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7 days in healthcare (April 8th-14th, 2024)

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Summary

From the point of view of Biomedicine, chatbots (devices that interact by text or voice with people based on artificial intelligence), are increasingly used in healthcare. In the UK, the NHS uses them in Primary Care to triage patients. One of the great challenges of future health management is determining what will be done in person and what will be done remotely, on the one hand; and what activity will require the presence of a professional or when these chatbots can be used. Possible important advance in the treatment of hepatitis type 1. The EMA is studying the first drug that has been shown to delay the onset of symptoms. There are 100,000 people affected in Spain, many of them children. Teplizumab, the active ingredient, prevents T lymphocytes from attacking the beta cells of the pancreas, which produce insulin.

Regarding Global Health, France proposes to recognize abortion as a constitutional right. 60% of women live in countries where abortion is completely legal; and 40% do it in countries where it is prohibited or has restrictions. Not having access to a safe abortion can have negative health effects. Exodus of health personnel in sub-Saharan Africa, precisely the region of the world where health professionals in relation to the population move in lower numbers. Employment conditions are degraded locally, while developed countries, with strong demand, open their arms to them. This questions health personnel policies based on the importation of personnel from developing countries, as some in our country seem to sponsor. This is said with the utmost respect for the freedom of movement of citizens and workers.

Regarding International Health Policy, according to the magazine Health Affairs, negotiations continue to establish the price of 10 drugs for Medicare. This was contained in the Inflation Reduction Act and is, possibly, the most far-reaching healthcare measure approved during Biden’s presidency. The negotiations must be finalized by September 1, 2024, for implementation from 2026. The United Kingdom limits treatments to children and young people who want a sex change, in line with what has already been implemented by some countries. Northern Europe: Finland, Sweden, Norway, Denmark. The NHS will no longer offer puberty-blocking drugs. As for hormones such as testosterone and estrogen, which produce permanent physical changes, they will be prescribed with extreme care. Macron’s government approves the euthanasia bill (although this word will be avoided, using the concept of “helping to die”). It is worth highlighting the profound debate carried out in France at all levels in relation to this text, with President Macron personally intervening on multiple occasions. Just like in Spain, where it was approved as if it were a modification of the VAT of a product, avoiding all types of reports. Simultaneously, a 10-year palliative care strategy is approved in France, endowed with 1.1 billion euros. In Italy, AGENAS was born, a hospital performance evaluation system, launched by the National Agency for Regional Health Services. How good it would be for Spain to implement a similar tool, which would allow us to compare the performance of our health institutions.

If we talk about National Health Policy (Spain), it is important to highlight the achievements of our health system. According to a recent publication by “Our World in Data”, which analyzes mortality from all causes in all countries, in 2019 Spain is the third best-placed country in adjusted mortality per 100,000 inhabitants (385.9). Only surpassed by Iceland (348.0) and Japan (323.3). This concept of mortality adjusted for pathologies can be related to the activity of the health system. A great success, in which activity is Spain in the Top3? For her part, the minister of Health continues to announce measures. She promised a law limiting private management of public hospitals, using the well-known slogan “healthcare is not for sale, it is defended.” Although we understand that politicians speak for their parish and those statements may have a fireworks component, using that demagogic and populist slogan taken from the white tides is not up to the health debate that our country requires. On the other hand, what is proposed as a panacea is “direct public management”, as if there were not enough published evidence (Prof. JJ Martín, from the University of Granada, among others) of the worse performance of direct management compared to centers with legal personality and labor personnel. The document “Statistics of public health expenditure 2022” is published. Public health spending reached 92 billion euros in 2022, reaching 6.8% of GDP, increasing by 4.6% compared to the previous year. From 2019 to 2022, public health spending increased by 22.8%, an annual average of 7.6%. Although we are still far from the most advanced countries in Europe in terms of percentage of GDP dedicated to public health spending, there is no doubt that in this period the growth of this spending was much higher than that of general GDP. 40,000 healthcare workers will retire each year until 2026, according to a report by the Spanish Society of Public Health and Health Administration (SESPAS). Important planning problem that arises. Spain, the country in the world with the most Medical Schools per inhabitant. There are now a total of 50, just 15 years ago there were 28, a figure that will increase in the coming years: San Jorge (Zaragoza); Nebrija (Madrid), and Loyola (Seville). The Deans of Medicine and the State Council of Medical Students, against this exponential and uncontrolled growth. It is doubtful that Spain as a country has sufficient and trained teachers to attend to this proliferation of Medical Faculties, unless these faculties become a kind of academies for the MIR. This is an issue of the Faculties of Medicine where the desire for political success of some communities (which are responsible for approving the creation of a Faculty of Medicine) operates, together with the commercial interests of some private Universities. The IMAS Foundation proposes its digital medical history, which would incorporate data from different health and social service providers, information generated by portable digital devices, and measurements made by the patients themselves. And everything within reach of the user and the professionals with whom they want to share it. Excellent initiative, at the height of the times, a concept of history that is only for the public system, that only contains information from the health system and that cannot be carried by the patient and allows the use of it to whoever they consider, is no longer valid. your criteria. Santiago Dexeus, pioneer of sexual and reproductive health and one of the first defenders of the contraceptive pill in Spain, dies. He well deserves a national tribute.

As for Companies, internationally, Moderna is putting its plans to launch a vaccine plant in Africa on hold. In terms of national information, Sanitas increases its turnover by 12% and achieves record growth in policyholders after its agreement with Generali.

Biomedicine

Global Health

International health policy

National health policy

Companies

7 days in healthcare (January 8th-14th, 2024)

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Summary

From the point of view of Biomedicine, it is worth highlighting the first results of the genomic studies of tumors carried out by the British public company, created in Cameron’s time, Genomics England, which will allow new therapeutic orientations in tumors. Certain hopes for patients with schizophrenia, a disease with a limited therapeutic arsenal. A Phase III trial gives promising results. It is expected that the drug can be approved in 2024 by the FDA. The WHO organizes a World Forum on Clinical Trials, establishing the four pillars for their development, which is of special interest to Spain, which is a power in clinical trials, a leader in Europe and only surpassed globally by the United States, China, India and Iran.

As far as Global Health is concerned, the WHO warns that a new pandemic will arrive and it will be more deadly.

In terms of International Health Policy, the growth of total health expenditures in the USA returns to pre-pandemic levels. They rose 4.1% in 2022, while in 2020 they had risen 10.6%. The New England Journal of Medicine publishes an interesting article on the “financialization” (non-financing) of health in the United States, distinguishing this from “corporatization” (the role of large corporations) or “privatization” (greater role of the private sector). “Financialization” refers to the greater role of financial or private equity companies in the healthcare world, in many cases as direct owners of healthcare companies, especially pharmaceutical and insurance companies. The effects of this phenomenon are not yet well analyzed. The FDA approves 55 drugs in 2023, up 48% from the previous year. Of those 55, 28 were intended for rare diseases. The Economist analyzes in an article that the British health system is acquiring a shape similar to that of the 1930s, with a large role of private companies and charities, when Aneurin Bevan created the NHS. It should be noted that the so-called generation Z (between 18 and 24 years old) are the largest users of private healthcare. The EU, through HERA, the body created as a result of Covid, will launch a vaccine development center.

If we talk about National Health Policy (Spain), the Ministry of Health agreed, in the face of the growth of the tripledemic, two measures: the first, the so-called “auto-sick leaves” (sick leaves of up to three days without prior medical report, by the exclusive decision of the worker); and, the second, the mandatory nature of masks in health centers. Both very controversial measures. The first was due to disagreements with the unions, employers and within the government itself, which speaks of improvisation on a very sensitive issue and which forced it to be postponed indefinitely. The second, with opposition from several communities and legal problems in its design. Measures continue to be taken to address problems such as pandemics without the expert advice of an organization such as the Public Health Agency, which has not yet been created, which could possibly have avoided or mitigated some of the problems that the Ministry has encountered. The Catalan government, faced with a growth in pharmaceutical spending, intends to control it with several measures. One of the requests is the transfer of the powers of the Interministerial Price Commission, in order to be able to negotiate the price of medicines with the laboratories at the community level. An issue that could threaten the necessary cohesion of the National Health System. Budgeted public health spending amounts to 89 billion in 2023, 29% more than in 2019, before the pandemic. The unions propose to the Ministry changes in the human resources policy and in the Framework Statute. Given the well-known aversion of unions to differentiation and individual and collective recognition, basic needs of the system, surely the approaches will not be very innovative.

In the field of Companies, on an international level, Goldman Sachs is making its debut in health, with a fund of 650 million dollars, in a line that seems to reinforce the idea of the “financialization” of health, discussed in the article this week from the New England Journal of Medicine. When it comes to national news, the highlight is the upheaval at Grifols, which has lost 3.2 billion euros in five days. After the Gotham Research City report, the company has not been able to convince shareholders of its reliability.

Biomedicine

Global Health

International health policy

National health policy

Companies