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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 (September 12th-18th, 2022)

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Summary

From the point of view of biomedicine, immunotherapy (in colon cancer) and CAR-T therapies (in lupus) continue to expand their therapeutic possibilities. Advances against infections for resistant bacteria. Will there ever come a time when cancer can be diagnosed by a simple blood test? This possibility does not seem very remote, according to papers presented at the meeting of the European Society of Medical Oncology.

Regarding Global Health, an important work directed by Jeffrey Sachs and published by The Lancet on the delays and errors of both governments and the WHO in dealing with the covid pandemic, which could have produced 17.7 million of  deaths, many of them preventable.

Regarding international health policy, the WHO says that the end of the covid pandemic may be in sight, although at the same time a new variant (BJ.1) of covid is evident in Europe. Important debate in Europe (Scotland and France) on euthanasia and assisted death. The French Ethics Committee opens the door to this possibility. The financing of the American FDA was questioned, due to its great economic dependence on the pharmaceutical industry. Biden launches a speech commemorating Kennedy’s in 1962 when he decided to go to the Moon, but this time oriented towards the fight against cancer.

If we talk about national health policy (Spain), the PDeCAT presents an amendment to the entire equity law, which it accuses of interfering in regional powers and of confusing agreement with privatization. Surprising statements from the Ministry of Health in a parliamentary response, saying that its functions in relation to the waiting lists are only to inform and monitor, as if it did not have the possibility of signing agreements with the communities to address this problem or of launching other actions. Concern, there are even demonstrations in the street, of the relatives of the elderly admitted to residences. The Community of Madrid announces that it will reduce the waiting lists by half. Although we would like it not to be the case this time, this announcement is preceded by other similar ones from different governments, which always came to nothing in terms of effectiveness. The search for solutions by the Ministry of Finance to the MUFACE model, highly impacted by inflation, seems to recognize its underfinancing.

In the field of companies, from the international point of view, important success for Sanofi, with its new vaccine against bronchiolitis. In Spain, important corporate movements in Korian, HM Hospitales, Miranza and Ribera.

Biomedicine

Global Health

International health policy

National health policy

Companies

 

7 days in healthcare (September 5th-11th, 2022)

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Summary

From the point of view of Biomedicine, to highlight the work that shows an association between artificial sweeteners and increased cardiovascular risk. Also that air pollution causes lung cancer.

As far as Global Health is concerned, apart from the serious humanitarian crises in Pakistan and Somalia, the most promising is the new malaria vaccine, which could be operational as early as 2023.

Regarding international health policy, assisted suicide and euthanasia are news in Canada (where the rate of euthanasia is very high and there is concern) and in France (which is considering passing a law). Macron has launched a major national debate on this issue, following a report to appear next week from the Ethics Committee. This great debate on such a delicate subject was missed in Spain. Certain issues should not be subject only to conjunctural parliamentary majorities, but should be preceded by a great national debate. It is also worth mentioning that Chile rejected the draft Constitution in a referendum. According to an article published in El País, doubts about the possibility of choosing the health system (the continuity of the ISAPRES, as health insurers are called in Chile), is one of the causes of this rejection.

If we talk about national health policy (Spain), it should be noted that Aragón proposes a great debate on the efficiency of the National Health System, a brave and valuable initiative. It will first analyze the Aragonese health system, and then share that analysis with the rest of the autonomies. Also that the Ministry of Health promises to change the law to favor the local manufacture of medicines. It is also worth underlining the pronouncement of the Catalan Evaluation Agency, on the need for a state policy for the digital transformation of the health system and the promotion of telemedicine.

In the field of companies, from the international point of view, to mention the purchase of Signify a home care group by CVS (an American pharmaceutical chain), in a process in which Amazon also showed interest. In terms of news at the national level, to highlight the great investment of Novartis in our country.

Biomedicine

Global Health

International health policy

National health policy

Companies