A call for a new skill mix in health professions

Skill-mix Innovation, Effectiveness and Implementation. Improving Primary and Chronic Care

Reforming healthcare

 A New Health and Care System: Escaping the Invisible Asylum

Drug scarcity

Shortages of medicines in OECD countries

Even in wealthy economies, access to medicines is increasingly affected by medicine shortages – an issue exacerbated with the onset of the COVID-19 pandemic. The aim of this paper was to examine the extent and nature of medicine shortages in OECD countries (pre-COVID-19) and explore the reasons for this growing global problem. Although differences in monitoring mechanisms make multi-country analyses challenging, a sample of 14 OECD countries reported a 60% increase in the number of shortage notifications over the period 2017-2019. While the complexity of pharmaceutical manufacturing and supply chains hampers root cause analyses, available literature suggests that shortages, as reported by marketing authorisation holders, are predominantly due to manufacturing and quality issues. Nevertheless, commercial factors - and the policy settings that influence them - may play an important role. Although several OECD countries have implemented policy measures to mitigate, monitor and prevent shortages, more robust data and further analyses of root causes and effective policy responses are needed. The way forward should involve a global approach that engages all relevant actors and looks beyond the health care sector alone.

 

Obamacare, before and after its implementation

The Trillion Dollar Revolution, How the Affordable Care Act Transformed Politics, Law, and Health Care in America

 Reinventing American Health Care.. How the Affordable Care Act will Improve our Terribly Complex, Blatantly Unjust, Outrageously Expensive, Grossly Inefficient, Error Prone System

Platforms, a business model (6)

 Advanced Introduction to Platform Economics

Attacking health care

PERILOUS MEDICINE.  The Struggle to Protect Health Care from the Violence of War

As a member of the Scientific Committee of Healing across the divides, please let me suggest this book by Leonard Rubinstein

Pervasive violence against hospitals, patients, doctors, and other health workers has become a horrifically common feature of modern war. These relentless attacks destroy lives and the capacity of health systems to tend to those in need. Inaction to stop this violence undermines long-standing values and laws designed to ensure that sick and wounded people receive care.

Leonard Rubenstein—a human rights lawyer who has investigated atrocities against health workers around the world—offers a gripping and powerful account of the dangers health workers face during conflict and the legal, political, and moral struggle to protect them. In a dozen case studies, he shares the stories of people who have been attacked while seeking to serve patients under dire circumstances including health workers hiding from soldiers in the forests of eastern Myanmar as they seek to serve oppressed ethnic communities, surgeons in Syria operating as their hospitals are bombed, and Afghan hospital staff attacked by the Taliban as well as government and foreign forces. Rubenstein reveals how political and military leaders evade their legal obligations to protect health care in war, punish doctors and nurses for adhering to their responsibilities to provide care to all in need, and fail to hold perpetrators to account.

Bringing together extensive research, firsthand experience, and compelling personal stories, Perilous Medicine also offers a path forward, detailing the lessons the international community needs to learn to protect people already suffering in war and those on the front lines of health care in conflict-ridden places around the world.

 

AI everywhere (12)

 The Tyranny of Algorithms: Freedom, Democracy, and the Challenge of AI

Alternative payment models for pharmaceuticals

Outcomes-based reimbursement for gene therapies in practice: the experience of recently launched CAR-T cell therapies in major European countries

Kymriah® and Yescarta® have relatively uniform list prices across the EU5, and are reimbursed according to their marketing authorisations. In France and the UK, reimbursement is on the condition of collecting additional data (at the cohort level) and subject to future reassessments; elsewhere, rebates (Germany) or staged payments (Italy and Spain) are linked to individual patient outcomes.

 Kymriah® and Yescarta® were two of the subject therapies used to pilot and validate the Valtermed system for roll-out in November. Kymriah® is reimbursed in the Spanish NHS through two outcomesbased, staged payments based on data collected through the Valtermed system: one at the time of treatment (reported to be 52% of the total €320,000 ), and a second payment at 18 months (reportedly the remaining 48%), provided that the patient has achieved and sustained a complete response to the treatment. Yescarta® was approved for reimbursement in July 2019, and follows a similar approach to Kymriah®, however, with payments linked to survival as collected through Valtermed: reportedly a first payment of €118,000, and a second payment of €209,000

 Adolf Mas (1907) exhibition at KBR

Free our genes (3)

 Patents on Life. Religious, Moral, and Social Justice Aspects of Biotechnology and Intellectual Property

Against patents, again (2)

 Patents, Human Rights, and Access to Medicines

Knowledge and decisions as the engine of health reform

 Better Doctors, Better Patients, Better Decisions: Envisioning Health Care 2020

On Amazon (anything but a river) (2)

 Fulfillment. Winning and Losing in One-Click America

DouDNA

The Code Breaker. Jennifer Doudna, Gene Editing, and the Future of the Human Race

An absolute must read!

Data & Society

 A Primer on Powerful Numbers: Selected Readings in the Social Study of Public Data and Official Numbers

This publication is intended to be a non-exhaustive syllabus organized around a series of teachable or debatable claims concerning  the influence institutions of authority have on how data and numbers are created, as well as how that information is used by the datafied state to make fundamental decisions about democratic policy and process. 

Official numbers are the foundation upon which modern societies trust data. An official number is different from any other number because it’s given with authority and always there for the taking. Official data sets come out of bureaucratic and corporate offices and are imbued with the authority of those in power.

Six key arguments that center on the authority of data:

1. Modern societies are built to trust in official numbers (they even let official numbers make key decisions);
2. Official numbers are made, not found;
3. We forget that official numbers have to be made even when things are going well;
4. Institutions make public data and they make data public;
5. Official numbers are political; and
6. Consensus on official numbers requires work.