by comparing with other methods (by open surgery and video assisted surgery).”

For which diseases should it be preferred?

“Robotic surgery can be safely applied to many diseases in chest surgery. Robotic surgery can be safely used in thoracic surgery diseases such as early stage “lung cancers”, tumors and cysts of the region called “ mediastinum” between both lungs in the chest cavity, “diaphragmatic diseases”, “thymoma”, “Myasthenia Gravis” (thymectomy).

Because the lymph nodes are cleaned more successfully than video assisted surgeries in lung cancers, it provides an oncologic superiority.”

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For the first time in history, an AIDS patient has been completely cleaned from the HIV virus!

As a result of the collaborations of Oxford, Cambridge, Imperial College London, University College London and King’s College London, For the first time in history, an AIDS patient has been completely purified from the HIV virus...

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n a joint research conducted by Oxford, Cambridge, Imperial Collage and London University, the most reputable universities in the UK, the HIV virus carried by a 44-year-old man with AIDS was cleaned from all of his body’s cells.

Researchers stated that they performed blood test on the said man after the treatment and they didn’t find the HIV virus in the

test results. Professor Mark Samuels, leader of the research team, saying they even remove “latent” (sleeping) HTV virus from cells, stated that they are on the brink of a groundbreaking development in the medicine world and said; “This is the most serious study done so far in AIDS treatment. Based on initial test results, we did not find HIV in the patient’s body. But it is too

early to say anything definite. We need some more time to be sure.”

Vaccination treatment first According to the research supported by the UK National Health Service (NHS), first, a specially developed vaccine is given to the patient. The vaccine in question strengthens the immune system and makes the patient resistant to HIV. Then, a drug

called Vorinostal is administered and it’s intended to remove the “sleeping” HIV virus in the cells of HIV positive persons. Professor Sarah Vidler from the research team, who said that 5 years are required to finalize the results; said “We were able to destroy even the sleeping HIV cells, and our work continues for definite results”.

Bogazici University develops robot for painless and fast colonoscopy Bogazici University Mechanical Engineering and Biomedical Engineering started a TUBITAK-supported project to develop a new medical device aiming to reduce the duration of the colonoscopy process by half and reduce patient’s pains after the operation

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hile about one million colon cancer/colorectal cancer (CRC) diagnoses are made, 500.000 patients lose their lives due to CRC. According to the data of cancer registry center of the Ministry of Health in twelve provinces in 2007-2008, in Turkey, CRC is third in women among all cancers with 7,8% and fourth in men with 7,5%. In colonoscopy application, which is one of the common methods for diagnosis and treatment of colon cancer will use first a domestic robot technology with an innovative device being developed in Bogazici University.

Colonoscopy is recommended every 10 years in patients between the ages of 50-70. In today’s standards, scanning is performed from large intestine to small intestine of the patient, who is preferred to be fainted, in colonoscopy procedure, where cancer scanning is performed in the intestine with a thin, long and flexible device and images are received through the device camera. If a cancer cell is detected, biopsy process can be also carried out with the same device. The problem with this procedure is that it’s difficult for endoscopist and a painful process for patient. While colonoscopy is a process takes between one hour and half an hour, it’s a difficult procedure, where endoscopist has to provide hand-eye coordination by looking at the screen, where the camera image is reflected. At the same time, in case the device strains column walls or crashes to walls, it’s a process causing painful periods and so causes drawback in people.

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It will be moved faster in diagnosing cancer A new approach to relieve the medical world regarding the colonoscopy process applied in the same way all over the world is coming from Bogazici University. Ass.Dr. Evren Samur, academic member of Bogazici University Mechanical Engineering Department, and his team aim to develop a robotic colonoscopy device for a painless and rapid process. Samur summarizes the disadvantages of classical colonoscopy as follows; “Because it’s a routine operation, the number of patients is very high. But the process takes a long time. Number of patients an endoscopist examine in a single day is about 8-10. Because the Ministry of Health requests in Turkey that this procedure is carried out routinely, the capacity cannot be completely met now.

If this period is reduced, more patients will be examined it will be able to progress quickly in cancer diagnosis”.

In the new project, the thin, long, flexible and constant length de-

sign will be the first robotic device in the world for colonoscopy. vice is left behind and an air-swellable balloon system is used instead of it. The patient discomfort will be eliminated through the device planned to go forward by taking the shape of intestine while swelling. The interesting thing about the device is that it is robotically designed. It was thought in this plan that instead of standing over the patient, the endoscopist sits in a more comfortable place and controls the device with a remote control. The de-

Painless and short colonoscopy Ass.Dr. Evren Samur says, “Such a demand came from physicians. The proc e s s was long and hand-eye coordination was difficult. When I was doing my doctorate, we received a suggestion to make colonoscopy as robotic.

There are research groups working on this; but there is no colonoscopy robot clinically proven and transformed to product in the world.�

As of January in this year, new endoscopy device development studies started to be supported with about 2 million TL

by TUBITAK as 1003 project are planned to be completed within three years. The entire research is carried out by Bogazici University by using the infrastructure of Mechanical Engineering Department and Institute of Life Sciences. Acibadem University undertakes medical scientific consulting and the responsibility of tests to be performed in the last year of the project. The company called Simeks Medikal supports the project in the production of the balloon system.

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New regulations on the sale of medical devices According to the amendment published in the Official Gazette, the sales centers, where the distribution and sale of medical devices are made, can not be opened in the premises and buildings with the health institutions and establishments

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he Regulation on the Amendment of the Medical Device Sales, Promotion and Advertisement Regulation of the Turkish Pharmaceutical and Medical Device Authority (TITCK) was published in the Official Gazette and entered into force. According to the regulation, a new sales and promotion staff will be assigned within 5 working days after the person who works as a sales and promotion staff in the center is dismissed from his / her job, his / her resignation, loses his / her sales and promotion staff conditions in any way.

In case of death of sales and promotion staff working in the same way, it’s required to report to the directorate of the sales center within 15 days and a new sales and promotion

staff must be employed within one month at the latest.

In addition, within the scope of the regulation, training activities for technical staff working in simulation centers and cadaver centers within bodies of health care institutions and organizations and health care professionals will not be considered as scientific and educational activities.

On the other hand, except for the buildings which have laboratory diagnosis centers, which provide only analysis and imaging services, pharmacists, optician institutions, hearing aid centers, custom dental prosthesis and orthosis centers, dental prosthesis laboratories, sales center will not be able to be opened in building and garden and in extension with

health institution and organization.

Who will sell medical supplies?

Within the scope of the Regulation, only the companies which have obtained licenses from the provincial health directorates will be able to sell medical supplies. Registration notifications of companies to the National Information Bank of Turkey Drug and Medical Device (TITUBB) and the Product Tracking System (UTS) that have not completed the licensing processes will be denied.

Dr.Ali Septioglu, TITCK Vice President of Medical Devices and Cosmetic Products, underlines that customers should be aware towards this matter, stated that citizens should pay attention to the badges of sales promotion staff indicating their qualifications in this field.

Yoshinori Ohsumi won the Nobel Prize in Medicine The Nobel Committee in Stockholm, the capital of Sweden, announced that the Japanese scientist Yoshinori Ohsumi won the Nobel Prize in Medicine 2016. The scientist was granted this prize because of his works on cell structure. Ohsumi won also the prize worth about $ 1 million. Last year, the prize was given to three scientists researched on parasites and malaria. Irish scientist William Campbell and Japanese researcher Satoshi Omura were awarded the Nobel for the medicine they developed for the treatment of diseases caused by parasites. The Chinese scientist Youyou Tu also received the Nobel Prize for Medicine in 2015 for the medicine he developed against malaria.

Phobias will be now defeated by virtual reality The company Ideasis operating in the fields of innovative technologies virtual and enhanced reality, health and security systems converted the works carried out within the scope of the project of Therapy Assistive Instrument Development by Virtual Reality Technology Applications in Simple Phobias supported by TUBITAK KOBI R&D Start-Up Support Program to product. In the project based on “exposure” method applied in the treatment of phobias, it’s aimed to exposure the person to the condition he fears. In this method, the person faces with the condition or object/situation he fears and is accustomed to that, and starts to be less afraid or not to be afraid over time.

Secret of the world’s toughest animal is revealed In the research conducted by a team from the University of Tokyo, whose results were published in Nature Communications journal, a protein protecting water bear from radiation, freezing cold and boiling by covering its DNA structure like a blanket was discovered. It was stated that Professor Takekazu Kunieda and his colleagues developed human cells producing this protein called “Dsup”, exposed the modified human cells to radiation and observed that the Dsup protein made DNAA much less damaged. Scientists state that the genes of this organism, which can survive in extraordinary environmental conditions could be used to protect species from radiation and x-rays in the future.

Particles that cause air pollution can reach the brain!

The research conducted at Lancaster University revealed findings that pollution-causing particles reach the brain tissue. The study, defined as “shocking” in the science world, brought up the effects of air pollution on human health again. It is believed that iron oxide particles found in brain tissue cause neurodegenerative diseases like Alzheimer. The study was published in the journal of “Proceedings of the National Academy of Sciences” (PNAS). The World Health Organization (WHO) report, pub36

lished at the year beginning, it was warned that air pollution is causing three million premature deaths every year.

New hope against super bacteria During the research, whose results were published in Scientific Reports journal, six important peptides in Tasmanian evil milk were re-created and these peptides were tested on 25 bacteria and 6 fungus types. It was observed in the research that the Saha CATH5 peptide is effective especially to kill MRSA virus. It was seen that Saha CATH5 is able to kill another super bacteria, an enterococcus resistant to Vancomycin, and the “Candida” fungus. If urgent measures are not taken, it’s worried that until 2050, super bacteria could lead to the death of one person in every three seconds in the world.

Signature of “Turkey” to the medical literature on Gynecological Cancers Particularly in Europe, the book on Gynecological Cancers to be used as reference in the world (Textbook of Gynaecological Oncology) was published in the editorship of Turkish scientists and signature of “Turkey” was put to the literature.

Breast cancer affects more than 1 million and 700 thousand women every year in the world Breast cancer, which is the most common cancer type in women, affects more than 1 million and 700 thousand women every year in the world. One in every 8 women in Turkey gets breast cancer at some point in her life. According to another research conducted by the Turkish Statistical Institute (TUIK) in 2007, 22 of 100 thousand women face this reality. Among deaths depending on all cancer types, deaths caused by breast cancer are second after lung cancer.

Hyperactivity solution by astronaut method In the Attention Academy founded in Erzurum, students with attention deficit and hyperactivity problems are treated by using the “Play Attention” method developed by the US National Aeronautics and Space Administration (NASA) used to increase attention levels of astronauts, pilots and athletes.

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Turkish designer developed a smart t-shirt predicting heart attack Turkey Design Week conducted in cooperation of the Ministry of Economy and Turkey Exporters Assembly (TIM) as first in this year brought many international names in industrial design, fashion and visual communication design together and it shed light to the future with conferences, world famous exhibitions, R&D and innovation focused designs

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ehmet Buyukeksi, TIM Chairman, said “Our event as an important milestone for the economic and cultural future of Turkey will contribute us to direct the future trends.

As TIM, our activities in R&D, innovation, design and brand fields will continue. In this context, we’ll conduct Turkey Design Week every year. Design is one of the most important elements providing added value in the world. We believe that by means of our event, all of our designers will make inspiring contri-

butions to our civilization and economy. Thus, by creating high added value, we can provide competitive power in the global arena”.

Ezra Cetin, founder of the Ezratuba brand, gave a “Design and Technology” themed lecture in the event, informed about smart t-shirt, which they designed a first in Turkey by support of TUBITAK MARTEK to provide maximum benefit to human health.

Ezra Cetin, explained that the smart t-shirts enable to predict diseases consti-

tute life risk such as heart attack one week before will be started to be sold in 2017 said; “with various color alternatives, we

designed six t-shirts for women, two t-shirts for men. Control of all parts of the body is provided by thin, leaf shaped fabrics in t-shirts worn in daily life and sports. If there is a situation going wrong in any area, we can get it through the system. Our t-shirts that can also be used under water will be sold at a reasonable price.

We will design the product for children in the near future. We also designed a bag that allows 20 colors and 60 designs to be used together. Users will be able to design the bag for themselves according to color and pattern available in the system by means of the applications loaded into the bag”.

Turkey gets 3 new Sehir Hastanesi Akfen Insaat undertaking the investment of Isparta, Eskisehir and Tekirdag Sehir Hastaneleri, signed an 18-year maturity project financing agreement with an amount of 344 million Euro with Garanti Bankasi and Turkiye Is Bankası for Eskisehir Sehir Hastanesi. In the project to be realized within a very short period of 3 months with the finance source from 2 banks of Turkey, the hospital with 1081 bed capacity will be delivered to the Ministry of Health at the end of 2017

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kfen Insaat wants to play an important role in building Sehir Hastaneleri, which has high energy efficiency, earthquake isolator, is a digital “smart hospitals” project that the Ministry of Health wants to bring to Turkey by the Public-Private Partnership (PPP) model, will use its experience and know-how in the build operate transfer field for the transformation of the health sector. Akfen Insaat, so far undertaken 3 different Sehir Hastanesi projects as Isparta, Tekirdag and Eskisehir by the Public-Private Partnership (PPP) model, will invest 3 billion TL for these 3 projects with a total bed capacity of 2,316. Akfen Insaat signed an 18-year maturity project financing agreement with Garanti Bankasi

and Turkiye Is Bankası for building Eskisehir Sehir Hastanesi.

Total bed capacity of three projects: 2,316 Eskisehir Sehir Hastanesi has a special position to meet the needs related to health conditions requiring special security such as forensic and psychiatry thanks to its high security section to have apart from general hospital, oncology hospital and cardiovascular surgery departments. The project, whose construction was started within the year, will be among outstanding hospitals of the region with its total bed capacity of 1081 on an area of 333 thousand square meters, 264 polyclinics and world-class advanced technology medical equipment. The hospital is planned to be completed until the end of 2017 and delivered to the Ministry of Health.

Isparta Sehir Hastanesi will provide an important contribution to the development of health care services in the region with its a total of 167 polyclinics, 19 operation theatres and a total of 755 bed capacity. The hospital to be built on an area of 222 thousand square meters will have

also a private Gynecology and Children’s Hospital. Akfen Insaat will bring one of first city hospitals to Turkey with Isparta Sehir Hastanesi to be completed until the end of this year. Tekirdag Sehir Hastanesi will be one of the largest hospitals of the region with its capacity of 480 beds.

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Is it possible to extend life?

Melih Acar, Assistant Professor, Bahcesehir University, School of Medicine Stem Cells, Cancer Biology, Genetics informs about important developments in the field of stem cells and cancer and even in the coming years human life can last up to 100 years in 4th International BAU Drug Design Congress by BahçeĹ&#x;ehir University (BAU) with the niche cells, there still remains uncertainty about where HSCs are localized in the bone marrow due to conflicting reports. Resolving this uncertainty and eventually understanding the HSC niche in detail are critically important to develop techniques that will ultimately allow researchers and clinicians to keep and expand HSCs in vitro or ex vivo. By taking advantage of a new reporter Mouse model, alpha-catulin GFP, which expresses an endogenous HSC marker, and by developing a tissue clearing and imaging technique that allows us to visualize hematopoietic tissues in 3D, now we are able to comprehensively analyze the entire set of HSCs in the marrow of long bones.

Hematopoietic stem cells (HSC) are one of the most studied adult stem cell types. Despite many publications about the localization of the HSCs and their interaction

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These novel techniques hopefully These novel techniques and tools we developed, not only will allow us to analyze the HSC niche in detail in 3D for the first time, but will also help us design and execute drug screens to identify factors that keep HSCs in vitro or ex vivo as undifferentiated and factors that induce HSC self-renewal and HSC expansion.

Treatments, markets and health system implications in Medical Tourism A shift towards patients from richer to less developed countries to access health services

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he global growth in the flow of patients and health professionals as well as medical technology, capital funding and regulatory regimes across national borders has given rise to new patterns of consumption and production of healthcare services over recent decades. A significant new element of a growing trade in healthcare has involved the movement of patients across borders in the pursuit of medical treatment and health; a phenomenon commonly termed ‘medical tourism‘. Medi-

cal tourism occurs when consumers elect to travel across international borders with the intention of receiving some form of medical treatment.

This treatment may span the full range of medical services, but most commonly includes dental care, cosmetic surgery, elective surgery, and fertility treatment. There has been a shift towards patients from richer, more developed nations travelling to less developed countries to access health services, largely driven by the low-cost treatments available in the

latter and helped by cheap flights and internet sources of information.

Rise of medical tourism Despite high-profile media interest and coverage, there is a lack of hard research evidence on the role and impact of medical tourism for OECD countries. Whilst there is an increasing amount written on the subject of medical tourism, such material is hardly ever evidence-based. Medical tourism introduces a range of attendant risks and opportunities for patients.

This review identifies the key emerging policy issues relating to the rise of medical tourism.

The different organisations and groups The review details what is currently known about the flow of medical tourists between countries and discusses the interaction of the demand for, and supply of, medical tourism services. It highlights the different organisations and groups involved in the industry, including the range of intermediaries and ancillary services that have grown up to service the industry. Treatment processes (including consideration of quality,

safety and risk) and system-level implications for countries of origin and destination (financial issues; equity; and the impact on providers and professionals of medical tourism) are highlighted. The review examines harm, liability and redress in medical tourism services with a particular focus on the legal, ethical and qualityof-care considerations.

There is a lack of systematic data concerning health services In light of this, our broad review outlines key health policy considerations, and draws attention to significant gaps in the research evidence.

The central conclusion from this re-

view is that there is a lack of systematic data concerning health services trade, both overall and at a disaggregated level in terms of individual modes of delivery, and of specific countries. This is both in terms of the trade itself, as well as its implications. Mechanisms are needed that help us track the balance of trade around medical tourism on a regular basis. The evidence base is scant to enable us to assess who benefits and who loses out at the level of system, programme, organisation and treatment.

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Saudi health delegation visits Turkey Dr. Tawfiq Fawzan Al Rabiah, Minister of the Kingdom of Saudi Arabia and his Delegation from Ministry of Health visited Turkey to conduct bilateral negotiations on the field of health between the dates of 15 – 19 October 2016.

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he guest Minister and the Delegation from Ministry of Health of the Kingdom of Saudi Arabia conducted technical and high-level negotiations on Turkey Health Transformation Program and operation of the health system. They carried out field visits in

Ankara and Istanbul to observe effects of 14-year experience of Turkey on health services. During the visit, Turkey’s health application systems and important places such as Central Appointment System (MHRS), Ministry of Health Communication Center (SABIM), Ankara

Public Hospitals Institutions 2. Regional Central Laboratory, Atatürk Training and Research Hospital, Gaziler Rehabilitation Hospital and Bilkent Medical City, which is under construction, have been examined.

At the Istanbul part of the program, the guest min-

ister had a meeting with representatives of Public Health Center for Primary Healthcare, Family Health Center and R&D Center for drug supply and follow-up and left Turkey on 19 October 2016 Wednesday.

Cooperation between Bayindir Saglik Grubu and TURSAB in the field of Health Tourism.

Bayindir Saglik Grubu, a subsidiary of Turkiye Is Bankasi, which continues its works for the development of health tourism in Turkey, cooperated with TURSAB, which contributed to the development of the tourism sector, on health services. Within the scope of the collaboration of two groups; Bayindir Saglik Grubu will provide health services to patients from abroad and TURSAB members...

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asaran Ulusoy, the president of TURSAB, talked about the cooperation, said by drawing attention to the advantageous position of Turkey in terms of health

tourism with its geographical location, natural beauties, fully equipped hospitals and health services with affordable prices that; “Turkey is the shining star of health tourism.

Very important and valuable works are being made in this field. Also, the health tourism is an important source of income for Turkey especially today. This agreement that we signed with Bayindir Saglik Grubu will make important contributions in terms of further progress of health tourism and making infrastructure organizations more regular”.

Sezai Sezgin, General Director of Bayindir Saglik Grubu, reminds Bayindir Saglik Grubu, a subsidiary of Turkey Is Bankasi, has been working continuously for many years that the health sector develops as healthy, reliable and value added, said; “We

serve with our experience accumulated for years in health tourism, our specialized and qualified staff following the modern medicine closely. In this context, we attach great importance to our cooperation with TURSAB. It’s a great pleasure to contribute to the promotion of our country’s potential in this matter by our cooperation. This cooperation will ensure the organizational infrastructure of the health tourism to be improved, to reach a certain standard and the quality and competitiveness of our services that we provide, to increase further. We will be very happy to serve also the TURSAB family”.

Resistant starch reduces the risk of obesity, sugar and heart disease The Marmara Research Center (TUBITAK MAM) produced a newly recognized resistant starch all over the world. An important step in the fight against obesity, heart disease and diabetes will be taken by utilizing resistant starch in production

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he TUBITAK Marmara Research Center (TUBITAK MAM), is a Turkish scientific and technological center carrying out research projects through its subordinate institutes on basic and applied science fields in the area of industrial needs to contribute to the increase of the global competitive power of the country.

Resistant starch, a fermentable carbohydrate, has been proposed to have properties similar to dietary fiber and therefore could also affect satiety and exert a beneficial role in weight regulation. Now, a new contender is here for the superfood crown: resistant starch, especially in the form of raw potato starch. If you haven’t encountered enthusiastic advice to add potato starch (just stirred into a glass of cool water, yum?!) to your diet in order to treat all manner of ills, you probably will soon!

Resistant starch is a type of highlyfermentable insoluble fiber. Unlike most starches, resistant starch isn’t fully broken down in your small intestine. It “resists” the action of your

digestive enzymes because of its molecular structure; and instead of being a source of slow-burning carbohydrates for you, it becomes food for specific types of bacteria in your colon (which ferment it to produce beneficial short-chain fatty acids like acetic acid, propionic acid, and butyric acid).

Effects of Resistant Starch As already mentioned, an array of studies prove that resistant starch provides tremendous benefits to our health. In addition to some of the more overt effects, like improved blood sugar regulation and cardiovascular disease risk factors, resistant starch can improve general health in more subtle, yet perhaps more profound, ways. For example, resistant starch can help increase absorption and bioavailability of many essential minerals from the diet, including: calcium, magnesium, zinc, iron and copper. Of course, other kinds of fiber can do this too, but this is likely one reason why supplementation with resistant starch can protect bone density during weight loss and positively impact the immune system.

The golden age of antibiotics ends

Dr. Cengiz Uzun, Infectious Diseases Specialist of Medicana International Istanbul Hospital

Although new antibiotics are were found as a solution to the problem of resistance development of microorganisms, new resistance patterns emerged within years following each new antibiotic becomes available and the golden age of antibiotics ended.

In recent years, new antibiotics cannot be developed very often same as before. Dr. Cengiz Uzun, Infectious Diseases Specialist of Medicana International Istanbul Hospital, stated that the use of antibiotics increased, causes such as unnecessarily use of antibiotics in diseases caused by viruses and in each inflammatory condition, failure to use them at appropriate doses and times, etc. lead to resistance against antibiotics, failure to treat diseases.

Antibiotics are the primary most consumed drugs.

“One third of the health spending in our country consists of drug expenses and antibiotics are primary drugs consumed. Today, we face diseases caused by antibiotic-resistant bacte-

ria. Number of patients that we have difficulty in treating increases day

by day. If the necessary precautions cannot be taken, microbes will win the war. In this war, states, health authorities, pharmaceutical industry, health care workers and patients have great duties.”

Good to be known before you consume antibiotic; • Consult your doctor absolutely.

• Antibiotics do not work in viral diseases such as cold, flu, influenza.

• There is no need to use antibiotics in each inflammatory disease.

• Antibiotics may have side effects such as diarrhea. Some side effects can lead to death.

• Always use antibiotics in the amount and at the time to be recommended by your doctor.

• Even if you feel good, do not discontinue to use antibiotics until your treatment is complete.

• Do not store remaining antibiotics, when the treatment is ended.

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Health services are not so healthy in many countries!

Iceland tops a new ranking of the world’s healthiest countries, in a vast new study conducted by The Lancet magazine. Turkey ranks 103rd in global list.

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massive study emerged from a decade-long collaboration focused on the worldwide distribution of disease. About a year and a half ago, the researchers involved decided their data might help measure progress on what may be the single most ambitious undertaking humans have ever committed themselves to: survival. In doing so, they came up with some disturbing findings, including that America ranks No. 28 overall, between Japan and Estonia while Turkey takes the 103rd level.

Published in The Lancet, the study assesses 33 health-related Sustainable Development Goal (SDG) indicators in 188 countries across 25 years.

In September 2015, the UN General Assembly had established the Sustainable Development Goals (SDGs), a resolution outlining a new framework to form the cornerstone of the sustainable development agenda for

the period leading up to 2030.

Using the UN’s sustainable development goals as guideposts, which measure the obvious (poverty, clean water, education) and less obvious (societal inequality, industry innovation), more than 1,870 researchers in 124 countries compiled data on 33 different indicators of progress toward the UN goals related to health.

The SDGs specify 17 universal goals, 169 targets, and 230 indicators leading up to 2030. The Lancet provided an analysis of 33 health-related SDG indicators based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015).

The healthiest countries One year into the SDGs, the results present a global picture of the progress made on the Millennium Development Goals, and the work still needed to achieve the Global Goals.

Iceland, Sweden and Singapore top the ranking, with overall scores of 85 out of 100 Iceland just takes top spot – by one decimal place. The report singles out the country’s tobacco control measures, and its publicly funded healthcare as major factors in its number one position. The top five is completed by Andorra and the UK. In the past 15 years, there has been significant progress across the indicators – and overall.

Universal healthcare has shown the greatest improvement, followed by family planning and hygiene. There have also been reductions in deaths among mothers and children aged under five.

The bad news is that on some indicators progress has actually reversed. Scores for hepatitis B, alcohol consumption and overweight children are now worse than they were in 2000.

Turkey donates medical equipment to Kenyan hospital Vital pediatric equipment to help treatment of newborns, prevent infant deaths

The Turkish government donated vital pediatric medical equipment worth millions of Kenya shillings to a hospital in central Kenya.

Donated by the Turkish International Cooperation and Development Agency (TIKA), the equipment aims to help in the treatment of newborns as well as help prevent infant deaths.

Speaking to Anadolu Agency, Turkish Ambassador to Nairobi, Deniz Eke, who delivered the donation to the Kiambu Sub-County Level 4 Hospital, said Turkey was among the top five medical tourism destinations in the world, and keen to help improve the state of the health sector in Kenya.

“We are happy to see that the Turkish people can contribute to improving the health conditions of the Kenyan citizens. Whatever you do for women and children contributes to a brighter future.

“That is why Turkey identifies health cooperation as one of its priority ar-

eas in its relations and development cooperation with Kenya,” she said.

The ambassador said that the Turkish government had previously worked with various hospitals and health institutions to improve the health sector in the East African country, adding Kenya would continue to receive medical support from Turkey.

More than 5 infants at the hospital could be sharing the same bed, according to Dr. Jonah Mwangari, who is in charge of Health Services in Kiambu County.

Mwangari thanked the Turkish government, saying that the donation of 40 bassinets would be a great help in this regard, and reduce the spread of diseases from infant to infant.

“We have received 40 baby cots, six incubators and four phototherapy machines. The nursery unit is quite small and we plan to expand it to improve antenatal care and infant care.

“We are very grateful to Turkey. This [donation] will help us tame our health budget,” he said.

Nancy Njeri, a mother whose child will be able to benefit from the donated incubators, said she was grateful for the donation.

“The expensive equipment that the hospital has received will really help my child and for that, I thank the people of Turkey,” she said.

The hospital’s medical superintendent David Kariuki also thanked the Turkish government saying that the equipment would help prevent infant deaths and improve how the facility cares for newborns.

The donated equipment includes baby incubators, LED phototherapy units, pediatric vital signs monitors, bassinets, infrared thermometers and oxygen concentrators among others.

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UAE healthcare market is projected to top $19.5 billion by 2020 says latest Alpen Capital’s GCC Healthcare Industry report

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he 4th GCC Healthscape summit will be held in Dubai on December 6 and 7, under the theme “Enabling a healthier procurement landscape in healthcare”.

The event, organised by IDE Consulting Services, a leading procurement consulting firm, is expected to host decision-makers and major players from regional government healthcare providers and private hospitals, along with consultants, architects and health projects contractors.

“We are happy to announce the 4th Edition of the HealthScape Summit in the Middle East. After an intensive analysis of the healthcare landscape in the GCC region we have come up with accurate data on regional projects, existing and upcoming, and their procurement prospects.

We know, for instance, that by 2020, the healthcare sector will have over 114,000 beds. This summit is therefore a unique opportunity to clinch huge deals and build partnerships,” said Ganesh Babu, Director - India & Middle East, IDE.

With a focus on GCC countries, the event will gather more than 160 buyers and project promoters, including representatives from healthcare complexes, multi-speciality hospitals, super-speciality hospitals, diagnostic centres and polyclinics. On the other hand, 80+ suppliers and solution providers will be there to showcase medical products and services from the healthcare-related segments of construction, architecture, interior design, engineering and technology.

The summit comes at a time when there is a rising demand for medical services and a strong governmental support to the investments in healthcare facilities.

The Alpen Capital’s GCC Healthcare Industry report issued in February 2016 has forecast growth of the GCC healthcare market from US$ 40.3 billion in 2015 to US$ 71.3 billion in 2020, with hospital beds reaching 113,925.

According to the same report, the UAE healthcare market is projected to top $19.5 billion by 2020, achieving an annual average growth of 12.7 per cent.

The number of hospital beds will increase at nearly 3 per cent annually to cross 13,800 beds by 2020. The Saudi Arabian healthcare market is projected to touch US$ 27.4 billion in 2020, registering a CAGR of 11% since 2015.

“There are more than 549 on-going projects in the region. At this summit, stakeholders in the healthcare market from UAE, KSA, Kuwait, Qatar, Bahrain and Oman will be inter-

acting directly with global suppliers who will present the latest innovations related to medical equipment, furniture, automation, information and communication technology and safety and security systems, among others,” Babuadded.

Panel discussions and presentations are planned to provide a full understanding of the GCC healthcare sector’s special characteristics and requirements, in addition to intro-

ducing distinctive projects and solutions.

IDE global is a leading regional procurement firm, with a mission of creating exclusive, captivating and unique deal flow initiatives. As one of the emerging leaders in the B2B realm, IDE is committed to creating value for each and every client by delivering remarkable experiences that build businesses.

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New drug molecule has been developed in the treatment of Mediterranean Anemia!

Turkish scientists have developed a new drug candidate molecule to be used in the treatment of Thalassemia known as Mediterranean Anemia. As the result of 3-year joint work of Üsküdar University and Sabancı University, a new chelating drug molecule from microalgae has been developed. European Patent has been applied in order to transform drug candidate molecule to drug that prevents iron overload which can lead to death in patients with thalassemia.

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ithin the scope of the studies initiated in 2013 in partnership of Üsküdar University and Sabancı University on the treatment of Thalassemia known as Mediterranean Anemia, a new drug candidate molecule has been developed.

Within the scope of TÜBİTAK Project, Üsküdar

University Faculty of Engineering and Natural Sciences, Molecular Biology and Genetics Department faculty member Assist.

Prof. Belkıs Atasever Arslan and Bioengineering Department faculty member Assist. Prof. Kaan Yılancıoğlu, and Dr. Ahmet Can Timuçin and Prof. Selim Çetiner from Sabancı University have

developed a new chelating drug molecule from microalgae as the result of their 3-year research.

European Patent has been applied in order to transform drug candidate molecule to drug. Through this patent, it is aimed to realize low-cost national pharmaceutical production that will be used for iron overload in many diseases

including Thalassemia, and will also provide high added value for the country’s economy.

Assist. Prof. Belkıs Atasever Arslan says that Mediterranean Anemia (Thalassemia) is a hereditary disease commonly seen in the Mediterranean region where our country is located, Middle East, India, Far East and Africa; and she continues, “Worldwide more than 300 children are born with this disease each year, there are several subgroups of this disease”.

Chelating drugs prevent iron overload Stating that chelating drug used in the treatment of the disease prevents iron overload, Arslan says, “Especially in beta thalassemia major, lifelong regular blood transfusions are required, however, this causes iron overload in the body. Iron overload leads to heart failure, cirrhosis, and endocrine abnormalities, and iron overload is one of the main causes of death in Mediterranean Anemia. For this reason, patients receive iron chelation therapy”.

International success in tube stomach operation 1000 operations of the Turkish physician was subjected to the famous science journal

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ethods applied by Prof.

Dr. Halil Coskun, famous Obesity and Metabolic

Surgeon, were subjected to Surgical

Endoscopy, one of the leading academic journals of the world. In the scientific article published as eight pages in the September issue of the

journal, special techniques implemented by Prof. Dr. Halil Coskun on 586 female patients of a total one thousand patients were mentioned.

Techniques implemented by Prof.Dr. Halil Coskun, who made an international success with operations he made, were recognized with a great success also in the science world.

Prof.Dr. Coskun gave these information about his scientific study aimed to reveal clinical findings of the use of fibrin (adhesive) in tube stomach operations; “Leaks and bleedings in the stapler (incision) line are worrying and frightening complications after Sleeve Gastrectomy (Tube Stomach Operation in morbid obesity patients with a body-mass index of over 40. The purpose of this study is to reveal the clinical findings of the use of fibrin (adhesive) in tube stomach operations. Patients had standard tube stomach operation by using fibrin (adhesive) were included in the study. Tube stomach operation was performed on a total of thousand patients with an average age of 42.6 (586 of them women (58.6%)).

Fibrin (tissue) adhesive was used in all operations. The average operation time was 72 minutes and the average hospitalization duration was 3.2 days. Bleeding was observed only in 3 patients (0.3%). Leakage and stenosis were not observed in any patient.

The rate of re-application to the hospital remained at 0.5 percent. Death case did not occur. This retrospective study shows that bariatric surgeons need to implement standard surgical techniques to reduce postoperative complications in tube stomach operation. The fibrin (tissue) adhesive is a reliable and useful tool to strengthen the stapler (incision) line, and reduces the risk of bleeding and leakage in tube stomach operations.�

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Abdi Ibrahim’s Kazakhstan Plant Receives GMP Certification Abdi İbrahim Chairman Nezih Barut noted: “We aim to be among global top 100 phermetucal companies within our 2020 strategy.”

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hortly after commencing production, Abdi İbrahim Global Pharm, Turkish pharmaceutical leader Abdi İbrahim’s Kazakhstan subsidiary, qualified for GMP certification, one of the key systemsin good manufacturing practices. “As regards our foreign investments, not only do we expand geographically but also we strive to maximize our production capacity. We are proud to be granted GMP certification with our $60-million Kazakhstan plant in such a short time after commencing operations,” commented Nezih Barut, Abdi İbrahim Chairman, on the facilities.

Offering pioneering, bold and innovative services for healing the life and the future for 105 years, Abdi İbrahim approaches its 2020 goals with

its Kazakhstan investment, the most critical foreign investment.

Abdi İbrahim invested 285 million dollars in its Esenyurt campus, which features a production facility as well as R&D and logistics centers. After breaking ground on Turkey’s largest biotechnological pharmaceutical manufacturing facility with a total investment budget of $100 million last year, Abdi İbrahim began production at its $60-million Kazakhstan plant, which boasts an annual capacity of 24 million units.

Only a short time after groundbreaking in 2013, Abdi Ibrahim’s Kazakhstan facilities qualified for GMP certification, a benchmark in best manufacturing practices. Abdi İbrahim Global Pharm, operating across a 12,000 square meter indoor area

and employing 190 people, will produce approximately 100 products, predominantly diabetes care and anti-viral products, as well as products for treatment of central nervous system and cardiovascular diseases. On the investment in Kazakhstan, Abdi İbrahim Chairman Nezih Barut noted: “Our plant in Kazakhstan is an indicator of our determination to become a powerful actor in global markets, one of the five growth areas within our 2020 strategy. As of now, we employ a total of around 190 people in Kazakhstan, and 95 personnel in the plant. First exports from the Kazakhstan plant went to Afghanistan and Azerbaijan. In 2017, Georgia will join those countries as well. We aim to expand our current potential by exporting to the Eurasian Customs Union and CIS member countries in the upcoming years. As we near 2020, we will maintain our momentum in the free market by stepping up exports. Our goal for Kazakhstan is $40 million.”

Production Facilities in GMP Standards Abdi İbrahim carries out its productions in the Esenyurt district of Istanbul, at its 64,900 square meters closed-space facility set up on a 83,000 square meters of ground. With 100 million dollars of investment in the year 2000, the facility was put into service using the most state-of-theart technologies in the world, and by using a two-shift work method, can produce 350 million units per year.

Abdi İbrahim Logistics Center, activated in 2010 with an investment of USD 35 million has an indoor area of 22,600 square meters and a total storage capacity of 14,500 pallets.

All operations, including material handling, at the center that represents the state of art technology used in logistics sector, are performed in a fully automated system controlled by computers; stocking a higher quantity of materials in a smaller area compared to manual storage.

line with its vision of healing lives and the world. Making investments since 1990, that have reached a value of USD 316 million, Abdi İbrahim has become one of the preferred companies of the international arena thanks to its global scale investments. Being the leader of Turkish pharmaceuticals sector since 2003, Abdi İbrahim continued to make investments that will reinforce its position, in 2014 as well.

Joint product development and partnerships Giving great importance to R&D activities and thus allocates approximately 6.5% of its annual turnover to R&D activities, Abdi İbrahim always keeps track of the opportunities of international R&D programs and partnerships. The Company has successfully implemented several co-development projects with market leaders in regulated markets such as EU and Canada. Abdi İbrahim’s R&D team has extensive international experience. Most of our employees hold M.Sc and PhD degrees from leading reputable universities.

The largest biotechnological pharmaceutical production facility of Turkey: AbdiBio AbdiBio is Abdi İbrahim’s 100 million dollar investment to manufacture biotechnological medicines for Turkey, which are almost totally imported today. AbdiBio’s ground breaking ceremony, which is going to become the largest biotechnological pharmaceutical production facility in Turkey once completed, was held on June 26, 2015. Following the completion of construction, AbdiBio will become operative around January 2017, and biotechnological medicines are going to be manufactured there for both Turkey and abroad.

One of the preferred companies of the international arena with its investments Abdi İbrahim makes investments in

Abdi İbrahim to start $115 million manufacturing investment early to drive Turkish economy Turkish drugmaker Abdi İbrahim is

to press ahead with two major manufacturing projects at its Istanbul site this year because it sees it as crucial to be ‘bolder in investment’ for the sake of the country’s future. The combined $115 million investments in two facilities to manufacture sterile injectable products and oncological treatments were planned for 2017, the company having broken ground on Turkey’s largest biotechnological pharmaceutical manufacturing facility at a cost of $100 million last year. That has now been brought forward, Abdi İbrahim’s chairman Nezih Barut said, because the company had decided to share its enthusiasm with the industry and to “make an ambitious contribution to the construction of a robust economy.”

Mr Barut added: “Our country has recently gone through difficult times, and we have defended our democracy and future as a whole nation. Now, we have to be bolder in investment, employment creation, and production. As such, before end2016 we have decided to undertake two investments worth $115 million previously planned for 2017.” Abdi İbrahim already employs almost 3,000 people, and this will increase by a further 300 by the end of the year. The company is also pressing ahead “relentlessly” with its overseas investments.

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Early Diagnosis Laboratory Will Save Lives Turkish scientists have developed a new drug candidate molecule to be used in the treatment of Thalassemia known as Mediterranean Anemia. As the result of 3-year joint work of Üsküdar University and Sabancı University, a new chelating drug molecule from microalgae has been developed. European Patent has been applied in order to transform drug candidate molecule to drug that prevents iron overload which can lead to death in patients with thalassemia.

An important step has been reached in the treatment of colon and breast cancer. With the project that has been carried out

by Istanbul Technical University Genomics Laboratory (GLAB),’Genetically Sequenced Test’ will be ap-

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plied who have colon and breast cancer risk. With tests that have the potential to become cancer will be determined by early diagnosis. Risk of developing cancer will be eliminated with preventive treatment.

Critical genetics are examined Istanbul Technical University Genomics Laboratory (GLAB) explained, “Thanks to the test, we will be able to offer preventory treatment for colon and breast cancer will be

offer to the public. In line with our activities, blood was taken from 4,000 cancer suffering people and the genetically sequenced tests were completed for 300 patients. During the test period, the critical genetics of risk groups are studied and these genes are examined from the mutation point of view.”

Turkey’s mutation map will be determined With the project of “Advanced Level Genetically Analyze Towards Family Cancer Syndrome Scans”, additional acquisitions will be provided. Turkey’s mutation map will be determined with the data to be obtained with the project.

In line with the project, all patients who apply to Umraniye Training Research and Goztepe Training Research Hospitals with the complaint of breast and colon cancer are included to GLAB scan network.

The clinicians contact patients with this network and research the existing profiles of the patients.

Is it possible to extend life?

Melih Acar, Assistant Professor, Bahcesehir University, School of Medicine Stem Cells, Cancer Biology, Genetics informs about important developments in the field of stem cells and cancer and even in the coming years human life can last up to 100 years in 4th International BAU Drug Design Congress by BahçeĹ&#x;ehir University (BAU)

H

ematopoietic stem cells (HSC) are one of the most studied adult stem cell types. Despite many publications about the localization of the HSCs and their interaction with the niche cells, there still remains uncertainty about where HSCs are localized in the bone marrow due to conflicting reports. Resolving this uncertainty and eventually understanding the HSC niche in detail are critically important to develop techniques that will ultimately allow researchers and clinicians to keep and expand HSCs in vitro or ex vivo. By taking advantage of a new reporter Mouse model, alpha-catulin GFP, which expresses an endogenous HSC marker, and by developing a tissue clearing and

imaging technique that allows us to visualize hemato-

poietic tissues in 3D, now we are able to comprehensively analyze the entire set of HSCs in the marrow of long bones.

These novel techniques hopefully

These novel techniques and tools we developed, not

only will allow us to analyze the HSC niche in detail in 3D for the first time, but will also help us design and

execute drug screens to identify factors that keep HSCs

in vitro or ex vivo as undifferentiated and factors that induce HSC self-renewal and HSC expansion.

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Pharmaceutical Production and Export Ecosystem Report “Pharmaceutical Production and Export Ecosystem Report” by Economic Policy Research Foundation of Turkey (TEPAV) in cooperation with Association of Research-Based Pharmaceutical Companies (AIFD) enlightens future of the pharmaceutical sector which has the strategic importance in the exports strategy of Turkey for 2023. The strategic importance of the pharmaceutical industry highlighted as an accelerating force in the report.

AIFD members focus their efforts on innovation, with the awareness that innovative and original products, developed upon benefiting from the opportunities offered in various fields. TEPAV focuses on fostering a competitive business environment, improving regional development within Turkey and supporting international economic integration. Representatives of AIFD and TEPAV, public and private sector, sector, international investors participated in the presentation of this new report which is complementary to R & D Ecosystem Roadmap Report published in 2015, and representatives of Ministry of Health, Ministry of Economy, Ministry of Development, SGK, Finance and TÜBİTAK.

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Six key topics highlighted in the Pharmaceutical Production and Export Ecosystem Report

Turkey’s a significant transformation through both structural factors and changes in production and export in the last thirty years. In this process, the

productivity increases realized by migration from the rural to the urban has been the most important growth source of the economy. Today, the urbanization rate of

Turkey is close to 75 percent. Turkish pharma industry boasts a long history, well-established production cultu-

re, high added value, advanced technology, experienced workforce and export potential. These features make Turkish pharma industry one of the leading sectors po-

ised to make a significant contribution to the country’s

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•

The pharmaceutical leap of the last two decades has prompted an interest in the field by Turkey’s state authorities, as well as private companies, whe-

re efforts intensified to look into the advancement of the pharmaceutical production in the country. A recent report released by the Ministry of Science, Industry and Technology draws attention to the likelihood of disaster in the country in case of war, epidemic diseases, and even a future embargo, through which Turkey will surely lack the proper pharmaceutical production. In the last 30 years, the Turkish economy has shifted from a

efforts towards its 2023 goals. The national income per

low-tech to a medium-tech structure. The high in-flow

the same as what needs to be done in order to reach

a driving force behind Turkey’s rising interest in the

capita from $ 1,500 to from $ 10,000 in 1980 is not

of the world’s pharmaceutical companies has also been

from $ 10,000 to $ 25,000.

field.

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Especially in the target of “Becoming Production Center of Eurasia in the Long Term” aim a manufacturing sector in 10th Development Plan, predicting a structure which creates higher added value in pharmaceuticals and medical device manufacturing, produces and uses environmentally friendly high technology with sustainable global competition power, reduces the import dependence in intermediate goods and investment. Providing developments in these areas, creating a progressive R&D and enterprise ecosystem in the medium term will increase the local production capacity and development of new molecules in the long term.

Expanding the export capacity of pharmaceuticals and medical devices with higher added value will increase the effectiveness in the global value chain. Technological renewal is important for achieving ‘Sustainable Development Targets’ with future transformations both for the economic growth and productivity gaining the sector and the influence of new technologies.

Biotechnology, by definition, is the use and manipulation of biological processes in a bid to garner innovative solutions to a wide set of problems ranging from agricultural efficiency to disease control.

According to world’s largest biotech trade association, Biotechnology Innovation Organization, there are over 250 medical products of biotech nature currently in circulation, with over 13 million farmers employing one form of biotech method or the other in their crop control and enhancement. With rapid changes in the pharmaceutical field, and inclusions of brand new technologies that oversee biotechnological and nanotechnological innovations, there is still time for pharmaceutical success. Many developing countries have upped their efforts in the recent decade in order to engage with today’s most profitable market, increasing spen-

•

•

ding, intensifying research.

The challenge is the successful development of biotechnology products, which is of the highest importance to us. The transformation from small molecule to biotechnological product development requires a talent pool with industrial experience in biotechnology.

Unfortunately, the current lack of such talent stands out as one of the most pressing challenges we should mitigate in the future. For example, we embarked on our operations in the Commonwealth of Independent States (CIS) 15 years ago at a time when this region was considered risky by the majority of industry experts. Now we see companies following in our footsteps. The same is also true for biotechnology, which we had integrated into our strategic plans. Last but certainly not the least.

Our country is able to create the terms of being an international center of attraction consolidating its regional role. Actions predicted in order to create these conditions are presented in 10th Development Plan and 64. Government Program. Especially in the target of “Becoming Production Center of Eurasia in the Long Term” aim a manufacturing sector in 10th Development Plan, predicting a structure which creates higher added value in pharmaceuticals and medical device manufacturing, produces and uses environmentally friendly high technology with sustainable global competition power, reduces the import dependence in intermediate goods and investment. Providing developments in these areas, creating a progressive R&D and enterprise ecosystem in the medium term will increase the local production capacity and development of new molecules in the long term. Expanding the export capacity of pharmaceuticals and medical devices with higher added value will increase the effectiveness in the global value chain.

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by Turkish engineers

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