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

• The clinical trials that will shape medicine in 2024. Nature magazine asked renowned scientists which were the most promising clinical trials for 2024, selecting these 11: 1. Genetic editing for hypercholesterolemia; 2. AI for early diagnosis of lung cancer; 3. T-cell vaccines for HIV; 4. Therapeutic app for perinatal depression; 5. Stem cells for Parkinson’s; 6. Machine learning for patient triage: 7. Immunotherapy for melanoma; 8. Long-term effectiveness of the R21 vaccine against malaria; 9. Conjugated antibodies for brain metastases; 10. Intervention model for childhood mental illness; and, 11. Computed tomography for lung cancer screening, https://www.nature.com/articles/s41591-023-02699-5
• Is xenotransplantation ready? A discussion on the need to promote clinical trials with this type of transplant https://www.nejm.org/doi/full/10.1056/NEJMp2309946
• Brain implants helped 5 people recover from traumatic injuries, https://www.nytimes.com/2023/12/04/health/traumatic-brain-injury-implants.html
• A simple blood test reveals the aging of the organs, https://elpais.com/salud-y-bienestar/2023-12-06/un-simple-analisis-de-sangre-revela-con-decadas-de-anticipation-accelerated-aging-of-organs.html
• It is deduced that exercise reduces mortality from lung cancer, https://www.larazon.es/salud/golpe-cancer-pulmon-ejercicio-reduce-riesgo-mortalidad-60-ano-segun-estudio_202312086572fccad6703700019c545f.html. Access to the original article: https://www.mdpi.com/2077-0383/12/23/7346

Global Health

• Health day at COP28: a partial victory. The day dedicated to health was on December 3 and $1 billion in aid was achieved for mitigation and adaptation and an emphasis on the transformation of health systems, which culminated in the signing of a Declaration on Climate and Health, signed by 124 countries. Populist leaders (Geert Wilders, in the Netherlands; Javier Milei, in Argentina; Bolsonaro, in Brazil; Trump, in the USA) have made the denial of climate change an electoral platform. On the other hand, the president of COP28 is the president of the state oil company Adnoc, and he went so far as to deny the scientific support for decarbonization https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02746-0/fulltext#:~:text=Planned%20to%20showcase%20the%20links,communities%20and%20vulnerable%20populations%20are
• Spain signs, together with 122 countries, the Climate and Health Declaration within the framework of COP28, https://elglobal.es/politica/espana-firma-junto-con-122-paises-la-declaracion-de-clima-and-health-in-the-framework-of-cop28/
• Sub-Saharan Africa is experiencing the largest decline in AIDS infections, according to UNAIDS. According to this organization, the number of people infected and dying from HIV has fallen, with sub-Saharan Africa being where the reduction is most marked. Altogether 630,000 people will die globally from HIV in 2022, https://www.bmj.com/content/383/bmj.p2843#:~:text=The%20report%20also%20found%20that,and%201.5%20million%20in%202010.

International health policy

• USA
  • American initiative to prevent gun violence. Faced with the passivity of Congress, President Biden creates an Office for the Prevention of Gun Violence in the White House. In 2022, more than 48,000 Americans (about 132 a day died from firearm-related injuries) https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02749-6/fulltext#:~:text=The%20most%20comprehensive%20gun%20violence,to%20go%20after%20firearms%20traffickers
  • A convincing explanation of drug deaths in the USA is offered by a group of economists, cited by The Economist. Until now, deaths from opiates in the USA were attributed to three possible causes: 1. death from despair (Case and Deaton theory); 2. Counties exposed to export competition from China; and. 3. commercial pressures from the pharmaceutical industry. The new study focuses on supply, finding a correlation between the number of deaths and the importation and use of opioids, https://www.economist.com/finance-and-economics/2023/12/07/at-last-a-convincing-explanation-for-americas-drug-death-crisis#
  • The White House delays a decision on banning menthol cigarettes. The decision is made after lobbying by the tobacco industry, pressure from convenience stores and pressure from black smokers. All this in an election year https://www.nytimes.com/2023/12/06/health/biden-menthol-cigarette-ban-black-voters.html

• 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

• United Kingdom and the National Health Service
  • Study shows being overweight in the UK costs £98bn in 2022, up from £58bn in 2020, https://www.theguardian.com/society/2023/dec/04/cost-of-people-being-overweight-in-uk-now-98bn-study-finds#:~:text=The%20cost%20has%20soared%20from,the%20thinktank%20by%20Frontier%20Economics.Original report by the Tony Blair Institute : https://www.institute.global/insights/public-services/unhealthy-numbers-the-rising-cost-of-obesity-in-the-uk
  • Brits love the NHS, but some have to pay to avoid it. Long waiting lists result in many paying for certain procedures. As health insurance is expensive in the UK, so people prefer to pay for surgeries and other procedures in the UK, https://www.nytimes.com/2023/12/09/world/europe/uk-nhs-private-health-care.html#:~:text=Love%20the%20N.H.S.-,Some%20Will%20Also%20Pay%20to%20Avoid%20It.,of%20the%20treasured%20public%20system.

• France
  • The bill on the end of life will be presented in February, it is presented as a new model, ranging from palliative care to helping those who wish to die, under certain eligibility conditions, https:// www.lemonde.fr/societe/article/2023/12/08/le-projet-de-loi-sur-la-fin-de-vie-sera-presente-courant-fevrier-selon-la-ministre-agnes-firmin-le-bodo_6204716_3224.html#:~:text=C%27est%20une%20promesse%20d,dans%20un%20entretien%20au%20Figaro.

• Germany
  • Germany announces a plan to strengthen its pharmaceutical industry. It seems that the plan will have as its axis a reinforcement of research and reindustrialization, https://diariofarma.com/2023/12/03/alemania-anuncia-un-plan-para-el-fortalecimiento-de-su-pharmaceutical-industry

• European Union
  • The EU approves the world’s first artificial intelligence law, https://elpais.com/tecnologia/2023-12-08/la-ue-aprob-la-primera-ley-de-inteligencia-artificial-del-mundo.html. Official note from the European Commission: https://ec.europa.eu/commission/presscorner/detail/en/ip_23_6473

National health policy

• The covid audit that never comes out
  • 3 years and four ministers later, the government still does not have the audit on the management of covid, despite the fact that said analysis was requested in the Lancet magazine by a renowned group of Spanish scientists and the government appointed on October 7, 2021 a five-member commission, whose work has not been made public, https://www.vozpopuli.com/espana/auditoria-covid-3-anos-4-ministros-despues-seguimos-trabajando-ello.html

• Oral Health Plan
  • What does this Ministry plan consist of, it seems that the coverage will be very limited, https://www.elmundo.es/ciencia-y-salud/salud/2023/12/05/656ef3bbe85ece4f648b4597.html

• Lack of professionals in Primary Care
  • The Ministry will address the lack of professionals in Primary Care on December 19 with the communities in a plenary session of the Human Resources Commission of the Interterritorial Council, and subsequently, on December 21, an in-person Interterritorial Council of the SNS will be held in Asturias , https://www.elmundo.es/ciencia-y-salud/salud/2023/12/07/6571ed0121efa0327f8b4582.html

• Waiting lists
  • Asturias’ plan consists of paying 57 million overtime hours to professionals, https://www.lne.es/asturias/2023/12/05/asturias-destinara-57-millones-afianzar-95442654.html#:~:text=The%20budget%20of%20Health%20for,a%20new%20roof%3A%202,308%20euros&text=P.,Á.&text=The%20announced%20project%20of%20la,concrete%3A%2057%20million

Companies

• International News
  • Roche also gets on the obesity bandwagon, https://cincodias.elpais.com/opinion/2023-12-07/roche-tambien-se-sube-al-carro-de-la-obesidad.html#:~:text=With%20more%20of%201,000%20million,%20carriage%20of%20obesity.
  • Roche acquires Carmot, a company specialized in obesity treatments for 2.8 billion, https://www.elespanol.com/invertia/observatorios/sanidad/20231204/roche-adquiere-carmot-compania-especializada-tratamientos-obesidad-millones/814668584_0.html

•  National News
  • Ribera finalizes the purchase of IMSKE to create its first hospital in Valencia, https://www.elespanol.com/valencia/economia/20231204/ribera-ultima-compra-imske-crear-primer-hospital-valencia/813918713_0.html
  • Ribera finalizes the purchase of IMSKE to create its first hospital in Valencia, https://www.elespanol.com/valencia/economia/20231204/ribera-ultima-compra-imske-crear-primer-hospital-valencia/813918713_0.html
  • Asho delves into healthcare in Portugal, https://www.plantadoce.com/empresa/asho-se-adentra-en-la-sanidad-de-portugal-y-sella-un-contrato-con-el-hospital-de-lisboa#:~:text=The%20catalana%20company%20has%20sealed,coding%20of%20the%20discharges%20ambulatory.
  • Isdin achieves a record profit, due to the recovery of cosmetics after the pandemic, https://cincodias.elpais.com/companias/2023-12-09/isdin-logra-su-beneficio-record-por-la-recuperacion-of-cosmetics-after-the-pandemic.html#
  • Indukern enters losses with 17.7 million, https://www.expansion.com/catalunya/2023/12/08/657373de468aebba6b8b460d.html#
  • The bankruptcy administrator of Dentix and the creditors ask to seize KKR, as responsible for the bankruptcy of Dentix, https://www.expansion.com/empresas/2023/12/04/6568c71a468aeb257d8b467d.html