Posts

7 days in healthcare (July 8th-14th, 2024)

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Summary

Biomedicine

  • Four decades of orphan drugs. The Orphan Drug Act (ODA) was approved in the USA in 1983, due to the lack of commercial interest in the development of these drugs. The law that developed incentives for production, the duration of patents and research was a success and more than 800 indications have already been approved. However, many rare diseases remain untreated and prices are unsustainable. This is why a new strategy is proposed for the next four decades.
  • Gene therapy offers hope for autoimmune diseases. Use of CAR-T, originally intended for cancers, in lupus. The initial findings offer hope to millions of patients with autoimmune diseases, four in five of which are women.

Global Health

  • Vaccines save lives. The measles vaccine alone is estimated to have prevented 23 million deaths between 2000 and 2018. Globally, the vaccination rate has increased for many diseases. However, in 2022 (the latest figure available) there were still 14.3 million children with zero doses. A lack of access and high production and cost costs among the reasons for this situation. New strategies are needed to boost utilization.
  • Counting the dead in Gaza. According to a letter published in The Lancet, as of June 24, 37,396 people had been killed in the Gaza Strip since the Hamas attack and the Israeli response, according to the Gaza Ministry of Health, figures not accepted by Israeli authorities, although they are by the United Nations and the WHO. If we take into account that the indirect deaths are estimated to be between three and fifteen the number of direct deaths, a conservative estimate with a multiple of four gives 186,000 deaths attributable to the current conflict. This is why an immediate ceasefire is advocated.

International health policy

  • The NHS is broken: In his first official statement released on July 5, the new UK Health Minister (Wes Streeting) says that his department’s official position is that “the NHS is broken.” . He is surprised by this clarity regarding the recognition of problems, which is to be expected to be followed by profound reforms.
  • Official statement from the Labor Party on preparing the NHS for the future: cutting waiting lists with 40,000 more appointments each week; double the number of cancer scans; a new Dental Plan; 8,500 more mental health professionals; back to the family doctor.
  • Starmer turns to Alan Milburn, former Minister of Health, close to Tony Blair, to fix the problems of the NHS, which is interpreted as meaning that the private sector and consumer choice will be at the center of the plans.
  • The first official report on Covid management in the United Kingdom is published. After multiple surveys, it will be published next Thursday and promises to reveal serious deficiencies in the management of Covid. It will be interesting to compare this report with the disappointing and incomplete one published in Spain, carried out by three experts selected by the government.
  • European hospitals lose more than 170,000 beds in a decade, but Spain increases them, despite continuing to be one of the European countries with the fewest beds per 100,000 inhabitants.

National Health Policy (Spain)

  • The State Public Health Agency, in limbo. The creation of this Agency takes forever. It’s a bit frustrating, says Eduardo Satué, president of the Spanish Society of Public Health and Health Administration (SESPAS).
  • Various communities offer bonuses and incentives to doctors: to cover the deficit in Primary Care (Andalusia) or to cover the wings of the region (Asturias).
  • AESEG requests a price difference between generics and brands, which Farmaindustria opposes, a measure that is already applied throughout Europe except in Spain. The sector has 21 production plants in Spain and generates more than 40,000 direct and indirect jobs.
  • Private healthcare runs the risk of dying of success. Waiting lists are exploding for private health insurance (which 1 in every four citizens already have), but, due to low premiums, reaching up to 20 or 30 euros per month, it is not possible to provide a good service. A giant is being built with feet of clay.
  • Serious management problems in the health sector, according to FEDEA. Despite the significant increase in resources in the health field, since the level of spending has grown from 13.2% in 1999 to the current 14.5% of the total spending of Public Administrations. Real public spending per inhabitant has grown by 48% since 2003. This reality contrasts with the idea that healthcare has experienced significant cuts in recent decades, when the only falls in real spending per inhabitant only occurred between 2010 and 2013.

Companies

  • International
    • Pfizer wants to enter the anti-obesity drug market, having an advanced trial with a daily pill, with which it intends to enter the obesity market that promises to be worth 100 billion dollars a year.
  • National
    • It is possible that Grifols will cease to be a listed company. The Grifols family in talks with the Brookfield fund to take the company private.

Biomedicine

  • NEJM review: Four decades of orphan drugs. The Orphan Drug Act (ODA) was approved in the USA in 1983, due to the lack of commercial interest in the development of these drugs. The law that developed incentives for production, the duration of patents and research was a success and more than 800 indications have already been approved. However, many rare diseases remain untreated and prices are unsustainable. This is why a new strategy is proposed for the next four decades (https://www.nejm.org/doi/full/10.1056/NEJMp2401487)
  • Non-communicable diseases in reproductive care. New approach to gestational diabetes (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01298-4/fulltext)
  • Gene therapy offers hope for autoimmune diseases. Use of CAR-T, originally intended for cancers, in lupus. Initial findings offer hope to millions of patients with autoimmune diseases, four in five of whom are women (https://www.ft.com/content/a974f4c1-bb8a-4a1b-9d88-a2cf14be5c6e)

Global Health

International health policy

National health policy

Companies

 

 

7 days in healthcare (May 15th-21st, 2023)

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Summary

From the point of view of Biomedicine, to point out certain warnings about the use of blood tests for the detection of cancer, an area with great growth, since in some cases there may be errors in diagnosis, over diagnosis and over treatment . Researchers are trying to improve Nuclear Resonance imaging, through fMRI, which will be able to detect brain activity on the millisecond scale. The WHO warns about the use of sweeteners for weight control and ChatGPT in health, without careful prior examination.

With regard to Global Health, The Lancet denounces in an editorial the continuation of the practice of the death penalty in some countries, but most fundamentally in China. The International Treaty on Pandemics, which may be one of the positive consequences of the covid, seems to be ready in May 2024.

Regarding International Health Policy, very interesting statements by the Director General of the WHO to The Economist magazine, following the lifting of the global alarm due to the covid. Trying to explain why the covid affected developed countries (such as the USA) in many cases more than developing countries, he comments that possibly a certain self sufficiency about the strength of their health systems and a concentration towards investments in specialized hospitals and high technology, in instead of public health, is at the origin of this situation. The crisis in the NHS continues, Starmer (Labor Party leader) says the system cannot be fixed without fixing the “fundamentals”. He seems to understand by “fundamentals” the need for reforms and not just more funding. EMA 2022 annual report, which greets that year as very positive due to the rapid development of new vaccines and new drugs.

If we talk about National Health Policy (Spain), apart from the rise in the incidence of covid, possibly the most far-reaching news is the shortage of certain medicines in pharmacies. It seems that the causes can be multiple, but basically three: the dependence on certain raw materials that are manufactured in India and China; parallel exports due to the lower price of medicines in Spain compared to other European countries; and the very low price of some drugs that discourages their production. In Primary Care, the real problems far exceed the weekend promises to give more money, apparently already committed. In-depth reforms and increased funding is what Primary Care needs, after a deep negotiation and consensus. The PP of Asturias promises to end, if it wins, with the exclusivity of doctors in that region, apparently already the only one in Spain that rigorously applies this regulation. The project of the new Hospital Clinic (Barcelona) of more than 1,500 million surprises by its grandeur. It is to be assumed that such a large investment is fully justified and explained very well to the population.

In the field of Companies, at the international level, a large fine was imposed on the pharmaceutical chain Walgreens in San Francisco for promoting the use of opiates. In Spain, the construction of a new hospital in Alicante by IMED stands out (is there a real boom in new private hospitals?); the sale to a German fund of 26% of ESTEVE; and, as unusual, the denunciation by the hospital employer ASPE of the agreement between Sanitas and Generali. It seems that the discrepancy is that Sanitas extends the advantageous rates that it had negotiated with suppliers, which are more favorable than those of Generali, to Generali customers in this way.

Biomedicine

Global Health

International Health Policy

  • China
    • What happened in China after the abandonment of the covid zero policy and the massive infection of omicron? The official figures for deaths are 87,475 between February 24 and March 16, 2023. Other estimates speak of between 1-1.5 million deaths. Surely the reality is somewhere in between (https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2804631)

National health policy

Companies

 

 

7 days in healthcare (April 17th-23rd, 2023)

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Summary

From the point of view of Biomedicine, this week, exceptionally, two important advances in Spain are mentioned. On the one hand, the important investigations of the team led by Dr. Obeso, at HM Hospitales, on how to “open” the blood-brain barrier, that barrier that, among other things, prevented the arrival of drugs to the brain. It seems that in this way possibilities could be opened for the treatment of Parkinson’s. On the other hand, at the Vall d’Hebrón Hospital in Barcelona, the first robotic lung transplant was approached through a small incision.

As far as Global Health is concerned, there is a great alarm, highlighted by UNICEF and The Lancet magazine, about the drop in immunizations in children after the covid. Although the covid highlighted the efficacy of the vaccines, it brought the side effect of this drop in immunizations globally. In Uganda, the new anti-homosexuality law takes repression against this sexual option to an extreme, endangering anti-HIV campaigns in that country. The G7, to be held in Japan in May, emphasizes various health issues, including the importance of universal health coverage and the need for resilient health systems.

Regarding International Health Policy, the WHO warns of the non-solution of the covid problem, since in the last 28 days there were 23,000 deaths and 3 million new cases globally, even with reduced test figures. High mortality in the USA, with around 245 deaths per day. In the United States, the government is preparing to finalize the guidelines for negotiating the price of drugs in Medicare in July, something totally new in that country and that is shocking the pharmaceutical industry. The American Supreme Court rectifies its previous decisions and allows the abortion pill mifepristone to continue to be used, amid abundant criticism of the Court, for having questioned something that the FDA had already authorized more than 20 years ago. According to The Economist, the annulment of the Roe v Wade ruling caused the number of abortions in the USA to drop by 6%. In the United Kingdom, the consequences in the NHS of the multiple and continuous strikes and conflicts of health personnel continue. The German government is clashing with other European governments in its efforts to reduce the timeframe for generics to appear, calling into question the pharmaceutical investment model, according to some.

If we talk about National Health Policy (Spain), the incidence of covid continues to rise, amid controversies about the advisability or not of suppressing masks where they are still mandatory (health centers, social health centers and pharmacies). Conflicts with health personnel continue in several autonomous communities. In public healthcare, quite important allocation of resources by the Ministry to primary care and mental health. In private health, in the first quarter of the year there was a growth of 7.5% in the policies of private health insurers. “Voting with your feet” is called that figure. The IDIS Foundation focuses, through an interesting publication, on an important problem: the mental health situation in our country. Since we have few problems, Catalonia insists on an artificial conflict: the use of Catalan in the healthcare system in that autonomous community. Both in Aragon and in Castilla-La Mancha, two initiatives of dubious utility and even suspected of electoralism are launched. In Aragon, a national debate on health is proposed through a very typical document of those that come out in the autonomous communities that could be summarized as “More money for health without reforms.” As for Castilla-La Mancha, a law on waiting lists is promoted, when the terminal state of the legislature suggests that it will not be approved.

In the field of Companies, internationally, Nestlé is accused of manufacturing unhealthy products, due to their high load of fat, sugar and salt. Merck makes a major investment buying Prometheus Biosciences for $11 billion. At the national level, Moderna opens a laboratory in Madrid.

Biomedicine

Global Health

International Health Policy

National health policy

Companies