It is the first week of January, everyone has returned to work, and tomorrow even the schools start again.
The politicians have started their election campaigning, it is all about the money, what they will spend, how much they will save, how they will fix the deficit, how they will save the NHS.....
January is always a tough month financially, we get paid earlier than usual in December, and then spend more than we can afford for Christmas, then spend some more in the sales just after Christmas, add to that for some reason the royal colleges and societies all demand their subscription fees in January, so I have spent a few days juggling, deferring, moving debt from one credit card to another and generally trying to limit the damage, acknowledging that for the next two months I will have nothing to put aside towards reducing the astronomical mortgage that is still outstanding on our home.
I go to work to find a pleasant surprise waiting for me, the numerous emails, form filling and essentially begging have been effective... the drug company has agreed to give my patient Carfilzomib free of charge.
This is a new cancer drug that is not yet approved for use in Europe, I am planning on giving it to my 73y old patient, who has had seven prior lines of chemotherapy for his myeloma, and who I first diagnosed eight year ago.
I am planning to give him the drug in combination with Pomalidomide, another relatively new drug, which is being funded through the cancer drug fund; a government funded pot of money specifically set aside for cancer drugs that have not yet been approved for general use.
Using the combination, if he were to pay for his treatment would costs £18,000 a month
In another part of the world, a lesser being is packing his bags and travelling back home to die.
He is 59y old and has advanced renal cell carcinoma, he previously lost a kidney, and his treatment options should include chemotherapy, antibody treatment, possibly followed by surgery, and long term dialysis.
In the West he might live for six years or more, but the West didn't think granting him a visa to come to the UK and have treatment funded by his family would be a good idea, so instead he will return from Jordan to Mosul, the second largest city in the apparently rich Iraq, to the city with the country's (previously) second most prestigious medical school, but where currently there is no chemotherapy, there is no antibody therapy, and even if he had surgery there is no dialysis available either.
Don't you just love this crazily imbalanced world?