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Doctors say the government's decision to ration Viagra
is arbitrary, "bizarre" and unfair.
Health Secretary Frank Dobson has set out guidelines
which limit the prescription of Viagra on the NHS to
people with certain physical problems and severe
psychological distress.
Dr John Dean, a GP specialising in erectile dysfunction,
said: "This is arbitrary and does not go anywhere to
meeting clinical need for the majority of impotent men."
He said only about 20-25% of patients he saw with
impotence were covered by Mr Dobson's categories.
If coronary artery disease, including high blood pressure,
was included, this would lift the number to 80%.
Fifty per cent of diabetics become impotent as a result
of their illness compared with 40% of people with
coronary artery disease.
"They are just as likely to suffer and they did not choose
their problem," he said.
Psychological causes
He added that it was very
difficult to draw a line
between physical and
psychological causes of
impotence in many cases.
A quarter of cases of diabetic
impotence were caused by
psychological rather than
physical reasons, he said.
"There is not a guaranteed
diagnostic test which can
show whether impotence is
due to physical or
psychological factors," he
said.
Moreover, Viagra did not
work as well for diabetics as
for people with coronary
artery disease.
Only 55-60% of diabetics responded to Viagra, he
claimed, compared to 80% of men with coronary artery
disease.
"He has chosen a group which is likely to respond the
least well to the drug," said Dr Dean.
He believes the decision to leave out some physical
causes of impotence is due to cost.
More people have coronary artery disease than diabetes
and it was more difficult to diagnose borderline vascular
disease than diabetes.
But a spokesman for the European Medical Association
said one reason for the decision could be that Viagra is
more risky for people with a history of heart disease or
hypertension.
More expensive treatments
Doctors also believe it is illogical to restrict Viagra while
still allowing more expensive treatments for impotence
which are less safe and more expensive, for example,
injection therapy.
And they predict that hospital
specialists will be inundated
with patients who say their
impotence is due to severe
psychological problems.
Dr Dean said GPs were
better equipped to decide if a
person's impotence was due
to psychological problems as
they knew the person's
history and personal
circumstances.
He said specialists in urological problems would not
necessarily be skilled in psychology.
Dr John Chisholm of the British Medical Association has
also hit out at the "unjustifiable" restrictions on Viagra
prescription.
The BMA's meeting on the subject on Thursday morning
forced the government's hand after months of delay.
But NHS managers have backed the decision. Stephen
Thornton, chief executive of the NHS Confederation,
said: "Setting limits to healthcare is never easy. The
government has been very brave with these proposals."
Dr Angela Coulter, director of policy
and development for the King's Fund
charity, also welcomed "clear rules"
on Viagra.
She said: "There does have to be some control. The
NHS has to set priorities. It cannot afford to provide
everything people might want."
She added that previously doctors and health authorities
had had to decide where to draw the line, but said the
government had now recognised that this could not go
on.
The government is setting up the National Institute for
Clinical Excellence later this year which will decide on
similar cases in the future.
Patients group backs Dobson
Roger Goss, of the Patients' Association, said Mr
Dobson's stance was "eminently responsible and
sensible".
He said: "Doctors are going
to be able to treat people
who have deep emotional
problems which if they did
not get treatment might
cause them even more
trouble and make them a
bigger cost to the health
service.
"But for people like me,
50-year-olds who might see
this as an opportunity to have
a bit more fun in life, it is not
realistic to allow me to subsidised."
Mr Goss said the Patients' Association wanted the
government to consult the public on what the priorities
for the health service should be.
However, a spokeswoman for the Impotence Association
said it was "extremely disappointed" by Mr Dobson's
annoucement.
She stated: "These are extremely restrictive guidelines.
"They don't take into account people suffering impotence
from the side effects of medicines or high blood pressure
and they make up a huge majority of impotence
sufferers."
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