Posts

7 days in healthcare (June, 10th-16th, 2024)

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Summary

Biomedicine

  • 40 years after the discovery of Helicobacter pylorii. The discovery of Helicobacter pylorii 40 years ago revolutionized the treatment of gastritis, peptic ulcer and stomach cancer, leading to Barry Marshall and Robin Warren being awarded the Nobel Prize in Medicine in 2005. This discovery transformed an incurable disease into one treatable with antibiotics. However, Helicobacter pylorii has a global prevalence of 35% among children and adolescents, especially in poor countries. This requires strengthening essential measures to reduce infection, such as hygiene education, water treatment and other health measures.
  • The Lancet Editorial: Taking persistent physical symptoms seriously. These complex symptoms are incorrectly treated by health systems. Recognizing that they were misguided by the traditional biomedical model, in 1977 the biopsychosocial model was proposed, which has been criticized. Now a new model is proposed, as a starting point for a correct approach to this problem.
  • The future of academic medicine. Academic medicine is in crisis globally, as demonstrated by commercial pressures and useless research and publications, which consume a lot of money. However, academic medicine is basic and science is the basis of medical practice and medical education. Evidence-based medicine, including research and practice, is the core element of academic medicine. The British Medical Journal launches a new global commission on the future of academic medicine.

Global Health

  • Hopes for a pandemic treaty, despite the failure to meet the deadline. Along with the extension of the Pandemic Treaty deadline to 2025, an important partial agreement was reached: the review of rules to prevent the global spread of some infections. Even in the global Treaty, much progress was made, which allows for a certain optimism.
  • Vaccine manufacturing is promoted in Africa. The African Vaccine Manufacturing Accelerator (AVMA), a new $1 billion+ initiative, an innovative financing mechanism designed by GAVI, offers African producers financial incentives to produce vaccines. The initiative will be launched at a high-level event in Paris.
  • 10 years after the 2014-2016 Ebola epidemic in Africa. The crisis initially affected Guinea, Liberia and Sierra Leone and it took months to identify the cause and almost three years to contain it, after claiming thousands of lives. The epidemic revealed weak health systems, poor detection mechanisms and inadequate response. Since then, work has been done on preparation for these risks, response mechanisms and international collaboration.

International health policy

  • Forecasts for 2023-32 healthcare expenditures in the United States. Healthcare spending is projected to grow faster than GDP growth over the next decade, reaching 19.7% of GDP in 2032 (from 17.3% in 2022). This indicates a large increase in the use of health services, linked to an increase in coverage that is estimated at 93.1% this year.
  • The King’s Fund summarizes the manifestos of the different parties (Labour, Conservative and Liberal-Democratic) on health ahead of the elections. The different proposals are analyzed in relation to: social care reform; access to hospitals; access to primary care and community services; access to dental care; additional funding commitments; investments in capital and buildings; social care funding; training and selection of personnel; support to social services personnel; international recruitment and migration; prevention, inequities and public health; mental health, learning disabilities and autism; cancer; maternity and women’s health services; medicines, research and life sciences; digital transformation and technology; and, other proposals.
  • “Aid in dying” in France. With the dissolution of the National Assembly, the “aid in dying” law is delayed indefinitely. With the call for elections, a very advanced legislative process declines, preceded by a great national debate with the personal intervention of President Macron.
  • Advanced practice nursing in Belgium. A Royal Decree establishes the functions of advanced practice nursing, in an attempt to define different profiles of nurses and make the profession more attractive. Maybe a good lesson for Spain.
  • Four industries responsible for 2.7 million deaths in Europe each year (7,400 per day): tobacco, alcohol, ultra-processed foods and fossil fuels.

National Health Policy (Spain)

  • Public Management and Integrity Law. Competence doubts complicate the processing of this Law, which is surely good news, given the government’s intentions.
  • Approved the law creating the Andalusian Health Institute. This is a new entity that brings together the Andalusian School of Public Health (EASP), the Progreso y Salud Foundation, as well as the General Secretariat of Public Health and R&D&I of the Ministry of Health, and will take the legal form of an agency. administrative and will have the nature of a public research organization. The headquarters will be in Seville, in the Ministry. Although we do not know the effects that this reform will have, the PP’s history in Andalusia of making public health companies disappear does not allow us to conceive much hope, on the contrary.
  • Adeslas threatens to leave MUFACE if conditions do not improve. Given that Adeslas does not usually make statements lightly, it must be considered that there is a real risk of the system disappearing.
  • Controversy over waiting for medications. Spain increases the wait for medicines, but improves availability, according to the WAIT report, prepared by the consulting firm IQVIA for the European Federation of Pharmaceutical Industries. The report says that in two years Spain has gone from 53% to 62% availability (compared to 88% in Germany or 77% in Italy), but the waiting time has gone from 629 to 661 days, almost two years of delay. On the other hand, César Hernández, general director of the Common Portfolio of the SNS and Pharmacy, criticizes the report and says that we are the country with the most access. The report does not take into account access through the mechanism provided for in RD 1015/2009, as well as medicines that arrive through clinical trials. Although the situation of access to medicines can surely be improved – and not only by the Ministry, but also by the intervention of the autonomous communities and hospitals – it does not seem that this issue is one of the most serious problems of the system, compared to what some they proclaim.
  • Public Health Agency. The Health Commission of June 19 will not address the State Public Health Agency, which will not be analyzed by this Commission until after the summer. This is interpreted as another milestone in the long history of delays of this initiative.
  • Center for Minority Diseases in Barcelona. Agreement between the Sant Joan de Deu Hospital and the Amancio Ortega Foundation for the launch of this center that will have financing of 60 million euros and will have a space of 14,000 square meters in a six-story building. With various genomics, metabolomics and radiomics platforms. The center will be part of the Red Única, a network made up of 30 hospitals throughout Spain and promoted by the Sant Joan de Deu Hospital and the Spanish Federation of Rare Diseases. Another great success for the Sant Joan de Deu Hospital, which many of us are already accustomed to.

Companies

  • International
    • Approved a new drug against Alzheimer’s. FDA panel approves Lilly’s Alzheimer’s drug. The modest benefits of Lilly’s drug donanemab outweigh the risks, the panel unanimously concludes.
  • National
    • Ribera incorporates the Covadonga Hospital in Gijón, with this incorporation there will now be six Spanish communities in which Ribera is present (Valencian Community, Murcia, Madrid, Galicia, Extremadura and Asturias).
    • Terafront Pharmatech, the Spanish semi-public pharmaceutical company, will have its own factory. Terafront will manufacture its own therapies and has chosen to build its own facilities, compared to other options being considered.

Biomedicine

Global Health

International health policy

National health policy

  • CSIC Biomedicine Strategic Plan
    • The CSIC presents its Strategic plan in Biomedicine. This plan is based on 10 strategic axes, among which are: strengthening internal communication and collaboration between researchers; create new collaborative structures with companies, hospitals and universities; increase the presence of the CSIC in key international organizations; improve knowledge transfer to industry and the health sector; attract or retain young talent: Key actions: the creation of a Rare Diseases Network; the creation of a OneHealth Bassoon Library; the creation of the Biomed Transfer Services Network (https://www.consalud.es/saludigital/innovacion-tecnologica/csic-presenta-plan-estrategico-biomedicina-liderar-innovacion-en-salud_144755_102.html)
  • Center for minority diseases in Barcelona
    • Agreement between the Sant Joan de Deu Hospital and the Amancio Ortega Foundation for the launch of this center that will have financing of 60 million euros and will have a space of 14,000 square meters in a six-story building. With various genomics, metabolomics and radiomics platforms. The center will be part of the Red Única, a network made up of 30 hospitals throughout Spain and promoted by the Sant Joan de Deu Hospital and the Spanish Federation of Rare Diseases (https://www.diariomedico.com/medicina/investigacion/primer-step-creation-pioneer-center-minority-diseases.html)

Companies

7 days in healthcare (February 26th-Mars 3rd, 2024)

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Summary

From the point of view of Biomedicine, certain advances stand out in the search for a treatment for multiple sclerosis, a disease that affects 1.8 million globally and for which at this time there is no effective therapy. As announced by the president of the Spanish Society of Nephrology, the new drugs will allow many cases of dialysis and transplant to be avoided.

As far as Global Health is concerned, the most worrying thing is the poor perspectives observed regarding the pandemic treaty, the objective that the WHO had proposed for 2024. The obstacles are the accumulation of vaccines and the sharing of knowledge about them, problems of rich countries and companies, respectively. The Lancet warns about the need to strengthen cervical cancer screening, which continues to cause hundreds of thousands of deaths a year, especially in low- and middle-income countries. Warning about ultra-processed foods (cereals, protein bars, soft drinks, and fast food) linked to 32 harmful health effects, including increased risk of vascular disease, cancer, type 2 diabetes, mental illness and premature death.

In terms of International Health Policy, a very serious problem with fentanyl in the United States, which in the last twelve months until September 23 had caused 105,000 deaths in that country. Until now, the policy was aimed primarily at preventing the entry of drugs; some extremist politicians had even proposed invading Mexico to put an end to the gangs. With the current Administration, efforts are directed more towards discouraging its use and treating addicts. Big problem for Republicans in the USA with the decision of the Alabama Supreme Court to declare frozen embryos as “extra-uterine children”, with all the obstacle that this has for the popular procedure of in vitro fertilization, so widespread in the United States as in other developed countries. This Alabama decision seems like a gift to Democrats: “First it was abortion, now it is in vitro fertilization and then it will be birth control,” warned Hillary Clinton. Even Trump was forced to distance himself from this decision. In France, the National Assembly is putting pressure on the pharmaceutical industry regarding the shortage of medicines, forcing laboratories to have a four-month reserve of “medicines of high therapeutic interest.” In order to strengthen drug R&D, the European Union is considering “giving away” a year’s patent to those drugs whose research has been carried out in Europe.

If we talk about National Health Policy (Spain), the current Ministry of Health, unlike previous Ministries, wants to get involved in the problems of the SNS, while the previous ones wanted to get involved as little as possible, with the argument that “everything was transferred” . This attitude seems, in principle, positive for the SNS. Another thing is priorities. It seems that among these are the suppression of 24-hour medical guards; addressing waiting lists; and, the State Public Health Agency. Regarding the first issue, the challenge is formidable, since medical guards, regardless of whether they are necessary or not, have become an important salary supplement. It is impossible to address this issue without considering the complements of medical personnel, which is no small issue. Regarding waiting lists, aware that their management corresponds to the communities, it seems that they want to establish a kind of “best practices”, with economic incentives for the communities that apply them. Not an easy matter either. And as for the State Public Health Agency, the ministry seems to have reached an agreement with the PNV and Junts, for the withdrawal of their amendments to the law. Let us hope that this agreement does not go against the strength and operation of the new Agency. For its part, SESPAS, the Spanish Society of Public Health, has published an interesting document on the characteristics that this body should have, with 11 very interesting recommendations. The Economic and Social Council of Spain (CES) publishes a report on the health system. Although the report is well prepared, it is difficult to find anything new in it that has not already been said or any innovative proposal. Taking advantage of the day of rare diseases (although it is now preferred to call them minority) the Spanish Association of Orphan and Ultra-orphan Drug Laboratories releases a report on the situation of these drugs in Spain. Much has been improved, although there is still room to advance. Both the La Paz hospital in Madrid and the Sant Joan de Deu in Barcelona launch special units to treat this type of illness.

As for Companies, on an international level, the Danish Zealand Pharma, a new relevant player in the field of obesity. On the national level, Viamed will launch a comprehensive unit for women in its hospital in Tarragona. New punishment in the Grifols Stock Market.

Biomedicine

Global Health

International health policy

National health policy

  • 24 hour guards
    • The Ministry of Health wants to end 24-hour medical guards this term. The Ministry will study the legislative framework that the autonomous communities can apply. The aim is to organize it by hospitals and without losing salary, since the guards can represent up to a quarter of the professionals’ salary. The challenge is formidable, since it must be implemented by the autonomous communities, it involves a reorganization of hundreds of services, an increase in staff and addressing the complements of medical personnel (https://www.eldiario.es/sociedad/sanidad-quiere-finish-medical-guards-24-hours-we-will-give-you-answer-legislature_1_10957897.html)
  • Economic and Social Council (CES) report on the health system
    • Report from the CES on the health system. Among the recommendations it supports public health and prevention; specify and update the SNS service portfolio; make Primary Care the true axis of the system; confront waiting lists; strengthen the comprehensive mental health model; enhance the quality of pharmaceutical provision; promote the planning and reinforcement of human resources of the SNS; reinforce patient participation; contribution of the private for-profit and non-profit sector; improvement of system management and evaluation (https://www.ces.es/documents/10180/5299170/INF_012024.pdf)

Companies

 

 

7 days in healthcare (February 19th-25th, 2024)

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Summary

From the point of view of Biomedicine, the mega-study of 250,000 genomes made public by the National Health Institutes of the USA stands out. This is in line with carrying out genome studies combining it with electronic medical record data from very large groups initiated in the United Kingdom by Genomics England and also developed in Iceland and Japan. A very promising way to improve knowledge of many diseases. New treatments for type 1 diabetes, based on the transplant of insulin-producing beta cells, obtained from stem cells, neutralizing the immune reaction. Gene therapy is the great promise for many rare diseases, currently without treatment. The problem to be solved is the high price of the treatments. At the present time, saying breast or prostate cancer is almost saying nothing. The treatment of tumors is no longer based on their anatomical origin, but rather on their molecular characterization. Bispecific antibodies that act on two targets at the same time, useful in hematological and solid tumors. The FDA approves a drug to prevent the amputation of fingers and limbs.

As far as Global Health is concerned, long covid was understood as a sequel to covid, but an article in The Economist states that covid is not the only infectious disease that leaves pathological conditions that are difficult to label. An article in Health Affairs places the solution to the obesity epidemic as a joint effort of prevention and treatment.

In terms of International Health Policy, more than half of USA’s rural hospitals do not offer childbirth services, which means that pregnant women have to be treated in centers located 30-40 minutes from their home, sometimes more. This is related to the high maternal and infant mortality in the USA, higher than that of most developed countries. The 4th anniversary of Brexit encourages the debate about whether it was good or bad for the National Health Service. The truth is that the NHS is worse now than before Brexit (waiting lists, professional strikes, etc.) and the difficulty of recruiting health professionals from the EU has increased. The investigation was also damaged. Increasing funding for the NHS was one of the arguments used by Brexiteers. France addresses the carbon footprint in the health system, within the general “France Nation Verte” program. Germany legalizes recreational cannabis, with one of the most liberal laws in Europe, after Malta and Luxembourg. More than controversial attempt in Germany to take control of non-communicable diseases from the Robert Koch Institute, one of the most prestigious organizations in German health, to give it to another organization, created as a result of covid. The European Medicines Agency recommends approving a drug against ALS.

If we talk about National Health Policy (Spain), as a result of a specific scandal, the entire problem of purchasing masks and other materials during covid is introduced into the national debate. Precisely everything related to the purchase of these materials was somewhat overlooked by the report “Evaluation of the Performance of the Spanish National Health System in the face of the covid-19 pandemic”, dated April 30, 2023, although published by the Ministry of Health in December of that year. It is already serious that an issue such as the problems of purchasing materials are not analyzed in the report, as if this had not been one of the most serious problems in the management of covid. The PNV requests the return of the text of the Public Health Agency law. That this law was going to have problems with the nationalist parties, always opposed to the creation of cohesion bodies in the National Health System, was something known. Surely this will mean delays in the appearance of the law and, what may be more serious, affect its content and functions. There is a risk that the announced Agency will be little more than an empty shell. The government creates the Extreme Temperature Observatory to analyze the health impact of climate change. The Basque Country approves a new Mental Health Plan 2023-2028. The EU denounces the high level of interim contracts in the Spanish public health system. At the current time, 43% of contracts are interim.

As for Companies, internationally, AstraZeneca reveals successes in the treatment of lung cancer. Indian drugmakers make versions of Novo Nordisk’s anti-obesity drug. At the national level, Sanitas intends to open a new hospital in Barcelona. Fever of construction of private hospitals in Valencia: Vithas, Quirón, IMED and Ascires in that race.

Biomedicine

Global Health

International health policy

  • United Kingdom and the National Health Service
    • Brexit and health. January 31, 2024 was celebrated as the 4th anniversary of the United Kingdom’s effective departure from the European Union. The Lancet asks whether or not that was good for the NHS, with two possible answers: the easy one, which says there is no evidence; and the difficult one, which confirms that the NHS is in fact worse now than before, as demonstrated by the long waiting lists and the continuous strikes by health professionals. What is certain is that it has become difficult to recruit doctors from the EU. At present, the majority of foreign doctors hired in the NHS are from outside the EU. Research plans were also negatively altered. (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00157-0/abstract)
    • The government changes its policy and plans to double the number of medical students in 2031 (https://ground.news/article/government-u-turn-on-plans-to-double-number-of-medical-students-in-england)

National health policy

Companies

7 days in healthcare (October, 16th-22nd, 2023)

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Summary

From the point of view of Biomedicine, the largest research project in the world is taking place in the United Kingdom. It is about collecting information of all kinds from 5 million Britons, to then put that information to work in the preventive, diagnostic, therapeutic, Public Health field, etc. A milestone where the great contribution of AI to health and healthcare will be seen.

In terms of Global Health, The Lancet analyzes the problem of deadly gun violence and the intended approach in the United States, under the leadership of Vice President Kamala Harris. Although we tend to believe that this is a typical and especially acute problem in North American society, the truth is that in many Latin American countries the situation is much more serious: Brazil, Mexico, Guatemala, Venezuela, El Salvador,…

In terms of International Health Policy, a novel approach to smoking in the United Kingdom, where it is being proposed to address this problem from the beginning, slowing down the age of starting to smoke. A report by European pharmacists confirms that the shortage of certain medicines is a problem throughout Europe.

If we talk about National Health Policy (Spain), it is worth highlighting that the Generalitat Valenciana intends to recover the public management of the Manises and Denia hospitals, managed by concession by Sanitas and Ribera, respectively, while at the same time it proposes to continue with the concession of Vinalopó, which ends in 2025, also managed by Ribera. A priori, it seems like a judicious and non-sectarian approach from the Valencian government. The government’s Budget Plan foresees a percentage of GDP for health in 2024 of 6.7%, which contrasts with the results of the latest report of the Health Accounts System (July, 2023), which shows a public health expenditure of 7 .8% of GDP in 2021. Given that, as in the 2010 crisis, measures to reduce health spending (such as lowering staff salaries, freezing substitutions or reducing the price of medicines) are not announced, it is difficult to believe that this objective of 6.7% in public health in 2024 will be met, especially when some communities, such as the Basque Country, are announcing increases in health spending. The Andalusian Health Institute is created, the result of the merger of the Andalusian School of Public Health and the Progreso y Salud Foundation, which lose their status as public companies and, therefore, a certain autonomy. Given the history of the current Andalusian government with public hospital companies, we fear that it is another step towards the “administrativeization” of the public health system. Time will tell if this is progress or setback, but they do not seem to bode well, given the poor results of the operation in the hospital setting.

In the field of Companies, on an international level, the purchase by MSD from Daiichi of several cancer drugs is worth highlighting. At the national level, OHLA is awarded the construction of the new Vithas hospital in Turia. Important commitment of venture capital (Advent) in the field of dental care (Vitaldent), which contrasts with the low commitment of the government in this field, which distances us from Europe, being one of the countries with the least public financing in dental care.

Biomedicine

Global Health

International health policy

National health policy

Companies