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 (November 27th-December 3rd, 2023)

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Summary

From the point of view of Biomedicine, the New England Journal of Medicine begins a series on the usefulness of wearable technology, the set of devices or instruments that are worn and transmit information about health, which could be useful in monitoring , diagnosis and treatment of various diseases or clinical situations. There is every impression that this technology will be part of the future and what the NEJM intends is to clarify its usefulness and indications in various diseases and specialties, starting with diabetes. Regarding CAR-T therapies, until now used in hematological processes, it is envisioned that they could also be useful in solid tumors.

Regarding Global Health, great prominence of the issue of health in the COP28 meeting, from two perspectives: the reduction of CO2 emissions, which can be harmful to health; and the emissions from the health system itself, which is a major polluter. It is confirmed in a new and extensive study carried out in Australia that the younger generations have worse mental health.

Regarding International Health Policy, in the United States an executive order by President Biden on AI, not specifically directed at the health sector, will, however, have an impact on this sector and the Ministry of Health is already preparing specific regulations. In China, it seems to be ruled out that the increase in respiratory infections is due to a new virus, but rather to common bacteria and viruses. The United Kingdom’s genetic database, UK Biobank, is about to reveal results, which seem to have an impact on new therapies. In France the price of a pack of tobacco is rising, despite this country’s failures in the fight against smoking. The new conservative government of New Zealand annuls the 2022 law, which prohibited the sale of tobacco from 2027. Austria launches a new health reform, which reinforces the digital route as access to the health system. Concern of several health groups in Argentina, given the health announcements of the new president-elect, Javier Milei.

If we talk about National Health Policy (Spain), the government of the Generalitat of Catalonia reactivates the results center, a model initiative in terms of transparency in the health sector, which had been largely paralyzed since the “procés”. All the data until 2022 has already been presented. Biosim demands new forms of purchasing and management adapted to biosimilars. Problems in the last research institute recognized by the Carlos III Health Institute, that of Asturias. Strong tensions for months between the management of ISPA (the Health Research Institute of the Principality of Asturias) and FINBA, a Foundation with a majority of private companies, which seeks to exercise control over ISPA. Unusual proposal from the Catalan medical colleges, which aims to introduce a “quota” for non-Catalans who aspire to study medicine in Catalonia.

In the field of Companies, on an international level, AstraZeneca is allying itself with AI Biologics. The linking of pharmaceutical companies with AI companies seems to be a general trend. At the national level, Vivanta confirms an ERE.

Biomedicine

Global Health

International health policy

National health policy

Companies

 

 

 

7 days in healthcare (November 20th-26th, 2023)

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Summary

From the point of view of Biomedicine, in the United Kingdom an initiative aims to be able to produce medicines for individual patients in less than a year. According to the National Bureau for Economic Research (NBER) of the United States, artificial intelligence, even with use cases already developed, will produce savings in healthcare expenses between 5-10%. This will offset the rise in other expenses in the sector, such as new medicines and medical technologies.

As far as Global Health is concerned, there is a relationship between the pattern of economic income and obesity, which occurs more in low-income workers, in relation to those with higher incomes. The fight against climate change has already produced some results. The COP28 conference, which will take place starting next week in Dubai, is expected to produce a declaration on climate and health. Polio is about to be eradicated in a few months, but the great challenge is that it does not return, since eradication is not the same as extinction.

Regarding International Health Policy, in its latest issue The Economist dedicates a supplement to forecasts for 2024. Among the 10 general forecasts, there is one that says that in an older world, health expenditures will grow to reach one tenth of global GDP. Among the specific health forecasts, it is noted that the pandemic has led to a growth in public spending on health (up to 80%, starting from 75%). Growth in private activity and an increase in the global pharmaceutical market is expected, with research efforts concentrating on medications against obesity and mRNA patents. In the United States, there is evidence of the inadequacy of private health insurance to provide financial security to the elderly for long-term care. Important agreement in the United Kingdom between the NHS and pharmaceutical companies, with which an annual growth in spending on medicines of 4% is agreed until 2027. Surely, an example for many countries, including Spain. Also in the United Kingdom, an agreement between the NHS and community pharmacies for the provision of a series of services, which will mean a large reduction in consultations in Primary Care. The health insurance boom in the United Kingdom, due to the problems of the NHS, is revealing certain limitations of private health insurance to meet demand. Something similar to what happens in Spain. Important document from the WHO (European region) and the Observatory on health systems, in which several governments participate, including the Spanish one, talking about the convenience of the participation of the private sector in the public health service, establishing the requirements for this to be successful. European countries warn of the health problems of climate change, since Europe is the continent in which temperatures have risen the most.

If we talk about National Health Policy (Spain), new change in the Ministry of Health. Going to minister for a year or less does not seem like the best formula to address the long-term challenges of healthcare, without prejudice to the qualities of the new minister, which will have to be observed. Record in the waiting list, after the publication of the lists as of June 30 by the Ministry of Health. Important study on obesity in Spain published by the Carlos III Health Institute and AESAN, which demonstrates the relationship between the level of obesity and the postal district. A study by the Institute of Fiscal Studies shows that between the beginning of 2020 and the end of 2022, the number of doctors in the SNS has decreased by 17,000, despite the fact that the number of staff has increased globally. The Valencian Community launches a specific competition for positions that are difficult to fill. Aside from the approach of the tender, it is good that the specificities of this type of places are taken into account. There is no doubt that the standardizing approach to personnel policy does not allow us to solve certain problems, such as what are now called difficult-to-fill positions. Farmaindustria carries out, in collaboration with scientific societies, a study on clinical research in Primary Care. We are a powerhouse in clinical research in hospitals and there is no doubt that the bases of this success must be extended to other environments.

In the field of Companies, on an international level, problems in Bayer with a sharp drop in the stock, which the CEO of this company attributes to a limited pipeline, a consequence of a lack of effort in investment. At the national level, Vithas confirms its new hospital project in Valencia. For its part, Sanitas announces an investment to grow in nursing homes.

Biomedicine

Global Health

International health policy

  • European Union
    • European countries warn of the health problem of climate change. It is estimated that last summer there were 62,000 deaths in Europe due to heat, since this is the continent with the highest temperature rises. 18 member states ask the European Commission and ECDC for action (https://www.ft.com/content/52e71922-d9fc-49b6-98b5-3a4d37c21dbc)

National health policy

Companies