Posts

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 (March, 20th-26th, 2023)

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Summary

From the point of view of Biomedicine, the journal Nature reveals the role of mitochondria in the process of tumor growth.

Regarding Global Health, editorial of The Lancet on Water and Health. Although in developed societies this may seem like a secondary issue, the truth is that a quarter of the world’s population suffers tensions with water and it is an area in which governance over water management is needed. Tuberculosis is rebounding throughout the world, as has not been seen for more than ten years.

Regarding International Health Policy, despite the fact that the covid has caused many problems (including 6.7 million deaths, confinements of entire countries and serious economic problems), this has not affected the global happiness of humanity, according to an international study on the subject. Mysteries of human nature. The American transplant system with long waiting lists, which permanently affects more than 100,000 Americans, of whom about 17 per day die waiting. In this field, Spain could probably teach some lesson. The health of adolescents, a great concern for the American Surgeon General, since the cases of suicides between 10 and 19 years have risen in a very striking way in recent years. China approves the first covid vaccine with mRNA technology, after permanently denying permission to the Moderna and Pfizer-BioNTech vaccine. In France, a bill is being discussed to protect children from screens. New health law in Croatia, which introduces concepts such as integration of care, complex patients, coordinated care and hospital without walls, as well as a reinforcement of Primary Care.

If we talk about National Health Policy (Spain), the incidence of covid drops slightly. Darias is preparing to leave the Ministry without having fulfilled the commitment to publish the report on the management of the pandemic, in contrast to what has been happening in many other countries, without going any further in the United States. A true national shame. In the motion of no confidence debated this week, the candidate Ramón Tamames favors a refounding of public health and pleads for something similar to what the Abril Martorell Report represented in 1981, thus joining many opinions in the sector. Demonstrations on public health continue, this time in Asturias, Andalusia and Madrid. The Complutense University, under the auspices of ASPE, publishes a report on the consequences of what it calls “low cost” health insurance. The real problem is that practically, to a greater or lesser degree, all health insurance is “low cost” and is based on low compensation for hospitals and doctors, which makes the system very unstable. The Roche Institute, which is directed by Federico Plaza and which is making so many valuable contributions to the health system, publishes an interesting report on the Health of the Future and Personalized Precision Medicine. The Supreme Court endorses the euthanasia law. However, seen with hindsight, it contrasts the scant citizen and professional debate that took place on this law in Spain, comparing it with what is happening in France with something similar, with the involvement of President Macron himself. It seems that this time the biomarkers are going to be introduced into the National Health System, without which there can be no advances in precision medicine.

In the field of companies, internationally, the effect of the release of some pharmaceutical patents is estimated at 30 billion euros. In Spain, the beginning of the evaluation of the authorization of the HIPRA covid vaccine stands out, which will be called “Bimervax”. AstraZeneca is going to make a very significant investment in research in Barcelona. The doctors of the Vizcaya IMQ are massively inclined towards the sale to Adeslas, which will control 75% of this insurer.

Biomedicine

Global Health

International Health Policy

National health policy

Companies

 

 

7 days in healthcare (January 23rd-29th, 2023)

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Summary

From the point of view of Biomedicine, it is worth highlighting, as the Nature article does, that among the 7 most promising technologies for 2023, at least three are directly related to biomedicine. It seems that not only neurons have a role in brain function, but also a relevant role of glial cells in certain disorders is beginning to be recognized.

As regards Global Health, the WHO requests 2.5 billion dollars to deal with health emergencies, particularly in Yemen, Afghanistan, Syria and Ethiopia.

As for International Health Policy, a consensus began to be created three years after the start of the pandemic that, although not totally overcome, it is no longer the emergency that it was. The problems in China with the covid continue. The crisis in the NHS is the biggest for many years. Basically, there are two positions: the one that seems to be held by the current conservative government that the system is unsustainable without co-payments and very profound changes; or the one represented by The Lancet, which says that the system is perfectly viable, if it is provided with more resources. What is clear is that the UK lags behind other European countries in many resources (hospital beds etc.). Two good news in terms of health policy are led by countries that are not usually at the forefront on these issues: the smoking ban in Mexico and the mental health law in Nigeria. Tensions between governments and pharmaceutical companies over the price of medicines are increasing and this time they are not only in Europe, but also in the United States (the largest pharmaceutical market).

If we talk about National Health Policy (Spain), the incidence of covid continues to drop, although mortality remains high (above 250 deaths per week). The medical conflict in public health continues, mainly in Primary Care. While there are communities that have reached agreements (Andalusia, Navarra, Aragon, Extremadura), in others (Madrid, Catalonia) there does not seem to be any sign of agreement, which makes us think and we will have to draw conclusions about different behaviors of the Administrations and of medical leaders. Conflict also between private health doctors and health insurers. It seems that the Equity Law is going ahead, after Darias’ agreement with Podemos. Interesting agreement in Madrid so that hospital specialists can also take leave. Aragon proposes that the issue of health be dealt with in the President’s Conference, which seems reasonable, given the seriousness of the problems, although the document of said community does not contain great innovative elements. After the more than debatable success of the operations in Alzira and Torrevieja, it seems that the Valencian government also wants to rescue Denia. At this point, a deeper and more articulate justification of political decisions should be demanded.

In the field of Companies, at the international level, it is necessary to highlight the great activity of private equity companies worldwide in the field of health, as revealed by the Bain report. In Spain, Ribera Salud leaves Extremadura. Important investments in our country from Bayer and Novartis are confirmed

Biomedicine

Global Health

International Health Policy

National health policy

Companies

7 days in healthcare (May 9th-15th, 2022)

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Summary

From the point of view of biomedicine, the important study published by the journal Science should be highlighted, outlining the most detailed atlas of human cells to date. The discussion about the origin of acute childhood hepatitis continues.

As far as Global Health is concerned, it is found that the United States has reached one million deaths from COVID and Europe two million. A sad milestone.

Regarding international health policy, in relation to COVID, the debate continues on the sustainability of the zero-COVID policy in China. Lockdowns in North Korea, possibly the most opaque country in the world. The debate continues in the United States on the modification of the Roe v Wade sentence. Pronouncements from scientific journals (Nature, The Lancet), as well as from the President of the American Medical Association. The ECDC (European Center for Disease Prevention and Control) stops recommending the use of masks on public transport in Europe.

If we talk about national health policy (Spain), the accumulated incidence of COVID continues to grow. Great debate regarding the announced new Abortion Law. It is more than doubtful that the Law will be approved and, if it is, that it will be complied with, given the large number of controversial elements (registration of conscientious objectors, the obligation that these interventions be carried out in public hospitals, the use of terminology of obstetric violence, etc.). The Ministry of Industry takes out the first tender of the cutting-edge health PERTE. Important editorial in El País on waiting lists, which it presents as a scourge of the SNS.

In the field of companies, the WHO denounces attempts to whiten tobacco companies, by way of presenting themselves as green companies.

Biomedicine

Global Health

International health policy

  • COVID-19

o The Director of the WHO affirms that the zero-covid policy in China is not sustainable (https://www.ft.com/content/9b81b9f0-e13d-4b0a-8bdf-91c97c7d61e7)

o A study says that lifting the “zero COVID” policy in China could mean 1.5 million deaths (https://www.theguardian.com/world/2022/may/11/lifting-zero-covid-policies-in -china-could-risk-16m-deaths-says-study)

o China considers the WHO statement on its zero COVID policy “irresponsible” (https://www.ft.com/content/2e20867b-5f1d-4307-93b0-1d9b07d65e34)

o China renounces organizing the 2023 Asian Soccer Cup, due to the pandemic (https://www.lemonde.fr/international/article/2022/05/14/la-chine-renonce-a-organiser-la- coupe-d-asie-2023-de-football-in-raison-de-la-pandemie-de-covid-19_6126096_3210.html)

o Confinement in North Korea, as the first cases of COVID are confirmed (https://www.ft.com/content/41dec58c-3860-4ae3-86c4-716ffe85dbdd)

o Alert in the state of New York, due to the increase in cases (https://www.nytimes.com/live/2022/05/13/world/covid-19-mandates-vaccine-cases)

  • The debate on abortion continues in the United States

o The pronouncement of medical and scientific journals continues against the annulment of the Roe v Wade ruling in the United States, for reasons of public health and worsening of the health of women and children, particularly those with fewer resources. Editorials in Nature (https://www.nature.com/articles/d41586-022-01249-2) and The Lancet (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22) 00870-4/fulltext), among others.

o Gerald E. Harmon, President of the AMA, the representation of American doctors, was “deeply concerned” about the impact on reproductive health in the United States of this possible modification (https://www.ama-assn.org/ delivering-care/population-care/why-leaked-abortion-opinion-antithetical-public-health)

o The New York Times assures that the annulment of same-sex marriage could be the next step (https://www.nytimes.com/2022/05/11/us/politics/roe-wade-supreme-court- abortion.html)

o Certain groups try to ban telemedicine prescription of pills that interrupt pregnancy (https://www.ft.com/content/6a3dd70e-8bb9-4727-af4a-4036a660db64)

  • Other themes

o The United States, willing to share vaccine technology with poor countries, says Biden (https://www.ft.com/content/ec6b5b3a-7cff-4aa9-8e68-cba3bbaae06f)

o The European Union Aviation Safety Agency and the European Center for Disease Prevention and Control (ECDC), eliminate the recommendation to use masks in airports and during flights (https://www.larazon.es/ society/20220511/2dur4ogv7zemfkl5bbwmsitpme.html)

o Disposable electronic cigarettes are imposed among adolescents in France (https://www.lemonde.fr/societe/article/2022/05/08/les-cigarettes-electroniques-jetables-s-imposent-parmi-les-adolescents_6125199_3224 .html)

o France will stop requiring a mask on public transport starting next Monday, May 16 (https://www.expansion.com/economia/2022/05/12/627ccd8e468aeb71118b4611.html)

National health policy

  • COVID

o The accumulated incidence continues to rise, growing 13 points since the last measurement and standing at 856.65 cases in the last 14 days per 100,000 inhabitants. The ward occupancy rate is 5.80% and the ICU occupancy rate is 4.07% (https://www.consalud.es/pacientes/especial-coronavirus/covid-19-espana-suma-31036-casos- 321-deceased-ia-uploads-856-points_114645_102.html)

  • Regulatory announcements

o The Government willing to approve next Tuesday, May 17, a new abortion law at the initiative of the Ministry of Equality. The 14-week period for abortion to be considered legal is not modified. Most controversial points: 1. Without permission or information to parents from the age of 16; 2. No to surrogacy; 3. Registration of conscientious objectors; 4. Abortion in public hospitals; 5. Leave due to painful menstruation, outside the regulations of the common disease; 6. The terminology of obstetric violence is maintained (https://www.abc.es/sociedad/abci-no-reforma-sino-ley-aborto-ultima-gobierno-diez-claves-rapidas-202205111920_noticia.html)

o The need to strengthen public healthcare so that it can address the 74,000 abortions that are performed in the private sector (https://elpais.com/sociedad/2022-05-14/la-sanidad-publica-debera-reforzarse-para-asumir -the-74000-abortions-that-now-derives-to-the-private.html)

o The Constitutional Court is preparing a ruling in favor of the 2010 Abortion Law for June, after an appeal by the PP, parked for 12 years (https://www.elconfidencial.com/espana/2022-05-13/constitucional-junio -judgment-favorable-law-abortion_3423623/)

  • Other themes

o The Ministry of Industry is putting out to tender the Vanguard Health PERTE for the pharmaceutical and health products sector (https://www.boe.es/boe/dias/2022/05/07/pdfs/BOE-B-2022-14280 .pdf)

o Important editorial in El País on waiting lists, which it presents as a major problem for the SNS (https://elpais.com/opinion/2022-05-10/largas-listas-de-espera.html)

o War of figures in the strike of medical specialists in Madrid (https://elpais.com/espana/madrid/2022-05-10/primer-dia-de-huelga-indefinida-de-medicos-en-madrid-basta -already-of-temporary.html)

o Castilla y León intends to lower the surgical delay in six months by 21 days (https://www.diariofarma.com/2022/05/11/castilla-y-leon-objetivo-bajar-21-dias-la-demora -surgical-in-6-months)

o The national 024 telephone line for suicide prevention is launched (https://www.larazon.es/sociedad/20220509/cubyq6iicncg3nfm6hieltpxvy.html)

o The SNS Interterritorial Council gives the green light to the Mental Health Plan (https://www.diariofarma.com/2022/05/11/el-cisns-da-luz-verde-al-plan-de-salud-mental -con-practica-unanimidad), which is criticized by the President of the Spanish Society of Psychiatry, saying that “Mental Health needs professionals and intermediate centers, not apps” (https://www.redaccionmedica.com/secciones/psiquiatria /-mental-health-needs-professionals-and-intermediate-centers-no-apps–8807)

o The Ministry publishes the list of 462 strategic medicines, which includes 249 active ingredients (https://www.diariomedico.com/farmacia/industria/estos-son-los-462-medicamentos-estrategicos-para-el-sns. html)

o Private doctors ask insurers to raise their fees, which according to them have been frozen for 32 years (https://theobjective.com/economia/2022-05-15/medicos-privados-honorarios/)

o Andalusia can have up to 8 Faculties of Medicine, after the steps in Jaén and Almería only Huelva remains (https://www.redaccionmedica.com/bisturi/-ocho-facultades-de-medicina-en-una-misma-region –3332), something (the proliferation of Medical Faculties) totally against the approaches of the CEEM (State Confederation of Medical Students) and the Conference of Deans

Companies, employers and other agents of the sector

  • International News

o The WHO asks countries to stop the tobacco companies that try to whitewash their image as a green industry (https://elpais.com/clima-y-medio-ambiente/2022-05-13/la-oms-pide- to-the-countries-that-stop-the-tobacco- companies-that-try-to-clean-up-their-image-as-a-green-industry.html)

o Pfizer will buy the biotech company Biohaven for 11.6 billion dollars (https://www.ft.com/content/ea9bb9bc-b5ec-4278-ab42-1f5f14a1a76f)

  • National News

o Vithas invests 3 million euros in the renovation of emergencies (https://www.plantadoce.com/empresa/vithas-madrid-la-milagrosa-invierte-tres-millones-de-euros-en-la-renovacion- of-your-emergencies.html)

o Vitaldent is committed to dental aesthetics by incorporating 73 Smysecret spaces into its clinics (https://www.plantadoce.com/empresa/vitaldent-apuesta-por-la-estetica-dental-e-incorpora-73-espacios-smysecret-a -your-clinics.html)

o Asisa buys a 600m2 center in Zaragoza (https://www.ondacero.es/programas/en-buenas-manos/asisa-compra-centro-medico-600-zaragoza_20220510627a3bbc64c3c90001106b03.html)

o Hospitales Parque grows in Talavera with a new building for outpatient consultations (https://www.plantadoce.com/empresa/hospitales-parque-crece-en-talavera-de-la-reina-con-un-nuevo-edificio- for-external-queries.html)

o Sanitas, SegurCaixa Adeslas and Línea Directa, the most profitable insurers (https://www.expansion.com/empresas/banca/2022/05/09/627567d7e5fdea58068b45f4.html)

o Novartis will manufacture an oncology drug for the whole world in Barcelona (https://www.eleconomista.es/salud/noticias/11765483/05/22/Novartis-fabricara-en-Zaragoza-un-oncologico-para-todo-el -world-.html)