Posts

7 days in healthcare (May 27th-June 2nd, 2024)

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Summary

Biomedicine

  • A blood test would allow predicting breast cancer: This possible advance is celebrated as a great step in the prediction of breast cancer at the Congress of the American Society of Clinical Oncology, held in Chicago.
  • Test to detect people at high risk of prostate cancer: Current PSA tests are not specific enough. A sputum DNA test has been developed that can detect high-risk men and rule out other forms of treatment. Early diagnosis is key.
  • Genetic inheritance influences the type of breast cancer and its prognosis: This contradicts the idea that breast cancer is the result of mutations that occur by chance and accumulate throughout life.
  • Oncologists warn that rapping can cause lung cancer: Although the first vapers were marketed in Spain in 2013 and there are no long follow-up series, some short series from the United States warn of this risk. Vapes contain more than 200 toxic substances and some of them carcinogenic.

Global Health

  • WHO gives itself one more year to reach an agreement on the pandemic treaty:  With the WHO World Assembly over, it gives itself one more year to reach an agreement on pandemics. This is not good news and underlines the great difficulties and tensions in reaching an agreement in 2024, as was the initial intention.
  • New fronts in the war against malaria: Two new vaccines (RTS,S/AS01 and R-21/MatrixM), effective in the fight against malaria. However, experts highlight new threats: more aggressive mosquitoes; resistant strains of the parasite and the effects of climate change.
  • The necessary global agenda in relation to bacterial resistance (AMR): High human cost of this disease, since a 2022 study says that it is estimated that almost 5 million deaths are due to this problem.

International health policy

  • Pro-choice options (following the ruling that limits abortion in the USA) influence the American elections: The pro-choice movement (in favor of abortion) can help Biden win.
  • Large clinical trial in the United Kingdom with cancer vaccines: In the United Kingdom, for the first time in the world, a massive form of clinical trial using these vaccines is being proposed.
  • European elections and health: Various experts say that health should be a priority in the next European Parliament.

National Health Policy (Spain)

  • Very negative allegations about the announced Public Management and Integrity law: Both the IDIS Foundation, ASPE, ACHPM, Cercle de Sanitat, and the Community of Madrid present very negative allegations about this announced bill. In general, the objections are related to the interference in the transferred management, the impact on patients and the non-existence of the problems that are intended to be resolved. The IDIS Foundation, apart from everything else, takes a more strategic approach to the contribution of private healthcare to public service, the European traditions of participation of private companies in public healthcare provision and the consideration of the private sector as a strategic ally. of the health sector. A poor diagnosis by the government should be highlighted: public/private collaboration is treated as a major problem, and, on the other hand, it does not address the problems of the public health sector through reforms.
  • Great controversy over the actions of the new Commissioner of Mental Health: Trying to solve the serious problems of psychiatric care in our country by recommending joining a union or a feminist association, as a joke may not be wrong, but seriously it is absolutely unacceptable that be said from any environment, and even less so, from the health administration.
  • The IDIS Foundation publishes a work on the perception of private healthcare:  Meritorious effort by the IDIS Foundation to carry out a serious survey among its users to detect their perception of the sector, which, in general, is very positive, although problems are detected such as repetition of tests by the public sector, without taking into account the studies carried out in the private sector. It is confirmed once again that the majority of private sector users also use the public one. Also that specialist consultations are the most used service in private healthcare.
  • Work that demonstrates that public/private collaboration does not produce worse health outcomes and less higher mortality than public management: In the face of some attempts to disqualify private healthcare by stating that it produces worse outcomes and more mortality, this is not confirmed in the extensive review national and international bibliography carried out. Even in places (Community of Madrid and Catalonia) where there are specific indicators on the behavior of the bulk of the public sector and public/private collaboration, better results are detected in the latter.

Companies

  • International
    • Nestlé reorients itself towards food for healthy aging: The largest food group in the world wants to focus on foods for healthy aging, considering it a priority at a time of reduced birth rates.
  • National
    • Rovi, ready to sell its third-party manufacturing area: Rovi is ready to sell its third-party manufacturing subsidiary for at least 3.1 billion.
    • The Miranza Foundation is born: With the purpose of ensuring the eye health of the most vulnerable.

Biomedicine

Global Health

International health policy

National health policy

  • Results in public/private collaboration
    • Bibliographic review carried out by a special Chair of the UCM on the results of public/private collaboration. Extensive review of national and international bibliography. The most notable are the results published in the Observatory of the Community of Madrid or in the Results Center of the Quality Agency of Catalonia. The conclusion is that there is no general evidence of worse results in public/private collaboration than in direct public management and, in the case of Spain, there is well-documented evidence of the opposite based on indicators in Catalonia and Madrid (https://isanidad.com/wp-content/uploads/2024/05/Informe-UCM-Colaboracion-publico-privada.pdf.pdf)

Companies

7 days in healthcare (15th-21st, 2024)

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Summary

From the point of view of Biomedicine, after an extensive study it is detected that in approximately 1 in 10 cases of multiple sclerosis, antibodies are detected in the blood years before the disease develops. It may be too early to draw conclusions about the repercussions of this finding.

As far as Global Health is concerned, plans to expand vaccine production to Africa are facing serious problems. This follows Moderna’s halt to the construction of a €500 million plant in Kenya, although other schemes continue, such as plans including facilities in Rwanda, Senegal and South Africa, carried out by BioNTech. Producing more vaccines in Africa is a moral imperative, says Martin Friede, head of vaccine research at the WHO. Article in Lancet Americas: Corruption, the greatest threat to healthcare. The cases in Peru as a result of the covid-19 pandemic and in Brazil (Rio de Janeiro) are discussed. It seems to be demonstrated, analyzing the experience of the few countries in which cannabis consumption has been legalized for a few years, that its legalization produces an increase in consumption in adults.

In terms of International Health Policy, initiatives in the USA against Chinese biotech companies will harm American patients. The Biosecure Act, which gained bipartisan support in Congress, proposes ending government contracts with biotechnology firms that have agreements with Chinese companies as clients or suppliers. This can greatly harm Americans, since, for example, BGI (Beijing Genomics Institute) is the largest human DNA sequencer in the world and operates in 100 countries. Facilitates the manufacture of prenatal tests and other diagnostic tests. In the United Kingdom, Brexit has exacerbated drug shortages in pharmacies. This is deduced from the study by the Nuffield Trust, a prestigious British health think tank, which released a report analyzing the impact of Brexit on the health system. Also in the United Kingdom there is a report published by Reform, a British think tank committed to public services and the effectiveness of the State, proposing a major organizational change in the health system in England, trying to decentralize and abolishing NHS England, since it is considered that such a centralized system is preventing the transition towards a more preventive model, guided by local needs. The role of NHS England would be assumed by the Department of Health, although with a much more strategic vision. England (with around 57 million people) is considered to be the most centralized healthcare system in Europe, despite devolution processes in Scotland (5.4 million), Wales (3.1 million) and Northern Ireland (1.9 million). This same idea of the problems of large centralization of the NHS is held by Nigel Edwards, former chief executive of the Nuffield Trust and now senior associate. The House of Commons votes in favor of the ban on smoking for those born after 2009, despite the Prime Minister being met with the vote against more than 50 Conservative MPs. A controversial measure whose only precedent is New Zealand and was recently repealed by the new government. In Germany, a commission recommends that abortions be legalized in the first 12 weeks. Although abortions in Germany are regulated by a 153-year-old law and are illegal, in practice they are performed in an accessible way. It is assumed that the current law does not meet current international standards.

If we talk about National Health Policy (Spain), the Ministry of Health seems to focus on issues such as the promise to the white tides of the imminent hearing of the Public Management Law; while the Commissioner of Mental Health prepares a guide to reduce psychotropic drugs, as well as launching more than debatable messages such as that “long-term drug treatments kill. These people live 20 years less”, which generated a negative response from Dr. Celso Arango, from the Gregorio Marañón Hospital; or he tries to change the 24-hour guard system, without really knowing how; “green” anesthesia; announcements that possibly, as intended in the United Kingdom, smoking will be banned for those born after 2009; etc. It does not seem that a very varied set of measures on often non-central issues constitute a strategy of anything. While serious underlying problems remain or worsen, such as waiting lists, which in the Ministry’s last publication reached a record of more than 850,000 people waiting. The Zendal Hospital, of the Community of Madrid, admitted one patient a day in 2023. It is increasingly clear that this hospital, launched without a minimum professional planning project, is a clear example of bad governance. The WHO threatens to break its agreement with the Andalusian School of Public Health, if it is diluted in the new Health Institute. The entity warns that the bilateral agreement signed in 1989 is not “transferable” and that, unless it is negotiated again, the collaboration as an associated center “automatically comes to an end.” The plans of the Andalusian Government in relation to the prestigious Andalusian School of Public Health are difficult to understand. Possibly the most regrettable operation underway in public health in Spain at the moment are the famous OPEs. The temporality wants to be resolved with a system of coverage of places with regional calls, not participating in the selection of the professionals nor the hospitals nor, much less, the services involved. There is a risk of destroying the unit and the configuration of services, which in many cases took years to implement. A real shame, much to the taste of the more traditional administration and the unions. In this sense, the 76 service heads of the 12 de Octubre hospital, in Madrid, have sent a letter to the counselor, warning of the problem of disintegration of services as a consequence of the ongoing OPE. We must see, in this sense, the recommendations of the Commission for Social and Economic Reconstruction, in whose opinion approved in Congress, it is committed to a national qualification for medical specialists and local hiring. In the MIR call, the worst figure is for Family Medicine, with 459 free places in the first round, double that in 2023. Making family medicine attractive – salary-wise and professionally – is indeed an emergency to be addressed and a problem important. The newspaper El Mundo reports on the cheapest health insurance. From ASISA (25.99 euros/month) to Sanitas (51.68). In all of them, hospitalization is included, with some form of co-payment. If this isn’t a price war, it certainly looks a lot like one. It is not surprising then that there are problems with rates for hospitals and professionals.

As for Companies, internationally, funds are moving on the board of Novavax, after the failures in the covid vaccine. In terms of national information, AI will revolutionize mental health, generating 2.5 billion euros in Spain. The largest seller of flu vaccines in Spain entrusts its production to Rovi.

Biomedicine

Global Health

International health policy

  • USA
    • Philip Morris funds smoking cessation plans. Medscape, a leading health information company in the USA, is accused of having accepted courses financed by this company. The criticism is based on the tobacco industry’s history of ignoring scientific teachings about the dangers of tobacco (https://www.bmj.com/content/385/bmj.q830)
    • American movements against Chinese biotech companies will harm American patients. The Biosecure Act, which gained bipartisan support in Congress, proposes ending government contracts with biotechnology firms that have agreements with Chinese companies as clients or suppliers. This can greatly harm Americans, since, for example, BGI (Beijing Genomics Institute) is the largest human DNA sequencer in the world and operates in 100 countries. Facilitates the manufacture of prenatal tests and other diagnostic tests (https://www.economist.com/leaders/2024/04/18/americas-moves-against-chinese-biotech-will-hurt-patients-at-home)
    • Scientists miss action against bird flu outbreaks on American farms (https://www.nytimes.com/2024/04/19/health/bird-flu-usda-cattle.html)

National health policy

  • Central government initiatives
    • Sánchez announces the expansion of the basic screening portfolio from 7 to 11 detectable diseases (https://www.diariomedico.com/medicina/politica/sanchez-anuncia-ampliacion-cartera-basica-cribado-neonatal-7-11- detectable-diseases.html)
    • García announces to the white tides the imminent hearing of the Public Management Law (https://diariofarma.com/2024/04/11/garcia-anuncia-a-las-mareas-blancas-la-inminente-audiencia- of-the-public-management-law-of-the-sns)
    • The Commissioner of Mental Health prepares a guide to reduce psychotropic drugs, as well as launches more than debatable messages such as that “long-term pharmacological treatments kill. These people live 20 years less”, which generated a negative response from Celso Arango , from the Gregorio Marañón Hospital (https://www.diariomedico.com/medicina/politica/comisionado-salud-mental-prepara-guia-prescripcion-psicofarmacos-reducer-consumo.html)

Companies

7 days in healthcare (April, 1st-7th, 2024)

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Summary

From the point of view of Biomedicine, the report published by the French National Academy of Medicine on generative AI systems in health is worth highlighting. It makes 10 recommendations, the first of which is that all health professionals should be trained in the use of generative AI. It seems that anti-obesity medications (initially, anti-diabetes) may be the closest thing to a universal panacea. There is already evidence that they can have benefits in many other diseases: heart, kidney, liver, brain (Alzheimer’s and Parkinson’s), as well as other organs.

With regard to Global Health, concern continues over the difficulties of advancing the Pandemic Treaty. The Treaty aims to prevent governments, institutions and populations from the errors of the covid-19 pandemic. In this sense, a more than interesting article by Mariana Mazzucato on aspects related to innovation, intellectual property (IP), public/private collaboration and financing. The Lancet speaks out in an editorial against the use of starvation (the total lack of food and mass famine) as a weapon of war, as we have seen in the war in Sudan and currently in Gaza, where Israeli action is taking on dimensions of destruction of Gaza, with the consequent health and humanitarian problems. Prostate cancer cases will double between 2020 and 2040.

Regarding International Health Policy, the French Prime Minister, Gabriel Attal, proposes a fine of five euros for those who miss scheduled medical appointments. But possibly the most far-reaching news is President Petro’s actions in healthcare in Colombia, with the intervention of the two largest EPS (Health Promotion Entities). This breaks the approach of the Colombian health system based since 1993 on Law 100, which established public/private collaboration through the EPS, companies that received public aid and were in charge of providing health services to their insured population. There is no doubt that the proliferation of populist governments in Latin America is a threat against any form of public/private collaboration in healthcare, as is also the case in Chile where ISAPRES (private insurers that receive public aid) are also threatened. The universalization of health coverage – something absolutely defensible and one of the great advances of our time, today in full expansion – leads some to interpret this as a monopoly of health care by the State and even a colonization of the management model by the traditional Administration, thus breaking a desirable freedom of choice, as well as a certain competition for the coexistence of different management models.

If we talk about National Health Policy (Spain), the Interterritorial Council of the National Health System unanimously supports the Comprehensive Plan for the Prevention and Control of Smoking. However, the Plan is fundamentally a roadmap and a declaration of intentions, some of which will have to be materialized through laws, with the uncertainty regarding the approval of new laws generated by the situation of the current legislature. The plan aims to increase smoke-free spaces (not specified); avoid promoting tobacco products; access to smoking cessation programs; equate electronic cigarettes with conventional tobacco; and, increase taxes on tobacco. The most controversial thing may be to equate electronic cigarettes with conventional tobacco, since the risks and damage to health are not comparable. A recent article in the New England Journal of Medicine states that there is sufficient evidence to show that switching from cigarettes to e-cigarettes reduces exposure to tobacco toxins, reduces respiratory symptoms and reverses physiological changes related to smoking cigarettes. The Government’s Regulatory Plan for 2024 announces four laws in the health field: 1. statute-framework; 2. law of guarantees; 3. alcohol consumption prevention law; and, 4. law on public management of health services. Same comment regarding the uncertainty regarding the approval of laws. Among these laws does not appear that of the State Public Health Agency, already being processed in Parliament. Of note is the meeting at the Ministry of Health of a representation of the same with representatives of doctors who work for health insurers. Regardless of the outcome of this meeting, it was not common until now for the Ministry of Health to enter into the problems of private healthcare. But welcome if there is a change in this regard.

As for Companies, internationally, drug shortages have recently reached unprecedented levels in several European countries and last year reached a ten-year high in the USA. Regarding national information, Grifols admits changes in its debt level and Recoletas is expanding to several regions through its reproductive business.

Biomedicine

Global Health

International health policy

National health policy

Companies

7 days in healthcare (March 25th-31st, 2024)

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Summary

From the point of view of Biomedicine, it should be noted that possibly the next “boom” will be everything related to anti-aging therapies, an aspect to which the Financial Times dedicates an article, following the appearance of three books on the subject. . The Economist dedicates a lot of space in its latest issue to the issue of AI in healthcare, no less than an editorial and four articles. The conclusion is that AI will have a great impact on healthcare. However, as Eric Topol, the well-known cardiologist and health publicist, comments in another article in the Financial Times, “AI is very transformational, but these things always take longer than you initially think.” Nature magazine analyzes the reasons for optimism about cancer vaccines. Vaccines to treat, not to prevent.

Regarding Global Health, the WHO focuses on the millions of undiagnosed cases of tuberculosis, which compromise efforts to combat this disease. The WHO estimates that in 2023 there will be three million new cases not known to health services. Problems continue between developed and developing countries, which do not agree on the Treaty on the prevention of pandemics, proposed by the WHO as a goal for 2024.

In terms of International Health Policy, the King’s Fund and the Nuffield Trust, two prestigious British think tanks on health, analyze satisfaction with the NHS, which is the lowest in the entire history of this institution. Only 24% of citizens in England, Scotland and Wales are happy with the service, with waiting lists being the most common complaint. In France, the Sorbonne Faculty of Medicine and a former health minister propose “strong measures” to, they say, prevent the degradation of the health system in France. Of the three measures they propose, one of them has to do with the preservation of “medical time” (through non-medical assistants in consultation); and the other with the promotion of advanced practice nursing.

If we talk about National Health Policy (Spain), based on Primary Care analysis that is on the Ministry’s website, it is observed that people treated in primary health centers who earn less than 18,000 euros per year are medicalized more frequently, have prescribed more chronic drugs and consume more pills for pain, anxiety or depression. The Ministry of Health is studying allowing price competition between medicines so that generics can gain market share. This would affect generics and biosimilars, which would be cheaper than brand-name ones and it would be the patient who, if they wanted, would assume the difference. The situation in Spain of the same price for generics as for branded ones is unique in Europe. The objective is to stimulate the development of the generic and biosimilar industry and, ultimately, reduce the pharmaceutical bill for these medicines, in order to allow the incorporation of innovations. If it is carried out, it will be great news. Of note is the agreement signed between the Colleges of Pharmacists of the Basque Country and the Department of Health of that community, with the idea of facilitating the integration of community pharmacies as health agents in the health system. More than interesting is the article published in Human Resources for Health, and whose first signatory is Sara Calderón-Larrañaga, and which analyzes the reasons why primary doctors leave Spain. The work consisted of a survey, focus groups and interviews with 158 primary doctors who had left Spain. The causes of their departure were, in order of importance: insufficient salary, temporary employment, excessive workload, poor governance of primary care, lack of flexibility in the workplace and personal circumstances. There are the keys to a reform of Primary Care.

As for Companies, internationally, a cancer drug (Keytruda, from Merck-MSD), the best-selling drug in the world. In Spain, the historic achievements of Rovi, with a business approach that goes beyond covid. We must also highlight Vithas’ hospital commitment in Barcelona, where construction is underway.

Biomedicine

Global Health

International health policy

National health policy

Companies

7 days in healthcare (March 4th-11th, 2024)

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Summary

From the point of view of Biomedicine, the possibility of making replicas of fetal organs stands out, which could facilitate fetal treatments without putting the pregnancy at risk. The Lancet publishes an editorial and several articles on menopause, a natural state in the aging process of women, often overmedicalized. FDA delays approval of Lilly’s long-awaited Alzheimer’s drug.

As far as Global Health is concerned, there was a shortage of cholera vaccines, at a time with many outbreaks, even in countries where it had been eradicated. Great absolute growth in the global figures of the scourge of genital mutilation in women, especially in Africa, but also in Asia and the Middle East. First published evidence that nanoplastics harm human health. Big problem with the lack of health professionals in Africa, which is proposed to be compensated as a quick solution with community health workers.

Regarding International Health Policy, in the United States President Biden gave his fourth and final State of the Union address. Surprising was a particularly energetic and mentally agile Biden, who maintained the interest of a vibrant speech during its more than 60-minute duration, even interacting with the Republican seats. Much of his speech was dedicated to health, undoubtedly a star issue in the next elections: the price of medicines; women’s reproductive rights, abortion and in vitro fertilization; the extension of Obamacare, a law he defended, during his term; and care for the elderly, both at home and in nursing homes, were the topics discussed. In France, President Macron has decided to make abortion a constitutional right, surprising the enormous support obtained on the right and left in the National Assembly: 780 votes in favor compared to only 72 against.

If we talk about National Health Policy (Spain), In its “Declaration of Córdoba” the Popular Party presents 4 proposals regarding health. The rural environment is left without doctors, according to the Spanish Society of Family and Community Medicine, saying that of the 11,000 rural doctors, half will retire in the next 5 years and it does not seem easy the arrival of new doctors. A specific health problem of one of the great gaps in our country: that of the rural-urban world. The Minister of Health makes two big promises: the decarbonization of the health system and the creation of an observatory on corruption in health (in response to problems with the purchases of masks and equipment during covid). Interesting, but we will have to see if these promises become realities. The PP will bring the ELA law to Congress.

As for Companies, at the international level, it is increasingly clear that the Novo Nordisk-Lilly duopoly in addressing obesity will be broken, giving way to other agents, given the large number of clinical trials on the subject. According to IQVIA, pharmaceutical companies will lose 6 billion a year until 2028 due to the expiration of many patents, converting many of these medications to generics and biosimilars. This loss will try to be compensated with the launch of new drugs, since it is estimated that between 2024 and 2028 there will be 175 new launches, especially in the field of oncology and neurology. Regarding national news, Grifols has revalued on the Stock Market, after the publication of its audited accounts without qualifications. Loss of 600 million of the insurance companies that operate in MUFACE (Adeslas, Asisa and DKV) during the period of validity of the current three-year agreement. It is evident that public/private collaboration is unviable if it condemns the participating companies to losses without any prospects.

Biomedicine

Global Health

International health policy

National health policy

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 (November 13th-19th, 2023)

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Summary

From the point of view of Biomedicine, The Economist speculates in an article about whether certain regenerated neurons of the dentate gyrus could reverse Alzheimer’s, based on studies in mice. AI, useful in improving the detection of breast cancer.

Regarding Global Health, the WHO points out the rebound in measles worldwide. The number of cases and, above all, mortality are increasing a lot.

In terms of International Health Policy, the United Kingdom encourages the EU and the USA to join its “subscription model” for the development of antibiotics. In practice, it introduces a system of incentives for pharmaceutical companies not linked to the sale of the drug, which can be useful if new antibiotics against resistant bacteria are intended to be of low use. The King’s Fund (an important British health think tank) launches a study in which it analyzes in great detail the inequities in waiting lists. Without a doubt interesting reading in our country. In France, the SNCF (equivalent to our RENFE) launches an interesting initiative to alleviate the problem of medical deserts: build telemedicine centers near the stations.

If we talk about National Health Policy (Spain), the confrontation between private doctors and insurers continues. Without a doubt, the problems of personnel policy do not only occur, as some might think, in the public sector. They also occur in the private sector. The Ministry of Health calls the comments about the transfer of the MIR to certain communities hoaxes. The problem is that this issue appears in the investiture agreements. Success of the PRAN (the plan to reduce antibiotic consumption), obtaining good results in our country, despite continuing to be one of the countries with the highest consumption of antibiotics, both in humans and in veterinary medicine.

In the field of Companies, on an international level, the sale of obesity drugs could be a great boom and reach 100 billion dollars in 2030. On a national level, Quirón is advancing in the approach of building its new hospital in Gijón. Sanitas-BUPA buys a Turkish insurer. The bankruptcy administrator blames KKR for the bankruptcy of the dental company Dentix.

Biomedicine

Global Health

International health policy

National health policy

Companies

 

 

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

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Summary

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

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

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

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

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

Biomedicine

Global Health

International health policy

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

National health policy

Companies

 

 

7 days in healthcare (October, 3rd-9th, 2022)

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Summary

From the point of view of biomedicine, to review the Nobel Prize in Physiology and Medicine, won by Svante Pääbo, a scientist who is recognized for his studies on the DNA of human ancestors, which allows us to better understand genetic evolution towards the “homo sapiens”. It seems that a study with Artificial Intelligence of the eye will help predict coronary risk in minutes, without the need for blood tests or other studies.

As far as Global Health is concerned, it is believed that malaria could be definitively eradicated from the world, with the help of new vaccines.

As for international health policy, alerts in Europe about avian flu and diphtheria, brought by immigrants from Africa and Asia. To highlight the changes in Portugal, which incorporate an independent team to the management of the SNS.

If we talk about national health policy (Spain), the rise in covid cases prevents the Interterritorial Council from approving the abolition of masks on public transport. The health items in the General State Budgets are analyzed with a magnifying glass in the professional press, despite the low weight of the expenses of the Central Administration in the total health expenses. However, it allows to detect some priorities for the Ministry, although the economic items are usually below the challenges: primary care, genomic portfolio, mental health, dental care, primary care infrastructure, etc. The CEOE charges against the Equity Law, which it describes as “unprecedented risk”. The debates and controversies continue in relation to the delays in the incorporation of pharmaceutical innovation in Spain. However, these debates do not usually consider that the approval by the EMA of a medicine does not mean automatic public financing in Spain, according to article 92 of the Law on Guarantees and rational use of medicines, which establishes the “financing selective and not indiscriminate” according to a series of criteria, which are established. AESEG and BIOSIM no longer agree with the plan approved a couple of years ago on generics and biosimilars, but want the new approaches to be included in the Guarantees Law.

In the field of companies, in the international arena, BioNTech signs an agreement with Australia, for the establishment of research centers in that country. As for national news, the growing weight of online pharmacy (prescription drugs excluded by law). HM reinforces itself in Andalusia, incorporating four hospitals in Malaga into its network.

Biomedicine

Global Health

International health policy

National health policy

  • General State Budgets (impact on health)

Companies

 

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

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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)