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

 

Summary

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

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

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

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

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

Biomedicine

Global Health

International health policy

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

National health policy

Companies

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

Summary

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

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

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

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

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

Biomedicine

Global Health

International health policy

  • United Kingdom and the National Health Service

National health policy

Companies

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

 

Summary

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

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

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

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

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

Biomedicine

Global Health

International health policy

National health policy

Companies

 

 

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

 

Summary

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

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

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

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

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

Biomedicine

Global Health

International health policy

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

National health policy

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

Companies

 

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

 

Summary

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

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

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

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

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

Biomedicine

Global Health

International health policy

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

National health policy

Companies

 

 

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

covidoriginandChina,

 

Summary

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

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

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

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

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

Biomedicine

Global Health

International health policy

National health policy

Companies

 

 

7 days in healthcare (January 8th-14th, 2024)

 

Summary

From the point of view of Biomedicine, it is worth highlighting the first results of the genomic studies of tumors carried out by the British public company, created in Cameron’s time, Genomics England, which will allow new therapeutic orientations in tumors. Certain hopes for patients with schizophrenia, a disease with a limited therapeutic arsenal. A Phase III trial gives promising results. It is expected that the drug can be approved in 2024 by the FDA. The WHO organizes a World Forum on Clinical Trials, establishing the four pillars for their development, which is of special interest to Spain, which is a power in clinical trials, a leader in Europe and only surpassed globally by the United States, China, India and Iran.

As far as Global Health is concerned, the WHO warns that a new pandemic will arrive and it will be more deadly.

In terms of International Health Policy, the growth of total health expenditures in the USA returns to pre-pandemic levels. They rose 4.1% in 2022, while in 2020 they had risen 10.6%. The New England Journal of Medicine publishes an interesting article on the “financialization” (non-financing) of health in the United States, distinguishing this from “corporatization” (the role of large corporations) or “privatization” (greater role of the private sector). “Financialization” refers to the greater role of financial or private equity companies in the healthcare world, in many cases as direct owners of healthcare companies, especially pharmaceutical and insurance companies. The effects of this phenomenon are not yet well analyzed. The FDA approves 55 drugs in 2023, up 48% from the previous year. Of those 55, 28 were intended for rare diseases. The Economist analyzes in an article that the British health system is acquiring a shape similar to that of the 1930s, with a large role of private companies and charities, when Aneurin Bevan created the NHS. It should be noted that the so-called generation Z (between 18 and 24 years old) are the largest users of private healthcare. The EU, through HERA, the body created as a result of Covid, will launch a vaccine development center.

If we talk about National Health Policy (Spain), the Ministry of Health agreed, in the face of the growth of the tripledemic, two measures: the first, the so-called “auto-sick leaves” (sick leaves of up to three days without prior medical report, by the exclusive decision of the worker); and, the second, the mandatory nature of masks in health centers. Both very controversial measures. The first was due to disagreements with the unions, employers and within the government itself, which speaks of improvisation on a very sensitive issue and which forced it to be postponed indefinitely. The second, with opposition from several communities and legal problems in its design. Measures continue to be taken to address problems such as pandemics without the expert advice of an organization such as the Public Health Agency, which has not yet been created, which could possibly have avoided or mitigated some of the problems that the Ministry has encountered. The Catalan government, faced with a growth in pharmaceutical spending, intends to control it with several measures. One of the requests is the transfer of the powers of the Interministerial Price Commission, in order to be able to negotiate the price of medicines with the laboratories at the community level. An issue that could threaten the necessary cohesion of the National Health System. Budgeted public health spending amounts to 89 billion in 2023, 29% more than in 2019, before the pandemic. The unions propose to the Ministry changes in the human resources policy and in the Framework Statute. Given the well-known aversion of unions to differentiation and individual and collective recognition, basic needs of the system, surely the approaches will not be very innovative.

In the field of Companies, on an international level, Goldman Sachs is making its debut in health, with a fund of 650 million dollars, in a line that seems to reinforce the idea of the “financialization” of health, discussed in the article this week from the New England Journal of Medicine. When it comes to national news, the highlight is the upheaval at Grifols, which has lost 3.2 billion euros in five days. After the Gotham Research City report, the company has not been able to convince shareholders of its reliability.

Biomedicine

Global Health

International health policy

National health policy

Companies

 

 

 

7 days in healthcare (January 1st-7th, 2024)

 

Summary

From the point of view of Biomedicine, scientists celebrate a new antibiotic, currently undergoing Phase 1 clinical trials, that can kill resistant bacteria. The magazine Nature publishes precisely an editorial in relation to the need to encourage the appearance of new antibiotics against resistant bacteria. The problem is that the current business model in the pharmaceutical industry does not introduce incentives to companies for investments in this field. This is why it proposes “push” solutions (strategies to reduce the cost that may include government aid for the initial stages of research) and “pull” (compensating companies that develop successful antibiotics).

As far as Global Health is concerned, we should mention an interesting article in The New York Times about the need to set up a kind of global immune system against multiple health threats. It would consist of a system of detection and immediate action. Great progress towards the objectives in relation to HIV, almost reaching the aspiration of achieving 95-95-95 (95% of patients with HIV, diagnosed; 95% with antiretroviral treatment; and, 95% with viral suppression).

In terms of International Health Policy, Case and Deaton’s theory in the United States of deaths due to despair (alcohol, drugs and suicide) seems to be dismantled, which would affect mainly white American men without university studies and who had reached relate even to Trump’s victory. Recent studies show that these deaths are not limited to this population, but affect all social classes. Also in the United States, the authorization by the FDA of the importation of medicines from Canada by the State of Florida is of great significance. The price is substantially cheaper for these medications than the one currently in force in the USA. Pharmaceutical companies have cried foul, since this is the first time this has happened in the USA. Litigation is more than assured. The tripledemic (respiratory infections of influenza A, covid and RSV in children) is spreading throughout Europe, with Spain and Italy being precisely the most affected countries.

If we talk about National Health Policy (Spain), the Interterritorial Council of the SNS will address next Monday (January 8) the measures against the tripledemic, in particular the possible mandatory nature of masks in health centers, something already imposed by some communities . The overcrowding in hospital emergencies highlights the absence of demand management: more role for Primary Care; less face-to-face activity  and online attention; and more paper for nursing. The El Español Health Observatory makes public a document of proposals for the health system, the result of the symposium held between October 2-5, 2023, with the participation of more than 150 speakers. The common genetics portfolio of the SNS will be presented on January 23, in what appears to be a great advance for the system. The Ministry of Health of Andalusia announces measures against waiting lists, based on what they call “restructuring the bases of activity.” Without a specific budget, trying to act on productivity without adequate management tools and avoiding agreements with the private sector, we dare say that the measures are doomed to failure.

In the field of Companies, on an international level, what stands out as a novelty is that Lilly is entering B2C, launching in the United States a website for direct sales of medicines to the public and even with a direct home delivery service. A very innovative experience, of which we will have to see the results. As far as Spain is concerned, Domus Vi sells five residences.

Biomedicine

Global Health

International health policy

  • USA
    • The theory of “deaths of despair” (Case and Deaton) no longer holds. This theory, which caused a lot of impact, said that in the USA deaths due to despair (alcohol, drugs and suicide) mainly affected whites without university education. This has changed and today it is known that they affect practically all social classes, without special predominance of the groups indicated by Case and Deaton (https://www.economist.com/united-states/2023/12/23/the-deaths-of-despair-narrative-is-out-of-date)
    • The FDA approves the first mass importation of medicines from Canada to Florida. The price is much lower than that of medicines in the USA, pharmaceutical companies are opposed and it is believed that the PhRMA (representative of American pharmaceutical companies) will file an appeal. Florida says it will save $150 million with the program in the first year alone. It is the first time that something like this has happened in the USA (https://www.nytimes.com/2024/01/05/health/drug-imports-canada-florida.html)
    • The rise in rates and costs drives the bankruptcy of healthcare companies. 18 healthcare companies went bankrupt in the last year. (https://www.ft.com/content/65dfbc81-2641-48fa-a40a-647076943194)
  • Europe
    • Europe fights against the tripledemic of respiratory infections. Tripledemic is the coexistence of covid, influenza A and RSV in children. Spain and Italy, the most affected countries. Also Germany and France. The term means that all three infections coexist, not that individuals have more than one disease. In fact, there are few cases of co-infection (https://www.ft.com/content/449c4748-ef63-4f0a-b26e-4e528889fac4)

National health policy

  • Recruitment of doctors in the Basque Country
    • After requiring Basque from doctors, it is now proposed to hire foreigners without requiring it (https://www.eldebate.com/sociedad/20240105/pais-vasco-queda-medicos-imponerles-euskera-ahora-contratara-extranjeros-exigirselo_164608. html – :~:text=The Government of the Basque Country, first time to non-EU personnel.)

Companies

 

 

7 days in healthcare (December 25th-31st, 2023). Happy New Year

 

Summary

From the point of view of Biomedicine, 2023 definitely seems to be the year where the great impact of artificial intelligence on health has become completely clear. The example of a stethoscope that incorporates AI and substantially modifies the one invented 200 years ago is nothing more than an example of this great change. Scientific journals explore what 2023 has represented (anti-obesity medications and awareness of the impact of climate change on health, among others), as well as analyze the advances that are foreseen for 2024 (surely the HIV vaccine and the cure cholesterol, among many others).

Regarding Global Health, The Lancet dedicates its last issue of 2023 to exposing a series of photos related to health experiences in Nigeria.

Regarding International Health Policy, an interesting article in JAMA magazine that will cause controversy: it relates the increase in medical errors in American hospitals to their acquisition by private equity companies. It is one year since the end of the covid-zero policy in China and the Financial Times analyzes how that experience is remembered in that society.

If we talk about National Health Policy (Spain), our country says goodbye to 2023 with the experience of three different Ministers of Health (Darias, Miñones and now García). It is evident that this dance of ministers (in 45 years there have been 28 Ministers of Health) can guarantee, in the best of cases, the continuity of the “ordinary administration”, but not the promotion of large renewing projects of change. SESPAS asks the Ministry to launch the Public Health Agency in 2024. The Ministry of Health of the Regional Government of Andalusia has experienced a serious crisis that led to the resignation of both the Vice-Minister and the Manager of the SAS. It seems that the underlying issue was the approach to addressing the waiting list and the involvement or not of the private sector in that resolution. If so, regardless of the anecdote of this moment, what it reflects is a very deep problem: the absence of a clear policy towards the private health sector on the part of the Popular Party. Madrid wants to promote a pharmaceutical hub, an issue in which Catalonia is by far in the lead.

In the field of Companies, on an international level, the great growth of the hair transplant market stands out, which already moves 8.7 billion euros annually. It seems that it is a nascent industry, but on the rise. The fever of anti-obesity drugs has meant that there are now 188 candidates, of which 25 are in advanced phase (III or IV). When it comes to national news, the fever of corporate operations in hospitals continues. Ribera, Quirón, Viamed and Vithas, the great protagonists.

Biomedicine

Global Health

International health policy

National health policy

Companies

7 days in healthcare (December 18th-24th, 2023)

 

Summary

From the point of view of Biomedicine, among the “star drugs” of 2023, the first drug based on CRISPR technology, from the North American company Vertex Pharmaceuticals, stands out.

Regarding Global Health, the WHO classifies a new variant of covid which it calls JN.1, which is characterized by its wide spread, although low risk.

Regarding International Health Policy, the New York Times summarizes the measures proposed in the United States to avoid drug shortages in pharmacies, after extensive discussion in Congress. Among the many measures, manufacturing by the government is considered, something that is also being considered in our country.

If we talk about National Health Policy (Spain), the news of the week was the appearance of the report on the management of covid, after months of waiting, after the commission in October 2021. The conclusion reflected by the press, which is a summary of the report, is that Spain was not prepared for the pandemic and the success of the vaccination campaign. However, and regardless of the prestige of the selected experts, it could be questionable that they were appointed by the government, compared to the possibility of having institutions (SESPAS, FACME, etc.) to appoint their own experts. Some comments on the report: although it is said that Spain had more mortality than other countries, there are no figures, no tables, nor is it specified which countries we are referring to; insufficient attention is given to the flagrant legal breaches, which led the Constitutional Court to declare the confinements illegal; at no time is there talk of serious problems and corruption in the purchase of materials; mortality among professionals is not quantified or given sufficient importance; although mortality in residences is discussed, the problem is not explained in detail or analyzed and a table comparing mortality in the different autonomous communities is not presented; although the need for the Public Health Agency is insisted upon, it is not specified what that Agency should have so that it would be comparable to others in other countries (Robert Koch, in Germany, for example) and avoid a “watered down” formula, such as which seems to be underway; finally, it is very striking that, among the proposals, there is none related to the production of materials (equipment and medicines) in Spain, precisely to achieve the “extended strategic autonomy”, of which the EU speaks.

In the field of Companies, on an international level, there is a change of leadership in the best-selling drug, Abbie with Humira, passes the baton to Keytruda, from MSD. In terms of national news, Abanca is preparing to launch its own health insurance, which highlights the attractiveness of this market.

Biomedicine

Global Health

International health policy

National health policy

Companies