In my personal experience working with patients with chronic pain, there are non-invasive treatments, such as repetitive magnetic stimulation, that are available in public hospitals and not in private ones. Week after week, I see patients who come to me desperate, who, after having received multiple treatments in private clinics, are now suffering from permanent iatrogenic effects and have been referred to public hospitals once the private system evicts them for being overly “medically complex.” At this point, there is very little I can do for these patients and I am often left feeling useless and enraged by the private system.

The pharmaceutical industry, which remains in private hands, also has important detrimental effects on the care and treatment of patients. In Spain, the elderly and retired are those who have the greatest part of their medications fully covered by the public healthcare system. People who are not retired must pay a portion of the costs of their medications, while the rest is covered by the state. This portion can be considerable depending on the type and number of medications. This, of course, means that there are patients who cannot afford the medications they are prescribed.

Despite having access to the public system, the socioeconomic stratification of patients is deepened by the private nature of the pharmaceutical industry. There is a major lack of transparency in the regulation of prices of medications and medical equipment, even in autonomous communities. In some cases, it has been argued that this way of stratifying prices is necessary for the economic sustainability of the public healthcare system, but patients and the medical community must be made aware that the pharmaceutical sector is disproportionately profiting from widening inequalities.

I do a lot of work around access to “orphan drugs” used to treat rare diseases, from which the pharmaceutical industry continues to profit. As a result, patient associations have been very active, especially in promoting the recognition of rare diseases. In Europe, rare diseases affect at least 1 out of every 2,000 inhabitants. It is estimated that there are 7,000 rare diseases in the world. The Spanish state, with 40 million inhabitants, has around 3 million people with rare diseases. These patients in Spain primarily receive medical assistance in the public healthcare system. The national system is responsible for covering these patients’ medical treatment, which in some cases has been approved for a finite protocol with orphan drugs. Although the pharmaceutical industry depends on public hospitals to carry out a large part of its research in clinical trials to discover treatments for these diseases, the industry then sets exorbitant prices for these treatments, where the benefits will only be passed onto pharmaceutical companies, despite the fact that the work was done by public healthcare workers and investments were made by the public system.

When we study medicine, we are required to take an oath to treat all patients. As a physician, I am often forced to tell patients that there is a treatment that could help them, but it is too expensive and not covered. For all these reasons, the pharmaceutical industry must be nationalized to ensure equal access to healthcare for everyone. There must be a healthcare budget that presides over the use of public money, which is increasingly spent on weapons to fund imperialist wars and the maintenance of a monarchy that should have been eliminated a long time ago, or at least voted on in a national referendum so that the people can decide whether to keep maintaining the legacy of a dictatorship, the transition out of which never really ended.