Impotence pains
09/16/98
Financial Times
USA Edition
Around the world, health systems have reacted in sharply differing ways to the challenge of paying for Viagra , the anti-impotence pill which gained its licence for European use yesterday. Germany has decided that as a so-called "lifestyle" drug it will be available only privately. Belgium and the UK have it under review. In the US, half of health plans won't pay for it, but Medicare, the health system for the elderly, will.
The challenge for those responsible for authorising payment is to decide a set of principles which can be applied not just to Viagra but to other "lifestyle" drugs which are just over the medical horizon -- obesity drugs and memory enhancers, for example.
Viagra should plainly not be available through public health services for purely recreational use. But given the misery that impotence causes, the drug clearly should be provided for people with a genuine clinical need -- diabetics, and those demonstrably impotent due to prostate surgery or other definable clinical causes.
In seeking to control the potential cost -- and possible abuse -- tightly drawn guidelines will be needed. But those in charge should not distort hospital priorities -- as the UK threatens to do -- by seeking to restrict precribing purely to specialists.
Beyond that -- and because impotence is not an all or nothing condition, but runs along a continuum -- regulations should be eased to make private prescribing of the drug easier by ordinary doctors. That would allow any usage which might be termed "lifestyle" rather than clinical need to be catered for under medical supervision at the price of hiring a couple of videos, rather than on the black market.
This twin-track approach could work equally well for memory enhancers, for example, if they assist in diseases such as Alzheimers, but also turn out improve the normal memory of a 70 year old to that of someone of 50.
Under this sort of arrangement, public health services could afford Viagra , as long as they took ever more rigorous steps to encourage doctors to prescribe what works and eschew what does not. Ending the unnecessary prescribing of antibiotics, for example, would alone save as much as Viagra , under such an approach, would be likely to cost. Patients would be both happier and better treated.
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