WHEN it comes to certain life events different folks tend to go for the same strokes. News of births, marriages, new jobs, and graduations are always occasions to crack open the congratulations.

Just as routine kicks in at the best of times, so it is with the worst, as on hearing that someone has died from cancer. How old was she, we ask. Did he have children? What ages? Rare indeed is the person who inquires: “Did they get the best treatment possible?” Somehow that seems too clinical, too cruelly rational, when what we want to convey to the bearer of the bad news is how sorry we are.

Yet a couple of events this week might prompt more of us to ask that seemingly too intrusive question in future, if only to ourselves. The first arrived on Sunday when it was announced that the Sunday Times’ writer AA Gill had died from lung cancer. The second was a story about what happened behind the scenes of government and the NHS after a newspaper reported the case of a Scots mother with breast cancer who had been denied a particular drug.

Gill initially went private, paying for the first consultation and tests himself. When the seriousness of his condition became clear he turned to the NHS, only to be told in time that the chemotherapy was not working. He needed immunotherapy with a particular drug, but it was not available on the NHS in England. The National Institute for Health and Care Excellence (Nice), which decides which treatments should be made available, had said no. (The same drug, nivolumab, costing £60,000-£100,000 a year, is available in Scotland.) Gill’s magazine piece ended with the footnote: “Since AA Gill wrote this article, he has started taking nivolumab.” The news pages, put together after the magazine, told only too poignantly how the story ended.

The second case concerns Anne Maclean-Chang, a breast cancer patient from Elgin. Mrs Maclean-Chang thought being treated with a certain drug, Kadcyla, would give her the best chance, but once again the medication was not on the approved list. This time it was the Scottish Medicines Consortium (the equivalent body to Nice) that said no. Only a panel of senior doctors could over-rule the Consortium, and they, too, had said no.

Mrs Maclean-Chang got in touch with the First Minister’s office. She began to raise money to fund her treatment. Eventually, her story was told by the Daily Record. As the Times reported yesterday, the publicity given to the case prompted a reaction behind the scenes. Emails went back and forth between the Scottish Government and NHS Grampian. Eventually, the First Minister told Holyrood that Mrs Maclean-Chang would be treated with Kadcyla.

Ms Sturgeon said: “This is not a case of of me and my Government intervening; it is a case of the system operating to get the patient the drug that I agree she should access”. But what would be so wrong in her intervening, you might ask? What person, in a position of power, would not tell officials to make some inquiries, to find out what was going on? And to what extent does a politician seeking more information amount to putting pressure on health officials?

Here we go again with the interrogative rituals. It happens every time there is a story about a cancer drug being denied on the NHS. There was another yesterday. As The Herald’s health correspondent Helen McArdle reported, a potentially life-saving treatment for breast cancer, pertuzumab, will not be made available in Scotland despite its use in the rest of the UK. This would leave patients in Scotland facing “the ultimate postcode lottery”, said campaigners.

There is undeniably a lottery when it comes to cancer. If you are born in the wrong place, at the wrong time, to the wrong parents, if you make the wrong choices, or are just plain old unlucky for whatever reason, the chances of winning the jackpot no-one wants increase. After a diagnosis is made a whole new venture begins, one in which ultimate outcomes are largely determined if not by postcode then by international dialling code. If you live in France, the five-year cancer survival rate is is 58.6%. In Sweden it is 64.7%. And in Scotland? 46.6%. The worst in the UK, behind England (50.2%), Wales (49.9%) and Northern Ireland (51%).

One thing on which all can agree is that the earlier the disease is diagnosed, and the quicker treatment begins, the better the patient’s chances. Thereafter, focussing on specific drugs is understandable. This is how we cope with the horrifically complex, ever ravenous monster that is cancer. Good luck to all those who manage to turn a spotlight on their plight and get the treatment they want, but it is not for everyone. Taking on health boards, running campaigns, is the last thing many can face at a time in their life when they are weakest, when they are only too conscious of time going by and the importance of not wasting it. The more this route is taken the lesser the chances of success over time. For all these reasons and more, expecting or encouraging people to enter this kind of publicity and campaigning lottery would be cruel indeed.

We know the NHS is a body facing huge and growing demands with finite resources. That is why the likes of the Scottish Medicines Consortium and Nice were set up – to make the best, independent, decisions about treatment based on the evidence available. One can argue whether they get it right in every case, but it is difficult to think of any other way the system could operate fairly. Where such bodies fall down is in the way their workings are presented to the public. The reasons why decisions are taken are set out on websites and elsewhere, but being medical these explanations are beyond the understanding of the layperson. All the public hears is No. It is particularly hard to take this as the final answer when a No in Scotland is a Yes in England or vice versa. Then there is always the suspicion that cost, not effectiveness, is the deciding factor. Would it distress the public to hear that? Could politicians cope with the flak?

In Scotland, much is expected from Dr Brian Montgomery’s review of how drugs are assessed and made available on the NHS. Announced in January, it was meant to report in the summer but the Scottish Government says it will be published soon. Separately, Scotland’s health minister, Shona Robison, yesterday announced a review of some cancer services after the fourth year of missing a waiting-time target of 62 days for treatment to begin.

As a society we have come so far in dragging cancer out of the shadows, but we have barely raised a sweat when it comes to answering the truly tough questions, such as why survival rates differ so much, and whether those who die really were given the best treatment possible, not just the treatment that was there. We owe it to them, and to those who come after, to find those answers.