Summary

From the point of view of Biomedicine, the contribution of Artificial Intelligence to medical diagnosis is reviewed by JAMA magazine. It seems clear that AI is not going to replace the so-called Narrative Medicine, that ability of the doctor to communicate and to listen and interpret the history of the patients. Interesting advances in the field of  a simple way to diagnose pre-eclampsia and Parkinson’s.

With regard to Global Health, more and more importance is given to loneliness and its consequences on health, according to an editorial in The Lancet. Hunger and famine as a product of human activity, especially armed conflicts, is treated by Nature. Concern regarding the AIDS situation in sub-Saharan Africa, where anti-retroviral therapy has barely reached.

Regarding International Health Policy, in the United States, the FDA approves the first drug to slow down the progression of Alzheimer’s. In the UK, three health think tanks (King’s Fund, Nuffield Trust and The Health Foundation) are addressing both the government and the opposition calling for solutions to the critical situation of the NHS. They denounce a decade of underfunding, which has led the UK to have far fewer human and material resources than most European countries. An interesting subscription model for antibiotics is being considered in the United Kingdom. Pharmaceutical companies will receive 20 million pounds per antibiotic put on the market, regardless of the prescription. In France, the Cour des comptes publishes documents to promote home palliative care and the development of advanced practice nursing. An interesting WHO-Europe document on hospitals and their challenges is published.

If we talk about National Health Policy (Spain), the beginning of the general elections on July 23, has made the different parties have made their programs public, including the health ones. The PP dedicates 24 measures to health. The strong points are: the Primary Care Shock Plan (although the title on emergencies is debatable); the State Public Health Agency; the Agency for Innovation and Quality (similar to NICE); digitization; palliative care; and, the mental health strategy. A new General Health Law is announced. Although the current law has many obsolete points, the legal technique of addressing a new law (instead of partial reforms in relation to different issues) is debatable. There is a risk of opening a very large melon, of generating long delays and of putting health into the same dynamic as education (a law for each new government). Conspicuous absences: nothing about financing, no mention of waiting lists (one of the most serious problems in the system), dental care (an area in which we are very far from Europe) and nothing about public/private collaboration. The PSOE program continues to identify public service with public management, thus distancing itself from any form of public/private collaboration. Many measures are contemplated, seeming more like a government plan than an electoral program, so the priorities are difficult to identify. The star measure seems to be announcing a law on waiting lists. Laws on waiting lists have never been effective in any autonomous community. The solution to the waiting lists does not go through a time guarantee law but rather resources and productivity of the public system and an updated and agile system of collaboration with the private sector. SUMAR incorporates the Podemos program: creation of a public pharmaceutical company; end of the MUFACE model; deprivatization plan, including cleaning, catering and laundry; progressive elimination of the pharmaceutical co-payment; they also announce a law on waiting lists. The Vox program represents an amendment to the whole: recentralization of health, recovering powers in health matters; approach waiting lists; repeal of the euthanasia and abortion law; strong criticism of the WHO, which they accuse of dependence on China. At the national level, the other great news is the alarm given by the insurers involved in the MUFACE model (Adeslas, Asisa and DKV) regarding the fact that its financing is generating large losses, unaffordable in the long term.

In the field of Companies, internationally, large pharmaceutical companies (Merck, BMS) are suing the American government for what they consider lowering prices, as a consequence of the anti-inflation law. In Spain, Ribera continues to bet on public/private collaboration, but this time in Portugal.

Biomedicine

• Artificial Intelligence in clinical diagnosis. JAMA discusses the opportunities, challenges, and hypermarket of AI in clinical diagnostics (https://jamanetwork.com/journals/jama/fullarticle/2807166)
• A blood test predicts pre-eclampsia in pregnant women. This test has been approved by the FDA. Preeclampsia mainly affects black women in the USA (https://www.nytimes.com/2023/07/03/health/pregnancy-preeclampsia-test.html)
• Smart watches can detect Parkinson’s years before its diagnosis (https://elpais.com/salud-y-bienestar/2023-07-03/los-relojes-inteligentes-pueden-detectar-el-parkinson-anos-before-your-diagnosis.html)

Global Health

• Editorial of The Lancet: Loneliness as a health problem. In the UK and Japan there are loneliness ministers. The health damages are clear: cardiovascular disease, hypertension, diabetes, infectious diseases, depression and anxiety. Loneliness is not the same as being alone and can affect all ages (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)01411-3/fulltext)
• Hunger and famines are not accidents, but facts created by human action. Around 200 million people experience acute food insecurity. Especially Afghanistan, Burkina Faso, Ethiopia, Mali, Sudan and Syria. Hunger and conflict are connected (https://www.nature.com/articles/d41586-023-02207-2)
• HIV in Africa. Antiretroviral therapy has transformed AIDS into a chronic disease. But in sub-Saharan Africa, where 70% of AIDS patients live, few have access to this therapy, which greatly decreases life expectancy in the area (https://www.nejm.org/doi/full/10.1056/NEJMp2304600)

International Health Policy

• COVID19
  • Weekly covid report published by the WHO, July 6, 2023. The African region has shown a slight increase in deaths with a decrease in cases. The remaining five WHO regions show a decrease in both the number of cases and deaths (https://apps.who.int/iris/handle/10665/370545)

• USA
  • The American regulator (FDA) approves the first medication to slow down the progression of Alzheimer’s. The trade name is Leqembi and it has been developed by Eisai and Biogen (https://www.ft.com/content/4fcebf1e-cf95-42d9-90d9-c251de7585bc)
  • Three vaccines for the fall: covid, flu and respiratory syncytial virus (https://www.nytimes.com/2023/07/05/health/flu-covid-rsv-vaccines.html)
  • Antibiotic Shortages May Increase Syphilis Epidemic (https://www.nytimes.com/2023/07/07/health/syphilis-epidemic-antibiotic-shortage-pfizer.html)

• United Kingdom and National Health Service
  • Three health think tanks (King’s Fund, Nuffield Trust and The Health Foundation) address government and opposition on NHS issues. They are betting that the next election will end short-term politics in the NHS. The recovery of NHS services and waiting lists must be a priority. They denounce a decade of underfunding. They welcome the long-term plan on personnel, published last week. They point out that life expectancy is the second worst (before only the USA) of the 19 health systems analyzed in the King’s Fund report (https://www.health.org.uk/news-and-comment/news/joint-letter-to-political-leaders-in-england-on-future-of-nhs)
  • The NHS intends to roll out the subscription model for antibiotics. Under the new proposal pharmaceutical companies would receive £20m for their new antibiotics, regardless of how many may be prescribed (https://www.ft.com/content/a0b5a2ad-06a4-499d-8195-b4d6a3f65f7a)

• France
  • The incidence of cancer in France has doubled since 1990. Apart from demographic causes, the other causes are related to lifestyles (alcohol, tobacco, being overweight, etc.) and the environment (https://www.lemonde.fr/sciences/article/2023/07/04/cancers-leur-incidence-a-double-en-france-depuis-1990_6180390_1650684.html#:~:text=Pas%20moins%20de%20433%20136,toutes%20localisations%20of%20cancer%20with fondues.)
  • La Cour des comptes calls to promote the development of palliative care at home (https://www.lemonde.fr/societe/article/2023/07/05/la-cour-des-comptes-appelle-a-developper-l-offre-de-soins-palliatifs-a-domicile-et-en-ehpad_6180614_3224.html). Original document: https://www.ccomptes.fr/system/files/2023-07/20230705-soins-palliatifs.pdf
  • The Cour des comptes calls to develop advanced practice nurses (https://www.ccomptes.fr/system/files/2023-07/20230705-Infirmiers-en-pratique-avancee.pdf)
  • More than half of public hospital doctors on strike due to the lack of attractiveness of the profession (https://www.lemonde.fr/societe/article/2023/07/03/les-medecins-de-l-hopital-public-appeles-a-la-greve-pour-alerter-sur-le-manque-d-attractivite_6180326_3224.html)
  • In vitro fertilization: the risks for children, insufficiently documented. At 45 years after the birth of the first test-tube baby, Louise Brown, there are no studies on medical data from this population (https://www.lemonde.fr/sciences/article/2023/07/02/fecondation-in-vitro-les-posibles-risques-sur-la-sante-des-enfants-sont-insuffisamment-documentes_6180243_1650684.html)

• WHO
  • Conclusions of a WHO-Europe meeting, held in April-22, on the future of hospitals. The document deals with topics such as new professionals, quality, digital health, hospital buildings, governance, public/private collaboration and others (https://www.who.int/europe/publications/i/item /WHO-EURO-2023-7160-46926-68505)

National health policy

• COVID19
  • The Council of Ministers approves the end of masks in health centers and pharmacies (https://www.elconfidencial.com/espana/2023-07-04/el-consejo-ministros-approves-final-mascarillas-centros-sanitarios-pharmacies_3685377/)
  • Spain closes the pandemic with excess deaths of 137,300 (https://theobjective.com/espana/2023-07-03/espana-exceso-mortalidad-pandemia/)

• 23 J elections: the health program of the PP
  • The PP dedicates 24 measures to health. The strong points are: the Primary Care Shock Plan (although the title urgent and emergencies is debatable); the State Public Health Agency; the Agency for Innovation and Quality (similar to NICE); digitization; palliative care; and, the mental health strategy. A new General Health Law is announced. Although the current law has many obsolete points, the legal technique of addressing a new law (instead of partial reforms in relation to different issues) is debatable. There is a risk of opening a very large melon, of generating long delays and of putting health into the same dynamic as education (a law for each new government). Conspicuous absences: nothing about funding, no mention of waiting lists (one of the most serious problems in the system), dental care (an area in which we are very far from Europe) and nothing about public/private collaboration (https://www.pp.es/sites/default/files/documentos/programa_electoral_pp_23j_feijoo_2023.pdf)

• 23 J elections: the health program of the PSOE
  • The PSOE program continues to identify public service with public management, thus distancing itself from any form of public/private collaboration. Many measures are contemplated, seeming more like a government plan than an electoral program, so the priorities do not look good. The star measure seems to be announcing a law on waiting lists. Laws on waiting lists have never been effective in any autonomous community. The solution to waiting lists does not go through a time guarantee law but resources and productivity of the public system and an updated and agile system of collaboration with the private sector (https://www.psoe.es/media-content/2023/07/PROGRAMA_ELECTORAL-GENERALES-2023.pdf)

• 23 J Elections: SUMAR’s health program
  • SUMAR incorporates the Podemos program: creation of a public pharmaceutical company; end of the MUFACE model; deprivatization plan, including cleaning, catering and laundry; progressive elimination of the pharmaceutical co-payment; they also announce a law on waiting lists (https://theobjective.com/wp-content/uploads/2023/07/un_programa_para_ti.pdf)

• 23 J elections: the Vox health program
  • Amendment to the entirety: recentralization of health, recovering competencies in health matters; approach waiting lists; repeal of the euthanasia and abortion law; strong criticism of the WHO, which they accuse of dependence on China (https://www.newtral.es/wp-content/uploads/2023/07/Programa_electoral_vox_23j_2023.pdf?x97595)

• MUFACE system
  • The insurers ASISA, Adeslas and DKV urge the government to review the financing of the MUFACE system, since they have lost 340 million euros in two years (https://cincodias.elpais.com/companias/2023-07-03/adeslas-asisa-and-dkv-urge-the-government-to-review-the-health-contracting-for-officials.html)
  • DKV will leave MUFACE if its premium does not grow by 40% (https://www.redaccionmedica.com/secciones/privada/dkv-amenaza-con-abandonar-muface-si-la-prima-no-sube-un-40-in-agreement-4622#)

• Consumption of morphine
  • Morphine consumption doubles in just 10 years in our country (https://www.elespanol.com/ciencia/salud/20230704/espana-pais-morfina-consumo-opioides-duplica-solo-anos/776172698_0.html#:~:text=As%20the%20Spanish%20Agency%20recognized%20had%20grown%20to%2020%2C86.). A WHO report, which denounces the absence of morphine in developing countries and a monopoly by the USA and Europe, places our country in fourth place among consumer countries: https://www.who.int/publications/i/item/9789240075269

• Fertility in Spain
  • Spain, in the tail of birth and fertility rates in Europe (https://www.consalud.es/pacientes/espana-cola-natalidad-fertilidad-en-europa-a-se-deben-estos-datos_131993_102.html# )

• Residences for the elderly
  • Deficit in residences for the elderly, which will require an investment of 5,700 million euros (https://www.expansion.com/inmobiliario/mercado/2023/07/03/64a2adcee5fdea6b698b45de.html#)

Companies

• International News
  • Large pharmaceuticals (Merck and BMS) sue the American government, due to the reduction in the price of their medicines due to the application of the anti-inflation law (https://www.consalud.es/salud35/internacional/grandes-farmaceuticas-demandan-US-government-reduction-price-drugs_131953_102.html)
  • Novartis sells its ophthalmological portfolio for 1,750 million dollars (https://www.plantadoce.com/empresa/novartis-suelta-lastre-y-vende-parte-de-su-cartera-oftalmologica-por-1750-millones-of-dollars.html)
  • Lilly acquires Sigilon Therapeutics (%20va%20of%20purchases.,of%20acute%20%20and%20chronic%20diseases.)

• National News
  • HM closes 2022 with a turnover of more than 600 million (https://cincodias.elpais.com/companias/2023-07-04/hm-hospitales-cierra-2022-superando-la-barrera-de-los-600-millones-de-billing.html)
  • Vithas aims for revenues of 700 million in 2023 (https://www.plantadoce.com/empresa/vithas-apunta-a-ingresos-de-700-millones-de-euros-en-2023.html#:~:text=The%20group%20hospital%20Spanish%20ha,hospitals%20in%20Barcelona%20and%20Valencia.)
  • Ribera plans to grow in Portugal through more collaboration agreements with the public sector (https://www.elespanol.com/invertia/observatorios/sanidad/20230703/ribera-salud-planea-crecer-portugal-mediante-acuerdos-colaboracion- public-sector-portuguese/775422663_0.html)