Summary

From the point of view of Biomedicine, a revolutionary blood test stands out that manages to detect colon cancer in early stages and, consequently, reduce the number of deaths. Early diagnosis of this cancer can prevent most deaths, possibly 73% of them. But this requires regular screening in adults. There are two options: colonoscopy every ten years or fecal test every three. Both are unpleasant procedures, the first involving the introduction of a tube into the rectum and the second manipulating the stool itself. But something much simpler is on the horizon: a simple blood test. AI can revolutionize clinical trials, a fundamental basis for the progress of medicine. Just as Moore’s law was known in computing (the information capacity in a circuit grew every two years and at a lower price), in clinical trials in 2012 Eroom’s law was defined, which is just the opposite, since in the 60s In previous years, the number of drugs placed on the market per 1 billion invested was reduced by half every nine years. Half of this time and money was dedicated to clinical trials. AI can disrupt this law by helping to manage clinical trials, including developing protocols, recruiting patients, and analyzing data.

As far as Global Health is concerned, alterations of the nervous system are the most frequent cause of poor health. Neurological diseases such as stroke, dementia and migraine constitute the largest global cause of disease burden. This is related to increased life expectancy. However, if we adjust the data with age, we see that between 1990 and 2021, the number of neurological problems decreased by 27% and the number of deaths by 34%, in that 31-year period. Impressive Egypt success story with hepatitis. In Egypt at the beginning of the 20th century, most of the population worked on farms in contact with the Nile, a source of schistosomiasis, which affected 60% of the population. A treatment was implemented, but without single-use needles. This generated a very high prevalence of hepatitis C, which was reduced in just a decade from 2014. The secret was the free tests and treatment for everyone, with Gilead medication, after having negotiated the price with this company.

In terms of International Health Policy, the NEJM analyzes the effects of vertical integration in American medicine. Vertical integration (purchase of medical practices by hospitals) is unstoppable in the USA. We don’t know the consequences well. In theory it should improve coordination, facilitate the exchange of information and develop economies of scale. But, in practice, what has been seen is an increase in prices. It is urgent to study the consequences of this phenomenon. Macron, after a broad national debate, which included a citizens’ convention, supports the law on the end of life, which must still be approved in Parliament. An impressive debate took place in France on this topic for several months, just the opposite of what happened in Spain where such a transcendental issue was processed as a bill (avoiding the opinions required by the bills) and with hardly any national debate, as if it were a question of modifying the VAT on some product. Agreement in the EU for the regulations on the European Health Data Space, which will allow access to clinical information to any EU patient in all the countries of the Union, as well as the use of this information for research. A great step that, however, will take time to implement, given the very different and heterogeneous development of healthcare digitalization in EU countries.

If we talk about National Health Policy (Spain), the debate continues on the purchase of masks during the pandemic, another example of the more than deficient management of Covid-19 that occurred in Spain. The Minister of Health presents her plans in the Senate. Ambitious battery of health measures: mental health; Public Health Agency; climate change; smoking, sexually transmitted diseases; waiting lists, among other issues. We will see how this agenda progresses, since changes in healthcare are never easy. The health insurers involved in MUFACE (Adeslas, Asisa and DKV) request a renewal of the contract admitting 20% less of the public sector capital without pharmacy, which would mean an increase of 50% on the current capital. They also ask for some system of indexing the capital to the evolution of the public sector. Possibly the extension of the budgets represents an obstacle to the renegotiation of the agreement. Interesting initiative: the Council of Ministers approves a commercial pioneer of advanced therapies with public/private capital, whose promoter and shareholder is the CDTI (50% of the shares), as well as Insud and Rovi (25% each of them). The goal is to develop advanced therapies. It is included in the PERTE and, together, will mobilize 74 million euros.

As for Companies, internationally, recovery of mergers in the pharmaceutical industry in 2023. Psychedelic therapies, in the focus of investors. At the national level, AstraZeneca’s big commitment to Catalonia, where it will invest 1.3 billion until 2027.

Biomedicine

• A revolutionary blood test manages to detect colon cancer in early stages and, consequently, reduce the number of deaths. Early diagnosis of this cancer can prevent most deaths, possibly 73% of them. But this requires regular screening in adults. There are two options: colonoscopy every ten years or fecal test every three. Both are unpleasant procedures, the first involving the introduction of a tube into the rectum and the second manipulating the stool itself. But something much simpler is on the horizon: a simple blood test. A study published in the NEJM shows that a blood test is capable of diagnosing 87% of cancers at an early and curable stage (https://www.nytimes.com/2024/03/13/health/colon-cancer-blood-test.html#:~:text=A%20study%20published%20on%20Wednesday,positive%20rate%20was%2010%20percent.). Access to the original article in the NEJM: https://www.nejm.org/doi/full/10.1056/NEJMoa2304714#:~:text=be%20of%20interest.-,In%20an%20average%2Drisk%20screening%20population%2C%20this%20cfDNA%20blood%2D,sensitivity%20for%20advanced%20precancerous%20lesions.
• New generation cell therapy, hope against the deadly brain cancer glioblastoma multiforme. The latest generation of CAR-T is a hope for these tumors. The article published in the NEJ; demonstrates notable reductions in tumor size after a single treatment. The article presents few cases, but it is a promising path (https://www.abc.es/salud/enfermedades/terapia-cellular-nueva-generacion-may-cancer-cerebral-20240313145908-nt.html#). Access to the original article in the NEJM: https://www.nejm.org/doi/full/10.1056/NEJMoa2314390
• AI explores the “dark genome” to explain tumor growth. Scientists have used AI to explore the so-called “dark genome” and potentially develop new ways to detect cancer (https://www.ft.com/content/2851edf3-4a5c-42a0-b3e5-36fec787f808)
• AI and clinical trials. Just as Moore’s law was known in computing (the information capacity in a circuit grew every two years and at a lower price), in clinical trials in 2012 Eroom’s law was defined, since in the previous 60 years, the number of medicines placed on the market for every 1,000 million invested were reduced by half every nine years. Half of this time and money was dedicated to clinical trials. AI can disrupt this law by helping manage clinical trials, including developing protocols, recruiting patients, and analyzing data (https://media.nature.com/original/magazine-assets/d41586-024-00753-x/d41586-024-00753-x.pdf)

Global Health

• Alterations of the nervous system, the most frequent cause of poor health. Neurological diseases such as stroke, dementia and migraine constitute the largest global cause of disease burden. This is related to increased life expectancy. However, if we adjust the data with age, we see that between 1990 and 2021, the number of neurological problems decreased by 27% and the number of deaths by 34%, in that 31-year period (https://www.ft.com/content/8c90fb61-e43b-4bdd-bbec-a0ce1722274b)
• Cancer and young people: why so many young people have cancer. Many cancers, especially of the digestive tract, are growing among people under 50 years of age. This is partly attributed to the higher percentage of obesity and cancer screening. But it seems that this does not explain everything and perhaps the microbiome or the genome of the tumors themselves plays a role (https://www.nature.com/articles/d41586-024-00720-6)
• A study reveals the high probability that covid came out of a laboratory, according to published studies by Australian Raina MacIntyre (https://www.alimente.elconfidencial.com/bienestar/2024-03-15/probibilidad-covid-laboratory_3849381/#:~:text=Your%20research%2C%20that%20has%20been,not%20natural%20of%20covid%2D19.). Access to the original article: https://onlinelibrary.wiley.com/doi/full/10.1111/risa.14291#:~:text=The%20mGFT%20scored%2041%2F60,origin%20cannot%20be%20easily%20dismissed.
• How to make COP28 rhetoric a reality. There is a risk that the results of the climate conference will come to nothing. This is why The Lancet recommends new forms of governance of the COP (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00199-5/abstract)
• Egypt’s hepatitis success story. In Egypt at the beginning of the 20th century, most of the population worked on farms in contact with the Nile, a source of schistosomiasis, which affected 60% of the population. A treatment was implemented, but without single-use needles. This generated a very high prevalence of hepatitis C, which was reduced in just a decade from 2014. The secret was the free tests and treatment for everyone, with Gilead medication, after having negotiated the price with this company (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00531-2/abstract?rss=yes)
• The deadline agreed for the Pandemic Treaty is at risk. The differences between rich and poor countries are making an agreement that, in principle, should be reached in May difficult. The most controversial point is article 12 on the creation of a genomic repository. American Republicans and Trump are against the Treaty (https://www.ft.com/content/afd0b4ba-bdd0-4450-ad51-26326eacad1d)

International health policy

• USA
  • The unknown health of the candidates for President in the USA. Everything is based on speculation. There is no official system to know the real health situation of either the presidents or the candidates. An attempt to create an expert body on the topic failed as recently as 2017 (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00528-2/fulltext?rss=yes)
  • The Lancet analyzes Biden’s health priorities in the State of the Union address. Commitment to women’s reproductive health; lowering drug prices, expanding Obamacare, preventing gun violence, among the most important priorities (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00529-4/abstract?rss=yes)
  • The effects of vertical integration in American medicine. Vertical integration (purchase of medical practices by hospitals) is unstoppable in the USA. We don’t know the consequences well. In theory it should improve coordination, facilitate the exchange of information and develop economies of scale. But, in practice, what has been seen is an increase in prices. It is urgent to study the consequences of this phenomenon (https://www.nejm.org/doi/full/10.1056/NEJMp2313406)

• United Kingdom and the National Health Service
  • A study shows a notable drop in cancer mortality since the 1990s. Although the number of cancer cases increased for people between 35 and 69 years old between 1993 and 2018, the number of deaths fell by 37% for men and 33% for women in these 25 years (https://www.theguardian.com/society/2024/mar/13/uk-cancer-study-big-fall-in-death-rates-middle-age#:~:text=Cases%20of%20cancer%20in%20that,over%20the%20same%2025%20years.)

• France
  • Macron supports the “end of life” bill, which will be discussed by Parliament in May. The term “assisted in dying” is used, rather than euthanasia or assisted suicide, which are considered more controversial. If approved, France will join the few European countries (Switzerland, Holland, Belgium, Spain) that have regulated this issue (https://www.ft.com/content/8129ad50-ae82-4cf9-8b06-cdd196cc57ef)

• European Union
  • EU: Council and Parliament agree on the regulations to make the European Health Data Space a reality. The agreement will have to be endorsed by the Council itself and Parliament. The new law will allow European citizens to access their health data from anywhere in the EU, including medical history, electronic prescriptions, medical images and laboratory results, as well as to health professionals, but only for matters relating to to the treatment of their patients. At the same time it will provide scientific research with a large amount of data of public interest. Given the very varied level of digitalization in European countries, a long term is expected for its complete implementation (https://www.diariomedico.com/medicina/politica/ue-consejo-parlamento-acuerdan-normativa-realidad-espacio-european-health-data.html)
  • Europe will adopt the Artificial Intelligence regulations, leaving healthcare among the high-risk activities (https://diariofarma.com/2024/03/13/la-ley-que-regulara-la-ia-en-europa-leave-healthcare-among-high-risk-sectors)

National health policy

• The controversy over the purchase of masks during the pandemic continues
  • Illa paid extra costs in the covid of up to 600% to two suppliers (https://www.eleconomista.es/actualidad/noticias/12716980/03/24/illa-pago-sobrecostes-en-el-covid-de-hasta-el-600-a-dos-providedores.html#:~:text=Salvador%20Illa%2C%20exministro%20de%20Sanidad,Archivos.&text=Salvador%20Illa%2C%20exministro%20de%20Sanidad%2C)

• Anti-smoking plan of the Ministry of Health
  • Health finalizes a plan for smoke-free zones and raises the price of tobacco (https://elpais.com/sociedad/2024-03-11/sanidad-ultima-el-plan-para-ampliar-las-zonas-libres-of-smoke-and-raising-the-price-of-tobacco.html)

• IDIS Foundation Publication
  • IDIS publishes the Business Activity Impact Monitor (https://www.fundacionidis.com/informes/otros-informes/monitor-de-la-activity-empresarial-en-el-sector-sanitario-espanol)

• Debate in the Senate
  • The Minister of Health presents her plans in the Senate. Wide range of health measures: mental health; Public Health Agency; climate change; smoking, sexually transmitted diseases; waiting lists, among other topics (https://gacetamedica.com/politica/monica-garcia-enumera-en-el-senado-una-amplia-bateria-de-medidas-sanitarias/)

• MUFACE
  • Insurers ask to increase the price of premiums by 50% to renew. What they propose is to be 20% below public premiums without pharmacy. They also ask to index the premiums to the aforementioned indicator. The extension of the budgets is an obstacle to reaching an agreement (https://www.eleconomista.es/salud/noticias/12723317/03/24/las-aseguradoras-piden-subir-un-50-las-primas-de-muface-to-renew.html)

• Deaths in Madrid residences
  • A devastating report estimates that more than 4,000 elderly people who died in 2020 in residences in Madrid could have been saved. Report of the Citizen Commission for the Truth, promoted by associations of family members and civil society (https://www.eldiario.es/madrid/politica/demoledor-informe-calcula-4-000-mayores-muertos-residencias-madrid-having-saved_1_11212584.html)

• Advanced therapies trading company
  • The Council of Ministers approves a commercial pioneer of advanced therapies with public/private capital, whose promoter and shareholder is the CDTI (50% of the shares), as well as Insud and Rovi (25% each of them). The objective is to develop advanced therapies It is included in PERTE and, together, it will mobilize 74 million euros (https://www.ciencia.gob.es/Noticias/2024/marzo/sociedad-mercantil-terapias-avanzadas.html)

• Workers leave
  • One million workers a day are absent from their jobs due to illness in Spain (https://elpais.com/economia/2024-03-13/un-millon-de-trabajadores-al-dia-se-ausentan-de-your-position-due-to-illness-in-spain.html#:~:text=or%20to%20country%20to%20lose,job%20dueto%20illness%20in%202023.)

• Genetics specialty
  • Spain is the only EU country without a clinical genetics specialty, which is related to diagnostic delays (https://elpais.com/sociedad/2024-03-16/anos-de-espera-y-gastos-para-a-diagnosis-spain-is-the-only-country-in-the-eu-without-clinical-genetics-specialty.html)

Companies

• International News
  • Nestlé shareholders want to reduce their presence in unhealthy products (https://www.ft.com/content/728e610b-e975-4136-bfd5-37ff906ee265)
  • Lilly reaches a dispenser agreement with Amazon (https://www.ft.com/content/64730a98-7744-4c16-abd3-b1f1e0aa43c7)
  • Mergers in the pharmaceutical industry recover in 2023 and moved 152,000 million dollars (https://www.elespanol.com/invertia/empresas/sanidad/20240311/fusiones-industria-farmaceutica-recuperan-movieron-millones-dolares/838416209_0.html#:~:text=Thus%20they%20put%20of%20manifesto,%20achieved%20the%20exercise%20previous.)
  • The psychedelic industry as a new investment for health investors (https://www.plantadoce.com/entorno/la-industria-de-los-psicodelicos-la-nueva-obsesion-de-los-inversores-en-health)
  • KKR refinances IVI with 1,000 million to support its growth (https://cincodias.elpais.com/companias/2024-03-11/kkr-refinancing-ivi-con-1000-millones-para-apuntalar-su-crecimiento.html)

• National
  • AstraZeneca will invest 1,300 million in Catalonia until 2027 (https://www.elconfidencial.com/empresas/2024-03-14/astrazeneca-inviertera-1-300-m-en-cataluna-hasta-2027_3849052/)
  • Hair health, a growing sector (https://www.plantadoce.com/entorno/el-negocio-capilar-de-cristiano-ronaldo-tiene-nuevo-administrador-asi-esta-el-sector-en-2023 )
  • Grupo HLA opens its first medical center in Extremadura (https://www.plantadoce.com/empresa/grupo-hla-abre-su-primer-centro-medico-en-extremadura#:~:text=Grupo%20HLA%20continues%20its%20expansion,of%20a%20ten%20of%20specialties.)
  • La Clínica de Navarra will grow by 9% due to greater demand (https://www.expansion.com/empresas/2024/03/11/65ef7538e5fdead8258b4586.html#)
  • Almirall joins forces with Eloxx to enter the field of rare dermatological diseases (https://cincodias.elpais.com/companias/2024-03-13/almirall-se-alia-con-eloxx-para-entrar-en-the-field-of-rare-dermatological-diseases.html#)