Conflicting views on human heritable genome editing

 Heritable Human Genome Editing: The Public Engagement Imperative

Now limited to preclinical research by a prohibitive federal statute, the conduct of HHGE in the United States may well be at the mercy of the mutable arc of public opinion, the trajectory of which is unknowable.44 Eventual public acceptance of HHGE may well follow if it can be shown to have a unique and favorable impact on the global burden of incurable genetic disease. Such a trajectory would be further buttressed by the plight of parents and their children, which is universally resonant and hard to ignore. Medical science has, after all, been down this road before. Standing in opposition to the prospect of HHGE are deep-rooted misgivings over runaway technological progress that is liable to shatter millennia-old societal norms. Additional concerns draw on the prospect of liberal eugenics, access inequities, imponderable impairment, and progeny-related harm. Reconciling the conflicting views of the current steady state will require time, perhaps generational time, before the dust settles. In the interim, it is nothing short of imperative that HHGE be subjected to the rigors of public deliberation along the lines applied to MRT and related reproductive technologies.45 What is called for is informed public judgment that has accounted for both the relevant concerns and the potential to advance human welfare.

 

Why Basque country spends in health 24% more than Catalonia?

Estadística de Gasto Sanitario Público

And why they spend 5,5% of GDP and Catalonia 4,9%?

On value (once again)

 From value for money to value-based health services: a twenty-first century shift

VBHS cannot be achieved without reorienting existing fragmented models of care towards one that rests on a strong primary health care foundation (19) with an integrated community care component and underpinned by the principle of people coproducing health. This may encompass a shift from inpatient to outpatient and ambulatory care, where appropriate. It requires investment in holistic and comprehensive care, including health promotion and prevention strategies that support people’s health and well-being (20). It further requires effective referral systems, flexible and multidisciplinary provider networks, and participatory monitoring and evaluation strategies.

Nothing new. 

Joaquim Mir

Economic evaluation of vaccination

 Evaluating Vaccination Programs That Prevent Diseases With Potentially Catastrophic Health Outcomes: How Can We Capture the Value of Risk Reduction?

Why QALYs doesn't fit for CEA of vaccination?

In the last 5 years, guidelines have been developed for performing cost-effectiveness analyses (CEAs) for the economic evaluation of vaccination programs against infectious diseases. However, these cost-effectiveness guidelines do not provide specific guidance for including the value of reducing the risk of rare but potentially catastrophic health outcomes, such as mortality or long-term sequelae. Alternative economic evaluation methods, including extended CEA, the impact inventory, cost-benefit analyses, willingness to pay or the value of a statistical life, to capture the value of this risk reduction could provide more complete estimates of the value of vaccination programs for diseases with potentially catastrophic health and nonhealth outcomes. In this commentary, using invasive meningococcal disease as an example, we describe these alternative approaches along with examples to illustrate how the benefits of vaccination in reducing risk of catastrophic health outcomes can be valued. These benefits are not usually captured in CEAs that only include population benefits estimated as the quality adjusted life-years gained and reduced costs from avoided cases.

 

We all require care

The Care Crisis,What Caused It and How Can We End It?

Interesting book about care and what it means, 

Care is conceived as all the supporting activities that take place to make, remake, maintain, contain and repair the world we live in and the physical, emotional and intellectual capacities required to do so.1 In this sense, care is at the heart of making and remaking the world. The propensity to care and the work of caring are the lifeblood of our social and economic system. Care is central to the reproduction of society and thus one of its bedrocks, part of a fundamental infrastructure which holds society together. Without care, life could not be sustained.

What happens to affective relations and caring activities when they are subsumed under market forces and turned into services that are sold? As ever more areas of social life and work are directly commercialised, the affective investments of care come into conflict with logics of measure, profitability, time constraints, cost reduction, standardisation, and economies of scale in multiple ways

However, instead of considering efficient ways to provide care, the political views surpass efficiency, a well known paradigm.

Valuing care means allocating resources, not taking them away. There is an urgent need to dismantle the apparatus that allows private wealth extraction from society’s care structures, so that any new funds made available for the public care infrastructures do not simply prop up profits. Care needs to be shielded from the volatilities of financial markets, not be drawn deeper into them. Therefore, the realms of care should not be available to high-risk forms of financial investment, including private equity and debt-based forms of financial engineering, where expectations of high returns on capital are upheld at the expense of quality of employment and quality of care. Nor should public services and the care sector be exposed to free trade agreements that undermine labour, consumer and environmental protections.9 This is a pressing issue in the wake of Britain’s departure from the European Union.

 Instead of considering public funding as the main option, and access according to need and not to willingness to pay, she proposes to dismantle private services...

Connected health

 Improving Access to Care: Telemedicine Across Medical Domains

Access to health care relies on the use of available resources in attempts to achieve optimal health outcomes. It is composed of three main components: entry into the health care system, an adequate supply of services available, and timely provision of care

The article provides some useful views on telemedicine. It says,

 Frequently cited clinical limitations of telemedicine include the inability to perform comprehensive physical examinations, sacrifice of patient–provider relationships, fragmentation of care, and the potential for overprescribing/excess health care utilization. These concerns are often unsubstantiated, and while it is important to anticipate the potential shortcomings of telemedicine, innovative solutions are continuously being adopted to overcome potential barriers to implementation. Examples of such solutions include the use of user-friendly devices to gather vitals and data to facilitate remote clinical assessment, as well as utilization of interchangeable electronic health records to enable sharing of information among various providers.

Overall, the promise of telemedicine seems encouraging, and we look to further examine notable examples of its efficacy through the lens of four diverse, prototypical medical conditions with the goal of recognizing common themes and identifying areas of needed improvement. These medical conditions include stroke, heart failure, diabetes, and pregnancy.

L’home que sabia mirar el món, Manuel Castro Galeria Jordi Barnadas de l'11 de març al 9 d'abril de 2021

 

Why Spain publicly funded health expenditure is 6,3% of GDP in Spain and in Catalonia is 5,3%?

Despesa sanitària pública sobre el PIB

 Despesa sanitària a Catalunya per agents 2010-2018

Mobile medicine transformation

THE TRANSFORMATIVE POWER OF MOBILE MEDICINE, Leveraging Innovation, SeizingOpportunities, and Overcoming Obstacles of mHealth

Eleven topics in a book reflecting current mhealth:

1. Innovations in mHealth Part 1

2. Innovations in mHealth, Part 2

3. Exploring the Strengths and Weaknesses of Mobile Apps

4. Mobile Apps Critique: Heart disease and hypertension

5. Mobile Apps Critique: Diabetes and asthma

6. Mobile Apps Critique: Mental health/Depression

7. Reinventing clinical decision support: Is there a role for mobile technology?

8. Telemedicine: Opportunities and Challenges

9. Patient Engagement must be our Top Priority

10. Security and privacy concerns

11. Designing the ideal mobile medical app

The value of life

 The Value and Meaning of Life

Deep topic,

Christopher Belshaw draws on earlier work concerning death, identity, animals, immortality, and extinction, and builds a large-scale argument dealing with questions of both value and meaning. Rejecting suggestions that life is sacred or intrinsically valuable, he argues instead that its value varies, and varies considerably, both within and between different kinds of things. So in some cases we might have reason to improve or save a life, while in others that reason will be lacking.

Therefore qaly is not always a qaly?. So.... 

 This book is about the value and meaning of life. Its focus is on several questions of current and widespread concern, and its aim is to provide answers to at least most of those questions which, as I hope, many will fnd compelling. So we can ask – is life valuable? Or better – which lives, if any, are valuable, and to what extent? What does their being valuable consist in? What sort, or sorts, of value do they have? How, if at all, does this value enjoin us to, or constrain us from, acting in relation to those lives? And then similarly – is life meaningful? But, again, there are better questions to be asked. Can lives have meaning? What sorts of lives? And what sorts of meaning can they have? How is this meaning arrived at? How might it be lost? The two sets of questions are, of course, not altogether distinct. And we can ask both whether a valuable life is, or is likely to be, a meaningful life; and also – different question – whether meaning is itself among the things that we should value.

Economists in need of philosophy.

 

Risk-adjusted Cost-effectiveness Analysis

 Health Technology Assessment With Diminishing Returns to Health: The Generalized Risk-Adjusted Cost-Effectiveness (GRACE) Approach

Cost-effectiveness analysis (CEA) is widely used to evaluate new medical technologies—for example, by the UK’s National Institute for Health and Care Excellence or by the Institute for Clinical and Economic Review. Standard methods calculate the average increase in treatment cost per average quality-adjusted life-year (QALY) gained, also known as the incremental cost-effectiveness ratio (ICER). 

Researchers have raised concern that traditional CEA discriminates against the severely ill or disabled.5,6 The U.S. Affordable Care Act forbids using CEA that discriminates against persons with disabilities, both by the Patient-Centered Outcomes Research Institute and in determining Medicare coverage and reimbursement. To address this concern, the Institute for Clinical and Economic Review now calculates the equal value of life-years gained in parallel with standard CEA analyses,7 and other departures from CEA have been proposed as ad hoc ways to repair this problem.6

These exceptions, exclusions, and prohibitions call for deeper examination of CEA’s theoretical foundations. In a new analysis, we develop a generalization of standard CEA methods that resolves many of these issues.

This is precisely what I call it risk-adjusted cost-effectiveness.

 

Why do Madrid spends twice than Catalonia in teaching residents ?

 Estadística de Gasto Sanitario Público 2019

Risk adjustment: a review

 REINSURANCE, REPAYMENTS, AND RISK ADJUSTMENT IN INDIVIDUAL HEALTH INSURANCE

McGuire, Schillo and Van Cleef provide an additional perspective to conventional risk-adjustment. They say:

Reinsurance can complement risk adjustment of health plan payments to improve fit of payments to plan spending at the individual and group level. This paper proposes three improvements in health plan payment systems using reinsurance. First, we base reinsurance payments on spending not accounted for by the risk adjustment system, rather than just high spending. Second, we propose pairing reinsurance for individual-level losses with repayments for individual-level profits. Third, we optimize the weights on the risk adjustors taking account of the presence of reinsurance/repayment.

It sounds good, however technical requirements are demanding to be to implemented.

The boundaries of ecosystems

 Towards a theory of ecosystems

In this article, you'll find a good description of the features of a business ecosystem. Unfortunately, too often this word is misused and abused.

We consider what makes ecosystems different from other business constellations, including markets, alliances, or hierarchically managed supply chains. Ecosystems, we posit, are interacting organizations, enabled by modularity, not hierarchically managed, bound together by the nonredeployability of their collective investment elsewhere. Ecosystems add value as they allow managers to coordinate their multilateral dependence through sets of roles that face similar rules, thus obviating the need to enter into customized contractual agreements with each partner. We explain how different types of complementarities (unique or supermodular, generic or specific, uni‐ or bi‐directional) shape ecosystems and offer a “theory of ecosystems” that can explain what they are, when they emerge, and why alignment occurs.

 

What world we want to leave for our children?

 What Gene Editing Can Do for Humankind?

In WSJ you'll find a good op-ed by Walter Isaacson,

 After millions of centuries during which evolution happened “naturally,” humans now can hack the code of life and engineer our own genetic futures. Or, for those who decry gene editing as “playing God,” let’s put it this way: Nature and nature’s God, in their wisdom, have evolved a species that can modify its own genome.

Like any evolutionary trait, this new ability may help our species to thrive—and perhaps even produce successor species. Or it may not. It could be one of those evolutionary traits that leads a species down a path that endangers its survival. Evolution is fickle that way.

This is why it is useful for all of us to try to understand this new room that we are about to enter, one that seems mysterious but can also fill us with hope. Not everything needs to be decided right away. We can begin by asking what type of world we want to leave for our children. Then we can feel our way forward together, step by step, and preferably hand in hand.

 Claudia Andujar at KBR