Posts

7 days in healthcare (March 18th-24th, 2024)

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Summary

From the point of view of Biomedicine, the transplant to a man of a genetically modified pig kidney stands out, a medical milestone that could lead to dialysis being declared obsolete, which would be an extraordinary advance and an improvement in the quality of life for hundreds of thousands of patients, currently dependent on the machine several times a week for their survival. Also notable is the beginning of a clinical trial on a vaccine for tuberculosis. The current BCG vaccine offers protection to infants and young children, but does not protect adults and adolescents from pulmonary tuberculosis. If the results are good, this vaccine can be transformative.

As far as Global Health is concerned, a study warns of serious declines in birth rates globally, which will mean that by 2050 it will fall below population replacement, which will have important social and labor changes.

Regarding International Health Policy, a great paradox in the USA, although abortion is prohibited in 14 states and restricted in many others, in 2023 there were more abortions than ever, many of them non-instrumental and through the abortion pill, already responsible of 60% of abortions. China is facing a population decline, a phenomenon that has already begun. The one-child policy, in force for 36 years, is only one of the causes of this phenomenon. The European Union is advancing in the approval of pharmaceutical legislation, contemplated with reluctance by both the EFPIA and Medicines for Europe (the two large European pharmaceutical associations). The Lancet sees the upcoming European elections as an opportunity to put health policy higher on the EU agenda.

If we talk about National Health Policy (Spain), three important initiatives of the Ministry of Health: anti-smoking plan, modification of the medical guard regime and waiting lists. In all three cases there may be problems due to the powers and regulations of the autonomous communities. From the point of view of the regions, the OPE of Asturias stands out, which brings together 19,000 candidates. Although logically, temporality was and is a serious problem of public healthcare, which needed a solution, the way to do it through macro-OPE’s (consolidating the position in property, and with hegemony of the administrative and union logic, above the professional and autonomy of organizations) does not seem to be the best. This type of mass examination is more reminiscent of previous calls for the “military service”, when it was in force, than the professional selection for complex organizations, in which the professional qualification, the needs of the different organizations, the projects of the services, etc. should be taken into account.

As for Companies, on an international level, China is seen as the large market for anti-obesity drugs. Bayer wants to renew its portfolio, entering into cell and genetic therapies. As for Spain, the CNMV has released its report on Grifols, with several objections to its accounts. Faes Farma is preparing to grow in Latin America. For its part, DKV, the health insurer, wants to concentrate on group insurance.

Biomedicine

Global Health

International health policy

National health policy

Companies

7 days in healthcare (November 6th-12th, 2023)

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Summary

From the point of view of Biomedicine, Victor R. Fuchs, a pioneer of health economics and possibly the most recognized and prestigious health economist in the world, dies. He always defended universal health coverage for the United States, although he was very aware of the difficulties of its implementation, due, among other circumstances that he explained, to the heterogeneity of American society. And it must be said that he was not wrong in that. The FDA has just approved an oral drug based on the intestinal microbiome, a new horizon in medicine.

As far as Global Health is concerned, although tuberculosis is preventable and treatable, it continues to be the infectious disease with the most mortality globally, after a short period of time in which it was covid. But 40% of the world’s population with tuberculosis is not treated.

In terms of International Health Policy, it seems that the covid pandemic did not damage developed economies as much as initially thought. This seems to be deduced from studies of initials from the United Kingdom and Italy. The EFPIA, the pharmaceutical industry’s association, continues to complain that the new European legislation could end incentives for innovation and put Europe in an even worse relative position than the one it already has with respect to the USA and China. The OECD has just published “Health at a Glance 2023”, a must-read.

If we talk about National Health Policy (Spain), the agreements of the PSOE and Junts (and also those signed with the PNV for the Basque Country and with the BNG for Galicia) contemplate the transfer of powers over the MIR (and in the case of the Basque Country also of the issuance of titles). Some say that constitutional values and democratic principles have been subordinated in the investiture agreements. Obviously, this does not happen with the MIR, but an important value is put at risk: the cohesion of the National Health System, based, among other issues, on the uniformity of the training system and recognition of titles and specialties, being , on the other hand, a highly recognized system. 11 public hospitals appear to be starting a lung cancer screening program. Since this procedure is not recognized in the SNS service portfolio, the innocent question is: who pays for this? Or is it simply a pilot program with special funding? The Community of Madrid proposes a modification of the current Law of Good Government, which required the appointment of managers of health centers by competition and which at the time was approved by broad consensus, to another system that allows the direct appointment of these positions by part of the SERMAS Board of Directors.

In relation to Companies, at the international level, the battle between pharmaceutical companies in relation to obesity continues (the main players are NovoNordisk, Lilly and AstraZeneca). Amazon is relaunching in health, providing health services through One Medical to its premium customers. At the national level, great growth in the 22nd year of dental, ophthalmological and aesthetic clinics. The purchase of the Eugin assisted reproduction clinics from Fresenius by KKR and GED is completed. The latter retains the business in Spain, while KKR will integrate the international business into IVI RMA.

Biomedicine

Global Health

International health policy

  • United Kingdom and the National Health Service
  • OECD
    • The OECD publishes “Health at a glance 2023”. Main conclusions: healthcare systems are under severe financial pressure; there has been no complete recovery after covid; unhealthy lifestyles cause millions of deaths; Access barriers persist, despite universal coverage in most OECD countries; the quality of care is improving; digital health has immense potential (https://www.oecd.org/health/health-at-a-glance/)

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 (May 8th-14th, 2023(

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Summary

From the point of view of Biomedicine, it is worth pointing out the expanded “pan-genomic” base, which significantly increases the letters of the DNA, which, apparently, will make it possible to improve the typing and treatment of certain diseases. Promising results of mRNA technology in pancreatic cancer. Potential of stool transplants against some bacteria not sensitive to antibiotics.

As far as Global Health is concerned, although covid is no longer a global emergency, the truth is that, as the WHO itself shows, the disease continues to kill and change.

Regarding International Health Policy, it is worth highlighting the great news coming from the British government, which will allow pharmacies to prescribe certain medications, as well as the contraceptive pill. The objective of the measure is to significantly reduce the number of visits to the primary doctor. In France, patients, faced with overloaded doctors, turn to self-medication. Euthanasia is already legal in Portugal. Great battle in Chile between the Boric government and the Isapres (Chilean health insurers). In a bill, the government, in order to respond to an erga omnes ruling (of universal application) of the Courts, proposes the payment by insurers of alleged amounts for overpayments, which would make the model unfeasible. The Association of Isapres has reacted with a harsh note, answered no less harshly by government spokesmen. Health and specifically the role of the Isapres, at the center of the political debate in Chile.

If we talk about National Health Policy (Spain), the most important news is the proposals by various medical associations (IMAS Foundation, FACME, General Council of Medical Associations) for a decalogue of proposals to reform the SNS, which they consider in total crisis, before the next legislature. New governance; new management model; citizen/patient and professional participation; measurement of results and transparency; new care model; digital transformation according to the citizen’s digital clinical history model, are some of the most important measures. We only have to congratulate those responsible for this initiative, which contrasts so much with the limited and timid proposals put forward by the majority political parties. To those parties (PSOE and PP) the proposals were raised in a meeting. The only possible consideration is whether a reform of the public system is possible without mentioning a limited and selective co-payment, the absence of which we are the exception in Europe, as well as the non-consideration of the private sector in that reform. Looking the other way from the private sector has never produced good results. On the other hand, the document emphasizes its proposal for changes in the management and care model, governance, the participation of citizens/patients and professionals, and transparency. But he doesn’t mention financing at all. Although financing as an isolated reform (which is very common to consider) would not solve much, this issue has specific problems. Having made these qualifications, as a whole it is a splendid document, a must-read. The Constitutional Court publishes the ruling declaring the 2010 law on abortion deadlines legal. A study in Catalonia shows that the rich wait less on the lists of Catalan public hospitals than the rest of the population, something that had already been demonstrated in the UK on the NHS. The CEOE-union agreement includes the control of sick leave by Mutual Societies, something whose real scope will have to wait to see its effects. The truth is that absenteeism had increased a lot in recent times.

In the field of Companies, at the international level, drugs for weight loss point to an area of great economic interest for the pharmaceutical industry. In Spain, the most striking thing is Fresenius’s intention to get rid of the part of Quirón in Latin America, as well as the fertility company Eugin. Mutua Madrileña and El Corte Inglés launch medical insurance under the Adeslas brand.

Biomedicine

Global Health

International Health Policy

  • Chili
    • The Boric government against the Isapres (private health insurance companies in Chile). In a bill, the government, in order to respond to an erga omnes ruling (of universal application) of the Courts, proposes the payment by insurers of alleged amounts for overpayments, which would make the model unfeasible. Hard note from the Association of Isapres, which has obtained a no less harsh response from the Government. (http://www.isapre.cl/images/PDF/Declaracion_Prensa_19_abril_VFdocx_1.pdf)

National health policy

Companies

 

 

7 days in healthcare (March 21-27, 2022)

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SUMMARY

From the point of view of biomedicine, the progress in the treatment of breast cancer should be highlighted, according to the article published by the NEJM, with a brake of around 80% of this advanced cancer and makes it disappear in 16%. .

As far as Global Health is concerned, there are undiagnosed cases of tuberculosis (the missing tuberculosis), a disease that continues to have 10 million new cases a year and causes 1.5 million deaths. The Lancet report on what needs to be done to meet target 3.4 of (on non-communicable diseases) of the Sustainable Development Goals. Inequality in covid vaccination and its possible ways to solve it are the subject of an analysis by the NEJM. Concern for the health of the 3.5 million refugees from Ukraine. The low mortality of covid in Africa, a continent that was thought could be devastated by this disease, remains a mystery.

As for international health policy, the debate continues on the covid-zero policy in China, which has achieved great results so far (both in terms of mortality and economics), but it is not known if it will be able to continue with the variant “omicron”. The WHO judges the lifting of COVID measures in Europe too premature, considering that cases are growing, among other countries, in the United Kingdom, Ireland, Greece, France, Italy and Germany.

If we talk about national health policy (Spain), we are witnessing a relaxation of the measures against covid, despite its upward trend in recent days. Arrival of Paxlovid, Pfizer’s treatment for severe cases of covid. The important report published by the Catalan Society of Health Management, with an exceptional team led by Jordi Varela, on the forms of contracting health services from the point of view of value, is very noteworthy. The deans of Medicine react to the Ministry’s announcement of the increase in the “numerus clausus” in medicine by 10%.

In the field of companies, it is worth highlighting the evolution of the purchase of the fertility company IVI, the largest operation carried out by private equity companies in healthcare in Spain and with a company valuation of around 2,500 million euros.

BIOMEDICINE

GLOBAL HEALTH

INTERNATIONAL HEALTH POLICY

NATIONAL HEALTH POLICY (SPAIN)

COMPANIES, EMPLOYERS AND OTHER AGENTS IN THE SECTOR