Posts

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 7th-12th, 2023)

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Summary

From the point of view of Biomedicine, the geneticist Francisco J Ayala, one of the great Spaniards of science, with important contributions in the field of the human genome and other diseases, dies. Some obscure episodes, not fully clarified, pointed to him as a target of the “me too” initiatives. It is increasingly clear that gene therapies will soon explode and will be useful in multiple hematological, cardiac, ocular, muscular and even neurodegenerative processes. An ethical reflection is essential, which ensures, on the one hand, that these treatments are accessible, and, on the other, the limits of these treatments. It seems that we are closer to having specific treatments against fatty liver, a serious disease responsible for tens of thousands of deaths.

As regards Global Health, young people, including adolescents, with gender dysphoria are growing all over the world. There is no accepted professional consensus on how to approach these situations. It seems increasingly clear that inequality in the face of covid vaccines responsible for thousands of deaths from this disease. Although there is no absolute consensus, it seems increasingly clear that smartphones and social networks are responsible for serious mental health problems among young people. 24/7 access to these technologies minimizes face-to-face contact between young people.

Regarding International Health Policy, the WHO maintains the covid as a “health emergency of international concern”. In the United States, the budget presented by Biden – which will not be approved – proposes a significant increase in funds for Medicare. Problems continue for the Walgreens pharmacy chain for not selling abortion pills in 21 states. The USA plans to eliminate hepatitis C, almost a decade after highly effective therapies for this disease appeared. Concern in the United Kingdom about the interruption of the improvement in life expectancy for a decade, before the covid, contrary to what is happening in France or Denmark, for example. Australia is preparing to tackle a health reform, after the preparation of an independent report, a model that could well be inspiring for Spain. Newsweek magazine publishes its well-known ranking of the best hospitals in the world. The Mayo Clinic, in Rochester, and the Cleveland Clinic, in Cleveland, considered the best hospitals in the world. Among the first hundred there are 6 Spaniards, all of them public, except one private: the Clínica Universidad de Navarra (CUN).

If we talk about National Health Policy (Spain), in terms of covid, the accumulated incidence continues to rise slightly, with a fairly high mortality (139 patients in one week). In Castilla y León, the health areas will have access to a team on rare diseases. Serious concerns among psychiatrists about the large increase in cases of gender dysphoria. The actors in the cyber attack on the Hospital Clínic de Barcelona request a ransom of 4.5 million dollars, which the Administration refuses to deliver. Some Catalan doctors are organized to attend only in Catalan, something against repeated court rulings and the Generalitat’s own protocols.

At the Corporate level, at the international level, investors are rubbing their hands at the prospects of big business in anti-obesity drugs. Morgan Stanley has quantified what this can mean in billions of dollars worldwide. Pfizer places its vaccine against covid as the drug with the highest income in the world. At the national level, Quirón reaches an agreement with the City Council for the construction of its hospital in Gijón and Hospitén announces the construction of a new hospital in Madrid with a large investment of 160 million euros. Thus, the boom in new private hospitals continues, for which there is a real race in which several actors participate (Quirón, Viamed, Vithas, Hospitén, Imed, and others). Hipra will return aid to the covid vaccine in ten years.

Biomedicine

Global Health

International Health Policy

  • Best hospitals in the world
    • Newsweek magazine publishes its traditional ranking of the best hospitals in the world. The first three are: the Mayo Clinic in Rochester, the Cleveland Clinic in Cleveland, and the Massachusetts General Hospital in Boston. Among the first 100 are 6 Spanish hospitals: La Paz, (53); Barcelona Clinic (62); October 12 (72); Vall d’Hebrón (83), Gregorio Marañón (90) and the CUN (97) (https://www.newsweek.com/rankings/worlds-best-hospitals-2023)

National health policy

Companies

7 days in healthcare (January 2nd-8th, 2023)

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Summary

From the point of view of Biomedicine, it is important to highlight significant advances in the treatment of some diseases, such as Alzheimer’s, breast cancer (a project inspired in its day by José Baselga), brain tumors, including the dreaded glioblastoma multiforme, and resistant tuberculosis.

With regard to Global Health, the WHO warns of global health threats in 2023: the Ebola outbreak in Uganda, which fortunately already seems to be in recession; the drought in the Horn of Africa; cholera, endemic in 69 countries; non-communicable diseases (particularly cardiovascular, diabetes, respiratory diseases and cancer), as well as the global stagnation due to the pandemic in the fight against various diseases: HIV, malaria and tuberculosis. Science reminds us that wastewater analysis has proven to be extremely useful for monitoring infectious diseases.

As for International Health Policy, with regard to covid, global concern is not so much for the cases that may come from China (which seem to correspond to the omicron that we already know) but for the new variant (Kraken) of United States, much more contagious than omicron and already affects a high percentage of cases in that country. The serious problems of the end of covid zero in China continue, with the opening of the country on January 8, which has been closed for three years. An editorial in The Economist looks at how the grand reopening may affect the global economy. Once again, the WHO says that mortality from covid in China is underestimated, if official figures are taken into account. Big change in the United States, where the abortion pill can be purchased in ordinary pharmacies. The large pharmacy chains, willing to participate in this sale. It must be remembered that a high percentage of abortions in the United States are already pharmacological. Serious crisis in the British National Health Service, with staff strikes, long waiting lists, saturation of emergencies and statements by unions and the Prime Minister. Labor wants to pass NHS employees to GPs (primary physicians), something that is in contradiction with the founding political pact of 1948 for the creation of the National Health Service, in which Aneurin Bevan participated. In France, health is also at the center of the political debate, with some statements on January 6 by President Macron, who considered among the solutions nothing less than ending fees per act, which in France are big words.

If we talk about National Health Policy (Spain), the year opens with the prospect of regional elections in 12 autonomous communities (May 28) and general elections at the end of the year, as well as a change in the head of the Ministry of Health. Several laws have been announced, including some advanced (new framework personnel statute, abortion, equity law), others more delayed (Public Health Agency, law of guarantees, possible reform of the dependency law). The Platform of Patient Organizations (POP) makes 10 proposals for chronic patients. As for professionals, some health insurance companies (DKV) have reacted quickly and announced increases in rates for doctors, which is undoubtedly a response to the criticism they had received from some medical associations, which even have raised certain protest actions. A piece of news says that the Zendal hospital has only 56 patients, which speaks of the fact that it has not yet found its place in Madrid’s health system, not surprising, since it seems that this hospital was established without the corresponding and obligatory Functional Plan (which defines the service portfolio, the population to be served, the incardination in the rest of the system, technology, personnel needs and other basic issues). Biosimilars, under the leadership of BIOSIM and starting in Extremadura, delve into the experience of shared benefit.

In the business sphere, in the international arena, Moderna acquires a genomics company. On the other hand, the completion of the Da Vinci robot patent will change the prospects for robotic surgery. At the national level, Ribera assumes the management of the Cascais hospital in Portugal, which is good news for public/private collaboration in our country.

Biomedicine

Global Health

International Health Policy

National health policy

Companies

7 days in healthcare (October 31st-November 6th, 2022)

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Summary

From the point of view of Biomedicine, the start of human trials of drugs discovered by Artificial Intelligence should be highlighted, something that is attracting the attention of all Big Pharma companies.

With regard to Global Health, it should be noted that COP27, the major international conference on climate change, will be held in Cairo on November 7 and 8. His opening coincides with the editorial in The Economist in which he says that the goal of keeping the temperature from rising 1.5º is totally unrealistic, proposing various alternatives. Ukraine’s health system prepares for nuclear disaster. Cholera outbreaks in various parts of the world.

Regarding International Health Policy, the WHO publishes a document on the development of telemedicine in Europe, identifying the problems of the user, technology and infrastructure as the main obstacles to its development. Problems in the British and French health systems.

If we talk about National Health Policy (Spain), the CESM denounces the proliferation of contracts for doctors without a MIR system. Surprisingly, there is no exact figure for how many doctors practice in Spain without MIR. Serious tensions in the Madrid healthcare system, mainly in out-of-hospital emergencies, although not only. It seems that the politics of confrontation prevails, which is neither positive nor desirable. There are no good memories of the famous “white tides” in Madrid, which should not be reactivated. The debate on the delay in access to medicines continues. The Ministry of Health affirms that part of this delay is due to pharmaceutical companies, which prioritize some countries over others in their marketing requests. At the national level, mention must be made of the death of Dr. Fernando Alonso-Lej, the great introducer of the MIR system in Spain and, therefore, deserving of maximum recognition.

In the Corporate arena, internationally J&J acquires a cardiac device company. In our country, it should be noted that the private sector builds more than 80% of nursing homes.

Biomedicine

Global Health

International health policy

National health policy

Companies

7 days in healthcare (August 15-21, 2022)

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Summary

From the point of view of biomedicine, the first drug is prepared using CRISPR (gene editing) technology. Important publication from The Lancet in the largest effort yet to identify risk factors in relation to cancer. Not surprisingly, however, tobacco and alcohol are the biggest risk factors, particularly tobacco.

As far as Global Health is concerned, polio is back and the UK is now offering vaccinations to children in London between the ages of 1 and 9.

Regarding international health policy, the famous North American Inflation Reduction Act has been signed by President Biden. Despite its name, the law has more to do with climate change and health, especially drug prices. No large growth in monkeypox is predicted, based on modeling carried out by The Economist. Deaths from covid remain high (15,000 a week globally) warns the Director General of the WHO. The Director of the American CDC denounces serious failures in the management of covid and announces substantial changes in the functioning of this body. A clear contrast to what is happening in Spain, where no conclusions seem to be drawn from the management of covid, despite being one of the most affected countries in terms of the number of cases and mortality in relation to the population.

If we talk about national health policy (Spain), the good news are that covid continues to decline, although there are still 62 deaths per day. The approval of the State Center for Public Health, scheduled for next week, is possibly the biggest consequence of covid. The birth rate in Spain falls to historical lows.

In the field of companies, drug prices break historical records in the USA. In Spain, HIPRA is preparing to manufacture 250 million doses of covid vaccines, pending approval by the EMA.

Biomedicine

Global Health

International health policy

National health policy

Companies

 

7 days in healthcare (April 11-17, 2022)

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SUMMARY

From the point of view of biomedicine, it is important to highlight the fact that greater access to antibiotics (reduced in many countries) is a basic element to overcome the pandemic of resistance to these drugs. Cases of acute hepatitis in children, detected in the United Kingdom and also in Spain, have been the subject of an alert by the WHO and the ECDC. Some of them require liver transplantation.

With regard to Global Health, the financing of the WHO is one of the great issues of global health, since this organization has always had a financing well below its challenges.

As for international health policy, President Biden’s Memorandum on “long covid” should be noted. Also the important article published in The Lancet that analyzes the circumstances surrounding the incidence of covid and its mortality in 177 countries, with some interesting conclusions. The “zero-covid” policy in China and, specifically, the confinement of Shanghai, continues to occupy the international front pages and is a policy that is beginning to be highly questioned, despite its successes so far in both the number of cases and in mortality, as in economic impact, if we believe the official figures from China. Great expectations regarding the new agency created by the Biden Administration: the ARPS-H (Advanced Research Projects Agency for Health)

If we talk about national health policy (Spain), 50,000 doses of covid have finally been distributed, albeit with great delay compared to the initial promises, although without having agreed on criteria regarding their use. Interesting proposal to the Ministry of Health of the Medical Collegiate Organization (OMC) on medical recertification, which includes a supervisory agency OMC-FACME, similar to a British one.

In the field of companies, from the international point of view, to highlight the declines in sales of covid vaccines. Regarding national news, the announcement of the forthcoming arrival of the HIPRA vaccine should be highlighted.

 BIOMEDICINE

GLOBAL HEALTH

INTERNATIONAL HEALTH POLICY

  • COVID

o President Biden’s memorandum on addressing the “long COVID” (https://www.whitehouse.gov/briefing-room/presidential-actions/2022/04/05/memorandum-on-addressing-the-long-term- effects-of-covid-19/). Article on the subject in JAMA magazine: https://jamanetwork.com/journals/jama-health-forum/fullarticle/2791210

o Preparedness for the pandemic and covid, an analysis of 177 countries. The relationship between various circumstances and the incidence of covid, as well as mortality, are analyzed (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00172-6/fulltext). Comments on this article, the WHO and health systems remain unprepared to deal with a pandemic like covid, which caused 494 million cases and more than 6 million deaths, as of April 5, 2022: https://www. thelancet.com/journals/lancet/article/PIIS0140-6736(22)00425-1/fulltext

o Shanghai lockdown shows signs of desperation among the population and lack of food (https://www.theguardian.com/world/2022/apr/17/shanghai-lockdown-desperation-rises-food-runs-low-china )

o The mystery of China with “ómicron”: 280,000 infections and zero deaths (https://www.abc.es/sociedad/abci-misterio-china-omicron-280000-contagios-y-cero-muertes-202204150122_noticia.html)

o The WHO confirms a decrease in new covid cases worldwide, for the third consecutive week (https://www.diariofarma.com/2022/04/13/la-oms-confirma-la-disminucion-de-nuevos -covid-cases-around-the-world)

o Covid infections start to fall in the UK (https://www.ft.com/content/0c2fc3ce-be3f-41b1-8b1f-e1b729882720)

o Valneva, the Franco-Austrian vaccine against covid, is the sixth approved in the United Kingdom (https://www.theguardian.com/world/2022/apr/14/valneva-approved-to-be-uks-sixth -covid-vaccine)

o The FDA authorizes the first breath-based covid test that produces results in less than three minutes (https://www.nytimes.com/2022/04/15/us/the-fda-authorizes-the- first-covid-19-breath-test.html)

  • Other themes

o Expectations about the new health agency created by Biden, called ARPA-H (Advanced Research Projects Agency for Health). Editorial in Science magazine (https://www.science.org/doi/10.1126/science.abq4814)

o The number of people on the NHS waiting list at record high (https://www.theguardian.com/society/2022/apr/14/number-of-people-on-nhs-waiting-lists-in-england -at-record-high)

o The number of primary care physicians (GPs) in the UK, down every year since 2015. Organizations representing doctors say the heavy workload, high expectations of patients, difficulties recruiting non-medical staff and the fear of errors due to overload, at the base of this situation (https://www.theguardian.com/society/2022/apr/11/gp-numbers-in-england-down-every-year-since-2015 -pledge-to-raise-them)

o A lawsuit by Cuban doctors has been accepted by the US justice system, accusing the PAHO (WHO organization for Latin America) of collaborating in the “forced labor” of Cuban doctors sent to Brazil (https://www. .bmj.com/content/377/bmj.o962)

NATIONAL HEALTH POLICY (SPAIN)

  • COVID

o Spain, the rich country where life expectancy fell the most due to the pandemic, after the United States (https://www.elespanol.com/ciencia/salud/20220414/espana-pais-rico-cayo-esperanza-pandemia-unidos /664683895_0.html)

o The covid increased health spending in 2020 by 10.9%, a record figure (https://www.diariofarma.com/2022/04/06/la-covid-incremento-el-gasto-sanitario-en-2020 -a-109-a-figure-record)

o The Ministry of Health has already distributed 50,000 doses of Paxlovid in Spain (https://www.consalud.es/politica/ministerio-sanidad/sanidad-distribuido-espana-50000-dosis-farmaco-covid-19-paxlovid_113219_102.html)

  • Other themes

o Three cases of childhood hepatitis of unknown origin detected in Spain, following an international alert from the WHO and the ECDC, originating in the United Kingdom (https://elpais.com/sociedad/2022-04-13/detectado- in-spain-the-first-case-of-an-infantile-hepatitis-of-unknown-origin.html)

o Spain, at the tail of the large European markets in access to cancer and orphan drugs (https://www.diariomedico.com/medicina/medicina-preventiva/politica/espana-la-cola-de-los-grandes-mercados -europeans-in-access-oncology-drugs-and-orphans.html)

o The Government wants to reduce tobacco consumption, without prohibiting smoking (https://elpais.com/sociedad/2022-04-10/espana-quiere-desatascar-la-caida-de-fumadores-sin-recurr-a-la- prohibition.html)

o The Collegiate Medical Organization (OMC) makes a proposal to the Ministry of Health on medical recertification according to the English model with three measures. It proposes that the OMC-FACME could be the supervisory agency, similar to the “Professionals Standards Authority for Health and Social Care”, of the United Kingdom (https://www.redaccionmedica.com/secciones/medicina/- English-model-of -medical-recertification-with-3-measures-of-competence-6828)

o The Spanish transplant model triumphs in Latin America, where organ donation grew by 100% between 2005 and 2019 (https://www.consalud.es/politica/donacion-organos-iberoamerica-programa-espanol_112999_102.html)

o Harassment of women who go to abortion clinics is declared a crime, through a modification of the Penal Code (https://www.consalud.es/pacientes/acoso-mujeres-acudan-clinicas-abortar-delito-jueves_113177_102. html)

o Family Medicine, Anesthesiology, Psychiatry and Radiodiagnosis, among the specialties that will have to increase their MIR offer to alleviate the deficit, according to a recent report (https://www.diariomedico.com/medicina/profesion/espana-pagara-en -five-years-the-lack-of-planning-in-medical-templates.html)

COMPANIES, EMPLOYERS AND OTHER AGENTS IN THE SECTOR

  • International News

o Walgreens, the American pharmacy chain, flooded the market with opiates and is accused of creating addicts (https://www.consalud.es/ecsalud/internacional/walgreens-farmaceutica-opiaceos-mercado-crear-adictos_113123_102.html)

o GSK, about to buy Sierra Oncology for 1,500 million pounds to boost its oncology offer (https://www.ft.com/content/d26ea24f-1ea9-4b09-842d-4708090bfe42)

o The vaccine business drops, with a 21% drop in sales (https://www.elespanol.com/invertia/observatorios/sanidad/20220412/business-vacunas-anticovid-cae-prevision-ventas-demanda/ 664183929_0.html)

  • National News

o Farmaindustria pays 452 million to the State for excess public spending on medicines in 2018 and 2019 (https://www.elespanol.com/invertia/observatorios/sanidad/20220411/farmaindustria-abona-millones-exceso-gasto-publico- medications/663433943_0.html)

o The HIPRA vaccine will arrive between May and June, according to Minister Morant (https://www.elespanol.com/ciencia/salud/20220411/vacuna-espanola-hipra-covid-llegara-ministra-morant/664183699_0.html)

o Boehringer Ingelheim reinforces its commitment to Spain with an investment in R&D of 42 million in 2021, 23% more than in the previous period (https://www.plantadoce.com/empresa/boehringer-ingelheim-refuerza-su -bet-on-spain-with-an-investment-of-42-million-in-2021.html)

o Lácer launches its sale process for more than 500 million euros (https://cincodias.elpais.com/cincodias/2022/04/08/companias/1649439648_227115.html)

o Insparya, the hair business that Cristiano Ronaldo is in, will take its clinics to Milan, Paris and Dubai and will continue to open in Spain (https://cincodias.elpais.com/cincodias/2022/04/08/companias/1649440871_986204. html)