DEFIANT DOCTORS TO GIVE VIAGRA

Defiant doctors are to continue prescribing the anti-impotence drug
Viagra on the NHS despite proposals by the Government yesterday to
limit it by law.

They described the announcement by Frank Dobson, the Health Secretary,
as unethical and cruel. Mr Dobson's proposal, which underlines the
Government's fears about the cost to the Health Service, was the first
overt example of a rationing decision made on such grounds.

There will be a six-week consultation period and in the meantime the
British Medical Association is advising doctors to prescribe Viagra on
the NHS - contrary to guidelines - while they can still legally do
so.

It is estimated that Viagra, which was licensed in Britain last
September, could cost the NHS between UKP50 million and UKP125 million
a year, against a total drug bill of UKP5,000 million. Present
anti-impotence treatments, such as penile injections, cost the service
between UKP10 million and UKP14 million.

Dr John Chisholm, the chairman of the British Medical Association's
GPs' committee, described Mr Dobson's announcement as "bizarre",
prompted by the intention to cut costs rather than serve patients'
needs. He said: "Doctors believe it is wholly unethical to
discriminate between patients of equal clinical need on the crude
basis of what is the cause of the problem. We will be making strong
representations to the Secretary of State about his proposals. We are
getting to a situation where access to effective drugs for clinical
needs will be based on the size of the patient's wallet."

Mr Dobson said that Viagra could increase the cost of treating
impotence tenfold or even more. He said: "To limit this impact, we
propose controls which reflect the priority given to the treatment for
impotence."

The Government proposes to limit Viagra to impotence caused by spinal
cord injury, diabetes, multiple sclerosis, single gene neurological
disease and for men who have had pelvic or prostate surgery. It will
exclude psychological causes of impotence and impotence caused by the
side effects of other drugs.

Mr Dobson said that impotence was neither life threatening nor did it
cause physical pain. If men did not have any of the conditions on the
list, GPs could refer them to hospital consultants. The proposals make
it clear that the status of all drugs for impotence on the NHS will
now be reviewed, with the implication that ineligible men who now use
other treatments would lose their right to NHS treatment. Mr Dobson's
proposals specify that the men who qualify should be allowed one
tablet a week, based on average frequency of sexual intercourse in men
aged 40 to 60 of once a week.

Mr Dobson also wants to make Viagra a Schedule II drug, joining only
seven others on a list which strictly limits their use on the NHS.
Schedule II is also a halfway house between private and NHS practice.

If patients fall outside the criteria, GPs may still prescribe the
listed drug on a private basis but take no fees. This means that the
patient pays only for the drug - perhaps UKP6 a pill for Viagra - at
the chemist. The NHS pays UKP4.84 per tablet.

Dr Ian Bogle, a GP and chairman of the BMA, said that if threat to
life and relief of pain were the criteria on which doctors offered NHS
treatment, it excluded most of his life's work. The BMA wanted to see
a debate about rationing, but the announcement about Viagra was not
the way to do it, he said.

Dr Bogle said: "What is ludicrous about this decision is that Viagra
is more effective than more expensive alternatives. We accept that
there are not limitless funds, but the NHS is under-funded."

Dr David Devlin, a Cambridge GP and the director of the Medical
Information Service, said: "I think this is quite unfair. I have more
than 100 patients on Viagra and all are suffering from impotence
caused by psychological or physical disorders. A lot of people
consider Viagra users to be promiscuous men. This is not true. The
typical user is between 45 to 70 and finds that his sexual equipment
doesn't work - often with disastrous effects on his marriage."

Ken Moran, the managing director of Pfizer, which makes Viagra, said:
"The Secretary of State seems to have gone against the advice of the
standing medical advisory committee, which concluded that any decision
should take into account equity of access as well as availability of
resource. The proposals are also against the basic principles on which
the NHS was founded - repeatedly reiterated by the Government - that
medical treatment should be available to patients on the basis of
clinical need and need alone."

But the NHS Confederation, which represents health authorities and
trusts, welcomed the proposals as a sensible and workable solution to
the cost problems that Viagra posed. Stephen Thornton, its chief
executive, said: "These are landmark proposals, representing the first
time that the Government has set clear eligibility criteria for a new
drug on a national basis. Setting limits to health care is never easy,
but we believe that these proposals are fair."