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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 (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