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

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Summary

Biomedicine

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

Global Health

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

International health policy

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

National Health Policy (Spain)

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

Companies

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

Biomedicine

Global Health

International health policy

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

National health policy

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

Companies

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

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Summay

Biomedicine

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

Global Health

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

International health policy

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

National Health Policy (Spain)

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

Companies

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

Biomedicine

Global Health

International health policy

National health policy

Companies

 

 

7 days in healthcare (October 7th-13th, 2024)

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Summary

Biomedicine

  • Two Americans win the Nobel Prize in Medicine for their discovery of microRNA and its role in how organisms develop and function. MicroRNA is critical in post-transcriptional gene regulation. It is now known that the human genome encodes more than 1,000 different microRNAs, which control a wide variety of processes.
  • Major advances in the treatment of breast cancer. Multi-agent adjuvant chemotherapy was introduced 50 years ago. More than 2 million women are diagnosed with breast cancer each year, resulting in 600,000 deaths. Analysis shows that women diagnosed after 2000 have much lower recurrence rates within 10 years than patients diagnosed before.

Global Health

  • Self-harm is increasingly being emphasized. Self-harm is defined as intentional harm to oneself, which can take many forms, including medication overdose, ingestion of harmful substances, cutting, burning or puncturing oneself. Self-harm is a behavior and not a diagnosis, with many underlying causes. There are at least 14 million episodes of self-harm currently in the world, with a ratio of 60 per 100,000 inhabitants per year.

International health policy

  • The American health system remains a problem. The results of the Commonwealth Fund report are discussed, which in its eighth version from 2004, continues to present the American system in an unfavorable position with the other countries with which it is compared: Australia, Canada, France, Germany, the Netherlands, Sweden, Switzerland and the United Kingdom.
  • Climate change and health receive different approaches between Democrats and Republicans. More than 200 medical journals have published a joint document declaring that global warming is the greatest threat to global health, this means reducing greenhouse gas emissions. The official Republican Party platform does not even mention climate change. The Democratic Party’s platform, on the other hand, includes several actions to reduce climate change through strong investments in clean energy.
  • Both Harris and Trump advocate lowering drug prices. Harris advocates new cuts, while Trump offers little specificity. Although both advocate lowering drug prices, Harris’ proposal is to extend Biden’s actions to more drugs, while Trump is less specific.
  • Obesity drugs could cost the American health system $35 billion over the next nine years. Currently, Medicare only provides these drugs in cases of comorbidity, such as risk of stroke, heart disease or sleep apnea. Both NovoNordisk and Lilly want the rules to be changed so that they can be offered in cases of obesity alone.
  • Productivity, a big problem for the NHS. Experts and politicians agree that productivity in the NHS is a problem. Hospitals have more staff than ever, however, the number of interventions is lower than before the pandemic. Between 2019 and 2023, the number of operations performed by each surgeon fell by 12%.
  • The promises of the Labour Party in the United Kingdom to “return to the primary care physician” are being questioned. Although Starmer promised the return of the GP, it is doubtful that this promise can be fulfilled and patients will increasingly see other types of professionals (nurses, physiotherapists or pharmacists, for example), according to a recent study.

National Health Policy (Spain)

  • The ELA law has been approved, although with the unknown of how it will be financed. The Luzón Foundation estimates that its implementation requires an investment of between 180-200 million euros per year.
  • Social Security is already negotiating with the communities to reinforce the role of mutual insurance companies in sick leave. It is assumed that the figures for temporary disability have reached record levels. The aim is to involve the mutual insurance companies more in the control of trauma sick leave. To this end, the signing of agreements between the Government, the autonomous communities and Social Security will be proposed. Spain spends 1.4% of its GDP on temporary disability benefits, two-tenths more than the EU average.
  • The Community of Madrid presents its Digital Health strategy, whose axes are the creation of a centralized Diagnostic Imaging network, the promotion of home hospitalization or the use of AI for disease prevention.
  • The Government gives insurance companies 25 days to respond to the offer for Muface. The offer is a 17.2% increase over two years. The insurance companies consider this increase “insufficient” and are considering their exit. Although, logically, insurance companies cannot be asked to lose money, since in the long term this is unacceptable for shareholders, it would be a shame to lose the most mature and important form of public/private collaboration in health in our country. Losing it is easy, but recovering it is very difficult. Although both the absence of primary care and the criticism of professionals, who these days are speaking out for the disappearance of the model as it is known, indicate the weaknesses of this form of health care. But what model doesn’t have weaknesses?
  • Spain, below the OECD average in per capita spending on medicines. In terms of per capita spending, Spain ranks 22nd out of the 34 most developed countries, with a per capita spending of 538 euros, below the OECD average.

Companies

  • International
    • European pharmaceutical companies face a risk of 30 billion euros due to patent expiration, according to IQVIA calculations.
  • National
    • Sanitas buys a new hospital in Poland, a centre specialising in orthopaedics and rehabilitation.
    • The HM group launches its ninth hospital in Madrid: the Madrid Rio Hospital.

Biomedicine

  • Americans Victor Ambros and Gary Ruvkun win the Nobel Prize in Medicine for their discovery of microRNA and its role in how organisms develop and function. MicroRNA is critical in post-transcriptional gene regulation. It is now known that the human genome encodes more than 1,000 different microRNAs, which control a wide variety of processes (https://www.ft.com/content/ce1f365e-ef68-4faf-a9f1-8c043e7875d9)
  • Advances in the treatment of breast cancer. Multi-agent adjuvant chemotherapy was introduced 50 years ago. More than 2 million women are diagnosed with breast cancer each year, resulting in 600,000 deaths. Analysis shows that women diagnosed after 2000 have much lower recurrence at 10 years than patients diagnosed before (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01823-3/abstract)
  • An army of nanorobots manages to repair brain aneurysms in rabbits. These magnetic nanorobots, 20 times smaller than a red blood cell, could be used to treat the dreaded consequences of aneurysms, which can rupture and cause severe bleeding (https://elpais.com/salud-y-bienestar/2024-10-07/un-ejercito-de-nanorrobots-logra-reparar-aneurismas-cerebrales-en-conejos.html) Access to the original article: https://onlinelibrary.wiley.com/doi/10.1002/smll.202400408

Global Health

  • The mpox emergency, a time for solidarity and equity. This NEJM article defines the five measures of international solidarity needed to address this health emergency, declared as such by the WHO in August 2024 (https://www.nejm.org/doi/full/10.1056/NEJMp2410395)
  • Mpox in pregnancy, risks, vertical transmission, prevention and treatment. The association of mpox with adverse obstetric effects is well known (https://www.nejm.org/doi/full/10.1056/NEJMp2410045)
  • Climate change, fighting misinformation with reliable knowledge. The relationship between climate change and damage to human health is a well-established fact. However, the forces of disinformation continue to attack this finding (https://www.bmj.com/content/387/bmj.q2211)
  • The Marburg outbreak in Rwanda shows some post-pandemic progress (https://www.ft.com/content/7ba16fc2-2290-44ca-b1e7-10d5f553bf7e)
  • The Lancet report on self-harm. Self-harm is defined as intentional harm to oneself, which can take many forms, including medication overdose, ingestion of harmful substances, cutting, burning or puncturing oneself. Self-harm is a behaviour and not a diagnosis, with many underlying causes. There are at least 14 million episodes of self-harm currently in the world, with a ratio of 60 per 100,000 population per year. Twelve recommendations have been identified to address this problem: for governments; for health care providers; for the media; for society; and for researchers (https://www.thelancet.com/commissions/self-harm)

International health policy

  • USA
    • The problems of the American health system. The results of the Commonwealth Fund report are discussed, which in its eighth version since 2024, continues to present the American system in an unfavorable position compared to the other countries with which it is compared: Australia, Canada, France, Germany, the Netherlands, Sweden, Switzerland and the United Kingdom. (https://www.nejm.org/doi/full/10.1056/NEJMp2410855). Access to the original document: Mirror, mirror 2024, A Portrait of the Failing US Health System: https://www.commonwealthfund.org/sites/default/files/2024-09/Blumenthal_mirror_mirror_2024_final_v2.pdf
    • Climate change, health and the American elections. More than 200 medical journals have published a joint document declaring that global warming is the greatest threat to global health, which means reducing greenhouse gas emissions. The official Republican Party platform does not even mention climate change. The Democratic Party’s platform, on the other hand, includes several actions to reduce climate change through strong investments in clean energy (https://www.bmj.com/content/387/bmj.q2183)
    • Drug prices: Harris advocates new cuts, while Trump offers little specificity. Although both advocate lowering drug prices, Harris’s proposal is to extend Biden’s actions to more drugs, while Trump is more vague (https://www.nytimes.com/2024/10/08/health/drug-prices-kamala-harris-donald-trump.html)
    • Obesity drugs could cost the American health system $35 billion over the next nine years, according to the Congressional Budget Office (CBO). Currently, Medicare only provides these drugs in cases of comorbidity, such as risk of stroke, heart disease or sleep apnea. Both NovoNordisk and Lilly want the rules to be changed so that they can be offered only in cases of obesity. (https://www.ft.com/content/f5a11e68-a56a-4a28-8a0a-dbba629ce519)
  • The UK and the National Health Service
    • The story of one NHS operation. Experts and politicians agree that productivity in the NHS is a problem. Hospitals have more staff than ever, yet the number of operations is lower than before the pandemic. Between 2019 and 2023, the number of operations performed by each surgeon fell by 12% (https://www.economist.com/britain/2024/10/08/the-story-of-one-nhs-operation)
    • Analysis casts doubt on Labour’s promise to “bring back the GP”. Although Starmer has promised to bring back the GP, it is doubtful that this promise can be kept and patients will increasingly see other types of professionals (nurses, physiotherapists or pharmacists, for example), according to a recent study (https://www.theguardian.com/society/2024/oct/06/gp-care-analysis-casts-doubt-labour-pledge-bring-back-family-doctor). Access to the original article: https://www.frontier-economics.com/media/0hohvq2y/balancing-supply-and-demand-in-primary-care_frontier-economics_october-2024.pdf

National health policy

Companies

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

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Summary

Biomedicine

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

Global Health

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

International Health Policy

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

National Health Policy (Spain)

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

Companies

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

Biomedicine

Global Health

International Health Policy

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

National health policy

Companies

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

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Summary

Biomedicine

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

Global Health

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

International health policy

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

National Health Policy (Spain)

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

Companies

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

Biomedicine

Global Health

International health policy

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

National health policy

Companies

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

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Summary

Biomedicine

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

Global Health

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

International health policy

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

National Health Policy (Spain)

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

Companies

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

Biomedicine

Global Health

International Health Policy

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

National health policy

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

Companies

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

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Summary

Biomedicine

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

Global Health

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

International health policy

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

National Health Policy (Spain)

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

Companies

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

Biomedicine

Global Health

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

International Health Policy

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

National health policy

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

Companies

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