Tag Archives: AstraZeneca

As jobs become available

Yup, there is always good news if we know where to look, even as we see a setting where over 50% of all coronavirus cases are in the USA, India and Brazil, we need to think hard of what numbers are not shown. Even as India has well over 3 times the population of the US, there is no way that the numbers add up, with the US having over 9 million cases and India barely passing 8 million, the stage is not completely seen. The population pressure and environment should give India a lot more than the US, so the stage is not clearly seen. I have less doubts (but some) with Brazil, there are over 5 million there and that number seems off (I am emphasising on seems), when we consider the 211 million people there, the pressures in Rio and Sao Paolo, the number seems low, more important, the mortality rate on Brazil merely seems high, in my personal view, either there are a lot more cases, or the mortality rate is skewed, optionally from connected complications. So as more people die, more jobs open up (one would hope). In this stage we could say that every silver lining is the foundation for a new dark cloud.

These numbers are important, especially as the EU goes into a new lockdown. There is the larger issue. We see Spain and France being at 1.2 and 1.3 million. Nothing wrong with that, but a similar setting of populations is seen in Germany with only 510K sick, these numbers do not add up, especially hen you consider that Germany has 83 million, France has 65 million and Spain has 46 million. The German numbers are as I see them off. This matters, because if the numbers are too surreal, the lockdown will merely be a pro forma exercise that does close to nothing in too many places. The problem is that I can see that these lockdowns are the best we can get until there is an actual vaccine, and there is not date on that. One source gives us “On Tuesday, front-runner Pfizer revealed in an earnings call that the first interim analysis in its Phase 3 clinical trial has not yet occurred. That means there hadn’t yet been enough Covid infections among the trial participants to take a first stab at analysing whether the people randomly assigned to receive vaccine were infected at a lower rate than people who were assigned to get a placebo injection”, so consider that phase three is not done and this needs to come and be confirmed before we have a setting where manufacturing can begin. And it is even earlier ‘the first interim analysis in its Phase 3 clinical trial has not yet occurred’, that implies that we get to a stage where any solution would not be here before January 2021, and that is if the second analyses of clinical trials those who precede towards ‘a vaccine is working’ is well over 8 weeks away, making the earliest stage of manufacturing would start on January 2nd, if a solution if found by coming Monday. Are you feeling frisky yet? And all this before the realisation starts that 2 billion doses will take more than a few days. I got (from Vaccine Europe) “On average, it takes between 12-36 months to manufacture a vaccine before it is ready for distribution” and on top of that Sanofi is one source stating that they can make 2.5 million doses a day. This gets us to the 2 billion shots, taking 800 days to make and that is if everything goes right the first time. So there will be a waiting list that is well over 2 years and that is WHEN a vaccine is a reality. Now consider it takes another 12 months before a vaccine is a reality, implying that Covid-19 will be around until January 2024 at the very least. At what stage will we learn that masks are a good idea, and I am happy to set the stage that lockdowns are some proof, but what proof remains the issue, do you still think those Swedes were nuts? 

And in this, consider the news that CNBC gave us in June ‘AstraZeneca is aiming to produce 2 billion doses of a coronavirus vaccine — and it could be ready by September’, do you still think that I was crazy saying that the media is a much larger cause of all the fake news we get?

I am not stating that I know when there is a solution, I am not proclaiming that I have all the answers, yet the numbers are clear and they tell a few stories, and in all those stories we see that some of the reflections offered to us are incorrect, incomplete and dazzled with issues. On the upside, my 5G IP has benefits under Covid (and lockdowns) but they were not designed as such, it is merely an upside to it all. And when we look on, we might see the corporate needs, but they are merely in it to keep their heads above water, and I do not begrudge them that, but a lot of the actions are made on incomplete views and more incomplete data, that much is certain. 

I get it when some state that there is an overreaction, yet some setting (like face masks) are never a bad idea, it makes sense that some lockdown measures are essential, yet how will that ever work in Mumbai, which is 4% the size of Sydney, but has close to 300% of the population, and people under why I doubt the Indian numbers? They test 500 a day, even as they had until recently 100,000 new cases a day. That it’s why the numbers make no sense. And this is merely getting worse, as economic barriers collapse, the setting will continue to degrade. I believe that India is in a much worse state, but that does not absolve Europe (or the US), this will get worse and those governing will be seeing the inside of courts, defending the stage, the setting and their actions. The media (even those with ludicrous headlines) they all want their digital media coin, so they will rely on hardline after headline and it will be about creating flames, not information. That is how I see it and feel free to disagree.

And as November is a mere 2 hours away, consider the time line I gave. Then consider the headline that the Guardian relied on yesterday ‘‘It’s possible’: the race to approve a Covid vaccine by Christmas’, unless the vaccine is properly tested by Friday, that deadline cannot be kept. So when you see “Kate Bingham, who heads the UK’s vaccine taskforce, said the UK was in “a very good place”. But there are still hurdles to clear in the coming weeks” (at https://www.theguardian.com/world/2020/oct/30/its-possible-the-race-to-approve-a-covid-vaccine-by-christmas), and when we see “It could be Oxford University, partnered with drug company AstraZeneca. It could be Moderna in the US. Or it could be Pfizer and the German company BioNTech. All three have either recruited the last of the tens of thousands of volunteers they need for the critical final trials or will shortly do so”, in this I merely wonder whose trumpet she is blowing. I am not blaming her or the three, they have a hard job, yet unrealistic time lines are hard on us and they are facilitating for those trying to manage bad news and that is not right, not in this case (well, most often not in any case).

So if you are hoping or relying on a vaccine, think again. The numbers do not add up, on several sides and the media is not asking questions, so I am.

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A no-go is not a failure

It happens, things especially in science take a little more than we think it does and it also takes more attempts than one, this was a given from the very beginning, so when I mentioned issues in ‘The worst is yet to come’ (at https://lawlordtobe.com/2020/09/06/the-worst-is-yet-to-come/) this wasn’t it. Yet I did give mention of it in a previous article, it was going to take time. So when we get ‘Oxford scientists: these are final steps we’re taking to get our coronavirus vaccine approved’ at September 8, 2020 8.04pm AEST, yet less than 1 hour ago we are treated to ‘AstraZeneca coronavirus vaccine trial suspended: Live news’, here we see “AstraZeneca says it has suspended trials of the coronavirus vaccine it is developing with the University of Oxford after one of the trials’ volunteers fell ill with an unexplained illness”, this is not a reason to panic, science will hit bumps and optionally this is merely a bump. Yet this bump translates to time, time that most governments no longer have. Yet it is the nature of things, so as we see “More than 27.5 million people around the world have been diagnosed with the coronavirus and 897,383 have died. More than 18.5 million people have recovered”, we see what some call dire statistics, yet in a population of 8,000 million, is it really dire? 

We also do not need to see ‘CSL unfazed by vaccine trial hold-up’, yet the text “Blood products giant CSL is pushing ahead with its preparations to manufacture the AstraZeneca COVID-19 vaccine, despite the multinational biotech halting its phase three trial on Wednesday” raises questions. Preparations make sense when the situation has been resolved, or the issue is not a real bump, but the text “This is a routine action which has to happen whenever there is a potentially unexplained illness in one of the trials, while it is investigated, ensuring we maintain the integrity of the trials”, gives a larger worry, and when we see governments eager to push out a vaccine is what might be regarded as a false sense of security, who would benefit? Now this is speculative because the situation is fluid, and even as we get the news from several media sources, they tend to have their own agenda and 7 hours ago, ABC gave us ‘Oxford coronavirus vaccine trial on hold over ‘potentially unexplained illness’, AstraZeneca says’, we are treated to the word ‘potentially’, this is actually fair, especially in light of the quote in the ABC article “AstraZeneca said it “voluntarily paused” the phase 3 clinical trial — which kicked off in July — to allow a review of the “single event” by an independent committee”, an action triggered by a single event, the setting of AstraZeneca makes perfect sense. It is a safety setting and here the no-go (for now) is not a failure. There is every chance that we will see the found explanation in the very near future and that makes AstraZeneca the winner.

In the setting of any normal timeline, we got lucky, if (and we emphasise on if) it becomes the cure, we will see that AstraZeneca has broken records in finding an optional cure for a disease that had no cure, no vaccine and that within a year is pretty spectacular. Especially when a timeline up to 18 months was an expected setting. So even if the bump implies that there will be a delay, AstraZeneca is well ahead of schedule, and before we go out on a limb and get crazy, less than a million died, in a setting with 8,000 million people, there is room to manoeuvre.

 

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Mental health or Medication

We have seen the premise in a few stages in the last decade and for the most people lean towards one or the other and that is fine, it is a hard choice to make and there is no real evidence which of the two is better in the long run. Mental health needs treatment, medication is at times not a cure, merely a way to create a timeline for treatment, or to minimise the impact of the situation. Yet there is also a medial state that is not mental health based, for example treating people with cystic fibrosis who have two copies of the F508del mutation, for them there is Orkambi. Yet, what is the status when this involves a politician? How delusional is a public speaker allowed to become before he is considered unhealthy and unable to perform his function?

That question came up when the Guardian gave me ‘Labour pledges to break patents and offer latest drugs on NHS‘ (at https://www.theguardian.com/politics/2019/sep/24/labour-pledges-to-break-patents-and-offer-latest-drugs-on-nhs). So not only is he making claims, he is basically pronouncing war on the World Trade Organisation, abolishing the TRIPS agreement and throwing it all overboard. As we realise that the World Health Organisation gives us: “As of February 2005, 148 countries are Members of the WTO. In becoming Members of the WTO, countries undertake to adhere to the 18 specific agreements annexed to the Agreement establishing the WTO. They cannot choose to be party to some agreements but not others“, the UK and the EU are both signatories, so Jeremy Corbyn is stupid enough to set a stage of war that endangers millions. To give a little consideration to the metrics, we get the numbers on Cystic Fibrosis, not merely those with these two mutations (a specific subset), we see that more than 70,000 people worldwide are living with cystic fibrosis. Approximately 1,000 new cases of CF are diagnosed each year. More than 75 percent of people with CF are diagnosed by age 2. More than half of the CF population is age 18 or older. Now this is not a good thing, we admit, yet we are looking to a population that is less than 0.001% of the entire population, more important the people that need Orkambi are a mere subset of that. And for the UK it would linearly mean that it affects only 0.1% of the 0.001% that optionally have it. That is his ‘limelight’; can someone please kick this idiot out of the Labour party (preferably out of UK politics altogether)?

And in the second part, no political party has any business being in the pharmaceutical industry, there is a reason why industrials should never have any political power (well, we lost that one ages ago, but still). His voice giving us: ‘party will create company to make cheap versions of drugs‘, whilst the metrics give us that it will be a population less than a 100 that have this version of Cystic Fibrosis that is what he is fighting for? He cannot even properly represent his constituency and now he is starting patent wars as well as a war with the World Trade Organisation on abolishing or severely changing The Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS)? Not only does it not make sense, the impact could be devastating for the UK. This is a person screaming ‘election’ and then spinning silent when it was offered.

It is my personal view that UK labour is better off getting the clown Ronald McDonald to do the Labour party bidding, and it will do a better job than Jeremy Corbyn ever could. His promises are no longer empty, they are now right-out dangerous.

Pharmaceuticals

There is a larger pharmaceutical issue and it has been going on for well over a decade, the issue that patents are reapplied well over 30 years after date, often in a slightly changed form, only barely passing the innovation line is the largest concern for generic medication, yet there are dozens of examples and Orkambi is nowhere near the top 10 in this. Lyrica (Pfizer), Rituxan (roche), Cialis (Eli Lilly), Xolair (Roche/Novartis), Restatis (Allergan) are 5 of the top 10 expiring patents with a value of a little over $16 billion in total, and those owners would like a little longer exclusivity, because the expiration will hit their bottom line in a real hard way. In that list Orkambi does not even stack up to any decent degree and we have larger issues gaining patents with a generic option and Corbyn’s need to make war with TRIPS, whilst the NHS has larger issues, especially as it was Labour who botched the NHS IT project losing £11 billion and small change to the degree of several millions is not one who should be casting voices on ending patents.

The sentiment is not wrong, but the chosen field is a little beyond stupid, making us wonder whether the man is personally dealing with mental health issues. We all have had that moment where we wanted to stand in front of Dwayne Johnson calling him Tinkerbell, not really wise, but we all have those inflated moments of self, to do what Jeremy Corbyn does worse hiding behind one 9 year old with: “Luis is denied the medicine he needs because its American manufacturer refuses to sell the drug to the NHS for an affordable price“, so this is not some Cystic Fibrosis case, this is a very specific case and the medication required many millions to create and pass FDA approval. A medication for CF patients with a rare mutation. With two specific mutations in a disease that knows more than 1,700 mutations that had been found in the CFTR gene. Orkambi works for patients with the F508del mutation in both copies the CFTR gene, the most common mutation in people with cystic fibrosis worldwide. So even if it is the most common, there are 1700 mutations meaning that his war on one medication to a specific subset that comes down to a lot less than 100 patients in the UK. So this idiot (read: Jeremy Corbyn) goes to war, promising to abolish TRIPS and leaving the WTO, all for a subset of people, too small to fill a village? Now consider that the UK has Pharmaceutical interests as well, the top two players in the UK are GlaxoSmithKline and AstraZeneca representing almost £132 billion pounds, because if he does what he does, then those two will vacate as well, this is how stupid Jeremy Corbyn is, but he is hoping that you will not notice this as he is in feigned tears for one nine year old child. I only mentioned the top two, the field is larger than that, but Jeremy Corbyn is willing to throw it all in the air.

Can you please explain to me how the government budget will be met when two companies representing a taxable £100,000,000,000 leave the UK? This is the kind of short-sighted, BS carrying ventures that Jeremy Corbyn is handing its constituents. His claim is ‘In England about 5,000 young patients could benefit, but the NHS said it could not afford to pay the bill‘, if there are worldwide 70,000 Cystic Fibrosis (CF) patients the UK cannot have that many, the claim of “US drugs company Vertex priced Orkambi at over £100,000 per patient per year” might be true and for 100 patients that is still serious money, but we need to recognise that we cannot hand every working person a Ferrari, we do not have the money, and it is that extreme. We are in a position where until a patent ends, the maker gets to set the price, or not sell the product. In light of the numbers I see, I want Jeremy Corbyn to give us an exact list of these 5,000 patients and what medication they need. I reckon that the picture shifts a lot faster at that point. And we agree that larger changes are required, yet making a direct case to the WTO that patents cannot be extended above the 35 years is a lot better than abolishing the WTO. Yet Jeremy Corbyn has no options to do that, so he comes with a delusional plan to start a company that ‘create company to make cheap versions of drugs‘, whilst there are plenty of companies doing that, the case remains that patents hand exclusivity until they expire, this year 26 drugs are facing patent expiration and yet, Orkambi is not among them, but 26 patents will become generic, before 2022 42 patents will expire and that is good for a lot of people, yet this system is already in place, we do not need some delusional politician to add his need to become a rich pharmaceutical cat as well.

To be honest, I have never had such a low regard of UK Labour ever before, the fact that I have twice the regard towards LibDems than towards Labour at present is something I never thought possible in the age of Ed Miliband, whomever thought that Corbyn would be a worthy successor deserved the title ‘Joker of the Year‘, as I personally see it, it is actually that bad at present.

So whomever is happy that this optional mental health case is running the UK labour party is in desperate need of some medication (generic NHS funded options will be available).

 

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EA Games is waking up

We agree that EA Games has had a rough time, there is the loot box gambling part, a part I am on the side of EA games and I do not agree with the findings on a few levels. Yet there is a side where EA Games needs to wake up fast. first the good parts, like Forbes in September (at https://www.forbes.com/sites/games/2018/09/13/nhl-19-review-the-good-the-bad-and-the-bottom-line). From my point of view NHL19 is the best NHL game they ever launched. They started really good at the launch of the PS2, then there was a really good version of the game in 20903 on the GameCube and after that it started to sizzle (as I see it). They were more asleep than awake and the NHL franchise fell behind and fell behind a fair bit. EA Games had a few more good moments. Madden NFL 2002 On the Xbox was surreal and amazing, but that too fell down a bit, most state to me that NFL19 is awesome on many levels and I might find it out for myself in the Christmas sales dumps (somewhere out there). I was never a soccer fan, so FIFA is not in the cards, but the reviews are good and I accept that, but this is not about that, it is about the flaws in NHL19 and there are a few. Most of them are around the cards that you have accumulated, there is an option missing and a few details going into space, all could have been avoided. I personally believe that all 19 games have the same flaws and that is such a shame.

Then there is the use of cards, in my case I ended with a free HUT silver card and I have absolutely no clue what it does. So EA Games is not informing the users on some of the cards, which basically amounts to deceptive conduct. In a stage where EA games cannot afford to get markers of deceptive conduct against them is not a good thing. I love it that you get a free pack of 4 every 8 hours, which is awesome. Yet that does not rack up a lot in all the things I found. The option of a decent CCG album would have been great, with the cards on the right (or left) and the other side a superimposed image of that card where you could read all the details, why is it not there (not the version that is there now and it is a little laughable)? The filtering in auctions and looking at your cards is awesome, yet the lack of certain elements would have made it better. The customisable main screen of NHL 19 is awesome, and the practice part is fantastic (the final deke is a nightmare), yet overall this addition will entice more new players to NHL, especially those who have a puck instead of a heart (like me), it’s fun to have one but it freaks out the cardiologist to no amount, which is additional fun to boot. Why not expand on Franchise mode? Perhaps I did something wrong, I found the beginning awesome as I got my favourite team (Caps), arena, logo and jerseys unlocked. Why not unlock more with each game you win, other caps jerseys? I think we can accept that these will be non-tradeable cards, most gamers will not care, consider all the teams, American, Canadian, Scandinavian and other team leagues in there, the amount of jerseys and logo’s to unlock, would it have been such a shame to add them as unlockable parts? Now, I get it that this does not apply to the players, yet you still have the option to get those in the free packs (up to three players a day). It adds to the replay power of the game, adding bang to the buck and value to the game. Overall NHL is a screaming success, yet the parts that I found have a 5-10 point negative impact, whilst that should not have been the case in the first place and I reckon that I would find the same failings in both NFL19 and FIFA19, so a failing thrice over, and then there are the auctions. It is great that the game gives a free pack every 8 hours and there is always a coin card with 100 coins or more. Having won more than one 1000 coin cards made me very happy, as it allowed me to get 20 arena’s and half a dozen jerseys in a mere three weeks, so this is all good. What is less it that there seems to be an auction bug. I have been the front runner more than once and feeling happy having won a few auctions as the auction ended with me having the highest bet, only to go to the menu finding my coins returned and no card, which feels like a total sham. I actually lost my money once, but not through the auction, that daily coin card just vanished. It was a mere 200 coins, so no biggie, but it feels a little sour for a few seconds.

The graphics are awesome on the PS4, the controls are for the most outstanding and actually feel intuitive (except for some dekes) and practice mode adds to the flavour of preparation, which makes you more and more in the winning state of mind. I feel that having to select the language every time I start the game is weird, but what the hell, so first the language, then selecting the game at the main screen, a part that could have been done better I guess. Forbes has a few additional parts, all worth consideration, and the quote “The balance between offense and defense is good. Poke checks aren’t out of control as they were in a previous version, but still, an effective way to stop an offensive player’s progress. I think this year’s game forces you to use all of your defensive tools more than others. The more tools you can command, the better you’ll be at the game, and that’s the way it should be“, is one I wholeheartedly agree with. In addition there should be mention that the soundtrack adds to the game in a way that must be noticed. or me the fun was that I didn’t know any of the songs, which is always nice, especially when you feel more in the mood to play hockey because of it. In the end, the scores varying from 80%-89% is decent, yet I personally believe that adding these few parts to the interface and adding the reward unlocks might have made this a 85%-94% game. When that realisation sets in, consider what FIFA and NFL are optionally missing out on, especially when you realise that some people will not consider a launch day game for any title scoring less than 90%, that racks up to a serious amount of cash.

As stated, NHL 19 is the best NHL game I have seen in many years and that is still a great victory to behold, especially to play it again just as my team won the Stanley cup for real, which after supporting them for almost 27 years is a real good feeling. Now, I just need to get them there in the Pro Career (which might be a taller order for me), yet I remain an eternal optimist.

You see, if Colonel general Igor Valentinovich Korobov can drop the ball in Salisbury to the extent that the ball has been dropped, I definitely could be a successful NHL goalie, preferably the Western division so that I do not have to go up against my own favourite team, do you think that the San Jose Sharks could use another goalie?

Oh, and I had initially planned on writing about the media BS that we are getting from AstraZeneca and Brexit, which especially in light of certain patent pains are a hoot, but I am still gathering materials, so that will take a few days.

 

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Behind the smiling numbers

An interesting story got to see the internet light by Nicholas Watt (at http://www.theguardian.com/society/2016/feb/16/income-tax-must-rise-3p-to-stop-nhs-staggering-from-year-to-year). The title ‘Income tax must rise 3p to stop NHS ‘staggering from year to year’‘, which implies initially that the NHS needs £1.95m, which might be OK. Yet the truth is far from that, the text gives us that Lord Kerslake stated “Income tax will have to increase by at least 3p in the pound…. “, which is another story entirely (and first evidence that members of the House of Lords are gifted with a decent sense of humour).

His lordship is quite correct when he states: “big questions needed to be asked to ensure that spending kept up with medical advances, an ageing population and the need to invest in hospitals“, yet these are mere facts that should have been asked almost a decade ago, there was a clear and near immediate danger to the health of the NHS. The logic we see after that becomes an issue (read: worry, concern, and both are debatable) “Health spending needs to rise at least in line with GDP. Arguably, we may need to go faster if we want to match European funding. You might argue there is a discount there because we have a more efficient system. But it’s got to be at least GDP-linked otherwise I don’t think we’ll get there“. So let’s take a look. First the Dutch version (at http://www.rijksbegroting.nl/2015/voorbereiding/begroting,kst199401_25.html) gives us two issues should we be willing to ignore language barrier. The BZK gets €71.3b, which is divided in €7.5b called budget financed expenditure and €63.8b from premium financed expenditures. So for argument sake, let’s take the total and divide that on a population of 17 million, this now implies that there is almost €4200 per person (remember that this is a terribly rough estimate).

Now for Belgium we get the VBO with €23.85b. Now we all know that Belgium is a much smaller nation (not that much smaller than the Netherlands in size) and with 11.5 million calling the Belgium nation their homestead we now see that they end up with €2075 per person (Rounded upwards). Perhaps his Lordship could give a slightly more detailed explanation for the remark “Health spending needs to rise at least in line with GDP. Arguably, we may need to go faster if we want to match European funding“. Considering that the Netherlands and Belgium are next to one another and their budgets per person are apart by a mere 49.404%.

This gets me to the core of the proclaimed matter, can anyone explain why we are linking healthcare to GDP? Perhaps, and this is merely a lose speculation, some people in the House of Lords had the time to read a paper by Santiago Lago Peñas (added at the end) called ‘On the relationship between GDP and Health Care expenditure; A new perspective‘, now that might be a good thing, there is nothing wrong with Spain taking the lead in matters (especially if it is a good idea). Santiago Lago Peñas as well as David Cantarero Prieto and Carla Blázquez Fernández have written an interesting paper.

First let’s take a look at part of the abstract, which states “Econometric results show that the long-run multiplier is close to unity, that health expenditure is more sensitive to per capita income cyclical movements than to trend movements, and that those countries with a higher share of private health expenditure fit faster and following a different pattern“. Now, I am not going to take a deep dive into this one (it is after all an abstract), but it gave me a few ideas on where to dig.

Next are a few quotes: “Attention is paid to several usually neglected dimensions of this link. With this aim, four different specifications are presented, with the logarithm of per capital total health care expenditure as the dependent variable in all cases” this doesn’t seem to be more than just a quote, but it will have impact down the track.

It is part 2 called previous evidence that is a first issue. When we accept the initial statement “the debate on this link has moved on whether the income elasticity of health expenditure is greater or less than 1 (Bac and Le Pen, 2002). An income elasticity less than 1 classified health expenditure and income inelastic, therefore, as a “necessary” good. On the other hand, if the elasticity is higher than 1, health will be classified as a “luxury” good“, which will do for now. You see, my issue is when we see the part that follows:

  • The seminal paper by Newhouse (1977)
  • An earlier study by Kleiman (1974) for a different set of countries
  • Leu (1986) using cross-sectional data for 19 OECD countries in 1974
  • Parkin et al. (1987) using similar methods and data from 1980
  • Brown (1987) using a sample of 20 OECD countries

Here we have the first issue. You see, this is not regarding the methodology, it is about the data, methods of data collection, usage of weights (if done), these numbers regarded in contrast towards those temporary populations in reflection to the whole. Health expenditure is one part, but based against which healthy part. Now consider the initial reflection I had on the Netherlands and Belgium. They have very different norms in respect to mental health care. Now consider the statements ‘19 OECD countries in 1974‘ and ‘20 OECD countries in 1987‘ I will again make a clear speculative declaration that the mental health norms are not equal, especially when considering economic differences, which gives my first thought, how useful is the paper on a whole (I am not attacking it) and how applicable this would be (read: could be) in reflection towards the whole.

You only need to scan for ‘psychology, psychiatry and mental health’ to see that the paper does not take this into consideration. As we know that the EEC nations have had their own approach to mental health in the past, is not a statement that they did anything wrong, but if this is the first element that does not align, what else will not align (there are a few). One that shines directly behind the ‘previous evidence‘. You see in my head the question comes to mind when I see “The econometric analysis relies on annual data for 31 OECD countries from 1970 to 2009 gathered from the OECD Health Data Set 2011“, so is this aggregated data or raw data. if it is aggregated data the foundation might not align giving an unbalanced and invalid view (in my personal opinion), if it is raw data, what ground line data (the full population) is added so that the individual record compares towards the national whole, if that is missing how can any calculation be truly reflective of what was, especially taking into account the data is reflective over different time zones with very different social pressures. In that case I wonder if I can get a similar result by calculating Z-scores and run a Crosstabs in IBM Statistics #JustSaying!

Now we get back to the article which comes with the image of a smiling Lord Kerslake. Does this paper validate or invalidate the idea? No it does not, but it leads to questions, serious ones.

The quote “John Appleby, the chief economist at the King’s Fund, has estimated that NHS spending is due to fall from 7.3% of GDP to 6.6% in 2020-21. If health spending were to keep pace with economic growth, Appleby estimates an extra £16bn would have to be found every year by 2020-21 to take the NHS budget to £158bn. This works out at 3p on all rates of income tax, according to the IFS” is next!

The term ‘NHS spending is due to fall‘ reads like an event Baron Munchausen could have come up with (the character from Raspe’s book in 1785, not the syndrome). Of course the prediction is 5 years away, which makes it speculative. Now we know that John Appleby is more than the Chief economist for The King’s fund. He is also a Visiting Professor at the Department of Economics at City University and he has a whole range of publications to his name, so why am I opposed?

Well, part of this starts with his own article ‘Social care: a future we don’t yet know‘ (at http://www.kingsfund.org.uk/blog/2015/11/social-care-future), the two quotes that get the foreground are “In our submission to the Spending Review we called for social care to be protected from further cuts and for the money previously agreed for the postponed Care Act funding reforms to be retained and invested in social care. But non-protected departments have been asked by HM Treasury to model cuts of 25 and 40 per cent – so further cuts seem inevitable“, as well as “What would happen if the spending cuts applied to social care over the past five years continue over the next five? Spending on social care for people of all ages as a share of GDP has already begun to fall. It was roughly 1.2 per cent in 2009 but if cuts continue at the same rate it will have halved by the end of this parliament to barely more than a half of one per cent of GDP“. Now there is nothing wrong with any of the texts, John Appleby is not where he is because he is silly, he is very (read: extremely) clued in. I am stating that the environment has changed, it has changed drastically from 2011 onwards and in addition; the changes the UK faces over the next three years will take some of these prediction to town in not so nice a manner.

You will now ask why, which is the question you should ask!

We get part of this from the London School of Economics and Political science (at http://cep.lse.ac.uk/pubs/download/special/cepsp26.pdf), the initial answer is given on page 13. Where we see “To summarise, treatments for the “common mental disorders” of depression and anxiety can be self-financing within the NHS. By spending more, we save even more. This is different from much of NHS expenditure. At the same time we relieve one of the main sources of suffering in our community“, in addition page 15 gives us “According to the 2007 survey, which covered a random sample of households, only 24% of people with depression and anxiety disorders were in any form of treatment“. This now gives us the first part in all this. The overall costs are not in league of the budgets because there is a missing foundations of equality on what falls ‘within’ the NHS. There is no option for the NHS other than to evolve into something ‘more’ complete. The UK is about to get 20,000 refugees from war torn Syria (over several years), the initial approved £1b seems to be nothing more than a drop of water on a hot plate, the ‘why’ will be clear shortly.

The UK has seen a massive rise in mental health issues in the last year alone. Depression and anxiety mainly due to economic events (cost of living) is now a serious concern, especially as the pressures of the economy are likely to continue a few more years. Consider my article two days ago (at https://lawlordtobe.com/2016/02/15/is-there-a-doctor-on-this-budget/) called ‘Is there a doctor on this budget?‘ where we saw the link to ‘Health Care for Undocumented Migrants: European Approaches‘. The graph shown on page 3 is the charm. If we consider the cube, we see that on the X-axis we see subcategories of undocumented migrants, yet the same expenditure would apply to refugees (or the population for that matter). Now consider the Y-axis which is about the type of services and the Z-axis are the funding arrangements. Now this can be treated like a glass with liquid. If we increase the base (X or Y) the funding arrangements go down, it is the simplest of physics, a bigger glass requires more fluid to fill, so we have a population with more health care needs, mental health care in this case and the types of services is not just against depression or anxiety, it will require the coverage of war trauma and shell shock. This will impact refugees of all ages. So the glass gets bigger and bigger and more and more funding will be required to keep funding arrangements on an equal level, this is merely the application of logic.

This is why I opposed John Appleby’s approach, it shows little application of a changing population, merely a greying one (which is a form of change), but it does not hold water against the massive change the UK has faced since 2013 and will face until 2019. This is why I am not in agreement with the statements of John Appleby. Now we get back to Lord Kerslake. You see, the paper I mentioned is an example. It might not even be the foundation of Lord Kerslake’s approach. Yet a multitude of papers clearly show that there seems to be no real no equality in the setting of healthcare (read: cost of health care). It seems to be wearing a different hat in nearly every European nation, it would already be a great leap forward if they all had the same colour, which does not seem to be the case either.

Now we get the quote that wakes us all up “Appleby estimates that NHS spending would have to increase by 30% or £43bn a year to take NHS total spending to the EU-15 average by 2020-21. The IFS estimates that this would involve an 8p increase on all rates of income tax“, which is one side of the option. How about the other side? When we see that AstraZeneca has been able to avoid corporation tax on a massive scale, which dwarves when we compare it to the mergers Pfizer and Allergan have achieved. Is it perhaps possible that his lordship looks at another solution like closing that tax abyss? Might I suggest an idea where any corporation involved in tax avoidance gets its medication ‘grey’ listed? Which means that any drug that could be begotten in a generic form from a place like India will be selected as a first solution? It could even result in India starting businesses in the UK (with the economic benefits that those places will give). It would also send a clear signal that if corporations would like to avoid taxation, which in legal correct way is just fine, but at that point other distributors of pharmaceuticals will be found. I reckon that between that announcement and the offer of reduced medications (read: less costs for the NHS) from pharmaceutical firms would be forthcoming within 24 hours of making the announcement.

Yet, this was not about the costing, it was about the increase and setting against the GDP. The fact that health spending and economic spending are on par reads more like an option for deferred payments to big pharma and medical supplier than anything else. In case of doctors it would mean that their incomes would go through the roof (which might be a deserved reality), but it is one that the coffers under the care of George Osborne cannot afford.

There is wisdom in his lordship stating that “a royal commission should be established to build a national consensus on NHS funding“, which sounds a lot more ‘reliable’ (read: acceptable) than the Labour party giving way by letting a banker (Sir Derek Wanless) set the NHS spending levels. It is of course desirable to go with the people and keep the directly funded NHS free at the point of use, yet that comes with a price tag that is no longer realistic in this day and age of deficit, in addition harder times are coming for a while longer, making the price tag we already have a non-linear shifting one. Yet I feel adamant to speak that mental health must be fully accepted as part of the NHS (for all people, anywhere in the UK), which slides the scales of budget by a lot. A reality many papers (as I expect it to be) did not take into account. Raising income taxation as implied could equally be an issue as that could potentially drive depression and suicide statistics overnight (the latter would lower rents but that seems just too harsh a solution).

What is a given is that Lord Kerslake is the catalyst that is making us ask several serious questions.

I am however not entirely convinced that his lordship took the best path in getting these issues out into the open.

On the relationship between GDP and Health Care expenditure; A new perspective

 

 

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The Illusion of control

It is three days after writing ‘Concerning the Commonwealth!‘, I stand by my piece. I think that the Commonwealth is facing increasing issues all over the field and as the numbers go up and up and up, healthcare will take a centre seat in a diminishing population of workers, which by the way include issues that will hit Australian shores too. Today (at http://news.sky.com/story/1287088/government-has-lost-control-of-the-nhs) we get to see more about the NHS, the mention of a 3 billion pound fiasco, which gets attached to the name Andrew Lansley, who is currently Leader of the House of Commons. He is also behind the Health and Social Care Act 2012, which is regarded to be highly controversial. However, before we go into any controversial parts, try finding a document called ‘ABPI UK NHS medicines bill projection 2012 – 2015‘, it is a PDF file (the Google link was too messy). There is a massive revelation on page 5, which diminishes a bible chapter with a similar name to a mere Paddington bear story.

As we ignore earlier mentions of a shake-up gone awry at 3 billion and mentions of an IT structure at the price of 10 billion that never worked, here we see that over the term 2013-2015 the use of brands go up from 14.2 to 15.5 billion, yet generic medication needs only rises from 3.2 to 3.9 billion. The interesting part is that even though there is still a brand growth, the bio-similar mention (generics) go up from 134 to 328, so there is more than 100% growth in change to generic medication, whilst the cost is still growing steadily on both sides (generic versus brands), what would the brand side have done if the generic side did not exist?

Three days ago I was extremely outspoken in regards to the need to get the NHS costs down. It seems that the search for generic alternatives is taking a backseat to other options. In an age of finding ways to make ends meet, the Health and Social Care Act 2012 has no space reserved in regards to the need for a stronger presence of generic medication.

When we look at:

233 General duties
(1) In exercising its functions NICE must have regard to—
               (a) the broad balance between the benefits and costs of the provision of health services or of social care in
               England,
               (b) the degree of need of persons for health services or social care in England, and
               (c) the desirability of promoting innovation in the provision of health services or of social care in England.

Why was the following not added?

                (d) the choice of generic medication where possibility for a responsible health care alternative warrants it.

Now, I will be the first one to admit that my choice of words is not the best one, but it seems where it is known that generic medication is such an important part for the survival of the NHS, that no mention at all (as far as I could tell) seems to raise a few more questions. Key message 4 on page 11 of the PDF shows exactly the part that matters: “Nine of the current top 20 selling brands lose patent exclusivity between 2012 and 2015” and when we consider the growth through bio-similars, we see that the right path seems to be taken as we read the numbers from the office of health economics. So, there is a path to better growth through managed costs (to some degree), the question becomes, why is this report quoting Jane Ellison as secretly taped? More important, why is Sky News not giving proper light to the NHS issues as they are (to a small extent) resolved? Why are they not taking a look a Professor Adrian Towse, Jon Sussex, Lesley Cockcroft or Martina Garau. I would think that the latter two as statistician and economist might be able to light a candle in the tunnel of ambiguous ‘tell tailing’ darkness ‘some’ are sailing.

None of these matters are coming to light at any stage. Even the Guardian on April fool’s day, did little more then http://www.theguardian.com/society/2014/apr/01/health-service-biggest-challenge-history-nhs-boss. I will admit that the article of the Guardian was decent, yet the quote “the NHS is facing a perfect storm of rising demand, funding pressures and worryingly low staff morale“, no matter how true, seems to be about the hardships (which remain true). Yet the information that the Office of health economics seem to have is escaping these Journo’s of bad news writings. Slide 13 of the initial PDF shows an even stronger view on how the UK is getting by, whilst the US is facing an overall hike from 176% to 281% compared to the UK index, Only Spain, Finland and France were barely better off. That part remains in question when we consider their population, if the results was correctly weighted (small oops on that slide), then the pressures for patent change from American shows just how desperate the American position is, which is shown even stronger on slide 6 when we see just how hard medication hits both Japan and USA as they spend well over 2% of GDP there, whilst the population of Japan is twice that of UK and the population of the USA is set at well over 400%. These slides will also leave is with other questions in several regards, yet the initial positive view is not reverberated over the press sites, or by the UK journalists. It seems to me that the information by certain newsgroups, especially in the LACKING sight on the importance of generic medication leaves us with questions. However, the Guardian was all over the business side of Pfizer trying to take over AstraZeneca. Did no one properly wonder why they were willing to dish over 69 billion? When did a US company EVER spend such an amount unless they knew that they would end up with double the amount? When we consider those events, we should wonder why the papers aren’t a lot more outspoken in regards to informing the public.

Even if this was all not true, don’t you think that the press would (should is a better word) have been all over the members of the Office of health economics I mentioned asking them the questions I am voicing and a few more after that? Is the silence of the press not deafening? The late April article in regards to Pfizer – Astranezeca headlines as ‘Pfizer refuses to guarantee UK jobs if AstraZeneca takeover goes through‘, which should make us wonder whether this is about income, jobs or patents. Would that takeover stopped any patents, or at least delayed them? If many patents have 1-2 years left, why pay that many billions, which information was kept hidden from us? It is the quote from Pfizer CEO Ian Read that states “The combination of Pfizer and AstraZeneca could further enhance the ability to create value for shareholders of both companies and bring an expanded portfolio of important treatments to patients.” This is a fair, honest (to some degree) and clear message. It is about the shareholders and the message that these billion will come back to ‘us’ and then some. This is clear business, I do not object, yet the overview for the UK? What will it cost them besides jobs? We saw little of that and the NHS has been played like a piñata donkey for a little too long. This is not me stating that the NHS is okay. Actually it is far from that, it is about getting the proper illumination on events, which does not seem to be happening either.

In the end, the quote in the Sky News article “A spokesman for the Department of Health told Sky News: ‘Giving operational control for the day-to-day running of services to doctors was the right decision but we’ve always been clear that ministers are responsible for the NHS’” might have been a correct one, the added information could have been a lot more insightful. When you Google ‘Office of health economics‘ you will not find any links to any newspaper, which is puzzling when you go to the Office of health economics and look at some of their publications. If I would add one more ‘light‘ remark then it would be that the members of the editorial and the policy board of the Office of health economics seem to have more degrees then a Kelvin scale, making them in my mind an essential source of health information for any journalist.

So where are these articles informing the public?

 

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