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7 days in healthcare (March 11th-17th, 2024)

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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

Global Health

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)
  • 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)

National health policy

  • Advanced therapies trading company

Companies

7 days in healthcare (March 4th-11th, 2024)

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Summary

From the point of view of Biomedicine, the possibility of making replicas of fetal organs stands out, which could facilitate fetal treatments without putting the pregnancy at risk. The Lancet publishes an editorial and several articles on menopause, a natural state in the aging process of women, often overmedicalized. FDA delays approval of Lilly’s long-awaited Alzheimer’s drug.

As far as Global Health is concerned, there was a shortage of cholera vaccines, at a time with many outbreaks, even in countries where it had been eradicated. Great absolute growth in the global figures of the scourge of genital mutilation in women, especially in Africa, but also in Asia and the Middle East. First published evidence that nanoplastics harm human health. Big problem with the lack of health professionals in Africa, which is proposed to be compensated as a quick solution with community health workers.

Regarding International Health Policy, in the United States President Biden gave his fourth and final State of the Union address. Surprising was a particularly energetic and mentally agile Biden, who maintained the interest of a vibrant speech during its more than 60-minute duration, even interacting with the Republican seats. Much of his speech was dedicated to health, undoubtedly a star issue in the next elections: the price of medicines; women’s reproductive rights, abortion and in vitro fertilization; the extension of Obamacare, a law he defended, during his term; and care for the elderly, both at home and in nursing homes, were the topics discussed. In France, President Macron has decided to make abortion a constitutional right, surprising the enormous support obtained on the right and left in the National Assembly: 780 votes in favor compared to only 72 against.

If we talk about National Health Policy (Spain), In its “Declaration of Córdoba” the Popular Party presents 4 proposals regarding health. The rural environment is left without doctors, according to the Spanish Society of Family and Community Medicine, saying that of the 11,000 rural doctors, half will retire in the next 5 years and it does not seem easy the arrival of new doctors. A specific health problem of one of the great gaps in our country: that of the rural-urban world. The Minister of Health makes two big promises: the decarbonization of the health system and the creation of an observatory on corruption in health (in response to problems with the purchases of masks and equipment during covid). Interesting, but we will have to see if these promises become realities. The PP will bring the ELA law to Congress.

As for Companies, at the international level, it is increasingly clear that the Novo Nordisk-Lilly duopoly in addressing obesity will be broken, giving way to other agents, given the large number of clinical trials on the subject. According to IQVIA, pharmaceutical companies will lose 6 billion a year until 2028 due to the expiration of many patents, converting many of these medications to generics and biosimilars. This loss will try to be compensated with the launch of new drugs, since it is estimated that between 2024 and 2028 there will be 175 new launches, especially in the field of oncology and neurology. Regarding national news, Grifols has revalued on the Stock Market, after the publication of its audited accounts without qualifications. Loss of 600 million of the insurance companies that operate in MUFACE (Adeslas, Asisa and DKV) during the period of validity of the current three-year agreement. It is evident that public/private collaboration is unviable if it condemns the participating companies to losses without any prospects.

Biomedicine

Global Health

International health policy

National health policy

Companies

 

7 days in healthcare (February 5th-11th, 2024)

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Summary

From the point of view of Biomedicine, the first effective medication against endometriosis, the growth of the mucosa that internally lines the uterus in other parts of the body, which produces serious disorders, is on the horizon. The Lancet insists that population screening, including genomic screening, requires robust evidence. Population screenings generate considerable expenses, in some cases they are not risk-free and can generate false expectations, so only the most proven ones should be launched. Obesity drugs show other superpowers. They seem to have the ability to control inflammation, including brain inflammation. In this way, it is thought that they may be useful in certain neurological diseases, such as Parkinson’s or Alzheimer’s.

As far as Global Health is concerned, malaria vaccines, currently in use in Africa, are one of the great current tests of Global Health. An article in The Lancet criticizes the WHO’s desire to assimilate policies on tobacco products with those on e-cigarettes. For the author this is a retrograde position, since they are not comparable products in terms of the damage they cause. It is said that the focus should remain on what is the main public health problem: the harmful effects of tobacco consumption. Some directors of scientific advisory committees on covid sign an article in The Lancet, with general recommendations for these committees. Among the signatories is Fernando Simón, whose role in Spain was highly questioned and criticized.

Regarding International Health Policy, British experts from the Academy of Medical Sciences warn of the decline in the level of health of children in the United Kingdom. Due to its importance in the Spanish debate, we simply have to mention that the French Social Security agreed to raise the price of consultations for liberal practice general practitioners to 30 euros per consultation.

If we talk about National Health Policy (Spain), after the monographic meeting of the Interterritorial Council of the SNS on Primary Care, it was agreed, among other things, that the government, after checking the teaching capacity by the autonomous communities, will increase the number of places in training for primary care, although it is simultaneously reported that up to 90% of those who do this specialty leave it for various reasons, to move to the emergency room, to do another specialty or to go abroad. Publication of the Health Observatory (Ministry of Health-CIS) corresponding to 2023. The time to be seen in primary care is very striking, since 70% of patients wait nine days to be seen. The Department of Health of Catalonia addresses the places that are difficult to fill in Primary Care, after identifying 73 primary care teams with these characteristics. Design an incentive program. Among the economic ones are 3,500 gross euros per year for doctors, which may seem little since it represents just over 200 euros net per month, although the Metges union considers it a big step. ASPE publishes, in collaboration with a team from the Complutense University of Madrid, a study on MUFACE, joined by the IDIS Foundation, which calls for a PP-PSOE political agreement and a review of the governance of the model. It is also made public that the insurers that are in MUFACE (Adeslas, Asisa and DKV) already assume losses of 200 million with the current agreement. This is difficult to maintain since private companies in public/private collaboration can be asked to innovate, offer high quality, invest or even, with a long-term perspective, take short-term losses, but not that they lose money continuously and indefinitely, since the possibility of that collaboration is put at risk. Osasunbidea (the Navarrese Health Service) opens, through the intervention of the LAB union, a file on several doctors for making public and private practice compatible, without giving up a supplement. It seems like a debate from another era. Furthermore, there are great differences in the application of this regulation in the national territory. Therefore, a strict approach to incompatibility is only being followed in Navarra and Asturias. A group of Catalan health workers asks to expel another group of Spanish speakers, a notable example of intransigence, regardless of the dubious legality. Another of the conclusions of the Ministry’s Health Observatory is the great growth of private insurance, which went from 6.5% of the population in 1995 to 30.9% in 2023. The great leap occurred in the last decade.

As for Companies, at the international level, Big Pharma still needs successes in clinical trials to compensate for the loss of patents. At the national level, Magnum Partners is preparing to launch a premium aesthetic medicine group. The giant DomusVi offers the largest portfolio of nursing homes in Spain for sale.

Biomedicine

Global Health

International health policy

National health policy

Companies

 

 

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

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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)

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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 (October 2nd-8th, 2023)

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Summary

From the point of view of Biomedicine, Katalin Karikó and Andrew Weissman, awarded the Nobel Prize in Medicine, for their discoveries that allowed the implementation of the mRNA vaccine against covid. When Watson and Crick discovered the structure of DNA in 1953, RNA was not known, not discovered until 1961. DNA is the matrix for RNA and this is the matrix for proteins to be produced in ribosomes. mRNA was later discovered. Dr. Karikó immigrated to the United States from her native Hungary in 1968 to find a therapeutic role for messenger RNA. For 20 years she worked unsuccessfully in that attempt. At the University of Pennsylvania, where she worked, she met Dr. Drew Weissman. They had made RNA, injected it into mice but they got sick and died. After some chemical changes in the RNA they avoided rejection. They believed they were on the path to discovering a new way of making vaccines. They tried to publish it in “Nature”, but the prestigious magazine rejected the work. They published it in 2005 in the minor journal “Immunology”. Two biotechnology companies saw the therapeutic potential of RNA: Moderna, in the United States, and BioNTech, in Germany. In 2013 Katalin Karikó became vice president of BioNTech, there she developed the vaccine against covid that has saved so many lives. In 2022 she left BioNTech to devote more time to research. She has returned to Hungary as a professor at the University of Szeged. Andrew Weissman’s life is less eventful, he is a professor of medicine at the University of Pennsylvania and had worked with Anthony Fauci, the doctor who led American efforts against covid-19. In another vein, The Lancet magazine publishes an experimental work in which a blood test detects tumors in asymptomatic people. It is only a first step, but the day does not seem far away when we can diagnose the existence of a tumor through a blood test.

Regarding Global Health, the WHO approves the long-awaited second vaccine against malaria. It should be noted that the number of cholera cases has doubled between 2021 and 2022, according to the WHO.

Regarding International Health Policy, in the United States, a strike at the important integrated insurer Kaiser Permanente ended without an agreement. The FDA launches a program to accelerate the emergence of therapies against rare diseases. Let’s not forget that most rare diseases have no treatment by 2023. Prime Minister Sunak of the United Kingdom seems determined to set limits on the age at which people start smoking. The EFPIA (European medicines association) appeals in writing to the European Parliament to amend the European pharmaceutical reform, which is underway.

If we talk about National Health Policy (Spain), as is known, the Government has authorized the increase in the number of places in Medical Schools. This initiative has been made against the opinion of the doctors and the Association of Medical Students. Obviously, the issue of health professionals requires planning, precisely what there has not been. Planning cannot be replaced with any measure if it is not well thought out and matured among the various agents of the health system. Andalusia takes a step to promote public/private collaboration, by approving 734 million euros to refer patients to private clinics. As for the Zendal Hospital, it seems that it the purpose of that hospital is already defined. After an investment of 50 million: the Zendal hospital will be a neurorehabilitation hospital. At one point it had been designed as a Covid hospital, something only seen in China and some other low-developed countries, not Europe. There was no functional plan for said hospital. We now do not know which studies have recommended its transformation into a neurorehabilitation hospital and whether the different agents (hospitals, scientific societies, expert groups, etc.) have been consulted.

In the field of Companies, on an international level, KKR finalizes the purchase of Eugin, to create a giant in assisted reproduction. At the national level, HM Hospitals announces the opening of its 9th hospital in Madrid. A story of undoubted success, based on a family initiative.

Biomedicine

Global Health

International health policy

National health policy

Companies

 

 

 

7 days in healthcare (September 25th-October 1st, 2023)

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Summary

From the point of view of Biomedicine, The Economist raises the issue of how research on aging makes the prospect of living to 120 years less unimaginable.

Regarding Global Health, The Lancet publishes a study prepared with information from 185 countries that shows how a more “feminist” approach could have saved hundreds of lives of women with cancer. Surprising news from COVAX, the body created to distribute covid vaccines to developing countries: billions of its budget unspent.

Regarding International Health Policy, the pharmaceutical industry warns against the possible harms of the application of the European Union’s pharmaceutical policy, in this case the reduction of medicines against rare diseases. The pharmaceutical policy has not yet been approved, so this sounds like putting the bandage before the wound.

If we talk about National Health Policy (Spain), the news of the week was the failed investiture of Feijóo. In his speech he addressed health problems. Although logically in a discourse of this type the sectoral details must necessarily be brief and what is interesting is the general tone, the poverty of the health discourse is surprising. The proposals are reduced to a shock plan for Primary Care and new medical calls, in addition to a “commission of experts” to address the problems of the sector for which no initial proposal is launched. It does not seem that there is a mature reform program in the PP when it comes to health. The news of the approval of a catalog of biomarkers in the SNS, which will be published electronically, seems like good news.

In the field of Companies, at the international level, the EU’s talks with Moderna for the new supply of covid vaccines should be highlighted. At the national level, Sanitas is reinforced in Andalusia with a new center in Malaga; an Austrian company will create a wellness center in Marbella; and, Atrys Health continues its expansion in Mexico, through an agreement with BUPA.

Biomedicine

Global Health

International health policy

National health policy

Companies

 

7 days in healthcare (July 31st-August 6th, 2023)

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Summary

From the point of view of Biomedicine, it seems that for the first time, apart from the complicated bariatric surgery, medicine will have a treatment for obesity, this disease that affects more than 1 billion people worldwide. With GLP-1 it seems that we are entering the phase of effective drugs against obesity. Generative AI, which is capable of generating new algorithms, based on the patterns and structure of the data, is called to play an important role in health care. It seems that cancer is growing at younger ages. The WHO declares the polypill, developed by the CNIC and Ferrer, as an “essential medicine”.

With regard to Global Health, a call by the editors of the most important scientific journals in the world, through a common article, for health professionals to get involved in the fight against the risk of nuclear war, since it seems that we are in a situation of risk not seen since the Cold War. The WHO detects progress in tobacco control in many countries, through the WHO Framework Agreement for Tobacco Control, signed 20 years ago.

Regarding International Health Policy, in the United States a cyberattack forces the paralyzation of the activity of several hospitals. In the United Kingdom, new diagnostic centers are being created to increase the capacity to carry out tests and reduce the waiting list. Of the 13 centers announced, 8 will be privately financed and managed. The waiting list is a political priority for Prime Minister Sunak.

If we talk about National Health Policy (Spain), the incidence of covid has risen since July. It is extremely striking that a new registry multiplies by four the official number of maternal mortality in Spain. Maternal mortality is precisely one of the indicators most taken into account when establishing the health of a country. The Health Accounts System document has been published, which updates the data with those of 2021. Between 2017 and 2021 there has been a 25% increase in health spending, including public and private. The MUFACE system is doubly threatened, firstly because of its high losses and, secondly, because the SUMAR program, Sánchez’s possible partner in a new government, is sponsoring its disappearance. The agreement signed in Aragon for the constitution of the new PP-Vox government contemplates resorting to public/private collaboration to address the waiting list. It should be noted that the integration of the workforce of the former Health Agencies of Andalusia has been completed, which affects 3,500 workers, who may be integrated as permanent statutory employees. An important regression, which reinforces the most rigid aspects of the public health system, precisely what the public hospitals with the configuration of public companies, unfairly called by the PP in Andalusia as “chiringuitos”, had tried to overcome with remarkable success. A blunder, not to use euphemisms, both from the Andalusian government and from the party that supports it. Information from the old management teams ensures that the deterioration is already taking place. If, rightly, an audit is required to see the results of the reversals of the concessions in the Valencian Community, something similar will have to be done in due course with these Andalusian hospitals.

In the field of Companies, internationally, Amazon launches a new documentation service based on generative AI. The pharmaceutical companies that had made cash with the covid vaccine are deflating, something that was already discounted by the market. At the national level, a new incursion of Magnum Partners into health, by buying the nutraceutical company Martínez Nieto. Apax acquires 50% of Palex, a company that had become a target for many funds, and which will surely herald a consolidation of the medical technology distribution sector.

Biomedicine

Global Health

International Health Policy

National health policy

Companies

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 (June 26th-July 2nd, 2023)

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Summary

From the point of view of Biomedicine, clinical trials in humans begin with drugs developed by artificial intelligence, such as one for idiopathic pulmonary fibrosis. Álvaro Pascual-Leone, a prestigious Spanish neuroscientist based in the United States, announces that in about ten years the brain will be able to be manipulated . Surely at that time the manipulation of the brain will be something as normal as today the replacement of the crystalline lens for the cataract. A new world is coming.

In Global Health, two charities (the Gates Foundation and the Wellcome Foundation) set to fund a TB vaccine, which could save 8.5 million lives over the next quarter century. Gavi, the organization that provides vaccines to developing countries, approves a vaccine that protects against polio and five other diseases.

Regarding International Health Policy, the editor of the American Journal Medicine publishes in the last issue an article with the five great challenges of the American health system in the 21st century. However, from a reporting point of view, the most interesting news comes from the UK. The King’s Fund, a major British health think tank, publishes a comparative analysis of that country’s health system, which it analyzes together with 19 health systems, including the Spanish one. The analysis is very interesting, and the conclusion is that the NHS is efficient, but with big problems, not only with waiting lists, but also with results. It seems to imply a chronic underfunding of the NHS, when compared to systems in other countries. For its part, the NHS publishes for the first time a long-term plan on personnel. It basically deals with three things: training, retention and reform. The Guardian hails the report but says it is years overdue. For their part, both The Lancet and the British Medical Journal publish editorials on the 75th anniversary of the NHS, which coincides with its deep crisis. In both positions, political consensus is claimed as a key piece to fix the serious problems of the NHS. The WHO-Europe publishes a document with architectural recommendations on the hospitals of the future.

If we talk about National Health Policy (Spain), there are several news of interest: the Audit Office of Catalonia publishes an interesting report on waiting lists. It seems that 9% of the cases on the waiting list in Catalonia were not counted on the Department of Health website, which leads some to use the word makeup. With regard to private healthcare, the IDIS is starting a very interesting project to share the patient’s clinical history among various provider and insurer entities, only an initial but very important step in what is to come. In the course of the pre-election debate, the President of the Popular Party announces a new General Health Law and a State Pact on Health if it reaches La Moncloa. Interesting announcements since, as The Lancet says for the NHS, only a certain political consensus and a new partnership, will be able to solve the problems of the health system in our country.

At the Corporate level, internationally, GSK completes the acquisition of Bellus Health. As far as national news is concerned, we must highlight Roche’s investment in Sant Cugat.

Biomedicine

Global Health

International Health Policy

  • USA
    • The challenges of the American healthcare system in the 21st century, according to the editor of the American Journal Medicine. Five big challenges: 1. Insufficient insurance coverage; 2. Low health education among the population; 3. Prevention and management of chronic diseases; 4. Great disparities in quality and results; and. 5. Trust in doctors? (https://www.amjmed.com/article/S0002-9343(23)00035-9/fulltext)

National Health Policy

Companies