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7 days in healthcare (July 3rd-9th, 2023)

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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

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)
  • 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)

National health policy

  • 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

Companies

 

7 days in healthcare (January 3-9, 2022)

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SUMMARY

From an international point of view, perhaps the most striking thing is the great global expansion of COVID, particularly of the “omicron” variant, with a record number of infections in the United States, of more than one million a day.

As for national news, official policy continues to trust everything to vaccination, avoiding other measures that may have certain political costs. The problem is the number of deaths, the collapse of the health system (which affects not only COVID cases, but the rest of the patients) and the large number of sick leave. The only measure at the national level is the obligation of the mask outdoors (about whose effectiveness many doubt), without addressing the need to control the aeration of premises based on CO2 meters; the avoidance of crowds; considering the mandatory nature of the vaccine for certain groups (health workers, teachers, etc.); the more agile activation of the third dose; ensuring the existence of antigen tests and regulating their price; the management of sick leaves in another more agile way, in such a way that Primary Care no longer completely collapses; and, ensuring the purchase and accessibility of new drugs against COVID.

Regarding company news, to highlight the record sale of 7 million antigen tests by pharmacies in the week of Christmas; and the great news that the Spanish HIPRA vaccine may be present in the second quarter of year 22.

INTERNATIONAL

  • 5 key articles published in JAMA on January 6: 1. A National Strategy for the New Normal of Life with Covid; 2. A National Strategy for COVID-19: Testing, Surveillance and Mitigation Strategies; 3. A National Strategy for COVID-19 Medical Countermeasures: Vaccines and Therapeutics; 4. The First 2 Years of COVID-19: Lessons to Improve Preparedness for the Next Pandemic; 5. The Pandemic Preparedness Program: Reimagining Public Health (JAMA, 6 at 22)
  • Deloitte publishes a document with the six major topics that will be present in health in 2022: 1. Health equity; 2. Corporate Social Responsibility: 3. Mental health and well-being; 4. Digital transformation and impact on delivery models; 4. The future of medical science; 5. Public Health, reimagined (Deloitte, https://www2.deloitte.com/content/dam/Deloitte/global/Documents/Life-Sciences-Health-Care/gx-health-care-outlook-Final.pdf)
  • The Lancet identifies humanitarian needs by 2022, the number of people in need of humanitarian assistance will rise in 2022 to 274 million, from 235 million in 2021 (The Lancet, Jan 8, 22)
  • Peter Singer, possibly the most famous bioethicist in the world, says that, in the face of a shortage of ICU beds, according to him, vaccinated people would have a preference (Project Syndicate, 5 at 22)
  • The USA reports a record number of infections throughout the pandemic, more than a million a day (FT, 4 in 22)
  • Italy declares COVID vaccination mandatory for those over 50 (The Guardian, 5 at 22)
  • A Chinese city of 1.2 million inhabitants, in confinement, before the appearance of three cases (The Guardian, 4 in 22)
  • Israel announces vaccination with a fourth dose for those over 60 years (Vozpópuli, 2 in 22)
  • The WHO follows the new IHU variant identified in France but states that it is not circulating very actively (El Mundo, 6 in 21)
  • More patients and fewer professionals push New York hospitals to the limit (NYT, 7 at 22)
  • Military deployed to London hospitals, to compensate for the absence of personnel (The Guardian, 7 at 22)
  • The French presidency of the European Union (first semester of 2022), intends to take steps in promoting the “European Health Union”, strengthening the ECDC, EMA and HERA (ConSalud, Jan 9, 22)

NATIONAL NEWS

  • “Spain, sick, resigned and incredulous”, hard and accurate article by José Antonio Zarzalejos, on the absence of a strategy against COVID-19. He accuses of attempts to trivialize the attitude of the Spanish authorities (both national and regional), trusting everything to vaccination, but not adopting other measures, as in other countries. It has not even debureaucratized sick leave. The government gets out of the way, individualizing the response to the pandemic. (El Confidencial, 8 at 22)
  • The number of cases in Spain reaches record figures throughout the pandemic (2,722 per 100,000 inhabitants in the last 14 days). The numbers of admitted and patients in ICU are somewhat lower than in other waves, but also worrying (Ministry of Health, Update no 537. Coronavirus disease (COVID-19). 01.07.2022)
  • Between the need to care for COVID, the administrative role for sick leaves and the personnel’s own dismissals, the «omicron» variant pushes Primary Care to the limit (El País, Jan 3, 22)
  • ICUs are as full as a year ago, with 10 times more incidence (El Español, 6 in 22)
  • More than a million children between 5 and 11 years old already have the first dose of the vaccine (El Confidencial, 4 in 22)
  • Spain is late in the purchase of new anti-COVID drugs, while other European countries already have reservations, but in Spain this was delegated to the autonomous regions (La Razón, 7 at 22)
  • The return to classes will be face-to-face at all stages from January 10, agreement of the Interterritorial Council (Sanitary Act, 4 at 22)
  • Health and communities say that at the school level, entire groups will only quarantine if there are five or more cases (El País, 7 out of 22)
  • Raise to five the positives in a classroom to confine them, something without scientific evidence, says the Spanish Association of Pediatrics (7 in 21)
  • Flurona, first cases of simultaneous influenza and covid infections in Spain (Expansión, 3 in 22)
  • December closes with 240,000 sick leave due to COVID, three times more than in November (CincoDías, 4 in 22)
  • A CIS study shows (?) That 55% of Spaniards are not being greatly affected by the pandemic (Vozpópuli, 3 in 22)
  • Great step back from smoking in Spain, they start smoking again like a decade ago (El Periódico de España, 4 at 22)
  • Almost forty organizations reject the Madrid Omnibus Law, published on December 23 and with a 7-day hearing procedure, between Christmas Eve and New Year’s Eve, modifying 33 laws and 5 decrees in force in the Community of Madrid (Acta Sanitaria, 4 Jan 22)

COMPANIES, EMPLOYERS AND MAIN ACTORS IN HEALTH

  • Pharmacies sold a record 7 million antigen tests in the week of Christmas (CincoDías, 4 in 22) and in six months they have sold more than 21 million tests (El Debate, 6 in 22)
  • According to the Minister of Health, antigen tests will only be sold in pharmacies, contrary to what happens in other European countries (Diariofarma, 4 in 22)
  • Private hospitals denounce the Xunta for not compensating for its intervention during the state of alarm (La Voz de Galicia, 4 at 22)
  • HIPRA, the Spanish vaccine, already has a release date in the second quarter of 2022 (La Razón, 4 at 22)
  • The vaccine triggers the value of Novavax, Moderna, BioNTech and Pfizer on the stock market (Expansión, 6 Jan 22)
  • Pfizer and BioNTech will search for a vaccine against herpes zoster (CincoDías, 5 en 22)
  • The German Synlab buys the Valencian company Sistemas Genónicos, belonging to the Ascires group (Expansión, 7 at 22)
  • Rovi, newcomer and favorite among IBEX stocks (CincoDías, 9 at 22)
  • Telefónica has more than 50,000 clients in its telemedicine service (The Objective, 6 in 22)