| Liz Revell from Buckinghamshire, England had been fighting the blood cancer myeloma for 24 years when in 2020 she nearly ran out of options. After previous treatments stopped having an effect, her last shot was a drug from Sanofi called IsaPD, which combines three cancer medicines. It worked. Revell's had four years of remission with the medicine — pretty unheard of among myeloma patients. Others won't be so lucky. Revell received IsaPD through a program that allows temporary access to new cancer drugs. But as a Bloomberg News report this week highlighted, the regulator, called the National Institute for Health and Care Excellence (NICE), has now decided it won't be available on the NHS for other patients. "It's difficult to understand really, because it's people's lives at risk," Revell tells me. About two years ago, England's regulator changed how it assesses new medicines. Until then, NICE had allowed drugs for patients with terminal conditions to cost more and still be available on the taxpayer-funded NHS. That mainly helped cancer medicines. With the change in methods, it wanted to give extra weighting to all severe conditions, not just those that would likely lead to someone's death. The change has also hit AstraZeneca and Daiichi Sankyo's breast cancer drug Enhertu that's been rejected for some patients. "Women are depending on these drugs coming through the system to give them that extra time to spend with their family, spend with their friends," Melanie Sturtevant, associate director of policy evidence and influencing Breast Cancer Now, says. It's bigger than just these two medicines. Sturtevant fears that more breast cancer medicines will face the same fate as Enhertu. Some other cancer drugs haven't even been submitted to the regulator since the change, meaning they will never get to patients in England. That's probably because pharmaceutical firms think it's now less likely that NICE will wave them through. The change and the wider system around assessing new medicines is extremely complex. But at its core, there's a simple question that several experts put to me: "Do you value patients with cancer near the end of their lives more than you value patients in general with severe diseases?" Big Pharma thinks you wouldn't need to choose if NICE had more flexibility and wasn't bound by strict rules on how to calculate cost effectiveness. But as the Nuffield Trust think tank's Mark Dayan tells me: There's no money left in the NHS for the regulator to have that leeway. In the meantime, NICE has kicked off a two-year study into what society actually wants. That's likely to be too long for some patients. — Ashleigh Furlong Public health had a tough day Thursday. First, a new report from the World Health Organization and the US Centers for Disease Control and Prevention revealed that global measles cases surged by more than 20% to an estimated 10.3 million last year as vaccine coverage declined. Then, President-elect Donald Trump nominated Robert F. Kennedy Jr. to run the Department of Health and Human Services. The son of the late senator and US Attorney General Robert F. Kennedy and nephew of late President John F. Kennedy, RFK Jr. has long been associated with conspiracy theories, the most notable of them being his suspicions of the safety and effectiveness of vaccines. Although not a doctor or a researcher, Kennedy claims that vaccines can cause autism and other conditions, an allegation that's been repeatedly debunked. Public health advocates were quick to protest the nomination. "If unassuming little viruses could talk, measles, mumps, and rubella would be loudly cheerleading for the nomination of this prolific spreader of scientific misinformation," said Peter Lurie, president of the Center for Science in the Public Interest and a former Food and Drug Administration official, in an email. Trump shares a disdain for public health experts with RFK Jr. that he demonstrated repeatedly as president. He downplayed the danger of the Covid pandemic to the US, promoted unproven therapies like hydroxychloroquine and ivermectin, and suggested that the virus could be treated with bleach and light. Before the election, Trump endorsed Kennedy's effort to "Make America Healthy Again" and wanted him to "go wild" on health. Now it's up to the Senate to decide whether Kennedy gets that chance. — John Lauerman | 
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