The Republic of Equatorial Khundu
My husband and I have been huge fans of The West Wing since it was first aired. Few other TV series stand up to it. It is humorous, thought provoking and engaging. There are so many parallels between what is shown on the screen and what happens in real life. There are so many lines in the show that summarise brilliantly a real world situation. And, in a great example of life imitating art, not long after the first ethnic minority US president was elected in The West Wing, Barack Obama was elected to the White House.
Developments in the Cancerland this week have once again reminded me of The West Wing. The Cancer Drugs Fund is money the Government has set aside to pay for cancer drugs that haven’t been approved by NICE and aren’t available within the NHS in England. The aim of the fund is to make it easier for people to get as much treatment as possible. The Cancer Drugs Fund started at the beginning of April 2011 and will continue until the end of March 2016. This week, the Fund cut a number of drugs from its list because it could not afford to continue paying for all of them. The cuts included three drugs used to treat secondary breast cancer. As you can imagine, there’s been a huge uproar about this in my breast cancer community. These drugs have been shown to give women precious extra months with their families. However, they were cut from the list on the basis that they did not offer sufficient clinical benefit. In other words, a cost benefit analysis showed that they weren’t worth funding.
These cuts have prompted a huge amount of activism amongst breast cancer (and other cancer) patients. As a result, there has been some rethinking. There have been petitions, and a large number of blogs and articles on the subject. But until now, I have stayed silent. My reaction has not been the same as that of many others. My reaction has been one of shame. Of embarrassment. Of guilt. Why? Because I have private medical insurance, I do not need to rely on the Fund. Instead, I am dependent on the whims of an insurance company. But those whims tend to be more generous than publicly funded treatment.
And here comes the West Wing analogy. In one season, there are a couple of episodes which focus on the conflict in a fictional African country, the Republic of Equatorial Khundu. Reports flood in of massacres, rapes and other atrocities. The fictional President Bartlett considers whether or not to send in peacekeeping troops and receives a number of briefings from his advisors on this. As the death toll rises, he broods on the likely casualties if he sends US troops to Khundu. He turns to one of his advisors and asks “Why is a Khundanese life worth less to me than an American life?” The brave advisor responds, “I don’t know sir, but it is.” The exchange serves to highlight the difference between the value of life in the first and third world. It is a very uncomfortable parallel which sits uneasily with a liberal left wing President.
The parallel struck me when considering the difference between the value of life of those reliant on drugs provided by the state in England and those who are fortunate enough to be covered by private medical insurance. We are a first world country – there should be no difference. Sure, private medicine will always exist but the difference should merely be about levels of comfort and convenience. The difference should not be about whether or not someone can have access to a drug that might mean the difference between life and death. That is simply too third world. That is not right. That is just plain unfair. And as a beneficiary of the unfairness, I felt I had to stay quiet this week while others argued about the cuts to the Cancer Drug Fund. I do not feel that my voice would be welcome amongst those who depend on the Fund. I do not feel able to take part in the debate. All life is precious. Full stop. This is not Equatorial Khundu.