Posts

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

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Summary

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

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

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

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

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

Biomedicine

Global Health

International health policy

National health policy

Companies

7 days in healthcare (November 20th-26th, 2023)

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Summary

From the point of view of Biomedicine, in the United Kingdom an initiative aims to be able to produce medicines for individual patients in less than a year. According to the National Bureau for Economic Research (NBER) of the United States, artificial intelligence, even with use cases already developed, will produce savings in healthcare expenses between 5-10%. This will offset the rise in other expenses in the sector, such as new medicines and medical technologies.

As far as Global Health is concerned, there is a relationship between the pattern of economic income and obesity, which occurs more in low-income workers, in relation to those with higher incomes. The fight against climate change has already produced some results. The COP28 conference, which will take place starting next week in Dubai, is expected to produce a declaration on climate and health. Polio is about to be eradicated in a few months, but the great challenge is that it does not return, since eradication is not the same as extinction.

Regarding International Health Policy, in its latest issue The Economist dedicates a supplement to forecasts for 2024. Among the 10 general forecasts, there is one that says that in an older world, health expenditures will grow to reach one tenth of global GDP. Among the specific health forecasts, it is noted that the pandemic has led to a growth in public spending on health (up to 80%, starting from 75%). Growth in private activity and an increase in the global pharmaceutical market is expected, with research efforts concentrating on medications against obesity and mRNA patents. In the United States, there is evidence of the inadequacy of private health insurance to provide financial security to the elderly for long-term care. Important agreement in the United Kingdom between the NHS and pharmaceutical companies, with which an annual growth in spending on medicines of 4% is agreed until 2027. Surely, an example for many countries, including Spain. Also in the United Kingdom, an agreement between the NHS and community pharmacies for the provision of a series of services, which will mean a large reduction in consultations in Primary Care. The health insurance boom in the United Kingdom, due to the problems of the NHS, is revealing certain limitations of private health insurance to meet demand. Something similar to what happens in Spain. Important document from the WHO (European region) and the Observatory on health systems, in which several governments participate, including the Spanish one, talking about the convenience of the participation of the private sector in the public health service, establishing the requirements for this to be successful. European countries warn of the health problems of climate change, since Europe is the continent in which temperatures have risen the most.

If we talk about National Health Policy (Spain), new change in the Ministry of Health. Going to minister for a year or less does not seem like the best formula to address the long-term challenges of healthcare, without prejudice to the qualities of the new minister, which will have to be observed. Record in the waiting list, after the publication of the lists as of June 30 by the Ministry of Health. Important study on obesity in Spain published by the Carlos III Health Institute and AESAN, which demonstrates the relationship between the level of obesity and the postal district. A study by the Institute of Fiscal Studies shows that between the beginning of 2020 and the end of 2022, the number of doctors in the SNS has decreased by 17,000, despite the fact that the number of staff has increased globally. The Valencian Community launches a specific competition for positions that are difficult to fill. Aside from the approach of the tender, it is good that the specificities of this type of places are taken into account. There is no doubt that the standardizing approach to personnel policy does not allow us to solve certain problems, such as what are now called difficult-to-fill positions. Farmaindustria carries out, in collaboration with scientific societies, a study on clinical research in Primary Care. We are a powerhouse in clinical research in hospitals and there is no doubt that the bases of this success must be extended to other environments.

In the field of Companies, on an international level, problems in Bayer with a sharp drop in the stock, which the CEO of this company attributes to a limited pipeline, a consequence of a lack of effort in investment. At the national level, Vithas confirms its new hospital project in Valencia. For its part, Sanitas announces an investment to grow in nursing homes.

Biomedicine

Global Health

International health policy

  • European Union
    • European countries warn of the health problem of climate change. It is estimated that last summer there were 62,000 deaths in Europe due to heat, since this is the continent with the highest temperature rises. 18 member states ask the European Commission and ECDC for action (https://www.ft.com/content/52e71922-d9fc-49b6-98b5-3a4d37c21dbc)

National health policy

Companies

 

7 days in healthcare (October, 16th-22nd, 2023)

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Summary

From the point of view of Biomedicine, the largest research project in the world is taking place in the United Kingdom. It is about collecting information of all kinds from 5 million Britons, to then put that information to work in the preventive, diagnostic, therapeutic, Public Health field, etc. A milestone where the great contribution of AI to health and healthcare will be seen.

In terms of Global Health, The Lancet analyzes the problem of deadly gun violence and the intended approach in the United States, under the leadership of Vice President Kamala Harris. Although we tend to believe that this is a typical and especially acute problem in North American society, the truth is that in many Latin American countries the situation is much more serious: Brazil, Mexico, Guatemala, Venezuela, El Salvador,…

In terms of International Health Policy, a novel approach to smoking in the United Kingdom, where it is being proposed to address this problem from the beginning, slowing down the age of starting to smoke. A report by European pharmacists confirms that the shortage of certain medicines is a problem throughout Europe.

If we talk about National Health Policy (Spain), it is worth highlighting that the Generalitat Valenciana intends to recover the public management of the Manises and Denia hospitals, managed by concession by Sanitas and Ribera, respectively, while at the same time it proposes to continue with the concession of Vinalopó, which ends in 2025, also managed by Ribera. A priori, it seems like a judicious and non-sectarian approach from the Valencian government. The government’s Budget Plan foresees a percentage of GDP for health in 2024 of 6.7%, which contrasts with the results of the latest report of the Health Accounts System (July, 2023), which shows a public health expenditure of 7 .8% of GDP in 2021. Given that, as in the 2010 crisis, measures to reduce health spending (such as lowering staff salaries, freezing substitutions or reducing the price of medicines) are not announced, it is difficult to believe that this objective of 6.7% in public health in 2024 will be met, especially when some communities, such as the Basque Country, are announcing increases in health spending. The Andalusian Health Institute is created, the result of the merger of the Andalusian School of Public Health and the Progreso y Salud Foundation, which lose their status as public companies and, therefore, a certain autonomy. Given the history of the current Andalusian government with public hospital companies, we fear that it is another step towards the “administrativeization” of the public health system. Time will tell if this is progress or setback, but they do not seem to bode well, given the poor results of the operation in the hospital setting.

In the field of Companies, on an international level, the purchase by MSD from Daiichi of several cancer drugs is worth highlighting. At the national level, OHLA is awarded the construction of the new Vithas hospital in Turia. Important commitment of venture capital (Advent) in the field of dental care (Vitaldent), which contrasts with the low commitment of the government in this field, which distances us from Europe, being one of the countries with the least public financing in dental care.

Biomedicine

Global Health

International health policy

National health policy

Companies

 

 

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

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Summary

From the point of view of Biomedicine, the contribution of Artificial Intelligence to medical diagnosis is reviewed by JAMA magazine. It seems clear that AI is not going to replace the so-called Narrative Medicine, that ability of the doctor to communicate and to listen and interpret the history of the patients. Interesting advances in the field of  a simple way to diagnose pre-eclampsia and Parkinson’s.

With regard to Global Health, more and more importance is given to loneliness and its consequences on health, according to an editorial in The Lancet. Hunger and famine as a product of human activity, especially armed conflicts, is treated by Nature. Concern regarding the AIDS situation in sub-Saharan Africa, where anti-retroviral therapy has barely reached.

Regarding International Health Policy, in the United States, the FDA approves the first drug to slow down the progression of Alzheimer’s. In the UK, three health think tanks (King’s Fund, Nuffield Trust and The Health Foundation) are addressing both the government and the opposition calling for solutions to the critical situation of the NHS. They denounce a decade of underfunding, which has led the UK to have far fewer human and material resources than most European countries. An interesting subscription model for antibiotics is being considered in the United Kingdom. Pharmaceutical companies will receive 20 million pounds per antibiotic put on the market, regardless of the prescription. In France, the Cour des comptes publishes documents to promote home palliative care and the development of advanced practice nursing. An interesting WHO-Europe document on hospitals and their challenges is published.

If we talk about National Health Policy (Spain), the beginning of the general elections on July 23, has made the different parties have made their programs public, including the health ones. The PP dedicates 24 measures to health. The strong points are: the Primary Care Shock Plan (although the title on emergencies is debatable); the State Public Health Agency; the Agency for Innovation and Quality (similar to NICE); digitization; palliative care; and, the mental health strategy. A new General Health Law is announced. Although the current law has many obsolete points, the legal technique of addressing a new law (instead of partial reforms in relation to different issues) is debatable. There is a risk of opening a very large melon, of generating long delays and of putting health into the same dynamic as education (a law for each new government). Conspicuous absences: nothing about financing, no mention of waiting lists (one of the most serious problems in the system), dental care (an area in which we are very far from Europe) and nothing about public/private collaboration. The PSOE program continues to identify public service with public management, thus distancing itself from any form of public/private collaboration. Many measures are contemplated, seeming more like a government plan than an electoral program, so the priorities are difficult to identify. The star measure seems to be announcing a law on waiting lists. Laws on waiting lists have never been effective in any autonomous community. The solution to the waiting lists does not go through a time guarantee law but rather resources and productivity of the public system and an updated and agile system of collaboration with the private sector. SUMAR incorporates the Podemos program: creation of a public pharmaceutical company; end of the MUFACE model; deprivatization plan, including cleaning, catering and laundry; progressive elimination of the pharmaceutical co-payment; they also announce a law on waiting lists. The Vox program represents an amendment to the whole: recentralization of health, recovering powers in health matters; approach waiting lists; repeal of the euthanasia and abortion law; strong criticism of the WHO, which they accuse of dependence on China. At the national level, the other great news is the alarm given by the insurers involved in the MUFACE model (Adeslas, Asisa and DKV) regarding the fact that its financing is generating large losses, unaffordable in the long term.

In the field of Companies, internationally, large pharmaceutical companies (Merck, BMS) are suing the American government for what they consider lowering prices, as a consequence of the anti-inflation law. In Spain, Ribera continues to bet on public/private collaboration, but this time in Portugal.

Biomedicine

Global Health

  • Editorial of The Lancet: Loneliness as a health problem. In the UK and Japan there are loneliness ministers. The health damages are clear: cardiovascular disease, hypertension, diabetes, infectious diseases, depression and anxiety. Loneliness is not the same as being alone and can affect all ages (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)01411-3/fulltext)
  • Hunger and famines are not accidents, but facts created by human action. Around 200 million people experience acute food insecurity. Especially Afghanistan, Burkina Faso, Ethiopia, Mali, Sudan and Syria. Hunger and conflict are connected (https://www.nature.com/articles/d41586-023-02207-2)
  • HIV in Africa. Antiretroviral therapy has transformed AIDS into a chronic disease. But in sub-Saharan Africa, where 70% of AIDS patients live, few have access to this therapy, which greatly decreases life expectancy in the area (https://www.nejm.org/doi/full/10.1056/NEJMp2304600)

International Health Policy

  • COVID19
    • Weekly covid report published by the WHO, July 6, 2023. The African region has shown a slight increase in deaths with a decrease in cases. The remaining five WHO regions show a decrease in both the number of cases and deaths (https://apps.who.int/iris/handle/10665/370545)
  • United Kingdom and National Health Service
    • Three health think tanks (King’s Fund, Nuffield Trust and The Health Foundation) address government and opposition on NHS issues. They are betting that the next election will end short-term politics in the NHS. The recovery of NHS services and waiting lists must be a priority. They denounce a decade of underfunding. They welcome the long-term plan on personnel, published last week. They point out that life expectancy is the second worst (before only the USA) of the 19 health systems analyzed in the King’s Fund report (https://www.health.org.uk/news-and-comment/news/joint-letter-to-political-leaders-in-england-on-future-of-nhs)
    • The NHS intends to roll out the subscription model for antibiotics. Under the new proposal pharmaceutical companies would receive £20m for their new antibiotics, regardless of how many may be prescribed (https://www.ft.com/content/a0b5a2ad-06a4-499d-8195-b4d6a3f65f7a)

National health policy

  • 23 J elections: the health program of the PP
    • The PP dedicates 24 measures to health. The strong points are: the Primary Care Shock Plan (although the title urgent and emergencies is debatable); the State Public Health Agency; the Agency for Innovation and Quality (similar to NICE); digitization; palliative care; and, the mental health strategy. A new General Health Law is announced. Although the current law has many obsolete points, the legal technique of addressing a new law (instead of partial reforms in relation to different issues) is debatable. There is a risk of opening a very large melon, of generating long delays and of putting health into the same dynamic as education (a law for each new government). Conspicuous absences: nothing about funding, no mention of waiting lists (one of the most serious problems in the system), dental care (an area in which we are very far from Europe) and nothing about public/private collaboration (https://www.pp.es/sites/default/files/documentos/programa_electoral_pp_23j_feijoo_2023.pdf)
  • 23 J elections: the health program of the PSOE
    • The PSOE program continues to identify public service with public management, thus distancing itself from any form of public/private collaboration. Many measures are contemplated, seeming more like a government plan than an electoral program, so the priorities do not look good. The star measure seems to be announcing a law on waiting lists. Laws on waiting lists have never been effective in any autonomous community. The solution to waiting lists does not go through a time guarantee law but resources and productivity of the public system and an updated and agile system of collaboration with the private sector (https://www.psoe.es/media-content/2023/07/PROGRAMA_ELECTORAL-GENERALES-2023.pdf)
  • 23 J Elections: SUMAR’s health program

Companies

 

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

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Summary

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

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

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

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

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

Biomedicine

Global Health

International Health Policy

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

National Health Policy

Companies

7 days in healthcare (March 13th-19th, 2023)

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Summary

From the point of view of Biomedicine, the debate on the governance, supervision and ethical limits of human genome editing is increasingly present, precisely when it seems that many medicines based on this technique are in advanced development, to treat many sicknesses. Nature publishes a novel approach to disseminate Magnetic Resonance, which fifty years after its birth is still a very expensive technique and not accessible to many countries. The mapping of the brain of a larva, after decades of research, heralds advances in the knowledge of more complex brains.

As regards Global Health, the WHO has drawn up the first draft of a treaty on pandemics, precisely to avoid what happened during the covid, the great differences in mortality, morbidity and access to treatment between the different countries.

Regarding International Health Policy, in the United States, the New York Times denounces that aggressive medical behavior continues to be common at the end of life. This same newspaper echoes in its editorial section the serious crisis of the British National Health Service, where several strikes are coexisting at this moment: nurses, consultants, junior doctors and ambulance drivers. The prestige of the NHS among the population plummets. Le Monde publishes in France a report on the change of pharmacies: from drug stores to health “hubs”. BCG releases a report on the scope and benefits of the metaverse in health.

If we talk about National Health Policy (Spain), the incidence of covid continues to increase. It is estimated that 1 million people in Spain may have persistent covid. The conflict between the Primary Care doctors in Madrid ends (it was about time). The SNS will address the problem of the carbon footprint of hospitals. The low remuneration of consultations by healthcare insurance companies is denounced, it is urgent in this sector to move from a model of payment by activity to another of payment by value.

At the Corporate level, internationally, Pfizer is addressing the purchase of Seagen, a biotech-oriented biotech company. As far as national news is concerned, it should be noted that HM Hospitales opens (in Rivas) its eighth hospital in Madrid.

Biomedicine

Global Health

International Health Policy

National Health Policy

Companies

Vithas: the second private hospital operator in Spain, with the vocation of being the first

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On December 15, 2022, within the series “Breakfasts with health sector leaders“, organized by Roland Berger, a breakfast with Pedro Rico, General Director of Vithas, took place.

A summary of the breakfast content is as follows:

The origins

The Vithas group was officially presented on November 21, 2012, now celebrating the 10th anniversary of its origin. At that time, the group had 1,000 beds in 10 hospitals located in Madrid, Vigo, Alicante, Almería, Granada, Málaga, Lleida, Vigo, Vitoria, Las Palmas and Tenerife. Regarding its billing figures, the group reached 196 million euros.

At the beginning, the property was owned by the Goodgrower Group, linked to the Gallardo family, which held 80% of the shares and Criteria, with 20%. Subsequently, Goodgrower acquired the participation of Criteria, going on to hold 100% of the shares. From the beginning, the Presidency of Vithas has been in the hands of Jorge Gallardo Piqué.

A growth story

In 2014, Vithas incorporated the Xanit Internacional hospital (Benalmádena).

This same year, the Vithas Salud centers were created, designed as local specialty centers without hospitalization, and the Vithas Salud Fisium centers were incorporated in the province of Pontevedra.

In 2015 the group signed a strategic agreement with the Juaneda Assistance Network (Baleares). That year the new Vithas hospital was inaugurated in Granada and the five centers of the Rincón Clinics in the province of Malaga were acquired. The Lema and Bandín laboratories joined the Vithas group, renamed Vithas Lab.

In 2017 the expansion of the group gained new impetus with the acquisition of the 7 hospitals that made up the NISA group. This operation, together with the hospitals of Almería and Málaga and the shareholding agreement with the Juaneda Assistance Network, positioned Vithas as a leader in private healthcare throughout the Mediterranean arc

Growth continues in 2018 when the group takes another step towards the incorporation of highly specialized centers such as the Eurocanarias Ophthalmological Institute.

In January 2020, the group acquired the emblematic La Milagrosa hospital, located in the center of Madrid, consolidating the group’s presence in this city, where it already had two other hospitals, 1 specialty center and Vithas Internacional.

Vithas during the pandemic

During the pandemic, the group is 100% involved in patient care and actively collaborates with the authorities to deal with the health crisis, of course applying the corresponding internal protocols to ensure the safety of professionals.

It is worth highlighting two relevant initiatives in this field: the so-called Aerobox, a portable device for individual isolation of patients that prevents the transmission of the virus; and the solidarity project with other companies and institutions to develop OxyVita, an efficient and low-cost emergency ICU ventilator, which has been made available to all hospitals and health systems in the world in open source and free of rights.

Digital transformation as an integration tool

Since January 2020, the group has been promoting its digital transformation through the implementation of a new IT tool.

The idea is to overcome the old pre-existing hospital culture and move towards what is called Vithas one, in such a way that it has:

  • unique data
  • Single electronic medical record
  • single database
  • A centralized contact center

The will to create a centralized access for patients, gave rise to the launch in 2020 of a centralized contact center, as a high-performance center, where more than 120 operators work, understood as a strategic pillar of quality improvement. , recruitment, loyalty and customer satisfaction.

Impulse to Vithas diagnosis

In 2020, Vithas Diagnosis was launched, with an offer in clinical laboratory, imaging and pathological anatomy, with the idea of centralizing all of the company’s diagnostic activity and, at the same time, providing services to third parties.

My Vithas

This project tries to build the foundations of the digital experience for Vithas patients, incorporating the web and an app.

The result by 2022 is that there are already 669,034 digital users and 631,749 online appointments have been managed. At this moment, 14.6% of the group’s transactions are online.

New projects

Vithas’ desire for growth continues in 2022 with the construction of a new hospital in the province of Barcelona (where until now it had no presence), and another hospital in the south of Valencia, the third in this city. Both will mean a joint investment of more than 90 million euros.

During 2022, the Vithas Salud Gibraltar and Vithas Salud Alzira centers were inaugurated, as well as the expansion of the Vithas Madrid Arturo Soria surgical unit and the completion of the expansion of Vithas Xanit Internacional, which doubles its care capacity on the Costa del Sol.

Mainstreaming of specialties

This work was preceded by a definition of the Clinical Care and Governance Model of the strategic specialties.

After the launch of the Vithas Cardiovascular Institute, the Vithas Neurosurgery Unit and the Vithas Oncology Institute were created, adding to all the existing benefits a transversal and comprehensive assistance service specialized in each of these three major therapeutic areas.

The idea for the future is to boost the growth and activity of the institutes in operation and to promote research, as well as to continue with the territorial expansion of the Institutes model.

A great concern for quality

Quality is the central axis of the entire Vithas strategy. Apart from accreditation by the Joint Commission International, the patient experience is a core element of the “Vithas culture“. There is a Director of Patient Experience.

Vithas people

Based on the confirmation that professionals are the most important asset of Vithas, the aim is to promote a patient-focused organization that cares for its professionals.

For this, the approach is to offer future projects, internal promotion, training and recognition policies, with specific training plans (eg, IESE executive leadership, Master of Nursing).

Vithas’ university vocation

As a sign of its commitment to the training and development of healthcare talent, in November 2022, the three centers in Madrid (Vithas Madrid Arturo Soria, Vithas Madrid Aravaca and Vithas Madrid La Milagrosa) are accredited as university hospitals.

Vithas and research

As a sign of concern for research, the Vithas Foundation is promoting scientific publications, with an impact factor that grows every year, as well as conducting commercial clinical trials, the number of which also increases every year.

The “new” Vithas

During this time the appearance of Vithas has completely changed, the number of beds, ICU positions, internal consultations and surgical interventions have doubled; the volume of business, professionals and operating rooms has tripled; and the number of centers and patients attended has quadrupled.

But, apart from these quantitative data, there are other qualitative ones, no less important:

  • Concern for quality and patient experience
  • The promotion of the university character and teaching and research
  • digital transformation
  • The integration process of differentiated cultures
  • The “mainstreaming” of specialties, through the Institutes
  • The offer of a growth project to its professionals

That is why it is not hyperbole to speak of a new Vithas.