Ethics and medical technology

29 11 2012

Because of its high costs there are much better medicine for, increasingly, fewer individuals.

Ética y Tecnología médica


Raymundo channels of the sourceIn current Western societies appears a deeply contradictory phenomenon in view of the increasingly high costs of medicine.

Medical advances are very bulky, We have a vast panorama of new treatments, novel drugs, minimally invasive surgery, custom therapies, genomic medicine and a long list of tools to make our work more efficiently and with less discomfort for the patient.

At the same time attention becomes more expensive. Without a doubt we can save more lives or prolong them with reasonable quality, but in view of the costs, fewer people have access to the most advanced.

The research for these magnificent results involves million dollar investments that have to be cleared by the end user, that is to say, the patient found to be sick in a situation of vulnerability, having limited its production capacity; to sum fewer individuals there are much better medicine for each time.


All Western healthcare systems are in crisis, from the most powerful country in the world, in which the newly re-elected Obama could not resolved access to medical care for their less-favoured social classes, for a simple reason: el costo; with greater reason countries with less developed, such as ours suffer crisis regarding the financing of health systems. While it is true that the popular insurance has much more coverage, diseases that are covered are contained in a list, that excludes many others and the reason is, Once again, el costo. Thethe costdeepens if Additionally the novelties coming from abroad, often countries with high level of development whose vocation is focused not only on return on investment, but in doing good business with the sale of this technology.


The only rational way to mitigate the effects of this crisis, virtually global, It is investing in our own scientific and technological developments, through a scheme involving the Government, the industry and the scientists around a table with that common objective. Mexico has people in high level in all these areas with proven ability to take forward projects of high magnitude, the political will of a determined Government we only need to finalize them although there is the natural opposition of commercial houses transnational. It is necessary and urgent for example, the development of equipment for the control of diabetes, for hemodialysis or minimally invasive surgery, otherwise we will witness a collapse of our health systems, already clearly threatened by high costs, coupled to the corruption of those who exercise the popular insurance resources, that is to say, the State secretariats of health. It is an ethical responsibility that we hope that the next Government has the ability to cope with. [en línea]Mexico DF (MEX): de noviembre de 2012 [REF. 11 November of 2012] Available on Internet: = note&section = opinion&Cat = 11&id_nota = 869083

Dr BRUGADA: The risk is not premium but in discouragement

3 09 2012

Prof. Josep Brugada Terradellas

Medical Director, Hospital Clínic, Barcelona


Every day we wake up with new bad news. There is no way to have a joy. When it is the risk premium not, It is the deficit and public debt but. And yet the country continues to operate, with extremely high unemployment rates (far can upload??), but we go forward. In the field of the health consequences of the crisis are terrible: lowering of wages and increased workloads, cuts in non-vital but certainly necessary benefits to the quality of life that society was used and a feeling that is not yet everything has been said.

In these circumstances one can enter into a process of detachment from reality, blame others (especially politicians) by having us carried this situation, and thus justify that our productivity is not at his best level. Certainly this attitude will not help to make the output of the well in which we are involved more quickly, or more solidarity, or more responsible.

There is another way to deal with this disaster. With fighting spirit, positive, thinking that we can overcome it and we can begin to see the light at the end of the tunnel if we all collaborate and give the best of each. Creativity, innovation, always in our society have expressed in times of great need. Now is when we need all the brilliant minds, they are many, in this country. The discouragement, fatigue, apathy should now be prohibited in our institutions. We must seize this very serious situation to unite people with common goals, and health care, research and innovation can be examples.

Let us not give excuses to those who believe that the only solution will be possible limiting resources. The solution is also to empower those who believe in a job well done and the personal effort every day.

Dr BALCELLS: The strategy for exiting the crisis of the catalan health system

7 11 2011

Manel Balcells i Díaz

Director of the area of the knowledge of the Consorci Sanitari of Terrassa

The health system is in crisis. Across Europe in general and in Catalonia particularly. The global economic crisis affects directly the cuts all countries apply to their health systems. The impact is, but, very different according to the starting point. In the United States, the debate has been very different. There has been a discussion of model that has become an instrument of political struggle between Democrats and Republicans. In emerging countries, Naturally, the problem is very different, and they are far from reaching what is known as our European welfare State.

In our case, fully immersed in the European reality, the crisis lies, especially, the sustainability of a system that shows ever more sophisticated and technological, You must attend an older population, with chronic pluripatologias, and that it had greater expectations of life, and above all, higher life quality.In Catalonia, the general infrafinanciacion and above all the health (1/3 of the total budget of the Generalitat), entails that in times of crisis and economic recession, general budget cuts do not affect more crude and obvious to the health system.

Our system is internationally recognized for its quality of care and the high level of its researchers and biomedical research that is generally practiced. The current lack of resources and the presumable continuity of the economic situation, It makes it necessary to pose rather than conjunctural character changes, but real structural changes.

We are talking about, because, make a change of paradigm, consider the health system, not only as a cost center, but, and above all, as a generator of wealth, so direct and indirect jobs, and also, as a dynamic instrument of the new economy based on medical technologies, in the spin-off from hospitals and research centers, and as a system capable of generating economic return to base to exploit knowledge in the form of patents and licences.

Some data
I system + (D) + catalan i is at the international level in terms of the volume of scientific publications. In fact, el 50% all of them refer to the biomedical research. According to the Citation Index Sience (SCI), in 2006, las 1.793 Catalan publications represented the 25% all of the State Spanish, el 2,5% the European votheme and the 0,9% of the world. And in terms of quality as measured by the so-called impact Factor, the global era of 6.189, with an average per item of 3.4. Therefore, Catalonia is an advantageous position on the international scene.

On the other hand, the number of patents generated by this knowledge is much lower in comparison with other European countries, and of course the U.S.. Spain represents the 1.4% of the total number of patent applications in the European Union, faced with the 44.1% of Germany and the 15.4% of France. In 2008, for example, in Catalonia they processed 75 patent applications, they counted 22 licences to companies, representing this the 38% patent and the 30% the set of the Spanish State license. Similar is the creation of enterprises Statistics.

We find ourselves, Therefore, to a considerable disproportion between the scientific production and the generation of economic activity. The weak point in our House, of the entire value chain is, because, the appraisal and transfer of knowledge.

Potential of innovation in hospitals
In Catalonia we have an excellent hospital network. Not only to the level of care, but also in scientific production. In fact, of the 10 hospitals statewide leaders in scientific production 6 they are Catalan and, In addition, located at the top. This great production and at the same time high level, it pivots in a binomial hospital-universidad by the research institutes located in large hospitals, where is performed as basic research and translational.

However, innovation, everything in medical technologies, in diagnostic imaging, health care processes and clinical management, It also pivots in the whole of the hospital network of Catalonia, where work more than 232.000 Professional, most of them, with a high academic qualification and long tradition of presence in international networks.

Multiple studies led by prestigious business schools, and recently the OECD report “Rewiews of Regional Innovation: Catalonia, Spain (2010)”, I pointed out that the catalan cluster is among five to ten first clusters in the world in terms of the dynamism of your network. Within the report, It also remarked the great potential of innovation in hospitals, with all that represents of immediacy in their applicability and subsequent marketing in the case, for example, new diagnostic and therapeutic techniques.

This environment represents a moment of opportunity, precisely, to try to convert our potential in biomedical knowledge in economic return direct to the system in general, as they are known and various countries. It is here where is the key to the involvement of the sector in the output of the current crisis.

Structural changes
Paradoxically, at a time of budget cuts, We must promote the creation of technology transfer instruments. If only to reduce spending, without above all based on the binomial cost-effective changes, everything will be useless. In order to make these changes, There are to innovate. And not only to innovate, but the technological improvements that mean savings, After a process of validation, and subsequent recovery and marketing.

We must introduce elements of competitive dialogue among technology buyers (hospitals) and innovative companies (Catalan or other parts implanted here), allow increase the productive fabric. With elements such as the innovative public procurement, This is possible.

I speak, because, changes in depth. Medium-term structural changes that allow us to have, as other countries do, centralized units of valorisation of innovation, and marketing their patents. I speak also of bringing venture capital to projects and leverage, If necessary, to them with public money, especially in the more early stages of development. However, We will always be dependent on joints and multinationals, and above all always restrictive budgets.

Proposals for the future
This is a future that should be present. The enormous economic potential of our health system (even trimmed) allows you to meet these challenges. Immediately would have to raise recovery instruments, After progressively introduce the methodology of innovation opened in our hospitals.

We must encourage entrepreneurship from the faculties of medicine and nursing, develop specific training programmes for accompaniment by professionals with innovative concern, with ideas that can become projects. A programme for hospital innovation must be urgently and must be developed in a way had the charge of all health centres.

Must be articulate immediately a (or more) capital funds willing to finance projects at early stage. Must be articulate public-private participation in all the projects with possibilities of reaching the market in an organized manner. All of this, in a participatory way, funded and urgent, with the complicity of all economic and social agents, and with international vision.

Underfunded economically, and with a sector and health system which is undergoing significant cuts, and at the same time presents great strengths in knowledge, It is time to make this sector an emerging economic sector.

Missing all these instruments that enable it to reverse a situation sufficiently analysed by all experts. There are, In short, that have the vision to invest in everything that represents the transfer of technology in this sector, If I want to get out, in a determined manner and medium-term, economic dependence on others, create jobs, attracting capital and help at the exit of the general crisis.

We have an opportunity. Who is capable of working in this line, to do so. For the sake of the country.

Dr BRUGADA: In times of crisis: thinking about the future

2 05 2011

Prof. Josep Brugada

Medical Director, Hospital Clínic, Barcelona

Our welfare state is not at its best. The economic reality we are placing at the level that is us as a modern State, democratic but less rich than we thought. We have consumed beyond our means and we now have to return what was spent. Many of the investments have been made without strategic planning and thinking more in the territorial or electoral immediacy that needs as a country.

Now we have to accept that we spend what we have and that many of the infrastructure will be underused resigned. Some because they had never built since its usefulness was more than doubtful, and other because does not have the means to implement them at full capacity. This includes, as not, health infrastructures. We have an enviable health care system in many respects. Universal coverage, free benefits, very limited co-payments (Pharmacy) and generosity with all social sectors, even those newcomers not involved of the financing of the same so far.

A system that has an expenditure ceiling. It is unthinkable to keep this situation indefinitely, especially if spending increases exponentially and income are reduced significantly by the decrease in the collection of the State. And this is the situation that we have experienced in recent years. Now have to rethink the entire system. Adapt our expenses to revenues. Do what have to argue why sustainable works and as argues the Prof. Guillem López-Casasnovas, making solvent, changing it, What is not now.

We cannot play as a country to this uncertainty in basic social benefits, and health certainly is one of them. The crisis should be the fuse that fired the necessary evolution towards a health smoothly and continue running regardless of political changes, Economic and social.

Healthcare technology

3 02 2011

Our national health system is recognized as one of the best in the world although it is subjected to various threats, notably the ageing of the population, given its effect on the number of people suffering from chronic diseases (the 5% patients consume the 70% of health resources) and its impact in terms of cost (health spending per capita of elders of 65 years is at least four times higher than children of this age).

For this reason, According to EUROSTAT estimates, the public budget Spain dedicated to health must grow from the 5,5% of GDP in 2007 up the 7,1% in 2060, When elders of 65 years have passed from 8 a 17 millions of people and elders of 80 years will be around 8 million compared to the 2 current. All this will happen in a situation in which the number of pensioners relative to the number of occupationally active contributors will grow significantly.

On the other hand, the technological progress and the idea of that health is priceless, Although a high cost, Health Services strongly without having previously demonstrated improvements in the effectiveness/cost ratio that will involve the introduction of new technologies. This fashion effect explained, among other reasons, by the preponderance of the distribution companies (It is estimated that only the 20% health products used in Spain are manufactured in our country) and its role in the continuous training of health professionals.

This situation there are two opposite ways. One is to develop technologies that maximize the cost/effectiveness ratio giving rise to families of generic health products by involving practitioners and health centres to establish their technical requirements and criteria of prescription, and the Spanish industry in its production, whether manufacturers of this sector or other sectors in crisis who wish to convert taking advantage of their technological capabilities and management.

He has indicated that, from a strictly economic perspective, on equal terms, purchases of products manufactured in Spain are less burdensome for the public finances than imports, given that generate a tax return that falls on the factors of production that does not occur in these (between a 30 and a 35 by 100 acquisition costs returns to the State via income tax, VAT, social security contributions, corporate tax, etc., not to mention saving that prevent unemployment benefits).

Another way is to take advantage of the crisis in which we are installed to reduce the budgets of public health and the quality of the services provided, What, without a doubt, It will limit the demand for those citizens who can afford private medical insurance, elaborating on the savings. I'm afraid that companies in this sector already are rubbing his hands. [en línea] Valencia (Spain): foForum-icv.org24 in January of 2011 [REF. 03 de febrero de 2011] Available on Internet: