Bioethicists have a term called the rule of rescue. It refers to the powerful human imperative to save identifiable individuals whose lives are endangered without giving much thought to the many nameless people who may, therefore, be denied health care. The rule suggests, in essence, that it is unfair to discriminate on the basis of the emotional tug exerted by well-publicised cases. Conversely, of course, there is much to be said for placing great value on any life, and politicians are certainly not immune to the feelgood factor promoted by such rescues. Some seeking power may even see advantages in embracing it. Whether or not such was the case in the ad hoc funding of Herceptin, it has led the Government down a particularly tortuous and tangled road.
The Prime Minister confirmed this week that funding for the breast cancer drug would be extended from nine weeks to a year. The shorter period was imposed by Pharmac in 2006 and reconfirmed this year. In August, after reviewing the drug's most appropriate course length, the drug-buying agency said it was not convinced the longer treatment offered any additional benefits over nine weeks. Herceptin did not, it said, stack up in either cost-effectiveness, clinical benefit or safety.
This, unsurprisingly, outraged the Breast Cancer Advocacy Coalition. The Women's Health Action Group took a more measured view, however, noting that the drug was not, as promoted, a magic bullet. District health boards also pointed to a lack of convincing evidence for 12-month treatment.
The National Party was, nonetheless, quick to nail its colours to the Herceptin mast. It may or may not have been swayed by the emotional appeals of a group of breast cancer patients dubbed the Herceptin Heroines, or the public campaign mounted by the manufacturer, Roche. It may or may not have dwelled on the consequences of funding this very expensive drug for people with other life-threatening conditions. Pharmac, however, must consider that overall picture, as well as finite public finances, every time it makes a funding decision.
National's decision to disregard Pharmac creates several problems. In the first instance, the Herceptin extension sets a difficult precedent. It suggests the Government is open to the sort of pressure that prompted the coining of the rule of rescue. Other small groups of sufferers may impose just as strong an emotional pull. Wisely, the previous government was content to leave such tough decisions to Pharmac, a body tasked with, and experienced in, making them.
In July, the Prime Minister acknowledged the Government could not direct Pharmac to approve funding of the 12-month course. But "they can say, 'look, we've got money available and you should take it'," he said. At least, John Key has had a rethink on that strategy. There is some understanding of the need to protect Pharmac's integrity in this week's decision to fund the Herceptin extension directly through the Health Ministry. But only a semblance.
Other pharmaceutical companies, and other groups dedicated to the sufferers of any illness, will be encouraged that they, too, through special pleading, can garner some of the $180 million that the Government plans to spend on pharmaceuticals over the next three years. The path to the Health Minister's door will be well-trodden. Ironically, a National government established Pharmac in part to prevent just this lobbying.
In announcing the Herceptin extension, Mr Key suggested up to 300 women a year would benefit from the year-long course. The cost of the drug was not, however, released for "reasons of commercial sensitivity". Nor was mention made of the opportunity cost of treating the many faceless people facing avoidable deaths from other causes.