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 (April 17th-23rd, 2023)

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Summary

From the point of view of Biomedicine, this week, exceptionally, two important advances in Spain are mentioned. On the one hand, the important investigations of the team led by Dr. Obeso, at HM Hospitales, on how to “open” the blood-brain barrier, that barrier that, among other things, prevented the arrival of drugs to the brain. It seems that in this way possibilities could be opened for the treatment of Parkinson’s. On the other hand, at the Vall d’Hebrón Hospital in Barcelona, the first robotic lung transplant was approached through a small incision.

As far as Global Health is concerned, there is a great alarm, highlighted by UNICEF and The Lancet magazine, about the drop in immunizations in children after the covid. Although the covid highlighted the efficacy of the vaccines, it brought the side effect of this drop in immunizations globally. In Uganda, the new anti-homosexuality law takes repression against this sexual option to an extreme, endangering anti-HIV campaigns in that country. The G7, to be held in Japan in May, emphasizes various health issues, including the importance of universal health coverage and the need for resilient health systems.

Regarding International Health Policy, the WHO warns of the non-solution of the covid problem, since in the last 28 days there were 23,000 deaths and 3 million new cases globally, even with reduced test figures. High mortality in the USA, with around 245 deaths per day. In the United States, the government is preparing to finalize the guidelines for negotiating the price of drugs in Medicare in July, something totally new in that country and that is shocking the pharmaceutical industry. The American Supreme Court rectifies its previous decisions and allows the abortion pill mifepristone to continue to be used, amid abundant criticism of the Court, for having questioned something that the FDA had already authorized more than 20 years ago. According to The Economist, the annulment of the Roe v Wade ruling caused the number of abortions in the USA to drop by 6%. In the United Kingdom, the consequences in the NHS of the multiple and continuous strikes and conflicts of health personnel continue. The German government is clashing with other European governments in its efforts to reduce the timeframe for generics to appear, calling into question the pharmaceutical investment model, according to some.

If we talk about National Health Policy (Spain), the incidence of covid continues to rise, amid controversies about the advisability or not of suppressing masks where they are still mandatory (health centers, social health centers and pharmacies). Conflicts with health personnel continue in several autonomous communities. In public healthcare, quite important allocation of resources by the Ministry to primary care and mental health. In private health, in the first quarter of the year there was a growth of 7.5% in the policies of private health insurers. “Voting with your feet” is called that figure. The IDIS Foundation focuses, through an interesting publication, on an important problem: the mental health situation in our country. Since we have few problems, Catalonia insists on an artificial conflict: the use of Catalan in the healthcare system in that autonomous community. Both in Aragon and in Castilla-La Mancha, two initiatives of dubious utility and even suspected of electoralism are launched. In Aragon, a national debate on health is proposed through a very typical document of those that come out in the autonomous communities that could be summarized as “More money for health without reforms.” As for Castilla-La Mancha, a law on waiting lists is promoted, when the terminal state of the legislature suggests that it will not be approved.

In the field of Companies, internationally, Nestlé is accused of manufacturing unhealthy products, due to their high load of fat, sugar and salt. Merck makes a major investment buying Prometheus Biosciences for $11 billion. At the national level, Moderna opens a laboratory in Madrid.

Biomedicine

Global Health

International Health Policy

National health policy

Companies

7 days in healthcare (March 7-13, 2022)

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SUMMARY

From the point of view of Biomedicine, the Lancet report on risk factors in COPD (chronic obstructive pulmonary disease), one of the great burdens of all health systems, should be highlighted. Also the finding that COVID can cause brain damage, although its scope is yet to be determined.

As for Global Health, it is worth noting the WHO complaint that 16 health facilities have been attacked in the war in Ukraine, as well as the organization’s statement that women should have access to safe abortions, to avoid mortality as well as hospitalizations due to complications.

When it comes to international health policy, the advice for the next pandemic contained in a major editorial in the Financial Times is important. There would be three priorities: 1. Reduce the risk of the appearance of a new pathogen (controlling the markets where animals are sold, for example); 2. Prevent it from spreading throughout the world; and 3. Develop an effective weaponry with vaccines and treatments as soon as possible. The incidence of COVID is increasing in England and France, just as the outbreak in China is the largest since the initial one in Wuhan. A report by The Lancet analyzes the mortality from COVID by country and even (as in the case of Spain) by region in the different countries. Spain is among the nations with the highest mortality from COVID per number of inhabitants. In the United Kingdom, a conservative think tank, with the support of the British Secretary of Health, proposes that primary care physicians become primarily salaried, thus breaking one of the fundamental elements of the political pact that gave rise to the NHS (on the one hand, hospitals are nationalized, but, on the other, the consideration of primary care physicians as independent mini-entrepreneurs is respected).

In national health policy, it is found that the drop in the incidence of COVID stagnates in Spain. Private healthcare, through the IDIS Foundation, considers the interoperability of the clinical history of private healthcare patients, regardless of insurer or provider.

Of the activity of the companies, an analysis of the Financial Times comments on how the economy of the pharmaceutical companies works against the development of antibiotics. Europe has lost the race against the United States in the development of new drugs. Important publication of the Roche Institute of a manual on personalized medicine aimed at health professionals.

BIOMEDICINE

GLOBAL HEALTH

INTERNATIONAL HEALTH POLICY

  • COVID

o Lessons for the next pandemic, after two years of covid, an important Financial Times editorial. Three priorities: 1. Reduce the risk of emergence of a new pathogen; 2. Prevent it from spreading throughout the world; and 3. Develop an effective weaponry with vaccines and treatments as soon as possible (https://www.ft.com/content/c9640c9c-5a65-49fa-a8b2-c22cc1ffe508)

o The COVID pandemic has lasted two years. Next steps may be divisive (https://www.nytimes.com/2022/03/12/us/covid-pandemic-vaccines-mandates.html)

o The covid does not decrease, but increases, in France (https://www.lemonde.fr/planete/article/2022/03/11/covid-19-olivier-veran-alerte-au-sujet-d-un -rebond-de-l-epidemie_6117120_3244.html)

o Covid cases and hospitalizations on the rise in England (https://www.theguardian.com/world/2022/mar/11/covid-cases-england-omicron-levels-ons-data)

o China, fighting the largest outbreak since Wuhan (https://www.ft.com/content/1e7dab0d-3247-4cb7-8370-e1697d70d693)

o Chinese scientists, in search of an alternative to the “zero COVID” policy, which the Chinese government boasts so much about (https://www.economist.com/china/2022/03/10/chinas-scientists-are-looking-for-a-way-out-of-the-zero-covid-policy)

o Where did the 5 “Trillion” (American) dollars of Covid stimulus go(https://www.nytimes.com/interactive/2022/03/11/us/how-covid-stimulus-money-was-spent.html)

o Mortality from COVID, three times higher than official figures (https://www.theguardian.com/world/2022/mar/10/global-covid-19-death-toll-may-be-three-times-higher-than-official-figures), according to a major report by The Lancet (http://www.thelancet-press.com/embargo/COVIDexcessmortality.pdf)

o Austria suspends the first universal vaccination obligation (https://www.ft.com/content/65650cbe-10b0-4350-8eb5-691624be8c2d)

  • Other topics

o The pandemic has accelerated the demand for private healthcare services in the UK (https://www.bmj.com/content/376/bmj.o566)

o The NHS app should be the new ‘gateway’ to the NHS, says UK health secretary (https://www.bmj.com/content/376/bmj.o621)

o British primary care physicians should be primarily salaried (https://www.bmj.com/content/376/bmj.o594), says a report by a conservative think tank (https://policyexchange.org.uk/publication/at-your-service/)

NATIONAL HEALTH POLICY (SPAIN)

  • COVID

o The drop in infections stagnates in Spain, with the incidence still at high risk, with 430.1 cases per 100,000 inhabitants, far from 50 (https://elpais.com/sociedad/2022-03-12/la-caida-de-contagios-de-covid-se-estanca-en-espana-con-la-incidencia-aun-en-riesgo-alto.html)

o Sánchez announces that the mandatory indoor mask will soon be abolished (https://www.rtve.es/noticias/20220306/sanchez-anuncia-pronto-se-supulsara-mascarilla-obligatoria-interiores/2303441.shtml)

o Spain destroys more than a million vaccines against covid, most of them from Janssen and AstraZeneca (https://www.elespanol.com/espana/politica/20220306/espana-destruye-vacunas-covid-19-mayoria-janssen-astrazeneca/654184713_0.html)

  • Political announcements

o Congress backs the proposal of the political party Ciudadanos for a law on ALS (https://www.larazon.es/sociedad/20220308/pvwdajf2yrgljceanzw4qgsr6a.html)

  • Other themes

o The Valencian health system carries out almost 600 sex change interventions in five years (https://www.eldiario.es/comunitat-valenciana/sanidad-valenciana-realiza-600-intervenciones-quirurgicas-cambio-sexo-cinco-anos_1_8822169.html)

o 9,932 candidates will be able to choose a MIR position (https://www.diariomedico.com/medicina/medico-joven/mir/9932-candidatos-podran-elegir-plaza-mir.html)

o The IDIS calls for more accessibility in Oncology (https://www.redaccionmedica.com/secciones/privada/el-idis-pide-un-modelo-de-organizacion-en-oncologia-accesible-y-equitativo-7382)

o Change in the General Directorate of Farmaindustria (https://cincodias.elpais.com/cincodias/2022/03/09/companias/1646826907_604545.html)

o The Royal National Academy of Medicine joins the European Academies of Medicine with a declaration on Ukraine (https://www.ranm.es/noticias/4799-declaracion-de-la-ranme-sobre-la-situacion-en-ucrania.html)

o Private healthcare invests 1.3 million euros to give private healthcare patients access to digital medical records in 2023 (https://www.elespanol.com/invertia/observatorios/sanidad/20220310/sanidad-privada-invierte-millones-pacientes-historia-clinica/656184536_0.html)

COMPANIES, EMPLOYERS AND OTHER AGENTS IN THE SECTOR

  • International News

o The Sacklers will pay $6 billion for Purdue’s opiate lawsuits (https://www.consalud.es/ecsalud/internacional/sacklers-pagaran-6000-millones-demandas-opiaceos-purdue_111017_102.html)

o Kirin goes beyond beer and goes into healthcare (https://www.ft.com/content/1d99a0be-6e76-4327-8516-da549a5f767e)

o How Pharmaceutical Economics Holds Back Antibiotic Development (https://www.ft.com/content/29292a3c-321d-4187-9ff0-59d70eb796f4)

o Europe loses the battle against the USA and only develops 22% of new medicines (https://cincodias.elpais.com/cincodias/2022/03/07/companias/1646677340_160102.html)

o Sanofi acknowledges that they were late for the covid vaccine (https://www.elmundo.es/ciencia-y-salud/salud/2022/03/13/6229d430fc6c832c328b4584.html)

  • National News

o Korian: 60 new beds and more purchases to bill one hundred million euros in Spain (https://www.plantadoce.com/empresa/korian-60-nuevas-camas-y-mas-compras-para-facturar-cien-millones-de-euros-en-espana.html)

o Europe asks HIPRA to expand its clinical trial of the covid vaccine (https://cincodias.elpais.com/cincodias/2022/03/07/companias/1646677340_160102.html)

o The Roche Institute publishes a personalized medicine manual for healthcare professionals (https://www.institutoroche.es/recursos/publicaciones/201/Propuesta_de_competencias_en_Medicina_Personalizada_de_Precision_de_los_profesionales_sanitarios)