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The conversation turned to the Gini coefficient of a feudal society. Azim argued in favour of a perfectly unequal, and intellectually beautiful, 1. Francesco’s stance: in practice, 1 just couldn’t hold—the reality was much messier and closer to 0. Keen to keep cruising through the verdant hills of Normandie, Nina and I just rolled our eyes. Today is Day 3 of (post-radiotherapy) Round 6 of chemotherapy, the final round under National Institute for Health and Care Excellence (NICE name, guys) guidelines. A scan in a couple of weeks will give us the latest bout score. But in the spirit of Francesco, the messy truth is this beast will keep throwing punches. I’m bracing myself for the ‘poetic beauty’ (as JD would put it) of a possible pugilistic 12 rounds. In the spirit of Azim, I’m running rates of return analyses on my counterpunch options. A warning: Azim is a good economist. His arguments are often mathematically elegant, attractively simple, and overladen with assumptions. His conclusions are, on the whole, useless. ‘I’d rather not be bored than happy’ comes to mind. Yet invariably and almost inexplicably he keeps serving up ‘overall survival’ (OS) boosting nuggets of wisdom. Here’s a sample of my calculations:  So what are the nuggets of wisdom? Firstly, the caveats. I can’t emphasise enough how approximate these figures are. There are all kinds of pinches of salt: statistical curves, limited sample sizes, contradictory studies, non-financial benefits and costs. Different tumours respond to different treatments in different ways at different points in time. This is one of the primary reasons finding a silver bullet against GBM has proven so elusive. Having said all that… Demand inelasticity (ie when prices goes up, buying habits stay about the same) for life can get pretty insane. Ingrid and I squirm at the ~$30,000 price tag of each year of my life saved by valganciclovir, a repurposed antiviral also crucial for fighting chronic fatigue, herpes and HIV/AIDS. On the other end of the price scale, the million dollar question: would you place a ~$300,000, one-year bet on a contraption that requires you to wear an ‘electric hat’ 18 hours per day connected to a 3 kg battery carried around in a back pack… extending your forecast OS by 3 months? Some people do, and I guess the reason is because life is, to quote Mastercard, ‘Priceless’ (how compelling would a GBM-rendition of that ad be?). I think another reason we pay so dearly is hope: hope that we’ll end up on the long side of the statistical curve, and hope that the treatment is just a stepping stone to a more effective treatment. The poker player in me tells me ‘the only way out is all in’. Buy as many lottery tickets as possible and pray one of them pays big. The socialist in me warns me this is irresponsible: how much should this tumour cost my family and our world? The price of a year of life for a GBMer purchased via 5 years of valganciclovir is about the same as the price of a year of life for a non-GBMer purchased via a low-cholesterol diet for the next 50 years (~$30,000); neither the most economically efficient of interventions. I can see why NICE guidelines limit chemotherapy care to 6 cycles. After that, it’s diminishing returns but steady costs. And so I dread living out Monty Python’s classic ‘he won’t be long’ scene (https://www.youtube.com/watch?v=Sh8mNjeuyV4). But if Azim and Francesco (lovingly, no doubt) club me over the head and throw me in the death collector’s cart I’ll understand.  Fortunately, there are a few cheaper options. In the same way governments have bought each of us on average an extra year of life at a price of ~$120 by passing laws to make seat-belt use mandatory, I could jump on a plane to India and buy some generic valganciclovir. If I make it long enough, the NHS and Metlife Insurance will one day cover treatments like dendritic cell vaccines. Inexpensive mushrooms have been used for thousands of years in Asia to combat cancer. Eating healthy has, in a way, made me stronger than ever. And then there’s the bike. No, Ingrid, I’m not angling for a higher cycling budget; just pointing out that a bit of exercise has been proven to go a long way in killing tumours. It makes sense. As the muscles consume glycogen, the cancerous cells struggle to tap into the sugar they crave. And as the sweat pours out, so do many of the medicinal toxins. And then there’s the most powerful cure of all. Thanks be to God, Ingrid, Godson (happy birthday Little Knight!), my family and friends that made this ride possible. To paraphrase Nina as I sipped a bottle of beer (baby-sized, but don’t tell my nutritionist!) after a long day on the saddle: ‘with November's news, I didn't think we'd be riding together again—let alone from London to Paris, return’. Amen. Just as mass is too short to get through all the stuff I’m thankful for, there are just too many ingredients to list out in words here. Still, I think a gift I recently received sums these up well. The gift is a painting by Armelle. She didn’t give me a name for it, so here I am christening this patchwork of everything that feeds life with life: The (Radical) Green Machine A few months ago I complained human activity (eg bed-making) accelerates the universe’s journey towards its extinction by generating entropy that moves us closer to thermodynamic equilibrium. I was relieved to learn from Azim and Francesco during our baguette stop that life actually reduces the entropy intrinsic to the mess of the world they’ve helped me waddle through. Radical! Yes Keynes, 'in the long run we are all dead', but in the short term we can all be radical green.  Comments are closed.
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