Posts

7 days in healthcare (June 24th-30th, 2024)

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Summary

Biomedicine

  • Advances in gene editing. Discovery of a new way to program DNA recombination. This increases the possibilities of the current CRISPR editing method. The new route is called the bridge RNA method.
  • Lifestyles can compensate for genetics. Lifestyles can improve genetics by 60% and add 5 years to life.

Global Health

  • Loneliness as a public health problem. Increases the chances of stroke by 56%. Given aging trends and changes in family structure, new ways to avoid loneliness will be a new public health problem.
  • A disease control, prevention and control center for Latin America. Although Latin America has only 8.2% of the global population, in the case of covid they had 10% of the global cases and 25% of the mortality. A group of experts proposes the creation of a Latin American Center for the prevention and control of diseases.
  • They propose warnings on ultra-processed foods. For some, ultra-processed foods need warnings, just like tobacco
  • Simple steps to prevent people from dying from heat stroke. In Europe 70,000 people died from the heat wave in 2023. Saudi Arabia reached 50º in the shade; Baltimore and Philadelphia, around 40º; also India. Far from being exceptional episodes, it is part of the new normal. The solution is simple, according to The Economist: put people out of the sun and in a cool environment. Surely easier said than done.

International health policy

  • Many Chinese doctors choose to leave the public sector to go to the private sector. The pressures of health reform on doctors cause many to opt for the private sector. The salary of doctors in China (equivalent to $13,000 per year on average) is lower than that of other Chinese professionals.
  • Changes in the NHS in the electoral programs  in the United Kingdom. The Lancet analyzes the health changes needed in the wake of the UK election. The NHS faces numerous challenges in many areas – from record waiting lists to repeated strikes – resulting in historic levels of dissatisfaction among patients and professionals. According to the Nuffield Trust think tank, none of the major parties promise a substantial increase in funding capable of addressing the serious problems.

National Health Policy (Spain)

  • Plan for Primary Care. Health announces the approval of the AP and Community Action Plan in the last quarter of the year. We do not know if this will be a reality or a new song to the sun, to which the Ministry has accustomed us.
  • Defense of the Catalan model of consortia. Mónica García defends the Catalan model, against criticism from Junts. She defends them because they are non-profit, as if having one would incapacitate collaboration with the public sector. Incredible.
  • Hiring non-community doctors. Madrid extends the exception to hire non-European doctors in the public sector to all medical specialties. If a position remains unfilled, a non-EU doctor may apply for it, that is, whose medical degree has not been issued by the EU. Madrid is a pioneer in this measure, which, apparently, violates state law. If the law is really broken, it is doubtful that this could be the solution. In the United States there is the ECFMG (Educational Commission for Foreign Medical Graduates), the famous “Foreign”. And in Europe there are community directives that regulate the curricular contents of all health professions.
  • A summer with 6,000 fewer doctors. The residents will finish later this year, due to the pandemic, and will not be able to fill the vacancies.
  • Universal benefit for children between 0 and 3 years old. The CES calls for a universal benefit for children from 0 to 3 years old that is not conditioned by income. The starting point is that Spain has an “unheard of” problem, which does not correspond to its level of wealth, the weight of the Welfare State or its ethical values: one in three minors lives at risk of poverty or exclusion. social. The problem is especially serious from six months to three years.
  • Statements by the prestigious health economist Félix Lobo. “It is not true that innovative therapies arrive late in Spain.” We need to know whether it is worth paying the high prices that pharmaceutical companies ask for medicines and health technologies, but we do not have good mechanisms to evaluate this. We need an organization independent of political power with means and prestige. It should be something similar to AIREF or the National Markets and Competition Commission (CNMC). Faced with these excellent statements, other groups propose populist solutions (in the sense of simple) to a complex problem and present the delays in the incorporation of new medications almost as the main problem of our health system, which is absurd and far from the reality.
  • Tumors become the leading cause of death in Spain. 26.6% of deaths in 2023 were related to some type of cancer. It is the first time that this cause surpasses ailments of the circulatory system.
  • Fertility rate in Spain. Below the OECD fertility rate and very far from the replacement level. We have gone from 3.3 children per woman in 1960 to 1.5 in 2022, below the replacement rate

Companies

  • International
    • A new market, that of exoskeletons. Aging is driving up the exoskeleton market, which will reach $1.5 billion by 2027. The prevalence of cerebrovascular accidents and the growing geriatric population are at the origin of this growth.
    • aNovoNordisk, in China. Novonordisk’s obesity drug Wegovy approved in China.
  • National
    • Ribera diversifies into several communities. The Ribera health group expands its presence in new Autonomous Communities and prepares its landing in Andalusia. The announcement will be made in July.
    • Esteve increases its production capacity. It will invest 100 million euros in building a new production unit in Girona.

Biomedicine

Global Health

International health policy

  • United Kingdom and the National Health Service
    • The Lancet analyzes the changes in health necessary as a result of the elections in the United Kingdom. The NHS faces numerous challenges in many areas – from record waiting lists to repeated strikes – resulting in historic levels of dissatisfaction among patients and professionals. As analyzed in the Nuffield Trust, none of the major parties promise a substantial increase in funding (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01344-8/fulltext)

National health policy

Companies

 

 

7 days in healthcare (June 17th-23rd, 2024)

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Summary

Biomedicine

  • 20 years of progress in the treatment of lung cancer. Until the 2000s, lung cancer was a lethal disease with very limited treatment options, based on platinum-based chemotherapy, which gave one-year survival in 33% of patients with advanced disease. In the last 20 years there has been incredible progress, always based on identification with biomarkers, which are now part of the routine.
  • A single injection provides total protection against HIV. One Gilead injection provides total protection from HIV, in a trial with African women, with extraordinary results, with just two injections a year.
  • The first drug against sleep apnea. It could be a new generation drug against diabetes and obesity. Sleep apnea is so common that this medication could represent something similar to obesity medications.

Global Health

  • The Sustainable Development Goals are failing. We are now halfway between 2015, when these Goals were announced, and 2030, when they should be achieved. The objectives have not materialized, remaining a “promise without a plan.” None of the 17 objectives are on track to be met and number 3 (dedicated to health and well-being) is no exception.

International health policy

  • Health coverage projections in the USA 2024-2034. The percentage of uninsured will increase in this period, going from 7.7% in 2024 to 8.9% in 2034. The main cause is the expiration of certain measures as a consequence of Covid regarding Medicaid.
  • The Surgeon General in the USA demands warnings against the danger of the platforms. He calls for danger warnings on social media platforms, similar to tobacco. He will ask Congress for such a measure, warning that the use of certain platforms can harm the mental health of adolescents.
  • The NHS wants to move medical studies to 4 years in 2026. From the current 5 in that country. Both the British Medical Association (BMA) and the Hospital Consultants and Specialists Association (HCSA) oppose the measure, warning that it risks producing a type of doctors without the necessary preparation and that this is dangerous for quality.
  • £38bn a year will be needed until 2029-2030 to “revive” the NHS. According to the think tank The Health Foundation, the system needs to grow 3.8% in real terms in the next decade, not 0.8% as planned. Politicians need to be honest on this issue, says the director of the think tank. There is a fairly widespread perception that 14 years of Conservative government spelled doom for the NHS. Perhaps a similar analysis was necessary with regard to the Spanish health system.
  • French pharmacists want to be able to dispense antibiotics without a prescription. For angina and cystitis, under certain conditions, following a decree published on June 18.

National Health Policy (Spain)

  • A scientific advisor in each ministry. This is similar to what is happening in the UK and the need for a better science-politics connection became very clear during Covid. This project will be coordinated by the National Scientific Advisory Office (ONAC).
  • Open Health Forum. It will incorporate the voice of patients, people with disabilities, citizens and professionals.
  • Green light to the Royal Decree creating the Public Health Surveillance Network, which includes the Early Warning and Rapid Response System.
  • Controversy among experts over the “singular financing” for Catalonia. The extension of a “Basque-style” model to Catalonia endangers the financing of the system, according to representatives of FEDEA (Diego Martínez López) and FUNCAS (Santiago Lago).
  • Castilla-La Mancha dedicates 1.3 million to the National Health Data Space. This community will house the data centers that must be implemented in Spain. The agreement was reached at the Sector Conference for Digital Transformation.
  • The reform of La Paz is transformed into the City of Health. With an investment of 1,000 million euros, it will house, among other spaces, the new Faculty of Medicine of the UAM, a research center and a pediatric cancer center.
  • The Constitutional Court endorses abortion without parental consent. Which allows 16 and 17 year old girls to terminate their pregnancies without this consent.
  • Three years of euthanasia law in Spain. Half of the applicants have their request rejected and a third die during the process. Since the law came into force, it was applied in 363 cases, half of the applicants. Not all autonomous communities are collaborating adequately. Surely this is a consequence of the hasty discussion of this important law, unlike what happened in France, although in that country the elections have paralyzed the processing of the law.

Companies

  • International
    • Lilly and NovoNnordisk in the race for anti-obesity drugs. They will invest $30 billion to expand the production of their anti-obesity therapies.
  • National
    • Growth of the residence sector. It earned 5,250 million euros in 2023, 6% more than the previous year.
    • Growth of ASISA. The ASISA group invoiced 4.9% more in 2023 and reached 1,761 million euros.

Biomedicine

Global Health

International health policy

  • Mexico
    • Health under the new president Claudia Sheinbaum. He will have an opportunity to improve the health of Mexicans, given his great advantage in the elections and the majority in both chambers. Her plan, called a Healthy Republic, plans to improve care by focusing on prevention, modernization and better training of professionals. She also proposes limiting private sector participation in public service. However, it is difficult for this to be achieved without improving health spending (2.9% of GDP), the lowest in the OECD (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01301-1/abstract)

National health policy

Companies

 

 

7 days in healthcare (March 25th-31st, 2024)

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Summary

From the point of view of Biomedicine, it should be noted that possibly the next “boom” will be everything related to anti-aging therapies, an aspect to which the Financial Times dedicates an article, following the appearance of three books on the subject. . The Economist dedicates a lot of space in its latest issue to the issue of AI in healthcare, no less than an editorial and four articles. The conclusion is that AI will have a great impact on healthcare. However, as Eric Topol, the well-known cardiologist and health publicist, comments in another article in the Financial Times, “AI is very transformational, but these things always take longer than you initially think.” Nature magazine analyzes the reasons for optimism about cancer vaccines. Vaccines to treat, not to prevent.

Regarding Global Health, the WHO focuses on the millions of undiagnosed cases of tuberculosis, which compromise efforts to combat this disease. The WHO estimates that in 2023 there will be three million new cases not known to health services. Problems continue between developed and developing countries, which do not agree on the Treaty on the prevention of pandemics, proposed by the WHO as a goal for 2024.

In terms of International Health Policy, the King’s Fund and the Nuffield Trust, two prestigious British think tanks on health, analyze satisfaction with the NHS, which is the lowest in the entire history of this institution. Only 24% of citizens in England, Scotland and Wales are happy with the service, with waiting lists being the most common complaint. In France, the Sorbonne Faculty of Medicine and a former health minister propose “strong measures” to, they say, prevent the degradation of the health system in France. Of the three measures they propose, one of them has to do with the preservation of “medical time” (through non-medical assistants in consultation); and the other with the promotion of advanced practice nursing.

If we talk about National Health Policy (Spain), based on Primary Care analysis that is on the Ministry’s website, it is observed that people treated in primary health centers who earn less than 18,000 euros per year are medicalized more frequently, have prescribed more chronic drugs and consume more pills for pain, anxiety or depression. The Ministry of Health is studying allowing price competition between medicines so that generics can gain market share. This would affect generics and biosimilars, which would be cheaper than brand-name ones and it would be the patient who, if they wanted, would assume the difference. The situation in Spain of the same price for generics as for branded ones is unique in Europe. The objective is to stimulate the development of the generic and biosimilar industry and, ultimately, reduce the pharmaceutical bill for these medicines, in order to allow the incorporation of innovations. If it is carried out, it will be great news. Of note is the agreement signed between the Colleges of Pharmacists of the Basque Country and the Department of Health of that community, with the idea of facilitating the integration of community pharmacies as health agents in the health system. More than interesting is the article published in Human Resources for Health, and whose first signatory is Sara Calderón-Larrañaga, and which analyzes the reasons why primary doctors leave Spain. The work consisted of a survey, focus groups and interviews with 158 primary doctors who had left Spain. The causes of their departure were, in order of importance: insufficient salary, temporary employment, excessive workload, poor governance of primary care, lack of flexibility in the workplace and personal circumstances. There are the keys to a reform of Primary Care.

As for Companies, internationally, a cancer drug (Keytruda, from Merck-MSD), the best-selling drug in the world. In Spain, the historic achievements of Rovi, with a business approach that goes beyond covid. We must also highlight Vithas’ hospital commitment in Barcelona, where construction is underway.

Biomedicine

Global Health

International health policy

National health policy

Companies

7 days in healthcare (August 7th-13th, 2023)

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Summary

From the point of view of Biomedicine, the NEJM insists on the need to prepare doctors for the new era of clinical algorithms, since misuse of these algorithms can be dangerous for patients. MIT advances may make conventional mammograms obsolete, as a “wearable” device can detect breast cancer using ultrasound. New facts are detected in relation to the growth of resistance to antibiotics: a species of virus parasites and air pollution. In any case, the United Nations says that by 2050 these resistances could represent more than 10 million deaths a year. Walking 4,000 steps a day can lower your risk of death from any cause.

As regards Global Health, Chris van Tulleken, famous doctor and TV presenter, is publishing a book on “ultra-processed food”, those whose manufacturing process makes them rich in calories, poor in nutrients and difficult to stop eating them, which poses a major health threat. In the United States, cases of syphilis are increasing, while penicillin to treat them is in short supply, given the low interest in the production of antibiotics by pharmaceutical companies.

Regarding International Health Policy, it should be noted that the WHO monitors the new variant of covid (EG.5), although it classifies its impact on public health as low. In the United Kingdom, a laboratory is created capable of launching new vaccines 100 days after the start of any pandemic. Let us remember that in the case of the covid the term was one year, which already represented a remarkable feat, something never seen before. Also in the United Kingdom, both private equity companies and the CEO of AXA, detect great business opportunities in the face of the great crisis of the National Health Service, something that should not surprise anyone, since the market is characterized by solving unsatisfied problems for what the population is willing to pay. The Nuffield Trust publishes its monthly monitoring of NHS performance, with particular monitoring of test and surgical waiting lists, cancer waiting lists, emergency room waiting times and ambulance response. A laudable initiative, which could well be imitated in our country.

If we talk about National Health Policy (Spain), although the measurement of the covid is not as rigorous as a few months ago, there are indirect indications that the incidence must be rising, as shown in the large increase in the sale of the antigen tests. The Sant Pau hospital begins an ambitious multidisciplinary Robotic Surgery program, which includes five surgical teams. Madrid launches the figure of the administrative assistant in Primary Care, something hopeful, but whose results will have to be seen.

In the field of Companies, internationally, Novo Nordisk and Lilly ready to conquer the promising obesity market. At the national level, anti-obesity drugs also enter our country, although of the three that exist (Ozempic and Wegoby, from Novo Nordisk; and Mounjaro, from Lilly) in Spain, only Ozempic is available and the public system only prescribes it for type 2 diabetes, not for obesity. The consolidation of the nursing home sector accelerates: Colisée, Vitalia, Clariane (formerly Korian), Domus Vi and Vivalto Vie, the most active players.

Biomedicine

Global Health

International Health Policy

National Health Policy

  • Public health innovations
    • Hospital Sant Pau starts a multidisciplinary Robotic Surgery Program that includes five surgical teams. Hepatobiliary and pancreatic surgery (HBP), Bariatric and Esophagogastric, Colon and Rectal, Gynecology and Thoracic Surgery (https://gacetamedica.com/profesion/el-hospital-sant-pau-inicia-un-programa-de-cirugia-robotica-multidisciplinary-that-includes-five-surgical-teams/#:~:text=They are%20five%20the%20surgical%20teams,and%20Thoracic%20Surgery%20(CTO).)
    • Madrid eliminates the bureaucracy of doctors with the figure of the administrative assistant (https://www.redaccionmedica.com/autonomias/madrid/madrid-empieza-a-liberar-de-burocracia-a-sus-medicos-con-una-new-figure-4733)

Companies