7 days in healthcare (August 28th-September 3rd, 2023)

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Summary

From the point of view of Biomedicine, it is worth highlighting how therapy with psychedelics is opening up among mental health professionals, especially for cases of depression, anxiety, post-traumatic stress, eating disorders and addictions.

As far as Global Health is concerned, a study of 18 clinical trials shows that screening for early detection of cancer does not make this population live longer than those who do not undergo this type of testing. WHO concern about blindness and vision disorders. More than 2.2 billion people globally have vision disorders, generally attributable to refractory disorders and cataracts.

In terms of International Health Policy, the expected bomb exploded from the application of the “Inflation Reduction Law”, approved in the USA in August 2022, which included something prohibited until now: price negotiation between pharmaceutical companies and Medicare. . The American government made public the 10 drugs that will be negotiated in 2023 and affects the main companies: Pfizer, Lilly, Novartis, AstraZeneca, J&J, etc. Although the established system is very gradual, since 10 drugs will be negotiated each year for the next four, the truth is that this breaks the status quo of the pharmaceutical industry not only in the USA (the largest drug market) but in the world. It is difficult to counter Biden’s argument, which he plans to use in the 2024 campaign, that Americans do not have to pay two to three times more for medicines than the rest of the developed countries, such as in Europe. However, The Economist, which recognizes the need for this price negotiation, nevertheless sees problems in its application due to the appeals filed by large pharmaceutical companies and the risk that these companies will distance themselves from the necessary medicines and concentrate on others unrelated to price control. He also says that if R&D expenses are taken into account, the profitability of pharmaceutical companies is not extraordinary, when compared to the companies in the S&P 500.

If we talk about National Health Policy (Spain), the incidence of covid shoots up by 70% in just one week. The Ministry of Health recommends the fifth dose to selected groups: over 60 years of age, health personnel and the vulnerable. The Supreme Court faces a complex issue: the ruling on thousands of compensation payments to businessmen due to the pandemic. These are property claims to the State due to Covid-19 from businessmen and self-employed workers, who are awaiting compensation for the damage caused by the restrictions during the states of alarm that were later cancelled.

In the field of Companies, on an international level, the most notable is the abandonment of CENTENE from the United Kingdom, where it had a chain of primary care centers and the CIRCLE hospital network. The movement follows his departure from Spain with the sale of Ribera. A concentration in the American market, difficulties with the anti-privatisation movements of healthcare in Europe and problems with hospital integration may be at the origin of the problems, to which perhaps we should also add an underdeveloped growth strategy for this American company in Europe. In any case, a shame, since CENTENE is a great American insurance company, with a lot to teach in the European world. As far as national news is concerned, Spain is the only country that has purchased (31 million euros) several million vaccines from HIPRA, which is not updated for the new strains. Big problem for the Ministry if it decides to use it.

Biomedicine

Global Health

International health policy

  • USA
    • The American government reveals the 10 drugs on which price negotiations will take place with Medicare. Under the proposed reform the minimum price decrease will be 25%. According to the Congressional Budget Office, the savings to the public coffers will be $100 billion over a decade. The affected companies are BMS, Pfizer, Boeheringer, Lilly, J&J, Merck, AstraZeneca, Novartis, Amgen, AbbVie, Novonordisk (https://www.ft.com/content/fa9b0422-6f93-4703-9358-6396660f63b6)
    • The Economist, critical of the American government’s measure, although it recognizes that price negotiation was obligatory. He says that the prohibition on negotiation was nonsense, but the proposed negotiation system could have perverse effects. If R&D expenses are taken into account, pharmaceutical companies do not have extraordinary profits, compared to those of the S&P 500 (https://www.ecocom/leaders/2023/08/30/americas-new-drug-pricing-rules-have-perverse-consequences)
    • Biden makes the negotiation of drug prices one of the central axes of his campaign for 2024, despite the fact that the price reduction will not begin until 2026 and that is if the law resists all judicial attacks (https://www.nytimes.com/2023/08/30/us/politics/biden-medicare-drug-prices-2024-campaign.html)
    • Opinion article in FT: “The world needs to stop depending on the American pharmaceutical industry.” Americans pay up to three times more than other developed countries for medications. The American market is the main market for pharmaceutical companies. This policy is popular among Americans, but it may affect drug R&D globally. Pharmaceutical companies can orient themselves from the most needed medicines to those that escape price control (https://www.ft.com/content/0c20c518-60a8-4dd0-87be-f03adc8ec0e1)

National health policy

  • Judicial consequences of the pandemic
    • The Supreme Court faces the sentencing of thousands of compensations to businessmen due to the pandemic. These are property claims to the State due to Covid-19 from businessmen and self-employed workers, who are awaiting compensation for the damage caused by the restrictions during the states of alarm that were later cancelled. About 9,000 resources are expected. The sentence is very complex, due, among other things, to the high economic amount that it could represent (https://www.expansion.com/juridico/sentencias/2023/09/01/64f1cc47e5fdea09658b45ba.html)

Companies

 

 

 

7 days in healthcare (August 21st-27th, 2023)

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Summary

From the point of view of Biomedicine, to highlight the results of the devices that read the brain and allow certain people to speak using their thoughts. In September the Human Brain Project will be presented, the most ambitious research project financed by the European Union. The British NICE recommends stool tests to be carried out at home for colorectal cancer screening.

As regards Global Health, the journal Science analyzes how climate change can amplify epidemics and give rise to new pandemics.

Regarding International Health Policy, important developments in the USA: the CDC establishes new standards for the approach to sepsis in hospitals; large increase in sex change surgeries in recent years; AstraZeneca is suing the American government for its plans to negotiate the price of medicines, which reflects the great tension between the pharmaceutical industry and the American government, which next week will reveal the 10 medicines on which the price is going to be negotiated; and, a large increase in mental health spending after the pandemic, something that is not expected to change. The British Nuffield Trust analyze the income of English doctors in the various categories. The WHO launches an interesting digital health initiative.

If we talk about National Health Policy (Spain), the Ministry of Public Health publish in the BOE the call for specialized health training with places for doctors, pharmacists, nurses, psychologists, chemists, biologists and physicists. The Ministry also publishes a very complete analysis on the relevance of lung cancer screening. Although it has been said that the Ministry refuses to implement this screening, the truth is that it has limited itself to publishing the report, which will be analyzed by the Interterritorial Council. In Europe there is no public system that has programs of this type in place. The positions of the Scientific Societies must be heard, but they are not the only ones to consider, taking into account that these Societies usually support everything that favors the activity of the respective specialty. But in these types of decisions, many circumstances must be weighed, including cost/effectiveness. Important confrontation between doctors and health insurers in Seville, which will take place throughout September. Some complaints from physicians have been made public in relation to the SELENE computer program, which is widely implemented in the hospital public sector. A subject on which it is difficult to pronounce, but clearly to follow, due to its importance. Having a user-friendly, fast computer application with innovative features is essential for medical practice.

In the field of Companies, internationally, it seems that Roche and MSD will lead the billing of pharmaceutical companies in the next five years. As far as national news is concerned, Europe is not opposed for competition reasons to the agreement between Esteve and Lubea.

Biomedicine

Global Health

International Health Policy

National health policy

Companies

 

 

 

7 days in healthcare (August 14th-20th, 2023)

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Summary

From the point of view of Biomedicine, surely the most far-reaching news is the success obtained with a transplant to a brain-dead human of a genetically modified pig kidney, which worked perfectly, both from the point of view of renal function and of non-rejection. This represents great hope for transplants, especially in the United States where transplant waiting lists are very long. It is estimated that some 5,000 people in the USA die each year waiting for a kidney transplant. The idea is to request authorization from the FDA to carry out a clinical trial.

As far as Global Health is concerned, an interesting WHO summit in India on traditional medicine (which includes treatments as varied as Ayurveda, yoga, homeopathy and complementary therapies), although we don’t have to expect much from the results. The truth is that traditional medicine is followed by billions of people and the WHO wants to see how it integrates with conventional medicine. The Lancet comments that malnutrition is the greatest risk for tuberculosis. In fact between 1900 and 1940 the incidence of tuberculosis plummeted, in the absence of any effective treatment or vaccines, simply because of improved socioeconomic conditions.

As for International Health Policy, two Chinese manufacturers are making “copycats” of weight-loss drugs, threatening Western companies in their development in this huge obesity market. An international study (United States, Germany and Switzerland) warns of the “cancer premium” in the price of medicines, which reaches up to three times that of medicines for other diseases, this price not being justified either by the manufacturing process or by because of the research, but, fundamentally, because of the extreme concern and anguish in the face of this disease. Although the study refers to those countries, this phenomenon occurs in all nations, including Spain.

If we talk about National Health Policy (Spain), denounce the low rates of insurers with doctors. Although the matter will surely have many nuances, the truth is that the low rate of insurers (20 euros on average for a first consultation and 10 for a subsequent one) make this model of care provision very unstable. La Rioja proposes with the new government of the PP to have a Faculty of Medicine. The map of the Faculties of Medicine in Spain has been highly denounced both by the Association of Medical Students and by the Medical Deans’ Conference. We have a ratio of medical schools per population that is second only to South Korea, of course much higher than that of France, the United Kingdom and Germany, which should be our benchmarks. The peculiar distribution of powers between the State, the communities and the Universities has led to this certainly anomalous situation. The pharmaceutical industry has become the leading export sector in Spain, ahead of the automobile industry, which traditionally led the ranking. A complete success for this industry, of which there are 173 production plants, most of them in Catalonia, followed by Madrid.

In the field of Companies, at the international level, Novartis plans to separate from Sandoz (its division for generics and biosimilars), following the same path as Pfizer with its Upjohn generic business, which it merged with Mylan to form Viatris. Various private equity firms interested in the operation. At the national level, it is worth highlighting the large increase in Ferrer’s profit.

Biomedicine

Global Health

International Health Policy

National health policy

Companies

 

 

7 days in healthcare (August 7th-13th, 2023)

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Summary

From the point of view of Biomedicine, the NEJM insists on the need to prepare doctors for the new era of clinical algorithms, since misuse of these algorithms can be dangerous for patients. MIT advances may make conventional mammograms obsolete, as a “wearable” device can detect breast cancer using ultrasound. New facts are detected in relation to the growth of resistance to antibiotics: a species of virus parasites and air pollution. In any case, the United Nations says that by 2050 these resistances could represent more than 10 million deaths a year. Walking 4,000 steps a day can lower your risk of death from any cause.

As regards Global Health, Chris van Tulleken, famous doctor and TV presenter, is publishing a book on “ultra-processed food”, those whose manufacturing process makes them rich in calories, poor in nutrients and difficult to stop eating them, which poses a major health threat. In the United States, cases of syphilis are increasing, while penicillin to treat them is in short supply, given the low interest in the production of antibiotics by pharmaceutical companies.

Regarding International Health Policy, it should be noted that the WHO monitors the new variant of covid (EG.5), although it classifies its impact on public health as low. In the United Kingdom, a laboratory is created capable of launching new vaccines 100 days after the start of any pandemic. Let us remember that in the case of the covid the term was one year, which already represented a remarkable feat, something never seen before. Also in the United Kingdom, both private equity companies and the CEO of AXA, detect great business opportunities in the face of the great crisis of the National Health Service, something that should not surprise anyone, since the market is characterized by solving unsatisfied problems for what the population is willing to pay. The Nuffield Trust publishes its monthly monitoring of NHS performance, with particular monitoring of test and surgical waiting lists, cancer waiting lists, emergency room waiting times and ambulance response. A laudable initiative, which could well be imitated in our country.

If we talk about National Health Policy (Spain), although the measurement of the covid is not as rigorous as a few months ago, there are indirect indications that the incidence must be rising, as shown in the large increase in the sale of the antigen tests. The Sant Pau hospital begins an ambitious multidisciplinary Robotic Surgery program, which includes five surgical teams. Madrid launches the figure of the administrative assistant in Primary Care, something hopeful, but whose results will have to be seen.

In the field of Companies, internationally, Novo Nordisk and Lilly ready to conquer the promising obesity market. At the national level, anti-obesity drugs also enter our country, although of the three that exist (Ozempic and Wegoby, from Novo Nordisk; and Mounjaro, from Lilly) in Spain, only Ozempic is available and the public system only prescribes it for type 2 diabetes, not for obesity. The consolidation of the nursing home sector accelerates: Colisée, Vitalia, Clariane (formerly Korian), Domus Vi and Vivalto Vie, the most active players.

Biomedicine

Global Health

International Health Policy

National Health Policy

  • Public health innovations
    • Hospital Sant Pau starts a multidisciplinary Robotic Surgery Program that includes five surgical teams. Hepatobiliary and pancreatic surgery (HBP), Bariatric and Esophagogastric, Colon and Rectal, Gynecology and Thoracic Surgery (https://gacetamedica.com/profesion/el-hospital-sant-pau-inicia-un-programa-de-cirugia-robotica-multidisciplinary-that-includes-five-surgical-teams/#:~:text=They are%20five%20the%20surgical%20teams,and%20Thoracic%20Surgery%20(CTO).)
    • Madrid eliminates the bureaucracy of doctors with the figure of the administrative assistant (https://www.redaccionmedica.com/autonomias/madrid/madrid-empieza-a-liberar-de-burocracia-a-sus-medicos-con-una-new-figure-4733)

Companies

 

 

 

7 days in healthcare (July 31st-August 6th, 2023)

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Summary

From the point of view of Biomedicine, it seems that for the first time, apart from the complicated bariatric surgery, medicine will have a treatment for obesity, this disease that affects more than 1 billion people worldwide. With GLP-1 it seems that we are entering the phase of effective drugs against obesity. Generative AI, which is capable of generating new algorithms, based on the patterns and structure of the data, is called to play an important role in health care. It seems that cancer is growing at younger ages. The WHO declares the polypill, developed by the CNIC and Ferrer, as an “essential medicine”.

With regard to Global Health, a call by the editors of the most important scientific journals in the world, through a common article, for health professionals to get involved in the fight against the risk of nuclear war, since it seems that we are in a situation of risk not seen since the Cold War. The WHO detects progress in tobacco control in many countries, through the WHO Framework Agreement for Tobacco Control, signed 20 years ago.

Regarding International Health Policy, in the United States a cyberattack forces the paralyzation of the activity of several hospitals. In the United Kingdom, new diagnostic centers are being created to increase the capacity to carry out tests and reduce the waiting list. Of the 13 centers announced, 8 will be privately financed and managed. The waiting list is a political priority for Prime Minister Sunak.

If we talk about National Health Policy (Spain), the incidence of covid has risen since July. It is extremely striking that a new registry multiplies by four the official number of maternal mortality in Spain. Maternal mortality is precisely one of the indicators most taken into account when establishing the health of a country. The Health Accounts System document has been published, which updates the data with those of 2021. Between 2017 and 2021 there has been a 25% increase in health spending, including public and private. The MUFACE system is doubly threatened, firstly because of its high losses and, secondly, because the SUMAR program, Sánchez’s possible partner in a new government, is sponsoring its disappearance. The agreement signed in Aragon for the constitution of the new PP-Vox government contemplates resorting to public/private collaboration to address the waiting list. It should be noted that the integration of the workforce of the former Health Agencies of Andalusia has been completed, which affects 3,500 workers, who may be integrated as permanent statutory employees. An important regression, which reinforces the most rigid aspects of the public health system, precisely what the public hospitals with the configuration of public companies, unfairly called by the PP in Andalusia as “chiringuitos”, had tried to overcome with remarkable success. A blunder, not to use euphemisms, both from the Andalusian government and from the party that supports it. Information from the old management teams ensures that the deterioration is already taking place. If, rightly, an audit is required to see the results of the reversals of the concessions in the Valencian Community, something similar will have to be done in due course with these Andalusian hospitals.

In the field of Companies, internationally, Amazon launches a new documentation service based on generative AI. The pharmaceutical companies that had made cash with the covid vaccine are deflating, something that was already discounted by the market. At the national level, a new incursion of Magnum Partners into health, by buying the nutraceutical company Martínez Nieto. Apax acquires 50% of Palex, a company that had become a target for many funds, and which will surely herald a consolidation of the medical technology distribution sector.

Biomedicine

Global Health

International Health Policy

National health policy

Companies

7 days in healthcare (July 24th-30th, 2023)

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Summary

From the point of view of Biomedicine, the mRNA vaccine for cancer and regenerative medicine seem to be the great promises in medical advances.

As regards Global Health, The Lancet dedicates an editorial to the need for a broader vision of women’s health, beyond maternal health. The most prevalent disease problems in women are the same as in men, but need insight into specific, poorly understood risks.

As for International Health Policy, the battle continues in the United States for the application of the new pharmaceutical policy that allows Medicare to negotiate the price of drugs, something that until now had been banned. This negotiation will begin in 2024 and it is expected that on September 1, 2023 the medicines on which it will be negotiated will be known. In a movement that seems to be ahead of events, several pharmaceutical companies (Janssen, Merck, Astellas Pharma and BMS) file a lawsuit against the American government. Apart from other possible considerations, it seems difficult to maintain that the price of medicines is much higher in the United States than in other countries, and not only in developing countries, but also in Europe. In the United Kingdom, the British Medical Journal focuses on the financing of pharmaceutical and medical technology companies to British scientific societies. For this, more transparency is required.

If we talk about National Health Policy (Spain), the political changes derived from the regional elections establish a new configuration of the Interterritorial Council, which will be numerically dominated by the PP (which will count, including the Canary Islands Coalition) 12 seats in the Council, by 3 of the PSOE (Castilla-La Mancha, Navarra, Asturias), 1 from the PNV (Basque Country) and 1 from ERC (Catalonia). The Radar Healthcare organization publishes a new ranking of healthcare systems and awards Spain a very favorable position in terms of quality. In general, these types of rankings must be looked at with a magnifying glass and consider the type of indicators analyzed and another series of circumstances. A biased and unprofessional interpretation of the international rankings on the Spanish health system has meant, in practice, a brake on the reforms. If we are so well, why reform anything? It is known that Spain is one of the OECD countries that devotes less public funding to dental care. What we did not know and what is now clear is that it has even dropped very significantly in the last decade, going from 5,245 million euros in 2010 to 3,681 in 2020. It seems clear that Spain, which globally has organized vaccination against covid very well However, it has failed to develop a vaccine: the HIPRA vaccine was delayed much longer than expected and the announced intranasal vaccine no longer even has a release date. It is difficult to compete with vaccines that appear less than a year after the onset of the disease, as has happened in the case of covid, with long development of vaccines that take years.

In the field of Companies, internationally, the president of Novartis (company of European origin) says that the price reform in the United States of medicines represents a threat to Public Health. At the national level, it is worth noting that spending on biosimilars has exceeded 1 billion euros in 2022, due to the fact that the patent for several biological drug molecules has expired and biosimilars have appeared.

Biomedicine

Global Health

International Health Policy

National health policy

  • Changes in the Interterritorial Council
    • Changes in the political sign of the autonomous communities completely modify the political weights in the Interterritorial Council. The popular ones will have 12 seats (with the Canary Islands Coalition), compared to 3 for the socialists (Castilla-La Mancha, Navarra and Asturias), 1 for the PNV (Basque Country) and 1 ERC (Catalonia) (https://gacetamedica.com/opinion/a-new-territorial-council-of-the-sns/)

Companies

7 days in healthcare (July 17th-23rd, 2023)

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Summary

From the point of view of Biomedicine, important editorial and several articles in The Economist on the problems of reproduction and in vitro fertilization. Since this technique began, 45 years ago, more than 12 million children have been born thanks to it. The issue is extremely important considering that one in six people suffer from infertility. IVF is experiencing an extraordinary “boom”. Important article from The New York Times on the demographic changes that will give rise to a whole new world in terms of population distribution. Some skepticism about the effects of Donamebad on the evolution of Alzheimer’s.

When it comes to Global Health, The Economist looks at why the malaria vaccine has taken so long to develop. This is apparently due to cycle changes of the Plasmodium parasite. Singapore is a world leader in the marketing of cultured meat, which is possibly called to change many things in our eating habits.

Regarding International Health Policy, the WHO in its weekly covid monitoring newsletter on covid warns that, although the number of new cases and mortality are falling, this disease continues to be a threat, which requires maintenance of surveillance systems and periodic reports. The National Health Service, despite its deep crisis, continues to be a benchmark in terms of reflections on health and health systems. This time the King’s Fund is publishing a report on the kind of participatory leadership needed in the healthcare system.

If we talk about National Health Policy (Spain), we want to highlight the interesting book “Conversations for better health”, which consists of deep and nuanced reflections on many topics, carried out by two consolidated values in Spanish healthcare arena (Jesús María Fernández Díaz and José Martínez Olmos): the importance of Public Health, the need for the Public Health Agency, the opacity of our system in terms of information on results and quality, financing, co-payment, the challenges of Primary Care, the necessary new care model, the contributions of digital health, etc. When improvisations and light comments abound, often made from advertising or simple communication, this conversation between two experienced experts, who treasure experience and knowledge, is a must read. It can be purchased on Amazon.

In the field of Companies, internationally, there are two great opportunities for the pharmaceutical industry, one in the short term, such as all medications against obesity and Alzheimer’s, and another in the longer term, such as anti-aging therapies.

Biomedicine

Global Health

International Health Policy

National health policy

Companies

 

 

7 days in healthcare (July 10th-16th, 2023)

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Summary

From the point of view of Biomedicine, there is little doubt that Artificial Intelligence will revolutionize medicine: from diagnosis, to the robotic-AI combination for surgical procedures, rehabilitation aid, support in the fight against infectious diseases, development of new drugs, etc. There will be few areas of medicine that are not affected by the development of Artificial Intelligence.

As regards Global Health, The Lancet insists on the WHO-Europe notice on the need to decontaminate the air, since pollution contributes to the appearance of a large number of diseases and premature deaths. This time, 12 African countries are going to receive 18 million doses of the malaria vaccine. Now one can dream of the disappearance of malaria – that secular plague – from our planet.

Regarding International Health Policy, the American regulator approves the first contraceptive pill that will be dispatched (in pharmacies, supermarkets and online) without the need for a prescription. Although the “pill” could be used in the USA for 50 years, until now it was always under medical prescription. It is believed that this measure will contribute to reinforcing women’s reproductive rights, which were so affected by the US Supreme Court ruling that repealed the previous interpretation of the federal constitutional right to abortion, leaving this regulation in the hands of the states. Great controversy as a result of the WHO declaration of the possible carcinogenic effects of aspartame, a sugar substitute widely used in many beverages, including Coca-Cola. The WHO statement is not without controversy.

If we talk about National Health Policy (Spain), to highlight the private health agreement in Madrid, with a rise of 15% in four years. The private provision employers address a decalogue of petitions to the new government. One of them is not addressed so much to the government as to health insurers, by requesting that relations between insurers and health centers be regulated in writing. The Coordinates Institute reveals the very different development of the right of choice in health in the national territory. On the other hand, the Minister of Health presents the new citizen folder. According to him “with one click you can access the medical history”. This of presenting a project of this magnitude a week before the elections cannot be taken very seriously.

In the field of Companies, internationally, Moderna has established itself in China. As for national news, Quirón announces a new hospital in Badajoz and Viamed the expansion of its hospital in Zaragoza. The funds, interested in radiodiagnostic companies, a sector so far very fragmented. ALSA, the bus company of Asturian origin, together with the Asturian health transport company Trasinsa, agree to launch a new health transport operator: SANIR.

Biomedicine

Global Health

International Health Policy

  • USA
    • The American regulator (FDA) approves the first contraceptive pill for sale without a prescription. It is called Opill and it will be available in pharmacies, supermarkets and online from 2024. The manufacturer is Perrigo, an American-Irish consortium. This pill can be used with a prescription for 50 years. The change is that, from now on, it is freely dispensed (https://www.nytimes.com/2023/07/13/health/otc-birth-control-pill.html)

National health policy

Companies

 

7 days in healthcare (July 3rd-9th, 2023)

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Summary

From the point of view of Biomedicine, the contribution of Artificial Intelligence to medical diagnosis is reviewed by JAMA magazine. It seems clear that AI is not going to replace the so-called Narrative Medicine, that ability of the doctor to communicate and to listen and interpret the history of the patients. Interesting advances in the field of  a simple way to diagnose pre-eclampsia and Parkinson’s.

With regard to Global Health, more and more importance is given to loneliness and its consequences on health, according to an editorial in The Lancet. Hunger and famine as a product of human activity, especially armed conflicts, is treated by Nature. Concern regarding the AIDS situation in sub-Saharan Africa, where anti-retroviral therapy has barely reached.

Regarding International Health Policy, in the United States, the FDA approves the first drug to slow down the progression of Alzheimer’s. In the UK, three health think tanks (King’s Fund, Nuffield Trust and The Health Foundation) are addressing both the government and the opposition calling for solutions to the critical situation of the NHS. They denounce a decade of underfunding, which has led the UK to have far fewer human and material resources than most European countries. An interesting subscription model for antibiotics is being considered in the United Kingdom. Pharmaceutical companies will receive 20 million pounds per antibiotic put on the market, regardless of the prescription. In France, the Cour des comptes publishes documents to promote home palliative care and the development of advanced practice nursing. An interesting WHO-Europe document on hospitals and their challenges is published.

If we talk about National Health Policy (Spain), the beginning of the general elections on July 23, has made the different parties have made their programs public, including the health ones. The PP dedicates 24 measures to health. The strong points are: the Primary Care Shock Plan (although the title on emergencies is debatable); the State Public Health Agency; the Agency for Innovation and Quality (similar to NICE); digitization; palliative care; and, the mental health strategy. A new General Health Law is announced. Although the current law has many obsolete points, the legal technique of addressing a new law (instead of partial reforms in relation to different issues) is debatable. There is a risk of opening a very large melon, of generating long delays and of putting health into the same dynamic as education (a law for each new government). Conspicuous absences: nothing about financing, no mention of waiting lists (one of the most serious problems in the system), dental care (an area in which we are very far from Europe) and nothing about public/private collaboration. The PSOE program continues to identify public service with public management, thus distancing itself from any form of public/private collaboration. Many measures are contemplated, seeming more like a government plan than an electoral program, so the priorities are difficult to identify. The star measure seems to be announcing a law on waiting lists. Laws on waiting lists have never been effective in any autonomous community. The solution to the waiting lists does not go through a time guarantee law but rather resources and productivity of the public system and an updated and agile system of collaboration with the private sector. SUMAR incorporates the Podemos program: creation of a public pharmaceutical company; end of the MUFACE model; deprivatization plan, including cleaning, catering and laundry; progressive elimination of the pharmaceutical co-payment; they also announce a law on waiting lists. The Vox program represents an amendment to the whole: recentralization of health, recovering powers in health matters; approach waiting lists; repeal of the euthanasia and abortion law; strong criticism of the WHO, which they accuse of dependence on China. At the national level, the other great news is the alarm given by the insurers involved in the MUFACE model (Adeslas, Asisa and DKV) regarding the fact that its financing is generating large losses, unaffordable in the long term.

In the field of Companies, internationally, large pharmaceutical companies (Merck, BMS) are suing the American government for what they consider lowering prices, as a consequence of the anti-inflation law. In Spain, Ribera continues to bet on public/private collaboration, but this time in Portugal.

Biomedicine

Global Health

  • Editorial of The Lancet: Loneliness as a health problem. In the UK and Japan there are loneliness ministers. The health damages are clear: cardiovascular disease, hypertension, diabetes, infectious diseases, depression and anxiety. Loneliness is not the same as being alone and can affect all ages (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)01411-3/fulltext)
  • Hunger and famines are not accidents, but facts created by human action. Around 200 million people experience acute food insecurity. Especially Afghanistan, Burkina Faso, Ethiopia, Mali, Sudan and Syria. Hunger and conflict are connected (https://www.nature.com/articles/d41586-023-02207-2)
  • HIV in Africa. Antiretroviral therapy has transformed AIDS into a chronic disease. But in sub-Saharan Africa, where 70% of AIDS patients live, few have access to this therapy, which greatly decreases life expectancy in the area (https://www.nejm.org/doi/full/10.1056/NEJMp2304600)

International Health Policy

  • COVID19
    • Weekly covid report published by the WHO, July 6, 2023. The African region has shown a slight increase in deaths with a decrease in cases. The remaining five WHO regions show a decrease in both the number of cases and deaths (https://apps.who.int/iris/handle/10665/370545)
  • United Kingdom and National Health Service
    • Three health think tanks (King’s Fund, Nuffield Trust and The Health Foundation) address government and opposition on NHS issues. They are betting that the next election will end short-term politics in the NHS. The recovery of NHS services and waiting lists must be a priority. They denounce a decade of underfunding. They welcome the long-term plan on personnel, published last week. They point out that life expectancy is the second worst (before only the USA) of the 19 health systems analyzed in the King’s Fund report (https://www.health.org.uk/news-and-comment/news/joint-letter-to-political-leaders-in-england-on-future-of-nhs)
    • The NHS intends to roll out the subscription model for antibiotics. Under the new proposal pharmaceutical companies would receive £20m for their new antibiotics, regardless of how many may be prescribed (https://www.ft.com/content/a0b5a2ad-06a4-499d-8195-b4d6a3f65f7a)

National health policy

  • 23 J elections: the health program of the PP
    • The PP dedicates 24 measures to health. The strong points are: the Primary Care Shock Plan (although the title urgent and emergencies is debatable); the State Public Health Agency; the Agency for Innovation and Quality (similar to NICE); digitization; palliative care; and, the mental health strategy. A new General Health Law is announced. Although the current law has many obsolete points, the legal technique of addressing a new law (instead of partial reforms in relation to different issues) is debatable. There is a risk of opening a very large melon, of generating long delays and of putting health into the same dynamic as education (a law for each new government). Conspicuous absences: nothing about funding, no mention of waiting lists (one of the most serious problems in the system), dental care (an area in which we are very far from Europe) and nothing about public/private collaboration (https://www.pp.es/sites/default/files/documentos/programa_electoral_pp_23j_feijoo_2023.pdf)
  • 23 J elections: the health program of the PSOE
    • The PSOE program continues to identify public service with public management, thus distancing itself from any form of public/private collaboration. Many measures are contemplated, seeming more like a government plan than an electoral program, so the priorities do not look good. The star measure seems to be announcing a law on waiting lists. Laws on waiting lists have never been effective in any autonomous community. The solution to waiting lists does not go through a time guarantee law but resources and productivity of the public system and an updated and agile system of collaboration with the private sector (https://www.psoe.es/media-content/2023/07/PROGRAMA_ELECTORAL-GENERALES-2023.pdf)
  • 23 J Elections: SUMAR’s health program

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7 days in healthcare (June 26th-July 2nd, 2023)

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Summary

From the point of view of Biomedicine, clinical trials in humans begin with drugs developed by artificial intelligence, such as one for idiopathic pulmonary fibrosis. Álvaro Pascual-Leone, a prestigious Spanish neuroscientist based in the United States, announces that in about ten years the brain will be able to be manipulated . Surely at that time the manipulation of the brain will be something as normal as today the replacement of the crystalline lens for the cataract. A new world is coming.

In Global Health, two charities (the Gates Foundation and the Wellcome Foundation) set to fund a TB vaccine, which could save 8.5 million lives over the next quarter century. Gavi, the organization that provides vaccines to developing countries, approves a vaccine that protects against polio and five other diseases.

Regarding International Health Policy, the editor of the American Journal Medicine publishes in the last issue an article with the five great challenges of the American health system in the 21st century. However, from a reporting point of view, the most interesting news comes from the UK. The King’s Fund, a major British health think tank, publishes a comparative analysis of that country’s health system, which it analyzes together with 19 health systems, including the Spanish one. The analysis is very interesting, and the conclusion is that the NHS is efficient, but with big problems, not only with waiting lists, but also with results. It seems to imply a chronic underfunding of the NHS, when compared to systems in other countries. For its part, the NHS publishes for the first time a long-term plan on personnel. It basically deals with three things: training, retention and reform. The Guardian hails the report but says it is years overdue. For their part, both The Lancet and the British Medical Journal publish editorials on the 75th anniversary of the NHS, which coincides with its deep crisis. In both positions, political consensus is claimed as a key piece to fix the serious problems of the NHS. The WHO-Europe publishes a document with architectural recommendations on the hospitals of the future.

If we talk about National Health Policy (Spain), there are several news of interest: the Audit Office of Catalonia publishes an interesting report on waiting lists. It seems that 9% of the cases on the waiting list in Catalonia were not counted on the Department of Health website, which leads some to use the word makeup. With regard to private healthcare, the IDIS is starting a very interesting project to share the patient’s clinical history among various provider and insurer entities, only an initial but very important step in what is to come. In the course of the pre-election debate, the President of the Popular Party announces a new General Health Law and a State Pact on Health if it reaches La Moncloa. Interesting announcements since, as The Lancet says for the NHS, only a certain political consensus and a new partnership, will be able to solve the problems of the health system in our country.

At the Corporate level, internationally, GSK completes the acquisition of Bellus Health. As far as national news is concerned, we must highlight Roche’s investment in Sant Cugat.

Biomedicine

Global Health

International Health Policy

  • USA
    • The challenges of the American healthcare system in the 21st century, according to the editor of the American Journal Medicine. Five big challenges: 1. Insufficient insurance coverage; 2. Low health education among the population; 3. Prevention and management of chronic diseases; 4. Great disparities in quality and results; and. 5. Trust in doctors? (https://www.amjmed.com/article/S0002-9343(23)00035-9/fulltext)

National Health Policy

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