DOCTORS URGED TO WAIT ON VIAGRA

Canada must still approve drug, insurers warn

The agencies that oversee and insure Canadian doctors are warning them not
to prescribe the impotence drug Viagra until it's approved in this country.

Doctors who do so could be exposing themselves to lawsuits from unhappy
patients, say the regulatory organizations.

``A doctor who writes a prescription for a medication that hasn't been
approved in Canada is increasing his risk for having trouble, for sure,''
said Dr. Guy Lemay of the Canadian Medical Protective Association, which
provides malpractice insurance to all the country's physicians.

If a patient had an adverse reaction and sued his doctor, said Lemay, ``It
might be difficult to defend him.''

`WELL INFORMED'

But physicians who have been prescribing the immensely popular drug,
approved for sale in the United States since March, say they're well
informed about its pros and cons and deny they're putting patients in any
danger.

They also note it's relatively easy to obtain the drug on the black market,
without the involvement of any doctor.

Viagra has been flying off the shelves of American pharmacies in almost
unprecedented quantities - and many of the customers in border towns and
cities have been Canadians.

While it is illegal to buy or sell the drug until it's approved by Health
Canada, doctors are not barred by law from prescribing it and patients can
import it from the U.S.

Still, the Ontario College of Physicians and Surgeons advises its members in
a notice on its Internet site that it ``does not recommend'' prescribing any
drug before it is approved here.

Other provincial colleges have taken a similar position.

A recent report by the U.S. Food and Drug Administration said 18 patients on
the medication had died during or immediately after intercourse in the first
four months that the drug was on the market. But there's no evidence Viagra
had anything to do with the deaths.

The pill was submitted to Ottawa for approval in January. With the
traditional 300-day study period, it should be approved for sale by early
November if all goes smoothly, said Health Canada spokesperson Steve
Jeffrey.

He warns that doctors would be unwise to prescribe Viagra before Ottawa has
finished its analysis.

``If a doctor does that, they're really out on a limb, especially if there
was some adverse reaction,'' said Jeffrey.

Doctors at the Canadian Men's Clinic, with branches in Toronto, Vancouver
and Ottawa, have prescribed the pills to ``a few hundred'' patients, said
spokesperson Carol Bresgi.

Urologists explain the benefits and side effects of the drug, tell patients
it hasn't been approved here and even have them sign a consent form before
prescribing it, she said.

``Our doctors feel very, very comfortable with what they're doing . . . and
I think it's really to the benefit of the patient.''

BLACK MARKET

Bresgi also said Viagra is readily available on the black market, adding
that she has had faxes from Canadian operators offering to sell it
illegally.

Dr. Morris Van Andel of the B.C. College of Physicians and Surgeons said his
group recommends against prescribing the drug but acknowledges there are
reasons why Canadian doctors might do so anyway.

One is that their patients can always see American physicians, some of whom
are handing out prescriptions ``by the bucket'' with little knowledge of the
patient, said Van Andel.

Checked-by: Don Beck