Alfonso Moreno, Professor & Head of Service, Pharmacology Clinic, Hospital San Carlos, Spain
“We have to be optimistic, but we also need to plan much better for the future with regard to health authorities and medical education. I believe that industry in Spain has a good future, despite the economic crisis casting a fairly bleak situation at the moment. It is true that politicians continually declare that Spain is overcoming the crisis, but that is not what people see on the streets,” states Alfonso Moreno, Professor and Head of Service at the Pharmacology clinic at Hospital San Carlos, Spain.
How would you describe the development of pharmacology in Spain at the medical and academic level in Spain?
I have been a professor of Pharmacology in the Faculty of Medicine at Universidad Complutense de Madrid for many years. In terms of actual studies in the Faculty of Medicine, pharmacology takes two years. By the third year, students start to deal with the mechanisms of the action of drugs and by the sixth year, they begin to engage in clinical pharmacology, with a more practical application to medical cases, recommendations of drug use in specific cases and medical development of pharmacovigilance.
I have taught both basic and clinical pharmacology courses, and today I focus more on basic. While pharmacology students in Spain are sufficiently trained, further studies could be useful in terms of applying what students have learned in a more practical setting to better prepare for their future careers. Furthermore, updates on studies are critical because pharmacology courses are always adapting to the changing environment of healthcare.
What do you perceive to be Spain’s capacity to develop personalized medicine?
Personalized medicine represents a new paradigm in medicine; this involves situations in which we deal with serious pathologies that require difficult and expensive treatments. Nevertheless, the individualization of treatments is an advantage from every angle in that you ensure positive results. When you personalize medicine, you are creating an in-depth analysis of the patient and pathology of the disease, which means more accurate treatments. I think personalized treatments can be very useful in serious pathologies like oncology, hematology, cardiology, and neurology among others. In any case, Spain is starting to invest in this niche.
Translational research is another important component to innovation in Spain. Does Spain have the necessary entrepreneurial talent to turn high quality research into commercial success?
We will see.
I think that the objective of clinical and medicinal research should be the ability to transform basic knowledge into a clinical setting, which would allow clinical treatments to significantly improve.
But this is not always possible because basic research does not always end with positive results. Therefore, Spain has heavily promoted research that can translate knowledge. This mantra is being encouraged in both public and private institutions as a way to generate products that can later be used for translation to the clinical field.
What effect will the recent privatization of a number of hospitals in the Madrid area have on the local healthcare system?
Despite much discussion, the government of Madrid has actually decided not to privatize hospitals. Rather, the management of hospitals will be externalized. Privatizing hospitals would have caused great discomfort among health professionals, and the community of Madrid has decided not to proceed. That being said, Spain does engage in research in externalized or purely private hospitals. For example, HM Hospitales is a private group in that its property and management are private. Therefore, HM runs on agreements with insurance companies and the State, who can send patients to these private hospitals when their own hospitals cannot satisfy the demand. In these hospitals the research is of very high quality, particularly in the fields of oncology, cardiology and neurology.
How do you perceive the relationship between hospitals and pharmaceutical companies?
Pharmaceutical companies need hospitals, and hospitals need pharmaceutical companies as their research project promoters; the relationship is symbiotic. This is particularly important for clinical assays; a company cannot do this alone. The more experience the hospital has doing research, the better it will respond to the problem. Also, the past years, research institutes have been created in public hospitals in Spain. As of now, there are 18 of these institutes in the hospitals; it is always in a big hospital and this is one of them. The Spanish government accredits these institutes through certificates, which is indeed an important acknowledgment. These accreditations are handled by Instituto de Salud Carlos III.
You were recognized for your work in the National Council for Specialties in Health Sciences by Prix Galien. You have said this will give an important motivation to research. How would you say innovation and research are present in Spain?
Innovation in the field of pharmacology research does not always have something groundbreaking every day. In fact, very few innovative drugs worldwide actually make it to the market every year. Innovation is what moves research forward. Everything that is done for research with the objective of innovation is positive. Prix Galien is a small part in a much bigger world for helping to improve innovation and I am happy to say that this institution recognizes innovation in the pharmacology field, among others. I hope Prix Galien continues to expand in its recognition of innovation around the world.
What exactly does the National Council of Specialties do?
Spain has a system for training specialists in the health sector, mainly doctors but also nurses, pharmacists, and psychologists. This system has been functioning in Spain for over 50 years and the last 25 years have been paramount. In fact, Spain is recognized as a leading, high-level country in the field of training professionals through rigorous high standards that are the norm in every university, hospital and clinic throughout the country.
In order to train professionals, a hospital has to be accredited based on a number of complex parameters. Once the hospital has received the accreditation, it is subjected to periodic audits. There is also an annual entry exam for students who want to be accredited with approximately 6,500 openings for 10,000 applicants each year. There has never been an issue with the exam, in terms of filtering information for example. When aspiring doctors do the exam, depending on their grades they have the opportunity to choose their specialization and location in Spain. This creates healthy competition among hospitals because they want to attract talented applicants. Thus, every candidate makes the best choice for himself or herself.
After this exam, doctors study for four to five years depending on the specialization. Normally, surgical specializations take five years and other medical specializations take four years. After this, doctors complete their studies of choice, and the diplomas they receive in their individual specializations allow them to practice in their specific fields.
The problem is that with the economic crisis today, there are not many job posts. In this moment, Spain is exporting talent to other countries like Germany, UK or other parts of Europe that have not invested in the budget for these doctors’ education.
Training specialists in Spain needs to be planned far in advance, particularly in terms of the number of specialized doctors according to the needs of the country.
If we are training around 6,000 specialists every year with no job posts, this is a big problem. My hope is that this will change once Spain has finally recovered from the crisis. Nevertheless, we still have to create a strategy for dispersing medical education around the country. Spain has more faculties of medicine than anywhere else in Europe, despite having a population smaller than countries like the UK or Germany. If we have doctors that spend years studying and specializing in a certain field, then this investment of time and capital is wasted. People are losing skills and practice. This is why doctors are going somewhere else; they cannot stay at home with books and magazines. They have to practice.
Do you think the future is optimistic?
We have to be optimistic, but we also need to plan much better for the future with regard to health authorities and medical education. I believe that industry in Spain has a good future, despite the economic crisis casting a fairly bleak situation at the moment. It is true that politicians continually declare that Spain is overcoming the crisis, but that is not what people see on the streets.
The pharmaceutical industry has a qualified workforce, both in Spain and worldwide. Research in the field of medicine could not be possible today without this industry’s contribution in addition to the contribution of public institutions. There is a need for a strong industry that invests in R&D in Spain. We see new pharmaceutical companies coming from Asia that have never invested in Spain before. Spain is attractive, most likely because we are the fifth market in Europe for medicines. The industry invests more than €1 billion in research, which is a lot of money. That is why it is important for the industry to continue relying on research in Spain as it always has.
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