October 10, 2021

Covid in Latin America

Pandemia y crisis: el covid-19 en América Latina

Free ebook:
La irrupción del coronavirus (Covid-19) ha provocado una multi-crisis sin precedentes. Sus consecuencias son globales y abarcadoras, aunque tengan particularidades en las diferentes regiones del mundo que la enfrenten en condiciones muy desiguales. Van más allá de un tema de salud debido a las repercusiones tan variadas y complejas. En este volumen se reúnen investigaciones desde las Ciencias Sociales y Humanidades que miden los impactos de la crisis sanitaria y de las medidas gubernamentales en América Latina y el Caribe durante la fase inicial de propagación de la enfermedad. Se analizan diferentes estrategias de políticas públicas y se mira cómo las desigualdades en torno al Covid-19 giran por diferentes lados; grupos específicamente vulnerables y efectos sobre subsistemas relevantes. Además, las investigaciones se enfocan en los discursos que circulan en el espacio público en relación con la crisis sanitaria que a su vez muestra las diferentes voces y posiciones en torno a la pandemia.

October 6, 2021

The role of hospitals

 Understanding Hospitals in Changing Health Systems

The health policy community has for decades opposed the roles of primary care and population health against those of hospitals, blinding us about how to govern and resource our health sectors properly

Gathering together expensive people and pieces of equipment in hospitals enables a delivery of care now and in the future which complements yet goes beyond what simpler settings can offer

October 3, 2021

Drug copayment

 Current drug copayment policy in NHS

Summary, 73% of population has income less than 18.000€. (!)

October 1, 2021

The business of pandemics



Chapter 1. Business and Management Lessons Learned from COVID-19

Jaime Ribera, IESE, Spain

Chapter 2. Developing Big Data, Computer Models, and Simulations for Predicting Its Spread

Scott Nestler, University of Notre Dame and Harrison Schramm, Center for Strategic and Budgetary Assessment, USA

Chapter 3. Conducting Global Business Virtually

Erin Makarius and Debmalya Mukharjee, University of Akron, USA

Chapter 4. Global Economic Impact Resulting from COVID-19

Thomas Hanson, Butler University, USA

Chapter 5. Communicating About COVID-19: Dealing with Fear and Emotion

Vincent Covella and Randall Hyer, Center for Risk Communication, USA

Chapter 6. Media and Communications About COVID-19: A WHO Perspective

John Butler and Gabriella Stern, WHO, Switzerland

Chapter 7. Growing Organizational Capacities for Increased Online Learning, Working, and Health

Sharif Nijim, University of Notre Dame and Paul Grist, Amazon Web Services (AWS)

Chapter 8. Social Impact Resulting from COVID-19

Wei Sun, Howard University, and Andrew Critchfield, Independent Scholar

Chapter 9. Online Learning and Educational Innovations Due to COVID-19

Darleen Opfer and Laura Hamilton, RAND Corporation, USA

Chapter 10. The New Work from Home Environment

David Cook, University College London (UCL), UK

Chapter 11. Re-Opening Markets and Businesses that Have Been Shut or Severely Curtailed

Rod McSherry and Matthew Jackson, University of Texas at San Antonio, USA

Chapter 12. Crisis Decision Making Using Analytics and Intuition

Gloria Wren, Loyola University-Maryland; Jean-Charles Pomerol, Université de la Sorbonne, Paris; Fred Adam and Karen Neville, UCC, Ireland

September 29, 2021

The pandemic in US

 Uncontrolled Spread. Why COVID-19 Crushed Us and How We Can Defeat the Next Pandemic

New book by Scott Gottlieb , former FDA comissioner

COVID revealed dangerous gaps in the US public health preparedness, medical infrastructure, and healthcare system. We lacked the public health capacity and resiliency we thought we had. In the most advanced healthcare system in the world, we ran out of medical masks. We had to retrofit anesthesia machines and turn them into respirators. We didn’t have enough swabs to collect samples from patients’ noses.

Our system was set up well to handle singular, technology-intensive, and complex problems like developing a novel vaccine or antibody drugs. We do this better than anyone. But it faltered when we were faced with more mundane problems like manufacturing those vaccines in bulk, deploying testing centers, or making nose swabs to collect respiratory samples. When we finally developed safe and effective therapeutics and vaccines that could treat or prevent infection, we couldn’t manufacture enough of them in time to supply the nation for the winter surge. We had to set up elaborate rationing schemes. Then, we were unable to establish an efficient distribution plan. Antibody drugs went unused because we couldn’t deliver them. 

The virus made clear that we’ll need to fundamentally alter the way we approach all of these risks. If we don’t, our society will remain excessively vulnerable. For starters, we’ll have to lean much more on our intelligence agencies, and in a different fashion. International agreements alone haven’t provided us with the information we need about emerging threats. There’s little reason to believe they’ll perform much better in the future. The devastation caused by the pandemic proved that these risks, and our preparedness for them, is a matter of national security on par with other threats. We’re going to have to build the capacity to seek out the information we need to protect ourselves. Sometimes that will demand that we avail ourselves of the tools and tradecraft of our clandestine services. The challenge will be to maintain collaboration and multilateral efforts even as we turn more heavily toward intelligence services to guard against the risk of new contagions. 


September 25, 2021

The value of life


How much is a human life worth? The question’s complexity resides in the fact that how we arrive at a price tag on human life says a great deal about our priorities. The price tags, and the methods used to develop them, are a reflection of our values as a society. They are infused with influences from economics, ethics, religion, human rights, and law.

Ideally, there would be a simple answer of how to value a human life that most people could agree on. Yet there is no such answer. The philosopher Isiah Berlin stated that humans have a “deep and incurable metaphysical need” to search for timeless truth that does not exist.

The task of valuing life has many competing truths and no simple answer. Readers may find it frustrating that we cannot conclude with one key bullet point or a single take-home message about how human life is valued, but topics as complicated as this often cannot be boiled down to one pithy solution that satisfies nearly all interested parties.

Some take the philosophical perspective that human life is priceless.2 Individuals who take this stance conclude that the question of how much a human life is worth is meaningless or unanswerable. However intellectually satisfying, this perspective ignores the reality that human life is constantly being monetized and that this should therefore be done in an equitable way.

This book has taken the pragmatic approach of focusing on the real-world methods of how life is valued and the implications and limitations of these methods. The prices depend on who is doing the valuation, the methods they are using, the purpose for the valuation, and quite often, whose life is being valued.

September 24, 2021

Economics of prediction

 Prediction Machines

The reference book on the issue:

September 23, 2021

Incentives in digital health

 Paying for Digital Health Care — Problems with the Fee-for-Service System

From NEJM:

Without payment-system changes, we can expect to have many unhappy patients and physicians struggling with this complex payment labyrinth. Only a payment system that encompasses some form of capitation will eliminate these issues.

The status quo isn’t viable, the current approach that relies on determining payments for each type of digital interaction is destined to fail because such interactions aren’t distinct services that can be easily differentiated. Unless we move rapidly toward capitated models, the health care system will continue to deliver suboptimal, non–patient-centered care that fails to harness the potential of the technology that  exists all around us.

PS . Topol on value-based care: It’s a joke, value-based care. Basically, we have one-third of the healthcare, but $3.6 trillion is waste—low-value care. We need to stop that. That’s part of why it’s so costly. And so this whole idea of value-based care doesn’t even get to it. There’s a long list of hundreds of things that each of the professional societies have called out as being shouldn’t be done anymore. And we’re doing it every day, you know, thousands, hundreds of thousands of times, every day and week in this country. We have to get rid of the waste and inappropriate and unnecessary care and we haven’t done anything to do that here of note. 

Palermo, 1963


September 22, 2021

Claiming for global regulation of genome editing (2)


 Last July the WHO Expert Advisory Committee on Developing Global Standards for Governance and Oversight of Human Genome Editing released its recommendations. This is a crucial document that all governments should take into account and develop its specific regulation. Time is running out

The Committee produced a series of recommendations in nine discrete areas: 1. Leadership by the WHO and its Director-General; 2. International collaboration for effective governance and oversight; 3. Human genome editing registries; 4. International research and medical travel; 5. Illegal, unregistered, unethical or unsafe research and other activities; 6. Intellectual property; 7. Education, engagement and empowerment; 8. Ethical values and principles for use by WHO and 9. Review of the recommendations.

PS: https://theconversation.com/who-guidelines-on-human-genome-editing-why-countries-need-to-follow-them-164895

September 21, 2021

Business as usual is unacceptable in a pandemic

 What are the obligations of pharmaceutical companies in a global health emergency?

Timely article by Ezequiel Emanuel et al. in The Lancet:

Pharmaceutical companies have special obligations in this emergency, which follow from their indispensable capacity to help to end the pandemic by developing, manufacturing, and distributing COVID-19 vaccines. However, the capacity to help alone does not fully specify companies’  obligations. Additionally, market-based arrangements, with patents, marketing exclusivity, and confidentiality clauses, give pharmaceutical companies the freedom to choose what treatments to research and develop, how to price and distribute their products, and whom to furnish with products through bilateral agreements.9 Indeed, companies need not produce vaccines or infectious disease therapies at all. Patents and exclusivity, alongside the absence of price controls or requirements for technology transfer, also permit companies to charge higher prices than they otherwise could.  Governments adopt intellectual property rights, limited pricing regulations (ie, each country has its own pricing, with no one countrycontrolling the pricing, at most being able to set limits on the prices that can be charged), trade agreements, and other limited  interventions (eg, manufacturing, inspections of facilities, etc) in the hope of incentivising the development, manufacturing, and distribution of socially valuable products. Everyone—including pharmaceutical companies— agrees that business as usual is unacceptable in a pandemic.

 Ethical obligations:

September 20, 2021

Misguided proposals

 Consideration Of Value-Based Pricing For Treatments And Vaccines Is Important, Even In The COVID-19 Pandemic

Prices send signals about consumer preferences and thus stimulate producers to make more of what people want. Pricing in a pandemic is complicated and fraught. The policy puzzle involves balancing lower prices to ensure access to essential medications, vaccines, and tests against the need for adequate revenue streams to provide manufacturers with incentives to make the substantial, risky investments needed to develop products in the first place. We review alternative pricing strategies (cost recovery models, monetary prizes, and advance market commitments) for coronavirus disease 2019 (COVID-19) drugs, vaccines, and diagnostics. 

All these stuff on consumer preferences is useless under a pandemic. We are all at risk, and this systemic risk has to be solved "systemically", by the government. It is not an issue of individual preferences. Forget value based in systemic risk events. Forget this misguided article. 

Sorolla 1903

September 18, 2021

The right to healthcare access

 Population Health and Human Rights

From NEJM article:

The study of population health encompasses two main objects of analysis: the health conditions affecting a population (the frequency, distribution, and determinants of diseases and risk factors) and the organized social response to those conditions, particularly the way in which that response is articulated in the health system, including the principles and rules that determine who has access to which services and at what cost to whom. These services include both clinical and public health interventions. Since the 19th century, national health systems have sought to provide health services to an increasing proportion of the population, using four eligibility principles: purchasing power, poverty, socially defined priority, and social rights. Reliance on purchasing power means that access is  determined by ability to pay, with governments limiting their role to basic regulation. Because this principle excludes many people, governments have historically intervened to expand access, either through public assistance programs covering families with incomes below a predetermined level or through social insurance schemes for prioritized groups (e.g., the armed forces, industrial workers, civil servants, or older adults). All these eligibility principles result in only  partial coverage, but the ideal of universality has influenced public policy in most countries, though the design and performance of health systems vary widely.

September 17, 2021

Theranos on trial

 Podcast: 'The Dropout: Elizabeth Holmes on Trial'

ABC News' #1 podcast is back with new episodes, available on Tuesdays.

Money. Romance. Tragedy. Deception. The story of Elizabeth Holmes and Theranos is an unbelievable tale of ambition and fame gone terribly wrong.

You'll find it in Spotify every week


September 16, 2021

Health expenditure after COVID

Right now we know the impact of COVID on health expenditure and the rise has been of 18%, the largest increase ever. We spent 1.786€ per capita in 2020 , 271€ more than in 2019 (1.515€). 

Public expenditure on health by catalan government was 13.392M€ in 2020 (provisional data), while in 2019 11.531M€ . We spent 48€ per capita on PCR tests in 2020. 

Until June 30 2021, the Health Department has executed an amount of € 5.918M, lower than in 2020 by € 257.8 million. We will have to wait for the end of the pandemic to have the final estimates of expenditure.

And now, what's next? Is this only a shock or it will remain consolidated for the future?. Place bets.

September 9, 2021

Creating conditions for population health

 Population Health Science: Fulfilling the Mission of Public Health

Great article. Selected statements:

In 1988, an Institute of Medicine commission defined the mission of public health as “assuring the conditions in which people can be healthy.” Yet much of public health continues to focus not on the conditions in which people can be healthy but rather on individual health.

Several forces have combined to push public health away from its historical mission.

First, science has been increasingly narrowly construed as the business of conducting randomized controlled trials (RCTs). The emphasis on RCTs took hold in the field of medicine as a useful antidote to expert opinion about the effectiveness and appropriateness of care. The resulting turn to evidence-based medicine has the potential—as yet only partially realized—to improve the quality of medical education and clinical care.3-6 However, to say that RCTs can lead to an evidence base that improves clinical care is not to say that RCTs are the only avenue to improving health. This point seems to have been lost on prominent gatekeepers of science. 

A second factor pushing public health away from its mission of assuring the conditions in which people can be healthy are the limits of our theoretical models. Public health can be proud of a long tradition of interdisciplinary collaboration, with economic, sociological, psychological, and other theoretical currents enriching the flow of public health research. But theoretical developments have often remained anchored in their home fields without ever creating a coherent theoretical base within public health. Within public health, our two methodological subfields—epidemiology and biostatistics—are empirical, not theoretical, fields.

Population health science starts with its own theoretical commitments: that the health and health equity of a population are different from and determined differently than the health of individuals. This is a point that was made long ago by Virchow and Durkheim and repeatedly since.19-21 While individual health may be determined by health behaviors or toxic exposures, progress on population health requires understanding why those behaviors and exposures happen. Population health science is invested in the population causes of incidence and not only the individual causes of susceptibility.

Population health science requires scientists from different disciplinary backgrounds to combine their knowledge and expertise to answer questions that individual disciplines alone cannot. It requires syncretic practice focused not on individual health, but on the mean and variation—the health equity—of outcomes in a population.

Creating the conditions for health is difficult work: far more difficult, for example, than admonishing people to act more healthfully. It is more difficult for medical delivery systems to take responsibility for keeping people healthy than to treat them when ill. It is more difficult to engage in politics with scientific integrity than to avoid political controversy altogether. And it is more difficult to think critically about the theoretical basis of what causes health in populations than to conduct randomized trials of clinical interventions.

 Henry Cartier-Bresson 1969

September 8, 2021

Global health impact labeling

 Global Health Impact. Extending Access to Essential Medicines

From the last chapter:

Beyond Global Health Impact Labeling, Licensing, and Investment: Advancing Public Health

The book began by making the case for a human right to health and to access essential medicines, in particular. It defended the right against recent critics. The second section explained the Global Health Impact initiatives. The final section made the case for consuming things with Global Health Impact and similar ethical labels and considered empirical evidence that can support such initiatives.
More precisely, the first chapter suggested that everyone should have an enforceable legal human right to health that includes a right to access essential medicines to treat diseases like malaria, tuberculosis (TB), and HIV/  AIDS because it protects individuals’ ability to live minimally good lives. It sketched an account of the minimally good life that has some advantages over the main alternative. It argued that a basic minimum of health supports,
and may even partly constitute, such lives. Moreover, it argued that the right (partly because it generates a derivative right to access essential medicines) protects this basic minimum. So, the first chapter concluded that everyone should have an enforceable legal human right to health.
The second chapter argued that the human right to health can help claimants, advocates, and duty bearers find ways to fulfill everyone’s claims. Even if this right cannot provide guidance for distributing scarce resources, the chapter argued that we should not reject it; the human right to health provides hope that can foster the virtue I call creative resolve. The right inspires a fundamental commitment to finding creative solutions to apparently
tragic dilemmas; it gives claimants, advocates, and duty bearers a response to apparent tragedy in motivating them to search for ways to avoid it.
The third chapter presented some creative new ways to use data on global health to address the access to medicines problem. It suggested utilizing information about medicines’ global health consequences to create incentives for positive change. More precisely, it claimed that having something like the Global Health Impact index provides a mechanism for incentivizing pharmaceutical companies and other organizations to extend access to essential drugs and technologies around the world. It opens the door to fruitful social activism including ethical labeling, fair licensing, lobbying insurance companies to include Global Health Impact products in their formularies, and so forth.
The fourth chapter made the moral case for supporting a Global Health Impact labeling initiative, in particular. It argued that (1) pharmaceutical companies violate rights and (2) do not do enough to address the access to medicines issue, so (3) if the initiative helps rectify these problems, people should generally purchase goods from Global Health Impact– certified companies. A similar argument might support many other ethical consumption initiatives as well.
The fifth chapter defended the new perspective on how consumers should think about their basic economic powers supporting the book’s argument for purchasing Global Health Impact– labeled goods. It defended positive change consumption: Under just institutions, people can consume what they want as long as they respect the institutions’ rules. Absent such institutions, significant moral constraints on consumption exist. Against recent critics, it argued that consumers can aim at democratic change but need not always do so.  emocratic constraints may prevent truly positive change; but, at the same time, democracy is important for bringing about such change. Although people can promote democracy, they can also promote other positive processes and outcomes.
This book’s final chapter considered how examining the prospects for Global Health Impact initiatives might expand traditional philosophical inquiry’s domain. It presented a proposal for testing consumers’ willingness to make decisions based on a Global Health Impact label. The basic idea is to put a Global Health Impact label on a few over- the- counter products and to collect data on changes in consumers’ willingness to purchase these products compared to otherwise similar products from sales.

September 3, 2021

The Theranos scam whistleblower

 Thicker Than Water

From the hero whistleblower of the infamous Theranos scam, Thicker than Water is a look at never-before-revealed details behind closed doors at the company, revealing a cautionary tale of corporate bullying, gaslighting, ego, and wealth run amok in Silicon Valley.

Tyler Shultz had been in the workforce for less than a year when he emailed Elizabeth Holmes, his employer and the CEO and founder of Theranos, with concerns that the company’s lab practices were faulty, ignored quality control, and were potentially dangerous to patients. The COO fired back with a dismissive and insulting email, to which Tyler replied: "Consider this my two weeks’ notice."

From there, his life spun out of control at the hand of Elizabeth, her team of high-powered lawyers, and the patriarch of Tyler’s own family, George Shultz—one of America’s most prominent statesmen, who sat among the top of the Theranos Board of Directors. And yet, Tyler forged on. To protect his own conscience, the honor and reputation of his grandfather, and the health of patients worldwide.

Thicker than Water is Tyler’s as-told-to story—a harrowing and heartbreaking roller coaster of biomedical drama, family intrigue, and redemption—that will ultimately make you feel as though you are at a dinner party, seated next to a brilliant friend with one hell of a story. 

September 1, 2021

What's normal?

 This Is Not Normal. The Politics of Everyday Expectations

What people tolerate, and what they abhor, depends on what else they are seeing. How norms change, and ultimately determine the shape of society and government is the focus of this book:


August 19, 2021

On how risk shifting affects trust

 Trusting Medicine

A book that explains that shifting financial risk onto doctors in a profit-making system seriously damages patient trust. In addition this undermines overall social capital, which in turn has been linked to health outcomes.

August 4, 2021

Reordering our society is possible

 What We Owe Each Other.A New Social Contract for a Better Society

A thought -provoking book. Chapter 5 is devoted to Health:

Being healthy is the most important determinant of our wellbeing. Physical and mental health (subjective well-being as it is called in the academic research) rank at the top of every major study of happiness across the world. Ultimately, this is why every society aspires to provide health care for its population. And because the costs of providing health care are reduced when a large population pools its resources, and because a healthy labour force is also good for the economy, the social contract in every society includes health care in some form or another.

The great issues:

  • Defining a Minimum for Universal Health Care
  •  How Should Health Care Be Provided?
  • Health Spending Is Only Going Up
  • A More Digital Future for Health
  • Individual and Social Responsibilities – Where Is the Balance?
The message:

We owe each other more. A more generous and inclusive social contract would recognise our interdependencies, provide minimum protections to all, share some risks collectively and ask everyone to contribute as much as they can for as long as they can. This is not about increasing the welfare state, but about investing in people and building a new system of risk sharing to increase overall well-being. Change will come inevitably because the forces of technology, demography and environmental pressures will drive it. The question is whether we prepare for that change or continue to allow our societies to be buffeted by these powerful forces, as we have in recent decades. This book lays out the challenges we face and provides a menu of alternatives for a better social contract around families, education, health, work, old age and between the generations. It is not a blueprint, but it provides a direction of travel that is economically feasible. Nor is it a fixed menu – countries may choose to  implement some elements and not others depending on their values and preferences.

August 3, 2021

Pharma industry regulation: extracting or creating value

 The Global Pharmaceutical Industry. The Demise and the Path to Recovery

The pharmaceutical industry has reached a tipping point. Its business growth is predicated upon fagrantly raising drug prices (especially in the U.S.), thereby increasing the inability of patients to afford medications. The clinical trials that provide the basis for pharma’s new drug development rely on biased designs to favor approvable outcomes, even as sponsors selectively publish mainly the reports that contain favorable results for their test drugs. The industry’s research process exerts a corrupting infuence on medical researchers and the channels of medical communication, while its everyday product promotions involve regular payments of financial and other inducements to prescribers that effectively constitute bribes. Even its involvement in continuing medical education poses a confict of interest and a corrupting infuence on medical practitioners.

If pharma continues operating in this manner, it cannot complain when citizens worldwide demand their governments impose onerous restrictions. Each passing week sees the emergence of additional outrages that make such controls more likely.

Any generalization doesn't fit with an objective observation of reality. However, in chapter 5, you'll find proposals for a new regulation.  

July 28, 2021

The relationship between value and values

 Value(s). Building a Better World for All

This book focuses on four major crises-the Global Financial Crisis, the Global Health Crisis, Climate Change and the 4th Industrial Revolution– and proposes responses to each. Quite a complicated issue. Therefore, my suggestion is to skip the first 2 parts, and go straight to chapter 14. And a key message:

Purpose, values and trust are not natural concepts for economists. The classic economic view, developed by Nobel laureate Ronald Coase, is that a company is a network of contracts in which everyone – owners, managers and workers – responds rationally to incentives. According to Coase’s The Nature of the Firm, the boundaries of the firm are defined by the differences in costs of providing a good or service through the market or a firm.48 Market transactions bear the costs of searching and gathering information, as well as of bargaining, policing and enforcement. Internalising these transactions within firms saves cost but at the expense of span of control, complexity and diseconomies of scale. The boundary of the firm is determined by the balance of these factors, with those activities that can be performed more efficiently and best done by command and control occurring within firms and the rest mediated through markets.

A strict interpretation of this approach misses how shared purpose can reduce transaction costs allowing activities outside the firm to become shared investments that advance the firm’s purpose, reinforcing its profitability and creating shared value. Shared purpose can alter the boundary of the firm (while increasing its ability to create value) by lowering transaction costs in market relationships as well as by making larger and more complex corporate entities possible. Confidence in shared purpose reduces the need for costly, fully complete contracts with suppliers and customers. At the same time, clarity of purpose within organisations, reinforced by strong internal culture, can lead to a type of continuous innovation that turns good companies into great ones.

This is important because, not for the first time, simple theoretical economic models can be poor guides to business in practice. A contractual model is only as good as the contracts, which in practice can be incomplete, difficult to enforce and subject to default. The assumption that human incentives will be solely guided by contractual terms is belied by the realities of people’s behaviours in a wide range of economic circumstances. Moreover, different parties have different time horizons and interests, which frustrate the achievement of optimal outcomes. As Martin Wolf argues, ‘If the rationale for the corporation is to substitute relational contracts, and so trust, for explicit contracts, and so enforcement, one cannot ignore this in deciding what businesses are for and who should control them.’49

The crucial insights of principal–agent theory are not limited to the need to align incentives of shareholders and management but extend to similar challenges between directors, management and employees as well as between companies and their suppliers and communities. When time horizons differ, there will always be incentives for one party to promise one thing and then renege. As we saw in Chapter 4, this is one of the classic motivations for delegated authority to central banks. And even that elegant solution has its limitations, underlining the importance of a shared mission and values.

A strong corporate culture is part of the solution to the problems of incomplete contracts and imperfect incentives. A strong corporate culture encourages stakeholders to internalise the behaviours firms want to create and sustain. In particular, purpose is indispensable to a culture of integrity. As we have seen, trust cannot be achieved merely by asserting rules and following protocols, but rather it is earned by multiple social interactions that reinforce behaviours and values. What are variously termed moral sentiments, social memes or behavioural cascades matter.

Thus purpose operates on a number of planes. First, internally, it creates the necessary social capital within the firm to underwrite foundations of value creation: tightly functioning teams, and high employee participation and engagement. Second, externally, it operates as a means of generating focus on customer service and alignment. The company’s external focus relates to the traditional purpose of a company: to serve its customers.50 If a firm does this well, it generates customer loyalty, and with time the consumer will become a stakeholder, reinforcing trust, good faith and fair dealing. Third, purpose operates as a social narrative, in communities and societies beyond the firm, helping to create and sustain the firm’s social licence to operate. At the highest level, purpose captures the moral contribution of companies to the betterment of the world now and in the future.

A firm is more than a nexus of contracts. However, how do we define it precisely is still unknown.

July 24, 2021

Digital health transformation

 Empowering the health workforce to make the most of the digital revolution

From the OECD report on digital health trasnformation: 

To address these issues to successful digital transformation, governments will need to provide the necessary political leadership and implement a range of policy actions to support three main objectives:

1. building trust in the benefits of digital transformation among health workers and patients while minimising any risks;

2. advancing expertise and skills needed for effective use of digital health technologies;

3. adapting the organisation of health service delivery and the related legal and financial



July 23, 2021

On Amazon (anything but a river)

 Amazon Unbound. Jeff Bezos and the Invention of a Global Empire

Twenty years ago, everybody thought that Amazon was going to sell books. Now that they have entered into health arena, it's the time to read this timely book.

July 21, 2021

Our fragile world

 Death, Grief and Loss in the Context of COVID-19

Outline of the book:

Introduction: Capturing the beginning of a long journey of loss, trauma and grief Panagiotis Pentaris

PART 1: Reconsidering Death and Grief in Covid-19

Chapter 1. Familiarity with death

Chapter 2: Grief in the COVID-19 pandemic

Chapter 3: Apocalypse now: COVID-19 and the crisis of meaning

Chapter 4: Physically distant but socially connected: Streaming funerals, memorials and ritual design during COVID-19

Chapter 5: Social death in 2020: Covid-19, which lives matter and which deaths count?

PART 2: Institutional Care and Covid-19

Chapter 6: End-of-life decision-making in the context of a pandemic

Chapter 7: NHS Values, Ritual, Religion, and Covid-19 Death

Chapter 8: Non-COVID-19 related dying and death during the pandemic

Chapter 9: Covid-19 and care home deaths and harms: A case study from the UK

Chapter 10: Impact of Covid-19 on mental health and associated losses

Chapter 11: Assisted dying and Covid-19

PART 3: Impact of COVID-19 in Context

Chapter 12: Losing touch? Older people and COVID-19

Chapter 13: Between cultural necrophilia and African American activism: life and loss in the age of COVID

Chapter 14: The biopolitics and stigma of the HIV and Covid-19 Pandemics

Chapter 15: Suicide in the context of the COVID-19 pandemic

Chapter 16: Death and dying during the COVD-19 pandemic: The Indian context

July 20, 2021

The bourgeois deal




Unfortunately things are not so crystal clear, the world may be better but it is not because the burgeois deal, many things contribute to it. Avoid any infograhic reductionism.

July 19, 2021

Economic science needs humanities

 Bettering Humanomics. A New, and Old, Approach to Economic Science

The discoveries I have made by responding critically, yet as amiably as I could manage, are two:

1. There seems to be emerging a new and I think more serious and sensible way of doing economic science—quantitatively serious, philosophically serious, historically serious, and ethically serious, too, as I argue in this volume. The economist Bart Wilson and a few others nowadays call it the “humanomics,” as in the title here.4

2. But, I argue in the other volume, neoinstitutionalism, from Douglass North and Daron Acemoglu and many other economists and political scientists, is not the way forward. Scientifically speaking, its factual claims, like those of the other recent neobehaviorist fashions, such as neuroeconomics and behavioral finance and happiness studies, are dubious—or, at best, questionably founded and argued. The neoinstitutionalists, like the others, do not listen, really listen, to the evidence of humans, or to their friends’ scientific questions and objections. Substantively, they treat creative adults like a flock of little children, terrible twos, to whom we need not listen. We need, they say, merely to “observe their behavior,” omitting for some reason linguistic behavior. And then we record the behavior in questionable metrics. The children-citizens will be pushed around with “incentives,” beloved of Samuelsonian economists and econowannabes. From a great height of fatherly expertise in discerning and designing Max U institutions, the neoinstitutionalist looks down with contempt on the merely human actions and interactions of free adults.

A key book by controversial Deirdre McCloskey, this is the outline:

Part I. The Proposal

Chapter 1. Humanomics and Liberty Promise Better Economic Science

Chapter 2. Adam Smith Practiced Humanomics, and So Should We

Chapter 3. Economic History Illustrates the Problems with Nonhumanomics

Chapter 4. An Economic Science Needs the Humanities

Chapter 5. It’s Merely a Matter of Common Sense and Intellectual Free Trade

Chapter 6. After All, Sweet Talk Rules a Free Economy

Chapter 7. Therefore We Should Walk on Both Feet, Like Ludwig Lachmann

Chapter 8. That Is, Economics Needs Theories of Human Minds beyond Behaviorism

Part II. The Killer App

Chapter 9. The Killer App of Humanomics Is the Evidence That the Great Enrichment Came from Ethics and Rhetoric

Chapter 10. The Dignity of Liberalism Did It

Chapter 11. Ideas, Not Incentives, Underlie It

Chapter 12. Even as to Time and Location

Chapter 13. The Word’s the Thing

Part III. The Doubts

Chapter 14. Doubts by Analytic Philosophers about the Killer App Are Not Persuasive

Chapter 15. Nor by Sociologists or Political Philosophers

Chapter 16. Nor Even by Economic Historians

July 12, 2021

Pandemic economic reasoning


The outline of the book:


An introduction to economic welfare


An introduction to externalities


An introduction to public and private action


An introduction to the value of a statistical life


An introduction to cost-benefit analysis


An introduction to thinking on the margin


An introduction to uncertainty and the knowledge problem


An introduction to endogeneity


An introduction to regulatory tradeoffs


An introduction to the price mechanism


An introduction to trade and specialization


An introduction to moral hazard


An introduction to public choice economics


An introduction to incentives


An introduction to political incentives


An introduction to the nature of an economy


And a message on cost-benefit:

Cost-benefit analysis is a useful economic technique for considering whether a project improves societal welfare and to compare the societal net benefits of different projects. To do cost-benefit analysis well, we must account for all the direct and indirect impacts of the proposed policy on societal welfare, account for externalities, and ensure that we compare like-with-like in both timeframe and measurement. When it comes to COVID-19, cost-benefit analysis can, in theory, be used to examine the efficacy of lockdowns. However, there are huge uncertainties that make it hard to weigh up the precise costs and benefits of those policies. Even if the societal benefits do appear to exceed the costs on reasonable assumptions, that doesn’t mean the exact contours of the lockdown are “optimal policy.” In an ideal world, we’d find the policy mix that minimizes the overall societal costs of the pandemic.

This ideal world doesn't exist. 

July 6, 2021

The health funding crisis (ten years after)

 Despesa sanitària a Catalunya

In a decade (2008-2018) the nominal growth of health expenditure has been 7,6%, 811m€ in absolute terms (!). If we apply de CPI to deflate such figure (14,6%), then  we conclude that we have reduced our expenditure in 887m€ after  10 years (!). In 2018, we were spending 8,3% less than in 2008 in real terms (!).  If we add a demographic growth of 3,3%, then the reduction in per capita terms is 11,6% (!). This is our "funding" for population health. The nominal growth in taxes during the same period has been 17,8%. Where is the money?

That's all folks, and now you can ask why Catalonia is asking for independence and why our politicians are not answering the outcry for a better funding for health.