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

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Summary

The most impactful news in health this week were:

  • Biomedicine: In the United Kingdom, cancer vaccines produced by BioNTech are being tested in 30 NHS hospitals.
  • Global health: The incidence of colon cancer is increasing among young people in Western countries, although not in Spain.
  • International health policy: The Institut Pasteur presents a report on Covid-19 mortality in 30 Western countries.
  • National health policy: The government presents the Strategic Plan for the Pharmaceutical Industry. Its appearance is celebrated by the three pharmaceutical industry associations: Farmaindustria, AESEG and BIOSIM.
  • Companies: KKR puts a price on its fertility empire: 3.6 billion euros.

Biomedicine

  • mRNA vaccines against cancer are already being tested. The rapid evolution of cancer vaccines in the United Kingdom. In the UK, 30 NHS hospitals are already testing mRNA vaccines, produced by the German company BioNTech

Global Health

  • The incidence of colon cancer is increasing among young people. The incidence of colon cancer is increasing among young people in Western countries, although not in Spain.

International health policy

  • More than 75 Nobel Prize winners (in medicine, chemistry, economics and physics) address the Senate to ask that Robert Kennedy (RFK) not be ratified as health secretary, who they present as a follower of conspiracy theories.
  • Robert Kennedy’s (RFK) lawyer addresses the FDA to revoke approval of the polio vaccine, which for decades has protected millions of people from a disease that can cause paralysis or death.
  • NHS spending on new drugs not the best use of money, says a report, which believes that it would have been better to have spent this money on existing services. The problem is spending on new drugs, which forces resources to be redirected.
  • Covid-19 at five years, data from European countries that have performed best in terms of mortality. This work by the Institut Pasteur analyses excess mortality in 30 Western European countries between January 2020 and June 2022. The countries with the highest mortality in relation to the population are: Italy, Belgium, the United Kingdom, the Netherlands, Portugal and Spain.

National Health Policy (Spain)

  • The government presents the Strategic Plan for the pharmaceutical industry. The most surprising thing is that it is welcomed positively by the three employers’ associations of the pharmaceutical industry: Farmaindustria, AESEG and BIOSIM, although we know that there are differences between them.
  • The Health Ministry will send the pending chapters of the Framework Statute to the unions this week. Surprisingly (or not), it is not sent to the professional and patient representation, as if it were not their business. It is known that it is easier to negotiate with the union representation.
  • Catalonia will design its new pharmaceutical policy. The new Comprehensive Plan for Drug Policy (Pipmed), which seeks to address future challenges in the field of medicine. A participatory process is currently underway to involve health professionals.
  • Co-payment in health will be decided at the great assembly of the PNV. This will be decided at the IX General Assembly of the PNV. It seems positive that the issue of co-payment in the system is being reconsidered in a rational way, but the presentation to an Assembly almost prejudges the negative result of the consultation.
  • 212 professionals are left without a permanent position due to their level of Catalan. According to El Mundo, the Generalitat refuses to stabilise these interim professionals by declaring them linguistically unfit. If this were the case, it is serious. It is happening at a time when complaints are being made by the Catalan Administration itself about the lack of professionals and the authorisation of non-EU doctors is being urged. Incredible.
  • The government is committed to presenting a new MUFACE tender before the end of the year.

Companies

  • International
    • KKR puts a price tag on its fertility empire: 3.6 billion euros.
  • National
    • Hospitén has plans to continue growing in Spain and Latin America.
    • Sanitas launches health insurance for disabled people for between 25 and 57 euros.

Biomedicine

Global Health

International health policy

National health policy

Companies

 

7 days in healthcare (December 2nd-8th, 2024)

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Summary

The most impactful news in health this week were:

  • Biomedicine: a very large study shows that prevention and early diagnosis have saved more lives in the last 45 years than treatments.
  • Global health: A Treaty on Plastics is necessary but it will take time.
  • International health policy: The British Parliament approves the law to legalize assisted dying in England and Wales.
  • National health policy: The government intends to launch a new competition on MUFACE.
  • Companies: The crime of the CEO of UnitedHealthcare brings to light the discontent of customers about abuses with health insurance in the USA.

Biomedicine

  • Lung cancer could be detected by a urine test.  It seems that the tumor produces zombie proteins, which could be detected by a sensor. This would allow the diagnosis of cancer in early stages, which would make treatment easier.
  • Prevention and detection has saved more lives in the last 45 years than treatments for these five types of cancer: breast, cervical, colorectal, lung and prostate. Eight out of ten deaths avoided are due to prevention and early diagnosis.

Global Health

  • A treaty on plastics is necessary, but reaching it will take time. 400 million tons of plastics are produced every year and the figure is expected to double by 2050. Plastics would be responsible for 15% of carbon emissions in 2050. There have been recent failed attempts at an international treaty on the subject.
  • Mpox: efforts are beginning to bear fruit, despite 60,000 cases recorded in Africa

International health policy

  • According to The Lancet: Strategic imperatives for the health policy of the new American Administration. According to The Lancet, the five priorities are: 1. Improve public health and address health inequities; 2. Move towards a more equitable health system; 3. Address climate change; 4. Promote the use of AI in health and healthcare; and 5. Strengthen science and innovation in health. What The Lancet says is interesting, all that is missing is for Trump to agree with these priorities.
  • Parliament approves the proposal to legalise “assisted death” in England and Wales, 54% of parliamentarians voted in favour of the law.

National Health Policy (Spain)

  • Government calendar: the Law of Guarantees, the Royal Decree on Price and Financing and the Strategic Plan of the Pharmaceutical Industry.
  • The Minister of Health’s plan on mental health involves combating the high rates of consumption of psychiatric drugs. There do not seem to be any other measures. Although it is true that in Spain the consumption of certain psychiatric drugs is high, the plan cannot be reduced to addressing this problem. 
  • The Government is committed to introducing clinical assistants to reduce bureaucracy in the activity of doctors in Catalonia and is considering paying healthcare teams based on the number of patients (not on activity with those patients).
  • The “Basque Pact” will address the drafting of six health strategies at the end of January. The six strategies are: health and citizen demand; quality and safety; professionals; information; the health sector as a creator of value and growth; and modernisation of health infrastructures.
  • Cruces Hospital achieves Joint Commission International accreditation. Compliance with almost 1,400 quality standards has been assessed.
  • The Government begins the process to unblock MUFACE by issuing a new tender.
  • Smoking falls sharply in Spain and is at its lowest level in 30 years.

Companies

  • International
    • The murder of the CEO of UnitedHealthcare brings to light the discontent of clients over abuses with health insurance in the USA. Although we know almost nothing about this still unsolved murder, it does not seem very risky to assume that it is related to the poor perception of health insurers among the public in the USA.
  • National
    • Sanitas is considering opening a large hospital in Madrid in Arganzuela:  13 floors and 110 beds.

Biomedicine

Global Health

International health policy

National health policy

Companies

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