BBC online: Viagra: a great British invention
Friday, December 11, 1998 Published at 16:17 GMT
This week I have been talking to Mr Alvan Pope M.D.
FRCS, a leading London urologist, on the subject of
Viagra:
Mr Pope was quick to point out that treatment of
impotence or erectile dysfunction (ED) is not new and
there are many existing successful treatments.
However, Viagra is the first clinically tested and licensed
drug to treat ED taken by mouth...and just like the
hovercraft it was a British invention, hurrah!.
Viagra works by affecting an enzyme which is only found
in the penis, allowing the substance that causes
erections, cyclic GMP, to hang around longer.
Viagra works for men with both physical and
psychological problems, particularly for those who are
not completely impotent but have difficulty maintaining
an erection.
Psychological factors are only the primary cause in
about 14% of men with ED, but more commonly these
psychological fears and worries combine with the effects
of pre-existing medical conditions to make erectile
dysfunction worse.
Viagra has been shown to be
very effective in these cases.
The Department of Health
has issued a temporary
block on the prescription of
Viagra on the NHS, saying it
should only be prescribed in
exceptional circumstances.
It is working on specific
guidelines on who should get
the drug and these are
expected to be published
before the end of the year.
Mr Pope told me that he has not prescribed Viagra on
the NHS, but has used it for a handful of private patients
with about a two-thirds success rate.
The point is that Viagra is the cheapest available
treatment compared to existing ones, but because of its
ease of administration by mouth, there will be an
increase in demand, and therefore the overall cost to the
NHS could be huge.
It is important that those taking Viagra are under medical
care as there are potential side effects and dangers if the
person is taking other drugs containing nitrates.
Experience in the US of 69 deaths in 3.5 million Viagra
prescriptions is not unexpected in the particular age
group and the US Food and Drug Administration has not
changed its view on the drug's safety.
Incidentally, those buying Viagra illegally for kicks are
wasting their money as it has no effect on normal
erections and could indeed be dangerous.
At present the Department of Health has sat on the
fence over Viagra, but the government needs to decide
whether the treatment of impotence is in or out of the
NHS.
It is not a practical option to have rationing of care
because there is no medical test for impotence and
therefore it would be almost impossible to apply fair and
consistent criteria for treatment across the board.
Mr Pope's personal view, and that of many of his
colleagues, is that Viagra should be freely available to
appropriate patients on the NHS.
It would be best prescribed by GPs in the first instance
and, if patients do not respond, that is the appropriate
time to refer to a specialist for further investigation and
treatment.
In the future more Viagra-type drugs will be on the way.
On the cards is a wafer popped under your tongue for the
desired effect without the nuisance of finding a glass of
water...
So be careful when asking for a wafer with your ice
cream from now on!
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