Posts

7 days in healthcare (January 29th-February 4th, 2024)

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Summary

From the point of view of Biomedicine, the use of gene therapy based on CRISPR for the treatment of hereditary angioedema should be highlighted. Great debate regarding Elon Musk’s brain chip, in general the scientific community has expressed serious reservations about this initiative. Beginning of the first trials with mRNA-based therapy in cancers of different types in the United Kingdom.

As far as Global Health is concerned, the beginning of routine malaria vaccination can without exaggeration be considered a historic event, given the high mortality of this disease in children in Africa. The WHO warns about the prospects for great growth in cancer globally and the notable differences in its prognosis, especially in breast and cervical cancer.

In terms of International Health Policy, the NHS England initiative is especially interesting, allowing pharmacies to prescribe certain medications and carry out some care practices, which is expected to result in a decrease of 10 million primary care consultations. The results of this experience deserve to be followed, since it could be part of the solution to Primary Care also in Spain. EU document on cancer in Europe, highlighting inequities in its approach.

If we talk about National Health Policy (Spain), it is worth continuing to comment on the intervention of the Minister of Health in the Health Commission of Congress. Although now it seems that nothing is important, the truth is that this intervention is one of the most relevant of any minister who reaches her position. The intervention has some lights and many shadows. Lights: recovery of a certain will for strategic direction of the SNS and decision to address the great problem of waiting lists (this is notable, since it contrasts with other ministers, who used to rather assume that everything was transferred and , therefore, the role of the Ministry was minimal). Shadows: very negative, offensive and unacceptable mentions of private healthcare, with arguments and quotes that are intellectually inconsistent and lacking rigor; staunch defense of direct public management, compared to other forms of public management; Public Health Agency, apart from doubts about its real content (no one hides the fact that the Agency does not make the influential nationalist parties very happy), the Ministry of Health gets out of the way to decide the location, handing over the baton to the Ministry of Territorial Policy and Democratic Memory, as if it were not also a health decision; Framework Statute, where are the negotiations with professionals?; medicines, no mention of the Strategic Plan of the pharmaceutical industry (in which the President of the Government himself had committed himself); Oral health, where is the economic memory? What care model will be followed? Is the inclusion of glasses in public provision, given the financial strains of the system, a reasonable priority? Is there prior consensus with other agents on this measure? In another order of things, in the Valencian Community the reversion to the public sector of the Denia concession has been completed and that of Manises will soon be granted, something to which the Administration has every right, once the concession contract has ended. The mentions of the concept of “expropriation”, used by some concessionaire company, are extemporaneous. Now, the official press release from the Ministry announces a very notable increase in staff in that hospital in Denia. Logically, uncontrolled growth in health spending, if it is not justified, cannot be the public alternative to concessions. Notable growth in the price of health insurance premiums in Spain, although its price must probably continue to be low, compared to other European countries. Something to analyze.

As for Companies, on an international level, Novo Nordisk was surprised by the great demand in Europe for medicines against obesity. In terms of national news, the pharmaceutical distributor HEFAME has experienced great growth in recent years and is considering expanding throughout Spain. At Grifols, the board is considering excluding the family from the company’s strategic decisions.

Biomedicine

Global Health

International health policy

  • European Union
    • Document on inequalities in the EU regarding cancer: “Beating cancer inequalities in the EU” Emphasis on prevention and early detection (https://www.oecd.org/health/beating-cancer-inequalities-in-the-eu -14fdc89a-en.htm)
    • The EU fined the pharmaceutical industry 780 million for anti-competitive practices between 2018 and 2022 (https://www.elespanol.com/invertia/observatorios/sanidad/20240130/ue-multo-millones-industria-farmaceutica-practicas-anticompetitivas /828667294_0.html#:~:text=The%20European%20Commission%20investigated%20one, euros%20for%20the%20laboratories%20involved.)
    • Brussels calls to promote vaccines against human papillomavirus (HPV) and hepatitis B throughout the EU (https://elpais.com/sociedad/2024-01-31/bruselas-llama-a-impulsar-las -vaccines-against-human-papillomavirus-hpv-and-hepatitis-b-across-the-eu.html#:~:text=Brussels%20has%20launched%20this%20Wednesday, the%20Hepatitis%20B%20(HBV).)

National health policy

  • Appearance of the Minister of Health before the health commission of the Congress of Deputies, on January 26, 2024
    • Lights and shadows in the appearance. Lights: recovery of a certain will for strategic direction of the SNS and willingness to address the great problem of waiting lists. Shadows: very negative and unacceptable mentions of private healthcare, with intellectually inconsistent arguments and quotes; staunch defense of direct public management, compared to other forms of public management; Public Health Agency, the ministry gets out of the way to decide the location, as if it were not also a health decision; Framework Statute, where are the negotiations with professionals and patient associations?; medications, no mention of the Strategic Plan of the pharmaceutical industry; Oral health, where is the economic memory?; Is the inclusion of glasses in public provision, given the financial strains of the system, a reasonable priority? Is there prior consensus with other agents on this measure? (https://www.youtube.com/watch?v=xlGfsMiuQDo)

Companies

 

7 days in healthcare (October 30th-November 5th, 2023)

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Summary

From the point of view of Biomedicine, the FDA opens the door to the first treatment with CRIPSR gene editing, applied in this case to sickle cell anemia. The “liquid biopsy” seems to be able to detect cancer recurrence before any radiological signs. A change is proposed in the regulation of embryo research. The laws and conventions in force do not allow embryos to be investigated in the laboratory beyond day 14. There is a gap until day 28, when embryos from abortions can already be investigated. This seems to prevent us from knowing many elements of organ development and that is what we are trying to modify. Although it is often assumed that dementia is increasing as the population ages, there appears to already be some evidence that the incidence of dementia is decreasing quite significantly.

As far as Global Health is concerned, the director general of the WHO is alarmed by the indescribable situation in Gaza. Nigeria is preparing to vaccinate 8 million girls with the papillomatosis vaccine, related to cervical cancer.

Regarding International Health Policy, in the United States, despite the prohibition of abortion in some states as a consequence of the Dobbs ruling of the Supreme Court, the abortion rate has not decreased a year after this ruling. The Economist considers how it is possible that doctors in the United States earn so much ($350,000/year on average), coming to the conclusion that it is due to an artificial shortage of doctors, due to the few places in Medical Schools, despite that there is no shortage of candidates. In the United Kingdom, the investigation into covid seems to show the disaster in management during the Boris Johnson period. Bad business, although the case of Spain is worse, where, despite promises, no report on the management of the pandemic has been made public. Health changes are on the horizon in Poland, following the arrival of the new government. Kenya, with 53 million inhabitants, joins the movement of so many other countries to move towards universal health coverage.

If we talk about National Health Policy (Spain), the XENOMA project in Galicia is very important, which aims to analyze the DNA of 400,000 Galicians. One of the precedents is the project to analyze the genome of 100,000 Britons, promoted during the David Cameron period and managed by Genomics England. Surely a project of this style should have been promoted at the national level, but it is good that, in the absence of the above, it should be promoted by an autonomous community. Doubts among experts about one of the measures of the PSOE-Sumar agreement on a law to end waiting lists. Without funding, better accounting and prioritization, organizational measures, new incentives and public/private collaboration, no law is capable of solving this problem. After all, a Royal Decree that establishes maximum times for certain procedures has already been in force since 2011, but it is not being complied with. Virtually all autonomous communities are approving increased health budgets for 2024, rising especially in Primary Care. Just because the budgets grow compared to the previous year does not mean that they are higher than the real spending in 2023, which is happening in Madrid, for example. The PSOE-ERC agreement contemplates the transfer of at least 150 million euros/year to Catalonia, for scientific and technical research.

In the field of Companies, on an international level, Google intends to grow in healthcare, based above all on artificial intelligence tools. Regarding the covid vaccine, GSK raises profit forecasts, while Moderna and Pfizer contemplate setbacks. At the national level, Fresenius sells its Quirón business in Peru. The Sant Joan de Deu Hospital in Barcelona creates an artificial intelligence laboratory with Microsoft.

Biomedicine

Global Health

International health policy

National health policy

Companies

 

 

 

 

7 days in healthcare (May 8th-14th, 2023(

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Summary

From the point of view of Biomedicine, it is worth pointing out the expanded “pan-genomic” base, which significantly increases the letters of the DNA, which, apparently, will make it possible to improve the typing and treatment of certain diseases. Promising results of mRNA technology in pancreatic cancer. Potential of stool transplants against some bacteria not sensitive to antibiotics.

As far as Global Health is concerned, although covid is no longer a global emergency, the truth is that, as the WHO itself shows, the disease continues to kill and change.

Regarding International Health Policy, it is worth highlighting the great news coming from the British government, which will allow pharmacies to prescribe certain medications, as well as the contraceptive pill. The objective of the measure is to significantly reduce the number of visits to the primary doctor. In France, patients, faced with overloaded doctors, turn to self-medication. Euthanasia is already legal in Portugal. Great battle in Chile between the Boric government and the Isapres (Chilean health insurers). In a bill, the government, in order to respond to an erga omnes ruling (of universal application) of the Courts, proposes the payment by insurers of alleged amounts for overpayments, which would make the model unfeasible. The Association of Isapres has reacted with a harsh note, answered no less harshly by government spokesmen. Health and specifically the role of the Isapres, at the center of the political debate in Chile.

If we talk about National Health Policy (Spain), the most important news is the proposals by various medical associations (IMAS Foundation, FACME, General Council of Medical Associations) for a decalogue of proposals to reform the SNS, which they consider in total crisis, before the next legislature. New governance; new management model; citizen/patient and professional participation; measurement of results and transparency; new care model; digital transformation according to the citizen’s digital clinical history model, are some of the most important measures. We only have to congratulate those responsible for this initiative, which contrasts so much with the limited and timid proposals put forward by the majority political parties. To those parties (PSOE and PP) the proposals were raised in a meeting. The only possible consideration is whether a reform of the public system is possible without mentioning a limited and selective co-payment, the absence of which we are the exception in Europe, as well as the non-consideration of the private sector in that reform. Looking the other way from the private sector has never produced good results. On the other hand, the document emphasizes its proposal for changes in the management and care model, governance, the participation of citizens/patients and professionals, and transparency. But he doesn’t mention financing at all. Although financing as an isolated reform (which is very common to consider) would not solve much, this issue has specific problems. Having made these qualifications, as a whole it is a splendid document, a must-read. The Constitutional Court publishes the ruling declaring the 2010 law on abortion deadlines legal. A study in Catalonia shows that the rich wait less on the lists of Catalan public hospitals than the rest of the population, something that had already been demonstrated in the UK on the NHS. The CEOE-union agreement includes the control of sick leave by Mutual Societies, something whose real scope will have to wait to see its effects. The truth is that absenteeism had increased a lot in recent times.

In the field of Companies, at the international level, drugs for weight loss point to an area of great economic interest for the pharmaceutical industry. In Spain, the most striking thing is Fresenius’s intention to get rid of the part of Quirón in Latin America, as well as the fertility company Eugin. Mutua Madrileña and El Corte Inglés launch medical insurance under the Adeslas brand.

Biomedicine

Global Health

International Health Policy

  • Chili
    • The Boric government against the Isapres (private health insurance companies in Chile). In a bill, the government, in order to respond to an erga omnes ruling (of universal application) of the Courts, proposes the payment by insurers of alleged amounts for overpayments, which would make the model unfeasible. Hard note from the Association of Isapres, which has obtained a no less harsh response from the Government. (http://www.isapre.cl/images/PDF/Declaracion_Prensa_19_abril_VFdocx_1.pdf)

National health policy

Companies

 

 

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

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Summary

From the point of view of Biomedicine, perhaps the most striking thing is that it is the 90th anniversary of the first transplant in humans, which took place in Kherson (Ukraine), a city that is so topical today due to the Russian invasion. It was a kidney transplant to a 26-year-old woman.

As regards Global Health, an important report on maternal mortality published by the United Nations. There is no decrease in frequency in recent years. Globally, 800 maternal deaths occur every day, a staggering figure. Cholera emerges globally, with outbreaks already in 30 countries, which indicates serious problems in water management and in the sanitary and hygienic conditions of the population.

Regarding International Health Policy, it seems that, despite the large outbreak of covid that occurred in China, after the abandonment of the covid-zero policy, this has not generated new variants of the virus. In the United Kingdom, conflicts persist in the NHS, with junior doctors joining the strikes. Important division in Colombia before the new health reform promoted by President Petro.

If we talk about National Health Policy (Spain), the cumulative incidence of covid continues to rise slightly, although mortality is decreasing. The medical conflict continues, both in Madrid and in other communities. The cost of putting a personal assistant to each Primary Care doctor is evaluated: 505 million euros. It’s a lot of money, but it’s possibly part of the solution. The pharmaceutical sector, with a large rise in 2022, consolidates as a large export sector in Spain.

At the Business level, internationally, Apple about to develop a smart watch that can detect blood glucose level, which can change diabetes management. Big Pharma is resisting at the international level that patents are expiring and giving way to generics, as reported by the Financial Times. It seems that Fresenius is going to concentrate on the area of hospitals and generics. In principle, the rumors of the possible sale of Quirón and the preparation of several private equity companies for this operation are dissipated. In Spain, significant increase in sales of Korian, Quirón and Asisa. BUPA and Mapfre alliance to sell certain insurance in some Latin American countries.

Biomedicine

Global Health

International Health Policy

National health policy

Companies

 

 

7 days in healthcare (February 21-27, 2022)

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SUMMARY

From the point of view of biomedicine, Bill Gates predicts another pandemic, although he estimates that he will catch us better prepared. Also to highlight the questioning of the traditional form of clinical trials. The latter is important, since Spain has become a power in clinical trials and it is important to analyze whether it is the right bet.

In terms of global health, it should be noted that COVAX has distributed exactly half of the COVID vaccines that it had as its objective. A great inequity in the distribution of vaccines in the world and, now, also of medicines against COVID.

As for international health policy, great controversy in the United Kingdom due to the lifting of all restrictions against COVID.

In national health policy (Spain), the incidence of COVID is low, although we continue with high mortality and without antivirals. The Ministry of Health takes the expansion of the service portfolio to a public hearing. Medical uneasiness before the reform of the Abortion Law, a BIOSIM proposal to promote the use of biosimilars and controversy over the financing of orphan drugs.

With regard to companies, it should be noted that the manufacture of Ventolín and Nolotil pollutes more than the automotive industry, which indicates how far the pharmaceutical industry has to go in implementing the United Nations Sustainable Development Goals. Also that Quirónsalud has exceeded the turnover of 4,000 million and Fresenius is open to incorporating new shareholders both in Quirónsalud and Eugin.

BIOMEDICINE

GLOBAL HEALTH

INTERNATIONAL HEALTH POLICY

NATIONAL HEALTH POLICY (SPAIN)

  • COVID

o The incidence of COVID continues to drop to 613 cases per 100,000 inhabitants (https://elpais.com/sociedad/2022-02-24/ultima-hora-del-coronavirus-hoy-en-espana-y-el-mundo-en-directo.html)

o 245 deaths in the sixth wave and still without antivirals (https://www.larazon.es/sociedad/20220225/3eq7hmpczjfe3ct7ruk3tz56wi.html)

o The subvariant of the stealthy “ómicron” accelerates its expansion in Spain (https://www.larazon.es/sociedad/20220224/3zfep56h6bf7jktf4fqvbnj3yq.html)

  • Political announcements

o The Ministry of Health takes out the draft order for the expansion of the service portfolio for a public hearing. Opinions in this regard can be sent via email informacion.publica@mscbs.es until March 10 (https://www.consalud.es/politica/sanidad-saca-audiencia-publica-orden-ministerial-actualiza-cartera-comun-sns_110420_102.html)

o AIReF announces a study on MUFACE spending in its plan for 2022 (https://www.airef.es/es/noticias/la-airef-publica-su-plan-de-actuaciones-2022-con-una-apuesta-clara-por-la-sostenibilidad-y-la-evaluacion/)

  • Other issues

o The medical groups, against the reform of the abortion law, propose the obligatory nature of performing it in public hospitals (https://www.larazon.es/sociedad/20220225/onwymfclwbbyfiamuan5il533e.html)

o Biosim presents 14 proposals to stimulate the use of biosimilars (https://www.diariofarma.com/2022/02/24/biosim-plantea-14-propuestas-para-fomentar-el-uso-de-los-biosimilares )

o Great controversy over the financing of orphan drugs, while the Ministry publishes a report with improvements in financing since 2016 (https://www.diariofarma.com/2022/02/23/sanidad-publica-un-analisis-sobre-la-financiacion-acceso-y-gasto-de-los-medicamentos-huerfanos-desde-2016) others insist that more than 50% of these medicines are not publicly funded (https://www.redaccionmedica.com/secciones/industria/el-50-de-los-medicamentos-huerfanos-estan-sin-financiar-en-espana-7267)

o The strategic health reserve today has 466 million masks and 955 respirators (https://www.elindependiente.com/espana/2022/02/27/la-reserva-estrategica-de-sanidad-cuenta-hoy-con-466-millones-de-mascarillas-y-955-respiradores/)

COMPANIES, EMPLOYERS AND OTHER AGENTS IN THE SECTOR

 

7 days in healthcare (8-14 November, 2021)

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ABSTRACT

 

From an international point of view, the appearance of two new drugs for COVID (Merck and Pfizer) is considered a milestone in the evolution of the pandemic. Both drugs are small molecule, easy to produce, and for oral use. The other great milestone of the pandemic was, at the time, the appearance of vaccines. Especially worrying are the high numbers of COVID in Europe, especially in the United Kingdom, Ireland, but also Germany and the Netherlands, without forgetting the special situation due to its seriousness in Romania and Bulgaria.

From the national point of view, the announced draft bill on Equity, Universality and Cohesion of the SNS is of great interest. Although the text of the preliminary draft is not known at the time of writing this note, from what was announced it could be said that the positive aspect is universality (provided that universality is not identified with equity) and the negative are the possible repeal of Law 15 / 97, on enabling new forms of management in the National Health System, the imposition of direct management compared to other more flexible forms of management and bad messages regarding co-payments. It seems that he wants to transfer the idea that “privatization” and “copayments” are the problems of the sector, which is absurd.

Regarding companies, the disappearance of large industrial business conglomerates, such as J&J and GE, is striking. It should be noted that in both operations one of the bets is health. This contrasts, instead, with the creation of tech giants (Google, Amazon, Apple, etc.).

 

INTERNATIONAL

 

  • The Economist forecast: COVID will most likely disappear by 2022. Success: vaccines and new drugs. Failure: immunity at terrible cost, 16.5 million deaths worldwide (The Economist, 8 Nov 21)
  • The Economist welcomes the extension of “assisted death” as a new and important right, started in 1995 in Australia and already legal in a dozen countries, most recently Portugal. It is not yet legal in the UK, but Parliament is discussing a law on the subject. In the Netherlands, 4% of deaths are assisted (The Economist, 13 Nov 21)
  • The new anti-COVID drugs represent a significant change in the pandemic (the first notable change was that of vaccines). The new drugs are malnupiravir (Merck) and paxlovid (Pfizer). Both are “small molecule” drugs, easy to produce and for oral use (The Economist, 12 Nov 21)
  • 100 Years of Insulin (Toronto, 1922), a therapeutic success, but a failure in its worldwide spread. The producing companies are Novo Nordisk, Eli Lilly and Sanofi. Now there is biosimilar (The Lancet, Nov 13, 21)
  • The 100,000 genomes project in the United Kingdom (Genomics England) has made it possible to catalog, and in some cases treat, many rare diseases (New England Journal of Medicine, 11 Nov 21)
  • The rise of the COVID epidemic in Germany (almost 500 cases in the last 14 days per 100,000 inhabitants), at the peak and rising, is considered an pandemic of the unvaccinated. Among the factors, the interim Merkel government is valued (NYT, 11 Nov 21). Merkel will meet with the “Länder” next week to take measures against the growth of the covid (El Mundo, 11 Nov 21)
  • The Netherlands imposes new restrictions, as COVID cases are very high (The Guardian, 12 Nov 21)
  • The governments of 42 countries (including the United States, the United Kingdom and Germany) ask to cut emissions from the healthcare sector. The sector’s emissions represent 5% of the total. If it were considered a country, the health sector would be the 5th emitter of CO2 pollution (NYT, 8 Nov 21)
  • The Economist analyzes the non-zero cost of China’s zero-COVID policy (The Economist, 13 Nov 21)
  • COVID vaccination will be mandatory for NHS staff starting next spring (FT, 9 Nov 21)
  • Waiting lists on the NHS soared. They grow by 100,000 people in a month. More than 5.8 million were waiting in September, with 12,500 awaiting treatment for more than two years (FT, Nov 11 21)

NATIONAL

 

  • The government approves the “preliminary draft of the Law by which various norms are modified to consolidate the equity, universality and cohesion of the National Health System” (reference of the Council of Ministers 8 Nov 21)
  • The Secretary of State for Health publishes a prior consultation on the draft bill of measures for equity, universality and cohesion of the National Health System, establishing the November 19 deadline for submitting opinions.
  • The Minister of Health, in public statements, mentions the laws that are going to be repealed or modified. Among those that will be repealed, “explicitly and expressly”, she mentions Law 15/97, on enabling new forms of management in the National Health System (El Periódico de España, 8 Nov 21)
  • The BOE publishes the agreement between the Government, certain autonomous communities and the Amando Ortega Foundation, for the implementation of 10 proton therapy equipment in the public system. A monitoring commission is created on the subject (BOE, no. 267, 8 Nov 21)
  • The health PERTE is presented on November 15. It is integrated into the five PERTES that the government has devised: cutting-edge healthcare, electric vehicle, new language economy, aerospace and smart and sustainable food chain. It appears that the health PERTE will have three components: 1. Innovative techniques and technologies for the diagnosis and prevention of diseases; 2. Development of advanced therapies; and, 3. Platform for the design and industrial production of medicines and vaccines (ConSalud, 11 Nov 21)
  • The autonomies claim to maintain the covid funds for 2022 (El País, 9 Nov 21)
  • The University of Washington predicts a sixth wave of covid in Spain (Vozpópuli, 8 Nov 21)
  • The cumulative incidence of covid grows in Spain to 71.5 cases per 100,000 inhabitants in the last 14 days. It is not comparable to the figures of other European countries, but it continues to rise slowly (ConSalud, 12 Nov 21)
  • The waiting list grows. The latest data published is from December 31, 2020 and the waiting time had passed, in relation to the previous record, from 121 to 148 days for interventions. Pending publication of the data corresponding to June 2021 (ConSalud, 8 Nov 21)

COMPANIES, EMPLOYERS AND MAIN ACTORS IN HEALTH

 

  • J&J (Johnson & Johnson) will be divided into two companies: one dedicated to consumer products and the other to drugs and medical devices (NYT, 12 Nov 21)
  • GE (General Electric) will be divided into three companies: health, energy and aviation (FT, 9 Nov 21)
  • The Spanish pharmaceutical industry proposes a plan of 1.7 billion to produce essential drugs (CincoDías, 10 Nov 21)
  • Moderna rejects the claims of the American government to appear as a co-inventor of vaccine technology (FT, 11 Nov 21)
  • BioNTech shoots its profit up to 7,126 million euros in the first nine months of the year. (Floor Twelve, Nov 9, 21)
  • The Zendal hospital in the post-pandemic: 400 personnel for 38 patients (Diario.es, Nov 7 21)
  • Fresenius is interested, along with other investors, in InsudPharma, specialized in biosimilars and valued at 1,000 million euros (El Periódico de España, Nov 9, 21)
  • Advent gives gas to Vitaldent, with the purchase of Smysecret (dental aesthetic treatments) (PlantaDoce, 12 Nov 21)
  • Acciona will build a hospital in Chile (PlantaDoce, 11 Nov 21)
  • KKR enters fertility with the purchase of GeneraLife from Invesindustrial (Expansión, 10 Nov 21)
  • HIPRA will imminently begin the new phase of clinical trials for its vaccine (El Economista, Nov 8, 21)
  • Grifols liquidates the blood bag business and closes production in Brazil and Murcia (Cinco Días, Nov 12, 21)