Prevention better than cure

My long-suffering optometrist would not have been impressed. ACC might have had a few questions too.

Just on dawn I was blundering blindly about in the murkiness of the basement like a wannabe arsonist, groping anything I could find in the hope it might be a petrol can.

My fingers were coated in dried glue from the previous evening's attempts to stick my spectacles back together.

The trusty plastics glue, which had worked a treat umpteen times before, had decided it had no desire to join the fractured bridge again, but would do its best to coat as many of my fingers as it could. The effect was similar to having gloves made of coarse sandpaper.

Removal attempts with acetone failed and, too tired to care, I went to bed, hopeful my dastardly digits would not shred the sheets before morning.

In brainwave mode in the early hours, I decided petrol was the answer. Sans glasses, and too stupid to insert my contact lenses, I shambled off in the half-dark in search of some.

All it did was increase my risk of self-combustion.

I tried picking off the glue but it seemed if this succeeded, I would be minus several layers of skin.

Fortunately, a renewed and more thorough effort with the nail polish remover eventually did the trick.

However, what about my glasses? Could I use each side like monocles or a one-lens version of opera glasses?

Would that mean I would be more one-eyed than usual, not capable of seeing the big picture?

Well, at least I wouldn't be alone.

We're not great at the big picture thing, particularly when it comes to health matters.

In the midst of all the pinkness of breast cancer awareness campaigns we don't hear much about lowering risk - including such possibly unpopular things as drinking no or less alcohol, regular exercise, keeping a healthy body weight (particularly after menopause), having children sooner rather than later and breast-feeding them.

And how measured was the recent debate over the funding of an expensive drug for late-stage melanoma?

Keytruda (pembrolizumab) is one of an exciting new class of immunotherapy drugs which work by pressing the body's own immune system into action to attack cancer cells. Long-term survival rates are not yet known, but early results suggest about a third of patients could expect their life expectancy significantly increased. A casual observer of much of the commentary could have been forgiven for thinking it was a miracle drug for every person with metastatic melanoma . It won't work for every patient.

There were some calling for political intervention so we could repeat the Herceptin vote-seeking folly of the 2008 National Government which overrode Pharmac's processes, making it fund 12-month treatments for breast cancer patients instead of the nine-week course preferred by Pharmac. Conveniently, it was not until the Keytruda debate the National Government fessed up that the Herceptin decision was wrong, when all members had been curiously quiet when former Health Minister Tony Ryall was still crowing about it as a triumph in his 2014 valedictory speech.

Pharmac may not be perfect, but it is its job to evaluate the value for money new drugs provide, in a country where we do not have unlimited health funding, and to do hard bargaining with the drug companies. When two companies are vying to sell you something, as in the case of the melanoma drugs, you are likely to get a better deal.

Funding drugs according to media campaigns weakens Pharmac's bargaining position. If the Government had overridden Pharmac and forced it to fund Keytruda, you can bet the cost would have been higher than that it has secured for the similar drug Opdivo (nivolumab).

In the midst of all this drama, has there been much talk about prevention?

Although we hear frequent clamouring for us to provide health care on a par with Australia, we have not come close to following the lead of seven states there by banning commercial sun beds.

This Government has not even got around to bringing in its namby-pamby rules restricting access to sun beds to those over 18. The Bill outlining this has not had its third reading yet, despite the second reading almost a year ago.

Is it time, as suggested by University of Otago public health professor Tony Blakely, to compare melanoma treatments with the cost-effectiveness of primary prevention, such as promoting hat use and sunblock for children. What about subsidising the cost of sunblock?

It's tough stuff, weighing up the merits of the personal and the greater good.

In the case of my glasses, I can see clearly now. The cost of a new pair will be preferable to the risk of a substantial ACC claim.

- Elspeth McLean is a Dunedin writer.

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