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

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Summary

Biomedicine

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

Global Health

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

International Health Policy

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

National Health Policy (Spain)

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

Companies

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

Biomedicine

Global Health

International Health Policy

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

National health policy

Companies

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

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Summary

Biomedicine

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

Global Health

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

International health policy

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

National Health Policy (Spain)

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

Companies

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

Biomedicine

Global Health

International health policy

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

National health policy

Companies

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

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Summary

Biomedicine

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

Global Health

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

International health policy

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

National Health Policy (Spain)

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

Companies

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

Biomedicine

Global Health

International Health Policy

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

National health policy

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

Companies

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

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Summary

Biomedicine

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

Global Health

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

International health policy

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

National Health Policy (Spain)

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

Companies

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

Biomedicine

Global Health

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

International Health Policy

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

National health policy

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

Companies

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

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Summary

Biomedicine

  • Prostate cancer incidence in Europe: beware of overdiagnosis. The conclusion of an article published in the BMJ is that the incidence of prostate cancer varies very significantly in the different countries of Europe (rates of 46 in Ukraine to 336 in France, per 100,000 inhabitants). The incidence began to decline in some countries. The interpretation of screening must be very cautious, to avoid damage due to overdiagnosis.
  • The Lancet review on obesity in adults. It has increased in incidence worldwide and the WHO has declared it a global epidemic. Complex disease. Lifestyle changes only produce lasting improvement in a minority of patients. Bariatric surgery remains the most effective and long-lasting treatment. Very notable progress has been made in the field of pharmacology.
  • AI raises hopes for a better diagnosis of cancer, based on pathological anatomy. The model is called the Clinical Histopathology Imaging Evaluation Foundation (CHIEF) and was developed by Harvard Medical School. This tool, published in Nature, is trained to analyze tumor images, covering 19 cancers.

Global Health

  • Temperature-related mortality analyzed in Europe. The Lancet Public Health publishes a review led by David García-León on the consequences of heat and cold in 854 European cities.
  • Avian influenza in humans, without previous exposure. The CDC confirms the first avian influenza patient without known exposure.

International health policy

  • The failed experiment of primary care as a for-profit enterprise in the USA. Although for some time it was thought that primary care could be a lucrative business for investors, including private equity firms, the latest evidence does not support this hope in the USA, possibly because current payment systems do not adequately value primary care. This is also causing basic primary care centers in shopping centers, which Walmart was a pioneer of, to close.
  • The new British Health Minister’s best wishes. The British Health Minister says that the NHS is not broken, but it needs three major changes: “from hospital to community”, “from analogue to digital” and from “disease to prevention”. As a desideratum it is perfect, now we have to see how it is implemented. These are not exactly plans that the NHS lacks.
  • King’s Fund explains GP contracts for 2024-25. Apart from salary increases for different concepts, an incentive scheme is maintained (for quality, The Quality and Outcomes Framework; for investments and for experience in access).
  • Uruguay introduces a controversial hospital law. Law 20,279 reinforces forced admission to hospitals without the patient’s consent, in cases of homeless people, mental health problems or addictions. Humanitarian and professional organisations, against it.
  • The European Union is not fully prepared for the next health crisis, warns the auditing body. A report by the European Court of Audit shows that a lack of coordination between Member States in terms of information and testing slowed down the US response to the Covid-19 outbreak and warns that greater cooperation is needed to address future crises.

National Health Policy (Spain)

  • The Ministry is already looking for a date to publish the Strategic Plan for the Pharmaceutical Industry, with the idea of ​​establishing a framework for collaboration between the different agents.
  • State Agency for Public Health, likely to be delayed indefinitely. The government has 44 key laws in limbo, including that of the State Agency for Public Health, due to the lack of support in Congress.
  • Metges is opposed to the creation of new Faculties of Medicine in Catalonia, because it thinks that adding more university centres “would increase saturation and decrease teaching quality”. It is considered that there is a risk of having a surplus of doctors again, as in the 1980s. The challenge, according to this organisation, is that the 1,000 doctors who graduate in Catalonia decide to stay here to practice their profession. The number of Faculties of Medicine in Spain per 100,000 inhabitants is only surpassed by South Korea. Are many of them Faculties of Medicine or academies specialising in the MIR exam?
  • Galicia launches the Xenoma project to detect diseases with AI, an initiative that will collect the DNA of 400,000 Galicians to identify high-risk genetic variants and be able to offer personalized pharmacological treatments.
  • The autonomous communities compete to retain MIRs. In La Rioja, Castilla y León, Aragón or the Valencian Community, there are plans to offer advantageous conditions to residents so that they stay.
  • Are there too many dentists in Spain? Job insecurity among dentists. In 2023, the number of registered professionals reached 42,075 professionals; that is 9,630 more than ten years ago (2013), an increase of 29.7%.
  • It seems that there will be no Profarma plan in 2024. The new Profarma will arrive in 2025 and will assess the aspects of strategic autonomy. This program is more than 30 years old and provides tax exemptions for pharmaceutical companies that contribute the most to GDP through their activity. This plan, which was in effect for more than three decades, will surely not be in force in 2024.
  • Catalonia promotes the PRECISEU project led by Biocat. PRECISEU, a giant step towards personalized medicine in Europe. Endowed with 23 million euros, the project wants to promote personalized medicine and advanced therapies in Europe. The project has 25 partners and will last until 2029.

Companies

  • International
    • Investment in cancer does not cover all types. Large disparities in pharmaceutical investments in relation to the types of cancer. While new treatments for breast, lung and prostate cancer have appeared in recent years, other tumours, also with a high mortality rate, are less well-neglected, such as pancreatic tumours, colon tumours or brain tumours.
  • National
    • Farmaindustria attacks the European pharmaceutical reform for hindering innovation, because it is thought to be a threat to the competitiveness of European companies, compared to American or Chinese ones, according to Jesús Ponce.

Biomedicine

Global Health

International health policy

  • European Union
    • The European Union is not fully prepared for the next health crisis, warns the audit body. A report by the European Court of Audit shows that a lack of coordination between member states on information and testing slowed down the US response to the Covid-19 outbreak and warns that greater cooperation is needed to tackle future crises (https://www.ft.com/content/ca61f33c-8bf8-40d3-90e4-d417b04e224d)

National health policy

Companies

7 days in healthcare (August 25th-September 1st, 2024)

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Summary

Biomedicine

  • AI to predict dementia. Scientists are using AI to analyse 1.6 million brain scans to develop predictive tools for dementia. The aim is to create digital tools that radiologists can use to determine their risk of dementia and diagnose the disease earlier.
  • The obesity drug Wegovy prevents deaths from Covid. People who take the medication do not avoid Covid disease, but after a large trial, it is shown that their mortality is much lower, for reasons that are unknown. The original work has been published in the Journal of the American College of Cardiology.
  • Leading French doctors defend phage therapy, as an alternative to antibiotics. In a column in Le Monde, a group of doctors advocates the creation of a public structure for the production of bacteriophage viruses, as an alternative to antibiotics. Discovered by Félix d’Hérelle in 1915, this therapy has not been considered in the West to the benefit of antibiotics, whose difficulties and limitations are being seen.

Global Health

  • The disappointing international response to mpox. The world has another opportunity to demonstrate collective commitment to addressing this international health crisis. The challenge is to provide effective diagnostics, vaccines and treatments to regions with poor health infrastructure – and to do so more quickly and efficiently than during the Covid pandemic. The signs so far are not encouraging.
  • The war in Sudan is the world’s problem. Although this conflict has received much less attention than the wars in Ukraine and Gaza, the truth is that it is much more serious in every sense, with a threat of millions of deaths this year from hunger. Middle Eastern states and Russia are sponsoring this conflict with impunity. Western countries look the other way and the United Nations is paralyzed. Sudan has suffered a civil war since its independence in 1956.
  • People should be paid for plasma. In a forceful editorial, The Economist argues that plasma donations should be paid for, a component of blood that is a crucial ingredient in several medicines and is in short supply worldwide. 80% of plasma comes from five countries, precisely those where donors are paid: USA, Austria, Czech Republic, Germany and Hungary. Those who oppose paid donation give two reasons: safety (especially worrying after the scandal in the United Kingdom) and equity (since it is feared that it will be the poor who allow access to their veins).

International health policy

  • Trump said last Thursday during the campaign that he wants to make IVF (in vitro fertilization) treatments free for all Americans. Until now, the simple authorization of IVF was a highly debated issue among Republicans, who entered into the controversy of the destruction of eggs, which some consider to be people, with all the ethical problems that their destruction or storage entails. The New York Times comments on the major problems that this initiative would pose, from economic to legal, since this would be the only free health care service for all Americans. But it seems that anything goes in the campaign.
  • The future of Medicare in the USA. The debate is between Medicare Advantage (more expensive and with the involvement of private insurers) and traditional Medicare. Important review on the subject published by the New England Journal of Medicine. Medicare is the largest and most important public health service in the USA.
  • Health consequences of delaying the retirement age in China. The impacts on health of delaying the retirement age in China are considered, where life expectancy has grown a lot and retirement is very early: 60 years for men and 50 or 55 years for women.
  • The WHO promotes a strategic plan to stop the Mpox outbreak that requires 135 million dollars of investment. The project covers from September 2024 to February 2025 and focuses on implementing prevention, preparation and response strategies.

National Health Policy (Spain)

  • Sumar has been blocking the Public Health Agency in Congress for six months. After the withdrawal of the amendments to the whole by PNV and Junts, the deadline for partial amendments has been extended up to 20 times. Sumar requests continuous extensions to present partial amendments, which it finally does not present, due to lack of support. • Fitch sees risks that the financing pact for Catalonia will take resources away from the rest of the communities. The American rating agency sees risks that the pact will take resources away from the system to level out public services.
  • The Government is preparing a record budget to save MUFACE. The offer will arrive in October and it is said that it will represent a strong increase. The State pays a premium of around 900 euros for each civil servant, while public spending on health (excluding pharmacy) is 1,674 euros. The insurers had requested an indexation with this expenditure, accepting 20% ​​less, which would be around 1,350 euros, 50% more.
  • Aid to rural pharmacies by the Provincial Council of Burgos. Pharmacies are not immune to the serious problem currently affecting rural Spain. The Provincial Council of Burgos has launched a series of aids to guarantee their survival: 1,500 euros for those located in municipalities with less than 1,000 inhabitants and 2,000 euros for VEC (Compromised Economic Viability).
  • Spain needs 25% more beds in residences. Which means about 125,000 more places than the 387,000 currently existing

Companies

  • International
    • From the covid vaccine to the cancer vaccine. Both Moderna and BioNTech are betting on cancer vaccines. BioNTech and its American rival Moderna, whose shares have fallen by around 80% since the peak of the pandemic in 2021, are using mRNA technology to generate cancer vaccines. Although it is a very attractive and exciting path, it is still full of problems and many pharmaceutical companies are betting on more conventional oncological treatments.
    • Lilly and NovoNordisk will be the champions in the battle in the field of obesity. They will capture 94% of sales.
  • National
    • The crisis continues at Grifols. Brookfield is looking for sovereign funds to join the takeover bid for Grifols.
    • Esteve wants to sell off its respiratory therapy subsidiary. This subsidiary (Esteve Teijin) had recently seen growth in sales, although a drop in profits.

Biomedicine

Global Health

International health policy

  • China
    • Health consequences of delaying the retirement age. The health impacts of delaying the retirement age in China are considered, where life expectancy has grown a lot and retirement is very early: 60 years for men and 50 or 55 years for women (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01777-X/fulltext)

National health policy

Companies

 

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

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Summary

Biomedicine

  • The Lancet provides a clinical update on persistent covid. Defined as symptoms that persist for more than three months. Although the approach is based on symptoms, work is being done on identifying the molecular profile and biomarkers.
  • There is no benefit for adults who drink alcohol in moderation. A long study shows that adults have no benefit from moderate alcohol consumption. After following 135,103 adults over 60 years of age, the conclusion is that alcohol is associated with increased cancer and does not produce the benefits on the heart that were attributed to it for some time.

Global Health

  • The WHO declares the Mpox outbreak in African countries a global emergency. Despite the severity, there are two facts that differentiate this outbreak from that of covid: the first is that the infection is not transmitted through the air, with the great difficulties of control that this entails, but by direct contact; the second is that this time there are already vaccines and many countries, such as Spain, have them in stock. We are not, therefore, facing a pandemic threat like the one we saw a few years ago.
  • Vaccine shortages threaten the response to Mpox. The outbreak has been detected in 13 African countries, most of them in the Democratic Republic of Congo. Concerns about vaccine supply and distribution come after similar problems during Covid. Bavarian Nordic, the only company producing this vaccine, received an order for more than 175,000 doses from the EU Emergency Preparedness and Response Centre (HERA) and, for its part, donated 40,000 vaccines to HERA. But with vaccine shortages, other measures must be taken, such as contact control and testing. The seriousness of the failure of the WHO and the international community in the face of the Pandemic Treaty is now being seen.
  • High heat-related mortality in Europe during 2023. This year was the hottest globally on record and the second hottest in Europe. An estimated 47,690 heat-related deaths in Europe are estimated. Mortality is estimated to have been 80% higher in the absence of adaptation measures this century, especially for the elderly. Specific strategies are needed to address this major threat.
  • 4.4 billion people lack safe water. This requires three requirements: available on demand; accessible in homes and free of contaminants, such as Escherichia coli and specific chemicals.

International health policy

  • Agreement on the price of 10 drugs in the USA. Biden and Harris announce savings of 7.5 billion dollars, as a result of the agreement on the change in the price of 10 drugs. The affected companies are not minor: Merck, NovoNordisk, AstraZeneca, Immunex, Boehringer Ingelheim, Janssen, BMS, Novartis, AbbVie, among others.
  • The Lancet sets out Kamala Harris’s health priorities in an editorial. The first thing to recognize is Biden’s merits in health policy: reestablishing funding for the WHO and the UN Fund for the population; returning to the Paris agreement on climate change (both Trump eccentricities); increasing credits for children; expanding Obamacare; and approving the law to reduce inflation (which has allowed the price agreement with the pharmaceutical industry). According to this editorial, Kamala Harris’ priorities would be four: 1. Reverse the decline in life expectancy in the USA (77.4 years in 2022, compared to 78.8 in 2019). The State of Mississippi has a life expectancy of 71.9 years, lower than Mongolia (72.6 years) and Syria (72.3 years); 2. Incentivize States with the poorest health indicators; 3. Regain confidence in science, lost by a large part of the population; and, 4. Strengthen the role of the USA in global health diplomacy. • The NHS launches a subscription system for antibiotics. The NHS will negotiate with pharmaceutical companies a subscription system of up to 20 million pounds per year per medicine. The tender will be launched next Monday and will reach 1.9 billion pounds in 16 years and will operate in the four nations of the United Kingdom.
  • The NHS “Pharmacy First” is not working properly. Pharmacies do not reach the minimum number of consultations. In the programme, seven specific pathologies had been defined to be attended to by pharmacies, which would receive extra payment. The programme is not working as well as expected, in the eyes of the pharmacies attached to the initiative.
  • Health strategies in the European Union are not given priority. According to an editorial in The Lancet Regional Health-Europe.

National Health Policy (Spain)

  • Spain faces Mpox. The Ministry of Health brings together technicians and autonomous communities in response to the Mpox health emergency and negotiates with the European Union the joint purchase of smallpox vaccines. It is known that the cases registered in Spain are unvaccinated people.
  • Health will reduce the time for drug approval. The Royal Decree that will define from now on the process of approval and financing of drugs has been made public. Deadlines are established for the approval of a new drug, which will go from the current average of 650 days to 210 days, a substantial change.
  • Extraordinary good reception of the Minister Olga Pané by the Catalan health sector. Some comments on this:
    • Apart from the outstanding qualities of the new Minister, it is not precisely the lack of competent councillors that has been seen in Catalonia. What was lacking was rather a good government concerned about “things”, as Ortega would say. Without a good government (with a project and willing to carry out a reformist project) there can be no success in health policy.
    • Catalonia can make an important contribution to its system and to the national system if it advances in the reform of the public management model and in personnel policy, key issues for the Catalan Society of Health Management, to which the minister is linked.
    • Far from emphasizing these issues, the PSC-ERC agreement insists above all on an endless list of infrastructure works, which apart from being difficult to fulfill, rather seems something similar to Gonzalo Fernández de la Mora’s “State of Works”. Logically, a plan for works is not a health policy. On the other hand, in this same section there is talk of “continuing with the processes of republification”, the scope of which is not specified, but which may contain worrying connotations.

Companies

  • International
    • Eight super drugs will lose their patent in the next five years. This affects Merck-MSD, BMS, Bayer, Pfizer, Lilly or Roche. The eight blockbusters that will lose their patent at the end of this decade are among the thirty best-selling drugs in the world.
    • Who is Bavarian Nordic, the company that makes the only vaccine against Mpox. It rises 38% on the stock market in four days. The CEO of this company, Paul Chaplin, assured that it will be able to meet the immunization needs of African nations. “We have inventory and we have the capacities. What we lack are the orders,” he said.
  • National
    • Problems continue at Grifols. Stock market crash and demand in the USA.

Biomedicine

Global Health

International health policy

  • USA
    • Biden and Harris announce savings of 7.5 billion dollars, as a result of the agreement on the change of prices of 10 drugs. The affected companies are not minor: Merck, NovoNordisk, AstraZeneca, Immunex, Boehringer Ingelheim, Janssen, BMS, Novartis, AbbVie, among others. (https://www.ft.com/content/718b52e8-9c57-4dcf-b2f4-84cf8d7da21c)
    • The Lancet editorial: Kamala Harris’s health priorities. The first thing to recognize are Biden’s merits in health policy: reestablishing the funding of the WHO and the UN Fund for the population; returning to the Paris agreement on climate change; increasing credits for children; expanding Obamacare; and approving the law to reduce inflation (which has allowed the price agreement with the pharmaceutical industry). According to this editorial, Kamala Harris has four priorities: 1. Reverse the decline in life expectancy in the USA (77.4 years in 2022, compared to 78.8 in 2019). The state of Mississippi has a life expectancy of 71.9 years, lower than Mongolia (72.6 years) and Syria (72.3 years); 2. Incentivize states with the poorest health indicators; 3. Restore trust in science, lost by a large part of the population; and, 4. Strengthen the role of the USA in global health diplomacy (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01687-8/fulltext)
    • Medicare expansion of obesity drugs could mean an increase in spending of between 3.1 and 6.1 billion dollars (https://www.healthaffairs.org/doi/10.1377/hlthaff.2024.00356)

National health policy

Companies

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

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Summary

Biomedicine

  • How to reduce the risk of dementia. A healthy lifestyle can prevent or delay at least half of cases. The Lancet article adds two risk factors to the 12 already identified in 2020: untreated vision loss and high cholesterol levels. Modifiable factors include tobacco, obesity, physical inactivity, high blood pressure, diabetes and excessive alcohol. No one doubts that the prevalence of dementia will increase as the population ages, although, adjusted for age, the incidence is falling.
  • It seems clear that women are better doctors than men. This is demonstrated by a broad review of 1.5 million medical records of adult patients.
  • The increasing number of cancers in young people points to the responsibility of the environment. Many of the cases are gastrointestinal, and could point to microplastics, as well as other risk factors, such as a sedentary lifestyle, a change in diet, as well as higher rates of obesity and diabetes.
  • Type 2 diabetes remission. According to a paper published in The Lancet, initial studies show that this type of diabetes can be put into remission with a “total diet replacement” (TDR) program. The issue is important, given the increasing prevalence of type 2 diabetes.
  • A new biomaterial capable of regenerating damaged joint cartilage is developed. As is known, cartilage does not regenerate. This new potential therapy may help address a serious and unmet clinical need. The new bioactive material successfully regenerated high-quality cartilage.

Global Health

  • Why the war on childhood obesity is failing. Since 1990, obesity rates have doubled among adults and quadrupled among children. In 2019, this caused 5 million deaths, 20 times more than malnutrition. No country has succeeded in reducing obesity: the problem is too complex to be solved with public health measures or drugs. Behind it there is a set of biological, economic and social factors.
  • The evolution of mortality under 5 years, a call for urgent action. Since 2000, the global incidence of mortality in children under five years has decreased by more than 50%. But the global community must not forget that millions of preventable deaths in children under five years of age occur every year. From 2000 to 2022, 162 million children under five years of age died.

International health policy

  • A study estimates the cost of cancer screening in the USA at 43 billion dollars. The study focuses on five cases in which screening is recommended: breast, cervical, colorectal, lung and prostate.
  • NHS England advocates four-year medical studies. In most countries, the studies are at least five years old, although in the USA and Canada they are already four years old.
  • The WHO triples the number of viruses and bacteria that threaten the world. The previous report was from 2018 and there were only a dozen pathogens; while the current report includes a total of 32 groups of microbes.
  • The EUDA, the new agency that will fight against drugs in the EU. Its mission would be to monitor drug trends, warn of emerging threats and share science-based knowledge.

National Health Policy (Spain)

  • The debate continues on the new financing system of Catalonia and its impact on the SNS. The government’s crossroads: raise taxes, cut benefits or increase the debt further. FEDEA considers that the Catalan agreement will allow the Generalitat to receive up to 13.2 billion from the common fund, which is detrimental to the income of other communities and a minimization of solidarity, which is what can be deduced from the PSC-ERC agreement. Although Illa’s arrival to the presidency of the Generalitat has encouraged a certain “do-goodism”, as if everything had already been resolved, the truth is that the problems with this agreement are of great magnitude, given the high price paid for it. Salvador Illa’s management at the head of the Ministry of Health does not contribute to optimism either. As Jordi Sevilla says, very critical of the agreement, “how can we believe that there will not be a referendum in Catalonia?” (https://www.elespanol.com/espana/politica/20240805/jordi-sevilla-carga-pacto-psc-erc-creernos-no-referendum-cataluna/875912880_0.html)
  • Massive incorporation of teachers to MUFACE. The incorporation of almost 36,300 teachers is expected.
  • Abuse of caesarean sections in the private health sector. One in three births in private health care ends in a caesarean section, much more than the WHO considers advisable (15%). In public health, it is performed in 22.4%. The organisation of the centres, the absence of midwives and the characteristics of the patients are some of the reasons given.

Companies

  • International
    • Mergers and acquisitions are booming in the pharmaceutical industry. Largely due to the loss of patents.
  • National
    • Spain, the fourth European market for medicines. Behind Germany, France and Italy.
    • Ribera is committed to sustainability. It reduced its carbon footprint by 13% in 2023.
    • Mapfre, the insufficiency of the premium is taking its toll on health insurance in Spain. Despite having increased turnover in 2024, the results of health insurance are negative (- 1.6 million, in the first two quarters of 2024). This is due to the increase in claims. The measures that are intended to be taken include reviewing rates and coverage, being strict in contracting and seeking maximum operational efficiency. Although it is clear that raising premiums and improving operational efficiency can be part of the solution, there is no solution for quality health insurance in our country without considering the interaction of the private insurance system with the public system (as happens in Germany, Switzerland, Holland and other countries), something that is apparently still taboo in our country.

Biomedicine

Global Health

International health policy

National health policy

Companies

7 days in healthcare (July 29th-August 4th, 2024)

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Summary

Biomedicine

  • 14 critical risk factors for developing dementia identified. High cholesterol and hearing problems are associated with the development of dementia, according to a large study, which also identifies 14 critical risk factors that, if reduced, can prevent or delay half of the cases.
  • The FDA approves a test for the detection of colon cancer. Although it is not a perfect alternative to colonoscopy, experts believe that this test will allow many people to be screened for colorectal cancers.
  • Is Ozempic good for everything? Ozempic is back in the spotlight: diabetes, obesity, reducing alcohol consumption and now also for quitting smoking. According to a study published in the Annals of Internal Medicine, people who use this drug have fewer problems not using tobacco.

Global Health

  • The WHO Pandemic Hub, threatened. The WHO Pandemic Hub was founded in the wake of the Covid-19 pandemic in Berlin on 1 September 2021 by Angela Merkel and the Director-General of the WHO. It is an intelligence tool that gives hope for better monitoring of all pandemics, but it has significant challenges, as it is based on reliable information systems in countries, which do not exist.

International health policy

  • Review of the past, present and future of primary care in the USA. Robust primary care is considered essential for any health system. In 2024, only 24% of American doctors were dedicated to primary care, when the ideal ratio is considered 50%. The reasons are insufficient financial compensation, heavy administrative burdens and poor job satisfaction. It is proposed that care be provided by a team, with doctors focused on complex tasks: diagnosis and management of patients with multiple problems. Documentation should be kept by administrators or by artificial intelligence. Routine issues with good guidelines, such as hypertension or diabetes, should be handled by nurses, advanced practice nurses or physician assistants.
  • Why so many Americans choose not to have children. It is not considered just a problem of hedonism, and, on the other hand, fertility is falling throughout the developed world. There are other more complex factors, such as the rising costs of raising children, housing problems and less optimism about the future.
  • Screening rates in Europe. Northern Europe leads the rate of screening for breast, cervical and colorectal cancers.

National Health Policy (Spain)

  • Various legislative initiatives on health, stuck. The first semester in Congress leaves several legislative initiatives in relation to health in the pipeline: the law of equity and cohesion of the SNS; law of universality of the SNS; and, the one that creates the State Agency of Public Health.
  • The PSC-ERC agreement, a threat to the entire National Health System? In the same way that during the pandemic it was impossible not to refer to covid-19, in the current situation, speaking of health, it is impossible not to mention the PSC-ERC agreement to invest Salvador Illa, as president of the Generalitat. Therefore, although it is a controversial issue, we will only make some general considerations. The agreement document entitled “Acord d’investidura entre el Partit dels Socialistes de Catalunya i Esquerra Republicana de Catalunya” has been published. It is 25 pages that are worth reading, since everything is very well explained.
    • General assessment: It seems that the PSC – and, according to statements, the PSOE leadership itself – assumes the pro-independence postulates and the entire ERC discourse. This is a very clear deduction from the document.
    • Topics covered: the document deals with many topics, but fundamentally three: the financing model, the linguistic policy and Catalonia’s foreign relations.
    • Healthcare in Catalonia: in this aspect the document commits to maintaining and consolidating the commitments made with professionals; it makes a broad list of the investments that are intended to be addressed (new Hospital Clínic, new health campus in Girona, expansion of the Hospital del Mar, etc.); it talks about implementing territorial centres for oral health; and, deploying the Mental Health pact. Likewise, among the legislative commitments, there is talk of a law for an integrated Social and Health Agency.
    • Impact on the National Health System. According to preliminary analysis by FEDEA, the impact on state coffers will be 30,000 million. This could mean a significant financial impact on the entire National Health System outside Catalonia, which would lead to either a deterioration in quality or the need to raise taxes.
    • Assessment of the candidate Illa. Given his status as former Minister of Health in the initial phase of the pandemic, Salvador Illa is well known in the health sector. His management has been considered to be an erratic policy, with little transparency and few contacts with the sector. This is the assessment conveyed by Rafael Matesanz in a must-read statement (https://www.larazon.es/sociedad/20210314/dnjfplptrbhtlfaelt6jx5f6au.html)
    • Difficulties in complying with the agreement. The difficulties of all kinds – legal, economic, political, etc. – are of such a formidable calibre that it is very doubtful that the agreements can be fulfilled, at least as they appear in the document.
  • More than 100,000 foreign health professionals without homologation. It seems that we have to wait up to three years. The Ministry of Universities is in charge of this procedure.

Companies

  • International
    • Roche wants to enter the obesity market. Roche intends to quickly launch a weight loss pill to compete with rivals. According to the CEO, Roche’s first anti-obesity drug is expected to appear in 2028.
    • Huge growth in the global implant market. According to a report, the global market for dental implants and prostheses has been valued at 11.64 billion dollars in 2024. It is expected to grow at a compound annual growth rate (CAGR) of 11.41%, to reach 34.3 billion dollars in 2034.
  • National
    • Edwards Lifesciences will open a heart valve factory in Valencia. It will create 1,200 jobs. This multinational company is dedicated to heart valves and hemodynamic monitoring. It is the sixth plant in the world and represents an investment of 150 million euros.
    • Manufacturing medicines in Spain, a strategic asset. In Spain there are 174 factories distributed across 13 communities. Of the total number of plants, 106 are factories for human use medicines; 22 manufacture veterinary medicines; and 46 are factories for the production of active ingredients.

Biomedicine

Global Health

International health policy

  • USA
    • A review in the American Journal of Medicine on the past, present and future of primary care in the USA. Robust primary care is considered essential for any health system. In 2024 only 24% of American physicians were dedicated to primary care, when the ideal ratio is considered to be 50%. The reasons are insufficient financial compensation, high administrative burdens and poor job satisfaction. It is proposed that care be delivered by a team, with physicians focused on complex tasks: diagnosis and management of patients with multiple problems. Documentation should be handled by administrative staff or by artificial intelligence. Routine issues with good guidelines, such as hypertension or diabetes, should be handled by nurses, advanced practice nurses, or physician assistants (https://www.amjmed.com/article/S0002-9343(24)00163-3/fulltext)
    • Why so many Americans choose not to have children. It is considered that it is not just a problem of hedonism and, on the other hand, fertility is falling throughout the developed world. There are considered to be other more complex factors, such as the increasing costs of raising children, housing problems and less optimism about the future (https://www.nytimes.com/2024/07/31/health/fertility-births-vance.html)
  • United Kingdom and the National Health Service

National health policy

Companies

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

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Summary

Biomedicine

  • Keys to a possible cure for AIDS. The 25th International AIDS Conference opened on July 22. Nearly 40 million people are now infected, there were 1.3 million new infections in 2023 and 630,000 AIDS-related deaths, compared with 2.1 million and 1.3 million in 2010, the reference year. Although there is no treatment, progress depends on two things: treating infected cases and preventing transmission. The goal is “95-95-95.” 95% of infected cases detected; 95% of them treated and 95% successful in treatment.
  • A rare nuclear isotope that could revolutionize cancer treatment. By combining a nuclear isotope with an antibody, the microscopic drug directly attacks cancer cells. Jeff Legos, global head of oncology at Novartis, says radiopharmacy could be the therapy of choice for many cancers.

Global Health

  • Dengue as a health threat. 2024 is the worst year for dengue according to all records. As of July 23, there are 10 million cases in 176 countries, more than 24,000 severe cases and 6,508 deaths. Dengue is a disease transmitted by a mosquito as a vector and produced by 4 serologically related viruses. The triad of urbanization, climate change and movement of people favor the expansion of dengue.
  • Guterres, secretary general of the UN, calls for accelerated action against extreme heat. According to him, it kills half a million people a year.

International health policy

  • A more preventive NHS. Report on the need to make prevention the activity of each individual. John Deanfield, a leader in personalised prevention, says that a kind of “pre-NHS” focused on prevention should be created, as he believes that the NHS continues to operate according to its traditional principles of 75 years ago, which is to address diseases. The current approach is considered unsustainable, both for the economy and for health. Deanfield wants more preventive services, such as checks on weight, cholesterol, and blood pressure. He also wants a new preventive portal to be added to the NHS app.
  • Reactions to the first report on covid. Led by retired judge Heather Hallet, it shows the failures of the government and calls for an independent body responsible for developing strategies against pandemics. It is worth noting that all of the covid reports in the United Kingdom have been led by a retired judge, which guarantees independence, which did not happen in Spain and the results are there.
  • A new tool in the NHS that could help minimize the problem of waiting lists: HIT (high intensity theatre). The experience has been developed at Guy’s and St. Thomas’ hospitals. Among other measures, staff are encouraged to work on weekends or evenings.
  • The EMA rejects the new Alzheimer’s drug. Trade name Leqenbi (lecanemab) produced by Eisai and Biogen. This comes after the approval by the FDA. The EMA is concerned about the side effects that have been described.

National Health Policy (Spain)

  • Call for specialized training places 2025; 11,943 places, 2.9% more than the previous year; family medicine only increases by 1%, despite medicine increasing by 3%. The exam will be on January 25-25. The face-to-face selection is resumed and the cut-off mark is removed. The low percentage increase in family medicine places has been strongly criticized, which adds to the recent economic distribution for primary care of 172.4 million, considered insufficient.
  • Waiting lists are causing patients to switch to private healthcare. Every day, since 2021, 1,250 patients have taken out private health insurance, which is 1,366,000 in just three years.

Companies

  • International
    • Abbott sentenced to pay 495 million dollars. The conviction of a Missouri jury for having caused a serious intestinal disease in a child.
  • National
    • Cuideo seeks to double its business in 2024. The home care company plans to grow through acquisitions and expansion.
    • Investments in anti-aging. Rafael Nadal and Juan Matjí promote investment in vitamins to prevent aging.

Biomedicine

Global Health

International health policy

National health policy

Companies