7 days in healthcare (November 25th-December 1st, 2024)

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Summary

The most impactful news in health this week were:

  • Biomedicine: lung cancer is dealt a blow, the USA has managed to increase survival by 26% in the last five years.
  • Global health: HIV/AIDS deaths have been the lowest in two decades.
  • International health policy: Biden proposes a broad expansion of anti-obesity drugs.
  • National health policy: Adeslas has announced that it will not participate in the new competition, which makes it very difficult, if confirmed, unless a new insurer willing to participate appears, the continuity of the MUFACE model, since ASISA will not be able to assume all of ADESLAS’ MUFACE policyholders.

Biomedicine

  • Scientists discover why ultra-processed foods are bad for health. According to the Nova classification, foods are classified into four types, according to their degree of processing, from 1 (minimally processed: fruit and milk); to 2, basic ingredients (such as butter and sugar); 3 (vegetables, bread) and 4, highly processed foods, which contain elements not commonly found in a home kitchen (sparkling drinks, sugary cereals, frozen pizzas). The latter contain many ingredients that are harmful to health (type 2 diabetes, obesity, cardiovascular disease, mental illness). There is no single ingredient identified as negative, but it must be a combination of several.
  • Lung cancer hit. The USA has managed to increase survival by 26% in the last five years. Mortality remains high, but something is beginning to change.

Global Health

  • HIV triumphs and threats in 2024. This year has been one of ups and downs in the effort to eradicate HIV globally. More people than ever are receiving antiretroviral treatment and AIDS deaths have been the lowest in two decades. However, the Sustainable Development Goals’ goal of ending HIV/AIDS as a global threat by 2030 is not going to be met.

International health policy

  • Biden proposes a broad expansion of coverage for anti-obesity drugs. The administration proposes the use of anti-obesity drugs for obese people without other associated conditions.
  • RFK’s (Trump-appointed health secretary) ideas on big pharma and the food industry generate a lot of controversy. Certain of RFK’s attitudes against Big Pharma and ultra-processed foods may go against long-held positions by Republicans.
  • The document “Health at a Glance, Europe 2024” appears. It analyzes information from 30 European countries, including the 25 EU countries and five others: Iceland, Norway, Switzerland, Turkey and the United Kingdom. The conclusions are: urgent action is needed on the shortage of professionals; promoting healthy longevity can reduce the burden of disease; there are significant gaps in life expectancy in Europe; progress in lifestyle changes has been met with great socio-economic disparities.

National Health Policy (Spain)

  • Royal Decree on Health Technology Assessment. The Ministry of Health will submit the Royal Decree on Health Technology Assessment to the Council of State on January 25, although its initial plan was to approve the regulation in 2024.
  • The creation of the Genetics specialty is moving forward, gaining momentum in the Ministry and Congress. The Ministry of Health will take the specialty to the Human Resources Commission on December 5.
  • Imminent green light for the Strategic Plan for the pharmaceutical industry, announced in 2021 and subject to numerous delays. It seems that it will be presented shortly.
  • Cantabria: 98 million for the digital health plan. This is the budget that the Cantabria Digital Health Plan 2024-2027 will have.
  • Adeslas informs mutualists that it will not apply for the new MUFACE health competition and that care will end on January 31. If this is confirmed, it will make the continuity of the model very difficult, since ASISA, apparently, cannot take on all the insured.

Companies

  • International
    • Carlyle supports investments of 1.5 billion dollars in a clinical trials fund.
  • National
    • Problems continue at Grifols. The share price plummets after Brookfield withdraws its offer.

Biomedicine

Global Health

International health policy

  • OECD
    • The document “Health at a Glance, Europe 2024” appears. Information from 30 European countries is analysed, including the 25 EU countries and five others: Iceland, Norway, Switzerland, Turkey and the UK. The conclusions are: urgent action is needed on the shortage of professionals; promoting healthy longevity can reduce the burden of disease; there are significant gaps in life expectancy in Europe; progress in lifestyle changes has been met with large socio-economic disparities (https://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-europe-2024_b3704e14-en)

National health policy

Companies

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

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Summary

The most impactful news in health this week were, from an international point of view,

  • The analysis of Trump’s victory and its consequences for health, generally valued as negative by most analysts.
  • The new health reform law approved in Germany, although the call for elections in that country will surely at least slow down its implementation

From a national point of view, the most relevant:

  • The debate and positions on the future of MUFACE continue

Biomedicine

  • Genetic screening can reduce premature deaths by 25%, according to a study. This makes it possible to stop a quarter of deaths from common diseases, including breast cancer, diabetes and hypertension, by identifying people at risk. This will allow vulnerable groups to be offered earlier studies and treatments, according to the study published by Stanford University

Global Health

  • The global incidence of diabetes doubles, while many patients are left without treatment. Diabetics are left without treatment, while the global incidence of the disease doubles (from 7% of the population to 14% between 1990 and 2022), while many middle- and low-income countries fail to provide care and access to treatment

International health policy

  • Analysis of Trump’s victory in the American elections and its consequences on health. Given Trump’s precedent of leaving the WHO, this will possibly mean a weakening of international aid programs against certain diseases (malaria, HIV/AIDS, etc.). At home, it will surely lead to a decrease in the population covered by the ACA (Obamacare) and a tightening of reproductive rights. It is more doubtful how the negotiation of drug prices, already initiated by Biden, will evolve. The future of the NHI, the largest funding agency for biomedical research in the world, is worrying. The personality of the new Secretary of Health, Robert F Kennedy, is also worrying vaccine manufacturers and baby food manufacturers. 
  • The US view of the NHS. The New England Journal of Medicine has published an interesting article on this topic:
  • Health care reform in Germany. How to fix the problematic German health care system. The new law was approved by the lower house, the Bundestag, on October 17, 2024, and recently by the upper house, the Bundesrat. The law establishes a new system of payment for hospitals, the consideration that there are too many hospitals, and a hospital reform. Germany has a high number of hospitals, 7.7 beds per 1,000 inhabitants, compared to the EU average of 5.3. The official position is that Germany spends a lot of money on health care, for a mediocre quality. We will have to see what happens after the call for elections in Germany.

National Health Policy (Spain)

  • The continuity of MUFACE is in doubt. The continuity of MUFACE remains in limbo, after the decision of ADESLAS and ASISA not to participate in the tender and the decision of the government to call for a new tender, perhaps under new rules. It has been leaked that the government is considering that those who opt for the insurance system will not be able to return to the public system, which is a fairly radical change. It would be something similar to the German model, but in a very different context. Meanwhile, there are controversial statements by doctors linked to the system who ask the government not to renew with the insurance companies. The CSIF union activates certain mobilizations.
  • SESCAM starts a telephone service to avoid transfers to health centers.

Companies

  • International
    • New generation of anti-obesity medication. NovoNordisk provides the results of a clinical trial on a new generation of anti-obesity medications.
  • National
    • Better Care finalizes an alliance with Oracle for the management of health data.
    • The new HM Madrid Río was inaugurated, with 10,000 square metres, 40 consultation rooms, 77 beds and 10 emergency rooms.

Biomedicine

Global Health

International health policy

  • USA
    • There are many published reactions to Trump’s victory in the USA and its impact on health, in general, very negative:
      • More mortality and more illness, according to Science. Trump had already decided to leave the WHO, in 2020, which never happened due to the year of transition period and the arrival of Biden. But now he will not have that limitation, which is why it is foreseeable that the global agenda against malaria, HIV/AIDS, and other diseases will be abandoned, as well as being an obstacle to the WHO Pandemic Treaty. This will mean “more mortality and more illness,” according to Ilona Kickbush, a global expert. The only guarantee is Trump’s unpredictability (https://www.science.org/content/article/more-mortality-more-illness-global-health-community-braces-impact-u-s-election)
      • Millions at risk of losing health insurance under Trump, according to NBC News. Subsidies to purchase insurance under the Affordable Care Act (Obamacare) will expire at the end of 2025. If they are not renewed, health coverage will be unaffordable for many Americans (https://www.nbcnews.com/health/health-news/millions-risk-losing-health-insurance-trumps-victory-rcna179146)
      • The impact of Trump’s election is analyzed by Health Affairs. This magazine analyzes the possible actions around: Affordable Care Act (ACA, Obamacare), with Biden a record number of enrollees had been achieved, it is not known whether with Trump the ACA will be totally rejected or weakened; Medicaid, although during the campaign there was talk of protecting Medicare, nothing was said about Medicaid; Reproductive Health; Health Equity; and the Medicare Drug Price Negotiation Program, a negotiation that has already concluded its first phase and will be implemented in 2026. The attitude of the new administration is not known, but there will likely be at least a delay in the application of this law (https://www.healthaffairs.org/content/forefront/impact-election-health-policy-and-courts)
      • What will Trump’s victory mean for the health system, according to JAMA. This journal analyzes possible changes in three areas: Price Transparency; Drug Prices; and, Reforms in the Affordable Care Act (Obamacare) (https://jamanetwork.com/journals/jama-health-forum/fullarticle/2825024)
    • Trump’s victory also worries the scientific community
      • Scientists must be united against Trump, according to Nature. This journal hopes that the new Trump presidency will not repeat the mistakes of the first, which implies respecting the scientific consensus when making regulations on public health, environmental issues, artificial intelligence and others (https://www.nature.com/articles/d41586-024-03648-z)
      • Trump’s victory and the NIH. The question is whether the new president and the Republican-dominated Congress will introduce major changes to the NIH, the largest biomedical research agency in the world, with a budget of 47 billion dollars (https://www.science.org/content/article/trump-won-nih-major-shake)
    • The appointment of anti-vaccine Robert F Kennedy generates special concern
    • First case of serious mpox in the USA, in California (https://www.nytimes.com/2024/11/16/health/mpox-california.html)
  • United Kingdom and the National Health Service
    • A view of the NHS from the USA, an article from the New England Journal of Medicine. Very interesting article, it begins by highlighting the three differences of the NHS with the American system: 1. A culture of public control and ownership; 2. A commitment to equity and access; and, 3. Weak funding. Among the lessons: 1. Underfunding can wreck any system; 2. The NHS has all the risks and benefits of centralised management; 3. A backlash from professionalism, discontent with certain reforms; and 4. A vulnerability of primary care (https://www.nejm.org/doi/full/10.1056/NEJMhpr2407495)
    • Why the NHS has a productivity problem. Pressures to fix the productivity problem in the NHS are greater after the budget increases. Lord Darzi’s report says that while resources have increased by 20% in the last 5 years, the number of patients treated has barely grown by 3%. Health Secretary Wes Streeting said last Wednesday that a kind of ranking of hospitals by productivity will be made and that managers who fail will be fired (https://www.ft.com/content/0dc04f38-249e-4ae0-af96-62e35e813259)
  • Germany
    • How to fix Germany’s troubled healthcare system. The new law was approved by the lower house, the Bundestag, on October 17, 2024 and recently by the upper house, the Bundesrat. The law establishes a new system of payment to hospitals, the consideration that there are too many hospitals and a hospital reform. (https://www.dw.com/en/how-to-fix-germanys-ailing-health-care-system/a-69236520)
    • Germany’s recipes for avoiding bankruptcy in hospitals: closing health centres and reforming emergency departments. The government is proposing the largest hospital reform in 20 years to contain spending and improve healthcare. “Not a single country in Western Europe has a worse life expectancy than us,” said the health minister, a doctor by profession. Germany has a high number of hospitals, 7.7 beds per 1,000 inhabitants, compared to the EU average of 5.3. The official position is that Germany spends a lot of money on healthcare, for mediocre quality (https://elpais.com/internacional/2024-11-11/germany-recipes-to-avoid-hospital-bankruptcy-cerrar-centros-de-salud-y-reformar-las-urgencias.html)

National health policy

Companies

7 days in healthcare (November 4th-10th, 2024)

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Summary

The most impactful news in health this week was, from an international point of view, Trump’s victory in the American elections, which will undoubtedly have consequences for health in that country, and, therefore, in all the others. As national news, the one with the most long-term consequences was the abandonment of the MUFACE insurers, apart from, of course, the health derivatives of the Valencian DANA.

Biomedicine

  • New treatment for lupus. CAR-T gene therapy can end lifelong medication.

Global Health

  • Annual meeting on climate change COP29. organized by the United Nations will take place next week in Azerbaijan, it is called the “financial conference”, since it will try to mobilize the billions that are needed to tackle climate change. According to an editorial in Science, a strong financial investment is imperative.

International health policy

  • Trump’s victory in the American elections. Given the character of the  person, it is difficult to know what he will do with all that he said, although whatever he proposes will not face obstacles in Congress, given the Republican majority in the Senate and the more than likely one in the House of Representatives. It is possible that he will propose changes to Obamacare (although Trump was not especially aggressive with this law during the campaign); changes in the law that allows the negotiation of the price of medicines with Medicare; changes in reproductive rights; and a different approach to global warming, which will affect health care. There is some concern among pharmaceutical companies regarding the possible influence of Robert Kennedy, a known anti-vaccine activist.
  • Health care under the new Labour government. After more than 14 years of conservative government and austerity policies that particularly affected health, the prestige of the NHS collapsed, going from 70% satisfaction among the population in 2010 to 24% in 2024. The budget presented by the government foresees an increase in the allocation to the NHS of 3.8% above inflation, well above the growth of the conservative period of 1-2%, but still insufficient, given the serious problems.

National Health Policy (Spain)

  • The continuity of MUFACE is in doubt. The decision of the health insurers, mainly ADESLAS and ASISA, not to submit a tender for MUFACE, which left it vacant, casts doubt on the continuity of this model. The government is considering calling for a new tender, presumably with more favourable financing conditions. We will see what happens in this new tender. It is said that the government is trying to convince other insurers, a mission that should not be easy, although perhaps not impossible. The unions announce mobilisations. The Ministry of Health, in the hands of SUMAR and, therefore, with declared anti-MUFACE militancy, says that it is already analysing the situation in the event of having to accommodate this entire group in the public system. It is more than doubtful that the government can face the high political cost among officials of the disappearance of the model.
  • Galicia will extend assisted reproduction up to 45 years of age. Which was a campaign commitment of the PP in that region.

Companies

  • International
    • CVC seeks to control its pharmaceutical company in outsourcing Genetic. For which it needs 700 million euros.
  • National
    • Cosmetic surgery, ophthalmology and dental clinics will invoice 2.2 billion euros in 2023.
    • Alan expands its presence in Spain. This French insurer, which has been present in Spain since 2020, will expand its workforce in Spain by 20% and will launch an AI-powered health assistant in 2025. Alan relies on DKV for its range of services, but the bulk of its business is being a health “partner”.

Biomedicine

Global Health

International health policy

  • The United Kingdom and the National Health Service

National health policy

Companies

7 days in healthcare (October 28th-November 2nd, 2024)

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Summary

Biomedicine

  • ADHD (adult attention deficit hyperactivity disorder) should not be treated as a disease. Until now, a binary scheme was applied, either you had or you didn’t have ADHD. Today we know that there is a wide spectrum of severity, like any other ordinary human trait. With certain aids, which should be in schools and workplaces, this problem can be addressed.
  • Hope for rare diseases. On October 28, the European Rare Disease Research Alliance was launched, an ambitious initiative with a budget of more than 380 million euros and which brings together 170 organizations with the aim of promoting research, prevention, diagnosis and treatment of rare diseases. Several countries want the UN World Assembly in 2025 to adopt a resolution on rare diseases.

Global Health

  • Tuberculosis: the number of cases in the world is stabilizing. The incidence of the disease is 8.5% lower than in 2015, but far from the objectives that had been set for 2025.
  • Deaths of elderly people due to extreme weather are increasing. The review of more than 100 scientists published in The Lancet shows how climate change threatens survival and quality of life.

International health policy

  • Shortage of medicines in the USA and Canada. A shortage is defined as when supply is below demand. In the USA at the end of 2023 there were 300 medicines in short supply. Low prices and lack of competition are cited as the main reasons for this shortage.
  • Special budget for NHS waiting lists. The NHS will receive 1.57 billion pounds to address waiting lists.
  • Alarm in Germany over the high burden of sick leave. Some studies say that fewer days off work would have prevented the decline of the German economy in the last year.

National Health Policy (Spain)

  • The DANA causes high mortality and destruction in several cities in the Valencian Community. According to The Economist, there have been widespread accusations that the warning calls issued by the authorities were very late and, if they had been made more quickly, many deaths would have been avoided. The central government has refused to establish a state of alarm, arguing that this is the responsibility of the Autonomous Community, which must ask for help if it needs it, which is reminiscent of the attitude in the covid policy, in which, at one point, the central government got out of the way, citing reasons of “co-governance”. According to experts, after 72 hours the dangers of infections worsen. COFARES sets up a device to ensure the supply of medicines.
  • Andalusia involves pharmacies in vaccination to improve coverage. The Council of Pharmacists of Andalusia and the Ministry of Health have signed an agreement in this regard.

Companies

  • International
    • The paradoxical opacity of the price of medicines. An OECD report explains that governments want greater transparency in the price of medicines but, at the same time, they refuse to report on what they pay.
  • National
    • Diagnostic imaging billed almost 400 million euros in 2023 in Spain. According to a DBK report, growth stands at 4% annually in the last two years.

Biomedicine

Global Health

International health policy

  • USA
    • Article from The Lancet: Harris or Trump: health after the American elections. This article discusses the different approaches of Harris and Trump, although both will be qualified by the majority of the chambers, although it seems that the Republicans can retain their majority in the House of Representatives and also reach the majority in the Senate (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02413-9/fulltext)
    • The shortage of medicines in the USA and Canada. A shortage is defined as supply being below demand. In the USA at the end of 2023 there were 300 medicines in short supply. Low prices and lack of competition are cited as the main reasons for this shortage (https://jamanetwork.com/journals/jama/article-abstract/2825539)

National health policy

  • AESEG
    • AESEG (generics employers’ association) sets out the challenges and proposals for generics (https://diariofarma.com/2024/10/29/autonomia-estrategica-aeseg-expone-los-desafios-y-propuestas-para-los-genericos). Access to the AESEG report entitled “European strategic autonomy”. Outlook for the generic drug sector in Spain (https://www.aeseg.es/informe-autonomia-estrategica-europea.pdf)

Companies

7 days in healthcare (October 14th-17th, 2024)

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Summay

Biomedicine

  • New applications for anti-obesity drugs. Ozempic and similar drugs also promise to control opioid and alcohol abuse by up to 50%.
  • Very good survival in Hodgkin’s lymphoma. Immune therapy achieves survival in Hodgkin’s lymphoma by almost 100%. Conclusions of a phase III trial.

Global Health

  • Two million children could die of hunger in Africa. The problem is that a nutrient for malnutrition has stopped arriving, according to UNICEF. The problem affects Mali, Nigeria, Niger and Chad the most, which have already exhausted their reserves and may affect another eight countries.
  • Low- and middle-income countries experience delays in access to essential medicines, according to a large study covering 1982-2024 in 75 countries. Since the launch, the period was 2.7 years in rich countries; 4.5 in upper-middle-income countries; 6.9 in low-middle-income countries; and 8 years for low-income people.
  • Major changes in human health improvement may occur by 2050. The Global Health Outlook for 2050. This study by The Lancet Commission concludes that the probability of premature death in their populations – the probability of dying before the age of 70 – can be reduced by 50% compared to 2019 levels. The strategy called “50 by 50” is an aspiration that can be achieved if we focus on 15 priorities.

International health policy

  • A law on assisted dying enters the British Parliament. The new project was introduced on October 16 by Kim Ladbeater, a Labour MP. It is not the first time that a project of this type has been analyzed in the House, the first time being in 1936.

National Health Policy (Spain)

  • It is said that the State Public Health Agency will respect the competences of the autonomous communities. It is stated that the Agency will not assume any competence that the Ministry does not have now. The problem is that, by way of political consensus, the Agency comes out watered down and very far from the requirements so well set out in the SESPAS document.
  • The minister says that she will change the waiting list law to avoid “statistical traps”. One might have thought that the objective would be to solve the waiting list problem, but we already see that the most urgent thing is to correct supposed “statistical traps” in some autonomous communities.
  • Castilla-La Mancha announces for 2025 the largest OPE in the history of SESCAM with 5,200 places. It is sold as a great success, and not only by Castilla-La Mancha, but by practically all the autonomous communities, which represents the greatest attack on a modern personnel policy in the health system, imposing the criteria of a nineteenth-century Civil Service.
  • Waiting lists are falling for the first time since the pandemic, but they remain at historic highs. 848,340 patients are waiting for a non-urgent operation. In 2019, before the pandemic, the number of people waiting for an operation was around 700,000.
  • The PSOE, in favour of cheaper prices for generics and biosimilars. The PSOE presents a non-legislative proposal (PNL) in Congress to promote generics and biosimilars. It is proposed that generics and biosimilars should always be cheaper than brand name medicines.
  • The irrational proliferation of medical schools continues. The autonomous communities open new medical schools against the criteria of the Ministry of Health and the deans. Spain has doubled the number of centres offering this degree in just over a decade; the autonomous executives want to implement them in their territories and the private ones see business due to the high demand.
  • Spain will bear the highest cost linked to the ageing of Europe in the coming decades. Brussels points to Spain as the economy where the cost of population ageing will be highest.

Companies

  • International
    • Sanofi joins its rivals in research into nuclear cancer treatments.
  • National
    • Health insurance will increase by more than 10% in 2025. Prices have risen by almost 50% in the last ten years, with an average growth of between 4% and 7%. This means that the average insurance policy has gone from 650 euros per year in 2015 to 950 euros in 2024 and could reach 1,100 euros next year.
    • Sanitas buys the eight Ibermedic centres in Madrid

Biomedicine

Global Health

International health policy

National health policy

Companies

 

 

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

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

7 days in healthcare (September 23rd-29th, 2024)

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Summary

Biomedicine

  • Organ donation, lessons from the Spanish model. Transplantation is the only valid treatment for the failure of certain organs and can transform the lives of these patients. According to the Global Observatory on Donations and Transplants, only 10% of the global demand for transplants is met. Transplant ratios vary greatly between countries, from 130 per million in the USA and Spain to 12 in India. In May 2024, a new WHO resolution was approved. The leader in donations is Spain, and success is based on three facts: a solid legislative framework; strong clinical leadership and very good logistics, organized by the National Transplant Organization.
  • Immunotherapy, a promise for the treatment of many diseases. The so-called CAR-T was first used in leukemia. The technique consists of extracting T cells, genetically modifying them and then returning them to the patient’s body. This therapy can be applied to asthma, heart disease and even for aging.
  • Article by Eric J Topol in Science. The revolution of high-throughput proteomics and AI. The recent ability to measure hundreds of plasma proteins from small blood samples may facilitate a new way of understanding human disease. The company SomaLogic has developed the means to measure more than 10,000 proteins. When this data is integrated with other information, we obtain relevant information about diseases.

Global Health

  • A global threat on the rise: antibiotic resistance. The problem threatens to kill 208 million people in 25 years. According to the report published in The Lancet, these infections will increase dramatically among those over 70 years of age. A global threat on the rise.
  • The global weight of antimicrobial resistance and the outlook for 2050. Antimicrobial resistance (AMR) is known as a global emergency that requires the concerted effort of all stakeholders. The statistical analysis of the study published by The Lancet says that mortality from AMR will rise to 8.22 million by 2050.
  • Antimicrobial resistance may be more deadly than cancer, according to Ara Darzi (Lord Darzi of Denham, author of the recent report on the NHS)

International health policy

  • The FDA approves the first drug against schizophrenia in decades. Until now treatments blocked dopamine receptors, with strong side effects. The new drug Cobenfy influences dopamine levels, but as an indirect effect.
  • Several British health think tanks comment on the speech of the Minister of Health: King’s Fund, Nuffield Trust and Health Foundation.
  • Jordan, the first country to eliminate leprosy. According to the WHO, Jordan is the first country to eliminate leprosy, still present in more than 120 countries.

National Health Policy (Spain)

  • The Ministry of Health will meet again with the pharmaceutical sector’s employers’ associations to finalise the loose ends of the Strategic Plan. The objective is still to publish the Plan next October.
  • The Generalitat of Catalonia is preparing a committee of experts (called Cairós) to reform its health system, which will be chaired by Manel del Castillo. Its objective will not be to draw up documents, but to evaluate policies. There is no doubt that the technical and professional level of the new Catalan government health team is exceptional, as has not been the case for years. It is important for the whole of Spain that they succeed, as they can contribute to unblocking and addressing certain basic issues of the system from a different perspective, such as the management model and the staff regime in the SNS, which, surprisingly, are not on the agenda of the central government or the regional governments. However, technical qualification is a prerequisite for success, but not a guarantee. From a general point of view, it is difficult to remain optimistic about the political situation of the Catalan and central governments.
  • The best employment after the MIR, community by community. The objective is that the 7,500 residents who finish do not leave their training community. Economic incentives and long-term contracts are the main offers.
  • Management of sick leave by the Mutual Societies. The door is opened for the autonomous communities to agree on the management of sick leave with the Mutual Societies for Work Accidents in traumatological processes. The measure could contribute to improving the management of sick leave, according to FEDEA.

Companies

  • International
    • Big pharma is abandoning new antibiotics: 81% are already being developed by SMEs. This is the conclusion of a long study published by Nature Reviews Microbiology.
    • Statements by the global CEO of Lilly: if Europe cuts patents, there will be no more investments.
  • National
    • Psychology, a “big business” about to explode due to growth without criteria or quality. Psychology is the career that has grown the most in number of students in the 21st century. There is a risk of producing a factory of unemployed, given the scarce presence of Psychology in the NHS.

Biomedicine

Global Health

International health policy

  • Jordan
    • Jordan, the first country to eliminate leprosy. According to the WHO, Jordan is the first country to eliminate leprosy, which is still present in more than 120 countries (https://www.bmj.com/content/386/bmj.q2069)

National health policy

Companies

7 days in healthcare (September 15th-22nd, 2024)

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Summary

Biomedicine

  • Recognition for the scientists who developed anti-obesity drugs. Joel Habener (USA), Svetlana Mojsov (North Macedonia) and Lotte Bjerre Knudsen (Denmark), the parents of Ozempic, win the American Nobel Prize, the Lasker-DeBakey Prize for Clinical Medical Research 2024. Their scientific achievements are estimated to have allowed the discovery and development of FLP-1, the family of drugs that have revolutionized the treatment of obesity.
  • Two technologies directly related to health among the 10 emerging technologies, according to the World Economic Forum: AI for scientific discoveries (including new drugs); and, genomics for transplants, which will allow the successful implantation of genetically modified organs.
  • Schizophrenia, the new drug for the “cancer of psychiatry”. Hope is in sight, if the experimental drug KarXT is approved by the FDA, it will be the first treatment for schizophrenia in more than seven decades.

Global Health

  • A global threat on the rise: antibiotic resistance. The problem threatens to kill 208 million people in 25 years. According to the report published in The Lancet, these infections will increase dramatically among those over 70 years of age. A global threat on the rise.
  • The worst global health crisis is childhood malnutrition. New report from the Bill and Melinda Gates Foundation. More than 400 million children do not get the nutrients they need to grow and develop. Climate change makes this more difficult to solve.
  • Strokes are skyrocketing worldwide. They already kill 7 million people, 70% more than in 1990. Most cases, up to 84%, are related to preventable risk factors.

International health policy

  • Health has a big impact on the 2024 US elections. The affordability of American health care is a very important issue for voters this year, second only to the economy, according to a survey by the Kaiser Family Foundation. Both Trump and Biden during his presidency have made efforts in this direction. The former signed the “No surprises” law, to avoid unexpected bills from insurers; while Biden approved the “Inflation Reduction Act”, which allows Medicare to negotiate with pharmaceutical companies to set prices.
  • British Prime Minister’s speech on health. He refers to the NHS saying: “reform or die”.
  • End of the conflict and big salary increase for residents in England. They accept a 22% salary increase over the next two years.
  • Controversial appointment of the new European Union Health Commissioner. Olivér Várhelyi, new European Commissioner for Animal Health and Welfare. The new commissioner – not yet ratified by Parliament – is Hungarian and very close to the ultra-nationalist Viktor Orbán.

National Health Policy (Spain)

  • The new ALS law lacks funding. This makes it a dead letter. It seems that the application of the law will require 240 million a year, according to the confederation of ALS entities. Although ALS is a terrible disease and the sick require all the attention of the health system and this Law has generated great satisfaction among the sick and their families, it is more than debatable that the approach to health problems is to make specific laws for diseases. Why yes for ALS and not for quadriplegics, for example?
  • The Government presents amendments to the Draft Law on the State Agency for Public Health. It seems that the government parties, PSOE and Sumar, have presented a text with new amendments to the Draft Law on the State Agency for Public Health, with a focus on health in all policies, as well as health determinants and a One Health approach. The private sector is also included when it comes to providing information. Although these elements sound very good, there may be some doubts that an effective and powerful Agency will be approved, in view of the composition of the government’s support, with nationalist parties always opposed to strengthening the State, except for the “State structures” themselves.
  • Important speech by the Catalan Health Minister. She calls for 4 billion euros more in funding for the health sector. She advocates allocating 7% of the community’s GDP and reaching 20 billion euros, starting from the current 5.7%. According to her, Catalonia is the community that allocates the least percentage to Health (5.7%), only surpassed in this point by the community of Madrid (4.2%). In this appearance she presented the twelve priority objectives: 1. Healthy aging; 2. Integrated Social and Health Care; 3. Reinforcement of Primary Care; 4. Public Health; 5. Oral health and reduction of inequalities; 6. Certain measures regarding professionals; 7. Green agenda; 8. Digital transformation and innovation; 9. Evidence and evaluation; 10. Financing for the economic stability of the sector; and, 12. Reform and sustainability of the health system. Apart from the questionable approach of applying a percentage of GDP to health by communities (In which country is a percentage of GDP established by region for health care? This seems like a nationalist objective, directly translated from some of the approaches of the Pompeu Fabra University), the objectives seem reasonable, although perhaps a certain lack of ambition is lacking, particularly in the points referring to professionals and health system reforms.
  • Galicia wants to become a reference bioregion. Galicia announces the creation of a knowledge transfer office for the biotechnology sector.
  • Basque Country: commitment to reducing bureaucracy in Primary Care in 6 months. The objective is to reduce 40% of the bureaucratic activity that doctors must carry out in Primary Care.
  • AIREF rejects bilateral negotiations on regional financing. Its president demands that financing be addressed jointly, to ensure that the measures taken do not affect sustainability.
  • Disappointing new report on Spain from the European Observatory on Health Systems. The report has been prepared by the Aragonese Institute of Health Sciences. In general, the report has a descriptive character and is very little analytical and propositional. This is probably the focus of these reports from the European Observatory of Health Systems, but a more structured analysis methodology is missing, such as that used by Ezekiel Emanuel in his book on the analysis of health systems. It seems to be deduced from the report that everything is fine “except for a few things”, as Rajoy would say. It is not surprising that the Ministry of Health is applauding this report with its ears. Without a doubt, the high level of the authors is far above the results of the dispensable report.

Companies

  • International
    • The obesity market will have 16 new drugs in the next five years. Sales of these slimming drugs will reach 200 billion dollars in 2031, according to Morningstar. Although NovoNordisk and Lilly are currently the leaders and everything indicates that they will continue to be so, there will be many new entrants in this field: Boehringer Ingelheim, Zealand Pharma, Pfizer, Roche, Amgen and others.
  • National
    • Health insurance could raise prices due to rising costs. The increase in policies and the resulting increase in turnover barely manage to maintain the level of profitability
    • Pharmaceutical company CINFA invests 40 million in a new factory in Navarra.

Biomedicine

Global Health

International Health Policy

  • USA
    • The impact of health on the 2024 American elections. The affordability of American health care is a very important issue for voters this year, second only to the economy, according to a survey by the Kaiser Family Foundation. Both Trump during his presidency, and Biden, have made efforts in this direction. The former signed the “No surprises” law, to avoid unexpected bills from insurers; while Biden approved the “Inflation Reduction Act”, which allows Medicare to negotiate with pharmaceutical companies to set prices (https://sph.emory.edu/features/2024/presidential-election/health-policy/)
    • The FTC (Federal Trade Commission) accuses Middlemen (the largest Pharmacy Benefit Managers) of inflating insulin prices (https://www.nytimes.com/2024/09/20/health/ftc-drug-price-inflation-insulin.html)

National health policy

  • New report on Spain from the European Observatory on Health Systems
    • The report has been prepared by the Aragonese Institute of Health Sciences. In general, the report has a descriptive character and is very little analytical and propositional. This is surely the approach of these reports from the European Observatory on Health Systems, but a more structured analysis methodology is missing, such as that used by Ezekiel Emanuel in his book on the analysis of health systems. It seems to be deduced from the report that everything is fine “except for a few things”, as Rajoy would say. It is not surprising that the Ministry of Health is applauding this report with its ears (https://www.consaludmental.org/publicaciones/Health-System-Review-2024.pdf)

Companies

7 days in healthcare (September 9th-15th, 2024)

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Summary

Biomedicine

  • Direct-to-consumer medical testing: an industry built on fear. This industry is growing rapidly and will reach $9 billion by 2033. Genetic tests, biochemical tests and monitoring systems are the most common offerings. A recent Australian study analyses several hundred tests offered directly to consumers and shows that the vast majority have little clinical use. Greater regulation of this industry is needed, as well as dialogue with the public regarding its benefits and risks. Although it is true that the citizen-consumer will have an increasing role in maintaining his or her own health, we must be careful to ensure that mere commercial interests do not act precisely against health.
  • A therapy attacks the tangles of a protein key to Alzheimer’s. The model has so far only been tested on mice, but offers promising results.
  • The new generation of radioactive drugs attacks cancer with molecular precision. Tumour-seeking radiopharmaceuticals mark a new direction for oncology and promise specific treatments with fewer side effects.

Global Health

  • Mariana Mazzucato promotes the economy of health for all with the WHO. The panel of conclusions of the WHO Council on Health Economics for All, chaired by the prestigious economist Mariana Mazzucato, is presented. It is based on the premise that the incredible economic development of the last century has brought many benefits, also in health, but at a high price of pollution, climate change, unhealthy diets and habits and a great weight of non-communicable diseases and resistance to antibiotics. The recommendations deal with four themes: Value, Financing, Innovation and Strengthening the capacities of the public health sector.
  • The lessons of covid-19 must be applied to control mpox in Africa. First, Africa does not have the resources to follow the disease; Second, vaccines must arrive quickly where they are needed; Third, Africa needs its own vaccine production and regulatory infrastructure.

International health policy

  • China to allow wholly foreign-owned hospitals to open for first time. China is opening up its system to the world. The Chinese government announced last Sunday that it will allow wholly foreign-owned hospitals to be set up in nine areas of the country, including the capital, in a bid to attract more foreign investment to boost its ailing economy.
  • Independent report on the NHS by Lord Darzi, a surgeon and former health minister. Key findings: Deterioration: The nation’s health has deteriorated over the past 15 years, with a marked increase in people living with multiple chronic conditions. Spending: A huge proportion of health spending is on hospitals and too little on the community and productivity is too low. Waiting lists: Waiting lists have grown, as have queues at emergency services. Cancer care: The UK has higher mortality rates than other countries. Lasting damage: The Health and Social Care Act 2012 did lasting damage to the NHS’s management and resource capacity. It took more than ten years to recover and the effects are still being felt. Productivity: too many resources have been allocated to hospitals, where productivity has fallen, compared to very few in the community. A non-technical report, very easy to read and prepared from common sense.
  • British Prime Minister Starmer launched his first long speech on health on September 12, after the publication of Lord Darzi’s report: “Major surgery is needed, not just bandages.” He announced a ten-year plan to reform the NHS. “Reform or die.” Instead of an exclusively top-down approach, the plan is intended to reflect the contributions of professionals and patients. It is unthinkable that such a speech would be made by a president of the Government in Spain, despite the fact that our SNS has as many or more problems than the NHS. Here we are dedicated to contingency policies, now the suicide plan and the ELA law, both interesting initiatives, but which do not address the problems of the system.
  • Draghi report on the future of competitiveness in Europe. The main ideas are: First, Europe needs to close the innovation gap with the USA and China; Second, Europe needs a plan for decarbonisation and competitiveness; and third, to increase security and reduce dependencies. This is a necessary report, since Europe has dedicated itself to outsourcing everything: innovation, production, energy and defence. In this way, it is impossible to preserve the European model, defined by Draghi himself, as characterised by prosperity, equity, freedom, peace and democracy.
  • The Draghi Report places the pharmaceutical industry as a strategic pillar in Europe. Among the things it mentions is that of the ten most sold biologicals in Europe only two are marketed by European companies.

National Health Policy (Spain)

  • The Ministry announces a plan to prevent suicide in Spain, where there is a disconcerting map of suicides and the suicide rate in Asturias doubles that of the Basque Country or Madrid.
  • The Asturian health system is experiencing an earthquake with 6,000 places affected. Almost one in three places will have a new owner, due to the transfer competitions and the stabilization competitions underway. The objective is to reduce temporary employment. Although the objective is perfectly defensible, the way of doing it threatens to make the cure worse than the disease. Transfer competitions inspired by unions, where seniority prevails and OPE’s designed without criteria and without intervention from either the medical units or the hospitals, threaten to destructure functioning teams and turn the whole system upside down.
  • FEDEA publishes a report on the Catalan agreement. The collection of all its taxes by Catalonia will mean a decrease in its contribution to the common fund and, therefore, represents a threat to services in other communities, mainly health. This will mean an increase in taxes paid by citizens of the territories that remain in the common regime, or a cut in state benefits that would also affect them negatively.
  • The Government proposes to increase MUFACE’s premiums by 28% to 1,300 euros, although this amount is still far from the public health expenditure without pharmacy of 1,608 euros. If the companies accepted this offer, the gap in relation to public health would be 308 euros, instead of the current 594. It seems that insurers would be willing to accept up to 20% less than public expenditure, which would be 1,335 euros, a figure very close to that offered by the government. Although there are voices from health employers’ associations complaining about this offer, the Government’s effort seems important and should not be underestimated, as seen from outside, it seems to be a great success in the negotiation of the insurers, carried out in very difficult circumstances. On the other hand, the association of independent doctors defends a mutual society without insurers, what they call direct Muface. As for the proposal of this association of a Muface without insurers, as a joke it is not bad. It seems to ignore something as simple as what health insurers do: the function of financing and purchasing services (selection of providers, evaluation and payment of the same) to attend to the health needs of the population covered. What they really do is manage a pool of risks. Are the associations of independent doctors going to perform these functions?
  • Generic medicines will have different prices to brand name medicines. Spain is the only country in Europe where generic and brand name medicines have the same price and that is a disincentive for the development of the generic industry. Generic penetration is stuck at 41% in units and 21% in economic value. Although there were differentiated prices for generics and brands in Spain, at one point the model was changed to equalize prices, distancing ourselves from what is usual in Europe. Originality, in dribs and drabs.

Companies

  • International
    • Sanofi is betting on a “revolutionary factory” to respond to future pandemics. Located in Neuville-sur-Saône, in the Rhône, the new production site is almost entirely mobile and modular and will allow up to four vaccines to be manufactured at a time.
    • Pharmaceutical groups want to control greenhouse gases produced by asthma inhalers. Both GSK and AstraZeneca are finalizing trials of inhalers that cause a much smaller carbon footprint.
  • National
    • The German Ulrich Medical is establishing its third international subsidiary in Spain. This century-old family business has already opened branches in the United States and France.

Biomedicine

Global Health

  • Moving forward in the economics of health for all. The panel of conclusions of the WHO Council on Health Economics for All, chaired by the prestigious economist Mariana Mazzucato, is presented. It is based on the premise that the incredible economic development of the last century has brought many benefits, also in health, but at a high price of pollution, climate change, unhealthy diets and habits and a great weight of non-communicable diseases and antibiotic resistance. The recommendations deal with four themes: Value, Financing, Innovation and Strengthening the capacities of the public health sector (https://www.thelancet.com/action/showPdf?pii=S0140-6736%2824%2901873-7)
  • Article from the journal Nature. The lessons of covid-19 must be applied to control mpox in Africa. First, Africa does not have the resources to follow the disease; second, vaccines must arrive quickly where they are needed; Third, Africa needs its own vaccine production and regulatory infrastructure (https://www.nature.com/articles/d41586-024-02912-6)
  • Cholera deaths are rising despite being easily preventable. According to the WHO, mortality rose by 71% last year, compared to only a 13% increase in cases (https://www.nytimes.com/2024/09/11/health/cholera-deaths-cases.html)

International Health Policy

  • UK and the National Health Service
    • Independent report on the NHS by Lord Darzi, a surgeon and former health minister. Key findings include: Deterioration: The nation’s health has deteriorated over the past 15 years, with a marked increase in people living with multiple chronic conditions. Spending: A very significant proportion of healthcare spending is in hospitals and too little in the community and productivity is too low. Waiting lists: Waiting lists have grown, as have queues at emergency departments. Cancer care: The UK has higher mortality rates than other countries. Lasting damage: The Health and Social Care Act 2012 did lasting damage to the NHS’s management and resourcing capacity. It took more than ten years to recover and the effects are still being felt. Productivity: Too many resources have been allocated to hospitals, where productivity fell, versus too few in the community. (https://www.nytimes.com/2024/09/11/health/cholera-deaths-cases.html). Nuffield Trust comment: why is the Darzi report so important (https://www.nuffieldtrust.org.uk/news-item/why-is-the-darzi-report-so-important)
    • On 12 September, following the publication of Lord Darzi’s report, British Prime Minister Starmer launches his first long speech on healthcare: “Major surgery is needed, not just plasters.” He announces a ten-year plan for NHS reform. “Reform or die.” Rather than a purely top-down approach, the plan is intended to reflect input from professionals and patients (https://www.gov.uk/government/news/pm-major-surgery-not-sticking-plaster-solutions-needed-to-rebuild-nhs). King’s Fund reaction to Prime Minister’s speech (https://www.kingsfund.org.uk/insight-and-analysis/press-releases/prime-minister-first-health-care-speech-since-taking-office)

National health policy

  • FEDEA and the Catalan agreement
    • FEDEA publishes a report of reflections on the Catalan agreement. The collection of all its taxes by Catalonia will mean a decrease in its contribution to the common fund and, therefore, represents a threat to services in other communities, mainly health. This will mean an increase in taxes paid by citizens of the territories that remain in the common regime, or a cut in state benefits that would also affect them negatively. (https://fedea.net/algunas-reflexiones-al-hilo-del-debate-sobre-el-concierto-catalan/)
  • MUFACE
    • The Government proposes to increase premiums by 28% to 1,300 euros, although this amount is still far from the public health expenditure without pharmacy of 1,608 euros. If the companies accepted this offer, the gap in relation to public health would be 308 euros, instead of the current 594. It seems that insurers would be willing to accept up to 20% less than public expenditure, which would be 1,335 euros, a figure very close to that offered by the government. On the other hand, the association of independent doctors defends a mutual insurance company without insurers, what they call direct Muface (https://theobjective.com/economia/2024-09-09/gobierno-propone-subir-primas-muface/)

Companies