Posts

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

/in /by

 

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 (January 8th-14th, 2024)

/in /by

 

Summary

From the point of view of Biomedicine, it is worth highlighting the first results of the genomic studies of tumors carried out by the British public company, created in Cameron’s time, Genomics England, which will allow new therapeutic orientations in tumors. Certain hopes for patients with schizophrenia, a disease with a limited therapeutic arsenal. A Phase III trial gives promising results. It is expected that the drug can be approved in 2024 by the FDA. The WHO organizes a World Forum on Clinical Trials, establishing the four pillars for their development, which is of special interest to Spain, which is a power in clinical trials, a leader in Europe and only surpassed globally by the United States, China, India and Iran.

As far as Global Health is concerned, the WHO warns that a new pandemic will arrive and it will be more deadly.

In terms of International Health Policy, the growth of total health expenditures in the USA returns to pre-pandemic levels. They rose 4.1% in 2022, while in 2020 they had risen 10.6%. The New England Journal of Medicine publishes an interesting article on the “financialization” (non-financing) of health in the United States, distinguishing this from “corporatization” (the role of large corporations) or “privatization” (greater role of the private sector). “Financialization” refers to the greater role of financial or private equity companies in the healthcare world, in many cases as direct owners of healthcare companies, especially pharmaceutical and insurance companies. The effects of this phenomenon are not yet well analyzed. The FDA approves 55 drugs in 2023, up 48% from the previous year. Of those 55, 28 were intended for rare diseases. The Economist analyzes in an article that the British health system is acquiring a shape similar to that of the 1930s, with a large role of private companies and charities, when Aneurin Bevan created the NHS. It should be noted that the so-called generation Z (between 18 and 24 years old) are the largest users of private healthcare. The EU, through HERA, the body created as a result of Covid, will launch a vaccine development center.

If we talk about National Health Policy (Spain), the Ministry of Health agreed, in the face of the growth of the tripledemic, two measures: the first, the so-called “auto-sick leaves” (sick leaves of up to three days without prior medical report, by the exclusive decision of the worker); and, the second, the mandatory nature of masks in health centers. Both very controversial measures. The first was due to disagreements with the unions, employers and within the government itself, which speaks of improvisation on a very sensitive issue and which forced it to be postponed indefinitely. The second, with opposition from several communities and legal problems in its design. Measures continue to be taken to address problems such as pandemics without the expert advice of an organization such as the Public Health Agency, which has not yet been created, which could possibly have avoided or mitigated some of the problems that the Ministry has encountered. The Catalan government, faced with a growth in pharmaceutical spending, intends to control it with several measures. One of the requests is the transfer of the powers of the Interministerial Price Commission, in order to be able to negotiate the price of medicines with the laboratories at the community level. An issue that could threaten the necessary cohesion of the National Health System. Budgeted public health spending amounts to 89 billion in 2023, 29% more than in 2019, before the pandemic. The unions propose to the Ministry changes in the human resources policy and in the Framework Statute. Given the well-known aversion of unions to differentiation and individual and collective recognition, basic needs of the system, surely the approaches will not be very innovative.

In the field of Companies, on an international level, Goldman Sachs is making its debut in health, with a fund of 650 million dollars, in a line that seems to reinforce the idea of the “financialization” of health, discussed in the article this week from the New England Journal of Medicine. When it comes to national news, the highlight is the upheaval at Grifols, which has lost 3.2 billion euros in five days. After the Gotham Research City report, the company has not been able to convince shareholders of its reliability.

Biomedicine

Global Health

International health policy

National health policy

Companies

 

 

 

7 days in healthcare (December 18th-24th, 2023)

/in /by

 

Summary

From the point of view of Biomedicine, among the “star drugs” of 2023, the first drug based on CRISPR technology, from the North American company Vertex Pharmaceuticals, stands out.

Regarding Global Health, the WHO classifies a new variant of covid which it calls JN.1, which is characterized by its wide spread, although low risk.

Regarding International Health Policy, the New York Times summarizes the measures proposed in the United States to avoid drug shortages in pharmacies, after extensive discussion in Congress. Among the many measures, manufacturing by the government is considered, something that is also being considered in our country.

If we talk about National Health Policy (Spain), the news of the week was the appearance of the report on the management of covid, after months of waiting, after the commission in October 2021. The conclusion reflected by the press, which is a summary of the report, is that Spain was not prepared for the pandemic and the success of the vaccination campaign. However, and regardless of the prestige of the selected experts, it could be questionable that they were appointed by the government, compared to the possibility of having institutions (SESPAS, FACME, etc.) to appoint their own experts. Some comments on the report: although it is said that Spain had more mortality than other countries, there are no figures, no tables, nor is it specified which countries we are referring to; insufficient attention is given to the flagrant legal breaches, which led the Constitutional Court to declare the confinements illegal; at no time is there talk of serious problems and corruption in the purchase of materials; mortality among professionals is not quantified or given sufficient importance; although mortality in residences is discussed, the problem is not explained in detail or analyzed and a table comparing mortality in the different autonomous communities is not presented; although the need for the Public Health Agency is insisted upon, it is not specified what that Agency should have so that it would be comparable to others in other countries (Robert Koch, in Germany, for example) and avoid a “watered down” formula, such as which seems to be underway; finally, it is very striking that, among the proposals, there is none related to the production of materials (equipment and medicines) in Spain, precisely to achieve the “extended strategic autonomy”, of which the EU speaks.

In the field of Companies, on an international level, there is a change of leadership in the best-selling drug, Abbie with Humira, passes the baton to Keytruda, from MSD. In terms of national news, Abanca is preparing to launch its own health insurance, which highlights the attractiveness of this market.

Biomedicine

Global Health

International health policy

National health policy

Companies

 

 

7 days in healthcare (October, 16th-22nd, 2023)

/in /by

 

Summary

From the point of view of Biomedicine, the largest research project in the world is taking place in the United Kingdom. It is about collecting information of all kinds from 5 million Britons, to then put that information to work in the preventive, diagnostic, therapeutic, Public Health field, etc. A milestone where the great contribution of AI to health and healthcare will be seen.

In terms of Global Health, The Lancet analyzes the problem of deadly gun violence and the intended approach in the United States, under the leadership of Vice President Kamala Harris. Although we tend to believe that this is a typical and especially acute problem in North American society, the truth is that in many Latin American countries the situation is much more serious: Brazil, Mexico, Guatemala, Venezuela, El Salvador,…

In terms of International Health Policy, a novel approach to smoking in the United Kingdom, where it is being proposed to address this problem from the beginning, slowing down the age of starting to smoke. A report by European pharmacists confirms that the shortage of certain medicines is a problem throughout Europe.

If we talk about National Health Policy (Spain), it is worth highlighting that the Generalitat Valenciana intends to recover the public management of the Manises and Denia hospitals, managed by concession by Sanitas and Ribera, respectively, while at the same time it proposes to continue with the concession of Vinalopó, which ends in 2025, also managed by Ribera. A priori, it seems like a judicious and non-sectarian approach from the Valencian government. The government’s Budget Plan foresees a percentage of GDP for health in 2024 of 6.7%, which contrasts with the results of the latest report of the Health Accounts System (July, 2023), which shows a public health expenditure of 7 .8% of GDP in 2021. Given that, as in the 2010 crisis, measures to reduce health spending (such as lowering staff salaries, freezing substitutions or reducing the price of medicines) are not announced, it is difficult to believe that this objective of 6.7% in public health in 2024 will be met, especially when some communities, such as the Basque Country, are announcing increases in health spending. The Andalusian Health Institute is created, the result of the merger of the Andalusian School of Public Health and the Progreso y Salud Foundation, which lose their status as public companies and, therefore, a certain autonomy. Given the history of the current Andalusian government with public hospital companies, we fear that it is another step towards the “administrativeization” of the public health system. Time will tell if this is progress or setback, but they do not seem to bode well, given the poor results of the operation in the hospital setting.

In the field of Companies, on an international level, the purchase by MSD from Daiichi of several cancer drugs is worth highlighting. At the national level, OHLA is awarded the construction of the new Vithas hospital in Turia. Important commitment of venture capital (Advent) in the field of dental care (Vitaldent), which contrasts with the low commitment of the government in this field, which distances us from Europe, being one of the countries with the least public financing in dental care.

Biomedicine

Global Health

International health policy

National health policy

Companies

 

 

7 days in healthcare (August 21st-27th, 2023)

/in /by

 

Summary

From the point of view of Biomedicine, to highlight the results of the devices that read the brain and allow certain people to speak using their thoughts. In September the Human Brain Project will be presented, the most ambitious research project financed by the European Union. The British NICE recommends stool tests to be carried out at home for colorectal cancer screening.

As regards Global Health, the journal Science analyzes how climate change can amplify epidemics and give rise to new pandemics.

Regarding International Health Policy, important developments in the USA: the CDC establishes new standards for the approach to sepsis in hospitals; large increase in sex change surgeries in recent years; AstraZeneca is suing the American government for its plans to negotiate the price of medicines, which reflects the great tension between the pharmaceutical industry and the American government, which next week will reveal the 10 medicines on which the price is going to be negotiated; and, a large increase in mental health spending after the pandemic, something that is not expected to change. The British Nuffield Trust analyze the income of English doctors in the various categories. The WHO launches an interesting digital health initiative.

If we talk about National Health Policy (Spain), the Ministry of Public Health publish in the BOE the call for specialized health training with places for doctors, pharmacists, nurses, psychologists, chemists, biologists and physicists. The Ministry also publishes a very complete analysis on the relevance of lung cancer screening. Although it has been said that the Ministry refuses to implement this screening, the truth is that it has limited itself to publishing the report, which will be analyzed by the Interterritorial Council. In Europe there is no public system that has programs of this type in place. The positions of the Scientific Societies must be heard, but they are not the only ones to consider, taking into account that these Societies usually support everything that favors the activity of the respective specialty. But in these types of decisions, many circumstances must be weighed, including cost/effectiveness. Important confrontation between doctors and health insurers in Seville, which will take place throughout September. Some complaints from physicians have been made public in relation to the SELENE computer program, which is widely implemented in the hospital public sector. A subject on which it is difficult to pronounce, but clearly to follow, due to its importance. Having a user-friendly, fast computer application with innovative features is essential for medical practice.

In the field of Companies, internationally, it seems that Roche and MSD will lead the billing of pharmaceutical companies in the next five years. As far as national news is concerned, Europe is not opposed for competition reasons to the agreement between Esteve and Lubea.

Biomedicine

Global Health

International Health Policy

National health policy

Companies

 

 

 

7 days in healthcare (October 24th-30th, 2022)

/in /by

 

Summary

From the point of view of Biomedicine, it is worth highlighting the studies that show that certain types of breast cancer, which respond to chemotherapy, will not require surgery. The link between Alzheimer’s and certain viruses is surprising. As for proton therapy, it seems that an increase in its indications (prostate, lung, etc.) is in sight.

As far as Global Health is concerned, the WHO study on a prioritized list of fungal threats should be noted. Cases of resistant tuberculosis, on the rise, which is a big problem with high mortality. Shortage of cholera vaccines. “Nature” magazine considers the possible second term of Bolsonaro in Brazil as a threat to science, democracy, the environment and the world. Said alarm had already been launched by this magazine as a result of his first term.

As for International Health Policy, monkeypox is in clear recession and covid is apparently less serious, possibly due to increased immunity. The truth is that mortality and cases requiring hospitalization are falling. Plan in the United Kingdom so that pharmacies can collaborate in the treatment of minor disorders (hypertension, high cholesterol, etc.)

If we talk about National Health Policy (Spain), a surprising proposal from ASPE to the Ministry of Health for the homologation of foreign doctors through a kind of two-year express MIR. The problem is surely more complex and it should be considered that we are one of the countries with the most doctors per 1,000 inhabitants and the most Faculties of Medicine. To analyze the shortage by areas and specialties, as well as the expansion of nursing work. It is doubtful that exporting quality doctors after an excellent MIR and importing foreign doctors with an express MIR is the solution. Perhaps the salary and working conditions of Spanish doctors should also be considered. Also striking is the new approach of the PSOE in terms of the Trans law, which tries to involve judges in changing sex between 12 and 15 years, compared to the bill approved by the Council of Ministers, which did not contemplate this possibility. AESEG, very willing to increase the use of generics, through regulatory and price changes.

In the field of Companies, at the international level, the extensive job cuts at Philips are striking, after its withdrawal of devices for sleep apnea. As for Spain, Sanitas publishes a study on mental health, which shows that the private health sector is agile in its response to a serious problem, which has become more evident after covid. Orange’s agreement with Mapfre confirms the great interest of telecommunications platforms in the world of health and their need to ally with traditional operators.

Biomedicine

Global Health

International health policy

National health policy

Companies

 

7 days in healthcare (October 17th-23rd, 2022)

/in /by

 

Summary

From the point of view of biomedicine, the announced “vaccine against cancer” should be highlighted, which could be prepared before 2030. Although not strictly a vaccine, it represents a promising treatment against this disease based on mRNA technology, the same used for covid vaccine.

Regarding Global Health, an important announcement by the WHO about the dangers of a sedentary lifestyle, which could produce 500 million chronic patients in 2030. The WHO dedicates 2,600 million in its next strategy 2022-2026 for the eradication of polio .

Regarding international health policy, an important debate introduced by The Economist on the massive use of antidepressants, when only in 15% of cases do they have an effect other than placebo. Opioids in the United States and antidepressants worldwide are examples of the misuse of medications, which can lead to, and in many cases lead to, health problems. The post-pandemic horizon has generalized a hybrid work model (face-to-face and online) for office professionals.

If we talk about national health policy (Spain), the pressure on hospitals due to covid remains low, despite a slight rise in this disease. Intense debate on the flight of Spanish doctors to other countries, attracted by better salary and professional conditions. No matter how much the number of MIR vacancies and Faculties of Medicine increases, the problem will not be solved if working conditions are not acted upon. Teleconsultations seem to consolidate in Primary Care, already being more than 50% of the visits. The Trans law is the subject of great controversy. Most psychiatrists and psychologists, against. Obviously, we are in favor of the position of the WHO by removing from the list of diseases already in 2018 these cases of having a gender identity other than biological sex and wanting to change the morphology of their body. We welcome that there is a law on the subject as in most Western civilized countries. But one thing is that and another that 14-year-olds can choose sex without a psychological evaluation carried out by experts, who can rule out cases. Irreversible problems may occur. There is a certain consensus that the current wording of the law does not sufficiently protect minors.

In the field of companies, at the international level, we must welcome the first agreement with a pharmaceutical company (Novartis) to produce an anticancer drug as a generic that is still protected by patent, for its production in developing countries. As far as Spain is concerned, the continuous growth of health insurance should be highlighted, which in 2022 until September grows considerably more than the insurance as a whole.

Biomedicine

Global Health

International health policy

National health policy

Companies