Posts

7 days in healthcare (August 19th-25th, 2024)

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Summary

Biomedicine

  • Brain implants to reduce Parkinson’s symptoms. Implants reduce Parkinson’s symptoms by reading brain activity. Parkinson’s is known to affect about 10 million patients globally. This approach, called deep brain stimulation (DBS), reduces Parkinson’s motor symptoms by half.

Global Health

  • The need for international coordination on Mpox. Editorial from The Lancet. 15 months ago, the WHO concluded that the Mpox outbreak no longer represented a Public Health Emergency of International Concern (PHEIC). On August 14, the WHO declared this Emergency for Mpox, following a declaration a day earlier by the African Center for Disease Control and Prevention. The strain is called clade 1b Mpox1, which is genomically distinct and more deadly than the one in the 2022-23 outbreak. More than 16,000 infections and 500 deaths have been reported in Congo in 2024. Cases have also been reported in the Central African Republic, Rwanda, Burundi, Uganda and Kenya, while Sweden and Pakistan have reported imported cases. The hope is that PHEIC will trigger an international response.
  • Mpox vaccines are not reaching Africa. The slow WHO regulatory process is blamed for the lack of vaccines. While some developed countries have their own regulatory bodies, many African countries rely on WHO regulation, which is especially cautious and slow.
  • Covid is resurgence again, although with fewer severe cases. New variants that evade immunity are causing a massive summer wave.

International health policy

  • Abortion takes centre stage in the American elections and, in particular, at the Democratic convention. At this major event, the star was Hadley Duvall, a woman from Kentucky, who had become pregnant at the age of 12 by her stepfather and asked Trump about his description of the abortion ban as a “beautiful thing”.
  • AI and healthcare productivity. The Nuffield Trust analyses whether AI is the “silver bullet” that will improve healthcare productivity. Although high hopes have been placed on the NHS, this article sets out certain cautions: 1. Limitations of the current information infrastructure; 2. Regulatory considerations; and, 3. Ethical considerations that the application of AI minimises the core values ​​of the NHS, patient-centredness, services based on need not the ability to pay.
  • Major conflicts in India over the rape of a doctor. The rape and murder of a doctor in India is generating major conflicts. There are 32,000 reported rapes in India in 2022, the last year with official figures, although the number may be much higher. The rape and murder of a 31-year-old doctor in training in West Bengal has sparked protests by women across the country.
  • The first non-Covid mRNA vaccine is approved in Europe. The mResvia, manufactured by Moderna, is intended to protect the elderly against the respiratory syncytial virus, which causes bronchiolitis.
  • The EU does not recommend mass vaccination or border control due to Mpox. The EU Health Security Committee, which met on Monday, has noted that border control is not recommended and that the risk to the EU is still low.

National Health Policy (Spain)

  • Mpox: vaccination only for risk groups. The Ministry of Health maintains the vaccination strategy for Mpox only for risk groups.
  • The Mpox emergency catches Spain without a Public Health Agency. Despite the Ministry’s promises that the Agency would be operational in 2024, the draft bill has been sleeping for six months in the Health Commission of Congress. The photo of a minister reporting on Covid, surrounded by an improvised spokesperson and military personnel, should not be repeated.
  • Extensive surgical activity in the private sector. According to the IDIS Foundation, private healthcare carries out 32% of total surgical activity. The IDIS has done a commendable job of disseminating the activity of the private sector. On the other hand, it is well known that the private sector carries out significant surgical activity and, in many cases, of high complexity. However, this percentage requires clarification. It would be necessary to see complexity, according to some classifications: minor, moderate and major surgery; Surgical Complexity Score (SCS); the classification of the American Society of Anesthesiology; the Case Mix Index, etc. In such a complex topic, simple percentages are not enough.

Companies

  • International
    • Growing volume of AI business in healthcare. The global AI market in healthcare has reached 19.54 billion in 2023 and is expected to reach 490 billion in 2032.
    • Big business of copies of anti-obesity drugs.
  • National
    • Catalonia, leader in Spain in pharmaceutical manufacturing. Catalonia concentrates 45% of the pharmaceutical manufacturing plants. Of the 174 drug production plants in the country, 79 are located in Catalonia. They are followed by Madrid and Castilla y León, with 22% and 8% of the factories.

Biomedicine

Global Health

  • The Lancet editorial: the need for international coordination on Mpox. 15 months ago, the WHO concluded that the Mpox outbreak no longer represented a Public Health Emergency of International Concern (PHEIC). On August 14, the WHO declared this Emergency for Mpox, following a declaration a day earlier by the African Centre for Disease Control and Prevention. The strain is called clade 1b Mpox1, which is genomically distinct and more deadly than the one in the 2022-23 outbreak. More than 16,000 infections and 500 deaths have been reported in Congo in 2024. Cases have also been reported in the Central African Republic, Rwanda, Burundi, Uganda and Kenya, while Sweden and Pakistan have reported imported cases. The hope is that PHEIC will trigger an international response (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01708-2/fulltext)
  • Why Mpox vaccines are not reaching desperately needed Africa. This NYT article blames the slow WHO regulatory process for the vaccines not arriving. While some developed countries have their own regulators, many African countries rely on WHO regulation, which is particularly cautious and slow (https://www.nytimes.com/2024/08/23/health/mpox-vaccines-who-africa.html)
  • Mpox and Gavi. Declaration of this association in an article in The Lancet. Gavi is acting on four lines: 1. Purchase of vaccine doses; 2. Coordination of donations; 3. Declaration of regional emergency, activating a series of actions; and 4. Investing in the generation of adequate information (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01706-9/fulltext)
  • Article in Science: Covid is re-emerging again, although with fewer serious cases. New variants that evade immunity are causing a massive summer wave (https://www.science.org/content/article/why-covid-19-surging-again-and-do-shots-still-make-sense)
  • NEJM article: Preventing and controlling global antimicrobial resistance. Antimicrobial resistance has been identified by WHO as one of the 10 most important threats to health. An estimated 1.3 million deaths globally in 2019 were attributed to this problem. Although the basic principles of the approach to this problem have been known for decades, and scientific and technological innovations are promising, implementation has been too slow (https://www.nejm.org/doi/full/10.1056/NEJMp2401360)

International health policy

National health policy

  • Private health care

Companies

7 days in healthcare (May 8th-14th, 2023(

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Summary

From the point of view of Biomedicine, it is worth pointing out the expanded “pan-genomic” base, which significantly increases the letters of the DNA, which, apparently, will make it possible to improve the typing and treatment of certain diseases. Promising results of mRNA technology in pancreatic cancer. Potential of stool transplants against some bacteria not sensitive to antibiotics.

As far as Global Health is concerned, although covid is no longer a global emergency, the truth is that, as the WHO itself shows, the disease continues to kill and change.

Regarding International Health Policy, it is worth highlighting the great news coming from the British government, which will allow pharmacies to prescribe certain medications, as well as the contraceptive pill. The objective of the measure is to significantly reduce the number of visits to the primary doctor. In France, patients, faced with overloaded doctors, turn to self-medication. Euthanasia is already legal in Portugal. Great battle in Chile between the Boric government and the Isapres (Chilean health insurers). In a bill, the government, in order to respond to an erga omnes ruling (of universal application) of the Courts, proposes the payment by insurers of alleged amounts for overpayments, which would make the model unfeasible. The Association of Isapres has reacted with a harsh note, answered no less harshly by government spokesmen. Health and specifically the role of the Isapres, at the center of the political debate in Chile.

If we talk about National Health Policy (Spain), the most important news is the proposals by various medical associations (IMAS Foundation, FACME, General Council of Medical Associations) for a decalogue of proposals to reform the SNS, which they consider in total crisis, before the next legislature. New governance; new management model; citizen/patient and professional participation; measurement of results and transparency; new care model; digital transformation according to the citizen’s digital clinical history model, are some of the most important measures. We only have to congratulate those responsible for this initiative, which contrasts so much with the limited and timid proposals put forward by the majority political parties. To those parties (PSOE and PP) the proposals were raised in a meeting. The only possible consideration is whether a reform of the public system is possible without mentioning a limited and selective co-payment, the absence of which we are the exception in Europe, as well as the non-consideration of the private sector in that reform. Looking the other way from the private sector has never produced good results. On the other hand, the document emphasizes its proposal for changes in the management and care model, governance, the participation of citizens/patients and professionals, and transparency. But he doesn’t mention financing at all. Although financing as an isolated reform (which is very common to consider) would not solve much, this issue has specific problems. Having made these qualifications, as a whole it is a splendid document, a must-read. The Constitutional Court publishes the ruling declaring the 2010 law on abortion deadlines legal. A study in Catalonia shows that the rich wait less on the lists of Catalan public hospitals than the rest of the population, something that had already been demonstrated in the UK on the NHS. The CEOE-union agreement includes the control of sick leave by Mutual Societies, something whose real scope will have to wait to see its effects. The truth is that absenteeism had increased a lot in recent times.

In the field of Companies, at the international level, drugs for weight loss point to an area of great economic interest for the pharmaceutical industry. In Spain, the most striking thing is Fresenius’s intention to get rid of the part of Quirón in Latin America, as well as the fertility company Eugin. Mutua Madrileña and El Corte Inglés launch medical insurance under the Adeslas brand.

Biomedicine

Global Health

International Health Policy

  • Chili
    • The Boric government against the Isapres (private health insurance companies in Chile). In a bill, the government, in order to respond to an erga omnes ruling (of universal application) of the Courts, proposes the payment by insurers of alleged amounts for overpayments, which would make the model unfeasible. Hard note from the Association of Isapres, which has obtained a no less harsh response from the Government. (http://www.isapre.cl/images/PDF/Declaracion_Prensa_19_abril_VFdocx_1.pdf)

National health policy

Companies

 

 

7 days in healthcare (April 24th-30th, 2023)

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Summary

From the point of view of Biomedicine, to mark the 70 years since the discovery of the structure of the DNA molecule, which was to revolutionize the field of biology and medicine, allowing in 2003 the development of the human genome and in 2023 the approval of the first drug based on gene therapy. Nature warns that the gene therapy revolution may be threatened if cost is not discussed, proposing regulatory changes and new intellectual property laws.

With regard to Global Health, a Fund was created (similar to that for HIV, tuberculosis or malaria) to fight against hepatitis, that great plague that worldwide causes more than a million deaths a year. Great repercussion of the conflict in Sudan on the health situation in that unfortunate country.

As for International Health Policy, any other international news pales in comparison to the importance of the new proposals from the European Commission regarding the new pharmaceutical regulation. They propose changes to fundamental rules that had worked without modification for more than twenty years. It is difficult to pronounce, given the great weight of the interests at stake: those of patients, those of pharmaceutical research in Europe, those of the pharmaceutical industry, those of the Member States that want to see their pharmaceutical bills reduced. The texts of the new Directive and new Regulation are still proposals, but they will give people talk.

If we talk about National Health Policy (Spain), the new Minister of Health pronounces himself saying that the waiting lists “are not the responsibility of the Government”, a statement that could be considered unacceptable, since someone might think that the Ministry has more responsibilities apart those of compiling and disseminating the lists. The IDIS Foundation publishes its annual report, now in its 13th edition, on “Private healthcare: providing value”, which has become essential in the sector, due to the transparency it gives to the situation of the private sector. The data from the WAIT report are not favorable for Spain, in terms of the average time elapsed since the approval of medicines by the European Agency and their availability in Spain. Our country is among those that accumulate the most delays in this process.

In the field of Companies, at the international level, spectacular news is the purchase by Kaiser Permanente (a giant on the American West Coast) of Geisinger (a smaller operator on the East Coast) to found a customer service system. non-profit community health. In Spain it seems that the INCOSOL model wants to be replicated outside of Spain.

Biomedicine

Global Health

International Health Policy

National health policy

  • Pharmaceutical policy
    • The WAIT 2022 report, which has just appeared, establishes the delays in different European countries, including Spain, for the incorporation of medicines. Spaniards have to wait an average of 629 days from the approval by the European Agency until they are available in Spain. Spain in the range of countries with the longest wait. The least expected countries are Germany and Denmark (https://www.abpi.org.uk/media/news/2023/april/efpia-wait-indicator-survey-2022-launches/)

Companies

7 days in healthcare (February 20th-26th, 2023)

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Summary

From the point of view of Biomedicine, perhaps the most striking thing is that it is the 90th anniversary of the first transplant in humans, which took place in Kherson (Ukraine), a city that is so topical today due to the Russian invasion. It was a kidney transplant to a 26-year-old woman.

As regards Global Health, an important report on maternal mortality published by the United Nations. There is no decrease in frequency in recent years. Globally, 800 maternal deaths occur every day, a staggering figure. Cholera emerges globally, with outbreaks already in 30 countries, which indicates serious problems in water management and in the sanitary and hygienic conditions of the population.

Regarding International Health Policy, it seems that, despite the large outbreak of covid that occurred in China, after the abandonment of the covid-zero policy, this has not generated new variants of the virus. In the United Kingdom, conflicts persist in the NHS, with junior doctors joining the strikes. Important division in Colombia before the new health reform promoted by President Petro.

If we talk about National Health Policy (Spain), the cumulative incidence of covid continues to rise slightly, although mortality is decreasing. The medical conflict continues, both in Madrid and in other communities. The cost of putting a personal assistant to each Primary Care doctor is evaluated: 505 million euros. It’s a lot of money, but it’s possibly part of the solution. The pharmaceutical sector, with a large rise in 2022, consolidates as a large export sector in Spain.

At the Business level, internationally, Apple about to develop a smart watch that can detect blood glucose level, which can change diabetes management. Big Pharma is resisting at the international level that patents are expiring and giving way to generics, as reported by the Financial Times. It seems that Fresenius is going to concentrate on the area of hospitals and generics. In principle, the rumors of the possible sale of Quirón and the preparation of several private equity companies for this operation are dissipated. In Spain, significant increase in sales of Korian, Quirón and Asisa. BUPA and Mapfre alliance to sell certain insurance in some Latin American countries.

Biomedicine

Global Health

International Health Policy

National health policy

Companies