Posts

7 days in healthcare (February 12th-18th, 2024)

Summary

From the point of view of Biomedicine, as is known, most rare diseases have no treatment, although this situation will surely be overcome in the not too distant future. A new drug (prozelimab) against the rare Chaple disease. A trial offers hope that a jab could prevent rheumatoid arthritis, the disease that affects 18 million people globally. Chances of a blood protein test warning about the onset of Alzheimer’s disease up to fifteen years in advance. A new powerful antibiotic (cresomycin), hope for antimicrobial resistance, which globally causes about five million deaths a year.

Regarding Global Health, despite the fact that 2021 marked the 100th anniversary of the appearance of insulin, many diabetes patients still do not have access to it. Important article in the New England Journal Medicine about e-cigarettes. There is sufficient evidence to show that switching from cigarettes to e-cigarettes reduces exposure to tobacco toxins, decreases respiratory symptoms, and reverses physiological changes related to cigarette smoking. There is not enough evidence that e-cigarettes are a good method to quit smoking.

In terms of International Health Policy, an unexpected consequence of the ruling of the United States Supreme Court, granting states the possibility of legislating on abortion, what was widely used to prohibit or restrict it: the taking of prescribed abortion pills by telemedicine and received by mail is a safe and effective method, according to a study. The European Commission approves the first gene editing treatment, in this case for beta thalassemia and sickle cell anemia. HERA (Health Emergency Preparedness and Response Authority) launches the Critical Medicines Alliance. It is said that this Alliance will contribute to changing the way medicines are produced and purchased in Europe.

If we talk about National Health Policy (Spain), there is great commotion in the sector as a result of the statements by Vice President Yolanda Díaz that she is negotiating to introduce in the budgets the modification of the health VAT from 0% to 21%. Regardless of the viability of this proposal, could it be considered whether this is the best way to make policy? Any study on the impact on the sector? Any previous negotiations with the health ecosystem? Although the Ministry of Health usually intervenes little in economic matters – remember that all the cuts during the financial crisis were not even discussed in the Interterritorial Council of the National Health System – this is a major issue that well deserves a position. and an analysis by the Ministry of Health. Asturias regulates financial compensation to professionals (442 euros for four hours of surgical activity and half for consultations for doctors) for extension of working hours to address the serious problem of waiting lists. Family doctors report a deficit of 2,600 professionals in the next year. As a consequence of the European Plan against Cancer, the launch of the first nine Comprehensive Cancer Centers in Spain is announced. The project is led in Spain by the Vall d’Hebron Hospital and the National Institute of Oncology.

As for Companies, on an international level, the British consulting firm Clarivate analyzes the 13 disruptive drugs for 2024. Oncology drugs predominate, although there is also the vaccine against respiratory syncytial virus and a new drug against COPD. At the national level, the growth of the egg freezing business in Spain is confirmed. It seems that the HIPRA vaccine is going to end up in the trash. There is nothing special, since failures are inherent to business, especially in an area as difficult as biotechnology. However, some excessively triumphalist government demonstrations could have been avoided.

Biomedicine

Global Health

International health policy

  • United Kingdom and the National Health Service

National health policy

Companies

7 days in healthcare (August 15-21, 2022)

Summary

From the point of view of biomedicine, the first drug is prepared using CRISPR (gene editing) technology. Important publication from The Lancet in the largest effort yet to identify risk factors in relation to cancer. Not surprisingly, however, tobacco and alcohol are the biggest risk factors, particularly tobacco.

As far as Global Health is concerned, polio is back and the UK is now offering vaccinations to children in London between the ages of 1 and 9.

Regarding international health policy, the famous North American Inflation Reduction Act has been signed by President Biden. Despite its name, the law has more to do with climate change and health, especially drug prices. No large growth in monkeypox is predicted, based on modeling carried out by The Economist. Deaths from covid remain high (15,000 a week globally) warns the Director General of the WHO. The Director of the American CDC denounces serious failures in the management of covid and announces substantial changes in the functioning of this body. A clear contrast to what is happening in Spain, where no conclusions seem to be drawn from the management of covid, despite being one of the most affected countries in terms of the number of cases and mortality in relation to the population.

If we talk about national health policy (Spain), the good news are that covid continues to decline, although there are still 62 deaths per day. The approval of the State Center for Public Health, scheduled for next week, is possibly the biggest consequence of covid. The birth rate in Spain falls to historical lows.

In the field of companies, drug prices break historical records in the USA. In Spain, HIPRA is preparing to manufacture 250 million doses of covid vaccines, pending approval by the EMA.

Biomedicine

Global Health

International health policy

National health policy

Companies

 

7 days in healthcare (March 14-20, 2022)

 

SUMMARY

From the point of view of biomedicine, to highlight the new treatment for malaria in children; the new variant “Delatacron”, similar to the “ómicron”; and, the possibilities of artificial intelligence to accelerate the appearance of new medicines. We would like to underline the studies promoted by Valentín Fuster on ultrasound of the neck and groin arteries and their possibilities of detecting the risk of myocardial infarction and stroke to be promising, although it is a topic that has been talked about for a long time without much results.

Regarding Global Health, an interesting editorial in the British Medical Journal, entitled climate change, pandemic and war: an uncontrolled multi-crisis, since it seems that in this decade of the 21st century all the problems have accumulated; the verification that the low level of vaccinations in Africa is not so much due to the low level of vaccines, but rather due to the difficulties of reaching the population; interesting report on Nigeria and the problems of its health system.

In terms of international health policy, the problems of Asia’s “covid zero” strategy are noteworthy, which gave so much political return to the Chinese regime, presenting its low mortality successes and comparing them with the high mortality rates of other countries in the world ( United States, Brazil, United Kingdom, India, etc.). It seems that the “ómicron” variant, due to its contagiousness, is not easily approachable with the “covid zero” strategy, since that would lead to massive confinements in China. Resurgence of covid cases in Europe and Asia, which coincides with a relaxation of control measures.

If we talk about national health policy (Spain), it should be noted that the incidence of covid is growing, while the measures are relaxed, although there is concern in the Ministry of Health about a possible new wave of covid at the gates of Easter. Very important COFARES report on the pharmacy sector, proposing many innovative measures, which contrasts with the usual narcissism and laudatory speeches about the “Mediterranean model of pharmacy”, so liked by some professional representatives. Primary Care is trying to get back to normal, although with a thousand fewer doctors than before the pandemic. The birth rate in Spain is at historic lows, which is a serious problem. The Council of Dentists, in reporting that 34 million Spaniards have cavities, presents us with the reality of poor dental care in our country. A revolution in the use of biosimilars is coming, given the large number of biological medicines that will lose their patent in the coming years.

In the field of companies, it should be noted that Pfizer and BioNTech have requested authorization in the United States for a second “booster” for older Americans. Grifols bets on a vaccine against Alzheimer’s. HIPRA, the veterinary pharmacy company until now, hopes to start marketing its vaccine against covid in June.

BIOMEDICINE

GLOBAL HEALTH

INTERNATIONAL HEALTH POLICY

  • COVID

o The “ómicron” variant is changing China’s “zero covid” strategy, at the moment more than 40 million Chinese are suffering some type of confinement, which is tolerated by the remaining 1.4 billion who lead normal lives. The legitimacy of the party is given by the low mortality. We’ll see if that can be sustained with the “omicron” (https://www.economist.com/china/2022/03/19/omicron-is-changing-chinas-covid-strategy)

o China reports the first deaths from covid in more than a year (https://www.nytimes.com/live/2022/03/18/world/covid-19-mandates-cases-vaccine)

o Shanghai, possible confinement, after the discovery of 150 new cases of covid (https://www.ft.com/content/659a5337-681b-4ef2-a9ac-db9aaaa78cef)

o Concern that new lockdowns in China may disrupt supply chains (https://www.economist.com/finance-and-economics/will-chinas-covid-lockdowns-add-to-strains-on-supply- chains/21808193)

o Resurgence of covid cases in Europe and Asia, infections have risen 8% worldwide, but they are skyrocketing in Vietnam and Germany (https://www.larazon.es/sociedad/20220317/z4bkdrxn2vddtcbvhi5equn45e.html)

  • Other issues

o According to an American study (Health Affairs), hospitals differ in their services depending on whether they are for-profit, non-profit or government-owned, with the former tending to offer more profitable services and discontinue the others (https://www.healthaffairs. org/doi/epdf/10.1377/hlthaff.2021.01115)

NATIONAL HEALTH POLICY (SPAIN)

  • COVID

o Latest report: the incidence of covid rise and 287 deaths, in Friday’s report (since Tuesday) (https://www.consalud.es/pacientes/especial-coronavirus/covid-19-espana-registra-64597 -cases-287-deaths-ia-upload-44580-points_111800_102.html)

o The new plan against covid will put an end to the isolation of positives (https://www.lavanguardia.com/vida/20220319/8136758/nuevo-plan-covid-pondra-aislamientos-positivos.html)

o The Ministry of Health fears the arrival of a new wave of covid at the gates of Holy Week (https://www.elespanol.com/espana/20220314/sanidad-llegada-septima-covid-puertas-semana-santa/656934435_0 .html)

o Paxlovid, the anticovid treatment promised by Sánchez, has not yet reached patients (https://www.elmundo.es/ciencia-y-salud/salud/2022/03/17/623244e021efa054348b458d.html)

  • Other themes

o Spain was left out of the top 10 in public health spending in 2020, according to a report made public by Eurostat and spent an average of 600 euros less per inhabitant than the EU average (https://www.consalud.es/politica/espana- top-10-ue-public-expenditure-health-2020_111467_102.html). To access the Eurostat report: https://ec.europa.eu/eurostat/databrowser/view/GOV_10A_EXP__custom_2243551/bookmark/table?lang=en&bookmarkId=8df11907-86e8-4f5b-a62e-a7d09828e303)

o Important COFARES report: pharmacist skills in the 21st century, proposing digitization, home delivery, legal changes and the sustainability of the pharmacy model (https://www.consalud.es/profesionales/profesionales-analizan- evolution-pharmacy-role-pharmacist_111660_102.html)

o The Ministry of Health and the regions coordinate health care for refugees from Ukraine (https://www.diariofarma.com/2022/03/18/sanidad-y-las-cc-aa-garantizan-la-atencion- health-for-refugees-from-ukraine)

o The Ministry of Health puts the average time to approve a drug at “9 months” (https://www.consalud.es/politica/ministerio-sanidad/sanidad-asegura-la-media-espana-aprobar-medicamento-9- months_111648_102.html)

o The flu enters Spain with force (https://www.lavanguardia.com/vida/20220317/8130742/gripe-fuerza-espana.html)

o Primary Care is trying to get back to normal, with a thousand fewer doctors than before the pandemic (https://elpais.com/sociedad/2022-03-20/la-atencion-primaria-intenta-volver-a-la- normality-with-a-thousand-less-doctors-than-before-the-pandemic.html)

o The birth rate in Spain, at lows not known in several centuries, according to a study by the San Pablo CEU University (https://www.eldebate.com/sociedad/20220315/pandemia-apenas-pasa-factura-natalidad-espana. html)

o A total of 34 million people in Spain have cavities, according to the General Council of Dentists (https://www.actasanitaria.com/politica-y-sociedad/total-34-millones-personas-en-espana-tienen- caries_2001822_102.html)

o The Ombudsman receives 2,300 health complaints in 2021, according to the report presented (https://www.defensordelpueblo.es/informe-anual/informe-anual-2021/)

o La Paz, on October 12 and Gregorio Marañón among the 100 best hospitals in the world, according to the classification prepared by Newsweek magazine (https://www.elmundo.es/madrid/2022/03/14/622e4da7e4d4d894118b45c8.html )

o Incorporating 6,000 doctors in primary care would cost 358 million euros, according to the Collegiate Medical Organization (https://www.elmundo.es/ciencia-y-salud/salud/2022/03/14/622df5e7fc6c83c80d8b4583.html)

o Mariano Esteban’s covid vaccine will not continue the clinical phase in Spain (https://www.diariomedico.com/medicina/enfermedades-infecciosas/empresas/la-vacuna-de-la-covid-de-mariano-esteban -csic-will-not-continue-the-clinical-phase-in-spain.html)

o Spain needs a plan for the second revolution in biosimilars, since one hundred biological drug patents expire between 2024 and 2029 (https://cincodias.elpais.com/cincodias/2022/03/16/companias/1647452966_841014.html)

COMPANIES, EMPLOYERS AND OTHER AGENTS IN THE SECTOR

  • International News

o Moderna supplies 70 million additional doses of its vaccine to Japan (https://www.plantadoce.com/empresa/moderna-suministra-70-millones-de-dosis-addicionales-de-su-vacuna-anti-covid- 19-a-japan.html)

o Pfizer and BioNTech request authorization for a second “booster” for older Americans (https://www.nytimes.com/2022/03/15/us/politics/pfizer-second-booster-shot-older-americans.html )

o AstraZeneca, prepared not to continue with the efforts to obtain authorization in the USA for the covid vaccine (https://www.ft.com/content/e1edb2b2-0e12-4c83-9257-eeeb2ba29267)

  • National News

o Grifols bets on the Alzheimer’s vaccine and ends phase II of clinical trials (https://www.plantadoce.com/empresa/grifols-apuesta-por-la-vacuna-contra-el-alzheimer-finaliza-la- phase-ii-trials-of-abvac40.html)

o The Danish A.P. Moller Holding completes the purchase of Unilabs (https://www.plantadoce.com/empresa/la-danesa-ap-moller-holding-completa-la-compra-de-unilabs.html)

o The founders of Rovi sell 5% after the success of the Moderna vaccine (https://www.europapress.es/economia/noticia-fundadores-laboratorios-rovi-venden-capital-empresa-1808-millones-20220315082314.html )

o Hipra hopes to market its covid vaccine in June (https://www.businessinsider.es/vacuna-hipra-covid-comercializar-junio-primera-espanola-1029741)

 

 

“Virtual-first” Primary Care

 

 

 

“Virtual-First” Primary Care

A revolution among American insurers

JAMA magazine has just published (see PDF) an article on the growing phenomenon of “Virtual First” Primary Care.

It all arises when in October 2021, the United Health group announced that it was going to offer a cheaper premium with a “virtual-first primary care” plan in which subscribers would receive longitudinal care by a virtual doctor for most of their primary care needs. This announcement follows similar initiatives from other large insurers such as Humana, Aetna, and many regional plans last year. Doctor on Demand, a telecare company supports many of these plans and announced that it is in the process of recruiting more than 1,000 doctors. Firefly Health, another telemedicine company, decided to launch its own insurance plan.

This growing phenomenon follows the rise of telemedicine during the pandemic and the fact that this practice has been achieving more and more comfort among patients and doctors.

Conceptually, this “virtual-first primary care” phenomenon means that patients will use the virtual channel as the first option to obtain service.

There are several variants, such as that of MDLive, in which the doctor or other virtual professional complements the activity of the doctor who is seen in person. But patients are encouraged to use their virtual doctor, whatever the problem they have, and the expectation is that this will be used more and more frequently.

The shift towards virtual care models arises from the difficulties of maintaining face-to-face activity in chronic diseases, which require almost continuous monitoring.

Possible concerns

Despite all its advantages, virtual care in primary care raises a number of questions. The first, that although many health problems can be solved by telemedicine, the question arises as to what portion of primary care can be solved without problems in a virtual way, without personal interaction and a physical examination. The second problem is how virtual models coexist with traditional primary doctors, if there is not a very adequate coordination between them.

A robust evaluation is needed to determine if these models deliver on the promise of better chronic disease management, fewer avoidable emergency room visits, and better referrals. There are no minor issues of analyzing patient satisfaction, or the responsibility of doctors when they offer their assistance virtually.

The future will tell us

Logically, it remains to be seen if this form of care substantially attracts patients to be viable in the long term, but we are inclined to think that a wise combination of face-to-face care-virtual care, with a good protocolization of in which cases virtual care is recommended and in which cases direct care is required can be the key to success.

An opportunity also for Spanish insurers

The operation of Spanish insurers is through an endless list of specialists who are accessed directly. There is, in practice, no primary care as such. This is one of the problems for Spanish insurers and a great challenge if they want to continue advancing in cost and quality control. This is an opportunity to set up primary care, without the need for a large investment or the creation of a new network. Success may be for Spanish insurers to reproduce an experience similar to “virtual-first primary care”, without breaking direct access to the specialist, one of the great attractions of the model.

The pressing issues for the Spanish Healthcare system in 2019

 

The Executive Summary of the document:

Executive Summary English

The sixth, and so far the last edition of the series on hot topics in Spanish health, was carried out with the collaboration of the Círculo de Empresarios.

The topics analyzed that year were:

  1. The patient experience, beyond satisfaction surveys.
  2. Companies: important agents of change and renewal in the sector.
  3. Private healthcare, a booming sector, which is here to stay.
  4. Reforms from the government or from the sector?
  5. Overcoming the consequences of the crisis: addressing the obsolescence of equipment, a problem not only of money.
  6. Is there a lack of doctors in Spain?
  7. High-cost innovative therapies, how to introduce them with the sustainability of the system in mind?
  8. Primary Care, is it really assumed that it is the axis of the National Health System?
  9. The “new entrants” in healthcare, a threat or an opportunity for traditional players?
  10. How to overcome the barriers to change projects?