VIAGRA & THE DEBATE ABOUT
RATIONING
Rationing is not a new concept in the NHS. There has always been some restriction of access to certain proceedures and waiting lists have meant that some people have died or become unfit for surgery (or even got better!) before they have been able to have their treatment. Rationing is not always just about money. The classic example here is transplant surgery where the availability of suitable organs is the limiting factor. Sometimes the availability of qualified specialists restricts access to certain treatments.
Rationing of prescription treatments is not new either. We are able to prescribe special foods for certain conditions but we have never been able to prescribe food for the general population - for obvious reasons! This is never a problem because most special foods are less appetising than normal food and there is not exactly a big demand for them. Rationing of drugs came in during the 1980's with the advent of the "limited list". Mostly this created a blanket ban on certain drugs such as Valium and Dalmane (though the "generic" equivalent of Valium, diazepam, is still allowed). However there are one or two drugs which though generally banned on the NHS are allowed for certain limited indications e.g. clobazam (Frisium) in epilepsy but which used to be used for anxiety as well.
So there is a precedent for the government's proposals to restrict the availabilty of the impotence drug Viagra to certain conditions. What is new is the potential popularity and demand for this drug which is the first effective tablet for this condition - though other less attractive treatments have been available for some time. Experience in other countries such as the USA confirms that if the drug were available to all who requested it on the NHS (even if you exclude those for whom it is not suitable) then the cost would be considerable.
What do you think? Send us your views by email The possible options are:
All new treatments that are effective should be available on the NHS to all patients irrespective of cost.
As (1) but only if the condition is life-threatening or causes significant pain or distress.
The government should balance cost against likely benefit and advise doctors what they can and can't prescribe.
The government should leave the decision on cost and benefit to the new Primary Care Groups at local level.
Individual doctors should make decisions about cost and benefit and should be able to refuse treatments to patients if they don't think the likely benefit is worth the money.
Treatments should be available to some and not others depending on what has caused their symptoms.
When treatments are refused on the basis of rationing should they always be available privately - are you worried that this could be abused?
One thing is certain, the health service will never have deep enough pockets to do absolutely everything that is possible. What do you think should guide decision makers in the medical profession and in government when setting priorities?
Suitable replies will feature (anonymised) in our Patients' Section.
Update (1/8/99) From the first of last month Viagra (and other impotence treatments) has been available on the NHS for patients in the following categories:
Men treated for prostate cancer
Men suffering from spinal cord injury
Men treated for kidney failure
Men with diabetes
Men with Multiple Sclerosis
Men with single gene neurological disease
Men with spina bifida
Men who have had polio
Men with Parkinson's disease
Men with severe pelvic injury
Men in receipt of a prescribed impotence treatment on 14/9/98.
There is also a category for men suffering severe stress from impotence which requires a consultants opinion although a definition of "severe stress" has yet to be defined.
All other men who might benefit from impotence treatment will need to pay the full cost of the medication for which we can now issue a private prescription.