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

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Summary

Biomedicine

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

Global Health

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

International health policy

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

National Health Policy (Spain)

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

Companies

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

Biomedicine

Global Health

International health policy

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

National health policy

Companies

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

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Summary

Biomedicine

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

Global Health

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

International health policy

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

National Health Policy (Spain)

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

Companies

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

Biomedicine

Global Health

International health policy

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

National health policy

Companies

 

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

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Summary

Biomedicine

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

Global Health

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

International health policy

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

National Health Policy (Spain)

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

Companies

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

Biomedicine

Global Health

International health policy

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

National health policy

Companies

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

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Summary

Biomedicine

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

Global Health

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

International health policy

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

National Health Policy (Spain)

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

Companies

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

Biomedicine

Global Health

International health policy

National health policy

Companies

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

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Summary

Biomedicine

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

Global Health

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

International health policy

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

National Health Policy (Spain)

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

Companies

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

Biomedicine

Global Health

International health policy

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

National health policy

Companies

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

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Summary

Biomedicine

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

Global Health

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

International health policy

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

National Health Policy (Spain)

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

Companies

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

Biomedicine

Global Health

International health policy

National health policy

Companies

 

 

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