Mort amb recepta (catalan version)
Annual report on Drugs in Catalonia (p.152)
Oxicodone in Catalonia: from 879.775 DDD in 2014 to 1.003.355 in 2019, a 14% increase. Tramadol: from 11.790.547 DDD in 2014 to 17.038.936 in 2019, a 69% INCREASE in 5 YEARS (p.152)
Daily Dose per Inhabitant (DDH)Tramadol: from 4,27 to 6,16 a 44,2% INCREASE in 5 YEARS
A worrying french situation
The documentary: Etats-Unis, la mort sur ordonnance
Nan Goldin denounces: Who profits form the opioid crisis?
Availability and funding of clinical genomic sequencing globally
A useful review on the current situation:
Our case studies, based on published and unpublished literature as well as discussions with key experts in each country, are illustrative of three types of funding systems:
Publicly funded/national system: UK, which is one of a few countries with national, government-based funding for NGS (others include Belgium, Denmark, the Netherlands and Australia).
Publicly funded/provincial system: Canada, for which public funding of tests is provided at the provincial level after approval based on meeting specific criteria.
Mixed private/public system: USA, which has variable private and public insurer coverage.
The 4 steps:
Invent and Wander: The Collected Writings of Jeff Bezos
We believe that a fundamental measure of our success will be the shareholder value we create over the long term. This value will be a direct result of our ability to extend and solidify our current market leadership position. The stronger our market leadership, the more powerful our economic model. Market leadership can translate directly to higher revenue, higher profitability, greater capital velocity, and correspondingly stronger returns on invested capital.
(1997, Shareholder letter)
LOBBYING FOR CHANGE . Find Your Voice to Create a Better Society
Great questions and answers, by Alberto Alemanno:
How do we make government work for us? How can we save us from ourselves?
We face a dramatic gap between the problem-solving ability of our political system and our needs as a society. While this gap explains much of our social disengagement and disillusionment with traditional politics, it opens up a promising space for new, unconventional forms of active citizenship and civic engagement, as well as individual and collective empowerment.
This is the space we want and can occupy, as citizens. And it is set to grow as people abandon mainstream politics. That’s the space I want to you show you in the second part of this book.
The Plague Cycle. The Unending War Between Humanity and Infectious Disease
Take away conclusion:
In the Bible’s Book of Revelations, the Four Horsemen of the Apocalypse are sent forth to “kill with sword and with famine and with pestilence and by wild beasts,” and carry off a quarter of the earth. The identities of the horsemen are a matter of some debate: the fevered poetry is hard to decipher. While the Fourth Horseman seems to be Death himself, the Third Horseman is universally recognized as famine, and the Second as war, argument rages over the identity of the First Horseman: some recent experts suggest he is pestilence, others argue that he is Jesus Christ or the embodiment of righteousness.
It’s ironic that pestilence occupies the disputed saddle, for while throughout most of history violence and famine were two of Death’s most useful tools, the only one of the three that has ever managed to carry off a quarter of the earth at one go is pestilence. Plague ended the age of antiquity and ushered in the Renaissance. Infection shaped the age of global empires, and its decline boosted the economy of the modern world. Neither violence nor famine can claim to be its equal.
The frequency of violence, pestilence, and famine combined is why the idea that a good life should be one free of tragedy was mocked as utopian until the Industrial Revolution. They are the tools that nature used to keep humans in Malthusian misery. And none—famine, violence, or pestilence—has nearly the grip on humanity that it had even fifty years ago. A huge part of that progress is due to the fight against infection, flattening the plague cycle, and their knock-on effects.
The extent of disease has always shaped economic and social relations. Pandemics from centuries ago still help determine wealth and poverty, democracy and autocracy to this day. But the last half century clearly demonstrates that not all trends are inexorable. We’ve seen a massive global improvement in the quality of life even in parts of the world that suffered the most from the arrows of the First Horseman through the last two thousand years. Malthusian fatalism had a declining empirical basis in the nineteenth century. Now it has no basis at all.
The Billion-Dollar Molecule. The Quest for the Perfect Drug
On the business of science, and about the Vertex pharmaceutical firm and its IPO.
How New Models Of Vaccine Development For COVID-19 Have Helped Address An Epic Public Health Crisis
This acceleration has largely been fueled by an influx of resources—both financial and human—that is likewise record-setting. Significant levels of cooperation and innovation, which enable more-efficient use of those resources, have also played a key role.
There may be additional opportunities for innovation that deserve exploration. For example, master protocols, in which multiple vaccine or drug candidates are tested against a single control arm, could further accelerate clinical trials without compromising safety. Innovations to overcome potential delivery impediments, including supply chain challenges and insufficient numbers of health care workers in some regions, would also be welcome.
If widespread COVID-19 vaccination is realized in the coming months and years, the approach undertaken to arrive at that point will offer lessons for how to optimize the development and accessibility of vaccines against other pathogens, under both outbreak and non-outbreak scenarios. Our experiences with COVID-19 may also offer knowledge spillovers to other areas of medicine and public health.
More details in this Health Affairs issue.
Government, Big Pharma, and The People. A Century of Dis-Ease
A book to read, with this Table of Contents:
White Market Drugs. BIG PHARMA AND THE HIDDEN HISTORY OF ADDICTION IN AMERICA
A book to understand the contribution to addiction over a century.
By showing how the twenty-first-century opioid crisis is only the most recent in a long history of similar crises of addiction to pharmaceuticals, Herzberg forces us to rethink our most basic ideas about drug policy and addiction itself—ideas that have been failing us catastrophically for over a century.
This is the outline:
Introduction
Complicated legacies: The human genome at 20
On genome and precision medicine:
Debates about precision medicine (PM), which uses genetic information to target interventions, commonly focus on whether we can “afford” PM (17), but focusing only on affordability, not also value, risks rejecting technologies that might make health care more efficient. Affordability is a question of whether we can pay for an intervention given its impact on budgets, whereas value can be measured by the health outcomes achieved per dollar spent for an intervention. Ideally, a PM intervention both saves money and improves outcomes; however, most health care interventions produce better outcomes at higher cost, and PM is no exception. By better distinguishing affordability and value, and by considering how we can address both, we can further the agenda of achieving affordable and valuable PM.
The literature has generally not shown that PM is unaffordable or of low value; however, it has also not shown that PM is a panacea for reducing health care expenditures or always results in high-value care (17). Understanding PM affordability and value requires evidence on total costs and outcomes as well as potential cost offsets, but these data are difficult to capture because costs often occur up front while beneficial outcomes accrue over time (18). Also, PM could result in substantial downstream implications because of follow-up interventions, not only for patients but also for family members who may have inherited the same genetic condition. Emerging PM tests could be used for screening large populations and could include genome sequencing of all newborns, liquid biopsy testing to screen for cancers in routine primary care visits, and predictive testing for Alzheimer's disease in adults. These interventions may provide large benefits, but they are likely to require large up-front expenditures.
Now that Jeff Bezos anounces that he is to step aside as CEO, a summary in one figure:
The history, in one book:
Breast Cancer Risk Genes — Association Analysis in More than 113,000 Women
Genetic testing for breast cancer susceptibility is widely used, but for many genes, evidence of an association with breast cancer is weak, underlying risk estimates are imprecise, and reliable subtype-specific risk estimates are lacking.
However,
We found strong evidence of an association with breast cancer risk (Bayesian false-discovery probability, <0.05) for protein-truncating variants in 9 genes, with a P value of less than 0.0001 for 5 genes (ATM, BRCA1, BRCA2, CHEK2, and PALB2) and a P value of less than 0.05 for the other 4 genes (BARD1, RAD51C, RAD51D, and TP53).
None of the other 25 genes in the panel had a Bayesian false-discovery probability of less than 0.10. Of note, 19 genes had an upper limit of the 95% confidence interval of the odds ratio of less than 2.0, with 2.0 representing a proposed threshold for “pathogenic, moderate risk alleles”9; we therefore conclude that these genes are not informative for the prediction of breast cancer risk. We confirmed that missense variants in BRCA1, BRCA2, and TP53 that would be classified as pathogenic according to clinical guidelines are indeed associated with clinically significant risks. We also found that rare missense variants in CHEK2 overall, as well as variants in specific domains in ATM, are associated with moderate risk.
The summary:
Variants in 8 genes — BRCA1, BRCA2, PALB2, BARD1, RAD51C, RAD51D, ATM, and CHEK2 — had a significant association with breast cancer risk.
