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

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Summary

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

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

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

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

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

Biomedicine

Global Health

International health policy

National health policy

Companies

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

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Summary

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

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

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

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

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

Biomedicine

Global Health

International health policy

National health policy

Companies

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

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Summary

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

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

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

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

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

Biomedicine

Global Health

International health policy

National health policy

Companies

7 days in healthcare (March 18th-24th, 2024)

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Summary

From the point of view of Biomedicine, the transplant to a man of a genetically modified pig kidney stands out, a medical milestone that could lead to dialysis being declared obsolete, which would be an extraordinary advance and an improvement in the quality of life for hundreds of thousands of patients, currently dependent on the machine several times a week for their survival. Also notable is the beginning of a clinical trial on a vaccine for tuberculosis. The current BCG vaccine offers protection to infants and young children, but does not protect adults and adolescents from pulmonary tuberculosis. If the results are good, this vaccine can be transformative.

As far as Global Health is concerned, a study warns of serious declines in birth rates globally, which will mean that by 2050 it will fall below population replacement, which will have important social and labor changes.

Regarding International Health Policy, a great paradox in the USA, although abortion is prohibited in 14 states and restricted in many others, in 2023 there were more abortions than ever, many of them non-instrumental and through the abortion pill, already responsible of 60% of abortions. China is facing a population decline, a phenomenon that has already begun. The one-child policy, in force for 36 years, is only one of the causes of this phenomenon. The European Union is advancing in the approval of pharmaceutical legislation, contemplated with reluctance by both the EFPIA and Medicines for Europe (the two large European pharmaceutical associations). The Lancet sees the upcoming European elections as an opportunity to put health policy higher on the EU agenda.

If we talk about National Health Policy (Spain), three important initiatives of the Ministry of Health: anti-smoking plan, modification of the medical guard regime and waiting lists. In all three cases there may be problems due to the powers and regulations of the autonomous communities. From the point of view of the regions, the OPE of Asturias stands out, which brings together 19,000 candidates. Although logically, temporality was and is a serious problem of public healthcare, which needed a solution, the way to do it through macro-OPE’s (consolidating the position in property, and with hegemony of the administrative and union logic, above the professional and autonomy of organizations) does not seem to be the best. This type of mass examination is more reminiscent of previous calls for the “military service”, when it was in force, than the professional selection for complex organizations, in which the professional qualification, the needs of the different organizations, the projects of the services, etc. should be taken into account.

As for Companies, on an international level, China is seen as the large market for anti-obesity drugs. Bayer wants to renew its portfolio, entering into cell and genetic therapies. As for Spain, the CNMV has released its report on Grifols, with several objections to its accounts. Faes Farma is preparing to grow in Latin America. For its part, DKV, the health insurer, wants to concentrate on group insurance.

Biomedicine

Global Health

International health policy

National health policy

Companies

7 days in healthcare (March 11th-17th, 2024)

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Summary

From the point of view of Biomedicine, a revolutionary blood test stands out that manages to detect colon cancer in early stages and, consequently, reduce the number of deaths. Early diagnosis of this cancer can prevent most deaths, possibly 73% of them. But this requires regular screening in adults. There are two options: colonoscopy every ten years or fecal test every three. Both are unpleasant procedures, the first involving the introduction of a tube into the rectum and the second manipulating the stool itself. But something much simpler is on the horizon: a simple blood test. AI can revolutionize clinical trials, a fundamental basis for the progress of medicine. Just as Moore’s law was known in computing (the information capacity in a circuit grew every two years and at a lower price), in clinical trials in 2012 Eroom’s law was defined, which is just the opposite, since in the 60s In previous years, the number of drugs placed on the market per 1 billion invested was reduced by half every nine years. Half of this time and money was dedicated to clinical trials. AI can disrupt this law by helping to manage clinical trials, including developing protocols, recruiting patients, and analyzing data.

As far as Global Health is concerned, alterations of the nervous system are the most frequent cause of poor health. Neurological diseases such as stroke, dementia and migraine constitute the largest global cause of disease burden. This is related to increased life expectancy. However, if we adjust the data with age, we see that between 1990 and 2021, the number of neurological problems decreased by 27% and the number of deaths by 34%, in that 31-year period. Impressive Egypt success story with hepatitis. In Egypt at the beginning of the 20th century, most of the population worked on farms in contact with the Nile, a source of schistosomiasis, which affected 60% of the population. A treatment was implemented, but without single-use needles. This generated a very high prevalence of hepatitis C, which was reduced in just a decade from 2014. The secret was the free tests and treatment for everyone, with Gilead medication, after having negotiated the price with this company.

In terms of International Health Policy, the NEJM analyzes the effects of vertical integration in American medicine. Vertical integration (purchase of medical practices by hospitals) is unstoppable in the USA. We don’t know the consequences well. In theory it should improve coordination, facilitate the exchange of information and develop economies of scale. But, in practice, what has been seen is an increase in prices. It is urgent to study the consequences of this phenomenon. Macron, after a broad national debate, which included a citizens’ convention, supports the law on the end of life, which must still be approved in Parliament. An impressive debate took place in France on this topic for several months, just the opposite of what happened in Spain where such a transcendental issue was processed as a bill (avoiding the opinions required by the bills) and with hardly any national debate, as if it were a question of modifying the VAT on some product. Agreement in the EU for the regulations on the European Health Data Space, which will allow access to clinical information to any EU patient in all the countries of the Union, as well as the use of this information for research. A great step that, however, will take time to implement, given the very different and heterogeneous development of healthcare digitalization in EU countries.

If we talk about National Health Policy (Spain), the debate continues on the purchase of masks during the pandemic, another example of the more than deficient management of Covid-19 that occurred in Spain. The Minister of Health presents her plans in the Senate. Ambitious battery of health measures: mental health; Public Health Agency; climate change; smoking, sexually transmitted diseases; waiting lists, among other issues. We will see how this agenda progresses, since changes in healthcare are never easy. The health insurers involved in MUFACE (Adeslas, Asisa and DKV) request a renewal of the contract admitting 20% less of the public sector capital without pharmacy, which would mean an increase of 50% on the current capital. They also ask for some system of indexing the capital to the evolution of the public sector. Possibly the extension of the budgets represents an obstacle to the renegotiation of the agreement. Interesting initiative: the Council of Ministers approves a commercial pioneer of advanced therapies with public/private capital, whose promoter and shareholder is the CDTI (50% of the shares), as well as Insud and Rovi (25% each of them). The goal is to develop advanced therapies. It is included in the PERTE and, together, will mobilize 74 million euros.

As for Companies, internationally, recovery of mergers in the pharmaceutical industry in 2023. Psychedelic therapies, in the focus of investors. At the national level, AstraZeneca’s big commitment to Catalonia, where it will invest 1.3 billion until 2027.

Biomedicine

Global Health

International health policy

  • USA
    • The unknown health of the candidates for President in the USA. Everything is based on speculation. There is no official system to know the real health situation of either the presidents or the candidates. An attempt to create an expert body on the topic failed as recently as 2017 (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00528-2/fulltext?rss=yes)
    • The Lancet analyzes Biden’s health priorities in the State of the Union address. Commitment to women’s reproductive health; lowering drug prices, expanding Obamacare, preventing gun violence, among the most important priorities (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00529-4/abstract?rss=yes)
    • The effects of vertical integration in American medicine. Vertical integration (purchase of medical practices by hospitals) is unstoppable in the USA. We don’t know the consequences well. In theory it should improve coordination, facilitate the exchange of information and develop economies of scale. But, in practice, what has been seen is an increase in prices. It is urgent to study the consequences of this phenomenon (https://www.nejm.org/doi/full/10.1056/NEJMp2313406)
  • France
    • Macron supports the “end of life” bill, which will be discussed by Parliament in May. The term “assisted in dying” is used, rather than euthanasia or assisted suicide, which are considered more controversial. If approved, France will join the few European countries (Switzerland, Holland, Belgium, Spain) that have regulated this issue (https://www.ft.com/content/8129ad50-ae82-4cf9-8b06-cdd196cc57ef)

National health policy

  • Advanced therapies trading company

Companies

7 days in healthcare (March 4th-11th, 2024)

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Summary

From the point of view of Biomedicine, the possibility of making replicas of fetal organs stands out, which could facilitate fetal treatments without putting the pregnancy at risk. The Lancet publishes an editorial and several articles on menopause, a natural state in the aging process of women, often overmedicalized. FDA delays approval of Lilly’s long-awaited Alzheimer’s drug.

As far as Global Health is concerned, there was a shortage of cholera vaccines, at a time with many outbreaks, even in countries where it had been eradicated. Great absolute growth in the global figures of the scourge of genital mutilation in women, especially in Africa, but also in Asia and the Middle East. First published evidence that nanoplastics harm human health. Big problem with the lack of health professionals in Africa, which is proposed to be compensated as a quick solution with community health workers.

Regarding International Health Policy, in the United States President Biden gave his fourth and final State of the Union address. Surprising was a particularly energetic and mentally agile Biden, who maintained the interest of a vibrant speech during its more than 60-minute duration, even interacting with the Republican seats. Much of his speech was dedicated to health, undoubtedly a star issue in the next elections: the price of medicines; women’s reproductive rights, abortion and in vitro fertilization; the extension of Obamacare, a law he defended, during his term; and care for the elderly, both at home and in nursing homes, were the topics discussed. In France, President Macron has decided to make abortion a constitutional right, surprising the enormous support obtained on the right and left in the National Assembly: 780 votes in favor compared to only 72 against.

If we talk about National Health Policy (Spain), In its “Declaration of Córdoba” the Popular Party presents 4 proposals regarding health. The rural environment is left without doctors, according to the Spanish Society of Family and Community Medicine, saying that of the 11,000 rural doctors, half will retire in the next 5 years and it does not seem easy the arrival of new doctors. A specific health problem of one of the great gaps in our country: that of the rural-urban world. The Minister of Health makes two big promises: the decarbonization of the health system and the creation of an observatory on corruption in health (in response to problems with the purchases of masks and equipment during covid). Interesting, but we will have to see if these promises become realities. The PP will bring the ELA law to Congress.

As for Companies, at the international level, it is increasingly clear that the Novo Nordisk-Lilly duopoly in addressing obesity will be broken, giving way to other agents, given the large number of clinical trials on the subject. According to IQVIA, pharmaceutical companies will lose 6 billion a year until 2028 due to the expiration of many patents, converting many of these medications to generics and biosimilars. This loss will try to be compensated with the launch of new drugs, since it is estimated that between 2024 and 2028 there will be 175 new launches, especially in the field of oncology and neurology. Regarding national news, Grifols has revalued on the Stock Market, after the publication of its audited accounts without qualifications. Loss of 600 million of the insurance companies that operate in MUFACE (Adeslas, Asisa and DKV) during the period of validity of the current three-year agreement. It is evident that public/private collaboration is unviable if it condemns the participating companies to losses without any prospects.

Biomedicine

Global Health

International health policy

National health policy

Companies

 

7 days in healthcare (February 26th-Mars 3rd, 2024)

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Summary

From the point of view of Biomedicine, certain advances stand out in the search for a treatment for multiple sclerosis, a disease that affects 1.8 million globally and for which at this time there is no effective therapy. As announced by the president of the Spanish Society of Nephrology, the new drugs will allow many cases of dialysis and transplant to be avoided.

As far as Global Health is concerned, the most worrying thing is the poor perspectives observed regarding the pandemic treaty, the objective that the WHO had proposed for 2024. The obstacles are the accumulation of vaccines and the sharing of knowledge about them, problems of rich countries and companies, respectively. The Lancet warns about the need to strengthen cervical cancer screening, which continues to cause hundreds of thousands of deaths a year, especially in low- and middle-income countries. Warning about ultra-processed foods (cereals, protein bars, soft drinks, and fast food) linked to 32 harmful health effects, including increased risk of vascular disease, cancer, type 2 diabetes, mental illness and premature death.

In terms of International Health Policy, a very serious problem with fentanyl in the United States, which in the last twelve months until September 23 had caused 105,000 deaths in that country. Until now, the policy was aimed primarily at preventing the entry of drugs; some extremist politicians had even proposed invading Mexico to put an end to the gangs. With the current Administration, efforts are directed more towards discouraging its use and treating addicts. Big problem for Republicans in the USA with the decision of the Alabama Supreme Court to declare frozen embryos as “extra-uterine children”, with all the obstacle that this has for the popular procedure of in vitro fertilization, so widespread in the United States as in other developed countries. This Alabama decision seems like a gift to Democrats: “First it was abortion, now it is in vitro fertilization and then it will be birth control,” warned Hillary Clinton. Even Trump was forced to distance himself from this decision. In France, the National Assembly is putting pressure on the pharmaceutical industry regarding the shortage of medicines, forcing laboratories to have a four-month reserve of “medicines of high therapeutic interest.” In order to strengthen drug R&D, the European Union is considering “giving away” a year’s patent to those drugs whose research has been carried out in Europe.

If we talk about National Health Policy (Spain), the current Ministry of Health, unlike previous Ministries, wants to get involved in the problems of the SNS, while the previous ones wanted to get involved as little as possible, with the argument that “everything was transferred” . This attitude seems, in principle, positive for the SNS. Another thing is priorities. It seems that among these are the suppression of 24-hour medical guards; addressing waiting lists; and, the State Public Health Agency. Regarding the first issue, the challenge is formidable, since medical guards, regardless of whether they are necessary or not, have become an important salary supplement. It is impossible to address this issue without considering the complements of medical personnel, which is no small issue. Regarding waiting lists, aware that their management corresponds to the communities, it seems that they want to establish a kind of “best practices”, with economic incentives for the communities that apply them. Not an easy matter either. And as for the State Public Health Agency, the ministry seems to have reached an agreement with the PNV and Junts, for the withdrawal of their amendments to the law. Let us hope that this agreement does not go against the strength and operation of the new Agency. For its part, SESPAS, the Spanish Society of Public Health, has published an interesting document on the characteristics that this body should have, with 11 very interesting recommendations. The Economic and Social Council of Spain (CES) publishes a report on the health system. Although the report is well prepared, it is difficult to find anything new in it that has not already been said or any innovative proposal. Taking advantage of the day of rare diseases (although it is now preferred to call them minority) the Spanish Association of Orphan and Ultra-orphan Drug Laboratories releases a report on the situation of these drugs in Spain. Much has been improved, although there is still room to advance. Both the La Paz hospital in Madrid and the Sant Joan de Deu in Barcelona launch special units to treat this type of illness.

As for Companies, on an international level, the Danish Zealand Pharma, a new relevant player in the field of obesity. On the national level, Viamed will launch a comprehensive unit for women in its hospital in Tarragona. New punishment in the Grifols Stock Market.

Biomedicine

Global Health

International health policy

National health policy

  • 24 hour guards
    • The Ministry of Health wants to end 24-hour medical guards this term. The Ministry will study the legislative framework that the autonomous communities can apply. The aim is to organize it by hospitals and without losing salary, since the guards can represent up to a quarter of the professionals’ salary. The challenge is formidable, since it must be implemented by the autonomous communities, it involves a reorganization of hundreds of services, an increase in staff and addressing the complements of medical personnel (https://www.eldiario.es/sociedad/sanidad-quiere-finish-medical-guards-24-hours-we-will-give-you-answer-legislature_1_10957897.html)
  • Economic and Social Council (CES) report on the health system
    • Report from the CES on the health system. Among the recommendations it supports public health and prevention; specify and update the SNS service portfolio; make Primary Care the true axis of the system; confront waiting lists; strengthen the comprehensive mental health model; enhance the quality of pharmaceutical provision; promote the planning and reinforcement of human resources of the SNS; reinforce patient participation; contribution of the private for-profit and non-profit sector; improvement of system management and evaluation (https://www.ces.es/documents/10180/5299170/INF_012024.pdf)

Companies

 

 

7 days in healthcare (February 19th-25th, 2024)

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Summary

From the point of view of Biomedicine, the mega-study of 250,000 genomes made public by the National Health Institutes of the USA stands out. This is in line with carrying out genome studies combining it with electronic medical record data from very large groups initiated in the United Kingdom by Genomics England and also developed in Iceland and Japan. A very promising way to improve knowledge of many diseases. New treatments for type 1 diabetes, based on the transplant of insulin-producing beta cells, obtained from stem cells, neutralizing the immune reaction. Gene therapy is the great promise for many rare diseases, currently without treatment. The problem to be solved is the high price of the treatments. At the present time, saying breast or prostate cancer is almost saying nothing. The treatment of tumors is no longer based on their anatomical origin, but rather on their molecular characterization. Bispecific antibodies that act on two targets at the same time, useful in hematological and solid tumors. The FDA approves a drug to prevent the amputation of fingers and limbs.

As far as Global Health is concerned, long covid was understood as a sequel to covid, but an article in The Economist states that covid is not the only infectious disease that leaves pathological conditions that are difficult to label. An article in Health Affairs places the solution to the obesity epidemic as a joint effort of prevention and treatment.

In terms of International Health Policy, more than half of USA’s rural hospitals do not offer childbirth services, which means that pregnant women have to be treated in centers located 30-40 minutes from their home, sometimes more. This is related to the high maternal and infant mortality in the USA, higher than that of most developed countries. The 4th anniversary of Brexit encourages the debate about whether it was good or bad for the National Health Service. The truth is that the NHS is worse now than before Brexit (waiting lists, professional strikes, etc.) and the difficulty of recruiting health professionals from the EU has increased. The investigation was also damaged. Increasing funding for the NHS was one of the arguments used by Brexiteers. France addresses the carbon footprint in the health system, within the general “France Nation Verte” program. Germany legalizes recreational cannabis, with one of the most liberal laws in Europe, after Malta and Luxembourg. More than controversial attempt in Germany to take control of non-communicable diseases from the Robert Koch Institute, one of the most prestigious organizations in German health, to give it to another organization, created as a result of covid. The European Medicines Agency recommends approving a drug against ALS.

If we talk about National Health Policy (Spain), as a result of a specific scandal, the entire problem of purchasing masks and other materials during covid is introduced into the national debate. Precisely everything related to the purchase of these materials was somewhat overlooked by the report “Evaluation of the Performance of the Spanish National Health System in the face of the covid-19 pandemic”, dated April 30, 2023, although published by the Ministry of Health in December of that year. It is already serious that an issue such as the problems of purchasing materials are not analyzed in the report, as if this had not been one of the most serious problems in the management of covid. The PNV requests the return of the text of the Public Health Agency law. That this law was going to have problems with the nationalist parties, always opposed to the creation of cohesion bodies in the National Health System, was something known. Surely this will mean delays in the appearance of the law and, what may be more serious, affect its content and functions. There is a risk that the announced Agency will be little more than an empty shell. The government creates the Extreme Temperature Observatory to analyze the health impact of climate change. The Basque Country approves a new Mental Health Plan 2023-2028. The EU denounces the high level of interim contracts in the Spanish public health system. At the current time, 43% of contracts are interim.

As for Companies, internationally, AstraZeneca reveals successes in the treatment of lung cancer. Indian drugmakers make versions of Novo Nordisk’s anti-obesity drug. At the national level, Sanitas intends to open a new hospital in Barcelona. Fever of construction of private hospitals in Valencia: Vithas, Quirón, IMED and Ascires in that race.

Biomedicine

Global Health

International health policy

  • United Kingdom and the National Health Service
    • Brexit and health. January 31, 2024 was celebrated as the 4th anniversary of the United Kingdom’s effective departure from the European Union. The Lancet asks whether or not that was good for the NHS, with two possible answers: the easy one, which says there is no evidence; and the difficult one, which confirms that the NHS is in fact worse now than before, as demonstrated by the long waiting lists and the continuous strikes by health professionals. What is certain is that it has become difficult to recruit doctors from the EU. At present, the majority of foreign doctors hired in the NHS are from outside the EU. Research plans were also negatively altered. (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00157-0/abstract)
    • The government changes its policy and plans to double the number of medical students in 2031 (https://ground.news/article/government-u-turn-on-plans-to-double-number-of-medical-students-in-england)

National health policy

Companies

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

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Summary

From the point of view of Biomedicine, as is known, most rare diseases have no treatment, although this situation will surely be overcome in the not too distant future. A new drug (prozelimab) against the rare Chaple disease. A trial offers hope that a jab could prevent rheumatoid arthritis, the disease that affects 18 million people globally. Chances of a blood protein test warning about the onset of Alzheimer’s disease up to fifteen years in advance. A new powerful antibiotic (cresomycin), hope for antimicrobial resistance, which globally causes about five million deaths a year.

Regarding Global Health, despite the fact that 2021 marked the 100th anniversary of the appearance of insulin, many diabetes patients still do not have access to it. Important article in the New England Journal Medicine about e-cigarettes. There is sufficient evidence to show that switching from cigarettes to e-cigarettes reduces exposure to tobacco toxins, decreases respiratory symptoms, and reverses physiological changes related to cigarette smoking. There is not enough evidence that e-cigarettes are a good method to quit smoking.

In terms of International Health Policy, an unexpected consequence of the ruling of the United States Supreme Court, granting states the possibility of legislating on abortion, what was widely used to prohibit or restrict it: the taking of prescribed abortion pills by telemedicine and received by mail is a safe and effective method, according to a study. The European Commission approves the first gene editing treatment, in this case for beta thalassemia and sickle cell anemia. HERA (Health Emergency Preparedness and Response Authority) launches the Critical Medicines Alliance. It is said that this Alliance will contribute to changing the way medicines are produced and purchased in Europe.

If we talk about National Health Policy (Spain), there is great commotion in the sector as a result of the statements by Vice President Yolanda Díaz that she is negotiating to introduce in the budgets the modification of the health VAT from 0% to 21%. Regardless of the viability of this proposal, could it be considered whether this is the best way to make policy? Any study on the impact on the sector? Any previous negotiations with the health ecosystem? Although the Ministry of Health usually intervenes little in economic matters – remember that all the cuts during the financial crisis were not even discussed in the Interterritorial Council of the National Health System – this is a major issue that well deserves a position. and an analysis by the Ministry of Health. Asturias regulates financial compensation to professionals (442 euros for four hours of surgical activity and half for consultations for doctors) for extension of working hours to address the serious problem of waiting lists. Family doctors report a deficit of 2,600 professionals in the next year. As a consequence of the European Plan against Cancer, the launch of the first nine Comprehensive Cancer Centers in Spain is announced. The project is led in Spain by the Vall d’Hebron Hospital and the National Institute of Oncology.

As for Companies, on an international level, the British consulting firm Clarivate analyzes the 13 disruptive drugs for 2024. Oncology drugs predominate, although there is also the vaccine against respiratory syncytial virus and a new drug against COPD. At the national level, the growth of the egg freezing business in Spain is confirmed. It seems that the HIPRA vaccine is going to end up in the trash. There is nothing special, since failures are inherent to business, especially in an area as difficult as biotechnology. However, some excessively triumphalist government demonstrations could have been avoided.

Biomedicine

Global Health

International health policy

  • United Kingdom and the National Health Service

National health policy

Companies

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

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Summary

From the point of view of Biomedicine, the first effective medication against endometriosis, the growth of the mucosa that internally lines the uterus in other parts of the body, which produces serious disorders, is on the horizon. The Lancet insists that population screening, including genomic screening, requires robust evidence. Population screenings generate considerable expenses, in some cases they are not risk-free and can generate false expectations, so only the most proven ones should be launched. Obesity drugs show other superpowers. They seem to have the ability to control inflammation, including brain inflammation. In this way, it is thought that they may be useful in certain neurological diseases, such as Parkinson’s or Alzheimer’s.

As far as Global Health is concerned, malaria vaccines, currently in use in Africa, are one of the great current tests of Global Health. An article in The Lancet criticizes the WHO’s desire to assimilate policies on tobacco products with those on e-cigarettes. For the author this is a retrograde position, since they are not comparable products in terms of the damage they cause. It is said that the focus should remain on what is the main public health problem: the harmful effects of tobacco consumption. Some directors of scientific advisory committees on covid sign an article in The Lancet, with general recommendations for these committees. Among the signatories is Fernando Simón, whose role in Spain was highly questioned and criticized.

Regarding International Health Policy, British experts from the Academy of Medical Sciences warn of the decline in the level of health of children in the United Kingdom. Due to its importance in the Spanish debate, we simply have to mention that the French Social Security agreed to raise the price of consultations for liberal practice general practitioners to 30 euros per consultation.

If we talk about National Health Policy (Spain), after the monographic meeting of the Interterritorial Council of the SNS on Primary Care, it was agreed, among other things, that the government, after checking the teaching capacity by the autonomous communities, will increase the number of places in training for primary care, although it is simultaneously reported that up to 90% of those who do this specialty leave it for various reasons, to move to the emergency room, to do another specialty or to go abroad. Publication of the Health Observatory (Ministry of Health-CIS) corresponding to 2023. The time to be seen in primary care is very striking, since 70% of patients wait nine days to be seen. The Department of Health of Catalonia addresses the places that are difficult to fill in Primary Care, after identifying 73 primary care teams with these characteristics. Design an incentive program. Among the economic ones are 3,500 gross euros per year for doctors, which may seem little since it represents just over 200 euros net per month, although the Metges union considers it a big step. ASPE publishes, in collaboration with a team from the Complutense University of Madrid, a study on MUFACE, joined by the IDIS Foundation, which calls for a PP-PSOE political agreement and a review of the governance of the model. It is also made public that the insurers that are in MUFACE (Adeslas, Asisa and DKV) already assume losses of 200 million with the current agreement. This is difficult to maintain since private companies in public/private collaboration can be asked to innovate, offer high quality, invest or even, with a long-term perspective, take short-term losses, but not that they lose money continuously and indefinitely, since the possibility of that collaboration is put at risk. Osasunbidea (the Navarrese Health Service) opens, through the intervention of the LAB union, a file on several doctors for making public and private practice compatible, without giving up a supplement. It seems like a debate from another era. Furthermore, there are great differences in the application of this regulation in the national territory. Therefore, a strict approach to incompatibility is only being followed in Navarra and Asturias. A group of Catalan health workers asks to expel another group of Spanish speakers, a notable example of intransigence, regardless of the dubious legality. Another of the conclusions of the Ministry’s Health Observatory is the great growth of private insurance, which went from 6.5% of the population in 1995 to 30.9% in 2023. The great leap occurred in the last decade.

As for Companies, at the international level, Big Pharma still needs successes in clinical trials to compensate for the loss of patents. At the national level, Magnum Partners is preparing to launch a premium aesthetic medicine group. The giant DomusVi offers the largest portfolio of nursing homes in Spain for sale.

Biomedicine

Global Health

International health policy

National health policy

Companies