Summary

From the point of view of Biomedicine, the FDA opens the door to the first treatment with CRIPSR gene editing, applied in this case to sickle cell anemia. The “liquid biopsy” seems to be able to detect cancer recurrence before any radiological signs. A change is proposed in the regulation of embryo research. The laws and conventions in force do not allow embryos to be investigated in the laboratory beyond day 14. There is a gap until day 28, when embryos from abortions can already be investigated. This seems to prevent us from knowing many elements of organ development and that is what we are trying to modify. Although it is often assumed that dementia is increasing as the population ages, there appears to already be some evidence that the incidence of dementia is decreasing quite significantly.

As far as Global Health is concerned, the director general of the WHO is alarmed by the indescribable situation in Gaza. Nigeria is preparing to vaccinate 8 million girls with the papillomatosis vaccine, related to cervical cancer.

Regarding International Health Policy, in the United States, despite the prohibition of abortion in some states as a consequence of the Dobbs ruling of the Supreme Court, the abortion rate has not decreased a year after this ruling. The Economist considers how it is possible that doctors in the United States earn so much ($350,000/year on average), coming to the conclusion that it is due to an artificial shortage of doctors, due to the few places in Medical Schools, despite that there is no shortage of candidates. In the United Kingdom, the investigation into covid seems to show the disaster in management during the Boris Johnson period. Bad business, although the case of Spain is worse, where, despite promises, no report on the management of the pandemic has been made public. Health changes are on the horizon in Poland, following the arrival of the new government. Kenya, with 53 million inhabitants, joins the movement of so many other countries to move towards universal health coverage.

If we talk about National Health Policy (Spain), the XENOMA project in Galicia is very important, which aims to analyze the DNA of 400,000 Galicians. One of the precedents is the project to analyze the genome of 100,000 Britons, promoted during the David Cameron period and managed by Genomics England. Surely a project of this style should have been promoted at the national level, but it is good that, in the absence of the above, it should be promoted by an autonomous community. Doubts among experts about one of the measures of the PSOE-Sumar agreement on a law to end waiting lists. Without funding, better accounting and prioritization, organizational measures, new incentives and public/private collaboration, no law is capable of solving this problem. After all, a Royal Decree that establishes maximum times for certain procedures has already been in force since 2011, but it is not being complied with. Virtually all autonomous communities are approving increased health budgets for 2024, rising especially in Primary Care. Just because the budgets grow compared to the previous year does not mean that they are higher than the real spending in 2023, which is happening in Madrid, for example. The PSOE-ERC agreement contemplates the transfer of at least 150 million euros/year to Catalonia, for scientific and technical research.

In the field of Companies, on an international level, Google intends to grow in healthcare, based above all on artificial intelligence tools. Regarding the covid vaccine, GSK raises profit forecasts, while Moderna and Pfizer contemplate setbacks. At the national level, Fresenius sells its Quirón business in Peru. The Sant Joan de Deu Hospital in Barcelona creates an artificial intelligence laboratory with Microsoft.

Biomedicine

• The US FDA opens the door to the first treatment with CRISPR gene editing. Specifically against sickle cell anemia, a painful disease with deformation of red blood cells (https://elpais.com/ciencia/2023-10-31/la-agencia-del-medicamento-de-ee-uu-open-the-door-to-the-first-treatment-with-crispr-genetic-editing.html)
• Detection with blood tests of tumor recurrence, before any radiological sign. Great possibilities of the so-called “liquid biopsy” (https://elpais.com/salud-y-bienestar/2023-11-03/klaus-pantel-oncologo-con-los-analisis-de-sangre-podemos-encontrar-signs-of-the-tumor-returning-months-before-the-radiologist-can-see-it.html#:~:text=The%20question%20that%20everyone has,could%20give%20u)
• Changes in the rules of research with embryos. There is currently a 14-day rule, which prevents embryos from being plated after day 14. This is the law in several countries, including the United Kingdom and Canada, and is widely practiced in all countries. There is a movement that tries to extend this limit, in order to better understand the development of some organs. Editorial in The Economist: https://www.economist.com/leaders/2023/11/02/why-the-rules-on-embryo-experiments-should-be-loosened#. Article in The Economist: https://www.economist.com/science-and-technology/2023/11/01/lab-grown-models-of-embryos-increasingly-resemble-the-real-thing. Editorial in The Lancet: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02452-2/fulltext
• What is behind the unexpected decline of dementia. Although it is often assumed that the aging of the population will trigger cases of dementia, there is evidence that goes against this assumption. A study shows that in Europe and the USA cases have decreased by 13% in the last 25 years (https://www.ft.com/content/184f6e81-d9ce-4a14-84f0-5190ea36e798)
• Some hope in monitoring dementia (https://www.ft.com/content/95291045-e65d-43e8-8a82-d435ee99682d)

Global Health

• WHO Director General: “The situation on the ground in Gaza is indescribable” (https://www.consalud.es/pacientes/tedros-adhanom-director-oms-situacion-sobre-terreno-en-gaza-es-indescribable_136483_102.html)
• It is time to address the climate and nature crisis as a global health emergency (https://www.bmj.com/content/383/bmj.p2355)
• The global fight against HIV, at risk (https://www.science.org/doi/10.1126/science.adm6975)
• Nigeria treats almost 8 million girls with the vaccine for papillomatosis, related to cervical cancer (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02450-9/fulltext#:~:text=Backed%20by%20Gavi%2C%20the%20Vaccine,%2C%202024%2C%20in%2021%20states.)
• Air pollution linked to an increase in type 2 diabetes, according to an Indian study (https://www.theguardian.com/global-development/2023/nov/01/air-pollution-raises-risk-of-type-2-diabetes-says-landmark-indian-study-acc#:~:text=They%20found%20that%20one%20month,for%20diabetes%20increased%20by%2022%25.)

International health policy

• USA
  • According to a survey, vaping among teens has decreased this year (https://www.nytimes.com/2023/11/02/health/vaping-teenagers-survey.html)
  • Infant deaths have increased for the first time in 20 years (https://www.nytimes.com/2023/11/01/health/infant-mortality-rate-rise.html)
  • Despite state bans, the abortion rate has not decreased in the USA (https://www.nytimes.com/2023/10/24/upshot/abortion-numbers-dobbs.html)
  • Why American doctors earn so much. A wrong training management system has artificially reduced the number of doctors. American doctors earn an average of $350,000/year and in a decade the country will have a shortage of 124,000 doctors. Meanwhile, many medical school applicants are rejected (https://www.economist.com/united-states/2023/10/31/why-doctors-in-america-earn-so-much#)

• United Kingdom and the National Health Service
  • The investigation into covid in the United Kingdom shows chaos in Boris Johnson’s government. Witnesses will be questioned until 2026. It seems clear that the UK did very poorly before the arrival of the vaccine (https://www.economist.com/britain/2023/11/01/the-covid-19-inquiry-exposes-chaos-in-boris-johnsons-government)
  • More and more companies in the UK are considering offering private insurance to their employees (https://www.ft.com/content/6c1c50e9-3426-485b-b288-30fcc2b2ea84)

• Poland
  • The new government, prepared to make changes in health. As the new government prepares to take power, doctors hope for improvements in what they say is a healthcare system broken by years of neglect and political mismanagement (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02449-2/fulltext)

• Kenya
  • Significant health reforms in Kenya. A new health system is in preparation after President Ruto signed four laws establishing universal healthcare on October 19. Three new funds are created: one for primary care, another for universal health insurance and the third to ensure equitable access to health services (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02451-0/fulltext#:~:text=Kenya%27s%20health%2Dcare%20system%20is,care%20without%20experiencing%20financial%20hardship.)

National health policy

• XENOMA Project in Galicia
  • The DNA of 400,000 Galicians is analyzed. This initiative, described as a “giant leap” by President Rueda, will begin in 2024, will have an investment of 20 million euros and is aimed at early diagnosis and the development of individualized pharmacological treatments (https://diariofarma.com/2023/10/31/proxecto-xenoma-dna-de-400-000-gallegos-to-capture-high-risk-genetic-variants/)

• Law on waiting lists
  • Doubts regarding the effectiveness of this announced law, agreed between the PSOE and Sumar. A royal decree guaranteeing maximum times for some procedures has already been in force since 2011, but it is not always complied with (https://elpais.com/sociedad/2023-11-04/revertir-las-listas-de-espera-sanitarias-by-law-is-viable-the-commitment-of-psoe-and-sumar.html)

• Judicial setback to private insurance
  • Due to the health cost during the pandemic, when the regulations of some autonomous communities prevented these patients from being treated in private centers and now impose exorbitant public prices (https://www.elconfidencial.com/empresas/2023-11-01/the-state-wins-asisa-and-obliges-him-to-pay-for-assistance_3765507/)

• Health budgets 2024, on the rise
  • The autonomous communities present rising health budgets, with a large weight of primary care, although in many cases this does not mean that they exceed the previous year’s spending (https://www.consalud.es/autonomias/ccaa-present-health-budgets-increase-2024-with-great-weight-ap_136521_102.html)

• MUFACE Impact
  • The impact of eliminating the MUFACE model is estimated at 3,000 million euros (https://www.epe.es/es/sanidad/20231102/muface-desaparicion-modelo-tendria-coste-94124919)

• New order for reference prices for medicines
  • It represents a saving of 217 million euros (https://elglobal.es/politica/la-nueva-opr-supondra-un-ahorro-de-21754-millones-de-euros-para-la-farmacia/)

• PSOE-ERC Agreement
  • This agreement entails a broad interpretation of what is contained in the Statute of Catalonia on exclusive competence in matters of scientific and technical research and contemplates an annual transfer of at least 150 million euros for R&D in health in Catalonia (https:// diofarma.com/2023/11/02/agreement-psoe-erc-the-state-will-transfer-at-least-150-million-year-for-id-to-cataluna/#:~:text=Policy-,Agreement %20PSOE%2DERC%3A%20the%20State%20willtransfer%20to%20less%20150%20million,for%20I%2BD%20to%20Catalonia&text=Fé). Text of the agreement: https://estaticos-cdn.elperiodico.com/epi/public/content/file/original/2023/1102/17/atrabajo-psoe-erc-021123-pdf.pdf (point 4, Singular management, of Annex 2)

Companies

• International News
  • Google’s plan for healthcare, its development seems to be based on the generation of AI tools for the healthcare sector (https://medicalfuturist.com/googles-masterplan-for-healthcare/)
  • Moderna suffers on the stock market due to lower demand for covid vaccines (https://www.ft.com/content/e580fad1-29c0-4bbd-8e79-d7298d4da49e)
  • GSK raises profit forecasts due to strong vaccine sales (https://www.ft.com/content/4cfdfef4-5d24-4ec4-b6b0-ea6d2aa5d249)
  • Pfizer loses more than 2.2 billion in the third quarter due to low demand for its anticovid products (https://www.elespanol.com/invertia/observatorios/sanidad/20231031/pfizer-pierde-millones-tercer-trimestre-baja-demand-anticovid-products/806169503_0.html)

• National
  • Fresenius continues to lose weight and sells his Quirón business in Peru (https://www.plantadoce.com/empresa/fresenius-sigue-adelgazando-y-vende-el-negocio-de-quironsalud-en-peru.html#:~:text=2023%20—%2011%3A18-,Fresenius%20continues%20losing%20and%20sells%20the%20business%20of%20Quirónsalud%20in,QuirónSalud%20says%20goodbye%20to%20P)
  • Hospital Sant Joan de Deu and Microsoft create an AI laboratory (https://www.plantadoce.com/sala-de-espera/el-hospital-sant-joan-de-deu-y-microsoft-crean-un-ia-laboratory.html)
  • Grifols makes money again and will sell Shanghai Raas before 2024 (https://www.eleconomista.es/salud/noticias/12519408/11/23/grifols-vuelta-a-ganar-dinero-y-vendera-shanghai-raas-before-2024.html#:~:text=Grifols%20returns%20to%20earn%20money%20and%20sell%20Shanghai%20Raas%20before%20of%202024,-The%20company%20se&text=T)