KEY POINTS:
We journalists know all about the power of "human interest" stories. Throw a bunch of statistics at people about, say, the number of children in poverty, and you barely rate more than a brief twinge on the collective conscience.
It's not that we don't care; it's just that faceless statistical lives have no emotional pull. Most people aren't good at imagining the plight of the unseen (though we're pretty good at assigning bad motives to them).
But give the statistics an appealing human face and all that changes. We engage, we identify, we want to ride to their rescue, especially if that person's life is threatened.
Bioethicists call this the "rule of rescue", the powerful human proclivity to rescue a single identifiable endangered life, regardless of the cost, and sometimes at the expense of many faceless others who, in the case of healthcare, miss out as a consequence.
The rule of rescue is a fine and noble thing if you happen to be stuck on Mt Cook in a blizzard, but it's becoming increasingly inconvenient to health funders around the world as they make tough choices about which expensive drugs to fund on limited health budgets, particularly when media involvement makes some patients more "identifiable" than others.
This is not just the case here, where Pharmac's decision to fund nine weeks rather than 12 months of Herceptin has been heavily criticised, but in the UK, where the National Institute for Health and Clinical Excellence (Nice) has just signalled in a review of its ethical guidelines that it won't be adopting the rule of rescue in making its decisions about the effectiveness and cost-effectiveness of drugs.
"When there are limited resources for healthcare, applying the 'rule of rescue' may mean that other people will not be able to have the care or treatment they need," it said.
"Nice recognises that when it is making its decisions it should consider the needs of present and future patients of the National Health Service who are anonymous and who do not necessarily have people to argue their case.
"Therefore, the Institute has not adopted an additional 'rule of rescue'." The Telegraph told its readers this meant they shouldn't expect the NHS to save their lives "if it costs too much".
"What on Earth could [they] have been thinking when they laid down a ruling that doctors and nurses were to defy the most fundamental moral inclination, not only of the medical profession, but of the human community: to do whatever is necessary to save an individual's life in one's care?"
Nice has come under growing criticism for rejecting a number of drugs already available throughout Europe and the US.
A fortnight ago, when it declined to sanction four kidney cancer drugs that could "double life expectancy", the headline in one paper declared that the decision was a "devastating 'death sentence' for cancer patients".
What didn't get discussed in the story is how inevitable this scenario has been since expensive "targeted" cancer drugs like Herceptin first made their entry.
As an article in Cancer World warned in early 2006, "Some commentators are predicting Herceptin and the raft of designer drugs that will follow could spell the end for Europe's tradition of social healthcare."
Indeed, a Belgian analysis noted that even if the health improvements of 12 months' Herceptin were thought to be large enough to justify the spending, it might still not be economically viable for many countries, for example Romania, Serbia and Poland, which were forced to limit access to the drug.
How much is too much when we're talking about extending the life of a friend, a patient, or a mother we can identify with on the news? It offends our sensibilities even to think in those terms, but that's an exercise Pharmac is required to undertake.
Pharmac says three other cancer sufferers' lives would be lost for every life that might be saved if 12-month Herceptin was publicly funded. It estimates that district health boards would have spent $78.5 million over three years for 880 patients to get the 12-months treatment, saving 1.1 lives per $1 million spent. Of course, it believes nine weeks' treatment offers the same benefit for much less money.
Pharmac says the benefits have to be kept in perspective.
"In the clinical trials, which have reported benefits over a short number of years, 74 to 88 out of every 100 patients who did not get Herceptin have remained disease-free. Looking across all trials, Herceptin (9 weeks or 12 months) had a small but significant benefit, with between 1 and 13 patients out of every 100 treated with Herceptin getting that benefit."
But the questions raised by Herceptin go beyond its effectiveness. A European report this year reckoned that if all new cancer medicines were to be funded in Britain, taxation would have to rise to 60 per cent.
NZ spent more than $11 billion on health in the 2007-08 financial year, almost double the $6 billion in 2000. How much more are we prepared to spend on expensive new treatments? What are we prepared to do without? And how will we fund any increase?
These are questions we all need to think about.
