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I have always had an element of sympathy for Pharmac in the sense the model we run in this country is a fiscal set of handcuffs.\xa0

If you have a set budget you can only spend what you have. Other countries have models that have criteria saying if the medicine or treatment reaches a certain threshold, it is funded.\xa0

Neither system is perfect and given the way medicine operates, there will always be someone who has a case or who has some sympathy behind their cause. There will always be a new treatment or breakthrough and that\u2019s before you get to the vexed areas of funding for cures as opposed to treatments.\xa0

How do you take all of those ever-changing and varying sets of circumstances and cover them off with a budget with a limit?\xa0

You can't, and that is the Pharmac dilemma.\xa0

But when you do it, you do it with professionalism and humility and that is where they have been found so atrociously wanting. With the realise of the various emails we find a CEO who treats people with arrogance and contempt.\xa0

The fact she was stupid enough to put it down in writing only adds another nail to her coffin. The fact she still hasn\u2019t been sacked given the story broke Friday is of some surprise.\xa0

It's not a complete surprise given the hallmark of this Government is allowing astonishingly long ropes in which people may, or may not, hang themselves.\xa0

For all the Official Information Act is maligned, and it is and rightly so, this time the OIA has done Sarah Fitt in.\xa0

She cannot continue. Doctors and patients are now openly calling for sackings, resignations or just her general removal. And they have every right to.\xa0

The stance Pharmac has taken around some cancer treatments is defendable, at least in part because of the constraints I mentioned. What is not defendable is the sneering arrogance of Fitt, who in her emails, shows a personality trait of a narcissist.\xa0

There are calls for the chairman to go as well. I am not sure we need to go that far, unless of course he doesn\u2019t remove her.\xa0

But the buck stops at the top. The crime was committed by the CEO, the evidence is irrefutable and the disgust and outcry entirely predictable and justifiable.\xa0

Pharmac need to be seen to be doing their best. They can never be perfect and they can never meet everyone's needs, but they can do what they can with professionalism and humility and give us all a sense they care about what they do and they work hard at it.\xa0

The Fitt emails show beyond a shadow of a doubt they are being led by the wrong person.\xa0

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