7 days in healthcare (September 20th-October 6th, 2024)

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Summary

Biomedicine

  • The father of CAR-T therapy, Dr. Carl H June, winner of the 5th edition of the Abarca Prize. The prize is awarded to Dr. June, a professor at the University of Pennsylvania, for his pioneering study and development of a revolutionary strategy to treat blood cancers, based on cellular engineering.
  • Slow progress in endometriosis. This disease affects 10% of women of reproductive age and substantially affects quality of life. Diagnosis is not easy. Australia, France and Denmark have national action plans against endometriosis (NAPE).
  • Mapping the brain of an adult fruit fly. This map is called a connectome and traces the connection of almost 140,000 neurons, allowing almost 55 million connections between them. This is a major breakthrough, which will allow us to understand how neurons process sensory information and transform it into instructions for action. In time (with technological improvement and many dollars) this may be done in humans, which will allow us to answer many questions.
  • AI offers a new way to diagnose mental illness. Until now, diagnosing a mental illness required speaking to a psychiatrist, which often takes months before a diagnosis is made. With the help of AI and language analysis, the ability to diagnose a wide variety of mental processes has been shown.

Global Health

  • Who sets the priorities for essential medicines? For almost 50 years, the WHO created a model for an essential medicines list, which has been gaining visibility. In 2017, 150 countries have adopted essential medicines lists, largely based on the WHO list. At the end of 2023, the WHO announced an update to the process for selecting medicines for this list. It is important to add clarity to the decision-making process in such an important process.
  • A tobacco-free generation would prevent more than a million deaths from lung cancer. This conclusion comes from a large study published in The Lancet.
  • Mpox in Africa: 886 deaths since the beginning of the year, according to the African CDC. Almost 35,000 cases have been recorded since January, mainly in the Democratic Republic of Congo, Burundi, Kenya, Uganda and Rwanda. This indicates that the epidemic is not under control on the continent.
  • We may have reached the peak of obesity. After years of global increases in the percentage of obesity, this trend may be changing. In the USA, between 2020 and 2023, the percentage of obesity fell by two points. We cannot be sure that this is due to new drugs, but it is most likely.

International Health Policy

  • Health care reform in the USA and the 2024 elections, addressed by the New England Journal of Medicine. Abortion and reproductive rights have been the main focus of the presidential campaign. Less attention has been paid to other issues such as the uninsured or underinsured population, the costs of the system and Medicare. Certain issues such as the economy and immigration have contributed to reducing the visibility of health care during the campaign. On the other hand, the success of Obamacare (ACA), reinforced during Biden’s term, has caused health policy to return to incrementalism rather than to major changes. The rejection of Obamacare was very present in Trump’s campaign in 2016, but not so much now. What he is proposing in this campaign is to apply it “much better” (?). For Harris’s part, she has strongly supported the reduction of the price of prescription drugs. What neither Democrats nor Republicans have addressed are certain key issues, such as the impact of climate change on health, the opioid crisis or consolidation in health markets.
  • The British government wants to fund a blood test that costs 120 pounds and is able to detect 12 of the most common forms of cancer. The initiative was presented by Wes Streeting, the health secretary, himself a cancer survivor, saying it will be a “gamechanger”.
  • NHS England is to genetically screen more than 100,000 children for more than 200 genetic conditions. Experts say this will be “transformational” for early diagnosis and treatment.

National Health Policy (Spain)

  • Pané focuses his actions on twelve areas to strengthen the Catalan health system. These include the Comprehensive Social and Health Agency and the Public Health Agency of Catalonia. He also referred to the order given to CAIROS (the committee of experts chaired by Manel del Castillo) to strengthen Primary Care, ensuring access to it within the first 48 hours.
  • The committee of experts (CAIROS, acronym for the Committee for Evaluation, Innovation, Operational Reform and Sustainability of the Health System) chaired by Manel del Castillo was established in Catalonia. Vicente Ortún, Beatriz González López-Valcárcel and Josep Tabernero are among the members, all of great prestige. Due to its composition, it seems that special importance is given to Primary Care, ageing, mental health, oncology and public health. To a large extent, its explicit starting point is the document “30 Measures to Strengthen the Health System”, published on September 21, 2020. This reference is very important, since this document contained very innovative proposals, for example, in the section Modernization of the management of the centers, in its point 10 it says: “create a specific management instrument for health centers (public health body) endowed with its own legal personality and full economic-financial management and human resources autonomy”. Exactly the opposite of what is being done in other parts of the system in Spain: dismantling public health companies (Andalusia) or promoting OPE’s that consolidate places with union transfer criteria and without counting on either the center or the service in their assignment. That is why it is important that this initiative is successful, despite the very negative political conditions, and it does not have the same fate that the 30 measures document had when it was presented to President Torra.
  • Castilla y León confirms the degree of medicine in Burgos and León. Between 70 and 100 places are being considered for the University of León and between 40 and 70 for the University of Burgos.
  • There is a great deal of controversy regarding the future of MUFACE. Key statements, among which it is surprising that there is none from the PP, given that it is an important issue in health:
    • The Minister of Health says that MUFACE is not a priority for Health and that it is the responsibility of the Civil Service. This is a very civil service-oriented understanding, in the bad sense of the word, of the responsibilities of the Ministry of Health, which must also be concerned about any external threat to the system and the disappearance of the MUFACE model impacts the system. This was the approach of Minister Julián García Vargas, who reinforced MUFACE, despite not being under his direct area of ​​competence, because he understood that its weakening would affect the health system as a whole.
    • The Minister of Health says that MUFACE is anachronistic and without primary care. The fact that it does not have primary education is indeed a problem, but it is a problem of regulation. In the tender documents that MUFACE calls for, the operation of primary care is not introduced as a requirement. This is the consequence of the Administration looking the other way when it comes to the private health system, which means that you can find yourself with a private system that is completely outside of public priorities.
    • Insurance companies threaten to leave MUFACE and send 1.5 million civil servants to public health. There is no company that can justify indefinitely to its shareholders its participation in an activity that has no clear horizons of profitability.
    • Doctors ask for a MUFACE without insurance companies. A real nonsense, which seems to ignore the functions of health insurance companies, which are fundamentally to manage a risk pool.
    • AIREF launches a survey among 82,000 civil servants to find out how the model works. The moment in which this survey is launched is striking.
  • Controversy over the concept of flexible sick leave. The concept should be flexible discharge, always based on medical recommendation, according to Lorenzo Armenteros, spokesman for the Society of General and Family Doctors. Multiple reactions to the proposal of the Minister of Social Security and Migration, Elma Sainz. The concept of flexible sick leave, with a 14% absenteeism rate and a productivity problem, may be something worth studying.

Companies

  • International
    • Alert on new anti-obesity drugs. George Yancopulos, co-founder and chief scientific officer of Regeneron, an American biotechnology company, says that new anti-obesity drugs may cause more harm than good, unless the rapid muscle loss associated with these treatments is resolved. Clinical studies suggest that patients treated with the new drugs – known as GLP-1 – lose muscle much faster than weight loss through diet or exercise, exposing them to health problems.
    • Gilead allows the generic version of the effective injection against HIV in poor countries. Gilead announced a plan to allow 6 generic companies in Asia and North Africa to produce the drug lenacapavir, which with two injections a year produces total protection against HIV.
  • National
    • Spain, first producer of medicinal marijuana in Europe. The 12 companies that have made Spain the largest producer of medicinal marijuana in Europe. This year Spain became one of the seven countries with the largest production of medicinal cannabis in the world and the first in Europe. o Barcelona will have a new private hospital in the 22@ district in 2027, an initiative of Sanitas, Mapfre and Colonial. It will have 120 beds and eight operating theatres. The investment will be 77 million euros.
    • The semi-public pharmaceutical company Terafront plans to build its own factory in the Basque Country.

Biomedicine

Global Health

International Health Policy

  • USA
    • The reform of the health system in the USA and the 2024 elections, addressed by the New England Journal of Medicine. Abortion and reproductive rights have had the greatest focus in the presidential campaign. Less attention has been paid to other problems such as the uninsured or underinsured population, the costs of the system and Medicare. Certain issues such as the economy and immigration have contributed to reducing the visibility of health care during the campaign. On the other hand, the success of Obamacare (ACA), reinforced during Biden’s term, has caused health policy to return to incrementalism rather than to major changes. The rejection of Obamacare was very present in Trump’s campaign in 2016, but not so much now. What he proposes in this campaign is to apply it “much better.” For Harris’s part, she has strongly supported the reduction of the price of prescription drugs. What neither Democrats nor Republicans have addressed are certain key issues, such as the impact of climate change on health, the opioid crisis or consolidation in health markets (https://www.nejm.org/doi/full/10.1056/NEJMp2410629)
    • Bird flu: the opacity of the American survey makes risk assessment difficult (https://www.lemonde.fr/planete/article/2024/10/01/grippe-aviaire-l-opacite-de-l-enquete-americaine-rend-impossible-l-evaluation-du-risque_6340343_3244.html)

National health policy

Companies