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

 

 

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

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Summary

Biomedicine

  • The benefits of GLP-1 medications, beyond obesity. These medications may be useful in a wide variety of chronic conditions. There are multiple clinical trials underway. The next decade is likely to allow for greater potential for GLP-1 drugs.
  • The fertility industry. Economic factors are delaying couples’ willingness to have children, which produces greater infertility in both men and women. 9% of births in advanced countries occur through in vitro fertilization (IVF), but the high cost of these treatments produces inequities in access, despite similar levels of infertility around the world. Better access is needed.

Global Health

  • The H5N1 bird flu virus can cause a human pandemic. So far there is no evidence that the virus has adapted to growing among humans, but this may change quickly. When COVID19 appeared, there was no natural immunity, no medications or vaccines. These three things exist today for H5N1.
  • The WHO and UNICEF warn of the high number of unvaccinated children. The goal of these institutions is to reduce the number of unvaccinated children by 2030, particularly in Africa, the Middle East and Asia.

International health policy

  • The King’s Speech 2024 at the opening of the legislature. It is known that, in British protocol, the King expresses the government’s intentions. Key elements mentioned: 1. Waiting lists; 2. Focus on prevention; 3. Mental health, including a law change; 4. Increase in the age for authorization to purchase tobacco and limits on vaping; 5. Restrictions on junk food advertising.
  • Module 1 of the covid survey appears, on the resilience and preparedness of the United Kingdom to the pandemic. Please note that this Module 1 will be followed by several others on: governance; sanitary system; vaccines and therapies; purchasing and distribution; testing and isolation programs; Young people and children; the economic response to the pandemic. The structure of the report is problems and recommendations. This accumulation of reports that deal with the different aspects of the management of the pandemic has nothing to do with the disappointing Spanish report commissioned by the government, in which so many elements of analysis were missing (behavior of the different autonomous communities, international comparison, purchasing aspects and distribution of materials, mortality of professionals, etc.).
  • GPs (primary doctors) who use artificial intelligence improve the cancer detection rate by 8%. The application, called “C the Signs,” checks medical records. This software is used in 15% of healthcare facilities in England. The results were published in the Journal of Clinical Oncology.
  • United Health, the controller of the Chilean insurer Banmédica, is leaving Chile. United Health is the largest health conglomerate in the world and the interpretation is that, since Latin America is a marginal business for them, they prefer to get out of the regulatory instability that currently affects the continent. Doubts about the appearance of a buyer for the insurer Banmédica.
  • EU health priorities for the coming years. Van der Leyen sets the EU health agenda: mental health care, development of a critical medicines law and greater promotion of research with the development of a new technology law as well.

National Health Policy (Spain)

  • Strategic Plan of the pharmaceutical industry. Health has already sent Farmaindustria the draft of the sector’s Strategic Plan, a long-promised and delayed Plan that will remain to be seen in what remains in practice.
  • The government approves 172 million for Primary Care. Reaction: Primary care needs reform, not crumbs. That money is less than the one-year budget of many hospitals.
  • Health OPEs advance. The autonomous communities are advancing in the health OPEs, including the Canary Islands, Madrid, Castilla y León, Castilla-La Mancha, Aragón,… This news should be good, but in fact it is quite bad, due to the way the OPEs are done, with the risk of distorting multiple medical services.
  • Debate on doctors’ salaries in Spain. Statements by Antón Costas, president of the CES: “At the remuneration level, Spain does not fare badly in healthcare”, since Spain is among the countries where the remuneration is highest compared to the average salary (2.6 times in the case of those who practice general medicine and 3 times for those who practice other specialties). An interesting contribution to a debate that must continue. It is evident that to compare doctors’ salaries it is not worth doing so with absolute figures (as is done using Medscape reports), but rather with what they represent in the average salary of each country. However, it remains to be seen whether, even so, Spanish medical salaries withstand international comparison.On the other hand, it is proven that Spanish medical salaries fell in absolute numbers between 2011 and 2017.

Companies

  • International
    • The main medications on the 2030 horizon: Oncology, CNS and obesity.
  • National
    • Movements to take Grifols private continue. Grifols signs Morgan Stanley and Goldman before the takeover bid by the family and Brookfield.

Biomedicine

Global Health

International health policy

National health policy

Companies

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

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Summary

Biomedicine

  • Four decades of orphan drugs. The Orphan Drug Act (ODA) was approved in the USA in 1983, due to the lack of commercial interest in the development of these drugs. The law that developed incentives for production, the duration of patents and research was a success and more than 800 indications have already been approved. However, many rare diseases remain untreated and prices are unsustainable. This is why a new strategy is proposed for the next four decades.
  • Gene therapy offers hope for autoimmune diseases. Use of CAR-T, originally intended for cancers, in lupus. The initial findings offer hope to millions of patients with autoimmune diseases, four in five of which are women.

Global Health

  • Vaccines save lives. The measles vaccine alone is estimated to have prevented 23 million deaths between 2000 and 2018. Globally, the vaccination rate has increased for many diseases. However, in 2022 (the latest figure available) there were still 14.3 million children with zero doses. A lack of access and high production and cost costs among the reasons for this situation. New strategies are needed to boost utilization.
  • Counting the dead in Gaza. According to a letter published in The Lancet, as of June 24, 37,396 people had been killed in the Gaza Strip since the Hamas attack and the Israeli response, according to the Gaza Ministry of Health, figures not accepted by Israeli authorities, although they are by the United Nations and the WHO. If we take into account that the indirect deaths are estimated to be between three and fifteen the number of direct deaths, a conservative estimate with a multiple of four gives 186,000 deaths attributable to the current conflict. This is why an immediate ceasefire is advocated.

International health policy

  • The NHS is broken: In his first official statement released on July 5, the new UK Health Minister (Wes Streeting) says that his department’s official position is that “the NHS is broken.” . He is surprised by this clarity regarding the recognition of problems, which is to be expected to be followed by profound reforms.
  • Official statement from the Labor Party on preparing the NHS for the future: cutting waiting lists with 40,000 more appointments each week; double the number of cancer scans; a new Dental Plan; 8,500 more mental health professionals; back to the family doctor.
  • Starmer turns to Alan Milburn, former Minister of Health, close to Tony Blair, to fix the problems of the NHS, which is interpreted as meaning that the private sector and consumer choice will be at the center of the plans.
  • The first official report on Covid management in the United Kingdom is published. After multiple surveys, it will be published next Thursday and promises to reveal serious deficiencies in the management of Covid. It will be interesting to compare this report with the disappointing and incomplete one published in Spain, carried out by three experts selected by the government.
  • European hospitals lose more than 170,000 beds in a decade, but Spain increases them, despite continuing to be one of the European countries with the fewest beds per 100,000 inhabitants.

National Health Policy (Spain)

  • The State Public Health Agency, in limbo. The creation of this Agency takes forever. It’s a bit frustrating, says Eduardo Satué, president of the Spanish Society of Public Health and Health Administration (SESPAS).
  • Various communities offer bonuses and incentives to doctors: to cover the deficit in Primary Care (Andalusia) or to cover the wings of the region (Asturias).
  • AESEG requests a price difference between generics and brands, which Farmaindustria opposes, a measure that is already applied throughout Europe except in Spain. The sector has 21 production plants in Spain and generates more than 40,000 direct and indirect jobs.
  • Private healthcare runs the risk of dying of success. Waiting lists are exploding for private health insurance (which 1 in every four citizens already have), but, due to low premiums, reaching up to 20 or 30 euros per month, it is not possible to provide a good service. A giant is being built with feet of clay.
  • Serious management problems in the health sector, according to FEDEA. Despite the significant increase in resources in the health field, since the level of spending has grown from 13.2% in 1999 to the current 14.5% of the total spending of Public Administrations. Real public spending per inhabitant has grown by 48% since 2003. This reality contrasts with the idea that healthcare has experienced significant cuts in recent decades, when the only falls in real spending per inhabitant only occurred between 2010 and 2013.

Companies

  • International
    • Pfizer wants to enter the anti-obesity drug market, having an advanced trial with a daily pill, with which it intends to enter the obesity market that promises to be worth 100 billion dollars a year.
  • National
    • It is possible that Grifols will cease to be a listed company. The Grifols family in talks with the Brookfield fund to take the company private.

Biomedicine

  • NEJM review: Four decades of orphan drugs. The Orphan Drug Act (ODA) was approved in the USA in 1983, due to the lack of commercial interest in the development of these drugs. The law that developed incentives for production, the duration of patents and research was a success and more than 800 indications have already been approved. However, many rare diseases remain untreated and prices are unsustainable. This is why a new strategy is proposed for the next four decades (https://www.nejm.org/doi/full/10.1056/NEJMp2401487)
  • Non-communicable diseases in reproductive care. New approach to gestational diabetes (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01298-4/fulltext)
  • Gene therapy offers hope for autoimmune diseases. Use of CAR-T, originally intended for cancers, in lupus. Initial findings offer hope to millions of patients with autoimmune diseases, four in five of whom are women (https://www.ft.com/content/a974f4c1-bb8a-4a1b-9d88-a2cf14be5c6e)

Global Health

International health policy

National health policy

Companies

 

 

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

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Summary

Biomedicine

  • Anniversary of IVF. The first in vitro baby turns forty years old, with the technique becoming the new normal. After 40 years of development and 12 million children born thanks to it, the technique has reached maturity, with less invasive techniques, more effective procedures and a change in the patient profile.
  • “Common Sense Oncology”. This association wants to provoke a public debate about a worrying trend in oncology. Although many cancer treatments have saved the lives of many patients or have prolonged their lives with well-being, there are more and more that offer small benefits for a very high price, a lot of toxicity and keeping patients in the hospital for a long time. time at the end of life.
  • Not everything is good at Ozempic. Harvard researchers link it to an increased risk of blindness.

Global Health

  • Political courage needed to prevent the next pandemic. In May 2021, the Independent Panel for Pandemic Preparedness and Response recommended a set of actions to make Covid-19 the latest pandemic with similar devastation. Three years later, progress is very limited, even though the threats are there.
  • 50% of the population will have myopia in 2050. Experts say that the abuse of screens and little outdoor activity favor this pathology.
  • The approval of a vaccine does not necessarily mean its dissemination. Although the malaria vaccine was approved in 2015, it was not included in vaccination programs in Africa until 2024.

International health policy

  • Biden calls on NovoNordisk and Lilly to lower the price of their slimming products. Both the President and Senator Bernie Sanders ask these companies to lower the price in a joint article published in USA Today, since they estimate that the cost is $1,100 per month.
  • Labour considers strengthening Whitehall (government) control over the NHS. It seems that Alan Milburn, former Minister of Health (1999-2003) under Tony Blair, who defends a greater role for the private sector, is playing an active role in the NHS plans. We will have to be very attentive from Spain to the movements in the NHS.
  • Australia against recreational vaping. In this pioneering country in the fight against smoking, vapes can only be purchased in pharmacies.
  • Thailand: the successes of universal coverage in a developing country. Life expectancy is 80 years (which must be compared with 73 in South East Asia). Last year 99.5% of the population of 72 million people was covered by health insurance. The GDP per capita is 11 times less than that of the USA.

National Health Policy (Spain)

  • The government approves the specialty of Urgencies and Emergencies. This ends an unprecedented situation in Europe. Currently, most of these professionals came from Primary Care, aggravating the crisis that this specialty is experiencing. The training of the new four-year specialty will be done in accredited teaching units. Infectious and Genetics are now the specialties awaiting recognition.
  • A Pact for Health is in sight in Balares and the Basque Country. In the absence of progress on a national plan, these regional pacts are welcome.
  • Health barometer (April-May 2024). Citizens’ assessment of public health has improved in the last year, although it is still below what it was before the pandemic. The grade for primary care is 6.29, compared to 6.19 a year ago, while hospitals and the care received in them continue to be the most valued by citizens: 7.51 points for emergencies and 7 .14 ​​points for “hospital care”. Regarding waiting lists, the percentage of citizens who consider that they have worsened is reduced by more than four points, from 39.2% to 34.6%.

Companies

  • International
    • Aging is the new horizon for investors. In 2050, 16% of the population will be over 65 years old, up from 9% today. In the United States and Europe this figure will be 27%. Healthcare is an obvious beneficiary. The universe reaches to pharma, implants and devices and services related to dental and eye care. Aside from treatments, financial services and hospital providers will play a greater role.
    • The FDA approves Lilly’s new drug (Kinsula, scientifically donanemab) against early Alzheimer’s. Lilly enters that market after Biogen and Eisai. The drug slows the development of Alzheimer’s, which causes memory loss, dementia and other cognitive impairments. The price will be $32,000 per year of treatment, 20% more than its rival Leqembi. Both treatments act on amyloid plaque in the brain.
  • National
    • Two new biopharmaceutical companies will operate in España. These are the American Dr. Ferrer and the German Bionorica.
    • HM hospitals increase their billing significantly. HM hospitals grow by 50% in billing in 2023 and exceed 650 million.

Biomedicine

Global Health

International health policy

  • Brazil
    • New abortion law in Brazil. Thousands of protesters have protested against what they consider an attack on women’s rights. The new law makes abortion after 22 weeks equivalent to homicide. In Brazil there are three situations in which abortion is permitted by law: fetal anencephaly, life-threatening pregnancy for the mother, and pregnancy resulting from rape (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01392-8/abstract)
  • Thailand

National health policy

Companies

7 days in healthcare (June 24th-30th, 2024)

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Summary

Biomedicine

  • Advances in gene editing. Discovery of a new way to program DNA recombination. This increases the possibilities of the current CRISPR editing method. The new route is called the bridge RNA method.
  • Lifestyles can compensate for genetics. Lifestyles can improve genetics by 60% and add 5 years to life.

Global Health

  • Loneliness as a public health problem. Increases the chances of stroke by 56%. Given aging trends and changes in family structure, new ways to avoid loneliness will be a new public health problem.
  • A disease control, prevention and control center for Latin America. Although Latin America has only 8.2% of the global population, in the case of covid they had 10% of the global cases and 25% of the mortality. A group of experts proposes the creation of a Latin American Center for the prevention and control of diseases.
  • They propose warnings on ultra-processed foods. For some, ultra-processed foods need warnings, just like tobacco
  • Simple steps to prevent people from dying from heat stroke. In Europe 70,000 people died from the heat wave in 2023. Saudi Arabia reached 50º in the shade; Baltimore and Philadelphia, around 40º; also India. Far from being exceptional episodes, it is part of the new normal. The solution is simple, according to The Economist: put people out of the sun and in a cool environment. Surely easier said than done.

International health policy

  • Many Chinese doctors choose to leave the public sector to go to the private sector. The pressures of health reform on doctors cause many to opt for the private sector. The salary of doctors in China (equivalent to $13,000 per year on average) is lower than that of other Chinese professionals.
  • Changes in the NHS in the electoral programs  in the United Kingdom. The Lancet analyzes the health changes needed in the wake of the UK election. The NHS faces numerous challenges in many areas – from record waiting lists to repeated strikes – resulting in historic levels of dissatisfaction among patients and professionals. According to the Nuffield Trust think tank, none of the major parties promise a substantial increase in funding capable of addressing the serious problems.

National Health Policy (Spain)

  • Plan for Primary Care. Health announces the approval of the AP and Community Action Plan in the last quarter of the year. We do not know if this will be a reality or a new song to the sun, to which the Ministry has accustomed us.
  • Defense of the Catalan model of consortia. Mónica García defends the Catalan model, against criticism from Junts. She defends them because they are non-profit, as if having one would incapacitate collaboration with the public sector. Incredible.
  • Hiring non-community doctors. Madrid extends the exception to hire non-European doctors in the public sector to all medical specialties. If a position remains unfilled, a non-EU doctor may apply for it, that is, whose medical degree has not been issued by the EU. Madrid is a pioneer in this measure, which, apparently, violates state law. If the law is really broken, it is doubtful that this could be the solution. In the United States there is the ECFMG (Educational Commission for Foreign Medical Graduates), the famous “Foreign”. And in Europe there are community directives that regulate the curricular contents of all health professions.
  • A summer with 6,000 fewer doctors. The residents will finish later this year, due to the pandemic, and will not be able to fill the vacancies.
  • Universal benefit for children between 0 and 3 years old. The CES calls for a universal benefit for children from 0 to 3 years old that is not conditioned by income. The starting point is that Spain has an “unheard of” problem, which does not correspond to its level of wealth, the weight of the Welfare State or its ethical values: one in three minors lives at risk of poverty or exclusion. social. The problem is especially serious from six months to three years.
  • Statements by the prestigious health economist Félix Lobo. “It is not true that innovative therapies arrive late in Spain.” We need to know whether it is worth paying the high prices that pharmaceutical companies ask for medicines and health technologies, but we do not have good mechanisms to evaluate this. We need an organization independent of political power with means and prestige. It should be something similar to AIREF or the National Markets and Competition Commission (CNMC). Faced with these excellent statements, other groups propose populist solutions (in the sense of simple) to a complex problem and present the delays in the incorporation of new medications almost as the main problem of our health system, which is absurd and far from the reality.
  • Tumors become the leading cause of death in Spain. 26.6% of deaths in 2023 were related to some type of cancer. It is the first time that this cause surpasses ailments of the circulatory system.
  • Fertility rate in Spain. Below the OECD fertility rate and very far from the replacement level. We have gone from 3.3 children per woman in 1960 to 1.5 in 2022, below the replacement rate

Companies

  • International
    • A new market, that of exoskeletons. Aging is driving up the exoskeleton market, which will reach $1.5 billion by 2027. The prevalence of cerebrovascular accidents and the growing geriatric population are at the origin of this growth.
    • aNovoNordisk, in China. Novonordisk’s obesity drug Wegovy approved in China.
  • National
    • Ribera diversifies into several communities. The Ribera health group expands its presence in new Autonomous Communities and prepares its landing in Andalusia. The announcement will be made in July.
    • Esteve increases its production capacity. It will invest 100 million euros in building a new production unit in Girona.

Biomedicine

Global Health

International health policy

  • United Kingdom and the National Health Service
    • The Lancet analyzes the changes in health necessary as a result of the elections in the United Kingdom. The NHS faces numerous challenges in many areas – from record waiting lists to repeated strikes – resulting in historic levels of dissatisfaction among patients and professionals. As analyzed in the Nuffield Trust, none of the major parties promise a substantial increase in funding (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01344-8/fulltext)

National health policy

Companies

 

 

7 days in healthcare (June 17th-23rd, 2024)

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Summary

Biomedicine

  • 20 years of progress in the treatment of lung cancer. Until the 2000s, lung cancer was a lethal disease with very limited treatment options, based on platinum-based chemotherapy, which gave one-year survival in 33% of patients with advanced disease. In the last 20 years there has been incredible progress, always based on identification with biomarkers, which are now part of the routine.
  • A single injection provides total protection against HIV. One Gilead injection provides total protection from HIV, in a trial with African women, with extraordinary results, with just two injections a year.
  • The first drug against sleep apnea. It could be a new generation drug against diabetes and obesity. Sleep apnea is so common that this medication could represent something similar to obesity medications.

Global Health

  • The Sustainable Development Goals are failing. We are now halfway between 2015, when these Goals were announced, and 2030, when they should be achieved. The objectives have not materialized, remaining a “promise without a plan.” None of the 17 objectives are on track to be met and number 3 (dedicated to health and well-being) is no exception.

International health policy

  • Health coverage projections in the USA 2024-2034. The percentage of uninsured will increase in this period, going from 7.7% in 2024 to 8.9% in 2034. The main cause is the expiration of certain measures as a consequence of Covid regarding Medicaid.
  • The Surgeon General in the USA demands warnings against the danger of the platforms. He calls for danger warnings on social media platforms, similar to tobacco. He will ask Congress for such a measure, warning that the use of certain platforms can harm the mental health of adolescents.
  • The NHS wants to move medical studies to 4 years in 2026. From the current 5 in that country. Both the British Medical Association (BMA) and the Hospital Consultants and Specialists Association (HCSA) oppose the measure, warning that it risks producing a type of doctors without the necessary preparation and that this is dangerous for quality.
  • £38bn a year will be needed until 2029-2030 to “revive” the NHS. According to the think tank The Health Foundation, the system needs to grow 3.8% in real terms in the next decade, not 0.8% as planned. Politicians need to be honest on this issue, says the director of the think tank. There is a fairly widespread perception that 14 years of Conservative government spelled doom for the NHS. Perhaps a similar analysis was necessary with regard to the Spanish health system.
  • French pharmacists want to be able to dispense antibiotics without a prescription. For angina and cystitis, under certain conditions, following a decree published on June 18.

National Health Policy (Spain)

  • A scientific advisor in each ministry. This is similar to what is happening in the UK and the need for a better science-politics connection became very clear during Covid. This project will be coordinated by the National Scientific Advisory Office (ONAC).
  • Open Health Forum. It will incorporate the voice of patients, people with disabilities, citizens and professionals.
  • Green light to the Royal Decree creating the Public Health Surveillance Network, which includes the Early Warning and Rapid Response System.
  • Controversy among experts over the “singular financing” for Catalonia. The extension of a “Basque-style” model to Catalonia endangers the financing of the system, according to representatives of FEDEA (Diego Martínez López) and FUNCAS (Santiago Lago).
  • Castilla-La Mancha dedicates 1.3 million to the National Health Data Space. This community will house the data centers that must be implemented in Spain. The agreement was reached at the Sector Conference for Digital Transformation.
  • The reform of La Paz is transformed into the City of Health. With an investment of 1,000 million euros, it will house, among other spaces, the new Faculty of Medicine of the UAM, a research center and a pediatric cancer center.
  • The Constitutional Court endorses abortion without parental consent. Which allows 16 and 17 year old girls to terminate their pregnancies without this consent.
  • Three years of euthanasia law in Spain. Half of the applicants have their request rejected and a third die during the process. Since the law came into force, it was applied in 363 cases, half of the applicants. Not all autonomous communities are collaborating adequately. Surely this is a consequence of the hasty discussion of this important law, unlike what happened in France, although in that country the elections have paralyzed the processing of the law.

Companies

  • International
    • Lilly and NovoNnordisk in the race for anti-obesity drugs. They will invest $30 billion to expand the production of their anti-obesity therapies.
  • National
    • Growth of the residence sector. It earned 5,250 million euros in 2023, 6% more than the previous year.
    • Growth of ASISA. The ASISA group invoiced 4.9% more in 2023 and reached 1,761 million euros.

Biomedicine

Global Health

International health policy

  • Mexico
    • Health under the new president Claudia Sheinbaum. He will have an opportunity to improve the health of Mexicans, given his great advantage in the elections and the majority in both chambers. Her plan, called a Healthy Republic, plans to improve care by focusing on prevention, modernization and better training of professionals. She also proposes limiting private sector participation in public service. However, it is difficult for this to be achieved without improving health spending (2.9% of GDP), the lowest in the OECD (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01301-1/abstract)

National health policy

Companies

 

 

7 days in healthcare (June, 10th-16th, 2024)

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Summary

Biomedicine

  • 40 years after the discovery of Helicobacter pylorii. The discovery of Helicobacter pylorii 40 years ago revolutionized the treatment of gastritis, peptic ulcer and stomach cancer, leading to Barry Marshall and Robin Warren being awarded the Nobel Prize in Medicine in 2005. This discovery transformed an incurable disease into one treatable with antibiotics. However, Helicobacter pylorii has a global prevalence of 35% among children and adolescents, especially in poor countries. This requires strengthening essential measures to reduce infection, such as hygiene education, water treatment and other health measures.
  • The Lancet Editorial: Taking persistent physical symptoms seriously. These complex symptoms are incorrectly treated by health systems. Recognizing that they were misguided by the traditional biomedical model, in 1977 the biopsychosocial model was proposed, which has been criticized. Now a new model is proposed, as a starting point for a correct approach to this problem.
  • The future of academic medicine. Academic medicine is in crisis globally, as demonstrated by commercial pressures and useless research and publications, which consume a lot of money. However, academic medicine is basic and science is the basis of medical practice and medical education. Evidence-based medicine, including research and practice, is the core element of academic medicine. The British Medical Journal launches a new global commission on the future of academic medicine.

Global Health

  • Hopes for a pandemic treaty, despite the failure to meet the deadline. Along with the extension of the Pandemic Treaty deadline to 2025, an important partial agreement was reached: the review of rules to prevent the global spread of some infections. Even in the global Treaty, much progress was made, which allows for a certain optimism.
  • Vaccine manufacturing is promoted in Africa. The African Vaccine Manufacturing Accelerator (AVMA), a new $1 billion+ initiative, an innovative financing mechanism designed by GAVI, offers African producers financial incentives to produce vaccines. The initiative will be launched at a high-level event in Paris.
  • 10 years after the 2014-2016 Ebola epidemic in Africa. The crisis initially affected Guinea, Liberia and Sierra Leone and it took months to identify the cause and almost three years to contain it, after claiming thousands of lives. The epidemic revealed weak health systems, poor detection mechanisms and inadequate response. Since then, work has been done on preparation for these risks, response mechanisms and international collaboration.

International health policy

  • Forecasts for 2023-32 healthcare expenditures in the United States. Healthcare spending is projected to grow faster than GDP growth over the next decade, reaching 19.7% of GDP in 2032 (from 17.3% in 2022). This indicates a large increase in the use of health services, linked to an increase in coverage that is estimated at 93.1% this year.
  • The King’s Fund summarizes the manifestos of the different parties (Labour, Conservative and Liberal-Democratic) on health ahead of the elections. The different proposals are analyzed in relation to: social care reform; access to hospitals; access to primary care and community services; access to dental care; additional funding commitments; investments in capital and buildings; social care funding; training and selection of personnel; support to social services personnel; international recruitment and migration; prevention, inequities and public health; mental health, learning disabilities and autism; cancer; maternity and women’s health services; medicines, research and life sciences; digital transformation and technology; and, other proposals.
  • “Aid in dying” in France. With the dissolution of the National Assembly, the “aid in dying” law is delayed indefinitely. With the call for elections, a very advanced legislative process declines, preceded by a great national debate with the personal intervention of President Macron.
  • Advanced practice nursing in Belgium. A Royal Decree establishes the functions of advanced practice nursing, in an attempt to define different profiles of nurses and make the profession more attractive. Maybe a good lesson for Spain.
  • Four industries responsible for 2.7 million deaths in Europe each year (7,400 per day): tobacco, alcohol, ultra-processed foods and fossil fuels.

National Health Policy (Spain)

  • Public Management and Integrity Law. Competence doubts complicate the processing of this Law, which is surely good news, given the government’s intentions.
  • Approved the law creating the Andalusian Health Institute. This is a new entity that brings together the Andalusian School of Public Health (EASP), the Progreso y Salud Foundation, as well as the General Secretariat of Public Health and R&D&I of the Ministry of Health, and will take the legal form of an agency. administrative and will have the nature of a public research organization. The headquarters will be in Seville, in the Ministry. Although we do not know the effects that this reform will have, the PP’s history in Andalusia of making public health companies disappear does not allow us to conceive much hope, on the contrary.
  • Adeslas threatens to leave MUFACE if conditions do not improve. Given that Adeslas does not usually make statements lightly, it must be considered that there is a real risk of the system disappearing.
  • Controversy over waiting for medications. Spain increases the wait for medicines, but improves availability, according to the WAIT report, prepared by the consulting firm IQVIA for the European Federation of Pharmaceutical Industries. The report says that in two years Spain has gone from 53% to 62% availability (compared to 88% in Germany or 77% in Italy), but the waiting time has gone from 629 to 661 days, almost two years of delay. On the other hand, César Hernández, general director of the Common Portfolio of the SNS and Pharmacy, criticizes the report and says that we are the country with the most access. The report does not take into account access through the mechanism provided for in RD 1015/2009, as well as medicines that arrive through clinical trials. Although the situation of access to medicines can surely be improved – and not only by the Ministry, but also by the intervention of the autonomous communities and hospitals – it does not seem that this issue is one of the most serious problems of the system, compared to what some they proclaim.
  • Public Health Agency. The Health Commission of June 19 will not address the State Public Health Agency, which will not be analyzed by this Commission until after the summer. This is interpreted as another milestone in the long history of delays of this initiative.
  • Center for Minority Diseases in Barcelona. Agreement between the Sant Joan de Deu Hospital and the Amancio Ortega Foundation for the launch of this center that will have financing of 60 million euros and will have a space of 14,000 square meters in a six-story building. With various genomics, metabolomics and radiomics platforms. The center will be part of the Red Única, a network made up of 30 hospitals throughout Spain and promoted by the Sant Joan de Deu Hospital and the Spanish Federation of Rare Diseases. Another great success for the Sant Joan de Deu Hospital, which many of us are already accustomed to.

Companies

  • International
    • Approved a new drug against Alzheimer’s. FDA panel approves Lilly’s Alzheimer’s drug. The modest benefits of Lilly’s drug donanemab outweigh the risks, the panel unanimously concludes.
  • National
    • Ribera incorporates the Covadonga Hospital in Gijón, with this incorporation there will now be six Spanish communities in which Ribera is present (Valencian Community, Murcia, Madrid, Galicia, Extremadura and Asturias).
    • Terafront Pharmatech, the Spanish semi-public pharmaceutical company, will have its own factory. Terafront will manufacture its own therapies and has chosen to build its own facilities, compared to other options being considered.

Biomedicine

Global Health

International health policy

National health policy

  • CSIC Biomedicine Strategic Plan
    • The CSIC presents its Strategic plan in Biomedicine. This plan is based on 10 strategic axes, among which are: strengthening internal communication and collaboration between researchers; create new collaborative structures with companies, hospitals and universities; increase the presence of the CSIC in key international organizations; improve knowledge transfer to industry and the health sector; attract or retain young talent: Key actions: the creation of a Rare Diseases Network; the creation of a OneHealth Bassoon Library; the creation of the Biomed Transfer Services Network (https://www.consalud.es/saludigital/innovacion-tecnologica/csic-presenta-plan-estrategico-biomedicina-liderar-innovacion-en-salud_144755_102.html)
  • Center for minority diseases in Barcelona
    • Agreement between the Sant Joan de Deu Hospital and the Amancio Ortega Foundation for the launch of this center that will have financing of 60 million euros and will have a space of 14,000 square meters in a six-story building. With various genomics, metabolomics and radiomics platforms. The center will be part of the Red Única, a network made up of 30 hospitals throughout Spain and promoted by the Sant Joan de Deu Hospital and the Spanish Federation of Rare Diseases (https://www.diariomedico.com/medicina/investigacion/primer-step-creation-pioneer-center-minority-diseases.html)

Companies

7 days in healthcare (June 3rd-9th, 2024)

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Summary

Biomedicine

  • Scientists who have revolutionized the treatment of obesity win the Princess of Asturias Award. This is the Canadian Daniel J Drucker; by the Danish Jens Juul Holst; and the Americans Jeffrey M Friedman, Joel F Habener and Stevlana Mojsov, whose research has culminated in several drugs to combat diabetes and obesity, such as Ozempic, an injectable drug whose sales are generating billions of euros each year.
  • Need to integrate scientific advances with the clinic and the community. Despite great progress in biomedical research in the USA, the health of Americans seems to be getting worse every day. This suggests that research should be integrated into clinical care and community settings.
  • Persistent Covid. A new report from the National Academies of the USA identifies up to 200 symptoms in persistent covid, to the point of making work difficult and lasting for months or years.

Global Health

  • Failure, after two years of negotiations, of the Pandemic Treaty. Pharmaceutical companies had opposed part of the deal. Oxfam International blames rich countries for lack of agreement.
  • Regional hub for the production of mRNA vaccines in Africa. Rwanda is positioned as the future regional hub in the production of mRNA vaccines. BioNTech wants to develop this technology in this country, totally devoid of a pharmaceutical industry.

International health policy

  • The American Cancer Society begins a prospective study with 100,000 black women. A large long-term study of cancer in black women begins. The American Cancer Society aims to enroll 100,000 black women to follow them for three decades and reach conclusions about the cause of more cancers and greater mortality.
  • AI-based hospital in China. China inaugurates the world’s first AI hospital that can treat 3,000 patients a day. The hospital, called Agent Hospital, will be the world’s first hospital fully powered by artificial intelligence and consists of a virtual clinic that employs AI-generated doctors and nurses to treat patients in a simulated environment. It is expected to diagnose diseases and establish treatment plans with an accuracy of 93.06%. Despite having only 14 doctors and 4 nurses, it is expected to be able to care for about 3,000 patients a day.
  • “Less medicines” program in France, promoted by the pharmaceutical industry. “The pharmaceutical industry launches a campaign to promote sobriety of medications from the age of 65. It is surprising that this initiative comes from an industry whose business model is based on selling medicines.
  • Portugal launches a general emergency program to transform the health system. The government publishes an emergency and transformation plan for health. The plan is structured into five strategic axes: 1. Response on time and hours; 2. Safety for babies; 3. Urgent and emergent care; 4. Nearby and family health; and, 5. Mental Health. For each of the strategic axes, urgent measures, priority measures and structural measures are established. Apart from that, five transversal programs are defined: 1. Contingency programs; 2. Evaluation programs; 3. Efficiency programs; 4. Medication programs; and, 5. Priority clinical programs.
  • Guarantee of waiting lists in Sweden. Sweden had passed a law guaranteeing waiting times already in 2010, which was never complied with. The new law reduces maximum waiting times and offers the patient the possibility of going to a center outside their region, at no extra cost.

National Health Policy (Spain)

  • Allegations continue to be known about the announced Public Management and Integrity law: News continues about the allegations presented to this public consultation, in this case those of the IMAS Foundation, which insists on general measures on public management, not only those of management by private companies. Regarding the CSC’s allegations, they focus on defending the Catalan healthcare model, in this case the consortia.
  • Covid. Covid cases have doubled in Spain in the last fifteen days.
  • Steps are taken to launch semi-public pharmaceuticals. The company called Terafront Pharmatech will have initial capital of 74 million euros, half public capital and the rest private. According to Minister Morant, the aim is that, being leaders in clinical trials, the patents do not end up being purchased by foreign companies.

Companies

  • International
    • Sanofi spin-off. Sanofi is going ahead with the spin-off of the consumer division for 20 billion euros.
  • National
    • New university hospital in Madrid. Hospitén lays the first stone of its future university hospital in Madrid. The hospital will mean a total investment of 200 million euros, it will have 160 hospital beds, twelve ICU beds, twenty emergency beds and 22 for a day hospital. It will have 17 operating rooms.

Biomedicine

Global Health

International health policy

National health policy

Companies