Posts

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

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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 (February 26th-Mars 3rd, 2024)

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Summary

From the point of view of Biomedicine, certain advances stand out in the search for a treatment for multiple sclerosis, a disease that affects 1.8 million globally and for which at this time there is no effective therapy. As announced by the president of the Spanish Society of Nephrology, the new drugs will allow many cases of dialysis and transplant to be avoided.

As far as Global Health is concerned, the most worrying thing is the poor perspectives observed regarding the pandemic treaty, the objective that the WHO had proposed for 2024. The obstacles are the accumulation of vaccines and the sharing of knowledge about them, problems of rich countries and companies, respectively. The Lancet warns about the need to strengthen cervical cancer screening, which continues to cause hundreds of thousands of deaths a year, especially in low- and middle-income countries. Warning about ultra-processed foods (cereals, protein bars, soft drinks, and fast food) linked to 32 harmful health effects, including increased risk of vascular disease, cancer, type 2 diabetes, mental illness and premature death.

In terms of International Health Policy, a very serious problem with fentanyl in the United States, which in the last twelve months until September 23 had caused 105,000 deaths in that country. Until now, the policy was aimed primarily at preventing the entry of drugs; some extremist politicians had even proposed invading Mexico to put an end to the gangs. With the current Administration, efforts are directed more towards discouraging its use and treating addicts. Big problem for Republicans in the USA with the decision of the Alabama Supreme Court to declare frozen embryos as “extra-uterine children”, with all the obstacle that this has for the popular procedure of in vitro fertilization, so widespread in the United States as in other developed countries. This Alabama decision seems like a gift to Democrats: “First it was abortion, now it is in vitro fertilization and then it will be birth control,” warned Hillary Clinton. Even Trump was forced to distance himself from this decision. In France, the National Assembly is putting pressure on the pharmaceutical industry regarding the shortage of medicines, forcing laboratories to have a four-month reserve of “medicines of high therapeutic interest.” In order to strengthen drug R&D, the European Union is considering “giving away” a year’s patent to those drugs whose research has been carried out in Europe.

If we talk about National Health Policy (Spain), the current Ministry of Health, unlike previous Ministries, wants to get involved in the problems of the SNS, while the previous ones wanted to get involved as little as possible, with the argument that “everything was transferred” . This attitude seems, in principle, positive for the SNS. Another thing is priorities. It seems that among these are the suppression of 24-hour medical guards; addressing waiting lists; and, the State Public Health Agency. Regarding the first issue, the challenge is formidable, since medical guards, regardless of whether they are necessary or not, have become an important salary supplement. It is impossible to address this issue without considering the complements of medical personnel, which is no small issue. Regarding waiting lists, aware that their management corresponds to the communities, it seems that they want to establish a kind of “best practices”, with economic incentives for the communities that apply them. Not an easy matter either. And as for the State Public Health Agency, the ministry seems to have reached an agreement with the PNV and Junts, for the withdrawal of their amendments to the law. Let us hope that this agreement does not go against the strength and operation of the new Agency. For its part, SESPAS, the Spanish Society of Public Health, has published an interesting document on the characteristics that this body should have, with 11 very interesting recommendations. The Economic and Social Council of Spain (CES) publishes a report on the health system. Although the report is well prepared, it is difficult to find anything new in it that has not already been said or any innovative proposal. Taking advantage of the day of rare diseases (although it is now preferred to call them minority) the Spanish Association of Orphan and Ultra-orphan Drug Laboratories releases a report on the situation of these drugs in Spain. Much has been improved, although there is still room to advance. Both the La Paz hospital in Madrid and the Sant Joan de Deu in Barcelona launch special units to treat this type of illness.

As for Companies, on an international level, the Danish Zealand Pharma, a new relevant player in the field of obesity. On the national level, Viamed will launch a comprehensive unit for women in its hospital in Tarragona. New punishment in the Grifols Stock Market.

Biomedicine

Global Health

International health policy

National health policy

  • 24 hour guards
    • The Ministry of Health wants to end 24-hour medical guards this term. The Ministry will study the legislative framework that the autonomous communities can apply. The aim is to organize it by hospitals and without losing salary, since the guards can represent up to a quarter of the professionals’ salary. The challenge is formidable, since it must be implemented by the autonomous communities, it involves a reorganization of hundreds of services, an increase in staff and addressing the complements of medical personnel (https://www.eldiario.es/sociedad/sanidad-quiere-finish-medical-guards-24-hours-we-will-give-you-answer-legislature_1_10957897.html)
  • Economic and Social Council (CES) report on the health system
    • Report from the CES on the health system. Among the recommendations it supports public health and prevention; specify and update the SNS service portfolio; make Primary Care the true axis of the system; confront waiting lists; strengthen the comprehensive mental health model; enhance the quality of pharmaceutical provision; promote the planning and reinforcement of human resources of the SNS; reinforce patient participation; contribution of the private for-profit and non-profit sector; improvement of system management and evaluation (https://www.ces.es/documents/10180/5299170/INF_012024.pdf)

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