Dr Antonio Alarco gives his insider take on the future of Spanish healthcare, personalized medicine, and the areas in which Spain needs to improve.
With Mariano Rajoy of the People’s Party (PP) stepping down after seven years as prime minister of Spain, what is your take on President Rajoy’s achievements?
I am a member of the PP and therefore not a neutral. What happened has been a democratic measure that is in our Constitution. It never happened in Spain that a motion of censure won and that a president was not elected through elections, but it is a democratic fact that Mariano Rajoy has been expelled and I hope it works well. It is a radical change based on an agreement between 15 different political parties on ideas and concepts including health.
We are proud of the progress made in Spanish health in the Rajoy period. The Spanish public health service is one of the best in the world, financed by public funds and provides free service. We provide the best services because the essence of the health system is not the politicians, but the citizens and the professionals who work for the public health system. I am proud to have worked in the public system for 40 years.
I only believe in one kind of health system: one in which services are provided to all, regardless of ability to pay. Recently in the Congress of Deputies [the lower house of the Cortes Generales, Spain’s legislative branch – Ed.], we allocated almost EUR 90 million to the public health system. In Spain, one in every three euros is dedicated to social welfare; an important detail.
The main issue has been ensuring that our universal health system covers all sections of the population. We believe that, ethically, life has no price, but economically health has a price and it is limited in relation to our resources. We can’t say to the citizen that we have all the services for everyone as this is not true.
In which areas do you hope to see further investment to improve the Spanish health system?
Innovation is the best investment; there will never be a real change without popular scientific divulgation (and I worked on introducing divulgation in the health system in Spain) as you need to involve citizens and allow them to understand the scientific language. Most of the public do not understand the science and health environment.
Where does Spain stand on further integration with its European counterparts?
We are in one European health system, this is a key concept, as we have common ideas and we need to plan together to build the same level of health services in all European countries. We must look for a universal European Health system in all the publicly financed countries. We need citizens with a European Health Card to be able to travel freely and expect good service.
Therefore, I say yes to a public European Health system. We requested this through our spokesman, we requested that the funds for the innovation will not be accounted as deficit as it is a different deficit and cannot be depreciated as any other general cost.
What have been the most important topics and issues on which the Senate has been working on in the field of healthcare?
The most important topic we have been discussing is an agreement on health because we were just at the point of reaching an agreement (before the expulsion of Rajoy) which is an urgent necessity because without it some categories of services will not be financed.
We have created a parliamentary commission on the human genome, the first one in Europe, as we need to know the human genome. There is no good personalized therapy and no good health system without knowing the human genome. We have also created a list of medical professionals in Spain which did not exist in any other country.
I proposed the first motion about suicide as in Spain it is the first cause of traumatic death. We need an early inference plan to identify suicidal personalities and avoid 4,500 deaths per year in the country. Since the first motion on suicide was passed, we have improved the data, the communication is better, and the problem is recognized in the correct way. This is a topic that needs to be discussed openly.
We have also discussed organ donations, passed a motion on rare diseases and are also looking at regulation for generic medicines.
Personalized medicine is a hot topic in the healthcare sector and stood as one of the healthcare priorities of the previous minister of health, Dolors Montserrat. How ready and prepared is Spain to embrace this new era of precision medicine?
Personalized medicine is not a fashion, it is a necessity. Genomics is ready already. Today it has been published in “Nature” an article about the possibility of avoiding chemotherapy based on the kind of cancer the patient is suffering from. Spain needs a national and European strategy for personalized therapy, otherwise, the fact that it is ready to be used will not be useful for us.
How would you define the role which pharmaceutical companies should play in the development of Spanish healthcare?
In the USA a man earning a lot of money is considered a gentleman, in Spain, he is considered a thief. This encapsulates the differences between the Lutheran and Latin tradition.
The private and public are two ways to see life and they have nothing to contend, there is nothing in common with the commercialization of diseases, it is more in relation to the development of the society, so the role of the pharmaceutical company is definitive. The good pharmaceutical companies are the ones who investigate diseases, who put their investigation to the service of the society, who practice social enterprise responsibility, if they don’t implicate the society they belong to then they are not good companies. The companies need to have good results, but they also need to practice CSR responsibilities…. sure, the money channel is important to continue to produce, but the most important is the CSR responsibility as part of an active Humanism.
Spain has highly skilled physicians and doctors, but what more can be done to incentivize the medical profession and prevent practitioners from migrating abroad where salaries are higher?
If you have EUR 1000 and I take 200, I am taking a cutout, but if you have 1000 and I help you avoid spending 1200 I am doing an adjustment. This is what has been done in Spain in the past years, adjustments. If tomorrow I move to France or Germany it should not be counted as brain drain as we are all part of the European Union.
If I move due to a lack of a job, even in this case, it is an occurrence for Spain and Germany too, in other words, still is useful. In a company what is more important, it is not the building or what they produce, the most important are the workers and the customers, so it is important to homogenize the mean, the consideration of all professionals on the national territory- the factor to emigrate is minor factor, as in another way it comes back anyway. We can’t control all diseases, especially rare diseases, so it is important to maintain the freedom of movement and the free circulation of knowledge.
You started your career as a surgeon before becoming director of the University Hospital of the Canary Islands in 1999 and entering politics in 2008 as the Senate Representative for Tenerife. What attracted you to step into the world of politics?
Waking up in the morning and knowing your goal is to be dedicated to the others is the same in both politics and medicine. I have held many different roles but I have always remained the same. I push myself to take care of others; if there were no other people in the world, my existence would not make sense.
What has also influenced me is the fact that I am the fifth of six sons, but as one of the last sons, I felt an obligation to show that I had skills to impress my parents and gain their attention.
Another major satisfaction was performing my first transplant and the first liver transplant in the world to an American man who was going to die. He wrote a book and dedicated it to me. I can’t describe the feeling you have while you are clearing the artery and the vein after surgery. After two hours of surgery, you go home and cannot shut down the endorphins, even when you are in bed.
Looking forward, what are the top priorities on your agenda?
We need a Europe-wide agreement on health: it is important to have a European Health Institution: working well, we have centralized money for health and research, so it is important to use them properly. As an example, if someone in Sweden does bad research or research which is not useful, everyone in Europe will pay for this. It’s important that everyone has access to health, unlike in the US.
It does not make sense to differentiate between ‘Europe’ and ‘Spain’. We need a common discussion and we need universalism. There is no future in localism or nationalism in a globalized world; it does not regulate any problem, the big issues regarding citizens are always at the European level. We have a common obligation to solve social problems.
You are not only a politician and surgeon but also the author of 23 books and more than 200 medical articles. What is your vision for the Spanish healthcare sector for the upcoming years?
In the future, I hope that we can have sufficient maturity to create a universal packet of services. If tomorrow we introduce beauty surgery into the public health system then colon cancer will no longer have any importance, so we need to pay attention to the areas we prioritize as resources are finite.
Genomic personalized medicine is a must. In Spain, there are three million people with psychiatric problems. The amount of money “wasted” trying to cure this with medicine is huge. I say “waste” because this medicine currently does not provide a resolution; it is palliative because we are not using genomic personalized medicine. Genomic medicine is necessary to create suitable and equal healthcare for all.
What advice would you give to future generations?
No one was not born as a politician, it is a voluntary act. To the youth, I say that it is important to dedicate yourself to public issues, but never leave your studies, never leave your education. You will never be paid back but you need a background, don’t depend on politics to survive.
