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

/in /by

 

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)

/in /by

 

Summary

Biomedicine

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

Global Health

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

International health policy

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

National Health Policy (Spain)

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

Companies

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

Biomedicine

Global Health

International health policy

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

National health policy

Companies

 

 

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

/in /by

 

 

Summary

Biomedicine

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

Global Health

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

International health policy

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

National Health Policy (Spain)

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

Companies

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

Biomedicine

Global Health

International health policy

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

National health policy

Companies

 

 

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

/in /by

 

 

Summary

Biomedicine

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

Global Health

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

International health policy

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

National Health Policy (Spain)

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

Companies

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

Biomedicine

Global Health

International health policy

National health policy

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

Companies

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

/in /by

 

Summary

Biomedicine

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

Global Health

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

International health policy

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

National Health Policy (Spain)

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

Companies

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

Biomedicine

Global Health

International health policy

National health policy

Companies

 

 

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

/in /by

 

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)

/in /by

 

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)

/in /by

 

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)

/in /by

 

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)

/in /by

 

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