I'll agree with that last, you could also argue that dead people don't
pay taxes.  I'll also agree that we need an open debate on what our
priorities are, and a transparent way of assigning them.

There is some debate going on, it's a fairly regular subject on BBC
Radio 4.  It was said recently that the NHS as presently structured has
no real way of assigning priorities between departments, the NICE
guidelines and the budgets are all we have.  There's no actual way of
taking the money saved by refusing someone Herceptin and using it to pay
for an A&E nurse, or someone's Alzheimer's drugs or whatever.

The reason why she can get Herceptin now and couldn't before, apart from
possible timing issues through the progressive introduction of the drug,
is statistical.  If she has a diagnosis of primary cancer, and say a 25%
risk of recurrence, within that a 25% chance of responding to Herceptin
at all, and within that say a 50% chance that it will prevent the cancer
spreading, then for every life prolonged, 32 patients have been given
the drug 'uselessly', because either they wouldn't have got a recurrence
anyway, or they died anyway.  But either way you don't know until
afterwards.  So while her particular course costs say £10,000, the real
cost is £320,000 per life prolonged.  Actually worse, because you can't
set the rules that precisely, you'd have to give it to people at lower
risk too.  (And some otherwise perfectly healthy patients may suffer
cardiac complications as a result.)  On the other hand, giving Herceptin
for secondary disease, you can stop the drug early if it is seen not to
be working, so it can be targeted to only those it will help.  But of
course the prolongation of life is rather less.

Tim