Posts

7 days in healthcare (August 5th-11th, 2024)

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Summary

Biomedicine

  • How to reduce the risk of dementia. A healthy lifestyle can prevent or delay at least half of cases. The Lancet article adds two risk factors to the 12 already identified in 2020: untreated vision loss and high cholesterol levels. Modifiable factors include tobacco, obesity, physical inactivity, high blood pressure, diabetes and excessive alcohol. No one doubts that the prevalence of dementia will increase as the population ages, although, adjusted for age, the incidence is falling.
  • It seems clear that women are better doctors than men. This is demonstrated by a broad review of 1.5 million medical records of adult patients.
  • The increasing number of cancers in young people points to the responsibility of the environment. Many of the cases are gastrointestinal, and could point to microplastics, as well as other risk factors, such as a sedentary lifestyle, a change in diet, as well as higher rates of obesity and diabetes.
  • Type 2 diabetes remission. According to a paper published in The Lancet, initial studies show that this type of diabetes can be put into remission with a “total diet replacement” (TDR) program. The issue is important, given the increasing prevalence of type 2 diabetes.
  • A new biomaterial capable of regenerating damaged joint cartilage is developed. As is known, cartilage does not regenerate. This new potential therapy may help address a serious and unmet clinical need. The new bioactive material successfully regenerated high-quality cartilage.

Global Health

  • Why the war on childhood obesity is failing. Since 1990, obesity rates have doubled among adults and quadrupled among children. In 2019, this caused 5 million deaths, 20 times more than malnutrition. No country has succeeded in reducing obesity: the problem is too complex to be solved with public health measures or drugs. Behind it there is a set of biological, economic and social factors.
  • The evolution of mortality under 5 years, a call for urgent action. Since 2000, the global incidence of mortality in children under five years has decreased by more than 50%. But the global community must not forget that millions of preventable deaths in children under five years of age occur every year. From 2000 to 2022, 162 million children under five years of age died.

International health policy

  • A study estimates the cost of cancer screening in the USA at 43 billion dollars. The study focuses on five cases in which screening is recommended: breast, cervical, colorectal, lung and prostate.
  • NHS England advocates four-year medical studies. In most countries, the studies are at least five years old, although in the USA and Canada they are already four years old.
  • The WHO triples the number of viruses and bacteria that threaten the world. The previous report was from 2018 and there were only a dozen pathogens; while the current report includes a total of 32 groups of microbes.
  • The EUDA, the new agency that will fight against drugs in the EU. Its mission would be to monitor drug trends, warn of emerging threats and share science-based knowledge.

National Health Policy (Spain)

  • The debate continues on the new financing system of Catalonia and its impact on the SNS. The government’s crossroads: raise taxes, cut benefits or increase the debt further. FEDEA considers that the Catalan agreement will allow the Generalitat to receive up to 13.2 billion from the common fund, which is detrimental to the income of other communities and a minimization of solidarity, which is what can be deduced from the PSC-ERC agreement. Although Illa’s arrival to the presidency of the Generalitat has encouraged a certain “do-goodism”, as if everything had already been resolved, the truth is that the problems with this agreement are of great magnitude, given the high price paid for it. Salvador Illa’s management at the head of the Ministry of Health does not contribute to optimism either. As Jordi Sevilla says, very critical of the agreement, “how can we believe that there will not be a referendum in Catalonia?” (https://www.elespanol.com/espana/politica/20240805/jordi-sevilla-carga-pacto-psc-erc-creernos-no-referendum-cataluna/875912880_0.html)
  • Massive incorporation of teachers to MUFACE. The incorporation of almost 36,300 teachers is expected.
  • Abuse of caesarean sections in the private health sector. One in three births in private health care ends in a caesarean section, much more than the WHO considers advisable (15%). In public health, it is performed in 22.4%. The organisation of the centres, the absence of midwives and the characteristics of the patients are some of the reasons given.

Companies

  • International
    • Mergers and acquisitions are booming in the pharmaceutical industry. Largely due to the loss of patents.
  • National
    • Spain, the fourth European market for medicines. Behind Germany, France and Italy.
    • Ribera is committed to sustainability. It reduced its carbon footprint by 13% in 2023.
    • Mapfre, the insufficiency of the premium is taking its toll on health insurance in Spain. Despite having increased turnover in 2024, the results of health insurance are negative (- 1.6 million, in the first two quarters of 2024). This is due to the increase in claims. The measures that are intended to be taken include reviewing rates and coverage, being strict in contracting and seeking maximum operational efficiency. Although it is clear that raising premiums and improving operational efficiency can be part of the solution, there is no solution for quality health insurance in our country without considering the interaction of the private insurance system with the public system (as happens in Germany, Switzerland, Holland and other countries), something that is apparently still taboo in our country.

Biomedicine

Global Health

International health policy

National health policy

Companies

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, 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 (December 25th-31st, 2023). Happy New Year

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Summary

From the point of view of Biomedicine, 2023 definitely seems to be the year where the great impact of artificial intelligence on health has become completely clear. The example of a stethoscope that incorporates AI and substantially modifies the one invented 200 years ago is nothing more than an example of this great change. Scientific journals explore what 2023 has represented (anti-obesity medications and awareness of the impact of climate change on health, among others), as well as analyze the advances that are foreseen for 2024 (surely the HIV vaccine and the cure cholesterol, among many others).

Regarding Global Health, The Lancet dedicates its last issue of 2023 to exposing a series of photos related to health experiences in Nigeria.

Regarding International Health Policy, an interesting article in JAMA magazine that will cause controversy: it relates the increase in medical errors in American hospitals to their acquisition by private equity companies. It is one year since the end of the covid-zero policy in China and the Financial Times analyzes how that experience is remembered in that society.

If we talk about National Health Policy (Spain), our country says goodbye to 2023 with the experience of three different Ministers of Health (Darias, Miñones and now García). It is evident that this dance of ministers (in 45 years there have been 28 Ministers of Health) can guarantee, in the best of cases, the continuity of the “ordinary administration”, but not the promotion of large renewing projects of change. SESPAS asks the Ministry to launch the Public Health Agency in 2024. The Ministry of Health of the Regional Government of Andalusia has experienced a serious crisis that led to the resignation of both the Vice-Minister and the Manager of the SAS. It seems that the underlying issue was the approach to addressing the waiting list and the involvement or not of the private sector in that resolution. If so, regardless of the anecdote of this moment, what it reflects is a very deep problem: the absence of a clear policy towards the private health sector on the part of the Popular Party. Madrid wants to promote a pharmaceutical hub, an issue in which Catalonia is by far in the lead.

In the field of Companies, on an international level, the great growth of the hair transplant market stands out, which already moves 8.7 billion euros annually. It seems that it is a nascent industry, but on the rise. The fever of anti-obesity drugs has meant that there are now 188 candidates, of which 25 are in advanced phase (III or IV). When it comes to national news, the fever of corporate operations in hospitals continues. Ribera, Quirón, Viamed and Vithas, the great protagonists.

Biomedicine

Global Health

International health policy

National health policy

Companies

7 days in healthcare (December 11th-17th, 2023)

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Summary

From the point of view of Biomedicine, CRISPR therapy, which begins with sickle cell anemia, is great hope. In the end, the FDA approves two gene therapies for this disease, which affects 7.7 million people globally and is a chronic, debilitating disease that causes pain and reduces the quality and expectancy of life. New approved therapies include extraction, genetic modification and reinfusion into patients of their own hematopoietic stem cells. The problem is that these patients live mainly in sub-Saharan Africa and India, which are far from having the infrastructure to apply this therapy. The price of these therapies is about 2 million euros per patient, which again raises the problem of the problems of universalization of precision medicine. Ozempic, Alzheimer’s drugs and malaria vaccines among the scientific milestones of 2023 for Science magazine. For its part, Nature magazine chooses a non-human among its scientists of the year: ChatGPT.

As far as Global Health is concerned, in the end, an international agreement is reached on the end of fossil fuels. COP28 was the first global conference on the subject after the Paris agreement in 2015 (COP21) in which a global limit to temperature growth was established at 1.5º. On December 13, 2023, the agreement on net zero emissions by 2050 will be reached. Fossil fuels generate a lot of wealth, but they are also the bulk of CO2 emissions. The problem is that there is no system that forces governments to meet that objective. A global treaty on plastics is proposed by the United Nations General Assembly (March, 2022). Plastic pollution is a global threat, since plastic is persistent and less than 10% is recycled, almost 6 billion tons now pollute the planet. This contains more than 10,500 chemicals, which includes carcinogens, neurotoxicants, etc.

Regarding International Health Policy, design by the European Union of a Plan to avoid shortages of more than 260 critical medicines, which includes storage and incentives for production

If we talk about National Health Policy (Spain), one in ten Spaniards on the waiting list, record numbers in health. At this moment there are 820,000 people to undergo surgery, a figure never reached. The Ministry of Health wants to raise this problem with the communities at the in-person meeting of the Interterritorial Council in Asturias on December 21. In theory there are two solutions: either self-concertation (the disdainfully called “peonadas”) or agreements with the private sector. In both cases money is needed. It is also necessary to review the indications, circuits and priorities. The CIS Barometer is released (3rd wave, October 2023). 57.5% value positively the functioning of the National Health System, which means a great setback with respect to previous editions. In an article in El País whose first signatory is Félix Lobo, it is proposed to strengthen the Ministry of Health. In 45 years there have been 28 ministers. And organizations with a clear health component have been separated from the Ministry, such as the Carlos III Health Institute, the Government Delegation for the National Drug Plan and the Food Safety and Nutrition Agency (AESAN). Although this reinforcement is necessary, it must surely be complemented with what we could call “cohesion bodies”, among which could be HISPANICE, also proposed by FUNCAS.

In the field of Companies, on an international level, Cigna renounces creating a health insurance giant in the USA, by becoming part of Humana. AstraZeneca enters the world of vaccines. Regarding national news, Quirón advances in the construction of its hospital in Gijón (Asturias) and receives from the Ministry of Defense the management of the hospital on Isaac Peral Street (former Generalísimo Franco), closed for more than 30 years. Good results from Miranza and Ribera, the latter contemplating three new projects.

Biomedicine

Global Health

International health policy

National health policy

  • Waiting lists
    • One in ten Spaniards on the waiting list, record figures in healthcare. At this moment there are 820,000 people to undergo surgery, a figure never reached. The Ministry of Health wants to raise this problem with the communities at the in-person meeting of the Interterritorial Council in Asturias on December 21. In theory there are two solutions: either self-concertion (the so-called “peonadas”) or conciliation with the private sector. In both cases money is needed. It is also necessary to review the indications, circuits and priorities (https://www.eldiario.es/sociedad/diez-espanoles-lista-espera-cifras-record-sanidad-quiere-atajar_1_10708957.html)
  • It is proposed to strengthen the Ministry of Health
    • In an article in El País whose first signatory is Félix Lobo, it is proposed to strengthen the Ministry of Health. In 45 years there have been 28 ministers. And organizations with a clear health component have been separated from the Ministry, such as the Carlos III Health Institute, the Government Delegation for the National Drug Plan and the Food Safety and Nutrition Agency (AESAN) (https://elpais.com/society/2023-12-11/potenciar-el-ministerio-de-sanidad.html)

Companies

 

7 days in healthcare (October 23rd-29th, 2023)

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Summary

From the point of view of Biomedicine, Nature magazine analyzes the great impact of Artificial Intelligence in medicine. Interesting article from the New York Times about the possible addictive nature of social networks.

Regarding Global Health, the WHO adds 6.9 million deaths from covid, although warning that the global figure could triple. Major humanitarian and health crisis in Gaza, which is the subject of WHO concern.

In terms of International Health Policy, the NEJM wonders if the introduction of the American government’s law that requires negotiating the price of drugs for Medicare will delay the appearance of new cancer drugs. The conclusion is that, although pharmaceutical companies will look for ways to maintain their profits, delaying the appearance of medications does not seem to be the best strategy, due to the ethical, reputational and financial considerations inherent to the operation. The Economist analyzes how it seems that healthcare has ceased to be the bottomless pit for public accounts, as it was for many years, in which, year after year, its relative weight in the countries’ GDP increased. Although health expenditure increased its share of GDP in the years 20-21, due to the joint effect of health expenditure due to the pandemic and the decline in GDP, it has since fallen to reach 2008 levels. In the United Kingdom, It seems highly unlikely that Prime Minister Sunak will deliver on his promises on NHS waiting lists.

If we talk about National Health Policy (Spain), given the evolution of the negotiations for the investiture and the possible continuity of Sánchez in the government, the national news of the week is the publication of the document “Spain advances”, which contains the agreements of the PSOE with SUMAR on different topics. The general tone of the document is more about promises than progress in certain necessary reforms and this same philosophy permeates the health part. On the other hand, the document does not cover all the topics (it does not talk about Defense, very little about foreign policy or other relevant issues). It gives the impression that this is the part in which SUMAR would intervene. From this point of view, as the health part is developed in some detail, it is assumed that a strong intervention by SUMAR in health is expected, regardless of whether the Ministry of Health is handed over to it. In summary, what is promised is to continue the processing of the Equity Law (which establishes direct public management as the preferred form of management in the SNS), a law is proposed with maximum times for waiting lists and there is talk of new benefits in mental health, oral health (although it seems to limit it to children and adolescents) and visual health. We consider the emphasis on the preferential nature of direct public management negative (there is multiple evidence of the good results of public companies and foundations or health concessions) and regarding the law on the waiting list it will surely not be the best way to solve this problem. We have already seen laws and regulations in some communities that had no effect. Both the PP, in the political sphere, and ASPE and ACES, in the world of health representation, have been against these measures.

In the field of Companies, on an international level, Amazon is torn between promises and realities in healthcare. Although large technology platforms will surely have an increasing role in healthcare (as in the financial world), it seems that they are finding it difficult to enter. Roche reaches an agreement to buy Telavant. At the national level, Ribera reaches an agreement with Microsoft to promote innovation and AI in healthcare. It seems that Grifols is making progress in its therapy against Alzheimer’s.

Biomedicine

Global Health

International health policy

National health policy

Companies

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 (June, 19th-25th, 2023)

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Summary

From the point of view of Biomedicine, ethical problems continue to be discussed as a consequence of the creation of embryos without eggs or sperm. Until now, an embryo required an egg and a sperm, but this new approach would allow, in hypothesis, to solve problems of infertility or pregnancy loss, but it is a matter to regulate very carefully. Two studies in Nature seem to show that the Y chromosome makes men more vulnerable to tumors.

With regard to Global Health, The Lancet focuses on the great threat of diabetes, since it is estimated that in 2050 there will be 1.3 billion diabetics, a disease related to obesity, diet, tobacco, alcohol and sedentary lifestyle. Inequalities in access to morphine are denounced, with the United States and Europe almost completely monopolizing its use. An important issue, since this drug has a relevant role in the treatment of pain and in palliative care.

Regarding International Health Policy, according to the weekly WHO report, covid is declining in both the number of cases and deaths in all WHO regions of the world. Only in the African region is there a slight increase in the number of deaths, with a decrease in the number of new cases. In the United States, the commercialization of meat grown in the laboratory is approved. One of the authorized establishments belongs to the Spanish philanthropist José Andrés. Also in the United States, not minor problems continue as a result of the annulment of the Roe v Wade ruling that transfers the authorization of abortion to the states. In the United Kingdom, the problems with the emergency services continue and a strike of resident doctors is called. New health insurance law in South Africa, which appears to represent progress towards universal coverage in that country.

If we talk about National Health Policy (Spain), according to the WHO weekly bulletin, Spain is the country in Europe with the highest mortality from covid. The government and the communities agree to abolish the mandatory nature of masks in health centers and pharmacies. Ayuso, proclaimed President of the Community of Madrid, after the last elections. Absence of great news in the announcements of health measures for this legislature. As was already known, Spain is consolidating itself as a world power in clinical trials, an achievement no less.

In the field of Companies, internationally, Walmart (the largest supermarket chain in the USA) enters the primary care business, with 32 centers in 5 states. Walmart was already in healthcare, but it was with small clinics for minor care. Significant company purchases by Merck MSD and Lilly, which seems to confirm that M&A activity in pharmaceutical companies is reviving. In the Spanish national arena, ASEBIO announces an increase in investment in R&D by biotech companies in 2022.

Biomedicine

Global Health

International Health Policy

National health policy

Companies

 

 

 

7 days in healthcare (April 3rd-9th, 2023)

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Summary

From the point of view of Biomedicine, vaccines against cancer and heart disease, based on mRNA technology, which are looming on the horizon 2030, seem to be the next great advance in medicine, potentially saving millions of lives. The Economist dedicates an article and an editorial to demonstrate the weak evidence for the therapy of gender transitions in adolescents, especially when they include pharmacological or surgical medication. Contrary to what had been a very popular assumption, moderate alcohol consumption does not produce health benefits, according to a study of more than 40 years published by the JAMA Network Open. Rather the opposite is true.

As regards Global Health, the WHO, born after the Second World War, is celebrating its 75th anniversary. He has emerged from the pandemic with injuries and issues, but acutely aware of his mission, purpose, and need for change. One of the problems it encounters is the discrepancies between countries in the discussion of a treaty on pandemics, which it intends to be approved in 2024. The Lancet publishes several articles on the commercial determinants of health, a subject of great interest. interest. Four industries – tobacco, unhealthy eating, oil and fossil fuels, and alcohol – are responsible for a third of deaths each year globally.

As for International Health Policy, in the United States, a federal judge in Texas has just banned the use of an abortion drug, which had been approved by the FDA more than 20 years ago. In France, the citizens’ convention, made up of 184 citizens chosen by lot, has just ruled in favor of euthanasia and assisted suicide, although with certain “red lines”. Macron wants to discuss the bill before the summer.

If we talk about National Health Policy (Spain), surgical waiting lists set a new record, according to the report made public by the Ministry of Health, with data as of December 31, 2022. Almost 900,000 people waiting for a surgical intervention. An absolutely delegitimizing element of the system. As is well known, the Ministry only makes public the waiting lists for surgical intervention or specialist consultations, but not for special tests (radiology, radiotherapy, ultrasound, etc.), on which there are no national data, although there are some autonomous communities. Interesting article published in Gaceta Sanitaria on the economic impact of including dental care in public coverage. This is an issue that the majority political parties have been pronouncing in favor of for several years, but nothing has been done on it. Spain is possibly the European country with the least percentage of its health spending devoted to dental care. The declarations of the Minister of Health of Catalonia are surprising, justifying the dismissal of the nurses who criticized the Catalan C1. Since this type of statement about specific dismissals is not common among regional ministers, it is to be assumed that there is an important political background. The decision of Navarra and Asturias to launch public companies, one for medical transport and another for a hospital laundry, is also surprising. Wouldn’t there have been the possibility of resorting to private initiative to solve these needs, perhaps more efficiently than through a public company?

In the field of Companies, internationally, agreement between Medtronic and Davita to launch Mozarc. At the national level, it is worth noting the start of work on the Viamed hospital in Tarragona, and the separation of the “pharmacy” and “chemistry” areas of the company Esteve.

Biomedicine

Global Health

International Health Policy

National Health Policy

Companies

 

 

7 days in healthcare (March 27th-April 2nd, 2023)

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Summary

From the point of view of Biomedicine, the latest issue of The Lancet dedicates a special article and an editorial to chronic pain, which affects millions of people daily; For its part, the New England Journal of Medicine publishes a review and an editorial on Artificial Intelligence in medicine. It seems that humanity will soon break historical records in terms of longevity. It is also worth highlighting the advances that are being announced in regenerative medicine (xenotransplant, 3D organ printing and stem cells).

With regard to Global Health, the most important thing is the WHO’s warning to governments in dedicating efforts to health professionals, since many of them are close to retirement and the needs are increasing for many reasons.

Regarding International Health Policy, in the United States, the FDA authorizes the free sale of Narcan, a nasal spray against opioid overdose, which represents life or death for many people. In the United Kingdom, the popularity of the NHS is the lowest it has been for 40 years, when this type of study began.

If we talk about National Health Policy (Spain), a new replacement in the Ministry of Health. Some consider that this Ministry has become the electoral launching pad for its incumbents (Illa, for Catalonia; Darias, for Las Palmas, and, apparently, Miñones, for Galicia). This approach, together with the short duration of the ministers, is one of the causes that contribute to the loss of prestige, leadership and role of the Ministry of Health, which has a policy of contingency management, but without a true project of transformation of the system, to propose to the different agents. The Minister of Health of Catalonia seems to have a plan to reinforce and retain professionals, something very necessary. I hope this plan works. The EMA has given the green light to the Spanish vaccine against the HIPRA covid, although only as a booster dose to the mRNA vaccines. Important social debate around surrogacy, as a result of the use of this procedure by a “celebrity”. Very different positions on the subject. Perhaps the most correct approach, as a quoted writer does, is to see who this procedure harms, if the parents, the unborn child, or the woman who lends her uterus. If the conclusion is that no one has been harmed, the most reasonable thing to do would be to approve this practice in our country, as it is in so many others.

In the field of Companies, internationally, BioNTech’s sales forecasts plummet, as a result of the lower demand for covid vaccines. At the national level, perhaps the most far-reaching news is the purchase by Viamed (Macquarie) of the Fátima hospital in Seville, after stiff competition with many other interested parties, including Vithas and Sanitas. Hospitales Parque (CASER) is set to grow at the rate of one hospital per year in the next three years.

Biomedicine

Global Health

International Health Policy

  • COVID
    • Data from Gisaid, the global repository of covid genomic data, increases the chances of discovering the origin of covid. Three years into the pandemic, it is still not certain whether the virus arose accidentally from a laboratory or was transmitted through an animal host (https://www.ft.com/content/f0733683-cb6d-4578-915a-aa60d7ba4c1d)

National Health Policy

Companies