Posts

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 (December 4th-10th, 2023)

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Summary

From the point of view of Biomedicine, Nature magazine analyzes the clinical trials that will shape medicine in 2024, including genetic editing for hypercholesterolemia; AI for early diagnosis of lung cancer; HIV vaccines; stem cells for Parkinson’s; the use of machine learning for patient triage; conjugated antibodies for brain metastases; and, computed tomography for lung cancer screening. The New England Journal of Medicine analyzes whether clinical trials with xenotransplants should be “liberalized” in the absence of human donors, especially in the United States.

Regarding Global Health, at COP28, 124 countries, including Spain, sign a Declaration on Climate and Health. It remains surprising, however, that the president of the COP28 meeting, held in Dubai, is the president of that country’s state oil company, which did not stop expressing its skepticism regarding decarbonization actions. On the other hand, populist leaders around the world (Wilders, Milei, Bolsonaro, Trump) have made climate change denial an electoral platform. Decline of AIDS worldwide, particularly in sub-Saharan Africa.

In terms of International Health Policy, the White House creates an Office for the Prevention of Firearm Violence. Large drop in state health insurance policyholders in China, the largest health insurance organization in the world. In the United Kingdom, the Tony Blair Institute for Global Change analyzes the high and increasing cost of being overweight. Many Britons, despite their adoration of the NHS, choose to pay for certain interventions and procedures, in order to avoid the waiting list. In that country, this form of payment for certain actions is more common than insurance, which is expensive in Britain. Germany announces a plan to strengthen the pharmaceutical industry. It seems that the promotion of research and production in the country will be the main axes. The European Union definitively approves the AI law, the first law in the world on this subject. Without a doubt, it will have a great impact on health.

If we talk about National Health Policy (Spain), after the constitution of the writing team appointed by the Ministry of Health in October 2021, 2023 is about to end without the official report on the management of the pandemic having been made public, which which puts us behind many countries that have already published analyzes and reports. On the other hand, it does not seem that, contrary to what was done in other countries, such as the United Kingdom, where even Boris Johnson had to appear, the Spanish commission has sought the opinion of many actors. Surely the delay in publication could come from the problems of managing the pandemic in our country: two confinements declared unconstitutional by the Constitutional Court, delay in decision-making, high mortality figures at the beginning, high mortality among professionals, serious problems in purchasing supplies, etc. The Minister of Health takes her first steps, having to face in the coming weeks the problem of the lack of doctors in Primary Care. In Asturias, the autonomous community will dedicate 57 million extra hours for professionals to address the problem of waiting lists. A measure that seems reasonable and that overcomes the criticism of the so-called “peonadas”, as if activity in the public sector could not be controlled.

In the field of Companies, on an international level, Roche is jumping on the obesity bandwagon, following moves in this direction by NovoNordisk, Lilly and AstraZeneca. In our country, Ribera is finalizing the purchase of IMSKEN, an important trauma hospital in Valencia. The bankruptcy administrator and creditors are demanding the seizure of KKR, which they accuse of the bankruptcy of Dentix.

Biomedicine

Global Health

International health policy

  • China
    • The Chinese state health insurance, the largest in the world with 1.3 billion insured, loses tens of millions of members. In 2022, 19 million people were no longer covered, an unprecedented drop. It is blamed on the rise in premiums and co-payment increases and the decline in household income, https://www.ft.com/content/0ef68e30-bbe7-4b6e-8d17-479a552be994

National health policy

  • Lack of professionals in Primary Care

Companies