7 days in healthcare (March 18th-24th, 2024)

 

Summary

From the point of view of Biomedicine, the transplant to a man of a genetically modified pig kidney stands out, a medical milestone that could lead to dialysis being declared obsolete, which would be an extraordinary advance and an improvement in the quality of life for hundreds of thousands of patients, currently dependent on the machine several times a week for their survival. Also notable is the beginning of a clinical trial on a vaccine for tuberculosis. The current BCG vaccine offers protection to infants and young children, but does not protect adults and adolescents from pulmonary tuberculosis. If the results are good, this vaccine can be transformative.

As far as Global Health is concerned, a study warns of serious declines in birth rates globally, which will mean that by 2050 it will fall below population replacement, which will have important social and labor changes.

Regarding International Health Policy, a great paradox in the USA, although abortion is prohibited in 14 states and restricted in many others, in 2023 there were more abortions than ever, many of them non-instrumental and through the abortion pill, already responsible of 60% of abortions. China is facing a population decline, a phenomenon that has already begun. The one-child policy, in force for 36 years, is only one of the causes of this phenomenon. The European Union is advancing in the approval of pharmaceutical legislation, contemplated with reluctance by both the EFPIA and Medicines for Europe (the two large European pharmaceutical associations). The Lancet sees the upcoming European elections as an opportunity to put health policy higher on the EU agenda.

If we talk about National Health Policy (Spain), three important initiatives of the Ministry of Health: anti-smoking plan, modification of the medical guard regime and waiting lists. In all three cases there may be problems due to the powers and regulations of the autonomous communities. From the point of view of the regions, the OPE of Asturias stands out, which brings together 19,000 candidates. Although logically, temporality was and is a serious problem of public healthcare, which needed a solution, the way to do it through macro-OPE’s (consolidating the position in property, and with hegemony of the administrative and union logic, above the professional and autonomy of organizations) does not seem to be the best. This type of mass examination is more reminiscent of previous calls for the “military service”, when it was in force, than the professional selection for complex organizations, in which the professional qualification, the needs of the different organizations, the projects of the services, etc. should be taken into account.

As for Companies, on an international level, China is seen as the large market for anti-obesity drugs. Bayer wants to renew its portfolio, entering into cell and genetic therapies. As for Spain, the CNMV has released its report on Grifols, with several objections to its accounts. Faes Farma is preparing to grow in Latin America. For its part, DKV, the health insurer, wants to concentrate on group insurance.

Biomedicine

Global Health

International health policy

National health policy

Companies

7 days in healthcare (March 11th-17th, 2024)

 

Summary

From the point of view of Biomedicine, a revolutionary blood test stands out that manages to detect colon cancer in early stages and, consequently, reduce the number of deaths. Early diagnosis of this cancer can prevent most deaths, possibly 73% of them. But this requires regular screening in adults. There are two options: colonoscopy every ten years or fecal test every three. Both are unpleasant procedures, the first involving the introduction of a tube into the rectum and the second manipulating the stool itself. But something much simpler is on the horizon: a simple blood test. AI can revolutionize clinical trials, a fundamental basis for the progress of medicine. Just as Moore’s law was known in computing (the information capacity in a circuit grew every two years and at a lower price), in clinical trials in 2012 Eroom’s law was defined, which is just the opposite, since in the 60s In previous years, the number of drugs placed on the market per 1 billion invested was reduced by half every nine years. Half of this time and money was dedicated to clinical trials. AI can disrupt this law by helping to manage clinical trials, including developing protocols, recruiting patients, and analyzing data.

As far as Global Health is concerned, alterations of the nervous system are the most frequent cause of poor health. Neurological diseases such as stroke, dementia and migraine constitute the largest global cause of disease burden. This is related to increased life expectancy. However, if we adjust the data with age, we see that between 1990 and 2021, the number of neurological problems decreased by 27% and the number of deaths by 34%, in that 31-year period. Impressive Egypt success story with hepatitis. In Egypt at the beginning of the 20th century, most of the population worked on farms in contact with the Nile, a source of schistosomiasis, which affected 60% of the population. A treatment was implemented, but without single-use needles. This generated a very high prevalence of hepatitis C, which was reduced in just a decade from 2014. The secret was the free tests and treatment for everyone, with Gilead medication, after having negotiated the price with this company.

In terms of International Health Policy, the NEJM analyzes the effects of vertical integration in American medicine. Vertical integration (purchase of medical practices by hospitals) is unstoppable in the USA. We don’t know the consequences well. In theory it should improve coordination, facilitate the exchange of information and develop economies of scale. But, in practice, what has been seen is an increase in prices. It is urgent to study the consequences of this phenomenon. Macron, after a broad national debate, which included a citizens’ convention, supports the law on the end of life, which must still be approved in Parliament. An impressive debate took place in France on this topic for several months, just the opposite of what happened in Spain where such a transcendental issue was processed as a bill (avoiding the opinions required by the bills) and with hardly any national debate, as if it were a question of modifying the VAT on some product. Agreement in the EU for the regulations on the European Health Data Space, which will allow access to clinical information to any EU patient in all the countries of the Union, as well as the use of this information for research. A great step that, however, will take time to implement, given the very different and heterogeneous development of healthcare digitalization in EU countries.

If we talk about National Health Policy (Spain), the debate continues on the purchase of masks during the pandemic, another example of the more than deficient management of Covid-19 that occurred in Spain. The Minister of Health presents her plans in the Senate. Ambitious battery of health measures: mental health; Public Health Agency; climate change; smoking, sexually transmitted diseases; waiting lists, among other issues. We will see how this agenda progresses, since changes in healthcare are never easy. The health insurers involved in MUFACE (Adeslas, Asisa and DKV) request a renewal of the contract admitting 20% less of the public sector capital without pharmacy, which would mean an increase of 50% on the current capital. They also ask for some system of indexing the capital to the evolution of the public sector. Possibly the extension of the budgets represents an obstacle to the renegotiation of the agreement. Interesting initiative: the Council of Ministers approves a commercial pioneer of advanced therapies with public/private capital, whose promoter and shareholder is the CDTI (50% of the shares), as well as Insud and Rovi (25% each of them). The goal is to develop advanced therapies. It is included in the PERTE and, together, will mobilize 74 million euros.

As for Companies, internationally, recovery of mergers in the pharmaceutical industry in 2023. Psychedelic therapies, in the focus of investors. At the national level, AstraZeneca’s big commitment to Catalonia, where it will invest 1.3 billion until 2027.

Biomedicine

Global Health

International health policy

  • USA
    • The unknown health of the candidates for President in the USA. Everything is based on speculation. There is no official system to know the real health situation of either the presidents or the candidates. An attempt to create an expert body on the topic failed as recently as 2017 (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00528-2/fulltext?rss=yes)
    • The Lancet analyzes Biden’s health priorities in the State of the Union address. Commitment to women’s reproductive health; lowering drug prices, expanding Obamacare, preventing gun violence, among the most important priorities (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00529-4/abstract?rss=yes)
    • The effects of vertical integration in American medicine. Vertical integration (purchase of medical practices by hospitals) is unstoppable in the USA. We don’t know the consequences well. In theory it should improve coordination, facilitate the exchange of information and develop economies of scale. But, in practice, what has been seen is an increase in prices. It is urgent to study the consequences of this phenomenon (https://www.nejm.org/doi/full/10.1056/NEJMp2313406)
  • France
    • Macron supports the “end of life” bill, which will be discussed by Parliament in May. The term “assisted in dying” is used, rather than euthanasia or assisted suicide, which are considered more controversial. If approved, France will join the few European countries (Switzerland, Holland, Belgium, Spain) that have regulated this issue (https://www.ft.com/content/8129ad50-ae82-4cf9-8b06-cdd196cc57ef)

National health policy

  • Advanced therapies trading company

Companies

7 days in healthcare (March 4th-11th, 2024)

 

Summary

From the point of view of Biomedicine, the possibility of making replicas of fetal organs stands out, which could facilitate fetal treatments without putting the pregnancy at risk. The Lancet publishes an editorial and several articles on menopause, a natural state in the aging process of women, often overmedicalized. FDA delays approval of Lilly’s long-awaited Alzheimer’s drug.

As far as Global Health is concerned, there was a shortage of cholera vaccines, at a time with many outbreaks, even in countries where it had been eradicated. Great absolute growth in the global figures of the scourge of genital mutilation in women, especially in Africa, but also in Asia and the Middle East. First published evidence that nanoplastics harm human health. Big problem with the lack of health professionals in Africa, which is proposed to be compensated as a quick solution with community health workers.

Regarding International Health Policy, in the United States President Biden gave his fourth and final State of the Union address. Surprising was a particularly energetic and mentally agile Biden, who maintained the interest of a vibrant speech during its more than 60-minute duration, even interacting with the Republican seats. Much of his speech was dedicated to health, undoubtedly a star issue in the next elections: the price of medicines; women’s reproductive rights, abortion and in vitro fertilization; the extension of Obamacare, a law he defended, during his term; and care for the elderly, both at home and in nursing homes, were the topics discussed. In France, President Macron has decided to make abortion a constitutional right, surprising the enormous support obtained on the right and left in the National Assembly: 780 votes in favor compared to only 72 against.

If we talk about National Health Policy (Spain), In its “Declaration of Córdoba” the Popular Party presents 4 proposals regarding health. The rural environment is left without doctors, according to the Spanish Society of Family and Community Medicine, saying that of the 11,000 rural doctors, half will retire in the next 5 years and it does not seem easy the arrival of new doctors. A specific health problem of one of the great gaps in our country: that of the rural-urban world. The Minister of Health makes two big promises: the decarbonization of the health system and the creation of an observatory on corruption in health (in response to problems with the purchases of masks and equipment during covid). Interesting, but we will have to see if these promises become realities. The PP will bring the ELA law to Congress.

As for Companies, at the international level, it is increasingly clear that the Novo Nordisk-Lilly duopoly in addressing obesity will be broken, giving way to other agents, given the large number of clinical trials on the subject. According to IQVIA, pharmaceutical companies will lose 6 billion a year until 2028 due to the expiration of many patents, converting many of these medications to generics and biosimilars. This loss will try to be compensated with the launch of new drugs, since it is estimated that between 2024 and 2028 there will be 175 new launches, especially in the field of oncology and neurology. Regarding national news, Grifols has revalued on the Stock Market, after the publication of its audited accounts without qualifications. Loss of 600 million of the insurance companies that operate in MUFACE (Adeslas, Asisa and DKV) during the period of validity of the current three-year agreement. It is evident that public/private collaboration is unviable if it condemns the participating companies to losses without any prospects.

Biomedicine

Global Health

International health policy

National health policy

Companies

 

7 days in healthcare (February 26th-Mars 3rd, 2024)

 

Summary

From the point of view of Biomedicine, certain advances stand out in the search for a treatment for multiple sclerosis, a disease that affects 1.8 million globally and for which at this time there is no effective therapy. As announced by the president of the Spanish Society of Nephrology, the new drugs will allow many cases of dialysis and transplant to be avoided.

As far as Global Health is concerned, the most worrying thing is the poor perspectives observed regarding the pandemic treaty, the objective that the WHO had proposed for 2024. The obstacles are the accumulation of vaccines and the sharing of knowledge about them, problems of rich countries and companies, respectively. The Lancet warns about the need to strengthen cervical cancer screening, which continues to cause hundreds of thousands of deaths a year, especially in low- and middle-income countries. Warning about ultra-processed foods (cereals, protein bars, soft drinks, and fast food) linked to 32 harmful health effects, including increased risk of vascular disease, cancer, type 2 diabetes, mental illness and premature death.

In terms of International Health Policy, a very serious problem with fentanyl in the United States, which in the last twelve months until September 23 had caused 105,000 deaths in that country. Until now, the policy was aimed primarily at preventing the entry of drugs; some extremist politicians had even proposed invading Mexico to put an end to the gangs. With the current Administration, efforts are directed more towards discouraging its use and treating addicts. Big problem for Republicans in the USA with the decision of the Alabama Supreme Court to declare frozen embryos as “extra-uterine children”, with all the obstacle that this has for the popular procedure of in vitro fertilization, so widespread in the United States as in other developed countries. This Alabama decision seems like a gift to Democrats: “First it was abortion, now it is in vitro fertilization and then it will be birth control,” warned Hillary Clinton. Even Trump was forced to distance himself from this decision. In France, the National Assembly is putting pressure on the pharmaceutical industry regarding the shortage of medicines, forcing laboratories to have a four-month reserve of “medicines of high therapeutic interest.” In order to strengthen drug R&D, the European Union is considering “giving away” a year’s patent to those drugs whose research has been carried out in Europe.

If we talk about National Health Policy (Spain), the current Ministry of Health, unlike previous Ministries, wants to get involved in the problems of the SNS, while the previous ones wanted to get involved as little as possible, with the argument that “everything was transferred” . This attitude seems, in principle, positive for the SNS. Another thing is priorities. It seems that among these are the suppression of 24-hour medical guards; addressing waiting lists; and, the State Public Health Agency. Regarding the first issue, the challenge is formidable, since medical guards, regardless of whether they are necessary or not, have become an important salary supplement. It is impossible to address this issue without considering the complements of medical personnel, which is no small issue. Regarding waiting lists, aware that their management corresponds to the communities, it seems that they want to establish a kind of “best practices”, with economic incentives for the communities that apply them. Not an easy matter either. And as for the State Public Health Agency, the ministry seems to have reached an agreement with the PNV and Junts, for the withdrawal of their amendments to the law. Let us hope that this agreement does not go against the strength and operation of the new Agency. For its part, SESPAS, the Spanish Society of Public Health, has published an interesting document on the characteristics that this body should have, with 11 very interesting recommendations. The Economic and Social Council of Spain (CES) publishes a report on the health system. Although the report is well prepared, it is difficult to find anything new in it that has not already been said or any innovative proposal. Taking advantage of the day of rare diseases (although it is now preferred to call them minority) the Spanish Association of Orphan and Ultra-orphan Drug Laboratories releases a report on the situation of these drugs in Spain. Much has been improved, although there is still room to advance. Both the La Paz hospital in Madrid and the Sant Joan de Deu in Barcelona launch special units to treat this type of illness.

As for Companies, on an international level, the Danish Zealand Pharma, a new relevant player in the field of obesity. On the national level, Viamed will launch a comprehensive unit for women in its hospital in Tarragona. New punishment in the Grifols Stock Market.

Biomedicine

Global Health

International health policy

National health policy

  • 24 hour guards
    • The Ministry of Health wants to end 24-hour medical guards this term. The Ministry will study the legislative framework that the autonomous communities can apply. The aim is to organize it by hospitals and without losing salary, since the guards can represent up to a quarter of the professionals’ salary. The challenge is formidable, since it must be implemented by the autonomous communities, it involves a reorganization of hundreds of services, an increase in staff and addressing the complements of medical personnel (https://www.eldiario.es/sociedad/sanidad-quiere-finish-medical-guards-24-hours-we-will-give-you-answer-legislature_1_10957897.html)
  • Economic and Social Council (CES) report on the health system
    • Report from the CES on the health system. Among the recommendations it supports public health and prevention; specify and update the SNS service portfolio; make Primary Care the true axis of the system; confront waiting lists; strengthen the comprehensive mental health model; enhance the quality of pharmaceutical provision; promote the planning and reinforcement of human resources of the SNS; reinforce patient participation; contribution of the private for-profit and non-profit sector; improvement of system management and evaluation (https://www.ces.es/documents/10180/5299170/INF_012024.pdf)

Companies

 

 

7 days in healthcare (February 19th-25th, 2024)

 

Summary

From the point of view of Biomedicine, the mega-study of 250,000 genomes made public by the National Health Institutes of the USA stands out. This is in line with carrying out genome studies combining it with electronic medical record data from very large groups initiated in the United Kingdom by Genomics England and also developed in Iceland and Japan. A very promising way to improve knowledge of many diseases. New treatments for type 1 diabetes, based on the transplant of insulin-producing beta cells, obtained from stem cells, neutralizing the immune reaction. Gene therapy is the great promise for many rare diseases, currently without treatment. The problem to be solved is the high price of the treatments. At the present time, saying breast or prostate cancer is almost saying nothing. The treatment of tumors is no longer based on their anatomical origin, but rather on their molecular characterization. Bispecific antibodies that act on two targets at the same time, useful in hematological and solid tumors. The FDA approves a drug to prevent the amputation of fingers and limbs.

As far as Global Health is concerned, long covid was understood as a sequel to covid, but an article in The Economist states that covid is not the only infectious disease that leaves pathological conditions that are difficult to label. An article in Health Affairs places the solution to the obesity epidemic as a joint effort of prevention and treatment.

In terms of International Health Policy, more than half of USA’s rural hospitals do not offer childbirth services, which means that pregnant women have to be treated in centers located 30-40 minutes from their home, sometimes more. This is related to the high maternal and infant mortality in the USA, higher than that of most developed countries. The 4th anniversary of Brexit encourages the debate about whether it was good or bad for the National Health Service. The truth is that the NHS is worse now than before Brexit (waiting lists, professional strikes, etc.) and the difficulty of recruiting health professionals from the EU has increased. The investigation was also damaged. Increasing funding for the NHS was one of the arguments used by Brexiteers. France addresses the carbon footprint in the health system, within the general “France Nation Verte” program. Germany legalizes recreational cannabis, with one of the most liberal laws in Europe, after Malta and Luxembourg. More than controversial attempt in Germany to take control of non-communicable diseases from the Robert Koch Institute, one of the most prestigious organizations in German health, to give it to another organization, created as a result of covid. The European Medicines Agency recommends approving a drug against ALS.

If we talk about National Health Policy (Spain), as a result of a specific scandal, the entire problem of purchasing masks and other materials during covid is introduced into the national debate. Precisely everything related to the purchase of these materials was somewhat overlooked by the report “Evaluation of the Performance of the Spanish National Health System in the face of the covid-19 pandemic”, dated April 30, 2023, although published by the Ministry of Health in December of that year. It is already serious that an issue such as the problems of purchasing materials are not analyzed in the report, as if this had not been one of the most serious problems in the management of covid. The PNV requests the return of the text of the Public Health Agency law. That this law was going to have problems with the nationalist parties, always opposed to the creation of cohesion bodies in the National Health System, was something known. Surely this will mean delays in the appearance of the law and, what may be more serious, affect its content and functions. There is a risk that the announced Agency will be little more than an empty shell. The government creates the Extreme Temperature Observatory to analyze the health impact of climate change. The Basque Country approves a new Mental Health Plan 2023-2028. The EU denounces the high level of interim contracts in the Spanish public health system. At the current time, 43% of contracts are interim.

As for Companies, internationally, AstraZeneca reveals successes in the treatment of lung cancer. Indian drugmakers make versions of Novo Nordisk’s anti-obesity drug. At the national level, Sanitas intends to open a new hospital in Barcelona. Fever of construction of private hospitals in Valencia: Vithas, Quirón, IMED and Ascires in that race.

Biomedicine

Global Health

International health policy

  • United Kingdom and the National Health Service
    • Brexit and health. January 31, 2024 was celebrated as the 4th anniversary of the United Kingdom’s effective departure from the European Union. The Lancet asks whether or not that was good for the NHS, with two possible answers: the easy one, which says there is no evidence; and the difficult one, which confirms that the NHS is in fact worse now than before, as demonstrated by the long waiting lists and the continuous strikes by health professionals. What is certain is that it has become difficult to recruit doctors from the EU. At present, the majority of foreign doctors hired in the NHS are from outside the EU. Research plans were also negatively altered. (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00157-0/abstract)
    • The government changes its policy and plans to double the number of medical students in 2031 (https://ground.news/article/government-u-turn-on-plans-to-double-number-of-medical-students-in-england)

National health policy

Companies

7 days in healthcare (February 12th-18th, 2024)

Summary

From the point of view of Biomedicine, as is known, most rare diseases have no treatment, although this situation will surely be overcome in the not too distant future. A new drug (prozelimab) against the rare Chaple disease. A trial offers hope that a jab could prevent rheumatoid arthritis, the disease that affects 18 million people globally. Chances of a blood protein test warning about the onset of Alzheimer’s disease up to fifteen years in advance. A new powerful antibiotic (cresomycin), hope for antimicrobial resistance, which globally causes about five million deaths a year.

Regarding Global Health, despite the fact that 2021 marked the 100th anniversary of the appearance of insulin, many diabetes patients still do not have access to it. Important article in the New England Journal Medicine about e-cigarettes. There is sufficient evidence to show that switching from cigarettes to e-cigarettes reduces exposure to tobacco toxins, decreases respiratory symptoms, and reverses physiological changes related to cigarette smoking. There is not enough evidence that e-cigarettes are a good method to quit smoking.

In terms of International Health Policy, an unexpected consequence of the ruling of the United States Supreme Court, granting states the possibility of legislating on abortion, what was widely used to prohibit or restrict it: the taking of prescribed abortion pills by telemedicine and received by mail is a safe and effective method, according to a study. The European Commission approves the first gene editing treatment, in this case for beta thalassemia and sickle cell anemia. HERA (Health Emergency Preparedness and Response Authority) launches the Critical Medicines Alliance. It is said that this Alliance will contribute to changing the way medicines are produced and purchased in Europe.

If we talk about National Health Policy (Spain), there is great commotion in the sector as a result of the statements by Vice President Yolanda Díaz that she is negotiating to introduce in the budgets the modification of the health VAT from 0% to 21%. Regardless of the viability of this proposal, could it be considered whether this is the best way to make policy? Any study on the impact on the sector? Any previous negotiations with the health ecosystem? Although the Ministry of Health usually intervenes little in economic matters – remember that all the cuts during the financial crisis were not even discussed in the Interterritorial Council of the National Health System – this is a major issue that well deserves a position. and an analysis by the Ministry of Health. Asturias regulates financial compensation to professionals (442 euros for four hours of surgical activity and half for consultations for doctors) for extension of working hours to address the serious problem of waiting lists. Family doctors report a deficit of 2,600 professionals in the next year. As a consequence of the European Plan against Cancer, the launch of the first nine Comprehensive Cancer Centers in Spain is announced. The project is led in Spain by the Vall d’Hebron Hospital and the National Institute of Oncology.

As for Companies, on an international level, the British consulting firm Clarivate analyzes the 13 disruptive drugs for 2024. Oncology drugs predominate, although there is also the vaccine against respiratory syncytial virus and a new drug against COPD. At the national level, the growth of the egg freezing business in Spain is confirmed. It seems that the HIPRA vaccine is going to end up in the trash. There is nothing special, since failures are inherent to business, especially in an area as difficult as biotechnology. However, some excessively triumphalist government demonstrations could have been avoided.

Biomedicine

Global Health

International health policy

  • United Kingdom and the National Health Service

National health policy

Companies

7 days in healthcare (February 5th-11th, 2024)

 

Summary

From the point of view of Biomedicine, the first effective medication against endometriosis, the growth of the mucosa that internally lines the uterus in other parts of the body, which produces serious disorders, is on the horizon. The Lancet insists that population screening, including genomic screening, requires robust evidence. Population screenings generate considerable expenses, in some cases they are not risk-free and can generate false expectations, so only the most proven ones should be launched. Obesity drugs show other superpowers. They seem to have the ability to control inflammation, including brain inflammation. In this way, it is thought that they may be useful in certain neurological diseases, such as Parkinson’s or Alzheimer’s.

As far as Global Health is concerned, malaria vaccines, currently in use in Africa, are one of the great current tests of Global Health. An article in The Lancet criticizes the WHO’s desire to assimilate policies on tobacco products with those on e-cigarettes. For the author this is a retrograde position, since they are not comparable products in terms of the damage they cause. It is said that the focus should remain on what is the main public health problem: the harmful effects of tobacco consumption. Some directors of scientific advisory committees on covid sign an article in The Lancet, with general recommendations for these committees. Among the signatories is Fernando Simón, whose role in Spain was highly questioned and criticized.

Regarding International Health Policy, British experts from the Academy of Medical Sciences warn of the decline in the level of health of children in the United Kingdom. Due to its importance in the Spanish debate, we simply have to mention that the French Social Security agreed to raise the price of consultations for liberal practice general practitioners to 30 euros per consultation.

If we talk about National Health Policy (Spain), after the monographic meeting of the Interterritorial Council of the SNS on Primary Care, it was agreed, among other things, that the government, after checking the teaching capacity by the autonomous communities, will increase the number of places in training for primary care, although it is simultaneously reported that up to 90% of those who do this specialty leave it for various reasons, to move to the emergency room, to do another specialty or to go abroad. Publication of the Health Observatory (Ministry of Health-CIS) corresponding to 2023. The time to be seen in primary care is very striking, since 70% of patients wait nine days to be seen. The Department of Health of Catalonia addresses the places that are difficult to fill in Primary Care, after identifying 73 primary care teams with these characteristics. Design an incentive program. Among the economic ones are 3,500 gross euros per year for doctors, which may seem little since it represents just over 200 euros net per month, although the Metges union considers it a big step. ASPE publishes, in collaboration with a team from the Complutense University of Madrid, a study on MUFACE, joined by the IDIS Foundation, which calls for a PP-PSOE political agreement and a review of the governance of the model. It is also made public that the insurers that are in MUFACE (Adeslas, Asisa and DKV) already assume losses of 200 million with the current agreement. This is difficult to maintain since private companies in public/private collaboration can be asked to innovate, offer high quality, invest or even, with a long-term perspective, take short-term losses, but not that they lose money continuously and indefinitely, since the possibility of that collaboration is put at risk. Osasunbidea (the Navarrese Health Service) opens, through the intervention of the LAB union, a file on several doctors for making public and private practice compatible, without giving up a supplement. It seems like a debate from another era. Furthermore, there are great differences in the application of this regulation in the national territory. Therefore, a strict approach to incompatibility is only being followed in Navarra and Asturias. A group of Catalan health workers asks to expel another group of Spanish speakers, a notable example of intransigence, regardless of the dubious legality. Another of the conclusions of the Ministry’s Health Observatory is the great growth of private insurance, which went from 6.5% of the population in 1995 to 30.9% in 2023. The great leap occurred in the last decade.

As for Companies, at the international level, Big Pharma still needs successes in clinical trials to compensate for the loss of patents. At the national level, Magnum Partners is preparing to launch a premium aesthetic medicine group. The giant DomusVi offers the largest portfolio of nursing homes in Spain for sale.

Biomedicine

Global Health

International health policy

National health policy

Companies

 

 

7 days in healthcare (January 29th-February 4th, 2024)

 

Summary

From the point of view of Biomedicine, the use of gene therapy based on CRISPR for the treatment of hereditary angioedema should be highlighted. Great debate regarding Elon Musk’s brain chip, in general the scientific community has expressed serious reservations about this initiative. Beginning of the first trials with mRNA-based therapy in cancers of different types in the United Kingdom.

As far as Global Health is concerned, the beginning of routine malaria vaccination can without exaggeration be considered a historic event, given the high mortality of this disease in children in Africa. The WHO warns about the prospects for great growth in cancer globally and the notable differences in its prognosis, especially in breast and cervical cancer.

In terms of International Health Policy, the NHS England initiative is especially interesting, allowing pharmacies to prescribe certain medications and carry out some care practices, which is expected to result in a decrease of 10 million primary care consultations. The results of this experience deserve to be followed, since it could be part of the solution to Primary Care also in Spain. EU document on cancer in Europe, highlighting inequities in its approach.

If we talk about National Health Policy (Spain), it is worth continuing to comment on the intervention of the Minister of Health in the Health Commission of Congress. Although now it seems that nothing is important, the truth is that this intervention is one of the most relevant of any minister who reaches her position. The intervention has some lights and many shadows. Lights: recovery of a certain will for strategic direction of the SNS and decision to address the great problem of waiting lists (this is notable, since it contrasts with other ministers, who used to rather assume that everything was transferred and , therefore, the role of the Ministry was minimal). Shadows: very negative, offensive and unacceptable mentions of private healthcare, with arguments and quotes that are intellectually inconsistent and lacking rigor; staunch defense of direct public management, compared to other forms of public management; Public Health Agency, apart from doubts about its real content (no one hides the fact that the Agency does not make the influential nationalist parties very happy), the Ministry of Health gets out of the way to decide the location, handing over the baton to the Ministry of Territorial Policy and Democratic Memory, as if it were not also a health decision; Framework Statute, where are the negotiations with professionals?; medicines, no mention of the Strategic Plan of the pharmaceutical industry (in which the President of the Government himself had committed himself); Oral health, where is the economic memory? What care model will be followed? Is the inclusion of glasses in public provision, given the financial strains of the system, a reasonable priority? Is there prior consensus with other agents on this measure? In another order of things, in the Valencian Community the reversion to the public sector of the Denia concession has been completed and that of Manises will soon be granted, something to which the Administration has every right, once the concession contract has ended. The mentions of the concept of “expropriation”, used by some concessionaire company, are extemporaneous. Now, the official press release from the Ministry announces a very notable increase in staff in that hospital in Denia. Logically, uncontrolled growth in health spending, if it is not justified, cannot be the public alternative to concessions. Notable growth in the price of health insurance premiums in Spain, although its price must probably continue to be low, compared to other European countries. Something to analyze.

As for Companies, on an international level, Novo Nordisk was surprised by the great demand in Europe for medicines against obesity. In terms of national news, the pharmaceutical distributor HEFAME has experienced great growth in recent years and is considering expanding throughout Spain. At Grifols, the board is considering excluding the family from the company’s strategic decisions.

Biomedicine

Global Health

International health policy

  • European Union
    • Document on inequalities in the EU regarding cancer: “Beating cancer inequalities in the EU” Emphasis on prevention and early detection (https://www.oecd.org/health/beating-cancer-inequalities-in-the-eu -14fdc89a-en.htm)
    • The EU fined the pharmaceutical industry 780 million for anti-competitive practices between 2018 and 2022 (https://www.elespanol.com/invertia/observatorios/sanidad/20240130/ue-multo-millones-industria-farmaceutica-practicas-anticompetitivas /828667294_0.html#:~:text=The%20European%20Commission%20investigated%20one, euros%20for%20the%20laboratories%20involved.)
    • Brussels calls to promote vaccines against human papillomavirus (HPV) and hepatitis B throughout the EU (https://elpais.com/sociedad/2024-01-31/bruselas-llama-a-impulsar-las -vaccines-against-human-papillomavirus-hpv-and-hepatitis-b-across-the-eu.html#:~:text=Brussels%20has%20launched%20this%20Wednesday, the%20Hepatitis%20B%20(HBV).)

National health policy

  • Appearance of the Minister of Health before the health commission of the Congress of Deputies, on January 26, 2024
    • Lights and shadows in the appearance. Lights: recovery of a certain will for strategic direction of the SNS and willingness to address the great problem of waiting lists. Shadows: very negative and unacceptable mentions of private healthcare, with intellectually inconsistent arguments and quotes; staunch defense of direct public management, compared to other forms of public management; Public Health Agency, the ministry gets out of the way to decide the location, as if it were not also a health decision; Framework Statute, where are the negotiations with professionals and patient associations?; medications, no mention of the Strategic Plan of the pharmaceutical industry; Oral health, where is the economic memory?; Is the inclusion of glasses in public provision, given the financial strains of the system, a reasonable priority? Is there prior consensus with other agents on this measure? (https://www.youtube.com/watch?v=xlGfsMiuQDo)

Companies

 

7 days in healthcare (January 22nd-28th, 2024)

 

Summary

From the point of view of Biomedicine, highlight the article by Dr. Topol, famous American cardiologist and doctor, who says how generative AI can contribute to significantly reducing medical errors, which cause hundreds of thousands of deaths a year in the United States and around the world. An initial cancer screening seems to be making its way through a simple blood test, taking advantage of the sharing of certain molecular characteristics in all cancers. The University of Gothenburg in Sweden is developing a blood test for the early diagnosis of Alzheimer’s disease.

With regard to Global Health, an editorial in The Lancet refers to the economic problems in low- and middle-income countries in addressing health expenditures, given the great weight of debt interest, which is why it proposes as a solution its condonation. The first mass malaria vaccination begins in Africa. Universal healthcare in Tanzania. Universal coverage, long exclusive to Europe and high-income countries (with the exception of the United States), is now spreading to developing countries as well.

In terms of International Health Policy, the next American elections in 2024 already show what could be the priority issues during the campaign for Democrats and Republicans. For the former, reducing the high price of prescription drugs and women’s health (with pro-choice options); for Republicans, overcoming covid-19 and drug overdose. It does not seem that the repeal of Obamacare, which has reached a record of 21 million affiliates, is going to be a priority in the Republican campaign.

If we talk about National Health Policy (Spain), presentation by Minister Mónica García of her priorities in the Congressional health commission. Laws against alcohol consumption in young people and to protect direct public management in public healthcare. Announcement of the legalization of cannabis and increase in the portfolio of services in “dental” and “visual health”. The imminent approval of the Public Health Agency and the reform of the Framework Statute in 2024 are announced. In relation to this last point, it was announced that negotiations are being carried out with the unions and the communities. And what about the professionals? Don’t they have anything to say on this topic? Important announcement by the Ministry of the genetic portfolio of the National Health System, to be launched gradually throughout 2024. Health maps are being reformed and simplified in several communities: Aragón, Cantabria, Valencian Community and Asturias . It is striking that the reforms are promoted by PP governments in the first three communities, while the reform in Asturias, sponsored by a PSOE government, is opposed by the PP. Catalonia promotes the discussion of a National Health Pact. Among other issues, the elimination of the statutory personnel regime is proposed. Possibly this change cannot be made legally from an autonomous community, but the much-needed idea and the opening of the discussion are welcome.

As for Companies, at the international level, Novo Nordisk and Lilly find themselves with a new player in their battle regarding obesity: the Danish biotech company Zeland Pharma. When it comes to national news, the problems with Grifols continue. Interesting article in Expansión on professionalization and corporate governance in family businesses.

Biomedicine

Global Health

International health policy

  • USA
    • Article in JAMA: Focus on health problems in the 2024 American elections. It seems that health care is going to be very present in the American elections. Democrats’ issues are lowering prescription drug prices and women’s health (with pro-choice options); while the Republican issues are overcoming covid-19 and drug overdoses and border control policies in this regard. Despite Trump’s criticism of the Obamacare law, repealing the law is unlikely to be made a campaign priority (https://jamanetwork.com/journals/jama/fullarticle/2814471)
    • Obamacare enrollment boom, reaching 21 million in 2024 (https://www.nytimes.com/2024/01/25/us/politics/obamacare-open-enrollment.html)

National health policy

Companies

 

 

7 days in healthcare (January 15th-21st, 2024)

covidoriginandChina,

 

Summary

From the point of view of Biomedicine, it is worth highlighting the fact that in China they created the first cloned monkey, which introduces us to the ethical debate of the possible cloning of human beings. Also the fact of the discovery of biomarkers that allow persistent covid to be diagnosed.

As far as Global Health is concerned, it is confirmed that cyber attacks, whose frequency is only growing, are one of the greatest dangers to health systems, which is forcing governments to reinforce security standards.

In terms of International Health Policy, as demonstrated by the American Cancer Society, mortality from cancer is falling in the United States, due to the combined effect of less smoking, earlier diagnoses and more effective treatments. An article in the New York Times summarizes the six reasons why medicines are so expensive in the United States (twice as much as in other high-income countries, such as Germany and the United Kingdom), perhaps the most important being the absence of a centralized price negotiation body, something about to be overcome, given the upcoming Medicare negotiation on these prices. A group of Nobel Prize winners and scientists are addressing the EU to ask for less rigidity in the regulations on genetic modification, in order to protect crops. The ECDC launches RespiCast, a new center for the prevention of respiratory diseases.

If we talk about National Health Policy (Spain), the tripledemic is on the decline, at least as far as the pressure on hospitals is concerned. Although it may seem like an anecdote, the situation of the pediatric ICU in La Paz is a metaphor for human resources policy in the health sector. This ICU remains closed, due to the loss of all medical staff, as a result of the judicial decision that reinstates a former head of the Unit in his position. The Statute leads to the situation where the actions of a single person can put a service, a hospital, a manager, a regional minister and the Ministry in check, indefinitely and without anything happening. It is an extreme case, but it is something that happens every day. In this way, centers that claim to be companies cannot be managed. In the field of transplants, Spain has been a world leader for 32 years in a row.

As for Companies, internationally, Lilly’s leadership among pharmaceutical companies seems destined to last. At the national level, problems at Grifols, which call into question the future of this company, as well as the control by its founding family. Losses by Ribera in its Galician hospitals.

Biomedicine

Global Health

International health policy

National health policy

Companies