A grizzled ex-minister, just back from an evidently refreshing holiday, was muttering the other day about what he calls the 'BBC mindset', by which he means all of us in the inky-fingered media trades.

"They're not against the Labour government or a Tory government, they're against government, against responsibility and decision-taking, which is messy," he complained. Then he quoted the German statesman, Bismarck: "The making of sausages and laws should never be examined too closely."

I thought of this when listening to the Today programme's discussion of the National Institute for Health and Clinical Excellence's latest brush with militant media over the four kidney cancer drugs - Sutent, Avastin, Nexavar and Torisel - which NICE has (provisionally) decided are too costly at£24,000-plus per patient year.

The "BBC mindset" must have been on holiday because I heard a constructive discussion between NICE's clinical and public health director Peter Littlejohns and Peter Johnson of Cancer Research UK. It's not always that civilised.

Disconnected from patients

Bismarck would have understood their dilemma. Professor Johnson admired NICE's procedures, which other countries are starting to copy. But he complained of a "disconnect" with patients and about the fact that we spend more on cancer research, have more patients in trials, than any other European state. We spend less than 10 per cent of our drugs budget on cancer drugs, "less than on indigestion pills", I think I heard him say.

Professor Littlejohns was also impressive. Quality adjusted life years are bound to be part of the process. There isn't an unlimited budget. The four drugs work medically, though not as well as docs and manufacturers claim. But is an extra year in great pain worth the huge cost to the NHS?

What he didn't say was that if£24,000 is spent on Sutent, it isn't there to spend on other NHS treatments. That's true of many things: drunks who need stitching up; those "happy pills" which, we read, are handed out by GPs for frivolous reasons; the Clomid fertility drug whose effectiveness has been challenged by new research.

Drug company motives

Sexual intercourse works better, the researchers concluded. But sex is (more or less) free, despite ever-dafter attempts to commercialise all aspects of it. Here's one aspect of the debate that campaigners, anxious patients and journalists rarely address, and docs too rarely admit: the pushy interests of drug companies to promote the product. Herceptin was a famous example.

Today got a second brownie point when the issue again arose this week, courtesy of the Rarer Cancers Forum's study of the wider variations in drug prescribing policy that exist across England's primary care trusts with drugs not yet NICE-approved.

No surprise there, surely? But hey, it's August, so Freedom of Information data from 62 of the 152 PCTs was extrapolated to suggest that up to 2,200 patients a year get "exceptional funding" - but 800 are rejected, for instance in South West Essex. Next door in Mid Essex 96 per cent get the thumbs up.

Why did Today's Evan Davis get my morning cheer? Because after the forum's Penny Wilson-Webb had emoted about the unfairness and chaos of it all, he reminded listeners that her research had been funded by the pharma firm Roche.

Acting like grown ups

It's horrid, I know. People want to do their best by their loved ones. But NICE has to be the grown up and like grown-ups it sometimes makes mistakes. So do PCTs, some of which need to be more open.

These debates will intensify. Last weekend the Lords-Commons joint committee on human rights put its ha'porth in. When ministers, Labour or Tory, get round to the promised UK bill of rights, they should include the right to health, it said.

That would be more an aspiration than a right you could take to court and use to get Sutent, the chair, Labour's Andrew Dismore, told me. So it won't be justifiable as such.

But it would be "underpinning", which might influence a court in favour of asserting such rights, much as the Court of Appeal ruled in May that NICE had been procedurally unfair in refusing anti-dementia drugs such as Aricept (a more modest£2.50 a day) to Alzheimer's patients.

One thing that doesn't change: the lawyers will do OK.