7 days in healthcare (October 7th-13th, 2024)

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Summary

Biomedicine

  • Two Americans win the Nobel Prize in Medicine for their discovery of microRNA and its role in how organisms develop and function. MicroRNA is critical in post-transcriptional gene regulation. It is now known that the human genome encodes more than 1,000 different microRNAs, which control a wide variety of processes.
  • Major advances in the treatment of breast cancer. Multi-agent adjuvant chemotherapy was introduced 50 years ago. More than 2 million women are diagnosed with breast cancer each year, resulting in 600,000 deaths. Analysis shows that women diagnosed after 2000 have much lower recurrence rates within 10 years than patients diagnosed before.

Global Health

  • Self-harm is increasingly being emphasized. Self-harm is defined as intentional harm to oneself, which can take many forms, including medication overdose, ingestion of harmful substances, cutting, burning or puncturing oneself. Self-harm is a behavior and not a diagnosis, with many underlying causes. There are at least 14 million episodes of self-harm currently in the world, with a ratio of 60 per 100,000 inhabitants per year.

International health policy

  • The American health system remains a problem. The results of the Commonwealth Fund report are discussed, which in its eighth version from 2004, continues to present the American system in an unfavorable position with the other countries with which it is compared: Australia, Canada, France, Germany, the Netherlands, Sweden, Switzerland and the United Kingdom.
  • Climate change and health receive different approaches between Democrats and Republicans. More than 200 medical journals have published a joint document declaring that global warming is the greatest threat to global health, this means reducing greenhouse gas emissions. The official Republican Party platform does not even mention climate change. The Democratic Party’s platform, on the other hand, includes several actions to reduce climate change through strong investments in clean energy.
  • Both Harris and Trump advocate lowering drug prices. Harris advocates new cuts, while Trump offers little specificity. Although both advocate lowering drug prices, Harris’ proposal is to extend Biden’s actions to more drugs, while Trump is less specific.
  • Obesity drugs could cost the American health system $35 billion over the next nine years. Currently, Medicare only provides these drugs in cases of comorbidity, such as risk of stroke, heart disease or sleep apnea. Both NovoNordisk and Lilly want the rules to be changed so that they can be offered in cases of obesity alone.
  • Productivity, a big problem for the NHS. Experts and politicians agree that productivity in the NHS is a problem. Hospitals have more staff than ever, however, the number of interventions is lower than before the pandemic. Between 2019 and 2023, the number of operations performed by each surgeon fell by 12%.
  • The promises of the Labour Party in the United Kingdom to “return to the primary care physician” are being questioned. Although Starmer promised the return of the GP, it is doubtful that this promise can be fulfilled and patients will increasingly see other types of professionals (nurses, physiotherapists or pharmacists, for example), according to a recent study.

National Health Policy (Spain)

  • The ELA law has been approved, although with the unknown of how it will be financed. The Luzón Foundation estimates that its implementation requires an investment of between 180-200 million euros per year.
  • Social Security is already negotiating with the communities to reinforce the role of mutual insurance companies in sick leave. It is assumed that the figures for temporary disability have reached record levels. The aim is to involve the mutual insurance companies more in the control of trauma sick leave. To this end, the signing of agreements between the Government, the autonomous communities and Social Security will be proposed. Spain spends 1.4% of its GDP on temporary disability benefits, two-tenths more than the EU average.
  • The Community of Madrid presents its Digital Health strategy, whose axes are the creation of a centralized Diagnostic Imaging network, the promotion of home hospitalization or the use of AI for disease prevention.
  • The Government gives insurance companies 25 days to respond to the offer for Muface. The offer is a 17.2% increase over two years. The insurance companies consider this increase “insufficient” and are considering their exit. Although, logically, insurance companies cannot be asked to lose money, since in the long term this is unacceptable for shareholders, it would be a shame to lose the most mature and important form of public/private collaboration in health in our country. Losing it is easy, but recovering it is very difficult. Although both the absence of primary care and the criticism of professionals, who these days are speaking out for the disappearance of the model as it is known, indicate the weaknesses of this form of health care. But what model doesn’t have weaknesses?
  • Spain, below the OECD average in per capita spending on medicines. In terms of per capita spending, Spain ranks 22nd out of the 34 most developed countries, with a per capita spending of 538 euros, below the OECD average.

Companies

  • International
    • European pharmaceutical companies face a risk of 30 billion euros due to patent expiration, according to IQVIA calculations.
  • National
    • Sanitas buys a new hospital in Poland, a centre specialising in orthopaedics and rehabilitation.
    • The HM group launches its ninth hospital in Madrid: the Madrid Rio Hospital.

Biomedicine

  • Americans Victor Ambros and Gary Ruvkun win the Nobel Prize in Medicine for their discovery of microRNA and its role in how organisms develop and function. MicroRNA is critical in post-transcriptional gene regulation. It is now known that the human genome encodes more than 1,000 different microRNAs, which control a wide variety of processes (https://www.ft.com/content/ce1f365e-ef68-4faf-a9f1-8c043e7875d9)
  • Advances in the treatment of breast cancer. Multi-agent adjuvant chemotherapy was introduced 50 years ago. More than 2 million women are diagnosed with breast cancer each year, resulting in 600,000 deaths. Analysis shows that women diagnosed after 2000 have much lower recurrence at 10 years than patients diagnosed before (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01823-3/abstract)
  • An army of nanorobots manages to repair brain aneurysms in rabbits. These magnetic nanorobots, 20 times smaller than a red blood cell, could be used to treat the dreaded consequences of aneurysms, which can rupture and cause severe bleeding (https://elpais.com/salud-y-bienestar/2024-10-07/un-ejercito-de-nanorrobots-logra-reparar-aneurismas-cerebrales-en-conejos.html) Access to the original article: https://onlinelibrary.wiley.com/doi/10.1002/smll.202400408

Global Health

  • The mpox emergency, a time for solidarity and equity. This NEJM article defines the five measures of international solidarity needed to address this health emergency, declared as such by the WHO in August 2024 (https://www.nejm.org/doi/full/10.1056/NEJMp2410395)
  • Mpox in pregnancy, risks, vertical transmission, prevention and treatment. The association of mpox with adverse obstetric effects is well known (https://www.nejm.org/doi/full/10.1056/NEJMp2410045)
  • Climate change, fighting misinformation with reliable knowledge. The relationship between climate change and damage to human health is a well-established fact. However, the forces of disinformation continue to attack this finding (https://www.bmj.com/content/387/bmj.q2211)
  • The Marburg outbreak in Rwanda shows some post-pandemic progress (https://www.ft.com/content/7ba16fc2-2290-44ca-b1e7-10d5f553bf7e)
  • The Lancet report on self-harm. Self-harm is defined as intentional harm to oneself, which can take many forms, including medication overdose, ingestion of harmful substances, cutting, burning or puncturing oneself. Self-harm is a behaviour and not a diagnosis, with many underlying causes. There are at least 14 million episodes of self-harm currently in the world, with a ratio of 60 per 100,000 population per year. Twelve recommendations have been identified to address this problem: for governments; for health care providers; for the media; for society; and for researchers (https://www.thelancet.com/commissions/self-harm)

International health policy

  • USA
    • The problems of the American health system. The results of the Commonwealth Fund report are discussed, which in its eighth version since 2024, continues to present the American system in an unfavorable position compared to the other countries with which it is compared: Australia, Canada, France, Germany, the Netherlands, Sweden, Switzerland and the United Kingdom. (https://www.nejm.org/doi/full/10.1056/NEJMp2410855). Access to the original document: Mirror, mirror 2024, A Portrait of the Failing US Health System: https://www.commonwealthfund.org/sites/default/files/2024-09/Blumenthal_mirror_mirror_2024_final_v2.pdf
    • Climate change, health and the American elections. More than 200 medical journals have published a joint document declaring that global warming is the greatest threat to global health, which means reducing greenhouse gas emissions. The official Republican Party platform does not even mention climate change. The Democratic Party’s platform, on the other hand, includes several actions to reduce climate change through strong investments in clean energy (https://www.bmj.com/content/387/bmj.q2183)
    • Drug prices: Harris advocates new cuts, while Trump offers little specificity. Although both advocate lowering drug prices, Harris’s proposal is to extend Biden’s actions to more drugs, while Trump is more vague (https://www.nytimes.com/2024/10/08/health/drug-prices-kamala-harris-donald-trump.html)
    • Obesity drugs could cost the American health system $35 billion over the next nine years, according to the Congressional Budget Office (CBO). Currently, Medicare only provides these drugs in cases of comorbidity, such as risk of stroke, heart disease or sleep apnea. Both NovoNordisk and Lilly want the rules to be changed so that they can be offered only in cases of obesity. (https://www.ft.com/content/f5a11e68-a56a-4a28-8a0a-dbba629ce519)
  • The UK and the National Health Service
    • The story of one NHS operation. Experts and politicians agree that productivity in the NHS is a problem. Hospitals have more staff than ever, yet the number of operations is lower than before the pandemic. Between 2019 and 2023, the number of operations performed by each surgeon fell by 12% (https://www.economist.com/britain/2024/10/08/the-story-of-one-nhs-operation)
    • Analysis casts doubt on Labour’s promise to “bring back the GP”. Although Starmer has promised to bring back the GP, it is doubtful that this promise can be kept and patients will increasingly see other types of professionals (nurses, physiotherapists or pharmacists, for example), according to a recent study (https://www.theguardian.com/society/2024/oct/06/gp-care-analysis-casts-doubt-labour-pledge-bring-back-family-doctor). Access to the original article: https://www.frontier-economics.com/media/0hohvq2y/balancing-supply-and-demand-in-primary-care_frontier-economics_october-2024.pdf

National health policy

Companies

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