Territoriality, the Health weapon to harm Madrid

Territoriality, the Health weapon to harm Madrid

More than 5 years ago, in November 2018, the "Address Plan for Advanced Therapies in the National Health System (SNS): CART medications" was launched in Spain. CARTs are immune cells artificially engineered to express a particular chimeric antigen receptor (CAR), which have shown great potential to kill cancer cells. Chimeric antigen receptors (CARs) are artificially produced recombinant receptors that have both antigen-binding and T-cell activation potential.

The therapeutic strategy is based on the clinical use of the patient's own lymphocytes which, once genetically modified "ex vivo", are administered as medications to destroy tumor cells, infected cells, self-reactive clones, etc. The use of CART medications constitutes a complex healthcare process, which is why the choice of hospitals where they could be worked with required very strict criteria. They had to be multidisciplinary and highly specialized units that could monitor and evaluate the results, have a clinicopathological committee for the evaluation of candidates for these drugs, as well as have preclinical experience with immunoeffector cells.

These therapies (which are now in their fourth generation) have represented a revolution in the approach to oncohematological diseases (leukemias, lymphomas and myelomas in their different presentations).

Double them in 4 years

Although there are currently 30 reference centers designated in Spain for the administration of CART treatments, they started out being 16 in 2018.It was not until the 14th June 2022 when the Minister of Health at that time, Carolina Darias gave a push for them to double, adding 14 more to the initial list. In that first designation of 16, there were only three hospitals in Madrid: La Paz, El Gregorio Marañón and Niño Jesús. We had to wait almost four years for, In 2022, they will include the rest of the Community's reference centers: the Puerta del Hierro Hospital in Majadahonda, the Ramón y Cajal University Hospital, the La Princesa University Hospital and the 12 de Octubre Hospital.

A situation that is very reminiscent of what has occurred in recent weeks with the designation of comprehensive cancer care centers, one of the first steps to assimilate in Spain the European Commission's Plan to Fight Cancer.

Let us remember that the Ministry of Health selected the Catalan Institute of Oncology (ICO) as the "sole beneficiary entity" to develop this call, which means that this body (whose jurisdiction is only subscribed to Catalonia) chose, with its own criteria, 10 Spanish centers among the 20 that were presented.

[[LINK:INTERNO|||Article|||65bfd5c20547b0e42f4bf836|||De los 8 hospitales que presentó la CAM –todos ellos referentes en Oncología tanto en España como en Europa– solo se seleccionó a La Paz,]]through a process considered by the heads of Oncology of the main hospitals throughout Spain, the Spanish Group of Cancer Patients (Gepac) and even the Spanish Society of Medical Oncology (SEOM) itself as "arbitrary and not very transparent." ».

[[H2:El criterio «sorpresa»]]

Nothing has been done to correct it despite the fact that The Ministry recognized that, in the election, "a territorial criterion" had been applied of which the parties involved in the process had not been informed. «But the internal procedure allows it, and so it was done, with the aim of creating a national network in the future, which would include as many CCs. AA, better," they noted.

Despite the multiple criticisms, the repeated requests by renowned Oncology professionals, the CAM Health Department, the Popular Party and Vox for Health make the evaluation criteria public and even repeat the process due to the irregularities observed, the department headed by Mónica García has taken the middle street. Thus, he declared last week that these 10 selected centers "will be the first but not the only ones, since" they have been chosen to pilot a certification model for future Comprehensive Cancer Centers, but others may be added until around thirty in 2028.

The Public Health Agency, outside Madrid

Although you don't have to go 5 years back in time to find examples on how to use the criteria of decentralization and territoriality to the detriment of Madrid. The expected State Public Health Agency (Aesap)- an outstanding debt of the Government since the pandemic to which the Council of Ministers gave the green light two weeks ago -It does not yet have a headquarters, but what was made clear from its conception is that it would not be Madrid. From the beginning, public health experts opted for decentralization of the organization, although now it doesn't seem so clear. And since it is not a newly created organization in the strict sense, new personnel will not be hired, but rather people who were already working in the ministerial field or in the Carlos III Health Institute will be transferred. Therefore, it will be much more complicated to transfer these people to the communities that are proposed as possible venues, such as Aragón, Murcia, Galicia, Andalusia, Valencian Community, Asturias, Extremadura or Castilla y León.