There was an undeniable rancour to AA Gill’s final article for the Sunday Times, published in the magazine at the weekend. As reported in the i newspaper, the critic – who died on Saturday – made swipes at NHS diagnosis and treatment systems (though not the staff) and seemed aggrieved that he was having to pay for an immunotherapy drug that is prescribed free of charge in some other European countries.
The drug in question is nivolumab , which – although it can’t ‘cure’ people in the same condition as the much-missed writer – can extend their lives by a year or two, at a cost of about £70,000 a year. The reason the NHS doesn’t prescribe it is because the service follows the recommendations of the National Institute for Health and Care Excellence (Nice), the body charged with weighing the cost-to-benefit ratio of any treatment across the whole of British society.
That’s quite a job, and Nice does it with great grace and sympathy, despite regular attacks. So, in the context of Gill’s death, it was good to hear praise for both the institute and the much maligned systems of the NHS on the Radio 4’s PM programme last night (Monday, 37:05).
The BBC tends to be a bit soupy about accounting in the health service; unwilling to acknowledge that successive governments have found a cure-all approach increasingly unaffordable. Yet, joining the chief executive of Nice and a consultant radiologist, here were a GP and a cancer sufferer – the BBC’s own Steve Hewlett, the presenter of Radio 4’s Media Show, who has an incurable condition – and they were all defending to the hilt the allocation of resources and the bodies that deliver them.
But, while the contributors to the discussion managed to put their case without talking ill of Gill, were they too sensitive to mention some factors that are surely worth touching on?
First, Gill was wealthy and well informed. He may have thought his ‘belief’ in the NHS precluded him from taking private health insurance (a huge triumph of hope over experience for such a seasoned sceptic); he may have thought, like many people who choose not to insure against a particular misfortune, that he’d rather pay bills when they’re called in. In his article, he doesn’t say, explicitly; so we can’t know.
Second, the drug for which he seemed to want a free prescription didn’t work for him. He died on it. Nivolumab only has a 25 per cent success rate overall, even if the odds for Gill’s particular condition are higher. Yet, while Nice believes the drug-company price for nivolumab is too much – full stop – Gill thought it should be free because its efficacy would soon become evident from the patient’s reaction (as, sadly, it was from his own).
Now, this might be where the debate opened up. But the clincher comes in a sidebar to Gill’s article, added by a Sunday Times editor. Among the facts and figures, it mentions ‘Pembrolizumab, [a] drug similar to nivolumab…Ten days ago, Nice announced it will finally be available on the NHS’.
The ‘finally’ seems pointed, as does the following sentence: ‘This is not the drug AA Gill’s oncologist recommended for him’. But before we condemn the Sunday Timmes too much, we should remember that this whole article was published in the full expectation that its writer would still be alive to see it in print.
No doubt the editor was emotionally involved in Gill’s predicament and wanted to express and engage sympathy. However, the fact that he died to deadline on Saturday, ready for Sunday’s front page, was actually unfortunate for the magazine – particularly with the Pembrolizumab news.
Gill’s final article is perhaps best forgotten. We all say things we don’t mean when we’re in pain and anxious. But let’s not forget the good news in the sidebar. Nice has found a drug the state can afford without paying through the nose. As a result, it will help far more British people than nivolumab ever could.