The cost of the cure

In one memorable episode of the Sex and the City television series, sex-mad Samantha deviates from type and does more than size up her current stud's lunchbox.

This happens when she is suffering from cancer and has to address a benefit in aid of fellow sufferers. As she took to the podium, Samantha was engulfed by the hot flushes which are side-effects of chemotherapy treatment. Sweat poured down her face and the glamorous wig, which she had bought to cover her bald scalp, started to itch madly. Samantha tried to get through her prepared speech, peppered with the usual clichés about putting a brave face on things. Then, as the rivulets of sweat coursed down her cheeks, she gave up on the talking, whipped off her wig and threw it to the audience, most of whom followed suit and clapped wildly.

Presumably, the script writers wanted to convey an image of empowerment and acceptance of the effects of the disease. To some extent, they managed to do so, but over the span of another couple of episodes, Samantha was in remission, sporting her own mane of regrown hair and indulging in sexual gymnastics.

Real life, however is far removed from the speedy recovery of small screen sex sirens. Most readers will be familiar with the prolonged pain and distress that cancer brings about. There are very few families who have not been touched by the disease. Sufferers and their relatives know that besides the physical agony and discomfort involved, there are practical difficulties to deal with. These relate to the cost of treatment and the financial strain borne by families where one of the bread-winners is out of action.

Besides the additional costs of medicines and nursing care, they have to contend with the fact that the family's earning capacity is severely curtailed when one parent has to lay off work because of treatment. This is especially difficult for people undergoing a period of sickness and emotional turmoil.

The financial difficulties faced by cancer patients was brought home to me a couple of years ago when I read about Ann Marie Rogers. She is a mother of three and was diagnosed with breast cancer. Her doctor had prescribed the potentially life-saving drug Herceptin, but the Swindon Primary Care Trust refused to fund her treatment as the trust held that it would pay for the drug only in exceptional circumstances.

Rogers, whose relatives had died from the same form of cancer, felt as if a death sentence had been delivered. She borrowed £5,000 to pay for the drug herself. But she could not borrow more, and she could not remortgage her home because of the cancer diagnosis. She had to stop the treatment. Luckily - and the word here is very relative - an appeals court overturned the earlier decision and ruled that it was more reasonable to focus on patients' clinical needs and fund those who had been properly prescribed Herceptin by their doctor.

The judges felt that their decision would not be opening the floodgates to all those suffering from breast cancer as only those satisfying the clinical criteria, as Rogers did, should qualify for treatment. She had won her fight for the drug that could prolong her life, but only after a protracted legal battle and an agonisingly long wait living in a financially precarious situation.

There are people in similarly difficult situations here. The breast cancer patients who have been prescribed Herceptin but cannot afford it, are hoping that Parliamentary Secretary for Health's promise that the expensive drug will be provided free of charge will soon materialise. Otherwise they rely on charity and help from organisations such as the Community Chest Fund.

These, however, cannot shell out the full costs of the treatment which may run to some €54,000 for a full course of Herceptin. That's such a crippling cost, that patients may have to make the agonising decision of whether to continue the treatment or to save the money for other purposes such as children's education.

A young woman diagnosed with breast cancer and the mother of a lively three-year-old daughter explained how difficult it was making ends meet. The total cost of her treatment will amount to some €35,500, of which the Community Chest Fund pays half. The rest must be forked out by a one-income household with a little girl to raise and where the mother's earnings have been negligible for the past three years. There is no way of knowing whether that family and others like theirs will share Samantha's happy screen ending, but state intervention to alleviate their undeserved financial burdens is called for.

Whenever the issue of funding expensive drugs such as Herceptin is discussed, it is invariably coupled with the question of whether there should be rationing of treatments available for free from the public health service. Should all medicines and treatments be provided gratis to all taxpayers from now until forever? Although this permanent provision of free health services is the stuff of countless pre-electoral promises, many of us feel that there is an unofficial form of rationing taking place, with a less generous provision of certain treatments and medications than was the case previously.

While welcoming any form of clampdown on people who abuse the free health system, I can't help pointing out the contrasting treatment being given to able-bodied men who whine for subsidies and early retirement schemes (the striking hearse-owners and the dockyard workers) and cancer patients fighting for their lives and to support their families. Don't the latter merit the same sort of generous treatment?

cl.bon@nextgen.net.mt