Posts

7 days in healthcare (August 12th-18th, 2024)

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Summary

Biomedicine

  • The Lancet provides a clinical update on persistent covid. Defined as symptoms that persist for more than three months. Although the approach is based on symptoms, work is being done on identifying the molecular profile and biomarkers.
  • There is no benefit for adults who drink alcohol in moderation. A long study shows that adults have no benefit from moderate alcohol consumption. After following 135,103 adults over 60 years of age, the conclusion is that alcohol is associated with increased cancer and does not produce the benefits on the heart that were attributed to it for some time.

Global Health

  • The WHO declares the Mpox outbreak in African countries a global emergency. Despite the severity, there are two facts that differentiate this outbreak from that of covid: the first is that the infection is not transmitted through the air, with the great difficulties of control that this entails, but by direct contact; the second is that this time there are already vaccines and many countries, such as Spain, have them in stock. We are not, therefore, facing a pandemic threat like the one we saw a few years ago.
  • Vaccine shortages threaten the response to Mpox. The outbreak has been detected in 13 African countries, most of them in the Democratic Republic of Congo. Concerns about vaccine supply and distribution come after similar problems during Covid. Bavarian Nordic, the only company producing this vaccine, received an order for more than 175,000 doses from the EU Emergency Preparedness and Response Centre (HERA) and, for its part, donated 40,000 vaccines to HERA. But with vaccine shortages, other measures must be taken, such as contact control and testing. The seriousness of the failure of the WHO and the international community in the face of the Pandemic Treaty is now being seen.
  • High heat-related mortality in Europe during 2023. This year was the hottest globally on record and the second hottest in Europe. An estimated 47,690 heat-related deaths in Europe are estimated. Mortality is estimated to have been 80% higher in the absence of adaptation measures this century, especially for the elderly. Specific strategies are needed to address this major threat.
  • 4.4 billion people lack safe water. This requires three requirements: available on demand; accessible in homes and free of contaminants, such as Escherichia coli and specific chemicals.

International health policy

  • Agreement on the price of 10 drugs in the USA. Biden and Harris announce savings of 7.5 billion dollars, as a result of the agreement on the change in the price of 10 drugs. The affected companies are not minor: Merck, NovoNordisk, AstraZeneca, Immunex, Boehringer Ingelheim, Janssen, BMS, Novartis, AbbVie, among others.
  • The Lancet sets out Kamala Harris’s health priorities in an editorial. The first thing to recognize is Biden’s merits in health policy: reestablishing funding for the WHO and the UN Fund for the population; returning to the Paris agreement on climate change (both Trump eccentricities); increasing credits for children; expanding Obamacare; and approving the law to reduce inflation (which has allowed the price agreement with the pharmaceutical industry). According to this editorial, Kamala Harris’ priorities would be four: 1. Reverse the decline in life expectancy in the USA (77.4 years in 2022, compared to 78.8 in 2019). The State of Mississippi has a life expectancy of 71.9 years, lower than Mongolia (72.6 years) and Syria (72.3 years); 2. Incentivize States with the poorest health indicators; 3. Regain confidence in science, lost by a large part of the population; and, 4. Strengthen the role of the USA in global health diplomacy. • The NHS launches a subscription system for antibiotics. The NHS will negotiate with pharmaceutical companies a subscription system of up to 20 million pounds per year per medicine. The tender will be launched next Monday and will reach 1.9 billion pounds in 16 years and will operate in the four nations of the United Kingdom.
  • The NHS “Pharmacy First” is not working properly. Pharmacies do not reach the minimum number of consultations. In the programme, seven specific pathologies had been defined to be attended to by pharmacies, which would receive extra payment. The programme is not working as well as expected, in the eyes of the pharmacies attached to the initiative.
  • Health strategies in the European Union are not given priority. According to an editorial in The Lancet Regional Health-Europe.

National Health Policy (Spain)

  • Spain faces Mpox. The Ministry of Health brings together technicians and autonomous communities in response to the Mpox health emergency and negotiates with the European Union the joint purchase of smallpox vaccines. It is known that the cases registered in Spain are unvaccinated people.
  • Health will reduce the time for drug approval. The Royal Decree that will define from now on the process of approval and financing of drugs has been made public. Deadlines are established for the approval of a new drug, which will go from the current average of 650 days to 210 days, a substantial change.
  • Extraordinary good reception of the Minister Olga Pané by the Catalan health sector. Some comments on this:
    • Apart from the outstanding qualities of the new Minister, it is not precisely the lack of competent councillors that has been seen in Catalonia. What was lacking was rather a good government concerned about “things”, as Ortega would say. Without a good government (with a project and willing to carry out a reformist project) there can be no success in health policy.
    • Catalonia can make an important contribution to its system and to the national system if it advances in the reform of the public management model and in personnel policy, key issues for the Catalan Society of Health Management, to which the minister is linked.
    • Far from emphasizing these issues, the PSC-ERC agreement insists above all on an endless list of infrastructure works, which apart from being difficult to fulfill, rather seems something similar to Gonzalo Fernández de la Mora’s “State of Works”. Logically, a plan for works is not a health policy. On the other hand, in this same section there is talk of “continuing with the processes of republification”, the scope of which is not specified, but which may contain worrying connotations.

Companies

  • International
    • Eight super drugs will lose their patent in the next five years. This affects Merck-MSD, BMS, Bayer, Pfizer, Lilly or Roche. The eight blockbusters that will lose their patent at the end of this decade are among the thirty best-selling drugs in the world.
    • Who is Bavarian Nordic, the company that makes the only vaccine against Mpox. It rises 38% on the stock market in four days. The CEO of this company, Paul Chaplin, assured that it will be able to meet the immunization needs of African nations. “We have inventory and we have the capacities. What we lack are the orders,” he said.
  • National
    • Problems continue at Grifols. Stock market crash and demand in the USA.

Biomedicine

Global Health

International health policy

  • USA
    • Biden and Harris announce savings of 7.5 billion dollars, as a result of the agreement on the change of prices of 10 drugs. The affected companies are not minor: Merck, NovoNordisk, AstraZeneca, Immunex, Boehringer Ingelheim, Janssen, BMS, Novartis, AbbVie, among others. (https://www.ft.com/content/718b52e8-9c57-4dcf-b2f4-84cf8d7da21c)
    • The Lancet editorial: Kamala Harris’s health priorities. The first thing to recognize are Biden’s merits in health policy: reestablishing the funding of the WHO and the UN Fund for the population; returning to the Paris agreement on climate change; increasing credits for children; expanding Obamacare; and approving the law to reduce inflation (which has allowed the price agreement with the pharmaceutical industry). According to this editorial, Kamala Harris has four priorities: 1. Reverse the decline in life expectancy in the USA (77.4 years in 2022, compared to 78.8 in 2019). The state of Mississippi has a life expectancy of 71.9 years, lower than Mongolia (72.6 years) and Syria (72.3 years); 2. Incentivize states with the poorest health indicators; 3. Restore trust in science, lost by a large part of the population; and, 4. Strengthen the role of the USA in global health diplomacy (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01687-8/fulltext)
    • Medicare expansion of obesity drugs could mean an increase in spending of between 3.1 and 6.1 billion dollars (https://www.healthaffairs.org/doi/10.1377/hlthaff.2024.00356)

National health policy

Companies

7 days in healthcare (July 15th-21st, 2024)

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Summary

Biomedicine

  • The benefits of GLP-1 medications, beyond obesity. These medications may be useful in a wide variety of chronic conditions. There are multiple clinical trials underway. The next decade is likely to allow for greater potential for GLP-1 drugs.
  • The fertility industry. Economic factors are delaying couples’ willingness to have children, which produces greater infertility in both men and women. 9% of births in advanced countries occur through in vitro fertilization (IVF), but the high cost of these treatments produces inequities in access, despite similar levels of infertility around the world. Better access is needed.

Global Health

  • The H5N1 bird flu virus can cause a human pandemic. So far there is no evidence that the virus has adapted to growing among humans, but this may change quickly. When COVID19 appeared, there was no natural immunity, no medications or vaccines. These three things exist today for H5N1.
  • The WHO and UNICEF warn of the high number of unvaccinated children. The goal of these institutions is to reduce the number of unvaccinated children by 2030, particularly in Africa, the Middle East and Asia.

International health policy

  • The King’s Speech 2024 at the opening of the legislature. It is known that, in British protocol, the King expresses the government’s intentions. Key elements mentioned: 1. Waiting lists; 2. Focus on prevention; 3. Mental health, including a law change; 4. Increase in the age for authorization to purchase tobacco and limits on vaping; 5. Restrictions on junk food advertising.
  • Module 1 of the covid survey appears, on the resilience and preparedness of the United Kingdom to the pandemic. Please note that this Module 1 will be followed by several others on: governance; sanitary system; vaccines and therapies; purchasing and distribution; testing and isolation programs; Young people and children; the economic response to the pandemic. The structure of the report is problems and recommendations. This accumulation of reports that deal with the different aspects of the management of the pandemic has nothing to do with the disappointing Spanish report commissioned by the government, in which so many elements of analysis were missing (behavior of the different autonomous communities, international comparison, purchasing aspects and distribution of materials, mortality of professionals, etc.).
  • GPs (primary doctors) who use artificial intelligence improve the cancer detection rate by 8%. The application, called “C the Signs,” checks medical records. This software is used in 15% of healthcare facilities in England. The results were published in the Journal of Clinical Oncology.
  • United Health, the controller of the Chilean insurer Banmédica, is leaving Chile. United Health is the largest health conglomerate in the world and the interpretation is that, since Latin America is a marginal business for them, they prefer to get out of the regulatory instability that currently affects the continent. Doubts about the appearance of a buyer for the insurer Banmédica.
  • EU health priorities for the coming years. Van der Leyen sets the EU health agenda: mental health care, development of a critical medicines law and greater promotion of research with the development of a new technology law as well.

National Health Policy (Spain)

  • Strategic Plan of the pharmaceutical industry. Health has already sent Farmaindustria the draft of the sector’s Strategic Plan, a long-promised and delayed Plan that will remain to be seen in what remains in practice.
  • The government approves 172 million for Primary Care. Reaction: Primary care needs reform, not crumbs. That money is less than the one-year budget of many hospitals.
  • Health OPEs advance. The autonomous communities are advancing in the health OPEs, including the Canary Islands, Madrid, Castilla y León, Castilla-La Mancha, Aragón,… This news should be good, but in fact it is quite bad, due to the way the OPEs are done, with the risk of distorting multiple medical services.
  • Debate on doctors’ salaries in Spain. Statements by Antón Costas, president of the CES: “At the remuneration level, Spain does not fare badly in healthcare”, since Spain is among the countries where the remuneration is highest compared to the average salary (2.6 times in the case of those who practice general medicine and 3 times for those who practice other specialties). An interesting contribution to a debate that must continue. It is evident that to compare doctors’ salaries it is not worth doing so with absolute figures (as is done using Medscape reports), but rather with what they represent in the average salary of each country. However, it remains to be seen whether, even so, Spanish medical salaries withstand international comparison.On the other hand, it is proven that Spanish medical salaries fell in absolute numbers between 2011 and 2017.

Companies

  • International
    • The main medications on the 2030 horizon: Oncology, CNS and obesity.
  • National
    • Movements to take Grifols private continue. Grifols signs Morgan Stanley and Goldman before the takeover bid by the family and Brookfield.

Biomedicine

Global Health

International health policy

National health policy

Companies

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

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Summary

Biomedicine

  • Four decades of orphan drugs. The Orphan Drug Act (ODA) was approved in the USA in 1983, due to the lack of commercial interest in the development of these drugs. The law that developed incentives for production, the duration of patents and research was a success and more than 800 indications have already been approved. However, many rare diseases remain untreated and prices are unsustainable. This is why a new strategy is proposed for the next four decades.
  • Gene therapy offers hope for autoimmune diseases. Use of CAR-T, originally intended for cancers, in lupus. The initial findings offer hope to millions of patients with autoimmune diseases, four in five of which are women.

Global Health

  • Vaccines save lives. The measles vaccine alone is estimated to have prevented 23 million deaths between 2000 and 2018. Globally, the vaccination rate has increased for many diseases. However, in 2022 (the latest figure available) there were still 14.3 million children with zero doses. A lack of access and high production and cost costs among the reasons for this situation. New strategies are needed to boost utilization.
  • Counting the dead in Gaza. According to a letter published in The Lancet, as of June 24, 37,396 people had been killed in the Gaza Strip since the Hamas attack and the Israeli response, according to the Gaza Ministry of Health, figures not accepted by Israeli authorities, although they are by the United Nations and the WHO. If we take into account that the indirect deaths are estimated to be between three and fifteen the number of direct deaths, a conservative estimate with a multiple of four gives 186,000 deaths attributable to the current conflict. This is why an immediate ceasefire is advocated.

International health policy

  • The NHS is broken: In his first official statement released on July 5, the new UK Health Minister (Wes Streeting) says that his department’s official position is that “the NHS is broken.” . He is surprised by this clarity regarding the recognition of problems, which is to be expected to be followed by profound reforms.
  • Official statement from the Labor Party on preparing the NHS for the future: cutting waiting lists with 40,000 more appointments each week; double the number of cancer scans; a new Dental Plan; 8,500 more mental health professionals; back to the family doctor.
  • Starmer turns to Alan Milburn, former Minister of Health, close to Tony Blair, to fix the problems of the NHS, which is interpreted as meaning that the private sector and consumer choice will be at the center of the plans.
  • The first official report on Covid management in the United Kingdom is published. After multiple surveys, it will be published next Thursday and promises to reveal serious deficiencies in the management of Covid. It will be interesting to compare this report with the disappointing and incomplete one published in Spain, carried out by three experts selected by the government.
  • European hospitals lose more than 170,000 beds in a decade, but Spain increases them, despite continuing to be one of the European countries with the fewest beds per 100,000 inhabitants.

National Health Policy (Spain)

  • The State Public Health Agency, in limbo. The creation of this Agency takes forever. It’s a bit frustrating, says Eduardo Satué, president of the Spanish Society of Public Health and Health Administration (SESPAS).
  • Various communities offer bonuses and incentives to doctors: to cover the deficit in Primary Care (Andalusia) or to cover the wings of the region (Asturias).
  • AESEG requests a price difference between generics and brands, which Farmaindustria opposes, a measure that is already applied throughout Europe except in Spain. The sector has 21 production plants in Spain and generates more than 40,000 direct and indirect jobs.
  • Private healthcare runs the risk of dying of success. Waiting lists are exploding for private health insurance (which 1 in every four citizens already have), but, due to low premiums, reaching up to 20 or 30 euros per month, it is not possible to provide a good service. A giant is being built with feet of clay.
  • Serious management problems in the health sector, according to FEDEA. Despite the significant increase in resources in the health field, since the level of spending has grown from 13.2% in 1999 to the current 14.5% of the total spending of Public Administrations. Real public spending per inhabitant has grown by 48% since 2003. This reality contrasts with the idea that healthcare has experienced significant cuts in recent decades, when the only falls in real spending per inhabitant only occurred between 2010 and 2013.

Companies

  • International
    • Pfizer wants to enter the anti-obesity drug market, having an advanced trial with a daily pill, with which it intends to enter the obesity market that promises to be worth 100 billion dollars a year.
  • National
    • It is possible that Grifols will cease to be a listed company. The Grifols family in talks with the Brookfield fund to take the company private.

Biomedicine

  • NEJM review: Four decades of orphan drugs. The Orphan Drug Act (ODA) was approved in the USA in 1983, due to the lack of commercial interest in the development of these drugs. The law that developed incentives for production, the duration of patents and research was a success and more than 800 indications have already been approved. However, many rare diseases remain untreated and prices are unsustainable. This is why a new strategy is proposed for the next four decades (https://www.nejm.org/doi/full/10.1056/NEJMp2401487)
  • Non-communicable diseases in reproductive care. New approach to gestational diabetes (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01298-4/fulltext)
  • Gene therapy offers hope for autoimmune diseases. Use of CAR-T, originally intended for cancers, in lupus. Initial findings offer hope to millions of patients with autoimmune diseases, four in five of whom are women (https://www.ft.com/content/a974f4c1-bb8a-4a1b-9d88-a2cf14be5c6e)

Global Health

International health policy

National health policy

Companies

 

 

7 days in healthcare (15th-21st, 2024)

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Summary

From the point of view of Biomedicine, after an extensive study it is detected that in approximately 1 in 10 cases of multiple sclerosis, antibodies are detected in the blood years before the disease develops. It may be too early to draw conclusions about the repercussions of this finding.

As far as Global Health is concerned, plans to expand vaccine production to Africa are facing serious problems. This follows Moderna’s halt to the construction of a €500 million plant in Kenya, although other schemes continue, such as plans including facilities in Rwanda, Senegal and South Africa, carried out by BioNTech. Producing more vaccines in Africa is a moral imperative, says Martin Friede, head of vaccine research at the WHO. Article in Lancet Americas: Corruption, the greatest threat to healthcare. The cases in Peru as a result of the covid-19 pandemic and in Brazil (Rio de Janeiro) are discussed. It seems to be demonstrated, analyzing the experience of the few countries in which cannabis consumption has been legalized for a few years, that its legalization produces an increase in consumption in adults.

In terms of International Health Policy, initiatives in the USA against Chinese biotech companies will harm American patients. The Biosecure Act, which gained bipartisan support in Congress, proposes ending government contracts with biotechnology firms that have agreements with Chinese companies as clients or suppliers. This can greatly harm Americans, since, for example, BGI (Beijing Genomics Institute) is the largest human DNA sequencer in the world and operates in 100 countries. Facilitates the manufacture of prenatal tests and other diagnostic tests. In the United Kingdom, Brexit has exacerbated drug shortages in pharmacies. This is deduced from the study by the Nuffield Trust, a prestigious British health think tank, which released a report analyzing the impact of Brexit on the health system. Also in the United Kingdom there is a report published by Reform, a British think tank committed to public services and the effectiveness of the State, proposing a major organizational change in the health system in England, trying to decentralize and abolishing NHS England, since it is considered that such a centralized system is preventing the transition towards a more preventive model, guided by local needs. The role of NHS England would be assumed by the Department of Health, although with a much more strategic vision. England (with around 57 million people) is considered to be the most centralized healthcare system in Europe, despite devolution processes in Scotland (5.4 million), Wales (3.1 million) and Northern Ireland (1.9 million). This same idea of the problems of large centralization of the NHS is held by Nigel Edwards, former chief executive of the Nuffield Trust and now senior associate. The House of Commons votes in favor of the ban on smoking for those born after 2009, despite the Prime Minister being met with the vote against more than 50 Conservative MPs. A controversial measure whose only precedent is New Zealand and was recently repealed by the new government. In Germany, a commission recommends that abortions be legalized in the first 12 weeks. Although abortions in Germany are regulated by a 153-year-old law and are illegal, in practice they are performed in an accessible way. It is assumed that the current law does not meet current international standards.

If we talk about National Health Policy (Spain), the Ministry of Health seems to focus on issues such as the promise to the white tides of the imminent hearing of the Public Management Law; while the Commissioner of Mental Health prepares a guide to reduce psychotropic drugs, as well as launching more than debatable messages such as that “long-term drug treatments kill. These people live 20 years less”, which generated a negative response from Dr. Celso Arango, from the Gregorio Marañón Hospital; or he tries to change the 24-hour guard system, without really knowing how; “green” anesthesia; announcements that possibly, as intended in the United Kingdom, smoking will be banned for those born after 2009; etc. It does not seem that a very varied set of measures on often non-central issues constitute a strategy of anything. While serious underlying problems remain or worsen, such as waiting lists, which in the Ministry’s last publication reached a record of more than 850,000 people waiting. The Zendal Hospital, of the Community of Madrid, admitted one patient a day in 2023. It is increasingly clear that this hospital, launched without a minimum professional planning project, is a clear example of bad governance. The WHO threatens to break its agreement with the Andalusian School of Public Health, if it is diluted in the new Health Institute. The entity warns that the bilateral agreement signed in 1989 is not “transferable” and that, unless it is negotiated again, the collaboration as an associated center “automatically comes to an end.” The plans of the Andalusian Government in relation to the prestigious Andalusian School of Public Health are difficult to understand. Possibly the most regrettable operation underway in public health in Spain at the moment are the famous OPEs. The temporality wants to be resolved with a system of coverage of places with regional calls, not participating in the selection of the professionals nor the hospitals nor, much less, the services involved. There is a risk of destroying the unit and the configuration of services, which in many cases took years to implement. A real shame, much to the taste of the more traditional administration and the unions. In this sense, the 76 service heads of the 12 de Octubre hospital, in Madrid, have sent a letter to the counselor, warning of the problem of disintegration of services as a consequence of the ongoing OPE. We must see, in this sense, the recommendations of the Commission for Social and Economic Reconstruction, in whose opinion approved in Congress, it is committed to a national qualification for medical specialists and local hiring. In the MIR call, the worst figure is for Family Medicine, with 459 free places in the first round, double that in 2023. Making family medicine attractive – salary-wise and professionally – is indeed an emergency to be addressed and a problem important. The newspaper El Mundo reports on the cheapest health insurance. From ASISA (25.99 euros/month) to Sanitas (51.68). In all of them, hospitalization is included, with some form of co-payment. If this isn’t a price war, it certainly looks a lot like one. It is not surprising then that there are problems with rates for hospitals and professionals.

As for Companies, internationally, funds are moving on the board of Novavax, after the failures in the covid vaccine. In terms of national information, AI will revolutionize mental health, generating 2.5 billion euros in Spain. The largest seller of flu vaccines in Spain entrusts its production to Rovi.

Biomedicine

Global Health

International health policy

  • USA
    • Philip Morris funds smoking cessation plans. Medscape, a leading health information company in the USA, is accused of having accepted courses financed by this company. The criticism is based on the tobacco industry’s history of ignoring scientific teachings about the dangers of tobacco (https://www.bmj.com/content/385/bmj.q830)
    • American movements against Chinese biotech companies will harm American patients. The Biosecure Act, which gained bipartisan support in Congress, proposes ending government contracts with biotechnology firms that have agreements with Chinese companies as clients or suppliers. This can greatly harm Americans, since, for example, BGI (Beijing Genomics Institute) is the largest human DNA sequencer in the world and operates in 100 countries. Facilitates the manufacture of prenatal tests and other diagnostic tests (https://www.economist.com/leaders/2024/04/18/americas-moves-against-chinese-biotech-will-hurt-patients-at-home)
    • Scientists miss action against bird flu outbreaks on American farms (https://www.nytimes.com/2024/04/19/health/bird-flu-usda-cattle.html)

National health policy

  • Central government initiatives
    • Sánchez announces the expansion of the basic screening portfolio from 7 to 11 detectable diseases (https://www.diariomedico.com/medicina/politica/sanchez-anuncia-ampliacion-cartera-basica-cribado-neonatal-7-11- detectable-diseases.html)
    • García announces to the white tides the imminent hearing of the Public Management Law (https://diariofarma.com/2024/04/11/garcia-anuncia-a-las-mareas-blancas-la-inminente-audiencia- of-the-public-management-law-of-the-sns)
    • The Commissioner of Mental Health prepares a guide to reduce psychotropic drugs, as well as launches more than debatable messages such as that “long-term pharmacological treatments kill. These people live 20 years less”, which generated a negative response from Celso Arango , from the Gregorio Marañón Hospital (https://www.diariomedico.com/medicina/politica/comisionado-salud-mental-prepara-guia-prescripcion-psicofarmacos-reducer-consumo.html)

Companies

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 (April, 1st-7th, 2024)

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Summary

From the point of view of Biomedicine, the report published by the French National Academy of Medicine on generative AI systems in health is worth highlighting. It makes 10 recommendations, the first of which is that all health professionals should be trained in the use of generative AI. It seems that anti-obesity medications (initially, anti-diabetes) may be the closest thing to a universal panacea. There is already evidence that they can have benefits in many other diseases: heart, kidney, liver, brain (Alzheimer’s and Parkinson’s), as well as other organs.

With regard to Global Health, concern continues over the difficulties of advancing the Pandemic Treaty. The Treaty aims to prevent governments, institutions and populations from the errors of the covid-19 pandemic. In this sense, a more than interesting article by Mariana Mazzucato on aspects related to innovation, intellectual property (IP), public/private collaboration and financing. The Lancet speaks out in an editorial against the use of starvation (the total lack of food and mass famine) as a weapon of war, as we have seen in the war in Sudan and currently in Gaza, where Israeli action is taking on dimensions of destruction of Gaza, with the consequent health and humanitarian problems. Prostate cancer cases will double between 2020 and 2040.

Regarding International Health Policy, the French Prime Minister, Gabriel Attal, proposes a fine of five euros for those who miss scheduled medical appointments. But possibly the most far-reaching news is President Petro’s actions in healthcare in Colombia, with the intervention of the two largest EPS (Health Promotion Entities). This breaks the approach of the Colombian health system based since 1993 on Law 100, which established public/private collaboration through the EPS, companies that received public aid and were in charge of providing health services to their insured population. There is no doubt that the proliferation of populist governments in Latin America is a threat against any form of public/private collaboration in healthcare, as is also the case in Chile where ISAPRES (private insurers that receive public aid) are also threatened. The universalization of health coverage – something absolutely defensible and one of the great advances of our time, today in full expansion – leads some to interpret this as a monopoly of health care by the State and even a colonization of the management model by the traditional Administration, thus breaking a desirable freedom of choice, as well as a certain competition for the coexistence of different management models.

If we talk about National Health Policy (Spain), the Interterritorial Council of the National Health System unanimously supports the Comprehensive Plan for the Prevention and Control of Smoking. However, the Plan is fundamentally a roadmap and a declaration of intentions, some of which will have to be materialized through laws, with the uncertainty regarding the approval of new laws generated by the situation of the current legislature. The plan aims to increase smoke-free spaces (not specified); avoid promoting tobacco products; access to smoking cessation programs; equate electronic cigarettes with conventional tobacco; and, increase taxes on tobacco. The most controversial thing may be to equate electronic cigarettes with conventional tobacco, since the risks and damage to health are not comparable. A recent article in the New England Journal of Medicine states that there is sufficient evidence to show that switching from cigarettes to e-cigarettes reduces exposure to tobacco toxins, reduces respiratory symptoms and reverses physiological changes related to smoking cigarettes. The Government’s Regulatory Plan for 2024 announces four laws in the health field: 1. statute-framework; 2. law of guarantees; 3. alcohol consumption prevention law; and, 4. law on public management of health services. Same comment regarding the uncertainty regarding the approval of laws. Among these laws does not appear that of the State Public Health Agency, already being processed in Parliament. Of note is the meeting at the Ministry of Health of a representation of the same with representatives of doctors who work for health insurers. Regardless of the outcome of this meeting, it was not common until now for the Ministry of Health to enter into the problems of private healthcare. But welcome if there is a change in this regard.

As for Companies, internationally, drug shortages have recently reached unprecedented levels in several European countries and last year reached a ten-year high in the USA. Regarding national information, Grifols admits changes in its debt level and Recoletas is expanding to several regions through its reproductive business.

Biomedicine

Global Health

International health policy

National health policy

Companies

7 days in healthcare (March 18th-24th, 2024)

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Summary

From the point of view of Biomedicine, the transplant to a man of a genetically modified pig kidney stands out, a medical milestone that could lead to dialysis being declared obsolete, which would be an extraordinary advance and an improvement in the quality of life for hundreds of thousands of patients, currently dependent on the machine several times a week for their survival. Also notable is the beginning of a clinical trial on a vaccine for tuberculosis. The current BCG vaccine offers protection to infants and young children, but does not protect adults and adolescents from pulmonary tuberculosis. If the results are good, this vaccine can be transformative.

As far as Global Health is concerned, a study warns of serious declines in birth rates globally, which will mean that by 2050 it will fall below population replacement, which will have important social and labor changes.

Regarding International Health Policy, a great paradox in the USA, although abortion is prohibited in 14 states and restricted in many others, in 2023 there were more abortions than ever, many of them non-instrumental and through the abortion pill, already responsible of 60% of abortions. China is facing a population decline, a phenomenon that has already begun. The one-child policy, in force for 36 years, is only one of the causes of this phenomenon. The European Union is advancing in the approval of pharmaceutical legislation, contemplated with reluctance by both the EFPIA and Medicines for Europe (the two large European pharmaceutical associations). The Lancet sees the upcoming European elections as an opportunity to put health policy higher on the EU agenda.

If we talk about National Health Policy (Spain), three important initiatives of the Ministry of Health: anti-smoking plan, modification of the medical guard regime and waiting lists. In all three cases there may be problems due to the powers and regulations of the autonomous communities. From the point of view of the regions, the OPE of Asturias stands out, which brings together 19,000 candidates. Although logically, temporality was and is a serious problem of public healthcare, which needed a solution, the way to do it through macro-OPE’s (consolidating the position in property, and with hegemony of the administrative and union logic, above the professional and autonomy of organizations) does not seem to be the best. This type of mass examination is more reminiscent of previous calls for the “military service”, when it was in force, than the professional selection for complex organizations, in which the professional qualification, the needs of the different organizations, the projects of the services, etc. should be taken into account.

As for Companies, on an international level, China is seen as the large market for anti-obesity drugs. Bayer wants to renew its portfolio, entering into cell and genetic therapies. As for Spain, the CNMV has released its report on Grifols, with several objections to its accounts. Faes Farma is preparing to grow in Latin America. For its part, DKV, the health insurer, wants to concentrate on group insurance.

Biomedicine

Global Health

International health policy

National health policy

Companies

7 days in healthcare (March 4th-11th, 2024)

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Summary

From the point of view of Biomedicine, the possibility of making replicas of fetal organs stands out, which could facilitate fetal treatments without putting the pregnancy at risk. The Lancet publishes an editorial and several articles on menopause, a natural state in the aging process of women, often overmedicalized. FDA delays approval of Lilly’s long-awaited Alzheimer’s drug.

As far as Global Health is concerned, there was a shortage of cholera vaccines, at a time with many outbreaks, even in countries where it had been eradicated. Great absolute growth in the global figures of the scourge of genital mutilation in women, especially in Africa, but also in Asia and the Middle East. First published evidence that nanoplastics harm human health. Big problem with the lack of health professionals in Africa, which is proposed to be compensated as a quick solution with community health workers.

Regarding International Health Policy, in the United States President Biden gave his fourth and final State of the Union address. Surprising was a particularly energetic and mentally agile Biden, who maintained the interest of a vibrant speech during its more than 60-minute duration, even interacting with the Republican seats. Much of his speech was dedicated to health, undoubtedly a star issue in the next elections: the price of medicines; women’s reproductive rights, abortion and in vitro fertilization; the extension of Obamacare, a law he defended, during his term; and care for the elderly, both at home and in nursing homes, were the topics discussed. In France, President Macron has decided to make abortion a constitutional right, surprising the enormous support obtained on the right and left in the National Assembly: 780 votes in favor compared to only 72 against.

If we talk about National Health Policy (Spain), In its “Declaration of Córdoba” the Popular Party presents 4 proposals regarding health. The rural environment is left without doctors, according to the Spanish Society of Family and Community Medicine, saying that of the 11,000 rural doctors, half will retire in the next 5 years and it does not seem easy the arrival of new doctors. A specific health problem of one of the great gaps in our country: that of the rural-urban world. The Minister of Health makes two big promises: the decarbonization of the health system and the creation of an observatory on corruption in health (in response to problems with the purchases of masks and equipment during covid). Interesting, but we will have to see if these promises become realities. The PP will bring the ELA law to Congress.

As for Companies, at the international level, it is increasingly clear that the Novo Nordisk-Lilly duopoly in addressing obesity will be broken, giving way to other agents, given the large number of clinical trials on the subject. According to IQVIA, pharmaceutical companies will lose 6 billion a year until 2028 due to the expiration of many patents, converting many of these medications to generics and biosimilars. This loss will try to be compensated with the launch of new drugs, since it is estimated that between 2024 and 2028 there will be 175 new launches, especially in the field of oncology and neurology. Regarding national news, Grifols has revalued on the Stock Market, after the publication of its audited accounts without qualifications. Loss of 600 million of the insurance companies that operate in MUFACE (Adeslas, Asisa and DKV) during the period of validity of the current three-year agreement. It is evident that public/private collaboration is unviable if it condemns the participating companies to losses without any prospects.

Biomedicine

Global Health

International health policy

National health policy

Companies

 

7 days in healthcare (February 26th-Mars 3rd, 2024)

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Summary

From the point of view of Biomedicine, certain advances stand out in the search for a treatment for multiple sclerosis, a disease that affects 1.8 million globally and for which at this time there is no effective therapy. As announced by the president of the Spanish Society of Nephrology, the new drugs will allow many cases of dialysis and transplant to be avoided.

As far as Global Health is concerned, the most worrying thing is the poor perspectives observed regarding the pandemic treaty, the objective that the WHO had proposed for 2024. The obstacles are the accumulation of vaccines and the sharing of knowledge about them, problems of rich countries and companies, respectively. The Lancet warns about the need to strengthen cervical cancer screening, which continues to cause hundreds of thousands of deaths a year, especially in low- and middle-income countries. Warning about ultra-processed foods (cereals, protein bars, soft drinks, and fast food) linked to 32 harmful health effects, including increased risk of vascular disease, cancer, type 2 diabetes, mental illness and premature death.

In terms of International Health Policy, a very serious problem with fentanyl in the United States, which in the last twelve months until September 23 had caused 105,000 deaths in that country. Until now, the policy was aimed primarily at preventing the entry of drugs; some extremist politicians had even proposed invading Mexico to put an end to the gangs. With the current Administration, efforts are directed more towards discouraging its use and treating addicts. Big problem for Republicans in the USA with the decision of the Alabama Supreme Court to declare frozen embryos as “extra-uterine children”, with all the obstacle that this has for the popular procedure of in vitro fertilization, so widespread in the United States as in other developed countries. This Alabama decision seems like a gift to Democrats: “First it was abortion, now it is in vitro fertilization and then it will be birth control,” warned Hillary Clinton. Even Trump was forced to distance himself from this decision. In France, the National Assembly is putting pressure on the pharmaceutical industry regarding the shortage of medicines, forcing laboratories to have a four-month reserve of “medicines of high therapeutic interest.” In order to strengthen drug R&D, the European Union is considering “giving away” a year’s patent to those drugs whose research has been carried out in Europe.

If we talk about National Health Policy (Spain), the current Ministry of Health, unlike previous Ministries, wants to get involved in the problems of the SNS, while the previous ones wanted to get involved as little as possible, with the argument that “everything was transferred” . This attitude seems, in principle, positive for the SNS. Another thing is priorities. It seems that among these are the suppression of 24-hour medical guards; addressing waiting lists; and, the State Public Health Agency. Regarding the first issue, the challenge is formidable, since medical guards, regardless of whether they are necessary or not, have become an important salary supplement. It is impossible to address this issue without considering the complements of medical personnel, which is no small issue. Regarding waiting lists, aware that their management corresponds to the communities, it seems that they want to establish a kind of “best practices”, with economic incentives for the communities that apply them. Not an easy matter either. And as for the State Public Health Agency, the ministry seems to have reached an agreement with the PNV and Junts, for the withdrawal of their amendments to the law. Let us hope that this agreement does not go against the strength and operation of the new Agency. For its part, SESPAS, the Spanish Society of Public Health, has published an interesting document on the characteristics that this body should have, with 11 very interesting recommendations. The Economic and Social Council of Spain (CES) publishes a report on the health system. Although the report is well prepared, it is difficult to find anything new in it that has not already been said or any innovative proposal. Taking advantage of the day of rare diseases (although it is now preferred to call them minority) the Spanish Association of Orphan and Ultra-orphan Drug Laboratories releases a report on the situation of these drugs in Spain. Much has been improved, although there is still room to advance. Both the La Paz hospital in Madrid and the Sant Joan de Deu in Barcelona launch special units to treat this type of illness.

As for Companies, on an international level, the Danish Zealand Pharma, a new relevant player in the field of obesity. On the national level, Viamed will launch a comprehensive unit for women in its hospital in Tarragona. New punishment in the Grifols Stock Market.

Biomedicine

Global Health

International health policy

National health policy

  • 24 hour guards
    • The Ministry of Health wants to end 24-hour medical guards this term. The Ministry will study the legislative framework that the autonomous communities can apply. The aim is to organize it by hospitals and without losing salary, since the guards can represent up to a quarter of the professionals’ salary. The challenge is formidable, since it must be implemented by the autonomous communities, it involves a reorganization of hundreds of services, an increase in staff and addressing the complements of medical personnel (https://www.eldiario.es/sociedad/sanidad-quiere-finish-medical-guards-24-hours-we-will-give-you-answer-legislature_1_10957897.html)
  • Economic and Social Council (CES) report on the health system
    • Report from the CES on the health system. Among the recommendations it supports public health and prevention; specify and update the SNS service portfolio; make Primary Care the true axis of the system; confront waiting lists; strengthen the comprehensive mental health model; enhance the quality of pharmaceutical provision; promote the planning and reinforcement of human resources of the SNS; reinforce patient participation; contribution of the private for-profit and non-profit sector; improvement of system management and evaluation (https://www.ces.es/documents/10180/5299170/INF_012024.pdf)

Companies

 

 

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