Posts

7 days in healthcare (December 11th-17th, 2023)

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Summary

From the point of view of Biomedicine, CRISPR therapy, which begins with sickle cell anemia, is great hope. In the end, the FDA approves two gene therapies for this disease, which affects 7.7 million people globally and is a chronic, debilitating disease that causes pain and reduces the quality and expectancy of life. New approved therapies include extraction, genetic modification and reinfusion into patients of their own hematopoietic stem cells. The problem is that these patients live mainly in sub-Saharan Africa and India, which are far from having the infrastructure to apply this therapy. The price of these therapies is about 2 million euros per patient, which again raises the problem of the problems of universalization of precision medicine. Ozempic, Alzheimer’s drugs and malaria vaccines among the scientific milestones of 2023 for Science magazine. For its part, Nature magazine chooses a non-human among its scientists of the year: ChatGPT.

As far as Global Health is concerned, in the end, an international agreement is reached on the end of fossil fuels. COP28 was the first global conference on the subject after the Paris agreement in 2015 (COP21) in which a global limit to temperature growth was established at 1.5º. On December 13, 2023, the agreement on net zero emissions by 2050 will be reached. Fossil fuels generate a lot of wealth, but they are also the bulk of CO2 emissions. The problem is that there is no system that forces governments to meet that objective. A global treaty on plastics is proposed by the United Nations General Assembly (March, 2022). Plastic pollution is a global threat, since plastic is persistent and less than 10% is recycled, almost 6 billion tons now pollute the planet. This contains more than 10,500 chemicals, which includes carcinogens, neurotoxicants, etc.

Regarding International Health Policy, design by the European Union of a Plan to avoid shortages of more than 260 critical medicines, which includes storage and incentives for production

If we talk about National Health Policy (Spain), one in ten Spaniards on the waiting list, record numbers in health. At this moment there are 820,000 people to undergo surgery, a figure never reached. The Ministry of Health wants to raise this problem with the communities at the in-person meeting of the Interterritorial Council in Asturias on December 21. In theory there are two solutions: either self-concertation (the disdainfully called “peonadas”) or agreements with the private sector. In both cases money is needed. It is also necessary to review the indications, circuits and priorities. The CIS Barometer is released (3rd wave, October 2023). 57.5% value positively the functioning of the National Health System, which means a great setback with respect to previous editions. In an article in El País whose first signatory is Félix Lobo, it is proposed to strengthen the Ministry of Health. In 45 years there have been 28 ministers. And organizations with a clear health component have been separated from the Ministry, such as the Carlos III Health Institute, the Government Delegation for the National Drug Plan and the Food Safety and Nutrition Agency (AESAN). Although this reinforcement is necessary, it must surely be complemented with what we could call “cohesion bodies”, among which could be HISPANICE, also proposed by FUNCAS.

In the field of Companies, on an international level, Cigna renounces creating a health insurance giant in the USA, by becoming part of Humana. AstraZeneca enters the world of vaccines. Regarding national news, Quirón advances in the construction of its hospital in Gijón (Asturias) and receives from the Ministry of Defense the management of the hospital on Isaac Peral Street (former Generalísimo Franco), closed for more than 30 years. Good results from Miranza and Ribera, the latter contemplating three new projects.

Biomedicine

Global Health

International health policy

National health policy

  • Waiting lists
    • One in ten Spaniards on the waiting list, record figures in healthcare. At this moment there are 820,000 people to undergo surgery, a figure never reached. The Ministry of Health wants to raise this problem with the communities at the in-person meeting of the Interterritorial Council in Asturias on December 21. In theory there are two solutions: either self-concertion (the so-called “peonadas”) or conciliation with the private sector. In both cases money is needed. It is also necessary to review the indications, circuits and priorities (https://www.eldiario.es/sociedad/diez-espanoles-lista-espera-cifras-record-sanidad-quiere-atajar_1_10708957.html)
  • It is proposed to strengthen the Ministry of Health
    • In an article in El País whose first signatory is Félix Lobo, it is proposed to strengthen the Ministry of Health. In 45 years there have been 28 ministers. And organizations with a clear health component have been separated from the Ministry, such as the Carlos III Health Institute, the Government Delegation for the National Drug Plan and the Food Safety and Nutrition Agency (AESAN) (https://elpais.com/society/2023-12-11/potenciar-el-ministerio-de-sanidad.html)

Companies

 

7 days in healthcare (August 14th-20th, 2023)

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Summary

From the point of view of Biomedicine, surely the most far-reaching news is the success obtained with a transplant to a brain-dead human of a genetically modified pig kidney, which worked perfectly, both from the point of view of renal function and of non-rejection. This represents great hope for transplants, especially in the United States where transplant waiting lists are very long. It is estimated that some 5,000 people in the USA die each year waiting for a kidney transplant. The idea is to request authorization from the FDA to carry out a clinical trial.

As far as Global Health is concerned, an interesting WHO summit in India on traditional medicine (which includes treatments as varied as Ayurveda, yoga, homeopathy and complementary therapies), although we don’t have to expect much from the results. The truth is that traditional medicine is followed by billions of people and the WHO wants to see how it integrates with conventional medicine. The Lancet comments that malnutrition is the greatest risk for tuberculosis. In fact between 1900 and 1940 the incidence of tuberculosis plummeted, in the absence of any effective treatment or vaccines, simply because of improved socioeconomic conditions.

As for International Health Policy, two Chinese manufacturers are making “copycats” of weight-loss drugs, threatening Western companies in their development in this huge obesity market. An international study (United States, Germany and Switzerland) warns of the “cancer premium” in the price of medicines, which reaches up to three times that of medicines for other diseases, this price not being justified either by the manufacturing process or by because of the research, but, fundamentally, because of the extreme concern and anguish in the face of this disease. Although the study refers to those countries, this phenomenon occurs in all nations, including Spain.

If we talk about National Health Policy (Spain), denounce the low rates of insurers with doctors. Although the matter will surely have many nuances, the truth is that the low rate of insurers (20 euros on average for a first consultation and 10 for a subsequent one) make this model of care provision very unstable. La Rioja proposes with the new government of the PP to have a Faculty of Medicine. The map of the Faculties of Medicine in Spain has been highly denounced both by the Association of Medical Students and by the Medical Deans’ Conference. We have a ratio of medical schools per population that is second only to South Korea, of course much higher than that of France, the United Kingdom and Germany, which should be our benchmarks. The peculiar distribution of powers between the State, the communities and the Universities has led to this certainly anomalous situation. The pharmaceutical industry has become the leading export sector in Spain, ahead of the automobile industry, which traditionally led the ranking. A complete success for this industry, of which there are 173 production plants, most of them in Catalonia, followed by Madrid.

In the field of Companies, at the international level, Novartis plans to separate from Sandoz (its division for generics and biosimilars), following the same path as Pfizer with its Upjohn generic business, which it merged with Mylan to form Viatris. Various private equity firms interested in the operation. At the national level, it is worth highlighting the large increase in Ferrer’s profit.

Biomedicine

Global Health

International Health Policy

National health policy

Companies

 

 

7 days in healthcare (July 10th-16th, 2023)

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Summary

From the point of view of Biomedicine, there is little doubt that Artificial Intelligence will revolutionize medicine: from diagnosis, to the robotic-AI combination for surgical procedures, rehabilitation aid, support in the fight against infectious diseases, development of new drugs, etc. There will be few areas of medicine that are not affected by the development of Artificial Intelligence.

As regards Global Health, The Lancet insists on the WHO-Europe notice on the need to decontaminate the air, since pollution contributes to the appearance of a large number of diseases and premature deaths. This time, 12 African countries are going to receive 18 million doses of the malaria vaccine. Now one can dream of the disappearance of malaria – that secular plague – from our planet.

Regarding International Health Policy, the American regulator approves the first contraceptive pill that will be dispatched (in pharmacies, supermarkets and online) without the need for a prescription. Although the “pill” could be used in the USA for 50 years, until now it was always under medical prescription. It is believed that this measure will contribute to reinforcing women’s reproductive rights, which were so affected by the US Supreme Court ruling that repealed the previous interpretation of the federal constitutional right to abortion, leaving this regulation in the hands of the states. Great controversy as a result of the WHO declaration of the possible carcinogenic effects of aspartame, a sugar substitute widely used in many beverages, including Coca-Cola. The WHO statement is not without controversy.

If we talk about National Health Policy (Spain), to highlight the private health agreement in Madrid, with a rise of 15% in four years. The private provision employers address a decalogue of petitions to the new government. One of them is not addressed so much to the government as to health insurers, by requesting that relations between insurers and health centers be regulated in writing. The Coordinates Institute reveals the very different development of the right of choice in health in the national territory. On the other hand, the Minister of Health presents the new citizen folder. According to him “with one click you can access the medical history”. This of presenting a project of this magnitude a week before the elections cannot be taken very seriously.

In the field of Companies, internationally, Moderna has established itself in China. As for national news, Quirón announces a new hospital in Badajoz and Viamed the expansion of its hospital in Zaragoza. The funds, interested in radiodiagnostic companies, a sector so far very fragmented. ALSA, the bus company of Asturian origin, together with the Asturian health transport company Trasinsa, agree to launch a new health transport operator: SANIR.

Biomedicine

Global Health

International Health Policy

  • USA
    • The American regulator (FDA) approves the first contraceptive pill for sale without a prescription. It is called Opill and it will be available in pharmacies, supermarkets and online from 2024. The manufacturer is Perrigo, an American-Irish consortium. This pill can be used with a prescription for 50 years. The change is that, from now on, it is freely dispensed (https://www.nytimes.com/2023/07/13/health/otc-birth-control-pill.html)

National health policy

Companies

 

7 days in healthcare (June, 19th-25th, 2023)

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Summary

From the point of view of Biomedicine, ethical problems continue to be discussed as a consequence of the creation of embryos without eggs or sperm. Until now, an embryo required an egg and a sperm, but this new approach would allow, in hypothesis, to solve problems of infertility or pregnancy loss, but it is a matter to regulate very carefully. Two studies in Nature seem to show that the Y chromosome makes men more vulnerable to tumors.

With regard to Global Health, The Lancet focuses on the great threat of diabetes, since it is estimated that in 2050 there will be 1.3 billion diabetics, a disease related to obesity, diet, tobacco, alcohol and sedentary lifestyle. Inequalities in access to morphine are denounced, with the United States and Europe almost completely monopolizing its use. An important issue, since this drug has a relevant role in the treatment of pain and in palliative care.

Regarding International Health Policy, according to the weekly WHO report, covid is declining in both the number of cases and deaths in all WHO regions of the world. Only in the African region is there a slight increase in the number of deaths, with a decrease in the number of new cases. In the United States, the commercialization of meat grown in the laboratory is approved. One of the authorized establishments belongs to the Spanish philanthropist José Andrés. Also in the United States, not minor problems continue as a result of the annulment of the Roe v Wade ruling that transfers the authorization of abortion to the states. In the United Kingdom, the problems with the emergency services continue and a strike of resident doctors is called. New health insurance law in South Africa, which appears to represent progress towards universal coverage in that country.

If we talk about National Health Policy (Spain), according to the WHO weekly bulletin, Spain is the country in Europe with the highest mortality from covid. The government and the communities agree to abolish the mandatory nature of masks in health centers and pharmacies. Ayuso, proclaimed President of the Community of Madrid, after the last elections. Absence of great news in the announcements of health measures for this legislature. As was already known, Spain is consolidating itself as a world power in clinical trials, an achievement no less.

In the field of Companies, internationally, Walmart (the largest supermarket chain in the USA) enters the primary care business, with 32 centers in 5 states. Walmart was already in healthcare, but it was with small clinics for minor care. Significant company purchases by Merck MSD and Lilly, which seems to confirm that M&A activity in pharmaceutical companies is reviving. In the Spanish national arena, ASEBIO announces an increase in investment in R&D by biotech companies in 2022.

Biomedicine

Global Health

International Health Policy

National health policy

Companies

 

 

 

7 days in healthcare (May 15th-21st, 2023)

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Summary

From the point of view of Biomedicine, to point out certain warnings about the use of blood tests for the detection of cancer, an area with great growth, since in some cases there may be errors in diagnosis, over diagnosis and over treatment . Researchers are trying to improve Nuclear Resonance imaging, through fMRI, which will be able to detect brain activity on the millisecond scale. The WHO warns about the use of sweeteners for weight control and ChatGPT in health, without careful prior examination.

With regard to Global Health, The Lancet denounces in an editorial the continuation of the practice of the death penalty in some countries, but most fundamentally in China. The International Treaty on Pandemics, which may be one of the positive consequences of the covid, seems to be ready in May 2024.

Regarding International Health Policy, very interesting statements by the Director General of the WHO to The Economist magazine, following the lifting of the global alarm due to the covid. Trying to explain why the covid affected developed countries (such as the USA) in many cases more than developing countries, he comments that possibly a certain self sufficiency about the strength of their health systems and a concentration towards investments in specialized hospitals and high technology, in instead of public health, is at the origin of this situation. The crisis in the NHS continues, Starmer (Labor Party leader) says the system cannot be fixed without fixing the “fundamentals”. He seems to understand by “fundamentals” the need for reforms and not just more funding. EMA 2022 annual report, which greets that year as very positive due to the rapid development of new vaccines and new drugs.

If we talk about National Health Policy (Spain), apart from the rise in the incidence of covid, possibly the most far-reaching news is the shortage of certain medicines in pharmacies. It seems that the causes can be multiple, but basically three: the dependence on certain raw materials that are manufactured in India and China; parallel exports due to the lower price of medicines in Spain compared to other European countries; and the very low price of some drugs that discourages their production. In Primary Care, the real problems far exceed the weekend promises to give more money, apparently already committed. In-depth reforms and increased funding is what Primary Care needs, after a deep negotiation and consensus. The PP of Asturias promises to end, if it wins, with the exclusivity of doctors in that region, apparently already the only one in Spain that rigorously applies this regulation. The project of the new Hospital Clinic (Barcelona) of more than 1,500 million surprises by its grandeur. It is to be assumed that such a large investment is fully justified and explained very well to the population.

In the field of Companies, at the international level, a large fine was imposed on the pharmaceutical chain Walgreens in San Francisco for promoting the use of opiates. In Spain, the construction of a new hospital in Alicante by IMED stands out (is there a real boom in new private hospitals?); the sale to a German fund of 26% of ESTEVE; and, as unusual, the denunciation by the hospital employer ASPE of the agreement between Sanitas and Generali. It seems that the discrepancy is that Sanitas extends the advantageous rates that it had negotiated with suppliers, which are more favorable than those of Generali, to Generali customers in this way.

Biomedicine

Global Health

International Health Policy

  • China
    • What happened in China after the abandonment of the covid zero policy and the massive infection of omicron? The official figures for deaths are 87,475 between February 24 and March 16, 2023. Other estimates speak of between 1-1.5 million deaths. Surely the reality is somewhere in between (https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2804631)

National health policy

Companies