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

• Scientists can help fetuses by growing small replicas of their organs, which would help in fetal medicine. Diagnosing the status of certain organs in the fetus can be difficult to make without putting the pregnancy at risk. Using cells from amniotic fluid, certain miniature organs can be reproduced, which reveal the disease and its response to certain medications or treatments (https://www.economist.com/science-and-technology/2024/03/05/scientists-can-help-fetuses-by-growing-tiny-replicas-of-their-organs#)
• The Lancet Editorial: New approaches to menopause. Although menopause is a natural phase of life, some companies and individuals with vested interests are overmedicalizing menopause (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00462-8/fulltext#:~:text=We%20need%20to%20send%20a,appropriate%20social%20and%20medical%20support.)
• FDA delays approval of Lilly’s long-awaited Alzheimer’s drug (donanemab). This drug was expected to be approved this month, but the FDA has decided to launch a panel of independent experts to evaluate its effectiveness and safety (https://www.nytimes.com/2024/03/08/health/alzheimers-drug-donanemab.html)

Global Health

• Shortage of cholera vaccines. 2022 was a bad year for cholera, with many outbreaks, even in countries where it had not been known for years. Global reserves of the oral vaccine are completely depleted. (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00467-7/abstract)
• Genital mutilation continues to increase globally. Although in many countries the rate is decreasing, in others, with great population growth, it is not. According to estimates, 144 million women have suffered this practice in Africa (especially Egypt, Ethiopia and Sudan); 80 million in Asia; and, 6 million in the Middle East (https://www.nytimes.com/2024/03/07/health/female-genital-cutting.html#:~:text=More%20than%20230%20million%20women,last%20global%20estimate%20in%202016.)
• A study reveals the first signs that nanoplastics harm human health. Patients with microscopic plastics in their arteries multiply their risk of heart attack, stroke and death by 4.5. For the first time this phenomenon is seen in humans, according to a study by an Italian University (https://elpais.com/salud-y-bienestar/2024-03-08/un-estudio-revela-los-primeros-indicios-that-nanoplastics-damage-human-health.html). Original article in the NEJM: https://www.nejm.org/doi/10.1056/NEJMoa2309822
• In Africa there is a lack of 6 million health professionals, which requires promoting community health workers, as a quick solution to cover the needs of the continent (https://elpais.com/planeta-futuro/red-de-expertos/2024-03-04/in-africa-there is a lack of six-million-health-care professionals.html#:~:text=For%202030%2C%20Africa%20will face%20one, it has%20never%20been%20more%20urgent.)
• Sao Paulo and a good part of Brazil, in emergency due to dengue, transmitted by the Aedes Aegypti mosquito, which sets records in Buenos Aires. The number of infected people exceeds 300 per 100,000 inhabitants, considered by the WHO to be the emergency level (https://www.elmundo.es/ciencia-y-salud/salud/2024/03/05/65e790b0e85ece8a368b45c3.html)
• In Tunisia, a disturbing rise in HIV cases, due to insufficient prevention and screening and the criminalization of homosexuality. Cases are increasing among men and drug users (https://www.lemonde.fr/afrique/article/2024/03/08/en-tunisie-une-inquietante-hausse-des-cas-de-contamination -au-vih_6220934_3212.html#:~:text=Selon%20les%20dernières%20données%20du,contre%204%20700%20en%202010.)

International health policy

• USA
  • Biden gives the presidential State of the Union address on March 7 before both houses of Congress, placing great emphasis on health issues: 1. Drug prices, with a drop in the price of insulin (from $400 a month to $35 $); establishing ceilings on the cost of medications for seniors in Medicare at $2,000 a year; and, by promoting the negotiation with Medicare of certain drugs, announcing that the price of more than 500 medications will be negotiated in the next decade; 2. Women’s reproductive rights, abortion and in vitro fertilization; promising to restore the situation before the overturning of Roe v Wade; 3. Obamacare, mentioning advances in the form of credits; 4. Services for the elderly, both at home and in nursing homes (https://www.advisory.com/daily-briefing/2024/03/08/sotu#:~:text=President%20Joe%20Biden%20on%20Thursday,price%20caps%20on%20certain%20drugs.)
  • Private equity ownership of medical practices is increasing in the period 2012-2021. Concerns about lack of competition (https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2023.00152?journalCode=hlthaff)
  • Prominent senators urge to stop the sale of illegal vapes (https://www.nytimes.com/2024/03/07/health/vaping-senators-warning-fda.html)
  • Psychedelic medications are growing in therapy against opioids (https://www.nytimes.com/2024/03/05/health/ibogaine-psychedelic-opioid-addiction.html#:~:text=109-,Powerful%20Psychedelic%20Gains%20Renewed%20Attention%20as%20a%20Treatment%20for%20Opioid,remains%20illegal%20in%20the%20U.S.)
  • Ozempic can strain the federal budget, taking into account that the cost of the drug is $15,000 per person per year (https://www.nytimes.com/2024/03/04/opinion/ozempic-wegovy-medicare-federal-budget.html)

• United Kingdom and the National Health Service
  • The debate on assisted dying is growing in the UK (https://www.ft.com/content/29bfb63a-51c4-4534-99b3-22e18b0cccf4)
  • Private hospitals in the UK cannibalize the NHS by doing 10% of elective surgery, according to The Guardian, which blames this situation on lack of investment in the NHS (https://www.theguardian.com/society/2024/Mar/08/private-hospitals-cannibalising-nhs-in-england-by-doing-10-of-elective-operations)

• France
  • Why France has made abortion a constitutional right. The constitutional review has obtained unusual support: 780 votes in favor compared to only 72 against from French legislators (https://www.economist.com/europe/2024/03/05/why-france-has-made-abortion-a-constitutional-right?utm_medium=cpc.adword.pd&utm_source=google&ppccampaignID=18151738051&ppcadID=&utm_campaign=a.22brand_pmax&utm_content=conversion.direct-response.anonymous&gad_)

• European Union
  • Sexually transmitted infections are thriving in Europe, according to the ECDC (https://www.lemonde.fr/planete/article/2024/03/09/les-infections-sexuellement-transmissibles-prosperent-en-europe_6221019_3244.html#:~:text=Selon%20plusieurs%20rapports%20publiés%20jeudi,et%2034%20%25%20pour%20la%20syphilis.)

National health policy

• Córdoba Declaration of the PP
  • In its Córdoba Declaration, signed by the President of the PP and by the regional presidents of this Party, 4 points in health are agreed upon: common framework regarding the vaccination schedule; common cancer prevention testing framework; homogeneous prevention program for newborns; and, shock plan to expand Primary Care doctors (https://www.pp.es/sites/default/files/documentos/24.03.10_declaracion_de_cordoba_-_atrabajos_.pdf)

• Doctors rural Spain
  • Rural Spain is left without doctors, in five years half of the 11,000 that remain could retire, according to estimates by the Spanish Society of Family and Community Medicine (https://www.elespanol.com/ciencia/salud/20240307/rural-spain-is-without-doctors-years-could-retire-half-remain/837916561_0.html#:~:text=Accordingto%20the%20estimates%20of%20the,rural%20doctors%20of%20our%20country.)

• SNS decarbonization
  • García announces that the SNS will be decarbonized in 2050. The minister has announced that legal changes will begin so that the health system is decarbonized before the first half of the century, since the health system accounts for more than 5% of all emissions global (https://www.consalud.es/ciencia-para-vivir-mejor/monica-garcia-anuncia-sns-estara-plenamente-descarbonizado-antes-2050_141003_102.html)

• Health fraud and corruption observatory
  • Mónica García announces before the Senate health commission an observatory against health fraud and corruption, precisely to avoid the errors and overpricing of health materials that occurred during the pandemic (https://gacetamedica.com/politica/monica-garcia-announces-a-strategy-and-an-observatory-against-fraud-and-health-corruption/)

• Royal Decree evaluation of health technologies
  • The appearance of this RD is announced in the coming weeks (https://elglobal.es/politica/el-rd-de-evaluacion-de-tecnologias-sanitarias-vera-la-luz-en-las-proximas-semanas/#:~:text=The%20Royal%20Decree%20(RD)%20of,which%20organizes%20the%20Fundación%20CEFI.)

• ALS Law
  • The PP will take the proposal of the ALS Law to the next plenary session of Congress (https://www.eldiario.es/politica/pp-llevara-proximo-pleno-congreso-proposition-ley-ela_1_10983604.html#:~:text=The%20president%20of%20Party%20Popular,Sclerosis%20Lateral%20Amyotrophic%20(ALS).)

• Transplants and donations
  • New strategy for organ transplants and donations in Spain, led by the ONT, although the process is in an incipient phase. The truth is that the network remains a reference in Europe (https://www.redaccionmedica.com/secciones/ministerio-sanidad/espana-da-el-primer-paso-para-renovar-la-estrategia-nacional-de -transplants-2435)

Companies

• International News
  • Great innovation is coming in drugs against obesity. Right now, Novo Nordisk and Lily have found a money making factory. But the market has limited supply, due to the shortage of active ingredients, and so far most sales are in the USA and some in Europe. But this is going to change, since more than 70 companies are developing about 100 clinical trials of different medications against obesity (https://www.economist.com/leaders/2024/03/07/a-frenzy-of-innovation-in-obesity-drugs-is-under-way)
  • Can Bayer recover from its chronic problems? In 1899, Bayer registered acetylsalicylic acid (aspirin), the first synthetic medicine that was to be one of the most successful globally. But last year Bayer lost more than 3 billion US$ and it does not seem that a simple painkiller can be the solution (https://www.economist.com/business/2024/03/07/can-bayer-recover-from-its-chronic-pain)
  • The more than “trillion” dollar battle for weight loss. The Novo Nordisk-Lilly duopoly is more than likely to be broken, for the entry of new players (https://www.economist.com/business/2024/03/04/the-battle-over-the-trillion-dollar-weight-loss-bonanza)
  • The drug Relyvrio (against ALS) fails in clinical trials and could be withdrawn from the market (https://www.nytimes.com/2024/03/08/health/als-drug-relyvrio.html)
  • Viking and Zealand want to stand up to Novo Nordisk and Lilly with their weight loss drugs. Both companies have drugs in clinical trials and the results so far are promising (https://www.elespanol.com/invertia/observatorios/sanidad/20240307/viking-zealand-quieren-plantar-cara-novo-nordisk-lilly-medicamentos-lose-weight/837916377_0.html)
  • Pharmaceutical companies will lose 6 billion a year due to the end of patents until 2028, according to the IQVIA study. More than half of the impact will be on biological medicines, with an increase in biosimilars. It is estimated that between 2024 and 2028 there will be 175 new launches. A third of these new drugs are expected to be cancer treatments and important groups in neurology (https://theobjective.com/economia/2024-03-07/farmaceuticas-perderan-millones-fin-patentes/#)

• National
  • Grifols soars on the stock market by 17.9% after publishing its accounts audited by KPMG without qualifications (https://www.elconfidencial.com/empresas/2024-03-08/cotizacion-grifols-cuentas-auditadas-salvedades-kpmg-gotham_3844863/)
  • Rovi signs Lazard to study the sale of its business to third parties (https://cincodias.elpais.com/companias/2024-03-07/rovi-contrata-a-lazard-para-la-posible-venta-de-your-third-party-manufacturing-business.html#)
  • Adeslas, Asisa and DKV lose 600 million in three years with health care for civil servants (https://cincodias.elpais.com/companias/2024-03-07/adeslas-asisa-y-dkv-se-dejan- 600-million-in-three-years-with-health-care-for-civil servants.html)