Posts

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 (May 29th-June 4th, 2023)

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Summary

From the point of view of Biomedicine, it is worth noting the death of the virologist Harald sur Hausen, whose name will not mean anything to many, but who 50 years ago discovered the relationship between papillomavirus and cervical cancer, initiating studies of the relationship between viruses and cancer. Reading the DNA of a large and highly varied number of primates allows us to better understand what a human person is and the origin of some diseases. An international consortium discovers that the nucleus of cells is metabolically active.

As regards Global Health, The Economist focuses on the decline in global fertility, due to a decrease in births, not an increase in deaths, a fact with great consequences in our societies. The WHO puts a target by means of cheap vaccines to the global vaccination against cervical cancer, which still produces a large number of deaths. The UN warns about the great sources of hunger in the world: Haiti, Mali, Burkina Faso and Sudan.

Regarding International Health Policy, Canada is preparing a regulation that will make it mandatory to carry warnings of negative health effects on each cigarette. The EU finalizes a regulation to remunerate plasma donations. The WHO celebrates the 76th World Assembly in Switzerland, in which several topics were discussed, among others, the next UN High-Level meeting on universal health coverage, to be held on September 23.

If we talk about National Health Policy (Spain), the call for early elections for July 23 paralyzes the processing of more than 60 laws in relation to health, including some as important as the Equity Law, the Framework Statute, the Law of the National Agency of Public Health or the Law of Guarantees and Rational Use of Medicines. In the Valencian Community, Mazón (the winning candidate of the PP in that Community and foreseeable new president) announces the freezing of the reversal process of the concessions of Manises, Denia and Elche, which had already started or were planned by the Ximo Puig government. He also doesn’t rule out launching new concessions. The Princess of Asturias Award for International Cooperation, awarded to the non-profit initiative Medicines for Neglected Diseases, which focuses not on rare diseases, but on highly prevalent diseases, especially in underdeveloped countries, such as Chagas disease, dengue fever, kala-azar or river blindness and which are considered to affect around 1,000-1,500 million people in those countries, without any research, industry or commercial effort commensurate with their importance.

In the field of Companies, internationally, China breaks the veto on Western vaccines and will allow Moderna to settle in that country. For its part, AstraZeneca defies geopolitical challenges and intends to grow in China. At the national level, Zurich joins forces with Google and DKV to launch digital health insurance. Quirónsalud intends to grow in telemedicine and closes a contract to serve university students.

Biomedicine

Global Health

International Health Policy

  • France
    • Tobacco use is stable in France, one in four adults smokes daily (https://www.lemonde.fr/sante/article/2023/05/31/avec-un-adulte-sur-quatre-qui-smoke-quotidiennement-le-tabagisme-reste-stable-en-france_6175491_1651302.html#:~:text=Tabac-,Tabac%20%3A%20avec%20un%20adulte%20sur%20quatre%20qui%20fume%20quotidiennement%2C% twenty)
  • Canada
    • Canada is going to require that a warning about the danger be printed on each cigarette, since it has been seen that young people start smoking when they receive the offer not of a pack, but of a cigarette (https://www.lemonde. fr/international/article/2023/05/31/le-canada-va-demiger-qu-un-avertissement-soit-imprime-sur-chaque-cigarette_6175630_3210.html)

National health policy

Companies