Malignant melanomas have ballooned in recent years, increasing 2-3% year-on-year among over-50s in the USA. Despite being riddled with the 'wrong' version of the various tumor-suppressor genes, the Irish did not much fall prey to this dread disease in times past: a) there isn't enough sun to get sunburnt b) bare flesh (even exposing the arms or legs) was frowned on my the moral-police c) naked bonking in hayricks never happened. It was a different matter entirely when a pale-skinned, red-hairs, freckly gasún or cailín went out to Australia. Wearing a hat wasn't part of their culture, sun-block hadn't been invented, and the sun beat down on them without pity. So melanoma was much more common in those emigrants than among their stay-at-home cousins.
Mr Crown's case was that Pembrolizumab a Merck product marketed as Keytruda, would save the lives of some dozens of Irish people whose got to treatment for Mal Mel too late, or had bad genes or bad luck and are now at late-stage metastasized melanoma for which the prognosis is very poor if left untreated. Crivens, it's saved the life of 91 y.o. ex-President Jimmy "Guinea-Worm" Carter [prev]. Indeed prognosis is effectively a synonym for curtains and that patient will almost certainly become one of this year's crop of 140 people scythed to the grave by this disease. Pembro [we're on first name terms now] is super-elegant in its mode of action - it gees up the immune system to do its job more effectively.
With the consummate rhetorical flourish which we expect of consultants, senators and talking heads, Crown asked [I paraphrase] "What is the hold up, here? I have patients who have exhausted all other treatment options. The National Centre for Pharmaceutical Economics NCPE has made the calculations and given approval. Is it that politicians have been so prim about forming a government that there is no direction from the new Minister of Health?". I didn't know that we had a NCPE, let alone that it employs sixteen [16!] people. Nice work if you can get it but, like its sister quango the Food Safety Authority of Ireland FSAI [prev], there are no current vacancies.
What the NCPE do is some sort of QALY analysis [prev] to determine if the costs [$150,000 /yr!] of a course of treatment outweigh the benefits [another year's life for one person, and much glee among the sales department and share-holders in Merck]. I'm going to guess that, at a minimum, 140 people are in line to take up this drug before they join the crop of dead for 2017. Actually, it will be more because the oncologists will surely want to apply the treatment, which is demonstrably effective as early as possible after diagnosis. But let's be conservative here: 140 x $150,000 = €20 million. That's 60 affordable social-housing units for families which are currently sleeping on blow-up mattresses in a hostel for homeless men. But I only mention that emotive statistic because that's what The Media have been talking large about since the election . . . when they aren't talking emotively about Freeing the Water - we Freed the gays last year. YMMV, like one of those choose your own adventure books from the 1980s. Have tried the one called Realekonometrika?
Q. You have €20million at your disposal do you want to:
- Build 60 3-bed semis in outer Dublinia
- Buy another year of life for some red-headed over 50s
- Treble your money by depriving the haemophiliacs of their free Factor VIII