Posts

7 days in healthcare (April 22nd-28th, 2024)

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Summary

From the point of view of Biomedicine, AI makes it possible to detect the origin of metastatic cancer. An algorithm examines images of metastatic cells to identify the primary location of the tumor. Currently the origin of up to 5% of all tumors cannot be identified. If this is confirmed, the concept of “metastasis of unknown origin” will disappear. Many mental illnesses have body triggers. Evidence is accumulating that a host of infections can activate conditions such as obsessive-compulsive syndrome, anxiety, depression and even psychosis. This finding can improve many psychiatric treatments. The EU approves a new antibiotic to track the growth of resistant bacteria. It will be used in pneumonia and urinary tract infections, representing an advance in the treatment of these bacteria. Health politicians are trying to introduce incentives for the development of these antibiotics linked to bacterial resistance.

Regarding Global Health, new publication of the European Observatory on Health Systems and Policies: health in all policies. The philosophy is to move from health in all policies to health through all policies. Smoking bans are coming. Countries are moving forward to ban tobacco use and vaping, which can save thousands of lives and billions of dollars. The WHO estimates that tobacco use costs the world $1.4 trillion each year in health spending and reduced productivity. The British initiative to ban tobacco consumption for those born after 2004 is very ambitious and would mean creating a smoke-free generation by 2040. Vaping is already more common in 2023 than smoking among young people, and its damage goes beyond lung and brain damage, according to a report from the University of Glascow, commissioned by WHO-Europe. Nicotine can have long-lasting effects on the adolescent brain. The upcoming ban on disposable vapes, for example in the United Kingdom, Belgium, France or Spain may not be enough. The WHO is concerned about the alarming consumption of alcohol and electronic cigarettes among adolescents, between 11 and 15 years old.

Regarding International Health Policy, National plan on waiting lists in Sweden. Waiting times have always been a problem in that country, with great disparities between regions and between different parts of healthcare. The plan seeks to identify areas with excess capacity in the country, allowing faster access to those waiting. The EU presents the Critical Medicines Alliance as a response to shortages. It is a consultative body to identify priorities for action and propose solutions. The Alliance will last for five years. On the part of Spain, among other entities, there will be the General Council of Pharmaceutical Colleges, Farmaindustria and the Spanish Society of Hospital Pharmacy. The European Parliament approves the European Health Data Space (EEDS), which will allow the primary (for care) and secondary (for research) use of health information. Secondary use for commercial purposes will not be permitted. Among companies, there is great concern, since they are above all concerned about, for example, “the voluntary acceptance of users.”

If we talk about National Health Policy (Spain), the competition for doctors to be permanent threatens the large hospitals in Madrid (and, without a doubt, in other communities). In the Community of Madrid there are more than 6,000 specialists who are involved in these stabilization processes. Logically, the problem is not stabilization, but two circumstances: that the solution is to transform the interim workers into statutory ones (wouldn’t it have been possible to favor an indefinite employment contract?) and, above all, that the selection is made without the intervention or of the hospital managements, nor of the services, nor of the professionals. A telematic system will be used, in which vacancies will appear to choose from. That method is incredible in the 21st century. Health outbreak against the norm that would allow a Basque MIR, by the highest representation of doctors and nursing. What is considered an unprecedented attack on the fairness of the SNS. The homogeneity in obtaining degrees and the mobility of professionals between the National Health System seemed to be one of the attributes of our health system. The Valencian Community will replace 1,800 professionals in Manises (who will be treated as statutory) and will create 400 new positions. It is difficult to understand that the statutory regime is the solution and that 400 more professionals are needed to do the same. The IDIS publishes its annual report, which is now called “Private Health Sector Observatory 2024”, maintaining the subtitle of “adding value”. This report is a very relevant contribution to the knowledge of a part of the health sector, such as the private part. Some criticize IDIS by saying that they are judge and party for the publication of this report. But it is true that the private health sector before the appearance of these IDIS reports was the great unknown and, furthermore, no one takes away from other institutions (call it the Ministry of Health, the Association of Health Economics, the Spanish Society of Public Health, etc.) to analyze and publish analysis on the private sector. This work of IDIS has come to fill a void. Farmaindustria denounces the Andalusian Health Service and the Andalusian Colleges of Pharmacists for favoring generics. The agreement between these entities involves the promotion of the dispensing of generics in pharmacies when they are prescribed by active ingredient. Farmaindustria rejects this agreement, considering it discriminatory towards the brand. They argue that branded medicines are in Spain at the same price as generic ones. The latter is true, but it is no less true that this constitutes an exception in Europe, which is more concerned with the promotion of generics and the promotion of companies related to their manufacturing and launch.

As for Companies, at the international level, an important article in the New England Journal of Medicine considers the existence of the free market in the pharmaceutical world a myth. Europe is falling below the USA and China in pharmaceutical innovation, warns the CEO of AstraZeneca. Clinical trials on obesity are growing by 68% and laboratories are preparing 124 drugs. Regarding national information, Domus Vi is considering divesting itself of the Mentalia division for more than 100 million euros. The anti-smoking plan threatens an investment by Philip Morris in Spain of up to 1.2 billion, based on the government plan to equate the taxation of new devices to traditional cigarettes. Caser boosts its dental clinic business with more capital, expanding by 4.25 million euros. This will undertake the opening and purchase of eight new dental clinics.

Biomedicine

Global Health

International health policy

National health policy

Companies

7 days in healthcare (July 24th-30th, 2023)

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Summary

From the point of view of Biomedicine, the mRNA vaccine for cancer and regenerative medicine seem to be the great promises in medical advances.

As regards Global Health, The Lancet dedicates an editorial to the need for a broader vision of women’s health, beyond maternal health. The most prevalent disease problems in women are the same as in men, but need insight into specific, poorly understood risks.

As for International Health Policy, the battle continues in the United States for the application of the new pharmaceutical policy that allows Medicare to negotiate the price of drugs, something that until now had been banned. This negotiation will begin in 2024 and it is expected that on September 1, 2023 the medicines on which it will be negotiated will be known. In a movement that seems to be ahead of events, several pharmaceutical companies (Janssen, Merck, Astellas Pharma and BMS) file a lawsuit against the American government. Apart from other possible considerations, it seems difficult to maintain that the price of medicines is much higher in the United States than in other countries, and not only in developing countries, but also in Europe. In the United Kingdom, the British Medical Journal focuses on the financing of pharmaceutical and medical technology companies to British scientific societies. For this, more transparency is required.

If we talk about National Health Policy (Spain), the political changes derived from the regional elections establish a new configuration of the Interterritorial Council, which will be numerically dominated by the PP (which will count, including the Canary Islands Coalition) 12 seats in the Council, by 3 of the PSOE (Castilla-La Mancha, Navarra, Asturias), 1 from the PNV (Basque Country) and 1 from ERC (Catalonia). The Radar Healthcare organization publishes a new ranking of healthcare systems and awards Spain a very favorable position in terms of quality. In general, these types of rankings must be looked at with a magnifying glass and consider the type of indicators analyzed and another series of circumstances. A biased and unprofessional interpretation of the international rankings on the Spanish health system has meant, in practice, a brake on the reforms. If we are so well, why reform anything? It is known that Spain is one of the OECD countries that devotes less public funding to dental care. What we did not know and what is now clear is that it has even dropped very significantly in the last decade, going from 5,245 million euros in 2010 to 3,681 in 2020. It seems clear that Spain, which globally has organized vaccination against covid very well However, it has failed to develop a vaccine: the HIPRA vaccine was delayed much longer than expected and the announced intranasal vaccine no longer even has a release date. It is difficult to compete with vaccines that appear less than a year after the onset of the disease, as has happened in the case of covid, with long development of vaccines that take years.

In the field of Companies, internationally, the president of Novartis (company of European origin) says that the price reform in the United States of medicines represents a threat to Public Health. At the national level, it is worth noting that spending on biosimilars has exceeded 1 billion euros in 2022, due to the fact that the patent for several biological drug molecules has expired and biosimilars have appeared.

Biomedicine

Global Health

International Health Policy

National health policy

  • Changes in the Interterritorial Council
    • Changes in the political sign of the autonomous communities completely modify the political weights in the Interterritorial Council. The popular ones will have 12 seats (with the Canary Islands Coalition), compared to 3 for the socialists (Castilla-La Mancha, Navarra and Asturias), 1 for the PNV (Basque Country) and 1 ERC (Catalonia) (https://gacetamedica.com/opinion/a-new-territorial-council-of-the-sns/)

Companies

7 days in healthcare (July 3rd-9th, 2023)

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Summary

From the point of view of Biomedicine, the contribution of Artificial Intelligence to medical diagnosis is reviewed by JAMA magazine. It seems clear that AI is not going to replace the so-called Narrative Medicine, that ability of the doctor to communicate and to listen and interpret the history of the patients. Interesting advances in the field of  a simple way to diagnose pre-eclampsia and Parkinson’s.

With regard to Global Health, more and more importance is given to loneliness and its consequences on health, according to an editorial in The Lancet. Hunger and famine as a product of human activity, especially armed conflicts, is treated by Nature. Concern regarding the AIDS situation in sub-Saharan Africa, where anti-retroviral therapy has barely reached.

Regarding International Health Policy, in the United States, the FDA approves the first drug to slow down the progression of Alzheimer’s. In the UK, three health think tanks (King’s Fund, Nuffield Trust and The Health Foundation) are addressing both the government and the opposition calling for solutions to the critical situation of the NHS. They denounce a decade of underfunding, which has led the UK to have far fewer human and material resources than most European countries. An interesting subscription model for antibiotics is being considered in the United Kingdom. Pharmaceutical companies will receive 20 million pounds per antibiotic put on the market, regardless of the prescription. In France, the Cour des comptes publishes documents to promote home palliative care and the development of advanced practice nursing. An interesting WHO-Europe document on hospitals and their challenges is published.

If we talk about National Health Policy (Spain), the beginning of the general elections on July 23, has made the different parties have made their programs public, including the health ones. The PP dedicates 24 measures to health. The strong points are: the Primary Care Shock Plan (although the title on emergencies is debatable); the State Public Health Agency; the Agency for Innovation and Quality (similar to NICE); digitization; palliative care; and, the mental health strategy. A new General Health Law is announced. Although the current law has many obsolete points, the legal technique of addressing a new law (instead of partial reforms in relation to different issues) is debatable. There is a risk of opening a very large melon, of generating long delays and of putting health into the same dynamic as education (a law for each new government). Conspicuous absences: nothing about financing, no mention of waiting lists (one of the most serious problems in the system), dental care (an area in which we are very far from Europe) and nothing about public/private collaboration. The PSOE program continues to identify public service with public management, thus distancing itself from any form of public/private collaboration. Many measures are contemplated, seeming more like a government plan than an electoral program, so the priorities are difficult to identify. The star measure seems to be announcing a law on waiting lists. Laws on waiting lists have never been effective in any autonomous community. The solution to the waiting lists does not go through a time guarantee law but rather resources and productivity of the public system and an updated and agile system of collaboration with the private sector. SUMAR incorporates the Podemos program: creation of a public pharmaceutical company; end of the MUFACE model; deprivatization plan, including cleaning, catering and laundry; progressive elimination of the pharmaceutical co-payment; they also announce a law on waiting lists. The Vox program represents an amendment to the whole: recentralization of health, recovering powers in health matters; approach waiting lists; repeal of the euthanasia and abortion law; strong criticism of the WHO, which they accuse of dependence on China. At the national level, the other great news is the alarm given by the insurers involved in the MUFACE model (Adeslas, Asisa and DKV) regarding the fact that its financing is generating large losses, unaffordable in the long term.

In the field of Companies, internationally, large pharmaceutical companies (Merck, BMS) are suing the American government for what they consider lowering prices, as a consequence of the anti-inflation law. In Spain, Ribera continues to bet on public/private collaboration, but this time in Portugal.

Biomedicine

Global Health

  • Editorial of The Lancet: Loneliness as a health problem. In the UK and Japan there are loneliness ministers. The health damages are clear: cardiovascular disease, hypertension, diabetes, infectious diseases, depression and anxiety. Loneliness is not the same as being alone and can affect all ages (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)01411-3/fulltext)
  • Hunger and famines are not accidents, but facts created by human action. Around 200 million people experience acute food insecurity. Especially Afghanistan, Burkina Faso, Ethiopia, Mali, Sudan and Syria. Hunger and conflict are connected (https://www.nature.com/articles/d41586-023-02207-2)
  • HIV in Africa. Antiretroviral therapy has transformed AIDS into a chronic disease. But in sub-Saharan Africa, where 70% of AIDS patients live, few have access to this therapy, which greatly decreases life expectancy in the area (https://www.nejm.org/doi/full/10.1056/NEJMp2304600)

International Health Policy

  • COVID19
    • Weekly covid report published by the WHO, July 6, 2023. The African region has shown a slight increase in deaths with a decrease in cases. The remaining five WHO regions show a decrease in both the number of cases and deaths (https://apps.who.int/iris/handle/10665/370545)
  • United Kingdom and National Health Service
    • Three health think tanks (King’s Fund, Nuffield Trust and The Health Foundation) address government and opposition on NHS issues. They are betting that the next election will end short-term politics in the NHS. The recovery of NHS services and waiting lists must be a priority. They denounce a decade of underfunding. They welcome the long-term plan on personnel, published last week. They point out that life expectancy is the second worst (before only the USA) of the 19 health systems analyzed in the King’s Fund report (https://www.health.org.uk/news-and-comment/news/joint-letter-to-political-leaders-in-england-on-future-of-nhs)
    • The NHS intends to roll out the subscription model for antibiotics. Under the new proposal pharmaceutical companies would receive £20m for their new antibiotics, regardless of how many may be prescribed (https://www.ft.com/content/a0b5a2ad-06a4-499d-8195-b4d6a3f65f7a)

National health policy

  • 23 J elections: the health program of the PP
    • The PP dedicates 24 measures to health. The strong points are: the Primary Care Shock Plan (although the title urgent and emergencies is debatable); the State Public Health Agency; the Agency for Innovation and Quality (similar to NICE); digitization; palliative care; and, the mental health strategy. A new General Health Law is announced. Although the current law has many obsolete points, the legal technique of addressing a new law (instead of partial reforms in relation to different issues) is debatable. There is a risk of opening a very large melon, of generating long delays and of putting health into the same dynamic as education (a law for each new government). Conspicuous absences: nothing about funding, no mention of waiting lists (one of the most serious problems in the system), dental care (an area in which we are very far from Europe) and nothing about public/private collaboration (https://www.pp.es/sites/default/files/documentos/programa_electoral_pp_23j_feijoo_2023.pdf)
  • 23 J elections: the health program of the PSOE
    • The PSOE program continues to identify public service with public management, thus distancing itself from any form of public/private collaboration. Many measures are contemplated, seeming more like a government plan than an electoral program, so the priorities do not look good. The star measure seems to be announcing a law on waiting lists. Laws on waiting lists have never been effective in any autonomous community. The solution to waiting lists does not go through a time guarantee law but resources and productivity of the public system and an updated and agile system of collaboration with the private sector (https://www.psoe.es/media-content/2023/07/PROGRAMA_ELECTORAL-GENERALES-2023.pdf)
  • 23 J Elections: SUMAR’s health program

Companies

 

7 days in healthcare (30th May-5th June, 2022)

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Summary

From the point of view of biomedicine, to highlight the Science article, showing that the brain and the immune system are interconnected. Monkeypox is transmitted by direct contact, therefore “ring vaccination” is indicated, only to contacts of an infected person.

As far as Global Health is concerned, the universal coverage approach in Nigeria, the most populous country in Africa, should be highlighted. It is seen that universal coverage is no longer just something of Europe or the industrialized countries.

As for international health policy, the frequent shootings in American schools are covered by medical journals (The Lancet, British Medical Journal), as it is also a health problem. Something perfectly avoidable.

If we talk about national health policy (Spain), it should be mentioned that private health offers to collaborate with public health in addressing the problem of waiting lists.

In the field of companies, Takeda’s statements are surprising, saying that pharmaceutical companies will be able to lower prices in the face of a global crisis. The acquisition of the HIPRA vaccine by Brussels is advancing.

Biomedicine

Global health

International health policy

  • Monkeypox

o 21 Americans affected by monkeypox, according to the CDC (https://www.nytimes.com/2022/06/03/health/monkeypox-vaccine-treatments.html)

o New York Times editorial: To fight monkeypox we have to learn the lessons of covid and HIV (https://www.nytimes.com/2022/05/29/opinion/monkeypox-covid-and- hiv.html)

o Concern in Europe that massive summer parties spread monkeypox (https://www.lavanguardia.com/vida/20220605/8317253/pretrabajo-fiestas-masivas-verano-extend-viruela-mono.html)

  • COVID-19

o Covid cases on the rise in the Americas: North and Central America) (https://www.bmj.com/content/377/bmj.o1355)

o Does the world need new covid vaccines? (https://www.nejm.org/doi/full/10.1056/NEJMe2204695)

o Doubts about whether the arrival BA.4 and BA.5 of the omicron will mean a new wave of covid in France (https://www.lemonde.fr/planete/article/2022/06/04/covid-19 -l-arrivee-de-ba-4-et-ba-5-en-france-va-t-elle-entrainer-une-nouvelle-vague-de-contaminations_6128892_3244.html)

o The subvariant of the BA.5 omicron is a cause of concern in Portugal (https://www.lemonde.fr/planete/article/2022/06/04/au-portugal-le-sous-variant-ba-5-d-omicron -restless_6128944_3244.html)

o The zero-covid policy in China is unfeasible in the long run, the only question is when it will abandon it to “live with covid”. Article in Science magazine (https://www.science.org/doi/10.1126/science.add1891)

  • Other themes

o The frequent shootings in American schools, also as a health problem, treated in medical journals. The Lancet: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01006-6/fulltext; British Medical Journal: https://www.bmj.com/content/377/bmj.o1378

o The black market of antivirals for covid (https://www.bmj.com/content/377/bmj.o1282)

o Shortage of doctors in Italy (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01009-1/fulltext)

o Medical abortion and telemedicine in a post-Roe v Wade phase (https://www.bmj.com/content/377/bmj.o1393)

o The Center for Medicare and Medicaid (CMS) in the USA plans to advance Value Based Healthcare (https://jamanetwork.com/journals/jama/fullarticle/2792275)

National health policy

  • Monkeypox

o Spain reaches 132 positives for monkeypox (https://www.consalud.es/pacientes/infecciosas/viruela-mono-espana-casos_115507_102.html)

  • COVID

o The incidence of covid in people over 60 years of age falls 45 points again (https://www.abc.es/sociedad/abci-incidencia-covid-mayores-60-anos-volve-caer-45-puntos-202206031649_noticia .html)

  • Regulatory announcements

o The Order to allocate 217 places to non-EU citizens was published in the Official Bulletin (BOE) (https://www.consalud.es/especial-mir/boe-orden-adjudicar-217-plazas-mir-vacantes-extracomunitarios_115651_102.html)

  • Other themes

o Private healthcare offers to reduce surgical waiting lists by 30%, according to ASPE (https://www.eleconomista.es/salud/noticias/11799678/06/22/La-sanidad-privada- offered-to-reduce-the-surgical-waiting-list-by-30.html)

o Aragon extends dental care up to 14 years of age (https://www.consalud.es/autonomias/aragon/aragon-amplia-hasta-14-anos-programa-atencion-salud-bucodental_115455_102.html)

Companies

  • International News

o GSK is going to buy the Affinivax biotech group for 3.0 billion dollars (https://www.ft.com/content/3a5e33ea-1af6-4554-bf50-225441fe4c24)

o BMS about to acquire drugmaker Turning Point for $4.1 billion (https://www.ft.com/content/9c5b319c-20c3-4558-826f-260d0698975b)

o Takeda says that pharmaceutical companies could lower prices in the face of a global crisis (https://www.ft.com/content/492beff8-a077-421e-8da9-faf378e15175)

o The company that manufactures the monkeypox vaccine has the capacity to produce 30 million doses (https://www.elespanol.com/invertia/observatorios/sanidad/20220531/empresa-fabrica-vacuna-viruela-capacity-produce -millions/676432695_0.html)

  • National News

o Brussels finalizes the acquisition of the HIPRA vaccine for covid (https://www.eleconomista.es/salud/noticias/11791545/05/22/Bruselas-ultima-la-adquisicion-de-la-vacuna-espanola-de -Hipra-for-the-Covid.html)

o HM acquires the Los Nogales Pontones center to build a new hospital (https://www.plantadoce.com/empresa/hm-hospitales-acquire-el-centro-los-nogales-pontones-para-levantar-un-nuevo- hospital.html)

o Vithas recovers from the covid downturn and grows 19% in 2021 (https://www.plantadoce.com/empresa/vithas-se-recupera-del-bache-del-covid-19-y-crece-un -Jan-19-2021.html)

o Grupo HLA targets 500 million revenues in 2022 (https://www.plantadoce.com/empresa/grupo-hla-apunta-a-500-millones-de-euros-en-ingresos-en-2022.html)

o The contracting of medical insurance skyrockets in Cantabria and Catalonia in 2021. At the national level, 24% of the population has private medical insurance, although low cost ones are included (only consultations and tests) (https://www. .elespanol.com/invertia/observatorios/sanidad/20220605/contratacion-seguros-medicos-dispara-cantabria-cataluna/677432488_0.html)

o The laboratories devastate the funds in their bid for Lacer (https://www.expansion.com/empresas/2022/05/30/6293eb1ee5fdea29048b45f4.html)

o Vithas has an agenda to achieve the 2030 goals (https://www.redaccionmedica.com/secciones/privada/vithas-se-fija-2025-para-alcanzar-el-80-de-los-objetivos-de-la -phonebook-2030-9828)

o DKV presents the 2021 corporate report and the Imagina 2025 Strategic Plan (https://dkv.es/corporativo/sala-prensa/noticias/informe-anual-2021)