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7 days in healthcare (August 7th-13th, 2023)

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Summary

From the point of view of Biomedicine, the NEJM insists on the need to prepare doctors for the new era of clinical algorithms, since misuse of these algorithms can be dangerous for patients. MIT advances may make conventional mammograms obsolete, as a “wearable” device can detect breast cancer using ultrasound. New facts are detected in relation to the growth of resistance to antibiotics: a species of virus parasites and air pollution. In any case, the United Nations says that by 2050 these resistances could represent more than 10 million deaths a year. Walking 4,000 steps a day can lower your risk of death from any cause.

As regards Global Health, Chris van Tulleken, famous doctor and TV presenter, is publishing a book on “ultra-processed food”, those whose manufacturing process makes them rich in calories, poor in nutrients and difficult to stop eating them, which poses a major health threat. In the United States, cases of syphilis are increasing, while penicillin to treat them is in short supply, given the low interest in the production of antibiotics by pharmaceutical companies.

Regarding International Health Policy, it should be noted that the WHO monitors the new variant of covid (EG.5), although it classifies its impact on public health as low. In the United Kingdom, a laboratory is created capable of launching new vaccines 100 days after the start of any pandemic. Let us remember that in the case of the covid the term was one year, which already represented a remarkable feat, something never seen before. Also in the United Kingdom, both private equity companies and the CEO of AXA, detect great business opportunities in the face of the great crisis of the National Health Service, something that should not surprise anyone, since the market is characterized by solving unsatisfied problems for what the population is willing to pay. The Nuffield Trust publishes its monthly monitoring of NHS performance, with particular monitoring of test and surgical waiting lists, cancer waiting lists, emergency room waiting times and ambulance response. A laudable initiative, which could well be imitated in our country.

If we talk about National Health Policy (Spain), although the measurement of the covid is not as rigorous as a few months ago, there are indirect indications that the incidence must be rising, as shown in the large increase in the sale of the antigen tests. The Sant Pau hospital begins an ambitious multidisciplinary Robotic Surgery program, which includes five surgical teams. Madrid launches the figure of the administrative assistant in Primary Care, something hopeful, but whose results will have to be seen.

In the field of Companies, internationally, Novo Nordisk and Lilly ready to conquer the promising obesity market. At the national level, anti-obesity drugs also enter our country, although of the three that exist (Ozempic and Wegoby, from Novo Nordisk; and Mounjaro, from Lilly) in Spain, only Ozempic is available and the public system only prescribes it for type 2 diabetes, not for obesity. The consolidation of the nursing home sector accelerates: Colisée, Vitalia, Clariane (formerly Korian), Domus Vi and Vivalto Vie, the most active players.

Biomedicine

Global Health

International Health Policy

National Health Policy

  • Public health innovations
    • Hospital Sant Pau starts a multidisciplinary Robotic Surgery Program that includes five surgical teams. Hepatobiliary and pancreatic surgery (HBP), Bariatric and Esophagogastric, Colon and Rectal, Gynecology and Thoracic Surgery (https://gacetamedica.com/profesion/el-hospital-sant-pau-inicia-un-programa-de-cirugia-robotica-multidisciplinary-that-includes-five-surgical-teams/#:~:text=They are%20five%20the%20surgical%20teams,and%20Thoracic%20Surgery%20(CTO).)
    • Madrid eliminates the bureaucracy of doctors with the figure of the administrative assistant (https://www.redaccionmedica.com/autonomias/madrid/madrid-empieza-a-liberar-de-burocracia-a-sus-medicos-con-una-new-figure-4733)

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