7 days in healthcare (May 27th-June 2nd, 2024)

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Summary

Biomedicine

  • A blood test would allow predicting breast cancer: This possible advance is celebrated as a great step in the prediction of breast cancer at the Congress of the American Society of Clinical Oncology, held in Chicago.
  • Test to detect people at high risk of prostate cancer: Current PSA tests are not specific enough. A sputum DNA test has been developed that can detect high-risk men and rule out other forms of treatment. Early diagnosis is key.
  • Genetic inheritance influences the type of breast cancer and its prognosis: This contradicts the idea that breast cancer is the result of mutations that occur by chance and accumulate throughout life.
  • Oncologists warn that rapping can cause lung cancer: Although the first vapers were marketed in Spain in 2013 and there are no long follow-up series, some short series from the United States warn of this risk. Vapes contain more than 200 toxic substances and some of them carcinogenic.

Global Health

  • WHO gives itself one more year to reach an agreement on the pandemic treaty:  With the WHO World Assembly over, it gives itself one more year to reach an agreement on pandemics. This is not good news and underlines the great difficulties and tensions in reaching an agreement in 2024, as was the initial intention.
  • New fronts in the war against malaria: Two new vaccines (RTS,S/AS01 and R-21/MatrixM), effective in the fight against malaria. However, experts highlight new threats: more aggressive mosquitoes; resistant strains of the parasite and the effects of climate change.
  • The necessary global agenda in relation to bacterial resistance (AMR): High human cost of this disease, since a 2022 study says that it is estimated that almost 5 million deaths are due to this problem.

International health policy

  • Pro-choice options (following the ruling that limits abortion in the USA) influence the American elections: The pro-choice movement (in favor of abortion) can help Biden win.
  • Large clinical trial in the United Kingdom with cancer vaccines: In the United Kingdom, for the first time in the world, a massive form of clinical trial using these vaccines is being proposed.
  • European elections and health: Various experts say that health should be a priority in the next European Parliament.

National Health Policy (Spain)

  • Very negative allegations about the announced Public Management and Integrity law: Both the IDIS Foundation, ASPE, ACHPM, Cercle de Sanitat, and the Community of Madrid present very negative allegations about this announced bill. In general, the objections are related to the interference in the transferred management, the impact on patients and the non-existence of the problems that are intended to be resolved. The IDIS Foundation, apart from everything else, takes a more strategic approach to the contribution of private healthcare to public service, the European traditions of participation of private companies in public healthcare provision and the consideration of the private sector as a strategic ally. of the health sector. A poor diagnosis by the government should be highlighted: public/private collaboration is treated as a major problem, and, on the other hand, it does not address the problems of the public health sector through reforms.
  • Great controversy over the actions of the new Commissioner of Mental Health: Trying to solve the serious problems of psychiatric care in our country by recommending joining a union or a feminist association, as a joke may not be wrong, but seriously it is absolutely unacceptable that be said from any environment, and even less so, from the health administration.
  • The IDIS Foundation publishes a work on the perception of private healthcare:  Meritorious effort by the IDIS Foundation to carry out a serious survey among its users to detect their perception of the sector, which, in general, is very positive, although problems are detected such as repetition of tests by the public sector, without taking into account the studies carried out in the private sector. It is confirmed once again that the majority of private sector users also use the public one. Also that specialist consultations are the most used service in private healthcare.
  • Work that demonstrates that public/private collaboration does not produce worse health outcomes and less higher mortality than public management: In the face of some attempts to disqualify private healthcare by stating that it produces worse outcomes and more mortality, this is not confirmed in the extensive review national and international bibliography carried out. Even in places (Community of Madrid and Catalonia) where there are specific indicators on the behavior of the bulk of the public sector and public/private collaboration, better results are detected in the latter.

Companies

  • International
    • Nestlé reorients itself towards food for healthy aging: The largest food group in the world wants to focus on foods for healthy aging, considering it a priority at a time of reduced birth rates.
  • National
    • Rovi, ready to sell its third-party manufacturing area: Rovi is ready to sell its third-party manufacturing subsidiary for at least 3.1 billion.
    • The Miranza Foundation is born: With the purpose of ensuring the eye health of the most vulnerable.

Biomedicine

Global Health

International health policy

National health policy

  • Results in public/private collaboration
    • Bibliographic review carried out by a special Chair of the UCM on the results of public/private collaboration. Extensive review of national and international bibliography. The most notable are the results published in the Observatory of the Community of Madrid or in the Results Center of the Quality Agency of Catalonia. The conclusion is that there is no general evidence of worse results in public/private collaboration than in direct public management and, in the case of Spain, there is well-documented evidence of the opposite based on indicators in Catalonia and Madrid (https://isanidad.com/wp-content/uploads/2024/05/Informe-UCM-Colaboracion-publico-privada.pdf.pdf)

Companies

7 days in healthcare (May 20th-26th, 2024)

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Summary

Biomedicine

  • Hope for quadriplegics: A promising non-invasive technique can offer hope to quadriplegics with paralyzed legs, with something as simple as electricity and exercise. Trial with 60 patients in three countries.
  • Promising trial in glioblastoma multiforme: A team from the University of Florida has announced the development of an mRNA vaccine. Although it has only been applied to four patients, the results are very good.
  • The cancer vaccine race is open: The battle between Moderna (for melanoma) and BioNTech (for pancreatic cancer), although both firms have patent litigation.
  • Possible control of fentanyl addiction: This drug is used as a pain treatment, but it generates a powerful addiction. In 2022, opioids accounted for about three-quarters of the 108,000 deaths associated with overdoses in the US. An article published in Nature describes that it is possible to control fentanyl addiction by controlling two different neuronal pathways in the brain.

Global Health

  • Cyberattacks in healthcare, a growing threat: According to Rick Pollack, president of the American Hospital Association (AHA). One of the problems is that healthcare organizations in the USA spend 7% of their budget on cybersecurity, while the average in other sectors is 11-12%.
  • Difficulties in reaching an agreement on the Pandemic Treaty: The countries of the world have failed to reach a consensus on this treaty, as evidenced by the World Health Assembly, which is being held in Geneva. The negotiators ask for more time to continue negotiations.

International health policy

  • Report on the problem of infected blood in the UK: Sir Brian Langstaff has led the public inquiry into transfusions with infected blood, which occurred in the UK between the 1970s and 1990s. More than 30,000 people were infected with hepatitis C or HIV after receiving transfusions, blood products or tissues. More than 3,000 have died and the death toll continues. At that time, Factor VIII concentrates from the USA and Austria were used. The report demands compensation for those affected without delay. With all the defects and problems they may have, when the British commission a report they do so seriously and the problems are analyzed in depth. From that point of view, a great lesson for Spain.
  • Air pollution problems decrease in Europe: It is believed that the decrease in air pollution is related to fewer heart diseases. The World Heart Federation says that between 2010 and 2019, deaths from heart disease in Europe attributed to pollution fell by 19.2% and from stroke by 25.3%.

National Health Policy (Spain)

  • Asturias defines a strategy against waiting lists: The plan aims to carry out 500 more interventions per month and consists of: afternoon plans for surgery, consultations and special tests; and, greater use of the concerted sector. It seems that the logic of facts prevails over ideology in addressing a complex problem.
  • Health insurance explosion leads to a “boom of private hospitals: Most of them are planned in Madrid, Catalonia and the Balearic Islands.
  • Changes are proposed in health insurance, given the aging of the population: Article by Enrique de Porres, CEO of ASISA, where he proposes the need to increase the duration of health insurance contracts beyond one year. One-year policies, like car insurance, are a great aberration in health insurance.
  • “Language policy” at the Hospital Clínic, Barcelona: The Hospital Clínic imposes Catalan among doctors and with patients. According to a survey by the Council of Medical Colleges of Catalonia, 52% of doctors do not use Catalan on a regular basis to communicate with patients in consultation. We had thought we understood that this Hospital was intended to be a great national and international center.
  • Quirón awarded the use of the building of the old Generalísimo Franco hospital: The Ministry of Defense awards the building on Isaac Peral Street for 75 years. The hospital was built in 1950 and had been closed since 2001. A competition was held last fall. The process was closed on January 24, with the award to the only bidder, the Jiménez Díaz Foundation, dependent on the Quirón Group. The advantage for the Quirón Group is that this hospital building is very close to the Jiménez Díaz Foundation.
  • New remuneration proposal for doctors: Interesting article by Julián Ezquerra, who proposes not fixed salaries, but rather paying for three concepts: charging for what he is, for what he does and for how he does it. It is about overcoming the current “coffee for all”, with such negative consequences.

Companies

  • International
    • Lilly wants to reinforce its presence in the anti-obesity market: It intends to capture the $100 billion market through an investment of $5.3 billion in the USA, to promote production in Indiana, near the company’s headquarters.
  • National
    • 5 new private hospitals in Madrid: Three from HM hospitals: HM Tres Cantos, HM Madrid Río and HM Nuevo Norte day hospital; one from Sanitas, in Valdebebas; another from Hospitén in Boadilla del Monte; and possibly another from Vithas.
    • Revenue from private hospitals will exceed €13 billion in 2023: 5% more than in 2022, according to DBK. Income from insurance companies, mutual societies and entities collaborating with Social Security represented 56% of total income (7,290 million euros, a growth of 6.2%). Income derived from public concerts was 4,465 million (an increase of 3.2%). Private clientele segment: 1,265 million and a growth of 4.5%.
    • Clínica Baviera enters the United Kingdom: With the purchase of Optimax. This group has 19 ophthalmology clinics in different cities in the United Kingdom.

Biomedicine

Global Health

International health policy

National health policy

Companies

7 days in healthcare (May 13th-19th, 2024)

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Summary

Biomedicine

  • Other uses of weight loss drugs: Weight loss drugs can reduce heart attacks by 20%, in what could be the biggest advance in this disease since statins.
  • Possible cheaper MRI equipment: A cheaper MRI machine can democratize access. MRIs have meant a spectacular advance in medicine by allowing images of soft tissues. But they are expensive and complex machines. The new devices allow us to spend a fraction of the energy and produce almost no noise. The development is by a team from the University of Hong Kong.
  • A revolutionary vaccine to combat HIV: This disease until now was refractory to the development of a vaccine for it. However, four publications in Science lay the foundations for developing formulas that allow obtaining antibodies against the virus.

Global Health

  • New covid variants: New covid variants (FLIRT) activate fear of an increase in cases in summer. The new variants of covid are spreading throughout the world. KP2, one of the variants, already represents 28.2% of cases in the USA. The WHO has said that FLIRT variants have already been found in 14 European countries, as well as Israel.
  • New version of the Global Burden of Disease (GBD): The publication in The Lancet of the GBD 2021 Causes of Death Collaborators analyzes the global burden of the disease and life expectancy. 288 causes of death and life expectancy in 204 countries are studied and territories for the period 1990-2021. Globally, life expectancy increased between 1990 and 2019, which has been interrupted by the pandemic.
  • New effort in vaccine research: Given the proliferation of vaccines against different diseases, the idea is to move from monopathogenic formulations, difficult to administer by any health system, to combinations against different diseases. A research effort is proposed in this field.

International health policy

  • Fall in overdose deaths in the USA: Overdose deaths fell in the USA in 2023 for the first time in the last 5 years, which is basically attributed to the decrease in deaths from synthetic opioids, mainly fentanyl, although deaths by stimulants, such as cocaine and methamphetamine, increased.
  • The Nuffield Trust (a major British health think tank) analyzes the changes in the NHS as a result of the increase in private activity: How private healthcare has changed British healthcare. In real terms, trusts (hospitals) spent £1.6bn in 2019/20; but this has risen to 3.12 billion in 2022/2023. Since Covid there has been a substantial increase in spending on the NHS purchasing private care.
  • Important hospital reform in Germany: Bankrupt hospitals in Germany approve a broad reform, which consists of the closure of part of the 1,700 hospitals, the most important reform in the last 20 years. Social Democratic German Health Minister Karl Lauterbach said there were too many hospitals and that Germany has neither the financial means nor the medical or nursing staff for that number. Its application will take about ten years and a transformation fund of 50,000 million euros has been allocated to implement it, half of which is borne by the federated states and the other half by the federal government.
  • Problems of private health insurers in Latin America: Both the ISAPRES in Chile (Boric government) and the EPS in Colombia (Petro government) are suffering very serious problems, which threaten their continuity.

National Health Policy (Spain)

  • The government proposes changes in private healthcare and its collaboration with the public system: The Ministry of Health puts out the draft Law on Public Management and Integrity of the SNS for public consultation. According to the text made public and the minister’s statements, the law proposes, among other things, to repeal Law 15/1997 (which established the framework for the participation of different forms of public and private management in the provision of public service and which was approved by broad consensus), as well as establish discrimination between private companies with business benefit and charitable companies. It is more than doubtful that this law will be approved, given the situation of the legislature, and, even in the highly unlikely event that it were approved, that it will have a significant impact, since the management of health services is transferred. However, it seems that modifying the MUFACE model is not on the government’s agenda.
  • In Madrid, the white tides return: This Sunday the white tides returned to Madrid, this time with the presence of the Minister of Health, in what seems a gesture difficult to understand from an institutional point of view, given that the demonstration was clearly directed against the Community of Madrid, in which there are many healthcare problems but which, however, has one of the lowest waiting lists in the country.

Companies

  • International
    • Takeda and the Alzheimer’s vaccine: Takeda reaches a $2 billion agreement to develop a vaccine against Alzheimer’s, by the Swiss start-up AC Inmune.
    • The WHO supports Takeda’s dengue vaccine: It does so at a time when several Latin American countries are suffering the worst dengue epidemic in their history. The vaccine is aimed at minors between 6 and 16 years old.
  • National
    • Vithas reaches one million digital patients: They access their private health area through the app or the website.
    • Esteve grows: Esteve grows by double digits in 2023, up to 710 million euros.
    • Sanofi announces layoffs in Barcelona: The pharmaceutical company Sanofi announces a collective layoff of 89 people, the majority from its Barcelona center.

Biomedicine

Global Health

International health policy

  • Germany
    • Bankrupt hospitals in Germany approve a broad reform, which consists of the closure of part of the 1,700 hospitals, the most important reform in the last 20 years. Social Democratic German Health Minister Karl Lauterbach said there were too many hospitals and that Germany has neither the financial means nor the medical or nursing staff for that number. Its application will take about ten years and to carry it out a transformation fund of 50,000 million euros has been allocated, half of which will be borne by the federated states and the other half by the federal government (https://elpais.com/society/2024-05-16/hospitals-in-bankruptcy-germany-approves-a-broad-reform-to-fight-against-its-precarious-situation.html)

National health policy

Companies

 

 

7 days in healthcare (May 6th-12th, 2024)

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Summary

Biomedicine

  • The enigma of the brain: The Economist highlights the enigma that the brain represents, made up of hundreds of trillions of cells that generate precise electrical impulses, which influence thoughts, memory and emotions, recommending 8 books on the subject, of which two They refer to the contributions of Ramón y Cajal, whom he compares with Darwin and Pasteur. The brain will be the focus of scientific advancement in the next 30-50 years.
  • CAR-T therapies, beyond blood cancer: Experiments in mice with this therapy manage to improve survival in brain, pancreas and lung tumors.

Global Health

  • One Health, from slogan to action plan: A group of European agencies, led by the ECDC, which includes the EMA, manage to transform the idea of One Health into an action plan, establishing five major strategic objectives.
  • The WHO Pandemic Treaty advances: WHO member states are about to reach an agreement on the response to pandemics, an agreement that, in principle, should be approved in May 2024.

International health policy

  • The great problem of hospital infections: The ECDC releases a report that shows that more than four million Europeans contract infections each year due to hospital admissions. This confirms the old criterion of hospital ethics: “Do not admit anyone unless it is strictly necessary and, if admitted, let them be in the hospital for the shortest possible time.”
  • Whooping cough is increasing in Europe: The ECDC publishes a report that warns of the increase in whooping cough cases in the European Union.

National Health Policy (Spain)

  • The government proposes new benefits in the SNS: condoms, sun creams and glasses: It is more than doubtful that with the financial tensions of an already very generous system (wide portfolio of services with hardly any co-payment), introducing new benefits without a debate in depth is a priority. Arguably, this has more to do with the political use of the system than with health policy.
  • The Catalan Generalitat will supervise the use of Catalan in its hospitals: CatSalut publishes exhaustive 9-page instructions on the subject. Same comment regarding political use of the system and health policy.
  • 18 patients die every day in Spain from hospital infections: According to a large study presented at the congress of the European Society of Clinical Microbiology and Infectious Diseases, four times more than those who died from traffic accidents. More than half of infections are considered preventable.
  • Workplace accidents increase: 56% in ten years. Both workplace accidents and the number of deaths increase in this period (452 deaths in 2012; 716 in 2022).
  • Innovative medicines take more than 800 days to reach patients in Spain: 621 days pass from the time a therapy is authorized by the European Commission until the Ministry of Health includes it in the list of approved treatments, according to the consulting firm. IQVA. To this figure we must add seven months or a year, depending on autonomy, until the treatment reaches the patients’ hands. In total, around 830 days.

Companies

  • International
    • The reengineering of addiction and the tobacco industry: For decades the tobacco industry has manipulated the design and composition of cigarettes to its benefit. Researchers and policy actors should be prepared to anticipate the tobacco industry’s response, given its long history of exploiting regulatory loopholes, according to an extensive article in the New England Journal of Medicine.
    • BioNTech looks to the future: It hopes that 2026 will be its debut in oncology with mRNA vaccines against cancer.
  • National
    • Vithas has a quality policy: The International Joint Commission accredits the Vithas Hospital of Almería, the fourth accredited hospital in this group.
    • Sanitas leaves the Manises hospital: Public reversal in this hospital. Sanitas leaves with discretion and elegance and leaving behind great management. How these things should be done.
    • Mutua Madrileña warns that Adeslas could leave MUFACE: Mutua Madrileña (50.01% shareholder of Adeslas, along with CaixaBank) warns that it will leave MUFACE if the government does not clearly improve conditions. The three companies that participated in the MUFACE model in these three years (Adeslas, Asisa and DKV) lost 600 million in this period. Logically, the possible departure of Adeslas would be a definitive death blow for the MUFACE model.

Biomedicine

Global Health

International health policy

National health policy

Companies

7 days in healthcare (April 29th-May 5th, 2024)

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Summary

From the point of view of Biomedicine, apart from advances in biological sciences, the American Journal of Medicine reflects in open articles on two very new elements in the new medical practice: what face-to-face contacts with the patient represent versus digital ones and the importance of Artificial Intelligence in the doctor-patient relationship. Digital technologies can revolutionize the way healthcare is delivered, enabling convenient, remote consultations. This should not lead us to underestimate the value of personal contact, which creates relationships and trust between patients and healthcare professionals. Non-verbal communication and physical examination are two great advantages of the in-person relationship. However, there are also numerous studies that show that telemedicine and telephone consultations have advantages in certain circumstances. Regarding AI in medicine, the conclusion is that, although evolving, it can offer great advantages, which are not available today. Animal experimentation raises hopes for the emergence of a universal flu vaccine, avoiding dependence on annual doses adapted to each year’s versions of the virus.

Regarding Global Health, New England Journal of Medicine editorial: The search for transformative tools to eradicate malaria. The conclusion is that there is no “silver bullet”, but rather a combination of interventions through a set of products and actions. Science Editorial: A treatise on pandemics is within reach. At the end of May, 194 WHO member countries will meet in the Assembly that will discuss the pandemic treaty, discussed over two years. In the course of the discussion, a false dilemma has emerged between science and innovation and equity. Equity is an ethical imperative. The Lancet Editorial: Housing as an important determinant of health. Unhealthy housing is correlated with poor health outcomes. Various articles point out the impact of climate change on very serious threats to health: the emergence of resistant superbacteria, the explosion of zoonotic diseases and the resurgence of malaria.

In terms of International Health Policy, the American government is about to classify cannabis as a less dangerous drug. Already three-quarters of Americans live in states where this drug is legal. This new federal classification could have significant economic repercussions. Important legislative changes regarding abortion in Arizona and Florida. President Biden proposes to regain, through a law, federal control over this issue. This law has no chance of being approved. Both immigration and abortion are the two big issues of this year’s American presidential campaign. In Sweden, the social model, to the limit. Conflicts are repeated among workers of the welfare state. The European Union publishes an evaluation of the implementation of the 2011 cross-border health directive (Directive 2011/24/EU). As is known, this Directive allows you to claim non-urgent health care in a European country other than the one of residence with an expense reimbursement system. The study, which analyzes 2022, draws attention to the low number of requests for assistance in Spain, despite being a tourist power that receives tens of millions of European tourists each year.

If we talk about National Health Policy (Spain), the government approves the Anti-Tobacco Plan 2024-2027, without raising the price of tobacco, which is criticized by experts, despite the fact that the increase in tobacco taxation was in the document approved on April 5 in the Interterritorial Council. The Non-Smoking Association says that, without an increase in the price of tobacco, we will continue to be Europe’s tobacconist. According to the WHO, tobacco taxes are the most effective means of reducing the prevalence of smoking. In most European countries, tobacco taxes are between 80 and 90 percent, while in Spain it is 51 percent. 22.1% of the adult population in our country continues to smoke, according to the 2020 European Health Survey and it causes close to 50,000 deaths per year. The fact that the price of tobacco has not been modified and that certain measures of the Plan require the approval of laws, in a highly uncertain legislature, mean that the Plan runs the risk of becoming a dead letter, despite the publicity from which it has come. accompanied by its approval. The Zendal hospital in Madrid already cares for ALS patients. The Community received advice from experts, relatives and caregivers of ALS, regarding the non-participation of these groups in the opening of the hospital itself, which is why the change in criteria of action must be celebrated. In Asturias, 400 positions that are difficult to fill are detected, only among doctors, according to the medical union. According to this union, the solution is to offer economic and non-economic incentives. Among the latter are aid to families, daycare, travel and housing. All of this is in contradiction with the current Statute-Framework, which is so allergic to any form of individual and collective recognition and differentiation. Given the instability among healthcare personnel in Catalonia, the president of the Council of Medical Associations demands an escape from the civil service system and asks to provide the teams with freedom and management capacity. Galicia has success with the vaccine against respiratory syncytial virus against childhood bronchiolitis. This winter, the community has immunized nine out of ten babies against RSV and has managed to prevent 80% from ending up in the hospital. Interesting initiative in some autonomous communities, such as Madrid and Murcia, by offering financial aid, if certain requirements are met, for access to the dentist, beyond the limited coverage of the public system.

As for Companies, internationally, Pfizer plans a direct-to-consumer platform for covid and migraine medications. The American group follows Lilly in setting up a website for patients to obtain medication online. NovoNordisk cuts price of anti-obesity drug Wegowy as competition heats up. As for national information, in Spain anti-obesity therapy from NovoNordisk (Wegovy, which will be available in pharmacies in the coming days) will cost up to 292 euros per month. Hipra announces its Covid vaccine adapted to the JN1 variant for this fall. The Quirón hospital in Gijón faces the latest urban planning procedures.

Biomedicine

Global Health

International health policy

National health policy

  • Central government initiatives
    • The government approves the Anti-Tobacco Plan 2024-2027, without raising the price of tobacco, which is criticized by experts, despite the fact that the increase in tobacco taxation was in the document approved on April 5 in the Interterritorial Council . The Non-Smoking Association says that, without an increase in the price of tobacco, we will continue to be Europe’s tobacconist. According to the WHO, tobacco taxes are the most effective means of reducing the prevalence of smoking. In most European countries, tobacco taxes are between 80 and 90 percent, while in Spain it is 51 percent. Although taxes on tobacco raise around 9 billion euros annually, it is estimated that the expenditure derived from smoking triples this amount. 22.1% of the adult population in our country continues to smoke, according to the 2020 European Health Survey and it causes close to 50,000 deaths per year. The materialization of the Plan’s measures will be through legislative reforms (https://www.alimente.elconfidencial.com/bienestar/2024-05-03/gobierno-tabaco-fumadores-precio-cigarrillos_3877594/)
    • The Interterritorial creates the Primary Care Commission and the Waiting List Working Group (https://gacetamedica.com/politica/el-interterritorial-crea-la-comision-de-atencion-primaria-y-el-grupo-of-work-of-waiting-lists/)

Companies

 

 

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

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Summary

From the point of view of Biomedicine, AI makes it possible to detect the origin of metastatic cancer. An algorithm examines images of metastatic cells to identify the primary location of the tumor. Currently the origin of up to 5% of all tumors cannot be identified. If this is confirmed, the concept of “metastasis of unknown origin” will disappear. Many mental illnesses have body triggers. Evidence is accumulating that a host of infections can activate conditions such as obsessive-compulsive syndrome, anxiety, depression and even psychosis. This finding can improve many psychiatric treatments. The EU approves a new antibiotic to track the growth of resistant bacteria. It will be used in pneumonia and urinary tract infections, representing an advance in the treatment of these bacteria. Health politicians are trying to introduce incentives for the development of these antibiotics linked to bacterial resistance.

Regarding Global Health, new publication of the European Observatory on Health Systems and Policies: health in all policies. The philosophy is to move from health in all policies to health through all policies. Smoking bans are coming. Countries are moving forward to ban tobacco use and vaping, which can save thousands of lives and billions of dollars. The WHO estimates that tobacco use costs the world $1.4 trillion each year in health spending and reduced productivity. The British initiative to ban tobacco consumption for those born after 2004 is very ambitious and would mean creating a smoke-free generation by 2040. Vaping is already more common in 2023 than smoking among young people, and its damage goes beyond lung and brain damage, according to a report from the University of Glascow, commissioned by WHO-Europe. Nicotine can have long-lasting effects on the adolescent brain. The upcoming ban on disposable vapes, for example in the United Kingdom, Belgium, France or Spain may not be enough. The WHO is concerned about the alarming consumption of alcohol and electronic cigarettes among adolescents, between 11 and 15 years old.

Regarding International Health Policy, National plan on waiting lists in Sweden. Waiting times have always been a problem in that country, with great disparities between regions and between different parts of healthcare. The plan seeks to identify areas with excess capacity in the country, allowing faster access to those waiting. The EU presents the Critical Medicines Alliance as a response to shortages. It is a consultative body to identify priorities for action and propose solutions. The Alliance will last for five years. On the part of Spain, among other entities, there will be the General Council of Pharmaceutical Colleges, Farmaindustria and the Spanish Society of Hospital Pharmacy. The European Parliament approves the European Health Data Space (EEDS), which will allow the primary (for care) and secondary (for research) use of health information. Secondary use for commercial purposes will not be permitted. Among companies, there is great concern, since they are above all concerned about, for example, “the voluntary acceptance of users.”

If we talk about National Health Policy (Spain), the competition for doctors to be permanent threatens the large hospitals in Madrid (and, without a doubt, in other communities). In the Community of Madrid there are more than 6,000 specialists who are involved in these stabilization processes. Logically, the problem is not stabilization, but two circumstances: that the solution is to transform the interim workers into statutory ones (wouldn’t it have been possible to favor an indefinite employment contract?) and, above all, that the selection is made without the intervention or of the hospital managements, nor of the services, nor of the professionals. A telematic system will be used, in which vacancies will appear to choose from. That method is incredible in the 21st century. Health outbreak against the norm that would allow a Basque MIR, by the highest representation of doctors and nursing. What is considered an unprecedented attack on the fairness of the SNS. The homogeneity in obtaining degrees and the mobility of professionals between the National Health System seemed to be one of the attributes of our health system. The Valencian Community will replace 1,800 professionals in Manises (who will be treated as statutory) and will create 400 new positions. It is difficult to understand that the statutory regime is the solution and that 400 more professionals are needed to do the same. The IDIS publishes its annual report, which is now called “Private Health Sector Observatory 2024”, maintaining the subtitle of “adding value”. This report is a very relevant contribution to the knowledge of a part of the health sector, such as the private part. Some criticize IDIS by saying that they are judge and party for the publication of this report. But it is true that the private health sector before the appearance of these IDIS reports was the great unknown and, furthermore, no one takes away from other institutions (call it the Ministry of Health, the Association of Health Economics, the Spanish Society of Public Health, etc.) to analyze and publish analysis on the private sector. This work of IDIS has come to fill a void. Farmaindustria denounces the Andalusian Health Service and the Andalusian Colleges of Pharmacists for favoring generics. The agreement between these entities involves the promotion of the dispensing of generics in pharmacies when they are prescribed by active ingredient. Farmaindustria rejects this agreement, considering it discriminatory towards the brand. They argue that branded medicines are in Spain at the same price as generic ones. The latter is true, but it is no less true that this constitutes an exception in Europe, which is more concerned with the promotion of generics and the promotion of companies related to their manufacturing and launch.

As for Companies, at the international level, an important article in the New England Journal of Medicine considers the existence of the free market in the pharmaceutical world a myth. Europe is falling below the USA and China in pharmaceutical innovation, warns the CEO of AstraZeneca. Clinical trials on obesity are growing by 68% and laboratories are preparing 124 drugs. Regarding national information, Domus Vi is considering divesting itself of the Mentalia division for more than 100 million euros. The anti-smoking plan threatens an investment by Philip Morris in Spain of up to 1.2 billion, based on the government plan to equate the taxation of new devices to traditional cigarettes. Caser boosts its dental clinic business with more capital, expanding by 4.25 million euros. This will undertake the opening and purchase of eight new dental clinics.

Biomedicine

Global Health

International health policy

National health policy

Companies

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

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Summary

From the point of view of Biomedicine, after an extensive study it is detected that in approximately 1 in 10 cases of multiple sclerosis, antibodies are detected in the blood years before the disease develops. It may be too early to draw conclusions about the repercussions of this finding.

As far as Global Health is concerned, plans to expand vaccine production to Africa are facing serious problems. This follows Moderna’s halt to the construction of a €500 million plant in Kenya, although other schemes continue, such as plans including facilities in Rwanda, Senegal and South Africa, carried out by BioNTech. Producing more vaccines in Africa is a moral imperative, says Martin Friede, head of vaccine research at the WHO. Article in Lancet Americas: Corruption, the greatest threat to healthcare. The cases in Peru as a result of the covid-19 pandemic and in Brazil (Rio de Janeiro) are discussed. It seems to be demonstrated, analyzing the experience of the few countries in which cannabis consumption has been legalized for a few years, that its legalization produces an increase in consumption in adults.

In terms of International Health Policy, initiatives in the USA against Chinese biotech companies will harm American patients. The Biosecure Act, which gained bipartisan support in Congress, proposes ending government contracts with biotechnology firms that have agreements with Chinese companies as clients or suppliers. This can greatly harm Americans, since, for example, BGI (Beijing Genomics Institute) is the largest human DNA sequencer in the world and operates in 100 countries. Facilitates the manufacture of prenatal tests and other diagnostic tests. In the United Kingdom, Brexit has exacerbated drug shortages in pharmacies. This is deduced from the study by the Nuffield Trust, a prestigious British health think tank, which released a report analyzing the impact of Brexit on the health system. Also in the United Kingdom there is a report published by Reform, a British think tank committed to public services and the effectiveness of the State, proposing a major organizational change in the health system in England, trying to decentralize and abolishing NHS England, since it is considered that such a centralized system is preventing the transition towards a more preventive model, guided by local needs. The role of NHS England would be assumed by the Department of Health, although with a much more strategic vision. England (with around 57 million people) is considered to be the most centralized healthcare system in Europe, despite devolution processes in Scotland (5.4 million), Wales (3.1 million) and Northern Ireland (1.9 million). This same idea of the problems of large centralization of the NHS is held by Nigel Edwards, former chief executive of the Nuffield Trust and now senior associate. The House of Commons votes in favor of the ban on smoking for those born after 2009, despite the Prime Minister being met with the vote against more than 50 Conservative MPs. A controversial measure whose only precedent is New Zealand and was recently repealed by the new government. In Germany, a commission recommends that abortions be legalized in the first 12 weeks. Although abortions in Germany are regulated by a 153-year-old law and are illegal, in practice they are performed in an accessible way. It is assumed that the current law does not meet current international standards.

If we talk about National Health Policy (Spain), the Ministry of Health seems to focus on issues such as the promise to the white tides of the imminent hearing of the Public Management Law; while the Commissioner of Mental Health prepares a guide to reduce psychotropic drugs, as well as launching more than debatable messages such as that “long-term drug treatments kill. These people live 20 years less”, which generated a negative response from Dr. Celso Arango, from the Gregorio Marañón Hospital; or he tries to change the 24-hour guard system, without really knowing how; “green” anesthesia; announcements that possibly, as intended in the United Kingdom, smoking will be banned for those born after 2009; etc. It does not seem that a very varied set of measures on often non-central issues constitute a strategy of anything. While serious underlying problems remain or worsen, such as waiting lists, which in the Ministry’s last publication reached a record of more than 850,000 people waiting. The Zendal Hospital, of the Community of Madrid, admitted one patient a day in 2023. It is increasingly clear that this hospital, launched without a minimum professional planning project, is a clear example of bad governance. The WHO threatens to break its agreement with the Andalusian School of Public Health, if it is diluted in the new Health Institute. The entity warns that the bilateral agreement signed in 1989 is not “transferable” and that, unless it is negotiated again, the collaboration as an associated center “automatically comes to an end.” The plans of the Andalusian Government in relation to the prestigious Andalusian School of Public Health are difficult to understand. Possibly the most regrettable operation underway in public health in Spain at the moment are the famous OPEs. The temporality wants to be resolved with a system of coverage of places with regional calls, not participating in the selection of the professionals nor the hospitals nor, much less, the services involved. There is a risk of destroying the unit and the configuration of services, which in many cases took years to implement. A real shame, much to the taste of the more traditional administration and the unions. In this sense, the 76 service heads of the 12 de Octubre hospital, in Madrid, have sent a letter to the counselor, warning of the problem of disintegration of services as a consequence of the ongoing OPE. We must see, in this sense, the recommendations of the Commission for Social and Economic Reconstruction, in whose opinion approved in Congress, it is committed to a national qualification for medical specialists and local hiring. In the MIR call, the worst figure is for Family Medicine, with 459 free places in the first round, double that in 2023. Making family medicine attractive – salary-wise and professionally – is indeed an emergency to be addressed and a problem important. The newspaper El Mundo reports on the cheapest health insurance. From ASISA (25.99 euros/month) to Sanitas (51.68). In all of them, hospitalization is included, with some form of co-payment. If this isn’t a price war, it certainly looks a lot like one. It is not surprising then that there are problems with rates for hospitals and professionals.

As for Companies, internationally, funds are moving on the board of Novavax, after the failures in the covid vaccine. In terms of national information, AI will revolutionize mental health, generating 2.5 billion euros in Spain. The largest seller of flu vaccines in Spain entrusts its production to Rovi.

Biomedicine

Global Health

International health policy

  • USA
    • Philip Morris funds smoking cessation plans. Medscape, a leading health information company in the USA, is accused of having accepted courses financed by this company. The criticism is based on the tobacco industry’s history of ignoring scientific teachings about the dangers of tobacco (https://www.bmj.com/content/385/bmj.q830)
    • American movements against Chinese biotech companies will harm American patients. The Biosecure Act, which gained bipartisan support in Congress, proposes ending government contracts with biotechnology firms that have agreements with Chinese companies as clients or suppliers. This can greatly harm Americans, since, for example, BGI (Beijing Genomics Institute) is the largest human DNA sequencer in the world and operates in 100 countries. Facilitates the manufacture of prenatal tests and other diagnostic tests (https://www.economist.com/leaders/2024/04/18/americas-moves-against-chinese-biotech-will-hurt-patients-at-home)
    • Scientists miss action against bird flu outbreaks on American farms (https://www.nytimes.com/2024/04/19/health/bird-flu-usda-cattle.html)

National health policy

  • Central government initiatives
    • Sánchez announces the expansion of the basic screening portfolio from 7 to 11 detectable diseases (https://www.diariomedico.com/medicina/politica/sanchez-anuncia-ampliacion-cartera-basica-cribado-neonatal-7-11- detectable-diseases.html)
    • García announces to the white tides the imminent hearing of the Public Management Law (https://diariofarma.com/2024/04/11/garcia-anuncia-a-las-mareas-blancas-la-inminente-audiencia- of-the-public-management-law-of-the-sns)
    • The Commissioner of Mental Health prepares a guide to reduce psychotropic drugs, as well as launches more than debatable messages such as that “long-term pharmacological treatments kill. These people live 20 years less”, which generated a negative response from Celso Arango , from the Gregorio Marañón Hospital (https://www.diariomedico.com/medicina/politica/comisionado-salud-mental-prepara-guia-prescripcion-psicofarmacos-reducer-consumo.html)

Companies

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

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Summary

From the point of view of Biomedicine, chatbots (devices that interact by text or voice with people based on artificial intelligence), are increasingly used in healthcare. In the UK, the NHS uses them in Primary Care to triage patients. One of the great challenges of future health management is determining what will be done in person and what will be done remotely, on the one hand; and what activity will require the presence of a professional or when these chatbots can be used. Possible important advance in the treatment of hepatitis type 1. The EMA is studying the first drug that has been shown to delay the onset of symptoms. There are 100,000 people affected in Spain, many of them children. Teplizumab, the active ingredient, prevents T lymphocytes from attacking the beta cells of the pancreas, which produce insulin.

Regarding Global Health, France proposes to recognize abortion as a constitutional right. 60% of women live in countries where abortion is completely legal; and 40% do it in countries where it is prohibited or has restrictions. Not having access to a safe abortion can have negative health effects. Exodus of health personnel in sub-Saharan Africa, precisely the region of the world where health professionals in relation to the population move in lower numbers. Employment conditions are degraded locally, while developed countries, with strong demand, open their arms to them. This questions health personnel policies based on the importation of personnel from developing countries, as some in our country seem to sponsor. This is said with the utmost respect for the freedom of movement of citizens and workers.

Regarding International Health Policy, according to the magazine Health Affairs, negotiations continue to establish the price of 10 drugs for Medicare. This was contained in the Inflation Reduction Act and is, possibly, the most far-reaching healthcare measure approved during Biden’s presidency. The negotiations must be finalized by September 1, 2024, for implementation from 2026. The United Kingdom limits treatments to children and young people who want a sex change, in line with what has already been implemented by some countries. Northern Europe: Finland, Sweden, Norway, Denmark. The NHS will no longer offer puberty-blocking drugs. As for hormones such as testosterone and estrogen, which produce permanent physical changes, they will be prescribed with extreme care. Macron’s government approves the euthanasia bill (although this word will be avoided, using the concept of “helping to die”). It is worth highlighting the profound debate carried out in France at all levels in relation to this text, with President Macron personally intervening on multiple occasions. Just like in Spain, where it was approved as if it were a modification of the VAT of a product, avoiding all types of reports. Simultaneously, a 10-year palliative care strategy is approved in France, endowed with 1.1 billion euros. In Italy, AGENAS was born, a hospital performance evaluation system, launched by the National Agency for Regional Health Services. How good it would be for Spain to implement a similar tool, which would allow us to compare the performance of our health institutions.

If we talk about National Health Policy (Spain), it is important to highlight the achievements of our health system. According to a recent publication by “Our World in Data”, which analyzes mortality from all causes in all countries, in 2019 Spain is the third best-placed country in adjusted mortality per 100,000 inhabitants (385.9). Only surpassed by Iceland (348.0) and Japan (323.3). This concept of mortality adjusted for pathologies can be related to the activity of the health system. A great success, in which activity is Spain in the Top3? For her part, the minister of Health continues to announce measures. She promised a law limiting private management of public hospitals, using the well-known slogan “healthcare is not for sale, it is defended.” Although we understand that politicians speak for their parish and those statements may have a fireworks component, using that demagogic and populist slogan taken from the white tides is not up to the health debate that our country requires. On the other hand, what is proposed as a panacea is “direct public management”, as if there were not enough published evidence (Prof. JJ Martín, from the University of Granada, among others) of the worse performance of direct management compared to centers with legal personality and labor personnel. The document “Statistics of public health expenditure 2022” is published. Public health spending reached 92 billion euros in 2022, reaching 6.8% of GDP, increasing by 4.6% compared to the previous year. From 2019 to 2022, public health spending increased by 22.8%, an annual average of 7.6%. Although we are still far from the most advanced countries in Europe in terms of percentage of GDP dedicated to public health spending, there is no doubt that in this period the growth of this spending was much higher than that of general GDP. 40,000 healthcare workers will retire each year until 2026, according to a report by the Spanish Society of Public Health and Health Administration (SESPAS). Important planning problem that arises. Spain, the country in the world with the most Medical Schools per inhabitant. There are now a total of 50, just 15 years ago there were 28, a figure that will increase in the coming years: San Jorge (Zaragoza); Nebrija (Madrid), and Loyola (Seville). The Deans of Medicine and the State Council of Medical Students, against this exponential and uncontrolled growth. It is doubtful that Spain as a country has sufficient and trained teachers to attend to this proliferation of Medical Faculties, unless these faculties become a kind of academies for the MIR. This is an issue of the Faculties of Medicine where the desire for political success of some communities (which are responsible for approving the creation of a Faculty of Medicine) operates, together with the commercial interests of some private Universities. The IMAS Foundation proposes its digital medical history, which would incorporate data from different health and social service providers, information generated by portable digital devices, and measurements made by the patients themselves. And everything within reach of the user and the professionals with whom they want to share it. Excellent initiative, at the height of the times, a concept of history that is only for the public system, that only contains information from the health system and that cannot be carried by the patient and allows the use of it to whoever they consider, is no longer valid. your criteria. Santiago Dexeus, pioneer of sexual and reproductive health and one of the first defenders of the contraceptive pill in Spain, dies. He well deserves a national tribute.

As for Companies, internationally, Moderna is putting its plans to launch a vaccine plant in Africa on hold. In terms of national information, Sanitas increases its turnover by 12% and achieves record growth in policyholders after its agreement with Generali.

Biomedicine

Global Health

International health policy

National health policy

Companies

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

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Summary

From the point of view of Biomedicine, the report published by the French National Academy of Medicine on generative AI systems in health is worth highlighting. It makes 10 recommendations, the first of which is that all health professionals should be trained in the use of generative AI. It seems that anti-obesity medications (initially, anti-diabetes) may be the closest thing to a universal panacea. There is already evidence that they can have benefits in many other diseases: heart, kidney, liver, brain (Alzheimer’s and Parkinson’s), as well as other organs.

With regard to Global Health, concern continues over the difficulties of advancing the Pandemic Treaty. The Treaty aims to prevent governments, institutions and populations from the errors of the covid-19 pandemic. In this sense, a more than interesting article by Mariana Mazzucato on aspects related to innovation, intellectual property (IP), public/private collaboration and financing. The Lancet speaks out in an editorial against the use of starvation (the total lack of food and mass famine) as a weapon of war, as we have seen in the war in Sudan and currently in Gaza, where Israeli action is taking on dimensions of destruction of Gaza, with the consequent health and humanitarian problems. Prostate cancer cases will double between 2020 and 2040.

Regarding International Health Policy, the French Prime Minister, Gabriel Attal, proposes a fine of five euros for those who miss scheduled medical appointments. But possibly the most far-reaching news is President Petro’s actions in healthcare in Colombia, with the intervention of the two largest EPS (Health Promotion Entities). This breaks the approach of the Colombian health system based since 1993 on Law 100, which established public/private collaboration through the EPS, companies that received public aid and were in charge of providing health services to their insured population. There is no doubt that the proliferation of populist governments in Latin America is a threat against any form of public/private collaboration in healthcare, as is also the case in Chile where ISAPRES (private insurers that receive public aid) are also threatened. The universalization of health coverage – something absolutely defensible and one of the great advances of our time, today in full expansion – leads some to interpret this as a monopoly of health care by the State and even a colonization of the management model by the traditional Administration, thus breaking a desirable freedom of choice, as well as a certain competition for the coexistence of different management models.

If we talk about National Health Policy (Spain), the Interterritorial Council of the National Health System unanimously supports the Comprehensive Plan for the Prevention and Control of Smoking. However, the Plan is fundamentally a roadmap and a declaration of intentions, some of which will have to be materialized through laws, with the uncertainty regarding the approval of new laws generated by the situation of the current legislature. The plan aims to increase smoke-free spaces (not specified); avoid promoting tobacco products; access to smoking cessation programs; equate electronic cigarettes with conventional tobacco; and, increase taxes on tobacco. The most controversial thing may be to equate electronic cigarettes with conventional tobacco, since the risks and damage to health are not comparable. A recent article in the New England Journal of Medicine states that there is sufficient evidence to show that switching from cigarettes to e-cigarettes reduces exposure to tobacco toxins, reduces respiratory symptoms and reverses physiological changes related to smoking cigarettes. The Government’s Regulatory Plan for 2024 announces four laws in the health field: 1. statute-framework; 2. law of guarantees; 3. alcohol consumption prevention law; and, 4. law on public management of health services. Same comment regarding the uncertainty regarding the approval of laws. Among these laws does not appear that of the State Public Health Agency, already being processed in Parliament. Of note is the meeting at the Ministry of Health of a representation of the same with representatives of doctors who work for health insurers. Regardless of the outcome of this meeting, it was not common until now for the Ministry of Health to enter into the problems of private healthcare. But welcome if there is a change in this regard.

As for Companies, internationally, drug shortages have recently reached unprecedented levels in several European countries and last year reached a ten-year high in the USA. Regarding national information, Grifols admits changes in its debt level and Recoletas is expanding to several regions through its reproductive business.

Biomedicine

Global Health

International health policy

National health policy

Companies

7 days in healthcare (March 25th-31st, 2024)

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Summary

From the point of view of Biomedicine, it should be noted that possibly the next “boom” will be everything related to anti-aging therapies, an aspect to which the Financial Times dedicates an article, following the appearance of three books on the subject. . The Economist dedicates a lot of space in its latest issue to the issue of AI in healthcare, no less than an editorial and four articles. The conclusion is that AI will have a great impact on healthcare. However, as Eric Topol, the well-known cardiologist and health publicist, comments in another article in the Financial Times, “AI is very transformational, but these things always take longer than you initially think.” Nature magazine analyzes the reasons for optimism about cancer vaccines. Vaccines to treat, not to prevent.

Regarding Global Health, the WHO focuses on the millions of undiagnosed cases of tuberculosis, which compromise efforts to combat this disease. The WHO estimates that in 2023 there will be three million new cases not known to health services. Problems continue between developed and developing countries, which do not agree on the Treaty on the prevention of pandemics, proposed by the WHO as a goal for 2024.

In terms of International Health Policy, the King’s Fund and the Nuffield Trust, two prestigious British think tanks on health, analyze satisfaction with the NHS, which is the lowest in the entire history of this institution. Only 24% of citizens in England, Scotland and Wales are happy with the service, with waiting lists being the most common complaint. In France, the Sorbonne Faculty of Medicine and a former health minister propose “strong measures” to, they say, prevent the degradation of the health system in France. Of the three measures they propose, one of them has to do with the preservation of “medical time” (through non-medical assistants in consultation); and the other with the promotion of advanced practice nursing.

If we talk about National Health Policy (Spain), based on Primary Care analysis that is on the Ministry’s website, it is observed that people treated in primary health centers who earn less than 18,000 euros per year are medicalized more frequently, have prescribed more chronic drugs and consume more pills for pain, anxiety or depression. The Ministry of Health is studying allowing price competition between medicines so that generics can gain market share. This would affect generics and biosimilars, which would be cheaper than brand-name ones and it would be the patient who, if they wanted, would assume the difference. The situation in Spain of the same price for generics as for branded ones is unique in Europe. The objective is to stimulate the development of the generic and biosimilar industry and, ultimately, reduce the pharmaceutical bill for these medicines, in order to allow the incorporation of innovations. If it is carried out, it will be great news. Of note is the agreement signed between the Colleges of Pharmacists of the Basque Country and the Department of Health of that community, with the idea of facilitating the integration of community pharmacies as health agents in the health system. More than interesting is the article published in Human Resources for Health, and whose first signatory is Sara Calderón-Larrañaga, and which analyzes the reasons why primary doctors leave Spain. The work consisted of a survey, focus groups and interviews with 158 primary doctors who had left Spain. The causes of their departure were, in order of importance: insufficient salary, temporary employment, excessive workload, poor governance of primary care, lack of flexibility in the workplace and personal circumstances. There are the keys to a reform of Primary Care.

As for Companies, internationally, a cancer drug (Keytruda, from Merck-MSD), the best-selling drug in the world. In Spain, the historic achievements of Rovi, with a business approach that goes beyond covid. We must also highlight Vithas’ hospital commitment in Barcelona, where construction is underway.

Biomedicine

Global Health

International health policy

National health policy

Companies